Heart Rate Variability and Performance of Commercial Airline Pilots during Flight Simulations

Enhancing Aviation Safety through AI-Driven Mental Health Management for Pilots and Air Traffic Controllers

This article provides an overview of the mental health challenges faced by pilots and air traffic controllers (ATCs), whose stressful professional lives may negatively impact global flight safety and security. The adverse effects of mental health disorders on their flight performance pose a particular safety risk, especially in sudden unexpected startle situations. Therefore, the early detection, prediction and prevention of mental health deterioration in pilots and ATCs, particularly among those at high risk, are crucial to minimize potential air crash incidents caused by human factors. Recent research in artificial intelligence (AI) demonstrates the potential of machine and deep learning, edge and cloud computing, virtual reality and wearable multimodal physiological sensors for monitoring and predicting mental health disorders. Longitudinal monitoring and analysis of pilots' and ATCs physiological, cognitive and behavioral states could help predict individuals at risk of undisclosed or emerging mental health disorders. Utilizing AI tools and methodologies to identify and select these individuals for preventive mental health training and interventions could be a promising and effective approach to preventing potential air crash accidents attributed to human factors and related mental health problems. Based on these insights, the article advocates for the design of a multidisciplinary mental healthcare ecosystem in modern aviation using AI tools and technologies, to foster more efficient and effective mental health management, thereby enhancing flight safety and security standards. This proposed ecosystem requires the collaboration of multidisciplinary experts, including psychologists, neuroscientists, physiologists, psychiatrists, etc. to address these challenges in modern aviation.

Metabolic flexibility associated with flight time among combat pilots of the Brazilian air force

INTRODUCTION

Fighter pilots must support the effects of many stressors, including physical and psychological exertion, circadian disturbance, jet lag, and environmental stress. Despite the rigorous selection of military pilots, those factors predispose to failures in physiological compensatory mechanisms and metabolic flexibility.

OBJECTIVES

We compared through NMR-based metabolomics the metabolic profile of Brazilian F5 fighter pilots with different flight experiences vs. the control group of non-pilots. We hypothesized that combat pilots have metabolic flexibility associated with combat flight time.

METHODS

We evaluated for the first time 34 Brazilian fighter pilots from Santa Cruz Air Base (Rio de Janeiro, RJ) allocated into three groups: pilots with lower total accumulated flight experience < 1,100 h (PC1, n = 7); pilots with higher total accumulated flight experience ≥ 1,100 h (PC2, n = 6); military non-pilots (CONT, n = 21). Data collection included anthropometric measurements, total blood count, lipidogram, markers of oxidative stress, and serum NMR-based metabolomics.

RESULTS

In comparison with controls (p < 0.05), pilots exhibited decreased levels of white blood cells (-13%), neutrophils (-15%), lymphocytes (-20%), alfa-glucose (-13%), lactate (-26%), glutamine (-11%), histidine (-20%), and tyrosine (-11%), but higher isobutyrate (+ 10%) concentrations. Significant correlations were found between lactate vs. amino acids in CONT (r = 0.55-0.68, p < 0.001), and vs. glutamine in PC2 (r = 0.94, p = 0.01).

CONCLUSION

Fighter pilots with lower experience showed a dysregulation in immune-metabolic function in comparison with controls, which seemed to be counteracted by the accumulation of flight hours. Those findings might have implications for the health preservation and operational training of fighter pilots.

Blink-Related Oscillations Provide Naturalistic Assessments of Brain Function and Cognitive Workload within Complex Real-World Multitasking Environments

BACKGROUND

There is a significant need to monitor human cognitive performance in complex environments, with one example being pilot performance. However, existing assessments largely focus on subjective experiences (e.g., questionnaires) and the evaluation of behavior (e.g., aircraft handling) as surrogates for cognition or utilize brainwave measures which require artificial setups (e.g., simultaneous auditory stimuli) that intrude on the primary tasks. Blink-related oscillations (BROs) are a recently discovered neural phenomenon associated with spontaneous blinking that can be captured without artificial setups and are also modulated by cognitive loading and the external sensory environment-making them ideal for brain function assessment within complex operational settings.

METHODS

Electroencephalography (EEG) data were recorded from eight adult participants (five F, M = 21.1 years) while they completed the Multi-Attribute Task Battery under three different cognitive loading conditions. BRO responses in time and frequency domains were derived from the EEG data, and comparisons of BRO responses across cognitive loading conditions were undertaken. Simultaneously, assessments of blink behavior were also undertaken.

RESULTS

Blink behavior assessments revealed decreasing blink rate with increasing cognitive load (p < 0.001). Prototypical BRO responses were successfully captured in all participants (p < 0.001). BRO responses reflected differences in task-induced cognitive loading in both time and frequency domains (p < 0.05). Additionally, reduced pre-blink theta band desynchronization with increasing cognitive load was also observed (p < 0.05).

CONCLUSION

This study confirms the ability of BRO responses to capture cognitive loading effects as well as preparatory pre-blink cognitive processes in anticipation of the upcoming blink during a complex multitasking situation. These successful results suggest that blink-related neural processing could be a potential avenue for cognitive state evaluation in operational settings-both specialized environments such as cockpits, space exploration, military units, etc. and everyday situations such as driving, athletics, human-machine interactions, etc.-where human cognition needs to be seamlessly monitored and optimized.

Heart Rate Variability Indices of Student Pilots Undergo Modifications During Flight Training

INTRODUCTION: Heart rate variability (HRV) indicates the temporal fluctuation of the intervals between adjacent beats. HRV expresses neuro-cardiac activity and is generated by heart-brain interactions and dynamics related to the function of the autonomous nervous system and other components. To investigate this issue, we started a series of experiments by coupling the flight tasks of student pilots and their HRV.METHODS: Before each experimental session, the participating student was fitted with a five-electrode, three-channel Holter electrocardiogram monitor. We defined three time-phases for each training mission: before flight operations on the ground, during flight operations, and after flight operations on the ground. The HRV analysis was performed by quantifying some indices of the time domain and the frequency domain.RESULTS: The analysis of RR-wave intervals revealed two types of trends: 1) students whose RR intervals decreased during flight operations compared to before flight ground operations; and 2) students whose RR intervals increased during flight operations compared to before flight ground operations. These differences found in the RR intervals produced changes in the indices of both the time and frequency domains of the two students' samples.DISCUSSION: Flight training involves regular and advanced tasks and/or emergency situations. When this happens, the total power of the heart decreases because the RR intervals are forced toward low values. Flight activity involves continuous demanding tasks that can be potentially read by an analysis of the HRV; a high HRV ensures better management of tasks that require a greater commitment of cardiovascular function.Li Volsi G, Monte IP, Aruta A, Gulizzi A, Libra A, Mirulla S, Panebianco G, Patti G, Quattrocchi F, Bellantone V, Castorina W, Arcifa S, Papale F. Heart rate variability indices of student pilots undergo modifications during flight training. Aerosp Med Hum Perform. 2023; 94(11):835-842.

Exploring objective measures for assessing team performance in healthcare: an interview study

Introduction

Effective teamwork plays a critical role in achieving high-performance outcomes in healthcare. Consequently, conducting a comprehensive assessment of team performance is essential for providing meaningful feedback during team trainings and enabling comparisons in scientific studies. However, traditional methods like self-reports or behavior observations have limitations such as susceptibility to bias or being resource consuming. To overcome these limitations and gain a more comprehensive understanding of team processes and performance, the assessment of objective measures, such as physiological parameters, can be valuable. These objective measures can complement traditional methods and provide a more holistic view of team performance. The aim of this study was to explore the potential of the use of objective measures for evaluating team performance for research and training purposes. For this, experts in the field of research and medical simulation training were interviewed to gather their opinions, ideas, and concerns regarding this novel approach.

Methods

A total of 34 medical and research experts participated in this exploratory qualitative study, engaging in semi-structured interviews. During the interview, experts were asked for (a) their opinion on measuring team performance with objective measures, (b) their ideas concerning potential objective measures suitable for measuring team performance of healthcare teams, and (c) their concerns regarding the use of objective measures for evaluating team performance. During data analysis responses were categorized per question.

Results

The findings from the 34 interviews revealed a predominantly positive reception of the idea of utilizing objective measures for evaluating team performance. However, the experts reported limited experience in actively incorporating objective measures into their training and research. Nevertheless, they identified various potential objective measures, including acoustical, visual, physiological, and endocrinological measures and a time layer. Concerns were raised regarding feasibility, complexity, cost, and privacy issues associated with the use of objective measures.

Discussion

The study highlights the opportunities and challenges associated with employing objective measures to assess healthcare team performance. It particularly emphasizes the concerns expressed by medical simulation experts and team researchers, providing valuable insights for developers, trainers, researchers, and healthcare professionals involved in the design, planning or utilization of objective measures in team training or research.

Stress and Workload Assessment in Aviation-A Narrative Review

In aviation, any detail can have massive consequences. Among the potential sources of failure, human error is still the most troublesome to handle. Therefore, research concerning the management of mental workload, attention, and stress is of special interest in aviation. Recognizing conditions in which a pilot is over-challenged or cannot act lucidly could avoid serious outcomes. Furthermore, knowing in depth a pilot's neurophysiological and cognitive-behavioral responses could allow for the optimization of equipment and procedures to minimize risk and increase safety. In addition, it could translate into a general enhancement of both the physical and mental well-being of pilots, producing a healthier and more ergonomic work environment. This review brings together literature on the study of stress and workload in the specific case of pilots of both civil and military aircraft. The most common approaches for studying these phenomena in the avionic context are explored in this review, with a focus on objective methodologies (e.g., the collection and analysis of neurophysiological signals). This review aims to identify the pros, cons, and applicability of the various approaches, to enable the design of an optimal protocol for a comprehensive study of these issues.

A narrative review of the interconnection between pilot acute stress, startle, and surprise effects in the aviation context: Contribution of physiological measurements

Aviation remains one of the safest modes of transportation. However, an inappropriate response to an unexpected event can lead to flight incidents and accidents. Among several contributory factors, startle and surprise, which can lead to or exacerbate the pilot's state of stress, are often cited. Unlike stress, which has been the subject of much study in the context of driving and piloting, studies on startle and surprise are less numerous and these concepts are sometimes used interchangeably. Thus, the definitions of stress, startle, and surprise are reviewed, and related differences are put in evidence. Furthermore, it is proposed to distinguish these notions in the evaluation and to add physiological measures to subjective measures in their study. Indeed, Landman's theoretical model makes it possible to show the links between these concepts and studies using physiological parameters show that they would make it possible to disentangle the links between stress, startle and surprise in the context of aviation. Finally, we draw some perspectives to set up further studies focusing specifically on these concepts and their measurement.

Effects of increased recirculation air rate and aircraft cabin occupancy on passengers' health and well-being - Results from a randomized controlled trial

BACKGROUND

Aircraft cabins are special environments. Passengers sit in close proximity in a space with low pressure that they cannot leave. The cabin is ventilated with a mixture of outside and recirculated air. The volume of outside air impacts the carbon footprint of flying. Higher recirculation air rates could be considered to save energy and divert less kerosene from producing thrust.

OBJECTIVES

To investigate whether higher recirculation air rates in aircraft cabins negatively affect passengers' health and well-being and if occupancy plays a role in this.

METHODS

In a 2 (occupancy: full and half-occupied) X 4 (ventilation regime) factorial design with stratified randomization, participants were exposed in an aircraft segment in a low-pressure tube during a 4-h simulated flight. Ventilation regimes consisted of increasing proportions of recirculated air up to a maximum CO₂ concentration of 4200 ppm. Participants rated comfort, health symptoms, and sleepiness multiple times. Heart rate (variability), as stress marker, was measured continuously.

RESULTS

559 persons representative of flight passengers regarding age (M = 42.7, SD = 15.9) and sex (283 men) participated. ANCOVA results showed hardly any effect of both factors on self-reported health symptoms, strong main effects of occupancy on comfort measures, and interaction effects for sleepiness and physiological stress parameters: Participants in the half-occupied cabin hardly reacted to increased recirculation air rates and show overall more favorable responses. Participants in the fully occupied cabin reported higher sleepiness and had stress reactions when the recirculation air rate was high.

DISCUSSION

This large-scale RCT shows the importance of occupancy, a previously neglected factor in indoor air research. The proximity of other people seems to increase stress and exacerbate reactions to air quality. Further studies on causal pathways are needed to determine if recirculation air rates can be increased to reduce the carbon footprint of flying without detrimental effects on passengers.

Analysis of heart rate variability during emergency flight simulator missions in fighter pilots

INTRODUCTION

Managing emergency situations in different simulated flight segments can entail a workload that could affect the performance of military pilots. The aim was to analyse the modifications in neurovegetative balance (using HR variability, HRV) of professional fighter pilots attending learning/training sessions on emergency situations in a flight simulator.

METHODS

A total of 18 pilots from the Spanish Air and Space Force were included. HRV was recorded simultaneously during diverse simulated emergency situations in three different flight segments: take-off, in-flight and landing.

RESULTS

The comparison between take-off and in-flight revealed a statistically significant increase (p<0.05) in percentage of consecutive RR intervals that differ by more than 50 ms from each other (pNN50), root mean square of the successive differences (rMSSD), standard desviation 1 and 2 (SD1 and SD2), and a statistically significant decrease (p<0.000) in stress score (SS) and in the sympathetic to parasympathetic ratio (S:PS). Between flight and landing, a statistically significant increase (p<0.05) in mean HR, minimum HR, maximum HR, SS and S:PS was shown, while experiencing a significant decrease (p<0.000) in pNN50, rMSSD and SD2. Finally, between take-off and landing, the variables which showed significant changes (p<0.05), with these changes being a significant increase, were mean HR, minimum HR, maximum HR, rMSSD, SD1 and SD2. SS and S:PS ratios showed a statistically significant decrease (p<0.000).

CONCLUSIONS

An emergency situation in a flight simulator manoeuvre produced an anticipatory anxiety response in pilots, demonstrated by low HRV, which increased during the flight segment and decreased during the landing segment of the flight.Trial registration number NCT04487899.

A green approach towards sorption of CO2 on waste derived biochar

Carbon capture technologies have advanced in recent years to meet the ever-increasing quest to minimize excessive anthropogenic CO₂ emissions. The most promising option for CO₂ control has been identified as carbon capture and storage. Among the numerous sorbents, char generated from biomass thermal conversion has shown to be an efficient CO₂ adsorbent. This study examines various characteristics that can be used to increase the yield of biochar suited for carbon sequestration. This review gives recent research progress in the area, stressing the variations and consequences of various preparation processes on textural features such as surface area, pore size and sorption performance with respect to CO₂'s sorption capacity. The adjoining gaps discovered in this field have also been highlighted herewith, which will serve as future work possibility. It aims to analyse and describe the possibilities and potential of employing pristine and modified biochar as a medium of CO₂ capture. It also examines the parameters that influence biochar's CO₂ adsorption ability and pertinent challenges regarding the production of biochar-based CO₂ sorbent materials.

Sleep, Workload, and Stress in Aerial Firefighting Crews

BACKGROUND:The challenges of climate change and increasing frequency of severe weather conditions has demanded innovative approaches to wildfire suppression. Australia’s wildfire management includes an expanding aviation program, providing both fixed and rotary wing aerial platforms for reconnaissance, incident management, and quick response aerial fire suppression. These operations have typically been limited to day visual flight rules operations, but recently trials have been undertaken extending the window of operations into the night, with the assistance of night vision systems. Already a demanding job, night aerial firefighting operations have the potential to place even greater physical and mental demands on crewmembers. This study was designed to investigate sleep, fatigue, and performance outcomes in Australian aerial firefighting crews.METHODS:A total of nine subjects undertook a 21-d protocol, completing a sleep and duty diary including ratings of fatigue and workload. Salivary cortisol was collected daily, with additional samples provided before and after each flight, and heart rate variability was monitored during flight. Actigraphy was also used to objectively measure sleep during the data collection period.RESULTS:Descriptive findings suggest that subjects generally obtained >7 h sleep prior to flights, but cortisol levels and self-reported fatigue increased postflight. Furthermore, the greatest reported workload was associated with the domains of ‘performance’ and ‘mental demand’ during flights.DISCUSSION:Future research is necessary to understand the impact of active wildfire response on sleep, stress, and workload on aerial firefighting crews.Sprajcer M, Roberts S, Aisbett B, Ferguson S, Demasi D, Shriane A, Thomas MJW. Sleep, workload, and stress in aerial firefighting crews. Aerosp Med Hum Perform. 2022; 93(10):749–754.

Case Study of the Psychophysical State of Student-Operators During UAVO Training, Based on Heart Rate Parameter

This article focuses on the human factor in UAV operations. In the manuscript, research on the psychophysical state of student-operators under the license of UAVO VLOS <4 kg. For the analysis of the psychophysical state, the pulse parameter was used, which is one of the values that describe the work of the cardiovascular system and is one for the objective methods of assessing the psychophysical state of a human being. The data collected were analyzed using the STATISTICA software. The article focuses on the above aspect and analyzes the psychophysical state of the student-operator during flight training. The obtained results were also related to research on similar topics in the chapter discussion section.

The Effect of Expertise during Simulated Flight Emergencies on the Autonomic Response and Operative Performance in Military Pilots

Heart rate variability (HRV) and performance response during emergency flight maneuvers were analyzed. Two expert pilots (ages 35 and 33) and two rookie pilots (ages 25) from the Portuguese Air Force participated in this case-control report study. Participants had to complete the following emergency protocols in a flight simulator: (1) take-off engine failure, (2) flight engine failure close to the base, (3) flight engine failure far away from the base, and (4) alternator failure. The HRV was collected during all these maneuvers, as well as the performance data (the time it took to go through the emergency protocol and the subjective information from the flight simulator operator). Results regarding autonomic modulation showed a higher sympathetic response during the emergency maneuvers when compared to baseline. In some cases, there was also a higher sympathetic response during the emergency maneuvers when compared with the take-off protocol. Regarding performance data, the expert pilots accomplished the missions in less time than the rookie pilots. Autonomic modulation measured from HRV through portable devices can easily relay important information. This information is relevant since characterizing these maneuvers can provide helpful information to design training strategies to improve those psychophysiological responses.

Associations of Human Cognitive Abilities with Elevated Carbon Dioxide Concentrations in an Enclosed Chamber

Fifteen participants were exposed in an enclosed environmental chamber to investigate the effects of elevated carbon dioxide (CO2) concentration on their cognitive abilities. Three CO2 conditions (1500, 3500, and 5000 ppm) were achieved by constant air supply and additional ultrapure CO2. All participants received the same exposure under each condition, during which they performed six cognitive tests evaluating human perception, attention, short-term working memory, risky decision-making, and executive ability. Generalized additive mixed effects model (GAMM) results showed no statistically significant differences in performance on the reaction time (RT) tests, the speed perception test, and the 2-back test. This suggests that elevated CO2 concentrations below 5000 ppm did not affect participants’ perception and short-term working memory. However, a significant increase in response time was observed in the visual search (VS) test, the balloon simulation risk test (BART), and the Stroop test at 5000 ppm compared to lower exposure concentrations. The slower responses reflected the detrimental effects of elevated CO2 concentrations on visual attention, risky decision-making, and executive ability. The findings suggest that the control level of CO2 concentrations should be tighter in enclosed workplaces where rapid response and operational safety are required.

The effects of warmth and CO2 concentration, with and without bioeffluents, on the emission of CO2 by occupants and physiological responses

The emission rate of carbon dioxide (CO₂ ) depends on many factors but mainly on the activity level (metabolic rate) of occupants. In this study, we examined two other factors that may influence the CO₂ emission rate, namely the background CO₂ concentration and the indoor temperature. Six male volunteers sat one by one in a 1.7 m³ chamber for 2.5 h and performed light office-type work under five different conditions with two temperature levels (23 vs. 28°C) and three background concentrations of CO₂ (800 vs. 1400 vs. 3000 ppm). Background CO₂ levels were increased either by dosing CO₂ from a cylinder or by reducing the outdoor air supply rate. Physiological responses to warmth, added CO₂ , and bioeffluents were monitored. The rate of CO₂ emission was estimated using a mass-balance equation. The results indicate a higher CO₂ emission rate at the higher temperature, at which the subjects were warm, and a lower emission rate in all conditions in which the background CO₂ concentration increased. Physiological measurements partially explained the present results but more measurements are needed.

Psychophysiological response of military pilots in different combat flight maneuvers in a flight simulator

OBJECTIVE

To analyze the psychophysiological response during takeoff, landing, air-air attack and air-ground attack maneuvers.

METHODS

A total of 11 expert pilots (age=33.36 (5.37)) from the Spanish Air Force participated in this cross-sectional study. Participants had to complete in a flight simulator the following missions: 1) takeoff; 2) Air-air attack; 3) Air-Ground attack, and 4) Landing. The electroencephalographic activity (EEG) and heart rate variability (HRV) were collected during all these maneuvers.

RESULTS

Significant higher values of theta (during takeoff, air-air attack and air-ground attack) EEG power spectrum were obtained when compared to baseline. Significant difference in the P3 scalp location was observed between landing and takeoff maneuvers in the beta EEG power spectrum. Furthermore, significant lower values of HRV were obtained during takeoff, landing, air-air attack and air-ground attack when compared to baseline values. Also, landing showed a higher sympathetic response when compared to takeoff maneuver.

CONCLUSION

Takeoff, landing, air-air attack or air-ground attack maneuvers performed in a flight simulator produced significant changes in the electroencephalographic activity and autonomic modulation of professional pilots. Beta EEG power spectrum modifications suggest that landing maneuvers induced more attentional resources than takeoff. In the same line, a reduced HRV during landing was obtained when compared to takeoff. These results should be considered to training purposes.

Impact of Real and Simulated Flights on Psychophysiological Response of Military Pilots

Objective: The present research aimed to analyse the autonomic, anxiety, perceived exertion, and self-confidence response during real and simulated flights. Methods: This cross-sectional study participated 12 experienced male pilots (age = 33.08 (5.21)) from the Spanish Air Force. Participants had to complete a real and a simulated flight mission randomly. The heart rate variability (HRV), anxiety, self-confidence, and rating of perceived exertion were collected before and after both manoeuvres, and HRV was also collected during both simulated and real flights. Results: When studying the acute effects of real and simulated flights, the mean heart rate, the R-to-R interval, the cognitive anxiety and the perceived exertion were significantly impacted only by real flights. Furthermore, significant differences in the mean heart rate and RR interval were found when compared to the acute effects of real and simulated flights (with higher acute effects observed in real flights). Additionally, when compared the HRV values during simulated and real flights, significant differences were observed in the RR and heart rate mean (with lower RR interval and higher heart rate mean observed during real flights). Conclusion: Real flights significantly reduced the RR interval and cognitive anxiety while increased the heart rate mean and the rating of perceived exertion, whereas simulated flights did not induce any significant change in the autonomic modulation.

Screening of Pathophysiological Mechanisms and Psychological and Occupational Factors, Determining Risk of Cardiovascular Diseases in High-Risk Professions

Cardiovascular diseases (CVD) are among the most significant and common chronic non-communicable diseases in Bulgaria. Screening, identification and registration of pathophysiological mechanisms and psychological and occupational factors related to CVD should be implemented in the diagnostic work-up. Job analysis contributes to the implementation of screening and identification of the most significant psychological and professional factors related to the work activity.

Aim: The aim of our study is to examine the pathophysiological mechanisms of autonomic cardiovascular control and psychological and occupational factors determining the risk of CVD.

Materials and methods: The following groups of individuals were examined: 83 physicians, 54 nurses, 23 employees and 40 militaries. The autonomic cardiovascular control was studied through the time-and frequency-domain based measures of the Analysis of Heart Rate Variability (HRV).

Results: The results of the ANOVA test showed that there was a statistically significant difference in the time-domain and frequency-domain based HRV measures between the compared groups: X [F (4; 225) = 4.455, p = 0.001]; SDNN [F (4; 225) = 3.876, p = 0.005]; SDNN5 [F (4; 225) = 3.083, p = 0.01]; pNN50 [F (4; 225) = 8.303, p < 0.001]; rMSSD [F (4; 225) = 8.711, p < 0.001]; SDSD [F (4; 225) = 8.323, p < 0.001; VLF [F (4; 225) = 1.204, p = 0.31]; LF [F (4; 225) = 3.874, p = 0.005]; HF [F (4; 225) = 7.790, p < 0.001] and LF/HF [F (4; 225) = 8.601, p < 0.001]. The results of our study revealed that occupational stress and cognitive workload in physicians, nurses, and employees induced a process of reciprocally combined inhibition of the parasympathetic branch of the autonomic nervous system (ANS) (SDNN, SDNN5, pNN50, rMSSD, and HF) and activation of the sympathetic branch of ANS (LF), while in military personnel they cause a process of co-activation of the parasympathetic and sympathetic branches of the ANS (rMSSD, SDNN, SDNN5, pNN50 and LF/HF).

Conclusion: Stress-induced dysfunctional autonomic cardiovascular regulation, patho-physiological control mechanisms, psychological and occupational factors determine the risk of CVD. Their identification could contribute to the diagnostics and prevention of CVD.

Aircraft Pilots Workload Analysis: Heart Rate Variability Objective Measures and NASA-Task Load Index Subjective Evaluation

Workload and fatigue of aircraft pilots represent an argument of great interest in the framework of human factors and a pivotal point to be considered in aviation safety. 75% of aircraft accidents are related to human errors that, in most cases, are due to high level of mental workload and fatigue. There exist several subjective or objective metrics to quantify the pilots’ workload level, with both linear and nonlinear relationships reported in the literature. The main research objective of the present work is to analyze the relationships between objective and subjective workload measurements by looking for a correlation between metrics belonging to the subjective and biometric rating methods. More particularly, the Heart Rate Variability (HRV) is used for the objective analysis, whereas the NASA-TLX questionnaire is the tool chosen for the subjective evaluation of the workload. Two different flight scenarios were considered for the studies: the take-off phase with the initial climb and the final approach phase with the landing. A Maneuver Error Index (MEI) is also introduced to evaluate the pilot flight performance according to mission requirements. Both qualitative and quantitative correlation analyses were performed among the MEI, subjective and objective measurements. Monotonic relationships were found within the HRV indexes, and a nonlinear relationship is proposed among NASA-TLX and HRV indexes. These findings suggest that the relationship between workload, biometric data, and performance indexes are characterized by intricate patterns of nonlinear relationships.

Performance Optimization Strategies for Complex Endourologic Procedures

OBJECTIVE

To identify and address factors that may impact a surgeon's performance during endourologic procedures.

METHODS

A literature review was performed for articles focusing on surgical ergonomics, education, sports and performance psychology.

RESULTS

As urologists and trainees have become more comfortable approaching complex pathology endoscopically, there remains an opportunity to refine surgeon-related factors and optimize extrinsic factors to maximize efficiency and provide patients with the highest quality outcomes and safety.

CONCLUSION

Medical centers and training programs should strive to include formal lessons on stress-coping mechanisms, communication, and dedicated ergonomic training, as these all play a role in physician well-being and may lead to improved clinical outcomes.

Is There an Optimal Autonomic State for Enhanced Flow and Executive Task Performance?

Introduction

Flow describes a state of optimal experience that can promote a positive adaptation to increasing stress. The aim of the current study is to identify the ideal autonomic state for peak cognitive performance by correlating sympathovagal balance during cognitive stress with (1) perceived flow immersion and (2) executive task performance.

Materials and Methods

Autonomic states were varied in healthy male participants (n = 48) using combinations of patterned breathing and skeletal muscle contraction that are known to induce differing levels of autonomic response. After autonomic variation, a Stroop test was performed on participants to induce a mild stress response, and autonomic arousal was assessed using heart rate variability. Subjective experience of flow was measured by standardized self-report, and executive task performance was measured by reaction time on the Stroop test.

Results

There were significant associations between autonomic state and flow engagement with an inverted U-shaped function for parasympathetic stimulation, sympathetic response, and overall sympathovagal balance. There were also significant associations between autonomic states and reaction times. Combining sympathetic and parasympathetic responses to evaluate overall sympathovagal balance, there was a significant U-shaped relationship with reaction time.

Discussion

Our results support the flow theory of human performance in which the ideal autonomic state lies at the peak of an inverted-U function, and extremes at either end lead to both suboptimal flow experience. Similarly, cognitive task performance was maximized at the bottom of the U-function. Our findings suggest that optimal performance may be associated with predominant, but not total, sympathetic response.