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All six participating nurses found the screening interview tool useful for initiating discussions about ACP and substitute decision-making. This nurse facilitated screening tool provides a simple, acceptable and feasible approach to introducing ACP to older general practice patients during routine health assessments.INTRODUCTION The use of systemic corticosteroids for upper respiratory tract infections has become increasingly common, but remains controversial. Given their purported ability to decrease duration of illness and hasten recovery, systemic corticosteroids offer an attractive treatment modality for flight surgeons desiring to minimize DNIF (Duty Not Including Flying) time. This commentary presents an evidence-based approach to the use of systemic corticosteroids for upper respiratory tract infections in flyers, concluding that the current body of evidence and missional concerns justify their routine use in sore throat and acute rhinosinusitis.Tanael M. Systemic corticosteroids for upper respiratory tract infections in the flyer. Aerosp Med Hum Perform. 2020; 91(5)453-454.BACKGROUND Aerospace Medicine is a small medical specialty. With the increasing need for aircraft pilots, continued low Earth orbit NASA operations, and the emergence of commercial spaceflight, there is a necessity for recruiting and educating the next generation of Aerospace Medicine specialists. This study was designed to create and validate a short Aerospace Medicine curriculum.METHODS Medical students at the University of Texas Medical Branch were recruited to attend a series of six 1-h meetings covering Aerospace Medicine career options and key Aerospace Medicine topics. A survey addressing student demographics, interest in a career in Aerospace Medicine, and knowledge of key Aerospace Medicine topics was administered at the beginning and end of the curriculum. Interest in pursuing a career in Aerospace Medicine pre- and postcurriculum was compared with an independent t-test. The knowledge-based portion of the survey was also evaluated using an independent t-test.RESULTS There were 23 participants who were recruited and filled out the initial survey and 15 participants who attended the final meeting and filled out the postcurriculum survey. Mean interest in pursuing a career in Aerospace Medicine did not change significantly (75.45% before involvement in the curriculum and 83.08% after participation). Knowledge of foundational Aerospace Medicine topics increased from 64.25% before involvement in the curriculum to 73.33% at the end of the study. There was an average of 12 participants at each meeting.DISCUSSION This demonstrates the utility of this curriculum as an educational tool for medical students. Future efforts will focus on dissemination of the curriculum nationally and internationally.Kreykes AJ, Petersen EH, Lowry CL. Expanding knowledge and exposure to aerospace medicine by creating a medical student curriculum. Aerosp Med Hum Perform. RK-701 ic50 2020; 91(5)448-452.INTRODUCTION Fatigue is a critical safety issue to U.S. Air Force (USAF) flight and ground crew. Nearly 15 yr of mishap reports were analyzed to determine how fatigue affects USAF operations with the goal of improving fatigue risk management policies and tools.METHODS Summary data for 19,920 aviation mishap reports dating back to 2003 were collected from the Air Force Safety Automated System (AFSAS). Fatigue-related mishaps were identified based on designations provided within AFSAS. Other metrics examined were characteristics such as timing, cost, and aircraft metrics, among others. Contingency tables built from these metrics were used to assess fatigue-related trends across the aviation community.RESULTS While only 3.88% of all mishaps were identified as fatigue-related, they are associated with 2.1 billion of medical expenses and property damage, or 18% of the 11.7 billion total cost of all mishaps included in the study. Nearly a quarter of the fatigue-related mishaps fall into the most severe mishap category and more than half occurred between 0100 and 0700, local time. Fatigue-related mishaps tended to be more common for Remotely Piloted Aircraft (RPA) and ground operations.DISCUSSION Fatigue is very costly to the USAF despite the relatively low incidence rate of fatigue-related mishaps. This is because larger proportions of severe mishaps were found to be fatigue-related. RPA and ground maintenance operators might be especially susceptible to fatigue and potentially lack adequate fatigue mitigation support and training tailored to their unique operational environment, suggesting a need to improve upon fatigue mitigation tools and strategies.Gaines AR, Morris MB, Gunzelmann G. Fatigue-related aviation mishaps. Aerosp Med Hum Perform. 2020; 91(5)440447.BACKGROUND Whether the unique environment of space affects astronaut risk of venous thromboembolism (VTE) is not known. On Earth, it is known that use of combined oral contraceptives (COCs) doubles the risk of VTE. Since some female astronauts choose to use COCs, this retrospective study examined known risk factors associated with VTE risk to determine whether the available data suggested elevated VTE risk in female astronauts.METHODS Longitudinal health data were requested for female astronauts who flew short and long duration missions between 2000 and 2014. Pre- and postflight hematological and biochemical blood markers were available and evaluated. Astronauts' postflight measurements were compared to clinically relevant terrestrial high risk levels to determine any trend toward increased risk for VTE following spaceflight. Secondarily, a comparison of pre- and postflight changes was made, as well as an assessment of COC impact.RESULTS A total of 38 astronaut-flights were included in this study and no VTE events were found. Analysis of potential VTE risk factors showed no evidence suggesting elevated VTE risk in female astronauts associated with spaceflight, regardless of contraceptive use.DISCUSSION Arguably, all astronauts encounter many physiological stressors during spaceflight missions, but women using the combined contraceptive pill add a known risk factor for VTE. The risk factors analyzed within this study showed no trend toward an increased risk of VTE for female astronauts. This study provides an evidence base supporting the safety of COC use by female astronauts and also reinforces the importance of healthy lifestyle on VTE risk reduction.Jain V, Ploutz-Snyder R, Young M, Charvat JM, Wotring VE. Potential venous thromboembolism risk in female astronauts. Aerosp Med Hum Perform. 2020; 91(5)432-439.