Military aircrew of rotary-wing aircraft often report cold and dysfunctional hands during cold-weather flying. Therefore, the cold protection and manual performance of in-service gloves was quantified in a laboratory study to support cold-weather advice to aircrew and glove procurement activities. There were 8 civilian men who undertook a 60-min thermal test simulating the metabolic cost of rear crew physical tasks and wearing representative clothing on 15 occasions, where 3 main glove types (Cape leather, C; Cape + silk liner, C + S; Gunner, G) and 5 air temperatures (TA; +20, +10, 0, -10, -20°C) were assessed. Physiological (including mean finger skin temperature, TFSK), subjective thermal, and manual performance (including bare-hand and gloved finger/hand dexterity) measures were obtained. At a TA of 0°C, mean TSKF was 15.2 (C), 17.9 (C + S), and 22.4°C (G). Finger cold discomfort occurred at a TA of 0°C in C, and at -10°C in C + S and G. Gloved finger/hand dexterity was impaired relative to bare hands by 46/4 (C), 56/14 (C + S), and 73/44% (G). There was no relationship between TSKF and dexterity performance. The performance of aircrew gloves has been baselined for male aircrew. Cape leather gloves are limited to a TA of +10°C. Adding silk liners and wearing the Gunner glove extended exposure down to a TA of 0°C but imposed considerable impairment on dexterity performance. Solutions are required to enhance cold protection at a lower cost to manual performance, which must demonstrate applicability to both male and female aircrew. Weller AS, Boyd JWR. Cold protection and manual performance assessment of aircrew gloves. Aerosp Med Hum Perform. 2026; 97(3):160-168.

Lung cancer is the leading cause of cancer-related deaths worldwide and among Singaporean males. While incidence in Singapore has declined due to reductions in smoking, patient outcomes have also improved because of advances in our understanding of cancer biology, lung cancer screening, and refinements in treatment. In the Republic of Singapore Air Force, its first diagnosed case of aircrew lung cancer was presented and deliberated at its Aeromedical Board in October 2024. A narrative review was conducted to summarize aeromedically relevant updates on the current assessment and management of lung cancer, with a focus on return-to-flying considerations as well as future implications for military aircrew. Developments in immune checkpoint inhibitors and targeted therapies has driven the requirement for molecular and immunohistochemical diagnosis in lung cancer management. Together with advances in radiation therapy and minimally invasive surgery techniques, lung cancer screening and smoking cessation have significantly improved disease mortality and morbidity. Despite this, a safe return to aviation duties may remain limited by treatment side effects and the possibility of late disease recurrence. While there is an opportunity to update current waiver policies for resectable early-stage lung cancer, additional considerations are still required to individualize aeromedical decision-making based on underlying cancer histology, treatment response, side effects of newer therapies, and risk of cancer recurrence after remission. In preserving their fitness for duty, emerging evidence and the continuously evolving treatment landscape will continue to challenge flight surgeons to keep aircrew well-informed of their management options. Low JW. Current lung cancer management and return-to-duty considerations for military aircrew. Aerosp Med Hum Perform. 2026; 97(3):185-193.

Diabetes screening is crucial in aviation medicine because of its impact on flight safety. This study compared the diagnostic performance of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) in Polish Air Force pilots ages 45 yr and older and assessed their role in optimizing screening protocols. Additionally, the study examined the relationships between age, body mass index (BMI), body fat percentage, and prediabetes or diabetes prevalence in this population. This study included 175 military flight personnel who were undergoing periodic medical examinations. Individuals with diagnosed diabetes were excluded. FPG, HbA1c, age, BMI and body fat percentage were measured. A multivariate regression model was used to examine their associations. Among 175 male pilots ages 45-60 yr (M = 50.05, SD = 3.74), 68.6% had normal HbA1c, 30.3% were prediabetic, and 1.1% were diabetic. FPG classified 43.4% of the subjects as normal, 53.1% as prediabetic, and 3.4% as diabetic. A normal BMI was found in 23.4% of the subjects, whereas a normal body fat percentage occurred in 37%. Regression revealed that body fat percentage was more strongly associated with HbA1c than was age or BMI. HbA1c testing has proven to be a practical and cost-effective tool for detecting abnormal glucose metabolism in military aircrew, particularly when used alongside FPG. Its implementation has reduced the need for further testing and may streamline periodic evaluations. Additionally, body fat percentage emerged as a more reliable predictor of dysglycemia than BMI was, suggesting the value of including body composition assessments in routine screenings. Kurek MA, Kwiatkowski F, Popiela D, Biernacki M, Gaździńska A, Rola M. Glycated hemoglobin vs. fasting glucose in routine screening of military aircrew. Aerosp Med Hum Perform. 2026; 97(3):169-175.

Imaging is central to modern clinical medicine and advancing the level of care on exploration-class missions will require imaging capabilities to reduce medical risk. The NASA Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool suite was designed for exploration-class mission probabilistic risk assessment and trade space analysis. The associated IMPACT Conditions List includes 119 in-flight medical conditions of high likelihood and/or consequence as established by flight and terrestrial data, as well as expert opinion. This study evaluates the utility of ultrasound (US) and radiography (XR) for these conditions. For each condition, two reviewers performed a rapid review of professional society guidelines and scientific literature, supplemented with subject-matter expertise, to semiquantitatively score the utility of US and XR for both diagnosis and management. XR was diagnostically highly useful in 36 conditions and US in 38 conditions. Conversely, for 63 (52.9%) conditions, neither XR nor US had any diagnostic utility. For management, XR was highly useful for 24 conditions, while US was highly useful for 21. In over one-third of conditions, XR possesses unique capabilities either complementary or superior to US. XR possesses superior diagnostic utility for bony injuries, dental conditions, and some pulmonary conditions, and superior management capability for orthopedic reductions and device placement confirmation. This analysis suggests future missions may consider augmenting the medical system with portable radiography if resource constraints allow, and future work should quantify the risk reduction provided by this capability. Boyle MJ, Pohlen M, Lehnhardt K, Parmar P, Easter B. X-ray and ultrasound for human spaceflight using the NASA IMPACT conditions list. Aerosp Med Hum Perform. 2026; 97(3):176-184.

Maintaining spatial orientation in flight remains a critical aspect of aviation safety. Monitoring an aviator's neurophysiological patterns may provide insight and opportunity to mitigate loss of spatial orientation. However, few studies have examined the utility of such measures. The purpose of the current study was to conduct a scoping review to document the research activities that have examined neurophysiological measures in relation to spatial orientation. Four databases were searched for literature using neurophysiological measures in studies assessing disorientation. The initial search yielded 110,135 articles. After removing duplicates and articles not meeting criteria, nine articles were reviewed. One of the nine articles used an aviation-relevant task. From the nine articles, evidence suggested roles of the parietal and frontal lobes maintaining orientation. Regarding the aviation-relevant task, the frontal lobe was supported for its involvement in the experience of unidentified spatial disorientation. Across all, the frontal lobe was consistently implicated (support from six studies) for its role in orientation. However, the studies differed in neurophysiological measures and outcomes evaluated. Electroencephalography emerged as a potential candidate for detecting disorientation, with six studies using it as the neurophysiological measurement device. Although the literature is limited on aviation-relevant tasks, there is strong support for activation patterns in the parietal and frontal lobes for orientation. This provides a starting point for experimental studies to further capture what patterns can be detected from neurophysiology when disorientation is experienced. Further research on aviation applications and using consistent measures is needed to further develop this area of research. Feltman KA, Wilkins J, Persson I, Stonehouse S. Neurophysiological measures to detect spatial disorientation. Aerosp Med Hum Perform. 2026; 97(3):194-203.

Traditional assessment of the anti-G straining maneuver through foot pedal force measurements has limitations in capturing muscle engagement. This study evaluated surface electromyography (EMG) as an alternative tool during routine centrifuge qualification. There were 19 aircrew trainees who underwent centrifuge testing with concurrent EMG monitoring of 4 muscle groups and pedal force measurements during gradual onset runs and rapid onset runs. EMG data from lower limb and abdominal muscles were compared with pedal forces to assess correlation and timing differences across acceleration profiles. EMG-pedal correlations were limited and profile dependent. Only right pedal force demonstrated consistent correlation with right vastus medialis activity across profiles (gradual onset: r = 0.756; rapid onset +6 Gz: r = 0.620; rapid onset +8 Gz: r = 0.463). No significant correlations were observed between pedal forces and hamstring or abdominal muscle activity. Duration analysis showed systematic differences, with right pedal force duration (46.36 ± 17.92 s) exceeding both rectus abdominis (28.98 ± 17.27 s) and vastus medialis activation (38.35 ± 14.90 s) during gradual onset runs. Rectus abdominis activation remained consistently lower than other muscles during rapid onset high-G exposure, reaching 48.67 ± 20.45% maximum voluntary contraction at +8 Gz compared with 72.28-82.56% in other groups. EMG provides more comprehensive assessment than pedal force alone, delineating muscle activation patterns and timing differences that conventional methods cannot detect. The profile-dependent correlations and duration discrepancies highlight limitations of foot pedal measurements. These findings support incorporating EMG into routine centrifuge qualification to improve assessment accuracy and enable more targeted training interventions. Woo JHA, Pollock RD, See B, Lim SWY. Electromyography vs. foot pedal force assessment during high-G centrifuge qualification testing. Aerosp Med Hum Perform. 2026; 97(3):204-209.

Removing nitrogen gas from body tissue by breathing 100% oxygen (denitrogenation) before exposure to a low-pressure environment reduces risk of decompression sickness (DCS) caused by nitrogen bubble formation. This is a priority in activities that include DCS risk such as unpressurized flight or astronaut extravehicular activity. Tissue denitrogenation is determined by perfusion, so modeling intercapillary distance (ICD) as a perfusion characteristic could be exploited to predict denitrogenation efficiency. Five inert gas exchange models were developed that combine a cylindrical conceptualization of tissue surrounding a single capillary (Krogh model) in which denitrogenation can occur, with estimates of ICD from 10-50 µm used to represent capillary density. Rate of nitrogen washout (dPN2 · dt-1) was estimated using ICD and initial tissue nitrogen pressure as predictor variables. Regressions were performed to compare model output to fractional washout volumes obtained using Behnke's whole-body washout functions as a benchmark. Mean denitrogenation fractions generated by these mixed-venous models correlated strongly with fractional Behnke washout curves (Pearson's r = 1). Emergent tissue nitrogen washout half-time rates ranged from 5.5-90 min. Differences in lean and adipose tissue ICD and nitrogen solubility impact tissue nitrogen concentration but not pressure. The use of a "leaky nitrogen reservoir" multicylinder ICD perfusion model offers a theoretical framework on which to base denitrogenation rates within and across tissue types. This modeling approach may permit the development of improved perfusion-enhancing denitrogenation strategies and DCS risk models. Dart T, Mock J, Beer J. Modeling intercapillary distance as a regulator of tissue denitrogenation rate. Aerosp Med Hum Perform. 2026; 97(3):137-144.

Military jet pilots are exposed to extreme +Gz, imposing strain on the cervical musculoskeletal system. Neck pain prevalence is well documented, but the acute effects of real flight on cervical muscles and kinematics remain unclear. This study assessed acute effects in Eurofighter pilots vs. non-pilot controls. It was hypothesized that acute high +Gz exposure during a real flight affects cervical 3D kinematics, muscle mechanical properties, and pilot-reported pain scores compared to a nonexposed control group and effects of acute high +Gz exposure persist 24 h postflight, resulting in altered cervical 3D kinematics, modified muscle mechanical properties, and increased subjective pain compared to the nonexposed control group. A controlled, longitudinal study compared 20 Eurofighter pilots with 20 matched controls. Cervical 3D kinematics, subjective neck pain, and cervical muscle stiffness were assessed preflight, immediately postflight, and 24 h postflight. Pilots executed high +Gz maneuvers during real flight following a scripted mission. Primary outcomes were group-by-time differences. Statistics included repeated-measures of variance. In pilots, cervical extension range of motion decreased postflight from 56.4 ± 6.5° to 52.4 ± 7.8°, and at 24 h to 53.3 ± 6.4°. Subjective neck pain increased postflight and persisted at 24 h [pain 0.0-10.0; medians from 0.0 (0.0)-2.1 (3.0), then 1.8 (2.9)]. Right trapezius muscle stiffness decreased postflight (241.0 ± 20.3-227.8 ± 20.7 N · m-1) and after 24 h at 234.1 ± 20.1 N · m-1. High +Gz exposure and extreme head postures reduce range of motion and increase neck pain in fighter pilots. The stiffness decrease suggests a muscular mechanical overload. Findings support the need for targeted neck conditioning and real-time monitoring to mitigate injury risk to sustain operational readiness. Lingscheid R, Nuesse R, Rein R, Goell F, Albracht K, Braunstein B. High +Gz flight reduces cervical 3D kinematics and increases neck pain in fighter pilots. Aerosp Med Hum Perform. 2026; 97(3):151-159.

Neck injuries are commonly sustained during emergency aircraft ejections, with head-neck posture identified as a critical factor influencing injury risk. Despite this, the relationship between the initial head-neck posture and neck injury during emergency ejection has not been comprehensively studied. The objective of the present study was to investigate the effects of head-neck postures on the dynamic neck response of pilots during ejection. Using the Total Human Model for Safety, simulations were conducted involving four initial postures (i.e., rotation, flexion, extension, and lateral bending), each set at 15°, and four initial rotation angles (0°, 15°, 30°, 45°). Ejection acceleration curves were also simulated to the T1 vertebra and its inferior segments. Neutral posture poses no risk of injury. In all the non-neutral postures (15°), only the rotation of 15° may cause risk of neck injury, and notably, this risk increases as the rotational angle increases. Initial head-neck posture markedly influences cervical loading and injury risk during ejection. Axial rotation presents the greatest risk by elevating vertebral stress and ligament tension, emphasizing the critical importance of maintaining a neutral posture to protect the cervical spine during pilot ejection. Du C-F, Zhang X-Y, Zhao H, Liu S-Y, Li T-C, Wang X-W, Zhou K-T. Initial head-neck posture affects neck injury risk in pilot emergency ejection. Aerosp Med Hum Perform. 2026; 97(3):145-150.