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    <title>Research in Progress (RIP)</title>
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    <copyright>Copyright © 2026. National Academy of Sciences. All rights reserved.</copyright>
    <docs>http://blogs.law.harvard.edu/tech/rss</docs>
    <managingEditor>tris-trb@nas.edu (Bill McLeod)</managingEditor>
    <webMaster>tris-trb@nas.edu (Bill McLeod)</webMaster>
    <image>
      <title>Research in Progress (RIP)</title>
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      <link>https://rip.trb.org/</link>
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    <item>
      <title>2021 FAA Aerospace Medical Certification Services Airman Customer Satisfaction Survey </title>
      <link>https://rip.trb.org/View/2431641</link>
      <description><![CDATA[The Civil Aerospace Medical Institute (CAMI) of the Federal Aviation Administration (FAA) surveys airmen who recently sought medical certification approximately every two years since 2006. The survey examines satisfaction with Aerospace Medical Certification Services provided by Aviation Medical Examiners (AME), FAA Regional Flight Surgeons (RFS), and the FAA Aerospace Medical Certification Division (AMCD) in Oklahoma City. Each survey aims to evaluate the degree of customer satisfaction with Aerospace Medical Certification Services (AMCS), identify areas in which the FAA may improve, and assess change in customer satisfaction as a result of improvements from previous iterations of the process. Survey results are used by the Office of Aerospace Medicine (OAM) to improve the process in which pilots apply and are evaluated for medical certificates to receive their license to fly. Administration of the survey meets federal requirements set forth initially by Executive Order No. 12862, “Setting Customer Service Standards,” and the Government Performance and Results Act of 1993.]]></description>
      <pubDate>Thu, 19 Sep 2024 12:10:42 GMT</pubDate>
      <guid>https://rip.trb.org/View/2431641</guid>
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    <item>
      <title>Estimated rate of failure to disclose psychiatric and cardiac conditions during FAA aeromedical certification examinations</title>
      <link>https://rip.trb.org/View/2114144</link>
      <description><![CDATA[Civilian aviators seeking first, second, or third class medical certificates are required to submit to periodic medical examinations. The exam includes physical examination, various tests, and review of the pilot’s medical history and medication use. Pilots face potential disqualification or being subjected to further medical review if they report medical conditions or medications. There is an obvious incentive to conceal medical conditions or medications which they fear may jeopardize their medical certificate application by simply failing to disclose medical conditions that do not have clear signs or symptoms that would be apparent on physical examination. The rate of failure to disclose medical information is not known, since there is no requirement to provide private medical records unless needed for review of a known or detected medical condition. Although the Federal Aviation Administration (FAA) does not require access to private medical records for all pilots, there are sources of medical information other than private medical records for a subset of pilots. Following a fatal aircraft accident, the FAA requests autopsy records and post-mortem samples for toxicology analysis. These post-mortem samples are analyzed at the FAA Civil Aerospace Medical Institute (CAMI) for ethanol and other volatiles, drugs of abuse, and a wide variety of both prescription and non-prescription medications and their metabolites as part of routine fatal mishap investigations. These records are stored at the FAA CAMI in the ToxFlo database, which is searchable by drug and metabolite name. Using post-mortem toxicology data, it is possible, within limits, to detect unreported psychiatric conditions at the time of the accident based on medications detected in post-mortem samples. In addition to toxicology results, the CAMI Medical ANalysis TRAcking registry (MANTRA) is a searchable database (2008 to present) used to store autopsy and civilian aviator aeromedical records data from fatal aircraft mishaps. MANTRA archives both conditions reported on certification exams as well as conditions reported at autopsy and the conditions are ICD coded. The ICD codes in MANTRA from 2008 to the present were recoded using ICD-10 (2017 version) and have been coded as such since then without code updates.  
DATA: Although the FAA does not require access to private medical records for all pilots, there are sources of medical information other than private medical records for a subset of pilots. Following a fatal aircraft accident, the FAA requests autopsy records and post-mortem samples for toxicology analysis. These post-mortem samples are analyzed at the FAA Civil Aerospace Medical Institute (CAMI) for ethanol and other volatiles, drugs of abuse, and a wide variety of both prescription and non-prescription medications and their metabolites as part of routine fatal mishap investigations. These records are stored at the FAA CAMI in the ToxFlo database, which is searchable by drug and metabolite name. Using post-mortem toxicology data, it is possible, within limits, to detect unreported psychiatric conditions at the time of the accident based on medications detected in post-mortem samples. In addition to toxicology results, the CAMI Medical ANalysis TRAcking registry (MANTRA) is a searchable database (2008 to present) used to store autopsy and civilian aviator aeromedical records data from fatal aircraft mishaps. MANTRA archives both conditions reported on certification exams as well as conditions reported at autopsy and the conditions are ICD coded. The ICD codes in MANTRA from 2008 to the present were recoded using ICD-10 (2017 version) and have been coded as such since then without code updates. METHOD: A compilation of targeted drugs used to treat anxiety, stress, depression, attention deficit disorder, and post-traumatic stress disorder is listed. The ToxFlo database will be searched by drug name (and metabolite if appropriate). Cases identified by toxicology will be followed by retrospective review of the pilot’s FAA medical certification records to determine if the corresponding conditions or medications were reported during the most recent or any prior medical certification exam. Only pilots with a current medical certificate at the time of the accident will be included in the dataset. 
MANTRA will be queried for targeted conditions by ICD-10 code as below. Pilots who reported on exam one of these conditions but allegedly discontinued use of the medication will be compared to toxicology results to see if they accurately reported their status. 
Once the toxicology results and medical record review results have been linked, all PII will be deleted from the record. Only the medications detected, the class of medical certificate (First, Second, Third) held by the pilot, and the results of the record review for each case will be retained. Data will be handled and stored according to the Data Management Plan. The cases will be sorted and grouped according to the type of medication (TCA, MAOI, etc).  The metrics calculated will include the following: (1) total number of cases identified for each medication type  /  total number of fatally injured medically certified pilots = % of fatally injured pilots with a target condition severe enough to require medication; (2) number of cases of a diagnosis or medication accurately reported on the most recent exam / total number of cases identified by toxicology for each medication type = % accurately reported on current exam; (3) number of cases of each diagnosis or medication accurately reported on any exam / total number of cases identified for each medication type = % ever reported on any exam; and (4) number of pilots who reported on exam taking, and discontinuing, one of the target medications but still had positive toxicology / total number of pilots who reported on exam taking, and discontinuing, one of the test medications = % of fatally injured pilots who falsely claimed to have stopped taking medication for a target condition. 
These metrics will be calculated for each of the medication classes for the aggregate of all fatally injured pilots with a current and valid medical certificate, and will also be calculated separately for First, Second, and Third Class medical certificates. Pilots with multiple medications will be addressed in a separate category. The results will measure the frequency of targeted medications, and by implication the targeted conditions, among fatally injured pilots as well as how accurately these pilots reported on exam their history of psychiatric conditions severe enough to require use of medication. The results also will measure the accuracy of pilot reports claiming that they have stopped taking a potentially disqualifying medication. 

A similar method will be used to estimate the rate of undisclosed select cardiac diagnoses.
Data: Although the FAA does not require access to private medical records for all pilots, there are sources of medical information other than private medical records for a subset of pilots. Following a fatal aircraft accident, the FAA requests autopsy records as part of the medical review process for the Medical Accident Review and Hazard Analysis Program (MARHAP). Summaries of the aeromedical certification exams and post-accident autopsy reports are summarized in the CAMI Medical ANalysis TRAcking registry (MANTRA). MANTRA is a searchable database (2008 to present) used to store autopsy and civilian aviator aeromedical records data from fatal aircraft mishaps. The conditions reported on certification exams as well as conditions reported at autopsy are CPT coded for medical procedure or ICD coded for diagnosis. The ICD codes in MANTRA from 2008 to the present were recoded using ICD-10 (2017 version) and have been coded as such since then without code updates. 
PART 1 Method: MANTRA aeromedical exam summaries of fatal aircraft accidents will be queried from 2008 to the present by ICD and CPT codes for the following:
1)	ICD (I25.2) old myocardial infarction 
2)	CPT (33157) coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft
3)	CPT (92933) percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch.
Cases identified as having reported one of these codes on exam will be compared to their autopsy reports to test the accuracy of the medical history as reported on certification exam. The sensitivity of autopsy for detecting these conditions and procedures will also be assessed. Only rated pilots and pilot-rated passengers with current medical certificates at the time of death will be reviewed. 



The metrics calculated will include the following:
1)	total number of cases identified for each diagnosis or procedure 
total number of fatally injured medically certificated pilots 
= % of all medically certificated fatally injured pilots with a pre-mortem reported history of myocardial infarction, coronary stent, or coronary bypass. 

2)	number of cases accurately reported on exam  
total number of cases reported on exam 
= % accurately reported on exam

3)	number of cases reported on exam and confirmed on autopsy 
total number of cases reported on exam 
= % accuracy of autopsy findings

PART 2 METHOD: MANTRA autopsy summaries will be queried from 2008 to the present for the same codes. Cases identified will be compared to aeromedical certification exams for those pilots.
The metrics calculated will include the following: 
1)	number of cases identified on autopsy for each diagnosis or procedure 
total number of fatally injured medically certificated pilots 
= % of all medically certificated fatally injured pilots with a post-mortem identified history of myocardial infarction, coronary stent, or coronary bypass. 
2)	(total number of cases identified on autopsy for each diagnosis or procedure – the cases reported on pre-mortem exam) 
total number of fatally injured medically certified pilots 
= % of medically certificated fatally injured pilots who failed to accurately report a history of myocardial infarction, coronary stent, or coronary bypass on certification exam. 
Results: These results will measure:
1)	the frequency of select cardiac conditions among medically certificated fatally injured pilots as well as how accurately these pilots reported their medical histories on their aeromedical certification exams, and
2)	the sensitivity of autopsy for detecting these conditions as a measure of the efficacy of using autopsy data for hazard analysis as related to cardiac history.

]]></description>
      <pubDate>Thu, 30 Mar 2023 10:15:46 GMT</pubDate>
      <guid>https://rip.trb.org/View/2114144</guid>
    </item>
    <item>
      <title>SMS – Validating simplifying assumptions for estimating pilot incapacitation risk 17.7</title>
      <link>https://rip.trb.org/View/2114826</link>
      <description><![CDATA[This research project will leverage existing aerospace, medical claims and mortality datasets to validate the following proposed simplifying assumptions for estimating pilot incapacitation risk: (1) the cardiovascular death rate can be taken to approximate the cardiovascular incapacitation rate, and (2) cardiovascular mortality data alone provides a reasonable approximation for all-cause sudden in-flight incapacitations.
]]></description>
      <pubDate>Wed, 08 Feb 2023 16:03:26 GMT</pubDate>
      <guid>https://rip.trb.org/View/2114826</guid>
    </item>
    <item>
      <title>SMS – Determining if there is a medical vs. human factors/experience risk tradeoff in pilots operating under Basic Med 17.6</title>
      <link>https://rip.trb.org/View/2114825</link>
      <description><![CDATA[This research project will compare pilot human factors vs. medically caused mishap rates across age deciles between pilots operating under BasicMed vs. a 3rd class medical certificate.  The purpose of this comparison is to determine whether the likely experience gained by age for older pilots can serve as a tradeoff for the likely increased risk due to medical factors associated with increased age.]]></description>
      <pubDate>Wed, 08 Feb 2023 15:59:58 GMT</pubDate>
      <guid>https://rip.trb.org/View/2114825</guid>
    </item>
    <item>
      <title>SMS – Determining the acceptable pilot incapacitation rate for FAA class 1 medical certificates 17.5</title>
      <link>https://rip.trb.org/View/2114823</link>
      <description><![CDATA[This research project will review the published literature on the derivation of the 1% rule as used by ICAO, validate/update assumptions, identify current U.S. sources for needed data, and recalculate the acceptable incapacitation rate for class 1 medical certificates assuming 2 pilot crews. The project will recommend: (1) follow up studies addressing important weaknesses in either assumptions or data, (2) alternative methods for determining an acceptable pilot incapacitation rate. Additionally, the project will compare combined part 121 and part 135 pilot human factors and medically caused mishap rates (combined fatal and nonfatal) across age deciles and recommend age adjustments to the acceptable incapacitation rate to minimize overall mishap rates.]]></description>
      <pubDate>Wed, 08 Feb 2023 15:46:43 GMT</pubDate>
      <guid>https://rip.trb.org/View/2114823</guid>
    </item>
    <item>
      <title>Aviation Medical Examiner Office-Based Pilot Functional Capability Assessment for Certification </title>
      <link>https://rip.trb.org/View/2040276</link>
      <description><![CDATA[The Aviation Medical Examiner evaluates a pilot to ascertain his/her/their health state and exercises subject matter expertise, aided by policy guidance, to determine the pilot’s ability to safely perform aviation duties and arrive at a medical certification decision. In the occupational medicine domain, the gold standard for making similar decisions is the functional assessment – i.e., can the individual demonstrate the ability to perform job essential tasks. At present, such an assessment for a pilot involves an observed live or simulated flight. Such an approach is not practical from a time, cost, and resource perspective for general application in aeromedical certification. 

The purpose of this project is to develop the ability to assess objectively a pilot’s ability to perform certain piloting tasks, taking into consideration health-related factors, in the Aviation Medical Examiner’s office setting. The research approach will leverage General Systems Performance Theory to define a set of pilot basic performance resources and associated resource availability measures; define a representative pilot high level task and associated task performance measures; empirically understand the relationship between resource availability and high level task performance in a flight simulator; and derive a set of minimum performance resource availabilities. A synthetic screening task will then be developed to efficiently assess performance resource availabilities relative to the minimums. The validity of the synthetic task will be subsequently validated and performance specifications developed for technology transition and commercialization.]]></description>
      <pubDate>Thu, 13 Oct 2022 22:31:40 GMT</pubDate>
      <guid>https://rip.trb.org/View/2040276</guid>
    </item>
    <item>
      <title>Aeromedical Collaboration Environment for Fusing Pilot Medical Certification and Operational Data </title>
      <link>https://rip.trb.org/View/2037218</link>
      <description><![CDATA[The purpose of this project is to fuse FAA pilot medical certification decisions with operational safety outcomes beyond the historical outcomes of interest of mishap and pilot incapacitation events. Achieving this objective requires enhancing the traditional aerospace medicine safety management system data environment to make it a collaborative innovation environment with joint FAA and industry participation. This project addresses the question of how the FAA can form a Public-Private Partnership (PPP) with the commercial airline industry to obtain pilot operational performance and safety data for linking to agency medical certification data to support advanced risk analyses. This project will include an industry outreach to create a PPP with one or more commercial airline partners, a feasibility assessment for creating an Aeromedical Collaborative Environment (ACE), and the design and construction of the ACE.]]></description>
      <pubDate>Sat, 08 Oct 2022 16:50:33 GMT</pubDate>
      <guid>https://rip.trb.org/View/2037218</guid>
    </item>
    <item>
      <title>Suggestive Events of the aeromedical certification safety failure</title>
      <link>https://rip.trb.org/View/2035613</link>
      <description><![CDATA[This project would locate source datasets, identify, collect, and analyze suggestive events of failure of the aeromedical certification safety case for certified pilots. These events include medical disqualification, new special issuance, pilot enforcement action for alcohol/drug use, and death match by NDI/CDC. The objective is to establish methods and algorithms to evaluate effectiveness of aeromedical dispositions and verify achievement of an Acceptable Level of Safety (ALOS) in the National Airspace System (NAS). The project will also establish datasets holding the results of the events, and thus contribute to data-driven safety management system (SMS).

For medical disqualification, new special issuance, pilot enforcement action for alcohol/drug use, events since year 2010 will be identified and collected. The trend analysis will be performed.

For NDI mortality data match to determine pilot off-flight incapacitation. The target cohort will be those former aeromedical certificate holders in the United States whose certificates expired in a previous time frame who did not seek to recertify. Such required data fields as names and SS numbers will be collected from each pilot's most recent application of aeromedical certificates to provide to the National Death Index supplied by the U.S. Centers for Disease Control (CDC) for potential death matches. The death rates and causes of death of these former aeromedical certificate holders will be assessed. Causes of death will also be evaluated for relevance to the aeromedical certification process.]]></description>
      <pubDate>Tue, 04 Oct 2022 16:35:24 GMT</pubDate>
      <guid>https://rip.trb.org/View/2035613</guid>
    </item>
    <item>
      <title>Pilot Incapacitation - Assessment of Data Sources</title>
      <link>https://rip.trb.org/View/2023437</link>
      <description><![CDATA[Identification of pilot incapacitation is essential for aviation safety. There are various databases of disparate origins that may contain different quality levels of pilot incapacitation information. Assessment of these data sources is critical to obtain a list of reliable and accurate pilot incapacitation events. This project evaluates the data sources and contents, data origin and flow, data availability and accessibility, and data quality ranking of the available data sources in FAA pertaining to pilot incapacitation. The project also explores potential algorithms including SQL and natural language processing (NLP) technologies to screen, identify, and collect pilot incapacitation events from the data sources in FAA. As a part of results, the project provides a sample roadmap and practice suggestions for leveraging the data sources, and a Venn diagram of pilot incapacitation events from 2008 to 2020 retrieved from the data sources.]]></description>
      <pubDate>Thu, 15 Sep 2022 14:26:14 GMT</pubDate>
      <guid>https://rip.trb.org/View/2023437</guid>
    </item>
    <item>
      <title>Computerized Neurocognitive Tests for Aeromedical Safety</title>
      <link>https://rip.trb.org/View/1874601</link>
      <description><![CDATA[This research will identify alternative neurocognitive tests for use in the FAA's Aviator Medical Certification process (a neurocognitive test is part of the initial screening assessment to detect aeromedically significant cognitive deficits) and obtain pilot normative data for these alternative neurocognitive tests. Data and analyses from this project will be used to potentially revise the FAA's Aviation Medical Examiners (AME) Guide, update clinical practices, and make changes to airmen certification protocols.]]></description>
      <pubDate>Wed, 25 Aug 2021 10:34:22 GMT</pubDate>
      <guid>https://rip.trb.org/View/1874601</guid>
    </item>
    <item>
      <title>Human Performance Impacts for Head-Worn Displays for General Aviation</title>
      <link>https://rip.trb.org/View/1503751</link>
      <description><![CDATA[A study of how pilots are affected by different types of head worn displays.
]]></description>
      <pubDate>Fri, 02 Mar 2018 13:37:07 GMT</pubDate>
      <guid>https://rip.trb.org/View/1503751</guid>
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