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Dennis V Canfield - One of the best experts on this subject based on the ideXlab platform.
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ethanol and drugs found in civil Aviation Accident pilot fatalities 1989 2013
Aerospace medicine and human performance, 2016Co-Authors: Arvind K Chaturvedi, Kristi J Craft, Jeffery S Hickerson, Paul Rogers, Dennis V CanfieldAbstract:BACKGROUND: Biological specimens from pilots fatally injured in civil Aviation Accidents are analyzed for ethanol and drugs at the Civil Aerospace Medical Institute (CAMI). Prevalence of these substances in the pilots has been evaluated at 5-yr intervals since 1989. In continuation, a fifth 5-yr study (2009-2013) was conducted. METHODS: The CAMI toxicology/medical certification and National Transportation Safety Board (NTSB) Aviation Accident databases were searched. RESULTS: During 2009-2013, samples from 1169 pilots were analyzed. Aircraft involved in the Accidents were primarily operating under general Aviation. Most airmen were private pilots and held third-class medical certificates. In relation to the first 5-yr (1989-1993) period, the pilot fatality cases decreased by 37% and the presence of ethanol and/or drugs in the pilots increased by 239% in the fifth 5-yr period. The ethanol usage was unchanged, but increases were 267% and 583% with illicit and prescription drugs, respectively. The use of ethanol and/or drugs by aviators, along with underlying medical conditions, was determined by the NTSB to be cause/factors in 5% of the Accidents. CONCLUSION: The observed decrease in the fatality cases does not necessarily suggest the decrease in Aviation Accidents, as active airmen numbers also declined. The increase in the drug positive cases is primarily attributed to the continuous rise in the use of prescription drugs. Although prevalence of ethanol and drugs has been evaluated in fatally injured aviators, such evaluation has not been performed in active pilots not involved in Accidents. This type of comparative study would be crucial in assessing Aviation safety. Chaturvedi AK, Craft KJ, Hickerson JS, Rogers PB, Canfield DV. Ethanol and drugs found in civil Aviation Accident pilot fatalities, 1989-2013. Aerosp Med Hum Perform. 2016; 87(5):470-476. Language: en
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drugs and alcohol in civil Aviation Accident pilot fatalities from 2004 2008
Aviation Space and Environmental Medicine, 2012Co-Authors: Dennis V Canfield, Arvind K Chaturvedi, Kurt M Dubowski, James E WhinneryAbstract:INTRODUCTION: The Federal Aviation Administration (FAA) Office of Aerospace Medicine sets medical standards needed to protect the public and pilots from death or injury due to incapacitation of the pilot. As a part of this process, toxicology testing is performed by the FAA on almost every pilot who is fatally injured in an Aviation Accident to determine the medical condition of the pilot, medications used by the pilot at the time of the Accident, and the extent of impairment, if any. METHOD: The data were extracted from the FAA toxicology database for all pilots who died from 2004 to 2008 in Aviation Accidents. RESULTS: The laboratory received and tested specimens from 1353 pilots who died in Aviation Accidents between 2004 and 2008; 507 of these pilots were found to be taking drugs and 92 had ethanol in excess of 0.04 g x dl(-1). DISCUSSION: This study was conducted to determine the extent of drug use in pilots who have died in Aviation Accidents from 2004 to 2008 and to determine the types of drugs most commonly found. A comparison of previously published reports with this study's report was made to determine trends in drug use by pilots who have died in Aviation Accidents over the past 20 yr. Factors were discussed that could influence drug trends. Diphenhydramine, an H1 antihistamine with impairing properties, is the most commonly found drug in pilots who died in an Aviation Accident. Language: en
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drugs and alcohol found in civil Aviation Accident pilot fatalities from 2004 2008
Aviation Space and Environmental Medicine, 2012Co-Authors: Dennis V Canfield, Arvind K Chaturvedi, Kurt M Dubowski, James E WhinneryAbstract:INTRODUCTION: The Federal Aviation Administration (FAA) Office of Aerospace Medicine sets medical standards needed to protect the public and pilots from death or injury due to incapacitation of the pilot. As a part of this process, toxicology testing is performed by the FAA on almost every pilot who is fatally injured in an Aviation Accident to determine the medical condition of the pilot, medications used by the pilot at the time of the Accident, and the extent of impairment, if any. METHOD: The data were extracted from the FAA toxicology database for all pilots who died from 2004 to 2008 in Aviation Accidents. RESULTS: The laboratory received and tested specimens from 1353 pilots who died in Aviation Accidents between 2004 and 2008; 507 of these pilots were found to be taking drugs and 92 had ethanol in excess of 0.04 g x dl(-1). DISCUSSION: This study was conducted to determine the extent of drug use in pilots who have died in Aviation Accidents from 2004 to 2008 and to determine the types of drugs most commonly found. A comparison of previously published reports with this study's report was made to determine trends in drug use by pilots who have died in Aviation Accidents over the past 20 yr. Factors were discussed that could influence drug trends. Diphenhydramine, an H1 antihistamine with impairing properties, is the most commonly found drug in pilots who died in an Aviation Accident. Language: en
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vitreous fluid and or urine glucose concentrations in 1335 civil Aviation Accident pilot fatalities
Journal of Forensic Sciences, 2009Co-Authors: Arvind K Chaturvedi, Dennis V Canfield, Sabra R Botch, Estrella M ForsterAbstract:During Aviation Accident investigations, vitreous fluid and urine samples from pilot fatalities are analyzed for glucose and blood for hemoglobin A(1c) (HbA(1c)) to monitor diabetic pilots and to discover other pilots with undiagnosed/unreported diabetes. The prevalence of elevated glucose concentrations in fatally injured pilots was evaluated by searching the Civil Aerospace Medical Institute's Toxicology Database for the period 1998-2005. Out of 1335 pilots involving 363 vitreous fluid, 365 urine, and 607 vitreous fluid and urine analyses, 43 pilots had elevated glucose in vitreous fluid (>125 mg/dL) and/or in urine (>100 mg/dL). Of the 20 pilots whose blood samples were analyzed, nine had >6% HbA(1c)-four were known diabetics, and five were unknown diabetics. Urinary glucose levels were elevated in all 13 known hyperglycemic pilots. A considerable number of pilots (30 of 43) had elevated glucose and HbA(1c) (5 of 20), suggesting undiagnosed/unreported diabetic conditions. Language: en
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medical histories of 61 Aviation Accident pilots with postmortem ssri antidepressant residues
Aviation Space and Environmental Medicine, 2007Co-Authors: Ahmet Sen, Dennis V Canfield, Ahmet Akin, Arvind K ChaturvediAbstract:INTRODUCTION: Selective serotonin reuptake inhibitor (SSRI) antidepressants are popularly prescribed, but these drugs are not currently approved for use by U.S. civilian aviators. In a 2003 study, the presence of 4 SSRIs--citalopram, fluoxetine, paroxetine, and sertraline-was reported in 61 pilot fatalities of civil Aviation Accidents that occurred during 1990-2001. However, it was not known whether these pilots had disqualifying psychological conditions, including depression, and had properly reported the use of the antidepressants. METHODS: The aeromedical history of the pilots was retrieved from the Federal Aviation Administration's (FAA's) Aerospace Medical Certification Database; additional pilot medical information and the cause/factor of the Accidents were obtained from the National Transportation Safety Board's (NTSB's) Aviation Accident Database. RESULTS: There were 59 pilots who had medical records in the FAA's Certification Database. Disqualifying psychological conditions were self-reported in the past examinations of only 7 (12%) of the 59 pilots, and the use of an SSRI was reported by 3 of the 7 pilots. In later examinations, 6 of the 7 indicated that they were free from the conditions and not taking SSRIs; thus, they were reissued medical certificates. Such conditions and/or drug use were not self-reported in the aeromedical records of the remaining 52 (88%) pilots. Nevertheless, the NTSB investigations revealed that 12 (20%) of the 61 pilots had a history of a psychological condition and/or an SSRI use, as suggested by their personal medical records. CONCLUSIONS: These findings reconfirm that SSRIs were used by the aviators but were not reported in their last aeromedical examinations. Language: en
Robert D. Johnson - One of the best experts on this subject based on the ideXlab platform.
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Distribution of Paroxetine in Postmortem Fluids and Tissues Distribution of Paroxetine in Postmortem Fluids and Tissues July 2015 6. Performing Organization Code 7. Author(s) 8. Performing Organization Report No
2020Co-Authors: Russell J. Lewis, Philip M Kemp, Robert D. JohnsonAbstract:This work was accomplished under the approved task AM-B-12-TOX-204. Abstract Paroxetine is a selective serotonin reuptake inhibitor that is a commonly prescribed drug for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, premenstrual dysphoric disorder, and post-traumatic stress disorder. There are certain side effects associated with paroxetine use that could negatively affect a pilot's performance and become a factor in an Aviation Accident. Such side effects include nausea, drowsiness, insomnia, and dizziness. It has also been suggested that paroxetine use may increase suicidal behavior and suicidal ideation. When relying on postmortem specimens for interpretive value, a general understanding of drug distribution throughout postmortem fluids and tissues is important. Utilizing an n-butyl chloride liquid/liquid extraction followed by gas chromatograph/mass spectrometer (GC/MS) analysis with selected ion monitoring, our laboratory developed a method for the identification, characterization, and quantitation of paroxetine. The linear dynamic range was determined to be 3.13 -1600 ng/mL in blood. Our laboratory then determined the postmortem concentrations of paroxetine in various postmortem tissues and fluids obtained from nine fatal Aviation Accident cases. The typical specimen types analyzed for each case included blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, brain, heart, and bile. Blood paroxetine concentrations obtained from these cases ranged from 0.019 to 0.865 µg/mL. The distribution of paroxetine, expressed as mean specimen/blood ratio, was: 1.67 ± 1.16 urine (n=4), 0.08 ± 0.04 vitreous humor (n=6), 5.77 ± 1.37 liver (n=8), 9.66 ± 2.58 lung (n=9), 1.44 ± 0.57 kidney (n=8), 3.80 ± 0.69 spleen (n=8), 0.15 ± 0.04 muscle (n=8), 4.27 ± 2.64 brain (n=7), and 1.05 ± 0.43 heart (n=8). The results from this study show that paroxetine is readily distributed to tissues and fluids in the body. The large standard deviations associated with the paroxetine distribution coefficients suggest that paroxetine likely can experience significant postmortem concentration changes
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paroxetine in postmortem fluids and tissues from nine Aviation Accident victims
Journal of Analytical Toxicology, 2015Co-Authors: Russell J. Lewis, Philip Kemp, Robert D. JohnsonAbstract:Paroxetine is a selective serotonin reuptake inhibitor commonly prescribed for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder. While the use of paroxetine is considered relatively safe, negative side effects, including nausea, drowsiness, insomnia and dizziness, can adversely affect a pilot's ability to safely operate an aircraft. The use of paroxetine may increase suicidal behavior and suicidal ideation. When relying on postmortem specimens for toxicological evaluation, a general understanding of drug distribution throughout postmortem specimens is important. This laboratory has determined the distribution of paroxetine in postmortem tissues and fluids from nine Aviation Accident fatalities. Specimens were processed using an n-butyl chloride liquid/liquid extraction followed by gas chromatographic/mass spectrometeric analysis. Blood paroxetine concentrations obtained from these cases ranged from 0.019 to 0.865 µg/mL. The distribution of paroxetine, expressed as mean specimen/blood ratio, was 1.67 ± 1.16 urine (n = 4), 0.08 ± 0.04 vitreous humor (n = 6), 5.77 ± 1.37 liver (n = 8), 9.66 ± 2.58 lung (n = 9), 1.44 ± 0.57 kidney (n = 8), 3.80 ± 0.69 spleen (n = 8), 0.15 ± 0.04 muscle (n = 8), 4.27 ± 2.64 brain (n = 7) and 1.05 ± 0.43 heart (n = 8). The large standard deviations associated with the paroxetine distribution coefficients suggest that paroxetine can experience significant postmortem concentration changes.
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analysis of sertraline in postmortem fluids and tissues in 11 Aviation Accident victims
Analytical Abstracts, 2013Co-Authors: Russell J. Lewis, Mike K. Angier, Kelly Williamson, Robert D. JohnsonAbstract:Sertraline (Zoloft) is a selective serotonin reuptake inhibitor that is a commonly prescribed drug for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, premenstrual dysphoric disorder and post-traumatic stress disorder. Although the use of sertraline is relatively safe, certain side effects may negatively affect a pilot's performance and become a factor in an Aviation Accident. The authors' laboratory investigated the distribution of sertraline and its primary metabolite, desmethylsertraline, in various postmortem tissues and fluids obtained from 11 fatal Aviation Accident cases between 2001 and 2004. Eleven specimen types were analyzed for each case, including blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, brain, heart and bile. Human specimens were processed utilizing solid-phase extraction, followed by characterization and quantitation employing gas chromatography-mass spectrometry. Whole blood sertraline concentrations obtained from these 11 cases ranged from 0.005 to 0.392 µg/mL. The distribution coefficients of sertraline, expressed as specimen/blood ratio, were as follows: urine, 0.47 ± 0.39 (n = 6); vitreous humor, 0.02 ± 0.01 (n = 4); liver, 74 ± 59 (n = 11); lung, 67 ± 45 (n = 11); kidney, 7.4 ± 5 (n = 11); spleen, 46 ± 45 (n = 10); muscle, 2.1 ± 1.3 (n = 8); brain, 22 ± 14 (n = 10); heart, 9 ± 7 (n = 11); and bile, 36 ± 26 (n = 8). Postmortem distribution coefficients obtained for sertraline had coefficients of variation ranging from 47-99%. This study suggests that sertraline likely undergoes significant postmortem redistribution.
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Postmortem Concentrations of Tramadol and O-Desmethyltramadol in 11 Aviation Accident Fatalities
2010Co-Authors: Russell J. Lewis, Roxane M Ritter, Robert D. Johnson, Ryan W CrumpAbstract:Tramadol is a centrally acting analgesic used to treat moderate-to-severe pain. Side effects of this medication include dizziness, confusion, drowsiness, seizures, and respiratory depression. Any of these side effects could negatively affect a pilot’s performance and become a factor in an Aviation Accident. Due to the severity of Aviation Accidents, blood samples are often not available, and frequently, only tissue specimens are available for analysis. Therefore, understanding the distribution of a drug throughout all fluids and tissues of the body is important when trying to interpret drug impairment and/or intoxication. Our laboratory has determined the distribution of tramadol and its main active metabolite, O-desmethyltramadol, in various postmortem tissues and fluids obtained from 11 fatal Aviation Accident cases. Whole blood tramadol concentrations obtained from these 11 cases ranged from 81-2720 ng/mL. When available, 10 specimen types were analyzed for each case, including blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, heart, and brain. Distribution, expressed as specimen/blood ratio, for tramadol was 69 ± 74 in urine, 2.58 ± 3.26 in vitreous humor, 4.90 ± 3.32 in liver, 3.43 ± 2.31 in lung, 3.05 ± 1.49 in kidney, 5.15 ± 2.66 in spleen, 1.18 ± 0.85 in muscle, 2.33 ± 1.21 in brain, and 1.89 ± 1.01 in heart. Distribution coefficients obtained had coefficient of variations (CV) ranging from 49-126%. With such large CV’s, the distribution coefficients have little use in predicting blood concentrations from the analysis of a tissue specimen. This study indicates that tramadol concentrations undergo significant postmortem changes.
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The postmortem distribution of vardenafil (Levitra) in an Aviation Accident victim with an unusually high blood concentration.
Journal of Analytical Toxicology, 2007Co-Authors: Robert D. Johnson, Russell J. Lewis, Mike K. AngierAbstract:: Vardenafil (Levitra) is one of the most widely prescribed treatments for erectile dysfunction. This report presents a rapid and reliable method for the identification and quantification of vardenafil in postmortem fluids and tissues, applies this method to a postmortem case, and describes the distribution of vardenafil in various fluids and tissues. This procedure utilizes sildenafil-d8, which is structurally closely related to vardenafil, as an internal standard for more accurate and reliable quantitation. The method incorporates solid-phase extraction and liquid chromatography-tandem mass spectrometry (MS) and MS-MS-MS utilizing an atmospheric pressure chemical ionization ion trap MS in the positive chemical ionization mode. Solid-phase extraction proved to be exceptionally efficient providing recoveries that ranged from 94% to 97%. The limit of detection for vardenafil was determined to be 0.19 ng/mL. The linear dynamic range for this compound was 0.39-200 ng/mL. This method was successfully applied to postmortem fluid and tissue specimens obtained from an Aviation Accident victim. The distribution of vardenafil in various fluids and tissues and the unusually high concentration of vardenafil in the victim's blood are examined.
Russell J. Lewis - One of the best experts on this subject based on the ideXlab platform.
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Distribution of Paroxetine in Postmortem Fluids and Tissues Distribution of Paroxetine in Postmortem Fluids and Tissues July 2015 6. Performing Organization Code 7. Author(s) 8. Performing Organization Report No
2020Co-Authors: Russell J. Lewis, Philip M Kemp, Robert D. JohnsonAbstract:This work was accomplished under the approved task AM-B-12-TOX-204. Abstract Paroxetine is a selective serotonin reuptake inhibitor that is a commonly prescribed drug for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, premenstrual dysphoric disorder, and post-traumatic stress disorder. There are certain side effects associated with paroxetine use that could negatively affect a pilot's performance and become a factor in an Aviation Accident. Such side effects include nausea, drowsiness, insomnia, and dizziness. It has also been suggested that paroxetine use may increase suicidal behavior and suicidal ideation. When relying on postmortem specimens for interpretive value, a general understanding of drug distribution throughout postmortem fluids and tissues is important. Utilizing an n-butyl chloride liquid/liquid extraction followed by gas chromatograph/mass spectrometer (GC/MS) analysis with selected ion monitoring, our laboratory developed a method for the identification, characterization, and quantitation of paroxetine. The linear dynamic range was determined to be 3.13 -1600 ng/mL in blood. Our laboratory then determined the postmortem concentrations of paroxetine in various postmortem tissues and fluids obtained from nine fatal Aviation Accident cases. The typical specimen types analyzed for each case included blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, brain, heart, and bile. Blood paroxetine concentrations obtained from these cases ranged from 0.019 to 0.865 µg/mL. The distribution of paroxetine, expressed as mean specimen/blood ratio, was: 1.67 ± 1.16 urine (n=4), 0.08 ± 0.04 vitreous humor (n=6), 5.77 ± 1.37 liver (n=8), 9.66 ± 2.58 lung (n=9), 1.44 ± 0.57 kidney (n=8), 3.80 ± 0.69 spleen (n=8), 0.15 ± 0.04 muscle (n=8), 4.27 ± 2.64 brain (n=7), and 1.05 ± 0.43 heart (n=8). The results from this study show that paroxetine is readily distributed to tissues and fluids in the body. The large standard deviations associated with the paroxetine distribution coefficients suggest that paroxetine likely can experience significant postmortem concentration changes
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paroxetine in postmortem fluids and tissues from nine Aviation Accident victims
Journal of Analytical Toxicology, 2015Co-Authors: Russell J. Lewis, Philip Kemp, Robert D. JohnsonAbstract:Paroxetine is a selective serotonin reuptake inhibitor commonly prescribed for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder. While the use of paroxetine is considered relatively safe, negative side effects, including nausea, drowsiness, insomnia and dizziness, can adversely affect a pilot's ability to safely operate an aircraft. The use of paroxetine may increase suicidal behavior and suicidal ideation. When relying on postmortem specimens for toxicological evaluation, a general understanding of drug distribution throughout postmortem specimens is important. This laboratory has determined the distribution of paroxetine in postmortem tissues and fluids from nine Aviation Accident fatalities. Specimens were processed using an n-butyl chloride liquid/liquid extraction followed by gas chromatographic/mass spectrometeric analysis. Blood paroxetine concentrations obtained from these cases ranged from 0.019 to 0.865 µg/mL. The distribution of paroxetine, expressed as mean specimen/blood ratio, was 1.67 ± 1.16 urine (n = 4), 0.08 ± 0.04 vitreous humor (n = 6), 5.77 ± 1.37 liver (n = 8), 9.66 ± 2.58 lung (n = 9), 1.44 ± 0.57 kidney (n = 8), 3.80 ± 0.69 spleen (n = 8), 0.15 ± 0.04 muscle (n = 8), 4.27 ± 2.64 brain (n = 7) and 1.05 ± 0.43 heart (n = 8). The large standard deviations associated with the paroxetine distribution coefficients suggest that paroxetine can experience significant postmortem concentration changes.
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analysis of sertraline in postmortem fluids and tissues in 11 Aviation Accident victims
Analytical Abstracts, 2013Co-Authors: Russell J. Lewis, Mike K. Angier, Kelly Williamson, Robert D. JohnsonAbstract:Sertraline (Zoloft) is a selective serotonin reuptake inhibitor that is a commonly prescribed drug for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, premenstrual dysphoric disorder and post-traumatic stress disorder. Although the use of sertraline is relatively safe, certain side effects may negatively affect a pilot's performance and become a factor in an Aviation Accident. The authors' laboratory investigated the distribution of sertraline and its primary metabolite, desmethylsertraline, in various postmortem tissues and fluids obtained from 11 fatal Aviation Accident cases between 2001 and 2004. Eleven specimen types were analyzed for each case, including blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, brain, heart and bile. Human specimens were processed utilizing solid-phase extraction, followed by characterization and quantitation employing gas chromatography-mass spectrometry. Whole blood sertraline concentrations obtained from these 11 cases ranged from 0.005 to 0.392 µg/mL. The distribution coefficients of sertraline, expressed as specimen/blood ratio, were as follows: urine, 0.47 ± 0.39 (n = 6); vitreous humor, 0.02 ± 0.01 (n = 4); liver, 74 ± 59 (n = 11); lung, 67 ± 45 (n = 11); kidney, 7.4 ± 5 (n = 11); spleen, 46 ± 45 (n = 10); muscle, 2.1 ± 1.3 (n = 8); brain, 22 ± 14 (n = 10); heart, 9 ± 7 (n = 11); and bile, 36 ± 26 (n = 8). Postmortem distribution coefficients obtained for sertraline had coefficients of variation ranging from 47-99%. This study suggests that sertraline likely undergoes significant postmortem redistribution.
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Postmortem Concentrations of Tramadol and O-Desmethyltramadol in 11 Aviation Accident Fatalities
2010Co-Authors: Russell J. Lewis, Roxane M Ritter, Robert D. Johnson, Ryan W CrumpAbstract:Tramadol is a centrally acting analgesic used to treat moderate-to-severe pain. Side effects of this medication include dizziness, confusion, drowsiness, seizures, and respiratory depression. Any of these side effects could negatively affect a pilot’s performance and become a factor in an Aviation Accident. Due to the severity of Aviation Accidents, blood samples are often not available, and frequently, only tissue specimens are available for analysis. Therefore, understanding the distribution of a drug throughout all fluids and tissues of the body is important when trying to interpret drug impairment and/or intoxication. Our laboratory has determined the distribution of tramadol and its main active metabolite, O-desmethyltramadol, in various postmortem tissues and fluids obtained from 11 fatal Aviation Accident cases. Whole blood tramadol concentrations obtained from these 11 cases ranged from 81-2720 ng/mL. When available, 10 specimen types were analyzed for each case, including blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, heart, and brain. Distribution, expressed as specimen/blood ratio, for tramadol was 69 ± 74 in urine, 2.58 ± 3.26 in vitreous humor, 4.90 ± 3.32 in liver, 3.43 ± 2.31 in lung, 3.05 ± 1.49 in kidney, 5.15 ± 2.66 in spleen, 1.18 ± 0.85 in muscle, 2.33 ± 1.21 in brain, and 1.89 ± 1.01 in heart. Distribution coefficients obtained had coefficient of variations (CV) ranging from 49-126%. With such large CV’s, the distribution coefficients have little use in predicting blood concentrations from the analysis of a tissue specimen. This study indicates that tramadol concentrations undergo significant postmortem changes.
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The postmortem distribution of vardenafil (Levitra) in an Aviation Accident victim with an unusually high blood concentration.
Journal of Analytical Toxicology, 2007Co-Authors: Robert D. Johnson, Russell J. Lewis, Mike K. AngierAbstract:: Vardenafil (Levitra) is one of the most widely prescribed treatments for erectile dysfunction. This report presents a rapid and reliable method for the identification and quantification of vardenafil in postmortem fluids and tissues, applies this method to a postmortem case, and describes the distribution of vardenafil in various fluids and tissues. This procedure utilizes sildenafil-d8, which is structurally closely related to vardenafil, as an internal standard for more accurate and reliable quantitation. The method incorporates solid-phase extraction and liquid chromatography-tandem mass spectrometry (MS) and MS-MS-MS utilizing an atmospheric pressure chemical ionization ion trap MS in the positive chemical ionization mode. Solid-phase extraction proved to be exceptionally efficient providing recoveries that ranged from 94% to 97%. The limit of detection for vardenafil was determined to be 0.19 ng/mL. The linear dynamic range for this compound was 0.39-200 ng/mL. This method was successfully applied to postmortem fluid and tissue specimens obtained from an Aviation Accident victim. The distribution of vardenafil in various fluids and tissues and the unusually high concentration of vardenafil in the victim's blood are examined.
Arvind K Chaturvedi - One of the best experts on this subject based on the ideXlab platform.
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ethanol and drugs found in civil Aviation Accident pilot fatalities 1989 2013
Aerospace medicine and human performance, 2016Co-Authors: Arvind K Chaturvedi, Kristi J Craft, Jeffery S Hickerson, Paul Rogers, Dennis V CanfieldAbstract:BACKGROUND: Biological specimens from pilots fatally injured in civil Aviation Accidents are analyzed for ethanol and drugs at the Civil Aerospace Medical Institute (CAMI). Prevalence of these substances in the pilots has been evaluated at 5-yr intervals since 1989. In continuation, a fifth 5-yr study (2009-2013) was conducted. METHODS: The CAMI toxicology/medical certification and National Transportation Safety Board (NTSB) Aviation Accident databases were searched. RESULTS: During 2009-2013, samples from 1169 pilots were analyzed. Aircraft involved in the Accidents were primarily operating under general Aviation. Most airmen were private pilots and held third-class medical certificates. In relation to the first 5-yr (1989-1993) period, the pilot fatality cases decreased by 37% and the presence of ethanol and/or drugs in the pilots increased by 239% in the fifth 5-yr period. The ethanol usage was unchanged, but increases were 267% and 583% with illicit and prescription drugs, respectively. The use of ethanol and/or drugs by aviators, along with underlying medical conditions, was determined by the NTSB to be cause/factors in 5% of the Accidents. CONCLUSION: The observed decrease in the fatality cases does not necessarily suggest the decrease in Aviation Accidents, as active airmen numbers also declined. The increase in the drug positive cases is primarily attributed to the continuous rise in the use of prescription drugs. Although prevalence of ethanol and drugs has been evaluated in fatally injured aviators, such evaluation has not been performed in active pilots not involved in Accidents. This type of comparative study would be crucial in assessing Aviation safety. Chaturvedi AK, Craft KJ, Hickerson JS, Rogers PB, Canfield DV. Ethanol and drugs found in civil Aviation Accident pilot fatalities, 1989-2013. Aerosp Med Hum Perform. 2016; 87(5):470-476. Language: en
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toxicological findings in fatally injured pilots of 979 amateur built aircraft Accidents
Aviation Space and Environmental Medicine, 2013Co-Authors: Arvind K Chaturvedi, Kristi J Craft, Jeffery S Hickerson, Paul B Rogers, John W SoperAbstract:Biological samples collected from fatally injured pilots in Aviation Accidents involving all types of aircraft, including amateur-built aircraft, are submitted to the Civil Aerospace Medical Institute (CAMI) for Accident investigation. These samples are analyzed for fire gases, ethanol, and drugs. Trends of amateur-built aircraft Accidents and toxicological findings in the associated pilot fatalities have not been examined. Amateur-built aircraft Accidents that occurred during 1990–2009 were evaluated by retrieving necessary information from the CAMI toxicology database. Probable cause and factor in the amateur-built aircraft mishaps were obtained from the National Transportation Safety Board's (NTSB's) Aviation Accident database. Of 6309 Aviation Accidents from which CAMI received postmortem samples, 979 (16%) were related to amateur-built aircraft. The highest number of Aviation mishaps occurred during summer, which was true with amateur-built as well as with all other aircraft. There was a decreasing trend in Accidents of non-amateur-built aircraft, whereas there was an increasing trend in Accidents of amateur-built aircraft. In the 979 Accidents (pilots), 392 were positive for ethanol and/or drugs. Ethanol was found in 29 pilots, drugs in 345, and ethanol plus drugs in 18. For ethanol/drug-related Accidents also, a decreasing trend was observed with non-amateur-built aircraft and an increasing trend with amateur-built aircraft. Of the 392 amateur-built aircraft, 388 (99%) were flying under the general Aviation category. In the 392 pilots, 238 (61%) held private pilot flying certificates and 260 (66%) third-class airman medical certificates. The spectrum of drugs found in the amateur-built aircraft Accident pilot fatalities was consistent with commonly used drugs in the general population. The percentage of pilots wherein prescription drugs were detected was 26% for amateur-built aircraft, whereas it was 16% for non-amateur built aircraft and 18% for all aircraft. Ethanol/drug use and medical condition were determined to be a cause or factor in 42 (11%) of the 385 ethanol/drug-positive amateur-built aircraft Accidents investigated by the NTSB. However, the contributory role of the mechanical malfunction of home-built aircraft cannot be ruled out in the observed increasing trends in their Accidents, with or without ethanol and/or drugs. The increasing trend of such Accidents is of significant concern.
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drugs and alcohol in civil Aviation Accident pilot fatalities from 2004 2008
Aviation Space and Environmental Medicine, 2012Co-Authors: Dennis V Canfield, Arvind K Chaturvedi, Kurt M Dubowski, James E WhinneryAbstract:INTRODUCTION: The Federal Aviation Administration (FAA) Office of Aerospace Medicine sets medical standards needed to protect the public and pilots from death or injury due to incapacitation of the pilot. As a part of this process, toxicology testing is performed by the FAA on almost every pilot who is fatally injured in an Aviation Accident to determine the medical condition of the pilot, medications used by the pilot at the time of the Accident, and the extent of impairment, if any. METHOD: The data were extracted from the FAA toxicology database for all pilots who died from 2004 to 2008 in Aviation Accidents. RESULTS: The laboratory received and tested specimens from 1353 pilots who died in Aviation Accidents between 2004 and 2008; 507 of these pilots were found to be taking drugs and 92 had ethanol in excess of 0.04 g x dl(-1). DISCUSSION: This study was conducted to determine the extent of drug use in pilots who have died in Aviation Accidents from 2004 to 2008 and to determine the types of drugs most commonly found. A comparison of previously published reports with this study's report was made to determine trends in drug use by pilots who have died in Aviation Accidents over the past 20 yr. Factors were discussed that could influence drug trends. Diphenhydramine, an H1 antihistamine with impairing properties, is the most commonly found drug in pilots who died in an Aviation Accident. Language: en
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drugs and alcohol found in civil Aviation Accident pilot fatalities from 2004 2008
Aviation Space and Environmental Medicine, 2012Co-Authors: Dennis V Canfield, Arvind K Chaturvedi, Kurt M Dubowski, James E WhinneryAbstract:INTRODUCTION: The Federal Aviation Administration (FAA) Office of Aerospace Medicine sets medical standards needed to protect the public and pilots from death or injury due to incapacitation of the pilot. As a part of this process, toxicology testing is performed by the FAA on almost every pilot who is fatally injured in an Aviation Accident to determine the medical condition of the pilot, medications used by the pilot at the time of the Accident, and the extent of impairment, if any. METHOD: The data were extracted from the FAA toxicology database for all pilots who died from 2004 to 2008 in Aviation Accidents. RESULTS: The laboratory received and tested specimens from 1353 pilots who died in Aviation Accidents between 2004 and 2008; 507 of these pilots were found to be taking drugs and 92 had ethanol in excess of 0.04 g x dl(-1). DISCUSSION: This study was conducted to determine the extent of drug use in pilots who have died in Aviation Accidents from 2004 to 2008 and to determine the types of drugs most commonly found. A comparison of previously published reports with this study's report was made to determine trends in drug use by pilots who have died in Aviation Accidents over the past 20 yr. Factors were discussed that could influence drug trends. Diphenhydramine, an H1 antihistamine with impairing properties, is the most commonly found drug in pilots who died in an Aviation Accident. Language: en
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vitreous fluid and or urine glucose concentrations in 1335 civil Aviation Accident pilot fatalities
Journal of Forensic Sciences, 2009Co-Authors: Arvind K Chaturvedi, Dennis V Canfield, Sabra R Botch, Estrella M ForsterAbstract:During Aviation Accident investigations, vitreous fluid and urine samples from pilot fatalities are analyzed for glucose and blood for hemoglobin A(1c) (HbA(1c)) to monitor diabetic pilots and to discover other pilots with undiagnosed/unreported diabetes. The prevalence of elevated glucose concentrations in fatally injured pilots was evaluated by searching the Civil Aerospace Medical Institute's Toxicology Database for the period 1998-2005. Out of 1335 pilots involving 363 vitreous fluid, 365 urine, and 607 vitreous fluid and urine analyses, 43 pilots had elevated glucose in vitreous fluid (>125 mg/dL) and/or in urine (>100 mg/dL). Of the 20 pilots whose blood samples were analyzed, nine had >6% HbA(1c)-four were known diabetics, and five were unknown diabetics. Urinary glucose levels were elevated in all 13 known hyperglycemic pilots. A considerable number of pilots (30 of 43) had elevated glucose and HbA(1c) (5 of 20), suggesting undiagnosed/unreported diabetic conditions. Language: en
Sankaran Mahadevan - One of the best experts on this subject based on the ideXlab platform.
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bayesian network modeling of Accident investigation reports for Aviation safety assessment
Reliability Engineering & System Safety, 2021Co-Authors: Xiaoge Zhang, Sankaran MahadevanAbstract:Abstract Safety assurance is of paramount importance in the air transportation system. In this paper, we analyze the historical passenger airline Accidents that happened from 1982 to 2006 as reported in the National Transportation Safety Board (NTSB) Aviation Accident database. A four-step procedure is formulated to construct a Bayesian network to capture the causal relationships embedded in the sequences of these Accidents. First of all, with respect to each Accident, a graphical representation is developed to facilitate the visualization of the escalation of initiating events into Aviation Accidents in the system. Next, we develop a Bayesian network representation of all the Accidents by aggregating the Accident-wise graphical representations together, where the causal and dependent relationships among a wide variety of contributory factors and outcomes in terms of aircraft damage and personnel injury are captured. In the Bayesian network, the prior probabilities are estimated based on the Accident occurrence times and the aircraft departure data from the Bureau of Transportation Statistics (BTS). To estimate the conditional probabilities in the Bayesian network, we develop a monotonically increasing function, whose parameters are calibrated using the probability information on single events in the available data. Finally, we develop a computer program to automate the generation of the Bayesian network in compliance with the XML format used in the commercial GeNIe modeler. The constructed Bayesian network is then fed into GeNIe modeler for Accident analysis. The mapping of the NTSB data to a Bayesian network facilitates both forward propagation and backward inference in probabilistic analysis, thereby supporting Accident investigations and risk analysis. Several Accident cases are used to demonstrate the developed approach.
