Research paper proposal for diabetes & aviation human factors

I need help, I want to do a study on diabetes effects of pilot performance in the aviation workplace the cockpit. This would use a simulator although I have limited hours access to this...and I have access to continuous glucose monitoring technology for logging glucose data.

The aviation authorities wont allow diabetics to fly due to the risk and effects of incapacitating hypoglycemia. However with careful management I believe this shouldnt be a issue.

I would like to try and pull together a research topic for this to submit to my academic supervisor (who has suggested 1 idea but it is negative towards diabetics and I think it is defeatist)

His proposal:

"Project title: The effect of simulated flying on performance and blood glucose levels in diabetic and non-diabetic pilots

Aim: To characterise the impact of simulated flying and flying emergencies on airman performance and blood glucose levels in diabetic and non-diabetic pilots.

Principal hypotheses: Diabetic pilots with medication-controlled blood glucose levels under conditions of simulated flying (including flying emergencies) will display

* a drop in blood glucose concentration that is significantly larger than in non-diabetic pilots under the same conditions;

* a reduction in performance that is significantly larger than in non-diabetic pilots under the same conditions.

Method:

The method will be approved by the Life Sciences Ethics Committee.

Subjects: 5 diabetic and an age/sex/flying experience matched group of non-diabetic pilots will be trained to fly in the CAA/FAA-validated xxx flying simulator to ensure a comparable experience baseline between subjects.

Blood glucose measurement: Blood glucose concentrations will be measured using the pin prick method (xxx) every xx min, and by using a Dexcom (xxx) continuous tissue glucose meter.

Performance measurement: Pilot performance will be measured...

Statistical analysis: xxx

Protocol: After training, subjects will participate in a 1hr session in the simulator as Pilot-In-Command (PIC). The session will be uniformly scheduled 2hr after a meal. Blood glucose concentration will be measured from 1 hour before the session to establish a baseline, and until 1 hr after the session. Simulation of take-off and emergencies (including resolution), and landing will take place, with the option of repeats of part of the protocol."

My response was:
Hi Areles,

The hypothesis seems rather negative and somewhat incorrect as it is known that blood sugars rise with stress and not fall. I got mixed up and told you this so I am sorry. It would be much better to have a positive slant I.e that with frequent enough blood sugar testing AND blood sugar management, that there are no significant safety issues but this is obviously biased positive so can we not have a middle/compromise hypothesis?

I know we have ethics issues etc but the BIG issue which faces diabetes in the cockpit is hypoglycemia (low glucose levels) Can we try and work this into the study somehow?

Thanks

Karl

His reply to that:
Hi Karl,

The hypothesis you are suggesting is understandable but very propagandist and impossible to substantiate with the proposed set of experiments (although it can be falsified). It is far better to create a clear, relevant and verifiable challenge, hopefully with the result that the challenge can be met by diabetic pilots. This would be a positive outcome that is substantiated by the data. This does not mean we can't tweak what I have written.

There are a few more issues. Regarding the blood testing, to gain a resolution of, let's say, a measurement every 5 min over 2-3 hours, the best way is to use a cannula, rather than individual pricks. We are currently having staff trained to do this and I'm sure we would get one of them to help if they are available. This also involves getting semi-instantaneous readings (within 1-2 min of the sample extraction) and therefore almost real-time monitoring of blood glucose; we have the portable gear. This is important because we need to set a minimum and perhaps maximum blood glucose level in which we conduct the experiment. If we go outside this range the ethics committee would not accept the proposal on safety grounds, particularly if we don't have a nurse or physician present.

On the academic side, it is unlikely that the project will be accepted with only the experiments we thought of so far. It is simply too thin for a year's work. We would have to consider expanding the experiments, for example to include manipulation of diet or day rhythm, and inclusion of further physical and cognitive tests. This has implications for, amongst other things, the demands we put on the subjects.

Have a think...

Areles

I really need some help, I have been messed around by various tutors and being passed from 1 to the 1 I am now with since MAY and I want to start the research this academic year in the UK.

Please help me with ideas and suggestions, my head has become a mess and is making me want to quit but my heart wants to study this as I am truely passionate and interested in diabetes and aviation human factors.

Looking forward to hearing from you

You are stating out with a bias. If you are taking an experimental approach, you are supposed to try to be objective. That is the first problem.

I see that you want to show that diabetics can indeed be pilots, but take an objective point of view. Do you know at least 10 diabetics very well? I have known a few, and two of them have, over the years, had unexpected blood sugar problems ...

I'll give you a big hint right here: your job is to show that it is possible for any diabetic to be able to COMPLETELY control the blood sugar so that there are NEVER and unexpected attacks. I don't think you can do that. But if you can, you win!!

Do you see what I mean? If you do not accomplish that, you can't make this argument. It's the same as if someone has epilepsy. If it can be totally ensured that an individual can prevent seizures without exception, then s/he can fly the aircraft.

I look forward to talking with you more about this if you want, but for now I want to see your response to this idea. In order to achieve your goal, you have to do research involving diabetes treatment rather than aviation.

Hi Kevin,
thanks for your reply.

I do understand you and I am really working to try and come up with a non bias
I do know 10 diabetics whom have very tight control and can maintain good sugars for flying privately, I do also understand that a majority of the diabetes community have poor control through their own fault or just not coping well despite their best efforts.

What I should say is, I suggest that it is all based around an 'ideal candidate' that would meet current guidelines for private flying medicals that are in force for restricted flying privileges.

This basically means no recent episodes of unexplained hypoglycaemia (low sugar levels) which require the intervention of someone else (ie you pass out/unconscious) rather than ANY diabetic taken from the street. Also that they will adhere to a testing regime during flight and take any control action ie ingestion of 10g of carb or an insulin injection.

The reason I suggest an 'ideal candidate' is being those diabetics who wish to fly understand that to either earn or keep the flying privileges their control must be on top form rather than say your average joe of the street who may struggle or be fine.

I also speak of the 'ideal' candidate due to the fact a lot of aviation regulations were based on data from the DCCT -Diabetes Complications and Control Trial in which a mass group of diabetics whom really were 'write-offs' through their own fault of poor control or who were struggling had their data collected which really created a standard model of a average/below average diabetic rather then an ideal diabetic pilot candidate. This DCCT trial led to blanket bans for certain flying privileges...where as individual candidates assessment based against a 'ideal candidate model' would be a better system...

" In order to achieve your goal, you have to do research involving diabetes treatment rather than aviation."

Kevin you have read my mind. Aviation was my burning passion all through my childhood. I worked hard to hopefully one day become an airline pilot. Sadly at 17 I got diagnosed with type 1 diabetes and had that dream crushed as well as some depressing restrictions placed upon my private flying. However getting diagnosed opened up a parallel interest into diabetes and I am now planning to go on and do graduate entry medicine to become a diabetes specialist doctor. This is becoming more of a reality now I have my 2:1 hons BSc in Aerospace Technology & Management. The whole idea of this masters degree is to utilise time that will be wasted until I can apply for medical school here in the UK. I feel a masters which you quite rightly say will involve diabetes treatment and other factors that are medical will give me a edge as well as giving me a small medical foundation which I will build upon during 1st year of medical school.

Anyway, I really don't know if I have just gone around chasing my tail there!! Haha
I hope that gives you some more insight into the mess of ideas/thoughts/confusion in my mind.

Thank you very much for replying, I look forward to reading your response.

Karl

looking forward to hearing back.

Karl

You know more about it that I do, but I think if any sufferers cannot control it despite best efforts then it will be hard to get the policy changed or make an argument that it should be changed.


Yep, I had a suspicion that this was the case....

About tail chasing, that is part of this kind of process. I have done a lot of tail chasing.

You can't prove that there are any ideal candidates who will not have complications.
There is a first time for everything.
However, we cannot predict that any pilot will not suddenly become incapable of doing the job.

For a commercial airline, you have to remember competition. Competition in the industry makes it so that an airline will have a hard time selling tickets if it is perceived as having lower standards for pilots.

The truth is, they all seem to have low standards, in the sense that pilots now report being asked to work 21 hour days, sleep deprived, not being paid a reasonable amount of money...

Can I remind you just how ridiculous the idea of flying in a metal cylinder really is? Well, fly privately, anyway, and practice medicine, but... I don't think working for a major airline is the best thing is the world, and neither is flying for the military. It sounds like you have been dealt a hand that makes you very well suited to some things, though... so...

How about doing qualitative research in a similar area, such as working conditions for pilots at major airlines.

Or working conditions for military pilots....

You can do a multiple case study, using each pilot you interview as a case. Look up grounded theory OR look up the work of Robert Yin on case study methods.

Learn about grounded theory or about case studies, and you will be ready to explore. You can conduct as many of these studies as you want.

The problem with your original idea is that it tries to accomplish to much all at once. Proving a diabetic can fly reliably will be something you work on over several related research projects, perhaps starting with a case study project about the work lives of pilots.

:-)

Hi Kevin, Thanks for your reply.

EF_Kevin:
You know more about it that I do, but I think if any sufferers cannot control it despite best efforts then it will be hard to get the policy changed or make an argument that it should be changed.

karlb123:
I see your views but in Canada commercial flying is allowed (obviously its with 2 pilots which is required for law as its a complex metal tube- haha!) The USA allows more private flying privileges than the UK and the UK has more privileges than countries where its disallowed or only with another pilot... so there is scope for regulations to be changed. The CAA have told me that the continuous glucose monitoring technology I use will be a 'door opener'. They just want more evidence/studies that will allow a change to be made either by filing a difference against ICAO (which is how Canada allowed commercial diabetic pilots to fly).

Have a read of this:

EF_Kevin:
Yep, I had a suspicion that this was the case....
About tail chasing, that is part of this kind of process. I have done a lot of tail chasing.
You can't prove that there are any ideal candidates who will not have complications.
There is a first time for everything.
However, we cannot predict that any pilot will not suddenly become incapable of doing the job.

karlb123:
I know this can be a bad thing, but I do understand I have to keep it non biased which is why I am trying to get help and why I dislike my lecturers idea as it immediately makes it negative towards diabetes.

We are all human and there will be complications sometimes but majority of pilots whom have diabetes have been flying in USA since 1997 with no major incidents and very very few minor ones. Incapacity is a fair point but as you say its ANY pilot...whether its a heart attack or passing out for some reason. However continuous glucose monitoring can allow some pilots to guarantee they will not go into a major low/hypoglycaemic episode.

EF_Kevin:
For a commercial airline, you have to remember competition. Competition in the industry makes it so that an airline will have a hard time selling tickets if it is perceived as having lower standards for pilots.

Karlb123:
Airlines are unable to discriminate against people with disabilities IF they can hold the relevant medical required for the job. In the UK there are employment disability discrimination laws to prevent this or allow a person to challenge the company. As I said, it has been no problem in Canada where there are around 15 type 1 diabetic pilots on the roster.

Kevin_EF:
The truth is, they all seem to have low standards, in the sense that pilots now report being asked to work 21 hour days, sleep deprived, not being paid a reasonable amount of money...

Can I remind you just how ridiculous the idea of flying in a metal cylinder really is? Well, fly privately, anyway, and practice medicine, but... I don't think working for a major airline is the best thing is the world, and neither is flying for the military. It sounds like you have been dealt a hand that makes you very well suited to some things, though... so...

Karlb123:
I agree with you, but this goes further than me wanting to jump back into my old dream. Thats gone, Im already walking down the path of flying privately and working towards becoming a medical student. I just now have a point to prove to doubters I have met as well as those I have come across in my life that are being prevented because of diabetes when in reality they are perfectly capable. Thank you for the comment regarding the hand ive been dealt. I see getting diabetes is a reason to make a change and help others as well as wanting to discover more by entering the medical field.

EF_Kevin:
How about doing qualitative research in a similar area, such as working conditions for pilots at major airlines.
Or working conditions for military pilots....
You can do a multiple case study, using each pilot you interview as a case. Look up grounded theory OR look up the work of Robert Yin on case study methods.

Learn about grounded theory or about case studies, and you will be ready to explore. You can conduct as many of these studies as you want.

Karlb123:
I couldn't, the main driving passion is there- diabetes. I am really passionate about both and I combined, I could achieve something amazing.

EF_Kevin:
The problem with your original idea is that it tries to accomplish to much all at once. Proving a diabetic can fly reliably will be something you work on over several related research projects, perhaps starting with a case study project about the work lives of pilots.

Karlb123:
Id rather spend a year working on part of this study that encompases diabetes and flying and if it left scope for further research when I have completed my medical degree (4 years for graduate entry medicine in the uk + 1 jnr year and + 1 snr year in hospitals)

Thanks Karl

Karl, this is some very interesting stuff. Well, the fact that diabetics are allowed to fly in some nations makes a big difference, and I'm excited about your potential to write a great research paper.

So, you can include some discussion of the fact that no crashes have ever been associated with blood sugar complications, about diabetic pilots who have made great contributions, and so forth.

The truth is, you can take this in a few different directions depending on which type of research method you want to use.

You can use a qualitative method: multiple case study. That is something I mentioned before. I think you might not need to choose only one aspect of the issue if you want to do a structured multiple case study according to the methods of Robert Yin, and you could design your case study protocol based on the various aspects of this issue... taking on the perspectives of various stakeholders, such as pilots, policy makers, airlines, etc.... What i would do is go deep into a reading of case study research design in the books by Robert Yin, and as you read you will come up with great ideas about how you want the focus of your study to be.

Know what I mean? There are so many types of research design that some researchers specialize only in one or two types... for example, case studies are what Yin seems to be all about.

You should read about the various types of research design (you probably already have), ane choose one that is exciting to you. Put a type of design that you like together with this issue that you care about, and you will get something totally unique. Remember, though, that this best thing to do if poswsible is to take the "next logical step" in the "discussion" that takes form as people to research studies about diabetes and aviation human factors. Both of these topics have had LOTS of research studies done on them, so focus on the most recent or most relevant ones.

You have a lot of work to do!! Good luck with it...

:-)

Could state what's the causes of diabetes and then cures or certain treatments for it.

Diabetes A Big Risk - research paper start?

The research paper has to be between 8-10 pages, that integrate sources from a diverse array of resources using MLA style, will have a clear thesis/research question as the backbone of the paper, will avoid fallacious rhetoric, and will construct logical arguments to advance the ideas in the paper.

Do you want the forum to write it for you? Write at least a draft with your ideas and then people will help you.

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