Decompression sickness predictive models for unsafe human exposure.

Decompression sickness (DCS) incidence prediction models have achieved useful predictive success under conditions of routine Navy diving. However, extrapolation into higher-risk exposures, e.g.

Deadly diving? Physiological and behavioural management of decompression stress in diving mammals.

Decompression sickness (DCS; 'the bends') is a disease associated with gas uptake at pressure. The basic pathology and cause are relatively well known to human divers. Breath-hold diving marine mammals were thought to be relatively immune to DCS owing to multiple anatomical, physiological and behavioural adaptations that reduce nitrogen gas (N(2)) loading during dives.

Modeling the Unites States government's economic cost of noise-induced hearing loss for a military population.

Objective: The purpose of this paper is to demonstrate the feasibility and utility of developing economic cost models for noise-induced hearing loss (NIHL). First, we outline an economic model of NIHL for a population of US Navy sailors with an "industrial"-type noise exposure. Next, we describe the effect on NIHL-related cost of varying the two central model inputs--the noise-exposure level and the duration of exposure.

Estimation of equivalent noise exposure level using hearing threshold levels of a population.

Objectives: Noise-induced hearing loss (NIHL) is costly in both human and economic terms. One means of reducing NIHL is to apply engineering controls to hazardous noise sources. To trade off the cost of engineering controls against the total direct monetary costs incurred by NIHL, a means of predicting the amount of NIHL that will be incurred over the life-cycle of a hazardous noise source is necessary.

Prophylactic high dose methylprednisolone fails to treat severe decompression sickness in swine.

Introduction: Controlled decompression from saturation conditions is not always an option, particularly in a disabled submarine scenario. Hypothesis Prophylactic high dose methylprednisolone (MP) would improve outcome in severe cases of decompression sickness (DCS).

Methods: Littermate pairs of male Yorkshire swine (n = 86, mean weight +/- SE = 19.

Using animal data to improve prediction of human decompression risk following air-saturation dives.

To plan for any future rescue of personnel in a disabled and pressurized submarine, the US Navy needs a method for predicting risk of decompression sickness under possible scenarios for crew recovery. Such scenarios include direct ascent from compressed air exposures with risks too high for ethical human experiments. Animal data, however, with their extensive range of exposure pressures and incidence of decompression sickness, could improve prediction of high-risk human exposures.

On the likelihood of decompression sickness during H(2) biochemical decompression in pigs.

A probabilistic model was used to predict decompression sickness (DCS) outcome in pigs during exposures to hyperbaric H(2) to quantify the effects of H(2) biochemical decompression, a process in which metabolism of H(2) by intestinal microbes facilitates decompression. The data set included 109 exposures to 22-26 atm, ca. 88% H(2), 9% He, 2% O(2), 1% N(2), for 0.

Natural history of severe decompression sickness after rapid ascent from air saturation in a porcine model.

We developed a swine model to describe the untreated natural history of severe decompression sickness (DCS) after direct ascent from saturation conditions. In a recompression chamber, neutered male Yorkshire swine were pressurized to a predetermined depth from 50-150 feet of seawater [fsw; 2.52-5.

Escape from a disabled submarine: decompression sickness risk estimation.

Individual crewmember escape from a disabled U.S. Navy nuclear submarine has never been necessary, but remains an important contingency.

Probabilistic models of the role of oxygen in human decompression sickness.

Probabilistic models of human decompression sickness (DCS) have been successful in describing DCS risk observed across a wide variety of N2-O2 dives but have failed to account for the observed DCS incidence in dives with high PO2 during decompression. Our most successful previous model, calibrated with 3,322 N2-O2 dives, predicts only 40% of the observed incidence in dives with 100% O2 breathing during decompression. We added 1,013 O2 decompression dives to the calibration data.

Improved probabilistic decompression model risk predictions using linear-exponential kinetics.

Using a data base of 2,383 air and nitrogen-oxygen dives resulting in 131 cases of decompression sickness (DCS), risk functions were developed for a set of probabilistic decompression models according to survival analysis techniques. Parameters were optimized using the method of maximum likelihood Gas kinetics were either traditional exponential uptake and elimination, or an exponential uptake followed by linear elimination (LE kinetics) when calculated supersaturation was excessive. Risk functions either used the calculated relative gas supersaturation directly, or a delayed risk using a time integral of prior supersaturation.

Hydrogen bonding. 30. Solubility of gases and vapors in biological liquids and tissues.

The general solvation equation log L = c + rR2 + pi H2 + a alpha H2 + b beta H2 + l log L16 has been used to analyze the solubility of solute gases and vapors, as log L values, in water, blood, and a variety of other biological fluids and tissues. The explanatory variables are R2, the solute excess molar refraction; pi H2, the solute dipolarity/polarizability; alpha H2 and beta H2, the solut hydrogen-bond acidity and basicity; and log L16, where L16 is the solute Ostwald solubility coefficient of hexadecane. The obtained coefficients then serve to characterize the biological phase as follows: r + s is the phase dipolarity/polarizability, a is the phase hydrogen-bond basicity, b is the phase hydrogen-bond acidity, ald l is the phase lipophilicity.

Predicting the time of occurrence of decompression sickness.

Probabilistic models and maximum likelihood estimation have been used to predict the occurrence of decompression sickness (DCS). We indicate a means of extending the maximum likelihood parameter estimation procedure to make use of knowledge of the time at which DCS occurs. Two models were compared in fitting a data set of nearly 1,000 exposures, in which greater than 50 cases of DCS have known times of symptom onset.

Maximum likelihood analysis of air and HeO2 dives.

The method of maximum likelihood analysis was applied to data consisting of 1,949 man-dives, of which 1,041 were on air and 908 were on HeO2 mixtures. These dives represented a wide range of bottom time and depth combinations, and had an overall incidence of decompression sickness (DCS) of 4.64%.

Relative decompression risk of dry and wet chamber air dives.

The difference in risk of decompression sickness (DCS) between dry chamber subjects and wet, working divers is unknown and a direct test of the difference would be large and expensive. We used probabilistic models and maximum likelihood estimation to examine 797 dry (and generally resting and comfortable) and 244 wet (and generally working and cold) chamber dives from the Defence and Civil Institute of Environmental Medicine, supplemented with 483 wet (working, cold) dives from the Navy Experimental Diving Unit. Several analyses considered whether dry and wet data were distinguishable using several models, whether models obtained from one set of exposure conditions would correctly predict the occurrence of DCS in the other condition, and whether a single wet-dry risk difference parameter was different from zero.

How countercurrent blood flow and uneven perfusion affect the motion of inert gas.

Monte Carlo simulations of the passage of inert gas through muscle tissue reveal that countercurrent gas exchange is more important than heterogeneity of flow in determination of the shape of inert gas washout curves. Semilog plots of inert gas washout are usually curved rather than straight. Two explanations often offered are that countercurrent flow may distort the shape and that uneven perfusion of the tissue gives rise to nonuniform washout.

Xenon kinetics in muscle are not explained by a model of parallel perfusion-limited compartments.

Experimental tissue gas kinetics do not follow the prediction for a single stirred perfusion-limited compartment. One hypothesis proposes that the kinetics might be explained by considering the tissue as a collection of parallel compartments, each with its own flow, reflecting the tissue microcirculatory flow heterogeneity. In this study, observed tissue gas kinetics were compared with the kinetics predicted by a model of multiple parallel compartments.

Use of the maximum likelihood method in the analysis of chamber air dives.

The method of maximum likelihood was used to evaluate the risk of decompression sickness (DCS) for selected chamber air dives. The parameters of two mathematical models for predicting DCS were optimized until the best agreement (as measured by maximum likelihood) corresponding to the observed DCS incidents from a series of dives was attained. The decompression data used consisted of 800 man-dives with 21 incidents of DCS and 6 occurrences of marginal symptoms.

The modulation of oxygen toxicity by intermittent exposure.

Intermittent delivery of hyperbaric O2 protects animals from pulmonary and central nervous system toxicity: more total O2 time can be tolerated if interrupted by short periods of low O2. Little is known about the mechanisms or optimization of systematically varied intermittency. Survival time was recorded in groups of 16 awake guinea pigs (239 +/- 23(SD) g) exposed to continuous O2 at 2.

Role of oxygen in the production of human decompression sickness.

In the calculation of decompression schedules, it is commonly assumed that only the inert gas needs to be considered; all inspired O2 is ignored. Animal experiments have shown that high O2 can increase risk of serious decompression sickness (DCS). A trial was performed to assess the relative risks of O2 and N2 in human no-decompression dives.

An analysis of decrements in vital capacity as an index of pulmonary oxygen toxicity.

Decrements in vital capacity (% delta VC) were proposed by the Pennsylvania group in the early 1970s as an index of O2-induced lung damage. These workers used the combined effects of PO2 and time of exposure to develop recommendations to limit expected % delta VC. Adopting this general approach, we fitted human pulmonary O2 toxicity data to the hyperbolic equation % delta VC = Bs.

Nitrogen gas exchange in the human knee.

Human decompression sickness is presumed to result from excess inert gas in the body when ambient pressure is reduced. Although the most common symptom is pain in the skeletal joints, no direct study of nitrogen exchange in this region has been undertaken. For this study, nitrogen tagged with radioactive 13N was prepared in a linear accelerator.

How well mixed is inert gas in tissues?

The washout of inert gas from tissues typically follows multiexponential curves rather than monoexponential curves as would be expected from homogeneous, well-mixed compartment. This implies that the ratio for the square root of the variance of the distribution of transit times to the mean (relative dispersion) must be greater than 1. Among the possible explanations offered for multiexponential curves are heterogeneous capillary flow, uneven capillary spacing, and countercurrent exchange in small veins and arteries.

In vivo microbubble detection in decompression sickness using a second harmonic resonant bubble detector.

A resonant bubble detection method based on a second harmonic technique has been used to monitor the femoral vascular system of dogs subjected to rapid decompression. For this study, the detector consisted of two acoustic transducers mounted at right angles to each other that were packaged in a perivascular cuff configuration. This detector responds selectively only to bubbles near resonant size (4.

Statistical aspects of the design and testing of decompression tables.

Before a decompression procedure is recommended for general use it is subjected to a limited number of human trial dives. Based on the trial, one attempts to reject unsafe procedures but accept those with a low incidence of decompression sickness (DCS). Binomial confidence regions are often so broad that even after 40 dives it may be impossible to distinguish between the possibility that the table being tested has a 0.