The probability and severity of decompression sickness.

Decompression sickness (DCS), which is caused by inert gas bubbles in tissues, is an injury of concern for scuba divers, compressed air workers, astronauts, and aviators. Case reports for 3322 air and N2-O2 dives, resulting in 190 DCS events, were retrospectively analyzed and the outcomes were scored as (1) serious neurological, (2) cardiopulmonary, (3) mild neurological, (4) pain, (5) lymphatic or skin, and (6) constitutional or nonspecific manifestations. Following standard U.S. Navy medical definitions, the data were grouped into mild-Type I (manifestations 4-6)-and serious-Type II (manifestations 1-3). Additionally, we considered an alternative grouping of mild-Type A (manifestations 3-6)-and serious-Type B (manifestations 1 and 2). The current U.S. Navy guidance allows for a 2% probability of mild DCS and a 0.1% probability of serious DCS. We developed a hierarchical trinomial (3-state) probabilistic DCS model that simultaneously predicts the probability of mild and serious DCS given a dive exposure. Both the Type I/II and Type A/B discriminations of mild and serious DCS resulted in a highly significant (p << 0.01) improvement in trinomial model fit over the binomial (2-state) model. With the Type I/II definition, we found that the predicted probability of 'mild' DCS resulted in a longer allowable bottom time for the same 2% limit. However, for the 0.1% serious DCS limit, we found a vastly decreased allowable bottom dive time for all dive depths. If the Type A/B scoring was assigned to outcome severity, the no decompression limits (NDL) for air dives were still controlled by the acceptable serious DCS risk limit rather than the acceptable mild DCS risk limit. However, in this case, longer NDL limits were allowed than with the Type I/II scoring. The trinomial model mild and serious probabilities agree reasonably well with the current air NDL only with the Type A/B scoring and when 0.2% risk of serious DCS is allowed.

Improved aortic enhancement in CT angiography using slope-based triggering with table speed optimization: a pilot study.

To assess whether a scan triggering technique based on the slope of the time-attenuation curve combined with table speed optimization may improve arterial enhancement in aortic CT angiography compared to conventional threshold-based triggering techniques. Measurements of arterial enhancement were performed in a physiologic flow phantom over a range of simulated cardiac outputs (2.2-8.1 L/min) using contrast media boluses of 80 and 150 mL injected at 4 mL/s. These measurements were used to construct computer models of aortic attenuation in CT angiography, using cardiac output, aortic diameter, and CT table speed as input parameters. In-plane enhancement was calculated for normal and aneurysmal aortic diameters. Calculated arterial enhancement was poor (<150 HU) along most of the scan length using the threshold-based triggering technique for low cardiac outputs and the aneurysmal aorta model. Implementation of the slope-based triggering technique with table speed optimization improved enhancement in all scenarios and yielded good- (>200 HU; 13/16 scenarios) to excellent-quality (>300 HU; 3/16 scenarios) enhancement in all cases. Slope-based triggering with table speed optimization may improve the technical quality of aortic CT angiography over conventional threshold-based techniques, and may reduce technical failures related to low cardiac output and slow flow through an aneurysmal aorta.

Contrast-enhanced magnetic resonance angiography: first-pass arterial enhancement as a function of gadolinium-chelate concentration, and the saline chaser volume and injection rate.

OBJECTIVE: To evaluate the effect of the contrast medium (CM) concentration and the saline chaser volume and injection rate on first-pass aortic enhancement characteristics in contrast-enhanced magnetic resonance angiography using a physiologic flow phantom. MATERIALS AND METHODS: Imaging was performed on a 3.0-T magnetic resonance system (MAGNETOM Trio, Siemens Healthcare Solutions, Inc, Erlangen, Germany) using a 2-dimensional fast low angle shot T1-weighted sequence (repetition time, 500 milliseconds; echo time, 1.23 milliseconds; flip angle, 8 degrees; 1 frame/s × 60 seconds). The following CM concentrations injected at 2 mL/s were used with 3 different contrast agents (gadolinium [Gd]-BOPTA, Gd-HP-DO3A, Gd-DTPA): 20 mL of undiluted CM (100%) and 80%, 40%, 20%, 10%, 5%, and 2.5% of the full amount, all diluted in saline to a volume of 20 mL to ensure equal bolus volume. The CM was followed by saline chasers of 20 to 60 mL injected at 2 mL/s and 6 mL/s. Aortic signal intensity (SI) was measured, and normalized SI versus time (SI/Tn) curves were generated. The maximal SI (SI(max)), bolus length, and areas under the SI/Tn curve were calculated. RESULTS: Decreasing the CM concentration from 100% to 40% resulted in a decrease of SI(max) to 86.1% (mean). Further decreasing the CM concentration to 2.5% decreased SI(max) to 5.1% (mean). Altering the saline chaser volume had no significant effect on SI(max). Increasing the saline chaser injection rate had little effect (mean increase, 2.2%) on SI(max) when using ≥40% of CM. There was a larger effect (mean increase, 19.6%) when ≤20% of CM were used. Bolus time length was significantly shorter (P < 0.001), and area under the SI/T(n) curve was significantly smaller (P < 0.01) for the CM protocols followed by a saline chaser injected at 6 mL/s compared with a saline chaser injected at 2 mL/s. CONCLUSION: With 40% of CM and a fast saline chaser, SImax close to that with undiluted CM can be achieved. An increased saline chaser injection rate has a more pronounced effect on aortic enhancement characteristics at lower CM concentrations than at higher CM concentrations.

The tubercles on humpback whales' flippers: application of bio-inspired technology.

The humpback whale (Megaptera novaeangliae) is exceptional among the large baleen whales in its ability to undertake aquabatic maneuvers to catch prey. Humpback whales utilize extremely mobile, wing-like flippers for banking and turning. Large rounded tubercles along the leading edge of the flipper are morphological structures that are unique in nature. The tubercles on the leading edge act as passive-flow control devices that improve performance and maneuverability of the flipper. Experimental analysis of finite wing models has demonstrated that the presence of tubercles produces a delay in the angle of attack until stall, thereby increasing maximum lift and decreasing drag. Possible fluid-dynamic mechanisms for improved performance include delay of stall through generation of a vortex and modification of the boundary layer, and increase in effective span by reduction of both spanwise flow and strength of the tip vortex. The tubercles provide a bio-inspired design that has commercial viability for wing-like structures. Control of passive flow has the advantages of eliminating complex, costly, high-maintenance, and heavy control mechanisms, while improving performance for lifting bodies in air and water. The tubercles on the leading edge can be applied to the design of watercraft, aircraft, ventilation fans, and windmills.

A simplified mass-transfer model for visual pigments in amphibian retinal-cone outer segments.

When radiolabeled precursors and autoradiography are used to investigate turnover of protein components in photoreceptive cone outer segments (COSs), the labeled components--primarily visual pigment molecules (opsins)--are diffusely distributed along the COS. To further assess this COS labeling pattern, we derive a simplified mass-transfer model for quantifying the contributions of advective and diffusive mechanisms to the distribution of opsins within COSs of the frog retina. Two opsin-containing regions of the COS are evaluated: the core axial array of disks and the plasmalemma. Numerical solutions of the mass-transfer model indicate three distinct stages of system evolution. In the first stage, plasmalemma diffusion is dominant. In the second stage, the plasmalemma density reaches a metastable state and transfer between the plasmalemma and disk region occurs, which is followed by an increase in density that is qualitatively similar for both regions. The final stage consists of both regions slowly evolving to the steady-state solution. Our results indicate that autoradiographic and cognate approaches for tracking labeled opsins in the COS cannot be effective methodologies for assessing new disk formation at the base of the COS.

Contrast material administration protocols for 64-MDCT angiography: altering volume and rate and use of a saline chaser to better match the imaging window--physiologic phantom study.

OBJECTIVE: The purpose of our study was to evaluate the effect of varying volumes and rates of contrast material, use of a saline chaser, and cardiac output on aortic enhancement characteristics in MDCT angiography (MDCTA) using a physiologic phantom. MATERIALS AND METHODS: Volumes of 75, 100, and 125 mL of iopamidol, 370 mg I/mL, were administered at rates of 4, 6, and 8 mL/s. The effect of a saline chaser (50 mL of normal saline, 8 mL/s) was evaluated for each volume and rate combination. Normal, reduced (33% and 50%), and increased (25%) cardiac outputs were simulated. Peak aortic enhancement and duration of peak aortic enhancement were recorded. Analysis of variance models were run with these effects, and the estimated mean levels for the sets of factor combinations were determined. RESULTS: Lowering the volume of contrast material resulted in reduced peak enhancement (example, -56.2 HU [p < 0.0001] with 75 vs 125 mL) and reduced duration of 75% peak enhancement (example, -9.0 seconds [p < 0.0001] with 75 vs 125 mL). Increasing the rate resulted in increased peak enhancement (example, 104.5 HU [p < 0.0001] with a rate of 8 vs 4 mL/s) and decreased duration of 75% peak enhancement (example, -13.0 seconds [p < 0.001]). Use of a saline chaser resulted in increased peak enhancement, and this increase was inversely proportional to contrast material volume. Peak enhancement increased when reduced cardiac output was simulated. Peak enhancement decreased when increased cardiac output was simulated. CONCLUSION: Reducing contrast material volume from 125 to 75 mL, increasing the rate to 6 or 8 mL/s, and use of a saline chaser result in an aortic enhancement profile that better matches the approximately 5-second imaging window possible with 64-MDCTA of the abdomen and pelvis. Even smaller volumes of contrast material may be adequate in patients with reduced cardiac output.

A computationally advantageous system for fitting probabilistic decompression models to empirical data.

To investigate the nature and mechanisms of decompression sickness (DCS), we developed a system for evaluating the success of decompression models in predicting DCS probability from empirical data. Model parameters were estimated using maximum likelihood techniques. Exact integrals of risk functions and tissue kinetics transition times were derived. Agreement with previously published results was excellent including: (a) maximum likelihood values within one log-likelihood unit of previous results and improvements by re-optimization; (b) mean predicted DCS incidents within 1.4% of observed DCS; and (c) time of DCS occurrence prediction. Alternative optimization and homogeneous parallel processing techniques yielded faster model optimization times.

Modifying peripheral IV catheters with side holes and side slits results in favorable changes in fluid dynamic properties during the injection of iodinated contrast material.

OBJECTIVE: The purpose of this study was to compare a standard peripheral end-hole angiocatheter with those modified with side holes or side slits using experimental optical techniques to qualitatively compare the contrast material exit jets and using numeric techniques to provide flow visualization and quantitative comparisons. MATERIALS AND METHODS: A Schlieren imaging system was used to visualize the angiocatheter exit jet fluid dynamics at two different flow rates. Catheters were modified by drilling through-and-through side holes or by cutting slits into the catheters. A commercial computational fluid dynamics package was used to calculate numeric results for various vessel diameters and catheter orientations. RESULTS: Experimental images showed that modifying standard peripheral IV angiocatheters with side holes or side slits qualitatively changed the overall flow field and caused the exiting jet to become less well defined. Numeric calculations showed that the addition of side holes or slits resulted in a 9-30% reduction of the velocity of contrast material exiting the end hole of the angiocatheter. With the catheter tip directed obliquely to the wall, the maximum wall shear stress was always highest for the unmodified catheter and was always lowest for the four-side-slit catheter. CONCLUSION: Modified angiocatheters may have the potential to reduce extravasation events in patients by reducing vessel wall shear stress.

Marginal DCS events: their relation to decompression and use in DCS models.

We consider the nature and utility of marginal decompression sickness (DCS) events in fitting probabilistic decompression models to experimental dive trial data. Previous works have assigned various fractional weights to marginal DCS events, so that they contributed to probabilistic model parameter optimization, but less so than did full DCS events. Inclusion of fractional weight for marginal DCS events resulted in more conservative model predictions. We explore whether marginal DCS events are correlated with exposure to decompression or are randomly occurring events. Three null models are developed and compared with a known decompression model that is tuned on dive trial data containing only marginal DCS and non-DCS events. We further investigate the technique by which marginal DCS events were previously included in parameter optimization, explore the effects of fractional weighting of marginal DCS events on model optimization, and explore the rigor of combining data containing full and marginal DCS events for probabilistic DCS model optimization. We find that although marginal DCS events are related to exposure to decompression, empirical dive data containing marginal and full DCS events cannot be combined under a single DCS model. Furthermore, we find analytically that the optimal weight for a marginal DCS event is 0. Thus marginal DCS should be counted as no-DCS events when probabilistic DCS models are optimized with binomial likelihood functions. Specifically, our study finds that inclusion of marginal DCS events in model optimization to make the dive profiles more conservative is counterproductive and worsens the model's fit to the full DCS data.

Lift and drag performance of odontocete cetacean flippers.

Cetaceans (whales, dolphins and porpoises) have evolved flippers that aid in effective locomotion through their aquatic environments. Differing evolutionary pressures upon cetaceans, including hunting and feeding requirements, and other factors such as animal mass and size have resulted in flippers that are unique among each species. Cetacean flippers may be viewed as being analogous to modern engineered hydrofoils, which have hydrodynamic properties such as lift coefficient, drag coefficient and associated efficiency. Field observations and the collection of biological samples have resulted in flipper geometry being known for most cetacean species. However, the hydrodynamic properties of cetacean flippers have not been rigorously examined and thus their performance properties are unknown. By conducting water tunnel testing using scale models of cetacean flippers derived via computed tomography (CT) scans, as well as computational fluid dynamic (CFD) simulations, we present a baseline work to describe the hydrodynamic properties of several cetacean flippers. We found that flippers of similar planform shape had similar hydrodynamic performance properties. Furthermore, one group of flippers of planform shape similar to modern swept wings was found to have lift coefficients that increased with angle of attack nonlinearly, which was caused by the onset of vortex-dominated lift. Drag coefficient versus angle of attack curves were found to be less dependent on planform shape. Our work represents a step towards the understanding of the association between performance, ecology, morphology and fluid mechanics based on the three-dimensional geometry of cetacean flippers.

Resolution and severity in decompression illness.

omegaWe review the terminology of decompression illness (DCI), investigations of residual symptoms of decompression sickness (DCS), and application of survival analysis for investigating DCI severity and resolution. The Type 1 and Type 2 DCS classifications were introduced in 1960 for compressed air workers and adapted for diving and altitude exposure with modifications based on clinical judgment concerning severity and therapy. In practice, these proved ambiguous, leading to recommendations that manifestations, not cases, be classified. A subsequent approach assigned individual scores to manifestations and correlated total case scores with the presence of residual symptoms after therapy. The next step used logistic regression to find the statistical association of manifestations to residual symptoms at a single point in time. Survival analysis, a common statistical method in clinical trials and longitudinal epidemiological studies, is a logical extension of logistic regression. The method applies to a continuum of resolution times, allows for time varying information, can manage cases lost to follow-up (censored), and has potential for investigating questions such as optimal therapy and DCI severity. There are operational implications as well. Appropriate definitions of mild and serious manifestations are essential for computing probabilistic decompression procedures where severity determines the DCS probability that is acceptable. Application of survival analysis to DCI data would require more specific case information than is commonly recorded.