Apple Inc. recently announced the release of ResearchKit, an open-source software framework that is expected to enhance medical research. Apple claims its product enables everyone to take part in research that will advance medical knowledge and that it is “taking research out of the lab and into the real world.”
Mobile health technology, including wearable sensors and mobile applications, has been available for some time. Companies have been developing mobile medical applications (MMAs) for so long that the U.S. Food and Drug Administration (FDA) has already established their classifications and safety-monitoring rules and the Federal Communications Commission (FCC) has established rules and the frequency band for use with wireless body sensors. While it appears that Apple actually was lagging behind, it is encouraging that it finally joined the trend.
While vacationing in Croatia, I heard a story about a diver who fits the description of people I sometimes call “robo-divers.” The story’s hero is a famous Croatian sponge diver, with whom I share an acquaintance. My friend, who is one of his teammates, described this robo-diver’s practice, which is similar to previously described empirical dive practices of other local sponge divers: Reportedly, he does four descents per day to extreme depths, after each of which he ascends very slowly without decompression stops. After the last dive of the day, he quickly takes his boat to shallow waters (within approximately 10 minutes) and descends for about two hours of decompression, split between stops at nine, six and three meters (30, 20 and 10 feet).
I don’t know about his decompression sickness history, but I do know that he is 64 years old now, and the fact that he has survived this long following those types of dive practices make me think of him more as a robot than as a man of flesh and bone. At very least, it is unlikely that this diver has a PFO.
Between July 15-17, the Office of Naval Research (ONR) and the Naval Sea Systems Command (NAVSEA) hosted an undersea medicine progress review meeting in Durham, North Carolina. The presentations focused primarily on topics of interest for the Navy, but most of the research also benefits recreational and technical divers. One topic I found particularly interesting concerns the combined effect of increased carbon dioxide levels (CO2) in breathing gas and the breathing resistance that breathing apparatuses impose on divers.
If breathing is unimpeded, slightly increased levels of CO2 pose no problem. However, the more CO2 that is inhaled, the less CO2 can be added, and a larger breathing volume per unit of time will be required to wash out the same amount of CO2. This increase of breathing volumes occurs automatically, successfully washing out the metabolic CO2 and maintaining a nearly normal level of CO2 in arterial blood (even during exercise when the internal metabolic production of CO2 is increased).
Acute breathing difficulty during swimming or diving may be associated with Immersion Pulmonary Edema (IPE). At SPUMS 2014, Peter Wilmshurst presented a summary of his rich clinical experience. In his opinion, IPE is an underestimated cause of fatalities. Problem with diagnosis of IPE in scuba diving is its rapid evolution. Divers may be overwhelmed with an internal lung flood before they realize the nature of their breathing difficulty and can safely exit the water.
At the 43rd Annual Scientific Meeting of South Pacific Underwater Medical Society going on May 18 – 25, 2014, a key theme is PFO and diving. The keynote speaker is Dr. Peter Wilmshurst, the cardiologist and diving physician who first described the association between PFO and decompression sickness in 1986. Here, he presented his findings in several hundred cases of DCS. His insight into this problem is most valuable and we are looking forward to the publication of a synthesis of his findings.
Deep vein thrombosis (DVT) is a condition in which a blood clot (thrombus) forms in one or more of the deep veins, usually in the legs. Blood clots can break free and travel with blood causing life-threatening condition like pulmonary embolism (PE) or a stroke due to paradoxical embolism in people with patent foramen ovale (PFO). DVT is not related to diving, but divers often travel and thus are exposed to risk of DVT. In case of acute DVT, divers must not dive.
Crowdsourcing is a means to raise funds through public contributions in a manner which allows a large number of small contributions to make a difference. Originally started in technology areas where considerable upfront capital was required to make the project viable, SciFund and Experiment.com have taken this into the research arena to allow small research projects to gain support. As those in research know, it is notoriously difficult to raise funds for small research projects and crowdsourcing provides that opportunity. As an example of how well it can work, Experiment has raised $600,000 over the last 4 years.