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Article: Testing of full face snorkel masks to examine recreational snorkeler deaths.

Farrell, Jane / Natoli, Michael J / Brown, Gregory J / Yook, Adam / Lance, Rachel M

Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc

2022 Volume 49, Issue 1, Page(s) 29–42

Abstract: A recent rise in snorkeling-related deaths in Hawaii has inspired several bans on full face snorkel masks (FFSMs). However, while there are theories to explain the deaths, little physiological data exists about the way the FFSMs provide gas to an ... ...

Abstract	A recent rise in snorkeling-related deaths in Hawaii has inspired several bans on full face snorkel masks (FFSMs). However, while there are theories to explain the deaths, little physiological data exists about the way the FFSMs provide gas to an exercising subject. To evaluate the safety of the FFSM concept, this study was designed to test how use of a full face snorkel mask (FFSM) may be physiologically different than use of a conventional snorkel, and to assess if any of those differences could lead to increased risk for the snorkeler. Ten (10) volunteer human subjects were tested using a variety of commercially available FFSMs, with real-time monitoring of blood oxygen saturation (SpO2), inspired airway pressure, and inspired and expired levels of carbon dioxide and oxygen. Two of the three FFSM design types were shown not to function as advertised, but none of the masks provided physiologically problematic gas supplies to the snorkelers. While this testing yielded no conclusive "smoking gun" to explain the snorkeler deaths, some of the mask models showed patterns of increasing breathing resistance with water intrusion because of a shared design characteristic, and this increased resistance could potentially create elevated levels of respiratory distress to snorkelers during real-world use.
MeSH term(s)	Carbon Dioxide ; Diving/adverse effects ; Exercise/physiology ; Humans ; Pulmonary Gas Exchange ; Respiration
Chemical Substances	Carbon Dioxide (142M471B3J)
Language	English
Publishing date	2022-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	1154414-4
ISSN	1066-2936
ISSN	1066-2936
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Article ; Online: Development of a graphical user interface for automatic separation of human voice from Doppler ultrasound audio in diving experiments.

Azarang, Arian / Blogg, S Lesley / Currens, Joshua / Lance, Rachel M / Moon, Richard E / Lindholm, Peter / Papadopoulou, Virginie

PloS one

2023 Volume 18, Issue 8, Page(s) e0283953

Abstract: Doppler ultrasound (DU) is used in decompression research to detect venous gas emboli in the precordium or subclavian vein, as a marker of decompression stress. This is of relevance to scuba divers, compressed air workers and astronauts to prevent ... ...

Abstract	Doppler ultrasound (DU) is used in decompression research to detect venous gas emboli in the precordium or subclavian vein, as a marker of decompression stress. This is of relevance to scuba divers, compressed air workers and astronauts to prevent decompression sickness (DCS) that can be caused by these bubbles upon or after a sudden reduction in ambient pressure. Doppler ultrasound data is graded by expert raters on the Kisman-Masurel or Spencer scales that are associated to DCS risk. Meta-analyses, as well as efforts to computer-automate DU grading, both necessitate access to large databases of well-curated and graded data. Leveraging previously collected data is especially important due to the difficulty of repeating large-scale extreme military pressure exposures that were conducted in the 70-90s in austere environments. Historically, DU data (Non-speech) were often captured on cassettes in one-channel audio with superimposed human speech describing the experiment (Speech). Digitizing and separating these audio files is currently a lengthy, manual task. In this paper, we develop a graphical user interface (GUI) to perform automatic speech recognition and aid in Non-speech and Speech separation. This constitutes the first study incorporating speech processing technology in the field of diving research. If successful, it has the potential to significantly accelerate the reuse of previously-acquired datasets. The recognition task incorporates the Google speech recognizer to detect the presence of human voice activity together with corresponding timestamps. The detected human speech is then separated from the audio Doppler ultrasound within the developed GUI. Several experiments were conducted on recently digitized audio Doppler recordings to corroborate the effectiveness of the developed GUI in recognition and separations tasks, and these are compared to manual labels for Speech timestamps. The following metrics are used to evaluate performance: the average absolute differences between the reference and detected Speech starting points, as well as the percentage of detected Speech over the total duration of the reference Speech. Results have shown the efficacy of the developed GUI in Speech/Non-speech component separation.
MeSH term(s)	Humans ; Diving ; Decompression Sickness/diagnostic imaging ; Embolism, Air/complications ; Ultrasonography, Doppler ; Subclavian Vein/diagnostic imaging
Language	English
Publishing date	2023-08-10
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0283953
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Article ; Online: Identification of the functional PD-L1 interface region responsible for PD-1 binding and initiation of PD-1 signaling.

Carter, Rachel / Alanazi, Fatimah / Sharp, Amanda / Roman, Jessica / Luchini, Alessandra / Liotta, Lance / Paige, Mikell / Brown, Anne M / Haymond, Amanda

The Journal of biological chemistry

2023 Volume 299, Issue 12, Page(s) 105353

Abstract: The PD-1/PD-L1 checkpoint pathway is important for regulating immune responses and can be targeted by immunomodulatory drugs to treat a variety of immune disorders. However, the precise protein-protein interactions required for the initiation of PD-1/PD- ... ...

Abstract	The PD-1/PD-L1 checkpoint pathway is important for regulating immune responses and can be targeted by immunomodulatory drugs to treat a variety of immune disorders. However, the precise protein-protein interactions required for the initiation of PD-1/PD-L1 signaling are currently unknown. Previously, we designed a series of first-generation PD-1 targeting peptides based on the native interface region of programmed death ligand 1 (PD-L1) that effectively reduced PD-1/PD-L1 binding. In this work, we further characterized the previously identified lead peptide, MN1.1, to identify key PD-1 binding residues and design an optimized peptide, MN1.4. We show MN1.4 is significantly more stable than MN1.1 in serum and retains the ability to block PD-1/PD-L1 complex formation. We further characterized the immunomodulatory effects of MN1.4 treatment by measuring markers of T cell activation in a co-culture model with ovarian cancer cells and peripheral blood mononuclear cells. We found MN1.4 treatment reduced cytokine secretion and suppressed T cell responses in a similar manner as recombinant PD-L1. Therefore, the PD-L1 interface region used to design MN1.4 appeared sufficient to initiate PD-1 signaling and likely represents the minimum necessary region of PD-L1 required for PD-1 recognition. We propose a peptide agonist for PD-1, such as MN1.4, could have several applications for treating autoimmune disorders caused by PD-1 deficiencies such as type 1 diabetes, inflammatory arthritis, or autoimmune side effects arising from monoclonal antibody-based cancer immunotherapies.
MeSH term(s)	Humans ; B7-H1 Antigen/chemistry ; B7-H1 Antigen/genetics ; B7-H1 Antigen/metabolism ; Immunotherapy ; Leukocytes, Mononuclear/metabolism ; Neoplasms/drug therapy ; Peptides/pharmacology ; Programmed Cell Death 1 Receptor/agonists ; Programmed Cell Death 1 Receptor/chemistry ; Programmed Cell Death 1 Receptor/metabolism ; Protein Binding ; Signal Transduction ; Mutation ; Models, Molecular ; Protein Structure, Quaternary ; Cell Line, Tumor ; Immunity/drug effects
Chemical Substances	B7-H1 Antigen ; Peptides ; Programmed Cell Death 1 Receptor
Language	English
Publishing date	2023-10-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2997-x
ISSN	1083-351X ; 0021-9258
ISSN (online)	1083-351X
ISSN	0021-9258
DOI	10.1016/j.jbc.2023.105353
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Article ; Online: The Dewey Monitor: Pulse Oximetry can Warn of Hypoxia in an Immersed Rebreather Diver in Multiple Scenarios.

Lance, Rachel M / Natoli, Michael J / Di Pumpo, Fabio / Beck, Timothy P / Gatrell, Alan / Brown, Gregory J / Schocken, Derek / Moon, Richard E

Annals of biomedical engineering

2022 Volume 50, Issue 2, Page(s) 222–232

Abstract: Divers who wish to prolong their time underwater while carrying less equipment often use devices called rebreathers, which recycle the gas expired after each breath instead of discarding it as bubbles. However, rebreathers' need to replace oxygen used by ...

Abstract	Divers who wish to prolong their time underwater while carrying less equipment often use devices called rebreathers, which recycle the gas expired after each breath instead of discarding it as bubbles. However, rebreathers' need to replace oxygen used by breathing creates a failure mechanism that can and frequently does lead to hypoxia, loss of consciousness, and death. The purpose of this study was to determine whether a pulse oximeter could provide a useful amount of warning time to a diver with a rebreather after failure of the oxygen addition mechanism. Twenty-eight volunteer human subjects breathed on a mixed-gas rebreather in which the oxygen addition system had been disabled. The subjects were immersed in water in four separate environmental scenarios, including cold and warm water, and monitored using pulse oximeters placed at multiple locations. Pulse oximeters placed on the forehead and clipped on the nasal ala provided a mean of 32 s (±10 s SD) of warning time to divers with falling oxygen levels, prior to risk of loss of consciousness. These devices, if configured for underwater use, could provide a practical and inexpensive alarm system to warn of impending loss of consciousness in a manner that is redundant to the rebreather.
MeSH term(s)	Adult ; Diving/adverse effects ; Equipment Failure ; Humans ; Hyperbaric Oxygenation/adverse effects ; Hypoxia/etiology ; Hypoxia/prevention & control ; Male ; Monitoring, Physiologic/instrumentation ; Oximetry/instrumentation ; Respiration
Language	English
Publishing date	2022-01-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	185984-5
ISSN	1573-9686 ; 0191-5649 ; 0090-6964
ISSN (online)	1573-9686
ISSN	0191-5649 ; 0090-6964
DOI	10.1007/s10439-022-02919-y
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Zs.A 1018: Show issues

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Article: Xanthogranulomatous cholangitis mimicking cholangiocarcinoma: Case report and review of literature.

Zhang, Jenny Q / Truong, Lance / Pan, Jason / Yakirevich, Evgeny / Hyder, Sarah M / Beard, Rachel E

International journal of surgery case reports

2022 Volume 93, Page(s) 106921

Abstract: Introduction: Xanthogranulomatous cholangitis is an extremely rare diagnosis and is believed to be an extension of xanthogranulomatous cholecystitis, a benign inflammatory process characterized by lipid-laden foamy macrophages (called "xanthoma cells") ... ...

Abstract	Introduction: Xanthogranulomatous cholangitis is an extremely rare diagnosis and is believed to be an extension of xanthogranulomatous cholecystitis, a benign inflammatory process characterized by lipid-laden foamy macrophages (called "xanthoma cells") occurring in a background of chronic inflammation consisting of lymphocytes, plasma cells, and eosinophils. Here, we report a case of xanthogranulomatous cholangitis mimicking cholangiocarcinoma. Case presentation: A 72 year old male with history of recurrent cholangitis had preoperative workup highly suggestive of intrahepatic cholangiocarcinoma. He underwent right hepatectomy and portal lymphadenectomy, with pathology showing xanthogranulomatous cholangitis, with no evidence of malignancy. Interestingly, the patient did not have xanthogranulomatous cholecystitis. Discussion: We reviewed the current literature on xanthogranulomatous cholangitis, and identified only 14 previously reported cases. In our case series, there were six female and eight male patients. Among the 14 patients, 11 presented to the hospital with jaundice. Twelve patients had preoperative workup concerning for malignancy. The diagnosis of xanthogranulomatous cholangitis was confirmed through pathology in 13 patients, and through endoscopic ultrasound biopsy in one patient. In our review, seven patients had associated xanthogranulomatous cholecystitis, three patients had an isolated case of xanthogranulomatous cholangitis, and four patients had unknown status. Our patient is the fourth case of isolated xanthogranulomatous cholangitis without xanthogranulomatous cholecystitis. Conclusion: Xanthogranulomatous cholangitis is a very rare phenomenon that can lead to benign strictures of the bile ducts, especially in the setting of recurrent cholangitis. It can mimic malignancies, such as cholangiocarcinoma, and should be considered in the differential diagnosis.
Language	English
Publishing date	2022-03-09
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2022.106921
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Article ; Online: An open-source framework for synthetic post-dive Doppler ultrasound audio generation.

Le, David Q / Hoang, Andrew H / Azarang, Arian / Lance, Rachel M / Natoli, Michael / Gatrell, Alan / Blogg, S Lesley / Dayton, Paul A / Tillmans, Frauke / Lindholm, Peter / Moon, Richard E / Papadopoulou, Virginie

PloS one

2023 Volume 18, Issue 4, Page(s) e0284922

Abstract: Doppler ultrasound (DU) measurements are used to detect and evaluate venous gas emboli (VGE) formed after decompression. Automated methodologies for assessing VGE presence using signal processing have been developed on varying real-world datasets of ... ...

Abstract	Doppler ultrasound (DU) measurements are used to detect and evaluate venous gas emboli (VGE) formed after decompression. Automated methodologies for assessing VGE presence using signal processing have been developed on varying real-world datasets of limited size and without ground truth values preventing objective evaluation. We develop and report a method to generate synthetic post-dive data using DU signals collected in both precordium and subclavian vein with varying degrees of bubbling matching field-standard grading metrics. This method is adaptable, modifiable, and reproducible, allowing for researchers to tune the produced dataset for their desired purpose. We provide the baseline Doppler recordings and code required to generate synthetic data for researchers to reproduce our work and improve upon it. We also provide a set of pre-made synthetic post-dive DU data spanning six scenarios representing the Spencer and Kisman-Masurel (KM) grading scales as well as precordial and subclavian DU recordings. By providing a method for synthetic post-dive DU data generation, we aim to improve and accelerate the development of signal processing techniques for VGE analysis in Doppler ultrasound.
MeSH term(s)	Humans ; Decompression Sickness ; Diving ; Embolism, Air/prevention & control ; Ultrasonography, Doppler ; Subclavian Vein
Language	English
Publishing date	2023-04-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0284922
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Article ; Online: Deep Learning-Based Venous Gas Emboli Grade Classification in Doppler Ultrasound Audio Recordings.

Azarang, Arian / Le, David Q / Hoang, Andrew H / Blogg, S Lesley / Dayton, Paul A / Lance, Rachel M / Natoli, Michael / Gatrell, Alan / Tillmans, Frauke / Moon, Richard E / Lindholm, Peter / Papadopoulou, Virginie

IEEE transactions on bio-medical engineering

2023 Volume 70, Issue 5, Page(s) 1436–1446

Abstract: Objective: Doppler ultrasound (DU) is used to detect venous gas emboli (VGE) post dive as a marker of decompression stress for diving physiology research as well as new decompression procedure validation to minimize decompression sickness risk. In this ... ...

Abstract	Objective: Doppler ultrasound (DU) is used to detect venous gas emboli (VGE) post dive as a marker of decompression stress for diving physiology research as well as new decompression procedure validation to minimize decompression sickness risk. In this article, we propose the first deep learning model for VGE grading in DU audio recordings. Methods: A database of real-world data was assembled and labeled for the purpose of developing the algorithm, totaling 274 recordings comprising both subclavian and precordial measurements. Synthetic data was also generated by acquiring baseline DU signals from human volunteers and superimposing laboratory-acquired DU signals of bubbles flowing in a tissue mimicking material. A novel squeeze-and-excitation deep learning model was designed to effectively classify recordings on the 5-class Spencer scoring system used by trained human raters. Results: On the real-data test set, we show that synthetic data pretraining achieves average ordinal accuracy of 84.9% for precordial and 90.4% for subclavian DU which is a 24.6% and 26.2% increase over training with real-data and time-series augmentation only. The weighted kappa coefficients of agreement between the model and human ground truth were 0.74 and 0.69 for precordial and subclavian respectively, indicating substantial agreement similar to human inter-rater agreement for this type of data. Conclusion: The present work demonstrates the first application of deep-learning for DU VGE grading using a combination of synthetic and real-world data. Significance: The proposed method can contribute to accelerating DU analysis for decompression research.
MeSH term(s)	Humans ; Decompression Sickness ; Deep Learning ; Sound Recordings ; Embolism, Air/diagnostic imaging ; Ultrasonography, Doppler
Language	English
Publishing date	2023-04-20
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't
ZDB-ID	160429-6
ISSN	1558-2531 ; 0018-9294
ISSN (online)	1558-2531
ISSN	0018-9294
DOI	10.1109/TBME.2022.3217711
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Zs.A 425: Show issues

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Article: Underwater blast injury: a review of standards.

Lance, Rachel M / Bass, Cameron R

Diving and hyperbaric medicine

2015 Volume 45, Issue 3, Page(s) 190–199

Abstract: The first cases of underwater blast injury appeared in the scientific literature in 1917, and thousands of service members and civilians were injured or killed by underwater blast during WWII. The prevalence of underwater blast injuries and occupational ... ...

Abstract	The first cases of underwater blast injury appeared in the scientific literature in 1917, and thousands of service members and civilians were injured or killed by underwater blast during WWII. The prevalence of underwater blast injuries and occupational blasting needs led to the development of many safety standards to prevent injury or death. Most of these standards were not supported by experimental data or testing. In this review, we describe existing standards, discuss their origins, and we comprehensively compare their prescriptions across standards. Surprisingly, we found that most safety standards had little or no scientific basis, and prescriptions across standards often varied by at least an order of magnitude. Many published standards traced back to a US Navy 500 psi guideline, which was intended to provide a peak pressure at which injuries were likely to occur. This standard itself seems to have been based upon a completely unfounded assertion that has propagated throughout the literature in subsequent years. Based on the limitations of the standards discussed, we outline future directions for underwater blast injury research, such as the compilation of epidemiological data to examine actual injury risk by human beings subjected to underwater blasts.
MeSH term(s)	Blast Injuries/etiology ; Blast Injuries/prevention & control ; Diving/injuries ; Guidelines as Topic/standards ; High-Energy Shock Waves/adverse effects ; Humans ; Hydrodynamics ; Pressure/adverse effects ; Reference Values ; Safety/standards ; Water
Chemical Substances	Water (059QF0KO0R)
Language	English
Publishing date	2015-09
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	2237920-4
ISSN	1833-3516
ISSN	1833-3516
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Zs.A 4375: Show issues

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Article ; Online: Did a "lucky shot" sink the submarine H.L. Hunley?

Lance, Rachel M / Warder, Henry / Bass, Cameron R Dale

Forensic science international

2017 Volume 270, Page(s) 103–110

Abstract: The H.L. Hunley was the first submarine to be successful in combat, sinking the Union vessel Housatonic outside Charleston Harbor in 1864 during the Civil War. However, despite marking a milestone in military history, little is known about this vessel or ...

Abstract	The H.L. Hunley was the first submarine to be successful in combat, sinking the Union vessel Housatonic outside Charleston Harbor in 1864 during the Civil War. However, despite marking a milestone in military history, little is known about this vessel or why it sank. One popular theory is the "lucky shot" theory: the hypothesis that small arms fire from the crew of the Housatonic may have sufficiently damaged the submarine to sink it. However, ballistic experiments with cast iron samples, analysis of historical experiments firing Civil War-era projectiles at cast iron samples, and calculation of the tidal currents and sinking trajectory of the submarine indicate that this theory is not likely. Based on our results, the "lucky shot" theory does not explain the sinking of the world's first successful combat submarine.
Language	English
Publishing date	2017-01
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	424042-x
ISSN	1872-6283 ; 0379-0738
ISSN (online)	1872-6283
ISSN	0379-0738
DOI	10.1016/j.forsciint.2016.11.038
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Zs.B 1104: Show issues

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Article ; Online: A Single-Center Retrospective Review of Perioperative Complications and Reoperation Rates Between Open Cranial Vault Remodeling and Distraction Osteogenesis for Unilateral Coronal Craniosynostosis.

Kamel, George N / Wong, Alvin / Segal, Rachel M / Carbulido, Mary Kristine / Hornacek, Michael / Ewing, Emily / Lance, Samuel H / Gosman, Amanda A

The Journal of craniofacial surgery

2021 Volume 32, Issue 7, Page(s) 2373–2378

Abstract: Background: Unilateral coronal craniosynostosis (UCS) is the third most prevalent form of craniosynostosis. Traditional treatment of UCS has been achieved with fronto-orbital advancement and cranial vault remodeling (FOAR), but utilization of cranial ... ...

Abstract	Background: Unilateral coronal craniosynostosis (UCS) is the third most prevalent form of craniosynostosis. Traditional treatment of UCS has been achieved with fronto-orbital advancement and cranial vault remodeling (FOAR), but utilization of cranial distraction osteogenesis (DO) techniques has increased. This study aims to compare perioperative complications and reoperation trends in FOAR versus DO techniques at a single institution. Methods: An Institutional Review Board-approved retrospective review was performed from January 1999 to November 2018 at a single institution. Patients were those that have undergone FOAR or DO with an anterior rotational flap technique as previously described. Indications for secondary procedures included: contour deformities, relapse, surgical site infection, and persistent cranial defects. Results: Eighty-one patients with UCS were identified, 64 patients underwent FOAR and 17 patients underwent DO. When perioperative characteristics were compared, patients who underwent DO were younger in age, however, there was no significant difference in transfusion requirement or length of stay between patient cohorts. Surgery time was increased in DO patients. When perioperative complications were compared, more intraoperative dural tears were observed in the FOAR cohort. When unplanned reoperation rates were compared, patients who had undergone FOAR had a statistically significant higher reoperation rates at 5 years of follow up. When including routine distractor removal as a reoperation, reoperative rate was increased in the DO cohort. No difference in reoperation rates was noted at 5 years following index operation. Conclusions: The safety profile of DO is similar to that of traditional FOAR techniques for treatment of UCS. Longer-term follow-up studies are needed to elucidate whether outcomes are durable, but the unplanned reoperation rate in DO is less than that of FOAR at 5 years and presents several advantages that warrants its use in patients with UCS.
MeSH term(s)	Craniosynostoses/surgery ; Humans ; Infant ; Osteogenesis, Distraction ; Reoperation ; Retrospective Studies ; Skull/surgery ; Treatment Outcome
Language	English
Publishing date	2021-06-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1159501-2
ISSN	1536-3732 ; 1049-2275
ISSN (online)	1536-3732
ISSN	1049-2275
DOI	10.1097/SCS.0000000000007831
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