Extremely deep recreational dives: the risk for carbon dioxide (CO 2 ) retention and high pressure neurological syndrome (HPNS)

Clear differences between professional and recreational deep diving are disappearing, at least when taking into account the types of breathing mixtures (oxygen, nitrox, heliox, and trimix) and range of dive parameters (depth and time). Training of recreational deep divers is conducted at depths of 120–150 metres and some divers dive to 180–200 metres using the same diving techniques. Extremely deep recreational divers go to depths of more than 200 metres, at which depths the physical and chemical properties of breathing gases create some physiological restrictions already known from professional deep diving. One risk is carbon dioxide retention due to limitation of lung ventilation caused by the high density of breathing gas mixture at great depths. This effect can be amplified by the introduction of the additional work of breathing if there is significant external resistance caused by a breathing device. The other risk for deep divers is High Pressure Neurological Syndrome (HPNS) caused by a direct compression effect, presumably on the lipid component of cell membranes of the central nervous system. In deep professional diving, divers use a mixture of helium and oxygen to decrease gas density, and nitrogen is used only in some cases for decreasing the signs and symptoms of HPNS. The same approach with decreasing the nitrogen content in the breathing mixture can also be observed nowadays in deep recreational diving. Moreover, in extremely deep professional diving, hydrogen has been used successfully both for decreasing the density of the breathing gas mixture and amelioration of HPNS signs and symptoms. It is fair to assume that the use of hydrogen will be soon “re-invented” by extremely deep recreational divers. So the scope of modern diving medicine for recreational divers should be expanded also to cover these problems, which previously were assigned exclusively to professional and military divers

New Polish occupational health and safety regulations for underwater works

In Poland, the new regulation of the Ministry of Health on Occupational Health for Underwater Works (dated 2007) pursuant to the Act on Underwater Works (dated 2003) has just been published. It is dedicated for commercial, non-military purposes. It defines health requirements for commercial divers and candidates for divers, medical assessment guide with a list of specific medical tests done on initial and periodical medical examination in order for a diver or a candidate for diver to be recognised fit for work, health surveillance during diving operations, compression and decompression procedures, list of content for medical equipment to be present at any diving place, formal qualifications for physicians conducting medical assessment of divers, requirements for certifications confirming the medical status of divers and candidates for divers. Decompression tables cover divings up to 120 meters of depth using compressed air, oxygen, nitrox and heliox as breathing mixtures. There are also decompression tables for repetitive diving, altitude diving and diving in the high-density waters (mud diving). It this paper, general description of health requirements for divers, as well as decompression tables that are included in the new Regulation on Occupational Health for Underwater Works are presented

Operation of Implantable Cardiac Devices in Hyperbaric Conditions

Implantable devices, including Implantable Cardiac Defibrillators (ICD) and Pacemakers (PM), are being seen with increasing frequency in patients wanting to conduct recreational diving or referred for Hyperbaric Oxygen Therapy (HBOT). Under hyperbaric conditions, these devices are at risk of malfunction, mostly by changes of ambient pressure. In some cases, manufacturers publish information on how their devices operate under increased pressure. Unfortunately, this is not always the case, and for other devices, someone must perform an individual risk-benefit analysis specific for single patient and his/her implanted device. In case of medical treatment, such analysis must take into account the patient’s clinical condition, the indication for HBOT, and the capability of the HBOT facility for monitoring and intervention in the chamber

An evaluation of sucrose as a possible contaminant in e-liquids for electronic cigarettes by hydrophilic interaction liquid chromatography–tandem mass spectrometry

The influence of sucrose combustion products on smoking and nicotine addiction is still controversial because the presence of the sucrose may be treated as a source of aldehydes and organic acids. In e-liquids used as refills for electronic cigarettes, which are made primarily of poly(propylene glycol), glycerine and ethanol, sucrose may be present at trace levels, and its impact on mainstream smoke formation, and hence on human health and smoking/nicotine addiction is unknown. An analytical method was developed where high-performance liquid chromatography in hydrophilic interaction liquid chromatography mode and tandem mass spectrometry were used for fast and simple determination of sucrose and other saccharides in e-liquids for electronic cigarettes. Minimal effort was required in the sample preparation step, and satisfactory results were obtained, and the sample matrix had an insignificant impact. The chromatographic separation was done using an Ascentis Express OH5 column (150 mm × 2.1 mm, 2.7 μm). The coefficients of variation for within-day precision for three concentrations were 2.4 %, 1.6 % and 2.3 %, and the between-day coefficients of variation for a single concentration were 2.1 %, 2.5 % and 1.7 % measured on the next 3 days. The detection limit was 0.73 μg/g, and the sucrose content in e-liquids ranged from 0.76 to 72.93 μg/g among 37 samples. Moreover, with the method presented it is possible to determine the presence of other saccharides such as fructose, glucose, maltose and lactose. However, only sucrose was found in all samples of e-liquids. The proposed method is rapid, simple and reliable in terms of high-performance liquid chromatography coupled with tandem mass spectrometry

Determination of nine high-intensity sweeteners in various foods by high-performance liquid chromatography with mass spectrometric detection

An analytical procedure involving solid-phase extraction (SPE) and high-performance liquid chromatography-mass spectrometry has been developed for the determination of nine high-intensity sweeteners authorised in the EU; acesulfame-K (ACS-K), aspartame (ASP), alitame (ALI), cyclamate (CYC), dulcin (DUL), neohesperidin dihydrochalcone (NHDC), neotame (NEO), saccharin (SAC) and sucralose (SCL) in a variety of food samples (i.e. beverages, dairy and fish products). After extraction with a buffer composed of formic acid and N,N-diisopropylethylamine at pH 4.5 in ultrasonic bath, extracts were cleaned up using Strata-X 33 μm Polymeric SPE column. The analytes were separated in gradient elution mode on C18 column and detected by mass spectrometer working with an electrospray source in negative ion mode. To confirm that analytical method is suitable for its intended use, several validation parameters, such as linearity, limits of detection and quantification, trueness and repeatibilty were evaluated. Calibration curves were linear within a studied range of concentrations (r2 ≥ 0.999) for six investigated sweeteners (CYC, ASP, ALI, DUL, NHDC, NEO). Three compounds (ACS-K, SAC, SCL) gave non-linear response in the investigated concentration range. The method detection limits (corresponding to signal-to-noise (S/N) ratio of 3) were below 0.25 μg mL−1 (μg g−1), whereas the method quantitation limits (corresponding to S/N ratio of 10) were below 2.5 μg mL−1 (μg g−1). The recoveries at the tested concentrations (50%, 100% and 125% of maximum usable dose) for all sweeteners were in the range of 84.2 ÷ 106.7%, with relative standard deviations <10% regardless of the type of sample matrix (i.e. beverage, yoghurt, fish product) and the spiking level. The proposed method has been successfully applied to the determination of the nine sweeteners in drinks, yoghurts and fish products. The procedure described here is simple, accurate and precise and is suitable for routine quality control analysis of foodstuffs

Employee engagement in organisations during a pandemic

PURPOSE: The purpose of this paper is to present the results of a study on employee engagement in organisations during the COVID-19 pandemic.DESIGN/METHODOLOGY/APPROACH: The paper presents the results of a survey conducted during the pandemic among 123 employees working for organisations of various kinds. The questionnaire survey was carried out using the computer-assisted web interviewing (CAWI) methodology. The process was based on certain claims of grounded theory. Statistical analysis was carried out using basic methods of descriptive statistics, statistical tests and selected methods of multivariate statistics, including the Kaiser-Meyer-Olkin Measure of Sampling Adequacy, Bartlett's Test of Sphericity.FINDINGS: The overall level of organisational engagement in organisations that operated during the pandemic was rated as moderate by the respondents, with the most favourably assessed issues including communication between employees and supervisors, sense of job stability, concern for the fate of the organisation, mutual inspiration to work, and employees' sense of satisfaction with being part of the organisation. The results also revealed statistically significant correlations between the different elements of organisational engagement.PRACTICAL IMPLICATIONS: The practical implications that arise from the results obtained in the study concern mainly the role of organisational engagement for effective operations of an organisation, including during a crisis situation, such as the COVID-19 pandemic. The results show that taking action to improve communication and cooperation, promoting the policy of equal opportunities and capabilities, fair treatment and evaluation of employees and many other instruments can foster the development of employee engagement, which brings results in the form of higher level of job satisfaction, stability and efficiency, thus improving the operations of the organisation.ORIGINALITY/VALUE: This paper is an attempt at filling the gap in the area of the status, role and value of organisational engagement during this pandemic, which may prove to be relevant for companies given the current circumstances, as well as possible future unpredictable challenges.The paper is funded under the program of the Minister of Science and Higher Education titled “Regional Initiative of Excellence” in 2019-2022, project number 018/RID/2018/19, the amount of funding PLN 10 788 423.16.peer-reviewe

Recompression treatment for decompression illness: 5-year report (2003-2007) from National Centre for Hyperbaric Medicine in Poland

A serious diving accident can occur in recreational diving even in countries where diving is not very popular due to the fact that diving conditions there are not as great as in some tropical diving locations. The estimated number of injured divers who need recompression treatment in European hyperbaric facilities varies between 10 and 100 per year depending on the number of divers in the population, number of dives performed annually, and number of hyperbaric centres in the country. In 5 years of retrospective observation in Poland (2003-2007) there were 51 cases of injured recreational divers recorded. They either dived locally or after returning home by air from a tropical diving resort. All of them were treated with recompression treatment in the National Centre for Hyperbaric Medicine in Gdynia which has capability to treat any patient with decompression illness using all currently available recompression schedules with any breathing mixtures including oxygen, nitrox, heliox or trimix. The time interval between surfacing and first occurrence of symptoms was significantly lower in the group of patients with neurological decompression sickness or arterial gas embolism (median 0.2 hours) than in the group of patients with other types of decompression sickness (median 2.0 hours). In both groups, there were different types of recompression tables used for initial treatment and different number of additional sessions of hyperbaric oxygenation (HBO) prescribed, but the final outcome was similar. Complete resolution of symptoms after initial recompression treatment was observed in 24 cases, and this number was increased to 37 cases after additional HBO sessions (from 1 to 20). In the final outcome, some residual symptoms were observed in 12 cases. In 2 cases initial diagnosis of decompression sickness type I was rejected after initial recompression treatment and careful re-evaluation of diving profiles, risk factors and reported symptoms

Rapid progression of massive hepatic calcification visible by CT : the case of a dialyzed patient

Background: There have been single reported cases of patients with diffuse hepatic calcifications revealed 4-36 months after the first examination in the course of hemodialysis-treated renal failure, severe heart failure, shock liver, primary amyloidosis, or corticosteroid administration. In the presented case, many different factors for liver calcification and dynamic tomographic manifestation are seen. Case Report: A 23-year-old man who was on hemodialysis because of acute renal failure after a motor vehicle accident (multiorgan trauma) with occurrence of hypovolemic shock was admitted to the hospital's intensive care unit presenting with clostridial infection of the lower extremities. During his stay at a prior hospital, ultrasonography did not reveal hepatic lesions. He underwent 22 sessions of treatment with hyperbaric oxygen as well as several necrectomies and amputation of both lower limbs. Abdominal CT performed three weeks after the accident demonstrated diffuse hepatic calcification which was later confirmed during autopsy. Liver parenchymal calcifications may be related to elevated calcium-phosphorus products in the uremic state and after multiple bone fractures and possible ischemic liver injury. Although a definitive explanation for the unusually short time of the appearance of liver calcification was not obtained, it may be related to many factors acting synergistically. Hyperbaric oxygen treatment is of unknown significance in this process. Conclusions: CT plays a basic role in detecting and assessing liver calcifications forming both diffuse lesions and those with well-defined borders. Diffuse calcifications revealed by CT must be analyzed together with the patient's history, especially considering renal and heart failure, bone fractures, states of shock, and treatment. Diffuse liver calcifications in these patients after respiratory therapy and transfusions when no subcapsular hematoma is found should be considered of metabolic origin

Summary of DAWN (Diabetes, Attitudes, Wishes and Needs) programme realization all over the world and in Poland

Cukrzyca stanowi jeden z większych problemów zdrowotnych na świecie. Przynajmniej połowa chorych na cukrzycę ciągle nie osiąga zadowalającej kontroli glikemii pomimo dostępności skutecznych metod leczenia i w konsekwencji miliony osób są zagrożone rozwojem poważnych powikłań. W 2001 roku przeprowadzono badanie Diabetes, Attitudes, Wishes and Needs (DAWN), dzięki któremu określono obszary wymagające poprawy w leczeniu cukrzycy. Czynniki psychologiczne stanowią główną barierę w poprawie wyników leczenia, dlatego też w wielu krajach na świecie zainicjowano aktywności skupione na psychospołecznych aspektach cukrzycy. W Polsce powołano Narodowy Program Wsparcia Osób z Cukrzycą w celu dotarcia z wiedzą z zakresu psychologii do wszystkich poziomów opieki zdrowotnej. Głównym celem programu jest poprawa jakości życia oraz wyników leczenia osób z cukrzycą poprzez pokonywanie psychologicznych barier w relacjach między lekarzem a pacjentem. W ramach programu są organizowane konferencje dla lekarzy specjalistów, warsztaty dla lekarzy opieki podstawowej prowadzone przez lekarzy specjalistów i psychologów klinicznych, szkolenia dla pielęgniarek oraz są przygotowywane, "narzędzia psychologiczne" - algorytmy dla lekarzy leczących chorych na cukrzycę.Diabetes is one of the major world health problems. Among people with diabetes at least half still do not achieve satisfactory glycemic control, despite the availability of effective treatments, and as a consequence millions of people are at risk of serious complications of the disease. In 2001 DAWN (Diabetes, Attitudes, Wishes and Needs) study was implemented and it identified several important gaps in the management of diabetes. Because psychological factors remain key barriers to improved outcomes, a lot of activities focused on psychosocial aspects of diabetes were implemented across a number of countries. In Poland National Programme to Support People with Diabetes was launched to address psychological issues at every level of health service. The main goals of the Programme are to improve quality of life and treatment results of people with diabetes by overcoming the psychological barriers in the patient-doctors relationship. The Programme is realized by organizing conferences for specialists, workshops for GP’s lead by specialists and clinical psychologists, trainings for nurses and preparation of "psychological tools" - algorithm for doctors treated patients with diabetes