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Concept: Cabin pressurization


Sensory effects in eyes and airways are common symptoms reported by aircraft crew and office workers. Neurological symptoms, such as headache, have also been reported. To assess the commonality and differences in exposures and health symptoms, a literature search of aircraft cabin and office air concentrations of non-reactive volatile organic compounds (VOCs) and ozone-initiated terpene reaction products were compiled and assessed. Data for tricresyl phosphates, in particular tri-ortho-cresyl phosphate (ToCP), were also compiled, as well as information on other risk factors such as low relative humidity. A conservative health risk assessment for eye, airway and neurological effects was undertaken based on a “worst-case scenario” which assumed a simultaneous constant exposure for 8h to identified maximum concentrations in aircraft and offices. This used guidelines and reference values for sensory irritation for eyes and upper airways and airflow limitation; a tolerable daily intake value was used for ToCP. The assessment involved the use of hazard quotients or indexes, defined as the summed ratio(s) (%) of compound concentration(s) divided by their guideline value(s). The concentration data suggest that, under the assumption of a conservative “worst-case scenario”, aircraft air and office concentrations of the compounds in question are not likely to be associated with sensory symptoms in eyes and airways. This is supported by the fact that maximum concentrations are, in general, associated with infrequent incidents and brief exposures. Sensory symptoms, in particular in eyes, appear to be exacerbated by environmental and occupational conditions that differ in aircraft and offices, e.g., ozone incidents, low relative humidity, low cabin pressure, and visual display unit work. The data do not support airflow limitation effects. For ToCP, in view of the conservative approach adopted here and the rareness of reported incidents, the health risk of exposure to this compound in aircraft is considered negligible.

Concepts: Evaluation, Risk, Assessment, Humidity, Relative humidity, Volatile organic compound, Tricresyl phosphate, Cabin pressurization


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.

Concepts: Nitrogen, Probability, Breathing gas, Underwater diving, Scuba diving, Probability and statistics, Dive computer, Cabin pressurization


In real aircraft structures the comfort and the occupational performance of crewmembers and passengers are affected by the presence of noise. In this sense, special attention is focused on mechanical and material design for isolation and vibration control. Experimental characterization and, in particular, experimental modal analysis, provides information for adequate cabin noise control. Traditional sensors employed in the aircraft industry for this purpose are invasive and provide a low spatial resolution. This paper presents a methodology for experimental modal characterization of a front fuselage full-scale demonstrator using high-speed 3D digital image correlation, which is non-invasive, ensuring that the structural response is unperturbed by the instrumentation mass. Specifically, full-field measurements on the passenger window area were conducted when the structure was excited using an electrodynamic shaker. The spectral analysis of the measured time-domain displacements made it possible to identify natural frequencies and full-field operational deflection shapes. Changes in the modal parameters due to cabin pressurization and the behavior of different local structural modifications were assessed using this methodology. The proposed full-field methodology allowed the characterization of relevant dynamic response patterns, complementing the capabilities provided by accelerometers.

Concepts: Structure, Materials science, Sound, Digital image correlation, Modal analysis, Aviation terminology, Passenger, Cabin pressurization


Human decompression sickness (DCS) is a condition associated with depressurization during underwater diving. Human research dive trial data containing dive outcome (DCS, no-DCS) and symptom information are used to calibrate probabilistic DCS models. DCS symptom onset time information is visualized using occurrence density functions (ODF) which plot the DCS onset rate per unit time. For the BIG292 human dive trial data set, a primary U.S. Navy model calibration set, the ODFs are bimodal, however probabilistic models do not produce bimodal ODFs. We investigate the source of bimodality by partitioning the BIG292 data based on dive type, DCS event severity, DCS symptom type, institution, and chronology of dive trial. All but one variant of data partitioning resulted in a bimodal or ambiguously shaped ODF, indicating that ODF bimodality is not related to the dive type or the DCS event severity. Rather, we find that the dive trial medical surveillance protocol used to determine DCS symptom onset time may have biased the reported event window. Thus, attempts to develop probabilistic DCS models that reproduce BIG292 bimodality are unlikely to result in an improvement in model performance for data outside of the calibration set.

Concepts: Time, Statistics, Probability theory, Calibration, Decompression sickness, Underwater diving, Scuba diving, Cabin pressurization


Airplane headache is a common problem with 100 million passengers annually suffering from the condition. It has been suggested that the changes in the cabin pressure during take-off and landing may cause inflammation in sinus tissues. This can lead to elevated levels of prostaglandin E2 and vasodilation of cerebral arteries resulting in airplane headache. Current evidence suggests opportunities to develop a treatment plan by examining future potential drugs for reducing the prostaglandin E2 level or preventing the vasodilation of the cerebral arteries.

Concepts: Inflammation, Sound pressure, Meningitis, Airport, Prostaglandin, Cabin pressurization


Air travel may imply a health hazard for patients with cystic fibrosis (CF) due to hypobaric environment in the aircraft cabin. The objective was to identify pre-flight variables, which might predict severe hypoxaemia in adult CF patients during air travel.

Concepts: Health, Epidemiology, Cross-sectional study, Cystic fibrosis, Rooms, Air travel, Aircraft cabin, Cabin pressurization


In aviation and diving, fast decrease in ambient pressure, such as during accidental loss of cabin pressure or when a diver decompresses too fast to sea level, may cause nitrogen (N2) bubble formation in blood and tissue resulting in decompression sickness (DCS). Conventional treatment of DCS is oxygen (O2) breathing combined with recompression.  However, bubble kinetic models suggest, that metabolic gases, i.e. O2 and carbon dioxide (CO2), and water vapor contribute significantly to DCS bubble volume and growth at hypobaric altitude exposures. Further, perfluorocarbon emulsions (PFC) and nitric oxide (NO) donors have, on an experimental basis, demonstrated therapeutic properties both as treatment and prophylactic intervention against DCS. The effect was ascribed to solubility of respiratory gases in PFC, plausible NO elicited nuclei demise and/or N2 washout through enhanced blood flow rate. Accordingly, by means of monitoring injected bubbles in exposed adipose tissue or measurements of spinal evoked potentials (SEPs) in anaesthetized rats, the aim of this study was to: 1) evaluate the contribution of metabolic gases and water vapor to bubble volume at different barometrical altitude exposures, 2) clarify the O2 contribution and N2 solubility from bubbles during administration of PFC at normo- and hypobaric conditions and, 3) test the effect of different NO donors on SEPs during DCS upon a hyperbaric air dive and, to study the influence of  NO on tissue bubbles at high altitude exposures. The results support the bubble kinetic models and indicate that metabolic gases and water vapor contribute significantly to bubble volume at 25 kPa (~10,376 m above sea level) and constitute a threshold for bubble stabilization or decay at the interval of 47-36 kPa (~6,036 and ~7,920 m above sea level). The effect of the metabolic gases and water vapor seemed to compromise the therapeutic properties of both PFC and NO at altitude, while PFC significantly increased bubble disappearance rate at sea level following a hyperbaric airdive. We found no protective effect of NO donors during DCS from diving. On the contrary, there was a tendency towards a poorer outcome when decompression was combined with NO donor administration. This observation is seemingly contradictive to recent publications and may be explained by the multifactorial effect of NO in combination with a fast decompression profile, speeding up the N2 release from tissues and thereby aggravating the DCS symptoms.

Concepts: Oxygen, Carbon dioxide, Water, Nitrogen, Pressure, Decompression sickness, Ocean, Cabin pressurization


Aviation deep vein thrombosis is a challenge poorly understood in modern aviation. The aim of the present project was to determine if cabin decompression might favor formation of vascular bubbles in commercial air travelers. Thirty commercial flights were taken. Cabin pressure was noted at take-off and at every minute following, until the pressure stabilized. These time-pressure profiles were imported into the statistics program R and analyzed using the package SCUBA. Greatest pressure differentials between tissues and cabin pressures were estimated for 20, 40, 60, 80 and 120 min half-time compartments. Time to decompress ranged from 11 to 47 min. The greatest drop in cabin pressure was from 1022 to 776 mBar, equivalent to a saturated diver ascending from 2.46 msw depth. Mean pressure drop in flights >2 h duration was 193 mBar, while mean pressure drop in flights <2 h was 165 mBar. The greatest drop in pressure over 1 min was 28 mBar. Over 30 commercial flights it was found that the drop in cabin pressure was commensurate with that found to cause bubbles in man. Both the US Navy and the Royal Navy mandate far slower decompression from states of saturation, being 1.7 and 1.9 mBar/min respectively. The median overall rate of decompression found in this study was 8.5 mBar/min, five times the rate prescribed for USN saturation divers. The tissues associated with hypobaric bubble formation are likely slower than those associated with bounce diving, with 60 min a potentially useful index.

Concepts: Vein, Deep vein thrombosis, Deep vein, Decompression sickness, United States Navy, Scuba diving, Cabin pressurization, Frigate


Early decompression may improve neurological outcome after spinal cord injury (SCI), but is often difficult to achieve because of logistical issues. The aims of this study were to determine (1) the time to decompression in cases of isolated cervical SCI in Australia and New Zealand and (2) where substantial delays occur as patients move from the accident scene to surgery. Data were extracted from medical records of patients aged 15-70 years with C3-T1 traumatic SCI between 2010 and 2013. A total of 192 patients were included. The median time from accident scene to decompression was 21h, with the fastest times associated with closed reduction (6h). A significant decrease in the time to decompression occurred from 2010 (31h) to 2013 (19h, p = 0.008). Patients undergoing direct surgical hospital admission had a significantly lower time to decompression compared to patients undergoing pre-surgical hospital admission (12h vs. 26h, p < 0.0001). Medical stabilisation and radiological investigation appeared not to influence the timing of surgery. The time taken to organise theatre following surgical hospital admission was a further factor delaying decompression (12.5h). There was a relationship between the timing of decompression and the proportion of patients demonstrating substantial recovery (2-3 AIS grades). In conclusion, the time of cervical spine decompression markedly improved over the study period. Neurological recovery appeared to be promoted by rapid decompression. Direct surgical hospital admission, rapid organisation of theatre and where possible use of closed reduction, are likely to be effective strategies to reduce the time to decompression.

Concepts: Medicine, Spinal cord, Hospital, Surgery, Vertebral column, Physician, Injury, Cabin pressurization


This study examined the ability of the Acti4 software for identifying physical activity types from accelerometers during free-living with different levels of movement complexity compared with video observations. Nineteen aircraft cabin cleaners with ActiGraph GT3X+ accelerometer at the thigh and hip performed one semi-standardised and two non-standardised sessions (outside and inside aircraft) with different levels of movement complexity during working hours. The sensitivity for identifying different activity types was 75.4-99.4% for the semi-standardised session, 54.6-98.5% outside the aircraft and 49.9-90.2% inside the aircraft. The specificity was above 90% for all activities, except ‘moving’ inside the aircraft. These findings indicate that Acti4 provides good estimates of time spent in different activity types during semi-standardised conditions, and for sitting, standing and walking during non-standardised conditions with normal level of movement complexity. The Acti4 software may be a useful tool for researchers and practitioners in the field of ergonomics, occupational and public health. Practitioner Summary: Being inexpensive, small, water-resistant and without wires, the ActiGraph GT3X+ by applying the Acti4 software may be a useful tool for long-term field measurements of physical activity types for researchers and practitioners in the field of ergonomics, occupational and public health.

Concepts: Health, Sensitivity and specificity, Accelerometer, Cabin pressurization