"As water covers over 75% surface area of the earth, humans have an innate desire to explore the underwater environment for various aims. Physiological responses are induced in humans and animals to adapt to different stresses imposed by the hyperbaric environment. When these stresses become overwhelming, certain hazards can occur to individuals in underwater or in similar hyperbaric environments, and they may include nitrogen narcosis, oxygen toxicity and decompression sickness (DCS). There are evidences showing that the autonomic nervous system (ANS) plays an important role in diving reflex and physiological responses to diving hazards. However, the assessment of the autonomic nervous activity during SCUBA dives and diving-related hazards are mostly absent from the literature. Thus, in order to evaluate the autonomic nervous alterations that may occur during diving, especially during DCS, the following three experiments were performed in this study: the simulated dives of human subjects in a hyperbaric chamber, the SCUBA diving performed in seawater and induced decompression sickness in a swine model. A novel algorithm developed in our lab, principal dynamic mode (PDM) analysis, is applied to the above data. It has been shown that the PDM is able to accurately separate the sympathetic and parasympathetic dynamics of the ANS, and subsequently it is able to obtain a better quantification of the autonomic nervous activity than a current golden-standard approach. Through the study, dominance of the parasympathetic modulation was found in both hyperbaric chamber and SCUBA diving conditions. And more stresses were present in real dives, compared to simulated dives in chamber. In the swine DCS model, we found neurological DCS and cardiopulmonary DCS resulted in different alterations in the ANS. Furthermore, tracking dynamics of the parasympathetic modulations via the PDM method may allow discrimination between cardiopulmonary DCS and neurological DCS, and has potential use as a marker for early diagnosis of cardiopulmonary DCS. "

<p>The intent of the work discussed in this dissertation is to apply the engineering methods of theory/modeling, numerics/computation, and experimentation to a diverse assemblage of projects. Several projects are discussed: probabilistic modeling of decompression sickness, comparative hydrodynamics of cetacean flippers, optimization of CT/MRI protocols, evaluation of modified catheters, rudder cavitation, and modeling of mass transfer in amphibian cone outer segments. </p><p>The first project discussed is the probabilistic modeling of decompression sickness (DCS). This project involved developing a system for evaluating the success of decompression models in predicting DCS probability from empirical data. Model parameters were estimated using maximum likelihood techniques, and exact integrals of risk functions and tissue kinetics transition times were derived. Agreement with previously published results was excellent including maximum likelihood values within one log-likelihood unit of previous results and improvements by re-optimization, mean predicted DCS incidents within 1.4% of observed DCS, and time of DCS occurrence prediction. Alternative optimization and homogeneous parallel processing techniques yielded faster model optimization times. The next portion of this project involved investigating the nature and utility of marginal decompression sickness (DCS) events in fitting probabilistic decompression models to experimental dive trial data. Three null models were developed and compared to a known decompression model that was optimized on dive trial data containing only marginal DCS and no-DCS events. It was found that although marginal DCS events are related to exposure to decompression, empirical dive data containing marginal and full DCS outcomes are not combinable under a single DCS model; therefore, marginal DCS should be counted as no-DCS events when optimizing probabilistic DCS models with binomial likelihood functions. The final portion of this project involved the exploration of a multinomial DCS model. Two separate models based on the exponential-exponential/linear-exponential framework were developed: a trinomial model, which is able to predict the probabilities of mild, serious and no-DCS simultaneously, and a tetranomial model, which is able to predict the probabilities of mild, serious, marginal and no-DCS simultaneously. The trinomial DCS model was found to be qualitatively better than the tetranomial model, for reasons found earlier concerning the utility of marginal DCS events in DCS modeling. </p><p>The next project discussed is comparative hydrodynamics of cetacean flippers. 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. The hydrodynamics of cetacean flippers have not previously 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, a baseline work is presented to describe the hydrodynamic properties of several cetacean flippers. It was 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. Larger cetacean flippers were found to have degraded performance at a Re of 250,000 compared to flippers of smaller odontocetes, while performance of larger and smaller cetacean flippers was similar at a swim speed of 2 m/s. Idealization of the planforms of cetacean flippers was found to capture the relevant hydrodynamic effects of the real flippers, although unintended consequences such as the lift curve slope changing from linear to nonlinear were sometimes observed. A numerical study of an idealized model of the humpback whale flipper showed that the leading-edge tubercles delay stall compared to a baseline (no tubercle) flipper because larger portions of the flow remaining attached at higher angles of attack. </p><p>The third project discussed is optimization of CT/MRI protocols. In order to optimize contrast material administration protocols for Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), a custom-built physiologic flow phantom was constructed to model flow in the human body. This flow phantom was used to evaluate the effect of varying volumes, rates, and types of contrast material, use of a saline chase, and cardiac output on aortic enhancement characteristics. For CT, reducing the volume of contrast material decreased duration peak enhancement and reduced the maximum value of peak enhancement. Increasing the rate of contrast media administration increased peak enhancement and decreased duration of peak enhancement. Use of a saline chase resulted in an increase in peak enhancement. Peak aortic enhancement increased when reduced cardiac output was simulated. For MRI, when the same volume of contrast material was injected at the same rate, the type of contrast material used has a significant effect on the greatest peak signal intensity and duration peak signal intensity. A higher injection rate of saline chaser is more advantageous than a larger volume of saline chaser to increase the peak aortic signal intensity using low contrast material doses. Furthermore, for higher volumes of contrast material, the effect of increasing the volume of saline chaser makes almost no difference while increasing the rate of injection makes a significant difference. When a saline chaser with a high injection rate is used, the dose of the contrast material may be reduced by 25-50% and more than 86% of the non-reduced dose peak aortic enhancement will be attained.</p><p>The next project discussed is evaluation of modified angiocatheters. In this study, a standard peripheral end hole angiocatheter was compared to those modified with side holes or side slits by using experimental techniques to qualitatively compare the contrast material exit jets, and by using numeric techniques to provide flow visualization and quantitative comparisons. A Schlieren imaging system was used to visualize the angiocatheter exit jet fluid dynamics at two different flow rates, and a commercial computational fluid dynamics (CFD) package was used to calculate numeric results for various catheter orientations and vessel diameters. Experimental images showed that modifying standard peripheral intravenous 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 always lowest for the 4 side slit catheter. Modified angiocatheters may have the potential to reduce extravasation events in patients by reducing vessel wall shear stress. </p><p>The next project discussed involves studying the effect of leading-edge tubercles on cavitation characteristics for marine rudders. Three different rudders were constructed and tested in a water tunnel: baseline, 3-tubercle leading edge, and 5-tubercle leading edge. In the linear (non-stall) regime, tubercled rudders performed equally to the smooth rudder. Hydrodynamic stall occurred at smaller angles of attack for the tubercled rudders than for the smooth rudder. When stall did occur, it was more gradual for the tubercled rudders, whereas the smooth rudder demonstrated a more dramatic loss of lift. At lower Re, the tubercled rudders also maintained a higher value of lift post-stall than the smooth rudder. Cavitation onset for the tubercled rudders occurred at lower angles of attack and higher values of cavitation number than for the smooth rudder, but cavities on the tubercled rudders were localized in the slots as opposed to the smooth rudder where the cavity spread across the entire leading edge. </p><p>In the final project discussed, modeling of mass transfer in amphibian cone outer segments, a detailed derivation of a simplified (continuum, one-dimensional) mathematical model for the radio-labeled opsin density profile in the amphibian cone outer segment is presented. This model relies on only one free parameter, which was the mass transfer coefficient between the plasmalemma and disc region. The descriptive equations were nondimensionalized, and scale analysis showed that advective effects could be neglected as a first approximation for early times so that a simplified system could be obtained. Through numeric computation the solution behavior was found to have three distinct stages. The first stage was marked by diffusion in the plasmalemma and no mass transfer in the disc region. The second stage first involved the plasmalemma reaching a metastable state whereas the disc region density increased, then involved both the plasmalemma and disc regions increasing in density with their distributions being qualitatively the same. The final stage involved a slow relaxation to the steady-state solution.</p> / Dissertation

Patent foramen ovale (PFO) has been associated with an increased risk of decompression sickness (DCS) in divers. Pathophysiologicaly this has been ascribed to paradoxical embolization of nitrogen bubbles from venous blood to systemic circulation, resulting in obstruction of peripheral capillaries and ischemic injury. However, the role of PFO has been largely debated and experimental and prospective clinical data has been missing. It is of note, that this hypothesis is not only of theoretical importance. The proof of PFO as a causative factor of DCS and, importantly, of unpredictable events (unprovoked DCS) could affect millions of divers worldwide through improved therapy and prevention. In our research we aimed to describe the pathophysiological role of PFO in decompression sickness and to determine whether the prevention of arterialization of post-dive venous gas emboli (VGE) would decrease the incidence of unprovoked DCS in divers. We have screened 489 scuba divers for the presence of PFO by means of transcranial color-coded Doppler ultrasonography. In a retrospective analysis we found that the incidence of unprovoked decompression sickness was 7% among these divers and that PFO was the only risk factor. Subsequently, we have studied the occurrence of VGE and arterial gas emboli (AGE) in divers with...

L’Accident de Décompression présente un risque majeur pour les plongeurs. Il est admis que la formation de bulles circulantes est à l’origine de l’ADD. Cependant, une forte variabilité inter individuelle existe entre plongeurs, avec une faible corrélation entre bulles et symptômes de l’ADD. Plusieurs mécanismes physiologiques ont été liés à l’ADD, mais aucun d’entre eux ne semble déterminant dans la mise en place de la pathologie. Dans ce contexte, des techniques issues de la médecine de précision pourraient apporter de nouveaux éléments de compréhension.Durant cette thèse, nous avons effectué des études protéomiques afin d’étudier les possibles changements du protéome plasmatique de rats et de plongeurs suite à une plongée avec ou sans ADD, dans le but de trouver de potentiels biomarqueurs de développement précoce de l’ADD. Nous avons de plus mis en évidence une potentielle implication de processus inflammatoires dans la mise en place des symptômes de l’ADD. Un protocole de sélection a ensuite été utilisé dans le but de créer une nouvelle souche de rats résistante à l’ADD. Une résistance à l’ADD est apparue en l’espace d’une génération chez les femelles, deux chez les mâles. Une caractérisation physiologique de la souche résistante a montré une potentielle implication d’une région spécifique du chromosome X, ainsi que des modifications du fonctionnement du muscle lisse vasculaire, de la résistance aux espèces réactives de l’oxygène, de la consommation d’oxygène mitochondriale, et du système immunitaire. Les suites de cette caractérisation se focaliseront sur des études transcriptomiques et génétiques, en particulier sur la région d’intérêt du chromosome X. / Decompression Sickness is one of the most serious hazards for divers. It is usually admitted that DCS origins from circulating bubbles. However, a strong inter-individual variability exists between divers, resulting in a poor correlation between bubble grade and DCS symptoms. Several physiological mechanisms have been linked with DCS, but none of them appeared to be determinant in the onset of the pathology. In this context, medicine precision techniques may offer new insights, with a broader approach.During this thesis, we used proteomics to investigate changes of the plasma proteome of rats and divers during diving, with and without DCS, and aimed at finding biomarkers of early DCS development. We found that acute inflammation may play a role in the onset on DCS, and that proteomics may be fitted to look for new biomarkers. We also used a selection protocol to create a new DCS resistant rat strain, which was significantly more resistant than classic Wistar rats. Moreover, DCS resistance was gained in a matter of only 2 reproductions cycles (only 1 for females), which gives evidence of heritable components of DCS resistance/susceptibility that might be carried out by the X chromosome. A characterization of this DCS resistant strain showed a number of physiological adaptations gained during the selection process. Indeed, DCS resistant rats showed a decreased mitochondrial oxygen global consumption, a decrease of vascular smooth muscle contraction and relaxation as well as a raise of neutrophils count among males.Further characterization of the DCS resistant strain will focus on transcriptomic and genetic studies, especially on the genomic region of interest located on the X chromosome.

Doctorat en kinésithérapie et réadaptation / info:eu-repo/semantics/nonPublished

L’accident de désaturation (ADD) est un accident de plongée lié à la charge en gaz diluants pendant la plongée, et à la formation de bulles dans l’organisme au cours de la décompression. Il est susceptible d’engendrer des séquelles neurologiques. Au cours de plongées utilisant l’hydrogène comme gaz diluant, la diminution de la charge tissulaire en hydrogène par l’inoculation au niveau de l’intestin de bactéries métabolisant ce gaz réduit le risque d’ADD.L’objectif de ce travail était d’évaluer si inversement : 1) la fermentation intestinale lors de la plongée peut favoriser la survenue d’un ADD, par l’intermédiaire de la production d’hydrogène endogène ; 2) la stimulation chronique de la fermentation avant plongée majore le risque d’ADD.Nos résultats sont en faveur d’un effet dual de la fermentation intestinale sur la décompression. Délétère à court terme lors de la plongée, la fermentation intestinale prolongée pourrait être favorable en dehors de la plongée en prévenant la survenue et la sévérité d’un ADD. L’hydrogène, molécule aux propriétés antioxydantes, et le butyrate, un acide gras à chaîne courte, sont en effet deux produits de la fermentation des hydrates de carbone qui ont des vertus neuroprotectrices.La prévention des accidents de désaturation pourrait passer par une exclusion des plongeurs présentant une fermentation importante le jour de la plongée, une élimination des gaz produits au niveau de l’intestin ou une modification de l’alimentation dans les 24 heures précédant une plongée. En revanche, tous les facteurs susceptibles de modifier le microbiote intestinal et d’augmenter la fermentation, en dehors de la plongée, pourraient être testés en prévention de l’ADD. En outre, l’hydrogène et le butyrate pourraient jouer un rôle bénéfique dans le cadre du traitement de l’ADD / Decompression sickness (DCS) is a diving accident related to the dissolution of diluent gas in blood and tissues during a dive, followed by bubble formation in the body during decompression. It can lead to neurological damage. In dives using hydrogen as the diluent gas, the concentration of hydrogen in the tissues can be reduced by the presence in the gut of bacteria capable of metabolising this gas and this reduces the risk of DCS.The aim of this work was conversely to check if: 1) fermentation in the gut at the time of diving could exacerbate DCS as a result of endogenous hydrogen generation; 2) long-term stimulation of fermentation before diving raises the risk of DCS.Our findings point to a two-edged effect of intestinal fermentation on decompression: although deleterious in the short term, i.e. at the time of diving, longer-term intestinal fermentation between dives might have a positive effect by preventing the occurrence of DCS and limiting its severity. Indeed, hydrogen which has antioxidant properties and butyrate, a short-chain fatty acid, are both by-products of the fermentation of carbohydrate and both have neuroprotective activity.DCS prevention could be promoted by excluding divers exhibiting strong fermentation on the day of a dive, by the elimination of gases being produced in gut or by modification of diet in the 24 hours before a dive. On the other hand, any factor that might affect the gut microbiota and stimulate fermentation between dives could be tested to investigate its potential in protecting against DCS. Furthermore, hydrogen and butyrate could play a positive role when it comes to treating DCS

Decompression sickness (DCS) is a risk associated with high-altitude aviation and diving. During these activities, decompression may lead to supersaturation of inert gas dissolved in bodily tissues and subsequently activate bubble formation in various bodily tissues, including in venous blood, known as venous gas emboli (VGE). It has been shown that the amount of VGE detected during and after decompression is linked to the risk of developing DCS. Thus, lowering the incidence of VGE would lower the risk of developing DCS. Previous studies have demonstrated that a session of whole-body vibration prior to a diving session is effective in lowering VGE formation. However, no study has investigated the effect of whole-body vibration on high-altitude-induced VGE. For the present study, 3 participants were recruited. The subjects performed on separate days (interspaced by 48 h) and in a randomised manner, three different preconditioning strategies: (A) 40-min seated rest, (B) 30-min seated rest followed by 150 knee squats performed over a 10 min period and (C) 30-min whole-body vibration (40 Hz) proceeded by a 10 min seated rest. Thereafter, subjects were exposed to an altitude of 24,000 ft continuously for 90 min, whilst laying in a supine position and breathing a normoxic gas mixture (PIO2 = 21 kPa). Heart rate (HR), cardiac output (CO) and stroke volume (SV) were monitored throughout the high-altitude exposure. Every 5 min, VGE prevalence was assessed ultrasonically and graded according to the Eftedal-Brubakk 5-point scale. In addition, every 15 min, subjects were asked to perform three fast, unloaded knee-bends while in their left-side horizontal recumbent position, with VGE prevalence being estimated both before and after the three knee-bends. The control strategy was associated with a higher VGE scores (2.7 ± 1.2) compared to vibration (1.0 ± 1.0) and squats (1.3 ± 0.6) strategies. VGE appeared earlier during the control strategy (35 ± 23 min) compared to the vibration (65 ± 31 min) and squats (50 ± 17 min) strategies. A strong negative correlation was only observed in the control strategy between VGE and CO (r = -0.63) and SV (r = -0.64). This study demonstrated that whole-body vibration is the most effective preconditioning strategy in lowering the amount of high-altitude-induced VGE compared with 40-min of seated-rest and 150 knee squats performed over a period of 10 min. / Att drabbas av dekompressionssjuka (DKS) utgör en risk vid såväl höghöjdsflygning som dykning. I samband med dessa aktiviteter, kan dekompression leda till övermättnad av inert-gas löst i kroppens vävnader, vilket i sin tur kan leda till bubbelformation i olika vävnader, inklusive i venblodet, där bubblorna benämns venösa gasembolier (VGE). Det har visats föreligga ett samband mellan mängden VGE som uppmäts under och efter dekompression och risken att utveckla DKS. Således kan det antas att en minskad incidens av VGE är förknippad med minskad risk att utveckla DKS. Tidigare undersökningar har påvisat att en period med helkroppsvibration före dykning påtagligt minskar bildningen av VGE. Hittills har man dock inte undersökt om helkroppsvibration påverkar höghöjdsinducerade VGE. I föreliggande undersökning, medverkade tre försökspersoner. De exponerades vid separata tillfällen (med 48 timmars mellanrum), och i olika ordningsföljd, för tre prekonditioneringsstrategier: (A) 40 min sittande vila, (B) 30 min sittande vila följt av 150 djupa knäböjningar som genomfördes under en 10-minutersperiod och (C) 10 min sittande vila följt av 30 min helkroppsvibration (40 Hz). Därefter exponerades försökspersonerna för en simulerad höjd motsvarande 24,000 fot ö.h. kontinuerligt under 90 min, under det att de i liggande ryggläge andades en normoxisk gasblandning (inspiratoriskt syrepartialtryck = 21 kPa). Hjärtfrekvens (HF), hjärtminutvolym (HMV) och hjärtats slagvolym (SV) mättes kontinuerligt under höghöjdsexponeringen. Var femte min bedömdes prevalensen av VGE med hjälp av ultraljudsteknik och en 5-gradig skattningsskala. Var femtonde min genomförde försökspersonerna 3 obelastade knäböjningar, liggande i vänster sidoläge, varvid VGE-prevalensen bedömdes såväl före som efter knäböjningarna. Kontrollbetingelsen (A) framkallade högre VGE-nivå (2,7 ± 1,2) än vibrationsbetingelsen (B; 1 ± 1) och knäböjbetingelsen (C; 1,3 ± 0,6). VGE uppträdde tidigare under kontrollbetingelsen (35 ± 23 min) än i vibrations- (65 ± 31 min) och knäböj-betingelserna (50 ± 17 min). Starka negativa samband påvisades mellan VGE och CO (r = -0,63) respektive SV (r = -0,64). Således visade föreliggande undersökning att helkroppsvibration.

Thesis (MScMedSc)-- Stellenbosch University, 2014. / ENGLISH ABSTRACT: Diving medical doctors frequently make use of Hyperbaric Facilities without fully realising their legal and ethical responsibilities towards the safety of their patients and their staff. Few have specific training in the technical or operational aspects of these facilities; this deficiency is exacerbated when these are established in remote areas. The potential dangers are real and the results can be devastating. Most current regulatory, manufacturing, safety and operational guidance documents are not flexible enough to be applied universally, nor do they offer practical guidance on the recognition and the mitigation of the unique and relevant hazards at a given facility. The goal of integrated safety is rarely achieved. The Risk Assessment Guide (RAG) was developed by the investigator as a tool to qualify the actual safety status of a hyperbaric facility and to offer guidance on how to improve and maintain it. Although the RAG has been subject to extensive peer review and field implementation over the past 13 years, it has not been subject to scientific validation. Therefore, the objective of this thesis was to do so by (1) retrospectively reviewing the most common safety concerns affecting facility status as identified by the RAG; (2) using the data derived from the analysis to produce a predictive model of likely safety status for un-assessed facilities; and (3) consolidating the results in the form of specific recommendations to improve and maintain safety status. Data collected from a consistent application of the RAG over a period of 13 years, covering 105 applicable facilities, was analysed to determine the common safety concerns, particularly those affecting safety status by means of a consolidated Risk Assessment Score (RAS). The RAS values permitted comparisons between the facilities assessed. The various factors associated with a higher RAS were determined by means of a multivariate regression. Thereupon, the most significant determinant factors were built into a predictive model for the likely safety status of an un-assessed facility. Finally, the most common safety concerns were identified and summarised so that medical practitioners are empowered to determine, improve and maintain the safety status of a given facility. The conclusions of this project are that: (1) the RAG is an appropriate tool to assess facilities for risk elements relevant to their safety status while simultaneously filling the knowledge gaps to equip medical practitioners and staff to improve and maintain safety; (2) reliable predictions on unknown facilities can be made to provide medical practitioners with the necessary information on whether a given facility is appropriate for patient referral; and (3) the RAG is a suitable benchmark for determining hyperbaric facility safety; the review of its application has provided objective data that will permit the formulation of future safety guidelines based on empirical rather than arbitrary information. / AFRIKAANSE OPSOMMING: Duikmediese dokters maak dikwels gebruik van hiperbariese fasiliteite sonder om die wetlike en etiese verantwoordelikhede ten opsigte van die veiligheid van hul pasiënte en personeel te besef. Weinig het spesifieke opleiding in die tegniese of operasionele aspekte van hierdie fasiliteite; hierdie tekort is gewoonlik erger in afgeleë gebiede. Die potensiële gevare is wesenlik en die gevolge kan verwoestend wees. Meeste van die huidige regulatoriese-, vervaardigings-, veiligheids en operasionele leidingsdokumente is nie buigsaam genoeg om in die algemeen toegepas te kan word nie. Hulle bied ook nie praktiese leiding oor die erkenning en die versagting van unieke en relevante gevare by 'n gegewe fasiliteit nie. Die doelwit van geïntegreerde veiligheid word selde bereik. Die “Risk Asssessment Guide” (RAG) is voorheen deur die navorser ontwikkel as 'n instrument om die werklike veiligheidsstatus van 'n hiperbariese fasiliteit te kwantifiseer en leiding te bied oor hoe om dit te verbeter en in stand te hou. Alhoewel die RAG onderhewig was aan uitgebreide eweknie hersiening en praktiese uitvoering oor die afgelope 13 jaar, was dit nie voorheen onderhewig aan wetenskaplike validasie nie. Die doelwit van hierdie tesis is dus om hierdie te bewerkstellig deur (1) die mees algemene veiligheidskommernisse wat fasiliteitstatus beïnvloed, soos deur die RAG geïdentifiseer, retrospektiewelik te hersien; (2) die data wat deur die hersiening verkry is te gebruik om 'n model te ontwikkel vir onbeoordeelde fasiliteite, wat die waarskynlike veiligheidsstatus kan voorspel, en (3) die resultate te konsolideer in die vorm van spesifieke aanbevelings om veiligheidsstatus te verbeter en in stand te hou. Die data wat ingesamel is deur die konsekwente toepassing van die RAG oor 'n tydperk van 13 jaar en wat 105 fasiliteite gedek het, is ontleed om die algemene veiligheidskommernisse, veral die wat die veiligheidsstatus beïnvloed, deur middel van 'n gekonsolideerde Risikoassesserings waarde (RAW) te bepaal. Die duidelike en aangepaste RAW laat toe om vergelykings tussen die fasiliteite te tref. Faktore wat verband hou met 'n hoër RAW was deur middel van 'n meervoudige regressie bepaal. Daarna is die belangrikste determinante in 'n voorspellende model gebou om die waarskynlike veiligheidsstatus van 'n onbeoordeelde fasiliteit te bepaal. Ten slotte was die mees algemene veiligheidskommernisse geïdentifiseer en opgesom om sodoende mediese praktisyns te bemagtig om die veiligheidsstatus van 'n gegewe fasiliteit vas te stel, te verbeter en in stand te hou. Die gevolgtrekkings van hierdie projek is dat: (1) die RAG 'n geskikte instrument is om fasiliteite te evalueer vir risiko-elemente wat relevant is tot hul eie veiligheidsstatus en terselfdertyd die kennisgapings te vul om geneeshere en personeel toe te rus om veiligheid te verbeter en in stand te hou; (2) redelik betroubare voorspellings oor onbekende fasiliteite kan gemaak word om vir mediese praktisyns die nodige inligting te verskaf aangaande die geskiktheid van 'n gegewe fasiliteit vir pasiënt-verwysing, en (3) dat die RAG 'n geskikte maatstaf is vir die bepaling van hiperbariese fasiliteit veiligheid. Die hersiening van die toepassing het objektiewe data voorsien wat die formulering van toekomstige veiligheidsriglyne, geskoei op empiriese eerder as arbitrêre inligting, sal toelaat.

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).