Persistence of critical flicker fusion frequency impairment after a 33 mfw SCUBA dive: evidence of prolonged nitrogen narcosis?

Narcotic Nitrogen Effects Persist after a Simulated Deep Dive

Background and Objectives: Scuba divers often experience persistent inert gas narcosis (IGN) even after surfacing. This study aimed to test the hypothesis that breathing oxygen (O2) before surfacing can reduce postdive IGN. Materials and Methods: A group of 58 experienced divers underwent a 5 min dive at a depth of 50 m in a multi-place hyperbaric chamber. They were decompressed using air (air group). Another group of 28 divers (O2 group) breathed 100% O2 during the end of decompression. Prior to and after the dive, all participants performed the Sharpened Romberg test (SRT) and a modified tweezers test. Results: In the air group, the number of positive SRT results increased postdive (47% vs. 67%), indicating a greater impairment in the vestibular system (Cohen's d = 0.41). In the O2 group, the percentage of positive SRT results remained constant at 68% both before and after the dive. In terms of the modified tweezers test, the air group showed no significant change in the number of picked beads (40 ± 9 vs. 39 ± 7), while the O2 group demonstrated an increase (36 ± 7 vs. 44 ± 10) (Cohen's d = 0.34). Conclusion: The results reveal that the SRT revealed a negative effect of nitrogen (N2) on the vestibular system in the air group. The increased number of beads picked in the O2 group can be attributed to the learning effect, which was hindered in the air group. Consistent with our hypothesis, breathing O2 during decompression appears to reduce postdive IGN.

Combined effects of mild hypothermia and nitrous-oxide-induced narcosis on manual and cognitive performance

Divers are at enhanced risk of suffering from acute cognitive deterioration because of the low ambient temperatures and the narcotic action of inert gases inspired at high pressures. Yet, the behavioral effects of cold and inert gas narcosis have commonly been assessed in isolation and during short-term provocations. We therefore evaluated the interactive influence of mild hypothermia and narcosis engendered by a subanesthetic dose of nitrous oxide (N2O; a normobaric intervention analog of hyperbaric nitrogen) on cognitive function during prolonged iterative exposure. Fourteen men partook in two ∼12-h sessions (separated by ≥4 days), wherein they performed sequentially three 120-min cold (20°C) water immersions (CWIs), while inhaling, in a single-blinded manner, either normal air or a normoxic gas mixture containing 30% N2O. CWIs were separated by a 120-min rewarming in room-air breathing conditions. Before the first CWI and during each CWI, subjects performed a finger dexterity test, and the Spaceflight Cognitive Assessment Tool for Windows (WinSCAT) test assessing aspects of attention, memory, learning, and visuospatial ability. Rectal and skin temperatures were, on average, reduced by ∼1.2 °C and ∼8 °C, respectively (P < 0.001). Cooling per se impaired (P ≤ 0.01) only short-term memory (∼37%) and learning (∼18%); the impairments were limited to the first CWI. N2O also attenuated (P ≤ 0.02) short-term memory (∼37%) and learning (∼35%), but the reductions occurred in all CWIs. Furthermore, N2O invariably compromised finger dexterity, attention, concentration, working memory, and spatial processing (P < 0.05). The present results demonstrate that inert gas narcosis aggravates, in a persistent manner, basic and higher-order cognitive abilities during protracted cold exposure.

Rapid Dual-Task Decrements After a Brief Period of Manual Tracking in Simulated Weightlessness by Water Submersion

OBJECTIVE

Investigating dual-task (DT) performance during simulated weightlessness by water submersion, using a manual tracking and a choice reaction task. In contrast to previous work, we focus on performance changes over time.

BACKGROUND

Previous research showed motor tracking and choice reaction impairments under DT and single-task (ST) conditions in shallow water submersion. Recent research analyzed performance as average across task time, neglecting potential time-related changes or fluctuations of task-performance.

METHOD

An unstable tracking and a choice reaction task was performed for one minute under ST and DT conditions in 5 m water submersion and on dry land in 43 participants. Tracking and choice reaction time performance for both tasks were analyzed in blocks of 10 seconds.

RESULTS

Tracking performance deteriorated underwater compared to dry land conditions during the second half while performing one minute in DT conditions. Choice reaction time increased underwater as well, but independent of task time and type.

CONCLUSION

Tracking error increased over time when performing unstable tracking and choice reaction together. Potentially, physiological and psychological alterations under shallow submersion further strain the human system during DT operations, exceeding available recourse capacities such that DT performance deteriorated over time.

APPLICATION

Humans operating in simulated weightlessness underwater should be aware of substantial performance declines that can occur within a short amount of time during DT situations that include continuous tracking.

Assessing Critical Flicker Fusion Frequency: Which Confounders? A Narrative Review

The critical flicker fusion frequency (cFFF) refers to the frequency at which a regularly recurring change of light stimuli is perceived as steady. The cFFF threshold is often assessed in clinics to evaluate the temporal characteristics of the visual system, making it a common test for eye diseases. Additionally, it serves as a helpful diagnostic tool for various neurological and internal diseases. In the field of diving/hyperbaric medicine, cFFF has been utilized to determine alertness and cognitive functions. Changes in the cFFF threshold have been linked to the influence of increased respiratory gas partial pressures, although there exist inconsistent results regarding this effect. Moreover, the use of flicker devices has produced mixed outcomes in previous studies. This narrative review aims to explore confounding factors that may affect the accuracy of cFFF threshold measurements, particularly in open-field studies. We identify five broad categories of such factors, including (1) participant characteristics, (2) optical factors, (3) smoking/drug use, (4) environmental aspects, and (5) breathing gases and partial pressures. We also discuss the application of cFFF measurements in the field of diving and hyperbaric medicine. In addition, we provide recommendations for interpreting changes in the cFFF threshold and how they are reported in research studies.

Cognitive Functions in Scuba, Technical and Saturation Diving

Scuba diving as a recreational activity is becoming increasingly popular. However, the safety of this activity, especially in the out-of-comfort zone, has been discussed worldwide. The latest publications bring conclusions regarding negative effects on cognitive functions. We compare the acute and chronic effects of diving on cognitive functioning depending on the type of dive performed, including recreational, technical and saturation diving. However, the results of research show that acute and chronic effects on cognitive functions can be negative. While acute effects are reversible after the ascent, chronic effects include white matter lesions in magnetic resonance imaging scans. We believe that more investigations should be performed to determine the chronic effects that could be observed after a few months of observations in a group of regular, intense divers. In addition, publications referring to technical divers are very limited, which is disquieting, as this particular group of divers seems to be neglected in research concerning the effects of diving on cognitive functions.

Neuropsychological and Neurophysiological Mechanisms behind Flickering Light Stimulus Processing

The aim of this review is to summarise current knowledge about flickering light and the underlying processes that occur during its processing in the brain. Despite the growing interest in the topic of flickering light, its clinical applications are still not well understood. Studies using EEG indicate an appearing synchronisation of brain wave frequencies with the frequency of flickering light, and hopefully, it could be used in memory therapy, among other applications. Some researchers have focused on using the flicker test as an indicator of arousal, which may be useful in clinical studies if the background for such a relationship is described. Since flicker testing has a risk of inducing epileptic seizures, however, every effort must be made to avoid high-risk combinations, which include, for example, red-blue light flashing at 15 Hz. Future research should focus on the usage of neuroimaging methods to describe the specific neuropsychological and neurophysiological processes occurring in the brain during the processing of flickering light so that its clinical utility can be preliminarily determined and randomised clinical trials can be initiated to test existing reports.

Critical Flicker Fusion Frequency: A Narrative Review

This review presents the current knowledge of the usage of critical flicker fusion frequency (CFF) in human and animal model studies. CFF has a wide application in different fields, especially as an indicator of cortical arousal and visual processing. In medicine, CFF may be helpful for diagnostic purposes, for example in epilepsy or minimal hepatic encephalopathy. Given the environmental studies and a limited number of other methods, it is applicable in diving and hyperbaric medicine. Current research also shows the relationship between CFF and other electrophysiological methods, such as electroencephalography. The human eye can detect flicker at 50-90 Hz but reports are showing the possibility to distinguish between steady and modulated light up to 500 Hz. Future research with the use of CFF is needed to better understand its utility and application.

Assessment of Alertness and Cognitive Performance of Closed Circuit Rebreather Divers With the Critical Flicker Fusion Frequency Test in Arctic Diving Conditions

Introduction: Cold water imposes many risks to the diver. These risks include decompression illness, physical and cognitive impairment, and hypothermia. Cognitive impairment can be estimated using a critical flicker fusion frequency (CFFF) test, but this method has only been used in a few studies conducted in an open water environment. We studied the effect of the cold and a helium-containing mixed breathing gas on the cognition of closed circuit rebreather (CCR) divers.

Materials and Methods: Twenty-three divers performed an identical dive with controlled trimix gas with a CCR device in an ice-covered quarry. They assessed their thermal comfort at four time points during the dive. In addition, their skin temperature was measured at 5-min intervals throughout the dive. The divers performed the CFFF test before the dive, at target depth, and after the dive.

Results: A statistically significant increase of 111.7% in CFFF values was recorded during the dive compared to the pre-dive values (p < 0.0001). The values returned to the baseline after surfacing. There was a significant drop in the divers’ skin temperature of 0.48°C every 10 min during the dive (p < 0.001). The divers’ subjectively assessed thermal comfort also decreased during the dive (p = 0.01).

Conclusion: Our findings showed that neither extreme cold water nor helium-containing mixed breathing gas had any influence on the general CFFF profile described in the previous studies from warmer water and where divers used other breathing gases. We hypothesize that cold-water diving and helium-containing breathing gases do not in these diving conditions cause clinically relevant cerebral impairment. Therefore, we conclude that CCR diving in these conditions is safe from the perspective of alertness and cognitive performance.

Oxygen-enriched Air Decreases Ventilation during High-intensity Fin-swimming Underwater

Oxygen-enriched air is commonly used in the sport of SCUBA-diving and might affect ventilation and heart rate, but little work exists for applied diving settings. We hypothesized that ventilation is decreased especially during strenuous underwater fin-swimming when using oxygen-enriched air as breathing gas. Ten physically-fit divers (age: 25±4; 5 females; 67±113 open-water dives) performed incremental underwater fin-swimming until exhaustion at 4 m water depth with either normal air or oxygen-enriched air (40% O ₂ ) in a double-blind, randomized within-subject design. Heart rate and ventilation were measured throughout the dive and maximum whole blood lactate samples were determined post-exercise. ANOVAs showed a significant effect for the factor breathing gas (F(1, 9)=7.52; P=0.023; η ²_p =0.455), with a lower ventilation for oxygen-enriched air during fin-swimming velocities of 0.6 m·s ⁻¹ (P=0.032) and 0.8 m·s ⁻¹ (P=0.037). Heart rate, lactate, and time to exhaustion showed no significant differences. These findings indicate decreased ventilation by an elevated oxygen fraction in the breathing gas when fin-swimming in shallow-water submersion with high velocity (>0.5 m·s ⁻¹ ). Applications are within involuntary underwater exercise or rescue scenarios for all dives with limited gas supply.

Effects of Hyperbaric Nitrogen Narcosis on Cognitive Performance in Recreational air SCUBA Divers: An Auditory Event-related Brain Potentials Study

BACKGROUND

The narcotic effect of hyperbaric nitrogen is most pronounced in air-breathing divers because it impairs diver's cognitive and behavioral performance, and limits the depth of dive profiles. We aimed to investigate the cognitive effects of simulated (500 kPa) air environments in recreational SCUBA divers, revealed by auditory event-related potentials (AERPs).

METHODS

A total of 18 healthy volunteer recreational air SCUBA divers participated in the study. AERPs were recorded in pre-dive, deep-dive, and post-dive sessions.

RESULTS

False-positive score variables were found with significantly higher differences and longer reaction times of hits during deep-dive and post-dive than pre-dive sessions. Also, P3 amplitudes were significantly reduced and peak latencies were prolonged during both deep-dive and post-dive compared with pre-dive sessions.

CONCLUSION

We observed that nitrogen narcosis at 500 kPa pressure in the dry hyperbaric chamber has a mild-to-moderate negative effect on the cognitive performance of recreational air SCUBA divers, which threatened the safety of diving. Although relatively decreased, this effect also continued in the post-dive sessions. These negative effects are especially important for divers engaged in open-sea diving. Our results show crucial implications for the kinds of control measures that can help to prevent nitrogen narcosis and diving accidents at depths up to 40 msw.

Physical Exercise Intensity During Submersion Selectively Affects Executive Functions

OBJECTIVE

The intact cognitive processing capacity in highly demanding and dynamically changing situations (e.g., in extreme environmental conditions) is of central relevance for personal safety. This study therefore investigated whether underwater physical exercise (PE) affected cognitive performance by comparing these effects during underwater fin-swimming as opposed to inactivity under normal environmental conditions.

BACKGROUND

Although acute bouts of PE can modulate cognitive performance under highly controlled and standardized laboratory conditions, no previous study has determined whether PE acutely modulates cognitive performance in non-laboratory testing conditions involving extreme environments (e.g., underwater).

METHOD

A total of 27 healthy volunteers (16 males and 11 females; 28.9 ± 7.4 years of age) participated in two experiments involving either moderate or high PE intensity. A PRE/POST crossover design was employed among participants while performing cognitive tests in a counterbalanced order (i.e., before and after 20 min of PE in submersion [WET] and once before and after inactivity [DRY] while in the laboratory). Cognitive performance was measured as a combination of executive functions through the Eriksen Flanker (inhibition) and Two-Back (working memory) Tasks using an underwater tablet computer.

RESULTS

ANOVAs revealed enhanced reaction times only in the Flanker test after moderate PE for the WET condition. No other effects were detected.

CONCLUSION

These findings indicate that cognitive performance is exercise-intensity-dependent with enhanced effects during moderate PE, even in extreme environments (i.e., underwater).

APPLICATION

These results should be relevant in recreational and occupational contexts involving underwater activity and may also apply to microgravity (e.g., during extra-vehicular activities).

DESCRIPTION

This study compared the acute effects of physical exercise (PE) on cognitive performance in an underwater environment while participants fin-swam with SCUBA (self-contained underwater breathing apparatus) gear. Findings revealed that 20 min of moderate PE positively affected cognitive performance (i.e., inhibitory control ability). However, no changes were observed after high-intensity exercise.

Case Studies in Physiology: Breath-hold diving beyond 100 meters-cardiopulmonary responses in world-champion divers

In this case study, we evaluate the unique physiological profiles of two world-champion breath-hold divers. At close to current world-record depths, the extreme physiological responses to both exercise and asphyxia during progressive elevations in hydrostatic pressure are profound. As such, these professional athletes must be capable of managing such stress, to maintain performing at the forefront human capacity. In both divers, pulmonary function before and after deep dives to 102 m and 117 m in the open sea was assessed using noninvasive pulmonary gas exchange (indexed via the O₂ deficit, which is analogous to the traditional alveolar to arterial oxygen difference), ultrasound B-line scores, airway resistance, and airway reactance. Hydrostatic-induced lung compression was also quantified via spirometry. Both divers successfully performed their dives. Pulmonary gas exchange efficiency was impaired in both divers at 10 min but had mostly restored within a few hours. Mild hemoptysis was transiently evident immediately following the 117-m dive, whereas both divers experienced nitrogen narcosis. Although B-lines were only elevated in one diver postdive, reductions in airway resistance and reactance occurred in both divers, suggesting that the compressive strain on the structural characteristics of the airways can persist for up to 3.5 h. Marked echocardiographic dyssynchrony was evident in one diver after 10 m of descent, which persisted until resolving at ∼77 m during ascent. In summary, despite the enormous hydrostatic and physiological stress to diving beyond 100 m on a single breath, these data provide valuable insight into the extraordinary capacity of those at the pinnacle of apneic performance.NEW & NOTEWORTHY This study shows that world-champion breath-hold divers demonstrate incredible tolerability to extreme levels of hydrostatic-induced lung compression. Immediately following dives to >100 m, there were acute impairments in pulmonary gas exchange efficiency, mild accummulation of extravascular lung fluid, noticable intrathoracic discomfort, and evident nitrogen narcosis, however, within a few hours, these had all mostly resolved.

Investigating critical flicker fusion frequency for monitoring gas narcosis in divers

INTRODUCTION

Critical flicker fusion frequency (CFFF) has been used in various studies to measure the cognitive effects of gas mixtures at depth, sometimes with conflicting or apparently paradoxical results. This study aimed to evaluate a novel automatic CFFF method and investigate whether CFFF can be used to monitor gas-induced narcosis in divers.

METHODS

Three hyperbaric chamber experiments were performed: 1) Automated and manual CFFF measurements during air breathing at 608 kPa (n = 16 subjects); 2) Manual CFFF measurements during air and heliox breathing at sea level (101.3 kPa) and 608 kPa (n = 12); 3) Manual CFFF measurements during oxygen breathing at sea level, 142 and 284 kPa (n = 10). All results were compared to breathing air at sea level.

RESULTS

Only breathing oxygen at sea level, and at 284 kPa, caused a significant decrease in CFFF (2.5% and 2.6% respectively compared to breathing air at sea level. None of the other conditions showed a difference with sea level air breathing.

CONCLUSIONS

CFFF did not significantly change in our experiments when breathing air at 608 kPa compared to air breathing at sea level pressure using both devices. Based on our results CFFF does not seem to be a sensitive tool for measuring gas narcosis in divers in our laboratory setting.

Assessment of sensory sensitivity through critical flicker fusion frequency thresholds after a maximum voluntary apnoea

INTRODUCTION

The influence of acute exercise on sensory sensitivity (SS) differs according to the type and duration of exercise performed. In the present study, we assessed changes on SS soon after a maximal dynamic apnoea.

METHODS

Thirty-nine experienced male breath-hold divers were recruited. Critical flicker fusion frequency (CFFF) thresholds were used to measure SS. Thresholds were determined before and after a maximal dynamic apnoea. Immediately after surfacing, heart rate and oxygen saturation (SpO₂) were recorded for two minutes.

RESULTS

After maximal dynamic apnoea, SpO₂ was significantly decreased (from mean 97.3% pre-dive to mean 63.1% post-dive; P < 0.0001; η2 P = 0.86), but this acute hypoxaemia did not trigger changes in SS (post-dive value 102% of baseline; P = 0.22; η2 P = 0.03). Pearson correlation analysis revealed a moderate association between SS with swimming speed (r = 0.423) and apnoea time (r = -0.404).

CONCLUSIONS

A maximal dynamic apnoea did not produce changes in central nervous system fatigue or cortical arousal. We found no relationship between the hypoxaemia level reached after a maximal apnoea and changes in the CFFF thresholds. This study suggests that the time of exposure to hypoxia during a maximal voluntary apnoea is not enough to produce changes in SS.

Early detection of diving-related cognitive impairment of different nitrogen-oxygen gas mixtures using critical flicker fusion frequency

INTRODUCTION

Cognitive impairment related to inert gas narcosis (IGN) is a threat to diving safety and operations at depth that might be reduced by using enriched air nitrox (EANx) mixtures. Using critical flicker fusion frequency (CFFF), a possible early detection of cognitive abilities/cerebral arousal impairment when breathing different oxygen (O2) fractions was investigated.

METHODS

Eight male volunteers performed, in random order, two dry chamber dives breathing either air or EANx40 (40% O₂-60% nitrogen) for 20 minutes (min) at 0.4 MPa. Cognition and arousal were assessed before the dive; upon arrival at 0.4 MPa; after 15 min exposure at 0.4 MPa; on surfacing and 30 min post-dive using behavioural computer-based testing psychology experiment building language (PEBL) and by CFFF while continuously recording brain oxygenation with near-infrared spectroscopy.

RESULTS

In both breathing conditions, CFFF and PEBL demonstrated a significant inverse correlation (Pearson r of -0.90, P < 0.0001), improved cognitive abilities/cerebral arousal occurred upon arrival at 0.4 MPa followed by a progressive deterioration. Initial brain activation was associated with a significant increase in oxyhaemoglobin (HbO2) and a simultaneous decrease of deoxyhaemoglobin (HHb). The magnitude of the changes was significantly greater under EANx (P = 0.038).

CONCLUSIONS

Since changes were not related to haemodynamic variables, HbO₂ and HHb values indicate a significant, O₂-dependent activation in the prefrontal cortex. Owing to the correlation with some tests from the PEBL, CFFF could be a convenient measure of cognitive performance/ability in extreme environments, likely under the direct influence of oxygen partial pressure, a potent modulator of IGN symptoms.

Inert gas narcosis in scuba diving, different gases different reactions

PURPOSE

Underwater divers face several potential neurological hazards when breathing compressed gas mixtures including nitrogen narcosis which can impact diver's safety. Various human studies have clearly demonstrated brain impairment due to nitrogen narcosis in divers at 4 ATA using critical flicker fusion frequency (CFFF) as a cortical performance indicator. However, recently some authors have proposed a probable adaptive phenomenon during repetitive exposure to high nitrogen pressure in rats, where they found a reversal effect on dopamine release.

METHODS

Sixty experienced divers breathing Air, Trimix or Heliox, were studied during an open water dive to a depth of 6 ATA with a square profile testing CFFF measurement before (T₀), during the dive upon arriving at the bottom (6 ATA) (T₁), 20 min of bottom time (T₂), and at 5 m (1.5 ATA) (T₃).

RESULTS

CFFF results showed a slight increase in alertness and arousal during the deep dive regardless of the gas mixture breathed. The percent change in CFFF values at T₁ and T₂ differed among the three groups being lower in the air group than in the other groups. All CFFF values returned to basal values 5 min before the final ascent at 5 m (T₃), but the Trimix measurements were still slightly better than those at T₀.

CONCLUSIONS

Our results highlight that nitrogen and oxygen alone and in combination can produce neuronal excitability or depression in a dose-related response.

Critical Flicker Fusion Frequency: A Marker of Cerebral Arousal During Modified Gravitational Conditions Related to Parabolic Flights

In situ evaluation of human brain performance and arousal remains challenging during operational circumstances, hence the need for a rapid, reliable and reproducible tool. Here we hypothesized that the Critical flicker fusion frequency (CFFF) reflecting/requiring visual integration, visuo-motor skills and decision-taking process might be a powerful, fast and simple tool in modified gravity environments. Therefore 11 male healthy volunteers were assessed for higher cognitive functions with CFFF during parabolic flights. They were assessed at different time points: upon arrival to the base, 30 min after subcutaneous scopolamine administration, before parabolas, during hypergravity and microgravity at break time (between the 16th and the 17th parabola), on the return flight and on the ground after landing. First, a stable, and consistent measurement of CFFF could be obtained within 12 s. Second, under modified gravitational conditions, the perceptual ability of participants is significantly modified. Compared to the baseline, evolution is characterized by a significant increase of CFFF when in microgravity (0g: 106.9 ± 5.5%), and a significant decrease of CFFF while in hypergravity (2g: 94.5 ± 3.8%). Other time-points were not statistically different from the baseline value. Although the underlying mechanism is still debated, we suggest that the CFFF test is a global marker of cerebral arousal as the result of visuo-motor and decision taking testing based on a simple visual stimulus with an uncomplicated set up that could be used under various environmental conditions. The authors express an opinion that it would be advisable to introduce CFFF measurement during spaceflights as it allows individual longitudinal assessment of individual ability even under conditions of incomplete physiological compensation, as shown here during parabolic flights.

Environmental Physiology and Diving Medicine

Man's experience and exploration of the underwater environment has been recorded from ancient times and today encompasses large sections of the population for sport enjoyment, recreational and commercial purpose, as well as military strategic goals. Knowledge, respect and maintenance of the underwater world is an essential development for our future and the knowledge acquired over the last few dozen years will change rapidly in the near future with plans to establish secure habitats with specific long-term goals of exploration, maintenance and survival. This summary will illustrate briefly the physiological changes induced by immersion, swimming, breath-hold diving and exploring while using special equipment in the water. Cardiac, circulatory and pulmonary vascular adaptation and the pathophysiology of novel syndromes have been demonstrated, which will allow selection of individual characteristics in order to succeed in various environments. Training and treatment for these new microenvironments will be suggested with description of successful pioneers in this field. This is a summary of the physiology and the present status of pathology and therapy for the field.

Effect of Cellular Mobile Phone Use and Cetrizine on Hand-Eye Coordination and Visual Acuity

INTRODUCTION

Cellular mobile phones are a major cause of distraction especially while driving. The aggressive and inappropriate use of cellular mobile phones has increased the risk of accidents. Similar alerts are available in literature for certain substances and drugs (e.g. second generation anti H1 drug -Cetirizine) which also derange psychomotor performance and parameters of alertness.

AIM

This study measured variations in hand-eye coordination and visual acuity due to use of cellular mobile phone in comparison to that of commonly used antihistaminic drug viz., single dose Cetirizine 10 mg.

MATERIALS AND METHODS

It was a single blind, single dose, interventional study, 100 healthy human volunteers divided into two groups. Baseline readings of all volunteers were noted. Group-I (n=50) was Cetirizine group (10mg orally stat), Group -II (n=50) Cellular mobile phone user group. Alertness was tested on hand- steadiness tester (Reaction Time Index = RTI) and on Flicker-fusion apparatus (visual acuity - Critical Flicker Fusion Frequency per second= CFFF/sec). Baseline readings of all volunteers were noted before intervention. Baseline was compared with readings at three hour post-intervention and was analysed by paired t-test. Inter-group comparison of parameters was also done and was analysed by unpaired t-test.

RESULTS

The baseline RTI (95.46±41.74, 85.11±39.05) and CFF low and high (40.07±9.970, 40.76±9.309 and 40.42±9.035, 40.48±9.863) respectively, in Cetirizine group and Mobile user group were comparable. The RTI increased significantly (116.4±51.46, 102.8±49.26) in both the groups after intervention. However, there is no significant change in CFF intensity from baseline in either group post-intervention.

CONCLUSION

Concurrent use of mobile phone while performing tasks, showed significant impairment of hand-steadiness which was comparable to that produced by single dose Cetirizine 10 mg and this may be one of the factors contributing to their close association with road traffic accidents.

Executive Functions of Divers Are Selectively Impaired at 20-Meter Water Depth

Moving and acting underwater within recreational or occupational activities require intact executive functions, since they subserve higher cognitive functions such as successful self-regulation, coping with novel situations, and decision making; all of which could be influenced by nitrogen narcosis due to elevated partial pressure under water. However, specific executive functions that could provide a differentiated view on humans' cognitive performance ability have not yet been systematically analyzed in full-water immersion, which is a research gap addressed within this approach to contribute to a better understanding of nitrogen narcosis. In this study, 20 young, healthy, and certified recreational divers participated and performed three different executive-function tests: the Stroop test (Inhibition), the Number/Letter test (Task switching), the 2-back test (Updating/Working memory), and a simple reaction time test (Psychomotor performance). These tests were performed once on land, at 5-meter (m) water depth, and at 20-meter (m) water depth of an indoor diving facility in standardized test conditions (26°C in all water depths). A water-proofed and fully operational tablet computer was used to present visual stimuli and to register reaction times. Performance of the simple reaction time test was not different between underwater and land testing, suggesting that reaction times were not biased by the utilization of the tablet in water immersion. Executive functions were not affected by the shallow water immersion of 5-m water depth. However, performance scores in 20-m water depth revealed a decreased performance in the incongruent test condition (i.e., an index of inhibitory control ability) of the Stroop test, while all other tests were unaffected. Even though only one out of the three tested cognitive domains was affected, the impairment of inhibitory control ability even in relatively shallow water of 20-m is a critical component that should be considered for diver's safety, since inhibition is required in self-control requiring situations where impulsive and automatic behavior must be inhibited. Our interpretation of these selective impairments is based on a discussion suggesting that different neural networks within the central nervous system, which process specific executive functions, are affected differently by nitrogen narcosis.

Diving Into Research of Biomedical Engineering in Scuba Diving

The physiologic response of the human body to different environments is a complex phenomenon to ensure survival. Immersion and compressed gas diving, together, trigger a set of responses. Monitoring those responses in real time may increase our understanding of them and help us to develop safety procedures and equipment. This review outlines diving physiology and diseases and identifies physiological parameters worthy of monitoring. Subsequently, we have investigated technological approaches matched to those in order to evaluated their capability for underwater application. We focused on wearable biomedical monitoring technologies, or those which could be transformed to wearables. We have also reviewed current safety devices, including dive computers and their underlying decompression models and algorithms. The review outlines the necessity for biomedical monitoring in scuba diving and should encourage research and development of new methods to increase diving safety.

The Application of Cortical Arousal Assessment to Control Neuromuscular Fatigue During Strength Training

The author's aim was to analyze the cortical arousal response during a conventional strength training session as a method to assess central nervous system fatigue. Sixteen trained men were recruited to perform the maximum number of training series composed of 6 exercises of 10 repetition each, at the intensity of 70% of the 1 maximum repetition, with a rest period of 2 min between exercises and 5 min between series, until exhaustion. Cortical arousal was measured using the critical flicker fusion threshold before, after warm-up, after each exercises series, after the recovery phase between series, and 15 min and 30 min after finishing the training session. Participants could not finish the fourth series of exercise, corresponding with a significant decrease of cortical arousal respect to the warm-up value. The assessment of cortical arousal using CFFT during a strength training session could be a fast and efficient method for assessing central nervous fatigue. Practically, coaches could modify the training protocol according to the individual cortical arousal response in order to improve training efficiency and prevent injuries.

Assessment of the interaction of hyperbaric N2, CO2, and O2 on psychomotor performance in divers

Diving narcosis results from the complex interaction of gases, activities, and environmental conditions. We hypothesized that these interactions could be separated into their component parts. Where previous studies have tested single cognitive tasks sequentially, we varied inspired partial pressures of CO₂, N₂, and O₂ in immersed, exercising subjects while assessing multitasking performance with the Multi-Attribute Task Battery II (MATB-II) flight simulator. Cognitive performance was tested under 20 conditions of gas partial pressure and exercise in 42 male subjects meeting U.S. Navy age and fitness profiles. Inspired nitrogen (N₂) and oxygen (O₂) partial pressures were 0, 4.5, and 5.6 ATA and 0.21, 1.0, and 1.22 ATA, respectively, at rest and during 100-W immersed exercise with and without 0.075-ATA CO₂ Linear regression modeled the association of gas partial pressure with task performance while controlling for exercise, hypercapnic ventilatory response, dive training, video game frequency, and age. Subjects served as their own controls. Impairment of memory, attention, and planning, but not motor tasks, was associated with N₂ partial pressures >4.5 ATA. Sea level O₂ at 0.925 ATA partially rescued motor and memory reaction time impaired by 0.075-ATA CO₂; however, at hyperbaric pressures an unexpectedly strong interaction between CO₂, N₂, and exercise caused incapacitating narcosis with amnesia, which was augmented by O₂ Perception of narcosis was not correlated with actual scores. The relative contributions of factors associated with diving narcosis will be useful to predict the effects of gas mixtures and exercise conditions on the cognitive performance of divers. The O₂ effects are consistent with O₂ narcosis or enhanced O₂ toxicity.

Heart rate variability and critical flicker fusion frequency changes during and after parachute jumping in experienced skydivers

PURPOSE

The purpose of this study was (1) to further explore the heart rate dynamics and assess a potential cardiovascular risk in response to 4000 m jumps in experienced skydivers; (2) to assess whether there is an impact of such jumps on skydivers' cortical arousal or not, which may impact their decision making processes.

METHOD

18 experienced skydivers performed successive jumps from a plane at 4000 m of height. Heart rate dynamics and cortical arousal were assessed by the use of heart rate variability and Critical Flicker Fusion Frequency (CFFF), respectively.

RESULTS

CFFF did not differ between the three measurement time points (p > 0.05). Mean heart rate increased during the jump (p < 0.001) and came back to pre-jump values after the jump (p < 0.001). Percentage of the differences of successive NN intervals greater than 50 ms (pNN50) decreased during the jump (p < 0.001) and kept lower values after the jump compared to pre-jump (p < 0.05). High-frequency power (HF) did not differ during the jump (p > 0.05) but decreased after the jump compared to both pre-jump (p < 0.01) and jump (p < 0.05). Sample entropy decreased during the jump (p < 0.001) and came back to pre-jump values after the jump (p > 0.05).

CONCLUSION

These results confirm a vagal input reduction associated with a rise of the sympathetic tone during the jump and suggests that the experienced skydiver is not exposed to a high cardiovascular risk. This study also shows that environmental stresses induced by free fall could not hamper the perceptual vigilance of experienced skydivers.

Effect of oxygen on neuronal excitability measured by critical flicker fusion frequency is dose dependent

INTRODUCTION

Reactive oxygen species are involved in the functional changes necessary for synaptic plasticity, memory, and cognitive function. It is far from clear whether the increased excitability, and which forms of neuronal excitability, should be considered a part of the learning process or, rather, cellular manifestation of neuronal oxygen poisoning. It is yet to be elucidated whether oxygen (O2)-induced learning and poisoning use the same or distinct cellular pathways.

PURPOSE

We hypothesized that O2-induced neuronal excitability might use the same or an intertwined signaling cascade as the poisoning cellular pathway.

METHOD

Eighty-one healthy, young males, mean age 27.7 ± 4.1 (SD) years, were exposed in the hyperbaric chamber to 0.7 atmosphere absolute (ATA) O2, 1.4 ATA O2, and 2.8 ATA O2. The critical flicker fusion frequency (CFFF), oxyhemoglobin saturation (SiO2), and heart rate (HR) were measured before exposure, after 30 min of oxygen breathing while still at pressure and then after exposure.

RESULTS

Normobaric (0.7 ATA) O2 exposure did not affect CFFF and HR. Medium hyperbaric O2 exposure (1.4 ATA) decreased CFFF but HR remained unchanged. High hyperbaric O2 exposure (2.8 ATA) increased CFFF and diminished HR. SiO2 was similar in all investigated groups. A correlation between CFFF, HR, and SiO2 was observed only at low oxygen (0.7 ATA).

CONCLUSIONS

The effect of O2 on neuronal excitability measured by CFFF in young healthy men was dose dependent: 0.7 ATA O2 did not affect CFFF; CFFF were significantly jeopardized at 1.4 ATA O2, while CFFF recovered at 2.8 ATA. With 2.8 ATA O2, the CFFF and oxygen poisoning transduction pathways seemed to be intertwined.

Moving in extreme environments: inert gas narcosis and underwater activities

Exposure to the underwater environment for pleasure or work poses many challenges on the human body including thermal stress, barotraumas, decompression sickness as well as the acute effects of breathing gases under pressure. With the popularity of recreational self-contained underwater breathing apparatus (SCUBA) diving on the increase and deep inland dive sites becoming more accessible, it is important that we understand the effects of breathing pressurised gas at depth can have on the body. One of the common consequences of hyperbaric gas is the narcotic effect of inert gas. Nitrogen (a major component of air) under pressure can impede mental function and physical performance at depths of as little as 10 m underwater. With increased depth, symptoms can worsen to include confusion, disturbed coordination, lack of concentration, hallucinations and unconsciousness. Narcosis has been shown to contribute directly to up to 6% of deaths in divers and is likely to be indirectly associated with other diving incidents at depth. This article explores inert gas narcosis, the effect on divers' movement and function underwater and the proposed physiological mechanisms. Also discussed are some of the factors that affect the susceptibility of divers to the condition. In conclusion, understanding the cause of this potentially debilitating problem is important to ensure that safe diving practices continue.

Physiological changes in response to apnea impact the timing of motor representations: a preliminary study

Background

Reduced physiological arousal in response to breath-holding affects internal clock processes, leading swimmers to underestimate the time spent under apnea. We investigated whether reduced physiological arousal during static apnea was likely to affect the temporal organization of motor imagery (MI).

Methods

Fourteen inter-regional to national breath-holding athletes mentally and physically performed two 15 m swimming tasks of identical durations. They performed the two sequences in a counterbalanced order, the first while breathing normally using a scuba, the second under apnea. We assessed MI duration immediately after completion of the corresponding task. Athletes performed MI with and without holding breath.

Results

MI durations (26.1 s ± 8.22) were significantly shorter than actual durations (29.7 s ± 7.6) without holding breath. Apnea increased MI durations by 10% (± 5%). Heart rate decrease in response to breath-holding correlated with MI durations increase (p < .01). Under apnea, participants achieved temporal congruence between MI and PP only when performing MI of the apnea swimming task. Self-report data indicated greater ease when MI was performed in a physiological arousal state congruent with that of the corresponding motor task.

Conclusions

Physiological arousal affected the durations of MI through its effects on internal clock processes and by impacting the congruency in physiological body states between overt and covert motor performance. Present findings have potential implications with regards to the possibility of preventing underestimation of durations spent under a state of reduced physiological arousal.