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  • 1.
    Hjelte, Carl
    et al.
    Lund University.
    Plogmark, Oskar
    Lund University .
    Silvanius, Mårten
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences. Swedish Armed Forces Diving and Naval Medicine Center.
    Ekström, Magnus
    Lund University.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Risk assessment of SWEN21 a suggested new dive table for the Swedish armed forces: bubble grades by ultrasonography2023In: Diving and Hyperbaric Medicine, ISSN 1833-3516, Vol. 53, no 4, p. 299-305Article in journal (Refereed)
    Abstract [en]

    Introduction: To develop the diving capacity in the Swedish armed forces the current air decompression tables are under revision. A new decompression table named SWEN21 has been created to have a projected risk level of 1% for decompression sickness (DCS) at the no stop limits. The aim of this study was to evaluate the safety of SWEN21 through the measurement of venous gas emboli (VGE) in a dive series. Methods: A total 154 dives were conducted by 47 divers in a hyperbaric wet chamber. As a proxy for DCS risk serial VGE measurements by echocardiography were conducted and graded according to the Eftedal-Brubakk scale. Measurements were done every 15 minutes for approximately 2 hours after each dive. Peak VGE grades for the different dive profiles were used in a Bayesian approach correlating VGE grade and risk of DCS. Symptoms of DCS were continually monitored. Results: The median (interquartile range) peak VGE grade after limb flexion for a majority of the time-depth combinations, and of SWEN21 as a whole, was 3 (3-4) with the exception of two decompression profiles which resulted in a grade of 3.5 (3-4) and 4 (4-4) respectively. The estimated risk of DCS in the Bayesian model varied between 4.7-11.1%. Three dives (2%) resulted in DCS. All symptoms resolved with hyperbaric oxygen treatment. Conclusions: This evaluation of the SWEN21 decompression table, using bubble formation measured with echocardiography, suggests that the risk of DCS may be higher than the projected 1%. Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

  • 2.
    Kjellberg, Anders
    et al.
    Karolinska, SWE.
    Douglas, Johan
    Blekingesjukhuset, SWE.
    Pawlik, Michael
    Catholic Charities Hosp, DEU.
    Kraus, Michael
    Bergmannsheil & Kinderklin Buer GmbH, DEU.
    Oscarsson, Nicklas
    Göteborgs University, SWE.
    Zheng, Xiaowei
    Karolinska, SWE.
    Bergman, Peter
    Karolinska, SWE.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering. Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Kowalski, Jan
    JK Biostat AB, SWE.
    Nyren, Sven Paul
    Karolinska, SWE.
    Silvanius, Mårten
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences. SwAF Diving and Naval Medicine Centre, Swedish Armed Forces, Karlskrona,.
    Sköld, Magnus
    Karolinska, SWE.
    Catrina, Sergiu-Bogdan
    Karolinska, SWE.
    Rodriguez-Wallberg, Kenny
    Karolinska, SWE.
    Lindholm, Peter
    Karolinska, SWE.
    Randomised, controlled, open label, multicentre clinical trial to explore safety and efficacy of hyperbaric oxygen for preventing ICU admission, morbidity and mortality in adult patients with COVID-192021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 7, article id e046738Article in journal (Refereed)
    Abstract [en]

    Introduction COVID-19 may cause severe pneumonitis and trigger a massive inflammatory response that requires ventilatory support. The intensive care unit (ICU)-mortality has been reported to be as high as 62%. Dexamethasone is the only of all anti-inflammatory drugs that have been tested to date that has shown a positive effect on mortality. We aim to explore if treatment with hyperbaric oxygen (HBO) is safe and effective for patients with severe COVID-19. Our hypothesis is that HBO can prevent ICU admission, morbidity and mortality by attenuating the inflammatory response. The primary objective is to evaluate if HBO reduces the number of ICU admissions compared with best practice treatment for COVID-19, main secondary objectives are to evaluate if HBO reduces the load on ICU resources, morbidity and mortality and to evaluate if HBO mitigates the inflammatory reaction in COVID-19. Methods and analysis A randomised, controlled, phase II, open label, multicentre trial. 200 subjects with severe COVID-19 and at least two risk factors for mortality will be included. Baseline clinical data and blood samples will be collected before randomisation and repeated daily for 7 days, at days 14 and 30. Subjects will be randomised with a computer-based system to HBO, maximum five times during the first 7 days plus best practice treatment or only best practice treatment. The primary endpoint, ICU admission, is defined by criteria for selection for ICU. We will evaluate if HBO mitigates the inflammatory reaction in COVID-19 using molecular analyses. All parameters are recorded in an electronic case report form. An independent Data Safety Monitoring Board will review the safety parameters. Ethics and dissemination The trial is approved by The National Institutional Review Board in Sweden (2020-01705) and the Swedish Medical Product Agency (5.1-2020-36673). Positive, negative and any inconclusive results will be published in peer-reviewed scientific journals with open access.

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    Randomised, controlled, open label, multicentre clinical trial
  • 3.
    Olsson, Andreas
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Kulesza, Wlodek
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    A New Method for As-built Burial Risk Assessment for Subsea Cables2022In: SyNERGY MED 2022 - 2nd International Conference on Energy Transition in the Mediterranean Area, Proceedings, Institute of Electrical and Electronics Engineers (IEEE), 2022Conference paper (Refereed)
    Abstract [en]

    A new method using burial measurements for risk assessment of subsea cable installations is proposed. Only methods comparing the design boundaries have previously been used to verify subsea cable installments. The disadvantage of utilizing design boundaries is the possibility of not fulfilling the risk requirements since the assumed burial depth of the cable and its measurement data can differ, leading to the challenge of assessing how the difference and its uncertainty affect burial risk. We proposed and tested the method for a scenario using seagoing vessel traffic data and sensor characteristics. The analysis is limited to white measurement noise but shows a deviation in risk estimation between the design-and measurement-based assessments. The presented result enables the approximation of the risk assessment for projects of varying specifications. The proposed statistical method is a less conservative way to assess the correct installment of a cable and possibly to evaluate verification specifications. © 2022 IEEE.

  • 4.
    Olsson, Andreas
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Kulesza, Wlodek
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    An Improvement of Assessing As-built Burial Risk for Subsea Cables2022In: SyNERGY MED 2022 - 2nd International Conference on Energy Transition in the Mediterranean Area, Proceedings, Institute of Electrical and Electronics Engineers (IEEE), 2022Conference paper (Refereed)
    Abstract [en]

    Available methods using the burial measurements to assess the subsea cable installations risks compare measurements to the design boundaries. The disadvantage of using this is that the assumed cable burial depths and their measurements can differ. However, it is unclear how the uncertainty in depth affects burial risk; hence, there is a need to verify the burial operations using a proper method to handle this aspect of risk reliability. We proposed a conservative cable burial scenario test, which evaluates the highest deviation between the measured risk and the design risk to indicate differences in risk based on the measurements. The result shows that the most significant deviation could be up to 55%. It proves that measurement uncertainty significantly affects the final risk evaluation. Moreover, this deviation in verifiable risk is not considered in today's boundary-level verification methodology. © 2022 IEEE.

  • 5.
    Olsson, Andreas
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Hassellöv, Ida-Maja
    Chalmers University of Technology.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Strategic development of environmental impact assessment decision support tool for offshore energy enables decreased costs, increased utilization, and quality2023In: Sustainable Energy Technologies and Assessments, ISSN 2213-1388, E-ISSN 2213-1396, Vol. 60, article id 103493Article in journal (Refereed)
    Abstract [en]

    In the transition to a sustainable energy system, there is an urgent need for expansion of offshore renewable energy installations. To ensure sustainable development also with respect to the marine environment, a variety of decision support tools (DSTs) are currently under development, aiming at potentially increased quality and efficiency for environmental risk assessment (EIA) of planned offshore energy installations. However, the savings potential of a DSTs is to a large extent governed by the timing of the DST development, which in turn is directly dependent on the investment rate over time. A set of development scenarios were evaluated, simulating different degrees of strategic implementation and successful utilization of the DST for offshore energy. Using the situation in Sweden as a case study, we demonstrate that a planned investment can lead to considerably lower total costs for the EIA at a national level, at the same time allowing for improved quality of the EIA in line with the ambitions in both marine spatial planning and existing goals within marine environmental management. © 2023 The Author(s)

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  • 6.
    Plogmark, Oscar
    et al.
    Lund University.
    Hjelte, Carl
    Lund University.
    Ekström, Magnus
    Lund University.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Agreement between ultrasonic bubble grades using a handheld self-positioning Doppler product and 2D cardiac ultrasound2022In: Diving and Hyperbaric Medicine, ISSN 1833-3516, Vol. 52, no 4, p. 281-285Article in journal (Refereed)
    Abstract [en]

    Introduction: Intravascular bubble load after decompression can be detected and scored using ultrasound techniques that measure venous gas emboli (VGE). The aim of this study was to analyse the agreement between ultrasonic bubble grades from a handheld self-positioning product, the O’Dive™, and cardiac 2D ultrasound after decompression. Methods: VGE were graded with both bilateral subclavian vein Doppler ultrasound (modified Spencer scale) and 2D cardiac images (Eftedal Brubakk scale). Agreement was analysed using weighted kappa (Kw ). Analysis with Kw was made for all paired grades, including measurements with and without zero grades, and for each method’s highest grades after each dive. Results: A total of 152 dives yielded 1,113 paired measurements. The Kw agreement between ultrasound VGE grades produced by cardiac 2D images and those from the O’Dive was ‘fair’; when zero grades were excluded the agreement was ‘poor’. The O’Dive was found to have a lower sensitivity to detect VGE compared to 2D cardiac image scoring. Conclusions: Compared to 2D cardiac image ultrasound, the O’Dive yielded generally lower VGE grades, which resulted in a low level of agreement (fair to poor) with Kw . © South Pacific Underwater Medicine Society and the European Underwater and Baromedical Society.

  • 7.
    Plogmark, Oscar
    et al.
    Lund University.
    Hjelte, Carl
    Lund University.
    Ekström, Magnus
    Lund University.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Response to Metelkina and Barbaud2023In: Diving and Hyperbaric Medicine, ISSN 1833-3516, Vol. 53, no 3Article in journal (Other academic)
  • 8.
    Plogmark, Oscar
    et al.
    Lund University.
    Silvanius, Mårten
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Olsson, Max
    Lund University.
    Hjelte, Carl
    Lund University.
    Ekström, Magnus
    Lund University.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Measuring whole body inert gas wash-out2023In: Diving and Hyperbaric Medicine, ISSN 1833-3516, Vol. 53, no 4, p. 321-326Article in journal (Refereed)
    Abstract [en]

    Introduction: Quantifying inert gas wash-out is crucial to understanding the pathophysiology of decompression sickness. In this study, we developed a portable closed-circuit device for measuring inert gas wash-out and validated its precision and accuracy both with and without human subjects. Methods: We developed an exhalate monitor with sensors for volume, temperature, water vapor and oxygen. Inert gas volume was extrapolated from these inputs using the ideal gas law. The device's ability to detect volume differences while connected to a breathing machine was analysed by injecting a given gas volume eight times. One hundred and seventy-two coupled before-and-after measurements were then compared with a paired t-test. Drift in measured inert gas volume during unlabored breathing was evaluated in three subjects at rest using multilevel linear regression. A quasi-experimental cross-over study with the same subjects was conducted to evaluate the device's ability to detect inert gas changes in relation to diving interventions and simulate power. Results: The difference between the injected volume (1,996 ml) and the device's measured volume (1,986 ml) was -10 ml. The 95% confidence interval (CI) for the measured volume was 1,969 to 2,003 ml. Mean drift during a 43 min period of unlaboured breathing was -19 ml, (95% CI, -37 to -1). Our power simulation, based on a cross-over study design, determined a sample size of two subjects to detect a true mean difference of total inert gas wash-out volume of 100 ml. Conclusions: We present a portable device with acceptable precision and accuracy to measure inert gas wash-out differences that may be physiologically relevant in the pathophysiology of decompression sickness. Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

  • 9.
    Silvanius, Mårten
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Franberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences. Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering.
    Permeability properties of a pressure induced compacted polymer liner in gas cylinder2021In: Journal of Applied Polymer Science, ISSN 0021-8995, E-ISSN 1097-4628, Vol. 138, no 18, article id 50335Article in journal (Refereed)
    Abstract [en]

    The permeability properties of composite gas cylinders for breathing gas with polymer inner-liner are investigated. The cylinder wall can be described as a composite membrane consisting of two layers. The permeability properties of the cylinder are presented as permeability coefficient and permselectivity. Deviation from the expected gas components might lead to incidents and potentially harmful situations when breathing gas from a compressed gas cylinder. Hence, gas permeability and potential changes in gas composition, must be considered when choosing cylinder materials. Cases of decompression sickness initiated this study. Experimental data show that pressure and oxygen fraction in the gas cylinder drops and that the permeability coefficient varies depending on the inner pressure. Permeability coefficients of 0.62–0.90 Barrer for oxygen and 0.44–0.56 Barrer for nitrogen are measured. Cracks in the inner-liner have caused an accentuated drop in of oxygen fraction and pressure. © 2020 The Authors. Journal of Applied Polymer Science published by Wiley Periodicals LLC.

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  • 10.
    Silvanius, Mårten
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    PPO2 sensor authentication for electronic closed circuit rebreathers2017Patent (Other (popular science, discussion, etc.))
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  • 11.
    Silvanius, Mårten
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Safety algorithm for predicting PO2 in electronic closed circuit rebreathers2016Other (Other (popular science, discussion, etc.))
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  • 12.
    Silvanius, Mårten
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering. Swedish Armed Forces Diving and Naval Medicine Centre, Karlskrona, SWE.
    Mitchell, Simon
    University of Auckland, NZL.
    Pollock, Neal
    Université Laval Québec, CAN.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering.
    Gennser, Mikael
    KTH.
    Lindén, Jerry
    Swedish Armed Forces Diving and Naval Medicine Centre, SWE.
    Mesley, Peter
    Lust for Rust Diving, NZL.
    Gant, Nicholas
    University of Auckland, NZL.
    The performance of 'temperature stick' carbon dioxide absorbent monitors in diving rebreathers2019In: Diving and Hyperbaric Medicine, ISSN 1833-3516, Vol. 49, no 1, p. 48-56Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Diving rebreathers use canisters containing soda lime to remove carbon dioxide (CO2) from expired gas. Soda lime has a finite ability to absorb CO₂. Temperature sticks monitor the exothermic reaction between CO₂ and soda lime to predict remaining absorptive capacity. The accuracy of these predictions was investigated in two rebreathers that utilise temperature sticks. METHODS: Inspiration and rEvo rebreathers filled with new soda lime were immersed in water at 19°C and operated on mechanical circuits whose ventilation and CO₂-addition parameters simulated dives involving either moderate exercise (6 MET) throughout (mod-ex), or 90 minutes of 6 MET exercise followed by 2 MET exercise (low-ex) until breakthrough (inspired PCO₂ [PiCO₂] = 1 kPa). Simulated dives were conducted at surface pressure (sea-level) (low-ex: Inspiration, n = 5; rEvo, n = 5; mod-ex: Inspiration, n = 7, rEvo, n = 5) and at 3-6 metres' sea water (msw) depth (mod-ex protocol only: Inspiration, n = 8; rEvo, n = 5). RESULTS: Operated at surface pressure, both rebreathers warned appropriately in four of five low-ex tests but failed to do so in the 12 mod-ex tests. At 3-6 msw depth, warnings preceded breakthrough in 11 of 13 mod-ex tests. The rEvo warned conservatively in all five tests (approximately 60 minutes prior). Inspiration warnings immediately preceded breakthrough in six of eight tests, but were marginally late in one test and 13 minutes late in another. CONCLUSION: When operated at even shallow depth, temperature sticks provided timely warning of significant CO₂ breakthrough in the scenarios examined. They are much less accurate during simulated exercise at surface pressure. Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

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  • 13.
    Silvanius, Mårten
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Rullgård, Hans
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Ekström, Magnus
    Lund University.
    Frånberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Proposed Thalmann algorithm air diving decompression table for the Swedish Armed Forces2023In: Undersea & Hyperbaric Medicine, ISSN 1066-2936, Vol. 50, no 2, p. 67-83Article in journal (Refereed)
    Abstract [en]

    The Swedish Armed Forces (SwAF) air dive tables are under revision. Currently, the air dive table from the U.S. Navy (USN) Diving Manual (DM) Rev. 6 is used with an msw-to-fsw conversion. Since 2017, the USN has been diving according to USN DM rev. 7, which incorporates updated air dive tables derived from the Thalmann Exponential Linear Decompression Algorithm (EL-DCM) with VVAL79 parameters. The SwAF decided to replicate and analyze the USN table development methodology before revising their current tables. The ambition was to potentially find a table that correlates with the desired risk of decompression sickness.  New compartmental parameters for the EL-DCM algorithm, called SWEN21B, were developed by applying maximum likelihood methods on 2,953 scientifically controlled direct ascent air dives with known outcomes of decompression sickness (DCS). The targeted probability of DCS for direct ascent air dives was ≤1% overall and ≤1‰ for neurological DCS (CNS-DCS). One hundred fifty-four wet validation dives were performed with air between 18 to 57 msw. Both direct ascent and decompression stop dives were conducted, resulting in incidences of two joint pain DCS (18 msw/59 minutes), one leg numbness CNS-DCS (51 msw/10 minutes with deco-stop), and nine marginal DCS cases, such as rashes and itching. A total of three DCS incidences, including one CNS-DCS, yield a predicted risk level (95% confidence interval) of 0.4-5.6% for DCS and 0.0-3.6% for CNS-DCS. Two out of three divers with DCS had patent foramen ovale. The SWEN21 table is recommended for the SwAF for air diving as it, after results from validation dives, suggests being within the desired risk levels for DCS and CNS-DCS. Copyright© Undersea and Hyperbaric Medical Society.

  • 14.
    Sundblad, Patrik
    et al.
    KTH, SWE.
    Franberg, Oskar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering.
    Siebenmann, Christoph
    KTH, SWE.
    Gennser, Mikael
    KTH, SWE.
    Measuring Uptake and Elimination of Nitrogen in Humans at Different Ambient Pressures2016In: Aerospace Medicine and Human Performance, ISSN 2375-6314, Vol. 87, no 12, p. 1045-1050Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To measure nitrogen (N-2) wash-out and uptake requires elaborate set-ups, especially when doing the measurements at increased or decreased ambient pressure. Here we present a transportable device for quantifying N-2 turnover in humans which can be used at different ambient pressures. METHODS: A modified close-circuit electronic rebreather was used to assess N-2 turnover. Changes in N-2 volume within the rebreathing circuit, reflecting N-2 uptake or washout, were derived from the continuously monitored total system volume and the calculated volumes of oxygen and water vapor. The calculation of continuous N-2 volume curves was performed off-line using dedicated computer software. RESULTS: Four subjects participated in the proof-of-concept tests. At steady state, the drift in calculated N-2 volume in the rebreathing circuit over a 1-h duration was minimal. Three of the subjects participated in additional N-2 steady-state measurements where 1019 mL (BTPD) of N-2 was injected into the rebreathing circuit over 20 min and the measured volume increase was 1006 +/- 32 mL. Lastly, N-2 elimination was assessed during decompression to 0.5 atm and while breathing hyperoxic gas. N-2 uptake was measured during compression to 1.8 atm. The elimination and uptake curves were deemed to be realistic. DISCUSSION: A method for assessing N-2 turnover in humans has been developed and a first evaluation has been performed. It is easy to work with operationally and can be used at different ambient pressures. More research is needed in order to further validate it as a method for assessing N-2 turnover in humans.

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