{"id":24713,"date":"2023-06-12T11:50:52","date_gmt":"2023-06-12T15:50:52","guid":{"rendered":"https:\/\/world.dan.org\/?post_type=dan_alert_diver&p=24713"},"modified":"2023-07-20T17:30:48","modified_gmt":"2023-07-20T21:30:48","slug":"petar-denoble-solving-practical-issues-for-divers","status":"publish","type":"dan_alert_diver","link":"https:\/\/world.dan.org\/fr\/alert-diver\/article\/petar-denoble-solving-practical-issues-for-divers\/","title":{"rendered":"Petar Denoble : R\u00e9soudre les probl\u00e8mes pratiques des plongeurs"},"content":{"rendered":"

PETAR DENOBLE, MD, D.SC., A CONSACRE SA CARRIERE A LA RECHERCHE ET AU DEVELOPPEMENT.<\/strong> \u00e0 l'exploration et \u00e0 la r\u00e9solution de probl\u00e8mes pratiques dans le domaine de la m\u00e9decine de plong\u00e9e. N\u00e9 en Croatie, il a appris \u00e0 nager tr\u00e8s t\u00f4t et a pass\u00e9 une grande partie de son temps libre \u00e0 faire de la plong\u00e9e en apn\u00e9e et \u00e0 p\u00eacher dans la mer Adriatique. Dipl\u00f4m\u00e9 de l'\u00e9cole de m\u00e9decine de l'universit\u00e9 de Zagreb, Denoble s'est ensuite engag\u00e9 dans la marine yougoslave pour se consacrer \u00e0 la m\u00e9decine de plong\u00e9e. <\/p>\n\n\n\n

Comment avez-vous commenc\u00e9 \u00e0 travailler chez DAN ?<\/h3>\n\n\n\n

\u00c0 27 ans, j'ai pass\u00e9 un entretien pour un internat en m\u00e9decine interne et j'ai appris l'existence de l'Institut de plong\u00e9e navale de l'ancienne marine yougoslave. J'ai \u00e9t\u00e9 impressionn\u00e9 par le d\u00e9partement hyperbare, leur \u00e9quipement de pointe et ce qu'ils faisaient. Je me suis engag\u00e9 dans la marine, non pas par enthousiasme pour l'arm\u00e9e, mais parce que je voulais suivre la voie de la m\u00e9decine de plong\u00e9e. <\/p>\n\n\n\n

Pendant trois ans, j'ai prodigu\u00e9 des soins m\u00e9dicaux, enseign\u00e9 la physiologie et la m\u00e9decine de la plong\u00e9e, pass\u00e9 de nombreux jours et nuits en mer \u00e0 veiller \u00e0 la s\u00e9curit\u00e9 des plongeurs et \u00e0 plonger moi-m\u00eame lorsque tous les autres plongeurs \u00e9taient hors de l'eau. J'ai ensuite effectu\u00e9 une r\u00e9sidence en m\u00e9decine navale et de plong\u00e9e, des \u00e9tudes de troisi\u00e8me cycle et une th\u00e8se de doctorat en physiologie de la plong\u00e9e.<\/p>\n\n\n\n

While watching combat divers\u2019 strenuous training, which not all candidates could complete, I started thinking about measuring the physiological cost of their activities and specific predictors of the suitability of candidates. When I transferred to a hyperbaric department and started my residency in naval and dive medicine, I was involved with a variety of practical research and the treatment of injured divers. Most cases were recreational divers with severe forms of decompression sickness (DCS). Observing frequent residual disability in severely injured divers furthered my interest in the prevention of dive injuries.<\/p>\n\n\n\n

J'ai rejoint le DAN fin 1991, gr\u00e2ce \u00e0 Peter Bennett, et j'ai travaill\u00e9 sous la direction de Richard Vann, qui \u00e9tait professeur au Duke Center for Hyperbaric Medicine and Environmental Physiology et directeur de recherche \u00e0 temps partiel au DAN. Alors que le DAN menait d\u00e9j\u00e0 des recherches, la plupart dans le laboratoire environnemental F.G. Hall de Duke, je suis devenu le premier chercheur \u00e0 plein temps du DAN en f\u00e9vrier 1992, marquant ainsi le d\u00e9but officiel du d\u00e9partement de recherche du DAN.<\/p>\n\n\n\n

\n
\n

Quel est le projet dont vous \u00eates le plus fier ou auquel vous pensez le plus ?<\/h3>\n\n\n\n

J'aime les \u00e9tudes qui visent \u00e0 r\u00e9soudre des probl\u00e8mes pratiques pour les plongeurs, c'est pourquoi j'appr\u00e9cie particuli\u00e8rement deux projets du DAN : la base de donn\u00e9es sur les blessures et les d\u00e9c\u00e8s en plong\u00e9e et le projet Exploration en plong\u00e9e. <\/p>\n\n\n\n

You may think that after centuries of diving we would know everything about what dive injuries can look like, but that\u2019s not the case. Our mental model of decompression illness is quite simplified. Even artificial intelligence (AI) would have difficulties diagnosing DCS in real time because of the gaps in our knowledge. By working on a qualitative and quantitative description of DCS, we help improve our diagnostic abilities.<\/p>\n\n\n\n

It\u2019s also important to know how exposure affects the outcome. You\u2019ll hear divers claim that because they didn\u2019t breach standards set by decompression tables or their dive computer that their symptoms couldn\u2019t be DCS, but that isn\u2019t true. We know that there is a continuum of DCS risk from minimal to fatal. The risk is more predictable in severe decompression exposure than in relatively innocuous diving, like recreational diving should be. Yet we\u2019ve witnessed that even in recreational diving, DCS can be unpredictably severe. <\/p>\n\n\n\n

Nous avons lanc\u00e9 le projet Exploration de la plong\u00e9e (PDE) en 1995 afin de collecter des donn\u00e9es sur la mani\u00e8re dont les plongeurs de loisir plongent et sur la fr\u00e9quence de leur DCS. Le PDE a \u00e9t\u00e9 g\u00e9r\u00e9 efficacement avec l'aide de nombreux b\u00e9n\u00e9voles et de l'industrie de la plong\u00e9e. Les fabricants d'ordinateurs de plong\u00e9e ont eu la gentillesse de modifier leurs logiciels afin que nous puissions r\u00e9cup\u00e9rer leurs donn\u00e9es. Il \u00e9tait important de disposer d'informations pr\u00e9cises sur l'exposition \u00e0 la plong\u00e9e afin de pouvoir \u00e9tablir un lien avec les r\u00e9sultats. Auparavant, nous ne disposions que d'ou\u00ef-dire et de rapports non v\u00e9rifi\u00e9s sur les blessures caus\u00e9es par telle ou telle plong\u00e9e. D\u00e9sormais, nous sommes en mesure d'obtenir des donn\u00e9es r\u00e9elles et objectives et de mesurer l'exposition \u00e0 la plong\u00e9e. <\/p>\n\n\n\n

Les ordinateurs de plong\u00e9e \u00e9tant nouveaux sur le march\u00e9, nous avions besoin d'outils pour examiner les donn\u00e9es qu'ils pouvaient collecter. \u00c0 l'\u00e9poque, DAN n'avait pas les moyens d'engager des professionnels de l'informatique. Il m'incombait donc de cr\u00e9er une application permettant de t\u00e9l\u00e9charger des profils de plong\u00e9e, de collecter des rapports post-plong\u00e9e et de les combiner avec les informations recueillies avant la plong\u00e9e. Je connaissais un peu l'anglais, mais pas du tout la programmation. J'ai donc re\u00e7u quelques conseils d'un ami comp\u00e9tent et j'ai appris le reste tout seul. C'\u00e9tait un travail fastidieux, surtout en ce qui concerne le d\u00e9bogage. Je n'ai jamais vraiment aim\u00e9 cela, mais c'\u00e9tait une partie importante du travail. <\/p>\n\n\n\n

Despite all the difficulties, we learned a lot of things. We confirmed that DCS is quite rare in recreational diving and established a baseline of incidence. We also confirmed that the exposure\u2013outcome relationship is highly variable and that we would need more research to identify the drivers of that variability.<\/p>\n\n\n\n

Quel est le r\u00f4le des collaborateurs et des b\u00e9n\u00e9voles de DAN ?<\/h3>\n\n\n\n

We\u2019ve always relied on volunteers. It\u2019s hard to establish a highly skilled lab with high capabilities to study multiple fields. Labs are usually specialized, but at DAN we don\u2019t focus on only one issue or topic. We\u2019re looking at the needs of divers in a broad sense. From doctors and physiologists to engineers and IT specialists, we need to collaborate with experts in various fields of research that align with our interests. We often are not the researcher ourselves \u2014 we\u2019re the coordinator or inspirator of studies. <\/p>\n\n\n\n

In a small organization such as DAN, we have to pick our fights and choose what we can do. I mostly worked on monitoring injuries and fatalities \u2014 trying to learn what issues need attention, engagement, and research. We would also run some studies that encompassed \u201corphan\u201d issues that nobody could address at that time except for DAN. <\/p>\n\n\n\n

The Flying After Diving research, for example, was a huge and expensive experimental study. With DAN\u2019s support under Richard Vann, the participation of the entire Duke lab, and volunteer divers, the study lasted for years. In the end, we developed and published results that improved our knowledge of the risks of flying after diving and DCS prevention.<\/p>\n\n\n\n

Quelles sont les strat\u00e9gies d'att\u00e9nuation des risques les plus efficaces pour les plongeurs sous-marins ? <\/h3>\n\n\n\n

La plong\u00e9e sous-marine a \u00e9t\u00e9 d\u00e9mystifi\u00e9e il y a longtemps, et dans une certaine mesure, c'\u00e9tait peut-\u00eatre une erreur. Ce qui m'a le plus surpris pendant mon s\u00e9jour au DAN, c'est la fr\u00e9quence \u00e0 laquelle les plongeurs s'en tirent avec des actes dangereux. J'h\u00e9site \u00e0 dire cela parce que les gens peuvent penser qu'ils peuvent s'en tirer sans risque, alors qu'en r\u00e9alit\u00e9 ils font des choses qui sont bien document\u00e9es et qui les mettent en danger. <\/p>\n\n\n\n

Data like that isn\u2019t an indicator of an unseen force watching out for drunkards and divers. Instead, it\u2019s further proof of the Swiss cheese model of accidents. Unsafe acts create holes in your dive plan, and it only takes those holes aligning once to cause a devastating accident. The nature of these accidents makes it difficult for divers to grasp that they must toujours<\/em> se m\u00e9fier des actes dangereux. <\/p>\n\n\n\n

Ceci \u00e9tant dit, je ne suis pas partisan de l'augmentation des barri\u00e8res et des restrictions \u00e0 la participation. Le d\u00e9partement de recherche du DAN et moi-m\u00eame avons vu plus de blessures en plong\u00e9e que n'importe qui d'autre, mais \u00e0 mon avis, les donn\u00e9es montrent que la plong\u00e9e sous-marine est g\u00e9n\u00e9ralement une activit\u00e9 s\u00fbre. Pour la rendre plus s\u00fbre, nous ne devons pas laisser les plongeurs individuels \u00eatre n\u00e9gligents ; nous devons les former. Les seuls plongeurs s\u00fbrs sont ceux qui sont conscients des risques. <\/p>\n\n\n\n

Les listes de contr\u00f4le avant la plong\u00e9e sont un outil efficace de r\u00e9duction des risques dont l'efficacit\u00e9 est mesur\u00e9e, mais elles ne sont pas un rem\u00e8de \u00e0 tout. Les strat\u00e9gies de r\u00e9duction des risques doivent \u00eatre adapt\u00e9es au type d'activit\u00e9s de plong\u00e9e et aux profils des plongeurs, ce que le DAN fait en fournissant des ressources d'apprentissage tout au long de la vie pour les plongeurs de loisir et les plongeurs techniques.<\/p>\n\n\n\n

Comment pouvons-nous pr\u00e9venir les accidents de plong\u00e9e ?<\/h3>\n\n\n\n

By staying healthy and being aware of your limitations. I stopped diving in the 1980s back in Croatia. I had an episode of severe arrhythmia that scared me. While I admired and loved diving as a young man, after that I didn\u2019t dare much to go underwater. <\/p>\n\n\n\n

I once met a diver who had some serious heart arrythmia issues \u2014 she was banned from diving, and her physician labeled her as unfit to dive. Disregarding this, she bought a full-face mask so that theoretically, if she passed out underwater, she would not drown. Her dive buddy was her husband, and he was well-informed of her condition and location at all times. They continued to dive conservatively and never had any issues. <\/p>\n\n\n\n

In most situations, people can find a way, but they have to be aware of their conditions and the risks involved to take proper risk-mitigation measures. I think people need to be honest with themselves. You can\u2019t just pretend that you don\u2019t have health issues when you do. It\u2019s human to have your health naturally decline.<\/p>\n\n\n\n

Quel est l'avenir de la recherche sur la plong\u00e9e ?<\/h3>\n\n\n\n

We need to learn more about what constitutes individual variability. Because nitrogen bubbles have a role in DCS, at least in describing severity of decompression stress, I would like DAN\u2019s New Bubble Study on bubble variability within and between divers to be expanded. I hope the data that Frauke Tillmans and her team are collecting will help establish some other new methodologies and new tools, and we may eventually be able to get to customized decompression procedures.<\/p>\n\n\n\n

Nous avons \u00e9galement besoin de chercheurs. Vous ne trouverez rien de nouveau dans l'IA. Elle peut r\u00e9sumer ce qui existe, mais nous, en tant que chercheurs, devons fournir de nouvelles informations et orienter nos recherches dans de nouvelles directions. L'IA peut \u00eatre un outil utile ; elle peut vous aider \u00e0 extraire ou \u00e0 analyser des informations \u00e0 partir d'\u00e9normes bases de donn\u00e9es, mais elle ne g\u00e9n\u00e9rera pas ou ne cr\u00e9era pas de nouvelles sciences. <\/p>\n\n\n\n

The value of these new tools is that they can help you be more precise, more consistent, or faster while doing things. They can increase the impact of research, but researchers still have to lead the way. We can all appreciate technology \u2014 it can help a lot \u2014 but it\u2019s still up to us to develop new ideas and to use the tools in the right ways. AD<\/p>\n<\/div>\n\n\n\n

\n
\"Denoble
Denoble and his wife, Dr. Ubavka Denoble, enjoy diving during their recent retirement trip in Gal\u00e1pagos.<\/figcaption><\/figure>\n\n\n\n
\"Denoble
Denoble surveille le plongeur Edoardo Pavia apr\u00e8s une plong\u00e9e lors de l'exp\u00e9dition Britannic en 2006.<\/figcaption><\/figure>\n\n\n\n
\"Denoble
Denoble s'entretient avec l'ancien plongeur spongieux grec Giannis Tsulfas.<\/figcaption><\/figure>\n\n\n\n
\"Denoble
Denoble se d\u00e9tend apr\u00e8s une conf\u00e9rence \u00e0 Tokyo en 2019.<\/figcaption><\/figure>\n\n\n\n
\"Denoble
Denoble a re\u00e7u le prix d'excellence en m\u00e9decine de plong\u00e9e de l'UHMS en 2017.<\/figcaption><\/figure>\n\n\n\n
\"Denoble
Il est reconnu comme conf\u00e9rencier principal par le Dr. Shinya Suzuki.<\/figcaption><\/figure>\n\n\n\n
\"Denoble
Denoble surveille les ondes cardiaques d'un volontaire de l'\u00e9tude DAN. <\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n

\u00a9 Alert Diver<\/em> - Q2 2023<\/p>\n\n\n\n

<\/div>","protected":false},"excerpt":{"rendered":"

PETAR DENOBLE, MD, D.SC. a consacr\u00e9 sa carri\u00e8re \u00e0 l'exploration et \u00e0 la r\u00e9solution des probl\u00e8mes pratiques de la m\u00e9decine de plong\u00e9e. <\/p>","protected":false},"featured_media":24715,"template":"","dan_alert_diver_categories":[466],"dan_alert_diver_issues":[485],"class_list":["post-24713","dan_alert_diver","type-dan_alert_diver","status-publish","has-post-thumbnail","hentry","dan_alert_diver_categories-researcher-profile","dan_alert_diver_issues-q2-2023"],"acf":[],"yoast_head":"\nPetar Denoble: Solving Practical Issues for Divers - DAN World<\/title>\n<meta name=\"description\" content=\"PETAR DENOBLE, MD, D.SC., HAS DEDICATED HIS CAREER to exploring and solving practical issues in dive medicine.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/world.dan.org\/fr\/th\/alert-diver\/article\/petar-denoble-solving-practical-issues-for-divers\/\" \/>\n<meta property=\"og:locale\" content=\"fr_CA\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Petar Denoble: Solving Practical Issues for Divers\" \/>\n<meta property=\"og:description\" content=\"PETAR DENOBLE, MD, D.SC., HAS DEDICATED HIS CAREER to exploring and solving practical issues in dive medicine.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/world.dan.org\/fr\/th\/alert-diver\/article\/petar-denoble-solving-practical-issues-for-divers\/\" \/>\n<meta property=\"og:site_name\" content=\"DAN World\" \/>\n<meta property=\"article:modified_time\" content=\"2023-07-20T21:30:48+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/world.dan.org\/wp-content\/uploads\/2023\/06\/Q2_96_Researchers-1200x600-1.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"600\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:description\" content=\"PETAR DENOBLE, MD, D.SC., HAS DEDICATED HIS CAREER to exploring and solving practical issues in dive medicine.\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"10 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/world.dan.org\\\/th\\\/alert-diver\\\/article\\\/petar-denoble-solving-practical-issues-for-divers\\\/\",\"url\":\"https:\\\/\\\/world.dan.org\\\/th\\\/alert-diver\\\/article\\\/petar-denoble-solving-practical-issues-for-divers\\\/\",\"name\":\"Petar Denoble: Solving Practical Issues for Divers - 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