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Vallée N, Dugrenot E, Desruelle AV, Richard S, Coupé S, Ramdani C, Guieu R, Risso JJ, Gaillard S, Guerrero F. Highlighting of the interactions of MYD88 and NFKB1 SNPs in rats resistant to decompression sickness: toward an autoimmune response. Front Physiol 2023; 14:1253856. [PMID: 37664439 PMCID: PMC10470123 DOI: 10.3389/fphys.2023.1253856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
Decompression sickness (DCS) with neurological disorders includes an inappropriate inflammatory response which degenerates slowly, even after the disappearance of the bubbles. There is high inter-individual variability in terms of the occurrence of DCS that could have been mastered by the selection and then the breeding of DCS-resistant rats. We hypothesized the selection of single-nucleotide polymorphisms (SNPs) linked to autoimmunity operated upon a generation of a DCS-resistant strain of rats. We used the candidate gene approach and targeted SNPs linked to the signaling cascade that directly regulates inflammation of innate immunity transiting by the Toll-like receptors. Twenty candidate SNPs were investigated in 36 standard rats and 33 DCS-resistant rats. For the first time, we identify a diplotype (i.e., with matched haplotypes)-when coinherited-that strengthens protection against DCS, which is not strictly homozygous and suggests that a certain tolerance may be considered. We deduced an ideal haplotype of six variants from it (MyD88_50-T, _49-A, _97-C coupled to NFKB_85-T, _69-T, _45-T) linked to the resistant phenotype. Four among the six identified variants are located in pre- and/or post-transcriptional areas regulating MyD88 or NFKB1 expression. Because of missense mutations, the other two variants induce a structural change in the NFKB1 protein complex including one damage alteration according to the Missense3D algorithm. In addition to the MyD88/NFKB1 haplotype providing rats with a strong resistance to DCS, this also highlights the importance that the immune response, here linked to the genetic heritage, can have in the development of DCS and offer a new perspective for therapeutic strategies.
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Affiliation(s)
- Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | | | - Anne-Virginie Desruelle
- Institut de Recherche Biomédicale des Armées, Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | | | | | - Céline Ramdani
- Institut de Recherche Biomédicale des Armées, Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Régis Guieu
- Université d’Aix-Marseille, Marseille, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
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Georgogiannis N, Tsalis G. The Effect of Post-Activation Potentiation on Swimming Starts in Adolescent Swimmers. J Funct Morphol Kinesiol 2023; 8:jfmk8020054. [PMID: 37218850 DOI: 10.3390/jfmk8020054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Post-activation potentiation (PAP) is a phenomenon in which there is an increase in induced momentum in sporting activities after muscle contractions. In swimming, the start of the race and the increase in speed in its first few meters are important. The aim of the present study was to investigate the effect of the PAP protocol, which included a simulated body weight start on the ground, on the swimming start and on the 25 m freestyle performance. METHODS The study included 14 male and 14 female swimmers, 14.9 ± 0.6 years old. All the swimmers performed three maximal attempts of 25 m freestyle swimming from the starting block on three different days in a randomly counterbalanced order. In each session, swimmers performed either a 25 m freestyle without any intervention before the swimming trial (CG), or performed four vertical simulated ground starts at maximal effort, 15 s before (15 sG) or 8 min before (8 minG) the swimming trial. The jump height, entry distance, flight time, and flight speed for each attempt were calculated. RESULTS The CG entry distance was significantly longer than that of the 15 sG and 8 minG (3.39 ± 0.20 vs. 3.31 ± 0.21 and 3.25 ± 0.25 m, respectively, p < 0.001). CONCLUSIONS Four simulated swim starts on the ground, 15 s or 8 min before the swim sprint, had no positive effect on the swim start or swim performance, and it is up to the swimmer to perform these jumps.
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Affiliation(s)
- Nikolaos Georgogiannis
- School of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, 62110 Serres, Greece
| | - George Tsalis
- School of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, 62110 Serres, Greece
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Homsy M, Bounds C, Glover M, Castledine B, Martindale T. Case report: Physiological changes due to a rapid ascent from 55 metres underwater. J Intensive Care Soc 2019; 22:88-91. [PMID: 33643438 DOI: 10.1177/1751143719892789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present the case of a diver who experienced an uncontrolled ascent from 55 m and presented with a severe decompression illness. She was clinically shocked and in multi organ failure due to massive fluid shifts. She demonstrated bilateral lower limb loss of power and sensation and required multiple hyperbaric therapy sessions. With joint critical care, hyperbaric and physical therapy involvement, she was discharged some five weeks after her presentation with an independent level of function.
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Affiliation(s)
- Michele Homsy
- Department of Anaesthesia and Intensive Care, St. Richards, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - Catherine Bounds
- Department of Anaesthesia and Intensive Care, St. Richards, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - Mark Glover
- Hyperbaric Medicine Unit, St Richard's Hospital, Chichester, UK
| | | | - Timothy Martindale
- Department of Anaesthesia and Intensive Care, St. Richards, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
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Desruelle AV, Louge P, Richard S, Blatteau JE, Gaillard S, De Maistre S, David H, Risso JJ, Vallée N. Demonstration by Infra-Red Imaging of a Temperature Control Defect in a Decompression Sickness Model Testing Minocycline. Front Physiol 2019; 10:933. [PMID: 31396102 PMCID: PMC6668502 DOI: 10.3389/fphys.2019.00933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022] Open
Abstract
The prevention, prognosis and resolution of decompression sickness (DCS) are not satisfactory. The etiology of DCS has highlighted thrombotic and inflammatory phenomena that could cause severe neurological disorders or even death. Given the immunomodulatory effects described for minocycline, an antibiotic in widespread use, we have decided to explore its effects in an experimental model for decompression sickness. 40 control mice (Ctrl) and 40 mice treated orally with 90 mg/kg of minocycline (MINO) were subjected to a protocol in a hyperbaric chamber, compressed with air. The purpose was to mimic a scuba dive to a depth of 90 msw and its pathogenic decompression phase. Clinical examinations and blood counts were conducted after the return to the surface. For the first time they were completed by a simple infrared (IR) imaging technique in order to assess feasibility and its clinical advantage in differentiating the sick mice (DCS) from the healthy mice (NoDCS). In this tudy, exposure to the hyperbaric protocol provoked a reduction in the number of circulating leukocytes. DCS in mice, manifesting itself by paralysis or convulsion for example, is also associated with a fall in platelets count. Cold areas ( < 25°C) were detected by IR in the hind paws and tail with significant differences (p < 0.05) between DCS and NoDCS. Severe hypothermia was also shown in the DCS mice. The ROC analysis of the thermograms has made it possible to determine that an average tail temperature below 27.5°C allows us to consider the animals to be suffering from DCS (OR = 8; AUC = 0.754, p = 0.0018). Minocycline modulates blood analysis and it seems to limit the mobilization of monocytes and granulocytes after the provocative dive. While a higher proportion of mice treated with minocycline experienced DCS symptoms, there is no significant difference. The infrared imaging has made it possible to show severe hypothermia. It suggests an modification of thermregulation in DCS animals. Surveillance by infrared camera is fast and it can aid the prognosis in the case of decompression sickness in mice.
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Affiliation(s)
- Anne-Virginie Desruelle
- Unité Environnements Extrêmes, Département Environnement Opérationnel, Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Pierre Louge
- Service de Médecine Hyperbare et Expertise Plongée, Hôpital d'Instruction des Armées, Toulon, France
| | | | - Jean-Eric Blatteau
- Unité Environnements Extrêmes, Département Environnement Opérationnel, Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Toulon, France.,Service de Médecine Hyperbare et Expertise Plongée, Hôpital d'Instruction des Armées, Toulon, France
| | | | - Sébastien De Maistre
- Service de Médecine Hyperbare et Expertise Plongée, Hôpital d'Instruction des Armées, Toulon, France
| | - Hélène David
- Apricot Inhalotherapeutics, Saint-Laurent-de-l'Île-d'Orléans, QC, Canada
| | - Jean-Jacques Risso
- Unité Environnements Extrêmes, Département Environnement Opérationnel, Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Nicolas Vallée
- Unité Environnements Extrêmes, Département Environnement Opérationnel, Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Toulon, France
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Affiliation(s)
- Michael S. Tift
- Department of Biology and Marine Biology, University of North Carolina Wilmington, Wilmington, NC, United States
| | - Paul J. Ponganis
- Center for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, United States
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Blatteau JE, Gaillard S, De Maistre S, Richard S, Louges P, Gempp E, Druelles A, Lehot H, Morin J, Castagna O, Abraini JH, Risso JJ, Vallée N. Reduction in the Level of Plasma Mitochondrial DNA in Human Diving, Followed by an Increase in the Event of an Accident. Front Physiol 2018; 9:1695. [PMID: 30555340 PMCID: PMC6282000 DOI: 10.3389/fphys.2018.01695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/09/2018] [Indexed: 01/02/2023] Open
Abstract
Circulating mitochondrial DNA (mtDNA) is receiving increasing attention as a danger-associated molecular pattern in conditions such as autoimmunity or trauma. In the context of decompression sickness (DCS), the course of which is sometimes erratic, we hypothesize that mtDNA plays a not insignificant role particularly in neurological type accidents. This study is based on the comparison of circulating mtDNA levels in humans presenting with various types of diving accidents, and punctured upon their admission at the hyperbaric facility. One hundred and fourteen volunteers took part in the study. According to the clinical criteria there were 12 Cerebro DCS, 57 Medullary DCS, 15 Vestibular DCS, 8 Ctrl+ (accident-free divers), and 22 Ctrl- (non-divers). This work demonstrates that accident-free divers have less mtDNA than non-divers, which leads to the assumption that hyperbaric exposure degrades the mtDNA. mtDNA levels are on average greater in divers with DCS compared with accident-free divers. On another hand, the amount of double strand DNA (dsDNA) is neither significantly different between controls, nor between the different DCS types. Initially the increase in circulating oligonucleotides was attributed to the destruction of cells by bubble abrasion following necrotic phenomena. If there really is a significant difference between the Medullary DCS and the Ctrl-, this difference is not significant between these same DCS and the Ctrl+. This refutes the idea of massive degassing and suggests the need for new research in order to verify that oxidative stress could be a key element without necessarily being sufficient for the occurrence of a neurological type of accident.
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Affiliation(s)
- Jean-Eric Blatteau
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | | | - Sébastien De Maistre
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Simone Richard
- Mediterranean Institute of Oceanography, Université de Toulon, Toulon, France
| | - Pierre Louges
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Emmanuel Gempp
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Arnaud Druelles
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Henri Lehot
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Jean Morin
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Olivier Castagna
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
| | - Jacques H. Abraini
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
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Lambrechts K, de Maistre S, Abraini JH, Blatteau JE, Risso JJ, Vallée N. Tirofiban, a Glycoprotein IIb/IIIa Antagonist, Has a Protective Effect on Decompression Sickness in Rats: Is the Crosstalk Between Platelet and Leukocytes Essential? Front Physiol 2018; 9:906. [PMID: 30050468 PMCID: PMC6050390 DOI: 10.3389/fphys.2018.00906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
In its severest forms, decompression sickness (DCS) may extend systemically and/or induce severe neurological deficits, including paralysis or even death. It seems that the sterile and ischemic inflammatory phenomena are consecutive to the reaction of the bubbles with the organism and that the blood platelet activation plays a determinant role in the development of DCS. According to the hypotheses commonly put forward, the bubbles could either activate the platelets by direct contact or be the cause of abrasion of the vascular epithelium, which would expose the basal plate glycogen and then prompt the platelets to activate. The purpose of this study is to confirm anti-platelet drugs specific to GPIIb/IIIa integrin could prevent DCS, using a rat model. There is a significant difference concerning the incidence of the drug on the clinical status of the rats (p = 0.016), with a better clinical outcome for rats treated with tirofiban (TIR) compared with the control rats (p = 0.027), even if the three anti-GPIIb/IIIa agents used have limited respiratory distress. TIR limited the decrease in platelet counts following the hyperbaric exposure. TIR help to prevent from DCS. TIR is specific to GPIIb/IIIa whereas eptifibatide and abciximab could inhibit αVβ3 and αMβ2 involved in communication with the immune system. While inhibiting GPIIb/IIIa could highlight a platelet-dependent inflammatory pathway that improves DCS outcomes, we wonder whether inhibiting the αVβ3 and αMβ2 communications is not a wrong approach for limiting mortality in DCS.
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Affiliation(s)
- Kate Lambrechts
- Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées - Equipe Résidente de Recherche Subaquatique Opérationnelle (Armed Forces Biomedical Research Institute - Resident Operational Subaquatic Research Team), Toulon, France.,Laboratoire Motricité Humaine Expertise Sport Santé (LAMHESS - Human Motricity, Education, Sport and Health Laboratory), Université du Sud Toulon Var, La Garde, France
| | - Sébastien de Maistre
- Hôpital d'Instruction des Armées - Service de Médecine Hyperbare et Expertise Plongée (Military Teaching Hospital - Hyperbaric Medicine and Diving Expertise Department), Toulon, France
| | - Jacques H Abraini
- Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées - Equipe Résidente de Recherche Subaquatique Opérationnelle (Armed Forces Biomedical Research Institute - Resident Operational Subaquatic Research Team), Toulon, France.,Département d'Anesthésiologie, Université Laval, Laval, QC, Canada.,Faculté de Médecine, Université de Caen Normandie (UNICAEN), Caen, France
| | - Jean-Eric Blatteau
- Hôpital d'Instruction des Armées - Service de Médecine Hyperbare et Expertise Plongée (Military Teaching Hospital - Hyperbaric Medicine and Diving Expertise Department), Toulon, France
| | - Jean-Jacques Risso
- Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées - Equipe Résidente de Recherche Subaquatique Opérationnelle (Armed Forces Biomedical Research Institute - Resident Operational Subaquatic Research Team), Toulon, France
| | - Nicolas Vallée
- Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées - Equipe Résidente de Recherche Subaquatique Opérationnelle (Armed Forces Biomedical Research Institute - Resident Operational Subaquatic Research Team), Toulon, France
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McDonald BI, Ponganis PJ. Insights from venous oxygen profiles: oxygen utilization and management in diving California sea lions. ACTA ACUST UNITED AC 2014; 216:3332-41. [PMID: 23926312 DOI: 10.1242/jeb.085985] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The management and depletion of O2 stores underlie the aerobic dive capacities of marine mammals. The California sea lion (Zalophus californianus) presumably optimizes O2 store management during all dives, but approaches its physiological limits during deep dives to greater than 300 m depth. Blood O2 comprises the largest component of total body O2 stores in adult sea lions. Therefore, we investigated venous blood O2 depletion during dives of California sea lions during maternal foraging trips to sea by: (1) recording venous partial pressure of O2 (P(O2)) profiles during dives, (2) characterizing the O2-hemoglobin (Hb) dissociation curve of sea lion Hb and (3) converting the P(O2) profiles into percent Hb saturation (S(O2)) profiles using the dissociation curve. The O2-Hb dissociation curve was typical of other pinnipeds (P50=28±2 mmHg at pH 7.4). In 43% of dives, initial venous S(O2) values were greater than 78% (estimated resting venous S(O2)), indicative of arterialization of venous blood. Blood O2 was far from depleted during routine shallow dives, with minimum venous S(O2) values routinely greater than 50%. However, in deep dives greater than 4 min in duration, venous S(O2) reached minimum values below 5% prior to the end of the dive, but then increased during the last 30-60 s of ascent. These deep dive profiles were consistent with transient venous blood O2 depletion followed by partial restoration of venous O2 through pulmonary gas exchange and peripheral blood flow during ascent. These differences in venous O2 profiles between shallow and deep dives of sea lions reflect distinct strategies of O2 store management and suggest that underlying cardiovascular responses will also differ.
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Affiliation(s)
- Birgitte I McDonald
- Center for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, La Jolla, CA 92093-0204, USA.
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Sivle LD, Kvadsheim PH, Fahlman A, Lam FPA, Tyack PL, Miller PJO. Changes in dive behavior during naval sonar exposure in killer whales, long-finned pilot whales, and sperm whales. Front Physiol 2012; 3:400. [PMID: 23087648 PMCID: PMC3468818 DOI: 10.3389/fphys.2012.00400] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 09/22/2012] [Indexed: 11/24/2022] Open
Abstract
Anthropogenic underwater sound in the environment might potentially affect the behavior of marine mammals enough to have an impact on their reproduction and survival. Diving behavior of four killer whales (Orcinus orca), seven long-finned pilot whales (Globicephala melas), and four sperm whales (Physeter macrocephalus) was studied during controlled exposures to naval sonar [low frequency active sonar (LFAS): 1-2 kHz and mid frequency active sonar (MFAS): 6-7 kHz] during three field seasons (2006-2009). Diving behavior was monitored before, during and after sonar exposure using an archival tag placed on the animal with suction cups. The tag recorded the animal's vertical movement, and additional data on horizontal movement and vocalizations were used to determine behavioral modes. Killer whales that were conducting deep dives at sonar onset changed abruptly to shallow diving (ShD) during LFAS, while killer whales conducting deep dives at the onset of MFAS did not alter dive mode. When in ShD mode at sonar onset, killer whales did not change their diving behavior. Pilot and sperm whales performed normal deep dives (NDD) during MFAS exposure. During LFAS exposures, long-finned pilot whales mostly performed fewer deep dives and some sperm whales performed shallower and shorter dives. Acoustic recording data presented previously indicates that deep diving (DD) is associated with feeding. Therefore, the observed changes in dive behavior of the three species could potentially reduce the foraging efficiency of the affected animals.
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Affiliation(s)
| | - P. H. Kvadsheim
- Norwegian Defence Research Establishment (FFI), Maritime Systems DivisionHorten, Norway
| | - A. Fahlman
- Woods Hole Oceanographic InstitutionWoods Hole, MA, USA
- Department of Life Sciences, Texas A&M Corpus ChristiTexas, TX, USA
| | - F. P. A. Lam
- Netherlands Organisation for Applied Scientific Research (TNO), Acoustics and Sonar Research GroupThe Hague, Netherlands
| | - P. L. Tyack
- Woods Hole Oceanographic InstitutionWoods Hole, MA, USA
- Sea Mammal Research Unit, University of St. AndrewsSt. Andrews, UK
| | - P. J. O. Miller
- Sea Mammal Research Unit, University of St. AndrewsSt. Andrews, UK
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