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Introduction: Hyperbaric oxygen treatment (HBOT) is considered definitive treatment for decompression illness. Delay to HBOT may be due to dive site remoteness and limited facility availability. Review of cases may help identify factors contributing to clinical outcomes., Methods: Injured divers treated in Townsville from November 2003 through December 2018 were identified. Information on demographics, initial disease severity, time to symptom onset post-dive, time to pre-HBOT oxygen therapy (in-water recompression or normobaric), time to HBOT, and clinical outcome was reviewed. Data were reported as median (interquartile range [IQR]) with Kruskal-Wallis and chi-square tests used to evaluate group differences. Significance was accepted at P < 0.05., Results: A total of 306 divers (184 males, 122 females) were included with a median age of 29 (IQR 24, 35) years. Most divers had mild initial disease severity (n = 216, 70%). Time to symptom onset was 60 (10, 360) min, time to pre-HBOT oxygen therapy was 4:00 (00:30, 24:27) h:min, and time to start of HBOT was 38:51 (22:11, 69:15) h:min. Most divers (93%) had a good (no residual or minor residual symptoms) outcome and no treated diver died. Higher initial disease severity was significantly associated with shorter times to symptom onset, oxygen therapy, and HBOT, and with worse outcomes. The paucity of cases receiving HBOT with minimal delay precluded meaningful evaluation of the effect of delay to HBOT., Conclusions: Most divers had mild initial disease severity and a good outcome. Higher initial disease severity accelerated the speed of care obtained and was the only factor associated with poorer outcome., Competing Interests: Professors Mitchell and Pollock are members of the editorial board of Diving and Hyperbaric Medicine but were not involved in the peer review or publication decision-making process for this article., (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.)

Mars' sedimentary rock record preserves information on geological (and potential astrobiological) processes that occurred on the planet billions of years ago. The Curiosity rover is exploring the lower reaches of Mount Sharp, in Gale crater on Mars. A traverse from Vera Rubin ridge to Glen Torridon has allowed Curiosity to examine a lateral transect of rock strata laid down in a martian lake ~3.5 billion years ago. We report spatial differences in the mineralogy of time-equivalent sedimentary rocks <400 meters apart. These differences indicate localized infiltration of silica-poor brines, generated during deposition of overlying magnesium sulfate-bearing strata. We propose that destabilization of silicate minerals driven by silica-poor brines (rarely observed on Earth) was widespread on ancient Mars, because sulfate deposits are globally distributed., (Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

The Curiosity rover's exploration of rocks and soils in Gale crater has provided diverse geochemical and mineralogical data sets, underscoring the complex geological history of the region. We report the crystalline, clay mineral, and amorphous phase distributions of four Gale crater rocks from an 80-m stratigraphic interval. The mineralogy of the four samples is strongly influenced by aqueous alteration processes, including variations in water chemistries, redox, pH, and temperature. Localized hydrothermal events are evidenced by gray hematite and maturation of amorphous SiO 2 to opal-CT. Low-temperature diagenetic events are associated with fluctuating lake levels, evaporative events, and groundwater infiltration. Among all mudstones analyzed in Gale crater, the diversity in diagenetic processes is primarily captured by the mineralogy and X-ray amorphous chemistry of the drilled rocks. Variations indicate a transition from magnetite to hematite and an increase in matrix-associated sulfates suggesting intensifying influence from oxic, diagenetic fluids upsection. Furthermore, diagenetic fluid pathways are shown to be strongly affected by unconformities and sedimentary transitions, as evidenced by the intensity of alteration inferred from the mineralogy of sediments sampled adjacent to stratigraphic contacts., (©2020. The Authors.)

Introduction: Divers with suspected decompression illness require high concentration oxygen (O₂). There are many different O₂ delivery devices, with few data comparing their performance. This study evaluated O₂ delivery, using tissue O₂ partial pressure (P tc O₂), in healthy divers breathing O₂ via three different delivery devices., Methods: Twelve divers had P tc O₂ measured at six limb sites. Participants breathed O₂ from: a demand valve using an intraoral mask with a nose clip (NC); a medical O₂ rebreathing system (MORS) with an oronasal mask and with an intraoral mask; and a non-rebreather mask (NRB) at 15 or 10 L·min⁻¹ O₂ flow. In-line inspired O₂ F I O₂) and nasopharyngeal F I O₂ were measured. Participants provided subjective ratings of device comfort, ease of breathing, and overall ease of use., Results: P tc O₂ values and nasopharyngeal FIO₂ were similar with the demand valve with intraoral mask, MORS with both masks and the NRB at 15 L·min⁻¹. P tc O₂ and nasopharyngeal F I O₂ values were significantly lower with the NRB at 10 L·min⁻¹. The NRB was rated as the most comfortable to wear, easiest to breathe with, and overall the easiest to use., Conclusion: Of the commonly available devices promoted for O₂ delivery to injured divers, similar PtcO₂ and nasopharyngeal F I O₂ values were obtained with the three devices tested: MORS with an oronasal or intraoral mask, demand valve with an intraoral mask and NRB at a flow rate of 15 L·min⁻¹. P tc O₂ and nasopharyngeal F I O₂ values were significantly lower when the flow rate using the NRB was decreased to 10 L·min⁻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.)

Introduction: High concentration normobaric oxygen (O₂) is a priority in treating divers with suspected decompression illness. The effect of different O₂ mask configurations on tissue oxygenation when breathing with a demand valve was evaluated., Methods: Sixteen divers had tissue oxygen partial pressure (PtcO₂) measured at six limb sites. Participants breathed O₂ from a demand valve using: an intraoral mask (IOM®) with and without a nose clip (NC), a pocket face mask and an oronasal mask. In-line inspired O₂ (FIO₂) and nasopharyngeal FIO₂ were measured. Participants provided subjective ratings of mask comfort, ease of breathing and holding in position., Results: PtcO₂ values and nasopharyngeal FIO₂ (median and range) were greatest using the IOM with NC and similar with the IOM without NC. O₂ measurements were lowest with the oronasal mask which also was rated as the most difficult to breathe from and to hold in position. The pocket face mask was reported as the most comfortable to wear. The NC was widely described as uncomfortable. The IOM and pocket face mask were rated best for ease of breathing. The IOM was rated as the easiest to hold in position., Conclusion: Of the commonly available O₂ masks for use with a demand valve, the IOM with NC achieved the highest PtcO₂ values. PtcO₂ and nasopharyngeal FIO₂ values were similar between the IOM with and without NC. Given the reported discomfort of the NC, the IOM without NC may be the best option., (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.)

Introduction: Vibration from a helicopter during aeromedical retrieval of divers may increase venous gas emboli (VGE) production, evolution or distribution, potentially worsening the patient's condition., Aim: To review the literature surrounding the helicopter transport of injured divers and establish if vibration contributes to increased VGE., Method: A systematic literature search of key databases was conducted to identify articles investigating vibration and bubbles during helicopter retrieval of divers. Level of evidence was graded using the Oxford Centre for Evidence-Based Medicine guidelines. A modified quality assessment tool for studies with diverse designs (QATSDD) was used to assess the overall quality of evidence., Results: Seven studies were included in the review. An in vitro research paper provided some evidence of bubble formation with gas supersaturation and vibration. Only one prospective intervention study was identified which examined the effect of vibration on VGE formation. Bubble duration was used to quantify VGE load with no difference found between the vibration and non-vibration time periods. This study was published in 1980 and technological advances since that time suggest cautious interpretation of the results. The remaining studies were retrospective chart reviews of helicopter retrieval of divers. Mode of transport, altitude exposure, oxygen and intravenous fluids use were examined., Conclusion: There is some physical evidence that vibration leads to bubble formation although there is a paucity of research on the specific effects of helicopter vibration and VGE in divers. Technological advances have led to improved assessment of VGE in divers and will aid in further research., (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.)

Clay minerals provide indicators of the evolution of aqueous conditions and possible habitats for life on ancient Mars. Analyses by the Mars Science Laboratory rover Curiosity show that ~3.5-billion year (Ga) fluvio-lacustrine mudstones in Gale crater contain up to ~28 weight % (wt %) clay minerals. We demonstrate that the species of clay minerals deduced from x-ray diffraction and evolved gas analysis show a strong paleoenvironmental dependency. While perennial lake mudstones are characterized by Fe-saponite, we find that stratigraphic intervals associated with episodic lake drying contain Al-rich, Fe 3+ -bearing dioctahedral smectite, with minor (3 wt %) quantities of ferripyrophyllite, interpreted as wind-blown detritus, found in candidate aeolian deposits. Our results suggest that dioctahedral smectite formed via near-surface chemical weathering driven by fluctuations in lake level and atmospheric infiltration, a process leading to the redistribution of nutrients and potentially influencing the cycling of gases that help regulate climate.

Introduction: Published normal transcutaneous oxygen partial pressures (P tc O 2 ) for the chest and lower limb have defined tissue hypoxia as a value of < 40 mmHg (< 30 mmHg in some patients, < 50 mmHg in others)., Aim: To determine 'normal' P tc O 2 for the upper and lower limb in healthy, non-smoking adults using the Radiometer® TCM400 with tc Sensor E5250., Method: Thirty-two volunteers had transcutaneous oxygen measurements (TCOM) performed on the chest, upper and lower limbs breathing air, with leg then arm elevated and whilst breathing 100% oxygen., Results: Room-air P tc O 2 (mmHg, mean (95% confidence interval)) were: chest: 53.6 (48.7-58.5); upper arm: 60.0 (56.1-64.0); forearm: 52.3 (44.8-55.8); dorsum of hand: 50.2 (46.1-54.3); thenar eminence: 70.8 (67.7-73.8); hypothenar eminence: 77.9 (75.1-80.7); lateral leg: 50.2 (46.2-54.2); lateral malleolus: 50.5 (46.6-54.3); medial malleolus: 48.9 (45.6-52.1); dorsum, between first and second toe: 53.1 (49.2-57.0); dorsum, proximal to fifth toe: 58.5 (55.0 - -62.0); plantar, 1st MTP: 73.7 (70.3-77.1). Nineteen subjects had at least one room-air P tc O 2 below 40 mmHg (nine upper limb, 13 lower limb, four chest). Approximately 10% lower limb P tc O 2 were < 100 mmHg on normobaric oxygen. Only one subject at one site had an upper limb P tc O 2 < 100 mmHg breathing oxygen., Conclusion: The broad dispersion in P tc O 2 in our healthy cohort reflects the inherent biologic variability in dermal perfusion and oxygen delivery, making it difficult to define narrow, rigid 'normal' values. Thus, we cannot recommend a single P tc O 2 value as 'normal' for the upper or lower limb. A thorough patient assessment is essential to establish appropriateness for hyperbaric oxygen therapy, with TCOM used as an aid to guide this decision and not as an absolute., (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.)

The Mars Science Laboratory Curiosity rover performed coordinated measurements to examine the textures and compositions of aeolian sands in the active Bagnold dune field. The Bagnold sands are rounded to subrounded, very fine to medium sized (~45-500 μm) with ≥6 distinct grain colors. In contrast to sands examined by Curiosity in a dust-covered, inactive bedform called Rocknest and soils at other landing sites, Bagnold sands are darker, less red, better sorted, have fewer silt-sized or smaller grains, and show no evidence for cohesion. Nevertheless, Bagnold mineralogy and Rocknest mineralogy are similar with plagioclase, olivine, and pyroxenes in similar proportions comprising >90% of crystalline phases, along with a substantial amorphous component (35% ± 15%). Yet Bagnold and Rocknest bulk chemistry differ. Bagnold sands are Si enriched relative to other soils at Gale crater, and H 2 O, S, and Cl are lower relative to all previously measured Martian soils and most Gale crater rocks. Mg, Ni, Fe, and Mn are enriched in the coarse-sieved fraction of Bagnold sands, corroborated by visible/near-infrared spectra that suggest enrichment of olivine. Collectively, patterns in major element chemistry and volatile release data indicate two distinctive volatile reservoirs in Martian soils: (1) amorphous components in the sand-sized fraction (represented by Bagnold) that are Si-enriched, hydroxylated alteration products and/or H 2 O- or OH-bearing impact or volcanic glasses and (2) amorphous components in the fine fraction (<40 μm; represented by Rocknest and other bright soils) that are Fe, S, and Cl enriched with low Si and adsorbed and structural H 2 O.

In 2012, NASA's Curiosity rover landed on Mars to assess its potential as a habitat for past life and investigate the paleoclimate record preserved by sedimentary rocks inside the ~150-kilometer-diameter Gale impact crater. Geological reconstructions from Curiosity rover data have revealed an ancient, habitable lake environment fed by rivers draining into the crater. We synthesize geochemical and mineralogical data from lake-bed mudstones collected during the first 1300 martian solar days of rover operations in Gale. We present evidence for lake redox stratification, established by depth-dependent variations in atmospheric oxidant and dissolved-solute concentrations. Paleoclimate proxy data indicate that a transition from colder to warmer climate conditions is preserved in the stratigraphy. Finally, a late phase of geochemical modification by saline fluids is recognized., (Copyright © 2017, American Association for the Advancement of Science.)

Introduction: Transcutaneous oximetry measurement (TCOM) is a non-invasive method of determining oxygen tension at the skin level using heated electrodes., Aim: To compare TCOM values generated by different machines and to establish lower limb TCOM values in a cohort of healthy individuals younger than 40 years of age., Method: Sixteen healthy, non-smoking volunteers aged 18 to 39 years were recruited. TCOM was obtained at six locations on the lower leg and foot using three different Radiometer machines. Measurements were taken with subjects lying supine, breathing air., Results: Except for one sensor site, there were no statistical differences in measurements obtained by the different TCOM machines. There was no statistical difference in measurements comparing left and right legs. Room air TCOM values for the different lower leg sites were (mean (SD) in mmHg): lateral leg 61.5 (9.2); lateral ankle 61.1 (9.7); medial ankle 59.1 (10.8); foot, first and second toe 63.4 (10.6); foot, fifth toe 59.9 (13.2) and plantar foot 74.1 (8.8). The overall mean TCOM value for the lower limb was 61 (10.8; 95% confidence intervals 60.05-62.0) mmHg., Conclusion: Lower-leg TCOM measurements using different Radiometer TCOM machines were comparable. Hypoxia has been defined as lower-leg TCOM values of less than 40 mmHg in non-diabetic patients and this is supported by our measurements. The majority (96.9%) of the lower leg TCOM values in healthy young adults are above the hypoxic threshold.

Introduction: There are limited data on the use of elastomeric infusion pumps during hyperbaric oxygen treatment., Aim: This study evaluated the flow rate of the Baxter elastomeric LV10 Infusor™ pump under normobaric (101.3 kPa) and three hyperbaric conditions of 203 kPa, 243 kPa and 284 kPa., Methods: Elastomeric pumps were secured to participants in the same manner as for a typical patient, except that a container collected the delivered antibiotic solution. Pumps and tubing were weighed before and after the test period to determine volume delivered and to calculate flow rates at sea level and the three commonly used hyperbaric treatment pressures at two different time periods, 0-2 hours (h) and 19-21 h into the infusion., Results: The mean flow rates in ml·h⁻¹ (SD) were: 9.5 (0.4), 10.3 (0.6), 10.4 (0.6), 10.4 (0.5) at 0-2 h and 10.5 (1.0), 12.2 (0.6), 9.4 (0.5), 10.3 (0.9) at 19-21 h for the normobaric, 203 kPa, 243 kPa and 284 kPa conditions respectively. There was no significant association between flow rate and time period (P = 0.166) but the 203 kPa flow rates were significantly faster than the other flow rates (P = 0.008). In retrospect, the 203 kPa experiments had all been conducted with the same antibiotic solution (ceftazidime 6 g). Repeating that experimental arm using flucloxacillin 8 g produced flow rates of 10.4 (0.8) ml·h⁻¹, with no significant associations between flow rate and time period (P = 0.652) or pressure (P = 0.705)., Conclusion: In this study, the flow rate of the Baxter LV10 Infusor™ device was not significantly affected by increases in ambient pressure across the pressure range of 101.3 kPa to 284 kPa, and flow rates were generally within a clinically acceptable range of 9-12 ml·h⁻¹. However, there was evidence that the specific antibiotic solution might affect flow rates and this requires further study.

Carbon dioxide is an essential atmospheric component in martian climate models that attempt to reconcile a faint young sun with planetwide evidence of liquid water in the Noachian and Early Hesperian. In this study, we use mineral and contextual sedimentary environmental data measured by the Mars Science Laboratory (MSL) Rover Curiosity to estimate the atmospheric partial pressure of CO 2 ( P CO2 ) coinciding with a long-lived lake system in Gale Crater at ∼3.5 Ga. A reaction-transport model that simulates mineralogy observed within the Sheepbed member at Yellowknife Bay (YKB), by coupling mineral equilibria with carbonate precipitation kinetics and rates of sedimentation, indicates atmospheric P CO2 levels in the 10s mbar range. At such low P CO2 levels, existing climate models are unable to warm Hesperian Mars anywhere near the freezing point of water, and other gases are required to raise atmospheric pressure to prevent lake waters from being lost to the atmosphere. Thus, either lacustrine features of Gale formed in a cold environment by a mechanism yet to be determined, or the climate models still lack an essential component that would serve to elevate surface temperatures, at least locally, on Hesperian Mars. Our results also impose restrictions on the potential role of atmospheric CO 2 in inferred warmer conditions and valley network formation of the late Noachian.

Tridymite, a low-pressure, high-temperature (>870 °C) SiO2 polymorph, was detected in a drill sample of laminated mudstone (Buckskin) at Marias Pass in Gale crater, Mars, by the Chemistry and Mineralogy X-ray diffraction instrument onboard the Mars Science Laboratory rover Curiosity The tridymitic mudstone has ∼40 wt.% crystalline and ∼60 wt.% X-ray amorphous material and a bulk composition with ∼74 wt.% SiO2 (Alpha Particle X-Ray Spectrometer analysis). Plagioclase (∼17 wt.% of bulk sample), tridymite (∼14 wt.%), sanidine (∼3 wt.%), cation-deficient magnetite (∼3 wt.%), cristobalite (∼2 wt.%), and anhydrite (∼1 wt.%) are the mudstone crystalline minerals. Amorphous material is silica-rich (∼39 wt.% opal-A and/or high-SiO2 glass and opal-CT), volatile-bearing (16 wt.% mixed cation sulfates, phosphates, and chlorides-perchlorates-chlorates), and has minor TiO2 and Fe2O3T oxides (∼5 wt.%). Rietveld refinement yielded a monoclinic structural model for a well-crystalline tridymite, consistent with high formation temperatures. Terrestrial tridymite is commonly associated with silicic volcanism, and detritus from such volcanism in a "Lake Gale" catchment environment can account for Buckskin's tridymite, cristobalite, feldspar, and any residual high-SiO2 glass. These cogenetic detrital phases are possibly sourced from the Gale crater wall/rim/central peak. Opaline silica could form during diagenesis from high-SiO2 glass, as amorphous precipitated silica, or as a residue of acidic leaching in the sediment source region or at Marias Pass. The amorphous mixed-cation salts and oxides and possibly the crystalline magnetite (otherwise detrital) are primary precipitates and/or their diagenesis products derived from multiple infiltrations of aqueous solutions having variable compositions, temperatures, and acidities. Anhydrite is post lithification fracture/vein fill.

The Windjana drill sample, a sandstone of the Dillinger member (Kimberley formation, Gale Crater, Mars), was analyzed by CheMin X-ray diffraction (XRD) in the MSL Curiosity rover. From Rietveld refinements of its XRD pattern, Windjana contains the following: sanidine (21% weight, ~Or 95 ); augite (20%); magnetite (12%); pigeonite; olivine; plagioclase; amorphous and smectitic material (~25%); and percent levels of others including ilmenite, fluorapatite, and bassanite. From mass balance on the Alpha Proton X-ray Spectrometer (APXS) chemical analysis, the amorphous material is Fe rich with nearly no other cations-like ferrihydrite. The Windjana sample shows little alteration and was likely cemented by its magnetite and ferrihydrite. From ChemCam Laser-Induced Breakdown Spectrometer (LIBS) chemical analyses, Windjana is representative of the Dillinger and Mount Remarkable members of the Kimberley formation. LIBS data suggest that the Kimberley sediments include at least three chemical components. The most K-rich targets have 5.6% K 2 O, ~1.8 times that of Windjana, implying a sediment component with >40% sanidine, e.g., a trachyte. A second component is rich in mafic minerals, with little feldspar (like a shergottite). A third component is richer in plagioclase and in Na 2 O, and is likely to be basaltic. The K-rich sediment component is consistent with APXS and ChemCam observations of K-rich rocks elsewhere in Gale Crater. The source of this sediment component was likely volcanic. The presence of sediment from many igneous sources, in concert with Curiosity's identifications of other igneous materials (e.g., mugearite), implies that the northern rim of Gale Crater exposes a diverse igneous complex, at least as diverse as that found in similar-age terranes on Earth.

Introduction: In Professional Association of Diving Instructors (PADI) Open Water Diver certification courses that cater to tourists, instruction is often condensed and potentially delivered in a language that is not the candidate's native language., Objective: To assess the incidence of middle ear barotrauma (MEBt) in open-water diver candidates during a condensed four-day certification course, and to determine if language of instruction affects the incidence of MEBt in these divers., Method: The ears of participating diving candidates were assessed prior to commencing any in-water compression. Tympanic membranes (TM) were assessed and graded for MEBt after the confined and open-water training sessions. Tympanometry was performed if the candidate had no movement of their TM during Valsalva. Photographs were taken with a digital otoscope., Results: Sixty-seven candidates participated in the study. Forty-eight had MEBt at some time during their course. MEBt was not associated with instruction in non-native language (adjusted odds ratio = 0.82; 95% confidence intervals 0.21-3.91). There was also no significant association between the severity of MEBt and language of instruction., Conclusion: Open-water diver candidates have a high incidence of MEBt. Education in non-native language does not affect the overall incidence of MEBt.

Decompression sickness (DCS) is a systemic disorder, assumed due to gas bubbles, but additional factors are likely to play a role. Circulating microparticles (MPs)--vesicular structures with diameters of 0.1-1.0 μm--have been implicated, but data in human divers have been lacking. We hypothesized that the number of blood-borne, Annexin V-positive MPs and neutrophil activation, assessed as surface MPO staining, would differ between self-contained underwater breathing-apparatus divers suffering from DCS vs. asymptomatic divers. Blood was analyzed from 280 divers who had been exposed to maximum depths from 7 to 105 meters; 185 were control/asymptomatic divers, and 90 were diagnosed with DCS. Elevations of MPs and neutrophil activation occurred in all divers but normalized within 24 h in those who were asymptomatic. MPs, bearing the following proteins: CD66b, CD41, CD31, CD142, CD235, and von Willebrand factor, were between 2.4- and 11.7-fold higher in blood from divers with DCS vs. asymptomatic divers, matched for time of sample acquisition, maximum diving depth, and breathing gas. Multiple logistic regression analysis documented significant associations (P < 0.001) between DCS and MPs and for neutrophil MPO staining. Effect estimates were not altered by gender, body mass index, use of nonsteroidal anti-inflammatory agents, or emergency oxygen treatment and were modestly influenced by divers' age, choice of breathing gas during diving, maximum diving depth, and whether repetitive diving had been performed. There were no significant associations between DCS and number of MPs without surface proteins listed above. We conclude that MP production and neutrophil activation exhibit strong associations with DCS., (Copyright © 2015 the American Physiological Society.)

Introduction: High-concentration normobaric oxygen (O₂) administration is the first-aid priority in treating divers with suspected decompression illness. The best O₂ delivery device and flow rate are yet to be determined., Aim: To determine whether administering O₂ with a non-rebreather mask (NRB) at a flow rate of 10 or 15 L·min ⁻¹ or with a demand valve with oronasal mask significantly affects the tissue partial pressure of O₂ (PtcO₂) in healthy volunteer scuba divers., Methods: Fifteen certified scuba divers had PtcO₂ measured at six positions on the arm and leg. Measurements were taken with subjects lying supine whilst breathing O₂ from a NRB at 10 or 15·L·min⁻¹, a demand valve with an adult Tru-Fit oronasal mask and, as a reference standard, an oxygen 'head hood'. End-tidal carbon dioxide was also measured., Results: While none of the emergency delivery devices performed as well as the head hood, limb tissue oxygenation was greatest when O₂ was delivered via the NRB at 15 L·min⁻¹. There were no clinically significant differences in end-tidal carbon dioxide regardless of the delivery device or flow rate., Conclusion: Based on transcutaneous oximetry values, of the commonly available emergency O₂ delivery devices, the NRB at 15 L·min ⁻¹ is the device and flow rate that deliver the most O₂ to body tissues and, therefore, should be considered as a first-line pre-hospital treatment in divers with suspected decompression illness.

The Mars Science Laboratory (MSL) rover Curiosity has documented a section of fluvio-lacustrine strata at Yellowknife Bay (YKB), an embayment on the floor of Gale crater, approximately 500 m east of the Bradbury landing site. X-ray diffraction (XRD) data and evolved gas analysis (EGA) data from the CheMin and SAM instruments show that two powdered mudstone samples (named John Klein and Cumberland) drilled from the Sheepbed member of this succession contain up to ~20 wt% clay minerals. A trioctahedral smectite, likely a ferrian saponite, is the only clay mineral phase detected in these samples. Smectites of the two samples exhibit different 001 spacing under the low partial pressures of H 2 O inside the CheMin instrument (relative humidity <1%). Smectite interlayers in John Klein collapsed sometime between clay mineral formation and the time of analysis to a basal spacing of 10 Å, but largely remain open in the Cumberland sample with a basal spacing of ~13.2 Å. Partial intercalation of Cumberland smectites by metal-hydroxyl groups, a common process in certain pedogenic and lacustrine settings on Earth, is our favored explanation for these differences. The relatively low abundances of olivine and enriched levels of magnetite in the Sheepbed mudstone, when compared with regional basalt compositions derived from orbital data, suggest that clay minerals formed with magnetite in situ via aqueous alteration of olivine. Mass-balance calculations are permissive of such a reaction. Moreover, the Sheepbed mudstone mineral assemblage is consistent with minimal inputs of detrital clay minerals from the crater walls and rim. Early diagenetic fabrics suggest clay mineral formation prior to lithification. Thermodynamic modeling indicates that the production of authigenic magnetite and saponite at surficial temperatures requires a moderate supply of oxidants, allowing circum-neutral pH. The kinetics of olivine alteration suggest the presence of fluids for thousands to hundreds of thousands of years. Mineralogical evidence of the persistence of benign aqueous conditions at YKB for extended periods indicates a potentially habitable environment where life could establish itself. Mediated oxidation of Fe 2+ in olivine to Fe 3+ in magnetite, and perhaps in smectites provided a potential energy source for organisms.

Introduction: Current guidelines for transcutaneous oximetry measurement (TCOM) for the lower limb define tissue hypoxia as a transcutaneous oxygen partial pressure < 40 mmHg. Values obtained with some newer machines and current research bring these reference values into question., Aim: To determine 'normal' TCOM values for the lower limb in healthy, non-smoking adults using the TCM400 oximeter with tc Sensor E5250., Method: Thirty-two healthy, non-smoking volunteers had TCOM performed at six positions on the lower leg and foot. Measurements were taken with subjects lying supine breathing air, then with leg elevated and whilst breathing 100 % oxygen., Results: Room-air TCOM values (mean mmHg, 95 % confidence interval (CI) ) were: lateral leg 41.3, CI 37.8 to 44.7; lateral malleolus 38.6, CI 34.1 to 43.1; medial malleolus 43.9, CI 40.2 to 47.6; dorsum, between first and second toe 39.3, CI 35.9 to 42.7; dorsum, proximal to fifth metatarsal-phalangeal joint 46.4, CI 43.4 to 49.3; plantar 52.3, CI 49.6 to 55.1. Using the currently accepted value of less than 40 mmHg for tissue hypoxia, 24 of our 32 'healthy' subjects had at least one air sensor reading that would have been classified as hypoxic. Seventeen subjects had TCOM values less than 100 mmHg when breathing 100 % normobaric oxygen., Conclusion: Normal lower limb TCOM readings using the TCOM400 with tc Sensor E5250 may be lower than 40 mmHg, used to define tissue hypoxia, but consistent with the wide range of values found in the literature. Because of the wide variability in TCOM at the different sensor sites we cannot recommend one TCOM value as indicative of tissue hypoxia. A thorough clinical assessment of the patient is essential to establish appropriateness for hyperbaric oxygen treatment, with TCOM used as an aid to help guide this decision, but not as an absolute diagnostic tool.

Background: Oxygen "wafting" provides a non-contact oxygen alternative for uncooperative paediatric patients in the emergency department (ED). The aim of this study was to identify the combination of oxygen delivery device, flow rate and device positioning that delivers the highest concentration of wafted oxygen., Methods: ED nursing staff were surveyed to determine current oxygen wafting practice. A simulated patient and oxygen sensor were used to compare wafted oxygen concentrations for six delivery devices in various positions and oxygen flow rates., Results: Only oxygen tubing and the paediatric non-rebreather mask consistently delivered wafted oxygen concentrations above 30%. The paediatric non-rebreather held below the face produced concentrations ranging from 26.1% (10 cm) to 39.8% (5 cm). At 15 L/min, tubing held in front of the face produced concentrations ranging from 31.2% (15 cm) to 56.7% (5 cm); reducing the flow rate to 6-8 L/min had no meaningful effect on the delivered oxygen concentration. When tubing was used below the face, flow rates between 6 and 8 L/min produced somewhat higher concentrations than 15 L/min (5 cm: 36.3% vs. 30.9%)., Conclusions: When delivering oxygen by wafting, the highest oxygen concentrations are achieved when positioning tubing 5-15 cm in front of the face or positioning tubing or a paediatric non-rebreather mask 5-10 cm below the face at 10-15 L/min flow. This should be considered when using oxygen wafting in the ED., (Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: Describe the characteristics, reasons for leaving and outcomes of patients who did not wait (DNW) to be seen by a health practitioner in a regional Australian ED., Methods: Prospective observational study of a convenience sample of ED DNW patients presenting to The Townsville Hospital between June 2011 and July 2012. Seven days from each month were selected, and DNW patients presenting on those days were enrolled. An investigator attempted to contact every DNW patient by telephone in the following week to elicit reasons for leaving, subsequent health contacts, outcomes and suggestions for system improvements. Additional outcome information was obtained from hospital electronic medical records., Results: Nearly 15 000 patients presented on the study days, with 648 (4.3%) DNWs: 415 (64.0%) adults, 193 (29.8%) children (1-16 years old) and 40 (6.2%) infants. Thirty-eight (5.9%) patients who DNW were Australasian Triage Scale (ATS) category 3, 546 (84.3%) were ATS category 4 and 64 (9.9%) were ATS category 5. Most DNW patients presented on Sundays and between 1600 and 2359. Just over half of the patients who DNW (52.9%) sought additional medical treatment, with 4.9% requiring subsequent hospital admission. Three psychiatric patients who DNW required urgent mental health interventions organised by the investigators. Frustration with perceived waiting times was the most common reason for leaving without being seen., Conclusions: Regional Australia ED patients who DNW often still require medical care, with approximately 1 in 20 requiring subsequent hospital admission. Patients with psychiatric conditions who DNW might be at particular risk., (© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Sedimentary rocks at Yellowknife Bay (Gale crater) on Mars include mudstone sampled by the Curiosity rover. The samples, John Klein and Cumberland, contain detrital basaltic minerals, calcium sulfates, iron oxide or hydroxides, iron sulfides, amorphous material, and trioctahedral smectites. The John Klein smectite has basal spacing of ~10 angstroms, indicating little interlayer hydration. The Cumberland smectite has basal spacing at both ~13.2 and ~10 angstroms. The larger spacing suggests a partially chloritized interlayer or interlayer magnesium or calcium facilitating H2O retention. Basaltic minerals in the mudstone are similar to those in nearby eolian deposits. However, the mudstone has far less Fe-forsterite, possibly lost with formation of smectite plus magnetite. Late Noachian/Early Hesperian or younger age indicates that clay mineral formation on Mars extended beyond Noachian time.

The Mars Science Laboratory rover Curiosity scooped samples of soil from the Rocknest aeolian bedform in Gale crater. Analysis of the soil with the Chemistry and Mineralogy (CheMin) x-ray diffraction (XRD) instrument revealed plagioclase (~An57), forsteritic olivine (~Fo62), augite, and pigeonite, with minor K-feldspar, magnetite, quartz, anhydrite, hematite, and ilmenite. The minor phases are present at, or near, detection limits. The soil also contains 27 ± 14 weight percent x-ray amorphous material, likely containing multiple Fe(3+)- and volatile-bearing phases, including possibly a substance resembling hisingerite. The crystalline component is similar to the normative mineralogy of certain basaltic rocks from Gusev crater on Mars and of martian basaltic meteorites. The amorphous component is similar to that found on Earth in places such as soils on the Mauna Kea volcano, Hawaii.

The Rocknest aeolian deposit is similar to aeolian features analyzed by the Mars Exploration Rovers (MERs) Spirit and Opportunity. The fraction of sand <150 micrometers in size contains ~55% crystalline material consistent with a basaltic heritage and ~45% x-ray amorphous material. The amorphous component of Rocknest is iron-rich and silicon-poor and is the host of the volatiles (water, oxygen, sulfur dioxide, carbon dioxide, and chlorine) detected by the Sample Analysis at Mars instrument and of the fine-grained nanophase oxide component first described from basaltic soils analyzed by MERs. The similarity between soils and aeolian materials analyzed at Gusev Crater, Meridiani Planum, and Gale Crater implies locally sourced, globally similar basaltic materials or globally and regionally sourced basaltic components deposited locally at all three locations.

Introduction: Middle ear barotrauma (MEBT) is the most common complication of hyperbaric oxygen therapy (HBOT). We wished to determine whether independent risk factors could predict which patients will require tympanostomy tubes in order to continue HBOT., Methods: Data regarding demographics, medical history and physical examination were collected prospectively over one year. Multivariate logistic regression was used to analyse the data., Results: One hundred and six patients were included. The cumulative risk of MEBT over the first five treatments was 35.8% and that for needing tympanostomy tubes was 10.3%, while that for needing tubes at any time was 13.2%. Risk factors for MEBT on bivariate analysis were older age, history of ENT radiation and anticoagulant use. Risk factors for requiring tympanostomy tubes included a history of cardiovascular disease and patients being treated for an infective condition. The adjusted multivariate logistic model identified history of difficulty equalising as the only characteristic significantly associated with MEBT during the first five treatments, adjusted odds ratio (AOR) (95%CI): 11.0 (1.1 - 111.7). Being female, AOR (95%CI): 24.7 (1.8 - 339.7), and having a history of cardiovascular disease, AOR (95%CI): 20.7 (2.0 - 215.3), were significantly associated with the need for tympanostomy tubes during the first five HBOT, but there was no significant association between any other characteristics and the need for tubes at any point., Conclusion: Despite some significant risk factors for MEBT being identified, we were unable to predict accurately enough which patients needed tympanostomy tubes during their HBOT to recommend these being placed prophylactically in selected patients.

Stable isotope ratios of H, C, and O are powerful indicators of a wide variety of planetary geophysical processes, and for Mars they reveal the record of loss of its atmosphere and subsequent interactions with its surface such as carbonate formation. We report in situ measurements of the isotopic ratios of D/H and (18)O/(16)O in water and (13)C/(12)C, (18)O/(16)O, (17)O/(16)O, and (13)C(18)O/(12)C(16)O in carbon dioxide, made in the martian atmosphere at Gale Crater from the Curiosity rover using the Sample Analysis at Mars (SAM)'s tunable laser spectrometer (TLS). Comparison between our measurements in the modern atmosphere and those of martian meteorites such as ALH 84001 implies that the martian reservoirs of CO2 and H2O were largely established ~4 billion years ago, but that atmospheric loss or surface interaction may be still ongoing.

Introduction: Several studies define normal transcutaneous oximetry measurements (TCOM) for the chest and lower limb, but not the upper limb. Standardised healthy-subject reference values for upper limb TCOM would make interpretation of these measurements in disease or injury more meaningful., Aim: To determine 'normal' TCOM values for the upper limb in healthy non-smoking adults., Method: Thirty-two healthy volunteers (16 male, 16 female) had TCOM performed on the chest and at five upper limb positions: lateral aspect of the upper arm midway between the shoulder and elbow; lateral aspect of the forearm, dorsum of the hand, thenar and hypothenar eminences. Measurements were taken using the TCM400 Monitoring System (Radiometer) with subjects breathing room air and whilst breathing 100% oxygen., Results: Room-air TCOM values (mean (SD), 95% confidence interval (CI)) were: chest: 50 (11.4) mmHg, 95% CI 46.0 to 54.2; upper arm: 53 (9.3) mmHg, 95% CI 49.7 to 56.4; forearm: 45 (11.3) mmHg, 95% CI 40.4 to 48.6; dorsum of hand: 39 (8.5) mmHg, 95% CI 35.5 to 41.7; thenar eminence: 54 (7.7) mmHg, 95% CI 51.7 to 57.2; and hypothenar eminence: 57 (7.5) mmHg, 95% CI 54.1 to 59.6. All readings showed a substantial increase when subjects breathed 100% oxygen. Using the currently accepted threshold for tissue hypoxia of < 40 mmHg, six forearm and 14 dorsum of the hand TCOM readings would have been classified as hypoxic., Conclusion: Normal upper limb TCOM readings are less than those established for the lower limb. Using lower-limb reference standards could result in false-positive determinations of tissue hypoxia. We recommend TCOM ≤ 30 mmHg as indicative of tissue hypoxia in the upper arm, thenar and hypothenar eminences, and < 20 mmHg in the forearm and dorsum of the hand.

Introduction: The sharpened Romberg test (SRT) is commonly used by diving and hyperbaric physicians as an indicator of neurological decompression illness (DCI). People who spend a prolonged time on a boat at sea experience impairment in their balance on returning to shore, a condition known as mal de debarquement ('sea legs'). This conditioning of the vestibular system to the rocking motion of a boat at sea may impact on the utility of the SRT in assessing a diver with potential DCI after a live-aboard dive trip., Aim: To assess the impact 'sea legs' has on the SRT after three days on a live-aboard dive trip., Methods: Thirty-nine staff and passengers of a three-day, live-aboard dive trip performed a SRT before and after their journey, with assessment of potential variables, including middle ear barotrauma, alcohol consumption, sea-sickness and occult DCI., Results: There was no statistically significant impact on SRT performance, with 100% completion pre-trip and 35 out of 36 divers (97.2%) post-trip. There were trends towards more attempts being required and time needed for successful SRT post-trip, but these were not statistically significant. There was a small, but noteworthy incidence of middle-ear barotrauma, with seven people affected pre-trip, and 13 post-trip. There was a higher incidence in student divers. Middle-ear barotrauma did not appear to have a direct impact on SRT performance., Conclusion: There was no significant impact on SRT performance resulting from 'sea legs' after three days at sea. Recreational divers, especially dive students, have a substantial incidence of mild middle ear barotrauma.

Vapor-deposited amorphous water ice when warmed above the glass transition temperature (120-140 K), is a viscous liquid which exhibits a viscosity vs temperature relationship different from that of liquid water at room temperature. New studies of thin water ice films now demonstrate that viscous liquid water persists in the temperature range 140-210 K. where it coexists with cubic crystalline ice. The liquid character of amorphous water above the glass transition is demonstrated by (1) changes in the morphology of water ice films on a nonwetting surface observed in transmission electron microscopy (TEM) at around 175 K during slow warming, (2) changes in the binding energy of water molecules measured in temperature programmed desorption (TPD) studies, and (3) changes in the shape of the 3.07 micrometers absorption band observed in grazing angle reflection-absorption infrared spectroscopy (RAIRS) during annealing at high temperature. whereby the decreased roughness of the water surface is thought to cause changes in the selection rules for the excitation of O-H stretch vibrations. Because it is present over such a wide range of temperatures, we propose that this form of liquid water is a common material in nature. where it is expected to exist in the subsurface layers of comets and on the surfaces of some planets and satellites.

Electron diffraction studies of vapor-deposited water ice have characterized the dynamical structural changes during crystallization that affect volatile retention in cometary materials. Crystallization is found to occur by nucleation of small domains, while leaving a significant part of the amorphous material in a slightly more relaxed amorphous state that coexists metastably with cubic crystalline ice. The onset of the amorphous relaxation is prior to crystallization and coincides with the glass transition. Above the glass transition temperature, the crystallization kinetics are consistent with the amorphous solid becoming a "strong" viscous liquid. The amorphous component can effectively retain volatiles during crystallization if the volatile concentration is approximately 10% or less. For higher initial impurity concentrations, a significant amount of impurities is released during crystallization, probably because the impurities are trapped on the surfaces of micropores. A model for crystallization over long timescales is described that can be applied to a wide range of impure water ices under typical astrophysical conditions if the fragility factor D, which describes the viscosity behavior, can be estimated.

Computer simulations of bulk and vapor deposited amorphous ices are presented. The structure of the bulk low density amorphous ice is in good agreement with experiments on pressure disordered amorphous ice. Both the low density bulk ice and the vapor deposited ices exhibit strong ordering. Vapor deposition of hot (300 K) water molecules onto a cold (77 K) substrate yields less porous ices than deposition of cold (77 K) water molecules onto a cold substrate. Both vapor deposited ices are more porous than the bulk amorphous ice. The structure of bulk high density amorphous ice is only in fair agreement with experimental results. Attempts to simulate high density amorphous ice via vapor deposition were not successful. Electron diffraction results on vapor deposited amorphous ice indicate that the temperature of the nucleation of the cubic phase depends upon the amount of time between the deposition and the onset of crystallization, suggesting that freshly deposited ice layers reconstruct on times of the order of hours. The temperature dependence of the microporosity of the vapor deposited amorphous ices might affect laboratory experiments that are aimed at simulating astrophysical ices in the context of the origin of prebiotic organic material and its transport to the Earth.

Selected area electron diffraction is used to monitor structural changes of vapor-deposited water ice in vacuum during warm-up from 15 to 188 K. A progression of three amorphous forms of water ice is found with well-defined transitions. The formation of a high-density amorphous form (Iah) at 15 K is confirmed, and the transition to the more familiar low-density form (Ial) occurs gradually over the range 38 to 68 K. At 131 K, the ice transforms into a third amorphous form (Iar), which precedes the crystallization of cubic ice (Ic) and coexists metastably with Ic from 148 K until at least 188 K. These structural transformations of amorphous water ice can be used to explain hitherto anomalous properties of astrophysical ices. The structural transition from Iah to Ial is responsible for the diffusion and recombination of radicals in ultraviolet-photolyzed interstellar ices at low temperatures. The occurrence and persistence of Iar explains anomalous gas retention and gas release from water-rich ices at temperatures above 150 K.

A series of surface-modified clays containing nanophase (np) iron oxide/oxyhydroxides of extremely small particle sizes, with total iron contents as high as found in Mars soil, were prepared by iron deposition on the clay surface from ferrous chloride solution. Comprehensive studies of the iron mineralogy in these "Mars-soil analogs" were conducted using chemical extractions, solubility analyses, pH and redox, x ray and electron diffractometry, electron microscopic imaging, specific surface area and particle size determinations, differential thermal analyses, magnetic properties characterization, spectral reflectance, and Viking biology simulation experiments. The clay matrix and the procedure used for synthesis produced nanophase iron oxides containing a certain proportion of divalent iron, which slowly converts to more stable, fully oxidized iron minerals. The clay acted as an effective matrix, both chemically and sterically, preventing the major part of the synthesized iron oxides from ripening, i.e., growing and developing larger crystals. The precipitated iron oxides appear as isodiametric or slightly elongated particles in the size range 1-10 nm, having large specific surface area. The noncrystalline nature of the iron compounds precipitated on the surface of the clay was verified by their complete extractability in oxalate. Lepidocrocite (gamma-FeOOH) was detected by selected area electron diffraction. It is formed from a double iron Fe(II)/Fe(III) hydroxy mineral such as "green rust," or ferrosic hydroxide. Magnetic measurements suggested that lepidocrocite converted to the more stable maghemite (gamma-Fe2O3) by mild heat treatment and then to nanophase hematite (alpha-Fe2O3) by extensive heat treatment. After mild heating, the iron-enriched clay became slightly magnetic, to the extent that it adheres to a hand-held magnet, as was observed with Mars soil. The chemical reactivity of the iron-enriched clays strongly resembles, and offers a plausible mechanism for, the somewhat puzzling observations of the Viking biology experiments. Their unique chemical reactivities are attributed to the combined catalytic effects of the iron oxide/oxyhydroxides and silicate phase surfaces. The reflectance spectrum of the clay-iron preparations in the visible range is generally similar to the reflectance curves of bright regions on Mars. This strengthens the evidence for the predominance of nanophase iron oxides/oxyhydroxides in Mars soil. The mode of formation of these nanophase iron oxides on Mars is still unknown. It is puzzling that despite the long period of time since aqueous weathering took place on Mars, they have not developed from their transitory stage to well-crystallized end-members. The possibility is suggested that these phases represent a continuously on-going, extremely slow weathering process.

Columnals of Neocrinus blakei, a modern species of stalked crinoid, were studied using a variety of analytical techniques. Analyses of the magnesium calcite of the crinoid stereom using powder X-ray diffraction and electron microprobe analysis yield a composition of Ca 88Mg 12C03. Scanning transmission electron microscopy (STEM) microanalytical data indicate that Mg incorporation into the calcite structure of the crinoid stereom is random and homogeneous to at least the 20 nm level. There appear to be no variations in composition at this level either within or between structural entities of the crinoid columnal stereom. TEM reveals a heterogeneity of contrast which may be due to incorporation of organic material or some other substance which is non-crystalline in character. Single-crystal X-ray diffraction data indicate that the individual skeletal plates are single crystals which yield diffuse and imperfect X-ray reflections due to a mosaic structure. Subsequent selected area electron diffraction (SAD) photographs via TEM, using various sizes of SAD apertures, indicate that the crystallites making up the mosaic structure are (order of magnitude) about 1.0 micrometer in size. The presence of mosaic structure in the single crystal skeletal elements may at least in part explain the lack of cleavage in fracture surfaces of echinoderm skeletal material. Based on these data, as well as data from skeletal elements of other deep water, stalked crinoids, we feel that these results may be applicable to crinoids in general, at least those existing in relatively constant temperature environments. The single-crystal nature of crinoid high magnesium calcite, and its remarkable homogeneity of composition suggest that a large "vital effect" (i. e., biologic control of skeletal deposition) mediates the mineralization process.

Microscopic diamond was recently discovered in oxidized acid residues from several carbonaceous chondrite meteorites (for example, the C delta component of the Allende meteorite). Some of the reported properties of C delta seem in conflict with those expected of diamond. Here we present high spatial resolution analytical data which may help to explain such results. The C delta diamond is an extremely fine-grained (0.5-10 nm) single-phase material, but surface and interfacial carbon atoms, which may comprise as much as 25% of the total, impart an 'amorphous' character to some spectral data. These data support the proposed high-pressure conversion of amorphous carbon and graphite into diamonds due to grain-grain collisions in the interstellar medium although a low-pressure mechanism of formation cannot be ruled out.

A series of equations is presented through which thin-film X-ray microanalytical data may be characterized statistically. Test statistics based on the Gaussian distribution are than presented, together with examples of the use and evaluation of an empirically derived Mg/Ca working curve.