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Introduction: Published normal transcutaneous oxygen partial pressures (PtcO2) 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' PtcO2 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 PtcO2 (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 PtcO2 below 40 mmHg (nine upper limb, 13 lower limb, four chest). Approximately 10% lower limb PtcO2 were < 100 mmHg on normobaric oxygen. Only one subject at one site had an upper limb PtcO2 < 100 mmHg breathing oxygen. Conclusion: The broad dispersion in PtcO2 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 PtcO2 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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·hr-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. [ABSTRACT FROM AUTHOR]

The Aotearoa/New Zealand Adoption Act 1955 legislated and governed adoption practices from 1955 to 1985. Through an exploration of the historical, cultural and social assumptions underlying the Adoption Act 1955, this article questions how the social power relations complicit with adoption legislation and policy produce and reproduce subject positions for adoptees. In-depth narrative interviews were conducted with 12 adoptees from throughout Aotearoa/New Zealand. The researchers found the legal constitution of adoptees produces them as legitimate; however, they remain 'other' through dominant discourses of heteronormative blood kinship that reiterates their illegitimacy. The legal fiction of their legitimacy as if born to failed to secure them space within normative narratives of kinship and compromised adoptees' ability to take up responsibility as neoliberal citizens. Current New Zealand debate on adoption fails to take account of the experience of adoptees, focusing instead on the rights of married couples, including same-sex couples, to continue practices of adoption. Our analysis informs the critical importance of listening to how adoptees experience repeated exclusions and enduring loss represented by the metaphor of no-man's land. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article examines the normal transcutaneous oximetry measurement (TCOM) values for the upper limb in healthy non-smoking adults. The researchers observed the TCOM on the chest and at upper five upper limb positions of the volunteers. Data show the room-air TCOM values and confidence interval for the chest, upper arm, forearm, dorsum of hand, thenar and hypothenar eminence. The researchers recommend a TCOM value as indicative of tissue hypoxia in the upper limb positions.

The article discusses a study on a sharpened Romberg test (SRT) after three days on a live-aboard dive boat. The researchers aimed to examine the impact of the sea legs condition, an experience involving an impairment in balance on returning to shore, on the SRT. Results of the study indicated that there was no significant effect on SRT performance caused by sea legs after three days at sea.

Context. Imatinib mesylate (Glivec[sup ®], Gleevec[sup ®], Novartis) has made a dramatic impact on the treatment available for both chronic myeloid leukaemia (CML) and gastrointestinal stromal tumours (GISTs). Both are rare diseases that have possibly been unfamiliar to many pharmacists until now. Objective. To provide readers with a structured overview of CML and GISTs and the trial data available to support the role imatinib is playing in the treatment of these diseases. Data sources. Published reviews and primary trial results were sourced via Medline to prepare the review. Articles published up to and including August 2002 were considered. Additionally, pertinent books were used to prepare the text and Novartis kindly supplied information currently only available on file at the company. As imatinib has only been available for a short time, all types and sizes of trials were considered for inclusion. The authors made the final decision as to the relevance and therefore subsequent inclusion of data. Conclusions. Imatinib is a new molecularly targeted therapy for the treatment of CML and GISTs. It has provided an efficacious alternative therapy choice for physicians managing the care of patients suffering from these diseases. In the future there is the possibility that imatinib may demonstrate activity in other disease states characterized by the genetic changes targeted by imatinib. The results of randomized controlled trials in new and existing indications are awaited. [ABSTRACT FROM AUTHOR]

Many members of the precariat in Aotearoa/New Zealand (NZ) struggle to access resources for leisure. This article draws on four interview waves with five precariat Māori (Indigenous peoples of Aotearoa/NZ) households (N = 32 interviews) using mapping and photo-elicitation interviews to explore participant leisure engagements. We document how precarious leisure for some Māori is assembled agentively by participants out of key elements associated with their situations (e.g. financial and housing insecurities) and core Māori principles and processes of whanaungatanga (cultivating positive relationships) and manaakitanga (caring for self and others). Participant accounts foregrounded the importance of mātauranga Māori (systems of knowledge) and culture in shaping contemporary leisure practices that can promote a sense of ontological security, place, belonging, connection, cultural continuity, and self as Māori. Though beneficial to self and others, participant leisure practices are rendered insecure by the resource restraints of life in the precariat. [ABSTRACT FROM AUTHOR]

This article outlines an exploratory grounded theory of women's experiences regarding body image. Eleven women, aged 18 to 25, participated in semi-structured interviews. The study explored a range of concerns, focusing on weight, size and appearance; the participants discussed how these concerns affected them, and what contributed to their concerns. The preliminary grounded theory suggests that all the women, to various degrees, monitor, evaluate and/or alter their bodies in specific ways to manage social relationships and maximise positive feelings about themselves, while minimising negative ones. The theory that emerged from this study is process oriented and suggests that for most of the women being happy with their bodies, or not feeling unhappy with them, is only a transitory part of an ongoing cyclical process of monitoring and evaluation. This theory gives rise to research possibilities which are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Harmful drinking is increasing among mid-life adults. Using social practice theory, this research investigated the knowledge, actions, materials, places and temporalities that comprise home drinking practices among middle-class adults (40-65 years) in Aotearoa New Zealand during 2021-2022 and post the COVID-19 pandemic lockdowns., Methods: Nine friendship groups (N = 45; 26 females, 19 males from various life stages and ethnicities) discussed their drinking practices. A subset of 10 participants (8 female, 2 male) shared digital content (photos, screenshots) about alcohol and drinking over 2 weeks, which they subsequently discussed in an individual interview. Group and interview transcripts were thematically analysed using the digital content to inform the analysis., Results: Three themes were identified around home drinking practices, namely: (i) alcohol objects as everywhere, embedded throughout spaces and places in the home; (ii) drinking practices as habitual, automatic and conditioned to mundane everyday domestic chores, routines and times; and (iii) drinking practices intentionally used by participants to achieve desired embodied states to manage feelings linked to domestic and everyday routines., Discussion and Conclusions: Alcohol was normalised and everywhere within the homes of these midlife adults. Alcohol-related objects and products had their own agency, being entangled with domestic routines and activities, affecting drinking in both automatic and intentional ways. Developing alcohol policy that would change its ubiquitous and ordinary status, and the 'automatic' nature of many drinking practices, is needed. This includes restricting marketing and availability to disrupt the acceptability and normalisation of alcohol in the everyday domestic lives of adults at midlife., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: Needle Exchange Programme (NEP) mobile outreach services in Aotearoa New Zealand distribute injecting equipment to people who inject drugs (PWID) living in remote regions. In disasters, continued access to such services is imperative for the health and wellbeing of PWID. Disasters can compound existing inequities, particularly in regions characterised by poor or limited infrastructure, smaller populations, and challenging socioeconomic conditions. To gain insight into the barriers that prevent access to NEP harm-reduction services and understand the needs of PWID prior to and during disasters, this study foregrounds the voices of PWID based on the West Coast of the South Island, Aotearoa New Zealand., Methods: This qualitative study applied an interpretive phenomenological analysis approach, where 14 PWID and one key NEP staff member took part in semi-structured interviews. The interviews provided the opportunity for participants to share their experiences and perspectives about accessing sterile drug-injecting equipment during disasters, including the four-week COVID-19 Level 4 lockdown in March 2020. In total five superordinate and 14 subordinate themes were identified from the interveiws., Results: This study focuses on four of the key themes that impacted accessibility to NEP services: infrastructural hazards and equipment costs; social capital and practical support from peers and key contact networks; social stigma in public locations, including NEP-based pharmacies and emergency centres; and potential solutions to NEP equipment accessibility as frequently suggested by participants., Conclusions: Access to NEP services is essential during natural hazard and human-generated disasters, as such NEP mobile outreach services and disaster resilience efforts should focus on maintaining service continuity for PWID during adverse times. This study champions a needs-based, stigma free approach to inclusive harm-reduction and emergency management practices for groups with specific needs in a disaster context., (© 2022. The Author(s).)