Wikipedia:Featured article candidates/Oxygen toxicity/archive1

The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted by Karanacs 20:41, 21 July 2009 [1].

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Oxygen toxicity

Nominator(s): RexxS (talk) 18:21, 24 June 2009 (UTC)

• Featured article candidates/Oxygen toxicity/archive1

I am nominating this for featured article because I believe the article meets the criteria for FA as well as conforming to WP:MOSMED. Although this is my first FA nomination, I have taken the article through GA and Peer Review and intend to resolve any criticisms promptly and to the best of my abilities. Oxygen toxicity is potentially the greatest danger to scuba divers at depth, and is also a concern in neonatal care and anywhere that supplemental oxygen is provided. As it affects such diverse disciplines, its importance deserves a featured article. RexxS (talk) 18:21, 24 June 2009 (UTC)

• Comment. Overall quality seems quite promising, even excellent. A quick and superficial review found some problems that need fixing, though; please see Talk:Oxygen toxicity#Quick FAC review. Eubulides (talk) 19:50, 24 June 2009 (UTC)

• Knowing that the review may end prematurely, I would preliminary vote Support, under condition that authors work to resolve remaining issues (not necessarily mine).

1) The front image loads too slowly, because its size is 0.5 Mb. The image quality and resolution are low (I guess due to the old source). My point is that image compression (gif) is very inefficient there. You have uploaded this image. Why don't you convert it to jpg ? Materialscientist (talk) 04:46, 25 June 2009 (UTC)

1) The reason I didn't convert the lead image to jpg is that I'm an idiot. The original was a gif and after I'd done my best to bring out the detail in it, I saved it as a gif because I always worry that changing formats loses detail - but I failed to check the file size. Eubulides has kindly rectifed that problem now, and it's a great help in reducing the load time. Thank you both. --RexxS (talk) 14:02, 25 June 2009 (UTC)

2) Two journal papers by Donald (1947) are put as "bibliography" whereas they are only 5 page long and should be cited directly (in-line) instead. Materialscientist (talk) 04:46, 25 June 2009 (UTC)

2) Donald's articles are short, but are a seminal study in this field. As such they were reprinted and expanded into the 1992 book, which has to be in the bibliography. It seemed natural to me to associate the papers and the book, and there is the advantage that multiple references to different pages can then be done by {{harvnb}}. The book is very expensive and hard to find now, but the papers are available online, so I chose to cite the papers (rather than the book), since the reader can easily refer to them. Given all of that, would you be prepared to reconsider your comment? The principle of not including short works in a bibliography seems to me not strong enough to outweigh the advantages of making an exception here. --RexxS (talk) 14:02, 25 June 2009 (UTC)

No. (i) You do not provide pages for ref. Donald 1992. (ii) you use three references to three works by Donald, which means they all should be in-line. It is a great inconvenience to click so much to get to the source.

2) I understand what you meant now - I had originally intended all 3 refs to be to the book, so had set up {{harvnb}}, then decided to reference the articles where I could to allow easier access. I've now replaced all 3 harvnb refs with inline citations. Thank you. As for the pages in ref Donald 1992: The reference is intended to source the statement During World War II, Donald and Yarbrough et al. performed over 2,000 experiments on oxygen toxicity to support the initial use of closed circuit oxygen rebreathers. - the whole book is a description of his studies, not any particular page. --RexxS (talk) 15:36, 26 June 2009 (UTC)

Is there any reason why those refs. are still in the bibliography ? Materialscientist (talk) 02:49, 28 June 2009 (UTC)

Donald's book was the starting point for much of what I have written about oxygen toxicity in divers - as such, I am obliged to acknowledge the source. I could now move the book to "Further reading", but as that section does not allow works referenced in the article, I can't move the 1947 original articles there as well. That would mean that the readers wouldn't see that they can read the original work online. I think that the value to the readers overrides stylistic conventions here. Perhaps you can suggest an alternative layout that works? --RexxS (talk) 19:19, 28 June 2009 (UTC)

Donald is Ok with me, but ref. Patel et al. not (same issue - no need for separating). Materialscientist (talk) 10:04, 29 June 2009 (UTC)

Patel et al's article is referenced at pages 234–7 (as current ref #14) and again at page 235 (as current ref #81). I used {{Harvnb}} to allow me to quote different page numbers in each cite, thus citing the whole book just once in "Sources". I was under the impression that this was the recommended method and haven't seen any guidelines to do otherwise, so you'll have to excuse me. Am I right in thinking that your advice is not to do that where there are only a couple of different page numbers? If so, I can easily change the harvnb to full inline cites and remove Patel's article from "Sources". --RexxS (talk) 16:11, 29 June 2009 (UTC)

I was the one who did the Harvard number on Patel et al., since articles should avoid having two different external links to the same external resource. I didn't realize the source was so short, though. If the source is a single journal article, or a single book chapter, there's typically no need for Harvard cites to individual pages. I just now changed it to use standard inline refs without individual page numbers. Eubulides (talk) 16:49, 29 June 2009 (UTC)

I understand now: no point in different pages via harvnb if it's such a short source - thank you for fixing it. --RexxS (talk) 19:17, 29 June 2009 (UTC)

3) The image File:Cylinder mod.jpg and its caption look weird (especially for an encyclopedia article on health issues) - as if somebody, by his own right, decided to label this bottle as 36% and 28m max. Aren't such things supposed to be properly imprinted by the manufacturer ? Materialscientist (talk) 04:46, 25 June 2009 (UTC)

3) A large part of the audience for this article will be scuba divers, as oxygen toxicity is one of the most potentially lethal problems they encounter. So I wanted the article to serve them in particular. You are quite right, I analysed the nitrox in that cylinder, and labelled it myself. That's exactly what we have to do. It means if it's wrong, nobody else is liable. Since a cylinder can commonly contain a mix of anything from 21% to 100% oxygen, it cannot be labelled by the manufacturer. But we have articles on nitrox and breathing gas, so I didn't think it was appropriate to include that much detail here. --RexxS (talk) 14:02, 25 June 2009 (UTC)

4) Lead: "In recent years, oxygen has be available for recreational use in oxygen bars and for scuba divers as nitrox." sounds strange "oxygen has been (typo) available as nitrox (?)"

4) You are quite right. I've rewritten that paragraph and hope that it makes more sense now. --RexxS (talk) 14:02, 25 June 2009 (UTC)

5) Ref. 98 needs volume number. Materialscientist (talk) 06:55, 26 June 2009 (UTC)

5) I've added the volume (5) to ref #98 and tidied it for consistency. --RexxS (talk) 15:36, 26 June 2009 (UTC)

6) Stupid question (I know nothing about this field). Take a Nepalese Sherpa, who was born and lived at ~4km where oxygen pressure is almost half of normal, and move him to live at 0km level. What will happen to his eyesight? I guess the question is about adaptation, which I haven't found in this article upon quick glance - you focus on short exposure of (untrained) person to high oxygen pressures. Materialscientist (talk) 06:55, 26 June 2009 (UTC)

6) Good question. The studies that I'm aware of (refs #69,71,72) all deal with the effect in navy divers breathing oxygen at 1.3+ bar partial pressure - about 6 times normal. Folks undergoing HBOT breathe oxygen at 2.8 bar ppO2 - about 14 times normal, so the effect there is not surprising. As there doesn't seem to be a concern about oxygen partial pressures at twice normal (this would be equivalent to diving on air to 10 metres or 33 ft), I would guess that the Sherpa wouldn't notice anything. But that would be WP:SYNTH, so I can only offer you my considered opinion. I have no sources that address it. --RexxS (talk) 15:36, 26 June 2009 (UTC)

7) A side note: I never thought I will get more than 3 questions to this article .. Thus it might be better to reply below each question; otherwise the question and reply will not fit into a PC screen.. Here comes comment No7: Please either do not define abbreviations or define them on first occurrence and use later (you define them several times). I myself prefer the former and advise the same - you repeat one abbreviation only 3-4 times over the article. Abbreviations do scare general readers. Materialscientist (talk) 12:27, 27 June 2009 (UTC)

I'm sorry about the distance between the questions and replies. I hope you will bear with me because this is my first time here. I diligently followed the instruction at WP:FAC (Supporting and opposing): "Per talk page guidelines, nominators should not cap, alter, strike, break up, or add graphics to comments from other editors; replies are added below the signature on the reviewer's commentary". I do agree with you on this but am torn between what is sensible and the fear of being "told off" for not following the accepted protocol here. I still find the whole process of GA/PR/FAC rather daunting and still have a lot to learn about it. Since you've been kind enough to provide a sig after each comment, I've boldly refactored this section to put Q & A together and hope nobody complains.

I was requested at GA to define abbreviations once per section: There are several abbreviations that that explained in one section and then used without explanation in another section. I believe few readers read all sections, but mostly dive into one somewhere in the middle. You should try to make sections stand on their own by writing out unusual abreviations (ppO2, ROP, BPD and ARDS) - and it seemed to me that Narayanese had a point. I'm willing to go back to defining only at first occurrence if you require it, but I actually think that would not improve the article. Nor would abandoning the abbreviations, since the full terms are often cumbersome. I do understand that abbreviations, like jargon, are a barrier to readers, but I was hoping that the scheme of defining them at first occurrence per section would be the best compromise. Would you reconsider this one or perhaps give me a specific example of how you think, say BPD should be used or where it should be defined? --RexxS (talk) 16:05, 27 June 2009 (UTC)

You are a specialist in the field and should not get intimidated by referees (I was in your shoes just few weeks ago). Please get to the point without apologies. I boldly went ahead and deleted most abbreviations: (i) Abbreviations do not need "" (ii) There is no logical sense or rule to define an abbreviation several times and never use it (which was the case). I might be gone too far and too fast (sorry, no time today). Please reintroduce what was needed. Materialscientist (talk) 02:34, 28 June 2009 (UTC)

Thanks, the article looks cleaner without so many abbreviations, and I agree that many of them (e.g. HBOT and COPD) were redundant. I'm still mulling over CNS, BPD and ROP, as they are hugely used in the sources. I think "CNS oxygen toxicity" is cumbersome, but "central nervous system oxygen toxicity" is worse. Axl has kindly volunteered to look over these for us and hopefully make some recommendations. --RexxS (talk) 19:19, 28 June 2009 (UTC)

A quick reply: neither "CNS oxygen toxicity" nor (especially) "central nervous system oxygen toxicity" are good, I have long noticed that the paper suffers from complex adjectives, but haven't got to that yet. How about "oxygen toxicity to central nervous system" ? Same with other similar phrases. Materialscientist (talk) 01:23, 29 June 2009 (UTC)

Thanks for the suggestion, but it's simply not the usage in the literature nor in common spoken usage. It's invariably "CNS oxygen toxicity" (spoken as "See-En-Ess") - just as "TNT" is almost always used instead of "trinitrotoluene". It seems pointless to ignore usage outside the encyclopedia in order to fit our concept of style. --RexxS (talk) 02:00, 29 June 2009 (UTC)

I admit my wrong here trying to fix medical terminology - this should be done ~50 years ago. Please ignore my comments on that. Just bear in mind that most abbreviations like CNS have dozens of meanings. Materialscientist (talk) 03:30, 29 June 2009 (UTC)

The term "central nervous system" is used infrequently enough that there isn't a clear benefit from the abbrevation "CNS". I am confident that any reader who understands "CNS oxygen toxicity" will also understand "central nervous system oxygen toxicity"; the reverse is not necessarily true. "Oxygen toxicity to central nervous sytem" seems to be more cumbersome. I am in favour of leaving the article as it currently stands, with "central nervous system oxygen toxicity" throughout. Axl ¤ [Talk] 20:55, 3 July 2009 (UTC)

8) Caption of the front figure "The subject in the centre is breathing oxygen under pressure." sounds funny (breathing under pressure :) . Should it be "breathing pressurised oxygen" ? Materialscientist (talk) 12:27, 27 June 2009 (UTC)

No, it's right. The caption in the source (Donald, Kenneth W. (17 May 1947). "Oxygen poisoning in man—part I". British Medical Journal (4506): 668. doi:10.1136/bmj.1.4506.667. PMC 2053251.) is "Subject breathing oxygen under pressure". Nevertheless, I've expanded the caption now to explain that the chamber is pressurised with air and only the subject is breathing 100% oxygen from a mask. --RexxS (talk) 16:05, 27 June 2009 (UTC)

9) The biggest problem of this paper is to explain things to a non-professional. It does contain unnecessary jargon. Please try to explain whatever you can in plain language. One example is caption of the second figure. I understand only few words of it and am absolutely sure it could be more accessible. As I said, I know nothing about the field, but I've learned from my parents (experienced doctors) that most medical terminology is designed on purpose so that the patients do not understand what the doctors are talking about :) If I find some time I will point to more specific examples in this article. Materialscientist (talk) 12:27, 27 June 2009 (UTC)

I have honestly tried to explain jargon as best I could (particularly in the lead), having spent 25+ years trying to explain things in simple terms to schoolkids. The nature of this subject (and its sources) lends itself to medical jargon, so I sympathise with you, but really need a fresh pair of eyes to tell me specifically what may be inaccessible now, as I think I'm just too familiar with the text. I had hoped Peer Review would have sorted that, but I'm rather naive about the processes, and do appreciate whatever help I can get. Thank you anyway for all the time you've invested here. I've recaptioned the rat lung, but accept that the image is less than ideal to a casual reader. --RexxS (talk) 16:50, 27 June 2009 (UTC)

10) It sound like a relieving joke to hear after a long and dead serious scientific article the story of Dr. Ox. The joke part is that "oxyhydrogen" mixtures are very explosive (no wonder that the villagers got excited :) With all do respect to Jules Verne, do we need to include such fantasies ? Materialscientist (talk) 12:27, 27 June 2009 (UTC)

That was (again) a specific suggestion at Peer Review by Ruhrfisch. Although there's no need for it, I actually think that the Dr. Ox story paints an interesting picture of Victorian fascination with pseudo-science and the unknown dangers of oxygen - in some ways, quite prescient! Perhaps I should say so in the article, or would that be WP:OR? Either way, I'd quite like to keep it, but as ever, I'm willing to be guided here. --RexxS (talk) 16:16, 27 June 2009 (UTC)

Let me repeat, hydrogen and oxygen gases spontaneously explode upon mixing, causing major destruction. I did delete that part and expect the one who restores it to explain why such things may stay there. One possibility was that Verne was not that naive and did not mean hydrogen (I can't check the original). Another problem was that this article and WP article on the novel gave somewhat different versions of what happened to that town :) Materialscientist (talk) 02:34, 28 June 2009 (UTC)

It is perfectly possible that Verne in 1874 had no idea that O2/H2 mixtures between 5% and 95% are explosive and he surely made up "oxyhydric" for the sound, rather than to represent a real gas mixture. The Barnes & Noble review is online and pretty much agrees with my summary, by the way. Nevertheless, the paragraph was only suggested to illustrate how oxygen was viewed in Victorian culture, and I won't contest its removal. --RexxS (talk) 17:44, 28 June 2009 (UTC)

I've read the novel and here is the summary: (i) Ox used electrolysis of water to separate oxygen and hydrogen (ii) Pure oxygen was pumped to the citizens (no hydrogen whatsoever - do not believe the reviews, read the originals) (iii) Verne clearly described that O2+H2 easily explodes, and the story ended by accident - industrial explosion destroying the factory of Dr. Ox (iv) In the end, Verne clearly summarized that the whole story on oxygen effect on humans, animals and plants is a pure fiction invented by him. Thus I am fine to have the story back provided it is fixed not to disgrace Jules Verne, as it did. Materialscientist (talk) 05:03, 29 June 2009 (UTC)

I liked that story. I read it as a kid and was bewildered by why Verne thought it was cool (now I'm beginning to understand better :-). I think a brief mention of it is a useful addition here. Eubulides (talk) 16:49, 29 June 2009 (UTC)

11) Lead: "Oxygen toxicity is treated by reducing the exposure to elevated oxygen levels." (?!?) - does this qualify as "treatment"?

MOSMED provides for a section called "Management" or "Treatment" and there's sometimes a grey line between them. But I agree that "managed" is much better than "treated" in the lead in this case, so I've changed it. Thank you. --RexxS (talk) 17:44, 28 June 2009 (UTC)

"the long term recovery from most types of oxygen toxicity is good." (?!?) - what is "good" ?

In the sense of "... made a good recovery from ...". I'd rather not have to define what I think is a common phrase, unless you insist. I can see that it looks awkward though, so I have rephrased the sentence to put the adjective next to the noun to try to improve how it reads. --RexxS (talk) 17:44, 28 June 2009 (UTC)

"Pulmonary": "an inflammation of the airways leading to and within the lungs (tracheobronchitis) which appears" - I understood this, but is it well written ?

No, but I've tried to fix it now. --RexxS (talk) 17:57, 28 June 2009 (UTC)

"History": phrase "operational oxygen procedures" seems incomplete. Materialscientist (talk) 04:40, 28 June 2009 (UTC)

In industrial or military contexts, there are standard operating procedures, issued to regulate the use of particular items. I'll try to clarify that. --RexxS (talk) 18:07, 28 June 2009 (UTC)

• Comments. I have two concerns about the chart in the "Classification" section:-

1. One result is "anoxemia". This means "the complete absence of oxygen in the blood", although interestingly the word is not defined in Dorland's Illustrated Medical Dictionary. I would be very surprised if anoxemia actually occurs prior to death. A more accurate word would be "hypoxemia".
2. Another result is "Chemical toxicity and destruction of any cell death". This doesn't make sense.

Unfortunately the nature of the chart (as a .jpg) makes it impossible for me to edit it. Axl ¤ [Talk] 11:41, 25 June 2009 (UTC)

I share your concerns. However, that chart is an exact reproduction of John Clark's original, by Gene Hobbs - see File:Clark1974.jpg and is also reproduced in Bennett and Elliott's physiology and medicine of diving, 5th Rev ed (the 'bible' of diving medicine) on page 359. So that's what the sources say, and I'm not in a position to argue with them. I can only suppose that Clark used anoxemia loosely, and that he meant "Chemical toxicity and destruction of any cell. Death", as consequent results, but applying my interpretations to a source is WP:OR. I made an editable version of that chart last October (File:Clark1974.svg), but decided not to use it as the text didn't scale well. Given all of that, I'm happy to be guided by you in what is best for the article. --RexxS (talk) 14:20, 25 June 2009 (UTC)

Thanks to Eubulides again - he's edited and clarified my old svg version and replaced the jpg. Hope that's better. --RexxS (talk) 15:36, 26 June 2009 (UTC)

I'm still unhappy about the use of the term "anoxemia". I've been digging around to clarify the meaning of the word. From its etymology, it should mean "the absence of oxygen in the blood". Mondofacto medical dictionary states "A condition in which the blood does not carry enough oxygen to keep an organism alive". The word is infrequently used in modern medical literature, partly because "hypoxemia" is more accurate, and partly because where it is used, it is often misused to mean "anoxia". It is particularly counter-intuitive that oxygen toxicity should lead to the absence of oxygen in the blood. Axl ¤ [Talk] 21:40, 26 June 2009 (UTC)

The following would be WP:OR, but that branch of the tree refers to pulmonary damage, and I'm certain that the most pernicious effect of oxygen toxicity on the lungs is to reduce their ability to exchange oxygen into the blood, owing to atelectasis. It may be that in the extreme, blood may be completely deoxygenated, causing death (and any small remaining amount of oxygen could still be metabolised as cells don't all die at once).

Anyway, we don't need my speculation: As Clark is the original source of the word in that diagram, I've looked at Clark's PhD thesis - it's a good read for anybody interested in the effects of oxygen on the lungs (apologies if you're already familiar with it). On page 20, he states, "Pulmonary oxygen toxicity is characterized by an insidious onset followed by a progressive increase in severity that eventually causes severe pulmonary damage, hypoxemia and death" (my emphasis). In which case, I don't see that altering Clark's chart to accommodate your misgivings would be a problem - we're just using another formulation of the same chain of events by the same author. --RexxS (talk) 23:39, 26 June 2009 (UTC)

Done. --RexxS (talk) 23:52, 26 June 2009 (UTC)

Thank you. Axl ¤ [Talk] 07:46, 27 June 2009 (UTC)

The layout of the article is different to that recommended at WP:MOSMED (the "History" section). I don't see any specific reason for this. Would you consider moving the "History" section to follow MOSMED? Axl ¤ [Talk] 21:46, 26 June 2009 (UTC)

As you may remember from GA, the article (thanks to your help) had a layout that exactly conformed with MOSMED's recommendations. However at its Peer Review, Ruhrfisch requested that "History" be moved higher. I explained to him about MOSMED, but agreed to ask at the Doctor's Mess. WhatamIdoing persuaded me that I could move the section as requested in Peer Review. Personally, I think the article looks as good either way, but I would find it disconcerting if I have to change the layout to one way for GA, to another for PR, and back for FA. Would you be able to review the Peer Review discussion and the discussion at Doctor's Mess, please, and come back to me with a definitive recommendation? --RexxS (talk) 22:56, 26 June 2009 (UTC)

Thanks for providing those links. I have invited Ruhrfisch to comment. Axl ¤ [Talk] 07:55, 27 June 2009 (UTC)

I made the suggestion to move the History section earlier in the article in the peer review because I thought it made more sense to describe the historical development of understanding of oxygen toxicity before going into all the details. While I still think it makes more sense there, I am fine with moving it elsewhere in the article. Unfortunately I do not have time to review the article in depth for this FAC, sorry. Ruhrfisch _><>°^° 11:35, 27 June 2009 (UTC)

Thanks, Ruhrfisch. I have moved the "History" section. Axl ¤ [Talk] 08:13, 28 June 2009 (UTC)

From the lead, paragraph 1: "Oxygen toxicity is a concern for ... astronauts." From "Prevention", "Hypobaric setting", it appears that oxygen toxicity is easily prevented in astronauts. Would you consider removing the comment about astronauts from the lead? I suggest that you leave the paragraph "Prevention", "Hypobaric setting", because this is relevant to the article, well-referenced and not given undue weight. Axl ¤ [Talk] 08:22, 28 June 2009 (UTC)

Done. thank you, that was a good catch. --RexxS (talk) 17:01, 28 June 2009 (UTC)

The first sentence of "Management": "During oxygen therapy, the patient will usually breathe 100% oxygen from a mask, while inside a hyperbaric chamber at an air pressure of around 2.8 bar (280 kPa)." Is this specifically referring to hyperbaric oxygen therapy? Axl ¤ [Talk] 08:28, 28 June 2009 (UTC)

Oh dear, I may be guilty of WP:OR. Hyperbaric chamber facilities (in the UK at least) are usually constructed to deal with decompression incidents in divers, and the commonest schedule pressurises the chamber to 2.8 bar, with the victim breathing 100% oxygen from a mask. This allows a convulsing patient to have the mask removed by the attendant, immediately dropping the ppO2 from 2.8 bar to less than 0.6 bar. That much I can reference (if so much detail is required). However, my work for the SAA has led me to be invited to various chambers, and while chatting with the operators, I discovered that they tend to cover their costs by offering HBOT to the NHS for treating CO poisoning, gas gangrene, ulceration, etc. They explained that naturally they tend to use the same sort of procedures for the therapy as they use for treatment of DCI. But I'm not a WP:RS. So what do you think? Were you just asking for it to read "During hyperbaric oxygen therapy ..." or did you want references? --RexxS (talk) 17:01, 28 June 2009 (UTC)

It seems to me that there are three main situations when oxygen toxicity occurs: diving, hyperbaric oxygen therapy, and (premature) neonates. Would you consider separating the "Management" section into three paragraphs along these lines (or possibly four if you want to separate retinopathy of prematurity from bronchopulmonary dysplasia)? Axl ¤ [Talk] 17:44, 28 June 2009 (UTC)

Yes, you're absolutely right. I've made four paragraphs: HBOT, diving, BPD (which really should include ARDS in adults as well), and ROP. I've taken the opportunity to rephrase the first two and hope that makes an improvement. --RexxS (talk) 18:32, 28 June 2009 (UTC)

That's great, thanks. Axl ¤ [Talk] 19:07, 28 June 2009 (UTC)

Regarding the detached retina images in "Management", would you consider adding labels to the images to assist people who are unfamiliar with the anatomy of the eye? Axl ¤ [Talk] 08:36, 28 June 2009 (UTC)

Done, but I only added "Pupil", "Lens", "Optic nerve", "Retina" and "Choroid" to the first image. I doubt whether more would help (and the casual reader is unlikely to understand "choroid", but I felt it needed that to show what the retina has detached from). --RexxS (talk) 22:53, 28 June 2009 (UTC)

There are problems with the "Percentage of severe visual impairment and blindness" chart in the "Epidemiology" section.

1. I am unconvinced of the benefit of inclusion of data about the epidemiology of retinopathy of prematurity, when oxygen toxicity is not the main risk factor.
2. Bar charts with this sort of data conventionally have the axes the other way around.
3. The categories with non-zero lower limits (Europe & Latin America) would be better represented as a floating column chart.
4. The title needs simplifying. Axl ¤ [Talk] 11:39, 28 June 2009 (UTC)

But oxygen toxicity is an important factor, if not the main one. There's a good read called Retrolental Fibroplasia: A Modern Parable where William Silverman documents the progress of ROP from WWII as supplemental O2 became increasingly available for neonates; into the 50s where the use of O2 was restricted leading to reduced ROP but higher mortality; and later where strict protocols were introduced to monitor for ROP while infants are receiving O2. Clare Gilbert observed the same issues existing in their different stages in other countries and I really think something about that epidemiology deserves to be in this article. Of course, the details of all that really belong in retinopathy of prematurity.

I've remade the barchart as you suggest. I hope it is an improvement. --RexxS (talk) 22:45, 28 June 2009 (UTC)

From "Causes", "Ocular toxicity": "Supplemental oxygen exposure, while a risk factor, is not the main risk factor for development of this disease." [This emphasis is not mine.] Axl ¤ [Talk] 07:25, 29 June 2009 (UTC)

From "Prevention", " Normobaric setting": The National Cooperative Study in 1954 showed a causal link between supplemental oxygen and retinopathy of prematurity, but subsequent curtailment of supplemental oxygen caused an increase in infant mortality. Oxygen toxicity is an important risk factor in ROP (which didn't exist prior to supplemental oxygen becoming available), but the point is that degree of prematurity is the principal risk factor. The trick is in balancing mortality against ROP in determining how much oxygen to give. That's why we have the screening protocols. The fact that incidence of ROP varies widely, indicating dependance on the stage of development of a country's neonatal care services, is relevant enough to justify inclusion in Epidemiology, imho. --RexxS (talk) 19:44, 29 June 2009 (UTC)

It has been tricky to find a freely available online journal article in English about the epidemiology of ROP that includes statistical analysis, but here is one. Of course oxygen use is a risk factor, but I think that you are overstating its significance. In the past ('50s & '60s), it has been a major cause of ROP. Duration of oxygen use and FiO₂ are risk factors, but they are no longer independent risk factors. In the logistic regression model, they are related to the duration of mechanical ventilation/CPAP. The odds ratio for duration of mechanical ventilation is 1.06. The duration of oxygen use was not independently significant.

From Nelson Textbook of Pediatrics, 18th edition (2007), pages 2599-2600 : "The risk factors associated with ROP are not fully known, but prematurity and the associated retinal immaturity at birth represent the major factors. Oxygenation, respiratory distress, apnea, bradycardia, heart disease, infection, hypercarbia, acidosis, anemia, and the need for transfusion are thought by some to be contributory factors.... Oxygen alone is neither sufficient nor necessary to produce ROP."

"The fact that incidence of ROP varies widely, indicating dependance on the stage of development of a country's neonatal care services, is relevant enough to justify inclusion in Epidemiology."

— RexxS

I respectfully disagree. This would be appropriate information for "Retinopathy of prematurity" and "Preterm birth". However it is only indirectly linked to oxygen toxicity. Axl ¤ [Talk] 07:26, 30 June 2009 (UTC)

While I agree that all of this (and more) would be certainly appropriate in the article Retinopathy of prematurity, I am left unsure about how much information about incidence of ROP you want to be included here. Silvermann has suggested (in: Arch Dis Child. 1982 October; 57(10): 731–733) here that "These landmark observations also suggest a mechanism (increased blood flow and raised transluminal pressure in the developing retinal vasculature) to explain how scarring complications can occur without exposure to supplemental oxygen." which indicates a mechanism where oxygen is capable of causing ROP even at normal respiratory fractions. Given the effect of aspirin in animal studies (ibid), where suppression of vasoconstriction in the developing retina can lead to cicatricial lesions, I cannot accept that ROP is only indirectly linked to oxygen toxicity. That other factors may overwhelm attempts to correlate oxygen exposure with ROP incidence does not refute the fact that the mechanism of the damage done to the eye is that of oxygen toxicity. The Nelson textbook is surely a gross oversimplification: hyperoxia is neither sufficient nor necessary to produce ROP; but oxygen surely is necessary.

Nevertheless, you are the medical expert and I want to be guided by you as to what should be included in this article. Would you be willing to cut from the Epidemiology section whatever you feel is extraneous, or indicate to me what you would like me to remove, please? None of this need be lost as we could always incorporate it into Retinopathy of prematurity in the future. --RexxS (talk) 15:01, 30 June 2009 (UTC)

Well, we don't agree on the significance of the aspirin experiments, nor on the strength of causality between supplemental oxygen and ROP.

"The Nelson textbook is surely a gross oversimplification: hyperoxia is neither sufficient nor necessary to produce ROP; but oxygen surely is necessary."

— RexxS

Yes, I suppose that's true, in the sense that the baby would die (and ROP would not occur) if it receives no oxygen at all. [I'm not intending to be facetious, but I'm unsure how else to interpret your comment.]

In any case, I would like to achieve a compromise with you. I would like to remove the chart from this article. However if you strongly feel that the chart should remain, let's leave the chart in, although I would suggest an alteration to the title: "Proportion of childhood severe visual impairment/bindness blindness due to retinopathy of prematurity". Axl ¤ [Talk] 14:27, 1 July 2009 (UTC)

From my reading of the literature, I think that ROP occurs like this: While an eye is developing, it grows blood vessels to supply the retina; if high blood flow occurs, bringing too much oxygen (even with 21% O2 @ 1ATA - but more so with raised FO2), usually vasoconstriction occurs as a negative feedback loop; if the oxygen excess continues for too long, then the free radicals overcome the superoxide dismutase, etc. that normally mop them up; those radicals damage the capillaries and arrest growth; when normal conditions are restored, the damage may be repaired over time (spontaneous regression), or may be have produced lesions (higher stages of ROP). Studies show that in infant animals, lesions are not observed - animals other than primates produce their own vitamin C (anti-oxidant), but aspirin prevents vasoconstriction and those animals will then produce lesions.

So what I'm trying to say is that many factors (early stage of development, lack of anti-oxidant, inability to vasoconstrict, excess oxygen) can all play a part in producing ROP in different ways. Nevertheless two factors are common: that they retina is still developing; and enough oxygen is present to overcome the anti-oxidants. That's what I meant by "oxygen is necessary to produce ROP" - clearly not testable directly because you can't eliminate oxygen to trial it, but can be inferred from the studies. And the damage done is attributable to the mechanisms of oxygen toxicity, hence the relevance.

That's probably a debate for the ROP article though. I actually don't feel strongly about the chart, other than it's difficult to find good images for a topic like this. The reason we include images is to express ideas that would be more difficult in words. The image shows clearly the wide regional variation in ROP and Clare Gilberts explains why. If we take it out, we won't have lost much more than a detail in the information presented. Anyway, I'll certainly change the title. Have a look at it when I've done that and if you still feel it's more than the article needs, please take it out. It will still be around when we work on the ROP article. --RexxS (talk) 16:34, 1 July 2009 (UTC)

I agree that the production of reactive oxygen species (probably) is the mechanism of damage. However reactive oxygen species are implicated in many other diseases. The first sentence from the lead: "Oxygen toxicity is a condition resulting from the harmful effects of breathing molecular oxygen at elevated partial pressures." [Emphasis is mine.] The link between ROP and elevated pO₂ is less clearcut.

We seem to be quibbling about minutiae. Please go ahead and adjust the chart. Thanks. Axl ¤ [Talk] 07:23, 2 July 2009 (UTC)

Thanks (only you misspelt "blindness"). ;-) Axl ¤ [Talk] 20:58, 3 July 2009 (UTC)

Corrected - thank you.--RexxS (talk) 21:26, 3 July 2009 (UTC)

From "Causes", "Central nervous system toxicity": "Short exposures ... are usually associated with central nervous system oxygen toxicity". This doesn't seem right. Axl ¤ [Talk] 15:08, 1 July 2009 (UTC)

Yes, it a hang-over from when it was directly contrasted with "Longer exposures ..." in the pulmonary section, before they were separated. I'll amend that. --RexxS (talk) 16:34, 1 July 2009 (UTC)

• Comments. I don't know if it is considered good etiquette to add my own comments, but there are three issues I have where I would appreciate comment from other users (I only just found the toolbox at the top of this page):

1. The readability of the article is at quite a high level, is this unusual for an article that necessarily contains many scientific terms? --RexxS (talk) 18:04, 27 June 2009 (UTC) Thanks for the explanations below. --RexxS (talk) 20:24, 20 July 2009 (UTC)

   Yes, the automated scripts do suggest that "Oxygen toxicity" is more complex than average. Other medical featured articles such as "Coeliac disease" and "Lung cancer" tend to be a little less complex. "Schizophrenia" is a notable exception, and its featured article status has been called into question because of this issue. In my opinion, the article is fairly straightforward to read compared to other medical articles (although I have a biased viewpoint). I'm not too concerned about these automated reports. Axl ¤ [Talk] 10:15, 28 June 2009 (UTC)

   Please do not rely on that tools, its output is flawed. Anyway readability analysis is an unscientific field and should not be applied to this encylopedia. — Dispenser 14:23, 7 July 2009 (UTC)

2. There is one link to a dab page, Vascular, but that page actually does more than disambiguate: it also defines "vascularised" more succinctly than any of the articles it points to. Must I change that link or might WP:IAR apply in this case? --RexxS (talk) 18:04, 27 June 2009 (UTC) Thanks to Axl for providing the solution. --RexxS (talk) 20:24, 20 July 2009 (UTC)

   I've now found and read WP:INTDABLINK - so I've created Vascular (disambiguation)‎ as a redirect to disambiguation, and linked to that in this article instead. --RexxS (talk) 00:56, 28 June 2009 (UTC)

   That's backwards: the idea is to not link to a dab page, rather to an article. (Also, just a note: WP:MEDMOS is a guideline, and when you need to alter the section order for a good reason, it's perfectly fine to do so when consensus agrees.) SandyGeorgia (Talk) 18:12, 29 June 2009 (UTC)

   But the problem I had was that I wanted to link to the "so-called" dab page. It's the only place on Wikipedia that defines "vascularized" properly. None of the "proper" articles that are linked from there do the job. If anybody could take a look at Vascular and suggest how I might solve this problem, I'd be grateful. --RexxS (talk) 18:46, 29 June 2009 (UTC)

   I changed it to link to Wiktionary. Axl ¤ [Talk] 19:08, 29 June 2009 (UTC)

3. Some of the external links in references show up as "Uncategorized redirects". is that a problem that I need to rectify? --RexxS (talk) 18:04, 27 June 2009 (UTC) Thanks for the explanations below. --RexxS (talk) 20:24, 20 July 2009 (UTC)

   It was a problem, yes. As a general rule, Wikipedia articles shouldn't contain external links to non-free sources (many of those were in that category). Also, it's nice when there's a redirect to a stable page to link directly to the page, as this avoids extra work by the user's browser. I fixed this a few hours ago, and I see from Ealdgyth's comment below that the article checks out now. Eubulides (talk) 16:49, 29 June 2009 (UTC)

   Please do not confuse these messages (green entries) with problems, "Uncategorized redirect" simply mean the AI wasn't able to sort it into the Working links or the Broken links. Also WP:R2D generally applies to external links, if not more so. Bypassing the redirect kills any archives source associate with that URL you might have been able to point if they went dead! — Dispenser 14:23, 7 July 2009 (UTC)

   I agree that green entries are not necessarily problems, but it's still wise to avoid external links to redirects unless you know that the source link is more stable than the target. Avoiding such redirects can yield noticeably better performance for the user. WP:R2D is about wikilinks, not external links, and WP:PERF doesn't apply here since this performance issue is outside Wikipedia. Eubulides (talk) 17:37, 7 July 2009 (UTC)

   Well in short, it kills any archive history you might have been able to retrieve from the Wayback machine or WebCite. — Dispenser 12:35, 14 July 2009 (UTC)

   Thank you for taking to the time to put those results into context for me - I hope you will excuse me as I'm new here. Having spotted the box called "Toolbox" at the top right of this subpage, I assumed that the results from those links would be germane to the discussion, so I checked them. Perhaps there should be some documentation on the use of the toolbox, or did I miss it? --RexxS (talk) 17:58, 7 July 2009 (UTC)

   Well most submitter already tend to miss the toolbox, but there's a link on the top right label documentation. I am now in the mitts of rewriting the documentation to be more relevant to editors and rearrange the navigation to have better position context (people kept not finding things because it was not where they excepted). — Dispenser 12:35, 14 July 2009 (UTC)

• Comments -
• What makes the following reliable sources?
  • http://www.rebreatherworld.com/rebreather-accidents-incidents/16705-standardizing-ccr-rescue-skills-3.html#post163661

Otherwise, sources look okay, links checked out with the link checker tool. Ealdgyth - Talk 15:28, 29 June 2009 (UTC)

Yes, that source's appearance is pretty dicey: a general reader cannot tell that it's a reliable source and not some random anonymous crank in a blog for all I can see. Is there a better source to support what the article says? Eubulides (talk) 16:49, 29 June 2009 (UTC)

WP:SPS: "Self-published material may, in some circumstances, be acceptable when produced by an established expert on the topic of the article whose work in the relevant field has previously been published by reliable third-party publications." The article text that it cites reads: Dr Simon Mitchell, chair of the Underwater and Hyperbaric Medical Society's diving committee, has recently pointed out that there is no evidence of expiratory obstruction during seizure, and that benefit may be gained by lifting the diver during the clonic phase. That forum post - although not normally a WP:RS - is Dr Mitchell stating his opinion and expresses an important controversy about how best to manage seizures underwater. Dr Mitchell is an acknowledged expert in the field of diving medicine and has respected published works in this field (see Lippmann, John; Mitchell, Simon (2005). Deeper into Diving (2nd ed.). Victoria, Australia: J.L. Publications. ISBN 097522901X. for example). I wish I could find a better source, but scuba divers have a habit of often discussing controversies online nowadays, rather than in print. --RexxS (talk) 19:12, 29 June 2009 (UTC)

I'll leave this out for other reviewers to decide for themselves. Ealdgyth - Talk 19:36, 29 June 2009 (UTC)

Thanks, RexxS, for clearing this up. I was looking just at the citation, not at the text it sources, so I missed the source's qualifications. To try to avoid further problems like this, I moved those qualifications into the citation. This is better style anyway, as the main text should focus on what's known (citations can focus on the sources). Eubulides (talk) 22:08, 29 June 2009 (UTC)

Thank you, that's an improvement. Although I would reserve the right to present opposing opinions sometimes (rather than fact), as long as we keep within V, RS, NPOV & UNDUE. --RexxS (talk) 23:09, 29 June 2009 (UTC)

• Support and comments An interesting article on a topic of which i know nothing, but found to be a good read. Two nit picks

• partial pressures I think needs wikilinking at the first occurence
• (·O₂^–) The superoxide anion is (O₂^–); although it has an unpaired electron, it's not normally shown as a free radical

jimfbleak (talk) 16:03, 3 July 2009 (UTC)

Thanks for the comments and support. Actually, 'partial pressures' is wikilinked in the very first sentence of the article, but I sometimes wonder if a second link should be made for those terms which recur much further on in an article. If you feel the place where you found it needs a link, please make one. I searched google (text and images) for "superoxide anion" and found a mix of " O₂^– ", " ·O₂^– " and " O₂·^– ", with the last style being slightly the commonest. I infer that the dot is probably shown when the intention is to emphasise that the ion is also a radical. Anyway, I'll take out the middot from the article, as it's already named as a ROS. --RexxS (talk) 17:46, 3 July 2009 (UTC)

• I think that you would need to mention blood oxygen and carbon dioxide as drivers of respiration in order to understand the effect of breathing a more concentrated oxygen mixture than air. In COPD low blood oxygen levels are often the driver for respiration rather than high CO2 levels, with loss of the main driver on inhaling concentrated oxygen. Snowman (talk) 20:14, 3 July 2009 (UTC)

This is possibly a remnant from the time when Hyperoxia redirected to Oxygen toxicity, but in the article it is mentioned in "Classification" as Hyperoxia can also indirectly cause carbon dioxide narcosis in patients with chronic obstructive pulmonary disease. [Patel, Dharmeshkumar N; Goel, Ashish; Agarwal, S.B.; Garg, Praveenkumar; Lakhani, Krishna K. (2003). "Oxygen toxicity" (PDF). Journal, Indian Academy of Clinical Medicine. 4 (3): 234–7. Retrieved 2008-09-28.] . The cite gives a concise description of the condition. However, I felt that this was only tangentially relevant to Oxygen toxicity as I've stuck with the distinction that hyperoxia is an excess of oxygen in the body; while oxygen toxicity is essentially the damage it may cause (directly). Possibly, we should have an article on Carbon dioxide narcosis and it certainly should be covered in Hyperoxia, but I'm not sure how much more than a mention would fit here. --RexxS (talk) 21:05, 3 July 2009 (UTC)

I did notice the short mention of "carbon dioxide" narcosis and I thought that the mechanism was not well described. The first line of the article says "Oxygen toxicity is a condition resulting from the harmful effects of breathing molecular oxygen (O2) at elevated partial pressures." and so clearly the article should not be dedicated to the direct toxic effect of oxygen on cells. If you explained the mechanism it would also be clearer why COPD patients should not go to oxygen bars, which is also mentioned. Snowman (talk) 21:58, 3 July 2009 (UTC)

I wondered about that myself, but I didn't feel strongly about it. Perhaps I should add a paragraph to "Causes", "Pulmonary toxicity"? Axl ¤ [Talk] 22:15, 3 July 2009 (UTC)

If you could, that would tie up the "loose ends" as Snowman points out. On reflection, there's little point in my suggesting a fuller description should be in Hypoxia, when that is a just a stub at present. Perhaps we can turn our attention there at some point in the future, which would increase the value of the link to it from this article? --RexxS (talk) 22:39, 3 July 2009 (UTC)

Okay, I have added a brief section about COPD. Please edit it as you see fit. Axl ¤ [Talk] 09:12, 4 July 2009 (UTC)

Thanks yet again. I've done a little rewriting to attempt to explain some of the terms in the simplest language that I can, I've and referenced Patel et al for the effects of carbon dioxide narcosis (might need a little expansion). I have a problem with the first bullet point though (remember I'm no medic), as I've read it several times as well as our articles on Vasoconstriction and Ventilation/perfusion ratio, but I still don't understand the way in which poor ventilation/perfusion matching impacts on problems of giving supplemental oxygen to COPD sufferers. Can you help me out with this? --RexxS (talk) 17:15, 4 July 2009 (UTC)

From Kim: "acute administration of supranormal levels of oxygen to patients with COPD and with ARF [acute respiratory failure] can lead to hypercapnia, and the primary mechanism is the release of hypoxic vasoconstriction in underventilated lung causing ventilation–perfusion imbalance."

From Nunn's Applied Respiratory Physiology: "Alveolar pO₂ is known to contribute to hypoxic pulmonary vasoconstriction and so help minimize V/Q mismatch. Administration of oxygen may therefore abolish hypoxic pulmonary vasoconstriction in poorly ventilated areas and so increase alveolar dead space. If minute volume of ventilation remains constant, hypercapnia will ensue."

In COPD, some parts of the lungs are well-ventilated, while other parts are poorly-ventilated. The alveolar pO₂ in poorly-ventilated lung tissue is low. This low pO₂ causes arteriolar vasoconstriction, limiting the blood flow through the poorly ventilated lung tissue. Giving supplemental oxygen raises the alveolar pO₂ in the poorly-ventilated lung tissue. The arterioles dilate, increasing blood flow. Unfortunately the ventilation in those areas remains low, causing ventilation/perfusion mismatch. The local alveolar pCO₂ rises and hypercapnia occurs. Axl ¤ [Talk] 18:15, 4 July 2009 (UTC)

From "Central nervous system toxicity", "Chronic obstructive pulmonary disease": "Most carbon dioxide is carried by the blood as bicarbonate, and deoxygenated hemoglobin promotes the production of bicarbonate. Increasing the amount of oxygen in the blood by administering supplemental oxygen reduces the amount of deoxygenated hemoglobin, and thus reduces the capacity of blood to carry carbon dioxide. This is known as the Haldane effect." Technically, this section is entirely accurate. However the increased bicarbonate production of unoxygenated hemoglobin actually constitutes about one third of the Haldane effect. Two thirds is due to increased carbamino carriage. Axl ¤ [Talk] 18:27, 4 July 2009 (UTC)

Thanks for the explanation, Axl. I must admit I trusted our article on Haldane effect which reads: "The majority of carbon dioxide in the blood is in the form of bicarbonate." That will teach me to believe what I read in Wikipedia. --RexxS (talk) 22:14, 4 July 2009 (UTC)

The article "Haldane effect" is technically correct. The majority of carbon dioxide in the blood is indeed in the form of bicarbonate (about 90%). "Haldane effect" is currently missing a description of carbamino compounds, which I shall now add. Axl ¤ [Talk] 11:50, 5 July 2009 (UTC)

• Thank you for asking me about the new section, which I was surprised to find is in list format. Perhaps it should give in indication of the relative importance of the three items on the list, including by shortening any lessor contributors perhaps. I think is could also say 95% oxygen and 5% CO2 mixture can be used in some circumstances to reduce some of the adverse effects of oxygen; see here, although better references should be provided. I think the 5%/95% gas mixture will provide some interest of the physiology and will help with the explanations. Please note that I have only been involved in the periphery of oxygen therapy and not as a specialist, but I hope that perhaps you might consider some of my ideas (not necessarily all). Snowman (talk) 18:41, 4 July 2009 (UTC)

• From "Kim", the relative contributions of these three effects are 48%, 30% and 22%. I'm not convinced that this information needs to be in our article. The 95% O₂/5% CO₂ mixture is not used to mitigate the adverse effects of oxygen. It is used at the end of general anaesthesia to speed recovery from the anaesthetic. It has no place in our article on "Oxygen toxicity". Axl ¤ [Talk] 19:28, 4 July 2009 (UTC)

• I have put a line through my error above. Snowman (talk) 19:42, 4 July 2009 (UTC)

• No worries. Would you like us to add the percentages I quoted to the article? Axl ¤ [Talk] 20:06, 4 July 2009 (UTC)

• There does not seem to be any out of the three with a very minor effect. I have done some copy editing instead. Please look for further improvements, and I hope to look again tomorrow. Snowman (talk) 21:27, 4 July 2009 (UTC)

• The "Causes" section. I am a little puzzles by the headings throughout this section. Is the section on "circumstances"? where there may be sub-headings on "neonates", divers, COPD. Or is the section on "Toxicity"? with sub-headings lungs, eyes, COPD, CNS. I think it might be best to change the heading from "Causes" to "Toxicity" and have anatomical sub-headings plus COPD. Snowman (talk) 23:11, 4 July 2009 (UTC)

No. Please see WP:MEDMOS#sections for the recommended layout of medical articles. Oxygen toxicity has completely different effects on different parts of the body, with different consequences. Generally, I find it useful to group together things which are similar - in the case of "Causes" (which includes risk factors. but not "Mechanism"), the similarities exist within the affected organ. Hence: CNS; Lungs; Eyes. Whereas grouping by Neonates, Adults on Supplemental O2, Divers, HBOT, Astronauts, etc. would draw together such dissimilar effects as BPD and ROP in neonates, yet separate similar effects such as BPD and ARDS, as well as CNS toxicity into Divers and HBOT. In such a broad subject, other sections may be better sub-organised in a different way (e.g. "Prevention"). I don't find that breaking up an article into large numbers of small subsections (based on minor differences) in any way improves it. --RexxS (talk) 23:21, 4 July 2009 (UTC)

Update: it has been reorganised to move the mechanisms in COPD from the section on "Causes" to "Mechanisms", which is much better. Snowman (talk) 08:34, 6 July 2009 (UTC)

Gene Hobbs disagrees with the inclusion of COPD information in the article. Here are his comments (copied from Talk:Oxygen toxicity):- Axl ¤ [Talk] 06:40, 7 July 2009 (UTC)

<RANT>

I WHOLEHEARTEDLY DISAGREE! It does NOT need to be here.

Many in the field initially resisted a change to the term "oxygen toxicity" and much preferred the old term "oxygen poisoning". The strongest argument against the change was that people would not know the difference between "oxygen toxicity" and the "toxic effects resulting from oxygen". They thought the use of the phrase "high partial pressures" in defining it would help. Even as recently as 1999, Lambertsen would not use oxygen toxicity without also saying oxygen poisoning in the same article. (JAP) We have now proven their concerns to be correct.

In my mind, Chronic obstructive pulmonary disease (COPD) and Retinopathy of prematurity (ROP) for that matter are far from the classic "oxygen poisoning". I indulged when ROP was included because it was listed in Mosby's Medical Dictionary as such and you were able to convince me that this is a good use of the term. With the relationship of COPD used in this article, we should be scrapping ALL other medical disorder articles and redirecting them to hypoxia. After all, people don't die from a hemmorage, Cardiac arrest or any other medical disorder, they die from the lack of oxygen to the tissues and brain. Maybe it's that I am clinging to history a little too much but if it should be included, why is the literature so poor and the use the term "oxygen toxicity" to describe this non-existent?

What are ICD9 and 10 codes for? Nobody I know ever uses these for either COPD or ROP. Might that be because it is not the best description of the disorders? (Yes, this is retorical)

I do agree the topics should be briefly addressed but calling the respiratory arrest resulting from oxygen breathing "oxygen toxicity" is just bad physiology.

And, why are we worried about other articles and their correctness as it relates to this one? If the others are bad, fix them next. If they are so bad that this article can not reach FA without improving them first, so be it. This article is FAR from ready for FA with all this "other" information creeping into it.

</RANT>

I'll obviously respect what ever you all decide and refrain from further comment. Thanks! --Gene Hobbs (talk) 21:02, 5 July 2009 (UTC)

• In reading the current version of the article I agree with Gene Hobbs that too much space is given to COPD and this should be trimmed back. I don't think COPD needs to be mentioned in Classification; nor in Causes (COPD doesn't cause oxygen toxicity!). The 200-word COPD discussion in Mechanism should be moved to some more-relevant article (it's a good discussion) and summarized here in (say) 50 words or less.
• The lead mentions COPD as part of an FDA warning, but this isn't specifically discussed in the body, in violation of WP:LEAD. I suggest replacing COPD with "heart or lung disease" in the lead.

Eubulides (talk) 18:11, 7 July 2009 (UTC)

I've searched Wikipedia for another article to move this to: Oxygen therapy# Negative effects has one paragraph describing the condition; Chronic obstructive pulmonary disease#Supplemental oxygen has one sentence; Hypoxia (medical) mentions COPD but doesn't describe this complication. Rather than start whole-scale rewriting of these articles, with the problem of WP:UNDUE, I'm (boldly) creating a spinout for the moment: Effect of oxygen on chronic obstructive pulmonary disease. Hopefully, those with medical expertise can use that to improve the articles to which it is most relevant, and I can always request a delete when that is done. --RexxS (talk) 20:04, 7 July 2009 (UTC)

With the new article now in place, I've removed the paragraphs on COPD, leaving only the brief mention in "Classification" because that is the present location of the information summarising effects which are not oxygen toxicity or only indirectly related to it. I've added a "See also" section for readers curious about oxygen and COPD. Any suggestions for improving those changes would be welcome. --RexxS (talk) 20:36, 7 July 2009 (UTC)

That's great, thanks RexxS. You've achieved a compromise that (hopefully) should keep all parties fairly happy. Axl ¤ [Talk] 04:47, 8 July 2009 (UTC)

Support. RexxS has created an excellent article. Axl ¤ [Talk] 04:52, 8 July 2009 (UTC)

Comment excellent indepth article. I am wondering if however a few more of the images should be set to default sizes. Makes it easier for slow machines.--Doc James (talk · contribs · email) 01:33, 9 July 2009 (UTC)

Thanks for that comment, Doc. I do appreciate that the sum total of the images used is around 100KB. The five svg's make up 85KB since they are rendered by the wikimedia software as full 32-bit png's quite unnecessarily. For example, the 30K image 700px-Clark1974.svg.png would be only 13K if a 256-colour palette png were to be used (and only 9K if a 16-colour palette were used). However, I'm not sure what you mean by default size. Unlike normal webservers - which serve an image at the size it is stored on the server and leave the browser to resize it - wikipedia servers first rescale images to the size set by the editor, and then serve that (usually smaller) image. That means, in this case, that the only way to help small machines would be to set smaller image sizes. I believe I've already made them as small as I can for viewability in the article (apart from the Paul_Bert_01.jpg which would be smaller if the |upright parameter were put back). If you wish, I can create optimised png's for each of the svg's and upload them for use in the article in place of the svg's. That would probably save around 50KB. --RexxS (talk) 18:24, 9 July 2009 (UTC)

The only images that are non-default sizes are Image:Clark1974.svg (which I just now tweaked from 700 to 600px), Image:Lipid peroxidation.svg (300px), and Image:Incidence of ROP.svg (400px). Making them much smaller would be iffy, and allowing them to be the default size would make them completely unreadable for most users. I did mark two upright images as upright; I don't know why the upright parameter was removed from the Paul Bert image (Image:Paul Bert 01.jpg), but it does seem to belong there. Eubulides (talk) 18:49, 9 July 2009 (UTC)

Unfortunately, the rendering of svg into png does not rescale text linearly, but in steps, resulting in text being clipped at the right edge if the width is set to 600px. If we can decide on a width for each svg, I'll prepare and upload optimised png's which should address all the issues. --RexxS (talk) 03:22, 10 July 2009 (UTC)

Sorry, I didn't notice that. I changed it back to 700px. If it were me, I wouldn't hassle with working around the bug; I'd just leave it at 700px. Eubulides (talk) 03:35, 10 July 2009 (UTC)

Oppose on image concerns:

• File:Pulm O2 tox histology.jpg: a source (url, archive, photo ID, or publication) is needed; other than Wikipedia and its mirrors, no other sites (including the Naval Medical Research Lab sites) carry this image.
• File:Paul Bert 01.jpg: contrary to its statements, the author is known (at least by surname)—Destréguil. See the frontispiece of this 1900 book. Undoubtably, it is public domain in US, but it might still be copyrighted in France if Destréguil was in his 20s when he took the photo (of a likely 50+ year old Bert) and lived to his 80s (meaning the photo becomes only PD in France during the 2010s). This image should be moved to Wikipedia, which I have taken the liberty to upload a superior copy at File:Paul Bert.jpg (point: use the Wikipedia copy).

All other images are appropriately licensed or verifiably in public domain. Jappalang (talk) 03:09, 14 July 2009 (UTC)

I fixed the 2nd image with this edit, which substitutes the superior copy you located (and thanks!). I left a note for the uploader of the 1st image asking for its source and pointing at this thread. Eubulides (talk) 05:28, 14 July 2009 (UTC)

OK, how do I say that the image was provided for this article upon request by a pathologist at NMRL following my request to a friend for a lung histology image following a prolonged O2 exposure? That pathologist and my friend have both been moved to other commands now so getting the exact project name for this might be next to impossible and research data is not archived like normal government images so it has no ID number. Remove it if you must, I can try to find something else (Though it took a month to find this after it was asked for). --Gene Hobbs (talk) 13:09, 14 July 2009 (UTC)

If the pathologist is willing to have his or her name here, along with with the date and as much detail about which part of NMRC it came from as you can muster, I think that would suffice (but perhaps Jappalang could weigh in as well). If they don't want to leave their name then I think it'd get a bit iffier, "anonymous researcher at NMRC" sounds a bit funny. Eubulides (talk) 20:33, 14 July 2009 (UTC)

One of the basic requirements is verifiability of the images (hence a source provided with details to faciliate verification). For photos obtained directly from the source, a Photo or Archive ID number (perhaps a Folder or Project number in this case?) helps for those who wants to verify the images with the NMRC. Failing that, the OTRS (which can cater for those wishing to remain anonymous by forwarding the creator's permission) is the "seal of approval" for images that are not the creations of the uploader. Jappalang (talk) 21:28, 14 July 2009 (UTC)

We have both thought for some time that particular image is in some ways the "weakest" because everyone unused to such slides will have difficulty in seeing the damage. However, there really are very few images available (in or out of copyright) that illustrate the effects of pulmonary oxygen toxicity, and Gene put a lot of effort into obtaining it, so we kept it. Nevertheless, I have an idea to replace it with a box containing the table of symptoms that Prof Donald observed in 1947 when he did the big study on Naval volunteers. It nicely shows the huge variability of tolerance and of severity of symptoms. Unless anyone thinks it's a bad idea, I'll try it out and see if it's a suitable replacement for the "Signs and symptoms" section. --RexxS (talk) 22:11, 14 July 2009 (UTC)

I solicited help from the Office of Naval Research and pathologypics.com today. Since the folks that gave this image to me to start with have moved on, it will be very hard to get info on this. If we come up with something, I'll get it loaded. Thanks all! --Gene Hobbs (talk) 23:12, 14 July 2009 (UTC)

I've substituted a summary table of symptoms from Donald's observations for the moment. That should help take the pressure off Gene. Hopefully, at some point the image will become unambiguously available and we can decide then what to do. If anyone feels the article would be improved by removing the table, or can modify it into something more aesthetic, I'm happy to comply. --RexxS (talk) 23:32, 14 July 2009 (UTC)

• Support I reviewed the article through GAN and I thought it is a good article for FA> Now it is even better!Nergaal (talk) 16:50, 21 July 2009 (UTC)

• Cough I don't see any more outstanding issues. Isn't it time to promote? Axl ¤ [Talk] 18:34, 21 July 2009 (UTC)

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