Ground State Electromagnetic Moments of ³⁷Ca

The hyperfine coupling constants of neutron deficient $^{37}$Ca were deduced from the atomic hyperfine spectrum of the $4s~^2S_{1/2}$ $\leftrightarrow$ $4p~^2P_{3/2}$ transition in Ca II, measured using the collinear laser spectroscopy technique. The ground-state magnetic-dipole and spectroscopic electric-quadrupole moments were determined for the first time as $\mu = +0.7453(72) \mu_N$ and $Q = -15(11)$ $e^2$fm$^2$, respectively. The experimental values agree well with nuclear shell model calculations using the universal sd model-space Hamiltonians versions A and B (USDA/B) in the $sd$-model space with a 95\% probability of the canonical nucleon configuration. It is shown that the magnetic moment of $^{39}$Ca requires a larger non-$sd$-shell component than that of $^{37}$Ca for good agreement with the shell-model calculation, indicating a more robust closed sub-shell structure of $^{36}$Ca at the neutron number $N$ = 16 than $^{40}$Ca. The results are also compared to valence-space in-medium similarity renormalization group calculations based on chiral two- and three-nucleon interactions

Aldosterone and the mineralocorticoid receptor in renal injury: A potential therapeutic target in feline chronic kidney disease

There is a growing body of experimental and clinical evidence supporting mineralocorticoid receptor (MR) activation as a powerful mediator of renal damage in laboratory animals and humans. Multiple pathophysiological mechanisms are proposed, with the strongest evidence supporting aldosterone‐induced vasculopathy, exacerbation of oxidative stress and inflammation, and increased growth factor signalling promoting fibroblast proliferation and deranged extracellular matrix homeostasis. Further involvement of the MR is supported by extensive animal model experiments where MR antagonists (such as spironolactone and eplerenone) abrogate renal injury, including ischaemia‐induced damage. Additionally, clinical trials have shown MR antagonists to be beneficial in human chronic kidney disease (CKD) in terms of reducing proteinuria and cardiovascular events, though current studies have not evaluated primary end points which allow conclusions to made about whether MR antagonists reduce mortality or slow CKD progression. Although differences between human and feline CKD exist, feline CKD shares many characteristics with human disease including tubulointerstitial fibrosis. This review evaluates the evidence for the role of the MR in renal injury and summarizes the literature concerning aldosterone in feline CKD. MR antagonists may represent a promising therapeutic strategy in feline CKD

Negative pressure wound therapy: Potential publication bias caused by lack of access to unpublished study results data

<p>Abstract</p> <p>Background</p> <p>Negative pressure wound therapy (NPWT) is widely applied, although the evidence base is weak. Previous reviews on medical interventions have shown that conclusions based on published data alone may no longer hold after consideration of unpublished data. The main objective of this study was to identify unpublished randomised controlled trials (RCTs) on NPWT within the framework of a systematic review.</p> <p>Methods</p> <p>RCTs comparing NPWT with conventional wound therapy were identified using MEDLINE, EMBASE, CINAHL and The Cochrane Library. Every database was searched from inception to May 2005. The search was updated in December 2006. Reference lists of original articles and systematic reviews, as well as congress proceedings and online trial registers, were screened for clues to unpublished RCTs. Manufacturers of NPWT devices and authors of conference abstracts were contacted and asked to provide study information. Trials were considered nonrandomised if concealment of allocation to treatment groups was classified as "inadequate". The study status was classified as "completed", "discontinued", "ongoing" or "unclear". The publication status of completed or discontinued RCTs was classified as "published" if a full-text paper on final study results (completed trials) or interim results (discontinued trials) was available, and "unpublished" if this was not the case. The type of sponsorship was also noted for all trials.</p> <p>Results</p> <p>A total of 28 RCTs referring to at least 2755 planned or analysed patients met the inclusion criteria: 13 RCTs had been completed, 6 had been discontinued, 6 were ongoing, and the status of 3 RCTs was unclear. Full-text papers were available on 30% of patients in the 19 completed or discontinued RCTs (495 analysed patients in 10 published RCTs vs. 1154 planned patients in 9 unpublished RCTs). Most information about conference abstracts and unpublished study information referring to trials that were unpublished at the time these documents were generated was obtained from the manufacturer Kinetic Concepts Inc. (KCI) (19 RCTs), followed by The Cochrane Library (18) and a systematic review (15). We were able to obtain some information on the methods of unpublished RCTs, but results data were either not available or requests for results data were not answered; the results of unpublished RCTs could therefore not be considered in the review. One manufacturer, KCI, sponsored the majority of RCTs (19/28; 68%). The sponsorship of the remaining trials was unclear.</p> <p>Conclusion</p> <p>Multi-source comprehensive searches identify unpublished RCTs. However, lack of access to unpublished study results data raises doubts about the completeness of the evidence base on NPWT.</p

The Self-Selection of Democracies into Treaty Design: Insights from International Environmental Agreements

Generally, democratic regime type is positively associated with participating in international environmental agreements. In this context, this study focuses on the legal nature of an agreement, which is linked to audience costs primarily at the domestic level that occur in case of non-compliance and are felt especially by democracies. Eventually, more legalized (\hard-law") treaties make compliance potentially more challenging and democratic leaders may anticipate the corresponding audience costs, which decreases the likelihood that democracies select themselves into such treaties. The empirical implication of our theory follows that environmental agreements with a larger share of democratic members are less likely to be characterized by hard law. This claim is tested using quantitative data on global environmental treaties. The results strongly support our argument, shed new light on the relationship between participation in international agreements and the form of government, and also have implications for the \words-deeds" debate in international environmental policy-making

Surgical debridement alone does not adequately reduce planktonic bioburden in chronic lower extremity wounds

Objective: It is commonly believed that sharp surgical debridement provides adequate bacteria control for local wound beds, despite limited supporting scientific evidence. We undertook a prospective study to evaluate the reduction in planktonic bacteria pre- and post-operative debridement in critically colonised wounds.Method: Twelve patients, corresponding to 14 wounds, underwent debridement with either hydrodebridement or sharp steel debridement with pulse irrigation. Wound quantitative tissue cultures were taken pre- and post-debridement. There was no significant difference in wound aetiology or surface area between the two groups.Results: The bacterial counts before debridement were 1x107 colony-forming units per gram (CFU/g) in the hydrodebridement group vs 1.4x107 CFU/g in the sharp debridement group; and 2.5x106 CFU/g (hydrodebridement) vs 7.5x105 CFU/g (sharp) after debridement (p=0.41). The total bacteria reduction was 7.5x106 CFU/g after hydrodebridement vs 1.3x107 CFU/g after sharp steel debridement (p=0.37). The mean percentage of bacteria killed from baseline was 75% by hydrodebridement and 93% killed by sharp debridement (p<0.05).Conclusion: Extensive operative debridement using either modality does not provide adequate immediate reduction in wound planktonic bioburden. However, all wounds appeared clinically appropriate for closure after debridement and postoperative antibacterial therapy. Postoperative antibacterial therapy may be imperative in cases of critically colonised wounds to achieve good outcomes

Negative pressure wound therapy with instillation (NPWTi) better reduces post-debridement bioburden in chronically infected lower extremity wounds than NPWT alone

Objective An overabundance of bacteria in the chronic wound plays a significant role in the decreased ability for primary closure. One means of decreasing the bioburden in a wound is to operatively debride the wound for wound bed optimization prior to application of other therapy, such as Negative Pressure Wound Therapy (NPWT). We undertook a prospective pilot study to assess the efficacy of wound bed preparation for a standard algorithm (sharp surgical debridement followed by NPWT) versus one employing sharp surgical debridement followed by Negative Pressure Wound Therapy with Instillation (NPWTi). Methods Thirteen patients, corresponding to 16 chronic lower leg and foot wounds were taken to the operating room for debridement. The patients were sequentially enrolled in 2 treatment groups: the first receiving treatment with operative debridement followed by 1 week of NPWT with the instillation of quarter strength bleach solution; the other receiving a standard algorithm consisting of operative debridement and 1 week of NPWT. Quantitative cultures were taken pre-operatively after sterile preparation and draping of the wound site (POD # 0, pre-op), post-operatively once debridement was completed (POD # 0, post-op), and on post-operative day 7 after operative debridement (POD # 7, post-op). Results After operative debridement (post-operative day 0) there was a mean of 3 (±1) types of bacteria per wound. The mean CFU/gram tissue culture was statistically greater - 3.7 × 106 (±4 × 10 6) in the NPWTi group, while in the standard group (NPWT) the mean was 1.8 × 106 (±2.36 × 106) CFU/gram tissue culture (p = 0.016); at the end of therapy there was no statistical difference between the two groups (p = 0.44). Wounds treated with NPWTi had a mean of 2.6 × 105 (±3 × 105) CFU/gram of tissue culture while wounds treated with NPWT had a mean of 2.79 × 106 (±3.18 × 106) CFU/gram of tissue culture (p = 0.43). The mean absolute reduction in bacteria for the NPWTi group was 10.6 × 106 bacteria per gram of tissue while there was a mean absolute increase in bacteria for the NPWT group of 28.7 × 106 bacteria per gram of tissue, therefore there was a statistically significant reduction in the absolute bioburden in those wounds treated with NPWTi (p = 0.016). Conclusion It has long been realized that NPWT does not make its greatest impact by bioburden reduction. Other work has demonstrated that debridement alone does not reduce wound bioburden by more than 1 Log. Wounds treated with NPWTi (in this case with quarter strength bleach instillation solution) had a statistically significant reduction in bioburden, while wounds treated with NPWT had an increase in bioburden over the 7 days. © 2014 Elsevier Inc. All rights reserved

Wound Conforming Matrix Containing Purified Homogenate of Dermal Collagen Promotes Healing of Diabetic Neuropathic Foot Ulcers: Comparative Analysis Versus Standard of Care

To compare outcomes of diabetic foot ulcers (DFUs) treated with a collagen Wound Conforming Matrix (WCM) or standard of care (SOC). WCM, a highly purified homogenate of 2.6% fibrillar bovine dermal collagen that conforms to the wound surface, was evaluated in comparison to daily saline-moistened gauze dressing changes (SOC) as part of a retrospective subset analysis of a randomized controlled trial in DFU. Following a 2-week run-in period during which patients received SOC, patients whose wounds did not reduce in area by >30% during run-in were randomly assigned to receive WCM (one or two applications) or SOC. Statistically significant acceleration of early healing rates was observed following a single application of WCM with weekly outer dressing changes compared with daily saline-moistened gauze dressing changes (SOC). Over a 4-week period, 50% of patients receiving a single application of WCM achieved ≥75% reduction in wound area compared with 13% for SOC. WCM appeared to be safe and well tolerated, with no adverse events related to treatment and no evidence of an immunologic reaction to bovine collagen. WCM is unique in its intimate contact with the wound bed and its ability to progress a wound toward healing with a single application. WCM is a treatment modality to accelerate DFU healing rates, with the potential to reduce the likelihood of infection and other complications, and cost of care