Negative pressure wound therapy with instillation: International consensus guidelines update.

The use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) has gained wider adoption and interest due in part to the increasing complexity of wounds and patient conditions. Best practices for the use of NPWTi-d have shifted in recent years based on a growing body of evidence and expanded worldwide experience with the technology. To better guide the use of NPWTi-d with all dressing and setting configurations, as well as solutions, there is a need to publish updated international consensus guidelines, which were last produced over 6 years ago. An international, multidisciplinary expert panel of clinicians was convened on 22 to 23 February 2019, to assist in developing current recommendations for best practices of the use of NPWTi-d. Principal aims of the meeting were to update recommendations based on panel members\u27 experience and published results regarding topics such as appropriate application settings, topical wound solution selection, and wound and patient characteristics for the use of NPWTi-d with various dressing types. The final consensus recommendations were derived based on greater than 80% agreement among the panellists. The guidelines in this publication represent further refinement of the recommended parameters originally established for the use of NPWTi-d. The authors thank Karen Beach and Ricardo Martinez for their assistance with manuscript preparation

Direct reactions for nuclear structure required for fundamental symmetry tests

A program of nuclear structure studies to support fundamental symmetry tests has been initiated. Motivated by the search for an electric dipole moment in Hg-199, the structure in the vicinity has been explored via direct reaction studies. To date, these have included the Hg-198,Hg-200(d, d') inelastic scattering reactions, with the aim to obtain information on the E2 and E3 strength distributions, and the Hg-198(d, p) and Hg-200(d, t) reactions to obtain information on the single-particle states in 199Hg. The studies using the 200Hg targets have been fully analyzed using the FRESCO reaction code yielding the E2 and E3 strength distribution to 4 MeV in excitation energy, and the (d, t) single-particle strength to over 3 MeV in excitation energy

Direct reactions for nuclear structure required for fundamental symmetry tests

A program of nuclear structure studies to support fundamental symmetry tests has been initiated. Motivated by the search for an electric dipole moment in Hg-199, the structure in the vicinity has been explored via direct reaction studies. To date, these have included the Hg-198,Hg-200(d, d') inelastic scattering reactions, with the aim to obtain information on the E2 and E3 strength distributions, and the Hg-198(d, p) and Hg-200(d, t) reactions to obtain information on the single-particle states in 199Hg. The studies using the 200Hg targets have been fully analyzed using the FRESCO reaction code yielding the E2 and E3 strength distribution to 4 MeV in excitation energy, and the (d, t) single-particle strength to over 3 MeV in excitation energy

138Ba(d,α)^{138}{\rm Ba}(d,\alpha) study of states in 136Cs^{136}{\rm Cs}: Implications for new physics searches with xenon detectors

We used the $^{138}$Ba$(d,\alpha)$ reaction to carry out an in-depth study of states in $^{136}$Cs, up to around 2.5~MeV. In this work, we place emphasis on hitherto unobserved states below the first $1^+$ level, which are important in the context of solar neutrino and fermionic dark matter (FDM) detection in large-scale xenon experiments. We identify for the first time candidate metastable states in $^{136}$Cs, which would allow a real-time detection of solar neutrino and FDM events in xenon detectors, with high background suppression. Our results are also compared with shell-model calculations performed with three Hamiltonians that were previously used to evaluate the nuclear matrix element (NME) for $^{136}$Xe neutrinoless double beta decay. We find that one of these Hamiltonians, which also systematically underestimates the NME compared to the others, dramatically fails to describe the observed low-energy $^{136}$Cs spectrum, while the other two show reasonably good agreement

Isospin mixing and the cubic isobaric multiplet mass equation in the lowest <i>T</i>=2, <i>A</i>=32 quintet

The isobaric multiplet mass equation (IMME) is known to break down in the first T = 2, A = 32 isospin quintet. In this work we combine high-resolution experimental data with state-of-the-art shell-model calculations to investigate isospin mixing as a possible cause for this violation. The experimental data are used to validate isospin-mixing matrix elements calculated with newly developed shell-model Hamiltonians. Our analysis shows that isospin mixing with nonanalog T = 1 states contributes to the IMME breakdown, making the requirement of an anomalous cubic term inevitable for the multiplet

Investigation of excited 0+ states in 160Er populated via the (p, t) two-neutron transfer reaction

Many efforts have been made in nuclear structure physics to interpret the nature of low-lying excited 0+ states in well-deformed rare-earth nuclei. However, one of the difficulties in resolving the nature of these states is that there is a paucity of data. In this work, excited 0+ states in the N = 92 nucleus 160Er were studied via the 162Er(p, t)160Er two-neutron transfer reaction, which is ideal for probing 0+ → 0+ transitions, at the Maier-Leibnitz-Laboratorium in Garching, Germany. Reaction products were momentum-analyzed with a Quadrupole-3-Dipole magnetic spectrograph. The 0+2 state was observed to be strongly populated with 18% of the ground state strength

The burn wound exudate—An under-utilized resource

INTRODUCTION: The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and protein content can provide much needed data relating to the local tissue damage, depth of the wound and probable systemic complications. This review examines the scientific data extracted from burn wound exudates over the years and proposes new investigations that will provide useful information from this underutilized resource. METHOD: A literature review was conducted using the electronic database PubMed to search for literature pertaining to burn wound or blister fluid analysis. Key words included burn exudate, blister fluid, wound exudate, cytokine burn fluid, subeschar fluid, cytokine burns, serum cytokines. 32 relevant article were examined and 29 selected as relevant to the review. 3 papers were discarded due to questionable methodology or conclusions. The reports were assessed for their affect on management decisions and diagnostics. Furthermore, traditional blood level analysis of these mediators was made to compare the accuracy of blood versus exudate in burn wound management. Extrapolations are made for new possibilities of burn wound exudate analysis. RESULTS: Studies pertaining to burn wound exudate, subeschar fluid and blister fluid analyses may have contributed to burn wound management decisions particularly related to escharectomies and early burn wound excision. In addition, information from these studies have the potential to impact on areas such as healing, scarring, burn wound conversion and burn wound depth analysis. CONCLUSION: Burn wound exudate analysis has proven useful in burn wound management decisions. It appears to offer a far more accurate reflection of the burn wound pathophysiology than the traditional blood/serum investigations undertaken in the past. New approaches to diagnostics and treatment efficacy assessment are possible utilizing data from this fluid. Burn wound exudate is a useful, currently under-utilized resource that is likely to take a more prominent role in burn wound management