Gastrointestinal haemorrhage in extracorporeal membrane oxygenation: insights from the national inpatient sample

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is associated with gastrointestinal haemorrhage (GIH), which may result from coagulopathy, systemic inflammation, reduced gastric perfusion, and arteriovenous malformation from non-pulsatile blood flow. Data are limited regarding the burden of this complication in the United States. MATERIAL AND METHODS: We analysed the National Inpatient Sample (NIS) database for the years 2007 to 2011 to identify hospitalisations in which an ECMO procedure was performed. Hospitalizations complicated by GIH in this cohort were then identified by relevant codes. RESULTS: Between 2007 and 2011, ECMO hospitalisations increased from 1869 to 3799 (p \u3c 0.01). The proportion of hospitalisations complicated by GIH increased from 2.12% in 2007 to 7.46% in 2011 (p \u3c 0.01). Gastrointestinal haemorrhage was more common in men (56.7%) and in Caucasians (57.4%). Common comorbidities in this population were renal failure (71%), anaemia (55%), and hypertension (26%). All-cause inpatient mortality showed a numerical but nonsignificant increase from 56.7% to 61.9% (p = 0.49). The average cost of care per hospitalisation with GIH associated with ECMO use increased from $132,420 in 2007 to$215,673 in 2011 (p \u3c 0.01). CONCLUSIONS: Gastrointestinal haemorrhage during ECMO hospitalisations occurred in small but significantly increasing proportions. The inpatient mortality rate and costs associated with GIH were substantial and increased significantly during the study period

THE INCIDENCE OF ALCOHOL USE DISORDERS DURING THE COVID-19 PANDEMIC

Background: The COVID-19 pandemic has introduced a myriad of challenges to healthcare systems and public health policies across the globe. Individuals with alcohol use disorders are at peaked risk due to mental, socio-demographic, and economic factors leading to hindered mental health service access, misinformation and adherence. Methods: Keywords including “alcohol use”, “death”, “hand sanitizer", "overdose" and "COVID-19" were used to obtain 8 media reports for case analysis. A review of 34 manually extracted records were also conducted using PubMed, MEDLINE, Scopus, and the Embase database with no time and language restrictions. Results: A total of 2,517 individuals with alcohol overdose across the United States, India, Canada, and Iran were presented. The majority of cases were male, ages 21-65. Common contributors were linked to socio-economic changes, disruption to mental health services, and physical isolation. Conclusion: While original studies are essential to evaluate the etiologies of alcohol use and misuse during pandemics, the dissemination of misinformation must be curbed by directing vulnerable individuals towards accurate information and access to mental health services

Nucleon-Gold Collisions at 200 AGeV Using Tagged d+Au Interactions in PHOBOS

Forward calorimetry in the PHOBOS detector has been used to study charged hadron production in d+Au, p+Au and n+Au collisions at sqrt(s_nn) = 200 GeV. The forward proton calorimeter detectors are described and a procedure for determining collision centrality with these detectors is detailed. The deposition of energy by deuteron spectator nucleons in the forward calorimeters is used to identify p+Au and n+Au collisions in the data. A weighted combination of the yield of p+Au and n+Au is constructed to build a reference for Au+Au collisions that better matches the isospin composition of the gold nucleus. The p_T and centrality dependence of the yield of this improved reference system is found to match that of d+Au. The shape of the charged particle transverse momentum distribution is observed to extrapolate smoothly from pbar+p to central d+Au as a function of the charged particle pseudorapidity density. The asymmetry of positively- and negatively-charged hadron production in p+Au is compared to that of n+Au. No significant asymmetry is observed at mid-rapidity. These studies augment recent results from experiments at the LHC and RHIC facilities to give a more complete description of particle production in p+A and d+A collisions, essential for the understanding the medium produced in high energy nucleus-nucleus collisions.Comment: 17 pages, 18 figure

Event-by-event fluctuations of azimuthal particle anisotropy in Au+Au collisions at sqrt(s_NN) = 200 GeV

This paper presents the first measurement of event-by-event fluctuations of the elliptic flow parameter v_2 in Au+Au collisions at sqrt(s_NN) = 200GeV as a function of collision centrality. The relative non-statistical fluctuations of the v_2 parameter are found to be approximately 40%. The results, including contributions from event-by-event elliptic flow fluctuations and from azimuthal correlations that are unrelated to the reaction plane (non-flow correlations), establish an upper limit on the magnitude of underlying elliptic flow fluctuations. This limit is consistent with predictions based on spatial fluctuations of the participating nucleons in the initial nuclear overlap region. These results provide important constraints on models of the initial state and hydrodynamic evolution of relativistic heavy ion collisions.Comment: 5 pages, 2 figures, Published in Phys. Rev. Lett

Centrality Dependence of Charged Particle Multiplicity at Mid-Rapidity in Au+Au Collisions at sqrt(s_NN) = 130 GeV

We present a measurement of the pseudorapidity density of primary charged particles near mid-rapidity in Au+Au collisions at sqrt(s_NN) = 130 GeV as a function of the number of participating nucleons. These results are compared to models in an attempt to discriminate between competing scenarios of particle production in heavy ion collisions.Comment: 5 pages, 4 figures, revtex (submitted to Phys. Rev. Letters

Charged-Particle Pseudorapidity Distributions in Au+Au Collisions at sqrt(s_NN)=62.4 GeV

The charged-particle pseudorapidity density for Au+Au collisions at sqrt(s_NN)=62.4 GeV has been measured over a wide range of impact parameters and compared to results obtained at other energies. As a function of collision energy, the pseudorapidity distribution grows systematically both in height and width. The mid-rapidity density is found to grow approximately logarithmically between AGS energies and the top RHIC energy. As a function of centrality, there is an approximate factorization of the centrality dependence of the mid-rapidity yields and the overall multiplicity scale. The new results at sqrt(s_NN)=62.4 GeV confirm the previously observed phenomenon of ``extended longitudinal scaling'' in the pseudorapidity distributions when viewed in the rest frame of one of the colliding nuclei. It is also found that the evolution of the shape of the distribution with centrality is energy independent, when viewed in this reference frame. As a function of centrality, the total charged particle multiplicity scales linearly with the number of participant pairs as it was observed at other energies.Comment: 6 pages, 7 figures, submitted to Phys. Rev. C - Rapid Communication

Non-flow correlations and elliptic flow fluctuations in gold-gold collisions at sqrt(s_NN)= 200 GeV

This paper presents results on event-by-event elliptic flow fluctuations in Au+Au collisions at sqrt(s_NN)=200Gev, where the contribution from non-flow correlations has been subtracted. An analysis method is introduced to measure non-flow correlations, relying on the assumption that non-flow correlations are most prominent at short ranges (Delta eta < 2). Assuming that non-flow correlations are of the order that is observed in p+p collisions for long range correlations (Delta eta > 2), relative elliptic flow fluctuations of approximately 30-40% are observed. These results are consistent with predictions based on spatial fluctuations of the participating nucleons in the initial nuclear overlap region. It is found that the long range non-flow correlations in Au+Au collisions would have to be more than an order of magnitude stronger compared to the p+p data to lead to the observed azimuthal anisotropy fluctuations with no intrinsic elliptic flow fluctuations.Comment: 9 pages, 7 figures, Published in Phys. Rev.

Pseudorapidity and centrality dependence of the collective flow of charged particles in Au+Au collisions at sqrt{s_NN} = 130 GeV

This paper describes the measurement of collective flow for charged particles in Au+Au collisions at sqrt{s_NN}} = 130 GeV using the PHOBOS detector at the Relativistic Heavy Ion Collider (RHIC). An azimuthal anisotropy is observed in the charged particle hit distribution in the PHOBOS multiplicity detector. This anisotropy is presented over a wide range of pseudorapidity (eta) for the first time at this energy. The size of the anisotropy (v_{2}) is thought to probe the degree of equilibration achieved in these collisions. The result here,averaged over momenta and particle species, is observed to reach 7% for peripheral collisions at mid-rapidity, falling off with centrality and increasing |eta|. Data are presented as a function of centrality for |eta|<1.0 and as a function of eta, averaged over centrality, in the angular region -5.0<eta<5.3. These results call into question the common assumption of longitudinal boost invariance over a large region of rapidity in RHIC collisions.Comment: 5 pages, 4 figures, submitted to Physical Review Letter

The significance of the fragmentation region in ultrarelativistic heavy ion collisions

We present measurements of the pseudorapidity distribution of primary charged particles produced in Au+Au collisions at three energies, sqrt(s_{NN}) = 19.6, 130, and 200 GeV, for a range of collision centralities. The centrality dependence is shown to be non-trivial: the distribution narrows for more central collisions and excess particles are produced at high pseudorapidity in peripheral collisions. For a given centrality, however, the distributions are found to scale with energy according to the "limiting fragmentation" hypothesis. The universal fragmentation region described by this scaling grows in pseudorapidity with increasing collision energy, extending well away from the beam rapidity and covering more than half of the pseudorapidity range over which particles are produced. This approach to a universal limiting curve appears to be a dominant feature of the pseudorapidity distribution and therefore of the total particle production in these collisions.Comment: 5 pages, 4 figure

Collision geometry scaling of Au+Au pseudorapidity density from sqrt(s_NN) = 19.6 to 200 GeV

The centrality dependence of the midrapidity charged particle multiplicity in Au+Au collisions at sqrt(s_NN) = 19.6 and 200 GeV is presented. Within a simple model, the fraction of hard (scaling with number of binary collisions) to soft (scaling with number of participant pairs) interactions is consistent with a value of x = 0.13 +/- 0.01(stat) +/- 0.05(syst) at both energies. The experimental results at both energies, scaled by inelastic p(pbar)+p collision data, agree within systematic errors. The ratio of the data was found not to depend on centrality over the studied range and yields a simple linear scale factor of R_(200/19.6) = 2.03 +/- 0.02(stat) +/- 0.05(syst).Comment: 5 pages, 4 figures, submitted to PRC-R