Utility of WIfI foot assessment tool in a Sri Lankan setting; an initial experience

Introduction: Potential for limb salvage and wound healing in a lower limb ulcer depends on degreeof ischemia, wound grade and superadded foot infection.Objectives: Our objective was to assess the feasibility of applying WIfI classification system to stratifypatients presenting with limb ulceration according to risk of undergoing amputation and benefit ofrevascularization.Methods: Fifty four consecutive patients with ulcerated limbs presenting over two months to theUniversity unit at the National Hospital were staged according to the Society for Vascular Surgery(SVS)Wound, Ischemia, and Foot Infection (WIfI) classification system.Results: The median age was 64 (39-93), and 42 (79%) patients were males. Diabetes (87%),hypertension (53%), ischemic heart disease (14%), cerebrovascular disease (13%), chronic renal disease(13%) were identified risk factors. Smoking was reported among 35%. Median Anterior TibialArtery(ATA), Posterior Tibial Artery(PTA), Toe pressures, Ankle Brachial Index, Pole test values ofthe affected side lower limbs were 114.5mmHg, 107.5mmHg, 41mmHg, 0.87 and 85cm respectively.Values for the contralateral limb were 140mmHg, 120mmHg, 74mmHg, 1.0 and 85cm respectively.84% of ATA and 90 % of PTA pulses were not palpable on the affected side. Grades of ischemia were;none (23.3%), mild (27.9%), moderate (18.6%), severe (30.2%), grades of infection were none (20.9%),mild (37.2%), moderate (39.5%), severe (2.3%), and wound grades were 0(0%), 1(20%.9), 2(39.5%),3(39.5%). Estimated risk of amputation were high (65.1%), moderate (11.6%), low (11.6%), very low(11.6%) and estimated benefit of revascularization were high (46.5%) moderate (23.3%), low (7.0%),very low (23.3%).Conclusions: Application of WIfI system was useful to prioritize patients with eminent limb loss forurgent intervention. Toe pressure assessment for diabetic foot ulcer stratification should become acommon practice

Expectations versus reality in chronic venous ulceration; a quality of life assessment study

Introduction: Chronic venous ulceration is a common problem worldwide with a significant effect onQuality of Life (QoL).Objectives: Our objective was to assess Sri Lankan patients’ perspective with regard to this scenario.Methods: We involved 141 consenting patients presenting to the OPD, National Hospital with a venousulcer lasting one month or more. Data was collected using an interviewer administered questionnaire, aclinical interview and a lower limb duplex scan. Short form 36 questionnaire was used for QoLassessment.Results: The majority were elderly (median age 53 years) men (n=9[69.5%]). Fifty four (38.3%) wereunemployed at the time of the study and 28 (19.9%) directly attributed the ulcer as the cause forunemployment. Median duration of ulcer was 10[1-360] months and mean Venous Clinical SeverityScore (VCSS) was 13.85(4-24). Family history (44[31.2%]), previous limb trauma or non-venoussurgery (24[17.0%]), smoking among men (57 [58.2%]) and history of pregnancy among females(34[79.1%]) were identified as risk factors. Role limitation due to physical health (28.4[SD 42.8]) androle emotional problems (40.9 [SD 46.7]) had a mean SF 36 score below 50. Factors such as pain,duration of ulcer, older age and higher BMI significantly affected many domains of QoL (p<0.05). Sixtysix (46.8%) patients continue to have ulcers despite having had surgical treatment for varicose veins.Conclusions: Venous ulcers have a considerable impact on the quality of life in Sri Lankan patientswith venous ulcer. The need for providing preventive and rapid healing methods together with socialsupport must be emphasized

Isolation of Flow and Nonflow Correlations by Two- and Four-Particle Cumulant Measurements of Azimuthal Harmonics in sNN=\sqrt{s_{_{\rm NN}}} = 200 GeV Au+Au Collisions

A data-driven method was applied to measurements of Au+Au collisions at $\sqrt{s_{_{\rm NN}}} =$ 200 GeV made with the STAR detector at RHIC to isolate pseudorapidity distance $\Delta\eta$-dependent and $\Delta\eta$-independent correlations by using two- and four-particle azimuthal cumulant measurements. We identified a component of the correlation that is $\Delta\eta$-independent, which is likely dominated by anisotropic flow and flow fluctuations. It was also found to be independent of $\eta$ within the measured range of pseudorapidity $|\eta|<1$. The relative flow fluctuation was found to be $34\% \pm 2\% (stat.) \pm 3\% (sys.)$ for particles of transverse momentum $p_{T}$ less than $2$ GeV/$c$. The $\Delta\eta$-dependent part may be attributed to nonflow correlations, and is found to be $5\% \pm 2\% (sys.)$ relative to the flow of the measured second harmonic cumulant at $|\Delta\eta| > 0.7$

Beam energy dependent two-pion interferometry and the freeze-out eccentricity of pions in heavy ion collisions at STAR

We present results of analyses of two-pion interferometry in Au+Au collisions at $\sqrt{s_{NN}}$ = 7.7, 11.5, 19.6, 27, 39, 62.4 and 200 GeV measured in the STAR detector as part of the RHIC Beam Energy Scan program. The extracted correlation lengths (HBT radii) are studied as a function of beam energy, azimuthal angle relative to the reaction plane, centrality, and transverse mass ($m_{T}$) of the particles. The azimuthal analysis allows extraction of the eccentricity of the entire fireball at kinetic freeze-out. The energy dependence of this observable is expected to be sensitive to changes in the equation of state. A new global fit method is studied as an alternate method to directly measure the parameters in the azimuthal analysis. The eccentricity shows a monotonic decrease with beam energy that is qualitatively consistent with the trend from all model predictions and quantitatively consistent with a hadronic transport model.Comment: 27 pages; 27 figure

Charged-to-neutral correlation at forward rapidity in Au+Au collisions at sNN\sqrt{s_{NN}}=200 GeV

Event-by-event fluctuations of the ratio of inclusive charged to photon multiplicities at forward rapidity in Au+Au collision at $\sqrt{s_{NN}}$=200 GeV have been studied. Dominant contribution to such fluctuations is expected to come from correlated production of charged and neutral pions. We search for evidences of dynamical fluctuations of different physical origins. Observables constructed out of moments of multiplicities are used as measures of fluctuations. Mixed events and model calculations are used as baselines. Results are compared to the dynamical net-charge fluctuations measured in the same acceptance. A non-zero statistically significant signal of dynamical fluctuations is observed in excess to the model prediction when charged particles and photons are measured in the same acceptance. We find that, unlike dynamical net-charge fluctuation, charge-neutral fluctuation is not dominated by correlation due to particle decay. Results are compared to the expectations based on the generic production mechanism of pions due to isospin symmetry, for which no significant (<1%) deviation is observed.Comment: 14 pages, 6 figure

Elliptic flow of electrons from heavy-flavor hadron decays in Au+Au collisions at sNN=\sqrt{s_{\rm NN}} = 200, 62.4, and 39 GeV

We present measurements of elliptic flow ($v_2$) of electrons from the decays of heavy-flavor hadrons ($e_{HF}$) by the STAR experiment. For Au+Au collisions at $\sqrt{s_{\rm NN}} =$ 200 GeV we report $v_2$, for transverse momentum ($p_T$) between 0.2 and 7 GeV/c using three methods: the event plane method ($v_{2}${EP}), two-particle correlations ($v_2${2}), and four-particle correlations ($v_2${4}). For Au+Au collisions at $\sqrt{s_{\rm NN}}$ = 62.4 and 39 GeV we report $v_2${2} for $p_T< 2$ GeV/c. $v_2${2} and $v_2${4} are non-zero at low and intermediate $p_T$ at 200 GeV, and $v_2${2} is consistent with zero at low $p_T$ at other energies. The $v_2${2} at the two lower beam energies is systematically lower than at $\sqrt{s_{\rm NN}} =$ 200 GeV for $p_T < 1$ GeV/c. This difference may suggest that charm quarks interact less strongly with the surrounding nuclear matter at those two lower energies compared to $\sqrt{s_{\rm NN}} = 200$ GeV.Comment: Version accepted by PR