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Byline: Rohit. Bhatia, Partha. Haldar, Inder. Puri, M. Padma Srivastava, Sanjeev. Bhoi, Menka. Jha, Anupam. Dey, Suprava. Naik, Satyabrata. Guru, Mamta. Singh, V. Vishnu, Roopa. Rajan, Anu. Gupta, Deepti. Vibha, [...]

Byline: Naman. Agrawal, Akshay. Kumar, Praveen. Aggarwal, Nayer. Jamshed Sympathetic crashing acute pulmonary edema (SCAPE) is the extreme end of the spectrum of acute pulmonary edema. It is important to [...]

The beneficial synergies of chemical process intensification and plant modularization present a unique step‐wise advancement opportunity for many chemical manufacturers, but economic case studies are needed to raise awareness of such opportunities. The primary objective of this case study is to better understand the business case economics of a specialty chemical plant using modular chemical process intensification (MCPI), by comparing it with that of a conventional stick‐built (CSB) plant that produces the same product at the same production capacity. When comparing MCPI against CSB approaches for a plant project strategy decision, analysts should thoroughly understand and model the differences and similarities in scope bases. The MCPI approach for this case study benefitted from dramatic reductions in capital expenditures (CAPEX). A sizeable reduction in plant spatial volume likely explains some of these reductions. Sizeable operational expenditure (OPEX) reductions with the MCPI plant appear to be associated with the reduced operator staffing required from converting a labor‐intensive batch process into an automated, continuous flow process. Traditional project investment economic measures strongly favored the MCPI case for the design, construction, and operation of the specialty chemical plant. The net present value for the MCPI case was nearly twice that for the CSB case over a ten‐year period, and the payback period for the CSB case was nearly five times longer than that of the MCPI case. The opinion‐based perspective of the study participant identified significant contributors to superior MCPI economic performance for this case study. With the two conditions of low MCPI CAPEX and high product profit margin, economic analysis indicates that incorporation of a backup MCPI train, for operational redundancy when downtime occurs, is a very beneficial strategy. [ABSTRACT FROM AUTHOR]

In this study, geometric features (e.g. road and shoulder width), pavement characteristics (e.g. shoulder type, skid number, and international roughness index), and traffic parameters (e.g. posted speed limit and average daily traffic) were extensively analyzed to identify the significant predictors and develop better-fit 85th percentile speed prediction models for the tangent sections of two-lane rural highways. Three models, representing all highways, lower speed limit highways, and higher speed limit highways, were developed using stepwise multiple linear regression analysis. About 80% data from 251 locations in the State of Oklahoma, United States, was used in model development and 20% for validation. The all highways model is the best-fit among the three. Two most significant parameters of this model are posted speed limit and skid number. Additionally, international roughness index is significant in the higher speed limit highway model. The lower speed limit highway model depends only on the posted speed limit. [ABSTRACT FROM AUTHOR]

Background: Cardiac myxoma is the most common primary benign tumor of the heart and it has diverse clinical presentations. It is known to embolize into systemic circulation. However, presentation with complete occlusion of the aorta is uncommon.Case Report: We report an 18-year-old female who presented to the emergency department with features of acute bilateral limb ischemia. Arterial Doppler ultrasonography showed infrarenal aortic occlusion. A bedside cardiac ultrasound was done in the emergency department which clinched the diagnosis of atrial myxoma. Complete surgical excision of the tumor and subsequent histopathologic examination confirmed the diagnosis of atrial myxoma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This report puts emphasis on the fact that atrial myxoma, though rare, may be considered as a source of embolism in patients presenting with acute limb ischemia. The importance of bedside ultrasonography for early diagnosis in such presentations is also highlighted. [ABSTRACT FROM AUTHOR]

INDUSEM was established as an INDO-US Satellite Knowledge Network in 2005. It brought together the academic leaders and innovators from India and the US with the goal of creating collaborative synergies and creative solutions to advance the knowledge and science of emergency medicine (EM) in India. Since 2005, the leadership of INDUSEM devoted substantial resources, effort, and expertise to ensure that newly implemented clinical institutes and training programs have the necessary resources and logistical support to effectively advance EM and Traumatology Sciences in India. As a result, significant synergies and progress were achieved toward establishing EM training programs and building clinical infrastructure through education, grant funding, research, skills development, bidirectional collaborations, and sustained influence on public health policy development. As INDUSEM's mission matures, its efforts will increasingly focus on creating long-term sustainability across clinical, didactic, educational, outreach, health policy, and research domains. In this joint statement, the authors describe the evolution of INDUSEM's institution of INDO-US Summit into the World Academic Congress of EM, with the parallel inception of an India-centric academic enterprise, EMINDIA. [ABSTRACT FROM AUTHOR]

There have been multiple incidents where doctors have been assaulted by patient relatives and hospital facilities have been vandalized. This has led to mass agitations by Physicians across India. Violence and vandalism against health-care workers (HCWs) is one of the biggest public health and patient care challenge in India. The sheer intensity of emotional hijack and the stress levels in both practicing HCWs and patient relative's needs immediate and detail attention. The suffering of HCWs who are hurt, the damage to hospital facilities and the reactionary agitation which affects patients who need care are all together doing everything to damage the delivery of health care and relationship between a doctor and a patient. This is detrimental to India where illnesses and Injuries continue to be the biggest challenge to its growth curve. The expert group set by The Academic College of Emergency Experts and The Academy of Family Physicians of India makes an effort to study this Public Health and Patient Care Challenge and provide recommendations to solve it. [ABSTRACT FROM AUTHOR]

Angiotensin converting enzyme (ACE) inhibitors therapy is aassociated with bothersome dry cough as an adverse effect. The mechanisms underlying this adverse effect are not clear. Therefore, influence of captopril (an ACE inhibitor) on acetylcholine (ACh)-induced bronchial smooth muscle contractions was investigated. Further, the mechanisms underlying the captopril-induced changes were also explored. In vitro contractions of rat bronchial smooth muscle to cumulative concentrations of ACh were recorded before and after exposure to captopril. Further, the involvement of kinin and inositol triphosphate (IP₃) pathways for captopril-induced alterations were explored. ACh produced concentration-dependent (5-500 µM) increase in bronchial smooth muscle contractions. Pre-treatment with captopril augmented the ACh-induced contractions at each concentration significantly. Pre-treatment with aprotinin (kinin synthesis inhibitor) or heparin (inositol triphosphate, IP₃-inhibitor), blocked the captopril-induced augmentation of bronchial smooth muscle contractions evoked by ACh. Further, captopril-induced augmentation was absent in calcium-free medium. These results suggest that captopril sensitizes bronchial smooth muscles to ACh-induced contractions. This sensitization may be responsible for dry cough associated with captopril therapy.