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Pancreatitis, panniculitis, and polyarthralgia (PPP) syndrome is a rare complication of chronic pancreatitis and occurs due to leakage of pancreatic enzymes in the systemic vasculature. This enzyme leakage leads to multiple manifestations such as polyarthralgia, panniculitis, and bone necrosis due to tissue autodigestion.The inciting pancreatic pathology may be masked, and the presentation may be due to one of the systemic consequences of enzyme leakage, which can present as a diagnostic challenge for clinicians. Here we present a patient who presented with nodular lesions and bone necrosis, and was found to have PPP syndrome. Therefore, a proper understanding of pathophysiology and radiology findings can help with prompt diagnosis and early exploration of management options.

Failure to rescue, defined as mortality following a surgical complication, is a widely accepted quality metric across many specialties and is becoming an important metric in cardiac surgery. The failure to rescue metric provides a target for improvements in patient outcomes after complications occur. To be used appropriately, the failure to rescue metric must be defined using a pre-specified set of life-threatening and rescuable complications. Successful patient rescue requires a systematic approach of complication recognition, timely escalation of care, effective medical management, and mitigation of additional complications. This process requires contributions from cardiac surgeons, intensivists, and other specialists including cardiologists, neurologists, and anesthesiologists. Factors affecting failure to rescue rates in cardiac surgery and cardiovascular critical care include nurse staffing ratios, intensivist coverage, advanced specialist support, hospital and surgical volume, the presence of trainees, and patient comorbidities. Strategies to improve patient rescue include working to understand the mechanisms of failure to rescue, anticipating postoperative complications, prioritizing microsystem factors, enhancing early escalation of care, and educating and empowering junior clinicians. When used appropriately, the failure to rescue quality metric can help institutions focus on improving processes of care that minimize morbidity and mortality from rescuable complications following cardiac surgery.

In these modern times, the requirement of the energy is not always constant but often periodic. In a hot climatic country like India, a large amount of energy is consumed in cooling application. A heat-exchanger which can store the thermal energy during off-peak hours and use the same energy during peak hours for cooling applications may flatten the periodic energy requirements. Water has a very high value of latent heat of fusion. This latent heat can be utilized to store the thermal energy and use it at a later stage for cooling purposes. The cooling temperature management will be more effective during the phase change process due to the constant fluid temperature. The present study analyzes the heat transfer performance of Ice-Freezing type phase change material (PCM) based heat-exchanger (HEX) during the solidification process. The prediction of solidification time and variation of heat transfer coefficient (HTC) under various configurations is performed. commercialized computational fluid dynamics (CFD) software, Fluent 19 is used to analyze the solidification phenomenon in water. To evaluate the optimum element size, Mesh-independent study is conducted on a single block. Initially, the single block is considered for analyzing the solidification process. The simulations are performed on multiple pipe with varying pitch. The results indicated a drastic change in solidification time as the pitch is decreased. An optimum pitch has to be decided based on the application. The transient variation of the HTC during the solidification process is studied. Initially, during the sensible cooling stage, the HTC decreases at a faster rate. While during the solidification process, the transient variation in HTC is less.

A comparative study to investigate the influences of single component fluxes on the depth-to-width ratio (DWR) of oxygen free copper was carried out with novel variants of tungsten inert gas (TIG) welding namely Activated TIG (A-TIG), Flux Bounded TIG (FB-TIG) and Flux Zoned TIG (FB-TIG) processes. The experiments to identify the fluxes delivering the higher DWRs in A-TIG welding among thirteen distinct fluxes were followed by the trials with FB-TIG and FZ-TIG employing those identified DWR fluxes. The fluxes which outperformed with all the techniques were MoO3 & MgO. Reversed Marangoni and arc constriction mechanisms were perceived to be opt for such an increase in DWR. Metallurgical characterization of the weldment indicated distinct grain morphologies and certain defects as well in the weld zones. The FZ-TIG welding is postulated to surpass all the techniques in terms of bringing about the upmost weld penetration.

The aim of this research work is to optimize material removal process parameters using CNC turning operation to get the desired value of the surface roughness. With an orthogonal array of L27, the Taguchi approach is used where three levels of each parameter are taken into account, which are cutting speed, feed and nose radius. The experiments were done on EN8D carbon steel and a carbide insert was used for a total run of 27 experiments. Using the surface roughness tester, the roughness values were obtained. Analysis of variance (ANOVA) was executed on Minitab software to recognize the impact of individual machining parameter on surface roughness. Regression equation is prepared from the experimental data and validated by performing random experiment.

This paper examines the effect of home country characteristics on the internationalization of emerging market multinational enterprises (EMNEs). Drawing on the institution-based view (IBV), we argue that institutional, political, and social characteristics will positively relate to the internationalization of EMNEs. Further, drawing on the knowledge-based view (KBV), we also argue that a firm’s knowledge stock (KS) will positively moderate the aforementioned relationship. Our research setting involves the incorporation of primary data collected from Iranian multinational enterprises (MNEs) operating in the food and beverage industry. The results provide support for the hypotheses that home country characteristics positively impact the international growth of EMNEs but this does not lead to their further expansion. Also, supported was the hypothesis that EMNEs' knowledge stock positively moderates the relationship between home country characteristics and their international growth. These findings not only contribute to the current knowledge about the drivers of EMNE’s internationalization but also stress upon the idiosyncratic role of home country institutions and the impact of knowledge-specific capabilities on the internationalization of EMNEs, their international growth, and expansion.

Fibers are the main load-carrying member in composites. Hence, it is required to examine the behavior of fiber against different strain rate (SR). In present study, the behavior of natural fiber (NF) and Natural fiber yarn (NFY) is investigated by varying the SR at lower SR: 0.17 × 10−4 s−1 to 1.25 × 10−4 s−1 (crosshead speed (CHS): 0.1 to 0.75 mm/min) and higher SR: 1.25 × 10−4 s−1 to 25.00 × 10−4 s−1 (CHS: 0.75 to 20 mm/min) and measure its effect on tensile strength (TS). Here, the range is proposed for SR of lower SR and higher SR. NF: hemp fiber, sisal fiber and banana fiber and NFY: flax fiber yarn, bamboo fiber yarn and cotton fiber yarn are procured for the tensile testing. The mathematical models: exponential model (EM), linear model (LM), logarithmic model (LOM), polynomial model (PM) and power model (POM) are also proposed to predict the TS at different SR. The paper signifies the outcome as: TS increases gradually at lower SR and decreases gradually at higher SR; PM is advised to use in the prediction of TS at lower SR and higher SR for NF and NFY.

Increased competition in market has forced small and medium scale industries to re-examine their methods of doing business. Corrosion cannot be eliminated completely and considered as major problem in industries. In Last decades industries have implemented corrosion prevention technique in order to sustain the competitive market. pH level of water used by customers based on geographic location and heating cycle affects most on metal parts of water heater. It results in pitting corrosion and reduction of life cycle with increased maintenance cost. Corrosion issues needs to be properly understood with prescribe necessary kind of treatment to ensure a long life span of the water heater. Many factor affects the material such as temperature, presence of moisture, reduced performance due to environmental effect and life of the water heater. Life cycle is improved when both inhibitor and protective coating method such as galvanizing, thermal spraying sacrificial method, impressed current, Zinc paint are used together or when protective coating is used together with cathodic protection. In present work authors have made an attempt to study Industrial economic aspects of corrosion issues in water heater and its prevention techniques analysis. Effect of galvanizing in various environments such as normal water, heated water and salty water is tested on metal parts and it has shown significant reduction in corrosion. Study of various corrosion prevention technique is focused on reduction in corrosion rate there by reducing the rework.

TOPIC: Occupational and Environmental Lung Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: E-cigarette or vaping product use-associated lung injury (EVALI) encompass a host of pulmonary complications including diffuse alveolar hemorrhage, lipoid pneumonia, hypersensitivity pneumonitis, and rarely, acute eosinophilic pneumonia (AEP) [1]. AEP presents as an acute febrile illness with hypoxemia, diffuse pulmonary infiltrates, and eosinophilia on bronchoalveolar lavage (BAL) without evidence of prior infection or atopic illness [2]. Presented is a young adult patient with a history of continuous vaping and extended exposure to kitchen smoke who developed acute hypoxemic respiratory failure later diagnosed as AEP. CASE PRESENTATION: An 18-year-old male with no significant past medical history presented to the emergency department with acute onset malaise, fever, non-productive cough, and shortness of breath over 12 hours. Social history revealed 3-week workplace exposure to smoke as a barbeque cook and a 5-year history of daily vaping with reported cessation 3 weeks prior. Vitals were notable for hypoxemia which was corrected with administration of 8L of oxygen via nasal cannula. Quickly after admission, he had worsening respiratory status: tachypnea, increased oxygen requirement, use of accessory muscles, and bilaterally diminished breath sounds. He was transferred to the medical intensive care unit for emergent endotracheal intubation. Laboratory testing revealed a neutrophil predominant leukocytosis of 19.3x109/L. COVID-19, rapid influenza A and B, and urine antigens for streptococcus and legionella were negative as were autoimmune serologies. A computed tomography (CT) scan of the chest revealed diffuse bilateral consolidative opacities [Figure 1] with worsening over the next 24 hours [Figure 2]. Further investigation was undertaken with bronchoscopy. A BAL was obtained, and cell count and cultures were sent. BAL cell count was remarkable for 33% eosinophilia. The diagnosis of AEP was made, and the patient was started on systemic glucocorticoids, with significant improvement within 24 hours. DISCUSSION: The modified Philit criteria is used to make the diagnosis of AEP, which the patient satisfied [3]. Although a 5-year vaping history was present, no previous significant respiratory symptoms were reported. Prior studies have demonstrated a relationship between workplace smoke exposure and AEP [3]. Based on the modified Philit criteria, we suspect that the patient had acute respiratory failure from AEP as a result of chronic EVALI acutely exacerbated by workplace smoke exposure. The treatment of AEP treatment involves high-dose intravenous glucocorticoids followed by a prolonged oral steroid taper. CONCLUSIONS: Obtaining occupation history as well as smoke exposure is as important as obtaining vaping history in an otherwise healthy young patient who presents with acute hypoxemic respiratory failure with bilateral diffuse opacities on imaging. REFERENCE #1: Winnicka L, Shenoy MA. EVALI and the Pulmonary Toxicity of Electronic Cigarettes: A Review. J Gen Intern Med. 2020;35(7):2130-2135. doi:10.1007/s11606-020-05813-2 REFERENCE #2: Allen JN, Pacht ER, Gadek JE, Davis WB. Acute Eosinophilic Pneumonia as a Reversible Cause of Noninfectious Respiratory Failure. N Engl J Med. 1989;321(9):569-574. doi:10.1056/nejm198908313210903 REFERENCE #3: Philit F, Etienne-Mastroianni B, Parrot A, Guerin C, Robert D, Cordier JF. Idiopathic acute eosinophilic pneumonia: A study of 22 patients. Am J Respir Crit Care Med. 2002;166(9):1235-1239. doi:10.1164/rccm.2112056 DISCLOSURES: No relevant relationships by Nurjahan Khatun, source=Web Response No relevant relationships by Parth Patel, source=Web Response No relevant relationships by Naleen Patel, source=Web Response No relevant relationships by Tarang Patel, source=Web Response No relevant relationships by SACHIN PATIL, source=Web Response No relevant relationships by Shyam Shankar, source=Web Response No relevant relationships by Rodger Wilhite, source=Web Response

Ipsilateral nonstenotic (50%) internal carotid artery (ICA) plaque, cardiac atriopathy, and patent foramen ovale (PFO) may account for a substantial proportion of embolic stroke of undetermined source (ESUS).Consecutive stroke patients at our center (2019-2021) with unilateral, anterior circulation ESUS were categorized into the following mutually exclusive etiologies: (1) nonstenotic ipsilateral ICA plaque (NSP, ≥3mm in maximal axial diameter), (2) sex-adjusted mod-to-severe left atrial enlargement (LAE), (3) PFO, and (4) "occult ESUS" (patients who failed to meet criteria for these 3 groups). Descriptive statistics and multivariable logistic regression were used to model group characteristics.Of 132 included patients, the median age was 65 (IQR 56-73), 74 (56%) of whom were White, and 54 (41%) were female. Twenty-one patients (16%) had NSP proximal to the infarct territory, 17 (13%) had LAE, 9 (7%) had a PFO, and 85 (64%) had no other mechanism. Patients with LAE were older (p=0.004), and had more frequent intracranial occlusions of the internal carotid and proximal middle cerebral artery (p=0.048), while tobacco use was most commonly found among patients with NSP (75%) when compared to other ESUS groups (p=0.02). Five of 9 patients with LAE who underwent outpatient telemetry had paroxysmal atrial fibrillation (56%), while zero patients with PFO or NSP had paroxysmal atrial fibrillation (p=0.005). Older age (adjusted OR [aOR] 1.05, 95%CI 1.03-1.07), coronary artery disease (aOR 3.22, 95%CI 1.61-6.44) and hypertension (aOR 2.16, 95%CI 1.14-4.06) were independently associated with LAE, while only tobacco use was associated with NSP when compared to other ESUS subclassifiers (OR 3.18, 95%CI 1.08-0.42). Age and tobacco use were both inversely associated with PFO (aOR 0.93, 95%CI 0.88-0.98, and aOR 0.10, 95%CI 0.02-0.90, respectively).Certain clinical and radiographic features may be useful in predicting the proximal source of occult cerebral emboli, and can be used for cost-effective outpatient diagnostic testing.

There is a considerable gap in academic theoretical literature about the international training of expatriates in multinational enterprises (MNEs). While the majority of research has focused on developed (Western) multinationals operating in developing countries, very limited research has been conducted on emerging multinational enterprises (EMNEs) operating in developed countries and the expatriates who work in them. In this study, we explore the international training of expatriates in Indian MNEs from the information technology industry operating in Australia to examine how they provide training to their expatriate staff who are sent on international assignments. We collected qualitative data in the form of multiple case studies via interviews with senior executives based in the Australian subsidiaries. Our findings reveal that Indian IT MNEs provide a variety of centralised training programmes for their managerial and technical expatriates and use training as a key instrument to leverage and transfer home country knowledge to their Australian subsidiaries. We also found that each stakeholder involved in the training process plays a distinct role in the knowledge transfer process, which allows Indian EMNEs to integrate the training with their people-centred business model to deliver IT services in host countries.

There is a growing body of literature on multinational enterprises (MNEs) and the extent to which they diffuse or transfer their human resource management (HRM) practices in foreign subsidiaries. Much of the research, however, examines the HRM practices of multinational enterprises from developed countries operating in developing countries rather than vice versa. This study investigates the transfer of HRM practices in Indian information technology MNEs with subsidiaries in Australia and draws on data collected through interviews with senior subsidiary managers. The findings indicate that contrary to what is suggested in the existing literature, Indian IT MNEs do not operate using a polycentric HR model but behave in a manner similar to Western MNEs. They adopt a hybridisation approach using headquarter(HQ)-local practices that merge home-country policies with locally responsive HRM practices to suit their Australian subsidiary context. This article discusses the implications of this finding for theory and practice in EMNEs.

Herein, we report a simple and eco-friendly method for synthesizing a heterogeneous organocatalyst “glycoluril” that can be utilized for the direct oxidation of alcohols and benzylic sp3 carbons to the corresponding carbonyls. The organocatalyst gave excellent conversion and selectivity of the products in an aqueous medium using 50% hydrogen peroxide at 60 °C. Investigation of the reaction mechanism using control reactions, electrochemical experiments, kinetic, and NMR studies indicated that the reaction proceeds via radical pathway assisted by the glycoluril catalyst. Overall, the study demonstrated that our catalyst, used here for the first time as a heterogeneous organocatalyst, is robust, universal, and easily applied to the oxidation of alcohols and benzylic sp3 carbons on the lab scale.

In this article, we report a catalytic reduction of CO2 to formate in the presence of metallic cobalt nanoparticles as an elegant heterogeneous catalyst. The aforementioned cobalt nanoparticles was prepared by the pyrolysis of impregnated cobalt precursor on cucurbit[6]uril (CB[6]). During the pyrolysis process, CB[6] framework transform to the nitrogen-rich graphitic carbon support in which cobalt nanoparticles were present in their metallic state. The synthesized catalyst was highly active for the catalytic hydrogenation of CO2 with 1 M KOH solution at 120 °C by applying 1:1 partial pressure of pCO2/pH2 to obtain a high TON of 82,265 in 24 h. Moreover, the influence of all the catalytic parameters was investigated with the reusability of the catalyst. In sort, the catalytic protocol shows excellent activity and robust nature for the CO2 utilization reaction with economical/ abundant metal source, in aqueous media and with molecular hydrogen.

Backgroud Modern day cataract surgery aims at a spectacle free vision which becomes difficult in cases with pre-operative astigmatism more than 1.5 D. Implantation of toric intra-ocular lenses (IOL) after phacoemulsification in such eyes is one of the ways to counteract this problem. Methods Thirty eyes with pre-operative astigmatism between 1.5 D and 4.5 D were implanted with toric IOLs following uneventful phaco-emulsification. The estimation of the axis of implantation of this toric IOL included calculating the surgically induced astigmatism (SIA) of the surgeon. Results Post-operatively, 20 (66.67%) patients had a visual acuity 6/9 or better and 17 (57%) had a visual acuity of 6/6 at 12 weeks. The mean postoperative uncorrected visual acuity (UCVA) was 0.12 ± 0.15 at 12 weeks. The difference between means of preoperative best corrected visual acuity (BCVA) LogMAR and postoperative UCVA at 12 wk LogMAR was found to be statistically significant at p = 0.001. Mean (SD) scores of pre-op astigmatism of study group was −2.20 (0.67) and residual astigmatism was −0.32 (0.44). Conclusions The difference between means of pre-op astigmatism and residual astigmatism in the study group was significant at p = 0.001 with 95% CI −2.22 to −1.50. This significant difference was because of the toric IOL implantation.

In recent years, safety of nuclear power plants against external missile impacts such as those due to tornadoes has gained significant attention. In many cases, advanced simulation tools based on finite element method (FEM) or smooth particle hydrodynamics (SPH) are being employed to simulate missile impact behavior and to evaluate vulnerability of nuclear facilities. Due to the complex nature of impact behavior, it requires appropriate calibration of parameters in the advanced simulation models that are used to represent them. In this manuscript, we propose a novel approach for modeling the behavior of reinforced concrete slabs subjected to missile impact. First, we use data from one experimental study to develop and calibrate various models needed to conduct the finite element analysis. Then, the calibrated models are used to conduct a predictive analysis for a different experimental setup. A comparison of the experiment and the analytical results for the new test provides confidence in the predictive capability of the simulation approach with calibrated parameters.

Finite volume method (FVM) has been implemented to envisage the influence of crank angle on pressure variation, turbulent kinetic energy and velocity distribution in two stroke engine. A three dimensional Fluent-Computational Fluid Dynamics (CFD) tool of ANSYS 15.0 was used to reveal these variations for increasing volume scavenging efficiency. Crank angle was varied from 86.25° to 300° for predicting behavior of exhaust gases in scavenging process. Highest volume scavenging efficiency was measured at crank angle of 300°. The results showed that volume scavenging efficiency highly depend on crank angle which will directly affect combustion process. By doing so, one can able to modify the configuration of intake ports and have better exhaust gas-charge out of the cylinder and drawing in a fresh draught of air or fuel/air mixture for the next cycle.