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Utilizing the self-organization of materials to make systematic and ordered wrinkled patterns can be very useful for optical, electronic, adhesives and many other applications. In this work, we have demonstrated the fabrication of a self-organized, linearly ordered, wrinkled pattern developed in the polystyrene (PS) thin film by controlled buckling in the film. Buckling was induced in the thin film by bending an elastic polydimethylsiloxane (PDMS) substrate along the two sides producing variable stress along both sides of the bending axis. Controlling of the self-organized patterns in the PS thin film was obtained by varying stress in the elastic PDMS substrate and thin-film thickness of PS. Theoretical analysis and experimental results were compared, and the developed structure was demonstrated to be used as a smart optical filter giving different intensities of diffused light for different positions of the substrate. [ABSTRACT FROM AUTHOR]

Background: High in-hospital mortality in sepsis patients remains challenging for clinicians worldwide. Early recognition, prognostication, and aggressive management are essential for treating septic patients. Many scores have been formulated to guide clinicians to predict the early deterioration of such patients. Our objective was to compare predictive values of quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score 2 (NEWS2) with respect to in-hospital mortality. Methods: This prospective observational study was conducted in a tertiary care center in India. Adults with suspected infection with at least two Systemic Inflammatory Response Syndrome criteria presenting to the emergency department (ED) were enrolled. NEWS2 and qSOFA scores were calculated, and patients were followed until their primary outcome of mortality or hospital discharge. The diagnostic accuracy of qSOFA and NEWS2 for predicting mortality was analyzed. Results: Three hundred and seventy-three patients were enrolled. Overall mortality was 35.12%. A majority of patients had LOS between 2 and 6 days (43.70%). NEWS2 had higher area under curve at 0.781 (95% confidence interval [CI] (0.59, 0.97)) than qSOFA at 0.729 (95% CI [0.51, 0.94]), with P < 0.001. Sensitivity, specificity, and diagnostic efficiency to predict mortality by NEWS2 were 83.21% (95% CI [83.17%, 83.24%]); 57.44% (95% CI [57.39%, 57.49%]); and 66.48% (95% CI [66.43%, 66.53%]), respectively. qSOFA score had sensitivity, specificity, and diagnostic efficiency to predict mortality of 77.10% (95% CI [77.06%, 77.14%]); 42.98% (95% CI [42.92%, 43.03%]); and 54.95% (95% CI [54.90%, 55.00%]), respectively. Conclusion: NEWS2 is superior to qSOFA in predicting in-hospital mortality for sepsis patients presenting to the ED in India. [ABSTRACT FROM AUTHOR]

Objective: Intravenous thrombolysis within 4.5 hours from time of onset has proven benefit in stroke. Universal standard for the door-to-needle (DTN) time is within 60 minutes from the time of arrival of patients to the emergency department. Our rapid thrombolysis protocol (RTPr) was developed with an aim to reduce the DTN time to a minimum by modifying our stroke post-intervention processes. Methods: This before-and-after study was conducted at a single center on patients who received intravenous thrombolysis in the emergency department. Consecutive patients who were thrombolysed using our RTPr (post-intervention group) were compared to the pre-intervention group who were thrombolysed before the implementation of the protocol. The primary outcomes were DTN time, time to recovery, and modified ranking score (mRS) on discharge. Secondary outcomes were mortality, symptomatic intracerebral hemorrhage, and hospital and intensive care unit length of stay. Results: Seventy-four patients were enrolled in each group. Mean DTN time in pre- and post-intervention group was 56.15 minutes (95% CI 49.98--62.31) and 34.91 minutes (95% CI 29.64--40.17) (p <0.001), respectively. In pre-intervention and post-intervention groups, 43.24% (95% CI 32.57--54.59) and 41.89% (95% CI 31.32--53.26) patients, respectively, showed neurological recovery in 24 hours. About 36.49% (95% CI 26.44--47.87) in pre-intervention group and 54.05% (95% CI 42.78--64.93) in post-intervention group had discharge mRS 0--2. Conclusion: The RTPr can be adapted by clinicians and hospitals to bring down the DTN times and improve outcomes for stroke patients. [ABSTRACT FROM AUTHOR]

Trauma to the adrenal glands is very rare. The variation in clinical manifestations is marked and markers for its diagnosis being limited, makes it tough to be diagnosed. Computed tomography remains the gold standard for detecting this injury. Prompt recognition and the potential for mortality with adrenal insufficiency can provide the best guidance for the treatment and care of the severely injured. We present a case of a 33-year-old trauma patient who was not responding to the management of his shock. He was finally found to have a right adrenal haemorrhage leading to adrenal crisis. The patient was resuscitated in the Emergency Department but succumbed 10 days post admission. [ABSTRACT FROM AUTHOR]

Objectives: Emergency department (ED) length of stay (LOS) is defined as the time a patient is registered to the time the patient is shifted to a hospital bed or discharged. Increasing demand for quality emergency care has resulted in increased wait times due to demand and supply mismatch. It is perceived that longer LOS in the ED of critical patients leads to poor outcomes. Our goal was to study the impact of LOS in the ED on the patients who required critical care admissions. Methods: This was a retrospective study conducted in the ED of a tertiary center. Data were collected using electronic health records (EHR) for patients admitted to the intensive care units (ICUs). Patient's LOS in ED was divided into 0--4, 4--8, 8--12, 12--24, and >24 hours. ED LOS was calculated from the registration time to the time patient was handed over in the ICU. Patients were divided into four categories (1--4) based on their criticality. LOS in ED, mortality, and total hospital LOS were analyzed in the study. Results: Three thousand four hundred and twenty-nine patients were enrolled in the study. Mean age was 62.69 years (95% CI 62.11--63.26). A total of 42.09% (95% CI 40.5--43.8) were Category 1 patients. Overall mortality rate was 52.46% (95% CI 50.79--54.13). LOS of 48.15% (95% CI 46.54--49.88) patients in the ED was between 0 and 4 hours, 19.90% (95% CI 18.62--21.29) between 4 and 8 hours, 8.21% (95% CI 7.35--9.19) between 8 and 12 hours, 15.50% (95% CI 14.34--16.77) between 12 and 24 hours, and 8.13% (95% CI 7.27--9.10) >24 hours. Mortality for LOS of 0--4 hours was 51.30% (95% CI 48.89--53.70), 54.03% (95% CI 50.28--57.73) for 4--8 hours, 48.94% (95% CI 43.16--54.75) for 8--12 hours, 51.50% (95% CI 47.26--55.72) for 12--24 hours, and 60.57% (95% CI 54.73--66.13) for >24 hours. Conclusion: We concluded that the longer the critically ill patients are boarded in the ED, the higher is the chance for mortality. Processes should be implemented to ease the throughput from the ED. [ABSTRACT FROM AUTHOR]

Introduction: It has been clearly established that thrombolysis using recombinant tissue plasminogen activator is strongly beneficial for acute stroke patients. The sensitivity of brain tissue to ischemia causes this time dependence on the effectiveness of recombinant tissue plasminogen activator. Early recognition of stroke and activation of a stroke alert/code are imperative to treat acute stroke patients effectively and to realize positive outcomes. Case Presentation: A 68-year-old man with right-sided weakness arrived at our emergency room and was thrombolysed in 6 minutes from time of arrival, after ruling out all contraindications. Conclusion: The case and our rapid thrombolysis protocol that helped in achieving the 6-minute door-to-needle time are described. A structured protocol is recommended to reduce door-toneedle times for thrombolysis in acute ischemic stroke. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Intubation is a skill that must be mastered by the emergency physician (EP). Today, we have a host of video laryngoscopes which have been developed to make intubations easier and faster. It may seem that in a busy emergency department (ED), a video laryngoscope (VL) in the hands of an EP would help him intubate patients faster compared to the traditional direct laryngoscope (DL). Our goal was to compare the time taken to successfully intubate patients coming in ED using King Vision VL (KVVL) and DL. MATERIALS AND METHODS: This was a prospective observational study on patients coming to the ED requiring emergent intubation. They were allocated one to one alternatively into two groups - KVVL and DL. Accordingly, KVVL or DL intubations were carried out by the EPs. Time taken to intubate, first-pass success, and crossover between laryngoscopes were recorded. RESULTS: A total of 350 patients were enrolled in the study. Overall, mean time to intubate patients using the DL was 15.85 s (95% confidence interval [CI] 14.05-17.65), while the meantime with KVVL was 13.75 s (95% CI 12.32-15.18) (P = 0.084). The overall first-pass success rates with DL and KVVL were 89.94% and 85.16%, respectively (P = 0.076). A total of 7.43% (95% CI 5.12-10.66) patients had crossover between laryngoscopes. CONCLUSION: We found the KVVL to have a similar performance to the DL in terms of time for intubations and ease in difficult airways. We consider the KVVL a useful device for EDs to equip themselves with. [ABSTRACT FROM AUTHOR]

Intensified dewetting of ultrathin polystyrene (PS) films induced by immersing in a homogeneous mixture of good solvent and water was previously reported to push the limits of dewetting to the sub-100 nm scale. Here, we systematically analyse the role of dewetting mixture composition, i.e. solvent to water ratio, on the length scales of instability. The effect of the solvent concentration in the dewetting mixture on the instability wavelength (λ ) and droplet diameter (d) are determined. The instability wavelength (λ ) for 50 nm thick PS film was found to be decreasing from nearly 17 to 7 μ m as the solvent concentration is decreased from 95 to 35% in the dewetting mixture. This is significantly smaller than the instability wavelength in air, which is nearly 50 μ m for the same PS film. The solubility of PS in the dewetting mixture is also examined and the mechanism of observed variation in the length scale is proposed. [ABSTRACT FROM AUTHOR]

Context: Tongue is a three dimensional structure and assessment of accurate tumor extent is important for surgical planning. Various imaging modalities are used to assess the dimensions and depth of tumor like MRI, CECT, and clinical examination with doubtful accuracy. Aim: To evaluate tumor thickness in three dimensions on MRI and whether it correlates well with final histopathology so as to assess its reliability in staging and planning treatment. Material and Methods: Fifty patients with biopsy proven squamous cell carcinoma of the tongue who were planned for surgery and willing to participate in the study were included. These patients underwent MRI to analyse tumor thickness and extent of tumor spread in three planes and it is correlated with final histopathology to assess the reliability of MRI in preoperative assessment. Setting and Design: This is a prospective study, conducted at a tertiary care hospital and research centre. Correlation and linear regression analysis were used to study the relationship between tumor dimensions in MRI and correlated with the results on final histopathology. Result: In this prospective study, we studied fifty cases of carcinoma tongue of which 38 were males and 12 were females. Mean age was 49 years. The tumor thickness on MRI correlated well with final histopathology and most values fell below the 1:1 (x=y) line of agreement. Also, depth of invasion on histopathology was correlated with MRI which also related well to the histopathology taking into account the shrinkage. Conclusion: There was a significant correlation between the MRI T staging and final histopathology and it is found that MRI findings and depth correlated well with final histopathology taking into account the shrinkage factor. [ABSTRACT FROM AUTHOR]

Objective: Members of the National Rural Health Student Network have expressed concerns that the quality and accessibility of rural placements might vary between health degrees. This study compared a range of placement factors between health student disciplines. Design: Cross‐sectional survey. Setting: An online survey tool was distributed in 2016 by the National Rural Health Student Network and its Rural Health Clubs to the National Rural Health Student Network's 10 218 members in all Australian states and territories. Participants: Responses were received from 897 health students (9% response rate). Participants were from the disciplines of medicine, dentistry, nursing, midwifery or an allied health degree. Main outcome measures: Bivariate analysis between medical and non‐medical students relating to the support received for rural placements: support provided to help students coordinate their placement; assistance with financial costs; mental health support; social support; and student orientation regarding both the placement's health service and community. Result: Compared with medical students, non‐medical students were more likely to have coordinated the majority of their placement themselves, but were less likely to have had control over their placement location or to have received financial support, mental health support, social support, a health service orientation or a community orientation. Conclusion: Among National Rural Health Student Network members, those studying health degrees other than medicine had significantly less rural placement support in all examined domains when compared with medical students. [ABSTRACT FROM AUTHOR]

The pulley-belt experiment for determining coefficient of friction (μ) between belt and pulley surface is a standard experiment in engineering mechanics laboratory of undergraduate engineering programs (freshman year). It is used as a measure to establish the relation between the loads applied, angle of lap (θ) and coefficient of friction between the contact surfaces of pulley and belt. The value of coefficient of friction is calculated from friction equation by using measured load ratios and angle of lap. However, the value of coefficient of friction shows significant variation as angle of lap varies from one extreme to another, as this variation leads to a deviation from the theoretical model of the experiment. This further compromises the quality of the output, i.e. coefficient of friction, in addition to its inability to be experimentally measured. Also, no quantitative measure is available to validate the results of the experiment on the basis of measurable variables, which if present could serve as an indirect measure to check the quality of the output (μ). In the present work, parameters are identified to validate the experimental results based on the measurable variables of the experiment, i.e. load ratios and angle of lap. These parameters, i.e. difference in standard deviation of μ, load ratios for forward and reverse loading, help to determine a range for angle of lap, for which this experimental setup shall yield results which are closest to the theoretical framework of the same, giving a quantitative measure to validate the results. [ABSTRACT FROM AUTHOR]

Background: Altered mental status (AMS) comprises a group of clinical symptoms rather than a specific diagnosis. A variety of neurological scales have been used to monitor these patients, including the Glasgow coma scale (GCS), AVPU (alert, responds to verbal stimuli, responds to painful stimuli, unresponsive) scale, and ACDU (alert, confused, drowsy, unresponsive) scale. The simplified motor scale (SMS) has been found to be a potential replacement for the GCS. In this study, we compare the interrater reliability of the GCS (individual components), AVPU, ACDU, and SMS to patients presenting to the ED with AMS. Materials and methods: This was a prospective observational study conducted in the emergency department of an urban tertiary-care hospital in New Delhi, India. Patients with AMS (traumatic and nontraumatic) presenting to the ED were assessed by two emergency physicians within 10 minutes of each other using the four neurological scales. Percentage agreement and kappa coefficient score were used to determine interrater reliability for SMS, individual components of GCS, AVPU, and ACDU. Results: The SMS had the best inter-rater percent agreement with 83.91% (95% CI 77.7-88.6%), followed by ACDU which was 76.44% (95% CI 69.0-81.6%), AVPU 75.29% (95% CI 67.8-80.6%), GCS Eye 74.14% (95% CI 66.6-79.6%), GCS Verbal 67.82% (95% CI 60.6-74.3%), and GCS Motor was 64.94% (95% CI 57.6-71.6%).The kappa coefficient for SMS was 0.75 (95% CI 0.67-0.83), followed by GCS Eye which was 0.63 (95% CI 0.540.72), AVPU 0.62 (95% CI 0.52-0.72), ACDU 0.60 (95% CI 0.49-0.71), and GCS Verbal 0.58 (0.49-0.66) and GCS Motor was 0.53 (95% CI 0.44-0.63). Conclusion: It can be said that SMS has the best interrater reliability in the ED and can be recommended for clinical use in the emergency departments for patients presenting with AMS. [ABSTRACT FROM AUTHOR]

Among all the noncardiac causes of pulmonary edema, unilateral reexpansion pulmonary edema is one of the rarest complication of expansion of a collapsed lung. It is largely unknown and a potentially fatal complication. We present the case of a 51-year-old gentleman who presented to our emergency department with shortness of breath. X-ray revealed significant right-sided pneumothorax with associated collapse of the right lung. An intercostal tube was inserted into the right 5th intercostal space and a repeat X-ray revealed well-expanded lung field. Soon, the patient developed increased shortness of breath and hypoxia. Repeat X-ray was suggestive of pulmonary edema. He was started on noninvasive positive pressure ventilation and responded well to it. Emergency physicians should have a high index of suspicion and initiate early management of reexpansion pulmonary edema in patients suffering from pneumothoraces which have undergone drainage. [ABSTRACT FROM AUTHOR]

Verma et al. meticulously prevented the further complications once they recognize the entrapped guidewire in the right ventricle. Authors were very correct to mention overzealous insertion of the guidewire without watching the monitor, which may lead to such complications; however, every time monitor is not available for assistance. The Seldinger technique is routinely used for inserting central venous (CV) and hemodialysis (HD) catheters; however, both are different entities and their designs and lengths including of their guidewires vary. During guidewire insertions, simply adhering to the safe length may prevent or minimize many guidewire-related complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hemorrhage is the second leading cause of death in trauma patients preceded only by traumatic brain injury. But hemorrhagic shock is the most common cause of preventable death within 6 hours of admission. Traumatic coagulopathy is a hypocoagulable state that occurs in the most severely injured. International normalized ratio (INR) and its relationship with trauma mortality have not been studied specifically. This study aimed to establish a predictive value of INR for trauma-related mortality. METHODS: A total of 99 trauma patients aged 18-70 years were included in the study. Their INR was determined and patient progression was followed up till death/discharge. According to previous retrospective studies, the cutoff value for INR in our study was kept at 1.5. RESULTS: The total mortality rate of the patients was 16.16% (16/99). The mean INR was 1.45 with a SD of 1.35. INR was deranged in a total of 14 patients (14.14%). Of these patients, 11 died (78.57%) and 3 survived. INR was deranged in 11 (68.75%) of the 16 patients who died, but 5 deaths (31.25%) had normal INR values. The sensitivity of INR was 69% (95%C/ 41%-88%) and the specificity 96% (95%C/ 90%-99%). The diagnostic accuracy of INR was 92% (95%C/ 85%-96%). Positive predictive value and negative predictive value were 79% (95%C/ 49%-95%) and 94% (95%C/ 87%-98%), respectively. CONCLUSION: Our results showed that INR is a good predictor of mortality in trauma patients. [ABSTRACT FROM AUTHOR]

We present a mini review of the recent progress in the fabrication of nanolenses and their use for highresolution optical imaging beyond the diffraction limit. Nanolenses break the diffraction limit by capturing near-field evanescent waves and refocusing them in the far-field image plane. The focus of this article is on our recent work on fabrication of nanolens and ordered lens arrays by a combination of the top-down and self-organization in unstable thin polymer films. Highly confined, thin (<50 nm) liquid polymer films spontaneously transform into microscale patterns of droplets by a spinodal instability leading to dewetting. The lateral length scales of these self-organized structures in air are limited by the weak van der Waals destabilizing force and a strong surface tension-induced stabilization. Limitations on slow dewetting kinetics and relatively large (>1 μm) length scales can be overcome by dewetting induced under an optimal mix of a non-solvent (water) and a good solvent, which reduces the interfacial tension without a concurrent solubilization of the polymer. This room temperature technique reduces both the time and the length scales of self-organized structures by over one order of magnitude. Further, directed dewetting combined with physico-chemically patterned substrates and films by e-beam, photolithography, laser ablation and nanoimprint lithography techniques can be used for fabrication of ordered nanostructures such as arrays of nanolenses. [ABSTRACT FROM AUTHOR]

The study on age specific life table of Bombyx mori Linn. race NB4D2 x SH6 reared on leaves of mulberry (Morus alba) plant variety S-1 at two different temperatures viz. control temperature (25 ± 1 °C) with 75 ± 5% relative humidity and room temperature in the laboratory of Sericulture Research, Demonstration and Training Unit, Department of Entomology, College of Agriculture, Sardar Vallabhbhai Patel University of Agriculture & Technology, Meerut-250110 (Uttar Pradesh), India. Data revealed that Bombyx mori Linn. race NB4D2 x SH6 required 37 and 40 days to complete its life cycle at control temperature (25 ± 1 °C) with 75 ± 5% relative humidity and room temperature, respectively. At control temperature, the highest mortality 85.19 per cent was exhibited at 36th day followed by 49.06 per cent at 35th day and the lowest mortality 1.12 per cent was recorded on 5th day followed by 1.14 per cent on 6th day. In case of room temperature, the highest mortality 88.89 per cent was recorded at 39th day followed by 66.67 per cent at 38th day and lowest mortality 1.20 per cent was recorded at 8th day followed by 1.35 per cent at 15th day. There an initial drop in survivorship (lx) was seen followed by an intermittent steady decline with long pauses till the formation of adult and sharp decline was observed at adult stage in both the conditions viz., control temperature (25 ± 1 °C) with 75 ± 5% relative humidity as well as at room temperature till the end of generation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bottle gourd (Lagenaria siceraria) is popularly known as lauki, ghia or dudhi in India. Its consumption is advocated by traditional medicine healers for controlling diabetes mellitus, hypertension, liver diseases, weight loss and other diseases. However, in last few years there have been reports of suspected toxicity due to consumption of its juice leading to severe vomiting and upper gastrointestinal bleeding. As emergency physicians we need to be aware of this very rare poisoning specially in India. METHODS: We present a case of a 52-year-old woman who presented with multiple episodes of hematemesis and shock to the emergency department (ED) after consuming bottle gourd juice. The patient was resuscitated and stabilized with fluids, proton pump inhibitors and antiemetics and shifted to the intensive care unit (ICU) under the care of a gastroenterology team for urgent endoscopy and further management. RESULTS: The patient received intravenous fluids, antibiotics, antiemetics, and antacids and underwent upper gastroenterologic endoscopy during the hospitalization. She was discharged in a stable condition 4 days later. CONCLUSIONS: As a member of the Cucurbitaceae family, bottle gourd contains toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste and toxicity. There is no known antidote for this toxicity, and clinicians treat such patients symptomatically only. It is important to educate the public about the harmful effects of this potentially life-threatening toxicity. [ABSTRACT FROM AUTHOR]

Paragangliomas are extra-adrenal tumours of the autonomic nervous system, which rarely present as primary retroperitoneal mass mimicking pancreatic malignancy (incidence 2-8 per million populations). Urinary Bladder Paraganglioma are also extremely rare (0.06% of all Bladder Tumour and 6% of Paragangliomas) with most being malignant and high grade tumours. Non-functional varieties of both tumours are usually incidentally diagnosed. The possibility for malignant transformation in them makes surgical excision the treatment of choice. A 45-year-old lady with abdominal pain was investigated to have a complex retroperitoneal mass behind head of pancreas and a urinary bladder mass. Complete excision of retroperitoneal and bladder lesion was done. Histopathological examinations of both specimens were suggestive of Paraganglioma with no abnormal mitotic activity and capsular/vascular invasion. Although concurrent non functional paragangliomas had been reported but the synchronous non-functional paragangliomas of retroperitoneum and urinary bladder reported in this case is extremely rare and is not reported so far in English literature. [ABSTRACT FROM AUTHOR]

Fouling in refinery equipment occurs predominantly by corrosion, chemical reaction, asphaltene precipitation or coke formation depending on prevalent operating conditions. Iron sulphide formation via a corrosion mechanism on metallic surfaces has been identified via past studies to precede coke formation. These studies however have been carried out at temperatures where coke formation blankets the sulphide layer (>350 °C). The present study reports results from experimental investigations conducted to understand crude oil corrosion fouling on a heated surface in a temperature range where this fouling mechanism is expected to be largely prevalent and not blanketed by other mechanisms (<300 °C). Experiments were conducted using a High Temperature Variable Shear (HTVS) coupon test rig. The test runs covered a wide range of fluid bulk temperatures and stirrer speeds (which incorporated a shear effect), ranging from 250 to 300 °C and 100 to 600 RPM respectively. Parts of the foulant deposits collected were found to strongly (hard) and weakly (soft) adhere to a coupon surface. These deposits were subsequently characterized using Thermogravimetry (TGA), Elemental analysis, Scanning Electron Microscopy (SEM) and X-Ray Diffraction (XRD). The nature of soft deposits was found to be distinct from the nature of crude oil used. The formation of hard and soft deposits on a Carbon Steel (CS) and Stainless-steel (SS) surface was investigated. Based on the data obtained, a mechanism is proposed to explain the underlying fouling phenomena. [ABSTRACT FROM AUTHOR]

We report here a facile method of modulating the lengthscales of self-organized dewetting of polystyrene thin films by varying the extent of silane grafting on the substrate. The self-assembled monolayers (SAM) of octadecyltrichlorosilane (OTS) were grafted on glass substrates by exposing them to different doses of OTS vapors in a controlled, low pressure environment. Measurement of water contact angles on the modified glass surfaces showed that the contact angles could be continuously increased from 40° to 70° by increasing the time of exposure to the OTS vapors from a few minutes to several hours. Polystyrene (PS) thin films were spin coated on the modified glass substrates and water-solvent mixture induced dewetting of the PS thin films was carried out, where the dewetting kinetics depended on the spreadability of water on the surface. We observed a reduction in the length scales of the dewetting, i.e. the wavelength of instability (λ) and droplet size (d), by increasing the extent of OTS exposure. The λ for a 50 nm thick PS film decreased from 12 to 4 µm while the droplet diameter (d) also decreased, from 2.5 to 1.6 µm. [ABSTRACT FROM AUTHOR]

Acute decompensated heart failure (ADHF) is responsible for a heavy clinical load on busy emergency departments (EDs) across the globe and especially in India. ADHF patients may present with severe respiratory distress, dyspnea, hypoxia, and high and low blood pressures. Managing the airway of such patients can at times be challenging. Nasal cannulae, face mask, and noninvasive positive pressure ventilation (NIPPV) are the cornerstones of providing oxygenation and ventilation to such patients while some extreme cases may require endotracheal intubation and mechanical ventilation. An elderly female in severe respiratory distress and altered sensorium presented to our ED and had to be administered ketamine to facilitate proper NIPPV and avoid mechanical ventilation. She was weaned off the NIPPV in the ED itself over the next four hours. There are some case reports of using ketamine for NIPPV in asthma exacerbations, but none for the use in ADHF. Avoiding invasive mechanical ventilation via endotracheal intubation should be a constant goal and the last resort. [ABSTRACT FROM AUTHOR]

Tumor lysis syndrome is a potentially life threatening condition which is most commonly encountered in patients being treated with chemotherapy. We report a case of spontaneous tumor lysis syndrome that developed intraoperatively in a patient with undiagnosed Burkitt's lymphoma. Characteristic electrolyte disturbances and white emulsion like urine following laparotomy and tumor handling intraoperatively suggested the diagnosis. This is a rare perioperative complication and the report emphasizes the importance of being vigilant in recognizing the same. [ABSTRACT FROM AUTHOR]

Venous malformations are low flow endothelial malformations with aberrant and ectatic venous channels. They are defects in vascular growth which causes functional and cosmetic impairment. Gradual growth in size of the lesion occurs due to venous congestion or thrombosis. Venous malformations in parapharyngeal space are a rare entity and are difficult to diagnose. Case Report. 13 year old boy presented with a history of hyposmia and progressive difficulty in breathing for a duration of 2.5 years. MRI face and neck with contrast showed a 4.5 × 4.3x3.6 cm lesion in the left parapharyngeal space. CT angiogram of brain and neck demonstrated a heterogeneously enhancing mass in the left parapharyngeal region. PET scan illustrated an ill-defined mass in the left pre styloid parapharyngeal space. Biopsy from the lesion showed features consistent with venolymphatic malformation. Flexible laryngoscopy showed a bulge over the left soft palate region with narrowing of nasopharyngeal lumen. Patient underwent transoral robotic surgery for complete excision of the mass. Post-operative period was uneventful. He has been on follow up for the past 1 year with no evidence of any residual or recurrent disease. Venolymphatic malformation is a rare lesion in the parapharyngeal space which is difficult to diagnose pre operatively. Surgical excision is the preferred modality of treatment for deep seated lesions in the parapharyngeal space. The advent of transoral robotic surgery have reduced the morbidity and improved clearance for such cases. [ABSTRACT FROM AUTHOR]

Malignant Peripheral Nerve Sheath Tumours (MPNST) arises from a peripheral nerve or exhibit nerve sheath differentiation on histology. Proximal portions of the upper and lower extremities and the trunk are the most common sites of occurrence. Around 50% are associated with Neurofibromatosis Type 1 (NF1) with incidence of two to five per cent in patients with NF1. The estimated incidence in general population without NF1 is 0.0001% of which gastrointestinal MPNST are extremely rare. A 45-year-old lady without pathological antecedent for NF1 was admitted with pain in right lower abdomen and multiple episodes of vomiting for 3 months. Preoperatively intussusception was diagnosed in the small bowel with USG and CECT abdomen showing characteristic target sign. On laparotomy Ileo-ileal intussusception (proximal ileum telescoping into distal ileum) was found 2 feet proximal to ileo-caecal junction with surrounding inflammed mesentery and presence of intraluminal tumour as lead point. Resection of involved segment of ileum along with its mesentery was done followed by ileo-ileal anastomosis. Histopathology was suggestive of high grade MPNST. Postoperative course and follow up for last 10 month is uneventful. This case is unique in terms of a rare tumour presenting with unusual complication and only one case had been reported so far in western literature. [ABSTRACT FROM AUTHOR]

Background: Indo-US Masters in Emergency Medicine (MEM) certification courses are rigorous three-year emergency medicine (EM) training courses that operate as a partnership between affiliate hospitals or universities in the United States with established EM training programs and local partner sites in India. Throughout their 15 years of operation, these global training partnerships have contributed to the EM workforce in India. Our objective in this study was to describe Indo-US MEM program graduates, their work environments, and their contribution to the growth of academic EM and to the coronavirus disease 2019 (COVID-19) response. Methods: An electronic survey was created by US and Indian MEM course stakeholders and distributed to 714 US-affiliated MEM program graduates. The survey questions investigated where graduates were working, their work environments and involvement in teaching and research, and their involvement in the COVID-19 response. We consolidated the results into three domains: work environment and clinical contribution; academic contribution; and contribution to the COVID-19 response. Results: The survey response rate was 46.9% (335 responses). Most graduates reported working within India (210, 62.7%) and in an emergency department (ED) setting (304, 91.0%). The most common reason for practicing outside of India was difficulty with formal MEM certificate recognition within India (97, 79.5%). Over half of graduates reported dedicating over 25% of their work hours to teaching others about EM (223, 66.6%), about half reported presenting research projects at conferences on the regional, national, or international level (168, 50.5%), and almost all graduates were engaged in treating COVID-19 patients during the pandemic (333, 99.4%). Most graduates agreed or strongly agreed that they were satisfied with their overall MEM training (296, 88.4%) and confident in their ability to practice EM (306, 91.6%). Conclusion: Indo-US MEM graduates have made a notable contribution to EM in India through clinical service delivery, teaching, and research, even more essential in the context of the COVID-19 pandemic. The roles of these graduates should be acknowledged and can contribute further to expandEM specialty and systems development across India. [ABSTRACT FROM AUTHOR]

Compared to other neutrino sources, the huge anti-neutrino fluxes at nuclear reactor based experiments empower us to derive stronger bounds on non-standard interactions of neutrinos with electrons mediated by light scalar/vector mediators. At neutrino energy around 200 keV reactor anti-neutrino flux is at least an order of magnitude larger compared to the solar flux. The atomic and crystal form factors of the detector materials related to the details of the atomic structure becomes relevant at this energy scale as the momentum transfers would be small. Non-standard neutrino-electron interaction mediated by light scalar/vector mediator arises naturally in many low-scale models. We also propose one such new model with a light scalar mediator. Here, we investigate the parameter space of such low-scale models in reactor based neutrino experiments with low threshold Ge and Si detectors, and find the prospect of probing/ruling out the relevant parameter space by finding the projected sensitivity at 90% confidence level by performing a χ2-analysis. We find that a detector capable of discriminating between electron recoil and nuclear recoil signal down to a very low threshold such as 5 eV placed in reactor based experiment would be able to probe a larger region in parameter space compared to the previously explored region. A Ge (Si) detector with 10 kg-yr exposure and 1 MW reactor anti-neutrino flux would be able to probe the scalar and vector mediators with masses below 1 keV for coupling products g ν g e ∼ 1 × 10−6 (9.5 × 10−7) and 1 × 10−7 (8 × 10−8), respectively. [ABSTRACT FROM AUTHOR]

Compared to other neutrino sources, the huge anti-neutrino fluxes at nuclear reactor based experiments empower us to derive stronger bounds on non-standard interactions of neutrinos with electrons mediated by light scalar/vector mediators. At neutrino energy around 200 keV reactor anti-neutrino flux is at least an order of magnitude larger compared to the solar flux. The atomic and crystal form factors of the detector materials related to the details of the atomic structure becomes relevant at this energy scale as the momentum transfers would be small. Non-standard neutrino-electron interaction mediated by light scalar/vector mediator arises naturally in many low-scale models. We also propose one such new model with a light scalar mediator. Here, we investigate the parameter space of such low-scale models in reactor based neutrino experiments with low threshold Ge and Si detectors, and find the prospect of probing/ruling out the relevant parameter space by finding the projected sensitivity at 90% confidence level by performing a χ2-analysis. We find that a detector capable of discriminating between electron recoil and nuclear recoil signal down to a very low threshold such as 5 eV placed in reactor based experiment would be able to probe a larger region in parameter space compared to the previously explored region. A Ge (Si) detector with 10 kg-yr exposure and 1 MW reactor anti-neutrino flux would be able to probe the scalar and vector mediators with masses below 1 keV for coupling products g ν g e ∼ 1 × 10−6 (9.5 × 10−7) and 1 × 10−7 (8 × 10−8), respectively. [ABSTRACT FROM AUTHOR]

Left ventricular (LV) pseudoaneurysm is a rare and grave complication of acute myocardial infarction. If left undetected, it has an extremely high rate of mortality. It is complicated by a ventricular free wall rupture contained by the pericardium and is characterized by the absence of myocardial tissue in its wall. The clinical presentation of these patients is nonspecific, making the diagnosis challenging. We came across a case of LV pseudoaneurysm diagnosed by transthoracic echocardiography, but unfortunately, the patient passed away within a few hours of presentation in the emergency department. This case depicts the importance of prompt diagnosis and management of such deadly complication. [ABSTRACT FROM AUTHOR]

The petroleum refining industry employs a wide variety of heat transfer-based equipment which tend to foul due to the complex nature of associated fluid streams and process conditions. Over the years, different test methods have been researched to understand fouling at the lab, pilot, and/or plant level. Several of these investigations have been limited to understanding fouling in static refinery streams or under non-practical operating conditions. The present study experimentally demonstrates the potential of a high-temperature batch stirred coupon test rig to characterize fouling under noncoking conditions for a specific refinery stream of interest. Experiments were conducted using a representative crude oil stream (obtained from a refinery) in a 2-liter batch autoclave system with a facility to immerse coupons attached to a rotating shaft into the stream during related test runs. The coupon Material of Construction (MOC) was chosen similar to the MOC of the tubes used in a refinery crude heat exchanger train. Experiments covered a range of bulk temperatures from 250°C to 300°C at 100 RPM. The foulant deposits obtained were found to have a strong (hard) and weakly (soft) adhering component. In the temperature range investigated, the hard and soft deposits were largely inorganic and organic in nature, respectively. The fluid bulk temperature was found to influence hard and soft deposit formation. The foulant deposits were characterized using TGA, CHNS, XRD, and SEM/EDAX, respectively. The iron and sulfur content in the hard deposit was more than 45% in total, indicating that the fouling mechanism was corrosion-based resulting from the formation of FeS on the surface. The thermal history of the soft deposit was distinct from the crude oil used. The results obtained confirm the potential of the coupon test rig for understanding fouling in refinery streams. [ABSTRACT FROM AUTHOR]

Urinary bladder cancer (UBC) is a common disease worldwide with a higher incidence rate in developed countries. Organochlorine pesticides (OCPs), potent endocrine disrupters, are found to be associated with several cancers such as prostate, breast, bladder, etc. Glutathione S-transferase (GST) is a polymorphic supergene family involved in the detoxification of numerous environmental toxins including OCPs. The present study was carried out in UBC subjects (n=50) and healthy control subjects (n=50) with an aim to determine the role of GSTM1 and GSTT1 polymorphism and its implication on the OCP detoxification or bioaccumulation which may increase the risk of UBC in humans. This study was also designed to identify the "gene-environment interaction" specifically between gene polymorphism in xenobiotic metabolizing genetic enzyme(s) and blood OCP levels. GSTM1/GSTT1 gene polymorphism was analysed by using multiplex PCR. OCPs levels in whole blood were estimated by Gas chromatography equipped with electron capture detector. The results demonstrated a significant (p< 0.05) increase in frequency of GSTM1^{-}/GSTT1^{-} (null) genotype in UBC cases without interfering the distribution of other GSTT1/GSTM1 genotypes. The blood levels of alpha (α), Beta (β), Gamma (γ), total - Hexachlorcyclohexane (HCH) and para-para - dichlorodiphenyltrichloroetane (p,p'-DDT) were found to be significantly (p< 0.05) high in UBC cases as compared to controls. Multiple regression analysis revealed a significant interaction between β-HCH and GSTM1^{-} genotype (p< 0.05) as well as in β-HCH and GSTT1^{-} genotype (p< 0.05) respectively. These findings indicate that "gene-environment interaction" may play a key role in increasing the risk for UBC in individuals who are genetically more susceptible due to presence of GSTM1/GSTT1 null deletion during their routine encounter with or exposure to OCPs. [ABSTRACT FROM AUTHOR]

The requirement for high tensile strength steel has placed greater emphasis on the cool-ing methods used in the cooling of a hot steel plate. The purpose of this research is to study the effect of surfactant concentration in water jet cooling, and its applicability in the study of ultrafast cooling (UFC) of a hot steel plate. The initial temperature of the plate, before the cooling starts, is kept at 900 °C which is usually observed as the "finish rolling temperature (FRT)" in the hot strip mill of a steel plant. The current heat transfer analysis shows that surfactant added water jet produces higher heat flux than the pure water jet due to the higher forced convection cooling area. Dissolved surfactant increases the transition boiling heat flux, nucleate boiling heat flux and critical heat flux. At a concentration of 600ppm, the maximum surface heat flux has been observed and fur-ther increase in surfactant concentration decreases the surface heat flux. The surface heat flux and the cooling rate show an increasing trend with the increasing water flow rate at a constant surfactant concentration. The achieved cooling rate in case of surfac-tant added water is almost twice that of jet with pure water, resulting in ultrafast cooling. By assuming the impinging surface consists of three different constant heat flux regions, the surface heat flux and the surface temperatures have been calculated by using INTEMP software. [ABSTRACT FROM AUTHOR]

[Display omitted] • Immobilized PUF combined with AC and SA showed higher removal efficiency. • The significant effect of glucose concentration on biodegradation was observed. • Maximum RE of 90.73 % and EC of 10.89 mg/L.d were found in PBBR. • The growth kinetics was accurately predicted by Andrew-Haldane model. Dyes are an important class of organic pollutants and are well known for their adverse effects on aquatic life and human beings. In this work, an effort has been made to treat the dye-containing wastewater using modified biocarriers in packed bed bioreactors (PBBRs). Lysinibacillus sp. immobilized polyurethane foam combined with activated carbon and sodium alginate was used for the biodegradation of Congo red dye. The optimum values of process time, glucose concentration, and dye concentration were obtained to be 4.0 days, 2.0 g/L, and 50 mg/L, respectively. The maximum dye removal efficiency (RE) of 92.63 % was obtained at the optimized conditions. The continuous PBBR offered a maximum RE and elimination capacity of 90.73% and 10.89 mg/L. d, respectively, at an inlet loading rate of 12 mg/L. d. Moreover, the growth kinetic of Lysinibacillus sp. was well predicted by the Andrew-Haldane model with a regression coefficient of 0.98. [ABSTRACT FROM AUTHOR]