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SummaryThe incidence and number of emergency room visits for esophageal foreign body and food impaction (EFB) are on the rise. However, its impact on the rate of inpatient admissions, utilization of endoscopic and surgical interventions, and healthcare outcomes is poorly understood. We conducted a study to analyze these outcomes using the national inpatient sample (NIS) database. Data on all adult patients (≥18 years) admitted with EFB was extracted from the NIS database from 1998 to 2013. The temporal trends in discharge rates as well as in length of stay (LOS), hospital charges, and in-hospital mortality rates were assessed by linear and polynomial regression. Average age, gender, and race of inpatients with EFB were not significantly different between 1998 and 2013. The rate of EFB admissions increased significantly from 1998 to 2005 followed by a decline thereafter (p = 0.01). LOS and hospital charges significantly increased by 0.02 days/year (p = 0.015) and $1,547/year (p

Group A streptococcus (GAS) is a rare yet potentially lethal cause of postpartum endometritis. Atypical early presentation and the routine use of post-delivery analgesics which might mask the symptoms preclude timely diagnosis and appropriate management. The invasive disease usually follows a rapidly progressive course that has considerable morbidity and mortality. Streptococcal toxic shock syndrome (TSS) can complicate this condition leading to refractory septic shock and possible death. We hereby present a case of a 42-year-old female patient who developed GAS postpartum endometritis complicated by streptococcal TSS resulting in death despite enormous resuscitative efforts. We aim to increase awareness of this lethal condition highlighting the importance of early recognition and prompt management.

The association between new-onset left ventricular (LV) dysfunction during sepsis with long-term heart failure outcomes is lesser understood.Retrospective cohort study of all adult patients with severe sepsis and septic shock between 2007 and 2014 who underwent echocardiography within 72 h of admission to the intensive care unit. Patients with prior heart failure, LV dysfunction, and structural heart disease were excluded. LV systolic dysfunction was defined as LV ejection fraction50% and LV diastolic dysfunction as ≥grade II. Primary composite outcome included new hospitalization for acute decompensated heart failure and all-cause mortality at 2-year follow-up. Secondary outcomes included persistent LV dysfunction, and hospital mortality and length of stay.During this 8-year period, 434 patients with 206 (48%) patients having LV dysfunction were included. The two groups had similar baseline characteristics, but those with LV dysfunction had worse function as demonstrated by worse LV ejection fraction, cardiac index, and LV diastolic dysfunction. In the 331 hospital survivors, new-onset acute decompensated heart failure hospitalization did not differ between the two cohorts (15% vs. 11%). The primary composite outcome was comparable at 2-year follow-up between the groups with and without LV dysfunction (P = 0.24). Persistent LV dysfunction was noted in 28% hospital survivors on follow-up echocardiography. Other secondary outcomes were similar between the two groups.In patients with severe sepsis and septic shock, the presence of new-onset LV dysfunction did not increase the risk of long-term adverse heart failure outcomes.

Extreme ultraviolet (EUV) lithography is crucial to enabling technology scaling in pitch and critical dimension (CD). Currently, one of the key challenges of introducing EUV lithography to high volume manufacturing (HVM) is throughput, which requires high source power and high sensitivity chemically amplified photoresists. Important limiters of high sensitivity chemically amplified resists (CAR) are the effects of photon shot noise and resist blur on the number of photons received and of photoacids generated per feature, especially at the pitches required for 7 nm and 5 nm advanced technology nodes. These stochastic effects are reflected in via structures as hole-to-hole CD variation or local CD uniformity (LCDU). Here, we demonstrate a synergy of film stack deposition, EUV lithography, and plasma etch techniques to improve LCDU, which allows the use of high sensitivity resists required for the introduction of EUV HVM. Thus, to improve LCDU to a level required by 5 nm node and beyond, film stack deposition, EUV lithography, and plasma etch processes were combined and co-optimized to enhance LCDU reduction from synergies. Test wafers were created by depositing a pattern transfer stack on a substrate representative of a 5 nm node target layer. The pattern transfer stack consisted of an atomically smooth adhesion layer and two hardmasks and was deposited using the Lam VECTOR PECVD product family. These layers were designed to mitigate hole roughness, absorb out-of-band radiation, and provide additional outlets for etch to improve LCDU and control hole CD. These wafers were then exposed through an ASML NXE3350B EUV scanner using a variety of advanced positive tone EUV CAR. They were finally etched to the target substrate using Lam Flex dielectric etch and Kiyo conductor etch systems. Metrology methodologies to assess dimensional metrics as well as chip performance and defectivity were investigated to enable repeatable patterning process development. Illumination conditions in EUV lithography were optimized to improve normalized image log slope (NILS), which is expected to reduce shot noise related effects. It can be seen that the EUV imaging contrast improvement can further reduce post-develop LCDU from 4.1 nm to 3.9 nm and from 2.8 nm to 2.6 nm. In parallel, etch processes were developed to further reduce LCDU, to control CD, and to transfer these improvements into the final target substrate. We also demonstrate that increasing post-develop CD through dose adjustment can enhance the LCDU reduction from etch. Similar trends were also observed in different pitches down to 40 nm. The solutions demonstrated here are critical to the introduction of EUV lithography in high volume manufacturing. It can be seen that through a synergistic deposition, lithography, and etch optimization, LCDU at a 40 nm pitch can be improved to 1.6 nm (3-sigma) in a target oxide layer and to 1.4 nm (3-sigma) at the photoresist layer.

Indian power system is one of the largest synchronously operated Power System Networks in the world. It has an installed capacity of about 303 GW. Indian power system has complex transmission network along with many cross border connections. It is monitored by a multi-level integrated Supervisory Control & Data Acquisition (SCADA)/ Energy Management System (EMS) installed at many control centres dispersed all over India. SCADA/EMS of National control centre is integrated with SCADA/EMS systems of five Regional control centres. SCADA/EMS systems of Regional control centres in turn are integrated with SCADA/EMS systems of 32 State control centres. It is important to use all real-time tools to help the operator in maintaining the grid in a highly secure and reliable manner. Successful implementation of State Estimator is said to be critical requirement for efficient EMS. An exercise was taken up by Power System Operation Corporation Limited (POSOCO) with an objective of improving the usage of State Estimation in Load Despatch Centres in India. In this process, it has been interacting with experts both in India and abroad with the objective of learning and making continuous improvement. Successful running of State Estimation at All India level involves maintaining and tuning of a large SCADA and Network database. Such a big database needs correction in topology, device parameters, connectivity model, etc. This paper focusses on all such related issues, its solution and impact on State Estimator output.

Indian power system is one of the largest Power System Networks in the world. It has installed capacity of about 245 GW. Indian power system has complex transmission network and many cross border connections. It is monitored by a multilevel integrated SCADA/EMS installed at many control centers dispersed all over India. SCADA/EMS of National control center is integrated with SCADA/EMS systems of five regional control centers. SCADA/EMS systems of regional control centers in turn are integrated with SCADA/EMS systems lower 32 state control center. National control center was established in 2009. Purpose of national control center is to watch inter-regional and international transfer of power for best utilizing the generating resources by balancing deficit/surplus, diversity in peaking times and seasonal variations in demand of different regions. SCADA/EMS system of NLDC and regional control centers has different manufacturers. Integrated operation of SCADA system of NLDC has been a unique experience and has imparted many learning to the system operator and SCADA engineers at NLDC. This paper is an attempt to consolidate these experiences and learning.