Kikuchi Disease: Recognizing a Common Presentation of an Uncommon Condition

INTRODUCTION Kikuchi disease, also known as histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease, is a rare condition that typically presents with fever and cervical lymphadenopathy in previously healthy young women. First described by Dr. Kikuchi and independently by Dr. Fujimoto in Japan in 1972, the disease is benign and usually self-limited. However, because it can present dramatically and mimic more serious conditions such as lymphoma and tuberculous adenitis, recognizing Kikuchi disease is crucial to avoid misdiagnosis and inappropriate treatment. This case describes a patient who presented with severe manifestations of Kikuchi disease that generated an extensive workup and differential diagnosis prior to its identification

Doctor of Philosophy

dissertationThis dissertation presents the development and validation of a variant of the One Dimensional Turbulence model (ODT) in an Eulerian reference frame. The ODT model solves unfiltered governing equations in one spatial dimension with a stochastic model for turbulence. The stand-alone ODT model implemented for this work resolves the full range of length and time scales associated with the flow, in 1D, with detailed chemistry, thermodynamics and transport in the gas phase. The model is first applied to a planar nonpremixed turbulent jet flame and results from the model prediction are compared with DNS data. Results indicate that the model accurately reproduces the DNS data set. Turbulence-chemistry interactions, including trends for extinction and reignition, are captured by the model. Differences observed between model prediction and data are the result of early excess extinction observed in the model. The reasons for the early extinction are discussed within the model context. A parameter sensitivity is also done for the current model. Simulations are performed over a range of jet Reynolds numbers for reacting and nonreacting configurations. Results from the simulations are compared with DNS and experimental data for reacting and nonreacting cases, respectively. Based on the identified sensitivity an empirical correlation is proposed and conclusions are drawn about the parameter estimation. The model is also applied to a planar premixed turbulent jet flame and results from the ODT simulations are compared with DNS data. Two different Da cases are considered in the study and comparisons between the model and DNS data in physical space are shown. Results indicate that the model qualitatively reproduces the DNS data set. Mixing is well captured by the model and the quantitative differences observed between model and data for thermochemistry are due to the curvature effects in the data. The reasons for the differences observed are discussed within the model context

An evaluation of the one-dimensional turbulence model: comparison with direct numerical simulation of CO/H2 jets with extinction and reignition

Journal ArticleAbstract A variant of the One-Dimensional Turbulence (ODT) model formulated in an Eulerian reference frame is applied to a planar nonpre mixed turbulent jet flame and results from the model prediction are compared with DNS data. The model employed herein solves the full set of conservation equations for mass, momentum, energy, and species on a one-dimensional domain corresponding to the transverse jet direction. The effects of turbulent mixing are modeled via a stochastic process, while the full range of diffusive-reactive length and time scales are resolved directly on the one-dimensional domain. A detailed chemical mechanism consisting of 11 species and 21 reactions and mixture averaged transport is used in this study (consistent with DNS simulations). Comparisons between the model and DNS data in physical and state space are shown, including conditional statistics. Results indicate that the model accurately reproduces the DNS data set. Turbulence-chemistry interactions, including trends for extinction and re-ignition, are captured by the model. Differences observed between model prediction and data are the result of early excess extinction observed in the model. The reasons for the early extinction are discussed within the model context

Does A Short, Thick Neck Predict Obstructive Sleep Apnea?: The Role of Physical Examination in OSA Screening

Purpose: The purpose of this study was to determine whether a short neck, alone or together with a thick neck, can predict obstructive sleep apnea (OSA). Methods: The laryngeal heights of 169 new adult patients presenting to a sleep medicine physician were measured over a period of 5 months. Neck circumference, Mallampati score, and body-mass index (BMI) were also determined, together with medical history, smoking status, and serum bicarbonate. Lastly, patients’ polysomnograms were obtained in order to ascertain the presence or absence of OSA as indicated by the apnea-hypopnea index, as well as other sleep study parameters. Results: No association was found between laryngeal height and presence of OSA, bicarbonate concentration or oxygen saturation. Of interest, neck circumference was also not significantly associated with any of the aforementioned parameters, although there was a trend towards significance in its association with OSA (p=0.055). Still, a combined short laryngeal height and large neck circumference was associated with lower nadir SaO2 (p=0.018). Of all clinical parameters we measured, only higher BMI, older age and male sex were positively associated with OSA (p\u3c0.05). Conclusion: This study challenges the popular notion that short necks predict OSA

Advanced Modeling of Cold-Formed Steel Walls under Fire

This paper discusses an advanced finite element model able to simulate the structural response of cold-formed steel walls during standard fire tests. The model includes experimental thermo-mechanical properties of materials, geometric imperfections, and temperature distributions on studs and sheathing boards. The model is capable of reasonably predicting the thermal bowing of walls, and estimating the shape, size and amount of joint openings between gypsum boards over time of fire exposure. Numerical results validated with experimental data indicate that the maximum out-of-plane displacements due to thermal gradients occur near the wall mid-height. Early in the heating process, joint openings develop on the exposed side of walls due to thermal bowing and contraction of gypsum boards at elevated temperatures, potentially altering the heat transfer and affecting the fire resistance of the entire system. Future work aims to utilize high fidelity modeling to study the response of load bearing cold-formed steel systems subjected to fire, and optimize their fire resistance

Taking the e out of Night MARe Rotation: Uncloaking Ghost Admissions via Teletracking and Reducing Paper Fatigue

Goal: To improve communication at admission for patients admitted from non-ED locations so that patient care delays are minimized and provider frustration decreases.https://jdc.jefferson.edu/patientsafetyposters/1015/thumbnail.jp

What is the Evidence for Over the Counter Laxatives to Treat Childhood Constipation?

PURPOSE OF REVIEW: Functional constipation is a common pediatric GI disorder that is responsible for a significant portion of pediatric office visits each year. It presents a significant stressor for patients, their families, and providers alike. There are a variety of over the counter agents available for treatment of pediatric constipation. RECENT FINDINGS: Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, remain the most effective and safe therapy for both long and short term treatment of pediatric functional constipation. Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories make excellent choices for adjunct therapies in specific clinical scenarios. There are multiple over the counter pharmacologic agents with various mechanisms of action that have demonstrated efficacy in pediatric functional constipation. These therapies are generally safe and well tolerated by patients