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Abstract Background Kikuchi–Fujimoto disease, which was originally described in young women, is a benign condition characterized by necrotizing lymphadenitis and fever. Even though the clinical course is usually self-limiting, it can be associated with recurrences and rarely can be associated with systemic lupus erythematosus or can be complicated with hemophagocytic lymphohistiocytosis. We report the case of a 17-year-old Sri Lankan Sinhalese schoolboy who presented with fever and cervical lymphadenopathy diagnosed as Kikuchi–Fujimoto disease and was complicated with hemophagocytic lymphohistiocytosis subsequently. Later he fulfilled the criteria for systemic lupus erythematosus. Case presentation A 17-year-old previously healthy Sinhalese schoolboy presented with high-grade fever associated with chills and rigors associated with loss of appetite and loss of weight for more than 40 days. On examination, he had bilateral firm matted tender cervical lymphadenopathy and firm hepatomegaly. An excision biopsy of his right cervical lymph node revealed necrotizing lymphadenitis and immunohistochemistry of a lymph node biopsy favored Kikuchi disease. Initial antinuclear antibody and anti-double-stranded deoxyribonucleic acid tests were negative and his C3 and C4 levels were normal. An infections screening was negative. He was treated with steroids. While in hospital he developed hemophagocytic lymphohistiocytosis and renal impairment. Later his antinuclear antibody titer became positive in 1:160 and fulfilled the diagnostic criteria for systemic lupus erythematosus. He was managed with steroids and immune suppressive drugs and showed remarkable improvement. Conclusion Although Kikuchi–Fujimoto disease is uncommon in male patients, it needs to be considered in patients with lymphadenopathy and fever. The disease can be complicated with hemophagocytic lymphohistiocytosis and the patients need continuous monitoring for the possible development of systemic lupus erythematosus later in the course.

Purpose: This research was conducted on SMEs of brown sugar. This business has difficulty increasing sales especially in the new products from SMEs, namely printed brown sugar products. Where previously this SMEs only produced and sold bulk brown sugar. Design/methodology/approach: The methods used are Fishbone and Pareto, to identify the factors that can support the sales strategy. Findings: The results showed that there are internal factors and external factors as a sales strategy. Fishbone and Pareto diagram shows that internal factors have strength and weakness, indicating that there are SMEs that have their own business capital, workers who are experienced in making brown sugar. Meanwhile, external factors, in the form of opportunities and threats, where SMEs already have markets and customers. Research limitations/implications: Current condition has several obstacles, such as facing increasingly competitive competition, more types of products, rapid technological developments, and the number of similar businesses. This has an effect on conventionally run businesses such as SMEs. Practical implications: The results showed that there are internal factors and external factors as a sales strategy. Fishbone and Pareto diagram shows that internal factors have strength and weakness, indicating that there are SMEs that have their own business capital, workers who are experienced in making brown sugar. Meanwhile, external factors, in the form of opportunities and threats, where SMEs already have markets and customers. In the Threat factor, technology and competitors are found to be a threat, but if examined again, these two things are real opportunities for SMEs. The use of technology in this digital era can be used as a promotional medium, while the identified competitors come from outside the area of SME. These competitors can surely be a driver of good performance in running their business. Paper type: is categorized as a research paper

Vibrational strong coupling (VSC) between a vacuum field and molecules in a cavity offers promising applications in cavity-modified chemical reactions and ultrasensitive vibrational spectroscopy. At present, in order to realize VSC, bulky microcavities with large mode volume are utilized, which limits their potential applications at the nanoscale. Here, we report on the experimental realization of strong coupling between molecular vibrations and infrared photons confined within a deeply subwavelength nanogap patch antenna cavity. Our system exhibits a characteristic anticrossing dispersion, indicating a Rabi splitting of 108 cm -1 at the single resonator level with excellent angular insensitivity. The numerical simulations and theoretical analyses quantitatively reveal that the strength of coupling depends on the cavity field-molecule overlap integral and the image charge effect. VSC at the single nanogap patch antenna level paves the way for molecular-scale chemistry, ultrasensitive biosensors, and the development of ultralow-power all-optical devices in the mid-infrared spectral range.

A toroidal dipole in metasurfaces provides an alternate approach for the excitation of high-Q resonances. In contrast to conventional multipoles, the toroidal dipole interaction strength depends on the time derivative of the surrounding electric field. A characteristic feature of toroidal dipoles is tightly confined loops of oscillating magnetic field that curl around the fictitious arrow of the toroidal dipole vector., (© 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Metamaterials that have broadband absorption at MIR frequencies, and yet, are transmitive at visible frequencies are fabricated using a semi-conducting Indium Tin Oxide (ITO) film as ground plane. The metamaterial absorber consists of an array of uniform aluminum disks separated by a Zinc Sulphide (ZnS) dielectric spacer layer from the ITO ground plane. The metamaterial was fabricated by a simple, cost-effective vapor deposition through a shadow mask. Compared with the usual metal/dielectric/metal tri-layer absorbers, the metal/dielectric/ITO absorber shows a peak absorbance of 98% and >70% over the mid-infrared regime from 4 to 7 μm. The broadband nature arises due to smaller dispersion in the dielectric permittivity of ITO compared to that of plasmonic metals at mid-infrared frequencies.

We propose a metamaterial saturable absorber mirror at midinfrared wavelengths that can show a saturation of absorption with intensity of incident light and switch to a reflecting state. The design consists of an array of circular metallic disks separated by a thin film of vanadium dioxide (VO(2)) from a continuous metallic film. The heating due to the absorption in the absorptive state causes the VO(2) to transit to a metallic phase from the low temperature insulating phase. The metamaterial switches from an absorptive state (R≃0.1%) to a reflective state (R>95%) for a specific threshold intensity of the incident radiation corresponding to the phase transition of VO(2), resulting in the saturation of absorption in the metamaterial. The computer simulations show over 99.9% peak absorbance, a resonant bandwidth of about 0.8 μm at 10.22 μm wavelengths, and saturation intensity of 140 mW cm(-2) for undoped VO(2) at room temperature. We also carried out numerical simulations to investigate the effects of localized heating and temperature distribution by solving the heat diffusion problem.

Simple designs for polarization independent, metamaterial absorbers at mid-infrared wavelengths and over wide angle of incidence are evaluated computationally. One design consists of an array of circular metallic disks separated from a continuous metallic film by a dielectric film, and shows over 99.9% peak absorbance and a resonant bandwidth of about 0.2 μm wavelengths. The effects of various geometric parameters are analyzed for this metamaterial. Another design consisting of an array of stacked metal-dielectric-metal disks is shown to have an absorbance of over 90% in a comparatively large band of over 1 μm bandwidth, although with a lower peak absorbance of 97%.

At Adventist HealthCare, a patient-centered medical home pilot project: Helped improve the health of high-risk members while increasing the efficiency of healthcare delivery. Supported the primary care physicians treating the high-risk patients. Reduced the costs of treating the patients.

Background: Mechanical circulatory support for intractable heart failure as a bridge to transplantation has been used infrequently in children. The lack of clinically available ventricular assist devices has resulted in the use of conventional extracorporeal circuits with oxygenator as the main modality for circulatory support. In this study we reviewed our experience with extracorporeal membrane oxygenation (ECMO) support in children with irreversible heart failure who were awaiting heart transplantation., Methods and Results: Since 1985, 14 children were placed on ECMO support for circulatory failure and were considered candidates for heart transplantation: 8 children had postcardiotomy contractile failure, 3 had dilated cardiomyopathy, and 3 had viral myocarditis. Five of these children had cardiac arrest and were placed on support during cardiopulmonary resuscitation. Mean duration of ECMO support was 109 +/- 20 hours. Eight patients developed pulmonary edema requiring decompression of the left ventricle, 3 by blade atrial septostomy and 5 by left atrial vent cannula. Nine of 14 received a heart transplant, 1 child recovered spontaneously (myocarditis), and 4 died of sepsis on ECMO. Of the children who received transplants, 6 were early survivors with 1 late death (lymphoproliferative disease), for a total of 7 of 14 (50%) early and 6 of 14 (43%) late survivors., Conclusions: Our experience suggests that ECMO is an effective means of circulatory support as a bridge to transplantation in children. Decompression of the left ventricle is often required to prevent pulmonary edema. Sepsis and bleeding remain a limitation to prolonged mechanical support with ECMO in children.

The present paper presents two brothers with a median upper lip cleft, associated with postaxial hexadactyly of both hands and feet. Very few similar cases have previously been reported in the literature by various workers. The similarity between the cases reported in the literature and the two cases presented here indicates the existence of a median cleft lip-hexadactyly-syndrome.