By: John Theodore Geneczko, MD

- Assistant Professor of Medicine

https://medicine.duke.edu/faculty/john-theodore-geneczko-md

Risk factors for developing tuberculosis: a 12-year follow-up of contacts of tuberculosis cases gastritis snacks purchase discount pyridium on-line. Guidelines for the investigation of contacts of persons with infectious tuberculosis gastritis from alcohol purchase generic pyridium line. Disseminated tuberculosis with or without a miliary pattern on chest radiograph: a clinical-pathologic-radiologic correlation gastritis kaj je order 200mg pyridium free shipping. Grading of a positive sputum smear and the risk of Mycobacterium tuberculosis transmission gastritis colitis purchase genuine pyridium line. The infectiousness of laryngeal tuberculosis: appropriate public health action based on false premises [Counterpoint]. Risk of developing tuberculosis from a school contact: retrospective cohort study, United Kingdom, 2009. Yield of source-case and contact investigations in identifying previously undiagnosed childhood tuberculosis. Predictive model to identify positive tuberculosis skin test result during contact investigations. Transmission of Mycobacterium tuberculosis through casual contact with an infectious case. Outbreak of tuberculosis among homeless persons coinfected with human immunodeficiency virus. Evaluation of a large-scale tuberculosis contact investigation in the Netherlands. Evaluation of investigations conducted to detect and prevent transmission of tuberculosis. Unsuspected recent transmission of tuberculosis among high-risk groups: implications of universal tuberculosis genotyping in its detection. Recommendations on modern contact investigation methods for enhancing tuberculosis control. Epidemiologic Notes and Reports: Crack cocaine use among persons with tuberculosis – Contra Costa County, California, 1987-1990. Outcomes of contact investigation among homeless persons with infectious tuberculosis. Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation. Outbreak of tuberculosis in a homeless population involving multiple sites of transmission. Impact of mobile radiographic screening on tuberculosis among drug users and homeless persons. Association of tuberculosis infection with increased time in or admission to the New York City jail system. Investigation of individuals exposed to a healthcare worker with cavitary pulmonary tuberculosis. Prevalence and determinants of positive tuberculin reactions of residents in old age homes in Hong Kong. Acceptance and safety of directly observed versus self-administered therapy in Aboriginal peoples in British Columbia. Evidence for airborne infectious disease transmission in public ground transport – a literature review. Large outbreak of isoniazid-monoresistant tuberculosis in London, 1995 to 2006: case–control study and recommendations. Generally, the objectives of a surveillance program are to guide health interventions, estimate trends, identify groups at high risk, monitor changes in patterns of transmission, evaluate pre vention strategies and suggest hypotheses for further research. These conditions may not be sufficiently symptomatic to induce patients to seek medical help on their own. Screening may be justified by the prevalence and/or potential 2 severity of the target condition, when its detection permits intervention that improves outcomes. Subsequent microbiologic confirmation with sputum smear and culture or other suitable specimens is always recommended (See Chapter 6, Treatment of Latent Tuberculosis Infection). Conditions under which either test is preferred and their interpretation are reviewed in Chapter 4, Diagnosis of Latent Tuberculosis Infection. Chest radiography also identifies abnormalities that are associated with increased reactivation risk. The likelihood that individuals will safely complete treatment as prescribed should also be taken into account. Canada is a leading destination for migrants and receives on average ~250,000 immigrants and refugees 5,6 annually, who account for almost 20% of the population (2006 Census). Over the past 40 years, there has been a major demographic shift in the source countries of new migrants. Before the 1960s, most individuals immigrating to Canada originated from European countries. The two main administrative classifications of migrants arriving in Canada are 1) permanent residents who come to Canada to resettle and 2) temporary residents who are visiting, studying or working in Canada but who maintain their own nationality. Permanent and temporary residents are further classified into several subgroups (see Table 2). In addition, Canada receives more 8 than 35 million international visitors per year. Most groups apply for permission to come to Canada while still living in their countries of origin, an important exception is refugee claimants 6 who apply for status after arrival in Canada. Classification of international migration to Canada (2010) Immigration category Annual number of migrants* Permanent residents Economic class (business and economic migrants) 187,000 Family class (family reunification) 60,000 Humanitarian class (refugees resettled from abroad 25,000 or selected in Canada from refugee claimant population) Others 9,000 Total 281,000 Temporary residents Migrant workers 182,000 International students 96,000 Refugee claimants 23,000 (those arriving in Canada and claiming to be a refugee) 81,000 Others Total 382,000 Other migrants Irregular migrants (no official migration status)† ~200,000 Visitors ~35,000,000 *Numbers rounded to nearest 1,000. It also includes those who may have entered the country illegally and did not register with authorities or apply for residence. Refugees and foreign-born children from high-incidence countries are particularly important subgroups to consider for targeted screening, for the reasons listed below. The 3-year moving average is used to adjust for unstable rates in some jurisdictions. Furthermore, estimated rates adjusted for under-reporting of cases are used for some countries, rather than the country’s reported incidence rate. Individuals with certain abnormalities on their chest x-ray must submit three consecutive sputum samples for smear and culture. Those unable to submit sputum will be required to repeat the chest radiography 6 months after the initial one to establish stability. Citizenship and Immigration Canada requirements for an immigration medical 24 examination Entrants to Canada Criteria Foreign nationals applying for permanent residency Mandatory for all. They must report to, or be contacted by, a public health authority within 30 days of entry. This is a passive surveillance system, and the implementation varies among the different provinces and territories, some having a centralized process and others having a decentralized system. Compliance is defined as keeping the first appointment with the clinician or being assessed by a specialist designated by public health. Participation in the Medical Surveillance Program is a formal “condition of landing. Immigrants are responsible for their own health care funding until eligible for provincial/territorial health care insurance, which in some jurisdictions may not be until 90 days after arrival. If these are present chest radiography and sputum 29 smears and cultures should be performed as deemed appropriate. In general, such people should be advised of the potential risk of reactivation and told to return for evaluation if symptoms arise (see also Chapter 6). There are, however, published primary care guidelines and several screening programs managed by different organizations, for example, school-based screening, immigrant and refugee clinics, 10,30-45 services for migrant workers and targeted screening of certain high-risk migrants. Undocumented migrants are difficult to access and remain a challenge, as they are not systema tically screened in any of the existing programs. Only 67% of those targeted for this surveillance actually completed the screening process, thus highlighting the importance of 47 improving the functioning of these programs. This suboptimal performance was due to losses and dropouts at all steps of the process: 69. In addition there are 350,000-400,000 new temporary residents, including foreign workers, foreign 6 students, refugee claimants and those in humanitarian groups, arriving each year in Canada. In Canada some temporary workers are screened, but most of these other groups are not (Table 3). Accessing this population is a challenge, as only a minority (20%-30%) seek pre-travel advice, and there are no programs to 55-57 routinely re-evaluate returning travelers. Provider barriers to offering screening to migrants are related to inadequate knowledge of which migrants should be 61-63 screened or how they should be followed up.

The best coordinate to gastritis fatigue cheap 200mg pyridium free shipping choose is gastritis kronis pdf order 200 mg pyridium otc, the angle that the T rod makes with the vertical chronic antral gastritis definition buy 200mg pyridium visa. In contrast gastritis zinc carnosine cheap pyridium line, if E < mgl, the pendulum completes only part of the circle before it comes to a stop and swings back the other way. If the highest point of the swing is 0, then the energy is E = mgl cos 0 We can determine the period T of the pendulum using (2. It’s actually best to calculate the period by taking 4 times the time the pendulum takes to go from = 0 to = 0. We have Z T/4 Z 0 d T = 4 dt = 4 p 2E/ml2 + (2g/l) cos 0 0 s Z l 0 d = 4 v (2. For what it’s worth, this integral turns out to be, once again, an elliptic integral. Firstly, it is possible to have energy conservation even if the force depends on the velocity. Conversely, forces which only depend on the position do not necessarily conserve energy: we need an extra condition. We have the following result: – 18 – Claim: There exists a conserved energy if and only if the force can be written in the form F = rV (2. We have i dE V x = mx · x + using summation convention dt xi t = x · (mx + rV) = 0 where the last equality follows from the equation of motion which is mx = rV. To go the other way, we must prove that if there exists a conserved energy E taking the form (2. If a force F acts on a particle and succeeds in moving it from x(t1) to x(t2) along a trajectory C, then the work done by the force is dened to be Z W = F · dx C this is a line integral (of the kind you’ve met in the Vector Calculus course). The scalar product means that we take the component of the force along the direction of the trajectory at each point. We can make this clearer by writing Z t 2 dx W = F · dt t1 dt the integrand, which is the rate of doing work, is called the power, P = F · x. Using Newton’s second law, we can replace F = mx to get Z t Z t 2 1 2 d W = m x · x dt = m (x · x) dt = T (t2) T (t1) t1 2 t1 dt where 1 T m x · x 2 is the kinetic energy. Except in all advanced courses of theoretical physics, kinetic energy is always denoted T which is why I’ve adopted the same notation here). But a simple result (which you will prove in your Vector Calculus course) says that (2. The resulting force also depends only on the distance to the origin and, moreover, always points in the direction of the origin, dV F(r) = rV = x (2. In these lectures, we’ll also use the notation r = x to denote the unit vector pointing radially from the origin to the position of the particle. In the vector calculus course, you will spend some time computing quantities such as rV in spherical polar coordinates. Then, using the chain rule, we have V V V rV =,, x1 x2 x3 dV r dV r dV r =,, dr x1 dr x2 dr x3 dV x1 x2 x3 dV =,, = x dr r r r dr 2. For now, we will just mention what is important about central forces: they have an extra conserved quantity. Let’s look at what happens to angular momentum in the presence of a general force F. We’re left with dL = mx x = x F dt the quantity = x F is called the torque. This gives us an equation for the change of angular momentum that is very similar to Newton’s second law for the change of momentum, dL = dt Now we can see why central forces are special. When the force F lies in the same direction as the position x of the particle, we have x F = 0. This means that the torque vanishes and angular momentum is conserved dL = 0 dt We’ll make good use of this result in Section 4 where we’ll see a number of important examples of central forces. They are • Gravity • Electromagnetism • Strong Nuclear Force • Weak Nuclear Force the two nuclear forces operate only on small scales, comparable, as the name suggests, 15 to the size of the nucleus (r0 10 m). We can’t really give an honest description of these forces without invoking quantum mechanics and, for this reason, we won’t discuss them in this course. It determines the strength of the gravitational force and is given by 11 3 1 2 G 6. We will devote much of Section 4 to studying the motion of a particle under the inverse-square force. The gravitational eld due to many particles is simply the sum of the eld due to each individual particle. If we x particles with masses Mi at positions ri, then the total gravitational eld is X M i (r) = G |r ri| i the gravitational force that a moving particle of mass m experiences in this eld is X M i F = Gm (r ri) |r r |3 i i the Gravitational Field of a Planet the fact that contributions to the Newtonian gravitational potential add in a simple linear fashion has an important consequence: the external gravitational eld of a spher ically symmetric object of mass M – such as a star or planet – is the same as that of a point mass M positioned at the origin. The proof of this statement is an example of the volume r integral that you will learn in the Vector Calculus course. Summing over the contribution from R all points x inside the planet, the gravitational eld is given by Z 3 G(x) (r) = d x Figure 5: |x|R |r x| It’s best to work in spherical polar coordinates and to choose the polar direction, = 0, to lie in the direction of r. We can use this to write an expression 2 2 2 for the denominator: |rx| = r +x 2rx cos. The gravitational eld then becomes Z R Z Z 2 2 (x)x sin (r) = G dx d d v r2 + x2 2rx cos 0 0 0 Z R Z 2 (x)x sin = 2G dx d v r2 + x2 2rx cos 0 0 Z R h i 1 v = 2 2 2 = 2G dx (x)x r + x 2rx cos 0 rx =0 Z R 2G = dx (x)x (|r + x| |r x|) r 0 – 23 – So far this calculation has been done for any point r, whether inside or outside the planet. R2 this is the familiar potential energy that gives rise to constant acceleration. If you want to escape the gravitational attraction of the planet for – 24 – ever, you will need energy E 0. The reason that this is dodgy is because, as we will see in Section 7, the laws of Newtonian physics need modifying for particles close to the speed of light where the eects of special relativity are important. Suppose that the escape velocity from the surface of a star is greater than or equal to the speed of light. Although the derivation above is not trustworthy, by some fortunate coincidence 2 it turns out that the answer is correct. If a star is so dense that it lies within its own Schwarzchild radius, then it will form a black hole. You’ll be pleased to hear that, because both objects are much larger than their Schwarzchild radii, neither is in danger of forming a black hole any time soon. The mass appearing in the second law represents the reluctance of a particle to accelerate under any force. In contrast, the – 25 – mass appearing in the inverse-square law tells us the strength of a particular force, namely gravity. Since these are very dierent concepts, we should really distinguish between the two dierent masses. We now know that the inertial and gravitational masses are equal to within about one part 13 in 10. Currently, the best experiments to study this equivalence, as well as searches for deviations from Newton’s laws at short distances, are being undertaken by a group at the University of Washington in Seattle who go by the name Eot-Wash. Their role – at least for the purposes of this course – is to guide any particle that carries electric charge. The force experienced by a particle with electric charge q is called the Lorentz force, F = q E(x) + x B(x) (2. By convention, particles with positive charge q are accelerated in the direction of the electric eld; those with negative electric charge are accelerated in the opposite direction. Due to a quirk of history, the electron is taken to have a negative charge given by 19 qelectron 1. It is a velocity dependent force, with magnitude proportional to the speed of the particle, but with direction perpendicular to that of the particle. In this case, the electric eld is always of the form E = r For some function (x) called the electric potential (or scalar potential or even just the potential as if we didn’t already have enough things with that name). Claim: the conserved energy is 1 E = mx · x + q(x) 2 Proof: E = mx · x + qr · x = x · (F + qr) = qx · (x B) = 0 where the last equality occurs because x B is necessarily perpendicular to x. Notice that this gives an example of something we promised earlier: a velocity dependent force which conserves energy. The key part of the derivation is that the velocity dependent force is perpendicular to the trajectory of the particle. A particle of charge Q sitting at the origin will set up an electric eld given by Q Q r E = r = (2. The quantity 0 has the grand name Permittivity of Free Space and is a constant given by 12 3 1 2 2 0 8. It is a remarkable fact that, mathematically, the force looks identical to the Newtonian gravitational force (2. We will study motion in this potential in detail in Section 4, with particular focus on the Coulomb force in 4.

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