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Tuberculosis Louisiana Statistics According to the State of Louisiana Public Health Office data, there were 139 cases of active TB cases in 1998 with a case rate of 13.5 /100 K population in Region 1 (New Orleans Metropolitan area and surrounding 5 parishes region). This reduced to 110 active cases in 1999, but increased again to 134 active cases in 2000. This data does not include PPD positive LTB cases and PPD negative contact cases. It is estimated that 5% of the population of Louisiana is PPD positive with latent TB. The LSU-Wetmore TB Clinic scheduled 1717 TB related clinic visits in 1999. Eighty eight percent of the active TB cases are on the DIRECT OBSERVED TREATMENT (DOT) program with 90% of these cases undergoing FIELD DOT conducted by DIS workers reaching these patients at home or at place of work.
Louisiana Office of Public Health - Tuberculosis Control Program TB Update Contemporary Topics in MTB 2010 The Orleans Parish Triangle of TB To Be Informed Newsletter To Be Informed is a newsletter/brochure in Vietnamese and English based on frequently asked questions by audience and participants of the TEACH Program. It is distributed to community venues and primary care clinics. Discussion Points Tuberculosis Synopsis Update 2011. Definition: LTBI, “Chemoprophylaxis”.
Targeted tuberculosis testing in high risk/high prevalence groups and “precision treatment” options. Three cut-off points for TST (tuberculin skin test) remain. US Public health Strength of recommendation ABC. Quality of evidence I II III. Duration of LTBI Rx: 9 months. Flexibility based on local public health considerations. Recent Changes in Emphasis.
Criteria for PPD TST (tuberculin skin test) positivity, by risk stratification. New definition of PPD TST (tuberculin skin test) converter: increase in 10 mm or more within a 2-year period.
Clinical monitoring. Lab monitoring in (a) HIV (b) pregnant (c) postpartum (d) Hx of liver disease (e) Those who continue use of alcohol regularly. (f) Other medical conditions. For cessation of Rx on the basis of LFTs recommended: Rule of “FASTS” 5 times if asymptomatic; 3 times if symptomatic. Intermittent Rx must be DOPT.
Rifabutin in place of Rifampin in HIV patients where PI’s are used. In pregnant women with HIV or recent contact history or conversion, treatment should be started even in the first trimester. In other lower risk pregnant patients, Rx can be deferred till after delivery. Options in INH resistant or PZA intolerant patients available. Immune-competent contacts of MDRTB with LTB, PZA/ETM or PZA/QUIN for 6 months.
Immune-compromised contacts of MDRTBRx for 12 months Teaching Bullets. Acid-fast.
Obligate aerobe: Involvement of spleen/heart?. Intracellular. Replication time 15-20 hours. New Colonies generally do not appear after 6 weeks.
99% Niacin-positive. Flouroscient stain more sensitive than CF stain ( Overall: low sensitivity with 10000 (10 X4) bact/cc. Quantitatively: Rare= 3-9/slide; few =10/slide; numerous 1/oil. PCR: false positive. DNA probe: rapid but expensive for ID. Other AFB = Nocordia,Legionella Micadei.
40-70% of patients with MTB isolated on culture have positive smears. Culture = egg based or agar based.
CXR: nodular= 10x2 –10x4; Cavitary=10x7-10x9 With treatment:. Within 15 days: TB bacilli decrease 2 log i.e. 10x6 to 10x4. Cough decreases in 40% in 1 week and 65% in 2 weeks. Drug regimens that do not include INH do not render the patient non infectious as rapidly. Operational implications regarding infectiousness should be modified depending upon living and working conditions.
Under standard conditions and humidity, 60% survive 3 hours and 30% survive 9 hours Rate of TB:. 15/1000 close contacts. 3/1000 - close contacts Control:. BCG reduces the growth of organisms in macrophages.
In low incidence areas-endogeneous infection—Rx LTB. In high incidence areas—exogeneous infection-TB control measures PPD test:. 48-72 hours –1 week. Plant Day 0; if not read in 7 days, replant 48-72 hours later.
Booster/2 step 0 2 weeks result -+ + Booster Reaction, not conversion + + Positive. Except in children, the size of the PPD TST (tuberculin skin test) reaction bears no relationship to the likelihood of active TB. BCG induced reactions are smaller and tend to wane more quickly than reactions caused by naturally occurring infections.
History of BCG generally ignored in the US LTB: Treatment (Chemoprophylaxis). 80% reduction in incidence of active TB. 50% less per year. Overall 60% reduction PULM TB. 35-80% of patients have fever. 11% have hyponatremia. Single early morning specimens have higher yield and lower rate of contamination than pooled specimens.
Increase in yield between 3-5 specimens is low. Drug resistant mutants: ETH 10x4; INH/SM 10x6;RIF 10x8.
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8-16% delinquent rates in 6 month DOT. INH induced hepatitis: 10/1000 ( 0.1-0.3-3%). Retrobulbar neuritis with ETH: 15% with 50mg/kg; 1-5% with 25mg/kg.
It’s been nearly four years since Apple refreshed the diminutive s hardware, but the Cupertino company finally updated the old-in-the-tooth PC’s hardware at its “More in the Making” event at Brooklyn’s Academy of Music this morning. The new features a familiar rectangular design (with the same size 7.7 x 1.4 x 7.7-inch, 2.9-pound enclosure), but in a space gray finish. It has Intel’s 8th generation processors — in 4- and 6-core i7, i5, and i3 flavors — and 60 percent faster graphics. The processor’s paired with up to 64GB of DDR4 SO-DIMM RAM (8GB comes standard) at 2666MHz and up to 2TB of SSD storage — double the capacity of previous Mac Minis. Overall, it’s up to 5 times faster than the previous-gen models, Apple claims, and can drive 4K and 5K Thunderbolt displays and output in three formats — HDMI, VGA, and DVI. In terms of ports, there’s plenty to go around: two USB-A, HDMI 2.0 video (up to 4K at 60 frames per second), four Thunderbolt USB-C, a 3.5mm audio out port, and a Gigabit Ethernet port (you can add up to 10 Gigabit Ethernet, if you so choose).
And on the wireless side of the equation, the new Mac Mini sports Bluetooth 5.0 and 802.11a/b/g/n/ac Wi-Fi. Also onboard is Apple’s T2 chip. It’s 64-bit ARMv8 silicon — a variant of Apple’s A10 — that runs Apple’s custom BridgeOS 2.0 operating system (an Apple WatchOS derivative).
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Principally, it provides a secure enclave for encrypted keys, handles system functions like the camera and audio control, and facilitates on-the-fly encryption and description for the onboard SSD. Additionally, it delivers HEVC video transcoding that’s 30 times faster.
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Last, but not least, the Mac Mini’s enclosure is made from 100 percent recycled aluminum and 60 percent post-consumer recycled plastic, which Apple says help reduce its carbon footprint by nearly 50 percent. The new Mac Mini starts at $799, which nets you a 3.6Ghz (with Turbo Boost Speeds up to 4.6GHz) quad-core Core i3 processor with Intel UHD Graphics 630 and 128GB of PCIe-based SSD storage. $1,099 gets you a 3GHz Core i5 processor (with Turbo Boost Speeds up to 4.1GHz) and 256GB of SSD storage. They’re available for preorder today, and hit stores on November 7. Upgrades don’t come cheap. 16GB of RAM costs an extra $200, while 32GB and 64GB run $600 and $1,400, respectively. Extra storage is just as expensive — for 1TB, you’ll have to shell out $800, or $1,600 if you opt for 2TB.
And the 10 Gigabit Ethernet switch is an added $100. The last-gen version, by comparison, debuted in three models, starting at $499, $699, and $999.
A brief history of the Mac Mini The Mac Mini’s upgrades were long overdue. The 2014 Mac Mini models, if you’ll recall, had dual-core i5 Haswell processors (the i5-4308U on the high end) clocked up to 2.8GHz (with turbo-boosting up to 3.3GHz) with Intel Iris Graphics 5100. The priciest model packed 8GB of 1600 MHz DDR3 soldered onto the board and up to a 1TB Fusion Drive. And in terms of connectivity, it supported Wi-Fi 802.11ac and Thunderbolt (with 2 ports). The storied “headless” Mac’s origins can be traced back to January 2005, when it was announced alongside the iPod shuffle at the Macworld Conference and Expo. It was described at the time by then-CEO Steve Jobs as “the cheapest, most affordable Mac ever.” It was originally positioned as a budget PC — an affordable answer to the high-end Macintosh lineup.
That was in part because of its heat constraints, which necessitated the use of low-power laptop components and low-profile hard drives and DIMMs. October 2009 saw the introduction of a new, smaller Mac Mini model with a second hard drive in place of an optical drive; it was marketed as an affordable server for small businesses and schools. And in June 2010, Apple took the wraps off a thinner, aluminum-clad SKU with a removable case and upgraded hardware, including an HDMI port and Nvidia GeForce graphics. Subsequently, the Mac Mini gained a Thunderbolt port, an Intel Core i5 processor (and quad-core Core i7 in the server model), integrated graphics, and an optional AMD Radeon graphics chip. The last Mac Mini update before today’s announcement was in October 2014 and brought Haswell processors, upgraded graphics, a $100 price cut, and non-upgradeable memory.
It’s a bit hard to believe now, but the original Mac Mini — which was made of aluminum capped with polycarbonate plastic on the top and bottom — measured 2.0 x 6.5 x 6.5 inches, had no visible screws, and was rated at just 110W on the high end. The slimmer 2010 model shrunk to a height of 1.4 inches, but was slightly wider at 7.7 inches and rose in weight from 2.9 pounds to 3.0 pounds. It traded an external power supply for an internal one (and ditched the polycarbonate plastic on the top and bottom). And the 2017 model — the lightest of all — still weighed a whopping 2.7 pounds. The Mac Mini became incredibly popular for home theater use cases, despite its lack of an integrated TV tuner card. Its IR receiver — and OS X’s Front Row, since discontinued — made it something of a plug-and-play entertainment PC. The 2014 model supported resolutions up to 2560 x 1600 via the Mini DisplayPort — short of 4K, but well in excess of 1080p.
The Mac Mini server, which initially came preloaded with OS X Server, and later the standard version of OS X (as well as a separate OS X Server Package containing apps like Serve App, File Sharing, Wiki Server, and Profile Manager), was discontinued in 2014. Apple said that over half of Mac buyers are new to Mac, and 76 percent of them are in China. The company also announced it has reached a new milestone:.