A minimum cardiorespiratory fitness standard was derived for firefighters following a metabolic demands analysis. Design and minimal acceptable performance of generic firefighting task simulations (i.e. hose running, casualty evacuation, stair climb, equipment carry, wild-land fire) were endorsed by a panel of operationally experienced experts. Sixty-two UK firefighters completed these tasks wearing a standard protective firefighting ensemble while being monitored for peak steady-state metabolic demand and cardiovascular strain. Four tasks, endorsed as valid operational simulations by ≥90% of participants (excluding wild-land fire; 84%), were deemed to be a sufficiently valid and reliable basis for a fitness standard. These tasks elicited an average peak steady-state metabolic cost of 38.1 ± 7.8 ml kg min. It is estimated that healthy adults can sustain the total duration of these tasks (~16 min) at ≤90% maximum oxygen uptake and a cardiorespiratory fitness standard of ≥42.3 ml kg min would be required to sustain work. Practitioner Summary: A cardiorespiratory fitness standard for firefighters of ≥42.3 ml kg min was derived from monitoring minimum acceptable performance of essential tasks. This study supports the implementation of a routine assessment of this fitness standard for all UK operational firefighters, to ensure safe physical preparedness for occupational performance.
The first beta-lactamase was identified in an isolate of Escherichia coli in 1940. To date, there are >130 TEM-type and >50 sulfhydryl variable (SHV)-type beta-lactamases, mainly in E. coli, Klebsiella pneumoniae, and Proteus mirabilis but also in other members of the Enterobacteriaceae family and in some nonenteric organisms, such as Acinetobacter species. The incidence of expanded-spectrum beta-lactamases (ESBLs) varies, depending on which area of the globe the isolates originate from. ESBLs render the oxyimino-cephalosporins ineffective, and ESBL-producing organisms frequently also possess resistance factors to other classes of antibiotics, such as aminoglycosides and fluoroquinolones, and possibly also piperacillin-tazobactam and cefepime. These results suggest that microbiology laboratories should routinely test for the presence of these strains among their isolates and that the antibiotics of choice for infections believed to be caused by these types of organisms are the carbapenems.
Collaboration between networks presents opportunities to increase analytical power and cross-validate findings. Multivariate analyses of 2 large, international datasets (MYSTIC and SENTRY) from the Global Advisory on Antibiotic Resistance Data program explored temporal, geographic, and demographic trends in Escherichia coli resistance from 1997 to 2001. Elevated rates of nonsusceptibility were seen in Latin America, southern Europe, and the western Pacific, and lower rates were seen in North America. For most antimicrobial drugs considered, nonsusceptibility was higher in isolates from men, older patients, and intensive care unit patients. Nonsusceptibility to ciprofloxacin was higher in younger patients, rose with time, and was not associated with intensive care unit status. In univariate analyses, estimates of nonsusceptibility from MYSTIC were consistently higher than those from SENTRY, but these differences disappeared in multivariate analyses, which supports the epidemiologic relevance of findings from the 2 programs, despite differences in surveillance strategies.
Background Tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral ribonucleic acid (RNA), using reverse transcription polymerase chain reaction (RT-PCR) are pivotal to detecting current coronavirus disease (COVID-19) and duration of detectable virus indicating potential for infectivity. Methods We conducted an individual participant data (IPD) systematic review of longitudinal studies of RT-PCR test results in symptomatic SARS-CoV-2. We searched PubMed, LitCOVID, medRxiv and COVID-19 Living Evidence databases. We assessed risk of bias using a QUADAS-2 adaptation. Outcomes were the percentage of positive test results by time and the duration of detectable virus, by anatomical sampling sites. Findings Of 5078 studies screened, we included 32 studies with 1023 SARS-CoV-2 infected participants and 1619 test results, from -6 to 66 days post-symptom onset and hospitalisation. The highest percentage virus detection was from nasopharyngeal sampling between 0 to 4 days post-symptom onset at 89% (95% confidence interval (CI) 83 to 93) dropping to 54% (95% CI 47 to 61) after 10 to 14 days. On average, duration of detectable virus was longer with lower respiratory tract (LRT) sampling than upper respiratory tract (URT). Duration of faecal and respiratory tract virus detection varied greatly within individual participants. In some participants, virus was still detectable at 46 days post-symptom onset. Interpretation RT-PCR misses detection of people with SARS-CoV-2 infection; early sampling minimises false negative diagnoses. Beyond ten days post-symptom onset, lower RT or faecal testing may be preferred sampling sites. The included studies are open to substantial risk of bias so the positivity rates are probably overestimated.
SM-7338, a new carbapenem antibiotic, was demonstrated to have potent antibacterial activity against a broad spectrum of aerobes, including Staphylococcus aureus, beta-hemolytic streptococci, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria spp., members of the family Enterobacternaceae, Pseudomonas spp., and gram-positive and gram-negative anaerobes in a collection of 1,102 unselected clinical isolates. At a concentration of 0.5 ,Lg/ml, SM-7338 inhibited 90% of these strains. The spectkrum of activity of ceftazidiine and cefotaxime was more limited, and many of the Enterobacteriaceae and Pseudomonas spp. were resistant to these agentsv, piperacillin, or gentamncin. A collection of ofloxacin-resistant strains was inhibited by or imipenem at 4 ,ug/ml. SM-7338 was more active than metronidazole and clindamycin against anaerobes. Of the carbapenems, inipenem had greater activity against staphylococci, but SM-7338 was much more active against Haemophius, BranhameUa, and Neisseria spp. and all genera of Enterobacteriaceae tested. The MIC of SM-7338 for 90% of these strains ranged from <0.008 to 0.13 ,ug/ml. When tested against 124 strains of Pseudomonas aeruginosa, SM-7338 inhibited 76% at 0.5 ,ug/ml but imipenem inhibited only 15% at this concentration. Both carbapenems exhibited similar activities against Bacteroides spp., but SM-7338 was more active than hinipenem against Clostridium spp. The MBC of SM-7338 was most commonly the same as or twice the MIC. SM-7338 and imipenem showed excellent activities against bacteria elaborating chromosome-or plasmid-mediated ,B-lactamases, including those conferring resistance to broad-spectrum cephalosporins. The activity of SM-7338 was generally unaffected by the culture nmedium used, pH, 25% human serum, and inoculum size, but the susceptibility of Xanthomonas maltophilia was medium dependent.
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