What Factors Predict Upper Body Push to Pull Ratios in Professional Firefighters?

International Journal of Exercise Science 13(4): 1605-1614, 2020. Shoulder joint injuries are common for professional firefighters. A potential cause of shoulder injury is an imbalance between anterior (push) and posterior (pull) shoulder joint musculature. Understanding what contributes to these imbalances may help to identify areas needing improvement. The purpose of this study was to investigate different push to pull (P2P) ratios and the relationships among common upper body fitness assessments, body composition, and push to pull (P2P) ratios in firefighters. Thirty-three professional firefighters completed the following testing protocol: one-repetition maximum (1RM) bench press, pull-up repetitions to failure, push-up repetitions to failure, and a body composition assessment. The endurance P2P (eP2P) was computed by dividing the number of push-up by pull-up repetitions, while strength P2P (sP2P) was the relative 1RM divided by pull-up repetitions. Bivariate relationships among variables were assessed with correlation coefficients and linear regression assessed association between eP2P and sP2P (p ≤ 0.05). The sP2P and eP2P were not associated (R2 = 0.032, p = 0.99). Strength P2P was related with bench press 1RM (r = 0.80) and push-ups (r = 0.40). Endurance P2P was related with pull-up repetitions (r = -0.62), body fat percentage (r = 0.40), and fat mass index (r = 0.34). The results of the present study suggest sP2P and eP2P ratios should not be used interchangeably. To improve sP2P and eP2P for firefighters, it is recommended to improve the strength of anterior and posterior upper body musculature, respectively, and reduce total body fat mass

The NOTES Approach to Management of Urinary Bladder Injury

This blinded feasibility study shows that urinary bladder injury occurring during NOTES can be successfully managed via a NOTES approach using currently available endoscopic accessories

Impact of the shedding level on transmission of persistent infections in Mycobacterium avium subspecies paratuberculosis (MAP)

Super-shedders are infectious individuals that contribute a disproportionate amount of infectious pathogen load to the environment. A super-shedder host may produce up to 10 000 times more pathogens than other infectious hosts. Super-shedders have been reported for multiple human and animal diseases. If their contribution to infection dynamics was linear to the pathogen load, they would dominate infection dynamics. We here focus on quantifying the effect of super-shedders on the spread of infection in natural environments to test if such an effect actually occurs in Mycobacterium avium subspecies paratuberculosis (MAP). We study a case where the infection dynamics and the bacterial load shed by each host at every point in time are known. Using a maximum likelihood approach, we estimate the parameters of a model with multiple transmission routes, including direct contact, indirect contact and a background infection risk. We use longitudinal data from persistent infections (MAP), where infectious individuals have a wide distribution of infectious loads, ranging upward of three orders of magnitude. We show based on these parameters that the effect of super-shedders for MAP is limited and that the effect of the individual bacterial load is limited and the relationship between bacterial load and the infectiousness is highly concave. A 1000-fold increase in the bacterial contribution is equivalent to up to a 2–3 fold increase in infectiousness.https://doi.org/10.1186/s13567-016-0323-

Colonoscopic polypectomy and associated techniques

Polypectomy of colonic polyps has been shown to reduce the risk of colon cancer development and is considered a fundamental skill for all endoscopists who perform colonoscopy. A variety of polypectomy techniques and devices are available, and their use can vary greatly based on local availability and preferences. In general, cold forceps and cold snare have been the polypectomy methods of choice for smaller polyps, and hot snare has been the method of choice for larger polyps. The use of hot forceps has mostly fallen out of favor. Polypectomy for difficult to remove polyps may require the use of special devices and advanced techniques and has continued to evolve. As a result, the vast majority of polyps today can be removed endoscopically. Since electrocautery is frequently used for polypectomy, endoscopists should be thoroughly familiar with the basic principles of electrosurgery as it pertains to polypectomy. Tattooing of a polypectomy site is an important adjunct to polypectomy and can greatly facilitate future surgery or endoscopic surveillance. The two most common post-polypectomy complications are bleeding and perforation. Their incidence can be decreased with the use of meticulous polypectomy techniques and the application of some prophylactic maneuvers. This review will examine the technique of polypectomy and its complications from the perspective of the practicing gastroenterologist

EFFECTS OF IMPLEMENTING A CONSEQUENTIAL ANNUAL FITNESS ASSESSMENT IN A LARGE COUNTY FIRE DEPARTMENT

Michael Toczko1, Robert Lockie2, Megan Sax van der Weyden1, Marcie Fyock-Martin1, Joel Martin1. 1George Mason University, Manassas, VA. 2California State University, Fullerton, CA. INTRODUCTION: To become a firefighter (FF) individuals must pass physically demanding exams, which assess ability to perform job tasks prior to entering a training academy. Despite the importance of health and fitness for FF only about 30% of US fire departments have health and wellness programs. Recently, a fire department in the US implemented mandatory annual fitness testing with punitive consequences for substandard performance. The purpose of the study is to report the effects of implementing a consequential fitness assessment (FA) within a fire department. METHODS: Retrospective data was provided from 1364 professional FF (Males:88%, Females: 12%, age: 40.0±8.8 yrs, years of service: 11.9±6.8 yrs) from 2019, 2020 and 2021. The FA consisted of maximum pull-ups (PL), maximum curl-ups (CU) within 60 seconds, maximum push-ups (PS) within 60 seconds, and 3-minute step test (ST) to estimate peak oxygen consumption. To examine the effect of exam year (EY) on fitness outcomes (FO) analyses of covariance (ANCOVA) were conducted while controlling for age and sex. Tukey’s Post-hoc Test were used to determine any significance differences between exam year (p\u3c0.05). RESULTS: The sample size for 2019, 2020, and 2021 were 1013, 777, and 1084 , respectively. There were no significant differences between sex distribution and age by EY. The ANCOVA revealed there was a significant small effect of EY on FO (PL: F(2, 2848) = 5.92, p \u3c0.01, η2= 0.003; CU: F(2, 2848) = 17.57, p \u3c0.001, η2= 0.01; PS: (F(2, 2848) = 18.50, p \u3c0.001, η2= 0.01; ST: F(2, 2848) = 26.19, p \u3c0.001, η2= 0.02). FF performance in 2021 was significantly better on CU, PS, and ST compared to 2019 (p\u3c0.001). PL performance in 2021 was significantly better than 2020 (p\u3c0.01). FF performed significantly better on CU and ST in 2020 than 2019 (p\u3c0.01). CONCLUSION: The results suggest the implementation of a consequential FA may be a plausible method for FF to maintain sufficient fitness to meet occupational demands. Although there was a significant difference between FO by EY it is not evident whether the small FO changes lead to increased performance of occupational tasks. Future research should explore whether changes in fitness lead to improvements in ability to perform occupational tasks

PHYSICAL FITNESS IN FIREFIGHTERS DIFFERS ACROSS YEARS OF SERVICE

Kayleigh Newman1, Michael Toczko1, Jatin Ambegaonkar1, Anne Akagi2, Megan Sax van der Weyden1, Marcie Fyock-Martin1, Joel Martin1. 1George Mason University, Manassas, VA. 2Charleston Southern University, Charleston, SC. INTRODUCTION: Firefighters (FFs) require adequate fitness levels to safely perform their professional tasks. Accordingly, fire departments assess their physical fitness (PF) annually during the work performance test. In the general population, PF levels - specifically muscular and cardiovascular fitness - decline as one ages. However, due to the physical nature of the profession, this decline in PF may not be as prominent in FFs. Therefore our purpose was to investigate the effect of years of service (YOS) on FF PF levels. METHODS: We analyzed retrospective data from 1364 professional FF(M: 88%, age: 40+8.82 yrs, YOS: 11.98+6.87 yrs). PF assessments consisted of maximum pull-ups (PL), curl-ups completed in 60 s(CU), push-ups completed in 60 s (PS). The 3-minute step test (ST) was used to estimate peak oxygen consumption (VO2peak). Participants were separated in to 3 groups based on YOS, (0-10, 11-20, 20+ years). Separate Analyses of Variance (ANOVA) followed by Turkey’s Post-hoc Tests, as appropriate, examined differences in outcome measures between groups using R environment (R Core Team, Vienna, Austria) p\u3c0.05. RESULTS: PL, CU, and PS differed across groups of YOS (PL; F(2, 2852) = 70.3, p \u3c0.001, η2= 0.05), (CU; F(2, 2852) = 67.5, p \u3c0.001, η2= 0.05), (PS; (F(2, 2852) = 38.5, p \u3c0.001, η2= 0.03). FF with 0-10 YOS performed greater PL, CU, and PS than those with 11-20 (p\u3c0.05) and 20+ (p\u3c0.05). FF with 11-20 YOS performed more PL, CU, and PS than FF with 20+ YOS(p\u3c0.05). There was no significant effect for YOS (F(2, 2852) = 1.568, p =0.21, η2= 0.001) on VO2peak. CONCLUSION: The findings support prior observations that PF and ability to perform occupational duties are related in firefighters. Specifically, FF with greater YOS display declines in occupational tasks performance. Given the previously described decreases in PF with age in the literature, future researchers should examine whether YOS mediates relationships between age and PF in professional FF. The current evidence suggests that fire departments should consider YOS in addition to age when providing additional resources to support maintenance of PF in their FF

Evaluation of microbial culture of pooled fecal samples for detection of Mycobacterium avium subsp. paratuberculosis in large dairy herds

abstract: Objective - To evaluate the sensitivity of microbial culture of pooled faecal samples for detection of Mycobacterium avium subsp. paratuberculosis (MAP) in large dairy herds and assess the use of the method for estimation of MAP prevalence. Animals - 1,740 lactating cows from 29 dairy herds in California. Procedure - Serum from each cow was tested by use of a commercial ELISA kit. Individual faecal samples were cultured and used to create pooled faecal samples (10 randomly selected faecal samples/pool; 6 pooled samples/herd). Sensitivity of MAP detection was compared between Herrold's egg yolk (HEY) agar and a new liquid culture method. Bayesian methods were used to estimate true prevalence of MAP-infected cows and herd sensitivity. Results - Estimated sensitivity for pooled faecal samples among all herds was 0.69 (25 culture-positive pools/36 pools that were MAP positive). Sensitivity increased as the number of culture-positive samples in a pool increased. The HEY agar method detected more infected cows than the liquid culture method but had lower sensitivity for pooled faecal samples. Prevalence of MAP-infected cows was estimated to be 4% (95% probability interval, 2% to 6%) on the basis of culture of pooled faecal samples. Herd-level sensitivity estimate ranged from 90% to 100% and was dependent on prevalence in the population and the sensitivity for culture of pooled faecal samples. Conclusions and Clinical Relevance - Use of pooled faecal samples from 10 cows was a cost-effective tool for herd screening and may provide a good estimate of the percentage of MAP-infected cows in dairy herds with a low prevalence of MAP