An Experimental Model of Heat Storage in Working Firefighters

Objective. Develop experimental models to study uncompensable heat stress (UCHS) in working firefighters (FFs). Methods. FFs ingested core temperature (Tc) capsules prior to performing sequential tasks in 40°C andpersonal protective ensemble (PPE), or 18°C andno PPE. Both trials were conducted in an environmental chamber with FFs using self-contained breathing apparatus (SCBA). Results. FFs exercising in heat andPPE reproduced UCHS conditions. For every FF in both trials for whom the capsules worked, Tc was elevated, andTc_max occurred after completion of study protocol. Trials with PPE resulted in a mean maximum temperature of 38.94°C (± 0.37°C); Tc_max reached 40.4°C. Without PPE, maximum Tc averaged 37.79°C (± 0.07°C). Heat storage values ranged from 131 to 1205 kJ, averaging 578 kJ (± 151.47kJ) with PPE and210.83 kJ (± 21.77kJ) without PPE. Conclusions. An experimental model has been developed that simulates the initial phases of an interior fire attack to study the physiology of UCHS in FF. The hot environment andPPE increase maximum Tc andheat storage over that due to the exertion required to perform the tasks andmay decrease time to volitional fatigue. This model will permit controlled studies to optimize work-rest cycles, rehab conditions, andphysical conditioning of FFs.     

Development and use of a prehospital-oriented ems computer bulletin board service

Objective. To describe a Level 1 trauma center's response to the need for centralized information for EMS providers by implementing a computer bulletin board service (BBS). This service permits rapid retrieval of continuing education and reference information as well as an electronic forum for EMS-related issues. Methods. A desktop computer with a modem supporting 14.4 kbps running Remote Access v2.01 is accessed by both local and toll-free telephone numbers. Users may connect using any personal computer or terminal equipped with a modem as no proprietary formats are used. The service is available 24 hours a day, free of charge, and requires users to register online. Results. The first 41 months of experience has seen 9,592 calls answered by the BBS. 1,372 users, who may be individuals or groups, have registered on the service. Usage occurs in every county in the sponsor's state. In one sample period, 49% of the activity was educationally related, followed by discussion forums (26%). The BBS is used most heavily in the afternoon and evening hours. Conclusions. A prehospital-oriented EMS BBS has seen increasing utilization in its first 41 months of existence. It has rapidly established itself as a statewide mainstay of EMS information while being inexpensive to develop and maintain. It provides focused service to a target audience and is easily accessible. The development of similar local resources elsewhere is encouraged.     

Pharmacokinetics,Safety, and Tolerability of GS-9851, a Nucleotide Analog Polymerase Inhibitor for Hepatitis C Virus,following Single Ascending Doses in Healthy Subjects

To investigate the pharmacokinetics, safety, and tolerability of GS-9851 (formerly PSI-7851), a new nucleotide analog inhibitor of hepatitis C virus (HCV), we conducted a double-blind, parallel, placebo-controlled, randomized, single-ascending-dose study. Healthy subjects received oral doses of 25 to 800 mg GS-9851. Peak concentrations of GS-9851 in plasma were achieved more rapidly than those of the metabolites GS-566500 (formerly PSI-352707) and GS-331007 (formerly PSI-6206), with time to maximum concentration of drug in plasma (t_max) values of 1.0 to 1.8 h, 1.5 to 3.0 h, and 3.0 to 6.0 h, respectively. The majority of systemic drug exposure was from the nucleoside GS-331007, with maximum concentration of drug in plasma (C_max) and area under the concentration-time curve to the last measurable concentration (AUC_0–t) values at least 7- and 41-fold higher, respectively, than those obtained for GS-9851 after adjusting for differences in molecular weight. The terminal elimination half-life (t_1/2) of GS-331007 increased with the dose, achieving a t_1/2 of 25.7 h at 800 mg GS-9851. Dose proportionality was not observed for GS-331007. The majority of drug recovered in urine was in the form of GS-331007, with the percentage of this metabolite in urine samples ranging from 57% to 27% with increasing dose. GS-9851 was generally well tolerated, with no maximum tolerated dose identified. In conclusion, GS-9851 and its metabolites demonstrated a favorable pharmacokinetic profile consistent with once-daily dosing, and therefore, further clinical studies evaluating GS-9851 in HCV-infected patients are warranted.     

A case of disseminated blastomycosis in Vermont

Blastomyces dermatitides is increasingly found in Canada along the St. Lawrence River. However, there are only rare reports of this disease in New England. We describe a case of disseminated blastomycosis in a patient from northern Vermont who acquired the fungus while gardening.