Cystic fibrosis: Infection prevention & control recommendations for universities, colleges and institutes of further and higher education - A practical guide.

BACKGROUND: The avoidance of cross-infection remains of critical importance to prevent the transmission of cystic fibrosis (CF)-related microbial pathogens to persons/people with cystic fibrosis (PwCF). To date, there has been a paucity of infection prevention and control (IPC) guidance relating to infection risk at higher educational institutions. With improvements in treatments, more PwCF are now attending universities/colleges and educational institutions now seek CF-specific guidance on IPC from clinical CF teams/centres. METHODS: Real world infection-related questions from university students, educators, university support staff and the CF multidisciplinary team were received and collated from various stakeholders, including individual consultations and focus group sessions with two local universities. Subsequently, evidence-based recommendations were compiled from existing peer-reviewed literature and from cystic fibrosis organisations. Glossaries were constructed relating to clinical, microbiological and educational/pedagogical terminology to aid with the understanding amongst these stakeholder groups. RESULTS: This review addresses CF-related IPC recommendations across five areas of university/college life, including (i) on campus estate, (ii) teaching (lectures/tutorials/small study group work/group assignments), (iii) laboratory practicals, (iv) field trips/study visits/work placements and (v) residential accommodation and lists practical recommendations to help prevent the transmission of infections to PwCF students. CONCLUSIONS: It is important that the educational institutional environment is safe permitting the PwCF student to enjoy their educational experience and journey through higher education, culminating in achievement of their educational goals, employment and independent living. The guidance presented in this review is intended to equip educational establishments in creating their own bespoke and robust IPC policies relating to PwCF students.

Nebulizer Cleaning Practices and Adherence to Nebulized Therapies in People With Cystic Fibrosis When Traveling.

BACKGROUND: Nebulized therapies form an important component of treatment in people with cystic fibrosis (CF). It is important for people with CF to continue to take their nebulized medications when traveling. METHODS: A self-completing anonymous questionnaire was developed, as part of a quality improvement project, to support people with CF educational needs when traveling. The questionnaire was prepared to gain an insight into (1) adherence to nebulized therapies when traveling and (2) nebulizer cleaning and disinfection practices while traveling. Polar questions (yes/no response) were mainly employed as well as free text and closed questions. RESULTS: There were 68 respondents to the survey, including 31 males, 33 females, and 4 respondents who did not enter their sex. Respondents who declared their age (n = 63) ranged from 17-71 y (median = 30 y; with 94% of respondents in age range 20-39 y). When traveling, 38% (25/66) of respondents indicated that nebulized therapy was not performed during travel. The most common method of nebulizer maintenance while traveling was washing with soap and water (43%), followed by boiling water (18%), as well as the employment of 5 other methods of nebulizer maintenance. Some respondents (2%) indicated that they did not perform any method of nebulizer maintenance while traveling until they returned home. CONCLUSIONS: This study identified that nebulizer care and hygiene are less than optimal when traveling as well as identifying a worrying trend of taking a "nebulizer vacation." People with CF need to be aware of risks to their health in being nonadherent with their nebulized medication(s) while traveling as well as risks of acquiring a new pathogen through suboptimal cleaning/disinfection/drying management of their nebulizer. CF multidisciplinary teams should emphasize the importance of sustaining nebulized treatments when traveling and practicing effective nebulizer washing, disinfection, and drying procedures.

The virtual CF clinic: Implications for sputum microbiology.

The COVID19 pandemic has shifted the paradigm of how outpatient clinics are delivered within CF care, resulting in a significant reduction of patient visits to CF centres. One consequence of this has been a reduction in the number of sputa/cough swabs that patients submit for routine analysis. This report examines why it is important to maintain optimal sputum microbiology and explores (i). the microbiological efficiency of postal submission of sputum specimens from the community and (ii) the regulatory conditions that must be met through postal submission of respiratory specimens. Virtual clinics have now been established within CF care and it is incumbent on each speciality within the CF MDT to explore ways to nurture and support their individual contribution to the success of the virtual clinic. Within microbiology, adopting innovative approaches to sputum collection in the community and transportation via postal services will allow for continued microbiological vigilance thereby supporting patient safety.

Nebuliser hygiene in cystic fibrosis: evidence-based recommendations.

Nebulised therapies are extensively used in the daily therapeutic management of cystic fibrosis both for mucociliary clearance and for the management of chronic infections. Extensive developments have been made in relation to nebulised drug delivery mechanisms and drug formulations, and guidelines have been prepared that have addressed the appropriate use of such therapies. However, due to these developments, a plethora of nebuliser devices and drug chambers exist, and frequently, the limited guidance provided in relation to nebuliser hygiene is to follow manufacturers' instructions. Such instructions are inconsistent and at times confusing, translating to an increase in the burden associated with nebuliser maintenance. An evidence-based universal guideline relating to nebuliser care and hygiene is urgently required that is applicable to both at-home use and inpatient use. This article reviews the scientific literature in order to propose an evidence-based approach to nebuliser hygiene to ensure optimum drug delivery, and infection prevention and control. EDUCATIONAL AIMS: To understand the reasons why nebuliser hygiene is important.To give an overview of the current nebuliser care instructions that have been described by manufacturers, societies and the scientific literature.To outline the current nebuliser hygiene practices used by persons with cystic fibrosis in the home and hospital settings.To highlight areas that need further evaluation to promote optimum nebuliser care.To establish an evidence-based guideline for nebuliser hygiene in relation to cystic fibrosis.

Diaton tonometry: an assessment of validity and preference against Goldmann tonometry.

BACKGROUND: To assess agreement between the Diaton, a new transpalpebral tonometer, and Goldmann applanation tonometry, the accepted gold standard. DESIGN: Comparative study of two devices in a hospital setting. PARTICIPANTS: Two hundred and fifty-one patients attending the eye casualty and general ophthalmology clinics at St James' University Hospital, Leeds between February and December 2009. METHODS: Intraocular pressure was measured using Goldmann applanation tonometry and Diaton tonometry by one examining ophthalmologist. Patient preference for either technique was also recorded. MAIN OUTCOME MEASURES: Intraocular pressure measured by Diaton was compared with intraocular pressure measured by Goldmann applanation tonometry. Limits of agreement were determined using the Bland-Altman method. RESULTS: Two hundred and fifty right eyes underwent both Goldmann applanation tonometry and Diaton tonometry. Mean intraocular pressure was 13.8 ± 3.6 mmHg using Goldmann applanation tonometry and 13.2 ± 4.3 mmHg using Diaton tonometry. Upper and lower limits of agreement were +8.4 mmHg and -9.6 mmHg, respectively. Order of intraocular pressure measurement and positioning did not influence limits of agreement in a clinically significant manner. Overall, more patients expressed preference for Diaton tonometry (40.2%) than Goldmann applanation tonometry (30.3%). Those aged 50 or less were more likely to prefer Diaton tonometry. CONCLUSIONS: The Diaton tonometer is portable, lightweight, user-friendly and well tolerated by patients. However, it shows poor agreement with Goldmann applanation tonometry, thereby precluding it from being regarded as a substitute in routine clinical practice.

Evaluation of the Bruker SMART X2S: crystallography for the nonspecialist?

An evaluation of the Bruker SMART X2S for the collection of crystallographic diffraction data, structure solution and refinement is carried out with a variety of materials with different electron densities, presenting some of the successes and challenges of automation in chemical crystallography.

Regulation of the gibberellin pathway by auxin and DELLA proteins.

The synthesis and deactivation of bioactive gibberellins (GA) are regulated by auxin and by GA signalling. The effect of GA on its own pathway is mediated by DELLA proteins. Like auxin, the DELLAs promote GA synthesis and inhibit its deactivation. Here, we investigate the relationships between auxin and DELLA regulation of the GA pathway in stems, using a pea double mutant that is deficient in DELLA proteins. In general terms our results demonstrate that auxin and DELLAs independently regulate the GA pathway, contrary to some previous suggestions. The extent to which DELLA regulation was able to counteract the effects of auxin regulation varied from gene to gene. For Mendel's LE gene (PsGA3ox1) no counteraction was observed. However, for another synthesis gene, a GA 20-oxidase, the effect of auxin was weak and in WT plants appeared to be completely over-ridden by DELLA regulation. For a key GA deactivation (2-oxidase) gene, PsGA2ox1, the up-regulation induced by auxin deficiency was reduced to some extent by DELLA regulation. A second pea 2-oxidase gene, PsGA2ox2, was up-regulated by auxin, in a DELLA-independent manner. In Arabidopsis also, one 2-oxidase gene was down-regulated by auxin while another was up-regulated. Monitoring the metabolism pattern of GA(20) showed that in Arabidopsis, as in pea, auxin can promote the accumulation of bioactive GA.

Auxin regulation of the gibberellin pathway in pea.

The auxin indole-3-acetic acid (IAA) has been shown to promote the biosynthesis of the active gibberellin (GA(1)) in shoots of pea (Pisum sativum). We used northern analysis to investigate the timing of IAA-induced changes in transcript levels of PsGA3ox1 (Mendel's LE), PsGA2ox1, PsGA2ox2, and PsGA20ox1, key genes for the later stages of GA(1) biosynthesis and metabolism in pea. Rapid (2-4 h) changes occurred in the transcript levels of PsGA3ox1, PsGA2ox1, and PsGA2ox2 after treatment with IAA. [(14)C]GA(1) metabolism studies in decapitated shoots indicated that IAA inhibits GA(1) deactivation, consistent with the suppression of PsGA2ox1 (SLN) transcript levels by IAA. Studies with the sln mutant also indicated that PsGA2ox1 activity is involved in GA(1) deactivation in decapitated shoots. Culture of excised internode tissue in the presence of auxin clearly demonstrated that internode tissue is a site of GA(1) biosynthesis per se. Excised internode tissue cultured in the presence/absence of cycloheximide showed that de novo protein synthesis is required for IAA-induced increases in PsGA3ox1 transcript levels. Auxin dose response studies indicated that IAA concentration is a critical determinant of GA(1) biosynthesis over 1 to 2 orders of magnitude, and a range of auxins was shown to affect the GA pathway.

Control of gibberellin levels and gene expression during de-etiolation in pea.

Gibberellin A(1) (GA(1)) levels drop significantly in wild-type pea (Pisum sativum) plants within 4 h of exposure to red, blue, or far-red light. This response is controlled by phytochrome A (phyA) (and not phyB) and a blue light receptor. GA(8) levels are increased in response to 4 h of red light, whereas the levels of GA(19), GA(20), and GA(29) do not vary substantially. Red light appears to control GA(1) levels by down-regulating the expression of Mendel's LE (PsGA3ox1) gene that controls the conversion of GA(20) to GA(1), and by up-regulating PsGA2ox2, which codes for a GA 2-oxidase that converts GA(1) to GA(8). This occurs within 0.5 to 1 h of exposure to red light. Similar responses occur in blue light. The major GA 20-oxidase gene expressed in shoots, PsGA20ox1, does not show substantial light regulation, but does show up-regulation after 4 h of red light, probably as a result of feedback regulation. Expression of PsGA3ox1 shows a similar feedback response, whereas PsGA2ox2 shows a feed-forward response. These results add to our understanding of how light reduces shoot elongation during de-etiolation.

Auxin-Gibberellin Interactions and Their Role in Plant Growth.

Recently it was discovered that auxin promotes gibberellin (GA) biosynthesis in decapitated stems of pea (Pisum sativum L.) and tobacco (Nicotiana tabacum L.), and here we review the evidence for this interaction. We also discuss the possible relationship between auxin and the mechanisms by which bioactive GAs (such as GA1) regulate their own levels, and the implications of the auxin-GA interaction for the control of plant growth. It is now possible to envisage auxin as a messenger linking the apical bud with the biosynthesis of active GAs in the expanding internodes. Finally, new evidence is presented that the promotion of growth by GA1 does not depend on GA1-induced increases in auxin content.