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Background: People with cystic fibrosis (CF) are recommended to wear face-masks when in healthcare settings. We previously demonstrated that face-masks significantly reduce the release of Pseudomonas aeruginosa (P. aeruginosa) aerosols during coughing in adults with CF. There is a knowledge gap in relation to the impact of mask wear in children with CF. This study aimed to examine the tolerability and effectiveness in lowering emissions of hospital-grade surgical and one type of commercially available cotton face-mask in children with CF., Methods: Twenty children with CF and P. aeruginosa infection were recruited. Participants performed three cough manoeuvres in a validated cough aerosol system both with and without face-masks of differing wear time. Cough aerosols were sampled at two meters using an Andersen Cascade Impactor. Quantitative sputum and aerosol bacterial cultures were performed. Participants also rated the comfort levels of the face-masks., Results: P. aeruginosa was cultured from the sputum in eight participants (40 %). During uncovered coughing (reference manoeuvre), seven of the 20 participants produced aerosols containing bacterial pathogens. There was a reduction in aerosolised bacterial load during coughing with both surgical and cotton face-masks. The mean percent reduction in CFU with both types of face-masks was 82 % (95 % CI 56 - 108) during the immediate face-mask wear test compared to the uncovered cough test. Face-masks were generally well tolerated., Conclusions: Face-masks are well tolerated and effective in reducing cough-generated bacterial aerosols in children with CF., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The following authors, George Tay, Michelle Wood, Congrong He, Kim Smith, Emma Ballard, and Lidia Morawska; declare no specific conflicts of interest related to the current manuscript. Rebecca Stockwell has received funding from a CF Foundation grant and a Vertex Travel grant. Claire Wainwright has received honoraria paid to her institution for presentations, educational meetings, and data safety monitoring roles, as well as serving as Deputy Editor for Thorax, Associate Editor for Respirology, and on the International Advisory Board for Vertex Pharmaceuticals. Scott Bell has received grants from the Cystic Fibrosis Foundation (BELL14A0 and BELL19A0), the National Health and Medical Research Council (NHMRC) of Australia (APP1102494), and payments to his institution from Vertex Pharmaceuticals (2020–2022), and the Cystic Fibrosis Foundation (USA) in March 2023 for presentation, educational meetings and advisory boards as well as holding unpaid leadership, committee, and data safety monitoring roles., (Copyright © 2025 European Cystic Fibrosis Society. All rights reserved.)

Background: Mycobacterium abscessus (MABS) group are environmental organisms that can cause infection in people with cystic fibrosis (CF) and other suppurative lung diseases. There is potential for person-to-person airborne transmission of MABS among people with CF attending the same care centre. Ultraviolet light (band C, UV-C) is used for Mycobacterium tuberculosis control indoors; however, no studies have assessed UV-C for airborne MABS., Aim: To determine whether a range of UV-C doses increased the inactivation of airborne MABS, compared with no-UVC conditions., Methods: MABS was generated by a vibrating mesh nebulizer located within a 400 L rotating drum sampler, and then exposed to an array of 265 nm UV-C light-emitting diodes (LED). A six-stage Andersen Cascade Impactor was used to collect aerosols. Standard microbiological protocols were used for enumerating MABS, and these quantified the effectiveness of UV-C doses (in triplicate). UV-C effectiveness was estimated using the difference between inactivation with and without UV-C., Findings: Sixteen tests were performed, with UV-C doses ranging from 276 to 1104 μW s/cm 2 . Mean (±SD) UV-C effectiveness ranged from 47.1% (±13.4) to 83.6% (±3.3). UV-C led to significantly greater inactivation of MABS (all P-values ≤0.045) than natural decay at all doses assessed. Using an indoor model of the hospital environment, it was estimated that UV-C doses in the range studied here could be safely delivered in clinical settings where patients and staff are present., Conclusion: This study provides empirical in-vitro evidence that nebulized MABS are susceptible to UV-C inactivation., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Pseudomonas aeruginosa ( Pa ) is the predominant bacterial pathogen in people with cystic fibrosis (CF) and can be transmitted by airborne droplet nuclei. Little is known about the ability of ultraviolet band C (UV-C) irradiation to inactivate Pa at doses and conditions relevant to implementation in indoor clinical settings. We assessed the effectiveness of UV-C (265 nm) at up to seven doses on the decay of nebulized Pa aerosols (clonal Pa strain) under a range of experimental conditions. Experiments were done in a 400 L rotating sampling drum. A six-stage Andersen cascade impactor was used to collect aerosols inside the drum and the particle size distribution was characterized by an optical particle counter. UV-C effectiveness was characterized relative to control tests (no UV-C) of the natural decay of Pa . We performed 112 tests in total across all experimental conditions. The addition of UV-C significantly increased the inactivation of Pa compared with natural decay alone at all but one of the UV-C doses assessed. UV-C doses from 246-1968 µW s/cm 2 had an estimated effectiveness of approximately 50-90% for airborne Pa . The effectiveness of doses ≥984 µW s/cm 2 were not significantly different from each other ( p -values: 0.365 to ~1), consistent with a flattening of effectiveness at higher doses. Modelling showed that delivering the highest dose associated with significant improvement in effectiveness (984 µW s/cm 2 ) to the upper air of three clinical rooms would lead to lower room doses from 37-49% of the 8 h occupational limit. Our results suggest that UV-C can expedite the inactivation of nebulized airborne Pa under controlled conditions, at levels that can be delivered safely in occupied settings. These findings need corroboration, but UV-C may have potential applications in locations where people with CF congregate, coupled with other indoor and administrative infection control measures.

Background: Volunteer infection studies have become a standard model for evaluating drug efficacy against Plasmodium infections. Molecular techniques such as qPCR are used in these studies due to their ability to provide robust and accurate estimates of parasitaemia at increased sensitivity compared to microscopy. The validity and reliability of assays need to be ensured when used to evaluate the efficacy of candidate drugs in clinical trials., Methods: A previously described 18S rRNA gene qPCR assay for quantifying Plasmodium falciparum in blood samples was evaluated. Assay performance characteristics including analytical sensitivity, reportable range, precision, accuracy and specificity were assessed using experimental data and data compiled from phase 1 volunteer infection studies conducted between 2013 and 2019. Guidelines for validation of laboratory-developed molecular assays were followed., Results: The reportable range was 1.50 to 6.50 log 10 parasites/mL with a limit of detection of 2.045 log 10 parasites/mL of whole blood based on a parasite diluted standard series over this range. The assay was highly reproducible with minimal intra-assay (SD = 0.456 quantification cycle (C q ) units [0.137 log 10 parasites/mL] over 21 replicates) and inter-assay (SD = 0.604 C q units [0.182 log 10 parasites/mL] over 786 qPCR runs) variability. Through an external quality assurance program, the QIMR assay was shown to generate accurate results (quantitative bias + 0.019 log 10 parasites/mL against nominal values). Specificity was 100% after assessing 164 parasite-free human blood samples., Conclusions: The 18S rRNA gene qPCR assay is specific and highly reproducible and can provide reliable and accurate parasite quantification. The assay is considered fit for use in evaluating drug efficacy in malaria clinical trials.

We aimed to describe the epidemiology, multi-drug resistance and seasonal distribution of bacteria cultured within 12 months following lower limb orthopaedic surgery in tropical and subtropical Australian hospitals between 2010 and 2017. We collected data from four tropical and two subtropical hospitals. Categorical variables were examined using the Pearson Chi-squared test or Fisher's Exact test, and continuous variables with the Student t-test or Mann-Whitney U test. A Poisson regression model was used to examine the relationship between season, weather and the incidence of Staphylococcus and nonfermentative species. We found that at tropical sites, nonfermenters ( Pseudomonas aeruginosa and Acinetobacter baumannii ) were more common (28.7% vs. 21.6%, p = 0.018), and patients were more likely to culture multi-drug-resistant (MDR) nonfermenters (11.4% vs. 1.3%, p = 0.009) and MDR Staphylococcus aureus (35.9% vs. 24.6%, p = 0.006). At tropical sites, patients were more likely to be younger (65.9 years vs. 72.0, p = < 0.001), male (57.7% vs. 47.8%, p = 0.005), having knee surgery (45.3% vs. 34.5%, p = 0.002) and undergoing primary procedures (85.0% vs. 73.0%, p = < 0.001). Species were similar between seasons in both tropical and subtropical hospitals. Overall, we found that following lower limb orthopaedic surgery in tropical compared with subtropical Australia, patients were more likely to culture nonfermenters and some MDR species.

Aims and Objectives: To extract, examine and report the highest available levels of evidence from healthcare disciplines in the use of simulation-based education as substitution for clinical placement in prelicensure programmes., Background: Simulation is widely employed across prelicensure health professional education to create safe, realistic clinical learning experiences for students. Whether simulation can be employed to substitute for actual clinical placement, and if so, in what proportion, replacement ratio and duration, is unclear., Methods: A systematic review and quality appraisal of primary studies related to prelicensure students in all health disciplines, guided by the PRISMA checklist., Results: Ten primary studies were included, representing 2,370 students from three health disciplines in four countries. Nine studies were experimental and quasi-experimental and methodological quality was assessed as moderate to high with good to very good inter-rater agreement. Direct substitution of simulation for clinical practice ranged from 5% to 50%. With one exception, replacement ratios were 1:1 and duration of replacement ranged from 21 hr-2 years. Levels of evaluation included measures of reaction, knowledge and behaviour transfer; no negative outcomes were reported. We appraised practicalities for design of substitution, design limitations and knowledge transfer to accreditation standards for prelicensure programmes., Conclusions: This review synthesised highest levels and quality of available evidence for substitution of simulation for clinical placement in health professional education. Included studies were heterogenous in simulation interventions (proportion, ratio and duration) and in the evaluation of outcomes. Future studies should incorporate standardised simulation curricula, widen the health professions represented and strengthen experimental designs., Relevance to Clinical Practice: Current evidence for clinical educational preparation does not appear to be translated into programme accreditation standards governing clinical practice experience for prelicensure programmes in relevant jurisdictions. Overall, a stronger evidence base is necessary to inform future curricula and policy development, to strengthen clinical practice in health., (© 2019 John Wiley & Sons Ltd.)

Healthcare-acquired infections (HAIs) continue to persist in hospitals, despite the use of increasingly strict infection-control precautions. Opportunistic airborne transmission of potentially pathogenic bioaerosols may be one possible reason for this persistence. Therefore, this study aimed to systematically review the concentrations and compositions of indoor bioaerosols in different areas within hospitals and the effects of different ventilation systems. Electronic databases (Medline and Web of Science) were searched to identify articles of interest. The search was restricted to articles published from 2000 to 2017 in English. Aggregate data was used to examine the differences in mean colony forming units per cubic metre (cfu/m 3 ) between different hospital areas and ventilation types. A total of 36 journal articles met the eligibility criteria. The mean total bioaerosol concentrations in the different areas of the hospitals were highest in the inpatient facilities (77 cfu/m 3 , 95% confidence interval (CI): 55-108) compared with the restricted (13cfu/m 3 , 95% CI: 10-15) and public areas (14 cfu/m 3 , 95% CI: 10-19). Hospital areas with natural ventilation had the highest total bioaerosol concentrations (201 cfu/m 3 , 95% CI: 135-300) compared with areas using conventional mechanical ventilation systems (20 cfu/m 3 , 95% CI: 16-24). Hospital areas using sophisticated mechanical ventilation systems (such as increased air changes per hour, directional flow and filtration systems) had the lowest total bioaerosol concentrations (9 cfu/m 3 , 95% CI: 7-13). Operating sophisticated mechanical ventilation systems in hospitals contributes to improved indoor air quality within hospitals, which assists in reducing the risk of airborne transmission of HAIs., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Background: The blood pressure response to exercise has been described as a significant increase in systolic BP (sBP) with a smaller change in diastolic BP (dBP). This has been documented in small numbers, in healthy young men or in ethnic populations. This study examines these changes in low to intermediate risk of myocardial ischaemia in men and women over a wide age range., Methods: Consecutive patients having stress echocardiography were analysed. Ischaemic tests were excluded. Manual BP was estimated before and during standard Bruce protocol treadmill testing. Patient age, sex, body mass index (BMI), and resting and peak exercise BP were recorded., Results: 3,200 patients (mean age 58±12years) were included with 1,123 (35%) females, and 2,077 males, age range 18 to 93 years. Systolic BP increased from 125±17mmHg to 176±23mmHg. The change in sBP (ΔsBP) was 51mmHg (95% CI 51,52). The ΔdBP was 1mmHg (95% CI 1, 1), from 77 to 78mmHg, p<0.001). The upper limit of normal peak exercise sBP (determined by the 90th percentile) was 210mmHg in males and 200mmHg in females. The upper limit of normal ΔsBP was 80mmHg in males and 70mmHg in females. The lower limit of normal ΔsBP was 30mmHg in males and 20mmHg in females., Conclusions: In this large cohort, sBP increased significantly with exercise. Males had on average higher values than females. Similar changes were seen with the ΔsBP. The upper limit of normal for peak exercise sBP and ΔsBP are reported by age and gender., (Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.)

The airborne route is a potential pathway in the person-to-person transmission of bacterial strains among cystic fibrosis (CF) populations. In this cross-sectional study, we investigate the physical properties and survival of common non- Pseudomonas aeruginosa CF pathogens generated during coughing. We conclude that Gram-negative bacteria and Staphylococcus aureus are aerosolised during coughing, can travel up to 4 m and remain viable within droplet nuclei for up to 45 min. These results suggest that airborne person-to-person transmission is plausible for the CF pathogens we measured., Competing Interests: Competing interests: During conduct of the study: SCB reports grants from Cystic Fibrosis Foundation Therapeutics, USA, and The Prince Charles Hospital Foundation and outside of the submitted work, travel support to attend conferences from Novartis and Gilead and meetings for clinical trials sponsored by Vertex, Abbvie, Raptor. LDK reports grants from the NHMRC during the conduct of the study. GRJ reports grants from Cystic Fibrosis Foundation Therapeutics, USA, and The Prince Charles Hospital Foundation during the conduct of the study. CEW reports outside of the submitted work: research grant from Novo Nordisk Pharmaceuticals; honorarium fees as speaker for Vertex, DKBmed; honorarium for consulting work (BMJ, Vertex), advisory board (Vertex); to present at conference (Novartis), attendance at meetings (University of Miami), Associate Editor duties (Thorax) and travel support to attend meetings for clinical trials sponsored by Vertex. CEW is Associate Editor Thorax and Associate Editor Respirology. MEW reports outside of submitted work: travel support to attend clinical trial meetings sponsored by Vertex and Galapagos., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Fallopian tube patency testing is an essential part of infertility evaluation. Hysterosalpingo-contrast sonography (HyCoSy) has been described as reliable, well tolerated and safe compared to other modalities such as laparoscopy and a dye test or hysterosalpingography. Limited availability of the previously used contrast has led to the introduction of a foam contrast agent as an alternative., Aims: To assess the tolerability, safety and occurrence of pregnancy post-procedure of hysterosalpingo-foam sonography (HyFoSy)., Materials and Methods: A retrospective cohort study of women who had a HyFoSy at Queensland Ultrasound for Women from March 2013 to February 2015. A questionnaire was sent to their referring doctor to identify any complications or subsequent pregnancies with or without artificial reproductive technology (ART) within six months of the HyFoSy., Results: Of 200 women, four cases were abandoned due to difficulty introducing the intracervical catheter, severe discomfort or a vasovagal episode. Response from referring doctors for 155 women reported no post-procedural complication. One hundred and eleven women were followed up for at least six months. Twenty-four out of 59 women (40.7%) who had ART and 24 out of 52 women (46.2%) who did not have ART conceived. Fifty percent of women who were nulligravida at the time of investigation, found to have at least one patent fallopian tube, whose partner had a normal semen analysis, spontaneously conceived within the time of follow up., Conclusions: HyFoSy is well tolerated and safe. A preponderance of pregnancies in the first month after HyFoSy suggests that a therapeutic effect may exist., (© 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Patient and health system determinants of outcomes following pancreatic cancer resection, particularly the relative importance of hospital and surgeon volume, are unclear. Our objective was to identify patient, tumour and health service factors related to mortality and survival amongst a cohort of patients who underwent completed resection for pancreatic cancer., Methods: Eligible patients were diagnosed with pancreatic adenocarcinoma between July 2009 and June 2011 and had a completed resection performed in Queensland or New South Wales, Australia, with either tumour-free (R0) or microscopically involved margins (R1) (n = 270). Associations were examined using logistic regression (for binary outcomes) and Cox proportional hazards or stratified Cox models (for time-to-event outcomes)., Results: Patients treated by surgeons who performed <4 resections/year were more likely to die from a surgical complication (versus ≥4 resections/year, P = 0.04), had higher 1-year mortality (P = 0.03), and worse overall survival up to 1.5 years after surgery (adjusted hazard ratio 1.58, 95 % confidence interval 1.07-2.34). Amongst patients who had ≥1 complication within 30 days of surgery, those aged ≥70 years had higher 1-year mortality compared to patients aged <60 years. Adjuvant chemotherapy treatment improved recurrence-free survival (P = 0.01). There were no significant associations between hospital volume and mortality or survival., Conclusions: Systems should be implemented to ensure that surgeons are completing a sufficient number of resections to optimize patient outcomes. These findings may be particularly relevant for countries with a relatively small and geographically dispersed population.

Objective: The purpose of this study was to identify the strongest and most consistent risk and protective factors associated with nonmedical use of prescription drugs (NMUPD) in multiple contexts, specifically in community-, school-, interpersonal-, and individual-level domains., Method: A literature search was conducted to review studies published from 2006 to 2012 that examined NMUPD among adolescents. Included were original research studies that focused specifically on risk and protective factors or review articles that included a section on factors associated with NMUPD. Risk and protective factors were included only if a minimum of two methodologically sound research studies reviewed the variable., Results: A variety of risk and protective factors were associated with adolescent NMUPD. At the community level, evidence suggested that ease of access increased the risk of NMUPD. Parental and peer prescription drug use and approval of NMUPD were associated with misuse of prescription drugs within the interpersonal domain. At the school level, academic failure/low educational attainment was associated with high school student NMUPD. However, results for college students' academic failure and NMUPD were inconclusive. At the individual level, previous use of substances was found to be a significant risk factor for NMUPD, as was adolescent aggressive/delinquent behavior and lower [corrected] perceived risk or harm of use., Conclusions: NMUPD is a serious concern among adolescents and emerging adults. Several areas exist for prevention efforts within the context of the community, school, interpersonal, and individual domains. Thus, to curb NMUPD, multifaceted approaches are needed that target factors across multiple domains.

Regular family meals have been shown to reduce adolescents' engagement in various risk behaviors. In this article, we comprehensively examine the literature to review the association between family meals and eight adolescent risk outcomes: alcohol, tobacco, marijuana and other drugs; aggressive and/or violent behaviors; poor school performance; sexual behavior; mental health problems; and disordered eating patterns. The majority of the studies reviewed found associations in the relationship between family meals and adolescents' risk profiles. More specifically, studies reporting significant associations found that adolescents who frequently ate meals with their family and/or parents were less likely to engage in risk behaviors when compared to peers who never or rarely ate meals with their families. Additionally, the influence of family meal frequency on youth risk outcomes appears to be dependent on gender, with family meals being a protective factor for females and males differently, depending on the outcome examined. However, the studies available about family meals and adolescent risk only examined the effect of family meal frequency, and not other components of family meals that contribute to the protective effect, and, thus, hinder the understanding of the mechanisms unique to family meals' protective characteristics. Regardless of these limitations, the studies examined indicate that family meals may be protective and, therefore, have practical implications for parents, clinicians, and organizations looking to reduce adolescent risk behaviors. However, further examination is needed to better understand the mechanisms that contribute to the protective effect afforded by family meal frequency on adolescents.

A real-time SYBR Green I assay was developed and evaluated as a biological and enzymatic polymerase chain reaction (Bio-PCR) protocol for the detection of Xanthomonas arboricola pv. pruni. Suppression subtractive hybridization was used to generate a X. arboricola pv. pruni-specific subtracted DNA library, using X. arboricola pv. corylina as the driver strain. Primer pair 29F/R, designed from cloned sequence, showed no homology to GenBank sequences and amplified a 344-bp product in all X. arboricola pv. pruni isolates. Compared with other published X. arboricola pv. pruni primers, this primer pair was shown to be the only one capable of differentiating X. arboricola pv. pruni from all other X. arboricola pathovars. A real-time assay was developed and shown to be capable of detecting less than 10 CFU and 0.1 pg of DNA. Epiphytic bacteria isolated from plum tissue was used to further evaluate the specificity of the assay. A Bio-PCR protocol, developed for field evaluation, confirmed X. arboricola pv. pruni isolation from asymptomatic and symptomatic plum tissue over a 9-week period between host flowering and the first appearance of leaf and fruit symptoms in an orchard. Dilution plating enabled X. arboricola pv. pruni numbers to be quantified, providing supportive evidence for the usefulness of the Bio-PCR protocol in plant pathology and quarantine surveillance.

For more than 3 decades, the recruitment and retention of African Americans for research in Alzheimer disease have been regarded as difficult undertakings with poor results. The typical explanation for failure to respond to research participation options is a widespread mistrust of research and the biomedical community. Mistrust is a reasonable response; given the historic reality of malfeasance, victimization, and mistreatment over the course of the research participation history of African Americans. The challenges are real but there are opportunities for successful recruitment and retention of African Americans for research including research on Alzheimer disease. Participation, however, comes with specific terms and considerations. Two of the most prominent criteria for research recruitment and retention are the transparency and accountability of the investigator, which may determine how he or she proceeds from the start of the process throughout the steps of recruitment, retention, and subsequent follow-up with the community.

The authors used structural equation modeling to examine associations among perceptions of negative affect, social support, and quality of sleep in a sample of caregivers (n = 175) and noncaregiver control participants (n = 169). The authors hypothesized that caregiver status would be related to sleep quality directly and also indirectly by way of negative affect and social support. This hypothesis was partially supported in that caregiving was found to be indirectly related to sleep quality. However, after accounting for the indirect effects of negative affect and social support, the direct effect of caregiving on sleep quality was no longer statistically significant. The structural model accounted for approximately 43% of the variance in sleep quality. The present findings may be useful in the development of successful sleep interventions for caregivers., (2006 APA, all rights reserved)

More than 4 million persons in the United States are believed to have Alzheimer disease. Seven of 10 are cared for in the community by family members who make numerous decisions ranging from those that have to do with personal care and daily activities to participation in research. Families who do participate in research or who agree for the dementia-impaired individual to participate, do so for a variety or reasons, including the altruistic reason of finding a cure or treatment that may help others. This paper looks at the caregiving experience and those issues that may influence the family to participate in research, what families expect from research, and how they expect researchers to treat the impaired relative.

Nine Consortium to Establish a Registry for Alzheimer's Disease (CERAD) sites were surveyed to identify barriers to recruiting black subjects. Major cited obstacles were expenses, transportation difficulties, and especially lack of rapport with clinic staff. Major factors in overcoming these barriers are a good referral network involving the black community, community education about Alzheimer's disease (AD), and professional staff who are particularly sensitive to the needs of the black population. CERAD efforts to increase community awareness of Alzheimer's disease and staff sensitivity to minority needs have nearly doubled the proportion of black subjects enrolled.