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Mycobacterium abscessus is an emerging pathogen in cystic fibrosis (CF) lung disease. Hospital transmission of M. abscessus has been described. This paper details the investigation into possible cross-transmission of M. abscessus locally at our paediatric hospital CF centre, and the subsequent infection control response.Whole genome sequencing (WGS) of M. abscessus respiratory isolates with epidemiological linkage analysis using hospital electronic medical records.6.7% (22/328) of CF patients had M. abscessus isolated from respiratory specimens. WGS revealed a cluster of three patients with genomically related isolates that differed by7 single nucleotide polymorphisms (SNPs), suggesting a shared recent ancestor and probable cross-transmission. Epidemiological investigation revealed multiple potential crossovers between patients with genomically similar M. abscessus isolates.Cross-infection of NTM occurs in CF hospital patients. Hospital infection control practices should be upgraded to reflect this. Consensus is needed between centres.

The traditional model of cystic fibrosis (CF) care revolves around regular (usually three monthly) in person appointments with the multidisciplinary CF team at specialised CF care centres. This article is protected by copyright. All rights reserved.

Cystic fibrosis (CF) is the most common, life-shortening, genetic illness affecting children in Australia and New Zealand. The genetic abnormality results in abnormal anion transport across the apical membrane of epithelial cells in a number of organs, including the lungs, gastrointestinal tract, liver and genito-urinary tract. Thus, CF is a multi-system disorder that requires a multi-disciplinary approach. Respiratory disease is the predominant cause of both morbidity and mortality in patients with CF. However, there are significant and clinically relevant gastrointestinal, liver, pancreatic and nutritional manifestations that must be detected and managed in a timely and structured manner. The aim of this review is to provide evidence-based information and clinical algorithms to guide the nutritional and gastrointestinal management of patients with CF.

Introduction In this cohort study spanning an 18-year period, we evaluated the prevalence and associated mortality rate of epidemic strains of pseudomonas aeruginosa (PsA), especially Australian Epidemic Strain Type 1 (AES1), in a pediatric cystic fibrosis center practicing cohort segregation and early PsA eradication. Methods Cohort segregation was introduced in January 2000. PsA clonal strain was determined by pulse-field-gel-electrophoresis (PFGE) at the time of routine collection of airway specimens. Children with PsA underwent eradication treatment with anti-pseudomonal antibiotics over 2-3 months. We analyzed changes in prevalence and mortality from 1999 to 2016. Results The prevalence of AES1 declined from 69 (20%) in 1999 to 16 (5.4%) in 2006, to 1 (0.4%) in 2016. The prevalence of PsA overall diminished less over the same period, from 128 (37%) patients in 1999 to 57 (23%) in 2016. New acquisition of AES1 became less common over time, with no new cases identified from 2011. Those who contracted AES1 had a greater risk of death than those who did not (Odds Ratio 4.9, 95%CI 2.5-9.6). Patients with other AES PsA types were uncommon (AES2 n = 5, AES5 n = 2, AES14 n = 3, AES19 n = 1). Conclusions Cohort segregation was associated with reduction in AES1 prevalence ascertained by PFGE surveillance for patients in a single large pediatric cystic fibrosis center. Other alterations in practice such as early eradication treatment may also have contributed to reduced PsA prevalence. These factors combined with the transition of chronically infected patients over time to adult centers has eliminated AES1 from our clinic, with an accompanying mortality decrease.

Cystic fibrosis (CF) is the most common, life-shortening, genetic illness affecting children in Australia and New Zealand. The genetic abnormality results in abnormal anion transport across the apical membrane of epithelial cells in a number of organs, including the lungs, gastrointestinal tract, liver and genito-urinary tract. Thus, CF is a multi-system disorder that requires a multi-disciplinary approach. Respiratory disease is the predominant cause of both morbidity and mortality in patients with CF. However, there are significant and clinically relevant gastrointestinal, liver, pancreatic and nutritional manifestations that must be detected and managed in a timely and structured manner. The aim of this review is to provide evidence-based information and clinical algorithms to guide the nutritional and gastrointestinal management of patients with CF.

Aim: Identifying predictors of pulmonary exacerbations in cystic fibrosis (CF) allows for earlier detection and timely treatment, possibly reducing negative impact. Methods: A prospective longitudinal analysis of children aged 0-7 years in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) study between 2005 and 2015. Inflammatory markers from routine annual bronchoalveolar lavage fluid (BALF) were examined against pulmonary exacerbations (hospitalisation for intravenous antibiotics) in the 6 months post-BALF. Kaplan-Meier curves were created and Weibull regression was used, adjusting for annually repeated measurements in the same patients. Results were adjusted for known risk factors of exacerbations. Results: 1200 BALF samples were taken from 322 children with a total of 492 person-years follow-up. 226 pulmonary exacerbations were recorded. 20% of children were admitted in the 6 months following BALF and in those the median time to admission was 19 days (interquartile range 9-83 days). The risk for a pulmonary exacerbation was increased if neutrophil elastase was detectable (hazard ratio (HR) 3.76, 95%-CI 2.16-3.95, p Conclusion: BALF inflammatory markers are significant predictors of pulmonary exacerbations in young children with CF.

Sarcoidosis is a rare disease, especially in the preschool age group where it usually presents with eye, joint, and skin involvement sparing the lungs. Multiple treatment regimes have been described with oral prednisolone being the usual first line treatment. We describe a case of a 4-year-old boy presenting with pulmonary sarcoidosis with no other organ involvement. The child was successfully managed with pulse intravenous methylprednisolone followed by oral prednisolone and has had a good outcome. This case reports a rare presentation of preschool sarcoidosis as well as the novel and successful use of pulse methylprednisolone in paediatric pulmonary sarcoidosis.

A 20-month-old girl weighing 12 kg presented with 2 weeks of worsening dry cough and wheeze. Aside from respiratory symptoms she was otherwise well, without fever or weight loss. There was no history of foreign body inhalation or choking. She had no significant personal or family medical history, and her immunisations were up to date. Prior to admission she had been treated for 1 week for a community-acquired pneumonia with oral amoxicillin and roxithromycin, as well as for a first presentation asthma exacerbation with oral prednisolone (2 mg/kg) and inhaled salbutamol, three hourly. Despite these interventions no clinical improvement had been noted. On examination, her respiratory rate and oxygen saturations were normal. She had mild respiratory distress, a loud biphasic wheeze and a prolonged expiratory phase. A chest X-ray (CXR) demonstrated hyperinflation of the right lung (figure 1A). Given the suspicion of a foreign body obstructing a right-sided airway, a rigid bronchoscopy was performed which showed an isolated submucosal lesion in the right main bronchus causing airway narrowing (figure 1B). To further characterise the lesion, a CT of the chest was performed, which demonstrated a subcarinal mass (figure 1C), causing significant extrinsic compression of the distal right main bronchus and bronchus intermedius. There was no intraluminal perforation of the mass. Figure 1 (A) Chest X-ray at presentation showing hyperinflation of right lung. (B) Image from rigid bronchoscopy showing occlusion of right main bronchus by submucosal lesion. (C) Initial CT scan showing subcarinal mass compressing the right main bronchus. (D) Lymph node biopsy demonstrating necrosis with nuclear debris surrounded by a thin layer of caseation and epithelioid cells with occasional Langhans giant cells. (E) Repeat CT scan showing reduction in size of mass with ongoing right main bronchus compression. The most likely differential diagnoses for a subcarinal mass in this patient include a neoplastic …

Rationale Wheezing is common in preschool children but objective evidence for airway obstruction and its reversibility are rarely available in clinical practice We assessed whether abnormalities of lung function and bronchodilator response can be detected in preschool children using the forced oscillation technique and measurements of specific airway resistance Methods Fifty nine children with a history of wheeze and 24 healthy controls aged 3-6 years were recruited Resistance and reactance at 6 and 8 Hz (Rrs6 Rrs8 Xrs6 and Xrs8 respectively) were measured using the forced oscillation technique and specific airway resistance was measured in a plethysmograph z Scores were calculated from published reference data Tests were repeated 15 min after 400 mcg salbutamol Bronchodilator response was expressed as the log transformed ratio of postbronchodilator/prebronchodilator values Results Technically acceptable measurements using the forced oscillation technique were obtained in n = 77 (93%) of children and in n = 56 (68%) using plethysmography There was no significant difference in baseline lung function or bronchodilator response assessed by either technique between those with a history of wheeze and healthy controls Conclusion Measurement of lung function is feasible in preschool children but neither of these techniques was able to identify diminished lung function or reversibility to bronchodilator in children with a history of wheeze Pediatr Pulmonol 2010, 45 1049-1056

Recent research has explored the meanings older people attribute to some of their daily occupations. However, limited inquiries have focused on computer use, an occupation less frequently associated with older age groups. In order to understand the meaning that older people attribute to computer use, qualitative data was gathered from 9 people aged 65 years and over living in various locations across Australia. Two asynchronous online focus groups were conducted over 10 consecutive days. Data analysis was inductive and informed by interpretive phenomenology. Five main themes connected to meaning emerged: feeling in control; an important part of daily life; keeping the brain active; relating to others; and personal gains from computer use. The findings indicated that the use of a computer was a highly valued and meaningful daily occupation for participants. Older people reported computer use as being both challenging and rewarding. It was also evident that this occupation contributed to well‐being, played ...

The definitive version is available at www.blackwell-synergy.com Background/aim: The qualitative research reported here investigated the perceptions of primary school teachers regarding the usefulness of occupational therapy reports from the Flinders Medical Centre. The reports included either recommendations alone or in conjunction with written programs for the students.Methods: This qualitative descriptive study employed in-depth semistructured interviews to gather the perspectives of four school teachers from primary schools in the southern suburbs of Adelaide. The interviews were audiotaped, transcribed, and analysed using a thematic inductive approach.Results: Four themes emerged from the data in relation to teachers' perceptions of the reports: (i) Understandable but not always useful; (ii) It's important ... we can't do it all; (iii) We never actually speak; and (iv) It's probably impossible but ... in an ideal world.Conclusions: The research findings provide an insight into the professional relationship between education and health professionals in the presence of minimal collaboration. The participants in this study described the occupational therapy reports as useful but they all wanted a higher level of interaction with therapists. The participants also gave suggestions for improving the current procedure to increase collaboration between health and education professionals. Such improvements could enhance educational outcomes for South Australian children with a disability. Refereed/Peer-reviewed

Sarcoidosis is a rare disease, especially in the preschool age group where it usually presents with eye, joint, and skin involvement sparing the lungs. Multiple treatment regimes have been described with oral prednisolone being the usual first line treatment. We describe a case of a 4-year-old boy presenting with pulmonary sarcoidosis with no other organ involvement. The child was successfully managed with pulse intravenous methylprednisolone followed by oral prednisolone and has had a good outcome. This case reports a rare presentation of preschool sarcoidosis as well as the novel and successful use of pulse methylprednisolone in paediatric pulmonary sarcoidosis.

Objective: A small exploratory qualitative study investigated key political activists' predictions regarding the process by which gay and lesbian older people will be included in aged care policies in the future in Australia. Method: In-depth semi-structured interviews were conducted with six activists in aged care and human rights. Results: Findings are discussed in relation to three broad themes: barriers to change; who should do what?; and strategies for success. Conclusions: The study points to predictions about gay and lesbian aged policy which warrant further attention. It identifies a need for further research which investigates aspects of the findings, particularly the collaborative process between gerontologists and gay and lesbian activists. Such a process may lead to policies which emphasise social justice and the recognition of diversity in gerontology.

Risk of infection with Pseudomonas aeruginosa in cystic fibrosis (CF) may be associated with environmental factors.To determine whether residential location is associated with risk of first acquisition of P. aeruginosa.We performed bronchoalveolar lavage and upper airway cultures in children newly diagnosed with CF to identify infection with P. aeruginosa during infancy and early childhood. Children were assessed according to their residence in a regional or metropolitan area. Multilocus sequence typing was used to determine P. aeruginosa genotype. An environmental questionnaire was also administered.A total of 105 of 120 (87.5%) infants diagnosed with CF were included in this study. Diagnosis in 65 infants (61.9%) followed newborn screening at mean age of 4.6 weeks. Sixty subjects (57.1%) were homozygous ΔF508, and 47 (44.8%) were female. Fifty-five (52.3%) infants were regional, of whom 26 (47.3%), compared with 9 of 50 (18.0%) metropolitan children, acquired infection with P. aeruginosa (odds ratio, 4.084; 95% confidence interval, 1.55-11.30). Age at acquisition was similar (regional: median, 2.31 yr; range, 0.27-5.96 yr; metropolitan: median, 3.10 yr, range, 0.89-3.70 yr). Strain typing identified P. aeruginosa genotypes often encountered in different ecological settings and little evidence of cross-infection. Ninety questionnaires (85.7%) were completed. Those who acquired P. aeruginosa were more likely to be living in a household that used water sprinkler systems (P = 0.032), but no differences were identified to explain increased risk of acquisition of P. aeruginosa in regional children.Geographical difference in residence of children with CF was associated with increased risk of first acquisition of P. aeruginosa, usually with strains associated with the environment rather than with cross-infection.

We aimed to determine whether myeloperoxidase (MPO) is the main peroxidase present in the airways of children with cystic fibrosis (CF) and to assess which oxidants it produces and whether they are associated with clinical features of CF. Children with CF (n=54) and without CF (n=16) underwent bronchoscopy and bronchoalveolar lavage (BAL) for assessment of pulmonary infection and inflammation. BAL fluid was analyzed for MPO, halogenated tyrosines as markers of hypohalous acids, thiocyanate, and protein carbonyls. MPO was the only peroxidase detected in BAL samples from children with CF and its concentration was markedly higher than in controls. Levels of 3-chlorotyrosine and 3-bromotyrosine in proteins were higher in the CF group. They correlated with neutrophils and MPO. The concentration of thiocyanate in BAL samples was below 1μM. Protein carbonyl levels correlated with MPO and halogenated tyrosines in patients with CF. Levels of MPO and halogenated tyrosines were higher in children with infections, especially Pseudomonas aeruginosa, and in the presence of respiratory symptoms. They also correlated with the Kanga clinical score. Our findings suggest that MPO produces hypobromous acid as well as hypochlorous acid in the airways of children with CF and that these oxidants are involved in the early pathogenesis of CF.

Official policy statements and parliamentary recommendations are re-emphasizing the importance of community care for elderly people. This paper * examines questions of responsibility in the light both of demographic changes and the associated increases in dependency amongst the elderly in Australia. Definitional questions are raised in relation to the concept of community. The distinction between care in and by the community is probed in relation to evidence concerning the role of women in the provision of care. The responsibilities for provision which exist at the statutory, commercial, voluntary and informal levels are outlined. Actual allocation of fiscal resources to home support services is detailed and policy considerations which arise from this analysis are proposed.