Europa is a premier target for advancing both planetary science and astrobiology, as well as for opening a new window into the burgeoning field of comparative oceanography. The potentially habitable subsurface ocean of Europa may harbor life, and the globally young and comparatively thin ice shell of Europa may contain biosignatures that are readily accessible to a surface lander. Europa's icy shell also offers the opportunity to study tectonics and geologic cycles across a range of mechanisms and compositions. Here we detail the goals and mission architecture of the Europa Lander mission concept, as developed from 2015 through 2020. The science was developed by the 2016 Europa Lander Science Definition Team (SDT), and the mission architecture was developed by the preproject engineering team, in close collaboration with the SDT. In 2017 and 2018, the mission concept passed its mission concept review and delta-mission concept review, respectively. Since that time, the preproject has been advancing the technologies, and developing the hardware and software, needed to retire risks associated with technology, science, cost, and schedule.

Background: Babies with cystic fibrosis diagnosed by neonatal screening often display no overt signs of respiratory disease. The role of traditional routine daily chest physiotherapy in this particular group of babies is unclear and has generated considerable international debate. There is currently no evidence addressing this issue and present circumstances preclude a rigorous trial in the UK. This study aimed to provide expert consensus regarding the physiotherapy management of asymptomatic infants with CF. Method: A Delphi consensus method was used to gather and refine expert opinions of senior paediatric physiotherapists in the UK. Agreement was sought on 16 statements reflecting aspects of physiotherapy management in 'asymptomatic' babies with cystic fibrosis. Results: Twenty-five senior paediatric physiotherapists from Specialist CF Centres throughout the UK participated in the study. Consensus was high amongst the respondents for 15 of the 16 statements. One statement failed to reach consensus. This related to the question of not routinely initiating a daily chest physiotherapy regimen in apparently healthy babies. Due to the lack of consensus an amendment to this statement was made, to allow a more flexible approach, where physiotherapists would not be obliged to initiate routine daily treatment in asymptomatic babies with CF, if they felt other another approach was justified. Conclusion: There was high consensus of opinion amongst senior physiotherapists in the UK on most aspects of the physiotherapy management of babies with CF Consensus could not be achieved on whether routine daily chest physiotherapy is necessary in 'asymptomatic' babies. An agreed amendment to the original statement allows professionals to modify or change traditional practice with the sanction of their senior colleagues. The results of this process will be used by the Association of Chartered Physiotherapists in Cystic Fibrosis to form the basis of national clinical guidelines.

We report the case of successful treatment of a 31-year-old lady with cystic fibrosis and an en-bloc liver–pancreas transplant, who developed cepacia syndrome on a background of chronic infection with the ET12 epidemic strain of Burkholderia cenocepacia. Combination therapy with nebulised and intravenous meropenem and tobramycin led to clinical improvement with a return to baseline function and complete resolution of the acute chest X-ray changes.

BACKGROUND:To explore whether Tension-free Vaginal Tape offers a solution for women with cystic fibrosis who suffer from severe stress incontinence.METHODS:Four adults with cystic fibrosis were formally assessed by gynaecological and urological specialists, prior to hospital admission for surgery.RESULTS:The procedure was tolerated well by all patients. In three, leakage ceased completely. The fourth patient experienced considerable improvement in symptoms.CONCLUSIONS:Tension-free Vaginal Tape is a safe, effective and worthwhile solution for stress incontinence in females with cystic fibrosis.

Introduction: This study focuses on the prevalence of pathogens colonising the respiratory tract of adult CF patients at our specialist centre between 1985 and 2005.During this time, the care and treatment of patients with CF has continued to evolve.Therefore, we hypothesised that sputum microbiology would have changed and new pathogens may have emerged.Method: A retrospective analysis using data from the Royal Brompton Hospital CF database was performed.Results: There were no significant changes in the proportion of patients colonised with Pseudomonas aeruginosa or Staphylococcus aureus between 1985 and 2005 (77 to 82%, p = 0.159; and 54% to 47%, p = 0.108 respectively).The prevalence of Haemophilus influenzae (48 to 6%; p 0.001) and Aspergillus species (18 to 9%; p = 0.002) decreased.Stenotrophomonas maltophilia and Methicillin-resistant Staphylococcus aureus significantly increased (1 to 4%, p = 0.02; and 1 to 6%, p = 0.002, respectively).Burkholderia cepacia significantly decreased (9% (1990) to 4% ( 2005), p = 0.041).The mean FEV 1 and body mass index increased (47 to 53% predicted, p = 0.0075; and 19 to 22, p < 0.001, respectively).Conclusion: There has been relatively little change in the proportion of patients with P. aeruginosa colonisation since 1985 and importantly, there has been a decline in the prevalence of B. cepacia, H. influenzae and Aspergillus sp.The health status of the patients has improved which, in part, may be due to the intensive antibiotic strategy which, so far has not resulted in clinically significant emergence of new pathogens.188 Bacteriology of sputum in cystic fibrosis -2 years of systematic monitoring

Aims: Optimal vaccination coverage rates are important aims of public health and especially for CF-patients.On the other hand CF-patients may escape immunization programs due to exacerbations.To determine the vaccination coverage rates we review the vaccination status of our patients.Methods: We did a review of the vaccination records of our CF-patients and compared the results with the current national recommendations.We distinguish between pediatric (group R < 18 years) and adult (group A) patients.Results: 105 out of 118 patients over two years of age (88.9%) presented their immunization records.72% percent were younger than 18 years (range 0.42 42.9.Median 12.08, 62% males and 38% females).Coverage of three doses of diphtheria, tetanus and poliomyelitis vaccination was > 97% (P) versus > 90% (A).The rate of age appropriate booster dose of diphtheria and tetanus were only 68% in adults.Cumulative coverage of measles, mumps, rubella (MMR) was > 94% (P) versus > 54% (A).Complete primary vaccinations of hepatitis B, pertussis and haemophilus influenzae type b was documented in > 85% (P).Coverage rates of even one dose of pneumococcal vaccination are 74% (P) versus 45% (A) and of influenza vaccination 76% (P) versus 55% (A).An unacceptable interval of the last booster dose was documented in 2% (P) versus 7% (A) for pneumococcal vaccination respectively 17% (P) versus 47% (A) for influenza immunization.Conclusions: High primary immunizations rates reflex the high acceptance of vaccinations.CF-centers should been an advocate for pneumococcal and influenza vaccination and time-or age-appropriate booster immunizations especially in adults and pre-transplant patients.

Introduction: We have previously reported the controversies of exercise referral to community gyms and the risks of cross infection for patients with different microbiological groups (MG) [1]. As per MACFU guidelines each individual is informed if another patient attends the same gym and specific attendance times arranged to avoid direct contact. The aim of the study was to determine if cross infection occurred between patients with different MG referred to the same gym. Methods: We surveyed the records of 41 referrals made over a 3 year period (2003 2005). Data was collected for MG and groups of patients attending the same gym. Attendance ratings and changes to microbiological grouping including strain typing were recorded. Results: 23 females and 18 males were referred. Mean (range) BMI 22.4 (14 38.3), FEV1 2.38 (0.85 4.4)l/rain. The MG consisted of 16 sporadic Pseudomonas aeruginosa (Pa), 13 transmissible Pa, 9 non-Pa, 2 Burkholderia cenocepacia, and 1 Burkholderia gladioli. Three pairs (6 patients), mean (range) BMI 21.95 (19.4 29.2) FEV12.3 (1.65 3.3) were referred with different MG's to 3 different venues. Pair 1: sporadic Pa and transmissible Pa. Pair 2: non-Pa and transmissible Pa; and pair 3: non-Pa and sporadic Pa. 5 of the 6 were classed as regular attenders (>1 visit per week) and 1 a poor attender. All patients reported lapses in attendance related to ill health or busy social/work spells for periods up to 2 months. None of the pairs attending the same venue changed microbiological group as a result of attendance at their exercise facility. Conclusion: Routine microbiological surveillance and negotiation of attendance times have prevented cross infection in patients with different MG's attending the same gym.