question: Why do Cystic Fibrosis patients have to stay 6 feet apart from other CF patients, but not anyone else?
comment: Cystic fibrosis, among many other things, causes very thick mucus to build up in the lungs. This creates an ideal environment for certain types of bacteria that aren't normally found in people's lungs, such as specific strains of *Pseudomonas aeruginosa*. CF patients staying away from one another is to stop these specific bacteria from passing between them.
passages: In 2010, survival is estimated to be 37 years for women and 40 for men. In Canada, median survival increased from 24 years in 1982 to 47.7 in 2007. In the United States those born with CF in 2016 have an expected life expectancy of 47.7 when cared for in specialty clinics.
  
  In the US, of those with CF who are more than 18 years old as of 2009, 92% had graduated from high school, 67% had at least some college education, 15% were disabled, 9% were unemployed, 56% were single, and 39% were married or living with a partner.
   Infection can spread by passing between different individuals with CF. In the past, people with CF often participated in summer "CF camps" and other recreational gatherings. Hospitals grouped patients with CF into common areas and routine equipment (such as nebulizers) was not sterilized between individual patients. This led to transmission of more dangerous strains of bacteria among groups of patients. As a result, individuals with CF are now routinely isolated from one another in the healthcare setting, and healthcare providers are encouraged to wear gowns and gloves when examining patients with CF to limit the spread of virulent bacterial strains.
   In the mid 1980s, Kaplan met David Romanoff, the medical director of the Inglis House—a residential care facility for adults with disabilities. Two residents of the facility were diagnosed with fibrodysplasia ossificans progressiva (FOP), a very rare medical condition in which the soft tissue of the body ossifies, or turns to bone, over time. Romanoff was "grappling" with caring for the patients, and asked Kaplan if he would like to meet them, which he did. This was his first encounter with the disease beyond reading about it.
   Section::::Plot.
  
  Stella Grant is a cystic fibrosis patient who actively uses social media to cope with her illness and tries to live a normal life. She meets another CF patient, Will Newman, who is at the hospital for a medication trial, in an attempt to get rid of the bacterial infection ("B. cepacia") he has in his lungs.
   People with CF may be listed in a disease registry that allows researchers and doctors to track health results and identify candidates for clinical trials.
  
  Section::::Diagnosis.:Prenatal.
   CF patients are strictly kept six feet apart to reduce the risk of cross-infection, as contracting bacterial infections from other CF patients can be dangerous, even life-threatening. Stella is determined to follow the rules, and initially dislikes Will, who likes to break the rules and take dangerous risks sometimes. Stella notices that Will isn't strictly following his treatment regimen and eventually manages get him to agree to. 
   In addition, the evidence is increasing that genetic modifiers besides "CFTR" modulate the frequency and severity of the disease. One example is mannan-binding lectin, which is involved in innate immunity by facilitating phagocytosis of microorganisms. Polymorphisms in one or both mannan-binding lectin alleles that result in lower circulating levels of the protein are associated with a threefold higher risk of end-stage lung disease, as well as an increased burden of chronic bacterial infections.
  
  Section::::Pathophysiology.
   Most of the cases of FOP were results of a new gene mutation: these people had no history of this particular disorder in their family. There are some cases which have shown people inheriting the mutation from one affected parent.
  
  Section::::Diagnosis.
  
  Outbreaks may be measurable clinically by elevated levels of alkaline phosphatase and bone-specific alkaline phosphatase.
  
  Section::::Treatment.
   Section::::Research.:Phage therapy.
  
  Phage therapy is being studied for multidrug resistant bacteria in people with CF.
  
  Section::::Research.:Small molecules.
   Over time, both the types of bacteria and their individual characteristics change in individuals with CF. In the initial stage, common bacteria such as "S. aureus" and "H. influenzae" colonize and infect the lungs. Eventually, "Pseudomonas aeruginosa" (and sometimes "Burkholderia cepacia") dominates. By 18 years of age, 80% of patients with classic CF harbor "P. aeruginosa", and 3.5% harbor "B. cepacia". Once within the lungs, these bacteria adapt to the environment and develop resistance to commonly used antibiotics. "Pseudomonas" can develop special characteristics that allow the formation of large colonies, known as "mucoid" "Pseudomonas", which are rarely seen in people who do not have CF. Scientific evidences suggest the interleukin 17 pathway plays a key role in resistance and modulation of the inflammatory response during "P. aeruginosa" infection in CF. In particular, interleukin 17-mediated immunity plays a double-edged activity during chronic airways infection; on one side, it contributes to the control of "P. aeruginosa" burden, while on the other, it propagates exacerbated pulmonary neutrophilia and tissue remodeling.
   Only 25% of patients show symptoms on both feet (bilateral involvement). The disease may also infiltrate the dermis or, very rarely, the flexor tendon sheath
  
  Section::::Risk factors.
   The first linkage between CF and another marker (Paroxonase) was found in 1985 by Hans Eiberg, indicating that only one locus exists for CF. In 1988, the first mutation for CF, ΔF508 was discovered by Francis Collins, Lap-Chee Tsui, and John R. Riordan on the seventh chromosome. Subsequent research has found over 1,000 different mutations that cause CF.
   Section::::Prognosis.:Quality of life.
  
  Chronic illnesses can be very difficult to manage. CF is a chronic illness that affects the "digestive and respiratory tracts resulting in generalized malnutrition and chronic respiratory infections". The thick secretions clog the airways in the lungs, which often cause inflammation and severe lung infections. If it is compromised, it affects the quality of life (QOL) of someone with CF and their ability to complete such tasks as everyday chores. 
   Because mutations in the "CFTR" gene are typically small, classical genetics techniques had been unable to accurately pinpoint the mutated gene. Using protein markers, gene-linkage studies were able to map the mutation to chromosome 7. Chromosome-walking and -jumping techniques were then used to identify and sequence the gene. In 1989, Lap-Chee Tsui led a team of researchers at the Hospital for Sick Children in Toronto that discovered the gene responsible for CF. CF represents a classic example of how a human genetic disorder was elucidated strictly by the process of forward genetics.
  
  Section::::Research.
  
  Section::::Research.:Gene therapy.
   According to Schmitz and Goldbeck (2006), CF significantly increases emotional stress on both the individual and the family, "and the necessary time-consuming daily treatment routine may have further negative effects on quality of life". However, Havermans and colleagues (2006) have shown that young outpatients with CF who have participated in the Cystic Fibrosis Questionnaire-Revised "rated some QOL domains higher than did their parents". Consequently, outpatients with CF have a more positive outlook for themselves. 
   People with nontraumatic causes of SCI have been found to be less likely to suffer complete injuries and some complications such as pressure sores and deep vein thrombosis, and to have shorter hospital stays. Their scores on functional tests were better than those of people with traumatic SCI upon hospital admission, but when they were tested upon discharge, those with traumatic SCI had improved such that both groups' results were the same. In addition to the completeness and level of the injury, age and concurrent health problems affect the extent to which a person with SCI will be able to live independently and to walk. However, in general people with injuries to L3 or below will likely be able to walk functionally, T10 and below to walk around the house with bracing, and C7 and below to live independently. New therapies are beginning to provide hope for better outcomes in patients with SCI, but most are in the experimental/translational stage.
   Section::::Criteria.
  
  The criteria for patient eligibility from the St. Louis Children's Hospital are:
  
  Section::::Criteria.:Walk independently.
  
  After the surgery, all patients walking independently before surgery regained independent walking within a few weeks after surgery. Patients maintain independent walking for the long term; when others have more difficulty walking independently they may eventually need an assistive device. In nearly all cases, spasticity can be eliminated and the quality of independent walking improves, however, physical therapy and braces become unnecessary after SDR. Orthopedic surgery is rarely required after SDR.
  
  Section::::Criteria.:Walk with walkers or crutches.
   A member of Anderson's junior varsity teams, Gottlieb was promoted to the varsity team in 2004-05 due to his strong work ethic and professional attitude. In a January 2005 interview Gottlieb spoke of the determination which was the basis of his ongoing success despite the adversity presented by cystic fibrosis. "I’ve got no choice, I can get up off my rear and go out and work or be at home in bed dying at age 45. It’s either live or die. With the goals, I’ve set for myself, there’s no way I can just sit around. I’ve got to do what I’ve got to do", he said, hoping his experience would encourage and inspire fellow sufferers, "I wish there was a way to get my story out to other CF patients, I tell the younger kids with CF to stay as active as possible. That’s been the biggest thing for me."
   Recent large-scale studies by Davenport et al. ("Annals of Surgery", 2008) show that the age of the patient is not an absolute clinical factor affecting prognosis. The influence of age differs according to the disease etiology—i.e., whether biliary atresia is isolated, cystic (CBA), or accompanied by splenic malformation (BASM).
   The symptoms expressed by FMD patients is largely dependent on the vascular bed(s) affected by the disease. Patients may also be entirely asymptomatic and have FMD discovered incidentally (e.g., when imaging studies are performed for other reasons). In a study from the United States Registry for Fibromuscular Dysplasia, the median age at first symptom was roughly 47 years.
  
  Section::::Signs and symptoms.:Renal arteries.
   Section::::Gene.:DeltaF508.:Prevalence.
   BULLET::::- Cystic Fibrosis Continuity of Care, LLC, is a US-based Specialty Nurse Consulting firm that provides both clinical and business process improvement services surrounding the coordination of care for patients living with CF.
  
  BULLET::::- Cystic Fibrosis Research, Inc. (CFRI), a US-based nonprofit organization founded in 1975 that funds CF research, offers innovative educational programs and provides support to those with CF, their families and caregivers.
   A 50-year follow-up study published in the "Journal of the American Medical Association" (2003) asserted the lifelong physical health, including cardiopulmonary and neurological functions, and mental health of people with idiopathic scoliosis are comparable to those of the general population. Scoliosis that interferes with normal systemic functions is "exceptional" and "rare", and "untreated [scoliosis] people had similar death rates and were just as functional and likely to lead productive lives 50 years after diagnosis as people with normal spines". In an earlier University of Iowa follow-up study, 91 percent of people with idiopathic scoliosis displayed normal pulmonary function, and their life expectancy was 2% longer than that of the general population.
   People in this class have good sitting balance. People with lesions at L4 have trunk stability, can lift a leg and can flex their hips. They can walk independently with the use of longer leg braces. They may use a wheelchair for the sake of convenience. Recommended sports include many standing related sports. People in this class have a total respiratory capacity of 88% compared to people without a disability.
  
  Section::::Governance.
   The aminoglycoside gentamicin has been used to treat lung cells from CF patients in the laboratory to induce the cells to grow full-length proteins. Another drug targeting nonsense mutations is ataluren, which is undergoing Phase III clinical trials .
  
  Section::::Society and culture.
  
  BULLET::::- "Mallory's 65 Roses", a children's picture book by Diane Shader Smith
  
  BULLET::::- "", a 1997 documentary film
  
  BULLET::::- "65_Redroses", a 2009 documentary film
  
  BULLET::::- "Breathing for a Living", a memoir by Laura Rothenberg
  
  BULLET::::- "Every Breath I Take, Surviving and Thriving With Cystic Fibrosis", book by Claire Wineland
  