SUAs that address a range of issues help create confidence for th

SUAs that address a range of issues help create confidence for the parties in the agreement, fostering the conditions necessary for successful sharing of resources while reducing the likelihood of termination (ChangeLab Solutions, 2009a and Zimmerman et al., 2013).

Community-based active living strategies (e.g., healthy eating and physical activity promotion) represent priorities for the Centers for Disease Control and Prevention (CDC). In the Communities Putting Prevention to Work (CPPW) program, for example, the local arm in Los Angeles County (LAC) – the Renew Environments for Nutrition, Exercise and Wellness in LA County initiative (RENEW) – focused on addressing three primary objectives: 1) improving the built environment; 2) increasing GSK J4 molecular weight access to click here healthy foods; and 3) decreasing sedentary behaviors through system and environmental change ( U.S. Department of Health and Human Services Centers for Disease Control and Prevention, 2010 and Bunnell et al., 2012). To address the third objective, RENEW supported several key school-based programs from 2010 to 2012. Among them, the Joint-Use Moving People to Play (JUMPP) Task

Force initiated and completed several SUAs in under-resourced communities with high prevalence of child and adult obesity. Although interest in SUAs is growing, much remains unknown about the processes required to construct and effectively implement them. Few studies have addressed physical activity-related SUAs, and even fewer have taken an in-depth look at the legal components that can foster a mutually beneficial partnership (ChangeLab Carnitine palmitoyltransferase II Solutions, 2009a). In the present article, we contribute to this gap in public health practice by reviewing 18 SUAs signed and implemented

in LAC. Where appropriate, we used mixed methods to describe the JUMPP effort, estimate the population reached by the SUA interventions, and examine the benefits of investing in shared-use strategies. Although the concerns of both parties in the agreement are important, the present study centered only on the interests of the school districts, the entities that have the greatest perceived risk of liability and costs (ChangeLab Solutions, 2009a, ChangeLab Solutions, 2009b and National Policy and Legal Analysis Network to Prevent Childhood Obesity (NPLAN), 2010). In 2010, with support from RENEW and guidance on the SUA process from the JUMPP Task Force (Table 1), school districts were identified and selected according to their childhood obesity prevalence (Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, 2011), with the highest receiving priority. The first seven eligible districts that provided RENEW with letters of commitment signed by their superintendents were recruited; the final list of districts included: ABC Unified, Compton Unified, El Monte City, Pomona Unified, Mountain View, Pasadena Unified, and the Los Angeles Unified School District (LAUSD).

The first results of the efficacy of rotavirus vaccines in develo

The first results of the efficacy of rotavirus vaccines in developing countries in Africa and Asia were published in 2010 [8], [9] and [10]. While these studies showed that the efficacy of both Rotarix™ and RotaTeq® were lower in the populations in these regions, because of the higher incidence of severe disease, the observed incidence rate reductions of severe rotavirus diarrhoea was higher than that observed in the developed countries. The preliminary results

of these trials were presented to WHO SAGE and formed the basis of the revised WHO recommendations [11]. While the SAGE noted the inverse relationship between child mortality rates and rotavirus vaccine efficacy, the recommendation for the use of the vaccines see more was extended to include all countries, especially those where diarrhoea disease accounts for ≥10% of child deaths [11]. This recommendation was made on the basis that despite the lower efficacy, the vaccines would still prevent a large amount of severe disease and deaths in the high mortality developing

countries in Africa and Asia. Several papers in this supplement provide additional information that improves our understanding of the efficacy and safety of rotavirus vaccines in populations with high child mortality. The pooled analysis of data from the Asian and African trials with RotaTeq® provided greater precision around the efficacy estimates against very severe rotavirus gastroenteritis

(Vesikari scale ≥14), which were higher than the efficacy estimates against severe rotavirus gastroenteritis (Vesikari scale ≥11), and against non-vaccine type rotavirus diarrhoea (Breiman et al.). The report of the efficacy of RotaTeq® in Kenya published in this supplement also showed that while the vaccine was not efficacious in preventing severe gastroenteritis from any cause in children attending a health care facility, it showed statistically significant efficacy against severe gastroenteritis of any cause in children visited at home (Feikin et al.). These analyses and other data published in this supplement (Madhi et al.) either that showed that the efficacy of Rotarix™ in the first year of life was higher than in the full follow up period, suggesting the possibility of a waning immunity in the second year of life. Despite the increasing amount of data on rotavirus diarrhoea and vaccines, there are a number of issues that remain to be fully addressed. It is assumed that despite the lower observed efficacy of the current vaccines, they are likely to prevent more cases of severe disease and deaths in populations with high child mortality rates. However, the magnitude of the impact of these vaccines in these populations still needs to be fully documented.

The results of this trial are consistent with the results of two

The results of this trial are consistent with the results of two other trials that evaluated the use of Kinesio Taping in people with chronic low back pain. One

study16 allocated people into three groups (Kinesio Taping and exercises, Kinesio Taping only and exercises only). The outcomes assessed in this study were pain intensity, disability and lumbar muscle activation measured by electromyography. No between-group differences were observed. Another study17 compared the effect of Kinesio Taping versus the control procedure of the present trial (Kinesio Taping without convolutions) for the outcomes pain, disability and range of motion for trunk flexion. People received only one application of the tape, which remained in situ for Lonafarnib datasheet one week. This study also did not identify any differences in favour of the Kinesio Taping. We do not know of any studies that have evaluated the Kinesio Taping Method using the global perceived effect scale. There are five published systematic reviews15, 28, 29, 30 and 31 evaluating the effectiveness of Kinesio Taping; one

specifically targeted the treatment and prevention of sports injuries,15 two examined different clinical conditions,29 and 30 and two looked at musculoskeletal conditions.28 and 31 However, none of these reviews found any clinically worthwhile benefits for this intervention. The studies compared Kinesio Taping with a range of treatments, as well as with no treatment BLZ945 nmr and placebo. These studies were, on average, of moderate methodological quality, with small sample sizes and very small follow-up periods. Regardless of the comparisons used (as well as the outcomes investigated), the results of clinical trials conducted so far have shown no difference or found just a trivial effect in favour of Kinesio Taping. Our group conducted the most updated systematic review32 with the greatest number of

clinical trials relevant to musculoskeletal conditions and our conclusions were similar to the existing reviews. The results of the present study challenge the importance of the presence of convolutions in Kinesio Taping for effectiveness of treatment in people with chronic low back pain. According to the creators of the Kinesio Taping Method14 these over convolutions increase blood and lymphatic flow, and aid in reducing pain. Therefore, applying proper tension is one of the key factors for effective treatment.14 However, the outcome with convolutions was not superior to the control group and so the improvement seen in both groups cannot be due to tape tension. The results of the present study challenge the theory that these convolutions are part of the mechanism. To date, the present study is the largest clinical trial conducted on the effectiveness of Kinesio Taping.

4C), amygdala (F(3–16) = 2 451;

The acute administration did not alter the mitochondrial complex II–III activity in the prefrontal cortex (F(3–16) = 0,759; p = 0,53 Fig. 4C), amygdala (F(3–16) = 2.451; Wnt assay p = 0.10 Fig. 4C) and hippocampus (F(3–16) = 1.519; p = 0,24 Fig. 4C). The chronic treatment increased the mitochondrial complex II-III activity in the prefrontal cortex (F(3–15) = 4.175; p = 0,03 Fig. 4C) and hippocampus (F(3–13) = 10.168; p = 0.001 Fig. 4C) with imipramine at the dose of 30 mg/kg and in the amygdala (F(3–14) = 10.512; p = 0.001 Fig. 4C) with all treatments, but did not alter in the prefrontal cortex (F(3–15) = 4.175; p > 0.05 Fig. 4C) and in the hippocampus

(F(3–13) = 10.168; p > 0.05 Fig. 4C). The acute administration increased Crizotinib ic50 the mitochondrial complex IV activity in the hippocampus (F(3–13) = 18.471; p < 0,001 Fig. 4D) with all treatments, compared with saline, but did not alter in the prefrontal cortex (F(3–12) = 0.828; p = 0.50 Fig. 4D) and amygdala (F(3–11) = 4,514; p = 0,27 Fig. 4D). The chronic treatment did not alter the mitochondrial complex IV activity in the prefrontal cortex (F(3–13) = 0.689; p = 0.57 Fig. 4D), amygdala (F(3–16) = 3.666; p = 0.35 Fig. 4D) or hippocampus (F(3–11) = 2.317; p = 0.13 Fig. 4D). The acute treatment decreased the Bcl-2 protein levels in the

prefrontal cortex (F(3–12) = 106.818; p < 0,001 Fig. 5A) and in the hippocampus (F(3–12) = 265,226; p < 0,001 Fig. 5A) with imipramine at the dose of 30 mg/kg and lamotrigine at the dose of 20 mg/kg, and also in the amygdala (F(3–12) = 87.304; p < 0.001 Fig. 5A) with all treatments, compared with saline. The chronic treatment decreased the Bcl-2 protein levels in the prefrontal cortex (F(3–12) = 310.093; p < 0.001 Fig. 5A), amygdala (F(3–12) = 238.818; p < 0.001

Fig. 5A) and hippocampus (F(3–12) = 557.669; p < 0.001 Fig. 5A) with all treatments. The acute treatment Levetiracetam increased the AKT protein levels in the prefrontal cortex (F(3–12) = 49.088; p = 0.000 Fig. 5B) with imipramine at the dose of 30 mg/kg, in the amygdala (F(3–12) = 70.335; p < 0.001 Fig. 5B) with lamotrigine at the dose of 20 mg/kg and in the hippocampus (F(3–12) = 21.011; p = 0.009 Fig. 5B), with imipramine at the dose of 30 mg/kg and with lamotrigine at the dose of 20 mg/kg, compared with saline. The acute treatment also decreased the AKT protein levels in the amygdala with imipramine at the dose of 30 mg/kg (F(3–12) = 70.335; p = 0.04 Fig. 5B) and in the hippocampus with lamotrigine at the dose of 10 mg/kg (F(3–12) = 21.011; p = 0.04 Fig. 5B). The chronic treatment increased the AKT protein levels in the prefrontal cortex (F(3–12) = 121.938; p < 0,001 Fig.

3A and B), proximal tibiae ( Fig  3C and D), and vertebrae ( Fig

3A and B), proximal tibiae ( Fig. 3C and D), and vertebrae ( Fig. 4A and C) when compared with OVX vehicle-treated mice. It was shown that BV/TV, Tb.N, BMD, and Conn.D were higher, whereas Tb.Sp and SMI were lower in DIM-treated OVX mice when compared with vehicle-treated OVX mice

( Fig. 3E and F). Taken together, these results indicated that DIM treatment effectively prevented OVX-induced changes in bone that could result in 26s Proteasome structure an osteopenic condition. To explore the cellular mechanism by which DIM prevented bone loss in a mouse model of osteoporosis, we first examined whether changes occurred in osteoclastic bone resorption in DIM-treated OVX mice using TRAP staining and histomorphometric analyses. As shown in Fig. 4B and D, compared with learn more sham mice, OVX mice exhibited a significant increase

in osteoclastic bone resorption parameters, such as N.Oc/B.Pm and Oc.S/BS. However, DIM-treated OVX mice exhibited decreased osteoclastic bone resorption when compared with vehicle-treated OVX mice. To examine whether osteoblastic bone formation is abnormal in DIM-treated OVX mice, we performed toluidine blue staining. No other differences between the DIM-treated OVX mice and the vehicle-treated OVX mice were observed in osteoblastic bone formation parameters such as N.Ob/B.Pm and Ob.S/BS (Fig. 4E). These results indicate that DIM treatment prevented ovariectomy-induced bone loss by inhibiting bone already resorption. Bone remodeling involves the removal of old or damaged bone by osteoclasts (bone resorption) and the subsequent replacement of new bone formed by osteoblasts (bone formation). Normal bone remodeling requires a tight coupling of bone resorption to bone formation, so that there is no appreciable alteration in bone mass or quality after each remodeling cycle (30) and (31). However, this important physiological

process can be perturbed by various endogenous factors such as menopause-associated hormonal changes, secondary diseases, and exogenous factors such as drugs and pollutants. Osteoclastic bone resorption may be substantially increased, and bone mass can be subsequently decreased, as a result of various pathologies such as osteoporosis, rheumatoid arthritis, and metastatic bone disease (32), (33), (34) and (35). Therefore, suppressing osteoclastic bone resorption can be prophylactic and/or an important therapeutic strategy for combating these types of bone diseases. AhR plays a critical role in various pathological and physiological processes. Our laboratory, and other groups that have more recently evaluated systemic AhR KO mice, have found that bone mass increased, and bone resorption (as assessed by N.Oc/B.Pm and Oc.S/BS) decreased, as a result of the aryl hydrocarbon receptor-deficiency in AhR KO mice (5) and (6). On the other hand, using transgenic mice expressing constitutively active AhR, Wejheden C et al.

The amount of protein extracted from 5 μL plasma by CTB or AV was

The amount of protein extracted from 5 μL plasma by CTB or AV was less than that in 0.01 μL plasma or less

than 0.1% of the starting protein concentration. Despite the relatively low resolution of a 2D-gel, there were distinct differences in the protein profile in the CTB- and AV-lipid vesicles (Figure 1). Plasma was first extracted for either CTB- or AV-vesicles followed by extraction for AV- and CTB-vesicles, respectively. The extracted vesicles were then assayed for CD9, a ubiquitous Nutlin-3a manufacturer membrane protein which was used here as a surrogate marker for plasma membrane. The level of CD9 in CTB-vesicles was similar before and after depletion with AV (Figure 2). Likewise, the level of CD9 in AV-vesicles was similar before and after depletion with CTB. Because neither of the vesicles was depleted by extraction of the other vesicle, the 2 vesicles did not share an affinity for either ligands and were distinct populations. Vesicles were isolated from plasma of preeclampsia and matched healthy pregnant women. They were then assayed for the presence of previously reported preeclampsia biomarkers using either ELISA or a commercially available antibody array. Plasma from 2 different sets of preeclampsia patients and matched healthy controls were used; 1 for each assay. Using a commercially available array of antibodies, CTB- and AV-vesicles from 6 PE patients

and 6 matched healthy controls were assayed for angiotensin-converting enzyme 2, angiopoietin 1, C reactive protein, E-selectin, endoglin (CD105), growth hormone, interleukin-6, P-selectin, plasminogen activator inhibitor-1 (PAI-1), Selleckchem JQ1 PlGF, procalcitonin, S100b, tumor growth factor β, tissue inhibitor of metallopeptidase 1, and tumor necrosis factor α (Figure 3 and Figure 4). Four proteins, namely CD105, interleukin-6,

PlGF, and tissue inhibitor of metallopeptidase 1 were significantly elevated in only CTB- but not AV-vesicles of preeclampsia patients. Another 4 PAI-1, procalcitonin, S100b, tumor growth factor β were elevated in both CTB- and AV-vesicles of PE patients. For other candidate biomarkers that Astemizole were not covered in the antibody array, CTB- and AV-vesicles from 5 PE patients and 5 matched controls were assayed by ELISA. The proteins assayed were CD9, vascular endothelial growth factor receptor 1 (VEGFR1), BNP, ANP, and PlGF. ANP was significantly increased in the CTB- but not AV-vesicles of PE patients although VEGFR1, BNP, and PlGF were significantly increased in both CTB- and AV-vesicles of PE patients (Figure 5). The statistically significant increased PlGF level (P = .047) in AV-vesicles of PE patients contrasted with its insignificant increase (P = .055) when assayed using antibody arrays. This discrepancy could be a statistical anomaly as the 2 assays were conducted using small samples of 2 independent sets of patients and controls (P = .055).

The number of eyes that met the criteria for rescue therapy durin

The number of eyes that met the criteria for rescue therapy during the study period was significantly higher in the IV bevacizumab group (n = 9) compared with the IV ranibizumab group (n = 4) (P = .042; paired t test). A multivariate

analysis comparing BCVA and central subfield thickness outcomes between the IV bevacizumab and IV ranibizumab groups, taking into account number of injections, baseline BCVA, and central subfield thickness, demonstrated a statistically significant influence of baseline BCVA on follow-up BCVA (P < .001) but no other significant differences between groups (P = .051) across follow-up time (P = .490) regarding these 2 outcomes. There was no significant Screening Library ic50 change in mean intraocular pressure compared EPZ5676 with baseline at any of the study follow-up visits in either group (P < .05). In the IV bevacizumab group, 1 patient experienced clinically significant cataract progression that prevented a clear view of the fundus after his ninth visit and another patient developed transient vitreous hemorrhage after an acute posterior vitreous detachment. There were 2 patients who developed endophthalmitis in the IV ranibizumab group (both patients were treated unilaterally) and 1 patient, also in the IV ranibizumab

group, who experienced increased blood pressure, controlled with oral Carnitine palmitoyltransferase II antihypertensive agents. Additionally, 1 patient developed transient worsening of renal function. This patient, who had the right eye treated with ranibizumab and the left eye treated with bevacizumab, had a serum creatinine level of 2.0 mg/dL at baseline and, during the study, his creatinine level increased to 2.9 mg/dL; at the last study visit, his creatinine level had returned to 2.0 mg/dL. No patient experienced

myocardial infarction, stroke, or gastrointestinal bleeding throughout the study period. In the present study, both groups achieved significant improvement in BCVA compared with baseline at all study visits (P < .05). At week 48, there was a mean BCVA improvement of 0.23 logMAR (∼11 letters) and 0.27 logMAR (∼13 letters) in the IV bevacizumab and IV ranibizumab groups, respectively. Similarly, 12 reported a mean BCVA improvement of 8.2 letters in patients with DME treated with IV ranibizumab plus prompt laser and 8.4 letters in patients treated with IV ranibizumab plus deferred laser after 1 year of follow-up. More recently, the RISE and RIDE 13 studies also showed significant improvements in BCVA associated with IV ranibizumab treatment for DME. In the RISE study, the IV ranibizumab 0.5 mg group demonstrated a mean improvement of 12 letters in BCVA at 1 year, and in the RIDE study, the IV ranibizumab 0.5 mg group demonstrated a mean improvement of 11 letters in BCVA at 1 year.

This figure is similar to Elner and associates’ findings, which w

This figure is similar to Elner and associates’ findings, which we calculated as 71%.15 Our estimate Alectinib mouse of 63% and its 95% confidence interval

range (50.4%–75.6%) for the population mean is no different. Subdural hemorrhages in the optic nerve sheath were detected bilaterally in all but 1 case. An intrascleral hemorrhage was found in 1 of these 2 eyes without subdural hemorrhage. Similarly, in Elner and associates’ study,15 subdural hemorrhage was found in all but 1 case, which, like ours, was positive for intrascleral hemorrhage. These exceptional cases illustrate that subdural hemorrhages are likely neither sufficient nor necessary for an intrascleral hemorrhage. It is our suspicion that scleral Veliparib nmr shearing forces are necessary to rupture the intrascleral

vessels. In yet another study, optic nerve sheath hemorrhages were found to be statistically more frequent in 18 abusive head trauma “cases” compared to 18 fatal, accidental, and traumatic “controls.”16 These findings align with our own and support the theory that shaking forces are likely critical for creating subdural and intrascleral hemorrhages. The acceleration–deceleration cycles responsible for causing vitreoretinal traction and intraocular trauma are likely similar to those that create damage at the scleral–optic nerve junction. This theory of tight tethering at this junction is consistent with other reports of intrascleral hemorrhages adjacent to the optic nerve.17 In the literature, only 2 cases of peripapillary intrascleral hemorrhage have occurred in the absence of abusive head trauma.18 Both of these cases involved neonates in utero of mothers involved in a motor vehicle accident, underscoring the requirement of intense acceleration–deceleration forces. Although subdural hemorrhages are one of the most sensitive findings for abusive head trauma, reaching 100% in 1 report,19 they are not always present in shaking trauma, as demonstrated by the 97% proportion in our own cases. No specific histopathologic finding, including subdural hemorrhage or any retinal hemorrhage, is sufficient or necessary for a diagnosis of abusive head trauma.20 Rather, it is the presence or absence of several findings,

with clinical clues from the history, that collectively lead to a reliable, valid, and correct diagnosis. In 100 hospitalized patients younger than 2 years, L-NAME HCl retinal hemorrhages were exclusively found in patients with inflicted injury, and only occasionally from serious accidental head injury.21 In the absence of other reasonable medical explanation, retinal hemorrhages most often require severe physical trauma. The proportion of retinal hemorrhages, 83% in all our abusive head trauma cases, is a figure that is essentially equivalent to the 85% found and summarized previously.22 Out of the 17% that did not have retinal hemorrhages, all but 4 eyes (2 cases) were unilateral and, therefore, detectable in the fellow eye. These other 4 eyes (6.

Secondly, residing in an area with high levels of maternal educat

Secondly, residing in an area with high levels of maternal education or belonging to a migrant family was associated with an increase in immunization rates in bivariate analyses. These effects disappeared in multivariable analyses, reflecting possible confounding by travel time to vaccine clinics. Overall, however, the effect of maternal education produced higher coverage with three doses of pentavalent vaccine at age 12 months in the most educated areas compared to the less educated ones. This result is consistent with 2008 Kenya

DHS data showing substantially higher coverage for all vaccines in children with educated mothers compared to those with uneducated mothers (unpublished data, selleck chemicals Kenya 2008 DHS), and buttresses the notion of a strong relationship between maternal education and child health. Geographic access to care in the Kilfi Epi-DSS is comparable to most other VE-822 in vitro regions of Kenya [31] and immunization coverage is similarly high based on data from the most recent Demographic and Health Survey and WHO/UNICEF joint coverage estimates. It is therefore likely that

the vast majority of Kenyan children enjoy as equitable and timely access to immunization as do residents of our study area. In this context, the introduction of a new, effective vaccine against pneumococcal disease is likely to reach all children at an early age and lead to substantial improvements in child health. The authors wish to thank the Immunization Coverage Survey field team including Francis Kanyetta, Joseph Kenga and Christopher Nyundo, as well as Li Xingyu for help with project management. The Kilifi Epi-DSS is part of the INDEPTH network of demographic surveillance sites. This study is published with the permission of the director of the Kenya Medical Research Institute (KEMRI), Nairobi. “
“The author’s wish to apologise that one reference was incorrectly represented in the original paper. The incorrect reference is: [15] Tangcharoensathien V, Limwattananon S, Chaugwon

R. and Research for Development of an Optimal Strategy for Prevention and Control of Cervical Cancer in Thailand. Research report submitted the World Bank. Nonthaburi: Ministry of Public Health, Thailand, 2008. “
“Pneumoviruses are an important cause of respiratory infections in mammals [1]. One well-known member of the pneumovirus genus is hRSV, a major cause of severe respiratory disease in infants and elderly [2]. A failed vaccine trial using formalin-inactivated hRSV (FI-RSV) in the 1960s that led to enhanced disease instead of immune protection [3], [4], [5] and [6], has triggered intense efforts to elucidate how to induce immune responses that can prevent or protect against natural hRSV infection without causing pathology.

Concomitant administration

of adolescent vaccines – quadr

Concomitant administration

of adolescent vaccines – quadrivalent meningococcal conjugate vaccine, Tdap and one of the three HPV doses – would be expected to facilitate improved compliance with the vaccination recommendations. In our study, we did not observe increased reactogenicity with concomitant or sequential administration of the investigational quadrivalent meningococcal CRM197 conjugate vaccine, MenACWY-CRM, with Tdap and HPV. In addition, immune responses to the antigens contained in MenACWY-CRM were not influenced by concomitant administration with Tdap and HPV. Using an hSBA titre ≥1:8 as an endpoint, predefined measures of non-inferiority for both concomitant and sequential administration of MenACWY-CRM were demonstrated for all serogroups. Using seroresponse as an endpoint, non-inferiority of sequential administration of MenACWY-CRM 1 month after Tdap and HPV was demonstrated for all serogroups except W-135. However, the response to serogroup W-135 was still robust, most importantly among those subjects with a seronegative titre at baseline where 90% of subjects achieved an hSBA titre of ≥1:8. Lower GMTs were reported for serogroups W-135 and Y when MenACWY-CRM was administered 1 month after Tdap. Nevertheless, non-inferiority of the immune response was still demonstrated for all serogroups.

The immune responses to the tetanus and diphtheria antigens contained in Tdap remained robust when Calpain given concomitantly or sequentially with MenACWY-CRM, and were non-inferior when compared with those induced by Tdap alone. Concomitant administration of Tdap and MenACWY-CRM augmented the anti-diphtheria response, as has been previously reported when adolescents were concomitantly administered diphtheria-toxoid

quadrivalent meningococcal conjugate and Td vaccine [16] and [17]. Using the group ratio of GMCs as the endpoint for pertussis antigens, non-inferiority was demonstrated for PT but not for FHA and PRN, when comparing concomitant administration with Tdap alone. The clinical relevance of this finding is not clear, as no correlates of protection for pertussis have been clearly established, and linkages of clinical efficacy to immunogenicity have only been evaluated in infants [18]. Responses to PT [19], or PT, PRN and FIM2 (fimbriae, an antigen not present in the tested vaccine) [20] and [21] have been suggested to be the major factors in protection against pertussis disease. Although the absolute GMCs for pertussis antigens in this study in the concomitant administration group were lower than those when Tdap was administered alone, they are comparable or higher than those shown to provide clinical protection in infants [18]. A robust response to the pertussis component was shown by 7.1–21.7-fold increases in GMCs for the three antigens.