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Enterotoxigenic Escherichia coli (ETEC) is a major cause of travellers' diarrhoea. We investigated the rate of diarrhoea attacks, safety, and feasibility of a vaccine containing heat-labile enterotoxin (LT) from ETEC delivered to the skin by patch in travellers to Mexico and Guatemala. In this phase II study, healthy adults (aged 18–64 years) who planned to travel to Mexico or Guatemala and had access to a US regional vaccination centre were eligible. A centralised randomisation code was used for allocation, which was masked to participants and site staff. Primary endpoints were to investigate the field rate of ETEC diarrhoea, and to assess the safety of heat-labile toxins from E coli (LT) delivered via patch. Secondary endpoints included vaccine efficacy against travellers' diarrhoea and ETEC. Participants were vaccinated before travel, with two patches given 2–3 weeks apart. Patches contained either 37·5 μg of LT or placebo. Participants tracked stool output on diary cards in country and provided samples for pathogen identification if diarrhoea occurred. Diarrhoea was graded by the number of loose stools in 24 h: mild (three), moderate (four or five), and severe (at least six). Analysis was per protocol. The trial is registered with ClinicalTrials.gov, number NCT00516659. Recruitment closed after 201 participants were assigned patches. 178 individuals received two vaccinations and travelled and 170 were analysed. 24 (22%) of 111 placebo recipients had diarrhoea, of whom 11 (10%) had ETEC diarrhoea. The vaccine was safe and immunogenic. The 59 LT-patch recipients were protected against moderate-to-severe diarrhoea (protective efficacy [PE] 75%, p=0·0070) and severe diarrhoea (PE 84%, p=0·0332). LT-patch recipients who became ill had shorter episodes of diarrhoea (0·5 days vs 2·1 days, p=0·0006) with fewer loose stools (3·7 vs 10·5, p<0·0001) than placebo. Travellers' diarrhoea is a common ailment, with ETEC diarrhoea illness occurring in 10% of cases. The vaccine patch is safe and feasible, with benefits to the rate and severity of travellers' diarrhoea. IOMAI Corporation.

Background and Objectives During a hot and humid summer period workers became ill with fever and flu-like symptoms after repairing a decanter for sludge concentration at a sewage treatment plant. The work took place over a period of 10 days in a small closed room, while another decanter was in operation and was consequently emitting aerosol to the environment, to which the workers were exposed. The aim of this study was to determine the cause of this outbreak of febrile illness so that additional cases could be prevented. Methods All 5 patients were seen and examined in the Department of Occupational Medicine. Furthermore 2 of the workers had recurrent illness and were examined during hospitalization. As Pontiac fever (nonpneumonic legionellosis) was suspected, antibodies to legionellae were measured in blood samples. After positive antibody titers to Legionella pneumophila were found, samples of the sludge were collected for legionellae culture. Results and conclusions The clinical picture agreeed with that described for Pontiac fever, and positive antibody titers to L pneumophila serogroup 1 were found in blood from all 5 patients. L pneumophila serogroup 1 was cultured in high amounts from sludge from the decanter. It was concluded that the fever was caused by L pneumophila emitted to the environment by the uncovered decanter. Procedures for preventing new cases were established.

The use of adjuvants to enhance the immune response to novel pandemic influenza vaccine candidates may overcome the poor immune responses seen in immunologically naïve populations. The confluence of a highly pathogenic H5N1 influenza virus and the widespread absence of pre-existing immunity has driven the search for effective strategies for immunization in the face of a lethal pandemic. The potent adjuvant, heat labile enterotoxin from E. coli (LT), placed over the immunization site in a patch, is a novel adjuvant strategy for immune enhancement, and was evaluated using an H5N1 injectable vaccine. In this observer-blind, placebo-controlled clinical study, 500 healthy adults 18–49 years of age were randomized to receive two intramuscular doses of A/Vietnam/1194/2004 A/H5N1 vaccine (5 μg, 15 μg or 45 μg) or placebo (saline) 21 days apart. For each of the influenza vaccine doses, a 50 μg LT adjuvant patch was applied over the injection site at either the second or both immunizations and the HI responses (titers) were compared to H5N1 vaccine alone. The study's primary endpoint was safety, and secondary immunogenicity endpoints were evaluated using European (CHMP) licensure criteria. The vaccine was safe and well tolerated, and subjects generally lacked pre-existing H5N1 immunity. The single-dose injection 45 μg HA/LT patch regimen met all CHMP licensure criteria, including a 73% seroprotection rate compared to 49% seroprotection without a patch. Significant adjuvant effects were seen at all HA doses on Day 21. By contrast, only modest adjuvant effects were observed with the boosting regimen in subjects first primed with H5N1 alone and given the adjuvant patch only on the second immunization. The two-injection/two-patch 45 μg HA regimen achieved significantly higher titers and GMFR compared to injection alone (GMFR 33.1 vs. 16.9, HI 226 vs. 94, p < 0.05) and a 94% seroprotection rate. The LT adjuvant patch placed over the injection site was safe, significantly enhanced the immune response to an H5N1 candidate vaccine, and achieved a 73% seroprotection rate after a single dose. The LT adjuvant patch has more modest benefits in recently primed populations similar to other candidate vaccine adjuvants, but a two-dose patch plus injection regimen resulted in robust HI responses.

Tetrahymena thermophila has been transformed to paromomycin-resistant phenotypes by microinjection of an aminoglycoside 3'-phosphotransferse (neo) gene under the control of the T. thermophila histone H4-I promoter. This chimeric neo gene, by itself or on a vector containing a rRNA-encoding DNA (rDNA) origin of replication, transforms T. thermophila. In cells transformed with the rDNA origin vector, the neo gene is usually found integrated into the endogenous rDNA molecules and is present in high copy number. In transformants obtained by microinjecting only the linear chimeric gene, the neo gene is found to have replaced the histone H4-I gene or is found integrated into the 5' flanking region of the H4-I gene. The relative transcript levels of the neo gene in T. thermophila transformed by the linear chimeric gene are much higher than in cells transformed with the vector. The neo gene provides an effective selectable marker for transformation of T. thermophila.

Deoxygenation is a global problem in coastal and open regions of the ocean, and has led to expanding areas of oxygen minimum zones and coastal hypoxia. The recent expansion of hypoxia in coastal ecosystems has been primarily attributed to global warming and enhanced nutrient input from land and atmosphere. The largest anthropogenically induced hypoxic area in the world is the Baltic Sea, where the relative importance of physical forcing versus eutrophication is still debated. We have analyzed water column oxygen and salinity profiles to reconstruct oxygen and stratification conditions over the last 115 y and compare the influence of both climate and anthropogenic forcing on hypoxia. We report a 10-fold increase of hypoxia in the Baltic Sea and show that this is primarily linked to increased inputs of nutrients from land, although increased respiration from higher temperatures during the last two decades has contributed to worsening oxygen conditions. Although shifts in climate and physical circulation are important factors modulating the extent of hypoxia, further nutrient reductions in the Baltic Sea will be necessary to reduce the ecosystems impacts of deoxygenation.

To determine and compare estimates of the smallest worthwhile effect (SWE) for physiotherapy in neck, shoulder, and low-back pain patients and to investigate the influence of sociodemographic, clinical, and psychological factors on these estimates. A structured telephone interview was conducted before treatment was commenced in 160 patients referred for primary care physiotherapy. The benefit-harm trade-off method was used to estimate the SWE of physiotherapy for the following outcomes; pain, disability, and time to recovery, compared with the improvement achieved without any treatment (natural course). Regression analyses were used to assess the influence of sociodemographics, clinical variables, and intake scores on pain, disability, and psychological scales. The median SWE for improvements on pain and disability was 20% (interquartile range 10%–30%), and the SWE for time to recovery was 10 days (interquartile range 7–14 days) over a period of 6 weeks. These estimates did not differ with respect to pain location (neck, shoulder, or back) and were generally unaffected by sociodemographic, clinical, and psychological factors. People with neck, shoulder, and low-back pain need to see at least 20% of additional improvement on pain and disability compared with natural recovery to consider that the effect of physiotherapy is worthwhile, given its costs, potential side effects, and inconveniences.

Engineering of materials with specific physical properties has recently focused on the effect of nano-sized ‘guest domains’ in a ‘host matrix’ that enable tuning of electrical, mechanical, photo-optical or thermal properties. A low thermal conductivity is a prerequisite for obtaining effective thermoelectric materials, and the challenge is to limit the conduction of heat by phonons, without simultaneously reducing the charge transport. This is named the ‘phonon glass–electron crystal’ concept and may be realized in host–guest systems. The guest entities are believed to have independent oscillations, so-called rattler modes, which scatter the acoustic phonons and reduce the thermal conductivity. We have investigated the phonon dispersion relation in the phonon glass–electron crystal material Ba 8 Ga 16 Ge 30 using neutron triple-axis spectroscopy. The results disclose unambiguously the theoretically predicted avoided crossing of the rattler modes and the acoustic-phonon branches. The observed phonon lifetimes are longer than expected, and a new explanation for the low κ L is provided. The presence of guest atoms—known as rattlers—in the cages of some clathrate structures is considered to be responsible for the low thermal conductivity of the materials. Neutron spectroscopy provides important evidence regarding the actual phonon dispersion in the material, and the precise way in which this is influenced by rattlers.

In the 1980s, Danish coastal waters suffered from eutrophication and several nutrient management plans have been implemented during the years to improve ecological status. This study aims at giving a holistic ecosystem perspective on 25 years of mitigation measures. We report trends of nutrient inputs and the responses to these in various chemical and biological components. Nutrient inputs from land were reduced by ~50 % for nitrogen (N) and 56 % for phosphorus (P) since 1990. These reductions resulted in significant and parallel declines in nutrient concentrations, and initiated a shift in the dominance of primary producers towards reduced phytoplankton biomass (chlorophyll a concentration) and increased cover of macroalgae in deeper waters. In the last 5 years, eelgrass meadows have also expanded towards deeper waters, in response to improving water clarity. An expected improvement of bottom water oxygen conditions has not been observed, presumably because more frequent stratification and higher water temperatures have counteracted the expected positive effects of reduced nutrient inputs. The biomass of the benthic macrofauna decreased as expected, but it was composed of a drastic decline of filter feeders paralleled by a more moderate increase of deposit feeders. This shift was most likely induced by increasing stratification. The reduced benthic filtration along with the limited eelgrass cover probably kept relatively more particles in suspension, which can explain why improvements in the Secchi depths were modest. Overall, several ecosystem components demonstrated clear signs of improvement, suggesting that at least partial recovery is attainable. On this basis, we propose a conceptual scheme for recovery of shallow coastal ecosystems following marked reductions in nutrient inputs.

Physical activity is associated not only with health-related parameters, but also with cognitive and academic performance. However, no large scale school-based physical activity interventions have investigated effects on cognitive performance in adolescents. The aim of this study was to describe the effectiveness of a school-based physical activity intervention in enhancing cognitive performance in 12-14 years old adolescents. A 20 week cluster randomized controlled trial was conducted including seven intervention and seven control schools. A total of 632 students (mean (SD) age: 12.9 (0.6) years) completed the trial with baseline and follow-up data on primary or secondary outcomes (74% of randomized subjects). The intervention targeted physical activity during academic subjects, recess, school transportation and leisure-time. Cognitive performance was assessed using an executive functions test of inhibition (flanker task) with the primary outcomes being accuracy and reaction time on congruent and incongruent trials. Secondary outcomes included mathematics performance, physical activity levels, body-mass index, waist-circumference and cardiorespiratory fitness. No significant difference in change, comparing the intervention group to the control group, was observed on the primary outcomes (p's>0.05) or mathematics skills (p>0.05). An intervention effect was found for cardiorespiratory fitness in girls (21 meters (95% CI: 4.4-38.6) and body-mass index in boys (-0.22 kg/m2 (95% CI: -0.39-0.05). Contrary to our predictions, a significantly larger change in interference control for reaction time was found in favor of the control group (5.0 milliseconds (95% CI: 0-9). Baseline to mid-intervention changes in physical activity levels did not differ significantly between groups (all p's>0.05). No evidence was found for effectiveness of a 20-week multi-faceted school-based physical activity intervention for enhancing executive functioning or mathematics skills compared to a control group, but low implementation fidelity precludes interpretation of the causal relationship. www.ClinicalTrials.gov NCT02012881.

Background Onset of allergic asthma has a strong association with childhood but only a few studies have analyzed incidence of asthma from childhood to late adulthood in relation to allergy. The purpose of the study was to assess age-specific incidence of allergic and non-allergic asthma. Methods Questionnaires were sent to 8000 randomly selected recipients aged 20–69 years in Finland in 2016. The response rate was 52.3% ( n  = 4173). The questionnaire included questions on e.g. atopic status, asthma and age at asthma diagnosis. Asthma was classified allergic if also a physician-diagnosed allergic rhinitis was reported. Results The prevalence of physician-diagnosed asthma and allergic rhinitis were 11.2 and 17.8%, respectively. Of the 445 responders with physician-diagnosed asthma, 52% were classified as allergic and 48% as non-allergic. Median ages at diagnosis of allergic and non-allergic asthma were 19 and 35 years, respectively. Among subjects with asthma diagnosis at ages 0–9, 10–19, 20–29, 30–39, 40–49, 50–59 and 60–69 years, 70, 62, 58, 53, 38, 19 and 33%, respectively, were allergic. For non-allergic asthma, the incidence rate was lowest in children and young adults (0.7/1000/year). It increased after middle age and was highest in older age groups (2.4/1000/year in 50–59 years old). Conclusions The incidence of allergic asthma is highest in early childhood and steadily decreases with advancing age, while the incidence of non-allergic asthma is low until it peaks in late adulthood. After approximately 40 years of age, most of the new cases of asthma are non-allergic.