Group A rotavirus (RVA) is a double stranded RNA virus consisting of 11 segments. Two outer capsid proteins, VP7 (G genotype) and VP4 (P genotype), independently elicit a serotype-specific neutralizing immune responses that may

play an important role in protection against recurrent infections [4]. These viruses are genetically BGJ398 in vitro diverse, and RVA VP4 and VP7 encoding genes have been classified into atleast 27 G genotypes (G1–27) and 37 P genotypes (P[1]–[37]), respectively, based on differences in their nucleotide sequences [5] and [6]. The segmented nature of rotavirus genome provides the mechanism for the generation of genetic diversity by the process of genetic reassortment, which may occur during co-infections of circulating human and animal strains [7], [8] and [9]. Two rotavirus vaccines namely Rotarix® (RV1; monovalent G1P[8]; GlaxoSmithKline Biologicals, Rixensart, Belgium) and RotaTeq® (RV5; pentavalent G1, G2, G3, G4,P[8]; Merck Vaccines, Whitehouse Station, NJ, USA) are commercially available since 2006. Recently, another oral live attenuated vaccine candidate buy Galunisertib has

been evaluated in phase III studies in India, and is derived from a G9P [11] human bovine reassortant strain 116E [10], [11] and [12]. Large scale vaccine trials with Rotarix and RotaTeq have shown high efficacy in developed countries of Europe, Australia and USA though efficacy is lower (39–72%) in low income countries of Asia and Africa [13], [14] and [15]. In spite of lower efficacy, these vaccines reduce a greater these number of severe rotavirus gastroenteritis events in developing countries because of the great background rate of disease, resulting in the WHO’s recommendations for introduction of RV vaccines in national immunization programs worldwide in 2009 [16]. However, RV vaccines have still not been introduced in national immunization programme of most South Asian and African countries,

for several reasons including lack of disease burden data and economic feasibility. During the past decade, several surveillance studies in hospitalized children have reported prevalence and strain diversity of RVA across India [18], [19], [20], [21] and [22]. A multicenter hospital based study (2005–2009) in India, including Eastern India, estimated 40% hospitalization rates due to rotavirus [17] and [21]. The predominant strain circulating during 2005–2009 was G1P[8], followed by G2P[4]. G3, G4, G9 and G12 strains were observed at lower frequency (<10%) [17], [21] and [22]. Most surveillance studies done in India were focussed on children hospitalized with acute gastroenteritis; however, the proportion of RVAs in cases of milder diarrhea and often reporting to outpatient departments (OPD) (some or no dehydration) remains largely unknown.

However, it has implications for students whose score is within the borderline pass/fail range. If the pass mark is 40 out of the total 80 marks on the 20 items, then 40 minus 6.5 (33.5) might be considered an outright fail, while 40 plus 6.5 (46.5) might be considered an outright pass. The values in between would require

a process for deciding on further assessment for confidence that the student has an adequate level of professional competence. There are many possible sources of error in assessment scores and these are likely to be related to circumstances, educator, student, and the interaction of these factors. If other indicators of student ability indicated competency, selleck kinase inhibitor a mark as low as 34 may be acceptable. Alternatively, if other assessments indicate a student consistently performs in the borderline range, further practice and assessment selleck compound library (or tailored remediation) may be triggered even by grades as high as 47. Norman et al (2003) reported that for health-related quality of life outcome measures, the change in measures of health outcomes that people typically consider to be important (minimal important difference) is approximately half a standard deviation of raw scores for a representative cohort. If the APP scores behaved as quality of life scores do, then an estimate of the possible minimally important difference would be 6–8 points, a proposal that warrants investigation. There will always be some

lack of agreement between raters and defining the limits of tolerable disagreement is challenging. Some variability would be expected due to the unpredictable challenges of a complex health services environment combined with variable opportunities for

educators to observe student ability across the spectrum of clinical skills. Despite these challenges, in this interrater reliability trial the physiotherapy clinical educators demonstrated a high level of consistency in the assessment and marking of physiotherapy students’ performance on clinical placements when using the Assessment of Physiotherapy Practice. Ethics: Approval for the study was provided by the Human Ethics Committees of Monash University and from the Human Ethics Committees of each of the participating universities. All participants gave written informed Org 27569 consent before data collection began. Competing interests: Nil. Support: Funding from the Australian Learning and Teaching Council (ALTC) enabled employment of a research assistant and travel to conduct focus groups and training workshops. The authors acknowledge the assistance of Curtin, James Cook, La Trobe, Griffith, Monash, and Sydney Universities and thank the clinical educators and students who participated. “
“Summary of: Hill JC et al (2011) Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 378: 1560–1571. Published Online September 29, 2011 DOI:10.

The data are presented as mean ± standard deviation of three determinations. Statistical analyses were performed using a one-way analysis of variance. Results were calculated by employing the statistical software (SPSS). Data are expressed as mean ± standard deviation (n = 3). P values: P < 0.05 (a); P < 0.01 (b); P < 0.001 (c) compared to the control value, respectively. n-Hexacosane (1): mp 56–58 °C,11 white solid, C26H54,m/z 366 (M+), IR (vmax) cm−1 (KBr): 2940, 2880, 730, 720. Polypodatetraene (2): pale yellow oil,12 C30H50, m/z 410

(M+), IR (vmax) cm−1 (KBr): 1650, 1630, 1385, 1370, 890.1H NMR (CDCl3, 300 MHz): 5.12 (3H, t), 2.01–1.15 (38H, m), 0.88 (3H, s), 0.85 (3H, s) and 0.82 (3H, ZD6474 nmr s). α-Amyrin acetate (3): mp 222–223 °C,13 and 14 white needles, C32H52O2, m/z 468 (M+), IR (vmax) cm−1 (KBr): 1730, 1650, 1380, 1350, 1250. 1H NMR (CDCl3, 300 MHz): 5.12 (1H, t), 4.50 (1H, dd), 2.05 (3H, s), 1.93-1.13 (23H, m), 1.06–0.78 (8 × CH3). Gluanol acetate (4): mp 184–85 °C,14 white needles, C32H52O2, m/z 468 (M+), IR (vmax) cm−1 (KBr):

1740, 1640, 1380, 1350, 1240, 970, 820. 1H NMR (CDCl3, 300 MHz): 5.18 (2H, m), 4.50 (1H, m), 2.05 (3H, s), 1.98–1.13 (22H, m) and 1.06-0.79 (9 × CH3). 13C NMR (CDCl3, 75 MHz): 171.0 (C O, C-1′), 145.2 (C-8), 139.7 (C-9), 124.3 (C-22), 121.6 (C-33), 80.9 (C-3), 59.0 (C-17), 55.2 (C-14), 47.5 (C-5), 41.6 (C-20), 39.7 (C-13), 37.7 (C-4), 34.7 (C-10), 33.3 (C-25), 39.6–25.9 (9 × CH2), HIF inhibitor 23.5–15.5 (9 × CH3). Lupeol acetate (5): mp 278–80 °C,15 white needles, C32H52O2, m/z 468 (M+), IR (vmax) cm−1 (KBr): 1750, 1640, 1385, 1360, 1310, 1245, 880. 1H NMR (CDCl3, 300 MHz): Cell press 4.69

(1H, broad s), 4.57 (1H, broad s), 4.40 (1H, m), 2.37 (1H, m), 2.04 (3H, s), 1.68 (3H, s), 1.64-1.20 (24H, m), 1.04 (3H, s), 0.97 (3H, s), 0.87 (3H, s), 0.85 (3H, s), 0.83 (3H, s), 0.78 (3H, s). β-Amyrin acetate (6): mp 236–37 °C,14 white powder, C32H52O2, m/z 468 (M+), IR (vmax) cm−1 (KBr): 1730, 1650, 1380, 1360, 1250, 960, 820. 1H NMR (CDCl3, 300 MHz): 5.12 (1H, t), 4.50 (1H, dd), 2.05 (3H, s), 1.93-1.13 (23H, m), 1.06–0.78 (8 × CH3). Bergenin (7): mp 236–38 °C,16 and 17 white granules, C14H16O9, m/z 328 (M+), IR (vmax) cm−1 (KBr): 3400 (broad) 1705, 1620, 1250, 1180, 1125, 1040, 1020, 990, 760. 1H NMR (CDCl3, 300 MHz): 7.58 (s, H-7), 4.85 (d,J = 10.2 Hz), 4.06 (dd, J = 12.3, 9.6 Hz), 3.99 (d, J = 6.0 Hz), 3.91 (3H, s, H-12), 3.85 (dd, J = 9.3, 8.7 Hz), 3.70 (1H, m, H-2), 3.49 (1H, t, J = 9.3 Hz).

When compared to AUCP1, AUCP2 exhibited more degree of cerebroprotection. Results of tissue TNF-α level are presented in Table 4 and Fig. 8. In comparison with I/R control group pyrimidines (AUCP1 and AUCP2) treatment significantly reduced the TNF-α levels and thereby contributed to its anti-inflammatory

activity. When compared to AUCP1, AUCP2 exhibited more degree of cerebroprotection. Results of tissue IL-10 levels are presented in Table 4 and Fig. 9. In comparison with I/R control group pyrimidines (AUCP1 and www.selleckchem.com/products/kpt-330.html AUCP2) treatment significantly enhanced the IL-10 levels and thereby contributed to its endogenous anti-inflammatory activity. When compared to AUCP1, AUCP2 exhibited more degree of cerebroprotection. In summary, AUCP2 has offered more degree of cerebroprotection when compared to AUCP1. The probable mechanisms involved Alisertib in the cerebroprotective activity of pyrimidines (AUCP1 and AUCP2) might be due to their antioxidant and anti-inflammatory properties. All authors

have none to declare. One of the authors (Venkata Satyanarayana Murthy Bendi) is thankful to the Principal, Andhra University College of Pharmaceutical Sciences, Visakhapatnam for providing required help in carrying out the pharmacological activities. “
“A new pharmaceutical preparation (gel) containing ketoprofen (Fig. 1) as an active compound with anti-inflammatory and analgesic activity was developed for treatment of diseases Adenosine of the muscolo-skeletal apparatus, in which a local action is preferred. In order to prevent bacterial

growth during the storage of the formulation,1 and 2 two commonly used preservatives—a mixture of the methyl ester and propyl ester of p-hydroxybenzoic acid Methyl Paraben (MP) ( Fig. 2) and Propyl Paraben (PP) ( Fig. 3)—have been used gas chromatography–mass spectrometry (GC–MS), 3 capillary electro chromatography, 4 and 5 high-performance liquid chromatography (HPLC) 6, 7 and 8, HPLC–MS 9 and 10 or micellar chromatography 11 as well. Only one HPLC method has been found in literature 12 for simultaneous determination of KP and its degradation products, but not in the presence of preservatives. Recently, preservatives in pharmaceuticals have to be quantified. HPLC analysis of MP and PP is frequently described in the literature 13, 14 and 15; another publication deals with simultaneous quantification of Ketoprofen and Parabens in a commercial gel formulation by RP–HPLC with UV detection, 16 but there is no any HPTLC method describing simultaneous determination of all three components—ketoprofen, MP and PP—in pharmaceutical preparations with no any HPTLC method describing simultaneous determination in this mobile phase with beneficial system suitability parameter. For such a formulation, a novel method capable to analyze simultaneously the active component ketoprofen, and its two preservatives Methyl Paraben and Propyl Paraben was developed.

005 and 0.0025 μg/ml respectively. The LOQ was 0.0175 and 0.00875 μg/ml of Metronidazole and Norfloxacin respectively. The results show very Trichostatin A good sensitivity of the developed method. Precision of the assay was determined by repeatability (intra-day) and intermediate precision (inter-day). The precision of the method was evaluated by carrying out five independent assays of the

sample. The intermediate precision was carried out by analyzing the sample at different day. Percentage of relative standard deviation was found to be less than 2% for within a day and day to day variations, which proves that method is precise. The accuracy studies were performed for both Metronidazole and Norfloxacin at three different levels (50%, 100% and 150%) and the mixtures were analyzed by the proposed method. The experiment was performed in triplicate and the results showed good recovery within limits. Robustness of the proposed method was determined by small deliberate changes in flow rate, change in composition of mobile phase ratio. The content of the drug was not adversely affected by these changes as evident from the low Screening Library value of RSD indicating that the method was rugged and robust (Table 3). The proposed method was applied to the

determination of Metronidazole and Norfloxacin in commercial dosage form Nor-metrogyl tablets and the result of these assays yielded 99.4 and 100.5% for Metronidazole and Norfloxacin respectively with RSD <2%. The result of the assay (Table 4) indicates that the method is selective for the assay of Metronidazole and Norfloxacin without interference from the excipients used in these tablets. MTMR9 To further confirm the stability indicating nature of the analytical method, Metronidazole and Norfloxacin were subjected to

stress testing as per ICH guidelines. The objective of stress study was to generate the degradation products under various stress conditions. The stress conditions varied both in terms of temperature and time to achieve the appropriate degradation. The spectral purity of the main peaks was evaluated using photodiode array detector to verify that the degradation peaks are well resolved from the main peaks. All degradation studies in solution were carried out at a drug concentration at 1000 μg/ml. Acid degradation was carried out in 0.1 N HCl and base degradation was carried out in 0.1 N NaOH. Both solutions are kept at room temperature for 90 min. Oxidative degradation studies were carried out in 3% H2O2 at room temperature for 15 min. Thermal degradation was carried out in water for 60 min at 60 °C. After the degradation treatments were completed, the stress content solutions were allowed to room temperature and diluted with mobile phase up to the mark. Filter the solution with 0.45 μ filters and injected to column under proposed conditions.

Ethics: The study was approved by the following Human Research Ethics Committees

(HREC): Selleck Vandetanib Alfred Health HREC; Bendigo Health HREC; Eastern Health HREC; Echuca Regional Health HREC; Goulburn Valley HREC; La Trobe University Faculty HREC; Peninsula Health HREC; Tasmania Health and Medical Human Research Ethics Council; St Vincent’s Health HREC; Southern Health HREC; Melbourne Health HREC. This study was a de-identified analysis of data collected within usual clinical care. Support: Funding sources for this research were the National Health and Medical Research Council of Australia (NHMRC Post Doctoral Fellowship for Dr Natalie de Morton, Grant no. 519555) and Eastern Health Allied Health Research Scholarship for Natasha Brusco. Competing interests: None declared. “
“Accurate quantification of the nature and dose of the interventions provided in rehabilitation settings selleck is an important challenge for both clinicians and researchers. For rehabilitation participants to reacquire skilled motor performance, a significant amount of repetitive task practice is required (Butefisch et al 1995, Classen et al 1998). Studies

of neural plasticity have shown that repetitive task training can change cortical organisation (Plautz et al 2003) however, the dose of repetitive task practice often available in therapy sessions is unlikely to be sufficient to induce cortical changes (Lang et al 2009). Some rehabilitation units seek to maximise the dose of repetitive task practice by the prescription of task-related exercises to be undertaken daily during the inpatient stay in the rehabilitation gymnasium (Olivetti et al 2007, Sherrington et al 2003). Unfortunately, therapists’

estimates of the amount of exercise that occurs in rehabilitation have been shown to be poor (Bagley et al 2009, Collier and Bernhardt 2008, Lang et al 2007). More accurate knowledge of exercise dosage may assist in intervention prescription and assessment of goal achievement. Thus a method for objectively recording the amount of exercise that participants complete is required. Mephenoxalone Establishing the effectiveness of different components of rehabilitation or ‘unpacking the black box’ has been identified as a key research area (Langhorne and Duncan 2001) and establishing the impact of a higher dose versus lower doses of rehabilitation intervention is an important aspect of this investigation (Kwakkel et al 2004). Guidelines for complex interventions suggest that a clear description of the intervention needs to be provided to enable others to replicate the intervention clinically, replicate the study, and combine evidence (Craig et al 2008). To date, the standard method used to quantify exercise dosage is the time rehabilitation participants spend in therapy (Cooke et al 2010, French et al 2008, Galvin et al 2008, Kwakkel et al 2004).

Additionally, our system of care may have certain referral characteristics and particular management features that may not make this information generalizable. Lastly, this study evaluates the initial introduction of a telecommunications system, which ran concurrently with standard channels of activation. While this has some comparative value in itself, established patterns of management made the initial acceptance of this new technology difficult,

which translated to a relatively infrequent use of the CHap software compared to regular channels (CHap was used in 17% of all STEMI system activations). Those patients treated after activation of the CHap system could be see more the subject of a biased selection, which cannot be excluded despite the fact that clinical and angiographic characteristics were compared in detail and were found to be statistically similar. Still, the derived limited number of CHap activations may have underpowered our ability to detect differences between groups. While we cannot rule out that the higher number of

regular activations represents a preference for the conventional system, we believe it represents a normal GSK2118436 solubility dmso process of acceptance to a newly implemented tool that drastically alters long-established patterns of behavior. This assumption is based on positive feedback from referral institutions and from the progressively increased use in the CHap system over the 12-month period evaluated in this study. The implementation of a two-way telecommunications system that allows for real-time interactions between the on-call interventional cardiologist and referring practitioners improves overall DTB time. In addition, non-significant trends suggesting fewer false activations may improve the cost efficiency

of a network’s STEMI system. Larger, randomized comparisons second are necessary to confirm our findings. “
“The correct spelling of the fourth author’s last name is Pavone. “
“The correct spelling of the second author’s last name is Kakkar. “
“In the following manuscript, Cardiovasc Revasc Med 2012;13:11-9 by Fefer P, et al. “The role of oxidized phospholipids, lipoprotein (a) and biomarkers of oxidized lipoproteins in chronically occluded coronary arteries in sudden cardiac death and following successful percutaneous revascularization,” (http://www.ncbi.nlm.nih.gov/pubmed/22079685) the name of the 5th author should read: Fumiyuki Otsuka (not Otsuma). “
“This article has been retracted: please see Elsevier Policy on Article Withdrawal http://www.elsevier.com/locate/withdrawalpolicy. This article has been retracted at the request of the Editor-in-Chief and the authors as it contains inaccurate data. It was found that patient data files were matched incorrectly in 33 cases to the corresponding quantitative coronary angiography results; therefore, the published data are inaccurate.

This is consistent with the two trials (Kjellman and Oberg

2002, Viljanen et al 2003) that reported medium- (WMD –2, 95% CI –7 to 4) and long-term (WMD –0.1, 95% CI –6 to 6) pain outcomes. Pooled results from the two trials that reported disability outcomes (Kjellman and Oberg 2002, Viljanen et al 2003) from general strength and conditioning exercise showed no significant difference compared with minimal intervention at the conclusion of treatment (WMD 1, 95% CI –3 to 5) or medium- (WMD 1, 95% CI –3 to 5) or long-term (WMD –3, 95% Birinapant nmr CI –7 to 2) follow-up. Manual therapy: In the three included trials of manipulation, there were four sham-controlled comparisons of the immediate analgesic effect of a single high-velocity manipulation. One trial ( Cleland et al 2005) investigated the effect of thoracic spine manipulation on neck pain and two trials ( Martinez-Segura et al 2006, Pikula 1999) investigated cervical spine manipulation. The three-arm trial by Pikula

and colleagues (1999) compared two different manipulation techniques with sham. The two manipulation groups in this trial were combined to create a single pair-wise comparison. Three trials Alectinib supplier ( Hemmila 2005, Hoving et al 2002, 2006, Skillgate et al 2007) were identified that compared manual therapy with minimal or no intervention. Pooled outcomes from three trials (Cleland et al 2005, Martinez-Segura et al 2006, Pikula 1999) show a significant analgesic benefit from a single manipulation compared with control (WMD –22, 95% CI –32 to –11). Medium- and longterm outcomes were not reported in these trials. Disability was not assessed. Pooled outcomes from two trials (Hoving et al 2002, Skillgate

et al 2007) show that manual therapy provided better pain relief after a course of treatment than minimal treatment (WMD –12, 95% CI –16 to –7). A similar benefit was not reported in the single trial (Hoving et al 2006) that reported medium- (MD –7, 95% CI –16 to 2) and long-term (MD –1, 95% CI –11 to 9) pain outcomes. Pooled outcomes from three trials (Hemmila 2005, Hoving et al 2002, Skillgate et al 2007) show that manual therapy resulted in significantly better disability science outcomes at the conclusion of treatment than control (WMD –6, 95% CI –11 to –2). A similar benefit was not demonstrated in the two trials (Hemmila 2005, Hoving et al 2006) that reported medium- (WMD –8, 95% CI –24 to 7) and long-term (WMD –1, 95% CI –12 to 9) disability outcomes. Multimodal physical therapies: Two trials compared multimodal physical therapies, which included exercises, massage, and various electrotherapies, with minimal treatment. One trial excluded manual therapies ( Hoving et al 2002, 2006), and one trial included manual therapies ( Palmgren et al 2006) in the range of treatments provided.

003) (Fig. 2A). On the other hand, a reduced eGFR of < 60 ml/min/1.73 m2 was not positively associated with the incidence of hypertension in nearly all of the subgroups tested (Fig. 2B). A reduced eGFR of < 50 ml/min/1.73 m2 (vs. eGFR ≥ 60 ml/min/1.73 m2) was significantly associated with the incidence of hypertension in several groups, with see more few interactions (Fig. 2C).

We conducted a sensitivity analysis BMI cut off of 23.0 kg/m2, because the Regional Office for Western Pacific Region of WHO (WPRO criteria) proposed a separate classification of obesity for Asia defining adult overweight as a BMI ≥ 23.0 kg/m2, and got similar results (data not shown). The present study, which employed annual blood pressure measurement for 10 years, demonstrated that dipstick proteinuria and a reduced eGFR are associated with incident hypertension independently of each other and act as potential confounders in young to middle-aged Japanese males. The

observed positive associations were consistent for proteinuria in various clinical subgroups. Similarly, a significant association between the eGFR and the incidence of hypertension was observed in the participants with an eGFR of < 50 ml/min/1.73 m2. When eGFR values of < 60 or ≥ 60 ml/min/1.73 m2 were compared, the associations p38 MAPK phosphorylation were not significant after adjusting for age and other potential confounders. Our results showing a positive association between proteinuria and incident hypertension Cytidine deaminase are in line with those of previous studies (Brantsma et al., 2006, Forman et al., 2008, Gerber et al., 2006, Inoue et al., 2006, Jessani et al., 2012, Wang et al., 2005 and Wang et al., 2007) and extend the literature in several aspects.

First, we confirmed the presence of this association among a large cohort of Asian males. Second, the association was independent of eGFR. Third, the association remained significant, even in the participants with an optimal BP at baseline. This means that our findings did not change after excluding individuals with latently elevated BP associated with proteinuria, who are likely to develop hypertension. Fourth, we observed a consistent association across several subgroups according to clinical risk factors, such as age, diabetes mellitus and dyslipidemia. Finally, we were able to evaluate the association for a long term of over 10 years. There are several potential mechanisms linking proteinuria to incident hypertension. Proteinuria exerts a toxic effect on proximal tubular epithelial cells, generating chemotactic factors, such as monocyte chemotactic protein-1 (MCP-1) and reactive oxygen species (ROS) (Morigi et al., 2002 and Wang et al., 1999). These factors damage the renal microvasculature and tubulointerstitium, resulting in the impairment of salt excretion and thus salt-sensitive hypertension (Johnson et al., 2002). Additionally, protein overload in proximal tubular cells leads to the secretion of endothelin-1, which can constrict systemic blood vessels (Dhaun et al., 2012).

The current study shows that vaccine use does not correlate directly

with national wealth, and a number of less developed countries outperformed richer nations. The global data shows that this was particularly notable amongst Latin American countries, where several had vaccine provision above the study “hurdle” rate, while a number of Eastern and Southern GSK1349572 European countries had lower levels of vaccine use, despite their more developed status. The sub-group analysis shows that a range of policy measures can influence immunization rates. The strongest correlation occurred with policies that have a direct connection with patients: reimbursement and communication. These appear more important than development status, while official public health authority vaccination recommendations alone appear to have little or no effect, but rather may be a necessary characteristic for greater vaccine use as they were present in all sub-group countries that achieved higher levels of provision. These findings mirror those from earlier work in Europe, which concluded that improving vaccine

coverage requires public communication/education campaigns and funding for vaccination, alongside health care workers proactively recommending immunization to at-risk patients [12]. The use of seasonal influenza vaccines not only helps protect against epidemics, but provides the foundations of pandemic preparedness [2]. Annual seasonal vaccine use sustains learn more production capacity, and therefore dictates the global capability to respond during a pandemic. However, despite the growth in seasonal influenza vaccine

use during the study period, uptake continues to be substantially lower than production capacity. A study by the international consultancy however Oliver Wyman [13] estimated that global seasonal manufacturing capacity stood at more than double the 449 million doses distributed by IFPMA IVS members in 2009, and was at least 50% greater than the WHO estimate of total worldwide production [9]. The consultancy predicted that within five years, capacity will increase to more than three times the highest level of vaccine provision achieved in the present study. Consequently, accelerating the growth in seasonal influenza vaccine use remains an important public health objective. This study shows that proactive vaccination policies provide an opportunity for many countries to achieve this, not just the most affluent. Indeed, of the nine countries in the sub-group analysis with notable increases in vaccine use (Brazil, China, Germany, Italy, Japan, Mexico, Thailand, UK, USA) all but one had reimbursement policies in place, and similarly all but one undertook broad communication activities, although four (46%) were classified as “less developed”.