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Respiratory mucosal immunity induced by vaccination is vital for protection from coronavirus infection in animal models. In humans, SARS-CoV-2 immunity has been studied extensively in blood. However, the capacity of peripheral vaccination to generate sustained humoral and cellular immunity in the lung mucosa, and how this is influenced by prior SARS-CoV-2 infection, is unknown. Bronchoalveolar lavage samples obtained from vaccinated donors with or without prior infection revealed enrichment of spike-specific antibodies, class-switched memory B cells and T cells in the lung mucosa compared to the periphery in the setting of hybrid immunity, whereas in the context of vaccination alone, local anti-viral immunity was limited to antibody responses. Spike-specific T cells persisted in the lung mucosa for up to 5 months post-vaccination and multi-specific T cell responses were detected at least up to 11 months post-infection. Thus, durable lung mucosal immunity against SARS-CoV-2 seen after hybrid exposure cannot be achieved by peripheral vaccination alone, supporting the need for vaccines targeting the airways.

RationaleStreptococcus pneumoniae serotype 3 (SPN3) is a cause of invasive pneumococcal disease and associated with low carriage rates. Following the introduction of pediatric 13-valent pneumococcal conjugate vaccine (PCV13) programmes, SPN3 declines are less than other vaccine serotypes and incidence has increased in some populations coincident with a shift in predominant circulating SPN3 clade, from I to II. A human challenge model provides an effective means for assessing the impact of PCV13 on SPN3 in the upper airway.ObjectivesTo establish SPN3's ability to colonise the nasopharynx using different inoculum clades and doses and the safety of an SPN3 challenge model.MethodsIn a human challenge study involving three well characterised and antibiotic sensitive SPN3 isolates (PFESP306 [clade Ia], PFESP231 [no clade] and PFESP505 [clade II]), inoculum doses (10,000, 20,000, 80,000, 160,000 CFU/100μL) were escalated until maximal colonisation rates were achieved, with concurrent acceptable safety.Outcome measuresPresence and density of experimental SPN3 nasopharyngeal colonisation in nasal wash samples, assessed using microbiological culture and molecular methods, on days 2, 7 and 14 post-inoculation.Results96 healthy participants (median age 21, interquartile range 19-25) were inoculated (n=6-10 per dose group, 10 groups). Colonisation rates ranged from 30.0-70.0% varying with dose and isolate. 30.0% (29/96) reported mild symptoms (82.8% sore throat, [24/29]), one developed otitis media requiring antibiotics. No serious adverse events occurred.ConclusionsAn SPN3 human challenge model is feasible and safe with comparable carriage rates to an established SPN6B human challenge model. SPN3 carriage may cause mild upper respiratory symptoms. Clinical trial registration available at www. https://www.isrctn.com/, ID: ISRCTN11306486.

Cellulose nanofibrils (CNF) have been explored as an emerging naturally sourced material for use in the preparation of new biomaterials. CNF fibrils have a high aspect ratio with fibril lengths of ~ 1 µm and diameters of 20–40 nm. The assembly of CNF impacts both bulk mechanical properties as well as localized cellular interaction. The ability to reproducibly tune CNF fiber alignment is an active area of CNF-based biomaterial research. Here, we present a simple CNF fibril alignment strategy based on application of constant unilateral force on thin CNF films drying on a flexible substrate. CNF fibril alignment/orientation was characterized using both Polarized Light Microscopy (PLM) and conventional Scanning Electron Microscopy (SEM) approaches. CNF is optically birefringent; therefore, calculation of the birefringence orientation index (BOI) can infer the extent of CNF fibril alignment with a non-destructive, cost-effective technique. CNF fibril alignment is markedly increased with application of 10.2 N force as assessed by both SEM and PLM analysis. SEM imaging resolved individual CNF and the alignment was analyzed using OrientationJ, an ImageJ plugin, to extract fibril angle whereas PLM microscopy provided a BOI value. Both the fibril alignment and BOI score were in agreement; therefore, it is acceptable to infer fibril organization with PLM techniques. Furthermore, the addition of nanoparticle hydroxyapatite did not diminish the CNF fibril alignment as assessed by both PLM and SEM highlighting the utility of the CNF film fabrication technique. In summary, the application of unilateral force on thin CNF films adhered to latex, is an elegant, scalable, and cost-effective technique for generating CNF films with reproducible fibril alignment.

Modern health care education requires effective testing of students, ability to efficiently conduct program evaluation, and availability of specialized technical personnel to foster increased utilization of technology. These activities are best accomplished through an integrated information technology (IT) plan. The transition from a paper-and-pencil system to a technology-driven system is a complex endeavor. However, this must be accomplished for an academic unit to provide needed services to students and faculty alike. A pilot project was developed and implemented to adapt existing technology for use in student testing, collection and analysis of student feedback and course evaluation data, creation of a department-specific "IT advisor," and assessment/promotion of additional facility development. The program was implemented and evaluated over a 12-month period. The overwhelming success of the program was reflected in financial, creative, and internal process improvements. These data generated substantial support for expanded and permanent program implementation within the health science division.

A quarter of preventable ill health worldwide is due to environmental factors, concludes a World Health Organisation report launched to coincide with last month's conference looking at progress since the earth summit of 1992 at Rio de Janeiro. Health and Environment in Sustainable Development: Five Years After the Earth Summit is a comprehensive report analysing trends in health and environment issues from the early 1970s to the …

The United Nations has called for an end to ritual female genital mutilation, a practice to which an estimated 130 million girls and women worldwide have been subjected. The heads of the WHO, Unicef, and the United Nations Population Fund published a statement last week calling for an international effort to bring about a “major decline” within 10 years in what they …

Before the Gulf war, Kuwait’s oil revenue guaranteed a high standard of living for its citizens and good public services. Large numbers of foreign workers were attracted to the country, to supply specialist skills needed by the economy but also to undertake the tasks which Kuwaitis no longer needed to do themselves. This situation changed with the Gulf War. The devastation of the country during the war has taken its toll on the economy, and the government is now scrutinising public expenditure much more carefully, including health-service spending. One of the proposals currently being considered to reduce government expenditure, is that health care should continue to be free for Kuwaitis but that foreign workers should make a contribution to their health care. A study undertaken by the four major providers of private insurancesuggested the introduction of a sliding scale of contributions. Foreign workers would pay approximately 30% of the cost of treatment in the first year, rising to 100% over 5 years. However, the government turned down this proposal, claiming that it involved them in too much expenditure at the outset. Instead, they have made it clear that they are looking for a method by which foreign workers can realistically be required to cover their own healthcare costs throughout their stay in the country. The insurance companies have been asked to provide alternative proposals to the Health Committee of the Kuwait parliament. According to Ahmad Shamlaan, deputy director of the Kuwait Insurance Company, there will be two main proposals put before the Parliamentary Health Committee. The first of these is simply to require non-Kuwaitis to pay the cost of any medical treatment. The second is to impose a compulsory health insurance on all foreigners. The report from the insurance companies examines which of these alternatives would be the easiest to implement. Linked with these proposals is

One of the United Nation's overlooked but none the less spectacular successes has been the brokering of a definitive end to Guatemala's brutal 36 year civil war in 1996. The European Union–a key player in the peace process–has just announced a joint declaration of assist-ance and cooperation with Guatemala, agreeing to provide $250m (£156m) until the year …

The Committee Against Torture, a United Nations human rights body in Geneva, has condemned Israel's systematic use of interrogation methods that it said amount to torture. Ambassador Corlette Avital, consul general of Israel in New York, rejected the committee's findings while simultaneously defending the use of force against prisoners on the grounds that the government's “first responsibility” …

A study by the United Nations Population Fund (UNFPA) reports that 120 million additional pregnancies 49 million abortions and 65000 maternal deaths will occur during 1995-2000 because Western nations are failing to meet their US $5.7 billion goal (one-third the global goal) toward reproductive health and family planning in developing countries by the year 2000. Although US $17 billion annually were promised at the 1994 International Conference on Population and Development (Cairo) 1995 figures show that developed nations contributed only $2 billion compared to developing country spending of $7.5 billion. The study describes "donor fatigue": grants and loans rose 40% annually in 1994 and in 1995 but did not increase in 1996. A 23% annual increase in assistance is now necessary to reach the promised goal. Depending on the amount of the shortfall the number of couples and individuals without access to family planning will range between 96 and 175 million. The results will include: 1) 120-220 million pregnancies that would not have occurred; 2) up to 1.5 million women at risk of permanent reproductive injury; and 3) 117000 additional maternal deaths. Nafis Sadik executive director of UNFPA called on developed countries to meet their commitments and for a global campaign to reduce unwanted pregnancy. The latter would reduce the prevalence of abortion and decrease the annual number of global deaths (70000) due to unsafe abortions.

The International Committee of the Red Cross estimates that thousands of people in Albania are facing shortages of food and medical supplies as a result of the widespread unrest. It has appealed for Sw fr15m (£6.5m; $10.4m) to cover emergency operations in Albania over the next 90 days. According to Daniel Augstburger, a committee spokesman, as many as 250000 people out of a population of …

Between the mid-1960s and 1990 the percentage of couples in the developing world using contraception went up from an average of 9% to 53%, according to data from the United States. The report Levels and Trends of Contraceptive Use as Assessed in 1994 covers 119 countries and about 90% of the world's population. Contraceptive use is widely accepted as the single greatest factor in recent decline in fertility rates …

For nearly 80 days 72 hostages have been caught up in a life or death political contest between the Peruvian government and the leftist Tupac Amaru Revolutionary Movement. The survival and good health of the diplomats and government officials from various countries is largely due to efforts by the International Committee of the Red Cross. The Tupac Amaru Revolutionary Movement seized the Japanese ambassador's residence in Lima, Peru, on …