09 M Tris borate, 2 mM EDTA, pH 7 8) at 90 mV for 60 min cDNA wa

09 M Tris borate, 2 mM EDTA, pH 7.8) at 90 mV for 60 min. cDNA was prepared from 2 μg of total RNA using the Superscript™ First-Strand Synthesis System (Invitrogen, Paisley, UK) with random hexamer primers according to the manufacturer’s protocol. Samples were incubated at 65 °C for 5 min then held

on ice for 1 min before the addition of Superscript III reverse transcriptase. Samples were then incubated at 25 °C for 10 min followed by reverse transcription at 50 °C for 50 min. The reaction was terminated by heating to 85 °C for 5 min to inactivate the enzyme. Quantitative PCR was carried out on a 7500 Real Time PCR Sequence Detection System (Applied Biosystems, Foster City, CA). TaqMan analysis was performed in a 25 μl reaction mixture containing 30 ng LEE011 cDNA, TaqMan Universal PCR Master Mix (comprising AmpliTaq Gold DNA polymerase, dNTPs with dUTP, passive reference and optimised Bleomycin buffer) and Assay-on-demand™ gene expression assay mixes containing specific primers and probes (all from Applied Biosystems). The PCR conditions comprised a 2 min incubation at 50 °C followed by a 10 min polymerase activation at 95 °C. This was followed by 40 cycles alternating between 95 °C for 15 sections and 60 °C for 1 min each.

Amplification curves were analysed using the SDS version 3.2 software (Applied Biosystems, Foster City, CA). The baseline and threshold values were set and the Ct values extracted for each gene of interest. Relative quantification was calculated using the geometric mean of two selected house-keeping genes, gapdh and mvp. Relative gene expression

levels were calculated using the equation 2−ΔCt. An arbitrary classification system was applied to the data quantifying relative expression levels of as ‘high’ >0.5, ‘moderate’ between 0.02 and 0.5, ‘low’ between 0.001–0.02 and ‘negligible’ <0.001. All transport experiments were conducted in standard buffer solution (SBS) comprising Hank’s Balanced Salt Solution (HBSS) supplemented with 20 mM 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid (HEPES). Cell layers were allowed to equilibrate in SBS for 60 min at 37 °C before TEER measurements were taken. Each condition was carried out in quadruplicate and only layers with a resistance >250 Ω cm2 were accepted for experimentation. For transport studies with radiolabelled markers, donor compartments were filled with 0.51 ml (apical to basolateral (AB) transport) or 1.51 ml (basolateral to apical (BA) transport) of SBS containing 25 nM 3H-digoxin and/or 6.55 μM 14C-mannitol. Receiver compartments were filled with 1.5 ml (AB transport) or 0.5 ml (BA transport) of SBS. At the start and end of the experiment, 10 μl samples were taken from the donor compartments for determination of the initial and final concentration. Every 30 min over a 2 h period, 300 μl samples (AB transport) and 100 μl samples (BA transport) were taken from the respective receiver chambers and replaced with the same volume of SBS.

In terms of standing, our finding is in contrast to Barclay-Godda

In terms of standing, our finding is in contrast to Barclay-Goddard et al (2009) and van Peppen et al (2006) who both reported no effect of biofeedback (force information via visual feedback) on standing, with Berg Balance Scale effects of MD –2, 95% CI –6 to 2 (2 trials) and SMD –0.20, 95% CI –0.79 to 0.39 (2 trials). It is possible that some of the positive effect of biofeedback could Bcl-2 inhibitor be explained by the amount of practice

carried out by the experimental group compared with the control group. When analysing only those trials where the control group practised the same activity for the same amount of time as the experimental group, with the only difference being the substitution of

biofeedback for therapist feedback in the experimental group, the effect of biofeedback was still clinically and statistically significant (SMD 0.51, 95% CI 0.20 to 0.83, I2 = 47%, fixed-effect model of 8 trials, see Figure 9 on eAddenda for detailed forest plot) and of a similar magnitude to the original analysis (SMD 0.49, 95% CI 0.22 to 0.75). This suggests that improvement in lower limb activities is due to the type of feedback selleckchem (ie, biofeedback compared with therapist feedback during usual therapy) rather than the amount of practice. Why might biofeedback be more effective than therapist feedback? An observational study of therapist-patient interactions during therapy found that the content of feedback was motivational rather than informative, with specific feedback rarely given (Talvitie 2000). As early as 1932, Trowbridge and Casen demonstrated that the content of feedback is important, with feedback containing specific information regarding ways to improve future practice, enhancing learning more than motivational feedback. By its very nature, biofeedback provides specific information that can be used to adapt

the next attempt at the task. This review has some potential limitations. Several of these limitations may have led to an overestimate of the effect of biofeedback. First, there old was a lack of blinding of participants and therapists since this is not always possible in trials of biofeedback. Second, even after including only high quality trials in the meta-analysis, the results are potentially affected by small trial bias, with an average number of 27 participants per trial (range 13–54 participants). Third, when multiple measures were reported, the measure used in the meta-analyses was the measure most congruent with the aim of the intervention, which may have introduced selection bias. On the other hand, the inclusion of trials that compared biofeedback only with usual therapy only does not distinguish the effect of biofeedback precisely, making the result from this systematic review a more conservative estimate of the effect.

Co-encapsulation of SOL components in MP enhanced their protectiv

Co-encapsulation of SOL components in MP enhanced their protective efficacy. One of the most interesting observations in this study was the levels

of IgG and IgA antibodies in the lungs after challenge. The levels of both PTd specific IgA and IgG in the MP group were significantly higher than all other groups ( Fig. 6). The levels of MCP-1 in the lung homogenates were higher in both SOL and MP group in comparison to Quadracel® or AQ formulations at day 3 after challenge (Fig. 7A). After 7 days we detected twice the amount of MCP-1 in the MP group compared to the SOL group. Hence the persistence of MCP-1 was extended after challenge in the MP group. Analysis of TNF-α, IL-10, IFN-γ and IL-12p40 cytokines showed that immunization with MP induced a predominantly Th1-type response in the lungs (Fig. 7B–E). Dasatinib mw Quadracel® produced a predominantly Th2-type of response. The levels of IL-10 were lower in all groups other

than Quadracel® but surprisingly the levels rebounded to that of Quadracel® at day 7 in SOL. Furthermore, IL-17 levels in lungs from Quadracel® and MP immunized mice were significantly higher than AQ or SOL groups (Fig. 7F). We conclude that immunization with MP induced higher levels of Th1 and Th17 type cytokines, while immunization with Quadracel® induced more Th2 type cytokines. In this study we found that a single subcutaneous immunization with MPs co-encapsulating CpG ODN, IDR and PCEP along with PTd provided better protection against pertussis than these components given in soluble formulation. The co-encapsulation of Selleck NU7441 the adjuvants and the antigen in MP provided a significantly higher Th1 and Th17 type response in the lung in spite of lower systemic humoral responses. Multi-component

vaccine formulations require an effective delivery system for co-delivery of all components to the immune cells and tissues to generate a desired response. As such, in the present work we used the polyphosphazene adjuvant PCEP in combination with complexes of CpG ODN and IDR for delivering PTd as a model antigen against pertussis. The formulation was delivered in two ways, either as a GPX6 soluble ad-mixture of all the components (SOL) or co-delivered in MPs in which PCEP itself was used as an encapsulating agent without the need for additional component for encapsulation. Here, we found that the MP group had about 100 times lower bacterial burden in the lungs compared to non-immunized mice. The advantage of using MP as a tool is that particulate delivery increases vaccine stability and uptake of the antigen to the MHC class I and class II compartments resulting in induction of both cell-mediated and humoral immune responses [20]. Historically, poly(lactic-co-glycolic acid) (PLGA), MPs and/or nanoparticles have been investigated extensively as delivery systems.

Given the improved nanoparticle entrapment seen with NIMslurry (F

Given the improved nanoparticle entrapment seen with NIMslurry (Figs. 2C, 3B and D), it appears that the maintenance of the wet state/absence of the oven-drying stage in the preparation of Nslurry was important. This helped to impart surface characteristics that facilitated nanoparticle residency in [w1] and/or prevented drying-induced augmentation of the hydrophobicity associated with PCL. With respect to the former hypothesis,

maintaining the wet state of the nanoparticles BI 6727 datasheet and resuspending them immediately in PVA solution may have allowed a satisfactory PVA ‘corona’ to form around the nanoparticles. It has previously been suggested that PVA can strongly absorb on the surface of protein-loaded PLGA nanoparticles [18], while its hydroxyl groups have also been envisaged to fix to the acetyl group of PLGA and thus improving the rehydration-ability of freeze-dried nanoparticles [19]. In the present work, the vinyl acetate segment of the partially hydrolysed PVA could have interpenetrated with the PCL molecule when the solvent diffuses

towards the aqueous phase during the polymer solidification process [20]. The adsorption of PVA on polymeric particles surface during their preparations is common [21], [22] and [23]. INK1197 datasheet It could be suggested that subsequent drying has disrupted the interaction between the PVA and the PCL molecules resulting in a more hydrophobic product (i.e. Ndried). Fig. 4A shows that when fractured to reveal their interiors, NIMslurry particles are seen to have a hollow core with nanoparticles below embedded within the wall of the microparticles. A mechanism leading to nanoparticle residency in the wall is proposed in Fig. 4B. The hollow core may be advantageous if capacity for the encapsulation of other agents is desired. Alternatively, if disadvantageous (e.g. leading to mechanical weakness), decreasing the

volume of [w1] or reducing water droplet size could be employed to reduce the volume of the void, or redistribute it into a number of smaller, individual voids. To determine the drug loading of typical NIM systems, three separate batches of NIMdried and NIMslurry were prepared and three samples taken from each for analysis. Drug loadings were found to be 3.80 ± 0.82% and 6.46 ± 1.26% for NIMdried and NIMslurry, respectively. This difference is statistically significant (Mann–Whitney U-Test; α = 0.05), again suggesting improved nanoparticle entrapment for NIMslurry. The in vitro cumulative drug release profiles are shown in Fig. 5 and provide further evidence of the different entrapment profiles for NIMslurry and NIMdried. For the latter, the drug release profile was very similar to that seen for nanoparticles alone, supporting other evidence that the nanoparticles were largely surface associated ( Fig. 3A). For NIMslurry, an initial lag phase was observed (no release for ∼1 day; only ‘noise’ on HPLC chromatograms).

If non-inferiority was demonstrated, the two-sided Fisher’s exact

If non-inferiority was demonstrated, the two-sided Fisher’s exact test was performed. Fig. 1 shows the patient disposition. A total of 402 subjects were screened, and 400 subjects randomized equally to both groups (two subjects did not meet all inclusion/exclusion criteria). Altogether, 396 subjects (99.0%) received all three vaccinations. The mean age was 6.7 (Tritanrix HB + Hib + Quinvaxem

group) and 6.8 weeks (Quinvaxem only group). Table 1 presents other demographic data. Immunogenicity results for the ATP population are given (ITT population results were similar). At baseline, the majority of subjects were seroprotected at the lower cut off level of ≥0.15 μg/mL in both treatment Angiogenesis inhibitor groups for Hib (Tritanrix™ HB + Hib + Quinvaxem 83.8% and Quinvaxem 84.8%). For tetanus toxoid, 88.7% of Tritanrix HB + Hib + Quinvaxem subjects and 91.9% of Quinvaxem subjects were seroprotected at baseline. For HepB almost one-third of subjects were seroprotected at baseline (Tritanrix™ HB + Hib + Quinvaxem 27.3% and Quinvaxem 30.8%), and for diphtheria less than

one-fifth of subjects were seroprotected (Tritanrix HB + Hib + Quinvaxem 17% and Quinvaxem 16.7%). One month after the third dose of vaccine, all subjects had achieved seroprotection for tetanus and Hib (100% for both antigens selleck compound for both treatment groups), all except one for diphtheria (100% for Tritanrix HB + Hib + Quinvaxem and 99.5% for Quinvaxem), next and all achieved seroconversion against B. pertussis except for two subjects (100% for Tritanrix HB + Hib + Quinvaxem and 99% for Quinvaxem). Seroprotection against hepatitis B was achieved

in 97.4% of Tritanrix HB + Hib + Quinvaxem and 94.9% of Quinvaxem subjects ( Fig. 2). The non-inferiority of Quinvaxem given interchangeably with Tritanrix HB + Hib compared with a full vaccination course of Quinvaxem was demonstrated. For all individual antigens, the lower limits of the two-sided CIs of the differences in seroprotection/seroconversion rates between the two groups were all greater than −10% (Fig. 3). For both groups, fewer solicited local AEs were reported after the third vaccination than after the first or second (Fig. 4). Tenderness (injection site pain) was the most common local solicited AE, but was experienced by more subjects in the Tritanrix HB + Hib + Quinvaxem group after the first (64.0% vs. 54.0%), second (62.1% vs. 54.3%) and third (44.2% vs. 38.2%) vaccinations than in the Quinvaxem only group. The majority of solicited local AEs were of mild to moderate severity. After the first vaccination, more subjects who had received Tritanrix HB + Hib reported severe local AEs than subjects who had received Quinvaxem (6 vs. 3 subjects). The incidence of fever (solicited systemic AE) (Fig.

Eligible clinical cases (identified by either search method) were

Eligible clinical cases (identified by either search method) were pooled and verified, duplicate entries excluded. Only the first hospitalization of any given patient was counted. Only cases providing written documentation of a definite or suspected diagnosis were considered eligible for this study and were included in a final listing of 255 clinical cases. Eligible cases were sorted by “CD+” for “Clinical diagnosis present”, and “CD−” for “clinical diagnosis absent” in each selleck chemical diagnostic category: “meningitis”,

“encephalitis” (ENC), “myelitis” (MYE), “ADEM” (ADEM). Cases with a discharge diagnosis of “meningitis” were further classified as “aseptic meningitis” (ASM), “bacterial meningitis” (BM) or “unspecified meningitis” (UM). In 7 cases “meningitis” was coded as one of the discharge diagnoses, but the letter indicated that the diagnosis had, in fact, been excluded during hospitalization. These cases were Fluorouracil tagged with “ND” for “no diagnosis”. An independent investigator (BR), who

had not previously been involved in the care of the patients, reviewed the medical records in a blinded fashion using the structured clinical report form (CRF). The extracted data in the CRF were confined to the variables required almost for the Levels 1–3 of the respective BC case definitions. [7] and [8]. The following labels were applied to all cases in each category (MEN, MYE, ENC, ADEM): “BC+” for “Brighton Collaboration Definition fulfilled”, “BC−” for “Brighton Collaboration

Definition not fulfilled”. The clinical tags were then unblinded and compared to the respective diagnostic categories according to the BC algorithm. In the absence of a gold standard for the diagnoses of encephalitis, meningitis, myelitis and ADEM, sensitivities and specificities cannot be calculated. The new test (i.e. the BC algorithm) was therefore tested against an imperfect, previously available reference test (i.e. the clinician’s diagnosis in the discharge summary). As a result, we determined overall rates of agreement (ORA), positive percent agreement (PPA) and negative percent agreement (NPA), respectively, including the 95% confidence intervals for a total sample size of 255 cases (See Appendices A1 and A2) [33] and [34]. Kappa scores were calculated (Stata Version 9.0se; College Station, TX) in order to find the probability of exceeding agreement expected by chance alone, when comparing the BC definition to the clinical assessment. Cases with discordant results between the physician’s diagnosis and BC category were reviewed individually.

The aldehyde group has been suggested to form an imino linkage wi

The aldehyde group has been suggested to form an imino linkage with amino groups on certain T cell surface receptors. This may generate co-stimulatory signals similar to those provided by activated antigen-presenting cells [10] and [12]. In our study, the enhanced immunogenicity elicited by subunit vaccine containing 50 μg or more GPI-0100 was accompanied by spleen enlargement and increased spleen weights in vaccinated mice. However, neither significant increase in splenocyte number nor any change in the relative frequency of B cells, CD4 and CD8 T cells was found. Therefore, it is unlikely that the observed effects are due to hyper immune-stimulation. Some saponin

adjuvants are known to possess an angiogenic effect and the spleen enlargement may thus be caused by increased blood supply [23] and [24]. Earlier lethality studies and toxicology tests analyzing serum creatinine kinase (CK) and aspartate aminotransferase (AST) levels (as CH5424802 indicator for muscle and liver damage, respectively) showed that GPI-0100 under 1000 μg has little to no effect in mice, a species reported

to be sensitive ATM inhibitor to saponin compounds [10] and [12]. Moreover, a clinical study with GPI-0100-adjuvanted prostate cancer vaccines showed high induction of antigen-specific IgM and IgG (IgG1 and IgG3) titers in the cancer patients without serious side effects at an ajuvant dose of 3000 μg [15]. Many adjuvants have been tested in animal models yet aluminum-based adjuvants have long been the only licensed adjuvants for use in human vaccines [25] and [26]. (-)-p-Bromotetramisole Oxalate In recent years, squalene-based adjuvants like MF59 and AS03 were also licensed in Europe as adjuvants for influenza vaccines, and a vaccine against human papilloma virus

containing monophosphoryl lipid (MPL) A was registered in the U.S. and around the world [27], [28] and [29]. Clinical trials with aluminum-based adjuvants in combination with pandemic influenza virus vaccines did not provide evidence for a significant immunostimulating effect of aluminum compounds on influenza-specific responses [30], [31] and [32]. On the other hand, MF59 and AS03 do enhance antibody responses to pandemic influenza virus vaccines and allow antigen dose reduction [28], [33], [34], [35], [36], [37] and [38]. An MF59-adjuvanted seasonal influenza vaccine is registered in Europe for use in elderly. Moreover, MF59 and AS03 were both used as adjuvants for H1N1 vaccines during the 2009 A/H1N1 pandemic. Clinical trials on MPLA-adjuvanted influenza virus vaccines are yet to be done. In our experiments, GPI-0100 enhanced influenza-specific IgG titers to A/PR/8 subunit vaccine by a factor of 30-230 with the greatest enhancement seen at low antigen doses. Moreover, GPI-0100 adjuvantation especially stimulated Th1-related immune responses (IgG2a and IFN-γ-producing T cells) and significantly improved the protective potential of influenza subunit vaccine.

The deduced amino acid sequences between rRmLTI, EST CK186726, an

The deduced amino acid sequences between rRmLTI, EST CK186726, and BmTI-6 are 99% identical. Nucleic acid sequence coding for six additional amino acids (EAEAEF) in the N-terminus, and thirty two amino acids (VPRAAAAASFLEQKLISEEDLNSAVDHHHHHH) in the C-terminal portion of the putative rRmLTI product was added during cloning procedures to allow insertion of a restriction site and coding sequence for the poly-His peptide. The similarity between

their partial amino acid sequences suggested that RmLTI in larvae is a member of the Kunitz-bovine pancreatic trypsin inhibitor (BPTI) family like BmTI-6 in the ovary of adult female cattle ticks. Further exploration of the putative function of RmLTI is reflected in Fig. 7. Relevant protein signature features identified in the deduced amino acid sequence encoded in the expressed sequence tag CK186726 include three putative Kunitz-BPTI Roxadustat domains and two putative Kunitz proteinase inhibitor I2 conserved sites. As noted in BmTI-6, six N-glycosylation

sites were present in the partial protein sequence of RmLTI. Six cysteine residues were observed within each of the three Kunitz domains, which are thought to form disulfide linkages contributing stability to the compact polypeptide in its folded form. Assessment of the efficacy against cattle tick infestation buy Imatinib in bovines using a vaccine containing the recombinant form of a member of the Kunitz-BPTI family from R. microplus produced

in the P. pastoris expression system is reported for the first time here. A specific and robust humoral immune response against rRmLTI was achieved with the vaccination protocol consisting of three immunizations, each applied every two weeks. The 32% efficacy obtained with the rRmLTI formulation reflects the significant challenge of discovering highly efficacious antigens protecting cattle against R. microplus infestation. Vaccination found experiments where Bos indicus cattle were immunized with a mixture of purified larval trypsin inhibitors containing one or two Kunitz-type domains afforded 72.8% efficacy against R. microplus infestation [22]. In contrast, the level of immunoprotection obtained in crossbred cattle vaccinated with the synthetic polypeptide containing 29 aa residues derived from the N terminus of the R. microplus trypsin inhibitor A was 18.4% [23]. As the gene encoding RmLTI remains to be fully characterized, the apparent discrepancy between specific antibody levels and the low level of efficacy obtained with the rRmLTI vaccine may be due to the partial gene sequence of the EST used to produce the recombinant protein product in the yeast expression system. Alternatively, the structural and functional redundancy in proteins belonging to the Kunitz family present in R.


He Selleck Verteporfin was given IV antibiotics and underwent immediate surgical intervention. Widespread excision and drainage were performed. Approximately 10 mL of pus was

drained and copious washout performed. Partial dorsal vein thrombosis was noted during surgical exploration (Fig. 2). Normal saline soaked gauze, combine, and crepe dressing were applied. The patient continued with 48 hours of IV piperacillin with tazobactam and daily dressings. He completed a further 2 weeks of oral antibiotics and daily dressings. Wound swab identified gram-negative rods suggestive of Fusiform Anaerobes. On review, day 31 postoperatively, the patient had a well-granulated wound almost completely healed by secondary intention (Fig. 3). Penile abscesses are an uncommon urologic condition that most commonly present with a localized penile swelling and painful erections. The causes of penile abscess are variable but might be associated with penile trauma,

injection, and disseminated infection. A significant number of Epigenetic pathway inhibitors spontaneous penile abscess cases are reported with no inciting event identified. The varied aetiologies of penile abscess are also reflected in the variation of organisms cultured from abscess swabs. Organisms cultured from penile abscesses in various case reports include the following: Streptococcus constellatus, Streptococcus intermedius, Prevotella bivia, Streptococcus anginosus, Enterococcus faecalis, Escherichia Coli, Mycobacterium tuberculosis,

and Staphylococcus aureus. 1 A recent review of penile abscess case reports by Dugdale et al identified Staphylococcus aureus, Streptocci, Bacteroides, these and Fusibacteria as the most commonly implicated organisms. Cases of penile abscess after intracavernosal injection have previously been reported in literature. Penile abscesses have been cited as a consequence of penile injection with both pharmaceutical substances, such as alprostadil and papaverine,1 and nonpharmaceutical substances, such as petroleum jelly.2 Injection of substances into the penis for the purposes of enhancing penile girth or sexual performance causes penile abscess by the introduction of bacteria and subsequent establishment of infection and localized abscess formation. The injection of illicit substances into the penis, however, is rare because of the paucity of the practice among intravenous drug users. Among intravenous drug users, the groin and neck are perceived to be the most dangerous site of injection and thus might account for its limited use as an injecting site.3 Approximately 6% of intravenous drug users inject into the groin area, with an even smaller proportion injecting into the penis.3 Often, genitalia are used as a site of drug injection in the absence of suitable peripheral limb access. Drug injection into the groin area tends to occur with prolonged length of intravenous drug injection.

g subdominant 1, subdominant 2 in order of prevalence) This all

g. subdominant 1, subdominant 2 in order of prevalence). This allows for collection of information regarding possible multiple serotype

carriage, albeit in a biased fashion. If there is only one morphology present, and it is later identified as non-pneumococcus, return to the primary culture plate and repeat colony selection at least once to verify that pneumococci are not present. Traditionally, identification of pneumococci has focused on isolates cultured from normally sterile sites that tend to display a classical phenotype, in particular being optochin susceptible and bile soluble. These identification criteria are generally satisfactory for clinical application and are widely applied in diagnostic microbiology. However, alternative pneumococcal forms are frequently cultured from NP specimens [58] and [59]. DAPT in vitro These non-classical forms may give test results normally expected for other members of the viridans group of streptococci [60] and [61] and some other viridans group streptococci have been

reported to give test results normally associated with pneumococci [62], [63] and [64]. For example, the original description of Streptococcus pseudopneumoniae was optochin susceptible when grown in ambient air conditions, and resistant when incubated in 5% CO2 atmosphere [62]. However, recent studies have found that these phenotypic characteristics are not universal for S. pseudopneumoniae Selleckchem RGFP966 [65]. These issues create difficulties for identification and differentiation between

pneumococci and other oral streptococci in carriage studies. Although optochin susceptibility and bile solubility are still considered key tests, we recommend extending the criteria for presumptive identification of pneumococci to encompass non-classical forms of pneumococci (Fig. 2). Further testing by a reference laboratory may be needed if the research question requires a more definitive identification than this algorithm provides. We now recommend that all α-hemolytic ALOX15 colonies growing on selective media are potentially analyzable, rather than just those with ‘typical pneumococcal colony morphology’ [66], and reiterate that the optochin test culture plate is incubated in 5% CO2 atmosphere, rather than ambient air. Further work is needed to more clearly differentiate pneumococci, particularly the non-classical forms, from other oral microbes. As a clearer understanding of how to fully define the species is achieved, a revised pragmatic definition of pneumococci will be needed for use in carriage studies. Non-culture based techniques have some advantages in detecting pneumococci from NP samples: they do not require viable organisms, preserve the original composition of the NP sample and, depending on the methods used, provide a detailed characterization and quantification of the pneumococci within a sample.