We are grateful to all patients who donated their blood samples f

We are grateful to all patients who donated their blood samples for this study and to Thongchai Hongsrimuang, Sunee Seethamchai, Pannadhat Areekul, Ratiporn Kosuwin, Urassaya Pattanawong, Teerayot Kobasa and the staff of the Bureau of Vector Borne Disease, Department of Disease Control, Ministry of Public Health, Thailand, for assistance in field work. This research was supported by grants from the National Research Council of Thailand and the Thai Government Research Budget

to S.J and C.P.; The Thailand Research Fund (RMU5080002) to C.P.; and from the National Institutes of Health (GM43940) to A.L.H. “
“Rotavirus is the most common cause of acute gastroenteritis in children under 5 years of age [1]. In developed countries, rotavirus gastroenteritis

remains a common find more cause of hospitalization at great cost to health services [2]. In England and Wales, the annual incidence PFI-2 of rotavirus hospitalizations is estimated at 4.5 per 1000 children under the age of 5 years and the cost to the National Health Service estimated to be GBP 14.2 million per year [3]. The second generation of live oral rotavirus vaccines have demonstrated safety and efficacy [4] and [5] and are increasingly being used routinely as part of childhood immunization schedules in a number of middle and high income countries [6] and [7]. The Rotarix vaccine, made from the most common human serotype G1P1A[8], is recommended Ergoloid by WHO as a two-dose schedule to be given at two and four months of age [8]. RotaTeq, a pentavalent vaccine developed from a bovine rotavirus strain and combined with reassorted strains of human serotypes G1, G2, G3, G4

and P1A[8], is WHO-recommended as a three-dose schedule to be given at two, four and six months of age [8]. In the United States, following the introduction of RotaTeq in 2006, there was a delay in the timing of peak incidence in the 2007–2008 season by two to four months and fewer cases overall compared to previous years [6]. This provides the first indication, post-licensure, that rotavirus vaccination reduces the burden of rotavirus disease in a large population and suggests that vaccination may also have an impact on transmission. Other high and middle income countries which have introduced rotavirus vaccination have shown similar effects [7] and [9]. In England and Wales, the introduction of rotavirus vaccination is currently under consideration. This study aims to develop a dynamic model of rotavirus transmission, and apply it to daily case reports of rotavirus disease from England and Wales. Using this model, we examine the potential epidemiological impact of a rotavirus mass vaccination programme. In temperate countries, most rotavirus disease occurs in late winter or early spring [10].

The studies to date, however, have reported a single point estima

The studies to date, however, have reported a single point estimate of physical activity (eg, steps or activity counts) and most have had small samples, ie, less than 20. There are now devices that provide more detailed information about the nature of physical activity. The Intelligent BTK animal study Device for Energy Expenditure and Activity (IDEEA) is one such device. It estimates duration and frequency of activity as well as distinguishing the

position of the body in which the activity is undertaken, eg, sitting, lying, standing, walking. In one study using this device, Sakamoto and colleagues (2008) found that nine community-dwelling stroke survivors stood for less time than healthy controls but lay, sat, and walked for about the same amount of time. Our study extends this work by using the IDEEA to examine the free-living physical activity of a larger sample of community-dwelling people with stroke compared with that of age-matched healthy controls. The specific research questions for this study were: 1. What is the duration and frequency of physical activity in community-dwelling people after stroke compared with age-matched healthy controls? A cross-sectional observational study examining the free-living physical activity of ambulatory community-dwelling people with stroke compared with

that of age-matched healthy controls was conducted in Sydney, Australia. Duration and frequency of physical activity was collected over two days. Each participant was randomly allocated a day of the week and wore the activity monitor on this day and again a week later on the same day. The days Pictilisib molecular weight for measurement of free-living physical activity were counterbalanced across the week so that there were the same number of participants represented on each day of theweek. Data were collected from 30 min after dressing until 30 min

prior to undressing. Participants were instructed to carry out their routine activities. Stroke survivors and healthy controls who were living in the community were recruited using advertisements in the local community, including stroke clubs. People with stroke were included in the study if they were over 50 years old, within 1 to 5 years of their whatever first stroke, able to walk 10 m independently, and retired from full-time employment. Healthy controls were included if they were over 50 years old, retired from full-time employment, and had no health problem that interfered with their ability to walk. They were excluded if they could not speak English or if they were unable to follow instructions. Free-living physical activity was collected using the Intelligent Device for Energy Expenditure and Activitya consisting of a recorder and five sets of sensors. The sets of sensors are attached to the front of the chest, the front of each thigh, and underneath each foot using medical tape, and measure angles of body segments and acceleration in two orthogonal directions.

Incubation was stopped after 5 or 7 min for hippocampus and corte

Incubation was stopped after 5 or 7 min for hippocampus and cortex, respectively, with three ice-cold washes of 1 ml HBSS, immediately followed by the addition of

0.5 N NaOH, which was then kept overnight. An aliquot of 10 μl was removed to protein determination. Unspecific uptake was measured using the same protocol described above, with differences in the temperature (4 °C) and medium composition (choline chloride instead of sodium chloride). Na+-dependent uptake was considered as the difference between the total uptake and the unspecific uptake. Incorporated radioactivity was measured using a liquid scintillation counter (Wallac 1409). Results were expressed as selleck screening library pmol [3H]glutamate uptake/mg protein min−1. Synaptosomal preparations were obtained by isotonic Percoll/sucrose discontinuous gradients at 4 °C, as previously described (Dunkley et al., 1986) with few modifications. Briefly, www.selleckchem.com/products/SB-431542.html homogenates (10%, w/v) from cortex and hippocampus were made in 0.32 M sucrose, 1 mM ethylenediaminetetraacetic acid (EDTA) and 6.25 mM dithiotreitol (DDT) (pH 7.4), and centrifuged at 800g for 10 min. The supernatants containing synaptosomes were subjected to 23%, 15%, 7% and 3% Percoll solution density gradient centrifugation at 24,000g for 10 min. The synaptosomal fractions were isolated, suspended and homogenized in buffered HBSS containing low K+ (pH 7.4), containing in mM: 133 NaCl, 2.4 KCl, 1.2 KH2PO4, 1.09 MgSO4, 27.7 HEPES, 1.2 glucose and 0.001 CaCl2

and centrifuged at 21,000g for 15 min. The supernatant was removed and the pellet gently resuspended in HBSS buffer. Determination of [3H]glutamate release was accomplished as described by Migues et al. (1999). Prior to the release assay, synaptosomal preparations

from cortex and hippocampus of mice were loaded with labeled [3H]glutamate for 15 min at 37 °C. Incubation was performed in a non-depolarizing medium (low potassium), containing, in mM: HEPES 27, NaCl 133, KCl 2.4, MgSO4 1.2, KH2PO4 1.2, glucose 12, CaCl2 1.0 in the presence of 0.5 μM of glutamate (0.1 μCi Adenosine [3H]glutamate). Aliquots of labeled synaptosomal preparations were centrifuged at 16,000g for 1 min. Supernatants were discarded and the pellets were washed four times in the medium by centrifugation at 16,000g for 1 min (at 4 °C). To assess the basal release of [3H]glutamate, the final pellet was resuspended in the same buffer and incubated for 1 min at 37 °C. Incubation was terminated by immediate centrifugation (16,000g for 1 min). Radioactivity present in supernatants and pellets was separately determined. The [3H]glutamate release was calculated as the percentage of total amount of radiolabel glutamate present at the start of the incubation period in preloaded synaptosomes. Protein concentration was measured according to Bradford (1976), using bovine serum albumin (1 mg/ml) as the standard. Step-through latencies are expressed as median and interquartile range, since these data demonstrated a non parametric distribution.

Results of the multivariate analysis are shown in Table 2 Combin

Results of the multivariate analysis are shown in Table 2. Combined motor function of the arm was not entered into the multivariate prediction models for upper limb function because there was a high correlation between severity of stroke and combined motor function of the arm (correlation Ruxolitinib supplier between

NIHSS and sum of MAS Items 6, 7, and 8 were r = 0.64 in the model for moving a cup, and r = 0.70 in the model for feeding oneself). Age and NIHSS were statistically significant (p < 0.05) predictors of recovery in ambulation and moving a cup. For recovery in feeding oneself, only NIHSS was statistically significant. The final multivariate models ( Table 2) were used to estimate probabilities of recovery in ambulation and functional use of the arm. The probabilities are shown graphically in Figure 2. All three multivariate backwards prediction models had good discrimination (ability to differentiate between participants who did and did not recover). The AUC for the prediction models were 0.84 (95% CI 0.77 to 0.92) for ambulation, 0.73 (95% CI 0.59 to 0.87) for moving a cup, and 0.82 (95% CI 0.70 to 0.94) for feeding oneself. The Hosmer-Lemeshow test was not statistically significant for any model (0.70 for ambulation,

0.74 for moving a cup, 0.38 for feeding oneself), indicating that there was no evidence of a failure of fit. However with Alectinib solubility dmso the sample size used here the Hosmer-Lemeshow test lacks the statistical power needed to provide a strong test of goodness of fit. Calibration curves

are shown in Figure 3. This study provides estimates of incidence of recovery in independent ambulation and upper limb function in a representative GPX6 acute stroke cohort six months after stroke. Using age and NIHSS, we were able to develop models to predict independent ambulation and upper limb function six months after stroke. Our estimates of recovery in independent ambulation (70% of those initially unable to ambulate) and upper limb function (41 to 45% of those initially without upper limb function) are broadly consistent with previous estimates from acute stroke cohorts. In studies that followed patients up six months after stroke, 79–85% of patients have been reported to recover independent ambulation (Veerbeek et al 2011, Wade and Hewer 1987) with a smaller proportion of patients (32–34%) recovering upper limb function (Au-Yeung and Hui-Chan 2009, Nijland et al 2010). The small differences between our estimates and those from these previous studies may be due to differences in the characteristics of cohorts or differences in the definitions of recovery in upper limb function.

In a retrospective analysis, however, Jackson et al5 suggested th

In a retrospective analysis, however, Jackson et al5 suggested that none of the urethral injuries require urethral substitution with graft and flaps as the first treatment. Contamination and inadequate circulation result with treatment failures.5 Regarding bladder injuries, the bladder must be closed with 2 layers of absorbable sutures. The most important issue after the repair of bladder rupture is adequate drainage

of the bladder. Thus, usage of a large-scaled urethral Foley catheter in addition to suprapubic cystostomy is recommended. The patient was operated by our department SKI-606 cost due to rectal bleeding and urethral and bladder injury. The urethra and the bladder were primarily repaired, a cystostomy was placed, and a long-term Foley drainage of the bladder was planned. The remnants of the prostate were debrided and also repaired before the reconstruction of the urethra, which is not reported previously. Multisystem traumas of the urethra, bladder, and rectum are seldom reported. Several forms of self-mutilation are known in schizophrenic patients; however, firing an explosive inside the body is an extreme condition. Explosive traumas should be managed carefully as the effects of thermal injury GSK-3 inhibition might be more severe than they seem. Even in those cases, reconstruction of the posterior urethra and bladder neck might be a reasonable option with appropriate surgical

techniques. “
“Traumatic dislocation of the testis (TDT) is an uncommon sequel of scrotal second trauma, occurring after direct pressure on

the scrotum and dislocating the testis outside its normal position to the surrounding tissue, usually the inguinal region.1 and 2 TDT may be a singular event1 or associated with blunt abdominopelvic trauma.3 Although TDT occurs more often at the time of injury,2 in a few cases, a TDT has been recognized as a later event.4 Ultrasound (U/S), color-flow Doppler U/S, and computed tomography (CT) are the main diagnostic tools of this condition.4 Early diagnosis and treatment are recommended to preserve testicular function and to avoid the risk of malignant transformation.1 In this study, we report on a case of TDT in an adult, with a brief review of this rare condition. A 27-year-old man was admitted to our Department 3 days after an injury from falling astride on a crossbar. The patient subsequently noted that the left testis was moved to the left inguinal region. There was not a history of undescendent or retractile testis in the past. On physical examination, his perineum and penoscrotum region had small abrasions, whereas the left scrotum was empty without hematoma. The testis was palpable in the left inguinal region (Fig. 1). The rectal tone was normal. A urine sample showed no blood. A color Doppler U/S revealed that the left testis was located in the inguinal canal, with normal size, and adequate blood supply of the testis (Fig. 2).

This can cause a bias toward the null, diluting an existing risk

This can cause a bias toward the null, diluting an existing risk Onalespib clinical trial because of inclusion of cases that were not exposed during embryogenesis. However, in August of 2013, Andersen et al9 from Denmark presented a second study using the same Danish registries covering more years (1997-2010) and more pregnant women (897,018 vs 608, 835). In contrast to Pasternak et al,8 Andersen’s study detected a 2-fold increased risk of cardiac malformations with ondansetron (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3–3.1),

leading to an overall 30% increased risk of major congenital malformations. To rule out confounding by indication, Andersen et al9 also examined metoclopramide taken for morning sickness, detecting no increase in teratogenic risk. The fact that the same large registry can be investigated to yield such opposing results is concerning. There

is an exponential rise in use of prescription database linkage to birth registries. None of these were designed specifically to address fetal drug safety, and there may be flaws in the quality and completeness of the available data. Of potential importance, a recent large case control study by the Sloan epidemiology unit and the Centers of Disease Control and Prevention, has reported a 2-fold increased risk for cleft palate associated with ondansetron taken for NVP selleck inhibitor in the first trimester of pregnancy

(OR, 2.37; 95% CI, 1.28–4.76).10 The maternal safety of ondansetron has been challenged in June 2012, when the FDA issued a warning of possible serious cardiac output (QT) prolongation and Torsade the Pointe among people receiving ondansetron. 11 As a result, the FDA requires strict workup of patients receiving ondansetron, to rule out long QT, electrolyte imbalance, congestive heart failure or taking concomitant medications that prolong the QT interval. 12 Because this drug is not approved by the FDA for pregnant women, the FDA did not specifically address precautions in pregnancy. However, in the context of NVP, women with severe NVP often exhibit electrolyte abnormalities (hypokalenia or hypomagnesemia). MYO10 Presently, counseling of women who receive ondansetron for morning sickness suggests that these FDA precautions are not being followed. Serotonin syndrome is a life-threatening disorder of excessive serotonergic activity, typically occurring when 2 or more serotonin-modifying agents are used simultaneously, although it may also occur with a single agent.12 From Jan. 1, 1998, to Dec. 30, 2002, Health Canada received 53 reports of suspected serotonin syndrome, most often reported with the use of selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors and selective serotonin- norepinephrine reuptake inhibitors.

Nevertheless, a similar exposure level as the IR formulation was

Nevertheless, a similar exposure level as the IR formulation was observed for the CR formulations for some of the BCS class 3 compounds (high CLint,CYP3A4 ⩾ 2500 μL/min/mg).

This could be a product of the aforementioned overestimation in absorption. BCS class 1 compounds, on the other hand, are more likely to be Selisistat molecular weight absorbed in distal regions of the GI tract ( Tannergren et al., 2009). Thus, for this type of compounds, the reduction in intestinal metabolism could lead to AUC levels higher than that observed for IR formulations ( Figs. 3A and S3A). A relative bioavailability of up to 220% was observed for the simulated CR formulations of highly CYP3A4-cleared compounds (CLint,CYP3A4 ⩾ 2500 μL/min/mg) (Fig. 6). These results were in good agreement with the clinical observations for CR release formulations, for buspirone, oxybutynin, quetiapine and cyclobenzaprine, where the increase in relative bioavailability in the CR formulations was dependent upon an apparent reduction in metabolic clearance of the aforementioned compounds. The use of in vivo data for the determination of the in vitro intrinsic clearance for the analysis in Fig. 6 seemed justified

as the in vitro values would have underpredicted the in vivo clearance for oxybutynin and buspirone. The in vitro clearance, varied between 268 and 442 μL/min/mg ( Gertz et al., 2011 and Zhu et al., 2005) for buspirone, and 78–278 μL/min/mg for oxybutynin ( Mizushima et al., 2007 and Yaich et al., 1998), whereas the value determined from AZD2281 mouse the in vivo clearances ( Table S3) were 5454 μL/min/mg and 2932 μL/min/mg for buspirone and oxybutynin, respectively. This underprediction was also observed, to a lesser extent, for cyclobenzaprine, whereas for quetiapine an in vitro value similar to the in vivo value was observed ( Table S3). The mechanisms behind said underpredictions when using human liver microsomes are still unknown; however it has been attributed to factors such as the ionization, binding to plasma proteins, and clearance model inaccuracies Idoxuridine ( Berezhkovskiy, 2011, Hallifax et al., 2010, Hallifax

and Houston, 2012, Poulin, 2013 and Poulin et al., 2012). Simvastatin (BCS class 2) represent an interesting case that was not in agreement with the simulated Frel across the defined parameter space. Even though simvastatin is classified as BCS class 2 the CR formulation showed 2–3-fold higher relative bioavailability that the IR formulation. One of the reasons for such disagreement with the simulated data was the use of an enabling CR formulation in one of the simvastatin studies ( Tubic-Grozdanis et al., 2008). The formulation employed in the aforementioned study contained a mixture of gelatine and lecithin intended to improve the wettability of simvastatin in the formulation and promote the formation of microemulsions or even micelles, thus improving simvastatin’s dissolution.

It was filtered through Whatmann Paper No 1 To the filtered extr

It was filtered through Whatmann Paper No.1. To the filtered extract, acetic acid and acid ninhydrin (Warm 1.25 g ninhydrin in 30 mL glacial acetic acid and 20 mL 6 M phosphoric acid) were added in the ratio 1:1 and then boiled for 1 h. Reaction was terminated by placing in ice bath after which 4 mL of benzene was added. Benzene layer was separated and warmed to room temperature. The absorbance values were determined at 520 nm.23 and 25 Standard curve was prepared using pure proline and used for the detection of proline in the experimental conditions. Proline accumulation is one of the common characteristics

in many monocotyledons under saline conditions.26 It is well documented that the accumulation of proline is a response of plants to increased noxious elements.27 Among these, sodium ion is known as the most prominent one.8 Very high accumulation Metformin manufacturer of cellular proline (above 100% of the total amino acid pool under stress

as compared to just 5% under the normal condition) has been earlier reported in many higher plants species due to increased synthesis GPCR Compound Library in vivo and decreased degradation under the stress conditions such as water, salt, drought and heavy metal.28 Seedlings of T. aestivum (wheat) was subjected to drought conditions of salinity with different concentrations of NaCl (0.5–5 M). Sample which was treated with 1.0 M NaCl showed high accumulation of proline with 65 times of more than that of the control, whereas at low saline conditions of 0.5 M NaCl it showed only 31.42% of proline. On increasing the saline conditions it was found to be 84.28% and 98.57% at salt concentrations of 2.5 M and 5 M, respectively ( Fig. 1). Above the concentration of 1 M NaCl the decline of proline accumulation at higher values might be some interference of other amino acids with the colorimetric reading. The standard plot was prepared using pure proline which shows the amount of accumulation of proline under various drought conditions of NaCl. From the above result we can conclude that there is accumulation of proline in the plant under induced drought conditions of salinity.

The accumulation is greater at higher concentration of sodium to chloride. The expected linear increase in colorimetric absorbance reading at 520 nm may have been affected by other interfering materials. Nevertheless, it has been seen that proline is accumulated under water stress and may have a role in protecting the plant, and helping in its recovery when replenished with water at a later time. All authors have none to declare. Authors are highly thankful to DBT for financial support and Principal, Dr. P. Hemalatha Reddy for providing lab facilities to work. “
“Annona squamosa L. belongs to the family Annonaceae. It is a widely used Indian medicinal plant for the cure of deadly disease, diabetes. 1 In recent decades, a great no. of chemical and pharmacological studies have been done on A. squamosa L.

LC neurons switch between phasic and high tonic discharge modes t

LC neurons switch between phasic and high tonic discharge modes to bias behavior differently and these shifts facilitate adaptation in a dynamic environment (Fig. 1) (see for

reviews (Aston-Jones and Cohen, 2005 and Bouret and Sara, 2005)). LC neuronal recordings in monkeys performing operant check details tasks suggest that phasic LC discharge is associated with focused attention and staying on-task whereas high tonic discharge is associated with labile attention and going off-task (Usher et al., 1999 and Rajkowski et al., 1994). A shift from phasic to high tonic LC discharge has been suggested to promote behavioral flexibility, disengaging animals from attention to specific stimuli and ongoing behaviors and favoring scanning the environment for stimuli that promote alternate, more rewarding behaviors (Aston-Jones and Cohen, 2005). The ability to shift between phasic and tonic firing modes would promote rapid

adjustments in response to a stressor or after stressor termination (Fig. 1). Convergent lines of evidence suggest that stressors that initiate the HPA response to stress also activate the LC-NE system and the parallel engagement of these two systems serves to coordinate endocrine and cognitive limbs of the stress response (Valentino and Van Bockstaele, 2008). This has been studied using different stressors including shock, auditory Stem Cells inhibitor stress, immunological stress, autonomic stressors, restraint and social stress and different endpoints including NE turnover, NE release, LC neuronal activity, c-fos expression or tyrosine hydroxylase expression (Cassens

et al., 1981, Cassens et al., 1980, Korf et al., 1973, Thierry et al., 1968, Beck and isothipendyl Fibiger, 1995, Bonaz and Tache, 1994, Britton et al., 1992, Campeau and Watson, 1997, Chan and Sawchenko, 1995, Chang et al., 2000, Curtis et al., 2012, Dun et al., 1995, Duncan et al., 1993, Funk and Amir, 2000, Graham et al., 1995, Ishida et al., 2002, Kollack-Walker et al., 1997, Lacosta et al., 2000, Makino et al., 2002, Rusnak et al., 2001, Sabban and Kvetnansky, 2001, Smagin et al., 1994, Smith et al., 1992, Smith et al., 1991 and Valentino et al., 1991). In response to acute stress LC spontaneous discharge increases and this is temporally correlated to cortical EEG activation indicative of arousal (Curtis et al., 2012, Lechner et al., 1997 and Page et al., 1992). Moreover, LC activation is necessary for forebrain EEG activation by stress because selective bilateral inactivation of LC neurons with clonidine microinfusions prevents this response (Page et al., 1992). As LC spontaneous discharge rate increases, responses to discrete sensory stimuli are attenuated (Curtis et al., 2012 and Valentino and Wehby, 1988a). Thus, acute stressors bias LC discharge towards a high tonic mode that would facilitate disengagement from ongoing tasks, scanning attention and behavioral flexibility, all of which would be adaptive in coping with an immediate threat (Fig. 2A).

Thus, WHO could not recommend their inclusion into national immun

Thus, WHO could not recommend their inclusion into national immunization programs until safety and efficacy were demonstrated in Asia and Africa [1]. Consequently, large multi-center randomized, double-blinded, placebo controlled trials were designed and implemented for each new vaccine [14] and [15]. Among the sites in five countries (3 in Africa and 2 in Asia) participating in two PRV trials, HIV seroprevalence

was high only in the Kenya site, with 14.9% in adults 15–49 years old being infected with HIV (2007) [16]. In this report, we evaluate the safety of PRV among participants in Kenya with respect to (1) all serious adverse events (SAE) that occurred

within 14 days Gefitinib mouse of any vaccination, and intussusception cases, deaths and vaccine-related SAEs throughout the study; and (2) all adverse events following immunizations (AEFI) with attention to vomiting, diarrhea, and elevated temperature for a subset of subjects (“intensive safety surveillance”) followed for 42 days following each dose. We also assessed serious and non-serious adverse events for a limited number of participants that were identified to be HIV-infected or Stem Cell Compound Library in vitro HIV-exposed, which is the first systematic evaluation of PRV in HIV-infected and -exposed infants. The PRV Phase 3 safety and efficacy trial in Kenya was conducted in Karemo division, Nyanza province, Western Kenya; Kenya was one of three sites in the multicenter trial conducted in Africa (the other two were in Mali and Ghana). A second safety and efficacy trial was conducted in Bangladesh and Vietnam [14] and [15]. In addition to a high prevalence of HIV/AIDS [16], Karemo is endemic for malaria [17] and high levels of malnutrition [18]. Consequently, Karemo also has among the highest rates of infant, child and maternal mortality rates in Kenya. According to the KEMRI/CDC Health and Demographic Surveillance System (HDSS), in Karemo in 2008, the infant mortality ratio was 107/1000 live births,

the under five mortality ratio was 203/1000 live births and the maternal those mortality ratio was 600 per 100,000 live births [17]. The Phase III trial study design has been described elsewhere [14] and [15]. In brief, a double-blind, placebo controlled, randomized phase III trial of PRV was conducted from 2007 to 2009. In Kenya, the trial was conducted from July 7, 2009 through September 30, 2009. Healthy infants aged 4–12 weeks were eligible for enrollment. Enrollment of infants with clinical evidence of any acute infection or febrile illness including active gastrointestinal disease (i.e., vomiting, diarrhea, elevated temperature) was delayed until these symptoms resolved.