Two main boundaries in the log permeability-pH plot are ABL and paracellular permeation (Fig. 6). The boundaries create a ‘dynamic range window’ (DRW), as evident in the plots (Avdeef, 2011). The sigmoidal log permeability-pH curve reaches a plateau at the ABL

limit at the top, and at the paracellular limit at the bottom of the DRW (cf., Fig. 6). If experimental data are within the DRW, intrinsic transcellular permeability with ABL correction can be derived. However, there are two pitfalls, if just a single-pH measurement is performed. Firstly, if the data are on the ABL limit, then permeability measured in the experiment simply reflects diffusion through the ABL. Secondly, if the monolayer used for the permeability assay was leaky to start with or VX-770 mw a leak developed with vigorous

stirring during the assay, the data could be on the paracellular permeation limit and merely reporting paracellular permeation of the compound. A good example of how multiple-pH measurements overcome the first problem is permeability assay of the lipophilic base XAV-939 propranolol at physiological pH 7.4. From the results in this study, at pH 7.4 the measured log Papp for propranolol is on the ABL limit. However, because the assay was conducted at multiple pH, guided by prediction from pCEL-X, some of the data points are within the DRW. Therefore, the ABL-corrected intrinsic transcellular next permeability could be derived. Care should be taken when choosing a single pH for permeability assay of lipophilic bases. For the second problem, cell monolayers with TEER value of 140 Ω cm2 were found to be very leaky in the permeability assay of dexamethasone. However, dexamethasone is relatively lipophilic, and hence the leakiness has a minimal interference on the determined log P0 (cf., Fig. 3c). In an in vitro co-culture BBB model of primary bovine brain endothelial cells and rat astrocytes, the paracellular permeation increased exponentially when TEER was below 131 Ω cm2

and 122 Ω cm2 when sodium fluorescein (376 Da) and FITC-labelled dextran (4 kDa) respectively were used as paracellular markers ( Gaillard and de Boer, 2000). For ionizable compounds, if sufficient data points at different pH fall within the DRW, then the intrinsic transcellular permeability P0 can still be derived. Hence, one way to make use of leaky cell monolayers is to conduct the permeability assay at multiple pH provided that the compounds of interest are ionizable (e.g., acetylsalicylic acid, Fig. 3a). The defined DRW boundaries indicate that the permeability of the neutral form of a lipophilic compound may be limited by the ABL, while the permeability of the charged form (i.e., cation or anion) may be limited by the paracellular pathway. For moderately lipophilic compounds (P0 < PABL), the top horizontal section of the sigmoidal curve is not limited by the ABL (e.g., diazepam, Fig.

At enrolment, a pre-vaccination baseline dried blood spot

(DBS) on filter paper was collected by heel prick puncture for measurement of retinol-binding protein (RBP) and C-reactive protein (CRP). The filter paper was dried in up-right position overnight and stored with silica desiccant at −20 °C until analysis. At the follow-up visits, capillary GSI-IX clinical trial blood was collected by heel puncture into a heparinised tube for whole-blood stimulation and in an EDTA-coated tube for differential counts, respectively. A DBS for RBP and CRP measurements was collected similarly to the baseline. A blood smear was microscopically inspected for malaria parasites. From collection to processing, the heparinised blood was kept at ambient temperature; the EDTA-treated blood was kept cold. All blood samples were collected by the same trained nurse and transported to the National Laboratory within 4 h. The whole blood stimulation assay was performed as previously described [6] and [7]. Briefly, the heparinised blood Rigosertib chemical structure was diluted 1:10 with RPMI-1640 medium (Invitrogen, Breda, Netherlands) supplemented with 2 mM glutamate, 1 mM pyruvate, 100 IU penicillin and 100 μg/ml streptomycin, and cultured at 37 °C with 5% CO2, stimulated with

lipopolysaccharide (LPS) (1 ng/ml, Sigma-Aldrich, Zwijndrecht, Netherlands) [a Toll-like receptor (TLR)4 agonist], (S)-(2,3-bis(palmitoyloxy)-(2-RS)-propyl)-N-palmitoyl-(R)-Cys-(S)-Ser-(S)-Lys4-OH,trihydrochloride (Pam3cys) (100 ng/ml, Cayla-InvivoGen Europe, Toulouse, France) [a TLR2 agonist], antigen purified protein derivative (PPD) of Mycobacterium tuberculosis (10 μg/ml, Statens Serum Institut, Copenhagen, Denmark), BCG (Statens Serum Institut, final concentration 1:100), trivalent OPV (final concentration 1:100) or phytohaemagglutinin (PHA) (2 μg/ml, Welcome Diagnostics, Dartford, UK) [a T cell mitogen]. Megestrol Acetate Controls were medium alone cultures (referred as medium). Supernatants were collected after one day (for LPS, Pam3cys and medium1) or three days

of incubation (for PPD, BCG, OPV, PHA, poly I:C and medium3) and stored below minus 40 °C until cytokine measurements. Cytokine concentrations in supernatants were analysed at Statens Serum Institut, Copenhagen, Denmark. IL-10 and TNF-α from day 1 supernatants stimulated with LPS and Pam3cys, and IL-2, IL-5, IL-10, TNF-α and IFN-γ from day 3 supernatants stimulated with PPD, BCG, OPV, PHA and poly I:C were analysed using Luminex cytokine kit and buffer reagent kit (BioSource, Camarillo, CA, USA) on a Luminex-200 cytometer (Luminex Corporation, Austin, TX, USA) equipped with Bio-Plex Manager version 5.0 (Bio-Rad, Hercules, CA,USA). The assay was performed according to the manufacturer’s instructions with slight modifications. Briefly, assays were performed in a 96-well U plate (NUNC, Roskilde, Denmark) at room temperature.

13 This study had 77% power to detect an association at a SNP with an allele frequency of 30% and an odds ratio of 1.6 under an additive model at a P value of .007, assuming a population disease prevalence of 5.67%. 14 These parameters are similar to those reported for most of these loci in cross-sectional studies of OAG genetics. Differences in the demographics of MK-1775 the available cohort were

assessed using IBM SPSS Statistics V20. Association analysis was conducted under a univariate allelic model and also using logistic regression under an additive model adjusted for baseline measurements of age, sex, mean IOP of both eyes, mean cup-to-disc ratio of both eyes, mean disc diameter of both eyes, and systolic and diastolic blood pressure using Plink.15 Statistical significance was set to P < .007 under a Bonferroni correction, to account for the 7 SNPs tested. SB203580 cost One associated SNP from each significant or nominally significant locus and the clinical variables were included in a logistic regression model using IBM SPSS Statistics V20. SNPs were coded to the number of OAG risk alleles carried by each participant at each SNP (0, 1, or 2). Collinearity between variables in the model were assessed

by calculating the tolerance and the variance inflation factor (VIF). No collinearity was detected (no VIF >2). The rank importance of each model component was also assessed using a large population of neural networks (produced using Matlab; The MathWorks, Inc, Natick, Massachusetts, USA). A neural network can be thought of as a small machine capable of learning. It is trained by exposure to a dataset comprising inputs (for example, the characteristics of horses in a race) and outputs (the winning horse). After each round of training, the link strengths within the network are changed, and further training is undertaken until its predictive

performance on a previously unseen “validation” dataset Ketanserin no longer improves. The resulting network’s performance is then measured using a final, also unseen “test” dataset. In this study, each neural network drew its inputs from unique subset of 7 SNPs and 7 clinical variables (age, sex, diastolic and systolic blood pressure, cup-to-disc ratio, IOP, and disc diameter). To cover all possible permutations of these 14 inputs, 16 383 neural networks were required. Each neural network was trained and tested with a cohort comprising glaucoma patients (n = 67) and an equal number of randomly selected controls: 70% of the cohort was used to train the network, 15% to validate its performance during training, and the remaining 15% were unseen during training and were used to test the final performance of each network. Each neural network was trained and tested 20 times. In separate analyses, controls were either age matched to within 2 years of incident cases or not age matched.

3 bacterial expression vector. pPACIB.3 is an “in house” developed plasmid for bacterial periplasmic expression of recombinant proteins via an ompA leader

sequence. The tryptophan promoter and a terminator see more sequence from the T4 phage ensure high expression levels and the vector provides expressed proteins with six-histidine tags at their C-terminus. The hrVEGF molecule was purified from bacterial periplasm using conventional IMAC procedures [16]. The recombinant P64K protein derived from Nm was supplied by the Development Department of the CIGB. P64K is produced routinely to be used as a vaccine carrier protein [17]. Clinical grade preparations (0.8 mg of protein/0.5 mL per vial) of VSSP were supplied by the Center for Molecular Immunology of Havana. The VSSP preparation is obtained by physical disorganization of outer membrane vesicles of Nm and further re-association and stabilization with the inclusion of GM3 gangliosides. VSSP induces the activation of CTL responses to peptides and proteins, and can also stimulate the humoral response to different antigens [18], [19] and [20]. The

oil-based adjuvant was obtained from Seppic (France). Emulsification was done as recommended by the supplier using two syringes, a connector, and 100 syringe passes. Animals were randomly assigned to five groups of five animals each and given: (a) six subcutaneous Alpelisib mw injections of 100 μg of the recombinant protein pP64K-hVEGFKDR− mixed with 200 μg of VSSP (hereafter denominated CIGB-247), in weekly or biweekly schedules,

or (b) six intramuscular injections of CIGB-247 in a volume of 0.1 mL, mixed with 0.1 mL of montanide ISA 51, in a biweekly schedule. Control (placebo) animals received only Tris 10 mM. The rats assigned to the weekly schedule received three additional injections of CIGB-247 25 days after the sixth immunization. A week after the last booster the animals were euthanized, sera and plasma collected and their organs processed for histopathology. Platelet rich and platelet depleted plasma were obtained as described [21]. Animals (three per group) were given: (a) six subcutaneous found injections of CIGB-247, in weekly or biweekly schedules, or (b) six intramuscular injections of CIGB-247 in a volume of 0.1 mL, mixed with 0.1 mL of montanide ISA 51, in a biweekly schedule. Control animals (two animals) received only Tris 10 mM. The animals assigned to the weekly schedule received an additional booster 21 days after the sixth immunization and were euthanized a week later. Sera were collected and organs dissected and fixed in 10% formalin for histological evaluation. Animals were screened first for antibodies to P64k and VEGF proteins and considered naive with respect to both antigens when specific antibodies were undetectable by ELISA (titer <1:50) (see methods below). Monkeys were subsequently ranked by weight and age and then randomly assigned to three groups of three animals each.

ncbi.nlm.nih.gov/). As shown in Table 1, the ‘G’ allele frequency of rs3922 was significantly higher in non-responders than those normally responded to HBV vaccination (45% vs. 26.83%, P = 0.045). Consequently carriers of the ‘G’ allele at rs3922 site had an increased risk of failing to respond to HBV vaccination than those carrying the ‘A’ allele (OR = 2.23, 95% CI 1.01–4.92). Similarly, the minor allele ‘G’ in rs676925 increased the risk of non-response to vaccination (OR = 2.66, 95% CI 1.04–6.79, P = 0.037). In the case of rs497916, both the allelotype

and genotype were related with HBV vaccine efficacy (allelotype: P = 0.008, genotype: www.selleckchem.com/products/forskolin.html P = 0.023). The ‘C’ allele in rs497916 protected from non-response (OR = 0.33, Wnt pathway 95% CI 0.14–0.77) and the genotypes ‘TT’ and ‘CT’ increased the possibility of non-response to vaccination (‘TT’: OR = 3.71, 95% CI 0.57–24.18, ‘CT’: OR = 2.67, 95% CI 0.89–8.01). Finally, the ‘TC’ genotype in rs355687 appears more frequently in the group defined as HBV responders (P = 0.038, OR = 0.30, 95% CI 0.09–0.97). Using the Haploview software, three possible blocks were constructed (Fig. 1). Strong linkage disequilibrium was found in two haplotypes in block one which was made up of rs497916, rs3922 and rs676925 within CXCR5. Compared to

HBV vaccination responders, the ‘CAC’ haplotype had a significantly lower frequency in non-responders (Responders vs. non-responders: 0.735 vs. 0.513, P = 0.013). The frequency of the ‘TGG’ haplotype was 0.266 in the study group and only 0.111 in the control group (P = 0.025). That is, an individual who has a ‘TGG’ haplotype containing the three risk alleles of rs497916, rs3922 and rs676925 is significantly more likely to have non-responsiveness to HBV vaccination. Changes in the SNP located in the 3′-UTR may cause a fluctuation in gene expression. To understand whether the 2 chosen

SNPs (rs3922, rs676925) that fall in the 3′-UTR Phosphoprotein phosphatase of CXCR5 affected gene’s expression levels, flow cytometry assays were performed to detect CXCR5+ populations in PBMCs from 29 healthy individuals. Based on their genotypes in rs3922 or rs676925, this cohort was divided into 3 groups. The percentage of CXCR5 positive cells and the mean fluorescence intensity (MFI) of CXCR5 in CD3+CD4+ T cell and CD3−CD19+ B cell populations were compared amongst these 3 groups. The gating strategy employed is defined in Fig. 2A. As summarized in Fig. 2B, in both CD4+CD3+ T cell and CD19+CD3− B cell populations, the percentage and MFI values for CXCR5+ cells in the rs3922 “GG” genotype group were significantly higher than those seen for the “AG” group (P < 0.05). Merging the data from both the “AA” group and “AG” group, still resulted in a statistical difference (P < 0.

05. The Cochran–Armitage trend test was performed using SAS 9.2 (SAS Institute Inc., USA). A temporal

cluster analysis of the HFRS epidemic between 1971 and 2011 was performed using the annual incidence data to detect the time periods of high HFRS risk. The procedure involves gradual scanning of a data window across time and noting the number of observed and expected observations inside each of the windows. For each scanning window of varying time, position and size, the risk of HFRS within and outside the window was tested by the Tanespimycin likelihood ratio (LLR) test, with the null hypothesis being equal risk. The expression of LLR was calculated as follows: LLR=cE(c)c×C−cC−E(c)C−c×I( )where C is the total number of cases, c is the observed number of cases within the window, and E(c) is the covariate adjusted expected number of cases within the window under the null-hypothesis. I() is an indicator function, which is equal to 1 when the window has more cases than expected under

the null-hypothesis, and 0 otherwise [25]. The window having the maximum LLR was indicative of the most likely cluster and considered check details the time period with the highest HFRS risk. In this study, a maximum temporal cluster size of 20%, 30%, 40% and 50% of the study period were specified in the temporal cluster analysis in order to detect the time period with the highest risk of HFRS in different temporal scales. The relative risk of HFRS within and outside the window and the average incidence

inside the window were calculated to evaluate the degree of HFRS risk. This analysis was performed using SatScan 7.0.3 (Information Management Services Inc., Boston, MA, USA). It is reported that vaccines can effectively protect from HFRS infection for up to four or five years after the initial vaccination [26]. Therefore, the cross correlation analysis was conducted to detect the correlation between the annual HFRS incidence and vaccination compliance PDK4 in Hu with a lag time of five years. The cross correlation could be identified if the cross correlation coefficient (CCF) was greater than two times the standard error (SE). This analysis was performed using SPSS 16.0 (SPSS Inc., Chicago, IL, USA). Wavelet analysis was employed to detect the shift of the periodic mode of the HFRS epidemic in Hu and the effect of the vaccination compliance on this shift. The Morlet wavelet was taken as the basis function for wavelet transforms, since it is able to decompose a signal using functions that narrow when high-frequency features are present and widen with low-frequency structures [27]. The series of HFRS cases were first filtered and then normalized. The local wavelet power spectrum (LWPS) was obtained by computing wavelet transforms and was subsequently color-coded from blue to red to denote increasing power. The global wavelet spectrum (GWS) was estimated by averaging the LWPS across time and the lower limit of significance was denoted by a dotted line.

7–74.4%)

[29] and a Latin American study on Rotarix (61–65%) [30]. Our results on the 105.6 FFU/serotype formulations are in line with these studies. A large Phase III clinical trial on the 105.6 GS-7340 in vivo FFU/serotype formulation is now planned to achieve licensure in India as well as prequalification by WHO for global application. Given the limited knowledge on correlates of protection for rotavirus vaccine, this phase III clinical trial is designed to demonstrate that the vaccine is efficacious against rotavirus gastroenteritis. In addition, through close surveillance, the trial will greatly expand the safety database available for the product. This double blind randomized placebo controlled study will be conducted in around 7500 infants at multiple sites in India. BRV-PV or placebo will be administered in 1:1 ratio at 6, 10 and 14 weeks of age along with Universal Immunization program (UIP) vaccines. A close follow up will be maintained for rotavirus gastroenteritis cases as well as safety issues till two years of age. Immunogenicity of the vaccine will be assessed in a subset along with polio type 1, 2 and 3 antibodies. Since UIP vaccines will be given concurrently with the three doses of BRV-PV, a separate Phase III study will formally assess the potential interference of the vaccine with routine UIP immunizations. In that study, the immunogenicity of three consecutively manufactured lots will also be Linsitinib supplier assessed to establish manufacturing

lot-to-lot consistency. Apart from the lyophilized presentation, SIIL is also working on a fully liquid formulation; ready-to-use vaccine which contains the reassortants of the same serotypes. Animal

toxicity studies of this formulation are anticipated to start in 2014. After technology transfer from NIAID, SIIL successfully continued the further development of the BRV-PV. The results of either the pre-clinical and clinical studies of the formulation developed at SIIL have shown that it is safe and immunogenic. The vaccine is now poised to enter the pivotal study for licensure. Eventual commercial availability of the vaccine will be important for public health programs in the developing world. The pre-clinical and clinical studies were funded by Serum Institute of India Ltd., Pune. We gratefully acknowledge the contribution of late Dr. A.Z. Kapikian; The National Institute of Allergy and Infectious Diseases (NIAID); USA, Dr. Carl Kirkwood of Murdoch Children’s Research Institute, Australia; Dr. Gagandeep Kang and Dr. Sudhir Babji of Christian Medical College, Vellore, Dr. Ashish Bavdekar; KEM Hospital Research Centre, Pune, and Dr. Sanjay Lalwani; Bharati Veedyapeeth Medical College, Pune. Conflict of interest: All study authors are employed by Serum Institute of India Ltd., Pune. “
“Rotaviruses, the primary etiological agents of severe gastroenteritis in children less than five years of age, cause more pediatric diarrhea-related deaths than any other agent in low and middle-income countries [1].

Studies were not excluded on the basis of language or publication status. The title and abstract were examined and full text was obtained if there was ambiguity regarding eligibility. If the two authors could not

reach agreement, a third author (ME) made the decision regarding eligibility. The reference lists selleckchem of any eligible studies were screened to identify other relevant studies. We asked the authors of eligible studies and manufacturers of inspiratory muscle training devices if they were aware of any other eligible studies. The following keywords were included in our search: randomised controlled trial, inspiratory/respiratory/ventilatory muscle training/conditioning, pressure threshold load, incremental Torin 1 datasheet threshold load, isocapnic/normocapnic hyperpnoea, resistance load, mechanical ventilation, weaning, critically ill, intubated/ventilated/tracheostomy (see Appendix 1 on the eAddenda for the full search strategy). Design

• Randomised controlled trial and quasi-randomised controlled trials* Participants • Patients aged > 16 years who were intubated or tracheostomised receiving full or partial mechanical ventilation Intervention • Inspiratory muscle training via any of the following: – isocapnic/normocapnic hyperpnoea – inspiratory resistive training – threshold pressure training – adjustment of ventilator pressure trigger sensitivity Outcome measures • Inspiratory muscle strength • Inspiratory muscle endurance • Duration of unassisted breathing periods • Weaning duration • Weaning success • Reintubation • Tracheostomy • Intensive care unit or hospital length of about stay • Mortality • Adverse effects Comparisons • Inspiratory muscle training versus sham/no training * Only the first arm of cross-over trials was included. Quality: The methodological quality of the

studies was assessed using the PEDro scale ( de Morton 2009). The PEDro scale scores the methodological quality of randomised controlled studies out of 10. The score for each included study was determined by a trained assessor (ME). Scores were based on all information available from both the published version and from communication with the authors. No study was excluded on the basis of poor quality. Participants: Studies involving hospitalised patients over 16 years of age who were intubated or tracheostomised receiving full or partial mechanical ventilation, and for whom liberation from mechanical ventilation was a goal of clinical care, were included in the study. Where available, the age, gender, height, weight, cause of admission, and severity score of the participants at admission were recorded. Pre-intervention characteristics including severity score, ventilation status, ventilation period and endotracheal tube/tracheostomy, inspiratory muscle strength and inspiratory muscle endurance were also recorded where available. Intervention: The experimental intervention was inspiratory muscle training.

A pool of HIV peptides (Mimotopes; 25 μg/mL) was used DAPT concentration as negative control (Supplementary Table 3). Cells were incubated with stimulants at 37 °C and 5% CO2 for 24 h. Plates were washed and biotinylated anti-human IFN-γ antibody (Thermo Scientific) was added to each well. Plates were refrigerated overnight. Thereafter, plates were washed and streptavidin-HRP (BD Biosciences, San Jose, CA) was added to each well and incubated for 2 h. Plates were washed and air-dried, and the substrate 3-amino-9-ethyl carbazole

was added. Numbers of IFN-γ-secreting cells (“spots”) were measured by anti-IFN-γ capture antibody and adjusted for background (medium alone) and baseline response. Spots were counted by CTL ImmunoSpot® Analyzer (CTL); data were processed by SpotMap® software. An immune response was pre-specified by algorithms that evaluated T-cell IFN-γ responses in terms of breadth, duration, and magnitude. In addition, a response to any pool or antigen was required to be ≥2-fold over assay background and display

at least a 2-fold increase from baseline (Supplementary Table 4). Thawed PBMCs (2 × 105 cells/well) were incubated with HBsAg, HBcAg, and HBx (1 and 10 μg/mL each). Candida albicans extract (Greer Labs., Lenoir, Kinase Inhibitor Library research buy NC; 20 μg/mL), tetanus toxoid (Colorado Serum Company, Denver, CO; 0.25 limes flocculation units/mL), and PHA (Roche Diagnostics, Indianapolis, IN, 5 or 12.5 μg/mL) were used as positive controls. Assay medium was used as negative control. Cells were incubated with test antigens in a humidified incubator at 37 °C and 5% CO2 for 6 days. Proliferation was measured by uptake of 3H-thymidine (Packard Topcount NXT, Downers Grove, Endonuclease IL), which was

added for the final 6 h of incubation, using a beta scintillation counter. PHA stimulation was measured after 3 days. The stimulation index (SI) for each antigen was calculated as the ratio of the median response in the presence and absence of antigen. A response was defined as SI ≥2 over baseline. Serum was harvested from blood samples collected before study treatment administration on days 1 and 29, and on day 28 of the post-treatment period. Anti-S. cerevisiae antibody (ASCA) IgA and IgG levels were measured by Quanta Lite™ ELISA kits (INOVA Diagnostics, San Diego, CA). Both ASCA IgA and IgG are known to bind to a specific epitope present in the cell wall of S. cerevisiae [10] and [11]. An ASCA value ≥25 U on treatment after subtraction of baseline unit value was considered to be a positive response. Serum was harvested from blood samples collected before study treatment administration at screening and on days 1, 15, 29, 57, and on day 28 of the post-treatment period; for subjects in Cohort A of each group, further samples were collected on days 8 and 22.

They feared side effects;

especially whether the vaccine would have a potential effect on future reproduction: “vaccinations in this country that are linked to issues of reproduction have had very bad results later on,” or the vaccine could “disorder and destroy the eggs that a girl has, and beta-catenin pathway reproducing would be a problem.” The aunt of one student was suspicious of the vaccine and had told her: “they are coming to implant cancer in people… they are coming to reduce reproduction” (GD Nyakato). Most participants trusted the safety of the vaccine, since it had been explained that the Tanzanian government had approved the vaccine: “I know the government cannot do something malicious to children” (parent, GD Mirongo). All parents stated they would agree to have their daughters vaccinated, but some hesitated when confronted with an unknown infection (HPV), disease (cervical cancer), and vaccine: “That disease you are talking about, we are completely in the dark about it” (parent, GD Mkolani), and “The vaccine will have a benefit if it does not have harmful side-effects” (parent, GD Mirongo). The five male teachers (GD, Malulu) who opposed vaccination also commented that the vaccine might give

girls a license to start sexual activity: “if this is introduced, a person would have the freedom to do anything.” A few religious representatives also echoed this concern but most found the vaccine a ‘good Navitoclax ic50 thing’ because it would protect adolescent girls. No parents thought that the vaccine would encourage sexual activity among the targeted girls. Generally, teachers, parents, students, and health workers preferred age-based vaccination

as they believed that this would target more students who had not yet started sexual activity; choosing students in School Year 6 [where the mean age Oxygenase is 13.9 years (range 11–22 years)] would include a greater age-range and older girls who might have started sex. Participants suggested vaccinating much younger girls: “a ten-year-old child has already started with sex, the ones who have not started are those aged seven” (parent, GD Mirongo). A few suggested testing girls’ HPV status before vaccination. If class-based delivery was to be used, participants preferred classes lower than Year 6. A few parents preferred class-based delivery because of simpler logistics, since each girl’s age would not need to be checked. Other interviewees focused more on student understanding and preferred 12-year-olds: these would be “mature enough” to understand the vaccination information and could help to “educate parents” (teacher, GD Serengeti); those in Year 6 would “value” the vaccine more (health worker, IDI Makongoro).