BackgroundT-cell responses against highly conserved influenza antigens have been previously associated with protection. However, these immune responses are poorly maintained following recovery from influenza infection and are not boosted by inactivated influenza vaccines. We have previously demonstrated the safety and immunogenicity of two viral vectored vaccines, modified vaccinia virus Ankara (MVA) and the chimpanzee adenovirus ChAdOx1 expressing conserved influenza virus antigens, nucleoprotein (NP) and matrix protein-1 (M1). We now report on the safety and long-term immunogenicity of multiple combination regimes of these vaccines in young and older adults.MethodsWe conducted a Phase I open-label, randomized, multi-center study in 49 subjects aged 18–46 years and 24 subjects aged 50 years or over. Following vaccination, adverse events were recorded and the kinetics of the T cell response determined at multiple time points for up to 18 months.FindingsBoth vaccines were well tolerated. A two dose heterologous vaccination regimen significantly increased the magnitude of pre-existing T-cell responses to NP and M1 after both doses in young and older adults. The fold-increase and peak immune responses after a single MVA-NP + M1 vaccination was significantly higher compared to ChAdOx1 NP + M1. In a mixed regression model, T-cell responses over 18 months were significantly higher following the two dose vaccination regimen of MVA/ChAdOx1 NP + M1.InterpretationA two dose heterologous vaccination regimen of MVA/ChAdOx1 NP + M1 was safe and immunogenic in young and older adults, offering a promising vaccination strategy for inducing long-term broadly cross-reactive protection against influenza A.Funding SourceMedical Research Council UK, NIHR BMRC Oxford.

The importance of supporting language development in preschool children from low-income families is discussed.

Continued concerns about educational equity for minority students require looking beyond analysis of enrollment in primary disability categories to additional issues of educational opportunity for students receiving special education services. This study examined the relationship between student ethnicity and language proficiency status with (a) number and type of disability labels, (b) access to the least restrictive environment, and (c) ancillary services using data from a large southwestern school district. Data quality was also examined as part of this study. The results suggest that minority students and English language learners were disproportionately enrolled in special education and placed in more segregated settings. A trend toward increased disability labels for minority students was also identified. Implications for research and practice are discussed.

Review of the Literature R esearch on the prevalence of behavior problems in preschool children from low-income families, and the risk factors associated with these behaviors, was reviewed. A systematic search of studies conducted between 1991 and 2002 yielded a total of 30 research reports that met all of the preestablished criteria. These studies yielded several findings. Children from low socioeconomic status (SES) backgrounds were found to have a higher incidence of behavior problems as compared to the general population. Behavior problems were associated with multiple risk factors found in these children's lives related to child, parent, and socioeconomic characteristics. The results are discussed in terms of implications for early identification and intervention and directions for future research. METHODSystematic searches were conducted of several major online databases in the fields of education and psychology: The Educational Resources Information Center (ERIC), PsycINFO, and Exceptional Children databases. We used different combinations of the following key words and phrases: behavior disorder, behavior problem, language disorder, social skills, language impairment and behavior problems, psychiatric disorders, Head Start, low income, poverty, low socioeconomic status (SES). The indices of the following journals were then hand-searched for articles that did not emerge from the computer search: Behavioral Disorders, Child Development, Development and Psychopathology, Early Education and Development, Journal of Abnormal Child Psychology, and Journal of the American Academy of Child and Adolescent Psychiatry.A data summary was prepared for each study, and these summaries were reviewed with the aim of excluding those studies that did not meet the criteria that follow:

PurposeMalignant pleural mesothelioma (MPM) has a high symptom burden and poor survival. Evidence from other cancer types suggests some benefit in health-related quality of life (HRQoL) with early specialist palliative care (SPC) integrated with oncological services, but the certainty of evidence is low.MethodsWe performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited. Intervention: review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30. Primary outcome: change in EORTC C30 Global Health Status 12 weeks after randomisation.ResultsBetween April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI −4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference −2.0 (95% CI −8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks or 24 weeks, although there was a consistent preference for care, favouring the intervention arm.ConclusionThere is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in centres with good access to SPC when required.Trial registration number ISRCTN18955704.