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Making informed health decisions requires knowledge and skills in appraising health claims, and teaching adolescents these skills may prepare them for future decision-making. This cluster randomized trial evaluated the effectiveness of an educational intervention on students' ability to identify and appraise health claims. Nine Australian high schools (4 control and 5 intervention) were recruited, comprising 974 students (382 control and 592 intervention) in Grades 7–10. Intervention impact was evaluated through baseline and follow-up evaluation. Follow-up mean scores on questions (maximum score of 25) from the Claim Evaluation Tools database (primary outcome) showed minimal between-group difference (intervention versus control: 14.4 versus 13.6; difference 0.8, 95% confidence interval [CI] −1.6 to 3.1; P  = 0.52). Change scores were only slightly higher in the intervention group (difference 1.2 [95% CI −0.7 to 3.1; P  = 0.21]). Between-group differences for secondary outcomes were also minimal. Most intervention group students 'trusted' and 'liked' the programme and found the content 'easy' and 'helpful'. Most teacher feedback was positive, some noting challenges of covering content in allocated time and maintaining student engagement. It is unlikely that the assessed educational intervention had a large effect. Future research priorities are suggested. [ABSTRACT FROM AUTHOR]

The study was performed to compare real‐time PCR after nucleic acid extraction directly from stool samples as well as from samples stored and transported on Whatman papers or flocked swabs at ambient temperature in the tropics. In addition, the possible suitability for a clear determination of likely aetiological relevance of PCR‐based pathogen detections based on cycle threshold (Ct) values was assessed. From 632 Tanzanian children <5 years of age with and without gastrointestinal symptoms, 466 samples were subjected to nucleic acid extraction and real‐time PCR for gastrointestinal viral, bacterial and protozoan pathogens. Equal or even higher frequencies of pathogen detections from Whatman papers or flocked swabs were achieved compared with nucleic acid extraction directly from stool samples. Comparison of the Ct values showed no significant difference according to the nucleic acid extraction strategy. Also, the Ct values did not allow a decision whether a detected pathogen was associated with gastrointestinal symptoms. [ABSTRACT FROM AUTHOR]

Summary: Exosomes in plasma of head and neck squamous cell carcinoma (HNSCC) patients comprise subsets of vesicles derived from various cells. Recently, we separated CD3(+) from CD3(–) exosomes by immune capture. CD3(–) exosomes were largely tumour‐derived (CD44v3+). Both subsets carried immunosuppressive proteins and inhibited functions of human immune cells. The role of these subsets in immune cell reprogramming by the tumour was investigated by focusing on the adenosine pathway components. Spontaneous adenosine production by CD3(+) or CD3(–) exosomes was measured by mass spectrometry, as was the production of adenosine by CD4+CD39+ regulatory T cells (Treg) co‐incubated with these exosomes. The highest level of CD39/CD73 ectoenzymes and of adenosine production was found in CD3(–) exosomes in patients with the stages III/IV HNSCCs). Also, the production of 5′‐AMP and purines was significantly higher in Treg co‐incubated with CD3(–) than CD3(+) exosomes. Consistently, CD26 and adenosine deaminase (ADA) levels were higher in CD3(+) than CD3(–) exosomes. ADA and CD26 levels in CD3(+) exosomes were significantly higher in patients with early (stages I/II) than advanced (stages III/IV) disease. HNSCC patients receiving and responding to photodynamic therapy had increased ADA levels in CD3(+) exosomes with no increase in CD3(–) exosomes. The opposite roles of CD3(+) ADA+CD26+ and CD3(–)CD44v3+ adenosine‐producing exosomes in early versus advanced HNSCC suggest that, like their parent cells, these exosomes serve as surrogates of immune suppression in cancer. [ABSTRACT FROM AUTHOR]

Summary: Head and neck squamous cell carcinoma (HNSCC) is a highly immunosuppressive malignancy. Exosomes in HNSCC patients' plasma are enriched in inhibitory cargo and mediate immunosuppression. As these exosomes are products of various cells, the cellular origin of immunoregulatory proteins they carry is unknown. To test whether tumour‐ or T cell‐derived exosomes in patients' plasma are immunosuppressive and impact upon disease activity, we separated CD3(–) from CD3(+) exosomes by immunocapture using anti‐CD3 antibodies. The exosome protein cargo was evaluated for immunoregulatory proteins using on‐bead flow cytometry. Tumour protein‐enriched CD3(–) exosomes were CD44v3(+). Surprisingly, mean levels of programmed death ligand 1 (PD‐L1), cytotoxic T lymphocyte antigen 4 (CTLA‐4) and cyclooxygenase‐2 (COX‐2) were similar in CD3(+) and CD3(–) exosomes, although the latter induced higher (P < 0·0025) ex‐vivo apoptosis of CD8(+) T cells and greater (P < 0·005) conversion of CD4+ T cells to CD4(+)CD39(+) regulatory T cells (Treg). CD3(+) and CD3(–) exosomes carrying high levels of immunosuppressive proteins were highly effective in mediating these functions. Exosomes of patients with Union for International Cancer Control (UICC) stages III/IV disease had higher levels of PD‐L1 and COX‐2 than stages I/II patients (P < 0·005). Patients with nodal involvement had exosomes with the higher inhibitory protein content than N0 patients (P < 0·03). CD3(+) and CD3(–) exosomes of HNSCC patients had higher PD‐L1, COX‐2 and CD15s levels than healthy donors' exosomes (P < 0·009), although levels of immunostimulatory OX40 or OX40L were not different. By isolating CD3(–)/CD44v3‐enriched and CD3(+) exosomes from plasma, the cellular origins of immunoregulatory proteins they carry were identified. Association of exosome molecular profiles with disease progression supports the exosome potential as future cancer biomarkers. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to systematically review quantitative and qualitative studies on the public's knowledge and beliefs about antibiotic resistance.Methods: We searched four databases to July 2014, with no language or study design restrictions. Two reviewers independently extracted data. We calculated the median (IQR) of the proportion of participants who agreed with each statement and synthesized qualitative data by identifying emergent themes.Results: Of 3537 articles screened, 54 studies (41 quantitative, 3 mixed methods and 10 qualitative) were included (55 225 participants). Most studied adults (50; 93% studies) and were conducted in Europe (23; 43%), Asia (14; 26%) or North America (12; 22%). Some participants [median 70% (IQR 50%-84%); n = 8 studies] had heard of antibiotic resistance, but most [median 88% (IQR 86%-89%); n = 2 studies] believed it referred to changes in the human body. Many believed excessive antibiotic use [median 70% (IQR 59%-77%); n = 11 studies] and not completing antibiotic courses [median 62% (IQR 47%-77%); n = 8 studies] caused resistance. Most participants nominated reducing antibiotic use [median 74% (IQR 72%-85%); n = 4 studies] and discussing antibiotic resistance with their clinician (84%, n = 1 study) as strategies to reduce resistance. Qualitative data supported these findings and additionally identified that: participants believed they were at low risk from antibiotic resistance participants; largely attributed its development to the actions of others; and strategies to minimize resistance should be primarily aimed at clinicians.Conclusions: The public have an incomplete understanding of antibiotic resistance and misperceptions about it and its causes and do not believe they contribute to its development. These data can be used to inform interventions to change the public's beliefs about how they can contribute to tackling this global issue. [ABSTRACT FROM AUTHOR]

Objectives: To systematically review clinicians' knowledge and beliefs about the importance and causes of antibiotic resistance, and strategies to reduce resistance. Methods: Four databases were searched (until July 2014), without restrictions on language, setting or study design. Fixed responses (from surveys) were grouped into categories. The proportion of participants who agreed with each category was expressed as median, percentage and IQR. Qualitative data were coded into emergent themes. Quantitative categories and qualitative themes were grouped into four overarching categories that emerged from the data. Results: There were 57 included studies (38 quantitative, 14 qualitative, 5 mixed methods) of 11593 clinicians. Most clinicians (69%, IQR 63%-72%, n = 5 studies) had heard of antibiotic resistance and 98% (IQR 93%-99%, n = 5 stud-ies) believed it was serious. The proportion who believed it was a problem for their practice (67%, IQR 65%-74%, n = 13 studies) was smaller than the proportion who believed it was a problem globally (89%, IQR 85%-97%, n = 5 studies) or nationally (92%, IQR 88%-95%, n = 21 studies). Most believed excessive antibiotic use (97%, IQR 91%-98%, n = 12 studies) and patient non-adherence (90%, IQR 82%-92%, n = 7 studies) caused resistance. Most knew of strategies to reduce resistance (e.g. clinician education, 90%, IQR 85%-96%, n = 7 studies). Qualitative findings support these data: they attributed responsibility for antibiotic resistance to patients, other countries and healthcare settings; resistance was considered a low priority and a distant consequence of antibiotic prescribing. Conclusions: Clinicians believe antibiotic resistance is a serious problem, but think it is caused by others. This needs to be accommodated in interventions to reduce antibiotic resistance. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study aimed to determine (i) risk factors for postdischarge falls and (ii) the effect of inpatient falls prevention education on rates of falls after discharge. METHODS: Participants (n = 343) were a prospective cohort nested within a randomized controlled trial (n = 1,206) of falls prevention patient education in hospital compared with usual care. Participants were followed up for 6 months after discharge and falls recorded via a falls diary and monthly telephone calls. Potential falls risk factors were assessed at point of discharge and at 6 months postdischarge using a telephone survey. RESULTS: There were 276 falls among 138 (40.2%) participants in the 6 months following discharge (4.52/1,000 person days) of which 150 were injurious falls (2.46/1,000 person days). Pairwise comparisons found no significant differences between groups in rates of falls after adjustment for confounding variables. Independent risk factors for all falls outcomes were male gender, history of falls prior to hospital admission, fall during hospital admission, depressed mood at discharge, using a walking aid at discharge, and receiving assistance with activities of daily living at 6 months following discharge. Receiving assistance with activities of daily living significantly reduced the risk of falls and injurious falls for high risk patients. CONCLUSIONS: Older patients are at increased risk of falls and falls injuries following discharge. Education that effectively reduced inpatient falls appears to have no ongoing protective effect after discharge. Independent risk factors for falls in this population differ from both hospital and general community settings. [ABSTRACT FROM AUTHOR]

C3a. when injected intravenously in guinea-pigs, caused a rapid drop of circulating neutrophils and platelets. The neutropenia was reversible and followed by a neutrophilia, which reached about 200% of baseline values. Upon challenge with octa- and hexapeptide, mimicking the C-terminal sequence of C3a, neutrophils and platelets reacted in the same manner. The hexapeptide-desArg (pentapeptide without the C-terminal arginine of hexapeptide) induced no neutropenia but a significant neutrophilia. Likewise, when injected in animals with a genetic deficiency or dysfunction of the C3a- receptor, the hexapeptide caused no drop of the neutrophils, but a neutrophilia, indicating that both neutrophil reactions are mediated by different mechanisms. With the octapeptide in viro dose- response studies were performed. Despite maximal doses of octapeptide about 40% of the neutrophils remained in circulation, indicating that some but not all PMNs are susceptible to C3a. By pretreating the animals with an inhibitor of the serum carboxypeptidase N (SCPN-Inh) the C3a- induced neutropenia could be significantly augmented. But intravenous application of the inhibitor itself caused a 20-40% reduction of neutrophils during the first hour after injection, followed by a neutrophilia. In histological studies the timecourse of neutrophil sequestration in the lung was established, showing that the initial high neutrophil content of the lung lasted for at least 1 h and declined thereafter. Structural derangements could not be detected. These observations stress the importance of C3a besides C5a as an important mediator of inflammatory processes in species, where the C3a-receptor is present on inflammatory cells such as granulocytes. [ABSTRACT FROM AUTHOR]