In many developing countries consumption of animal source foods (ASF) among the poor is still at a level where increasing its share in total caloric intake may have many positive nutritional benefits. This paper explores whether ownership of different livestock species increases consumption of ASF and helps improving child nutritional status, finding some evidence that both food consumption patterns and nutritional outcomes may be affected by livestock ownership in rural Uganda. Our results are suggestive that promoting (small) livestock ownership has the potential for affecting human nutrition in rural Uganda, but further research is needed to more precisely estimate the direction and size of these effects.

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms intervention (campaign, mass media) and outcomes (antibiotic, antimicrobial resistance). 7References were screened for inclusion by one author with a random subset of 10% screened 8 by a second author. No date restrictions were applied and only articles of English language 9 were considered. Studies had to have a control group or be an interrupted time-series. 10Outcomes had to measure change in antibiotic-related prescribing/consumption and/or the 11 publics' knowledge, attitudes or behaviour. Two reviewers assessed the quality of studies. 12Narrative synthesis was performed.

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BackgroundHospital antimicrobial stewardship strategies, such as ‘Start Smart, Then Focus’ in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using ‘review and revise’. However, only a minority of review decisions are to stop antibiotics. Research suggests that this is due to both behavioural and organizational factors.ObjectivesTo develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational and behavioural intervention that supports implementation of ‘review and revise’ to help healthcare professionals safely stop unnecessary antibiotics.MethodsA theory-, evidence- and person-based approach was used to develop and optimize ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative research with doctors, nurses and pharmacists in UK hospitals. Barriers to and facilitators of the intervention and its implementation, and ways to address them, were identified and then used to inform the intervention’s development.ResultsA key barrier to stopping antibiotics was reportedly a lack of information about the original prescriber’s rationale for and their degree of certainty about the need for antibiotics. An integral component of ARK was the development and optimization of a Decision Aid and its implementation to increase transparency around initial prescribing decisions.ConclusionsThe key output of this research is a digital and behavioural intervention targeting important barriers to stopping antibiotics at review (see http://bsac-vle.com/ark-the-antibiotic-review-kit/ and http://antibioticreviewkit.org.uk/). ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS.

Background Antimicrobial resistance poses a major threat to global health. Excessive use of antibiotics accelerates the process of resistance. Interventions to prevent the inappropriate use of antibiotics can be targeted at doctors, patients, and the public. The aim of this systematic review was to identify the components of successful communication interventions targeted at the general public to improve antibiotic use. Methods The databases Medline, Embase, CINAHL, Web of Science, and Cochrane Library were searched in July, 2015. The main search terms were related to the population (public, community, population, neighbourhood), intervention (communication, campaign, mass media), and outcomes (antibiotic, antimicrobial resistance). For each search term, synonyms and controlled vocabulary for respective databases were used. Titles, abstracts, and full-text references were screened for inclusion by one author with a random subset of 10% screened by a second author. No date restrictions were applied, and only articles in English were considered. Studies had to have a control group or be an interrupted time-series with interventions targeted at the general public. Outcomes had to measure change in antibiotic-related prescribing or consumption, knowledge, attitudes, or behaviour. Two reviewers assessed the quality of studies. Narrative synthesis was performed. Findings 14 studies were included with an estimated 74-75 million participants. Most studies were conducted in the USA or Europe, used mass media, targeted both the general public and clinicians, and measured changes in antibiotic prescribing. There was quite strong (p<0•05 to ≥0•01) to very strong (p<0•001) evidence that interventions conducted on a national, community, and household level that targeted antibiotic prescribing for respiratory tract infections could achieve substantial reductions in antibiotic prescribing. The largest change in antibiotic prescribing was a 30% reduction. Insuffi cient studies were available to distinguish the separate components of interventions. No studies of high quality were identifi ed.

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In many developing countries consumption of animal source foods (ASF) among the poor is still at a level where increasing its share in total caloric intake may have many positive nutritional benefits. This paper explores whether ownership of different livestock species increases consumption of ASF and helps improving child nutritional status, finding some evidence that both food consumption patterns and nutritional outcomes may be affected by livestock ownership in rural Uganda. Our results are suggestive that promoting (small) livestock ownership has the potential for affecting human nutrition in rural Uganda, but further research is needed to more precisely estimate the direction and size of these effects.

Summary The bacterial superantigen exotoxins of Staphylococcus aureus and Streptococcus pyogenes are potent stimulators of polyclonal T‐cell proliferation. They are the causes of toxic shock syndrome but also induce CD25+ FOXP3+ regulatory cells in the CD4 compartment. Several studies have recently described different forms of antigen‐induced regulatory CD8+ T cells in the context of inflammatory diseases and chronic viral infections. In this paper we show that bacterial superantigens are potent inducers of human regulatory CD8+ T cells. We used four prototypic superantigens of S. aureus (toxic shock syndrome toxin‐1 and staphylococcal enterotoxin A) and Str. pyogenes (streptococcal pyrogenic exotoxins A and K/L). At concentrations below 1 ng/ml each toxin triggers concentration‐dependent T‐cell receptor Vβ‐specific expression of CD25 and FOXP3 on CD8+ T cells. This effect is independent of CD4+ T‐cell help but requires antigen‐presenting cells for maximum effect. The cells also express the activation/regulatory markers cytotoxic T‐lymphocyte antigen‐4 and glucocorticoid‐induced tumour necrosis factor receptor‐related protein and skin homing adhesins CD103 and cutaneous lymphocyte‐associated antigen. Superantigen‐induced CD25+ FOXP3+ CD8+ T cells were as potent as freshly prepared naturally occurring CD4+ regulatory T cells in suppressing proliferation of CD4+ CD25− T cells in response to anti‐CD3 stimulation. Although superantigen‐induced CD8+ CD25+ FOXP3+ express interleukin‐10 and interferon‐γ their suppressive function is cell contact dependent. Our findings indicate that regulatory CD8+ T cells may be a feature of acute bacterial infections contributing to immune evasion by the microbe and disease pathogenesis. The presence and magnitude of regulatory CD8+ T‐cell responses may represent a novel biomarker in such infections. Superantigen‐induced regulatory CD8+ T cells also have therapeutic potential.