These mixed Th1/Th2 responses might explain the unbiased IgG1/2a

These mixed Th1/Th2 responses might explain the unbiased IgG1/2a ratio of anti-FliC induced by LCFS-immunization. In contrast to this reaction, the cells from mice immunized with FliC plus cSipC exhibited mainly Th2-type cytokine production. Greater amounts of IL-4 and IL-5 were produced by FliC-stimulation, and IL-4 and IL-10 Lapatinib datasheet were also induced by cSipC-stimulation. Notably, IL-12 was also released by stimulation with both FliC and cSipC. Therefore, these immune responses were mixed Th1/Th2-type although they were different from the immune responses by LCFS-immunization. The present

study demonstrated that FliC and FliC-fused antigens displayed on the cell-surface of L. casei elicit innate immune responses in vitro and showed that immunogenicities of these recombinant lactobacilli were affected by the species and the physical position

of the antigens. It was also suggested that the adoptive immunity induced by the recombinant lactobacilli was mixed but mainly Th1-type. Because flagellin is considered to be a potential adjuvant, information provided in this study could be useful for designing of vaccines using lactobacilli as delivery agents. This study was supported by a grant from the Ministry of Health, Labor, and Welfare of MEK inhibitor Japan (Research on Food Safety) and partly by a grant from the Food Safety Commission of Japan. “

immune responses have been traditionally associated with protection against influenza. In Thiamine-diphosphate kinase addition, T cell responses against influenza virus in humans have been extensively documented [1], [2], [3], [4], [5], [6] and [7] and their contribution to protection against influenza has been reported in humans and animal models [8], [9], [10], [11] and [12]. T cells specific for influenza may not only play a role in recovery from infection, but have also been found to be protective in the absence of a protective antibody titer [8] and [10]. Importantly in older adults, a population with increased susceptibility to influenza infection, measures of the T cell response to influenza virus have a better predictive value for protection against influenza than the antibody response [13] and [14]. The role of T cell-mediated immunity in protection against culture-confirmed influenza has also been demonstrated in infants and young children [15]. Moreover, children who died because of influenza infection lacked CD8+ T cells in the lungs, suggesting the importance of an adequately functioning cellular immune response against influenza [16]. T cell responses to the conserved epitopes within the types and subtypes of influenza contained in a vaccine may also provide cross-protective immunity against pandemic influenza [17], [18], [19] and [20].

Stool samples were tested for rotavirus by enzyme-linked immunogl

Stool samples were tested for rotavirus by enzyme-linked immunoglobulin assay (ELISA;

Rotaclone, Meridian Bioscience). Rotavirus-positive samples were tested at DDL Diagnostic Laboratory (Voorburg, the Netherlands) by reverse transcriptase polymerase chain reaction (RT-PCR), followed by reverse hybridization assay and/or sequencing in order to determine the rotavirus G and P genotypes and to differentiate presence of wild-type G1 rotavirus from the vaccine-strain virus [15]. Vaccine efficacy in the first Antidiabetic Compound Library cell line year of life has been reported for both cohorts in the initial analysis [3], however, Cohort 1 subjects were not included in the second-year efficacy follow-up period as they had terminated study participation before the protocol was amended to evaluate the efficacy of HRV over 2 consecutive rotavirus seasons. This report consequently

focuses on vaccine efficacy over two consecutive rotavirus seasons in Cohort 2 of the study, which involved follow-up until the end of the 2007 rotavirus season. The severity of all gastroenteritis episodes was evaluated with the use of the 20-point Vesikari scale, on which a score of 11 or more indicates severe gastroenteritis [16]. Vaccine efficacy was also measured for rotavirus-confirmed gastroenteritis of any severity, all-cause gastroenteritis, and all-cause severe gastroenteritis. Blood samples were collected from approximately 10% of infants in Cohort 1 prior to the first dose of study drug and one month after however the last dose of study drug had been administered, IWR-1 in vitro to determine serum concentrations of anti-rotavirus immunoglobulin A (IgA) antibody. We have previously reported on the IgA seropositivity rates for the pooled analysis of either 2 or 3 doses of HRV [3], however, we now extend this analysis to report on the immunogenicity of the HRV_2D and HRV_3D arms of the study. Serum from blood

samples were stored at −70 °C until being analyzed by ELISA at GlaxoSmithKline Biologicals, with the assay cutoff point set at 20 U/mL [17] and [18]. A randomization list was generated at GSK Biologicals, Rixensart, using a standard SAS® program (SAS Institute, Cary, NC, USA). A randomization blocking scheme (1:1:1 ratio) was used to ensure that balance between treatments was maintained throughout the study. The vaccine doses were distributed to each study center while respecting the randomization block size. The targeted sample size of 4950 participants between the South African and Malawi sites was based on evaluating the primary objective of determining if HRV (pooled HRV_2D and HRV_3D groups) given concomitantly with routine childhood vaccines could prevent S-RVGE (≥11 on the 20-point Vesikari scoring system) [16] caused by the circulating wild-type RV strains during the period from 2 weeks after the last dose of HRV vaccine or placebo until 1 year of age (after the first rotavirus season).

X–Z sectioning was performed to detect dye depth of penetration

X–Z sectioning was performed to detect dye depth of penetration. For viewing Z-stacks of full skin thickness, the Z-axis images were gathered at 10 μm planes to a total depth of 200 μm using the 543 nm Argon laser line set to 40% of output. The frame size was set to 1024 × 1024 pixels, and the image was composed of 3 frames. Gain and offset were maximized to enhance contrast.

Subsequent image visualization was performed Caspase inhibitor using High Performance 3D–4D imaging software (Volocity 5.5, Improvision). The depth of the microchannels was estimated indirectly based on the depth of dye permeation. Where appropriate, a Mann–Whitney U or a Kruskal–Wallis test followed by a post hoc Dunn’s test was used to analyze permeation data using SPSS software (SPSS Inc., Chicago, IL, USA). In all cases, P ⩽ 0.05 denoted significance. The study involved assessment of the effect of characteristics of PLGA NPs (size, hydrophilicity, and charge) and dyes encapsulated therein (molecular weight, solubility, and % initial loading) on skin permeation using the dual MN/nanoencapsulation approach. PD0332991 price The structures of the two dyes used in the study (Rh B and FITC) are shown in Fig. 1. At physiological pH, Rh B is zwitterionic with a net neutral charge, while FITC is anionic [25]. The design of polymer MN arrays and application mode used in this study was based on data reported earlier for the effect of MN characteristics

on in vitro skin permeation of nanoencapsulated Rh B [10]. As shown in Fig. 2, MNs were conical in shape, with an average basal width of 300 μm, an average length of 600 μm and arranged at an inter-needle spacing of

300 μm with a density of 121 MNs per array. PLGA NPs with controlled physicochemical properties were prepared using 2% w/v polymer and an emulsion–solvent no evaporation method [10] with modulation of formulation variables and homogenization speeds (Table 1). The variable levels were optimized in order to modulate a target property without appreciably affecting other dependent properties. A total of eight Rh B and four FITC test NP formulations were used (Table 1). NPs prepared with DMAB (F1–F11) had a positive zeta potential due to adsorption of the cationic emulsion stabilizer, while those prepared with PVA (F12) had a negative surface charge conferred by the free end carboxylic groups of PLGA. Positive zeta potential values were generally greater than 30 mV. Table 1 shows that Rh B-loaded PLGA 50:50 NPs (F1–F3) with different size (422.3–155.2 nm) could be obtained using 3% w/v DMAB by increasing emulsion homogenization speed while keeping other formulation variables constant. Further, modulation of NPs hydrophilicity (F4–F6) was achieved by using PLGA with different lactide to glycolide ratio (100:0, 75:25, and 50:50) without discernibly affecting particle size, PDI, and zeta potential of NPs.

The high level of agreement

The high level of agreement selleck chemical found by this study suggests that therapists demonstrate good judgement regarding the ability of rehabilitation patients to count exercise repetitions accurately. The observation of a patient counting for a small period (1-2 minutes) to look for obvious errors in counting can be used by therapists to determine if the patient is able to count accurately. It is often perceived by clinicians that rehabilitation patients with neurological diagnoses

have less ability to concentrate and multi-task. The results of this study indicate that patients with neurological diagnoses can be accurate in counting their exercises repetitions. However, a lower percentage of participants with DAPT neurological diagnoses met this study’s inclusion criteria (67% for people admitted to the neurological rehabilitation unit vs 82% of people admitted to the aged care rehabilitation unit were included). Therefore there were more rehabilitation patients with neurological diagnoses excluded from the study because they were obviously unable to count their exercise repetitions accurately. This appears to be the first observational study to analyse the accuracy

of quantification of exercise dosage by patients undertaking rehabilitation. Previous methods of analysing exercise dosage include the use of time in therapy already and behaviour mapping (Kwakkel et al 2004, Mackey et al 1996). Both methods were based on time rather than dosage of exercise. In this study the number of exercise repetitions observed in the 30-minute sessions varied greatly, with a range of 4 to 369

repetitions. Those studies that only consider time will not take into account the rate and therefore the intensity of exercise. A strength of this study is the blinding of both participant and therapist to when the covert observation was occurring. In addition, a variety of therapy contexts were observed, meaning that the results are representative of daily therapy practice. The participants were also observed at various time points in their rehabilitation. Another strength is that the method used to identify patients who are able to count is simple and efficient so it can be replicated clinically. A limitation of this study could be the 30-minute observation period. This represents a small proportion of time the participant would be in therapy each day at Bankstown-Lidcombe Hospital. However, for pragmatic reasons a substantial yet not exhaustive time period was chosen. It is reasonable to believe that if a participant is able to count in this period, that skill would be transferable to other times.

Both MF59 and AS03 are squalene-based oil-in-water emulsion adjuv

Both MF59 and AS03 are squalene-based oil-in-water emulsion adjuvants and AS04 is a combination of two adjuvants, alum and monophosphoryl lipid A [7]. Given the lack of licensed adjuvants, the search for new vaccine adjuvants is a high priority for vaccinologists. 3′, 5′-Cyclic diguanylic acid (Fig. 1 where X = Y = O) is an intracellular signaling molecule first identified in Gluconacetobacter xylinus (formerly Acetobacter xylinum) where it regulates cellulose production by modulating cellulose synthase activity [8]. Research has suggested that c-di-GMP-mediated

signaling is widespread in bacterial species from Escherichia coli to Bacillus subtilis to Caulobacter crescentus Palbociclib concentration [9], [10] and [11]. However, it has not been found in higher eukaryotes [9], leading many to believe that c-di-GMP signaling is an exclusively bacterial

characteristic. Its seemingly ubiquitous presence in bacteria would seem to suggest that c-di-GMP plays a role in one or more critical bacterial functions and in fact, an increasing body of research has revealed the importance of c-di-GMP as a bacterial second messenger (cf. [12], [13] and [14]) in the regulation of many physiological processes important for bacterial survival (such as adhesion, cell-to-cell communication, exopolysaccharide synthesis, buy Cabozantinib and motility [15], [16], [17] and [18]). The recent finding that c-di-GMP can act as a danger signal on eukaryotic cells [19] has prompted the study of the immunostimulatory and immunomodulatory properties of c-di-GMP Thiamine-diphosphate kinase in an effort to determine whether c-di-GMP might be further developed as

a potential vaccine adjuvant. This review focuses on the recent studies of the immunostimulatory properties of c-di-GMP and the progress that has been made in the preclinical development of c-di-GMP as a potential vaccine adjuvant for systemic and mucosal vaccination ( Table 1). Several studies have now convincingly demonstrated that c-di-GMP does indeed have strong immunostimulatory properties. In vitro experiments have shown that c-di-GMP stimulates human immature dendritic cell (DC) expression of MHC class II, costimulatory molecules CD80/CD86 and maturation marker CD83, increases their secretion of cytokines and chemokines interleukin (IL)-12, interferon (IFN)-γ, IL-8, monocyte chemotactic protein 1 (MCP-1), IFN-γ inducible protein 10 (IP-10), and regulated on activation normal T cell expressed and secreted (RANTES), and alters expression of chemokine receptors including CCR1, CCR7 and CXCR4 [20]. Also, c-di-GMP-matured DCs demonstrated enhanced T cell stimulatory activity [20]. More importantly, the immunostimulatory properties of c-di-GMP have also been demonstrated in vivo. Intraperitoneal (i.p.

0 μmol of free fatty acid liberated min−1 Bacterial colonies sho

0 μmol of free fatty acid liberated min−1. Bacterial colonies showing orange fluorescent halo, when cultured in Rhodamine B agar medium was selected for further characterization. The strain is a gram positive cocci, 0.7–1.2 μm in dia, nonmotile, nonspore forming and anerobic. Fermentation with lactose, dextrose and sucrose produced acid. No hydrogen sulphide production was observed. Identification of the strain by partial 16S rRNA gene sequencing confirms it as Staphylococcus aureus MTCC 10787. The obtained sequence has been deposited in GenBank under accession no. HQ658162 and named as MKV 2011. The sequence had 96% identity to Staphylococcus simiaeDQ127902 and 95% identity to Staphylococcus capraeJN644490

and Staphylococcus epidermidisAY699287 and are grouped together in a phylogenetic tree ( Fig. 1). Fig. 2 shows the effect of incubation period on growth rate and lipase activity of S. aureus. It is evident from Alectinib molecular weight the results, that there was no enzyme

activity at 0 h and lipase production increased gradually from 20 h and after 27 h, the cell biomass reached its highest value. Lipase production observed at 48 h was 19.5 μg/ml/min. Growth rate was found to be high, when there is maximum lipase activity. Since, the lipase production is organism specific and released during the late logarithmic or stationary phase. 12 and 13 Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7, Fig. 8, Fig. 9, Fig. 10 and Fig. 11 depicts the effect of pH, temperature, tryptone, short and long chain carbon lipids, CaCl2 and HgCl2, Hexane, Triton X100 on lipase production. Maximum production of 10.9 μg/ml/min was observed at pH 7.5 signifies it to be a pH dependent enzyme. Lipases are generally LY294002 in vivo stable at or near neutral. In the present study, lipase activity showed gradual increase with the increase of temperature from 30 °C. The lipase production at 45 °C was found to be 14.8 μg/ml/min and further increase of temperature beyond 45 °C showed decreased lipase production. Whereas, Werasit Kanlayakrit

reported Staphylococcus warneri having optimum of 40 °C. 14 But our results are well correlated with the reports of Pallavi Pogaku et al. 15 The influence of incubation temperature ranging from 7 °C to 51 °C was satisfactory with Ratkowsky extended model as reported by Alzbeta Medvedova. Edoxaban 16 Tryptone seemed to play an important role in lipase synthesis producing 10.82 μg/ml/min. Maximum lipase production of 15.78 μg/ml/min was observed in butter fat at 1.5%, whereas no significant production was observed with olive oil. Since, the enzymatic activity of lipases is very sensitive to its physical state of substrate, chain length selectivity constitutes an important difference between Staphylococcal lipases. Both S. aureus and Staphylococcus hyicus lipase have a strong preference for short chain substrates. 17 Non-specific lipases from S. aureus, S. hyicus 18 and 19 act randomly on the triacylglyceride molecule leading to a synthesis of fatty acid and glycerol.

BALB/c mice (6–8

BALB/c mice (6–8 weeks), free of specific pathogens, were maintained in individually ventilated cages, housed in autoclaved cages and fed on OVA-free diets, in an

air-conditioned room on a 12 h light/dark cycle. Sterile special processing forage and water were provided adequately. Cages, bedding, food, and water were sterilized before use. Pregnant mice went into labor on 20 day of pregnancy and newborn mice were raised and maintained in the same conditions. Mice were divided into the following groups: (1) sensitizations and challenges with ovalbumin (OVA group); (2) treatment with PCV7 immunization in infant, sensitizations and challenges with OVA in adult (PCV7 + OVA group); (3) the control group. On day 21, mice in the PCV7 + OVA group were administered 7-valent pneumococcal conjugate vaccine (PCV7, Wyeth, USA) 33 μl intranasally every 12 h for

three doses [8]. The mice in the OVA and PCV7 + OVA groups were sensitized intraperitoneally with 100 μg ovalbumin (OVA, Sigma) diluted in 50% aluminum hydroxide (Pierce) to a total volume of 200 μl on day 28 and day 42. From day 49 to 52, the mice were challenged with OVA aerosolized for 30 min every day lasting for 4 days. The control group mice were sensitized and challenged with GSK1349572 sterile PBS at the same time. AAD was assessed 24 h after the final challenge. In our experiment, each experiment was repeated three times. Two to three mice were used in every experimental test described hereafter. This study was approved by the Institutional Animal Care and Research Advisory Committee at the Chongqing Medical University. All experimental animals were used in accordance however with the guidelines issued by the Chinese Council on Animal Care. AHR was assessed in vivo by measuring changes in transpulmonary

resistance using a mouse plethysmograph and methods similar to those previously described [12]. Briefly, 24 h after the final challenge, AHR was assessed in conscious, unrestrained mice by means of whole-body plethysmography (Emca instrument; Allmedicus, France). Each mouse was placed into a plastic chamber and exposed to aerosolized PBS followed by increasing concentrations of an aerosolized methacholine (Sigma-Aldrich, St. Louis, Mo. USA) solution (3.125, 6.25, 12.5, 25, and 50 mg/ml; Sigma) in PBS for 3 min exposures and then the mice had a rest for 2 min, after which a computer program was used to calculate Penh from the continuously recorded pressure and flow data for 5 min. Then take the average of the 5 min records as the value of Penh of this concentration. Penh is a dimensionless value and correlates with pulmonary airflow resistance. It represents a function of the ratio of peak expiratory flow to peak inspiratory flow and a function of the timing of expiration. After formalin fixation, the left lung was dissected and embedded in paraffin. Sections of 4 μm thickness were cut and stained with hematoxylin and eosin (H&E; Sigma).

8 mg/mL respectively RIF was dissolved in a small amount of dime

8 mg/mL respectively. RIF was dissolved in a small amount of dimethyl sulphoxide (DMSO) and then added Cabozantinib chemical structure with sterile distilled water to obtain a stock

solution of 4 mg/mL. The derivatives, INH-C16, INH-C17 and INH-C18 were each dissolved in DMSO to obtain a stock solution of 1 mg/mL. These stock solutions were subsequently diluted with distilled water on the day of experiment to attain the desired working concentrations and then filter-sterilized. For the interaction study, the configuration of drug combinations was based on a fixed-ratio method as described by Fivelman et al.9 The concentrations of the drugs were prepared so that the MIC value for each drug alone would be at the fifth well of the two-fold serial dilution during the MIC determination assay as described in the following section. The dilutions of each of the two drugs were prepared in fixed-ratios of 0:10, 2:8, 4:6, 5:5, 6:4, 8:2 and 10:0 (in μg/mL). For instance, the seven combinations of INH and INH-C16 were prepared at concentrations of 0:1.25, 0.5:1.0, 1.0:0.75, 1.25:0.625, Selleck AC220 1.5:0.5, 2.0:0.25, and 2.5:0 respectively with the first and last solutions being the drug tested individually. M. tuberculosis,

strain H37Rv (ATCC 25618) and 7 M. tuberculosis clinical isolates (namely TB01, TB02, TB03, TB04, TB05, TB06, and TB07) were used in this study. For the purpose of standardization, a 10 day-old culture grown on Middlebrook 7H10 agar supplemented with 0.5% of glycerol and 10% OADC enrichment at 37 °C in 8% CO2 was used throughout this study. The culture was then emulsified in 10 mL Middlebrook 7H9

broth supplemented with 0.2% glycerol and 10% ADC and grown for 3 days to reach log phase of growth. The turbidity of the log phase culture was adjusted to McFarland No. 1 standard solution and then nearly further diluted to 1:25 in the Middlebrook 7H9 broth. The MIC values of the drugs were determined using the Tetrazolium Microplate assay (TEMA) as described by Caviedes et al.10 The assay was performed in 96-well sterile microplates. Two different drugs either alone or in combination were tested in triplicate three times. Initially, a volume of 200 μL of sterile distilled water was added into the outer wells to prevent dehydration of broth during incubation. A volume of 100 μL of the enriched Middlebrook 7H9 broth was added into wells 3 until 11 in rows B to G. An equal volume of drug either alone or in combination was added in triplicate into wells in columns 2 and 3. The solutions were serially diluted with multichannel pipette from wells in columns 3 to 4 through to 10. The last 100 μL of solutions from wells in column 10 were then discarded. Finally, 100 μL of bacterial suspension was added into all the test wells. The wells in column 11 functioned as controls (without any drugs). The plates were sealed and incubated at 37 °C in 8% CO2 for 5 days.

All participants gave written informed consent before data collec

All participants gave written informed consent before data collection began. Competing interests: The authors declare no conflict of interest related to this work. Support: This study is funded by a partnership grant from the National Health and Medical Research Council

Australia (ID 541958). The authors would like to sincerely thank Dr Dennis Wollersheim for his contribution in assisting with activity monitor data extraction. “
“The dose-response relationship between intensity of therapy and increased recovery of motor function after stroke is well supported by evidence FG-4592 solubility dmso (Kwakkel et al 2004, Galvin et al 2008, Cooke et al 2010), and is reflected in clinical guidelines for stroke rehabilitation (National Stroke Foundation, 2010), although the effect size of this benefit varies between individual studies (Kwakkel et al 2004, Galvin et al

2008). Despite this evidence, many observational studies have shown that people with stroke spend very little time engaged in physical activity during the course of a day in rehabilitation, with therapy sessions being the most active part of the day (Ada et al 1999, Bernhardt et al 2004). Therefore, physiotherapists working in stroke rehabilitation are constantly challenged to maximise the amount of active therapy stroke survivors are engaged in each day. In order to change clinical behavior it is important to Selleck PLX3397 be able to assess the existing behaviour or practice accurately. Only two studies have specifically examined the accuracy of therapists in reporting therapy time (Wittwer et al 2000, Bagley et al 2009), both of which used video-recordings of therapy sessions as the criterion standard. In an observational study embedded in a clinical trial of stroke rehabilitation, Bagley et al (2009) found that physiotherapists systematically overestimated the duration of therapy sessions by more than 20 per cent. In an earlier study, Wittwer et al (2000) found moderate to high correlations (Spearman Tolmetin rank order correlation

coefficient 0.49 to 0.83) between therapist estimates and video-recorded time for subcategories of physical activity (upper limb, bed mobility, sitting, sit to stand, standing, and early gait activities), but the presence of systematic over- or under-estimations was not examined. Both of these studies investigated the accuracy of individual therapy sessions. The accuracy of therapists in estimating therapy duration for group circuit class therapy sessions has not been examined. The Circuit Class Therapy for Increasing Rehabilitation Intensity of Therapy after Stroke (CIRCIT) trial is a multicentre randomised trial currently investigating alternative models of physiotherapy service provision (Hillier et al 2011).

All observations were completed in the rehabilitation gymnasium w

All observations were completed in the rehabilitation gymnasium with therapy staff present. The exercise observed was semi-supervised meaning therapists may sometimes provide feedback and check on progress including current participant exercise tally. No independent

exercise, eg, exercise that occurred outside the therapy setting, was observed. However, due to the nature of the gymnasium environment and the fact that participants were exercising alone but in the presence of others, it is possible that the results may be extrapolated to home/room based programs. Another limitation of the study is the low power to detect factors that influence the accuracy of exercise repetition counting. We did not find strong correlations between accuracy of exercise repetition counting and cognition, age, or disability level. Future research SAHA HDAC with a larger sample could further investigate ABT 888 predictors of accurate exercise repetition counting. In conclusion, this study indicates that therapist-identified rehabilitation participants are able to count their repetitions of exercise accurately. This method can be used clinically or in future research. Ethics: The Human Research Ethics Committee (Western Zone) of the Sydney South West Area Health Service approved this study on the 13th August

2008. Project number QA2008/049. All patients consent to the counting and documenting of exercise repetitions as part of their usual care on the rehabilitation units. Competing interests: Nil. Support: This study was supported by an infrastructure grant (number 07-08/007) from the Ingham Health Research Institute. Acknowledgements: Dharani Khandasamy assisted

with completing observations and data entry. to Bankstown-Lidcombe Hospital physiotherapy staff and students assisted with observations including significant contributions from Simone Dorsch, Susan Mayo, Lily Jian, James Ruddell, and Dimyana Tanyous. “
“Summary of: Allen KD et al (2010) Telephone-based self-management of osteoarthritis: a randomized trial. Ann Intern Med 153: 570-579. [Prepared by Kåre Birger Hagen and Margreth Grotle, CAPs Editors.] Question: What are the comparative effects of telephone-based self-management support, health education materials (attention control), or usual care for primary care patients with hip or knee osteoarthritis (OA)? Design: A randomised clinical trial with equal assignment to three intervention groups. Setting: Primary care clinic, USA. Participants: Men and women with a physician diagnosis of hip or knee osteoarthritis, and persistent, current symptoms. Exclusion criteria included other rheumatologic conditions, psychoses, dementia, or being on a waiting list for arthroplasty. Randomisation of 523 participants allocated 174 to self-management, 175 to health education, and 174 to usual care.