Blood lipid measures [total cholesterol, total:high-density lipoprotein (HDL) cholesterol

ratio, low-density lipoprotein (LDL) cholesterol and triglycerides], CD4 cell counts, weight and use of lipid-lowering drugs following initiation of HAART were extracted at each follow-up time. The follow-up period buy Omipalisib was divided into baseline, month 6, month 12 and 12-month intervals thereafter, using the measurement closest to each time-point of interest within a window of 3 months before to 3 months after. The primary endpoint of interest was the occurrence of a grade 3 or 4 elevation in any blood lipid measurement (total cholesterol, total:HDL cholesterol ratio, LDL cholesterol or triglycerides) or use of lipid-lowering click here drugs at any time during follow-up after the initiation of HAART. In addition, the occurrence of a grade 3 or 4 elevation of total cholesterol, total:HDL

cholesterol ratio, LDL and triglycerides was also individually determined. Total cholesterol measurements were classified as grade 0 (<5.16 mmol/L), grade 1 (5.16–6.19 mmol/L), grade 2 (6.20–7.77 mmol/L), grade 3 (7.78–10.35 mmol/L) and grade 4 (>10.35 mmol/L) [14]. Total:HDL cholesterol ratio was classified as grade 1 (5.0–6.0), grade 2 (6.01–7.0), grade 3 (7.01–8.0) and grade 4 (>8.0) [14]. LDL measurements were classified as grade 1 (3.5–4.5 mmol/L), grade 2 (4.51–5.0 mmol/L), grade 3 (5.01–6.0 mmol/L) and grade 4

(>6.0 mmol/L) [14]. Triglyceride measurements were classified as grade 2 (4.52–8.47 mmol/L), grade 3 (8.48–13.55 mmol/L) and grade 4 (>13.55 mmol/L) [14]. Baseline demographic and clinical characteristics were compared among HIV-monoinfected, HIV/HBV-coinfected and HIV/HCV-coinfected individuals. In these comparisons, individuals with tri-infection (HIV/HCV/HBV) were included in the HIV/HCV-coinfected group as it was assumed Cell press that any lipid effect of HBV would be dominated by that of HCV. Continuous variables were described with medians and interquartile ranges and compared using Kruskal–Wallis tests. Categorical variables were described with frequencies and percentages and compared using χ2 tests or Fisher’s exact tests as appropriate. Proportions of patients with moderate to severe toxicity grading for any blood lipid measure (total cholesterol, total:HDL cholesterol ratio, LDL cholesterol or triglycerides) or hyperlipidaemia were determined and presented in bar graphs by hepatitis status at baseline and months 6, 12, 24, 36, 48, 60 and >60. Proportions of participants with elevations in each blood lipid were also presented separately in bar graphs by hepatitis status. Proportions in HIV/HBV- and HIV/HCV-coinfected participants were compared to HIV-monoinfected participants at each follow-up time using χ2 tests.

The qRT-PCR and relative transcription

of genes were analyzed as described previously (Wang et al., 2009). Brucella melitensis strains were grown overnight in TSB medium with aeration at 37 °C. For each strain, three 1-mL aliquots of cultures in TSB medium (initial OD600 nm 0.05) were incubated at 37 °C with shaking in a 24-well plate containing an insert plate with a porous membrane (diameter, 1.0 μm) (BD Falcon). After 24 h, bacteria were fixed for 20 min with 4% paraformaldehyde, and plates were centrifuged for 10 min at 1500 g. Membranes were cut and dehydrated for 5 min in 25%, 50%, 75%, 95% and 100% ethanol at room temperature. They were finally prepared by critical-point drying, mounted on an aluminum stub and covered with a thin layer of gold (20–30 nm). Examination JQ1 purchase was carried out with a scanning electron microscope (Hitachi S450). Exopolysaccharide was stained as follows: bacteria in a middle logarithmic-phase culture (OD600 nm 1.0) were fixed with 4% paraformaldehyde for 20 min before staining. For detection of polysaccharides, 1 mL of 0.05% calcofluor white (fluorescent whitener 28; Sigma) was added to 0.1 mL of paraformaldehyde-fixed cells. Visualization was accomplished using an epifluorescence microscope (Olympus

IX71). The susceptibilities of Brucella strains to polymyxin B (Sigma) were determined hypoxia-inducible factor pathway following a protocol described previously (Martinez de Tejada et al., 1995) with modifications. Brucella melitensis strains were cultured for 72 h on TSA. Then, bacterial suspensions of approximately 1 × 104 CFU mL−1 were prepared in phosphate-buffered saline and 100-μL aliquots were mixed with different concentrations of DNA ligase 100 μL polymyxin B (the final concentrations in the wells were 2000, 1000, 500 and 250 μg mL−1, respectively) and cultured in 96-well plates. After a 1-h incubation at 37 °C in a 5% CO2 atmosphere, a 50-μL aliquot of each well was serially diluted and spread in triplicate on TSA plates for CFU

determination. The results were expressed as the mean±SD of three assays. All the results represent the averages from at least three separate experiments. The sensitivity of Brucella strains to hydrogen peroxide, high-salinity or high-osmolarity stresses was determined as follows: B. melitensis strains inoculated into TSB medium were grown to the early logarithmic phase (OD600 nm 0.6) at 37 °C. To determine the effect of high-salinity or high-osmolarity stress on B. melitensis, the log-phase cells were incubated at 37 °C for 20 min in the presence of NaCl (1.5 M) or sorbitol (1.5 M). To test the effect of oxidative stress, the cells were incubated for 30 min in 440 mM H2O2. After the treatment, the survival percent of the bacteria was determined as above. All the results represent the averages from at least three separate experiments. Previously, we compared proteome differences between BM and BMΔvirB in GEM4, a which strongly induces virB.

(2010) have reported slight increase in the sensitivity of a combined grxΔ and gssΔ double mutant to hydrogen peroxide, Doxorubicin supplier but no difference between gss+ and gssΔcells. They have also reported that glutathionyspermidine could form mixed disulfides with proteins, but their results do not exclude the possibility that comparable binding occurs with intracellular glutathione. In our C14-spermidine incorporation assays,

we found more than 98% of the counts are in the TCA supernatant, and only < 2% counts in TCA precipitate with the macromolecules. In this experiment, the gss+ cells showed twice more counts than gss− cells in the TCA precipitate (data not shown). Although we have not been able to define a specific function for the gss gene, we feel that the microarray results clearly show that this gene has a considerable effect on the physiology and gene expression of the bacteria. Comparison of the gss+ and gss− strains in the microarray studies showed marked differences in the regulation of different mRNAs. These differences have been listed in Tables 3, 4 and 5. Some of the gene expression changes in gss+ vs. gss− cells are in the polyamine metabolisms and arginine metabolisms pathways, as expected. We felt that it was important to show that glutathionylspermidine is not just an inactive end-product, but is metabolically active. Our isotope exchange experiments

show buy PD-0332991 that glutathionylspermidine is metabolically active in both logarithmically growing (data not shown) and stationary cultures (Tabor & Tabor, 1975). Thus, it could be possible that even in the log-phase cells, where glutathionylspermidine content is < 10%, there is always some change in spermidine and glutathione pools due to activities of both the synthetase and amidase domains of gss+ as compared to gss− cells. For further understanding of regulatory pathways involved in the gene PJ34 HCl expression pattern of up- or down-regulated genes in gss+ vs. gss− cells, we performed bioinformatics analyses.

The microarray results show an up-regulation of succinate metabolism (sdhD, sdhC, sdhA), which increases fumarate synthesis in the cells and on the other hand down-regulation of fumarate metabolism (frdC, frdD, and frdB), which could increase fumarate level in the gss− cells. The transcription of sdhCABD is enhanced during a switch from aerobic to anarerobic growth by ArcA transcriptional regulators (Maklashina et al., 1998). The carAB regulon is regulated by arginine, pyrimidine, and purine levels (Devroede et al., 2004). The genes for purine metabolisms (e.g. purM, purD, and purH) are regulated by PurRP (Meng et al., 1990). The precise mechanism of how these genes are regulated by gss gene deletion is not known. However, as shown in Table 5, fourteen transcriptional regulators are either up- or down-regulated in gss− culture.

Therefore, it cannot be excluded that the fluorescent clusters stem from an aggregation of HupS–GFP, or proteins targeted for localized degradation in bacterial-type proteasomes. However, to resolve the subcellular location of the functional uptake hydrogenase in N. punctiforme and to investigate the possible presence of proteasomes in cyanobacteria, more research is required. This work was kindly supported selleck products by the Swedish Energy Agency, the Knut and Alice Wallenberg Foundation, the Nordic Energy Research Program (project BioH2), the EU/Energy FP7 project SOLAR-H2 (contract

# 212508), and the Magnus Bergvall Foundation. The plasmid pSB1A2 carrying part BBa_I13504 was

kindly distributed by the Registry of Standard Biological Parts (MIT). Appendix S1. Construction of the gfp-modified hup-operon. Fig. S1. SDS-PAGE/Western blot using GFP antibodies. Fig. S2. Transmission electron micrographs of isolated heterocysts from Nostoc punctiforme: see more (a) strain SHG, harbouring the vector pSHG expressing the HupS–GFP fusion protein and (b) WT. Please note: Wiley-Blackwell is not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries (other than missing material) should be selleck screening library directed to the corresponding author for the article. “
“Magnetotactic bacteria (MTB), which

can mineralize nanosized magnetite or greigite crystals within cells, play important roles in biogeochemical processes, for example iron and sulfur cycling, and depositional remanent magnetization acquisitions. Despite decades of research, the knowledge of MTB distribution and ecology is still limited. In the present study, we investigated the temporal variation of MTB communities in freshwater sediment microcosms based on 16S rRNA genes and unifrac analyses. Two microcosms (MY8 and MY11) collected from two separate sites in Lake Miyun (Beijing, China) were analyzed. The majority of retrieved sequences belonged to alphaproteobacterial magnetotactic cocci in both microcosms (representing 64.29% of clones from MY8 and 100% of clones from MY11), whereas so-called ‘Magnetobacterium bavaricum’-like MTB affiliated within Nitrospira phylum were exclusively found in microcosm MY8. Over a 3-month period, the temporal variation of MTB communities was evident in both microcosms. In addition, the phylogenetic discrepancy of MTB communities between two microcosms is more prominent than that of the same microcosm at different times, implying adaptation of MTB phylogenetic lineages to specific microenvironments.

In classical cases, this prodrome may be followed by skin rash, bite-eschar(s), regional

lymphadenopathy, conjunctival injection, icteric sclera, jaundice, and bradycardia. 25,27 Later, patients may develop potentially fatal complications including adult respiratory distress syndrome (ARDS), especially in older patients, hypotensive shock, acute renal failure, encephalomyelitis, and disseminated intravascular coagulation (DIC). 25 Frequently, patients presenting with similar constellations of constitutional symptoms and few pathognomonic signs (eschar, rash, and hearing loss) in rural scrub typhus-hyperendemic areas are often treated preemptively and empirically with oral doxycycline. 26 PLX3397 purchase Rural regions may have limited access to specific serological tests (immunofluorescent antibody assays and paired sera comparisons for rising specific antibody titers) required to differentiate scrub typhus from other endemic rickettsial diseases. 25,26 Weekly doses of 200 mg

of doxycycline can prevent O tsutsugamushi infections. 25 The house-mouse mite, L sanguineus, maintains a rickettsial zoonosis in its preferred Selleck Dabrafenib house-mouse (Mus musculus) reservoir, and can transmit rickettsialpox caused by R akari through bites. 1,27,28 Although initially described in clusters in crowded apartment buildings in large US cities, including New York, Boston, Cleveland, Philadelphia, and Pittsburgh, rickettsialpox has now been reported in rural areas of the United States and Eurasia. 27,28 Many experts now feel that rickettsialpox is underreported

and distributed in silent sylvan cycles worldwide. 27,28 The incubation period and initial clinical manifestations of rickettsialpox mirror those of scrub typhus with bite-eschar formation within 10 to 12 days, followed by fever, chills, severe headache, conjunctival injection, and truncal maculopapular, then vesicular, rash. 27,28 Unlike scrub typhus, complications are rare, but may include thrombocytopenia and interstitial pneumonia. 27,28 Hearing loss does not occur, and regional lymphadenopathy Glutamate dehydrogenase is uncommon in rickettsialpox. The clinical manifestations, diagnosis, and management of scrub typhus and rickettsialpox are contrasted in Table 3. In summary, mites are mostly ubiquitous, bothersome pests, with few species of medical importance and, of these, most are scabies mites, trombiculid larvae, and rodent mites. All patients with scabies and their close household, institutional, and sexual contacts should be informed that scabies is a highly transmissible ectoparasitic infestation and that several topical treatments and an effective oral treatment are readily available and highly effective at present. Finally, only the Asian and Eurasian Leptotrombidium species of trombiculid larvae (chiggers) can transmit scrub typhus in endemic regions of Asia, Eurasia, and the South and West Pacific; and only the house-mouse mite can transmit rickettsialpox in both urban and rural dwellings worldwide. Support for Prof.

Although these fitness trade-off scenarios are commonly observed in natural and experimental systems, few studies have focused on their underlying mechanisms. Some of these trade-off scenarios are observed in drug-resistant isolates of C. albicans. Evidence of AP in drug-resistant mechanisms was observed in a single isolate from our recent evolutionary study of C. albicans (Huang et al., 2011). In this study, cell populations were evolved under the selective pressures of fluconazole and limiting carbon source (glucose). An adaptive clone isolated from one population (DP-1-M5) showed a significant increase in the relative fitness compared to the parental strain in the presence

of MG-132 mw drug, but the increased drug resistance had a fitness cost, as the mutant showed a lower relative fitness in the absence of the drug (Table 1), demonstrating a clear case of AP. However, the majority of the isolates from this study fall in the IA or CA categories described above, where mutations that are beneficial in the presence of the drug are either neutral or beneficial in the absence of the drug (see Table 1). This is contrary to results from Cowen et al. (2001); in their study, most isolates with DNA Damage inhibitor increased fitness

in the presence of the drug compared with the parental strain showed neutral or negative fitness in the absence of the drug (AP or IA). Possible explanations for the difference in our observations may be due to the differences in C. albicans strains used for the evolution experiments, the media used for the evolution (yeast nitrogen base vs. RPMI 1640), and the population size and evolution system used (chemostat vs. serial batch transfer). The use of serial batch transfer involves a larger bottleneck effect during each transfer. Thus, it is likely that the majority of the beneficial mutations that arise are lost in the process. In a continuous system, on the other hand, beneficial mutants have a higher probability of being retained in the system for further evolution. However, the exact mechanisms for the fitness trade-offs will require further studies

to identify all the underlying adaptive mutations and to characterize their exact fitness effects. Both in vivo and in vitro data have shown C. albicans populations to be heterogeneous and that clonal interference plays Edoxaban an important role in the population structure during exposure to antifungal agents. With the development of VERT, we can now track the population dynamics during adaptive evolution to readily estimate the frequency at which drug-resistant mutants arise in the population and to isolate mutants in a systematic manner. While clinical isolates from patients throughout the course of treatment would be the ideal system to study the emergence of antifungal drug resistance, it is difficult and often not practical to control. In vitro systems using bioreactors offer controlled and more reproducible environments.

The tooth was then prepared for a SSC, which was fixed with glass ionomer luting cement (Hy-Bond GI CX®, Shofu, Kyoto, Japan). One paediatric dentist performed all treatment. At the 6–11 month and 12–29 month recalls, clinical and radiographic examinations were performed by another paediatric dentist who was blinded to which treatment group the teeth had been assigned. The intra-examiner reliability was 100%

and 90% for the clinical and radiographic evaluations, respectively. The criteria used for determination BGB324 chemical structure of clinical and radiographic success were as follows: (i) absence of a fistula, swelling of the periodontal tissue, and/or abnormal tooth mobility; (ii) absence of clinical symptoms of irreversible pulpitis such as spontaneous pain or pain persisting after removal of the stimulus; (iii) an intact lamina dura and the absence of radiolucency at the bifurcation or periapical regions or thickening of PD0325901 research buy the periodontal

space which would indicate the presence of irreversible pathology or necrosis; (iv) absence of internal or external root resorption. If canal obliteration was observed, it was not regarded as a treatment failure[22]. Partial discontinuity of the lamina dura in some areas and/or thickening of the periodontal space, which could not definitively indicate the presence of irreversible pathology or necrosis, were observed at the first recall. We classified these teeth into an ‘observe’ group for further evaluation at the next recall. All of the radiographic criteria were evaluated by periapical radiograph examination. The preoperative radiographs of a mandibular first and second primary molar treated with CH-IPT and 3Mix-MP, respectively, are seen in Fig. 1a and of a CH-IPT-treated mandibular first primary molar is shown in Fig. 2a. The presence of deep carious lesions approaching the pulp, as well as intact

lamina dura can be observed, and neither internal/external resorption nor interradicular/periapical radiolucencies can be seen. Any teeth showing both clinical and radiographic success were recorded as overall treatment success. Those that showed clinical and/or radiographic signs or symptoms of irreversible pulp pathology DCLK1 or necrosis were recorded as overall failures. The Pearson chi- square and Fisher, s exact tests at the 95% confidence level were used to analyse the differences between the percent of overall success in both groups. At the 6–11 month recall (mean = 7.12 ±1.36 months), 76 of 82 mandibular primary molars were available for clinical and radiographic evaluation. Two of 41 teeth in the CH-IPT group (5%) and 4 of 41 teeth (10%) in the 3Mix-MP group dropped out. The distribution of teeth evaluated at 6–11 months by tooth type and treatment method is shown in Table 1. None of the teeth in either group showed clinical signs/symptoms of irreversible pulpitis or necrosis such as pain, fistula, or enhanced tooth mobility.

The tooth was then prepared for a SSC, which was fixed with glass ionomer luting cement (Hy-Bond GI CX®, Shofu, Kyoto, Japan). One paediatric dentist performed all treatment. At the 6–11 month and 12–29 month recalls, clinical and radiographic examinations were performed by another paediatric dentist who was blinded to which treatment group the teeth had been assigned. The intra-examiner reliability was 100%

and 90% for the clinical and radiographic evaluations, respectively. The criteria used for determination selleck screening library of clinical and radiographic success were as follows: (i) absence of a fistula, swelling of the periodontal tissue, and/or abnormal tooth mobility; (ii) absence of clinical symptoms of irreversible pulpitis such as spontaneous pain or pain persisting after removal of the stimulus; (iii) an intact lamina dura and the absence of radiolucency at the bifurcation or periapical regions or thickening of Sotrastaurin manufacturer the periodontal

space which would indicate the presence of irreversible pathology or necrosis; (iv) absence of internal or external root resorption. If canal obliteration was observed, it was not regarded as a treatment failure[22]. Partial discontinuity of the lamina dura in some areas and/or thickening of the periodontal space, which could not definitively indicate the presence of irreversible pathology or necrosis, were observed at the first recall. We classified these teeth into an ‘observe’ group for further evaluation at the next recall. All of the radiographic criteria were evaluated by periapical radiograph examination. The preoperative radiographs of a mandibular first and second primary molar treated with CH-IPT and 3Mix-MP, respectively, are seen in Fig. 1a and of a CH-IPT-treated mandibular first primary molar is shown in Fig. 2a. The presence of deep carious lesions approaching the pulp, as well as intact

lamina dura can be observed, and neither internal/external resorption nor interradicular/periapical radiolucencies can be seen. Any teeth showing both clinical and radiographic success were recorded as overall treatment success. Those that showed clinical and/or radiographic signs or symptoms of irreversible pulp pathology Sclareol or necrosis were recorded as overall failures. The Pearson chi- square and Fisher, s exact tests at the 95% confidence level were used to analyse the differences between the percent of overall success in both groups. At the 6–11 month recall (mean = 7.12 ±1.36 months), 76 of 82 mandibular primary molars were available for clinical and radiographic evaluation. Two of 41 teeth in the CH-IPT group (5%) and 4 of 41 teeth (10%) in the 3Mix-MP group dropped out. The distribution of teeth evaluated at 6–11 months by tooth type and treatment method is shown in Table 1. None of the teeth in either group showed clinical signs/symptoms of irreversible pulpitis or necrosis such as pain, fistula, or enhanced tooth mobility.

Risk factors were assessed using Poisson regression analysis. A total of 5090 HIV-infected patients were included in the study, with 32 390 person-years of follow-up. We recorded 416 tumours in 390 HIV-infected patients. Two hundred of these (48.1%) were ADCs, 138 (33.2%) were non-virus-related NADCs and 78 (18.7%) were virus-related NADCs. An increased risk (SIR = 4.2) of cancers overall was found in HIV-infected patients. A large excess of ADCs (SIR = 31.0) and virus-related NADCs (SIR = 12.3) was observed in HIV-infected patients, Selleck Lapatinib while the excess risk for non-virus-related NADCs was small (SIR = 1.6). The highest SIRs were observed for Kaposi

sarcoma among ADCs and for Hodgkin lymphoma among virus-related NADCs. Conversely, among non-virus-related

NADCs, SIRs for a broad range of malignancies were close to unity. In multivariate analysis, increasing age and CD4 cell count < 50 cells/μL were the only factors independently associated with all cancers. Among HIV-infected people there was an excess of ADCs and also of NADCs, particularly those related to viral infections. Ageing and severe immunodeficiency were the strongest predictors. Anti-infection Compound Library manufacturer “
“The aim of this study was to describe trends in the management of pregnancies in HIV-infected women and their outcomes over a 14-year period in Denmark on a national basis. The study was a retrospective cohort study of all HIV-infected women in Denmark giving birth to one or more children between 1 June 1994 and 30 June 2008. We identified 210 HIV-infected women with 255 pregnancies, ranging from 7 per year in 1995 to 39 per year in 2006. Thirty per cent of the women were Fossariinae Caucasian and 51% were Black African. Knowledge of HIV status before pregnancy increased from 8% (four of 49) in 1994–1999 to 80% (164 of 206) in 2000–2008. Only 29% (53 of 183) of the women chose to consult an infectious disease specialist when

planning pregnancy, while 14% (27 of 199) received assistance with fertility. The proportion of women on antiretroviral therapy (ART) increased from 76% (37 of 49) in 1994–1999 to 98% (201 of 206) in 2000–2008. Vaginal deliveries ranged from 0 in 2003 to 35% of pregnancies in 2007. Mother-to-child transmission (MTCT) of HIV decreased from 10.4% in 1994–1999 to 0.5% in 2000–2008. All women giving birth to an HIV-positive child were diagnosed with HIV during or after delivery and did not receive prophylactic ART. The annual number of HIV pregnancies increased fivefold during this 14-year period and substantial changes in pregnancy management were seen. No woman treated according to the national guidelines, i.e. ART before week 22, intravenous zidovudine (ZDV) during labour, neonatal ZDV for 4 to 6 weeks and no breastfeeding, transmitted HIV to her child. Mother-to-child transmission (MTCT) accounts for more than 90% of all HIV infections in children.

Our three keynote speakers will, we are sure, inspire us all. Their presentations will focus on behaviour change and issues of addiction. The established role of pharmacists in substance misuse (tobacco and drugs) and their emerging role in managing excessive alcohol consumption, make

these presentations particularly relevant to the conference theme and selleck kinase inhibitor audience. In advance of the conference we would like to thank everyone who has already contributed in various ways, illustrating how successful team working can be! We thank those who have submitted scientific abstracts, the HSRPP steering committee, Pharmacy Research UK, the University of Aberdeen CPD Services Unit, and all our sponsors.  Special thanks go to the Society for the Study of Addictions which has sponsored the substance misuse workshop, including a networking lunch, and two prizes for the best substance misuse-related presentation and poster. Finally, we hope these two days will be productive and enjoyable for both new and experienced researchers. “
“Objective  To examine the views of regular pharmacy clients on pharmacist prescribing and employ agency theory in considering the relationship between the stakeholders involved. Methods  Computer assisted telephone interviews were conducted with 400 pharmacy clients recruited around Australia. Potential respondents

were identified using BMS-354825 mw a random number generation function in Microsoft Excel. Data were analysed with SPSS version 17 using one-way analysis of variance, principal component analysis and linear regression. The relationships between the main stakeholders involved were explored

using agency theory. Key findings  A total of 1153 answered calls recruited 400 consenting pharmacy clients. Most respondents (71%) trusted pharmacists adopting an expanded role in prescribing, however the majority (66%) supported this only after a diagnosis had been made by a doctor. Those who accepted pharmacist diagnosing and prescribing preferred that this was limited to pain management and antibiotics. Most respondents (64%) considered that expanded pharmacist prescribing would improve their access to prescription medicines, although those over 65 years of age were less supportive than Ponatinib younger respondents. Factors which contributed positively to clients’ perception of trust in an expanded prescribing role for pharmacists were identified, and improved access to medicines was found to be the strongest predictor (P < 0.0001). Conclusion  Most pharmacy clients trusted pharmacists adopting an expanded prescribing role, but preferred that this was limited to doctors performing the initial diagnosis. Agency theory would conceptualize the introduction of pharmacist prescribers, as disrupting the principal (patient) agent (doctor) relationship. Its introduction would best be facilitated by careful change management. "
“Reporting of adverse drug reactions (ADRs) may differ between countries.