Furthermore, in the subset of see more patients with an eGFR pre-cART ≥90 mL/min per 1.73 m2, the time of a confirmed eGFR reduction from pre-cART levels was alternatively

defined as the date of the first of two consecutive eGFR values <90 mL/min per 1.73 m2. Poisson regression analyses including the same variables as were included in the main analysis were employed to identify independent predictors of a reduction of eGFR. Patients included in the analysis (n=1505) showed significant differences in immunovirological variables compared with excluded patients (n=5762; Table 1); included patients had higher CD4 cell counts (505 vs. 450 cells/μL, respectively; P<0.0001) and higher median HIV RNA levels (4.14 vs. 3.00 log10 HIV-1 RNA copies/mL, respectively; P<0.0001) at baseline. Included patients were younger (38 vs. 39 years, respectively; P<0.0001) and more likely

to be affected by diabetes and/or hypertension (2%vs. 1%, respectively; P=0.02); a lower percentage of included patients acquired HIV infection thorough injecting drug use (29% of the included patients vs. 35% of the excluded patients). There were no clinical differences in the percentage of female patients or CD8 cell count. A total of 1505 patients satisfied the inclusion criteria for the cross-sectional analysis. The clinical and immunovirologic characteristics of the patients, stratified by eGFR at baseline Vemurafenib clinical trial (<90 or ≥90 mL/min/1.73 m2), are summarized in Table 2. A

confirmed eGFR<90 mL/min/1.73 m2 was observed in 363 (24%) of the patients. Of these, 353 (97%) had an eGFR in the range of 60–89 mL/min/1.73 m2, while only 10 patients Chlormezanone (3%) had an eGFR of 30–59 mL/min/1.73 m2 and none had an eGFR below 30 mL/min/1.73 m2. In univariable analysis, compared with patients with normal eGFR, patients with a value of eGFR<90 mL/min/1.73 m2 at baseline were older, had higher CD4 cell counts, and were more likely to be female and to have suffered from diabetes and/or hypertension prior to baseline; in contrast, patients with normal eGFR were more likely to be coinfected with hepatitis B or C virus (Table 2). After adjustment, older age [odds ratio (OR) 1.58 per 10 years older; 95% confidence interval (CI) 1.37–1.82], female gender (OR 2.41 vs. male; 95% CI 1.75–3.31), a prior history of diabetes and/or hypertension (OR 2.36 vs. neither; 95% CI 1.08–5.14), baseline CD4 count (OR 1.06 per 100 cells/μL higher; 95% CI 1.01–1.11) and hepatitis coinfection (OR 0.51 vs. HIV monoinfection; 95% CI 0.34–0.78) were the sole independent predictors of a value<90 mL/min/1.73 m2 at baseline (Table 2). A total of 644 patients (43% of the total studied) started cART at some point during follow-up and were included in the longitudinal analysis (Table 3). The median calendar year of cART initiation was 2005 (range 2000–2009) and the median number of creatinine values post cART was 6 [interquartile range (IQR) 2–10].

The CREB-responsive microRNA miR-132 has been shown to regulate synaptic transmission KU-60019 and we set out to investigate a role for this microRNA in recognition memory and its underlying plasticity mechanisms. To this end we mediated the specific overexpression of miR-132 selectively in the rat perirhinal cortex and demonstrated impairment in short-term recognition memory. This functional deficit was associated with a reduction in both long-term depression and long-term

potentiation. These results confirm that microRNAs are key coordinators of the intracellular pathways that mediate experience-dependent changes in the brain. In addition, these results demonstrate a role for miR-132 in the neuronal mechanisms underlying the formation of short-term recognition memory. “
“Olfactory sensory neurons (OSNs) which express distinct odorant receptor (OR) genes are spatially arranged within the mouse olfactory epithelium. Towards an understanding of the mechanisms which determine these patterns, representative OR genes which are typically expressed in the unique central patch of the epithelium were investigated. Inside

the patch, numerous OSNs which initially selected a representative Bcl-2 inhibitor gene from this OR group finally expressed another gene from the group, indicating that OSNs inside the patch ‘switch’ between these genes. If an OSN successively chose genes from the same OR gene cluster, these originated from the same parental chromosome. A deletion of the olfactory cyclic nucleotide-gated ion channel altered the distribution pattern of distinct OSN populations; they were no longer located exclusively inside the patch. Together, the results

indicate that OSNs inside Reverse transcriptase the patch initially sample several OR genes for expression; for their correct patterning in the OE, odor-induced activity appears to play a critical role. “
“Staphylococcus lugdunensis is a human skin commensal organism, but it is considered as a virulent Staphylococcus species. In a previous study, we described the first S. lugdunensis autolysin, AtlL. This enzyme displays two enzymatic domains and generates two peptidoglycan hydrolases, an N-acetylmuramoyl-l-alanine amidase and an N-acetylglucosaminidase. In this study, to further investigate the functions of this autolysin, a ΔatlL mutant was constructed. The microscopic examination of the mutant showed cell aggregates and revealed a rough outer cell surface demonstrating, respectively, the roles of AtlL in cell separation and peptidoglycan turnover. This ΔatlL mutant exhibited a lower susceptibility to Triton X-100-induced autolysis assays and appears to be more resistant to cell wall antibiotic-induced lysis and death compared with its parental strain. The atlL mutation affected the biofilm formation capacity of S. lugdunensis. Furthermore, the ΔatlL mutant showed trends toward reduced virulence using the Caenorhabditis elegans model.

Overall, as expected, patients infected via homosexual contact showed the best viro-immunological outcomes and were differentiated significantly from patients infected via other routes. The estimate of the proportion of patients with undetectable viraemia in the absence of therapy is consistent with those obtained in other studies of the natural history of HIV infection in elite controllers [24]. In our analysis, the percentage of patients with unsuppressed VL was high and stable over time in ART-naïve patients and in patients on ART interruption.

As to the main analysis, we opted to show the trend in the prevalence of patients with an adverse immunological profile over time INCB024360 in the whole study population regardless of current ART use; we believe that such an analysis is crucial as it allows the detection of potential signals of failure in clinical care or access to care. For example, the high proportion of patients with a CD4 count ≤200 cells/μL in recent

years may have been attributable to several factors such as late presentation, buy C59 wnt or a delay in ART initiation until the CD4 cell count was already below the currently recommended level for starting ART. However, it is unlikely that late presentation could have a major role in explaining these findings as results were similar when we restricted the analysis to patients who had been in follow-up for ≥12 months prior to the CD4 cell count/VL measurement used from in

the analysis. The apparent increase in the risk of a poor prognosis in 2008 is likely to be driven by a larger proportion of newly enrolled patients about to start ART and for whom there was a delay in data reporting. Indeed, the same trend was not seen in the subset of patients who had been receiving ART for ≥6 months. Regarding the possible effect of age on the risk of having an adverse CD4 cell count/VL prognosis, older patients were at increased risk of having a low CD4 cell count and at a reduced risk of having a detectable VL. This finding may be explained by the fact that older patients tend to be more adherent and therefore they may experience better virological responses, but also, for a given VL, older patients are less likely to show a recovery in CD4 cell count because of possible reductions in thymic function and the production of naïve T cells [25]. Regarding the effect of other factors, most analyses indicated that patients living in the north of Italy had an increased risk of a poor virological prognosis and a reduced risk of a poor immunological prognosis, compared with patients with residence in central Italy, while patients in the south had increased risks in both categories. Coinfection with HCV showed a strong association with the risk of immunological failure, and yet was not significantly associated with VL outcomes. No apparent association with HBV coinfection was found for either outcome.

The elderly stated significantly more frequent consumption of meat and similar vegetable consumption (χ2 test; P<0.04) compared with omnivores. The exercise levels of vegetarians and omnivores were comparable. Vegetarians LDE225 had 12 ± 62% more and the elderly had 31 ± 21% less 16S rRNA gene relative to absolute quantified genes compared with omnivores (Fig. 2a). Many SCFA-synthesizing bacteria

belong to the Clostridium clusters lV and XlVa. The Clostridium cluster lV (Fig. 2b) was significantly more abundant in omnivores (36.3 ± 11.2%) than in the elderly (27 ± 11.7%, P=0.04) quantified relative to total bacterial 16S rRNA genes. Vegetarians harboured 31.86 ± 17.00% of Clostridium cluster IV. The Clostridium cluster XlVa (Fig. 2c) was significantly more abundant in omnivores (19.01 ± 6.7%, P>0.01) and vegetarians (14.52 ± 5.6%, P=0.049) than in the elderly (9.89

± 6.64%). The elderly had significantly fewer copies (1.52 × 1011± 1.36 × 1010 copies g−1 faeces) of the butyryl-CoA:acetate CoA-transferase gene compared with the omnivores (4.96 × 1011± 3.22 × 1010 copies g−1 faeces, P=0.01) and the vegetarians (1.37 × 1012± 1.47 × 1011 copies g−1 faeces, P=0.048) (Fig. 2d). The amount of the butyryl-CoA:acetate CoA-transferase gene did not correlate significantly with the amount of total bacteria. The E. hallii/A. coli melt peaks tend to be higher in vegetarians (P=0.08) and omnivores (P=0.09) than in the elderly. check details Bcl-w The abundance of E. rectale/Roseburia spp. melt peak differed significantly between vegetarians and the elderly (P=0.04). Melt peak attributed to F. prausnitzii was significant lower in the elderly than in omnivores (P=0.049) (Fig. 1a). Spearman’s rank showed no significant correlation between the amount of the butyryl-CoA:acetate CoA-transferase gene and that of Clostridium clusters IV and XIVa at an individual level. Analysis of the overall abundance of bacterial 16S rRNA genes reveals that the vegetarians

harboured more bacteria than the omnivores. The low numbers of bacteria in the elderly individuals (Fig. 2a) may reflect physiological alterations such as prolonged colonic transit time, reduced dietary energy requirement and food uptake (Morley, 2007). Figure 2b illustrates the significantly higher abundance of Clostridium cluster IV in omnivores. Mueller et al. (2006) detected the highest levels of the Clostridium cluster IV in a Swedish study population, whose dietary habits were characterized by a high consumption of fish and meat (Mueller et al., 2006). Despite high meat consumption in the elderly, the generally smaller capacity for energy harvest from food may decrease the abundance of Clostridium cluster IV (Li et al., 2008). The elderly gut microbiota is also characterized by a significantly lower relative contribution of Clostridium cluster XIVa compared with young study participants (Fig. 2c).

The elderly stated significantly more frequent consumption of meat and similar vegetable consumption (χ2 test; P<0.04) compared with omnivores. The exercise levels of vegetarians and omnivores were comparable. Vegetarians Cabozantinib molecular weight had 12 ± 62% more and the elderly had 31 ± 21% less 16S rRNA gene relative to absolute quantified genes compared with omnivores (Fig. 2a). Many SCFA-synthesizing bacteria

belong to the Clostridium clusters lV and XlVa. The Clostridium cluster lV (Fig. 2b) was significantly more abundant in omnivores (36.3 ± 11.2%) than in the elderly (27 ± 11.7%, P=0.04) quantified relative to total bacterial 16S rRNA genes. Vegetarians harboured 31.86 ± 17.00% of Clostridium cluster IV. The Clostridium cluster XlVa (Fig. 2c) was significantly more abundant in omnivores (19.01 ± 6.7%, P>0.01) and vegetarians (14.52 ± 5.6%, P=0.049) than in the elderly (9.89

± 6.64%). The elderly had significantly fewer copies (1.52 × 1011± 1.36 × 1010 copies g−1 faeces) of the butyryl-CoA:acetate CoA-transferase gene compared with the omnivores (4.96 × 1011± 3.22 × 1010 copies g−1 faeces, P=0.01) and the vegetarians (1.37 × 1012± 1.47 × 1011 copies g−1 faeces, P=0.048) (Fig. 2d). The amount of the butyryl-CoA:acetate CoA-transferase gene did not correlate significantly with the amount of total bacteria. The E. hallii/A. coli melt peaks tend to be higher in vegetarians (P=0.08) and omnivores (P=0.09) than in the elderly. Ixazomib Casein kinase 1 The abundance of E. rectale/Roseburia spp. melt peak differed significantly between vegetarians and the elderly (P=0.04). Melt peak attributed to F. prausnitzii was significant lower in the elderly than in omnivores (P=0.049) (Fig. 1a). Spearman’s rank showed no significant correlation between the amount of the butyryl-CoA:acetate CoA-transferase gene and that of Clostridium clusters IV and XIVa at an individual level. Analysis of the overall abundance of bacterial 16S rRNA genes reveals that the vegetarians

harboured more bacteria than the omnivores. The low numbers of bacteria in the elderly individuals (Fig. 2a) may reflect physiological alterations such as prolonged colonic transit time, reduced dietary energy requirement and food uptake (Morley, 2007). Figure 2b illustrates the significantly higher abundance of Clostridium cluster IV in omnivores. Mueller et al. (2006) detected the highest levels of the Clostridium cluster IV in a Swedish study population, whose dietary habits were characterized by a high consumption of fish and meat (Mueller et al., 2006). Despite high meat consumption in the elderly, the generally smaller capacity for energy harvest from food may decrease the abundance of Clostridium cluster IV (Li et al., 2008). The elderly gut microbiota is also characterized by a significantly lower relative contribution of Clostridium cluster XIVa compared with young study participants (Fig. 2c).

FAFLP profiles of the 50 isolates in the study consisted of 46–102 fragments ranging in size from 50 to 600 bp. The profiles of each of the individual working cultures submitted by the eight participating laboratories were compared with the corresponding reference strain profiles

obtained from NCTC (Fig. 1). A total of 10 distinct FAFLP profiles were exhibited among the 50 isolates in this study. Arbitrary numbers, P1–P10, were assigned to the different find more FAFLP profiles, depending on the number of AF differences (Tables 1 and 2). Profiles differing by one or two AFs were designated with an ‘a’ after the corresponding profile number, for example P1a exhibited 1 AF difference from profile P1. AF differences of more than or equal to three were assigned a unique profile number. The FAFLP profiles of the eight working cultures of both S. Nottingham and B. cereus were compared GSK2118436 molecular weight with the profile of the corresponding reference strain. Two FAFLP profiles were exhibited among the nine S. Nottingham isolates, and the profiles consisted of 46–47 AFs. Six of the eight working cultures analysed had a profile identical to that of the reference strain NCTC 7832, P1. The remaining two isolates from Laboratory #7 and #8 shared

an identical profile, P1a, which differed from the reference profile by 1 AF (Table 1). The difference of 1 AF suggests that the isolates are similar to the reference strain, but not identical. The FAFLP profile of the nine B. cereus isolates consisted of a total of 84 AFs. All the eight isolates submitted by the different laboratories had a profile identical to the reference strain profile, P9 (Table 1). No detectable genetic changes were observed within

the B. cereus panel of isolates by FAFLP. The genetic profiles of the L. monocytogenes isolates submitted by the eight laboratories were compared with the corresponding reference strain profile (P2) obtained by FAFLP analysis. Eight of these isolates consisted of working cultures from each of the eight participating laboratories. In addition, Laboratory #5 submitted an additional working culture for testing from their reference stock prepared on cryoprotective beads. Laboratory #5 identified that the working culture of L. monocytogenes was, on both occasions, prepared from a LENTICULE disc purchased from the HPA’s Culture Collection (Table 2). A further five LENTICULE discs MYO10 from various LENTICULE disc batches were subcultured and analysed by FAFLP (Table 2). The profile of the L. monocytogenes isolates examined in this study comprised of 57–81 AFs. Thirteen of the 14 isolates exhibited an FAFLP profile which was identical to the reference strain profile, P2. The profile of the remaining isolate, submitted as the first working culture by Laboratory #5, differed from that of the reference strain by 24 AFs (profile P3, Table 1). A total of 21 isolates of S. aureus were examined by FAFLP, including the reference strain NCTC 6571.

The plates were inoculated with 10 μL of the cell suspension mentioned above and incubated in swimming plates for 24 h or in swarming plates for 72 h at 30 °C. Flagellar basal bodies were isolated as described previously for other microorganisms (Aizawa et al., 1985; Terashima et al., 2006), with minor modifications. An overnight culture (grown in TBSW) was inoculated at a 100-fold

dilution into the same growth medium (1 L) and subsequently cultured for 4 h at 30 °C (OD600 nm=0.6). Cells were harvested in a cold sucrose solution (0.5 M sucrose, 50 mM Tris-Cl, pH 8.0) and converted Trichostatin A mouse into spheroplasts by the addition of lysozyme and EDTA at a final concentration of 0.1 mg mL−1 and 2 mM, respectively. Lysis of spheroplasts was achieved by adding Triton X-100 from a 20% stock solution to a final concentration of 1% (w/v) and the suspension was incubated for 40 min at 4 °C, after which MgSO4 and Dnase I were added to a final concentration of 5 mM Selleck SP600125 and 0.1 mg mL−1, respectively. After the viscosity decreased, EDTA (5 mM) was added. Whole cells and cell debris were removed by centrifugation at 17 000 g for 20 min at 4 °C. The supernatant was incubated with polyethylene glycol 6000 and NaCl at a final concentration of 2% and 100 mM, respectively, and incubated for

1 h at 4 °C. The suspension was centrifuged at 27 000 g for 30 min at 4 °C. The pellet was suspended in 6 mL of Tris-Cl 10 mM, pH 8.0, EDTA 5 mM, 1% Triton X-100 (w/v), 5% glycerol (TET buffer). Cell debris were removed by centrifugation at 1000 g for 15 min at 4 °C. The supernatant was centrifuged at 100 000 g for 30 min and the pellet was suspended in 300 μL of TET buffer. This isolated fraction was further purified by molecular sieve filtration in a Sepharose CL-4B column (100 mm × 10 mm) as described previously (West & Dreyfus, 1997). The column was equilibrated with TET buffer that was filtered previously through Amicon (0.22 nm) and 0.5-mL fractions were collected at 4 °C. The protein concentration was determined using the method described previously (Bradford, 1976) and samples were analyzed

in sodium dodecyl sulfate polyacrylamide Tideglusib gel electrophoresis (SDS-PAGE) gels (Laemmli, 1970). The bands obtained were further analyzed by MS. The protein bands were excised from the Coomassie-stained SDS-PAGE gels, destained, reduced, carbamidomethylated, washed, digested with modified porcine trypsin (Promega, Madison, WI) and extracted as described previously (Xolalpa et al., 2007). MS analysis of the tryptic peptides was carried out using a 3200 Q TRAP hybrid tandem mass spectrometer (Applied Biosystems/MDS Sciex, Concord, ON, Canada), equipped with a nanoelectrospray ion source (NanoSpray II) and a MicroIonSpray II head. The instrument was coupled on line to a nano-Acquity Ultra Performance LC system (Waters Corporations, Milford, MA).

28. We suggest an accelerated vaccination schedule (three single [20 μg] doses given over 3 weeks at 0, 7–10 and 21 days) be considered only in selected patients with CD4 counts >500 cells/μL where there is an imperative need to ensure rapid completion of vaccination and/or where compliance with a full course is doubtful (2B).  29. We recommend anti-HBs Epacadostat purchase levels should be measured 4–8 weeks after the last vaccine dose (1B). Vaccine recipients with anti-HBs <10 IU/L should be offered three further 40 μg doses of vaccine, given at monthly intervals

with retesting of anti-HBs recommended 4–8 weeks after the final vaccine dose (2B).  30. We suggest vaccine recipients with an anti-HBs response >10 but <100 IU/L should be offered one additional 40 μg dose of vaccine and the response checked 4–8 weeks later (2B).  31. We recommend a booster (40 μg) dose of vaccine should be offered to those whose anti-HBs levels have declined to <10 IU/L (1C). 4.4.2 Good

practice points  32. We recommend patients who are unable to develop an antibody response to vaccine or in whom anti-HBs levels have fallen below 10 IU/L continue to be screened for HBsAg as there remains a risk of infection.  33. We recommend following successful immunisation, the anti-HBs level should be measured regularly. The frequency of screening for anti-HBs should be guided by the anti-HBs level measured after vaccination: every year for levels between 10 IU/L and 100 IU/L and every 2 years for higher levels. 4.4.3 Auditable outcomes Proportion of HAV and HBV non-immune patients who are immunised Proportion with anti-HBs levels http://www.selleckchem.com/products/Vorinostat-saha.html <10 IU/L post-primary vaccination offered three further 40 μg doses at one-month intervals Proportion with anti-HBs levels between 10–100 IU/L post-primary course of vaccine

offered one further 40 μg dose of vaccine Proportion with successful HBV immunisation receiving annual or bi-annual anti-HBs screening Proportion following successful HBV vaccination receiving a booster dose of vaccine when anti-HBS levels fall below 10 IU/L 5 Antiretroviral therapy 5.1.1 Recommendations  34. We recommend ARV choice should take into consideration pre-existing liver disease but ART should not be delayed because of a risk of Thymidine kinase drug-induced liver injury (1B).  35. We suggest ART should be used with close monitoring in patients with ESLD (Child-Pugh B/C) and consideration given to performing plasma level monitoring of ART agents (2C), particularly for the case where ritonavir-boosted PIs and NNRTIs are used.  36. We suggest when abacavir is prescribed with ribavirin, the ribavirin should be weight-based dose-adjusted (2C). 5.1.2 Good practice points  37. We recommend initiation of ART be considered in all viral hepatitis coinfected patients irrespective of CD4 cell count.  38. We recommend patients should have baseline transaminases checked before initiating a new ARV and that this is followed by routine monitoring after 1 month, and then every 3–6 months.  39.

subtilis sigI-rsgI promoter (Asai et al., 2007).

Interestingly, both putative −35 and −10 regions in the B. subtilis sigI-rsgI promoter as well as those in experimentally confirmed promoters of C. thermocellum contain nucleotides described as characteristic of ECF σ-dependent promoters (Qiu & Helmann, 2001; Helmann, 2002; Staroñet al., 2009). Analysis of DNA sequences upstream of genes encoding cellulose-degrading enzymes and cellulosome-associated proteins of the C. thermocellum (Table 1) suggests that some of these genes may be regulated via the interaction of σI-like factors with RsgI-like proteins. Nevertheless, it is currently difficult to assess the precise location and nucleotide composition of the presumed −35 region, due to the lack of the Sigma70_r4_2 domain in the C. thermocellumσI-like factors (Fig. S2). The find more extracellular CBMs of the putative anti-σI-like proteins in C. thermocellum can play a role as potential sensors of the status of the biomass Omipalisib molecular weight in

the extracellular medium. As shown in the proposed model (Fig. 4), in the absence of a substrate, the σI-like factor is bound to the cytoplasmic N-terminal subdomain of the RsgI-like protein. When the appropriate polysaccharide interacts with the corresponding RsgI-borne CBM, a signal is transferred, whereby the σI is released from the RsgI-like subdomain. σI then associates with RNAP, which transcribes the target gene(s), including those that code for various carbohydrate-active enzymes (CAZymes) and cellulosomal structural components, as well as the σI/RsgI-like operon itself. The different CBMs are specific Roflumilast for different plant cell wall polysaccharides, and the specificity is maintained in the respective σI-like factors, which induce different sets of CAZyme genes (coding for GHs, carbohydrate esterases and/or polysaccharide lyases), located at various loci on the genome. To date, very limited knowledge has accumulated regarding the regulation of cellulosomal and related cellulase genes involved in plant cell wall degradation. Our findings indicate that the C. thermocellum

genome encodes multiple copies of putative σI- and RsgI-like proteins, which may be involved in novel regulatory mechanisms that govern crucial processes in this archetypical cellulolytic bacterium, including the formation and function of the cellulosome complex. Multiple σI/RsgI-like systems may thus coordinate substrate-specific regulation of cellulosomal subunit composition and additional components of the plant cell wall-degrading system of C. thermocellum to reflect changing growth conditions. We are currently addressing experimentally the functional components of the C. thermocellum RsgI-like proteins (Nataf et al., 2010), including their specific binding to cognate σI-like proteins, their functional association with the cell membrane, their effect on transcription and more detailed analyses of their CBMs and other C-terminal domains.

In-depth qualitative interviews were undertaken

with 11 key MHRA members. A recorded semi-structured interview conducted within MHRA’s building, a topic guide (the role of pharmacists and GPs, which elements should be considered and how this should be communicated) was used to interview. A purposive sample of knowledgeable participants recruited thought a gatekeeper from different employment levels, including senior management, middle management, employees and senior employees, with knowledge of the counterfeiting medicines issue. University ethics committee approval for the overall project was gained. Framework Navitoclax supplier analysis approach was used to identify themes (2). Three main themes were identified relating to the roles of pharmacists and GPs in combating counterfeit medicines from the perspective of MHRA’s members. The first theme identified four roles for pharmacists and GPs in combating counterfeit medicines; these were: being vigilant for any suspicion of counterfeit cases; being a good source of reporting to the regulatory agency; providing selleck screening library awareness and advice for patients; as well as needing to source their medicines from a secured supply chain. The second theme related to how those roles should be communicated by the regulatory agency to pharmacists and GPs; participants recommended using media tools, working with their professional bodies and training

such as undergraduate and CPD courses. The third theme focused on what decision-makers within a regulatory agency should consider when defining those roles. Participants suggested; the regulatory agency should consider improving their communication and

speeding access to the relevant information; the need for the regulatory agency to taking patient’s confidentiality seriously in dealing with this issue; and the amount of information the agency should share with the pharmacists and GPs regarding counterfeiting medicines. This study was developed in the context of a very limited range of published Adenosine triphosphate literature. Senior and middle management MHRA managers have a clear view as to what the role of pharmacists and GPs should be in the combatting counterfeit medicines. A need to better communicate the role of pharmacists and GPs was also identified in addition to methods of delivering this. The views of the professions themselves on this are currently unknown. For the roles of pharmacists and GPs in combating counterfeit medicines to be better understood and refined, further studies are required to address the contribution and views of other stakeholders of the regulatory agency. 1. Jackson G, Patel S, Khan S. Assessing the problem of counterfeit medications in the United Kingdom. International Journal of Clinical Practice. 2012;66(3):241–250. 2. Srivastava A, Thomson SB. Framework analysis: a qualitative methodology for applied policy research. JOAAG. 2009;4(2):72–79. H. Family, E. Bell, V. Choo, S. Hassan, D.