Given the need to immunize patients at higher risk rapidly,

this is a strategy that might be considered. Higher dose vaccination may enhance the anti-HBs response [21]. Patients who are anti-HBc positive, but negative for anti-HBs, anti-HBV envelope selleck chemicals llc (anti-HBe) and HBsAg, may either have had previous exposure to HBV and be protected, or have had a false-positive anti-HBc test result and be vulnerable [22]. These patients will need HBV vaccination [23]. Patients coinfected with HBV and/or HCV are also vulnerable to acute HAV infection, which may lead to decompensation of underlying liver disease [24,25]. For a fuller discourse and further details on viral hepatitis vaccination and post-exposure prophylaxis in HIV-positive patients, please refer to the BHIVA immunization guidelines 2008 [23]. All newly diagnosed HIV-infected patients should have an anti-HBc test and additionally an anti-HBs test if they have previously been immunized. If negative for both they should receive a course of vaccination (I). The initial evaluation of all patients with chronic viral hepatitis should include a history and clinical examination [26]. The history should

include questions about IDU (current and remote), past immunization for hepatitis Selleckchem APO866 A/B, episodes of jaundice, travel abroad and potential risk activity there (blood transfusion, IDU and sexual), alcohol use (current and past), family history of HBV infection, liver disease or HCC, and previous investigation for hepatitis [26,27]. A clinical examination for evidence of chronic liver disease (peripheral stigmata, splenomegaly and ascites) should be performed. Blood tests should include a full biochemical profile including bilirubin, albumin, aminotransferases, prothrombin time, alpha fetoprotein and full blood count. A baseline battery of tests to look for alternative causes of

chronic liver disease should also be performed. This should include serum ferritin, autoantibodies, serum ceruloplasmin, serum angiotensin converting enzyme (ACE), and alpha 1 anti-trypsin levels. A scan of the liver should be performed using imaging with ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI). RVX-208 Liver biopsy remains the silver standard for the staging of liver disease [28]. However, because of sampling error, liver biopsy can overestimate or underestimate the degree of liver fibrosis. Increasingly, some physicians are commencing therapy in individuals without performing liver biopsy [29]. Liver biopsy is an important diagnostic tool in the work-up of patients with liver disease. In those individuals with HIV, who may have other co-factors contributing to liver damage and fibrosis, it remains a useful tool and should always be considered and discussed.

Moreover, this study revealed that the oligomeric structures of proteins with amino Obeticholic Acid nmr acid substitutions do not appear to be modified. Our data strongly suggest that different amino acids are involved in the thermostabilization of proteins and in membrane fluidity regulation and are localized in the α-crystallin domain. Bacteria use several mechanisms including heat shock protein (Hsp) synthesis to cope with environmental stress (Watson, 1990). Small Hsp (smHsp)

is a ubiquitous class of molecular chaperones that is similar in amino acid structure to the α-crystallins of the vertebrate eye lens (Narberhaus, 2002). They share monomer sizes ranging from 12 to 43 kDa. Although the smHsp family is the most diverse in terms of amino acid sequence, they are structurally subdivided into an N-terminal region of variable sequence and length, a conserved region of about

100 amino acids called the α-crystallin domain and a short C-terminal region (Krappe et al., 2002; Nakamoto & Vigh, 2007). SmHsps act as chaperones in vitro by binding to partially unfolded proteins in an ATP-independent manner, preventing their irreversible Adriamycin nmr aggregation under heat shock (Haslbeck et al., 2005). This chaperone activity has also been demonstrated in Escherichia coli cells expressing an smHsp, Oshsp 16.9 of rice, by evaluating the thermostabilization of cellular proteins (Yeh et al., 1997). Previous biochemical studies with various smHsp family members Afatinib have shown a strong relationship between chaperone activity and oligomerization (Lentze et al., 2003; Giese & Vierling, 2004; Haslbeck et al., 2004). The active forms of smHsps are usually

large oligomers made up of an association of multiple subunits (MacRae, 2000; Narberhaus, 2002). The quaternary structure of α-crystallins is dynamic, which is reflected by a rapid subunit exchange (van den Oetelaar et al., 1990; Bova et al., 1997; Van Montfort et al., 2001). Under various stress conditions, the cytoplasmic membrane is the first sensitive target of damage in cells, as demonstrated by the leakage of intracellular substances and variation in membrane fluidity (Da Silveira et al., 2003). The cytoplasmic location of the smHsp is very variable and some are associated with cellular membrane fractions. This is indeed the case for the smHsp Lo18 from the lactic acid bacteria Oenococcus oeni, Hsp17 from Synechocystis PCC 6803, Sp21 from Stigmatella aurantiaca and Hsp12 of Saccharomyces cerevisiae (Lunsdorf et al., 1995; Jobin et al., 1997; Horvath et al., 1998; Sales et al., 2000). This type of localization has been related to a newly described function of the smHsp, i.e. its ability to interact with in vitro model lipid membranes and to increase lipid order in the liquid crystalline state (Török et al., 2001).

Moreover, this study revealed that the oligomeric structures of proteins with amino Ganetespib in vitro acid substitutions do not appear to be modified. Our data strongly suggest that different amino acids are involved in the thermostabilization of proteins and in membrane fluidity regulation and are localized in the α-crystallin domain. Bacteria use several mechanisms including heat shock protein (Hsp) synthesis to cope with environmental stress (Watson, 1990). Small Hsp (smHsp)

is a ubiquitous class of molecular chaperones that is similar in amino acid structure to the α-crystallins of the vertebrate eye lens (Narberhaus, 2002). They share monomer sizes ranging from 12 to 43 kDa. Although the smHsp family is the most diverse in terms of amino acid sequence, they are structurally subdivided into an N-terminal region of variable sequence and length, a conserved region of about

100 amino acids called the α-crystallin domain and a short C-terminal region (Krappe et al., 2002; Nakamoto & Vigh, 2007). SmHsps act as chaperones in vitro by binding to partially unfolded proteins in an ATP-independent manner, preventing their irreversible find more aggregation under heat shock (Haslbeck et al., 2005). This chaperone activity has also been demonstrated in Escherichia coli cells expressing an smHsp, Oshsp 16.9 of rice, by evaluating the thermostabilization of cellular proteins (Yeh et al., 1997). Previous biochemical studies with various smHsp family members Pyruvate dehydrogenase have shown a strong relationship between chaperone activity and oligomerization (Lentze et al., 2003; Giese & Vierling, 2004; Haslbeck et al., 2004). The active forms of smHsps are usually

large oligomers made up of an association of multiple subunits (MacRae, 2000; Narberhaus, 2002). The quaternary structure of α-crystallins is dynamic, which is reflected by a rapid subunit exchange (van den Oetelaar et al., 1990; Bova et al., 1997; Van Montfort et al., 2001). Under various stress conditions, the cytoplasmic membrane is the first sensitive target of damage in cells, as demonstrated by the leakage of intracellular substances and variation in membrane fluidity (Da Silveira et al., 2003). The cytoplasmic location of the smHsp is very variable and some are associated with cellular membrane fractions. This is indeed the case for the smHsp Lo18 from the lactic acid bacteria Oenococcus oeni, Hsp17 from Synechocystis PCC 6803, Sp21 from Stigmatella aurantiaca and Hsp12 of Saccharomyces cerevisiae (Lunsdorf et al., 1995; Jobin et al., 1997; Horvath et al., 1998; Sales et al., 2000). This type of localization has been related to a newly described function of the smHsp, i.e. its ability to interact with in vitro model lipid membranes and to increase lipid order in the liquid crystalline state (Török et al., 2001).

This large number of intergenic transcripts suggests that noncoding RNA may play a significant role in transcriptional regulation. The results also indicate that almost 50% more rRNA transcripts are generated at the lower temperature consistent with high levels of aflatoxin production. Among the 13 487 known genes signaling pathway in the A. flavus genome, 72% were expressed under both conditions. Overall, 8626 genes were not significantly affected by the growth temperature, while 1153 were

differentially expressed. Among the latter, 551 genes had higher expression levels, while 602 genes had lower expression levels at lower temperature. Notably, six times more genes were highly upexpressed at 30 °C. Thus, 77 genes were highly upexpressed, while only 12 were highly downexpressed at that temperature. Most of the highly upexpressed genes were involved LGK-974 nmr in aflatoxin biosynthesis as discussed below. To evaluate the effect of temperature on the regulation of secondary metabolite biosynthesis, we used the smurf program (http://www.jcvi.org/smurf) (Khaldi et al., 2010) to identify putative secondary metabolite gene clusters (Table S2). Among the 55 clusters identified in the A. flavus genome, 11 clusters were upregulated (clusters #1, 11, 13, 23, 20, 21, 30, 43, 45, 54 and 55), while only two clusters were downregulated (cluster #2 and 3) at lower temperature.

Among upregulated clusters three were associated with known products: conidial pigment (cluster #10), aflatoxin (cluster #54) and cyclopiazonic acid (CPA) (cluster #55). Further analysis of the aflatoxin biosynthesis cluster quantitatively demonstrated that aflatoxin production is one of the most tightly regulated processes in a fungal cell. Most genes in C59 the aflatoxin cluster were highly upexpressed at 30 °C, while not expressed at 37 °C (Table 1). The five most highly expressed genes encoded the following enzymes:

reductase AflD, ketoreductase AflM, alcohol dehydrogenase AflH, O-methyltransferase AflO and VERB synthase AflK. Notably, adjacent sugar utilization genes (nadA, hxtA, glcA and sugR) (Yu et al., 2000), had higher expression levels under conditions nonconducive to aflatoxin production. This suggests that they are not controlled by the aflatoxin pathway regulatory genes and not directly involved in aflatoxin biosynthesis contrary to previous reports (Yu et al., 2000, 2004a, b). Intriguingly, aflR and aflS (formerly designated aflJ), the two transcriptional regulators of the aflatoxin biosynthesis pathway, were expressed at both temperature conditions. Their expression levels were five and 24 times higher, respectively, at the lower temperature. They were among the three most expressed genes in the cluster at the higher temperature. It was hypothesized previously that AflS binds to AflR to prevent inhibitor binding and to allow for the aflatoxin pathway transcription (Chang, 2004).

Although there have been recent advances in broad-spectrum sunscreens and photoprotective clothing, few peer-reviewed publications have focused on preventive strategies for excessive solar radiation exposures during travel to temperate,

tropical, and high altitude regions with high UV indices. In response, the objectives of this review were (1) to describe the adverse health effects of excessive UV radiation exposures, (2) to review recent cohort studies of public perceptions regarding sun exposure and protective behaviors, (3) to identify special populations at increased risks of UV photosensitivity, and (4) to recommend simple and effective photoprotection strategies for travelers. Internet search engines were queried with the key words as search terms Osimertinib manufacturer to examine the latest references on photoprotection and the epidemiology of UV-associated skin cancers and other adverse effects of UV-radiation exposures. This search yielded only three references on photoprotection for travelers including a British comparison of photoprotection recommendations from five travel guides for travelers to Spain, a German article on sun and insect bite protection while outdoors, and a French article on sunglasses and sunscreens during travel to tropical areas.[1-3] Solar UV radiation is classified by wavelength into UVA1 (340–400 nm), UVA2 (320–340 nm), UVB (290–320 nm), and UVC (100–290 nm). The stratospheric ozone layer

effectively absorbs most UVB radiation and all UVC radiation; but some this website UVB and all UVA2 wavelengths still reach the earth’s surface. UVB is mostly absorbed by the epidermis and is primarily responsible for erythema and sunburn. UVB radiation damages DNA at neighboring pyrimidine sites and can cause local mutations in p53 tumor suppressor genes with resulting squamous cell carcinomas (SCCs).[4, 5] The skin is continuously exposed to UV radiation outdoors, receives Fluorometholone Acetate the largest doses of radiation, and suffers the most significant adverse effects, including photoaging, sun allergy, premalignant skin lesions [actinic keratoses (AK)], and skin cancers, of which the most common types are non-melanoma

skin cancers [basal cell carcinoma (BCC) and SCC] and cutaneous malignant melanoma (CMM).[6-16] Skin cancers exhibit different sun-exposure-related risk factors with early, intermittent overexposures and blistering sunburns associated with BCC and CMM, and chronic and cumulative overexposures associated with SCC.[7, 14, 17-19] The non-melanoma skin cancers (NMSCs) comprise 95% of all skin cancers and are the most commonly occurring malignancies among fair-skinned populations worldwide.[10-13] The annual world incidence of NMSCs is estimated to be 2 to 3 million cases each year.[10-13] An upward trend in NMSCs has now been observed in Australia, Europe, and the United States (US) with an average annual increase between 3% and 8%.

burnetii this website strain

(RSA493) Nine Mile phase I genomic sequence, which revealed a set of genes with significant homology to the Dot/Icm type IVB secretion system (T4BSS) of Legionella pneumophila. In L. pneumophila, the T4BSS system consists of 26 ORFs, of which 23 share significant homology with C. burnetii ORFs (Seshadri et al., 2003). Studies show that the L. pneumophila T4BSS is required for intracellular survival, effector protein secretion, and replication within host cells (Marra et al., 1992; Berger & Isberg, 1993; Vogel et al., 1998; Bruggemann et al., 2006; Ninio & Roy, 2007; Kubori et al., 2008; Shin & Roy, 2008), thus playing a vital role in the infectious process of L. pneumophila. Moreover, the genome sequence revealed C. burnetii ORFs containing eukaryotic Ankyrin-binding repeat domains (Pan et al., 2008; Voth et al., 2009). Subsequently, these ORFs were shown to be secreted by L. pneumophila in a T4BSS-dependent manner (Pan et al., 2008; Voth et al., 2009), further implicating

the C. burnetii T4BSS as a significant contributor to cellular pathogenesis, BIBF 1120 chemical structure and yet characterization of the T4BSS structure in C. burnetii is lacking. In general, T4SS serve to export virulence factors, which include nucleoprotein complexes and effector proteins, into a host or into the extracellular milieu (Christie & Vogel, 2000; Sexton & Vogel, 2002; Cascales & Christie, 2003). T4SS have been subdivided into two families: (1) the VirB/D4 (T4ASS) and (2) the Dot/Icm (T4BSS) systems (Christie & Vogel, 2000).

The T4ASS of Agrobacterium tumefaciens directly injects effector molecules into adjacent cells (Christie Linifanib (ABT-869) & Vogel, 2000) as well as into the extracellular environment (Dillard & Seifert, 2001; Hofreuter et al., 2001). Interestingly, VirB8, part of the core complex, was reported to localize at the pole of A. tumefaciens cells (Kumar et al., 2000), and the bacterium attaches to host plant cells perpendicular to the bacterial poles (Matthysse, 1987). In L. pneumophila, the T4BSS is essential for cellular pathogenesis via secretion of effector proteins into a host cell (Sexton & Vogel, 2002; Christie et al., 2005). In L. pneumophila, the T4BSS component, DotF, appears to demonstrate polar localization (Jeong et al., 2006). Virulence factors localize or are dispersed about the pole(s) of a wide range of bacteria, and include alternate secretion systems, effector protein molecules, and surface membrane-associated proteins. Evidence suggests that the T3SS of Shigella flexneri is present at the poles of the bacteria before the secretion of IpaC (Jaumouille et al., 2008). Recently, the Mycobacterium marinum Esx-1 T7SS was shown to secrete Mh3864 at the poles and that a core Esx-1 component, Mh3870, localized preferentially to the poles (Carlsson et al., 2009).

The first two subjects ran the complete experiment (i.e. four TOT blocks) but reported extreme tiredness in relationship to using the bite bar for the entire experimental session. Thus, we reduced the session to two TOT blocks for the remaining two subjects. Consequently, data in Fig. 5 are from TOT 1 and TOT 2 only. We Selleckchem Enzalutamide ran the following sequences: Free-viewing high TC, free-viewing low TC, fixation high TC, fixation low TC. Fixation low TC, fixation high TC, free-viewing low TC, free-viewing low TC. Free-viewing low TC, free-viewing high TC. Fixation high TC, fixation

low TC. All other details were as in the main experiment. One subject presented a partial pupil occlusion (from her eyelid) in her right eye so we used data from her left eye only. All eye movement analyses for her data were as described above, except that no

binocular criterion was used for saccade detection. We determined the effects of mental fatigue (i.e. TOT and TC) on fixational and saccadic SB431542 mw eye movements during a simulated ATC task. The ATC task required the detection of airplane conflicts in low-complexity (eight planes) and high-complexity (16 planes) radar scenarios, in both free-viewing and fixation conditions. TOT was divided in four 30-min blocks: TOT 1, TOT 2, TOT 3 and TOT 4. Whereas TC analyses used data from the ATC task, TOT analyses used data from non-ATC tasks, i.e. control trials, including a fixation task and a guided saccade task, interleaved with the ATC trials; See ‘Materials and methods’ for details. To examine the effectiveness of the TOT and TC manipulations we analysed performance results (percentage of correct answers and their RTs) and responses to subjective questionnaires (NASA-TLX, SSS and Borg scores). The subjective results indicated Chlormezanone the successful manipulation of mental fatigue (i.e. TOT): participants

experienced higher levels of fatigue and sleepiness as the experiment progressed (Table 2). TOT did not affect the participants’ performance, however: percentage of correct answers and their RTs were stable across the four 30-min blocks (Table 2). Participants may have increased their efforts to maintain an acceptable level of performance to compensate for increasing fatigue (Hockey, 1997). Performance and subjective results, moreover, indicated the correct manipulation of TC: the high-complexity task led to slower RTs and more incorrect answers than the low-complexity task, as well as to higher scores in the subjective scale of TC (Table 3). Subjective ratings were similar for the fixation and free-viewing conditions, although the fixation condition resulted in faster but less accurate answers (Table 3). See Supporting Information for further details. Microsaccadic and saccadic peak velocity–magnitude relationship slopes decreased with increased TOT (Fig. 3; Table 4), indicating, for the first time, an effect of mental fatigue on microsaccadic dynamics.

gallisepticum

strains PG31 and S6 in broth medium containing subinhibitory concentrations of tiamulin or valnemulin. A portion of the gene encoding 23S rRNA gene (domain V) and the gene encoding ribosome protein L3 were amplified and sequenced. No mutation could be detected in ribosome protein L3. Mutations were found at nucleotide positions 2058, 2059, 2061, 2447 and 2503 of 23S rRNA gene (Escherichia coli numbering). Although a single mutation could cause elevation of tiamulin and valnemulin MICs, combinations of two or three mutations were necessary to produce high-level resistance. All the mutants were cross-resistant to lincomycin, chloramphenicol and florfenicol. Mutants with the A2058G or the A2059G mutation exhibited Stem Cell Compound Library mouse cross-resistance to macrolide antibiotics erythromycin, tilmicosin and tylosin. Pleuromutilin antibiotics inhibit

protein synthesis by binding to the bacterial 50S ribosomal subunit (Hunt, 2000; Yan et al., 2006). This group of antibiotics is derived from pleuromutilin, which is a natural Osimertinib nmr product of the basidiomycete Pleurotus mutilus (now called Clitopilus scyphoides) (Kavanagh et al., 1951). X-ray crystallographic data (Schlünzen et al., 2004; Davidovich et al., 2007) and biochemical information from chemical footprinting analysis (Poulsen et al., 2001; Long et al., 2006a) have revealed that this class of antimicrobial agents binds at the peptidyl transferase center and inhibits the peptide bond formation. Pleuromutilin antibiotics, such as tiamulin and valnemulin, have been exclusively used in veterinary medicine to treat infections caused by various pathogens in pigs and poultry. However, because of the emergence and spread of pathogenic bacteria resistant to existing antibiotics, there has been a renewed interest in developing novel pleuromutilin derivatives to treat bacterial infections in humans. Retapamulin, the first pleuromutilin derivative used in humans, has recently been approved for the topical treatment of skin infections caused by Staphylococcus aureus or Streptococcus pyogenes

(Jacobs, 2007). Furthermore, pleuromutilins exhibit excellent antibacterial activity against Mycoplasma spp., and valnemulin has been used in isolated cases in human medicine to treat resistant selleck products mycoplasma infections in immunocompromised patients (Heilmann et al., 2001). Mycoplasma gallisepticum, which causes chronic respiratory disease (CRD) in chickens and sinusitis in turkeys, is one of the most significant pathogens of poultry (Ley & Yoder, 1997). Infections with M. gallisepticum are highly prevalent in almost all poultry-producing areas and cause major economic losses to the poultry industry (Mohammed et al., 1987). Tiamulin and valnemulin have been used in the treatment of M. gallisepticum infection, but the clinical use of these antibiotics could not eradicate the infection probably due to the emergence of resistant isolates.

bovis with both narGHJI and narK2X genes from M. tb failed to restore nitrate reductase activity in M. bovis, suggesting the involvement of additional genes/regulatory mechanisms for nitrate reduction that are absent in M. bovis. The −6T/C promoter-linked SNP enabled clear differentiation of M. tb from the other members of the M. tb complex, including M. bovis, BCG, Mycobacterium africanum and Mycobacterium microti, through a PCR-RFLP assay. Tuberculosis in humans is chiefly caused by Mycobacterium tuberculosis (M. tb). However, Mycobacterium bovis (M. bovis), the major tuberculosis pathogen in cattle, also causes disease in humans and is usually implicated in extrapulmonary tuberculosis (Wilkins

et al., 1986). Other members of the M. tb complex (MTC), such as M. bovis BCG (BCG), Mycobacterium africanum and Mycobacterium selleck chemicals microti, rarely cause disease in immunocompromised populations (Metchock et al., 1999; Niemann et al., 2000). Zoonotic transmission of these organisms to humans, especially of M. bovis from cattle and unpasteurized milk, is an important health concern (O’Reilly & Daborn, 1995; Shah et al., 2006). Because M. bovis is naturally resistant to pyrazinamide (Scorpio & Zhang, 1996), a first-line antituberculosis drug, therefore, differentiation of M. tb infection from M. bovis infection is of paramount importance for administering

the appropriate treatment. A classical assay that differentiates M. tb from M. bovis is its high aerobic nitrate reductase Low-density-lipoprotein receptor kinase activity (Virtanen, 1960). Furthermore, the nitrate Selleck Ion Channel Ligand Library reductase activity of M. tb, but not M. bovis,

increases drastically upon entry into the anaerobic dormant state (Virtanen, 1960; Wayne & Doubek, 1965; Weber et al., 2000). It is thought that M. tb might survive in low-oxygen microenvironments (granulomas) by reducing nitrate to nitrite, using nitrate as a terminal electron acceptor in respiration (Wayne & Hayes, 1998; Wayne & Sohaskey, 2001). Nitrate reduction was shown to be mediated by narGHJI-encoded nitrate reductase in M. tb, but the enhanced reduction of nitrate during hypoxia was attributed to upregulation of NarK2, a putative nitrate/nitrite transporter (Sohaskey & Wayne, 2003). The inability of M. bovis and BCG to efficiently reduce nitrate under both aerobic and hypoxic conditions was ascribed to inactive narGHJI and narK2X gene/gene products (Stermann et al., 2004; Honaker et al., 2008; Sohaskey & Modesti, 2009). Single nucleotide polymorphisms (SNPs) were detected in the narGHJI promoter region (−215T/C), although it was not ruled out that other SNPs within the narGHJI operon itself could also contribute to this difference in activity (Garnier et al., 2003; Stermann et al., 2004). The response regulator DevR controls the transcription of narK2X in M. tb by binding to multiple Dev boxes (Chauhan & Tyagi, 2008a). A recent study showed that two DevR regulon genes, narK2 and narX, are inactive in M. bovis and BCG, compared with M.

[1,18,19] Integration of electronic prescribing in hospital, community and aged-care settings has been trialled, and national implementation, in line with the development

BI 6727 molecular weight of national electronic health records, is currently under review.[20] However, the implementation of electronic prescribing requires training for healthcare staff, funding, technological resources and compatibility with the existing medication recording system,[1,19,20] limiting the potential for expansion in rural areas. Relevant exploratory research for implementation in rural areas is lacking. It is crucial to review medication orders or prescriptions for compliance with legislative or PBS requirements and clinical appropriateness prior to supply or administration of the medication, a task commonly undertaken by pharmacists. The Regulation specifies that pharmacists must follow Quality PF-02341066 purchase Standards during dispensing of medications to consumers (section 4A).[5] The standards that apply are the Pharmaceutical Society of Australia (PSA) Professional Practice Standards.[21] Specifically, the pharmacist should review the medication order by considering the patient’s medication history, drug interactions or appropriateness of dosing regimen when dispensing the prescribed medication.[2,21,22] Studies have shown that the support from a pharmacist in reviewing prescribing decisions is perceived

by prescribers as valuable.[19,23–25] Electronic transfer of prescriptions (under development

in Australia) has integrated computer-based SDHB clinical decision-support systems for checking of the patient’s medication history for interactions, allergies and duplicate ordering, to enhance appropriate prescribing and patient safety.[1,8,19,26] Although studies exploring such systems have been limited to certain settings or institutions,[1,26] the implementation of nationwide electronic health records will allow a consistent and complete set of patients’ medication records to improve provision of healthcare.[20] While the benefits of support systems in assisting with prescribing have been reported, some of the shortcomings identified in the literature were blocking features for privacy, excessive or inappropriate alerting systems and variability or inconsistencies across products.[1,19,20] Although research and evidence is lacking in terms of the superiority of computerised systems as opposed to pharmacotherapeutic knowledge of an actual healthcare provider, such as a pharmacist, adjunct use of such support systems has the potential to improve the process of reviewing medication orders. No reports were identified involving non-pharmacists’ review of prescribing decisions in a rural setting, although nursing staff were reported to perform occasional clarification of medication orders.