Pharmacists also considered their own personal views. This study used hypothetical cases, which may have been handled differently if presented as real scenarios in the pharmacy. This study may have benefitted practice by raising

awareness of the complexity of decision-making, as well as highlighting the impact of personal selleck compound beliefs and GP relationships on practice. 1. Cooper RJ, Wingfield J, Bissell P. Ethical, religious and factual beliefs about the supply of emergency hormonal, contraception by UK community pharmacists. Journal of Family Planning and Reproductive Health Care 2008; 34: 47–50. 2. Hanna LA, Hughes CM. ‘First, Do No Harm’: Factors that Influence Pharmacists Making Decisions about Over-the-Counter Medication A Qualitative Study in Northern Ireland. Drug Safety 2010; 33: 245–255. Michael Wilcock, Joanna Lawrence Pharmacy, Royal Trametinib Cornwall Hospitals NHS Trust, Truro, UK Inter-professional collaboration as a means of improving patient care requires that clinical pharmacists have good communication skills. Doctors’ and nurses’ views on how well pharmacists communicate were captured via a brief survey. The results have informed a short tailored training programme on communication

skills for pharmacists and technicians. To ensure that patients receive the optimum level of care it is essential that clinical pharmacists, as members of the healthcare team, can effectively communicate with prescribers and nurses. A recent report acknowledge that the future for pharmacy practice will see the wider

pharmacy team drawing on their individual clinical and communication skills to work with other healthcare professionals and patients to optimise the use of medicines.1 As part of a wider service improvement Etoposide cell line project, designed to assess and develop the communication skills of the pharmacist team, we undertook a baseline assessment of how clinical staff perceive the pharmacists’ communication skills. Two 3rd year medical students, attached to the pharmacy department for a two week Special Study Unit, undertook a brief survey of doctors and nurses on a range of hospital wards. The survey instrument consisted of 4 closed questions (3 requiring answers on a 5-point Likert scale and the fourth requiring a simple yes/no response), and a final question seeking free text comments. Staff were advised of the broad purpose of the survey (to ascertain how they perceive the ability of the clinical pharmacists to communicate with clinical staff) and reassured that the survey was anonymous. This was deemed service improvement performed to meet specific local needs and ethics approval was not sought. During April 2013, thirty-eight clinical staff (18 junior doctors, 20 nurses) were approached and agreed to answer the survey.

“
“UK guidelines recommend routine HIV testing in general clinical settings when the local HIV prevalence is > 0.2%. During pilot programmes evaluating the guidelines, we used laboratory-based testing of oral fluid from patients accepting tests. Samples (n = 3721) were tested

manually using the Bio-Rad Genscreen Ultra HIV Ag-Ab test (Bio-Rad Laboratories Ltd, Hemel Hempstead, UK). This was a methodologically robust method, but handling of samples was labour intensive. We performed a validation study to ascertain whether automation of oral fluid HIV testing using the fourth-generation HIV test on the Abbott Architect (Abbott Diagnostics, Maidenhead, UK) platform was possible. Oral fluid was collected from 143 patients (56 selleck inhibitor known HIV-positive volunteers and 87 others having contemporaneous HIV serological tests) using the Oracol+ device (Malvern Medicals, Worcester, UK). Samples were tested concurrently: manually using the Genscreen Ultra test and automatically on the Abbott Architect. For oral fluid, the level selleck chemicals of agreement of results between the platforms was 100%. All results

agreed with HIV serology. The use of the Oracol+ device produced high-quality samples. Subsequent field use of the test has shown a specificity of 99.97% after nearly 3000 tests. Laboratory-based HIV testing of oral fluid requires less training of local staff, with fewer demands on clinical time and space than near-patient testing. It is acceptable to patients. The validation exercise and subsequent clinical experience

support automation, Paclitaxel with test performance preserved. Automation reduces laboratory workload and speeds up the release of results. Automated oral fluid testing is thus a viable option for large-scale HIV screening programmes. Since 2007, a change in the HIV testing paradigm in the UK has been proposed to reduce both undiagnosed and late-stage diagnosed HIV infection. Guidance from the National Institute for Health and Clinical Excellence follows that from the British Association for Sexual Health and HIV, and the British HIV Association, in calling for more widespread testing, including routine HIV testing in general medical settings in areas where HIV prevalence exceeds 0.2% [1-4]. Expansion of HIV testing has driven the development and appraisal of new HIV testing technologies, such as near-patient point-of-care tests (POCTs) and the use of various biological specimens to diagnose HIV infection, including whole blood, serum, capillary blood, dried blood spots and oral fluid. Oral fluid testing has several advantages over blood-based techniques: it is less invasive and less painful, the specimen collection can be performed by the patient without direct supervision, and oral fluid sampling is likely to be less hazardous to health care personnel. To date, the only licensed oral fluid-based HIV test is the OraQuick® ADVANCE Rapid HIV-1/2 Antibody test (OraSure Technologies, Inc.

Our voltage-clamp experiments demonstrate that both N- and T-type currents can induce SK channel opening, both when short (2 ms) and long (20 ms) depolarizing voltage steps are produced. L-, R- and P/Q channels are not effective in this respect. These results are consistent with those of Penington & Fox (1995), who did not observe any P-, Q-, or R-Type Ca2+ currents in raphe neurons. It is intriguing that co-application of mibefradil and ω-conotoxin did not inhibit the outward current more than either agent alone after long pulses (see below).

In addition, the combination of the two blockers did not abolish the current in voltage-clamp experiments, suggesting that another, minor, source of Ca2+ could exist in these neurons. However, the percentage block after short pulses amounted to ~90% and the Enzalutamide cost small size of this residual current precluded a thorough analysis of its properties. In current clamp, we only found evidence of a role for N-type channels in

the generation of the mAHP, in apparent contradiction to the voltage-clamp data. However, it should be remembered that voltage-clamp data were obtained in the presence of 5 mm TEA. The use of this compound was needed to block other K+ currents which would otherwise have contaminated our measurements. It is probable that this compound altered the membrane potential waveform in the dendrites as well as the extent of the dendritic compartment that followed the voltage command. Therefore, one reasonable explanation of this discrepancy is that more remote areas High Content Screening of the dendrites were exposed to more depolarized voltages during our voltage-clamp steps than during natural action potentials. This would imply that N-type channels are more proximal to the soma and T-type channels more distal.

There is evidence for this in other neurons. For example, T-type channels are clearly located in distal dendrites of thalamic reticular nucleus neurons (Crandall et al., 2010). It is not possible from our data to infer what the location of SK channels is within serotonergic neurons. However, studies in other types of neurons have suggested that these channels are located both on the soma and on the dendrites, where they may play Dichloromethane dehalogenase different roles. This seems to be the case both in hippocampal pyramidal (Adelman et al., 2012) and in dopaminergic (Deignan et al., 2012) neurons. In the first case, dendritic SK channels are involved in a local negative feedback loop where they inhibit Ca2+ influx through NMDA channels by their hyperpolarizing effect (Ngo-Anh et al., 2005). In this regard, one possible explanation for the lack of additive effect of mibefradil and ω-conotoxin in voltage clamp is that both N- and T-type channels may activate the same population of SK channels in serotonergic neurons. Further experiments are, however, needed to test this hypothesis, as well as to decipher the topography of SK channels and voltage-dependent Ca2+ channels in these neurons.

The exact mechanism of the anti-inflammatory activity of S. boulardii extract is not clear. However, in light of these results, it is tempting to speculate that the leading mechanism involves the modulation of neutrophils’ response. IL-8 influenced only chemotaxis and the activation of neutrophils, while the spectrum of IL-1β activity is wide and includes the activation of T helper, NK cells

and macrophages, maturation and proliferation of B cells. Slight stimulation of IL-1β and IL-8 expression in Caco-2 cells by S. boulardii extract may not indicate an inflammatory reaction, but rather the stimulation of the host defense. Induction of IL-8 expression by nonpathogenic microorganisms such as Saccharomyces cerevisiae ICG-001 chemical structure (Saegusa et al., 2004, 2007) or Escherichia coli Nissle 1917 (Lammers et al., 2002) was shown previously, and is believed to be beneficial for the normal state of the host immune system preparing for pathogen infection. Further studies are needed to fully understand the mechanism of S. boulardii action against C. albicans hyphae formation and adhesion to intestinal cell lines. We are now determining the chemical structure of active molecule/s secreted by S. boulardii, which will Dasatinib nmr allow further elucidation of the mechanism of its biological activity. This work was partly supported

by a grant from Biocodex, France. “
“Normally, Lactobacillus brevis has two glutamate decarboxylase (GAD) genes; gadA and gadB. Using PCR, we cloned the gadA gene from L. brevis strain NCL912, a high yield strain for the production of gamma-aminobutyric acid (GABA). However, despite using 61 different primer pairs, including degenerate primers

from conserved regions, we were unable to use PCR to clone gadB from the NCL912 strain. Furthermore, we could not clone it by genomic walking over 3000 bp downstream of the aldo-keto reductase gene, a single-copy gene that is located 1003 bp upstream of gadB in L. brevis ATCC367. Altogether, the data suggest that L. brevis NCL912 does not contain a gadB gene. By genomic walking, we cloned regions upstream and downstream of the gadA gene to obtain a 4615 bp DNA fragment that included the complete gadA locus. The locus contained the GAD gene (gadA) and the glutamate:GABA antiporter gene (gadC), which appear to be Dichloromethane dehalogenase transcribed in an operon (gadCA), and a transcriptional regulator (gadR) of gadCA. During whole fed-batch fermentation, the expression of gadR, gadC and gadA was synchronized and correlated well with GABA production. The gadA locus we cloned from NCL912 has reduced homology compared with gadA loci of other L. brevis strains, and these differences might explain the ability of NCL912 to produce higher levels of GABA in culture. “
“We studied the effect of hydrogen peroxide (H2O2) stress on the anaerobic sulfate-reducing bacterium Desulfovibrio vulgaris Hildenborough. In a lactate/sulfate medium, growth was affected from 0.1 mM H2O2 and totally inhibited at 0.7 mM.

, 1998). Dimerization via the HisKA

domain of EnvZ is essential for its autophosphorylation and phosphotransfer functions. The HisKA domain comprises a four-helix bundle formed by two identical helix–turn–helix subunits, revealing the molecular assembly of two active sites within the dimeric kinase (Tomomori et al., 1999). KdpD functions as a homodimer (Heermann et al., 1998). Coproduction of two kinase inactive KdpD derivatives KdpD/His673Gln and KdpD/Asn788Asp resulted in a KdpD protein that regained kinase activity in vitro. This result suggested that the functional state of KdpD is at least a dimer and that Pexidartinib purchase the kinase reaction occurs in trans, meaning that one subunit binds ATP in the HATPase_c domain and phosphorylates the other subunit in the HisKA domain. A similar mechanism of autophosphorylation has been observed for other histidine kinases (Yang & Inouye, 1991; Ninfa et al., 1993; Swanson et al., 1993; Wolfe & Stewart, 1993). To solve the question whether KdpD undergoes a monomer-to-dimer transition upon activation, the relative molecular masses of nonphosphorylated KdpD and phosphorylated KdpD were Selumetinib supplier determined using several techniques. The molecular mass of native KdpD correlated with a KdpD dimer, and there was no difference between KdpD and phospho-KdpD. Cross-linking experiments with single Cys KdpD derivatives provided evidence for a close contact between

the monomers in the transmitter domain as well as in TM1, but the Cys residues did not play a role in the stabilization of the dimer (Heermann et al., 1998). Nevertheless, an intramolecular disulfide bridge formed between Cys852 and Cys874 was found to be Vildagliptin important for kinase activity (Jung et al., 1998). Each histidine kinase contains a highly specific stimulus-percepting

domain, the so-called input domain. The input domain of KdpD comprises a large cytoplasmic N-terminal domain, four transmembrane domains (TM1–TM4), and a short part of the C-terminal cytoplasmic domain (Fig. 1). In the C-terminal part of the input domain, adjacent to TM4, a cluster of positively charged amino acids (Arg residues) was identified that is important for the ratio between kinase and phosphatase activities (Jung & Altendorf, 1998a). Replacement of these Arg residues by Gln resulted in KdpD derivatives with either an increased kinase and decreased phosphatase activity (Arg511Gln) or a decreased kinase and increased phosphatase activity (Arg503Gln, Arg506Gln, Arg508Gln). Because the removal of one positively charged amino acid residue was sufficient to perturb the ratio of the KdpD activities, it was proposed that electrostatic interactions within the protein affect the kinase to phosphatase equilibrium (Jung & Altendorf, 1998a). Earlier, the transmembrane domains of KdpD were thought to be essential for sensing.

, 1998). Dimerization via the HisKA

domain of EnvZ is essential for its autophosphorylation and phosphotransfer functions. The HisKA domain comprises a four-helix bundle formed by two identical helix–turn–helix subunits, revealing the molecular assembly of two active sites within the dimeric kinase (Tomomori et al., 1999). KdpD functions as a homodimer (Heermann et al., 1998). Coproduction of two kinase inactive KdpD derivatives KdpD/His673Gln and KdpD/Asn788Asp resulted in a KdpD protein that regained kinase activity in vitro. This result suggested that the functional state of KdpD is at least a dimer and that SRT1720 datasheet the kinase reaction occurs in trans, meaning that one subunit binds ATP in the HATPase_c domain and phosphorylates the other subunit in the HisKA domain. A similar mechanism of autophosphorylation has been observed for other histidine kinases (Yang & Inouye, 1991; Ninfa et al., 1993; Swanson et al., 1993; Wolfe & Stewart, 1993). To solve the question whether KdpD undergoes a monomer-to-dimer transition upon activation, the relative molecular masses of nonphosphorylated KdpD and phosphorylated KdpD were Ruxolitinib determined using several techniques. The molecular mass of native KdpD correlated with a KdpD dimer, and there was no difference between KdpD and phospho-KdpD. Cross-linking experiments with single Cys KdpD derivatives provided evidence for a close contact between

the monomers in the transmitter domain as well as in TM1, but the Cys residues did not play a role in the stabilization of the dimer (Heermann et al., 1998). Nevertheless, an intramolecular disulfide bridge formed between Cys852 and Cys874 was found to be TGF-beta inhibitor important for kinase activity (Jung et al., 1998). Each histidine kinase contains a highly specific stimulus-percepting

domain, the so-called input domain. The input domain of KdpD comprises a large cytoplasmic N-terminal domain, four transmembrane domains (TM1–TM4), and a short part of the C-terminal cytoplasmic domain (Fig. 1). In the C-terminal part of the input domain, adjacent to TM4, a cluster of positively charged amino acids (Arg residues) was identified that is important for the ratio between kinase and phosphatase activities (Jung & Altendorf, 1998a). Replacement of these Arg residues by Gln resulted in KdpD derivatives with either an increased kinase and decreased phosphatase activity (Arg511Gln) or a decreased kinase and increased phosphatase activity (Arg503Gln, Arg506Gln, Arg508Gln). Because the removal of one positively charged amino acid residue was sufficient to perturb the ratio of the KdpD activities, it was proposed that electrostatic interactions within the protein affect the kinase to phosphatase equilibrium (Jung & Altendorf, 1998a). Earlier, the transmembrane domains of KdpD were thought to be essential for sensing.

, 2005) and mediate GAS adherence to and internalization by human cells (Caswell et al., 2007). The amino-terminal part of the

Scl proteins, termed the variable (V) region, forms a globular domain that is protruded away from the GAS cell surface by the CL region (Xu et al., 2002). The V-region sequences vary significantly between Scl1 and Scl2. In addition, the V-region sequence of each Scl protein is conserved in strains of the same M-type, but differs considerably among Scls from strains of different M-types. Despite the observed sequence variation, LY2157299 two main ligands have been identified that bind different Scl1 variants via their V-regions. The Scl1.6 and Scl1.55 proteins of M6- and M55-type GAS, respectively, bind human plasma glycoproteins factor H and the factor H-related protein 1 (Caswell et al., 2008b). On the contrary, several other Scl1 variants bind the low-density lipoprotein (LDL) including Scl1 proteins

of the M1-, M2-, M12-, M28-, and M41-type GAS (Han et al., 2006a). The latter Scl1.41 protein also binds integrins α2β1 and α11β1 via direct interaction with the CL region (Caswell et al., 2008a). This suggests specialization in ligand binding among Scl1 proteins and underscores their importance as pathogenicity traits. The binding of the ECM components by pathogens is known to be a common strategy used to establish host colonization. Several GAS cell-surface molecules Selleckchem GW-572016 have been reported to initiate this interaction Megestrol Acetate including several M proteins, F1/SfbI, F2, SOF, SfbII, Lbp, and Shr (Hanski & Caparon, 1992; Kreikemeyer et al., 1995; Jaffe et al., 1996; Molinari & Chhatwal, 1998; Courtney et al., 1999; Terao et al., 2002; Fisher et al., 2008). Thus, in this work, we hypothesized that Scl proteins possess binding capacities to ECM components that, in turn, would facilitate bacterial adhesion to human ECM and internalization by host cells. It is known that Scl1 is expressed by virtually all GAS strains (Lukomski et al., 2000; Rasmussen et al., 2000); therefore, this

work further supports the role of Scl1 protein as an important accessory, multifunctional surface adhesin of GAS. The M41-type MGAS 6183 wild type and the scl1 mutant strains were used. The isogenic scl1 mutant of MGAS 6183 was constructed by allelic replacement as described previously (Caswell et al., 2007). To prepare GAS cells for experiments, cultures were grown overnight on brain–heart infusion agar (BD Biosciences, Sparks, MD) at 37 °C in an atmosphere of 5% CO2–20% O2. Overnight cultures were used to inoculate Todd–Hewitt broth (BD Biosciences) supplemented with 0.2% yeast extract and the cultures were incubated at 37 °C until they reached the logarithmic phase of growth (OD600 nm∼0.5).

, 2011); in pure culture, it was shown to degrade 50% of 34 μM RDX within 7 days as a sole source of nitrogen, but was incapable of TNT or HMX degradation, despite previous research showing that the genus Prevotella increased

significantly during an 8-h HMX AZD4547 solubility dmso incubation in WRF (Perumbakkam & Craig, 2012). Removal of TNT and all metabolites (< 5% of original TNT recovered as a metabolite) occurred for Butyrivibrio fibriosolvens, Fibrobacter succinogenes, Lactobacillus vitulinus, Selenomonas ruminantium, Streptococcus caprinus, and Succinovibrio dextrinosolvens (De Lorme & Craig, 2009). Anaerovibrio lipolyticus and Desulfovibrio desulfuricans were inhibited by TNT (De Lorme see more & Craig, 2009) and HMX (this study), but not by RDX (Eaton et al., 2013). Streptococcus caprinus and the Clostridia organisms have

shown a strong degradative ability for TNT and RDX, but not HMX (Zhao et al., 2003; De Lorme & Craig, 2009). Lactobacillus vitulinus tends to favor TNT over RDX, although it can degrade both (De Lorme & Craig, 2009; Eaton et al., 2013), while L. ruminus has not been found to be capable of degrading any energetic compound. The general trend we have observed is that microorganisms from the rumen, while sometimes capable as individual strains/isolates, excel as a community in the bioremediation of explosives. Phytoruminal bioremediation is a technique that is proving to be viable for the remediation of energetic compounds, which includes TNT (Fleischmann et al., 2004; Smith et al., 2008; De Lorme & Craig, 2009), RDX (Eaton et al., 2011, 2013), and now HMX (Perumbakkam & Craig, 2012). The authors would like to thank Michael Wiens for technical assistance. This research was supported in part by a gift from Ruminant Solutions, UC (New Mexico), the Oregon Agricultural Experiment Station (project ORE00871) and the USDA, Agriculture

Research Service (project 50-1265-6-076). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the U.S. Department of Agriculture. The authors have no conflict of interests to declare. “
“Human-β-defensins 1-3 (HBD-1-3) and their C-terminal analogs Phd-1-3 do not show antibacterial activity learn more against Escherichia coli in the presence of mono- and divalent cations. Activity of peptides was examined against E. coli pretreated with carbonyl cyanide m-chlorophenylhydrazone (CCCP) and salt remedial Escherichia coli ftsEX, a deletion mutant of FtsEX complex [an ATP-binding cassette (ABC) transporter protein], in the presence of Na+, Ca2+, and Mg2+. Activity was observed in the presence of Na+ and Ca2+, although not in the presence of Mg2+ against E. coli, when proton motive force (PMF) was dissipated by CCCP. The peptides exhibited antibacterial activity against E.

Data were analyzed by Wilcoxon test (α = 5%). At the periods of 0 to 16 h, the toothbrushes had intense bacterial contamination (score 3). From the 18-h, there was a statistically significant decrease in the MS viability (P = 0.0078), with predominance of score 1 on periods of 20 to 44 h. The most detected ECP amount was at 0- and 12-h period (P < 0.05) with reduction until 32-h period. Mutans streptococci remained viable on toothbrushes bristles, in vivo, for 44 h. "
“International Journal of Paediatric Dentistry 2011; 21: 249–253 Background.  Atraumatic restorative treatment (ART) has the advantages of reducing pain and fear and of being more cost-effective than the traditional

approach. Aim.  The aim of this study was to investigate the survival of ART class I and II restorations in primary molars at 2 years. Design.  The sample consisted of 190 restorations and placed in 155 children selleck products 6–7 years old of both genders. The treatment was performed by two final-year

dental students. All patients were treated in a completely supine position on tables available in the schools. The restorations were evaluated at 1, 12, and 24 months. Results.  The best results were found for class I in each period of follow-up. After 1 month, the success of class I restorations was 94.6% and class II BI 6727 cell line restorations 70.1%. After 12 months, the success rate was 50.6% for class I and 15.2% for class II. The most frequent failure characteristics were totally or partially lost and gross marginal defect. Conclusions.  The rate of success of restorations using the ART approach was significantly lower for class II. “
“OHRQoL comprises an apparently complex array of biological and psychological aspects of oral health. To determine the relative

contribution of sociodemographic, psychosocial, or clinical characteristics to OHRQoL in adolescents. A cross-sectional study of Dunedin adolescents was carried out. Each participant completed a self-administered questionnaire and underwent a clinical examination. Information collected included sociodemographic characteristics Progesterone (sex, ethnicity, and household deprivation), psychosocial characteristics (self-esteem, psychological well-being, somatisation, and self-perception scores for body image), and clinical measures (DMFS and Dental Aesthetic Index). OHRQoL was measured using the 16-item impact short-form CPQ11–14 questionnaire. Linear regression analyses used the CPQ11–14 as the dependent variable, with independent variables entered in related groups. Three hundred and fifty-three children (48.4% females) took part, representing a 58.8% response rate. Linear regression modelling of the CPQ11–14 score showed that sociodemographic characteristics were predictors, but the model’s overall explanatory power was low (R2 = 0.05). This increased slightly with inclusion of the clinical variables. When the psychosocial variables were added, however, the R2 increased to 0.

The pharmacists’ resultant survey scores were correlated against their actual rate of documenting clinical interventions. Results  The tool had relatively good internal consistency. Significant differences were seen between the three groups of students (P < 0.01). Community pharmacists with additional clinical qualifications had a significantly higher score than other participating pharmacists (P < 0.01). A moderate, but significant, correlation was seen between the BIBW2992 chemical structure pharmacists’ survey score

and their clinical intervention rate in practice during the trial (P < 0.01). Conclusion  The clinical knowledge measurement tool appeared to estimate a pharmacist's ability to detect and resolve DRPs within the community pharmacy environment. "
“Objectives The aim of this study was to develop a ranked thematic list encompassing the positive and negative exemplars of patient-centred professionalism in community pharmacy. Methods An adapted Nominal Group Work (NGW) method was used in six individual consultation workshops (two with established pharmacists, one with newly qualified pharmacists, Neratinib one with pharmacy staff, one with stakeholders and one with members of the public) followed by a mixed-group

forum event. Key findings Each of the six workshops resulted in the production of approximately 10 positive and 10 negative exemplars of patient-centred professionalism. The thematization of these exemplars allowed the development of

11 broad themes. The mixed-group forum event then provided a mechanism for ranking the importance of these themes. Safety, professional characteristics and relationships with patients were ranked as the most important themes by our study participants. “
“Objectives  This paper provides an explanatory policy analysis of the new legislation which permits pharmacist prescribing in Alberta, Canada: the Pharmacists Profession Regulations (2006) to the Health Professions Act (1999). Its Tangeritin purpose is to provide useful insights for pharmacy regulatory bodies in other jurisdictions internationally that are in a position to pursue similar opportunities. Methods  A search for government and regulatory body documents related to Alberta healthcare system and pharmacist prescribing was performed. Correspondence was initiated with authors and regulators to clarify or obtain current data. Key findings  Research to support policy change recommendations and communication among healthcare professionals, regulators and other stakeholders is essential for developing and implementing legislative change regarding health professionals’ scopes of practice at a time when legislative change is possible. Stakeholder barriers to implementation need to be identified early to provide opportunity to address and resolve.