reuteri, affects on streptococcus mutants, colonization of the te

reuteri, affects on streptococcus mutants, colonization of the teeth surface by lactobacilli Less carries after the ingestion of living or oral vaccination with heat-killed lactobacilli Enhanced nutrient value Chr. Hansen (Horsholm, Denmark) Snow Brand Milk Products Co., Ltd (Tokyo, Japan) Institut Rosell (Montreal, Canada) Rhodia, Inc. (Madison, WI) Nebraska Cultures, Erlotinib ic50 Inc. (Lincoln, NE) L. casei DN014001 (Immunitas) Danone Le Plessis- Robinson (Paris, France) Urex Biotech Inc. (London, Ontario, Canada) L. johnsonii La1 (same as Lj1) Nestlé (Lausanne, Switzerland) Probi AB (Lund, Sweden) L. reuteri SD2112

(same as MM2) Valio Dairy (Helsinki, Finland) Essum AB (Umeå, Sweden) University College (Cork, Ireland) Morinaga Milk Industry Co., Ltd (Zama-City, Japan) L. delbrueckii subsp. bulgaricus 2038 Meiji Milk Products (Tokyo, Japan) Lacteol Laboratory (Houdan, France) Arla Dairy (Stockholm, Sweden) Biocodex Inc. (Seattle, WA) New Zealand Dairy Board The intestinal microbial community is a complex ecosystem, and introducing new organisms into this highly competitive environment is difficult. Thus, organisms that can produce a product that inhibits the growth of existing organisms have a characteristic advantage. The ability of probiotics to establish in the GI

tract is enhanced selleck inhibitor by their ability to eliminate competitors. Some antimicrobials with producer organisms are enlisted in Table 3. In different studies on humans and animals, beneficial microorganisms are used to improve the colonization resistance on body surfaces, such as GI, the urogenital, and the respiratory tract. Bifidobacteria produce acetic and lactic acids in a molar ratio of 3 : 2 (Desjardins

& Roy, 1990). Lactobacillus acidophilus and Lactobacillus casei produce lactic acid as the main end product of fermentation. In addition to lactic and acetic acids, probiotic organisms produce other acids, such as hippuric and citric acid. Lactic acid bacteria also produce hydrogen peroxide, diacetyl, and bacteriocin as antimicrobial substances. These inhibitory substances create antagonistic environments for foodborne pathogens and spoilage organisms. Yoghurt bacteria are reported to produce bacteriocin against probiotic bacteria and vice versa (Dave & Shah, 1997). Wide-spectrum antibiotic Acidolin, Acidophilin, Buspirone HCl Lactocidin, Lactocin B L. delbrueckii ssp. bulgaricus L. sake L45, L. sake Lb706 Nisin, Lactostrepsin, Lactocin, Lacticin Pediococcus pentosaceous, P. acidilactis Enterococcus faecium DPC1146 Goldin & Gorbach (1980) reported that the introduction of L. acidophilus into the diet lowers the incidence of chemically induced colon tumors in rats. Later, the same authors also suggested that diet and antibiotics can lower the generation of carcinogens in the colon and reduce chemically induced tumors (Goldin & Gorbach, 1984). These effects appear to be mediated through the intestinal microbial communities.

Briefly, genetically fused Ubi4-(N-degron: Phe)-target molecule i

Briefly, genetically fused Ubi4-(N-degron: Phe)-target molecule is inducibly expressed under the regulation of Ptrp. The resulting fusion protein is cleaved by constitutively expressed Ubp1, and the resultant Phe present at the NH2 terminal of the target protein was further degraded ALK inhibitor by ClpAP, which is inducibly expressed under the regulation of the Lac operon system. As endogenous tryptophanase,

TnaA, interferes with TrpR activity by degrading its cofactor tryptophan, we replaced the tnaA gene with the trpR gene. (Schematic representation used in this study is shown in Supporting information, Fig. S1) Targets in Table 1 are known as essential genes in E. coli and some pathogens of RTIs including S. pneumoniae and H. influenzae. By monitoring killing curves of such bacterial strains under the condition in which the Selleckchem Temsirolimus expression of the target molecule is suppressed, both bactericidal and bacteriostatic profiles were examined. Escherichia coli K-12 MG1655 (ATCC47076, American Type Culture Collection) was used as a host for homologous recombination. Escherichia coli DH5α (competent high E. coli DH5α, Toyobo Co., Ltd) was used for gene cloning. pKO3 (Link et al., 1997b) and pKOV (Bulyk et al., 2004) (both have cat, repA (ts), sacB) were obtained from

Harvard Medical School. pKD4 and pKD13 (Datsenko & Wanner, 2000) (both have kan) were obtained from Yale University. pKD46 (Datsenko & Wanner, 2000) has the amp gene, Red recombinase (γ, β, and exo) and BAD promoter. pKD46r (BAD promoter of pKD46 was replaced with rhamnose promoter) was constructed

in this study. pFLAG-CTC (amp) was purchased from Sigma. pCRII-Blunt Topo (kan, Zero Blunt TOPO PCR cloning kit) was used as a cloning vector. Genomic DNA of S. cerevisiae S288C was purchased from Promega. Each E. coli strain was grown in Luria–Bertani (LB) broth or LB agar (BD Biosciences) containing the following antibiotics: carbenicillin (100 μg mL−1, CBPC; Sigma), for amp coding plasmid), chloramphenicol (20 μg mL−1, CP; Sigma), for cat coding plasmid), and kanamycin (50 μg mL−1, KM; Sigma), for kan coding plasmid. Escherichia coli genomic DNA was extracted HSP90 with a DNeasy Tissue Kit (Qiagen). Plasmid DNA was extracted with a QIAprep Spin Miniprep Kit (Qiagen). PCR products and plasmids digested by restriction enzymes were purified with a QIAquick PCR Purification Kit (Qiagen). PCR products digested by restriction enzyme were purified with a MinElute Reaction Cleanup Kit (Qiagen). Overnight cultures of E. coli were diluted 200-fold in 100 mL of LB broth and grown at 37 °C until the OD600 nm reached 0.5. In strains transformed with pKD46r, the bacteria were cultured at 30 °C in LB broth medium containing both CBPC (100 μg mL−1) and l-rhamnose (100 mM, Wako Pure Chemical Industries, Ltd). Cultures were incubated on ice for 10 min and centrifuged at 2440 g at 4 °C for 15 min. Then, the bacterial pellet was washed twice with an equal volume of ice-cold water and then subjected to another wash with a 0.

, 2004) In pgsA mutant cells, the deficiency in the acidic phosp

, 2004). In pgsA mutant cells, the deficiency in the acidic phospholipids, phosphatidylglycerol and cardiolipin, causes retarded translocation of newly synthesized proteins across the inner membrane due to impaired activation of SecA in the translocation machinery (Dowhan et al., 2004), impairment in the production of OmpF protein and flagellin (Inoue et al.,

1997), and activation of the Rcs phosphorelay regulatory system (Shiba et al., 2004; Nagahama et al., 2006). The impairment of flagellin production in pgsA3 mutant cells is due to the transcription repression of the flagellar master operon flhDC (Kitamura et al., 1994). Our recent studies have shown that accumulation of σS is involved in the repression of the master operon. The transcriptional activity, as monitored via rpoS′-lacZ

transcriptional fusion Tigecycline cell line check details and real-time PCR, in pgsA3 mutant cells is 2.6 times as high as in pgsA+ cells (Uchiyama et al., in press). While the enhanced transcription could conceivably be solely responsible for the accumulation, post-transcriptional accumulation has also been suggested to play an important role in the mutant cells, because the σS content in the mutant cells is significantly higher even if the same level of rpoS mRNA is expressed from a regulatable promoter (Uchiyama et al., in press). It is well known that σS is the master regulator that controls the genes expressed upon entry into the stationary phase and against general stress, including starvation (Tanaka et al., 1993; Pratt & Silhavy, 1998; Hengge-Aronis, 2002). Various levels Interleukin-3 receptor of σS regulation are affected by various stress signals; an increased content of σS might be obtained by rpoS transcription or rpoS mRNA translation, or by inhibition of σS proteolysis (which, under nonstress conditions in logarithmic growth, is quite rapid via the ClpXP protease) (Pratt & Silhavy,

1998; Hengge-Aronis, 2002; Majdalani et al., 2002; Bougdour et al., 2006; Peterson et al., 2006). In the present study, we focus on the mechanisms for post-transcriptional σS accumulation, that is, we investigate the translation of rpoS mRNA and the proteolytic degradation of the sigma factor in mutant cells with acidic phospholipid deficiency. The E. coli K-12 strains and plasmids used in this study are listed in Table 1. New strains were constructed by P1 phage transduction and the methods described below, and their genotypes were verified by drug resistance tests, PCR amplification, nucleotide sequencing, and determination of phospholipid composition, as applicable. Strain BW25113ΔclpPX was constructed using the λ Red system (Datsenko & Wanner, 2000).

Authors who have compared samples from different age groups[20, 2

Authors who have compared samples from different age groups[20, 25, 30, 31] have observed that owing to hypomineralized enamel breakdown, as a result of chewing forces and possible caries development, older children present more severe defects than Atezolizumab clinical trial younger children. Only longitudinal studies of children with MIH would make it possible to measure the clinical changes in defects over time and to detect affected teeth among those that erupt later. Although some research has speculated on the importance of gender in MIH development[12, 32], the data obtained

in the present study agree with other authors[2, 3, 6, 7, 20, 25, 33-35], in finding no difference in MIH prevalence by sex. Despite being termed MIH, the definition of this defect already gives an indication that it mainly affects the permanent first molars. The permanent first molars and incisors begins to mineralize within a very short time of each other, so empirically

they could be expected to be similarly affected, as in chronological hypoplasia. However, like other previous results[15, 17, 25, 36, 37], this study confirms that the permanent first molars are more frequently affected and that one of the fundamental characteristics of MIH is its asymmetry. The different studies show different check details results for associations between the affected molars and incisors. Although some authors[1, 6, 7, 12, 15, 22, 27, 30, 34, 38, 39] have found a significant association between the number of molars affected and the presence of defects in incisors, the present study, like Jasulaityte et al.[25], and Kotsanos et al.[40], has found no statistically significant correlation between the number of molars and number of incisors affected, although it has been suggested a tendency for

more incisors to be affected as the severity of MIH in the permanent first molars increases. Besides the permanent first molars, the most affected teeth were the maxillary central incisors and less frequently the Phosphoglycerate kinase maxillary lateral incisors and mandibular lateral incisors, as found in other studies[3, 22, 37, 38]. Unlike other studies[1, 6, 12, 30, 32, 33, 35, 40], the present study was unable to establish whether susceptibility to MIH is greater in the maxillary or mandibular teeth. In the present study, the mean number of teeth and molars affected was 3.5 and 2.4, respectively, similar to the findings of other studies with similar or more MIH prevalence rates[5, 6, 30], to others with far lower prevalence rates, between 5.6% and 9.7%[1, 7, 8], or even to the study conducted in China, where the prevalence of this defect in the population was 2.8%[12].

Authors who have compared samples from different age groups[20, 2

Authors who have compared samples from different age groups[20, 25, 30, 31] have observed that owing to hypomineralized enamel breakdown, as a result of chewing forces and possible caries development, older children present more severe defects than BAY 73-4506 concentration younger children. Only longitudinal studies of children with MIH would make it possible to measure the clinical changes in defects over time and to detect affected teeth among those that erupt later. Although some research has speculated on the importance of gender in MIH development[12, 32], the data obtained

in the present study agree with other authors[2, 3, 6, 7, 20, 25, 33-35], in finding no difference in MIH prevalence by sex. Despite being termed MIH, the definition of this defect already gives an indication that it mainly affects the permanent first molars. The permanent first molars and incisors begins to mineralize within a very short time of each other, so empirically

they could be expected to be similarly affected, as in chronological hypoplasia. However, like other previous results[15, 17, 25, 36, 37], this study confirms that the permanent first molars are more frequently affected and that one of the fundamental characteristics of MIH is its asymmetry. The different studies show different Erlotinib results for associations between the affected molars and incisors. Although some authors[1, 6, 7, 12, 15, 22, 27, 30, 34, 38, 39] have found a significant association between the number of molars affected and the presence of defects in incisors, the present study, like Jasulaityte et al.[25], and Kotsanos et al.[40], has found no statistically significant correlation between the number of molars and number of incisors affected, although it has been suggested a tendency for

more incisors to be affected as the severity of MIH in the permanent first molars increases. Besides the permanent first molars, the most affected teeth were the maxillary central incisors and less frequently the Protein tyrosine phosphatase maxillary lateral incisors and mandibular lateral incisors, as found in other studies[3, 22, 37, 38]. Unlike other studies[1, 6, 12, 30, 32, 33, 35, 40], the present study was unable to establish whether susceptibility to MIH is greater in the maxillary or mandibular teeth. In the present study, the mean number of teeth and molars affected was 3.5 and 2.4, respectively, similar to the findings of other studies with similar or more MIH prevalence rates[5, 6, 30], to others with far lower prevalence rates, between 5.6% and 9.7%[1, 7, 8], or even to the study conducted in China, where the prevalence of this defect in the population was 2.8%[12].

This was accentuated by the participants’ focus on meeting patien

This was accentuated by the participants’ focus on meeting patients’ demands, provided safety was

not compromised. Participants’ also queried advice issued by the Medicines and Healthcare Products Regulatory Agency that OTC cough and cold products no longer be used in children under 6, with five participants (three tutors and two trainees) in favour of their use. One participant related advocating their use to parent demand, ‘because it helps the parents as well, peace of mind …’ (Trainee 5). This view was also supported by tutors. However, safety was still considered http://www.selleckchem.com/products/c646.html paramount. It appears an evidence-based approach is not a central component of pre-registration training relating to OTC consultations. There was inconsistency in how products were viewed in terms of evidence and participants appeared not to deter patients from purchasing OTC medicines they GPCR Compound Library cost considered were not effective, provided they were not harmful. Initial themes are based on limited

numbers of interviews which will continue until data saturation is achieved. On-going research may provide a useful platform to develop future programmes for pre-registration training. 1. Hanna LA, Hughes CM. Public’s views on making decisions about over-the-counter medication and their attitudes towards evidence of effectiveness: a cross-sectional questionnaire study. Patient Educ Couns 2011; 83: 345–351. 2. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev 2012; Issue 8: Art. No.: CD001831. DOI: 10.1002/14651858.CD001831.pub4 Wasim Baqir1,2, Steven Barrett1, Julian Hughes1,3, Nisha Desai1, Jane Riddle2, Annie Laverty1, Joanne MacKintosh1, Peter Derrington1, Richard Copeland1, Aileen Beatty1, Joan Lowerson1, Yvonne Storey1, David Campbell1 1Northumbria

Healthcare, North Shields, UK, 2The Village Green Surgery, Wallsend, UK, 3Newcastle University, Newcastle, UK, 4Age UK, North Tyneside, UK Can multidisciplinary team (MDT) reviews involving pharmacists reduce unnecessary prescribing in care homes? For every 3 to 4 medicines reviewed, one was stopped with only 6 minor adverse events reported Unnecessary or inappropriate medicines taken by care home residents can be safely stopped Residents in care homes are more likely to be prescribed multiple medicines and inappropriate nearly prescribing has been reported in the literature.1 Excessive prescribing can lead to medicines-related harm and hospital admissions. There is potential for savings to be made when patients have their medicines reviewed in the care home setting.2 Residents in care homes often have little involvement in prescribing decisions about them. This Health Foundation funded Shine project aimed to develop a pragmatic approach at optimising medicines taken by care home residents. A model was tested whereby pharmacists undertook detailed medication reviews.

Earlier pharmacological and POMC gene transfer studies demonstrat

Earlier pharmacological and POMC gene transfer studies demonstrate that melanocortin activation in either site alone improves insulin sensitivity and reduces obesity. The present study, for the first time, investigated the long-term

efficacy of POMC gene transfer concurrently into both sites in the regulation of energy metabolism in aged F344xBN rats bearing adult-onset obesity. Pair feeding was included to reveal http://www.selleckchem.com/products/Lapatinib-Ditosylate.html food-independent POMC impact on energy expenditure. We introduced adeno-associated virus encoding either POMC or green fluorescence protein to the two brain areas in 22-month-old rats, then recorded food intake and body weight, assessed oxygen consumption, serum leptin, insulin and glucose, tested voluntary wheel running, analysed POMC expression, and examined fat metabolism in brown and white adipose tissues.

POMC mRNA was significantly increased in both the hypothalamus and NTS region at termination. Relative to pair feeding, POMC caused sustained weight reduction and additional fat loss, lowered fasting insulin and glucose, and augmented white fat hormone-sensitive lipase activity and brown fat uncoupling protein 1 level. By wheel running assessment, the POMC animals ran twice the distance as the Control or pair-fed rats. Thus, the dual-site POMC treatment ameliorated adult-onset obesity effectively, selleck inhibitor involving a moderate hypophagia lasting ∼60 days, enhanced lipolysis and thermogenesis, and increased physical activity in the form of voluntary wheel running. The latter finding provides a clue for countering age-related decline in physical activity. “
“Sympathetic preganglionic neurons (SPNs) are located in the intermediolateral column

(IMLC) of the spinal PTK6 cord. This specific localization results from primary and secondary migratory processes during spinal cord development. Thus, following neurogenesis in the neuroepithelium, SPNs migrate first in a ventrolateral direction and then, in a secondary step, dorsolaterally to reach the IMLC. These migratory processes are controlled, at least in part, by the glycoprotein Reelin, which is known to be important for the development of laminated brain structures. In reeler mutants deficient in Reelin, SPNs initially migrate ventrolaterally as normal. However, most of them then migrate medially to become eventually located near the central canal. Here, we provide evidence that in wild-type animals this aberrant medial migration towards the central canal is prevented by Reelin-induced cytoskeletal stabilization, brought about by phosphorylation of cofilin. Cofilin plays an important role in actin depolymerization, a process required for the changes in cell shape during migration. Phosphorylation of cofilin renders it unable to depolymerize F-actin, thereby stabilizing the cytoskeleton.

The US military could contribute to and benefit from this collabo

The US military could contribute to and benefit from this collaboration. In the Horn of Africa and elsewhere, the US military could draw on its expertise in electronic syndromic surveillance[14, 15] and its global public health

and laboratory network,[16, 17] including World Health Organization (WHO) Collaborating Center laboratories in Egypt and Kenya, to enhance such surveillance among US service members in Africa and establish a model military surveillance platform. Under the International Health Regulations [IHR(2005)], which entered into force in 2007, all countries must develop core capacities for disease surveillance to avert “public health emergencies of international concern,” such as potential pandemics. Militaries can contribute selleck chemicals to global health security and IHR(2005) implementation by strengthening their disease surveillance systems, so that outbreaks are detected, and contained, before

spreading further. They should “join forces” with the civilian public health community,[18] and be part of the inter-sector collaboration that the World Health Assembly (the decision-making body of the WHO, comprising delegations from all WHO Member States) recently called on WHO Member States to strengthen in support of IHR(2005).[19] We call on US and other military public health leadership to critically evaluate the current gaps http://www.selleckchem.com/products/lee011.html in public health surveillance capacity among deployed populations, and to adapt current “best” practices utilized by other militaries to implement effective infectious disease surveillance systems in deployed settings. These systems will help protect US and other military personnel from ever-changing infectious disease threats, and dually serve an important role in informing global health. The views expressed do not necessarily represent those of the Department of Defense. The authors state that they have no conflicts of interest. “
“A previously

healthy febrile patient with travel history to Nicaragua showed rapid clinical deterioration with hemodynamic shock and anuria. Diagnosis of severe Amino acid malaria was established based on intra-erythrocytic parasites and antimalarial treatment was initiated. However, upon reevaluation Babesia microti infection was suspected and molecular characterization by polymerase chain reaction and sequence analysis was performed. A 63-year-old previously healthy male Austrian resident of US-American origin presented with ongoing fever for 2 weeks at the emergency department of the Vienna General Hospital in August 2009. The patient reported frequent short course overseas working assignments due to his employment by an international organization. Eight weeks prior to presentation he had been on a 7-day mission to the capital of Nicaragua.

1% over 5 years the 95% CI is

from 689 to 2127, represent

1% over 5 years the 95% CI is

from 689 to 2127, representing the NNH for the upper (RR=2.45) and lower (RR=1.47) ranges of the 95% confidence interval for the relative rate of MI for patients on abacavir reported by the D:A:D study, respectively. To determine how different risk components contribute to the change in the underlying risk of MI and NNH variability, we performed a series of analyses using different risk assumptions over two different time periods (Table 1), choosing a patient profile that reflects D:A:D patients’ characteristics as described in the Methods section: male, aged 40 years, nonsmoking with no diagnosis of diabetes, no changes in electrocardiogram (ECG), an sBP of 120 mmHg, a total cholesterol value of 170 mg/dL (4.4 mmol/L) and an HDL cholesterol value of 60 mg/dL (1.5 mmol/L). The NNH drops from 1111 to 555 for such a patient Rucaparib manufacturer when the

patient is diagnosed with diabetes, and by the same amount when the patient develops hypercholesterolaemia (total cholesterol value of 240 mg/dL; 6.2 mmol/L) or left ventricular hypertrophy is present on ECG. The NNH drops further to 370 if the patient’s sBP increases to 160 mmHg or his HDL cholesterol value decreases to 35 mg/dL (0.9 mmol/L) and to 277 selleck chemicals llc if the patient starts smoking. When two risk components with unfavourable levels coexist at the same time and in the same patient, the NNH drops from 1111 to around 100 for most pairs of risk factors, except smoking combined with unfavourable HDL cholesterol, for which the NNH decreases even further to 69. The NNH decreases to 7 when all risk factors are defined as unfavourable at the same time and the underlying 5-year risk of an MI is 15%. The NNH was further calculated after adjusting for the presence of a history of CVD, as defined in the Methods next section, and was found to drop from 1111 to 22 and from 370 to 11, for 5- and 10-year risks of MI, respectively. Figure 2 presents a series of graphs relating NNH to any possible age and sBP, and categorizes it according to smoking status and two chosen lipid profiles. In these graphs it is also

possible to observe the change in NNH while different risk components are modified separately or consecutively. These graphs illustrate the impact on NNH of the introduction of an additional risk factor, here smoking and unfavourable lipid profile. Comparison of graphs A and B demonstrates that smoking produces a marked decrease in NNH, which means that you would need to treat considerably fewer smokers to observe one additional MI, and comparison of graphs C and D demonstrates that a further decrease in NNH is seen with an additional risk of an unfavourable lipid profile. To give a specific example, a 50-year-old, nonsmoking patient with favourable lipid profiles and sBP of 120 mmHg will have an NNH in the range of 200–500 (graph A), while a patient of the same age who smokes (but who also has favourable lipid profiles and sBP of 120 mmHg) will have an NNH in the range of 50–100 (graph B).

DMURs comprised 1% of MURs provided in the previous

DMURs comprised 1% of MURs provided in the previous Epigenetics Compound Library month; key barriers to provision were not receiving discharge medication summaries, and restrictions on provision to housebound patients/patients in care homes. Community pharmacists identified a clear need for DMURs and want to play a greater part in managing patients’ medicines after discharge Targeted medicines use reviews (MUR) were introduced in late

2011 and included reviews after a patient’s discharge from hospital (DMURs) but to date there are no published studies on this important service. The aims of our study were to investigate: i) community pharmacists’ experiences of, and involvement in, provision of DMURs Cell Cycle inhibitor and ii) pharmacists’ suggestions for service improvement. An online survey of community pharmacists in NHS Airedale, Bradford & Leeds (NHS ABL) was conducted in March 2013. The questionnaire was developed drawing on published research and practice literature. Piloting was conducted with six pharmacists and included review by both community and hospital practitioners. Questions were mostly structured, some invited additional comments. Data were analysed using Survey Monkey online

software. Ethical approval was granted by University of Bradford and NHS research governance approval by NHS ABL. Study information and a link to the online survey was publicised by Community Pharmacy West Yorkshire to the 450 pharmacies

in the area. The survey was open for two weeks from March 14th with a reminder after one week. Twenty-six community pharmacists participated; two thirds worked in pharmacies with five or more branches, three quarters had been qualified for 11 years or longer. Twenty respondents reported providing 643 MURs in the previous months, 76% of which were targeted C59 MURs. Seven DMURs (1.1%) were provided by eight pharmacies. More than two thirds of respondents disagreed that patients were well educated about their medicines on leaving hospital. Not knowing when a patient had been in hospital and discharged was the most frequently cited barrier to greater involvement. Discharge medication summaries (DMS) were rarely received, (0–1 per week by most pharmacists), and mainly for patients discharged with a compliance aid. Patients who are not able to visit the pharmacy (those who are housebound or discharged to nursing homes) were reported as key barriers to DMUR provision. Workload, staffing and motivation were far less frequently cited. In addition to increased communication from hospitals respondents rated receipt of discharge summaries, wider permission to conduct telephone MURs for housebound patients and those in nursing homes, and funding for domiciliary MURs, most highly for service improvement.