Lastly, the benefits of dual-task practice were only examined in young healthy adults. It remains to be determined whether such effect would be generalised to individuals known to have limited attentional resources, such as elderly individuals and patients with brain damage. In conclusion, our data support the role of dPM in mediating the dual-task practice benefit in which a secondary choice RT task enhanced learning of a primary finger sequence task. This study provides preliminary evidence that dPM is an important node of the planning circuitry that is differentially engaged under dual-task practice. The authors declare that they do not have any competing interests. We thank Department of Radiology

at Keck School of Medicine, University of Southern California, USA, for providing structural MRI brain scan. We would like to thank Dr. Carolee Winstein for the insightful discussion during designing phase of this study. We acknowledge Mr. Todd D Combs’s assistance Protease Inhibitor Library order in experimental set-up and data collection. Abbreviations B block dPM dorsal premotor cortex FDI first dorsal interosseous M1 primary motor cortex MEP motor evoked potential MRI magnetic resonance imaging R retention test RMT resting motor threshold RT reaction time rTMS repetitive transcranial magnetic stimulation “
“Human infants rapidly develop their auditory perceptual abilities and acquire culture-specific knowledge

in speech and music MG-132 cell line in the second 6 months of life. In the adult brain, neural rhythm around 10 Hz in the temporal lobes is thought to reflect sound analysis and subsequent cognitive processes such as memory and attention. To study when and how such rhythm emerges in infancy, we examined electroencephaolgram (EEG) recordings in

infants 4 and 12 months of age during sound stimulation and silence. In the 4-month-olds, the amplitudes of narrowly tuned 4-Hz brain rhythm, recorded from bilateral temporal electrodes, were modulated Astemizole by sound stimuli. In the 12-month-olds, the sound-induced modulation occurred at faster 6-Hz rhythm at temporofrontal locations. The brain rhythms in the older infants consisted of more complex components, as even evident in individual data. These findings suggest that auditory-specific rhythmic neural activity, which is already established before 6 months of age, involves more speed-efficient long-range neural networks by the age of 12 months when long-term memory for native phoneme representation and for musical rhythmic features is formed. We suggest that maturation of distinct rhythmic components occurs in parallel, and that sensory-specific functions bound to particular thalamo-cortical networks are transferred to newly developed higher-order networks step by step until adult hierarchical neural oscillatory mechanisms are achieved across the whole brain. “
“The prelimbic (PL) and infralimbic (IL) medial prefrontal cortex (mPFC) are thought to play opposing roles in drug-seeking behaviour.

Blips are frequent and represent random variation around a mean undetectable VL [5-7]. Many patients have at least one at some time [8] when they are not predictive of virological failure or associated with emergent resistance in most studies [5, 9, 10]. VL assay variation and laboratory processing artefacts account for many blips (i.e. no ‘true’ increase in viral replication), which partly explains why blips do not appear to compromise long-term outcomes [9, 11-13]. However, those with sustained low-level increases

in VL run a higher risk of virological failure. Most blips Y-27632 mouse are low level [median magnitude 79 copies/mL in one study (range 51–201)] and short lived [median 2.5 days (range 2–11.5)] [7]. In a retrospective study,

28.6% of patients, experienced VL increases from 50 to 500 copies/mL over 8 years; 71% of these were blips [8]. Review and reiteration of the importance of full adherence, as well as looking for any tolerability/toxicity issues, DDIs/food interactions, and archived resistance should take place. However, blips do not appear to be related to intercurrent illness, vaccination, baseline CD4 cell count/VL, duration of preceding suppression or level of adherence [7, 14, 15]. Therefore, it is the recommendation of the Writing Group that a VL result of 50–400 copies/mL preceded and followed by an undetectable buy Vemurafenib VL should not be a cause of clinical concern. In the context of repeated

blips, it may then be useful to test for resistance [16, 17]. Low-level viraemia (LLV) is defined as a repeatedly detectable but low level of viraemia over a sustained period of time. For the purposes of these guidelines, <400 copies/mL is used although it is recognized that some patients have VLs up to 1000 copies/mL without development of resistance and with therapeutic drug levels. LLV is observed in up to 8% of individuals [18] and is associated with an increased risk of virological rebound (>400 copies/mL) [6, 19]. The likelihood of resuppression after LLV is greater for lower magnitudes of viraemia: 41% after two consecutive VLs >50 copies/mL compared with 12% after two VLs >200 copies/mL mafosfamide [20]. LLV is associated with resistance (37% in one study [21]) that may be associated with LLV magnitude; in one analysis, maximum VL was higher in those with who developed resistance (368 vs. 143 copies/mL; P=0.008). LLV is also associated with immune activation [10]. Low-level antigenic exposure differentially affects T-cell activation and HIV-specific T-cell response. In cohort studies [19] and clinical trials [21], patients on PI/r-based ART are more likely to experience detectable viraemia than those on NNRTI. In the absence of clear data, the Writing Group believes LLV on a low-genetic barrier regimen warrants prompt regimen change.

2, a gradual decrease in bacterial motility was clearly observed in the presence of increasing concentrations of BE. This result further verifies that BE specifically targets AI-2-mediated bacterial virulence pathways in E. coli O157:H7. To elucidate the effect of BE on an AI-3-mediated QS system, we examined whether the activation of ler promoter

by norepinephrine was also compromised by addition of BE. To address this question, Cell Cycle inhibitor we created a green fluorescent protein (GFP) reporter strain, in which the gfp gene was transcribed by the ler promoter. As shown in Fig. 3, green fluorescence intensity was increased ∼1.37 fold by the addition of norepinephrine (second vs. third bar). The addition of BE, however, decreased the norepinephrine-stimulated production of GFP significantly (fourth vs. third bar). This result suggests

that BE can prevent the transcription of ler, regulated by AI-3-mediated QS system, from being activated and therefore may block a complex signaling cascade that regulates the expression of genes encoding proteins necessary Cilomilast for full virulence of E. coli O157:H7. Next, we tried to determine whether BE could attenuate the virulence of E. coli O157:H7 in vivo using C. elegans as a host. Caenorhabditis elegans is used as a simple and economic invertebrate animal model for the study of mechanisms of microbial pathogenesis (Nicholas & Hodgkin, 2004; Sifri et al., PIK3C2G 2005). In particular, it was reported that C. elegans is a good model organism

to evaluate the virulence of E. coli O157:H7 and the antibacterial efficacy of many types of chemical compounds (Breger et al., 2007; Lee et al., 2008). As shown in Fig. 4, there were no significant differences in the survival rate of C. elegans for 2 days, but the survival rate of the nematodes fed on E. coli O157:H7 in the presence of 0.5% (v/v) of BE were significantly higher than those fed only on the pathogen for 3 days or more (Fig. 4). Notably, the survival rates of C. elegans fed on E. coli O157:H7 with 0% and 0.5% of BE after 8 days were 21.5% and 50%, respectively (Fig. 4). However, the survival rate of the nematodes fed on E. coli OP50, an avirulent strain routinely used as a nutrient source for C. elegans, was not affected by the presence of 0.5% BE (Fig. 4). These results suggest that BE can considerably protect the nematodes against a pathogenic attack by E. coli O157:H7, and thus, BE treatment can be developed as an agent to attenuate bacterial virulence in vivo. We then examined the effects of BE on the expression of virulence-associated genes by qRT-PCR. We analyzed the transcript levels of luxS and pfS, because these two genes are critically involved in AI-2 synthesis (Gonzalez Barrios et al., 2006). We also tested flhD and eae, which are involved in flagella regulation and type III secretion, respectively (Hughes et al., 2009). As shown in Fig.

60, P = 0.004) and Consolidation Period (F3,90 = 4.23, Selleck MI-503 P = 0.017). Scheffe’s

post-hoc tests revealed that the main effect of Group can be attributed to significantly greater sequence-specific offline learning in the 1 Hz group compared with the Control and 5 Hz rTMS groups (P = 0.030 and 0.003, respectively) (Fig. 4A – dark grey bars). The main effect of Sequence can be attributed to greater consolidation of implicit motor learning from Day 4 to the retention test compared with consolidation between Day 2 to Day 3 and Day 3 to Day 4 (P < 0.001 and P = 0.024, respectively) (Fig. 4B – dark grey bars). The Group by Sequence anova on spatial error revealed main effects of Group (F2,30 = 5.10, P < 0.012) and Consolidation Period (F3,90 = 4.09, P < 0.014). The main effects of Group (Fig. 4A – light grey bars) and Consolidation Period (Fig. 4B – light grey bars) reveal that the changes in RMSE can be attributed to consolidation of spatial accuracy. The mixed-measures Group

by Sequence anova with time lag as the dependent measure failed to reveal any effects. None of www.selleckchem.com/products/Trichostatin-A.html the analyses on RMSE, spatial accuracy or lag revealed any effects associated with change in implicit performance from Block 1 to Block 3 on each day of practice. Online learning within each practice day was consistent for all groups. Three of the 11 individuals in the 5 Hz rTMS group acquired sufficient explicit awareness of the repeating sequence to be able to recognize it at the recognition test. This was also the case for two individuals in the 1 Hz rTMS group and one individual in

the Control group. The mixed-measures Group by Time anovas performed on RMT and MEP amplitude failed to reveal any significant effects of the varied forms of rTMS following continuous tracking on excitability in M1 (Table 2). The present study is the first to demonstrate the cumulative impact of rTMS over PMd immediately following practice upon consolidation of implicit sequence-specific motor learning. While all three experimental groups (1 Hz rTMS, 5 Hz rTMS and sham stimulation) demonstrated improvement in performance over time, only the group receiving 1 Hz rTMS Interleukin-3 receptor over the PMd immediately following task practice enhanced offline learning of an implicit motor skill (Experiment 1). Enhanced implicit sequence-specific learning with 1 Hz rTMS following practice was largely explained by improved spatial rather than temporal accuracy of movements (Experiment 1). Furthermore, enhanced motor learning associated with 1 Hz rTMS over the PMd during early consolidation does not appear to be attributable to spread of stimulation to M1 or to PMd to M1 connections, as M1 excitability was not changed by rTMS over PMd (Experiment 2). The enhancement of motor learning following application of 1 Hz rTMS over PMd immediately after practice of the continuous visuomotor tracking task differs from our previous results (Boyd & Linsdell, 2009).

coli BL21(DE3)pLysS. The transformant was grown in Luria–Bertani broth containing ampicillin (50 μg mL−1) and chloramphenicol (34 μg mL−1) Talazoparib with shaking (230 r.p.m.) at 37 °C until an OD600 nm of 0.6 was attained. The cultures were induced by adding 0.4 mM isopropyl-1-thio-d-galactopyranoside and cultivated for another 4 h. Bacterial pellets harvested by centrifugation were stored overnight at −20 °C and were then suspended in 50 mM Tris-HCl buffer (pH 8.0) containing 0.2 mg mL−1 lysozyme and 0.1 mg mL−1

DNAse. Cells were disrupted by sonication, and subsequent centrifugation (30 min at 16 000 g) allowed the collection of inclusion bodies containing the recombinant T. cervina LiP proteins. Trametes cervina LiP proteins that were either isolated from the culture medium (Miki et al., 2006) or heterologously produced in E. coli were purified using sodium dodecyl sulfate polyacrylamide gel electrophoresis. In-gel tryptic digestion and matrix-assisted laser desorption/ionization-time-of-flight-MS (MALDI-TOF-MS) analysis were performed as described by Shimizu et al. (2005). The appropriate bands were excised. The gel pieces were washed with 40% 1-propanol and then with 0.1 M ammonium bicarbonate containing

50% acetonitrile. The proteins in the gel pieces were digested overnight with 20 ng μL−1 modified trypsin (Promega) in 0.1 M ammonium bicarbonate at 37 °C. The digested peptides were extracted with 0.1 M PF-02341066 concentration ammonium bicarbonate and then

with 80% acetonitrile containing 0.1% trifluoroacetic acid. The extracts were combined and concentrated. The peptide solutions were analyzed by MALDI-TOF-MS (Voyager DE; Applied Biosystems) using α-cyano-4-hydroxycinnamic Inositol oxygenase acid in H2O/acetonitrile (1 : 1) containing 0.1% trifluoroacetic acid as the matrix. Some peptides were sequenced with electrospray ionization-MS (ESI-MS)/MS (Q-Tof2; Micromass). Homology modeling of T. cervina LiP was performed using the molecular operating environment (moe) program (Chemical Computing Group). The P. chrysosporium LiP crystal structure (PDB entry 1LLP) was selected as the best template due to the highest degree of amino acid sequence identity (50.1%) to T. cervina LiP. After modeling and energy minimization using the AMBER89 force field, 10 model intermediates were generated. The best intermediate with the lowest packing score (−2.2551) was used for further revision and full energy minimization: the cis-conformation at Ser300 was revised to trans-conformation using the AMBER89 force field, and full-energy minimization was run with the Engh–Huber force field. Finally, a model with a favorable geometry (root mean square deviation of Cα topology=0.008 Å) was obtained. All modeling and energy minimization steps were carried out under the conditions including heme from the template. To better understand the T. cervina LiP molecule, we isolated its cDNA and characterized its molecular structure.

The loci in Scaffolds 300 and 1635 had considerable variability and identified three and four different haplotypes, respectively. This variation was equivalent to what we found using a variable part of the EF1α gene, whereas no differences were found in the ITS sequences among

the 12 A. apis isolates. When all five intergenic loci and EF1α sequences were combined into one analysis, seven different haplotypes were identified among the 12 A. apis isolates (Fig. 3). These seven haplotypes could also be distinguished from each other using a combined data set of the three most variable loci (Scaffold 300, Scaffold 1635 and EF1α), or in any combined data sets where these three loci were included. We describe five new polymorphic intergenic loci and a variable part of the gene encoding EF1α that can be used to differentiate haplotypes of A. apis. Sequence analysis using 12 A. apis isolates, ten originating from Denmark and two from North America, HCS assay demonstrated a high level of intraspecific variation at these loci. We detected no differences in the sequences of the ITS region among our A. apis isolates, which is congruent with the result reported by

Anderson et al. (1998), who used 23 A. apis isolates with origins that were even more widespread than our samples. The genetic heterogeneity among our ten Danish and the two North American A. apis isolates was surprisingly high, and within this small sample size, seven different haplotypes were detected. All seven could be differentiated by combining 3-MA ic50 the three most variable loci: EF1α, Scaffold 300, and Scaffold 1635. In a study conducted including 84 South American and

two Japanese A. apis isolates, only five distinct types were found using a repetitive element PCR fingerprinting method with BOX, REP, and ERIC as random primers (Reynaldi et al., 2003). This could reflect a founder effect because honey bees are not native to America. The first scarce introduction of honey bees to this continent took place during the 4th Colon trip in 1536 at Santo Domingo mafosfamide Island, and around a century later, a few colonies were introduced to South America, Uruguay and Brazil (Bierzychudek, 1979). The differences in the observed heterogeneity between South American and Danish isolates could, however, also reflect that our method is more effective at identifying haplotypes. Repetitive element DNA fingerprinting is a quick and cheap method, but the fragment patterns can be difficult to reproduce between laboratories (Deplano et al., 2000). Furthermore, such fingerprinting methods cannot handle complex biomasses in a cultivable independent manner, but requires in vitro isolation of the target organism. Our method should be more repeatable because of high primer specificity and could be applied directly to DNA extracted from field samples of diseased larvae, and similarly, direct processing of field samples is also possible with the microsatellite primers recently developed for A.

, 1998) at the SacII/XbaI site (for the 5′-flanking region) and the EcoRI/SalI site (for the 5′-portion of CDS) of p97CGH (Nakayama et al., 1998), resulting in the plasmid p97RAM2. Approximately a 2.5-kb DNA fragment obtained by

digesting p97RAM2 with SacII and SalI was used to transform ACG4 (Nakayama et al., 1998); the resulting strains were designated tet-RAM2. Primers RAM2CHA (nt −750 to −731) and RAM2CHB (nt 385–405) were used to confirm the correct integration sites (data not shown). For ERG20, the 5′-flanking region (nt −457 to −217) or the 5′-CDS region (nt −6 to 350) of ERG20 was amplified with PCR using the primers ERG20AF and ERG20AR or ERG20BF and ERG20BR, respectively. Both amplified fragments of ERG20 were digested at the SacII/XbaI site (for the 5′-flanking Inhibitor Library region) and the MunI/SalI site (for the 5′-portion of CDS) and cloned into the SacII/XbaI site (for region A) and the EcoRI/SalI site (for region B) of p97CGH to facilitate ligation to the CgHIS3-97t, resulting in plasmid p97ERG20. Approximately a 2.5-kb DNA fragment obtained by digesting p97ERG20 with SacII and SalI was used to transform ACG4; the resulting strains were designated tet-ERG20.

Integration at the correct genomic site was confirmed by PCR using the primers ERG20CHA (nt −666 to −648) and ERG20CHB (nt 483–503) (data not shown). The primers used in this study are listed in Table 2. For time-course experiments, approximately 104 mutant cells mL−1 were inoculated and cultured in YEPD medium at 37 °C with or without 10 μg mL−1 of doxycycline. Growth was monitored learn more by measuring OD600 nm at indicated times after adding doxycycline. The number of viable cells was determined Suplatast tosilate by counting aliquots of individual colonies on agar plates after incubation for 24 h at 37 °C. For measuring growth in serum-, FPP- or GPP-containing media, approximately 103 cells (200 μL) were inoculated and cultured in YEPD medium at 37 °C for 14 h, with or without 10 μg mL−1 of doxycycline, and in the presence of various concentrations of human serum (Irvine Scientific), FPP (Sigma-Aldrich) or GPP (Sigma-Aldrich). Male CD-1 mice

were immunocompromised by injecting cyclophosphamide (200 mg kg−1) 3 days before infection and 100 mg kg−1 0, 3, 7 and 11 days after infection. In addition to cyclophosphamide, mice were also coinjected with 125 mg kg−1 cortisone acetate. Each mouse was intravenously inoculated with 105C. glabrata cells, and administered doxycycline (2 mg mL−1), dissolved in a 5% sucrose solution, as drinking water 6 days before infection. At indicated times, 0 or 14 days after infection, mice were killed, and their kidneys were removed and homogenized. The homogenates were spread on YEPD agar plates containing penicillin G (200 U mL−1) and streptomycin (200 μg mL−1). After a 24-h incubation at 37 °C, the number of yeast colonies appearing on agar plates was counted.

In travelers with prolonged visits to endemic regions, prophylaxis must include a 2-week terminal course of primaquine to eradicate the hypnozoite phase and prevent relapse following discontinuation of primary prophylaxis. Given the difficulties of adhering to prophylaxis

regimens for extended durations and in combat situations, it is unsurprising that only 41% of troops deployed to Afghanistan reported taking terminal prophylaxis.5 NU7441 ic50 This case highlights the importance of education efforts within the military to improve adherence to terminal prophylaxis in at-risk troops. Extended travelers and military personnel on long deployments are unlikely to recall details of their pretravel clinic visit and seek or fill a second prescription after return. For this reason, the off-label use of single-agent Luminespib primaquine as primary prophylaxis against primary and relapsing malaria has been advocated as a means to avoid the need for a separate terminal prophylaxis regimen.10 A regimen of 30 mg base daily starting 1 day before travel and ending 7 days after return has been endorsed by The Centers for Disease Control and Prevention for primary malaria prophylaxis in nonpregnant patients after G6PD testing.11 In conclusion, military troops, including the hundreds of thousands of troops who have

been deployed to Afghanistan and Iraq since 2001, are at substantial risk for contracting tropical infections, many of which present as undifferentiated fever, such as malaria, typhoid, typhus, tick-borne relapsing fever, tuberculosis, and leptospirosis. In particular, a high index of suspicion for malaria is warranted for delayed presentation of febrile illness long after return Thiamet G from deployment.

The authors state they have no conflicts of interest to declare. “
“Background. Although acute respiratory tract infections (RTI) have been recognized as a significant cause of illness in returning travelers, few studies have specifically evaluated the etiologies of RTI in this population. Methods. This prospective investigation evaluated travelers returning from countries with endemic influenza A(H1N1) 2009, and who were seen in our department at the onset of the outbreak (April–July 2009). Patients were included if they presented with signs of RTI that occurred during travel or less than 7 days after return from overseas travel. Patients were evaluated for microbial agents with RespiFinder plus assay, and throat culture according to clinical presentation. Results. A total of 113 travelers (M/F ratio 1.2:1; mean age 39 y) were included. They were mainly tourists (n = 50; 44.2%) mostly returning from North America (n = 65; 58%) and Mexico (n = 21; 18.5%). The median duration of travel was 23 days (range 2–540 d).

2%.14 In the press statement,4 the IDF stated that the recently published actual prevalence data should be ‘a wakeup call for governments and policy makers to take action on diabetes’. This is true. What is perhaps more questionable is the assertion in the same press release that ‘China has overtaken India and become the global epicenter of the diabetes epidemic’. It seems difficult to reach this conclusion given that the IDF predictions contained within the 2010 4th edition

Atlas seem to be flawed when compared to measured prevalence data in many other countries – perhaps it is more probable that the IDF estimates for India are also too low. Indeed, recent evidence suggests that this www.selleckchem.com/products/icg-001.html is exactly the case with the IDF Atlas predicting a 7.1% prevalence against 16% measured in 1239 subjects.17 In another study in Kerala, Southern India, the prevalence of diabetes in 2009 was shown to

be 14.6% in 1990 adults,18 again over twice the IDF estimate for 2010. In the recent data from China the actual prevalence of diabetes was established at 9.7%.5 Thus it would appear that, in contradistinction to the statement by the IDF, India still leads China as the epicentre of the diabetes pandemic. What does all this show? Firstly, there http://www.selleckchem.com/products/dabrafenib-gsk2118436.html is a strong suggestion that the predictions contained within the 2010 4th edition IDF Atlas should be treated with great caution, as in numerous instances they seem to be significantly below established, Chlormezanone published prevalence. Secondly, it demonstrates that the diabetes pandemic is probably much worse than already thought. Thirdly, and perhaps most importantly, it confirms the views of the authors of the 2004 paper1 that predictions are prone to errors – possibly multiple. The foreword of the latest IDF Atlas is correct in suggesting that policy makers, and national and international governmental agencies need good evidence-based information upon

which to base their future planning. However, clear shortcomings appear to exist in the present, and probably previous, iteration(s) of the IDF Diabetes Atlas. In light of these, it is perhaps time to revisit existing published evidence of proven diabetes prevalence, and where data are limited to establish the current scale of the diabetes pandemic properly through formal research. In this way there can be no more speculation, and no more nasty surprises. There are no conflicts of interest. “
“The human kidney has a key role in the regulation of blood glucose predominantly by reabsorption of glucose from the glomerular filtrate via sodium glucose co-transporter 2 (SGLT-2) channels. These are expressed in the proximal renal tubules and are blocked by SGLT-2 inhibitors, which are novel pharmacological agents currently in development.

Results.  The children of diseased mothers more frequently had periodontal diseases, especially gingivitis. In addition, clinical parameters of gingival inflammation were more expressed and oral hygiene was worse in this group of children. VPI and VPI% of the diseased and

healthy mothers differed significantly. The most common oral pathogens were P. intermedia/nigrescens and A. actinomycetemcomitans. The children of healthy mothers harboured pathogens less frequently than the children of diseased mothers. The sharing of P. intermedia/nigrescens was more frequent (5 families) than A. actinomycetemcomitans (2 families). Conclusion.  Maternal indicators, such as periodontitis, hygiene habits, and periodontal microflora are risk factors for childhood periodontal diseases, and might be predictive of future childhood and adolescent periodontitis. Erlotinib datasheet “
“Jeremy Sokhi, James Desborough, Nigel Norris, David Wright University of East Anglia, Norwich, Norfolk, UK This study aimed to explore

the views of the Ponatinib cell line senior learning and development managers (SLDMs) at large multiple community pharmacies (LMCPs) on pharmacist professional development. Participants recognised that community pharmacists cannot fulfil their roles without further development. Employer support for postgraduate qualifications as a means to address these development needs has been limited and opportunities have tended to be restricted to community pharmacists performing successfully in their role. The need to develop strategies for post-registration career development of pharmacists is recommended to maximise pharmacy’s contribution to the health of the nation.1 Whilst the hospital sector has an established approach facilitated through completion of a postgraduate diploma, the career pathway in community pharmacy is less formalised and postgraduate training has been largely dependent on individual motivation. With the majority (54%) of community pharmacists working for large

multiples2 it was decided to explore the views of the SLDMs employed at LMCPs concerning pharmacist professional development. In-depth interviews were conducted with the SLDM at four LMCPs. This was a convenience sample utilising prospective participants Buspirone HCl who had already consented to their companies’ employees participating in a related study. A semi-structured approach was adopted using a prepared topic guide consisting of a number of open questions which could be adapted as the interview progressed. Interviews were transcribed verbatim. A thematic analysis was undertaken to derive themes which reflected the majority view. Ethical approval was obtained from a University of East Anglia ethics committee. Two main themes, ‘effects of changes in the profession’ and ‘responding to changes in the profession’, were identified. The minor theme ‘changes in the profession’ describes the increased clinical focus of the role underpinning the main themes.