“
“The aim of the study was to examine temporal and geographical patterns of mode of delivery in the European Collaborative Study (ECS), identify factors associated with elective caesarean section (CS) delivery in the highly active antiretroviral

therapy (HAART) era and explore associations between mode of delivery and mother-to-child transmission (MTCT). The ECS is a cohort study in which HIV-infected pregnant women are enrolled and their infants prospectively followed. Data on 5238 mother–child pairs (MCPs) enrolled in Western European ECS sites between 1985 and 2007 were analysed. The elective CS rate increased from 16% in 1985–1993 to 67% in 1999–2001, declining to 51% by 2005–2007. In 2002–2004, 10% of infants were delivered vaginally, increasing to 34% by 2005–2007. During the HAART era, women in Belgium, the United Kingdom and the Netherlands were less selleck inhibitor likely to deliver by elective CS than those

in Italy and Spain [adjusted odds ratio (AOR) 0.07; 95% confidence interval (CI) 0.04–0.12]. The MTCT rate in 2005–2007 was 1%. Among MCPs with maternal HIV RNA<400 HIV-1 RNA copies/mL (n=960), elective CS was associated with 80% decreased MTCT risk (AOR 0.20; 95% CI 0.05–0.65) adjusting for HAART and prematurity. Two infants born to 559 women with viral loads <50 copies/mL were infected, one of whom was delivered by elective CS (MTCT rate 0.4%; 95% CI 0.04–1.29). Our findings suggest that elective CS prevents MTCT even at low maternal viral loads, but the study was insufficiently powered to enable a conclusion to be drawn as to whether this applies for viral loads <50 copies/mL. Ensartinib solubility dmso Diverging mode of delivery patterns in Europe reflect uncertainties regarding the risk–benefit balance of elective CS for women on successful HAART. Prevention Florfenicol of mother-to-child transmission (PMTCT) of HIV-1 (HIV) has become increasingly effective in the past decade, with mother-to-child transmission (MTCT) rates declining

from around 20–25% to <1–2% in developed country settings [1–4]. The effectiveness of elective caesarean section (CS) in reducing MTCT was first suggested by observational studies in the early 1990s, with an approximate halving of risk [5,6]. In 1998, an analysis from the French Perinatal Cohort indicated that, among HIV-infected women on zidovudine prophylaxis, elective CS was associated with an 80% reduced risk of MTCT [7]. In 1999 the results of the only randomized controlled trial of vaginal delivery vs. elective CS demonstrated an 80% efficacy for planned elective CS [8], while a large international individual patient data meta-analysis reported a 50% decreased MTCT risk associated with elective CS [9]. Use of antiretroviral drugs in pregnancy, initially zidovudine monotherapy [10,11] and subsequently highly active antiretroviral therapy (HAART), has been a key factor behind declining MTCT rates [3,4,12].

pastoris by fusing the mature r-PhyA170 gene to the 3′-half of α-agglutinin gene. The fusion construct was then placed under the control of AOX1 promoter and directly downstream of an α-factor secretion signal. Talazoparib clinical trial After the pPhyA170-agg construct was transformed into P.

pastoris KM71, the integration of the construct into P. pastoris genome was verified by genomic PCR with 5′AOX and 3′AOX primers (data not shown). Positive clones yielded an approximately 3.4-kb DNA product, which was the predicted size of the fusion gene (2.8 kb of rPhyA170-agg plus regions of AOX1 promoter and AOX1 terminator). After the strain was induced with methanol, the presence of rPhyA170-agg on the cell surface of P. pastoris was verified by indirect immunofluorescence (Fig. 1). The green fluorescent signal can be clearly observed in almost all cells harboring the rPhyA170-agg construct, whereas labeling was negligible for cells harboring the control pPICZαA plasmid, or pPICZ-rPhyA170 plasmid (lacking the α-agglutinin anchor; data

not shown). The celPhyA170-agg strain expressing phytase on the cell surface exhibited Selleckchem Osimertinib phytase activity in both intact cell and cell wall preparations, as expected (Fig. 2). To demonstrate that phytase was attached to the cell wall by glycosylphosphatidylinositol-anchored α-agglutinin, laminarinase probing was performed. Laminarinase is a glucanase that hydrolyzes β-1,3 glucan bonds, including C-X-C chemokine receptor type 7 (CXCR-7) bonds in glycosylphosphatidylinositol anchor systems.

After treatment with laminarinase, phytase activity decreased in the cell wall preparation, and was detected in the supernatant. With increasing laminarinase concentration, cell wall activity decreased further, whereas higher activity could be detected in the supernatant. The results suggested that association of phytase with yeast cell wall could be disrupted by cleavage of β-1,3 glucan bonds, in accordance with glycosylphosphatidylinositol-anchored display of phytase. The activity of phytase displayed on the cell surface was characterized. The recombinant phytase exhibited activity of approximately 300 U g−1 cell dry weight after 3 days of induction with methanol. The effect of pH on activity was determined by measuring enzymatic activity at different pH values. Similar to the native phytase (data not shown) and secreted phytase (Promdonkoy et al., 2009), the cell-surface-displayed phytase exhibited two peaks of optimal pH at 3 and 5.5 (Fig. 3a), conditions which are similar to those in the stomach and intestine of most animals. The cell-surface-displayed phytase also exhibited broad pH stability, as >70% of activity remained after incubation at pH 2–8 (Fig. 3b). The effect of temperature on the activity of the cell-surface-displayed phytase was investigated (Fig. 3c). Similar to the native phytase (data not shown) and secreted phytase, the surface-displayed phytase exhibited optimal temperatures at 50–55 °C.

, 1995). Vibrio cholerae biofilm formation is enhanced by bile acids, which are normally antibacterial

(Hung et al., 2006). In addition, growth in a biofilm has recently been shown to PD98059 cost induce a ‘hyperinfectious phenotype’ in V. cholerae (Tamayo et al., 2010). Thus, formation of a biofilm affords V. cholerae a survival advantage both in its natural environment and in the host. Biofilm formation is tightly regulated by numerous environmental signals. One group of signals, polyamines, regulate biofilm formation by a variety of bacteria including V. cholerae, Yersinia pestis, and Bacillus subtilis (Karatan et al., 2005; Patel et al., 2006; Lee et al., 2009; McGinnis et al., 2009; Burrell et al., 2010). Polyamines are short hydrocarbon chains

containing two or more amine groups that are positively charged at physiological pH. They are ubiquitous molecules synthesized by virtually all organisms and are essential for the normal growth of most prokaryotes and eukaryotes (Tabor & Tabor, 1984). For V. cholerae, the triamine norspermidine is a positive signal for biofilm formation. Norspermidine is synthesized Natural Product Library cost by decarboxylation of carboxynorspermidine by the enzyme carboxynorspermidine decarboxylase encoded by the nspC gene (Lee et al., 2009). Maintaining adequate levels of norspermidine in the cell is important for V. cholerae biofilm formation as inhibition of norspermidine biosynthesis severely hinders this process (Lee et al., 2009). Exogenous norspermidine

can also enhance V. cholerae biofilm formation by a different mechanism involving the periplasmic norspermidine sensor NspS. NspS is hypothesized Carbachol to interact with the GGDEF-EAL family protein MbaA and regulate V. cholerae biofilm formation in response to environmental norspermidine (Karatan et al., 2005). The purpose of the current study was to gain more insight into how norspermidine and norspermidine synthesis pathways regulate V. cholerae biofilm formation. We overexpressed the nspC gene and determined the effect of the increased levels of the NspC protein on biofilm formation, exopolysaccharide gene expression, motility, and cellular and extracellular polyamine levels in V. cholerae O139. The bacterial strains, plasmids, and primers used are listed in Table 1. Vibrio cholerae serotype O139 strain MO10 was used for all experiments. Experiments were conducted in Luria–Bertani (LB) media containing 100 μg mL−1 streptomycin and 2.5 μg mL−1 tetracycline. Primers were purchased from Eurogentec (San Diego, CA) or Eurofins MWG Operon (Huntsville, AL). F-ø80lacZ∆M15, ∆(lacZYA-argF)U169, deoR, recA1, phoA, endA1, hsdR17(rk2, mk+), supE44, thi-1, gyrA96, relA1, λ- The nspC gene was amplified from chromosomal DNA using primers that annealed 40 bp upstream and 177 bp downstream of the coding sequence. Following amplification, the nspC gene was first cloned into pCR2.

4a–d). However, some cells of MD20 could form asymmetric septum at one pole (Fig. 4b), indicating initiation of sporulation. In contrast,

mutants MC78, MQ43 and MP64 were blocked at the later stages of sporulation. They could form spore-like structures and produced crystal inclusion. Electron microscopy showed that the cortices and coats of the wild-type spores were well arranged, and the dark-staining spore core could be observed (Fig. 4e). Whereas the MQ43 and MC78 spores exhibited fuzzy cortexes, no spore coat could be formed and the spore core could not JQ1 molecular weight be well compacted (Fig. 4f and g). Mutant MP64 completed the engulfment and formed normal forespores but exhibited a deformed ovoidal sporangium with a narrow cortical layer external to the inner forespore membrane (Fig. 4h). SDS-PAGE analysis showed that the mutants that were blocked at later stages of sporulation synthesized two crystalline mosquito-larvicidal proteins of 51 kDa

(BinB) and 42 kDa (BinA) during sporulation, similar to the wild-type strain, whereas no binary toxin could be detected in asporogenous mutants blocked at early stages (Fig. 5a). Although no binary toxin could be detected in the mutants MD20, MB41 or MN49 by SDS-PAGE, immunoblotting showed that Bin proteins might be expressed in very low quantities (Fig. 5b). Bioassay results against fourth instar larvae showed that mutants blocked at early stages of sporulation (MC06, MD20, MB41 and MN49), in which no visible crystal could be detected, retained limited toxicity at a much lower level than the wild type (Table 2). This toxicity presumably results from the mosquitocidal toxins (Mtxs) Selleckchem Belnacasan produced during the vegetative growth stage (El-Bendary et al., 2005). However, mutant MD20, which could form septum, had much higher toxicity than MC06, MB41 and MN49, and was only 50-fold less toxic than wild type. Therefore, it is likely that MD20 produces a small quantity of Bin crystal protein (Table 2). Mutants blocked at the later stages of sporulation (MQ43, MP64 and MC78) were able to form crystals and had a high toxicity comparable to that of the wild type (Table 2). Bacillus sphaericus can

produce the main mosquitocidal protein binary toxin Docetaxel chemical structure during sporulation. Although various sporulation-defective mutants of B. sphaericus have been isolated by chemical mutagenesis approaches (Charles et al., 1988), the exact genes involved in sporulation have not been identified experimentally. Thus, a random mutant library was constructed using the mariner-based transposon mutagenesis method and mutants were screened for sporulation-defective phenotypes. The data presented in this paper demonstrate that the mariner-based transposon system works effectively in B. sphaericus. The aim of this study was to identify genes associated with sporulation and Bin protein synthesis. We identified seven sporulation-defective mutants using a genome-wide mutagenesis approach.

damselae, a marine

bacterium that causes infections in marine animals and in humans, produces up to three different haemolysins involved in virulence, which include the pPHDD1 plasmid-encoded damselysin (Dly) and HlyApl, and the chromosome-encoded HlyAch. We screened 45 isolates from different origins, and found a correlation between their haemolytic phenotypes and the differential haemolysin gene content. All highly and medium haemolytic strains harboured pPHDD1, with amino acid substitutions in HlyApl and HlyAch being the cause of the medium haemolytic phenotypes in some pPHDD1-harbouring strains. Weakly haemolytic check details strains contained only hlyAch, whereas nonhaemolytic isolates, in addition to lacking pPHDD1, either lacked hlyAch or contained a hlyAch pseudogene. Sequence analysis of the genomic context of hlyAch uncovered an unexpected genetic diversity, suggesting that hlyAch is located in an unstable chromosomal region. Phylogenetic JNK inhibitor mouse analysis

suggested that hlyApl and hlyAch originated by gene duplication within P. damselae subsp. damselae following acquisition by horizontal transfer. These observations together with the differential distribution of pPHDD1 plasmid among strains suggest that horizontal gene transfer has played a main role in shaping the haemolysin gene baggage in this pathogen. “
“Shewanella oneidensis MR-1 encodes both a [NiFe]- and an [FeFe]-hydrogenase. While the output of these proteins has been characterized Roflumilast in mutant strains expressing only one of the enzymes, the contribution of each to H2 synthesis in the wild-type organism is not clear. Here, we use stable isotope analysis of H2 in the culture headspace, along with transcription data and

measurements of the concentrations of gases in the headspace, to characterize H2 production in the wild-type strain. After most of the O2 in the headspace had been consumed, H2 was produced and then consumed by the bidirectional [NiFe]-hydrogenase. Once the cultures were completely anaerobic, a new burst of H2 synthesis catalyzed by both enzymes took place. Our data are consistent with the hypothesis that at this point in the culture cycle, a pool of electrons is shunted toward both hydrogenases in the wild-type organisms, but that in the absence of one of the hydrogenases, the flux is redirected to the available enzyme. To our knowledge, this is the first use of natural-abundance stable isotope analysis of a metabolic product to elucidate substrate flux through two alternative enzymes in the same cellular system. “
“Galbonolides A and B are antifungal compounds, which are produced by Streptomyces galbus. A multimodular polyketide synthase (PKS) was predicted to catalyze their biosynthesis, and a methoxymalonyl-acyl carrier protein (methoxymalonyl-ACP) was expected to be involved in the biosynthesis of galbonolide A.

and vocal sounds as deviants (P = 0.2), while the reverse was true for the other two blocks. In each block, standards always consisted of just one token of one sound category (for example, just a female voice), while deviants consisted of both tokens of the opposite sound category (for example, a cello and a French Horn). Both tokens of the deviant sounds occurred Acalabrutinib order equiprobably (P = 0.1 each). Both standards and deviants were of two durations – 350 and 550 ms, with each duration occurring equiprobably (P = 0.5). The 200-ms difference between short and long sounds used in the current study is similar to that used in previous studies employing the auditory distraction paradigm (e.g. Schröger

& Wolff, 2000; Mager et al., 2005). RG7204 mouse Each block consisted of 200 trials (160 standards and 40 deviants). The inter-stimulus interval varied randomly between 1.6 and 2 s. The ROT condition was identical to the NAT condition, with the only difference being that spectrally-rotated versions of voices and musical sounds were used throughout. Table 1 lists all conditions and blocks of the study. Figure 2 details the structure of a single block. The eight blocks of the experiment were presented in a Latin square design, lasting approximately 6 min each. Participants were instructed to press one

response button for short sounds and another for long sounds. Three examples of short and three of long sounds present in each block were always played at the beginning of a block to familiarize participants with the sounds they were instructed to categorize. Hand to response button mapping was counterbalanced across participants. Importantly, unlike in odd-ball paradigms, responses were provided for all sounds (i.e. standards and deviants). The N1 ERP component elicited by the onset of auditory stimuli was evaluated in order to compare the two groups’ early neural processing of musical and vocal sounds. N1 is a measure of early sensory encoding of the physical properties of sound, such as frequency, complexity and intensity

(Näätänen & Picton, 1987). Importantly, previous ERP research has demonstrated the influence of musical training on the amplitude of N1 and its N1c subcomponent. For example, it has been shown to be enhanced in musicians Adenosine triphosphate in response to both musical notes and pure tones, with greater enhancement for the sounds of the instrument of training (e.g. Pantev et al., 1998, 2001; Shahin et al., 2003; Baumann et al., 2008). We therefore predicted that musicians would exhibit a larger N1 component to musical sounds. We also speculated that given the similarity of vocal and musical timbres and their underlying acoustic properties, musicians might also show an enhanced N1 to voices. Additionally, we have evaluated several behavioral and electrophysiological measures associated with distraction.

Another reason why this traveler might have been more susceptible to Salmonella infection is that he was on the proton pump inhibitor, pantoprazole, which reduces gastric acidity possibly making the individual more prone to acquiring such an infection.6 Enteric fever is caused by S typhi or Salmonella paratyphi and is associated with poor sanitation and contaminated food and water. It can

present with a variety of symptoms, the most common being fever, headache, nausea/vomiting, constipation/diarrhea, malaise, and dry cough. If untreated, it can lead to serious systemic complications like intestinal perforation, sepsis, meningitis, hepatic and splenic abscesses, pancreatitis, etc.7 An increasing incidence of multidrug resistant and nalidixic acid resistant strains of S typhi raises concern as to the choice of antibiotic for the treatment of typhoid

fever. Even in the United Pembrolizumab price States, infection with resistant S typhi strains is associated with foreign travel, especially the Indian Subcontinent.8 The typhoid organism from South Asia is usually reported to be sensitive to ciprofloxacin but resistant to nalidixic acid; importantly, the latter is a truer reflection of ciprofloxacin sensitivity. A recent study showed that an increasing number of typhoid patients in the United States are infected with S typhi strains with a decreased susceptibility to fluoroquinolones.8 People with suspected enteric fever from South Asia should

not be treated with ciprofloxacin. Azithromycin with better intracellular concentrations is an optimal choice.9 A similar increasing emergence of infection with Selleckchem Enzalutamide strains of S paratyphi group A that are resistant to nalidixic acid, coupled with either decreased sensitivity or, in some cases, clinical resistance to fluoroquinolones Lck has been seen.10 Typhoid is a vaccine-preventable disease. The vaccine is recommended for travelers to the Indian Subcontinent and other developing countries in Central and South America, the Caribbean, Africa, and Asia.11 It may be important to receive the vaccination even for short stays of less than a week to typhoid endemic countries.12 Two types of typhoid vaccines are available, the inactivated polysaccharide Vi parenteral vaccine and the live oral vaccine. The parenteral vaccine is given as a single injection with a booster recommended every 2 years, whereas the oral Ty21a vaccine is taken as a single capsule every other day for four doses. Booster is recommended every 5 years.11 The oral vaccine should not be given to severely immunocompromised patients. Although indicated in the traveler to South Asia, these vaccines give only 50% to 80% protection.3 Currently there is no vaccination against S paratyphi. One needs to avoid contaminated food and water in conjunction with being vaccinated to try to effectively prevent enteric fever.

1% of the physicians. 77.4% of the physicians claimed that they often prescribe generic medicines. Most patients (78%) accepted generic substitution and believed that it can provide significant saving. Surveyed patients (78%) agreed that they should have the option of choosing between generic and originator and 74% believed that physicians should give them that choice. These results showed a significant statistical correlation with the monthly income of the patient, percentage

medicine cost they pay and number of medicines prescribed (P < 0.05). However, Physicians mostly (72.1%) opposed to generic substitution being allowed upon patient selleck products request. Most pharmacists had a positive view on generic medicines in general with 87.7% of the respondents believing that a generic medicine is bio-equivalents to the originator. The majority pharmacists (90.1%) were in favour

of implementing a compulsory generic prescribing policy. More than 80% of the pharmacists supported generic substitution in most cases. Similarly, physician predominantly (80.1%) welcomed the implementation selleck of prescribing using International Nonproprietary Name (INN) to support generic supply. More than two thirds of the physicians (69.5%) accepted generic substitution by pharmacists. More physicians in the public sector (40.2%) accepted generic substitution compared to the private sector (29.3%) (P < 0.05). The findings Diflunisal from this study showed the positive attitude of all stakeholders involved towards generic medications and their high willingness and acceptance of strategies that encourage generic utilisation in Jordan such as generic substitution and INN prescribing. All these strategies would help reduce the high expenditure on drugs in Jordan. These insights will help policy makers in Jordan to develop a robust generic policy which could be used

to achieve greater clinical effectiveness and economic efficiency from drug prescribing. 1. Holmes D. R., Becker J. A., Granger C. B., Limacher, M. C., Page R. L. Sila, C. ACCF/AHA 2011 Health Policy Statement on Therapeutic Interchange and Substitution.Circulation. 2011; 124: 1290–1310. 2. King DR, Kanavos P. Encouraging the use of generic medicines: implications for transition economies.Croatian Medical Journal 2002; 43: 462–469. Rosario Sorrentino, Ilaria Uomo, Maurizio Pastorello Department of Pharmacy ASP Palermo, Sicily, Italy Biosimilar erythropoietins have lower pricing than originator medicines but they are still under-prescribed by the physicians, expecially in Italy. Interchangeability from one branded medicine to a biosimilar must be made only by the physician, such as determined by the Italian Medicines Agency in agreement with other international Position Papers.

g. to seeing $5 as opposed to 10 cents), but also reflects something about action. We started out defining an ‘urge’ as ‘how much someone wants something’. Based on the current paradigms

at least, the concept of urge could be refined to ‘how much someone wants something when action is required to get it’. In respect of the need for action, our findings are at X-396 concentration odds with those of (Kapogiannis et al., 2008), who identified an effect of reward on the motor cortex using paired-pulse TMS in a paradigm in which the participants did not make any response. However, with the task used in their study, they could not identify whether the effect was determined by the size of the reward or the probability of receiving it (in that CHIR-99021 study the effect related to a strong reduction in uncertainty when observing whether a reward materialized over a specific time interval). We suspect that the changing reward probabilities drove the observed effect and, therefore, having an action was not critical in their paradigm. Here, in our money paradigm, the task was set up to measure the strength of the urge, manipulated solely by the size of the monetary reward ($5 or $0.1), while keeping the probability of seeing $5 or $0.1 on any trial exactly the same. In these experiments, the MEPs likely reflect multiple contributing factors,

including not only the urge (determined by the value of the stimulus), but also action preparation. Hence, we caution the reader that comparing MEPs (raw or normalized) across different experiments might be misleading. It is only the relative difference between MEPs observed for different levels of urge (within an experiment, when all other factors are controlled) that can be reliably interpreted. Even a comparison of MEPs between baseline and non-baseline trials within

the same experiment is difficult to interpret because the probability of seeing a baseline trial was lower than the probability of seeing a non-baseline trial in all three experiments and, therefore, differences in the probabilities could confound such a comparison. We used baseline trials only for normalizing the MEPs within each participant (to reduce variance between participants). Thus, we have shown that the strength of an urge can be indexed via ‘spill over’ into motor system excitability, at one time-point and not another, and only when a response is needed Resveratrol for satisfying the urge. Moreover, unlike prior studies, we have separated the preparation to make a response from response execution itself. Further, by recording motor excitability before the participant knew which response to prepare, we also show that the effect on motor excitability is not purely one of motor preparation but must also reflect a motivational component. Further, by manipulating the response-requirement in the money task, we show that the effect is also not purely related to general brain arousal but must also include an action-relevant component.

This clinical audit and was conducted at a large teaching hospital NHS Trust from February to March 2014. Adult inpatients receiving vancomycin during the study period were identified by a list that was generated daily by the microbiology deportment. Paediatric patients, patients receiving haemodialysis,

patients admitting to a ward that does not follow guidelines, patients with missing data on dosing were excluded from this audit. Patients’; medical charts were reviewed and information about patient demographics, the nature of infection and vancomycin dosing and monitoring were collected using a pre-designed data collection form, which was designed according Daporinad concentration to a literature review, expert opinions and a pilot study. Descriptive MAPK Inhibitor Library clinical trial statistics were used to describe the proportion of patients given the correct LD, correct MD, whose first PDL reached 10–20 mg/L. The time to maintaining within the therapeutic level was also calculated. This audit was conducted under the Trust’s research guidance and ethical approval was not required. Of the 104 eligible patients, 14 on dialysis, 8 from non-adherence wards and 5 had missing data were excluded. Of the 77 included patients, 55 (71.4%) were prescribed a LD according to guidelines; and 37 (67.3%) of the 54 patients were also prescribed a

MD according to guidelines. The overall adherence to the dosing guideline was 48.1%. Of the 37 patients whose LD and MD were prescribed correctly, 23 (62.2%) first PDL reached 10–20 mg/L. In contrast, of the 40 patients whose LD or MD was prescribed incorrectly, 21 (52.5%) patients’; first

PDL reached 10–20 mg/L. Sixteen (20.8%) of the 77 patients were excluded from the calculation for time to reach maintaining therapeutic learn more range due to missing data on dates and times for LD or only one PDL reading available. Of the 61 patients who had more than one PDL measure, 29 (47.5%) were given the correct LD and MD, and 14 (48.3%) of them maintained at the therapeutic level, and it took an average of 4.8 days to reach. Of the 32 patients given the incorrect LD or MD, only 10 maintained at the therapeutic level, it took 6.7 days to reach the level. Almost half of patients were prescribed vancomycin following the dosing guideline, and adherence to the guidelines increased the likelihood that therapeutic level was obtained and the therapeutic level was reached quicker. Further research is needed to explore reasons for non-adherence to vancomycin dosing guideline and evaluate the clinical outcomes related to appropriate dosing. R. Sivam, I. Sanghera, F. Turnbull Northwick Park Hospital, Harrow, UK The Nursing and Midwifery Council (NMC) ‘Standards for Medicines Management’ recommends that nurses should carry several checks before administering an injectable medicine. Only 51% (n = 90) of drug charts were documented with two signatures.