17, 20, 21 and 22 The

study was approved by Oxfordshire R

17, 20, 21 and 22 The

study was approved by Oxfordshire Research Ethics Committee B (08/H0605/102). Nasal swabs were taken by all participants on recruitment under research nurse supervision. A dry Crenolanib cotton swab was placed in the tip of both nostrils and rotated three times. All S. aureus positive participants, all students and all participants from the last practice were posted a nasal swabbing kit one and two months after recruitment, and then every two months thereafter. The swabbing technique was demonstrated on recruitment and explained in a leaflet included with each kit. Swabs were returned by post in charcoal medium (typically <1 week), and stored at 4 °C on receipt before processing (processing took <1 week; up to two weeks in total). As the study objective was to investigate S. aureus dynamics,

isolation protocols focussed on identifying all strains, even those present at low frequencies. To increase the sensitivity of culture, swabs were therefore incubated overnight at 37 °C in 5% NaCl enrichment broth (E&O Laboratories, Bonnybridge, UK). A 5 mm loop-full of broth was sub-cultured onto SASelect® chromogenic agar (Bio-Rad, Limerick, Ireland) and incubated at 37 °C overnight. Pink colonies were tested further using DNAse, catalase and Staphaurex tests following standard procedures. 23 Samples positive in all three tests were presumed to be S. aureus. A selection of pink colonies from the SASelect agar were resuspended FER in saline from which one aliquot was stored as glycerol stock at −20 °C

and another added Entinostat chemical structure to 10 μl 0.85% Saline (E&O Laboratories) and 50 μl TE buffer (Sigma, Dorset, UK), heated at 99.9 °C for 10 min, then centrifuged to separate the supernatant. From this, 50 μl was removed and stored at −20 °C as a crude chromosomal DNA extract. spa-typing was performed as described, 24 with DNA amplification and sequencing using the Microlab Star Liquid Handling Workstation (Hamilton Robotics Ltd, Birmingham, UK). Chromatograms for the spa gene were assembled using Ridom StaphType. 24 Samples with mixed chromatograms were re-cultured and six-12 colonies separately typed. spa-types were grouped into spa-Clonal Complexes (CCs) using BURP clustering, and CCs labelled as their MLST equivalent for ease of comparison with other studies. 25 Epidemiological and healthcare information was collected from a structured questionnaire at recruitment, general practice and OUH records (see Supplementary Methods). After two years follow-up, general practice and OUH records were re-reviewed to ascertain antimicrobial use and inpatient admissions throughout follow-up. (1) Loss of carriage (primary outcome) Confirmed loss of carriage was defined as two consecutive negative swabs (or two consecutive swabs without the previous spa-type for analysis of spa-types (spa-level)).

A produção de toxina binária foi identificada em apenas 25% dos c

A produção de toxina binária foi identificada em apenas 25% dos casos, nomeadamente nos ribotipos 027, 126, 203 e novo ribotipo 3. Os autores concluíram no estudo apresentado não haver nenhum ribotipo dominante e também não se ter verificado associação entre a gravidade da doença e os ribotipos isolados. O estudo apresentado é inovador e, embora tenha um número reduzido de doentes incluídos, é muito importante como alerta deste problema. A caracterização dos diferentes ribotipos de C. difficile e das suas características, mais ou menos patogénicas, é determinante na orientação clínica dos doentes com DACD. De salientar que neste

estudo foi efetuada também a determinação dos ribotipos em causa por amplificação por PCR, o que permitiu ainda

a descoberta de 3 novos ribotipos, desconhecidos até ao momento. CDK assay Trata-se, portanto, de um grande contributo em termos científicos, uma vez que com ponto de partida neste estudo virão a ser incluídos na tabela classificativa europeia dos ribotipos já identificados de C. difficile. O facto de não se ter detetado um ribotipo dominante poderá estar associado ao número limitado de doentes estudados, apenas 20, o que se apresenta como uma amostra reduzida. Neste estudo todos os doentes reverteram o quadro clínico com antibioterapia de uma forma favorável. De salientar que não se registaram casos de DACD com critérios de gravidade e por isso não houve qualquer caso fatal a mencionar. Esta situação também poderá estar relacionada com o tamanho da amostra, bem como o facto de não ter sido possível estabelecer qualquer relação entre a gravidade da doença e os ribotipos identificados. A importância clínica deste tema exige a necessidade de serem efetuados SB203580 mouse mais estudos sobre o assunto, uma vez que existe ainda um largo caminho a percorrer até à completa identificação dos ribotipos de C. difficile e das suas características específicas. Artigo relacionado com: http://dx.doi.org/10.1016/j.jpg.2013.01.002 “
“Non-steroidal anti-inflammatory drugs’ (NSAIDs) use, including acetylsalicylic acid (ASA), 5-FU mw has been increasing over the last years, being amongst the most commonly prescribed and used drugs. A study conducted in Portugal showed that the most prescribed

therapeutic class by Family Physicians was NSAIDs totalling 8.2%, while ASA and derivatives represented 1.3% of all medicines.1 Other studies in Portugal showed that NSAIDs, analgesics and antipyretic drugs rank as fifth among the chronically used medicines, being used by 12–15% of the studied users.2 NSAIDs are highly effective agents; however, its use is associated to adverse events, especially gastrointestinal. NSAIDs-related adverse events accounted for 11% of the reports received by the Portuguese Drug Prescription Vigilance System between 1993 and 2002 and gastrointestinal complications represented 19% of the overall reports. Severe adverse reactions to NSAIDs, which represented more than 50% of the reports, caused hospitalization in 31% of the cases.

On the other

hand, gastric intubation with 25 mg cypermet

On the other

hand, gastric intubation with 25 mg cypermethrin per kg bodyweight (ca. 20-40% LD50; see below for discussion) for 28 d resulted in reduced bodyweight in male Wistar rats [32]. Consumption of α-cypermethrin or curcumin alone did not affect the activities of the liver damage markers ALT, ALP, and AST in plasma in the present experiment (Table 2). The combined intake of α-cypermethrin with curcumin significantly increased plasma ALT, but not ALP or AST activities. However, because the activities of liver enzymes remained within the reference ERK inhibitor clinical trial ranges for healthy rats [26] in all groups, this statistically significant increase is likely without biological importance. In support of our

data, even high-dose feeding of 420 mg cypermethrin/kg Selleck Enzalutamide BW for 6 months did not result in increases in serum liver enzymes in rats [38]. Even the increases in the activities of liver enzymes in cypermethrin-exposed rats observed in some studies [23] and [32] remained within the reference ranges for healthy rats and are thus not indicative of hepatic injury. Hence, it appears that statistically significant effects on liver enzymes that remained within the boundaries of normal biological variation have in the past been incorrectly interpreted as pesticide-induced liver damage in some studies. α-Cypermethrin was only present in organs of animals fed the pesticide, but not of control and curcumin only-fed animals (Table 3). The fat-soluble α-cypermethrin accumulated in adipose tissues at concentrations of up to 9.8 μg/g tissue, whereas its contents

(in descending order) were much lower in kidney, liver, and brain tissues. The simultaneous ingestion of curcumin did not alter α-cypermethrin concentrations in any of these tissues (Table 3). The higher concentrations of α-cypermethrin residues in adipose compared to brain and other tissues is in agreement with observations in male Sprague-Dawley rats given a single oral dose of a mixture of four pyrethroids (each administered at 3 mg/kg bodyweight; including cypermethrin) dissolved in glycerol formal. These authors proposed that the higher concentrations and longer persistence of the pesticides in adipose tissue may be due to its slower metabolism and lack of STK38 enzymes required for pyrethroid hydrolysis [24]. Similarly, cypermethrin concentrations in rats orally administered a single dose of a mixture of six pyrethroids (of which 29% were cypermethrin) in corn oil (total pyrethroids, 27.4 mg/kg bodyweight; cypermethrin, 8 mg/kg bodyweight) were higher in adipose tissue (1.07 μg/g), than in the brain (0.14 μg/g) and liver (0.40 μg/g) 2.5 h after dosing [39]. The higher α-cypermethrin concentrations in the adipose tissues of our animals are likely explained by the longer intervention period (7 weeks vs.

In some cases, the results showed that several stakeholders were

In some cases, the results showed that several stakeholders were ignored at the initial step of aquaculture planning which directly hindered participation. The lesson to be derived is that regional or national interest should never ignore the local level of decision-making – and instead directly jump to higher levels – since this is the level at which the projects will actually be implemented. These facts point to the need for designing and enabling inclusive participatory decision-making procedures that ensure: (i) timely and public provision of transparent, clear and adequate information so that each stakeholder can properly evaluate different development options,

(ii) allocation of public funds for public research and for supporting best practices selleck screening library directed to environmentally and socially desirable outcomes serving collective needs, and (iii) prioritization of local needs and concerns. All of the above transformative arguments are of paramount importance for forthcoming aquaculture policies as in some cases decision-making authorities tend towards eliminating any obstacle to aquaculture unless there are strong conflicts [31]. In line with this, the efforts to decrease the administrative burden of the sector have to be carefully

analyzed. There are two issues related to this objective that shall be distinguished from each other. First, in many countries, several actors complain about the complex and unclear character of application and decision-making structure. Selleckchem Dapagliflozin In many cases, it is not clear where to apply for a new farm or for complaints about its impacts, neither which public body has what authority. Urease Its clarification and simplification would be beneficial for each stakeholder in order to improve the discussion and participation. Secondly, there is the issue of long application periods necessary to obtain a license in Europe. These long periods can be a result of the former, i.e. they may be due to the

complex set of bureaucratic requirements, which do not function properly. However, in many cases, it can also be a result of the need for public consultation, which is crucial to ensure participation and inclusion of several concerns, best practices and social acceptance. Finally, the present study remarks that there are already notable conflicts with a potential to become even stronger, unless the policies encouraging the expansion of marine finfish aquaculture cover all social and environmental aspects. As a consequence, while avoiding the emergence of conflicts – through well-designed public policies – may not be seen as a priority for the European finfish aquaculture industry in the context of stagnation [39], it may become a very relevant issue also for the sector while following the growth objective.

The X chromosome is full of surprises and if the future of the fi

The X chromosome is full of surprises and if the future of the field is anything like the last few years, it would seem we have much to look forward to. Papers of particular interest, published within the period of review, have been highlighted as: • of special interest This work was supported by NIH/NHGRIT32 buy Crizotinib HG000044 and U01-HL100397. “
“Current Opinion in Genetics & Development 2013, 23:316–323 This review comes from a themed issue on Molecular and genetic bases of disease Edited by Jim Lupski and Nancy Maizels For a complete overview see the Issue and the Editorial Available online 17th April 2013 0959-437X/$

– see front matter, © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.gde.2013.02.015 Thrombocytopenia with absent radii (TAR) syndrome is characterized by a reduction in the number of platelets (the cells that make the blood clot) (generally below 50 × 109 L−1, normal range 150–350 × 109 L−1) and the absence of one of the bones in the forearm (the radius) but with preservation of the thumb. TAR syndrome was first described by Gross et al. [ 1] and Shaw and Oliver in 1959 [ 2], but Judith Hall was the first to define it as a syndrome in 1969, presenting

clinical findings in a cohort of 40 patients [ 3]. The presence of the thumbs distinguishes TAR from other syndromes that combine blood abnormalities with absence of the radius, such as Fanconi anemia [ 3, 4 and 5]. The severity of skeletal abnormalities varies from absence selleck chemicals llc of radii to virtual absence of upper limbs (phocomelia) with or without lower limb defects, such as malformations of the hip and knee [ 3 and 5]. TAR cases have low numbers of megakaryocytes, the platelet precursor cells that reside in the bone marrow, and cases frequently present with bleeding episodes in the SPTLC1 first year of life [ 3 and 5]. A remarkable feature of TAR syndrome is that the platelet count can improve with

age and bleeding diminishes [ 5]. Other symptoms have been described in a series of 34 TAR patients [ 6], with renal anomalies and cardiac anomalies in respectively 23% and 15% of patients, and 47% suffering from intolerance to cow’s milk. TAR syndrome has an incidence of approximately 1 in 240 000 births [7] and was thought to be inherited as an autosomal recessive disease [8] based on finding affected siblings. There is however no clear evidence of increased incidence in consanguineous families with only one case reported [9]. On the other hand, vertical parent-to-child transmission has been reported [10], as well as the case of a male patient and maternal uncle [11]. This unusual inheritance pattern has complicated the application of classic linkage analysis methods and homozygosity mapping approaches.

Wir schließen daraus, dass die Demethylierung von MeHg zu Hg2+ ni

Wir schließen daraus, dass die Demethylierung von MeHg zu Hg2+ nicht der Mechanismus ist, der für die Entwicklung neurologischer Effekte im Verlauf der chronischen Latenzphase während der Exposition verantwortlich ist. Clarkson und Magos [2] schlugen vor, dass die Demethylierung von MeHg ein Teil der Verteidigungsstrategie der Gliazellen sein könnte, was einmal mehr die Bedeutung der interzellulären find protocol Abhängigkeit zwischen Neuronen

und Gliazellen betont. Wir haben bereits auf die Bedeutung von SH-Gruppen für die Bindung von Quecksilber hingewiesen, durch die wiederum die Konzentration von „freiem” Quecksilber verringert wird, das eine Interaktion mit sensitiven zellulären Bindungsstellen eingehen kann. Purkinje-Zellen sind reich an SH-Gruppen [120], die als inerte Bindungsstellen fungieren und so ein Quenching der Wirkung von Hg im Zellinnern herbeiführen können, was den Zellen eine höhere Toleranz gegenüber Hg verleiht [121] and [122]. Bei einer MeHg-Behandlung von Astrozyten im Cerebellum ist eine stärkere Depletion von GSH

beobachtet worden als bei Astrozyten im Kortex [123]. Der Grund für die höhere Produktion BGB324 von ROS in cerebellären Astrozyten war der höhere Gehalt an GSH in kortikalen Astrozyten im Vergleich zu cerebellären Astrozyten. Jedoch wurden keine Unterschiede hinsichtlich der zellulären Verteilung von GSH zwischen Körner- und Purkinje-Zellen festgestellt [124]. Nach Exposition gegenüber MeHg wurde vor allem in Bergmann-Gliazellen, Purkinje-Zellen, Astrozyten und Gliazellen der weißen Substanz Metallothionein (MT) nachgewiesen, nicht dagegen in Körnerzellen [103]. Metallothioneine bestehen aus etwa 62 Aminosäuren, wobei 20 davon Cysteinreste sind. Dies verleiht dem Protein eine außerordentlich hohe Kapazität für die Chelierung von Metallen, die an SH-Gruppen binden. Daher

stellen Metallothioneine einen wichtigen Faktor dar, der die Bindung von Quecksilber an funktionell bedeutsame SH-Gruppen almost reduzieren kann. Dies sind wichtige Gesichtspunkte im Hinblick auf die unterschiedlichen Effekte in Neuronen sowie im Zusammenhang mit indirekten Wirkungen auf Neuronen als Ergebnis von Effekten, die in Gliazellen ausgelöst werden. Zusammenfassend lässt sich also sagen, dass der Gehalt an SH-Gruppen die MeHg-bedingten toxischen Effekte beeinflussen und zum Teil die unterschiedliche Sensitivität der verschiedenen Zelltypen erklären kann, die sich z. B. anhand von Befunden zur Synthese von Makromolekülen zeigen lässt [125], [126] and [127]. MeHg stört die Synthese von DNA, RNA und Proteinen. Der Mechanismus ist nicht bekannt, jedoch kann angenommen werden, dass die Bindung an wichtige SH-Gruppen bei diesen Veränderungen eine bedeutende Rolle spielt, z. B. durch sekundäre Veränderungen an DNA und RNA sowie Konformationsänderungen bei ribosomalen Proteinen [128].

, 1987 and Bento and Miniti, 1989), but full functional recovery

, 1987 and Bento and Miniti, 1989), but full functional recovery is seldom achieved. Nerve repair requires a complex interaction among a scaffold for axonal growth guidance, supportive cells such as Schwann cells, growth factors, and extracellular matrix (Da-Silva et al., 1985, Costa et al., 2006 and Costa et al., 2009a). The combination of axonal scaffolds and transplanted cells provides adequate support for neural regeneration, and has been investigated as a strategy to overreach the limitations of surgical repair (Evans et al., 2002, Cheng and Chen, 2002, Udina et al., 2004 and Rodrigues et al., 2012).

In particular, the polyglycolic acid tube (PGAt), composed of absorbable material, has been established as an appropriate conduit for nerve grafting, and has been approved by the Food and EGFR inhibitor Drug Ku-0059436 supplier Administration (FDA, USA) for use in the clinical setting (Mackinnon and Dellon, 1986, Da-Silva et al., 1987, Mackinnon and Dellon, 1990, Weber et al., 2000, Costa et al., 2006, Costa et al., 2009b, Schlosshauer et al., 2006 and Nectow

et al., 2011). Isolated and cultured Schwann or stem cells have been employed in the surgical repair of the peripheral nerve (Dezawa et al., 2001, Cuevas et al., 2002, Evans et al., 2002, Fansa and Keilhoff, 2004, Udina et al., 2004, McKenzie et al., 2006, Chen et al., 2007, Lavdas et al., 2008, Ishikawa et al., 2009, Wang et al., 2009, Wakao et al., 2010, Wei et al., 2010, Ladak et al., 2011, Wang et al., 2011, Rodrigues et al., 2012 and Salomone et al., 2013). Schwann-like cells have been reported to differentiate in vitro from bone marrow stroma mesenchymal stem cells (BMSC)

primarily cultured from rat femurs ( Dezawa et al., 2001 and Chen et al., 2007). Schwann-like cells experimentally employed in peripheral nerve repair have improved myelination ( Dezawa et al., 2001, Tyrosine-protein kinase BLK Cuevas et al., 2002, Chen et al., 2007, Ishikawa et al., 2009 and Wang et al., 2011). Although there are limited data on the association of PGAt and genetically modified BMSC-derived Schwann-like cells in the repair of the facial nerve ( Shi et al., 2009), a thorough, objective analysis on the functional nerve recovery and of in vivo cell survival is lacking. Our approach in the current study has been to employ the gold-standard nerve repair procedure, nerve autografting, combined to bone marrow mesenchymal stem cells seeded in purified basement membrane as a secondary scaffold, used to fill the lumen of PGAt. Our aims were to compare the facial nerve functional and morphological outcomes, and to evaluate the presence and phenotype of the exogenous cells in the autografted nerve, six weeks after implantation. The use of five different animal groups allowed for progressive addition of each component to be tested.

Our study evidently proves that alkalinity effect on current dens

Our study evidently proves that alkalinity effect on current density is not important in MXCs treating domestic wastewater. Instead, the biodegradability of the wastewater is significant for current density in the MXCs. At Run 5 (acetate and 5 mM bicarbonate buffer), the current density was recovered from 0.30 ± 0.1 A/m2 to 1.7 ± 0.2 A/m2. However, the current density learn more sharply dropped to 0.4 ± 0.15 A/m2 again at Run 6 (76% reduction against 1.7 ± 0.2 A/m2 at Run 5) in which SS collected from the domestic wastewater was added to acetate medium;

SS concentration was 230 ± 28 mg/L in the anode chamber, which is close to the average SS concentration in the domestic wastewater (260 ± 15 mg/L). This substantial reduction of current density at Run 6 shows that particulate

matters seriously prevent ARB from generating current in anode biofilm. Particulate substances can attenuate current generation find more via several routes. Particulates readily accumulate on biofilm anode [1,29], and the accumulated particulates can alleviate substrate diffusion from bulk liquid to biofilm anode, accentuating substrate limitation. In addition, particulates can mitigate the opportunity of ARB to proliferate on the surface of the anode or expel existing ARB from the biofilm due to space competition. The growth of non-ARB (e.g., fermenters or methanogens) present in SS can compete with ARB for substrate, and as a result current density can be decreased [4] and [28]. Particulates can also limit extracellular electron transfer, since their inert fractions accumulated on biofilm anode can deteriorate the conductivity of anode biofilm

matrix or bother the diffusion rate of shuttling compounds between ARB and the anode [30]. It is interesting to observe the slight increase of current density from 0.4 ± 0.15 A/m2 at Run Adenosine 6 (acetate with particulates) to 0.5 ± 0.15 A/m2 at Run 7 (raw domestic wastewater). This current density at Run 7 is even higher than 0.30 A/m2 observed at Run 3 and 4 (filtered wastewater with and without 50 mM bicarbonate buffer). The small increase of current density at Run 7 is not meaningful in terms of energy recovery, but seems to provide a clue on how to improve current density in MXCs treating domestic wastewater. Particulates added to the anode chamber at Run 6 mainly worked as physical/chemical barriers to ARB metabolism in anode biofilm or extracellular electron transfer, as discussed above. It is expected that air exposure during SS collection (30–45 min) would suppress the activity of anaerobic microorganisms present in SS, so the syntrophic interactions between ARB and non-ARB (fermenters and methanogens) would not be promoted well.

ELISA was used with the aim of evaluating the antigenic cross-rea

ELISA was used with the aim of evaluating the antigenic cross-reactivity

of S. plumieri whole venom with Stonefish antivenom. The assays were performed as described previously by Chávez-Olórtegui PI3K activation et al., 1991. Falcon flexible microtitration plates purchased from Becton Dickinson Labware Europe (Becton Dickinson France S.A.) were coated with 100 μl of a 5 μg/ml solution of the S. plumieri venom in 0.02 M sodium bicarbonate buffer, pH 9.6 and incubated overnight at 5 °C. After blocking non-specific sites with 2% (w/v) casein solution for 1h at 37 °C, the immobilized venom proteins were titrated with decreasing concentrations of stonefish antivenom (from 1:200 to 1:204800 dilution) and incubated at 37 °C for 1h.

Non-specific binding was measured in the presence of pre-immune horse serum at the same conditions. Bound IgG was detected via peroxidase conjugated antibody raised against Selleck MG 132 horse IgG diluted 1:1000. Wells coated with 2% casein were taken as blank and subtracted from all values. Absorbance values were determined at 492 nm with a Titertek Multiscan spectrophotometer. All measurements were made in triplicate and the results expressed as the mean of two assays. Results were expressed as mean ± SEM (Standard Error of the Mean) and were evaluated using one- or two-way analysis of variance (ANOVA) followed by the Tukey post hoc test. Results were also evaluated by Student’s t-test. In all cases, differences were considered significant at p < 0.05. For determination of the edematogenic response induced by S. plumieri venom, doses of 7.5, 15 and 60 μg of venom/animal were used. Fig. 1A shows the time-course evaluation of edematogenic

effect. It is possible to observe that the venom induced an intense and sustained dose-dependent edematogenic response with a maximal activity observed 30 min after injection of 58 ± 6% with 7.5 μg, 61 ± 6% with 15 μg, and 82 ± 2% check with 60 μg of protein/animal. The edema remained significantly elevated compared to control group over 6 h at the dose of 7.5 μg, 24 h at the dose of 15 μg and 72 h at the dose of 60 μg. Higher doses were unable to increase the edematogenic response compared to the response induced by 60 μg of SpV (data not shown). Likewise, a significant nociceptive response was observed. Fig. 1B shows that the SpV induced an increase of paw licking duration that reached its maximum with 15 μg of protein/animal (124.5 ± 29.3 s). Doses >15 μg of S. plumieri venom were unable to increase the paw licking duration in a dose-related way, nevertheless each dose presented significant values ( Fig. 1B). The vehicle control (PBS) had no significant effect on the experiment. The ability of SFAV in neutralizing the inflammatory activity induced by S. plumieri venom was evaluated by pre-incubation of SpV with SFAV. Fig. 2 shows that SFVA succeeded in neutralizing the in vivo edematogenic and nociceptive effects of SpV.

A summary of all interviews and focus group was made to identify

A summary of all interviews and focus group was made to identify overall meaning [25]. Content analysis of the transcriptions was performed concomitantly by constant back

and forth from codes and categories to raw data (verbatim excerpts). A comprehensive coding grid that evolved as new categories linked selleck inhibitor to the study theme emerged from the data was used. The coded content relating to study theme (ethical issues) was then grouped into categories (by JB and AR) and discussed with the research team until consensus was reached about essential meanings. Quotes were identified based on the following system: R (relative), S (stroke client), ID number, T1 (Time 1), T2 (Time 2). Characteristics of participants at Phase 1 are presented in Table 2. Relatives (n = 25) were aged between 31 and 72 years,

nine of whom were interviewed at both times (following discharge from T1 [acute care] and T2 [rehabilitation]) for a total of 34 interviews. Stroke clients (n = 16) were aged between 37 and 76 years, ten of whom participated at T1 and T2 (n = 26 interviews). Participants SGI-1776 in the focus group (Phase 2) for relatives (n = 5) were aged between 43 and 66 years, three of whom were women. Participants in the stroke client focus group were mainly men (n = 3/4), while participants in the health professional focus group were mainly women (n = 4/5). For the latter, a variety of disciplines were represented from throughout the continuum of stroke care (acute care, in-patient rehabilitation, out-patient rehabilitation), including a nurse, a physiotherapist, a speech language pathologist, a social worker, and a specialized educator, while the two facilitators were occupational therapists. Four main themes relating to ethical issues emerged from the interviews:

(1) overemphasis of caregiving role with an unclear legitimacy of relative to also be a client; (2) communication as a key issue to foster respect and a family-centered approach; (3) availability and attitudes of health professionals as a facilitator or a barrier to a family-centered approach; and (4) NADPH-cytochrome-c2 reductase constant presence of relatives as a protective factor or creating a perverse effect. If there was an overarching theme, it would be about the tension between the dual roles of relatives with a predominance of the caregiving role mainly as being a source of information “Let me tell you, sometime I had the feeling they were not communicating the information to each other because they were asking over and over the same questions” (R10T1) and a blurred legitimacy for relatives to receive services as a client “…I told myself, I better stop asking questions, because I feel, I feel I’m getting on their nerves … I didn’t want to become irritating, you know” (R7T1).