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Four general approaches to the teaching of cultural content in the foreign language class are described. Two of them, the audio‐visual and the communicative, are implicit approaches only in the sense that culture as such is not taught but is assumed rather to ‘come with’ the language. The civilisation module and the intercultural approach, on the other hand, treat cultural learning as an educational objective in its own right, distinct from language acquisition. The competence aimed at, and the definition of culture, differs from method to method. In some approaches culture is presented as being homogeneous within a society and as having universal validity for all societies. In others it is presented as incorporating intra‐ and inter‐cultural variations. The first approach insists on cultural similarities and on collective identification, whereas the second focuses on the diversity of positions within a culture and across cultures. Only the intercultural approach includes non‐observable, subjecti...

In vivo1H NMR spectral editing techniques were used to monitor cerebral lactate production during remotely controlled temporary forebrain ischemia in rats. The lactate/N-acetylaspartate (NAA) ratio correlated with survival after ischemia and subsequent reperfusion. The lactate/NAA ratio that predicted death after ischemia in rats was estimated to be approximately 1.3. © 1987 Academic Press, Inc.

The magnetic field-dependent phosphodiester (PDE) signal found in 31P NMR spectra of liver and brain has been studied using saturation transfer and proton decoupling techniques. This PDE component, which accounts for as much as 45% of the signal in vivo, has been identified as primarily phospholipid bilayer with a small contribution from a motionally averaged macromolecule(s).

Fluorinated derivatives of the chelator o-aminophenol-N,N,O-triacetic acid (APTRA) have been developed, synthesized, and analyzed for use as 19F NMR indicators of free cytosolic magnesium concentration. Magnesium dissociation constants for the 4-fluoro, 5-fluoro, and 4-methyl-5-fluoro species were determined to be 3.1, 0.9, and 0.6 mM, respectively, on the basis of UV absorption measurements at 37 degrees C in 115 mM KCl and 20 mM NaCl, pH 7.1, buffered with 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid-tris-(hydroxymethyl)aminomethane. The corresponding pK values, which reflect protonation of the nitrogen atom, were determined by 19F NMR to be 4.15, 5.45, and 5.55, respectively, so that the chelators are insensitive to pH variations near the normal physiological range. The dissociation constants of these chelators for calcium ions are lower than those for magnesium but roughly 2-3 orders of magnitude above typical basal cytosolic free calcium levels, so that calcium ions will not interfere with the determinations of magnesium levels. 19F NMR studies carried out at 339.7 MHz indicate that magnesium ions are in slow exchange with the 5-fluoro and 4-methyl-5-fluoro APTRA derivatives and in fast exchange with the 4-fluoro APTRA derivative. In contrast, calcium ions were found to be in intermediate to fast exchange with all chelators. The apparent anomaly of higher thermodynamic stability of the APTRA complexes for calcium relative to magnesium but lower kinetic stability (higher k-1 values) for the calcium complexes reflects the very different association rates for the two ions. Thus, the magnesium association rates are 3 orders of magnitude slower than those for calcium ions.(ABSTRACT TRUNCATED AT 250 WORDS)

Previous investigations from this laboratory have indicated that arachidonic acid stimulates a rapid, dose-dependent and reversible increase in hPL release which is not dependent on cyclooxygenase or lipoxygenase metabolism. To investigate further the mechanism by which arachidonic acid stimulates the release of hPL, the effect of arachidonic acid on the release of 45Ca from perifused cells prelabelled with 45CaCl was examined in an enriched cell culture population of term human syncytiotrophoblast. Arachidonic acid (10-100 microM) stimulated a dose-dependent, rapid, and reversible increase in the release of both 45Ca and hPL from the perifused placental cells. On the other hand, palmitic acid had little effect on either hPL release or 45Ca release even at concentrations as high as 100 microM. Ionophore A23187 (1-10 microM) also stimulated a dose-dependent and reversible increase in hPL release. Since arachidonic acid increases the mobilization of cellular calcium, as reflected by the increased 45calcium efflux, and since an increase in the intracellular calcium concentration appears to stimulate an increase in hPL release, these results suggest that the stimulation of hPL release by arachidonic acid may be due, at lease in part, to the effects of the fatty acid on cellular calcium mobilization.

Changes in cytosolic free magnesium ion concentration (Mgi) during myocardial ischemia were measured by 19F NMR in perfused rat hearts loaded with fluorine-labeled derivatives of the magnesium chelator o-aminophenol-N,N,O-triacetate. The perfused rat hearts were loaded intracellularly with the appropriate magnesium indicator by perfusion with 200-400 ml of Krebs-Henseleit buffer containing 5 microM acetoxymethyl ester of the indicator. Basal Mgi concentrations measured by three different indicators averaged 0.85 +/- 0.10 mM (n = 9) and showed no correlation with the KD of the indicator used. 31P NMR measurements of the magnesium-dependent shift between alpha- and beta-phosphates of ATP demonstrate that there is no measurable lowering of Mgi during loading with fluorinated o-aminophenol-N,N,O-triacetate. Between 10 and 15 min of ischemia, Mgi rose nearly 3-fold to 2.1 +/- 0.4 mM. This increase in Mgi occurred over the same time course as the decrease in ATP. After 20 min of reperfusion with Krebs-Henseleit buffer, Mgi declined to 1.5 +/- 0.5 mM. This sustained elevation of Mgi above basal levels may inhibit calcium release from sarcoplasmic reticulum, thereby contributing to the well documented impairment of mechanical function that occurs after a reversible period of ischemia.

Phosphorus-31 surface coil spectroscopy has been used to study the effects of L-ethionine administration on the hepatic metabolism of the anesthetized Sprague-Dawley rat. ATP levels were found to decrease by approximately 30% 3 to 4 hr after administration of 1 mg/g body wt of L-ethionine to the anesthetized rat by gastric gavage. ATP levels returned to control values approximately 8 hr postadministration. The relatively small decrease in ATP level was confirmed by extraction and conventional enzyme assay and is a consequence of the mode of administration of the ethionine. Hepatic inorganic phosphate levels rose concomitantly with the ATP fall. There were no significant changes in either cellular pH or Mg2+ levels as monitored by the 31P shifts of sensitive metabolites. In vivo 31P NMR spectroscopy provides a promising approach to study the effects of hepatotoxicants on cellular ATP, pH, and Mg levels.

Reproduction and lactation upon fat-free diets and the role played by the essential unsaturated fatty acids have been reported in detail (1). The role of these essential unsaturated fatty acids in reproduction and lactation with diets whose sole source of energy consists of saturated fatty acids forms the subject of the investigation reported in this paper. Diet 675 used in this study consisted of casein L-XI (l), 40; hydrogenated coconut oil,’ 60; and Salt Mixture 185 (2), 5. The usual vitamin supplements for fatfree diets were furnished by 1 gm. of ether-extracted brewers’ yeast2 daily for vitamins B and G, non-saponifiable matter from 83 mg. of cod liver oil daily for vitamins A and D, non-saponifiable matter from 0.5 gm. of wheat germ oil weekly for vitamin E, and 50 mg. daily of Preparation 48-e (1) for vitamin F (the essential unsaturated fatty acids). The technique and materials used in this study were identical with those described (1) for the fat-free diet. Gestation without Essential Unsaturated Fatty Acids-When hydrogenated coconut oil (free from linoleic acid) served as the source of energy instead of sucrose, the results were markedly simi

The in vitro erythrocyte uptake of I131-labeled l-triiodothyronine was determined reproducibly in a routine clinical laboratory 424 times in 348 subjects. The erythrocyte uptake was significantly lower in euthyroid females than in euthyroid males. Hyperthyroidism caused a significant elevation, whereas hypothyroidism, menstruation, pregnancy and liver disease caused a significant depression of the uptake. The administration of iodine-containing compounds was associated with an increase in the erythrocyte uptake, but not sufficient to interfere with the usefulness of the test. This test is an inexpensive simple and rapid method of estimating thyroid function; the administration of radioisotope is eliminated. The results compare favorably in accuracy with those of other currently used thyroid function tests, and may be more useful for purposes of following the effects of therapy in thyroid disease, and in the management and diagnosis of normal and disordered pregnancy.

Hematopoietic cell transplantation (HCT) is a highly specialized and resource-intense medical procedure that can be associated with disparities in access to transplantation. Barriers to access to HCT are multifactorial, complex, and interrelated. Our current knowledge of specific barriers that prevent access to HCT is very limited. As the utilization of HCT increases, it is imperative that underserved populations receive the benefit of this life-saving procedure. We review the prevailing literature on access to HCT and describe research priorities for eliminating disparities in transplantation. Better understanding of these complex barriers will minimize inequities, inform health policy, guide development of interventions targeted to eliminate disparities, and continue the expansion of HCT in the future.

Cardioprotection, such as preconditioning and postconditioning, has been shown to result in a significant reduction in cell death. Many of the signaling pathways activated by cardioprotection have been elucidated, but there is still a lack of understanding of the mechanisms by which these signaling pathways reduce cell death. Mitochondria have been reported to be an important player in many types of apoptotic and necrotic cell death. If mitochondria play an important role in cell death, then it seems reasonable to consider that cardioprotective mechanisms might act, at least in part, by opposing mitochondrial cell death pathways. One of the major mechanisms of cell death in ischemia–reperfusion is suggested to be the opening of a large conductance pore in the inner mitochondrial membrane, known as the mitochondrial permeability transition pore. Inhibition of this mitochondrial pore appears to be one of the major mechanisms by which cardioprotection reduces cell death. Cardioprotection activates a number of signaling pathways that reduce the level of triggers (reactive oxygen species and calcium) or enhances inhibitors of the mitochondrial permeability transition pore at the start of reperfusion. This article is part of a Special Issue entitled: Mitochondria and Cardioprotection.

Shortage of manpower and center capacity is expected to be a major challenge to the anticipated future growth in the utilization of allogeneic hematopoietic cell transplantation (HCT) in the United States. Using data from the National Marrow Donor Program's Transplant Center Network Renewal Survey, we describe transplant center and transplant physician capacity in the United States from 2005 to 2009. Over this 5-year period, the number of allogeneic transplants increased by 30%, bed capacity increased by 17%, and physician full-time equivalents increased by 26%. The number of related donor HCT increased by 15% and unrelated donor HCT increased by 45%. In addition to large centers, small- and medium-sized centers also made a major contribution to overall national transplant volumes for both related and unrelated donor HCT. Increase in utilization of unrelated donor HCT occurred in centers irrespective of their size. The majority of transplant centers were performing more transplantations using existing physician and bed capacity. Our study provides important descriptions of allogeneic transplant activity and capacity of U.S. centers, and our data will assist policy makers plan for the projected growth in the use of transplantation.

The previously developed chelator O-aminophenol-N,N,O-triacetic acid (APTRA) (L. A. Levy, E. Murphy, B. Raju, and R. E. London. Biochemistry 27: 4041-4048, 1988) has been modified to yield a fluorescent analogue which can be utilized as an intracellular probe for ionized Mg2+. The fluorescent analogue, FURAPTRA, with a magnesium dissociation constant of 1.5 mM, is structurally analogous to the calcium chelator fura-2 and exhibits a similar excitation shift on magnesium complexation. Hence, data on the intracellular Mg2+ concentration can be obtained using an analogous ratio method. The acetoxymethyl form of the chelator is readily loaded into cells and has been used to determine a cytosolic free Mg2+ concentration of 0.59 mM for isolated rat hepatocytes. As a consequence of the relatively high levels of cytosolic Mg2+, the problem of ion buffering is much less severe than for the analogous calcium indicators.

To determine whether epithelial ion transport abnormalities in cystic fibrosis (CF) might reflect abnormal regulation of intracellular Ca2+ levels, cytosolic free calcium (Cai2+) was measured using fura-2 or quin2 in suspensions of normal or CF nasal epithelial cells derived from primary cell culture. The basal Cai2+ level measured with fura-2 in CF nasal epithelia was 155 +/- 9 nM (n = 5), a value not significantly different from normal nasal epithelia (143 +/- 16 nM, n = 5). Total cell calcium was measured by atomic absorption spectroscopy and no differences were observed between CF (6.3 +/- 0.5 nmol/mg protein; n = 3) and normal (6.2 +/- 1.2 nmol/mg protein; n = 3) nasal epithelial cells. Placing Na+ loaded cells in a low (10 mM) extracellular Na+ solution resulted in a rapid increase in Cai2+ consistent with Ca2+ uptake via a plasmalemmal Na+-Ca2+ exchanger. The level of Cai2+ achieved by this low Na+ maneuver was not significantly different in CF cells compared to normal cells. Neither isoproterenol (10(-5) M) nor forskolin (10(-6) M) had any effect on Cai2+ in normal or CF nasal epithelial cells. Thus, it appears that differences in cell Cai2+, as measured by fluorescent chelators in suspensions of cultured cells, do not account for the abnormalities in basal or isoproterenol stimulated ion transport in CF tissues.

Clinical evaluation of uveal melanomas by nuclear magnetic resonance (NMR) techniques depends on ascertaining how these tumors characteristically appear in NMR images and spectra. The authors have determined NMR characteristics of suspected uveal melanomas by phosphorus-31 ( 31 P) NMR spectroscopy of freshly enucleated human eyes. Nuclear magnetic resonance examination was performed at 8.45 Tesla within 90 minutes after enucleation. Enucleated eyes were maintained at 4°C in tissue culture medium during the 30 minutes required for transport. Nuclear magnetic resonance spectra were obtained within 10 minutes, a clinically acceptable time, using a two-turn 31 P surface coil. Spectral parameters included 10-kHz spectral width, 1024 data points, and 0.5-second recycle delay. Phosphorus-31 NMR spectroscopy allowed differentiation of choroidal melanomas from normal ocular structures. Differentiating features include significant peaks in tumor spectra due to the phosphodiesters glycerol 3-phosphoryl ethanolamine (GPE) and glycerol 3phosphorylcholine (GPC), and the phosphomonoesters phosphorylethanolamine (PE)and phosphorylcholine (PC). These preliminary data are encouraging and suggest that clinical trials at the lower magnetic field strengths available in NMR imaging systems seem feasible and warrant investigation.

Changes in cytosolic free calcium concentration during myocardial ischemia were measured by 19F NMR in 5FBAPTA-loaded perfused rat hearts. The hearts were perfused with Krebs-Henseleit buffer containing 5 microM of the acetoxymethyl ester of 5FBAPTA, which was hydrolyzed by cytosolic esterases to achieve cytosolic concentrations of 5FBAPTA of 0.12 to 0.65 mM. Cytosolic free calcium concentrations were calculated as the product of the ratio of peak areas for bound and free 5FBAPTA in the NMR spectra and the dissociation constant (708 nM). The basal cytosolic calcium concentration, measured in potassium or magnesium arrested hearts, was 252 nM, and the time-average calcium concentration in beating hearts was 630 nM. Following the onset of total ischemia, there was no immediate substantial change in cytosolic calcium despite a rapid decline in creatine phosphate and ATP and a marked increase in inorganic phosphate as monitored by 31P NMR, but by 10 minutes, there was a substantial increase in free calcium concentration. The ratio of peak areas of bound and free 5FBAPTA returned to the preischemic value during reperfusion, and there was no detectable loss of 5FBAPTA from the heart. Creatine phosphate was also restored to its preischemic level during reperfusion. These results indicate that cytosolic free calcium increases during ischemia and is not immediately associated with lethal injury. This increase in cytosolic calcium may activate degradative enzymes that eventually could compromise myocyte viability.

• Clinical evaluation of uveal melanomas by magnetic resonance imaging (MRI) techniques depends on developing an understanding of the appearance of these tumors in magnetic resonance (MR) images. We have determined MR characteristics of uveal melanomas by proton ( 1 H) and sodium 23 MRI of freshly enucleated human eyes at 1.5 tesla. The MR images were obtained using two-turn proton and 23 Na surface coils, designed to both transmit and receive the radiofrequency signal. Proton MRI techniques included saturation recovery and spin echo; the gradient-recalled echo technique was used for 23 Na MRI. Proton and 23 Na MR images provide complementary information; contrast between intraocular tumors and vitreous, lens, or subretinal hemorrhage may be varied by using MR pulse sequences that emphasize tissues based on T 1 , T 2 , proton, or sodium density values. A combination of proton and 23 Na MRI provides differentiation between normal ocular structures and intraocular tumors, as well as associated complications, such as retinal detachments and subretinal hemorrhages.

A review of the beliefs and research results on the influence of the time of insemination on the sex ratio is presented. The ancient Greek notion that more males were produced by early postmenstrual insemination was supported as late as the early 1900s, although, by then, that belief was not uncontested. The view soon changed to the one of Dechman in which midcycle insemination favored the birth of males because of the deterioration of the ovum and other dominance/submission arguments. There were also some 20th century writers who recommended premenstrual insemination for producing male offspring. More recent thinking, taking advantage of new knowledge in reproductive physiology, holds that insemination immediately prior to ovulation favors males, whereas earlier insemination favors females. Artifical insemination of women 3 or more days before ovulation has been reported to result in an excess of females, while natural insemination during the same time-frame produced an excess of males. More clinical research, utilizing a uniform methodology for determining the time of ovulation, is needed to elucidate the relationship between the date of insemination, menstrual-cycle day, and sex outcome to the sex ratio. Possible causes for natural variations in the sex ratio should also be investigated.

Several investigators (Trumpet al., 1976; Nayler, 1981; Nayler and Grinwald, 1981; J. G. Murphyet al., 1987) have suggested that the movement and redistribution of cellular ion contents, especially calcium, play a key role in the pathophysiology of cardiac ischemia. Since 1982 (Murphyet al.) our investigations have focused on the study of subcellular ionic mechanisms underlying this pathophysiology. We have utilized a model system of heart cells grown in culture to obtain basic information about (1) the regulation of ion transport in cardiac cells (Liebermanet al., 1984) and (2) the relationship between maintenance of ionic homeostasis, metabolic integrity, and the onset of irreversible cell injury (Liebermanet al., 1985).

Cytosolic free magnesium concentration [Mg2+]i and its regulation were studied in cultured embryonic chicken heart cells by use of the fluorescent indicator 2-[2-(5-carboxy)oxazole]-5-hydroxy-6-aminobenzofuran-N,N,O-triacet ic acid (Furaptra). The intracellular location of Furaptra was confirmed by its complete release from cells upon addition of saponin. The basal [Mg2+]i, which averaged 0.48 +/- 0.03 mM (n = 31), increased 3-fold on perfusion with sodium-free solution. This increase could not simply be attributed to intracellular sodium-extracellular magnesium exchange because a similar increase in [Mg2+]i occurred with magnesium-free, sodium-free perfusion. Furthermore, the increase in [Mg2+]i was largely attenuated when calcium was removed from the sodium-free perfusate. Thus, a substantial part of the increase in [Mg2+]i that occurs upon sodium-free perfusion is dependent on an increase in cytosolic free calcium (intracellular sodium-extracellular calcium exchange). The data suggest that [Mg2+]i is altered by calcium, most likely due to a competition for intracellular binding sites.

While the primary, culturally endorsed prototype for parenthood in the United States is one of marriage, followed by conception and birth, recent studies (U.S. Bureau of the Census, 1969; U.S. Department of Health, Education, and Welfare, 1968a) have shown substantial departure from this traditional childbearing pattern and deviations in timing within different patterns. Two deviations of the marriage-conception-birth sequence will be considered here: premaritally conceived births (babies who were conceived before the marriage of their biological parents but whose birth certificate was registered as legitimate, i.e., carrying nondiscrepant parent surnames), and out-of-wedlock births (babies who were conceived and born outside of marriage and whose birth certificate indicated no father's name or discrepant surnames for mother and father). Although in all past and present societies, some proportion of marital births occur soon after marriage and are likely to have been premaritally conceived (Monahan, 1960), the extent of premarital conception, the societal reaction, and personal and social consequences of the phenomenon have been noted to be different (Christensen, 1960). Premaritally conceived births in some countries are very common and have been interpreted as a component of a stable and integrated cultural pattern with few undesirable personal and social sequelae (Christensen, 1960; Croog, 1952), while in others the phenomenon is less frequent and is thought of as being socially deviant, necessitating hasty marriages and increasing the probability of marital dissolution (Christensen, 1960, 1963). Different timing patterns of conception after marriage and variations in frequency of premarital conception are generally considered as prime examples of cultural relativism in effect (Christensen, 1960). Cultural reactions to differential timing of birth after marriage must be distinguished from the historically dominant attitudes toward out-of-wedlock births. While most communities are relatively tolerant about nonmarital conceptions as long as marriage is forthcoming (Monahan, 1960), there is little historical evidence that any society has formally condoned illegitimate fertility (Davis, 1939; Malinowski, 1930).

The study reported on in this paper used a framework of benefits, challenges and solutions to categorize data from a design experiment using synchronous online communication for learning French as a second language (FSL). Participants were 92 Grade 6, FSL students and four teachers from urban and rural areas of Newfoundland, Canada. Data collection relied on online observation, teachers’ use of blogs and an online discussion forum, face-to-face planning and reflection meetings for teachers as well as interviews with all participants. Benefits included independence and peer-learning; authenticity and motivation; anonymity and confidence; enhanced self-esteem. Challenges related to teacher multi-tasking; poor sound quality; technical problems; momentum; grouping; scheduling. Solutions included use of student moderators; audio tutorials and direct messaging; activity tutorials; technical support and capacity building. The categories and their subcategories were grouped into two themes of positive affect and student-centered learning. Résumé : L’étude décrite dans le présent article a utilisé un cadre prenant en considération les bénéfices, les défis et les solutions afin de classer les données d’un dispositif expérimental utilisant la communication synchrone en ligne pour l’apprentissage du français langue seconde (FLS). Les participants étaient 92 élèves en FLS de sixième année et quatre enseignants de milieux urbains et ruraux de Terre-Neuve, Canada. La collecte des données s’est fondée sur l’observation en ligne, l’utilisation de cybercarnets et d’un forum de discussion en ligne par les enseignants, la planification en face-à-face et des réunions de réflexion pour les enseignants, ainsi que des entrevues avec tous les participants. Les bénéfices comprenaient : l’indépendance et l’apprentissage entre pairs; l’authenticité et la motivation; l’anonymat et la confiance; l’amélioration de l’estime de soi. Les défis se rapportaient à : la multiplicité des tâches incombant aux enseignants; la mauvaise qualité sonore; les problèmes techniques; la dynamique; le regroupement; la planification. Les solutions incluaient : l’utilisation d’élèves à titre de modérateurs; les tutoriels audio et la messagerie directe; le renforcement des capacités; les tutoriels d’activités. Les catégories et leurs sous-catégories ont été regroupées en deux thèmes, soit l’affect positif et l’apprentissage centré sur l’élève.

This paper provides an illustrative example of an approach to creating and reporting individual profiles of engagement in particular behaviours in an online asynchronous discussion (OAD). Individual results of analysis of transcripts of an OAD can provide insights different from those gained by focusing on aggregate measures of group behaviours. In this case, we focused on individual behaviours associated with Problem Formulation and Resolution (PFR) in a one-month long OAD with seven graduate students. The transcripts of each participant were analysed for patterns of PFR behaviours using a previously designed instrument. Individual profiles of the seven participants were created. The paper provides examples of how the approach facilitated identification and comparison of individual weaknesses and strengths. Also provided are examples of how individual profiles might be useful in professional development and instructional contexts for formative or summative assessment purposes.

This paper presents one of five categories of findings of a qualitative study of students' experiences of challenges encountered in a web-based graduate program. The findings relate to the category of experiences with online asynchronous discussions. Data collection relied on a discussion, questionnaire and interview all conducted within WebCTTM. The category's findings were grouped into four sub-categories of challenges as follows: student behaviour; text-only, online communication; purpose and quality of the discussion; and forum features. Challenges related to students' behaviour included domination of the discussion by individual students or groups of students resulting in feelings of exclusion, frustration and inadequacy. Text-only communication caused difficulties related to misinterpretation and conveying and deriving intent. Challenges related to the purpose and value of the discussion resulted from low quality and high quantities of postings to meet grade requirements. Technical features that presented challenges included the inability to delete messages.

ed summaries and general concepts can be formulated, which may, upon further investigation, be found to be germane to a wider variety of settings. Case studies, therefore are not necessarily restricted

Objectives: Supplementary prescribing (SP) represents a recent development in non-medical prescribing in the UK, involving a tripartite agreement between independent medical prescriber, dependent prescriber and patient, enabling the dependent prescriber to prescribe in accordance with a patient-specific clinical management plan (CMP). The aim in this paper is to review, thematically, the literature on nurse and pharmacist SP, to inform further research, policy and education. Methods: A review of the nursing and pharmacy SP literature from 1997 to 2007 was undertaken using searches of electronic databases, grey literature and journal hand searches. Results: Nurses and pharmacists were positive about SP but the medical profession were more critical and lacked awareness/understanding, according to the identified literature. SP was identified in many clinical settings but implementation barriers emerged from the empirical and anecdotal literature, including funding problems, delays in practicing and obtaining prescription pads, encumbering clinical management plans and access to records. Empirical studies were often methodological weaknesses and under-evaluation of safety, economic analysis and patients' experiences were identified in empirical studies. There was a perception that nurse and pharmacist independent prescribing may supersede supplementary prescribing. Conclusions: There is a need for additional research regarding SP and despite nurses' and pharmacists' enthusiasm, implementation issues, medical apathy and independent prescribing potentially undermine the success of SP. Refereed/Peer-reviewed