Team-based comanagement of diabetes in rural primary care.

OBJECTIVE: To explore clinical indicators among patients with diabetes in southern Alberta and assess changes over time, and to compare patients with diabetes attending a reference clinic (RC), which had adapted its service model to address the specific needs of the patient population, with patients with diabetes attending comparison clinics (CCs) in the same region. DESIGN: Analysis of longitudinal data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). SETTING: Rural southern Alberta. PARTICIPANTS: A community-based family medicine clinic and the 6 other CPCSSN clinics in the same region at the time of the study. MAIN OUTCOME MEASURES: A range of data elements from patients with diabetes within the RC, as well as from patients with diabetes from the CCs, were analyzed by CPCSSN to compare rates of comorbidity and mean body mass index, hemoglobin A1c levels, and blood pressure, as well as service use and measurement frequency. Rate of change per year was modeled longitudinally for each of the outcomes. RESULTS: The RC had higher proportions of patients with comorbid conditions and a consistently higher mean body mass index. Mean HbA1c levels varied minimally between the RC and CCs, with both sets worsening slightly. However, the rate of worsening among patients with diabetes in the RC was found to be significantly greater (P < .05) than for those in the CCs. Blood pressure also varied minimally between the RC and the CCs, with both sets improving; however, the RC had a significantly greater (P < .001) rate of improvement than the CCs did. Finally, a greater proportion of patients in the RC had complete data for these 3 outcome measures, and RC patients made a greater number of clinic visits compared with the CC patients (P < .001). CONCLUSION: This study describes a team-based comanagement organizational model and might provide useful commentary about organizational effectiveness in primary care. Although improvement in health outcomes cannot be directly attributed to any specific change in clinic organization, some statistically and likely clinically significant benefit was found associated with the service model of the RC in a relatively medically and socially challenged patient population and in a conservative evaluative design.

Recombinant expression of the beta-subunit of HLA-DR10 for the selection of novel lymphoma targeting molecules.

Selective high-affinity ligands (SHALs) were selected as substitutes for monoclonal antibodies (mAbs) to deliver radioisotopes to malignant tumors. Because a SHAL (5 KD) is considerably smaller in comparison to an antibody (150 KD), a significant therapeutic index (TI) enhancement for radioimmunotherapy (RIT) is anticipated. The antibody-antigen (Ab-Ag) model system chosen for the development of SHALs consists of Lym-1, a MAb with proven selectivity in non-Hodgkin's lymphoma (NHL) patients and its well-characterized Ag, the beta subunit of HLA DR10. Whereas Lym-1 is readily available, the subunit of HLA-DR10 is not. Native, heterodimeric (alpha and beta subunits) HLA-DR10 can be purified from Raji cells, which are known to overexpress this Ag. Inconsistent homogeneity between preparations of HLA-DR10 solubilized in the presence of detergents prompted us to express a recombinant form of the beta subunit of HLA-DR10 in Escherichia coli. Negligible production yields (

Generating short peptidic ligands for silver nanowires from phage display random libraries.

We report the generation of peptide ligands for silver nanowires using a linear 12-mer peptide phage display random library technique. Phage clones that specifically bind the silver nanowires are sequenced after three rounds of biopanning, and obtained DNA sequences suggest that there are a few conserved amino acid residues which may be critical for binding. A selected binding peptide, together with two mutant peptide sequences, were subsequently synthesized on Tentagel resins to examine the importance of both the identities and positions of the conserved amino acid residues.

Stereoselective synthesis and anti-inflammatory activities of 6- and 7-membered dioxacycloalkanes.

A class of 5-trifluoroacetylamino-1,3-dioxacycloalkanes, 5-benzoylamino-1,3-dioxacycloalkanes, and 5-amino-1,3-dioxacycloalkane compounds were stereoselectively synthesized as potential anti-inflammatory drug candidates. The anti-inflammatory activities of these compounds were tested using the xylene-induced mouse ear edema model, from which multiple compounds possessing anti-inflammatory properties which surpass aspirin were identified; these compounds were then compared to establish structure-activity relationships.