A collaborative care model for patients with Type-2 diabetes.

The research on diabetes has shown the need to move from a traditional medical model to a patient-team orientation. This has led to a number of collaborative programs targeting the patient and family's comprehensive needs. This paper details one collaborative care program for underserved patients with Type-2 diabetes set in rural, eastern North Carolina. Roles of the therapeutic team are incorporated along with a case example highlighting the bio-psychosocial-spiritual model in action. Sustainability, challenges, and strengths are included to facilitate a realistic appraisal of the program.

Inositol 1,3,4,5,6-pentakisphosphate 2-kinase from maize: molecular and biochemical characterization.

Inositol 1,3,4,5,6-pentakisphosphate 2-kinase, an enzyme encoded by the gene IPK1, catalyzes the terminal step in the phytic acid biosynthetic pathway. We report here the isolation and characterization of IPK1 cDNA and genomic clones from maize (Zea mays). DNA Southern-blot analysis revealed that ZmIPK1 in the maize genome constitutes a small gene family with two members. Two nearly identical ZmIPK1 paralogs, designated as ZmIPK1A and ZmIPK1B, were identified. The transcripts of ZmIPK1A were detected in various maize tissues, including leaves, silks, immature ears, seeds at 12 d after pollination, midstage endosperm, and maturing embryos. However, the transcripts of ZmIPK1B were exclusively detected in roots. A variety of alternative splicing products of ZmIPK1A were discovered in maize leaves and seeds. These products are derived from alternative acceptor sites, alternative donor sites, and retained introns in the transcripts. Consequently, up to 50% of the ZmIPK1A transcripts in maize seeds and leaves have an interrupted open reading frame. In contrast, only one type of splicing product of ZmIPK1B was detected in roots. When expressed in Escherichia coli and subsequently purified, the ZmIPK1 enzyme catalyzes the conversion of myo-inositol 1,3,4,5,6-pentakisphosphate to phytic acid. In addition, it is also capable of catalyzing the phosphorylation of myo-inositol 1,4,6-trisphosphate, myo-inositol 1,4,5,6-tetrakisphosphate, and myo-inositol 3,4,5,6-tetrakisphosphate. Nuclear magnetic resonance spectroscopy analysis indicates that the phosphorylation product of myo-inositol 1,4,6-trisphosphate is inositol 1,2,4,6-tetrakisphosphate. Kinetic studies showed that the K(m) for ZmIPK1 using myo-inositol 1,3,4,5,6-pentakisphosphate as a substrate is 119 microm with a V(max) at 625 nmol/min/mg. These data describing the tissue-specific accumulation and alternative splicing of the transcripts from two nearly identical ZmIPK1 paralogs suggest that maize has a highly sophisticated regulatory mechanism controlling phytic acid biosynthesis.

Diminished emotionality and social functioning in schizophrenia.

There is indirect evidence to suggest that a subgroup of patients with schizophrenia exhibit a diminished capacity to experience both positive and negative emotions. To date however, no studies have focused specifically on this diminished emotionality (DE). The main objective of the present project was to determine whether patients with self-reported DE differed from other patients in level of social functioning, physical and social anhedonia, and negative/deficit symptoms. Seventy-three state hospital patients with DSM-IV diagnosed schizophrenia and 22 nonpsychiatric controls were examined. Results provided mixed support for the present hypotheses. Patients with self-reported DE (N = 10) versus those without (N = 63) had poorer social functioning, similar levels of physical and social anhedonia, and significantly less severe negative/deficit symptoms. Moreover, there was a substantial amount of discrepancy between patients' self-reported levels of emotionality and the ratings of their emotionality as made by trained observers. Implications of these results are discussed.