Search

BackgroundWe compared two implementation approaches for a health literacy diabetes intervention designed for community health centers.MethodsA quasi-experimental, clinic-randomized evaluation was conducted at six community health centers from rural, suburban, and urban locations in Missouri between August 2008 and January 2010. In all, 486 adult patients with type 2 diabetes mellitus participated. Clinics were set up to implement either: 1) a clinic-based approach that involved practice re-design to routinely provide brief diabetes education and counseling services, set action-plans, and perform follow-up without additional financial resources [CARVE-IN]; or 2) an outsourced approach where clinics referred patients to a telephone-based diabetes educator for the same services [CARVE-OUT]. The fidelity of each intervention was determined by the number of contacts with patients, self-report of services received, and patient satisfaction. Intervention effectiveness was investigated by assessing patient knowledge, self-efficacy, health behaviors, and clinical outcomes.ResultsCarve-out patients received on average 4.3 contacts (SD = 2.2) from the telephone-based diabetes educator versus 1.7 contacts (SD = 2.0) from the clinic nurse in the carve-in arm (p

The anisotropic and magic-angle fluorescence decay of the single tryptophan (Trp) residue of melittin, a bee venom peptide, is investigated by time-resolved fluorescence anisotropy using a streak camera setup. Decay-associated spectra of the isotropic fluorescence decay show three time components in the range of ~20 picoseconds, 500 picoseconds, and ~3500 picoseconds, respectively.

The photophysics of Trp (tryptophan) and Trp in a small 22-mer peptide is investigated using polarized fluorescence spectroscopy with picosecond time resolution. Both Trp alone and Trp in the peptide exhibit a multiexponential isotropic fluorescence decay that is associated with ground-state heterogeneity due to different rotamers of Trp.

Objective To systematically review mobile applications currently available to patients to support outpatient medication self-management. Methods Three online stores were searched in March 2013 using nine distinct search terms. Applications were selected if they supported general outpatient medication self-management for adults; they were excluded if they focused on only one medication or condition, provided only a medication list or reference, only ordered refills, were written in a non-English language, or were for local pharmacy/hospital patients only. A multi-step review process was utilized by two independent reviewers to identify eligible applications. A standardized form was used to abstract data. User reviews were compiled from a subsample of applications and qualitatively coded to identify common criticisms. Results 14 893 applications were initially identified. After the multi-step review process, 424 applications were deemed eligible for inclusion by reviewers (κ=0.85). On average, applications were rated 2.8 stars (out of 5) from 107 reviews. Almost all provided medication reminders (91.0%), half enabled patients to create a medication history or log (51.5%), and 22% could email the log to a third party. Few helped patients organize their regimen (6.2%), check for drug interactions (2.8%), or identify pills (4.0%). User reviews (N=1091) from the subsample of 26 applications revealed common criticisms, including technical malfunctions, poor compatibility with certain medications, and absence of desired features. Conclusions Hundreds of applications exist in the marketplace to support medication self-management. However, their quality, content, and functionality are highly variable. Research is needed to determine optimal capabilities, evaluate utility, and determine clinical benefit. [ABSTRACT FROM AUTHOR]

BACKGROUND: We compared two implementation approaches for a health literacy diabetes intervention designed for community health centers. METHODS: A quasi-experimental, clinic-randomized evaluation was conducted at six community health centers from rural, suburban, and urban locations in Missouri between August 2008 and January 2010. In all, 486 adult patients with type 2 diabetes mellitus participated. Clinics were set up to implement either: 1) a clinic-based approach that involved practice re-design to routinely provide brief diabetes education and counseling services, set action-plans, and perform follow-up without additional financial resources [CARVE-IN]; or 2) an outsourced approach where clinics referred patients to a telephone-based diabetes educator for the same services [CARVE-OUT]. The fidelity of each intervention was determined by the number of contacts with patients, self-report of services received, and patient satisfaction. Intervention effectiveness was investigated by assessing patient knowledge, self-efficacy, health behaviors, and clinical outcomes. RESULTS: Carve-out patients received on average 4.3 contacts (SD = 2.2) from the telephone-based diabetes educator versus 1.7 contacts (SD = 2.0) from the clinic nurse in the carve-in arm ( p < 0.001). They were also more likely to recall setting action plans and rated the process more positively than carve-in patients ( p < 0.001). Few differences in diabetes knowledge, self-efficacy, or health behaviors were found between the two approaches. However, clinical outcomes did vary in multivariable analyses; carve-out patients had a lower HbA1c ( β = −0.31, 95 % CI −0.56 to −0.06, p = 0.02), systolic blood pressure ( β = −3.65, 95 % CI −6.39 to −0.90, p = 0.01), and low-density lipoprotein (LDL) cholesterol ( β = −7.96, 95 % CI −10.08 to −5.83, p < 0.001) at 6 months. CONCLUSION: An outsourced diabetes education and counseling approach for community health centers appears more feasible than clinic-based models. Patients receiving the carve-out strategy also demonstrated better clinical outcomes compared to those receiving the carve-in approach. Study limitations and unclear causal mechanisms explaining change in patient behavior suggest that further research is needed. [ABSTRACT FROM AUTHOR]

Themolecular stacking of an artificial light-harvesting antennaself-assembled from 31-aminofunctionalized zinc-chlorinswas determined by solid-state NMR in combination with quantum-chemicaland molecular-mechanics modeling. A library of trial molecular stackingarrangements was generated based on available structural data fornatural and semisynthetic homologues of the Zn-chlorins. NMR assignmentsobtained for the monomer in solution were validated for self-assembledaggregates and refined with 1H–13C heteronuclearcorrelation spectroscopy data collected from samples with 13C at natural abundance. Solid-state ring-current shifts for the 1H provided spatial constraints to determine the molecularoverlap. This procedure allows for a discrimination between differentself-assembled structures and a classification of the stacking modein terms of electric dipole alignment and π–π interactions,parameters that determine the functional properties of light-harvestingassemblies and conducting nanowires. The combination with quantum-mechanicalmodeling then allowed building a low-resolution packing model in silicofrom molecular stacks. The method allows for moderate disorder andresidual polymorphism at the stack or molecular level and is generallyapplicable to determine molecular packing structures of aromatic moleculeswith structural asymmetry, such as is commonly provided by functionalizedside chains that serve to tune the self-assembly process. [ABSTRACT FROM AUTHOR]

Abstract: The light-harvesting complex II (LHCII) is the main component of the antenna system of plants and green algae and plays a major role in the capture of sun light for photosynthesis. The LHCII complexes have also been proposed to play a key role in the optimization of photosynthetic efficiency through the process of state 1–state 2 transitions and are involved in down-regulation of photosynthesis under excess light by energy dissipation through non-photochemical quenching (NPQ). We present here the first solid-state magic-angle spinning (MAS) NMR data of the major light-harvesting complex (LHCII) of Chlamydomonas reinhardtii, a eukaryotic green alga. We are able to identify nuclear spin clusters of the protein and of its associated chlorophyll pigments in 13C–13C dipolar homonuclear correlation spectra on a uniformly 13C-labeled sample. In particular, we were able to resolve several chlorophyll 131 carbon resonances that are sensitive to hydrogen bonding to the 131-keto carbonyl group. The data show that 13C NMR signals of the pigments and protein sites are well resolved, thus paving the way to study possible structural reorganization processes involved in light-harvesting regulation through MAS solid-state NMR. [Copyright &y& Elsevier]