RESUMO
Dietary variation within and across species drives the eco-evolutionary responsiveness of genes necessary to metabolize nutrients and other components. Recent evidence from humans and other mammals suggests that sugar-rich diets of floral nectar and ripe fruit have favoured mutations in, and functional preservation of, the ADH7 gene, which encodes the ADH class 4 enzyme responsible for metabolizing ethanol. Here we interrogate a large, comparative dataset of ADH7 gene sequence variation, including that underlying the amino acid residue located at the key site (294) that regulates the affinity of ADH7 for ethanol. Our analyses span 171 mammal species, including 59 newly sequenced. We report extensive variation, especially among frugivorous and nectarivorous bats, with potential for functional impact. We also report widespread variation in the retention and probable pseudogenization of ADH7. However, we find little statistical evidence of an overarching impact of dietary behaviour on putative ADH7 function or presence of derived alleles at site 294 across mammals, which suggests that the evolution of ADH7 is shaped by complex factors. Our study reports extensive new diversity in a gene of longstanding ecological interest, offers new sources of variation to be explored in functional assays in future study, and advances our understanding of the processes of molecular evolution.
RESUMO
OBJECTIVE: To describe the development and challenges of a pharmacist-directed peer support program among adolescents with diabetes. PRACTICE DESCRIPTION: The program was designed as adjunctive therapy for adolescents receiving care at the Diabetes Education and Research Center (DERC). DERC is an interdisciplinary facility at which the clinical pharmacist provides direct, diabetes-related patient care services. Through collaboration with DERC, pharmacists developed and facilitated each component of the program. PRACTICE INNOVATION: The U. S. Diabetes Conversation Map program was used for the educational component of the program. This is an innovative, American Diabetes Association-approved tool for providing group education on diabetes self-management. As trained facilitators of the conversation maps, the investigators educated group leaders on how to be facilitators for their peers. MAIN OUTCOME MEASURES: Glycosylated hemoglobin (A1C), diabetes self-management skills, and diabetes-related quality of life were measured at baseline and following program completion. Qualitative outcomes were measured via validated questionnaires in adolescents with type 1 diabetes. The investigators facilitated the gathering of all quantitative and qualitative data. RESULTS: Several participants did not meet all inclusion criteria; therefore, data from only six participants were assessed. A1C increased among participants, affirming the challenge of metabolic control during adolescence. Despite this, qualitative analysis of questionnaires revealed improvements in adherence to lifestyle modifications and health perception after program completion. CONCLUSION: Evidence illustrates beneficial effects of peer-facilitated support on the physical and psychological challenges of diabetes self-management; however, challenges existed when implementing this program among adolescents. Suggestions to overcome these challenges include same-sex support groups, use of an appealing setting for participants, incorporation into camps or after-school programs, and extended program length. Pharmacists are well equipped to assist individuals in comprehensive diabetes management programs such as the one described here because of their education and training in medication management, therapeutic lifestyle changes, and patient communication.
