Although Actinobacillus actinomycetemcomitans has been recognized as a primary etiological agent in localized juvenile periodontitis, questions remain concerning the source of infection, mode of transmission, and relative virulence of strains. DNA fingerprinting analysis, using a randomly cloned chromosomal DNA fragment as a probe, revealed that previously characterized strains of A. actinomycetemcomitans displayed significant restriction site heterogeneity which could be applied to the typing of clinical isolates of this bacterium such that individual strains or variants could be traced within subjects from localized juvenile periodontitis families. Hybridization data derived from an analysis of bacterial isolates obtained from families participating in an ongoing longitudinal study of the disease showed that a single individual could be infected with more than one strain or variant of A. actinomycetemcomitans and that various members of the same family could harbor different strains or variants of the bacterium. In several cases the clinical isolates were matched to characterized laboratory strains by comparing hybridization patterns generated by digestion of the DNA with several restriction enzymes in independent reactions. Thus, probe-specific DNA fingerprinting of A. actinomycetemcomitans will permit us to determine if particular strains or variants are frequently associated with sites of periodontal destruction. Attention could then be focused on determining the virulence properties of those strains or variants that have in vivo significance.

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Objective. To measure changes in pharmacy and medical students' physician-pharmacist collaboration scores resulting from a workshop designed to promote understanding of the others' roles in health care. Methods. More than 88% of first-year pharmacy (n 5 215) and medical (n 5 205) students completed the Scale of Attitudes Toward Physician-Pharmacist Collaboration on 3 occasions in order to establish a baseline of median scores and to determine whether the scores were influenced by an interprofessional workshop. Results. Participation in the interprofessional workshop increased pharmacy students' collaboration scores above baseline (p50.02) and raised the scores of medical students on the education component of the collaboration survey instrument (p50.015). The collaboration scores of pharmacy students greatly exceeded those of medical students (p,0.0001). Conclusion. A workshop designed to foster interprofessional understanding between pharmacy and medical students raised the physician-pharmacist collaboration scores of both. Crucial practical goals for the future include raising the collaboration scores of medical students to those of pharmacy students.

Objective. To determine the impact of performing critical-thinking and reflection assignments within interdisciplinary learning teams in a biochemistry course on pharmacy students' and prospective health professions students' collaboration scores. Design. Pharmacy students and prospective medical, dental, and other health professions students enrolled in a sequence of 2 required biochemistry courses. They were randomly assigned to interdisciplinary learning teams in which they were required to complete case assignments, thinking and reflection exercises, and a team service-learning project. Assessment. Students were asked to complete the Scale of Attitudes Toward Physician-Pharmacist Collaboration prior to the first course, following the first course, and following the second course. The physician-pharmacist collaboration scores of prospective health professions students increased significantly ( p,0.001). Conclusions. Having prospective health professions students work in teams with pharmacy students to think and reflect in and outside the classroom improves their attitudes toward physician-pharmacist collaboration.

Diabetes is a complex and progressive disease that has a major societal and economic impact. The most common form of diabetes, type 2 diabetes mellitus (T2DM), is a multifactorial disease, the pathophysiology of which involves not only the pancreas but also the liver, skeletal muscle, adipose tissue, gastrointestinal tract, brain, and kidney. Novel therapies with mechanisms of action that are different from most existing drugs are emerging. One such class consists of compounds that inhibit renal sodium-glucose cotransporter 2, which is responsible for the bulk of glucose reabsorption by the kidneys. This new class of compounds improves glycemic control independently of insulin and promotes weight reduction, providing an additional tool to treat patients with T2DM. This review discusses the underlying pathophysiology of T2DM, clinical guidelines, and available and emerging treatment options, with particular emphasis on sodium-glucose cotransporter 2 inhibitors.

Summary What is known and Objective:  Incretin‐based glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) and dipeptidyl peptidase‐4 (DPP‐4) inhibitor therapies provide glycaemic control with reduced risks associated with weight gain or hypoglycaemia. Incretin therapies are compared with their mechanisms of action, effects on haemoglobin A1C (HbA1C), fasting plasma glucose (FPG), post‐prandial glucose (PPG), body weight, β‐cell function, cardiovascular biomarkers and in their safety profiles to aid clinicians in the selection of individualized pharmacotherapy for patients with type 2 diabetes. Methods:  Relevant articles for a systematic review were identified through PubMed. Randomized, head‐to‐head comparison studies among incretin therapies were identified and included in the review. Additionally, randomized, controlled monotherapy and combination therapy studies examining glycaemic and extraglycaemic effects of individual incretin therapies from 2007 to 2011 were reviewed. Results and Discussion:  Glucagon‐like peptide‐1 receptor agonists are generally preferred over DPP‐4 inhibitors because of their greater effectiveness in reducing HbA1C, FPG and PPG excursions, and greater weight loss potentiation. As a monotherapy option, longer‐acting GLP‐1 RAs, including liraglutide and exenatide once‐weekly, may be preferred at higher HbA1C because of their more pronounced effects on FPG. At lower/near normal HbA1C, a short‐acting GLP‐1 RA, such as exenatide twice‐daily, may be a better choice as its effects are more pronounced with PPG. Ideal patients or patient situations for DPP‐4 inhibitors include patients who need minimal reduction in HbA1C, elderly patients, patients who are unwilling or unable to take an injectable agent, when GLP‐1 RAs are contraindicated or when the patient will not benefit from weight loss. Treatment benefits common to all incretin‐based therapies include minimal hypoglycaemia risk, potential preservation of β‐cell function and effective targeting of multiple organs underlying type 2 diabetes and of comorbidities commonly associated with type 2 diabetes, such as obesity and hypertension. What is new and Conclusion:  Key differences in mechanisms of action and in glycaemic and extra‐glycaemic treatment outcomes exist among incretin therapies, both within the GLP‐1 RA class, and between GLP‐1 RAs and DPP‐4 inhibitors. Clinical judgment acknowledging important differences among incretin therapies and treatment‐related patient characteristics will aid in the selection of the appropriate incretin agent for individualized pharmacotherapy.

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