The influence of patient characteristics on healthcare-seeking behavior : a multilevel analysis of 70 primary care practices in urban-suburban regions in Malta

This work was co-financed by the European Commission in the 7th Framework Programme under the Grant Agreement Number 242141.Background: Social homogeneity and an almost indiscernible rural-urban difference are generally assumed to be strong factors that reduce any tendency for health inequities in a small island community. A strong primary health care system is one of the components that protect populations against inequities. Aim: The aim of this study was to examine healthcare- seeking behaviour in urban and suburban regions in Malta. Methods: The dataset of the Maltese arm of the QUALICOPC Project was analysed. A descriptive, cross- sectional study was designed. Seventy practicing general practitioners were selected randomly from the Malta Medical Council Family Medicine register after systematically removing the inactive practices. Ten patients presenting quasi-randomly in each primary care clinic completed a self- administered questionnaire. The chi-square test was used to test for differences in demographic and health care characteristics between the urban and suburban primary health care service. Generalized Linear and Latent Mixed Models (GLLAMM) were used to perform the multilevel analysis using Stata/SE version 12. Results: None of the 4 predictors (patients’ primary or secondary educational level, age and gender) emerged to be significant for coping better with illness after GP visit. 82% of the total variance in this response (Yes/No) was between patients, 13% was between clinics and 5% between regions. General practitioners offered more health promotion services and asked more about polypharmacy when their patients were older. Conclusion: Such findings provide information for policy makers to improve equity and resource allocations within the setting of urban Malta to help improve patients’ outcomes, particularly for the at-risk or vulnerable population.peer-reviewe

Comparison of patients’ experiences in public and private primary care clinics in Malta

Demographic changes, technological developments and rising expectations require the analysis of public–private primary care (PC) service provision to inform policy makers. We conducted a descriptive, cross-sectional study using the dataset of the Maltese arm of the QUALICOPC Project to compare the PC patients’ experiences provided by public-funded and private (independent) general practitioners in Malta. Seven hundred patients from 70 clinics completed a self-administered questionnaire. Direct logistic regression showed that patients visiting the private sector experienced better continuity of care with more difficulty in accessing out-of-hours care. Such findings help to improve (primary) healthcare service provision and resource allocation.peer-reviewe

Classifying Defects in Pallet Stringers by Ultrasonic Scanning

Detecting and classifying defects are required to grade and sort pallet parts. Use of quality parts can extend the life cycle of pallets and can reduce long-term cost. An investigation has been carried out to detect and classify defects in yellow-poplar (Liriodendron tulipifera, L.) and red oak (Quercus rubra, L.) stringers using ultrasonic scanning. Data were collected for sound and unsound knots, bark pockets, decay, holes, and wane using rolling transducers in a pitch-catch arrangement. Data from eight ultrasonic variables—energy, pulse length, time of flight (TOF)-amplitude, TOF-energy, TOF-centroid, energy value, energy pulse value, and peak frequency—were used to classify defects. Three different types of classifiers were used to categorize defects—a multi-layer perceptron network (MLP), a probabilistic neural network (PNN), and a k-nearest neighbor (KNN) classifier. Mean values for the energy variables demonstrated statistically significant differences between clear wood and defects and among defect types. Mean values for the TOF variables did not differ significantly between clear wood and knots. All three types of classifiers were able to distinguish defected from clear wood in oak with accuracies above 95%; accuracies for yellow-poplar were somewhat lower for the MLP and PNN classifiers. Among the defect classes, decay exhibited the highest recognition rate for both yellow-poplar and oak. Wane and holes in oak were readily confused owing to their common loss of transducer contact. Overall accuracy at the data-point level varied from 69-78%. Simple post-processing operations are expected to improve that substantially. Based on accuracy performance alone, the MLP and KNN appear equally preferable for this task

IEX-1 directly interferes with RelA/p65 dependent transactivation and regulation of apoptosis

The early response gene IEX-1 plays a complex role in the regulation of apoptosis. Depending on the cellular context and the apoptotic stimulus, IEX-1 is capable to either enhance or suppress apoptosis. To further dissect the molecular mechanisms involved in the modulation of apoptosis by IEX-1, we analysed the molecular crosstalk between IEX-1 and the NF-kappa B pathway. Using GST-pulldown assays, a direct interaction of IEX-1 with the C-terminal region of the subunit RelA/p65 harbouring the transactivation domain of the NF-kappa B transcription factor was shown. This interaction negatively regulates RelA/p65 dependent transactivation as shown by GAL4-and luciferase assay and was confirmed for the endogenous proteins by co-immunoprecipitation experiments. Using deletion constructs, we were able to map the C-terminal region of IEX-1 as the critical determinant of the interaction with RelA/p65. We could further show, that IEX-1 mediated NF-kappa B inhibition accounts for the reduced expression of the anti-apoptotic NF-kappa B target genes Bc1-2, Bcl-xL, cIAP1 and cIAP2, thereby sensitizing cells for apoptotic stimuli. Finally, ChIP-assays revealed that IEX-1 associates with the promoter of these genes. Altogether, our findings suggest a critical role of IEX-1 in the NF-kappa B dependent regulation of apoptotic responses. (C) 2007 Elsevier B.V All rights reserved

DNA Looping Kinetics Analyzed Using Diffusive Hidden Markov Model

Tethered particle experiments use light microscopy to measure the position of a micrometer-sized bead tethered to a microscope slide via a ~micrometer length polymer, in order to infer the behavior of the invisible polymer. Currently, this method is used to measure rate constants of DNA loop formation and breakdown mediated by repressor protein that binds to the DNA. We report a new technique for measuring these rates using a modified hidden Markov analysis that directly incorporates the diffusive motion of the bead, which is an inherent complication of tethered particle motion because it occurs on a time scale between the sampling frequency and the looping time. We compare looping lifetimes found with our method, which are consistent over a range of sampling frequencies, to those obtained via the traditional threshold-crossing analysis, which vary depending on how the raw data are filtered in the time domain. Our method does not involve such filtering, and so can detect short-lived looping events and sudden changes in looping behavior.Comment: 3 page pdf including 3 figures corrections: 2nd page, 1st column, values of diffusion coefficient, spring constant and the decay time were typed incorrectly. No conlcusions were affecte

Narcissistic Self-Sorting of n-Acene Nano-Ribbons yielding Energy-Transfer and Electroluminescence at p-n Junctions

The 2,3-didecyloxy-derivative of an n-type anthracene (n-BG) and a p-type tetracene (p-R) have been synthesized and their self-assembly into nano-ribbons studied. Hyperspectral fluorescence imaging revealed their narcissistic self-sorting, leading to separated nanoribbons emitting with very different colors (blue or green for n-BG, depending on the growth solvent, and red for p-R). It is unique that the usual origins of self-sorting, such as specific H-bonding, different growth kinetics, or incompatible steric hindrance can be ruled out. Hence, the narcissistic behaviour is herein proposed to originate from a sofar unconsidered cause: the discrepancy between the quadrupolar character of n-BG and dipolar character of p-R. At the pn-junctions of these nanoribbons, inter-ribbon FRET and electro-luminescence switch-on were observed by fluorescence microscopy.Modulation of Organic Optic Information InterfacesFabrication Supramoléculaire de Dispositifs OLED Haute Résolution par voie ImprimableSoft Materials Advanced Research Training Networ

Narcissistic self-sorting of n-acene nano-ribbons yielding energy-transfer and electroluminescence at p–n junctions

The 2,3-didecyloxy derivative of an n-type anthracene (n-BG) and a p-type tetracene (p-R) have been synthesized and their self-assembly into nano-ribbons studied. Hyperspectral fluorescence imaging revealed their narcissistic self-sorting, leading to separated nanoribbons emitting with very different colors (blue or green for n-BG, depending on the growth solvent, and red for p-R). It is unique that the usual origins of self-sorting, such as specific H-bonding, different growth kinetics, or incompatible steric hindrance can be ruled out. Hence, the narcissistic behaviour is herein proposed to originate from a so-far unconsidered cause: the discrepancy between the quadrupolar character of n-BG and dipolar character of p-R. At the p–n junctions of these nanoribbons, inter-ribbon FRET and electro-luminescence switch-on were observed by fluorescence/luminescence microscopy.Fabrication Supramoléculaire de Dispositifs OLED Haute Résolution par voie ImprimableModulation of Organic Optic Information Interface

Analysis of the 10q11 Cancer Risk Locus Implicates MSMB and NCOA4 in Human Prostate Tumorigenesis

Genome-wide association studies (GWAS) have established a variant, rs10993994, on chromosome 10q11 as being associated with prostate cancer risk. Since the variant is located outside of a protein-coding region, the target genes driving tumorigenesis are not readily apparent. Two genes nearest to this variant, MSMB and NCOA4, are strong candidates for mediating the effects of rs109939934. In a cohort of 180 individuals, we demonstrate that the rs10993994 risk allele is associated with decreased expression of two MSMB isoforms in histologically normal and malignant prostate tissue. In addition, the risk allele is associated with increased expression of five NCOA4 isoforms in histologically normal prostate tissue only. No consistent association with either gene is observed in breast or colon tissue. In conjunction with these findings, suppression of MSMB expression or NCOA4 overexpression promotes anchorage-independent growth of prostate epithelial cells, but not growth of breast epithelial cells. These data suggest that germline variation at chromosome 10q11 contributes to prostate cancer risk by influencing expression of at least two genes. More broadly, the findings demonstrate that disease risk alleles may influence multiple genes, and associations between genotype and expression may only be observed in the context of specific tissue and disease states

An Acidic Motif Retains Vesicular Monoamine Transporter 2 on Large Dense Core Vesicles

The release of biogenic amines from large dense core vesicles (LDCVs) depends on localization of the vesicular monoamine transporter VMAT2 to LDCVs. We now find that a cluster of acidic residues including two serines phosphorylated by casein kinase 2 is required for the localization of VMAT2 to LDCVs. Deletion of the acidic cluster promotes the removal of VMAT2 from LDCVs during their maturation. The motif thus acts as a signal for retention on LDCVs. In addition, replacement of the serines by glutamate to mimic phosphorylation promotes the removal of VMAT2 from LDCVs, whereas replacement by alanine to prevent phosphorylation decreases removal. Phosphorylation of the acidic cluster thus appears to reduce the localization of VMAT2 to LDCVs by inactivating a retention mechanism