Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: identification of risk factors, preventive factors and key elements for treatment--a cohort study

Background Chronic localized pain syndromes, especially chronic low back pain (CLBP), are common reasons for consultation in general practice. In some cases chronic localized pain syndromes can appear in combination with chronic widespread pain (CWP). Numerous studies have shown a strong association between CWP and several physical and psychological factors. These studies are population-based cross-sectional and do not allow for assessing chronology. There are very few prospective studies that explore the predictors for the onset of CWP, where the main focus is identifying risk factors for the CWP incidence. Until now there have been no studies focusing on preventive factors keeping patients from developing CWP. Our aim is to perform a cross sectional study on the epidemiology of CLBP and CWP in general practice and to look for distinctive features regarding resources like resilience, self-efficacy and coping strategies. A subsequent cohort study is designed to identify the risk and protective factors of pain generalization (development of CWP) in primary care for CLBP patients. Methods/Design Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months). Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly) for pain generalization (outcome: incident CWP). Discussion This cohort study will be the largest study which prospectively analyzes predictors for transition from CLBP to CWP in primary care setting. In contrast to the typically researched risk factors, which increase the probability of pain generalization, this study also focus intensively on protective factors, which decrease the probability of pain generalization.

Structural model of the CopA copper ATPase of Enterococcus hirae based on chemical cross-linking

The CopA copper ATPase of Enterococcus hirae belongs to the family of heavy metal pumping CPx-type ATPases and shares 43% sequence similarity with the human Menkes and Wilson copper ATPases. Due to a lack of suitable protein crystals, only partial three-dimensional structures have so far been obtained for this family of ion pumps. We present a structural model of CopA derived by combining topological information obtained by intramolecular cross-linking with molecular modeling. Purified CopA was cross-linked with different bivalent reagents, followed by tryptic digestion and identification of cross-linked peptides by mass spectrometry. The structural proximity of tryptic fragments provided information about the structural arrangement of the hydrophilic protein domains, which was integrated into a three-dimensional model of CopA. Comparative modeling of CopA was guided by the sequence similarity to the calcium ATPase of the sarcoplasmic reticulum, Serca1, for which detailed structures are available. In addition, known partial structures of CPx-ATPase homologous to CopA were used as modeling templates. A docking approach was used to predict the orientation of the heavy metal binding domain of CopA relative to the core structure, which was verified by distance constraints derived from cross-links. The overall structural model of CopA resembles the Serca1 structure, but reveals distinctive features of CPx-type ATPases. A prominent feature is the positioning of the heavy metal binding domain. It features an orientation of the Cu binding ligands which is appropriate for the interaction with Cu-loaded metallochaperones in solution. Moreover, a novel model of the architecture of the intramembranous Cu binding sites could be derived.

Tracks of immigrant political incorporation

Models of Immigrant Political Incorporation brings together a multidisciplinary group of scholars to consider pathways by which immigrants may be incorporated into the political processes of western democracies. It builds on a rich tradition of studying immigrant incorporation, but each chapter innovates by moving beyond singular accounts of particular groups and locations toward a general causal model with the scope and breadth to apply across groups, places, and time. Models of Immigrant Political Incorporation addresses three key analytic questions: what, if anything, are the distinctive features of immigrants or immigrant groups? How broadly should one define and study politics? What are the initial premises for analyzing pathways toward incorporation; does one learn more by starting from an assumption of racialization and exclusion or from an assumption of engagement and inclusion? While all models engage with all three key analytic questions, chapters vary in their relative focus on one or another, and in the answers they provide. Most include graphical illustrations of the model, as well as extended examples applying the model to one or more immigrant populations. At a time when research on immigrant political incorporation is rapidly accumulating - and when immigrants are increasingly significant political actors in many democratic polities — this volume makes a timely and valuable intervention by pushing researchers to articulate causal dynamics, provide clear definitions and measurable concepts, and develop testable hypotheses. Furthermore, the wide array of frameworks examining how immigrants become part of a polity or are shunted aside ensure that activists and analysts alike will find useful insights. By including historians, sociologists, and political scientists, by ranging across North America and Western Europe, by addressing successful and failed incorporative efforts, this handbook offers guides for anyone seeking to develop a dynamic, unified, and supple model of immigrant political incorporation.

The Yanque prospect (Peru): from polymetallic Zn-Pb mineralization to a nonsulfide deposit

The Yanque nonsulfide Pb-Zn deposit (inferred resources 12.5 Mt @ 3.7% Pb and @ 3.5% Zn) is located in the Andahuaylas-Yauri ore province (Cuzco, southern Peru). The deposit occurs within a base metal mineralized district, centered on the medium-sized Dolores porphyry copper. A thorough geological, mineralogical and geochemical study has carried out in order to define: the relationships between the Dolores Cu-porphyry ore and the Yanque Zn-Pb polymetallic mineralization, and the characteristics of the economic nonsulfide concentrations. Both sedimentary and igneous rocks constitute the backbone of the Yanque-Dolores area. The sedimentary lithologies belong to the Soraya, Mara and Ferrobamba Fms. (upper Jurassic-middle Cretaceous). The Yanque orebody is hosted by the Mara Fm., which prevailingly consists of a siliciclastic sedimentary breccia. The original sulfide mineralization consisted of galena, pyrite and sphalerite. The host rock has been affected by a strong hydrothermal alteration, characterized by prevailing sericite/illite, as in the typical porphyry-related phyllic-argillic alteration stage, and by minor kaolinite, dolomite and quartz. Minor element geochemistry, characterized by Sb, As, Mn, Ag and locally also by Cu, points to magmatic-hydrothermal related mineralizing fluids. The Pb isotopic compositions from Dolores and Yanque sulfides are similar, and are typical of the Tertiary magmatically-derived ores in this part of Peru. The hydrothermally altered rocks at Yanque have the same Pb isotopic compositions as the sulfides, thus confirming the hypothesis that the Yanque primary Zn-Pb mineralization may have been produced by hydrothermal circulation related to the emplacement of the Dolores Cu-porphyry, as it is the case of other porphyry Cu systems associated with polymetallic mineralization elsewhere. However, no simple genetic model for the mineralization involving just one fluid circulation episode is able to explain the data. The Yanque economic nonsulfide ore association consists of sauconite, hemimorphite, smithsonite and cerussite, which result from the weathering and alteration of the original sulfide mineralization. Zinc is allocated mainly in sauconite (Zn-smectite), rather than in carbonates: a factor strictly related to the prevailing siliciclastic character of the host rock. Distinctive features of the Yanque orebody are the comparable ore grades for both Pb and Zn (3.5% Zn and 3.7% Pb), and the inverse supergene chemical zoning. In fact, contrary to other supergene ores of this type, zinc prevails in the top zone of the Yanque deposit, whereas lead content increases with depth. Considering the different mobility of the two metals in solution, it may be assumed that most of the primary zinc that was the source for the Yanque nonsulfides was originally located far from the position occupied by the galena mineralization, whose remnants have been observed on site. Zinc sulfides may have been originally contained in the eroded rock volumes that surrounded the actual deposit: the zinc-rich solutions have possibly migrated through the siliciclastic Mara Fm. and precipitated the nonsulfide minerals by porosity filling and replacement processes. In this sense, the Yanque secondary Zn-Pb deposit could be considered as a special type of “Exotic” mineralization.

Radar investigations of Apollinaris Mons on Mars: Exploring the origin of the fan deposits

Apollinaris Mons is an isolated volcano on Mars straddling the boundary between the southern highlands and the northern plains. One of its most distinctive features is its massive fan-shaped deposit that extends from a breach on its summit to distances of more than 150 km and drapes its entire southern flank. The composition and formation mechanism of these deposits remains controversial. We investigate the radar properties of the fan deposits (FD) of Apollinaris Mons using low-frequency sounding radar data in combination with high-resolution images and crater-size frequency analysis to constrain their inner shape and bulk composition. Our analysis indicates that the FD attains an irregular thickness and is gradually thinner towards their lateral margins. The crater-size frequency analysis shows that they may have undergone repeated resurfacing, which is suggestive of long-term evolution. Our analysis of Shallow Radar (SHARAD) radargrams traversing different sections of the FD reveals multiple and different subsurface interfaces among the radargrams crossing the thinnest part, which suggests a layered and complex inner shape. Our estimates for the bulk real part of the dielectric constant of the FD ranges from 3 to 5, which is consistent with an icy-silicate mixture or pyroclastic composition. Therefore, we conclude that lahars or pyroclastic flows are the most likely mechanism that created the FD, yet we cannot rule out additional contributions from lava flows. A combination of multiple processes is also possible since the deposits appear to have been modified by fluvial processes at a later stage of their formation.

Export Restrictions on Critical Minerals and Metals: Testing the Adequacy of WTO Disciplines

Conventional wisdom on the insufficiency of existing WTO disciplines on export restrictions has triggered momentum on the issue. In this book, Ilaria Espa offers a comprehensive analysis of the scope and coverage of WTO disciplines on export restrictions in light of emerging case law. She investigates whether such rules still provide a credible and effective framework capable of preventing abuses in the use of export restrictive measures on critical minerals and metals during a period of economic crisis and change in international trade patterns. Giving a broad overview of the export restrictions applied to these materials, Espa identifies distinctive features in the proliferation of export barriers and analyses the existing WTO rules to reveal their gaps and inconsistencies. She goes on to present solutions based upon her findings with the aim of bringing more coherence and equity to WTO rules on the export side.

Astroblastoma with rhabdoid features and favorable long-term outcome: report of a case with a 12-year follow-up

Astroblastoma is a historically traded microscopic diagnosis to denote a rare neuroepithelial tumor of uncertain nosology, involving a distinctive pattern of pseudorosette arrangement of neoplastic cells. While displaying some glial properties, the latter shall not - by definition - be either reducible to or part of any conventional glioma type. We report on clinicopathologic correlations in a case of astroblastoma involving an extensive rhabdoid phenotype of tumor cells. The male patient was operated on at the age of 53 and 59 years for a left parietal tumor measuring 5.8 cm in diameter at the first presentation. On magnetic resonance imaging and angiography, both the primary and its recurrence were discrete, highly vascularized, and contrast-enhancing. The second surgery was complemented with radiotherapy of 66 Gy, followed by chemotherapy with Temozolomide. Twelve years into clinical history, the patient has stable minimal residual disease at the age of 65. A review of pathology samples from both surgeries showed well-differentiated astroblastoma according to current standards, with an MIB-1 labeling index of 1% and 4%, respectively. Neither of the specimens involved cellular anaplasia, overt mitotic activity, microvascular proliferation, or palisading necrosis. Most tumor cells harbored paranuclear filamentous rhabdoid inclusions that were immunostained for vimentin and, in part, also for GFAP. No polyantigenic reactivity was observed. This example contributes another facet to the spectrum of the so-called composite rhabdoid tumors. Involving a low-grade parent neoplasm, it also further substantiates the incipient perception that the rhabdoid phenotype neither is a peculiar but nonspecific convergence point of anaplastic evolution, nor are such lesions indiscriminately bound for a relentless course.