Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

<p>Abstract</p> <p>Background</p> <p>Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain.</p> <p>Methods</p> <p>This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months</p> <p>Results</p> <p>A total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM.</p> <p>Conclusion</p> <p>The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.</p

Structural basis for the binding of IRES RNAs to the head of the ribosomal 40S subunit

Some viruses exploit internal initiation for their propagation in the host cell. This type of initiation is facilitated by structured elements (internal ribosome entry site, IRES) upstream of the initiator AUG and requires only a reduced number of canonical initiation factors. An important example are IRES of the virus family Dicistroviridae that bind to the inter-subunit side of the small ribosomal 40S subunit and lead to the formation of elongation-competent 80S ribosomes without the help of any initiation factor. Here, we present a comprehensive functional and structural analysis of eukaryotic-specific ribosomal protein rpS25 in the context of this type of initiation and propose a structural model explaining the essential involvement of rpS25 for hijacking the ribosome

Influence of Hyper-Alkaline pH Leachate on Mineral and Porosity Evolution in the Chemically Disturbed Zone Developed in the Near-Field Host Rock for a Nuclear Waste Repository

This paper evaluates the effect of hyper-alkaline (NaOH/KOH) leachate on the mineralogy and porosity of a generic quartzo-feldspathic host rock for intermediate- and low-level nuclear waste disposal following permeation of the cementitious repository barrier by groundwater. The analysis is made with reference to expected fluid compositions that may develop by contact of groundwater with the cementitious barrier to form a chemically disturbed zone (CDZ) in the adjacent host rock, as informed by relevant natural analogue sites. Theoretical analysis and numerical modelling is used to explore the influence of different host rock mineral assemblages on changes in pore fluid chemistry, multiple mineral dissolution and precipitation reactions and matrix porosity within the CDZ under these conditions. The numerical modelling accounts for kinetic and surface area effects on the mineral transformation and porosity development for periods of up to 10,000 years travel time from the repository and ambient temperature of 20∘C. The analysis shows that dissolution of quartz, feldspar and muscovite in the host rock, by the hyper-alkaline waste leachate, will create relatively high concentrations of dissolved Si and Al in the pore fluid, which migrates as chemical fronts within the CDZ. Precipitation of secondary mineral phases is predicted to occur under these conditions. The increase in matrix porosity that arises from dissolution of primary aluminosilicate minerals is compensated by a reduction in porosity due to precipitation of the secondary phases, but with a net overall increase in matrix porosity. These coupled physical and geochemical processes are most important for contaminant transport in the near-field zone of the CDZ and are eventually buffered by the host rock within 70 m of the repository for the 10,000 year travel time scenario. The predicted changes in matrix porosity may contribute to increased transport of radionuclides in the host rock, in the absence of attenuation by other mechanisms in the CDZ

Modelling of multi-minerals kinetic evolution in hyper-alkaline leachate for a 15-year experiment

Cement has been widely used for low- to intermediate-level radioactive waste management; however, the long-term modelling of multiple mineral transfer between the cement leachate and the host rock of a geological disposal facility remains a challenge due to the strong physical-chemical interactions within the chemically disturbed zone. This paper presents a modelling study for a 15-year experiment simulating the reaction of crystalline basement rock with evolved near-field groundwater (pH = 10.8). A mixed kinetic equilibrium (MKE) modelling approach was employed to study the dolomite-rich fracture-filling assemblage reacting with intermediate cement leachate. The study found that the mineralogical and geochemical transformation of the system was driven by the kinetically controlled dissolution of the primary minerals (dolomite, calcite, quartz, k-feldspar and muscovite). The initial high concentration of calcium ions appeared to be the main driving force initiating the dedolomitization process, which played a significant role in the precipitation of secondary talc, brucite and Mg-aluminosilicate minerals. The modelling study also showed that most of the initially precipitated calcium silicon hydrate phases redissolved and formed more stable calcium silicon aluminium hydrate phases. The findings highlight the importance of a deep and insightful understanding of the geochemical transformations based on the type and characteristics of the host rock, where the system is under out of equilibrium conditions, and the rates of mineral reactions

Ein erweitertes Marktzinsmodell: Matrixdarstellung und Ablaufdiagramm

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