Targeted muscle reinnervation for the management of pain in the setting of major limb amputation

The life altering nature of major limb amputations may be further complicated by neuroma formation in up to 60% of the estimated 2 million major limb amputees in the United States. This can be a source of pain and functional limitation of the residual limb. Pain associated with neuromas may limit prosthetic limb use, require reoperation, lead to opioid dependence, and dramatically reduce quality of life. A number of management options have been described including excision alone, excision with repair, excision with transposition, and targeted muscle reinnervation. Targeted muscle reinnervation has been shown to reduce phantom limb and neuroma pain for patients with upper and lower extremity amputations. It may be performed at the time of initial amputation to prevent pain development or secondarily for the treatment of established pain. Encouraging outcomes have been reported, and targeted muscle reinnervation is emerging as a leading surgical technique for pain prevention in patients undergoing major limb amputations and pain management in patients with pre-existing amputations

The core planar cell polarity gene, Vangl2, directs adult corneal epithelial cell alignment and migration

This work was supported by a Biotechnology and Biological Sciences Research Council (BBSRC) DTG PhD studentship to A.F., an Anatomical Society PhD Studentship (‘The Roles of planar cell polarity genes in a classical anatomical system: the cornea’) to D.A.P./J.M.C. and BBSRC Project Grants BB/J015172/1 and BB/J015237/1 to J.D.W. and J.M.C., respectively.Peer reviewedPublisher PD

The UV, Optical, and IR Properties of SDSS Sources Detected by GALEX

We discuss the UV, optical, and IR properties of the SDSS sources detected by GALEX as part of its All-sky Imaging Survey Early Release Observations. Virtually all of the GALEX sources in the overlap region are detected by SDSS. GALEX sources represent ~2.5% of all SDSS sources within these fields and about half are optically unresolved. Most unresolved GALEX/SDSS sources are bright blue turn-off thick disk stars and are typically detected only in the GALEX near-UV band. The remaining unresolved sources include low-redshift quasars, white dwarfs, and white dwarf/M dwarf pairs, and these dominate the optically unresolved sources detected in both GALEX bands. Almost all the resolved SDSS sources detected by GALEX are fainter than the SDSS 'main' spectroscopic limit. These sources have colors consistent with those of blue (spiral) galaxies (u-r<2.2), and most are detected in both GALEX bands. Measurements of their UV colors allow much more accurate and robust estimates of star-formation history than are possible using only SDSS data. Indeed, galaxies with the most recent (<20 Myr) star formation can be robustly selected from the GALEX data by requiring that they be brighter in the far-UV than in the near-UV band. However, older starburst galaxies have UV colors similar to AGN, and thus cannot be selected unambiguously on the basis of GALEX fluxes alone. With the aid of 2MASS data, we construct and discuss median 10 band UV-optical-IR spectral energy distributions for turn-off stars, hot white dwarfs, low-redshift quasars, and spiral and elliptical galaxies. We point out the high degree of correlation between the UV color and the contribution of the UV flux to the UV-optical-IR flux of galaxies detected by GALEX.Comment: 35 pages, 11 figures, 3 tables; to appear in the AJ. PS with better figures available from http://www.astro.washington.edu/agueros/pub

Trends in the Population Prevalence of People Who Inject Drugs in US Metropolitan Areas 1992–2007

Background: People who inject drugs (PWID) have increased risk of morbidity and mortality. We update and present estimates and trends of the prevalence of current PWID and PWID subpopulations in 96 US metropolitan statistical areas (MSAs) for 1992–2007. Current estimates of PWID and PWID subpopulations will help target services and help to understand long-term health trends among PWID populations. Methodology: We calculated the number of PWID in the US annually from 1992–2007 and apportioned estimates to MSAs using multiplier methods. We used four types of data indicating drug injection to allocate national annual totals to MSAs, creating four distinct series of component estimates of PWID in each MSA and year. The four component estimates are averaged to create the best estimate of PWID for each MSA and year. We estimated PWID prevalence rates for three subpopulations defined by gender, age, and race/ethnicity. We evaluated trends using multi-level polynomial models. Results: PWID per 10,000 persons aged 15–64 years varied across MSAs from 31 to 345 in 1992 (median 104.4) to 34 to 324 in 2007 (median 91.5). Trend analysis indicates that this rate declined during the early period and then was relatively stable in 2002–2007. Overall prevalence rates for non-Hispanic black PWID increased in 2005 as compared to other racial/ethnic groups. Hispanic prevalence, in contrast, declined across time. Importantly, results show a worrisome trend in young PWID prevalence since HAART was initiated – the mean prevalence was 90 to 100 per 10,000 youth in 1992–1996, but increased to >120 PWID per 10,000 youth in 2006–2007. Conclusions: Overall, PWID rates remained constant since 2002, but increased for two subpopulations: non-Hispanic black PWID and young PWID. Estimates of PWID are important for planning and evaluating public health programs to reduce harm among PWID and for understanding related trends in social and health outcomes

A conserved filamentous assembly underlies the structure of the meiotic chromosome axis

The meiotic chromosome axis plays key roles in meiotic chromosome organization and recombination, yet the underlying protein components of this structure are highly diverged. Here, we show that 'axis core proteins' from budding yeast (Red1), mammals (SYCP2/SYCP3), and plants (ASY3/ASY4) are evolutionarily related and play equivalent roles in chromosome axis assembly. We first identify 'closure motifs' in each complex that recruit meiotic HORMADs, the master regulators of meiotic recombination. We next find that axis core proteins form homotetrameric (Red1) or heterotetrameric (SYCP2:SYCP3 and ASY3:ASY4) coiled-coil assemblies that further oligomerize into micron-length filaments. Thus, the meiotic chromosome axis core in fungi, mammals, and plants shares a common molecular architecture, and likely also plays conserved roles in meiotic chromosome axis assembly and recombination control

Planning for Project ECHO in New Hampshire

Assuring a healthy New Hampshire requires making sure that all of the state’s residents can get the right care in the right place at the right time. Yet, access to timely, effective health care is not always a given in our state, especially for vulnerable populations. Health and community care workforce shortages, long distances to care, and social, economic, and cultural barriers make accessing care challenging for many. The Project ECHO Model™ is an evidence-based method using web-based teleconferencing to link specialist teams with community-based sites to help community providers improve their ability to manage complex conditions. It has been proven to improve health care outcomes for vulnerable populations with limited access to care because of socioeconomic factors or geography. The New Hampshire Project ECHO® (Extension for Community Healthcare Outcomes) Planning for Implementation and Business Sustainability Project (Planning for Project ECHO in NH) undertook a planning process to inform how to best to develop Project ECHO at UNH to serve New Hampshire health and community care providers and ultimately improve access to effective, timely care. Planning for Project ECHO in NH also developed a business and sustainability plan for long-term success of the UNH Project ECHO Hub and an evaluation plan for measuring efficacy. Planning for Project ECHO in NH included: A Project ECHO Needs Assessment and Prioritization Process, including review of existing needs assessments in the field; a stakeholder survey of health and community care providers conducted by the New Hampshire Citizens Health Initiative (Initiative); and analysis of data from the NH Comprehensive Health Information System (NH CHIS), NH’s all-payer claims database (APCD). A business and sustainability plan including Key Informant Interviews, an environmental scan, and a template for business sustainability planning to identify funding sources and structures to sustain Project ECHO in NH. A framework for Project ECHO evaluation