Mirror visual feedback therapy for treatment of phantom limb pain: a clinical practice guideline

Authors: Garrett B Hoskins, SPT; Erick T Moon, SPT; Roger J. Allen, PT, PhD Mirror visual feedback therapy for treatment of phantom limb pain: a clinical practice guideline. Purpose: A growing number of recent controlled studies report mirror visual feedback therapy (MT) holds promise for treatment of phantom limb pain (PLP) following amputation, via facilitation of neuroplastic cortical remodeling. However, available research reports typically do not contain sufficient detail regarding the MT components utilized to allow clinicians to implement protocols found to be effective. The purpose of this study was to synthesize a clinical practice guideline, based on a systematic review of current MT research, that articulates the components, dosing, and parameters of efficacious MT protocols for PLP intervention. Number of Subjects: Twenty quantitative studies from peer-reviewed journals were reviewed. All studies included MT as a treatment intervention and used at least one pain outcome measure pertaining to PLP. Studies not available as full text or not accessible in English were excluded. Methods: CINAHL, Cochran Library, Google Scholar and PubMed were searched between Jan 2016-Feb 2017 for phantom limb pain, and/or mirror therapy . Systematic reviews, randomized control trials, controlled pilot studies, and controlled and uncontrolled case series were reviewed. A compendium was established of MT treatment intervention components utilized, frequency and settings of practice, outcome measures and adverse reactions, with cross-study efficacy comparisons to determine viable MT elements. When published studies contained insufficient detail on MT intervention, principle investigators were contacted by email with requests for additional information on treatment details and dosing. Results: Among the 20 studies reviewed, MT was used as the primary treatment for PLP. MT was frequently preceded by laterality training and graded motor imagery. Effective treatment components utilized during MT sessions included multifaceted somatosensory stimulation, distal movements, and functional activities. MT was found effective whether via direct therapist supervision in-clinic or with therapist-designed activities conducted as home programs. A comprehensive clinical practice guideline was synthesized for presentation, based on positive outcome measures regarding pain and clinical usefulness. Conclusions: Current literature shows that MT can significantly reduce pain and improve pain-related function in patients with PLP. Treatment elements found to be effective in controlled studies have afforded synthesis of a comprehensive clinical practice guideline for implementation of MT by therapists treating PLP. Clinical Relevance: MT efficacy literature has established the viability of MT as a treatment for PLP, however, lack of sufficient published detail regarding components and parameters of treatment left therapists at a loss as to how to most effectively implement MT with patients. This clinical practice guideline helps therapists easily implement mirror therapy; rendering a more thorough and effective plan of care for patients with PLP. Keywords: phantom limb pain, graded motor imagery, mirror therapy References: Casale R, Damiani C, Rosati V. Mirror therapy in the rehabilitation of lower-limb amputation: are there any contraindications? Am J Phys Med Rehabil 2009;88:837-42. Darnall B, Li H. Home-based self-delivered mirror therapy for phantom pain: A pilot study. J Rehabil Med 2012;44:254-260. Foell J, Bekrater-Bodmann R, Diers M, Flor H. Mirror therapy for phantom limb pain: brain changes and the role of body representation. Euro J Pain 2014;18:729-739. Hagenberg A, Carpenter C. Mirror visual feedback for phantom pain: international experience on modalities and adverse effects discussed by an expert panel: A Delphi Study. PMR. 2014;6:708-15. Rothgangel A, Braun S, de Witte L, Beurskens A, Smeets R. Development of a clinical framework for mirror therapy in patients with phantom limb pain: an evidence-based practice approach. Pain Pract 2016;16:422-434

Drosophila by the dozen

A report of the 48th Annual Drosophila Research Conference, Philadelphia, USA, 7-11 March 2007

Portable propellant cutting assembly, and method of cutting propellant with assembly

A propellant cutting assembly and method of using the assembly to cut samples of solid propellant in a repeatable and consistent manner is disclosed. The cutting assembly utilizes two parallel extension beams which are shorter than the diameter of a central bore of an annular solid propellant grain and can be loaded into the central bore. The assembly is equipped with retaining heads at its respective ends and an adjustment mechanism to position and wedge the assembly within the central bore. One end of the assembly is equipped with a cutting blade apparatus which can be extended beyond the end of the extension beams to cut into the solid propellant

Behavioral responses of Australian fur seals to boat approaches at a breeding colony

In Australia, a multi-million-dollar industry is based on viewing the Australian fur seal (Arctocephalus pusillus doriferus), predominantly through boat visits to breeding colonies. Regulation of boat approaches varies by site and no systematic investigations have been performed to inform management guidelines. To investigate possible effects of disturbance, experimental boat approaches were made to a colony at Kanowna Island in northern Bass Strait and seal responses were monitored using instantaneous scan sampling. Colony attendance (individuals remaining ashore) was found to be influenced by approach distance and time of day, but was not affected by environmental variables or season, whereas onshore resting behavior was influenced by approach distance, time of day, ambient temperature and wind direction. Onshore resting behavior decreased following experimental boat approaches to 75 m, but changes in abundance of individuals ashore were not observed at this distance. In contrast, approaches to 25 m elicited a strong response, with a steep decline in the number of individuals ashore. This response was strongest when approaches occurred in the morning, with a decline of approximately 47% of individuals, compared to a decline of 21% during afternoon approaches. With regard to onshore resting behavior, afternoon approaches to 75 m led to minimal response. The remaining three combinations of approach distance and time of day had a similar pattern of reductions in the proportion of individuals engaging in onshore resting behavior. The strongest response was again seen during approaches to 25 m conducted in the morning. These behavior changes suggest that unrestricted boat-based ecotourism at Australian fur seal colonies has the potential to increase energy expenditure and reduce the number of seals ashore. Increasing minimum approach distances to ≥75 m and/or restricting visits to afternoons may minimize these impacts at Kanowna Island during the post-molt and non-breeding seasons. As several studies have demonstrated considerable intra-species variation in seal responses to boat approaches, research at other colonies is needed before these findings can be generalized to the remainder of the Australian fur seal population

100 kW Nested Hall Thruster System Development

Large scale cargo transportation to support human missions to the Moon and Mars will require very high power Solar Electric Propulsion (SEP) systems operating between 200 and 400 kW. Aerojet Rocketdyne's NextSTEP program is developing and demonstrating a 100 kW EP system, the XR-100, using a Nested Hall Thruster (NHT) designed for powers up to 200 kW, a modular power processor and a modular flow controller. The three year program objective is to operate the integrated EP system continuously at 100 kW for 100 h, advancing this very high power Electric Propulsion (EP) system to Technology Readiness Level (TRL) 5. With our University of Michigan, Jet Propulsion Laboratory and NASA Glenn Research Center teammates, Aerojet Rocketdyne has completed the initial phase of the program, including operating the thruster at up to 30 kW to validate the thermal models and developing and operating multiple power processor modules in the required seriesparallel configuration. The current phase includes completing a TRL 4 integrated system test at reduced power to validate all system operating phases. Design upgrades to demonstrate the TRL 5 capabilities are underway. This paper will present the high power XR-100 capabilities, overall program and design approach and the latest test results for the 100 kW EP system demonstration program

Heterochromatic sequences in a Drosophila whole-genome shotgun assembly

BACKGROUND: Most eukaryotic genomes include a substantial repeat-rich fraction termed heterochromatin, which is concentrated in centric and telomeric regions. The repetitive nature of heterochromatic sequence makes it difficult to assemble and analyze. To better understand the heterochromatic component of the Drosophila melanogaster genome, we characterized and annotated portions of a whole-genome shotgun sequence assembly. RESULTS: WGS3, an improved whole-genome shotgun assembly, includes 20.7 Mb of draft-quality sequence not represented in the Release 3 sequence spanning the euchromatin. We annotated this sequence using the methods employed in the re-annotation of the Release 3 euchromatic sequence. This analysis predicted 297 protein-coding genes and six non-protein-coding genes, including known heterochromatic genes, and regions of similarity to known transposable elements. Bacterial artificial chromosome (BAC)-based fluorescence in situ hybridization analysis was used to correlate the genomic sequence with the cytogenetic map in order to refine the genomic definition of the centric heterochromatin; on the basis of our cytological definition, the annotated Release 3 euchromatic sequence extends into the centric heterochromatin on each chromosome arm. CONCLUSIONS: Whole-genome shotgun assembly produced a reliable draft-quality sequence of a significant part of the Drosophila heterochromatin. Annotation of this sequence defined the intron-exon structures of 30 known protein-coding genes and 267 protein-coding gene models. The cytogenetic mapping suggests that an additional 150 predicted genes are located in heterochromatin at the base of the Release 3 euchromatic sequence. Our analysis suggests strategies for improving the sequence and annotation of the heterochromatic portions of the Drosophila and other complex genomes

Assessing the impact of comparative genomic sequence data on the functional annotation of the Drosophila genome

BACKGROUND: It is widely accepted that comparative sequence data can aid the functional annotation of genome sequences; however, the most informative species and features of genome evolution for comparison remain to be determined. RESULTS: We analyzed conservation in eight genomic regions (apterous, even-skipped, fushi tarazu, twist, and Rhodopsins 1, 2, 3 and 4) from four Drosophila species (D. erecta, D. pseudoobscura, D. willistoni, and D. littoralis) covering more than 500 kb of the D. melanogaster genome. All D. melanogaster genes (and 78-82% of coding exons) identified in divergent species such as D. pseudoobscura show evidence of functional constraint. Addition of a third species can reveal functional constraint in otherwise non-significant pairwise exon comparisons. Microsynteny is largely conserved, with rearrangement breakpoints, novel transposable element insertions, and gene transpositions occurring in similar numbers. Rates of amino-acid substitution are higher in uncharacterized genes relative to genes that have previously been studied. Conserved non-coding sequences (CNCSs) tend to be spatially clustered with conserved spacing between CNCSs, and clusters of CNCSs can be used to predict enhancer sequences. CONCLUSIONS: Our results provide the basis for choosing species whose genome sequences would be most useful in aiding the functional annotation of coding and cis-regulatory sequences in Drosophila. Furthermore, this work shows how decoding the spatial organization of conserved sequences, such as the clustering of CNCSs, can complement efforts to annotate eukaryotic genomes on the basis of sequence conservation alone

Climate change: the necessary, the possible and the desirable Earth League climate statement on the implications for climate policy from the 5th IPCC Assessment

The development of human civilisations has occurred at a time of stable climate. This climate stability is now threatened by human activity. The rising global climate risk occurs at a decisive moment for world development. World nations are currently discussing a global development agenda consequent to the Millennium Development Goals (MDGs), which ends in 2015. It is increasingly possible to envisage a world where absolute poverty is largely eradicated within one generation and where ambitious goals on universal access and equal opportunities for dignified lives are adopted. These grand aspirations for a world population approaching or even exceeding nine billion in 2050 is threatened by substantial global environmental risks and by rising inequality. Research shows that development gains, in both rich and poor nations, can be undermined by social, economic and ecological problems caused by human-induced global environmental change. Climate risks, and associated changes in marine and terrestrial ecosystems that regulate the resilience of the climate system, are at the forefront of these global risks. We, as citizens with a strong engagement in Earth system science and socio-ecological dynamics, share the vision of a more equitable and prosperous future for the world, yet we also see threats to this future from shifts in climate and environmental processes. Without collaborative action now, our shared Earth system may not be able to sustainably support a large proportion of humanity in the decades ahead

Finishing a whole-genome shotgun: Release 3 of the Drosophila melanogaster euchromatic genome sequence

BACKGROUND: The Drosophila melanogaster genome was the first metazoan genome to have been sequenced by the whole-genome shotgun (WGS) method. Two issues relating to this achievement were widely debated in the genomics community: how correct is the sequence with respect to base-pair (bp) accuracy and frequency of assembly errors? And, how difficult is it to bring a WGS sequence to the accepted standard for finished sequence? We are now in a position to answer these questions. RESULTS: Our finishing process was designed to close gaps, improve sequence quality and validate the assembly. Sequence traces derived from the WGS and draft sequencing of individual bacterial artificial chromosomes (BACs) were assembled into BAC-sized segments. These segments were brought to high quality, and then joined to constitute the sequence of each chromosome arm. Overall assembly was verified by comparison to a physical map of fingerprinted BAC clones. In the current version of the 116.9 Mb euchromatic genome, called Release 3, the six euchromatic chromosome arms are represented by 13 scaffolds with a total of 37 sequence gaps. We compared Release 3 to Release 2; in autosomal regions of unique sequence, the error rate of Release 2 was one in 20,000 bp. CONCLUSIONS: The WGS strategy can efficiently produce a high-quality sequence of a metazoan genome while generating the reagents required for sequence finishing. However, the initial method of repeat assembly was flawed. The sequence we report here, Release 3, is a reliable resource for molecular genetic experimentation and computational analysis

Versatile P(acman) BAC Libraries for Transgenesis Studies in Drosophila melanogaster

We constructed Drosophila melanogaster BAC libraries with 21-kb and 83-kb inserts in the P(acman) system. Clones representing 12-fold coverage and encompassing more than 95percent of annotated genes were mapped onto the reference genome. These clones can be integrated into predetermined attP sites in the genome using Phi C31 integrase to rescue mutations. They can be modified through recombineering, for example to incorporate protein tags and assess expression patterns