A Systematic Review of Occupational Therapy-Related Interventions for Pediatric Chronic Pain.

Occupational therapists have distinct value providing pediatric chronic pain interventions (e.g., pain management, normalizing sensory responses, increasing participation); however, limited evidence exists. This review appraised empirical studies on occupational therapy pediatric chronic pain management. Three reviewers independently screened 2,401 titles, 250 abstracts, and 71 full-text sources for studies published in English, after 2008, and with sample sizes >10, participants <18 years, with chronic pain >3 months, and outcomes related to pain/function. Studies were assessed for risk of bias. The review included 23 studies on psychological, interprofessional, virtual/telehealth, or biomechanical management, demonstrating significant decreases in pain/disability. Most studies had high risk of bias for lack of randomization and control groups, and homogeneous sampling. The occupational therapists' role in chronic pain interventions is still unclear. Research including larger, heterogenous samples is warranted to examine occupational therapy's specific role providing pain interventions as part of a team.

Osteohistological description of ostrich and emu long bones, with comments on markers of growth.

Ostriches and emus are among the largest extant birds and are frequently used as modern analogs for the growth dynamics of non-avian theropod dinosaurs. These ratites quickly reach adult size in under 1 year, and as such do not typically exhibit annually deposited growth marks. Growth marks, commonly classified as annuli or lines of arrested growth (LAGs), represent reduced or halted osteogenesis, respectively, and their presence demonstrates varying degrees of developmental plasticity. Growth marks have not yet been reported from ostriches and emus, prompting authors to suggest that they have lost the plasticity required to deposit them. Here we observe the hind limb bone histology of three captive juvenile emus and one captive adult ostrich. Two of the three juvenile emus exhibit typical bone histology but the third emu, a 4.5-month-old juvenile, exhibits a regional arc of avascular tissue, which we interpret as a growth mark. As this mark is not present in the other two emus from the same cohort and it co-occurs with a contralateral broken fibula, we suggest variable biomechanical load as a potential cause. The ostrich exhibits a complete ring of avascular, hypermineralized bone with sparse, flattened osteocyte lacunae. We identify this as an annulus and interpret it as slowing of growth. In the absence of other growth marks and lacking the animal's life history, the timing and cause of this ostrich's reduced growth are unclear. Even so, these findings demonstrate that both taxa retain the ancestral developmental plasticity required to temporarily slow growth. We also discuss the potential challenges of identifying growth marks using incomplete population data sets and partial cortical sampling.