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Ocean warming is increasing the incidence, scale, and severity of global-scale coral bleaching and mortality, culminating in the third global coral bleaching event that occurred during record marine heatwaves of 2014-2017. While local effects of these events have been widely reported, the global implications remain unknown. Analysis of 15,066 reef surveys during 2014-2017 revealed that 80% of surveyed reefs experienced significant coral bleaching and 35% experienced significant coral mortality. The global extent of significant coral bleaching and mortality was assessed by extrapolating results from reef surveys using comprehensive remote-sensing data of regional heat stress. This model predicted that 51% of the world’s coral reefs suffered significant bleaching and 15% significant mortality, surpassing damage from any prior global bleaching event. These observations demonstrate that global warming’s widespread damage to coral reefs is accelerating and underscores the threat anthropogenic climate change poses for the irreversible transformation of these essential ecosystems.

Background Osteopathy is a recent addition to the modern day healthcare community. The majority of patients attending osteopathic practices in the United Kingdom are self funders, and studies have reported a high rate of satisfaction in patients receiving osteopathic treatment. Objective This study aimed to determine patient perception of osteopathic education and relate that to patient reported experience. Method The study was conducted through newspapers, GP surgeries and osteopathic clinics. A questionnaire was either completed on-line or a paper copy was returned to the investigator. Results Over seven hundred people respondent though for this part of the study 202 were excluded either because they reported both good and bad experiences or did not complete the section on osteopathic education. Similar to other studies this current study reported that the majority of respondents reported a good experience (88.7%). However, there was no statistical significance demonstrated for any of the patient demographics or for the respondents perception of osteopathic education and experience. Discussion and conclusion Further work is required to assess what patients require for a ‘good' experience and what osteopathic patients determine as key competencies required in an osteopath.

Summary: This study investigated the influence of visceral osteopathic technique (VOT) on the behaviour and gastrointestinal (GI) symptoms of children with autism using a validated questionnaire to measure outcome. Methods: The 49 recruited autistic children suffered GI symptoms and impaired social interaction and communication, but were otherwise healthy. Thirty minute VOT sessions were applied to the abdomens of the children over a 6 week period whilst their GI and behavioural parameters were recorded. Outcomes were measured using a modified Autism Research Institute Secretin Outcomes Survey Form, the ‘S.O.S Form’. Four questionnaires were completed by parents before treatment (control period), four completed during treatment (treatment period) and one completed six weeks after the last treatment (post treatment period). Subjects acted as their own controls. Results: Results from repeat ANOVA demonstrated a positive, overall significant, symptomatic improvement (p < 0.05) in ‘social behaviour and communication’ and ‘digestive signs’ subscales of the questionnaire comparing before and after VOT. Significant improvement in vomiting (p = 0.00029), poor appetite (p = 0.039) and eye contact (p = 0.035) was also demonstrated after VOT application. Discussion and conclusion: The experimental hypothesis has been supported indicating a positive effect of VOT on some of the measured GI symptoms and behavioural patterns in this group of children with autism. This data indicates that the application of VOT may be of benefit to children with autism and GI disturbance.

In previous study, we found a bilateral difference in broadband ultrasound attenuation (BUA) of the calcaneus, using the McCue Cubaclinical II device. The purpose of the present study was to determine whether a calcaneal bilateral difference (greater than that that would be expected from the coefficient of variation) was also found by other instruments and their technologies. Twenty-four subjects (ages 22–81) were each scanned by the same operator using three devices: the Cubaclinical (ultrasound [US], BUA), the Lunar Achilles plus (US, BUA and stiffness index), and the Pixi (dual X-ray absorptiometry, bone mineral density). To allow for the different variables used by the three devices, the following computation was applied to the data for comparison purposes (left – right) ÷ (right). Analysis of variance showed no significant difference. We conclude that the three devices do not differ in their ability to detect a proportional difference between right and left calcanei. In an additional investigation, using the Cubaclinical, 23 subjects were scanned. The direction of the US wave between emitter and receiver transducers was reversed to determine the effect, if any, on bilateral BUA readings. In this case, the direction of the US wave was not influential.

The purpose of this study was to determine calcaneal broadband ultrasound attenuation (BUA) of marathon race participants and compare this information with previously obtained normative data. BUA was assessed using the McCue CUBA clinical device in 217 male and 184 female runners, aged 20-93 yr, participating in the 2004 Flora London Marathon. The normative data included 267 men and 334 women, aged 20-80 yr. A significantly higher mean BUA (p0.001) was observed for all the men (91.2 dB/MHz, standard deviation [SD] 18.2 dB/MHz) in the study compared to the women (81.6 dB/MHz, SD 17.0 dB/MHz) and for the marathon runners compared to the nonrunners (p0.001) among men (97.2dB/MHz, SD 17.6 dB/MHz and 87.7 dB/MHz, SD 17.6 dB/MHz, respectively) and women (89.2dB/MHz, SD 14.2dB/MHz and 77.4dB/MHz, SD 17.0 dB/MHz, respectively). A significant decline in BUA with age was observed in all males and females, with the males starting from a higher baseline and with the rate of decline significantly ameliorated by marathon training (from -0.35 to -0.25 dB/MHz per year in men and -0.51 to -0.15 dB/MHz per year in women). This study provides observational evidence in support of the potential benefits of weight-bearing exercise, such as marathon training and running, on BUA of the calcaneus, an index of bone mineral density.

Background Patient satisfaction is a complex process, which is not solely based on the patient outcome, but also patient's perception and expectation as well as communication and information from the healthcare practitioner. Patients who are satisfied are known to have greater treatment compliance, better outcomes and result in fewer malpractice cases. Methods Adverts were placed in a number of national newspapers; posters were placed in osteopathic clinics, Osteopathic Educational Institutes and GP surgeries directing patients who had undergone osteopathic treatment to an online or postal questionnaire. Not all questions needed to be completed. Respondents could answer for good and/or bad experiences. Local ethical approval was granted. Results There were 764 responses: 547 responses reported a good experience, 68 reported a bad experience and 149 reported both good and bad experiences. There was no significant difference in gender ( p = 0.14) or age for reported experience. There was no difference in health status and reported experiences ( p = 0.7). Those who reported good experiences were significantly more likely to have been referred to an osteopath ( p = 0.01), though referral was from a number of sources. There was no statistical significance between the expectation of recovery or outcome between good and bad experiences. Visual analogue scale after treatment was significantly lower in those who reported a good experience compared to those who had a bad experience ( p p ≤ 0.01) and the osteopaths were significantly less likely to have performed a risk assessment with respondents who described a bad experience ( p p Conclusions Osteopathic patients report a high level of satisfaction in both this current study and in other published studies. However, those patients who did report a bad experience one of the issues was a failure of the osteopath to explain to the patient the treatment method, the risks and to perform a risk assessment. Explaining treatment effects and risks more effectively could further improve patient satisfaction in osteopathy.

Introduction Autism or Autistic Spectrum Disorder (ASD) is a Pervasive Developmental Disorder (PDD) with abnormal or impaired development in reciprocal social interaction, abnormal or impaired social communication and social imagination. Recent theories focused on the possibility of autism being linked with gastrointestinal (GI) abnormalities. Moreover, the problem behaviour typical of autism might be linked to the underlying medical symptoms such as abdominal pain, diarrhoea, and bloating typical of GI dysfunction. Methods The study utilised VOT on 49 autistic children aged 3–8 yrs to investigate possible effects of the techniques. The children in the study were suffering from gastrointestinal symptoms and presented with impaired social relationship and communication, but were otherwise healthy. VOT was applied to the abdomen (duodenum, ileo-caecal valve, sigmoid and pancreas areas) and gastrointestinal and behavioural changes were measured after 6 osteopathic treatment sessions, once a week for six weeks. Each intervention session was for thirty minutes. The evaluation of the study was accessed via 8 questionnaires given to the parents who were asked to grade the child's response following the VOT intervention e.g. frequency of bowel movement, appetite eye contact and other parameters. Four questionnaires were given to the parents before initiation of the osteopathic treatment and the other four were given during the treatment phase of the research. Ethics approval was granted by The British College of Osteopathic Medicine and by University of Westminster Ethics Committee – London UK. Results Wilcoxon Signed-Rank Test has been used to compare the “pre treatment” data and the “during treatment” data. Statistical analysis indicated improvement in the gastrointestinal symptom of vomiting (p = 0.00029) and in the parameter of poor appetite (p = 0.039) after application of VOT. The subjects also had a significant improvement in eye contact (p = 0.035) one of the most characteristic social behavioural symptoms of autistic patients. Conclusions The experimental hypothesis has been supported indicating a positive effect of VOT on the measured symptoms and behavioural patterns of Autistic children. This data indicates that the use of VOT on GI function may be of benefit to autistic children.

Spinal manipulative treatment is widely used among manual therapists, although knowledge regarding the absolute physiological effects has not been clearly established. In this study, 20 healthy male subjects underwent a unilateral high-velocity low-amplitude thrust (HVLAT) to the lumbosacral junction, while the cutaneous blood flow in the corresponding dermatome of the lower limb was monitored.Subjects underwent a sham manipulation before the actual manipulation and acted as their own control. Laser Doppler flowmetry was used to measure relative changes in the cutaneous blood flow over the L5 dermatome for 5 minutes before the sham manipulation, for 5 minutes between the sham and the actual manipulation, and for 5 minutes after the spinal adjustment. Analysis of variance (ANOVA) and Tukey post hoc analysis was used in the interpretation of the data.Twelve nonsmoking subjects, who received a successful HVLAT manipulation, showed a significant increase (P.001) in blood perfusion, both ipsilaterally and contralaterally. Six smokers responded with a significant decrease in blood flow ipsilaterally (P.01) and contralaterally (P.001) after HVLAT manipulation.The results from this study support previous published hypotheses that spinal adjustments outside the region of the sympathetic outflow result in an increase in cutaneous blood flow. Further studies will be needed to confirm the outcome of this study, and more knowledge is needed regarding the specific neurophysiological effects of spinal manipulation.

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Introduction: Spinal manipulation is commonly employed by osteopaths to correct somatic and visceral dysfunction. Much research has concentrated on the somatovisceral effects of spinal manipulation, with many studies demonstrating sympathoexcitation/inhibition following spinal manipulation. The mechanisms behind the neurophysiological effects of spinal manipulation still remains poorly understood. No published study to date has investigated the effect of spinal manipulation on the sympathetic innervation of regions of the body with no known neural connections. Previous studies that used cutaneous blood flow (CBF) as measures of sympathetic activity have not considered the contribution that breathing or postural perturbation have on study outcomes. The aim of this study was to investigate the effect a unilateral lumbosacral HVLAT on CBF to the upper limb, and to estimate the contribution that breathing or postural perturbation may have on the study outcome. Design: The study was a strictly controlled, carry-over design on a cohort of twenty-eight asymptomatic, male osteopathic students of similar age and body mass index. Methods: CBF to the distal, palmar surface of the both forearms was measured using Laser Doppler Flowmetry (LDF). After 10minute acclimatising period, each subject acted as their own control whilst an initial 5-minute baselinemeasurement of CBFwas established. This was followed directly by the first control, postural perturbation for the HVLAT in right rotation, and a further 5-minute ‘post-control 1’ recording phase. This was then followed directly by the second control, postural perturbation for the HVLAT in right rotation and breathing relaxation, and a further 5-minute ‘post-control 2’ recording phase. The experimental intervention (HVLAT to L5-S1) was then applied, and followed by a further 5-minute ‘post-experimental intervention’ recording of CBF. Results: All raw data for the different interventions were converted into percentiles relative to the baseline reading so the data could be analysed by a one way ANOVA and post-hoc Tukey’s tests. The results indicated that there was a significant change in CBF from baseline level to the experimental intervention (p 0.05). However, the results illustrate the contribution that postural perturbation and especially breathing have on the outcome of this study which was calculated to be 4.2% and 7.5%, and 48% and 65%, respectively for the contralateral and ipsilateral upper limb respectively. Conclusion: This study provides preliminary evidence that a unilaterally applied HVLAT to the right L5/S1 lumbar zygo-apophyseal joint results in side-specific peripheral changes in the upper limbs. However, there is also preliminary evidence in this study that the breathing relaxation technique used in HVLAT’s contributes to the magnitude of the outcome as assessed by changes in CBF. It is concluded that the breathing effect should be included in interpreting past studies and in the design of future studies.

Introduction As scientific research into the use of hydrotherapy is scarce and often vague in its recommendation for practical use, this study was designed to test and compare the effects on upper limb blood flow of differing time lengths of short cold hydrotherapy application, with a view to improving the current short duration hydrotherapy application guidelines used in the British College of Osteopathic Medicine clinic. It was proposed that the different time lengths of hydrotherapy application would have a significantly different influence on both ipsilateral and contralateral blood perfusion and skin temperature. Design Crossover design, intervention study. Methods Intervention: Short duration application of cold hydrotherapy of duration 30s, 1min, 2min, 3min and 5min using cold wraps at 12°C to the dominant forearm. Participants: Thirty-five asymptomatic, right-hand dominant male subjects. Outcome Measures: Blood flow and skin temperature measured by the Microflo DSP Digital Laser Perfusion Monitor. Results All short duration time lengths of application of cold hydrotherapy had a significant effect on blood perfusion both in the arm to which the hydrotherapy was applied and to the contralateral arm. There was a significant difference in the skin temperature of the arm to which the hydrotherapy was applied but not to the contralateral arm. The results also showed that there was no significant difference in blood perfusion between the differing time lengths of application. Conclusions It was concluded therefore that short duration applications of hydrotherapy do have a significant effect on blood perfusion in both the limb to which they are applied and to the contralateral limb. It was also concluded that there was no significant difference between the different time lengths of application thus a 1-min application of cold hydrotherapy overall had a similar effect on blood flow as a 5-min application.