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  • Robert Sapolsky, answering the Edge question for 2016: "What do you consider the most interesting recent scientific news?" with an ebola essay, recounting the highlights, with/from an American perspective, in his own splendidly hyperbolic and entertaining way.
    Diane
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    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

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    • Sexual transmission involved in tail end of Ebola epidemic

      https://www.sciencedaily.com/release...0518120113.htm

      An international team of researchers has produced a detailed picture of the latter stages of the outbreak in Sierra Leone, using real-time sequencing of Ebola virus genomes carried out in a temporary laboratory in the country.

      While the study did not suggest that unconventional transmission was more common than previously thought, the authors describe several instances including a mother who may have transmitted Ebola to her baby via breastfeeding, and an Ebola survivor who passed on the virus sexually a month after being released from quarantine. [More details of cases in the notes to editors].

      The research, published in the journal Virus Evolution, suggests that rapid sequencing of viral genomes in the midst of an epidemic could play a vital role in bringing future outbreaks under control, by allowing public health workers to quickly trace new cases back to their source.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • Toward a Common Secure Future: Four Global Commissions in the Wake of Ebola

        http://journals.plos.org/plosmedicin...l.pmed.1002042

        Summary Points

        Four global commissions reviewing the recent Ebola virus disease epidemic response consistently recommended strengthening national health systems, consolidating and strengthening World Health Organization (WHO) emergency and outbreak response activities, and enhancing research and development.

        System-wide accountability is vital to effectively prevent, detect, and respond to future global health emergencies.

        Global leaders (e.g., United Nations, World Health Assembly, G7, and G20) should maintain continuous oversight of global health preparedness, and ensure effective implementation of the Ebola commissions’ key recommendations, including sustainable and scalable financing.
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

        Comment


        • Mammalian biogeography and the Ebola virus in Africa

          http://onlinelibrary.wiley.com/doi/1...12074/abstract

          Keywords:
          chorotypes;distribution modelling;favourability;fuzzy logic;reservoirs

          Abstract

          1. Ebola virus is responsible for the fatal Ebola virus disease (EVD).

          2. Identifying the distribution area of the Ebola virus is crucial for understanding the risk factors conditioning the emergence of new EVD cases. Existing distribution models have underrepresented the potential contribution that reservoir species and vulnerable species make in sustaining the presence of the virus.

          3. In this paper, we map favourable areas for Ebola virus in Africa according to environmental and zoogeographical descriptors, independent of human-to-human transmissions. We combine two different biogeographical approaches: analysis of mammalian distribution types (chorotypes), and distribution modelling of the Ebola virus.

          4. We first obtain a model defining the distribution of environmentally favourable areas for the presence of Ebola virus. Based on a review of mammal taxa affected by or suspected of exposure to the Ebola virus, we model favourable areas again, this time according to mammalian chorotypes. We then build a combined model in which both the environment and mammalian distributions explain the favourable areas for Ebola virus in the wild.

          5. We demonstrate that mammalian biogeography contributes to explaining the distribution of Ebola virus in Africa, although vegetation may also underscore clear limits to the presence of the virus. Our model suggests that the Ebola virus may be even more widespread than previously suspected, given that additional favourable areas are found throughout the coastal areas of West and Central Africa, stretching from Cameroon to Guinea, and extend further East into the East African Lakes region.

          6. Our findings show that the most favourable area for the Ebola virus is significantly associated with the presence of the virus in non-human mammals. Core areas are surrounded by regions of intermediate favourability, in which human infections of unknown source were found. The difference in association between humans and other mammals and the virus may offer further insights on how EVD can spread.
          Jo Bowyer
          Chartered Physiotherapist Registered Osteopath.
          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

          Comment


          • Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey

            http://journals.plos.org/plosmedicin...l.pmed.1002096

            Abstract

            Background

            The Ebola virus disease (EVD) epidemic has threatened access to basic health services through facility closures, resource diversion, and decreased demand due to community fear and distrust. While modeling studies have attempted to estimate the impact of these disruptions, no studies have yet utilized population-based survey data.

            Methods and Findings

            We conducted a two-stage, cluster-sample household survey in Rivercess County, Liberia, in March–April 2015, which included a maternal and reproductive health module. We constructed a retrospective cohort of births beginning 4 y before the first day of survey administration (beginning March 24, 2011). We then fit logistic regression models to estimate associations between our primary outcome, facility-based delivery (FBD), and time period, defined as the pre-EVD period (March 24, 2011–June 14, 2014) or EVD period (June 15, 2014–April 13, 2015). We fit both univariable and multivariable models, adjusted for known predictors of facility delivery, accounting for clustering using linearized standard errors. To strengthen causal inference, we also conducted stratified analyses to assess changes in FBD by whether respondents believed that health facility attendance was an EVD risk factor. A total of 1,298 women from 941 households completed the survey. Median age at the time of survey was 29 y, and over 80% had a primary education or less. There were 686 births reported in the pre-EVD period and 212 in the EVD period. The unadjusted odds ratio of facility-based delivery in the EVD period was 0.66 (95% confidence interval [CI] 0.48–0.90, p-value = 0.010). Adjustment for potential confounders did not change the observed association, either in the principal model (adjusted odds ratio [AOR] = 0.70, 95%CI 0.50–0.98, p = 0.037) or a fully adjusted model (AOR = 0.69, 95%CI 0.50–0.97, p = 0.033). The association was robust in sensitivity analyses. The reduction in FBD during the EVD period was observed among those reporting a belief that health facilities are or may be a source of Ebola transmission (AOR = 0.59, 95%CI 0.36–0.97, p = 0.038), but not those without such a belief (AOR = 0.90, 95%CI 0.59–1.37, p = 0.612). Limitations include the possibility of FBD secular trends coincident with the EVD period, recall errors, and social desirability bias.

            Conclusions

            We detected a 30% decreased odds of FBD after the start of EVD in a rural Liberian county with relatively few cases. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas. These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies.
            Jo Bowyer
            Chartered Physiotherapist Registered Osteopath.
            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

            Comment


            • Ebola nurse Pauline Cafferkey: I was hung out to dry by health officials who put lives at risk

              http://www.telegraph.co.uk/news/2016...ampaign=buffer

              Ebola nurse Pauline Cafferkey has said she was “hung out to dry” by health officials who cleared her to fly to Scotland to cover up the fact that their failure to detect the virus put lives at risk.

              The 40-year-old she was “made a scapegoat for a catalogue of errors” by Public Health England (PHE), who were responsible for checking her on her return from Sierra Leone in 2014.

              Speaking for the first time since being cleared of wrongdoing at a Nursing and Midwifery Council (NMC) hearing in Edinburgh last week, she said the PHE officials who pointed the finger of blame at her should now be investigated.
              Jo Bowyer
              Chartered Physiotherapist Registered Osteopath.
              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

              Comment


              • Reduced Risk of Importing Ebola Virus Disease because of Travel Restrictions in 2014: A Retrospective Epidemiological Modeling Study

                http://journals.plos.org/plosone/art...l.pone.0163418

                Abstract

                Background

                An epidemic of Ebola virus disease (EVD) from 2013–16 posed a serious risk of global spread during its early growth phase. A post-epidemic evaluation of the effectiveness of travel restrictions has yet to be conducted. The present study aimed to estimate the effectiveness of travel restrictions in reducing the risk of importation from mid-August to September, 2014, using a simple hazard-based statistical model.

                Methodology/Principal Findings

                The hazard rate was modeled as an inverse function of the effective distance, an excellent predictor of disease spread, which was calculated from the airline transportation network. By analyzing datasets of the date of EVD case importation from the 15th of July to the 15th of September 2014, and assuming that the network structure changed from the 8th of August 2014 because of travel restrictions, parameters that characterized the hazard rate were estimated. The absolute risk reduction and relative risk reductions due to travel restrictions were estimated to be less than 1% and about 20%, respectively, for all models tested. Effectiveness estimates among African countries were greater than those for other countries outside Africa.

                Conclusions

                The travel restrictions were not effective enough to expect the prevention of global spread of Ebola virus disease. It is more efficient to control the spread of disease locally during an early phase of an epidemic than to attempt to control the epidemic at international borders. Capacity building for local containment and coordinated and expedited international cooperation are essential to reduce the risk of global transmission.
                my italics

                Besides which, this suggested approach would go further in helping to mitigate human misery.
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • Preparation and Response to the 2014 Ebola Virus Disease Epidemic in Nigeria—The Experience of a Tertiary Hospital in Nigeria

                  http://journals.plos.org/plosone/art...l.pone.0165271

                  Abstract

                  Introduction

                  The 2014 Ebola Virus Disease (EVD) outbreak elicited global attention and challenged health systems around the world, Nigeria inclusive. We hereby report the preparation and response to the outbreak by a tertiary teaching hospital in Bayelsa State, Nigeria.

                  Method

                  Between 4th August and 31st October 2014, we conducted a mixed cross sectional and qualitative study to ascertain the EVD-related fear, myths and misconceptions among healthcare workers (HCWs), and to evaluate the plans, activities and challenges faced by the hospital during the outbreak. Data was collected using a self-administered questionnaire as well as by documented observations during the outbreak. HCWs were asked to rate their fear of EVD from 1 (no fear) to 10 (highest fear).

                  Results

                  Out of 189 respondents, majority (>75%) reported uncertainty about the myth that EVD can be prevented by drinking salt water or eating Garcinia kola, while 82% of respondents believed that EVD can be prevented by avoiding crowded places. About 40% of respondents expressed fear ratings of EVD of ≥ 7 out of 10. In response to the outbreak, the hospital established an EVD response team, organised EVD-sensitization and training programmes and commenced routine EVD surveillance activities. An EVD-isolation ward was constructed from an existing ward, a field incinerator was designed, hand sanitizers were produced locally and personal protective equipment were procured. No case of EVD was reported in the hospital, although three false alarms caused panic. Some HCWs adopted overly protective and avoidance behaviours, but these behaviours were abandoned after the outbreak was declared over.

                  Conclusion

                  Our results suggest that the fear, myth and misconceptions were common among HCW during the outbreak. The EVD outbreak, however, helped to strengthen gaps in infection control and emergency preparedness in the hospital. Strategies to allay fear are required to contain future outbreaks of EVD in Nigeria hospitals.
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                  Comment


                  • Minimally Symptomatic Infection in an Ebola ‘Hotspot’: A Cross-Sectional Serosurvey

                    http://journals.plos.org/plosntds/ar...l.pntd.0005087

                    Abstract

                    Introduction

                    Evidence for minimally symptomatic Ebola virus (EBOV) infection is limited. During the 2013–16 outbreak in West Africa, it was not considered epidemiologically relevant to published models or projections of intervention effects. In order to improve our understanding of the transmission dynamics of EBOV in humans, we investigated the occurrence of minimally symptomatic EBOV infection in quarantined contacts of reported Ebola virus disease cases in a recognized ‘hotspot.’

                    Methodology/Principal Findings

                    We conducted a cross-sectional serosurvey in Sukudu, Kono District, Sierra Leone, from October 2015 to January 2016. A blood sample was collected from 187 study participants, 132 negative controls (individuals with a low likelihood of previous exposure to Ebola virus), and 30 positive controls (Ebola virus disease survivors). IgG responses to Ebola glycoprotein and nucleoprotein were measured using Alpha Diagnostic International ELISA kits with plasma diluted at 1:200. Optical density was read at 450 nm (subtracting OD at 630nm to normalize well background) on a ChroMate 4300 microplate reader. A cutoff of 4.7 U/mL for the anti-GP ELISA yielded 96.7% sensitivity and 97.7% specificity in distinguishing positive and negative controls. We identified 14 seropositive individuals not known to have had Ebola virus disease. Two of the 14 seropositive individuals reported only fever during quarantine while the remaining 12 denied any signs or symptoms during quarantine.

                    Conclusions/Significance

                    By using ELISA to measure Zaire Ebola virus antibody concentrations, we identified a significant number of individuals with previously undetected EBOV infection in a ‘hotspot’ village in Sierra Leone, approximately one year after the village outbreak. The findings provide further evidence that Ebola, like many other viral infections, presents with a spectrum of clinical manifestations, including minimally symptomatic infection. These data also suggest that a significant portion of Ebola transmission events may have gone undetected during the outbreak. Further studies are needed to understand the potential risk of transmission and clinical sequelae in individuals with previously undetected EBOV infection.
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • Ebola vaccine is safe and effective, scientists declare after trials

                      https://www.theguardian.com/world/20...als-successful

                      More than 11,000 people died in the outbreak, which began unnoticed in December 2013 and spread across the region, infecting at least 28,600 people and triggering a global response, including a race to get an effective vaccine tested and into use.

                      Final results for the vaccine that was rushed into trials in Guinea and later Sierra Leone show that it was highly effective against one of the most lethal known pathogens in existence. Ten days after vaccination, none of the trial subjects developed Ebola virus disease. The very few who did, in the days immediately following vaccination, are thought to have been infected already.

                      “While these compelling results come too late for those who lost their lives during west Africa’s Ebola epidemic, they show that when the next Ebola outbreak hits, we will not be defenceless,” said Dr Marie-Paule Kieny, the World Health Organisation’s assistant director general for health systems and innovation, and the study’s lead author.
                      Jo Bowyer
                      Chartered Physiotherapist Registered Osteopath.
                      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                      Comment


                      • Detection of Viral RNA in Tissues following Plasma Clearance from an Ebola Virus Infected Patient

                        http://journals.plos.org/plospathoge...l.ppat.1006065

                        Abstract

                        An unprecedented Ebola virus (EBOV) epidemic occurred in 2013–2016 in West Africa. Over this time the epidemic exponentially grew and moved to Europe and North America, with several imported cases and many Health Care Workers (HCW) infected. Better understanding of EBOV infection patterns in different body compartments is mandatory to develop new countermeasures, as well as to fully comprehend the pathways of human-to-human transmission. We have longitudinally explored the persistence of EBOV-specific negative sense genomic RNA (neg-RNA) and the presence of positive sense RNA (pos-RNA), including both replication intermediate (antigenomic-RNA) and messenger RNA (mRNA) molecules, in the upper and lower respiratory tract, as compared to plasma, in a HCW infected with EBOV in Sierra Leone, who was hospitalized in the high isolation facility of the National Institute for Infectious Diseases “Lazzaro Spallanzani” (INMI), Rome, Italy. We observed persistence of pos-RNA and neg-RNAs in longitudinally collected specimens of the lower respiratory tract, even after viral clearance from plasma, suggesting possible local replication. The purpose of the present study is to enhance the knowledge on the biological features of EBOV that can contribute to the human-to-human transmissibility and to develop effective intervention strategies. However, further investigation is needed in order to better understand the clinical meaning of viral replication and shedding in the respiratory tract.
                        This appears to be confirmation that the ebola virus has potential to cause airborne infection.

                        Much has been learned from this outbreak and it's spread and comparisons have been made with the H1N1 flu outbreak of 1919 which took three months to spread world wide. Nowadays with increased international travel, the potential for global pandemics is increased.

                        Human error and hubris may be a factor. Those who don't feel well will often travel because they "just want to go home".
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • Transcriptomic signatures differentiate survival from fatal outcomes in humans infected with Ebola virus

                          http://genomebiology.biomedcentral.c...059-016-1137-3

                          Abstract

                          Background
                          In 2014, Western Africa experienced an unanticipated explosion of Ebola virus infections. What distinguishes fatal from non-fatal outcomes remains largely unknown, yet is key to optimising personalised treatment strategies. We used transcriptome data for peripheral blood taken from infected and convalescent recovering patients to identify early stage host factors that are associated with acute illness and those that differentiate patient survival from fatality.

                          Results
                          The data demonstrate that individuals who succumbed to the disease show stronger upregulation of interferon signalling and acute phase responses compared to survivors during the acute phase of infection. Particularly notable is the strong upregulation of albumin and fibrinogen genes, which suggest significant liver pathology. Cell subtype prediction using messenger RNA expression patterns indicated that NK-cell populations increase in patients who survive infection. By selecting genes whose expression properties discriminated between fatal cases and survivors, we identify a small panel of responding genes that act as strong predictors of patient outcome, independent of viral load.

                          Conclusions
                          Transcriptomic analysis of the host response to pathogen infection using blood samples taken during an outbreak situation can provide multiple levels of information on both disease state and mechanisms of pathogenesis. Host biomarkers were identified that provide high predictive value under conditions where other predictors, such as viral load, are poor prognostic indicators. The data suggested that rapid analysis of the host response to infection in an outbreak situation can provide valuable information to guide an understanding of disease outcome and mechanisms of disease.


                          Longitudinal peripheral blood transcriptional analysis of a patient with severe Ebola virus disease

                          http://stm.sciencemag.org/content/9/385/eaai9321.full

                          The evolving Ebola virus host response

                          Although the Ebola virus sporadically causes outbreaks in humans, there is a relative paucity of information regarding the dynamics of the immune response in patients. During the recent outbreak, a health care worker with severe Ebola virus disease was evacuated to the NIH Clinical Center, where he received supportive care and had longitudinal blood samples drawn up to almost a year after infection. Kash et al. performed transcriptomic analyses on these blood samples to see how his body responded to the virus through the different phases of infection and recovery, and compared them to clinical symptoms and viral loads. These valuable data provide insights into Ebola pathogenesis and could help guide future treatments.

                          Abstract

                          The 2013–2015 outbreak of Ebola virus disease in Guinea, Liberia, and Sierra Leone was unprecedented in the number of documented cases, but there have been few published reports on immune responses in clinical cases and their relationships with the course of illness and severity of Ebola virus disease. Symptoms of Ebola virus disease can include severe headache, myalgia, asthenia, fever, fatigue, diarrhea, vomiting, abdominal pain, and hemorrhage. Although experimental treatments are in development, there are no current U.S. Food and Drug Administration–approved vaccines or therapies. We report a detailed study of host gene expression as measured by microarray in daily peripheral blood samples collected from a patient with severe Ebola virus disease. This individual was provided with supportive care without experimental therapies at the National Institutes of Health Clinical Center from before onset of critical illness to recovery. Pearson analysis of daily gene expression signatures revealed marked gene expression changes in peripheral blood leukocytes that correlated with changes in serum and peripheral blood leukocytes, viral load, antibody responses, coagulopathy, multiple organ dysfunction, and then recovery. This study revealed marked shifts in immune and antiviral responses that preceded changes in medical condition, indicating that clearance of replicating Ebola virus from peripheral blood leukocytes is likely important for systemic viral clearance.
                          Update 12/04/2017
                          Last edited by Jo Bowyer; 13-04-2017, 12:03 AM.
                          Jo Bowyer
                          Chartered Physiotherapist Registered Osteopath.
                          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                          Comment


                          • Predicting Ebola Severity: A Clinical Prioritization Score for Ebola Virus Disease

                            http://journals.plos.org/plosntds/ar...l.pntd.0005265

                            Abstract

                            Background

                            Despite the notoriety of Ebola virus disease (EVD) as one of the world’s most deadly infections, EVD has a wide range of outcomes, where asymptomatic infection may be almost as common as fatality. With increasingly sensitive EVD diagnosis, there is a need for more accurate prognostic tools that objectively stratify clinical severity to better allocate limited resources and identify those most in need of intensive treatment.

                            Methods/Principal Findings

                            This retrospective cohort study analyses the clinical characteristics of 158 EVD(+) patients at the GOAL-Mathaska Ebola Treatment Centre, Sierra Leone. The prognostic potential of each characteristic was assessed and incorporated into a statistically weighted disease score. The mortality rate among EVD(+) patients was 60.8% and highest in those aged <5 or >25 years (p<0.05). Death was significantly associated with malaria co-infection (OR = 2.5, p = 0.01). However, this observation was abrogated after adjustment to Ebola viral load (p = 0.1), potentially indicating a pathologic synergy between the infections. Similarly, referral-time interacted with viral load, and adjustment revealed referral-time as a significant determinant of mortality, thus quantifying the benefits of early reporting as a 12% mortality risk reduction per day (p = 0.012). Disorientation was the strongest unadjusted predictor of death (OR = 13.1, p = 0.014) followed by hiccups, diarrhoea, conjunctivitis, dyspnoea and myalgia. Including these characteristics in multivariate prognostic scores, we obtained a 91% and 97% ability to discriminate death at or after triage respectively (area under ROC curve).

                            Conclusions/Significance

                            This study proposes highly predictive and easy-to-use prognostic tools, which stratify the risk of EVD mortality at or after EVD triage.
                            Author Summary

                            The unprecedented spread of EVD across the fragile healthcare systems of West Africa during the 2013–2015 outbreak infected over 28,600 patients and established it as a disease for which low-income countries are at disproportionate risk. In order to improve the standard of patient care, it is essential to better allocate scarce resources amongst the heterogeneous symptomatic presentations of EVD. This retrospective cohort study on 158 EVD(+) patients in Sierra Leone constructs 2 easy-to-use scoring systems that accurately stratify EVD severity and thus objectively identify the patients in most need of intensive therapy. Using statistically weighted symptoms and demographic characteristics, we obtained scores with a 91% and 97% ability to discriminate death at or after triage respectively. These scores included Ebola viral load, patient age and referral time as well as the symptoms of disorientation, haemorrhage and myalgia. Further univariate analysis revealed several independent predictors of mortality, where patients aged between 5 and 25 years were most likely to survive, while malaria co-infection increased the risk of death by 2.5-fold (p = 0.01). Correcting referral-time for viral load, we also quantify the benefits of early reporting as a 12% mortality risk reduction per day (p = 0.012). Mortality in this cohort was 3-fold more than patients treated in resource-rich settings (60.8% vs. 18%) and we propose that focused patient care is a feasible and low-cost effort that may begin to close this gap.
                            Jo Bowyer
                            Chartered Physiotherapist Registered Osteopath.
                            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                            Comment


                            • http://www.who.int/mediacentre/news/...ne-results/en/
                              An experimental Ebola vaccine was highly protective against the deadly virus in a major trial in Guinea, according to results published today in The Lancet. The vaccine is the first to prevent infection from one of the most lethal known pathogens, and the findings add weight to early trial results published last year.
                              We don't see things as they are, we see things as WE are - Anais Nin

                              I suppose it's easier to believe something than it is to understand it.
                              Cmdr. Chris Hadfield on rise of poor / pseudo science

                              Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                              We don't need a body to feel a body. Ronald Melzack

                              Comment


                              • See also Guardian report on this #160
                                Jo Bowyer
                                Chartered Physiotherapist Registered Osteopath.
                                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

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