Muscle energy technique (MET) has been advocated for the treatment of restricted range of motion in the upper neck. However, there is little evidence to determine the effectiveness of MET on the optimal duration of isometric contraction during the technique. The aim of this study was to investigate the effect of various durations of MET isometric contractions on active atlanto-axial rotation range of motion. 52 asymptomatic subjects (age 18-43) who displayed a unilateral active atlanto-axial rotation asymmetry of 4 degree or more were randomly allocated to either a 5 (n=17) or 20 second (n=18) isometric contraction MET group, or a sham (n=17) treatment control group. Active atlanto-axial end range measurements were recorded pre and post-intervention, and the examiner was blinded to group allocation. Analysis with a one-way ANOVA revealed significant differences (p=0.04) in the mean change between the 5-second MET group and the control, but not between the 20-second MET group and control. MET using 5-second contractions produced the largest mean increase in rotation, both to the restricted (+6.65 degrees) and non-restricted sides (+0.71 degrees). The 5-second MET produced a large effect size (d=1.01), whereas the 20-second MET (d=0.68) and control (d=0.33) produced medium and small effects. This study failed to demonstrate a significant benefit in the use of a longer (20-second) isometric contraction when treating the upper cervical spine with MET. The use of a 5-second isometric contraction appeared to be more effective than longer contraction durations for increasing cervical range with MET, but further investigation is recommended. This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program.

The sacroiliac joint (SIJ) is a true source of pain commonly tested in osteopathic practice. This study investigated the inter examiner reliability and validity of pain provocation tests at the SIJ. Two examiners tested fifty participants, mean age 23. Sixteen participants were symptomatic for sacroiliac joint dysfunction. Examiners were blinded to participants inclusion criteria and examinations findings. Cohen's kappa and percentage agreement were used to evaluate inter examiner reliability. Validity was measured using sensitivity, specificity, positive and negative predictive values. Percentage agreement between examiners was 76% and Cohen's kappa findings included a kappa = 0.475 overall. Total validity findings included; sensitivity 0.34, specificity 0.93, positive predictive value 0.70 and negative predictive value 0.75. Investigation identified a poor level of validity of pain provocation tests at the SIJ and of inter examiner agreement using compression and gapping tests. A good level of inter examiner agreement occurred using the high thrust and Faber test (k=0.674 0.611 respectively). This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program.

Although research has been undertaken into the effects of manual intervention on common respiratory conditions, very little research has been undertaken into whether manual therapy can produce a significant improvement in the respiratory function of asymptomatic volunteers one week after the manual intervention. To test whether a relationship exists between the effects of thoracic HVLA and rib raising (RR) on the pulmonary function of asymptomatic volunteers one week after the manual intervention, 38 participants (males = 25, females = 13) were randomly assigned to either a HVLA (n=11), RR (n=14) or a HVLA + RR group (n=13). Statistically significant increases were observed in both FVC (p=0.005) and FEV1 (p=0.002) within each of the three groups over time (pre-test, post-test, 1 week). However, no significant increases were found neither in the chest diameter values within the three treatment groups with respect to time nor between the three groups at any of the three time periods. The greatest increases in percentage change occurred in FEV1 and FVC values at the 1 week time period, particularly for the HVLA + RR and the RR group in which respective FEV1 increases of 10.5% and 7.41% occurred. The results of this study suggest that HVLA and rib raising ought to be equally effective in improving the pulmonary function of asymptomatic individuals , given that no statistically significant difference was found between the mean FEV1 and FVC values within the 3 groups over time. Since previous research shows that rib raising produces within subject increases in both FEV1 and FVC over time that are statistically significant in asthmatics, it may be possible to infer that HVLA may be as useful an adjunct as rib raising in the long-term management of stable asthma. This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program.

A survey of regional Victoria's general practitioners was undertaken to determine their referral patterns and attitudes towards Chiropractors, Osteopaths and Physiotherapists. The objective was to determine whether there is a need for greater numbers of manual therapists in regional Victoria and whether the supposed shortfall of regional therapists plays a role in the knowledge and referral patterns of GPs. The study was carried out via a postal survey, conducted between April 2003 and May 2003. A random selection was made of 100 male and female regional GPs listed in Yellow Pages Online. The response rate was 10.3% (n=103). The main outcome measures sought of the GP's were; knowledge of professions, source of learning, perceived benefits of manual therapy, previous interaction and outcomes with manual therapists, education of and referral rates to complementary practitioners. 90% of GPs actively support the referral of patients to manual therapists, with the majority (88.3%) opting to refer patients to Physiotherapists. Factors determining referral were based largely upon knowledge and relationships with individuals within that profession. These results were largely consistent with those of previous studies, and suggest that there is no significant difference in referral patterns between regional and urban GP's. This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program.

There has been much research into equality on the grounds of socio-economic status (SES), as well as into the socio-demographics of people who attend complimentary healthcare practitioners. The purpose of this study is to examine the socio-economic status and demographic profiles of the patients attending the Victoria University Student Osteopathic Medicine Clinic. Data was collected from the files held at the Victoria University Student Clinic, specifically the patient's age, sex, occupation and postcode. Postcodes are given an index of socio-economic status, which was compiled by the Australian Bureau of Statistics according to census data. The study found that more females than males attend the clinic, that patients are generally of a higher level of SES and are frequently students or office workers. This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program.

Duchenne Muscular Dystrophy (DMD) is a severe and progressive skeletal muscle wasting disease characterised by [Ca2+]-induced hyper-catabolism, and subsequently, a higher demand for energy production to modulate intracellular Ca2+ homeostasis, and protein degradation and synthesis pathways. The broad aim of this thesis was to elucidate potential defects in metabolism of the C57BL/10 mdx mouse model of DMD, and to determine the role of Ca2+ in any such defects. In particular, this thesis has examined the efficacy of the nutritional supplements creatine (Cr) and to a lesser extent, isolated whey protein (WP), in improving intracellular Ca2+ regulation, energy and protein balance and tissue architecture, thus alleviating a degree of the dystrophic pathology. 1. Whether the ATP-producing capacity of dystrophic mitochondria is defective remains largely contentious, and no study to date has directly quantified and contrasted ATP-production rate under the major macronutrient pathways feeding the mitochondria in either mdx hind limb or the more human DMD phenotype-like diaphragm. Chapter Three has demonstrated severely depressed mitochondrial ATP production rate (MAPR) of mdx diaphragm across all macronutrient substrate pathways, but to a lesser extent under protein metabolism, and in tibialis anterior (TA) across the sum of all macronutrient substrate pathways. Function of the electron transport chain complex II was not impaired in dystrophic diaphragm, but was notably depressed in TA. Citrate synthase activity was comparable to controls in both muscles, as was mitochondrial protein content. However, the susceptibility of dystrophic mitochondrial to mechanical damage during the mitochondria isolation process was significantly greater in mdx compared to controls, and in diaphragm compared to TA. It is postulated that mdx skeletal muscle has an intrinsic inability to utilise macronutrient substrates leading to substrate “back-up” and inhibition/down-regulation of key Krebs’ cycle enzymes, thus creating an intracellular “starvation” scenario. That protein metabolism was less affected than the other macronutrient substrate pathways suggests that a portion of the muscle hyper-catabolism observed in DMD may occur due to autophagy to increase amino acid funnelling to mitochondria for ATP production. 2. Supplementation of the high-energy storage nutrient Cr is demonstrably beneficial in maintaining muscle function, energy status and cell survival rate in human DMD and dystrophic mdx skeletal muscle. Long-term chronic dose supplementation regimes, however, have been associated with down-regulation of creatine transporter (CreaT) expression thus making such regimes futile in maintaining consistently high intramuscular PCr stores. Chapter Four has demonstrated successful prevention of CreaT mRNA down-regulation by a chronic dose in utero and life-long Cr supplementation protocol, and subsequently persistently elevated [PCr] compared to unsupplemented mdx skeletal muscle. This was associated with a drastically reduced amount of muscle damage as depicted by Evan’s blue dye (EBD) uptake into myofibres, and a lesser degree of damage to those fibres that were permeant to EBD. This unequivocally demonstrates that muscle wasting occurs secondary to metabolic compromise and failure to maintain ATP supply to intracellular mechanisms that promote cell survival. 3. Effective intracellular Ca2+ regulation by the sarcoplasmic reticulum (SR) is integral to muscle function and becomes of paramount importance to the maintenance of cell survival in conditions of increasing [Ca2+]i such as that evident in DMD. Chapter Five details an optimised method for the fluorometric quantitation of SR Ca2+ flux kinetics currently utilised by our laboratory. It was demonstrated that the SR Ca2+ ATPase (SERCA) preferentially utilises ATP produced by a linked creatine kinase (CK) system over both exogenously administered ATP and ATP produced by SR-linked glycolytic enzymes, and as such, SR Ca2+ uptake rate was considerably faster under these conditions. It was also demonstrated that high [ADP] proximal to the SR vesicles impairs the binding of Ca2+ to Fura-2 and that the presence of 25mM PCr and low [ADP] drastically reduces passive Ca2+ leak from the SR. Thus, this study provides sound rationale for the use of Cr supplementation to improve intracellular Ca2+ handling by the SR subsequent to increasing PCr stores and the buffering of rising [ADP] during metabolic compromise. 4. It has been suggested that the beneficial effects observed in human DMD and dystrophic mdx skeletal muscle following Cr supplementation result from an improved capacity for intracellular Ca2+ handling by the SR and, therefore, delayed degenerative progression. Chapter Six has demonstrated no direct modulatory effect for Cr supplementation on SERCA or RyR function such to increase/decrease SR Ca2+ uptake, leak or release rates, but postulates that the benefit imparted by Cr supplementation is in maintaining maximum uptake (and subsequently release) velocity secondary to buffering rising [ADP] and collapse of the ATP:ADP ratio proximal to the SR. This study has also investigated the effects of supplementation with WP and a Cr+WP combination. As with Cr supplementation, WP induced no direct modulation of SR Ca2+ flux kinetics. Both supplements were shown to modulate differential expression of specific intracellular protein pools, although not necessarily net protein accretion. It is speculated that modification of expressed intracellular protein pools permits the “switching” of dystrophic mdx skeletal muscle from a “functional” phenotype to a “cell survival” phenotype, and that this is inhibited in unsupplemented muscle by a lack of amino acid and energy resources. It was also apparent that Cr and WP supplementation exerted different effects on tissue architecture maintenance. Cr supplementation increased the proportional area of functional muscle tissue and decreased non-muscle “gap” areas thus suggesting a role in muscle hypertrophy, where as Cr+WP combined increased active/recent degeneration and regeneration and the proportion of centrally-nucleated previously damaged fibres compared to peripherally-nucleated undamaged fibres in functional muscle tissue, thus indicating a potentially damaging effect. Collectively, the studies comprising this thesis indicate that the progressive skeletal muscle wasting evident in DMD is closely related to dissipating energy stores, and that the primary disease pathology may, therefore, be an intrinsic metabolic defect caused by the DMD genotype that subsequently induces Ca2+ dys-regulation. Cr supplementation was shown to provide several benefits to dystrophic mdx skeletal muscle architecture, including reduced severity of degenerative cycles, maintenance of muscle tissue and reduced proportional area of non-muscle tissue secondary to increased intramuscular [PCr]. The findings of Chapter Five suggest that Cr supplementation modulates its effect by maintaining normal [PCr] and a high ATP:ADP and PCr:Cr proximal to the SR, such to maintain maximum Ca2+ uptake velocity and reduce passive Ca2+ leak. Both Cr and WP supplementation also seem to modulate intracellular protein synthesis such to increase the capacity for myofibre survival. Thus, these supplements could be of benefit in the adjunct treatment of DMD, and warrant further investigation as to their long-term and mechanistic efficacy.

This study investigated three aspects of the life history of Swamp Paperbark (Melaleuca ericifolia Sm.) that have implications for the ecology, management and restoration of wetlands occupied by the species: i) seed germination responses and tolerances; ii) clonal growth characteristics; and iii) safe sites for recruitment. Laboratory studies included the responses and tolerances of seed to three key environmental factors: light; temperature; salinity; and the potential interactions they may have on germination. Germination percentages were used as indicators of success. Darkness, moderate temperatures (~ 200C) and low salinity levels (< 2 gL-1) were found to be the most ideal germination conditions. Additional studies were carried out on secondary structures, hypocotyl hairs, which were shown to influence establishment success of seedlings. The conditions found ideal for germination proved to be suitable for hypocotyl hair formation. Field and laboratory studies were carried out to determine the allocation of resources to reproductive effort and seed production in M. ericifolia. Comparative studies were carried out between two sympatric Melaleuca species with contrasting life histories and reproductive strategies (clonal vs. non-clonal) to determine if there were differences in reproductive capacity and commitment of resources to either sexual or asexual reproductive effort. There was low germinability of the clonal species M. ericifolia (< 40%) when compared to the non-clonal M. parvistaminea (< 70%). Germinability of M. ericifolia was reduced as population size decreased and distance to nearest population and degree of disturbance increased. Laboratory and field studies were undertaken to investigate the growth characteristics and ecological significance of the clonal growth form. Genetic methods were used to determine the genetic diversity and clonal intermingling in existing populations. Individual genets were found to contain thousands of stems and cover areas greater than 3,000 m2. Intermingling of the genets was not found. Air-photograph interpretation and structural analysis of individual clones were used to determine colonisation rates, longevity and time since recruitment. Lateral growth rates were generally found to be rapid, up to 0.5m per year. The largest plants found (3,274 m2), were determined to be approximately 52 years old. Safe sites for germination and recruitment were determined using historical aerial photographs and climate data combined with on-ground confirmation and characterisation of conditions. Microtopographical relief provided by hummocks within the wetland provided suitable safe sites for recruitment by modifying light, salinity and moisture levels to a range suitable for germination and hypocotyl hair production. Recruitment was however, restricted to a limited range of climatic conditions that diluted salinity levels but did not inundate newly germinated seedlings: flood conditions in spring followed by average rainfall in summer. Recommendations for landscape-scale rehabilitation of wetlands using M. ericifolia were formulated. The implications of the findings of this study on current ecological restoration theory and practice are discussed. Germination from seed in the highly modified conditions found in many wetlands in South-eastern Australia is problematic due to the specific climatic and on-ground conditions needed for successful recruitment. The findings of the growth and genetic studies of M. ericifolia indicate that planting of nursery grown stock is possible and even preferable if the growth characteristics of the plant are taken into consideration. Present planting methods used for non-clonal terrestrial species, hand planting large numbers of seedlings at close spacings, is inappropriate for M. ericifolia. A planting method that carefully selects planting sites, uses smaller numbers of plants and factors in clonality and lateral growth rates (time) would reduce restoration costs and improve long-term survival of planted stock.

It is well established that following eccentric exercise (contractions during which muscles are actively lengthened) and myotoxic injection, disturbances in the regulation of intracellular calcium (Ca2+) homeostasis and increased rate of protein degradation will eventually lead to muscle damage (see Allen et al., 2005). Enhancing the rate at which muscles recover from injury may involve reducing the initial amount of damage by improving the intracellular Ca2+ handling ability of the muscle, or increasing the rate of regeneration by enhancing muscle protein synthesis. Two dietary supplements that may accomplish this are creatine monohydrate and whey protein. Thus, the purpose of this thesis was to examine the effects of creatine monohydrate and whey protein consumption on force recovery after eccentrically-induced muscle damage in healthy individuals. Moreover, to confirm these results by analysing force recovery in two parallel animal studies after controlled, chemically-induced injury. In addition, to determine the mechanisms by which creatine and whey protein exert their effects by examining morphological and biochemical properties of fast-twitch (extensor digitorum longus, EDL) and slow-twitch (soleus) rat skeletal muscle during recovery. In the human studies, muscle strength was significantly higher in the whey protein- and creatine-supplemented groups compared to those consuming a carbohydrate placebo following eccentrically-induced muscle damage. Lower plasma creatine kinase and lactate dehydrogenase levels in the days after injury was indicative of less muscle damage, and thus, supported the improved functional capabilities observed. In the animal studies, creatine supplementation significantly enhanced functional capacity of the regenerating EDL muscles by reducing the extent of fibre necrosis and augmenting fibre regeneration following myotoxic injury. These effects occurred as a direct result of increased muscle protein content, regenerating fiber CSA and muscle mass. Whey protein supplementation significantly enhanced functional capacity of the regenerating EDL muscles by reducing the extent of fibre necrosis following myotoxic injury. Similar to creatine supplementation, enhanced functional capacity of the EDL muscles was due to direct increases in muscle protein content, regenerating fiber CSA and muscle mass. However, in contrast to creatine supplementation, improved muscle recovery was only evident in the early stages of muscle regeneration, with no effects from whey protein supplementation observed in the later stages of muscle regeneration. Similarly, only limited effects were observed in the soleus muscles with either supplement. In conclusion, the results from this thesis have shown the creatine monohydrate and whey protein supplementation may help reduce the extent of, or enhance recovery from, muscle damage. This would not only benefit athletes during intense training phases, competition and during recovery from injury, but may also return people to the workplace earlier. Furthermore, improved functional recovery would also be of considerable benefit to a variety of populations, including those suffering from muscle wasting conditions, weakness associated with aging, neuromuscular disorders, acquired immunodeficiency syndrome, burn injury, cancer cachexia and prolonged sepsis.

The severity of postoperative pain is affected by many factors including the patient’s age, sex, personality, knowledge of and confidence in the procedure, attitude of the staff, and the individual's physiological condition. The same procedure can produce different degrees of postoperative pain in different patients. Even though, in most cases, upper abdominal or thoracic surgery causes severe postoperative pain, superficial operations still cause mild postoperative pain. Patients usually feel the most pain in the first few hours after surgery. Postoperative pain can result in irritability, insomnia, increased heart rate, hypertension, excessive perspiration, overactive metabolism, tachycardia, diaphoresis, mydriasis, pallor and increased myocardial oxygen consumption. In patients with coronary artery disease, postoperative pain can result in myocardial ischemia and possible infarction that in turn may delay postoperative recovery. Intravenous patient-controlled analgesia (PCA) is an accepted method to relieve postoperative pain. Opioids are often used as an analgesic for severe pain management. Possible adverse effects are respiratory depression, constipation, vomiting, gastroparesis, and central nervous system depression including somnolence and consciousness disturbance. Opioid-related side effects often occur post-operatively, and are related to the total dosage of opioid medication. Non-pharmaceutical products can be an alternative in the treatment of post-operative pain and produce less adverse effects. Acupuncture’s ability to control pain has been documented for thousands of years and has become well-accepted in modern Western medicine. Electro-stimulation has a postoperative pain relieving effect when applied as either electro-acupuncture (EA), transcutaneous nerve stimulation (TENS) or Silver Spike Point (SSP) therapy. SSP as needle-free EA and has been shown to have a similar analgesic effect to standard EA, where electrical stimulation is applied to needles that have been inserted into acupuncture points, and a superior effect than TENS. The acupuncture analgesic mechanism remains unclear in spite of successful clinical applications and recognition by WHO. This study investigated SSP needle-free EA's role in managing of postoperative pain and in reducing the adverse side effects of opioids. Acupuncture has generated much interest in western countries like Australia, and is considered a rather safe clinical treatment method for a wide range of disorders. However, in clinical applications, there are some contraindications and complications with using needles. SSP needle-free EA offers many benefits over standard acupuncture treatment such as: reduced hazardous waste, no skin penetration and therefore a reduced risk of infection. SSP EA provides a range of stimulation types that are particularly suitable for sensitive patients including young children and the elderly. A particular advantage of SSP EA is that it can be safely used on acupuncture points all over the body, whereas incorrect acupuncture needling over major organs and the spinal cord can cause serious problems. In this study, we examined the effects of Silver Spike Point (SSP) therapy, also known as needle-free electro-acupuncture (EA), at the classical bilateral acupuncture point Zusanli (ST36) on postoperative pain and opioid-related side effects following hysterectomy. Based on a double blind, sham and different intervention controlled clinical experimental design, four groups of randomised patients were enrolled into the study as subjects. Group 1 was assigned as the control group; Subjects in group 2 were applied SSP electrode at a sham acupuncture point; Group 3 received SSP stimulation at 100 Hz and Group 4 received SSP stimulation by a mixture of at 3 Hz, 10 Hz, and 20 Hz on Zusanli (ST36). It was planned that each group was to consist of 25 women who had undergone hysterectomy. The research evaluated the analgesic effect of SSP needle-free EA for post-operative pain relief of women who had been given a hysterectomy, and comparing the difference between high frequency and low frequency stimulation. The hypothesis was that the groups that received the double treatment of SSP needle-free EA (both pre- and post-surgery) at acupuncture point Zusanli (ST36) would demonstrate increased analgesic relief over a longer period of time, i.e. longer duration before requiring the first PCA dose, fewer PCA doses required, and fewer opioid related side effects compared to the sham and control groups. In addition, the group that received the low frequency treatment would achieve better analgesic relief compared to the high frequency treatment, the sham, and the control groups. The Results were analyzed using a One-way analysis of variance (ANOVA) for Visual Analogue Scale (VAS) of Patient Controlled Analgesia (PCA) doses delivered, and PCA doses demanded by the patients. This method is for testing the differences between means of independent samples. In this case, using SPSS and Student-Newman-Keuls (SNK) and Tukey post-hoc analysis performed a One-way ANOVA. F-tests were also carried out to determine significance between means of the variables, time of first ambulation, bowel movement, total PCA demand and total PCA doses. Statistical significance is based on P value with P < 0.05; clinical beneficial is based on P < 0.10. The results indicated that the means and standard deviations of the four groups were within a close range. Forty-seven women who had hysterectomies met the criteria. The women were randomly allocated to four different groups. Except for those in the control group, treatment was given by an acupuncturist preoperatively and consisted of a course of either sham, low or high frequency stimulation. All groups were assessed during the postoperative period for 24 hours. The Visual Analogue Scale (VAS) was used to determine the amount of perceived pain felt by each subject. It was a 0-10 scale with 0 being no pain and 10 being most severe pain. The data was collected over a 24-hour period commencing post operatively. The significant differences between the groups at each specific time interval were examined. Results showed a clearly decreasing trend in the amount of pain felt over the 24-hour period for all the four groups with respect to the PCA and time. Significant differences or clinical benefits were found between the means at two hours post-operatively with F(3,42) = 2.66 at p<0.10; three hours post-operatively, F(3,42) = 3.68; p<0.05, four hours post-operatively, F(3,42) = 4.33, p<0.05; eight hours post-op, F(3,42) = 3.33, p<0.05; sixteen hours post-op, F(3,42) = 4.25, p<0.05; and twenty-four hours, F(3,42) = 4.67, p<0.01. Further post-hoc analysis showed that at one hour post-operatively, groups one and four were different to each other at the p<0.10 level. At three hours, group 1 (M=6.05) was significantly higher, at the p<0.05 level, than group 4 (M=3.00). This difference was also found at four hours, group 1 (M=5.65) and group four (M=2.71); eight hours, group 1 (M=4.808) and group four (M=2.57); sixteen hours, group 1 (M=4.46) and group 4 (M=2.0); and twenty - four hours, group1 (M= 3.50) and group 4 (M=1.21). Both post-hoc comparison tests indicate that group 4 was significantly different from groups 1, 2, and 3 at twenty-four hours. Differences between the means (M) over the four time intervals for Patient Controlled Analgesia (PCA) doses requirement were also examined. Significant differences were found with F(3,43) = 3.69 at p<0.05, in the Post Operative Room (POR) between the groups. Post-hoc analysis confirmed that group 4 (M=2.30) was significantly lower than groups 2 (M=5.17), and 3 (M=4.58). Post-hoc comparison tests indicate that mean PCA doses in the POR, for group 4 was significantly different from group 2 and 3. Mean PCA doses between groups 1 and 4 have no differences. Differences between the groups between one and eight hours post-operatively were also found with F(3,43)=2.33 at p<0.10. However, post-hoc analysis did not confirm this finding between any of the four groups. To compare the mean amount of Patient Controlled Analgesia (PCA) demands of the four groups over the 24 hours post-operative, a one-way ANOVA with S.N.K and Tukey-HSD post-hoc tests were applied. The results showed that the four groups had a similar trend within 24 hours postoperatively. However, significant differences were found between the means at the Post Operating room with F(3,43) = 4.80 at p<0.01, and 1 to 8 hours postoperative with F(3,43) = 3.49 at p<0.05. Post-hoc analysis confirmed the significant difference between the means at 1 to 8 hours postoperative as group 2 (M=55.75) was significantly higher than group 4 (M=22.30). Post-hoc analysis also confirmed that group 2 (M=30.83) was significantly higher than group 3 (M=13.00) and group 4 (M=5.90) at the POR. No other significance was found between means. The results of PCA doses demanded by subjects indicated that there was no significant difference between the total PCA doses given for the four groups over twenty-four hour period post-operatively. However, a one way ANOVA was applied to compare the groups for total PCA doses demanded and significant differences were found between the groups with F(3,42) = 3.59 at p<0.05. Post-hoc analysis confirmed the difference between groups 1 (M=84.54) and 4 (M=41.60). Moreover, differences were found between the four groups for the amount of analgesia delivered in mg, F(3,43)=2.45, p<0.10. Post-hoc analysis confirmed this finding between group one (M=38.63) and four (M=29.29). The thesis concludes with a discussion of methodological issues related to conducting randomized, placebo-controlled trials of electro-acupuncture and goals for future research in this area of pain management. Treatment outcome of SSP needless electro-acupuncture showed an improvement of the time of first bowel movement and ambulation, opioid related side effects, total amount of PCA demand, and total amount of PCA doses. The clinical significance of this particular study is of great interest, especially for those patients who wish for a non-pharmacological analgesia without side effects. Although further study is needed to ultimately determine whether SSP needle-free electro-acupuncture (EA) has a place in postoperative pain treatment, this study has suggested that SSP needle-free EA does have a place as an adjunct to standard medical care for post-operative surgical pain. Arguably this ‘needle free approach’ has benefits for patients who have difficulties with traditional acupuncture needling and at the same time are interested in a non-pharmacological approach to treating pain.

Currently DNA profiling methods only compare a suspect’s DNA with DNA left at the crime scene. When there is no suspect, it would be useful for the police to be able to predict what the person of interest looks like by analysing the DNA left behind in a crime scene. Determination of the age of the suspect is an important factor in creating an “identikit” (set of drawings of different features that can be put together to form the face of a person). This study investigated if one could use a correlation between telomere length and age, to predict the age of an individual from their DNA. Telomere length, in buccal cells, of 167 individuals aged between 1 and 96 years old was measured using quantitative real time PCR. The causes for the presence of large variation in telomere lengths in the population were further investigated. The age prediction accuracies were low even after dividing samples into non-related Europeans, males and females (5%, 9% and 1% respectively). Mean telomere lengths of eight age groups representing each decade of life showed a non-linear decrease in telomere length with age. There were variations in telomere lengths even among similarly aged individuals aged 26 years old (n = 10) and age 54 years old (n = 9). One of the factors that causes large inter individual variation could be the inheritance of telomere length. If there is a strong paternal or maternal influence, this could be incorporated into the age prediction formula. Parents’ telomere lengths were compared with children’s telomere lengths.