Screening for obstructive sleep apnoea in patients with serious mental illness.

OBJECTIVE: Patients with serious mental illness (SMI) are at increased risk of obstructive sleep apnoea (OSA). Despite this, OSA is frequently under-recognised in the psychiatric population. This study describes the results of OSA screening in SMI patients. METHOD: Patients with SMI attending a metropolitan mental health clinic were screened for OSA using the OSA50, STOP-BANG Questionnaire (SBQ), Epworth Sleep Score (ESS) and the Pittsburgh Sleep Quality Index (PSQI). They were then offered diagnostic sleep testing via ResMed ApneaLinkTM and polysomnography. RESULTS: Of the 65 patients recruited, 65% had a primary diagnosis of schizophrenia or schizoaffective disorder, 85% were on antipsychotic medications and the majority were obese. Approximately 50% of patients reported poor sleep quality via the PSQI, in contrast to 12% with elevated daytime sleepiness via the ESS. 46% of our cohort were at risk of OSA due to an elevated OSA50 or SBQ. Of the five patients who agreed to proceed to diagnostic sleep testing, three were diagnosed with OSA. CONCLUSION: A high proportion of patients with psychiatric illness are at risk of sleep-disordered breathing. Sleep dissatisfaction is high. The low uptake of sleep investigation requires improved patient engagement to improve OSA diagnosis in this high-risk group.

The importance of spawning behavior in understanding the vulnerability of exploited marine fishes in the U.S. Gulf of Mexico.

The vulnerability of a fish stock to becoming overfished is dependent upon biological traits that influence productivity and external factors that determine susceptibility or exposure to fishing effort. While a suite of life history traits are traditionally incorporated into management efforts due to their direct association with vulnerability to overfishing, spawning behavioral traits are seldom considered. We synthesized the existing biological and fisheries information of 28 fish stocks in the U.S. Gulf of Mexico to investigate relationships between life history traits, spawning behavioral traits, management regulations, and vulnerability to fishing during the spawning season. Our results showed that spawning behavioral traits were not correlated with life history traits but improved identification of species that have been historically overfished. Species varied widely in their intrinsic vulnerability to fishing during spawning in association with a broad range of behavioral strategies. Extrinsic vulnerability was high for nearly all species due to exposure to fishing during the spawning season and few management measures in place to protect spawning fish. Similarly, several species with the highest vulnerability scores were historically overfished in association with spawning aggregations. The most vulnerable species included several stocks that have not been assessed and should be prioritized for further research and monitoring. Collectively, the results of this study illustrate that spawning behavior is a distinct aspect of fish ecology that is important to consider for predictions of vulnerability and resilience to fisheries exploitation.

Effect of depression, anxiety, and stress symptoms on response to cognitive behavioral therapy for insomnia in patients with comorbid insomnia and sleep apnea: a randomized controlled trial.

STUDY OBJECTIVES: Patients with comorbid insomnia and sleep apnea (COMISA) report increased severity of depression, anxiety, and stress symptoms compared to patients with either insomnia or sleep apnea alone. Although cognitive behavioral therapy for insomnia (CBTi) is an effective treatment for COMISA, previous research suggests a reduced response to CBTi by patients with insomnia and depression, anxiety, and stress symptoms. Therefore, we used randomized controlled trial data to investigate the impact of depression, anxiety, and stress symptoms before treatment on changes in insomnia after CBTi vs control in patients with COMISA. METHODS: 145 patients with COMISA (insomnia as defined by the International Classification of Sleep Disorders, third edition and apnea-hypopnea index ≥ 15 events/h) were randomized to CBTi (n = 72) or no-treatment control (n = 73). One-week sleep diaries and standardized questionnaire measures of insomnia, sleepiness, fatigue, depression, anxiety, and stress were completed pretreatment and posttreatment. Mixed models were used to examine interactions between depression, anxiety, and stress symptoms before treatment, intervention-group (CBTi, control), and time (pretreatment, posttreatment) on insomnia symptoms. RESULTS: Approximately half of this COMISA sample reported at least mild symptoms of depression (57%), anxiety (53%), and stress (48%) before treatment. Patients reporting greater depression, anxiety, and stress symptoms before treatment also reported increased severity of insomnia, daytime fatigue, and sleepiness. Improvements in questionnaire and diary-measured insomnia symptoms improved during CBTi and were not moderated by severity of depression, anxiety, or stress symptoms before treatment (all interaction P ≥ .11). CONCLUSIONS: We found no evidence that symptoms of depression, anxiety, or stress impair the effectiveness of CBTi in improving insomnia symptoms in patients with COMISA. Patients with COMISA and comorbid symptoms of depression, anxiety, and stress should be referred for CBTi to treat insomnia and improve subsequent management of their obstructive sleep apnea. CLINICAL TRIAL REGISTRATION: Registry: Australian New Zealand Clinical Trials Registry; Name: Treating comorbid insomnia with obstructive sleep apnea (COMISA) study: A new treatment strategy for patients with combined insomnia and sleep apnea; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365184; Identifier: ACTRN12613001178730.

Cognitive behavioural therapy for insomnia reduces sleep apnoea severity: a randomised controlled trial.

Insomnia and obstructive sleep apnoea (OSA) frequently co-occur and may be causally related through sleep fragmentation and/or hyperarousal mechanisms. Previous studies suggest that OSA treatment can improve insomnia severity. However, the effect of insomnia treatment on OSA severity has not been investigated. We performed a randomised controlled trial to investigate the effect of cognitive behavioural therapy for insomnia (CBTi) on OSA severity, controlling for potential sleep-stage and posture effects. 145 patients with comorbid insomnia (International Classification of Sleep Disorders, 3rd Edn) and untreated OSA (apnoea-hypopnoea index (AHI) ≥15 events·h-1 sleep) were randomised to a four-session CBTi programme or to a no-treatment control. Overnight sleep studies were completed pre- and post-treatment to measure AHI, arousal index and sleep architecture, to investigate the effect of intervention group, time, sleep stage (N1-3 or REM) and posture (supine or nonsupine) on OSA severity. The CBTi group showed a 7.5 event·h-1 greater AHI difference (mean (95% CI) decrease 5.5 (1.3-9.7) events·h-1, Cohen's d=0.2, from 36.4 events·h-1 pre-treatment) across sleep-stages and postures, compared to control (mean increase 2.0 (-2.0-6.1) events·h-1, d=0.01, from 37.5 events·h-1 at pre-treatment; interaction p=0.012). Compared to control, the CBTi group also had a greater reduction in total number (mean difference 5.6 (0.6-10.6) greater overall reduction; p=0.029) and duration of nocturnal awakenings (mean difference 21.1 (2.0-40.3) min greater reduction; p=0.031) but showed no difference in the arousal index, or sleep architecture. CBTi consolidates sleep periods and promotes a 15% decrease in OSA severity in patients with comorbid insomnia and OSA. This suggests that insomnia disorder may exacerbate OSA and provides further support for treating insomnia in the presence of comorbid OSA.

Diversification insulates fisher catch and revenue in heavily exploited tropical fisheries.

Declines in commercial landings and increases in fishing fleet power have raised concerns over the continued provisioning of nutritional and economic services by tropical wild fisheries. Yet, because tropical fisheries are often data-poor, mechanisms that might buffer fishers to declines are not understood. This data scarcity undermines fisheries management, making tropical fishing livelihoods particularly vulnerable to changes in marine resources. We use high-resolution fisheries data from Seychelles to understand how fishing strategy (catch diversification) influences catch rates and revenues of individual fishing vessels. We show that average catch weight decreased by 65% over 27 years, with declines in all nine species groups coinciding with increases in fishing effort. However, for individual vessels, catch diversity was associated with larger catches and higher fishing revenues and with slower catch declines from 1990 to 2016. Management strategies should maximize catch diversity in data-poor tropical fisheries to help secure nutritional security while protecting fishing livelihoods.

The effect of cognitive and behavioral therapy for insomnia on week-to-week changes in sleepiness and sleep parameters in patients with comorbid insomnia and sleep apnea: a randomized controlled trial.

STUDY OBJECTIVES: While cognitive and behavioral therapy for insomnia (CBTi) is an effective treatment in patients with comorbid moderate and severe obstructive sleep apnea (OSA), there is concern that the bedtime restriction component of CBTi might dangerously exacerbate daytime sleepiness in such patients. We examined randomized controlled trial data to investigate the effect of OSA severity, and pretreatment daytime sleepiness on week-to-week changes in daytime sleepiness and sleep parameters during CBTi and no-treatment control. METHODS: One hundred and forty-five patients with untreated physician-diagnosed OSA (apnea-hypopnea index ≥15) and psychologist-diagnosed insomnia (ICSD-3) were randomized to a 4-week CBTi program (n = 72) or no-treatment control (n = 73). The Epworth sleepiness scale (ESS) and sleep diaries were completed during pretreatment, weekly CBTi sessions, and posttreatment. Effects of OSA severity, pretreatment daytime sleepiness, and intervention group on weekly changes in daytime sleepiness and sleep parameters were investigated. RESULTS: The CBTi group reported a 15% increase in ESS scores following the first week of bedtime restriction (M change = 1.3 points, 95% CI = 0.1-2.5, p = 0.031, Cohen's d = 0.27) which immediately returned to pretreatment levels for all subsequent weeks, while sleep parameters gradually improved throughout CBTi. There were no differences in changes in daytime sleepiness during treatment between CBTi and control groups or OSA-severity groups. Higher pretreatment ESS scores were associated with a greater ESS reduction during CBTi. CONCLUSIONS: CBTi appears to be a safe and effective treatment in the presence of comorbid moderate and severe OSA. Nevertheless, patients living with comorbid insomnia and sleep apnea and treated with CBTi should be monitored closely for increased daytime sleepiness during the initial weeks of bedtime restriction therapy. CLINICAL TRIAL REGISTRATION: Treating comorbid insomnia with obstructive sleep apnoea (COMISA) study: A new treatment strategy for patients with combined insomnia and sleep apnoea, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 365184 Australian New Zealand Clinical Trials Registry: ACTRN12613001178730. Universal Trial Number: U1111-1149-4230.

Observations on the levels of total mercury (Hg) and selenium (Se) in species common to the artisanal fisheries of Seychelles.

Exposure to mercury (Hg) in Seychelles is expected to be high owing to the large amounts of fish regularly consumed. In spite of this consumption, a recent long-term study of child development found no evidence that higher prenatal exposure to Hg increases the risk of neurological disorders. To identify the major sources of mercury in the diets of Seychellois fish consumers, 16 species of fish common to local markets were tested for total Hg. Selenium (Se), which may act as an antidote to Hg toxicity, was also measured. Mercury and selenium were measured using standardised laboratory procedures. The average total Hg concentration across all species was 0.07mg/kg while the Se concentrations averaged 0.29mg/kg. Based on the pooled species dataset, there was no correlation between total Hg and Se concentrations, suggesting that joint bioaccumulation of these elements does not occur in the reef fishes tested. Barracuda (Sphyraena jello) had the highest concentration of Hg (0.36mg/kg), a level that was below European Union guidelines. Although Seychellois traditionally eat a large amount of fish, barracuda would need to be consumed more than 5 times a week for FAO/WHO Total Hg Provisional Tolerable Weekly Intake (PTWI) limits to be exceeded, an unusual rate of consumption. Further investigations are needed to assess the risks posed to the population through the consumption of marine fish and fish products.

The fishing sector in Seychelles: an overview, with an emphasis on artisanal fisheries.

Seychelles has a well-developed fishing sector that is a vital part of the social and economic development of the country. Three main types of fisheries are recognised: artisanal fisheries targeting demersal and semi-pelagic species, semi-industrial fisheries targeting pelagic species, and industrial fisheries targeting species of tuna. In economic terms, the industrial fisheries are of greatest importance. The per capita consumption of fish in Seychelles is one of the highest in the world and the artisanal fisheries contribute significantly to the protein requirements of the country. Artisanal fisheries catches have remained fairly stable since comprehensive monitoring began in 1985, averaging 4568 MT per annum. A wide range of fish and invertebrate species are targeted and the general catch composition has remained stable. Landing of tuna by the purse seine fleets has grown substantially over the last 18 years, attaining a record catch of approximately 42 945 MT in 2002. The demersal stocks targeted by the artisanal fisheries are known to be over- or optimally exploited close to centres of population, and lightly exploited elsewhere, whilst the industrialised fisheries for pelagic species require a precautionary approach to management as some stocks are being exploited close to maximum sustainable yield levels. Future development in Seychelles is tightly linked to fisheries and the marine environment in general.

Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: a randomized clinical trial.

STUDY OBJECTIVES: Insomnia and obstructive sleep apnea (OSA) commonly co-occur which makes OSA difficult to treat with continuous positive airway pressure (CPAP). We conducted a randomized controlled trial in participants with OSA and co-occurring insomnia to test the hypothesis that initial treatment with cognitive and behavioral therapy for insomnia (CBT-i), versus treatment as usual (TAU) would improve insomnia symptoms and increase subsequent acceptance and use of CPAP. METHODS: One hundred and forty-five participants with OSA (apnea-hypopnea index ≥ 15) and comorbid insomnia were randomized to either four sessions of CBT-i, or TAU, before commencing CPAP therapy until 6 months post-randomization. Primary between-group outcomes included objective average CPAP adherence and changes in objective sleep efficiency by 6 months. Secondary between-group outcomes included rates of immediate CPAP acceptance/rejection, and changes in; sleep parameters, insomnia severity, and daytime impairments by 6 months. RESULTS: Compared to TAU, participants in the CBT-i group had 61 min greater average nightly adherence to CPAP (95% confidence interval [CI] = 9 to 113; p = 0.023, d = 0.38) and higher initial CPAP treatment acceptance (99% vs. 89%; p = 0.034). The CBT-i group showed greater improvement of global insomnia severity, and dysfunctional sleep-related cognitions by 6 months (both: p < 0.001), and greater improvement in sleep impairment measures immediately following CBT-i. There were no between-group differences in sleep outcomes, or daytime impairments by 6 months. CONCLUSIONS: In OSA participants with comorbid insomnia, CBT-i prior to initiating CPAP treatment improves CPAP use and insomnia symptoms compared to commencing CPAP without CBT-i. OSA patients should be evaluated for co-occurring insomnia and considered for CBT-i before commencing CPAP therapy. CLINICAL TRIAL: Treating comorbid insomnia with obstructive sleep apnea (COMSIA) study: A new treatment strategy for patients with combined insomnia and sleep apnea, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365184 Australian New Zealand Clinical Trials Registry: ACTRN12613001178730. Universal Trial Number: U1111-1149-4230.

Publisher Correction: Productive instability of coral reef fisheries after climate-driven regime shifts.

In the version of this Article originally published, a technical error meant two proof corrections were not actioned. In the sentence that started "Fishery changes were underpinned…", a citation to ref. 9 was missing, and that to ref. 22 was misplaced. The sentence should have read: "Fishery changes were underpinned by species' differential responses to the post-bleaching benthic trajectories, suggesting that projections for reef fisheries that are based on habitat-driven loss of fish biomass (for example ref. 9) have overlooked the potential for increased productivity of low trophic levels22, particularly browsing herbivores on regime-shifted reefs." These errors have now been corrected in the Article.

Oral delivery of the anti-tumor necrosis factor α domain antibody, V565, results in high intestinal and fecal concentrations with minimal systemic exposure in cynomolgus monkeys.

OBJECTIVE: V565 is a novel oral anti-tumor necrosis factor (TNF)-α domain antibody being developed for topical treatment of inflammatory bowel disease (IBD) patients. Protein engineering rendered the molecule resistant to intestinal proteases. Here we investigate the formulation of V565 required to provide gastro-protection and enable optimal delivery to the lower intestinal tract in monkeys. METHODS: Enteric-coated V565 mini-tablets were prepared and dissolution characteristics tested in vitro. Oral dosing of monkeys with enteric-coated mini-tablets containing V565 and methylene blue dye enabled in vivo localization of mini-tablet dissolution. V565 distribution in luminal contents and feces was measured by enzyme-linked immunosorbent assay (ELISA). To mimic transit across the damaged intestinal epithelium seen in IBD patients an intravenous (i.v.) bolus of V565 was given to monkeys and pharmacokinetic parameters of V565 measured in serum and urine by ELISA. RESULTS: Enteric-coated mini-tablets resisted dissolution in 0.1 M HCl, before dissolving in a sustained release fashion at neutral pH. In orally dosed monkeys methylene blue intestinal staining indicated the jejunum and ileum as sites for mini-tablet dissolution. Measurements of V565 in monkey feces confirmed V565 survival through the intestinal tract. Systemic exposure after oral dosing was very low consistent with limited V565 mucosal penetration in healthy monkeys. The rapid clearance of V565 after i.v. dosing was consistent with renal excretion as the primary route for elimination of any V565 reaching the circulation. CONCLUSIONS: These results suggest that mini-tablets with a 24% Eudragit enteric coating are suitable for targeted release of orally delivered V565 in the intestine for topical treatment of IBD.

Productive instability of coral reef fisheries after climate-driven regime shifts.

Tropical coastal communities are highly reliant on coral reefs, which provide nutrition and employment for millions of people. Climate-driven coral bleaching events are fundamentally changing coral reef ecosystems and are predicted to reduce productivity of coral reef fish and fisheries, with significant implications for food security and livelihoods. Yet evidence of long-term bleaching impacts on coral reef fishery productivity is lacking. Here, we analyse over 20 years of fish abundance, catch and habitat data to assess long-term impacts of climate-driven coral mass mortality and regime shifts on nearshore artisanal coral reef fisheries in the Seychelles. Contrary to expectations, total catch and mean catch rates were maintained or increased after coral bleaching, consistent with increasing abundance of herbivorous target species in underwater surveys, particularly on macroalgal-dominated reefs. Catch instability increased as habitats followed divergent post-disturbance trajectories and the distribution of target species became more spatially variable, potentially impacting fisher incomes and local market supply chains. Although coral bleaching increased fishery dependence on herbivore species, our results show that climate-impacted reefs can still provide livelihoods and fish protein for coastal communities.

Improving service delivery for neuromuscular diseases: a survey of consumers at a tertiary Australian hospital.

Patients with neuromuscular diseases benefit from coordinated multidisciplinary care to achieve best outcomes. The integration of multi-specialty healthcare delivered in a single clinic can be challenging for service providers due to cost and resource limitation. Our cross-sectional survey of 53 adult patients with neuromuscular disease across Queensland revealed only 27% support the introduction of an integrated multidisciplinary clinic. The most cited reason for opposition to a multidisciplinary clinic was a perceived loss of contact with one's usual doctor. Modifying service delivery in neuromuscular disease is a complex undertaking and will need input from numerous stakeholders.

Contemplative Practices: A Strategy to Improve Health and Reduce Disparities.

Health has many dimensions, and intolerance and lack of compassion may contribute to the poor health and disparities in our nation. Tolerance can convey an inherent paradox or dissonance that can be associated with stress. However, tolerance has a dimension of acceptance, an acknowledgement and acceptance of what "is" at the present moment, that can relieve tension associated with differing beliefs and practices. Compassionate consideration of others can be combined with acceptance to create harmony within and across individuals. In this article, we explore how contemplative practices can cultivate tolerance and compassion and contribute to improvements in individual and population health.

Restricted grouper reproductive migrations support community-based management.

Conservation commonly requires trade-offs between social and ecological goals. For tropical small-scale fisheries, spatial scales of socially appropriate management are generally small-the median no-take locally managed marine area (LMMA) area throughout the Pacific is less than 1 km(2). This is of particular concern for large coral reef fishes, such as many species of grouper, which migrate to aggregations to spawn. Current data suggest that the catchment areas (i.e. total area from which individuals are drawn) of such aggregations are at spatial scales that preclude effective community-based management with no-take LMMAs. We used acoustic telemetry and tag-returns to examine reproductive migrations and catchment areas of the grouper Epinephelus fuscoguttatus at a spawning aggregation in Papua New Guinea. Protection of the resultant catchment area of approximately 16 km(2) using a no-take LMMA is socially untenable here and throughout much of the Pacific region. However, we found that spawning migrations were skewed towards shorter distances. Consequently, expanding the current 0.2 km(2) no-take LMMA to 1-2 km(2) would protect approximately 30-50% of the spawning population throughout the non-spawning season. Contrasting with current knowledge, our results demonstrate that species with moderate reproductive migrations can be managed at scales congruous with spatially restricted management tools.

The influence of fisher knowledge on the susceptibility of reef fish aggregations to fishing.

Reef fishes that exhibit predictable aggregating behaviour are often considered vulnerable to overexploitation. However, fisher knowledge of this behaviour is often heterogeneous and, coupled with socioeconomic factors that constrain demand for or access to aggregated fish, will influence susceptibility to fishing. At two case study locations in Papua New Guinea, Ahus and Karkar islands, we conducted interview-based surveys to examine how local context influenced heterogeneity in knowledge of fish aggregations. We then explored the role of fisher knowledge in conferring susceptibility to fishing relative to socioeconomic drivers of fishing effort. Local heterogeneity in knowledge of aggregating behaviour differed between our case studies. At Ahus, variable access rights among fishers and genders to the main habitats were sources of heterogeneity in knowledge. By contrast, knowledge was more homogenous at Karkar and the sole source of variation was gear type. Differences between locations in the susceptibility of aggregations to fishing depended primarily on socioeconomic drivers of fishing effort rather than catchability. While Ahus fishers were knowledgeable of fish aggregations and used more selective gears, Karkar fishers were less constrained by tenure in their access to aggregation habitat. However, fishing effort was greater at Ahus and likely related to high dependency on fishing, greater access to provincial capital markets than Karkar and a weakening of customary management. Moreover, highly efficient fishing techniques have emerged at Ahus to exploit the non-reproductive aggregating behaviour of target species. Understanding how knowledge is structured within fishing communities and its relation to socioeconomic drivers of fishing effort is important if customary practices for conservation, such as tambu areas, are to be supported. The findings of this study call for a holistic approach to assessing the risks posed to reef fish aggregations by fishing, grounded in the principals of fisheries science and emerging social-ecological thinking.

The Second Physical Therapy Summit on Global Health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases.

Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n = 32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World Café(TM) methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization's non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.

Effect of macroalgal expansion and marine protected areas on coral recovery following a climatic disturbance.

Disturbance plays an important role in structuring marine ecosystems, and there is a need to understand how conservation practices, such as the designation of Marine Protected Areas (MPAs), facilitate postdisturbance recovery. We evaluated the association of MPAs, herbivorous fish biomass, substrate type, postdisturbance coral cover, and change in macroalgal cover with coral recovery on the fringing reefs of the inner Seychelle islands, where coral mortality after a 1998 bleaching event was extensive. We visually estimated benthic cover and fish biomass at 9 sites in MPAs where fishing is banned and at 12 sites where fishing is permitted in 1994, 2005, 2008, and 2011. We used analysis of variance to examine spatial and temporal variations in coral cover and generalized additive models to identify relations between coral recovery and the aforementioned factors that may promote recovery. Coral recovery occurred on all substrate types, but it was highly variable among sites and times. Between 2005 and 2011 the increase in coral cover averaged 1%/year across 21 sites, and the maximum increase was 4%/year. However, mean coral cover across the study area (14%) remained at half of 1994 levels (28%). Sites within MPAs had faster rates of coral recovery than sites in fished areas only where cover of macroalgae was low and had not increased over time. In MPAs where macroalgae cover expanded since 1998 there was no recovery. Where coral was recovering on granite reefs there was a shift in relative prevalence of colony life-form from branching to encrusting species. This simplification of reef structure may affect associated reef fauna even if predisturbance levels of coral cover are attained.