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Beyond the spin, beyond the handouts, here’s how to get a handle on what’s really happening on budget night

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/peter-martin-682709">Peter Martin</a>, <a href="https://theconversation.com/institutions/crawford-school-of-public-policy-australian-national-university-3292">Crawford School of Public Policy, Australian National University</a> Three weeks from now, some of us will be presented with a <a href="https://budget.gov.au/">mountain</a> of budget papers, and just about all of us will get to hear about them on radio, TV or news websites on budget night. The quickest way to find out what the budget is really doing will be to listen to the treasurer’s speech, or to peruse online the aptly-named “<a href="https://treasury.infoservices.com.au/page/budget2023">glossy</a>” – a document that last year was titled “<a href="https://archive.budget.gov.au/2023-24/overview/download/budget_overview.pdf">Stronger foundations for a better future</a>”. <figure class="align-right zoomable"><a href="https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=45&auto=format&w=237&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=848&fit=crop&dpr=1 600w, https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=848&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=848&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/589444/original/file-20240422-23-vkinrm.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" alt="Cover of 2023 budget glossy" /></a><figcaption>Glossies are used to make each budget attractive. <a class="source" href="https://archive.budget.gov.au/2023-24/overview/download/budget_overview.pdf">Commonwealth Treasury</a></figcaption></figure> But they will tell you exactly what the government wants you to hear, exactly as it wants you to hear it. If you are looking instead for the truth – what the government is actually trying to achieve and what it is holding itself and its officials to, I would suggest something else, tucked away on about page <a href="https://cdn.theconversation.com/static_files/files/3225/8787.pdf">87</a> of the main budget document. It is required by the <a href="https://www.legislation.gov.au/C2004A05333/latest/text">Charter of Budget Honesty Act</a> introduced in 1998 by Peter Costello, the treasurer under Prime Minister John Howard. On taking office in 1996, Costello set up a <a href="https://webarchive.nla.gov.au/awa/20101119021633/http://www.finance.gov.au/archive/archive-of-publications/ncoa/execsum.htm">National Commission of Audit</a> to examine the finances he had inherited from the Hawke and Keating governments, presumably with an eye to discovering they had been mismanaged. But the members of the commission weren’t much interested in that. Instead, they decided to deal with something more fundamental. <h2>Budget as you wish, but explain your strategy</h2> Governments were perfectly entitled to manage money in whatever way they wanted, and they were perfectly entitled to spend more money than they raised (which they usually do, it’s called a <a href="https://www.investopedia.com/terms/d/deficit.asp">budget deficit</a>). What the commission wanted was for governments to make clear what they were doing, and to spell out the strategy behind it. Only part of it was about being upfront with the public. The commission also wanted governments to be upfront with themselves – to actually develop frameworks for what they were doing, rather than doing whatever they felt like. The commission recommended a <a href="https://webarchive.nla.gov.au/awa/20101119021633/http://www.finance.gov.au/archive/archive-of-publications/ncoa/execsum.htm">Charter of Budget Honesty</a>, which among other things requires officials to prepare independent assessments of the finances before each election, requires budget updates six months after each budget, and requires <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BriefingBook45p/TaxExpenditures">tax expenditures</a> (tax breaks) to be accounted for like other expenditures. And it requires the publication and regular updating of a <a href="https://cdn.theconversation.com/static_files/files/3227/CBH_Fiscal_strategy.pdf">fiscal strategy statement</a>. <h2>Where treasurers hold themselves accountable</h2> The <a href="https://cdn.theconversation.com/static_files/files/3225/8787.pdf">fiscal strategy</a> can be thought of as an exam question set by the student who is being examined – something along the lines of “this is what you say you want your budget to achieve, please set out the means by which you plan to achieve it”. It turns out to have been exceptionally effective in getting governments to organise their thoughts, make budgets at least try to achieve something, and let the rest of us know what they are trying to achieve. Every few years, treasurers change the strategy, as is their right. Treasurer Jim Chalmers says he’ll change it again this budget, to de-emphasise the fight against inflation and to more greatly emphasise the need to <a href="https://ministers.treasury.gov.au/ministers/jim-chalmers-2022/transcripts/press-conference-washington-dc-0">support economic growth</a>. His statement will tell us what’s behind his actions in a way the glossy words in his brochure and speech might not. <h2>The strategy that has signposted 26 years</h2> Previous statements have signposted all the important turns in what the budget is trying to do. The first, in <a href="https://images.theconversation.com/files/589686/original/file-20240423-16-rncqg3.PNG">1998</a>, committed Costello and Howard to achieving a budget surplus on average over the economic cycle and whenever “growth prospects remain sound”. Making that commitment more difficult was another “not to introduce new taxes or raise existing taxes over the term of this parliament”. Two years later, after the government had won an election promising a new goods and services tax, that commitment was <a href="https://images.theconversation.com/files/589692/original/file-20240423-18-q843xn.PNG">changed</a> to “no increase in the overall tax burden from its 1996-97 level”, a condition met by calling the GST a state tax. <h2>Hockey and Morrison wound back spending</h2> The Labor budgets from 2008 <a href="https://images.theconversation.com/files/589702/original/file-20240423-18-mikx6f.PNG">loosened</a> the tax target to the average share of GDP below the reference year, which they changed to the higher-tax year of 2007-08. The first Coalition budget under Treasurer Joe Hockey in 2014 changed the target from tax to spending, pledging to bring down the ratio of <a href="https://images.theconversation.com/files/589705/original/file-20240423-16-9spkdy.PNG">payments to GDP</a>, and pledging a surplus of 1% of GDP by 2023-24. Any new spending would be more than offset by cuts elsewhere, and if the budget did receive a burst of unexpected revenue it would be “banked” rather than spent. In 2018 Treasurer Scott Morrison reintroduced tax as a target, that he spelled out precisely. Tax was not to increase beyond <a href="https://images.theconversation.com/files/589706/original/file-20240423-16-b7gj5d.PNG">23.9%</a> of GDP. <h2>During COVID, Frydenberg spent big</h2> In 2020, in the face of a COVID-induced recession and soaring unemployment, Finance Minister Mathias Cormann and Treasurer Josh Frydenberg pushed the old strategy to one side. They would spend big now to keep the economy afloat so they wouldn’t have to spend more bailing it out later, and they wouldn’t return to their old concern about the deficit until the unemployment rate was “<a href="https://cdn.theconversation.com/static_files/files/3228/fs2020.pdf">comfortably below 6%</a>”. So well did they succeed that in 2021 Frydenberg made the momentous decision to keep going, abandoning the promise to return to worrying about the deficit when unemployment fell below 6%. Instead he promised to keep spending big until unemployment was “<a href="https://images.theconversation.com/files/589709/original/file-20240423-16-9pmpaf.PNG">back to pre-crisis levels or lower</a>”. The decision propelled unemployment down to a 50-year low of <a href="https://www.datawrapper.de/_/wPfXO/">3.5%</a>. Along with high iron ore prices, that one change of strategy has probably helped deliver Chalmers two consecutive budget surpluses – the one he announced last year for 2022-23, and the one he is set to announce this year for 2023-24. More of us have been in jobs <a href="https://www.finance.gov.au/publications/commonwealth-monthly-financial-statements/2024/mfs-january">paying tax</a>, and fewer have been out of jobs <a href="https://theconversation.com/half-a-million-more-australians-on-welfare-not-unless-you-double-count-227342">on benefits</a>. It’s a powerful demonstration of the real-world difference budget decisions can make, and the way in which the <a href="https://cdn.theconversation.com/static_files/files/3225/8787.pdf">fiscal strategy</a> tells the story.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228387/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-martin-682709">Peter Martin</a>, Visiting Fellow, <a href="https://theconversation.com/institutions/crawford-school-of-public-policy-australian-national-university-3292">Crawford School of Public Policy, Australian National University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/beyond-the-spin-beyond-the-handouts-heres-how-to-get-a-handle-on-whats-really-happening-on-budget-night-228387">original article</a>. </div>

Money & Banking

What happens when I stop taking a drug like Ozempic or Mounjaro?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Drugs like Ozempic are very <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.12932">effective</a> at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger. But does weight come back when you stop using it? The short answer is yes. Stopping <a href="https://jamanetwork.com/journals/jama/fullarticle/2812936">tirzepatide</a> and <a href="https://doi.org/10.1111/dom.14725">semaglutide</a> will result in weight regain in most people. So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far. <h2>It’s a long-term treatment, not a short course</h2> If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone. For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns. Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.) Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less. <h2>Why do people stop?</h2> Research trials show anywhere from <a href="https://asean-endocrinejournal.org/index.php/JAFES/article/view/1771">6%</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/35015037/">13.5%</a> of participants stop taking these drugs, primarily because of <a href="https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more">side effects</a>. But these studies don’t account for those forced to stop because of cost or <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">widespread supply issues</a>. We don’t know how many people have needed to stop this medication over the past few years for these reasons. Understanding what stopping does to the body is therefore important. <h2>So what happens when you stop?</h2> When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to <a href="https://pubmed.ncbi.nlm.nih.gov/30565096/">move out of your system</a>. As it does, a number of things happen: <ul> <li>you start feeling hungry again, because both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119845/">your brain and your gut</a> no longer have the medication working to make you feel full</li> </ul> <ul> <li> blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index">low glycemic index</a> to stabilise your blood sugars </li> <li> over the longer term, most people experience a return to their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092593/">previous blood pressure and cholesterol levels</a>, as the weight comes back </li> <li> weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle. </li> </ul> While you were on the medication, you will have lost <a href="https://academic.oup.com/jes/article/5/Supplement_1/A16/6240360">proportionally less skeletal muscle than fat</a>, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat. <h2>Is stopping and starting the medications a problem?</h2> People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">yo-yo dieting</a>. When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to <a href="https://www.jomes.org/journal/view.html?doi=10.7570/jomes.2017.26.4.237">deal with</a> spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01735-x">stress</a> your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual. Interestingly, the risk to the body from weight fluctuations is greater for people who are <a href="https://jech.bmj.com/content/74/8/662">not obese</a>. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight. <h2>How can you avoid gaining weight when you stop?</h2> Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include: <ul> <li> getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a> </li> <li> exercising in a way that builds and maintains muscle. While on the medication, you will <a href="https://pubmed.ncbi.nlm.nih.gov/32628589/">likely have lost muscle</a> as well as fat, although this is not inevitable, especially if you <a href="https://www.europeanreview.org/article/34169">exercise regularly</a> while taking it </li> </ul> <ul> <li> addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491">fat-phobic and discriminates</a> against people in larger bodies </li> <li> eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes. </li> </ul> Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224972/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-when-i-stop-taking-a-drug-like-ozempic-or-mounjaro-224972">original article</a>. </div>

Body

"What has to happen?" Kyle Sandilands' controversial take after knife attacks

Kyle Sandilands has shared his controversial opinion on arming security guards in the wake of two violent stabbing attacks in Sydney. On Saturday, six people were killed at the hands of Joel Cauchi who went on a stabbing rampage through Bondi Junction Westfield, while on Monday night, a teenage boy stabbed a bishop and a priest during a church service in western Sydney. One of Joel Cauchi's victims was Faraz Tahir, a security guard at the shopping centre, while another guard was injured during the rampage. In the days after the eastern suburbs tragedy, Kyle, who has a <a href="https://oversixty.com.au/health/caring/kyle-sandilands-family-member-among-first-victims-stabbed-in-bondi" target="_blank" rel="noopener">connection</a> to one of the people injured during Cauchi's attack, launched into a tirade live on-air, calling for security guards to be given firearms. "I saw the [NSW] premier [Chris Minns] last night on TV saying firearms for security guards are not on the agenda. And I was like, 'Well, what has to happen before a security guard can actually secure the place for us?'" Sandilands raged. "Every shopping centre and every school should have armed security guards, trained specialists, not just some guy getting a little firearms licence. I mean, proper trained." Most retail security staff in NSW are unarmed, with batons classified as prohibited weapons that require special licensing and training. "There's people that work at Westfield, for example, women that work in shops that have told their husbands, 'I ain't never going back to Westfield. I'm never going back to work again'," Sandilands continued, adding that those retail workers are "traumatised forever" following Saturday's stabbings. Sandilands' opinions have been echoed by fellow controversial broadcaster Ray Hadley, who on Monday demanded on his 2GB Sydney radio show that security guards be armed across the state. "For years I've been arguing that all security guards in the state in hospitals and shopping centres should be better equipped," he said. "And these poor security guards, unarmed, unable to do what they should do - protecting the people that they are there to protect." Image credits: KIISFM

Legal

Guy Sebastian reveals what happened when Marcia Hines collapsed

Guy Sebastian has revealed what really happened on the set of Australian Idol when Marcia Hines <a href="https://oversixty.com.au/health/caring/marcia-hines-rushed-to-hospital" target="_blank" rel="noopener">collapsed</a> behind the scenes and was rushed to hospital. Sebastian appeared on Sunrise on Monday morning, explaining how he was meant to perform on the talent show that launched his career, and ended up having to fill in as co-host. The 42-year-old told Nat Barr and Shirvo that he showed up on set to rehearse the performance of his new single Antidote when he was asked to step in to co-host the show in Marcia's absence. "We were just sound checking and when we got there, it was quite a sombre mood," he explained. "Marcia had to leave but from what I know she was ok. And then Kyle [Sandilands] made a joke about them getting me to fill in and I laughed." "And literally at the same time, my manager [walked over] and said 'Guy we need to speak', and then I jumped in to fill in." He went on to say it was a "full circle moment for me, because I will never forget Marcia's reassuring, affirming, beautiful nature when I was on Idol." "I know I don't possess quite the same nurturing energy, but I did my best." The Australian entertainment industry was struck with concern on Sunday night as news broke that Marcia had been rushed to the hospital just before filming for Australian Idol was about to begin. Fortunately, reports indicate that she is now in stable condition, though the precise nature of her illness remains undisclosed. Image credits: Instagram / Sunrise

Caring

Not all mourning happens after bereavement – for some, grief can start years before the death of a loved one

<a href="https://theconversation.com/profiles/lisa-graham-wisener-1247893">Lisa Graham-Wisener</a>, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> and <a href="https://theconversation.com/profiles/audrey-roulston-1512057">Audrey Roulston</a>, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> For many people, grief starts not at the point of death, but from the moment a loved one is diagnosed with a life-limiting illness. Whether it’s the diagnosis of an advanced cancer or a non-malignant condition such as dementia, heart failure or Parkinson’s disease, the psychological and emotional process of grief can begin many months or even years before the person dies. This experience of mourning a future loss is known as <a href="https://link.springer.com/referenceworkentry/10.1007/978-3-319-69892-2_1006-1">anticipatory grief</a>. While not experienced by everyone, anticipatory grief is a <a href="https://spcare.bmj.com/content/bmjspcare/early/2022/02/10/bmjspcare-2021-003338.full.pdf?casa_token=IWNMDFN5SoIAAAAA:2EybwyPcKu73VdrACTNk7jITor-mMIXK8rv76arXgdjV9cA2Y0MV0LyZLLwcYe1rZUAQymOzFYo">common</a> part of the grieving process and can include a range of conflicting, often difficult thoughts and emotions. For example, as well as feelings of loss, some people can experience guilt from wanting their loved one to be free of pain, or imagining what life will be like after they die. <h2>Difficult to define, distressing to experience</h2> Anticipatory grief has proved <a href="https://journals.sagepub.com/doi/full/10.1177/02692163221074540#bibr13-02692163221074540">challenging to define</a>. A <a href="https://journals.sagepub.com/doi/full/10.1177/02692163221074540#bibr13-02692163221074540">systematic review</a> of research studies on anticipatory grief identified over 30 different descriptions of pre-death grief. This lack of consensus has limited research progress, because there’s no shared understanding of how to identify anticipatory grief. Therese Rando, a <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781315800806-9/grief-mourning-accommodating-loss-therese-rando">prominent theorist</a>, has proposed that anticipatory grief can help prepare for death, contributing to a more positive grieving experience post-bereavement. Rando also suggests that pre-death mourning can aid with adjustment to the loss of a loved one and reduce the risk of <a href="https://www.cruse.org.uk/understanding-grief/effects-of-grief/complicated-grief/">“complicated grief”</a>, a term that describes persistent and debilitating emotional distress. <figure><iframe src="https://www.youtube.com/embed/AapGn60DZSA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> But pre-death mourning doesn’t necessarily mean grief will be easier to work through once a loved one has died. Other <a href="https://www.sciencedirect.com/science/article/pii/S0277953621005724?casa_token=I9mbdSv3d3gAAAAA:MqxN5X_iWbcqa6BYj7IXmImUviheOQWAVA4UBy6795UDuS1uOHG9b245qMkyOiLcvjv_SU6yVA">research evidence</a> shows that it’s possible to experience severe anticipatory grief yet remain unprepared for death. <h2>Carers should seek support</h2> Carers of people with life-limiting illnesses may notice distressing changes in the health of their loved ones. Witnessing close-up someone’s deterioration and decline in independence, memory or ability to perform routine daily tasks, such as personal care, is a painful experience. It is essential, then, for carers to acknowledge difficult emotions and seek support from those around them – especially because caring for a loved one at the end of their life <a href="https://www.mind.org.uk/information-support/helping-someone-else/carers-friends-family-coping-support/your-mental-health/">can be an isolating time</a>. Where possible, it can also be beneficial for carers to offer their loved one <a href="https://compassionatecommunitiesni.com/our-programs/dying-to-talk/">opportunities to reflect</a> on significant life events, attend to unfinished business, and to discuss preferences for funeral arrangements. For some, this may involve supporting loved ones to reconnect with friends and family, helping them to put legal or financial affairs in order, talking about how the illness is affecting them, or making an <a href="https://www.england.nhs.uk/publication/universal-principles-for-advance-care-planning/">advance care plan</a>. <figure><iframe src="https://www.youtube.com/embed/wrJaTXW1Xvk?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Talking is key</h2> Living with altered family dynamics, multiple losses, transition and uncertainty can be <a href="https://www.tandfonline.com/doi/full/10.1080/07481187.2021.1998935">distressing for all family members</a>. It may be difficult to manage the emotional strain of knowing death is unavoidable, to make sense of the situation, and to <a href="https://hospicefoundation.ie/i-need-help/i-am-seriously-ill/how-to-talk-to-those-you-care-about/">talk about dying</a>. However, talking is key in <a href="https://www.cruse.org.uk/about/blog/important-conversations-death/">preparing for an impending death</a>. Organisations who offer specialist palliative care have information and trained professionals to help with difficult conversations, including <a href="https://www.mariecurie.org.uk/help/support/diagnosed/talking-children/children">talking to children</a> about death and dying. Navigating anticipatory grief can involve self-compassion for both the patient and carer. This includes acknowledging difficult emotions and treating oneself with kindness. Open communication with the person nearing the end of their life can foster emotional connection and help address their concerns, alongside support from the wider circle of family and friends. Extending empathy and understanding to those nearing death – and those grieving their impending loss – will help contribute to a compassionate community that supports those experiencing death, dying and bereavement.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221629/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lisa-graham-wisener-1247893">Lisa Graham-Wisener</a>, Lecturer of Health Psychology, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> and <a href="https://theconversation.com/profiles/audrey-roulston-1512057">Audrey Roulston</a>, Professor of Social Work in Palliative Care, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/not-all-mourning-happens-after-bereavement-for-some-grief-can-start-years-before-the-death-of-a-loved-one-221629">original article</a>.

Caring

11 beauty trends that should have never happened

Avoid these beauty buzzkills at all costs Recent years have seen particularly vibrant, eccentric and unpredictable movements in the beauty sphere. Don’t get us wrong; beauty is an aesthetic concept that is indeed subjective to the eye of the beholder, but some of these recent trends aren’t as appealing as you might think. While you’re recovering from the traumatic fashion trends embedded in our history, take comfort in knowing that just about every decade has encountered questionable decisions – whether that be sartorial or cosmetic. If the thought of sporting orange Crocs and popcorn shirts makes you cringe, consider discarding these unflattering beauty trends as well. As proven peeves for guys, makeup artists and job employers alike, these 11 beauty trends actually do the opposite of their intended purpose. Overly sticky lip gloss We all love to sport a glossy pout, but when your lips are so sticky that they begin to look like you doused your mouth in maple syrup, that’s a problem. Wearing it outside especially doesn’t help; nobody likes spending the day with sticky, raspberry pink-streaked strands. Not surprisingly, men aren’t fans of it either; surveys have found that the majority of men vote against women donning it on a dinner date. Not only does it diminish the whole effortless, woke-up-like-this impression you’re trying to pull off, but nobody wants to make out with super glue. Instead, try opting for long-lasting lip tints that moisturise with a subtle sheen. Extensive self-tanner Unless you’re naturally blessed with the wondrous genes of a luminous rose gold complexion, the rest of us mere mortals have been turning to self-tanners to bestow that subtle bronze glow. This doesn’t come with no strings attached however; not only can it ruin that expensive white cashmere sweater you just bought, one coat too many and you’ll begin to resemble a baked pastry. Instead of that “fresh-out-of-the-oven” look, try a tinted moisturiser instead. Stiff hair Applying too much hairspray can make your locks crunchier than a forest floor during September. Instead of spritzing half a bottle of hairspray on your poor scalp, keep it minimal or natural. Hair add-ins While synthetic clip-ons can be cute on a kid or at Coachella, feathers, extensions, and bells on a regular basis can come off rather childish. To prevent looking like a walking Christmas tree (and avoid making your hair look like an arts-and-crafts project), opt for dangling these trinkets on handbags or sporting them as jewellery instead. Neon lips While we’ve all seen the numerous images floating of (admittedly cool-looking) vibrant lipstick styles all over Pinterest, we’re still left scratching our heads as to what public setting one can don a neon green pout. Sporting electrifying colours too drastically divergent from your natural lip colour may make yourself come off as unprofessional and overly aggressive, so it’s best to stay away from the popping lips if you’re attending a job interview. Wet hair look Makeup artists worldwide have predicted this to be the major hair trend of the year. With celebrities like Rosie Huntington-Whiteley and Kim Kardashian West donning it on red carpets and said to have been inspired from Calvin Klein’s campaigns in the ‘90s, it has caught major spotlight everywhere. Although the tousled, wet hair look may look nice on the beachside, having a twist with too much slick on the streets may just come across as greasy, unwashed hair. Colour-blocked makeup Colour-blocking on clothing is undeniably chic, but colour-blocked makeup can make your face appear much too angular, and not in a good way. If you want to avoid looking like a makeup novice, don’t neglect the blending brush. Hangover makeup You know those mornings after a particularly rough night out, and you awaken to the sight of a bloated, saggy face? Well, now there’s a makeup trend striving for just that. A new trend known as “hangover beauty,” this look praises “aegyo-sal” (translated into “charming fat”), striving to highlight the puffiness under one’s eyes. To achieve the look, one has to line the bags underneath the eye and add blush above the cheekbones before blending them together into a reddish hue. This one’s pretty straightforward: don’t try to enhance what the rest of society usually tries to cover up. While having your eyes appear puffy and red-rimmed may have been an intentional choice for you, chances are people are just going to wonder how much sleep you got last night. Furry nails Ever since Jan Arnold, renown co-founder of CND nail polish, showcased furry nails on the runway, people have been plastering actual faux fur on their nails. Several obvious questions arise to the impracticality factor of this trend (how do you even eat or wash your hands with those?), but this nail art might be stretching it a tad too far, even for nail aficionados. You don’t want someone holding your hand to feel like he’s on a date with Sasquatch, so stick with the gel and acrylic for first impressions. Stark ombre hair Don’t get us wrong; we love ombre for many reasons – when done right. The biggest advice you could take for this is to seriously invest in a reputable hair stylist, or else your hair may just end up looking like you are in desperate need of a root touch-up. Never go cheap with ombre, and make sure your colour transition is gradual as opposed to stark. Bleached brows We have Cara Delevingne to thank for sparking the brow obsession; the pencil-thin arches reminiscent of the ’90s have officially been eliminated for thicker, fuller brows. But if you thought microblading was a bold move, think again. Stars like Katy Perry, Kendall Jenner and Rita Ora have all plunged into the peroxide party, inciting an entire movement of people grabbing the bleach to make their arches completely invisible. While that’s fine and all – if you’re into that sort of thing – fuller brows are proven to make you look younger. Image credits: Getty Images This article was originally published on <a href="https://www.readersdigest.com.au/healthsmart/beauty/11-beauty-trends-that-should-have-never-happened?pages=1" target="_blank" rel="noopener">Reader's Digest</a>.

Beauty & Style

What happens if King Charles can no longer perform his duties?

<a href="https://theconversation.com/profiles/anne-twomey-6072">Anne Twomey</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> King Charles III’s <a href="https://www.abc.net.au/news/2024-02-06/king-charles-cancer-diagnosis-revealed-by-buckingham-palace/103430320">cancer diagnosis</a> will turn minds to the question of what happens if he becomes unable to fulfil his constitutional duties. Buckingham Palace has announced he will continue performing his official paperwork and his weekly meetings with the prime minister throughout his treatment. But what happens if he becomes seriously ill? There are three options: counsellors of state, regency and abdication. <h2>Counsellors of state</h2> First, King Charles can delegate some or most of his royal functions to <a href="https://www.legislation.gov.uk/ukpga/Edw8and1Geo6/1/16/section/6">counsellors of state</a>, as happens most commonly when he is travelling overseas. Two counsellors of state act jointly in exercising royal powers such as assenting to laws, receiving ambassadors and holding <a href="https://commonslibrary.parliament.uk/research-briefings/cbp-7460/">Privy Council</a> meetings. The <a href="https://www.royal.uk/counsellors-of-state">counsellors of state</a> are the spouse of the sovereign and the next four adults in line of succession to the throne – being Queen Camilla, Prince William, Prince Harry, Prince Andrew and Princess Beatrice. However, Prince Harry is excluded while he is outside the United Kingdom, and in practice Prince Andrew and Princess Beatrice are not called on to act as they are not “working royals”. As this left only Queen Camilla and Prince William to perform the role, a <a href="https://www.legislation.gov.uk/ukpga/2022/47/2022-12-07/data.html#:%7E:text=An%20Act%20to%20add%20His,delegated%20as%20Counsellors%20of%20State.">law</a> was passed in the UK in 2022 to <a href="https://commonslibrary.parliament.uk/creating-more-counsellors-of-state/">add Princess Anne and Prince Edward</a> to the list. Counsellors of state may carry out most of the sovereign’s functions while he is ill, but they cannot dissolve parliament, except on his instruction, and they cannot create peers. Whether they can appoint a prime minister remains a matter of debate. Most significantly, they cannot exercise powers with respect to the King’s other realms, such as Australia. <h2>Regency</h2> The second option is a regency. This occurs if the King “is by reason of infirmity of mind or body <a href="https://www.legislation.gov.uk/ukpga/Edw8and1Geo6/1/16/section/2">incapable</a> for the time being of performing the royal functions”. The sovereign does not control when or for how long a regency occurs. Instead, it is initiated by a declaration of three or more of: the sovereign’s spouse, the lord chancellor, the speaker of the House of Commons, the lord chief justice of England and the <a href="https://www.judiciary.uk/about-the-judiciary/who-are-the-judiciary/judges/profile-mor/">master of the rolls</a>. The UK’s Regency Act <a href="https://www.legislation.gov.uk/ukpga/Edw8and1Geo6/1/16/section/3">requires</a> Prince William to be regent, as he is the next adult in line of succession to the crown. The regent has the powers of the King with respect to the United Kingdom, but cannot change the order of succession to the crown. The Regency Act does not give the regent powers in relation to realms such as Australia and New Zealand. New Zealand resolved the problem by inserting a <a href="https://www.legislation.govt.nz/act/public/1986/0114/latest/DLM94216.html">section</a> into its Constitution Act which provides that whoever is made regent under the law of the UK may perform the royal functions of the sovereign with respect to New Zealand. Australia, however, has done nothing in this regard, so a British regent would have no powers with respect to Australia. <h2>Abdication</h2> The final option for an incapacitated monarch is abdication. This leads to difficult questions about how an abdication would operate in relation to each of the realms. When King Edward VIII abdicated in 1936, it was achieved by both a signed <a href="https://www.nationalarchives.gov.uk/education/resources/significant-events/abdication-of-edward-viii-1936/">instrument of abdication</a> and the enactment of <a href="https://www.legislation.gov.uk/ukpga/Edw8and1Geo6/1/3/enacted#:%7E:text=(1)Immediately%20upon%20the%20Royal,and%20there%20shall%20be%20a">legislation</a> to which the various realms, including Australia, assented. This is not possible today, as the UK can <a href="https://www6.austlii.edu.au/cgi-bin/viewdoc/au/legis/cth/num_act/aa1986114/s1.html">no longer legislate</a> with respect to Australia. Abdication would therefore raise difficult questions about whether there needed to be a separate abdication of the King of Australia, to trigger the application of the rules of succession that are now part of Australian law, or whether <a href="http://www.austlii.edu.au/cgi-bin/viewdoc/au/legis/cth/consol_act/coaca430/s2.html">covering clause 2</a> of the Constitution, which defines the sovereign by reference to Queen Victoria’s “heirs and successors in the sovereignty of the United Kingdom”, would apply. Because of the potential constitutional messiness of dealing with the King’s role in his 14 realms beyond the United Kingdom, it is likely abdication would be avoided. <h2>Consequences for Australia</h2> If King Charles were incapacitated and counsellors of state or a regent were appointed, would this cause any real problem in Australia? The King’s only remaining substantial powers with respect to Australia are the appointment and removal of the governor-general and the state governors. The governor-general’s term is expected to expire in the middle of the year. If King Charles were then seriously ill and unable to appoint a new governor-general, no one could do so, as neither counsellors of state nor a regent could do so. Instead, the current governor-general, David Hurley, could choose to continue in office, as there is no formal termination of his office until he is replaced. Alternatively, he could resign and his office could be filled on a temporary basis by a state governor as <a href="http://www.austlii.edu.au/cgi-bin/viewdoc/au/legis/cth/consol_act/coaca430/xx4.html">administrator</a>, as is the usual practice when there is a vacancy in the office. If the office of a state governor becomes vacant, the <a href="https://www.governor.nsw.gov.au/governor/lieutenant-governor/role-of-the-lieutenant-governor/">lieutenant-governor</a>, who is often the chief justice of the state, can exercise the governor’s functions. However, if a regency were to continue for a long time – perhaps years – this could become unsustainable. The other consideration is that if there is a regency, there is no power to <a href="https://www.theaustralian.com.au/national-affairs/opinion/in-race-to-palace-governor-general-has-inside-running/news-story/d3918f42af1d081f203daa65f5b53e0f">dismiss a governor-general</a>. So if a constitutional crisis arose, such as that in 1975 with the dismissal of the Whitlam government, the governor-general would know that he or she could act without the prospect of dismissal on the advice of the prime minister. This unbalances the constitutional pressures that are deliberately built into the system, giving a stronger hand to the governor-general and weakening the position of the prime minister. The <a href="https://michaelwest.com.au/king-charles-illness-affects-australia/">problem</a> could be addressed in the same way as the rules of succession to the throne were changed <a href="https://www.legislation.gov.au/C2015A00023/asmade/text">in 2015</a> to remove gender discrimination. It would involve each state enacting a law requesting the Commonwealth to enact a law that recognised the authority of a regent to exercise the sovereign’s powers with respect to Australia. While it is not essential to fix this problem, it would still be wise, as a matter of orderly constitutional housekeeping, to address it before any real difficulties arise.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222870/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/anne-twomey-6072">Anne Twomey</a>, Professor emerita, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-if-king-charles-can-no-longer-perform-his-duties-222870">original article</a>.

Caring

Alzheimer’s may have once spread from person to person, but the risk of that happening today is incredibly low

<a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> An article published this week in the prestigious journal <a href="https://www.nature.com/articles/s41591-023-02729-2">Nature Medicine</a> documents what is believed to be the first evidence that Alzheimer’s disease can be transmitted from person to person. The finding arose from long-term follow up of patients who received human growth hormone (hGH) that was taken from brain tissue of deceased donors. Preparations of donated hGH were used in medicine to treat a variety of conditions from 1959 onwards – including in Australia from the mid 60s. The practice stopped in 1985 when it was discovered around 200 patients worldwide who had received these donations went on to develop <a href="https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/creutzfeldt-jakob-disease-cjd/">Creuztfeldt-Jakob disease</a> (CJD), which causes a rapidly progressive dementia. This is an otherwise extremely rare condition, affecting roughly one person in a million. <h2>What’s CJD got to do with Alzehimer’s?</h2> CJD is caused by prions: infective particles that are neither bacterial or viral, but consist of abnormally folded proteins that can be transmitted from cell to cell. Other prion diseases include kuru, a dementia seen in New Guinea tribespeople caused by eating human tissue, scrapie (a disease of sheep) and variant CJD or bovine spongiform encephalopathy, otherwise known as mad cow disease. This raised <a href="https://en.wikipedia.org/wiki/United_Kingdom_BSE_outbreak">public health concerns</a> over the eating of beef products in the United Kingdom in the 1980s. <h2>Human growth hormone used to come from donated organs</h2> Human growth hormone (hGH) is produced in the brain by the pituitary gland. Treatments were originally prepared from purified human pituitary tissue. But because the amount of hGH contained in a single gland is extremely small, any single dose given to any one patient could contain material from around <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00000563.htm">16,000 donated glands</a>. An average course of hGH treatment lasts around four years, so the chances of receiving contaminated material – even for a very rare condition such as CJD – became quite high for such people. hGH is now manufactured synthetically in a laboratory, rather than from human tissue. So this particular mode of CJD transmission is no longer a risk. <h2>What are the latest findings about Alzheimer’s disease?</h2> The Nature Medicine paper provides the first evidence that transmission of Alzheimer’s disease can occur via human-to-human transmission. The authors examined the outcomes of people who received donated hGH until 1985. They found five such recipients had developed early-onset Alzheimer’s disease. They considered other explanations for the findings but concluded donated hGH was the likely cause. Given Alzheimer’s disease is a much more common illness than CJD, the authors presume those who received donated hGH before 1985 may be at higher risk of developing Alzheimer’s disease. Alzheimer’s disease is caused by presence of two abnormally folded proteins: amyloid and tau. There is <a href="https://actaneurocomms.biomedcentral.com/articles/10.1186/s40478-017-0488-7">increasing evidence</a> these proteins spread in the brain in a <a href="https://pubmed.ncbi.nlm.nih.gov/8086126/">similar way to prion diseases</a>. So the mode of transmission the authors propose is certainly plausible. However, given the amyloid protein deposits in the brain <a href="https://www.nia.nih.gov/news/estimates-amyloid-onset-may-predict-alzheimers-progression">at least 20 years</a> before clinical Alzheimer’s disease develops, there is likely to be a considerable time lag before cases that might arise from the receipt of donated hGH become evident. <h2>When was this process used in Australia?</h2> In Australia, donated pituitary material <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/the-cjd-review-final-report.pdf">was used</a> from 1967 to 1985 to treat people with short stature and infertility. <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/the-cjd-review-final-report.pdf">More than 2,000 people</a> received such treatment. Four developed CJD, the last case identified in 1991. All four cases were likely linked to a single contaminated batch. The risks of any other cases of CJD developing now in pituitary material recipients, so long after the occurrence of the last identified case in Australia, are <a href="https://www.mja.com.au/journal/2010/193/6/iatrogenic-creutzfeldt-jakob-disease-australia-time-amend-infection-control">considered to be</a> incredibly small. Early-onset Alzheimer’s disease (defined as occurring before the age of 65) is uncommon, accounting for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356853/">around 5%</a> of all cases. Below the age of 50 it’s rare and likely to have a genetic contribution. <h2>The risk is very low – and you can’t ‘catch’ it like a virus</h2> The Nature Medicine paper identified five cases which were diagnosed in people aged 38 to 55. This is more than could be expected by chance, but still very low in comparison to the total number of patients treated worldwide. Although the long “incubation period” of Alzheimer’s disease may mean more similar cases may be identified in the future, the absolute risk remains very low. The main scientific interest of the article lies in the fact it’s first to demonstrate that Alzheimer’s disease can be transmitted from person to person in a similar way to prion diseases, rather than in any public health risk. The authors were keen to emphasise, as I will, that Alzheimer’s cannot be contracted via contact with or providing care to people with Alzheimer’s disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222374/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/alzheimers-may-have-once-spread-from-person-to-person-but-the-risk-of-that-happening-today-is-incredibly-low-222374">original article</a>.

Mind

What happens to your liver when you quit alcohol

<a href="https://theconversation.com/profiles/ashwin-dhanda-1359529">Ashwin Dhanda</a>, <a href="https://theconversation.com/institutions/university-of-plymouth-717">University of Plymouth</a> According to Greek mythology, Zeus punished Prometheus for giving fire to humans. He chained Prometheus up and set an eagle to feast on his liver. Each night, the liver grew back and each day, the eagle returned for his feast. In reality, can a liver really grow back? The liver is the largest internal organ in the human body. It is needed for hundreds of bodily processes, including breaking down toxins such as alcohol. As it is the first organ to “see” alcohol that has been drunk, it is not surprising that it is the most susceptible to alcohol’s effects. However, other organs, including the brain and heart, can also be damaged by long-term heavy alcohol use. As a liver specialist, I meet people with alcohol-related liver disease every day. It is a <a href="https://britishlivertrust.org.uk/information-and-support/liver-conditions/alcohol-related-liver-disease/">spectrum of disease</a> ranging from laying down of fat in the liver (fatty liver) to scar formation (cirrhosis) and it usually doesn’t cause any symptoms until the very late stages of damage. At first, alcohol makes the liver fatty. This fat causes the liver to become inflamed. In response, it tries to heal itself, producing scar tissue. If this carries on unchecked, the whole liver can become a mesh of scars with small islands of “good” liver in between – cirrhosis. In the late stages of cirrhosis, when the liver fails, people can turn yellow (jaundice), swell with fluid and become sleepy and confused. This is serious and can be fatal. Most people who regularly drink more than the recommended limit of 14 units of alcohol per week (about six pints of normal strength beer [4% ABV] or about six average [175ml] glasses of wine [14% ABV]) will have a fatty liver. Long-term and heavy alcohol use increases the risk of developing <a href="https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/">scarring and cirrhosis</a>. <h2>Good news</h2> Fortunately, there is good news. In people with fatty liver, after only two to three weeks of giving up alcohol, the liver can heal and looks and functions <a href="https://arcr.niaaa.nih.gov/volume/41/1/natural-recovery-liver-and-other-organs-after-chronic-alcohol-use">as good as new</a>. In people with liver inflammation or mild scarring, even within seven days of giving up alcohol, there are noticeable reductions in liver <a href="https://www.mdpi.com/2072-6643/13/5/1659">fat, inflammation and scarring</a>. Stopping alcohol use for several months lets the liver heal and return to normal. In heavy drinkers with more severe scarring or liver failure, giving up alcohol for several years reduces their chance of <a href="https://www.cghjournal.org/article/S1542-3565(22)01113-2/fulltext">worsening liver failure and death</a>. However, people who drink heavily can be physically dependent on alcohol and stopping suddenly can cause alcohol withdrawal. In its mild form, it causes shaking and sweating. But if severe, it can cause hallucinations, fits and even death. Going “cold turkey” is never recommended for heavy drinkers, who should seek medical advice about how to safely give up alcohol. <h2>Other benefits</h2> Giving up drinking also has positive effects on <a href="https://alcoholchange.org.uk/blog/benefits-of-dry-january-and-when-you-can-expect-to-see-them">sleep, brain function and blood pressure</a>. Avoiding alcohol for long periods also reduces the risk of several types of <a href="https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer">cancer</a> (including liver, pancreas and colon) and the risk of <a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/effects-of-alcohol-on-your-heart">heart disease and stroke</a>. However, alcohol is not the only cause of ill health. Giving it up has many health benefits, but it is not a panacea. It should be seen as part of a healthy lifestyle, including a balanced diet and regular physical exercise. So, to answer the question posed by the myth of Prometheus, the liver has an amazing power to repair itself after it has been damaged. But it cannot grow back as new if it was already severely scarred. If you stop drinking and only have a fatty liver, it can quickly turn back to normal. If you had a scarred liver (cirrhosis) to start with, stopping alcohol will allow some healing and improved function but can’t undo all the damage that has already been done. If you want to look after your liver, drink in moderation and have two to three alcohol-free days each week. That way, you won’t have to rely on the liver’s magical self-healing power to stay healthy.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/220490/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ashwin-dhanda-1359529">Ashwin Dhanda</a>, Associate Professor of Hepatology, <a href="https://theconversation.com/institutions/university-of-plymouth-717">University of Plymouth</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-to-your-liver-when-you-quit-alcohol-220490">original article</a>.

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What happens to your vagina as you age?

<a href="https://theconversation.com/profiles/louie-ye-1465100">Louie Ye</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/martha-hickey-551323">Martha Hickey</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> The vagina is an internal organ with a complex ecosystem, influenced by circulating hormone levels which change during the menstrual cycle, pregnancy, breastfeeding and menopause. Around and after menopause, there are normal changes in the growth and function of vaginal cells, as well as the vagina’s microbiome (groups of bacteria living in the vagina). Many women won’t notice these changes. They don’t usually cause symptoms or concern, but if they do, symptoms can usually be managed. Here’s what happens to your vagina as you age, whether you notice or not. <h2>Let’s clear up the terminology</h2> We’re focusing on the <a href="https://www.ncbi.nlm.nih.gov/books/NBK545147/">vagina</a>, the muscular tube that goes from the external genitalia (the vulva), past the cervix, to the womb (uterus). Sometimes the word “vagina” is used to include the external genitalia. However, these are different organs and play different roles in women’s health. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" alt="Diagram of female reproductive system including the vagina" /></a><figcaption>We’re talking about the internal organ, the vagina. <a class="source" href="https://www.shutterstock.com/image-illustration/female-reproductive-system-image-diagram-243154639">Suwin66/Shutterstock</a></figcaption></figure> <h2>What happens to the vagina as you age?</h2> Like many other organs in the body, the vagina is sensitive to female sex steroid hormones (hormones) that change around puberty, pregnancy and menopause. Menopause is associated with a drop in circulating oestrogen concentrations and the hormone progesterone is no longer produced. The changes in hormones affect the vagina and its ecosystem. <a href="https://www.ncbi.nlm.nih.gov/books/NBK564341/">Effects</a> may include: <ul> <li>less vaginal secretions, potentially leading to dryness</li> <li>less growth of vagina surface cells resulting in a thinned lining</li> <li>alteration to the support structure (connective tissue) around the vagina leading to less elasticity and more narrowing</li> <li>fewer blood vessels around the vagina, which <a href="https://pubmed.ncbi.nlm.nih.gov/2989746/">may explain</a> less blood flow after menopause</li> <li>a <a href="https://www.nature.com/articles/s41564-022-01083-2">shift</a> in the type and balance of bacteria, which can change vaginal acidity, from more acidic to more alkaline.</li> </ul> <h2>What symptoms can I expect?</h2> Many women do not notice any bothersome vaginal changes as they age. There’s also little evidence many of these changes cause vaginal symptoms. For example, there is no direct evidence these changes cause vaginal infection or bleeding in menopausal women. Some women notice vaginal dryness after menopause, which may be linked to less vaginal secretions. This may lead to pain and discomfort during sex. But it’s not clear how much of this dryness is due to menopause, as younger women also commonly report it. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136974/pdf/nihms957122.pdf">one study</a>, 47% of sexually active postmenopausal women reported vaginal dryness, as did around 20% of premenopausal women. Other organs close to the vagina, such as the bladder and urethra, are also affected by the change in hormone levels after menopause. Some women experience recurrent urinary tract infections, which may cause pain (including pain to the side of the body) and irritation. So their symptoms are in fact not coming from the vagina itself but relate to changes in the urinary tract. <h2>Not everyone has the same experience</h2> Women vary in whether they notice vaginal changes and whether they <a href="https://www.flinders.edu.au/research/vitalmeno">are bothered</a> by these to the same extent. For example, women with vaginal dryness who are not sexually active may not notice the change in vaginal secretions after menopause. However, some women notice severe dryness that affects their daily function and activities. In fact, <a href="https://www.imsociety.org/2021/06/21/a-core-outcome-set-for-vasomotor-symptoms-associated-with-menopause-the-comma-core-outcomes-in-menopause-global-initiative/">researchers globally</a> are taking more notice of women’s experiences of menopause to inform future research. This includes prioritising symptoms that matter to women the most, such as vaginal dryness, discomfort, irritation and pain during sex. <h2>If symptoms bother you</h2> Symptoms such as dryness, irritation, or pain during sex can usually be effectively managed. Lubricants may reduce pain during sex. Vaginal moisturisers may reduce dryness. Both are available over-the-counter at your local pharmacy. While there are many small clinical trials of individual products, these studies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942543/">lack the power</a> to demonstrate if they are really effective in improving vaginal symptoms. In contrast, there is robust evidence that vaginal oestrogen is <a href="https://www.cochrane.org/CD001500/MENSTR_use-postmenopausal-women-creams-pessaries-or-vaginal-ring-apply-oestrogen-vaginally-symptoms-vaginal">effective</a> in treating vaginal dryness and reducing pain during sex. It also <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005131.pub2/full">reduces</a> your chance of recurrent urinary tract infections. You can talk to your doctor about a prescription. Vaginal oestrogen is usually inserted using an applicator, two to three times a week. Very little is absorbed into the blood stream, it is <a href="https://pubmed.ncbi.nlm.nih.gov/31913230/">generally safe</a> but longer-term trials are required to confirm safety in long-term use beyond a year. Women with a <a href="https://www.menopause.org.au/hp/position-statements/the-use-of-vaginal-estrogen-in-women-with-a-history-of-estrogen-dependent-breast-cancer">history of breast cancer</a> should see their oncologist to discuss using oestrogen as it may not be suitable for them. <h2>Are there other treatments?</h2> New treatments for vaginal dryness are under investigation. One avenue relates to our growing understanding of how the vaginal microbiome adapts and modifies around changes in circulating and local concentrations of hormones. For example, a <a href="https://pubmed.ncbi.nlm.nih.gov/29381086">small number of reports</a> show that combining vaginal probiotics with low-dose vaginal oestrogen can improve vaginal symptoms. But more evidence is needed before this is recommended. <h2>Where to from here?</h2> The normal ageing process, as well as menopause, both affect the vagina as we age. Most women do not have troublesome vaginal symptoms during and after menopause, but for some, these may cause discomfort or distress. While hormonal treatments such as vaginal oestrogen are available, there is a pressing need for more non-hormonal treatments. <hr /> Dr Sianan Healy, from Women’s Health Victoria, contributed to this article.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/212198/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/louie-ye-1465100">Louie Ye</a>, Clinical Fellow, Department of Obstetrics and Gynecology, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/martha-hickey-551323">Martha Hickey</a>, Professor of Obstetrics and Gynaecology, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-to-your-vagina-as-you-age-212198">original article</a>.

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What happens to teeth as you age? And how can you extend the life of your smile?

<a href="https://theconversation.com/profiles/arosha-weerakoon-792707">Arosha Weerakoon</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> A healthy smile <a href="https://pubmed.ncbi.nlm.nih.gov/37314011/">helps us</a> live long, well and happy lives. But just <a href="https://pubmed.ncbi.nlm.nih.gov/37436910/">like our bodies</a>, our teeth succumb to age-related changes. So what happens to teeth as you age? And what can you do to ensure your smile lasts the distance? <h2>First, what are teeth made of?</h2> The tooth crown is covered by a hard enamel coat that surrounds softer, brown dentine, which protects a centrally located pulp. Enamel is a complex weave of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584618/">brittle</a>, honeycomb-clustered strands that interact with light to make teeth appear opalescent (a pearly, milky iridescence). <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1601-1546.2012.00269.x">Dentine under enamel</a> forms most of the tooth crown and root, and is made of collagen, mineral, water and proteins. Collagen strands are <a href="https://www.sciencedirect.com/science/article/pii/S0003996922002102?via%3Dihub#bib12">woven</a> to stretch and spring back, to <a href="https://www.sciencedirect.com/science/article/pii/S0003996922002102?via%3Dihub#bib12">prevent teeth</a> from cracking and breaking when we grind and chew. The pulp has blood vessels and nerves that communicate with the rest of your body. Enmeshed in the dentine mineral and collagen are small, <a href="https://pubmed.ncbi.nlm.nih.gov/8809302/">interconnected tubules</a> formed by specialised cells called <a href="https://www.sciencedirect.com/science/article/abs/pii/S1047847799940960">odontoblasts</a> that settle around the pulp, once our teeth completely form. Each tooth contains a <a href="https://pubmed.ncbi.nlm.nih.gov/23803461/">finite number of odontoblasts</a>, unlike the constantly replenished special bone cells that renew. <h2>How do our teeth change as we age?</h2> Unable to renew, our teeth <a href="https://www.sciencedirect.com/science/article/pii/S0003996922002102?via%3Dihub#bib19">become brittle</a>, and prone to fracture as dentine loses its spring. This is <a href="https://www.sciencedirect.com/science/article/pii/S0002817714613532?casa_token=1K9Y6CJXmsAAAAAA:t6y_b_Iy02AWpUGaiz4H8Fk0Kdfx6z1ypHiGOEjFqFNlU1jvSRCVjfYOyysgIErJvgCzh33c2hfX">more common</a> in teeth with existing crack lines, large fillings or root canal treatments. With time, the outer surface of enamel <a href="https://www.sciencedirect.com/science/article/abs/pii/S0022391305004348?casa_token=xXfdecXrLaoAAAAA:YE_0swAFtT3RyCUeJmPwciixQ0hwL-foLyC2RGtnlyUSJ9O-pPLQz0B8XNd4Gq1AMtCN2BgnCrqo">thins</a> to reveal the relatively opaque dentine that darkens as we age. The dentine darkens because the collagen weave <a href="https://www.sciencedirect.com/science/article/abs/pii/S1047847722000697">stiffens and shrinks</a>, and the fluid in the tubules <a href="https://www.sciencedirect.com/science/article/pii/S2590152422000010?via%3Dihub">fills with mineral</a>. The odontoblasts continue to form dentine inside the tooth to reduce the translucent pulp space. The increase in dentine makes our teeth appear <a href="https://www.sciencedirect.com/science/article/abs/pii/S0003996913003294">opaque</a> and insulates from hot and cold sensations. This is why <a href="https://www.sciencedirect.com/science/article/pii/S0300571215000494?casa_token=iiLtoxOZOYQAAAAA:RfaGR7lrq9dgWuO_nh6hLETzVUiIWdu-mB-Ev019vZH5t6meVyAHs3YpZzcu9FNrDBYQL6OExu6j">X-rays</a> are useful to detect cavities we may not feel. Food and drink particles fill micro-gaps and age-related fine crack lines that run up and down enamel to <a href="https://www.researchgate.net/profile/Yash-Kapadia/publication/322509199_Tooth_staining_A_review_of_etiology_and_treatment_modalities/links/5b4cd922a6fdcc8dae245b7d/Tooth-staining-A-review-of-etiology-and-treatment-modalities.pdf">discolour and stain</a>. These stains are easily managed by <a href="https://www.sciencedirect.com/science/article/pii/S2772559622000207">tooth whitening</a>. How else can you extend the life of your teeth and brighten your smile? Here are seven tips to avoid dental decline: <h2>1. Avoid unnecessary forces</h2> Avoid <a href="https://www.nature.com/articles/sj.bdj.2012.722">using</a> your teeth to hold things such as working tools or to open packaging. Take measures to avoid forces such as <a href="https://www.sciencedirect.com/science/article/pii/S1882761622000059">grinding or clenching</a> by wearing a night guard. If you have <a href="https://www.sciencedirect.com/science/article/pii/S0109564122002421">large fillings</a> or <a href="https://www.sciencedirect.com/science/article/pii/S0109564122001579?casa_token=kQPjGNgU2iQAAAAA:ytMnT5MLV8aRehNyyWD7qC7FXSBE5xpPCxnzZ2ryKsuyJePq1jHisue1udtN0Cs6NDYJ37xYHy_5">root canal-treated</a> teeth, speak to your dentist about <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/aej.12002?casa_token=RwMhhwmgjwwAAAAA%3AGCWVA9vjFX68S2DdKbCFl4jwTAjMeqVDoT3GtXTSjA7SMEc3ksktOMCUSz9ArikD4XhBM5v08nGCvmVF0g">specific filling materials or crowns</a> that can protect your teeth from cracking or breaking. <h2>2. Share the load</h2> If you are missing molars or premolars, distribute chewing forces evenly to prevent overloading your remaining teeth. Replace missing teeth with <a href="https://www.sciencedirect.com/science/article/pii/S010956411100858X?casa_token=4vrj3ssj0PEAAAAA:UODaFxNDCKmQ_lQs1faL6lh0xIeIfSFrRQBq-s0KF1ZvUJd6ytbXX37TVaiHLRzJPJaSDF_2aVmL">bridges</a>, <a href="https://aap.onlinelibrary.wiley.com/doi/full/10.1902/jop.2008.080188?casa_token=uA0r7imcRbUAAAAA%3AeXGszI5-Dcu4oKi33FCrRRviiAj0uyoP7V5wApIRQD1-1Zu-rkLAcoLhKMAJYVnC9tEnxj33UdNJIndEBA">implants</a> or well-fitted <a href="https://www.mdpi.com/1660-4601/18/13/6776">dentures</a> to support your bite. Get your dentures <a href="https://www.sciencedirect.com/science/article/pii/S0022391320301554">checked regularly</a> to ensure they fit and support adequately, and replace them at least every ten years. <h2>3. Preserve your enamel</h2> Reduce <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12330?casa_token=W2Ib34A77-QAAAAA%3AnLZtwwqZuueyHf1CMX0K9MERSW_Pvc3w0KlpArFT1KNusuopjEUcWmGd8pDUA7fQcj6DMkcS-JnXISFV1w">further enamel and dentine loss</a> by selecting soft-bristled <a href="https://www.tandfonline.com/doi/full/10.1080/00016350802195041?casa_token=E-ErdP543QUAAAAA%3A0Wz5AWwQxntBIc3UndFX_5nVbAYoPDx-PX1tg7Umxjr_QepX3CSIFVXYcrrxWV9iTx99Afk8c_zff-o">tooth brushes and non-abrasive toothpastes</a>. Certain whitening toothpastes can be abrasive, which can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8874033/">roughen and wear</a> the tooth surfaces. If you are unsure, stick with toothpastes that are labelled “sensitive”. Reduce your exposure to <a href="https://www.nature.com/articles/sj.bdj.2012.722">acid</a> in food (think lemons or apple cider vinegar) or illness (reflux or vomiting) where possible to maintain enamel and prevent erosion. <h2>4. Enhance your saliva</h2> <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jtxs.12356?casa_token=1moXbwnrDQIAAAAA%3AHz3Im9lmR3h75TmG8FSUQH-8_0UGnQ9TNkgaPL79LlrCmwC3kzZZJaAB2mSZHf4X7PX5y3GKaVoY5cm5JA">Saliva</a> protects against acid attacks, flushes our teeth, and has antibacterial properties to reduce erosion and decay (holes forming). Saliva is also important to help us chew, swallow and speak. But our saliva quality and quantity reduces because of age-related changes to our salivary glands as well as certain medications prescribed to <a href="https://pubmed.ncbi.nlm.nih.gov/19392837/">manage chronic illnesses</a> such as depression and high blood pressure. Speak to your doctor about other medication options to improve your saliva or manage reflux disease to prevent erosion. <h2>5. Treat gum disease</h2> Aesthetically, <a href="https://pubmed.ncbi.nlm.nih.gov/37358230/">treating gum disease (periodontitis)</a> reduces gum shrinkage (recession) that typically exposes the relatively darker tooth roots that are more <a href="https://journals.sagepub.com/doi/abs/10.1177/00220345231166294">prone to developing holes</a>. <h2>6. Manage and prevent senescence</h2> <a href="https://pubmed.ncbi.nlm.nih.gov/36908187/">Cellular senescence</a> is the process that changes DNA in our cells to reduce our ability to withstand physical, chemical or biological damage. Cellular senescence enhances new cancer formation, the spread of existing cancers and the onset of chronic illnesses such as Alzheimer’s disease, diabetes, osteoporosis and heart disease. You can prevent cell damage by managing lifestyle factors such as smoking, uncontrolled diabetes and chronic infections such as gum disease. <h2>7. Adapt and ask for help</h2> <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15769?casa_token=SC-LouFQThsAAAAA%3A4jcvLRuJ56dGEm7ttvMad65hvUoZ7V5nvILg5sLFVZo8jxyQGR6YFeTcfM8sByTbdVrCWR1O5ytI3Z_crA">Ageing</a> can affect our cognition, hand dexterity and eyesight to prevent us from cleaning our teeth and gums as effectively as we once could. If this describes you, talk to your dental care team. They can help clean your teeth, and <a href="https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2020.29.9.520?casa_token=_rol0NXx9c8AAAAA%3Aq8zgxiMSASwF1MRQZnZzfzmttn2x7FfGwsiIv71C_s_PTTmGD9JOIbqqtLNXa0oF9ogOjOCZwwpwB94">recommend products and tools</a> to fit your situation and abilities.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/215786/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/arosha-weerakoon-792707">Arosha Weerakoon</a>, Senior Lecturer, School of Dentistry, The University of Queensland and General Dentist., <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-to-teeth-as-you-age-and-how-can-you-extend-the-life-of-your-smile-215786">original article</a>.

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Explainer: Australia has voted against an Indigenous Voice to Parliament. Here’s what happened

<a href="https://theconversation.com/profiles/amy-maguire-129609">Amy Maguire</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> A majority of Australian voters have rejected the proposal to establish an Aboriginal and Torres Strait Islander Voice to Parliament, with the final results likely to be about 40% voting “yes” and 60% voting “no”. <h2>What was the referendum about?</h2> In this referendum, Australians were asked to vote on whether to establish an Aboriginal and Torres Strait Islander <a href="https://voice.gov.au/referendum-2023/referendum-question-and-constitutional-amendment">Voice</a> to Parliament. The Voice was proposed as a means of recognising Aboriginal and Torres Strait Islander peoples as the <a href="https://aiatsis.gov.au/explore/australias-first-peoples">First Peoples of Australia</a> in the Constitution. The Voice proposal was a modest one. It was to be an advisory body for the national parliament and government. Had the referendum succeeded, Australia’s Constitution would have been amended with a new section 129: <blockquote> In recognition of Aboriginal and Torres Strait Islander peoples as the First Peoples of Australia: i. there shall be a body, to be called the Aboriginal and Torres Strait Islander Voice ii. the Aboriginal and Torres Strait Islander Voice may make representations to the Parliament and the Executive Government of the Commonwealth on matters relating to Aboriginal and Torres Strait Islander peoples iii. the Parliament shall, subject to this Constitution, have power to make laws with respect to matters relating to the Aboriginal and Torres Strait Islander Voice, including its composition, functions, powers and procedures. </blockquote> This proposal was drawn from the <a href="https://ulurustatement.org/the-statement/view-the-statement/">Uluru Statement from the Heart</a> from 250 Indigenous leaders, which called for <a href="https://deadlystory.com/page/culture/Annual_Days/NAIDOC_Week/NAIDOC_2019/Hey_you_Mob_it_s_NAIDOC_week#:%7E:text=The%20statement%20outlines%20a%20need,see%20below%20for%20more%20information">three phases of reform</a> - Voice, followed by Treaty and Truth -telling about Australia’s colonial history. The proposal was for constitutional change to ensure the Voice would not be abolished by government in future, as previous Indigenous bodies have been. <h2>How did Australians vote?</h2> Voting is <a href="https://www.aec.gov.au/about_aec/publications/voting/">compulsory</a> in Australia. Every eligible Australian citizen over 18 years of age is obliged to vote in elections and referendums. Australia has one of the <a href="https://peo.gov.au/understand-our-parliament/your-questions-on-notice/questions/how-many-people-voted-in-the-last-election/#:%7E:text=According%20to%20the%20Australian%20Electoral,voter%20turnouts%20in%20the%20world.">highest rates of voter turn out</a> in the world - over 90% of those eligible have voted in every national election since compulsory voting was introduced in 1924. Australia has a written <a href="https://www.legislation.gov.au/Details/C2013Q00005">Constitution</a>. A successful referendum vote is required to <a href="https://www.aph.gov.au/About_Parliament/House_of_Representatives/Powers_practice_and_procedure/Practice7/HTML/Chapter1/Constitution_alteration">change</a> the Constitution in any way. To succeed, a referendum proposition requires a <a href="https://voice.gov.au/referendum-2023/how-referendum-works#:%7E:text=For%20a%20referendum%20to%20be,4%20out%20of%206%20states.">double majority</a>. This means it must be agreed to by a majority of voters, and a majority of states. Australia has six <a href="https://digital-classroom.nma.gov.au/images/map-australia-showing-states-and-territories">states</a>, so at least four must have a majority of voters in favour for a referendum to succeed. Australia also has two territories - individuals in the <a href="https://theconversation.com/state-and-territory-ballots-will-be-counted-differently-at-the-voice-referendum-is-that-fair-212703">territories</a> contribute to the overall vote, but the territories do not count towards the majority of states. It’s very difficult to achieve constitutional change in Australia. Since federation in 1901, 45 questions have been put to Australian voters in <a href="https://www.aec.gov.au/elections/referendums/referendum_dates_and_results.htm">referendums</a>. Only eight of those have succeeded. In the Voice referendum, only the Australian Capital Territory voted “yes” by majority. A <a href="https://tallyroom.aec.gov.au/ReferendumNationalResults-29581.htm">clear majority</a> of the national electorate voted “no”. All states returned majority “no” results. Aboriginal and Torres Strait Islander people constitute <a href="https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/estimates-aboriginal-and-torres-strait-islander-australians/latest-release#:%7E:text=Data%20downloads-,Key%20statistics,Queensland%20and%20Western%20Australia%20combined.">3.8% of Australia’s population</a>. Government members claimed on ABC TV in the referendum coverage that polling booths including high proportions of Indigenous voters, for example Palm Island in Queensland, returned high “yes” votes. However, in a majoritarian democracy like Australia, such a small proportion of the national population cannot dictate the outcome of a national poll. Importantly, the Voice referendum did not have unanimous support across the two main political parties in Australia. The Labor government <a href="https://theconversation.com/were-all-in-declares-an-emotional-albanese-as-he-launches-the-wording-for-the-voice-referendum-202435">announced</a> and has campaigned for “yes”. The leader of the opposition, Liberal Queensland MP <a href="https://www.abc.net.au/news/2023-09-05/peter-dutton-voice-to-parliament-yes-no-vote-referendum/102797582">Peter Dutton</a>, campaigned strongly against the referendum proposal. <h2>What happens now?</h2> The government is bound to abide by the referendum result. Prime Minister Anthony Albanese has confirmed that his government <a href="https://www.theguardian.com/australia-news/2023/oct/08/labor-wont-try-to-legislate-indigenous-voice-if-referendum-fails-albanese-says#:%7E:text=The%20prime%20minister%2C%20Anthony%20Albanese,away%20from%20the%20voice%20altogether%3F%E2%80%9D">will not seek to legislate a Voice</a> as an alternative to the constitutional model. Albanese, conceding the failure of the referendum, <a href="https://www.abc.net.au/news/2023-10-14/live-updates-voice-to-parliament-referendum-latest-news/102969568">said</a>: “Tomorrow we must seek a new way forward”. He called for a renewed focus on doing better for First Peoples in Australia. The referendum outcome represents a major loss for the government. But much more important than that will be the negative impacts of the campaign and loss on Aboriginal and Torres Strait Islander people. On ABC TV, Arrernte/Luritja woman <a href="https://www.snaicc.org.au/about/contact/staff-bios/">Catherine Liddle</a> called for a renewed focus on truth-telling and building understanding of Australia’s history across the population. She said the failure of the referendum reflected a lack of understanding about the lives and experiences of Indigenous people in Australia. “Yes” campaign advocates reported <a href="https://www.smh.com.au/politics/federal/we-are-tired-victorian-yes-advocates-devastated-as-no-vote-refuses-voice-20231012-p5ebse.html">devastation</a> at the <a href="https://www.theguardian.com/australia-news/2023/oct/14/australian-voters-reject-proposal-for-indigenous-voice-to-parliament-at-historic-referendum">outcome</a>. Sana Nakata, writing <a href="https://theconversation.com/the-political-subjugation-of-first-nations-peoples-is-no-longer-historical-legacy-213752">here</a>, said: “now we are where we have always been, left to build our better futures on our own”. Some First Nations advocates, including Victorian independent Senator <a href="https://www.aljazeera.com/news/2023/8/16/lidia-thorpe-says-australias-voice-referendum-should-be-called-off">Lidia Thorpe</a> - a Gunnai, Gunditjmara and Djab Wurrung woman - argued the Voice proposal lacked substance and that the referendum should not have been held. Advocates of a “<a href="https://www.sbs.com.au/news/the-feed/article/these-progressive-no-campaigners-are-looking-beyond-the-vote-heres-what-they-want/tdyj2ilx6">progressive no</a>” vote (who felt the Voice didn’t go far enough) will continue to call for recognition of continuing First Nations sovereignty and self-determination through processes of treaty and truth-telling. The information landscape for Australian voters leading up to this referendum was murky and difficult to navigate. The Australian Electoral Commission published a <a href="https://www.aec.gov.au/media/disinformation-register-ref.htm">disinformation register</a>. <a href="https://www.sbs.com.au/news/article/extremely-politicised-and-very-worrying-how-misinformation-about-the-voice-spread/w9sl4pzba">Misinformation and lies</a>, many circulated through social media, have influenced the decision-making of a proportion of voters. It’s open to question whether constitutional change of any kind can be achieved while voters remain so exposed to multiple versions of “<a href="https://www.amnesty.org.au/sorting-fact-from-fiction-in-the-voice-to-parliament-referendum/">truth</a>”. For many First Nations people, the proliferation of lies and misinformation driven by <a href="https://www.bbc.com/news/world-australia-66470376">racism</a> throughout the Voice debate have been <a href="https://www.abc.net.au/news/2023-10-03/indigenous-mental-health-impacts-of-voice-referendum-debate/102923188">traumatising</a> and brutal. Indigenous Australians’ Minister, Wiradjuri woman Linda Burney, spoke to Aboriginal and Torres Strait Islander people after the result: “Be proud of your identity. Be proud of the 65,000 years of history and culture that you are part of”. Her <a href="https://www.9news.com.au/videos/national/linda-burney-gives-emotional-speech-following-referendum-result/clnpw6w0n009u0jp8kvgbijuy">pain</a> was patently obvious as she responded to the referendum outcome.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/215155/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/amy-maguire-129609">Amy Maguire</a>, Associate Professor in Human Rights and International Law, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/explainer-australia-has-voted-against-an-indigenous-voice-to-parliament-heres-what-happened-215155">original article</a>.

Legal

What happens to old cruise ships?

Cruise control Cruise ships are a way to explore the world and have a holiday out on the sea. Before the COVID-19 pandemic, going on a cruise to a new destination was a popular way for people to travel to new countries while being mindful of their travel budget. However, have you ever wondered what happens to cruise ships after they’re no longer in use? Where do cruise ships go? Like every other work of machinery in the world, cruise ships can’t run forever. Typically, a cruise ship is built to run about 30 years. When a cruise ship is no longer running smoothly or it’s time for it to retire, there are a few different factors for consideration which include the state of the ship when it goes into retirement along with how many people are interested in purchasing the cruise ship.” In some cases, retired ships could have a second life and be sold to other companies,” Colleen McDaniel, editor-in-chief of Cruise Critic, tells Reader’s Digest. “In other cases, they’re sold for scrap – meaning the ship will dock at a shipyard and the most valuable parts will be sold piece-by-piece, and the rest of the ship stripped.” While cruise ships can be sold to other cruise lines and repurposed that way, given the current climate with the pandemic, ships may skip that route and go straight to the scrapyard. “Currently, as cruise lines are retiring select ships, we’re seeing a mix of both– some ships have been transferred to different cruise lines, others are headed to shipyards to be sold as scrap,” says McDaniel. How is a cruise ship taken apart? Like retired airplanes, cruise ships have their own final resting place. “The term ‘cruise ship graveyard’ is usually meant to describe those final destinations for ships that have been scrapped,” McDaniel says. You might be surprised to know that the largest scrap yard for ships in the world located in Alang, India recycles around 50 per cent of decommissioned cruise ships. Cruise ships either use their own power to go or they’re towed, which is a bit more difficult. Then there is a process in order to tear cruise ships down. “If the ship is no longer profitable or has mechanical or other systemic issues, then it will be sold for demolition. In recent years, the most popular place for old cruise ships to get demolished has been Alang, in India, where there is a ten-mile stretch of beach with a 25-foot tidal variance,” says Peter Knego, a cruise journalist and historian. “Ships are beached there at high tide, then when the tide recedes, workers head out, remove all salvageable fittings and begin cutting the ship down. As the ship gets cut away, it is gradually winched ashore until it finally disappears.” Cruise ships as tourists attractions Another option is to use retired cruise ships as popular tourist attractions. While we may never know the mysteries of the Titanic, one of the most famous cruise liners of all time, we can get an inside look at other ships like the Queen Mary. With tours and attractions and various dining options available, you’re able to learn more about Queen Mary’s history and learn fun facts, like how the building of this ship was a technological achievement. What has happened to cruise ships due to the pandemic? The pandemic has upended many aspects of everyday life. “The pandemic sped up the process of cruise ship disposal since cruise lines could not afford to keep vast fleets in warm layup (with full crews to make sure all systems are in working order, the ship is clean, safe, etc.) or even cold layup,” says Knego. Sadly, many cruise ships have had their lives cut short due to the pandemic. “The eighteen ships that the Carnival Corporation (parent company of Carnival Cruises with multiple cruise lines) and three that Royal Caribbean have thus far disposed of were still viable and popular ships until the pandemic struck,” explains Knego. “For the most part, they could have all been kept in service for several more years but without the demand and with the overhead being so high, they had no choice and had to begin paring down their fleets. If the pandemic continues for much longer, what we have seen thus far is only the beginning of a much larger purge.” Image credits: Getty Images This article originally appeared on <a href="https://www.readersdigest.com.au/travel/what-happens-to-old-cruise-ships" target="_blank" rel="noopener">Reader's Digest</a>.

Cruising

What happens in our body when we encounter and fight off a virus like the flu, SARS-CoV-2 or RSV?

<a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> <a href="https://www.labcorp.com/coronavirus-disease-covid-19/covid-news-education/covid-19-vs-flu-vs-rsv-how-tell-difference">Respiratory viruses</a> like influenza virus (flu), SARS-CoV-2 (which causes COVID) and respiratory syncytial virus (RSV) can make us sick by infecting our respiratory system, including the nose, upper airways and lungs. They spread from person to person through respiratory droplets when someone coughs, sneezes, or talks and can cause death in serious cases. But what happens in our body when we first encounter these viruses? Our immune system uses a number of strategies to fight off viral infections. Let’s look at how it does this. <h2>First line of defence</h2> When we encounter respiratory viruses, the <a href="https://www.sciencedirect.com/science/article/pii/S193131281600038X?via%3Dihub/">first line of defence</a> is the physical and chemical barriers in our nose, upper airways, and lungs. Barriers like the mucus lining and hair-like structures on the surface of cells, work together to trap and remove viruses before they can reach deeper into our respiratory system. Our defence also includes our behaviours such as coughing or sneezing. When we blow our nose, the mucus, viruses, and any other pathogens that are caught within it are expelled. But sometimes, viruses manage to evade these initial barriers and sneak into our respiratory system. This activates the cells of our innate immune system. <h2>Patrolling for potential invaders</h2> While our acquired immune system develops over time, our innate immune system is present at birth. It generates “non-specific” immunity by identifying what’s foreign. The cells of innate immunity act like a patrol system, searching for any invaders. These innate cells patrol almost every part of our body, from our skin to our nose, lungs and even internal organs. Our respiratory system has different type of innate cells such – as macrophages, neutrophils and natural killer cells – which patrol in our body looking for intruders. If they recognise anything foreign, in this case a virus, they will initiate an attack response. Each cell type plays a slightly different role. Macrophages, for example, will not only engulf and digest viruses (phagocytosis) but also release a cocktail of different molecules (cytokines) that will warn and recruit other cells to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cmi.12580">fight against the danger</a>. In the meantime, natural killer cells, aptly named, attack infected cells, and stop viruses from multiplying and <a href="https://www.nature.com/articles/s41577-021-00558-3">invading our body further</a>. Natural killer cells also promote inflammation, a <a href="https://www.hindawi.com/journals/jir/2018/1467538/">crucial part of the immune response</a>. It helps to recruit more immune cells to the site of infection, enhances blood flow, and increases the permeability of blood vessels, allowing immune cells to reach the infected tissues. At this stage, our immune system is fighting a war against viruses and the result can cause inflammation, fevers, coughs and congestion. <h2>Launching a specific attack</h2> As the innate immune response begins, another branch of the immune system called the adaptive immune system is <a href="https://www.ncbi.nlm.nih.gov/books/NBK21070/">activated</a>. The adaptive immune system is more specific than the innate immune system, and it decides on the correct tools and strategy to fight off the viral invaders. This system plays a vital role in eliminating the virus and providing long-term protection against future infections. Specialised cells called T cells and B cells are key players in acquired immunity. T cells (specifically, helper T cells and cytotoxic T cells) recognise viral proteins on the surface of infected cells: <ul> <li> helper T cells release molecules that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764486/">further activate immune cells</a> </li> <li> cytotoxic T cells directly kill infected cells with a very great precision, <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2018.00678/full">avoiding any healthy cells around</a>. </li> </ul> B cells produce antibodies, which are proteins that can bind to viruses, neutralise them, and mark them for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247032/">destruction by other immune cells</a>. B cells are a critical part of memory in our immune system. They will remember what happened and won’t forget for years. When the same virus attacks again, B cells will be ready to fight it off and will neutralise it faster and better. Thanks to the adaptive immune system, vaccines for respiratory viruses such as the COVID mRNA vaccine keep us protected from <a href="https://www.health.gov.au/our-work/covid-19-vaccines/our-vaccines/how-they-work">being sick or severely ill</a>. However, if the same virus became mutated, our immune system will act as if it was a new virus and will have to fight in a war again. <h2>Neutralising the threat</h2> As the immune response progresses, the combined efforts of the innate and adaptive immune systems helps control the virus. Infected cells are cleared, and the virus is neutralised and eliminated from the body. As the infection subsides, symptoms gradually improve, and we begin to feel better and to recover. But recovery varies depending on the specific virus and us as individuals. Some respiratory viruses, like rhinoviruses which cause the common cold, may cause relatively mild symptoms and a quick recovery. Others, like the flu, SARS-CoV-2 or severe cases of RSV, may lead to more severe symptoms and a longer recovery time. Some viruses are very strong and too fast sometimes so that our immune system does not have the time to develop a proper immune response to fight them off. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207023/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, Research Leader in Virology and Infectious Disease, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, Research Fellow, Institute for Glycomics, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-in-our-body-when-we-encounter-and-fight-off-a-virus-like-the-flu-sars-cov-2-or-rsv-207023">original article</a>.

Body

Tourists flock to the Mediterranean as if the climate crisis isn’t happening. This year’s heat and fire will force change

<a href="https://theconversation.com/profiles/susanne-becken-90437">Susanne Becken</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/johanna-loehr-1457342">Johanna Loehr</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Thousands of people on the beach. Children reportedly falling off evacuation boats. Panic. People fleeing with the clothes on their backs. It felt like “the end of the world”, according to <a href="https://www.theguardian.com/world/2023/jul/23/british-tourists-tell-of-nightmare-in-rhodes-fires-greece">one tourist</a>. The fires sweeping through the Greek islands of Rhodes and Corfu are showing us favourite holiday destinations are no longer safe as climate change intensifies. For decades, tourists have flocked to the Mediterranean for the northern summer. Australians, Scandinavians, Brits, Russians all arrive seeking warmer weather. After COVID, many of us have been keen to travel once again. But this year, the intense heatwaves have claimed <a href="https://inews.co.uk/news/world/heatwave-pictures-wildfires-worsen-greece-italy-spain-europe-us-2488556">hundreds of lives</a> in Spain alone. Major tourist drawcards such as the Acropolis in Athens have been closed. Climate scientists are “stunned by the ferocity” of the <a href="https://www.theguardian.com/commentisfree/2023/jul/25/northern-hemisphere-heatwaves-europe-greece-italy-wildfires-extreme-weather-climate-experts">heat</a>. This year is likely to force a rethink for tourists and for tourism operators. Expect to see more trips taken during shoulder seasons, avoiding the increasingly intense July to August summer. And expect temperate countries to become more popular tourist destinations. Warm-weather tourist destinations will have to radically change. <h2>What will climate change do to mass tourism?</h2> Weather is a major factor in tourism. In Europe and North America, people tend to go from northern countries to southern regions. Chinese tourists, like Australians, often head to Southeast Asian beaches. In Europe, the north-south flow is almost hardwired. When Australians go overseas, they often choose Mediterranean summers. Over the last decade, hotter summers haven’t been a dealbreaker. But this year is likely to drive change. You can already see that in the growing popularity of shoulder seasons (June or September) in the traditional Northern Hemisphere summer destinations. Many of us are shifting how we think about hot weather holidays from something we seek to something we fear. This comes on top of consumer shifts such as those related to sustainability and <a href="https://theconversation.com/flight-shaming-how-to-spread-the-campaign-that-made-swedes-give-up-flying-for-good-133842">flight shame</a>. What about disaster tourism? While thrillseekers <a href="https://www.theguardian.com/us-news/2023/jul/22/death-valley-tourism-extreme-weather-california">may be flocking</a> to Death Valley to experience temperatures over 50℃, it’s hard to imagine this type of tourism going mainstream. What we’re more likely to see is more people seeking “<a href="https://www.tandfonline.com/doi/abs/10.1080/09669582.2016.1213849?journalCode=rsus20">last-chance</a>” experiences, with tourists flocking to highly vulnerable sites such as the Great Barrier Reef. Of course, this type of tourism isn’t sustainable long-term. <h2>What does this mean for countries reliant on tourism?</h2> The crisis in Rhodes shows us the perils of the just-in-time model of tourism, where you bring in tourists and everything they need –food, water, wine – as they need it. The system is geared to efficiency. But that means there’s little space for contingencies. Rhodes wasn’t able to easily evacuate 19,000 tourists. This approach will have to change to a just-in-case approach, as in other <a href="https://www.forbes.com/sites/willyshih/2022/01/30/from-just-in-time-to-just-in-case-is-excess-and-obsolete-next/?sh=195cd054daf7">supply chains</a>. For <a href="https://www.sciencedirect.com/science/article/abs/pii/S0261517712002063">emergency services</a>, tourists pose a particular challenge. Locals have a better understanding than tourists of risks and escape routes. Plus tourists don’t speak the language. That makes them much harder to help compared to locals. Climate change poses immense challenges in other ways, too. Pacific atoll nations like Kiribati or Tuvalu <a href="https://www.pacificpsdi.org/assets/Uploads/PSDI-TourismSnapshot-TUV3.pdf">would love</a> more tourists to visit. The problem there is water. Sourcing enough water for locals is getting harder. And tourists use a lot of water – drinking it, showering in it, swimming in it. Careful planning will be required to ensure local carrying capacities are not exceeded by tourism. So does this spell the end of mass tourism? Not entirely. But it will certainly accelerate the trend in countries like Spain away from mass tourism, or “overtourism”. In super-popular tourist destinations like Spain’s Balearic Islands, there’s been an increasing pushback from locals against <a href="https://theconversation.com/were-in-the-era-of-overtourism-but-there-is-a-more-sustainable-way-forward-108906">overtourism</a> in favour of specialised tourism with smaller numbers spread out over the year. Is this year a wake-up call? Yes. The intensifying climate crisis means many of us are now more focused on what we can do to stave off the worst of it by, say, avoiding flights. The pressure for change is growing too. Delta Airlines is being sued over its announcement to go carbon neutral by <a href="https://www.theguardian.com/environment/2023/may/30/delta-air-lines-lawsuit-carbon-neutrality-aoe">using offsets</a>, for instance. <h2>Mountains not beaches: future tourism may look a lot different</h2> You can already see efforts to adapt to the changes in many countries. In Italy, for instance, domestic mountain tourism is <a href="https://www.euromontana.org/en/neve-diversa-how-mountain-tourism-can-adapt-to-climate-change/">growing</a>, enticing people from hot and humid Milan and Rome up where the air is cooler – even if the snow is disappearing. China, which doesn’t do things by halves, is investing in mountain resorts. The goal here is to offer cooler alternatives like northern China’s <a href="https://english.news.cn/20230714/9ae6f89a6b7b433ebde3ec689b87f6db/c.html">Jilin province</a> to beach holidays for sweltering residents of megacities such as Beijing and Shanghai. Some mountainous countries are unlikely to seize the opportunity because they don’t want to draw more tourists. Norway is considering a <a href="https://www.forbes.com/sites/davidnikel/2022/12/03/norway-to-consider-introducing-tourist-tax-from-2024/?sh=710871eb1b27">tourist tax</a>. Forward-thinking countries will be better prepared. But there are limits to preparation and adaptation. Mediterranean summer holidays will be less and less appealing, as the region is a <a href="https://www.unep.org/unepmap/resources/factsheets/climate-change">heating hotspot</a>, warming 20% faster than the world average. Italy and Spain are still <a href="https://joint-research-centre.ec.europa.eu/jrc-news-and-updates/severe-drought-western-mediterranean-faces-low-river-flows-and-crop-yields-earlier-ever-2023-06-13_en">in the grip</a> of a record-breaking drought, threatening food and water supplies. The future of tourism is going to be very different. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/210282/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susanne-becken-90437">Susanne Becken</a>, Professor of Sustainable Tourism, Griffith Institute for Tourism, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/johanna-loehr-1457342">Johanna Loehr</a>, , <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/tourists-flock-to-the-mediterranean-as-if-the-climate-crisis-isnt-happening-this-years-heat-and-fire-will-force-change-210282">original article</a>.

International Travel

What happens when doctors don’t act as they should? And what’s the ruling against neurosurgeon Charlie Teo?

<a href="https://theconversation.com/profiles/christopher-rudge-108366">Christopher Rudge</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> After several years of controversy, and both praise and blame for his willingness to perform high-risk surgeries, neurosurgeon Charlie Teo has been subject to <a href="http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/nsw/NSWMPSC//2023/2.html">practice restrictions</a> by a special committee of the Medical Council of New South Wales. <blockquote class="twitter-tweet"> Charlie Teo was fighting two complaints of unprofessional conduct from the families of two different women, who say they were not properly warned about the risk of death before consenting to surgery. <a href="https://t.co/gvhiQdWnRF">https://t.co/gvhiQdWnRF</a> — ABC News (@abcnews) <a href="https://twitter.com/abcnews/status/1678952850238349312?ref_src=twsrc%5Etfw">July 12, 2023</a></blockquote> So how does the process of restricting doctors’ medical practice work? And what did this mean for Teo? <h2>How are health practitioners regulated in Australia?</h2> Health practitioner regulators in Australia aren’t generally empowered to make punitive decisions about health professionals’ conduct. Instead, Australia’s health practitioner regulations (the so-called “national law”) require decision-makers to exercise their powers to protect patients. They operate in what is often called a “<a href="https://www.mcnsw.org.au/sites/default/files/case_note_-_legal_case_note_-_medical_council_v_lee_-_concerning_stay_applications.pdf">protective jurisdiction</a>”. And though the regulator may sometimes impose fines, it is rare. That’s because it may do so only <a href="https://legislation.nsw.gov.au/view/html/inforce/current/act-2009-86a#sec.146C">when</a> it is “satisfied there is no other order, or combination of orders, that is appropriate in the public interest”. In all state <a href="https://legislation.nsw.gov.au/view/html/inforce/current/act-2009-86a#sec.3A">versions</a> of the national law, regulators may <a href="https://www.legislation.qld.gov.au/view/html/inforce/current/act-2009-hprnlq#sec.3A">restrict doctors’ medical practices</a> only if it’s “necessary to ensure health services are provided safely and of an appropriate quality”. But the NSW national law includes additional wording. In all its decisions, the regulator <a href="https://legislation.nsw.gov.au/view/whole/html/inforce/current/act-2009-86a#sec.3A">must regard</a> the “health and safety of the public” as the “paramount consideration.” This can have unusual effects. As the <a href="https://www.ama.com.au/sites/default/files/2022-03/Ahpra---Regulatory-guide---a-full-guide.PDF">Australian Health Practitioners Regulation Agency (AHPRA)</a> acknowledges, requirements to protect the public may sometimes result in “a determination that is harsher on the practitioner than if punishment were the sole purpose”. <h2>What happened in the Teo case?</h2> In late 2022, proceedings commenced against Teo via two complaints by the New South Wales <a href="https://www.hccc.nsw.gov.au/">Health Care Complaints Commission</a> (HCCC). The complaints concerned two brain surgeries on two patients. Both involved “radical resections” (“en bloc” removals) of these patients’ brain tumours. Tragically, neither patient regained consciousness after the operations and both patients died – one just ten days after. In legal terms, the complaints were based on a provision of the national law that defines certain categories of wrongdoing as <a href="https://legislation.nsw.gov.au/view/whole/html/inforce/current/act-2009-86a#sec.139B">unsatisfactory professional conduct</a>. The HCCC alleged Teo had engaged in two categories of this wrongdoing: conduct below the standard reasonably expected of a doctor of his training and experience, and unethical conduct. The HCCC alleged Teo’s decisions to operate were inappropriate and substandard because the risks of “neurological morbidity” (so-called brain death) outweighed the (potential) benefits of the interventions. There was no allegation that Teo’s surgical skills were substandard. The surgeries were also unethical, it was alleged, as informed consent had not been obtained from the patients and one patient was required to pay an expensive upfront fee in circumstances of clear vulnerability. <h2>What were the findings and consequences for Teo?</h2> The HCCC Professional Standards Committee, made up of an experienced judge, two expert neurosurgeons and a lay member, applied the civil standard of proof – the balance of probabilities – to the evidence. Though the committee is not legally bound to <a href="https://legislation.nsw.gov.au/view/html/inforce/current/act-2009-86a#sch.5D-sec.2">apply the rules of evidence</a> applied in criminal courts, it decided, broadly for procedural fairness reasons, to receive and consider all of Teo’s unchallenged evidence. In a decision of more than 100 pages, the committee found Teo guilty of unsatisfactory professional conduct. It determined to “reprimand” Teo (this means a <a href="https://www.medicalboard.gov.au/sitecore/content/Home/Registration/Monitoring-and-compliance/Removal-of-reprimands.aspx">record of “reprimand” is</a> noted on the public copy of his practitioner licence) and to impose four conditions on his practice. Three conditions involve increased oversight of his practice records. But a more restrictive condition will require Teo to obtain written support from a neurosurgeon approved by the Medical Council of New South Wales for any neurosurgery involving “recurring malignant tumours in the brain or brain stem”. While this order was hotly contested in the proceedings, the committee determined that, for reasons including Teo’s evidenced “isolation from his peers”, the condition was “necessary to protect the health and safety of the public”. <h2>What about patient autonomy or clinical freedom?</h2> Difficult ethical questions arise in medical regulation. Here, the committee had to balance the practitioner’s right to practise medicine against the paramount consideration of patient health and safety and against the patient’s right to exercise autonomy. This last right is sometimes seen as a patient’s <a href="https://jme.bmj.com/content/40/5/293">moral right to be wrong</a>. On these considerations, the committee relied on accepted evidence from ethical experts that proposed that, as a matter of ethics, "a surgeon does not have a licence to undertake any conceivable procedure even with the agreement or acquiescence of the patient." <h2>Is medical regulation strict in Australia and NSW?</h2> Many <a href="https://www.ahpra.gov.au/News/2016-08-10-Independent-review-on-chaperoning.aspx">reviews</a> and <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3668054">academic</a> <a href="https://pubmed.ncbi.nlm.nih.gov/34907681/">studies</a> find the national law to be fair and appropriate, or not strict enough. However, some scholars and representative groups including the Australian Medical Association (AMA) find some aspects <a href="https://www.ama.com.au/ama-rounds/16-july-2021/articles/upholding-natural-justice-doctors">are</a> too <a href="https://www.ama.com.au/media/law-change-threatens-doctors-hard-earned-reputations-and-risks-their-mental-health">strict</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/36763016/">unsympathetic</a> to practitioners. But a potted history of NSW medical history showcases how successive medical scandals have tended to drive strong regulatory reform. In 1984, when the tragic impacts of the shocking and unethical treatment at <a href="https://piac.asn.au/legal-help/public-interest-cases/deep-sleep-tragedy/">Chelmsford psychiatric hospital</a> were <a href="http://www5.austlii.edu.au/au/journals/ALRCRefJl/1988/77.pdf">coming to light</a>, NSW was the first jurisdiction globally to establish a complaints body for health consumers. Known as the Complaints Unit, this body is now the HCCC. Another milestone occurred in the early 2000s following several scandals, including the so-called “Butcher of Bega” episode. An <a href="https://www.parliament.nsw.gov.au/ladocs/inquiries/2112/Final%20Report%20on%20Graeme%20Reeves.pdf">inquiry</a> into these events prompted the NSW government to introduce laws permitting medical practitioners to be immediately suspended if the regulator considered it was in the “public interest”. This was the first power of its kind in Australia and was only adopted into the broader national law of other states in <a href="https://doi.org/10.1071/AH19293">2018</a>. <h2>What next for Teo?</h2> Teo may appeal the orders of the committee to the NSW Civil and Administrative Tribunal or seek a review of the conditions. But as the conditions are not subject to an end date, it appears they will otherwise continue indefinitely.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209612/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christopher-rudge-108366">Christopher Rudge</a>, Law lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Instagram This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-when-doctors-dont-act-as-they-should-and-whats-the-ruling-against-neurosurgeon-charlie-teo-209612">original article</a>.

Legal

What is ‘sundowning’ and why does it happen to many people with dementia?

<a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> The term “<a href="https://www.nia.nih.gov/health/tips-coping-sundowning#:%7E:text=Late%20afternoon%20and%20early%20evening,tired%20caregivers%20need%20a%20break.">sundowning</a>” is sometimes used to describe a tendency for people living with dementia to become more confused in the late afternoon and into the night. At the outset, I should emphasise the term “sundowning” is overly simplistic, as it’s a shorthand term that can encompass a vast number of behaviours in many different contexts. When assessing changed behaviours in dementia, it’s always better to hear a full and accurate description of what the person is actually doing at these times, rather than to just accept that “they’re sundowning.” This set of behaviours commonly described as “sundowning” often includes (but is not limited to) confusion, anxiety, agitation, pacing and “shadowing” others. It may look different depending on the stage of dementia, the person’s personality and past behaviour patterns, and the presence of specific triggers. Why then, do such altered behaviours tend to happen at specific times of the day? And what should you do when it happens to your loved one? <h2>Fading light</h2> We all interpret the world via the information that enters our brains through our five senses. Chief among these are sight and sound. Imagine the difficulty you’d have if asked to perform a complex task while in a darkened room. People living with dementia are just as dependent on sensory input to make sense of and correctly interpret their environment. As <a href="https://www.medicalnewstoday.com/articles/314685#causes">light fades</a> towards the end of the day, so too does the amount of sensory input available to help a dementia patient interpret the world. The <a href="https://www.medicalnewstoday.com/articles/314685#causes">impact</a> of this on a brain struggling to integrate sensory information at the best of times can be significant, resulting in increased confusion and unexpected behaviours. <h2>Cognitive exhaustion</h2> We have all heard it said that we only use a fraction our brain power, and it is true we all have far more brain power than we typically require for most of the day’s mundane tasks. This “cognitive reserve” can be brought to bear when we are faced with complex or stressful tasks that require more mental effort. But what if you just don’t have much cognitive reserve? The changes that ultimately lead to symptoms of Alzheimer’s disease can begin to develop for as many as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486209/">30 years</a> before the onset of symptoms. During that time, in simple terms, the condition eats away at our cognitive reserve. It is only when the damage done is so significant our brains can no longer compensate for it that we develop the first symptoms of Alzheimer’s disease and other dementias. So by the time someone first presents with very early dementia symptoms, a lot of damage has already been done. Cognitive reserve has been lost, and the symptoms of memory loss finally become apparent. As a result, people living with dementia are required to exert far more mental effort during the course of a routine day than most of us. We have all felt cognitively exhausted, run down and perhaps somewhat irritable after a long day doing a difficult task that has consumed an extreme amount of mental effort and concentration. Those living with dementia are required to exert similar amounts of mental effort just to get through their daytime routine. So is it any surprise that after several hours of concerted mental effort just to get by (often in an unfamiliar place), people tend to get <a href="https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning">cognitively exhausted</a>? <h2>What should I do if it happens to my loved one?</h2> The homes of people living with dementia should be <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/gps.5712">well-lit</a> in the late afternoons and evenings when the sun is going down to help the person with dementia integrate and interpret sensory input. A <a href="https://www.nia.nih.gov/health/tips-coping-sundowning">short nap</a> after lunch may help alleviate cognitive fatigue towards the end of the day. It gives the brain, and along with it a person’s resilience, an opportunity to “recharge”. However, there is no substitute for a fuller assessment of the other causes that might contribute to altered behaviour. <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/sundowning#:%7E:text=The%20reasons%20why%20sundowning%20happens,to%20sunlight%20during%20the%20day">Unmet needs</a> such as hunger or thirst, the presence of pain, depression, boredom or loneliness can all contribute, as can stimulants such as caffeine or sugar being given too late in the day. The behaviours too often described by the overly simplistic term “sundowning” are complex and their causes are often highly individual and interrelated. As is often the case in medicine, a particular set of symptoms is often best managed by better understanding the root causes.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208005/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-sundowning-and-why-does-it-happen-to-many-people-with-dementia-208005">original article</a>.

Mind

Here’s what would happen to your body if you didn’t have your morning coffee

What happens when you skip coffee entirely? Coffee is a morning constant for many, as reliable as the sunrise or the tides. Miss it, and you can feel dazed, confused and even risk a pounding headache. There’s a good reason for that: Caffeine produces some reliable physical changes in your body upon which you can easily become dependent. With that first sip of coffee, caffeine enters your bloodstream and begins making its way to your brain where it blocks an inhibitory neurotransmitter called adenosine, according to the National Academy of Sciences. That, in turn, sets off the release of feel-good hormones like dopamine and serotonin, causing a stimulant effect. Coffee’s so-called half-life – meaning the amount of time it takes for the amount of caffeine in the body to be reduced by 50 per cent – is about five hours on average. That explains why the average energy drink or coffee buzz lasts about that long. But how quickly caffeine leaves your system depends on a number of things, including age, medical conditions, drug interactions and lifestyle habits (like smoking). A shock to the system So, no surprise, when you’re deprived of your morning coffee, you don’t just suffer due to routine alteration. You suffer chemically, too. As anybody who’s kicked their coffee habit will tell you: The side effects can be pretty noticeable and jarring. Some of the more common symptoms of caffeine withdrawal stem from the inherent perks of those multi cups of Joe. Minus the kickstart to your metabolism, you’ll feel tired, sluggish, foggy-headed, and physically delayed, according to a review of studies published in 2020 in StatPearls. Researchers found that the more caffeine you consume, the more severe the withdrawal; but abstinence from even small amounts – we’re talking one cup of coffee per day – also produced symptoms of caffeine withdrawal. They kick in 12 to 24 hours after your last caffeine fix and may last up to nine days, says Dr Sherry A Ross, women’s health expert, author of She-ology: The She-quel. “Caffeine is a stimulating drug that some people can easily become addicted to,” she explains. “Depending on the quantity and type of caffeine you are consuming daily, your body type and frequency of consumption can set you up for a caffeine addiction.” Coffee's not all bad Just because you can develop a dependence on your morning jolt doesn’t mean that cup of java belongs on the do-not-consume list. Just the opposite, in fact. A large review of studies published in 2017 in the journal BMJ found that coffee consumption is not only safe for most people (except pregnant women and women who are at an increased risk of fracture), it also provides a number of health benefits, especially for people with chronic liver disease. The review also showed that participants who consistently drank at least three cups of coffee per day had a lower risk of type 2 diabetes, kidney disease, gallstone disease, cancer (including melanoma, leukaemia and prostate, endometrial, oral, and liver cancer), as well as cardiovascular disease, coronary heart disease and stroke as compared with coffee abstainers. The trick, of course, is practicing portion control. The researchers found that the health benefits of coffee top out at three to four cups a day (as compared to none). That echoes the larger caffeine recommendation from the US Food and Drug Administration, which suggests no more than 400 mg of caffeine per day; that’s the amount in about four cups of coffee, 10 cans of cola, or two energy drinks. Image credits: Getty Images This article originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/heres-what-would-happen-to-your-body-if-you-didnt-have-your-morning-coffee" target="_blank" rel="noopener">Reader's Digest</a>.

Food & Wine

Iconic movie scenes that nearly didn’t happen

There are a multitude of significant changes that get made throughout the creation of a feature film. These iconic movie scenes nearly didn’t happen but thankfully, a spark of genius made these beloved movie moments make it on our screens. 1. E.T. the Extra Terrestrial <iframe src="https://www.youtube.com/embed/gTVoFCP1BLg?feature=oembed" width="500" height="281" frameborder="0" allowfullscreen="allowfullscreen"></iframe> Originally, Spielberg went for a bleak ending where E.T. dies in government captivity, but people thought this ending was much too miserable. Instead, the ending was famously reworked to see E.T fly across the moon into freedom. Spielberg also ended up making that shot the logo of his production company Amblin Entertainment. 2. Lady and the Tramp <iframe src="https://www.youtube.com/embed/9gwZC5s2IU0?feature=oembed" width="500" height="281" frameborder="0" allowfullscreen="allowfullscreen"></iframe> The spaghetti date between Lady and the Tramp is the most iconic moment in the 1955 animation. Walt Disney thought the idea was a bit far-fetched to begin with and so he cut the scene from the first storyboards. “Walt wasn't convinced that that would be a very clean-cut scene," former Disney archivist Steven Vagnini told Yahoo Movies. "As you can imagine, if you have two pets and they eat a plate of spaghetti, it's hard to envision that being too graceful." Thankfully, the adorable scene was included. 3. Rocky The original ending of Rocky was going to feature Sylvester Stallone crowd surfing towards Adrian after his victory. However, there were not enough extras to carry Stallone so instead, a more intimate scene was created where he yells his girlfriend’s name. 4. Star Trek II: Wrath of Khan <iframe src="https://www.youtube.com/embed/LXVqSa2l6mg?feature=oembed" width="400" height="300" frameborder="0" allowfullscreen="allowfullscreen"></iframe> Wrath of Khan’s ending was altered after a test audience said Spock’s death was too bleak. A last-minute scene was shot showing his coffin landing on the Genesis Planet, giving a glimmer of hope of his return. Leonard Nimoy only learned of the change when he watched the completed film. Images: Universal Pictures

Movies

Hit your head while playing sport? Here’s what just happened to your brain

It’s Friday night, your team is playing, and scores are nail-bitingly close. A player intercepts the ball, and bam! A player tackles his opponent to the ground. Trainers and doctors gather nervously while the commentators wait for confirmation: a concussion, mild traumatic brain injury, head knock, strike, tap, bump, blow … there are many terms for it. How to prevent and treat such injuries is the subject to a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Headtraumainsport">Senate inquiry</a>, with public hearings this week. But what exactly are these injuries? What’s going on in the brain? <h2>What is concussion?</h2> Concussion is a form of traumatic brain injury (TBI). Concussion typically falls at the milder end of the spectrum, and so is often called mild TBI. Concussions happen most often when the head directly hits against something. But it can also happen without head impact, when a blow to the body causes the head to move quickly. The brain is a soft organ in a hard case, floating in a thin layer of <a href="https://medlineplus.gov/lab-tests/cerebrospinal-fluid-csf-analysis/">cerebrospinal fluid</a>. The brain can be damaged away from the site of impact for this reason, as it bounces with force within the skull. Concussions that happen during sport can be complex because the head often rotates as the person falls. This “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3979340/">rotational acceleration</a>” can cause more damage to the brain. This is especially the case for cells in the long tracts of white matter responsible for relaying signals around the brain. As well as causing initial damage to brain cells at the time of injury, concussion sets off a cascade of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479139/">chemical and biological changes</a>. These occur within minutes and may last for days or even weeks after concussion. Cell membranes become permeable (more leaky), causing an imbalance of brain chemicals inside and outside cells. Cellular functions shift into overdrive to try to restore balance, using more fuel in the form of glucose. At the same time, blood flow to the brain is often reduced, resulting in a mismatch between energy supply and demand. The structural scaffolding of cells in the white matter may begin to weaken or break, preventing or reducing the ability of cells to communicate. Sensing danger, cells from the <a href="https://pubmed.ncbi.nlm.nih.gov/28910616/">immune system</a> begin to migrate to the brain in an attempt to stem the damage, spouting chemical signals to recruit other inflammatory cells to the sites of injury. These initial responses to concussion typically resolve over time, but the recovery period may be different for each person, and may persist even after symptoms go away. <h2>What are the symptoms?</h2> Concussion <a href="https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594">symptoms</a> can differ depending on the person and the circumstances of injury. Some people have more obvious symptoms like loss of consciousness, vomiting and confusion; others may have headaches, problems with their vision, or thinking and concentration. Some people may have one symptom while others have many. Some people’s symptoms may be severe, and others may have only mild symptoms. So diagnosing and managing concussion can be difficult. Most people who have a concussion will find their symptoms subside within days or weeks. But around <a href="https://pubmed.ncbi.nlm.nih.gov/26918481/">20% of people</a> will have persistent symptoms beyond three months after their concussion. Ongoing symptoms can make it harder to perform at work or school, to socialise with friends and to maintain relationships. Scientists don’t know why recoveries are different for different people. We have no way to <a href="https://bmjopen.bmj.com/content/11/5/e046460.info">predict</a> who will recover from concussion and who won’t. <h2>How about repeat blows to the head?</h2> People who play contact sports are more likely to have multiple concussions over a playing career. Higher numbers of concussions tend to mean <a href="https://pubmed.ncbi.nlm.nih.gov/28387556/">worse symptoms and slower recovery</a> for subsequent concussions. This indicates the brain doesn’t get used to concussions, and each concussion is likely to impart additional damage. Emerging evidence suggests repeated concussions may lead to <a href="https://n.neurology.org/content/88/15/1400.short">ongoing changes</a> in people’s brain cell structure and function. <a href="https://pubmed.ncbi.nlm.nih.gov/32326805/">Inflammation</a> may persist inside and outside the brain. Inflammation may also <a href="https://pubmed.ncbi.nlm.nih.gov/30535946/">cause or contribute</a> to someone developing symptoms, and long-term brain functional and structural changes. Prolonged symptoms and long-term brain changes may be worse in the long run for people who experience their concussions as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6595074/">young adults</a> compared to people who have concussions as older adults. Scientists are also starting to find differences in <a href="https://pubmed.ncbi.nlm.nih.gov/30618335/">symptoms</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8596946/">brain alterations</a> in males and females. These could be related to newfound sex differences in the <a href="https://pubmed.ncbi.nlm.nih.gov/29104114/">scaffolding proteins</a> of male and female brains, making female brains more susceptible. <h2>We’ve known about this for a long time</h2> The long-term brain and behaviour changes resulting from repeated sports concussions have been reported since at least the <a href="https://www.bmj.com/content/1/3306/816">1920s</a>. Back then, it was seen in boxers and termed dementia pugilistica, or <a href="https://jamanetwork.com/journals/jama/article-abstract/260461">punch-drunk syndrome</a>. We now call this condition <a href="https://www.sciencedirect.com/science/article/abs/pii/S1934148211005296">chronic traumatic encephalopathy</a> (CTE). People found to have CTE don’t always experience severe symptoms. Instead, symptoms tend to emerge or worsen later in life, even decades after injury or at the end of a playing career. People also have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166432/">varied symptoms</a> that can sometimes be hard to measure, like confusion, impaired judgement and aggression. This has made diagnosis difficult while people are alive. We can only confirm CTE after someone dies, by detecting altered structural proteins of the brain in <a href="https://link.springer.com/article/10.1007/s12024-023-00624-3">specific brain areas</a>. There is still a lot to learn about CTE, including the exact processes that cause it, and why some people will develop it and others won’t. <h2>Concussion is common</h2> Concussion is a common injury almost <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048626/">30%</a> of us will experience in our lifetime. Although we have a lot still to learn, the current advice for people who experience concussion is to seek medical advice to help with initial management of symptoms and guide decisions on returning back to playing sports. This article originally appeared on <a href="https://theconversation.com/hit-your-head-while-playing-sport-heres-what-just-happened-to-your-brain-203038" target="_blank" rel="noopener">The Conversation</a>. Images: Getty

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