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What happens if you want access to voluntary assisted dying but your nursing home won’t let you?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/charles-corke-167297">Charles Corke</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Voluntary assisted dying is now lawful in <a href="https://theconversation.com/voluntary-assisted-dying-will-soon-be-legal-in-all-states-heres-whats-just-happened-in-nsw-and-what-it-means-for-you-183355">all Australian states</a>. There is also <a href="https://nationalseniors.com.au/uploads/VAD-Report-correct-month-12.8.21.pdf">widespread community support</a> for it. Yet some residential institutions, such as hospices and aged-care facilities, are obstructing access despite the law not specifying whether they have the legal right to do so. As voluntary assisted dying is implemented across the country, institutions blocking access to it will likely become more of an issue. So addressing this will help everyone – institutions, staff, families and, most importantly, people dying in institutions who wish to have control of their end. <h2>The many ways to block access</h2> While voluntary assisted dying legislation recognises the right of doctors to <a href="https://theconversation.com/was-take-on-assisted-dying-has-many-similarities-with-the-victorian-law-and-some-important-differences-121554">conscientiously object</a> to it, the law is generally silent on the rights of institutions to do so. While the institution where someone lives has no legislated role in voluntary assisted dying, it can refuse access in various ways, including: <ul> <li> restricting staff responding to a discussion a resident initiates about voluntary assisted dying </li> <li> refusing access to health professionals to facilitate it, and </li> <li> requiring people who wish to pursue the option to leave the facility. </li> </ul> <h2>Here’s what happened to ‘Mary’</h2> Here is a hypothetical example based on cases one of us (Charles Corke) has learned of via his role at Victoria’s <a href="https://www.safercare.vic.gov.au/about/vadrb">Voluntary Assisted Dying Review Board</a>. We have chosen to combine several different cases into one, to respect the confidentiality of the individuals and organisations involved. “Mary” was a 72-year-old widow who moved into a private aged-care facility when she could no longer manage independently in her own home due to advanced lung disease. While her intellect remained intact, she accepted she had reached a stage at which she needed significant assistance. She appreciated the help she received. She liked the staff and they liked her. After a year in the facility, during which time her lung disease got much worse, Mary decided she wanted access to voluntary assisted dying. Her children were supportive, particularly as this desire was consistent with Mary’s longstanding views. Mary was open about her wish with the nursing home staff she felt were her friends. The executive management of the nursing home heard of her intentions. This resulted in a visit at which Mary was told, in no uncertain terms, her wish to access voluntary assisted dying would not be allowed. She would be required to move out, unless she agreed to change her mind. Mary was upset. Her family was furious. She really didn’t want to move, but really wanted to continue with voluntary assisted dying “in her current home” (as she saw it). Mary decided to continue with her wish. Her family took her to see two doctors registered to provide assessments for voluntary assisted dying, who didn’t work at the facility. Mary was deemed eligible and the permit was granted. Two pharmacists visited Mary at the nursing home, gave her the medication and instructed her how to mix it and take it. These actions required no active participation from the nursing home or its staff. Family and friends arranged to visit at the time Mary indicated she planned to take the medication. She died peacefully, on her own terms, as she wished. The family informed the nursing home staff their mother had died. Neither family nor staff mentioned voluntary assisted dying. <h2>Staff are in a difficult position too</h2> There is widespread community support for voluntary assisted dying. In a 2021 survey by National Seniors Australia, <a href="https://nationalseniors.com.au/uploads/VAD-Report-correct-month-12.8.21.pdf">more than 85%</a> of seniors agreed it should be available. So it’s likely there will be staff who are supportive in most institutions. For instance, in a survey of attitudes to voluntary assisted dying in a large public tertiary hospital, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.15285">88% of staff</a> supported it becoming lawful. So a blanket policy to refuse dying patients access to voluntary assisted dying is likely to place staff in a difficult position. An institution risks creating a toxic workplace culture, in which clandestine communication and fear become entrenched. <h2>What could we do better?</h2> 1. Institutions need to be up-front about their policies Institutions need to be completely open about their policies on voluntary assisted dying and whether they would obstruct any such request in the future. This is so patients and families can factor this into deciding on an institution in the first place. 2. Institutions need to consult their stakeholders Institutions should consult their stakeholders about their policy with a view to creating a “<a href="https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-021-00891-3">safe</a>” environment for residents and staff – for those who want access to voluntary assisted dying or who wish to support it, and for those who don’t want it and find it confronting. 3. Laws need to change Future legislation should define the extent of an institution’s right to obstruct a resident’s right to access voluntary assisted dying. There should be safeguards in all states (as is already legislated <a href="https://documents.parliament.qld.gov.au/tp/2021/5721T707.pdf">in Queensland</a>), including the ability for individuals to be referred in sufficient time to another institution, should they wish to access voluntary assisted dying. Other states should consider whether it is reasonable to permit a resident, who does not wish to move, to be able to stay and proceed with their wish, without direct involvement of the institution. <hr /> The opinions expressed in this article are those of the authors and do not necessarily reflect the views of Victoria’s Voluntary Assisted Dying Review Board.<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/183364/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, Associate Professor in Law, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/charles-corke-167297">Charles Corke</a>, Associate Professor of Medicine, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</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-if-you-want-access-to-voluntary-assisted-dying-but-your-nursing-home-wont-let-you-183364">original article</a>. </div>

Caring

How to write creative non-fiction history

Discovering an old photo album from the 1920s, celebrated author and adjunct professor Paul Ashton embarked on a journey to turn historical research into engaging creative non-fiction, blending meticulous evidence with captivating storytelling. Here he shares he insights on the fascinating process. One afternoon my elderly father and niece came to my home for lunch. On their way they had seen something on a council clean up. ‘We thought you might be interested in this,’ said my father handing me a small, brown photo album. I was. The album contained around 100 undated black and white photographs. It became apparent quickly that this was the record of a road trip done in the 1920s or 1930s. A boy, two women and a man had gone on a trip from Sydney up through New England, to Tamworth then to Brisbane and back to Sydney. Shadows in some of the images indicate that they were taken by the man and at least one of the women. The album provided the basis for my first children’s book, Palmer’s Mystery Hikes. One photograph stood out for me. Hundreds of people were gathered somewhere in the bush. In the far left-hand corner in the background was an elevated table covered with a large white tablecloth. With a magnifying glass I could just make out ‘Palmers [something] Hike’. In 1932 Palmer’s men and boys’ department store, in Park Street in Sydney, had established a hiking club to promote the sale of hiking apparel. You bought a ‘mystery’ ticket from New South Wales Railways with which Palmer had an arrangement; turned up at Central Station on Sunday morning; and were taken to a mystery destination. From there you did a ten-mile hike to another station and were then trained back to Sydney. There were five hikes. The third one to the Hawkesbury River attracted over 8,000 people. Turning historical research into believable fiction or creative non-fiction has certain demands. How do you strike a balance between historical research and evidence and the narrative form? This is a big question and will ultimately depend on many things, including the availability of primary and secondary sources and the nature of the particular narrative. But perhaps the most important question is: how do writers use the past to give their work historical dimensions and insights? For me, the most critical element is context. And it’s the thing most missing in much historically based fictional literature. Evoking people, places and periods involves understandings of things such as continuity and change over time, historical process – like colonisation and suburbanisation – ideologies and superstitions. Where appropriate, these should form subtle backgrounds to the narrative. Fiction and creative non-fiction as historical modes of presenting history should also show – not tell. My edited collection, If It’s not True It Should Be (Halstead Press), explores writing history using fictional techniques. As Peter Stanley has written in that book, ‘those who seek to illuminate the past through the imaginative recreation of historical fiction … [are] motivated by the fundamental conviction that what links the fidelity of the historian and the imagination of the historical novelist is that the work of both should be offered and read as if it were true.’ ABOUT THE AUTHOR Paul Ashton is adjunct professor and co-founder of the Australian Centre for Public History at the University of Technology Sydney and adjunct professor at the University of Canberra and Macquarie University. He has authored, co-authored, edited and co-edited over 40 books and is editor of the journal Public History Review. His series of creative non-fiction children’s histories – Accidental Histories – is being published by Halstead Press. Images: Supplied

Books

Menopause can bring increased cholesterol levels and other heart risks. Here’s why and what to do about it

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Menopause is a natural biological process that marks the end of a woman’s reproductive years, typically between 45 and 55. As women approach or experience menopause, common “change of life” <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9244939/">concerns</a> include hot flushes, sweats and mood swings, brain fog and fatigue. But many women may not be aware of the <a href="https://pubmed.ncbi.nlm.nih.gov/32705886/">long-term effects</a> of menopause on the heart and blood vessels that make up the cardiovascular system. Heart disease accounts for <a href="http://world-heart-federation.org/what-we-do/women-cvd/">35% of deaths</a> in women each year – more than all cancers combined. What should women – and their doctors – know about these risks? <h2>Hormones protect hearts – until they don’t</h2> As early as 1976, the <a href="https://pubmed.ncbi.nlm.nih.gov/970770/">Framingham Heart Study</a> reported more than twice the rates of cardiovascular events in postmenopausal than pre-menopausal women of the same age. Early menopause (younger than age 40) also <a href="https://pubmed.ncbi.nlm.nih.gov/25331207/">increases heart risk</a>. Before menopause, women tend to be protected by their circulating hormones: oestrogen, to a lesser extent progesterone and low levels of testosterone. These sex hormones help to relax and dilate blood vessels, reduce inflammation and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503403/">improve lipid (cholesterol) levels</a>. From the mid-40s, a decline in these hormone levels can <a href="https://pubmed.ncbi.nlm.nih.gov/10362825/">contribute to unfavourable changes</a> in cholesterol levels, blood pressure and weight gain – all risk factors for heart disease. <h2>4 ways hormone changes impact heart risk</h2> 1. Dyslipidaemia– Menopause often involves <a href="https://pubmed.ncbi.nlm.nih.gov/38002671/">atherogenic changes</a> – an unhealthy imbalance of lipids in the blood, with higher levels of total cholesterol, triglycerides, and low-density lipoprotein (LDL-C), dubbed the “bad” cholesterol. There are also reduced levels of high-density lipoprotein (HDL-C) – the “good” cholesterol that helps remove LDL-C from blood. These changes are a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503403/">major risk factor for heart attack or stroke</a>. 2. Hypertension – Declines in oestrogen and progesterone levels during menopause contribute to narrowing of the large blood vessels on the heart’s surface, arterial stiffness and <a href="https://pubmed.ncbi.nlm.nih.gov/35722103/">raise blood pressure</a>. 3. Weight gain – Females are born with one to two million eggs, which develop in follicles. By the time they <a href="https://www.thewomens.org.au/health-information/fertility-information/getting-pregnant/ovulation-and-conception">stop ovulating</a> in midlife, fewer than 1,000 remain. This depletion progressively changes fat distribution and storage, from the hips to the waist and abdomen. Increased waist circumference (greater than 80–88 cm) has been <a href="https://pubmed.ncbi.nlm.nih.gov/18359190/">reported to contribute to heart risk</a> – though it is <a href="https://theconversation.com/good-news-midlife-health-is-about-more-than-a-waist-measurement-heres-why-226019">not the only factor to consider</a>. 4. Comorbidities – Changes in body composition, sex hormone decline, increased food consumption, weight gain and sedentary lifestyles impair the body’s ability to effectively use insulin. This <a href="https://pubmed.ncbi.nlm.nih.gov/11133069/">increases the risk</a> of developing metabolic syndromes such as type 2 diabetes. While risk factors apply to both genders, hypertension, smoking, obesity and type 2 diabetes confer a greater relative risk for heart disease in women. <h2>So, what can women do?</h2> Every woman has a different level of baseline cardiovascular and metabolic risk pre-menopause. This is based on their genetics and family history, diet, and lifestyle. But all women can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351755/">reduce their post-menopause heart risk with</a>: <ul> <li>regular moderate intensity exercise such as brisk walking, pushing a lawn mower, riding a bike or water aerobics for 30 minutes, four or five times every week</li> <li>a healthy heart diet with smaller portion sizes (try using a smaller plate or bowl) and more low-calorie, nutrient-rich foods such as vegetables, fruit and whole grains</li> <li>plant sterols (unrefined vegetable oil spreads, nuts, seeds and grains) each day. A review of 14 clinical trials found plant sterols, at doses of at least 2 grams a day, produced an average reduction in serum LDL-C (bad cholesterol) of about 9–14%. This could reduce the risk of heart disease by <a href="https://pubmed.ncbi.nlm.nih.gov/10731187/">25% in two years</a></li> <li>less unhealthy (saturated or trans) fats and more low-fat protein sources (lean meat, poultry, fish – especially oily fish high in omega-3 fatty acids), legumes and low-fat dairy</li> <li>less high-calorie, high-sodium foods such as processed or fast foods</li> <li>a reduction or cessation of smoking (nicotine or cannabis) and alcohol</li> <li>weight-gain management or prevention.</li> </ul> <h2>What about hormone therapy medications?</h2> Hormone therapy remains the most effective means of <a href="https://pubmed.ncbi.nlm.nih.gov/15495039/">managing hot flushes and night sweats</a> and is beneficial for <a href="https://pubmed.ncbi.nlm.nih.gov/18418063/">slowing the loss of bone mineral density</a>. The decision to recommend oestrogen alone or a combination of oestrogen plus progesterone hormone therapy depends on whether a woman has had a hysterectomy or not. The choice also depends on whether the hormone therapy benefit outweighs the woman’s disease risks. Where symptoms are bothersome, hormone therapy has <a href="https://pubmed.ncbi.nlm.nih.gov/33841322/">favourable or neutral effects on coronary heart disease risk</a> and medication risks are low for healthy women younger than 60 or within ten years of menopause. Depending on the level of stroke or heart risk and the response to lifestyle strategies, some women may also require medication management to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351755/">control high blood pressure or elevated cholesterol levels</a>. Up until the early 2000s, women were underrepresented in most outcome trials with lipid-lowering medicines. The <a href="https://pubmed.ncbi.nlm.nih.gov/25579834/">Cholesterol Treatment Trialists’ Collaboration</a> analysed 27 clinical trials of statins (medications commonly prescribed to lower cholesterol) with a total of 174,000 participants, of whom 27% were women. Statins were about as effective in women and men who had similar risk of heart disease in preventing events such as stroke and heart attack. Every woman approaching menopause should ask their GP for a 20-minute <a href="https://www.health.gov.au/news/heart-health">Heart Health Check</a> to help better understand their risk of a heart attack or stroke and get tailored strategies to reduce it. <a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), <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/menopause-can-bring-increased-cholesterol-levels-and-other-heart-risks-heres-why-and-what-to-do-about-it-228010">original article</a>. </div>

Body

I can’t afford olive oil. What else can I use?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> If you buy your olive oil in bulk, you’ve likely been in for a shock in recent weeks. Major supermarkets have been selling olive oil for up to A$65 for a four-litre tin, and up to $26 for a 750 millilitre bottle. We’ve been hearing about the health benefits of olive oil for years. And many of us are adding it to salads, or baking and frying with it. But during a cost-of-living crisis, these high prices can put olive oil out of reach. Let’s take a look at why olive oil is in demand, why it’s so expensive right now, and what to do until prices come down. <h2>Remind me, why is olive oil so good for you?</h2> Including olive oil in your diet can reduce your risk of developing type 2 diabetes and improve heart health through more favourable <a href="https://www.mdpi.com/2072-6643/12/6/1548">blood pressure</a>, <a href="https://www.mdpi.com/2072-6643/7/9/5356">inflammation</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0939475319302662">cholesterol levels</a>. This is largely because olive oil is high in <a href="https://www.mdpi.com/2072-6643/4/12/1989">monounsaturated fatty acids</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300823/">polyphenols</a> (antioxidants). Some researchers have suggested you can get these benefits from consuming up to <a href="https://www.frontiersin.org/articles/10.3389/fnut.2022.1041203/full">20 grams a day</a>. That’s equivalent to about five teaspoons of olive oil. <h2>Why is olive oil so expensive right now?</h2> A European heatwave and drought have <a href="https://www.abc.net.au/news/rural/2024-04-27/olive-oil-alternatives-what-you-can-use-in-cooking/103761718">limited</a> Spanish and Italian producers’ ability to supply olive oil to international markets, including Australia. This has been coupled with an unusually cold and short growing season for Australian <a href="https://www.abc.net.au/news/rural/2023-08-02/record-olive-oil-price-set-to-increase-again/102675452">olive oil suppliers</a>. The lower-than-usual production and supply of olive oil, together with heightened demand from shoppers, means prices have gone up. <h2>How can I make my olive oil go further?</h2> Many households buy olive oil in large quantities because it is cheaper per litre. So, if you have some still in stock, you can make it go further by: <ul> <li> storing it correctly – make sure the lid is on tightly and it’s kept in a cool, dark place, such as a pantry or cabinet. If stored this way, olive oil can typically last <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218649/">12–18 months</a> </li> <li> using a spray – sprays distribute oil more evenly than pourers, using less olive oil overall. You could buy a spray bottle to fill from a large tin, as needed </li> <li> straining or freezing it – if you have leftover olive oil after frying, strain it and reuse it for other fried dishes. You could also freeze this used oil in an airtight container, then thaw and fry with it later, without affecting the oil’s <a href="https://link.springer.com/article/10.1007/s00217-022-04078-9">taste and other characteristics</a>. But for dressings, only use fresh oil. </li> </ul> <h2>I’ve run out of olive oil. What else can I use?</h2> Here are some healthy and cheaper alternatives to olive oil: <ul> <li> canola oil is a good alternative for frying. It’s relatively <a href="https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/canola-oil">low</a> in saturated fat so is generally considered healthy. Like olive oil, it is high in <a href="https://pubmed.ncbi.nlm.nih.gov/23731447/">healthy monounsaturated fats</a>. Cost? Up to $6 for a 750mL bottle (home brand is about half the price) </li> <li> sunflower oil is a great alternative to use on salads or for frying. It has a mild flavour that does not overwhelm other ingredients. Some <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/conjugated-linoleic-acid-versus-higholeic-acid-sunflower-oil-effects-on-energy-metabolism-glucose-tolerance-blood-lipids-appetite-and-body-composition-in-regularly-exercising-individuals/6C035B5C6E9FD7C9D6D7F806ADA56983">studies</a> suggest using sunflower oil may help reduce your risk of heart disease by lowering LDL (bad) cholesterol and raising HDL (good) cholesterol. Cost? Up to $6.50 for a 750mL bottle (again, home brand is about half the price) </li> <li> sesame oil has a nutty flavour. It’s good for Asian dressings, and frying. Light sesame oil is typically used as a neutral cooking oil, while the toasted type is used to flavour sauces. Sesame oil is <a href="https://onlinelibrary.wiley.com/doi/10.1002/ptr.6428">high in</a> antioxidants and has some anti-inflammatory properties. Sesame oil is generally sold in smaller bottles than canola or sunflower oil. Cost? Up to $5 for a 150mL bottle. </li> </ul> <h2>How can I use less oil, generally?</h2> Using less oil in your cooking could keep your meals healthy. Here are some alternatives and cooking techniques: <ul> <li> use alternatives for baking – unless you are making an olive oil cake, if your recipe calls for a large quantity of oil, try using an alternative such as apple sauce, Greek yoghurt or mashed banana </li> <li> use non-stick cookware – using high-quality, non-stick pots and pans reduces the need for oil when cooking, or means you don’t need oil at all </li> <li> steam instead – steam vegetables, fish and poultry to retain nutrients and moisture without adding oil </li> <li> bake or roast – potatoes, vegetables or chicken can be baked or roasted rather than fried. You can still achieve crispy textures without needing excessive oil </li> <li> grill – the natural fats in meat and vegetables can help keep ingredients moist, without using oil </li> <li> use stock – instead of sautéing vegetables in oil, try using vegetable broth or stock to add flavour </li> <li> try vinegar or citrus – use vinegar or citrus juice (such as lemon or lime) to add flavour to salads, marinades and sauces without relying on oil </li> <li> use natural moisture – use the natural moisture in ingredients such as tomatoes, onions and mushrooms to cook dishes without adding extra oil. They release moisture as they cook, helping to prevent sticking.<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/228788/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Accredited Practising Dietitian and Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</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/i-cant-afford-olive-oil-what-else-can-i-use-228788">original article</a>. </div>

Food & Wine

Flight attendant reveals what happens if a passenger dies onboard

A flight attendant has revealed what happens if a passenger dies onboard, and the morbid reason the protocol has changed in recent years. Mandy Smith has been a flight attendant for 12 years and thankfully, hasn’t had to encounter such a tragedy during one of her flights. According to the protocol of the airline she serves, previously when passengers passed away on board they used to be put inside the bathrooms, but now their bodies are laid across the front seats. She explained to LadBible, “This has not happened to me, thankfully. It happened to a friend of mine, where they had a passenger pass away on the flight.” “Now, we used to have to put passengers in the bathrooms, and then lock the bathrooms off. But because they would be seated on the toilet, as they sat there - if rigour mortis set in - then they would be then stuck in that position, and they wouldn't be able to fit in their coffin.” 'So, unfortunately, now, we have to lay them across the front of the seats and try and calm their loved ones down, treat them with respect, cover them with blankets, and maybe just cordon the area off with blankets tucked into the overheads, which is what I would probably do.' Mandy also explained that according to different laws, if someone dies on a flight, cabin crew officially have to keep going to their final destination. She said, “If they passed away on board, it's the law that we, as cabin crew, have to keep going. So, we have to keep doing any kind of resuscitation until they're deemed to be deceased.” “So, if it was an accident that happened on board, or if they had a heart attack, we would then just keep going doing CPR.” “But if it was someone who passed away from natural causes, or another kind of ailment, then obviously, we wouldn't need to do anything to them then.” “We'd need to contact the ground services to be met by an ambulance or the coroner. We wouldn't really do it as an emergency landing, we'd just treat it as a normal landing if that person's definitely passed away.” Image credits: YouTube

Travel Trouble

"What an honour": Kevin Costner pays tribute to fallen Yellowstone costar

Kevin Costner has paid tribute to his Yellowstone costar Dabney Coleman, who has passed away at the age of 92. Coleman, who played the role of John Dutton, Sr. in the Paramount drama, died on Thursday at his home in Santa Monica, according to his daughter Quincy Coleman, who broke the news in a statement to The Associated Press. She said he "took his last earthly breath peacefully and exquisitely." “My father crafted his time here on earth with a curious mind, a generous heart, and a soul on fire with passion, desire and humour that tickled the funny bone of humanity. As he lived, he moved through this final act of his life with elegance, excellence and mastery,” she said. Yellowstone shared the news on Instagram with the message, "We're saddened by the passing of the Dabney Coleman, a legendary actor and member of the Yellowstone family." Kevin Costner stars as John Dutton, the son of Dabney's character on the show, paid tribute to the late actor as he shared a powerful flashback scene from the season 2 finale to his Instagram. Along with a photo from the moving TV moment, Costner wrote, "One of the most heart wrenching scenes I've been a part of. What an honor to have gotten to work with Dabney Coleman. May he rest in peace." Fans left thoughtful comments about Dabney's performance as John Dutton, Sr. on the show, with one person writing, "Most touching scene of the whole show when he played that part! He will be greatly missed." Dabney earned his first acting credit in an episode of Naked City in 1961, before he went on to appear in countless TV spots over the course of his career, including The Donna Reed Show, I Dream of Jeannie, Columbo, Law & Order: SVU, Recess The Guardian, Boardwalk Empire, and Ray Donovan before landing his role on Yellowstone. Image credits: Instagram

Caring

Do red bags get loaded onto a plane first? Travel hack goes viral

One TikTok user has racked up over 75 million views for their hack which warns travellers against buying red suitcases. The reason behind it? He claims that red suitcases are always loaded onto a plane first - meaning that they will be the last ones to come out at the baggage carousel. The <a href="https://www.tiktok.com/@airportlife_/video/7359248989134327072" target="_blank" rel="noopener">viral video</a> showed a plane's cargo being loaded, with all the red bags being loaded first. Many commenters have shared their theories on why this might be the case. "If the red are at the back then they are less likely to get left behind when unloading," one wrote. "So that it's easier to check if there is any bag left at end corner of loading area and prevent missing out black bags at dark corners, maybe," another added. However, a spokesperson for KLM Royal Dutch Airlines has debunked this theory and claimed that the video is "nonsense" and "was made purposefully to mislead or provide false information". They also said that there was simply not enough time for their baggage handlers to sort suitcases out by colour. The question of "Do red bags get loaded onto a plane first?" also made its way to Reddit, after the video went viral, and one user who claimed to be a ramp worker denied the theory. "If we had taken the time and brain power to load bags based on colour I'd still be loading flights from 2015." Image: TikTok

Travel Tips

Longer appointments are just the start of tackling the gender pain gap. Here are 4 more things we can do

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/michelle-oshea-457947">Michelle O'Shea</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/hannah-adler-1533549">Hannah Adler</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/marilla-l-druitt-1533572">Marilla L. Druitt</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>, and <a href="https://theconversation.com/profiles/mike-armour-391382">Mike Armour</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Ahead of the federal budget, health minister Mark Butler <a href="https://www.abc.net.au/news/2024-05-10/endometriosis-australia-welcomes-govt-funding-for-endometriosis/103830392">last week announced</a> an investment of A$49.1 million to help women with endometriosis and complex gynaecological conditions such as chronic pelvic pain and polycystic ovary syndrome (PCOS). From July 1 2025 <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/historic-medicare-changes-for-women-battling-endometriosis">two new items</a> will be added to the Medicare Benefits Schedule providing extended consultation times and higher rebates for specialist gynaecological care. The Medicare changes <a href="https://www1.racgp.org.au/newsgp/clinical/longer-consults-for-endometriosis-sufferers-on-the">will subsidise</a> $168.60 for a minimum of 45 minutes during a longer initial gynaecologist consultation, compared to the standard rate of $95.60. For follow-up consultations, Medicare will cover $84.35 for a minimum of 45 minutes, compared to the standard rate of $48.05. Currently, there’s <a href="https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=104&qt=item&criteria=104">no specified time</a> for these initial or subsequent consultations. But while reductions to out-of-pocket medical expenses and extended specialist consultation times are welcome news, they’re only a first step in closing the gender pain gap. <h2>Chronic pain affects more women</h2> Globally, research has shown chronic pain (generally defined as pain that persists for <a href="https://www.healthdirect.gov.au/chronic-pain">more than three months</a>) disproportionately affects <a href="https://academic.oup.com/bja/article/111/1/52/331232?login=false">women</a>. Multiple biological and psychosocial processes likely contribute to this disparity, often called the gender pain gap. For example, chronic pain is frequently associated with conditions influenced by <a href="https://www.sciencedirect.com/science/article/abs/pii/S0304395914003868">hormones</a>, among other factors, such as endometriosis and <a href="https://theconversation.com/adenomyosis-causes-pain-heavy-periods-and-infertility-but-youve-probably-never-heard-of-it-104412">adenomyosis</a>. Chronic pelvic pain in women, regardless of the cause, can be debilitating and <a href="https://www.nature.com/articles/s41598-020-73389-2">negatively affect</a> every facet of life from social activities, to work and finances, to mental health and relationships. The gender pain gap is both rooted in and compounded by gender bias in medical research, treatment and social norms. The science that informs medicine – including the prevention, diagnosis, and treatment of disease – has traditionally focused on men, thereby <a href="https://www.theguardian.com/lifeandstyle/2015/apr/30/fda-clinical-trials-gender-gap-epa-nih-institute-of-medicine-cardiovascular-disease">failing to consider</a> the crucial impact of sex (biological) and gender (social) factors. When medical research adopts a “male as default” approach, this limits our understanding of pain conditions that predominantly affect women or how certain conditions affect men and women <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10921746/">differently</a>. It also means intersex, trans and gender-diverse people are <a href="https://www.deakin.edu.au/about-deakin/news-and-media-releases/articles/world-class-centre-tackles-sex-and-gender-inequities-in-health-and-medicine">commonly excluded</a> from medical research and health care. Minimisation or dismissal of pain along with the <a href="https://www.hindawi.com/journals/ecam/2016/3467067/">normalisation of menstrual pain</a> as just “part of being a woman” contribute to significant delays and misdiagnosis of women’s gynaecological and other health issues. Feeling dismissed, along with perceptions of stigma, can make women less likely <a href="https://link.springer.com/article/10.1186/s12905-024-03063-6">to seek help</a> in the future. <h2>Inadequate medical care</h2> Unfortunately, even when women with endometriosis do seek care, many <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.15494?saml_referrer">aren’t satisfied</a>. This is understandable when medical advice includes being told to become pregnant to treat their <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-023-02794-2">endometriosis</a>, despite <a href="https://academic.oup.com/humupd/article/24/3/290/4859612?login=false">no evidence</a> pregnancy reduces symptoms. Pregnancy should be an autonomous choice, not a treatment option. It’s unsurprising people look for information from other, often <a href="https://www.mdpi.com/2227-9032/12/1/121">uncredentialed</a>, sources. While online platforms including patient-led groups have provided women with new avenues of support, these forums should complement, rather than replace, <a href="https://journals.sagepub.com/doi/full/10.1177/1460458215602939">information from a doctor</a>. Longer Medicare-subsidised appointments are an important acknowledgement of women and their individual health needs. At present, many women feel their consultations with a gynaecologist are <a href="https://www1.racgp.org.au/newsgp/clinical/longer-consults-for-endometriosis-sufferers-on-the">rushed</a>. These conversations, which often include coming to terms with a diagnosis and management plan, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496869/">take time</a>. <h2>A path toward less pain</h2> While extended consultation time and reduced out-of-pocket costs are a step in the right direction, they are only one part of a complex pain puzzle. If women are not listened to, their symptoms not recognised, and effective treatment options not adequately discussed and provided, longer gynaecological consultations may not help patients. So what else do we need to do? 1. Physician knowledge Doctors’ knowledge of women’s pain requires development through both practitioner <a href="https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00815-4/tables/2">education and guidelines</a>. This knowledge should also include dedicated efforts toward understanding the <a href="https://www.newyorker.com/magazine/2018/07/02/the-neuroscience-of-pain">neuroscience of pain</a>. Diagnostic processes should be tailored to consider gender-specific symptoms and responses to <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00137-8/fulltext">pain</a>. 2. Research and collaboration Medical decisions should be based on the best and most inclusive evidence. Understanding the complexities of pain in women is essential for managing their pain. Collaboration between health-care experts from different disciplines can facilitate comprehensive and holistic pain research and management strategies. 3. Further care and service improvements Women’s health requires multidisciplinary treatment and care which extends beyond their GP or specialist. For example, conditions like endometriosis often see people presenting to emergency departments in <a href="https://www.aihw.gov.au/reports/chronic-disease/endometriosis-in-australia/contents/treatment-management/ed-presentations">acute pain</a>, so practitioners in these settings need to have the right knowledge and be able to provide support. Meanwhile, pelvic ultrasounds, especially the kind that have the potential to visualise endometriosis, take longer to perform and require a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0015028223020757/">specialist sonographer</a>. Current rebates do not reflect the time and expertise needed for these imaging procedures. 4. Adjusting the parameters of ‘women’s pain’ Conditions like PCOS and endometriosis don’t just affect women – they also impact people who are gender-diverse. Improving how people in this group are treated is just as salient as addressing how we treat women. Similarly, the gynaecological health-care needs of culturally and linguistically diverse and Aboriginal and Torres Strait islander women may be even <a href="https://www.mdpi.com/1660-4601/20/13/6321">less likely to be met</a> than those of women in the general population. <h2>Challenging gender norms</h2> Research suggests one of the keys to reducing the gender pain gap is challenging deeply embedded <a href="https://pubmed.ncbi.nlm.nih.gov/29682130/">gendered norms</a> in clinical practice and research. We are hearing women’s suffering. Let’s make sure we are also listening and responding in ways that close the gender pain gap.<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/229802/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michelle-oshea-457947">Michelle O'Shea</a>, Senior Lecturer, School of Business, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/hannah-adler-1533549">Hannah Adler</a>, PhD candidate, health communication and health sociology, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/marilla-l-druitt-1533572">Marilla L. Druitt</a>, Affiliate Senior Lecturer, Faculty of Health, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>, and <a href="https://theconversation.com/profiles/mike-armour-391382">Mike Armour</a>, Associate Professor at NICM Health Research Institute, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</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/longer-appointments-are-just-the-start-of-tackling-the-gender-pain-gap-here-are-4-more-things-we-can-do-229802">original article</a>. </div>

Body

"What a joke": Backlash over new strict speed limit

Melbourne residents have lashed out at a local council over the controversial decision to reduce the speed limit on bust roads. Every street in Fitzroy and Collingwood, except state-managed roads such as major thoroughfares, are now under the new strict speed limit of a mere 30 kilometres an hour, which has been enforced by the Yarra City Council. Thoroughfares that are currently exempt from the 30km/h limit include Johnston Street, Nicholson Street, Hoddle Street, Alexandra Parade and Victoria Parade, although the council is working hard to bring the speed limits on these major roads down to 40km/h or 60km/h. Yarra City Council Mayor, Edward Crossland, said there is clear evidence that reducing speed limits will lessen the number of road accidents and save lives. “We want to make our streets safer and better places for people of all ages and abilities whether you are walking, wheeling, cycling or driving. 30km can have a huge benefit and we know there is a lot of support for this initiative across our community,” he said. “Research shows that a person walking is at least twice as likely to be killed by a driver travelling at 40km than at 30km and that safer speed limits in urban areas has minimal impact on travel time." The council first began trialling the 30km/h speed limit in 2018 in northern parts of Fitzroy and Collingwood, and brought the number of crashes down by 52 percent over the first 12 months. Despite the evidence that reduced speeds help the community at large, not everyone is impressed by the change, with social media users claiming the lower speed limit will “never be enforced”. Another claimed, “When the police commissioner comes out and says it’s ridiculous and nobody will follow the limits then yeah, fair to say it won’t be enforced.” In 2023, Victorian Police chief commissioner Shane Patton, told ABC radio that changing the speed limit to 30km/h was “not the answer”. “I think no one’s going to obey it. It’s ridiculous,” he said. Social media users have branded the change an attempt at “revenue raising”, with one commenter saying: “Just another way to nab us with fines! All about the revenue.” “What a joke,” another person said, while one claimed people might as well start pushing their cars if the speed limit is so low. However, there are also those that have praised the council’s decision, branding it a “great initiative”. “Great news! More traffic calming please,” one person said. Image credits: Shutterstock

Legal

What is allyship? A brief history, present and future

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/wendy-marie-cumming-potvin-542762">Wendy Marie Cumming-Potvin</a>, <a href="https://theconversation.com/institutions/murdoch-university-746">Murdoch University</a> Despite social change, LGBTQI+ people still face discrimination <a href="https://www.ohchr.org/en/statements/2019/10/inclusion-lgbt-people-education-settings-paramount-importance-leaving-no-one">at school</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/10304312.2023.2296344">in the community</a>. Language for diverse genders and sexualities is continually changing. LGBTQI+ allyship is part of this change. But what is allyship? Allyship refers to people outside of a group – say, straight people – who actively support and work with people inside a group – say, LGBTQI+ people. It can also mean people from different groups working together to support each other’s goals. A key example of this was at the <a href="https://www.tandfonline.com/doi/full/10.1080/10304312.2023.2296344">Stonewall riots in 1969</a>, when lesbians, gay men and transgender people joined with Black Panthers and civil rights activists in New York City to protest against police brutality. But defining allyship can be challenging. Some people disagree about who an ally is. Others disagree about what an ally does. <h2>What is an ally?</h2> The term “ally” first appeared in US universities among students <a href="https://files.eric.ed.gov/fulltext/ED336682.pdf#page=215">in the early 1990s</a>. It was used to describe how majority group members (straight students) helped minorities (gay, lesbian and bisexual students), by advocating to end sexuality-based oppression in higher education. For many years, scholars have seen straight allyship for lesbian, gay and bisexual people as helpful for activism. Straight allies have played important roles in <a href="https://www.jstor.org/stable/j.ctt7pf5j">policy</a> and in <a href="https://www.tandfonline.com/doi/full/10.1080/19361653.2014.969867">combating prejudice</a> on high school and university campuses. Research has shown university and high school gay–straight alliances <a href="https://www.tandfonline.com/doi/full/10.1080/19361653.2017.1326867?casa_token=A6nQuWeFBIYAAAAA%3Ad-Tg1edyeiOyRDuHKyeHDcWuvqLLVhAFqyhXMjOe8RtWJH6pdwxUpES759QaY_zacNUS-TtqMXYK">have contributed</a> to more positive campus environments and a reduction in gender- and sexuality-based discrimination. Over many years, gay–straight teacher alliances have <a href="https://go.gale.com/ps/i.do?id=GALE%7CA227011983&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=10813004&p=LitRC&sw=w&userGroupName=anon%7E40663b6e&aty=open-web-entry">successfully used</a> inquiry groups to combat homophobia and explore <a href="https://theconversation.com/explainer-what-does-intersectionality-mean-104937">intersectionality</a> (the way different facets of someone’s identity intersect) within their schools. These groups highlighted LGBTQI-themed literature in English class, and encouraged teachers to be outspoken in their support by attending community events, such as pride parades. But allyship can be exclusionary. While early perspectives of allyship focused on helping gay or lesbian university students, transgender or non-binary folk <a href="https://www.routledge.com/LGBTQI-Allies-in-Education-Advocacy-Activism-and-Participatory-Collaborative/Cumming-Potvin/p/book/9781032298832">were often ignored</a>. There is also contention about <a href="https://www.queensjournal.ca/justin-timberlakes-queer-allyship-strips-ally-of-its-meaning/">how much “work”</a> a straight ally has to do to earn recognition. Some people say that for someone to be called an ally they need to actively work for change, not just say they support others. As allies, we are continually learning. And sometimes we get it wrong. When we make mistakes, it’s important to apologise and continue supporting those we wish to serve. <h2>Allyship from within the community</h2> Many current definitions of allyship only encompass allies outside of the group they are supporting. But a broadened definition of allyship would be useful. LGBTQI+ people, especially with leadership roles, can be strong allies in their communities. Laverne Cox uses her stardom <a href="https://ccrjustice.org/home/blog/2019/08/02/evening-activism-laverne-cox">to advocate</a> for her community of transgender women of colour and other LGBTQI+ people. Georgie Stone made medical processes <a href="https://www.theguardian.com/society/2019/sep/07/it-takes-a-lot-of-courage-rebekah-robertson-on-raising-transgender-activist-georgie-stone">easier for transgender children</a> in Australia. <figure><iframe src="https://www.youtube.com/embed/-_dpLOXfOUE?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Because identities can shift, identifying who sits inside and outside LGBTQA+ communities can be challenging. Sometimes, there are clear social group insiders. Sometimes, there are clear outsiders. Other times, things are less clear. A person might hover inside and outside minority groups. They may not identify as straight, but they may not live publicly as LGBTQI+. Or a bisexual person may live in a straight relationship for many years. This means allyship is also dynamic. It <a href="https://www.suu.edu/pridealliance/pdf/reynolds.pdf">shifts</a> depending on power, privilege and life experiences. For example, in one social context, a white, heterosexual woman may have power as a LGBTQI+ ally. But in a professional setting where the majority of attendees are white heterosexual men, this same woman may not be as powerful. <h2>An intersectional process</h2> Allyship needs to understand that many people’s gender and sexuality interact with language fluency, class, geography, race, age and disability. This means that despite victories such as marriage equality, LGBTQI+ people who are homeless, transgender or people of colour may face <a href="https://theconversation.com/despite-recent-victories-plights-of-many-lgbt-people-remain-ignored-49273">significant barriers</a> in society. For example, as of May 2024, <a href="https://translegislation.com/">550 anti-trans bills</a> have been introduced in US legislatures. <a href="https://www.creativespirits.info/aboriginalculture/people/lgbti-aboriginal-people-diversity-at-the-margins">Because of</a> discrimination, racism and a silencing around Black queer history, LGBTQA+ Aboriginal and Torres Strait Islander people can receive inappropriate services, for example, <a href="https://journals.sagepub.com/doi/epdf/10.1177/10497323211069682">in healthcare and education</a>. Understanding the multiple identities of LGBTQI+ people will support strong allyship to reduce <a href="https://www.murdoch.edu.au/news/articles/national-survey-reveals-mental-health-burden-on-first-nations-lgbtqa-youth">negative health outcomes</a> for Aboriginal communities. <h2>What’s next for allyship?</h2> Recent Canadian work has grouped researchers, school boards and teacher federations to make <a href="https://trans-affirm.edu.uwo.ca/toolkit/Trans-Affirming%20Toolkit.pdf">ally resources</a> for supporting trans and gender-diverse students in Ontario. This tool kit includes modules for having conversations about gender identity and teaching about transgender policy. The final module introduces action plans for supporting transgender students through whole school approaches. History has shown coming together can lead to social transformation and better outcomes for marginalised groups. In 2016, US President Barack Obama designated the Stonewall Inn <a href="https://www.theguardian.com/world/2016/jun/24/obama-announces-stonewall-inn-national-monument">a national US monument</a> to celebrate gay history. Apart from acknowledging evolving ideas about gender and sexuality, future LGBTQI+ allyship needs to be intersectional. This means that factors like age, social class, geography, race, language and disability count. And when barriers are broken down across sectors, like healthcare, education and housing, allies become stronger.<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/220668/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/wendy-marie-cumming-potvin-542762">Wendy Marie Cumming-Potvin</a>, Associate Professor/ Director of Research (School of Education), <a href="https://theconversation.com/institutions/murdoch-university-746">Murdoch University</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-is-allyship-a-brief-history-present-and-future-220668">original article</a>. </div>

Caring

"What goes around...": Colonial-era statue toppled

The statue honouring a controversial colonialist has been vandalised in Tasmania, with local councillors up in arms over the destruction. The statue paid tribute to William Crowther, a politician and surgeon who cut off and stole the skull of Aboriginal man William Lanne in 1869, with the intention of sending it to London's Royal College of Surgeons. On Wednesday morning, the statue was found face down after being sawn off at the ankles and falling from its plinth, with the words "what goes around" and "decolonize" spray-painted on the memorial. The toppling of the statue comes just hours after someone attempted to saw through the statue's ankles but stopped about two-thirds through. Hobart City Councillor Louise Elliot said she had noticed graffiti on the statue at midday on Tuesday and reported it, and then the cuts were found. When Councillor Elliot visited the statue at 8pm on Tuesday, she noted that "no security was here" after she stood at the site for "half an hour". She said she was "appalled" that a statue had been vandalised in a "completely foreseeable" incident. "I found out about this from Crowther's great-great granddaughter in tears ringing me," she said. "I'm really disappointed that the council, in my opinion, didn't take enough protective and preventive action to protect [the statue]." ast year, the council voted to remove the statue, which was appealed in the Tasmanian Tribunal of Civil and Administrative Tribunal on the basis its removal would detract from the site's heritage value. But in its decision, which was handed down today after the statue was toppled, the tribunal upheld the council's original decision to remove it. Deputy Premier Michael Ferguson said it was" regrettable" that someone thought to take the law into their own hands. <div data-component="EmphasisedText"> "Regardless of anybody's sentiment or feeling, good intentions or otherwise, that's not how we run a civil society," he said. </div> "Horrible things happened in our history, but you don't resolve history [through] vandalism." As members of Tasmania's indigenous community have been campaigning for years to have the statue removed, Tasmanian Aboriginal Centre (TAC) campaign manager Nala Mansell said the desecration of the statue reflected community attitudes. "I'm not endorsing what's happened but I think it goes to show that the people of Tasmania are people who understand right from wrong [and are] saying 'enough is enough.' "We've been fighting for decades for it to be gone," she said. <div data-component="EmphasisedText"> "Good on them for taking that action and doing what needed to be done a long time ago." </div> Image credits: Instagram - Kate Doyle ABC

Legal

It’s so hard to see a doctor right now. What are my options?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/anthony-scott-10738">Anthony Scott</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Deciding whether to wait and see if your health condition improves or go to a GP can be a difficult task. You might be unsure about where to go, whom to see, how much it will cost and whether you’ll need to take time off work. These choices can create significant barriers to accessing health care in Australia. There is often limited information available about the pros and cons of the different options. Often, we stick to what we know, unaware of better alternatives. But making the wrong decision about how to access care can impact both your health and finances. So what are your options? And what policy reforms are needed to improve affordable access to care for all Australians? <h2>How quickly can I be seen?</h2> Access depends on how long it takes you to speak to a GP, or be seen in an emergency department, or by a community pharmacist, or a nurse practitioner whom you can see directly. Access depends on where you live and the time of day. The rise of telehealth means GPs now get paid to talk to you on the phone, which is great for many minor ailments, medical certificates, repeat scripts or getting test results. Call centres such as <a href="https://www.healthdirect.gov.au/">Healthdirect</a> have been available for some time and now <a href="https://www.vved.org.au/patients/">virtual emergency departments</a> can also see you online. There are even GPs who only provide their services <a href="https://www.instantscripts.com.au/gp-online/">online</a> if you can pay. A phone call can save you valuable time. Before COVID, you needed to take half a day off work to see a GP, now it takes five to ten minutes and the GP even calls you. Things get more tricky outside of normal working hours and at weekends – appointments are harder to come by, it is unlikely you will be able to see a GP whom you know, and out-of-pocket costs might be higher. If you can’t wait, your local emergency department is likely to be more accessible, or you might be lucky enough to live near a bulk-billed Medicare <a href="https://www.health.gov.au/find-a-medicare-ucc">urgent care clinic</a>, where you don’t need an appointment. Tomorrow’s federal budget <a href="https://www.smh.com.au/politics/federal/more-free-urgent-care-clinics-part-of-8-5-billion-health-commitment-20240511-p5jcse.html">will include</a> funding for another 29 urgent care clinics, on top of the 58 already operating. But things are much worse if you live if a rural or remote area, where choice is limited and you need to wait much longer for GP appointments or travel long distances. Telehealth helps but can be expensive if it is not with your usual doctor. <h2>Who will I see?</h2> Access depends on who you will see. At the moment, this will usually be your GP (or, depending on the severity of your health concern, your community pharmacist or local emergency department staff). But to see your preferred GP you might need to wait as they are usually very busy. But a <a href="https://www.health.gov.au/resources/collections/issues-papers?language=en">review</a> of “scope of practice” in primary care aims to free up GPs’ time and use their skills more effectively. So in future, you could receive more of your health care from qualified nurses, nurse practitioners, pharmacists and other health professionals. But which tasks can be delegated to other health professionals is a significant bone of contention for GPs. For GP practices facing significant cost pressures, safely delegating tasks to other less costly health professionals also makes good business sense. <h2>How much will it cost?</h2> Access depends on out-of-pocket costs. Bulk billing of GP services reached a peak of <a href="https://www.health.gov.au/resources/publications/medicare-quarterly-statistics-state-and-territory-december-quarter-2023-24?language=en">89.6%</a> in the September quarter of 2022 but plummeted to 76.5% by the September quarter of 2023. Last November, bulk billing incentives for children under 16 and those on concession cards were tripled, and between November and December 2023 bulk billing had <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/bulk-billing-slide-stopped-thanks-to-albanese-government?language=en">increased</a> from 76.5% to 77.7%. They key issue for patients is that it remains uncertain whether a GP will bulk bill you. You often don’t know this until you get into the consultation, at which point you can’t back out. Unless the whole practice bulk bills and so it is guaranteed, it’s entirely up to the GP whether you are bulk billed. It’s difficult to think of any other service where you don’t know how much you will pay until after you have used it. <h2>How can policymakers improve access to care?</h2> Government policies to strengthen primary care have focused on giving patients improved access through telehealth, urgent care clinics and <a href="https://www.health.gov.au/resources/publications/strengthening-medicare-taskforce-report?language=en">Strengthening Medicare</a> initiatives, which are currently being developed. But uncertainty surrounding out-of-pocket costs can deter people from seeking medical attention, or delay care or go instead to the emergency department or urgent care clinic where there is no out-of-pocket cost. <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release">Cost is a factor</a> that leads to 20% of those with a mental health problem and 30% of those with chronic disease to delay or avoid visiting a health professional. Those most in need are more likely to miss out on necessary visits and prescriptions, sometimes with disastrous consequences. A recent <a href="https://academic.oup.com/qje/advance-article-abstract/doi/10.1093/qje/qjae015/7664375?login=false">study</a> shows people can die if they stop heart medications due to increased out-of-pocket costs. The next task for policymakers should be developing policies to guarantee there are no out-of-pocket costs for those on low incomes. This could be a worthwhile investment in our health and should be included in tomorrow’s budget.<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/229191/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/anthony-scott-10738">Anthony Scott</a>, Professor of Health Economics, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</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/its-so-hard-to-see-a-doctor-right-now-what-are-my-options-229191">original article</a>. </div>

Caring

Too many Australians aren’t getting a flu vaccine. Why, and what can we do about it?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/holly-seale-94294">Holly Seale</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Australia’s childhood immunisation program gets very good uptake every year – <a href="https://www.health.gov.au/topics/immunisation/immunisation-data/childhood-immunisation-coverage">almost 94% of five-year-olds</a> have had all their routine vaccinations. But our influenza vaccine coverage doesn’t get such a good report card. Looking back over <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/historical-national-influenza-vaccination-coverage-end-year-age">recent years</a>, for kids aged six months to five years, we saw a peak in flu vaccine coverage at the beginning of the COVID pandemic at 46%, which then declined to 30% by the 2023 season. While we’re still relatively early in the 2024 flu season, only <a href="https://ncirs.org.au/influenza-vaccination-coverage-data">7% of children</a> under five have received their flu shot this year so far. Although young children are a particular concern, flu vaccination rates appear to be lagging for the population as a whole. Reports indicate that <a href="https://www.abc.net.au/news/2024-05-07/calls-to-vaccinate-young-children-against-flu-as-season-begins/103783508">from March 1 to April 28</a>, 16% fewer people were vaccinated against the flu compared with the same period last year. So what’s going on, and what can we do to boost uptake? <h2>Why do we vaccinate kids against the flu?</h2> Last year, <a href="https://www.health.gov.au/sites/default/files/2023-12/aisr-2023-national-influenza-season-summary.pdf">reported cases of flu</a> were highest in children aged five to nine, followed by those aged zero to four. This is not a new trend – we record a high number of flu cases and hospital admissions in kids every year. So far <a href="https://nindss.health.gov.au/pbi-dashboard/">this year</a> children aged zero to four have had the highest number of infections, marginally ahead of five- to nine-year-olds. While kids are more likely to catch and spread the flu, they’re also <a href="https://theconversation.com/kids-are-more-vulnerable-to-the-flu-heres-what-to-look-out-for-this-winter-117748">at greater risk</a> of getting very sick from it. This particularly applies to children under five, and the flu vaccine is available for free for this age group. The flu vaccine isn’t perfect – it may not prevent infections entirely – but it’s definitely our best chance of protection. Research has shown influenza-related visits to the GP were <a href="https://pubmed.ncbi.nlm.nih.gov/27577556/">more than halved</a> in vaccinated children compared with unvaccinated children. <h2>So why are kids not receiving the vaccine?</h2> Often, it comes down to misunderstandings about who is eligible for the vaccine or whom it’s recommended for. But we can address this issue by nudging people via <a href="https://www.annfammed.org/content/15/6/507?sf174332549=1">a text message reminder</a>. Some parents <a href="https://www.sciencedirect.com/science/article/pii/S0264410X17318285">report concerns</a> about the vaccine, including the old dogma that it can cause the flu. The flu vaccine <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/flu-influenza-immunisation">can’t give you the flu</a> because it doesn’t contain live virus. Unfortunately, that myth is really sticky. For <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.15235">some parents</a>, the challenge can be forgetting to book or accessing an appointment. <h2>It’s not just kids at higher risk</h2> Adults aged 65 and over are also <a href="https://theconversation.com/im-over-65-and-worried-about-the-flu-which-vaccine-should-i-have-204810">more vulnerable</a> to the flu, and can receive a <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">free vaccine</a>. For this group, we usually get around <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/historical-national-influenza-vaccination-coverage-end-year-age">65% vaccinated</a>. So far this year, <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people-age-group">around 35%</a> of over-65s have received their flu vaccine. Aboriginal and Torres Strait Islander people are likewise eligible for a free flu vaccine. While previously coverage rates were higher among Aboriginal and Torres Strait Islander peoples compared to the overall population, this gap has narrowed. There’s even some movement backwards, especially <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/historical-national-influenza-vaccination-coverage-end-year-age">in younger age groups</a>. The flu vaccine is also free for pregnant women and anyone who has <a href="https://www.health.gov.au/topics/immunisation/when-to-get-vaccinated/immunisation-for-people-with-medical-risk-conditions">a medical condition</a> such as heart disease, chronic lung disease, diabetes or kidney disease. Past studies have found flu vaccine coverage <a href="https://www.phrp.com.au/wp-content/uploads/2022/06/PHRP31232111.pdf">for pregnant women</a> varies around the country from 39% to 76% (meaning in some jurisdictions up to 60% of pregnant women are not getting vaccinated). When it comes to adults with chronic health conditions, we don’t have a good sense of how many people receive the vaccine. The reasons adults don’t always get the flu vaccine overlap with the reasons for children. Often <a href="https://www.tandfonline.com/doi/full/10.1080/08870446.2021.1957104">concerns about side effects</a> are cited as the reason for not getting vaccinated, followed by time constraints. We also know <a href="https://www.aihw.gov.au/reports/primary-health-care/coordination-of-health-care-experiences-barriers/summary">accessing medical services</a> can be difficult for some people, such as those living in rural areas or experiencing financial hardship. <h2>Filling the gaps</h2> In Australia, GPs offer flu vaccines for all ages, while flu vaccination is also available at pharmacies, generally from age five and up. While some people make a conscious decision not to get themselves or their children vaccinated, for many people, the barriers are related to access. Programs offering vaccination outside the doctor’s office are increasing globally, and may assist in <a href="https://www.tandfonline.com/doi/full/10.1080/14760584.2019.1698955">filling gaps</a>, especially among those who don’t have regular access to a GP. For some people, their only point of contact with the <a href="https://pubmed.ncbi.nlm.nih.gov/34272104/">medical system</a> may be during emergency department visits. Others may have more regular contact with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046372/">specialist</a> who coordinates their medical care, rather than a GP. Offering vaccine education and programs <a href="https://journals.sagepub.com/doi/10.1177/0009922810374353">in these settings</a> has been shown to improve immunisation rates and may play a pivotal role in filling access gaps. Outside medical and pharmacy settings, the workplace is the most common place for Australian adults to receive their flu vaccine. A <a href="https://www.sciencedirect.com/science/article/pii/S1326020023004272">survey</a> showed Australian adults find workplace vaccination convenient and cost-effective, especially where free or subsidised vaccines are offered. Expanding vaccination settings, such as with <a href="https://journals.sagepub.com/doi/10.1177/19375867221087360?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">drive-through</a> and mobile clinics, can benefit groups who have unique access barriers or are under-served. Meanwhile, offering vaccination through faith-based organisations has been shown to improve uptake among <a href="https://pubmed.ncbi.nlm.nih.gov/37013523/">racial and ethnic minority groups</a>. Eleftheria Lentakis, a masters student at the School of Population Health at UNSW Sydney, 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/229477/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/holly-seale-94294">Holly Seale</a>, Associate Professor, School of Population Health, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</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/too-many-australians-arent-getting-a-flu-vaccine-why-and-what-can-we-do-about-it-229477">original article</a>. </div>

Body

Photos are everywhere. What makes a good one?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/t-j-thomson-503845">T.J. Thomson</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> We upload some <a href="https://theconversation.com/3-2-billion-images-and-720-000-hours-of-video-are-shared-online-daily-can-you-sort-real-from-fake-148630">3 billion images online each day</a>. We make <a href="https://www.tandfonline.com/doi/full/10.1080/1051144X.2023.2281163">most of these photos on smartphones</a> and use these devices to document everything from gym progress and our loved ones to a memorable meal. But what makes a “quality” photo? Many people, even those who make images for work, struggle to answer. They often say something along the lines of “I know it when I see it”. But knowing some dimensions of a quality photograph can help make your images stand out and make you a <a href="https://medialiteracy.org.au/media-literacy-framework/">more literate</a> media maker and consumer. Quality can be relative, but knowing the various dimensions at play can help you draw on those that are most relevant for your particular audience, context and purpose. I identified <a href="https://doi.org/10.1177/14648849241253136">six dimensions</a> which will impact the quality of photographs. Here’s what I learnt – and what you can apply to your own photographs. <h2>1. Production and presentation</h2> Think of the factors <a href="https://journals.sagepub.com/doi/full/10.1177/1522637918823261">in front of and behind the lens</a>. If you know you’re being recorded, this can affect your behaviour compared to a candid depiction. You might be more or less comfortable posing for a friend or family member than for a stranger. This comfort, or its lack, can lead to more stiff and awkward poses, or ones that look more natural and confident. Presentation circumstances, like the viewing size and context, also matter. A group shot can make a nice statement piece above a fireplace, but it wouldn’t have the same effect as a profile photo. Be aware of how “busy” your image is, and whether the viewing conditions are well-suited for the nature of your photo. Images with lots of elements, fine textures or other details need to be viewed large to be fully appreciated. Images with fewer, larger and simpler elements can usually be appreciated at smaller sizes. <h2>2. Technical aspects</h2> Technical aspects include proper exposure – meaning the image isn’t too dark or too bright – adequate focus, and appropriate camera settings. Some of these camera settings, like shutter speed, affect whether motion is seen as frozen or blurred. If the image is too blurry, too pixelated, or too light or dark, these technical aspects will negatively impact the photograph’s quality. But some motion blur, as distinct from camera shake, can make more dynamic an otherwise static composition. <h2>3. Who or what is shown</h2> Who or what is shown in the photographs we see is affected, in part, by access and novelty. That’s why we often make more photos during our holidays compared to documenting familiar settings. Some people or locations can be <a href="https://journals.sagepub.com/doi/full/10.1177/1329878X221094374">under-represented</a> and photographing them can lead to more visibility, and, depending on the context, a more empowering framing. Consider in your photography if you’re including people who are typically under-represented, such as older individuals, people of colour, people living with disabilities and queer people. Also consider whether you’re representing them in stereotypical or disempowering ways. As examples, <a href="https://www.tandfonline.com/doi/abs/10.1080/22041451.2022.2137237">when photographing older people</a>, consider whether you’re showing them as lonely, isolated, passive, or in need of mobility aids. <h2>4. Composition</h2> Composition includes positioning of elements in the frame, the balance between positive and negative space, and depth, among others. Generally, images that centre the subject of interest aren’t as visually engaging as images that offset the subject of interest. This is what’s known as the <a href="https://www.adobe.com/au/creativecloud/photography/discover/rule-of-thirds.html">rule-of-thirds</a> approach. Likewise, images that have no depth are generally not as interesting as images with a clear foreground, midground and background. “Seeing through things” with your compositions can help increase the visual depth of your photos alongside their visual appeal. <h2>5. The psycho-physiological</h2> The psycho-physiological concerns how the viewer reacts to what is shown. This includes the <a href="https://psycnet.apa.org/record/2011-07236-024">biological reaction</a> we have to seeing certain colours, for example the way the colour red can increase our heart rate. It also can include the feeling we have when seeing a photo of someone we know. The most powerful photos use colour and other elements of visual language strategically for a specific effect. Looking at these images might evoke a specific emotion, such as empathy or fear, and influence how the viewer responds. <h2>6. Narrative</h2> Narrative concerns the storytelling quality of the image. Images can show something in a literal way (think a photograph from a real estate listing) or they can tell a bigger story about the content represented or about the human condition (think about some of the iconic photos that emerged during Australia’s <a href="https://journals.sagepub.com/doi/abs/10.1177/1329878X211008181">black summer bushfire season</a>). Literal photos help us see what something or someone looks like but they might not have as much of an impact as iconic photos. For example, the well-known photo of three-year-old Syrian boy Aylan Kurdi’s lifeless body on a beach in Turkey <a href="https://www.reuters.com/article/idUSKBN14V2MG/">boosted fundraising for refugees</a> 100-fold. <h2>A more thoughtful process</h2> Next time you pull out your smartphone to make an image, don’t just “<a href="https://www.digitalphotomentor.com/do-you-wait-for-the-decisive-moment-or-do-you-spray-and-pray/">spray and pray</a>”. Try to pre-visualise the story you want to tell and wait for the elements to line up into place. Being aware of aesthetic and ethical considerations alongisde technical ones and emotional resonance can all help engage viewers and lead to more standout imagery. To challenge yourself further, consider taking your phone off full-auto mode and play with camera settings to see how they impact the resulting photos.<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/229011/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/t-j-thomson-503845">T.J. Thomson</a>, Senior Lecturer in Visual Communication & Digital Media, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</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/photos-are-everywhere-what-makes-a-good-one-229011">original article</a>. </div>

Technology

Vitamins and supplements: what you need to know before taking them

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/neelaveni-padayachee-1018709">Neelaveni Padayachee</a>, <a href="https://theconversation.com/institutions/university-of-the-witwatersrand-894">University of the Witwatersrand</a> and <a href="https://theconversation.com/profiles/varsha-bangalee-1253468">Varsha Bangalee</a>, <a href="https://theconversation.com/institutions/university-of-kwazulu-natal-1941">University of KwaZulu-Natal</a> If you were to open your medicine cabinet right now, there’s a fair chance that you’d find at least one bottle of vitamins alongside the painkillers, plasters and cough syrup. After all, people are definitely buying vitamins: in 2020, the global market for complementary and alternative medicines, which includes multivitamin supplements, had an estimated value of <a href="https://www.grandviewresearch.com/industry-analysis/complementary-alternative-medicine-market">US$82.27 billion</a>. The use of natural health products such as minerals and amino acids has <a href="https://journals.lww.com/nutritiontodayonline/Abstract/2007/03000/Why_People_Use_Vitamin_and_Mineral_Supplements.4.aspx">increased</a> – and continues to rise, partly driven by consumers’ buying habits during the COVID-19 pandemic. People <a href="https://www.businesslive.co.za/bd/companies/healthcare/2021-02-08-native-sales-of-sas-vitamins-and-nutritional-supplements-boom/">sought out</a> vitamins C and D, as well as zinc supplements, as potential preventive measures against the virus – even though the <a href="https://www.health.harvard.edu/blog/do-vitamin-d-zinc-and-other-supplements-help-prevent-covid-19-or-hasten-healing-2021040522310">evidence</a> for their efficacy was, and <a href="https://pubmed.ncbi.nlm.nih.gov/35888660/#:%7E:text=Concluding%2C%20available%20data%20on%20the,trials%20(RCTs)%20are%20inconsistent">remains</a>, inconclusive. Multivitamins and mineral supplements are easily accessible to consumers. They are often marketed for their health claims and benefits – sometimes unsubstantiated. But their potential adverse effects are not always stated on the packaging. Collectively, vitamins and minerals are known as micronutrients. They are essential elements needed for our bodies to function properly. Our bodies can only produce micronutrients in small amounts or not at all. We get the bulk of these nutrients <a href="https://www.iprjb.org/journals/index.php/IJF/article/view/1024">from our diets</a>. People usually buy micronutrients to protect against disease or as dietary “insurance”, in case they are not getting sufficient quantities from their diets. There’s a common perception that these supplements are harmless. But they can be dangerous at incorrect dosages. They provide a false sense of hope, pose a risk of drug interactions – and can delay more effective treatment. <h2>Benefits</h2> Vitamins are beneficial if taken for the correct reasons and as prescribed by your doctor. For example, folic acid supplementation in pregnant women has been shown to prevent neural tube defects. And individuals who reduce their intake of red meat without increasing legume consumption require a vitamin B6 supplement. But a worrying trend is increasing among consumers: intravenous vitamin therapy, which is often punted by celebrities and social media marketing. Intravenous vitamins, nutrients and fluids are administered at pharmacies as well as beauty spas, and more recently “<a href="https://www.health.harvard.edu/blog/drip-bar-should-you-get-an-iv-on-demand-2018092814899">IV bars</a>”. Users believe these treatments can quell a cold, slow the effects of ageing, brighten skin, fix a hangover or just make them feel well. Intravenous vitamin therapy was previously only used in medical settings to help patients who could not swallow, needed fluid replacements or had an electrolyte imbalance. However, the evidence to support other benefits of intravenous vitamin therapy is limited. No matter how you choose to get additional vitamins, there are risks. <h2>Warning bells</h2> Most consumers use multivitamins. But others take large doses of single nutrients, especially vitamin C, iron and calcium. As lecturers in pharmacy practice, we think it’s important to highlight the potential adverse effects of commonly used vitamins and minerals: <ul> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-a/">Vitamin A/retinol</a> is beneficial in maintaining good eye health. But it can cause toxicity if more than 300,000IU (units) is ingested. Chronic toxicity (hypervitaminosis) has been <a href="https://www.ncbi.nlm.nih.gov/books/NBK532916/">associated</a> with doses higher than 10,000IU a day. Symptoms include liver impairment, loss of vision and intracranial hypertension. It can cause birth defects in pregnant women. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/niacin-vitamin-b3/">Vitamin B3</a> is beneficial for nervous and digestive system health. At moderate to high doses it can cause peripheral vasodilation (widening or dilating of the blood vessels at the extremities, such as the legs and arms), resulting in skin flushing, burning sensation, pruritis (itchiness of the skin) and hypotension (low blood pressure). </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-b6/">Vitamin B6</a> is essential for brain development and in ensuring that the immune system remains healthy. But it can result in damage to the peripheral nerves, such as those in the hands and feet (causing a sensation of numbness and often referred to as pins and needles) at doses over 200mg/daily. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-c/">Vitamin C</a> is an antioxidant and assists in the repair of body tissue. Taken in high doses it can cause kidney stones and interactions with drugs, such as the oncology drugs doxorubicin, methotrexate, cisplatin and vincristine. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-d/">Vitamin D</a> is essential for bone and teeth development. At high doses it can cause hypercalcaemia (calcium level in the blood is above normal) that results in thirst, excessive urination, seizures, coma and death. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/calcium/#:%7E:text=Calcium%20is%20a%20mineral%20most,heart%20rhythms%20and%20nerve%20functions">Calcium</a> is essential for bone health, but can cause constipation and gastric reflux. High doses can cause hypercalciuria (increased calcium in the urine), kidney stones and secondary hypoparathyroidism (underactive parathyroid gland). It can have drug interactions with zinc, magnesium and iron. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/magnesium/">Magnesium</a> is important for muscle and nerve functioning. At high doses it can cause diarrhoea, nausea and abdominal cramping, and can interact with tetracyclines (antibiotics). </li> <li> Zinc <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781367/">can impair</a> taste and smell, and doses over 80mg daily have been <a href="https://link.springer.com/article/10.1007/s10654-022-00922-0#:%7E:text=Zinc%20supplementation%20of%20more%20than,zinc%20supplements%20among%20adult%20men.">shown</a> to have adverse prostate effects. </li> <li> <a href="https://www.hsph.harvard.edu/nutritionsource/selenium/">Selenium</a> can cause hair and nail loss or brittleness, lesions of the skin and nervous system, skin rashes, fatigue and mood irritability at high doses. </li> <li> <a href="https://www.sciencedirect.com/science/article/pii/S0098299720300364#:%7E:text=Expert%20guidelines%20for%20oral%20iron%20supplementation&text=Traditionally%2C%20the%20recommended%20daily%20dose,iron%20(Brittenham%2C%202018).">Iron</a> at 100-200mg/day can cause constipation, black faeces, black discoloration of teeth and abdominal pain. </li> </ul> <h2>Recommendations</h2> People need to make <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8377299/">informed decisions</a> based on evidence before consuming health products. Regular exercise and a well-balanced diet are more likely to do us good, as well as being lighter on the pocket. Seeking advice from a healthcare professional before consuming supplements can reduce the risk of adverse effects. Be aware of the potential adverse effects of vitamins and seek a healthcare professional’s guidance if you have symptoms.<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/198345/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/neelaveni-padayachee-1018709">Neelaveni Padayachee</a>, Senior Lecturer, Department of Pharmacy and Pharmacology, <a href="https://theconversation.com/institutions/university-of-the-witwatersrand-894">University of the Witwatersrand</a> and <a href="https://theconversation.com/profiles/varsha-bangalee-1253468">Varsha Bangalee</a>, Associate Professor, Pharmaceutical Sciences, <a href="https://theconversation.com/institutions/university-of-kwazulu-natal-1941">University of KwaZulu-Natal</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/vitamins-and-supplements-what-you-need-to-know-before-taking-them-198345">original article</a>. </div>

Body

Terminal lucidity: why do loved ones with dementia sometimes ‘come back’ before death?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/yen-ying-lim-355185">Yen Ying Lim</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/diny-thomson-1519736">Diny Thomson</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Dementia is often described as “the long goodbye”. Although the person is still alive, dementia slowly and irreversibly chips away at their memories and the qualities that make someone “them”. Dementia eventually takes away the person’s ability to communicate, eat and drink on their own, understand where they are, and recognise family members. Since as early as the <a href="https://pubmed.ncbi.nlm.nih.gov/21764150/">19th century</a>, stories from loved ones, caregivers and health-care workers have described some people with dementia suddenly becoming lucid. They have described the person engaging in meaningful conversation, sharing memories that were assumed to have been lost, making jokes, and even requesting meals. It is estimated <a href="https://pubmed.ncbi.nlm.nih.gov/20010032/">43% of people</a> who experience this brief lucidity die within 24 hours, and 84% within a week. Why does this happen? <h2>Terminal lucidity or paradoxical lucidity?</h2> In 2009, researchers Michael Nahm and Bruce Greyson coined the term “<a href="https://pubmed.ncbi.nlm.nih.gov/21764150/">terminal lucidity</a>”, since these lucid episodes often occurred shortly before death. But not all lucid episodes indicate death is imminent. <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.13667">One study</a> found many people with advanced dementia will show brief glimmers of their old selves more than six months before death. Lucidity has also been <a href="https://www.sciencedirect.com/science/article/pii/S0167494311001865?via%3Dihub">reported</a> in other conditions that affect the brain or thinking skills, such as meningitis, schizophrenia, and in people with brain tumours or who have sustained a brain injury. Moments of lucidity that do not necessarily indicate death are sometimes called <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12579">paradoxical lucidity</a>. It is considered paradoxical as it defies the expected course of neurodegenerative diseases such as dementia. But it’s important to note these episodes of lucidity are temporary and sadly do not represent a reversal of neurodegenerative disease. <h2>Why does terminal lucidity happen?</h2> Scientists have struggled to explain why terminal lucidity happens. Some episodes of lucidity have been reported to occur in the presence of loved ones. Others have reported that <a href="https://psywb.springeropen.com/articles/10.1186/s13612-014-0024-5">music can sometimes improve lucidity</a>. But many episodes of lucidity do not have a distinct trigger. <a href="https://www.sciencedirect.com/science/article/pii/S0300957223002162">A research team from New York University</a> speculated that changes in brain activity before death may cause terminal lucidity. But this doesn’t fully explain why people suddenly recover abilities that were assumed to be lost. Paradoxical and terminal lucidity are also very difficult to study. Not everyone with advanced dementia will experience episodes of lucidity before death. Lucid episodes are also unpredictable and typically occur without a particular trigger. And as terminal lucidity can be a joyous time for those who witness the episode, it would be unethical for scientists to use that time to conduct their research. At the time of death, it’s also difficult for scientists to interview caregivers about any lucid moments that may have occurred. Explanations for terminal lucidity extend beyond science. These moments of mental clarity may be a way for the dying person to say final goodbyes, gain closure before death, and reconnect with family and friends. Some believe episodes of terminal lucidity are representative of the person connecting with an afterlife. <h2>Why is it important to know about terminal lucidity?</h2> People can have a variety of reactions to seeing terminal lucidity in a person with advanced dementia. While some will experience it as being peaceful and bittersweet, others may find it deeply confusing and upsetting. There may also be an urge to modify care plans and request lifesaving measures for the dying person. Being aware of terminal lucidity can help loved ones understand it is part of the dying process, acknowledge the person with dementia will not recover, and allow them to make the most of the time they have with the lucid person. For those who witness it, terminal lucidity can be a final, precious opportunity to reconnect with the person that existed before dementia took hold and the “long goodbye” began.<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/202342/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/yen-ying-lim-355185">Yen Ying Lim</a>, Associate Professor, Turner Institute for Brain and Mental Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/diny-thomson-1519736">Diny Thomson</a>, PhD (Clinical Neuropsychology) Candidate and Provisional Psychologist, <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/terminal-lucidity-why-do-loved-ones-with-dementia-sometimes-come-back-before-death-202342">original article</a>. </div>

Mind

What are heart rate zones, and how can you incorporate them into your exercise routine?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/hunter-bennett-1053061">Hunter Bennett</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> If you spend a lot of time exploring fitness content online, you might have come across the concept of heart rate zones. Heart rate zone training has become more popular in recent years partly because of the boom in wearable technology which, among other functions, allows people to easily track their heart rates. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537749/">Heart rate zones</a> reflect different levels of intensity during aerobic exercise. They’re most often based on a percentage of your maximum heart rate, which is the highest number of beats your heart can achieve per minute. But what are the different heart rate zones, and how can you use these zones to optimise your workout? <h2>The three-zone model</h2> While there are several models used to describe heart rate zones, the most common model in the scientific literature is the <a href="https://journals.humankinetics.com/view/journals/ijspp/9/1/article-p100.xml">three-zone model</a>, where the zones may be categorised as follows: <ul> <li> zone 1: 55%–82% of maximum heart rate </li> <li> zone 2: 82%–87% of maximum heart rate </li> <li> zone 3: 87%–97% of maximum heart rate. </li> </ul> If you’re not sure what your maximum heart rate is, it can be calculated using <a href="https://www.jacc.org/doi/full/10.1016/S0735-1097%2800%2901054-8">this equation</a>: 208 – (0.7 × age in years). For example, I’m 32 years old. 208 – (0.7 x 32) = 185.6, so my predicted maximum heart rate is around 186 beats per minute. There are also other models used to describe heart rate zones, such as the <a href="https://journals.humankinetics.com/view/journals/ijspp/14/8/article-p1151.xml">five-zone model</a> (as its name implies, this one has five distinct zones). These <a href="https://journals.humankinetics.com/view/journals/ijspp/9/1/article-p100.xml">models</a> largely describe the same thing and can mostly be used interchangeably. <h2>What do the different zones involve?</h2> The three zones are based around a person’s <a href="https://link.springer.com/article/10.2165/00007256-200939060-00003">lactate threshold</a>, which describes the point at which exercise intensity moves from being predominantly aerobic, to predominantly anaerobic. Aerobic exercise <a href="https://www.healthline.com/health/fitness-exercise/difference-between-aerobic-and-anaerobic">uses oxygen</a> to help our muscles keep going, ensuring we can continue for a long time without fatiguing. Anaerobic exercise, however, uses stored energy to fuel exercise. Anaerobic exercise also accrues metabolic byproducts (such as lactate) that increase fatigue, meaning we can only produce energy anaerobically for a short time. On average your lactate threshold tends to sit around <a href="https://www.tandfonline.com/doi/full/10.2147/OAJSM.S141657">85% of your maximum heart rate</a>, although this varies from person to person, and can be <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00043.2013">higher in athletes</a>. In the three-zone model, each zone loosely describes <a href="https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2015.00295/full">one of three types of training</a>. Zone 1 represents high-volume, low-intensity exercise, usually performed for long periods and at an easy pace, well below lactate threshold. Examples include jogging or cycling at a gentle pace. Zone 2 is threshold training, also known as tempo training, a moderate intensity training method performed for moderate durations, at (or around) lactate threshold. This could be running, rowing or cycling at a speed where it’s difficult to speak full sentences. Zone 3 mostly describes methods of high-intensity interval training, which are performed for shorter durations and at intensities above lactate threshold. For example, any circuit style workout that has you exercising hard for 30 seconds then resting for 30 seconds would be zone 3. <h2>Striking a balance</h2> To maximise endurance performance, you need to strike a balance between doing enough training to elicit positive changes, while avoiding over-training, injury and burnout. While zone 3 is thought to produce the largest improvements in <a href="https://www.sciencedirect.com/science/article/pii/S1440244018309198">maximal oxygen uptake</a> – one of the best predictors of endurance performance and overall health – it’s also the most tiring. This means you can only perform so much of it before it becomes too much. Training in different heart rate zones improves <a href="https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=38c07018c0636422d9d5a77316216efb3c10164f">slightly different physiological qualities</a>, and so by spending time in each zone, you ensure a <a href="https://link.springer.com/article/10.1007/bf00426304">variety of benefits</a> for performance and health. <h2>So how much time should you spend in each zone?</h2> Most <a href="https://www.frontiersin.org/articles/10.3389/fspor.2023.1258585/full">elite endurance athletes</a>, including runners, rowers, and even cross-country skiers, tend to spend most of their training (around 80%) in zone 1, with the rest split between zones 2 and 3. Because elite endurance athletes train a lot, most of it needs to be in zone 1, otherwise they risk injury and burnout. For example, some runners accumulate <a href="https://journals.humankinetics.com/view/journals/ijsnem/22/5/article-p392.xml?content=pdf">more than 250 kilometres per week</a>, which would be impossible to recover from if it was all performed in zone 2 or 3. Of course, most people are not professional athletes. The <a href="https://www.who.int/news-room/fact-sheets/detail/physical-activity">World Health Organization</a> recommends adults aim for 150–300 minutes of moderate intensity exercise per week, or 75–150 minutes of vigorous exercise per week. If you look at this in the context of heart rate zones, you could consider zone 1 training as moderate intensity, and zones 2 and 3 as vigorous. Then, you can use heart rate zones to make sure you’re exercising to meet these guidelines. <h2>What if I don’t have a heart rate monitor?</h2> If you don’t have access to a heart rate tracker, that doesn’t mean you can’t use heart rate zones to guide your training. The three heart rate zones discussed in this article can also be prescribed based on feel using a simple <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2004.00418.x">10-point scale</a>, where 0 indicates no effort, and 10 indicates the maximum amount of effort you can produce. With this system, zone 1 aligns with a 4 or less out of 10, zone 2 with 4.5 to 6.5 out of 10, and zone 3 as a 7 or higher out of 10. Heart rate zones are not a perfect measure of exercise intensity, but can be a useful tool. And if you don’t want to worry about heart rate zones at all, that’s also fine. The most important thing is to simply get moving.<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/228520/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hunter-bennett-1053061">Hunter Bennett</a>, Lecturer in Exercise Science, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</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-are-heart-rate-zones-and-how-can-you-incorporate-them-into-your-exercise-routine-228520">original article</a>. </div>

Body

Australians lose $5,200 a minute to scammers. There’s a simple thing the government could do to reduce this. Why won’t they?

<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> What if the government was doing everything it could to stop thieves making off with our money, except the one thing that could really work? That’s how it looks when it comes to <a href="https://www.scamwatch.gov.au/types-of-scams">scams</a>, which are attempts to trick us out of our funds, usually by getting us to hand over our identities or bank details or transfer funds. Last year we lost an astonishing <a href="https://www.accc.gov.au/media-release/scam-losses-decline-but-more-work-to-do-as-australians-lose-27-billion">A$2.74 billion</a> to scammers. That’s more than $5,200 per minute – and that’s only the scams we know about from the 601,000 Australians who made reports. Many more would have kept quiet. If the theft of $5,200 per minute seems over the odds for a country Australia’s size, a comparison with the United Kingdom suggests you are right. In 2022, people in the UK lost <a href="https://www.ukfinance.org.uk/system/files/2023-05/Annual%20Fraud%20Report%202023_0.pdf">£2,300</a> per minute, which is about A$4,400. The UK has two and a half times Australia’s population. It’s as if international scammers, using SMS, phone calls, fake invoices and fake web addresses are targeting Australia, because in other places it’s harder. If we want to cut Australians’ losses, it’s time to look at rules about to come into force in the UK. <h2>Scams up 320% since 2020</h2> The current federal government is doing a lot – almost everything it could. Within a year of taking office, it set up the <a href="https://www.accc.gov.au/national-anti-scam-centre">National Anti-Scam Centre</a>, which coordinates intelligence. Just this week, the centre reported that figure of $2.74 billion, which is down 13% on 2022, but up 50% on 2021 and 320% on 2020. It’s planning “<a href="https://treasury.gov.au/consultation/c2023-464732">mandatory industry codes</a>” for banks, telecommunication providers and digital platforms. But the code it is proposing for banks, set out in a <a href="https://treasury.gov.au/sites/default/files/2023-11/c2023-464732-cp.pdf">consultation paper</a> late last year, is weak when compared to overseas. <h2>Banks are the gatekeepers</h2> Banks matter, because they are nearly always the means by which the money is transferred. Cryptocurrency is now much less used after the banks agreed to limit payments to high risk exchanges. Here’s an example of the role played by banks. A woman the Consumer Action Law Centre is calling <a href="https://consumeraction.org.au/wp-content/uploads/2024/02/Joint-submission-CALC-CHOICE-ACCAN-31012024-Scams-Mandatory-code-treasury-consultA.pdf">Amelia</a> tried to sell a breast pump on Gumtree. The buyer asked for her bank card number and a one-time PIN and used the code to whisk out $9,100, which was sent overseas. The bank wouldn’t help because she had provided the one-time PIN. Here’s another. A woman the Competition and Consumer Commission is calling <a href="https://www.accc.gov.au/system/files/Targeting%20scams%202022.pdf">Niamh</a> was contacted by someone using the National Australia Bank’s SMS ID. Niamh was told her account was compromised and talked through how to transfer $300,000 to a “secure” account. After she had done it, the scammer told her it was a scam, laughed and said “we are in Brisbane, come find me”. <h2>How bank rules protect scammers</h2> And one more example. Former University of Melbourne academic <a href="https://www.researchgate.net/publication/377766055_Scams_Blaming_the_Victims">Kim Sawyer</a> (that’s his real name, he is prepared to go public) clicked on an ad for “St George Capital” displaying the dragon logo of St. George Bank. He was called back by a man using the name of a real St. George employee, who persuaded him to transfer funds from accounts at the AMP, Citibank and Macquarie to accounts he was told would be in his and his wife’s name at Westpac, ANZ, the Commonwealth and Bendigo Banks. They lost <a href="https://www.afr.com/wealth/personal-finance/i-lost-2-5m-of-my-super-to-scammers-20240423-p5flzp">$2.5 million</a>. Sawyer says none of the banks – those that sent the funds or those that received them – would help him. Some cited “<a href="https://www.choice.com.au/money/financial-planning-and-investing/stock-market-investing/articles/st-george-capital-investment-scam">privacy</a>” reasons. The Consumer Action Law Centre says the banks that transfer the scammed funds routinely tell their customers “it’s nothing to do with us, you transferred the money, we can’t help you”. The banks receiving the funds routinely say “you’re not our customer, we can’t help you”. That’s here. Not in the UK. <h2>UK bank customers get a better deal</h2> In Australia in 2022, only <a href="https://download.asic.gov.au/media/mbhoz0pc/rep761-published-20-april-2023.pdf">13%</a> of attempted scam payments were stopped by banks before they took place. Once scammed, only 2% to 5% of losses (depending on the bank) were reimbursed or compensated. In <a href="https://www.psr.org.uk/information-for-consumers/app-fraud-performance-data/">the UK</a>, the top four banks pay out 49% to 73%. And they are about to pay out much more. From October 2024, reimbursement will be compulsory. Where authorised fast payments are made “because of deception by fraudsters”, the banks will have to reimburse <a href="https://www.thomsonreuters.com/en-us/posts/investigation-fraud-and-risk/app-fraud-uk">the lot</a>. Normally the bills will be split <a href="https://www.psr.org.uk/news-and-updates/latest-news/news/psr-confirms-new-requirements-for-app-fraud-reimbursement/">50:50</a> between the bank transferring the funds and the bank receiving them. Unless there’s a need for further investigations, the payments must be made within five days. The <a href="https://www.psr.org.uk/media/as3a0xan/sr1-consumer-standard-of-caution-guidance-dec-2023.pdf">only exceptions</a> are where the consumer seeking reimbursement has acted fraudulently or with gross negligence. The idea behind the change – pushed through by the Conservative government now led by UK Prime Minister Rishi Sunak – is that if scams are the banks’ problem, if they are costing them millions at a time, they’ll stop them. <a href="https://www.thepost.co.nz/business/350197309/banks-given-fraud-ultimatum">New Zealand</a> is looking at doing the same thing, <a href="https://www.biocatch.com/blog/mas-shared-responsibility-fraud-losses">as is Singapore</a>. But here, the treasury’s discussion paper on its mandatory codes mentions reimbursement <a href="https://treasury.gov.au/sites/default/files/2023-11/c2023-464732-cp.pdf">only once</a>. That’s when it talks about what’s happening in the UK. Neither treasury nor the relevant federal minister is proposing it here. <h2>Australia’s approach is softer</h2> Assistant Treasurer Stephen Jones is in charge of Australia’s rules. Asked why he wasn’t pushing for compulsory reimbursement here, Jones said on Monday <a href="https://ministers.treasury.gov.au/ministers/stephen-jones-2022/transcripts/interview-mark-gibson-abc-perth">prevention was better</a>. <blockquote> I think a simplistic approach of just saying, ‘Oh, well, if any loss, if anyone incurs a loss, then the bank always pay’, won’t work. It’ll just make Australia a honeypot for these international crime gangs, because they’ll say, well, ‘Let’s, you know, focus all of our activity on Australia because it’s a victimless crime if banks always pay’. </blockquote> Telling banks to pay would certainly focus the minds of the banks, in the way they are about to be focused in the UK. The <a href="https://www.ausbanking.org.au/submissions/">Australian Banking Association</a> hasn’t published its submission to the treasury review, but the <a href="https://consumeraction.org.au/scams-mandatory-industry-codes-consultation-paper/">Consumer Action Law Centre</a> has. It says if banks had to reimburse money lost, they’d have more of a reason to keep it safe. In the UK, they are about to find out. If Jones is right, it might be about to become a honeypot for scammers. If he is wrong, his government will leave Australia even further behind when it comes to scams – leaving us thousands more dollars behind per day.<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/228867/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/australians-lose-5-200-a-minute-to-scammers-theres-a-simple-thing-the-government-could-do-to-reduce-this-why-wont-they-228867">original article</a>. </div>

Money & Banking

What is childhood dementia? And how could new research help?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/kim-hemsley-1529322">Kim Hemsley</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/nicholas-smith-1529324">Nicholas Smith</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>, and <a href="https://theconversation.com/profiles/siti-mubarokah-1529323">Siti Mubarokah</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> “Childhood” and “dementia” are two words we wish we didn’t have to use together. But sadly, around <a href="https://doi.org/10.1093/brain/awad242">1,400 Australian children and young people</a> live with currently untreatable childhood dementia. Broadly speaking, childhood dementia is caused by any one of <a href="https://www.childhooddementia.org/what-is-childhood-dementia#what">more than 100</a> rare genetic disorders. Although the causes differ from dementia acquired later in life, the progressive nature of the illness is the same. <a href="https://doi.org/10.1093/brain/awad242">Half</a> of infants and children diagnosed with childhood dementia will not reach their tenth birthday, and most will die <a href="https://www.childhooddementia.org/what-is-childhood-dementia#what">before turning 18</a>. Yet this devastating condition has lacked awareness, and importantly, the research attention needed to work towards treatments and a cure. <h2>More about the causes</h2> Most types of childhood dementia are <a href="https://academic.oup.com/brain/article/146/11/4446/7226999">caused</a> by <a href="https://www.genome.gov/genetics-glossary/Mutation">mutations</a> (or mistakes) in our <a href="https://www.genome.gov/genetics-glossary/Deoxyribonucleic-Acid">DNA</a>. These mistakes lead to a range of rare genetic disorders, which in turn cause childhood dementia. <a href="https://doi.org/10.1093/brain/awad242">Two-thirds</a> of childhood dementia disorders are caused by “<a href="https://www.ncbi.nlm.nih.gov/books/NBK459183/">inborn errors of metabolism</a>”. This means the metabolic pathways involved in the breakdown of carbohydrates, lipids, fatty acids and proteins in the body fail. As a result, nerve pathways fail to function, neurons (nerve cells that send messages around the body) die, and progressive cognitive decline occurs. <h2>What happens to children with childhood dementia?</h2> Most children initially appear unaffected. But after a period of apparently normal development, children with childhood dementia <a href="https://doi.org/10.1016/j.pediatrneurol.2023.09.006">progressively lose</a> all previously acquired skills and abilities, such as talking, walking, learning, remembering and reasoning. Childhood dementia also leads to significant changes in behaviour, such as aggression and hyperactivity. Severe sleep disturbance is common and vision and hearing can also be affected. Many children have seizures. The age when symptoms start can vary, depending partly on the particular genetic disorder causing the dementia, but the average is around <a href="https://doi.org/10.1093%2Fbrain%2Fawad242">two years old</a>. The symptoms are caused by significant, progressive brain damage. <h2>Are there any treatments available?</h2> Childhood dementia treatments currently <a href="https://www.childhooddementia.org/news/report-reveals-global-research-inequity">under evaluation</a> or approved are for a very limited number of disorders, and are only available in some parts of the world. These include gene replacement, <a href="https://doi.org/10.1002/jmd2.12378">gene-modified cell therapy</a> and protein or <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1712649">enzyme replacement therapy</a>. Enzyme replacement therapy is available in Australia for <a href="https://australianprescriber.tg.org.au/articles/cerliponase-alfa-for-neuronal-ceroid-lipofuscinosis-type-2-disease.html">one form of childhood dementia</a>. These therapies attempt to “fix” the problems causing the disease, and have shown promising results. Other experimental therapies include ones that <a href="https://doi.org/10.3390/life12050608">target</a> faulty protein production or <a href="https://doi.org/10.1056/nejmoa2310151">reduce inflammation</a> in the brain. <h2>Research attention is lacking</h2> Death rates for Australian children with cancer <a href="http://www.childhooddementia.org/getasset/2WX39O">nearly halved</a> between <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/cancer-incidence-survival">1997 and 2017</a> thanks to research that has enabled the development of multiple treatments. But over recent decades, <a href="http://www.childhooddementia.org/getasset/2WX39O">nothing has changed</a> for children with dementia. In 2017–2023, research for childhood cancer received over four times more funding per patient compared to funding for <a href="https://www.childhooddementia.org/getasset/2WX39O">childhood dementia</a>. This is despite childhood dementia causing a <a href="https://doi.org/10.1093/brain/awad242">similar number of deaths</a> each year as childhood cancer. The success <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/cancer-incidence-survival">for childhood cancer sufferers</a> in recent decades demonstrates how adequately funding medical research can lead to improvements in patient outcomes. Another bottleneck for childhood dementia patients in Australia is the lack of access to clinical trials. An <a href="https://www.childhooddementia.org/news/report-reveals-global-research-inequity">analysis</a> published in March this year showed that in December 2023, only two clinical trials were recruiting patients with childhood dementia in Australia. Worldwide however, 54 trials were recruiting, meaning Australian patients and their families are left watching patients in other parts of the world receive potentially lifesaving treatments, with no recourse themselves. That said, we’ve seen a slowing in the establishment of <a href="https://www.childhooddementia.org/news/report-reveals-global-research-inequity">clinical trials</a> for childhood dementia across the world in recent years. In addition, we know from <a href="https://www.childhooddementia.org/join-us/professionals/impacts">consultation with families</a> that current care and support systems <a href="https://www.childhooddementia.org/getasset/44MLP8">are not meeting the needs</a> of children with dementia and their families. <h2>New research</h2> Recently, we were awarded <a href="https://www.premier.sa.gov.au/media-releases/news-items/major-funding-boost-for-research-into-childhood-dementia">new funding</a> for <a href="https://www.flinders.edu.au/giving/our-donors/impact-of-giving/improving-the-lives-of-children-with-dementia">our research</a> on childhood dementia. This will help us continue and expand studies that seek to develop lifesaving treatments. More broadly, we need to see increased funding in Australia and around the world for research to develop and translate treatments for the broad spectrum of childhood dementia conditions. Dr Kristina Elvidge, head of research at the <a href="https://www.childhooddementia.org/our-people">Childhood Dementia Initiative</a>, and Megan Maack, director and CEO, 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/228508/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kim-hemsley-1529322">Kim Hemsley</a>, Head, Childhood Dementia Research Group, Flinders Health and Medical Research Institute, College of Medicine and Public Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/nicholas-smith-1529324">Nicholas Smith</a>, Head, Paediatric Neurodegenerative Diseases Research Group, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>, and <a href="https://theconversation.com/profiles/siti-mubarokah-1529323">Siti Mubarokah</a>, Research Associate, Childhood Dementia Research Group, Flinders Health and Medical Research Institute, College of Medicine and Public Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders 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-childhood-dementia-and-how-could-new-research-help-228508">original article</a>. </div>

Mind

What just happened to Bonza? Why new budget airlines always struggle in Australia

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/ian-douglas-2932">Ian Douglas</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> and <a href="https://theconversation.com/profiles/seena-sarram-1469656">Seena Sarram</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> The history of budget jet airlines in Australia is a long road <a href="https://www.smh.com.au/traveller/travel-news/grounded-five-of-australias-biggest-airline-failures-20221216-h28pzn.html">littered with broken dreams</a>. New entrants have consistently struggled to get a foothold. Low-cost carrier Bonza has just become the industry’s <a href="https://www.afr.com/companies/transport/bonza-flights-cancelled-as-aircraft-repossessed-20240430-p5fnjf">latest casualty</a>, entering voluntary administration on Tuesday after abruptly cancelling all flights. Losing the airline would be heartbreaking for the 24 regional Australian locations that were <a href="https://www.accc.gov.au/system/files/domestic-airline-competition-report-february2024_0.pdf">not connected directly</a> by any other airline. It would also mean even less competition in a heavily concentrated domestic air travel market. Over 85% of routes are operated by just <a href="https://www.accc.gov.au/system/files/domestic-airline-competition-report-february2024_0.pdf">three airline groups</a>. But Bonza hasn’t just fallen into this situation by chance. Strategic missteps likely played a key role from the very beginning. <h2>What went wrong</h2> First, running an airline is an expensive business – any cost savings airlines can find are extremely valuable. Bonza chose to enter the Australian market with a very small fleet of <a href="https://skybrary.aero/aircraft-family/b737-series">Boeing B737</a> jet aircraft. But these had no operating cost advantage over the B737s already flown by Qantas, Virgin and Rex. Bonza’s small fleet also lacked any scale advantage in scheduling aircraft or crew. Second, to sell tickets, Bonza adopted a radically different “<a href="https://flybonza.com/media/bonza-gets-wheels-up#:%7E:text=Bonza%20is%20the%20first%20airline,uniform%20including%20custom%20Bonza%20sneakers.">app first</a>” approach. The only place customers could search for and book tickets directly was the official Bonza app. But this meant potential customers using conventional search tools – such as search engines or booking websites – often couldn’t find Bonza flights. The fact Bonza <a href="https://www.couriermail.com.au/business/qld-business/gold-coast-airport-sweetheart-deals-raise-concern-for-bonza/news-story/5ecdfe749b7c8a636cfe740ee0359ba3">struggled</a> to gain traction on its routes to Gold Coast airport, which handles a sizeable 250,000 domestic passengers each month, underscores this issue with the company’s approach. And third, although it served a unique range of locations, Bonza’s flight schedule across its network was far from optimal. In some cases, routes were flown only once weekly, compared to much more frequent gateway city services on Rex and QantasLink. For European airlines like easyJet or Ryanair, less-than-daily flights to smaller tourist destinations might be viable. But these airlines have the scale and connectivity to offer customers alternative pathways across their networks. Unlike Bonza, small regional routes are not at the core of their business model. <h2>Making an airline succeed</h2> Bonza isn’t the first Australian budget carrier to fail, and likely won’t be the last. Why are so many new entrants doomed to fail? Making a jet airline succeed hinges on optimising three key factors – market scale, airport access, and geography. For would-be budget airlines, Australia offers a brutal starting ground on all three. Market scale <a href="https://www.icao.int/sustainability/Pages/Low-Cost-Carriers.aspx">Low-cost carrier</a> and ultra low-cost carrier airlines have successfully gained strong footholds in Europe, the US, and Southeast Asia. But these markets are orders of magnitude larger than Australia. The US, for example, offers airlines a market of <a href="https://www.statista.com/statistics/183600/population-of-metropolitan-areas-in-the-us/">large cities across a large area</a>. New York’s population is approaching 20 million, Chicago 9.6 million, Houston 7.1 million, and Miami 6.1 million. The population of the European Union is close to 450 million. And if you include the UK, there are over 30 cities in Europe with populations over 1 million. Australian carriers have only a handful of cities on that scale. Australia lacks both the population density of Europe, and the range of secondary airports that European low-cost carriers have leveraged to access nearby markets and to drive down operating costs. After more than a year of operation, Bonza had only achieved an overall market share of <a href="https://www.accc.gov.au/system/files/domestic-airline-competition-report-february2024_0.pdf">about 2%</a>. Airport access Airport access is the next key barrier facing low-cost and ultra low-cost market entrants. The main routes between large Australian cities are all in a corridor along the east coast, and the largest flow into Sydney. Use of Sydney airport is heavily constrained, both by the incumbent operators who <a href="https://australianaviation.com.au/2023/07/sydney-slot-system-a-threat-to-bonza-owner-hints/">hold most of the slots</a>, and by regulations that artificially limit the flow of aircraft at peak times to just 80 movements (take-offs or landings) per hour. In contrast, London Heathrow, another constrained two-runway airport, delivers a capacity of <a href="https://www.caa.co.uk/media/dwfgyk53/estimating-the-congestion-premium-at-heathrow.pdf">88 movements per hour</a>. Completion of the new Western Sydney Airport will provide some relief from this capacity constraint. But it will not alter the fact Sydney Airport operates under an imposed constraint on operations. Geography Geography is the third constraint in Australia. Unlike Europe, the US, or Southeast Asia, most of our major cities are in a line on the east coast. There is no hub to connect our major cities with smaller regional points. Towns that are too distant for convenient rail or road links often have populations that are too small to support viable – let alone frequent – flights to the larger centres. Some regional routes are successfully serviced by small “<a href="https://nbaa.org/business-aviation/business-aircraft/turboprop-aircraft/">turboprop</a>” aircraft. Operating these incurs a higher cost per passenger than the passenger jets connecting the major cities. But it makes no sense to fly larger aircraft on these routes if the planes are half empty. <h2>A big loss for regional Australia</h2> The combination of Australia’s small population, the capacity constraints imposed on Sydney Airport, the presence of strong incumbent airlines, and our linear east coast market make new entry difficult. Virgin Blue occupied the space created by the collapse of Ansett. But Impulse, Tiger, Air Australia, Ozjet, and two versions of Compass were unsuccessful market entrants. Even Air New Zealand – which has the fleet, brand strength, and market access to support entering the market – chooses not to operate domestically in Australia. Understanding why new entrants fail offers little consolation to underserved regional towns in Australia. But given Bonza’s small footprint, capital city travellers looking for more competition on the major east coast routes will hardly notice a change.<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/228995/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ian-douglas-2932">Ian Douglas</a>, Honorary Senior Lecturer, UNSW Aviation., <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> and <a href="https://theconversation.com/profiles/seena-sarram-1469656">Seena Sarram</a>, Lawyer and Casual Academic, UNSW School of Aviation, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Bonza - PR Image 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-just-happened-to-bonza-why-new-budget-airlines-always-struggle-in-australia-228995">original article</a>. </div>

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