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Hospice nurse shares what happens to the body after death

A hospice nurse has revealed the reality of what happens to our bodies in the minutes, hours and days after we die. In her efforts to break down the taboo around conversations about death, Julie McFadden, a hospice nurse from the US, posts candid videos about death and dying to help us be more informed and prepared. In Julie’s latest video, she explains exactly what happens to the human body in the moments, hours and days after someone dies. Nurse Julie said that in the immediate moments after death, the body completely relaxes, beginning the first stage of decomposition, called hypostasis. “All of the things in your body that are holding fluids in, relaxes. That's why death can be messy sometimes.” She clarified that because of how relaxed the body becomes, those who have just died may urinate, have bowel movements or experience bodily fluids coming out of their nose, mouth, ears or eyes. Nurse Julie added, “I like to talk about it so people aren't surprised if that happens - very normal and to be expected sometimes.” This is also when the stage of decomposition called autolysis, or “the self-digestion” stage, occurs and enzymes begin to break down oxygen-deprived tissue, also causing the body temperature to drop. As the body settles in the hours after death, Nurse Julie said the blood will begin to pool downward toward the ground. She said, “If you let someone lie there for long enough - which we do sometimes; you don't have to hurry up and make sure your loved one leaves the house - if you turn them you will notice usually the back of their legs the whole backside of them will look purple or darker that's because all their blood is pulling down.” “Gravity is pulling it down. So they will eventually get a darker colour tone of skin on their backside.” One to two hours after death is also when rigor mortis - or the stiffening of a body’s muscles - sets in and continues for about the next 24 hours Nurse Julie said, “I have seen people become very stiff almost immediately - like a few minutes - after death and other people, their body takes longer.” Additionally, about 12 hours after death, the body will feel cool to the touch. About a day to a day and a half after a person dies, rigor mortis subsides and the body will begin to loosen again, as Nurse Julie said the body's tissues relax and cause the stiffness to break down. By this time, the body is usually in the mortuary, which will prepare the body in whichever way the family has requested, whether it is for burial or cremation. She added, “In a world where people didn't have access to a mortuary or a healthcare system and they just died naturally, our bodies are built to, after death, decompose.” Image credits: Shutterstock / Instagram / YouTube

Body

Romance fraud doesn’t only happen online – it can turn into real-world deception

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/cassandra-cross-122865">Cassandra Cross</a>, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</a> We often think of fraudsters as people on the opposite side of the world. They will manipulate and exploit victims through words on a computer screen, or loving messages through the phone. But romance fraud can also happen in person, with the fraudster sleeping in the bed beside you. This was the circumstance Australian writer Stephanie Wood found herself in. It’s also the basis for the new <a href="https://www.paramountanz.com.au/news/fake-breaks-subscription-and-streaming-records-on-paramount/">television series Fake</a>, currently screening on Paramount+. A dramatisation of Wood’s powerful memoir by the same name, the series outlines the many lies and betrayals of an intimate relationship. It’s a brutal insight into the world of deception which characterises romance fraud. <h2>When love hurts</h2> Romance fraud (or romance scams) is what it sounds like – offenders use the guise of a relationship to gain a financial reward. In most cases, it’s through the direct transfer of money from the victim, but it can also be through using personal credentials to commit identity crimes. From the outside, it’s hard to understand how romance fraud is so effective. However, <a href="https://eprints.qut.edu.au/233966/">research has documented</a> the range of grooming techniques, social engineering tactics and methods of psychological abuse deployed by offenders. Offenders know exactly what to do and say to gain the compliance of their victim. <hr /> <hr /> Offenders target a person’s vulnerability and work hard to build strong levels of trust. There are endless calls, texts and emails that create a bond. Then follows the inevitable “crisis”, whereby the offender needs money urgently for a health emergency, criminal justice situation, business need or even a <a href="https://www.accc.gov.au/media-release/romance-baiting-scams-on-the-rise">cryptocurrency investment</a> opportunity. For many, this can result in ongoing payments and substantial losses. Over <a href="https://www.accc.gov.au/about-us/publications/serial-publications/targeting-scams-reports-on-scams-activity/targeting-scams-report-of-the-accc-on-scams-activity-2023">A$200 million</a> was reported lost by Australians to this fraud type in 2023, but this is likely a gross underestimation of actual figures. It also doesn’t capture the many <a href="https://www.aic.gov.au/sites/default/files/2020-05/29-1314-FinalReport.pdf">non-financial harms</a>, including physical and emotional declines in wellbeing. When the relationship finally ends, it’s too late. The money is gone, the extent of the deception is laid bare, and recovery from the heartache and loss is a constant battle. There is a well-documented “<a href="https://journals.sagepub.com/doi/full/10.1177/1748895815603773">double hit</a>” of victimisation, with individuals needing to grieve the relationship as well as any financial losses. <h2>Seeing is not believing</h2> There are countless incidents of romance fraud where the offender and victim never meet: the deception takes place entirely online. But it’s important to know fraudsters also operate in person. Wood’s memoir details an extraordinary level of lies and dishonesty presented to her throughout her relationship. Stories that laid the groundwork for later fabrications. Stories that were deliberate and calculated in how they were used to gain her trust, and later used against her. The motivations of these real-world deceivers are not always straightforward. Often it’s about money, but not always. For Wood, not being asked for money allayed potential suspicions, but it didn’t reduce her feelings of loss and emotional devastation upon discovering the extent of the lies. <figure><iframe src="https://www.youtube.com/embed/K_1Akqhjy6M?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Wood is by no means alone in her experience. Marketing executive Tracy Hall endured a similarly sophisticated and all-encompassing level of deceit in her relationship with <a href="https://www.theguardian.com/australia-news/2019/jun/20/conman-hamish-mclaren-jailed-for-up-to-16-years-after-swindling-76m-from-victims">convicted conman Hamish McLaren</a> (known to her as Max Tavita). In her book, <a href="https://tracyhall.com.au/the-last-victim">The Last Victim</a>, Hall recounts snippets of their daily lives over a 16-month period, with McLaren portraying himself as a successful professional in finance. His mail was addressed to Max Tavita and his phone conversations were with real people. Yet his whole identity and the world he represented to Hall was a complete fabrication. The experiences of Wood and Hall highlight the sheer depth of elaborate deception that can be perpetrated in an intimate relationship. Critically, it highlights romance fraud isn’t relegated to an online environment. <h2>How can we prevent romance fraud?</h2> There is an overwhelming amount of <a href="https://eprints.qut.edu.au/83702/">shame and stigma</a> associated with romance fraud. The dynamics of these deceptive relationships are misunderstood, and this perpetuates negative stereotypes and a discourse of victim blaming, even from friends and family. In hindsight, the warning signs might seem obvious, but fraudsters tend to effectively disguise these in real time and deploy deliberate tactics to overcome any suspicion. We must all create a culture that empowers victims to come forward to raise awareness. This isn’t intended to create fear or anxiety, but to normalise the threat fraud poses, and to allow for difficult conversations if it happens. Ongoing silence from victims only favours the offender. <h2>How to protect yourself from romance fraud</h2> It’s inevitable we’ll continue to swipe right in our efforts to find love. But keep a healthy level of scepticism and an open dialogue with family and friends in any quest for a new relationship. Don’t be afraid to conduct your own searches of people, places and situations presented to you in a relationship. There is a memorable moment in Fake where the protagonist refutes her friend’s offer of assistance, saying “this is a love story not an investigation”. Sadly, sometimes an investigation is necessary. No matter what the circumstance or the person, think carefully before sending any money. Only give what you are willing to lose. Deception comes in many forms. We must recognise it for what it is, and the impact it has on victims. But we must also not give into those who lie, and let them define who we are or dictate our ability to trust. If you or someone you know has been a victim of romance fraud, you can report it to <a href="https://www.cyber.gov.au/report-and-recover/report">ReportCyber</a>. For support, contact <a href="https://www.idcare.org/">iDcare</a>. For prevention advice, consult <a href="https://www.scamwatch.gov.au/">Scamwatch</a>.<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/237653/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/cassandra-cross-122865">Cassandra Cross</a>, Associate Dean (Learning & Teaching) Faculty of Creative Industries, Education and Social Justice, <a href="https://theconversation.com/institutions/queensland-university-of-technology-847">Queensland University of Technology</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/romance-fraud-doesnt-only-happen-online-it-can-turn-into-real-world-deception-237653">original article</a>. </div>

Legal

I’m due for a cervical cancer screening. What can I expect? Can I do it myself? And what happened to Pap smears?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/karen-canfell-22668">Karen Canfell</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/deborah-bateson-16105">Deborah Bateson</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/megan-smith-131901">Megan Smith</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Cervical screening in Australia has <a href="https://pubmed.ncbi.nlm.nih.gov/34499374/">changed</a> over the past seven years. The test has changed, and women (and people with a cervix) now have much more choice and control. Here’s why – and what you can expect if you’re aged 25 to 74 and are <a href="https://www.health.gov.au/our-work/national-cervical-screening-program">due for a test</a>. <h2>When and why did the test change?</h2> In 2017, Australia became one of the first two countries to transition from Pap smears to tests for the presence of the human papillomavirus (HPV). HPV causes virtually all cervical cancers, so testing for the presence of this virus is a very good indicator of a person’s current and future risk of the disease. This contrasts with the older Pap smear technology, which involved inspection of cells every two years for the changes resulting from HPV infection. The change to screening was supported by a very large body of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62218-7/abstract">international</a> and <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002388">Australian</a> data showing primary testing for HPV is more accurate than Pap smears. Women and people with a cervix who do not have HPV detected on their test are at a very low risk of developing cervical cancer over the next five years, or even longer. This was the basis for lengthening the screening interval when HPV screening was introduced. Australia now <a href="https://www.health.gov.au/our-work/national-cervical-screening-program">recommends</a> five-yearly HPV screening, starting at age 25 up to the age of 74 for eligible people, whether or not they have been vaccinated against HPV. Many other countries are following suit to transition to HPV screening. All established screening tests – which are conducted in people without any symptoms – are associated with health benefits but also with some harms. These can include the psychological and clinical consequences of receiving a “positive” screening result, which needs to be investigated further. However, recent World Health Organization (WHO) <a href="https://www.nejm.org/doi/full/10.1056/NEJMsr2030640">reviews of the evidence</a> have found: <ul> <li>HPV is a more effective screening test than Pap smears or any other method</li> <li>it substantially reduces incidence and death rates from cervical cancer</li> <li>it is the method of cervical screening that has the <a href="https://www.nature.com/articles/s41591-023-02600-4">best balance</a> of benefits to harms.</li> </ul> As a consequence, the WHO now unequivocally <a href="https://www.who.int/publications/i/item/9789240030824">recommends</a> HPV screening as the best-practice method. <h2>Now you can collect your own sample</h2> One of the major benefits of switching to HPV screening is it opened the door for a person being able to <a href="https://www.health.gov.au/self-collection-for-the-cervical-screening-test">collect their own sample</a> (which was impossible with the Pap smear). If HPV is present, it can be detected in the vagina rather than having to directly sample the cervix. In 2022, Australia became one of the <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/landmark-changes-improving-access-to-life-saving-cervical-screenings">first countries</a> in the world to introduce a universal option to choose self-collection within a major national-level screening program. This means people eligible for screening, under the guidance of a primary care practitioner, can now choose to collect their own vaginal sample, in privacy, using a simple swab. By the end of 2023, <a href="https://www.ncsr.gov.au/about-us/news-and-media/self-collection-for-cervical-screening--at-an-all-time-high.html">27% of people</a> were choosing to take the test this way, but this is on an upward trajectory and is likely to increase further, with an <a href="https://acpcc.org.au/self-collection-campaign/">awareness campaign</a> due to start next month. <h2>So what happens when I have a test?</h2> You’ll receive an invitation from the <a href="https://www.ncsr.gov.au/information-for-participants/participant-forms-and-guides.html#cervical-forms">National Cancer Screening Register</a> to attend your first screen when you turn 25. If you’re older, you’ll receive reminders when you are due for your next test. You will be invited to visit your GP or community health service for the test. You should be asked whether you would prefer to have a clinician collect the test or whether you would prefer to take the sample yourself. There’s no right or wrong way. The accuracy of testing has been <a href="https://www.bmj.com/content/363/bmj.k4823">shown</a> to be equivalent for clinician or self-collected sampling. This is a matter of choice. If the clinician does the test, they will undertake a pelvic examination with a speculum inserted into the vagina. This enables the doctor or nurse to view the cervix and take a sample. If you are interested in the self-collection option, check whether the practice is offering it when making an appointment. If you opt for self-collection, you’ll be able to do so in private. You’ll be given a swab (which looks like a COVID test swab with a longer stem), and you’ll be given instructions about how to insert and rotate the swab in the vagina to take the sample. It takes only a few minutes. <h2>What does it mean if my test detects HPV?</h2> If your test detects HPV, this means you have an HPV infection. These are very common and by itself doesn’t mean you have cancer, or even pre-cancer (which involves changes to cervical cells that make them more likely to develop into cancer over time). It does mean, however, that you are at higher risk of having a pre-cancer, or developing one in future, and that you will benefit from further follow-up or diagnostic testing. Your doctor or nurse will <a href="https://www.cancer.org.au/clinical-guidelines/cervical-cancer/cervical-cancer-screening">guide you</a> on the next steps in line with national guidelines. If you require a diagnostic examination, this will involve a procedure called colposcopy, where the cervix is closely examined by a gynaecologist or other specially trained healthcare practitioner, and a small sample may be taken for detailed examination of the cells. If you have a pre-cancer, you can be treated simply and quickly, usually without needing to be admitted to hospital. Treatment involves ablating or removing a small area of the cervix. This treatment will drastically reduce your risk of ever developing cervical cancer. <h2>What does this mean for cervical cancer rates?</h2> Cervical screening for HPV is a very effective method of preventing cervical cancer. Because of Australia’s HPV screening, combined with HPV vaccination in younger people, Australia is <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30183-X/fulltext">expected</a> to achieve such low rates of cervical cancer by 2035 that it will be considered eliminated. Last year, the government launched a <a href="https://www.health.gov.au/sites/default/files/2023-11/national-strategy-for-the-elimination-of-cervical-cancer-in-australia.pdf">national strategy for cervical cancer elimination</a> which provides key recommendations for eliminating cervical cancer, and for doing so equitably in all groups of women and people with a cervix. One of the best things you can do to protect yourself is to have your cervical screening test when you become eligible, whether or not you have been vaccinated against HPV. Marion Saville, a pathologist and Executive Director at the Australian Centre for the Prevention of Cervical Cancer, co-authored 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/229495/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/karen-canfell-22668">Karen Canfell</a>, Professor & Director, Daffodil Centre, A Joint Venture with Cancer Council NSW, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/deborah-bateson-16105">Deborah Bateson</a>, Professor of Practice, The Daffodil Centre, a joint venture with Cancer Council NSW, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/megan-smith-131901">Megan Smith</a>, Principal Research Fellow, The Daffodil Centre, a joint venture with Cancer Council NSW, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of 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/im-due-for-a-cervical-cancer-screening-what-can-i-expect-can-i-do-it-myself-and-what-happened-to-pap-smears-229495">original article</a>. </div>

Body

Antarctic heat, wild Australian winter: what’s happening to the weather and what it means for the rest of the year

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/martin-jucker-379172">Martin Jucker</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Australia’s south and east have seen <a href="https://theconversation.com/southern-australia-is-freezing-how-can-it-be-so-cold-in-a-warming-climate-233977">freezing temperatures</a> and <a href="https://www.theguardian.com/australia-news/article/2024/jul/29/australia-winter-weather-forecast-east-coast-colder-records">wild weather</a> this winter. At the same time, the continent as a whole – and the globe – have <a href="https://www.abc.net.au/news/2024-08-03/australia-suffers-cold-winter-weather-despite-mild-forecast/104176284">continued to warm</a>. What’s going on? As ever, it’s hard to pinpoint a single cause for weather events. But a key player is likely an event unfolding high above Antarctica, which itself may have been triggered by a heatwave at surface level on the frozen continent. Here’s what’s happening – and what it might mean for the rest of this year’s weather. <h2>When the stratosphere heats up</h2> Out story begins in the cold air over Antarctica. July temperatures in the stratosphere, the layer of air stretching between altitudes of around 10 and 50 kilometres, are typically around –80°C. The winds are also very strong, averaging about 300 kilometres per hour in winter. These cold, fast winds loop around above the pole in what is called the <a href="https://sites.krieger.jhu.edu/waugh/research/polarvortex">stratospheric polar vortex</a>. Occasionally, persistent high air pressure in the lower atmosphere can influence large-scale waves that extend around the globe and up into the stratosphere. There they cause the strong winds to slow down, and the air high above the pole to become much warmer than normal. In extreme situations the stratospheric winds can completely break down, in what is called a “sudden stratospheric warming” event. These events occur every few years in the northern hemisphere, but only one has ever been observed in the south, in 2002 (though another <a href="https://theconversation.com/the-air-above-antarctica-is-suddenly-getting-warmer-heres-what-it-means-for-australia-123080">almost happened in 2019</a>). <h2>Pushing polar weather our way</h2> Once the polar vortex is disturbed, it can in turn influence the weather at the surface by steering weather systems from the Southern Ocean towards the Equator. However, this is a slow process. The impact at the surface may not be felt until <a href="https://doi.org/10.1175/JCLI-D-22-0425.1">a few weeks or even months</a> after the initial weakening of the stratospheric polar vortex. Once it begins, the stratospheric influence can prevail for more weeks or months, and helps meteorologists make <a href="https://doi.org/10.5194/acp-22-2601-2022">long-range weather forecasts</a>. In climate science terms, the weak stratospheric winds put an atmospheric system called the <a href="http://www.bom.gov.au/climate/sam/">Southern Annular Mode</a> into a negative phase. The main effect of this on surface weather is to bring westerly winds further north. In winter, this means polar air outbreaks can reach places like Sydney more easily. As a result, we see more <a href="https://doi.org/10.1175/JCLI4134.1">rain over much of southern Australia</a>, and snowfall in alpine regions. In spring and summer it means westerly winds blow over the continent before reaching the east coast, bringing warm and dry air to southeastern Australia. The exact impact of a weaker polar vortex depends on how much and for how long the weather systems are being pushed further northward. It will also depend on other weather influencers such as El Niño and the Indian Ocean Dipole. <h1>This winter’s weirdness</h1> Unpicking exactly why any weather event occurs is tricky at the moment, because global weather has been absolutely crazy over the past 12 months or so. Global temperatures are <a href="https://theconversation.com/we-just-blew-past-1-5-degrees-game-over-on-climate-not-yet-213364">much higher than usual</a>, which is making unusual weather very common. But there are indications that the stratosphere is having some influence on our weather this winter. The stratospheric polar vortex started to warm in mid-July, and is about 20°C warmer than the long-term average. At the time of writing, the winds slowed down to about 230 kilometres per hour, 70 kilometres per hour slower than average. These numbers mean that, technically, the event does not qualify as a sudden stratospheric warming. However, further warming may still occur. If we look at how southern hemisphere winds have evolved in the past few weeks, we see a pattern which looks like what we would expect from a sudden stratospheric warming. First, we see warming in the stratosphere which is <a href="https://doi.org/10.1029/2021GL095270">at first accompanied by a poleward shift of weather systems</a>. The stratosphere’s influence then propagates downward and seems to <a href="https://doi.org/10.1175/JCLI-D-22-0425.1">induce many weeks</a> of weather systems shifted towards the equator. This coincides with the period of cold and rainy weather along Australia’s east coast in late July and the beginning of August. Forecasts suggest the Southern Annular Mode will be a long way from normal conditions in the first half of August – four standard deviations below average, which is extremely rare. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/611211/original/file-20240804-19-sp862a.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/611211/original/file-20240804-19-sp862a.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/611211/original/file-20240804-19-sp862a.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/611211/original/file-20240804-19-sp862a.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/611211/original/file-20240804-19-sp862a.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/611211/original/file-20240804-19-sp862a.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/611211/original/file-20240804-19-sp862a.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/611211/original/file-20240804-19-sp862a.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" alt="Diagram showing atmospheric warming and winds" /></a><figcaption>How initial warming high in the stratosphere ends up changing winds near the surface and pushing polar weather further north. <a class="source" href="https://stratobserve.com">Z.D. Lawrence / StratObserve / Annotated by Martin Jucker</a></figcaption></figure> <h1>A surface disturbance</h1> The main reason for the polar vortex to slow down is disturbances from the surface. Weather over the Amundsen Sea near Antarctica in the South Pacific is <a href="https://doi.org/10.1175/JCLI-D-22-0425.1">an important source</a> of these disturbances. This year, we have seen disturbances of this sort. There have been <a href="https://www.theguardian.com/world/article/2024/aug/01/antarctic-temperatures-rise-10c-above-average-in-near-record-heatwave">near-record surface temperatures around Antarctica</a>. These disturbances may be due to the globally high ocean temperatures, or even lingering effects of the <a href="https://doi.org/10.1175/JCLI-D-23-0437.1">eruption of the Hunga Tonga volcano in 2022</a>. But more research will be required to confirm the causes. <h1>What should we expect for the rest of the year?</h1> There are two pathways until the end of the year. One is that the stratospheric winds and temperatures recover to their usual values and no longer influence surface weather. This is what the forecasts from <a href="https://ozonewatch.gsfc.nasa.gov">Ozone Watch</a> seem to suggest. Another is that the stratosphere keeps warming and the winds keep being slower all the way into summer. In this scenario, we would expect a persistent negative Southern Annular Mode, which would mean a spring and potentially even summer with warmer and drier than usual weather over southeastern Australia, and a small ozone hole. The seasonal forecasting models from the European Centre for Medium Range Weather Forecasts <a href="https://x.com/drahbutler/status/1819142206348759170?s=46&t=sayfGwpo3_s310BwYpcdcQ">seem to favour this second scenario</a>. <a href="https://theconversation.com/profiles/martin-jucker-379172">Martin Jucker</a>, Senior Lecturer in Atmospheric Science, <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/antarctic-heat-wild-australian-winter-whats-happening-to-the-weather-and-what-it-means-for-the-rest-of-the-year-236067">original article</a>. </div>

Travel Trouble

What happens in an autopsy? A forensics expert explains

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/hayley-green-1542041">Hayley Green</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Sometimes it’s unclear how or why a person died. A detailed examination of the body after death, known as an autopsy or postmortem, can help find answers. Despite what you may have seen on TV crime shows, most autopsies are minimally invasive; body often stays intact throughout a mostly observational procedure. Sometimes, though, a more extended investigation is needed. Through each step of the autopsy process, the dignity and respect of the deceased is prioritised by all involved. <h2>Not every death will result in an autopsy</h2> If someone dies from natural causes, there is no evidence of suspicious circumstances or there is a recent medical history, the death is certified by a doctor. The person is then taken into the care of a funeral service. But when questions about the death remain, specialist doctors, <a href="https://pathology.health.nsw.gov.au/articles/pride-of-workmanship-award-for-nepean-mortuary-technician/">technicians</a> and support staff might investigate further. Sometimes this involves an autopsy. <h2>Non-coronial and coronial autopsies</h2> Depending on the circumstances of death, there are two types of autopsies in Australia: non-coronial and coronial. A non-coronial autopsy is done when the cause of death is known but more information is needed. For example, the family may wish to know: <ul> <li> the extent of a known medical condition that led to the death </li> <li> how effective any treatments leading up to the time of death were, or </li> <li> if there’s evidence of a potential undiagnosed medical condition that may have contributed to the death. </li> </ul> Non-coronial autopsies are done in a hospital mortuary or a forensic pathology facility by an anatomical pathologist or forensic pathologist. An anatomical pathologist is a specialist in the detection and diagnosis of disease in organs and tissues (mainly in the living). A forensic pathologist takes part in medico-legal investigations and examines the body and its organs to look for disease or injury that may have caused death. A coronial autopsy happens when death is unexpected, violent, unnatural or the result of an accident. Deaths like these are classified as “reportable” deaths; by law they must be reported to the coroner, who is a magistrate of the court with legal training. These reports (typically prepared by the police), as well as the <a href="https://legislation.nsw.gov.au/view/pdf/asmade/act-2009-41">legislation</a> relevant to the state, assist the coroner to decide whether or not to order an autopsy. This order can be a minimally invasive external examination, an internal examination of a single body cavity or an invasive multiple cavity autopsy. Coronial autopsies are done in a <a href="https://www.abc.net.au/news/2019-05-27/australias-biggest-and-newest-morgue-in-sydneys-west/11142810">forensic pathology facility</a> by a <a href="https://pathology.health.nsw.gov.au/articles/a-video-profile-of-the-role-of-forensic-pathologist-at-nsw-health-pathology">forensic pathologist</a>. <h2>The first steps</h2> Someone who has died under “reportable” circumstances will be admitted to the forensic facility. The person’s identity will be established, where possible. If the coroner orders an autopsy, the body first undergoes a CT scan, which may be enough for the forensic pathologist to determine cause of death without further investigation. If not, the body will then be laid carefully on an examination table where any clothing and personal belongings are removed. The pathologist will then do an external examination, searching the body surface and recording any visible signs of cause of death or identifying marks. These might include tattoos or scars that can establish or confirm the identity of the deceased. Photographs of the body can be taken, and body fluids such as urine, blood and vitreous fluid from the eyes are sampled and tested for drugs, poisons or other substances. In many cases, the cause of death can be determined from the external examination alone and no further examination is necessary. Other times, more invasive methods are needed. <h2>Organ removal</h2> Evisceration is the important process of removing organs for the pathologist to examine in detail to help determine cause of death. The most common evisceration technique used in Australia is known as the <a href="https://www.pathologyoutlines.com/topic/forensicsautopsytechniques.html">Letulle method</a> (sometimes called the en masse method), where organs are removed in a single large block that starts at the tongue and throat and extends to the rectum. The first step of this process involves using a scalpel to make a large incision in the skin known commonly as the y-incision. This incision extends from behind each ear, or at times, the collar bones, to the mid line of the chest (just above the sternum). The incision will be extended through the centre of the chest towards the abdomen, stopping at the front of the pelvic bone. Skin, fat and muscle layers are pulled back to expose the neck structures, abdominal organs and the rib cage. The rib cage will then be cut on each side using shears to allow the front of the chest plate to be removed, revealing the heart and lungs. After an inspection of the positioning of the organs in the chest and abdomen, the bowel can be removed. Connections between organs and the body wall are separated and the organ block is then lifted from the body. Once out, the pathologist can do a detailed examination, weighing each organ individually. They will then dissect it to determine if there are any visible signs of disease or trauma that could have contributed to the cause of death. Tissue samples will be taken from each organ for histology (studying it under a microscope) to look for evidence of a cause of death. <h2>The brain</h2> A coroner may also request an examination of the brain. This involves an incision across the scalp within the hairline where possible, so the skin can be peeled back to expose the skull. The top of the skull will be removed using an oscillating saw to access the brain, which will then be removed (after separating it from the brainstem). The pathologist will look for signs of blood clots, trauma or disease. In some <a href="https://www.abc.net.au/news/2023-08-10/domestic-violence-repetitive-head-injury-cte-routine-screening/102682870">cases</a>, the coroner may make an order to keep the brain for a longer period of time for a more detailed and thorough examination. After the autopsy is over, the organs are returned to the abdominal cavity and all incisions are stitched closed. The body can then be released to the family and funeral arrangements made. An interim report on the cause of death is prepared for the coroner and made available to the family. This will be updated with a final determination on the cause of death after test results come back. Sometimes the cause of death will be listed as “unascertained”, meaning the cause of death could not be determined.<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/232603/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hayley-green-1542041">Hayley Green</a>, Senior Lecturer - Forensic Anthropology, <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/what-happens-in-an-autopsy-a-forensics-expert-explains-232603">original article</a>. </div>

Body

What happens in my brain when I get a migraine? And what medications can I use to treat it?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/mark-slee-1343982">Mark Slee</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/anthony-khoo-1525617">Anthony Khoo</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Migraine is many things, but one thing it’s not is “just a headache”. “Migraine” <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1029040/">comes from</a> the Greek word “hemicrania”, referring to the common experience of migraine being predominantly one-sided. Some people experience an “aura” preceding the headache phase – usually a visual or sensory experience that evolves over five to 60 minutes. Auras can also involve other domains such as language, smell and limb function. Migraine is a disease with a <a href="https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30322-3/fulltext">huge personal and societal impact</a>. Most people cannot function at their usual level during a migraine, and anticipation of the next attack can affect productivity, relationships and a person’s mental health. <h2>What’s happening in my brain?</h2> The biological basis of migraine is complex, and varies according to the phase of the migraine. Put simply: The earliest phase is called the prodrome. This is associated with activation of a part of the brain called the hypothalamus which is thought to contribute to many symptoms such as nausea, changes in appetite and blurred vision. <figure class="align-center "><img src="https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=485&fit=crop&dpr=1 600w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=485&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=485&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=610&fit=crop&dpr=1 754w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=610&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=610&fit=crop&dpr=3 2262w" alt="" /><figcaption>The hypothalamus is shown here in red. <a class="source" href="https://www.shutterstock.com/image-vector/brain-cross-section-showing-basal-ganglia-329843930">Blamb/Shutterstock</a></figcaption></figure> Next is the aura phase, when a wave of neurochemical changes occur across the surface of the brain (the cortex) at a rate of 3–4 millimetres per minute. This explains how usually a person’s aura progresses over time. People often experience sensory disturbances such as flashes of light or tingling in their face or hands. In the headache phase, the trigeminal nerve system is activated. This gives sensation to one side of the face, head and upper neck, leading to release of proteins such as CGRP (calcitonin gene-related peptide). This causes inflammation and dilation of blood vessels, which is the basis for the severe throbbing pain associated with the headache. Finally, the postdromal phase occurs after the headache resolves and commonly involves changes in mood and energy. <h2>What can you do about the acute attack?</h2> A useful way to conceive of <a href="https://www.migraine.org.au/factsheets">migraine treatment</a> is to compare putting out campfires with bushfires. Medications are much more successful when applied at the earliest opportunity (the campfire). When the attack is fully evolved (into a bushfire), medications have a much more modest effect. <iframe id="Pj1sC" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/Pj1sC/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> Aspirin For people with mild migraine, non-specific anti-inflammatory medications such as high-dose aspirin, or standard dose non-steroidal medications (NSAIDS) can be very helpful. Their effectiveness is often enhanced with the use of an anti-nausea medication. Triptans For moderate to severe attacks, the mainstay of treatment is a class of medications called “<a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1678146819/Factsheet_15_2023.pdf?1678146819">triptans</a>”. These act by reducing blood vessel dilation and reducing the release of inflammatory chemicals. Triptans vary by their route of administration (tablets, wafers, injections, nasal sprays) and by their time to onset and duration of action. The choice of a triptan depends on many factors including whether nausea and vomiting is prominent (consider a dissolving wafer or an injection) or patient tolerability (consider choosing one with a slower onset and offset of action). As triptans constrict blood vessels, they should be used with caution (or not used) in patients with known heart disease or previous stroke. Gepants Some medications that block or modulate the release of CGRP, which are used for migraine prevention (which we’ll discuss in more detail below), also have evidence of benefit in treating the acute attack. This class of medication is known as the “gepants”. Gepants come in the form of injectable proteins (monoclonal antibodies, used for migraine prevention) or as oral medication (for example, rimegepant) for the acute attack when a person has not responded adequately to previous trials of several triptans or is intolerant of them. They do not cause blood vessel constriction and can be used in patients with heart disease or previous stroke. Ditans Another class of medication, the “ditans” (for example, lasmiditan) have been approved overseas for the acute treatment of migraine. Ditans work through changing a form of serotonin receptor involved in the brain chemical changes associated with the acute attack. However, neither the gepants nor the ditans are available through the Pharmaceutical Benefits Scheme (PBS) for the acute attack, so users must pay out-of-pocket, at a <a href="https://www.migraine.org.au/cgrp#:%7E:text=While%20the%20price%20of%20Nurtec,%2D%24300%20per%208%20wafers.">cost</a> of approximately A$300 for eight wafers. <h2>What about preventing migraines?</h2> The first step is to see if <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1677043428/Factsheet_5_2023.pdf?1677043428">lifestyle changes</a> can reduce migraine frequency. This can include improving sleep habits, routine meal schedules, regular exercise, limiting caffeine intake and avoiding triggers such as stress or alcohol. Despite these efforts, many people continue to have frequent migraines that can’t be managed by acute therapies alone. The choice of when to start preventive treatment varies for each person and how inclined they are to taking regular medication. Those who suffer disabling symptoms or experience more than a few migraines a month <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1915327">benefit the most</a> from starting preventives. Almost all migraine <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1708566656/Factsheet_16_2024.pdf?1708566656">preventives</a> have existing roles in treating other medical conditions, and the physician would commonly recommend drugs that can also help manage any pre-existing conditions. First-line preventives include: <ul> <li>tablets that lower blood pressure (candesartan, metoprolol, propranolol)</li> <li>antidepressants (amitriptyline, venlafaxine)</li> <li>anticonvulsants (sodium valproate, topiramate).</li> </ul> Some people have none of these other conditions and can safely start medications for migraine prophylaxis alone. For all migraine preventives, a key principle is starting at a low dose and increasing gradually. This approach makes them more tolerable and it’s often several weeks or months until an effective dose (usually 2- to 3-times the starting dose) is reached. It is rare for noticeable benefits to be seen immediately, but with time these drugs <a href="https://pubmed.ncbi.nlm.nih.gov/26252585/">typically reduce</a> migraine frequency by 50% or more. <hr /> <iframe id="jxajY" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/jxajY/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>‘Nothing works for me!’</h2> In people who didn’t see any effect of (or couldn’t tolerate) first-line preventives, new medications have been available on the PBS since 2020. These medications <a href="https://pubmed.ncbi.nlm.nih.gov/8388188/">block</a> the action of CGRP. The most common PBS-listed <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1708566656/Factsheet_16_2024.pdf?1708566656">anti-CGRP medications</a> are injectable proteins called monoclonal antibodies (for example, galcanezumab and fremanezumab), and are self-administered by monthly injections. These drugs have quickly become a game-changer for those with intractable migraines. The convenience of these injectables contrast with botulinum toxin injections (also <a href="https://www.migraine.org.au/botox">effective</a> and PBS-listed for chronic migraine) which must be administered by a trained specialist. Up to half of adolescents and one-third of young adults are <a href="https://deepblue.lib.umich.edu/bitstream/handle/2027.42/147205/jan13818.pdf">needle-phobic</a>. If this includes you, tablet-form CGRP antagonists for migraine prevention are hopefully not far away. Data over the past five years <a href="https://pubmed.ncbi.nlm.nih.gov/36718044/">suggest</a> anti-CGRP medications are safe, effective and at least as well tolerated as traditional preventives. Nonetheless, these are used only after a number of cheaper and more readily available <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1677043425/Factsheet_2_2023.pdf?1677043425">first-line treatments</a> (all which have decades of safety data) have failed, and this also a criterion for their use under the PBS.<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/227559/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mark-slee-1343982">Mark Slee</a>, Associate Professor, Clinical Academic Neurologist, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/anthony-khoo-1525617">Anthony Khoo</a>, Lecturer, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders 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-in-my-brain-when-i-get-a-migraine-and-what-medications-can-i-use-to-treat-it-227559">original article</a>. </div>

Body

Nude athletes and fights to the death: what really happened at the ancient Olympics

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/konstantine-panegyres-1528527">Konstantine Panegyres</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> The first recorded victor at the Olympics was <a href="https://anastrophe.uchicago.edu/cgi-bin/perseus/citequery3.pl?dbname=GreekNov21&getid=1&query=Paus.%205.8.8#:%7E:text=This%20I%20can%20prove%3B%20for%20when%20the%20unbroken%20tradition%20of%20the%20Olympiads%20began%20there%20was%20first%20the%20foot%2Drace%2C%20and%20Coroebus%20an%20Elean%20was%20victor.%20There%20is%20no%20statue%20of%20Coroebus%20at%20Olympia%2C%20but%20his%20grave%20is%20on%20the%20borders%20of%20Elis.">Coroebus of Elis</a>. A cook by profession, Coroebus won the event called the “stadion” – a footrace of just under 200 metres, run in a straight line. Coroebus was victorious in the year 776 BC, but this was probably not the year of the first Olympic games. A few ancient writers, such as the historian <a href="https://quod.lib.umich.edu/m/moa/acl3129.0001.001/320">Aristodemus of Elis</a> (who lived in the 2nd century AD or earlier), <a href="https://www.attalus.org/translate/eusebius2.html#:%7E:text=Aristodemus%20of%20Elis,in%20between%20them.">believed</a> there had been as many as 27 Olympic contests prior to 776 BC, but the results had never been recorded because people before that time did not care about recording the names of the winners. The games were held every four years at <a href="https://www.britannica.com/place/Olympia-ancient-site-Greece">Olympia</a>, a site in Western Greece that had a famous temple to the god <a href="https://www.britannica.com/topic/Zeus">Zeus</a>. The games started in mid-August and were part of a religious festival dedicated to Zeus. <figure><iframe src="https://www.youtube.com/embed/VdHHus8IgYA?wmode=transparent&start=25" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>The Olympics began as part of a religious festival honouring the Greek god Zeus.</figcaption></figure> <h2>Competing for glory</h2> In the early days of the Olympics, there was only one event (the “<a href="https://www.britannica.com/sports/stade-footrace#:%7E:text=ancient%20Olympic%20Games&text=The%20race%2C%20known%20as%20the,the%20diaulos%2C%20roughly%20similar%20to%E2%80%A6">stadion</a>”) and one victor. Over the centuries, other events were added, like chariot races, wrestling, long-distance running and boxing. The Roman emperor <a href="https://www.britannica.com/biography/Nero-Roman-emperor">Nero</a> (37-68 AD) even “introduced a musical competition at Olympia”, as the biographer <a href="https://www.oxfordreference.com/display/10.1093/acref/9780198606413.001.0001/acref-9780198606413-e-6117">Suetonius</a> (1st/2nd century AD) <a href="https://www.loebclassics.com/view/LCL038/1914/volume.xml">informs</a> us. Victors at Olympia won a wreath of wild olive. Unlike today, there were no prizes for second or third. The athlete <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0104%3Aalphabetic+letter%3DI%3Aentry+group%3D2%3Aentry%3Diccus-bio-1">Iccus of Tarentum</a>, who lived in the 5th century BC and won victory in the pentathlon at the Olympics of 476 BC, apparently <a href="https://www.loebclassics.com/view/LCL448/1959/volume.xml">said</a> that for him “the prizes meant glory, admiration in his lifetime, and after death an honoured name”. Mostly men competed for the prizes but some women took part. <a href="https://www.jstor.org/stable/43610326">Cynisca</a>, daughter of King <a href="https://www.britannica.com/biography/Archidamus-II">Archidamus II of Sparta</a>, was the first woman to achieve an Olympic victory. She got the prize because the horses she trained won the chariot racing event in the year 396 BC, as the traveller <a href="https://www.britannica.com/biography/Pausanias-Greek-geographer">Pausanias</a> (2nd century AD) <a href="https://www.loebclassics.com/view/LCL188/1926/volume.xml">writes</a>: <blockquote> Cynisca was exceedingly ambitious to succeed at the Olympic games and was the first woman to breed horses and the first to win an Olympic victory. After Cynisca, other women have won Olympic victories but none of them was more distinguished for their victories than her. </blockquote> But competing in the games could be dangerous. <a href="https://www.oxfordreference.com/display/10.1093/oi/authority.20110803100454522">Lucius Annaeus Seneca</a> (c. 50 BC-c. 40 AD) <a href="https://www.loebclassics.com/view/LCL463/1974/volume.xml">describes</a> how a father lost both sons in the “<a href="https://www.britannica.com/sports/pankration">pancration</a>”, a type of combat sport that was a violent mixture of boxing and wrestling: <blockquote> A man trained his two sons as pancratists, and presented them to compete at the Olympic games. They were paired off to fight each other. The youths were both killed together and had divine honours decreed to them. </blockquote> <h2>Going to the games</h2> People travelled far to see the athletes competing in the famous games. The rhetorician <a href="https://www.oxfordreference.com/display/10.1093/acref/9780198606413.001.0001/acref-9780198606413-e-4094">Menander</a> (3rd/4th century AD) <a href="https://www.loebclassics.com/view/LCL539/2019/volume.xml">said</a> of the Olympic games: “the journey there is very difficult but nevertheless people take the risk”. In 44 BC, the Roman statesman <a href="https://www.britannica.com/biography/Cicero">Cicero</a> (106-43 BC) <a href="https://books.google.com.au/books?id=BzJsGtpNTwMC&pg=PA125&dq=%22A+winter+voyage+is+disagreeable,+and+that+is+why+I+asked+you%22&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwjd5ca9m62HAxXKSWwGHf13DPEQ6AF6BAgKEAI#v=onepage&q=%22A%20winter%20voyage%20is%20disagreeable%2C%20and%20that%20is%20why%20I%20asked%20you%22&f=false">wrote</a> a letter to his friend Atticus about planning a trip to Greece to see the games: <blockquote> I should like to know the date of the Olympic games […] of course, as you say, the plan of my trip will depend on chance. </blockquote> Cicero never made it to the Olympics – he was interrupted by other business. If he had gone, the trip would have involved a voyage by sea from Italy to Greece, then a carriage ride to Olympia. Once at Olympia, travellers stayed at lodging houses with other travellers. There they mixed with strangers and made new friends. There is a famous story about what happened when the philosopher <a href="https://www.britannica.com/biography/Plato">Plato</a> (428/427-348/347 BC) stayed at Olympia for the games. Plato lived there with others who did not realise he was the celebrated philosopher and he made a good impression on them, as the Roman writer <a href="https://www.britannica.com/biography/Aelian#:%7E:text=Aelian%20(born%20c.,%22Honey%2Dtongued%22).">Claudius Aelian</a> (2nd/3rd century AD) <a href="https://www.loebclassics.com/view/LCL486/1997/volume.xml">recalled</a>: <blockquote> The strangers were delighted by their chance encounter […] he had behaved towards them with modesty and simplicity and had proved himself able to win the confidence of anyone in his company. </blockquote> Later on, Plato invited his new friends to Athens and they were amazed to find out he was in fact the famous philosopher who was the student of <a href="https://www.britannica.com/biography/Socrates">Socrates</a>. It’s unclear how many people actually visited the ancient games each time they were held, although some modern scholars <a href="https://olympics.com/ioc/ancient-olympic-games/spectators">think</a> the number could have been as high as 50,000 in some years. <h2>Watching the games</h2> The Greek writer <a href="https://www.britannica.com/biography/Chariton-Greek-author">Chariton</a> (1st century AD) in his novel Callirhoe <a href="https://www.loebclassics.com/view/LCL481/1995/volume.xml">wrote</a> how athletes – who had often also made a long journey to get to the games – arrived at Olympia “with an escort of their supporters”. Athletes competed naked, and women were usually not permitted to watch. But there were some exceptions. For example a woman called Pherenice, who lived in the 4th century BC, was permitted to attend the Olympics as a spectator. As Claudius Aelian <a href="https://www.loebclassics.com/view/LCL486/1997/volume.xml">explains</a>: <blockquote> Pherenice brought her son to the Olympic festival to compete. The presiding officials refused to admit her as a spectator but she spoke in public and justified her request by pointing out that her father and three brothers were Olympic victors, and she was bringing a son who was a competitor. She won over the assembly and she attended the Olympic festival. </blockquote> As the contest was held in the middle of summer, it was usually extremely hot. According to Claudius Aelian, some people <a href="https://www.loebclassics.com/view/LCL486/1997/volume.xml">thought</a> watching the Olympics under “the baking heat of the sun” was a “much more severe penalty” than having to do manual labour such as grinding grain. The site at Olympia also had problems with freshwater supply. According to the writer <a href="https://www.britannica.com/biography/Lucian">Lucian of Samosata</a> (2nd century AD), visitors to the games sometimes <a href="https://www.tertullian.org/rpearse/lucian/peregrinus.htm#:%7E:text=Coming%20at%20last,that%20same%20water!">died of thirst</a>. This problem was fixed when <a href="https://www.britannica.com/biography/Herodes-Atticus">Herodes Atticus</a> built an <a href="http://www.perseus.tufts.edu/hopper/artifact?name=Olympia%2C+Nymphaeum&object=Building">aqueduct</a> to the site in the middle of the 2nd century AD. The atmosphere of the crowd was electric. The Athenian general and politician <a href="https://penelope.uchicago.edu/Thayer/E/Roman/Texts/Plutarch/Lives/Themistocles*.html">Themistocles</a> (6th/5th century BC) apparently <a href="https://www.loebclassics.com/view/LCL486/1997/volume.xml">said</a> the most enjoyable moment of his life was “to see the public at Olympia turning to look at me as I entered the stadium”. They praised him when he visited the games at Olympia because of his recent victory against the Persians at the <a href="https://www.britannica.com/event/Battle-of-Salamis">battle of Salamis</a> (480 BC). When the games were over, winning athletes returned home to a hero’s welcome. According to Claudius Aelian, when the athlete <a href="https://ia801308.us.archive.org/18/items/PWRE09-10/Pauly-Wissowa_V1_1151.png">Dioxippus</a> (4th century BC) <a href="https://www.loebclassics.com/view/LCL486/1997/volume.xml">returned to Athens</a> after being victorious in the pancration at Olympia, “a crowd collected from all directions” in the city to celebrate him. <h2>The end of the ancient games</h2> The Roman historian <a href="https://www.oxfordreference.com/display/10.1093/oi/authority.20110803115406219">Velleius Paterculus</a> (born 20/19 BC) <a href="https://www.loebclassics.com/view/LCL152/1924/volume.xml">called</a> the Olympic games “the most celebrated of all contests in sports”. Current research <a href="https://www.cambridge.org/core/books/end-of-greek-athletics-in-late-antiquity/DF60B2B859B4F1A7FE7549B17B61E9A1">suggests</a> the ancient games probably ended in the reign of the Roman emperor Theodosius II (reigned 408-450 AD). There may have been a number of reasons for the demise but some ancient sources specifically <a href="http://ancientolympics.arts.kuleuven.be/sourceEN/D219EN.html#:%7E:text=Scholia%20in%20Lucianum%2041.9.42%2D46%3A%0AThe%20Olympic%20games%20%C3%AF%C2%BF%C2%BD%20existed%20for%20a%20long%20time%20until%20Theodosius%20the%20younger%2C%20who%20was%20the%20son%20of%20Arcadius.%20After%20the%20temple%20of%20Olympian%20Zeus%20had%20been%20burnt%20down%2C%20the%20festival%20of%20the%20Eleans%20and%20Olympic%20contest%20were%20abandoned.">say</a> it was caused by a fire that destroyed the temple of Zeus at Olympia during Theodosius II’s reign: <blockquote> After the temple of Olympian Zeus had been burnt down, the festival of the Eleans and the Olympic contest were abandoned. </blockquote> The Olympics were not revived again until 1896, the year of the first <a href="https://olympics.com/en/olympic-games/athens-1896">modern Olympics</a>.<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/234912/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/konstantine-panegyres-1528527">Konstantine Panegyres</a>, McKenzie Postdoctoral Fellow, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image: 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/nude-athletes-and-fights-to-the-death-what-really-happened-at-the-ancient-olympics-234912">original article</a>. </div>

International Travel

Bird strike: what happens when a plane collides with a bird?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/doug-drury-1277871">Doug Drury</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Late last night, Virgin Australia flight VA 148 set out from Queenstown in New Zealand bound for Melbourne. Not long after takeoff, the right engine of the Boeing 737-800 jet started <a href="https://www.sbs.com.au/news/article/virgin-australia-flight-makes-emergency-landing-after-engine-catches-fire/iquv5w1is">emitting loud bangs</a>, followed by flames. The pilot flew on with the remaining engine, bringing the plane’s 73 passengers and crew to a safe emergency landing at nearby Invercargill airport. Virgin Australia says the dramatic turn of events was caused by a “possible bird strike”. Queenstown Airport <a href="https://www.theaustralian.com.au/business/aviation/bird-strike-blamed-for-fiery-virgin-australia-emergency-out-of-queenstown/news-story/9ef5c57829d0535baed223d2caf0b55f">played down</a> the likelihood of bird strike, saying “no birds were detected on the airfield at that time”. While we don’t know exactly what happened, bird strike is a common and real risk for aircraft. It can damage planes, and even lead to deaths. <h2>How common are bird strikes?</h2> A bird strike is a <a href="https://skyaviationholdings.com/bird-strikes-on-planes/">collision between</a> an aircraft and a bird. (Though the definition is sometimes expanded to include <a href="https://aawhg.org/">collisions on the ground</a> with land animals including deer, rabbits, dogs and alligators.) The <a href="https://digitalcommons.unl.edu/icwdm_usdanwrc/1459/">first bird strike</a> was recorded by Orville Wright in 1905, over a cornfield in Ohio. Now they happen every day, with some seasonal variability due to the <a href="https://www.faa.gov/air_traffic/publications/atpubs/aim_html/chap7_section_5.html">migratory patterns</a> of birds. Perhaps the most famous migratory bird strike occurred in 2009, when <a href="https://en.wikipedia.org/wiki/US_Airways_Flight_1549">US Airways Flight 1549</a> encountered a flock of migrating Canadian geese shortly after taking off from LaGuardia Airport in New York. Both of the plane’s engines failed, and captain Sully Sullenberger was forced to pilot it to an unpowered landing in the Hudson River. Between 2008 and 2017, the Australian Transport Safety Board recorded <a href="https://www.atsb.gov.au/publications/2018/ar-2018-035">16,626 bird strikes</a>. In America, the Federal Aviation Administration reported <a href="https://www.washingtonpost.com/travel/2023/04/25/bird-strike-plane-american-airlines/">17,200 bird strikes</a> in 2022 alone. <h2>Where do bird strikes happen, and what are the effects?</h2> According to the <a href="https://www.icao.int/Pages/default.aspx">International Civil Aviation Organization</a>, 90% of bird strikes happen near airports. In general, this is while aircraft are taking off or landing, or flying at lower altitudes where most bird activity occurs. The effect of bird strike depends on many factors including the type of aircraft. Outcomes may include shutting down an engine, as may have happened with the Virgin Australia flight. This plane was a Boeing 737-800, which has the capability to fly on a single engine to an alternate airport. In smaller aircraft, particularly single-engine aircraft, bird strikes can be fatal. Since 1988, <a href="https://aawhg.org/#:%7E:text=The%20majority%20happen%20at%20low,billion%20in%20aircraft%20damage%20annually.">262 bird strike fatalities</a> have been reported globally, and 250 aircraft destroyed. <h2>How do manufacturers and pilots defend against bird strike?</h2> Most <a href="https://aawhg.org/">bird strikes</a> occur early in the morning or a sunset when birds are most active. Pilots are trained to be vigilant during these times. Radar can be used to <a href="https://detect-inc.com/aircraft-birdstrike-avoidance-radar/?gad_source=1&gclid=Cj0KCQjwvb-zBhCmARIsAAfUI2ullN-s0MdDfzV2Hu9fLfdr8pKQCuyZWsoJfRN2W5s-tSm6Vo0wHgwaAgBMEALw_wcB">track flocks of birds</a>. However, this technology is ground-based and not available worldwide so it can’t be used everywhere. The two largest manufacturers of passenger jets, Boeing and Airbus, use <a href="https://aerospaceengineeringblog.com/jet-engine-design/">turbofan engines</a>. These use a series of fan blades to compress air before adding fuel and flame to get the thrust needed to take off. <figure><iframe src="https://www.youtube.com/embed/lgspIiTFWIk?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Engine manufacturers test how well they are likely to stand up to a bird strike.</figcaption></figure> Bird strike in one of these engines can cause severe damage to the fan blades, causing the engine to fail. Engine manufacturers test the safety of these engines by firing <a href="https://www.aerospacetestinginternational.com/news/engine-testing/faa-proposes-new-engine-test-for-bird-ingestion.html">a high-speed frozen chicken</a> at them while the engine is operating at full thrust. The Australian Government’s Civil Aviation Safety Authority <a href="https://www.casa.gov.au/wildlife-hazard-management">circular on wildlife hazard management</a> outlines what airports should do to keep birds and animals away from the vicinity of the airport. One technique is to use small gas explosions to mimic the sound of a shotgun to deter birds from loitering near the runway. In areas with high bird populations, airports may also use certain grasses and plants that do not attract the birds.<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/232702/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/doug-drury-1277871">Doug Drury</a>, Professor/Head of Aviation, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</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/bird-strike-what-happens-when-a-plane-collides-with-a-bird-232702">original article</a>. </div>

Travel Trouble

Here’s what happens to your body during plane turbulence – and how to reduce the discomfort it causes

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a> This week has seen another barrage of <a href="https://www.theguardian.com/uk-news/2024/jan/22/uk-weather-storm-jocelyn-to-follow-isha-with-more-strong-winds-and-heavy-rain">unsettled weather</a> sweep across the UK, with many flights delayed or cancelled. Some of those who were fortunate enough to take off found themselves arriving at destinations that weren’t on their boarding passes – such as passengers travelling from Stansted to Newquay who eventually diverted to <a href="https://uk.news.yahoo.com/storm-isha-creates-flight-diversion-142821278.html">Malaga</a>. One thing that was consistently described by passengers was that parts of the flights and the attempted landings were some of the most unnerving they’d ever experienced, due to turbulence. Turbulence results from uneven air movement, which is <a href="https://agupubs.onlinelibrary.wiley.com/doi/10.1029/2023GL103814">increasing</a> in frequency. If you turn your hair dryer on at home and hold it still, the air moves at a constant rate, but once you begin drying your hair and moving the hairdryer around, the air movement becomes uneven, that is to say, turbulent. Although turbulence may be unnerving and make you feel unwell, it is important to recognise that it is very common and typically <a href="https://pubmed.ncbi.nlm.nih.gov/18018437/">nothing to worry about</a> if you’re in your seat with your seatbelt fastened. <h2>How the body detects and responds to turbulence</h2> The body recognises itself within any environment. Its relationship with objects in terms of distance and direction is called <a href="https://www.sciencedirect.com/science/article/abs/pii/B9780123750006003414">spatial orientation</a>. When flying, this is typically moving forwards, ascending, some turns and a descent. However, turbulence disrupts this relationship and confuses the sensory information being received by the brain – it makes the body want to respond or recalibrate. Our inner ears play a pivotal role in all this. It consists of complex apparatuses that undertake more than hearing. These include the cochlea, <a href="https://www.ncbi.nlm.nih.gov/books/NBK279394/">three semi-circular canals</a>, <a href="https://radiopaedia.org/articles/utricle-ear?lang=gb">the utricle</a> and <a href="https://radiopaedia.org/articles/saccule-ear-1?lang=gb">the saccule</a>. The cochlea is responsible for hearing. It converts <a href="https://www.ncbi.nlm.nih.gov/books/NBK531483/">sound energy into electrical energy</a> that is then “heard” by the brain. The remaining structures are responsible for the balance and position of the head and body. The semi-circular canals are positioned in a vertical (side to side), horizontal and front-to-back plane, detecting movement in a nodding, shaking and touching ear-to-shoulder direction. Attached to these canals are <a href="https://www.ncbi.nlm.nih.gov/books/NBK532978/">the utricle and saccule</a>, which can detect <a href="https://www.ncbi.nlm.nih.gov/books/NBK10792/">movement</a> and <a href="https://www.cell.com/current-biology/pdf/S0960-9822(05)00837-7.pdf">acceleration</a>. All of these apparatuses use microscopic hair cells in a specialised fluid called <a href="https://www.ncbi.nlm.nih.gov/books/NBK531505/">endolymph</a> that flows with the head to create a sense of movement. When the plane encounters turbulence, this fluid moves around, but unpredictably. It takes <a href="https://www.ncbi.nlm.nih.gov/books/NBK518976/">about ten to 20 seconds</a> for the fluid to recalibrate its position, while the brain struggles to understand what is going on. When the aircraft hits turbulence, the balance apparatus <a href="https://www.frontiersin.org/articles/10.3389/fneur.2023.949227/full">cannot distinguish</a> the movement of the plane from that of the head, so the brain interprets the aircraft movement as that of the head or body. But this doesn’t match the visual information being received, which causes sensory confusion. The reason the inner ear causes so much confusion is because during flights you are devoid of your primary sensory tool relative to the external environment – your sight and the horizon. Eighty per cent of <a href="https://www.ncbi.nlm.nih.gov/books/NBK518976/">spatial information</a> comes from your eyes during flight. However, you only have the seat in front of you or the cabin as a reference point, which means your inner ear becomes the dominant sensory message to the brain during turbulence and disrupts the <a href="https://www.ncbi.nlm.nih.gov/books/NBK545297/">“vestibulo-ocular reflex”</a>. This reflex keeps your vision <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130651/">aligned</a> with your balance or expected position. Vision is the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777262/">most valued</a> of the senses and one-third of the brain is attributed to its function, reinforcing its importance in spatial orientation. This sensory mixed messaging often results in things like dizziness and sweating as well as gastrointestinal symptoms, such as <a href="https://www.airmedicaljournal.com/article/S1067-991X(02)70038-2/fulltext">nausea and vomiting</a>. Motion sickness can be triggered by turbulence and although research into specific airsickness is limited, other modes that induce motion sickness suggest that <a href="https://pubmed.ncbi.nlm.nih.gov/16018346/">women</a> are <a href="https://pubmed.ncbi.nlm.nih.gov/26466829/">more susceptible</a> than men, particularly in the <a href="https://pubmed.ncbi.nlm.nih.gov/16235881/">early stages</a> of the menstrual cycle. The turbulence also causes an increase in your heart rate, which is already higher than normal when flying because of a <a href="https://pubmed.ncbi.nlm.nih.gov/15819766/">decrease in oxygen saturation</a>. <h2>What about the pilots?</h2> Commercial pilots accrue thousands of hours at the controls, they are subject to the same forces as the passengers. Over time, they can <a href="https://academic.oup.com/milmed/article/180/11/1135/4160573">adapt to these forces</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/15828634/">experiences</a>, but they also have a couple of additional resources that most passengers don’t. They have the view out of the cockpit windows, so have a horizon to use as a reference point and can see what lies immediately ahead. If it is cloudy or visibility is low, their instruments provide additional visual <a href="https://www.faa.gov/sites/faa.gov/files/regulations_policies/handbooks_manuals/aviation/phak/19_phak_ch17.pdf">reference</a> to the position of the aircraft. This doesn’t mean they are immune to the effects of turbulence, with some studies reporting up to <a href="https://pubmed.ncbi.nlm.nih.gov/26540704/">71% of trainee pilots</a> reporting episodes of airsickness. <h2>How to reduce the discomfort</h2> A window seat can help, or even looking out the window. This gives the brain some sensory information through visual pathways, helping calm the brain in response to the vestibular information it is receiving. If you can get one, a seat towards the front or over the wing reduces the effects of turbulence. Deep or rhythmical breathing can help reduce motion sickness induced by turbulence. Focusing on your breathing <a href="https://pubmed.ncbi.nlm.nih.gov/25945662/">calms the nervous system</a>. Don’t reach for the alcohol. While you may feel it calms your nerves, if you hit turbulence it’s going to interfere with your <a href="https://pubmed.ncbi.nlm.nih.gov/7610847/">visual and auditory processing</a> and increase the likelihood of vomiting. If you suffer from motion sickness and are worried about turbulence while flying, then there are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241144/">drugs that can help</a>, including certain <a href="https://www.nhs.uk/medicines/cinnarizine/about-cinnarizine/">antihistamines</a>. Finally, it’s important to remember that although turbulence can be unpleasant, aircraft are designed to withstand the forces it generates and many passengers, even frequent fliers, will rarely encounter the most severe categories of turbulence because pilots actively plan routes to avoid it.<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/221780/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, Professor and Director of the Clinical Anatomy Learning Centre, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster 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/heres-what-happens-to-your-body-during-plane-turbulence-and-how-to-reduce-the-discomfort-it-causes-221780">original article</a>. </div>

Travel Tips

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

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 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>

Travel Trouble

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

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

Money & Banking

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

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

Body

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

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

Legal

Guy Sebastian reveals what happened when Marcia Hines collapsed

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

Caring

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

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

Caring

11 beauty trends that should have never happened

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

Beauty & Style

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

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

Caring

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

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

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