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Why IBD is so hard to treat – and how scientists are making progress

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/falk-hildebrand-1490022">Falk Hildebrand</a>, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a>; <a href="https://theconversation.com/profiles/katarzyna-sidorczuk-1490026">Katarzyna Sidorczuk</a>, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a>, and <a href="https://theconversation.com/profiles/wing-koon-1490274">Wing Koon</a>, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a></em></p> <p>Inflammatory bowel disease (IBD) is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478758/">life altering</a> chronic illness that is <a href="https://bmjopen.bmj.com/content/13/3/e065186">rising dramatically globally</a>. It is stubbornly difficult to treat, and many people find the treatments we have just don’t work for them.</p> <p>Over the last 30 years, there has been almost a 50% increase in cases – now affecting around 5 million people. Not to be confused with irritable bowel syndrome (IBS) which is a condition that affects the digestive system, IBD is more serious. It is the term for two severe illnesses called <a href="https://www.nhs.uk/conditions/crohns-disease/">Crohn’s disease</a> and <a href="https://www.nhs.uk/conditions/ulcerative-colitis/">ulcerative colitis</a>. More women are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9958616/#:%7E:text=Male%20predominance%20in%20IBD.,%2C%202.32%3A1%20in%20CD.">diagnosed with Crohn’s disease</a> while more men are affected by ulcerative colitis.</p> <p>People with IBD can experience a variety of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106026/">symptoms</a>, ranging from diarrhoea and blood in the stool, to weight loss and belly aches. On paper, this may sound no worse than mild food poisoning, however, this is no normal stomach upset.</p> <p>Experiences are often extreme; people with IBD can suffer excruciating pain and in some cases, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963331/">require surgery</a> to remove parts of the bowel. This is done by redirecting the bowel to a hole in the abdomen, where faeces are collected in a <a href="https://www.nhs.uk/conditions/colostomy/">colostomy bag</a>.</p> <p>However, we still don’t fully understand the cause of IBD.</p> <h2>The impact of inflammation</h2> <p>The main symptom of IBD is excessive and uncontrolled <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805548/">inflammation</a> – normally a sign of the body fighting off an infection. Although inflammation is an important aspect of our immune system, in IBD it is happening when the body is not under attack. Since we don’t know what causes this over-the-top reaction, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8720971/">treatments</a> are limited to managing the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964397/">derailed immune system</a>.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373857/">Inflammation is controlled</a> by cell signalling. Our cells detect bacteria using receptors that attach to parts of bacteria. This activates the receptor, causing it to send a signal to proteins, and each protein sends on more signals, creating a signal cascade. This is what tells the body it’s under attack.</p> <p>Many treatments follow the strategy of intercepting signals and preventing the signal cascade from starting. However, they are <a href="https://journals.lww.com/co-gastroenterology/abstract/2022/07000/management_of_refractory_inflammatory_bowel.6.aspx">not effective</a> for many people.</p> <p>Scientists are trying to target a different protein network, called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924159/">NOD2</a>, that often goes haywire in people with IBD but is not targeted by current treatments. A protein, called <a href="https://www.frontiersin.org/articles/10.3389/fphar.2021.650403/full">RIPK2</a>, seems like a promising target since it is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939834/">only found</a> in this network. Researchers from the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10485824/">European Molecular Biology Laboratory</a> are investigating its structure to help scientists design a new medication that will block the signals from this protein.</p> <h2>Importance of the microbiome</h2> <p>Another inspiration for new treatments comes from the bacteria residing in our guts. This community of bacteria, called the gut microbiome, has been associated with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314516/">all sorts of health conditions</a> ranging from asthma to obesity.</p> <p>Gut bacteria work closely with our bodies and play a vital role in digesting food and managing our <a href="https://www.nature.com/articles/s41422-020-0332-7">immune system</a>. In a healthy person, there is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143175/">fine balance</a> between gut bacteria and the immune system. Disruption of this balance can lead to disease, starting from minor discomfort to more severe, long-term conditions.</p> <p>Scientists are trying to understand how our bodies interact with gut bacteria, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102608/">what changes</a> when people develop IBD.</p> <p>The gut microbiome is an ecosystem. Just like a forest has animals eating different things, microbes can form a <a href="https://www.frontiersin.org/articles/10.3389/fevo.2019.00153/full">food web</a>. Some bacteria will use up one type of food, while others feed off other foods. Some rely on the waste of other bacteria after they’ve eaten. It is now believed that disruption to the gut microbiome is a characteristic of IBD and contributes to its development and progression.</p> <p>It’s a chicken and egg situation. Is there a change in the bacteria and food web that alters our bodies? Or does something else in the body, like our immune system, change the food web, subsequently limiting which bacteria can grow? Scientists aren’t sure of the answer.</p> <p>Instead of trying to figure out what happens first, a team at the <a href="https://www.nature.com/articles/s41467-023-42112-w">Hudson Institute of Medical Research</a> in Australia have focused on investigating which interactions in the food web are the most affected in IBD. This could help scientists to prioritise certain gut bacteria, or their food source, to restore the balance in the microbiome and improve patients’ symptoms.</p> <p>Hopefully, this specialised targeting of the microbiome will lead to more effective and longer lasting treatments.</p> <p>Although we have a long way to go before these ideas for treatments can become a reality, it is a step in the right direction. Targeting a new signalling pathway will hopefully control the inflammation in more patients. And studying the microbiome may reveal how we can reverse changes associated with IBD.</p> <p>Since they are key features of IBD, these developments could allow doctors to stop the disease in the early stages and reduce complications.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/218307/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/falk-hildebrand-1490022">Falk Hildebrand</a>, Researcher in Bioinformatician, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a>; <a href="https://theconversation.com/profiles/katarzyna-sidorczuk-1490026">Katarzyna Sidorczuk</a>, Research Scientist in Metagenomics, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a>, and <a href="https://theconversation.com/profiles/wing-koon-1490274">Wing Koon</a>, PhD student in Bioinformatics, <a href="https://theconversation.com/institutions/quadram-institute-5557">Quadram Institute</a></em></p> <p><em>Image credits: Shutterstock  </em></p> <p><em>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/why-ibd-is-so-hard-to-treat-and-how-scientists-are-making-progress-218307">original article</a>.</em></p> </div>

Body

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Food and exercise can treat depression as well as a psychologist, our study found. And it’s cheaper

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/adrienne-oneil-268324">Adrienne O'Neil</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/sophie-mahoney-1557294">Sophie Mahoney</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a></em></p> <p>Around <a href="https://www.aihw.gov.au/getmedia/6b19e493-0ebe-420f-a9a3-e48b26aace9f/aihw-aus-249-ib.pdf?v=20240628145747&amp;inline=true">3.2 million</a> Australians live with depression.</p> <p>At the same time, <a href="https://www.aihw.gov.au/getmedia/6b19e493-0ebe-420f-a9a3-e48b26aace9f/aihw-aus-249-ib.pdf?v=20240628145747&amp;inline=true">few</a> Australians meet recommended dietary or physical activity guidelines. What has one got to do with the other?</p> <p>Our world-first trial, <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065%2824%2900136-6/fulltext">published this week</a>, shows improving diet and doing more physical activity can be as effective as therapy with a psychologist for treating low-grade depression.</p> <p>Previous studies (including <a href="https://link.springer.com/article/10.1186/s12916-017-0791-y">our own</a>) have found “lifestyle” therapies are effective for depression. But they have never been directly compared with psychological therapies – until now.</p> <p>Amid a nation-wide <a href="https://www.health.gov.au/sites/default/files/2023-10/national-mental-health-workforce-strategy-2022-2032.pdf">shortage</a> of mental health professionals, our research points to a potential solution. As we found lifestyle counselling was as effective as psychological therapy, our findings suggest dietitians and exercise physiologists may one day play a role in managing depression.</p> <h2>What did our study measure?</h2> <p>During the prolonged COVID lockdowns, Victorians’ distress levels were <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50831">high and widespread</a>. Face-to-face mental health services were limited.</p> <p>Our trial targeted people living in Victoria with elevated distress, meaning at least mild depression but not necessarily a diagnosed mental disorder. Typical symptoms included feeling down, hopeless, irritable or tearful.</p> <p>We partnered with our <a href="https://www.barwonhealth.org.au/mhdas/">local mental health service</a> to recruit 182 adults and provided group-based sessions on Zoom. All participants took part in up to six sessions over eight weeks, facilitated by health professionals.</p> <p>Half were randomly assigned to participate in a program co-facilitated by an accredited practising dietitian and an exercise physiologist. That group – called the lifestyle program – developed nutrition and movement goals:</p> <ul> <li>eating a wide variety of foods</li> <li>choosing high-fibre plant foods</li> <li>including high quality fats</li> <li>limiting discretionary foods, such as those high in saturated fats and added sugars</li> <li>doing enjoyable physical activity.</li> </ul> <p>The second group took part in psychotherapy sessions convened by two psychologists. The psychotherapy program used cognitive behavioural therapy (CBT), the gold standard for treating depression in <a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2730724">groups and when delivered remotely</a>.</p> <p>In both groups, participants could continue existing treatments (such as taking antidepressant medication). We gave both groups <a href="https://link.springer.com/article/10.1186/s12888-022-03840-3">workbooks and hampers</a>. The lifestyle group received a food hamper, while the psychotherapy group received items such as a colouring book, stress ball and head massager.</p> <h2>Lifestyle therapies just as effective</h2> <p>We found similar results in each program.</p> <p>At the trial’s beginning we gave each participant a score based on their self-reported mental health. We measured them again at the end of the program.</p> <p>Over eight weeks, those scores showed symptoms of depression reduced for participants in the lifestyle program (42%) and the psychotherapy program (37%). That difference was not statistically or clinically meaningful so we could conclude both treatments were as good as each other.</p> <p>There were some differences between groups. People in the lifestyle program improved their diet, while those in the psychotherapy program felt they had increased their social support – meaning how connected they felt to other people – compared to at the start of the treatment.</p> <p>Participants in both programs increased their physical activity. While this was expected for those in the lifestyle program, it was less expected for those in the psychotherapy program. It may be because they knew they were enrolled in a research study about lifestyle and subconsciously changed their activity patterns, or it could be a positive by-product of doing psychotherapy.</p> <p>There was also not much difference in cost. The lifestyle program was slightly cheaper to deliver: A$482 per participant, versus $503 for psychotherapy. That’s because hourly rates differ between dietitians and exercise physiologists, and psychologists.</p> <h2>What does this mean for mental health workforce shortages?</h2> <p>Demand for mental health services is increasing in Australia, while at the same time the workforce <a href="https://www.health.gov.au/sites/default/files/2023-10/national-mental-health-workforce-strategy-2022-2032.pdf">faces worsening nation-wide shortages</a>.</p> <p>Psychologists, who provide <a href="https://www.aihw.gov.au/getmedia/6b19e493-0ebe-420f-a9a3-e48b26aace9f/aihw-aus-249-ib.pdf?v=20240628145747&amp;inline=true">about half</a> of all mental health services, can have long wait times. Our results suggest that, with the appropriate training and guidelines, allied health professionals who specialise in diet and exercise could help address this gap.</p> <p>Lifestyle therapies can be combined with psychology sessions for multi-disciplinary care. But diet and exercise therapies could prove particularly effective for those on waitlists to see a psychologists, who may be receiving no other professional support while they wait.</p> <p>Many dietitians and exercise physiologists already have advanced skills and expertise in motivating behaviour change. Most accredited practising dietitians are trained in managing <a href="https://link.springer.com/content/pdf/10.1007/978-3-030-67929-3_38-1.pdf">eating disorders</a> or <a href="https://www.nature.com/articles/s41572-020-0200-2">gastrointestinal conditions</a>, which commonly overlap with depression.</p> <p>There is also a cost argument. It is <a href="https://journals.sagepub.com/doi/full/10.1177/1355819616668202">overall cheaper</a> to train a dietitian ($153,039) than a psychologist ($189,063) – and it takes less time.</p> <h2>Potential barriers</h2> <p>Australians with chronic conditions (such as diabetes) can access subsidised dietitian and exercise physiologist appointments under various Medicare treatment plans. Those with eating disorders can also access subsidised dietitian appointments. But mental health care plans for people with depression do not support subsidised sessions with dietitians or exercise physiologists, despite <a href="https://dietitiansaustralia.org.au/sites/default/files/2024-04/Dietitians%20Australia%20Mental%20Health%20Evidence%20Brief%202024.pdf">peak bodies</a> urging them to do so.</p> <p>Increased training, upskilling and Medicare subsidies would be needed to support dietitians and exercise physiologists to be involved in treating mental health issues.</p> <p><a href="https://foodandmoodcentre.com.au/academy">Our training</a> and clinical <a href="https://www.tandfonline.com/doi/full/10.1080/15622975.2022.2112074">guidelines</a> are intended to help clinicians practising lifestyle-based mental health care within their scope of practice (activities a health care provider can undertake).</p> <h2>Future directions</h2> <p>Our trial took place during COVID lockdowns and examined people with at least mild symptoms of depression who did not necessarily have a mental disorder. We are seeking to replicate these findings and are now running <a href="https://foodandmoodcentre.com.au/projects/the-harmone-trial/">a study</a> open to Australians with mental health conditions such as major depression or bipolar disorder.</p> <p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/235952/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></em></p> <p><em><a href="https://theconversation.com/profiles/adrienne-oneil-268324">Adrienne O'Neil</a>, Professor, Food &amp; Mood Centre, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/sophie-mahoney-1557294">Sophie Mahoney</a>, Associate Research Fellow, Food and Mood Centre, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a></em></p> <p><em>Image </em><em>credits: Shutterstock</em></p> <p><em>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/food-and-exercise-can-treat-depression-as-well-as-a-psychologist-our-study-found-and-its-cheaper-235952">original article</a>.</em></p> </div>

Mind

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

<div class="theconversation-article-body"> <p><em><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></em></p> <p>Migraine is many things, but one thing it’s not is “just a headache”.</p> <p>“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.</p> <p>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.</p> <p>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.</p> <h2>What’s happening in my brain?</h2> <p>The biological basis of migraine is complex, and varies according to the phase of the migraine. Put simply:</p> <p>The earliest phase is called the <strong>prodrome</strong>. 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.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;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&amp;q=45&amp;auto=format&amp;w=600&amp;h=485&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=485&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=485&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=610&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=610&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=610&amp;fit=crop&amp;dpr=3 2262w" alt="" /><figcaption><span class="caption">The hypothalamus is shown here in red.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/brain-cross-section-showing-basal-ganglia-329843930">Blamb/Shutterstock</a></span></figcaption></figure> <p>Next is the <strong>aura phase</strong>, 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.</p> <p>In the <strong>headache phase</strong>, 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.</p> <p>Finally, the <strong>postdromal phase</strong> occurs after the headache resolves and commonly involves changes in mood and energy.</p> <h2>What can you do about the acute attack?</h2> <p>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.</p> <p><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></p> <p><strong>Aspirin</strong></p> <p>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.</p> <p><strong>Triptans</strong></p> <p>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.</p> <p>Triptans vary by their route of administration (tablets, wafers, injections, nasal sprays) and by their time to onset and duration of action.</p> <p>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).</p> <p>As triptans constrict blood vessels, they should be used with caution (or not used) in patients with known heart disease or previous stroke.</p> <p><strong>Gepants</strong></p> <p>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”.</p> <p>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.</p> <p>They do not cause blood vessel constriction and can be used in patients with heart disease or previous stroke.</p> <p><strong>Ditans</strong></p> <p>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.</p> <p>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.</p> <h2>What about preventing migraines?</h2> <p>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.</p> <p>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.</p> <p>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:</p> <ul> <li>tablets that lower blood pressure (candesartan, metoprolol, propranolol)</li> <li>antidepressants (amitriptyline, venlafaxine)</li> <li>anticonvulsants (sodium valproate, topiramate).</li> </ul> <p>Some people have none of these other conditions and can safely start medications for migraine prophylaxis alone.</p> <p>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.</p> <p>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.</p> <hr /> <p><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></p> <hr /> <h2>‘Nothing works for me!’</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><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></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>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>.</em></p> </div>

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Two young fundraising heroes treated to private party at Buckingham Palace

<p>Two fundraising heroes have been treated to a private tea party, hosted by Queen Camilla herself, after being forced to miss previous royal events.</p> <p>Tony Hudgell, nine, and Lyla O’Donovan, 11, were due to attend a garden party in May, but Hudgell got stuck in a major traffic jam, while Lyla was undergoing treatment for cancer. </p> <p>Tony — whose legs were amputated after horrific child abuse - was devastated to miss the royal event, as his adoptive mother Paula shared on X (formerly Twitter) how they spent two hours stuck behind a fire truck on a major highway. </p> <p>However, a response on the Royal Family indicated all was not lost, as they replied, “Sorry to hear this, Tony! We were looking forward to seeing you too. Fancy trying again another day? Leave it with us.”</p> <p>Two months on, the two youngsters arrived at Buckingham Palace for the rescheduled treat last week and were given a front-row spot to watch the Changing of the Guard.</p> <p>The two children and their families then enjoyed a private tea party with Queen Camilla, 76, in the palace garden’s Summer House.</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">🫖 🍰 When Tony and Lyla came to tea … <a href="https://t.co/LTfLrPDjT7">pic.twitter.com/LTfLrPDjT7</a></p> <p>— The Royal Family (@RoyalFamily) <a href="https://twitter.com/RoyalFamily/status/1807667556120969625?ref_src=twsrc%5Etfw">July 1, 2024</a></p></blockquote> <p>The Queen then presented Tony with his British Empire Medal after his nomination in the 2024 New Year’s Honours.</p> <p>Tony, who lost his legs as a baby due to his parents’ cruelty, inspired the nation after doing a 10km walk, raising $2.4 million at age five.</p> <p>Paula said, “We were all extremely honoured and grateful to be invited for afternoon tea with the Queen. Everyone was so kind and thoughtful and made us feel comfortable and relaxed."</p> <p>“Tony chatted to the Queen as if they were old friends. She was lovely with him.</p> <p>“An exceptionally proud moment was when the Queen gave Tony his BEM. It was one of the most memorable days we’ll ever have.”</p> <p>Lyla has raised funds to grant wishes to children affected by cancer or lifelong illness. She said of the event, “Everyone made us feel so comfortable and made me feel super-special. We’re so grateful.”</p> <p>Dad Paul said, “It was an amazing moment for us. Lyla was gutted about missing the original Garden Party but she said she’s glad she missed it now as she’s got to meet the Queen."</p> <p>“There’s no one more important than her, apart from the King, of course.”</p> <p><em>Image credits: Buckingham Palace/WPA Pool/Shutterstock Editorial </em></p>

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What are the most common symptoms of menopause? And which can hormone therapy treat?

<p><em><a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p>Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers.</p> <p>Adding to the uncertainty, a recent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">series in the Lancet</a> medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate.</p> <p>So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says.</p> <h2>Remind me, what exactly is menopause?</h2> <p>Menopause, simply put, is complete loss of female fertility.</p> <p>Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause).</p> <p>Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months.</p> <p>Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder).</p> <h2>What are the most common symptoms of menopause?</h2> <p><a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">Our study</a> of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are:</p> <ul> <li>hot flushes and night sweats (known as vasomotor symptoms)</li> <li>disturbed sleep</li> <li>musculoskeletal pain</li> <li>decreased sexual function or desire</li> <li>vaginal dryness and irritation</li> <li>mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.</li> </ul> <p>However, none of these symptoms are menopause-specific, meaning they could have other causes.</p> <p>In <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">our study of Australian women</a>, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats.</p> <p>But the severity of these symptoms <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">varies greatly</a>. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55.</p> <p>So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are <a href="https://journals.lww.com/menopausejournal/fulltext/2022/05000/prevalence,_severity,_and_associated_factors_in.9.aspx">similarly affected</a>.</p> <p>Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span.</p> <p>The <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">most robust guidelines</a> do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of <a href="https://www.cell.com/cell/abstract/S0092-8674(23)00905-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867423009054%3Fshowall%3Dtrue">menopausal hormonal changes</a>.</p> <p>The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">Some studies</a> suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">have not been shown to change</a>.</p> <h2>Who might benefit from hormone therapy?</h2> <p>The Lancet papers <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">suggest</a> menopause hormone therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext">alleviates</a> hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats).</p> <p>In contrast, the highest quality <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">clinical guidelines</a> consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy.</p> <p>Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency).</p> <p>However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”.</p> <p>Despite musculoskeletal pain being the most common menopausal symptom in <a href="https://journals.lww.com/menopausejournal/abstract/2016/07000/prevalence_and_severity_of_vasomotor_symptoms_and.6.aspx">some populations</a>, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied.</p> <p>Some guidelines, such as an <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Australian endorsed guideline</a>, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease.</p> <h2>What are the risks?</h2> <p>The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot.</p> <p>Oestrogen-only menopause hormone therapy is <a href="https://www.nice.org.uk/guidance/ng23">consistently considered</a> to cause little or no change in breast cancer risk.</p> <p>Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, <a href="https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf">has been associated with a small increase</a> in the risk of breast cancer, although any <a href="https://www.bmj.com/content/bmj/371/bmj.m3873.full.pdf">risk appears to vary</a> according to the type of therapy used, the dose and duration of use.</p> <p>Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels <a href="https://www.bmj.com/content/bmj/364/bmj.k4810.full.pdf">prescribed at standard doses</a></p> <h2>What if I don’t want hormone therapy?</h2> <p>If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats.</p> <p>In Australia, most of these options are “off-label”, although the new medication <a href="https://australianprescriber.tg.org.au/articles/management-of-menopause.html">fezolinetant</a> has just been <a href="https://www.tga.gov.au/resources/artg/401401">approved</a> in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat).</p> <p>Unfortunately, most over-the-counter treatments promoted for menopause are either <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">ineffective or unproven</a>. However, cognitive behaviour therapy and hypnosis <a href="https://journals.lww.com/menopausejournal/abstract/2023/06000/the_2023_nonhormone_therapy_position_statement_of.4.aspx">may provide symptom relief</a>.</p> <p><em>The Australasian Menopause Society has useful <a href="https://www.menopause.org.au/health-info/fact-sheets">menopause fact sheets</a> and a <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">find-a-doctor</a> page. The <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Practitioner Toolkit for Managing Menopause</a> is also freely available.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/225174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">original article</a>.</em></p>

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Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?

<p><em><a href="https://theconversation.com/profiles/iris-lim-1204657">Iris Lim</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>Dealing with chronic urinary tract infections (UTIs) means facing more than the occasional discomfort. It’s like being on a never ending battlefield against an unseen adversary, making simple daily activities a trial.</p> <p>UTIs happen when bacteria sneak into the urinary system, causing pain and frequent trips to the bathroom.</p> <p>Chronic UTIs take this to the next level, coming back repeatedly or never fully going away despite treatment. <a href="https://www.ncbi.nlm.nih.gov/books/NBK557479/">Chronic UTIs</a> are typically diagnosed when a person experiences two or more infections within six months or three or more within a year.</p> <p>They can happen to anyone, but some are more prone due to their <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults">body’s makeup or habits</a>. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes during menopause that can decrease the protective lining of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred around the area.</p> <p>Up to <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults#Related%20Resources">60% of women</a> will have at least one UTI in their lifetime. While effective treatments exist, <a href="https://www.health.harvard.edu/bladder-and-bowel/when-urinary-tract-infections-keep-coming-back#:%7E:text=Your%20urine%20might%20be%20cloudy,they%20take%20on%20your%20life.">about 25%</a> of women face recurrent infections within six months. Around <a href="https://sciendo.com/article/10.33073/pjm-2019-048?tab=article">20–30%</a> of UTIs don’t respond to standard antibiotic. The challenge of chronic UTIs lies in bacteria’s ability to shield themselves against treatments.</p> <h2>Why are chronic UTIs so hard to treat?</h2> <p>Once thought of as straightforward infections cured by antibiotics, we now know chronic UTIs are complex. The cunning nature of the bacteria responsible for the condition allows them to hide in bladder walls, out of antibiotics’ reach.</p> <p>The bacteria form biofilms, a kind of protective barrier that makes them nearly impervious to standard antibiotic treatments.</p> <p>This ability to evade treatment has led to a troubling <a href="https://theconversation.com/rising-antibiotic-resistance-in-utis-could-cost-australia-1-6-billion-a-year-by-2030-heres-how-to-curb-it-149543">increase in antibiotic resistance</a>, a global health concern that renders some of the conventional treatments ineffective.</p> <p>Antibiotics need to be advanced to keep up with evolving bacteria, in a similar way to the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would wane, just as overused antibiotics lose their power against bacteria that have adapted.</p> <p>But fighting bacteria that resist antibiotics is much tougher than updating the flu vaccine. Bacteria change in ways that are harder to predict, making it more challenging to create new, effective antibiotics. It’s like a never-ending game where the bacteria are always one step ahead.</p> <p>Treating chronic UTIs still relies heavily on antibiotics, but doctors are getting crafty, changing up medications or prescribing low doses over a longer time to outwit the bacteria.</p> <p>Doctors are also placing a greater emphasis on thorough diagnostics to accurately identify chronic UTIs from the outset. By asking detailed questions about the duration and frequency of symptoms, health-care providers can better distinguish between isolated UTI episodes and chronic conditions.</p> <p>The approach to initial treatment can significantly influence the likelihood of a UTI becoming chronic. Early, targeted therapy, based on the specific bacteria causing the infection and its antibiotic sensitivity, may reduce the risk of recurrence.</p> <p>For post-menopausal women, <a href="https://link.springer.com/article/10.1007/s00192-020-04397-z">estrogen therapy</a> has shown promise in reducing the risk of recurrent UTIs. After menopause, the decrease in estrogen levels can lead to changes in the urinary tract that makes it more susceptible to infections. This treatment restores the balance of the vaginal and urinary tract environments, making it less likely for UTIs to occur.</p> <p>Lifestyle changes, such as <a href="https://journals.lww.com/co-nephrolhypertens/FullText/2013/05001/Impact_of_fluid_intake_in_the_prevention_of.1.aspx">drinking more water</a> and practising good hygiene like washing hands with soap after going to the toilet and the recommended front-to-back wiping for women, also play a big role.</p> <p>Some swear by cranberry juice or supplements, though researchers are still figuring out <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001322.pub2/full">how effective these remedies truly are</a>.</p> <h2>What treatments might we see in the future?</h2> <p>Scientists are currently working on new treatments for chronic UTIs. One promising avenue is the development of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052183/pdf/pathogens-12-00359.pdf">vaccines</a> aimed at preventing UTIs altogether, much like flu shots prepare our immune system to fend off the flu.</p> <p>Another new method being looked at is called <a href="https://link.springer.com/article/10.1007/s12223-019-00750-y">phage therapy</a>. It uses special viruses called bacteriophages that go after and kill only the bad bacteria causing UTIs, while leaving the good bacteria in our body alone. This way, it doesn’t make the bacteria resistant to treatment, which is a big plus.</p> <p>Researchers are also exploring the potential of <a href="https://www.mdpi.com/2079-6382/12/1/167">probiotics</a>. Probiotics introduce beneficial bacteria into the urinary tract to out-compete harmful pathogens. These good bacteria work by occupying space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves.</p> <p>Probiotics can also produce substances that inhibit the growth of harmful bacteria and enhance the body’s immune response.</p> <p>Chronic UTIs represent a stubborn challenge, but with a mix of current treatments and promising research, we’re getting closer to a day when chronic UTIs are a thing of the past.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/223008/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/iris-lim-1204657">I<em>ris Lim</em></a><em>, Assistant Professor, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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/why-do-i-keep-getting-urinary-tract-infections-and-why-are-chronic-utis-so-hard-to-treat-223008">original article</a>.</em></p>

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Are catnip and treats like it safe for cats? Here’s how they affect their minds and moods

<p><em><a href="https://theconversation.com/profiles/mia-cobb-15211">Mia Cobb</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/anne-quain-12802">Anne Quain</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>Cats kept indoors can <a href="https://safeandhappycats.com.au/">live a good life</a> when they get access to a variety of positive experiences. Examples include performing natural behaviours, feeling safe at home and using their full sensory capabilities, including their sense of smell.</p> <p>Plants such as catnip, cat thyme and silver vine are potent smelly stimulants that can affect cat minds and moods.</p> <p>Ever wondered if these mind-altering substances are safe gifts for our feline friends? And importantly, is it OK to provide these, or is offering catnip to a cat like offering alcohol to a child?</p> <h2>Catnip, cat thyme and silver vine, oh my!</h2> <p>Owners who are concerned about their cats feeling bored and frustrated might offer them fresh or dried catnip (<em>Nepeta cataria</em>), silver vine (<em>Actinidia polygama</em>), cat thyme (<em>Teucrium marum</em>) or other plant materials such as valerian (<em>Valeriana officinalis</em>) and Tatarian honeysuckle (<em>Lonicera tatarica</em>). These last couple <a href="https://bmcvetres.biomedcentral.com/articles/10.1186/s12917-017-0987-6">could offer an alternative</a> if your cat doesn’t respond to catnip.</p> <p>Toys filled with the leaves or extracts of these plants can cause apparently euphoric behaviour in domestic cats (as well as big cats like leopards and jaguars). Not all cats respond this way to these smells, which is <a href="https://bmcbiol.biomedcentral.com/articles/10.1186/s12915-022-01369-1">believed to have a genetic basis</a>.</p> <h2>Are these treats safe for cats?</h2> <p>Cats have a highly developed sense of smell. Some plants release chemical compounds to deter insects or to attract predators of insects that might otherwise destroy them. This includes <a href="https://www.science.org/doi/10.1126/sciadv.aba0721">nepetalactone</a>, an ingredient isolated from catnip and silver vine.</p> <p>Indeed, <a href="https://www.science.org/content/article/why-cats-are-crazy-catnip">it has been argued </a> that exposure to nepetalactone leads to an increase in feel-good hormones in cats. It may also act as a <a href="https://www.science.org/doi/10.1126/sciadv.abd9135">natural mosquito repellent</a> (note that it does not repel all mosquitoes and is not effective for flea or tick control).</p> <p>This may be why sniffing catnip, silver vine and some other plants causes cats to roll on their backs and rub their chins, cheeks and bodies on the plants. Other <a href="https://bmcvetres.biomedcentral.com/articles/10.1186/s12917-017-0987-6">observed behaviours</a> include: licking, shaking their head while carrying plant material in their mouth, drooling, kicking the plant material with their hind feet, and a “wavelike” motion of the skin over their backs as muscles contract and relax.</p> <p>These responses <a href="https://bmcvetres.biomedcentral.com/articles/10.1186/s12917-017-0987-6">generally don’t last long</a>, usually seconds to minutes, before cats relax or resume their normal behaviour.</p> <p>Rather than becoming addicted to these substances, cats are more likely to become habituated and desensitised, with the plants having less effect over time. When sniffed, these plants <a href="https://www.cell.com/iscience/fulltext/S2589-0042(23)01925-9">appear</a> to have <a href="https://bmcbiol.biomedcentral.com/articles/10.1186/s12915-022-01369-1">no adverse effects</a> on cats.</p> <figure><iframe src="https://www.youtube.com/embed/yNUz4zQTA1E?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Cats (and a dog!) react to the active compound in catnip and silver vine, nepetalactone.</span></figcaption></figure> <h2>Is it ethical to alter the minds of our cats?</h2> <p>When considering how to improve the lives of animals we care for, we tend to focus on whether the benefits outweigh the potential harms.</p> <p>Despite some marketing claims that these plants activates the brain’s opioid system, delivering a “natural high” for cats, there is no evidence these substances actually alter the minds of cats in the same way as alcohol or other drugs alter the minds of humans.</p> <p>The marketing of these cat treats as “kitty crack” or “<a href="https://www.meowijuana.com/">meowijuana</a>” and silver vine sticks as “<a href="https://www.nekopiapets.com.au/product-page/joycat-cat-cigarettes-silvervine-stick">kitty cigarettes</a>” is likely to deter some people from offering their cats <a href="https://bmcbiol.biomedcentral.com/articles/10.1186/s12915-022-01369-1">this kind of olfactory stimulation</a>.</p> <p>Unlike offering alcohol to a child, though, the evidence suggests our cats are OK when given access to these treats. These items won’t induce psychosis and won’t lead to addiction or withdrawal symptoms. And we don’t need to worry about our cats operating heavy machinery or making important decisions under the influence of mind-altering substances!</p> <p>Provided they can walk away at any time, it seems reasonable to let them opt in to a fun time.</p> <p>In fact, we harness the power of cats’ sense of smell in other ways by using <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435919/">synthetic feline facial pheromones</a>. This can help reduce fear, anxiety and distress in cats. These substances can come in useful in settings such as multi-cat households or when moving house.</p> <h2>How to make sure your cat has the purr-fect time</h2> <p>Offering a range of smells (olfactory stimulation) is just one way to ensure your cat has a varied and interesting life. Here are some tips:</p> <ul> <li> <p>offer cats choices to interact with treats and toys – don’t force them</p> </li> <li> <p>rotate the toys and experiences on offer, so every day offers something fresh</p> </li> <li> <p>offer items that cats can scratch – scratching posts and corrugated cardboard are popular items</p> </li> <li> <p>if you are concerned your cat has swallowed part of a toy or seems unwell, check in with your vet.</p> </li> </ul> <p>Given the short-lived effects of these plant-based olfactory stimulants on cats, it is important that we <a href="https://www.sciencedirect.com/science/article/abs/pii/S0168159119301054">optimise their environment, lifestyle and interactions</a> with humans to improve their welfare. We can’t just rely on catnip or silver vine to give our cats a good life indoors – it’s really up to us!<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/214947/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/mia-cobb-15211"><em>Mia Cobb</em></a><em>, Research Fellow, Animal Welfare Science Centre, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/anne-quain-12802">Anne Quain</a>, Senior Lecturer, Sydney School of Veterinary Science, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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/are-catnip-and-treats-like-it-safe-for-cats-heres-how-they-affect-their-minds-and-moods-214947">original article</a>.</em></p>

Family & Pets

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Woolworths impresses customers with welcome "treat"

<p>Woolworths have given their customers a reason to smile after giving shoppers an unexpected offer. </p> <p>The supermarket giant has been praised for a simple but thoughtful gesture to customers trying to beat the heat while doing groceries. </p> <p>On a particularly hot day, a Woolworths store put bins of ice and bottles of water by the entrance for shoppers to take, with no charge. </p> <p>"Dear customers, we are in for a warm day. Stay safe and hydrated. Please enjoy a bottle of cold water from the store team," read signs attached to tubs at the shop.</p> <p>The small but significant gesture didn't go unnoticed by grateful shoppers, with one customer sharing a photo of the freebies on Facebook and describing it as a "great idea".</p> <p>Another shopper agreed, commenting, "As it was 40°C in Adelaide today, cold water would have been a treat."</p> <p>"Can grab some apples for the kids and a bottle of water," added someone else, referencing the free fruit for children also offered by the retailer.</p> <p>A spokesperson from Woolworths shared with <a href="https://au.news.yahoo.com/woolworths-stuns-with-unexpected-offer-for-customers-085030601.html" target="_blank" rel="noopener"><em>Yahoo News Australia</em></a> that this offer embodies a commitment to acts of kindness that are encouraged among the retailer's network of supermarkets.</p> <p>"Our store teams try and bring a little good to our customers every day," the spokesperson said.</p> <p>Not everyone was impressed by the generous offer, however, including a critic who suggested that what the supermarket was "really saying is that there's no air conditioning in their store".</p> <p>Others were also quick to comment that while the bottles of water were a nice offer, what would really help them would be a reduction in soaring grocery prices as the cost of living crisis continues. </p> <p><em>Image credits: Facebook / Shutterstock</em></p>

Caring

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Name that rash: 6 common skin conditions (and how to treat them)

<p><strong>Psoriasis</strong></p> <p><span style="text-decoration: underline;"><em>What psoriasis is like:</em></span> Psoriasis is made of red, scaly plaques that can be itchy and painful. It can show up anywhere but is most commonly found on the scalp, as well as the outside of the elbows and knees. It usually starts between age 10 and 30 and tends to be a chronic condition. “It’s a stubborn disease that waxes and wanes, so people have it for their whole lives,” says dermatologist Paul Cohen.</p> <p><span style="text-decoration: underline;"><em>What causes psoriasis:</em></span> This skin rash is the result of your immune system attacking the skin’s cells, and creating new ones too quickly, which then build up into the plaques. There’s no one single cause, but the condition runs in families. Stress, obesity, smoking and having many infections (particularly strep throat) increase your risk.</p> <p><span style="text-decoration: underline;"><em>How to treat psoriasis:</em></span> The first step is generally topical steroids, which can be used for a week or two at a time to clear up the plaques. For ongoing treatment, people use a synthetic form of vitamin D (which slows skin growth), medicated shampoos and retinoids (a topical version of vitamin A). Daily exposure to sunlight also seems to help, as does moisturising well. For more serious cases, options include oral medications that suppress the immune system and phototherapy done in a doctor’s office with a special light. (Discover more applications of light therapy.)</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> Serious cases can involve the joints, a condition called psoriatic arthritis. Also, psoriasis increases your chances of having some other diseases, including type 2 diabetes, cardiovascular disease and autoimmune conditions such as Crohn’s – all of which are, like psoriasis, linked to inflammation.</p> <p><strong>Hives</strong></p> <p><span style="text-decoration: underline;"><em>What hives are like:</em></span> Hives are itchy, raised welts that often have a red ring around them. Their most salient characteristic is that they disappear after about a day, only to show up later in a different location. They come in two forms: acute, which lasts six weeks or less, and chronic.</p> <p><span style="text-decoration: underline;"><em>What causes hives:</em></span> Hives are often the result of the body releasing histamine as part of an allergic reaction to drugs, food or some other irritant. They also commonly appear after a viral illness, as a side effect of your immune system revving up to battle the disease. “There are a number of potential triggers,” says dermatologist Katie Beleznay. In most cases, she adds, the specific origin is never determined.</p> <p><span style="text-decoration: underline;"><em>How to treat hives:</em></span> Since hives are a histamine reaction, over-the-counter antihistamines are the first line of defence. If that doesn’t clear them up, ask a doctor if you should use a stronger antihistamine or oral prednisone, an anti-inflammatory medication.</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> Rarely, people suffer from ongoing outbreaks of hives almost daily for six weeks or more, a condition called chronic idiopathic urticaria (CIU). The treatment for CIU is the same as for regular hives, but in some cases, it can also be a sign of an underlying thyroid disease or cancer.</p> <p><strong>Eczema</strong></p> <p><span style="text-decoration: underline;"><em>What eczema is like:</em></span> Eczema presents as patches of red, scaly skin that are extremely itchy, especially at night. These rashes often appear on the inside of your elbows and knees. If it’s more serious, the skin might blister or look thickened and white in those areas.</p> <p><span style="text-decoration: underline;"><em>What causes eczema:</em></span> Eczema is the result of having a weakened skin barrier, which can lead to inflammation and an overreaction from your immune system. Most people are born with it, and your genes are partly to blame. “You’re more predisposed to eczema if you have a family history of asthma, hay fever or the condition itself,” says Lisa Kellett, a dermatologist in Toronto. Some research also suggests that it might be a reaction to pollution, or to not being exposed to enough germs in childhood. (Kids who have dogs, for example, are less likely to have eczema.)</p> <p><span style="text-decoration: underline;"><em>How to treat eczema:</em></span> For general maintenance, apply a thick, hypoallergenic moisturizer to affected areas immediately after a bath or shower and at night. More serious flares will need topical prescription steroid creams or non-steroid immunosuppressant creams. People with stubborn eczema might also try phototherapy, which uses UVB light to help calm your immune system and reduce itchiness.</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> Rarely, what looks like eczema is actually skin cancer, as both can appear red and scaly. “The difference with skin cancer is that it doesn’t go away if you use a steroid,” says Kellett.</p> <p><strong>Contact Dermatitis</strong></p> <p><span style="text-decoration: underline;"><em>What contact dermatitis is like:</em></span> Contact dermatitis is a variation of eczema, and it looks similar – red, itchy patches on your skin. But unlike that chronic condition, this skin rash is a reaction to something specific and appears only where the offending object has made contact. “Poison ivy, for instance, will show up as a streak where the branch touched the skin,” says Beleznay.</p> <p><span style="text-decoration: underline;"><em>What causes contact dermatitis:</em></span> Besides poison ivy, other common culprits that can cause the immune system to go into overdrive are face cream, jewellery or fragrances. You can also develop a new intolerance to something you’ve used for a long time, such as Polysporin. If it’s not clear what caused it, your dermatologist can do a patch test, putting small amounts of suspected substances on your skin to see if you react.</p> <p><span style="text-decoration: underline;"><em>How to treat contact dermatitis:</em></span> Contact dermatitis is treated with topical steroids, or a stronger oral one, to calm down your immune system and stop the reaction.</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> Like eczema, the red and scaly presentation of contact dermatitis could be confused for skin cancer, which is another reason to visit your doctor if you’re not sure what caused it.</p> <p><strong>Rosacea</strong></p> <p><span style="text-decoration: underline;"><em>What rosacea is like:</em></span> As rosacea is a dilation of the blood vessels in your cheeks and nose, it often presents as red, sensitive skin in those places. Another form of the condition also includes bumps that resemble acne. For some people, the skin on their nose thickens, making it appear larger.</p> <p><span style="text-decoration: underline;"><em>What causes rosacea:</em></span> We don’t know what brings rosacea on, but, as with eczema, you’re more likely to have it if others in your family do, too. You’re also prone to acquire the condition if you have sun-damaged skin. “Rosacea usually begins around the age of 35 and gets worse with time,” says Kellett. People often find their flare-ups come after eating or drinking specific things.</p> <p><span style="text-decoration: underline;"><em>How to treat rosacea:</em></span> For many, preventing activation of their rosacea is as simple as avoiding triggers – but that’s easier than it sounds and can be a serious test of a sufferer’s willpower. “Those are often the good things in life,” says Beleznay, citing coffee, spicy foods and alcohol as common aggravators. Some women find that everyday makeup is enough to cover up the cosmetic impact of the condition, while others use prescription creams or laser or light therapy to constrict the blood vessels in the cheeks and reduce redness. For those whose rosacea includes bumps, topical creams or oral antibiotics often get rid of them.</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> Rarely, what looks like rosacea can be confused for the butterfly rash that’s a symptom of lupus, a serious autoimmune disease. The butterfly rash is named as such because of the shape it makes on the nose and both cheeks.</p> <p><strong>Shingles</strong></p> <p><span style="text-decoration: underline;"><em>What shingles is like:</em></span> Shingles normally starts out as a tingly, numb or bruised feeling in a small area, most commonly a patch on the abdomen. A few days later, a painful skin rash with blisters appears over those places. As the condition follows the path of a nerve, the rash eventually presents as a stripe that lasts from two to six weeks.</p> <p><span style="text-decoration: underline;"><em>What causes shingles:</em></span> This one’s easy: chicken pox. Even once you have fully recovered from that virus, your body never totally beats it; it simply retreats and lies dormant in your nerve cells, where, decades later, it can re-erupt as shingles. You’re more likely to get them if you’re immunocompromised or over 50, the age at which most public health agencies recommend you get the vaccine.</p> <p><span style="text-decoration: underline;"><em>How to treat shingles:</em></span> If you suspect you have shingles, see your doctor immediately. “You have to go right away because studies show that people do much better if the antiviral pills are started within 72 hours of the rash onset,” says Cohen. Additionally, sufferers are often given medication, like a local anaesthetic or codeine, to help control the pain.</p> <p><span style="text-decoration: underline;"><em>Possible red flag:</em></span> The real worry with shingles is that for some people, if it is not contained quickly, the virus can lead to longer-term pain lasting over three months and in some cases over a year. If the skin rash appears on the face, it can even cause blindness.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/name-that-rash-6-common-skin-conditions-and-how-to-treat-them" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

Body

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5 ways to protect your voice while barracking for the Matildas – and how to treat a hoarse voice after

<p><a href="https://theconversation.com/profiles/amy-hume-1393423">Amy Hume</a>, <em><a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>“It was definitely loud,” said Matildas player Caitlin Foord last week after the team played Denmark in Sydney, <a href="https://sport.optus.com.au/news/womens-world-cup-2023/os61164/matildas-beat-denmark-wwc-caitlin-foord-wish-loud-crowd-sydney">adding "</a>I loved it. We definitely hear it, we feel it and the louder the crowd I feel the better we are."</p> <p>Now fans are set to get even louder, whether watching at home or in a stadium, as the Australian team prepare to face England in their first-ever World Cup semi final.</p> <p>While the Matildas are warming up their limbs and muscles pre-match, spectators need to warm up our vocal folds. With a barracking job to do, we need to be match-fit. Here’s why.</p> <h2>Why do we need to warm up at all?</h2> <p>A sudden night of cheering can lead to vocal strain. The short-term risk is that you have a hoarse voice for a couple of days. Repeated vocal abuse can lead to <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/voice-disorders">permanent damage</a> that may require therapy or surgery.</p> <p>But with some good habits and preparation, you’ll be able to get loud safely. Here are five ways to build vocal stamina for tonight.</p> <h2>1. Get your body ready</h2> <p>The amount of volume you can have in your voice all begins with your body. If you are feeling tight, especially around the neck and shoulders, the muscles around the vocal folds may <a href="https://britishvoiceassociation.org.uk/voicecare_muscle-tension-dysphonia.htm">overcompensate</a>, giving you a tired or strained feeling. Before the match, take a moment to stretch your neck and shoulders for a more open and relaxed throat, ready to roar.</p> <p>And just as the Matilda’s will aim to stay well hydrated, you should too to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925668/">protect your voice</a>. The vocal structures consist of soft tissues that vibrate better when wet.</p> <h2>2. Yawn – even though you’re excited</h2> <p>Yawning stretches your soft palate (the fleshy back portion of the roof of the mouth) and its flexibility is essential for safe screaming. A vocal technique called <a href="https://pubmed.ncbi.nlm.nih.gov/8353622/">yawn-sigh</a> can also help stretch and warm up the structures like the tongue and pharynx (the passage at the top back of the throat) that are important for voice.</p> <p>Try yawning “horizontally” – smiling widely as you yawn. Then try yawning in the usual “vertical” way. When yawning horizontally, you should feel a different stretch in the back of your mouth and throat that targets your soft palate.</p> <figure><iframe src="https://www.youtube.com/embed/aFxKt1sexVc?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">‘Yawn a lot,’ says actor Morgan Freeman. ‘It relaxes your throat muscles, it relaxes your vocal chords.’</span></figcaption></figure> <h2>3. Breathe</h2> <p>If the semi final is anything like the <a href="https://www.abc.net.au/news/2023-08-13/matildas-world-cup-win-over-france-game-stopped-nation/102723254">quarter final against France</a>, it may be hard to remember to breathe. But breath gives your voice <a href="https://voicefoundation.org/health-science/voice-disorders/anatomy-physiology-of-voice-production/breakdowns-result-voice-disorders/#:%7E:text=If%20the%20airflow%20source%20is,for%20long%20periods%20of%20time.">power</a>.</p> <p>If you roar and cheer without a decent in-breath, the muscles of your throat will tense and strain to try to make the sound louder. It’s not efficient and will tire you out quickly. So every time you go to cheer, allow a big breath in first.</p> <h2>4. Work out your vocal folds</h2> <p>Your voice is like a muscle – actually a <a href="https://www.ncbi.nlm.nih.gov/books/NBK535342/">complex arrangement</a> of cartilage, muscle, ligaments and soft layers. If you stretch it before a workout, it will not only make the exercise easier but also aid recovery time.</p> <p>Your vocal folds are small bands of muscle in the larynx, and you can think of them like elastic. If unused, they can lose stretch and have less vibration capacity to produce sound.</p> <p>Simple exercises like humming and lip trilling can help keep the elasticity of your vocal folds. Start with <a href="https://www.tandfonline.com/doi/abs/10.1179/136132802805576436?journalCode=yslh19">humming</a> at a comfortable pitch and glide up and down your range.</p> <figure><iframe src="https://www.youtube.com/embed/Ddal_OAzkLQ?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">The vocal folds in action.</span></figcaption></figure> <h2>5. Put your whole self into it</h2> <p>Your <a href="https://www.frontiersin.org/articles/10.3389/fnins.2016.00506/full">voice, body and emotions</a> are constantly taking cues from one another. If you allow your body to be expressive, your voice will follow. Let your fandom take over your whole body and come into your face too – gestures and facial expressions change the sound of your voice and can bring enormous energy to your roars.</p> <p>Fully commit and trust your body and voice. When we are completely connected to communication, huge breaths can fly in, sound travels up through the vocal folds and rings through the body, giving your voice enormous carrying power.</p> <p>If you try to make your voice low pitched when it wants to come out high, or you hold back from being loud when your voice wants to be heard, tension can come into your throat and lead to strain.</p> <h2>How to treat your voice after the match</h2> <p>You got excited. You overdid the shouting. Understandable! After a full match, you may feel some level of <a href="https://pubmed.ncbi.nlm.nih.gov/20840041/#:%7E:text=Vocal%20fatigue%20is%20defined%20by,component%20of%20other%20voice%20disorders.">vocal fatigue</a>. If your voice sounds rough, hoarse or scratchy with unpredictable pitch, you might have what speech pathologists and ear, nose and throat (ENT) specialists call <a href="https://www.ncbi.nlm.nih.gov/books/NBK565881/">dysphonia</a>.</p> <p>As the Matildas jump in an ice bath, it’s your time to give your voice some TLC.</p> <p>Stretching, yawning, deep breathing and gentle <a href="https://www.ncbi.nlm.nih.gov/books/NBK534632/">voice exercises</a> like humming and trills work for recovery as well as warming up. An exercise I use with actors after a show is gentle whimpering sounds (like a puppy) to soothe vocal folds. Although it’s not widely researched, actors love it.</p> <p>Again, <a href="https://www.nidcd.nih.gov/health/taking-care-your-voice">hydration</a> is important for vocal hygiene, so drink up or <a href="https://www.sciencedirect.com/science/article/abs/pii/S0892199716304805">try a humidifier</a>. Special techniques like <a href="https://pubmed.ncbi.nlm.nih.gov/30408272/">singing through a straw</a> into a half-glass of water can help. Avoid whispering, which can <a href="https://pubmed.ncbi.nlm.nih.gov/16503476/">produce more strain</a> than talking naturally. <a href="https://www.enthealth.org/be_ent_smart/how-to-prevent-hoarseness-dysphonia/">Avoid</a> smoking or smoky spaces, excessive throat clearing and alcohol or caffeine that can dry out the throat and thicken mucus.</p> <p>With all the love behind the Matildas, they’ve got a chance of reaching the World Cup final. Even more reason to look after your voice and maintain match fitness. Go Matildas!<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/211499/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/amy-hume-1393423">Amy Hume</a>, Lecturer In Theatre (Voice), Victorian College of the Arts, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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/5-ways-to-protect-your-voice-while-barracking-for-the-matildas-and-how-to-treat-a-hoarse-voice-after-211499">original article</a>.</em></p>

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Do psychedelics really work to treat depression and PTSD? Here’s what the evidence says

<p><em><a href="https://theconversation.com/profiles/sam-moreton-194043">Sam Moreton</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a></em></p> <p>As of July 1, authorised psychiatrists have been allowed to prescribe MDMA (the chemical found in “ecstasy”) to treat post-traumatic stress disorder (PTSD), and psilocybin (found in “magic mushrooms”) to treat depression that hasn’t responded to other treatment.</p> <p>Psychedelic therapies have researchers excited because evidence suggests they might have lasting beneficial effects on factors that cause psychological distress beyond the treatment period. These include <a href="https://link.springer.com/article/10.1007/s00213-017-4701-y">feeling disconnected from other people</a>, <a href="https://link.springer.com/article/10.1007/s00213-019-05391-0">fear of death</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S2212144719301140?casa_token=OP6tKGxjPHAAAAAA:NTQ4khgsOY5wmsQ5HzCMcZ4eZ43wQV-sdhUbf5LXFiIeKWNwdonhfCxo77k7QbNk4G69EfX-">rigid ways of thinking</a>.</p> <p>This stands in contrast to most medications for psychological issues, which only directly help while people keep taking them regularly.</p> <p>But how strong is the evidence for psychedelic therapy?</p> <h2>Early promise</h2> <p>Early results from studies around the world have found psychedelic therapy <a href="https://www.ranzcp.org/getmedia/0cf57ea2-0bd7-4883-9155-d2ba1958df86/cm-therapeutic-use-of-mdma-for-ptsd-and-psilocybin-for-treatment-resistant-depression.pdf">might be effective</a> for treating a range of psychological issues.</p> <p>For instance, most studies (<a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032994">but not all</a>) have found patients tend to report <a href="https://pubmed.ncbi.nlm.nih.gov/37357767/">fewer depression symptoms</a> for periods ranging from several weeks to several months after psilocybin therapy.</p> <p>Similarly, studies have found <a href="https://journals.sagepub.com/doi/10.1177/0269881120965915">reductions in PTSD symptoms</a> three weeks after MDMA therapy.</p> <h2>Not so fast</h2> <p>However, as psychedelic research has grown, <a href="https://pubmed.ncbi.nlm.nih.gov/35243919/">limitations</a> of the research have been identified by researchers both <a href="https://psyarxiv.com/ak6gx/">within</a> and <a href="https://www.sciencefictions.org/p/psychedelics">outside</a> the psychedelic field.</p> <p>One issue is that we aren’t sure whether findings might be due to a <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/placebo-effect">placebo effect</a>, which occurs when a treatment works because people expect it to work.</p> <p>In clinical trials, participants are often given either a medication or a placebo (inactive) drug – and it’s important they don’t know which they have been given. However, due to the strong effects, it is difficult to prevent participants from knowing whether they have been given a psychedelic drug.</p> <p>Researchers have tried to use a range of different drugs (such as Ritalin) as a placebo in order to “trick” those participants not given a psychedelic into thinking they have received one. But this can be difficult to achieve.</p> <p>In 2021, researchers <a href="https://www.tandfonline.com/doi/full/10.1080/17512433.2021.1933434?casa_token=Dovn7x_rkdUAAAAA%3AsPzBTYNTPnNwqj9NvwN0m9ptrP4x4-c83gp3tGcshs30dWHNnmB_Vx-X5H5Y3pZJdG02IWW6X2E">reviewed</a> clinical trials involving psychedelics such as LSD, psilocybin, and dimethyltryptamine (found in animals and plants) for mood and anxiety disorders. They found trials either had not assessed whether participants guessed correctly which drug they had been given, or that this had been tested and participants tended to guess correctly.</p> <p>More recent trials <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032994">either don’t measure this</a> or find participants have a <a href="https://journals.sagepub.com/doi/full/10.1177/02698811231154852?casa_token=VsPt344fVGwAAAAA%3AA-i1VPBE1EWyFITWNncZEt876lWMiC7rtTOLJBQnb2pHI2775imUJhrzeSZW6r9doaBeDaj61D0">pretty good idea</a> of whether they’ve had a placebo or a psychedelic drug.</p> <p>Given the publicity and excitement around psychedelic research in recent years, it is likely most participants have <a href="https://culanth.org/fieldsights/the-pollan-effect-psychedelic-research-between-world-and-word">strong beliefs</a> such therapies work. This could lead to a significant placebo effect for participants given a psychedelic dose. Additionally, participants who realise they have received a placebo could experience <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10184717/">disappointment and frustration</a>, resulting in worse symptoms. The benefits of a psychedelic may seem even greater when they are compared to the experiences of disappointed participants.</p> <h2>Translating trials to practice</h2> <p>Anecdotally, patients might be motivated to report they have gotten better, even when they haven’t.</p> <p>On a 2021 podcast, one clinical trial participant <a href="https://www.psymposia.com/powertrip/">described</a> how, in hindsight, the information they provided to the trial did not accurately capture the worsening of their symptoms. Trial participants are likely aware their results might affect whether treatments are legalised. They may not want to “ruin” the research by admitting the treatment didn’t work for them.</p> <p>There is also uncertainty about whether the findings from clinical trials mean treatments will work in private practice. There may be a lack of clarity around <a href="https://psyarxiv.com/ak6gx/">how trial participants</a> are recruited and selected. Therefore participants may not represent the typical person with PTSD or treatment-resistant depression.</p> <p>And while <a href="https://journals.sagepub.com/doi/full/10.1177/02698811211069100">the safety of psychedelics</a> within controlled contexts is often emphasised by advocates, less is known about safety of psychedelic therapy <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2021.737738/full">outside</a> clinical trials.</p> <h2>Resolving issues</h2> <p>These issues do not mean the promising psychedelic research conducted over the past several decades is worthless. Nevertheless, a <a href="https://pubmed.ncbi.nlm.nih.gov/35285280/#full-view-affiliation-1">recent review</a> of the effects of MDMA and psilocybin on mental, behavioural or developmental disorders by Australian researchers concluded the “overall certainty of evidence was low or very low”.</p> <p>Dutch researchers recently drafted a <a href="https://psyarxiv.com/ak6gx/">roadmap for psychedelic science</a> with a checklist for future research to help avoid these pitfalls. When more research is done, it might turn out psychedelic treatments help patients and don’t come with unacceptable harms – we simply don’t know that yet.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/208857/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/sam-moreton-194043">Sa<em>m Moreton</em></a><em>, Associate Lecturer, School of Psychology, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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/do-psychedelics-really-work-to-treat-depression-and-ptsd-heres-what-the-evidence-says-208857">original article</a>.</em></p>

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“The heart of Hollywood” Treat Williams dead at 71

<p dir="ltr">Richard Treat Williams, a Hollywood heavyweight with over 129 acting credits to his name, has passed away at the age of 71.</p> <p dir="ltr">The actor was involved in a tragic accident with a car while riding his motorbike in Dorset, Vermont. Treat was the only person who sustained injuries in the crash, and while a helicopter was called in to airlift him to hospital, he sadly passed away. </p> <p dir="ltr">As Dorset’s fire chief Jacob Gibble told <em>People</em>, investigators believed that the car’s driver had been turning and didn’t notice the motorbike. </p> <p dir="ltr">And Treat’s agent of 15 years, Barry McPherson, said the same while confirming the news to the publication.</p> <p dir="ltr">“He was killed this afternoon. He was making a left or a right [and] a car cut him off," McPherson said. "I'm just devastated. He was the nicest guy. He was so talented.</p> <p dir="ltr">"He was an actor's actor. Filmmakers loved him. He's been the heart of Hollywood since the late 1970s. He was really proud of his performance this year. He's been so happy with the work that I got him. He's had a balanced career."</p> <p dir="ltr">Treat’s family later issued a statement regarding his passing to Deadline, where they shared that “it is with great sadness that we report that our beloved Treat Williams has passed away tonight in Dorset, Vermont after a fatal motorcycle accident. </p> <p dir="ltr">“As you can imagine, we are shocked and greatly bereaved at this time. Treat was full of love for his family, for his life and for his craft, and was truly at the top of his game in all of it. It is all so shocking right now, but please know that Treat was dearly and deeply loved and respected by his family and everyone who knew him. </p> <p dir="ltr">“We are beyond devastated and ask that you respect our privacy as we deal with our grief. To all his fans, please know that Treat appreciated all of you and please continue to keep him in your hearts and prayers.”</p> <p dir="ltr">Treat is survived by his wife of 35 years, Pam Van Sant, and their two children, Gill and Ellie, as well as his significant Hollywood legacy. </p> <p dir="ltr">He was a star across both the screen and stage over the course of his impressive career, with over 50 years of experience behind him. From <em>Prince of the City</em> to<em> A Streetcar Named Desire</em>, <em>Hair</em>, <em>Chicago Fire</em>, <em>Everwood</em>, and <em>Miss Congeniality 2</em>, he’d dipped his toes in a wide variety of content.</p> <p dir="ltr">Treat won over fans and co-workers alike with his presence, and they felt the weight of his passing, taking to social media to share their grief, and to pay tribute to the late star. </p> <p dir="ltr">“We are heartbroken over the passing of beloved … star of <em>Chesapeake Shores</em>, <em>The Christmas House</em> and so much more,” the Hallmark Channel wrote. “We will forever cherish him in our hearts, and extend our condolences to Treat’s family, friends, and loved ones.”</p> <p dir="ltr">“Working with Treat Williams in Mamet’s <em>Speed the Plow</em> at Williamstown in ‘91 was the start of great friendship. Damn it, damn it. Treat, you were the best. Love you,” writer and director Justine Bateman shared. </p> <p dir="ltr">“Treat Williams was a passionate, adventurous, creative man. In a short period of time, he quickly befriended me &amp; his adventurous spirit was infectious. We worked on just 1 film together but occasionally connected over the years. Kind and generous with advice and support. RIP,” actor Wendell Pierce said of Treat. </p> <p dir="ltr">And on behalf of many, actor Billy Baldwin noted down just a handful of the qualities he would remember his friend by, writing that “he truly and deeply cared about what’s going on here in America and around the world. Climate change, social justice, freedom, truth, tolerance… love. Beloved by his family, friends, fans, colleagues… his community. </p> <p dir="ltr">“A terrible loss. You will be missed.”</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">He had it all.<br />Smart.<br />Talented.<br />Funny.<br />Charming.<br />Successful.<br />Handsome.<br />Compassionate.<br />Heart of gold.<br />And that name… Treat Williams.</p> <p>He truly and deeply cared about what’s going on here in America and around the world. Climate change, social justice, freedom, truth, tolerance…… <a href="https://t.co/7cKP4nETTz">pic.twitter.com/7cKP4nETTz</a></p> <p>— Billy Baldwin (@BillyBaldwin) <a href="https://twitter.com/BillyBaldwin/status/1668458525335646208?ref_src=twsrc%5Etfw">June 13, 2023</a></p></blockquote> <p dir="ltr"><em>Images: Getty</em></p>

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Why understanding how spiders spin silk may hold clues for treating Alzheimer’s disease

<p><a href="https://theconversation.com/profiles/michael-landreh-1328287">Michael Landreh</a>, <em><a href="https://theconversation.com/institutions/karolinska-institutet-1250">Karolinska Institutet</a></em> and <a href="https://theconversation.com/profiles/anna-rising-1440132">Anna Rising</a>, <em><a href="https://theconversation.com/institutions/karolinska-institutet-1250">Karolinska Institutet</a></em></p> <p>Really, we should envy spiders. Imagine being able to make silk like they do, flinging it around to get from place to place, always having a <a href="https://pubs.acs.org/doi/10.1021/acsmacrolett.8b00678">strong-as-steel safety line</a> or spinning a comfy hammock whenever they need a rest.</p> <p>The fascinating properties of spider silk make it no wonder that scientists have been trying to unravel its secrets for decades.</p> <p>If we could understand and recreate the spinning process, we could produce artificial spider silk for a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0141813021021292">range of medical applications</a>. For example, artificial silk can help <a href="https://doi.org/10.1016/j.biomaterials.2021.120692">regenerate the nerves that connect our brain and limbs</a>, and can shuttle <a href="https://doi.org/10.1021/acs.biomac.0c01138">drug molecules directly into the cells where they are needed</a>.</p> <figure><iframe src="https://www.youtube.com/embed/zNtSAQHNONo?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Spider silk is made of <a href="https://www.sciencedirect.com/topics/engineering/spidroins">proteins called spidroins</a>, which the spider stores in a silk gland in its abdomen. There are several types of spidroin for spinning different sorts of silk. Spiders <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673682/">store them as a liquid</a> that resembles oil droplets.</p> <p>But one of the questions that has eluded scientists so far is how spiders turn these liquid droplets into silk. We decided to investigate why the spidroins form droplets, to get us closer to replicating a spider’s spinning process.</p> <h2>Weaving a web</h2> <p>The trick that spiders use to speed up their spinning process can be used to spin better artificial silk, or even develop new spinning processes.</p> <p>In 2017, we learned to <a href="https://www.nature.com/articles/ncomms15504">make synthetic silk fibres</a> by emulating the silk gland, but we did not know how things work inside the spider. Now we know that forming droplets first <a href="https://pubmed.ncbi.nlm.nih.gov/37084706/">speeds up the conversion to these fibres</a>.</p> <p>An important clue to how the droplets and fibres are related came from an unexpected area of our research – on <a href="https://pubmed.ncbi.nlm.nih.gov/23013511/">Alzheimer’s and Parkinson’s diseases</a>. Proteins that are involved in these diseases, called <a href="https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/alpha-synuclein#:%7E:text=%CE%B1%2DSynuclein%20is%20a%20highly,linked%20to%20familial%20Parkinson%20disease.">alpha-synuclein</a> and <a href="https://www.alz.org/media/Documents/alzheimers-dementia-tau-ts.pdf">tau</a>, can assemble into tiny, oil-like droplets in human cells.</p> <p>Tau is a protein that helps stabilise the internal skeleton of nerve cells (neurons) in the brain. This internal skeleton has a tube-like shape through which nutrients and other essential substances travel to reach different parts of the neuron.</p> <p>In Alzheimer’s disease, an abnormal form of tau builds up and clings to the normal tau proteins, creating “tau tangles”.</p> <p>Alpha-synuclein is found in large quantities in <a href="https://www.webmd.com/mental-health/what-is-dopamine">dopamine-producing nerve cells</a>. Abnormal forms of this protein are linked to Parkinson’s disease.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/528217/original/file-20230525-25-p40y48.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/528217/original/file-20230525-25-p40y48.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/528217/original/file-20230525-25-p40y48.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/528217/original/file-20230525-25-p40y48.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/528217/original/file-20230525-25-p40y48.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/528217/original/file-20230525-25-p40y48.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/528217/original/file-20230525-25-p40y48.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/528217/original/file-20230525-25-p40y48.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=3 2262w" alt="Beautiful spider web with water drops close-up" /></a><figcaption><span class="caption">The trick spiders use to speed up their spinning process can be used to spin better artificial silk.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-spider-web-water-drops-close-155560781">Aastels/Shutterstock</a></span></figcaption></figure> <p>Oil droplets of either one of these proteins form in humans when they become entangled, like boiled spaghetti on a plate. At first, the proteins are flexible and elastic, much like spidroin oil droplets.</p> <p>But if the proteins remain entangled, they get stuck together which alters their shape, changing them into rigid fibres. These can be toxic to human cells – for example, in neurodegenerative conditions such as Alzheimer’s.</p> <p>However, <a href="https://pubmed.ncbi.nlm.nih.gov/33148640/">spidroins can form droplets</a> too. This left us wondering if the same mechanism that causes neurodegeneration in humans could help the spider to convert liquid spidroins into rigid silk fibres.</p> <p>To find out, we used a <a href="https://www.nature.com/articles/nchembio.2269">synthetic spidroin called NT2RepCT</a>, which can be produced by bacteria. Under the microscope, we could see that this synthetic spidroin formed liquid droplets when it was dissolved in phosphate buffer, a type of salt found in the spider’s silk gland. This allowed us to replicate spider silk spinning conditions in the lab.</p> <h2>Silky science</h2> <p>Next, we studied how the spidroin proteins act when they form droplets. To answer this question, we turned to an analysis technique <a href="https://www.britannica.com/science/mass-spectrometry">called mass spectrometry</a>, to measure how the weight of the proteins changed when they formed droplets. To our surprise, we saw that the spidroin proteins, which normally form pairs, instead split into single molecules.</p> <p>We needed to do more work to find out how these protein droplets help spiders spin silk. Previous research has shown spidroins have different parts, called domains, with separate functions.</p> <p>The end part of the spidroin, called c-terminal domain, makes it form pairs. The c-terminal also starts <a href="https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1001921">fibre formation when it comes into contact with acid</a>.</p> <p>So, we made a spidroin which contained only the c-terminal domain and tested its ability to form fibres.</p> <p>When we used phosphate buffer to entangle the proteins into droplets, they turned into rigid fibre instantly. When we added acid without first making droplets, fibre formation took much longer.</p> <p>This makes sense since the spidroin molecules must find each other when forming a fibre. Entangling the spidroins like spaghetti helps them rapidly assemble into silk.</p> <p>This finding tells us how the spider can instantly convert its spidroins into a solid thread. It also uncovered how nature uses the same mechanism that can make brain proteins toxic to create some of its most amazing structures.</p> <p>The surprising parallel between spider silk spinning and fibres toxic to humans could one day lead to new clues about how to fight neurodegenerative disorders.</p> <p>Scientists may use spider silk research, including what we have learned about the spider silk domains, to keep human proteins from sticking together – to stop them from becoming toxic. If spiders can learn how to keep their sticky proteins in check, perhaps so can we.<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/205857/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/michael-landreh-1328287">Michael Landreh</a>, Researcher, Department of Microbiology, Tumor and Cell Biology, <em><a href="https://theconversation.com/institutions/karolinska-institutet-1250">Karolinska Institutet</a></em> and <a href="https://theconversation.com/profiles/anna-rising-1440132">Anna Rising</a>, Researcher in Veterinary medicine biochemistry, <em><a href="https://theconversation.com/institutions/karolinska-institutet-1250">Karolinska Institutet</a></em></p> <p><em>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/why-understanding-how-spiders-spin-silk-may-hold-clues-for-treating-alzheimers-disease-205857">original article</a>.</em></p> <p><em>Images: Getty</em></p>

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Why you need to treat money just like you do health and fitness

<p>Have you heard of Fitbits? They are devices designed to help you set personal health goals and track your progress, keeping you motivated – and they’re rapidly rising in popularity.</p> <p>Since Fitbits combine goal setting, progress tracking and the reward (of reaching your fitness goals) they’ve been lauded as successful in encouraging sustainable behavourial change and improving health.</p> <p>But it’s not the big things that have to change – baby steps help. Or in the case of fitness, literal steps – counting each of the little, regular actions you do every day and integrating that into your daily routine is achievable, thus has a better payoff.</p> <p>In similar vain, small behavioural changes that you can monitor for a longer-lasting and sustainable change to your finances is an important cornerstone to financial success.</p> <p>It may seem boring to spend less than you earn, pay off all your credit card debt every month on time, make extra mortgage repayments or salary sacrifices into your super. But in the end, it all adds up.</p> <p>Downloading budget apps for your phone or computer that can track your spending will help you both see your spending on a daily or weekly basis, and help you decide what small, repeatable actions you can do in order to save. Perhaps it’s dropping your would-be morning latte money into your savings account for the week and having one at home before you leave instead.</p> <p>Whatever it is that you choose to do in order to reach your financial goals, make sure you have a means of staying accountable. You could ask your partner, a friend, your accountant or financial planner.</p> <p>And when you reach your milestones? Celebrate! You’re making progress on getting and staying financially fit. </p> <p><em>Image credit: Shutterstock</em></p> <p><strong>Related links: </strong></p> <p><strong><em><span style="text-decoration: underline;"><a href="../finance/money/2015/09/aussie-credit-cards-pay-extra/">Australian credit card holders are paying too much</a></span></em></strong></p> <p><strong><em><span style="text-decoration: underline;"><a href="../finance/money/2015/08/asking-for-discounts/">5 things you should say to save money</a></span></em></strong></p> <p><strong><em><span style="text-decoration: underline;"><a href="../finance/money/2015/08/do-you-need-funeral-insurance/">Should you get funeral insurance?</a></span></em></strong></p>

Money & Banking

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"She treats it like a sport": Richard Wilkins reveals toughest interview

<div class="post-action-bar-component-wrapper" style="box-sizing: border-box; margin: 0px; padding: 0px; border: 0px; font-size: 16px; vertical-align: baseline;"> <div class="post-actions-component" style="box-sizing: border-box; margin: 0px; padding: 0px; border: 0px; font-size: 16px; vertical-align: baseline; visibility: visible;"> <div class="upper-row" style="box-sizing: border-box; margin: 8px 16px; padding: 0px; border: 0px; font-size: 16px; vertical-align: baseline; display: flex; justify-content: space-between; align-items: flex-end;"> <div class="right-box-container" style="box-sizing: border-box; margin: 0px; padding: 0px; border: 0px; font-size: 16px; vertical-align: baseline; display: flex; justify-content: flex-end; color: #323338; font-family: Figtree, Roboto, Rubik, 'Noto Kufi Arabic', 'Noto Sans JP', sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"> </div> </div> </div> </div> <div> <div> <div> <div> <div> <p dir="ltr">Richard Wilkins has opened up about the toughest interview of his career.</p> <p dir="ltr">The <em>Nine Entertainment </em>reporter revealed that a 2015 interview he did with <em>Material Girl</em> singer Madonna, kept him on his toes.</p> <p dir="ltr">"I guess Madonna would have to be up there. I've done a few interviews with her. She treats it like a sport," Wilkins revealed.</p> <p dir="ltr">In the interview, Wilkins played a drinking game with the singer, where she told him that their chat would not be "your average interview".</p> <p dir="ltr">"One of the last interviews I did with her she had a bottle of tequila and two shot glasses. She said if you ask a really good question, I'll have a shot and if you ask a really stupid question you have to have a shot."</p> <p dir="ltr">As the interview went on the two shot glasses remained empty.</p> <p dir="ltr">At one point, the singer let out an expletive in response to one of Wilkins’ questions and immediately apologised, to which Wilkins jokingly asked whether she should have a shot for swearing.</p> <p dir="ltr">"No, that's not part of the... I make up the rules to this game, OK," she quipped, with a smile creeping across her lips.</p> <p dir="ltr">The two were super competitive as the bottle of tequila remained untouched throughout the interview.</p> <p dir="ltr">When they discussed Madonna’s thirteenth album <em>Rebel Heart</em>, Wilkins finally broke the streak after asking her a question about changing her image.</p> <p dir="ltr">Without uttering a word Madonna pours him a shot, to which Wilkins groans, “Oh come on”.</p> <p dir="ltr">“I always answer the same way,” the singer justified and then told Wilkins to “drink up”.</p> <p dir="ltr">Wilkins recalled this moment as if it happened yesterday.</p> <p dir="ltr">"I said, this new record, you know you're going in a different direction... 'Oh, the reinvention question, alright here you go'," he recalled, miming pouring a drink.</p> <p dir="ltr">"It was all fun and games, but you've got to be on your toes when you interview Madonna, because she does not take any prisoners,” he added.</p> <p dir="ltr"> </p> <p dir="ltr"><em>Image: 9Honey</em></p> </div> </div> </div> </div> </div>

TV

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Shoppers left feeling nostalgic over new chocolate treats

<p dir="ltr">Chocolate lovers are in for a treat with Cadbury’s new range hitting supermarket shelves.</p> <p dir="ltr">The confectionary giant’s new “slices” range may feel quite familiar to some, especially those who often follow their sweet tooth into well-stocked bakeries, which makes perfect sense when considering the new blocks are inspired by the likes of crackle, hedgehog, and mint cream slices. </p> <p dir="ltr"><a href="https://www.cadbury.com.au/brand/cadbury-slices">The Cadbury Slices</a>, which carry a price tag of $5.50, are described by their makers as being “inspired by iconic Australian bakery slices and mixed with our iconic Cadbury chocolate to create a new way to enjoy icons, perfect for sharing.”</p> <p dir="ltr">They were an immediate hit with the masses, with one social media snack reviewer even declaring one of the new blocks to be “up there with some of my current favourites”. </p> <p dir="ltr">In a video posted to her Instagram account, she could be seen entering a Woolworths supermarket to pick up the new range, and outlined her journey before reviewing the goods. </p> <p dir="ltr">She did not, however, try the Old Gold mint cream, noting that she wasn’t really a fan of mint chocolate to begin with. </p> <p dir="ltr">First up was the Caramilk hedgehog, and after explaining the “classic Aussie no-bake slice”, she described how the block had a Caramilk base and contained almonds, toasted coconut, and rice crisps, before noting that she “absolutely loved the taste”. </p> <p dir="ltr">Next came the block “inspired by a chocolate crackle”, which also featured rice crisps and toasted coconut, and “definitely resembled the chocolate crackle flavour”. She noted that it had that “recognisable Copha taste”, although she didn’t believe that was one of the ingredients. </p> <p dir="ltr">“It was so delicious,” she surmised, “and I hope this one stays around for a while.” </p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/reel/Cr7-qyFJS1q/?utm_source=ig_embed&amp;utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/Cr7-qyFJS1q/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by Snack Reviews Aus (@snackreviews_aus)</a></p> </div> </blockquote> <p dir="ltr">Her joy at the range and their nostalgic flavours were exactly what the company had been aiming for, and as Paul Chatfield - vice president marketing for ANZ Mondelez International - told <em>news.com.au</em>, “the new Cadbury Slices range, features a variety of familiar and nostalgic flavours that Cadbury and chocolate-fans alike will enjoy.</p> <p dir="ltr">“We know Aussies share fond memories of bakery slices and hope they too will build new memories with family and friends as they share a Cadbury Slices block.”</p> <p dir="ltr"><em>Images: Instagram </em></p>

Food & Wine

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Limited edition Mother's Day treat for the mum who has everything

<p dir="ltr">Tim Tam has released a limited edition gift box just in time for Mother’s Day. </p> <p dir="ltr">The Australian made Tim Tam scented candle and reed diffuser set will leave the house smelling like a “rich and decadent chocolate oasis”. </p> <p dir="ltr">At just $100, the scented candle and reed diffuser is vegan and cruelty-free. </p> <p dir="ltr">“This premium set has been carefully blended to truly immerse yourself in the aromatic layers of Tim Tam decadence,” the Tim Tam website reads.</p> <p dir="ltr">“Indulge your senses with rich, decadent, cocoa notes from a chocolate absolute accented with layers of caramel, tonka bean and a hint of sandalwood.”</p> <p dir="ltr">Each box contains a one Tim Tam scented Diffuser 200ml, a Tim Tam scented Candle 300g, a packet of Tim Tam Deluxe Salted Caramel Brownie 175g and a packet of Tim Tam Original 200g. </p> <p dir="ltr"><span style="box-sizing: border-box; font-size: 16px; color: #444444; font-family: Raleway, sans-serif, 'Helvetica Neue', Helvetica, Arial; background-color: #ffffff;">For more brilliant gift ideas for Mum, check out the full range of </span><a style="box-sizing: border-box; color: #d90000; text-decoration-line: none; background-color: #ffffff; transition: all 0.2s ease-in-out 0s; font-size: 16px; border: 0px; font-family: Raleway, sans-serif, 'Helvetica Neue', Helvetica, Arial; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;" href="https://www.innovations.com.au/p/gifts/mothers-day-gifts?utm_source=over60&amp;utm_medium=nativearticle&amp;utm_campaign=MothersDayGifts" target="_blank" rel="noopener">Innovations Mother’s Day Gift Ideas here</a><span style="box-sizing: border-box; font-size: 16px; color: #444444; font-family: Raleway, sans-serif, 'Helvetica Neue', Helvetica, Arial; background-color: #ffffff;">. </span></p> <p dir="ltr"><em>Image: Tim Tam Shop</em></p>

Family & Pets

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Readers Respond: What was your go-to summer treat growing up?

<p dir="ltr">Summer is here and we asked you what your favourite summer treat was growing up!</p> <p dir="ltr">Some of them even go way back. Take a look at some of your favourite treats:</p> <p dir="ltr">Nola Schmidt- Mum's homemade ice cream when we got a refrigerator. Before that chips of ice when the iceman delivered. Or icy poles from local milk bar.</p> <p dir="ltr">Susanne Foan- Ducky doubles from the little shop at the caravan park we stayed at in Capel WA.</p> <p dir="ltr">Robyn Harrison- Tip Top FruJu natural frozen juice on a stick.</p> <p dir="ltr">Lynne Abbott - The ice blocks made by my Mum and my nextdoor best friend's Mum.</p> <p dir="ltr">Mum made ice blocks with Raspberry cordial and my friend's Mum made them with chocolate milk. We ran back and forth between the houses getting cups of ice blocks from both Mums.</p> <p dir="ltr">Linda Stone- Hawaiian Delight ice block.</p> <p dir="ltr">Denise McGoldrick- Either homemade ice cream or watermelon (My Dad grew them to sell for extra money and he would chop up the ones he couldn't sell for us). Great days.</p> <p dir="ltr">Tracie Lee- Raspberry Freezer.</p> <p dir="ltr">Robyn Harrison- Coconut paddle pop, they do not make them now. We had real coconut in them.</p> <p dir="ltr">Jill Selwood- An ice cream in a cone. Or an apple-usually Granny Smith.</p> <p dir="ltr">Meegan Barclay- Frozen Cappuccino cups gold Coast in the 70s.</p> <p dir="ltr">Rhonda Jones- Iced Pineapple Drink from Lolly Shop/Milk Bar in Glenferrie Road Malvern, no longer there.</p> <p dir="ltr">Beverley Pye- Home made Ice blocks made with milk and strawberry topping, toffee apple</p> <p><em>Image: Getty</em></p> <p dir="ltr"> </p>

Food & Wine

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COVID nasal sprays may one day prevent and treat infection

<p>We have vaccines to boost our immune response to SARS-CoV-2, the virus that causes COVID. We have medicines you can take at home (and in hospital) to treat COVID. Now researchers are trialling something new.</p> <p>They want to develop drugs that stop the virus getting into the body in the first place. That includes nasal sprays that stop the virus attaching to cells in the nose.</p> <p>Other researchers are looking at the potential for nasal sprays to stop the virus replicating in the nose, or to make the nose a hostile place to enter the body.</p> <p>Here’s where the science is up to and what we can expect next.</p> <h2>How could we block the virus?</h2> <p>“Viral blockade”, as the name suggests, is a simple premise based on blocking SARS-CoV-2. In other words, if something gets in its way, the virus cannot attach to a cell and it can’t infect you.</p> <p>As SARS-CoV-2 is a respiratory virus, it makes sense to deliver this type of medicine where the virus mainly enters the body – via the nose, in a nasal spray.</p> <p>There are various groups around the world working on this concept. Some research is still being conducted in the lab. Some agents have progressed to preliminary human trials. None are yet available for widespread use.</p> <p><strong>Heparin</strong></p> <p>Heparin is a common medicine that’s been used for decades to thin the blood. Studies in mice show that when heparin is delivered via the nose, <a href="https://link.springer.com/article/10.1007/s11095-022-03191-4" target="_blank" rel="noopener">it’s safe</a> and <a href="https://journals.asm.org/doi/10.1128/JVI.01987-20" target="_blank" rel="noopener">effective</a> in preventing the virus binding to nose cells. Researchers believe heparin binds to the virus itself and stops the virus attaching to the cells it’s trying to infect.</p> <p>A <a href="https://clinicaltrials.gov/ct2/show/NCT05204550" target="_blank" rel="noopener">clinical trial</a> is being <a href="https://www.premier.vic.gov.au/covid-nasal-spray-treatment-clinical-trials-begin" target="_blank" rel="noopener">conducted in Victoria</a> in collaboration between multiple Melbourne-based research centres and the University of Oxford.</p> <p><strong>Covixyl-V</strong></p> <p>Covixyl-V (ethyl lauroyl arginine hydrochloride) is another nasal spray <a href="https://assets.researchsquare.com/files/rs-911449/v1/0577f1f1-56f8-476f-97f6-d27d332ea9ca.pdf?c=1643375660" target="_blank" rel="noopener">under development</a>. It aims to prevent COVID by blocking or modifying the cell surface to prevent the virus from infecting.</p> <p>This compound has been explored for use in various viral infections, and <a href="https://assets.researchsquare.com/files/rs-911449/v1/0577f1f1-56f8-476f-97f6-d27d332ea9ca.pdf?c=1643375660" target="_blank" rel="noopener">early studies</a> in cells and small animals has shown it can prevent attachment of SARS-CoV-2 and reduce the overall viral load.</p> <p><strong>Iota-carrageenan</strong></p> <p>This molecule, which is extracted from seaweed, acts by blocking virus entry into <a href="https://www.frontiersin.org/articles/10.3389/fviro.2021.746824/full" target="_blank" rel="noopener">airway cells</a>.</p> <p>One study of about 400 health-care workers suggests a nasal spray may reduce the incidence of COVID <a href="https://www.dovepress.com/efficacy-of-a-nasal-spray-containing-iota-carrageenan-in-the-postexpos-peer-reviewed-fulltext-article-IJGM" target="_blank" rel="noopener">by up to 80%</a>.</p> <p><strong>IGM-6268</strong></p> <p>This is <a href="https://www.nature.com/articles/s41586-021-03673-2" target="_blank" rel="noopener">an engineered antibody</a> that binds to SARS-CoV-2, <a href="https://www.sciencedaily.com/releases/2021/06/210603171306.htm" target="_blank" rel="noopener">blocking</a> the virus from attaching to cells in the nose.</p> <p>A nasal and oral (mouth) spray are in a clinical trial <a href="https://clinicaltrials.gov/ct2/show/NCT05184218?term=IGM-6268&amp;draw=2&amp;rank=2" target="_blank" rel="noopener">to assess safety</a>.</p> <p><strong>Cold atmospheric plasma</strong></p> <p>This is a gas that contains charged particles. At cold temperatures, it can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165322" target="_blank" rel="noopener">alter the surface</a> of a cell.</p> <p>A <a href="https://www.thno.org/v12p2811.htm" target="_blank" rel="noopener">lab-based study</a> shows the gas changes expression of receptors on the skin that would normally allow the virus to attach. This results in less SARS-CoV-2 attachment and infection.</p> <p>Scientists now think this technology could be adapted to a nasal spray to prevent SARS-CoV-2 infection.</p> <h2>How could we stop the virus replicating?</h2> <p>Another tactic is to develop nasal sprays that stop the virus replicating in the nose.</p> <p>Researchers are designing genetic fragments that bind to the viral RNA. These fragments – known as “<a href="https://www.nature.com/articles/s41467-022-32216-0" target="_blank" rel="noopener">locked nucleic acid antisense oligonucleotides</a>” (or LNA ASOs for short) – put a proverbial spanner in the works and stop the virus from replicating.</p> <p>A spray of these genetic fragments delivered into the nose <a href="https://www.nature.com/articles/s41467-022-32216-0" target="_blank" rel="noopener">reduced virus replication in the nose</a> and prevented disease in small animals.</p> <h2>How could we change the nose?</h2> <p>A third strategy is to change the nose environment to make it less hospitable for the virus.</p> <p>That could be by using a nasal spray to change moisture levels (with saline), alter the pH (making the nose more acidic or alkaline), or adding a virus-killing agent (iodine).</p> <p>Saline can reduce the amount of <a href="https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2768627" target="_blank" rel="noopener">SARS-CoV-2 in the nose</a> by simply washing away the virus. One study has even found that saline nasal irrigation <a href="https://journals.sagepub.com/doi/10.1177/01455613221123737" target="_blank" rel="noopener">can lessen COVID disease</a> severity. But we would need further research into saline sprays.</p> <p>An Australian-led study has found that an iodine-based nasal spray <a href="https://www.theajo.com/article/view/4466/html" target="_blank" rel="noopener">reduced the viral load</a> in the nose. Further <a href="https://www.uwa.edu.au/news/Article/2022/February/Study-finds-nasal-spray-could-aid-battle-against-COVID" target="_blank" rel="noopener">clinical trials</a> are planned.</p> <p><a href="https://www.sciencedirect.com/science/article/pii/S1386653222001809#!" target="_blank" rel="noopener">One study</a> used a test spray – containing ingredients including eucalyptus and clove oils, potassium chloride and glycerol. The aim was to kill the virus and change the acidity of the nose to prevent the virus attaching.</p> <p>This novel formulation has been tested in the lab and in a <a href="https://www.sciencedirect.com/science/article/pii/S1386653222001809#!" target="_blank" rel="noopener">clinical trial</a> showing it to be safe and to reduce infection rate from about 34% to 13% when compared to placebo controls.</p> <h2>Barriers ahead</h2> <p>Despite promising data so far on nasal sprays for COVID, one of the <a href="https://www.nature.com/articles/d41586-022-03341-z" target="_blank" rel="noopener">major barriers</a> is keeping the sprays in the nose.</p> <p>To overcome this, most sprays need multiple applications a day, sometimes every few hours.</p> <p>So based on what we know so far, nasal sprays will not singlehandedly beat COVID. But if they are shown to be safe and effective in clinical trials, and receive regulatory approval, they might be another tool to help prevent it.</p> <p><strong>This article originally appeared on <a href="https://theconversation.com/covid-nasal-sprays-may-one-day-prevent-and-treat-infection-heres-where-the-science-is-up-to-193840" target="_blank" rel="noopener">The Conversation</a>.</strong></p> <p><em>Image: Shutterstock</em></p>

Body

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Chocolate Chunk Cookies

<p dir="ltr">When you want gooey indulgent cookies in a hurry, these are your new go-to! Throw it all in a bowl, bake and you’re done!</p> <h2 dir="ltr">Ingredients</h2> <p dir="ltr">1½ cups self raising flour</p> <p dir="ltr">¼ cup plain flour</p> <p dir="ltr">¼ cup cocoa</p> <p dir="ltr">1 cup caster sugar</p> <p dir="ltr">½ cup brown sugar</p> <p dir="ltr">180g block dark chocolate, coarsely chopped</p> <p dir="ltr">180g block white chocolate, coarsely chopped</p> <p dir="ltr">150g butter, melted</p> <p dir="ltr">1 egg</p> <p dir="ltr">1 egg yolk</p> <p dir="ltr">1 tsp vanilla extract</p> <h2 dir="ltr">Method</h2> <p><span id="docs-internal-guid-13d0f60a-7fff-8698-643a-89a2269906a5"></span></p> <ol> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Preheat oven to 160C fan-forced (180C conventional). Lightly grease and line 3 oven trays with baking paper.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">In a large bowl, sift combined flours and cocoa. Stir in sugars. Add butter, egg, extra yolk, and vanilla. Stir to combine (you may need to use your hands at the end to combine).</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Combine dark and white chocolate in a bowl and stir in two-thirds of the chopped chocolate to the dough.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Roll heaped tbsps of mixture into balls. Arrange on trays, 4cm apart. Flatten slightly. Press a little extra chocolate onto tops. Bake 10-12 mins until just set.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">When cookies are straight out of the oven, press extra reserved chocolate onto tops of cookies while still warm. Allow to cool slightly, then serve.</p> </li> </ol> <p><em>Image: Better Homes &amp; Gardens</em></p>

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