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Paris in spring, Bali in winter. How ‘bucket lists’ help cancer patients handle life and death

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/leah-williams-veazey-1223970">Leah Williams Veazey</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/alex-broom-121063">Alex Broom</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/katherine-kenny-318175">Katherine Kenny</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>In the 2007 film <a href="https://www.imdb.com/title/tt0825232/">The Bucket List</a> Jack Nicholson and Morgan Freeman play two main characters who respond to their terminal cancer diagnoses by rejecting experimental treatment. Instead, they go on a range of energetic, overseas escapades.</p> <p>Since then, the term “bucket list” – a list of experiences or achievements to complete before you “kick the bucket” or die – has become common.</p> <p>You can read articles listing <a href="https://www.cnbc.com/2023/01/11/cities-to-visit-before-you-die-according-to-50-travel-experts-and-only-one-is-in-the-us.html">the seven cities</a> you must visit before you die or <a href="https://www.qantas.com/travelinsider/en/trending/top-100-guide/best-things-to-do-and-see-in-australia-travel-bucket-list.html">the 100</a> Australian bucket-list travel experiences.</p> <figure><iframe src="https://www.youtube.com/embed/UvdTpywTmQg?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>But there is a more serious side to the idea behind bucket lists. One of the key forms of suffering at the end of life <a href="https://onlinelibrary.wiley.com/doi/10.1002/pon.4821">is regret</a> for things left unsaid or undone. So bucket lists can serve as a form of insurance against this potential regret.</p> <p>The bucket-list search for adventure, memories and meaning takes on a life of its own with a diagnosis of life-limiting illness.</p> <p>In a <a href="https://journals.sagepub.com/doi/10.1177/14407833241251496">study</a> published this week, we spoke to 54 people living with cancer, and 28 of their friends and family. For many, a key bucket list item was travel.</p> <h2>Why is travel so important?</h2> <p>There are lots of reasons why travel plays such a central role in our ideas about a “life well-lived”. Travel is often linked to important <a href="https://doi.org/10.1016/j.annals.2003.10.005">life transitions</a>: the youthful gap year, the journey to self-discovery in the 2010 film <a href="https://www.imdb.com/title/tt0879870/">Eat Pray Love</a>, or the popular figure of the “<a href="https://theconversation.com/grey-nomad-lifestyle-provides-a-model-for-living-remotely-106074">grey nomad</a>”.</p> <p>The significance of travel is not merely in the destination, nor even in the journey. For many people, planning the travel is just as important. A cancer diagnosis affects people’s sense of control over their future, throwing into question their ability to write their own life story or plan their travel dreams.</p> <p>Mark, the recently retired husband of a woman with cancer, told us about their stalled travel plans: "We’re just in that part of our lives where we were going to jump in the caravan and do the big trip and all this sort of thing, and now [our plans are] on blocks in the shed."</p> <p>For others, a cancer diagnosis brought an urgent need to “tick things off” their bucket list. Asha, a woman living with breast cancer, told us she’d always been driven to “get things done” but the cancer diagnosis made this worse: "So, I had to do all the travel, I had to empty my bucket list now, which has kind of driven my partner round the bend."</p> <p>People’s travel dreams ranged from whale watching in Queensland to seeing polar bears in the Arctic, and from driving a caravan across the Nullarbor Plain to skiing in Switzerland.</p> <p>Nadia, who was 38 years old when we spoke to her, said travelling with her family had made important memories and given her a sense of vitality, despite her health struggles. She told us how being diagnosed with cancer had given her the chance to live her life at a younger age, rather than waiting for retirement: "In the last three years, I think I’ve lived more than a lot of 80-year-olds."</p> <h2>But travel is expensive</h2> <p>Of course, travel is expensive. It’s not by chance Nicholson’s character in The Bucket List is a billionaire.</p> <p>Some people we spoke to had emptied their savings, assuming they would no longer need to provide for aged care or retirement. Others had used insurance payouts or charity to make their bucket-list dreams come true.</p> <p>But not everyone can do this. Jim, a 60-year-old whose wife had been diagnosed with cancer, told us: "We’ve actually bought a new car and [been] talking about getting a new caravan […] But I’ve got to work. It’d be nice if there was a little money tree out the back but never mind."</p> <p>Not everyone’s bucket list items were expensive. Some chose to spend more time with loved ones, take up a new hobby or get a pet.</p> <p>Our study showed making plans to tick items off a list can give people a sense of self-determination and hope for the future. It was a way of exerting control in the face of an illness that can leave people feeling powerless. Asha said: "This disease is not going to control me. I am not going to sit still and do nothing. I want to go travel."</p> <h2>Something we ‘ought’ to do?</h2> <p>Bucket lists are also a symptom of a broader culture that emphasises conspicuous <a href="https://www.youtube.com/watch?v=JH_Pa1hOEVc">consumption</a> and <a href="https://productiveageinginstitute.org.au/">productivity</a>, even into the end of life.</p> <p>Indeed, people told us travelling could be exhausting, expensive and stressful, especially when they’re also living with the symptoms and side effects of treatment. Nevertheless, they felt travel was something they “<a href="https://doi.org/10.1080/14461242.2021.1918016">ought</a>” to do.</p> <p>Travel can be deeply meaningful, as our study found. But a life well-lived need not be extravagant or adventurous. Finding what is meaningful is a deeply personal journey.</p> <hr /> <p><em>Names of study participants mentioned in this article are pseudonyms.</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/225682/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/leah-williams-veazey-1223970">Leah Williams Veazey</a>, ARC DECRA Research Fellow, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/alex-broom-121063">Alex Broom</a>, Professor of Sociology &amp; Director, Sydney Centre for Healthy Societies, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/katherine-kenny-318175">Katherine Kenny</a>, ARC DECRA Senior Research Fellow, <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/paris-in-spring-bali-in-winter-how-bucket-lists-help-cancer-patients-handle-life-and-death-225682">original article</a>.</em></p> </div>

Caring

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How music is changing the way dementia patients think

<p dir="ltr">New research has proven that music truly is the universal language, with experts discovering how the power of music is helping those suffering with dementia. </p> <p dir="ltr">Music therapists have shown that music brings dementia patients back to the present, with some even finding their voice thanks to the nostalgic memories of the past. </p> <p dir="ltr">According to Registered Music Therapist and Managing Director of music therapy company Music Beat, Dr Vicky Abad, the power of music is not to be overlooked when it comes to degenerative diseases.</p> <p dir="ltr">“Music is a window into people’s pasts,” she said. “It builds on strengths and abilities against a disease that can strip a person of their dignity, abilities and quality of life.”</p> <p dir="ltr">The team at <a href="https://www.tricare.com.au/">TriCare Aged Care and Retirement</a>, who see the devastating impact of dementia each and every day,  also experience first-hand the impact music has on residents, with many noticing “unrecognisable” changes in personality when a nostalgic tune is played.</p> <p dir="ltr">Louis Rose, an 80-year-old dementia patient and TriCare resident, was diagnosed with dementia six years ago, and requires assistance with many aspects of day to day life. </p> <p dir="ltr">However, listening to music is one thing he can enjoy on his own.</p> <p dir="ltr">“I grew up in Mauritius and while we didn’t have a lot, we certainly had music. Listening to music has always been an escape for me and a way to relax,” Mr Rose said.</p> <p dir="ltr">“When your brain starts to slow down and you find yourself forgetting things, it can be quite frustrating and confusing. Listening to music has been a way to distract myself from what’s going on in my head, it has helped me so much.”</p> <p dir="ltr">Tamsin Sutherland is a regular live music performer at TriCare facilities across Queensland, and has been able to witness incredible moments with the residents as they come alive as soon as she starts to play. </p> <p dir="ltr">“Watching residents who are often non-verbal sing along to the words is incredible,” she said “It really is like they are coming back to life and reconnecting with who they once were. To be part of that is quite emotional for me.”</p> <p dir="ltr">According to Dr Abad, music can help prevent the restless behaviour that often leads to pacing and wandering, especially in the evenings, which are often difficult times for those battling the disease. </p> <p dir="ltr">“Sundowning usually occurs in the late afternoon as dusk approaches, a time that is also associated with what used to be a busy time period in people’s lives,” she noted. </p> <p dir="ltr">“Personalised music is a simple and effective tool to help residents feel validated in their emotions during this time and provides them an opportunity to experience a calmer state of mind”.</p> <p dir="ltr"><em>Image credits: Getty Images </em></p>

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What actually is palliative care? And how is it different to end-of-life care?

<p><em><a href="https://theconversation.com/profiles/samar-aoun-1437641">Samar Aoun</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a></em></p> <p>Although it is associated with dying, palliative care is an approach focused on improving <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405258/#:%7E:text=QOL%20can%20also%20be%20defined,QOL%20(2%E2%80%934).">quality of life</a> – or how people feel about and respond to facing a life-threatening illness.</p> <p>Palliative care aims to prevent and relieve physical, social, emotional, spiritual and existential distress. Palliative care also supports family caregivers during the disease journey and bereavement phase. You might have heard it mentioned for cancer, but it is beneficial for the majority of life-limiting conditions. It has been shown to reduce health-care costs by <a href="https://palliativecare.org.au/publication/kpmg-palliativecare-economic-report/">preventing</a> unnecessary hospital admissions.</p> <p>Palliative care is not voluntary assisted dying. It does not aim to hasten or prolong death. It is not just for people who are about to die and seeking palliative care does not mean “giving up”. In fact, it can be a profound and positive form of care that the World Health Organization (WHO) has <a href="https://www.who.int/news-room/fact-sheets/detail/palliative-care">recognised</a> as a basic human right. But what does it involve?</p> <h2>Not just for someone’s final days</h2> <p>Palliative care is often seen as a “last resort” rather than a service that empowers terminally ill people to live as well as possible for as long as possible.</p> <p>The full benefit of this holistic approach can only be realised if people are referred early to <a href="https://palliativecare.org.au/resource/what-is-palliative-care/">palliative care</a> – ideally from the time they are diagnosed with a terminal illness. Unfortunately, this rarely happens and palliative care tends to blur with <a href="https://www.nia.nih.gov/health/providing-comfort-end-life">end-of-life care</a>. The latter is for people who are likely to die within 12 months but is often left to the last few weeks.</p> <figure><iframe src="https://www.youtube.com/embed/qMbq0fP9kr4?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Palliative is not just for the very end of someone’s life.</span></figcaption></figure> <h2>Palliative care can involve difficult conversations</h2> <p>Palliative care provides a time to ask some usually taboo questions. What kind of death do you want to experience? Who is in your personal network? How will they respond to your life ending? What kind of support can they offer?</p> <p>Palliative care can be provided at home, hospital, hospice or residential aged care facility, depending on the preference and circumstances of patients and their family carers.</p> <p>In general, patients are referred by their treating specialist, health professional or GP. Patient preferences for care and what matters most to them are discussed with their doctor or other health professionals and with their loved ones with <a href="https://www.advancecareplanning.org.au/">advance care planning</a>. These discussions can include information on their preferred place of care, preferred place of death, personal care needs such as dietary preferences and religious and spiritual practices.</p> <p>This helps those caring to make decisions about the patient care when the patient cannot anymore. However, advance care planning can start at any time in life and without a diagnosis.</p> <h2>How palliative care delivery has changed</h2> <p>Once upon a time, we were born at home and we died at home. Death was a social event with a medical component. Now it is close to the opposite. But research indicates a solely clinical model of palliative care (mainly symptom management funded through the health system) is <a href="https://www.mdpi.com/2227-9032/9/12/1615">inadequate</a> to address the complex aspects of death, dying, loss and grief.</p> <p>A <a href="https://www.phpci.org/">public health</a> palliative care approach views the community as an equal partner in the long and complex task of providing quality health care at the end of someone’s life. It promotes conversations about patients’ and families’ goals of care, what matters to them, their needs and wishes, minimising barriers to a “good death”, and supporting the family post-bereavement.</p> <p>These outcomes require the involvement of family carers, friendship networks and not-for-profit organisations, where more detailed conversations about life and death can happen, instead of the “pressure cooker” rushed environment of hospitals and clinics. Investment could develop stronger <a href="https://pubmed.ncbi.nlm.nih.gov/29402101/">death literacy</a> and grief literacy in the community and among health professionals, who may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312518/#:%7E:text=Some%20struggle%20with%20the%20limitations,lead%20in%20opening%20a%20dialogue">reluctant</a> to raise or discuss these topics. This would likely see the take up of advance care planning increase, from the current low levels of <a href="https://www1.racgp.org.au/newsgp/clinical/advance-care-planning-in-an-ageing-population#:%7E:text=A%20paper%20exploring%20the%20cognitive,advance%20health%20directive%20in%20place.">less than 15%</a> of Australians (<a href="https://theconversation.com/only-25-of-older-australians-have-an-advance-care-plan-coronavirus-makes-it-even-more-important-144354">25% of older Australians</a> accessing health and aged-care facilities).</p> <p>One such successful approach is the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9720808/">Compassionate Communities Connectors Program</a> in Western Australia, using trained <a href="https://comcomnetworksw.com/compassionate-connectors-program/">community volunteers</a> to enhance the social networks of terminally ill people.</p> <p>Our research trial trained 20 community volunteers (“connectors”) and 43 patients participated over 18 months. In sourcing others to help (who we called “caring helpers”), connectors built the capacity of the community and social networks around patients in need. Caring helpers assisted with transport, collecting prescriptions, organising meals and linked clients to community activities (such as choirs, walking groups, men’s shed). And they helped complete advance care planning documentation. About 80% of patients’ needs were social, particularly around reducing feelings of isolation.</p> <p>Patients in the trial had fewer hospital admissions and shorter hospital stays.</p> <h2>Tailored to need</h2> <p>Palliative care should be tailored to each person, rather than a one-size-fits-all clinical model that doesn’t respect autonomy and choice.</p> <p>Many people are dying in a way and a place that is not reflective of their values and their end-of-life is interrupted with preventable and costly admissions to hospital where control and even dignity are surrendered. Palliative care hospitalisations have <a href="https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia/contents/summary">increased</a> in recent years compared to all hospitalisations, with 65% of such admissions ending with the patient dying in hospital.</p> <p>It is unrealistic and unaffordable to have a palliative care service in every suburb. There needs to be a shift to a more comprehensive, inclusive and sustainable approach, such as Compassionate Communities, that recognises death, dying, grief and loss are everyone’s business and responsibility.<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/205488/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/samar-aoun-1437641">Samar Aoun</a>, Perron Institute Research Chair in Palliative Care, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</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-actually-is-palliative-care-and-how-is-it-different-to-end-of-life-care-205488">original article</a>.</em></p>

Caring

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Should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts

<p><em><a href="https://theconversation.com/au/team#fron-jackson-webb">Fron Jackson-Webb</a>, <a href="http://www.theconversation.com/">The Conversation</a></em></p> <p>Australian of the Year and body positivity advocate Taryn Brumfitt has <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">called for</a> doctors to avoid discussing a patient’s weight when they seek care for unrelated matters.</p> <p>A 15-minute consultation isn’t long enough to provide support to change behaviours, Brumfitt says, and GPs don’t have enough training and expertise to have these complex discussions.</p> <p>“Many people in larger bodies tell us they have gone to the doctor with something like a sore knee, and come out with a ‘prescription’ for a very restrictive diet, and no ongoing support,” Brumfitt <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">told the Nine newspapers</a>.</p> <p>By raising the issue of weight, Brumfitt says, GPs also risk turning patients off seeking care for other health concerns.</p> <p>So should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts.</p> <p><strong>Brett Montgomery - GP academic</strong></p> <p>Yes, sometimes – but with great care.</p> <p>I agree that weight stigma is damaging, and insensitively raising weight in consultations can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251566" target="_blank" rel="noopener">hurt people's feelings and create barriers</a>to other aspects of health care.</p> <p>I also agree people can sometimes be “overweight” yet <a href="https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0287218" target="_blank" rel="noopener">quite healthy</a>, and that common measures and categories of weight are <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">questionable</a>.</p> <p>On the other hand, I know obesity <a href="https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Obesity-prevention-and-management.pdf" target="_blank" rel="noopener">is associated with</a> heart disease, joint problems, diabetes and cancers.</p> <p>GPs should be ready to help people with their weight when they want help. <a href="https://www.bmj.com/content/377/bmj-2021-069719.full?ijkey=FnARkmvxLOMFvlb&amp;keytype=ref">Our assistance somewhat effective</a>, though sadly dietary efforts often have minimal effect on weight in the long term. Meanwhile, treatments causing larger weight changes (<a href="https://insightplus.mja.com.au/2021/10/bariatric-surgery-public-system-access-still-terrible/">surgery</a> and <a href="https://www.nature.com/articles/s41366-022-01176-2">some medicines</a> are often financially inaccessible.</p> <p>I feel safe discussing weight when my patient raises the issue. Fearing hurting people, I often avoid raising it myself. I focus instead on health rather than weight, discussing physical activity and healthy diet – these are good things for people of any size.</p> <p><strong>Emma Beckett - Nutrition scientist</strong></p> <p>No. It’s not likely to succeed. Large systematic reviews bringing together multiple studies of multiple weight-loss diets show weight loss is not generally maintained long term (<a href="https://pubmed.ncbi.nlm.nih.gov/32238384/">12 months</a> to <a href="https://www.nature.com/articles/0802982">four years</a>).</p> <p>The idea that weight is about willpower is outdated. The current body of evidence <a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">suggests</a> we each have a weight set point that our body defends. This is determined by genetics and environment more so than education.</p> <p>There may be associations between weight and health outcomes, but losing weight <a href="https://theconversation.com/just-because-youre-thin-doesnt-mean-youre-healthy-101185">does not necessarily equate</a> with improving health.</p> <p>Fat stigma and fatphobia are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/">harmful too</a> and can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/">compromise access to health care</a>.</p> <p>Instead, consider asking a better question. Healthy eating reduces disease risk <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935663/">regardless of weight</a>. So maybe ask how many vegetables are your patients eating. Would they like to see a dietitian to discuss strategies for a better-quality diet?</p> <p><strong>Liz Sturgiss - GP/researcher </strong></p> <p>No. A <a href="https://pubmed.ncbi.nlm.nih.gov/33211585/">US study</a> estimates it would take a family doctor 131% of their work hours to implement all preventive health-care recommendations. It's impossible to address every recommendation for preventative care at every consultation. One of the key skills of a GP is balancing the patient and doctor agenda.</p> <p><a href="https://www.obesityevidencehub.org.au/collections/treatment/weight-bias-and-stigma-in-health-care">Weight stigma</a> can deter people from seeking health care, so raising weight when a patient doesn't have it on their agenda can be harmful. A strong <a href="https://academic.oup.com/fampra/article/38/5/644/6244494?login=false">therapeutic relationship</a> is critical for safe and effective health care to address weight. </p> <p>Weight is always on my agenda when there is unexpected weight loss. If a patient has rapid weight loss, I am concerned about an undetected <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283307/">cancer</a> or infection. Additionally, I am increasingly seeing patients who are unable to afford food, who often have <a href="https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/introduction">poor oral health</a>, who lose weight due to <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1747-0080.12580">poverty</a>. Weight loss for the wrong reasons is also a very concerning part of general practice.</p> <p><strong>Nick Fuller - Obesity researcher </strong></p> <p>Yes. GPs should play a role in the early detection of weight issues and direct patients to evidence-based care to slow this progression. <a href="https://pubmed.ncbi.nlm.nih.gov/31032548/">Research</a> shows many people with obesity are motivated to lose weight (48%). <a href="https://pubmed.ncbi.nlm.nih.gov/31032548/">Most</a> want their clinician to initiate a conversation about weight management and treatment options.</p> <p>However, this conversation <a href="https://pubmed.ncbi.nlm.nih.gov/32385580/">rarely occurs</a>, resulting in <a href="https://pubmed.ncbi.nlm.nih.gov/33621413/">significant delays to treatment</a>.</p> <p>Starting the conversation presents challenges. Although obesity is a complex disease related to multiple factors, it's still <a href="https://pubmed.ncbi.nlm.nih.gov/25752756/">highly stigmatised</a>in our society and even in the <a href="https://pubmed.ncbi.nlm.nih.gov/23144885/">clinical setting</a>. Sensitivity is required and the wording the clinician uses is important to make the patient feel safe and avoid placing blame on them. Patients often <a href="https://pubmed.ncbi.nlm.nih.gov/20823355/">prefer terms</a> such as “weight” and “BMI” (body mass index) over “fatness,” “size” or “obesity”, <a href="https://pubmed.ncbi.nlm.nih.gov/27354290/">particularly women</a>.</p> <p>Measuring weight, height and waist circumference should be <a href="https://pubmed.ncbi.nlm.nih.gov/33621413/">considered routine in primary care</a>. But this needs to be done without judgement, and in collaboration with the patient.</p> <p><strong>Helen Truby - Nutrition scientist </strong></p> <p>Yes. A high body weight contributes to many chronic conditions that negatively impact the <a href="https://www.aihw.gov.au/australias-health/summaries">quality of life and mental health</a> of millions of Australians.</p> <p>Not all GPs feel confident having weight conversations, given the sensitive nature of weight and its stigma. GPs' words matter – they are a <a href="https://doi.org/10.1111/nbu.12320">trusted source</a> of health information. It’s critical GPs gain the skills to know when and how to have <a href="https://doi.org/10.1186/s12875-019-1026-4">positive weight conversations</a>.</p> <p>GPs need to offer supportive and affordable solutions. But effective specialist weight management programs are few and far between. More equitable access to programs is essential so GPs have referral pathways after conversations about weight.</p> <p>GPs' time is valuable. Activating this critical workforce is essential to meet the <a href="https://www.health.gov.au/resources/publications/national-obesity-strategy-2022-2032?language=en">National Obesity Strategy.</a></p> <p><em><a href="https://theconversation.com/au/team#fron-jackson-webb">Fron Jackson-Webb</a>, Deputy Editor and Senior Health Editor, <a href="http://www.theconversation.com/">The Conversation</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/should-gps-bring-up-a-patients-weight-in-consultations-about-other-matters-we-asked-5-experts-209681">original article</a>.</em></p>

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Too big, too heavy and too slow to change: road transport is way off track for net zero

<p><a href="https://theconversation.com/profiles/robin-smit-594126">Robin Smit</a>, <em><a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a></em></p> <p>The need to cut the emissions driving climate change is urgent, but it’s proving hard to decarbonise road transport in Australia. Its share of the nation’s total greenhouse gas emissions <a href="https://ageis.climatechange.gov.au/">doubled</a> from 8% in 1990 to 16% in 2020. New vehicles sold in Australia have <a href="https://theconversation.com/we-thought-australian-cars-were-using-less-fuel-new-research-shows-we-were-wrong-122378">barely improved</a> average emissions performance for the last decade or so.</p> <p>The federal government <a href="https://www.dcceew.gov.au/climate-change/publications/australias-emissions-projections-2022">publishes</a> emission forecasts to 2035 – 15 years short of 2050, the net-zero target date. Our <a href="https://www.transport-e-research.com/_files/ugd/d0bd25_7a6920bdd9e8448385863a7c23ec9ecf.pdf">newly published study</a> forecasts road transport emissions through to 2050. The estimated reduction by 2050, 35–45% of pre-COVID levels in 2019, falls well short of what’s needed.</p> <p>Our findings highlight three obstacles to achieving net zero. These are: Australia’s delay in switching to electric vehicles; growing sales of large, heavy vehicles such as SUVs and utes; and uncertainties about hydrogen as a fuel, especially for freight transport. These findings point to policy actions that could get road transport much closer to net zero.</p> <h2>How was this worked out?</h2> <p>Emissions and energy use vary from vehicle to vehicle, so reliable forecasting requires a detailed breakdown of the on-road fleet. Our study <a href="https://www.transport-e-research.com/software">used</a> the Australian Fleet Model and the net zero vehicle emission model (n0vem).</p> <p>The study focused on so-called <a href="https://www.cummins.com/news/2022/05/26/well-wheel-emissions-simplified">well-to-wheel emissions</a> from fuel production, distribution and use while driving. These activities account for about 75–85% of vehicle emissions. (<a href="https://theconversation.com/how-climate-friendly-is-an-electric-car-it-all-comes-down-to-where-you-live-179003">Life-cycle assessment</a> estimates “cradle-to-grave” emissions, including vehicle manufacture and disposal.)</p> <p>Working with European Union colleagues, our emissions simulation drew on an updated <a href="https://www.transport-e-research.com/_files/ugd/d0bd25_7a6920bdd9e8448385863a7c23ec9ecf.pdf">EU scenario</a> (EU-27) showing the changes in the EU vehicle fleet needed to meet the latest (proposed) CO₂ targets. Our study assumed Australia will be ten years behind the EU across all vehicle classes.</p> <p>We further modified the scenario to properly reflect Australian conditions. For instance, the EU has a much higher proportion of plug-in hybrid vehicles than Australia, where buyers are now bypassing them for wholly electric vehicles.</p> <h2>Energy use is shifting, but too slowly</h2> <p>Using this modified scenario, the simulation produces a forecast fall in total wheel-to-wheel emissions from Australian transport from 104 billion tonnes (Mt) in 2018 to 55-65Mt in 2050. Within the range of this 35–45% reduction, the outcome depends largely on the balance of renewable and fossil-fuel energy used to produce hydrogen.</p> <p>The modelling nonetheless predicts a large shift in energy use in road transport in 2050, as 2019 was basically 100% fossil fuels.</p> <p>The on-road energy efficiency of battery electric vehicles is roughly twice that of fuel cell electric (hydrogen) vehicles and roughly three times that of fossil-fuelled vehicles of similar type.</p> <p>The modelling results make this clear. In 2050, battery electric vehicles account for about 70% of total travel, but 25% of on-road energy use and only about 10% of total emissions.</p> <p>In contrast, fossil-fuelled vehicles account for about 25% of total travel in 2050, 60% of energy use and 75-85% of emissions. That’s even allowing for expected efficiency improvements.</p> <p>This means the shift to a mostly electric fleet by 2050 plus the use of hydrogen is predicted to fall short of what’s needed to get to net zero. It will require aggressive new policies to increase the uptake of electric vehicles across all classes.</p> <h2>Lighter vehicles make a big difference</h2> <p>But that is not the whole story. One neglected issue is the growing proportion of <a href="https://theconversation.com/we-may-be-underestimating-just-how-bad-carbon-belching-suvs-are-for-the-climate-and-for-our-health-190743">big, heavy passenger vehicles</a> (SUVs, utes). This trend is very noticeable in Australia. The laws of physics mean heavier vehicles need much more energy and fuel per kilometre of driving, and so produce more emissions.</p> <p>Currently, a large diesel SUV typically emits a kilogram of CO₂ for every 3 kilometres of driving, compared to 15km for a light electric vehicle and 200 kilometres for an e-bike. An average electric vehicle currently emits 1kg of CO₂ every 7km.</p> <p>This distance is expected to be around 60km in 2050, when renewables power the electricity grid. A lightweight electric car will more than double the distance to 125km per kilogram of CO₂. Reducing vehicle weights and optimising energy efficiency in transport will be essential to meet emission targets.</p> <p>The study modelled the impacts of <a href="https://www.automotiveworld.com/special-reports/vehicle-lightweighting-2/">lightweighting</a> passenger vehicles while keeping buses and commercial vehicles the same. If Australians had driven only small cars in 2019 for personal use, total road transport emissions would have been about 15% lower.</p> <p>The reduction in emissions from simply shifting to smaller cars is <a href="https://www.dcceew.gov.au/climate-change/publications/national-greenhouse-accounts-2019/national-inventory-report-2019">similar to</a> emissions from domestic aviation and domestic shipping combined. Importantly, lightweighting cuts emissions for all kinds of vehicles.</p> <h2>The uncertainties about hydrogen</h2> <p>Fuel cell electric vehicles using hydrogen account for only a few percent of all travel, but most will likely be large trucks. As a result, in our scenarios, they use a little over 10% of total on-road energy and produce 5-20% of total emissions, depending on the energy source used for hydrogen production and distribution.</p> <p>The modified EU scenario includes a significant uptake of hydrogen vehicles by 2050. That’s by no means guaranteed.</p> <p>The uptake in Australia has been negligible to date. That’s due to costs (vehicle and fuel), the need for new hydrogen fuel infrastructure, less mature technology (compared to battery electric vehicles) and limited vehicle availability. <a href="https://theconversation.com/we-must-rapidly-decarbonise-transport-but-hydrogens-not-the-answer-166830">Unresolved aspects</a> of hydrogen in transport include lower energy efficiency, the <a href="https://theconversation.com/for-australia-to-lead-the-way-on-green-hydrogen-first-we-must-find-enough-water-196144">need for clean water</a>, uncertainty about leakage, fuel-cell durability and value for consumers.</p> <h2>How do we get back on track?</h2> <p>Our study suggests Australia is on track to miss the net-zero target for 2050 mainly because of the large proportions of fossil-fuelled vehicles and large and heavy passenger vehicles.</p> <p>These two aspects could become targets for new policies such as public information campaigns, tax incentives for small, light vehicles, bans on selling fossil fuel vehicles and programs to scrap them. Other options to cut emissions include measures to reduce travel demand, optimise freight logistics and shift travel to public transport, to name a few.</p> <p>The study confirms the scale of the challenge of decarbonising road transport. Australia will need “all hands on deck” – government, industry and consumers – to achieve net zero in 2050.<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/208655/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/robin-smit-594126">Robin Smit</a>, Adjunct Associate Professor, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a></em></p> <p><em>Image credits: </em><em>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/too-big-too-heavy-and-too-slow-to-change-road-transport-is-way-off-track-for-net-zero-208655">original article</a>.</em></p>

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Astonishing report identifies Covid’s alleged “patient zero”

<p>A bombshell report has claimed the infamous Covid-19 "patient zero” was a Wuhan scientist carrying out experiments on souped-up coronaviruses.</p> <p>The scientist in question, Ben Hu, was conducting risky tests at the Wuhan Institute of Virology with two colleagues, Ping You and Yan Zhu, the report states.</p> <p>It is understood that all three suffered Covid-like symptoms and required hospital care weeks before China broke the news of the virus outbreak to the rest of the world.</p> <p><em>The Sun</em> reported that the name of “patient zero" has never been disclosed until now.</p> <p>Many US government officials have now identified the three scientists in a shocking report by journalists Michael Shellenberger and Matt Taibbi.</p> <p>Writing in the Substack newsletter <em>Public</em>, the pair alleged the scientists were experimenting with coronaviruses when they fell ill in 2019.</p> <p>Several experts and intelligence officials have long suspected scientists at the lab accidentally spread the virus during so-called “gain of function” experiments on bat coronaviruses.</p> <p>The naming of “patient zero” could prove to be the smoking gun, only adding to mounting circumstantial evidence of a lab leak.</p> <p>It is unclear who in the US government had the intelligence about the sick lab workers, how long they had it, and why it was not shared with the public.</p> <p><em>The Australian</em> journalist and <em>Sky News</em> host Sharri Markson spoke to <em>The Sun</em> about the lab leak theory in 2021 and dubbed it an “explosive development”.</p> <p>Jamie Metzl, a former member of the World Health Organisation advisory committee on human genome editing, described it as a possible “game changer”.</p> <p>“It’s a game changer if it can be proven that Hu got sick with Covid before anyone else,” he said.</p> <p>“That would be the ‘smoking gun’. Hu was the lead hands-on researcher in (virologist Shi Zhengli’s) lab.”</p> <p>DRASTIC, an international team of scientists and sleuths attempting to piece together Covid-19’s origins, researched the three scientists in 2021.</p> <p>The Wuhan Institute of Virology’s website lists Hu’s biography showing he was working as an assistant researcher.</p> <p>He was said to be the “star pupil” of virologist Shi Zhengli — the virologist at the lab who became known as “batwoman” for her research on bat coronaviruses.</p> <p>Markson, the author of <em>What Really Happened in Wuhan</em>, said that Hu was running a state-funded project in 2019 to test if new coronaviruses could infect humans.</p> <p>The study involved souping up the viruses and experimenting with them on humanised mice.</p> <p>However, the results were never published and the study’s existence was erased from the internet as Covid-19 was spreading around the globe, which raised suspicion of a possible lab leak.</p> <p>A source told <em>The Sun</em> that footage from 2017 that was aired by Chinese state-run TV showed Hu working in the lab without protective gear.</p> <p>The same video shows scientists from the Wuhan lab searching for bat viruses with inadequate protective gear.</p> <p>Alina Chan, a molecular biologist at MIT and Harvard, told <em>Public</em>, “Ben Hu is essentially the next Shi Zhengli.</p> <p>“He was her star pupil. He had been making chimeric SARS-like viruses and testing these in humanised mice.</p> <p>“If I had to guess who would be doing this risky virus research and most at risk of getting accidentally infected, it would be him.”</p> <p>She noted, “If this info had been made public in May of 2020, I doubt that many in the scientific community and the media would have spent the last three years raving about a raccoon dog or pangolin in a wet market.”</p> <p>US scientist Dr Steven Quay, “He was always my first choice for one of the infected Wuhan Institute of Virology workers but it seemed too simple.”</p> <p>A bill signed by US President Joe Biden in 2023 called for the release of the names of the sick scientists, their symptoms, and whether they had been involved with or exposed to coronavirus research.</p> <p>The US is currently preparing to release previously classified material, which could include the names of the three Wuhan scientists.</p> <p>Earlier in 2023, FBI director Christopher Wray said, “the FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident in Wuhan”.</p> <p>China has long been accused of attempting to cover up or distort its involvement with Covid-19, but they continue to deny claims.</p> <p>In March 2023, China’s former government scientist confessed the Wuhan lab leak theory shouldn’t be ruled out, sparking uproar in Beijing.</p> <p>Professor George Gao, the former chief of China’s Centre for Disease Control, played a key role in the efforts to trace the origins of Covid-19, insisting scientists should “suspect anything”.</p> <p>Speaking to the BBC Radio 4 podcast <em>Fever: The Hunt for Covid’s Origin</em>, Professor Gao said, “You can always suspect anything. That’s science.</p> <p>“Don’t rule out anything.”</p> <p>Professor Gao retired from the CDC in 2022 after playing a key role in the pandemic response and efforts to find the mysterious origin of the virus.</p> <p>He would have had access to highly classified government information on the outbreak of Covid-19.</p> <p>According to Professor Gao, a formal investigation into the Wuhan Institute of Virology was carried out by a government department.</p> <p>The government scientist claimed the “lab was double-checked by the experts in the field”.</p> <p>Investigators believe scientists were working with the Chinese military to develop a mutant virus and pursue bioweapons just as the pandemic began.</p> <p>The findings followed a team of US investigators who combed through top-secret intercepted communications and research.</p> <p>In 2016, researchers discovered a new fatal type of coronavirus in a mineshaft in Mojiang, Yunnan province.</p> <p>However, they kept it under wraps, with the sample then transported to the Wuhan lab and dubbed as classified work.</p> <p>The virus is the only known immediate relative of Covid-19 known to exist prior to the pandemic.</p> <p>Speaking to<em> The Times</em>, one US investigator said, “The trail of papers starts to go dark.</p> <p>“That’s exactly when the classified program kicked off.</p> <p>“My view is that the reason it was covered up was due to military secrecy related to the army’s pursuit of dual-use capabilities in virological biological weapons and vaccines.”</p> <p>The findings came after a scientist who worked closely with the Wuhan lab claimed the virus was genetically engineered and leaked from the facility.</p> <p><em>Image credit: Getty</em></p>

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Movies that received zero stars

<p>There are good movies, so-so movies and bad movies. Is there anything worse, though, than a bad movie? Yes, there is. And I have seen my share.</p> <p>For decades, <em>Newsday </em>has used a four-star rating system for its film reviews. When I became the paper's movie critic in 2008, I had to figure out how to approach this system. Obviously, it's rare to see a four-star movie – even if it's not <em>Citizen Kane</em>, it has to be something truly outstanding.</p> <p>Three stars signals a wholehearted recommendation, though not exactly a masterpiece. Many movies fall into the two-and-a-half-star range: They're just meh. Tougher to call is the one-star or half-star movie – how do you decide between a D grade and a D-minus?</p> <p>Then there's the nuclear option: zero stars. What makes a movie so awful that it deserves zero stars? Like the four-star movie, this is a rare breed.</p> <p>This is a movie whose redeeming qualities are either infinitesimal or non-existent. It's a movie that fails so spectacularly it doesn't get credit for decent lighting or being in focus. A zero-star movie doesn't even get credit for existing.</p> <p>Every zero-star movie is unique in its own way, but over the years I've noticed that the worst of the worst tend to fall into a few different categories.</p> <p>Here are four examples.</p> <p><strong>Vanity projects</strong></p> <p>It's easy to poke fun at A-list stars and their outsize egos, but they often bring it upon themselves. Remember when John Travolta thought that <em>Battlefield Earth</em> would turn us all into Scientologists? Or when Mariah Carey played a version of herself in <em>Glitter</em>? Remember almost every movie Madonna ever made?</p> <p>For sheer self-centredness, though, nothing beats last year's <em>By the Sea</em>, written and directed by Angelina Jolie-Pitt and starring herself and her husband, Brad. (They produced it as well.) They play an American writer and his wife who stay in a beachside French hotel during the 1970s.</p> <p>He's depressed, she's depressed, they never have sex. With little dialogue and even less action, the movie mostly features the two stars standing around in chic outfits, smoking cigarettes and gazing with despair upon million-dollar views of the coast.</p> <p>Kinder critics praised the cinematography and scenery, but I couldn't find a reason to give this extended Chanel No. 5 commercial even a half-star. I figured the two actors got enough gratification just admiring themselves on screen for two hours.</p> <p><strong>Insults to intelligence</strong></p> <p>Filmmakers often assume their audiences will swallow just about anything. In the sci-fi failure <em>Transcendence</em>, Johnny Depp uploaded his consciousness into the cloud – a literal one, in the sky. (I gave that movie a half-star for sheer nuttiness.)</p> <p>In the zero-star fantasy<em> Jupiter Ascending</em>, the Wachowskis told the story of a housemaid (Mila Kunis) who sells her eggs to buy a telescope but discovers she's a princess. These movies took years to make, yet we spotted their idiocy within minutes.</p> <p>Then there's <em>Aloha</em>, Cameron Crowe's zero-star comedy-drama from 2015.</p> <p>Among its many terrible ideas were casting Emma Stone as a native Hawaiian (as if nobody would notice?), hoping we'd swoon when Bradley Cooper says cheesy things like "Would you stop getting more beautiful?" and creating a baffling climax in which an orbiting space object is destroyed by rock music.</p> <p>Filmmakers tend to be smart people, but moviegoers are no dopes, either.</p> <p><em>Aloha </em>made just US$26.3 million on its US$37 million budget, one of the year's major flops.</p> <p><strong>Lapses in taste</strong></p> <p>Taste is subjective, of course, but some movies cross a line just to cross it. Adam Sandler's zero-star comedy <em>That's My Boy </em>(2012), whose plot hinged on statutory rape and incest, marked a new low – until Peter Farrelly reset the bar with<em> Movie 43</em>.</p> <p>An anthology comedy spearheaded by Farrelly with several directors and writers, <em>Movie 43</em> (2013) rounds up more than a dozen A-list stars in an orgy of nastiness and vulgarity.</p> <p>Among the more hideous highlights are Chris Pratt and his real-life wife, Anna Faris, as lovers with a scatological fetish; Richard Gere as the CEO of a product that hacks off its customers' penises; and Chloe Grace Moretz as a teenager getting her period.</p> <p>"Once you see it, you can't unsee it," the trailers promised.</p> <p>As for the cast, they probably wish they could un-be in it.</p> <p><strong>Sheer ineptitude</strong></p> <p>Finally, some movies are so badly made that they barely qualify as movies. <em>Left Behind</em>, for instance, a faith-based rapture-fantasy starring Nicolas Cage, was so sloppy and disorganised that it literally couldn't keep track of night and day.</p> <p>At least that film was made by relative amateurs. <em>The Last Airbender</em> (2010), a fantasy-adventure based on the Nickelodeon series, was directed by M Night Shyamalan, the maestro who gave us <em>The Sixth Sense</em>. Here, Shyamalan completely loses his ability to coherently tell the story of Aang (Noah Ringer), a boy with mystical powers trying to unite four tribes. The dialogue is so crammed with fictional exposition that the actors sound like they're reading a Pokemon manual, while the choppy editing seemed almost random.</p> <p>Not even the special effects deserved a half-star: The postproduction 3-D made the whole movie look as flat as a View-Master slide. With its US$150 million budget, <em>The Last Airbender</em> was an inexcusable, zero-star disaster.</p> <p>As a last note, a truly terrible movie is just as exceptional as a truly great one, and in some ways just as fascinating. It's my job, though, to sit through them so you don't have to.</p> <p>You're welcome.</p> <p><strong>THE WORST OF THE WORST</strong></p> <p><strong>10. <em>All About Steve</em> (2009)</strong></p> <p>There's a reason you've never heard of this romantic comedy starring A-listers Sandra Bullock and Bradley Cooper: It's because she plays an irritating crossword fanatic and he plays an uninteresting person. In terms of on-screen chemistry, they're the equivalent of bleach and ammonia.</p> <p><strong>9. <em>Moms' Night Out</em> (2014)</strong></p> <p>This botched comedy (starring Trace Adkins and Patricia Heaton) stands out for many things, but one is a technical reason: The filmmakers somehow managed to capture the weirdest, ugliest facial expression on nearly every actor in nearly every scene. It's like a 90-minute flip-book of ruined family photos.</p> <p><strong>8. <em>Jem and The Holograms</em> (2015)</strong></p> <p>Aubrey Peeples plays an aspiring singer who is shocked – shocked! – to discover that global stardom requires personal and artistic sacrifice. File this movie's profound message under Things a 9-Year-Old Could Have Told You.</p> <p><strong>7. <em>Remember Me</em> (2010)</strong></p> <p>In this saccharine yet creepy romance, Robert Pattinson plays a young, moody guy – no stretch there – who sleeps with a woman to get revenge on her father. Aww, how cute! The plot also hinges on the World Trade Centre attacks. Double cute!</p> <p><strong>6. <em>Jupiter Ascending</em> (2015)</strong></p> <p>This sci-fi fantasy from the Wachowskis (The Matrix) defies description, but here's an attempt: A humble house-cleaner (Mila Kunis) discovers she's a galactic princess thanks to a part-wolf warrior (Channing Tatum). It's a statistical marvel whose 127 minutes include not a single good idea.</p> <p><strong>5. <em>Rock The Kasbah</em> (2015)</strong></p> <p>A washed-up rock manager (Bill Murray) decides to make a pop star out of an Afghan singer (Leem Lubany). Magically, she reverses centuries of religious and cultural stigmas by performing the songs of Cat Stevens, now known as Yusuf Islam. Possibly the most misguided comedy ever made.</p> <p><strong>4. <em>Aloha </em>(2015)</strong></p> <p>Cameron Crowe's cloying romance stars Bradley Cooper as an ex-military man trying to bed a happily married woman (gross!) while flirting with a native Hawaiian (played by Emma Stone?) and trying to stop an outer-space missile (say what?). The movie is so wide of the mark that you can't even tell where it was aiming.</p> <p><strong>3. <em>Movie 43</em> (2013)</strong></p> <p>Richard Gere, Halle Berry, Kate Winslet, Hugh Jackman and many other talented people run through the most repulsive, unimaginative and unfunny skits ever filmed. The whole thing almost literally stinks. <em>Movie 43</em> currently holds a difficult-to-attain 4 per cent rating on RottenTomatoes.com.</p> <p><strong>2. <em>The Last Airbender</em> (2010)</strong></p> <p>M Night Shyamalan's fantasy-adventure is so disjointed and disorganised that you might think the reels got mixed up – possibly with a whole other movie. You could watch it 10 times and still not understand a thing, though by then you'd have gone permanently insane.</p> <p><strong>1. <em>By The Sea</em> (2015)</strong></p> <p>Think back to the most pretentious European art-film you've ever had to endure. Now imagine Angelina Jolie making that movie, and you've got <em>By the Sea</em>, starring herself and Brad Pitt as depressed Americans who visit France and smoke a lot. Remember how Jean-Paul Sartre said hell is other people? That's because he hadn't seen this movie.</p> <p><em>Written by Rafer Guzman. First appeared on <a href="http://Stuff.co.nz" target="_blank" rel="noopener"><strong><span>Stuff.co.nz</span></strong></a>.</em></p> <p><em>Images: Columbia Pictures</em></p>

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Lucid dying - what some patients experience as they’re going through CPR

<p>A study of people who received cardiopulmonary resuscitation (CPR) in hospital has found that some of them had what’s being dubbed “lucid experiences of death,” accompanied by spikes in brain activity.</p> <p>The research found that roughly one in five CPR survivors described unique experiences, including feeling separated from their bodies, observing the events without pain or distress, and a meaningful evaluation of life.</p> <p>These experiences were different to hallucinations, dreams, or CPR-induced consciousness, according to the researchers, who presented their findings at the American Heart Association’s Scientific Sessions 2022 conference.</p> <p>The international team of researchers collected data on 567 patients whose hearts stopped beating, in UK and US hospitals, between May 2017 and March 2020.</p> <p>While they were all treated immediately, fewer than 10% of these people were ultimately discharged from hospital.</p> <p>In addition to hearing the patients’ experiences, the researchers observed spikes in brain activity – specifically, in so-called gamma, delta, theta, alpha and beta waves.</p> <p>In some cases, these activity spikes were observed when CPR had been going on for up to an hour.</p> <p>“These recalled experiences and brain wave changes may be the first signs of the so-called near-death experience, and we have captured them for the first time in a large study,” says lead investigator Dr Sam Parnia, an intensive care physician and associate professor in the Department of Medicine at New York University Langone Health, US.</p> <p>“Our results offer evidence that while on the brink of death and in a coma, people undergo a unique inner conscious experience, including awareness without distress.”</p> <p>While plenty of people have personal accounts of near-death experiences before, they’re difficult to judge empirically.</p> <p>“These lucid experiences cannot be considered a trick of a disordered or dying brain, but rather a unique human experience that emerges on the brink of death,” says Parnia.</p> <p>It may be linked to disinhibition – the release of barriers in the brain as it shuts down.</p> <p>The researchers are keen to investigate the lucid dying experiences further.</p> <p><strong>This article originally appeared on <a href="https://cosmosmagazine.com/health/lucid-dying-cpr/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Ellen Phiddian.</strong></p> <p><em>Image: Shutterstock</em></p>

Mind

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Not “your average beanie”: Smart Aussie invention to help stroke and trauma patients

<p dir="ltr">A new ‘smart helmet’ packed with tech is being developed to monitor brains of patients who have suffered a stroke, injury or trauma by a team of Australian scientists and developers thanks to funding from the Victorian government.</p> <p dir="ltr">Patients with these kinds of injuries often experience brain swelling and have parts of their skull removed to prevent the brain from pushing on structures such as the brainstem, the part of the brain that regulates the cardiovascular and respiratory systems, <a href="https://www.urmc.rochester.edu/news/story/brain-drowns-in-its-own-fluid-after-a-stroke" target="_blank" rel="noopener">which can be fatal</a>.</p> <p dir="ltr">The SkullPro, developed by Anatomics Pty Ltd and the CSIRO, is a customised protective helmet that includes sensors that relay data back to the patient’s neurosurgeon to help them determine the best time to repair the skull.</p> <p dir="ltr">With the helmet, the conditions of patients’ brains can be monitored while they recover at home.</p> <p><span id="docs-internal-guid-c30fb9f0-7fff-5de6-6b83-53be40564edb"></span></p> <p dir="ltr">Neurosurgeons can monitor their brain function in real time thanks to a ‘brain machine interface’ developed using machine learning, advanced sensors and microelectronics.</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/p/CDApuNgj68s/?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/p/CDApuNgj68s/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by Anatomics (@anatomicsrx)</a></p> </div> </blockquote> <p dir="ltr">Victorian Premier Daniel Andrews announced that Anatomics’ development of the helmet would be among 11 Victorian medical technology products funded through the latest round of MedTech grants.</p> <p dir="ltr">“This isn’t your average beanie. This is a Smart Helmet,” Mr Andrews <a href="https://www.facebook.com/DanielAndrewsMP/posts/pfbid02SJfjW1BcypXz8ubJHtQUTPvG349spbWAch4Eib1nguHedjAH1fFhWg4DaPJ9V5kNl" target="_blank" rel="noopener">wrote</a> on social media.</p> <p dir="ltr">“It helps monitor the brains of patients who've had a stroke or suffered traumatic brain injury. It lets doctors know how the brain is healing and helps surgeons decide on the ideal time to perform operations on the skull to give patients the best possible chance of a full recovery. It's been researched, designed and manufactured right here in Bentleigh East by Anatomics.</p> <p dir="ltr">“It's the kind of technology that doesn't just save lives – it changes lives too.”</p> <p dir="ltr">Mr Andrews added that the series of grants would help support “Victorian innovation” and create jobs.</p> <p dir="ltr">“We're backing Anatomics and 11 other Victorian medical technology manufacturers with a new round of MedTech grants. Creating jobs and supporting Victorian innovation,” the post continued.</p> <p dir="ltr"><span id="docs-internal-guid-2c713391-7fff-9b9e-2205-2217707d9715"></span></p> <p dir="ltr">“That's something we can all get behind.”</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/p/B8xqoDDnORs/?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/p/B8xqoDDnORs/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by Anatomics (@anatomicsrx)</a></p> </div> </blockquote> <p dir="ltr">The team developing the SkullPro hope it will lay the foundation for research relating to brain injuries, diagnostics, and treatments in Australia.</p> <p dir="ltr">In a <a href="https://www.anatomics.com/au/news/2020/07/24/smart-skullpro.html" target="_blank" rel="noopener">statement</a>, Professor Paul D’Urso, a neurosurgeon and the founder of Anatomics, said the grant would “greatly benefit brain injured patients throughout the world”.</p> <p dir="ltr">"The recently announced funding through MTPConnect’s BioMedTech Horizons program will allow Anatomics and CSIRO to lay the foundations for advanced diagnostics and therapies for decades to come that will greatly benefit brain injured patients through-out the world,” he said.</p> <p dir="ltr">"We should all be proud of the pioneering R&amp;D (Research &amp; Development) that has already occurred in Australia and the opportunities that this grant will deliver to our future."</p> <p dir="ltr"><span id="docs-internal-guid-bb14f8a1-7fff-b6d7-650f-abcedbfc94fc"></span></p> <p dir="ltr"><em>Image: @anatomicsrx (Instagram)</em></p>

Mind

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You’re less likely to die if you’re treated in your own language

<div> <p>Hospital patients who speak the same language as their physicians end up healthier, according to new research.</p> <p>The study, which was <a href="https://doi.org/10.1503/cmaj.212155" target="_blank" rel="noreferrer noopener">published</a> in the Canadian Medical Association Journal, found that hospital patients had shorter stays and were less likely to die, fall, or catch infections during their treatment if they had a physician speaking their language.</p> <p>The researchers examined medical records for home-care care recipients in Ontario, Canada, between 2010 and 2018. In total, they looked at 189,690 records.</p> <p>A third of Ontario’s population doesn’t speak English as a first language. Among these home-care recipients, 84% were English speakers (Anglophones), 13% spoke French (Francophones) and 2.7% spoke other languages (Allophones).</p> <p>The researchers examined whether these patients were treated by a physician who spoke their first language (language concordant) or didn’t (language discordant).</p> <p>“We found that patients who received language-discordant care had more adverse events (such as falls and infections), longer hospital stays and were more likely die in hospital,” the researchers told Cosmos over email.</p> <p>Francophones treated by a French speaker were 24% less likely to die, while Allophones’ chances of death dropped by 54% when they had language-concordant care.</p> <p>The authors float a few reasons for this disparity. Previous studies have shown that better patient-physician communication leads to faster and more accurate diagnoses, and more patient cooperation – both of which have better health outcomes on average. Language discordance, on the other hand, correlates to cultural differences between patients and healthcare workers, which is typically bad for patients.</p> <p>“These are staggering findings that make a strong case for providing care in the same language for linguistic minorities in hospitals,” says co-author Dr Peter Tanuseputro, a physician scientist in the Department of Medicine of The Ottawa Hospital, Institut du Savoir Montfort and Bruyère Research Institute, Ottawa, Ontario.</p> <p>“It’s clearly easier to convey important information about your health in your primary language. Regardless, the more than doubling in odds of serious harms, including death, for patients receiving care in a different language is eye-opening.”</p> <p>Just 44% of Francophones and under 2% of Allophones received care from physicians who spoke their language. For comparison, 58% of physicians in the study spoke English exclusively.</p> <p>“We expect these disparities to be more pronounced in linguistically diverse populations for the following reason: the odds of receiving care from a physician who speaks your primary language decreases if there are more linguistic groups in the population,” the researchers told Cosmos.</p> <p>“We believe that the results of our study highlight the importance of identifying patients who live in minority language communities so that appropriate strategies can be implemented to increase the provision of language-concordant care to these patients.”</p> <p>This means hospitals should ask patients what languages they speak, establish directories of their staff’s language proficiencies, refer patients to doctors who share their languages, and use professional interpreters.</p> <p>“Furthermore, a healthcare system’s ability to provide language-concordant care depends on the languages spoken by physicians, which should match that of the general population,” say the researchers.</p> <p>“This could be optimised by recruiting physicians with specific language proficiencies, and by dedicating resources to increase opportunities for medical education among minority language communities.”</p> <p><em>Image credits: Getty Images</em></p> <p><em><!-- End of tracking content syndication --></em></div> <div id="contributors"> <p><em>This article was originally published on <a href="https://cosmosmagazine.com/health/language-hospitals-care/" target="_blank" rel="noopener">cosmosmagazine.com </a>and was written by Ellen Phiddian. </em></p> </div>

Mind

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Moral injury: what happens when exhausted health workers can no longer provide the care they want for their patients

<p>Healthcare workers in New Zealand already face life-and-death decisions daily. But as multiple winter illnesses add pressure to a system already stretched by COVID, staff now also have to deal with <a href="https://www.stuff.co.nz/national/politics/local-democracy-reporting/300534812/covid19-union-and-frontline-worker-say-staff-at-middlemore-hospital-facing-increasing-abuse" target="_blank" rel="noopener">daily abuse</a>, acute <a href="https://www.newshub.co.nz/home/new-zealand/2022/05/christchurch-hospital-cancels-surgeries-as-it-hits-112-pct-capacity.html" target="_blank" rel="noopener">staff shortages</a> and <a href="https://www.1news.co.nz/2022/06/17/dhb-clashes-with-union-over-stretched-palmerston-north-ed/" target="_blank" rel="noopener">unsafe working conditions</a>. At times, they cannot provide the care they would like for their patients.</p> <p>The impact on health workers is often described as <a href="https://www.nzherald.co.nz/rotorua-daily-post/news/great-minds-health-workers-on-covid-19-frontlines-burnt-and-bled-by-two-years-of-virus/T7JXOXGXEKKCICUNOMUJYT4QWM/" target="_blank" rel="noopener">stress and burnout</a>. The consequences of this prolonged pressure can be seen in the number of <a href="https://www.nzdoctor.co.nz/article/undoctored/acem-welcomes-111b-health-nz-budget-urges-fixes-health-workforce-crisis" target="_blank" rel="noopener">doctors</a>, <a href="https://www.nzherald.co.nz/nz/nursing-shortage-nurses-broken-while-sector-faces-thousands-of-vacancies/L7NUXOPG4AB472OKXOH5QJSUMU/" target="_blank" rel="noopener">nurses</a> and other <a href="https://capsulenz.com/be/therapist-shortage-nz/" target="_blank" rel="noopener">health professionals</a> leaving their jobs for overseas positions and the private sector, or being lost to their professions completely.</p> <p>Many of these healthcare workers may well be suffering from a more serious form of psychological distress than burnout: moral injury.</p> <p><a href="https://www.phoenixaustralia.org/wp-content/uploads/2020/07/Moral-Stress-Healthcare-Workers-COVID-19-Guide-to-Moral-Injury.pdf" target="_blank" rel="noopener">Moral injury</a> refers to the psychological, social and spiritual impact of events on a person who holds strong values (such as caring for patients) and operates in high-stakes situations (hospital emergency care), but has to act in a way inconsistent with those values.</p> <p>Examples include having to turn patients away despite them being in pain or discomfort; being unable to provide adequate care due to staff shortages; having to care for a dying patient isolated from their loved ones while wearing full protective gear.</p> <p>Symptoms of moral injury can include strong feelings of guilt and shame (about not being able to uphold healthcare values, for example) as well as high levels of anger and contempt towards the system that prevents proper care.</p> <p>High levels of self-criticism, loss of trust in people and organisations and a weakening of personal relationships are further <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00113-9/fulltext" target="_blank" rel="noopener">symptoms</a> of moral injury.</p> <p>It can be viewed as a <a href="https://www.afta.org/wp-content/uploads/2019/07/Physicians-aren%E2%80%99t-%E2%80%98burning-out.%E2%80%99-They%E2%80%99re-suffering-from-moral-injury..pdf" target="_blank" rel="noopener">more severe form of burnout</a>. But while burnout can happen in most workplaces, moral injury requires the three core components listed above.</p> <p><strong>From war to the operating table</strong></p> <p>The term moral injury arose in <a href="https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp" target="_blank" rel="noopener">military psychology</a> to refer to situations where, for example, soldiers were unable to intervene to save lives in case they risked breaching the rules of engagement. More recently, the term has been adapted to apply to healthcare.</p> <p>Viewing the experiences of health workers through this lens can help us understand why they may experience a seesawing emotional state and the confusing conflict of simultaneously wanting to be at work while wishing they were anywhere but.</p> <p>For healthcare workers, understanding the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752815/#:%7E:text=Over%20time%2C%20these%20repetitive%20insults,is%20in%20some%20way%20deficient" target="_blank" rel="noopener">concept of moral injury</a> may help reframe it as something that is happening to them rather than because they don’t have the skills to cope. The latter can sometimes be a mistaken implication of the term burnout.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Exhausted nurse" /><figcaption><span class="caption">Staff shortages can take health workers beyond exhaustion and burnout.</span> <span class="attribution">Getty Images</span></figcaption></figure> <p>While healthcare workers are largely at the mercy of the organisations they work for, there are some steps individuals can take to alleviate moral injury. Firstly, simply recognising they may be suffering from this condition can reduce confusion and validate their experiences.</p> <p>Secondly, reconnecting back to an individual’s values and beliefs can help refocus and re-energise, at least temporarily. Reminding themselves why they got into this job in the first place is a useful place to start.</p> <p><strong>Organisational responses</strong></p> <p>Organisations and businesses must play a lead role in preventing and treating moral injury. Many of the factors leading to it (lack of resources or staff, a pandemic or peak flu season) are outside the control of individuals.</p> <p>Most modern businesses will be aware they have a legal responsibility under the 2015 <a href="https://www.legislation.govt.nz/act/public/2015/0070/latest/DLM5976660.html" target="_blank" rel="noopener">Health and Safety at Work Act</a> to look after their employees’ mental and physical well-being.</p> <p>At a high level, organisations can advocate for systemic change and increases in funding and resourcing, where needed. But these higher-level changes take time to achieve. In the meantime, it is important healthcare workers are protected and supported.</p> <p>Broad steps an organisation can take to prevent or reduce moral injury include removing the burden of difficult ethical decisions from frontline workers and instead adopting evidence-based policies to guide an organisation-wide response. Where possible, rotating staff between high and low-stress environments may help.</p> <p>Providing funding for workers to access professional psychological supervision is another practical step businesses can consider. At a team level, it can be helpful to have leaders who are visible, validating and can help make sense of the moral conflict. Leaders can also play a role in keeping alive professional values and modelling their own struggles with the situation.</p> <p>The general public also has a role to play in supporting healthcare workers. Any steps we can take to protect our own health and thereby reduce pressure on the system can have a cumulative effect on the well-being of doctors, nurses and allied health clinicians. The health of our nation rests with those who work in this field and it is in all our interest that their health is protected and prioritised.<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/185485/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/dougal-sutherland-747623" target="_blank" rel="noopener">Dougal Sutherland</a>, Clinical Psychologist, <a href="https://theconversation.com/institutions/te-herenga-waka-victoria-university-of-wellington-1200" target="_blank" rel="noopener">Te Herenga Waka — Victoria University of Wellington</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com" target="_blank" rel="noopener">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/moral-injury-what-happens-when-exhausted-health-workers-can-no-longer-provide-the-care-they-want-for-their-patients-185485" target="_blank" rel="noopener">original article</a>.</em></p> <p><em>Image: Getty Images</em></p>

Caring

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Cancer patients go untreated due to hospital debts

<p dir="ltr">A cancer centre in Palestine is turning away patients for the first time in its history, with some 500 patients turned away since September last year for one reason - it’s owed $96 million ($NZ 105 million).</p> <p dir="ltr">The cancer unit in the Augusta Victoria Hospital in eastern Jerusalem is owed the funds from the Palestinian Authority (PA) and is unable to buy the chemotherapy drugs needed to treat patients, according to the <em><a href="https://www.bbc.com/news/world-middle-east-60829319" target="_blank" rel="noopener">BBC</a></em>.</p> <p dir="ltr">“It’s the first time in our history that we’ve been forced to take the decision not to accept new patients,” Dr Fadi al-Atrash, the hospital’s deputy CEO, told the <em>BBC</em>.</p> <p dir="ltr">“We’re facing a very critical situation where we might be forced to close some departments in future. We might have to stop the treatment of patients already in our care.</p> <p dir="ltr">“It means that more people might die of cancer because they’re not receiving their treatment on time, or according to the right schedule.”</p> <p dir="ltr">A lack of funds for healthcare isn’t the only problem for the PA, which says it’s facing the worst financial crisis since it began 30 years ago, due to a combination of the pandemic, inflation and the Palestinian conflict with Israel.</p> <p dir="ltr">Salem al-Nawati, a 16-year-old with leukaemia from Gaza, collapsed outside the PA Health Ministry in Ramallah earlier in the year and was declared dead soon after.</p> <p dir="ltr">His uncle, Jamal al-Nawati, was fighting to secure a hospital bed for Salem, and detailed the barriers his nephew faced in accessing treatment.</p> <p dir="ltr">Since hospitals in Gaza are ill-equipped to treat many serious cases of cancer, Salem was given a medical referral and PA financial guarantee for treatment in a private hospital in Nablus.</p> <p dir="ltr">However, after being initially refused a travel permit by Israel, Salem arrived for treatment a month later and was turned away from the Nablus hospital because its bills hadn’t been paid by the PA.</p> <p dir="ltr">“I was wondering what we’d done wrong, what had this poor patient ever done?” Mr al-Nawati said.</p> <p dir="ltr">“Salem’s condition was deteriorating hour-by-hour, day-by-day. He was so sad, asking me why he was being refused treatment, and I was doing my best to reassure him.”</p> <p dir="ltr">Though an influential family friend intervened, resulting in the PA offering to send Salem to an Israeli hospital, his permit didn’t allow him to travel there.</p> <p><span id="docs-internal-guid-b31a38f8-7fff-8814-5572-e68c5e23bcab"></span></p> <p dir="ltr"><em>Image: Getty Images</em></p>

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Some Covid patients develop resistance to Sotrovimab treatment

<p dir="ltr">As treatments continue to be developed for patients with COVID-19, some scientists have found that one in particular may cause the virus to mutate so that it becomes harder to treat.</p> <p dir="ltr">A team of Australian researchers analysed samples from the first 100 people to be treated with Sotrovimab - an increasingly popular treatment that targets the Omicron variant and prevents severe COVID-19 symptoms - only to make some interesting findings.</p> <p dir="ltr">They took samples from the patients before and after they were treated with Sotrovimab and sequenced the genome of the virus in each sample.</p> <p dir="ltr">In four of the patients, the team found that the virus had mutated in ways that made it more resistant to treatment within 13 days of treatment.</p> <p dir="ltr">“We discovered that the virus that causes COVID-19 can develop mutations within the patient several days after Sotrovimab treatment, which reduces the effectiveness of this treatment by greater than 100-fold,” Dr Rebecca Rockett, a Sydney researcher in infectious disease and co-author of the study, <a href="https://www.scimex.org/newsfeed/covid-19-patients-can-develop-resistance-to-treatment-with-sotrovimab" target="_blank" rel="noopener">said</a>.</p> <p dir="ltr">This research, published in the <em><a href="https://www.nejm.org/doi/10.1056/NEJMc2120219" target="_blank" rel="noopener">New England Journal of Medicine</a></em>, is the first to show the mutations in clinical models, with previous research finding the mutations developed in animal models and when growing the virus in a lab setting.</p> <p dir="ltr">With this finding, the researchers are calling for the use of Sotrovimab to be monitored to prevent treatment-resistant versions of the virus from spreading in the community.</p> <p dir="ltr">“Resistant virus samples could be readily grown in the laboratory, a marker that individuals who develop resistance may transmit the resistance virus to others,” said Professor Vitali Sintchenko, the study’s senior author and a fellow researcher in infectious disease.</p> <p dir="ltr">“(Sotrovimab) is the only one (treatment) we have evidence against so far, but we need to be more on the front foot in terms of efficacy,” Dr Rockett told <em><a href="https://7news.com.au/news/coronavirus/australian-covid-19-patients-developed-resistance-to-antiviral-drug-as-virus-mutates-within-days-of-first-treatment-study-finds--c-6001171" target="_blank" rel="noopener">7News</a></em>.</p> <p dir="ltr">“I don’t think the infrastructure is in place to capture the resistance. We need better surveillance.”</p> <p dir="ltr">Since the research was published, GSK, the manufacturer of Sotrovimab, has confirmed that the study’s findings were consistent with the company’s large clinical studies.</p> <p dir="ltr">“Resistance is also seen in studies for other COVID-19 monoclonal antibodies and oral treatments, and relates to how the immune system interacts with the virus,” a spokesperson said, per <em>7News.com.au</em>.</p> <p dir="ltr">“This report does not change the positive benefit-risk of sotrovimab for use in the treatment of mild to moderate COVID-19 in patients at high risk of progression.”</p> <p><span id="docs-internal-guid-7f583be8-7fff-e05d-5e6b-eef460dbcdaf"></span></p> <p dir="ltr"><em>Image: Getty Images</em></p>

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“We can’t leave”: Russians accused of holding hospital staff and patients “hostage”

<p dir="ltr">Officials of Ukraine’s besieged city Mariupol <a href="https://www.news.com.au/world/russia-ukraine-war-updates-mariupol-hospital-staff-patients-taken-hostage/news-story/290f75e5198aed84789d7d8d27c3bc67" target="_blank" rel="noopener">have claimed</a> that 400 hospital staff and patients have been taken as “hostages” by Russian forces.</p> <p dir="ltr">“We received information that the Russian army captured our biggest hospital,” Sergei Orlov, Mariupol’s deputy mayor, <a href="https://www.bbc.com/news/world-europe-60757133" target="_blank" rel="noopener">told the BBC</a>.</p> <p dir="ltr">Pavlo Kirilenko, the head of the Donetsk Regional Military Administration, took to Facebook to share an account from a hospital employee who managed to communicate with authorities.</p> <p dir="ltr">“Russian occupiers in Mariupol took doctors and patients hostage,” Mr Kirilenko <a href="https://www.facebook.com/pavlokyrylenko.donoda/posts/506102444405648" target="_blank" rel="noopener">wrote</a>.</p> <p dir="ltr">“One of the hospital employees had time to pass this news.</p> <p dir="ltr">“‘It is impossible to get out of the hospital. There is heavy shooting, we sit in the basement. Vehicles have not been able to drive to the hospital for two days. </p> <p dir="ltr">“‘The Russians forced 400 people from neighbouring houses to come to our hospital. We can’t leave’.”</p> <p dir="ltr">Mr Kirilenko added that the hospital had been “practically destroyed” by the Russian forces, but that staff have continued to work and treat patients in the basement.</p> <p dir="ltr">“I appeal to international human rights organisations to respond to these vicious violations of the norms and customs of war, to these blatant crimes against humanity,” he said.</p> <p dir="ltr">“Russia and every citizen involved in crimes in Ukraine must be punished!”</p> <p dir="ltr">Mr Kirilenko said the hospital holding the “hostages” was the same one that was damaged by a strike last week, as Mariupol continued to suffer constant shelling.</p> <p dir="ltr">Russian troops have surrounded the city for nearly two weeks, with gas, running water and electricity cut off to the estimated 350,000 residents trapped there.</p> <p dir="ltr">The local council said about 2,000 cars left the city on Tuesday, with 2,000 others waiting to leave.</p> <p dir="ltr">However, as food and medical supplies dwindle, no aid has been allowed in.</p> <p><span id="docs-internal-guid-fa019eb7-7fff-7fda-e018-45f8494a695a"></span></p> <p dir="ltr"><em>Image: Getty Images</em></p>

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"We are back to zero": Family speak out after son’s fatal sting

<p dir="ltr">A 14-year-old boy who was stung by a box jellyfish in Far North Queensland has died.</p> <p dir="ltr">Mark Angelo Ligmayo was stung on Saturday at Eimeo Beach in the Mackay region and was taken to Mackay Hospital in a critical condition.</p> <p dir="ltr">He went into cardiac arrest on the beach and succumbed to his injuries about an hour after he arrived at the hospital.</p> <p dir="ltr">A witness told the <em><a href="https://www.couriermail.com.au/news/queensland/mackay/eimeo-beach-teenager-suffers-reported-cardiac-arrest-after-jellyfish-sting/news-story/d91418b68df167610cd2ecf652b2b5c6" target="_blank" rel="noopener">Daily Mercury</a></em> that she saw him make it to shore with an “unreadable expression on his face” and his legs “covered in tentacles”.</p> <p dir="ltr">The publication also reported that the screams erupted on the beach from parents calling for their children to get out of the water while others rushed to help him.</p> <p dir="ltr">“We were there as he exited the water, quickly after that he was semi-conscious,” Eimeo Surf Life Saving Club president Ross Gee told the outlet.</p> <p dir="ltr">“We had a defib on him the whole time, he never lost his pulse, there was shallow breathing.</p> <p dir="ltr">“We doused him with approximately 30 litres of vinegar, all the vinegar on the beach.”</p> <p dir="ltr">The beach has been closed until further notice and the public has been urged to stay out of the water.</p> <p><span id="docs-internal-guid-de6e0373-7fff-aba5-364d-57c6cb94adde"></span></p> <p dir="ltr">Eimeo Surf Life Saving Club shared their condolences for the family on Sunday, and thanked the members of the public who assisted their volunteer lifesavers in helping Mark Angelo.</p> <p><iframe style="border: none; overflow: hidden;" src="https://www.facebook.com/plugins/post.php?href=https%3A%2F%2Fwww.facebook.com%2Feimeo.slsc%2Fposts%2F3137194476599351&amp;show_text=true&amp;width=500" width="500" height="725" frameborder="0" scrolling="no" allowfullscreen="true"></iframe></p> <p dir="ltr">Agnes Guinumtad, Mark Angelo’s mother, told <em><a href="https://www.couriermail.com.au/news/queensland/mackay/mackay-fatal-box-jellyfish-sting-parents-tribute-to-14yearold-boy/news-story/14d5421b775d48f88080528702a266e3" target="_blank" rel="noopener">The Mercury</a></em> the family had been excited to spend the day at the beach together three months after she, Mark Angelo, and his sister joined her husband in starting a new life in Australia.</p> <p dir="ltr">Nick Guinumtad came to Australia nearly a decade ago, working as a boilermaker and taking every opportunity to visit his family in the Philippines, where they waited for visas to join him.</p> <p dir="ltr">After Covid delayed their reunion, they were reunited in December last year and began to settle in.</p> <p dir="ltr">“I could see my son’s face, and I could see the pain,” Mrs Guinumtad said of the moment she saw lifeguards and bystanders attempt to save her son’s life.</p> <p dir="ltr">“I kept praying and praying, I didn’t stop praying. I prayed that he would say something.”</p> <p dir="ltr">With the death of Mark Angelo, his family said they don’t know where to go from here.</p> <p dir="ltr">“We are back to zero,” Mr Guinumtad told the outlet.</p> <p dir="ltr">Mrs Guinumtad has expressed her wish to take her son’s body back to the Philippines so that her parents, who often raised him while she worked, can say a final goodbye.</p> <p dir="ltr">“I don’t know the process, I don’t even know where to start,” she said.</p> <p dir="ltr">The family has asked for anyone in the community who may know how to help to reach out and have started a <a href="https://www.gofundme.com/f/help-guinumtad-family-bring-their-son-home" target="_blank" rel="noopener">GoFundMe</a> to raise funds to take him home.</p> <p dir="ltr">They have also thanked the lifeguards and bystanders who worked so hard to save their son and others who cared for their daughter while they went with him to the hospital.</p> <p dir="ltr">Mark Angelo’s death marks the third fatal box jellyfish sting since 2006.</p> <p dir="ltr">Large box jellyfish - which are regarded as one of the world’s most venomous animals - have caused more than 70 fatalities in Australia, according to Queensland Health.</p> <p dir="ltr">“If you don’t have a protective suit and you know there could be stingers or jellyfish in the water, just don’t go in,” Queensland Health has previously <a href="https://7news.com.au/news/disaster-and-emergency/deadly-box-jellyfish-sting-kills-queensland-teen-near-mackay-c-5855865" target="_blank" rel="noopener">warned</a>.</p> <p dir="ltr">“It’s also important that people are familiar with resuscitation methods - early resuscitation after major stings from box jellies has saved lives in the past few years.”</p> <p dir="ltr"><span id="docs-internal-guid-6f2ffc80-7fff-c775-9bfa-c5243c61dc54"></span></p> <p dir="ltr"><em>Image: Nic Guinumtad (Facebook)</em></p>

Travel Trouble

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Free to good home: The house that costs zero dollars but comes with a catch

<p><span style="font-weight: 400;">In a deal that’s almost too good to be true, a four-bedroom Sydney house is free to a good home. </span></p> <p><span style="font-weight: 400;">But, it comes with a catch: its new owners will need to remove it from the property and find a new patch of land to transport it to.</span></p> <p><span style="font-weight: 400;">The home, listed on Facebook and </span><a rel="noopener" href="https://www.gumtree.com.au/s-ad/cronulla/other-real-estate/house-for-removal-free-/1288343408" target="_blank"><span style="font-weight: 400;">Gumtree</span></a><span style="font-weight: 400;">, is sure to gain some interest as property prices continue to skyrocket across the city.</span></p> <p><span style="font-weight: 400;">In Kirrawee in Sydney’s south, where the home is currently located, the median house price reached $1.3 million in the year ending last September, coming at an 18.2 percent increase on prices from the year prior.</span></p> <p><span style="font-weight: 400;">In comparison, the new homeowners will only need to pay to remove the home - which can cost </span><a rel="noopener" href="https://www.smh.com.au/property/news/four-bedroom-house-offered-free-with-just-one-catch-20220117-p59oru.html" target="_blank"><span style="font-weight: 400;">around $70,000</span></a><span style="font-weight: 400;"> on top of reconnection to services and plaster setting at the new site.</span></p> <blockquote class="twitter-tweet"> <p dir="ltr">Not your usual Facebook marketplace item! Free house - you only need to pay for removal and transport! How does that work out financially? Is that something anyone’s had experience with? Excuse me for being fascinated by any concept that isn’t COVID and/or Djokovic 😂 🏡 <a href="https://t.co/ugD9keuSLV">pic.twitter.com/ugD9keuSLV</a></p> — Lucy Thackray (@LucyThack) <a href="https://twitter.com/LucyThack/status/1482281605163286530?ref_src=twsrc%5Etfw">January 15, 2022</a></blockquote> <p dir="ltr">According to the ad, which has since been shared on Twitter, the home is about 60 years old and comes with two bathrooms, two living spaces, a modern kitchen and a laundry.</p> <p dir="ltr">Homes have been known to sell without the land they stand on, with the home used as the set for<span> </span><em>The Castle</em><span> </span>selling for $40,000 at auction in 2017 as a relocatable home.</p> <p dir="ltr">In 2018, another house-only sale made headlines when it was listed for just $5,000 - a much cheaper option compared to the $25,000 it may have cost to demolish.</p> <p dir="ltr">As for the Kirrawee house, the deadline to clear the site is at the end of February, with the home able to be picked up at the start of March.</p> <p dir="ltr"><em>Images: @LucyThack (Twitter), Gumtree</em></p>

Real Estate

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Blue-sky thinking: net-zero aviation is more than a flight of fantasy

<p>As international air travel rebounds after COVID-19 restrictions, greenhouse gas emissions from aviation are expected to rise dramatically – and with it, scrutiny of the industry’s environmental credentials.</p> <p>Aviation emissions have almost <a href="https://www.newscientist.com/article/2253626-aviations-contribution-to-global-warming-has-doubled-since-2000/">doubled since 2000</a> and in 2018 reached <a href="https://ourworldindata.org/co2-emissions-from-aviation">one billion tonnes</a>. Climate Action Tracker rates the industry’s climate performance as <a href="https://climateactiontracker.org/sectors/aviation/">critically insufficient</a>.</p> <p>As the climate change threat rapidly worsens, can aviation make the transition to a low-carbon future – and perhaps even reach net-zero emissions? The significant technological and energy disruption on the horizon for the industry suggests such a future is possible.</p> <p>But significant challenges remain. Achieving a net-zero aviation sector will require a huge collaborative effort from industry and government – and consumers can also play their part.</p> <p><iframe width="440" height="260" src="https://www.youtube.com/embed/nW6J989UBhA?wmode=transparent&amp;start=0" frameborder="0" allowfullscreen=""></iframe></p> <h2>Build back better</h2> <p>The aviation sector’s progress in cutting emissions has been disappointing to date. For example, in February last year, <a href="https://theconversation.com/major-airlines-say-theyre-acting-on-climate-change-our-research-reveals-how-little-theyve-achieved-127800">research</a> on the world’s largest 58 airlines found even the best-performing ones were not doing anywhere near enough to cut emissions.</p> <p>Most recently, at the COP26 climate change summit in Glasgow, the industry merely reasserted a commitment to a plan known as the <a href="https://www.icao.int/environmental-protection/CORSIA/Pages/default.aspx">Carbon Offsetting and Reduction Scheme for International Aviation</a>.</p> <p>The scheme relies on carbon offsetting, which essentially pays another actor to reduce emissions on its behalf at lowest cost, and doesn’t lead to absolute emissions reduction in aviation. The scheme also encourages alternative cleaner fuels, but the level of emissions reduction between fuels varies considerably.</p> <p>Governments have generally failed to provide strong leadership to help the aviation sector to reduce emissions. This in part is because pollution from international aviation is not counted in the emissions ledger of any country, leaving little incentive for governments to act. Aviation is also a complex policy space to navigate, involving multiple actors around the world. However, COVID-19 has significantly jolted the aviation and travel sector, presenting an opportunity to build back better – and differently.</p> <p>Griffith University recently held a <a href="https://www.griffith.edu.au/institute-tourism/our-research/rethinking-aviation/aviation-reimagined-2021?fbclid=IwAR3Hd8xLJkEWMaHae8sho1MiSfV6TzbPbf30vo2fbJ0CHMg-xdvywNCmZbU">webinar series</a> on decarbonising aviation, involving industry, academic and government experts. The sessions explored the most promising policy and practical developments for net-zero aviation, as well as the most significant hurdles.</p> <p><img src="https://images.theconversation.com/files/437570/original/file-20211214-25-1rc1cnc.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" alt="passengers queue at airport" /> <span class="caption">COVID-19 has significantly jolted the aviation sector.</span> <span class="attribution"><span class="source">Steven Senne/AP</span></span></p> <h2>Nations soaring ahead</h2> <p>Some governments are leading the way in driving change in the aviation industry. For example, as a result of <a href="https://www.government.se/495f60/contentassets/883ae8e123bc4e42aa8d59296ebe0478/the-swedish-climate-policy-framework.pdf">government policy</a> to make Sweden climate-neutral by 2045, the Swedish aviation industry developed a <a href="https://fossilfrittsverige.se/en/roadmap/the-aviation-industry/#:%7E:text=The%20strategic%20objective%20for%202030,line%20with%20the%20Government%27s%20goals">roadmap</a> for fossil-free domestic flights by 2030, and for all flights originating from Sweden to be fossil-free by 2045.</p> <p>Achieving fossil-free flights requires replacing jet fuel with alternatives such as sustainable fuels or electric and hydrogen propulsion.</p> <p>The European Union plans to <a href="https://ec.europa.eu/commission/presscorner/detail/en/qanda_21_3662">end current tax exemptions</a> for jet fuel and introduce measures to <a href="https://www.eurocontrol.int/article/eus-fit-55-package-what-does-it-mean-aviation">accelerate</a> the uptake of sustainable fuels.</p> <p>The United Kingdom is finalising its strategy for <a href="https://www.gov.uk/government/consultations/achieving-net-zero-aviation-by-2050">net-zero aviation</a> by 2050 and a public body known as UK Research and Innovation is <a href="https://www.ukri.org/our-work/our-main-funds/industrial-strategy-challenge-fund/future-of-mobility/future-flight-challenge/">supporting</a> the development of new aviation technologies, including hybrid-electric regional aircraft.</p> <p>Australia lacks a strategic framework or emissions reduction targets to help transition the aviation industry. The <a href="https://www.infrastructure.gov.au/infrastructure-transport-vehicles/aviation/emerging-aviation-technologies/drones/eatp">Emerging Aviation Technology Program</a> seeks to reduce carbon emissions, among other goals. However, it appears to have a strong focus on freight-carrying drones and <a href="https://www.greenbiz.com/article/7-urban-air-mobility-companies-watch">urban air vehicles</a>, rather than fixed wing aircraft.</p> <p><img src="https://images.theconversation.com/files/437569/original/file-20211214-13-lsswi6.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" alt="plane taking off" /> <span class="caption">Some governments are leading the way in driving change in the aviation industry.</span> <span class="attribution"><span class="source">Zhao Xiaojun/AP</span></span></p> <h2>Building tomorrow’s aircraft</h2> <p>Low-emissions aircraft technology has developed substantially in the last five years. Advancements include electric and hybrid aircraft (powered by hydrogen or a battery) – such as that being developed by <a href="https://www.airbus.com/en/innovation/zero-emission/hydrogen/zeroe">Airbus</a>, <a href="https://www.rolls-royce.com/innovation/accel.aspx">Rolls Royce</a> and <a href="https://www.zeroavia.com/">Zero Avia</a> – as well as <a href="https://boeing.mediaroom.com/2021-07-14-Boeing-and-SkyNRG-Partner-to-Scale-Sustainable-Aviation-Fuels-Globally">sustainable aviation fuels</a>.</p> <p>Each of these technologies can reduce carbon emissions, but only battery and hydrogen electric options significantly reduce non-CO₂ climate impacts such as oxides of nitrogen (NOx), soot particles, oxidised sulphur species, and water vapour.</p> <p>For electric aircraft to be net-zero emissions, they must be powered by renewable energy sources. As well as being better for the planet, electric and hydrogen aircraft are likely to have <a href="https://www.zeroavia.com/">lower</a> energy and maintenance <a href="https://www.scientificamerican.com/article/electric-aviation-could-be-closer-than-you-think/">costs</a> than conventional aircraft.</p> <p>This decade, we expect a rapid emergence of electric and hybrid aircraft for short-haul, commuter, air taxi, helicopter and general flights. Increased use of sustainable aviation fuel is also likely.</p> <p>Although electric planes are flying, commercial operations are not expected until at least 2023 as the aircraft must undergo rigorous testing, safety and certification.</p> <p><img src="https://images.theconversation.com/files/437571/original/file-20211214-23-1clsep1.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" alt="A solar powered aircraft prototype flies in mountainous terrain" /> <span class="caption">Electric planes exist, but the route to commercialisation is long. Pictured: a solar powered aircraft prototype flies near the France-Italy border.</span> <span class="attribution"><span class="source">Laurent Gillieron/EPA</span></span></p> <h2>Overcoming turbulence</h2> <p>Despite real efforts by some industry leaders and governments towards making aviation a net-zero industry, significant strategic and practical challenges remain. Conversion to the commercial mainstream is not happening quickly enough.</p> <p>To help decarbonise aviation in Australia, industry and government should develop a clear strategy for emissions reduction with interim targets for 2030 and 2040. This would keep the industry competitive and on track for net-zero emissions by 2050.</p> <p>Strategic attention and action is also needed to:</p> <ul> <li> <p>advance aircraft and fuel innovation and development</p> </li> <li> <p>update regulatory and certification processes for new types of aircraft</p> </li> <li> <p>enhance production and deployment of new aviation fuels and technologies</p> </li> <li> <p>reduce fuel demand through efficiencies in route and air traffic management</p> </li> <li> <p>create “greener” airport operations and infrastructure</p> </li> <li> <p>build capability with pilots and aerospace engineers.</p> </li> </ul> <p>The emissions created by flights and itineraries can <a href="https://theicct.org/sites/default/files/publications/variation-aviation-emissions-itinerary-jul2021-1.pdf">vary substantially</a>. Consumers can do their part by opting for the lowest-impact option, and offsetting the emissions their flight creates via a <a href="https://theconversation.com/flying-home-for-christmas-carbon-offsets-are-important-but-they-wont-fix-plane-pollution-89148">credible program</a>. Consumers can also choose to fly only with airlines and operators that have committed to net-zero emissions.</p> <p>Net-zero aviation need not remain a flight of fantasy, but to make it a reality, emissions reduction must be at the heart of aviation’s pandemic bounce-back.<!-- 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; text-shadow: none !important;" src="https://counter.theconversation.com/content/171940/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><span><a href="https://theconversation.com/profiles/emma-rachel-whittlesea-1280917">Emma Rachel Whittlesea</a>, Senior Research Fellow, <em><a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em> and <a href="https://theconversation.com/profiles/tim-ryley-1253269">Tim Ryley</a>, Professor and Head of Griffith Aviation, <em><a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></span></p> <p>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/blue-sky-thinking-net-zero-aviation-is-more-than-a-flight-of-fantasy-171940">original article</a>.</p> <p><em>Image: Shutterstock</em></p>

Domestic Travel

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Doctor makes international headlines for unusual note on patient's chart

<p dir="ltr">A Canadian doctor who cited climate change on a patient’s medical chart and attracted worldwide attention has now clarified what he meant by doing so.</p> <p dir="ltr">During a heatwave in Nelson, British Columbia, in late June, a 70-year-old woman’s health deteriorated, and GP Dr Kyle Merritt believed that extreme weather conditions during the North American summer were a contributing factor. The woman was already suffering from diabetes and heart failure, and lived in a caravan with no air conditioning, during a heatwave that would come to be known as the<span> </span><a rel="noopener" href="https://www.timescolonist.com/bc-news/bcs-chief-coroner-reveals-city-death-tolls-due-to-heat-wave-4710606" target="_blank">hottest and deadliest</a><span> </span>in Canadian history.</p> <p dir="ltr">Speaking to<span> </span><a rel="noopener" href="https://au.news.yahoo.com/doctor-reveals-why-he-wrote-climate-change-on-patients-medical-chart-023010837.html?guccounter=1" target="_blank"><em>Yahoo News</em></a>, Dr Merritt said, “Oftentimes it's vulnerable patients that are the most affected. It’s people who don't have air conditioning in their homes in the case of the heat dome, or live in places where they can’t get away from the wildfire smoke. ‘</p> <p dir="ltr">“To see a patient affected that way and being forced to come in and get admitted to hospital because where they're living is not really safe for them anymore, I found it upsetting. “ wanted to think about the the underlying factors that were driving (her deterioration), so that's why I wrote it down.”</p> <p dir="ltr">Dr Merritt clarified that he only mentioned climate change on one patient’s chart, as he believed it “had to be part of the reason” his 70-year-old patient was admitted to the emergency room. He said he “wasn’t trying to make a big deal out of it”, but felt that it was important for both him and his colleagues to “recognise the truth” and acknowledge the contributing factor of climate change on people’s ill health.</p> <p dir="ltr">While some headlines have claimed he diagnosed a patient with ‘climate change’, Dr Merritt confirmed that this was not the case, as "climate change is not a medical condition”, but merely a contributing factor which can worsen existing illnesses, much like exposure to any extreme temperatures or weather conditions can worsen people’s health.</p> <p dir="ltr">He explained, “The diagnosis has to be a specific medical condition that's recognised as a medical condition. As physicians, we can’t just start making things up, of course we work within a medical framework."</p> <p dir="ltr">The links between climate change and people’s health are already well documented, with the<span> </span><a rel="noopener" href="https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health" target="_blank">World Health Organisation</a><span> </span>describing climate change as the “biggest health threat facing humanity”. The WHO predicts that between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year, primarily from malnutrition, diarrhoea, and heat stress. This is because climate change severely impacts the social and environmental determinants of health - clean air, safe drinking water, sufficient food and secure shelter. Without these basic necessities, it becomes incredibly difficult for people to maintain good health.</p> <p dir="ltr">Dr Merritt told<span> </span><em>Yahoo<span> </span></em>that he hopes that in the coming years, GPs will seek to recognise the impact of climate change on the health of their patients. He said, “In a lot of places, and certainly in my corner of the world, we're starting to see the direct impacts of climate change on human health.</p> <p dir="ltr">“It’s always difficult to make the link, but it's got a lot more clear as time has gone on.”</p>

Caring

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Patient zero of Black Death found

<p><span style="font-weight: 400;">New evidence has suggested a man who died 5300 years ago in Latvia was infected with the earliest-known strain of the plague that caused the Black Death.</span></p> <p><span style="font-weight: 400;">Waves of the plague swept through Europe for several centuries from the 1300s, causing millions of deaths.</span></p> <p><span style="font-weight: 400;">“Up to now this is the oldest-identified plague victim we have,” Dr Ben Krause-Kyora of the University of Kiel in Germany said of the remains.</span></p> <p><span style="font-weight: 400;">The man was buried with three others at a Neolithic burial site in Latvia near the River Salac, which connects to the Baltic Sea.</span></p> <p><span style="font-weight: 400;">The research, published in </span><em><span style="font-weight: 400;">Cell Reports</span></em><span style="font-weight: 400;">, involved the sequencing of the DNA from the bones and teeth of the four individuals.</span></p> <p><img style="width: 500px; height:375px;" src="https://oversixtydev.blob.core.windows.net/media/7842261/60da287e1477f300188c82ae.jpg" alt="Dominik Göldner / BGAEU" data-udi="umb://media/1f7ae3fb0a0c41a49c6b87ea085cbef8" /></p> <p><span style="font-weight: 400;">When the bodies were tested for bacteria and viruses, the researchers were surprised to find one hunter-gatherer - a man in his twenties - was infected with an ancient strain of the plague, caused by the </span><span style="font-weight: 400;">Yersinia pestis</span><span style="font-weight: 400;"> bacterium.</span></p> <p><span style="font-weight: 400;">“He was most likely bitten by a rodent, got the primary infection of </span><span style="font-weight: 400;">Yersinia pestis</span><span style="font-weight: 400;"> and died a couple of days [later] - maybe a week later - from the septic shock,” said Dr Krause-Kyora.</span></p> <p><span style="font-weight: 400;">The researchers suggest that this strain appeared about 7000 years ago at the same time that agriculture started to appear in central Europe.</span></p> <p><span style="font-weight: 400;">They also believe the bacterium may have sporadically jumped from animals to humans and that it became better at infecting humans over time, evolving into the form known as the bubonic plague.</span></p> <p><span style="font-weight: 400;">The research has been welcomed by other experts, though it doesn’t rule out the hypothesis that the disease was spreading throughout Europe at the time.</span></p> <p><span style="font-weight: 400;">Though the disease is still around today, it is treatable with antibiotics if caught early.</span></p> <p><em><span style="font-weight: 400;">Images: </span><span style="font-weight: 400;">Dominik Göldner / BGAEU</span></em></p>

Body

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Nurse swipes credit card from dead patient and USES it in vending machine

<p>UK healthcare worker, Ayesha Basharat, has been slammed as she stole a dead patient's card and used it at the hospital's vending machine.</p> <p>She had taken an 83-year-old woman's card from her room in the heartlands Hospital's COVID-19 ward and used the card six times at the vending machine, making contactless payments.</p> <p>Basharat had stolen the card from the woman just moments after she died on January 24th, according to<span> </span><a rel="noopener" href="https://west-midlands.police.uk/news/hospital-worker-used-dead-patients-bank-card-buy-sweets-and-fizzy-pop?fbclid=IwAR0zaC47A9DaQWcq_aaGVGjmJOOV9ccbobeGBpAjHpu-SHpTsADEfOmeqso" target="_blank">West Midlands Police</a>.</p> <p>Police caught up to her after she continued to use the credit card despite the family of the woman cancelling it.</p> <p>Basharat has been given two concurrent jail terms of five months each, both of which were suspended for 18 months.</p> <p>Detective Constable Andrew Snowdon said the act was an "abhorrent breach of trust".</p> <p>“This was an abhorrent breach of trust and distressing for the victim’s family," he said.</p> <p>“They were having to come to terms with the death of a loved one from Covid when they found the bank card missing – and then of course the realisation that the card was taken by someone who should have been caring for her.</p> <p>“I wish the family all the best for the future and with this conviction hope they can move on from this upsetting episode.”</p>

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