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

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

Body

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

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

Caring

11 beauty trends that should have never happened

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

Beauty & Style

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

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

Caring

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

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

Mind

What happens to your liver when you quit alcohol

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

Body

What happens to your vagina as you age?

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

Body

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

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

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What happens to old cruise ships?

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

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

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

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

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

International Travel

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

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

Mind

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

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

Food & Wine

Iconic movie scenes that nearly didn’t happen

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

Movies

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

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

Body

Strange things happening inside your body

Our bodies do an amazing job of keeping us healthy and happy. How they do that however can be a little on the stomach churning side. Here are five completely normal but slightly disgusting things your body is doing right now. <ol> <li>Producing huge amounts of sticky mucous – While we only really associate mucous with having a cold, our body is producing it constantly. Up to one litre a day is made to help prevent pathogens from making their way into our bodies.</li> <li>Processing food using gastric juices – The path from your mouth to the other end is quite remarkable. After you eat, the food travels to your stomach where it’s broken down by litres of gastric juice. It then travels through metres and metres of intestine before finally being “expelled”.</li> <li>Dust mites are colonising your eyelashes – According to recent research, there are two types of dust mite that make their home on your eyelashes where they live happily and uninterrupted for months on end.</li> <li>Your tonsils are storing plenty of stuff – If you’ve still got your tonsils, chances are good they are stashing plenty of stuff. Tonsils are filled with nooks and crannies which often fill with dead cells, mucous and bacteria. While most people can manage this build up perfectly fine, others find that they develop tonsil stones from too much build up.</li> <li>You’re producing litres of saliva – The body seems to love producing liquid. Case in point? Saliva. We produce one to two litres of the stuff a day to help break down food and aid digestion.</li> </ol> Related links: <a href="../health/wellbeing/2015/10/best-high-protein-foods/">Best high-protein foods for your diet</a> <a href="../health/wellbeing/2015/10/easy-at-home-weight-workout/">An easy at-home weights workout</a> <a href="../health/wellbeing/2015/10/simple-way-to-fight-depression/">The simple thing that's proven to fight depression</a> Image credit: Shutterstock

Body

We were told we’d be riding in self-driving cars by now. What happened to the promised revolution?

According to <a href="https://electrek.co/2015/12/21/tesla-ceo-elon-musk-drops-prediction-full-autonomous-driving-from-3-years-to-2/">predictions</a> <a href="https://www.vanityfair.com/news/2016/09/lyfts-president-says-car-ownership-will-all-but-end-by-2025">made</a> nearly a decade ago, we should be riding around in self-driving vehicles today. It’s now clear the autonomous vehicle revolution was overhyped. Proponents woefully underestimated the technological challenges. It turns out developing a truly driverless vehicle is hard. The other factor driving the hype was the amount of money being invested in autonomous vehicle startups. By 2021, it was estimated more than <a href="https://www.washingtonpost.com/outlook/2022/02/04/self-driving-cars-why/">US$100 billion</a> in venture capital had gone into developing the technology. While advances are being made, it is important to understand there are multiple levels of autonomy. Only one is truly driverless. As established by <a href="https://www.sae.org/blog/sae-j3016-update">SAE International</a>, the levels are: <ul> <li> level 0 — the driver has to undertake all driving tasks </li> <li> level 1, hands on/shared control — vehicle has basic driver-assist features such as cruise control and lane-keeping </li> <li> level 2, hands off – vehicle has advanced driver-assist features such as emergency braking, adaptive cruise control, auto park assist and traffic-jam assist </li> <li> level 3, eyes off — vehicle drives itself some of the time </li> <li> level 4, mind off — vehicle drives itself most of the time </li> <li> level 5, steering wheel option — vehicle drives itself all the time. </li> </ul> <h2>Why the slow progress?</h2> It’s estimated the technology to deliver safe autonomous vehicles is about <a href="https://www.theguardian.com/technology/2022/mar/27/how-self-driving-cars-got-stuck-in-the-slow-lane">80% developed</a>. The last 20% is increasingly difficult. It will take a lot more time to perfect. Challenges yet to be resolved involve unusual and rare events that can happen along any street or highway. They include weather, wildlife crossing the road, and highway construction. Another set of problems has emerged since <a href="https://www.forbes.com/sites/simonmainwaring/2022/08/22/cruise-ride-hailing-goes-green-and-driverless/?sh=6a7439376843">Cruise</a> and <a href="https://www.theverge.com/2022/11/19/23467784/waymo-provide-fully-driverless-rides-san-francisco-california">Waymo</a> launched their autonomous ride-hailing services in San Francisco. The US National Highway Traffic and Safety Administration <a href="https://techcrunch.com/2022/12/16/cruises-autonomous-driving-tech-comes-under-scrutiny-from-safety-regulators/">opened an investigation</a> in December 2022, only six months after the <a href="https://www.theguardian.com/technology/2022/jun/03/california-driverless-taxi-cars-san-francisco">services were approved</a>. It cited incidents where these vehicles “may have engaged in inappropriately hard braking or became immobilized”. The San Francisco County Transportation Authority <a href="https://www.nytimes.com/2023/02/01/technology/self-driving-taxi-san-francisco.html" target="_blank" rel="noopener">stated</a>, "[I]n the months since the initial approval of autonomous taxi services in June 2022, Cruise AVs have made unplanned and unexpected stops in travel lanes, where they obstruct traffic and transit service and intrude into active emergency response scenes, including fire suppression scenes, creating additional hazardous conditions." In several cases, Cruise technicians had to be called to move the vehicles. <h2>What’s happening now?</h2> Active autonomous vehicle initiatives can be grouped into two categories: ride-hailing services (Cruise, Waymo and Uber) and sales to the public (Tesla). Cruise is a subsidiary of General Motors founded in 2013. As of September 2022, it operated 100 robotaxis in San Francisco and had plans to increase its fleet to 5,000. Critics said this would increase city traffic. Cruise also began to offer services in Chandler (a Phoenix suburb), Arizona, and Austin, Texas, in December 2022. Waymo, formerly the Google Self-Driving Car Project, was founded in January 2009. The company lost <a href="https://www.theverge.com/2022/11/11/23453262/waymo-av-driverless-taxi-phoenix-california-dmv-progress">US$4.8 billion in 2020 and US$5.2 billion in 2021</a>. Waymo One provides autonomous ride-hailing services in <a href="https://www.theverge.com/2023/2/28/23617278/waymo-self-driving-driverless-crashes-av">Phoenix as well as San Francisco</a>. It plans to expand into <a href="https://www.theverge.com/2022/10/19/23410677/waymo-los-angeles-autonomous-robotaxi-service-launch">Los Angeles</a> this year. Uber was a major force in autonomous vehicle development as part of its business plan was to replace human drivers. However, it ran into problems, including a crash in March 2018 when a self-driving Uber killed a woman walking her bicycle across a street in Tempe, Arizona. In 2020, Arizona Uber sold its AV research division to Aurora Innovation. But in October 2022 Uber got back into autonomous vehicles by <a href="https://www.forbes.com/sites/samabuelsamid/2022/10/06/motional-and-uber-announce-10-year-deal-to-deploy-automated-vehicles-in-multiple-us-markets/?sh=44d83a84273e">signing a deal</a> with Motional, a joint venture between Hyundai and Aptiv. Motional will provide autonomous vehicles for Uber’s ride-hailing and delivery services. Lyft, the second-largest ride-sharing company after Uber, operates in the US and Canada. Like Uber, Lyft had a self-driving unit and in 2016, Lyft co-founder John Zimmer <a href="https://www.vanityfair.com/news/2016/09/lyfts-president-says-car-ownership-will-all-but-end-by-2025">predicted</a> that by 2021 the majority of rides on its network would be in such vehicles (and private car ownership would “all but end” by 2025). It didn’t happen. By 2021, Lyft had also <a href="https://techcrunch.com/2021/04/26/lyft-sells-self-driving-unit-to-toyotas-woven-planet-for-550m/">sold its self-driving vehicle unit</a>, to Toyota. In 2022, Zimmer <a href="https://techcrunch.com/2022/10/20/lyft-co-founder-says-autonomous-vehicles-wont-replace-drivers-for-at-least-a-decade/">said</a> the technology would not replace drivers for at least a decade. However, Lyft did partner with Motional in August 2022 to launch <a href="https://www.prnewswire.com/news-releases/lyft-and-motional-deliver-the-first-rides-in-motionals-new-all-electric-ioniq-5-autonomous-vehicle-301606519.html">robotaxis in Las Vegas</a> and <a href="https://www.reuters.com/business/autos-transportation/lyft-motional-launch-robotaxi-service-los-angeles-2022-11-17/">Los Angeles</a>. Telsa is the <a href="https://www.ev-volumes.com/">world leader in sales</a> of battery electric vehicles. It also purports to sell vehicles with full automation. However, by the end of 2022, no level 3, 4 or 5 vehicles were for sale in the United States. What Telsa offers is a full self-driving system as a US$15,000 option. Buyers acknowledge they are buying a beta version and assume all risks. If the system malfunctions, Telsa does not accept any responsibility. In February 2023, the National Highway Traffic Safety Administration <a href="https://amp.theguardian.com/technology/2023/feb/16/tesla-recall-full-self-driving-cars">found</a>, "[Fully self-driving] beta software that allows a vehicle to exceed speed limits or travel through intersections in an unlawful or unpredictable manner increases the risk of a crash." This led to Tesla <a href="https://www.theguardian.com/technology/2023/feb/16/tesla-recall-full-self-driving-cars">recalling 362,000 vehicles</a> to update the software. Another setback for autonomous vehicle sales to the public was the October 2022 announcement that Ford and VW had decided to <a href="https://techcrunch.com/2022/10/26/ford-vw-backed-argo-ai-is-shutting-down/">stop funding autonomous driving technology company Argo AI</a>, resulting in its closure. Both Ford and VW decided to shift their focus from level 4 automation to levels 2 and 3. <h2>So, what can we expect next?</h2> Autonomous vehicle development will continue, but with less hype. It’s being recognised as more an evolutionary process than a revolutionary one. The increasing cost of capital will also make it harder for autonomous vehicle startups to get development funds. The areas that appear to be making the best progress are autonomous ride-hailing and heavy vehicles. Self-driving car sales to the public are <a href="https://www.drive.com.au/news/level-4-self-driving-technology-mercedes-benz/">further down the track</a>. This article originally appeared on <a href="https://theconversation.com/we-were-told-wed-be-riding-in-self-driving-cars-by-now-what-happened-to-the-promised-revolution-201088" target="_blank" rel="noopener">The Conversation</a>. Images: Getty

Technology

Here’s what happens in your brain when you’re trying to make or break a habit

Did you set a New Year’s resolution to kick a bad habit, only to find yourself falling back into old patterns? You’re not alone. In fact, research suggests up to <a href="https://doi.apa.org/doiLanding?doi=10.1037/0022-3514.83.6.1281">40% of our daily actions are habits</a> – automatic routines we do without thinking. But how do these habits form, and why are they so difficult to break? Habits can be likened to riverbeds. A well-established river has a deep bed and water is likely to consistently flow in that direction. A new river has a shallow bed, so the flow of water is not well defined – it can vary course and be less predictable. Just like water down a riverbed, habits help our behaviour “flow” down a predictable route. But what we are really talking about here is learning and unlearning. <h2>What happens in the brain when we form a habit?</h2> <a href="https://doi.org/10.1146/annurev-psych-122414-033417">During the early stages of habit formation</a>, the decision parts of your brain (pre-frontal cortices) are activated, and the action is very deliberate (instead of hitting snooze you make the choice to get out of bed). When a new routine is initiated, brain circuits – also called neural networks – are activated. The more often you repeat the new action, the stronger and more efficient these neural networks become. This reorganising and strengthening of connections between neurons is called neuroplasticity, and in the case of building habits – <a href="https://en.wikipedia.org/wiki/Long-term_potentiation">long-term potentiation</a>. Each time you perform the new action while trying to form a habit, you need smaller cues or triggers to activate the same network of brain cells. <a href="https://oce.ovid.com/article/00006832-200710000-00001/HTML">Habits strengthen over time</a> as we form associations and earn rewards – for example, not hitting snooze makes getting to work on time easier, so you feel the benefits of your new habit. Later, as habits strengthen, the decision parts of the brain no longer need to kick in to initiate the action. The habit is now activated in memory and considered automatic: the neural circuits can perform the habit without conscious thought. In other words, you don’t need to choose to perform the action any more. <h2>How long does it really take to form a habit?</h2> Popular media and lifestyle advice from social media influencers often suggest it takes 21 days to make or break a habit – an idea <a href="https://books.google.com.au/books/about/Psycho_Cybernetics.html?id=J8dqtO6XqPMC&redir_esc=y">originally presented in the 1960s</a>. This is generally considered an oversimplification, though empirical evidence is surprisingly sparse. A seminal study published in the <a href="https://doi.org/10.1002/ejsp.674">European Journal of Social Psychology</a> is often cited as showing habits take anywhere from 18 to 254 days to form, with an average of about 66 days. In that study, 96 people were asked to choose a new health habit and practice it daily for 84 days. Of the original 96 participants, 39 (41%) successfully formed the habit by the end of the study period. The level of success in forming a habit, and the length of time to form the habit, appeared to vary based on the type of goal. For example, goals related to drinking a daily glass of water were more likely to be successful, and be performed without conscious thought faster than goals related to eating fruit or exercising. Furthermore, the time of day appeared important, with habits cued earlier in the day becoming automatic more quickly than those cued later in the day (for example, eating a piece of fruit with lunch versus in the evening, and walking after breakfast versus walking after dinner). The study was fairly small, so these findings aren’t definitive. However, they suggest that if you haven’t been able to embed a new habit in just 21 days, don’t fret – there’s still hope! <h2>What about breaking unwanted habits?</h2> Most of us will also have habits we don’t like – unwanted behaviours. Within the brain, breaking unwanted habits is associated with a different form of neuroplasticity, called <a href="https://en.wikipedia.org/wiki/Long-term_depression">long-term depression</a> (not to be confused with the mental health condition). Instead of strengthening neural connections, long-term depression is the process of weakening them. So, how do you silence two neurons that previously have been firing closely together? One popular approach to <a href="http://dx.doi.org/10.1080/17437199.2011.603640">breaking a bad habit</a> is pinpointing the specific cue or trigger that prompts the behaviour, and the reward that reinforces the habit. For example, someone might bite their nails when feeling stressed, and the reward is a temporary feeling of distraction, or sensory stimulation. Once the person has identified this connection, they can try to experiment with disrupting it. For example, by using a bitter nail polish, and focusing on deep breathing exercises when feeling stressed. Once disrupted, over time the old behaviour of biting their nails can gradually fade. <h2>Tips on how to form or break a habit</h2> To break a habit: <ul> <li>identify your triggers, and then avoid or modify them</li> <li>find a substitute: try replacing the old habit with a new and healthier one</li> <li>practise self-compassion: setbacks are a natural part of the process. Recommit to your goal and carry on.</li> </ul> To form a habit: <ul> <li>start small: begin with a simple and achievable habit that you can easily integrate into your daily routine</li> <li>be consistent: repeat the habit consistently until it becomes automatic</li> <li>reward yourself along the way to stay motivated.</li> </ul> If you think of habits like that riverbed, what deepens a river is the volume of water flowing through. With behaviour, that means repetition and similarity in repetition: practising your new habit. Because new habits might be overwhelming, practising in small chunks can help – so that you are not creating a new riverbed, but maybe just deepening parts of the main stream. <a href="https://doi.org/10.1111/jcpp.12811">Finding meaning</a> in the new habit is critical. <a href="https://doi.org/10.1016/j.chb.2022.107373">Some studies</a> have reported strong findings that the belief you can change a habit is also critical. Believing in change and being aware of its potential, along with your commitment to practice, is key. Image credits: Shutterstock This article originally appeared on <a href="https://theconversation.com/heres-what-happens-in-your-brain-when-youre-trying-to-make-or-break-a-habit-201189" target="_blank" rel="noopener">The Conversation</a>.

Mind

The pleasure and pain of cinephilia: what happened when I watched Groundhog Day every day for a year

“What would you do if you were stuck in one place, and every day was exactly the same, and nothing that you did mattered?” So asks time-stranded weatherman Phil Connors, played by Bill Murray, as he begins to come to grips with his predicament in the 1993 comedy classic Groundhog Day. On February 2, while reporting on the annual Groundhog Festival in the quaint Pennsylvanian town of Punxsutawney, Phil becomes trapped in a time warp where he lives the same day over and over again. In 2021 I was wrestling with the same question. Living in lockdown, I was feeling frustration, ennui, and like forward progress had ground to a halt. The circumstances created an opportunity to subject myself to a very unusual challenge: to watch the same film once a day, every day, for a year. As a film scholar and cinephile, I wanted to find out how well a movie would sustain this kind of viewing and what a viewer might get out of the experience. Groundhog Day was the natural candidate. On a Monday morning in September of 2021, I sat down on my couch and hit play. <h2>The act of watching</h2> In the first month, my primary engagement was with the narrative. Like many previous viewers, I found myself asking how long Phil was trapped in the loop for (my own approximation is 30 years, which sits between the 10 years offered by director Harold Ramis and the 10,000 years in the original screenplay by Danny Rubin). I questioned the credibility of Rita (Andie MacDowell) falling in love with Phil having only known him for a day. I wondered how much of Murray’s performance was improvised (in Rubin’s words, <a href="https://www.reddit.com/r/IAmA/comments/qhkyh/comment/c3xp27e/">some “colouring”</a> but proportionally less than is assumed). Gradually, my familiarity with the narrative led me to shift focus. Rewatching became about exploration, as I sought to discover details the average viewer may have missed. I began to notice the re-occurrence of certain extras from scene to scene, building my own narrative around their identities. I realised the boy in a wheelchair in the background of the hospital scene is the same boy Phil will eventually save from breaking his leg every day. I consumed as much extra material on the film as possible. <a href="https://howtowritegroundhogday.com/">Rubin’s screenplay</a> and accompanying commentary, film critic Ryan Gilbey’s <a href="https://www.bloomsbury.com/us/groundhog-day-9781838716035/">detailed monograph</a> and Harold Ramis’s commentary were all illuminating. I realise in hindsight that I was following my natural inclination as a scholar, to try to understand something more fully by diving more deeply into it. And then I reached the doldrums. <h2>Shifting perspectives</h2> By the midway point, my viewing had shifted into a mode of cataloguing and memorisation. Phil Connors’ weather reports ran through my head unbidden, and I had built myself a mental map of Punxsutawney to the extent I felt like I could give directions to a visitor. I began to talk to the film as it played. Some days, the viewing felt like a curse. When Rita discovers Phil’s dilemma, she says: “Maybe it’s not a curse. Maybe it depends on how you look at it.” My own shift in perspective came into play in the final three months. I found myself returning to the exploratory mode of viewing, encouraged by sharing and discussing theories with others who liked the film but who weren’t nutty enough to watch it hundreds of times. New theories emerged. I decided the bartender at the Pennsylvanian Hotel is clearly aware of Phil’s predicament (make note of his knowing looks and how quickly he serves them their favourite drinks), and that one of the Punxsutawney townspeople is clearly having an affair, as he can be seen visiting the Groundhog Festival with his wife and the banquet with his mistress. I’m not the first to posit <a href="https://www.cbr.com/groundhog-day-movie-theory-ned-ryerson-devil/">alternative readings</a> of the film, but I understood in my final stretch of viewing that a film can transform with us, revealing new layers from viewing to viewing. <h2>Films as friends</h2> In recent years, many scholars have examined the practice of repeat viewing, particularly with the emergence of technologies that provide flexibility to view when and where we like. Film theorist Barbara Klinger <a href="https://www.ucpress.edu/book/9780520245860/beyond-the-multiplex">suggests</a> familiar movies have the capacity to become our “friends” and she introduced the term “karaoke cinema” to describe the joy of deep familiarity and quotability, arguing this experience provides the audience with an element of both comfort and mastery. My experience certainly affirms her claims. Watching Groundhog Day every day for a year provided me with a deeper appreciation for how a film may contain multitudes – particularly those we choose to willingly re-experience. The legacy of Groundhog Day can be seen in the recurring appeal of the time loop narrative in TV shows and films such as Palm Springs, Russian Doll and Happy Death Day. And, like every piece of worthwhile art, it can also sustain its own deep interrogation and reveal to the curious rewatcher its multifaceted layers and dimensions. On reaching the finish line I was elated and celebrated with a final viewing on the big screen. I have a feeling it will be some time before I revisit the film, but it’s comforting to know it will be there when I’m ready, an old friend who welcomes visitors. Image credits: Columbia Pictures This article originally appeared on <a href="https://theconversation.com/the-pleasure-and-pain-of-cinephilia-what-happened-when-i-watched-groundhog-day-every-day-for-a-year-198668" target="_blank" rel="noopener">The Conversation</a>.

Movies

What happens to your body on a long-haul flight?

<a href="https://theconversation.com/profiles/tony-schiemer-1345516">Tony Schiemer</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> If crowded airports are a sign, Australians are keen to get back into the skies. And if you’re flying long haul, in a few years you could have an even longer option. Qantas <a href="https://australianaviation.com.au/2022/05/video-inside-qantas-project-sunrise-a350-1000s/">has announced</a> from <a href="https://www.qantasnewsroom.com.au/media-releases/qantas-announces-project-sunrise-aircraft-order-for-non-stop-flights-to-australia/">late 2025</a>, it will fly passengers on non-stop flights from Australia’s east coast to London that would see you in the air for more than 19 hours in one stretch. That’s compared with current flights that take the best part of 24 hours but are broken up into shorter legs. So what will happen to your body during one of these longer flights? Is it any different to what happens when you fly long-haul now? <h2>1. You can become dehydrated</h2> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551461/">Dehydration</a> is common on long-haul flights. It can explain why your throat, nose and skin can feel dry on an aeroplane. The longer the flight, the greater the risk of dehydration. That’s because of <a href="https://www.ncbi.nlm.nih.gov/books/NBK207472/">low levels of humidity</a> in the cabin compared with what you’d expect on the ground. This is mostly because a lot of the air circulating through the cabin is drawn from the outside, and there’s not a lot of moisture in the air at high altitudes. You also risk dehydration by not drinking enough water, or drinking too much alcohol (alcohol is a diuretic, resulting in an increase in fluid lost). So drink water before you jump on the plane. During the flight, you’ll also need to drink more water than you usually would. <h2>2. The cabin can play havoc with your ears, sinuses, gut and sleep</h2> As the cabin pressure changes, the gas in our bodies reacts accordingly. It expands as the aircraft climbs and pressure decreases, and the opposite occurs as we descend. This can lead to common problems such as: <ul> <li> <a href="https://my.clevelandclinic.org/health/diseases/17929-airplane-ear">earaches</a> – when the air pressure either side of your eardrum is different, placing pressure on the eardrum </li> <li> <a href="https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-017-0788-0">headaches</a> – can be caused by expanding air trapped in your sinuses </li> <li> gut problems – just accept that you’re going to fart more. </li> </ul> You can also feel more sleepy than usual. That’s due to the body not being able to absorb as much oxygen from the cabin air at altitude than it would on the ground. Slowing down is the body’s way of protecting itself, and this can make you feel sleepy. The good news is that most of these problems won’t necessarily be more pronounced on longer flights. They’re mainly an issue as the plane climbs and descends. <h2>3. You could develop blood clots</h2> Blood clots, associated with being immobile for long periods, are usually a big concern for passengers. These include clots that form in the leg (<a href="https://theconversation.com/explainer-what-is-deep-vein-thrombosis-11140">deep vein thrombosis</a> or DVT) that can travel to the lung (where it’s known as a <a href="https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647">pulmonary embolism</a>). If you don’t move around on the plane, and the more of the following <a href="https://search.informit.org/doi/epdf/10.3316/informit.666315070819684">risk factors</a> you have, the greater the chance of blood clots developing: <ul> <li> older age </li> <li> obesity </li> <li> previous history or a family history of clots </li> <li> certain types of clotting disorders </li> <li> cancer </li> <li> recent immobilisation or surgery </li> <li> pregnancy or recently given birth </li> <li> hormone replacement therapy or oral contraceptive pill. </li> </ul> According to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149067/">review</a> in 2022, combining data from 18 studies, the longer you travel, the greater the risk of blood clots. The authors calculated there was a 26% higher risk for every two hours of air travel, starting after four hours. So what about the risk of clots on these longer flights? We won’t know for sure until we start studying passengers on them. Until that evidence comes in, the current advice still applies. Keep moving, stay hydrated and limit alcohol consumption. There’s also <a href="https://www.cochrane.org/CD004002/PVD_compression-stockings-preventing-deep-vein-thrombosis-dvt-airline-passengers">evidence</a> for wearing compression stockings to prevent blood clots. These stockings are said to promote blood flow in the legs and to help blood return to the heart. This would normally happen by muscle contractions from moving or walking. A 2021 <a href="https://www.cochrane.org/CD004002/PVD_compression-stockings-preventing-deep-vein-thrombosis-dvt-airline-passengers">Cochrane review</a> combined the results of nine trials with 2,637 participants who were randomised to wear compression stockings (or not) on flights lasting more than five hours. No participants developed symptomatic DVTs. But there was evidence people who wore the stockings considerably reduced their chance of developing clots without symptoms, and we know that any clot can potentially grow, move and subsequently, cause symptoms. So if you are concerned about your risk of developing blood clots, see your GP before you fly. Usually if you do develop a blood clot, you won’t know about it until after the flight, as the clot takes time to form and travel. So keep an eye out for symptoms after the flight – pain and swelling in a leg (often just the one), chest pain, coughing and shortness of breath. And seek emergency health care if you do. <h2>4. Then there’s jet lag, radiation, COVID</h2> Then there’s <a href="https://www.mayoclinic.org/diseases-conditions/jet-lag/symptoms-causes/syc-20374027#:%7E:text=Drink%20plenty%20of%20water%20before,it's%20nighttime%20at%20your%20destination.">jet lag</a>, which is a stranger to few of us. This is a disconnect between the time your body thinks it is and the time by the clock, as you cross time zones. Longer flights mean you are more likely (but not always) to cross more time zones. Jet lag will usually become more problematic when you cross three or more, especially if you’re travelling east. And if you take long-haul flights very often, it’s reasonable to assume that the longer you’re in the air, the greater the exposure to <a href="https://www.cdc.gov/niosh/topics/aircrew/cosmicionizingradiation.html">cosmic radiation</a>. As the name suggests, this is radiation that comes from space, which may increase the risk of cancer and reproductive issues. We don’t know what level of exposure is safe. However, unless you fly frequently it’s unlikely to be a problem. If you’re pregnant or have other concerns, have a chat to your GP before you fly. And don’t forget COVID. Take the usual precautions – wash your hands regularly, wear a mask and don’t fly if you’re unwell. <h2>In a nutshell</h2> Research into how the body reacts to these longer, non-stop flights between Australia and Europe is in its early stages. <a href="https://www.qantasnewsroom.com.au/media-releases/qantas-to-operate-project-sunrise-research-flights-direct-new-york-london-to-australia/">Teams in Australia</a> are looking at this now. Until then, if you’re taking a regular long-haul flight, the advice is relatively simple. Follow the advice the airlines give you, and see your GP before you travel if necessary. During flight, make that extra effort to move about the cabin, drink water, wear a mask and practise good hand hygiene. And see a doctor immediately for any worrying symptoms after your flight, as blood clots can take hours or even days to form, grow and move along your veins.<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/183034/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/tony-schiemer-1345516">Tony Schiemer</a>, Commercial Pilot | Aerospace Medicine Specialist | Clinical Lecturer, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-to-your-body-on-a-long-haul-flight-183034">original article</a>.

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Here’s what happens in your brain when you’re trying to make or break a habit

The pleasure and pain of cinephilia: what happened when I watched Groundhog Day every day for a year

What happens to your body on a long-haul flight?

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Entertainment

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

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

11 beauty trends that should have never happened

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

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

What happens to your liver when you quit alcohol

What happens to your vagina as you age?

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

What happens to old cruise ships?

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

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

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

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

Iconic movie scenes that nearly didn’t happen

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

Strange things happening inside your body

We were told we’d be riding in self-driving cars by now. What happened to the promised revolution?

Here’s what happens in your brain when you’re trying to make or break a habit

The pleasure and pain of cinephilia: what happened when I watched Groundhog Day every day for a year

What happens to your body on a long-haul flight?

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