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What’s the difference between a heart attack and cardiac arrest? One’s about plumbing, the other wiring

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/michael-todorovic-1210507">Michael Todorovic</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/matthew-barton-1184088">Matthew Barton</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> In July 2023, rising US basketball star Bronny James collapsed on the court during practice and was sent to hospital. The 18-year-old athlete, son of famous LA Lakers’ veteran LeBron James, had experienced a <a href="https://apnews.com/article/bronny-james-cardiac-arrest-3953eee8789e83f3cccfb6dd798bc54e">cardiac arrest</a>. Many media outlets incorrectly referred to the event as a “<a href="https://en.as.com/nba/lebron-james-son-bronny-plays-for-the-usc-trojans-for-the-first-time-since-suffering-a-heart-attack-n/">heart attack</a>” or used the terms interchangeably. A cardiac arrest and a heart attack are distinct yet overlapping concepts associated with the heart. With some background in <a href="https://www.youtube.com/watch?v=uKrgEv7-rVM&t=16s">how the heart works</a>, we can see how they differ and how they’re related. <h2>Understanding the heart</h2> The heart is a muscle that contracts to work as a pump. When it contracts it pushes blood – containing oxygen and nutrients – to all the tissues of our body. For the heart muscle to work effectively as a pump, it needs to be fed its own blood supply, delivered by the coronary arteries. If these arteries are blocked, the heart muscle doesn’t get the blood it needs. This can cause the heart muscle to become injured or die, and results in the heart not pumping properly. <h2>Heart attack or cardiac arrest?</h2> Simply put, a heart attack, technically known as a myocardial infarction, describes injury to, or death of, the heart muscle. A cardiac arrest, sometimes called a sudden cardiac arrest, is when the heart stops beating, or put another way, stops working as an effective pump. In other words, both relate to the heart not working as it should, but for different reasons. As we’ll see later, one can lead to the other. <h2>Why do they happen? Who’s at risk?</h2> Heart attacks typically result from blockages in the coronary arteries. Sometimes this is called coronary artery disease, but in Australia, we tend to refer to it as ischaemic heart disease. The underlying cause in about <a href="https://www.ncbi.nlm.nih.gov/books/NBK507799/#:%7E:text=It%20has%20been%20reported%20that,increases%20beyond%20age%2050%20years.">75% of people</a> is a process called <a href="https://youtu.be/jwL4lkSlvSA?si=H2as7dQkhbIqWWkU">atherosclerosis</a>. This is where fatty and fibrous tissue build up in the walls of the coronary arteries, forming a plaque. The plaque can block the blood vessel or, in some instances, lead to the formation of a blood clot. Atherosclerosis is a long-term, stealthy process, with a number of risk factors that can sneak up on anyone. High blood pressure, high cholesterol, diet, diabetes, stress, and your genes have all been implicated in this plaque-building process. Other causes of heart attacks include spasms of the coronary arteries (causing them to constrict), chest trauma, or anything else that reduces blood flow to the heart muscle. Regardless of the cause, blocking or reducing the flow of blood through these pipes can result in the heart muscle not receiving enough oxygen and nutrients. So cells in the heart muscle can be injured or die. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/597616/original/file-20240531-17-o2j0w.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" alt="Heart attack vs cardiac arrest" /></a><figcaption>Here’s a simple way to remember the difference. Author provided</figcaption></figure> But a cardiac arrest is the result of heartbeat irregularities, making it harder for the heart to pump blood effectively around the body. These heartbeat irregularities are generally due to <a href="https://www.youtube.com/watch?v=M_soKG-Tzh0&t=903s">electrical malfunctions</a> in the heart. There are four distinct types: <ul> <li> ventricular tachycardia: a rapid and abnormal heart rhythm in which the heartbeat is more than <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10541285/">100 beats per minute</a> (normal adult, resting heart rate is generally 60-90 beats per minute). This fast heart rate prevents the heart from filling with blood and thus pumping adequately </li> <li> ventricular fibrillation: instead of regular beats, the heart quivers or “fibrillates”, resembling a bag of worms, resulting in an irregular heartbeat greater than 300 beats per minute </li> <li> pulseless electrical activity: arises when the heart muscle fails to generate sufficient pumping force after electrical stimulation, resulting in no pulse </li> <li> asystole: the classic flat-line heart rhythm you see in movies, indicating no electrical activity in the heart. </li> </ul> Cardiac arrest can arise from numerous underlying conditions, both heart-related and not, such as drowning, trauma, asphyxia, electrical shock and drug overdose. James’ cardiac arrest was attributed to a <a href="https://www.espn.com.au/mens-college-basketball/story/_/id/38260006/bronny-james-cardiac-arrest-caused-congenital-heart-defect">congenital heart defect</a>, a heart condition he was born with. But among the many causes of a cardiac arrest, ischaemic heart disease, such as a heart attack, stands out as the most common cause, accounting <a href="https://pubmed.ncbi.nlm.nih.gov/11898927/">for 70%</a> of all cases. So how can a heart attack cause a cardiac arrest? You’ll remember that during a heart attack, heart muscle can be damaged or parts of it may die. This damaged or dead tissue can disrupt the heart’s ability to conduct electrical signals, increasing the risk of developing arrhythmias, possibly causing a cardiac arrest. So while a heart attack is a common cause of cardiac arrest, a cardiac arrest generally does not cause a heart attack. <h2>What do they look like?</h2> Because a cardiac arrest results in the sudden loss of effective heart pumping, the most common signs and symptoms are a sudden loss of consciousness, absence of pulse or heartbeat, stopping of breathing, and pale or blue-tinged skin. But the common signs and symptoms of a heart attack include chest pain or discomfort, which can show up in other regions of the body such as the arms, back, neck, jaw, or stomach. Also frequent are shortness of breath, nausea, light-headedness, looking pale, and sweating. <h2>What’s the take-home message?</h2> While both heart attack and cardiac arrest are disorders related to the heart, they differ in their mechanisms and outcomes. A heart attack is like a blockage in the plumbing supplying water to a house. But a cardiac arrest is like an electrical malfunction in the house’s wiring. Despite their different nature both conditions can have severe consequences and require immediate medical attention.<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/229633/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-todorovic-1210507">Michael Todorovic</a>, Associate Professor of Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/matthew-barton-1184088">Matthew Barton</a>, Senior lecturer, School of Nursing and Midwifery, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-a-heart-attack-and-cardiac-arrest-ones-about-plumbing-the-other-wiring-229633">original article</a>. </div>

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Woman “bullied” on plane over budget seating trick

A young woman has recalled a flight from hell when she was “bullied” by a couple who were trying to utilise a seating hack that went viral on TikTok. The solo traveller took to Reddit to recount the story and ask social media users if she was in the wrong for her action. The woman began by saying she usually pays more to select her plane seat ahead of time, but a medical emergency on another plane had her waiting on standby and left with no option other than to sit in a middle seat. When she was finally able to board, she was greeted by a couple who had purchased both the window and aisle seats in a bid to have more space, utilising a travel “trick” that has been popular on TikTok. The method, which has been dubbed the 'poor man's business class', usually leaves travellers with an empty middle seat and more space, and few travellers opt to pick a middle seat. “When I got to my row the man and woman were chatting and sharing a snack... it was obvious they were together. I mentioned to the man that I'm in the middle, and he got up to let me in,” the unsuspecting traveller wrote on Reddit. “I asked them if they would prefer to sit together, I said I was totally okay with that. The woman reacted rudely to this and said ‘you're not supposed to be sitting here anyway’.” After noticing how the plane was full, she offered to show the pair her new ticket with the correct seat number on it. “She flicked her hand at my ticket and made a disgusted sound. I offered again if they wanted to sit together to which she didn't reply, her partner said it's okay and... made some small talk,” she continued. The man’s girlfriend then interrupted their conversation to ask,”'Did you use one of those third party websites to book your flight? It's so frustrating when people cheap out to inconvenience others.” The American woman explained that she had booked her flight directly and she had been placed on standby like everyone else and didn't choose the middle seat - she was assigned it. She then tried to keep the peace by refusing to engage with the furious woman. “I was so done with her attitude, I put my headphones on and attempted to do my own thing,” she explained. But the “entitled” girlfriend wasn't letting it go, as the woman explained, “This woman kept reaching over me and tapping her partner and trying to talk to him in a way that was super intrusive.” “I could tell even her partner was trying to engage her less so that she would hopefully stop, but she didn't.” “I think they tried to pull that tactic where they don't sit together on purpose...hoping no one will sit between them. But on full flights it doesn't work. And even so - it's not the other person's fault.” The traveller's post was met with hundreds of comments slamming the girlfriend’s behaviour, as one person wrote, “It's like a toddler having a tantrum.” “She was disappointed and a total a**hole. Gross entitled people,” another added. Another person applauded the traveller’s level-headed behaviour, writing, “Wow! You are my hero for keeping it classy - I’m afraid I would not have been as kind as you.” Image credits: Shutterstock

Travel Trouble

Are you up to date with your COVID, flu and other shots? It might depend on who your GP is

<a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Too many older Australians are <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">missing out</a> on recommended vaccinations for COVID, flu, shingles and pneumococcal that can protect them from serious illness, hospitalisation and even death. A new <a href="https://grattan.edu.au/">Grattan Institute report</a> shows vaccination rates vary widely from GP to GP, highlighting an important place to look for opportunities to boost vaccination. Many people get vaccinated at pharmacies, and those vaccinations are counted in our analysis. But we looked at GPs because they have a unique role overseeing someone’s health care, and an important role promoting vaccination. We found that for some GPs, nine in ten of their older patients were vaccinated for flu. For others, the rate was only four in ten. The differences for shingles and COVID were even bigger. For pneumococcal disease, there was a 13-fold difference in GPs’ patient vaccination rates. While some variation is inevitable, these differences are large, and they result in too many people missing out on recommended vaccines. <h2>Some GPs treat more complex patients</h2> A lot of these differences reflect the fact that GPs see different types of patients. Our research shows older people who aren’t proficient in English are up to 15% less likely to be vaccinated, even after other factors are taken into account. And the problem seems to be getting worse. COVID vaccination rates for people 75 years and older fell to just 36% in May 2024. But rates were even lower – a mere 11% – for people who don’t speak English proficiently, and 15% for those who speak a language other than English at home. Given these results, it’s no surprise that GPs with fewer patients who are vaccinated also have more patients who struggle with English. For GPs with the lowest vaccination rates, one-quarter of their patients aren’t proficient in English. For GPs with the highest vaccination rates, it is only 1%. GPs with fewer vaccinated patients also saw more people who live in rural areas, are poorer, didn’t go to university, and don’t have regular access to a GP, all of which reduce the likelihood of getting vaccinated. Many of these barriers to vaccination are difficult for GPs to overcome. They point to structural problems in our health system, and indeed our society, that go well beyond vaccination. But GPs are also a key part of the puzzle. A <a href="https://www.ijidonline.com/article/S1201-9712(14)01379-4/fulltext">strong</a> <a href="https://www.tandfonline.com/doi/full/10.1080/21645515.2020.1780848">recommendation</a> from a GP can make a big difference to whether a patient gets vaccinated. <a href="https://www.aihw.gov.au/reports/primary-health-care/general-practice-allied-health-primary-care">Nearly all</a> older Australians visit a GP every year. And some GPs have room for improvement. <h2>But GPs seeing similar patients can have very different vaccination rates</h2> We compared GPs whose patients had a similar likelihood of being vaccinated, based on a range of factors including their health, wealth and cultural background. Among the GPs whose patients were least likely to get a flu vaccination, some saw less than 40% of their patients vaccinated, while for others in that group, the rate was over 70%. Among GPs with patients who face few barriers to vaccination, the share of their patients who were vaccinated also varied widely. Even within neighbourhoods, GP patient vaccination rates vary a lot. For example, in Bankstown in Sydney, there was a seven-fold difference in COVID vaccination rates and an 18-fold difference for pneumococcal vaccination. Not everything about clinics and patients can be measured in data, and there will be good reasons for some of these differences. But the results do suggest that some GPs are beating the odds to overcome patient barriers to getting vaccinated, while other GPs could be doing more. That should trigger focused efforts to raise vaccination rates where they are low. <h2>So what should governments do?</h2> A comprehensive national reform agenda is <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">needed to increase adult vaccination</a>. That includes clearer guidance, national advertising campaigns, SMS reminders, and tailored local programs that reach out to communities with very low levels of vaccination. But based on the big differences in GPs’ patient vaccination rates, Australia also needs a three-pronged plan to help GPs lift older Australians’ vaccination rates. First, the way general practice is funded needs to be overhauled, providing more money for the GPs whose patients face higher barriers to vaccination. Today, clinics with patients who are poorer, sicker and who struggle with English tend to get less funding. They should get more, so they can spend more time with patients to explain and promote vaccination. Second, GPs need to be given data, so that they can easily see how their vaccination rates compare to GPs with similar patients. And third, Primary Health Networks – which are responsible for improving primary care in their area – should give clinics with low vaccination rates the help they need. That might include running vaccination sessions, sharing information about best practices that work in similar clinics with higher vaccination rates, or offering translation support. And because pharmacies also play an important role in promoting and providing vaccines, governments should give them data too, showing how their rates compare to other pharmacies in their area, and support to boost vaccination uptake. These measures would go a long way to better protect some of the most vulnerable in our society. Governments have better data than ever before on who is missing out on vaccinations – and other types of health care. They shouldn’t miss the opportunity to target support so that no matter where you live, what your background is, or which GP or pharmacy you go to, you will have the best chance of being protected against 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/234175/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, Senior Associate, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</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/are-you-up-to-date-with-your-covid-flu-and-other-shots-it-might-depend-on-who-your-gp-is-234175">original article</a>.

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Emirates takes cheeky swipe at other airlines in new safety video

Emirates have taken a cheeky swipe at Qantas, Air New Zealand and British Airways with their new “no nonsense” in-flight safety video. The Dubai-based airline took a different approach to other major airlines, saying they chose not to include dancers and singers for its in-flight entertainment because they “take your safety seriously”. “Hello and welcome on board your Emirates flight today,” a flight attendant says at the start of the four minute video. “This is your no-nonsense safety video. We do not have dancers breaking into song, characters from movies, or celebrities trying to be funny I’m afraid.” Another cabin crew member then chips in, “But at Emirates, safety always comes first. So it’s important that we take you through some safety features before takeoff. And then you can all get back to our award-winning entertainment system.” <iframe title="YouTube video player" src="https://www.youtube.com/embed/MCW5kH1G_1Y?si=IgvSjvOEa-n_f01v" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe> The decision to stick to the basics for such an important video has been praised online, with many comparing the video to others by competing airlines. “Excellent video. No fuss, no faff, just informative and not distracting. These videos are about safety first and foremost, not entertainment,” wrote one fan. “Emirates got it right. This is THE safety video, simple and comprehensive which it should be,” agreed another. “This video is sending a message to other airlines,” stated a third. Emirates has gone in the opposite direction to its Aussie partner <a href="https://oversixty.com.au/travel/travel-trouble/disappointing-new-inflight-qantas-video-slammed-for-missing-the-mark">Qantas</a>, as a safety video from the Flying Kangaroo went viral earlier this year for all the wrong reasons. The video was widely panned for being “elitist” and “sexist”, while skimming over vital safety information, as one person on social media wrote, “I’d prefer just focus on, oh I dunno, in flight safety during the in-flight safety video? “Why do we need a long video with all this added stuff?” The video, which replaced an earlier retro video released in 2020 that marked the airline’s 100th birthday, features frequent flyers and Qantas staff delivering the pre-flight safety announcement from their favourite “magic places” around the world. Image credits: Emirates

International Travel

We finally know why some people got COVID while others didn’t

<a href="https://theconversation.com/profiles/marko-nikolic-1543289">Marko Nikolic</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> and <a href="https://theconversation.com/profiles/kaylee-worlock-1543639">Kaylee Worlock</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> Throughout the pandemic, one of the key questions on everyone’s mind was why some people avoided getting COVID, while others caught the virus multiple times. Through a collaboration between University College London, the Wellcome Sanger Institute and Imperial College London in the UK, we set out to answer this question using the world’s first controlled <a href="https://www.nature.com/articles/s41591-022-01780-9">“challenge trial” for COVID</a> – where volunteers were deliberately exposed to SARS-CoV-2, the virus that causes COVID, so that it could be studied in great detail. Unvaccinated healthy volunteers with no prior history of COVID were exposed – via a nasal spray – to an extremely low dose of the original strain of SARS-CoV-2. The volunteers were then closely monitored in a quarantine unit, with regular tests and samples taken to study their response to the virus in a highly controlled and safe environment. For our <a href="https://www.nature.com/articles/s41586-024-07575-x">recent study</a>, published in Nature, we collected samples from tissue located midway between the nose and the throat as well as blood samples from 16 volunteers. These samples were taken before the participants were exposed to the virus, to give us a baseline measurement, and afterwards at regular intervals. The samples were then processed and analysed using single-cell sequencing technology, which allowed us to extract and sequence the genetic material of individual cells. Using this cutting-edge technology, we could track the evolution of the disease in unprecedented detail, from pre-infection to recovery. To our surprise, we found that, despite all the volunteers being carefully exposed to the exact same dose of the virus in the same manner, not everyone ended up testing positive for COVID. In fact, we were able to divide the volunteers into three distinct infection groups (see illustration). Six out of the 16 volunteers developed typical mild COVID, testing positive for several days with cold-like symptoms. We referred to this group as the “sustained infection group”. Out of the ten volunteers who did not develop a sustained infection, suggesting that they were able to fight off the virus early on, three went on to develop an “intermediate” infection with intermittent single positive viral tests and limited symptoms. We called them the “transient infection group”. The final seven volunteers remained negative on testing and did not develop any symptoms. This was the “abortive infection group”. This is the first confirmation of abortive infections, which were previously <a href="https://www.nature.com/articles/s41586-021-04186-8">unproven</a>. Despite differences in infection outcomes, participants in all groups shared some specific novel immune responses, including in those whose immune systems prevented the infection. When we compared the timings of the cellular response between the three infection groups, we saw distinct patterns. For example, in the transiently infected volunteers where the virus was only briefly detected, we saw a strong and immediate accumulation of immune cells in the nose one day after infection. This contrasted with the sustained infection group, where a more delayed response was seen, starting five days after infection and potentially enabling the virus to take hold in these volunteers. In these people, we were able to identify cells stimulated by a key antiviral defence response in both the nose and the blood. This response, called the “interferon” response, is one of the ways our bodies signal to our immune system to help fight off viruses and other infections. We were surprised to find that this response was detected in the blood before it was detected in the nose, suggesting that the immune response spreads from the nose very quickly. <h2>Protective gene</h2> Lastly, we identified a specific gene called HLA-DQA2, which was expressed (activated to produce a protein) at a much higher level in the volunteers who did not go on to develop a sustained infection and could hence be used as a marker of protection. Therefore, we might be able to use this information and identify those who are probably going to be protected from severe COVID. These findings help us fill in some gaps in our knowledge, painting a much more detailed picture regarding how our bodies react to a new virus, particularly in the first couple of days of an infection, which is crucial. We can use this information to compare our data to other data we are currently generating, specifically where we are “challenging” volunteers to other viruses and more recent strains of COVID. In contrast to our current study, these will mostly include volunteers who have been vaccinated or naturally infected – that is, people who already have immunity. Our study has significant implications for future treatments and vaccine development. By comparing our data to volunteers who have never been exposed to the virus with those who already have immunity, we may be able to identify new ways of inducing protection, while also helping the development of more effective vaccines for future pandemics. In essence, our research is a step towards better preparedness for the next pandemic.<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/233063/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/marko-nikolic-1543289">Marko Nikolic</a>, Principal Research Fellow/Honorary consultant Respiratory Medicine, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> and <a href="https://theconversation.com/profiles/kaylee-worlock-1543639">Kaylee Worlock</a>, Postdoc Research Fellow, Molecular and Cellular Biology, <a href="https://theconversation.com/institutions/ucl-1885">UCL</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/we-finally-know-why-some-people-got-covid-while-others-didnt-233063">original article</a>.

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‘Sleeping on it’ really does help and four other recent sleep research breakthroughs

<a href="https://theconversation.com/profiles/dan-denis-158199">Dan Denis</a>, <a href="https://theconversation.com/institutions/university-of-york-1344">University of York</a> Twenty-six years. That is roughly <a href="https://www.nature.com/articles/s41467-022-34624-8">how much of our lives</a> are spent asleep. Scientists have been trying to explain why we spend so much time sleeping since at least the <a href="https://plato.stanford.edu/entries/alcmaeon/">ancient Greeks</a>, but pinning down the exact functions of sleep has proven to be difficult. During the past decade, there has been a surge of interest from researchers in the nature and function of sleep. New experimental models coupled with advances in technology and analytical techniques are giving us a deeper look inside the sleeping brain. Here are some of the biggest recent breakthroughs in the science of sleep. <h2>1. We know more about lucid dreaming</h2> No longer on the fringes, the neuroscientific study of dreaming has now become mainstream. US researchers in a 2017 study woke their participants up at regular intervals during the night and asked them what was going through their minds prior to the alarm call. Sometimes participants couldn’t recall any dreaming. The study team then looked at what was <a href="https://www.nature.com/articles/nn.4545">happening in the participant’s brain</a> moments before waking. Participants’ recall of dream content was associated with increased activity in the posterior hot zone, an area of the brain closely <a href="https://www.nature.com/articles/d41586-018-05097-x">linked to conscious awareness</a>. Researchers could predict the presence or absence of dream experiences by monitoring this zone in real time. Another exciting development in the study of dreams is research into lucid dreams, in which <a href="https://theconversation.com/the-ability-to-control-dreams-may-help-us-unravel-the-mystery-of-consciousness-52394">you are aware that</a> you are dreaming. A 2021 study established <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(21)00059-2?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0960982221000592%3Fshowall%3Dtrue">two-way communication</a> between a dreamer and a researcher. In this experiment, participants signalled to the researcher that they were dreaming by moving their eyes in a pre-agreed pattern. The researcher read out maths problems (what is eight minus six?). The dreamer could respond to this question with eye movements. The dreamers were accurate, indicating they had access to high level cognitive functions. The researchers used <a href="https://www.mayoclinic.org/tests-procedures/polysomnography/about/pac-20394877">polysomnography</a>, which monitors bodily functions such as breathing and brain activity during sleep, to confirm that participants were asleep. These discoveries have dream researchers excited about the future of “interactive dreaming”, such as practising a skill or solving a problem in our dreams. <h2>2. Our brain replays memories while we sleep</h2> This year marks the centenary of the first demonstration that <a href="https://www.jstor.org/stable/1414040?origin=crossref">sleep improves our memory</a>. However, a 2023 review of recent research has shown that memories formed during the day <a href="https://portlandpress.com/emergtoplifesci/article/7/5/487/233796/Neural-reactivation-during-human-sleep">get reactivated</a> while we are sleeping. Researchers discovered this using machine learning techniques to “decode” the contents of the sleeping brain. <a href="https://www.nature.com/articles/s41467-021-24357-5">A 2021 study</a> found that training algorithms to distinguish between different memories while awake makes it possible to see the same neural patterns re-emerge in the sleeping brain. A different study, also in 2021, found that the more times these patterns re-emerge during sleep, <a href="https://www.nature.com/articles/s41467-021-23520-2">the bigger the benefit</a> to memory. In other approaches, scientists have been able to reactivate certain memories by <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(19)31035-8?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0960982219310358%3Fshowall%3Dtrue">replaying sounds</a> associated with the memory in question while the participant was asleep. A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144680/">2020 meta-analysis of 91 experiments</a> found that when participants’ memory was tested after sleep they remembered more of the stimuli whose sounds were played back during sleep, compared with control stimuli whose sounds were not replayed. Research has also shown that sleep strengthens memory for the <a href="https://www.pnas.org/doi/10.1073/pnas.2202657119">most important aspects</a> of an experience, restructures our memories to form <a href="https://www.jneurosci.org/content/40/9/1909">more cohesive narratives</a> and helps us come up with <a href="https://journals.sagepub.com/doi/10.1177/0956797619873344">solutions to problems</a> we are stuck on. Science is showing that sleeping on it really does help. <h2>3. Sleep keeps our minds healthy</h2> We all know that a lack of sleep makes us feel bad. Laboratory sleep deprivation studies, where researchers keep willing participants awake throughout the night, have been combined with <a href="https://www.open.edu/openlearn/body-mind/health/health-sciences/how-fmri-works">functional MRI brain scans</a> to paint a detailed picture of the sleep-deprived brain. These studies have shown that a lack of sleep severely disrupts the <a href="https://www.nature.com/articles/nrn.2017.55">connectivity between</a> different brain networks. These changes include a breakdown of connectivity between brain regions <a href="https://link.springer.com/article/10.1007/s11682-018-9868-2">responsible for cognitive control</a>, and an amplification of those involved in <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(19)30761-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0960982219307614%3Fshowall%3Dtrue">threat and emotional processing</a>. The consequence of this is that the sleep-deprived brain is worse at <a href="https://academic.oup.com/cercor/article/33/5/1610/6573958">learning new information</a>, <a href="https://academic.oup.com/sleep/article/44/6/zsaa289/6053003">poorer at regulating emotions</a>, and unable to <a href="https://journals.sagepub.com/doi/10.1177/2167702620951511">suppress intrusive thoughts</a>. Sleep loss may even make you less likely to <a href="https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3001733">help other people</a>. These findings may explain why poor sleep quality is so <a href="https://onlinelibrary.wiley.com/doi/10.1111/jsr.13930">ubiquitous in poor mental health</a>. <h2>4. Sleep protects us against neurodegenerative diseases</h2> Although we naturally <a href="https://www.nature.com/articles/s41467-022-34624-8">sleep less as we age</a>, mounting evidence suggests that sleep problems earlier in life <a href="https://jnnp.bmj.com/content/91/3/236">increase the risk</a> of dementia. The build-up of β-amyloid, a <a href="https://www.nhs.uk/conditions/alzheimers-disease/causes/">metabolic waste product</a>, is one of the mechanisms underlying Alzheimer’s disease. Recently, it has become apparent that deep, undisturbed sleep is good for <a href="https://www.science.org/doi/10.1126/sciadv.aav5447">flushing these toxins</a> out of the brain. Sleep deprivation increases the the rate of build-up of β-amyloid in parts of the brain involved in memory, <a href="https://www.pnas.org/doi/full/10.1073/pnas.1721694115">such as the hippocampus</a>. A longitudinal study published in 2020 found that sleep problems were associated with a higher rate of β-amyloid accumulation at a follow-up <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(20)31171-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0960982220311714%3Fshowall%3Dtrue">four years later</a>. In a different study, published in 2022, sleep parameters <a href="https://elifesciences.org/articles/78191">forecasted the rate</a> of cognitive decline in participants over the following two years. <h2>5. We can engineer sleep</h2> The good news is that research is developing treatments to get a better night’s sleep and boost its benefits. For example, the <a href="https://onlinelibrary.wiley.com/doi/10.1111/jsr.14035">European Sleep Research Society</a> and the <a href="https://jcsm.aasm.org/doi/10.5664/jcsm.8986">American Academy of Sleep Medicine</a> recommend cognitive behavioural therapy for insomnia (CBT-I). <a href="https://www.cntw.nhs.uk/services/nctalkingtherapies/what-do-nc-talking-therapies-offer/cbt-i-cbt-for-insomnia/">CBT-I works by</a> identifying thoughts, feelings and behaviour that contribute to insomnia, which can then be modified to help promote sleep. In 2022, a CBT-I app became the <a href="https://www.nice.org.uk/news/article/nice-recommends-offering-app-based-treatment-for-people-with-insomnia-instead-of-sleeping-pills">first digital therapy</a> recommended by England’s National Institute for Health and Care Excellence for treatment on the NHS. These interventions can improve other aspects of our lives as well. A <a href="https://www.sciencedirect.com/science/article/pii/S1087079221001416?via%3Dihub">2021 meta-analysis</a> of 65 clinical trials found that improving sleep via CBT-I reduced symptoms of depression, anxiety, rumination and stress.<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/230484/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/dan-denis-158199">Dan Denis</a>, Marie Skłodowska-Curie Senior Research Fellow, <a href="https://theconversation.com/institutions/university-of-york-1344">University of York</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/sleeping-on-it-really-does-help-and-four-other-recent-sleep-research-breakthroughs-230484">original article</a>.

Body

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

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

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Does hosting the Olympics, the World Cup or other major sports events really pay off?

<a href="https://theconversation.com/profiles/ivan-savin-678930">Ivan Savin</a>, <a href="https://theconversation.com/institutions/escp-business-school-813">ESCP Business School</a> After a long battle, <a href="https://www.france24.com/en/europe/20240213-paris-booksellers-stay-olympics-macron-bouquiniste-france">Paris’s beloved bouquinistes will be staying put</a> this summer. The decision, announced on 13 February by the French government, came after considerable public backlash to the police prefecture’s original plan to move part of the iconic Seine booksellers elsewhere for the inauguration of the Olympics Games on 26 July. Meanwhile, less than six months away from the event, Parisians continue to grumble over a <a href="https://www.ouest-france.fr/jeux-olympiques/cest-aberrant-ce-maire-vient-dapprendre-que-sa-ville-accueillera-les-jeux-de-paris-ab1fa968-cfd1-11ee-89c0-6cefac77e04a">lack of consultations</a> with locals, warnings of <a href="https://www.rfi.fr/en/france/20231130-paris-vehicle-traffic-to-be-heavily-restricted-during-2024-olympic-games">gridlocked traffic</a>, closed metro stations, extensive video surveillance and other grievances. So for host countries, what was the point of the Olympics, again? In academia, the debate about the potential positive and negative effects of large-scale sporting events is ongoing. Although these events are often associated with substantial economic losses, the long-term benefits are the main argument in favour of hosting them. These include the development of material and soft infrastructure such as hotels, restaurants or parks. Big games can also help put the host region on the map as an attractive place for sports and cultural events, and inspire a better entrepreneurial climate. <h2>The pros and the cons of big sporting events?</h2> The cost of these benefits, as the Parisians have realised, is steep. Host countries appear to suffer from increased tax burdens, low returns on public investments, high construction costs, and onerous running cost of facilities after the event. Communities can also be blighted by noise, pollution, and damage to the environment, while increased criminal activity and potential conflicts between locals and visitors can take a toll on their quality of life. As a result, in the recent past several major cities, including Rome and Hamburg, <a href="https://www.dw.com/en/6-cities-that-rejected-the-olympics/a-46289852">withdrew their bids to host the games</a>. A common feature of the economics of large-scale sporting events is that our expectations of them are more optimistic than what we make of them once they have taken place. Typically, expenditure tends to tip over the original budget, while the revenue-side indicators (such as the number of visitors) are rarely achieved. When analysing the effect of hosting large-scale sporting events on tourist visits, it is important to take into consideration both the positive and negative components of the overall effect. While positive effects may be associated with visitors, negative effects may arise when “regular” tourists refuse to visit the location due to the event. This might be because of overloaded infrastructure, sharp increases in accommodation costs, and inconveniences associated with overcrowding or raucous or/and violent visitors. On top of that, reports of poverty or crime in the global media can actually undermine the location’s attractiveness. <h2>When big sporting events crowd out regular tourists</h2> In an <a href="https://doi.org/10.1177/1527002523120639">article published in the Journal of Sports Economics</a> with Igor Drapkin and Ilya Zverev, I assess the effects of hosting large-scale sporting events, such as Winter and Summer Olympics plus FIFA World Cups, on international tourist visits. We utilise a comprehensive dataset on flow of tourists covering the world’s largest destination and origin countries between 1995 and 2019. As a first step, we built an econometric model that effectively predicts the flow of tourists between any pair of countries in our data. Subsequently we compared the predicted tourist inflow in a hypothetical scenario where no large-scale sporting event would have taken place with the actual figures. If the actual figures exceed the predicted ones, we consider the event to have a net positive impact. Otherwise, we consider that it had a “crowding out” effect on “regular” tourists. While conducting this analysis, we distinguished between short-term (i.e., focusing just on the year of the event) and mid-term (year of the event plus three subsequent years). Our results show that the effects of large-scale sporting events vary a lot across host countries: The World Cup in Japan and South Korea 2002 and South Africa 2010 were associated with a distinct increase in tourist arrivals, whereas all other World Cups were either neutral or negative. Among the Summer Olympics, China in 2008 is the only case with a significant positive effect on tourist inflows. The effects of the other four events (Australia 2000, Greece 2004, Great Britain 2012, and Brazil 2016) were found to be negative in the short- and medium-term. As for the Winter Olympics, the only positive case is Russia in 2014. The remaining five events had a negative impact except the one-year neutral effect for Japan 1998. Following large-scale sporting events, host countries are therefore typically less visited by tourists. Out of the 18 hosting countries studied, 11 saw tourist numbers decline over four years, and three did not experience a significant change. <h2>The case for cautious optimism</h2> Our research indicates that the positive effect of hosting large-scale sporting events on tourist inflows is, at best, moderate. While many tourists are attracted by FIFA World Cups and Olympic games, the crowding-out effect of “regular” tourists is strong and often underestimated. This implies that tourists visiting for an event like the Olympics typically dissuade those who would have come for other reasons. Thus, efforts to attract new visitors should be accompanied by efforts to retain the already existing ones. Large-scale sporting events should be considered as part of a long-term policy for promoting a territory to tourists rather than a standalone solution. Revealingly, our results indicate that it is easier to get a net increase in tourist inflows in countries that are less frequent destinations for tourists – for example, those in Asia or Africa. By contrast, the United States and Europe, both of which are traditionally popular with tourists, have no single case of a net positive effect. Put differently, the large-scale sporting events in Asia and Africa helped promote their host countries as tourist destinations, making the case for the initial investment. In the US and Europe, however, those in the last few decades brought little return, at least in terms of tourist inflow.<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/222118/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ivan-savin-678930">Ivan Savin</a>, Associate professor of quantitative analytics, research fellow at ICTA-UAB, <a href="https://theconversation.com/institutions/escp-business-school-813">ESCP Business School</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/does-hosting-the-olympics-the-world-cup-or-other-major-sports-events-really-pay-off-222118">original article</a>.

Travel Tips

Vitamin D supplements can keep bones strong – but they may also have other benefits to your health

<a href="https://theconversation.com/profiles/martin-hewison-1494746">Martin Hewison</a>, <a href="https://theconversation.com/institutions/university-of-birmingham-1138">University of Birmingham</a> Most of us don’t worry about getting vitamin D when the weather’s warm and the sun is shining. But as winter approaches, accompanied by overcast days and long nights, you may be wondering if it could be useful to take a vitamin D supplement – and what benefit it might have. During the summer, the best way to get vitamin D is by getting a bit of sunshine. Ultraviolet rays (specifically UVB, which have a shorter wavelength) interact with a form of cholesterol called <a href="https://www.ncbi.nlm.nih.gov/books/NBK278935/">7-dehydrocholesterol</a> in the skin, which is then converted into vitamin D. Because vitamin D production is dependent on UVB, this means our ability to make it <a href="https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/#:%7E:text=From%20about%20late%20March%2Fearly,enough%20vitamin%20D%20from%20sunlight.">declines in the winter months</a>. Vitamin D production also <a href="https://pubmed.ncbi.nlm.nih.gov/24494042/">depends on where you live</a>, with people living nearer to the equator making more vitamin D than those living nearer the poles. Vitamin D deficiency is a <a href="https://assets.publishing.service.gov.uk/media/5a804e36ed915d74e622dafa/SACN_Vitamin_D_and_Health_report.pdf">problem in the UK</a> during the winter months. This is due to its northerly position and cloudy weather, and lack of time spent outdoors. One study of over 440,000 people in the UK found that <a href="https://pubmed.ncbi.nlm.nih.gov/33309415/">18% were vitamin D deficient</a> during the winter months. Vitamin D deficiency was even higher in certain ethnic groups – with the data showing 57% of Asian participants and 38% of black participants were vitamin D deficient. This is because the melanin content of skin determines a person’s ability to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946242/#:%7E:text=Skin%20pigmentation%2C%20i.e.%2C%20melanin%2C,%5B7%5D%20and%20more%20generally.">make UVB into vitamin D</a>. Given the prevalence of vitamin D deficiency in the UK, and the importance it has for our health, in 2016 the UK’s Science Advisory Council on Nutrition outlined recommendations for the <a href="https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report#:%7E:text=In%20a%20change%20to%20previous,aged%204%20years%20and%20older">amount of vitamin D</a> people should aim to get in the winter. They recommend people aim to get ten micrograms (or 400 IU – international units) of vitamin D per day. This would help people avoid severe deficiency. This can be achieved either by taking a supplement, or eating <a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/nutrition/ask-the-expert/foods-high-in-vitamin-d">certain foods</a> that are rich in vitamin D – including fatty fish such as herring, mackerel and wild salmon. A 100 gram serving of fresh herring, for example, would have approximately five micrograms of vitamin D. The clearest benefit of taking a vitamin D supplement is for <a href="https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/">bone health</a>. In fact, vitamin D was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899558/">first discovered</a> 100 years ago because of its ability to prevent the disease rickets, which causes weak bones that bend. Although rickets <a href="https://www.nhs.uk/conditions/rickets-and-osteomalacia/#:%7E:text=The%20number%20of%20rickets%20cases,from%20sunlight%2C%20can%20develop%20rickets.">isn’t very common</a> in the UK today, it can still occur in children if they lack vitamin D. In adults, vitamin D deficiency can cause bone pain, tenderness and muscles weakness, as well as increased risk of osteomalacia – often called “soft bone disease” – which leads to weakening or softening bones. The reason a lack of vitamin D can have such an effect on bone health is due to the vitamin’s relationship with <a href="https://pubmed.ncbi.nlm.nih.gov/18844850/">calcium and phosphate</a>. Both of these minerals help keep our bones strong – but they require vitamin D in order to be able to reinforce and strengthen bones. <h2>Other health benefits</h2> In addition to its effects on the skeleton, a growing body of research is beginning to indicate that vitamin D supplements may have additional benefits to our health. For example, <a href="https://ar.iiarjournals.org/content/42/10/5009.long">research shows</a> there’s a link between vitamin D deficiency and increased risk of catching certain viral illnesses, including the <a href="https://pubmed.ncbi.nlm.nih.gov/19237723/">common cold</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231123/">flu</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385774/">COVID</a>. Similarly, several studies – <a href="https://pubmed.ncbi.nlm.nih.gov/32904944/">including my own</a> – have demonstrated in cell models that vitamin D promotes immunity against microbes, such as the bacteria which causes tuberculosis. This means vitamin D may potentially prevent some types of infections. Vitamin D may also dampen inflammatory immune responses, which could potentially protect against autoimmune diseases, such as <a href="https://pubmed.ncbi.nlm.nih.gov/29243029/">multiple sclerosis</a> and <a href="https://www.frontiersin.org/articles/10.3389/fmed.2020.596007/full">rheumatoid arthritis</a>. One 2022 trial, which looked at over 25,000 people over the age of 50, found taking a 2,000 IU (50 micrograms) vitamin D supplement each day was associated with an <a href="https://www.bmj.com/content/376/bmj-2021-066452">18% lower risk</a> of autoimmune disease – notably rheumatoid arthritis. Vitamin D supplements may also be linked with lower risk of cardiovascular disease. A <a href="https://www.bmj.com/content/381/bmj-2023-075230">major Australian study</a>, which looked at over 21,000 people aged 60-84, found that participants who took a 2,000 IU vitamin D supplement a day for five years had a lower risk of suffering a major cardiovascular event (such as stroke or heart attack) compared to those who didn’t take a supplement. It’s currently not known why vitamin D may have these benefits on these other areas of our health. It’s also worth noting that in many of these trials, very few of the participants were actually vitamin D deficient. While we might speculate the observed health benefits may be even greater in people with vitamin D deficiency, it will be important for future research to study these factors. While it’s too early to say whether vitamin D supplements have broad health benefits, it’s clear it’s beneficial for bone health. It may be worthwhile to take a supplement in the winter months, especially if you’re over 65, have darker skin or spent a lot of time indoors as these factors can put you at <a href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-deficiency/faq-20058397#:%7E:text=However%2C%20some%20groups%20%E2%80%94%20particularly%20people,sun%20exposure%20or%20other%20factors.">increased risk of vitamin D deficiency</a>. The research also shows us that we should be rethinking vitamin D supplementation advice. While in the UK it’s recommended people get 400 IU of vitamin D a day, many trials have shown 2,000 IU a day is associated with health benefits.<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/219521/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/martin-hewison-1494746">Martin Hewison</a>, Professor of Molecular Endocrinology, <a href="https://theconversation.com/institutions/university-of-birmingham-1138">University of Birmingham</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/vitamin-d-supplements-can-keep-bones-strong-but-they-may-also-have-other-benefits-to-your-health-219521">original article</a>.

Body

How does cancer spread to other parts of the body?

<a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/john-eddie-la-marca-1503690">John (Eddie) La Marca</a>, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> All cancers begin in a single organ or tissue, such as the lungs or skin. When these cancers are confined in their original organ or tissue, they are generally more treatable. But a cancer that spreads is much more dangerous, as the organs it spreads to may be vital organs. A skin cancer, for example, might spread to the brain. This new growth makes the cancer much more challenging to treat, as it can be difficult to find all the new tumours. If a cancer can invade different organs or tissues, it can quickly become lethal. When cancer spreads in this way, it’s called metastasis. Metastasis is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745820/">responsible for</a> the majority (67%) of cancer deaths. <h2>Cells are supposed to stick to surrounding tissue</h2> Our bodies are made up of trillions of tiny cells. To keep us healthy, our bodies are constantly replacing old or damaged cells. Each cell has a specific job and a set of instructions (DNA) that tells it what to do. However, sometimes DNA can get damaged. This damage might change the instructions. A cell might now multiply uncontrollably, or lose a property known as adherence. This refers to how sticky a cell is, and how well it can cling to other surrounding cells and stay where it’s supposed to be. If a cancer cell loses its adherence, it can break off from the original tumour and travel through the bloodstream or lymphatic system to almost anywhere. This is how metastasis happens. Many of these travelling cancer cells will die, but some will settle in a new location and begin to form new cancers. Particular cancers are more likely to metastasise to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381616/">particular organs</a> that help support their growth. Breast cancers commonly metastasise to the bones, liver, and lungs, while skin cancers like melanomas are more likely to end up in the brain and heart. Unlike cancers which form in solid organs or tissues, blood cancers like leukaemia already move freely through the bloodstream, but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8722462/">can escape</a> to settle in other organs like the liver or brain. <h2>When do cancers metastasise?</h2> The longer a cancer grows, the more likely it is to metastasise. If not caught early, a patient’s cancer may have metastasised even before it’s initially diagnosed. Metastasis can also occur after cancer treatment. This happens when cancer cells are dormant during treatment – drugs may not “see” those cells. These invisible cells can remain hidden in the body, only to wake up and begin growing into a new cancer months or even years later. For patients who already have cancer metastases at diagnosis, identifying the location of the original tumour – called the “primary site” – is important. A cancer that began in the breast but has spread to the liver will probably still behave like a breast cancer, and so will respond best to an anti-breast cancer therapy, and not anti-liver cancer therapy. As metastases can sometimes grow faster than the original tumour, it’s not always easy to tell which tumour came first. These cancers are called “cancers of unknown primary” and are the <a href="https://www.canceraustralia.gov.au/cancer-types/unknown-primary-cancer/statistics">11th most commonly diagnosed cancers in Australia</a>. One way to improve the treatment of metastatic cancer is to improve our ways of detecting and identifying cancers, to ensure patients receive the most effective drugs for their cancer type. <h2>What increases the chances of metastasis and how can it be prevented?</h2> If left untreated, most cancers will eventually acquire the ability to metastasise. While there are currently no interventions that specifically prevent metastasis, cancer patients who have their tumours surgically removed may also be given chemotherapy (or other drugs) to try and weed out any hidden cancer cells still floating around. The best way to prevent metastasis is to diagnose and treat cancers early. Cancer screening initiatives such as Australia’s <a href="https://www.health.gov.au/our-work/national-cervical-screening-program">cervical</a>, <a href="https://www.health.gov.au/our-work/national-bowel-cancer-screening-program">bowel</a>, and <a href="https://www.health.gov.au/our-work/breastscreen-australia-program">breast</a> cancer screening programs are excellent ways to detect cancers early and reduce the chances of metastasis. New screening programs to detect cancers early are being researched for many types of cancer. Some of these are simple: CT scans of the body to look for any potential tumours, such as in England’s new <a href="https://theconversation.com/how-englands-new-lung-cancer-screening-could-save-thousands-of-lives-expert-qanda-208867">lung cancer screening program</a>. Using artificial intelligence (AI) to help examine patient scans is also <a href="https://theconversation.com/ai-can-help-detect-breast-cancer-but-we-dont-yet-know-if-it-can-improve-survival-rates-210800">possible</a>, which might identify new patterns that suggest a cancer is present, and improve cancer detection from these programs. More advanced screening methods are also in development. The United States government’s Cancer Moonshot program is currently funding research into blood tests that could detect <a href="https://theconversation.com/a-blood-test-that-screens-for-multiple-cancers-at-once-promises-to-boost-early-detection-191728">many types of cancer at early stages</a>. One day there might even be a RAT-type test for cancer, like there is for COVID. <h2>Will we be able to prevent metastasis in the future?</h2> Understanding how metastasis occurs allows us to figure out new ways to prevent it. One idea is to <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2019/breast-cancer-chemotherapy-sensitizing-dormant-cells">target dormant cancer cells</a> and prevent them from waking up. Directly preventing metastasis with drugs is not yet possible. But there is hope that as research efforts continue to improve cancer therapies, they will also be more effective at treating metastatic cancers. For now, early detection is the best way to ensure a patient can beat their cancer.<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/219616/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, Senior Research Officer, Blood Cells and Blood Cancer Division, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/john-eddie-la-marca-1503690">John (Eddie) La Marca</a>, Senior Resarch Officer, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</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/how-does-cancer-spread-to-other-parts-of-the-body-219616">original article</a>.

Body

5 reasons why climate change may see more of us turn to alcohol and other drugs

<a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a> Climate change will affect every aspect of our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01859-7/fulltext">health and wellbeing</a>. But its potential harms go beyond the body’s ability to handle extreme heat, important as this is. Extreme weather events, such as floods, droughts, storms and wildfires, are becoming more frequent and severe. These affect our <a href="https://pubmed.ncbi.nlm.nih.gov/36165756/">mental health</a> in a multitude of <a href="https://www.nature.com/articles/s41558-018-0102-4">ways</a>. Coping with climate change can be overwhelming. Sometimes, the best someone can do is to seek refuge in alcohol, tobacco, over-the-counter and prescription drugs, or other psychoactive substances. This is understandable, but dangerous, and can have serious consequences. We outline <a href="https://journals.sagepub.com/doi/full/10.1177/17456916221132739">five ways</a> climate change could increase the risk of harmful substance use. <h2>1. Mental health is harmed</h2> Perhaps the most obvious way climate change can be linked to harmful substance use is by damaging mental health. This <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12448">increases the risk</a> of new or worsened substance use. People with a mental disorder are <a href="https://www.hindawi.com/journals/psychiatry/2018/5697103/">at high risk</a> of also having a <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-25#:%7E:text=Prevalence%20of%20comorbidity%20in%20epidemiological%20studies&text=Among%20subjects%20with%20an%20alcohol,a%20comorbid%20SUD%20%5B39%5D.">substance-use disorder</a>. This often precedes their mental health problems. Climate change-related increases in the number and nature of extreme events, in turn, are escalating risks to mental health. For example, extreme heat is linked to increased <a href="https://pubmed.ncbi.nlm.nih.gov/27727320/">distress</a> across the whole population. In extreme heat, more people go to the <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2789481">emergency department</a> for psychiatric problems, including for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969720338249">alcohol</a> and <a href="https://www.nature.com/articles/s43856-023-00346-1">substance use</a> generally. This is even true for <a href="https://www.sciencedirect.com/science/article/pii/S0048969720325572">a single very hot day</a>. Post-traumatic stress disorder, depression, anxiety and <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja13.10307">other mental health</a> problems are <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2019.00367/full">common</a> at the time of extreme weather events and can persist for months, even years afterwards, especially if people are exposed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116266/">multiple events</a>. This can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101235/">increase</a> the likelihood of using substances as a way to cope. <h2>2. Worry increases</h2> With <a href="https://climatecommunication.yale.edu/publications/climate-change-in-the-american-mind-beliefs-attitudes-december-2022/">increasing public awareness</a> of how climate change is endangering wellbeing, people are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/worriesaboutclimatechangegreatbritain/septembertooctober2022#:%7E:text=The%20level%20of%20worry%20about,lives%20right%20now%20(29%25).">increasingly worried</a> about what will happen if it remains unchecked. Worrying isn’t the same as meeting the criteria for a mental disorder. But <a href="https://www.undp.org/publications/peoples-climate-vote">surveys</a> show climate change generates complex emotional responses, <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00278-3/fulltext">especially in children</a>. As well as feelings of worry, there is anxiety, fear, guilt, anger, grief and helplessness. Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/">emotional states</a>, such as <a href="https://www.pnas.org/doi/full/10.1073/pnas.1909888116">sadness</a>, are linked with long-term tobacco use and also make substance use <a href="https://pubmed.ncbi.nlm.nih.gov/16011392/">relapse</a> more likely. <h2>3. Physical injuries hurt us in many ways</h2> Physical injuries caused by extreme weather events – such as smoke inhalation, burns and flood-related cuts and infections – increase the risk of harmful substance use. That’s partly because they <a href="https://pubmed.ncbi.nlm.nih.gov/20033251/">increase</a> the risk of psychological distress. If injuries cause long-term illness or disability, consequent feelings of hopelessness and depression can dispose some people to self-medicate with alcohol or other drugs. Substance use itself can also generate long-term physiological harm, disabilities or other chronic health problems. These are <a href="https://www.tandfonline.com/doi/abs/10.3109/00952999609001655">linked with</a> higher rates of harmful substance use. <h2>4. Our day-to-day lives change</h2> A single catastrophic event, such as a storm or flood, can devastate lives overnight and change the way we live. So, too, can the more subtle changes in climate and day-to-day weather. Both can disrupt behaviour and routines in ways that risk new or worsened substance use, for example, using stimulants to cope with fatigue. Take, for example, hotter temperatures, which disrupt <a href="https://www.cell.com/one-earth/fulltext/S2590-3322(22)00209-3?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2590332222002093%3Fshowall%3Dtrue">sleep</a>, undermine <a href="https://jhr.uwpress.org/content/57/2/400">academic performance</a>, <a href="https://www.nature.com/articles/s41562-017-0097">reduce physical activity</a>, and promote <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00173-5/fulltext">hostile language</a> and <a href="https://www.cambridge.org/core/elements/abs/climate-change-and-human-behavior/F64471FA47B8A6F5524E7DDDDE571D57">violent behaviour</a>. <h2>5. It destabilises communities</h2> Finally, climate change is destabilising the socioeconomic, natural, built and geopolitical <a href="https://www.nature.com/articles/s41558-018-0102-4">systems</a> on which human wellbeing – <a href="https://theconversation.com/climate-change-and-health-ipcc-reports-emerging-risks-emerging-consensus-24213">indeed survival</a> – depends. Damaged infrastructure, agricultural losses, school closures, homelessness and displacement are significant <a href="https://www.nature.com/articles/s41558-018-0102-4">sources of psychosocial distress</a> that prompt acute (short-term) and chronic (long-term) stress responses. <a href="https://doi.org/10.1196/annals.1441.030">Stress</a>, in turn, can <a href="https://doi.org/10.1007/s002130100917">increase</a> the risk of <a href="https://link.springer.com/article/10.1007/s002130100917">harmful substance use</a> and make people more likely to relapse. <h2>Why are we so concerned?</h2> Substance-use disorders are economically and socially <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30337-7/fulltext">very costly</a>. Risky substance use that doesn’t meet the criteria for a formal diagnosis <a href="https://digitalcommons.fiu.edu/srhreports/health/health/32/">can also harm</a>. Aside from its direct physical harm, harmful substance use disrupts <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843305/">education</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234116/">employment</a>. It increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676144/">accidents</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/09595230600944479">crime</a>, and it undermines social relationships, intimate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795906/#:%7E:text=Results%20indicated%20that%20alcohol%20use,drinkers%20with%20low%20relationship%20satisfaction.">partnerships</a> and <a href="https://www.cambridge.org/core/journals/development-and-psychopathology/article/abs/longitudinal-relations-between-parental-drinking-problems-family-functioning-and-child-adjustment/CE508589A9E799FD6DC9E23DF364FB8F">family functioning</a>. <h2>Politicians take note</h2> As we head towards the <a href="https://www.cop28.com">COP28 global climate talks</a> in Dubai, climate change is set to hit the headlines once more. Politicians know climate change is undermining human health and wellbeing. It’s well past time to insist they act. As we have seen for populations as a whole, there are multiple possible ways for climate change to cause a rise in harmful substance use. This means multidimensional <a href="https://www.nature.com/articles/s41558-018-0102-4">prevention strategies</a> are needed. As well as addressing climate change more broadly, we need strategies including: <ul> <li> supporting vulnerable individuals, especially <a href="https://journals.sagepub.com/doi/full/10.1177/21677026211040787">young people</a>, and marginalised commmunities, who are <a href="https://www.nature.com/articles/s41558-018-0102-4">hit hardest</a> by extreme weather-related events </li> <li> focusing health-related policies more on broadscale health promotion, for example, healthier eating, active transport and community-led mental health support </li> <li> investing in climate-resilient infrastructure, such as heat-proofing buildings and greening cities, to prevent more of the destabilising effects and stress we know contributes to mental health problems and harmful substance use. </li> </ul> There is now <a href="https://news.un.org/en/story/2022/10/1129912">no credible pathway</a> to avoiding dangerous climate change. However, if <a href="https://carnegieendowment.org/2023/01/12/climate-protests-tracking-growing-unrest-pub-88778#:%7E:text=These%20are%20just%20a%20few,even%20more%20numerous%20and%20influential.">increasing rates</a> of climate protests are anything to go by, the world may finally be ready for radical change – and perhaps for reduced harmful substance use.<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/217894/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, Honorary Professor, Centre for Health Systems and Safety Research, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, Associate Professor, Psychosocial Difficulties, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</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/5-reasons-why-climate-change-may-see-more-of-us-turn-to-alcohol-and-other-drugs-217894">original article</a>.

Mind

It wasn’t just a tree: why it feels so bad to lose the iconic Sycamore Gap tree and others like it

<a href="https://theconversation.com/profiles/rebecca-banham-830381">Rebecca Banham</a>, <a href="https://theconversation.com/institutions/university-of-tasmania-888">University of Tasmania</a> The famous <a href="https://oversixty.co.nz/finance/legal/you-can-t-forgive-that-teen-arrested-after-felling-of-iconic-200-year-old-tree" target="_blank" rel="noopener">Sycamore Gap tree</a> was felled last week, prompting global expressions of sorrow, anger and horror. For some, the reaction was puzzling. Wasn’t it just a single tree in northern England? But for many, the tree felt profoundly important. Its loss felt like a form of grief. Trees tell us something important about ourselves and who we are in the world. That is, they contribute to <a href="https://www.tandfonline.com/doi/full/10.1080/23251042.2020.1717098">ontological security</a> – our sense of trust that the world and our selves are stable and predictable. Trees – especially those celebrated like England’s sycamore or Tasmania’s 350-year-old El Grande mountain ash – feel like they are stable and unchanging in a world where change is constant. Their loss can destabilise us. <h2>What makes a tree iconic?</h2> Individual trees can become important to us for many reasons. When the wandering ascetic Siddhartha Gautama sat at the foot of a sacred fig around 500 BCE, he achieved the enlightenment which would, a few centuries later, lead to his fame as the Buddha. This sacred fig would become known as the Bodhi Tree. One of its descendants <a href="https://www.britannica.com/plant/Bo-tree">attracts millions</a> of pilgrims every year. Sometimes a tree becomes iconic because of its association with pop culture. U2’s hit 1987 album The Joshua Tree has inspired fans to seek out the tree on the cover in the United States’ arid southwest – <a href="https://www.rollingstone.com/feature/u2s-the-joshua-tree-10-things-you-didnt-know-106885/">a potentially dangerous trip</a>. Other trees become famous because they’re exceptional in some way. The location of the world’s tallest tree – a 115-metre high redwood known as Hyperion – is <a href="https://www.smithsonianmag.com/smart-news/the-worlds-tallest-tree-is-officially-off-limits-180980509/">kept secret for its protection</a>. Niger’s Tree of Ténéré was known as the world’s most isolated, eking out an existence in the Sahara before the lonely acacia was accidentally knocked down by a truck driver in 1973. Its site is <a href="https://www.atlasobscura.com/places/last-tree-tenere">marked by a sculpture</a>. In 2003, the mountain ash known as El Grande – then the world’s largest flowering plant – was accidentally killed in a burn conducted by Forestry Tasmania. The death of the enormous tree – 87 metres tall, with a 19 metre girth – drew <a href="https://catalogue.nla.gov.au/catalog/3945157">“national and international”</a> media attention. This year, <a href="https://www.abc.net.au/news/2023-08-14/vandalism-sacred-birthing-tree-buangor-police-investigate/102726014">vandals damaged</a> a birthing tree sacred to the local Djab Wurrung people amidst conflicts about proposed road works in western Victoria. And in 2006, someone poisoned Queensland’s Tree of Knowledge – a 200-year-old ghost gum <a href="https://www.australiantraveller.com/qld/outback-qld/longreach/tree-of-knowledge-is-dead/">famous for its connection</a> to the birth of trade unionism in Australia. Under its limbs, shearers organised and marched for better conditions. The dead tree has been preserved in a memorial. <h2>What is it to lose a tree?</h2> Sociologist Anthony Giddens defines ontological security as a <a href="https://books.google.com.au/books/about/Modernity_and_Self_Identity.html?id=Jujn_YrD6DsC&redir_esc=y">“sense of continuity and order in events”</a>. To sustain it, we seek out feelings of safety, trust, and reassurance by engaging with comfortable and familiar objects, beings and people around us – especially those important to our self-identity. When there is an abrupt change, it challenges us. If your favourite tree in your street or garden dies, you mourn it – and what it gave you. But we mourn at a distance too – the Sycamore Gap tree was <a href="https://www.theguardian.com/uk-news/gallery/2023/sep/28/hadrians-wall-sycamore-gap-tree-in-pictures">world-famous</a>, even if you never saw it in real life. In <a href="https://figshare.utas.edu.au/articles/thesis/Seeing_the_forest_for_the_trees_ontological_security_and_experiences_of_Tasmanian_forests/23238422">my research</a>, I have explored how Tasmanian forests – including iconic landscapes and individual trees – can give us that sense of security we all seek in ourselves. As one interviewee, Leon, told me: <blockquote> These places should be left alone, because in 10,000 years they could still be there. Obviously I won’t be, we won’t be, but perhaps [the forest will be]. </blockquote> Temporality matters here. That is, we know what to expect by looking to the past and imagining what the future could be. Trees – especially ancient ones – act as a living link between the past, present, and future. As my interviewee Catherine said: <blockquote> You lie under an old myrtle and you just go, ‘wow - so what have you seen in your lifetime?’ Shitloads more than me. </blockquote> That’s why the loss of the Sycamore Gap tree has upset seemingly the entire United Kingdom. The tree was famous for its appearance: a solitary tree in a <a href="https://www.northumberlandnationalpark.org.uk/places-to-visit/hadrians-wall/sycamore-gap/">photogenic dip</a> in the landscape. Its loss means a different future for those who knew it. It’s as if you were reading a book you know – but someone changed the ending. <h2>Loss of connection</h2> We respond very differently when humans do the damage compared to natural processes. In one study, UK homeowners found it <a href="https://www.tandfonline.com/doi/full/10.1080/13698570802381162">harder to accept</a> their house being burgled than for it to be flooded, seeing flooding as more natural and thus less of a blow to their sense of security. This is partly why the sycamore’s death hurt. It didn’t fall in a storm. It was cut down deliberately – something that wasn’t supposed to happen. The sycamore was just a tree. But it was also not just a tree – it was far more, for many of us. It’s more than okay to talk about what this does to us – about how the loss of this thread of connection makes us grieve. Yes, we have lost the Sycamore Gap tree, just as we lost El Grande and many others. It is useful to talk about this - and to remember the many other beautiful and important trees that live on. <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/214841/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rebecca-banham-830381">Rebecca Banham</a>, Postdoctoral fellow, <a href="https://theconversation.com/institutions/university-of-tasmania-888">University of Tasmania</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/it-wasnt-just-a-tree-why-it-feels-so-bad-to-lose-the-iconic-sycamore-gap-tree-and-others-like-it-214841">original article</a>.

Travel Trouble

Taking an antidepressant? Mixing it with other medicines – including some cold and flu treatments – can be dangerous

<a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> In the depths of winter we are more at risk of succumbing to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522168/">viral respiratory infections</a> – from annoying sore throat, common cold and sinusitis, to the current resurgence of respiratory syncytial virus (RSV), influenza and COVID. Symptoms of upper respiratory tract infection range in severity. They can include fever, chills, muscle or body aches, cough, sore throat, runny or stuffy nose, earache, headache, and fatigue. Most antibiotics target bacteria so are <a href="https://pubmed.ncbi.nlm.nih.gov/32495003/">not effective</a> for viral infections. Many people seek relief with over-the-counter medicines. While evidence varies, guidelines suggest medicines taken by mouth (such as cough syrups or cold and flu tablets) have a <a href="https://pubmed.ncbi.nlm.nih.gov/25420096/">limited but potentially positive</a> short-term role for managing upper respiratory infection symptoms in adults and children older than 12. These include: <ul> <li>paracetamol or ibuprofen for pain or fever</li> <li>decongestants such as phenylephrine or pseudoephedrine</li> <li>expectorants and mucolytics to thin and clear mucus from upper airways</li> <li>dry cough suppressants such as dextromethorphan</li> <li>sedating or non-sedating antihistamines for runny noses or watery eyes.</li> </ul> But what if you have been prescribed an antidepressant? What do you need to know before going to the pharmacy for respiratory relief? <h2>Avoiding harm</h2> An audit of more than 5,000 cough-and-cold consumer enquiries to an Australian national medicine call centre found questions frequently related to drug-drug interactions (29%). An 18-month analysis showed 20% of calls <a href="https://pubmed.ncbi.nlm.nih.gov/26590496/">concerned</a> potentially significant interactions, particularly with antidepressants. Australia remains in the “<a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-%20prescriptions#Prescriptionsbytype">top ten</a>” antidepressant users in the <a href="https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PHMC">OECD</a>. More than <a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions">32 million</a> antidepressant prescriptions are dispensed on the Pharmaceutical Benefits Scheme each year. Antidepressants are commonly prescribed to manage symptoms of anxiety or depression but are also used in chronic pain and incontinence. They are classified primarily by how they affect chemical messengers in the nervous system. These classes are: <ul> <li>selective serotonin reuptake inhibitors (SSRI) such as fluoxetine, escitalopram, paroxetine and sertraline</li> <li>serotonin and noradrenaline reuptake inhibitors (SNRI) such as desvenlafaxine, duloxetine and venlafaxine</li> <li>tricyclic antidepressants (TCA) such as amitriptyline, doxepin and imipramine</li> <li>monoamine oxidase inhibitors (MAOI) such as tranylcypromine</li> <li>atypical medicines such as agomelatine, mianserin, mirtazapine, moclobemide, reboxetine and vortioxetine</li> <li>complementary medicines including St John’s wort, S-adenosyl methionine (SAMe) and L-tryptophan</li> </ul> Medicines within the same class of antidepressants have similar actions and side-effect profiles. But the molecular differences of individual antidepressants mean they may have different interactions with medicines taken at the same time. <h2>Types of drug interactions</h2> Drug interactions can be: <ul> <li>pharmacokinetic – what the body does to a drug as it moves into, through and out of the body. When drugs are taken together, one may affect the absorption, distribution, metabolism or elimination of the other</li> <li>pharmacodynamic – what a drug does to the body. When drugs are taken together, one may affect the action of the other. Two drugs that independently cause sedation, for example, may result in excessive drowsiness if taken together.</li> </ul> There are many <a href="https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/pnp.429">potential interactions</a> between medications and antidepressants. These include interactions between over-the-counter medicines for upper respiratory symptoms and antidepressants, especially those taken orally. Concentrations of nasal sprays or inhaled medicines are generally lower in the blood stream. That means they are less likely to interact with other medicines. <h2>What to watch for</h2> It’s important to get advice from a pharmacist before taking any medications on top of your antidepressant. Two symptoms antidepressant users should monitor for shortly after commencing a cough or cold medicine are central nervous system effects (irritability, insomnia or drowsiness) and effects on blood pressure. For example, taking a selective SSRI antidepressant and an oral decongestant (such as pseudoephedrine or phenylephrine) can cause irritability, insomnia and affect blood pressure. Serotonin is a potent chemical compound produced naturally for brain and nerve function that can also constrict blood vessels. Medicines that affect serotonin are common and include most antidepressant classes, but also decongestants, dextromethorphan, St John’s wort, L-tryptophan, antimigraine agents, diet pills and amphetamines. <a href="https://reference.medscape.com/drug-interactionchecker">Combining drugs</a> such as antidepressants and decongestants that both elevate serotonin levels can cause irritability, headache, insomnia, diarrhoea and blood pressure effects – usually increased blood pressure. But some people experience orthostatic hypotension (low blood pressure on standing up) and dizziness. For example, taking both a serotonin and SNRI antidepressant and dextromethorphan (a cough suppressant) can add up to high serotonin levels. This can also occur with a combination of the complementary medicine St John’s Wort and an oral decongestant. Where serotonin levels are too high, <a href="https://pubmed.ncbi.nlm.nih.gov/15666281/">severe symptoms</a> such as confusion, muscle rigidity, fever, seizures and even death have been reported. Such symptoms are rare but if you notice any of these you should stop taking the cold and flu medication straight away and seek medical attention. <h2>Ways to avoid antidepressant drug interactions</h2> There are a few things we can do to prevent potentially dangerous interactions between antidepressants and cold and flu treatments. 1. Better information Firstly, there should be more targeted, consumer-friendly, <a href="https://www.webmd.com/interaction-checker/default.htm">online drug interaction information</a> available for antidepressant users. 2. Prevent the spread of viral infections as much as possible Use the non-drug strategies that have worked well for COVID: regular hand washing, good personal hygiene, social distancing, and facemasks. Ensure adults and children are up to date with immunisations. 3. Avoid potential drug interactions with strategies to safely manage symptoms Consult your pharmacist for strategies most appropriate for you and only use cold and flu medications while symptoms persist: <ul> <li>treat muscle aches, pain, or a raised temperature with analgesics such as paracetamol or ibuprofen</li> <li>relieve congestion with a nasal spray decongestant</li> <li>clear mucus from upper airways with expectorants or mucolytics</li> <li>dry up a runny nose or watery eyes with a non-sedating antihistamine.</li> </ul> Avoid over-the-counter cough suppressants for an irritating dry cough. Use a simple alternative such as honey, steam inhalation with a few drops of eucalyptus oil or a non-medicated lozenge instead. 4. Ask whether your symptoms could be more than the common cold Could it be influenza or COVID? Seek medical attention if you are concerned or your symptoms are not improving. <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/208662/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: 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/taking-an-antidepressant-mixing-it-with-other-medicines-including-some-cold-and-flu-treatments-can-be-dangerous-208662">original article</a>.

Body

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

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

Body

"We love each other": Mayor marries reptile in stunning ceremony

Love comes when you least expect it and for one mayor in the small town of San Pedro Huamelula, Mexico, his match caiman he never looked back. Victor Hugo Sosa, the mayor of the town has said “I do” to his “princess girl”, a caiman named Alicia Adriana, and his wedding speech is one for the books. 'I accept responsibility because we love each other. That is what is important. You can't have a marriage without love... I yield to marriage with the princess girl,' he vowed. Onlookers clapped and danced in celebration as the mayor kissed and embraced his new bride who was dressed in a white gown and veil. The ceremony is part of a 230-year tradition which symbolises the joining of humans with the divine, as she is thought to be a deity representing mother earth. It also commemorates the day when two Indigenous groups came to peace- with the marriage between a Chontal king, now represented by the mayor, and a princess girl of the Huave Indigenous group, now represented by the female alligator. The age-old ritual involves the reptile being taken house to house before the wedding so that residents can take their turn dancing with it. She is later on changed into her wedding dress, which Olivia Perez was in charge of during this ceremony. "For us, the crocodile is important because she is the princess who comes to bring us water, a good harvest, rains, so that God the Almighty Father sends us food, fish, corn, the harvest," she said. After the wedding, the mayor dances with his bride to traditional music. Local fishermen would also take part in the ritual and toss their nets on the ground in hopes that their marriage would bring “'good fishing, so that there is prosperity, equilibrium and ways to live in peace.” Images: Getty, Oaxaca Informa10 Twitter

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ChatGPT and other generative AI could foster science denial and misunderstanding – here’s how you can be on alert

<a href="https://theconversation.com/profiles/gale-sinatra-1234776">Gale Sinatra</a>, <a href="https://theconversation.com/institutions/university-of-southern-california-1265">University of Southern California</a> and <a href="https://theconversation.com/profiles/barbara-k-hofer-1231530">Barbara K. Hofer</a>, <a href="https://theconversation.com/institutions/middlebury-1247">Middlebury</a> Until very recently, if you wanted to know more about a controversial scientific topic – stem cell research, the safety of nuclear energy, climate change – you probably did a Google search. Presented with multiple sources, you chose what to read, selecting which sites or authorities to trust. Now you have another option: You can pose your question to ChatGPT or another generative artificial intelligence platform and quickly receive a succinct response in paragraph form. ChatGPT does not search the internet the way Google does. Instead, it generates responses to queries by <a href="https://www.washingtonpost.com/technology/2023/05/07/ai-beginners-guide/">predicting likely word combinations</a> from a massive amalgam of available online information. Although it has the potential for <a href="https://hbr.org/podcast/2023/05/how-generative-ai-changes-productivity">enhancing productivity</a>, generative AI has been shown to have some major faults. It can <a href="https://www.scientificamerican.com/article/ai-platforms-like-chatgpt-are-easy-to-use-but-also-potentially-dangerous/">produce misinformation</a>. It can create “<a href="https://www.nytimes.com/2023/05/01/business/ai-chatbots-hallucination.html">hallucinations</a>” – a benign term for making things up. And it doesn’t always accurately solve reasoning problems. For example, when asked if both a car and a tank can fit through a doorway, it <a href="https://www.nytimes.com/2023/03/14/technology/openai-new-gpt4.html">failed to consider both width and height</a>. Nevertheless, it is already being used to <a href="https://www.washingtonpost.com/media/2023/01/17/cnet-ai-articles-journalism-corrections/">produce articles</a> and <a href="https://www.nytimes.com/2023/05/19/technology/ai-generated-content-discovered-on-news-sites-content-farms-and-product-reviews.html">website content</a> you may have encountered, or <a href="https://www.nytimes.com/2023/04/21/opinion/chatgpt-journalism.html">as a tool</a> in the writing process. Yet you are unlikely to know if what you’re reading was created by AI. As the authors of “<a href="https://global.oup.com/academic/product/science-denial-9780197683330">Science Denial: Why It Happens and What to Do About It</a>,” we are concerned about how generative AI may blur the boundaries between truth and fiction for those seeking authoritative scientific information. Every media consumer needs to be more vigilant than ever in verifying scientific accuracy in what they read. Here’s how you can stay on your toes in this new information landscape. <h2>How generative AI could promote science denial</h2> Erosion of epistemic trust. All consumers of science information depend on judgments of scientific and medical experts. <a href="https://doi.org/10.1080/02691728.2014.971907">Epistemic trust</a> is the process of trusting knowledge you get from others. It is fundamental to the understanding and use of scientific information. Whether someone is seeking information about a health concern or trying to understand solutions to climate change, they often have limited scientific understanding and little access to firsthand evidence. With a rapidly growing body of information online, people must make frequent decisions about what and whom to trust. With the increased use of generative AI and the potential for manipulation, we believe trust is likely to erode further than <a href="https://www.pewresearch.org/science/2022/02/15/americans-trust-in-scientists-other-groups-declines/">it already has</a>. Misleading or just plain wrong. If there are errors or biases in the data on which AI platforms are trained, that <a href="https://theconversation.com/ai-information-retrieval-a-search-engine-researcher-explains-the-promise-and-peril-of-letting-chatgpt-and-its-cousins-search-the-web-for-you-200875">can be reflected in the results</a>. In our own searches, when we have asked ChatGPT to regenerate multiple answers to the same question, we have gotten conflicting answers. Asked why, it responded, “Sometimes I make mistakes.” Perhaps the trickiest issue with AI-generated content is knowing when it is wrong. Disinformation spread intentionally. AI can be used to generate compelling disinformation as text as well as deepfake images and videos. When we asked ChatGPT to “<a href="https://www.scientificamerican.com/article/ai-platforms-like-chatgpt-are-easy-to-use-but-also-potentially-dangerous/">write about vaccines in the style of disinformation</a>,” it produced a nonexistent citation with fake data. Geoffrey Hinton, former head of AI development at Google, quit to be free to sound the alarm, saying, “It is hard to see how you can prevent the bad actors from <a href="https://www.nytimes.com/2023/05/01/technology/ai-google-chatbot-engineer-quits-hinton.html">using it for bad things</a>.” The potential to create and spread deliberately incorrect information about science already existed, but it is now dangerously easy. Fabricated sources. ChatGPT provides responses with no sources at all, or if asked for sources, may present <a href="https://economistwritingeveryday.com/2023/01/21/chatgpt-cites-economics-papers-that-do-not-exist/">ones it made up</a>. We both asked ChatGPT to generate a list of our own publications. We each identified a few correct sources. More were hallucinations, yet seemingly reputable and mostly plausible, with actual previous co-authors, in similar sounding journals. This inventiveness is a big problem if a list of a scholar’s publications conveys authority to a reader who doesn’t take time to verify them. Dated knowledge. ChatGPT doesn’t know what happened in the world after its training concluded. A query on what percentage of the world has had COVID-19 returned an answer prefaced by “as of my knowledge cutoff date of September 2021.” Given how rapidly knowledge advances in some areas, this limitation could mean readers get erroneous outdated information. If you’re seeking recent research on a personal health issue, for instance, beware. Rapid advancement and poor transparency. AI systems continue to become <a href="https://www.nytimes.com/2023/05/01/technology/ai-google-chatbot-engineer-quits-hinton.html">more powerful and learn faster</a>, and they may learn more science misinformation along the way. Google recently announced <a href="https://www.nytimes.com/2023/05/10/technology/google-ai-products.html">25 new embedded uses of AI in its services</a>. At this point, <a href="https://theconversation.com/regulating-ai-3-experts-explain-why-its-difficult-to-do-and-important-to-get-right-198868">insufficient guardrails are in place</a> to assure that generative AI will become a more accurate purveyor of scientific information over time. <h2>What can you do?</h2> If you use ChatGPT or other AI platforms, recognize that they might not be completely accurate. The burden falls to the user to discern accuracy. Increase your vigilance. <a href="https://www.niemanlab.org/2022/12/ai-will-start-fact-checking-we-may-not-like-the-results/">AI fact-checking apps may be available soon</a>, but for now, users must serve as their own fact-checkers. <a href="https://www.nsta.org/science-teacher/science-teacher-januaryfebruary-2023/plausible">There are steps we recommend</a>. The first is: Be vigilant. People often reflexively share information found from searches on social media with little or no vetting. Know when to become more deliberately thoughtful and when it’s worth identifying and evaluating sources of information. If you’re trying to decide how to manage a serious illness or to understand the best steps for addressing climate change, take time to vet the sources. Improve your fact-checking. A second step is <a href="https://doi.org/10.1037/edu0000740">lateral reading</a>, a process professional fact-checkers use. Open a new window and search for <a href="https://www.nsta.org/science-teacher/science-teacher-mayjune-2023/marginalizing-misinformation">information about the sources</a>, if provided. Is the source credible? Does the author have relevant expertise? And what is the consensus of experts? If no sources are provided or you don’t know if they are valid, use a traditional search engine to find and evaluate experts on the topic. Evaluate the evidence. Next, take a look at the evidence and its connection to the claim. Is there evidence that genetically modified foods are safe? Is there evidence that they are not? What is the scientific consensus? Evaluating the claims will take effort beyond a quick query to ChatGPT. If you begin with AI, don’t stop there. Exercise caution in using it as the sole authority on any scientific issue. You might see what ChatGPT has to say about genetically modified organisms or vaccine safety, but also follow up with a more diligent search using traditional search engines before you draw conclusions. Assess plausibility. Judge whether the claim is plausible. <a href="https://doi.org/10.1016/j.learninstruc.2013.03.001">Is it likely to be true</a>? If AI makes an implausible (and inaccurate) statement like “<a href="https://www.usatoday.com/story/news/factcheck/2022/12/23/fact-check-false-claim-covid-19-vaccines-caused-1-1-million-deaths/10929679002/">1 million deaths were caused by vaccines, not COVID-19</a>,” consider if it even makes sense. Make a tentative judgment and then be open to revising your thinking once you have checked the evidence. Promote digital literacy in yourself and others. Everyone needs to up their game. <a href="https://theconversation.com/how-to-be-a-good-digital-citizen-during-the-election-and-its-aftermath-148974">Improve your own digital literacy</a>, and if you are a parent, teacher, mentor or community leader, promote digital literacy in others. The American Psychological Association provides guidance on <a href="https://www.apa.org/topics/social-media-internet/social-media-literacy-teens">fact-checking online information</a> and recommends teens be <a href="https://www.apa.org/topics/social-media-internet/health-advisory-adolescent-social-media-use">trained in social media skills</a> to minimize risks to health and well-being. <a href="https://newslit.org/">The News Literacy Project</a> provides helpful tools for improving and supporting digital literacy. Arm yourself with the skills you need to navigate the new AI information landscape. Even if you don’t use generative AI, it is likely you have already read articles created by it or developed from it. It can take time and effort to find and evaluate reliable information about science online – but it is worth it.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/204897/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/gale-sinatra-1234776">Gale Sinatra</a>, Professor of Education and Psychology, <a href="https://theconversation.com/institutions/university-of-southern-california-1265">University of Southern California</a> and <a href="https://theconversation.com/profiles/barbara-k-hofer-1231530">Barbara K. Hofer</a>, Professor of Psychology Emerita, <a href="https://theconversation.com/institutions/middlebury-1247">Middlebury</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/chatgpt-and-other-generative-ai-could-foster-science-denial-and-misunderstanding-heres-how-you-can-be-on-alert-204897">original article</a>.

Technology

Long-married couples said not to know each other as well as newlyweds

You would think decades of marriage together would give older couples plenty of time to get to know each other but an interesting new study suggests otherwise, finding that couples who have been together for decades are worse at predicting what their partner likes than newlyweds. The study, published in the Journal of Consumer Psychology, tested young couples, aged from 19 to 32, who had been together for an average of two years and older couples, aged from 62 to 78, who had been together for at least 40 years. Each of the 116 participants was presented with a series of descriptions (of foods, movies, house designs and so on) and asked to rate his or her preference and predict how their partner would rate the item. They were also asked to estimate how many of their predictions were correct. And well, overall, we’re not great at knowing what our significant other likes, even though we think we are. Young couples got 42 per cent of their predictions right and older couples only predicted 36 per cent of their partners’ preferences, when both couple groups overconfidently estimated they would get 62 per cent of answers right. “This is surprising because, compared to younger couples, older couples had much more time and opportunities to learn about each other's preferences over the course of their relationship,” the team of psychologist wrote. They suggested that younger couples may be more motivated to understand their partners during the early stages of a relationship. “Another reason could be that older couples pay less attention to each other, because they view their relationship as already firmly committed or because they think they already know their partner well,” said one of the researchers, Dr Benjamin Scheibehenne of the University of Basel. Image credit: Shutterstock

Relationships

Famous movie plots that were stolen from other films

Some films stand the test of time, and you can watch them again and again. But unlike what we’ve been led to believe, the storylines of some famous flicks were ‘heavily influenced’ by other (read: lesser-known) films. Is it plagiarism or just inspiration? You decide. 1. Star Wars & The Hidden Fortress George Lucas appears to be so enamoured with Japanese director Akira Kurosawa’s The Hidden Fortress that he took what he could for his first Star Wars film and used the leftovers in the second. Using two tag-along types (R2D2 and C3PO) to tell the story is probably the most well documented similarity with The Hidden Fortress. In a 2001 interview, George Lucas openly discussed this specific component of his influences for Star Wars, saying “I remember the one thing that really struck me about The Hidden Fortress,” he said, “the one thing I was really intrigued by, was the fact that the story was told from the two lowest characters. I decided that would be a nice way to tell the Star Wars story. Take the two lowliest characters, as Kurosawa did, and tell the story from their point of view. Which, in the Star Wars case is the two droids, and that was the strongest influence. 2. Reservoir Dogs & City on Fire While Reservoir Dogs is not a direct copy of City on Fire, there are definitely similarities in the plot (a group of criminals plan and blow a big job) and a couple of whole scenes that are very similar. Quentin Tarantino’s 1992 hit’s famous scenes echo the Chinese film, for instance both have four men walking in black suits, a tense standoff where three characters point a gun at each other, and shooting cops through a windscreen that shatters. Tarantino admits it too, saying to the Baltimore Sun that City on Fire is "a really cool movie. It influenced me a lot. I got some stuff from it." 3. A Fistful of Dollars & Yojimbo Once again we see Akira Kurosawa’s name pop up, with another of his films being used as inspiration for the Clint Eastwood classic. This time the samurais are replaced with cowboys, and a hero with no name (Eastwood) arrives in a small town where two rival gangs fight for control. Unfortunately for director Sergio Leone, he was sued by Toho Productions due to the similarities, which delayed release of the film for three years. Eventually the two settled out of court and A Fistful of Dollars went on to become a major hit. 4. The Lion King & Kimba the White Lion Besides the obvious similarities between the main characters’ names (Simba and Kimba sound quite alike don’t they?), many more elements of the plot mirror each other. Both the Disney film and the Japanese Manga have a bird, baboon and hyenas as supporting characters in the movies. There is a scene in which both Simba and Kimba stand on the cliff tops overlooking their future kingdoms, and each has an evil lion wanting to claim their stake at the throne (both ’Scar’ and ‘Claw’ have a scar on one eye). Despite having many similar scenes, it seems that the Kimba creators didn’t want to take on the behemoth that is Disney. They are quoted in the LA Times as saying "Our company's general opinion is The Lion King is a totally different piece from [Kimba] and is an original work completed by [Disney's] long-lasting excellent production technique." Images: Jolly Film

Movies

Screwed over: how Apple and others are making it impossible to get a cheap and easy phone repair

If Apple and other tech companies have their way, it will only become harder to have our phones and other devices repaired by third-party businesses. Smartphones and many other tech devices are increasingly being designed in ways that make it challenging to repair or replace individual components. This might involve soldering the processor and flash memory to the motherboard, gluing components together unnecessarily, or using non-standard <a href="https://www.ifixit.com/News/14279/apples-diabolical-plan-to-screw-your-iphone">pentalobe screws</a> which make replacements problematic. Many submissions to an Australian “right to repair” <a href="https://www.pc.gov.au/inquiries/current/repair/submissions#initial">inquiry</a> have called on tech manufacturers to provide a fair and competitive market for repairs, and produce products that are easily repairable. The <a href="https://www.pc.gov.au/inquiries/current/repair/issues/repair-issues.pdf">right to repair</a> refers to consumers’ ability to have their products repaired at a competitive price. This includes being able to choose a repairer, rather than being forced by default to use the device manufacturer’s services. But it seems Apple doesn’t want its customers to fix their <a href="https://www.vice.com/en/article/evmeya/apple-iphone-right-to-repair-california">iPhones</a>or <a href="https://www.inputmag.com/culture/apples-repair-policies-are-utterly-shameful-and-shouldnt-be-allowed-e-waste-recycling-macbooks-t2">Macbooks</a> themselves. The company has <a href="https://www.vice.com/en/article/nz85y7/apple-is-lobbying-against-your-right-to-repair-iphones-new-york-state-records-confirm">lobbied against</a> the right to repair in the United States and has <a href="https://www.npr.org/2020/11/18/936268845/apple-agrees-to-pay-113-million-to-settle-batterygate-case-over-iphone-slowdowns">been accused of deliberately slowing down</a> iPhones with older batteries. <a href="https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2019/10/16/tech-giants-fight-digital-right-to-repair-bills">Opposition</a> against the right to repair from tech companies is to be expected. Cornering consumers into using their service centres increases their revenue and extends their market domination. In its defence, Apple has said <a href="https://time.com/4828099/farmers-and-apple-fight-over-the-toolbox/">third-party repairers</a> could use lower quality parts and also make devices vulnerable to hackers. It also defended its <a href="https://venturebeat.com/2019/08/14/apple-defends-iphone-unauthorized-battery-warning-as-a-safety-feature/">battery warning indication</a> as a “safety” feature, wherein it started to alert users if their phone’s replacement battery hadn’t come from a certified Apple repairer. In the US, Apple’s <a href="https://support.apple.com/irp-program">independent repair provider program</a> grants certain providers access to the parts and resources needed to fix its devices. Independent repair shops in <a href="https://www.apple.com/newsroom/2020/07/apple-expands-iphone-repair-services-to-hundreds-of-new-locations-across-the-us/">32 countries</a> can now apply, but the scheme has yet to extend outside the US. <h2>Impact on users</h2> With the iPhone 12 — the latest iPhone offering — Apple has <a href="https://www.ifixit.com/News/45921/is-this-the-end-of-the-repairable-iphone">made it even harder</a> for third-party repairers to fix the device, thereby increasing users’ reliance on its own services. Apple has hiked its <a href="https://support.apple.com/en-au/iphone/repair/service/screen-replacement">repair charges</a> for iPhone 12 by more than 40%, compared with the iPhone 11. It is <a href="https://support.apple.com/en-au/iphone/repair/service/screen-replacement">charging</a> more than A$359 to fix an iPhone 12 screen outside of warranty and A$109 to replace the battery. Historically, third-party repairers have been a cheaper option. But using a third-party repairer for an iPhone 12 could render some phone features, such as the camera, <a href="https://www.theverge.com/2020/10/30/21542242/apple-iphone-12-third-party-repairs-ifixit-camera-module-replacement">almost inoperable</a>. According to reports, fixing the iPhone 12’s camera requires <a href="https://9to5mac.com/2020/10/30/iphone-12-camera-repair/">Apple’s proprietary</a> system configuration app, available only to the company’s own authorised technicians. It’s not just Apple, either. <a href="https://www.techradar.com/au/news/samsungs-galaxy-s20-ultra-is-unsurprisingly-difficult-to-repair">Samsung’s</a> flagship phones are also quite tricky for third-party repairers to fix. <h2>Impact on environment</h2> When certain parts for repairs aren’t available, manufacturers will produce new phones instead, consuming <a href="https://www.envirotech-online.com/news/environmental-laboratory/7/breaking-news/how-do-smartphones-affect-the-environment/48339">more energy and resources</a>. In fact, manufacturing one smartphone <a href="https://www-sciencedirect-com.ezproxy.cqu.edu.au/science/article/pii/S095965261733233X">consumes</a> as much energy as using it for ten years. As smartphones become harder to repair, electronic waste will grow. Apple and Samsung both cited environmental benefits when they announced they would no longer ship <a href="https://theconversation.com/apples-iphone-12-comes-without-a-charger-a-smart-waste-reduction-move-or-clever-cash-grab-148189">chargers</a> with their phones. Yet, they’ve turned a blind eye to the environmental damage that would arise from completely cornering the repair market. The average Australian home has <a href="https://thinktv.com.au/facts-and-stats/australian-homes-are-experiencing-a-screen-explosion/">6.7 devices</a>, including televisions, personal computers, laptops, tablets and smartphones. With diminishing opportunities for repair, the environmental burden from disposing of these devices will increase. <h2>What is being done?</h2> Phone giants make it tough for third-party repairers to do their job in a variety of ways. This includes constantly changing designs, adding hurdles to the repair process, and restricting access to parts, diagnostic software and repair documentation. Meanwhile, consumers are left with broken phones and huge repair bills — and repairers are left with less business. The fight to remove barriers to repair is gaining momentum outside Australia, too, in countries including <a href="https://www.policyalternatives.ca/publications/monitor/when-will-canadians-have-right-repair">Canada</a>, the <a href="https://www.thetimes.co.uk/article/right-to-repair-means-spare-parts-for-household-appliances-mr5gmkjxr">United Kingdom</a> and the <a href="https://www.repair.org/legislation">United States</a>. Legislative reforms have been introduced in the <a href="https://repair.eu/news/european-parliament-calls-for-ambitious-right-to-repair/">European Union</a> and <a href="https://www.vice.com/en/article/93wy8v/newly-passed-right-to-repair-law-will-fundamentally-change-tesla-repair">Massachusetts</a>. France has introduced a <a href="https://www.ecologie.gouv.fr/indice-reparabilite">Repairability Index</a> requiring electrical and electronic equipment companies to inform consumers about their products’ repairability on a scale of one to ten. This takes into account the ease of repairability, availability and price of spare parts and availability of technical repair documents. <h2>The path moving forward</h2> Until the push for right to repair legislative reform gathers pace globally, consumers will have little choice but to pay up to big companies to access their authorised repair services. If they don’t, they may risk losing their warranty, ending up with a non-functional device and even <a href="https://static1.squarespace.com/static/5e449c8c3ef68d752f3e70dc/t/5ea8a6d93b485d0feb9b5d6b/1588111098207/Report_RightToRepair_HanleyKellowayVaheesan-1.pdf">infringing</a> upon the manufacturers’ software copyrights. Ideally, phone companies (and others) would assist users with the repair process by providing replacement parts, repair documentation and diagnostic tools to third-party repairers. This would also help <a href="https://www.apple.com/au/newsroom/2020/07/apple-commits-to-be-100-percent-carbon-neutral-for-its-supply-chain-and-products-by-2030/">Apple</a> and <a href="https://www.samsung.com/us/aboutsamsung/sustainability/environment/">Samsung</a> reduce their carbon footprint and achieve their environmental goals. Although the way things are going, it’s unlikely tech companies will be able to escape their self-inflicted repair obligations. In the past, Apple CEO Jeff Williams has <a href="https://www.apple.com/newsroom/2019/08/apple-offers-customers-even-more-options-for-safe-reliable-repairs/">said, "</a>we believe the safest and most reliable repair is one handled by a trained technician using genuine parts that have been properly engineered and rigorously tested." But with only so much workforce available even to Apple, sharing the load with smaller repairers will help. And for consumers’ benefit, the right to repair legislation must be taken seriously, with consistent repairability scores developed across the globe. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/screwed-over-how-apple-and-others-are-making-it-impossible-to-get-a-cheap-and-easy-phone-repair-156871" target="_blank" rel="noopener">The Conversation</a>.

Technology

‘Everything Everywhere All at Once’ and other Oscars 2023 films show a trend towards linguistic realism in Hollywood

At the 95th Academy Awards, <a href="https://www.theguardian.com/film/2023/mar/13/daniel-kwan-and-daniel-scheinert-win-best-director-oscar-for-everything-everywhere-all-at-once">Daniel Scheinert and Daniel Kwan’s</a> Everything Everywhere All at Once took home <a href="https://variety.com/2023/awards/awards/everything-everywhere-all-at-once-oscars-record-1235544633/">wins in acting, editing and directing categories, and also won the coveted best picture</a> award. The quirky and expansive sci-fi action film is famed for its absurdist take on the idea of a multiverse, yet it is still grounded in realness and humanity: In one masterfully choreographed scene in Everything Everywhere, <a href="https://www.youtube.com/watch?v=H2wID9_FFD0">three languages are spoken by three generations of one chaotic immigrant family</a> over dinner. As a linguist, I am interested in how screenwriters and directors use language in film to <a href="https://books.google.ca/books/about/Multilingualism_in_the_Movies.html?id=hfhclpshb8UC&redir_esc=y">do much more than just convey dialogue</a>: Language and subtitles also provide characterization, establish the tone of a scene and ground fictional stories in reality. Increasing use of non-English languages and subtitles demonstrates both a trend toward linguistic realism in Hollywood and also broader acceptance of linguistic diversity in a globalized society. <figure></figure> But filmmakers must negotiate the tension between narrative goals and audience engagement. By <a href="https://www.routledge.com/English-with-an-Accent-Language-Ideology-and-Discrimination-in-the-United/Lippi-Green/p/book/9780415559119">examining different ideologies held by filmmakers and audiences alike</a>, we can also still sometimes find long-standing associations between foreign language and villainy. <h2>Languages breaking through</h2> As South Korean filmmaker <a href="https://www.cjenm.com/en/news/director-bong-joonhos-parasite-wins-the-best-foreign-language-film-at-the-77th-golden-globe-awards/">Bong Joon-ho</a> described in his <a href="https://variety.com/2020/film/awards/south-koreas-parasite-crashes-the-subtitles-barrier-1203488979/">Golden Globes acceptance speech for 2019’s Parasite</a>, when audiences move past the “one-inch tall barrier of subtitles” a richer world of film awaits. <a href="https://doi.org/10.1177/0963947013519551">Telling authentic stories</a> in a modern, globalized and multicultural world means fairly portraying the languages spoken and signed all throughout our society. Hence, at times, the need for subtitles. In another scene in Everything Everywhere, spoken language is eschewed altogether: Two rocks converse silently while gazing over a barren canyon, with black and white subtitles appearing on a bright blue sky. This simple yet <a href="https://twitter.com/Refinery29/status/1635118157206794243">emotionally resonant scene</a> was somehow enough to <a href="https://www.refinery29.com/en-gb/everything-everywhere-all-at-once-review">move many viewers to tears</a>. Although <a href="https://ew.com/movies/movie-reviews/tar-cate-blanchett-todd-field-nina-hoss/">Todd Field’s Tár</a> did not clinch any Oscar wins this year, star Cate Blanchett notched multiple <a href="https://www.vogue.com/article/full-winners-list-golden-globes-2023">other acting awards</a> <a href="https://www.vanityfair.com/hollywood/2023/01/awards-insider-critics-choice-awards-2023-winners">for her role</a> as the titular orchestra conductor. In some of the film’s best scenes, the maestro uses only German during orchestra rehearsals and subtitles are dropped completely. Non-Germanophone audiences might not understand the words Blanchett says, but they are instead encouraged to focus on the visual aspects of the character’s communication: her facial expressions, physical tics and tremors and the building tension, both visible and audible, between her ego and everyone around her. The Oscar performance of “Naatu Naatu,” from the Indian <a href="https://www.bbc.com/news/world-asia-india-64935389">Telugu-language blockbuster</a> <a href="https://www.bbc.com/news/world-asia-india-64935389">RRR</a>, which received a standing ovation, was evidence that performances can cross language boundaries by leaning into creative elements far beyond words. <h2>Two sides of language representation</h2> The flip side of positive aspects of linguistic representation is that filmmakers, free to use the tool of multilingualism to provide characterization and establish tone, and even to showcase threatened languages, are also free to use it to entrench certain linguistic stereotypes, namely the association between foreignness and villainy. The <a href="https://screenrant.com/black-panther-wakanda-forever-talokan-lore-phase-5-complicated/">warriors of the underwater Talokan kingdom</a> in Ryan Coogler’s Black Panther: Wakanda Forever never speak a word of English. In this Marvel Cinematic Universe story, the fictional kingdom of Atlantis was <a href="https://www.smithsonianmag.com/history/the-mesoamerican-influences-behind-namor-from-black-panther-wakanda-forever-180981106">repositioned as a Mesoamerican-inspired society</a>. The <a href="https://globalvoices.org/2023/01/05/indigenous-and-proud-a-maya-speakers-reaction-to-black-panther-wakanda-forever/">language of Talokan is the real-world language of Yucatec Maya</a>, spoken by Indigenous people in present-day <a href="https://www.britannica.com/topic/Yucatec-language">Guatemala, Belize and southern Mexico</a>. <h2>Sharing an Indigenous language</h2> Yucatec Maya is stigmatized and marginalized in the geographic areas where it is traditionally spoken, one of the <a href="https://theconversation.com/in-mexico-how-erasing-black-history-fuels-anti-black-racism-175315">long-lasting consequences of colonization</a>. But Coogler’s creative decision to use Yucatec Maya as the language of Talokan, as well as to borrow heavily from Mayan and Aztec cultures for <a href="https://www.hollywoodreporter.com/movies/movie-news/black-panther-wakanda-forever-ruth-e-carter-oscar-costume-design-1235349112/">visual inspiration</a>, has delighted some <a href="https://globalvoices.org/2023/01/05/indigenous-and-proud-a-maya-speakers-reaction-to-black-panther-wakanda-forever/">Maya-speaking Indigenous moviegoers</a> who say they saw their culture represented and are happy to see the language widely shared. Two strong minor characters, Namora and Attuma, speak only in Yucatec Maya throughout the entire movie, with English subtitles in an elegant blue script. <h2>Archetypes of antagonism?</h2> Yet, these characters are the primary villains of the story, portrayed as powerful and physically otherworldly. Thus, while the characters are not one-dimensional, their language seems to narratively underscore certain archetypes of antagonism, beyond simply showcasing a real Indigenous language of the world. This is especially noticeable when contrasted with the protagonists, the mostly-anglophone Wakandans. Although the <a href="https://screenrant.com/black-panther-movie-wakanda-language-xhosa-explained">language of Wakanda is the real-world language of Xhosa</a>, spoken in South Africa, in Wakanda Forever, it was mostly relegated to greetings and asides. Instead, the protagonists speak a kind of pan-African accented English. Unlike in James Cameron’s <a href="https://www.hollywoodreporter.com/movies/movie-news/avatar-the-way-of-water-vfx-oscar-2023-1235343383/">Avatar: The Way of Water</a>, viewers are never explicitly told that what the audience hears has been “translated” for us. <h2>Refreshing to see, hear more languages</h2> In Avatar, which took the <a href="https://www.nzherald.co.nz/entertainment/oscars-2023-all-the-kiwis-nominated-at-the-academy-awards-this-year/G7PU6REBKFDRVLTOTUZJ4TEM4A/">Oscar for best visual effects,</a> the protagonists all speak Na'vi, the language of <a href="https://gamerant.com/avatar-creation-human-navi-hybrids-explained/">the species living across</a> the fictional Pandora. Most of the language has been “translated” in the mind of the narrator, Jake Sully. In a neat expositional trick, the main character narrates the beginning of the film and explains that he learned the alien language well enough that it just sounds like English to him. This way, audiences won’t have to read for the entire film, and the heroes (and actors) can speak only English without sacrificing the “realism” of the science-fictional universe. It has been refreshing to see, <a href="https://mashable.com/article/minari-korean-language">in recent years</a>, many productions in film achieve critical and commercial success in the anglophone world despite being in non-English languages and <a href="https://www.latimes.com/entertainment-arts/movies/story/2021-03-04/sound-of-metal-deaf-actors-chelsea-lee-jeremy-lee-stone">using subtitles</a>. There’s much more room for films to highlight both linguistic diversity as well as authentic characterization of characters who speak and sign without resorting to potentially harmful tropes. And I’m sure audiences wouldn’t mind hearing more Na'vi in Avatar 3. Image credit: Getty

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