tag:theconversation.com,2011:/institutions/neuroscience-research-australia-976/articlesNeuroscience Research Australia2022-06-01T03:51:54Ztag:theconversation.com,2011:article/1820432022-06-01T03:51:54Z2022-06-01T03:51:54ZI’m getting older, how can I prevent falls?<figure><img src="https://images.theconversation.com/files/462616/original/file-20220512-13-e6jcqp.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C5796%2C3713&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Falls are common. Each year <a href="https://www.who.int/publications/i/item/9789241563536">one in every three</a> people aged over 65 will fall. Around <a href="https://protect-au.mimecast.com/s/TmbBC6XQ4LfoyR3W3CpQkee?domain=cambridge.org">one in ten falls</a> lead to serious injury. Most of us have a friend or relative who has experienced an injury from a fall and know what a life-changing event it can be. </p>
<p>The most common serious injuries are fractures and brain injuries. Falls can also result in a loss of confidence, which can lead to restriction of activity and a lower quality of life. Many older people never regain their pre-fall level of function and might even struggle to keep living by themselves. </p>
<p>The consequences of falls cost Australia a staggering <a href="https://www.aihw.gov.au/reports/injury/falls-in-older-australians-2019-20-hospitalisation/contents/about">$4.3 billion</a> every year. The good news is <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012424.pub2/full">20-30% of falls</a> among older Australians can be prevented. </p>
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<h2>Why do we fall in older age?</h2>
<p>Falls happen when there is a mismatch between our physical abilities and the immediate demands of the environment or activity being undertaken. </p>
<p>Falls become more common as we get older because as we age, there is a natural decline in muscle strength, balance and vision, all of which are important for helping us stay upright. </p>
<p>The risk of falls is increased by certain medical conditions (such as Parkinson’s disease, dementia and stroke) and certain medications (such as sleeping tablets). </p>
<p>But this doesn’t mean falls are inevitable.</p>
<h2>Exercise makes the most difference</h2>
<p><a href="https://bjsm.bmj.com/content/54/15/885">Exercise</a> that aims to improve balance and leg strength is the most effective in preventing falls.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/462685/original/file-20220512-15-imz9uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older people doing yoga" src="https://images.theconversation.com/files/462685/original/file-20220512-15-imz9uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462685/original/file-20220512-15-imz9uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462685/original/file-20220512-15-imz9uz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462685/original/file-20220512-15-imz9uz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462685/original/file-20220512-15-imz9uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462685/original/file-20220512-15-imz9uz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462685/original/file-20220512-15-imz9uz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Exercise for strength and balance should be done often.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>This means exercise that is carried out while standing (not while seated), with the feet positioned close together or while standing on one leg (if safe to do so), while performing controlled movement of the upper body (leaning and reaching movements, for example). </p>
<p>Balance training combined with strength training for the major muscle groups is most effective. </p>
<p>These exercises need to be tailored to individual abilities. Middle-aged people with good physical function will benefit from harder exercises (such as functional training at a gym or boot camp incorporating squats and step-ups). </p>
<p><a href="https://www.safeexerciseathome.org.au/">Effective exercises</a> for people with impaired physical function or frailty will follow the same principles but should be modified for safety and effectiveness. These include everyday activities such as standing up from a seated position without using arms for support, walking up and down stairs, walking in one line, stepping over obstacles or balancing on one leg.</p>
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<p>For lasting impacts, it’s important this type of exercise is done often. The <a href="https://www.who.int/news-room/fact-sheets/detail/physical-activity">World Health Organization</a> recommends incorporating these exercises two to three times a week as part of the 150-300 minutes a week of moderate activity recommended for improving health. </p>
<p>Not everyone enjoys exercising, which means some people struggle to prioritise it. It’s very important to know nobody is ever “too old” to start exercising, and benefits are gained at any age. But don’t hold off to start exercising either – the earlier we start to build our strength and balance, the better off we will be in our older years.</p>
<p>Starting small and building up the amount and intensity of activity, and choosing something enjoyable, are the best ways to start. If you can’t reach a high dose of exercise initially, any amount is better than nothing. </p>
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<a href="https://images.theconversation.com/files/462622/original/file-20220512-12-qljf6d.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman sitting in chair. Woman pushing herself up with her legs. Woman standing." src="https://images.theconversation.com/files/462622/original/file-20220512-12-qljf6d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462622/original/file-20220512-12-qljf6d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462622/original/file-20220512-12-qljf6d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462622/original/file-20220512-12-qljf6d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462622/original/file-20220512-12-qljf6d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462622/original/file-20220512-12-qljf6d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462622/original/file-20220512-12-qljf6d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Simple sit-to-stand exercises can improve strength and balance.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>If you like exercising in a group, consider finding a local program and invite a friend along for added support and social connection. Your <a href="https://www.activeandhealthy.nsw.gov.au/">state government</a> or local council should have their classes listed online.</p>
<p>If you’re not sure where to start, the best thing to do is to seek professional help to select exercises that suit your abilities and health conditions. Talk to your GP, local <a href="https://choose.physio/find-a-physio">physio</a> or <a href="https://www.essa.org.au/find-aep/">exercise physiologist</a>.</p>
<h2>What else can we do to prevent falls?</h2>
<p>In addition to exercise to improve balance and strength, other actions that can reduce the risk of falls include talking to your doctor or pharmacist to review your medications, seeing a podiatrist if you have painful feet, and maximising the safety of your home environment by installing adequate lighting and grab rails, and ensuring walkways are free from clutter and liquid spills.</p>
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<a href="https://images.theconversation.com/files/462669/original/file-20220512-20-arf332.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man with his GP" src="https://images.theconversation.com/files/462669/original/file-20220512-20-arf332.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462669/original/file-20220512-20-arf332.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462669/original/file-20220512-20-arf332.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462669/original/file-20220512-20-arf332.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462669/original/file-20220512-20-arf332.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462669/original/file-20220512-20-arf332.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462669/original/file-20220512-20-arf332.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">If you have had a fall or are worried about mobility, talk to your GP.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Falls are not inevitable as we age. We need investment in strategies to help older Australians stay active and independent, and avoid falls. Despite knowing what works to avoid them, we have no national policy or strategy to implement and fund fall prevention programs. Doing so would not only help older Australians, but the budget bottom-line too.</p>
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<img src="https://counter.theconversation.com/content/182043/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Tiedemann receives funding from the National Health and Medical Research Council.</span></em></p><p class="fine-print"><em><span>Cathie Sherrington receives funding from the National Health and Medical Research Institute.</span></em></p><p class="fine-print"><em><span>Kim Delbaere receives funding from the National Health and Medical Research Council. Kim Delbaere is the President of the Australian and New Zealand Falls Prevention Society. </span></em></p>Exercise that targets balance and strength is the most effective for reducing the risk of falls.Anne Tiedemann, Professor of Physical Activity and Health, University of SydneyCathie Sherrington, Professor, University of SydneyKim Delbaere, Senior Principal Research Scientist, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1682632021-10-01T02:30:07Z2021-10-01T02:30:07ZSport and physical activity play important roles for Aboriginal and Torres Strait Islander communities, but there are barriers to participation<p>Physical activity and sport are important in Aboriginal and Torres Strait Islander cultures. Traditional activities like <a href="https://aiatsis.gov.au/sites/default/files/research_pub/benefits-cfc_0_2.pdf">hunting and caring for Country</a> are still practiced today. These activities require physical exertion and have cultural significance. </p>
<p>Organised sport is important in many regional and remote communities where higher numbers of Aboriginal and Torres Strait Islander peoples live. This can be seen through competitions like the <a href="https://en.wikipedia.org/wiki/NSW_Koori_Knockout">NSW Koori Knockout</a> and the <a href="https://wa.netball.com.au/naidoc-netball-carnival">NAIDOC Netball Carnival</a>.</p>
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<h2>Why is this important?</h2>
<p>Many factors influence Aboriginal and Torres Strait Islander participation in physical activity and sport. These can be classified as facilitators, that enable participation, or barriers, that can make participation more challenging. </p>
<p>Data from the <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4727.0.55.004%7E2012-13%7EMain%20Features%7EAdults%20in%20non-remote%20areas%7E7">Australian Bureau of Statistics</a> show fewer than four in ten Aboriginal and Torres Strait Islander adults are doing enough physical activity. This is despite high Indigenous representation in professional sport, for example in <a href="https://www.nrl.com/community/indigenous/">Rugby League</a> and <a href="http://community.afl/indigenous">AFL</a>. </p>
<p>Doing physical activity has lots of positive health benefits, such as reducing the risk of heart disease and diabetes. There are also social benefits of participating in sport. Our <a href="https://theconversation.com/are-sports-programs-closing-the-gap-in-indigenous-communities-the-evidence-is-limited-120413#comment_1973668">previous research</a> found some evidence of benefits for education, employment, culture, well-being, life skills and crime prevention. </p>
<p>Our <a href="https://www.mdpi.com/1660-4601/18/18/9893">new review</a> found 62 different facilitators and 63 different barriers to physical activity and sport. Multiple, complex facilitators and barriers were experienced by Aboriginal and Torres Strait Islander adults across Australia. </p>
<p>The review included 27 studies of over 750 total participants aged 18 and over. The studies were published between 2008 and 2020 and took place in urban, rural/regional and remote areas. Most involved interviews, “<a href="https://www.yarning.com.au/what-is-yarning">yarning</a>” or storytelling with Aboriginal and Torres Strait Islander people. </p>
<p>Some studies focused on physical activity <a href="https://search.informit.org/doi/10.3316/informit.199093316520319">programs</a>. Some studies had a <a href="https://pubmed.ncbi.nlm.nih.gov/25103025/">sport focus</a>. And some focused on <a href="https://www.iuih.org.au/our-services/health-and-wellbeing-services/work-it-out/">physical activity together with nutrition</a>.</p>
<p>The main physical activity and sport motivators were support from family, friends and program staff, and opportunities to connect with community or culture. The main barriers were a lack of transport and financial constraints. Also, a lack of time due to work, family or cultural commitments.</p>
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<h2>Feedback through Action Statements</h2>
<p>Each facilitator and barrier were examined together to give five clear “Action Statements”. These statements give practical guidance for how future programs can increase and sustain participation. They also give advice to improve current programs and strategies. </p>
<p><strong>Action Statement 1: personal attitudes and life circumstances of Aboriginal and Torres Strait Islander people should be considered</strong></p>
<p>Many different attitudes, expectations and self-beliefs were identified that could either facilitate or hinder physical activity and sport participation. Physical activity needs to fit in with people’s daily life and personal circumstances. These circumstances include health issues and socioeconomic issues. In urban areas, self-motivation made participation more achievable. But a lack of self‐motivation was a barrier in all geographic locations. </p>
<p><strong>Action Statement 2: promote the holistic health and personal benefits of physical activity and address participation challenges</strong> </p>
<p>People described wanting to improve their health as a motivation to do physical activity and sport. However, health or physical issues were barriers to participating. This means coming up with strategies to overcome these barriers are essential. People also described being motivated to participate as they enjoy physical activity. However, injury or illness was also described as a barrier. </p>
<p><strong>Action Statement 3: recognise the importance of family and cultural connections</strong></p>
<p>Providing opportunities for positive connections with family, peers and networks can help people do physical activity and sport. Family commitments, including caring for children, were a common barrier. Racism was also a barrier. But the importance and influence of family, friends, community members and role models were very evident.</p>
<p><strong>Action Statement 4: respect connections to culture and support communities to be supportive, safe, and well-resourced</strong></p>
<p>At the community level, infrastructure and neighbourhood safety are important factors. Community relationships also play an important role that can help or hinder physical activity participation. Connecting to culture and access to culturally safe places and activities is also important. </p>
<p><strong>Action Statement 5: physical activity and sport programs should be sustainably funded and open to participants’ needs and expectations</strong></p>
<p>Programs must accommodate the needs and expectations of Aboriginal and Torres Strait Islander people. Programs that are cost‐free, have a structure, provide transport and childcare and that are professionally delivered and well‐organised were appealing. </p>
<h2>Next steps</h2>
<p>Future decisions about Aboriginal and Torres Strait Islander physical activity and sport need to be made in partnership with Aboriginal and Torres Strait Islander people. It is also important to acknowledge the diversity in different Aboriginal and Torres Strait Islander cultures. Decisions should be consistent with local views and customs. </p>
<p>Future research could evaluate the impact of future programs, or changes to current programs. This way, we can best understand the benefits of physical activity and sport for Aboriginal and Torres Strait Islander people and enhance future opportunities.</p><img src="https://counter.theconversation.com/content/168263/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rona Macniven receives funding from the Heart Foundation. </span></em></p><p class="fine-print"><em><span>John Evans receives funding from the Australian Research Council</span></em></p><p class="fine-print"><em><span>Bridget Allen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Physical activity and sport are important in Aboriginal and Torres Strait Islander cultures. However, there are barriers to these activities for some communities. How can this be addressed?Rona Macniven, Research Fellow, UNSW SydneyBridget Allen, Research assistant, Neuroscience Research AustraliaJohn Evans, Professor, Indigenous Health Education, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1189132019-06-18T19:56:22Z2019-06-18T19:56:22ZWhat do Aboriginal Australians want from their aged care system? Community connection is number one<figure><img src="https://images.theconversation.com/files/279962/original/file-20190618-118510-190n5wk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Aged Care Royal Commission is currently looking at aged care for Indigenous Australians. </span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>The Australian Aboriginal and Torres Strait Islander population is ageing <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0%7E2016%7EMain%20Features%7EAboriginal%20and%20Torres%20Strait%20islander%20Population%20Article%7E12">at a much faster rate</a> than the non-Indigenous population.</p>
<p>Aboriginal Australians record high mid-life rates of <a href="https://www.aihw.gov.au/reports/indigenous-health-welfare/indigenous-health-welfare-2015/contents/health-disability-key-points">multiple chronic diseases</a> including heart disease and stroke, lung disease, and type 2 diabetes. Type 2 diabetes, for example, is more than twice as common in the Indigenous population than the non-Indigenous population.</p>
<p>Aboriginal Australians also experience <a href="https://www.alzheimersanddementia.com/article/S1552-5260(14)00113-7/fulltext">higher rates of dementia in later life</a> – three to four times the rates seen in non-Indigenous people. </p>
<p>There remains a life expectancy gap of <a href="https://www.aihw.gov.au/reports/indigenous-health-welfare/indigenous-health-welfare-2015/contents/life-expectancy-and-mortality-key-points">around ten years</a> between the Aboriginal population and the non-Indigenous population.</p>
<p>The poor Aboriginal health status when compared with the majority population reflects the persisting social, emotional and physical disadvantage experienced by the Aboriginal population. All of these factors relate to the long-term effects of intergenerational trauma.</p>
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<p>This week, the Royal Commission into Aged Care Quality and Safety has turned its attention to aged care in remote areas. Hearings in Broome are looking at issues of access and inclusion, and the unique care needs of Aboriginal Australians.</p>
<p>Aboriginal people face several barriers to accessing appropriate aged care services in their communities. Aged care policy must consider the diversity of circumstances and needs of older Aboriginal people across different locations.</p>
<h2>Most Aboriginal Australians live in cities</h2>
<p>Remote communities face specific challenges related to their geographic isolation, such as limited workforce and sparsity of services. But where cultural values and community preferences often go unrecognised, living in an urban location doesn’t necessarily mean better access to services for Aboriginal people. </p>
<p>Although the Commission is currently looking at care in remote communities, <a href="https://www.abs.gov.au/ausstats/abs@.nsf/mf/3238.0.55.001">the majority of Aboriginal Australians</a> (more than 80%) actually live in urban rather than remote communities. This includes many thousands of older Aboriginal people.</p>
<p>So it’s important when we’re thinking about older Aboriginal Australians, we don’t only consider those living in remote settings.</p>
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<h2>My Aged Care</h2>
<p>My Aged Care is the portal designed for older Australians to access aged care services including home care and residential aged care. But this in itself – a relatively impersonal and highly bureaucratic system – forms a major access barrier to older Aboriginal peoples’ information gathering and decision making. </p>
<p>Firstly, Aboriginal older people across all geographic locations often lack basic reliable phone and internet access to the centralised My Aged Care assessment process.</p>
<p>Further, while the system focuses on the individual and prioritises the privacy of the client, Aboriginal people are likely to perceive this approach as hostile to family involvement in their care.</p>
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<img alt="" src="https://images.theconversation.com/files/279963/original/file-20190618-118543-sswwlu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/279963/original/file-20190618-118543-sswwlu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/279963/original/file-20190618-118543-sswwlu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/279963/original/file-20190618-118543-sswwlu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/279963/original/file-20190618-118543-sswwlu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/279963/original/file-20190618-118543-sswwlu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/279963/original/file-20190618-118543-sswwlu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s only the minority of Aboriginal people who live in remote communities.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>The My Aged Care process must recognise that Aboriginal aged care involves extended families and communities. In fact, <a href="https://www.aihw.gov.au/reports/aus/215/australias-welfare-2017-in-brief/contents/ageing-aged-care">most Australian aged care</a> is carried out by families, and aged care services primarily support family carers.</p>
<p>Policymakers must act urgently to facilitate access by less educated or cognitively impaired older people in general, and by Aboriginal aged and their family carers in particular. If they can’t navigate the services available to them, it’s not a promising starting point.</p>
<h2>The ‘older’ old and the importance of culturally secure care</h2>
<p>The number of Aboriginal Australians aged 75 years or older – the “older old” – is <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Products/C19A0C6E4794A3FACA257CC900143A3D?opendocument">rising rapidly</a> in remote, regional and urban areas. </p>
<p>In this group, the need for community or residential care in Aboriginal communities is often determined by cognitive decline and subsequent dementia. In these circumstances, family support is essential.</p>
<p>The aged care needs of the “older old” are currently met by community support within the local area, and by high levels of extended family support, including Indigenous cultural constructions of the role of aunts and uncles, elders and children.</p>
<p>These concepts don’t necessarily align with the non-Indigenous emphasis on individualised care and privacy.</p>
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Read more:
<a href="https://theconversation.com/nearly-2-out-of-3-nursing-homes-are-understaffed-these-10-charts-explain-why-aged-care-is-in-crisis-114182">Nearly 2 out of 3 nursing homes are understaffed. These 10 charts explain why aged care is in crisis</a>
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<p>Aboriginal people are often reluctant to engage with mainstream service providers based on past negative experiences including perceived inconsistent, unreliable or culturally insensitive service provision.</p>
<p>We’ve heard in the Commission that <a href="https://www.theguardian.com/australia-news/2019/jun/18/no-fresh-fish-and-no-respite-care-the-challenges-facing-indigenous-aged-care">Torres Strait Islander nursing home residents</a> are being denied access to their traditional foods in care.</p>
<p>Aboriginal Australians often favour assessment and service provision by <a href="https://caringforspirit.neura.edu.au/">Aboriginal-controlled organisations</a> within their local communities.</p>
<p>And as we’ve heard during this week’s hearings, <a href="https://www.smh.com.au/national/indigenous-people-want-to-age-on-country-and-shun-residential-care-20190617-p51yf5.html">ageing on Country</a> is felt to be important for culturally appropriate aged care for many Aboriginal people living in remote areas.</p>
<h2>Capitalising on community care</h2>
<p>All Australians are ageing rapidly, but Indigenous Australians are ageing with added challenges.</p>
<p>In working towards the provision of culturally appropriate aged care for Aboriginal Australians, Indigenous voices must be heard strongly. From policy making to direct episodes of care, the actions of non-Indigenous people caring for older Aboriginal Australians must be informed by their cultural needs.</p>
<p>Aboriginal access to person centred care requires its delivery in an Aboriginal framework of family and community involvement, and ideally through Aboriginal community controlled services. </p>
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Read more:
<a href="https://theconversation.com/aboriginal-australians-want-care-after-brain-injury-but-it-must-consider-their-cultural-needs-115128">Aboriginal Australians want care after brain injury. But it must consider their cultural needs</a>
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<p>Aboriginal Australians are well served by their local communities and by the <a href="https://www.naccho.org.au/about/">143 Aboriginal Controlled Community Health Organisations</a> across remote regional and urban settings.</p>
<p>These health services have unique cultural competency, but not yet the capacity, to navigate at risk, disadvantaged, older Aboriginal people through the fractured Australian aged care system. They are the future agents of choice to provide the bulk of acceptable Aboriginal aged care assessment and services.</p><img src="https://counter.theconversation.com/content/118913/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tony Broe receives funding from NHMRC. He is Senior Principal Research Scientist at Neura, Randwick in Aboriginal Health and Ageing; Professor of Geriatric Medicine at UNSW; and member of the Aged Care Sector Committee Diversity Sub-group (December 2017) Aged Care Diversity Framework Commonwealth Department of Health Working Group in Aboriginal Aged Care. He has no financial conflict of interest in Aboriginal Aged Care.</span></em></p>As the Aged Care Royal Commission shifts its focus to aged care for Indigenous Australians, access isn’t the only challenge. Often problems arise when services don’t accommodate their cultural needs.Tony Broe, Senior Principal Research Fellow, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1026512018-09-25T19:59:05Z2018-09-25T19:59:05ZWhat causes schizophrenia? What we know, don’t know and suspect<figure><img src="https://images.theconversation.com/files/237840/original/file-20180925-85767-1dhlufw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The causes of schizophrenia are largely unknown.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/Ilo2O4eukB4">Nicola Fioravanti/Unsplash</a></span></figcaption></figure><p>Schizophrenia is one of the world’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/15207959">top ten causes of disability</a>. It develops between the ages of 16 and 30 and often persists for life. It affects between <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/schizophrenia">100,000 and 200,000 Australians</a>.</p>
<p>Symptoms include delusions and hallucinations (“psychotic” symptoms), diminished emotional expression, poverty of speech and lack of purposeful action (known as “negative” symptoms), and incoherent speech and disorganised behaviour (“disorganised” symptoms). A <a href="https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-fact-sheets">diagnosis</a> of schizophrenia requires at least two symptoms, including one psychotic or disorganised, to be present for at least six months. These must result in significant social or occupational dysfunction. </p>
<p>It is thought <a href="https://www.bmj.com/content/295/6600/681">disruptions in brain development</a> early in life may underlie the emergence of schizophrenia in later years. While the causes of these disruptions aren’t exactly clear, research points to several possible reasons.</p>
<h2>Genes</h2>
<p><a href="http://www.szgene.org/">Hundreds of genes</a> have been linked to schizophrenia, but do not appear to follow typical patterns of inheritance across generations, where disorders can be predicted with confidence. Like diabetes and coronary heart disease, schizophrenia cannot be predicted from family history alone. This is because no one gene, or set of genes, has definitively been identified as causing the disorder. </p>
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Read more:
<a href="https://theconversation.com/schizophrenia-bipolar-disorder-and-depression-share-genetic-roots-study-16955">Schizophrenia, bipolar disorder and depression share genetic roots: study</a>
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<p>Family studies do provide robust evidence of a genetic contribution. For instance, across the population, a <a href="https://www.ncbi.nlm.nih.gov/pubmed/11479071">person’s risk</a> of developing schizophrenia is 1%. If one of their parents has the disorder, the risk increases to 15%. </p>
<p>Twin studies have found a 50% increase in the risk of schizophrenia in the identical twin of a person with schizophrenia. Because identical twins share 100% of their DNA, this means environmental risk factors must also be involved. We do not currently know exactly which genes interact with which environmental factors, nor the extent of these interactions. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/237845/original/file-20180925-85773-br4sxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/237845/original/file-20180925-85773-br4sxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237845/original/file-20180925-85773-br4sxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237845/original/file-20180925-85773-br4sxn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237845/original/file-20180925-85773-br4sxn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237845/original/file-20180925-85773-br4sxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237845/original/file-20180925-85773-br4sxn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237845/original/file-20180925-85773-br4sxn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hundreds of genes have been implicated in schizophrenia.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>There is also an <a href="https://www.ncbi.nlm.nih.gov/pubmed/19683417">association between the age of the father</a> at the time the child is born and an increased risk of schizophrenia in the child. If the father is over the age of 55, the child’s risk of schizophrenia increases by 50%. This may be due to rare mutations in paternal sperm that could lead to abnormal development, or to family factors associated with having an older father. </p>
<h2>Obstetric complications</h2>
<p>Various <a href="https://www.ncbi.nlm.nih.gov/pubmed/12091183">obstetric complications</a> in utero and at birth have also been identified as risk factors for schizophrenia in the offspring. Complications during pregnancy include maternal bleeding, diabetes, rhesus incompatibility (when the mother has Rh-negative blood and the fetus Rh-positive, or vice versa), pre-eclampsia and abnormal fetal growth and development. </p>
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Read more:
<a href="https://theconversation.com/blood-groups-beyond-a-b-and-o-what-are-they-and-do-they-matter-75063">Blood groups beyond A, B and O: what are they and do they matter?</a>
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<p>Maternal exposure to <a href="https://www.ncbi.nlm.nih.gov/pubmed/28338900">famine</a> during pregnancy has been linked to schizophrenia in the offspring. Complications at delivery include uterine atony (failure of the uterus to contract after delivery), lack of oxygen to the fetus and emergency caesarean. </p>
<p>Most of these obstetric associations are small, and other potential influencing factors weren’t controlled for. For example, exposure to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479084/">maternal infections</a>, such as upper respiratory tract and genital or reproductive infections, has been linked to schizophrenia in the offspring. If exposed to these infections, these could be the real culprits rather than the obstetric complications described above.</p>
<p>Exposure to infections in childhood, such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/25877655"><em>Toxoplasma gondii</em></a> (a parasitic organism carried by domestic cats) and <a href="https://www.ncbi.nlm.nih.gov/pubmed/22704639">viral central nervous system infections</a> (such as meningitis), have also been linked to schizophrenia in adulthood. Again, if exposed, these could have led to the mental illness as opposed to complications in delivery.</p>
<h2>Immune markers</h2>
<p>Markers of <a href="https://www.ncbi.nlm.nih.gov/pubmed/22104141">infection</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23428789">inflammation</a> are often increased in adults with schizophrenia. This means immune system dysfunction may be involved in the development of the disorder.</p>
<h2>Drug use</h2>
<p>Studies following people from birth to adulthood have identified <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140673607611623/abstract">cannabis use</a> in childhood or adolescence as a likely risk factor. </p>
<p>These studies have adjusted for other risk factors and taken into account intoxication effects and reverse causation (that schizophrenia may cause cannabis use). They found a dose-response effect, which means the risk of psychosis increased as the frequency of cannabis use increased. Such dose-response effects provide the most robust evidence of causation.</p>
<p>The neurological and biological mechanisms of cannabis use are similar to those in schizophrenia, with the same neurons showing activity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/237842/original/file-20180925-85767-18iybpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/237842/original/file-20180925-85767-18iybpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237842/original/file-20180925-85767-18iybpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237842/original/file-20180925-85767-18iybpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237842/original/file-20180925-85767-18iybpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237842/original/file-20180925-85767-18iybpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237842/original/file-20180925-85767-18iybpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237842/original/file-20180925-85767-18iybpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There is strong evidence for the association between cannabis use in early life and schizophrenia.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/22193527">Methamphetamines</a>, particularly ice or crystal methamphetamine, have been linked to increased risk of persistent psychosis, and not just substance-induced psychosis. Controlled amphetamine administration that triggers temporary psychosis in healthy individuals can also be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3554477/">blocked by antipsychotics</a>. This further strengthens the evidence of association. </p>
<h2>Social factors</h2>
<p>There is solid evidence supporting the link between having experienced <a href="https://www.ncbi.nlm.nih.gov/pubmed/22716913">child abuse</a>, or any type of abuse that includes <a href="https://www.tandfonline.com/doi/abs/10.1080/17522439.2015.1053969">bullying</a>, and schizophrenia. Stressful <a href="https://www.ncbi.nlm.nih.gov/pubmed/23671196">life events in adulthood</a> have been associated with schizophrenia too.</p>
<p>People living in <a href="https://www.ncbi.nlm.nih.gov/pubmed/23015685">urban areas</a>, particularly areas with <a href="https://www.ncbi.nlm.nih.gov/pubmed/23594564">high income inequality</a>, also show increased risk, which may be associated with <a href="https://www.ncbi.nlm.nih.gov/pubmed/24114240">social fragmentation</a>. Both first- and second-generation <a href="https://www.ncbi.nlm.nih.gov/pubmed/15625195">immigrants</a> show increased risk, with surprisingly greater risk seen in the second generation.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/extreme-stress-in-childhood-is-toxic-to-your-dna-99009">Extreme stress in childhood is toxic to your DNA</a>
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<p>Studies have also found a greater risk of schizophrenia in ethnic minority groups living in areas of low ethnic density than those living in high ethnic density areas. These finding indicate that sustained social marginalisation, particularly from early childhood, may have greater adverse effects than migration itself. </p>
<h2>Stress</h2>
<p>Social stressors can lead to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26346639">biological disruptions</a>. For instance, stress <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127444/">increases the release of dopamine</a>. And evidence shows people with schizophrenia have increased <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730746/">dopamine production and release</a>. </p>
<p>Stress is also associated with dysregulation of a brain network known as the hypothalamic-pituitary-adrenal (HPA) axis, which is <a href="https://www.ncbi.nlm.nih.gov/pubmed/25108162">sensitised in people with schizophrenia</a>. </p>
<p>Stress associated with being raised in a harsh environment has been linked to the emergence of an <a href="https://www.ncbi.nlm.nih.gov/pubmed/20431047">inflammatory gene expression</a> in adolescents. And people with schizophrenia show immune system dysfunction in both the <a href="https://www.ncbi.nlm.nih.gov/pubmed/23062357">early</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/21641581">late</a> stages of the disorder. </p>
<p>Disruption to these biological systems can cause paranoid ideas, social withdrawal and other behavioural problems. These in turn cause additional stress and further biological disruption. In time, paranoid ideas can become <a href="https://www.ncbi.nlm.nih.gov/pubmed/20624329">delusional and fixed</a>, signalling schizophrenia, particularly in the presence of other symptoms.</p>
<p>While much progress has been made in identifying the potential causes of schizophrenia, most of the evidence comes from population-level studies that may or may not be applicable to a particular individual. More research is required to determine the various individual pathways to schizophrenia.</p><img src="https://counter.theconversation.com/content/102651/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sandy Matheson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Genes, drugs in early life, and stress have been linked to the development of schizophrenia.Sandy Matheson, Scientist and Digital Librarian, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/999392018-07-20T00:29:07Z2018-07-20T00:29:07ZResearch Check: do neckties reduce blood supply to the brain?<figure><img src="https://images.theconversation.com/files/227737/original/file-20180716-44076-1myqmfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The fashion advice is generally to tighten ties so they're tight but not too tight.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>News reports about a <a href="https://link.springer.com/article/10.1007%2Fs00234-018-2048-7">study from Germany</a> may provide the ultimate excuse for men to dress more casually for work, finding neckties reduce blood supply to the brain.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1015988077364498432"}"></div></p>
<p>The study showed that wearing a tie that causes slight discomfort can reduce blood flow to the brain by 7.5%, but the reduction is unlikely to cause any physical symptoms, which generally begin at a reduction of 10%. </p>
<h2>How was the research conducted?</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1771792/">Past research</a> shows that compression of the jugular vein in the neck reduces blood flow to the brain. In this new study, <a href="https://link.springer.com/article/10.1007%2Fs00234-018-2048-7">published recently in the journal Neuroradiology</a>, the researchers tested whether the pressure of a necktie could induce these changes. </p>
<p>They recruited 30 young men aged 21 to 28 years and split them into two groups: those wearing neckties and those without. </p>
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Read more:
<a href="https://theconversation.com/research-check-does-drinking-coffee-help-you-live-longer-99287">Research Check: does drinking coffee help you live longer?</a>
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<p>Using magnetic resonance imaging (MRI), the researchers tested the cerebral blood flow (total blood flow to the brain) using a technique that showed changes to the flow via a colour change. They also tested the blood flow from their jugular vein.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/227741/original/file-20180716-44088-t88pq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/227741/original/file-20180716-44088-t88pq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/227741/original/file-20180716-44088-t88pq3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/227741/original/file-20180716-44088-t88pq3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/227741/original/file-20180716-44088-t88pq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/227741/original/file-20180716-44088-t88pq3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/227741/original/file-20180716-44088-t88pq3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">MRI scans showed changes in blood flow.</span>
<span class="attribution"><span class="source">Ken Treloar</span></span>
</figcaption>
</figure>
<p>The first MRI took a “baseline” scan, while the participants in both groups had an open collar (and those in the tie-wearing group had a loosened tie).</p>
<p>For the second scan, the men’s collars were closed and participants in the tie group tightened their Windsor knot until they felt slight discomfort. </p>
<p>A third scan followed, in the same conditions as the baseline scan. All scans lasted 15 minutes. </p>
<h2>What did they find?</h2>
<p>The authors found that wearing a necktie with a Windsor knot tightened to level of slight discomfort for 15 minutes led to a 7.5% drop in cerebral blood flow, and a 5.7% drop in the 15 minutes after the tie was loosened. </p>
<p>The men’s blood flow in the control group – those who weren’t wearing a tie – didn’t change.</p>
<p>No change was found in jugular venous flow between the two groups.</p>
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Read more:
<a href="https://theconversation.com/research-check-does-paracetamol-in-pregnancy-cause-child-behavioural-problems-63994">Research Check: does paracetamol in pregnancy cause child behavioural problems?</a>
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<h2>What does it mean?</h2>
<p>The study didn’t go into any detail about the effects, so let’s consider what they might be. </p>
<p>The researchers found a reduction in blood flow to the brain of 7.5%, which is unlikely to cause problems for most men. </p>
<p>Healthy people are likely to begin experiencing symptoms when blood flow to the brain reduces by about 10% – so, a larger reduction than the study found. Along with an <a href="http://stroke.ahajournals.org/content/strokeaha/23/12/1743.full.pdf">increase in blood pressure at the site</a>, a 10% reduction in blood flow can cause dizziness, light-headedness, headaches and nausea.</p>
<p>But even with a 7.5% drop in blood loss to the brain, a person could still experience some temporary dizziness, headaches or nausea.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/228140/original/file-20180718-19940-yw9hs1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/228140/original/file-20180718-19940-yw9hs1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/228140/original/file-20180718-19940-yw9hs1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/228140/original/file-20180718-19940-yw9hs1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/228140/original/file-20180718-19940-yw9hs1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/228140/original/file-20180718-19940-yw9hs1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/228140/original/file-20180718-19940-yw9hs1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Changes in blood flow can have different effects on people, depending on their health status and age.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Compounded with other factors, such as smoking or advanced age, a 7.5% decrease could bring some people over this 10% threshold of blood flow loss, placing extra stress on their already strained bodies and increasing their risk of <a href="http://stroke.ahajournals.org/content/strokeaha/23/12/1743.full.pdf">losing consciousness</a> or developing <a href="http://stroke.ahajournals.org/content/strokeaha/23/12/1743.full.pdf">high-blood pressure</a>.</p>
<p>It’s unclear why there was no change to the jugular, but this may be due to the circular nature of the restriction: the pressure is equally distributed across the neck, rather than just the jugular.</p>
<h2>What else do we need to take into account</h2>
<p>Further research is needed to assess the impact of wearing a tie for longer periods and wearing different knots. </p>
<p>Any pressure on the neck is slightly discomforting, and <a href="https://www.gq.com/story/how-to-tie-a-tie-the-right-way-gq-guide">men’s style guides</a> advise tightening a necktie to be “tight but not too tight”. Whether this tightness aligns with the participants’ classification of “slight discomfort” is unclear.</p>
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<strong>
Read more:
<a href="https://theconversation.com/research-check-can-baby-wipes-cause-childhood-food-allergies-94981">Research Check: can baby wipes cause childhood food allergies?</a>
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<p>This study had a sample size of 30 participants, which is relatively small. Most human studies investigating blood pressure and cerebral blood flow have at least 40 to 60 participants. </p>
<p>Another limitation is that the study did not include a discussion about the potential impact of the blood restriction, or the finding that jugular blood flows didn’t change. </p>
<p>But overall, the study is simple and well-designed. It adds to a small but growing body of research about the problems with neckties: they can lead to higher rates of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410X.2009.08440.x">infection</a>, as they’re infrequently washed; and they may increase intraocular <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1771792/">pressure</a> (blood pressure in the eyes) to the point of increasing the risk of glaucoma. </p>
<p>Perhaps it’s time to get rid of this unwelcome guest from our wardrobe, or restrict it to special occasions. <strong>– Steve Kassem</strong></p>
<hr>
<h2>Blind peer review</h2>
<p>This is a fair and accurate assessment of the research. But it’s important to note that 40% of the control group – those without neckties – also reported a decrease in cerebral blood flow. This could be a stress response. In future studies, we need larger sample sizes combined with longer durations to verify these findings. <strong>– Yugeesh Lankadeva</strong></p>
<p><em><a href="https://theconversation.com/research-check-can-tea-towels-cause-food-poisoning-98152">Research Checks</a> interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one academic not involved with the study, and reviewed by another, to make sure it’s accurate.</em></p><img src="https://counter.theconversation.com/content/99939/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Wearing a tie that causes slight discomfort can reduce blood flow to the brain by 7.5%, but the reduction is unlikely to cause any physical symptoms, which generally begin at a reduction of 10%.Steve Kassem, Postdoctoral fellow, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/986222018-06-28T19:57:42Z2018-06-28T19:57:42ZWeakened code risks Australia’s reputation for research integrity<figure><img src="https://images.theconversation.com/files/224638/original/file-20180625-19408-mj02hh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are under pressure to deliver publications and win grants. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-researcher-typing-on-keyboard-labaratory-571691131">from www.shutterstock.com </a></span></figcaption></figure><p>In 2018, Australia still does not have appropriate measures in place to maintain research integrity. And <a href="https://www.nhmrc.gov.au/guidelines-publications/r41">recent changes to our code of research conduct</a> have weakened our already inadequate position. </p>
<p>In contrast, China’s <a href="https://www.nature.com/articles/d41586-018-05359-8">recent move to crack down on academic misconduct</a> moves it into line with more than twenty <a href="http://www.enrio.eu/">European countries</a>, the <a href="http://ukrio.org/">UK</a>, <a href="https://ori.hhs.gov/">USA</a>, <a href="https://www.nrc-cnrc.gc.ca/eng/about/policies/research_integrity/index.html">Canada</a> and others that have national offices for research integrity. </p>
<p>Australia risks its reputation by turning in the opposite direction.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-australia-should-do-to-ensure-research-integrity-17091">What Australia should do to ensure research integrity</a>
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</p>
<hr>
<h2>Research integrity is vital</h2>
<p>Our confidence in science relies on its <a href="https://wcrif.org/guidance/singapore-statement">integrity</a> – relating to both the research literature (its freedom from errors), and the researchers themselves (that they behave in a principled way). </p>
<p>However, the pressures on scientists to publish and win grants can <a href="https://www.theguardian.com/science/blog/2018/jan/29/professors-eat-their-own-young-how-competition-can-stifle-good-science">lead to misconduct</a>. This can range from cherry-picking results that support a favoured hypothesis, to making up experimental, animal or patient results from thin air. A <a href="http://mbio.asm.org/content/7/3/e00809-16.abstract">recent report</a> found that around 1 in 25 papers contained duplicated images (inconsistent with good research practice), and about half of these had features suggesting deliberate manipulation. </p>
<p>For science to progress efficiently, and to remain credible, we need good governance structures, and as transparent and open a system as possible. Measures are needed to identify and correct errors, and to rectify misbehaviour. </p>
<p>In Australia, one such measure is the <a href="https://www.nhmrc.gov.au/guidelines-publications/r41">Australian Code for the Responsible Conduct of Research</a>. But recently published revisions of this code allow research integrity to be handled internally by institutions, and investigations to be kept secret. This puts at risk the hundreds of millions of dollars provided by the taxpayer to fund research.</p>
<p>As a nation, we can and must do much better, before those who invest in and conduct research go elsewhere – to countries that are serious about the governance of research integrity. </p>
<h2>Learning from experience – the Hall affair</h2>
<p>Developed jointly by the National Health and Medical Research Council (<a href="https://www.nhmrc.gov.au/">NHMRC</a>), the Australian Research Council (<a href="http://www.arc.gov.au/">ARC</a>) and <a href="https://www.universitiesaustralia.edu.au/">Universities Australia</a>, the Australian Code for the Responsible Conduct of Research has the stated goal of improving research integrity in Australia.</p>
<p>The previous version of the Australian Code was written in 2007, partly in response to the “Hall affair”. </p>
<p>In 2001, complaints of research misconduct were levelled at Professor Bruce Hall, an immunologist at University of New South Wales (UNSW). After multiple inquiries, UNSW Vice Chancellor Rory Hume concluded that Hall was not guilty of scientific misconduct but had “committed errors of judgement sufficiently serious in two instances to warrant censure.” All allegations were denied by Hall. </p>
<p>Commenting on the incident in 2004, Editor-in-Chief of the Medical Journal of Australia Martin Van Der Weyden highlighted the <a href="https://www.mja.com.au/system/files/issues/180_04_160204/van10035_fm.pdf">importance of external and independent review in investigating research practice</a>: </p>
<blockquote>
<p>The initial inquiry by the UNSW’s Dean of Medicine [was] patently crippled by perceptions of conflicts of interest — including an institution investigating allegations of improprieties carried out in its own backyard! </p>
<p>Herein lies lesson number one — once allegations of scientific misconduct and fraud have been made, these should be addressed from the beginning by an external and independent inquiry.</p>
</blockquote>
<h2>An external and independent panel</h2>
<p>Avoiding conflicts of interest – real or perceived – was one of the reasons the <a href="https://www.nhmrc.gov.au/guidelines-publications/r39">2007 version</a> of the Australian Code required “institutions to establish independent external research misconduct inquiries to evaluate allegations of serious research misconduct that are contested.” </p>
<p>But it seems this lesson has been forgotten. With respect to establishing a panel to investigate alleged misconduct, the <a href="https://www.nhmrc.gov.au/_files_nhmrc/file/publications/17653_nhmrc_-_guide_to_managing_and_investigating_potential_breaches_-_v2-0-accessible_pdf.pdf">revised Code says meekly</a>: </p>
<blockquote>
<p>There will be occasions where some or all members should be external to the institution.</p>
</blockquote>
<p>Institutions will now be able to decide for themselves the terms of reference for investigations, and the number and composition of inquiry panels.</p>
<h2>Reducing research misconduct in Australia</h2>
<p>The chief justification for revising the 2007 Australian Code was to reduce research misconduct. </p>
<p>In its initial <a href="https://www.nhmrc.gov.au/media/nhmrc_updates/2016/review-australian-code-responsible-conduct-research-code">draft form in 2016</a>, the committee charged with this task suggested simply removing the term “research misconduct” from the Code, meaning that research misconduct would no longer officially exist in Australia. </p>
<p>Unsurprisingly, this <a href="https://retractionwatch.com/2017/02/23/labeling-bad-behavior-scientific-misconduct-help-hurt-research-integrity-debate-rages/">created a backlash</a>, and, in the final version of the revised Code, a <a href="https://www.nhmrc.gov.au/_files_nhmrc/file/publications/17628_nhmrc_-_nhmrc_the_australian_code_for_the_responsible_conduct_of_research_-_v1-1-accessiblefinal_0.pdf">definition</a> of the term “research misconduct” has returned: </p>
<blockquote>
<p>Research misconduct: a serious breach of the Code which is also intentional or reckless or negligent.</p>
</blockquote>
<p>However, institutions now have the option of “whether and how to use the term ‘research misconduct’ in relation to serious breaches of the Code”.</p>
<h2>Principles not enough</h2>
<p>The new Code is split into a set of principles of responsible research conduct that lists the responsibilities of researchers and institutions, together with a set of guides. The <a href="https://www.nhmrc.gov.au/guidelines-publications/r42">first guide</a> describes how potential breaches of the Code should be investigated and managed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-survey-found-questionable-research-practices-by-ecologists-and-biologists-heres-what-that-means-94421">Our survey found 'questionable research practices' by ecologists and biologists – here's what that means</a>
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<p>The principles of responsible research conduct are fine, and exhort researchers to be <em>honest</em> and <em>fair</em>, <em>rigorous</em> and <em>respectful</em>. No one would have an issue with this. </p>
<p>Similarly, no one would think it unreasonable that institutions also have responsibilities, such as to <em>identify and comply with relevant laws, regulations, guidelines and policies related to the conduct of research</em>. </p>
<p>However, having a set of lofty principles alone is not sufficient; there also need to be mechanisms to ensure compliance, not just by researchers, but also by institutions.</p>
<h2>Transparency, accountability, and trust</h2>
<p>The new Code says that institutions must ensure that all investigations are confidential. There is no requirement to make the outcome public, but only to “consider whether a public statement is appropriate to communicate the outcome of an investigation”. </p>
<p>Combining mandatory confidentiality with self-regulation is bound to undermine trust in the governance of research integrity. </p>
<p>In the new Code there is no mechanism for oversight. The outcome of a misconduct investigation can be appealed to the Australian Research Integrity Committee (<a href="https://www.nhmrc.gov.au/research/responsible-conduct-research/australian-research-integrity-committee">ARIC</a>), but only on the grounds of improper process, and not based on evidence or facts. </p>
<p>Given that the conduct of investigations as well as the findings are to be confidential, it will be difficult to make an appeal to ARIC on any grounds.</p>
<h2>We need a national office of research integrity</h2>
<p>It is not clear why Australia does not learn from the experience of countries with independent agencies for research integrity, and adopt one of the models that is already working elsewhere in the world. </p>
<p>Those who care about research and careers in research should ask their politicians and university Vice Chancellors why a national office of research integrity is necessary in the nations of Europe, the UK, US, Canada and now China, but not in Australia.</p>
<hr>
<p><em>This article was prepared with input from Glenn Begley (BioCurate), Robert Graham (Victor Chang Cardiac Research Institute), Andrew Holmes (University of Melbourne), Misty Jenkins (The Walter and Eliza Hall Institute), Oliver Mayo (University of Adelaide), Graham Mitchell (Foursight Associates) and Robert Williamson (Murdoch Children’s Research Institute).</em></p><img src="https://counter.theconversation.com/content/98622/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Vaux receives funding from the NHMRC, and is on the Board of Directors of the Center for Scientific Integrity, the parent organization of Retraction Watch.</span></em></p><p class="fine-print"><em><span>Peter Brooks has previously received funding from NHMRC and ARC. </span></em></p><p class="fine-print"><em><span>Simon Gandevia receives funding from the National Health and Medical Research Council.</span></em></p>Without a national office for research integrity, Australia risks losing scientists and research funders to countries with more robust setups.David Vaux, Medical Researcher, Walter and Eliza Hall InstitutePeter Brooks, Professor, Centre for Health Policy, Melbourne School of Population and Global Health, The University of MelbourneSimon Gandevia, Deputy Director, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/759182017-04-27T20:04:41Z2017-04-27T20:04:41ZWhy brain stimulation isn’t what it’s cracked up to be<figure><img src="https://images.theconversation.com/files/166782/original/file-20170426-2838-rtgqtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">About half of studies of some types of brain stimulation cannot be reproduced. So, how do we know if these work?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/521251375?src=3ExGRfV8-B3WHzPbsBaQuw-1-7&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Interest in <a href="https://en.wikipedia.org/wiki/Transcranial_direct-current_stimulation">electrical brain stimulation</a> has skyrocketed in recent years, both in the <a href="https://theconversation.com/brain-stimulation-offers-hope-for-depression-but-dont-try-it-at-home-31625">popular</a> <a href="https://theconversation.com/brain-stimulation-is-getting-popular-with-gamers-is-it-time-to-regulate-it-66845">media</a> and <a href="http://www.cell.com/neuron/abstract/S0896-6273(14)00389-4">scientific literature</a>. </p>
<p>Scientists and clinicians are using the non-invasive and cheap technique to treat various <a href="http://www.sciencedirect.com/science/article/pii/S1388245716306344">neurological and psychiatric disorders</a>, including depression, epilepsy and addiction. The US military is researching whether it <a href="http://www.bbc.com/future/story/20140603-brain-zapping-the-future-of-war">improves learning and attention</a>. And those who train elite athletes <a href="http://www.nature.com/news/brain-doping-may-improve-athletes-performance-1.19534">can see its potential</a> to enhance performance.</p>
<p>But <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175635">our research shows</a> the evidence to back electrical brain stimulation varies in quality, and the results are commonly not reproduced in other studies. Our survey also unearthed the lengths to which some researchers go to to present their findings in the best light.</p>
<h2>What is electrical brain stimulation?</h2>
<p>The type of electrical brain stimulation we studied is transcranial direct-current stimulation. This is when a small electric current is applied to the brain for 20 to 30 minutes. Electrodes are placed on the patient’s head, and some of the current passes through the skull to the brain. </p>
<p>It is thought this alters brain function mainly by inducing persistent changes in the excitability of neurones.</p>
<p>This isn’t to be confused with <a href="https://www.beyondblue.org.au/the-facts/depression/treatments-for-depression/medical-treatments-for-depression/electroconvulsive-therapy-(ect)">electroconvulsive therapy</a>, which uses currents hundreds of times larger. This induces a seizure.</p>
<h2>What we did</h2>
<p>We used an online survey to ask researchers if they could reproduce published findings related to electrical brain stimulation. We invited all researchers who served as corresponding authors on a published scientific paper on electrical brain stimulation in humans to do so. </p>
<p>In all, 976 researchers from all over the world were invited to answer the question of whether they could reproduce published electrical brain stimulation effects. </p>
<p>We also asked whether researchers used, but didn’t report, questionable research practices in their own research – such as fiddling with statistics to make them look more favourable and selectively reporting results. And we asked if they thought other researchers used these questionable techniques, and whether they should be reported in publications. </p>
<p>To check what researchers actually do, we audited a random selection of 100 publications featuring research on electrical brain stimulation. We looked to see if they admitted to the dodgy practices in their publications.</p>
<h2>What we found</h2>
<p>For the two most popular types of electrical brain stimulation (anodal and cathodal stimulation), only 45 to 50% of researchers routinely reproduced published findings.</p>
<p>Some researchers were aware of others who handpicked which experimental conditions (36%) and which results (41%) to publish. They also knew researchers who manipulated results by excluding data based on a gut feeling (20%) and fiddling with the statistics (43%).</p>
<p>As expected, fewer researchers admitted to personally using these types of shady research practices. Still, 25% admitted to adjusting statistical analysis to optimise results – namely <a href="https://theconversation.com/how-we-edit-science-part-2-significance-testing-p-hacking-and-peer-review-74547">p-hacking</a>, when researchers manipulate the statistics to make results appear more statistically significant than they might otherwise be.</p>
<p>Our research also revealed the difference between whether these questionable types of practices <em>should be</em> reported in research papers, and whether they <em>are</em>. Although 92% of respondents said all researchers should admit to the questionable practices in their publications, we found only two such admissions (2%) in our audit of published studies.</p>
<h2>So, what do we make of this?</h2>
<p>Meta-analyses, which are studies that pool results from several other studies, indicate electrical brain stimulation is effective in <a href="http://bjp.rcpsych.org/content/208/6/522">major depression</a>. But it isn’t in fibromyalgia (where people experience widespread pain without a known cause), food craving and overeating, Parkinson’s disease, and speech problems after a stroke.</p>
<p>Unfortunately, a general finding is that electrical brain stimulation studies are often of low quality and that, when present, therapeutic effects are often small. So, before you decide to strap electrodes to your head, speak to an informed health professional.</p>
<p>Poor reproducibility and bad science <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124">are not unique</a> to electrical brain stimulation research. Nor are these problems new. But <a href="https://theconversation.com/we-need-to-talk-about-the-bad-science-being-funded-61916">public funds are being wasted</a> on poorly conducted research that cannot be reproduced, which means the results are questionable. Such poor research is tarnishing the genuine efforts of researchers to improve human brain function.</p>
<p>The main reason researchers engage in questionable researcher practices is the continual pressure to <a href="https://theconversation.com/why-isnt-science-better-look-at-career-incentives-65619">publish scientific papers</a> to gain funding or to progress scientific careers. If results are statistically significant, researchers are <a href="http://science.sciencemag.org/content/345/6200/992">more likely to be published</a>. So, researchers may consciously, or unconsciously, resort to questionable or fraudulent research practices.</p>
<h2>What can we do about it?</h2>
<p>Awareness of bad science is on the rise – and <a href="https://www.nature.com/articles/s41562-016-0021">recommendations</a> and <a href="http://www.acmedsci.ac.uk/policy/policy-projects/reproducibility-and-reliability-of-biomedical-research/">guidelines are emerging</a> to deal with this. But there needs to be more education and true incentives for scientists to conduct better, reproducible science. </p>
<p>If not, some scientists will continue to do as they have always done. Incentives to improve the culture of research include promoting researchers who do more <a href="https://cos.io/">open science</a>, and funding projects that adhere to open science practices as well as those that attempt to replicate studies.</p>
<p>The responsibility to improve the quality of our science lies with research institutions and universities, <a href="http://www.nature.com/news/policy-nih-plans-to-enhance-reproducibility-1.14586">funding agencies</a>, scientific publishers and individual researchers.</p>
<p>Our goal of clinically useful brain stimulation techniques is a worthy one. But our progress is limited by findings of often variable and small effects currently reported, as well as the poor quality of some of the studies that claim any effects at all.</p><img src="https://counter.theconversation.com/content/75918/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Electrical brain stimulation is used to treat a range of conditions, from depression to epilepsy. But how confident can we be that it works?Martin Héroux, Senior Research Fellow, Neuroscience Research AustraliaColleen Loo, Professor of Psychiatry, UNSW SydneySimon Gandevia, Deputy Director, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/748452017-04-10T20:11:18Z2017-04-10T20:11:18ZYes, car seats protect children. But you need the right restraint, fitted properly<figure><img src="https://images.theconversation.com/files/164400/original/image-20170407-29399-1kf15c0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Laws introduced in 2009 and 2010 stipulate specific car restraints for children of different ages. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/71104492?src=hFKOGdz-r4UQxvPRJB3M_g-1-3&size=huge_jpg">from www.shutterstock.com </a></span></figcaption></figure><p>Road transport accidents remain a leading cause of death, with between <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737423340">one and two in every 100,000 Australian children</a> dying on our roads each year. </p>
<p>There is no doubt using a restraint protects against harm during a crash. In Australia we have seen <a href="https://search.informit.org/documentSummary;dn=569711338424475;res=IELHEA;subject=Health">steady declines in death and injury</a> among children in cars since the late 1970s, when laws requiring children to buckle up in cars were first introduced.</p>
<p>But just having a restraint available is not enough. In terms of risk of death and injury, the <a href="http://pediatrics.aappublications.org/content/early/2010/01/11/peds.2009-1171">protection provided to children</a> in a crash progressively increases from simply having them restrained, to having them restrained in an age appropriate restraint, to having them restrained correctly in an age appropriate restraint. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S0001457510001946">One in every two</a> restrained children travelling in cars in NSW has at least one error in how the restraint is being used. </p>
<h2>The physics of car crash survival</h2>
<p>Modern vehicles are designed to reduce crash forces on occupants by absorbing some of the crash energy. Restraint systems protect passengers in crashes by effectively tying them as tightly as possible to the car. This prevents excess movement, and allows passengers to make the best use of safety features built into modern cars. </p>
<p>These features aim to ensure that in a crash, passengers come to a stop over the longest possible distance, reducing the force and therefore risk and severity of injury in a crash. </p>
<p>But in tying the passenger to the car, it’s important the forces applied to the body are distributed over the strongest parts of the body, and that the motion of the body is controlled. This is where design of child restraints comes in.</p>
<h2>Different seats for different kids</h2>
<p>Laws were introduced across Australia in 2009 and 2010 that stipulated <a href="http://www.austlii.edu.au/au/legis/sa/consol_reg/arr210/s266.html">the exact type of restraint</a> that should be used by children of different ages. The laws vary slightly from state to state, but generally these require:</p>
<ul>
<li>children up to at least 6 months of age use a rearward facing infant restraint</li>
<li>children up to at least 4 years use a forward facing child seat with in-built harness, and </li>
<li>children up to at least 7 years use a booster seat. </li>
</ul>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/pdkZ-ZDxwtA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Different sized children need different types of car seats, or restraints.</span></figcaption>
</figure>
<p>Since then we’ve seen <a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12070/abstract">improvements in the numbers</a> of children using the right type of restraint. </p>
<p>While there has not yet been any rigorous evaluation of the impact of these laws on crash injury, they are linked with a reduction in fatalities. Figures from the <a href="https://bitre.gov.au/statistics/safety/fatal_road_crash_database.aspx">Bureau of Infrastructure, Transport and Regional Economics</a> show that before the new laws, on average, about 70 children died every year in Australia in car crashes. The average number of child passengers dying each year is now around 40.</p>
<h2>Using the restraint properly</h2>
<p>To get the best possible protection in a crash, restraints need to be used correctly. <a href="http://www.sciencedirect.com/science/article/pii/S0001457510001946">One in every two</a> restrained children travelling in cars in NSW has at least one error in how the restraint is being used. </p>
<p>There are three broad types of errors that occur when children use restraints:</p>
<ol>
<li>errors in the way the restraint is installed in the vehicle</li>
<li>errors in the way children are secured within the restraint, and </li>
<li>errors that are introduced by children while they travel in the car. </li>
</ol>
<p>Errors are often present even when parents are confident in their ability to correctly use restraints. Sometimes parents are aware of the errors, but don’t realise the potential negative impact. </p>
<p>The biggest problem is when the error loosens how tightly the child is tied to the vehicle. This includes slack in the belts tying the restraint to the car, or the harness tying the child to the restraint, and when the harness or belt is not placed over the correct parts of the body. </p>
<p>The latter commonly occurs when the harness (or seat belt in a booster seat) is not used correctly either because the parent has not secured the child correctly or the child removes their arms during travel.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the lap of luxury…and safety.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/162411116?src=wqy3XuO_13lVf_iFP7iexg-2-30&size=huge_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>The new laws of 2009 and 2010 have been followed by a slight increase in correct use of child restraints. In children aged two to five years in low socioeconomic areas of Sydney, we saw correct use <a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12070/abstract">increase from 36% to 47%</a> in 2010, just after the introduction of the new laws.</p>
<h2>I need help!</h2>
<p><a href="http://roadsafety.transport.nsw.gov.au/cgi-bin/index.cgi?action=authrestraintfitting.form">Restraint Fitting Stations</a>, and restraint fitting check days run by local governments and safety stakeholders can help parents make sure restraints are installed correctly, and can also provide advice about how to correctly secure their children within restraints. </p>
<p>We have found that children of parents who had not used these services were <a href="http://www.sciencedirect.com/science/article/pii/S0001457510003982">twice as likely</a> as other children to be incorrectly restrained. But these services can’t be on hand to check restraints every day when parents need to move children between cars or when the restraint settings need to be modified as children grow. </p>
<p>In these circumstances the best available information is the information supplied with the restraint. But parents currently find this information <a href="http://search.informit.com.au/documentSummary;dn=445046962727704;res=IELHEA">difficult to use, and difficult to understand</a>. And neither of these measures addresses the interaction between the child and the restraint.</p>
<p>Information supplied with child restraint systems should be be user friendly – for all users, including those with lower levels of English literacy. Restraint systems must also be easier to use. Many current restraints are not intuitively easy to use, and sometimes physically difficult to use correctly. </p>
<p>As child safety advocates we need to shift our focus again. Instead of focusing on encouraging parents to use restraints correctly, let’s focus on working with industry to ensure information supplied with child restraints is comprehensible, and to improve restraint design so they’re actually difficult to use incorrectly.</p>
<hr>
<p><em>For more information on how to choose the right restraint type, and to use it correctly see <a href="https://www.childcarseats.com.au/">Child Car Seats</a></em></p>
<p><em>To take part in the child restraint research program at Neura, visit <a href="https://www.neura.edu.au/">www.neura.edu.au</a></em></p><img src="https://counter.theconversation.com/content/74845/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Brown receives funding from the National Health & Medical Research Council, the Australian Research Council, State Road Authorities and is conducting research to address usability of child restraints in partnership with Australian child restraint manufacturers. She is the former Chair, and current Vice Chair of Kidsafe NSW.</span></em></p>Car seats and their endless harnesses, straps and buckles feel like an engineering nightmare for parents. But they work.Julie Brown, Senior Research Fellow , Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/681422017-01-16T00:57:20Z2017-01-16T00:57:20ZHealth Check: is snoring anything to worry about?<figure><img src="https://images.theconversation.com/files/149001/original/image-20161207-15197-yg50n6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Snoring occurs due to vibration of the soft tissues of your upper airway. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/timothykrause/6015643797/in/photolist-aazKjv-aa6HE1-a5Aort-adxXrK-acMJky-adMgzq-9TPULP-9TPWV2-adANr9-9XuHN7-adANc1-adMg3u-a1ksGd-aazC86-a5apUd-acJUsx-aaCw83-abtsvh-9TPWGP-fEmwBV-9TgMKd-9VgGNP-acMPvq-9Y6YRX-aazHGe-9Y6V3t-9TSHUm-a1hCe2-9TPWtv-aazKMc-abSfbi-a1kssh-9YqNZ5-9YqNLd-9TSJbf-a1kpe3-abV7s5-9YE1na-a3uhT7-9RMDSW-9Y6Stg-abSgSK-9VXnng-9YnVYZ-9TPV6H-abts6f-9VXnXi-aazzT4-9Y9Ms9-9Y9TU1">timothykrause/flickr </a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>There’s nothing quite like the sound of snoring as the ultimate sleep interrupter. </p>
<p>But snoring can be more than just a frustration to those in your vicinity. Sometimes snoring is linked to more serious health problems, such as obstructive sleep apnoea. An emerging line of research suggests snoring may directly contribute to cardiovascular health problems. </p>
<h2>How does snoring occur?</h2>
<p>When we go to sleep, the muscles of the upper airway relax, causing it to become “floppy” and partially <a href="http://www.sciencedirect.com/science/article/pii/S0272523114000409">collapse</a>. This occurs to some extent in all of us. </p>
<p>However, in some people the airway is excessively narrowed, particularly at the level of the tongue and soft palate/uvula (the visible structure you see hanging at the back of the throat). As we breathe in, we produce suction pressures to draw air into the lungs. This further narrows the airway (similar to when sucking too hard on a straw) and can cause upper airway tissues such as the soft palate to <a href="http://www.sciencedirect.com/science/article/pii/B9780323242882001124">vibrate or flutter</a>, like a flag in the wind. This movement creates the noise of snoring. </p>
<p>Rapid opening and closing of the airway – such as the base of the tongue banging against the back of the throat – also contributes to snoring. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/150216/original/image-20161214-2505-kk6f0c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/150216/original/image-20161214-2505-kk6f0c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150216/original/image-20161214-2505-kk6f0c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150216/original/image-20161214-2505-kk6f0c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150216/original/image-20161214-2505-kk6f0c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150216/original/image-20161214-2505-kk6f0c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150216/original/image-20161214-2505-kk6f0c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The noise of snoring is due to vibration, fluttering and open/closing of soft structures in the upper airway (including the tongue and soft palate). OSA = obstructive sleep apnoea.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-119610079/stock-vector-snoring-and-sleep-apnea.html?src=C0TNOzD5vHezeEax8lD8jw-1-61">from shutterstock.com</a></span>
</figcaption>
</figure>
<h2>What can trigger snoring?</h2>
<p>If you don’t normally snore, <a href="http://www.sciencedirect.com/science/article/pii/B9780323242882001124">alcohol</a> is a key trigger as it blocks your nose and can relax airway muscles. If you already snore, alcohol is likely to make your snoring a lot louder!</p>
<p>Being <a href="http://www.sciencedirect.com/science/article/pii/B9780323242882001124">overweight</a> increases fat around the neck, compressing and narrowing the throat. But thin people do snore too, and many who are overweight do not. </p>
<p>A <a href="http://link.springer.com/article/10.1007%2Fs11325-003-0063-2">blocked nose</a> – due to a cold, allergies, polyps or anatomical abnormality – creates the need for greater suction pressures to draw air into the lungs when breathing, which further narrow the airway. Mouth opening often occurs when the nose is blocked during sleep, which itself can cause snoring (via airway anatomy and pressure changes).</p>
<p><a href="http://www.journalsleep.org/ViewAbstract.aspx?pid=25810">Sleeping on your back</a> contributes to collapse of the airway, as gravity pushes the tongue and soft palate towards the back of the throat.</p>
<p><a href="http://thorax.bmj.com/content/60/6/511">Enlarged tonsils</a> narrow the airway, and are a primary cause of snoring in children. </p>
<p><a href="http://www.atsjournals.org/doi/full/10.1164/rccm.200404-474OC#">Smoking</a> can irritate the membrane that lines the nose and throat, causing fluid build-up (oedema) that narrows the airways. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/B9780323242882001124">Excessive sleepiness</a> following sleep deprivation can enhance airway floppiness the next time you sleep. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/B9780323242882001562">Pregnancy</a> often triggers snoring in the second and third trimester as a result of physiological changes that narrow the upper airway.</p>
<h2>Burden of snoring for well-being</h2>
<p>Snoring can create a dry mouth, sore throat or headache, and can leave you feeling <a href="http://www.sciencedirect.com/science/article/pii/S0012369208603505">tired</a>. </p>
<p>It can place significant strains on <a href="https://www.ncbi.nlm.nih.gov/pubmed/25904676">personal relationships</a>, particularly your bed partner, but also those sleeping in an adjacent room or even sometimes on the other side of the house! </p>
<p>Snoring forces many couples to sleep in separate bedrooms, disrupting intimate bonds. Snorers are often embarrassed to sleep among others, promoting anxiety and hindering their social relationships. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/150218/original/image-20161215-2505-1u00mlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/150218/original/image-20161215-2505-1u00mlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=367&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150218/original/image-20161215-2505-1u00mlg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=367&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150218/original/image-20161215-2505-1u00mlg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=367&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150218/original/image-20161215-2505-1u00mlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=461&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150218/original/image-20161215-2505-1u00mlg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=461&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150218/original/image-20161215-2505-1u00mlg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=461&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Snorers may be banished from the bedroom, disrupting intimate relationships.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/restlessglobetrotter/1659319250/in/photolist-5MfTPJ-7reoPf-6ECKjU-NaZtb-bNvzXr-3wCrNA-ne31Vi-9H58vR-atWgkX-ayzP5L-fkL9MY-ayzPaU-5zqrH5-7q1jZJ-fkw1k4-5nUGsM-6HFJsL-3QTUfj-5Pk8NS-3QTRmb-4c9hMZ-aNUBpZ-ayx8Jg-8RGaUk-atWfW6-ayzPe3-5UoUnR-aMUyzx-uzTqA-5dNDzQ-atYVFd-aEJtaq-aMUyKM-bkiEsb-47XQhZ-atWgDr-mMt4-ayx9de-aqiYbn-atYWg1-atYV9S-atWg6P-7kb5Ax-atWfSz-4N7CBf-5xRQxS-6kYorH-tuNmEW-5a7nrt-cWhZwS">restlessglobetrotter/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Sleep disruption caused by snoring can make you and others cranky and irritable during the day, but also may lead to <a href="http://www.sciencedirect.com/science/article/pii/B9780323242882000052">impaired memory and concentration</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856739/">obesity and reduced immunity</a>.</p>
<p>Snoring even has the potential to <a href="https://www.ncbi.nlm.nih.gov/pubmed/12921130">cause hearing loss</a> for your bed partner. Given some snores reach over 80 decibels (equivalent to the loudness of a jack hammer, motorcycle or low flying jet), this idea is not so far-fetched. </p>
<h2>Serious health consequences</h2>
<p>Snoring can be a marker for <a href="https://theconversation.com/explainer-what-is-obstructive-sleep-apnoea-9884">obstructive sleep apnoea</a>, a disorder where the upper airway repeatedly closes during sleep, and breathing stops for at least ten seconds at a time. Obstructions to breathing can sometimes last for more than a minute and occur over 100 times an hour, starving the body of oxygen and fragmenting sleep. </p>
<p>Obstructive sleep apnoea sufferers are often excessively sleepy and at greater <a href="https://theconversation.com/explainer-what-is-obstructive-sleep-apnoea-9884">risk</a> of car and industrial accidents, cardiovascular disease – high blood pressure, heart attack, stroke – and reduced brain function, including poor memory and learning.</p>
<p>Over the last decade, <a href="http://www.journalsleep.org/ViewAbstract.aspx?pid=27245">some research</a> suggests heavy snoring itself may be a direct cause of cardiovascular complications, particularly a condition known as carotid artery atherosclerosis. </p>
<p>The carotid artery is the main vessel supplying blood to the brain. When affected by atherosclerosis, fatty deposits known as plaques form in the wall of the artery. Over time these can cause the blood vessel to narrow and limit blood flow. </p>
<p>One study has shown that <a href="http://jap.physiology.org/content/100/5/1547.long">snoring vibrations are transmitted to the carotid artery</a>, which can <a href="http://www.journalsleep.org/ViewAbstract.aspx?pid=28147">damage its wall</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1002/lary.24527/abstract;jsessionid=5B99869850EBA04825E3283E7D2E7442.f03t04">lead to the development</a> of atherosclerosis. Subsequently, snoring may rupture a formed plaque, resulting in pieces of the plaque moving through the bloodstream and blocking small vessels in the brain. However, additional research is required to bring further clarity to this hypothesis. </p>
<p>In children, snoring is associated with <a href="http://pediatrics.aappublications.org/content/114/1/44.long">behavioural issues</a> and <a href="http://pediatrics.aappublications.org/content/107/6/1394.long">poorer academic performance</a>.</p>
<h2>Current snoring treatments</h2>
<p>Given the multiple causes of snoring, there are numerous potential treatments available that work on some but not others. </p>
<p>Recommended lifestyle <a href="http://www.sciencedirect.com/science/article/pii/B9780323242882001124">changes</a> include:</p>
<ul>
<li>avoiding alcohol before bed (minimises airway floppiness)</li>
<li>losing excess weight (reduces airway compression)</li>
<li>stopping smoking (reduces airway irritation and fluid accumulation)</li>
<li>avoiding sleep deprivation (minimises airway floppiness) </li>
</ul>
<p>There are several medical treatments for snoring that require professional advice. If you snore regularly, it is highly recommended you see a sleep and respiratory doctor for diagnosis and to determine the right treatment for you. </p>
<p>For more information on all things sleep related, the <a href="http://www.sleephealthfoundation.org.au/public-information/fact-sheets-a-z.html">Sleep Health Foundation</a> offers some helpful fact sheets.</p><img src="https://counter.theconversation.com/content/68142/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jason Amatoury is supported by a NeuroSleep NHMRC Centre of Research Excellence Postdoctoral Fellowship (1060992).</span></em></p>Snoring has been linked to serious health conditions such as obstructive sleep apnoea and even cardiovascular disease.Jason Amatoury, Postdoctoral Research Fellow, Biomedical Engineer, Upper Airway Physiologist, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/673762016-10-31T04:28:55Z2016-10-31T04:28:55ZHealth Check: why do we get dizzy?<figure><img src="https://images.theconversation.com/files/142457/original/image-20161020-15097-1e9xt2v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While dizziness might be annoying when mild and infrequent, it can also be severely debilitating and impairing. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/downloading_tips.mhtml?code=&id=365594900&size=medium&image_format=jpg&method=download&super_url=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTQ3Njk2NjYzOCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMzY1NTk0OTAwIiwiayI6InBob3RvLzM2NTU5NDkwMC9tZWRpdW0uanBnIiwibSI6IjEiLCJkIjoic2h1dHRlcnN0b2NrLW1lZGlhIn0sIjMzTDBsS1dXWERQVHJLWTZYQVF0eXJYT28wZyJd%2Fshutterstock_365594900.jpg&racksite_id=ny&chosen_subscription=134&license=multi_share&src=NL5zzDYW-Az81-EDgJ1u6g-1-15">from www.shutterstock.com.au</a></span></figcaption></figure><p>Many people in their lifetime experience a sudden feeling of dizziness, be it head spinning, light-headedness, a floating sensation or a loss of balance, sometimes associated with nausea. In fact, dizziness is a frequent complaint. </p>
<p>It is estimated <a href="https://www.ncbi.nlm.nih.gov/pubmed/10798469">30% of the general population</a> have experienced moderate to severe dizziness at least once in their lifetime, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/18955641">nearly 2% of adults</a> seek medical attention annually for a new symptom of moderate to severe dizziness or vertigo.</p>
<p>The prevalence of symptoms of dizziness is particularly high among older people, with between 10% and 30% thought to suffer. Dizziness can be extremely distressing and physically debilitating and can markedly impair quality of life. In older people, in particular, experiencing dizziness makes the sufferer twice as likely to report disability, worsening of depressive symptoms, reduced participation in social activities, poor health and falls.</p>
<p>People generally find it hard to describe their dizziness symptoms and use vague terms such as floating, spinning, unsteadiness and giddiness. This imprecise symptom description is a major reason why dizziness is complex to assess and treat.</p>
<p>Doctors describe it as a feeling of altered orientation in space and classify it into four main subtypes: </p>
<ol>
<li>unsteadiness caused by leg weakness and impaired sensation </li>
<li>dizziness from severe anxiety </li>
<li>light-headedness</li>
<li>vertigo</li>
</ol>
<h2>Why do we feel dizzy?</h2>
<p>Vertigo is diagnosed when patients express having the illusion of head or body spinning. Vertigo tends to be caused by the inner ear (vestibular) - most commonly by the displacement of calcium crystals (small stones in the inner ear whose movement informs the eyes and the brain of horizontal or vertical movements) from their correct chambers in the inner ear – a condition called Benign Paroxysmal Positional Vertigo or BPPV. </p>
<p>As the calcium crystals blunder their way through one of the three inner ear canals, they activate very thin nerve cells (known as hair cells) connected to the brain and the eyes. The hair cells are highly sensitive to any slight movement and their signals to the brain normally reflect head movements and enable eye movements and body posture to be instantly adjusted.</p>
<p>In BPPV, the hair cells incorrectly inform the brain of head movement. This differs from the information provided by the eyes causing disorienting head movement or dizziness. Closing the eyes removes one of the disagreeing sensory inputs and the dizziness subsides.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=631&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=631&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=631&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=794&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=794&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143833/original/image-20161030-15810-ar9mpk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=794&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<hr>
<p>Similar feelings of head spinning can also be caused by other inner ear conditions, including vestibular nerve or inner ear infections (neuritis) or blocked vestibular canals, affecting the nervous pathway (called a “reflex”) that links the inner ear and the eyes.</p>
<p>The role of this reflex is to keep stable and clear vision when the head is moving, especially at fast speeds, for instance when walking quickly, running or even sitting in a car on a bumpy road. If this reflex isn’t functioning properly, vision is like watching the world as it appears on a poor quality homemade video: shaky and unstable.</p>
<p>Almost as frequent is the feeling of light-headedness people experience when getting up after lying on the couch or a bed quickly or from standing up from a chair after sitting for a long time. </p>
<p>In this instance, blood has pooled in our legs and the heart does not increase its beating rate sufficiently to compensate for the increase in blood pressure needed for standing up. This inadequate blood pressure regulation results in too long a time lag for providing the brain with oxygenated blood and dizziness occurs.</p>
<h2>How to treat dizziness</h2>
<p>Treatments for dizziness include physical manoeuvres such as moving the crystals back into their chamber for BPPV, blood pressure medication management and balance training. Many middle-aged and older sufferers, however, often find it hard to receive a correct diagnosis and are unable to gain relief from their symptoms. </p>
<p>This may be due to the unavailability of diagnostic tests for some inner ear conditions, the off-and-on nature of the problem making it hard to pinpoint, more than one issue leading to the problem and health care providers being only being able to diagnose one or two of several possible causes.</p>
<p>At NeuRA we are completing a study evaluating a one-stop assessment and treatment for dizziness. If successful in reducing dizziness episodes and handicap, we hope to make this strategy available for incorporating in clinical services.</p><img src="https://counter.theconversation.com/content/67376/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Lord receives funding from the NHMRC and ARC, Australia </span></em></p><p class="fine-print"><em><span>Jasmine Menant receives funding from the NHMRC, Australia. </span></em></p>It is estimated 30% of the general population have experienced moderate to severe dizziness at least once in their lifetime.Stephen Lord, Senior Principal Research Fellow, Neuroscience Research AustraliaJasmine Menant, Senior Research Officer, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/548282016-09-22T20:26:45Z2016-09-22T20:26:45ZWhy psychology lost its soul: everything comes from the brain<figure><img src="https://images.theconversation.com/files/132748/original/image-20160802-17165-1e7f01z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most functions attributed to the soul can be explained by the brain.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/28681973@N00/14071012267/in/photolist-nrpBHM-7ALMTk-95Yxmp-6NkmjL-qYY4AW-s1EY4-9xcuCw-5Jk1DJ-kH8bDg-r5xEGj-6C8tcg-mpnmWJ-pzHMvF-8PPonW-6X4HJU-ncXv2V-rQX39k-kycGzp-7FGCDx-nAUTwt-edEdzL-Gvqep3-bQKpKV-cpB4ys-kegAWB-ptmoFj-7LEfXK-rdkfUw-ssk3nu-82krcX-b8gkW8-p89rmZ-5p3wLf-6xRnWw-73NPBW-8BbNQ5-dH2jhP-az4KrZ-HdpSbR-5Y6xfV-5jH2wg-qrbTiR-9Lx9go-3RmRxq-aEtcA4-o1i1Wa-4XkfCS-9ku4S4-5DfL4c-pjQQXp">Rodger Evans/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Many people today <a href="http://www.abc.net.au/radionational/programs/earshot/february-26---soul-searching/6161200">believe they possess a soul</a>. While conceptions of the soul differ, many would describe it as an “<a href="http://www.abc.net.au/radionational/programs/earshot/february-26---soul-searching/6161200">invisible force that appears to animate us</a>”. </p>
<p>It’s often believed the soul can survive death and is intimately associated with a person’s memories, passions and values. Some <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9001777&fileId=S1477175613000195">argue the soul has no mass</a>, takes no space and is localised nowhere.</p>
<p>But as a neuroscientist and psychologist, I have no use for the soul. On the contrary, all functions attributable to this kind of soul can be explained by the workings of the brain.</p>
<p>Psychology is the study of behaviour. To carry out their work of modifying behaviour, such as in treating addiction, phobia, anxiety and depression, psychologists do not need to assume people have souls. For the psychologists, it is not so much that souls do not exist, it is that there is no need for them. </p>
<p>It is said psychology lost its soul in the 1930s. By this time, the discipline fully became a science, relying on experimentation and control rather than introspection.</p>
<h2>What is the soul?</h2>
<p>It is not only religious thinkers who have proposed that we possess a soul. Some of the most notable proponents have been philosophers, such as Plato (424-348 BCE) and René Descartes in the 17th century.</p>
<p>Plato believed we <a href="http://plato.stanford.edu/entries/ancient-soul/#3">do not learn new things</a> but recall things we knew before birth. For this to be so, he concluded, we must have a soul. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/132747/original/image-20160802-17187-1o91m6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/132747/original/image-20160802-17187-1o91m6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132747/original/image-20160802-17187-1o91m6u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132747/original/image-20160802-17187-1o91m6u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132747/original/image-20160802-17187-1o91m6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132747/original/image-20160802-17187-1o91m6u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132747/original/image-20160802-17187-1o91m6u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some people believe the soul has no mass, takes no space and is localised nowhere.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/michmutters/15993430505/in/photolist-qnhvFP-nrpBHM-7ALMTk-95Yxmp-6NkmjL-qYY4AW-s1EY4-9xcuCw-5Jk1DJ-kH8bDg-r5xEGj-6C8tcg-mpnmWJ-pzHMvF-8PPonW-6X4HJU-ncXv2V-rQX39k-kycGzp-7FGCDx-nAUTwt-edEdzL-Gvqep3-bQKpKV-cpB4ys-kegAWB-ptmoFj-7LEfXK-rdkfUw-ssk3nu-82krcX-b8gkW8-p89rmZ-5p3wLf-6xRnWw-73NPBW-8BbNQ5-dH2jhP-az4KrZ-HdpSbR-5Y6xfV-5jH2wg-qrbTiR-9Lx9go-3RmRxq-aEtcA4-o1i1Wa-4XkfCS-9ku4S4-5DfL4c">Michelle Robinson/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Centuries later, Descartes wrote his thesis Passions of the Soul, where he argued <a href="http://www.corwin.com/sites/default/files/upm-binaries/23183_Chapter_11.pdf">there was a distinction</a> between the mind, which he described as a “thinking substance”, and the body, “the extended substance”. He wrote:</p>
<blockquote>
<p>… because we have no conception of the body as thinking in any way, we have reason to believe that every kind of thought which exists in us belongs to the soul.</p>
</blockquote>
<p>One of the many arguments Descartes advanced for the existence of the soul was that the brain, which is a part of the body, is mortal and divisible – meaning it has different parts – and the soul is eternal and indivisible – meaning it is an inseparable whole. Therefore, he concluded they must be different things.</p>
<p>But advances in neuroscience have shown these arguments to be false. </p>
<h2>Stripping humans of the soul</h2>
<p>In the 1960s, Nobel laureate Roger Sperry <a href="http://people.psych.ucsb.edu/gazzaniga/PDF/A%20divided%20mind.%20Observations%20on%20the%20conscious%20properties%20of%20separated%20hemispheres%20(1977).pdf">showed that the mind and our consciousness are divisible</a>, therefore disproving that aspect of Descartes’ theory. </p>
<p>Sperry studied patients whose corpus callosum, the superhighway connecting the right and left hemispheres, had been severed by surgery aiming to control the spread of epileptic seizures. The surgery blocked or reduced the transfer of perceptual, sensory, motor and cognitive information between the two hemispheres. </p>
<p>Sperry showed each hemisphere could be trained to perform a task, but this experience was not available to the untrained hemisphere. That is, each hemisphere could process information outside the awareness of the other. In essence, this meant the operation produced a double consciousness. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/132749/original/image-20160802-17160-1jws0xt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/132749/original/image-20160802-17160-1jws0xt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=421&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132749/original/image-20160802-17160-1jws0xt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=421&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132749/original/image-20160802-17160-1jws0xt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=421&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132749/original/image-20160802-17160-1jws0xt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=529&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132749/original/image-20160802-17160-1jws0xt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=529&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132749/original/image-20160802-17160-1jws0xt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=529&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Roger Sperry showed consciousness is divisible.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/neilconway/3792906411/in/photolist-6MaCW8-5SWdgZ-64zrPn-9UwYi-4AkYYV-aaaWt8-64zrPt-84cP5K-sq4RNt-6RwrC-dHP5pM-wj8x-LPMMQ-5H2bU-NDMUU-aaawos-rx7fD-cgJcUs-4683Gw-bCVps-JtSW9-9XkxiP-8bFv9f-J8bQCu-5fbHci-645D1o-jypVk8-wTEZDo-61eaPC-xbQUur-aDNE65-5vGNkE-5pUBZM-dPuvJT-bPewqD-GCePiF-pRf9pH-qDbwbV-G9PtQ-9UwYp-7Dvjs2-5z9F41-dzaRhj-gayZDq-6do3r1-8nuU6d-Y6ff-bs3gLL-83eNFU-6zHHi9">Neil Conway/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Thus, Descartes cannot be correct in his assertion the brain is divisible but the soul, which can be read as the mind or consciousness, is not. In his effort to prove the existence of the soul in humans, Descartes actually provided an argument against it.</p>
<p>Rather than endowing rats with souls, psychologists stripped humans of theirs. In 1949, psychologist D.O. Hebb <a href="https://www.routledge.com/The-Organization-of-Behavior-A-Neuropsychological-Theory/Hebb/p/book/9780415654531">claimed the mind</a> is the integration of the activity of the brain. </p>
<p>Many neurophilosophers have come to the same conclusion as the psychologists, with Patricia Churchland more recently <a href="https://mitpress.mit.edu/books/neurophilosophy">claiming there is no ghost in the machine</a>.</p>
<h2>The brain does it all</h2>
<p>If the soul is where emotion and motivation reside, where mental activity occurs, sensations are perceived, memories are stored, reasoning takes place and decisions are taken, then there is no need to hypothesise its existence. There is an organ that already performs these functions: the brain.</p>
<p>This idea goes back to the ancient physician Hippocrates (460-377 BCE) <a href="http://classics.mit.edu/Hippocrates/sacred.html">who said</a>:</p>
<blockquote>
<p>Men ought to know that from nothing else but the brain come joys, delights, laughter and sports, and sorrows, griefs, despondency and lamentations. And by this … we acquire wisdom and knowledge, and see and hear, and know what are foul and what are fair, what are bad and what are good, what are sweet and what are unsavoury…</p>
</blockquote>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/132750/original/image-20160802-17180-1c3fyp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/132750/original/image-20160802-17180-1c3fyp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=738&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132750/original/image-20160802-17180-1c3fyp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=738&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132750/original/image-20160802-17180-1c3fyp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=738&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132750/original/image-20160802-17180-1c3fyp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=927&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132750/original/image-20160802-17180-1c3fyp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=927&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132750/original/image-20160802-17180-1c3fyp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=927&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If we listen to Plato, memory is a function that belongs to the soul.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dfuster74/9307132682/in/photolist-fbruhS-7NxHvj-5JPCB4-pG2CB1-rXtWCF-FALJr-bamJnD-qd65Nf-ppb9bu-9aT3GZ-EZkEm7-p7Rwre-p7RvAM-deExRT-dwZxxD-dUVk6Z-7DMUD3-5dypM-5oTQyL-fuXSsD-p62XZh-5CVshc-bm99ZC-fuXRQi-fvdc43-9zhFyJ-iqL1yy-b75dJz-6PNatB-4hSgY4-a4F77-o4TLSK-fuXSGp-p885Cn-fuXRXR-BPE5-fuXVm2-fvdcGY-5FVX9w-edge6w-7cPZ9f-6y4pzR-69S2Sz-aTaP1K-p862Eu-du6mCL-7EYt9S-dRgB35-fvdbDw-eq8ETD">Daniel Gonzalez Fuster/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The brain is the organ with a map of our body, the outside world and our experience. Damage to the brain, as in accidents, dementias or congenital malformations, produces a commensurate damage to personality.</p>
<p>Consider one of the functions supposedly – if we listen to Plato – carried out by the soul: memory. A major knock on the head can make you lose your memories of the past several years. If the soul is an immaterial substance separate from our physical being, it should not be injured by the knock. If memory were stored in the soul, it should not have been lost.</p>
<p>The neuronal activity in the brain is responsible for the <a href="http://thehumanist.com/magazine/january-february-2014/skeptical-eye/skeptical-eye-autism-atheism-and-the-soul">cognitive and emotional dysfunctions</a> in people with autism; it would be cruel and unethical to blame their hypothetical souls.</p>
<p>Manipulation of the brain is sufficient to alter emotion and mood. The soul is totally superfluous to this process.</p>
<p>The ability of psychotherapeutic drugs to alter mood provides another line of evidence against the presence of the soul. If you produce a chemical imbalance in the brain, such as by depleting dopamine, noradrenaline and serotonin with tetrabenazine, you can <a href="http://jnnp.bmj.com/content/67/4/550.1.full">induce depression</a> in some people.</p>
<p>Correspondingly, many depressed people can be helped by drugs that increase the function of these neurotransmitters in the brain.</p>
<p>The brain is where thinking takes place, love and hatred reside, sensations become perceptions, personality is formed, memories and beliefs are held, and where decisions are made. As <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9001777&fileId=S1477175613000195">D.K. Johnson said</a>: “There is nothing left for the soul to do.”</p><img src="https://counter.theconversation.com/content/54828/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>George Paxinos does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many people believe they have a soul. But for psychologists, who study behaviour, it is not so much that souls do not exist, it is that there is no need for them.George Paxinos, Visiting/Conjoint Professor of Psychology and Medical Sciences, UNSW & NHMRC Australia Fellow, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/619162016-07-18T20:06:05Z2016-07-18T20:06:05ZWe need to talk about the bad science being funded<figure><img src="https://images.theconversation.com/files/130667/original/image-20160715-2110-t669yb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Good science loses out when bad science gets the funding.</span> <span class="attribution"><span class="source">Shutterstock/Looker Studio</span></span></figcaption></figure><p>Spectacular failures to replicate key scientific findings have been documented of late, particularly in <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0144151">biology</a>, <a href="http://science.sciencemag.org/content/349/6251/aac4716">psychology</a> and <a href="http://www.nature.com/nature/journal/v483/n7391/full/483531a.html">medicine</a>.</p>
<p>A report on the issue, published in Nature this May, found that about <a href="http://www.nature.com/news/1-500-scientists-lift-the-lid-on-reproducibility-1.19970">90%</a> of some 1,576 researchers surveyed now believe there is a reproducibility crisis in science.</p>
<p>While this rightly tarnishes the public belief in science, it also has serious consequences for governments and philanthropic agencies that fund research, as well as the pharmaceutical and biotechnology sectors. It means they could be wasting billions of dollars on research each year.</p>
<p>One contributing factor is easily identified. It is the high rate of so-called false discoveries in the literature. They are <a href="http://www.livescience.com/32767-what-are-false-positives-and-false-negatives.html">false-positive findings</a> and lead to the erroneous perception that a definitive scientific discovery has been made. </p>
<p>This high rate occurs because the studies that are published often have <a href="http://rsos.royalsocietypublishing.org/content/1/3/140216">low statistical power to identify a genuine discovery</a> when it is there, and the effects being sought are often small.</p>
<p>Further, dubious scientific practices boost the chance of finding a statistically significant result, usually at a probability of less than one in 20. In fact, our probability threshold for acceptance of a discovery should be more stringent, just as it is for discoveries of new particles in physics. </p>
<p>The English mathematician and the father of computing <a href="http://www.biography.com/people/charles-babbage-9193834">Charles Babbage</a> noted the problem in his 1830 book <a href="https://books.google.com.au/books?id=K5BW2hsvDEQC&lpg=PA175&ots=aACXxMKOgT&dq=%E2%80%9Choaxing%2C%20forging%2C%20trimming%20and%20cooking%E2%80%9D%20charles%20babbage&pg=PA175#v=onepage&q=%E2%80%9Choaxing,%20forging,%20trimming%20and%20cooking%E2%80%9D%20charles%20babbage&f=false">Reflections on the Decline of Science in England, and on Some of Its Causes</a>. He formally split these practices into “hoaxing, forging, trimming and cooking”.</p>
<h2>‘Trimming and cooking’ the data today</h2>
<p>In the current jargon, trimming and cooking include failing to report all the data, all the experimental conditions, all the statistics and reworking the probabilities until they appear significant.</p>
<p>The frequency of many of these indefensible practices is above 50%, as <a href="http://www.psychologicalscience.org/index.php/news/releases/questionable-research-practices-surprisingly-common.html">reported by scientists themselves</a> when they are given some <a href="http://pss.sagepub.com/content/23/5/524">incentive for telling the truth</a>.</p>
<p>The English philosopher <a href="http://www.biography.com/people/francis-bacon-9194632">Francis Bacon</a> <a href="http://www.gutenberg.org/files/45988/45988-h/45988-h.htm">wrote almost 400 years ago</a> that we are influenced more by affirmation than negatives and <a href="http://www.goodreads.com/quotes/63465-man-prefers-to-believe-what-he-prefers-to-be-true">added</a>: </p>
<blockquote>
<p>Man prefers to believe what he prefers to be true.</p>
</blockquote>
<p>Deep-seated cognitive biases, consciously and unconsciously, drive scientific corner-cutting in the name of discovery.</p>
<p>This includes <a href="http://psr.sagepub.com/content/2/3/196.abstract">fiddling the primary hypothesis being tested</a> after knowing the actual results or fiddling the statistical tests, the data or both until a <a href="http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1002106">statistically significant result is found</a>. Such practices are common.</p>
<p>Even large randomised controlled clinical trials published in the leading medical journals are affected (see <a href="http://compare-trials.org/">compare-trials.org</a>) – despite research plans being specified and registered before the trial starts.</p>
<p>Researchers rarely stick exactly to the plans (about 15% do). Instead, they commonly remove registered planned outcomes (which are presumably negative) and add unregistered ones (which are presumably positive).</p>
<h2>Publish or perish</h2>
<p>We do not need to look far to expose the fundamental cause for the problematic practices pervading many of the sciences. The “<a href="https://theconversation.com/publish-or-perish-culture-encourages-scientists-to-cut-corners-47692">publish or perish</a>” mantra says it all.</p>
<p>Academic progression is hindered by failure to publish in the journals controlled by peers, while it is enhanced by frequent publication of, nearly always positive, research findings. Does this sort of competitive selection sound familiar? </p>
<p>It is a form of cultural natural selection – natural, in that it is embedded in the modern culture of science, and selective in that only survivors progress. The parallels between biological natural selection and selection related to culture have long been accepted. Charles Darwin even described its role in development of language in his <a href="http://www.goodreads.com/book/show/185407.The_Descent_of_Man">The Descent of Man</a> (1871). </p>
<p>Starkly put, the rate of publication varies between scientists. Scientists who publish at a higher rate are preferentially selected for positions and promotions. Such scientists have “children” who establish new laboratories and continue the publication practices of the parent.</p>
<h2>Good science suffers</h2>
<p>In another <a href="https://arxiv.org/abs/1605.09511">study published in May</a>, researchers modelled the intuitive but complex interactions between the pressure and effort to publish new findings and the need to replicate them to nail down true discoveries. It is a well-argued simulation of the operation and culture of modern science. </p>
<p>They also conclude that there is natural selection for bad scientific practice because of incentives that simply reward “publication quantity”:</p>
<blockquote>
<p>Scrupulous research on difficult problems may require years of intense work before yielding coherent, publishable results. If shallower work generating more publications is favored, then researchers interested in pursuing complex questions may find themselves without jobs, perhaps to the detriment of the scientific community more broadly.</p>
</blockquote>
<p>The authors also reiterate the low power of many studies to find a phenomenon if it was truly there. Despite entreaties to increase statistical power, for example by collection of more observations, it has remained consistently low for the last 50 years.</p>
<p>In some fields, it <a href="http://www.nature.com/nrn/journal/v14/n5/full/nrn3475.html">averages only 20% to 30%</a>. Natural academic selection has favoured publication of a result, rather than generation of new knowledge.</p>
<p>The impact of Darwinian selection among scientists is amplified when government support for science is low, growth in the scientific literature continues unabated, and universities produce an increasing number of PhD graduates in science.</p>
<p>We hold an idealised view that science is rarely fallible, particularly biology and medicine. Yet many fields are filled with publications of low-powered studies with perhaps <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124">the majority being wrong</a>.</p>
<p>This problem requires action from scientists, their teachers, their institutions and governments. We will not turn natural selection around but we need to put in place selection pressures for getting the right answer rather than simply published.</p><img src="https://counter.theconversation.com/content/61916/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Gandevia receives funding from the National Health and Medical Research Council.</span></em></p>New studies on the quality of published research shows we could be wasting billions of dollars a year on bad science, to the neglect of good science projects.Simon Gandevia, Deputy Director, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/573412016-06-07T20:19:06Z2016-06-07T20:19:06ZHow Australians Die: cause #3 – dementia (Alzheimer’s)<figure><img src="https://images.theconversation.com/files/123325/original/image-20160520-4484-j763ej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dementia can affect the ability to perform tasks such as dressing, showering and eating.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>This is the third in the <a href="https://theconversation.com/au/topics/how-australians-die">How Australians Die</a> series that focuses on the country’s top five causes of death and how we can drive down rates of these illnesses. Tomorrow’s piece will explore the fourth leading cause of death: chronic lower respiratory diseases. You can read yesterday’s piece on cancers <a href="http://theconversation.com/how-australians-die-cause-2-cancers-58063">here</a>.</em></p>
<hr>
<p>In Australia, dementia is the third leading cause of death after heart disease and cancers. Typically, people with dementia deteriorate gradually and eventually die from complications such as respiratory failure – from pneumonia for instance – or other infections. Dementia will in these cases be registered as the underlying cause of death.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=192&fit=crop&dpr=1 600w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=192&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=192&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=241&fit=crop&dpr=1 754w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=241&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=241&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<p>Dementia is a general term for severe disorders with mental decline. Subtypes include Lewy body dementia, vascular dementia (with cerebrovascular disease) and fronto-temporal dementia. Of these types, Alzheimer’s disease is the most <a href="http://cargocollective.com/ritamaldonadobranco/Visualising-dementia">common diagnosis of dementia</a>, accounting for 50-75% of all cases. As such, Alzheimer’s disease and dementia are often used interchangeably.</p>
<p>As the population ages, the number of people with dementia is expected to rise, as is the number of deaths caused by the disease.</p>
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<figure><figcaption>The How Australians Die series has combined all cancer deaths to make them the second leading cause of death after heart diseases and stroke. Alzheimer’s is number 3, respiratory diseases number 4 and diabetes number 5.</figcaption></figure>
<hr>
<h2>History of Alzheimer’s dementia</h2>
<p>Alzheimer’s disease <a href="http://info-centre.jenage.de/assets/pdfs/library/stelzmann_et_al_alzheimer_CLIN_ANAT_1995.pdf">was first reported</a> by German psychiatrist Alöis Alzheimer in 1906. After comparing autopsy reports of some of his patients, he described the presence of two abnormal brain structures made up of accumulated clusters of sticky proteins between nerve cells. </p>
<p>These abnormally accumulated proteins are considered the classic pathological hallmarks of the disease. </p>
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<img alt="" src="https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=890&fit=crop&dpr=1 600w, https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=890&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=890&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1118&fit=crop&dpr=1 754w, https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1118&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1118&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alzheimer’s disease is named after psychiatrist Alois Alzheimer.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3AAlois_Alzheimer_003.jpg">Wikimedia Commons</a></span>
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<p>About 5% of <a href="http://www.mayoclinic.org/alzheimers/art-20048356">dementia cases show early onset</a> or familial inheritance, where dementia develops before the age of 65, sometimes in adults as young as 35. However, the disease most commonly presents as the age-related dementia with which we are familiar. </p>
<p>The frequency of the disease is markedly increased in adults over 65. After this age, <a href="https://www.alz.org/downloads/facts_figures_2012.pdf">it doubles every six-and-a-half years</a>. It ultimately affects one-third of those older than 85. </p>
<h2>Dementia signs and symptoms</h2>
<p>Dementia can take several years to develop. It is often categorised as mild (early stage), moderate (mid stage) and advanced (late stage). Symptoms include:</p>
<ul>
<li><p>cognitive impairment: problems with memory, communication, comprehension and ability to recognise familiar objects and people</p></li>
<li><p>psychiatric or behavioural symptoms: severe depression, delusions and hallucinations (visual and auditory), and increased aimless wandering, agitation and confusion</p></li>
<li><p>dysfunction in daily living activities: in the earlier stages of dementia, the ability to perform routine tasks such as shopping may be disrupted. Dementia in the later stages can affect the ability to perform more basic tasks such as dressing, showering and eating.</p></li>
</ul>
<p>People living with dementia may have different symptoms at various times, depending on the person and the parts of the brain affected. </p>
<p>There is no single established screening test to accurately diagnose dementia. Neurologists use reports from physical examinations, memory or cognitive tests, caregiver interviews, questionnaires, medical histories, genetic tests and brain scans.</p>
<p>Risks of dementia include having a family history of the disorder, a <a href="https://fightdementia.org.au/sites/default/files/20070900_Nat_NP_13DemRiskRedEvidence.pdf">history of repeated head trauma</a> and lifestyle factors, such as hypertension, uncontrolled diabetes, high cholesterol, <a href="https://www.sciencedaily.com/releases/2014/03/140310102208.htm">poor cardiovascular fitness</a> and atherosclerosis. Moderate exercise and controlled weight <a href="https://www.sciencedaily.com/releases/2013/12/131209181059.htm">can reduce the risks</a> of cognitive impairment and dementia.</p>
<p>Studies <a href="https://books.google.com.au/books?id=L4YQ50SbBnsC&pg=PA249&lpg=PA249&dq=Longitudinal+effects+of+estrogen+replacement+therapy+on+PET+cerebral+blood+flow+and+cognition&source=bl&ots=1XzLNsUXXE&sig=Kh4tz_CF7pib-GKoDnptDj0g4Zo&hl=en&sa=X&ved=0ahUKEwjkjY6F2KnMAhUDMKYKHVRaCcAQ6AEINTAF#v=onepage&q=Longitudinal%20effects%20of%20estrogen%20replacement%20therapy%20on%20PET%20cerebral%20blood%20flow%20and%20cognition&f=false">have also shown being female</a> can put you at higher risk of cognitive decline. The exact reasons for this are somewhat controversial. It could be because risk increases with age and women tend to outlive men. </p>
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<p>But some evidence shows that the risk increases parallel to a reduction in female hormone production after menopause, so the incidence is <a href="https://fightdementia.org.au/sites/default/files/20111014_Nat_Access_DemAcrossAust.pdf">slightly higher</a> in women after the age of 75. Female hormones are known to <a href="https://books.google.com.au/books?id=L4YQ50SbBnsC&pg=PA249&lpg=PA249&dq=Longitudinal+effects+of+estrogen+replacement+therapy+on+PET+cerebral+blood+flow+and+cognition&source=bl&ots=1XzLNsUXXE&sig=Kh4tz_CF7pib-GKoDnptDj0g4Zo&hl=en&sa=X&ved=0ahUKEwjkjY6F2KnMAhUDMKYKHVRaCcAQ6AEINTAF#v=onepage&q=Longitudinal%20effects%20of%20estrogen%20replacement%20therapy%20on%20PET%20cerebral%20blood%20flow%20and%20cognition&f=false">play a protective role</a> in cardiovascular function, cognition and memory.</p>
<h2>Disease burden</h2>
<p>It is <a href="http://www.alz.co.uk/research/world-report-2015">estimated that, in 2015</a>, 47 million people had dementia globally. These numbers are projected to double every two decades and reach 131.5 million by 2050.</p>
<p>In the United States, dementia was the second leading cause of death after heart disease in 2014. While the <a href="http://www.cdc.gov/nchs/products/databriefs/db233.htm">number of deaths from dementia</a> increased by 119% from the year 2000, rates of deaths from heart disease dropped by 24% over the same period. </p>
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<p>The number of Australians living with dementia is more than <a href="https://fightdementia.org.au/about-us/media/key-facts-and-statistics">353,800</a> (around 1.5% of the total population). This is <a href="https://fightdementia.org.au/sites/default/files/20111014_Nat_Access_DemAcrossAust.pdf">projected to increase to 553,000</a> by 2030. The projections may be conservative as the current number is actually higher than the number (329,243) projected <a href="https://fightdementia.org.au/sites/default/files/20111014_Nat_Access_DemAcrossAust.pdf">in 2011</a>.</p>
<p>The <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737422943">total direct cost</a> of dementia to the Australian health and aged care system was estimated to be more than A$4.9 billion in the 2009-10 financial year. <a href="http://apo.org.au/resource/residential-aged-care-australia-2008-09">Nearly 59%</a> of residential aged care expenditure was spent on dementia patients in June 2009.</p>
<p>A firm diagnosis usually occurs three years after noticeable symptoms are manifested and noticed by family members. This is often at the early to mid stage of the disease. From this stage, the only management available is the possible alleviation of symptoms with prescription drugs – although depending on the person and disease severity, these might help little.</p>
<p>It is critical we identify those at risk so that timely medical interventions can be provided before dementia onset, with the possibility of delaying the onset. This would considerably reduce the time people live with dementia and the overall associated disease burden. It’s estimated a delay of dementia onset by five years would reduce the <a href="http://www.alzheimersresearchuk.org/treatment-to-delay-dementia-by-five-years-would-reduce-cases-by-33/">number of cases by a third</a>. </p>
<p>The best current approach to the dementia epidemic is to promote a healthy lifestyle from an early age as poor cardiovascular fitness in teenage years is <a href="https://www.sciencedaily.com/releases/2014/03/140310102208.htm">predicted</a> to increase dementia risk.</p>
<hr>
<p><em>Correction: a decimal point was missing from the prevalence of dementia in Australia so it read 15% instead of 1.5%. This has now been amended.</em></p><img src="https://counter.theconversation.com/content/57341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Siva Purushothuman receives funding from National Health and Medical Research Council (NHMRC) & Australian Research Council (ARC). </span></em></p>Dementia is the third leading cause of death in Australia. As the population ages, the number of people with dementia is expected to rise, as is the number of deaths from dementia.Siva Purushothuman, NHMRC Postdoctoral Fellow, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/594002016-05-27T04:49:31Z2016-05-27T04:49:31ZPeter, Paul, Kylie … David! Why we forget family members’ names<figure><img src="https://images.theconversation.com/files/123732/original/image-20160524-20530-jk14ag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Does your mum list all your siblings' names before she gets to yours? Don't worry, she doesn't love them more. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Have you ever been called somebody else’s name? How often has your own mother forgotten your name? Does she ever cycle through the names of each of your siblings, and perhaps even the family pet, before getting to yours? </p>
<p>Don’t worry, it’s probably not because she loves them more than you. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/27106910">According to researchers at Duke University</a>, misnaming is a common cognitive slip-up. In fact, it seems to occur most frequently between family members and close friends.</p>
<p>The researchers examined survey data from more than 1,700 participants, who were either undergraduate students or older individuals from the community. Regardless of age, those who had been misnamed reported being misnamed by someone they knew well. Likewise, those who had misnamed someone reported doing so to a familiar person. </p>
<p>Misnaming usually occurs within the same semantic category. So, family members are misnamed with another family member’s name and friends are misnamed with another friend’s name. </p>
<p>Names are also more likely to be confused when they share phonetic similarities. For example, misnaming will potentially occur more often if you have children named Dan and Stan.</p>
<p>Notably, the study found misnaming has little to do with physical similarity – which is certainly reassuring if you have ever been called by the dog’s name.</p>
<h2>A method to the madness</h2>
<p>The finding that we often mix up names that are semantically and phonetically related, rather than at random, gives insights into the way our memories for names are organised in the brain. </p>
<p>The brain tends to group names that are related. They can be related because they belong to a similar semantic category (e.g. family members, school friends, work friends). Or, they can be related because they sound alike (e.g., names starting with “S”). </p>
<p>According to <a href="https://www.researchgate.net/publication/200045115_A_Spreading_Activation_Theory_of_Semantic_Processing">network theories of language</a>, each individual word is linked to other words that share similar conceptual properties. For example, your brother’s name, Paul, might be linked to your other siblings’ names (Kylie, David), as well as other names that start with “P” (Peter). </p>
<p>Because these names share links and are stored in close proximity in the brain, saying one name may also bring to mind other semantically or phonetically similar names. This maximises efficiency, as the brain is able to retrieve closely related information faster.</p>
<h2>What happens when these processes break down?</h2>
<p>Like knowledge about other types of cognitive abilities, much has been gained from studying people where the ability has been disrupted due to damage in the brain. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/123734/original/image-20160524-19272-152t4tj.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/123734/original/image-20160524-19272-152t4tj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/123734/original/image-20160524-19272-152t4tj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=571&fit=crop&dpr=1 600w, https://images.theconversation.com/files/123734/original/image-20160524-19272-152t4tj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=571&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/123734/original/image-20160524-19272-152t4tj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=571&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/123734/original/image-20160524-19272-152t4tj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=717&fit=crop&dpr=1 754w, https://images.theconversation.com/files/123734/original/image-20160524-19272-152t4tj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=717&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/123734/original/image-20160524-19272-152t4tj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=717&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Complex pathways in the brain are working to retrieve stored information on faces and names.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p><a href="https://www.neura.edu.au/FRONTIER">Our research group</a> has a special interest in studying individuals with <a href="http://www.ftdtalk.org/ftd-factsheets/factsheet-5-what-is-semantic-dementia/">semantic dementia</a>. Like other types of dementia, semantic dementia is caused by the abnormal accumulation of proteins in the brain. This ultimately leads to cell death and shrinkage of different brain regions. </p>
<p>In semantic dementia, the anterior temporal lobe, a part of the brain situated behind the ear, is most affected. </p>
<p>Individuals with semantic dementia, as the name suggests, show a progressive loss of semantic knowledge (our knowledge about facts, places, things and names). One of the earliest symptoms in semantic dementia is difficulty in naming things. </p>
<h2>Naming difficulties in semantic dementia</h2>
<p>People with semantic dementia show very specific types of naming errors. For example, they may call a “zebra” a “horse”, or an “animal”. This suggests that as semantic knowledge is lost, our understanding of the world becomes less specific and more generalised.</p>
<p>People with semantic dementia also have difficulty in recognising and naming people. This depends on which side of the brain is more affected.</p>
<p>People with semantic dementia who have more atrophy/shrinkage in the left hemisphere of the brain commonly struggle to <a href="https://www.researchgate.net/publication/51971055_Famous_People_Knowledge_and_the_Right_and_Left_Temporal_Lobes">recognise names</a>. In contrast, those with greater atrophy in the right hemisphere have more trouble <a href="https://www.researchgate.net/publication/274011385_Do_I_know_you_Examining_face_and_object_memory_in_frontotemporal_dementia?ev=prf_pub">recognising people’s faces</a>.</p>
<p>This kind of research gives us important insights into how names are represented in the brain.</p>
<h2>It’s harder than it looks</h2>
<p>The ability to recognise someone and call them by their correct name is incredibly complex, even though it feels like second nature to us.</p>
<p>Calling a person by their correct name requires integration of information across both hemispheres of the brain to connect face and name knowledge in mere milliseconds.</p>
<p>Understanding how this process goes wrong – whether through misnaming someone, struggling to say that word on the tip of your tongue, or switching around two words or sounds – gives us important insights into how our brain stores and retrieves the seemingly endless number of names and faces we know.</p>
<p>What does this mean for those of us who frequently misname our family and friends? Based on what we know about how names are organised in the brain, this common cognitive slip-up could be the brain’s way of trying to make our life easier, rather than a sign of something sinister.</p>
<p>So next time you say the wrong name, spare a moment to consider how challenging this ability is and how much work our brains do in order for us to call someone by their name.</p><img src="https://counter.theconversation.com/content/59400/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona Kumfor receives funding from the National Health and Medical Research Council (NHMRC) and the Australian Research Council (ARC). </span></em></p><p class="fine-print"><em><span>Stephanie Wong does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How often has your own mother forgotten your name? Does she ever cycle through the names of each of your siblings – and perhaps even the family pet – before getting to yours?Fiona Kumfor, Postdoctoral fellow, Neuroscience Research AustraliaStephanie Wong, PhD Student, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/573482016-04-28T03:58:53Z2016-04-28T03:58:53ZFight, flight or … faint? Why some people pass out when they see blood or feel pain<figure><img src="https://images.theconversation.com/files/118258/original/image-20160412-15861-uk0n7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are a few explanations as to why some people faint when they get needles or feel pain. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/venndiagram/5331296718/">Dave/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Most people find the sight of blood or a hypodermic needle enough to cause some discomfort, but why do some people faint when faced with them? If you’re someone who finds yourself sweating about your upcoming flu jab, you might have your prehistoric ancestors to thank.</p>
<p><a href="https://theconversation.com/explainer-what-are-phobias-9667">Phobias</a> are part of the anxiety disorder family. They are thought to arise because of a learned response to a stimulus following a traumatic event (being bitten by a dog might lead to a fear of dogs), or because of intrinsic adaptive mechanisms that promote survival, which might underlie a fear of spiders or heights.</p>
<p>Most people are familiar with the experience of fear. It may be fear of an upcoming presentation, or of a mouse running across your kitchen floor. Fear is a basic emotion central to the experience of threat, where an animal either fights the threat or runs away. </p>
<p>A phobia, on the other hand, is an intense, pervasive and debilitating fear of something that might seem entirely harmless to others.</p>
<h2>The blood-injection-injury phobia</h2>
<p>The blood-injection-injury phobia is a fairly common phenomenon. It is experienced by approximately <a href="http://www.ncbi.nlm.nih.gov/pubmed/9794020">3% of the population</a>. The phobia can be triggered by the sight of blood, by sustaining an injury, receiving an injection, or some other type of medical procedure. </p>
<p>All humans have a natural tendency to be squeamish in these situations, but for some people the response is more extreme. They experience a temporary spike in heart rate and blood pressure, followed by a dramatic drop. This results in skin pallour, sweating, nausea and fainting.</p>
<p>This fainting response is unique to the blood-injection-injury phobia, in contrast with the usual acceleration of heart rate and elevation in blood pressure in all other phobias.</p>
<p>So why does a fear of blood or needles leave a person weak at the knees, while confrontation with a spider or a Ferris wheel leaves the body armed and ready to fight or run away?</p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/15337864">earliest “adaptationist” hypothesis</a> to explain the blood-injection-injury phobia suggests fainting at the sight of blood increases the chance of survival, because a dramatic drop in blood pressure minimises blood loss in the case of injury. However, this does not explain why people faint when faced with needles or minor injuries, where little or no blood loss is involved.</p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/3048117">second evolutionary hypothesis</a> posits that blood-induced fainting in mammals is controlled by the same physiological mechanism that regulates disgust. It suggests that, in some people, the sight of their own (or another’s) blood might induce a disgust response.</p>
<p>However, disgust (and associated nausea and vomiting) is thought to have evolved to protect mammals from the risk of disease-laden food. It’s difficult to imagine the adaptive benefit of fainting when confronted with bad chicken; simple avoidance seems like a much better approach to maintaining health and survival.</p>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/15944875">third explanation</a> describes the adaptive benefit of fainting during periods of inescapable threat in the mid-Paleolithic era. During warfare, confrontation with a “stranger wielding a sharp object” was likely to be associated with threat to life. Humans’ tendency to faint (or “play dead”), rather than attempt to flee or fight, may therefore have evolved as an alternative stress-induced fear-circuitry response.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/9794020">Epidemiological studies</a> have consistently shown a higher prevalence of blood-injection-injury phobia in women compared with men. Prevalence of the blood-injection-injury phobia also decreases after puberty in boys. </p>
<p>The Paleolothic-threat hypothesis suggests that, during warfare, a phobic response to the sight of blood or an approaching sharp object was likely to be maladaptive for men who engaged in combat. For women and children, however, this behaviour may have been adaptive; fear-induced fainting may have increased the likelihood of being taken captive rather than being killed.</p>
<p>In an <a href="http://www.ncbi.nlm.nih.gov/pubmed/4009521">interesting research experiment</a>, blood donors were more likely to faint when blood was collected by an experienced phlebotomist rather than an inexperienced phlebotomist. </p>
<p>Consistent with the Paleolithic-threat hypothesis, it was concluded that the novice phlebotomist may have a more deliberate, slower-moving and more talkative approach than their more experienced counterparts. A sharp object held by a fast-moving, non-communicative stranger may resemble more closely a mid-Paleolithic assailant signalling life-threatening danger.</p>
<h2>Why do only some people faint?</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/9754622">Heritability estimates</a> are high in the blood-injection-injury phobia; many people report strong family histories, and concurrence of this phobia is high among twins.</p>
<p>Specific phobias, including the blood-injection-injury phobia, are <a href="http://www.ncbi.nlm.nih.gov/pubmed/9794020">frequently associated with</a> a range of other mental health problems, particularly anxiety disorders. Phobias are also <a href="http://www.ncbi.nlm.nih.gov/pubmed/20099272">more common in individuals</a> who have endured abuse, neglect or trauma in early life.</p>
<p>Some people might actually be <a href="http://www.ncbi.nlm.nih.gov/pubmed/11514377">predisposed to fainting</a> due to a dysregulation in their autonomic nervous system. The blood-injection-injury phobia appears to develop in these individuals as a conditioned fear response, after they endure repeated traumatic fainting episodes.</p>
<p>Given its trademark physiological response, traditional methods of relaxation and deep breathing techniques are not the best approach when it comes to a fear of blood, needles or medical procedures. You might find yourself slowing your heart rate and inadvertently accelerating your trip to the floor. </p>
<p>Instead, engaging in conversation, increasing muscle tone and maintaining tension in your body will keep your heart rate up and your dizziness at bay. This could even provide you with enough distraction until it’s all over.</p><img src="https://counter.theconversation.com/content/57348/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cynthia Murray does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most people find the sight of blood or a hypodermic needle enough to cause some discomfort, but why is it that some people faint when they’re faced with them?Cynthia Murray, Clinical Neuropsychology Registrar and Research Assistant, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/461972015-08-31T04:12:03Z2015-08-31T04:12:03ZHealth Check: do you need to stretch before and after exercise?<figure><img src="https://images.theconversation.com/files/92040/original/image-20150817-5085-1ktm65b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some people believe stretching reduces the risk of injury, reduces soreness experienced after exercise, or enhances sporting performance.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/nataliejohnson/2585333542/">natalie/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Many people stretch when they exercise or play sport. Others don’t stretch but feel they should. And some people don’t see any reason to stretch at all.</p>
<p>The reasons for stretching are diverse. Most people think stretching makes them more flexible. Some believe stretching reduces the risk of injury, reduces soreness experienced after exercise, or enhances sporting performance. Optimists think stretching does all these things.</p>
<p>But do we really need to stretch when we exercise? And does stretching increase flexibility, reduce the risk of injury, reduce soreness and enhance sporting performance? The answer is neither yes nor no.</p>
<h2>Randomised trials</h2>
<p>The only way researchers can get a really clear idea of the effects of stretching is to conduct randomised trials. (<a href="http://www.testingtreatments.org/tt-main-text/">Here’s a clear explanation</a> of why randomised trials are special that you can read later.) </p>
<p>In randomised trials, a lottery is used to allocate each participant to either receive the treatment (in this case, stretching) or not. Then the outcomes (injury, muscle soreness or sporting performance) of the trial participants who stretched are compared with the outcomes of those who didn’t. The difference in the outcomes of the two groups tells us about the effects of stretching.</p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/10694106">first two trials</a> of the effects of stretching on risk of injury, <a href="http://www.ncbi.nlm.nih.gov/pubmed/11676730">conducted on 2,631 army recruits</a>, showed three months of routine stretching before exercise didn’t appreciably reduce injury risk. A more recent <a href="http://bjsm.bmj.com/content/early/2009/06/11/bjsm.2009.062232.abstract">trial</a> on 2,377 recreationally active people had very similar findings: three months of regular stretching had little or no effect on risk. </p>
<p>Together, these trials strongly suggest stretching doesn’t appreciably reduce injury risk.</p>
<p>A number of other randomised trials have investigated the effects of stretching before and after physical activity on the soreness experienced after exercise. They suggest stretching does reduce soreness, but the effect is very small. </p>
<p><a href="http://www.cochrane.org/CD004577/MUSKINJ_stretching-to-prevent-or-reduce-muscle-soreness-after-exercise">A review</a> of such trials concluded that:</p>
<blockquote>
<p>muscle stretching, whether conducted before, after, or before and after exercise, does not produce clinically important reductions in delayed-onset muscle soreness in healthy adults.</p>
</blockquote>
<h2>Flexibility and strength</h2>
<p>The effect of stretching on sporting performance is less clear, or at least more complex. </p>
<p>Few randomised trials have measured sporting performance as an outcome. Instead, most have studied the effect of stretching on two intermediaries that are likely to affect sporting performance: flexibility and the ability of muscles to generate force. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/92043/original/image-20150817-5121-tj4a7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/92043/original/image-20150817-5121-tj4a7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92043/original/image-20150817-5121-tj4a7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92043/original/image-20150817-5121-tj4a7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92043/original/image-20150817-5121-tj4a7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92043/original/image-20150817-5121-tj4a7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92043/original/image-20150817-5121-tj4a7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ballet dancers and yoga teachers, who stretch a lot, tend to be more flexible than the rest of us.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/quinnanya/5282138008/">Quinn Dombrowski/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>To understand the effects of stretching on flexibility and muscle force generation, it’s necessary to distinguish its acute and chronic effects. Acute effects manifest immediately after a stretch whereas chronic effects manifest only after repeated bouts of stretching, perhaps over months or years.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/11470302">Stretching acutely increases flexibility</a>: after just a few seconds or a few minutes of stretching, joints move further and resist movement less. But this effect is transient. Once the stretching stops, flexibility returns to pre-stretch levels. And recovery is largely complete within a few minutes of finishing the stretch.</p>
<p>It’s possible, but less certain, that stretching also has chronic effects on flexibility. Regular stretching could stimulate adaptations of muscles and other tissues that bring about lasting increases in flexibility. </p>
<p>Everyday observations suggest that’s true, because ballet dancers and yoga teachers, who stretch a lot, tend to be more flexible than the rest of us. But, while it seems obvious that regular stretching makes people more flexible, it has proved remarkably difficult to demonstrate that in controlled experiments. </p>
<p>Stretching does make <a href="http://www.ncbi.nlm.nih.gov/pubmed/8951730">people tolerate stretch more</a>. That is, it makes people feel able to get into more stretched positions. And this increase in stretch tolerance may make people feel more flexible even when they’re not.</p>
<p>Either way, the effects of stretching on flexibility – acute or chronic – could be exploited to enhance performance of some sports. It seems likely that hurdlers or gymnasts, for instance, could perform better if they were more flexible. More generally, it appears likely that stretching could increase performance in sports that require flexibility.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/92042/original/image-20150817-5110-1ojw9kf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/92042/original/image-20150817-5110-1ojw9kf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92042/original/image-20150817-5110-1ojw9kf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92042/original/image-20150817-5110-1ojw9kf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92042/original/image-20150817-5110-1ojw9kf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92042/original/image-20150817-5110-1ojw9kf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92042/original/image-20150817-5110-1ojw9kf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It seems likely that hurdlers could perform better if they were more flexible.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/piratepix2/4540836076/">Melinda Huntley/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>The other way stretching could affect performance is through its effects on the ability of muscles to produce force. The <a href="http://www.ncbi.nlm.nih.gov/pubmed/22316148">clearest conclusion</a> that arises from studies on humans is that stretching typically produces a small, temporary reduction in the strength of stretched muscles. </p>
<p>This suggests it may be unwise to stretch muscles immediately prior to sport if it requires generation of large muscle forces. </p>
<h2>To stretch or not to stretch?</h2>
<p>For recreationally active people, these research findings suggest stretching might have a very small benefit and probably won’t do any harm. If you like stretching, stretch. If you don’t like stretching, don’t do it and don’t feel guilty about not doing it. </p>
<p>For high-level athletes, there’s more at stake and the decision is harder. Stretching might increase performance in sports that require lots of flexibility but could temporarily decrease muscle strength; it makes more sense to stretch if you’re a hurdler than if you’re a weightlifter.</p>
<p>These conclusions come with some caveats. First, most of the research into the effects of stretching has investigated the effects of “static” stretching – stretches that are applied and sustained for a short while. There are <a href="http://www.livestrong.com/article/539154-7-types-of-stretching-exercises/">many other ways of stretching</a>, but most have been the subject of relatively little research, or only poor-quality research. </p>
<p>Another caveat is that, while quite a lot is known about the acute effects of stretching, much less is known about its chronic effects. No one has attempted to conduct a randomised trial of the effects of regular stretching over periods of years. </p>
<p>It may be that, in the long term, regular stretching has important effects. Then again, it may be that the long-term effects of stretching are harmful, or that there’s no long-term effect at all: we just don’t know. </p>
<p>Similarly, good evidence of the superiority of one method of stretching over another, or of the long-term effects of particular kinds of stretching, doesn’t exist.</p>
<p>To finish on a more positive note: while it appears that stretching doesn’t appreciably reduce risk of injury, there’s good evidence that <a href="http://www.biomedcentral.com/1741-7015/10/75">warming up does</a>. An intensive, well-structured, active warm-up can substantially reduce risk of injury, so try doing that the next time you exercise.</p><img src="https://counter.theconversation.com/content/46197/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rob Herbert received funding from the NSW Sporting Injuries Committee Research and Injury Prevention Scheme to support one of the trials reported here. He was one of the investigators in several of the studies cited in this article.</span></em></p>Many people stretch when they exercise or play sport. Others don’t stretch but feel they should. And some people don’t see any reason to stretch at all.Rob Herbert, Senior Principal Research Fellow, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/442962015-07-23T20:12:56Z2015-07-23T20:12:56ZHow did it get so late so soon? Why time flies as we get older<figure><img src="https://images.theconversation.com/files/89426/original/image-20150723-22852-1rza2je.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The difference between “real” time, measured by clocks, and our own sense of time can sometimes seem enormous.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/an_solas/6722345695/in/photolist-bf2MaZ-54H6Vk-2wmtQU-9Jw4ZA-qi6o9Z-5DQKyC-nvBRCq-8Wy24N-aF3VRL-5BWVUb-9gKi6F-8dcZzA-qsbQ1g-q3dFzV-rKStBh-apoD6F-4wKyXW-EmsRz-tiUPNz-4haUGe-bEx8qg-4mDooC-uZcgZ9-njqMsS-pHcHM2-qS9iii-52H7K4-6XzhwK-nvbKHq-8kQUdS-e8b6XN-8w5ywj-7L9CKX-rqJYiZ-as8KUo-4h1HL4-daWSsk-aKHznX-6tnSaV-4zWRaS-72ERMX-6rd23p-5aiqaC-pWeGHU-sAYs4U-2saPB2-5Ss157-84Tcwu-4wXpus-cMgbim">Seán Ó Domhnaill/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><blockquote>
<p>How did it get so late so soon?<br>
It’s night before it’s afternoon.<br>
December is here before it’s June.<br>
My goodness how the time has flewn.<br>
How did it get so late so soon?<br>
<br>
Dr Seuss</p>
</blockquote>
<p>The passage of time is a puzzling thing. While few will dispute that a minute comprises 60 seconds, the perception of time can vary dramatically from person to person and from one situation to the next. Time can race, or it can drag interminably. On rare occasions, it feels as if it’s standing still.</p>
<p>The difference between “real” time, measured by clocks and calendars, and our own individual sense of time can sometimes seem enormous. This is because, in many ways, we are the architects of our sense of time. </p>
<h2>Measuring time</h2>
<p>Humans have created reliable instruments to measure time by using predictable repeating events that occur naturally, such as day turning to night or winter becoming spring. We think of these events in terms of days, weeks and years, and we use clocks and calendars to mark their passage.</p>
<p>But we also appear to possess an internal timepiece, which regulates our circadian (day/night) rhythms and allows us to register the duration of particular events. We use this “pacemaker” to compare the length of each new event with representations stored in memory. Effectively, we build up a knowledge bank of what a minute, an hour or a day feels like.</p>
<p>What typically begins as our brain’s ability to register short durations - from minutes to seconds - is transformed into an understanding of the flow of time across the lifespan. But, unfortunately, our internal pacemaker doesn’t always keep time as accurately as our external gadgets. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/88467/original/image-20150715-7554-2q1288.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/88467/original/image-20150715-7554-2q1288.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/88467/original/image-20150715-7554-2q1288.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/88467/original/image-20150715-7554-2q1288.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/88467/original/image-20150715-7554-2q1288.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=552&fit=crop&dpr=1 754w, https://images.theconversation.com/files/88467/original/image-20150715-7554-2q1288.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=552&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/88467/original/image-20150715-7554-2q1288.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=552&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Time always seems to fly when we’re having fun.</span>
<span class="attribution"><span class="source">clock and balloons from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Individual perceptions of time are strongly influenced by our level of focus, physical state and mood. Just as “a watched pot never boils”, when we are concentrating on an event, time occasionally appears to pass more slowly than usual. This is also the case when we’re bored; time can seem to drag endlessly. </p>
<p>In other circumstances, time can appear to speed up. When our attention is divided, for instance, and we’re busy with several things at once, time seems to pass by much more swiftly. This may be because we <a href="http://www.sciencedirect.com/science/article/pii/S0001691813002515">pay less attention</a> to the flow of time when we are multi-tasking.</p>
<p>The emotional quality of an event also influences our perception of time. Negative emotional states, such as feeling sad or depressed, have the effect of making time feel as if it’s passing more slowly. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152725/">Fear has a particularly powerful effect</a> on time, slowing down our internal clock so that the fearful event is perceived as lasting longer. In contrast, fun and happy times seem to be over in the blink of an eye.</p>
<p>Just as time may slow or quicken depending on our current emotional state, our perception of time may also become distorted as we age. People over the age of 60 often <a href="http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780198566427.001.0001/acprof-9780198566427-chapter-6">report time becoming more variable</a>. Christmas seems to come around sooner each year, and yet the days feel long and drawn out.</p>
<h2>Key factors</h2>
<p>Anomalies in time perception as we age may relate to a number of necessary cognitive processes, including how much attention we can devote to a particular task and how effectively we can divide our attention between several ongoing tasks at once. Our efficiency in these domains gradually dampens as we age and may influence the subjective perception of time. </p>
<p>Perhaps more importantly, our frame of reference for the duration of events also changes as we age. Memories we have stored throughout our lives allow us to create a personal timeline. There’s a suggestion that our perception of time may be in proportion to the length of our lifespan. Known as the “proportional theory”, this idea posits that as we age, our sense of “present” time begins to feel relatively short in comparison to our entire lifespan. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/89427/original/image-20150723-22816-16bm8tp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/89427/original/image-20150723-22816-16bm8tp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/89427/original/image-20150723-22816-16bm8tp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/89427/original/image-20150723-22816-16bm8tp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/89427/original/image-20150723-22816-16bm8tp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=527&fit=crop&dpr=1 754w, https://images.theconversation.com/files/89427/original/image-20150723-22816-16bm8tp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=527&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/89427/original/image-20150723-22816-16bm8tp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=527&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Improving attention and memory can help fine-tune our internal pacemakers and bring the river of time to a slow meander.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/isadocafe/38561119/">isado/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Proportional theory makes intuitive sense if we consider how a year in the lifespan of someone who is 75 years old may feel much quicker, for instance, in comparison to a year in the life of a ten-year-old. But it cannot fully explain our experience of present time as we can move from hour to hour and day to day independently of the past. </p>
<p>Memory may hold the key to time perception, as the clarity of our memories is believed to mould our experience of time. We mentally reflect on our past and use historic events to achieve a sense of our self existing across time.</p>
<p>As the most vividly remembered experiences tend to occur in our formative years, that is, between the ages of 15 and 25, this decade is associated with an increase in self-defining memories, known as the “<a href="http://leadserv.u-bourgogne.fr/files/publications/000876-self-centered-memories-the-reminiscence-bump-and-the-self.pdf">reminiscence bump</a>”. This memory cluster may help explain why time speeds up with age, as older people move further away from this critical period in their lives. </p>
<p>Accuracy of time perception is also disrupted in various clinical conditions. Developmental disorders, such as <a href="http://onlinelibrary.wiley.com/doi/10.1111/1469-7610.00173/full">autism and attention-deficit hyperactivity disorder</a>, for instance, are often associated with difficulties in accurately estimating time intervals. At the other end of the life spectrum, conditions such as Alzheimer’s or Parkinson’s disease are also associated with <a href="http://www.sciencedirect.com/science/article/pii/S0278262613000882">inaccuracy in timing short intervals</a>, as well as with <a href="http://www.sciencedirect.com/science/article/pii/S0010945210000262">difficulty in travelling back in subjective time </a> to remember the past. </p>
<p>Can we slow down the ever-quickening pace of life? Perhaps. Improving cognitive abilities, especially attention and memory, can help us fine-tune our internal pacemakers. And <a href="http://www.sciencedirect.com/science/article/pii/S1053810013000792">meditation and mindfulness</a> may help anchor our awareness in the here and now. Indeed, they may gradually help us to bring the fast river of time to a slow meander.</p><img src="https://counter.theconversation.com/content/44296/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Muireann Irish receives funding from the Australian Research Council (ARC DECRA) and is a previous grant recipient from Alzheimer's Australia. She is an Associate Investigator in the Australian Research Council Centre of Excellence in Cognition and its Disorders.</span></em></p><p class="fine-print"><em><span>Claire O'Callaghan receives funding from the Australian National Health and Medical Research Council.</span></em></p>While few will dispute that a minute comprises 60 seconds, the perception of time can vary dramatically from person to person and from one situation to the next. Time can race, or it can drag.Muireann Irish, Senior Research Officer, Neuroscience Research AustraliaClaire O'Callaghan, Clinical research fellow, Behavioural and Clinical Neuroscience Institute, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/408442015-06-01T04:31:19Z2015-06-01T04:31:19ZHealth Check: can your brain be ‘full’?<figure><img src="https://images.theconversation.com/files/83074/original/image-20150527-4854-1yx94lk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The answer is a resounding no – brains are more sophisticated than that.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/kirsanov/123015436/">Dmitry Kirsanov/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>The brain is truly a marvel. A seemingly endless library, whose shelves house our most precious memories as well as our lifetime’s knowledge. But is there a point where it reaches capacity? In other words, can the brain be “full”?</p>
<p>The answer is a resounding no, because, well, brains are more sophisticated than that. A study published in <a href="http://www.nature.com/neuro/journal/v18/n4/full/nn.3973.html">Nature Neuroscience</a> earlier this year shows that instead of just crowding in, old information is sometimes pushed out of the brain for new memories to form. </p>
<p><a href="https://www.researchgate.net/profile/Michael_Anderson18/publication/15268332_Remembering_can_cause_forgetting_retrieval_dynamics_in_long-term_memory/links/00b7d51705ff2d24b9000000.pdf">Previous behavioural studies</a> have shown that learning new information can lead to forgetting. But in this study, researchers used new neuroimaging techniques to demonstrate for the first time how this effect occurs in the brain.</p>
<h2>The experiment</h2>
<p>The paper’s authors set out to investigate what happens in the brain when we try to remember information that’s very similar to what we already know. This is important because similar information is more likely to interfere with existing knowledge, and it’s the stuff that crowds without being useful.</p>
<p>To do this, they examined how brain activity changes when we try to remember a “target” memory, that is, when we try to recall something very specific, at the same time as trying to remember something similar (a “competing” memory). Participants were taught to associate a single word (say, the word sand) with two different images – such as one of Marilyn Monroe and the other of a hat. </p>
<p>They found that as the target memory was recalled more often, brain activity for it increased. Meanwhile, brain activity for the competing memory simultaneously weakened. This change was most prominent in regions near the front of the brain, such as the prefrontal cortex, rather than key memory structures in the middle of the brain, such as the hippocampus, which is traditionally associated with memory loss. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/83072/original/image-20150527-4820-1eyw20o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/83072/original/image-20150527-4820-1eyw20o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83072/original/image-20150527-4820-1eyw20o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83072/original/image-20150527-4820-1eyw20o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83072/original/image-20150527-4820-1eyw20o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83072/original/image-20150527-4820-1eyw20o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83072/original/image-20150527-4820-1eyw20o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/125992663@N02/14414604077/">Allan Ajifo/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The prefrontal cortex is involved in a range of complex cognitive processes, such as planning, decision making, and selective retrieval of memory. <a href="http://www.sciencedirect.com/science/article/pii/S0960982213006362">Extensive research</a> shows this part of the brain works in combination with the hippocampus to retrieve specific memories. </p>
<p>If the hippocampus is the search engine, the prefrontal cortex is the filter determining which memory is the most relevant. This suggests that storing information alone is not enough for a good memory. The brain also needs to be able to access the relevant information without being distracted by similar competing pieces of information.</p>
<h2>Better to forget</h2>
<p>In daily life, forgetting actually has clear advantages. Imagine, for instance, that you lost your bank card. The new card you receive will come with a new personal identification number (PIN). Research in this field suggests that each time you remember the new PIN, you gradually forget the old one. This process improves access to relevant information, without old memories interfering. </p>
<p>And most of us will be able to identify with the frustration of having old memories interfere with new, relevant memories. Consider trying to remember where you parked your car in the same carpark you were at a week earlier. This type of memory (where you are trying to remember new, but similar information) is particularly <a href="http://learnmem.cshlp.org/content/14/1-2/47.full.pdf+html">susceptible to interference</a>.</p>
<p>When we acquire new information, the brain automatically tries to incorporate it within existing information by forming associations. And when we retrieve information, both the desired and associated but irrelevant information is recalled. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/83073/original/image-20150527-4844-1ly0srn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/83073/original/image-20150527-4844-1ly0srn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83073/original/image-20150527-4844-1ly0srn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83073/original/image-20150527-4844-1ly0srn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83073/original/image-20150527-4844-1ly0srn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83073/original/image-20150527-4844-1ly0srn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83073/original/image-20150527-4844-1ly0srn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If the hippocampus is the search engine, the prefrontal cortex is the filter determining which memory is the most relevant.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/centralasian/5055255544/">Playing Futures: Applied No/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The majority of previous research has focused on how we learn and remember new information. But current studies are beginning to place greater emphasis on the conditions under which we forget, as its importance begins to be more appreciated. </p>
<h2>The curse of memory</h2>
<p>A very small number of people are able to remember almost every detail of their life in great detail; <a href="http://www.tandfonline.com/doi/abs/10.1080/13554790500473680">they have hyperthymestic syndrome</a>. If provided with a date, they are able to tell you where and what they were doing on that particular day. While it may sound like a boon to many, people with this rare condition often find their unusual ability burdensome. </p>
<p>Some report an inability to think about the present or the future, because of the feeling of constantly living in the past, caught in their memories. And this is what we all might experience if our brains didn’t have a mechanism for superseding information that’s no longer relevant and did indeed fill up.</p>
<p>At the other end of the spectrum is a phenomenon called “accelerated long-term forgetting”, which has been observed in <a href="http://www.jocn-journal.com/article/S0967-5868%2813%2900394-9/abstract">epilepsy</a> and <a href="http://journal.frontiersin.org/article/10.3389/fnbeh.2014.00320/abstract">stroke</a> patients. As the name suggests, these people forget newly learnt information at a much faster rate, sometimes within a few hours, compared to what’s considered normal.</p>
<p>It’s believed this represents a failure to “consolidate” or transfer new memories into long-term memory. But the processes and impact of this form of forgetting are still largely unexplored. </p>
<p>What studies in this area are demonstrating is that remembering and forgetting are two sides of the same coin. In a sense, forgetting is our brain’s way of sorting memories, so the most relevant memories are ready for retrieval. Normal forgetting may even be a safety mechanism to ensure our brain doesn’t become too full.</p><img src="https://counter.theconversation.com/content/40844/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The brain is truly a marvel. A seemingly endless library, whose shelves house our most precious memories as well as our lifetime’s knowledge. But is there a point where it reaches capacity?Fiona Kumfor, Postdoctoral fellow, Neuroscience Research AustraliaSicong Tu, PhD Candidate, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/375162015-02-13T03:02:12Z2015-02-13T03:02:12ZDarling, I love you … from the bottom of my brain<figure><img src="https://images.theconversation.com/files/71900/original/image-20150212-13186-1nadvsf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's time for lovers to exchange images of the organ really responsible for their emotions on Valentine’s Day.</span> <span class="attribution"><span class="source">Emil Jeyaratnam/The Conversation</span></span></figcaption></figure><p>In William Shakespeare’s comedy <a href="http://en.wikipedia.org/wiki/The_Merchant_of_Venice">Merchant of Venice</a>, the play’s <a href="http://en.wikipedia.org/wiki/Portia_%28The_Merchant_of_Venice%29">heroine Portia</a> sings:</p>
<blockquote>
<p>Tell me where is fancy bred,<br>
Or in the heart or in the head.</p>
</blockquote>
<p>If you look at Valentine’s Day cards, it’s clear fancy is bred in the heart and not in the head; all the cards have red hearts on them. But they’re all wrong. Love does, in fact, live in the brain.</p>
<p>The irrelevance of the heart to love has been amply demonstrated by cardiac transplant surgeons. Heart transplant recipients do not fall in love with the lovers of the dead donors, Hollywood notwithstanding. Surely this proves that wherever else love may reside, in the heart it does not. </p>
<p>Further support for love’s actual home comes from neuroscience. This shows that <a href="http://www.ncbi.nlm.nih.gov/pubmed/20807326">love is a complex function</a>, which includes appraisal, goal-directed motivation, reward, self-representation and body image – none of which can be found in the heart.</p>
<h2>On the right track</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/71913/original/image-20150213-13203-ktlaur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/71913/original/image-20150213-13203-ktlaur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/71913/original/image-20150213-13203-ktlaur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/71913/original/image-20150213-13203-ktlaur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/71913/original/image-20150213-13203-ktlaur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/71913/original/image-20150213-13203-ktlaur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/71913/original/image-20150213-13203-ktlaur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hippocrates’ view on the bodily origin of feelings could be taught in any neuroscience department today.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/edenpictures/8278213840">Eden, Janine and Jim/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Historically, the erroneous attribution of love to the heart can be traced to the ancient Egyptians of the third millennium BC. They considered the heart to be the seat of thought, memory, will and emotion. Hearts, stomachs and intestines were considered important for afterlife, but not the brain. Before burial, the ancient Egyptians heedlessly discarded the brain, so for millennia pharaohs arrived brainless for their afterlife. </p>
<p>The problem with the brain is that, unlike the heart, it doesn’t flutter when lovers kiss. </p>
<p>The scientist credited with the discovery of the relationship between the mind and the brain was Alcmaeon (circa 520-450 BC; possibly a student of Pythagoras) who lived in the Greek-speaking colony of <a href="http://en.wikipedia.org/wiki/Crotone">Kroton</a> (Crotone of today’s southern Italy). It’s thought Alcmaeon was led to his astonishing conclusion by observing that all senses are connected to the brain through channel-like structures. Today, we call them nerves.</p>
<p>Alcmaeon’s concept is thought to have passed on to the island of Kos, where Hippocrates (460-370 BC), the most significant physician of antiquity, worked. Hippocrates expressed an amazingly modern view:</p>
<blockquote>
<p>Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter and jests, as well as our sorrows, pain, griefs and tears. Through it, in particular, we think, see, hear and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant…</p>
</blockquote>
<p>Hippocrates’ view could be taught in any neuroscience department today.</p>
<h2>A backwards step</h2>
<p>Then things went downhill for the brain for a long while. Plato (429-347 BC) retained the primacy of the brain and attributed to it the seat of the rational, immortal soul. But, in his tripartite division of the soul, he confused matters and attributed to the heart the emotional soul. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/71914/original/image-20150213-13223-1k7w02c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/71914/original/image-20150213-13223-1k7w02c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=785&fit=crop&dpr=1 600w, https://images.theconversation.com/files/71914/original/image-20150213-13223-1k7w02c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=785&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/71914/original/image-20150213-13223-1k7w02c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=785&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/71914/original/image-20150213-13223-1k7w02c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=987&fit=crop&dpr=1 754w, https://images.theconversation.com/files/71914/original/image-20150213-13223-1k7w02c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=987&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/71914/original/image-20150213-13223-1k7w02c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=987&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">While Plato retained the primacy of the brain for emotions, his student Aristotle placed the seat of the soul in the heart.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/11304375@N07/2769553173">Image Editor/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The worst blow to the brain came from Aristotle (384-322 BC), who was Plato’s student, the greatest classical biologist and first anatomist. Aristotle observed that humans have the largest brain for their body size, but strangely he attributed to the brain the pedestrian function of literally cooling the blood. He placed the seat of the soul in the heart.</p>
<p>Aristotle’s views were dismissed as absurd by Galen (130-201 AD), who was an admirer of Hippocrates and served as physician to the Roman emperor Marcus Aurelius. Galen proposed the psychic pneuma (mind) resided in the ventricles of the brain and, via the nerves, was in receipt of sensory information and controlled the muscles.</p>
<p>The cardiocentric (heart-centred, Aristotle) and encephalocentric (brain-centred, Galen) theories of the psyche/mind/emotions battled one another until the dawn of modern science. </p>
<h2>Technology and the truth</h2>
<p>Modern science has not only rejected the heart as the seat of love, but is making progress in identifying specific structures in the brain involved in the erotic, cognitive, emotional and behavioural components of love. </p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/11117499">first major work on the subject</a> was published in 2000. Researchers studied the brain activity of people who were deeply in love via <a href="https://theconversation.com/the-science-of-medical-imaging-magnetic-resonance-imaging-mri-15030">functional MRI</a> while the subjects viewed pictures of their partners (compared to viewing friends of similar age and sex). </p>
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<img alt="" src="https://images.theconversation.com/files/71918/original/image-20150213-13211-1mbmlhb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/71918/original/image-20150213-13211-1mbmlhb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/71918/original/image-20150213-13211-1mbmlhb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/71918/original/image-20150213-13211-1mbmlhb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/71918/original/image-20150213-13211-1mbmlhb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/71918/original/image-20150213-13211-1mbmlhb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/71918/original/image-20150213-13211-1mbmlhb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The cardiocentric and encephalocentric theories of the psyche/mind/emotions battled one another until the dawn of modern science.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ohhbetty/4487197017">Soffie Hicks/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>The caudate/putamen (brain area receiving dopamine and involved with reward), medial insula (a multi-sensory area involved in the allocation of attention and control of the heart rate) and the anterior cingulate (an area involved in autonomic regulation, emotion and obsessive-compulsive behaviour) were activated. The amygdala (an area involved in fear) was deactivated. </p>
<p>Researchers have since extended these observations by showing that sexual desire and love <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2012.02651.x/abstract">recruit some common brain structures</a> that promote bodily sensations, reward expectation and social cognition.</p>
<p>The notion that love doesn’t reside in the heart but in the brain is now as well established as the theory of anthropogenic global warming. Clearly, it’s time the fallacious cardiocentric theory of love is abandoned and on Valentine’s Day lovers exchange images of the organ really responsible for their emotion, whose shape is every bit as beautiful as that of the heart.</p><img src="https://counter.theconversation.com/content/37516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>George Paxinos receives funding from the National Health and Medical Research Council, the Australian Research Council and the National Institute of Health (NIH, USA)</span></em></p>In William Shakespeare’s comedy Merchant of Venice, the play’s heroine Portia sings: Tell me where is fancy bred, Or in the heart or in the head. If you look at Valentine’s Day cards, it’s clear fancy…George Paxinos, Visiting/Conjoint Professor of Psychology and Medical Sciences, UNSW & NHMRC Australia Fellow, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/364212015-01-28T19:23:32Z2015-01-28T19:23:32ZStill Alice: a rare look at how dementia steals memories from millions<p>For many of us, memories are our most precious possessions; they makes us the people we are. Consider how you would feel then if your memories were stripped from you, as they are from people diagnosed with dementia. This is exactly what happens to the central character of <a href="http://www.imdb.com/title/tt3316960/">Still Alice</a>, a film opening today nationally.</p>
<p>Directed by Wash Westmoreland and Richard Glatzer, the film is based on the <a href="http://www.goodreads.com/book/show/2153405.Still_Alice">eponymous novel by Lisa Genova</a>. Julianne Moore has been tipped to win the Best Actress Oscar for her portrayal of Alice Howland, a distinguished linguistics professor at Columbia University.</p>
<p>Still Alice captures the emotional upheaval that results from a diagnosis of dementia and provides a compelling insight into the world of people living with the condition. </p>
<h2>The shock of diagnosis</h2>
<p>When the film opens, Alice Howland appears to have it all. At 50 years of age, she is the picture of elegance and good health, exercising frequently, cooking elaborate meals and maintaining a world-class academic career as well as a happy family life.</p>
<p>But it quickly becomes clear that Alice’s memory is failing. Fleeting moments of disorientation and confusion begin to punctuate her life. Wondering if she has a brain tumour, Alice consults a neurologist only to find she is in the early stages of Alzheimer’s disease.</p>
<p>Current estimates suggest approximately 7.7 million new cases of dementia are diagnosed worldwide each year. The disease typically evokes images of the frail elderly, but younger-onset dementia, which is what affects Alice, strikes people under the age of 65. </p>
<p>Estimates suggest younger-onset dementia affects <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2947856/">approximately 54 in every 100,000 people</a> aged between 30 and 65 across the population. There are now even calls for care facilities to adapt so they can cater for these often physically healthy people. </p>
<p>The diagnosis of dementia affects Alice and her family in profound and different ways. The implications of Alice’s condition dawn on her husband as he begins to comprehend the care she will need. Her children move from shock to sadness and, ultimately, fear as they grapple with the decision to undergo genetic testing for Alzheimer’s disease.</p>
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<p>A fifth of <a href="http://www.ncbi.nlm.nih.gov/books/NBK1236/">younger-onset Alzheimer’s disease</a> is familial, meaning there is a genetic cause for the condition. Currently, we have genetic tests for three causative genes – presenilin 1 and 2 and amyloid precursor protein (APP). If someone has one of these genetic mutations, they will usually show clinical signs of dementia before the age of 65 years, and have a 50% risk of passing the gene on to their children. </p>
<h2>A rare glimpse</h2>
<p>Alzheimer’s disease was first described and named in the early 1900s; its causative proteins (amyloid and tau) were described in the 1980s. There’s no cure for the disease, but there are a few treatments that slow disease progression. And diagnosis is often met with stigma and embarrassment. </p>
<p>The film provides a glimpse of the daily struggles of people living with younger-onset Alzheimer’s disease. In a poignant scene, Alice says she wishes she had been diagnosed with cancer, as there would be less stigma and more support for her and her family. </p>
<p>Until recently, most research (and funding) was focused on medical conditions, such as cancer, which cause many deaths. But with the growing awareness of our ageing population, research money is now targeting Alzheimer’s disease and other neurodegenerative conditions.</p>
<p>The idea of suicide is also raised as Alice plans to end her life when she can no longer answer basic questions about herself. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12145457">Research shows</a> that suicide attempts are not uncommon among people with Alzheimer’s disease.</p>
<p>Alice remains eloquent and insightful throughout her struggles, most notably when she delivers a powerful speech at the Alzheimer’s Association carers’ meeting. The scene is particularly moving as the thoughts, feelings and wishes of individuals living with dementia are rarely articulated in this manner. It is a powerful reminder that people with dementia still retain hopes, dreams and wishes for the future. </p>
<p>Still Alice is a poignant window on the world of the millions of people living with Alzheimer’s disease. It’s an important reminder for society as a whole of our responsibility to plan for and manage this rapidly growing condition.</p>
<p>For those of us working in the field of dementia research, the film is a sobering reminder of why we entered this speciality area, and serves as powerful motivation in our quest for an eventual cure.</p>
<p><em>Still Alice opens in Australian cinemas nationally on January 29.</em></p><img src="https://counter.theconversation.com/content/36421/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Muireann Irish receives funding from the Australian Research Council and is a previous grant recipient from Alzheimer's Australia. She is an Associate Investigator in the Australian Research Council Centre of Excellence in Cognition and its Disorders.</span></em></p><p class="fine-print"><em><span>Rebekah Ahmed receives funding from the Royal Australian College of Physicians and MND Research Australia.</span></em></p>For many of us, memories are our most precious possessions; they makes us the people we are. Consider how you would feel then if your memories were stripped from you, as they are from people diagnosed…Muireann Irish, Senior Research Officer, Neuroscience Research AustraliaRebekah Ahmed, Consultant neurologist & PhD student, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.