Oxford University Press's Blog, page 474

Obstacles in transgender healthcare

When the two co-medical directors of the Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ) Clinic at the University of Iowa Hospitals and Clinics delivered a Grand Round presentation for the Department of Pathology, it was eye-opening for many of our pathology staff who were unaware of terminology and many of the issues presented. This is not surprising given that many of the technologists, nurses, physicians, and other staff in our department likely received little or no formal training in LGBTQ health-related issues.

The last several years have seen increased visibility of transgender individuals in the media in United States. While this has served to increase attention on some issues related to the transgender population, what often gets overlooked is that the transgender population remains one of the most underserved groups in the country. Standards of care for the transgender population, recently published by the World Professional Association for Transgender Health, is a step in the right direction but more concerted efforts are required to achieve the highest standards of care in the future.

There are a variety of pathology-related issues with regard to transgender patients. Some of these issues are technical in nature such as interpretation of Pap smears in transmasculine persons who are receiving testosterone therapy. Others are wider issues that affect the entire healthcare community. A good example is whether patient-preferred names are displayed in the electronic medical records in addition to the legal name.

Instituting an Electronic Medical Record System reduces the need to manage and store growing volumes of patient charts, a major challenge in resource-limited settings. Image by CDC Global. CC BY 2.0 via Flickr.

At a broad level, one of the most fundamental challenges in healthcare with regard to the transgender population is that much of medicine and the medical record is structured around sex. Electronic medical records display sex as one of the basic patient identifiers in addition to name, medical record number, and date of birth. In most electronic medical records, the sex field usually only allows two choices – Male/Female – or sometimes a third option such as “Unknown” for rare situations such as severe burns where the patient identity may not be readily apparent. Clinics may bear designations such as “Women’s Care” or “Men’s Health”.

At a more detailed level, the interpretation of many laboratory tests utilize reference or normal ranges that are sex-specific. This includes some of the most frequently ordered tests such as complete blood count, lipids, liver function tests, and hormone assays. Calculations or algorithms often use equations incorporating sex as a variable that allow for interpretation of laboratory tests. The most common example would be estimated kidney function using calculated glomerular filtration rate (GFR). However, there has been very little investigation into reference or normal ranges for laboratory tests for transgender patients. In some regards, this is similar to the situation that existed years ago in pediatrics. Many laboratory tests did not have detailed pediatric ranges (especially in very young children) until researchers put in the effort, sometimes with external funding, to conduct detailed reference range studies in children. This has now allowed for very detailed age and sex pediatric normal ranges. A similar effort will be needed for transgender patients. This will likely be challenging because even within the transgender population, there are a range of transitioning options including various hormonal therapies and surgical procedures that affect laboratory test results.

Sex also determines a range of decisions and criteria in medicine. Within pathology, this is probably most evident in transfusion medicine. Eligibility criteria for blood donors are separate for men and women. Potential risk of receiving blood products may also differ based on sex. Current regulations often don’t address where transgender individuals fit in these regulations.

Lastly, although much of pathology operates “behind the scenes” from the patient perspective, some areas such as phlebotomy, blood bank, and cytopathology interact face-to-face with patients. In this regard, the ability to know the patient’s preferred name and gender becomes quite important in providing the best customer service. Our own institution is currently engaged in an effort to allow the electronic medical record to show the patient’s preferred name in addition to legal name. One of the main drivers for this effort was to provide more welcoming care for transgender patients.

This seemingly simple change has been surprisingly complicated in that patient name is used so ubiquitously throughout the electronic medical record. There are some instances when preferred name is appropriate (e.g., when calling patients from the waiting room) but other cases (e.g., billing to insurance) where it may not be suitable. We have also found that while our institution’s electronic medical record can accommodate preferred name, many of the various other computer systems that interact with the electronic medical record cannot. Examples include various software within pathology and radiology that transmit patient data to the electronic medical record. Further, in some situations, existing regulations require patient’s full legal name and preferred name is not acceptable. An example would be in the administration of blood products where careful match of patient identity is essential to avoid infusion of the wrong product. Overcoming these practical challenges takes time but delivers a very inclusive message the patients.

Featured image credit: Medical record health patient form by vjohns1580. CC0 Public Domain via Pixabay.

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Can we encourage healthier choices by the way we display food options?

Does the way food is displayed influence the choices you make? Given worldwide concerns related to obesity, it is critical to understand factors that affect healthful consumption.

The results of our recent experiments show that displaying healthy food to the left of an unhealthy option can influence the selection and consumption volume of the healthier choice. Since managers typically have considerable flexibility in terms of how they display food items in retail outlets and restaurant menus, they can use this to design optimal menu formats to suit their sales objectives.

The results of our studies demonstrate that when a healthy and an unhealthy item are organized laterally, there is relatively greater preference for the healthy option when it is displayed to the left (vs. right) of the unhealthy option. Why does this happen? We found that consumers’ natural tendency is to mentally organize healthy items (e.g., grilled chicken) to the left of unhealthy items (e.g., fried chicken). Hence, a food display that is congruent with this natural mental representation facilitates information processing, which in turn enhances self-control, and ultimately leads to relatively higher likelihood of choosing healthy options.

In one of the experiments, half the participants received a menu where the healthy items (e.g., salads) were displayed to the left of the unhealthy items (e.g., burgers), while the other half of the participants received a menu with the opposite display pattern. The figure below illustrates the menu used. Participants were then asked to indicate their preference for one food item from the menu. The results showed that there was greater preference for the healthy items when they were displayed to the left (vs. right) of the unhealthy items on the menu.

Food menu by Marisabel Romero, Dipayan Biswas. Used with permission.

We also found that even the consumption amount of healthy and unhealthy items are influenced by left-right positions of healthy/unhealthy items. Before bringing in the participants to the lab, a healthy beverage (high-vitamin orange juice) was placed to the left (vs. right) of an unhealthy beverage (high-calorie orange soda) based on where the participants would be seated. The beverages had comparable color and texture. Participants were then instructed to drink as much of each beverage as they wanted. Consumption volume was measured by weighing the cups before and after consumption. The results of this experiment showed that participants consumed a higher volume of the healthy beverage when it was placed to the left (vs. right) of the unhealthy beverage.

Choosing between healthy and unhealthy options often entails trading off between short-term benefits in terms of taste/pleasure and long-term benefits in terms of health/well being. As a result, self-control plays an influential role in determining final choice outcome between healthy and unhealthy options. Our research shows that laterally displaying healthy options to the left (than to the right) of unhealthy options is congruent with their natural mental representation. This facilitates processing of the information and enhances self-control, which in turn increases likelihood of choosing the healthy option.

This could have interesting implications for retail product displays and menu designs. For instance, if a store wants to enhance sales of their healthy items, they can display them to the left (vs. right) of the unhealthy options from the consumer’s visual perspective. Similarly, while designing restaurant menus, a restaurant wanting to enhance sales of healthy food items might want to display the healthy items on the left side of the menu and the unhealthy items on the right side. With growing trends towards focusing on healthy eating, optimal menu designs can help restaurant managers and consumer advocates in influencing sales of healthy versus unhealthy items. In fact, given the limited research in the academic literature on the psychological aspects of menu designs, this is an important step in this direction by identifying how lateral display patterns of healthy/unhealthy items on a menu can potentially influence choice.

The findings also have implications for consumer welfare in terms of facilitating healthy choice behavior. Policy makers and consumers might want to promote having healthy items displayed to the left (vs. right) of unhealthy items in order to nudge healthier food choices and consumption.

Featured image credit: market fruits vegetables food by StockSnap. Public domain via Pixabay.

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Top ten essential books for aspiring lawyers

Legal knowledge doesn’t just come from textbooks and lectures. Last year, we asked Martin Partington, author of Introduction to the English Legal System, for his top ten film recommendations for law students and aspiring lawyers. This year he turns his attention to inspiring books that will get you thinking about our legal system, our society, and the role of lawyers – what would you add to his list?

The Rule of Law by Tom Bingham

I start, not with a work of fiction, but this book by a former Lord Chief Justice and President of the Supreme Court of the United Kingdom which is, quite simply, THE must-read book in the list. The ‘rule of law’ is a concept often mentioned in public debate but with little analysis of what the phrase actually means. Here, the late Lord Bingham sets out clearly and accessibly what the rule of law is, and why all lawyers need to be aware of its importance. It is about the proper limits of power and who should have responsibility for setting boundaries to the use of power. As an introduction to this fundamental constitutional principle on which the UK legal system is founded, it is without equal.

The Trial by Franz Kafka

The Trial tells the story of Josef K, who is arrested and prosecuted by a remote, inaccessible authority, with the nature of his crime revealed neither to him nor indeed to the reader. All law students should read this work as it forces the reader to consider what can happen if accepted norms of behaviour by public authorities are not adhered to – indeed what can happen if the rule of law is ignored. Its themes are relevant not just in the context of criminal justice but also administrative justice.

Bleak House by Charles Dickens

This is the tale of, among other things, the long-running case of Jarndyce v Jarndyce. Charles Dickens was critical of many aspects of the legal system as it operated in 19th century England. In Bleak House there are two particular targets in his sights. First the extent to which proceedings could be drawn out by endless procedural steps that failed to move the case forward – an issue that has only relatively recently been improved following Lord Woolf’s reforms of the civil justice system. Second, and related to the first, is that a claimant in an action may ultimately succeed in his action, but because of the delay and expense of the lawyers involved, there is ultimately no money left to satisfy an award of the court. This is an essential point that to this day needs to be borne in mind whenever civil litigation is contemplated.

Billy Budd by Herman Melville

This is a brilliant short story/novella which raises profound questions about the relationship between law and justice. Billy Budd tells the story of a sailor who, after a false accusation of conspiracy to mutiny, fatally injures one of his ship mates. While his remaining ship mates believe in Billy’s moral innocence, he must still face a court-martial and bear the consequences of his actions. Many works of literature explore this tension between law and justice – consider contemporary issues such as mercy killing. In what circumstances can killing be excused?

Order and Dispute by Simon Roberts

I was a colleague of the late Professor Roberts at the London School of Economics. He published the first edition of this wonderfully readable book on legal anthropology in 1979; a second edition appeared in 2013. In Order and Dispute Roberts makes the argument that there has been a tendency in the West to assume that only courts can be the true resolvers of disputes. He argues that, by looking at the ways in which other societies keep order and solve disputes, valuable light can be thrown on contemporary debates about order and dispute resolution in our own society. These issues remain at the centre of discussions about reform not only of the family, but also the civil and administrative justice systems in England and Wales.

Njal’s Saga by Anon

Years ago, when I did some teaching at the University of Kent, Njal’s Saga was one of the books recommended to first year students. Written in the thirteenth century, it tells the story of a fifty-year blood feud that, despite its distance from us in time and place, is driven by passions familiar to us all. It explores perennial human problems – from failed marriages to divided loyalties, from the law’s inability to curb human passions to the terrible consequences when decent men and women are swept up in a tide of violence beyond their control.

In particular it explores the extent to which disputes can be settled by agreement, and examines the terrible things that happen when revenge becomes an overwhelming social force. Although a tale from another time, it is not hard to think of modern contexts in which revenge rather than the rule of law is dominant, and should encourage you to reflect on the dangerous consequences of a society in which a revenge culture becomes embedded. You may think this choice is a bit off the wall; but a great topic for an interview?

Arthur and George by Julian Barnes

This is a very enjoyable novel about a real life case that arose at the beginning of the 20th century. George Edalji was a Parsi English solicitor and son of a vicar in a South Staffordshire village. He served three years’ hard labour after being convicted on a charge of injuring a pony. His case came to the attention of Arthur Conan Doyle – author of Sherlock Holmes. He arranged for investigations to be made which demonstrated that George could not have committed the crimes for which he was convicted.

At the time, the legal system offered only extremely limited opportunities for appealing against unsafe criminal convictions. Indeed, the events surrounding the case were a key element in a campaign which eventually led to the creation of the Court of Criminal Appeal in 1907.

Since that time, of course, there have been further changes, in particular the creation of the Criminal Cases Review Commission in 1997.  The story reminds the reader how difficult it can be to get the balance right between ensuring that the public can be confident in the integrity of the criminal justice system confidence and at the same time being sufficiently flexible to ensure that miscarriages of justice do not occur, and that where they do, remedial action is taken.

1984 by George Orwell

This is perhaps the most frightening book I have ever read. The horrors of Room 101 disturbed me for weeks. I include it in this list because it shows the terrible consequences for societies that wholly reject the fundamental moral bases of truth and fairness. It is a work that has become more relevant as technologies have developed to enable organs of the state to monitor the activity of its citizens. Just consider current debates on privacy, and the powers of the police and other state agencies to ‘eavesdrop’ on the lives of citizens and to manipulate the truth.

There are big questions posed by the novel which all prospective lawyers should consider, so that they can ask themselves: what are the limits beyond which the state should not pass to maintain personal freedom? What should lawyers do when they fear that the state is proposing to go beyond what is acceptable and to do things which could undermine individual freedom? Can the rule of law set those boundaries? How can abuse of power be kept in check?

Resurrection by Leo Tolstoy

Less well known, and shorter, than War and Peace, Resurrection is nonetheless an excellent novel that raises profound questions about the justice of man-made laws. The story is about a nobleman, who seeks redemption for a sin committed years earlier. Following a brief affair with a maid, Maslova, she was fired and ended up in prostitution. Framed for murder, she is convicted of the crime and sent to Siberia. Nekhlyudov, the nobleman, goes to visit her in prison, meets other prisoners, hears their stories, and slowly comes to realize that all around his charmed and golden aristocratic world, yet invisible to it, is a much larger world of oppression, misery and barbarism. It illustrates the dire consequences of a criminal justice system that lacks fairness and humanity.

Justice: what’s the right thing to do? by Michael J Sandel

For my final choice, I leave the world of fiction again and propose this thoughtful and engaging book by Harvard Professor Michael Sandel. This work, published in 2009, was written to accompany a course Sandel has taught at Harvard for more than 30 years. He introduces the reader to the views of different philosophers about how they perceive the concept of justice, as well as introducing his own views on the meaning of Justice. You can see his lectures and also see him introducing the book in a TED talk: a great introduction to some of the key questions which underpin the study of law.

Featured image credit: Library by Foundry. CCO Public Domain via Pixabay.

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An egalitarian and organic history of the periodic table

Our story has to begin somewhere and why not with the Manchester schoolteacher John Dalton who revived the atomic theory of the ancient Greek philosophers? In addition to supposing that the ultimate components of all matter were atoms, Dalton set about putting this idea on a quantitative foundation.

He published the first list in which he compared the weights of the atoms of all the elements that were known at the time. Dalton did this by assigning a weight of one unit to the lightest element, namely hydrogen. Next he assumed that a compound like water consisted of one atom of hydrogen and one of oxygen. By appealing to data on how much hydrogen combines chemically with how much oxygen, he arrived at the weight of one atom of oxygen relative to the weight of a hydrogen atom and so on for all the other elements. Of course the formula of water is now known as “H2O” rather than “HO” but this was already a good start.

Once relative atomic weights had been established in this way, other chemists began looking for possible numerical relationships between the atomic weights of different elements. Two such relationships were soon found.

In 1827 Wolfgang Döbereiner discovered triads of elements for which one of a set of three elements had an atomic weight that was approximately the average of the weights of the other two elements. Lithium, sodium, and potassium represent a typical example, in which the atomic weight of lithium (7) added to the atomic weight of potassium (39) divided by two, gives 23 or the approximate weight of sodium atoms. Even more suggestively, the reactivity of sodium is intermediate between those of nonreactive lithium and highly reactive potassium. Here then is a relationship not only connecting together three distinct elements but apparently also capturing something about their relative tendencies to react chemically. Suddenly the diversity displayed by fifty or so distinct elements appears to have some unified aspects, some underlying order.

Next the physician William Prout, working in London, also took as his point of departure the published set of atomic weights of all the known elements. He noticed that most of the weights were whole number multiples of the weight of the lightest atom, that of hydrogen. Prout’s conclusion was that perhaps all the atoms, and therefore all the elements which they made up, were literally composites of hydrogen atoms. Here again we see a hint of an underlying order, a unity lying underneath the existence of seemingly very different elements, each with its distinctive properties.

Moving forward in time to the 1860s we find the simultaneous discovery of chemical periodicity and the associated periodic table which serves to represent this behavior by at least six individuals all working independently of each other and mostly in different geographical locations. The first of them was a French engineer Emile Alexandre de Chancourtois who arranged the elements along a line in order by increasing atomic weights. He then wrapped this line around a metal cylinder to form a spiral, so that vertical lines connecting different parts of the spiral reflected the fact that the properties of chemical elements seemed to recur approximately. For example, he was able to recover many of Döbereiner’s triads of elements such as lithium, sodium, and potassium as mentioned earlier.

Dimitri Mendeleev is one of the most well-known scientists credited for the discovery of chemical periodicity, though he is not the only to have made this discovery. Image uploaded by Serge Lachinov. Public Domain via Wikimedia Commons.

Over a matter of just seven years essentially the same discovery was made again, twice in London by John Newlands and William Odling, in Iowa by the Dane Gustav Hinrichs, by the German Julius Lothar Meyer and, best known of all, by the Russian chemist Dimitri Mendeleev.

Most people have only heard of the last of these discoverers for various reasons. Science historians and scientists themselves tend to regard the notion of multiple or simultaneous discovery as something to be explained away and are generally keen to identify just one ‘true discoverer’. In the case of chemical periodicity they have latched onto Mendeleev with some degree of justification. Unlike some of the others mentioned in this context, Mendeleev left gaps in his periodic tables and believed that there were new elements waiting to be discovered. He also went further in predicting the properties of these as yet undiscovered elements, many of which turned out to be remarkably correct. His most notable successes lay with three elements that he provisionally called eka-boron, eka-gallium and eka-silicon. All three of these elements were isolated from minerals within a period of 15 years and were found to have almost exactly the properties that Mendeleev claimed they would have.

But none of this success should overshadow the fact that scientific discoveries are almost invariably made by two or more independent researchers working over very similar time periods. Such a view would seem to evoke the notion of an evolutionary growth of scientific discovery, which over-rides the contributions of individual and often rival scientists. It seems to suggest that scientific development has a life of its own and perhaps it challenges the traditional image of exceptionally gifted individuals whose superior rational and practical skills allow them to prevail over other scientists.

Finally, I believe the same is true about the historical development of our knowledge of atomic structure that took place at the beginning of the 20th century and, I venture to suggest, all scientific development whatever the instance might be.

The traditional historical accounts of how atomic structure unfolded feature such luminaries as Thomson, Rutherford, Röntgen, the Curies, Bohr, Moseley, Pauli, G.N. Lewis, and Langmuir among others. A more egalitarian and unified account would also feature a host of virtually unknown contributors including Nicholson, van den Broek, Abegg, Bury, Main Smith, and Stoner. I challenge any reader of this blog to recall what any of this latter list of scientists contributed to the present understanding of atoms and how electrons are arranged around them.

Seen from the global perspective that I am promoting all of these contributors can be seen as equal partners as part of a living and organic scientific mind.

Featured image credit: Portion of the Periodic Table depicted with cupcakes by the Chemical Heritage Foundation. CC BY-SA 3.0 via Wikimedia Commons.

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The rapidly growing senior population [infographic]

Today is National Senior Citizen’s Day. It’s a time to celebrate the individuals in our society who have achieved so much over the last several decades of their lives, and still have more of an impact to make.


The older population is increasing rapidly worldwide, both in their demographic size and in their diversity. This in turn has far-reaching effects on all of society’s social institutions whether it is the family, workplace, educational system, health care system, or private business sector.

To better understand the dramatic growth and changes in this population, we created an infographic based on some interesting U.S. statistics.

Featured image credit:  “Elderly” by Moyan Brenn. CC BY 2.0 via Flickr.

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Measuring athletic greatness

As Michael Phelps pulled away from the field in the 200 IM to win his thirteenth individual Olympic Gold Medal, he set the standard by which athletic greatness will be measured. The greatest athletes are not just good at one thing—the measurement of true greatness, established from antiquity to the present, is the ability to dominate different events, and the ability to do so more than once.

The medley is a classic example of an event designed that tests skill across different styles, the sort of thing fans want to see, it’s a way of settling disputes about whether a competitor who is good at one aspect of a sport is better than one who dominates at another. Fans have been asking those questions and wanting events that demand contrasting skills for as long as they have been watching competitive sport.

The classics example of a “combined skills” events is the ancient Greek sport of pankration, easily the nastiest of all events in the ancient Olympics.

“Michael Phelps” by Marco Paköeningrat. CC BY-SA 2.0 via Flickr.

Pankration combined boxing and wrestling. Brutal and dangerous, one Olympic champion actually died in the final match. He won because he was inflicting so much pain on his opponent that the opponent surrendered just before the stranglehold he was using killed the “victor.” The more successful champions managed to survive, but only the greatest, and this is evocative of Phelps’ accomplishment, could win in either boxing or wrestling in the same Olympics as their pankration victory.

Since all boxing, wrestling and pankration competition was held on the same day, an athlete would go straight, just like Phelps did when he swam the semi of the 200 Meter Butterfly less than an hour after dominating the 200 IM final (no surprise that he won today’s final when he had some rest). It’s that sort of versatility combined with endurance that Greeks recognized as the sign of absolute greatness. People who could win the pankration final after winning another event the same day were compared with the god Herakles, the patron of violent sport. There were only five people who could claim this in the course of about a thousand years of ancient athletic history.

Phelps has shown multiple skills and endurance. The third quality of greatness is longevity. The man whose record Phelps eclipsed last night was Leonidas of Rhodes, who won twelve individual Olympic crowns across four Olympiads. Like Phelps he also won in different kinds of races—the equivalent of the one and two hundred meter sprints and a race in armor, which combined aspects of a demolition derby with an endurance contest. He was one of only seven men known to have won all three in the same games, and he was the only person to do it more than once. The one man to have a longer career of Olympic success was a wrestler, Milo of Croton, who won six straight Olympic crowns from 540 to 516 BC. He lost in the finals in his seventh Olympics to a wrestler from his own city—a man he must have trained with.

A final quality is the ability to dominate the competition. As Michael Phelps swam away from the field last night you had to wonder whether there will ever be another swimmer who will have his ability to take over a race. That too was recognized as a measure of greatness. Milo was so dominant that people would simply concede rather than be crushed by him.

However we measure greatness in athletes who compete at the highest level, whether through their ability to dominate their events, their versatility, their endurance, or their longevity, Michael Phelps now stands at the top of the list.

Featured image credit: “Olympic Flame” by GoToVan. CC BY 2.0 via Flickr. 

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Around the world in 15 travel health tips

It’s time for holidays! Your suitcase is packed, you’re ready to leave, and cannot wait to get a proper tan to show on social media. Mark Twain used to say that “travel is fatal to prejudice, bigotry, and narrow-mindedness”, but unfortunately the health problems we may come across while travelling are far less poetic. Danger is always lurking, especially in far-flung and unexplored destinations. A simple stomach upset or sunstroke may be enough to turn the holiday you’ve been dreaming about all winter, into an unforgettable nightmare.

Each destination has its own set of risks, but this golden rule applies to any location you visit: never travel unprepared. For this reason we asked delegates attending the 2016 North European Travel Medicine Conference to write down some useful health tips for responsible globetrotters. From visiting Tanzania to avoiding smelly feet, here is everything you need to know to prevent potential drama – and make the most of your holidays.

To help you dive into this sea of wisdom, we’ve collected some of the best tips for your perusal. Happy travelling!

Image Credit: ‘Mosquito’ by FotoshopTofs. CCO Public Domain via Pixabay.

A Bug’s Life

Always wash your feet when you arrive in the tropics. Mosquitoes are attracted to smelly feet and ankles.
When in Northern Europe, be aware of ticks: use repellent.
If travelling ants are on the move, in the direction of your house or tent, use kerosene around the perimeter – it will make the ants go in another direction.
When camping or staying in any simple accommodation, always check your boots BEFORE putting them on (in case of spiders or scorpions etc).

Learning from experience

Instead of a face flannel ‒ take a jay cloth: light and easy to dry.
Duct tape can be used for a multitude of situations: to hold up a mosquito net, to cover holes in net, to hold footwear together, to mend a backpack, could even be used to strap an ankle.
Take half as many clothes and twice as much money.
Don’t forget to put sun cream on the backs of your hands.
Bugs are not the only dangerous things. Look out for plants – they can be beautiful but may be harmful as well.


Image Credit: ‘Colored Pencils’ by stux. CC0 Public Domain via Pixabay.

Customs and traditions

Dress local: make sure you don’t look like a tourist when you’re in less safe areas.
Be careful when talking to officials and always be polite: sometimes they have a low threshold for travellers. Don’t give them any excuse to arrest you.
Pens are a great gift for children in developing countries – take as many as you can!
When taking a taxi in Thailand, ask for “Takametr” (i.e. to turn on the meter). If the driver says “Yes”, stay. If he/she says something else, change taxi.

Better safe than sorry

Scan all important documents into an email address that you can access around the world, so that if you get them lost or stolen, you can still access your information (for example your Yellow Fever Certificate).
Wash your hands ‒ and knife, fork, and spoon.
Keep a referee whistle handy: if in fear of attack or mugging, blow ‒ it will give you enough time to get away.
Take a door wedge on your travels – hotel and hostel doors open inwards so put it under your closed door at night to stay safe from intruders/staff with a master key.
If you’re travelling to busy cities, write your mobile number on your children’s forearm in marker pen – if you get separated people will be able to call you.

Water, water everywhere, but not a drop to drink

Carry a water purifier when in the desert. Local tribes store rain mainly in limestone, underground storage areas.
Take care with eating salads – the water used to wash them is not always pure.

Medical kit and caboodle

If you are going to undertake a quick trek to Kilimanjaro you should consider taking acetazolamide to prevent altitude sickness.
Spray DEET into the air and walk through the mist. This stops the mosquitoes biting through your hair.
Always carry a small tube of anti-bacterial hand gel. You may not always get the opportunity to wash your hands.







Tape can be used for a multitude of situations: to hold up a mosquito net, to cover holes in net, to hold footwear together, to mend a backpack, could even be used to strap an ankle.







Keep a referee whistle handy: if in fear of attack or mugging, blow ‒ it will give you enough time to get away.







Be careful when talking to officials and always be polite: sometimes they have a low threshold for travellers. Don’t give them any excuse to arrest you.







If travelling ants are on the move, in the direction of your house or tent, use kerosene around the perimeter – it will make the ants go in another direction.







Take a door wedge on your travels – hotel and hostel doors open inwards so put it under your closed door at night to stay safe from intruders/staff with a master key.







Dress local: make sure you don’t look like a tourist when you’re in less safe areas.







Wash your hands ‒ and knife, fork, and spoon.







Instead of a face flannel ‒ take a jay cloth: light and easy to dry.







Always wash your feet when you arrive in the tropics. Mosquitoes are attracted to smelly feet and ankles.







Scan all important documents into an email address that you can access around the world, so that if you get them lost or stolen, you can still access your information (for example your Yellow Fever Certificate).







When in Northern Europe, be aware of ticks: use repellent.

Carousel Image Credits: ‘Travel Tips from the 2016 North European Travel Medicine Conference’ Copyright Oxford University Press.

Featured Image Credit: ‘Mountains’ by Unsplash. CC0 Public Domain via Pixabay.

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How much do you know about the origins of the Olympics? [quiz]

Since the very beginning of the games at Olympia, the event has served to strengthen unity, bring peace, and celebrate individuals for achieving greatness after endless hours of hard work. The Olympics have always been a source of inspiration and a connection to our own humanity.

Maybe you know how many gold medals Michael Phelps has won over the past 12 years, or how fast Usain Bolt can run 100 meters, but do you know much about the first Olympians? How much do you know about the original Olympic Games that started over 2,500 years ago?

Find out if you would fit right in the crowd at Olympia, or would be completely confused about what you’re witnessing.

Featured image credit:  “Olympia in Ancient Greece” by Pierers Universal-Lexikon, 1891. Public Domain via Wikimedia Commons.

Quiz background image credit:  “Olympia in Ancient Greece” by 31774. CC0 Public Domain via Pixabay.

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Ben-Hur: tracing the iconic novel and films through history

The latest film adaptation of the story of fictional Jewish noble Judah Ben-Hur is premiering in theaters today. You’ve probably seen the 1959 film version starring Charlton Heston, but do you know about the story’s rich history and impact over the last 136 years?

For instance, we bet you probably didn’t know that:

“Combined (and adjusted for inflation), the authorized and licensed adaptations of Ben-Hur along with independent Ben-Hur companies, businesses, brands, and products have amassed billions of dollars and perpetuated the Ben-Hur name and its chariot imagery throughout the popular culture” (Jon Solomon).

In celebration of the movie premiere, we’ve created a timeline highlighting key events in this iconic work’s history.

Featured image credit: “Provocation” by aka Tman. CC BY 2.0 via Flickr.

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Years of education may protect against dementia

Attaining a higher level of education is considered to be important in order to keep up good cognitive functioning in old age. Moreover, higher education also seems to decrease the risk to develop dementia. This is of high relevance in so far that dementia is a terminal disease characterized by a long degenerative progression with severe impairments in daily functioning. Despite a great amount of research emphasizing the relevance of education, it is not entirely clear how education protects cognitive functioning in old age and how much education is possibly ‘enough’. Scientific theories assume mainly two mechanisms: first, individuals with a high level of education may engage in a healthier lifestyle which protects them against dementia, and second, higher education builds up a so called ‘cognitive reserve’, which is the ability to keep up a good cognitive performance despite of brain pathology.

In order to get a better understanding of the role of education in the risk of developing dementia, we investigated in more detail how education – its concepts and its operationalization – impacts dementia risk. Individuals aged 75 years and older were recruited from the population registry office in the city of Leipzig, Germany. A total of 1,692 community-dwelling individuals (with 11.3% living in retirement homes) were identified. We observed the incidence of dementia in up to five follow-up assessments at an interval of 1.5 years and a final assessment after 15 years.

We analyzed the impact of education on dementia taking into account the effects of other important risk factors of dementia (age, gender, living situation, having had a stroke, heart attack diabetes, and depression). Our results demonstrated that – even when taking into account those other risk factors – every additional year of education significantly decreased the risk to develop dementia. Moreover, our results pointed out that ‘having completed more than ten years of education’ or a ‘tertiary level of education’ could be an important threshold for significantly reducing dementia risk. Complex classifications of education, which focused on occupational expertise and hierarchy of levels, did not seem to be relevant concerning dementia risk.

The protective effect of education against dementia seems to be primarily driven by the duration of mental training

This therefore leads to an important assumption: the protective effect of education against dementia seems to be primarily driven by the duration of mental training – i.e. years of education. A possible explanation could be that at the age when we typically go to school, the brain is in a major developmental phase and therefore more school years could influence the development of the brain over a longer period. However, this raises the question whether the content of education matters and what skills and training may result in the strongest protection against dementia. It would be very interesting to learn in further studies what educational content – acquiring knowledge or rather the formation of skills in critical thinking, interpersonal communication, goal setting, or interpretation of information – matters most in reducing the risk of developing dementia.

Overall, our findings support the theoretical propositions that education builds up a so called ‘cognitive reserve’ and in this way keeps up a good cognitive performance despite of brain pathology, irrespective of socioeconomic implications. Further studies are necessary to investigate whether education lowers dementia risk in addition to socioeconomic factors such as income and social rank. If adverse socioeconomic conditions during childhood increase the risk of developing dementia, can higher education overcome this disadvantage? Are there perhaps interacting effects? Moreover, it is not yet entirely clear how education influences dementia risk on a biological level. Further research should explore the details of the biological pathways from education to dementia risk considering definitions and operationalization. Only by being aware of the applied definitions and operationalization will it be possible to gain a better understanding of the biological processes which actively influence dementia risk. Nonetheless, as attaining a higher level of education is important to keep up good cognitive functioning in old age, it ought to be a major public health goal. Developing countries are expected to suffer from an increased burden due to dementia in the near future and universal education as a public health goal could be an essential factor in alleviating burden on health care systems and the society.

Featured image: Old friends by stevepb. CC0 Public Domain via Pixabay.

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