When A Period Is Very Late (Post-Menopause)

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Knowledge Is Power Safety, Post-Menopause Too

Note: this article will be most relevant for a subset of our subscribership, but it’s a very large subset, so we’re going to go ahead and address the reader as “you”.

If, for example, you are a man and this doesn’t apply to you, we hope it will interest you anyway (we imagine there are women in your life).

PS: the appendicitis check near the end, works for anyone with an appendix

We’ve talked before about things that come with (and continue after) menopause:

But what’s going on if certain menstrual symptoms reappear post-menopause (e.g. after more than a year with no menstruation)?

Bleeding

You should not, of course, be experiencing vaginal bleeding post-menopause. You may have seen “PSA” style posts floating around social media warning that this is a sign of cancer. And, it can be!

But it’s probably not.

Endometrial cancer (the kind that causes such bleeding) affects 2–3% of women, and of those reporting post-menopausal bleeding, the cause is endometrial cancer only 9% of those times.

So in other words, it’s not to be ignored, but for 9 people out of 10 it won’t be cancer:

Read more: Harvard Health | Postmenopausal bleeding: Don’t worry—but do call your doctor

Other more likely causes are uterine fibroids or polyps. These are unpleasant but benign, and can be corrected with surgery if necessary.

The most common cause, however is endometrial and/or vaginal atrophy resulting in tears and bleeding.

Tip: Menopausal HRT will often correct this.

Read more: The significance of “atrophic endometrium” in women with postmenopausal bleeding

(“atrophic endometrium” and “endometrial atrophy” are the same thing)

In summary: no need to panic, but do get it checked out at your earliest convenience. This is not one where we should go “oh that’s weird” and ignore.

Cramps

If you are on menopausal HRT, there is a good chance that these are just period cramps. They may feel different than they did before, because you didn’t ovulate and thus you’re not shedding a uterine lining now, but your body is going to do its best to follow the instructions given by the hormones anyway (hormones are just chemical messengers, after all).

If it is just this, then they will probably settle down to a monthly cycle and become quite predictable.

Tip: if it’s the above, then normal advice for period cramps will go here. We recommend ginger! It’s been found to be as effective as Novafen (a combination drug of acetaminophen (Tylenol), caffeine, and ibuprofen), in the task of relieving menstrual pain:

See: Effect of Ginger and Novafen on menstrual pain: A cross-over trial

It could also be endometriosis. Normally this affects those of childbearing age, but once again, exogenous hormones (as in menopausal HRT) can fool the body into doing it.

If you are not on menopausal HRT (or sometimes even if you are), uterine fibroids (as discussed previously) are once again a fair candidate, and endometriosis is also still possible, though less likely.

Special last note

Important self-check: if you are experiencing a sharp pain in that general area and are worrying if it is appendicitis (also a possibility), then pressing on the appropriately named McBurney’s point is a first-line test for appendicitis. If, after pressing, it hurts a lot more upon removal of pressure (rather than upon application of pressure), this is considered a likely sign of appendicitis. Get thee to a hospital, quickly.

And if it doesn’t? Still get it checked out at your earliest convenience, of course (better safe than sorry), but you might make an appointment instead of calling an ambulance.

Take care!

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  • Flexible Dieting – by Alan Aragon

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    This is the book from which we were working, for the most part, in our recent Expert Insights feature with Alan Aragon. We’ll re-iterate here: despite not being a Dr. Aragon, he’s a well-published research scientist with decades in the field of nutritional science, as well as being a personal trainer and fitness educator.

    As you may gather from our other article, there’s a lot more to this book than “eat what you like”. Specifically, as the title suggests, there’s a lot of science—decades of it, and while we had room to cite a few studies in our article, he cites many many more; several citations per page of a 288-page book.

    So, that sets the book apart from a lot of its genre; instead of just “here’s what some gym-bro thinks”, it’s “here’s what decades of data says”.

    Another strength of this book is how clearly he explains such a lot of science—he explains terms as they come up, as well as having a generous glossary. He also explains things clearly and simply without undue dumbing down—just clarity of communication.

    The style is to-the-point and instructional; it’s neither full of fitness-enthusiast hype nor dry academia, and keeps a light and friendly conversational tone throughout.

    Bottom line: if you’d like to get your diet in order and you want to do it right while also knowing which things still need attention (and why) and which you can relax about (and why), then this book will get you there.

    Click here to check out Flexible Dieting, and take an easy, relaxed control of yours!

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  • Can Saturated Fats Be Healthy?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Saturated Fat: What’s The Truth?

    We asked you for your health-related opinion of saturated fat, and got the above-pictured, below-described, set of results.

    • Most recorded votes were for “Saturated fat is good, but only some sources, and/or in moderation”
      • This is an easy one to vote for, because of the “and/or in moderation” part, which tends to be a “safe bet” for most things.
    • Next most popular was “Saturated fat is terrible for the health and should be avoided”
    • About half as many recorded votes were for “I’m not actually sure what makes saturated fat different”, which is a very laudable option to click. Admitting when we don’t know things (and none of us know everything) is a very good first step to learning about them!
    • Fewest recorded votes were for “Saturated fat is the best source of energy; we should get plenty”.

    So, what does the science say?

    First, a bit of physics, chemistry, and biology

    You may be wondering what, exactly, saturated fats are “saturated” with. That’s a fair question, so…

    All fats have a molecular structure made up of carbon, hydrogen, and oxygen atoms. Saturated fats are saturated with hydrogen, and thus have only single bonds between carbon atoms (unsaturated fats have at least one double-bond between carbon atoms).

    The observable effect this has on them, is that fats that are saturated with hydrogen are solid at room temperature, whereas unsaturated fats are liquid at room temperature. Their different properties also make for different interactions inside the human body, including how likely or not they are to (for example) clog arteries.

    See also: Could fat in your bloodstream cause blood clots?

    Saturated fat is the best source of energy; we should get plenty: True or False?

    False, in any reasonable interpretation, anyway. That is to say, if your idea of “plenty” is under 13g (e.g: two tablespoons of butter, and no saturated fat from other sources, e.g. meat) per day, then yes, by all means feel free to eat plenty. More than that, though, and you might want to consider trimming it down a bit.

    The American Heart Association has this to say:

    ❝When you hear about the latest “diet of the day” or a new or odd-sounding theory about food, consider the source.

    The American Heart Association recommends limiting saturated fats, which are found in butter, cheese, red meat and other animal-based foods, and tropical oils.

    Decades of sound science has proven it can raise your “bad” cholesterol and put you at higher risk for heart disease.❞

    Source: The American Heart Association Diet and Lifestyle Recommendations on Saturated Fat

    The British Heart Foundation has a similar statement:

    ❝Despite what you read in the media, our advice is clear: replace saturated fats with unsaturated fats and avoid trans fats. Saturated fat is the kind of fat found in butter, lard, ghee, fatty meats and cheese. This is linked to an increased risk of heart and circulatory disease❞

    Source: British Heart Foundation: What does fat do and what is saturated fat?

    As for the World Health Organization:

    ❝1. WHO strongly recommends that adults and children reduce saturated fatty acid intake to 10% of total energy intake

    2. WHO suggests further reducing saturated fatty acid intake to less than 10% of total energy intake

    3. WHO strongly recommends replacing saturated fatty acids in the diet with polyunsaturated fatty acids; monounsaturated fatty acids from plant sources; or carbohydrates from foods containing naturally occurring dietary fibre, such as whole grains, vegetables, fruits and pulses.❞

    Source: Saturated fatty acid and trans-fatty acid intake for adults and children: WHO guideline

    Please note, organizations such as the AHA, the BHF, and the WHO are not trying to sell us anything, and just would like us to not die of heart disease, the world’s #1 killer.

    As for “the best source of energy”…

    We evolved to eat (much like our nearest primate cousins) a diet consisting mostly of fruits and other edible plants, with a small supplementary amount of animal-source protein and fats.

    That’s not to say that because we evolved that way we have to eat that way—we are versatile omnivores. But for example, we are certainly not complete carnivores, and would quickly sicken and die if we tried to live on only meat and animal fat (we need more fiber, more carbohydrates, and many micronutrients that we usually get from plants)

    The closest that humans tend to come to doing such is the ketogenic diet, which focuses on a high fat, low carbohydrate imbalance, to promote ketosis, in which the body burns fat for energy.

    The ketogenic diet does work, and/but can cause a lot of health problems if a lot of care is not taken to avoid them.

    See for example: 7 Keto Risks To Keep In Mind

    Saturated fat is terrible for the health and should be avoided: True or False?

    False, if we are talking about “completely”.

    Firstly, it’s practically impossible to cut out all saturated fats, given that most dietary sources of fat are a mix of saturated, unsaturated (mono- and poly-), and trans fats (which are by far the worst, but beyond the scope of today’s main feature).

    Secondly, a lot of research has been conducted and found insignificant or inconclusive results, in cases where saturated fat intake was already within acceptable levels (per the recommendations we mentioned earlier), and then cut down further.

    Rather than fill up the newsletter with individual studies of this kind here’s a high-quality research review, looking at 19 meta-analyses, each of those meta-analyses having looked at many studies:

    Dietary saturated fat and heart disease: a narrative review

    Saturated fat is good, but only some sources, and/or in moderation: True or False?

    True! The moderation part is easy to guess, so let’s take a look at the “but only some sources”.

    We were not able to find any convincing science to argue for health-based reasons to favor plant- or animal-sourced saturated fat. However…

    Not all saturated fats are created equal (there are many kinds), and also many of the foods containing them have additional nutrients, or harmful compounds, that make a big difference to overall health, when compared gram-for-gram in terms of containing the same amount of saturated fat.

    For example:

    1. Palm oil’s saturated fat contains a disproportionate amount of palmitic acid, which raises LDL (“bad” cholesterol) without affecting HDL (“good” cholesterol), thus having an overall heart-harmful effect.
    2. Most animal fats contain a disproportionate amount of stearic acid, which has statistically insignificant effects on LDL and HDL levels, and thus is broadly considered “heart neutral (in moderation!)
    3. Coconut oil’s saturated fat contains a disproportionate amount of lauric acid, which raises total cholesterol, but mostly HDL without affecting LDL, thus having an overall heart-beneficial effect (in moderation!)

    Do you know what’s in the food you eat?

    Test your knowledge with the BHF’s saturated fat quiz!

    Enjoy!

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  • The 6 Pillars Of Nutritional Psychiatry

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    Dr. Naidoo’s To-Dos

    This is Dr. Uma Naidoo. She’s a Harvard-trained psychiatrist, professional chef graduating with her culinary school’s most coveted award, and a trained nutritionist. Between those three qualifications, she knows her stuff when it comes to the niche that is nutritional psychiatry.

    She’s also the Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital (MGH) & Director of Nutritional Psychiatry at MGH Academy while serving on the faculty at Harvard Medical School.

    What is nutritional psychiatry?

    Nutritional psychiatry is the study of how food influences our mood (in the short term) and our more generalized mental health (in the longer term).

    We recently reviewed a book of hers on this topic:

    This Is Your Brain On Food – by Dr. Uma Naidoo

    The “Six Pillars” of nutritional psychiatry

    Per Dr. Naidoo, these are…

    Be Whole; Eat Whole

    Here Dr. Naidoo recommends an “80/20 rule”, and a focus on fiber, to keep the gut (“the second brain”) healthy.

    See also: The Brain-Gut Highway: A Two-Way Street

    Eat The Rainbow

    This one’s simple enough and speaks for itself. Very many brain-nutrients happen to be pigments, and “eating the rainbow” (plants, not Skittles!) is a way to ensure getting a lot of different kinds of brain-healthy flavonoids and other phytonutrients.

    The Greener, The Better

    As Dr. Naidoo writes:

    ❝Greens contain folate, an important vitamin that maintains the function of our neurotransmitters. Its consumption has been associated with a decrease in depressive symptoms and improved cognition.❞

    Tap into Your Body Intelligence

    This is about mindful eating, interoception, and keeping track of how we feel 30–60 minutes after eating different foods.

    Basically, the same advice here as from: The Kitchen Doctor

    (do check that out, as there’s more there than we have room to repeat here today!)

    Consistency & Balance Are Key

    Honestly, this one’s less a separate item and is more a reiteration of the 80/20 rule discussed in the first pillar, and an emphasis on creating sustainable change rather than loading up on brain-healthy superfoods for half a weekend and then going back to one’s previous dietary habits.

    Avoid Anxiety-Triggering Foods

    This is about avoiding sugar/HFCS, ultra-processed foods, and industrial seed oils such as canola and similar.

    As for what to go for instead, she has a broad-palette menu of ingredients she recommends using as a base for one’s meals (remember she’s a celebrated chef as well as a psychiatrist and nutritionist), which you can check out here:

    Dr. Naidoo’s “Food for Mood” project

    Enjoy!

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  • Is owning a dog good for your health?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Australia loves dogs. We have one of the highest rates of pet ownership in the world, and one in two households has at least one dog.

    But are they good for our health?

    Mental health is the second-most common reason cited for getting a dog, after companionship. And many of us say we “feel healthier” for having a dog – and let them sleep in our bedroom.

    Here’s what it means for our physical and mental health to share our homes (and doonas) with our canine companions.

    Pogodina Natalia/Shutterstock

    Are there physical health benefits to having a dog?

    Having a dog is linked to lower risk of death over the long term. In 2019, a systematic review gathered evidence published over 70 years, involving nearly four million individual medical cases. It found people who owned a dog had a 24% lower risk of dying from any cause compared to those who did not own a dog.

    A golden retriever pants on the grass next to a ball.
    Having a dog may help lower your blood pressure through more physical activity. Barnabas Davoti/Pexels

    Dog ownership was linked to increased physical activity. This lowered blood pressure and helped reduce the risk of stroke and heart disease.

    The review found for those with previous heart-related medical issues (such as heart attack), living with a dog reduced their subsequent risk of dying by 35%, compared to people with the same history but no dog.

    Another recent UK study found adult dog owners were almost four times as likely to meet daily physical activity targets as non-owners. Children in households with a dog were also more active and engaged in more unstructured play, compared to children whose family didn’t have a dog.

    Exposure to dirt and microbes carried in from outdoors may also strengthen immune systems and lead to less use of antibiotics in young children who grow up with dogs.

    A boy in sunglasses talks to his jack russell terrier on a beach.
    Children in households with a dog were often more active. Maryshot/Shutterstock

    Health risks

    However, dogs can also pose risks to our physical health. One of the most common health issues for pet owners is allergies.

    Dogs’ saliva, urine and dander (the skin cells they shed) can trigger allergic reactions resulting in a range of symptoms, from itchy eyes and runny nose to breathing difficulties.

    A recent meta-analysis pooled data from nearly two million children. Findings suggested early exposure to dogs may increase the risk of developing asthma (although not quite as much as having a cat does). The child’s age, how much contact they have with the dog and their individual risk all play a part.

    Slips, trips and falls are another risk – more people fall over due to dogs than cats.

    Having a dog can also expose you to bites and scratches which may become infected and pose a risk for those with compromised immune systems. And they can introduce zoonotic diseases into your home, including ring worm and Campylobacter, a disease that causes diarrhoea.

    For those sharing the bed there is an elevated the risk of allergies and picking up ringworm. It may result in lost sleep, as dogs move around at night.

    On the other hand some owners report feeling more secure while co-sleeping with their dogs, with the emotional benefit outweighing the possibility of sleep disturbance or waking up with flea bites.

    Proper veterinary care and hygiene practices are essential to minimise these risks.

    A dog peers out from under a doona while a man sleeps.
    Many of us don’t just share a home with a dog – we let them sleep in our beds. Claudia Mañas/Unsplash

    What about mental health?

    Many people know the benefits of having a dog are not only physical.

    As companions, dogs can provide significant emotional support helping to alleviate symptoms of anxiety, depression and post-traumatic stress. Their presence may offer comfort and a sense of purpose to individuals facing mental health challenges.

    Loneliness is a significant and growing public health issue in Australia.

    In the dog park and your neighbourhood, dogs can make it easier to strike up conversations with strangers and make new friends. These social interactions can help build a sense of community belonging and reduce feelings of social isolation.

    For older adults, dog walking can be a valuable loneliness intervention that encourages social interaction with neighbours, while also combating declining physical activity.

    However, if you’re experiencing chronic loneliness, it may be hard to engage with other people during walks. An Australian study found simply getting a dog was linked to decreased loneliness. People reported an improved mood – possibly due to the benefits of strengthening bonds with their dog.

    Three dogs on leash sniff each other.
    Walking a dog can make it easier to talk to people in your neighbourhood. KPegg/Shutterstock

    What are the drawbacks?

    While dogs can bring immense joy and numerous health benefits, there are also downsides and challenges. The responsibility of caring for a dog, especially one with behavioural issues or health problems, can be overwhelming and create financial stress.

    Dogs have shorter lifespans than humans, and the loss of a beloved companion can lead to depression or exacerbate existing mental health conditions.

    Lifestyle compatibility and housing conditions also play a significant role in whether having a dog is a good fit.

    The so-called pet effect suggests that pets, often dogs, improve human physical and mental health in all situations and for all people. The reality is more nuanced. For some, having a pet may be more stressful than beneficial.

    Importantly, the animals that share our homes are not just “tools” for human health. Owners and dogs can mutually benefit when the welfare and wellbeing of both are maintained.

    Tania Signal, Professor of Psychology, School of Health, Medical and Applied Sciences, CQUniversity Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Decoding Hormone Balancing in Ads

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Time!

    This is the bit whereby each week, we respond to subscriber questions/requests/etc

    Have something you’d like to ask us, or ask us to look into? Hit reply to any of our emails, or use the feedback widget at the bottom, and a Real Human™ will be glad to read it!

    Q: As to specific health topics, I would love to see someone address all these Instagram ads targeted to women that claim “You only need to ‘balance your hormones’ to lose weight, get ripped, etc.” What does this mean? Which hormones are they all talking about? They all seem to be selling a workout program and/or supplements or something similar, as they are ads, after all. Is there any science behind this stuff or is it mostly hot air, as I suspect?

    Thank you for asking this, as your question prompted yesterday’s main feature, What Does “Balancing Your Hormones” Even Mean?

    That’s a great suggestion also about addressing ads (and goes for health-related things in general, not just hormonal stuff) and examining their claims, what they mean, how they work (if they work!), and what’s “technically true but may be misleading* cause confusion”

    *We don’t want companies to sue us, of course.

    Only, we’re going to need your help for this one, subscribers!

    See, here at 10almonds we practice what we preach. We limit screen time, we focus on our work when working, and simply put, we don’t see as many ads as our thousands of subscribers do. Also, ads tend to be targeted to the individual, and often vary from country to country, so chances are good that we’re not seeing the same ads that you’re seeing.

    So, how about we pull together as a bit of a 10almonds community project?

    • Step 1: add our email address to your contacts list, if you haven’t already
    • Step 2: When you see an ad you’re curious about, select “share” (there is usually an option to share ads, but if not, feel free to screenshot or such)
    • Step 3: Send the ad to us by email

    We’ll do the rest! Whenever we have enough ads to review, we’ll do a special on the topic.

    We will categorically not be able to do this without you, so please do join in—Many thanks in advance!

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  • Hospitals worldwide are short of saline. We can’t just switch to other IV fluids – here’s why

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Last week, the Australian Therapeutic Goods Administration added intravenous (IV) fluids to the growing list of medicines in short supply. The shortage is due to higher-than-expected demand and manufacturing issues.

    Two particular IV fluids are affected: saline and compound sodium lactate (also called Hartmann’s solution). Both fluids are made with salts.

    There are IV fluids that use other components, such as sugar, rather than salt. But instead of switching patients to those fluids, the government has chosen to approve salt-based solutions by other overseas brands.

    So why do IV fluids contain different chemicals? And why can’t they just be interchanged when one runs low?

    Pavel Kosolapov/Shutterstock

    We can’t just inject water into a vein

    Drugs are always injected into veins in a water-based solution. But we can’t do this with pure water, we need to add other chemicals. That’s because of a scientific principle called osmosis.

    Osmosis occurs when water moves rapidly in and out of the cells in the blood stream, in response to changes to the concentration of chemicals dissolved in the blood plasma. Think salts, sugars, nutrients, drugs and proteins.

    Too high a concentration of chemicals and protein in your blood stream leads it to being in a “hypertonic” state, which causes your blood cells to shrink. Not enough chemicals and proteins in your blood stream causes your blood cells to expand. Just the right amount is called “isotonic”.

    Mixing the drug with the right amount of chemicals, via an injection or infusion, ensures the concentration inside the syringe or IV bag remains close to isotonic.

    A woman connected to an IV drip looks out a hospital window.
    Australia is currently short on two salt-based IV fluids. sirnength88/Shutterstock

    What are the different types of IV fluids?

    There are a range of IV fluids available to administer drugs. The two most popular are:

    • 0.9% saline, which is an isotonic solution of table salt. This is one of the IV fluids in short supply
    • a 5% solution of the sugar glucose/dextrose. This fluid is not in short supply.

    There are also IV fluids that combine both saline and glucose, and IV fluids that have other salts:

    • Ringer’s solution is an IV fluid which has sodium, potassium and calcium salts
    • Plasma-Lyte has different sodium salts, as well as magnesium
    • Hartmann’s solution (compound sodium lactate) contains a range of different salts. It is generally used to treat a condition called metabolic acidosis, where patients have increased acid in their blood stream. This is in short supply.

    What if you use the wrong solution?

    Some drugs are only stable in specific IV fluids, for instance, only in salt-based IV fluids or only in glucose.

    Putting a drug into the wrong IV fluid can potentially cause the drug to “crash out” of the solution, meaning patients won’t get the full dose.

    Or it could cause the drug to decompose: not only will it not work, but it could also cause serious side effects.

    An example of where a drug can be transformed into something toxic is the cancer chemotherapy drug cisplatin. When administered in saline it is safe, but administration in pure glucose can cause life-threatening damage to a patients’ kidneys.

    What can hospitals use instead?

    The IV fluids in short supply are saline and Hartmann’s solution. They are provided by three approved Australian suppliers: Baxter Healthcare, B.Braun and Fresenius Kabi.

    The government’s solution to this is to approve multiple overseas-registered alternative saline brands, which they are allowed to do under current legislation without it going through the normal Australian quality checks and approval process. They will have received approval in their country of manufacture.

    The government is taking this approach because it may not be effective or safe to formulate medicines that are meant to be in saline into different IV fluids. And we don’t have sufficient capacity to manufacture saline IV fluids here in Australia.

    The Australian Society of Hospital Pharmacists provides guidance to other health staff about what drugs have to go with which IV fluids in their Australian Injectable Drugs Handbook. If there is a shortage of saline or Hartmann’s solution, and shipments of other overseas brands have not arrived, this guidance can be used to select another appropriate IV fluid.

    Why don’t we make it locally?

    The current shortage of IV fluids is just another example of the problems Australia faces when it is almost completely reliant on its critical medicines from overseas manufacturers.

    Fortunately, we have workarounds to address the current shortage. But Australia is likely to face ongoing shortages, not only for IV fluids but for any medicines that we rely on overseas manufacturers to produce. Shortages like this put Australian lives at risk.

    In the past both myself, and others, have called for the federal government to develop or back the development of medicines manufacturing in Australia. This could involve manufacturing off-patent medicines with an emphasis on those medicines most used in Australia.

    Not only would this create stable, high technology jobs in Australia, it would also contribute to our economy and make us less susceptible to future global drug supply problems.

    Nial Wheate, Professor and Director Academic Excellence, Macquarie University and Shoohb Alassadi, Casual academic, pharmaceutical sciences, University of Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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