No, most people aren’t in severe pain when they die

 Symptoms of an illness usually improve the 
closer a person gets to dying. Photo by Dawid Zawiła on Unsplash

Many people fear death partly because of the perception they might suffer increasing pain and other awful symptoms the nearer it gets. There’s often the belief palliative care may not alleviate such pain, leaving many people to die excruciating deaths.

But an excruciating death is extremely rare. The evidence about palliative care is that pain and other symptoms, such as fatigue, insomnia and breathing issues, actually improve as people move closer to death. More than 85% of palliative care patients have no severe symptoms by the time they die.

Evidence from the Australian Palliative Care Outcomes Collaboration (PCOC) shows that there has been a statistically significant improvement over the last decade in pain and other end-of-life symptoms. Several factors linked to more effective palliative care are responsible.

These include more thorough assessments of patient needs, better medications and improved multidisciplinary care (not just doctors and nurses but also allied health workers such as therapists, counsellors and spiritual support).

But not everyone receives the same standard of clinical care at the end of life. Each year in Australia, about 160,000 people die and we estimate 100,000 of these deaths are predictable. Yet, the PCOC estimates only about 40,000 people receive specialist palliative care per year.

Symptoms at the end of life

For the greater majority of those who do receive palliative care, the evidence shows it is highly effective.

The most common symptom that causes people distress towards the end of life is fatigue. In 2016, 13.3% of patients reported feeling severe distress due to fatigue at the start of their palliative care. This was followed by pain (7.4%) and appetite (7.1%) problems.

Distress from fatigue and appetite is not surprising as a loss of energy and appetite is common as death approaches, while most pain can be effectively managed. Other problems such as breathing, insomnia, nausea and bowel issues are experienced less often and typically improve as death approaches.

Contrary to popular perceptions, people in their final days and hours experience less pain and other problems than earlier in their illness. In 2016, about a quarter of all palliative care patients (26%) reported having one or more severe symptoms when they started palliative care. This decreased to 13.9% as death approached.

The most common problem at the start was fatigue, which remained the most common problem at the end. Pain is much less common than fatigue. In total, 7.4% of patients reported severe pain at the beginning of their palliative care and only 2.5% reported severe pain in the last few days. Breathing difficulties cause more distress than pain in the final days of life.

These figures must be considered in relation to a person’s wishes. It’s true for a small number of patients that existing medications and other interventions do not adequately relieve pain and other symptoms.

But some patients who report problematic pain and symptoms elect to have little or no pain relief. This might be because of family, personal or religious reasons. For some patients, this includes a fear opioids (the active ingredient in drugs like codeine) and sedating medications will shorten their life. For others, being as alert as possible at the point of death is essential for spiritual reasons.

Not everyone gets this care

Patient outcomes vary depending on a range of factors such as the resources available and geographical location. People living in areas of high socioeconomic status have better access to palliative care than those who live in lower socioeconomic areas.

The PCOC data demonstrate those receiving care in a hospital with dedicated specialist palliative care services have better pain and symptom control (due to the availability of 24-hour care) compared to those receiving palliative care at home. There is now a national consensus statement to improve the provision of palliative care in hospitals. This needs to be extended to include death at home and death in residential care.

Although there are national palliative care standards and national safety and quality standards, each state, territory, health district and organisation is responsible for the individual delivery of palliative care. Subsequently, differing approaches to delivery and resources exist in the provision of palliative care.

Recent reports by the New South Wales and Victorian Auditor-General Offices highlight the demand for palliative care services and the need for appropriate resourcing to support patients, carers and families as well as for more integrated information and service delivery across care settings.

Australia can do better

The Australian Palliative Care Outcomes Collaboration holds information on more than 250,000 people who have received specialist palliative care over the last decade. Although participation in the data collection is voluntary, there has been steady uptake. The collaboration estimates that information on more than 80% of specialist palliative care patients is being reported each year.

Australia is in a unique position internationally as it has a national system to routinely measure the outcomes and experience of palliative care patients and their families. These data can help clinicians to measure the effectiveness of their care and help providers adopt best practice. This information is also critical evidence that can be used to inform public debate.

The evidence is Australian palliative care is effective for almost everyone who receives it. But the problem is that many thousands of people die each year without access to the specialist palliative care they need. As a country, we need to do better.

This article was co-authored by:
Image of Kathy EagarKathy Eagar – [Professor and Director at Australian Health Services Research Institute University of Wollongong, University of Wollongong];
Image of Sabina ClaphamSabina Clapham – [Research fellow, Palliative Care Outcomes Collaboration, University of Wollongong]
Image of Samuel AllinghamSamuel Allingham – [Research Fellow, Applied Statistics, University of Wollongong]





This article is part of a syndicated news program via


Listen To Older Voices – Carol Cochran: Part 1

Welcome to Listen To Older Voices, a program produced by Rob Greaves 
for Uniting Melba and podcast through the Toorak Times and Tagg.

Listen To Older Voices presents the stories, views and opinions of our older citizens. It is predominantly in a life & times format, with interviewees reflecting upon their lives from earliest memories. An underlying principal of the program is to promote the concept of positive ageing, reinforcing the principle that older people have & continue to make a valuable contribution to both their local & wider community.

This is the first part of a 3-part program featuring the Life and Times of 71-year-old baby boomer, Carol Cochran. Carol is a natural storyteller and her manner in which she tells of her life is most engaging. In this program we learn about her early life and in doing so are introduced to her parents. Being the oldest girl in the family, the task fell upon her to help look after the home and siblings when her father passed away from cancer.

In unravelling her early lifer carol gives us an insight into the many everyday activities that kids did in the late 1940’s and early ‘50’s. This was a time when the baker and the milkman delivered to the door, and, kids at primary school were given milk to drink, milk that was often left out in the hot sun. These are stories of a lifestyle now long gone.

Click to hear Carol Cochran – Part 1

Previous LTOV Programs can be accessed clicking on this icon – 




[Listen To Older Voices receives funding from the Commonwealth Government through the Commonwealth Home Support Program Program]

What to teach your preschooler about internet safety

 Internet safety in early childhood is a new area 
of research because, until now, children as young as four weren’t able 
to easily access the internet. 

Fifteen years ago, parents and caregivers did not have to worry about teaching pre-school aged children about internet safety. A new report prepared for the Children’s Commissioner of England suggests this time has passed.

Children now live in a digital age, which means internet access is a daily part of life for many young children around the world.

It’s easier for very young kids to go online now, because touchscreen technology requires less fine motor skills. Shutterstock

Touchscreen technologies have changed how accessible the internet is for very young children, particularly between the ages of four and five. It’s now quicker and easier to connect to the internet using these technologies, as they don’t require the same level of fine motor and literacy skills used to navigate a mouse and keyboard.

More recently, the Internet of Things has become widespread. The Internet of Things uses small chips embedded in everyday items, including children’s toys, to communicate information to the net. Children’s dolls, teddy bears and figurines can record their play and upload this information as data to the web. This can occur without children’s consent because they wouldn’t be aware they’re generating data.

The three main risks

Internet safety addresses three main risks faced by children online. These are contact, conduct and content risks:

  • contact risks involve children talking to unknown people on the internet. Contact risks also include the harvesting of children’s data, such as recording their activity on an online game
  • conduct risks are about behaving respectfully online and learning to manage digital footprints
  • content risks are concerned with the type of material children view and consume when accessing the internet.

For pre-school aged children, content risks include accidentally viewing inappropriate content such as pornography. Content also considers the quality of material made available to children. How people are represented in society is mirrored back to children through the media they consume. Quality content for young children has been a concern of the Australian Council on Children and the Media for many years.

Contact risks are most likely to occur for pre-school aged children in the form of pop-ups. Children of this age can also be active in virtual worlds, such as Pocoyo World or Club Penguin, where they can engage with other members. Children may not always know the members they are playing with in these worlds.

Conduct involves learning how to be respectful online. Parents can model good conduct behaviours to their children by always asking permission to take photos before posting to social media.

Children as young as four are now online

Internet safety in early childhood is a new area of research because, until now, children as young as four weren’t able to easily access the internet.

A recent study conducted with 70 four-year old children examined what children understand about the internet and being safe online. In this study, only 40% of children were able to describe the internet. This was despite all of the children having access to internet at home, predominately through touchscreen technologies.

Children’s understandings of the internet were associated with their experiences going online and using technologies with their families. They defined the internet as being “in the iPad” or something they used “in the lounge room” to “play games”.

Children were also aware the internet “was used by Mummy for her work” or “by my big sister for her emails”. Some 73% of the children said they would tell someone their address on the internet. And 70% said they would also tell someone how old they were. A further 89% of children indicated they would click on a pop-up even if they did not know what the pop-up was about.

Parenting young children for internet safety

Because children face content, contact and conduct risks online, they require a basic understanding of the internet. The most important thing parents can teach their children about internet safety is that “the internet” means a network of technologies that can “talk” to each other.

This is like teaching children to be sun smart. First, we explain the sun can harm our skin. Next we teach children to wear a hat, a long-sleeved shirt and sunscreen to protect themselves.

For internet safety, we should first explain the internet uses many technologies that share information created and collected by lots of people. Then we can teach our children how to protect themselves online. Some things to teach your child are:

  • seek adult help when you encounter a pop-up
  • only use adult approved sources for content
  • don’t share personal information online
  • try to be near an adult when using a device
  • only click on apps and tabs a parent or caregiver has set up for you.

The internet forms a large part of daily life for many young children. From watching their favourite YouTube clips, to playing games, to talking with a long-distance relative over video-conferencing, being online is not much different to a young child than being offline. Being safe in both spaces is possible with adult support.

This article was written by:
Image of Susan EdwardsSusan Edwards – [Professor of Education, Australian Catholic University]






This article is part of a syndicated news program via

How parents and teens can reduce the impact of social media on youth well-being

 Engaging with your teen’s online 
world will make it easier to have difficult conversations about some of the 
risks and ways  to manage them. 

Knowing how to navigate the online social networking world is crucial for parents and teens. Being educated and talking about online experiences can help reduce any negative impacts on youth mental health and well-being.

The Australian Psychology Society (APS) recently released a national survey looking at the impact of technology and social media on the well-being of Australians.

Around 1,000 adults over the age of 18 and 150 young people aged 14-17 years took part. The survey found more than three in four young people (78.8%) and more than half of all adults (54%) were highly involved with their mobile phones. Young people are reportedly using social media for an average of 3.3 hours each day, on five or more days of the week.

The vast majority of adults and teenagers reported their screens and social media accounts were a positive part of their lives. Many use social media channels to connect with family, friends and to entertain themselves.

Too much social media use can effect self-esteem

Despite social media playing a positive role for most, the survey found the high use of social media and technology can have a negative impact on youth self-esteem. Two in three young people feel pressure to look good and nearly a third of youth have been bullied online. Nearly half (42%) of frequent users look at social media in bed before sleeping.

The survey also found 15% of teenagers reported being approached by strangers on a daily basis through their online world.

Around 60% of parents never monitor their teen’s social media account and are wrestling their own issues about how much is too much screen time. Most are unsure of how to provide good guidance of appropriate social media use with their teens.

Engage with your teen’s online world

Parents and teens need to be informed about engaging with the online world. Parents can ask their teen to show them how they use social media and what it is. Try to navigate the social world together, rather than acting as a supervisor. Ask your teen to help you understand how they use the internet so you can make good decisions about social media use together.

Here are a few tips to connect with your teen’s online world:

  • Together with your teen visit their social media channels. Take a look at what your teen is posting online. Check out their favourites and which YouTube channels they are subscribed to. Favourites and subscriptions can give you clues about what they’re watching on the site
  • Ask your teen to create playlists of their favourite videos, while you create your own. Then, sit and watch them together. You can see what they’re watching, and it gives them an opportunity to share what they enjoy online with you
  • Make using the internet together a game. For example, you can guess what kinds of videos are popular in a particular place and use the “advanced search” function to see videos only in that location.

Difficult conversations about social media

An important step in navigating the risks of social networking is to have ongoing conversations about social media use with your teens. If you’re already engaged in your teen’s online world, it will be easier to have difficult conversations about some of the risks and ways to manage them.

Many people believe internet browsing is anonymous. Educate your teen about their digital reputation. Whenever your teen visits a website, shares content, posts something on a blog or uploads information, they’re adding to their digital footprint.

This information can be gathered under their real name and possibly accessed by future employers or marketing departments. This can happen without you or your teen knowing. Protecting your personal information and knowing it’s not truly anonymous are important conversations to have together.

Cyberbullying can occur if online users try to intimidate, exclude or humiliate others online through abusive texts or emails, hurtful messages, images or videos, or online gossip and chat. Let your teen know to try not to retaliate or respond, and to speak to a trusted adult right away. Aim to block the bully and report the behaviour to the social media platform.

Create a family media plan to help manage social media use with options to create different guidelines for each teen. In the plan, promote healthy technology use habits with your teen. This includes not using technology too close to bed time.

Research showsusing technology at night can have a negative impact on sleep quality. Try to not to use technology for around 30 minutes to an hour before bedtime. Consider using devices in the living spaces in the house rather than in the bedroom  when it’s time to go to sleep.

Here’s some more information on how to talk to your teens about their internet use, and thriving in an online age.

This article was written by:





They know where you go: dockless bike sharing looms as the next disruptor – if key concerns are fixed

 Information about who rides where and when is useful 
for city planners and policymakers, but also a valuable commodity 
in its own right. AAP

Beyond the benefits of dockless bike sharing for people’s mobility and health, these services are producing an ever more useful byproduct: journey data. Mapped through global positioning system (GPS) devices on the bikes or via Bluetooth using GPS data from users’ smartphones, the journey data that operators collect could be a powerful tool for city planners and policymakers, possibly even a valuable commodity.

Each trip taken on a dockless bike is recorded in a database. At UNSW’s City Futures Research Centre, we have been working with Bicycle Network’s Riderlog app data. We have mapped more than 120,000 journeys and are exploring how the data can be both used and protected.

We have been able to create Bicycling Dashboards for all the capital cities of Australia, an example of which is shown below. The dashboard can show riders’ behaviours and movements across each city.

Bicycling Dashboard: visualising cyclists’ behaviour across the city. Created by Dr Simone Z. Leao, City Futures, UNSW, Author provided

Dockless, the next big disruption?

Dockless sharing schemes use bikes that are self-locking and tracked through GPS. Using a smartphone app, riders can pick up a bike, use it, then essentially leave it at their destination.

In an era of smart cities and ubiquitous computing, dockless bike sharing adds another layer of connection through digital platforms and smartphone apps to navigate and interact with the built environment. Our dependency on these new and useful technologies is driving their disruptive impacts.

Technology-based services are reshaping how city residents and visitors access essential services such as transport and housing. Bower and Christensen first coined the term disruptive technologies in 1995.

The two disruptive technology pinups are Uber and Airbnb. Uber has disrupted the business model of the taxi industry, while Airbnb has disrupted the short-term accommodation market. In the last 10 years both have exploded globally and now hold formidable market shares in more than 100 cities across the world.

The new kid on the block is dockless bikes.

A key advantage in bike sharing

An interesting point of difference to other city disruptors is that there is not one dominant dockless bike market leader. In Australia, over just a few months, we have seen the arrival of at least six operators: Reddy Go, OBike, ofo, mobike, Earth bike and Airbike.

To use the oBike, riders download the app and use it to scan the QR code on the back of the bike. shahphoto/Shutterstock

yrone Siu/Reuters

All dockless bike schemes allow the rider to leave the bike in public spaces close to their destination. This is the key difference from docked bike-sharing systems, which required the rider to pick up and return the bike at dedicated docking stations. Having hired such bikes in Chicago and Glasgow, I can attest to the challenges of finding the elusive docking station and then returning the bike to a station that is not as close as I would like to my destination.

The dockless bike can provide an important link in the “mobility as a service” value chain, whether it’s used for the “last mile” commute or the tourist experience. Either way, having more bikes on our roads must encourage more cycling, which can only be a good thing, right?

Smart but revealing

Our work at City Futures makes clear just how much the collected journey data can tell us about the users. Across Australian capital cities, we have mapped more than 120,000 cycle journeys by 7,600 users over three-and-half years.

Through cleaning and visualising this data, we can start to understand at a fine scale where and when people are riding through the city and where they are not, and what age and gender the cyclists are.

As the Bicycling Dashboards show, this is a rich source of information for city planners and policymakers. If linked to other data it could just as easily be a valuable commodity in its own right.

So one might speculate if collecting fine-scale mobility data is part of the dockless bike operators’ business model.

The collection of personal mobility data also raises questions about its security and anonymity. The data visualised in the Bicycling Dashboard has gone through a process of formatting, cleaning, validating and, importantly, anonymisation.

Safeguarding personal data is essential. It should be of paramount concern to dockless bike operators as they collect detailed information about each individual’s movements. Other personal information typically collected includes the cyclist’s phone number and credit card details.

Aggregating this information to understand mobility patterns is valuable for city planners and policymakers. However, the individual traces of a person as they travel the city must be guarded for reasons of privacy and personal security.

Every user of a docked bike leaves digital traces of their journey around the city. Shahjehan/Shutterstock

Guidelines to getting it right

Data collection is but one of the opportunities and challenges facing dockless bike operators. Many also see visual clutter as a key drawback. China has bike graveyards filled with dockless bikes; in Melbourne, dozens of dockless bikes have been dredged from the Yarra River; and in Sydney, six inner-city councils (Inner West, City of Sydney, Randwick, Waverley, Woollahra and Canada Bay) developed bike-sharing provider guidelines, giving operators three months to comply.

The guidelines are sensible and importantly include “data sharing” between bike-sharing operators and councils as one of seven key principles.

However, dockless bikes are still having a marked impact in Sydney. In the recently released draft Future Transport Strategy 2056, TransportNSW identified bike sharing as part of the solution to people’s transport needs.

We can see dockless bikes as the next link in the chain to mobility as a service. I hope the operators can get it right, so more Australians can get on a bike and realise the health benefits of active transport.

Dr Simone Z. Leao created the Bicycling Dashboard shown in this article.

This article was written by:
Image of Christopher PettitChristopher Pettit – [Professor of Urban Science, UNSW]






This article is part of a syndicated news program via

NATHANIEL NEWMAN (Living with Treacher Syndrome)

Treacher Syndrome is a very rare cranio-facial condition that effects 1 in 50,000 births in the USA alone and sadly there is no way of knowing if your child is going to have it until the day of birth. This is one very little brave boys story, please meet Nathaniel.

As luck would have it, one beautiful night whilst out walking along the beach, both Magda and Russel would meet by chance, and shortly after marry. As with most young parents, the desire to add to their family came some three years later when Magda announced to Russel she was pregnant with their first child.

It is nearly midnight in a hospital in Manhattan where nurses in the delivery ward are urging one of the expectant mothers to keep trying, keep pushing. Magda Newman and her husband Russel have been in labour for hours. The endless waiting nearly just as agonising as the physical pain she is enduring.

Magda and Russel were both concerned, the delivery was taking far too long. The doctor just kept putting it down to it being her first delivery and that she wasn’t pushing hard enough. When the child inside her started showing signs of distress, the doctors made an on the spot decision to do a caesarean.

Once the child was delivered, life for both these parents, would change forever.

Russel’s first thought after seeing his new born son was that he didn’t even look like a human being. A crushing blow to a dream of parenthood that itself had only been born some three years earlier. Magda had a seemingly trouble free pregnancy. Magda was 24 years old, she appeared in the best of health, so why would doctors have reason for concern. She was in the ultimate low risk pregnancy category, so no extra testing was required. Her later diagnosis did not show up on any of Magda’s pre-natal scans – a common occurrence in cases of Treacher Collins.

Back in the operating room after 17 hours of labour, happiness turns to despair and horror. Russel doesn’t recall fainting, but he certainly recalls screaming at the top of his voice “oh my god, oh my god”. Still unaware of what is happening, Magda began reading peoples facial expressions, and knew something was majorly wrong. The baby was removed and immediately taken to another room. Magda at this stage watched as 20 or so people ran into the room. She feared the worst as she still hadn’t heard the baby cry. Her continued questions “Is he alive?, What is wrong? I want to see my baby?” go unanswered by hospital staff. They didn’t want to show her, her own baby.

Russel recalls Nathanial had no distinctive cheek bones, no upper or lower eyelids. He also had no eye sockets, ears, and had a severely undeveloped jaw. His face was totally disfigured and even more terrifying, Nathanial is not breathing. Magda is at this stage was left in the delivery room as doctors frantically try to save the baby’s life. His nasal passageway is nearly solid bone and his airway is so narrow it was like trying to breathe through a soda straw. Eating would also become problematic. Regardless of all the negatives, one positive would remain, Nathaniel’s brain function was completely unaffected.

Whilst this was all going on, a doctor called Russel out of the operating room and began to flick through an old book, written in the 60’s with black and white pictures. He recalls looking at the pictures of teenage children with Treacher Collins Syndrome, thinking to himself “that is what my child is going to look like”.

After officially naming their child Nathanial, they made contact with the Institute of Reconstructive Plastic Surgery at NYU Langone Medical Centre, a leading hospital working with children with this rare condition. Russel leaves a message and within hours receives a call back. The person on the other end of the phone was Shelly Cohen a speech and language therapist who immediately says “Hey, Mr. Newman, You had a baby boy, I heard. That’s wonderful.”

This was the first time the new parents had been congratulated on their son’s birth. Russel recalls thinking “are you freaking nuts?”. People were still in shock, paralysed in their own bodies, not knowing what to do next. Shelly told Russel that his son was going to live a long, healthy, happy, wonderful life and Russel believed every word of it.

Nathanial is transferred to the Neonatal Intensive Care Unit at NCIU and it is here where he will spend the first month of his life. The Newman’s here meet a nurse named Pat Chibbaro. Pat recalls how distraught the parents were. They kept asking when is the surgery going to take place to make this all go away and make their son normal.

This was when she explained to them that its going to be a journey, it’s not just one quick fix surgery. And for the Newman’s, the journey was just beginning. Then something happened that would give them hope, hope that would remain with them through the course of Nathanial’s treatments, and the years ahead. Whilst in the hospital, Russel was watching the Grammy Awards on the tv, and the show opens with Christina Aguilera and she was performing her latest hit ‘Beautiful”. Russel recalls the lyrics, “I am beautiful, no matter what they say, words can’t bring me down”. It was at this moment they believed that their son would be beautiful, not because of his appearance but because of who he was inside. Once they listened to the performance by Christina, they immediately went to see their son, and this was the first time they held onto his little hand and Russel recalls how awesome it felt.

Right there and then, both parents made a pledge to each other and their son that they would always see the beauty in him and would never hide him from the world or hide the world from him.

Magda recalls that it would take nearly a year before she could bring herself to look into Nathaniel’s beautiful little face without flinching or crying.

Later Nathaniel would undergo some 10 surgeries to improve his quality of life that his mother described as brutal, where they had to break most of the bones in his face so they could be reset and make it easier for him to breathe. After several failed surgical attempts to open his nasal passages, an emergency tracheotomy was performed on Nathaniel – a surgical procedure in which an incision is made in the trachea creating a direct airway. It is a procedure as life-altering as it is life-saving.

Once your life becomes dependent on a trach, your life changes completely. Both Nathaniel’s brain and body must now learn to breath in a totally different way to what the body wants. He also becomes prone to infection. Bathing can be very scary, and particular care must be taken to avoid water entering the trach tube.

Both parents also had to work out a roster where they would share shifts, so they could constantly monitor their fragile sons sleeping through the night..

Keeping to her word, Magda was committed to giving Nathaniel as normal life she possibly could, so when she took her son for walks in the stroller, people would approach and ask to see the baby. She never once heard “oh he’s cute, or congratulations”, it was more “Oh god bless you”.   It was gut wrenching.

By the time Nathaniel was two, both parents started talking about having another child, a decision they didn’t take lightly. There was still a 50-50 chance their second child would also be born with Treacher Collins Syndrome also. They embarked on a path of endless tests, hoping to ensure that it would not become a repeat performance. Both parents DNA was sent off to John Hopkins and when the result came back that there was a 99 per cent chance their next child would not be affected by Treacher Collins, they tried to become pregnant almost immediately.

The birth of their second son in the delivery room would be nothing like the first.   From the moment Magda arrived at the hospital, she knew it would be a quick delivery. Some twenty minutes later, they were celebrating the birth of their second son Jacob without complications. Russel recalls how different the two boys looked at their moment of birth. Jacob looked like a porcelain doll, where Nathaniel looked disfigured and alien like.

When Nathaniel turned five, this was when he first realised he looked different to everyone else and became conscious of his own face.   The realisation would come at school when another little boy called him a ‘Monster”. Nathaniel was insulted, but his parent helped him realize that the kids didn’t really know what they were saying, and that they were really a product of their parents because they did nothing to correct them.

By the time Nathaniel turned 11, he had endured 54 surgeries, and isn’t really bothered any more about his features. He has learnt to accept it, and thinks of himself as more unique than disfigured.

In 2015, Nathaniel began 6th grade at B.D. Billinghurst Middle School in Reno, Nevada. This meant he would be subjected once again to a room full of children he had never met before, but this time his parents had a plan.

To ease the transition, the Newman’s came up with a plan to have Nathaniel write a letter to his classmates explaining his condition, but also that he was as normal as any of them. In the letter Nathaniel told his classmates that he had three dogs and liked Pokemon and Star Wars. In the letter they also included a current picture of Nathaniel in the hope of avoiding any first day shock, but they also included a copy of the book “Wonder”. “Wonder” by RJ Palacio, a novel published in 2012 has sold more than 5 million copies and been translated into 45 languages. The book is based around a little girl that Palacio had the chance encounter with, with severe facial deformity. This was when Nathaniel adopted the nick-name “Wonderboy”.

After nearly 60 surgeries, Nathaniel’s parents make the agonising decision to meet with surgeons at Seattle Children’s Hospital to perform radical surgery to open up Nathaniel’s airway enough to finally remove his trach. This meant, that Dr Richard Hopper, the Chief surgeon at the hospitals Craniofacial centre, would have to rearrange the bones in Nathaniel’s face. Children with a tracheostomy live in constant fear of this small plastic tube becoming dislodged or blocked with mucous, which can be life threatening. It is a very stressful existence for a patient and their family, especially in very young children. Having a tracheotomy also makes important life experiences such as swimming, playing contact sports, or even sometimes speaking or swallowing more challenging and occasionally impossible.”

As with all Nathaniel’s surgeries prior, his father would carry his son into the operating room. “It never gets easier. Putting your son on a metal table, surrounded by things that are going to cut him open,” Russel is quoted saying.

During the 12-hour surgery doctors separated Nathaniel’s skull from his face and moved it into the correct position, anchoring the bones in place with a metal halo that would remain attached to his head for three months. When Nathaniel woke up, his jaw was wired shut to the halo and he could not eat or speak. Attached to that halo were tiny turning devices that Russel and Magda were required to screw three times a day to continue the excruciatingly slow process of moving Nathaniel’s face.

The whole process had the Newman’s second guessing if they had in fact made the right decision for their son. In August of 2016, doctors finally removed the metal halo from Nathaniel’s head. The day they had long been waiting for finally arrived. Nathaniel’s tracheostomy was removed. He was able to breathe through an unobstructed airway for the first time in nearly 13 years. In 30 seconds, the tracheostomy that had been with Nathaniel his whole life was gone, and the hole in his neck was patched up with a simple bandage.

After thirteen years living with the trach, the struggle and perseverance finally paid off, and a dream was now a reality.

This year Nathaniel started 8th grade, and as with previous years, the Newman family would write a letter to Nathaniel’s teacher and fellow students describing Treacher Collins Syndrome and the long medical journey Nathaniel has faced throughout his life. This year however, they decided not to write a letter. Nathaniel wanted his fellow classmates to accept him for who he is, a creative, compassionate, normal teenager and not let his medical history define him.

A truly amazing story and inspiring little man. We will continue to follow Nathaniel’s journey into adulthood.









People love parklets, and businesses can help make them happen

 The Wray Avenue Solar Parklet by Seedesign 
Studio is in Fremantle. Jean-Paul HorréAuthor provided

As councils across Australia strive to enhance their liveability, parklets are proving popular among city communities. A poll of 300-plus citizens gathered for the inaugural Perth City Summit in August found parklets are the street activation people would most like to see. But why are they so desirable?

San Francisco is central to the parklet story. In 2005, the design collective Rebar turned a parking space into a “park” for two hours as a comment on the use and control of public space in the city. This was followed in 2006 by the installation of more than 40 temporary parks for PARK(ing) Day, now an annual international event.

By 2010, San Francisco had introduced a policy to help create parklets. This has set an important precedent for parklet policies in Australia and internationally.

There are now more than 50 parklets across San Francisco. According to its Pavements to Parks program, these parklets have “appeared … under the sponsorship of nonprofits, small businesses, neighborhood groups, and others”.

This account conveys a strong sense of democracy and accessibility: anyone can install a parklet in their city, and apparently many do. The Deepistan National Parklet (aka “the Deeplet”), the parklet installed by Deep Jawa outside his home in the Mission District, is a celebrated example.

The Deepistan parklet is a celebrated example created by a community-minded individual. Steve Rhodes/flickr 

Mark Hogan/flickr

The neglected role of business

We hear much less about the businesses behind parklets. Cafes, bakeries, bars and pizza shops have installed almost all of the 50-plus parklets in San Francisco. Deepistan is exceptional not merely for its topiary dinosaur but for its non-commercial nature.

This is not surprising, since the proponent pays for installation and maintenance. And the costs are significant (typically these can be well over A$20,000).

The term “parklet” can be traced to San Francisco (it was coined by City planner Andres Power as a catchier name for Rebar’s proposed “walklet”). But there are many other precedents for the intervention itself.

Rebar’s temporary parklet in 2005, the first of many to show vividly how much space we set aside for private cars.

Perhaps the most obvious, given the strong connection between parklets and cafes, is the long-standing use of footpaths and roadways as restaurant dining areas. The parklet outside Vans Cafe in Cottesloe, for example, was approved under an alfresco dining licence. Converting a parking space into a sitting space is hardly revolutionary.

Yet advocates of parklets rarely make this connection. The story of parklets as entirely new, stemming from Rebar’s DIY park, is far more appealing, suggesting a bottom-up, creative and democratic remaking of the public realm. The link to one of the world’s most innovation-rich cities doesn’t hurt, either.

The reluctance of planners and policymakers to connect parklets to business also reflects concerns about the commercialisation and commodification of the city. The problems of privately owned public spaces (“POPOs” – provided by large developers in exchange for variations to planning rules) are well documented, particularly the issues of high levels of management and surveillance.

Parklets, however, are not privately owned public spaces. Parklets are installed on public land, are temporary and cannot be controlled by the business that installed them. Each bears a sign proclaiming the public nature of the space. Anyone can use parklets, whether they buy something or not.

Parklets are only temporary structures paid for and built by the proposer. SDOT Photos/Flickr

One might critique parklets for their scale, their distribution or their use. They are tiny and do very little to meet important needs for play, exercise or engagement with nature. Some appear a little neglected; many are in areas that are already leafy.

San Francisco’s Parklet Manual gives detailed instructions on creating a parklet. City of San Francisco

In San Francisco, some parklets have been rejected for fear they will contribute not to community empowerment but to gentrification.

Why so popular?

So how can we explain the popularity of the parklet? Perhaps because parklets support, and build off, the kinds of places people like – and these aren’t just green spaces.

As US urban activist and writer Jane Jacobs explained so powerfully, cities need more than parks and plazas: commercial activity is a crucial component of public life. Cafes are increasingly important sites for community interaction as other places for local exchange disappear, including banks, post offices, corner delis and newsagents, on top of the local hardware, haberdashery and other specialist shops lost to competition from larger retailers and the digital marketplace. Parklets present some hope for walkable, local commerce.

Or perhaps their popularity has more to do with the lack of options for public participation in shaping the city. Parklets may be led by businesses, but they are local businesses, sometimes supported with public or crowdsourced funds, and parklet policies mean that the spaces cannot be private. Opportunities for participation are often much greater than for the larger public spaces created by professionals. They also show vividly how much space we waste on private cars.

North Perth’s Angove Street Off-cut Parklet, designed by NOMA. NOMA, Author provided

After parklets, the second-most-desired street activation, according to the Perth City Summit poll, was “creative installations”, followed by street events and murals. In comparison, parklets offer a more tangible and accessible option.

Clearly, we can’t rely on businesses alone to provide adequate and appropriate public spaces. The role of local and state governments in providing a high-quality public realm continues to be important. But parklets show that businesses are not all seeking to play the system. As we think about public life, parklets might provide a useful model to build on.

This article was written by:
Image of Amelia ThorpeAmelia Thorpe – [Senior Lecturer and Director of Environmental Law Programs, UNSW]






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China’s growing footprint on the globe threatens to trample the natural world

 A Chinese road-building corporation felling  
rainforest in the Congo Basin. Bill LauranceAuthor provided

Many observers of China’s escalating global program of foreign investment and infrastructure development are crossing their fingers and hoping for the best. In an ideal world, China’s unbridled ambitions will improve economic growth, food security and social development in many poor nations, as well as enriching itself.

Such hopes are certainly timely, given the isolationism of the US Trump administration, which has created an international leadership vacuum that China is eager to fill.

But a close look reveals that China’s international agenda is far more exploitative than many realise, especially for the global environment. And the Chinese leadership’s claims to be embracing “green development” are in many cases more propaganda than fact.

To help steer through the maze, I provide here a snapshot of China’s present environmental impacts. Are China’s assertions reasoned and defensible, or something else altogether?

Predatory force?

For a start, China is overwhelmingly the world’s biggest consumer of illegally poached wildlife and wildlife products. From rhino horn, to pangolins, to shark fins, to a menagerie of wild bird species, Chinese consumption drives much of the global trade in wildlife exploitation and smuggling.

Over the past 15 years, China’s rapacious appetite for ivory has largely driven a global collapse of elephant populations. In response to growing international criticism, China promised to shut down its domestic ivory trade by the end of 2017.

The author examining a Forest Elephant gunned down by ivory poachers in central Africa. Mahmoud Mahmoud

But even before China’s ban has taken full force, a black market for ivory is developing in neighbouring Laos. There, Chinese entrepreneurs are churning out great quantities of carved ivory products, specifically designed for Chinese tastes and openly sold to Chinese visitors.

China is also the world’s biggest importer of illegal timber, a trade that imperils forestswhile defrauding developing nations of billions of dollars each year in timber royalties.

China claims to be working to reduce its illegal timber imports, but its efforts are half-hearted at best, judging by the amount of illegal timber still flowing across its border with Myanmar.

A queue of logging trucks in Southeast Asia. Jeff Vincent

Infrastructure tsunami

More damaging still are China’s plans for infrastructure expansion that will irreparably degrade much of the natural world.

China’s One Belt One Road initiative alone will carve massive arrays of new roads, railroads, ports, and extractive industries such as mining, logging, and oil and gas projects into at least 70 nations across Asia, Europe, and Africa.

A partial representation of China’s One Belt One Road scheme, circa 2015. Mercator Institute for China Studies

Chinese President Xi Linping promises that the Belt and Road initiative will be “green, low-carbon, circular and sustainable”, but such a claim is profoundly divorced from reality.

As my colleagues and I recently argued in Science and Current Biology, the modern infrastructure tsunami that is largely being driven by China will open a Pandora’s box of environmental crises, including large-scale deforestation, habitat fragmentation, wildlife poaching, water pollution and greenhouse gas emissions.

China’s pursuit of natural resources is also escalating across Latin America. In the Amazon, for example, big mining projects – many of which are feeding Chinese industries – don’t just cause serious local degradation, but also promote widespread deforestation from the networks of roads bulldozed into remote areas to access the mines.

Why roads are so dangerous for nature.

Overall, China is the most aggressive consumer of minerals on the planet, and the biggest driver of tropical deforestation.

Beyond this, China is pushing to build a 5,000km railroad across South America, to make it cheaper for China to import timber, minerals, soy and other natural resources from ports along South America’s Pacific coast. If it proceeds, the number of critical ecosystems that would be impacted by this project is staggering.

World Bank study of more than 3,000 overseas projects funded or operated by China revealed how it often treats poor nations as “pollution havens” – transferring its own environmental degradation to developing nations that are desperate for foreign investment.

Finally, much has been made of the fact that China is beginning to temper its appetite for domestic fossil-fuelled energy. It is now a leading investor in solar and wind energy, and recently delayed construction of more than 150 coal-fired electricity plants in China.

These are unquestionably pluses, but they need to be seen in their broad context. In terms of greenhouse-gas emissions, China has exploded past every other nation. It now produces more than twice the carbon emissions of the United States, the second-biggest polluter, following the greatest building spree of coal, nuclear, and large-scale hydro projects in human history.

Despite its new post-Trump role as the world’s de facto climate leader, China’s overall agenda could scarcely be described as green.

A tiger relaxes along a grassy bank. Matt Gibson/Shutterstock

Iceberg ahead

Some would say it’s unfair to criticise China like this. They would argue that China is merely following a well-trodden path of exploitative development previously forged by other nations and colonial powers.

But China is not the same as any other nation. The astounding growth and size of its economy, its dangerously single-minded vision for exploiting natural resources and land internationally, its intolerance of internal and external criticism, and its increasingly closed media and official myopia all combine to make it unique.

President Xi admits that many Chinese corporations, investors and lenders operating overseas have often acted aggressively and even illegally overseas. But he says his government is powerless to do much about it. The most notable government response to date is a series of “green papers” containing guidelines that sound good in theory but are almost universally ignored by Chinese interests overseas.

Indigenous forest people in the Congo Basin become increasingly poor and marginalised as foreign miners, loggers and poachers invade their lands.Mahmoud Mahmoud

Are Xi’s assertions of powerlessness believable? He increasingly rules China with an iron hand. Is it really impossible for China to guide and control its overseas industries, or are they simply so profitable that the government doesn’t want to?

Of course, China’s huge international ambitions will have some positive effects, and could even be economically transformative for certain nations. But many other elements will benefit China while profoundly damaging our planet.

This article was written by:
Image of Bill LauranceBill Laurance – [Distinguished Research Professor and Australian Laureate, James Cook University]






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You should never drive into floodwater – some roads are more deadly than others

 A flooded street in Euroa, Victoria. 
AAP Image/Brendan McCarthy

The floods that deluged parts of Victoria over the weekend are the latest in the state’s long history of flooding, following on from major floods in 2010, 2011, 2012 and 2016. In all such events, emergency services are on standby to rescue motorists who drive into floodwaters and get stuck or washed away – with potentially fatal consequences.

Most of the 178 flood-related deaths since 2000 have been a consequence of motorists driving into floodwaters.

Although there is a growing body of research on the decision-making of people who choose to enter floodwater, little research has been done before now on the factors that make some stretches of road more dangerous than others.

Why do people drive into floodwater? Often they are trying to get to or from work, or carrying out work-related duties such as surveying farmland or driving trucks. It is hard to judge the depth and speed of water, or to tell if there is debris or damage below the surface. A simple error of judgement can prove fatal, which is why emergency services warn against driving through floods even when the conditions look benign.

Our research, carried out by Risk Frontiers, Macquarie University and the Bushfire and Natural Hazards Cooperative Research Centre (CRC), is among the first to consider the influence of road characteristics on flood deaths.

We analysed the road characteristics at 21 sites in NSW, Victoria, Western Australia and Queensland where flood-related motoring deaths have occurred since 2010. We found that some roads are clearly more dangerous than others.

Several factors increase the danger of a particular stretch of road, including:

  • small upstream catchment size
  • the presence of roadside barricades
  • the depth of flooding next to the roadway
  • absence of street lighting
  • dipping road grade
  • lack of kerbs and guttering
  • inability of motorists to easily turn around.

Each of these factors was observed in at least half of the cases we studied. Yet these kinds of risk profiles largely not considered in emergency planning or flood-management approaches, which tend to focus on urban flood risk. The large number of flood-prone road sections means that we need to prioritise those roads that are most in need of safety improvements.

Rapid threat

At eight of the sites we studied, emergency services or passers-by were on the scene within several minutes, either to attempt rescue or to call for assistance. This suggests that road conditions in some locations are so dangerous that first responders will be unable to help if a vehicle is submerged or swept away.

At 12 of our study sites, roadside flood signage was probably present at the time of the incident. (As our assessments were done some time after the deaths occurred, we have to use the best available information, which presents a small degree of uncertainty that the signage may have changed.)

Depth markers were the most common, followed by “Road subject to flooding” signs. This suggests that some motorists ignore, misinterpret or fail to notice warning signs, or that signs can be damaged, lost or obscured after installation. We suggest that signage should be improved in areas identified as high-risk.

The difficulty of turning a vehicle around at many sites underlines the importance of encouraging motorists to plan ahead, rather than make a snap decision to enter floodwater.

When severe weather is forecast, motorists should plan journeys in advance, with the help of up-to-date road information from an authoritative source such as the VicRoads website.

As many motorists enter floodwater for work-related purposes, employers also have a responsibility to promote safe driving behaviour.

Whatever the exact reasons, all of the deaths at our study sites ultimately happened because someone decided to drive into floodwater. Our study showed that roads vary widely in safety. The water might look shallow and easy to negotiate, but you can never be completely sure. For that reason, the safest option is always to stay well clear.

This article was written by:
Image of Andrew GissingAndrew Gissing – [Director Resilience, Macquarie University]






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Sustainable Shopping: the eco-friendly guide to online Christmas shopping

 Online shopping is quick and fun. 
There are ways to make it eco-friendly.

Online shopping has recently smashed retail records worldwide, while its growth has continued significantly in Australia. With Christmas just around the corner, Australia Post expects this to be the busiest year it has ever seen.

December is the largest buying month in Australia, with online shopping hitting its peak during the Christmas period. In 2016, total online spending hit a staggering A$21.7 billionwith a 10.4% growth in parcels.

An increase in purchases usually leads to an increased carbon footprint, but online shopping can actually be more environmentally friendly than traditional shopping – as long as you follow these simple rules.

Online shopping can be better than buying in-store

During the 2016 Christmas period, Australian Post handled more than 34 million domestic parcels. It might seem natural to assume that all this package delivery increases the environmental impact of our shopping, but research shows that completely online buying is better than going to a store.

The major reason for online shopping’s lower carbon footprint is the reduced number of trips we make to stores. A delivery truck uses far less fuel per package than an equivalent number of people driving in person to pick them up.

However, many people will check products in-store before buying them online, which negates the benefit of online shopping. A 2013 study from the MIT Center for Transporation and Logistics found that shoppers who visit stores before buying online generate a carbon footprint almost twice the size of a purely online purchase.

Online shopping festivals result in huge sales. But this also amounts to a ridiculous amount of disposable packaging. EPA/HOW HWEE YOUNG

Problems also arise when consumers are not at home, as redeliveries add a significant amount of carbon emssions to online purchases. Flexible delivery options, like Australia Post’s Safe Drop, can help mitigate this (and some overseas companies actually allow adjustable delivery times).

Another environmental concern is the packaging itself. Most packaging boxes consist of cardboard and various types of plastics. Sadly, almost half of the boxes are not recycled. And while you might feel guilty about this waste, the bigger issue lies in your returns.

At Zalando, one of the biggest online retail websites, where shipping and returns are free, the return rate of packages is 50%. In the US, the chain of returned goods used 4.5 billion litres of diesel fuel and emitted 12 million tonnes of carbon emissions in 2015 alone.

In summary, picking up items after a failed delivery or at a click-and-collect point, returning unwanted items, or other complementary shopping trips all increase the carbon footprint.

Thousands of unpackaged items in one of many hundreds of logistic centres around the world. EPA/CHRISTOPH SCHMIDT

The 4 Rs of sustainable online shopping

Although the entire delivery process is complex and consists of many variables, there are some simple things to keep in mind. I call them the four Rs:

Rethink: online purchasing is better for the environment, but only if the entire process remains digital from start to finish. So, no brick-and-mortar store visiting. Signing up for suitable delivery options helps to ensure your parcel arrives on time, eliminates extra deliveries and reduces your carbon impact.

Relax: buy well in advance, thereby avoiding same-day or next-day delivery. The gives transport companies the chance to consolidate the packages into fewer trips, increasing efficiency and reducing emissions.

Returns: do you really need to order that T-shirt in three sizes? Every avoided return is a contribution to the environment.

Reuse: opt for eco-friendly packaging and reuse it, especially boxes and cushioning materials. Planet Ark, an Australian environmental organisation, has lots of information on recycling if you want to understand the size of the problem.

Ultimately, although these steps can help, eco-friendly shopping begins with what you buy, and from where.

In most cases, transportation counts for only a small part of an item’s overall environmental impact, so it’s important to choose the right producer. Keep in mind that, although delivery is important, there is an entire supply chain that comes before it. Happy sustainable shopping!

This article was written by:
Image of David M. HeroldDavid M. Herold – [Sustainable Logistics Researcher, Griffith University]






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