You go to hospital for treatment and to get better. But sometimes, you get something much less welcome: an infection.

Pneumonia, an infection of the lungs, is one of the most common and deadly infections people develop in hospital. Around 50,000 patients contract pneumonia in Australian hospitals every year. Around 1,900 of them die from it.

It’s rarely monitored and rarely reported. And to date, few studies have looked at how it can be prevented.

But our new trial, published today in The Lancet Infectious Diseases, shows a surprisingly simple action can make a major difference: brushing patients’ teeth.

We found this can reduce the chance of getting this type of pneumonia, called non-ventilator hospital-acquired pneumonia, by 60%.

What is this type of pneumonia?

Non-ventilator hospital-acquired pneumonia occurs in patients who aren’t on a ventilator, usually outside of intensive care settings.

Patients are infected when bacteria from the mouth or throat are breathed into the lungs.

Patients who develop this type of pneumonia stay in hospital between ten and 48 days longer, and are around eight times more likely to die during their admission.

A simple intervention made a big difference

We studied 8,870 patients across three Australian hospitals to see whether improving oral care – which included tooth-brushing – could reduce this type of pneumonia.

Usually, when patients go to hospital, they don’t pack a toothbrush – especially in emergencies.

In busy hospital wards, oral care isn’t always given the attention it needs, nor are oral care products always readily available. Patients don’t always get reminders to brush their teeth and many patients need help with their oral care.

The intervention in our study was deliberately simple. We:

• gave patients in hospital a toothbrush and toothpaste in a bag when they were admitted

• educated patients and hospital staff about the importance of tooth-brushing. The toothbrush also had a written prompt on it – “Brush away pneumonia”

• assisted patients who needed help with tooth-brushing

• audited how oral care was being delivered and gave feedback to hospital wards.

We introduced the intervention into one ward at a time over 12 months at each hospital. This gradual roll-out is known as a stepped-wedge cluster randomised trial. It can test new health interventions when it’s too difficult to randomise individuals without revealing who is receiving the intervention and who isn’t.

We found that this relatively simple intervention increased the proportion of people who cleaned their teeth from 16% to 62%.

This increasing oral care led to a 60% reduction in the risk of acquiring pneumonia, from the equivalent of eight infections per month on a typical ward of 30 patients, to less than four infections per month.

This is the largest trial of its kind and the first completed across multiple hospitals.

Why does brushing teeth help?

The mouth is home to billions of bacteria. Oral hygiene often deteriorates when people are unwell, sedated, immobile, or taking certain medications.

When this happens, bacteria build up on the teeth, gums and tongue. If these bacteria are breathed in – even in tiny amounts – they can cause pneumonia.

Daily tooth-brushing reduces this bacteria. It’s a simple mechanical action with a powerful protective effect.

Yet in busy hospitals, oral care is often overlooked. Patients may not know just how important oral care is. Staff are often busy with competing priorities and oral care can be de-prioritised. There is also a general lack of understanding about the importance of oral care.

Patients can help protect themselves

One of the most important messages from our research is patients aren’t powerless. While health-care staff such as nurses play a crucial role, patients who are able to brush their own teeth can meaningfully reduce their own risk.

If you or a loved one is admitted to hospital, you can:

• bring your own toothbrush and toothpaste
• brush your teeth twice a day if you’re able
• ask staff for help if you can’t
• remind staff if oral care has been missed.

These small actions can reduce the risk of a serious, life-threatening infection.

What happens next?

Pneumonia is costly – in lives, hospital days and the financial cost of care. But because non-ventilator hospital-acquired pneumonia isn’t routinely reported, it’s often invisible.

Our research challenges the assumption that hospital-acquired pneumonia is an unavoidable complication when you go to hospital.

It also highlights the need for hospitals to monitor non-ventilator hospital-acquired infections, in the same way they monitor falls, pressure injuries and other preventable harms.

Finally, our study strengthens the case for including oral care in national infection-prevention guidelines and nursing practice.

Oral care isn’t glamorous, expensive or technologically advanced – but it works. Sometimes, the simplest interventions are the most powerful.

Brett Mitchell receives funding from the Medical Research Future Fund which helped fund the reported study. Brett also receives funding from the National Health and Medical Research Council through an Investigator grant. He is affiliated with Avondale University and the Hunter Medical Research Institute. Brett is Editor-in-Chief of Infection, Disease and Health.

Allen Cheng receives funding from the National Health and Medical Research Council and the Australian Government for research studies and surveillance systems. He is a member of the Infection Prevention and Control Advisory Committee for the Australian Commission for Safety and Quality in Healthcare - the views expressed in this article may not reflect the views of the committee.

Nicole White receives funding from the Medical Research Future Fund which helped fund the reported study. She is a member of the Statistical Society of Australia and holds editorial roles with the Infection, Disease and Health journal and Significance magazine.

Philip Russo is an NHMRC Early Career Research Fellow at Monash University and Director of Nursing Research at Cabrini Health.

Peta Ellen Tehan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Marjane Satrapi, best known for her memoir and film Persepolis, has died, aged 56. The death of this much loved Iranian–French artist, graphic novelist, film-maker and activist has been met with widespread celebration of her life – and its dedication to resistance, freedom and humanity. French president Emmanuel Macron paid tribute to “a great artist who transformed an Iranian childhood into a universal fable”.

Satrapi was born in Rasht (like my own mother) in 1969, then raised in Tehran. She came of age during the Iranian Revolution and the turbulent years that followed. As political repression intensified, members of her family and wider social circle were arrested, persecuted – and in some cases, executed, like her uncle Anoosh, a former political prisoner and exile, executed by the Islamic Republic.

First published in 2000, Persepolis created a transformative shift in comics, memoir and political storytelling. Eventually extended into four volumes, it follows Satrapi’s childhood, her adolescence in Vienna (where her parents sent her to study in 1983) and her later struggle to navigate belonging between Iran and Europe. Satrapi returned to Tehran to attend university in 1989. In 1994, she moved back to Europe.

Satrapi finished her studies in France, where she settled, gaining French nationality in 2006. Last year, she refused France’s prestigious legion d'honneur, over its “hypocrisy” in its dealings with Iran.

Satrapi illustrated the dislocations of revolution, migration, adolescence and return in such a way that her memoir travelled far beyond her home country. Through its deceptively simple black-and-white illustrations, Persepolis became globally influential because it offered an intimate account of revolutionary Iran and exile that challenged dominant stereotypes.

For many readers, Satrapi is still the woman who explained Iran in the simplest, yet most powerful way.

Growing up between worlds with Marjane

Today, reading Persepolis with a cup of tea and a candle lit in Satrapi’s memory, I am struck by how little my reaction has changed since first watching the film at a university screening in France in 2019.

Like Marjane, I grew up between worlds: the child of returnees in the early days of the revolution, a girl who wore the compulsory hijab, listened to Western music, argued with authority, fell in love, had her heart broken and dreamed of lives beyond the horizon. Later, I welcomed political activism, harassment, migration and multiple exiles into my life. Yet what made Persepolis so powerful was not that it reflected my experiences of repression, but that it captured everything beyond.

Satrapi reminded the world that Iranians are not merely subjects of geopolitics or victims of authoritarianism. We have families, friendships, humour, terrible fashion choices, impossible romances and complicated identities.

Like all great memoirs, Persepolis made the particular universal. It allowed readers to see themselves in an Iranian girl from Tehran. In doing so, it made it harder to deny our shared humanity. Her art has the kind of charm that allows everyone to see themselves in one corner of it or another.

In Satrapi’s hands, exile was neither heroic nor tragic. It was disorienting, lonely, creative and politically productive. Her enduring legacy, however, lies not simply in what she told the world about the country she left behind, but in what she revealed about the experience of living between worlds as a human being.

“I was a Westerner in Iran, an Iranian in the West. I had no identity.”

Few lines from Persepolis capture the condition of exile more powerfully than this one.

Reading Persepolis at different times of one’s life offers a language for contradictions that often feel impossible to explain: loving one’s country while criticising it, belonging to multiple places while feeling fully accepted by none, and carrying memories across borders that others struggle to understand.

In telling her own story, Satrapi captured something far larger than herself. In her 56 years of life, she stayed true to herself and never forgot where she came from.

Iran: misunderstood and dehumanised

After the Islamic Revolution, the hostage crisis in the United States, the wars with Iraq and the emergence of a new world order after 9/11, Iran became a misunderstood country, its population dehumanised. Satrapi’s memoir restored its complexities and nuances to the imaginations of readers from different backgrounds.

The power of Persepolis comes precisely from its ordinariness. Readers follow the life of a rebellious teenager. They learn about her family, grandparents, friends, teenage crushes, a failed marriage and the arguments that liven up any dinner table. Marjane’s story – garnished with music, humour and grief – reveals how extraordinary historical events are experienced through the mundane rhythms of everyday life.

Yet Persepolis is equally about leaving behind familiarity and home. Throughout, family becomes both refuge and history.

In one of the book’s most moving sections, Satrapi’s beloved Uncle Anoosh tells her, “Our family memory must not be lost.” Decades later, those words resonate for me. Reading them, I often think of my own uncle, Kambiz, whom I lost long before my birth, when he was executed by the Islamic Republic aged 23.

But the significance of this moment extends beyond the boundaries of any single household. In authoritarian contexts, where states often seek to monopolise history and memory, families become custodians of alternative narratives. In stories passed down by parents, grandparents and relatives, Satrapi preserves memories of political imprisonment, resistance – and hope that official accounts might prefer to erase.

Nominated for an Oscar

Satrapi returned to Iran before eventually settling in France, where she built the artistic career that would make her one of the most influential voices of the Iranian diaspora. She created several graphic storytelling books.

She co-wrote and co-directed the animated 2007 film adaptation of Persepolis, and was nominated for an Oscar, becoming the first woman nominated in the category of best animated feature. She went on to direct feature films.

Satrapi’s alternative view of Iran is so compelling because she refuses to romanticise her own country, or to idealise Europe or the West. She rejects both nostalgic nationalism and complete assimilation. Instead, she inhabits the uncomfortable space in between.

For many Iranian migrants and exiles who came after her, this condition feels deeply familiar. Loving a country while criticising it. Belonging to multiple places while feeling fully accepted by none. Carrying memories that others cannot quite understand. Satrapi transformed these contradictions into a language that could be shared.

She critiqued the repression of the Islamic Republic while remaining critical of Western hypocrisy. She condemned fanaticism without embracing cultural superiority. “Between one’s fanaticism and the other’s disdain, it’s hard to know which side to choose,” she wrote in Persepolis.

Importantly, Satrapi never positioned herself as the sole voice of Iran. Rather, she understood her work as a form of translation. As Iran enters yet another period of uncertainty, marked by regional conflict, repression and deepening social fractures at home and in the diaspora, Satrapi continued to insist on the humanity and complexity of Iranian lives.

Her activism included supporting the Woman, Life, Freedom movement, following the death of Mahsa Jina Amini: a 22-year-old Kurdish-Iranian woman detained for allegedly not properly wearing the Islamic headscarf in 2022.

Her final years were spent challenging both the authoritarianism of the Iranian state and what she saw as the West’s persistent tendency to reduce Iranians to geopolitical abstractions, rather than people with histories, aspirations and agency.

A gift for generations of exiles

For many Iranian exiles, Persepolis remains more than a memoir. It is a map. A guide to memory, identity, belonging and survival. It reminds me that exile is not simply a matter of geography, but of consciousness. It has taught me that dignity can be an act of resistance and that memory itself can become a political act in times of political amnesia.

Her characters rarely find liberation through departure alone; instead, they grapple with loneliness, reinvention and the persistent question of belonging. Yet Satrapi approached these themes with humour, tenderness and an insistence on complexity.

Marjane Satrapi spent her life ensuring that humanity, resistance and the memory of Iran is never forgotten. In doing so, she gave generations of readers – and generations of exiles – a more sophisticated language for understanding home, freedom and what it means to remain human between worlds.

Shadi Rouhshahbaz does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Marjane Satrapi, best known for her memoir and film Persepolis, has died, aged 56. The death of this much loved Iranian–French artist, graphic novelist, film-maker and activist has been met with widespread celebration of her life – and its dedication to resistance, freedom and humanity. French president Emmanuel Macron paid tribute to “a great artist who transformed an Iranian childhood into a universal fable”.

Satrapi was born in Rasht (like my own mother) in 1969, then raised in Tehran. She came of age during the Iranian Revolution and the turbulent years that followed. As political repression intensified, members of her family and wider social circle were arrested, persecuted – and in some cases, executed, like her uncle Anoosh, a former political prisoner and exile, executed by the Islamic Republic.

First published in 2000, Persepolis created a transformative shift in comics, memoir and political storytelling. Eventually extended into four volumes, it follows Satrapi’s childhood, her adolescence in Vienna (where her parents sent her to study in 1983) and her later struggle to navigate belonging between Iran and Europe. Satrapi returned to Tehran to attend university in 1989. In 1994, she moved back to Europe.

Satrapi finished her studies in France, where she settled, gaining French nationality in 2006. Last year, she refused France’s prestigious legion d'honneur, over its “hypocrisy” in its dealings with Iran.

Satrapi illustrated the dislocations of revolution, migration, adolescence and return in such a way that her memoir travelled far beyond her home country. Through its deceptively simple black-and-white illustrations, Persepolis became globally influential because it offered an intimate account of revolutionary Iran and exile that challenged dominant stereotypes.

For many readers, Satrapi is still the woman who explained Iran in the simplest, yet most powerful way.

Growing up between worlds with Marjane

Today, reading Persepolis with a cup of tea and a candle lit in Satrapi’s memory, I am struck by how little my reaction has changed since first watching the film at a university screening in France in 2019.

Like Marjane, I grew up between worlds: the child of returnees in the early days of the revolution, a girl who wore the compulsory hijab, listened to Western music, argued with authority, fell in love, had her heart broken and dreamed of lives beyond the horizon. Later, I welcomed political activism, harassment, migration and multiple exiles into my life. Yet what made Persepolis so powerful was not that it reflected my experiences of repression, but that it captured everything beyond.

Satrapi reminded the world that Iranians are not merely subjects of geopolitics or victims of authoritarianism. We have families, friendships, humour, terrible fashion choices, impossible romances and complicated identities.

Like all great memoirs, Persepolis made the particular universal. It allowed readers to see themselves in an Iranian girl from Tehran. In doing so, it made it harder to deny our shared humanity. Her art has the kind of charm that allows everyone to see themselves in one corner of it or another.

In Satrapi’s hands, exile was neither heroic nor tragic. It was disorienting, lonely, creative and politically productive. Her enduring legacy, however, lies not simply in what she told the world about the country she left behind, but in what she revealed about the experience of living between worlds as a human being.

“I was a Westerner in Iran, an Iranian in the West. I had no identity.” Few lines from Persepolis capture the condition of exile more powerfully than this one.

Reading Persepolis at different times of one’s life offers a language for contradictions that often feel impossible to explain: loving one’s country while criticising it, belonging to multiple places while feeling fully accepted by none, and carrying memories across borders that others struggle to understand.

In telling her own story, Satrapi captured something far larger than herself. In her 56 years of life, she stayed true to herself and never forgot where she came from.

Iran: misunderstood and dehumanised

After the Islamic Revolution, the hostage crisis in the United States, the wars with Iraq and the emergence of a new world order after 9/11, Iran became a misunderstood country, its population dehumanised. Satrapi’s memoir restored its complexities and nuances to the imaginations of readers from different backgrounds.

The power of Persepolis comes precisely from its ordinariness. Readers follow the life of a rebellious teenager. They learn about her family, grandparents, friends, teenage crushes, a failed marriage and the arguments that liven up any dinner table. Marjane’s story – garnished with music, humour and grief – reveals how extraordinary historical events are experienced through the mundane rhythms of everyday life.

Yet Persepolis is equally about leaving behind familiarity and home. Throughout, family becomes both refuge and history.

In one of the book’s most moving sections, Satrapi’s beloved Uncle Anoosh tells her, “Our family memory must not be lost.” Decades later, those words resonate for me. Reading them, I often think of my own uncle, Kambiz, whom I lost long before my birth, when he was executed by the Islamic Republic aged 23.

But the significance of this moment extends beyond the boundaries of any single household. In authoritarian contexts, where states often seek to monopolise history and memory, families become custodians of alternative narratives. In stories passed down by parents, grandparents and relatives, Satrapi preserves memories of political imprisonment, resistance – and hope that official accounts might prefer to erase.

Nominated for an Oscar

Satrapi returned to Iran before eventually settling in France, where she built the artistic career that would make her one of the most influential voices of the Iranian diaspora. She created several graphic storytelling books.

She co-wrote and co-directed the animated 2007 film adaptation of Persepolis, and was nominated for an Oscar, becoming the first woman nominated in the category of best animated feature. She went on to direct feature films.

Satrapi’s alternative view of Iran is so compelling because she refuses to romanticise her own country, or to idealise Europe or the West. She rejects both nostalgic nationalism and complete assimilation. Instead, she inhabits the uncomfortable space in between.

For many Iranian migrants and exiles who came after her, this condition feels deeply familiar. Loving a country while criticising it. Belonging to multiple places while feeling fully accepted by none. Carrying memories that others cannot quite understand. Satrapi transformed these contradictions into a language that could be shared.

She critiqued the repression of the Islamic Republic while remaining critical of Western hypocrisy. She condemned fanaticism without embracing cultural superiority. “Between one’s fanaticism and the other’s disdain, it’s hard to know which side to choose,” she wrote in Persepolis.

Importantly, Satrapi never positioned herself as the sole voice of Iran. Rather, she understood her work as a form of translation. As Iran enters yet another period of uncertainty, marked by regional conflict, repression and deepening social fractures at home and in the diaspora, Satrapi continued to insist on the humanity and complexity of Iranian lives.

Her activism included supporting the Woman, Life, Freedom movement, following the death of Mahsa Jina Amini: a 22-year-old Kurdish-Iranian woman detained for allegedly not properly wearing the Islamic headscarf in 2022.

Her final years were spent challenging both the authoritarianism of the Iranian state and what she saw as the West’s persistent tendency to reduce Iranians to geopolitical abstractions, rather than people with histories, aspirations and agency.

A gift for generations of exiles

For many Iranian exiles, Persepolis remains more than a memoir. It is a map. A guide to memory, identity, belonging and survival. It reminds me that exile is not simply a matter of geography, but of consciousness. It has taught me that dignity can be an act of resistance and that memory itself can become a political act in times of political amnesia.

Her characters rarely find liberation through departure alone; instead, they grapple with loneliness, reinvention and the persistent question of belonging. Yet Satrapi approached these themes with humour, tenderness and an insistence on complexity.

Marjane Satrapi spent her life ensuring that humanity, resistance and the memory of Iran is never forgotten. In doing so, she gave generations of readers – and generations of exiles – a more sophisticated language for understanding home, freedom and what it means to remain human between worlds.

Shadi Rouhshahbaz does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Cricket and soccer are two of, if not the biggest national sporting codes in Australia.

Yet the governing bodies of both have recently been in the news for their financial difficulties.

How can it be these two dominant codes are struggling?

Major sports, major problems

Football Australia (FA) recently announced it will cut around 20% of its workforce, following a loss of more than $15 million. This has raised concerns about organisational performance.

But the financial detail suggests something more structural.

In 2025, FA generated record revenue of approximately $139 million, yet reported a net loss of $15.3 million – about 11% of total income.

This follows a deficit of $8.5 million the previous year.

Revenue has been rising but financial stability remains elusive, a pattern also evident in Cricket Australia (CA).

CA reported around $455 million in revenue and an operating surplus of $109.6 million in 2024–25. However, after distributing roughly $120 million to state associations, it recorded a net deficit of about $11 million.

This highlights how large revenues in sport do not necessarily deliver financial strength.

In many governing body models, revenue functions less as retained capital and more as a redistribution mechanism to support leagues, grassroots systems, pathways and national teams.

Revenue growth without financial stability

At first glance, both organisations appear financially strong.

FA has expanded commercial partnerships and participation while CA has benefited from increased attendance and broadcast income associated with major international series.

However, much of this revenue is cyclical, particularly in cricket where income fluctuates with international scheduling, while soccer revenues remain exposed to changes in participation patterns and media markets.

This suggests FA’s high fixed costs relative to variable costs are limiting profitability.

Much of FA’s cost base is now structurally embedded: national team investment, women’s soccer expansion, technical infrastructure and participation systems. These create recurring expenditure that is difficult to reduce quickly without damaging sporting or political objectives.

On the expenditure side, both organisations face relatively inflexible cost structures. FA’s employee and team-related expenses increased to more than $63 million in 2025, up from about $50 million the previous year.

Wages alone rose by roughly $11 million over the same period.

CA faces comparable pressures. Total expenses rose to nearly $346 million, with player payments exceeding $133 million – representing the largest category of expenditure.

While CA generated a substantial operating surplus, much of that cash flow is redistributed via state funding arrangements, player payments and system-wide commitments.

In practice, CA functions more like a financing institution for the broader national cricket economy.

What the financial data actually show

FA’s revenue increased from $124 million in 2024 to $139 million in 2025, yet its losses expanded from $8.5 million to $15.3 million during the same period.

This divergence reinforces earlier evidence that expenditure growth, particularly in labour-intensive areas, is outpacing revenue, reflecting cost pressures within the system.

These costs appear structurally embedded, which means they can’t be easily reduced in the short term.

FA has also been affected by the A-League’s own turbulent finances.

While FA is the governing body for soccer in Australia, the A-League is independent. FA does not directly cover the league’s losses but does support the A-League by allowing it to retain money it might otherwise have owed.

This is because a financially stable A-League is critical to the health of the entire soccer system, including player development, national team performance and the sport’s commercial viability in Australia.

CA’s position reflects a different structural constraint. While the organisation generated an operating surplus of $109.6 million, distributions of around $120 million to state associations effectively absorbed that surplus, resulting in a net deficit.

This financial uncertainty led CA to recently investigate raising money by selling some or all of its Big Bash League teams to private equity. However, the move was quashed by the states.

Read more: Cricket Australia’s Big Bash cash grab is rejected – but there are better options on the table

Governance constraints and contested reform

Australian sports’ governing bodies are increasingly caught between globalised cost structures and comparatively limited domestic market scale. Many remain dependent on cyclical broadcast markets and concentrated domestic audiences.

These structural pressures are made worse because FA still has financial obligations tied to the A-League. But anticipated A-League revenues have not been fully realised, transferring financial strain onto the FA.

CA provides a comparable example, where proposals to restructure commercial arrangements, such as the proposed Big Bash equity sales, have been constrained by stakeholder resistance.

Together, these cases illustrate how federated governance structures constrain financial adaptability, creating structurally embedded pressures in which cyclical revenues and rising cost bases generate financial strain even during periods of growth.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.