Marine heatwaves and the collapse of marginal North Atlantic kelp forests.

Extreme climatic events including marine heatwaves (MHWs) are becoming more frequent and severe in the Anthropocene. However, our understanding of how these events affect population dynamics of ecologically important species is limited, in part because extreme events are rare and difficult to predict. Here, we quantified the occurrence and severity of MHWs over 60 years in warm range edge kelp forests on both sides of the North Atlantic. The cumulative annual intensity of MHWs increased two- to four-fold during this period, coinciding with the disappearance of kelps. We experimentally demonstrated a relationship between strong and severe 2018 heatwaves and high kelp mortality in both regions. Patterns of kelp mortality were strongly linked to maximum temperature anomalies, which crossed lethal thresholds in both regions. Translocation and tagging experiments revealed similar kelp mortality rates on reefs dominated by healthy kelp forests and degraded sediment-laden algal 'turfs', indicating equal vulnerability to extreme events. These results suggest a mechanistic link between MHWs and broad-scale kelp loss, and highlight how warming can make ecosystem boundaries unstable, forcing shifts to undesirable ecosystem states under episodically extreme climatic conditions.

Tragedy, utopia and medical progress.

In this article, tragedy and utopia are juxtaposed, and it is proposed that the problem of "medicalisation" is better understood in a framework of tragedy than in a utopian one. In utopia, it is presupposed that there is an error behind every setback and every side effect, whereas tragedy brings to light how side effects can be the result of irreconcilable conflicts. Medicalisation is to some extent the result of such a tragic conflict. We are given power by medical progress, but are also confronted with our fallibility, thus provoking insecurity. This situation is illustrated by the sudden infant death syndrome (SIDS). Recent epidemiological investigations have shown that infants sleeping in a prone position have a 15-20 times higher risk of dying from SIDS than infants sleeping in a supine position. A simple means of preventing infant death is suggested by this discovery, but insecurity is also created. What else has been overlooked? Perhaps a draught, or wet diapers, or clothes of wool are just as dangerous as sleeping prone? Further investigations and precautions will be needed, but medicalisation prevails.

Diseases are invisible.

The success of modern medicine is closely related to its ability to transcend the human senses. Technological advances such as stethoscopes, microscopes, and x rays overstep the boundaries of human perception. They enable us to see what is invisible to the unaided senses. These technologies have brought about fundamental changes to medicine-for the most part for the better. But they have also caught us in a tragic trap. They have left us in an odd position where we can no longer trust our senses concerning the health status of our body. Sense transcending technologies have made us aware that we can have a serious disease without experiencing any symptoms at all. In order to benefit from these technologies, we have to live with inescapable side effects.

Coping with obligations towards patient and society: an empirical study of attitudes and practice among Norwegian physicians.

A questionnaire relating to attitudes towards setting economic priorities within the health care system was sent to all 151 general practitioners in Northern Norway. Of these, 109 (72 per cent) responded. Ninety-six per cent of the respondents agreed or partly agreed that the setting of economic priorities within the health care system was necessary. Ninety-three per cent had experienced a conflict between their responsibility towards the individual patient and the requirement for them to manage the health budget. The responses suggest that doctors act more in the interests of their patient than the interests of society. However, 68 per cent reported having refrained from giving the best treatment to patients because it was too expensive. As many as 60 per cent of the respondents wanted more public guidelines. Only 10 per cent wanted doctors to have more influence in difficult questions arising from setting priorities.

Left ventricular performance and cerebral haemodynamics during xenon anaesthesia. A transoesophageal echocardiography and transcranial Doppler sonography study.

The effects of xenon anaesthesia on myocardial function and cerebral blood flow velocities were investigated with transoesophageal echocardiography and transcranial Doppler sonography. Seventeen ASA 1 patients undergoing open cholecystectomy (n = 16) or abdominal hysterectomy (n = 1) were studied. Anaesthesia with 65% xenon in oxygen was induced by ventilating the lungs through a circle system with minimal fresh gas flow. The echocardiographically obtained mean (SD) fractional area change in a short axis view of the left ventricle at the level of the papillary muscles was 65 (10)% (n = 14) before xenon. There was no significant change after 5, 10 and 15 min of xenon anaesthesia. Cerebral blood flow velocities were unchanged during the first 5 min of xenon anaesthesia, but were significantly increased in the left and right middle, and the right anterior, cerebral arteries after 15 and 30 min (n = 16) (p < 0.05). In conclusion, xenon anaesthesia had no adverse effect on myocardial function, but probably increased cerebral flood flow.

[Is the main goal of the health care services to produce health?]. / Er helsevesenets viktigste oppgave å produsere helse?

A questionnaire on the relative weight attached to severity of disease and health gain when allocating scarce resources between patient groups was answered by 99 doctors in general practice. The same questionnaire had been previously answered by politicians. Doctors and politicians alike tended to emphasize severity of disease rather than health gain when allocating scarce resources. Furthermore, many did not emphasize either of these factors, but distributed the resources equally between the different patient groups. If the patients were equally ill, the doctors attached greater weight than the politicians did to health gain. The answers to the questionnaire indicate that the obligation to help the most seriously ill and to uphold the ideal of equality are regarded as more fundamental than the goal of producing health effectively.