Medical Autopsy Need of Time. 2019.

autopsy viktig

Også i våre dager, selv med all “superteknikk”, er det meget viktig med å få utført autopsy, som nærmest er “gullstandaren” for hva som feilte pasienten, hva som gjorde at pasienten døde,  hvordan pasienten døde, og nye ikke oppdagede funn.

Dessverre er det stor reduksjon av antallet obduksjoner, blant annet fordi kliniske leger ikke tror man finner noe nytt (stor variasjon mellom de forskjellige avdelinger) og fordi patologer er “overanstrengte” (også alt for få patologer) med mange andre oppgaver med pasienter ( blant annet å stille/ avkrefte alle kreftdiagnosene).

Post-Mortem Examination as a Quality Improvement Instrument. Dtsch Arztebl Int 2018; 115: 653-8. DOI: 10.3238/arztebl.2018.0653 Wittekind, C; Gradistanac, T

Post-Mortem Examination as a Quality Improvement Instrument

Dtsch Arztebl Int 2018; 115: 653-8. DOI: 10.3238/arztebl.2018.0653

Wittekind, CGradistanac, T

Background: Autopsies are considered an important quality assurance instrument in medicine, yet autopsy rates in many countries have been declining for many years. The proper role of the post-mortem examination in modern medicine is a matter deserving of study.

Methods: This review is based on a selective search of the literature for publications on the role of autopsies as a quality assurance instrument.

Results: Multiple studies have revealed substantial rates of discrepancy between pre- and post-mortem diagnoses, with reported rates lying in the range of 10% to 40%. The frequency of so-called Goldman I erroneous diagnoses, i.e., those that are determined at autopsy and might have influenced the patient’s survival, ranges from 2.4% to 10.7%. It can be assumed that the rate of serious diagnostic errors revealed by autopsy would fall if autopsy rates were to rise. Independently of the above-mentioned studies, a large-scale study of data from the period 1988–2008 revealed a decline in the rate of Goldman I erroneous diagnoses by more than half. The qualitative effects of autopsies, however, are difficult to measure. At present, imaging studies and minimally invasive or endoscopic diagnostic procedures can be performed post mortem as well, but the available studies show that these methods do not yet suffice to enable a coherent pathogenetic classification of disease processes.

Conclusion: Autopsies should still be performed in the interest of quality assurance in medicine. Uniform standards in the performance and reporting of autopsies could lead to improvement in the use of the data acquired through them.

LNSLNS

Ever since G. B. Morgagni (1) first showed the scientific value of autopsies, many reasons have arisen for carrying out autopsies over the centuries (2). Despite the manifold indications for autopsy, however, over the past few decades autopsy rates have been falling all over the world, and so they have in Germany. Opinions vary as to what lies behind this drop in autopsy rates. Our own experience, based on many interviews and conversations, suggests that many doctors, especially young ones, believe that clinical findings and causes of death can be adequately investigated using available clinical diagnostic techniques, so that autopsies have become unnecessary. This view is contradicted, however, by many publications showing that discrepancies continue to exist between pre-mortem and post-mortem diagnoses. In this article, we discuss alternatives to the “classical” autopsy.

The clinical autopsy: definition and indications

A clinical autopsy is a macroscopic medical examination by a physician of (if possible) all three body cavities of a deceased person, supplemented by clinical information relating to the medical history, cause of death, and clinical questions (Box 1).

Discrepancies between pre-mortem and post-mortem diagnoses are of varying significance for the treatment of the patient and are usually classified according to the Goldman criteria (3):

  • Class I error: Misdiagnosis that may have affected survival and probably would have required alteration of treatment
  • Class II error: Misdiagnosis that did not affect survival and would not have required alteration of treatment
  • Class III and class IV errors: Missed minor diagnoses unrelated to the disease course

Discrepancies between pre-mortem and post-mortem diagnoses

Since 1912, up to 2002 and even later, numerous studies have shown considerable differences between pre- and post-mortem diagnoses (Table 1) (413e2e5).

In 2003, a literature search by Shojania et al. (14) for the period 1966 to 2002 identified a total of 45 studies (53 different autopsy series). Irrespective of methodological problems, which they discussed, these authors reached the following conclusions: On average, the rate of class I errors was 9% (range: 0 to 20.7%). As time went by, a relative reduction in class I errors of 33.4% (95% confidence interval [CI]: [8.4; 51.6]) per decade was seen. Based on the studies they had analyzed, the authors estimated for 2003 that with a 5% autopsy rate the percentage of class I errors would be 6.7% (95% CI [3.8; 11.4]), with a 37% autopsy rate it would be 5.8%, and with a 100% autopsy rate it would be 4.1%. Their explanation for this tendency was that when the autopsy rate is low, it may be assumed that the percentage of clinically suspect cases is higher.

Wittschieber et al. (15) reported on more than 1800 adult autopsies in Berlin. Cases from the years 1988, 1993, 1998, 2003, and 2008 were investigated. Class I errors went from 25.8% in 1988 down to 10.7% in 2008 (p<0.00001; 95% CI: [7.7%; 14.7%]). Class III errors rose from 13.7% (1988) to 27.0% (2008) (p<0.00001). The course over time of class I and class II errors showed a drop from 43.4% (1988) to 27.1% (2008) and that of class III and class IV errors a rise from 16.4% (1988) to 33.0% (2008) (p<0.00001) (15). A comparative study by Erlmeier et al. (16) of two university hospitals in Germany confirmed a fall in autopsy rates (hospital 1: autopsy rate 20.8% [243 cases] in 2005 and 11.1% [167 cases] in 2014; hospital 2: autopsy rate 11.5% [118 cases] in 2005 and 7.3% [85 cases] in 2014). The discrepancy rate in the cases they studied was 6.6% (88.9% agreement between the clinically assumed cause of death and the autopsy finding, 4.5% no information). Marshall and Milikowski (17), too, in a 6-year retrospective study of adult autopsies, found a class I discrepancy between pre-mortem and post-mortem diagnoses in 9.9% of cases (33 out of 334).

There was little variation in discrepancy rates between pre-mortem and post-mortem diagnoses in cancer patients, patients with infections, and trauma patients, and similar rates were seen in patients in intensive care units, intermediate care units, and normal wards. Tables 1 and 2 show the discrepancy rates and frequently occurring misdiagnoses.

A meta-analysis that included only studies of patients who had died in intensive care between 1966 and 2011 reviewed 31 studies of 5863 autopsies (18). The prevalence of misdiagnoses ranged from 5.5% to 100%; 28% of autopsies showed at least one misdiagnosis, 8% of which were class I and 18% class II errors. The calculated rate of misdiagnoses assuming a hypothetical 100% autopsy rate was 6.3% (95% CI: [4.0%; 7.5%]). The most common misdiagnoses were pulmonary embolism, myocardial infarction, pneumonia, and aspergillosis. The authors concluded that around 34 000 (95% CI: [22 000; 40 500]) patients die every year in intensive care units in the USA as a result of class I errors, assuming that these misdiagnosed conditions were the cause of death.

In one study carried out at a general hospital in collaboration with the Leipzig University Hospital Institute of Pathology, it emerged that as the autopsy rate rose from about 3% to 26%, the rate of errors with implications for prognosis (class I errors) was seen to fall from 18.8% (95% CI: [10.2; 31.9]) to 11.6% [95% CI: [7.4; 17.9]) (19).

A study from the Leipzig University Hospital Institute of Pathology analyzed all 4592 autopsies carried out in the period from 2000 to 2009. This showed that 263 malignant tumors had not been found during the patient’s lifetime, equating to 5.7% of all autopsies or 20.2% of all proven malignant tumors; 23% of the malignant tumors that had not been discovered while the patient was alive were at least contributory causes of death. The most common were prostate cancer (23.9%), colorectal cancer (16.3%), renal cancer (13.0%), lung cancer (12.7%), and liver cancer (6.5%) (5e1).

In addition to detecting discrepancies in patients with cancer, our experience shows that even now, autopsies still have an often undervalued part to play in identifying clinically obscure focuses of infection in cases where sepsis or septicopyemia has been diagnosed.

Potential uses of autopsy as a quality assurance tool

In addition to the purposes stated by the American Society for Clinical Pathology (ASCP) (20) (Box 2), quality assurance appears to be possible in the following areas:

  • Internal quality assurance within Pathology Departments through autopsy audits
  • Evaluation of the efficacy and potential unwanted effects of new drugs, new surgical techniques, and new genetic engineering techniques
  • Acquisition of knowledge about new patterns of old diseases (e.g., tuberculosis and syphilis)
  • Provision of information to relatives.

A key point is the call from the ASCP to give greater prominence in medical curricula and training to the importance of autopsies for quality assurance, with the aim of influencing autopsy behavior in the long term.

Prevalence of autopsies in Germany

An article by Grassow-Narlik et al. (21) gives the drop in autopsy rate between 2005 and 2014 as 30%. About 4% of people who died in Germany in 2014 underwent autopsy. In university hospitals, the autopsy rate was about 5% higher than in non-university hospitals.

Assessment of autopsy findings from the perspective of clinicians and cancer centers

In 2017, expectations of clinical autopsy findings were formulated from the point of view of various clinical specialties, in order to produce more meaningful reports for clinicians. From the point of view of clinicians from various specialties, particular requirements for a “good” autopsy were indicated – including appropriate and timely communication of the autopsy findings (2225).

Hofstadter (26) has emphasized that planned legal requirements such as certification programs for health care structures can only be effective if clinical autopsy is included within the structure of clinical cancer registration.

Possible reasons for the decline in autopsy numbers

Autopsy numbers have been falling for years. If you ask clinicians and pathologists why this is, they usually say it is because relatives are becoming less willing to agree to autopsy. The true reasons are more complex (22728), but include:

  • Medical curricula and clinicians’ attitudes
  • The role of the pathologist
  • Financial reasons
  • The role of the family

Medical curricula and clinicians’ attitudes

Many of the younger generation of doctors never had the importance of autopsies explained to them during their training, and so they are insufficiently aware of how much there is to learn from autopsies. The time when consent for an autopsy needs to be sought is a time of great psychological stress for the doctors who have to break the news of the death, as it is for the families who have to receive it. Younger doctors having these conversations are not prepared for these situations and often will not mention the possibility of an autopsy nor ask for consent for one.

In addition, there is the fear that any errors in treatment could be revealed by the autopsy. Fear of having one’s mistakes discovered can lead to a situation where the relatives of a patient who has died are not even asked whether they would agree to an autopsy.

Role of the pathologist

Some pathologists—both in the academic environment and in private practice—have described a reluctance to performing autopsies (16). Time needed for an autopsy is time taken away from research and publishing. Recent research findings in molecular pathology offer better opportunities for high-impact publications (2). Many pathologists have a great deal to say about the importance of autopsies, but do nothing about developing initiatives to increase the autopsy rate.

Financial reasons

Financial reasons are reported as a highly probable cause of the fall in autopsy rates. A complex autopsy, including consultation with clinicians and preparation of the autopsy report, requires many hours of work. Depending on the degree of difficulty involved, the actual cost of an autopsy should be reckoned at between €700 and €1200.

Autopsy is less well compensated financially than biopsy. In the overall finances of a hospital, too, money (= time) is often too short for clinicians to be able to devote the time required to the consultations associated with autopsies.

Role of the family

Emotional upset and grief on the part of family members also play a part in the withholding of consent to autopsy. However, a recent survey has shown that, if the question is put sensitively, 40% to 50% of relatives agree to an autopsy (29). It is unlikely that the willingness of the family to agree to autopsy is the main reason limiting the number of autopsies.

Measuring the quality effects of autopsy

Autopsy itself is not error-free, since pathologists, like all other doctors, sometimes mistake a diagnosis. To date there are no studies that have investigated the misdiagnosis rate in autopsy diagnoses (30). Neither are there any systematic studies on the question of how often no (unequivocal) cause of death can be established at autopsy. Autopsy protocols and reports are not at all uniformly presented: practically every institution has its own way of handling autopsy data, diagnoses, and reports. This makes it difficult to compare autopsy findings in a systematic way.

Recently, the Federal Association of German Pathologists (Bundesverband Deutscher Pathologen) and the German Society of Pathology (Deutsche Gesellschaft für Pathologie) published an S1 guideline for the performance of autopsies, in which many problems, tools, etc., relating to autopsies were described and discussed (31). The requirements set out in the guideline as a step towards standardization of autopsy reports will be an important instrument of quality assurance within pathology departments. In 2017, Friemann stated that “if there is to be a sustained revaluation of the clinical autopsy by the medical profession, autopsies need to reach an adequate standard of quality all over the country. One of the marks of quality is that autopsy reports reach the hospital within the period when the clinicians can still remember the deceased patient” (32).

There are no data to support the widespread belief that autopsies lead to improvements in patient care (33). This could mean that belief in the qualitative importance of autopsies really is a “matter of faith,” and that doubters can cite a lack of evidence. On the other hand, many clinicians and pathologists know the teaching effect of an unexpected autopsy diagnosis, which can continue to benefit patients with identical patterns of illness for many years after. Measuring the improvement in quality will remain difficult.

Our view is that discrepancies between pre-mortem and post-mortem diagnoses need to be recorded and compared over defined time periods. One way of retrospectively determining the usefulness of autopsies is to send out short survey forms designed to record the main features by which the usefulness of and autopsy is assessed (by the clinicians) (eQuestionnaire). Our own experience shows that a return rate of about 60% of these forms can be achieved, and that therefore autopsies—as assessed by clinicians in our hospital—have yielded relevant diagnostic and/or therapeutic information in about 60% of cases.

New legal basis

The guidance issued by the pathologists about autopsy quality (S1 guideline) was one building block along the road to developing a legal foundation for payments for autopsies (31). On 1 January 2016, when the German Hospital Structuring Law (Krankenhausstrukturgesetz) came into effect, the principle that autopsies as a valuable quality assurance tool might under certain conditions be paid for by supplementary funding became established for the first time under social law. The German National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), the German Association of Private Health Insurers (Verband der Privaten Kran­ken­ver­siche­rungen), and the German Hospital Federation (Deutsche Krankenhausgesellschaft) are currently working together on a negotiated agreement on clinical autopsies in accordance with § 9 paragraph 1a N3.3 of the German Hospital Fees Act (KHEntgG, Krankenhausentgeltgesetz) (34).

Alternatives to the classical autopsy

In view of the falling numbers of autopsies in various countries, new techniques are being developed to enable post-mortem findings to be obtained. For this purpose, imaging techniques (computed tomography, magnetic resonance imaging, angiography) are being used post-mortem, providing an opportunity to obtain post-mortem biopsies from clinically suspect areas of morbidity and study them under the microscope. Other procedures include:

  • Minimally invasive autopsy
  • Endoscopic autopsy
  • Virtual autopsy (3440e6).

These procedures can afford insights into circumscribed disease processes and can also provide clues to causes of death. However, a complete pathogenetic account of disease processes cannot be achieved by this means (Table 3). One recent study concludes that “at present, postmortem imaging can only supplement the clinical/pathological autopsy; it cannot replace it” (40).

Conclusions for clinical practice

With discrepancy rates between premortem and postmortem diagnoses remaining steady over the years at around 10%, most clinicians and pathologists continue to regard autopsies as necessary. The autopsy rate can be increased by maintaining standards in carrying out and reporting on autopsies. On the legislative side, changes are being introduced by which autopsy is recognized as a quality assurance tool and conditions set out for improved financial compensation. At the present date, various techniques of post-mortem examination can supplement but not replace conventional autopsy.

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 6 November 2017, revised version accepted on
18 June 2018.

Translated from the original German by Kersti Wagstaff, MA.

Corresponding author:
Prof. Dr. med. Christian Wittekind

Institut für Pathologie, Universitätsklinikum Leipzig

Liebigstr. 26, 04103 Leipzig, Germany

Christian.Wittekind@medizin.uni-leipzig.de

HEAVY SUMMER SNOW BURIES PARTS OF SOUTHEAST AUSTRALIA DECEMBER 2, 2019 CAP ALLON.

Extreme Weather GSM 

HEAVY SUMMER SNOW BURIES PARTS OF SOUTHEAST AUSTRALIA

An unseasonable “cold snap” -ha- is still delivering significant dumps of summer snow across the Victorian Alps, as well as rare flurries as low as Mount William in the Grampians.

Many Aussie ski resorts have reported large accumulations of summer snow over the weekend, as the Grand Solar Minimum continues its intensification down-under.

Mount Hotham had a healthy 30+ cm (11.8+ inches) on the ground by Monday morning, with more snow expected throughout the day. Falls Creek registered 25+ cm (9.8+ inches) and Mount Buller saw 21+ cm (8.3+ inches).

Sam Perry@samskis1

20-30cms of snow has falls here in @Falls_Creek its starting to feel like Christmas. I may even go for a ski…. @abcnews

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“We have had over 25 cm of snow overnight, and it is still going,” said Grace Smith from Falls Creek.

“We did think about reopening, but we thought we might leave this one to the locals, to get the last turns in for 2019.”


The rest of the week is expected to remain anomalously cold across vast swathes of Australia, too — with temps holding well-below the December average.

In Melbourne, for example, residents will likely have to wait until next Sunday for any warm-up.

Despite these real-world observations, the BOM are sticking with their original summer forecast, with stubborn senior meteorologist Michael Efron saying: “climate indicators suggest we’re actually in for a warmer and drier than average December”.

Climate indicators?!

Let me guess, all this unseasonable cold and snow is weather, right Mike? While next week’s warm-up will be classed as climate?

This is beyond a joke.

robert alexander@r0to00

mel”k so one for the impossible file. looking at 30cm of snow hotham alpine resort in australia’s second day of summer. weird polar vortex ~ “

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Anthony Bergelin@Bergeonline

The prophesy has come true. The Apocalyptic heating has started!

Snow at Mt Buller Australia this morning on first day of summer. @JWSpry @JaggerMickOZ @AndyOz2 https://twitter.com/Bergeonline/status/1200320082888445953 

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Anthony Bergelin@Bergeonline

Apocalyptic catastrophic global heating is unstoppable in Australia as we head into summer. Snow forecast for the next 4 days! @JWSpry @dbirch214 @drwaheeduddin @AndyOz2 #ClimateEmergency

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Anthony Bergelin@Bergeonline

As the morning of the first day of summer progresses the temperature at Mt Hotham Australia has dropped to minus 2 degrees Celsius and the snow has started to fall.

Apocalyptic catastrophic global heating is unstoppable.

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41 people are talking about this

AN EMAIL I RECENTLY RECEIVED FROM PETER, A GUY ON THE GROUND:

I live in south east Australia, we have been having winter like temperatures all October and November, everyone is talking about it, but to the north of the state of Victoria it is pretty normal, they are in drought and have fires but Victoria and Tasmania are very cold, no drought here thankfully and it is green, Sunday is the first of summer and we are tipped to have snow on he mountains and only 11C 50F here, this is UNHEARD of and there is talk it may break a cold record for the first day of summer, nobody in the media is reporting on this, the BOM blames the SSW and the strong negative AAO, we were thinking perhaps this might become more common during a Grand solar minimum because studies showed south east Australia was unusually colder and wetter during the maunder minimum, ‘through core samples etc.

 Just thought you might be interested in knowing in November where I live it was 2C colder than average and places like Falls Creek in the mountains were 4.4C colder than average, but Melbourne was average, people are now questioning whether the heat island effect may be responsible there as everywhere else is 1.5C to 5C colder than average — most here are 1.5C to 5C colder…

The cold times are returning in line with historically low solar activity.

NASA has recently revealed this upcoming solar cycle (25) will be “the weakest of the past 200 years,” and they’ve correlated previous solar shutdowns to prolonged periods of global cooling here.

Our future is one of ever-descending COLD — prepare accordingly — grow your own.

Social Media channels are restricting Electroverse’s reach — be sure to subscribe to receive new post notifications by email (the box is located in the sidebar >>> or scroll down if on mobile).

And/or become a Patron by clicking here: patreon.com/join/electroverse

Any way you can, help us spread the message so others can survive and thrive in the coming times.

Grand Solar Minimum + Pole Shift

Snowfalls in Australia have a colourful history, we reminisce, as south-east braces for cold blast. ABC Weather By Kate Doyle Updated 8 Aug 2019, 2:57am

Snowfalls in Australia have a colourful history, we reminisce, as south-east braces for cold blast

Updated 

Snow falls on the mountains every year in Australia, but only rarely does it spread down onto the plains and cities.

According to Blair Trewin, senior climatologist at the Bureau of Meteorology and probably Australia’s leading weather history aficionado, the wintery snowfall event forecast for the next few days is likely to be one of the most significant in recent years.

“[But] it certainly doesn’t look like we’re going to see anything on the scale of some of the events we’ve seen historically,” he said.

Historically it has been much worse.

“Obviously our records do get more sketchy the further we go back in time,” Dr Trewin said.

So let’s delve into the fabulously sketchy world of old news and weather records, all the way back to colonisation.

June 1836

Snow in Sydney. Seriously. It didn’t stick and it has never been repeated, but according to Dr Trewin it was the first time white settlers reported seeing snow around the renowned harbour.

Snow in Australia generally comes off the Southern Ocean, so by the time it gets across to the east coast it usually runs out of steam and is sheltered by the Great Dividing Range.

But apparently not on this particular day in 1836.

August 1849

August 31, 1849, was the first big snow event in Melbourne since European settlement. The Argus newspaper, the following day, reported:

“Yesterday morning inhabitants of Melbourne were astonished at beholding the streets and housetops covered with snow to the depth of several inches, being the first occurrence of the kind which has happened since the existence of the town.”

Curiously, by the time The Argus did its 80-year review of the event in 1929, published alongside an advertisement of maternity corsets, the depth had mysteriously grown to “upwards of a foot”.

But back to 1849.

“The fall of snow was welcomed by our native-born youth, some of whom, at the age of 20 years, had never seen such a thing in their existence,” the paper reported of the currency lads and lasses.

It reports that the subsequent flooding was so severe that, “a cabman earned a handsome sum by conveying passengers across Elizabeth Street, at its junction with Collins Street, for which a penny a head was charged”.

According to Dr Trewin, this is the only time snow is known to have settled on the ground in central Melbourne.

“We have seen nothing like it since,” he said.

July 1882

By the 1880s The Argus was publishing weather charts. The chart produced for July 26, 1882 looks remarkably similar to what the south-east is expecting over the next few days.

Sure enough the following day the reports were in:

“Yesterday a spectacle of a decidedly novel and, as far as is officially known, unprecedented character, was observed by the citizens of Melbourne and suburbs, vis., a genuine snowfall.”

It may have been a good idea for them to have checked back though their old editions before claiming it was “unprecedented”, but I’m told life before the internet was hard and we all make mistakes. Getting excited and forgetful about weather is evidently not a new phenomenon.

Hopefully more accurately, it goes on:

“The fall lasted about half an hour, during which time large numbers of people in all parts of the city and suburbs watched the unusual sight with a keen and evident interest.

“The fall was by no means confined to the metropolis, for according to the communications of our correspondents, supplemented by information from the Observatory, it has extended over the whole south-eastern portion of Australia and has also embraced the elevated districts of New South Wales.”

July 1900

This was one of what Dr Trewin calls localised “oddball” snow events — where snowfall is the result of an upper level cold pool of air on the back of a low pressure system, rather than a big widespread, cold southerly outbreak pushing up into the continent, as is the case with most of the other events on this list.

He said 60 centimetres of snow fell around Bathurst, with more than a metre falling in higher areas. Another oddball occurred in 1987 around Bombala in New South Wales.

Bombala’s other claim to fame is its long snowfall record.

Dr Trewin says there are fairly limited places where we actually have good long-term systematic records at low elevations. But they did unearth one a few years ago at a place called Bukalong, which is a farm near Bombala at 750 metres elevation.

“We analysed those and found that the frequency of snow events have dropped off by about half from 1950 through to the early 2000s,” Dr Trewin said.

It is not the only place that has seen a decline in low-level snowfall.

“Historically Canberra had a snowfall significant enough for snow to settle on the ground, typically two or three times a decade,” Dr Trewin said.

“But we have to go back to 2000 for the last time we saw substantial snow settle on the ground in the central city.

“Some people probably remember that event, if nothing else, for the NRL match between Canberra and Wests which was played in the snow.”

Canberra’s biggest snowfall on record was in July 1949, when Dr Trewin says it snowed on and off for two days.

July 1901

According to Dr Trewin this was probably the most extensive fall since European settlement.

Adelaide’s Advertiser from July 31, 1901 includes reports of snow from most towns in South Australia and as far away as New South Wales and southern Queensland.

It also included a poem, from which this is a mere extract:

On July’s seventh and twentieth day,

Of nineteen hundred and one,

Was seen a wonderful display,

When sank the wintery sun.

Each rocky ridge and wooded hill,

And valley, high and low,

Showed clear, and beautiful and still,

Beneath a shroud of snow.

Robert Caldwell, Valley of the Onkaparinga.

Here’s to bringing back the publication of weather-inspired poetry.

July 1951

According to Dr Trewin this system brought snow to the suburbs of Melbourne but not in the central business district.

July 1965

This event saw the most northerly snow on record. It came in two waves: the first bringing heavy snow to the Blue Mountains, the next bringing snow all the way up to the hills around Mackay in Queensland.

Yes, the tropical end of the Great Barrier Reef — Mackay.

The hills have elevations of around 1,000 metres — pretty high. But still.

July 1986

After snow on July 25, 1986, only 20 per cent of the workers of Hobart showed up — showing perhaps less conviction than those who paid their penny at Elizabeth and Collins streets in 1849.

Snow was also reported in the suburbs of Melbourne and was widespread in surrounding regions.

Space to play or pause, M to mute, left and right arrows to seek, up and down arrows for volume.

 

VIDEO: ABC News TV reports of the snow in Hobart on July 25, 1986 (ABC News)

October 1995

Another ‘oddball’ event, especially unusual in both its timing and location.

According to Dr Trewin, it affected primarily the northern agricultural areas of South Australia, where my family was living at the time.

Sure enough, the mere mention of snow and my father revelled in the tale of cancelled cricket.

“It was a Saturday, so I was nominally going to be playing cricket at Railways Oval in Peterborough,” Dad Doyle said.

“The Willowie team only made it as far as the Morchard Hotel and rang up to say that it was snowy over there and they were quite comfortable where they were.

“And, um, we just basically, with the Clarke boys and others, just hung around for most of the day drinking the supplies that we had stocked down there for the game.”

The outback cricket game was called off because of snow, so both teams spent the day sitting around drinking beer.

The dates check out. You can’t make this stuff up.

October is late but not unheard of.

Ocean temperatures take longer to warm up than land, so October is still really late winter for the ocean, according to Dr Trewin.

“There was a particularly significant [event] actually in southern Western Australia in November 1992, which was arguably one of their two or three most significant snowfalls of the past 50 years at any time of year,” he said.

Then there was the Christmas Day snowfall in Tasmania and Victoria in 2006.

Again, according to Dr Trewin, it was about the presence of the Southern Ocean as a source of cold air.

“You actually get far more summer snowfalls to relatively low elevations in southern Australia than you would at comparable latitudes in Europe or North America,” he said.

July 2015

According to Dr Trewin, the snow in 2015 was likely to be more severe than what is forecast over the next few days.

Forskere avslører planters nervesystem. De snakker sammen, gjenkjenner slektninger og har hukommelse. Fra ILLUSTRERT VITENSKAP (Se mere der, Sep.15, 2019).

Med rolige bevegelser kravler en sulten larve langsomt opp plantestengelen, helt til den befinner seg midt på et grønt blad, som den tar en stor jafs av.

Utenfra ser allting fredelig ut, og det ser ikke ut til at planten i det hele tatt enser den gnagende gjesten. Men under overflaten ringer alarmklokkene for fullt, og planten er allerede godt i gang med å beskytte seg mot angrepet fra larven.

Bittet har nemlig skrudd på et elektrisk signal forårsaket av elektrisk ladning fra ioner som raskt sprer seg fra gjerningsstedet og rundt i resten av plantecellene for å advare om det sultne insektet.

Signalet er satt i gang av aminosyren glutamat, som også fungerer som signalstoff i nervesystemet til pattedyr. Og nettopp glutamat har vist seg å være den brikken forskerne lenge har manglet for å forklare hvordan ulike plantedeler kommuniserer med hverandre – og gjøre det så raskt at de rekker å gardere seg mot angrep.

VIDEO – Se plante reagere på larvebitt:

Larvebitt starter signal

Ved hjelp av et lysende protein i plantene kan forskerne se hvordan en ring av kalsium pipler fram omkring bittet.

Signal strømmer ut i bladet

Etter om lag 66 sekunder har kalsiumbølgen spredt ut seg i hele bladet, som nå lyser opp.

Hele planten blir alarmert

På 100 sekunder har kalsiumionene spredt seg fra området som er angrepet og ut i de ytterste avkrokene av planten.

Denne oppdagelsen kom fram ved en tilfeldighet, da en gruppe amerikanske og japanske forskere fra blant annet University of Wisconsin og Saitama-universitetet i Japan ville undersøke hvordan planter reagerer på tyngdekraft.

Og funnet tyder på at planter faktisk har en form for nervesystem som kan sammenlignes med det som finnes i mennesker og dyr – en konklusjon som understreker at våre jordbundne slektningers liv og kommunikasjonsnettverk er mye mer omfattende og avansert enn vi har trodd.

Angrep setter fart på signal

I studien plasserte forskerne en samling genspleisede planter under et lysmikroskop som skulle overvåke nivåene av kalsiumioner i plantecellene.

Kalsiumionene opptrer ofte i planter som en reaksjon på for eksempel berøring, endringer i retningen av tyngdekraften og temperatursvingninger. Og ved å gjøre plantene i stand til å produsere et protein som lyser opp ved høye konsentrasjoner av kalsium, kunne forskerne holde øye med plantens reaksjoner under mikroskopet.

Når forskerne plasserte en larve på en av plantene, kunne de se en bølge av lys som startet rundt det området der larven hadde tatt en bit og etter bare noen sekunder spredte ut seg i de fjerneste avkrokene av planten.

Deretter startet produksjonen av et arsenal av giftstoffer som skulle forsvare mot ytterligere angrep.

Men da forskerne senere blokkerte de proteinene på celleoverflaten som aktiveres av glutamat, forsvant lysbølgen. Dermed var det ingen tvil om at denne aminosyren spiller en viktig rolle for plantens raske reaksjon på å bli såret – på samme måte som det gjør i nervesystemet til pattedyr, der det også overfører signaler mellom cellene ved å åpne ion-kanaler.

Planter kan se, sove og sladre

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Ny forskning har vist at planter er utrustet med mange av de samme evnene som dyr. For eksempel kan de både sanse omgivelsene sine ved hjelp av bestemte lyssensitive celler i bladene, sove ved å endre trykket i cellene og snakke med hverandre gjennom luftbårne kjemiske signaler.

© Ken Ikeda/Shutterstock

Men selv om både planter og dyr ifølge studien bruker stoffet glutamat til å kommunisere mellom cellene, er det fortsatt stor forskjell på hvordan de to systemene fungerer.

Den viktigste forskjellen er at planter, i motsetning til pattedyr, ikke har egentlige nerveceller og derfor heller ikke kan merke smerte – en forskjell som gir god mening for de rotfestede plantene, siden smertesignalet har som formål å gi et signal om at dyrene skal flykte fra noe farlig. Samtidig er hastigheten på de elektriske signalene i dyr og planter også ganske ulike.

Under forsøket spredte kalsiumsignalet i de genspleiset plantene seg med en fart på om lag en millimeter i sekundet, noe som er lynraskt i planteverdenen, men ekstremt langsomt sammenlignet med farten signaler har i dyrene, der de elektriske strømningene kan bevege seg med opptil 120 meter i sekundet.

Planter har en god hukommelse

Men på tross av de opplagte forskjellene bruker dyr og planter altså det samme signalstoffet til å kommunisere mellom cellene. Og det er slett ikke første gang de grønne organismer overrasker forskerne med ulike egenskaper som minner om dyr. For eksempel har flere studier vist at planter både kan å lære og huske.

I en studie fra The University of Western Australia forsøkte forskere å trene erteplanter på samme måte som hunder trenes til å sette likhetstegn mellom for eksempel lyd fra en klokke og mat – såkalt assosiativ læring. I forsøket ble små stiklinger av erteplantene plassert under en enkel labyrint som består av et vannrør med to utganger.

Når plantene nådde en viss høyde, kom de til en skillevei, der de måtte vokse til enten høyre eller til venstre i røret.

Mykorrhizasopper danner enorme nettverk under bakken, i forlengelse av røttene. Plantene bruker nettverket til blant annet å dele næringsstoffer og advare hverandre om sykdommer.

© Science Source/ImageSelect

Forskerne delte plantene i to grupper som fikk ulik behandling. En gruppe ble utsatt for en luftstrøm fra en vifte etterfulgt av blått lys gjennom samme rør, mens den andre gruppen først mottok luft fra det ene røret og deretter lys fra det andre.

Senere ble plantene testet, og det viste seg at erteplantene i den første gruppen vokste mot vinden – selv når det ikke var lys.

De hadde altså trukket lærdom av sine tidligere erfaringer og koblet vinden fra viften sammen med lyset. Eksperimenter på Mimosa-planter bekrefter den avanserte atferden. Plantene er ekstremt sensitive overfor berøring og folder sammen bladene sine som en forsvarsmekanisme så snart de blir berørt.

I forsøket lot forskere plantene falle fra 15 centimeters høyde flere ganger. Ved de første tre til fire fallene lukket plantene bladene sammen som vanlig, men ved det femte fallet var de mer nølende, og etter 60 reagerte de ikke lenger.

Plantene lærte at fallene ikke var livsfarlige og sluttet med å bruke krefter på å forsvare seg – også da forskerne testet dem igjen en måned etterpå. Da forskerne rusket i plantene, foldet de derimot fortsatt sammen bladene, så den manglende reaksjonen var altså ikke bare et resultat av at de var ødelagt.

Advarer hverandre

At planter har mange flere triks enn det vi ser på overflaten, er ikke noe nytt. Allerede i 1880 foreslo den engelske biologen Charles Darwin at planter er intelligente, og at de har noe som svarer til en hjerne i røttene – en konklusjon som flere ganger har blitt bekreftet. Forskere har blant annet funnet et nettverk i forlengelse av røttene som plantene bruker til å hjelpe hverandre ved å sende næringsstoffer og advarsler.

Planter bruker samme signalstoff som dyr

Når en plante blir såret, sender den ut en bølge av elektrisitet i alle celler og stimulerer en slags immunrespons. Forskere har nå avslørt at nøkkelen til signalet er aminosyren glutamat, som også er et viktig signalstoff i nervesystemet til pattedyr.

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En planteeter tar en bit av planten, som i løpet av få sekunder utløser signalstoffet glutamat i det vevet som blir skadet.

2.

Signalstoffet lekkes enten direkte fra det ødelagte området eller produseres aktivt fra cellene på grunn av skaden. Derfra strømmer glutamatet ut i det nærliggende karsystemet.

3.

Glutamatet setter seg på såkalte glutamatreseptorer som sitter på cellenes overflate og åpner for ionkanaler.

4.

Åpningen av ionkanalene gjør at kalsium kan strømme inn i cellene og åpne for nye kanaler, slik at kalsiumionene kan bevege seg mellom cellene.

Nettverkene består av sopper som kalles mykorrhiza, og den samlede massen på jorda av disse soppene er trolig hele 30 milliarder tonn.

En stor andel av planteartene er trolig forbundet til disse nettverkene, som først oppsto for 400 millioner år siden. Det gjør dem blant annet i stand til å advare hverandre om sykdommer i nærområdet ved hjelp av kjemiske signaler og sende karbohydrater til artsfrender som har havnet i skyggen og dermed mangler energi.

Mye tyder altså på at de grønne organismene har mange evner vi som har vært skjult lenge. Og funnet av glutamat som et viktig signalstoff i planters forsvar mot angrep er enda en overraskende oppdagelse som viser at de kan kommunisere.

Planter – ikke helt grønnsak. Planter kan være smartere enn vi tror.

Planter – ikke helt grønnsak

Planter kan være smartere enn vi tror. Ny forskning tyder på at amerikanske ørkenbusker ikke bare kan sende beskjeder til hverandre. De kommuniserer til og med bedre med slekta.

PUBLISERT 
Den snakkende busken, Artemisia tridentata, ser ut til å prate bedre med sine egne. (Foto: Merikanto, Wikimedia Commons)

Den snakkende busken, Artemisia tridentata, ser ut til å prate bedre med sine egne. (Foto: Merikanto, Wikimedia Commons)

Kan ei plante kjenne igjen seg selv?

Det er jo unektelig en fordel for eksempel å dra kjensel på sine egne rottråder, så man ikke konkurrerer beinhardt med seg selv om plass i jorda.

Forskere har tidligere sett tegn på akkurat dette.

Flere undersøkelser har vist at røtter som vanligvis hemmer veksten til rottråder fra andre planter, slakker av på forsvarstiltakene når de treffer på sine egne tråder, skriver de i rapporten som nylig ble publisert i Ecology Letters.

Men dette har bare holdt stikk når røttene sitter fast på samme planta. Hvis de kampglade røttene treffer røttene fra en stikling – altså genetisk sett nøyaktig den samme planta, selv om de to ikke sitter fast i hverandre – er det full krig.

Men nå har Richard Karban fra University of California, Davis og Kaori Shiojiri fra Tokyo University gjort et eksperiment som kan tyde på at det faktisk finnes planter som kjenner igjen sine egne stiklinger.

De forstår nemlig fjernsendte varselsignaler fra sine egne bedre enn lignende skrekkrop fra andre artsfrender.

Hjelp – vi blir spist

Forskerne tok utgangspunkt i planta sagebrush – Artemisia tridentata. Tidligere forsøk har nemlig vist at akkurat denne veksten sender ut varsler når den blir angrepet av gresshopper og andre bladknaskere – eller slemme forskere med hekksaks.

Planter av samme art som vokser i nærheten oppfatter signalene, og begynner antageligvis å lage kjemiske forsvarsstoffer som gjør dem vonde å spise eller vanskelige å fordøye, skriver forskerne.

Resultatet er i hvert fall at plantene som ligger rundt skadede busker får færre angrep fra planteetere enn andre busker, uansett om det er gresshopper eller forskere som stod for skadene.

Busken ser ut til å sende kjemiske beskjeder igjennom lufta. Da Rick Karban la tett plast rundt planta, fant han ingen tegn til at den oppfattet signalene. (Foto: Richard Karban)

Busken ser ut til å sende kjemiske beskjeder igjennom lufta. Da Rick Karban la tett plast rundt planta, fant han ingen tegn til at den oppfattet signalene. (Foto: Richard Karban)

Men hva slags signaler sender egentlig ei plante?

Forskerne er ikke helt sikre, men mye tyder på at det dreier seg om kjemiske stoffer som plantene slipper fri i lufta rundt seg, i omtrent tre dager etter at de er blitt skadet. Det har nemlig vist seg at planter som ikke deler luft med de skadede vekstene, ikke oppfatter signalene.

Advarer seg selv

Forskerne tror faktisk at plantene har utviklet kommunikasjonsevnen for at den enkelte planta skal kunne advare seg selv fra grein til grein. Dersom skadedyra går løs på en del av planta, kan den hurtigadvare de andre greinene, så de kan sparke forsvarsmekanismene sine i gang.

Det var akkurat dette forskere tok utgangspunkt i, da de ville teste om plantene hadde evne til å kjenne igjen seg selv. Hvis vekstene har utviklet kommunikasjonsstrategien for å kunne varsle egne greiner, vil de kanskje være i stand til å skille sine egne signaler fra signaler fra andre buskene.

Karban og Shiojiri tok stiklinger fra 30 ulike busker, og dyrket dem i egne, tette potter. Så satte forskerne pottene tilbake rundt buskene. Noen busker ble omringet av potter med egne stiklinger – altså små deler av seg selv. Andre busker fikk potter med fremmede stiklinger.

Så skadet forskerne stiklingene rundt noen av buskene, mens andre fikk være i fred. Og etterpå var det bare å vente på gresshoppene. Fire måneder senere undersøkte forskerne hvordan det hadde gått.

Best advarsel fra sine egne

Det viste seg at buskene som var omringet av uskadede stiklinger, ble hardest angrepet av småkryp. Plantene som menget seg med skadede stiklinger fra en annen busk slapp lettere unna, mens de som hadde sine egne skamferte stiklinger i nærheten, klarte seg desidert best.

På en eller annen måte klarte altså plantene å skille signaler fra egne stiklinger fra beskjedene fra fremmede planter, og reagerer sterkere på dem.

– Dette betyr at planter kan vise en mer sofistikert oppførsel enn vi hadde forestilt oss, konkluderer Karban ifølge ei pressemelding fra University of California, Davis.

Referanse

R. Karban & Kaori Shiojiri, Self-recognition affects plant communication and defense, Ecology Letters, 12, 2009.

Lenke:

University of California, Davis: Plant Communication: Sagebrush Engage in Self-Recognition and Warn of Danger

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Flått sett gjennom mikroskop. Biteområdet med hård overflate og underliggende muskler. Se videre bilder, picture.

PATOLOGI OG SKYPAT- for helse, naturvitenskap, realisme og fornuft.
Selv om vi i våre dager har oppdaget, funnet eller kommet frem til mange naturvitenskaplige empiriske konklusjoner eller forhold, bygger nærmest alle resultater på “overveiende sannsynlige konklusjoner”, men med usikkerheter og i beste fall trolig opp mot 100 % sannsynlig.
Trolig er nærmest intet eller mulig lite 100% sikkert. For å “sikre” har man i mange år utført forsøk, vurdert reelle vitenskaplige funn, betraktninger og kommet til konklusjoner, for å komme så nær den ønskelige100% sikkerheten.
Reel vitenskaplig tilegning gjelder som kjent innen multipple områder.
Selv om dette burde være ett overordnet fornuftig prinsipp, får man inntrykk av at flere og flere personer bruker pseudovitenskaplige innfall, som ofte bygger på pseudovitenskaplige innspill fra såkalte vitenskappersoner (mulig også vitenskappersoner i andre felt-/ fag- områder), “ikke vitenskaplige personer”/ “kvakksalvere”/ forståsegpåere, med “sikkerhet”-tankegang/ tro.
Noen saker blir også nærmest “religøs tro”, “sannheter” med politisk innhold og med gruppepress.
Dette kan også bero på at reell vitenskaplig tilnærming til feltet er er for svak/ vanskelig, eller i våre dager nærmest umulig og mulige konklusjoner kan også kreve lang tid for å komme videre.
Som kjent er det gjennom tidene også vitenskaplige sannheter son er blitt forandret senere.
Det er derfor viktig å forstå reell vitenskap og vi eller andre er ikke en slags GUD”!
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Vanskelig med “sikkerhet/ skråsikkerhet”! Tolkninger. Bias!

Selv om mikroskopering er en gammel teknikk, er tolkningen av mikroskopbildene ofte gullstandard for sykdomsprosessen. Det foreligger enorm informasjon i de mikroskopiske bildene.

Som kjent kan man si at hva du ser i verden med dine øyne og også ved hjelp av mikroskop gjelder:

DET VANSKELIGSTE AV ALT ER Å SE DET SOM LIGGER RETT FORAN ØYNENE DINE!

Was ist das Schwerste von allem? Was dir das Leichteste dünket. Mit den Augen zu sehn, was vor den Augen dir lieget. Quelle: Xenien aus dem Nachlaß 45 (Johann Wolfgang von Goethe).

Det har kommet mange andre sofistikerte medisinske apparater og undersøkelsesmetoder i helsevesenet for å stille pasientdiagnoser for behandling, men en del gir ikke resulteter eller tolkningsforhold som er forenlig med den virkelige gullstandard- selv om helsepersonell mener dette.

Man kan delvis si:”A fool with a tool is still a fool”

Dessverre hører ofte en person bare på hva han tror han forstår (Goethe).

DIAGNOSE.

Innen forskjellige områder forsøker man ofte å stille diagnoser, særlig innen medisin. Man tenker at en diagnose har noe felles og ensartethet for den avgitte diagnose, og at man således kan sette diagnosen i en “bås”.

I ytterste konsekvens og hvordan man definerer diagnoser, kan det derfor bli relativt få eller nesten uendelig med diagnoser. Imidlertid praktisk setter man ofte flere fellestrekk i en diagnose.

I medisin stiller man diagnoser, også med tanke på at en viss behandling har vist seg å passe til diagnosen. Om denne tankegangen er helt riktig/ den beste, eller om “hendelser- behandling” burde vært vurdert på en annen måte er uvisst.

PROGNOSE

Prognose inneholder mye emperi
(sannsynlig- erfaring) og bygger mye på skjønnsmessig vurdering og statistisk materiale/ analyser/ vurderinger. Det gjelder forutsigelse / avansert spådom. Å avgi vitenskaplige prognoser er vanskelig/ er mer eller mindre sikre/ usikre.

F.eks. innen “klima- endring” mener endel at man går mot en “varmere verden”, mens andre mener man går mot en “kaldere verden”/ istid (søk på Google: mot ny istid). Alt bygger på prognoser/ fremtid.

Innen medisin gjelder stort sett prognose for større grupper med en diagnose, men ikke tydelig for en enkeltperson med diagnosen!

https://www.youtube.com/watch?v=Vfl-WtNMSYs
http://climatechangereconsidered.org/
EKTE VITENSKAP!
Nongovernmental International Panal on Climate Change:
http://climatechangereconsidered.org/

Wikipedia om Nongovenmental International Panel on Climate Change:
https://en.wikipedia.org/wiki/Nongovernmental_International_Panel_on_Climate_Change_(NIPCC)

Riviera. Varmere!
Hyggelig med normalt klima!
Det blir kaldere! Snø i sahara.
Snø i sahara.