bluuebunny/crossref_metadata_2025 huggingface dataset:
Weather data generator to study climate change on buildings
Authors: van Paassen A HC , Luo Q X
Published: January 2003

Most computer programs that analyse the yearly performance of buildings require an input of historical series of weather data measured at the location of interest. However, analyses of climate change scenarios needs hourly weather data series that allow realistic changes in various weather parameters. This can not be done easily with the reference years based on measured weather data normally used. In this paper a weather generator is proposed in which climate changes can be implemented. Based on weather data observed over years a stochastic weather model is developed. This model is used to make a general model independent of the location and with which climate changes can be simulated. The general model can be adapted to a local climate change. Only new averaged values of the weather variables being the result of a climate change should be used as input. The model is able to generate hourly weather data that can be used as input for all kind of simulation programs to study the effect of climate change on the design and energy consumption of HVAC systems.
Which came first – building cooling loads or global warming? – a cause and effect examination
Authors: Degelman L O
Published: January 2003

While weather changes from day to day, climate change occurs on a time scale far in excess of a human lifetime. Climate had been changing dramatically even before humans evolved on Earth. Notwithstanding this, there is evidence supporting an accelerated global warming trend over the last century. Scientists agree that much of the global warming can be attributed to increases in certain greenhouse gases, notably water vapour and carbon dioxide. What scientists disagree over is what amount of the greenhouse effect is due to human activity. This paper's purpose is to quantify, through computer simulations, the increased cooling loads imposed by recognized climate change models and give designers a framework within which to set goals for new building efficiency measures. The paper does not include proposals for methods of reducing energy consumption in buildings – instead, it demonstrates the probable impact global warming trends have on buildings' cooling loads and vice versa.
Influence of heat island phenomenon on building heat load
Authors: Akasaka H , Nimiya H , Soga K
Published: January 2003

Urbanization causes the so-called heat island phenomenon that raises urban atmospheric temperature higher than that in the suburbs. The phenomenon leads to a decrease in heating load and an increase in cooling load in the urban buildings. In this paper, the effect of the heat island phenomenon on the heat load of buildings was analysed by year-to-year changes in the heat load both in the urban and suburban areas. Tokyo was selected as the target urban area and Choshi, as a less urbanized city, among 30 stations located in a range of about 100 km both east-west and north-south centering on Tokyo. Investigation on the relationship between the changes in heat load during the past 100 years confirmed that

• The heating load of Choshi has decreased about 20% since 1900, whereas the heating load of Tokyo has decreased about 40% in the same period of time.

Also

• The cooling load of Tokyo has increased about 20% since 1900, but the similar increase can be seen in that of Choshi.
Climate models and climate extremes
Authors: Jones P D
Published: January 2003

Climate change will alter expectations about the future to such an extent that past statistics about averages, variability and extremes will no longer be relevant. Scenarios of the future depend upon the rate of greenhouse gas increases (and changes in aerosol distributions) in the atmosphere, and are best produced by coupled ocean-atmosphere climate models. Uncertainties in the scenarios are large, however, not only because future emissions have to be estimated, but also because the climate system is complex and varies considerably from decade to decade naturally. The temporal and spatial scales for which information can be produced generally means that detail can only be developed through downscaling procedures. Until recently, downscaling was generally achieved by statistical means using relationships between spatial scales. Increasingly, downscaling is now being undertaken using regional-scale models embedded within the global model (e.g., for the scale of Europe). Resolutions of 50 km in space at the daily timescale are possible, but just as with the large models there is still a need for model verification, particularly with respect to the daily variability and extremes, the timescale at which much of climate change is perceived by nonatmospheric scientists.
A many-facet Rasch analysis of the second language group oral discussion task
Authors: Bonk William J. , Ockey Gary J.
Published: January 2003

FACETS many-facet Rasch analysis software (Linacre, 1998a) was utilized to look at two consecutive administrations of a large-scale (more than 1000 examinees) second language oral assessment in the form of a peer group discussion task with Japanese English-major university students. Facets modeled in the analysis were examinee, prompt, rater, and five rating category ‘items.’ Unidimensionality was shown to be strong in both datasets, and approaches to interpreting fit values for the facets modeled in the analysis were discussed. Examinee ability was the most substantial facet, followed by rater severity, and item. The prompt facet was negligible in magnitude. Rater differences in terms of severity were generally large, but this characteristic was not stable over time for individuals; returning raters tended to move toward greater severity and consistency, while new raters showed much more inconsistency. Analysis of the scales showed general validity in gradations of scale steps, though raters had some difficulty discerning between categories at the ends of the scales for pronunciation and communicative skills.
Improved oxygenation with reduced recirculation during venovenous ECMO: comparison of two catheters
Authors: Rais-Bahrami Khodayar , Walton Dawn M , Sell Jeffrey E , Rivera Oswaldo , Mikesell Gerald T , Short Billie L
Published: January 2003

Objectives: To determine whether the new double-lumen catheter made by OriGen Biomedical (Austin, TX) for venovenous (VV) extracorporeal membrane oxygenation (ECMO) would reduce recirculation and improve oxygenation during VV ECMO when compared with the Kendall double-lumen catheter (Kendall Healthcare Products, Mansfield, MA).

Design: Prospective intervention study.

Setting: The animal research laboratory at Children’s National Medical Center, Washington, DC.

Subjects: Nine newborn lambs one to seven days old and weighing 4.4± 0.8 kg.

Intervention: Animals were anesthetized, intubated, and ventilated. The ductus arteriosus was ligated. Femoral arterial and venous, cephalic jugular vein, and pulmonary artery catheters were placed. After systemic heparinization, the catheter to be tested, an OriGen catheter, was placed in the right internal jugular vein and advanced into the right atrium. The animal was placed on ECMO and stabilized, with the ventilator settings decreased to a peak inspiratory pressure of 15-20 cmH2O, peak end-expira-tory pressure of 5 cmH2O, rate of 15-25 breaths/min, and a fractional inspired oxygen concentration of 0.21-0.30. ECMO flows were increased in 100-ml increments from 200 to 600 ml/min with measurements taken 15 min after each change. The OriGen catheter was removed, the Kendall catheter was placed, and the studies were repeated.

Measurements and Main Results: Heart rate, mean blood pressure, paO2, jugular cerebral oxygen saturation, pulmonary artery oxygen saturation, pump venous oxygen saturation, and postmembrane circuit pressures were measured at each study period. The OriGen catheter improved oxygenation, with higher systemic paO2, higher pulmonary artery and cerebral oxygen saturations, and lower pump venous oxygen saturations (indicating less recirculation). With the OriGen catheter, paO2 levels ranged from 69± 18 mmHg [9.2± 2.4 kPa] to 114 ± 45 mmHg [15.2± 6.0 kPa], compared range from 61± 15 mmHg [8.1± 2.0 kPa] to 87± 34 mmHg [11.5± 4.5 kPa] for the Kendall catheter. These findings indicate that, at all flow rates studied, less recirculation occurred with the OriGen catheter than with the Kendall catheter. The postmembrane pressures were significantly lower for the OriGen catheter at any given flow (from 30 ± 5 to 122 ± 18 mmHg) when compared with the Kendall catheter (from 77± 16 to 330 ± 78 mmHg).

Conclusions: These findings indicate that the OriGen catheter resulted in a reduction of recirculation, thereby resulting in an improvement in oxygenation while on VV ECMO. The lower postmembrane pressure potentially could reduce the risk of ECMO circuit complications such as tubing rupture, bleeding complications, as well as hemolysis. This new catheter makes VV ECMO more effective and represents a design that could be used for neonatal and/or pediatric ECMO.
Impact of cardiopulmonary bypass management on postcardiac surgery renal function
Authors: Fischer Uwe M , Weissenberger Wilko K , Warters R David , Geissler Hans J , Allen Steven J , Mehlhorn Uwe
Published: January 2003

Objective: Cardiac surgery on cardiopulmonary bypass (CPB) is associated with postoperative renal dysfunction and up to 4% of patients with normal preoperative renal function develop acute renal failure (ARF) requiring dialysis. According to recent investigations, CPB management is not evidence-based and, thus, current clinical CPB practice may favor renal dysfunction. The purpose of our study was to investigate if postcardiac surgery renal dysfunction is influenced by CPB management.

Methods: We selected three groups of patients with normal preoperative renal function who had been subjected to cardiac surgical procedures on CPB: 44 patients with postoperative ARF requiring hemofiltration/dialysis (ARF group), 51 patients with postoperative renal dysfunction not requiring hemofiltration/dialysis (serum creatinine increase > 0.5 mg/dl within 48 h postsurgery: CREAgroup), and 48 patients with normal postoperative renal function (Control group). The patients’ on-line CPB records were analyzed for CPB duration, CPB perfusion pressure, CPB flow, and periods on CPB at a perfusion pressure < 60 mmHg. On-CPB diuretic and vasoconstrictor medication was recorded.

Results: Patient demographics were similar for the three groups. In the ARF group, CPB duration was longer (166± 77 [standard deviation, SD] min) compared to CREA (115± 41 min; p < 0.001) and to Control groups (107± 40 min; p < 0.001), and mean CPB flow was lower (2.35± 0.36 l/min/m2) compared to CREA (2.61± 0.35 l/min/m2; p=0.0015) and to Control groups (2.51± 0.33 l/min/m2; p= 0.09). Mean arterial pressure on CPB (ARF: 61± 10; CREA: 60± 7; Control: 63± 9 mmHg; p= 0.19) as well as furosemide and norepinephrine medication on CPB were similar for the groups. Compared to Control (46± 26 min), CPB duration at arterial pressures < 60 mmHg was longer in ARF (78± 60 min; p= 0.034) and in CREA (62± 36 min; p=0.048).

Conclusions: Our data suggest that current clinical CPB management impacts postoperative renal function. We found that patients with normal preoperative renal function who developed postoperative ARF had longer CPB duration, lower CPB perfusion flow, and longer periods on CPB at pressures < 60 mmHg compared to patients with no post CPB ARF. However, our data do not allow us to separate these CPB-related factors from the potential influence of perioperative low cardiac output syndrome as a cause for postoperative ARF. Thus, future clinical studies are required to elucidate CPB-induced ARF and to optimize CPB management for ARF prevention.
Differential regulation of MMP-2, TIMP-2 and IL-6 in valve replacement versus CABG patients
Authors: Watanabe Masazumi , Hasegawa Satoru , Ohshima Nagahisa , Tanaka Hiroyuki , Sakamoto Tohru , Sunamori Makoto
Published: January 2003

Background: Extracellular matrix degradation may play an important role in left ventricular (LV) remodeling. It has been reported that matrix metalloproteinase-2 (MMP-2) is activated under mechanical stress conditions. Therefore, we examined the release of MMP-2, its inhibitor and interleukin-6 (IL-6), which affects MMPs, in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

Methods: Arterial blood samples were obtained from 20 patients undergoing cardiac surgery and six patients with descending aortic replacement (as noncardiac control) with CPB. Samples were assayed for plasma MMP-2, tissue inhibitors of matrix metalloproteinase-2 (TIMP-2) and IL-6 concentration.

Results: Plasma MMP-2 concentrations in the valvular disease patients were greater than in other patients ( p < 0.05) and correlated with the LV mass (r= 0.810, p < 0.0001) prior to the operation. Plasma MMP-2 concentrations decreased during CPB and gradually recovered to the baseline levels after CPB. Plasma TIMP-2 concentrations increased significantly during and after CPB in a biphasic manner. Plasma IL-6 concentrations also increased significantly during CPB ( p < 0.05 versus baseline levels).

Conclusion: Plasma MMP-2 concentrations reflect the state of the left ventricle, and changes in plasma MMP-2 and TIMP-2 concentrations during CPB may play an important role in LV remodeling after cardiac surgery.
Is there any impact of the shape of aortic end-hole cannula on stroke occurrence? Clinical evaluation of straight and bent-tip aortic cannulae
Authors: Albert A A , Beller C J , Arnrich B , Walter J A , Rosendahl U P , Hetzel A , Priss H , Ennker J
Published: January 2003

Objective: To compare the impact of straight and bent-tip aortic cannulae on stroke occurrence, location, and severity.

Methods: Prospective data were collected on 8129 patients (coronary artery bypass grafting (CABG) and/or valvular surgery). ‘Bent-tip’ aortic cannulae were used in 15.6% of cases and ‘straight’ end-hole cannulae in 84.4% of cases.

Results: There were a total of 137 strokes: right anterior 52, left anterior 39, bilateral 23, posterior 18, and location not established5. With the use of bent-tip cannulae, the incidence of strokes was 0.9% versus 1.8% with straight cannulae (c2, p=0.026). Bilateral and posterior strokes occurred more often with the use of straight cannulae (c2, p= 0.015). Straight cannulae also related to the severity of strokes (c2, p= 0.003).

Conclusions: There is an influence of the type of cannula on the occurrence, location, and severity of strokes. Straight cannulae cause significantly more often and more severe bilateral and posterior strokes than bent-tip cannulae.
Has aphasia therapy been swallowed up?
Authors: Enderby Pam , Petheram Brian
Published: January 2003

Objective: To review the change in number of referrals to speech and language therapy for dysphasia and dysphagia over one decade.

Design: This retrospective study analyses data collected on an information system developed speci cally for the use of speech and language therapists in the management of their services.

Setting: Eleven health care providers used the system between 1985 and 1995 and recorded details of 73 758 patients referred to speech and language therapy during that period.

Results: Whilst there were 12 times as many dysphasic patients as dysphagic patients referred to speech and language therapy in 1987, the position was reversed by 1995 with twice as many dysphagic as dysphasic patients being referred to these services. Dysphagia in 1987 accounted for less than 1% of the referrals to speech and language therapy. This percentage increased, until in 1995 20% of referrals were for dysphagia.

Conclusion: No causal relationship between the changes in referral to speech and language therapy for these two groups has been established in this study. However, there has been a signi cant increase in referral to speech and language therapy of people with dysphagia. Whilst referrals for dysphasia have increased, they represent a lower percentage increase and now receive less treatment per case than in 1987.
The timed ‘Up & Go’ is dependent on chair type
Authors: Siggeirsdóttir K , Jónsson B Y , Jónsson H , Iwarsson S
Published: January 2003

Introduction: The timed ‘Up & Go’ (TUG) is a performance test identifying problems in functional mobility. More knowledge on how the type of chair used in uences test results is needed.

Objective: To investigate inter-rater agreement on the time score and to assess if chair type used in uenced the performance of the test.

Setting: (1) Inter-rater agreement investigation on the time score was carried out with elderly individuals living in a retirement home (n = 31). (2) Four types of chairs were tested on elderly individuals in three different health care centres (n = 100).

Results: The two observers were close in timing (mean difference = 0.04 s). From a reference chair the median time for TUG was 15.7 s compared with 16.9 s from a chair with a low seat (p < 0.001). It was signi cantly more dif cult to stand up from a chair without armrests (p < 0.001), and from the lowest chair (p < 0.001), which was also the only chair dif cult to sit down on (p = 0.02).

Conclusion: The inter-rater agreement of the time scoring of the TUG has been con rmed. Test performance is dependent on chair type; chairs with armrests and a seating height of 44-47 cm should be used. Clinicians must follow standard procedures and equipment when using the test or else risk invalidating test findings.
Responsiveness of two upper extremity function instruments for stroke inpatients receiving rehabilitation
Authors: Hsueh I-Ping , Hsieh Ching-Lin
Published: January 2003

Objective: To compare the responsiveness of the Action Research Arm test (ARAT) and the upper extremity section of the Motor Assessment Scale (UE-MAS) in assessing the recovery of upper extremity function in stroke inpatients receiving rehabilitation.

Subjects: Forty-eight stroke inpatients.

Setting: The physical medicine and rehabilitation department of a medical centre.

Design: The patients were tested at admission and at discharge from the department.

Methods: Various indices, including effect size d, Wilcoxon test and Spearman's rho, were used to assess responsiveness. The change in score of the upper extremity subscale of the Fugl-Meyer scale was used as the external criterion.

Results: The responsiveness indices of both total scores of the ARAT and UE-MAS are generally moderate and similar ( d = 0.52, Wilcoxon Z = 5.03, p < 0.001 and rho = 0.66 for the ARAT; d = 0.45, Z = 4.54, p < 0.001 and rho = 0.7 for the UE-MAS). Responsiveness indices are small to moderate and similar in each of the subscales of both instruments.

Conclusion: The results of this study support the value of the ARAT and UE-MAS for measuring recovery of upper extremity function in stroke patients.
Development and validation of two new sensory tests of the hand for patients with stroke
Authors: Dannenbaum Ruth M , Michaelsen Stella M , Desrosiers Johanne , Levin Mindy F
Published: January 2003

Objective: To establish validity and reliability of two new sensory tests evaluating moving (MTP) and sustained (STP) touch-pressure and their relationship to hand function for patients with stroke. The STP had four components in which a light or heavy ball was applied passively or held actively.

Participants: Twenty-eight participants with hemiparesis (1–109 months) from rehabilitation hospitals or outpatient programmes.

Design: Content validity was established. Then reliability and concurrent and construct validity were determined. Sensation was compared with hand functional ability using the Modified Moberg recognition task, the Box and Block test and one task of the TEMPA test.

Results: Reliability: Both types of reliability were significant for MTP (ICC = 0.92) and all components of STP (ICC = 0.62 to 0.92). Concurrent validity:MTP and STP correlated significantly ( r = -0.39 to -0.83) with the Semmes–Weinstein Monofilament test used as a ‘gold standard' comparison. Construct validity: MTP was significantly related to Moberg ( r = 0.49). Three of four components of STP correlated with TEMPA ( r = 0.49–0.53) and Moberg (0.45–0.71). Only STP (heavy ball) correlated with Box and Block (0.42–0.48). Of the four components of STP, only the passive STP (light ball) was not related to hand function.

Conclusion: The new sensory tests of moving, and three components of sustained touch-pressure were reliable. The passive STP (light ball) was discarded. All but this test were relevant to the two functional roles of sensation: exploration for MTP and dexterity during holding for STP.
Measurement of sitting balance using the Manchester Active Position Seat (MAPS): a feasibility study
Authors: Powell E S , Pyburn R E , Hill E , Smith K S , Ribbands M S , Mickelborough J , Pomeroy V M
Published: January 2003

Background: Evaluation of the effectiveness of therapy to improve sitting balance has been hampered by the limited number of sensitive objective clinical measures. We developed the Manchester Active Position Seat (MAPS) to provide a portable system to track change in the position of centre of force over time.

Objectives: (1) To investigate whether there is correspondence between the measurement of position change by a forceplate and by MAPS. (2) To explore whether and how MAPS measures changes in position when seated healthy adults change posture.

Design: A feasibility study. Methods: (1) An adult subject sat on MAPS placed on top of a forceplate. The x and y coordinates of the centre of pressure recorded from the forceplate and centre of force from MAPS during movement were compared graphically. (2) Four adults sat on MAPS using a standardized starting position and moving into six sets of six standardized target postures in a predetermined randomized order. The absolute shift in centre of force from the starting position was calculated.

Results: (1) The pattern of change of position over time was similar for the forceplate and for MAPS although there was a measurement difference, which increased with distance from the centre. (2) The direction of change of position corresponded to the direction of movement to the target postures but the amount of change varied between subjects.

Conclusions: MAPS shows promise as an objective clinical measure of sitting balance, but peripheral accuracy of measurement needs to be improved.
Comparative effect of positive and negative static magnetic fields on heart rate and blood pressure in healthy adults
Authors: Hinman Martha R
Published: January 2003

Objective: To compare changes in heart rate (HR) and blood pressure (BP) associated with short-term exposure to static magnetic fields (SMFs) of positive versus negative polarity.

Design: A double-blind, randomized controlled trial using a time series design.

Setting: Physical therapy laboratory in a university setting.

Subjects: Seventy-five adults with a mean age of 30.6 years were assigned to one of three treatment groups. No subjects had any symptoms of cardiovascular disease or cardiac irregularity.

Interventions: Fifteen-minute exposure to an SMF by lying on a mattress pad containing magnets of positive polarity, negative polarity, or none (placebo).

Main outcome measures: HR and BP were monitored prior to exposure, at 1-minute, 5-minute, 10-minute and 15-minute intervals following exposure, and again 5 minutes after exposure.

Results: Subjects in all groups demonstrated slight decreases in HR and BP, but none of these changes were associated with the intervention ( p = 0.170).

Conclusions: Short-term exposure to an SMF of either positive or negative polarity does not appear to cause any clinically meaningful changes in HR or BP among asymptomatic subjects. This finding supports the safe use of unipolar SMFs that contain low-intensity magnets (<1000 gauss) relative to the cardiovascular system.
Effect of task context on reaching performance in children with spastic hemiparesis
Authors: Volman M (Chiel) JM , Wijnroks A (Lex) , Vermeer Adri
Published: January 2003

Objective: To investigate the effect of task context on the quality of reaching movements in children with spastic hemiparesis.

Design: Randomized controlled experimental trial.

Setting: Institute for the Study of Education and Human Development (ISED).

Subjects: Twelve children (8–14 years of age) with spastic hemiplegic cerebral palsy.

Interventions: Subjects made fast reaching movements with the affected or nonaffected arm on a digitizer in three context conditions: (a) reach to press a light switch to turn on a red light ( functional), (b) reach to press the light switch; no light ( semi-functional), and (c) reach to a marker ( nonfunctional).

Main outcome measures: Kinematics of reaching movements of affected and nonaffected arms: movement time (MT), peak velocity (PV), time to PV, percentage of MT where peak velocity occurred (PPV), and smoothness (i.e. number of movement units (MU)).

Results: The functional condition elicited better quality of reaching for the nonaffected, but particularly the affected arm. Reaching of the affected arm was faster (larger MT; F = 10.21, p < 0.01), smoother (fewer MU; F = 19.95, p < 0.001), and better-controlled (right shift of PPV; F = 16.03, p < 0.001) compared with the semi and nonfunctional condition. Reaching of the nonaffected arm was also faster (longer MT, F = 4.81, p < 0.05), and more smooth (fewer MU, F = 7.23, p < 0.05).

Conclusions: These findings suggest that providing a functional context to perform a task may enhance the quality of reaching movements of the affected arm in children with spastic hemiparesis.
Self-reports are not related to objective assessments of cognitive function and sedation in patients with cancer pain admitted to a palliative care unit
Authors: Klepstad Pal , Hilton Priscilla , Moen Jorunn , Fougner Bjørn , Borchgrevink Petter C , Kaasa Stein
Published: January 2003

Cancer patients often report complaints of cognitive impairment and sedation. It is not well known if subjective complaints reflect objective assessments of cognitive function (CF) and sedation. We obtained self-reports of sedation and CF from 29 patients admitted to a palliative care unit and receiving morphine treatment. Sedation was reported on a verbal rating scale (VRS) and CF was reported using the EORTC QLQ-C30 health-related quality-of-life questionnaire CF scale. The self-reports were compared with objective assessments of sedation and CF by applying the Observer's Assessment of Alertness/Sedation (OAA/S) scale and Mini Mental State Examination (MMS), respectively. The assessments were repeated for seven patients who were readmitted to the palliative care unit. The patient self-reports of memory, concentration and sedation were dichotomized into noncomplainers and complainers. The percentages of complainers were 54%, 46% and 37% for memory, concentration and sedation, respectively. Patients who complained from difficulties with concentration or memory did not score differently from noncomplainers on objective assessments of CF (MMS score), but had a significantly higher level of fatigue. Patients complaining from sedation did not score differently from noncomplainers on objective assessments of sedation (OAA/S score). We observed no significant correlations between EORTC QLQ-C30 CF scale scores and MMS scores, or between VRS sedation scores and OAA/S scores. The study demonstrates a lack of relationship between patient self-reports and objective methods for assessing sedation and cognitive failure. This finding illustrates the importance of differentiating between observations and patient self-reports. The results also question the validity of patient self-reports for measurements of cognitive failure and sedation.
Analyses of nursing home residents in hospice care using the Minimum Data Set
Authors: Buchanan Robert J , Choi Maryann , Wang Suojin , Huang Chunfeng
Published: January 2003

Objective: To present comprehensive profiles of residents in hospice care at admission to the nursing home using the Minimum Data Set (MDS).

Design and Setting: We analysed 40,622 MDS admission assessments for nursing home residents in hospice care. The MDS contains resident-focused data on pain, cognitive patterns, physical function, disease diagnoses, medications, nutrition, and specific treatments received.

Results: About four in five recently admitted hospice residents had ‘do not resuscitate’ orders and only 27% had a living will. Over 70% of recently admitted hospice residents experienced pain, with almost one half experiencing daily pain. Over one half of those hospice residents in pain experienced moderate pain and almost one third experienced horrible or excruciating pain. About 57% of recently admitted hospice patients had cancer, 21% had congestive heart failure, 20% had emphysema/chronic obstructive pulmonary disease, and 18% had depression. About one in two recently admitted hospice residents exhibited at least moderate impairment in cognitive function.

Conclusions: There is a need to improve pain management, advanced directives, and mental health services for residents dying in nursing homes.
Palliative venting gastrostomy in malignant intestinal obstruction
Authors: Brooksbank M A , Game P A , Ashby M A
Published: January 2003

This retrospective clinical study reports on the experience of palliative venting gastrostomy (PVG) in an integrated acute teaching hospital and hospice-based palliative care service over a seven-year period (1989 97). PVG was performed for 51 patients with refractory nausea and vomiting resulting from varying degrees and levels of persisting or intermittent malignant bowel obstruction. There were 32 females and 19 males; the mean age was 61 years (range 25–86 years). All patients had advanced and incurable cancer with intra-abdominal spread, originating from the following primary sites: colon and rectum (27), ovary (16), breast (2), pancreas (2), and other (4). The venting gastrostomy tube was inserted endoscopically by a railroading technique in 46 patients (using a 16- to 20-French Dobhoff PEG tube), at open laparotomy in four cases and under radiological (abdominal computerized tomography) control in one case. Endoscopic insertion was attempted and abandoned for technical reasons in a further two cases. The median survival of all 51 patients from the time of gastrostomy insertion was 17 days (range 1–190). In 47/51 (92%), the symptoms of nausea and vomiting were relieved by the procedure, and these patients experienced restoration of some level of oral soft food and fluid intake. Twenty patients were discharged home, and six died at home. In a small group of highly selected patients, for whom pharmacological measures failed to palliate the effects of malignant bowel obstruction, PVG was shown to be a safe and effective means of abolishing or substantially improving vomiting. Provided that the intervention is appropriate to the given clinical situation and acceptable to the patient, it should be considered.
Deaths from heart failure in general practice: implications for palliative care
Authors: Seamark David A , Ryan Mary , Smallwood Neil , Gilbert James
Published: January 2003

Trial and observational research indicates a high one-year mortality with a significant potential for specialist palliative care for patients with heart failure. A community observational study was undertaken in two general practices, with a total population of 21,000. There were three objectives: to determine the prevalence of symptomatic heart failure, to document mortality in the cohort over six and 12 months, and to establish the population in which a palliative care approach was adopted. A search of the computerized medical records yielded 548 patients with symptomatic heart failure (2.6% of the total study population). Over a six-month period, 31 patients (6% of the cohort) died and over a 12-month period 64 patients (12% of the cohort) died. ‘Sudden death’ was recorded in the records of 14 patients and death from coexisting malignancy was recorded in seven patients. A palliative care approach in patients not dying suddenly or of malignancy was recorded in 21 cases (33% of the total deaths). The findings do not indicate a high mortality in patients with symptomatic heart failure in general practice. The role of specialist palliative care in many cases would appear to be limited by the difficulty in predicting prognosis. In a significant number of cases, general practitioners appear to be aware of the need for a palliative care approach in patients dying of heart failure.
The ‘Little Ice Age’ maximum in the Southern Alps, New Zealand: preliminary results at Mueller Glacier
Authors: Winkler Stefan
Published: January 2003

Lichenometric-dating studies using the yellow-green Rhizocarpon subgenus at Mueller Glacier in the region of Mt Cook, Southern Alps, New Zealand, reveal a ‘Little Ice Age’ maximum about ad 1725/1730. Differences from previous studies are shown to result from different methods, especially the type of mathematical functions used for calculating the lichenometric dating curves. Previous work also used variable sample sizes, distal moraine slopes, and, to some extent, different fixed points. Schmidt hammer measurements enable the differentiation of ‘Little Ice Age’ from pre-‘Little Ice Age’ frontal moraines in the outer glacier foreland and confirm the status of the ‘Little Ice Age’ as a separate glacier advance among several advances during the Holocene.
Seasonality of instability phenomena (hailstorms and thunderstorms) in Padova, northern Italy, from archive and instrumental sources since AD 1300
Authors: Camuffo Dario , Cocheo Claudio , Enzi Silvia
Published: January 2003

In northern Italy, and especially in the Po Valley, instability phenomena such as hail and thunder storms are mainly associated with the penetration of Atlantic disturbances, especially cold fronts, or pre-frontal squall lines in the mid-seasons, and with the thermal convection of hot and moist air in the summer. Changes of their seasonal distribution may be considered as an index of anomalies in the synoptic pressure pattern, which determines the general circulation over Europe. Two different types of meteorological data have been analysed: (1) historical, non-specialist descriptions, taken from chronicles, annals or diaries after AD 1300, when people began to record, in addition to the most outstanding climatic events and natural hazards, minor observations including instability phenomena; (2) regular daily observations made by trained meteorologists after 1740. The historical descriptions show that in the Po Valley the highest thunderstorm frequency is in the summer, between June and August, but in the 1500s the distribution was anomalous. In that century, a broad maximum was found between March and August, and a secondary maximum was found in December. In the early period of observations made by trained meteorological personnel, i.e., 1740–1799, a summer maximum of thunderstorm frequency was found, almost equally distributed from June to August, followed by May and September. In the most recent period, i.e., 1940–1989, the seasonal distribution was very regular for three decades (1940 to 1969) with the mode in June, followed by July and August, and it then changed, with more late peaks. The historical written sources show that the seasonal distribution of hail was more homogeneous than thunderstorms. Hail was especially frequent in the summer, from June to August, except in the 1500s, when the seasonal distribution was practically one month earlier. In the early period of regular meteorological observations, hail was seasonally distributed less regularly than thunderstorms, with more skew and earlier in the year. The maximum frequency was in June, followed by April, May, July and August. In the most recent period, the distribution was still irregular, with marked fluctuations, the distribution being displaced later in the season.
Discovery of early Holocene wood and peat on the forefield of the Pasterze Glacier, Eastern Alps, Austria
Authors: Nicolussi Kurt , Patzelt Gemot
Published: January 2003

During recent years a number of fragments of Pinus cembra and Larix decidua as well as peat were found in front of the tongue of the Pasterze Glacier in the Eastern Alps.These were washed out by the stream from under the present ice. The wood originates from trees which reached ages of upto 400 years or more. Radiocarbon dating shows them to come from the early Holocene. They indicate that between cal.BC 8100 and cal. BC 6900 the Pasterze Glacier was smaller than at present. The Pasterze Glacier advanced around cal.BC 6900. A lump of peat shows that around cal. Bc 6300 at the latest the Pasterze Glacier was again smaller than today. The radiocarbon age of the fulvic acid fraction of thepeat suggests that growth could have continued until cal.BC 5430-5080. Further wood samples, dated to around cal. Bc 4800 and cal. Bc 3800, show that at these times the Pasterze Glacier was smaller than at present. The Pasterze Glacier had a relatively limited extent over long periods inthe early Holocene. Thus mostly favourable climatic conditions can be inferred for these time periods.
Holocene cirque glacier activity in western Spitsbergen, Svalbard: sediment records from proglacial Linnévatnet
Authors: Snyder J. A. , Werner A. , Miller G. H.
Published: January 2003

Holocene glacial variations of a presently ice-free cirque in western Spitsbergen are inferred from sediment records from the proglacial lake Linnévatnet. Glaciation is indicated in the core records by increased intensity of laminae derived from the cirque inflow and by increase in sediment accumulation rate. Radiocarbon ages on terrestrial plant macrofossils limit the onset of glaciation in the cirque to within the last six centuries. No evidence for earlier glaciation is recognized in the core records, indicating that the threshold for glaciation in the cirque was not reached during prior Neoglacial advances. Local climate events favouring glacier expan sion were either of greater magnitude or of longer duration during the ‘Little Ice Age’ than at any other time during the Holocene.
Middle-and late-Holocene environments and vegetation history of Kunashir Island, Kurile Islands, northwestern Pacific
Authors: Korotky A. M. , Razjigaeva N. G. , Grebennikova T. A. , Ganzey L. A. , Mokhova L. M. , Bazarova V. B. , Sulerzhitsky L. D. , Lutaenko K. A.
Published: January 2003

Natural middle-and late-Holocene environmental development of Kunashiri Island reflects global climatic changes and the migration of warm and cold currents. Dry and cool climate changed to warm and moist about 7000–6500 BP, later than on Hokkaido Island. At this time Kuroshio Current system became more active. On Kunashir Island birch assemblages were replaced by cool-temperate broadleaf forests in the south and mixed coniferous/broadleaf forests in the north. The highest sea-level position reached 2.5–3 m above PSL about 6500–6300 BP. Cooling about 4700–4500 BP island vegetation weakly changed that connected with warm current influence. Major regression at this period led to formation of extensive coastal dunefields. The warming at the beginning of the late Holocene was almost similar to the Holocene Optimum. Two minor transgressions are recorded about 4010–3400 and 2950–2620 BP. Active entrance of detrital material to the coastal zone resulted in growth of accumulative landforms. Vegetation changes and climatic deterioration took place in the second half of the late Holocene. Coniferous and mixed coniferous/broadleaf forests shifted southward and occupied a large part of the island. During cooling at 1700–1300 BP the isthmus area increased, coastal wetlands with lakes and coastal dunes were formed, and grassland and swamp landscapes developed. Late-Holocene warming was not intensive. Active aeolian accumulation took place during the ‘Little Ice Age’ cooling and regression.
Radiocarbon dated Pinus sylvestris L. wood from beyond tree-line on the Kola Peninsula, Russia
Authors: MacDonald Glen M. , Gervais Bruce R. , Snyder Jeff A. , Tarasov Gennady A. , Borisova Olga K.
Published: January 2003

Radiocarbon dates were obtained from 24 samples of Pinus sylvestris L. (Scots pine) wood recovered from sites beyond the modern conifer tree-line on the Kola Peninsula of Russia. Twenty-one of the samples came from the shallow waters and eroding peats at the edges of two small lakes at 68°439N, 35°109E, located north of the modern conifer tree-line. Three samples came from a small pond located above the modern elevational limits of Pinus sylvestris at 68°259N, 35°199E. The radiocarbon dates indicate that pine trees grew approximately 20 km north of the mapped modern limits of the species from 6680 BP to 3830 BP. Pine trees were also growing some 40 m above their modern elevational limits between 5890 BP and 3450 BP. Nineteen of the samples date from 6680 BP to 5070 BP, suggesting that the density of trees north of the modern tree-line was greatest between 7000 and 5000 BP. The timing of tree-line advance and greatest density on the Kola Peninsula are in agreement with the results of similar studies from northern Fennoscandia which indicate that maximum northern and elevational extension of tree-line occurred between 7000 BP and 4000 BP. The general agreement between tree-line reconstructions suggests that the climatic changes that promoted mid-Holocene tree-line extension along the North Atlantic margins in northern Fennoscandia propagated eastward to the Kola Peninsula. The late timing of initial pine expansion on the Kola and in adjacent northern Fennoscandia remains problematic and may relate to lower winter insolation, temperature regimes in the adjacent oceans or slow rates of migration.
Pedosedimentary and palaeoenvironmental significance of a Holocene alluvial sequence in the southern Pampas, Argentina
Authors: Zárate Marcelo , Kemp Rob A. , Espinosa Marcela , Ferrero Laura
Published: January 2003

A representative section of the Holocene alluvial record of the southern Pampas (Argentina) com prises a sequence of clastic sediments, a diatomite and two palaeosols. Detailed macro- and micromorphological descriptions provide the basis for the reconstruction of its pedosedimentary history. Combining the pedosedi mentary reconstruction with palaeoecological data allows a detailed overview of alluvial landscape development and associated palaeoenvironmental change in the region during the Holocene. The early-Holocene shift from a subhumid dry to humid climate was marked initially by a diminution in clastic sedimentation, the development of the Puesto Callejón Viejo Soil and then re-establishment of fluvial aggradation with a dominance of bioclastic sedimentation. Loess inputs increased during the mid-Holocene as the climate reverted to subhumid dry, and temporary subaerial exposure of the sediments led to the formation of the Puesto Berrondo Soil. More variable environmental conditions followed with natural fluvial aggradation ceasing in the late Holocene, though aeolian sedimentation has continued until the present day. The resultant surface accretionary soil has been modified by recent alluvial inputs from flood events linked to agricultural disturbance in adjacent catchments.
Long-term tree-ring variations in Juniperus at the upper timber-line in the Karakorum (Pakistan)
Authors: Esper Jan
Published: January 2003

Ring-width series of Juniperus excelsa M. Bieb and Juniperus turkestanica Kom. from six different sites, in the Hunza-Karakorum, were used in reconstructing modes of regional climate over the past 500 years. All reconstructions were derived from trees growing close to the upper timber-line (approx. 4000 m a.s.l.). Standardized site chronologies, derived from ring-width measurements, display common low-and high-frequency variation that is synchronous between all sites. Since the documented increase in atmospheric CO2 loading, roughly 150 years ago. Hunza-Karakorum trees are not growing as well as they were previously. From the mid-nineteenth century to the present, these trees appear to be alternating between states of more extreme favourable and unfavourable growth periods of different amplitude and duration. Maximum (favourable) variations occurred between AD 1579 and 1603, whereas minimum (unfavourable) variations occurred between AD 1825 and 1850.
Near-infrared spectrometry (NIRS): a new tool for inferring past climatic changes from lake sediments
Authors: Rosén Peter , Dåbakk Eigil , Renberg Ingemar , Nilsson Mats , Hall Roland
Published: January 2003

This study tests the hypothesis that lake sediments containclimate–related information that can be detected by near–infrared spectrometry (NIRS), and that NIRS can be used to infer past climatic changes from analysis of sediment cores. NIRS is a rapid and non–destructive technique that measures attributes of the chemical composition of organic materials. A training set of 76 lakes from northern Sweden, spanning a broad altitudinal gradient, was used to assess whether lake altitude and vegetation zones can be modelled from NIR spectra of surface sediments (0–1 cm) using partial least squares (PLS) regression and soft independent modelling of class analogies (SIMCA) classification. Lake altitude served as a surrogate variable reflecting differences in climatic conditions among sites. After spectral filtering using orthogonal signal correction (OSC), cross-validated predictions explained 86% of the variance in altitude and the prediction error (root mean square error) was 78 m, corresponding to 8.3%o of the gradient (390–1250 m above sea level). To evaluate the significance of NIR spectral differences between surface sediments of lakes in different vegetation zones (mountain–birch forest, dwarf shrub and alpine heath), principal component analysis (PCA) models were developed separately for lakes in each vegetation zone. Multivariate classification analysis demonstrated that NIR spectra of surficial sediments differed between lakes located in different vegetation zones. A separate sediment data set from 56 lakes was used to assess sediment ageing effects on NIR signals. Marked similarities between NIR spectra in surface sediments (0–1 cm) and sediments from 1–2 cm depth indicated that degradation of organic material following sediment consolidation resulted in little loss or change of climate–related information. Finally, to assess the ability of NIRS methods to reconstruct past climatic changes over Holocene timescales, we applied the NIRS–altitude model to sediments in a core from a small mountain lake. Estimates of mean July air temperature based on the NIRS–altitude transfer function showed similar trends compared with inferences from chironomids, diatoms and pollen from the same core. Overall, the results indicate that changes in NIR spectra from lake sediments reflect differences in climate, and that NIRS models based on surface–sediment samples can be applied to sediment cores for retrospective analysis.
Evidence of 550-year and 1000-year cyclicities in North Atlantic circulation patterns during the Holocene
Authors: Chapman Mark R. , Shackleton Nicholas J.
Published: January 2003

Sedimentological colour data obtained from North Atlantic deep-sea sediment core NEAP15K pro vide a continuous climate record for the last 11500 yr with a mean sampling interval of <15 yr. Variations in sediment lightness, a proxy for changes in North Atlantic Deep Water (NADW) circulation, are characterized by high-frequency fluctuations with periodicities equivalent to 550 and 1000 yr, as well as a <1600-yr cyclicity comparable to that reported in other studies of Holocene climate. Cross-spectral analysis suggests that the 550-yr and 1000-yr cyclical variations in NADW circulation were coherent with fluctuations in atmospheric con ditions over Greenland, where both these periodicities have been identified previously in the Holocene GISP2 d18O record (Stuiver et al., 1995). A similar statistical comparison provides evidence that high-frequency (550-yr) variability in NADW circulation patterns may have been linked to short-term variations in atmospheric 14C values during the Holocene. In general, NADW production was lower and 14C levels were higher when colder climatic conditions prevailed. These results imply that the pattern of NADW production has been a significant factor affecting centennial-to millennial-scale Holocene climate variability in the North Atlantic region.