A workshop was held at the University of the West Indies, Jamaica, in May 2012 to build capacity in climate data rescue and to enhance knowledge about climate change in the Caribbean region. Scientists brought their daily observational surface temperature and precipitation data from weather stations for an assessment of quality and homogeneity and for the calculation of climate indices helpful for studying climate change in their region. This study presents the trends in daily and extreme temperature and precipitation indices in the Caribbean region for records spanning the 1961-2010 and 1986-2010 intervals. Overall, the results show a warming of the surface air temperature at land stations. In general, the indices based on minimum temperature show stronger warming trends than indices calculated from maximum temperature. The frequency of warm days, warm nights and extreme high temperatures has increased while fewer cool days, cool nights and extreme low temperatures were found for both periods. Changes in precipitation indices are less consistent and the trends are generally weak. Small positive trends were found in annual total precipitation, daily intensity, maximum number of consecutive dry days and heavy rainfall events particularly during the period 1986-2010. Correlations between indices and the Atlantic multidecadal oscillation (AMO) index suggest that temperature variability and, to a lesser extent, precipitation extremes are related to the AMO signal of the North Atlantic surface sea temperatures: stronger associations are found in August and September for the temperature indices and in June and October for some of the precipitation indices.

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Singular value decomposition (SVD) techniques are used to deduce a relationship between rainfall over the Caribbean basin and oppositely signed sea-surface temperature anomalies in the Pacific and Atlantic. The analysis is done for four 3 month seasons. The first two seasons: November-January (NDJ) and February-April (FMA) encompass the Caribbean dry period, and the other two, May-July (MJJ) and August-October (ASO), include the early and late Caribbean rainy seasons. The first SVD mode for all seasons represents variability due to El Niño-southern oscillation (ENSO) and, with the exception of the later wet season, the second SVD mode represents variability due to tropical North Atlantic sea-surface temperatures. ENSO has the greatest impact during the late rainfall season (ASO) and the early dry season (NDJ), whereas the tropical Atlantic controls variability in the early rainfall season (MJJ). The configuration of concurrent but oppositely signed sea-surface temperature anomalies in the tropical Pacific and Atlantic basins is only associated with rainfall modification in the late Caribbean rainfall season (ASO) and the early Caribbean dry season (NDJ).

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to design and build health care facilities founded on research or the best available information, ensuring that the relatively permanent physical environment facilitates the delivery of quality care, thereby improving patients' outcomes and safety. 2 Review of the Literature on EBD in Critical and Acute CareSubstantial support exists for the view that a health care structure itself affects quality of care, patients' safety and satisfaction, as well as staff satisfaction and service efficacy. 3 In a report to the Center for Health Design funded by the Robert Wood Johnson Foundation, Ulrich and associates 4 identified more than 600 studies that link hospital design with clinical outcomes. In recent years, evidence-based design (EBD) has become a more pronounced guiding principle in health care. The concept of EBD is BACKGROUND In 2 landmark publications, the Institute of Medicine reported on significant deficiencies in our current health care system. In response, an area of research examining the role of the physical environment in influencing outcomes for patients and staff gained momentum. The concept of evidence-based design has evolved, and the development of structural guidelines for new hospital construction was instituted by the American Institute of Architects in 2006.OBJECTIVE To determine perceptions of patients and their families of evidence-based design features in a new heart center.METHODS Hospitalized patients and their families, most of whom were in intensive care and step-down units, were surveyed and data from the Hospital Consumer Assessment of Healthcare Providers and Systems were reviewed to determine perceptions of evidence-based design features incorporated into a new heart center and to assess patients' satisfaction with the environment. RESULTS Responses were reviewed and categorized descriptively. Five general environment topics of focus emerged: privacy, space, noise, light, and overall atmosphere. Characteristics perceived as being dissatisfying and satisfying are discussed.CONCLUSIONS Critical care nurses must be aware of the current need to recognize how much the physical environment influences care delivery and take steps to maximize patients' safety, satisfaction, and quality of care. This article has been designated for CE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Discuss the concept of evidence-based design in health care environments 2. Identify evidence-based design features associated with improved patient care 3. Recognize the role of physical environment in influencing patient outcomes