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Background: Approximately 90%of persons living with dementia experience behavioral symptoms, including frontal lobe features involving motivation, planning, social behavior, language, personality, mood, swallowing, and gait. Objective: We conducted a two-stage study with a development sample (n = 586) and validation sample (n = 274) to evaluate a brief informant-rated measure of non-cognitive features of frontal lobe dysfunction: the Frontal Behavioral Battery (FBB). Methods: In the development sample, internal consistency, principal factor analysis, and correlations between the FBB and outcomes were evaluated. In the validation sample, we examined (a) FBB scores by diagnosis, (b) known-group validity by demographics, subjective complaints, and dementia staging, and (c) correlation between FBB and MRI volumes. Receiver operator characteristic curves assessed the ability of the FBB to discriminate individuals with frontal lobe features due to a neurodegenerative disease. Results: The FBB characterized 11 distinct frontal lobe features. Individuals with dementia with Lewy bodies and frontotemporal degeneration had the greatest number of frontal lobe features. Premorbid personality traits of extroversion, agreeableness, and openness were associated with fewer frontal lobe behavioral symptoms, while subjective cognitive complaints were associated with greater symptoms. The FBB provided very good discrimination between individuals with and without cognitive impairment (diagnostic odds ratio: 13.1) and between individuals with and without prominent frontal lobe symptoms (diagnostic odds ratio: 84.8). Conclusion: The FBB may serve as an effective and efficient method to assess the presence of non-cognitive symptoms associated with frontal lobe dysfunction, but in a brief fashion that could facilitate its use in clinical care and research.

Mindfulness (being present in the moment without judgement) has been linked to greater caregiver emotional health. Recent mindfulness-based interventions report improved coping skills, mood, and reduced stress in dementia caregivers. In this cross-sectional study of 141 ADRD caregivers, we assessed whether the relationship between caregiver mindfulness and caregiver experience varies by caregiver gender, relationship to patient (spouse-vs-child), etiology (AD-vs-LBD), or stage (MCI-vs-dementia). A stratified univariate analytic approach was used. Four mindfulness parameters (AMPS scale) were used: global score (GS), decentering (F1), positive (F2), and negative emotional regulation (F3). Outcomes included positive and negative appraisals of caregiving (PANAC), preparedness, care confidence, and depression. GS was linked to positive outcomes in male (rPANAC+=0.32/p=0.005), spouse caregivers (rPANAC+)=0.32/p=0.006 ) of ADRD patients regardless of etiology (rPANAC+=0.31/p=0.013 for AD; rconfidence=0.31/p=0.036 for LBD) and stage (rPANAC+=0.33/p=0.010 and rpreparedness=0.38,/p=0.008 for MCI; rPANAC+=0.29/p=0.011 and rconfidence=0.31/p=0.007 for dementia). Inverse relationships were observed with negative outcomes in male (rPANAC-=-0.46/p=0.002 and rdepression=-0.41/p=0.005), spouse caregivers (rPANAC-=-0.25/p=0.035 and rdepression=-0.30/p=0.009) of AD patients (rPANAC-=-0.25/p=0.043 and rdepression=-0.33/p=0.009) in early stages (rdepression=-0.41/p=0.001). F2 contributed to most relationships, with F3 and F1 significant in some but not all caregiver groups. Specifically, male spouse caregivers of AD patients regardless of stage may benefit from full-scope (F1-F3) programs while those of LBD patients from programs focused on improving emotional regulation (F2-F3). Wives of AD and LBD patients may in turn benefit from programs to improve positive emotional regulation (F2). Findings suggest that tailoring mindfulness-based interventions to specific caregiver groups may be effective in improving caregiver experience and mood.

The importance of family becomes magnified at times of serious illness, when people must grapple not only with the illness experience but also with facing end of life. The importance of family remains central regardless of family configuration or degree of presence. Social workers’ language and behaviors signal respect and support for diverse family variations. This chapter discusses the concept and complexity of family, family assessment, and common challenges for families in the palliative care context. The importance of attention to families’ nuanced experiences of culture, discrimination, and loss is punctuated. Information about communication and conducting interprofessional family conferences is presented. As members of interprofessional healthcare teams, social workers must articulate, model, and apply their expertise to advocate for and optimize family care experiences, recognizing their significance for bereavement.

Background: There is increasing interest in lifestyle modification and integrative medicine approaches to treat and/or prevent mild cognitive impairment (MCI) and Alzheimer’s disease and related dementias (ADRD). Objective: To address the need for a quantifiable measure of brain health, we created the Resilience Index (RI). Methods: This cross-sectional study analyzed 241 participants undergoing a comprehensive evaluation including the Clinical Dementia Rating and neuropsychological testing. Six lifestyle factors including physical activity, cognitive activity, social engagements, dietary patterns, mindfulness, and cognitive reserve were combined to derive the RI (possible range of scores: 1–378). Psychometric properties were determined. Results: The participants (39 controls, 75 MCI, 127 ADRD) had a mean age of 74.6±9.5 years and a mean education of 15.8±2.6 years. The mean RI score was 138.2±35.6. The RI provided estimates of resilience across participant characteristics, cognitive staging, and ADRD etiologies. The RI showed moderate-to-strong correlations with clinical and cognitive measures and very good discrimination (AUC: 0.836; 95% CI: 0.774–0.897) between individuals with and without cognitive impairment (diagnostic odds ratio = 8.9). Individuals with high RI scores (> 143) had better cognitive, functional, and behavioral ratings than individuals with low RI scores. Within group analyses supported that controls, MCI, and mild ADRD cases with high RI had better cognitive, functional, and global outcomes than those with low RI. Conclusion: The RI is a brief, easy to administer, score and interpret assessment of brain health that incorporates six modifiable protective factors. Results from the RI could provide clinicians and researchers with a guide to develop personalized prevention plans to support brain health.

Introduction The National Institute on Aging Alzheimer's Disease Research Center program added the Lewy body dementia module (LBD-MOD) to the Uniform Data Set to facilitate LBD characterization and distinguish dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). We tested the performance of the LBD-MOD. Methods The LBD-MOD was completed in a single-site study in 342 participants: 53 controls, 78 AD, and 110 DLB; 79 mild cognitive impairment due to AD (MCI-AD); and 22 MCI-DLB. Results DLB differed from AD in extrapyramidal symptoms, hallucinations, apathy, autonomic features, REM sleep behaviors, daytime sleepiness, cognitive fluctuations, timed attention tasks, and visual perception. MCI-DLB differed from MCI-AD in extrapyramidal features, mood, autonomic features, fluctuations, timed attention tasks, and visual perception. Descriptive data on LBD-MOD measures are provided for reference. Discussion The LBD-MOD provided excellent characterization of core and supportive features to differentiate DLB from AD and healthy controls while also characterizing features of MCI-DLB.

The risk of motion sickness is considerably higher in autonomous vehicles than it is in human-operated vehicles. Their introduction will therefore require systems that mitigate motion sickness. We investigated whether this can be achieved by augmenting the vehicle interior with additional visualizations. Participants were immersed in motion simulations on a moving-base driving simulator, where they were backward-facing passengers of an autonomous vehicle. Using a Head-Mounted Display, they were presented either with a regular view from inside the vehicle, or with augmented views that offered additional cues on the vehicle's present motion or motion 500ms into the future, displayed on the vehicle's interior panels. In contrast to the hypotheses and other recent studies, no difference was found between conditions. The absence of differences between conditions suggests a ceiling effect: providing a regular view may limit motion sickness, but presentation of additional visual information beyond this does not further reduce sickness.

This comprehensive literature review analyzed relevant studies on the effects of exercise interventions for older adults with dementia. An extensive search of databases was conducted to identify re...

Experiencing stress during training is a way to prepare professionals for real-life crises. With the help of feedback tools, professionals can train to recognize and overcome negative effects of stress on task performances. This paper reports two studies that empirically examined the effect of such a feedback system. The system, based on the COgnitive Performance and Error (COPE) model, provides its users with physiological, predicted performance and predicted error-chance feedback. The first experiment focussed on creating stressful scenarios and establishing the parameters for the predictive models for the feedback system. Participants (n=9) performed fire-extinguishing tasks on a virtual ship. By altering time pressure, information uncertainty and consequences of performance, stress was induced. COPE variables were measured and models were established that predicted performance and the chances on specific errors. In the second experiment a new group of participants (n=29) carried out the same tasks while receiving eight different combinations of the three feedback types in a counterbalanced order. Performance scores improved when feedback was provided during the task. The number of errors made did not decrease. The usability score for the system with physiological feedback was significantly higher than a system without physiological feedback, unless combined with error feedback. This paper shows effects of feedback on performances and usability. To improve the effectiveness of the feedback system it is suggested to provide more in-depth tutorial sessions. Design changes are recommended that would make the feedback system more effective in improving performances. © 2016 The Authors. Published by Elsevier Ltd.

BACKGROUND This study reports cancer-treating institutions' capacity to deliver comprehensive psychosocial support services. METHODS Oncology care providers at 60 cancer-treating institutions completed surveys assessing the capacity of their institutions to provide psychosocial care. Capacity was assessed with the Cancer Psychosocial Care Matrix (CPCM) from the National Cancer Institute (NCI). Scores represented individuals' perceptions of their cancer program's performance with respect to 10 fundamental elements of psychosocial care. RESULTS Among 2134 respondents, 62% reported a mid-level capacity for ≥5 of 10 CPCM items. In comparison with other types of cancer programs (eg, NCI-designated, academic, or comprehensive centers), providers at community cancer programs reported a significantly greater capacity with respect to patient-provider communication, psychosocial needs assessment, and continuity in the delivery of psychosocial care over time. Nurses and primary medical providers reported a significantly lower capacity for linking patients and families with needed psychosocial services within their respective cancer programs. They also reported a significantly higher capacity for conducting follow-up, re-evaluations, and adjustments of psychosocial treatment plans. CONCLUSIONS Cancer programs are performing moderately well in terms of communicating to patients the importance of psychosocial care, identifying patient psychosocial needs, and referring patients and families to psychosocial services. They are doing less well with respect to the provision of that care over time. Findings suggest that gaps in psychosocial service capacity are a function of patient, provider, and system characteristics. These results may be useful in formulating strategies to enhance psychosocial care delivery. Cancer 2016;122:1937–45. © 2016 American Cancer Society.

Disciplinary diversity in team composition is a valuable vehicle for oncology care teams to provide high-quality, person-centered comprehensive care. Such diversity facilitates care that effectively addresses the complex needs (biologic, psychosocial, and spiritual) of the whole person. The concept of professional or disciplinary diversity centers on differences in function, education, and culture, reflecting variety and heterogeneity in the perspectives of team members contributing to care. Thorough understanding of the skills, knowledge, and education related to each team member’s professional or lay expertise is critical for members to be able to optimize the team’s potential. Furthermore, respect and appreciation for differences and similarities across disciplinary cultures allow team members to create a positive collaboration dynamic that maintains a focus on the care of the person with cancer. We present a case study of one oncology team’s provision of care to the patient, a Chinese immigrant woman with breast cancer. The case illuminates the strengths and challenges of disciplinary diversity in team composition in assessing and addressing potential barriers to care. Coordinated sharing of information among the varied team members facilitated understanding and care planning focused on the patient’s concerns, needs, and strengths. Importantly, collaboration across the disciplinarily diverse set of team members facilitated high-quality oncology care and promoted equity in access to the full range of care options, including enrollment on a National Cancer Institute–sponsored clinical trial. Further implications of disciplinary diversity in oncology care teams are considered for both clinical practice and research.

Communication is an ongoing challenge for clinicians working with people facing life-threatening illnesses and end of life. Family conferences offer patient-focused, family-oriented care that brings together patients, family members, and health care providers.The aim of this study was to develop a research-based model for family conferences to help physicians and other health care providers conduct such conferences effectively and improve communication with patients and families.We prospectively studied family conferences for patients facing life-threatening illness in two inpatient medical centers. We videotape and audiotape recorded real-life conferences and postconference interviews with participants.Twenty-four family conferences were included in the study. Participants consisted of 24 patients, 10 of whom took part in the family conferences, 49 family members, and 85 health care providers.A multidisciplinary team conducted a qualitative analysis of the videotaped and audiotaped materials using thematic analysis. The team used a multistage approach to independently and collectively analyze and integrate three data sources.The resulting theoretical model for family conferences has 4 main components. These include the underlying structural context of conference organization and the key process components of negotiation and personal stance. Emotional engagement by health care providers, emotion work, appears central to the impact of these components on the successful outcome of the conference. In addition to the theoretical model, the authors found that family conference participants place specific value on the "simultaneous presence" of conference attendees that leads to being on the "same page."Physicians and other health care professionals can use the model as a guide for conducting family conferences and strengthening communication with patients, families and colleagues.

Increasing emphasis is being placed on the need for advanced care planning (ACP) at the end of life. The Preferred Priorities for Care (PPC) document is a patient-held record promoted by the End of Life Care Strategy as an ACP tool to promote discussion and communication amongst patients, family and health care providers. However, little research exists into evaluating its effectiveness or exploring patient and carer views, particularly in non-malignant disease. Because the majority of patients with Motor Neurone Disease (MND) lose verbal communication, early discussion of patients’ wishes and preferences, a central aspect of ACP, is vital. This study examined MND patients’ bereaved relatives’ experiences of using the PPC document and their perceptions about its impact on end-of-life care using qualitative methods. Key findings adding to existing literature were that the PPC document was felt to have little impact on end-of-life care amongst this patient group and that there was a perceived lack of awareness of the document amongst health care professionals (HCPs), in particular hospital staff. This was felt to limit the effectiveness of the document. This has obvious implications for practice, looking at awareness amongst HCPs and ways to improve this situation, particularly in light of the current pressures to meet patient preferences at the end of life.

Background— One of the key targets in treating mitral regurgitation (MR) is reducing the otherwise progressive left ventricular (LV) remodeling that exacerbates MR and conveys adverse prognosis. We have previously demonstrated that severing 2 second-order chordae to the anterior mitral leaflet relieves tethering and ischemic MR acutely. The purpose of this study was to test whether this technique reduces the progression of LV remodeling in the chronic ischemic MR setting. Methods and Results— A posterolateral MI was created in 18 sheep by obtuse marginal branch ligation. After chronic remodeling and MR development at 3 months, 6 sheep were randomized to sham surgery (control group) and 12 to second-order chordal cutting (6 each to anterior leaflet [AntL] and bileaflet [BiL] chordal cutting, techniques that are in clinical application). At baseline, chronic infarction (3 months), and follow-up at a mean of 6.6 months post-myocardial infarction (MI) (euthanasia), we measured LV end-diastolic (EDV) and end-systolic volume (ESV), ejection fraction, wall motion score index, and posterior leaflet (PL) restriction angle relative to the annulus by 2D and 3D echocardiography. All measurements were comparable among groups at baseline and chronic MI. At euthanasia, AntL and BiL chordal cutting limited the progressive remodeling seen in controls. LVESV increased relative to chronic MI by 109±8.7% in controls versus 30.5±6.1% with chordal cutting ( P P P P Conclusions— Reduced leaflet tethering by chordal cutting in the chronic post-MI setting substantially decreases the progression of LV remodeling with sustained reduction of MR over a chronic follow-up. These benefits have the potential to improve clinical outcomes.

High-quality palliative care includes effective communication with families, including the patient. Regardless of family composition, the family is the core social context for a patient's illness experience. The family serves as a key source of support, and strain, for many people, and it is recognised as the unit of care in palliative care and care settings of those with life-limiting illness. As a result, communication with families is a key aspect of palliative care but one for which few professionals are well-prepared. Social workers are particularly trained and positioned to work with families, bringing expertise to family care in the palliative care setting. The theoretical approaches and clinical skills applied by social workers make them logical leaders for practice and guidance in family-oriented communication and care. Healthcare providers, particularly social workers, assess and explore diverse aspects of family life when caring for families and planning communication with family members, including the patient. These family considerations are discussed in this article as they are central to building appropriate family communication. While communication with families takes place in numerous forms and configurations, family conferences are recognised as an important part of the work with families in the setting of palliative care. An overview of family conferences offers information about this form of communication with specific attention to distinctive contributions of social workers. Effective communication by the healthcare team has a tremendous effect on the experience of families facing life-threatening illness and the loss of a family member.

Objective Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. Principal treatment options for ADHD today include the psychostimulants, mainly methylphenidate (MPH). However, approximately 30% to 50% of children and adults with ADHD either do not respond to or do not tolerate treatment with stimulants. In this 8-week open-label, MPH-controlled, parallel group design study, we investigate the efficacy of reboxetine, a new selective norepinephrine reuptake inhibitor, in the treatment of boys with ADHD with a history of intolerance to MPH therapy. Method Twenty-seven outpatient boys, aged 6 to 16 years, diagnosed with ADHD, participated in the study. Those with a history of intolerance to MPH therapy were assigned to treatment with reboxetine (2-8 mg/d), and the rest were assigned to treatment with MPH (10-20 mg/d) as the control group. The primary outcome measure for this study was the change in rating scores on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ADHD Scale (DAS) that was assessed at baseline and at 8 weeks. Results At the end of 8 weeks, both reboxetine and MPH treatment regimens resulted in significant improvement in ADHD symptoms. The change in the reduction in the total DAS score and the DAS subscale scores between the reboxetine group and the MPH group was not statistically significant in any of the scores. Conclusions Although preliminary, results of this study indicate that the use of reboxetine, a new selective norepinephrine reuptake inhibitor, in the treatment of ADHD could increase treatment options available for children who have shown intolerance or who are unresponsive to MPH.

In the setting of an international conference on malignant bowel obstruction as a model for randomized controlled trials (RCTs) in palliative care, we discuss the importance of incorporating prospective cultural considerations into research design. The approach commonly used in biomedical research has traditionally valued the RCT as the ultimate "way of knowing" about how to best treat a medical condition. The foremost limitation of this approach is the lack of recognition of the impact of cultural viewpoints on research outcomes. We propose that interest relevant to cultural viewpoints should be emphasized in conceptualizing and interpreting research questions, designs, and results. In addition to recognizing our cultural biases as individuals and researchers, we recommend two major shifts in designing and implementing RCTs: 1) inclusion of a multidisciplinary team of researchers to inform the diversity of perspectives and expertise brought to the research, and 2) use of mixed methods of inquiry, reflecting both deductive and inductive modes of inference.

Aims We compare our experience with available circular multi-electrode catheters for atrial fibrillation (AF) ablation: PVAC®, a phased radiofrequency system, and nMARQ™, an irrigated tip-CARTO-based technology. Methods and results Prospective observational study of 175 consecutive patients with follow-up duration of at least 5 months who underwent pulmonary vein isolation (PVI) for symptomatic AF using PVAC® ( n = 93, age 61.4 ± 9.8 years; 60% male, 13% persistent AF) vs. nMARQ™ ( n = 82, age 63.2 ± 10.6 years; 67% male, 24% persistent AF). Procedure and radiation times were 94 ± 27 and 33 ± 13 min for PVAC® and 81 ± 18 and 30 ± 8.5 for nMARQ™ ( P = 0.0008 and P = 0.18), respectively. The number of applications and the total burning time (min) were 20 ± 7 and 19 ± 6.7 for PVAC® and 16 ± 5.6 and 11 ± 4 for nMARQ™ ( P < 0.0001 for both), respectively. In two nMARQ™ patients with small atria and pulmonary veins (PVs) and in two PVAC® patients with large PVs, the procedure failed; switching to the alternative technology was successful. Acute success rate was 97% for PVAC® and 95% for nMARQ™. There was one tamponade in nMARQ™ group and non-significant different minor complications for both techniques. One-year freedom from AF was 79 and 80.7% with PVAC® vs. nMARQ™, after one PVI, and 88 vs. 87.7% after two PVIs. Conclusion Both technologies have short procedure and fluoroscopy times, comparable complication rates, and comparable acute and 1-year success rates. The number of applications and total procedure and burning times were shorter with nMARQ™. nMARQ™ was more suitable for larger atria and PVs. Thus, a patient-based pre-ablation anatomy definition is probably warranted for appropriate selection of technology type.

The National Consensus Project (NCP) Guidelines for Quality Palliative Care, the National Quality Forum (NQF), and multiple Institute of Medicine reports all recommend a team approach as the optimal way to provide patient-and-family-focused care, yet our current socialization of professionals remains discipline-specific. This chapter will provide readers an opportunity to consider various strategies useful in increasing team effectiveness. The use of family meetings is highlighted as an important palliative care team intervention.

Pain and symptom management is critical for quality end-of-life care in the hospital. Although guidelines support the use of unrestricted opiate administration to treat refractory pain and suffering in the dying patient, many patients die suffering with symptoms that could have been addressed.A multidisciplinary convenience sample of 381 hospital-based health care providers completed a survey evaluating their understanding of the principles of treating refractory pain and suffering at the end of life in the hospital, knowledge of the institution's policy about how to implement such care, and attitudes about and comfort with such treatment.Respondents recognized pain and symptom management as a goal of unrestricted opiate use at the end of life, but 12% identified comfort for families or treatment of nonphysical suffering as the principal goal of this modality. Two thirds of respondents felt that unrestricted opiates were used too rarely and 45% felt they were used too late. However, 16% felt uncomfortable administering unrestricted opiates and 21% of physicians and nurses who had used restricted opiates reported having felt pressured to increase dosing of opiates. Knowledge deficits concerning appropriate candidates for unrestricted opiates and the protocol for appropriate implementation were common.Knowledge deficits and attitudinal concerns may hamper the administration of unrestricted opiates for refractory pain and suffering at the end of life in the hospital. Clinician education and clarification of the appropriate use of this modality when there are differences in clinician and family perception of discomfort are needed.

Medical education inadequately prepares students for interdisciplinary collaboration, an essential component of palliative care and numerous other areas of clinical practice. This study developed and evaluated an innovative interdisciplinary educational program in palliative care designed to promote interdisciplinary exchange and understanding.The study used a quasi-experimental longitudinal design. Thirty-three medical students (third and fourth year) and 38 social work students (second year of masters degree) were recruited. The intervention group students (21 medical and 24 social work students) participated in a series of four training sessions over four weeks while the control group students received written materials after the study. The curriculum and teaching methods were based on theories of professional socialization and experiential learning. The intervention included experiential methods to promote interdisciplinary interaction to foster communication, exchange of perspectives, and the building of mutual trust and respect. Both groups completed assessments of perceived role understanding, a primary component of effective interdisciplinary teamwork, in palliative care. Self-administered surveys were completed at baseline, intervention completion, and three months later. The intervention group also completed an anonymous evaluation about the interdisciplinary education.The intervention group demonstrated a significant increase in perceived role understanding compared with the control group. Three-month follow-up data suggested that intervention group subjects maintained gains in perceived role understanding.An interdisciplinary educational intervention improves role understanding early in the process of professional socialization in a pilot program. Further implementation of interdisciplinary education should evaluate the effect on subsequent interdisciplinary practice and the quality of patient care.

Social robots may comfort and support children who have to cope with chronic diseases like diabetes. In social interactions, it is important to be able to express recognizable emotions. Studies show that the iCat robot, with its humanoid facial features, has this capability. In this paper we look if a Nao robot, without humanoid facial features, but with a body and colored eyes is also able to express recognizable emotions. We compare the recognition rates of the emotions between the Nao and the iCat. First a set of bodily expressions of the Nao for five basic emotions (angry, fear, happy, sad, surprise) was created and evaluated. With a signal detection task, the best recognizable bodily expression for each emotion was chosen for the final set. Then, fourteen children between 8 and 9 years old interacted both with the Nao and iCat to recognize the emotions within context, in a story-telling session, and without context. These interactions were repeated one week later to study the learning effect. For both robots, recognition rates for the expressions were relatively high (between 68 and 99 % accuracy). Only for the emotional state of sadness, the recognition was significantly higher for the iCat (95 %) than for the Nao (68 %). The emotions shown within context had higher recognition rates than those without context and during the second interaction the emotion recognition was also significantly higher than during the first session for both robots. To conclude: we succeeded to design a set of well-recognized dynamic emotional expressions for a robot platform, the Nao, without facial features. These expressions were better recognized when placed in a context, and when shown a week later. This set provides useful ingredients of social robot dialogs with children.

Samples of Jerusalem limestones were exposed to high levels of common air pollutants (SO2, NO) in the presence and absence of hydrocarbon, water vapor and ultra-violet light. After exposure, the outer layers were shaved off and analyzed for sulfate and nitrate. The results revealed that even after one day of exposure significant concentrations of CaSO4 and Ca(NO3)2 could be detected in the external 40 μm layers. Sulfate formation was found to relate very strongly to relative humidity with nearly undetectable production at humidities below 10%. Nitrate formation was found to relate to UV light and to a limited extent to the presence of hydrocarbon but was unchanged at different humidities. Surface samples were taken from different sites of the old city wall and were also analyzed for the same substances. The data showed that the concentrations of especially CaSO4, and to a limited extend Ca(NO3)2, measured at various points along the city walls were higher than the expected values extrapolated from laboratory simulations. The elevated pollution content may be explained in part due to the deposition of transported ions, especially sulfate, onto the stone surface. It was concluded that although air pollution may not cause any structural damage in the foreseeable future it definitely deteriorates the fine details of the ancient monument.