The origin of the European Medieval Warm Period"

Proxy records and results of a three dimensional climate model show that European summer temperatures roughly a millennium ago were comparable to those of the last 25 years of the 20th century, supporting the existence of a summer "Medieval Warm Period" in Europe. Those two relatively mild periods were separated by a rather cold era, often referred to as the "Little Ice Age". Our modelling results suggest that the warm summer conditions during the early second millennium compared to the climate background state of the 13th–18th century are due to a large extent to the long term cooling induced by changes in land-use in Europe. During the last 200 years, the effect of increasing greenhouse gas concentrations, which was partly levelled off by that of sulphate aerosols, has dominated the climate history over Europe in summer. This induces a clear warming during the last 200 years, allowing summer temperature during the last 25 years to reach back the values simulated for the early second millennium. Volcanic and solar forcing plays a weaker role in this comparison between the last 25 years of the 20th century and the early second millennium. Our hypothesis appears consistent with proxy records but modelling results have to be weighted against the existing uncertainties in the external forcing factors, in particular related to land-use changes, and against the uncertainty of the regional climate sensitivity. Evidence for winter is more equivocal than for summer. The forced response in the model displays a clear temperature maximum at the end of the 20th century. However, the uncertainties are too large to state that this period is the warmest of the past millennium in Europe during winter.

Pica and refractory iron deficiency anaemia: a case report

ABSTRACT: INTRODUCTION: Iron deficiency is the most common cause of anaemia worldwide. Pica, the ingestion of substances that are inappropriate for consumption, is associated with iron deficiency and may be under-diagnosed. CASE PRESENTATION: A 34-year-old woman presented with iron deficiency anaemia refractory to treatment for more than a decade. The clinical presentation, endoscopic findings and laboratory investigations were consistent with pica. Subsequent geophysical analysis confirmed that the ingested material was kaolin, a negatively charged silicate. CONCLUSION: Prolonged unexplained iron deficiency anaemia should prompt clinicians to remember and inquire about pica. In our patient, this would have averted numerous unnecessary investigations and prevented a decade-long suffering.