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This study explores teachers' awareness of intuition, and how that awareness affects their classroom practices both conceptually and pragmatically. Scholars have long supported the notion that intuition is a crucial form of knowing that supports teaching. Teachers rely heavily on their intuition to deal with complex classroom situations, especially those that require on-the-spot problem solving, decision-making, and creativity. Yet, how they do so has rarely been the topic of empirical investigation. In this study, qualitative data were gathered from two groups of in-service teachers (17 in total) while they participated in a professional development programme designed to improve their awareness of intuitions through meditative and embodied exercises. Reflection log entries revealed that teachers' awareness of intuitions includes preparing for, sensing, and considering intuitive signals. Furthermore, participants perceived increased awareness of intuitions as well as perceived positive effects on individual pupils, groups of pupils, and on themselves. This study reveals teacher experiences in their journey to becoming aware of their intuition, developing it, and putting it to use in the classroom. Recommendations are given for further inquiry into the crucial teacher quality of intuition.

Informed study decisions are pivotal for student retention in higher online education. A self-assessment prior to enrolment has been proposed as a promising approach to enable informed decision-making and to build resources for retention. To determine whether such a self-assessment affects the decision-making process as intended, thorough and careful validation is a necessity. This study reports on two validity aspects that are less commonly addressed in that respect, but essential for evaluating effectiveness: response processes and consequences of (self-) testing. To map the response processes and consequences of the current self-assessment, a mixed-methods approach was used in which eight prospective students took a self-assessment in an observed think-aloud mode and were interviewed before and after that. Results show different response processes depending on the type of subtest that is taken. The results also indicate that consequential aspect of validity must be considered in the context of decision-making phases. The demonstrated evidence and possible threats to validity are discussed in light of refining the self-assessment and embedding it in counselling practice.

Although teachers' commitment to continuous professional learning is crucial for high quality education, research shows that this learning cannot be taken for granted. To better understand how teachers' learning at work can be supported, this study investigates how effects of job demands (i.e. work pressure and emotional pressure) and job resources (i.e. task autonomy, transformational leadership, and collegial support) on teachers' learning commitment (i.e. learning frequency and engagement) can be explained by basic psychological need satisfaction and autonomous motivation, as posited by self-determination theory. At two occasions, approximately one year apart, data was collected in a sample of 678 (T1) and 536 (T2) Dutch secondary school teachers. Structural equation models showed the consecutive positive longitudinal relationships between teachers' experience of job resources, basic psychological need satisfaction, autonomous motivation, and commitment to professional learning. Job demands were not related to basic need satisfaction over and above the effects of job resources. Implications for how self-determination theory and the job demands resources model can mutually inform each other are discussed. In addition, implications for stimulating teachers' professional learning in practice are provided.

The power of portfolios in enhancing student motivation is frequently emphasised. Portfolios are conceptualised as a tool to implement Assessment for Learning (AfL) in classroom practice. However, the relation between portfolios and AfL on the one hand, and student motivation on the other hand, is complex and subject to many assumptions. This study investigates whether portfolio use actually supports the integration of AfL in classroom practice and the relation with students' motivation. Questionnaires were administered to a total of 419 grade 4 to 6 students from seven Dutch elementary schools. The results of structural equation modelling did not confirm a direct relation between portfolio use and students' motivational orientation. The findings indicate that the relation between portfolios and motivational orientation is fully mediated by students' perceptions of AfL. The findings indicate that the tool portfolio is not related to students' motivation, however, AfL practices do affect motivation.

Introduction: In this study, we applied the Intervention Model for Affective Involvement (IMAI) to four participants who are congenitally deafblind and their 16 communication partners in 3 different settings (school, a daytime activities center, and a group home). We examined whether the intervention increased affective involvement between the participants and their communication partners and whether it increased positive emotions and reduced negative emotions in the participants. Methods: We used video observations in a multiple-baseline design across subjects to assess the effects of the 20-week intervention on the communication partners' interactions with the participants. Results: After onset of the intervention, affective involvement increased for three participants, while all four participants showed an increase in positive emotions and a decrease in negative emotions. During follow-up, the positive effect on the participants' behaviors decreased in most cases, but remained visible as compared to the baseline level. Discussion: The findings demonstrate that the IMAI can be successfully applied to persons who are congenitally deafblind. Given the small number of participants, replication of the intervention is recommended. Implications for practitioners: Affective involvement can be increased by training, but it is difficult to maintain this effect over time. Coaching of communication partners on a more permanent basis is recommended to maintain the sharing of emotions between persons who are congenitally deafblind and their communication partners.

Students do not always feel that their ideas for improving educational quality are taken seriously. Student-staff partnerships may help take this feeling away. In such partnerships, students equally collaborate with staff and participate in shared decision-making and implementation processes for improving education. However, empirical research has hitherto paid scant attention to the question of how students experience such student-staff collaborations, whether they are willing to participate in these partnerships and, if so, under which circumstances. We therefore conducted an explanatory mixed-methods study, for which we administered a student-staff partnership questionnaire to 87 students and held four focus groups. In the students' view, students can provide a unique perspective on educational improvement. Yet, they did not consider their collaborations with staff as full partnerships, because their role remained restricted to giving advice and they were not involved in the implementation process. Although students felt respected by staff, they expressed a wish to be informed of what happened with their suggestions, and to be seen as equal partners while appreciating the difference in students and staff members' roles. Additionally, students pointed to a need for clear and well-communicated role descriptions. We conclude that to render student-staff partnerships effective, students should be empowered more.

Teachers' innovative behaviour and professional development are important aspects of high-quality education. It is often thought that motivation influences teachers' innovative behaviour and professional development. The main purpose of this study is to gain more insight into motivational processes contributing to teachers' innovative behaviour. Using Self-Determination Theory, both intrinsic motivation and basic psychological need satisfaction are addressed. From an organizational psychology perspective, occupational self-efficacy is also included in the hypothesized model. Online survey data from teachers in primary, secondary, and vocational education in the Netherlands (n = 2,385) are analysed using structural equation modeling. Results show that basic psychological need satisfaction affects both intrinsic motivation and occupational self-efficacy, and that the latter strongly supports innovative behaviour.

Background: Assessment for Learning (AfL) is believed to create a rich learning environment in which students develop their cognitive and metacognitive strategies. Monitoring student growth and providing scaffolds that shed light on the next step in the learning process are hypothesized to be essential elements of AfL that enhance cognitive and metacognitive strategies. However, empirical evidence for the relation between AfL and students' strategy use is scarce. Aim: This study investigates the relation between AfL and elementary school students' use of cognitive and metacognitive strategies. Sample: The sample comprised 528 grade four to six students (9-to 12-year-olds) from seven Dutch elementary schools. Methods: Students' perceptions of AfL and their cognitive and metacognitive strategy use were measured by means of questionnaires. Structural equation modelling was used to investigate the relations among the variables. Results: The results reveal that monitoring activities that provide students an understanding of where they are in their learning process predict Students' task orientation and planning. Scaffolding activities that support students in taking the next step in their learning are positively related to the use of both surface and deep-level learning strategies and the extent to which they evaluate their learning process after performing tasks. Conclusions: The results underline the importance of assessment practices in ceding responsibility to students in taking control of their own learning.

This study focuses on learning in three different hypermedia environments that either support autonomous learning, learner-controlled learning or system-controlled learning and explores the mediating role of academic self-regulation style (ASRS; i.e. a macro level of motivation) on learning. This research was performed to gain more insight in the conditions under which learning in hypermedia environments is effective. Sixty-nine grade five students from a primary school answered short essay questions using video material from a hypermedia environment. The effects on task motivation and test performance were measured. It was found that learners in the autonomy supported hypermedia environment reported lower levels of controlled task motivation, compared to the learners in the system-controlled and learner-controlled hypermedia environments. But there were no effects of hypermedia environment on autonomous task motivation or the reported need fulfilment for autonomy. Furthermore, learners in the learner-controlled hypermedia environment scored lower on a delayed, In-Depth Knowledge Test compared to learners in the other two environments. Moreover, learners in the autonomy supported hypermedia environment watched more (unique) videos compared to learners in the system-controlled and the learner-controlled hypermedia environments. As for the role of learners' ASRS, we found no interaction with the type of hypermedia environment on task motivation or performance. Learners' ASRS did, however, affect the learners' motivation for the task. And, when presented with advice (as in the autonomy supported hypermedia environment) learners with an autonomous self-regulation style followed more advice, compared to learners with a more controlled self-regulation style.

This study examined the effects of a 20-week intervention to foster affective involvement during interaction and communication between an adult with congenital deafblindness (CDB) and his caregivers in a group home and a daytime activities center. Using a single-subject design, we examined whether the intervention increased affective involvement between the participant and his caregivers, and whether the participant's positive emotions increased and his negative emotions decreased. In both settings, an increase in affective involvement and very positive emotions coincided with the onset of the intervention, with the clearest effects in the daytime activities center. Negative emotions decreased in the daytime activities center. During follow-up, affective involvement decreased in both settings but remained above baseline. The caregivers indicated that it was easier to share positive emotions than negative emotions. This study demonstrates that it is possible to foster affective involvement with an adult with CDB, both during interaction and communication.

In this study the perception of psychological needs and motivation in a student-centred and a teacher-centred learning environment are compared, using Self Determination Theory as a framework. The self-report Intrinsic Motivation Inventory was completed by 230 students (mean age 16.1 years) in pre-vocational secondary education. School records on absenteeism and achievement were also analysed. As predicted, multi-level analyses showed that students in the student-centred learning environment reported higher levels of perceived autonomy, competence, relatedness and motivation, measured by pleasure and effort. Furthermore, boys were less absent. Achievement shows no differences. These results suggest that a student-centred form of learning can be more beneficial for students' motivation if granted autonomy is embedded in a supportive environment.

This study examines whether teachers are able to apply the principles of autonomy support and structure support in designing digital problem based learning (PBL) tasks. We examine whether these tasks are more autonomy- and structure-supportive and whether primary and secondary school students experience greater autonomy, competence, and motivation in these tasks. Participants were 184 fifth-, sixth-, seventh- and eighth-grade students and 20 teachers. The results showed that teachers indicated that their digital PBL tasks were more autonomy- and structure-supportive after completing the training. Furthermore, students' perceived autonomy, perceived competence, and intrinsic motivation in the digital PBL tasks were higher after teachers completed the training. In addition, there was an interaction effect between training and school type on perceived autonomy, perceived competence, and intrinsic motivation. Compared to primary school students, secondary school students evidenced a greater increase in perceived autonomy, perceived competence, and intrinsic motivation on the PBL tasks.

In the present study, the ways in which digital learning tasks contribute to students' intrinsic motivation and learning outcomes were examined. In particular, this study explored the relative contributions of autonomy support and the provision of structure in digital learning tasks. Participants were 320 fifth- and sixth-grade students from eight elementary schools throughout the Netherlands. The results show that a digital learning task that combined autonomy support and structure had a positive effect on both intrinsic motivation and learning outcomes in students. A digital learning task that only provided structure also had a positive effect on learning outcomes, but a digital learning task with only autonomy support did not yield a similar effect.

The way students perceive a learning climate (e.g. controlling or stimulating) is significantly influenced by feedback and assessment. However, at present much is unclear about the relation between feedback and motivational state. More specifically, the interplay with student characteristics is unclear. Since there is a strong increase of group work, the central research question is what are the effects of positive, neutral or negative feedback presented to collaborating teams of students, on students' intrinsic motivation, performance and on group processes? One hundred thirty-eight higher education students participated in this study. There were no significant differences in performance across conditions. Multi-level analysis enabled a detailed comparison between groups and individual members of groups. Amongst others, it was found that feelings of competence facilitate the effect of positive feedback at the group level, which suggests that positive feedback boosts interest especially in groups of highly competent students. (Contains 4 tables.)

In order to stimulate student teachers to thoroughly comprehend the main variables influencing their work, teaching and assessment strategies in teacher education have changed significantly. One of the changes in the assessment of student teachers in teacher education programs is the use of case-based assessment instruments. Such instruments evaluate the extent to which student teachers are able to handle authentic problems. It is expected that implementing this mode of assessment will stimulate student teachers to adopt a deep approach to learning. In this study we examine student teachers' learning approaches in the context of case-based assessment. Hereto, we investigated the direct effects of the student teachers' general beliefs on the cognitive demands of assessment on their learning approaches. Also the student teachers' perceptions of the cognitive demands of the case-based assessment instrument were considered as a mediating variable. The present study is conducted in the Netherlands, in the third year of a 4-year initial teacher training program for primary education. A case-based assessment instrument, called the OverAll Test, was implemented as the major determinate of the third-year final examination grade of the student teachers. The results of the correlation analyses and the path analyses indicate a strong influence of student teachers' general beliefs on the cognitive demands of assessment on their perceptions of the cognitive demands of the OverAll Test. The student teachers' perception of the deep-level demands of the OverAll Test mediates the effect of their beliefs on the adoption of deep approaches to learning. (Contains 3 figures and 2 tables.)

In an e-learning environment there is a need to integrate various e-learning services like assessment services, collaboration services, learning design services and communication services. In this article we present the design and implementation of a generic integrative service framework, called CopperCore Service Integration (CCSI). We will concentrate on the integration of two services: CopperCore, an IMS Learning Design service and an IMS Question and Test Interoperability service called Assessment Provision through Interoperable Segments (APIS). One of the design goals of the architecture was to minimize the intrusion for both the services as well as any legacy client that already uses these services. The result of this work is that the flow of learning activities can be made dependent on test results. (Contains 3 figures.)

Many forms of e-learning (such as online courses with authentic tasks and computer-supported collaborative learning) have become important in distance education. Very often, such e-learning courses or tasks are set up following constructivist design principles. Often, this leads to learning environments with authentic problems in ill-structured tasks that are supposed to motivate students. However, constructivist design principles are difficult to implement because developers must be able to predict how students perceive the tasks and whether the tasks motivate the students. The research in this article queries some of the assumed effects. It presents a study that provides increased insight into the actual perception of electronic authentic learning tasks. The main questions are how students learn in such e-learning environments with "virtual" reality and authentic problems and how they perceive them. To answer these questions, in two e-learning programs developed at the Open University of the Netherlands (OUNL) designers' expectations were contrasted with student perceptions. The results show a gap between the two, for students experience much less authenticity than developers assume. (Contains 4 tables.)

The aim of this study was to examine the fidelity and completeness of the implementation of a school-based healthful diet promotion programme called "Krachtvoer" (we use the Dutch title of the programme throughout this article. A possible translation is Power Food, but this does not reflect the play on words in the Dutch title), aimed at lower vocational training students aged 12-14 years. The teachers' and students' opinions of the programme were also assessed, as well as the association between these opinions and the level of implementation. Data were collected through structured teachers' monitoring reports, in-class observations and in-depth interviews with teachers. Further data were drawn from a student questionnaire included in a concurrent cluster-randomized baseline post-test experimental study evaluating the effects of the programme. The present study indicates that the teachers implemented the programme largely according to plan, that the teachers appreciated most parts of the programme and that the students who were exposed to the programme were more appreciative of their nutrition education lessons than students who followed the usual curriculum. However, programme elements that teachers did not like were often not implemented. We conclude that the Krachtvoer programme is a promising tool to encourage students in lower vocational training to adopt diets that are more healthful. The present study revealed the stronger and weaker parts of the programme and can thus guide programme improvement. (Contains 3 tables.)

Tools to support knowledge elicitation are used more and more in situations where employees or students collaborate using the computer. Studies indicate that differences exist between experts and novices regarding their methods of work and reasoning. However, the commonly preferred approach tends to deal with team members as a single system with "common," shared preferences. The question is, to what extent this approach is optimal. Potential difficulties with uniform knowledge elicitation support for workplace or workplace-like settings of teamwork can be derived from the literature. We carried out two studies to investigate whether or not support tools for knowledge elicitation should explicitly take into account the expertness of team members. Summary of Statistics for Toulmin Based Elicitation Preferences is appended. (Contains 4 tables and 1 figure.)

Developed seven Internet-delivered tests of prior knowledge for distance education students in the Netherlands interested in gaining information about future studies. Analysis of 151 responses received through the Web site showed student appreciation of the instruments and the assessment process. (SLD)

The effects of prior knowledge and progress assessment on learning behaviors and motivation were studied in the context of self-study by students at the Open University of the Netherlands. Results with 1,482 adult students show their positive appreciation of assessments for student support but less appreciation of feedback received by mail. (SLD)

The text presents a conversation with Dutch designer Karel Martens held in his studio in Amsterdam, the Netherlands, in 2014. In this dialog, we focus on Karel Martens as a designer-author. We also offer an insight to specific book case studies designed by this multifaceted creator and his collaborators. Particular emphasis is given to his long lasting collaboration with the Dutch architecture magazine OASE, a publication he has engaged with since 1990. In addition, the talk also examines the particularities of printing matters before and after the digital era from a personal perspective, and how technological changes can be both a constraint and an inspiration. [ABSTRACT FROM AUTHOR]

Attributing the start of peat growth to an absolute timescale requires dating the bottom of peat deposits overlying mineral sediment, often called the basal peat. Peat initiation is reflected in the stratigraphy as a gradual transition from mineral sediment to increasingly organic material, up to where it is called peat. So far, varying criteria have been used to define basal peat, resulting in divergent approaches to date peat initiation. The lack of a universally applicable and quantitative definition, combined with multiple concerns that have been raised previously regarding the radiocarbon dating of peat, may result in apparent ages that are either too old or too young for the timing of peat initiation. Here, we aim to formulate updated recommendations for dating peat initiation. We provide a conceptual framework that supports the use of the organic matter (OM) gradient for a quantitative and reproducible definition of the mineral-to-peat transition (i.e., the stratigraphical range reflecting the timespan of the peat initiation process) and the layer defined as basal peat (i.e., the stratigraphical layer that is defined as the bottom of a peat deposit). Selection of dating samples is often challenging due to poor preservation of plant macrofossils in basal peat, and the representativity of humic and humin dates for the age of basal peat is uncertain. We therefore analyse the mineral-to-peat transition based on three highly detailed sequences of radiocarbon dates, including dates of plant macrofossils and the humic and humin fractions obtained from bulk samples. Our case study peatland in the Netherlands currently harbours a bog vegetation, but biostratigraphical analyses show that during peat initiation the vegetation was mesotrophic. Results show that plant macrofossils provide the most accurate age in the mineral-to-peat transition and are therefore recommendable to use for 14C dating basal peat. If these are unattainable, the humic fraction provides the best alternative and is interpreted as a terminus-ante-quem for peat initiation. The potential large age difference between dates of plant macrofossils and humic or humin dates (up to ∼1700 years between macrofossil and humic ages, and with even larger differences for humins) suggests that studies reusing existing bulk dates of basal peat should take great care in data interpretation. The potentially long timespan of the peat initiation process (with medians of ∼1000, ∼1300 and ∼1500 years within our case study peatland) demonstrates that choices regarding sampling size and resolution need to be well substantiated. We summarise our findings as a set of recommendations for dating basal peats, and advocate the widespread use of OM determination to obtain a low-cost, quantitative and reproducible definition of basal peat that eases intercomparison of studies. • We present three detailed radiocarbon sequences of the mineral-to-peat transition. • Basal peat needs to be clearly defined based on a quantitative reproducible parameter. • Peat initiation is a process of a certain timespan rather than an event. • Plant macrofossil dates are most accurate, humic/humin dates are likely too young. • A conceptual framework and recommendations for dating peat initiation are presented. [ABSTRACT FROM AUTHOR]

Indicators by themselves tell us little about how well a system is progressing in relation to the goal of sustainability. Especially at the regional level, existing indicator frameworks do not typically permit the inclusion of relevant region-specific information. Furthermore, they do not provide comprehensive information on overall system sustainability. The real challenge is not to identify indicators-there are hundreds of good lists-but to seek out the best way to put all of them to work. The INSURE project, carried out in four case-study regions in Europe (including the Limburg region of The Netherlands), attempted to develop an adaptive indicator framework for integrated monitoring of sustainable development. During the project, it became increasingly clear that indicators are not only more meaningful when viewed within the context of the whole system, but also that science and policy play different, but complementary, roles. This article discusses the challenges and the lessons learned during the Limburg project. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study in the Netherlands in which differences in social class were taken into account when considering differences in educational level between minority and indigenous children. The main problem was the extent to which migration factors and social class can explain differences in educational achievement between ethnic groups. The four largest ethnic minorities in the Netherlands were studied and compared with indigenous Dutch pupils. The analysis showed that differences in social background can partly explain the lower level of achievement among minority pupils. In other west European countries, migration factors together with the unfavourable socioeconomic position of parents largely explains the difference in educational achievement between minority and indigenous pupils. Social class and migration factors do not completely explain the differences in educational level reached.

One of the most hectic debates among Dutch ethnic minority researchers is on the significance of general and ethnic-specific factors for the explanation of social arrears of ethnic minorities. Dependent on the outcomes of their analyses, some researchers predict the coming of an ethnic under-class, while others claim that 'there is nothing particular happening to minority groups ` On this ground they reject specific policy measures for ethnic minorities. This article does not aim at deciding on such far-reaching consequences of research findings. Instead, it criticizes the outcomes themselves for being grounded on incorrect methods. Therefore, a recent article in Mens en Maatschappij is used as a starting point for discussing several methods which are being used in minority research. The main conclusions are (1) that, given the problem definition of ethnic minority research, methods in which separate models are estimated for different groups, are superior to methods in which 'overall' models are estimated, and (2) that even these superior methods are nor able to answer questions on the far-reaching consequences of social arrears of ethnic minority groups. For the time being, such questions appear to be losing some of their relevance, since ethnic minorities in the Netherlands increasingly show social diversity, which means that they increasingly resemble the native Dutch population. [ABSTRACT FROM AUTHOR]

Schizophrenia-spectrum disorders (SSD) are associated with increased inflammatory markers, both in brain and periphery. Augmentation with drugs that lower this pro-inflammatory status may improve clinical presentation. Simvastatin crosses the blood-brain barrier, has anti- inflammatory and neuroprotective effects and reduces metabolic syndrome. In this study, we investigated if 12 months of simvastatin augmentation can improve symptoms and cognition in patients with early SSD. This double-blind placebo-controlled trial included 127 SSD patients across the Netherlands, <3 years after their diagnosis. From these, 119 were randomly assigned 1:1 to simvastatin 40 mg (n = 61) or placebo (n = 58), stratified for sex and study site. Primary outcomes were symptom severity and cognition after 12 months of treatment. Depression, symptom subscores, general functioning, metabolic syndrome, movement disorders, and safety were secondary outcomes. Intention to treat analyses were performed using linear mixed models and ANCOVA. No main effect of simvastatin treatment was found on total symptom severity after 12 months of treatment as compared to placebo (X2(1) = 0.01, P = .90). Group differences varied over time (treatment*time X2(4) = 11.2; P = .025), with significantly lower symptom severity in the simvastatin group after 6 months (mean difference = -4.8; P = .021; 95% CI: -8.8 to -0.7) and at 24 months follow-up (mean difference = -4.7; P = .040; 95% CI: -9.3 to -0.2). No main treatment effect was found for cognition (F(1,0.1) = 0.37, P = .55) or secondary outcomes. SAEs occurred more frequently with placebo (19%) than with simvastatin (6.6%). This negative finding corroborates other large scale studies on aspirin, minocycline, and celecoxib that could not replicate positive findings of smaller studies, and suggests that anti-inflammatory augmentation does not improve the clinical presentation of SSD., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.)

We conducted the study described in this paper to investigate the impact of ambient temperature on mortality in the Netherlands during 1979-1997, the impact of heat waves and cold spells on mortality in particular, and the possibility of any heat wave- or cold spell-induced forward displacement of mortality. We found a V-like relationship between mortality and temperature, with an optimum temperature value (e.g., average temperature with lowest mortality rate) of 16.5 degrees C for total mortality, cardiovascular mortality, respiratory mortality, and mortality among those [Greater and equal to] 65 year of age. For mortality due to malignant neoplasms and mortality in the youngest age group, the optimum temperatures were 15.5 degrees C and 14.5 degrees C, respectively. For temperatures above the optimum, mortality increased by 0.47, 1.86, 12.82, and 2.72% for malignant neoplasms, cardiovascular disease, respiratory diseases, and total mortality, respectively, for each degree Celsius increase above the optimum in the preceding month. For temperatures below the optimum, mortality increased 0.22, 1.69, 5.15, and 1.37%, respectively, for each degree Celsius decrease below the optimum in the preceding month. Mortality increased significantly during all of the heat waves studied, and the elderly were most effected by extreme heat. The heat waves led to increases in mortality due to all of the selected causes, especially respiratory mortality. Average total excess mortality during the heat waves studied was 12.1%, or 39.8 deaths/day. The average excess mortality during the cold spells was 12.8% or 46.6 deaths/day, which was mostly attributable to the increase in cardiovascular mortality and mortality among the elderly. The results concerning the forward displacement of deaths due to heat waves were not conclusive. We found no cold-induced forward displacement of deaths.