Were climatic forcings the main driver for mid-holocene changes in settlement dynamics on the Varamin Plain (Central Iranian Plateau)?

Settlement crises in ancient cultures of Western Asia are commonly thought to be caused by climatic events such as severe droughts. However, the insufficient climate proxy situation in this region challenges the inference of clear relationships between climate and settlement dynamics. We investigate the Holocene climatic changes on the Varamin Plain in the context of the climatic history of Western Central Asia by using a transient comprehensive Earth System Model simulation (8 ka BP to pre-industrial), a high-resolution regional snapshot simulation and a synthesis of pollen-based climate reconstructions. In line with the reconstructions, the models reveal only slightly varying mean climatic conditions on the Varamin Plain but indicate substantial changes in seasonality during the Holocene. Increased precipitation during spring, combined with lower temperature and potentially stronger snow accumulation on the upstream Alborz mountains may have led to an increased water supply on the alluvial fan during the vegetation period and thus to more favourable conditions for agricultural production during the Mid-Holocene compared to modern times. According to the model, dry periods on the Central Iranian Plateau are related to particularly weak Westerly winds, fostering the subsidence in the mid-troposphere and hampering precipitation over the region. The model reveals that dry periods have spatially heterogenous manifestations, thus explaining why they do not appear in all proxy records in the wider study region. In fact, the climatic signal may depend on local environmental conditions. The interaction of the topography with the atmospheric circulation leads to additional spatial heterogeneity. Although our results provide several indications for a connection between climate and settlement dynamics, the small overall changes in moisture call into question whether climate is the main driver for settlement discontinuities on the Central Iranian Plateau. To shed further light on this issue, more high-resolution long-term proxy records are needed.

Improving Clinical Data Integrity by using Data Adjudication Techniques for Data Received through a Health Information Exchange (HIE).

Growing participation in Healthcare Information Exchange (HIE) has created opportunities for the seamless integration of external data into an organization's own EHR and clinical workflows. The process of integrating external data has the potential to detect data integrity issues. Lack of critiquing external data before its incorporation can lead to data unfit for use in the clinical setting. HIE data adjudication, by detecting inconsistencies, physiological and temporal incompatibilities, data completeness and timeliness issues in HIE data, facilitates corrective actions and improves clinical data integrity.

Institutional collaboration not competition: preparing family nurse practitioners to serve rural areas.

In response to the need for an increased number of family nurse practitioners in rural Texas, The University of Texas at Tyler, Texas Tech University Health Sciences Center, and Midwestern State University entered into a collaborative arrangement to provide advanced education to nurses in outlying areas of the state. The catchment area for the project encompassed 72 counties, representing half the land mass in Texas. This article presents the development of the collaborative model, strategies used for implementation, and evaluation of this collaborative effort. The collaborative family nurse practitioner program is based on collegiality rather than competition to better meet the needs of students and communities in a cost-effective manner. Communication between the institutions and faculty has been a key factor in the success of the program. The addition of nurse practitioners from this project has the potential to greatly increase access to health care in large, underserved populations.