The commonly held belief that the emergence and establishment of farming communities in the Levant was a smooth socio-economic continuum during the Pre-Pottery Neolithic (ca. 12,000-9,000 cal BP) with only rare minor disruptions is challenged by recently obtained evidence from this region. Using a database of archaeological radiocarbon dates and diagnostic material culture records from a series of key sites in the northern Levant we show that the hitherto apparent long-term continuity interpreted as the origins and consolidation of agricultural systems was not linear and uninterrupted. A major cultural discontinuity is observed in the archaeological record around 10,000 cal BP in synchrony with a Holocene Rapid Climate Change (RCC), a short period of climatic instability recorded in the Northern Hemisphere. This study demonstrates the interconnectedness of the first agricultural economies and the ecosystems they inhabited, and emphasizes the complex nature of human responses to environmental change during the Neolithic period in the Levant. Moreover, it provides a new environmental-cultural scenario that needs to be incorporated in the models reconstructing both the establishment of agricultural economy in southwestern Asia and the impact of environmental changes on human populations.

Abstract

Previous projects (Combell I & II) to assess clinical skills were conducted in medical schools in Catalonia, in order to introduce a model of such an assessment using standardized patients (SP). The aim of this study (Combell III) was to measure selected characteristics of our model. Seventy-three medical students in the final year at the Bellvitge teaching unit of the University of Barcelona participated in a clinical skills assessment (CSA) project that used 10 SP cases. The mean group scores for the four components of clinical skills for each day of testing were studied, and ratings for each student in the 10 sequential encounters were checked. The study also compared the clinical skills scores with their academic grades. The total case mean score (mean score of history-taking, physical examination and patient notes scores) was 51.9%, and the mean score for communication skills was 63.6%. The clinical skills scores over the 8 testing days showed no day-to-day differences. The study did not find differences among the sequential encounters for each student (training effect). There was a lack of correlation between clinical skills scores and academic grades. The project demonstrated the feasibility of the method for assessing clinical skills, confirmed its reliability, and showed that there is no correlation between scores with this method and academic examinations that mainly reflect knowledge.

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This article discusses contact, social relationships, and social organization between sites at the end of the Pre-Pottery Neolithic in the Euphrates valley; all of which are of high importance for reconstructing and modelling social organization in consolidated agricultural villages. Our analysis has succeeded in identifying a complex range of overlapping levels and types of social interaction that occurred simultaneously and operated at different scales including the household, the community and inter-regional communities. This complex mixture of interacting spheres, together with the identification of cultural-social boundaries, enables us to understand and explain inter-site variation in material culture and mortuary practices. Moreover, they reflect the growing social complexity of large farming communities at the end of the Pre-Pottery Neolithic and the role played by settlement as the social unit through which these communities became more distinctive and self-consciously different.