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Previous paleoclimate studies have suggested a warm/dry event during the mid-Holocene in páramo vegetation of the tropical Andes of South America. However, the timing of the mid-Holocene warm/dry event in Tres Lagunas, Ecuador, remains uncertain, since a previously reported bog core record characterized the warm/dry event during a hiatus in sediment deposition. In order to understand the timing of the warm/dry event in Tres Lagunas in relation to regional records, a lake sediment core was collected. Subsamples from the core were analyzed for radiocarbon dates, pollen, magnetic susceptibility, and charcoal to reconstruct the depositional, vegetational, and fire history of the area. A near-constant sedimentation rate in the lake core indicated that the lake did not dry, in contrast to the adjacent previously reported bog core. Increases in lower elevation pollen types suggest a warm period between 2700 and 2200 cal. yr BP, with the peak of warming at 2200 cal. yr BP co-occurring with the end of hiatus in the bog core record. Statistically significant increases in charcoal influx and magnetic susceptibility from 3900 to 800 cal. yr BP also suggest a dry climate during this period. While the lake record corroborates the presence of a warm/dry period in Tres Lagunas during the mid-Holocene, this record suggests a shorter period of warm/dry climate where the intensity was not sufficient to cause the lake to dry. However, anthropogenic alteration of the landscape, either vegetation or burning, must also be considered when interpreting Holocene records from this region.

Background: Health care organizations are designing comprehensive care programs to reduce hospital utilization by high-risk patients with multiple chronic illnesses. Local Problem: A community hospital recognized patients with multiple chronic conditions had higher rates of inpatient stays and emergency department (ED) visits. Methods: Patients (n = 36) with multiple chronic conditions enrolled in a supportive care program. Researchers analyzed hospital utilization, inpatient stays, and ED visits preintervention and postgraduation for the participants enrolled. Palliative care nurses were assigned to patients enrolled in the supportive care program.Results: There was a statistically significant decrease in hospital utilization (Z = −2.540, P = .011) and inpatient stays (Z = −4.037, P < .001) following the implementation of the supportive care program. Conclusions:The study met its aim of reducing hospital utilization and inpatient stays by creating a comprehensive approach to support high-risk patients in self-management of their chronic illnesses.

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