Multidecadal Climate Variability and the Florescence of Fremont Societies in Eastern Utah

Fremont societies of the Uinta Basin incorporated domesticates into a foraging lifeway over a 1,000-year period from AD 300 to 1300. Fremont research provides a unique opportunity to critically examine the social and ecological processes behind the adoption and abandonment of domesticates by hunter-gatherers. We develop and integrate a 2,115-year precipitation reconstruction with a Bayesian chronological model for the growth of Fremont societies in the Cub Creek reach of Dinosaur National Monument. Comparison of the archaeological chronology with the precipitation record suggests that the florescence of Fremont societies was an adaptation to multidecadal precipitation variability with an approximately 30-plus-year periodicity over most, but not all, of the last 2,115 years. Fremont societies adopted domesticates to enhance their resilience to periodic droughts. We propose that reduced precipitation variability from AD 750 to AD 1050, superimposed over consistent mean precipitation availability, was the tipping point that increased maize production, initiated agricultural intensification, and resulted in increased population and development of pithouse communities. Our study develops a multidecadal/multigenerational model within which to evaluate the strategies underwriting the adoption of domesticates by foragers, the formation of Fremont communities, and the inherent vulnerabilities to resource intensification that implicate the eventual dissolution of those communities. Las sociedades de Fremont de la cuenca de Uinta incorporaron a los domesticados en una forma de vida de alimentación durante un período de 1.000 años desde 300–1300 dC. La investigación de Fremont brinda una oportunidad única para examinar críticamente los procesos sociales y ecológicos detrás de la adopción y el abandono de los domésticos por parte de los cazadores-recolectores. Desarrollamos e integramos una reconstrucción de precipitación de 2.115 años con un modelo cronológico Bayesiano para el crecimiento de las sociedades de Fremont en el alcance de Cub Creek del Dinosaur National Monument. La comparación de la cronología arqueológica con el registro de precipitación sugiere que la floración de las sociedades de Fremont fue una adaptación a la variabilidad de precipitación multidecadal con una periodicidad de aproximadamente 30 años en la mayoría, pero no en todos, de los últimos 2.115 años. Las sociedades de Fremont adoptaron domesticados para mejorar su resistencia a las sequías periódicas. Proponemos que la variabilidad reducida de la precipitación desde 750–1050 dC, superpuesta sobre la disponibilidad de precipitación media constante, fue el punto de inflexión que aumentó la producción de maíz, inició la intensificación agrícola y dio como resultado un aumento de la población y el desarrollo de las comunidades de médulas. Nuestro estudio desarrolla un modelo multidecadal/multigeneracional dentro del cual evaluar las estrategias que sustentan la adopción de domesticados por parte de los recolectores, la formación de comunidades de Fremont y las vulnerabilidades inherentes a la intensificación de recursos que implican la eventual disolución de esas comunidades

Usability Testing of the Kidney Score Platform to Enhance Communication About Kidney Disease in Primary Care Settings: Qualitative Think-Aloud Study

BackgroundPatient awareness of chronic kidney disease (CKD) is low in part due to suboptimal testing for CKD among those at risk and lack of discussions about kidney disease between patients and clinicians. To bridge these gaps, the National Kidney Foundation developed the Kidney Score Platform, which is a web-based series of tools that includes resources for health care professionals as well as an interactive, dynamic patient-facing component that includes a brief questionnaire about risk factors for kidney disease, individualized assessment of risk for developing CKD, and self-management tools to manage one’s kidney disease. ObjectiveThe aim of this study is to perform usability testing of the patient component of the Kidney Score platform among veterans with and at risk for kidney disease and among clinicians working as primary care providers in Veterans Affairs administration. MethodsThink-aloud exercises were conducted, during which participants (veterans and clinicians) engaged with the platform while verbalizing their thoughts and making their perceptions, reasonings, and decision points explicit. A usability facilitator observed participants’ behaviors and probed selectively to clarify their comprehension of the tool’s instructions, content, and overall functionality. Thematic analysis on the audio-recording transcripts was performed, focusing on positive attributes, negative comments, and areas that required facilitator involvement. ResultsVeterans (N=18) were 78% (14/18) male with a mean age of 58.1 years. Two-thirds (12/18) were of non-White race/ethnicity, 28% (5/18) had laboratory evidence of CKD without a formal diagnosis, and 50% (9/18) carried a diagnosis of hypertension or diabetes. Clinicians (N=19) were 29% (5/17) male, 30% (5/17) of non-White race/ethnicity, and had a mean of 17 (range 4-32) years of experience. Veterans and clinicians easily navigated the online tool and appreciated the personalized results page as well as the inclusion of infographics to deliver key educational messages. Three major themes related to content and communication about risk for CKD emerged from the think-aloud exercises: (1) tension between lay and medical terminology when discussing kidney disease and diagnostic tests, (2) importance of linking general information to concrete self-management actions, and (3) usefulness of the tool as an adjunct to the office visit to prepare for patient-clinician communication. Importantly, these themes were consistent among interviews involving both veterans and clinicians. ConclusionsVeterans and clinicians both thought that the Kidney Score Platform would successfully promote communication and discussion about kidney disease in primary care settings. Tension between using medical terminology that is used regularly by clinicians versus lay terminology to promote CKD awareness was a key challenge, and knowledge of this can inform the development of future CKD educational materials