Evidence for local carbon-cycle perturbations superimposed on the Toarcian carbon isotope excursion.

A Jurassic negative carbon isotope excursion (CIE), co-evolved with Toarcian Oceanic Anoxic Event (OAE) at ~183 Ma, is suggested to be linked to a global carbon-cycle perturbation and is well documented for Toarcian terrestrial fossil woods and marine sediments around the globe. A theoretically coupled δ C -δ C pattern due to such dubbed global carbon-cycle event from the negative CIE in Dotternhausen Toarcian stratigraphic profile (southwest Germany) is unexpectedly disturbed by two-step δ C -δ C decoupling in which the last step, upper in the stratigraphic order, is of higher magnitude. However, the trigger(s) for these sudden decoupling disturbances are still poorly constrained.

Physician Collaboration - Now needed more than ever.

Driven by the changing reimbursement climate from volume to value-based, hospital systems must initiate technology and training to insure that communications between all HCPs involved with a given patient are coordinated and all test results and care plans are immediately available at every point of care in the system. Since the enactment of the Patient Protection and Affordable Care Act (PPACA), there has been intense pressure on hospitals and health systems to reduce costs. Many hospitals are responding by merging and buying doctors' practices, while some are beginning to offer their own health plans for the first time and setting up accountable care organizations that would provide coordinated high quality health care for large groups of patients.