Previous interdisciplinary paleoenvironmental and archaeological research along the Río Verde Valley of Oaxaca, Mexico, showed that Holocene erosion in the highland valleys of the upper drainage basin triggered geomorphic changes in the river's coastal floodplain. This article uses stratigraphic data from sediment cores extracted from Laguna Pastoría, an estuary in the lower Río Verde Valley, to examine changes in coastal geomorphology potentially triggered by highland erosion. Coastal lagoon sediments contain a stratigraphically and chronologically distinct record of major hurricane strikes during late Holocene times. Three distinct storm facies are identified from sediment cores obtained from Laguna Pastoría, which indicate that profound coastal environmental changes occurred within the region and are correlated with increased sediment supplied from highland erosion. The Chione/Laevicardium facies was deposited in an open bay while the Mytella/barnacle facies and sand facies were deposited in an enclosed lagoon following bay barrier formation. We argue that highland erosion triggered major geomorphic changes in the lowlands including bay barrier formation by ∼2500 cal yr B.P. These environmental changes may have had significant effects on human populations in the region. The lagoon stratigraphy further indicates an increase in mid–late Holocene hurricane activity, possibly caused by increased El Niño frequencies.

This article discusses the results of ten years of interdisciplinary archaeological research along the Río Verde drainage basin, Oaxaca, Mexico. In the highland valleys of the upper drainage basin we have documented six periods of significant geomorphic change. The first two were probably the result of climatic change during the mid-Holocene. The four subsequent periods of landscape change are correlated with major shifts in demographics and human land use; we argue that these factors may be causally related. Erosion in the highland valleys led to modification of stream channel dynamics, alluviation and expansion of the agriculturally rich floodplain in the lower Rio Verde Valley. Increasing agricultural productivity in the lowlands may explain in part the rapid increase in population and social complexity beginning in the Late Formative. However, increased flooding also created risks for people living on the floodplain. The research demonstrates the dynamic nature of prehispanic ecology in the Río Verde drainage basin of Oaxaca.

Paleoecological archives from three paleomeander sites and one archeological feature located in the lower Río Verde Valley, Oaxaca, Mexico, are used to develop a spatial understanding of the patterns of prehistoric agricultural land use over the last ~3000 years. Multiproxy paleoecological data at each site (i.e. magnetic susceptibility, micro-and macroscopic charcoal, pollen and stable carbon isotopes) provide a history of land use. By examining the spatial differences in agricultural indicators at all the sites through time, augmented with our understanding of changes in demography and settlement patterns determined through the archeological record, we are able to reconstruct the complex human/land interactions in the western portion of the valley.

Background and Introduction:Disease registries, as part of electronic health records (EHRs), have shown promise in improving care and outcomes. However, little is known about how best to implement them across communities, especially in communities that are not highly integrated. The Western New York (WNY) primary care community consists largely of independent practices using at least 20 different EHR products. This paper discusses the processes undertaken to develop a communitywide EHR disease registry in WNY, improvements it engendered, barriers overcome, and the lessons learned.Methods:HEALTHeLINK, under the Office of the National Coordinator for Health Information Technology Beacon Community Initiative, reached out to 98 primary care practices in the WNY region to establish EHR-based diabetes registries. Working with practices, community partners, and vendors, registry specifications were created. The registry was piloted with practices using one local vendor’s EHR product and then rolled out to other practices, including five other EHR products. Using identified and de-identified registry datasets, quality benchmarking within and between practices and population health management were undertaken.Findings:From 2011 to 2013, the WNY Beacon Community assisted 98 practices (344 providers) serving over 50,000 adult diabetic patients. A major focus was on EHR registry development across diverse systems, and overcoming the challenges this presented. The Beacon diabetes registry was implemented at 85 of the 98 targeted practices. Of these registries, 65 met the criteria described in a later section for quality benchmarking and population health management purposes. Practices received quarterly benchmark reports summarizing their performance on key diabetes quality metrics and were compared to community practice averages. Practices used their registries for population health management by identifying and targeting patients in need of follow-up or specific diabetes-related care.Discussion and Conclusion:The creation of the registry infrastructure required unified registry technical specifications as well as close collaboration between all parties involved. The WNY experience showed that a useful disease registry can be established in a community largely consisting of numerous disparate primary care practices. This laid the groundwork for the future use of EHR data for a variety of purposes in the community. The methods used and lessons learned through this endeavor may benefit other communities in a similar position, with several disconnected EHRs, to establish unified registries.

This article examines the effects of anthropogenic landscape modification in the upper drainage basin of the Río Verde on environments and populations of the lower Río Verde Valley, Oaxaca, Mexico. Archaeological and geomorphological research conducted by the Río Verde Formative Project indicates that Late Formative (400–100 B.C.) population growth and agricultural intensification in the Oaxaca and Nochixtlán valleys increased erosion and runoff from the Verde's upper drainage. This geomorphic change in the highland valleys altered the drainage system and led to increased flooding and alluviation in the lower Río Verde Valley. The environmental effect in the lower valley may have increased the agricultural potential of the region, leading to population growth, and at least indirectly to social change.