Analysis of Oklahoma amputation trends and identification of risk factors to target areas for limb preservation interventions.

OBJECTIVE: Annual trends of lower extremity amputation due to end-stage chronic disease are on the rise in the United States. These amputations are leading to massive expenses for patients and the medical system. In Oklahoma, we have a high-risk population because access to care is low, the number of uninsured is high, cardiovascular health is poor, and our overall health care performance is ranked 50th in the country. But we know little about Oklahomans and their risk of limb loss. It is, therefore, imperative to look closely at this population to discover contemporary rates, trends, and state-specific risk factors for amputation due to diabetes and/or peripheral arterial disease (PAD). We hypothesize that state-specific groups will be identified as having the highest risk for limb loss and that contemporary trends in amputations are rising. To create implementable solutions to limb preservation, a baseline must be set. METHODS: We conducted a 12-consecutive-year observational study using Oklahoma's hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using International Classification of Disease-9 and -10 codes. Amputation rates were calculated per 1000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups. RESULTS: Over 5,000,000 discharges were identified from 2008 to 2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per 1000 discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC, 6.0; 95% confidence interval [CI], 4.7-7.3). Most amputations were minor (59.5%), and although minor, increased at a faster rate compared with major amputations (minor amputation APC, 8.1; 95% CI, 6.7-9.6 vs major amputation APC, 3.1; 95% CI, 1.5-4.7); major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (P = .001) when compared within their respective category. CONCLUSIONS: Amputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide health care problem. We also present imperative examples of amputation health care disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention.

Coccidioidomycosis in Oklahoma: A retrospective case series.

BACKGROUND: Coccidioidomycosis is a systemic fungal disease endemic to arid regions of the Western Hemisphere. In the south-western US, Coccidioides spp. may account for up to 20%-25% of all cases of community acquired pneumonia. Clinical manifestations vary widely, from asymptomatic infection to life-threatening disease, especially in immunocompromised hosts. OBJECTIVES: The primary objective of the study was to characterise cases of coccidioidomycosis in an area of the United States not considered traditionally endemic for the disease. METHODS: We performed a single-centre retrospective study of all cases of coccidioidomycosis from 1 January 2000 to 31 December 2020, in the University of Oklahoma Health Sciences Medical Center. RESULTS: A total of 26 patients were included for analysis. The central nervous system (CNS) and the lungs were the sites most frequently involved. Twenty (77%) had travelled to a coccidioidomycosis endemic region. Most were male (81%) with a median age of 42 years (range: 3-78 years). The majority (46%) were Caucasians, 19% were African American, 19% Hispanic, and 12% Native American. The most common comorbidities were diabetes mellitus and acquired immunodeficiency syndrome, identified in 27% and 23% of patients, respectively. Patients on immunosuppressive therapy accounted for 12% of all cases. CONCLUSION: Our study is one of the largest single-centre case series of coccidioidomycosis from a non-endemic area. Diabetes mellitus was the most frequent comorbidity. Compared to other case series of coccidioidomycosis, our patient population had higher rates of immunosuppression and had both a higher rate of disseminated disease and overall mortality.

Applying the extended parallel process model to understand households' responses to tornado and earthquake risks in Oklahoma.

Oklahoma is a multihazard environment where both natural (e.g., tornadoes) and technological hazards (e.g., induced seismicity) are significant, making Oklahoma a unique setting to better understand how to manage and prepare for multiple hazards. While studies have attempted to understand drivers of hazard adjustments, few have focused on the overall number of adjustments undertaken instead of individual adjustments or adjustments in a multihazard environment. To address these gaps, we employ a survey sample of 866 households in Oklahoma to understand households' danger control responses (protective hazard adjustments) for tornado and earthquake risks in Oklahoma. We apply the extended parallel processing model (EPPM) to categorize respondents according to their relative level of perceived threat and efficacy of protective actions in predicting the number of hazard adjustments they intend to or have adopted in response to tornadoes and induced earthquakes. In line with the EPPM, we found that households have the highest number of danger control responses when their perceived threat and efficacy are both high. Counter to the EPPM literature, we found low threat coupled with high efficacy moved some individuals toward the adoption of danger control responses in response to both tornadoes and earthquakes. When households have high efficacy, threat appraisals matter in tornado danger control responses but not in earthquake danger control responses. This EPPM categorization opens new research approaches for studies of natural and technological hazards. This study also provides information for local officials and emergency managers making mitigation and preparedness investments and policies.

Characterization of hypersaline Oklahoma native microalgae cultivated in flowback and produced water: growth profile and contaminant removal.

This work explores the potential of three hypersaline native microalgae strains from Oklahoma, Geitlerinema carotinosum, Pseudanabaena sp., and Picochlorum oklahomensis, for simultaneous treatment of flowback (FW) and produced wastewater (PW) and the production of algal biomass. The quality of wastewater before and after treatment with these microalgae strains was evaluated and a characterization of algal biomass in terms of moisture, volatile matter, fixed carbon, and ash contents was assessed. The experimental results indicated how all the microalgae strains were able to grow in both FW and PW, revealing their potential for wastewater treatment. Although algal biomass production was limited by nutrient availability both in PW and FW, a maximum biomass concentration higher than 1.35 g L-1 were achieved by the three strains in two of the PWs and one of the FWs tested, with Pseudanabaena sp. reaching nearly 2 g L-1. Interestingly, higher specific growth rates were obtained by the two cyanobacteria strains G. carotinosum and Pseudanabaena sp. when cultivated in both PW and FW, compared to P. oklahomensis. The harvested algal biomass contained a significant amount of energy, even though it was significantly reduced by the very high salt content. The energy content fell within the recommended range of 16-17 MJ kg-1 for biomass as feedstock for biofuels. The algal treatment resulted in the complete removal of ammonia from the wastewater and a significant reduction in contaminants, such as nitrate, phosphate, boron, and micronutrients like zinc, manganese, and iron.

Burkholderia thailandensis Isolated from the Environment, United States.

Burkholderia thailandensis, an opportunistic pathogen found in the environment, is a bacterium closely related to B. pseudomallei, the cause of melioidosis. Human B. thailandensis infections are uncommon. We isolated B. thailandensis from water in Texas and Puerto Rico and soil in Mississippi in the United States, demonstrating a potential public health risk.

Geographic and social economic disparities in the risk of exposure to ambient air respiratory toxicants at Oklahoma licensed early care and education facilities.

BACKGROUND: Early life exposures to hazardous air pollutants has been associated with adverse asthma-related outcomes. Neighborhood-level social and economic factors play an essential role in the distribution of hazardous air pollutants and children spend a substantial amount of time at early care and education (ECE) facilities. While the indoor air quality of these facilities has been described, particularly for criteria air pollutants such as volatile organic compounds and particulate matter, little is known about the ambient air quality of ECE facilities. OBJECTIVES: We conducted a cross-sectional study to estimate the ambient air quality of Oklahoma licensed ECE facilities and to explore associations between ambient air quality and select geographic predictors. METHODS: We estimated ambient air quality using the total respiratory hazard quotient from the National Air Toxics Assessment according to the geographical location of licensed Oklahoma ECE facilities (N = 3184). We then determined whether urban and rural ECE facilities' air respiratory toxicant exposure risk differed by ECE facilities' neighborhood-level social and economic inequities including: 1) racial-ethnic minority community, 2) neighborhood socioeconomic status, and 3) residential segregation. RESULTS: Urban ECE facilities in Hispanic segregated counties were five times more likely to be at risk of high air respiratory exposure, adjusted for integrated urban counties (p < 0.0001, 95% CI [3.824, 7.699]). Rural ECE facilities in African American segregated counties were nine times more likely to be at risk of high air respiratory toxicant exposure, adjusted for integrated rural counties (p < 0.0001, 95% CI [5.641, 15.928]). CONCLUSION: We found geographically and socially disparate patterns of higher exposures to ambient air respiratory toxicants at Oklahoma ECE facilities. Safer siting policies and interventions are needed to mitigate air respiratory toxicant exposures, which may help to reduce asthma control disparities and improve respiratory health outcomes in Oklahoma ECE facilities.

Collective health behavior and face mask utilization during the COVID-19 pandemic in Oklahoma, USA.

BACKGROUND: Face mask use offers an important public health tool for reducing the spread of coronavirus disease 2019 (COVID-19), yet the politicization of COVID-19 has resulted in uneven adherence. This study assesses the effects of setting characteristics and the sociodemographic composition of crowds on group-level masking rates. METHODS: We conducted 123 site observations of masking behavior at public locations across Oklahoma (USA) between June and September 2020. We used analyses of variance and t-tests to examine variation in masking and ordinary least squares regression to model the effect of setting and sociodemographic characteristics on site-level masking rates. RESULTS: The masking rate across all sites averaged 34% but varied widely. Site-level masking rates were higher at metropolitan sites and sites with a store or municipal masking mandate. The masking rate at sites where women or older adults (60+) were the predominant group did not differ significantly from other sites. Ethnically diverse sites exhibited significantly higher masking rates compared with predominantly white sites. Findings indicate that setting characteristics explained a greater amount of variation in collective masking rates than sociodemographic differences. CONCLUSIONS: This study underscores the importance of place and policy for mask adherence. In the absence of state-level mandates, masking policies at a more local level may be effective.

Economic returns and the perceived obstacles to adopting active management in the forest-grassland transition ecoregion in south-central USA.

Forest-grassland ecotones are a mosaic of grassland, savanna, and upland forest. As such, landowners may have opportunities to choose to manage their lands for multiple objectives. We estimated the economic returns from managing forest and rangeland in southeastern Oklahoma, USA to produce different combinations of timber, cattle forage, and white-tailed deer (Odocoileus virginianus Zimmermann) browse for a 40-year period. We further conducted a survey to understand landowner perceptions of obstacles to adopting active management that involve timber harvest and prescribed fire. The highest net return was obtained from the treatment with harvested timber that was burned every four years (uneven-aged woodland/forest) because it had the greatest gross return from a combination of timber (46%), cattle forage (42%), and deer browse (11%). The return from this treatment was greater than that for managed for timber only (closed-canopy forest) or prioritizing cattle and deer (savanna). Survey results suggested that landowners were aware of the benefits of active management but that the majority (66%) considered cost a major obstacle in the management of their forest or rangeland. In particular, women forestland owners and older landowners considered cost an obstacle. Our findings advocate integrated timber, cattle, and deer management as the best economic strategy within the forest-grassland ecotone and for targeted outreach and landowner education related to the benefits of active management.

Traumatic Pediatric Fatalities: Are They Preventable?

INTRODUCTION: Trauma related injury remains the leading cause of mortality in pediatric patients, many of which are preventable. The goal of our study was to identify the mechanism of injury (MOI) in pediatric trauma-related fatalities and determine if these injuries were preventable to direct future injury prevention efforts within trauma programs. METHODS: After IRB approval, a retrospective, single-institution review of pediatric (age ≤18) trauma fatalities from 2010 to 2019 was performed. MOI, use of protective devices, demographics, and whether the injury was preventable were collected. Patients were divided into five age cohorts, and frequencies and proportions were used to summarize data. Bivariate testing was done using Fisher's exact and Monte Carlo estimates for the exact test. RESULTS: MOI was found to vary by age with non-accidental trauma found to be the most common cause of trauma related deaths in children <1 (88.5%) and 1-4 (33.3%). MVC was the most common MOI in children >5 y, with 68.4% in the 5-9, 34.4% in the 10-14, and 45.8% in the 15-18 age group. The majority of fatalities resulted from a preventable injury (P < 0.0001) in the younger children with a negative association as age increased: 92.3% <1, 53.3% in 1-4, 36.8% in 5-9, 46.9% in 10-14 and 48.6% in 15-18. Of the preventable injuries, non-accidental trauma was the most common MOI in children <5, while GSW was the most common MOI in children >10. CONCLUSIONS: This study demonstrates many pediatric fatalities are the result of a preventable traumatic injury. This data can guide focused traumatic injury prevention efforts.

Vogt-Koyanagi-Harada disease in a Native American population in Oklahoma.

PURPOSE: To describe the presentation, features, and outcomes of patients with Vogt-Koyanagi-Harada disease (VKH) seen by uveitis specialists in Oklahoma. METHODS: Clinical data were collected for 26 patients (52 eyes) diagnosed with VKH and seen between 1992 and 2018. Main outcome measures included rates of visual loss, ocular complications, and remission. RESULTS: There were 11 Native American (NA) patients (11/26, 42.3%) and 15 non-Natives (n-NA). NA VKH patients were significantly more likely to present at a younger age (18.6 years) than n-NA VKH patients (30.1 years) (p = 0.023). NA patients were less likely to have meningismus (0.00 vs. 42.9%; 0.048) or systemic symptoms (50.0% vs. 93.3%; p = 0.023) than n-NA patients, but more likely to develop cataracts (100.0% vs. 66.7%; p = 0.003). There were similar rates of macular edema, epiretinal membrane, subretinal fibrosis, and recurrent uveitis between the two groups. Oral corticosteroid use was similar between both groups (72.7% vs. 86.7%; p = 0.61). CONCLUSIONS: VKH may manifest with earlier disease course in NA patients than n-NA patients, particularly regarding ocular findings. However, NA patients were less likely to have systemic symptoms than n-NA patients.

A Snapshot of Oklahoma's CHR/CHW Workforce: Results from the Region 6 Training Needs Assessment Survey, 2019.

Background ­: The Region 6 South Central Public Health Training Center conducts needs assessments to inform the development of online trainings tailored to the HRSA Region 6 health and public health workforce. The purpose of this study was to assess Oklahoma's Community Health Representative (CHR) / Community Health Worker (CHW) workforce characteristics, current trainings, and training needs to guide the development of online trainings. Methods ­: This survey-based needs assessment for health and public health workforce training needs asked about alternative job titles, top three health issues addressed, roles played, skills used, current trainings, and training needs. Descriptive statistical analysis provided insights about CHRs/CHWs. The Fisher's exact test was used to compare frequency of responses between CHRs and CHWs, with p-values <0.05 considered significant. We analyzed qualitative data by using a modified content analysis. Results ­: Fifty-one self-identified CHRs/CHWs in Oklahoma participated in the 2019 regional health and public health training needs assessment. Most CHRs/CHWs were female and identified as "frontline public health workers." Respondents reported a range of educational attainment and diverse job titles. CHRs worked at tribal health or public health organizations primarily in rural areas. Most CHWs worked in urban areas and were employed by state and local health departments or community-based organizations. CHRs/CHWs had a broad spectrum of roles and skills, with required trainings reflecting various organizational needs. CHRs/CHWs expressed strong interest in receiving additional trainings via multiple delivery formats. Discussion and Conclusions ­: Oklahoma's CHRs/CHWs would benefit from and utilize workforce development, including trainings on a broad spectrum of roles and skills in multiple delivery formats. Potential employers and funders across the state would benefit from education on CHRs/CHWs as a workforce, team-integration, and sustainable funding.

Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Group Ticks.

We determined prevalence of Rickettsia spp. in 172 ticks of the Amblyomma maculatum group collected from 16 urban sites in Oklahoma City, Oklahoma, USA, during 2017 and 2018. Most ticks (59.3%) were collected from 1 site; 4 (2.3%) were infected with Rickettsia parkeri and 118 (68.6%) with Candidatus Rickettsia andeanae.

Children's Exposure to Single Incidents of Terrorism: Perspectives Over 25 Years Since the Oklahoma City Bombing.

PURPOSE OF REVIEW: This paper traces advances in our knowledge about children's exposure and reactions to terrorist events over the last 25 years, beginning with the 1995 Oklahoma City bombing, and offers observations about cross-cutting issues including implications for services. RECENT FINDINGS: Direct and indirect interpersonal exposures have been examined in community samples and in samples of children selected because of their event experiences. Despite its present exclusion from the stressor criterion for a diagnosis of posttraumatic stress disorder, considerable research has documented an association between children's initial subjective reaction and outcomes. Few studies have examined the influence of community or distant effects on outcomes, but contact with media coverage has been well studied. This review confirms the central role of exposure in influencing children's reactions to terrorist incidents and supports recent efforts to distinguish specific experiences that constitute children's event exposures.

The ecological and economic determinants of eastern redcedar (Juniperus virginiana) encroachment in grassland and forested ecosystems: A case study from Oklahoma.

Frequent fires were used as a management tool to maintain prairies, savannas, and woodlands in the southern Great Plains of the United States. However, fire exclusion beginning in the mid-1900s allowed for the establishment and growth of fire-intolerant species such as eastern redcedar (Juniperus virginiana: ERC) beyond their naturally occurring habitats. Apart from the reduction in burning, wide soil and climate adaptability, and seed dispersal by birds have facilitated the expansion of ERC in the southern Great Plains. The encroachment of ERC has caused heavy ecological and economic losses to Oklahoma and thus has been a major management concern for the past few decades. This study utilized count data modeling to analyze USDA Forest Service's (USFS) Forest Inventory and Analysis (FIA) data to investigate the relationship between available ecological and economic factors and the abundance of ERC in grassland and forested ecosystems of Oklahoma. The results suggested that low site productivity, high basal area, dense canopy, and silt loam soil texture significantly increase the abundance of ERC on a given site. The results also indicated that the rate of ERC encroachment is 3.3% higher in the softwood and 2.0% higher in the miscellaneous forests, compared to the hardwood forests. However, the economic variables of the study such as ownership type, adoption of active management, and proximity to a metropolitan area did not show a significant relationship to the abundance of ERC.

Diabetes among Hispanics in Oklahoma: Assessing Disparities to Guide Basic and Applied Research.

Background ­: Diabetes, a leading cause of morbidity and mortality in the United States, disproportionally affects minority populations. In 2015, Hispanics, the largest minority in the country, had the third highest rate of diabetes prevalence and the third highest age-adjusted rate of diabetes-related mortality. Substantial progress in understanding diabetes disparities nationally and in many areas of the country has been made. However, little is known about diabetes and related mortality among Hispanics in Oklahoma, which is known as a Hispanic "new Settlement" state due to the relatively recent and substantial growth of this population. Methods ­: We used Oklahoma Behavioral and Risk Factor Surveillance Survey data (2011-2016) to calculate population estimates of diabetes prevalence and selected sociodemographic characteristics for Hispanic and Non-Hispanic adults in the state. We used Oklahoma Death Registry data to estimate diabetes-related mortality rates for Hispanic and Non-Hispanic adults for the same five-year period. We examined differences in diabetes prevalence and diabetes-related mortality across selected sociodemographic characteristics. Results ­: Hispanics are the largest minority group in Oklahoma. Spanish is the most common non-English language spoken in the state. Hispanics are younger, poorer, less educated and experience less access to health care compared to other populations in Oklahoma. While Hispanics had the fifth highest reported diabetes prevalence rate during the five-year period examined, they had the third highest diabetes-related mortality rate in the state. Discussion and Conclusions ­: There is a need for community engagement and basic and applied research to help identify and reduce diabetes disparities in the growing Hispanic population in Oklahoma.

"What Should Sex Look Like?" Students' Desires for Expanding University Sexual Assault Prevention Programs to Include Comprehensive Sex Education.

Rates of sexual assault and sexual violence among college-aged adults are much higher than the national rates of sexual assault and sexual violence. Therefore, reduction and prevention of sexual violence among university students is critical and is consistent with national public health priorities. Often times, messages to students focus only on sexual assault and omit larger notions of sexual health. Four focus groups with a total of 24 participants (nine men, 15 women) highlighted three main perceptions about the sexual assault programming offered at this large university: themes of resistance to traditional programming, a need for holistic sexual health programming, and a desire to have an environment, which normalizes conversations surrounding sex, sexuality, and sexual health.

Voluntary Smoke-Free Measures Among Oklahoma Nightlife Owners: Barriers and Facilitators.

Smoke-free policies prevent exposure to secondhand smoke and encourage tobacco cessation. Local smoke-free policies that are more comprehensive than statewide policies are not allowed in states with preemption, including Oklahoma, which has the sixth highest smoking prevalence in the United States. In states with preemption, voluntary smoke-free measures are encouraged, but little research exists on venue owners' and managers' views of such measures, particularly in nightlife businesses such as bars and nightclubs. This article draws from semistructured interviews with 23 Oklahoma bar owners and managers, examining perceived risks and benefits of adopting voluntary smoke-free measures in their venues. No respondents expressed awareness of preemption. Many reported that smoke-free bars and nightclubs were an inevitable societal trend, particularly as younger customers increasingly expected smoke-free venues. Business benefits such as decreased operating and cleaning costs, improved atmosphere, and employee efficiency were more convincing than improved employee health. Concerns that voluntary measures created an uneven playing field among venues competing for customers formed a substantial barrier to voluntary measures. Other barriers included concerns about lost revenue and fear of disloyalty to customers, particularly older smokers. Addressing business benefits and a level playing field may increase support for voluntary smoke-free nightlife measures.

Influenza C Virus in Cattle with Respiratory Disease, United States, 2016-2018.

We identified influenza C virus (ICV) in samples from US cattle with bovine respiratory disease through real-time PCR testing and sequencing. Bovine ICV isolates had high nucleotide identities (≈98%) with each other and were closely related to human ICV strains (≈95%). Further research is needed to determine bovine ICV's zoonotic potential.

Repeat computed tomography scans among inter-facility transferred major trauma patients in Oklahoma, 2009-2015.

PURPOSE: Computed tomography (CT) scans play a vital role in the diagnosis and evaluation of trauma patients. Repeat CT scans occurred often among transferred trauma patients. The objective was to describe CT use and identify patient- and hospital-level factors associated with repeat CT scans among inter-facility transferred major trauma patients. METHODS: A retrospective cohort study was conducted using data extracted from the Oklahoma State Trauma Registry between 2009 and 2015. Both bivariate and multivariate analyses were employed to assess the factors associated with repeat CT scans. RESULTS: During the 7-year study period, 8678 major trauma patients were transferred between acute-care hospitals in Oklahoma. Among them, 4311 patients had at least one repeat CT scan. Head CT scans were the most commonly performed as well as repeated. Bivariate analysis showed that differences in repeat CT scans were associated with age, injury type, injury severity score, head injury severity, revised trauma score, payer source, transport mode to referring facilities, and facility levels at the 5% level. Multivariate analysis showed the odds of repeat CT scans were higher for adult and geriatric patients, patients with blunt injuries, severely injured patients, patients with severe head injuries, patients with a good revised trauma score, patients discharged alive, and mode to referring facilities. CONCLUSIONS: Our study demonstrated that inter-facility transfers within an organized rural trauma system often underwent repeat CT scans. The large proportion of patients with multiple and repeated CT scans should underline the importance of trauma systems evaluating the necessity of CT scans, image-sharing capability, and obtaining appropriate scans in order to optimize use. Overall, reducing unnecessary CT scans should be an essential part of trauma care quality improvement efforts.

Perceptions of Government and Research Expert Groups and Their Implications for Watershed Management in Oklahoma, USA.

The collaborative approach for sustainable management of watersheds is built on engagement of diverse stakeholders. Climate variability and anthropogenic activities increasingly impose challenges to successful management, as do contrasts in stakeholder perceptions about those processes. To assess differences in perceptions about watershed issues, we conducted a focus group meeting of expert stakeholder groups from research institutions, and state and federal agencies in the management of Cimarron River Watershed, Oklahoma. We employed the Strengths, Weaknesses, Opportunities, and Threats (SWOTs) approach to identify important issues, and the analytic hierarchy process to rank the perceptions of these groups. We found incongruity between these two groups over internal factors (SW) and external factors (OT) risking sustainable watershed management. External threats such as climate change dominated the research group perceptions, whereas internally prevalent weaknesses such as inability to track water use and lack of a common platform to share scientific data, dominated the government group perceptions. Despite these differences, both groups identified the negative aspect (W + T) as dominant over the positive aspect (S + O), which suggests a pessimistic watershed management future, with risks prevailing over the opportunities. We see this particular congruity of these two stakeholders as an opportunity to initiate a collaborative approach to watershed management in Oklahoma. We also note that the most important factor from each group corresponds to a relatively modest importance from the other group, and therefore suggests the possibility of cooperation rather than conflict in management goals should collaborative watershed management become established in the watershed.