Evaluation of an autonomous acoustic surveying technique for grassland bird communities in Nebraska.

Monitoring trends in wildlife communities is integral to making informed land management decisions and applying conservation strategies. Birds inhabit most niches in every environment and because of this they are widely accepted as an indicator species for environmental health. Traditionally, point counts are the common method to survey bird populations, however, passive acoustic monitoring approaches using autonomous recording units have been shown to be cost-effective alternatives to point count surveys. Advancements in automatic acoustic classification technologies, such as BirdNET, can aid in these efforts by quickly processing large volumes of acoustic recordings to identify bird species. While the utility of BirdNET has been demonstrated in several applications, there is little understanding of its effectiveness in surveying declining grassland birds. We conducted a study to evaluate the performance of BirdNET to survey grassland bird communities in Nebraska by comparing this automated approach to point count surveys. We deployed ten autonomous recording units from March through September 2022: five recorders in row-crop fields and five recorders in perennial grassland fields. During this study period, we visited each site three times to conduct point count surveys. We compared focal grassland bird species richness between point count surveys and the autonomous recording units at two different temporal scales and at six different confidence thresholds. Total species richness (focal and non-focal) for both methods was also compared at five different confidence thresholds using species accumulation curves. The results from this study demonstrate the usefulness of BirdNET at estimating long-term grassland bird species richness at default confidence scores, however, obtaining accurate abundance estimates for uncommon bird species may require validation with traditional methods.

Effect of Biomass Water Dynamics in Cosmic-Ray Neutron Sensor Observations: A Long-Term Analysis of Maize-Soybean Rotation in Nebraska.

Precise soil water content (SWC) measurement is crucial for effective water resource management. This study utilizes the Cosmic-Ray Neutron Sensor (CRNS) for area-averaged SWC measurements, emphasizing the need to consider all hydrogen sources, including time-variable plant biomass and water content. Near Mead, Nebraska, three field sites (CSP1, CSP2, and CSP3) growing a maize-soybean rotation were monitored for 5 (CSP1 and CSP2) and 13 (CSP3) years. Data collection included destructive biomass water equivalent (BWE) biweekly sampling, epithermal neutron counts, atmospheric meteorological variables, and point-scale SWC from a sparse time domain reflectometry (TDR) network (four locations and five depths). In 2023, dense gravimetric SWC surveys were collected eight (CSP1 and CSP2) and nine (CSP3) times over the growing season (April to October). The N0 parameter exhibited a linear relationship with BWE, suggesting that a straightforward vegetation correction factor may be suitable (fb). Results from the 2023 gravimetric surveys and long-term TDR data indicated a neutron count rate reduction of about 1% for every 1 kg m-2 (or mm of water) increase in BWE. This reduction factor aligns with existing shorter-term row crop studies but nearly doubles the value previously reported for forests. This long-term study contributes insights into the vegetation correction factor for CRNS, helping resolve a long-standing issue within the CRNS community.

Strengthening Linkages Between Health Care and Public Health: A Novel Framework for Public Health Action in Health Care Settings to Improve Cardiovascular Disease Risk.

The Chronic Disease Prevention and Control Program (CDPCP) at the Nebraska Department of Health and Human Services developed a novel public health framework and tools to translate public health knowledge, grant work, and terminology to a health care audience in order to inform clinical practice changes in the management of hyperlipidemia and hypertension. The CDPCP piloted the tools with 2 accountable care organizations that included 19 clinics and then funded 9 independent clinics. The project sought to empower clinics to design and implement interventions for reducing high blood pressure and high blood cholesterol focused on populations disproportionately at risk for those conditions utilizing electronic health records. A team comprising the CDPCP and evaluation specialists created a framework called CAAPIE (Capture, Assess, Action Plan, Implement, Evaluate) to provide a clinic-friendly approach to the public health-focused work. For the capture phase, baseline data were collected from clinics. To guide the assess, action plan, and evaluate phases, the team created a Scan & Plan Tool for clinics to assess practices and policies and then use results to develop an action plan. The assessment was repeated upon completion of the project to evaluate change. Interviews were conducted to assess the utility of these tools and capture information related to the implementation of the project. Clinicians reported the framework and tools provided a useful approach, aiding clinics in understanding public health terminology and intended outcomes of the project. Work resulted in the creation of new or enhanced clinical policies and procedures that led to modest improvements in the management of high blood pressure and high cholesterol. The CAAPIE framework is a novel approach for state health departments to utilize in translating public health grant work to health care professionals, promoting a working relationship between the spheres to achieve positive impacts on individual and population-based health care.

Outcome Evaluation of a Public Health Intervention on Cardiovascular Disease (CVD) Prevention Among Women Aged 40-64 with Low Incomes in Nebraska.

OBJECTIVES: To evaluate the effectiveness of the program interventions on cardiovascular disease in Nebraska women who are low income and have no health insurance. DESIGN: This evaluation used pre- and post-comparison approach. Paired t test and McNemar's test were used to examine the changes after the program interventions. PARTICIPANTS: Nebraska women aged 40 to 64 years, without health insurance, and with household incomes up to 225% Federal Poverty Level. SETTING AND INTERVENTION: A network of community-clinical linkages in which medical providers provided preventive screening services and risk reduction counseling in clinical settings and community health workers provided lifestyle interventions in community settings either over the phone or in person. MAIN OUTCOME MEASURE: The data included weight, blood pressure measures, self-blood pressure monitoring and management, total cholesterol, fasting glucose or A1C, smoking status, nutrition, and physical activities. RESULTS: Among 2649 participants, 82.2% were overweight, 50.3% had hypertension, 52.7% had high cholesterol, 20.7% had diabetes, 22.5% were current smokers, and 56.4% had more than 1 risk factor. A total of 1312 participants (57.3%) participated in at least 1 lifestyle intervention session, and among them, 65.8% completed at least 3 sessions. Paired t test and McNemar's test indicated significant improvement in hypertension control and self-management; a significant amount of weight loss with 24.1% losing at least 5 pounds; and an increase in healthy eating and physical activity. CONCLUSIONS: These participants benefited from the Nebraska program. Utilizing a statewide clinical network and participating in lifestyle interventions through local health departments, participants improved some chronic health conditions and decreased their risks of developing cardiovascular diseases.

Gut Microbial Composition of Cyprinella lutrensis (Red Shiner) and Notropis stramineus (Sand Shiner): Insights from Wild Fish Populations.

The gut microbiome is a highly intricate ecosystem that exerts a pivotal influence on the host's physiology. Characterizing fish microbiomes is critical to understanding fish physiology and health, but little is known about the ecology and colonization dynamics of microorganisms inhabiting fish species. In this study, we investigated the bacterial communities of two small-bodied fish species, Cyprinella lutrensis (red shiner) and Notropis stramineus (sand shiner), two fish species where gut microbiomes have not been investigated previously and surrounding waters, collected from rivers in Nebraska, USA. Our study focused on evaluating microbial diversity in small-bodied fish and identifying autochthonous microbes present within these species irrespective of location to better understand bacterial community composition and possible roles of such bacterial species. Our results revealed that both red shiner and sand shiner exhibited gut bacterial communities dominated by typical bacterial phyla found in freshwater fish. The phylum Bacteroidota was minimally abundant in both species and significantly lower in relative abundance compared to the surrounding water microbial community. Furthermore, we found that the gut microbiomes of red shiner and sand shiner differed from the microbial community in the surrounding water, suggesting that these fish species contain host-associated bacterial species that may provide benefits to the host such as nutrient digestion and colonization resistance of environmental pathogens. The fish gut bacterial communities were sensitive to environmental conditions such as turbidity, dissolved oxygen, temperature, and total nitrogen. Our findings also show bacterial community differences between fish species; although they shared notable similarities in bacterial taxa at phyla level composition, ASV level analysis of bacterial taxa displayed compositional differences. These findings contribute to a better understanding of the gut bacterial composition of wild, freshwater, small-bodied fish and highlight the influence of intrinsic (host) and environmental factors on shaping the bacterial composition.

Evidence-based practice criteria's effect on the implementation of the Family First Prevention Services Act in Nebraska and Colorado.

Child abuse, particularly neglect, is often preventable because many causes of harm stem from poverty, lack of social connections, substance use disorders, mental illness, lack of childcare, and other family support shortages. Prevention of child abuse and neglect starts with family support in these areas. The federal government recognized this need for prevention, and through considerable bipartisan support, passed the Family First Prevention Services Act on February 9, 2018. The Family First Prevention Services Act was designed to divert investment away from long-term foster care and toward programs that prevent unnecessary placement and child protective services interventions. The Family First Prevention Services Act restricts the state's use of federal funds for institutional foster care placements and uses those savings to fund reimbursements for evidence-based family preservation. The requirement for evidence-based prevention is a first in child-welfare federal law, and compliance with this requirement requires public-private partnership with agencies implementing the models, infrastructure, and evaluation standards that most states must build to be eligible for the new funding. This evaluation research analyzed how the stringent guidelines for prevention funding and the requirement of federally approved evidence-based practice programming affect the implementation of the Family First Prevention Services Act in Nebraska and Colorado.

Association of Disability Status and Type With Binge Drinking and Prescription Opioid Misuse Among Adults From a 3-State Sample.

BACKGROUND: Research examining at-risk substance use by disability status is limited, with little investigation into differences by disability type. We investigated binge drinking and prescription opioid misuse among adults with and without disabilities, and by type of disability, to inform need for assessment and intervention within these populations. METHODS: Secondary analyses of adults who completed the disability, alcohol, and prescription opioid misuse items in the 2018 Ohio, Florida, or Nebraska Behavioral Risk Factor Surveillance System surveys (n = 28 341), the only states that included prescription opioid misuse in 2018. Self-reported disability status (yes/no) relied on 6 standardized questions assessing difficulties with: vision, hearing, mobility, cognition, self-care, and independent living (dichotomous, nonmutually exclusive, for each disability). Logistic regression models estimated the association of disability status and type with (1) past 30-day binge drinking and (2) past-year prescription opioid misuse. Additional models were restricted to separate subsamples of adults who: (a) currently drink, (b) received a past-year prescription opioid, and (c) did not receive a past-year prescription opioid. RESULTS: One-third reported at least one disability, with mobility (19.5%), cognitive (11.5%), and hearing (10.2%) disability being the most common. Disability status was associated with lower odds of binge drinking (adjusted odds ratio [AOR] = 0.74, 95% confidence interval [CI] 0.68-0.80, P ≤ .01). However, among adults who currently drink, people with disabilities had higher odds of binge drinking (AOR = 1.11, 95% CI 1.01-1.22, P ≤ .05]. Disability was associated with higher odds of past-year prescription opioid misuse (AOR = 2.51, 95% CI 2.17-2.91, P ≤ .01). CONCLUSIONS: Adults with disabilities had higher odds of prescription opioid misuse, and among adults who currently drink, higher odds for binge drinking were observed. The magnitude of the association between disability status and prescription opioid misuse was particularly concerning. Providers should be trained to screen and treat for substance use problems for people with disabilities.

Engaging Communities in Cancer Prevention and Control Activity Prioritization through a Statewide Needs Assessment: A Case Study from Nebraska.

Community outreach and engagement (COE) activities are important in identifying catchment area needs, communicating these needs, and facilitating activities relevant to the population. The National Cancer Institute-designated cancer centers are required to conduct catchment-wide cancer needs assessments as part of their COE activities. The University of Nebraska Medical Center Buffett Cancer Center undertook a three-year-long process to conduct a needs assessment, identify priorities, and develop workgroups to implement cancer prevention and control activities. Activities were conducted through collaborations with internal and external partners. The needs assessment focused on prevention, early detection, and treatment of cancer and involved secondary data analysis and focus groups with identified underrepresented priority populations (rural, African American, Hispanic, Native American, and LGBTQ+ populations). Results were tailored and disseminated to specific audiences via internal and external reports, infographics, and presentations. Several workgroups were developed through meetings with the internal and external partners to address identified priorities. COE-specific initiatives and metrics have been incorporated into University of Nebraska Medical Center and Buffett Cancer Center strategic plans. True community engagement takes a focused effort and significant resources. A systemic and long-term approach is needed to develop trusted relationships between the COE team and its local communities.

Patterns of delta 8 THC and cannabis uptake in Nebraska: A cannabis prohibition state.

BACKGROUND: Following the passage of the 2018 Farm Bill, derived psychoactive cannabis products containing delta 8 tetrahydrocannabinol (THC) have become increasingly popular across the US, particularly in states that lack medical or recreational cannabis programs. Despite this, little is known about patterns of delta 8 THC use. METHODS: A sample of Nebraska residents (a state without legal medical or recreational cannabis) were surveyed to gather data on substance use, including delta 8 THC and cannabis, across the state. Then, logistic regressions were used to calculate relative odds ratios to understand the factors that increased the likelihood at which Nebraska residents use delta 8 THC or cannabis products. RESULTS: Analysis revealed that younger adults have higher odds of delta 8 THC use but not cannabis and that non-white participants had higher odds of delta 8 use than white non-Hispanic groups but there was no difference for cannabis use. Political affiliation, sexual orientation, access, and knowledge of friends who used cannabis were also associated with cannabis use but not delta 8 THC use. Past substance use and personal opinion regarding cannabis use increased likelihood for both delta 8 THC and cannabis use. CONCLUSION: These results illuminate several factors which affect cannabis and delta 8 THC use while providing insight on the people that are most likely to be impacted by the potential consequences of substance use, especially when considering the inconsistent laws governing cannabis and delta 8 THC use across the US.

Evidence of Active Orbivirus Transmission in 2016 in Kansas and Nebraska.

Retrospective serological and case diagnostic data of endemic bluetongue virus (BTV) and epizootic hemorrhagic disease virus (EHDV) provide evidence of viral transmission among livestock and wildlife from 2016 in Kansas and Nebraska. Serological testing of mature cattle in nine distinct regional zones of Kansas revealed 76% to 100% had detectable antibodies to BTV and/or EHDV. Specimens tested in the Kansas Veterinary Diagnostic Laboratory (55 submissions) were 51% test positive for antibodies to BTV and/or EHDV. Specimens tested in the Nebraska Veterinary Diagnostic Center (283 submissions) were 25% test positive for antibodies to BTV and/or EHDV. Low disease incidence in white-tailed deer and other susceptible wild ungulates was observed during 2016. However, there were no confirmed reports of disease in livestock in either state. The reasons for emergence of significant clinical disease in livestock and wildlife populations remain undefined.

Confirmed Case of Longstanding Respiratory Francisella tularensis holarctica Infection: Nebraska, 2022.

A male patient with distant history of extensive rabbit contact and pulmonary nodules for 6 years developed empyema. Francisella tularensis holarctica was isolated from thoracentesis fluid. Retrospective immunohistochemical examination of a pulmonary nodule, biopsied 3 years prior, was immunoreactive for F. tularensis. These findings suggest the potential for chronic tularemia.

African American and Hispanic Cancer Survivors' and Caregivers' Experiences in Nebraska.

Racial and ethnic minority populations experience poorer cancer outcomes compared to non-Hispanic White populations, but qualitative studies have typically focused on single subpopulations. We explored experiences, perceptions, and attitudes toward cancer care services across the care continuum from screening through treatment among African American and Hispanic residents of Nebraska to identify unique needs for education, community outreach, and quality improvement. We conducted four focus groups (N = 19), April-August 2021 with people who were aged 30 or older and who self-identified as African American or Hispanic and as cancer survivors or caregivers. Sessions followed a structured facilitation guide, were audio recorded and transcribed, and were analyzed with a directed content analysis approach. Historical, cultural, and socioeconomic factors often led to delayed cancer care, such as general disuse of healthcare until symptoms were severe due to mistrust and cost of missing work. Obstacles to care included financial barriers, transportation, lack of support groups, and language-appropriate services (for Hispanic groups). Knowledge of cancer and cancer prevention varied widely; we identified a need for better community education about cancer within the urban Hispanic community. Participants had positive experiences and a sense of hope from the cancer care team. African American and Hispanic participants shared many similar perspectives about cancer care. Our results are being used in collaboration with national and regional cancer support organizations to expand their reach in communities of color, but structural and cultural barriers still need to be addressed.

Psychometrics of psychosocial behavior items under age 6 years: Evidence from Nebraska, USA.

Because healthy psychosocial development in the first years of life is critical to lifelong well-being, governmental, and nongovernmental organizations are increasingly interested in monitoring psychosocial behaviors among populations of children. In response, the World Health Organization is developing the Global Scales of Early Development Psychosocial Form (GSED PF) to facilitate population-level psychosocial monitoring. Once validated, the GSED PF will be an open-access, caregiver-reported measure of children's psychosocial behaviors that is appropriate for infants and young children. This study examines the psychometric validity evidence from 45 items under consideration for inclusion in the GSED PF. Using data from N = 836 Nebraskan (USA) children aged 180 days to 71 months, results indicate that scores from 44 of the 45 (98%) items exhibit positive evidence of validity and reliability. A bifactor model with one general factor and five specific factors best fit the data, exhibited strong reliability, and acceptable model fit. Criterion associations with known predictors of children's psychosocial behaviors were in the expected direction. These findings suggest that measurement of children's psychosocial behaviors may be feasible, at least in the United States. Data from more culturally and linguistically diverse settings is needed to assess these items for global monitoring.

Debido a que el desarrollo sicosocial en los primeros años de vida es crítico para el bienestar de toda la vida, las organizaciones gubernamentales y no gubernamentales están más y más interesadas en observar vigilantemente las conductas sicosociales en la población infantil. Como respuesta, la Organización Mundial de la Salud está desarrollando el Formulario Sicosocial de las Escalas Globales del Temprano Desarrollo (GSED PF) para facilitar la observación sicosocial alerta al nivel del grupo de población. Una vez que se haya convalidado, el GSED PF será una medida de acceso abierto, que reportará el cuidador, sobre las conductas sicosociales de los niños que son apropiadas para infantes y niños pequeñitos. Este estudio examina la evidencia de la validez sicométrica de 45 puntos bajo consideración para ser incluidos en el GSED PF. Usando datos de N = 836 niños de Nebraska (Estados Unidos), de edad entre 180 días y 71 meses, los resultados indican que los puntajes de 44 de los 45 (98%) puntos muestran evidencia positiva de validez y confiabilidad. Un modelo bifactorial con un factor general y cinco factores específicos, que mejor encaja con los datos, mostró una fuerte confiabilidad y un modelo aceptable que encaja. Las asociaciones de criterio con factores de predicción conocidos acerca de las conductas sicosociales de los niños se encontraban en la dirección esperada. Estos resultados sugieren que la medida de las conductas sicosociales de los niños pudiera ser posible, por lo menos en los Estados Unidos. Se necesitan datos de escenarios más diversos cultural y lingüísticamente para evaluar estos puntos para la estar alerta en la observación global.

Differences in Role and Support Between Volunteer and Paid Community Health Workers in the State of Nebraska.

Despite the growing importance of community health workers (CHWs) in public health, it has been difficult to characterize the roles and scope of services for this workforce in part because of the variability in the employment status of CHWs, ranging from full-time, part-time, to volunteer. Based on analysis of survey data from a statewide assessment of the CHW workforce in Nebraska (n = 142) conducted between 2019 and 2020, the proportions of CHWs who worked full-time, part-time, or volunteer were respectively 64%, 12%, and 21%. Over three quarters (76.7%) of volunteer CHWs were primarily working with Hispanic communities, as compared to less than 30% among full-time and part-time CHWs. About 80% of volunteer CHWs received training before becoming a CHW, substantially higher than the corresponding proportions among full-time (46.2%) and part-time CHWs (52.9%). In terms of tasks performed, the proportion of volunteer CHWs who provided health screenings (70%) were much higher than full or part-time CHWs (41.8% and 11.8% respectively, p < 0.001); whereas the latter two groups were significantly more likely than volunteer CHWs to provide other tasks such as coordinating care, health coaching, social support, transportation, interpretation, data collection, advocacy, and cultural awareness. Volunteer CHWs may hold potential for serving non-Hispanic communities. Future development of the CHW workforce can benefit from understanding and leveraging the significant differences in roles and scope of services among CHWs with various employment statuses.

In-depth assessment of critical access hospital stewardship program adherence to the CDC Core Elements in Iowa and Nebraska.

In 21 antimicrobial stewardship programs in critical-access hospitals in Nebraska and Iowa that self-reported nonadherence to a CDC Core Element or Elements, in-depth program assessment and feedback revealed that accountability and education most needed improvement. Recommendations included providing physician and pharmacist training, tracking interventions, and providing education. Program barriers included lack of time and/or personnel and antimicrobial stewardship and/or infectious diseases expertise.

Cover crop performance under a changing climate in continuous corn system over Nebraska.

Fall-planted cover crop (CC) within a continuous corn (Zea mays L.) system offers potential agroecosystem benefits, including mitigating the impacts of increased temperature and variability in precipitation patterns. A long-term simulation using the Decision Support System for Agrotechnology Transfer model was made to assess the effects of cereal rye (Secale cereale L.) on no-till continuous corn yield and soil properties under historical (1991-2020) and projected climate (2041-2070) in eastern Nebraska. Local weather data during the historical period were used, while climate change projections were based on the Canadian Earth System Model 2 dynamically downscaled using the Canadian Centre for Climate Modelling and Analysis Regional Climate Model 4 under two representative concentration pathways (RCP), namely, RCP4.5 and RCP8.5. Simulations results indicated that CC impacts on corn yield were nonsignificant under historical and climate change conditions. Climate change created favorable conditions for CC growth, resulting in an increase in biomass. CC reduced N leaching under climate change scenarios compared to an average reduction of 60% (7 kg ha- 1 ) during the historical period. CC resulted in a 6% (27 mm) reduction in total water in soil profile (140 cm) and 22% (27 mm) reduction in plant available water compared to no cover crop during historical period. CC reduced cumulative seasonal surface runoff/soil evaporation and increased the rate of soil organic carbon buildup. This research provides valuable information on how changes in climate can impact the performance of cereal rye CC in continuous corn production and should be scaled to wider locations and CC species.

The Behavioral Health Education Center of Nebraska: A Creative Solution to a Persistent Behavioral Health Workforce Shortage.

States all across the United States are experiencing a shortage in their behavioral health workforces. Although many studies have suggested factors that contribute to or mitigate the shortage-particularly in rural and underserved areas-no nationwide guidance exists on best practices to develop a behavioral health workforce that can meet community need. The Behavioral Health Education of Nebraska (BHECN) can serve as an exemplar for others looking to take a multifaceted approach to develop the behavioral health workforce in their community. Evidence from published studies is reviewed, and BHECN's approach and practices are explained.

Integrated flood risk assessment of properties and associated population at county scale for Nebraska, USA.

Risk assessment of properties and associated population was conducted for the state of Nebraska, leveraging only open-source datasets. The flood risk framework consisted of interactions among drivers, i.e. hazard, exposure, vulnerability, and response, to assess the risks related to properties and associated populations. To quantify hazard on a county scale, we considered properties at risk of flooding based on a flood score (a higher score represents a greater chance of flooding). Exposure was quantified by considering population density at the county level. We quantified vulnerability under four categories: social, ecological, economic, and health. Response, a relatively newer component in flood risk assessment, was also quantified under three distinct categories: structural, non-structural, and emergency. Overall, we found that counties in eastern Nebraska (Sarpy, Dakota, Wayne, and Adams) have a higher risk of flooding consequences due to more exposure to vulnerable assets such as population and property. The assessment also observed that counties in eastern Nebraska are in the process of improving their flood control measures with dams, levees, and higher insurance coverage that can subdue the risks associated with flooding. The results from this study are anticipated to guide water managers and policymakers in making more effective and locally relevant policies and measures to mitigate flood risks and consequences.

Phylogeny and paleobiogeography of the enigmatic North American primate Ekgmowechashala illuminated by new fossils from Nebraska (USA) and Guangxi Zhuang Autonomous Region (China).

Ekgmowechashala is a poorly documented but very distinctive primate known only from the late early Oligocene (early Arikareean) of western North America. Because of its highly autapomorphous dentition and spatiotemporal isolation, the phylogenetic and biogeographic affinities of Ekgmowechashala have long been debated. Here, we describe the oldest known fossils of Ekgmowechashala from the Brown Siltstone Beds of the Brule Formation, White River Group of western Nebraska. We also describe a new ekgmowechashaline taxon from the Nadu Formation (late Eocene) in the Baise Basin of Guangxi Zhuang Autonomous Region in southern China. Phylogenetic analysis suggests that North American Ekgmowechashala and the new Chinese taxon are sister taxa that are nested within a radiation of southern Asian adapiforms that also includes Gatanthropus, Muangthanhinius, and Bugtilemur. The new Chinese ekgmowechashaline helps fill the considerable disparity in dental morphology between Ekgmowechashala and more primitive ekgmowechashalids known from southern Asia. Our study underscores the fundamental role of southern Asia as a refugium for multiple primate clades during the cooler and drier climatic regime that prevailed after the Eocene-Oligocene transition. The colonization of North America by Ekgmowechashala helps define the beginning of the Arikareean Land Mammal Age and corresponds to an example of the Lazarus effect, whereby a taxon (in this case, the order Primates) reappears suddenly in the fossil record after a lengthy hiatus.

Developing a survey instrument to assess flood health beliefs among residents of river flood zones in the Heartland.

INTRODUCTION: Flooding represents a significant health risk to residents of states bordering the Missouri and Missis-sippi Rivers. In Nebraska and Iowa, nearly 280,000 individuals live in floodplains that put them at higher risk for expe-riencing a flood. In Nebraska, 8.60 percent of residents live within floodplains, while in Iowa, 3.83 percent of residents live in floodplains.1 Flooding poses immediate risks including injury and loss of life, but it additionally threatens long-er-term impacts due to increased exposure to environmental health risks and damage to physical and social infrastruc-ture.2,3 Health education interventions depend on risk communication based on accurate knowledge of the health beliefs of at-risk individuals. This paper outlines the development of a survey instrument designed to solicit flooding health beliefs of individuals living in river flood zones. METHODS: This study developed the survey instrument through a series of revisions designed to increase the con-struct validity of the data collected. These steps included item sourcing and modification, expert review, and cognitive interviewing. Content for the initial survey draft was sourced from existing flood risk survey instruments and other standardized demographic surveys.4-8 This study then validated the instrument through sequential expert review and cognitive interviewing, collecting and conducting qualitative analysis of data collected through each phase. RESULTS: Themes from the expert review include (1) improvement of the user experience through revision of re-sponse categories and removal of unnecessary structural elements, (2) improvement of construct representativity through attentiveness to existing flood preparedness policies in the Heartland, and (3) streamlining of data analysis through revision and clarification of item prompts and responses. Themes from the cognitive interviewing include (1) the addition of items soliciting respondents' awareness of their flood risk as well as open-ended items soliciting respond-ents' existing personal flood plan components, (2) revision of existing demographic items to solicit respondents' esti-mated-rather than exact-household income, and (3) clarification of our definition of a flooding event. DISCUSSION: This study adapted existing survey items into an instrument designed to gather data on respondents' flood health beliefs and relevant demographic characteristics, producing a developed instrument that can be used to measure a population's flood health beliefs with reasonable evidence of validity. This instrument may be further tested by gathering baseline data and conducting psychometric testing to determine which items wield significant influence over respondents' decision to develop a personal or household flood plan.9 Additionally, this study provides a model for risk communication professionals seeking to adapt existing survey items to develop instruments designed to gather data on locally relevant health outcomes.10.