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.

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.

Primary amebic meningoencephalitis (PAM) is a rare and lethal infection caused by Naegleria fowleri. We report an epidemiological and environmental investigation relating to a case of PAM in a previously healthy boy age 8 years. An interview of the patient\'s family was conducted to determine the likely exposure site and to assess risk factors. Data from the United States Geological Survey site at Waterloo, NE, on the Elkhorn River were used to estimate water temperature and streamflow at the time and site of exposure. Data from the National Weather Service were used to estimate precipitation and ambient air temperature at the time and site of exposure. Despite conventional treatment, the patient died 2 days after hospital admission. The patient participated in recreational water activities in the Elkhorn River in northeastern Nebraska 5 days before symptom onset. In the week before exposure, water and ambient air high temperatures reached annual highs, averaging 32.4°C and 35.8°C, respectively. The day before infection, 2.2 cm of precipitation was reported. Streamflow was low (407 ft3/s). Infections in several northern states, including Nebraska, suggest an expanding geographic range of N. fowleri transmission, which may lead to increased incidence of PAM in the United States. Similar environmental investigations at suspected exposure sites of future cases will allow data aggregation, enabling investigators to correlate environmental factors with infection risk accurately.

BACKGROUND: Three current and former awardees of the Centers for Disease Control and Prevention\'s Colorectal Cancer Control Program launched integrated cancer screening strategies to better coordinate multiple cancer screenings (e.g., breast, cervical, colorectal). By integrating the strategies, efficiencies of administration and provision of screenings can be increased and costs can be reduced. This paper shares findings from these strategies and describes their effects.
METHODS: The Idaho Department of Health and Welfare developed a Baseline Assessment Checklist for six health systems to assess the current state of policies regarding cancer screening. We analyzed the checklist and reported the percentage of checklist components completed. In Rhode Island, we collaborated with a nurse-patient navigator, who promoted cancer screening, to collect details on patient navigation activities and program costs. We then described the program and reported total costs and cost per activity. In Nebraska, we described the experience of the state in administering an integrated contracts payment model across colorectal, breast, and cervical cancer screening and reported cost per person screened. Across all awardees, we interviewed key stakeholders.
RESULTS: In Idaho, results from the checklist offered guidance on areas for enhancement before integrated cancer screening strategies, but identified challenges, including lack of capacity, limited staff availability, and staff turnover. In Rhode Island, 76.1% of 1023 patient navigation activities were for colorectal cancer screening only, with a much smaller proportion devoted to breast and cervical cancer screening. Although the patient navigator found the discussions around multiple cancer screening efficient, patients were not always willing to discuss all cancer screenings. Nebraska changed its payment system from fee-for-service to fixed cost subawards with its local health departments, which integrated cancer screening funding. Screening uptake improved for breast and cervical cancer but was mixed for colorectal cancer screening.
CONCLUSIONS: The results from the case studies show that there are barriers and facilitators to integrating approaches to increasing cancer screening among primary care facilities. However, more research could further elucidate the viability and practicality of integrated cancer screening programs.

Globally, the management of invasive plants is motivated by a desire to improve ecosystem services (e.g., recreation, flood mitigation, soil fertility for agriculture, aesthetics) and critical habitat for imperiled species. To reduce invader populations and impacts, it is important to document the social and ecological basis (i.e., the social-ecological system) for the management that has been employed and areas where a greater level of coordination among stakeholder groups (managers, scientists, legislators, resource users) could improve efforts. We present a conceptual model that builds on current thinking for how best to connect these four stakeholder groups-to foster stronger citizen lobbying for impacted resources, science-based governance, legislator-driven noxious weed laws and funding for management and science, knowledge co-production by scientists and managers, and co-management by managers and resource users. In light of our model, we present two case studies based in Nebraska and Utah, U.S.A. involving a common North American wetland invader, Phragmites australis (non-native common reed). In Nebraska, potential lawsuits stemming from water conveyance was strong motivation for funding management. In Utah, duck hunters and other resource users initially instigated management. Progress toward the successful management of Phragmites has been the result of manager-scientist partnerships addressing a knowing-doing gap among practitioners, the complexities of management mosaics, as well as overcoming economic and logistical constraints. Our model demonstrates how legislative initiatives can fund new research and bolster on-going management, while organically building strong partnerships among scientists, managers, and resource users that are key for successfully managing invasive species.

Shewanella species are Gram-negative, saprophytic, motile bacilli. Exposure to aquatic environment and raw fish ingestion have been defined as significant associated risk factors. The two species most commonly associated with human infections are Shewanella algae and Shewanella putrefaciens and major portion of infections (80%) caused by the former. Herein, we report a case of Shewanella septicaemia in a 70-year-old man in Omaha, NE who had no exposure to aquatic environment. To date, no defined treatment guidelines are present due to rarity of Shewanella infections, which is contributing to emerging antibiotic resistance.

A hybrid model was used to characterize potential ecological risks posed by atrazine to the endangered Topeka shiner. The model linked a Topeka shiner individual-based bioenergetics population model (TS-IBM) to a comprehensive aquatic system model (CASMTS ) to simulate Topeka shiner population and food web dynamics for an Iowa (USA) headwater pool. Risks were estimated for monitored concentrations in Iowa, Missouri, and Nebraska (USA), and for monitored concentrations multiplied by 2, 4, and 5. Constant daily atrazine concentrations of 10, 50, 100, and 250 µg/L were assessed. Exposure-response functions were developed from published atrazine toxicity data (median effect concentrations [EC50s] and no-observed-effect concentrations). Two toxicity scenarios were developed: the first included sensitive and insensitive species of algae, and the second reduced algal EC50 values to increase atrazine sensitivity. Direct and indirect effects of atrazine on Topeka shiner prey were modeled; direct effects on Topeka shiner were not assessed. Risks were characterized as differences between population biomass values of 365-d baseline and exposure simulations. The results indicated no discernable food web effects for monitored atrazine concentrations or constant exposures of 10 µg/L on Topeka shiner populations for either toxicity scenario. Magnified monitored concentrations and higher constant concentrations produced greater modeled indirect effects on Topeka shiners. The hybrid model transparently combines species-specific and surrogate species data to estimate food web responses to environmental stressors. The model is readily updated by new data and is adaptable to other species and ecosystems. Environ Toxicol Chem 2019;38:2243-2258. © 2019 SETAC.

This study sought to address the gaps in the literature on Asian American gerontology with a multiply marginalized group in terms of gender, immigration status, and context. Guided by a multiple case study approach, we sought to explore how social support was experienced by four Vietnamese elderly refugee women residing in different living arrangements (i.e., alone, with spouse, with adult children, or in a multigenerational household). Within-case analyses were conducted to yield descriptive information about each individual. Additionally, three overarching themes emerged across each of the living arrangements: (1) Burden of care-taking, (2) Distinguishing family from nonfamily help, and (3) Ambivalence toward government-sponsored services. Our findings provide a contextualized understanding of social support to explain the inconsistencies that have been found in the literature on Asian American gerontology and family support. The benefits of living alone are described, along with the potential risks of coresidency.

Medicare patients seeking care from nurse practitioners (NPs) increased 15-fold from 1998 to 2010, and a 2.5-fold patient increase was recorded in states that have eased the regulatory environment for NPs. It is increasingly important that state regulatory and licensing boards-charged with protecting the public through the assurance of a qualified health-care workforce-examine whether their state regulatory environment restricts or promotes public access to quality health care. This article presents a case study of a statutory scope of practice credentialing review process for NPs in Nebraska. It examines in depth what individuals involved in policy change processes found most useful for informed decision making. The methodology included observation of the process, review of submitted documents, and a survey to individuals involved in the decision-making process (n = 22/48). The study findings have application for those seeking scope of practice policy changes, with specific suggestions for how to better prepare themselves and present information in formats that are helpful to decision makers. Our results also shed new light on what specific evidence submitted during a scope of practice review process is most valued for promoting the understanding of decision makers to effect change.

Infectious bovine keratoconjunctivitis (IBK), also known as pinkeye, is the most costly eye disease of cattle. The principal etiologic agent of IBK is the Gram-negative bacterium Moraxella bovis. However, there have been reports of IBK outbreaks associated with Moraxella bovoculi. A retrospective study of IBK diagnostic cases submitted from July 1, 2010 through October 31, 2013 was conducted. Included in the study were 1,042 Moraxella isolates from 1,538 swabs of lacrimal secretions collected from 282 herds from 30 U.S. states. Moraxella isolates were identified to the species level and were composed of M. bovoculi (701 isolates), M. bovis (295 isolates), Moraxella ovis (5 isolates), and other Moraxella spp. (41). Minimum inhibitory concentrations required for 90% growth inhibition (MIC90) was calculated for representative isolates. The MIC90 values for both M. bovis and M. bovoculi were as follows: ampicillin and ceftiofur: ≤0.25 µg/ml; clindamycin: 2 µg/ml; danofloxacin and enrofloxacin: ≤0.12 µg/ml; florfenicol: 0.5 µg/ml; gentamicin: 1 µg/ml; neomycin: 4 µg/ml; tulathromycin: 2 µg/ml; and tylosin: 8 µg/ml. The MIC90 values for M. bovoculi included the following: chlortetracycline: ≤0.5 µg/ml; oxytetracycline: 4 µg/ml; penicillin: 0.25 µg/ml; spectinomycin: 32 µg/ml; sulfadimethoxine: >256 µg/ml; tiamulin: 1 µg/ml; and trimethoprim-sulfamethoxazole: 4 µg/ml. For M. bovis, MIC90 values included the following: chlortetracycline and oxytetracycline: 1 µg/ml; penicillin: ≤0.12 µg/ml; spectinomycin: 16 µg/ml; sulfadimethoxine: ≤256 µg/ml; tiamulin: ≤0.5 µg/ml; and trimethoprim-sulfamethoxazole: ≤2 µg/ml. The current work describes the frequency of isolation and differences in antimicrobial sensitivity observed among Moraxella isolates from case submissions.