Rural hospitals across the United States face growing financial and operational pressures, with many at risk of closure due to workforce shortages, aging infrastructure, and limited access to capital. In response, many rural healthcare organizations are exploring strategic affiliations with larger health systems as a pathway to long-term sustainability. In January 2021, St. Lawrence Health, a three-hospital system serving a geographically large and medically underserved region in northern New York, formally affiliated with Rochester Regional Health.This article examines the experience of integrating a rural health system into a larger regional network and highlights key outcomes, challenges, and lessons learned. At the same time, the integration process presented important challenges common to rural health system affiliations. Geographic distance between organizations, integration during the COVID-19 pandemic, differences in labor environments between unionized and non-unionized workforces, and concerns about community identity required thoughtful leadership and sustained engagement.The experience of St. Lawrence Health provides a practical example of how system affiliation can support rural healthcare delivery while also revealing the operational, cultural, and workforce complexities that accompany rural-urban health system integration.

Plague is a zoonotic disease of mammals caused by the bacterium Yersinia pestis. Because plague is primarily transmitted by fleas (Siphonaptera), rates of plague transmission are expected to increase with flea abundance. Edaphic factors can influence the abundance and dispersion of fleas, suggesting that soils may play important roles in plague ecology. From June to August 2010-12, in northern New Mexico, USA, we investigated the effects of soil texture, soil moisture, and soil water-holding capacity on the abundance of adult fleas parasitizing colonial, burrowing black-tailed prairie dogs (Cynomys ludovicianus, BTPDs). We sampled BTPDs 1,741 times on 20 sampling plots distributed among 13 BTPD colonies, detecting 9,541 adult fleas on BTPDs. Fleas were most abundant on BTPDs in areas with coarse surface soils, and in areas with moderately textured subsurface soils at the average depth of BTPD nest chambers. Coarse surface soils may facilitate water percolation to BTPD nests, where the moisture could generate humid microclimates that benefit desiccation-prone fleas. Moderately textured subsurface soils, of intermediate water-holding capacity, can store water, which may increase burrow humidity. Moreover, moderately textured subsurface soils in BTPD nests may increase survival of flea larvae and pupae, facilitating their development to adulthood. That said, excessive moisture and sodden soils can favor fungi and mites, some of which are lethal to fleas. In our study, fleas were most abundant in areas with subsurface soils of intermediate moisture content. Our findings complement an accumulating number of studies, indicating that edaphic factors play important roles in flea and plague ecology.

The Northeastern United States experienced the highest rates of synthetic opioid overdose deaths in 2019, and in 2020, 3 of the 8 states with higher rural than urban drug overdose death rates were in the Northeast. To inform delivery of evidence-based substance use treatment in rural areas, we examined approaches to recruiting health care practitioners and community collaborators who work with people with opioid use disorder (OUD) in 4 northeastern states to complete needs assessment surveys. This article also outlines our methodological approaches to engaging rural health care practitioners and community collaborators. We developed tailored approaches to identify eligible practitioners and community collaborators using existing lists, state partner outreach, participant referrals, and social media advertisements. Eligible participants received email invitations to complete a survey. We calculated cooperation and response rates and described differences in online survey response and practitioner characteristics by state. Vermont, New Hampshire, Maine, and Northern New York. Health care practitioners and community collaborators who worked with people with OUD. From 2020 to 2023, 951 practitioners in 4 states and 388 community collaborators in 3 states completed needs assessments, with approximately 70% of respondents working in rural areas. States where we had access to long practitioner contact lists produced 50%-120% larger practitioner samples than those without existing lists. Response rates for all respondents ranged from 13% in Maine to 70% in New Hampshire, where participants completed eligibility screening before the survey. Our tailored approach to recruitment for each state allows for data collection across a range of practitioners and community collaborators engaged in OUD treatment, particularly rural practitioners often underrepresented in previous studies. These methods may serve as models for future efforts to engage rural substance use treatment practitioners and guide data collection through academic-community health partnerships in rural areas.

Detectable concentrations of per- and polyfluoroalkylsubstances(PFAS) have been observed in soils in remote areas and presumablyoriginate from atmospheric deposition. These anthropogenic backgroundconcentrations may enable some PFAS to leach to groundwater at levelsthat exceed regulatory criteria for drinking water. However, anthropogenicbackground soil concentrations and their connection to groundwaterare not well characterized. We developed a boosted regression treemodel to predict perfluorooctanesulfonic acid (PFOS) and perfluorooctanoicacid (PFOA) concentrations in shallow soils across northern New England.Low soil pH was the most important predictor of elevated anthropogenicPFOS and PFOA concentrations in background soils, rather than potentialPFAS sources, land use, or population density. Total organic carbon(TOC) was also an important predictor for PFOS soil concentrations.Model predictions indicate that 73% of the shallow soils within Maine,Vermont, and New Hampshire exceed New Hampshire’s Soil RemediationStandard for PFOS (0.5 ng/g) and 41% exceed the PFOA standard (0.4ng/g). Analysis of soil model results and groundwater data suggeststhat areas with high soil pH are associated with higher groundwaterdetection frequencies, illustrating how areas with less retentionin soil are, conversely, also areas with potentially greater groundwatervulnerability. Further analysis indicates that groundwater may bemore vulnerable in calcareous lithologies.

Forecasted increases in intense rainfall events in northern New England will impact the export quantity of polluted runoff, affecting shellfish harvesting activities in receiving estuaries. Evaluations of how estuaries with varied hydrodynamic characteristics respond to relatively intense rainfall can thereby provide a base of knowledge important for coastal management decision-making with implications to aquaculture and shellfish harvesting. Here we summarize results from runoff simulations implemented to quantify hydrologic responses to relatively high-intensity rainfall events in 10 different watersheds entering four estuaries connected to Frenchman Bay, Maine (USA). Stream outflow hydrographs predicted from 24-h precipitation time series are used to force the streamflow in three-dimensional, idealized hydrodynamic simulations implemented to examine the spatial extent of the polluted freshwater in the four estuaries in the days after the rainfall event. By utilizing a "worst-case scenario" load concentration of fecal coliform bacteria, it is shown that estuary geometry exhibits major control on water quality recovery after periods of heavy rainfall. The simulations predict that the estuaries governed by density-driven dynamics take over one week to recover from runoff generated from 2″ (∼51mm) of precipitation in 24h, a quantity that triggers a management response along Maine's coast. Some estuary sub-areas have relatively lower susceptibility to contamination following runoff events due to variations in estuary channel geometry. The outcomes demonstrate a pathway to advance the basis for shellfish management decision-making using place-based hydrologic and hydrodynamic simulations to highlight the implications of local coastal geomorphological conditions for water quality recovery following rainfall runoff events.

Globally, the geographic ranges of numerous species are contracting. Identifying spatiotemporal patterns of threat impact can illuminate why species decline in some parts of their range but persist in others. We developed a correlative approach to identify species' response thresholds and locate ecological refuge areas associated with persistence to inform conservation planning and management. We integrated changes in realized niche characteristics for a threatened Australian mammal, the brush-tailed rock-wallaby (Petrogale penicillata), with the distributions of threatening processes and environmental features to identify predictors of extirpation and persistence. We used occurrence records to construct historical (2004 or before) and contemporary (2005-2022) species distribution models. We then determined differences in niche characteristics between areas of extirpation and persistence. We applied generalized additive mixed models to determine species-specific thresholds for extirpation, which we used to identify ecological refuges. Across the two periods, brush-tailed rock-wallaby habitat declined by 75%, resulting in realized niche shifts. Extirpations occurred where habitat distance to water increased, and red fox (Vulpes vulpes) densities and feral goat (Capra hircus) habitat suitability were relatively high. Relatively high topographic ruggedness and highminimum temperatures were associated with persistence. Species persistence was also positively correlated with increasing dingo (Canis familiaris) habitat suitability, and inappropriate fire regimes (e.g., more frequent fires than expected for a vegetation group), both of which have been suggested as threats to the species. Specific refuge locations were identified in southeastern Queensland and northern New South Wales. Our findings highlight the importance of quantitative species-specific threat assessments to prevent misguided conclusions from cross-taxa threat generalizations. As spatial data become increasingly accessible, our novel approach will provide practitioners with evidence on which to base fine-scale investigations. Our approach can be applied to other species undergoing range contractions.

ABSTRACT Bipedal shuvosaurid archosaurs were present for much of the Late Triassic Period. The clade is particularly diverse in Upper Triassic assemblages in the western U.S.A. Isolated bones are easily differentiated from contemporary archosaurs, but the two named North American species, Shuvosaurus inexpectatus and Effigia okeeffeae, display remarkably similar skeletons. Here we describe a new shuvosaurid species, Labrujasuchus expectatus, gen. et sp. nov., from the middle Norian (∼212 Ma) Hayden Quarry of northern New Mexico, U.S.A., located within the Petrified Forest Member of the Chinle Formation, that fills the temporal gap between the two species. The holotype consists of a partial skeleton, with additional shuvosaurid material from the Hayden Quarry likely pertaining to this taxon. This taxon is distinguished by four autapomorphies and assignable to Shuvosauridae based on a deep fossa present on the posterodorsal edge of the coracoid, the proximal portion of the humerus less than twice the width of the midshaft, the anteromedial tuber of the femur large and ‘hooked’ posteriorly, and a ventrally descended posterolateral portion of the femoral head. Recent Bayesian estimates of archosaur phylogeny and divergence times suggested a Middle Triassic split for Shuvosauridae as well as a decrease in the rate of morphological evolution for the clade relative to that of other archosaurs. The anatomical similarity of L. expectatus with other shuvosaurids is consistent with these estimated low rates, and the long gaps in the fossil record for the clade suggest that much of their evolutionary history remains to be sampled. http://zoobank.org/urn:lsid:zoobank.org:pub:E2636A39-A394-4FAB-B1A9-CBED014A4E7B

So You Want to be a Rural General Surgeon: Optimizing Surgical Training to Support the Needs of Rural Hospitals.

Opioid-related overdose deaths have risen sharply in rural areas of the United States during the past decade. Intranasal naloxone (IN) can reverse the effects of opioid overdose if given promptly. However, access to IN is often hampered by cost, availability, and stigma. Dispensing IN in vending machines (VMs) offers a means of addressing these barriers and increasing the availability of this form of overdose prevention for the general public in rural communities. From September 2022 to December 2024, the University of Vermont Center on Rural Addiction undertook a descriptive exploratory multi-site intranasal naloxone vending machine (INVM) implementation project, partnering with five organizations in underserved rural areas throughout northern New England. In this report, we describe our stepwise approach to site selection, machine design and installation, community relations, and data collection and monitoring that we developed to facilitate program implementation. Monthly total IN doses dispensed per machine typically peaked in the first month after installation (mean 131; range 44–226) and subsequently averaged 47 (range 10–98) doses per month, with 19.3% of doses dispensed on weekends, and 49.5% occurring outside of business hours. Concerns voiced by rural community members in response to the anticipated placement of a VM were addressed by engagement with stakeholders and communication of facts about IN. Overall, these results suggest that VM-based naloxone distribution is feasible in rural communities and holds substantial potential for addressing opioid-related harm in these hard-hit areas.

Lower Devonian (ca. 418–407 Ma) volcanic rocks of the Dalhousie Group of the Gander Zone from the northern mainland Appalachians of northern New Brunswick are part of an overstep unit (the Middle Paleozoic Matapedia cover sequence) deposited across the accreted vestiges of the early Paleozoic Iapetus Ocean (proto-Atlantic Ocean). These shallow marine to subaerial mainly bimodal volcanic rocks were deposited in a post-collisional extensional setting. The felsic melts were generated by anhydrous melting of associated basalts in the lower continental crust with melting initiated by heat from rising underplated mafic magma. The ɛ Nd (t) values of rhyolites are positive (+ 3.45 – + 4.7) and similar to those of associated basalts (+3.9 - + 4.2). Likewise, their depleted model mantle ages ranging from ∼610 to ∼770 Ma are similar to those of basalts (∼700–790 Ma) and interpreted to represent enrichment ages associated with ancient Neoproterozoic subduction. The origin of the volcanic rocks of the Dalhousie Group is probably related to post-Salinic relaxation, extension, and breakoff of the Acadian Seaway slab and marks the transition to the Acadian orogenic cycle.

Timely initiation of postoperative radiotherapy (PORT) within 6 weeks of surgery improves survival for patients with head and neck squamous cell carcinoma. Rural populations experience disproportionate delays, yet contextual drivers remain poorly understood. To identify barriers, facilitators, and themes influencing the receipt of timely PORT in rural settings to inform a future multilevel intervention. This qualitative study used a phased, patient- and caregiver-involved design at 2 rural northern New England cancer center clinics at Dartmouth Health. Phase 1 included 2 facilitated dialogues with patients, caregivers, and staff, followed by participant-led coding (referred to as Partnership Academies). Phase 2 included 3 facilitated dialogues focused on refining barriers, facilitators, and solutions-focused themes (2 with patients/caregivers and 1 with staff; referred to as Community Engagement Studios). Phase 3 included reviewing preliminary insights at a clinic staff retreat for feedback. Data were collected from November 2024 to April 2025 and analyzed from November 2024 to May 2025. Barriers, facilitators, and themes related to timely PORT initiation. Analysts used an inductive-deductive approach guided by Intervention Mapping and the Consolidated Framework for Implementation Research, version 2.0. Eleven individuals participated in the Partnership Academies and 18 in the Community Engagement Studios. Five barriers were identified (communication, care coordination, access to dental care, transportation, and confronting negative emotions), and 4 facilitators were identified (key staff as central contacts, caregivers as advocates, rural culture, and leveraging preexisting resources). Four themes emerged: (1) leveraging strengths, (2) managing the steep learning curve after cancer diagnosis, (3) the value of peer support, and (4) the desire for information support was far-reaching. This qualitative study examines PORT delays in a rural context with patient, caregiver, and staff voices. Findings highlight the importance of community resources, effective communication, and peer support to inform multilevel strategies aimed at reducing delays and improving equity in cancer care.

Interseeding, the practice of planting cover crops into standing cash crops, can enhance soil health, nutrient cycling, and weed suppression, although performance depends on species and environmental context. We evaluated three cover crop mixtures with potential for use in the Northeast United States: (i) oats ( Avena sativa ) and field peas ( Pisum sativum ) (OP); (ii) cereal rye ( Secale cereale ) and hairy vetch ( Vicia villosa ) (WRV); and (iii) annual ryegrass ( Lolium multiflorum ) and crimson clover ( Trifolium incarnatum ) (ARGCL). These were interseeded in two separate trials: (i) sweet corn ( Zea mays ) and (ii) storage cabbage ( Brassica oleracea ) over two growing seasons. Both trials included a no-cover-crop control for comparison. Cover crop biomass, weed biomass, soil nitrate, soil water dynamics, and cash crop yields were measured, and an integrated suitability score of the cover crops was calculated to compare overall performance. The results indicated cover species- and environmentally dependent variation in cover crop biomass. OP frequently ranked highest in the integrated suitability assessment across years and in both cash crops, although individual performance metrics were often not significantly different among treatments. ARGCL and WRV also demonstrated high suitability scores for sweet corn in 2022 environmental conditions. Surprisingly, weed biomass, soil nitrate, and soil water content did not differ among cover crop species, indicating that interseeded cover crops did not substantially alter these measures. Cash crop yields were generally maintained across treatments, although in 2024, cabbage yields in the ARGCL plots were reduced. These findings suggest that, under the conditions of this study, carefully selecting cover crop mixtures according to management and ecological setting may support expanded interseeding adoption without consistent yield penalties in Northern New England.

The timing and duration of primary moult in the endemic variable oystercatcher (Haematopus unicolor) are described from 204 records obtained during banding operations and from photographs of birds in flight or wing-stretching. All records were from adults and were collected between 36° and 37° S in northern New Zealand. Records were collected throughout the year, and were analysed using the R package ‘moult’, which implements the Underhill-Zucchini moult model. Primary moult was not synchronised; the average start date was 04 February, but the 95% confidence limits of start date extended from 12 December to 30 March. The average end date was 08 August (95% confidence limits 15 June to 1 October). Primary moult was therefore very protracted, lasting on average 185 days (6.1 months), and with the whole moult period (first birds to start moult through to the last birds to finish) occupying at least 9.6 months. Birds commonly moulted right through the coldest winter months. This extended moult period is consistent with the fact that adults of this species are non-migratory and highly sedentary. Primary moult also regularly overlapped with breeding. Birds in moult had on average 2.4 primaries active at any time (range = 1–5), with a higher number active while the smaller inner primaries were being re-grown. The gap in the wing caused by primary moult averaged 10% of the total primary feather mass, with a maximum of about 20%. Secondary moult typically began when the primary moult score was in the range 22–30.

Lumbar spinal stenosis (LSS) is a prevalent cause of pain and disability in elderly individuals, characterized primarily by neurogenic claudication resulting from narrowed spinal canals. Traditional treatment for LSS spans from conservative approaches to decompressive surgery, the latter of which poses significant complication risks. Minimally Invasive Lumbar Decompression® (MILD®, Vertos Medical) offers a less invasive alternative, with its efficacy supported by preliminary studies such as the MiDAS ENCORE. This retrospective study evaluates the real-world outcomes of the MILD® procedure in managing LSS accompanied by hypertrophied ligamentum flavum (HLF) in 300 patients who have failed conservative management. A single-center observational study. We conducted a retrospective review of 300 patients treated with MILD® at a single center in Northern New Jersey. Patients had documented cases of central LSS with HLF and persistent symptoms despite being treated with conventional therapies. The procedure involved percutaneous lumbar decompression using fluoroscopic guidance. Outcomes measured included scores on the Numeric Pain Rating Scale (NPRS) and patient-reported improvement percentages at intervals of up to one year. MILD® significantly reduced NPRS scores at all follow-up points, with the most substantial improvements noted within 3 months after the operation and sustained benefits up to a year. The average patient-reported improvement in pain and function was robust, beginning as early as 2 weeks after the procedure. No serious adverse events were reported, affirming the procedure's safety. The absence of a control group and the study's single-center nature might have limited the generalizability of results. These factors highlight the necessity for multicenter controlled trials to validate findings across diverse populations. The MILD® procedure is a safe and effective treatment for LSS, providing significant and sustained improvements in pain and function, making the technique particularly suitable for patients ineligible for surgery or at higher risk of experiencing complications from it.

Abstract During a survey of oat and barley crops in northern New South Wales (NSW) and southern Queensland (Qld), a novel member of the genus Luteovirus (family Tombusviridae ) causing leaf reddening and yellow dwarf symptoms in oats and barley was found in both States. A near-complete genome of the virus tentatively named cereal red leaf virus (CrRLV; tentative species name Luteovirus foliarubra ) was obtained through high throughput sequencing. The virus was genomically distinct from, but reacted with antibodies to, barley yellow dwarf virus-MAV. CrRLV was transmitted by Rhopalosiphon padi but not by R. maidis . Barley yellow dwarf virus-PAV was found in both NSW and Qld on barley and oats. Additionally, barley virus G was found for the first time in Qld and NSW, on barley, barley yellow dwarf virus-PAS for the first time in Qld, on barley, cereal yellow dwarf virus-RPS for the first time in NSW, on oats, and cereal yellow dwarf virus-RPV was found in NSW on oats and barley and for the first time in Qld, on oats.

Patients who present with ST-elevation myocardial infarction (STEMI) to a hospital without primary percutaneous coronary intervention (PPCI) capability may be transferred for PPCI or receive fibrinolytic therapy, depending on whether the first medical contact to balloon time of ≤120 minutes can be achieved. We hypothesized that travel distance to the percutaneous coronary intervention (PCI) center might impact STEMI outcomes in a rural STEMI system of care. We retrospectively analyzed 6225 consecutive STEMI patients from the Northern New England Cardiovascular Disease Study Group registry from 2018 to 2023. Residential distance to care was calculated by road travel distance between ZIP Code centroids and grouped into quartiles. Patients were categorized by treatment strategy: initial presentation to a PCI center, transfer for PPCI, or pharmacoinvasive PCI. The primary outcome was in-hospital mortality. Multivariable logistic regression evaluated the association between residential distance and treatment strategy with in-hospital mortality. The median residential distance to PCI center for STEMI patients in Northern New England was 38.2 miles (IQR, 47.1). Of the overall cohort, 44.4% (median travel distance: 17.2 miles) had index presentation to a PCI hospital, 23.8% (median travel distance: 40.1 miles) underwent interhospital transfer for primary PCI, and 31.9% (median travel distance: 66.5 miles) were transferred for pharmacoinvasive PCI after initial lytic therapy. There was no association between distance to PCI hospital and adjusted in-hospital mortality after STEMI, irrespective of the treatment group. In Northern New England with contemporary regional STEMI referral networks, distance to PCI hospital did not impact STEMI mortality despite substantial travel distances for many patients.

Summary: Many rural emergency nurses are nervous caring for pediatric patients; they care for the critically ill pediatric patient infrequently, especially in smaller rural or frontier communities. Over the last few years, the Child Ready program, with the support of an HRSA grant, has partnered with such communities to offer education and support to improve pediatric outcomes. One specific example is a rural facility in Northern New Mexico, using the EMSC pediatric readiness score as a measure, the Child Ready team worked with the facility, offering both in-person and virtual education and support for physicians and nurses. An initial pediatric readiness score of 64 was assessed, and areas of improvement were identified. The education was specifically targeted towards the facility’s needs, utilizing their equipment and virtual mock codes to increase staff confidence in responding to emergencies. In person events facilitated team building with the Child Ready team supporting the relationship between the Child Ready Virtual Pediatric Emergency Department and the rural facility. With this support, the rural facility improved confidence to utilize equipment and respond to pediatric emergencies, policies and procedures were written and implemented, and pediatric-specific equipment was procured. The rural facilities EMSC Pediatric Readiness score jumped from 64 to 94 with the support of the Child Ready program, improving the rural response to pediatric care. We will discuss how the use of a virtual platform combined with in-person support can improve pediatric readiness and nursing confidence.

BackgroundPeople who inject drugs (PWID) are at high risk for acquiring and transmitting the hepatitis C virus (HCV). Access to HCV testing and treatment remains limited in rural communities. Mobile healthcare interventions are promising models to reach underserved populations like rural PWID. Understanding the characteristics of effective interventions to engage rural PWID in HCV care can guide design strategies for HCV treatment and elimination in rural areas.MethodsThe Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE) study randomized 150 participants with chronic HCV to examine Mobile Tele-HCV Care (MTC) versus Enhanced Usual Care (EUC). On-the-spot qualitative interviews (n = 34) were conducted with study participants, community providers, and study van staff to understand the context for protocol implementation. For this study, qualitative coding and thematic analyses identified the characteristics of successful HCV treatment engagement among PWID in rural areas.ResultsThis successful HCV treatment engagement intervention with out-of-treatment rural PWID had three essential characteristics: convenience, effective rapport, and skilled staff. Convenience factors included dependable and easily accessible locations with drop-in availability that made it easy to make HCV treatment a priority. Rapport with participants through a harm reduction approach engendered respect for autonomy and tailoring the protocol to accommodate the complexities of daily life that PWID face. Skilled staff were flexible across multiple roles including on-site phlebotomy, a notable barrier to rural PWID obtaining HCV treatment, and were competent in caring for PWID.ConclusionsWe identified salient characteristics that contributed to high trust and treatment adherence among a marginalized population of rural PWIDs. Tailored, flexible approaches and specialized skills are required to engage and retain PWID in rural areas.Trial registrationNCT05466331.

Accurate estimation of earthquake source parameters—such as moment magnitudes, corner frequencies, and stress drops—is essential for improving seismic hazard assessments and understanding earthquake physics. In this study, moment magnitudes (MW) are calculated for 31,581 earthquakes associated with wastewater injection in the Raton Basin (located along the border between northern New Mexico and southern Colorado) between 2016 and 2024 using radiative transfer theory to fit coda decay envelopes. Our results show that it is feasible to estimate moment magnitudes down to MW ~1 with coda envelopes from a small local monitoring network. Significant differences were found between MW and local magnitudes (ML) for small earthquakes (M < 3.0). A linear relationship was optimized to convert ML to MW: MW = 0.7ML + 0.96 and MW = 0.73 ML + 0.99 (for the events reported by the U.S. Geological Survey), which can be applied in future studies of Raton Basin seismicity. We find that b-values calculated employing different methods and using ML are approximately 1.0, while those using MW range from 1.2 to 1.4. A larger estimate of the b-value could influence interpretations of the statistical behavior of earthquakes associated with injection and consequently seismic hazard assessments based on a magnitude–frequency distribution. The potential differences between local versus moment magnitude-based earthquake statistics should be considered in other seismically active regions.

Assessing seismic hazards in regions with hidden or poorly expressed faults is one of the major challenges in paleoseismology today. Here, we used computed tomography imaging to quantify the dimensions and distribution of liquefaction structures in ≤17.5-thousand-year-old tephra layers in 18 lakes scattered across the poorly expressed Hamilton Basin fault system in northern New Zealand. These "tephra seismites," embedded in unconsolidated, organic-bearing lake sediment, increase in occurrence and dimensions toward known faults and indicate the occurrence of a local hidden fault segment. Through incorporating peak ground acceleration modeling, we found that the spatial distribution of tephra seismites directly relates to the ground shaking induced by near-field fault ruptures. We used the variability in tephra seismites within the stratigraphic record and tephrochronology to better constrain the recurrence intervals and magnitudes of paleoearthquakes from both the Hamilton Basin and adjacent Hauraki Basin fault systems. Our methodology is globally applicable in volcanic and tectonic regions where liquefaction structures are preserved among (hidden) faults.