Healthcare has shifted toward team-based patient care to address the increasing complexities of patient care as studies have demonstrated that a team-based approach results in better outcomes and safer patient care. Medical students are future leaders of healthcare teams yet current medical school curricula does not include a leadership or team-based teaching component. The goal of this project was to design a pilot program to teach the fundamentals of leadership and communication skills as relevant to medical students. To assess the aptitude and educational need of the target audience, a medical school-wide student survey was distributed to all the medical students. Course curriculum was subsequently developed to include an online didactic component and an in-person simulation component. The didactic activity taught fundamentals of communication, active listening, giving and receiving feedback. Participant knowledge was assessed upon completion of the didactic course (pre-activity) and after completion of the simulation component (post-activity) using a 10-question quiz. Participants were divided into groups, given specific scenarios and roles that explored these themes. Students were primarily in their pre-clinical years however, each group had one student who was completing clinical clerkships. Participants rotated through the three scenarios and had an opportunity to complete each role within their group. At the end of the session, feedback was given and participants completed a final survey and post-quiz. A paired t-test was used to analyze the participants' answers on each of these questions. The survey was deployed to all 280 medical students and 78 responses were obtained which demonstrated an interest in a leadership development course. Initial interest exceeded capacity. A total of 14 students completed the pilot course in its entirety, including the post-activity survey. Participant knowledge before and after the course was analyzed using a t-test which evaluated knowledge of the 4-part communication model, active listening skills, and fundaments of giving and receiving feedback. Each question in the 10-question survey was analyzed using a t-test with each question having its own p-value. There were no statistically significant differences between the results of the pre-activity quiz and the post-activity quiz. Student interest in this course exceeded the expectations of the author, which strengthens the assertion that medical students would benefit from formal communication and leadership training as future leaders of the healthcare team. There was no statistically significant difference between the results of the pre-activity quiz and the post-activity quiz. This was likely due to several factors including small sample size, and the fact that the pre-activity quiz took place after completion of the didactic course. In the future, the pre-activity quiz should take place prior to the didactic course to better assess competencies. Verbal feedback of the course during the debrief session was largely positive. The next phase of this pilot course should focus on expanding the number of medical student participants and creating a diversity of simulation scenarios.

In the United States, offspring outcomes of preterm birth and low birth weight contribute to numerous infant health complications and healthcare costs. Food insecurity during the prenatal period may negatively impact maternal and child health, though limited research exists investigating this unique independent relationship. Especially amidst the COVID-19 pandemic, which elevated rates of food insecurity, it is necessary to understand food insecurity as a unique stressor with a potential relationship to adverse pregnancy outcomes. Using a large diverse prospective cohort of pregnant people in South Dakota, this study investigated the independent relationship between FI and infant outcomes, early gestational age and low birth weight. Data from 1,478 pregnant people were obtained from the Environmental Influences on Child Health Outcomes in the Northern Plains PASS-ECHO study in South Dakota from 2020-2023. Maternal and infant outcomes were obtained through a hierarchy of medical record abstraction and self-reported data. Self-reported food insecurity was measured using a modified United States Department of Agriculture food security questionnaire. Descriptive statistics and logistic regression were conducted using SAS software to identify significant relationships between food insecurity and adverse offspring outcomes. In the sample, 20.7% (n=306) of pregnant people experienced food insecurity. Unadjusted data in the univariate model showed a statistically significant relationship between earlier gestational age and maternal food insecurity, with food insecure infants born on average around 3 days before food secure infants (p=0.0009), which made the average food insecure infant preterm, less than 37 weeks gestational age. Similarly, there was a statistically significant relationship between low infant birth weight and maternal food insecurity, with food insecure infants weighing 3.3% less than their food-secure counterparts on average (p=0.0203). However, in the multiple linear regression, adjusted for covariates accounting for socioeconomic status, these associations did not remain significant. Elevated pre-pregnancy BMI continued to have a statistically significant association with low birth weight and preterm birth even after adjusting for covariates. Study findings showed there was no statistically significant association between food insecurity and low birth weight or earlier gestational age in adjusted models despite a statistically significant association existing in unadjusted models. However, elevated pre-pregnancy BMI was independently associated with low birth weight and earlier gestational age and should be investigated further regarding maternal food insecurity during pregnancy. Understanding food insecurity as a social determinant of health has critical consequences for both maternal and child health. Future research should investigate interventions to decrease food insecurity during pregnancy.

Binge-drinking behavior is a prevalent and costly burden that many face. To expand potential treatments for alcohol use disorder and improve treatment efficacy, calcineurin (CN) inhibiting cyclosporine A (CsA) is investigated as a potential treatment for this disorder based on a neuroinflammation-driven approach to addictive behaviors and stress maladaptation. CsA has previously been shown to reduce binge-drinking behaviors, and this study aims to provide a connection between binge-drinking reduction and stress response to the expression of the neuroinflammasome. CamKIIa and CRF neuronal CN knockout mice were characterized for knockout of CN expression through immunohistochemistry and RNA scope imaging of selected brain regions. Others from this cohort were then subjected to 6-week binge-drinking behavioral experiments in the format of "Drinking-in-the-Dark" (DID). Experimental mice were tracked for ethanol intake overtime and following injection of either vehicle only intraperitoneal injection or CsA and vehicle injection for any changes. These transgenic mice were separately subjected to 1-hour restraint stress experiments with exposure to either CsA or vehicle only. These cohorts were sacrificed with their brain tissue harvested and microdissected for rtPCR characterization of inflammatory gene products. Expression of CD45, COX- 2, CYC, Iba-1, IL-1b, IL-6, TNF-a, ACTB, CCL2, and CCR2 was quantified. The expression for CsA exposed mice was then compared to vehicle-only mice through the log2 fold change analysis for final comparison. Immunohistochemistry with RNA scope imaging for calcineurin expression revealed widespread CN knockout in the experimental lineage. CN knockout revealed no effect on ethanol consumption in DID models for both CamkIIa and CRF neuronal CN knockout compared to wild type. CsA did still induce a large reduction in ethanol intake for both lines of CN knockout mice compared to baseline. In the restraint stress study, rtPCR log2 fold analysis revealed that CsA reduced a wide-range of stress-induced neuroinflammatory markers. Specifically, the authors observed a generalized reduction in inflammatory gene expression with IL-1b seeing a nearly 6-fold decrease in both the central nucleus of the amygdala as well as the paraventricular nucleus. The findings of normal baseline drinking behaviors and improved parameters following treatment with CsA in wild type and neuronal CN knockout lineages indicate that CN at the level of neurons is not responsible for CsA-induced reduction in binge-drinking behavior. These findings, in conjunction with the reduction of neuroinflammatory gene product expression, implicate glial cells as possibly responsible for these changes. Further investigation into glia cell specific CN knockout is warranted under similar conditions. Ultimately, these findings improve the characterization of the mechanism of CsA-induced reduction in binge drinking behaviors and aid in discovering new treatments for alcohol use disorder.

Chest pain is a common reason for visits to the emergency department. This project explored weather related events, particularly thunder events, and their association with chest pain and myocardial infarction. Changing weather patterns have previously been linked to cardiovascular complaints in the emergency department. Additionally, researchers have been able to link chronic noise pollution, like traffic noise, to a significant increase in cardiovascular disease. However, little is known about the relationship between a single loud noise, such as thunder after a lightning strike, and myocardial infarction. Location and time of lightning events in a 100-mile radius of Avera McKennan Hospital in Sioux Falls, SD from June 1, 2021 through July 31, 2021 was obtained from Global measurement instruments company Vaisala. Data for thunder was not available. The McKennan Emergency Department electronic medical record was queried for chief complaints of chest pain and dermatologic complaints (control group) during the same timeframe using ICD codes. Patients presenting to the ED for chest pain were further evaluated to determine if they were diagnosed with a myocardial infarction. Date of patient presentation to the ED was then cross-referenced to the Vaisala lightning data to determine if lightning, and therefore thunder, occurred on the date of presentation. The number of chest pain complaints on days with lightning was compared to number of dermatologic complaints to determine statistical significance using a chi-squared test. From June 1, 2021, to July 31, 2021, 188 of 309 patients presented to Avera McKennan Emergency Department with a chest pain complaint on a day with lightning. A total of 5 patients were diagnosed with myocardial infarction. Of the patients diagnosed with a myocardial infarction, 4 of the 5 patients presented on a day with recorded lightning. Lightning was recorded on 39 of the 61 days of our timeframe. To evaluate differing lead times for lightning events, p-values for various times post-lightning strike were analyzed. A p-value less than or equal to 0.5 was considered significant. This study showed a p-value of 0.034 at 0.5 hours after lightning strike. At 2.5, 3, 4, 4.5, 5, and 5.5 hours after a lightning strike occurred the p-values were 0.047, 0.033, 0.029, 0.018, 0.019, and 0.039 respectively. This study showed a significant increase in patients presenting to the emergency department with chest pain complaints 0.5 hours after lightning strike and between 2.5-5.5 hours after lightning strike. Limitations to this study include distance from lightning strike and intensity of lightning strike not being considered. Additionally, there was a small sample size for the group of patients diagnosed with an MI (n=5). These are areas that could be looked at further to better understand the relationship between a single loud event and chest pain. There was a trend toward significant association between lightning strikes and myocardial infarction, but due to the small sample size, no statistically significant correlation was found.

Menstrual hygiene management (MHM) is essential to women's reproductive health; literature demonstrates there are mental, social, and economic consequences to inadequate MHM in rural and developing countries. Emerging studies show that US women who are impoverished, experiencing homelessness, or incarcerated also face poor MHM. To understand the implications of poor MHM in South Dakota, a largely rural state, a thorough gynecologic health history is essential; this needs assessment explores the scope of MHM questions asked by SD providers. This study used survey methodology to determine the quality and depth of gynecologic health histories commonly taken regarding hygiene. The electronic survey was sent to local primary care providers and nursing staff via email. The survey records the provider's awareness of their patients' menstrual hygiene, and the frequency of specific questions asked. The results of this needs-assessment led to the development of a waiting room screening tool that would allow providers efficient access to their patients' MHM information. Providers' (N = 70) awareness of MHM in South Dakota varied. The maximum score (57) denotes a respondent who selected "very aware" and "always" for each question. The average score was 22.11; scores ranged from 9 to 47. Twenty-four percent said they were not at all aware of their patients' access to MHM products. Seventy-four percent report never asking their patients if they have access to adequate water and sanitation resources. Fifteen percent report never asking their patients which type of hygiene product they use. This needs assessment demonstrates providers may lack vital information with the potential to inform patient care. While poor MHM is considered in less developed nations, it persists unidentified in populations in South Dakota.

Determining if injuries are the result of abuse in the pediatric population continues to be an arduous task for medical providers. In pediatric patients who are not yet mobile or verbal, diagnosing abuse can be even more difficult as histories must be taken from someone other than the patient, who may potentially be the abuser. Rates of child abuse also vary widely by demographics, including location. Rural areas have higher risk factors for child physical abuse, including higher rates of childhood poverty. This study aimed to identify injury trends and demographic populations of physical child abuse related to fractures in a rural Midwest pediatric population and compare them to national statistics. This study utilized a retrospective chart review of Sanford Health Enterprise patients less than 12 months of age with ICD-10 fracture diagnoses between 2017 and 2021. An initial chart review was performed to identify mechanism of injury, demographics, and other medical information. A second chart review was performed, by a child abuse pediatrician, for inter-rater reliability, as well as context for perpetrator information, location of abuse, and child abuse specialist findings. This child abuse pediatrician then categorized each patient's case as "Consistent with Abuse", "Concern for Abuse/Indeterminant", or "Accidental/Medical". Wilcoxon rank-sum and Fisher's exact tests were conducted to identify statistically significant differences among patients in each category. 107 patients were included in the study. Patients with injuries consistent with abuse were younger than those with injuries deemed indeterminate or concerning for abuse, as well as those with accidental or medical injuries (p =0.008). Injuries such as skull, facial, and rib fractures, injuries to the chest, and bruising were more strongly associated with abuse, while upper and lower extremity injuries were not. Over half of the cases consistent with abuse involved patients with undocumented or inconsistent explanations for their injuries. Compared to femur fractures being the most common bone fracture secondary to child abuse in national studies, rib fractures and chest injuries were more common in this rural Midwest pediatric sample. Additionally, the presence of other fractures identified through skeletal surveys further increased the likelihood of abuse. This study highlights the correlation between injury patterns of physically abused pediatric patients in the rural population. Younger patients with bone fractures were more likely to be abused compared to those with accidental injuries. Inconsistent or undocumented mechanisms of injury were also more common in abuse cases. These findings suggest younger patients with bone fractures or an unknown mechanism should be extensively evaluated for child abuse. Skeletal surveys remain paramount to investigating abuse, with many additional bone fractures secondary to abuse being identified with this method. These findings underscore the importance of thorough documentation, examination, and use of skeletal surveys in patients less than twelve months old with bone fractures.

It is estimated that 27.2% of adults in the United States and 23.8% of people in South Dakota have a disability of some kind. Though individuals with disabilities are now recognized as an underserved population in healthcare, many disparities persist, infringing on the health of these individuals. A commonly cited barrier to receiving high quality care is provider misconceptions, and fallacies of life with disability. A minority of US medical schools have a specific disability curriculum. The University of South Dakota Sanford School of Medicine (USDSSOM) does not currently have specific training on disability beyond the medical and biological concepts. The objective of this study was to assess the efficacy of a two-session course designed to provide didactic information about caring for individuals with intellectual and developmental disabilities (IDDs) and a hands-on panel discussion with patients with IDD and their caregivers. Participants were recruited from USD-SSOM to participate in a study including a two-session course to discuss guidelines for caring for patients with disabilities and providing exposure to the disability experience using a panel discussion. Participants were asked to complete a survey before and after each meeting. The survey contained open-ended questions and a series of 13 statements using a Likert scale for rating from "strongly disagree" to "strongly agree." The ratings of the statements were converted to numerical values for analysis. The data were analyzed using a paired samples t-test to assess if there was a significant change in responses. A p-value of less than 0.05 was considered to be significant. The data from the first and second meetings were analyzed separately. Study participants (N=35) were primarily white medical students between the ages of 23 and 29, and a majority of responders endorsed fewer than five hours of formal training on caring for individuals with IDD. For both meetings participants had statistically significant changes in their responses to 11 of 13 survey statements. The first meeting, containing didactic education focused on caring for patients with IDD, showed the most difference in response to statements regarding capability of adapting communication and approach during a visit with a patient with IDD, with mean difference of 1.000. The second meeting, a 90-minute panel discussion led by the researchers with individuals with IDD and a caregiver, showed a mean difference of 1.667 in response to the statement about "feeling capable of providing the same level of care to a patient regardless of disability status." Persons with intellectual and developmental disabilities face a multitude of health disparities that can be addressed, in part, by further training of medical professionals. This study demonstrated that medical students are interested in this topic. It further demonstrated that it is feasible to provide low cost, low resource programs that lead to the advancement of knowledge and competencies needed to improve care for persons with disabilities.

Advanced care planning (ACP) is a process that enables patients to specify their preferences for healthcare should they become unable to communicate their wishes. With the global population aged 60 and older comprising 11% of the total population-projected to rise to 22% by 2050-the need for ACP is increasingly urgent. This issue is even more pronounced in rural areas, like South Dakota, where older and sicker populations are disproportionately represented. Despite the numerous benefits of ACP, only 28% of adults in South Dakota have an advanced directive, and alarmingly, between 65% and 76% of physicians are unaware of their patients' existing advanced directives. Healthcare professionals who work with vulnerable adult populations were recruited through partnerships with long term care organizations and personnel to participate in an educational program. The program consisted of four separate one-hour long virtual sessions over the lunch hour once monthly and were designed to enhance understanding and use of ACP tools. The program consisted of four discussion-based sessions, focused on the personal grief experienced during the COVID-19 pandemic and how it intersected with the practice of ACP. Half of each session involved didactics, and half was discussion-based facilitated by a physician with extensive long term care experience. Continued medical education credits were provided. Session topics included: 1. Moving forward after the Covid-19 pandemic, 2. Appropriate use of the Medical Order for Scope of Treatment (MOST) form 3. Shared decision making, and 4. Communicating when emotions are intense. Evaluation methods included pre- and post-program knowledge surveys and the Professional Quality of Life Scale (ProQOL), which assesses compassion, satisfaction, burnout, and secondary trauma stress. The program had variable attendance, with participants from diverse professional roles and settings including nursing, EMS workers, chaplains, administrators, social workers, hospice, community health workers, educators, and physicians. The first session had 58 participants, the second had 42, the third had decreased attendance at 23, and the fourth session had 53 total participants. Post-session evaluations revealed a small, statistically insignificant improvement across all ProQOL subcategories. Notable improvements were observed in participants' confidence and competence in using ACP tools appropriately. The educational sessions successfully increased health care professionals' comfort in using ACP tools and enhanced their professional well-being. The sessions fostered valuable discussions among participants from various settings including long term care facilities, assisted living facilities, emergency services, and administration. Much of the discussion helped to address difficult topics related to end-of-life care. Despite positive outcomes, the study was limited by participants not completing all four sessions. Future research should explore the application of implementation science to better integrate ACP tools and training into clinical settings, enhancing both patient care and provider support.

Walk With Ease (WWE) is an evidence-based arthritis self-management program developed by the Arthritis Foundation. Although the target audience is individuals with arthritis, any adult interested in increasing their physical activity can benefit. WWE provides community-level access to physical activity in rural South Dakota through internet access or trained local leaders. Before WWE started in South Dakota in 2018, South Dakota did not have an online, state-specific physical activity program. WWE is a free program that aims to help sedentary adults increase their physical activity and improve their overall health. This project evaluated the self-reported benefits to participants that accessed the online portal for WWE using multiple metrics collected during the year 2022. 234 participants filled out the pre-survey, 145 people were lost to follow up and not included in analysis, 89 participants completed the pre- and post-survey and were included in the analysis. Of the 89 participants, 15 were male, 70 were female, and 4 participants preferred not to answer that question. The average age of the participants included in analysis was 50 years old, (the minimum age was 23 and maximum age was 77). Of note, the pre- and post-surveys asked about participants' self-reported "overall health," "daily minutes walked," and how the participants felt they "managed their chronic health condition(s)." The post-survey also included questions about the ease of use of the online portal to access additional resources. These metrics were measured before participants began the program and after completion of the program to see if this free program provided benefits. From pre-survey to post-survey, 26% of participants reported their "overall health" improved, 67% stayed the same, and 7% reported a decrease. "Minutes walked" was another metric analyzed, 30% of participants increased their daily minutes walked by anywhere from 1 minute to 30+ minutes, 57% stayed the same, and 13% decreased. Participants reported "management of their chronic health condition(s)" were 44% improved, 34% stayed the same, and 22% decreased. As for "Ease of online portal usage", 44% of participants reported the online portal was "very easy to use," 46% reported it was "easy to use," and 10% reported it was "neutral." Overall, the majority of participants in the WWE program improved or stayed the same for their selfreported "overall health," "daily minutes walked," and "management of their chronic health condition(s)." Limitations of this study include the small sample size (of 234 initial participants, only 91 participants completed the pre- postsurveys and were included in the study. This study did show that an evidence-based, arthritis self-management program like WWE has potential to help participants improve their exercise metrics with the implementation of an online portal for participants to access additional resources at any time.