Outbreak of Human Trichinellosis - Arizona, Minnesota, and South Dakota, 2022.

Trichinellosis is a parasitic zoonotic disease transmitted through the consumption of meat from animals infected with Trichinella spp. nematodes. In North America, human trichinellosis is rare and is most commonly acquired through consumption of wild game meat. In July 2022, a hospitalized patient with suspected trichinellosis was reported to the Minnesota Department of Health. One week before symptom onset, the patient and eight other persons shared a meal that included bear meat that had been frozen for 45 days before being grilled and served rare with vegetables that had been cooked with the meat. Investigation identified six trichinellosis cases, including two in persons who consumed only the vegetables. Motile Trichinella larvae were found in remaining bear meat that had been frozen for >15 weeks. Molecular testing identified larvae from the bear meat as Trichinella nativa, a freeze-resistant species. Persons who consume meat from wild game animals should be aware that that adequate cooking is the only reliable way to kill Trichinella parasites and that infected meat can cross-contaminate other foods.

Monitoring the Spatial Distribution of Cover Crops and Tillage Practices Using Machine Learning and Environmental Drivers across Eastern South Dakota.

The adoption of conservation agriculture methods, such as conservation tillage and cover cropping, is a viable alternative to conventional farming practices for improving soil health and reducing soil carbon losses. Despite their significance in mitigating climate change, there are very few studies that have assessed the overall spatial distribution of cover crops and tillage practices based on the farm's pedoclimatic and topographic characteristics. Hence, the primary objective of this study was to use multiple satellite-derived indices and environmental drivers to infer the level of tillage intensity and identify the presence of cover crops in eastern South Dakota (SD). We used a machine learning classifier trained with in situ field samples and environmental drivers acquired from different remote sensing datasets for 2022 and 2023 to map the conservation agriculture practices. Our classification accuracies (>80%) indicate that the employed satellite spectral indices and environmental variables could successfully detect the presence of cover crops and the tillage intensity in the study region. Our analysis revealed that 4% of the corn (Zea mays) and soybean (Glycine max) fields in eastern SD had a cover crop during either the fall of 2022 or the spring of 2023. We also found that environmental factors, specifically seasonal precipitation, growing degree days, and surface texture, significantly impacted the use of conservation practices. The methods developed through this research may provide a viable means for tracking and documenting farmers' agricultural management techniques. Our study contributes to developing a measurement, reporting, and verification (MRV) solution that could help used to monitor various climate-smart agricultural practices.

AMA and SDSMA Membership After Graduation.

INTRODUCTION: One way to foster collaboration and continuing education is medical students' participation in medical associations. However, it isn't clear if being a student member leads to continued membership. In this study, the primary goal is to determine if student membership increases membership in the South Dakota State Medical Association (SDSMA) and American Medical Association (AMA) after graduation. METHODS: After validation with 10 physicians through a pilot study, the finalized survey was emailed by the South Dakota Board of Medical and Osteopathic Examiners to every South Dakota licensed physician. The survey included questions about membership in AMA, SDSMA, and other medical organizations. Descriptive data was assessed using counts and percentages. Comparisons were made based on Chi-square tests. RESULTS: In total, 438 individuals consented and participated. Overall, 296 (67.6%) indicated membership in a medical association in medical school; 101 only AMA, 38 only SDSMA, 133 both, and 24 only other. For the 234 with a student AMA membership, 71 (30.3%) continued. Of the 171 with a student SDSMA membership, 88 (51.5%) continued. Comparing those with and without a student AMA membership, 22.6% without joined after graduation and 30.3% with continued (p = 0.07). For SDSMA memberships, 28.5% without joined after graduation, while 51.5% of those with continued. Common reasons for maintaining included professional advocacy (n = 44) and educational opportunities (n = 32), for AMA and professional advocacy (n = 58) and networking (n = 45), for SDSMA. Common reasons for non-continuation in both AMA and SDSMA, were lack of specialty representation and political disagreement. CONCLUSIONS: Those who were members of SDSMA as students were more likely to maintain their membership. This difference was less pronounced for AMA. Networking was a common reason for maintaining SDSMA. Focusing on this aspect may be beneficial for retaining members.

Bridging the Gap From Rural Trauma to Rural Healthcare: Fire Department Education Sessions.

INTRODUCTION: Many rural communities within the United States rely upon volunteer firefighters and EMS personnel in emergency response scenarios. However, it has been found that "medical direction in rural EMS was identified as a major issue for a majority of states" within America. With the consideration that some firemen can arrive on the scene ~15 minutes before an ambulance, a gap exists in time and skills where knowledge of basic emergency response techniques could equip firefighters to assist EMS personnel in life-sensitive scenarios. METHODS: Our study took place in Parkston, South Dakota with a volunteer crew of ~ 30 firefighters and EMS personnel. Outside of their pre-scheduled bi-weekly meetings, our study provided further training for firefighters with various emergency response skills. Three nights of training were provided with pre-and post-surveys administered for each training station, analyzing confidence levels on a five-point system. Mean pre- and post-training confidence levels were obtained. Standard deviation, standard error, 95% confidence interval, and percent increase in mean confidence levels where calculated. Grouped bar graphs were plotted and analyzed for statistical significance. RESULTS: With the exception of two stations in night 2, all remaining training stations in nights 1, 2, and 3 demonstrated a statistically significant increase in mean confidence levels for each skill being taught. CONCLUSIONS: Based on the data obtained from this study, a statistically significant increase in mean confidence levels per training station demonstrates value in continued delivery of rural training sessions to firefighter personnel. As firefighter and EMS numbers across the United States continue to decline, timing is becoming increasingly more important in emergency response scenarios within our country's rural communities. Creating confident firefighters that are trained in skills beyond basic first aid and CPR may provide immense value for the continued evolution of rural emergency healthcare.

South Dakota Dermatology: Urban vs Rural Wait Times and Dermatologist Density.

BACKGROUND: As of 2019, South Dakota had only 32 registered dermatologists, one per 27,569 people. Wait times for dermatologic care are affected by factors such as socioeconomic status, provider distribution, and patient to provider ratios. This inaccessibility to care or prolonged wait times may lead to diagnosis and treatment delays as well as disease progression. We hypothesized wait times to see a dermatologist would be longer in rural areas than urban areas in South Dakota. METHODS: Dermatology clinics throughout South Dakota were contacted to obtain wait times. An internet search was conducted to develop a list of dermatology providers. A population of 50,000 or greater defined an urban area and a ratio of four dermatologists per 100,000 people was used as an ideal patient to provider ratio. RESULTS: Overall, 75% of South Dakota's dermatology clinics participated with an equal rural to urban distribution. There was no difference in wait times for new (p=0.787) or established patients (p=0.461) comparing rural and urban clinics. All South Dakota cities with clinics met the goal patient to dermatologist ratio except for Dakota Dunes (included as part of the Sioux City, Iowa, metro population). CONCLUSIONS: The data does not support the hypothesis that wait times for dermatologists would be longer in rural locations than urban locations. Despite adequate dermatologist to patient ratios throughout most of South Dakota, wait times of over six weeks were found at both urban and rural locations, indicating the need for future studies to assess potential solutions for improving timely access to dermatologic care.

Variation in Consult and Referral Patterns for Facial Lacerations by Emergency Department Provider Type: A Retrospective Cohort Study.

INTRODUCTION: Facial lacerations are a common reason for emergency department (ED) visits in the U.S. Proper laceration repair is imperative as poor wound management can lead to functional and aesthetic impairment and significantly impact patient quality of life. For the best outcomes and long-term scar reduction, treatment by and follow-up with a plastic surgeon or facial trauma specialist is recommended. The present study examines variations in facial trauma specialist consultation and referral by ED provider type for adult patients at hospitals within a large rural South Dakota health system. METHODS: Records for patients above the age of 18 who received treatment for facial lacerations between January 1, 2017 and January 1, 2022 were retrospectively reviewed across multiple hospitals in South Dakota, spanning a large rural catchment area. Multivariable logistic regression and Fisher's exact test were performed to examine the relationship between ED provider type and the probability of receiving specialty consult and/or referral. RESULTS: One hundred fifty-four ED visits were included in the analysis. Among these patients, 53 received specialty consult and/or follow-up referral and 101 were treated without consult or referral. ED provider type was significantly associated with the probability of having a specialty consult (OR = 5.11, 95% CI [1.05, 24.96]). When the patients had a certified nurse practitioner (CNP) as their ED provider, they had a significantly higher chance (40%) of receiving specialist consultation. CONCLUSION: For patients presenting to the ED with facial lacerations, facial trauma specialist consultation and referral for follow up varies based on provider type. CNPs placed specialist consultations more often than other ED provider types.

State of South Dakota's Child: 2023.

In 2022, there was a decrease in births in the state with 111 fewer resident newborns than in the previous year. This represented a decrease of 1% of its white and 3.5% of its AIBO (American Indian, Black and Other) births. The 2022 birth rate per 1,000 population for the state (12.3) is higher than observed nationally (10.9) but matches its 2020 rate that was an historic low. Approximately 22% of all births in 2022 were AIBO and this percent of the state's entire birth cohort has decreased in the past several years. The American Indian contribution to the AIBO cohort has also decreased as its racial diversity has increased. The percent of births that are low birth weight has consistently been lower in South Dakota than nationally. An increase of 16 infant deaths in 2022 from 2021 and the decreased number of births led to an increase in the infant mortality rate (IMR = deaths in first year of life per 1,000 live births) from 6.3 to 7.8, but this 2022 IMR is not statistically significantly higher than its previous five-year mean. Further, the 2022 increase in the IMR was almost entirely among white infants with the post neonatal mortality rate (PNMR = deaths between 28 and 365 days of life) decreasing between these two years for AIBO infants. Nonetheless, the state's five year mean rates of death (2018-2022) are significantly higher for the AIBO than white infants for the neonatal (0-27 days) and post neonatal periods of the first year of life. Recently, however, the ratio of AIBO to white post neonatal mortality rate (PNMR) has decreased, but increased for the neonatal mortality rate (NMR). Infants in South Dakota are significantly more likely between 2018 and 2022 to die of congenital anomalies, sudden unexpected infant death (SUID), and accidents/homicides than in the United States in 2021. SUID remains the leading cause of post neonatal death and its risk may be decreased when babies are placed to sleep supine and alone in environments that are devoid of soft hazards.

Substance Use Disorder in Adults with ADHD in South Dakota.

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) increases the risk for comorbid psychiatric and substance use disorders. This study examined the prevalence of ADHD in residential addiction treatment and the prevalence of monosubstance, comorbid substance, and polysubstance use disorders (PUD) as a function of ADHD status. METHOD: All adults admitted to residential substance use disorder treatment center in South Dakota during November 2021 to June 2022 were included (N= 55). The participants underwent a clinical interview and objective assessment to determine ADHD status. The participants were also administered ADHD questionnaire developed by investigators to assess ADHD history and treatment. SAS statistical software using an α level of 0.05 was used for all analyses. RESULTS: Almost half, 25 of the total 55 participants, had ADHD (45%). A quarter (n=14) of participants were diagnosed with ADHD during childhood. A fifth (n=11) of participants were diagnosed with ADHD during this study. Thirty participants (54%) were not found to have ADHD. A majority of ADHD patients (n=21; 84%) were diagnosed with PUD. Participants with ADHD had a higher prevalence of PUD (p=0.054) compared to participants without ADHD. Approximately a quarter of patients with alcohol use disorder and three-quarters of patients with methamphetamine use disorder had ADHD. CONCLUSIONS: ADHD and substance use disorders have notable comorbidity. This study demonstrates a high prevalence of ADHD in populations with substance use disorder. The presence of ADHD may be a risk factor for PUD.

A Case of Chagas Disease in South Dakota: Diagnosis and Treatment.

Chagas disease is a chronic, systemic parasitic infection caused by the protozoan Trypanosoma cruzi. The primary mode of transmission to humans is by the Reduviid insect, endemic to South America. Recent migration of the vector has led to increased cases in the southern United States and has prompted increased surveillance and blood donation screening. It is unusual to diagnose and treat individuals with Chagas disease in the northern United States. This case describes an immigrant female from El Salvador that was informed she had Chagas disease from a blood bank screening. Confirmation and treatment of the disease were performed by her South Dakota primary care provider thus demonstrating the importance of identifying Chagas disease in the immigrant population in regions where Chagas disease infection is uncommon.

Acute Arthritis Presentations of Gonorrhea and Syphilis - A Concise Update.

According to the 2021 CDC sexually transmitted disease surveillance report, national cases of syphilis and gonorrhea continue to rise. Currently, South Dakota ranks #1 in syphilis and #2 in gonorrhea cases per 100,000 population. The higher incidence increases the likelihood South Dakota clinicians will encounter different presentations of syphilis and gonorrhea. Recently, we have seen patients presenting with acute STI related inflammatory arthritis. This review discusses the acute arthritic presentations associated with gonorrhea and syphilis and its treatment.

Sensitivity of US Preventive Services Task Force and PLCOm2012 lung cancer screening eligibility criteria in individuals with lung cancer in South Dakota self-reporting as Indigenous and non-Indigenous.

BACKGROUND: Lung cancer is the leading cause of cancer deaths. Screening individuals who are at elevated risk using low-dose computed tomography reduces lung cancer mortality by ≥20%. Individuals who have community-based factors that contribute to an increased risk of developing lung cancer have high lung cancer rates and are diagnosed at younger ages. In this study of lung cancer in South Dakota, the authors compared the sensitivity of screening eligibility criteria for self-reported Indigenous race and evaluated the need for screening at younger ages. METHODS: US Preventive Services Task Force (USPSTF) 2013 and 2021 (USPSTF2013 and USPSTF2021) criteria and two versions of the PLCOm2012 risk-prediction model (based on the 2012 Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial), one with a predictor for race and one without, were applied at USPSTF-equivalent thresholds of ≥1.7% in 6 years and ≥1.0% in 6 years to 1565 individuals who were sequentially diagnosed with lung cancer (of whom 12.7% self-reported as Indigenous) at the Monument Health Cancer Care Institute in South Dakota (2010-2019). RESULTS: Eligibility sensitivities of USPSTF criteria did not differ significantly between individuals who self-reported their race as Indigenous and those who did not (p > .05). Sensitivities of both PLCOm2012 models were significantly higher than comparable USPSTF criteria. The sensitivity of USPSTF2021 criteria was 66.1% and, for comparable PLCOm2012 models with and without race, sensitivity was 90.7% and 89.6%, respectively (both p < .001); 1.4% of individuals were younger than 50 years, and proportions did not differ by Indigenous classification (p = .518). CONCLUSIONS: Disparities in screening eligibility were not observed for individuals who self-reported their race as Indigenous. USPSTF criteria had lower sensitivities for lung cancer eligibility. Both PLCOm2012 models had high sensitivities, with higher sensitivity for the model that included race. The PLCOm2012noRace model selected effectively in this population, and screening individuals younger than 50 years did not appear to be justified. PLAIN LANGUAGE SUMMARY: Lung cancer is the leading cause of cancer deaths. Studies show that using low-dose computed tomography scans to screen people who smoke or who used to smoke and are at elevated risk for lung cancer reduces lung cancer deaths. This study of 1565 individuals with lung cancer in South Dakota compared screening eligibility using US Preventive Services Task Force (USPSTF) criteria and a lung cancer risk-prediction model (PLCOm2012; from the 2012 Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial). The model had higher sensitivity and picked more people with lung cancer to screen compared with USPSTF criteria. Eligibility sensitivities were similar for individuals who self-reported as Indigenous versus those who did not between USPSTF criteria and the model.

A metagenomic view of novel microbial and metabolic diversity found within the deep terrestrial biosphere at DeMMO: A microbial observatory in South Dakota, USA.

The deep terrestrial subsurface is a large and diverse microbial habitat and vast repository of biomass. However, in relation to its size and physical heterogeneity we have limited understanding of taxonomic and metabolic diversity in this realm. Here we present a detailed metagenomic analysis of samples from the Deep Mine Microbial Observatory (DeMMO) spanning depths from the surface to 1.5 km into the crust. From eight geochemically and spatially distinct fluid samples we reconstructed ~600 partial to near-complete metagenome-assembled genomes (MAGs), representing 50 distinct phyla and including 18 candidate phyla. These novel clades include members of the candidate phyla radiation, two new MAGs from OLB16, a phylum originally identified in DeMMO fluids and for which only one other MAG is currently available, and new MAGs from the Eisenbacteria, Omnitrophota, and Edwardsbacteria. We find that microbes spanning this expansive phylogenetic diversity and physical subsurface space gain a competitive edge by maintaining a wide variety of functional pathways, are often capable of numerous dissimilatory energy metabolisms and poised to take advantage of nutrients as they become available in isolated fracture fluids. Our results support and expand on emerging themes of tight nutrient cycling and genomic plasticity in deep subsurface biosphere taxa.

Adverse childhood experiences and prescription opioid use during pregnancy: an analysis of the North and South Dakota PRAMS, 2019-2020.

OBJECTIVES: This study assesses the association between adverse childhood experiences (ACEs) and prescription opioid use during pregnancy. METHODS: This study uses data on 2,999 individuals from the 2019 and 2020 Pregnancy Risk Assessment Monitoring System (PRAMS) from North Dakota and South Dakota. The relationship between ACEs and prescription opioid use during pregnancy is examined using multiple logistic regression. RESULTS: The prevalence of prescription opioid use increases alongside more ACE exposure. Compared to those with no ACEs, recent mothers with three or more ACEs have a 2.4 greater odds of prescription opioid use during pregnancy (aOR [adjusted odds ratio] = 2.437; 95% CI [confidence interval] = 1.319, 4.503). CONCLUSION: Exposure to three or more ACEs are associated with a higherrisk of prescription opioid use during pregnancy. Additional research is needed better understand the mechanisms that link ACEs and prescription opioid use during pregnancy, as well as how to best support those with ACEs exposure in a trauma-informed manner to reduce the risk of substance use.

Promoting harm reduction in rural South Dakota using an interdisciplinary consortium.

BACKGROUND: Deaths from drug-related overdoses are increasing. Rural areas continue to have fewer accessible resources than urban areas. The START-SD (Stigma, Treatment, Avoidance, and Recover in Time - South Dakota) project is funded by the Health Resources and Services Administration and aims to address needs surrounding substance use disorder (SUD) in South Dakota. Pharmacists can play a key role in these efforts. OBJECTIVE: Describe harm reduction and prevention activities implemented through START-SD to reduce the impact of SUD in South Dakota. PRACTICE DESCRIPTION: The interdisciplinary team at South Dakota State University, including pharmacists and student pharmacist researchers, partnered with collaborating organizations to provide improved access to prevention, treatment, and recovery services for those impacted by SUD. PRACTICE INNOVATION: Given the rural and conservative nature of the state, the START-SD team used an innovative framework to implement harm reduction and prevention programs that other states could adopt. EVALUATION METHODS: Because the START-SD project uses evidence-based programs, evaluation focuses on the number of programs implemented and the number of people subsequently served. Data are collected and reported biannually by the team. RESULTS: The core team established and expanded an interdisciplinary consortium and advisory board. A variety of harm reduction and prevention strategies were implemented: establishing and developing partnerships with key organizations, working to increase access to harm reduction programs, facilitating educational activities and trainings, and working to reduce stigma related to SUD and harm reduction. DISCUSSION: Reducing the impact of SUD requires a broad, multifaceted approach, as well as overcoming many environmental barriers. Pharmacists and pharmacy staff are uniquely positioned to positively affect harm reduction for patients. CONCLUSION: More work to decrease the impact of SUD is needed, particularly in rural areas. Pharmacists can play a key role in projects to increase the reach and impact of prevention, treatment, and recovery efforts.

South Dakota Dermatology: Urban vs Rural Wait Times Survey and Dermatologist Density.

BACKGROUND: As of 2019, the state of South Dakota had only 32 registered dermatologists, one per 27,569 people. Wait times to be seen for dermatologic care are affected by factors such as socioeconomic status, provider distribution, and patient to provider ratios. This inaccessibility to care or prolonged wait times may lead to diagnosis and treatment delays, and disease progression. We hypothesized wait times to see a dermatologist would be longer in rural areas than urban areas in South Dakota. METHODS: Dermatology clinics throughout South Dakota were contacted to obtain wait times. An internet search was conducted to develop a list of dermatology providers. A population of 50,000 or greater defined an urban area and a ratio of 4 dermatologists per 100,000 people was used as an ideal patient to provider ratio. RESULTS: Overall, 75% of South Dakota's dermatology clinics participated with an equal rural to urban distribution. There was no statistically significant difference in wait times for new (p=0.787) or established patients (p=0.461) comparing rural and urban clinics. All South Dakota cities with clinics met the goal patient to dermatologist ratio except for Dakota Dunes (included as part of the Sioux City, Iowa metro population). CONCLUSIONS: The data does not support the hypothesis that wait times for dermatologists would be longer in rural locations than urban locations. Despite adequate dermatologist to patient ratios throughout most of South Dakota, wait times of over 6 weeks were found at both urban and rural locations, indicating the need for future studies to assess potential solutions for improving timely access to dermatologic care.

The Journey of Medicine - An Imperative Step in Fostering Gender Equality in Medicine.

While great advancements have been made towards gender equality in medicine, disparities between female and male physicians continue to persist. The Journey of Medicine was created as a day-long event of panelists, Q and As, hands on physical exam and suture technique, as well as short quizzes. The goal of the event was to provide education and create a strong network for young, high school women in South Dakota. Survey data showed 100% of women learned "a lot" or answered "yes" to learning something new. Key comments made from the event included "It was really informational and enjoyable" and "I think you did a fantastic job organizing this event and getting women interested in medical professions." We conclude that this event educated students and was well-received. In the future, refining our marketing technique, increasing hands-on activities, and offering additional locations will expand the reach and impact of the event.

Health Challenges in South Dakota: Creation of Healthcare Provider Referral List for Special Olympic Athletes.

INTRODUCTION: Individuals with intellectual and developmental disabilities (IDD) face significant health challenges affecting their overall morbidity and mortality. Special Olympics is one of the largest non-profit organizations that focuses on the promotion of health and fitness for individuals with IDD (referred to as athletes) year-round. At the state level, Special Olympics South Dakota (SOSD) hosts an annual Summer Games where athletes are provided the opportunity to obtain free health screenings. If an area is identified as needing further attention, a referral is made for the athlete to obtain more in-depth care. The referral process often leads to difficulties for athletes, ranging from finding a healthcare provider (HCP) who is comfortable working with individuals with disabilities, to ensuring the acceptance of a wide range of health insurances (such as Medicaid). Obstacles to finding a HCP for a referral is what necessitates the need for a statewide HCP referral list. The purpose of this project is to increase the ease of accessibility to HCPs for individuals with IDD who are Special Olympics South Dakota athletes. METHODS: Data from Special Olympics and the CDC Disability and Health Data System (DHDS) was gathered to compare health outcomes between those with disabilities nationwide to those with disabilities in South Dakota. The referral list obtained HCPs via an online two-part survey. Survey 1 focused on demographic information on HCP and place of practice and Survey 2 focused on HCP training and professional work with those with IDD. The surveys were sent to individual providers via their respective professional state associations as well as through convenience sampling (relationship with Clinical Directors for SOSD). Survey 1 gathered 233 responses total, with 95 meeting completion criteria. Survey 2 offered to those 95 and gathered 66 responses total. RESULTS: Data on multiple health outcomes from the Special Olympics and CDC DHDS revealed individualized areas of concern with little overlap between the two datasets. Of the 95 HCPs added to the referral list (40% completion rate from Survey 1), the majority were localized to areas of higher population density in South Dakota (Sioux Falls and Rapid City areas). In Survey 2, 90% of HCPs indicated some level of training for working with individuals with IDD and 74% of responding HCPs were interested in obtaining further training. All HCPs that responded to Survey 2 had encounters with individuals with IDD in their current professional role, with 94% having 4 or more encounters. CONCLUSIONS: The Special Olympics South Dakota HCP referral list provides a direct method for SOSD athletes to find referral care. Currently, this is the only database of health care providers that is accessible to individuals with IDD that are members of SOSD. Geographically however, much of South Dakota is not represented on the current HCP referral list. While 90% of HCPs have training, 30% indicate not having received formal training on working with individuals with IDD during their professional training, also showcasing a need for HCPs to strive to limit potential gaps in care.

Surveying Motivations to Use Tanning Beds Among Undergraduate Students at South Dakota Universities.

BACKGROUND: Exposure to UV radiation is one of the biggest risk factors for developing all types of skin cancer. It is estimated that in the United States, 7.8 million young adults engage in indoor tanning. It is hypothesized that certain populations of students at undergraduate universities, such as sorority participants, have greater frequency of tanning bed usage than other populations and that regardless of sorority status, the most important motivating factor will be the intent to enhance one's appearance. METHODS: This study was granted exemption from the USD Institutional Review Board (IRB). Study participants were recruited through survey distribution to email addresses affiliated with undergraduate student organizations/clubs. Inclusion criteria were undergraduate student status at The University of South Dakota (USD) or South Dakota State University (SDSU), and age 18+. Survey development included interviews of dermatologists and public health professionals. Qualtrics database was used for both anonymous data collection and storage. RESULTS: Overall, 95 of 321 participants identified as being in a sorority. When asked to identify motivations for tanning bed use, the 3 highest ranked responses of participants in a sorority were: "I think I look better when I am tan", "I tan to look better for special events", and "I have more self-confidence when I am tan" with 56.47%, 48.65%, and 60.71% of participants answering, "strongly agree", respectively. There were 147 participants that identified as not being in a sorority. The 3 highest ranked responses for motivations for indoor tanning use were the same as those in a sorority with 40.82%, 26.00%, and 40.15% of participants answering "strongly agree" to the above options, respectively. CONCLUSION: The data does support the hypothesis that the most important motivating factor for young adults to use tanning beds is one's appearance. Understanding motivations for tanning bed use among at risk populations such as undergraduate students or more specifically, those participating in sororities, allows opportunity for education on the risks associated with UV radiation exposure.

Burnout Among South Dakota-Licensed Physicians.

INTRODUCTION: Physician well-being is a topic of increasing attention nationwide. In collaboration with the South Dakota Board of Osteopathic and Medical Examiners and the South Dakota State Medical Association, we undertook an anonymous, web-based survey of all licensed physicians to assess the current baseline level of physician burnout. METHODS: The survey consisted of demographic questions and a single, validated burnout question that correlates with the lengthier Maslach Burnout Index. A link to take the survey was emailed to all licensees by the Board, and a single reminder email and link was sent two weeks later. The collector was open for 4 weeks from date of the initial invitation. Both quantitative and qualitative analyses were performed on the responses. RESULTS: There were 612 responses (10%). Overall 33.0% of responses were positive for burnout. Comparing subgroups divided by average work hours, practice size, community size, geographic location within the state, employment status, and specialty type, only those practicing primarily telemedicine demonstrated statistically significant lower prevalence of burnout (17%). Qualitative analysis identified themes that both increased risk and offered protection against burnout, including sense of control, availability of resources, relationships, and meaning in work. CONCLUSION: Burnout among physicians licensed by South Dakota is prevalent, though lower than the rate reported in most studies of physicians nationally. Apart from practicing primarily telemedicine, there was no correlation between burnout and practice characteristics, but provoking and palliating factors across practice types were identified that may offer potential areas for intervention to improve wellness.

A Case of Neurocysticercosis in Rural South Dakota.

Neurocysticercosis (NCC) is a rare, potentially life-threatening parasitic infection endemic in many developing countries where pig farming and pork consumption are popular. The rates of neurocysticercosis could increase in the U.S. due to the influx of immigration from Central and South America, sub-Saharan Africa, and parts of Asia. Careful evaluation, diagnosis, and treatment is needed to prevent complications from the disease. We present a case of neurocysticercosis which presented as an unresponsive adult female in a rural South Dakota healthcare facility.