Myocarditis in Minnehaha County, South Dakota, 1880-1939.

From 1920 to 1940 in Minnehaha County there was an apparent striking increase in the incidence of fatal myocarditis and chronic myocarditis. Based on an analysis of the interment records of the Mt. Pleasant Cemetery, word frequency studies in two prominent American medical journals and a general review of related medical publications, we explore this increase. We conclude that there was no actual increase in the frequency of inflammatory disorders of the myocardium in Minnehaha County during this period. Rather, it appears that the use of the diagnostic terms was a matter of choice among local physicians that was not supported by contemporaneous clinical and pathophysiologic publications in available journals.

Fatal Accidental Drowning in Minnehaha County, South Dakota, 1880-1939.

Drowning is currently the second leading cause of injury-related death for children 1-4 years of age in the United States and is the leading cause of death worldwide for boys ages 5-14 years. The World Health Organization (WHO) classifies it as a public health threat and advocates for reducing drowning deaths by understanding geographical, cultural, and societal risk factors. To these three we added a fourth: historical studies. To that end, we analyzed accidental causes of death between January 1, 1880, and December 31, 1939, in Minnehaha County, South Dakota, based on interment records from the Mt. Pleasant Cemetery. From these six decades (1880-1939) of data, we classified 217 cases as accidental deaths. Drowning was the leading cause of accidental mortality, accounting for 50 accidental deaths (23%). Drowning deaths were analyzed by the decedents' age and date of death. We discuss specific historical drowning risk factors and hypothesize how they may have affected drowning deaths from 1880-1939 in Minnehaha County.

Examining Trajectories of Change for Prosperous Forest Landscapes in Cambodia.

Tropical forest landscapes are undergoing rapid transition. Rural development aspirations are rising, and land use change is contributing to deforestation, degradation, and biodiversity loss, which threaten the future of tropical forests. Conservation initiatives must deal with complex social, political, and ecological decisions involving trade-offs between the extent of protected areas and quality of conservation. In Cambodia, smallholders and industrial economic land concessions drive deforestation and forest degradation. Rural economic benefits have not kept pace with development aspirations and smallholders are gradually expanding agriculture into protected forests. We examine the drivers and effects of rural forest landscape transitions in Cambodia to identify trade-offs between conservation and development. Using historical trends analysis and information gathered through key informant interviews, we describe how local communities perceive social and ecological changes, and examine the implications of local development aspirations for conservation. We explore three scenarios for the future of conservation in Cambodia, each with different conservation and community development outcomes. We contend that conservation efforts should focus on strengthening governance to meet social and environmental requirements for sustainable forest landscapes. We suggest potential entry points for governance improvements, including working with local decision-makers and fostering collaboration between stakeholders. There is a need for realistic priority setting in contested tropical forest landscapes. Prosperous rural economies are a necessary but not sufficient condition for conservation.

Physicians and Reform: The State of The Art and The Challenge to Physicians.

Within the context of medical reformation outlined by Hoffman in a series of three papers in South Dakota Medicine and the challenge of legislation involving the independent practice of advanced practice nurses, we undertook two surveys of physicians and patients. We wanted to better understand physicians' attitudes toward certain opportunities for reform and how they conformed to the viewpoints of our patients. We found that, at least with respect to nurse practice legislation, physicians' perceptions were at odds with their patients over questions of access and quality. Moreover, we found attitudinal differences among physicians depending upon whether they were independent or affiliated with a health care system and whether they were primary care physicians or specialists. We concluded that physicians do not yet share the common understanding necessary to advocate for a principle of medical practice encompassing the core needs of patients and the spectrum of caregivers.

Understanding complex drivers of wildlife crime to design effective conservation interventions.

In conservation understanding the drivers of behavior and developing robust interventions to promote behavioral change is challenging and requires a multifaceted approach. This is particularly true for efforts to address illegal wildlife use, where pervasive-and sometimes simplistic-narratives often obscure complex realities. We used an indirect questioning approach, the unmatched count technique, to investigate the drivers and prevalence of wildlife crime in communities surrounding 2 national parks in Uganda and combined scenario interviews and a choice experiment to predict the performance of potential interventions designed to tackle these crimes. Although poverty is often assumed to be a key driver of wildlife crime, we found that better-off households and those subject to human-wildlife conflict and those that do not receive any benefits from the parks' tourism revenue sharing were more likely to be involved in certain types of wildlife crime, especially illegal hunting. The interventions predicted to have the greatest impact on reducing local participation in wildlife crime were those that directly addressed the drivers including, mitigating damage caused by wildlife and generating financial benefits for park-adjacent households. Our triangulated approach provided insights into complex and hard-to-access behaviors and highlighted the importance of going beyond single-driver narratives.

Comprensión de los Conductores Complejos de los Delitos con Vida Silvestre para Diseñar Intervenciones Efectivas de Conservación Resumen En la conservación, la comprensión de los conductores del comportamiento y el desarrollo de intervenciones sólidas para promover cambios en el comportamiento es un reto que requiere de una estrategia multifacética. Esto es particularmente cierto para los esfuerzos que se realizan para tratar el uso ilegal de la fauna, en donde las narrativas generalizadas - y en algunas ocasiones simples - comúnmente ocultan las realidades complejas. Usamos una estrategia de cuestionamiento indirecto, la técnica de conteo sin par, para investigar los conductores y la prevalencia de los delitos con fauna en las comunidades que rodean a dos parques naciones en Uganda, así como entrevistas de escenario combinado y un experimento de elección para predecir el desempeño de las intervenciones potenciales diseñadas para acabar con estos delitos. Aunque frecuentemente se asume a la pobreza como un conductor importante de los delitos con fauna, encontramos que los hogares con mayor probabilidad de estar involucrados en ciertos tipos de delitos, especialmente la cacería ilegal, son los que se encuentran en mejores condiciones, están sujetos al conflicto humano-fauna y los que no reciben beneficio alguno de las ganancias del turismo en los parques. Las intervenciones que se pronosticó tendrían el mayor impacto en la reducción de la participación local dentro del delito con fauna fueron aquellas que trataron directamente con los conductores, incluyendo la mitigación del daño causado por la fauna y la generación de beneficios económicos para los hogares circundantes al parque. Nuestra estrategia triangulada proporcionó percepciones hacia los comportamientos complejos y de difícil acceso y resaltó la importancia de ir más allá de las narrativas unifactoriales.

Santayana's Axiom: The South Dakota State Medical Association and Medical Practice Legislation in 1929 and 2017.

In 1928 members of the South Dakota State Medical Association (SDSMA or the Association) held a special meeting in Huron to consider a basic science bill that conformed "…in its entirety to the conditions existing in our state." Their draft bill proposed a standardized examination for all practitioners of the healing arts. A legislative committee, with its attorney, "…was in Pierre during the early part of the 1929 legislative session to make sure the bill was properly launched and in effective channels." Shortly after its introduction, the bill was withdrawn due to opposition from one SDSMA district whose legislative representatives were among the most influential in the legislature. A similar bill promoted by the SDSMA in 1933 also failed. It would be another six years before a basic science bill was enacted by the legislature. Eighty-nine years later, a bill governing the practice of certified nurse practitioners (NP) and certified nurse midwives (NM), including a board independent of the South Dakota Board of Medical and Osteopathic Examiners, was considered (Senate Bill 61). Introduced by a senator who characterized herself as representing the "House of Nursing," the bill challenged "…the overarching role that medicine thinks and perceives that they may have regarding advanced practice nursing practice." SB 61 passed in the senate and house and was signed by the governor. For this legislation in the 1930s and in 2017, the SDSMA's interest was defining and maintaining control of medical practice under the twin rubrics of quality and patient welfare. In both circumstances, legislators and other health care professional organizations contested not only the SDSMA's motivations, but also the evidence supporting their efforts. Our research explored (1) whether the collective viewpoints and conduct of the legislature, the SDSMA, and non-physician medical professionals are comparable in the two circumstances; and (2) if the circumstances are comparable, can we derive a useful concept or theme that could help guide the SDSMA in the future?

Games as Tools to Address Conservation Conflicts.

Conservation conflicts represent complex multilayered problems that are challenging to study. We explore the utility of theoretical, experimental, and constructivist approaches to games to help to understand and manage these challenges. We show how these approaches can help to develop theory, understand patterns in conflict, and highlight potentially effective management solutions. The choice of approach should be guided by the research question and by whether the focus is on testing hypotheses, predicting behaviour, or engaging stakeholders. Games provide an exciting opportunity to help to unravel the complexity in conflicts, while researchers need an awareness of the limitations and ethical constraints involved. Given the opportunities, this field will benefit from greater investment and development.

A Case of Silent Q Fever Endocarditis.

Q fever endocarditis is a rare, culture negative endocarditis caused by Coxiella burnetii, a spore-forming gram negative coccobacillus. Presenting symptoms can be very non-specific; thus, diagnosis may be delayed. We present a case of a 65-year-old male patient with history of aortic aneurysm who complained of chronic fatigue. He was found to have aortic valve vegetation on routine echocardiography. Q fever endocarditis was diagnosed based on elevated Q fever serology; there was absence of fever. This case illustrated a rare, under-recognized and atypical manifestation of Q fever endocarditis. We would like to encourage physicians of rural states like South Dakota to remain vigilant when it comes to screening for the suspected cases of Q fever, specifically in cases of unexplained fatigue and valvulopathy.