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.

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.

Unique SARS-CoV-2 Variants, Tourism Metrics, and B.1.2 Emergence in Early COVID-19 Pandemic: A Correlation Analysis in South Dakota.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, which is the source of the coronavirus disease 2019 (COVID-19), was declared a pandemic in the March of 2020. Travel and tourism were severely impacted as restrictions were imposed to help slow the disease spread, but some states took alternative approaches to travel restrictions. This study investigated the spread of COVID-19 in South Dakota during the early pandemic period to better understand how tourism affected the movement of the virus within the region. Sequences from the fall of 2020 were retrieved from public sources. CDC and other sources were used to determine infections, deaths, and tourism metrics during this time. The data were analyzed using correlation and logistic regression. This study found that the number of unique variants per month was positively correlated with hotel occupancy, but not with the number of cases or deaths. Interestingly, the emergence of the B.1.2 variant in South Dakota was positively correlated with increased case numbers and deaths. Data show that states with a shelter-in-place order were associated with a slower emergence of the B.1.2 variant compared to states without such an order, including South Dakota. Findings suggest complex relationships between tourism, SARS-CoV-2 infections, and mitigation strategies. The unique approach that South Dakota adopted provided insights into the spread of the disease in areas without state-wide restrictions. Our results suggest both positive and negative aspects of this approach. Finally, our data highlight the need for future surveillance efforts, including efforts focused on identifying variants with known increased transmission potential to produce effective population health management.

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.

The Relationship of Modified Rankin Score and Risk Factors with Stroke Mortality in the South Dakota Native American Population: A Descriptive Study.

OBJECTIVE: To describe the impact of multiple risk factors on stroke outcomes among Native Americans in South Dakota. METHODS: This is a retrospective chart review of 189 Native American patients treated for stroke in South Dakota between Jan. 1, 2016, to May 1, 2021 at a single hospital system. RESULTS: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. CONCLUSION: These results align with previous studies that concluded many stroke risk factors are more prevalent among Native Americans in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in Native American populations to reduce risk for stroke with subsequent related disability or death.

The Relationship of Modified Rankin Score and Risk Factors with Stroke Mortality in the South Dakota American Indian Population: A Descriptive Study.

INTRODUCTION: To describe the impact of multiple risk factors on stroke outcomes among American Indians in South Dakota. METHODS: This is a retrospective chart review of 189 American Indian patients treated for stroke in South Dakota between Jan 1, 2016, to May 1, 2021, at a single hospital system. RESULTS: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. CONCLUSIONS: These results align with previous studies that concluded many stroke risk factors are more prevalent among American Indians in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in American Indian populations to reduce risk for stroke with subsequent related disability or death.

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.

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.

Identifying the Use of Tanning Beds Among Undergraduate Students at South Dakota Universities and the Role of Providers: A Survey Analysis.

INTRODUCTION: Tanning bed use is common among young adults in the United States, and it contributes to over 400,000 cases of skin cancer annually. Many college students acknowledge the risk of skin cancer with tanning bed use, but this is not always a deterrent to the behavior. This study assesses the trends regarding tanning bed usage among university students and analyzes the role that primary care providers (PCPs) and dermatologists could play in reducing participation in this risky habit. METHODS: This study used a digital survey to assess the tanning bed usage trends and other aspects of skin health among undergraduate students at South Dakota universities. The survey was developed through interviews with dermatologists and public health professionals affiliated with the University of South Dakota. RESULTS: 321 students responded to the survey; 80% identified as female, 86% as Caucasian, and 93% were from the Midwest. 41% of respondents reported having previously used tanning beds. 46% of respondents reported never having seen a dermatologist for a skin check, and 42% indicated that their PCP does not perform a skin check during routine visits. When asked how a provider might influence participants to reconsider the use of tanning beds, responses included being presented statistics related to skin cancer and visualization of physical damage resulting from exposure to ultraviolet light. CONCLUSION: This study aims to better understand the prevalence of tanning bed usage among students at South Dakota universities. It also sought to better understand how providers can intervene to help reduce participation in this behavior. Given the risk associated with tanning bed exposure, our findings suggest that many students may be at increased risk of skin cancer from this behavior alone. This should encourage PCPs to consider incorporating skin checks into their examinations and provide preventative counseling recommendations to this population.

Substance Use Disorder in Adults with ADHD in South Dakota.

INTRODUCTION: Attention-deficit hyperactivity disorder (ADHD) increases the risk for multiple comorbid psychiatric disorders, such as substance use disorder. Comorbid ADHD and substance use disorder has been shown to increase the risk of adverse occupational, social, psychological, and physical outcomes. Because of the severe risks of substance use, it is useful to determine the relative comorbidity of ADHD among different types of substance use disorders. This study examined the prevalence of ADHD in residential addiction treatment as well as the relative prevalence of ADHD among mono-substance use, comorbid substance use (2 comorbid substance use disorders), and polysubstance use (3+ substance use disorders). METHODS: Participants were adults admitted to residential treatment of substance use disorder. Participants were asked to complete a Wender Utah ADHD rating scale to assess the presence of ADHD. A cutoff score of 46 was used to determine presence of ADHD in this rating assessment. Participants were also provided with an ADHD history questionnaire designed for this study to gather information on childhood ADHD diagnoses, substance use history, and early-life effects o f attention disorders. RESULTS: Using the Wender Utah assessment scores, 55 participants with substance use disorder demonstrated an ADHD prevalence of 45% (n=30). Of the study population, 20% (n=11) of participants being diagnosed in childhood and another 25% (n=14) having a positive Wender Utah questionnaire score for ADHD as adult patients without a childhood diagnosis. All participants who had a childhood diagnosis of ADHD had received treatment for this disorder. Polysubstance use disorder (n=21) had an ADHD prevalence of 62%. Alcohol use disorder (n=21) had an ADHD prevalence of 24%. Methamphetamine use disorder (n=4) had an ADHD prevalence of 75%. Participants with ADHD (either during childhood or adulthood) had a nearly significant increase in the prevalence of polysubstance use disorder as compared to participants without ADHD (p = 0.0542). CONCLUSIONS: ADHD and substance use disorder have notable comorbidity. This study, among similar studies, demonstrates a high prevalence of ADHD in populations with substance use disorder. The presence of ADHD in patients with substance use disorder may influence which substances those patients choose to use. The difference in patients treated for childhood ADHD and those having a diagnosis of ADHD demonstrates a deficit in effective childhood ADHD screening. As such, effective screening and prevention of substance use disorder in patients with ADHD may be a useful tool in reducing the risk of developing substance use disorder. Additionally, adequate treatment of ADHD could be considered useful in treating a contributing element of substance use disorder.

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.

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.

Carbon footprint of South Dakota dairy production system and assessment of mitigation options.

Livestock production contributes to greenhouse gas (GHG) emissions. However, there is a considerable variability in the carbon footprint associated with livestock production. Site specific estimates of GHG emissions are needed to accurately focus GHG emission reduction efforts. A holistic approach must be taken to assess the environmental impact of livestock production using appropriate geographical scale. The objective of this study was to determine baseline GHG emissions from dairy production in South Dakota using a life cycle assessment (LCA) approach. A cradle-to-farm gate LCA was used to estimate the GHG emissions to produce 1 kg of fat and protein corrected milk (FPCM) in South Dakota. The system boundary was divided into feed production, farm management, enteric methane, and manure management as these activities are the main contributors to the overall GHG emissions. The production of 1 kg FPCM in South Dakota dairies was estimated to emit 1.23 kg CO2 equivalents. The major contributors were enteric methane (46%) and manure management (32.7%). Feed production and farm management made up 14.1 and 7.2%, respectively. The estimate is similar to the national average but slightly higher than the California dairy system. The source of corn used in the dairies influences the footprint. For example, South Dakota corn had fewer GHG emissions than grain produced and transported in from Iowa. Therefore, locally and more sustainably sourced feed input will contribute to further reducing the environmental impacts. Improvements in efficiency of milk production through better genetics, nutrition animal welfare and feed production are expected to further reduce the carbon footprint of South Dakota dairies. Furthermore, anaerobic digesters will reduce emissions from manure sources.

Trends in Eligibility and Geographic Variations in Breast Cancer Screening Participation Among Underserved Women in South Dakota.

INTRODUCTION: Breast cancer is the most common cancer among women and early detection is critical to improve breast cancer survival. The All Women Count! (AWC!) Program, part of the National Breast and Cervical Cancer Early Detection Program, provides breast and cervical screening services at no cost to underserved women in South Dakota. Aiming to investigate program participation, we examined trends in the number of women eligible for breast cancer screening services through the AWC! Program along with mammography screening participation by county. METHODS: Using the State-level Small Area Health Insurances Estimates data and the AWC! data, we calculated the proportion of South Dakotan women eligible for mammography screening under the AWC! Program from 2016 to 2019, and calculated the standardized participation ratio and 95 percent confidence interval by county (2019). To investigate differences in screening participation over time and by counties, analysis of variance (ANOVA) and Tukey statistical test were conducted, respectively. RESULTS: From 2016 to 2019, the number of women eligible for breast cancer screening services declined by 12 percent. Differences in screening participation were not statistically significant over the four-year period. Conversely, county-level variations in screening participation were found. In 2019, among the 59 counties with screening data, 15 percent presented statistically higher participation in screening. CONCLUSION: A decrease in the number of women eligible for breast cancer services provided by AWC! was observed. Additionally, screening participation varied by county. A more comprehensive investigation is needed to explain these geographic disparities so prevention strategies can reduce the burden of breast cancer among South Dakota underserved women.

State of South Dakota's Child: 2022.

In 2021, South Dakota observed an increase in the number of births from 2020 when the state experienced its lowest historic birth rate. Nonetheless, this increase represented a 3.7 percent decrease from the state's previous five year (2016-2020) mean of live births. This growth in the 2021 cohort of newborns was seen almost entirely among its white population. Further, South Dakota's current rate of birth remains slightly higher than that observed nationally. Over recent years, the racial diversity of South Dakota's newborns became similar to that observed nation-wide with nearly one quarter being American Indian, Black or Other races (AIBO). This trended down in 2021 with 22 percent of the state's newborns AIBO. Further, in South Dakota, the percent of all AIBO newborns who are American Indian is decreasing. Currently, 60 percent of the AIBO population is American Indian compared to more than 90 percent in 1980. During the pandemic years of 2020 and 2021, racial disparities in perinatal outcome occurring during previous years continued to be observed but the onset of prenatal care in the first trimester for both white or AIBO pregnant women did not change. There were 71 infant deaths in 2021 yielding a decrease in South Dakota's infant mortality rate (IMR) from 7.4 to 6.3 (higher than the 5.4 IMR for 2020 for the U.S.). Though there was a decrease in the state's 2021 IMR to 6.3, the reduced rate from its previous five year mean of 6.5 is not statistically significant. The state's 2021 neonatal mortality rate (NMR = 0 to 27 days per 1,000 live births) and post neonatal mortality rate (PNMR=28 to 364 days per 1,000 live births) dropped for the white population and increased for the AIBO population, though the actual number of AIBO deaths associated with these rate increases were low. Between 2017- 2021, the South Dakota rates of death for AIBO compared to white newborns was significantly higher for perinatal causes, sudden unexpected death (SUID), and other causes. Compared to the U.S.' 2020 rates of infant mortality, South Dakota's comparable 2017-21 rates were significantly higher for congenital anomalies. In 2021 there were 15 deaths in the state due to SUID; a decrease from the previous year, yet little overall improvement in decreasing the rate of this cause of death has not been achieved. Between 2017 and 2021, SUIDs comprised 22 percent of infant deaths for both white and AIBO infants. A discussion of strategies to prevent these persisting tragedies is presented.

Comparing Travel Distance to Care and Staging of Parotid Gland Malignancies in South Dakota and Surrounding States.

BACKGROUND: Parotid gland malignancies are difficult to characterize in terms of incidence and risk factors due to their relatively rare occurrence. Common cancers often present more aggressively in rural areas, albeit occurring less frequently. Some previous studies have found increased distance to care has been linked to more advanced malignancies. This study hypothesized decreased access to parotid gland malignancy specialists (otolaryngologists or dermatologists), evaluated as longer travel distances, would be associated with more advanced staging of parotid gland malignancies. METHODS: A retrospective chart review of the Sanford Health system electronic medical record in South Dakota and surrounding states from 2008-2018 was conducted to obtain data of parotid gland malignancies, respective staging, and patient home addresses to assess distance, both driving and straight-line, to the nearest parotid gland malignancy specialist, including outreach clinics. Travel distance was categorized (0-20 miles, 20-40 miles, and 40+ miles) and compared to categorized tumor stage (early 0/I, late II/III/IV) using a Fisher's Exact test. RESULTS: Overall, chart review yielded 134 patients with parotid gland malignancies from 2008-2018 in the Sanford Health system and associated data was gathered. The malignancies were categorically organized as 52.3 percent in early stage (0/I) vs. 47.7 percent in late (II/III/IV). When comparing parotid malignancy stage to driving distance, no significant association was found when outreach clinics were excluded (p=0.938) or included (p=0.327). When comparing parotid malignancy stage to straight-line distance, no significant association was found when outreach clinics were excluded (p=0.801) or included (p=0.874). CONCLUSIONS: Although no association was established between travel distance and parotid gland malignancy staging, further studies are needed to evaluate at population levels the incidence of parotid gland malignancies in rural communities and if there are specific risk factors in these areas for these malignancies which is currently unknown.