Scholarship Pathways Program

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  Transition to Noninvasive Testing from the Gold Standard of Liver Biopsy

  Heidi Bien, Sabina Choudhry, Christine Pocha, and University of South Dakota Sanford School of Medicine & Avera Health System

  Purpose: Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, represents a rapidly growing public health concern, affecting roughly 30% of the global population. MASLD encompasses a spectrum from simple steatosis to its more progressive form, metabolic dysfunction–associated steatohepatitis (MASH). Early and accurate assessment of liver disease is critical for risk stratification and management, yet the current gold standard-liver biopsy remains invasive, costly, and limited by sampling variability and interpretive subjectivity. Noninvasive imaging modalities, particularly magnetic resonance elastography (MRE), have emerged as promising alternatives, but their concordance with biopsy in real-world clinical practice remains underexplored.

  Methods: This retrospective study analyzed medical records from 21 patients treated at a hospital system in the Upper Midwest region of South Dakota between 2018 and 2023. Eligible patients had a diagnosis of MASLD or MASH and underwent both liver biopsy and MRE. Demographic and clinical data, including age, sex, race, BMI, diabetes status, and laboratory biomarkers (liver enzymes, platelets, APRI, albumin), were abstracted. Imaging data included liver stiffness, iron concentration, and proton density fat fraction. Liver biopsy results for fibrosis and steatosis served as the reference standard. Statistical analysis included descriptive statistics, Cohen’s kappa to assess agreement, and McNemar’s test for discordance, with significance set at p< 0.05.

  Results: The study cohort was predominantly female (71%), white (95%), non-Hispanic (100%), with a mean age of 57.7 years and mean BMI of 34.9. Slight agreement was observed between liver biopsy and imaging for fibrosis staging (κ=0.18), and fair agreement for steatosis grading (κ=0.21). Moderate agreement was found for steatosis grade 0 (κ=0.44), and fair agreement for fibrosis stage 1 (κ=0.34). Notably, biopsy more frequently assigned fibrosis stage 1, while imaging more often graded steatosis as grade 1. McNemar’s test revealed significant discordance for fibrosis stage 1 (p=0.025) and steatosis grade 1 (p=0.014), indicating systematic differences in classification between modalities.

  Conclusions: These findings highlight the limitations of both liver biopsy and MRE in assessing MASLD, particularly in early-stage disease. Although MRE and MRI-based biomarkers offer noninvasive, reproducible, and comprehensive liver evaluation, their concordance with histopathological findings remains only slight to fair. This limited agreement stems from biopsy sampling and interpretive variability, along with technical and biological factors affecting imaging. Nevertheless, MRE’s safety, comfort, and repeatability support its growing role in MASLD evaluation, especially for monitoring over time.

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  Head Impacts in Collegiate Rodeo Athletes: An Observational Study

  Colton D. Carlson, Jacob Miller, Jason C. Dorman, Verle D. Valentine, and Thayne A. Munce

  Head Acceleration Events in Collegiate Rodeo Athletes

  Colton Carlson, MS4

  Mentor: Thayne Munce, PhD

  Introduction: Brain health has been a growing concern across a wide range of contact sports in the last three decades. While most of the early brain health research was focused on identifying and preventing concussions, newer research has found that an accumulation of repetitive head impacts (RHI) is more predictive of long-term brain health than the number of concussions sustained. Consequently, being able to assess RHI in sports despite the lack of outward symptoms has become paramount in promoting the long-term health of athletes. While the sport of rodeo has long been regarded as one of the most dangerous sports in America, minimal research has been done in the sport regarding athlete safety. Current studies on rodeo are limited to minimal epidemiological research on injury rates that has largely backed up its dangerous reputation. Despite this, no further research has been done into head impacts in rodeo athletes.

  Methods: Thirteen athletes competing in the “Roughstock” events of Bareback Riding, Saddle Bronc Riding and Bull Riding were recorded across five rodeo competitions sanctioned by the National Intercollegiate Rodeo Association. Head acceleration events (HAE) were measured using an instrumented mouthguard (iMG) (Prevent Biometrics, Inc; Edina, MN) consisting of a triaxial accelerometer and gyroscope housed within a rubber mouthguard. The iMG recorded information including peak linear acceleration, peak angular acceleration and location of HAE. HAE were included if they exceeded a 5 g linear acceleration threshold. All rides were videoed, and all included HAE were subsequently video verified and categorized based on mechanism of HAE.

  Results: A total of 112 rides were monitored across five collegiate rodeo competitions capturing 344 HAE. Bareback Riding (7 [4-10] HAE/ride) experienced a significantly higher (p < 0.001) median frequency of HAE than the other two events (1 [0-2] HAE/ride for each) however, median peak linear acceleration was significantly lower (p < 0.01) in Bareback Riding (8.7 [6.6-11.1] g) compared to Bull Riding (10.7 [8.4-15.5] g) and Saddle Bronc Riding (10.2 [8.9-13.9] g). Bull Riding and Saddle Bronc Riding HAE frequency and median peak linear acceleration were comparable to each other. Whiplash was the most common cause of HAE across events, outpacing direct caused of HAE such as impacts with the animal or impacts with the ground. Whiplash (8.9 [6.6-11.1] g) however resulted in a significantly lower (p < 0.001) median peak linear acceleration than impacts with the animal (10.7 [8.7-20.1] g) or impacts with the ground (11.4 [8.7-15.8] g).

  Conclusions: Rodeo athletes across the Roughstock Events experience significant HAE throughout the course of competition. Athletes in Bareback Riding tend to experience a high volume of load magnitude HAE while athletes in Saddle Bronc Riding and Bull Riding experience fewer, higher magnitude HAE. Much of the HAE load is the result of whiplash type injury as opposed to direct impacts to the head which suggests that whiplash reducing measures such as neck rolls may be an option to reduce cumulative HAE load on athletes. Direct head impacts however still result in the highest magnitude HAE confirming the utility of helmets in athlete safety.

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  Addressing Vaccine Hesitancy with Patient Education

  Belle Grady and Victor Huber

  Addressing Vaccine Hesitancy with Patient Education

  Belle Grady, MD | Mentor: Victor Huber, PhD

  Background: Vaccine hesitancy is a complex global issue, exacerbated by pandemics and social media. In addition to hesitancy, state policies loosening childhood vaccine requirements and alternative vaccination schedules may contribute to recent vaccine-preventable illness outbreaks in the United States. In South Dakota alone, kindergarten vaccination rates have gradually declined over the past decade. Such vaccine hesitancy and decreasing vaccination rates is a public health concern and must be addressed. Accessible patient education resources on the topic are necessary to increase vaccination rates.

  Project Description: This project consisted of three phases: a survey, information gathering, and booklet synthesis. A Qualtrics survey regarding vaccine hesitancy was posted on social media and in three South Dakota medical clinics to gather information on which vaccines and which aspects of vaccination patients were most concerned about. Guided by the survey results, information from reputable sources and peer-reviewed articles was gathered and utilized to create a patient education booklet for distribution in medical clinics. This project was IRB exempt.

  Outcomes: The survey received 31 responses. According to survey participants, top vaccination concerns include ingredients, side effects, safety of receiving multiple vaccines at once, and pharmaceutical company gains. Vaccines participants feel most hesitant to receive or give their children are COVID-19, influenza, and HPV vaccines. The final 30-page patient education resource covered topics such as types of vaccinations, information on each routine childhood vaccine, the diseases vaccines protect against, and answers to common questions regarding vaccines. Local family medicine physicians and pediatricians welcomed the booklet as a resource for their patients.

  Conclusion: This project has identified common causes of vaccine hesitancy in South Dakota which may be contributing to decreasing vaccination rates. An educational booklet containing information on routine vaccinations was produced to be distributed in South Dakota clinics. The goal of this resource is to increase vaccine confidence as well as decrease time spent discussing vaccine concerns during patient visits. The booklet will be available in print and pdf form. Although patient responses will not be collected after reading the resource, the information in the booklet provides answers to commonly asked questions about vaccines to decrease vaccine hesitancy.

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  Impact of Dermatology Access on Dermatofibrosarcoma Protuberans Outcomes

  Joseph H. Kelly and Marcus L. Frohm

  Impact of Dermatology Access on Dermatofibrosarcoma Protuberans Outcomes

  Joseph H. Kelly MD

  Mentor: Marcus L. Frohm, MD

  Introduction: Dermatofibrosarcoma protuberans is a locally aggressive rare dermal sarcoma with a relatively high rate of local recurrence. Incidence in the United States has been reported around 4 occurrences per million people per year, and recurrence rates have been reported between 2 to 19%. Recurrence poses a higher risk for sarcomatous transformation, increasing the risk for metastasis. Early and accurate diagnosis, coupled with appropriate management, is essential to minimize these risks. This study extended previous research by evaluating whether access to dermatology care influences dermatofibrosarcoma protuberans treatment outcomes in a larger cohort and larger geographical area.

  Methods: This study was a retrospective review currently including 72 adults with histologically confirmed dermatofibrosarcoma protuberans. The first endpoint null hypothesis states the rate of pre-treatment biopsy does not differ between dermatology and non-dermatology providers. The second endpoint null hypothesis states the rate of peripheral and deep en face margin assessment or wide local excision with at least 2 cm margins does not differ between lesions with and without pre-treatment biopsy. The third endpoint null hypothesis states the rate of positive margins or primary recurrence does not differ between lesions with and without peripheral and deep en face margin assessment or wide local excision with 2 cm margins. The fisher exact test and chi-squared test with Yates correction were used in analysis.

  Results: For all three endpoints, the data rejected the null hypothesis. Dermatologists had a higher rate of pre-treatment biopsy (P=.0053; OR=8.02[1.63,39.48]). Lesions with a pre-treatment biopsy had a higher rate of peripheral and deep en face margin assessment or wide local excision with at least 2 cm margins (P< .00001; OR=288[38.72, 2164.57]). Lesions that received peripheral and deep en face margin assessment or wide local excision with 2 cm margins had a lower rate of positive margins or recurrence (P< .00001; OR=39.6[8.69, 214.76]). Clinical tumor size did not independently impact endpoint 2 (P=.872; OR=1.04[0.40, 2.69]). Post-hoc analysis showed inappropriate primary treatment did not influence positive margins or recurrence after appropriate secondary treatment (P=.455; OR=2.55[0.47, 13.77]).

  Conclusion: These findings support previous analysis of these endpoints with smaller sample sizes. Unlike previous results, this study suggests that access to dermatology affects the rates of pre-treatment biopsy on initial presentation. This study supports previous conclusions that diagnostic biopsy performed prior to treatment improves outcomes and decreases morbidity. Increased clinical awareness and appropriate biopsy or referral to dermatology for evaluation are recommended for suspicious lesions to improve the management of dermatofibrosarcoma protuberans.

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  Calcineurin-Mediated Immunosuppressants in Binge Ethanol Drinking and Stress Responsivity

  E. Kirschenmann, J. Agar, T. P. Beresford, and P. J. Ronan

  Calcineurin-Mediated Immunosuppressants in Binge Ethanol Drinking and Stress Responsivity

  Emily Kirschenmann MD | Patrick J. Ronan PhD

  Introduction: Previous research has found that the calcineurin-mediated immunosuppressants cyclosporine A (CsA) and tacrolimus inhibit binge alcohol drinking in mice. Further research has shown that this effect is mediated directly in brain, as intracerebroventricular administration also significantly decreases drinking. As these immunosuppressants have severe systemic toxic effects along with dangerous inhibition of immune function, our goal is to determine proximal mechanisms by which these immunosuppressants are working in order to develop effective treatments for alcohol use disorder (AUD) with fewer side effects. One major question is whether immunosuppressants are acting through neuronal signaling pathways, regulating reward and stress/anxiety pathways, or in glia, mediating neuroinflammatory effects.

  Methods: This study employs genomic, molecular, transcriptomic, metabolomic, anatomic, and behavioral approaches to explore the relationship between binge alcohol drinking, stress, and calcineurin mediated immunosuppressants. Calcineurin is a somewhat ubiquitous phosphatase, involved in a wide range of signaling pathways - both in neurons and glia. The authors developed multiple transgenic models using a floxed calcineurin line (C57BL/6-Ppp3r1tm1Stl/J) crossed with various Cre driver lines to knockout CN in various neuronal or glial populations. Results are presented from two neuronal CN knockout lines: a “panneuronal” CN knockout line (CamKIIα-Cre) and a corticotropin releasing factor specific CN knockout line (CRH-Cre). The authors are also investigating the effects of CsA on candidate brain signaling pathways in models of both binge drinking and stress, as stress is a primary factor driving drinking behaviors. The CeA and PVN were microdissected from 300 mm frozen sections and qRT-PCR was performed.

  Results: Panneuronal knockout of CN appeared to have minimal effect on binge-alcohol consumption in this study. Furthermore, CsA showed reduction in alcohol consumption in both control and CN neuronal knockout populations. Overall, CsA inhibited the stress-induced expression of a wide range of neuroinflammatory markers in these regions including cytokines such as IL-2, IL-1b, IL-6, TNFa; markers of glial activation: CD45 and Iba-1; chemokine and chemoattractant molecules such as CCR2 and CCL2; as well as other inflammatory signaling molecules such as COX-2. Some of the largest effects were seen on IL-1b and IL-6 expression in both CeA and PVN. While CsA inhibited the expression of CD45 and iba1 in the CeA, in the PVN these effects were striking.

  Conclusion: These findings indicate that neuronal calcineurin is not a major contributor to binge-like alcohol consumption, as panneuronal CN deletion did not alter drinking behavior and CsA remained effective in its absence. In contrast, CsA robustly suppressed stress-induced neuroinflammatory signaling, including cytokine induction and glial activation markers, in key stress- and reward-related nuclei. Together, these results support a model in which calcineurin-mediated immunosuppressants reduce binge ethanol intake primarily through glial-dependent neuroimmune mechanisms rather than neuronal CN signaling, highlighting glial pathways as promising therapeutic targets for AUD with fewer systemic side effects.

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  Bias Analysis and the Movement Toward A Bias-Free Curriculum

  Haley J. McMahon and DenYelle Kenyon

  Implicit biases within medical education can influence learners’ perceptions, clinical reasoning, and future patient interactions. This study analyzed implicit bias within the University of South Dakota Sanford School of Medicine’s (USD SSOM) Pillar I pre‑clerkship curriculum using a two‑phase mixed‑methods approach. Phase I consisted of a subjective content analysis of randomly selected lectures across ten system blocks, examining both textual and visual materials for evidence of bias in eleven domains identified by the Association of American Medical Colleges. Phase II employed quantitative survey data from the MD Class of 2027, who rated perceived bias in lecture content, lecture images, exam content, and exam images across the same eleven categories. Subjective review revealed recurring patterns of racial and ethnic bias, particularly through overrepresentation of pathologies presented on Caucasian skin and limited diversity in clinical examples. Survey findings showed low mean bias ratings overall, though race, weight, and socioeconomic status emerged most consistently across content types. Chi‑square analysis identified race and ethnicity as the only bias domain demonstrating a statistically significant difference across content modalities (p = 0.0493). Students additionally noted that diversity dialogues were effective in raising awareness of bias within medical instruction. Recommendations include diversifying imagery, varying patient demographics in clinical vignettes, incorporating disability and weight diversity in physical examination examples, and developing a standardized bias‑avoidance checklist for faculty. This study highlights areas for improvement in the curriculum and provides actionable strategies to reduce implicit bias and promote equitable medical education.

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  Visual Outcomes and Quality of Life in a Randomized Trial of Topography-Guided LASIK with Novel GIS-Software Versus Wavefront Optimized LASIK

  Elise V.H. Meide, Tanner J. Ferguson, John P. Berdahl, Vance M. Thompson, and Daniel C. Terveen

  Visual Acuity and Quality of Life Results in a Randomized Trial of Topography-Guided with GIS-Software Versus Wavefront Optimized LASIK

  Elise V.H. Meide, MD | Daniel C. Terveen, MD

  Purpose: To compare post-operative visual acuity, refractive outcomes and patient-reported visual quality of life between topography-guided (TG) laser-assisted in situ keratomileusis (LASIK) with novel geographic imaging system (GIS) based software versus wavefront-optimized (WFO) LASIK. Main outcome measures included the rate of patients with uncorrected distance visual acuity (UDVA) of 20/16 or better 3 months post-operatively. Secondary and exploratory endpoints include best corrected visual acuity (BCVA), residual refractive error, low contrast visual acuity, percent of patients with post-op UDVA equal or better to pre-op corrected distance visual acuity (CDVA) and subject satisfaction as measured by Patient Reported Outcome With LASIK questionnaire.

  Methods: This was a prospective, multicenter, dual-arm randomized clinical trial. 117 eligible, bilateral LASIK subjects were randomized 1:1 to bilateral TG using GIS surgical planning software or WFO using the Wavelight EX500 excimer laser. Patients and technicians assessing patients were blinded. The 32-question PROWL visual questionnaire was administered at the pre-operative appointment and 3 months postoperatively; each response was transformed linearly to a score with a range of 0-100.

  Results: 117 subjects (234 eyes) were enrolled. For monocular UDVA, 29% of WFO achieved 20/12.5 and 74.6% 20/16 or better versus 18% (p=0.05) and 67% of GIS eyes (p=0.29), respectively. For MRSE, the % of eyes within ±0.50 D of plano was 97% in WFO and 91% in GIS (p=0.09). WFO had 14% of eyes gain 2 lines of CDVA versus 7% (p=0.09) in the GIS group. Overall satisfaction was similar between groups (93.66, 91.77, p=0.18) but there was increased satisfaction as it relates to magnitude of starbursts in GIS (85.74 GIS, 81.62 WFO, p=0.03).

  Conclusions: WFO demonstrated significantly higher rates of 20/12.5 UDVA but achieved similar rates of 20/16 UDVA and slightly superior refractive outcomes compared to GIS. Overall, visual and refractive outcomes were favorable in both groups. Both groups had high patient satisfaction with the category of starbursts significantly higher in the GIS group.

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  Targeted Skin Cancer Education Improves Agricultural Workers' Safe Sun Practices and Knowledge in South Dakota: A Farm Show Survey

  Leah Naasz, Kianna Thelen, and Candace Zeigler

  Targeted Skin Cancer Education Improves Agricultural Workers' Safe Sun Practices and Knowledge in South Dakota: A Farm Show Survey

  Leah Naasz, MD | Candace Zeigler, MD

  Background: Agricultural workers are at increased risk for skin cancer due to prolonged ultraviolet (UV) exposure, yet many underutilize sun protection. Brief, community-based educational interventions may improve knowledge and preventive behaviors.

  Objective: To provide a targeted skin cancer educational session to increase awareness and promote sun protection behaviors among agricultural workers in South Dakota.

  Methods: Twenty agricultural workers attending the Vermillion and Sioux Falls Farm Shows participated in a pre- and post-educational survey. Inclusion criteria included: ≥18 years old, English-speaking, and working in agriculture. Participants completed a seven-question pre-survey assessing sun exposure, sun protection habits, and knowledge of skin cancer. They then received a 10-minute tutorial on skin cancer risk factors, sun protection, and self-examinations. A post-survey assessed knowledge gained and intended behavior changes. Paired t-tests and Wilcoxon signed-rank tests evaluated pre- to post-intervention changes, with significance set at p < 0.05.

  Results: Post-intervention, participants showed significant improvements in recognizing melanoma warning signs (mean Δ = 0.90; p < 0.001) and identifying the most common type of skin cancer (mean Δ = 0.65; p < 0.001). Intent to use sunscreen increased significantly (mean Δ = 0.38; p = 0.009), though no meaningful changes were observed for wide-brim hat or protective clothing use. Participants reported a high likelihood of engaging in sun protection behaviors (mean 4.38/5).

  Conclusion: Brief, targeted educational sessions at farm shows effectively increased skin cancer awareness and self-reported intent to adopt sun-protective behaviors among South Dakota agricultural workers.

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  Visual Arts and Humanities in Medical Education

  Lauren Schild and Craig Uthe

  Introduction: In medicine today, physicians are expected to be impartial, emotionally intelligent, and have the observational skills to pick up on and interpret ambiguous body language, skin changes, and hygiene factors which may aid in a diagnosis. However, medical students are often not directly taught these observational or emotional intelligence skills. Art has historically been used by the artist to express thoughts and emotions for themselves and to allow viewers to explore their own feelings. The aim of this course is to provide an opportunity for students to advance their observation and communication skills through the study and creation of artworks while providing an introduction to the use of art as a method for emotional processing.

  Methods: The class consisted of eight two-hour sessions during which students had the opportunity to evaluate and discuss an artwork individually and as a class, and the opportunity to experience creating works using a variety of mediums. A short pre/post-course written assessment in which students evaluate an artwork was used to track changes in observational analyses, and weekly post-session surveys were used to assess the administration each session. Subjective data from the written assessments were qualitatively analyzed on a scale from mostly physical descriptions of the artwork to mostly interpretations of observations.

  Outcomes: A pre-course and post-course written assessment were obtained from all nine participants in the first year of the course. Responses were assigned a score from one to ten, with one representing a purely physical description of the artwork and ten representing a purely interpretive description. The results from the pre-course (M = 4.11, SD = 2.76) and post-course (M = 6.89, SD = 1.96) show a statistically significant shift toward interpretation of observations at the end of the course, p = 0.006. Student evaluations of the course were also obtained during both the first and second years of the course and responses to questions of time management, quality of instruction, and quality of instructors ranged from “agree” to “strongly agree”.

  Conclusions: This course expands on existing humanities education at the Sanford School of Medicine and offers a unique experience through instruction in visual arts. Overall, students responded positively to the course offering and design and the goal of introducing students to emotional processing through art was met through both the discussions surrounding interpretations of artwork and the opportunity for creative outlet in every session. By the end of the course, students began communicating more about their interpretation of an artwork in addition to describing their observations.

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  Infections and Patient Satisfaction for WALANT Hand Surgery in Hospital Procedure Room

  Michaela Derby, Kelly N. McKnight, and Robert E. Van Demark Jr.

  Background: Wide awake hand surgery has allowed many hand procedures to be moved out of the operating room and into minor procedure rooms while increasing efficiency, maintaining safety, and reducing both patient and hospital costs. The goal of this study was to evaluate patient satisfaction and postoperative complications of wide-awake local anesthesia with no tourniquet procedures performed in a community-based hospital procedure room.

  Methods: A total of 786 patients underwent 948 elective hand procedures in a hospital procedure room. At the conclusion of their surgeries, the patients were surveyed regarding their satisfaction. Following surgery, patients were evaluated for postoperative complications including infections. The trend in postoperative infection rates across eight age groups was analyzed using a Cochran-Armitage test in R.

  Results: The overall infection rate was 6.2% (n=59). All infections were superficial. Carpal tunnel had the highest number of infections (n=25), followed by trigger finger (n=8), and the combination trigger finger with carpal tunnel (n=7). All infections were managed with antibiotics and/or soaks. Three patients did require a return to the operating room for irrigation and debridement. Ninety-nine percent of patients said the procedure room experience was better or the same as going to the dentist, would recommend wide-awake anesthesia to a friend or family member, and would undergo the procedure again.

  Conclusion: Wide awake procedures performed in a hospital procedure room have low infection rates with high patient satisfaction.

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  Leadership and Team Communication Course for Medical Students as Future Healthcare Leaders

  Claire Foerster

  As healthcare increasingly adopts a team-based model to address complex patient needs, the role of physicians as effective team leaders becomes critical. Despite this, formal leadership training is not a standard component of medical school curricula. This study presents the development and evaluation of a pilot leadership and communication course designed for medical students at the University of South Dakota. The course combined didactic instruction with simulation-based learning to teach essential skills such as active listening, giving and receiving feedback, and effective communication. A pre-course survey assessed students’ confidence and needs, informing the course design. Post-course assessments, including quizzes and participant feedback, evaluated knowledge retention and the emotional realism of the simulations. Results indicated strong student interest, particularly among early-year students, and highlighted the value of experiential learning in leadership development. The study underscores the importance of integrating structured leadership training into medical education and suggests directions for future curriculum enhancement and research.

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  Effects of Calcineurin Mediated Immunosuppressant Cyclosporine on Binge Alcohol Drinking and Stress Responsivity

  Brock Goeden, Emily Dorn, Jennifer Agar, Thomas P. Beresford, and Patrick J. Ronan

  Stress and neuroinflammation are increasingly recognized as interdependent processes that contribute to the development of psychiatric disorders. This study investigates the bidirectional relationship between stress exposure and neuroimmune activation, focusing on the expression of pro-inflammatory cytokines and behavioral outcomes in rodent models. Using the learned helplessness (LH) paradigm, the authors demonstrate that stress-induced neuroinflammation, particularly elevated IL-1β expression in the hypothalamus, is associated with susceptibility to maladaptive behaviors. The immunosuppressant cyclosporine A (CsA) was shown to attenuate stress-induced expression of neuroinflammatory markers, including IL-1β, IL-6, and CRF. Furthermore, direct intracerebroventricular administration of lipopolysaccharide (LPS), a TLR4 agonist, induced LH-like behavioral deficits in the absence of stress, confirming that neuroinflammation alone can mimic stress-induced behavioral phenotypes. These findings underscore a functional link between stress and neuroinflammatory signaling and suggest that targeting neuroimmune pathways may offer therapeutic potential for stress-related disorders such as depression, PTSD, and alcohol use disorder.

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  Utilizing Registered Dietitians to Improve Nutrition Education for Medical Students

  Andee James and Pasquale Manzerra

  Despite the well-established link between nutrition and chronic disease prevention, medical education continues to underemphasize nutrition training. This study explores the impact of integrating registered dietitians (RDs) into pre-clerkship medical education to enhance students’ knowledge, confidence, and perception of nutrition in clinical care. A series of optional, system-based nutrition lectures were delivered by RDs and supplemented by senior medical students who shared real-world clinical case studies. Pre- and post-session surveys assessed students’ confidence in providing dietary counseling, understanding of the physician’s and dietitian’s roles, and the perceived importance of nutrition in disease management. Results showed significant improvements across all metrics, with confidence in counseling rising from 26.9% to 79.1%, and understanding of the dietitian’s role increasing from 64.7% to 92.5%. Student feedback highlighted the value of interdisciplinary teaching and real-world application. This initiative demonstrates that leveraging RDs in medical education can effectively address gaps in nutrition training and better prepare future physicians for holistic patient care.

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  Lightning Assocated with More Visits to the ED for Chest Pain

  Bailee Lichter and Benjamin Aaker

  This study investigates the potential association between lightning events,used as a proxy for thunder, and increased emergency department (ED) visits for chest pain and myocardial infarction (MI). Electronic medical records from Avera McKennan Hospital were analyzed for chest pain and MI diagnoses between June 1 and July 31, 2021. Lightning data within a 100-mile radius were obtained from Vaisala and cross-referenced with patient presentation times. Statistical analysis revealed a significant increase in chest pain-related ED visits within 0.5 hours and between 2.5 to 5.5 hours following lightning strikes, with p-values ranging from 0.018 to 0.047. Although a trend toward increased MI diagnoses on lightning days was observed, the small sample size limited statistical significance. These findings suggest that acute weather-related noise events may contribute to cardiovascular symptoms, warranting further investigation into environmental stressors and their impact on public health.

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  Transitional Understanding of Kindness in Medical Students

  Madigan Moore, Jerome Freeman, Ann Cook, and Jamie Messerli

  This qualitative study explores how medical students at the University of South Dakota Sanford School of Medicine understand and practice kindness throughout their medical education. Through individual interviews and focus groups conducted in two phases, before and after clinical immersion, the research identifies four central themes: definition of kindness, clinical environments, provider practices, and ethics. Findings reveal that students initially view kindness as an innate trait but increasingly recognize it as a deliberate decision influenced by clinical challenges. Contextual factors such as time constraints, emotional exhaustion, and negative work environments were found to hinder expressions of kindness. Students also noted that ethical preparedness improved significantly after clinical exposure and ethics coursework. The study underscores the importance of integrating kindness and humanitarian values into medical curricula to foster compassionate care and ethical decision-making.

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  Developing Program Infrastructure for Effective Intercultural Education at the Sanford School of Medicine

  Andrew Nerland and DenYelle Kenyon

  This study evaluates the intercultural patient care education at the University of South Dakota Sanford School of Medicine (USD-SSOM) through a mixed-methods survey of medical students. The research explores student perspectives on the importance, effectiveness, and preferred formats of intercultural education, with a focus on preparing future physicians to serve diverse and underserved populations. Findings reveal strong student endorsement of intercultural education but mixed satisfaction with current programming, particularly among female and non-white respondents. Students expressed a preference for longitudinal, required, and in-person education delivered in clinical and community settings. Topics such as Native American health disparities, LGBTQ+ care, and the role of Indian Health Services were identified as areas needing greater curricular emphasis. The study highlights the need for curriculum reform aligned with student preferences and suggests integrating public health education and diverse clinical placements to enhance intercultural competency.

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  Maternal Food Insecurity and Adverse Birth Outcomes

  Narysse Nicolet, Amrita Bhagia, Katie Ziegler, Lacey McCormack, Amy Elliott, and Christine Hockett

  Background: Despite being a high-income country, the United States faces persistent food insecurity (FI), disproportionately affecting women of reproductive age. This study investigates the association between prenatal FI and adverse birth outcomes, specifically birth weight (BW) and gestational age (GA), among a diverse cohort of pregnant individuals in South Dakota.

  Methods: A longitudinal analysis was conducted using data from 1,478 mother-infant pairs enrolled in the Safe Passage Cohort of the ECHO study. Prenatal FI was assessed using a modified USDA Household Food Security Questionnaire. Birth outcomes were analyzed using both univariate and multivariate regression models, adjusting for maternal sociodemographic and health variables.

  Results: Unadjusted analyses revealed statistically significant associations between FI and lower BW and earlier GA. Infants born to food-insecure mothers weighed on average 85 grams less and were more likely to be born preterm. However, after adjusting for covariates, these associations were no longer statistically significant. Higher pre-pregnancy BMI, gravidity, and parity remained significantly associated with adverse birth outcomes.

  Conclusion: While prenatal FI showed marginal associations with adverse birth outcomes after adjustment, the findings underscore the importance of addressing FI as a social determinant of health. The study highlights the need for targeted interventions, particularly among American Indian/Alaska Native populations, and calls for further research into the complex interplay between FI, maternal health, and infant outcomes.

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  Minimizing Grief and Loss Through Advance Care Planning

  Hannah Paauw and Victoria Walker

  Advanced Care Planning (ACP) is a process used to identify or update a specific patient’s preferences of care and treatment in the event that they lack the capacity to do so. ACP is especially important for the aging population and those living with chronic conditions. Currently 11% of the world’s population is above the age of 60 and this number is projected to climb to 22% by 2050. The effects of aging are even greater in rural areas, such as South Dakota, where there is a disproportionate number of older and sicker people.

  This study examined the effectiveness of a program designed to inform South Dakota health professionals about the uses and limitations of different ACP tools including Power of Attorney, Living Will, Comfort One, and MOST (Medical Orders for Scope of Treatment). Health care professionals who work with vulnerable adult populations were recruited through partnerships with long-term care organizations. Participants attended four one-hour long discussion-based sessions about grief, loss, and how it relates to ACP. Continued medical education credit was provided. The primary goals were to increase the comfort level of using ACP tools and help decrease the negative emotional impact on the health care professional. A pre/post knowledge survey and the Professional Quality of Life Scale are used to evaluate these measures.

  Overall, the sessions increased the health care professionals’ comfort with using the ACP tools appropriately and increased professional well-being. Additionally, the sessions were well received and facilitated difficult discussions between professionals in various settings. The study was limited by the number of participants and participants who were not in attendance at all sessions. Further research on barriers to using ACP tools and outcomes of addressing these barriers could help with the overall usage of ACP in South Dakota. The use of implementation science in integrating these skills and tools into the clinical setting should be explored.

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  Ultrasonographic Accuracy in Rural vs Urban Counties

  Riley T. Paulsen, Avery D. Franzen, Amy M. Eichfeld, and Laurie Landeen

  Background: Rural communities in the United States face significant barriers to prenatal care, including limited access to birthing facilities and obstetric providers. Accurate prenatal ultrasonography is essential for identifying congenital anomalies and predicting birth outcomes, particularly in these underserved areas.

  Objective: This study aimed to evaluate whether ultrasonographic accuracy differs between rural and urban counties, specifically in predicting birth weight and detecting congenital anomalies.

  Methods: A retrospective chart review was conducted using data from the Sanford Health system. Maternal and fetal data were collected from second trimester ultrasounds and compared with postnatal outcomes. Counties with populations under 50,000 were classified as rural. Statistical analyses included t-tests, ANOVA, and linear regression.

  Results: Fetal weight percentile at the second trimester ultrasound was not predictive of birth weight percentile in either rural (R² = 0.165) or urban (R² = 0.1103) settings, with no significant difference between models (p = 0.7478). Anomaly detection rates were 50.0% in rural and 31.7% in urban counties, also not statistically significant (p = 0.6416). Maternal age and cervical length differed significantly between groups, but other variables showed no meaningful differences.

  Conclusion: Ultrasonographic accuracy in predicting birth weight and detecting anomalies did not significantly differ between rural and urban counties. Further research with larger sample sizes and consideration of equipment variability is needed to validate these findings and improve prenatal care in rural settings.

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  Improving Interactions During Medical Interpretation: Educational Module for Medical Students

  Alyssa Reinschmidt, DenYelle Kenyon, and Hilda Sanchez-Herrera

  As the population of individuals with limited English proficiency (LEP) continues to grow in South Dakota and across the United States, healthcare systems face increasing challenges in providing equitable care. This study evaluates the implementation of an educational module designed to prepare first-year medical students at the University of South Dakota Sanford School of Medicine (SSOM) to work effectively with medical interpreters and patients with LEP. The module included a didactic session, role-play, open discussion, and pre- and post-surveys assessing students’ knowledge, attitudes, preparedness, and perceptions of the educational environment. Results from 68 participants demonstrated statistically significant improvements across all measured domains. Students reported increased confidence and understanding of interpreter roles, and feedback highlighted the value of incorporating virtual interpretation methods. The findings support the integration of formal interpretation training into medical curricula to enhance future physicians’ ability to deliver culturally and linguistically appropriate care.

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  Menstrual Hygiene Screening Needs Assessment in South Dakota

  Mariah M. Shafer and DenYelle Kenyon

  Introduction: 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.

  Methods: 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.

  Results: 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. 24% said they were not at all aware of their patients’ access to MHM products. 74% report never asking their patients if they have access to adequate water and sanitation resources. 15% report never asking their patients which type of hygiene product they use.

  Discussion: 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.

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  Walk With Ease Benefiting South Dakota

  Bailey Thooft and Jennifer Kerkvliet

  The Walk With Ease (WWE) program is a free, evidence-based, six-week walking initiative originally developed by the Arthritis Foundation to support adults with arthritis and other chronic conditions. This study evaluates the impact of WWE in South Dakota, focusing on participant outcomes related to overall health, physical activity, and chronic condition management. Participants engaged in either instructor-led or self-directed formats and accessed an online portal for resources. Pre- and post-surveys revealed that most participants improved or maintained their health metrics, with 44% reporting improved management of chronic conditions and 30% increasing daily walking time. The online portal was well-received, with 90% of users rating it as easy or very easy to use. Despite limitations such as a 61% loss to follow-up and a small sample size, the findings suggest that WWE, especially with digital support, can be a valuable tool for promoting physical activity and health management in rural populations like South Dakota’s. Future research should explore program fidelity and compare outcomes before and after the implementation of online resources.

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  Disability Lectures, Panel Discussion Improve Medical Student Attitudes, Knowledge in SD

  Keely Walker and Eric Kurtz

  Despite growing recognition of persons with disabilities (PWDs) as an underserved population, healthcare disparities persist, often exacerbated by provider misconceptions and lack of training. This study evaluated the impact of a two-part educational module consisting of a didactic session and a panel discussion with individuals with disabilities focused on healthcare students’ knowledge and comfort in caring for patients with intellectual and developmental disabilities (IDDs). Conducted at the University of South Dakota, the sessions included pre- and post-surveys assessing attitudes, confidence, and perceived competencies. Results from 35 participants, primarily medical students, showed statistically significant improvements in 11 of 13 measured domains, including communication skills, understanding of disability experiences, and comfort discussing sensitive topics. The findings support the feasibility and effectiveness of brief, low-resource educational interventions in enhancing disability competency among future healthcare providers. The study highlights the importance of integrating disability education into medical curricula and suggests future directions for interdisciplinary and inclusive training.

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  Examining the Relationships between Work Environment and Stress Coping Mechanisms with Burnout in Medical Students

  Oluwafunke Oluwatosin Ogunremi

  Introduction: Throughout the duration of medical training, learners are oftentimes overworked and faced with high levels of stress and pressure; this can decrease quality of life for many individuals. The goal of this study was to gain an understanding of how work environments and stress coping mechanisms play a role in the amount of burnout experienced by medical students.

  Methods: Data was collected from medical students at the University of South Dakota Sanford School of Medicine by using a 22 question Qualtrics survey. The survey remained open until a 50% response rate was achieved from the student body. The results of the survey were analyzed by using 2 sample t-tests and ANOVA tests as appropriate.

  Results: No statistically significant differences were found in total burnout ratings, coping mechanisms, and perception of the work environment between the different cohorts of medical students. Students who had healthier behaviors, such as following CDC recommendations on sleep, exercise, and fruit and vegetable consumption or practicing meditation and mindfulness, had lower levels of burnout compared to those who did not. Students who stated on the survey that they were experiencing burnout had a lower overall score on the survey, indicating higher levels of burnout.

  Conclusion:Some medical students may recognize when they are burning out, so providing resources to help them incorporate healthier behaviors into their lifestyles may help aid in burnout recovery. Finding effective ways to help students deal with stressors and develop coping mechanisms improves their own quality of life and can hence improve patient outcomes.