Archives for May 18, 2022

Finding Solutions Beyond The Classroom

By Molly C. Nance

UNL Students Develop New Ag Technologies

Finding solutions to complex problems is like finding a needle in a haystack — or maybe finding something more useful, like answers about crop health from infrared satellite imagery or ways to use robots that keep farmers out of dangerous grain bins or methods to move cattle between pastures without fencing. These futuristic technologies are in development right now through entrepreneurial startups at a business incubator partnership in Nebraska called The Combine.

 

THE COMBINE

Launched in October 2019, The Combine is a partnership with the Institute of Agriculture and Natural Resources at the University of Nebraska–Lincoln and Invest Nebraska, a nonprofit venture development organization that advises and invests in companies and early-stage business ideas in Nebraska.

Several private businesses, government agencies and nonprofit organizations are also involved, creating a powerful public-private partnership to foster innovation. The Combine works to provide capital, connections and curricula to help early-stage agriculture technology and food entrepreneurs from the Sandhills to the banks of the Missouri River.

A key to The Combine’s success is its connection with IANR, said Matt Foley, The Combine’s program director.

“Most important is IANR’s knowledge base, expertise and workforce development potential,” he said. “We’ve had out-of-state companies interested in partnering with us because they know we have brilliant professors and students focused on the future of agriculture and food production.”

Michael Boehm, University of Nebraska System vice president and Harlan Vice Chancellor for IANR said, “Building The Combine and, in the process, a bridge between Nebraska’s researchers and entrepreneurs makes all the sense in the world.

“UNL has a worldwide reputation as a leader in agricultural innovation, and Nebraskans are famous for their work ethic, ingenuity and systems thinking. … Throw in some long-standing and incredibly productive partnerships with industry, state and federal agencies, commodity groups and venture capital, and you have the perfect hub for all things ag- and food-tech. I can’t imagine a place better suited for this kind of collaboration and growth than Nebraska.”

Located in the Rise Building on Nebraska Innovation Campus, The Combine has a physical incubation space where undergraduate and graduate students, faculty and staff can work alongside other motivated, like-minded entrepreneurs. The organization provides educational programming, access to capital investment, networking opportunities and business resources to support the development and scale of new ag-tech companies.

 

SENTINEL FERTIGATION

One of those promising startups is Sentinel Fertigation, which uses drone- and satellite-collected imagery to predict when a corn crop needs fertilization.

“When I came to Nebraska as a master’s student, I knew I wanted to work on the nitrogen dilemma — nitrogen management for farmers,” said Jackson Stansell, CEO and founder of Sentinel Fertigation and a UNL doctoral candidate. “It’s a significant problem throughout the country, but especially in Nebraska because of groundwater contamination. It’s also a profitability issue because nitrogen is an expensive resource.”

A Harvard graduate and Alabama native, Stansell said Nebraska is also unique in the prevalence of irrigation. “We have the most irrigated acres of any state in the United States,” he said. “Fertigation is the process of applying fertilizer through irrigation, most commonly through pivots, and the technology hasn’t advanced much. Our team at UNL saw an opportunity to improve this and better manage fertigation.”

Stansell’s approach involves multispectral imaging and a unique algorithm he helped develop to evaluate crop plant health.

“Basically, we’re providing farmers with information about whether or not they need to apply fertilizer in a given week,” he said. “We help them manage their fertigation better and do it in a way that helps protect the environment and human health by reducing excessive nitrogen applications.”

Sentinel Fertigation uses patent-pending technology that analyzes plant nitrogen sufficiency using light reflectance off the crop canopy.

“Our indicator block framework gives us a week lead time, so we can provide predictive recommendations that allow the farmer to get ahead of nitrogen stress,” Stansell said. “The farmer can then apply fertilizer just before stress happens and preserve the yield potential of the crop.”

Importantly, this improved efficiency also adds to profitability.

“In 96% of our test cases, this system has resulted in higher yield per unit of nitrogen applied versus what farmers were doing previously,” he said. “Across those fields, we’ve saved an average of 22 pounds of nitrogen per acre, which is a significant amount considering farmers use an average of 200 to 250 pounds of nitrogen per acre.”

For reference, Nebraska is home to 5.2 million acres of irrigated corn crops.

Sentinel Fertigation has the potential to enable more value for growers, while also reducing nitrogen load in soil and groundwater.

“With ecosystem services markets that are coming online now, and with consumer-packaged goods, sustainability is important,” Stansell said. “We can be one of the companies that can verify sustainable, environmentally sound practices were used.”

Stansell said the system is geared toward larger farm operations and most likely will be used by agronomic advisers. “Farmers and consultants have been excited to learn about the system. They want to see a finished product,” he said. “We’re working on getting this to a seamless web application that’s easy for users to learn and implement, with recommendations delivered in a straightforward way.”

Farmers aren’t the only ones excited about Sentinel Fertigation. Stansell has received a $100,000 prototype grant from the Nebraska Department of Economic Development; a $25,000 strategic investment and development partnership with Agri-Inject Inc. of Yuma, Colorado; and a $25,000 investment from the Husker Venture Fund, a UNL College of Business program supported by private gifts from alumni and friends.

Stansell also was named Outstanding Graduate Student Inventor of the Year by NUtech Ventures, a nonprofit technology commercialization affiliate of the University of Nebraska, serving the Lincoln and Kearney campuses.

In addition, he received student support from the Daugherty Water for Food Global Institute at the University of Nebraska. Stansell is quick to share credit for his success with his University of Nebraska faculty, graduate students and extension educators.

“I’ve been blessed with university resources and connections here in Nebraska that I don’t think I would have found anywhere else,” Stansell said.

“The Combine has helped us get off to a strong start. Now, if we can gain additional funding, we can get a precision agronomist and some software developers on board and also grow our executive management team to really take Sentinel Fertigation to the next level.”

What does the future possibly hold for this high-tech startup?

“Honestly, I hope Sentinel Fertigation does not exist as a standalone app five to 10 years down the road,” he said. “Farmers and agronomists don’t want another app. I’d like to see this technology integrated into irrigation management systems to increase efficiency so farmers can manage everything about their irrigation and fertilization needs in one place.”

 

GRAIN WEEVIL

Grain Weevil is another prospering member of The Combine, born from a farmer’s request that he and his kids never have to enter a grain bin again.

Farmers often enter the bins to break up clumps or clogs to get the grain to flow out freely — a dangerous practice because of the risk of suffocation in the grain, which can behave like quicksand.

Grain bin accidents account for more than 20 deaths each year and many more injuries caused by augers within the bins that can crush limbs as a farmer attempts to move grain through them.

“Neither my son nor I are farmers,” said Grain Weevil CEO Chad Johnson, who founded the company with his son, Ben, a graduate of the UNL College of Engineering. “But we have always been interested in robots. Ben had an opportunity to develop a robot for a company in Chicago while he was in high school. A family friend saw that robot and asked if Ben could make a robot to keep him and his kids out of the grain bin.”

The pair did their research and found that although there are mechanical spreaders and electrical sensors in grain bin management, there weren’t any robots that could move and manipulate the grain.

“My electrical engineering education at the university helped me gain the knowledge I needed to develop the technology,” said Ben Johnson, Grain Weevil co-founder and chief innovation officer. “The Combine got us off the ground quickly — connecting us with partners and sharing ways to grow this idea into a business model.”

After several test concepts, the Grain Weevil robot progressed to a model that works well on grain using auger-based propulsion. Like a giant grain weevil bug, the device scurries across the grain, breaking clumps or clogs and feeding grain into extraction augers. Multiple robots can work together, manipulating the surface of stored grain and accomplishing different tasks.

 

“We started this as a safety device,” said Chad Johnson. “Farmer well-being is our No. 1 mission. But there are huge efficiencies we’ve discovered along the way. While the Grain Weevil is doing its thing, the farmer can be doing other tasks or watching their kid play baseball. Plus, there’s also improved quality by more effectively monitoring and managing stored grain.”

In addition to moving grain, the robots are collecting a variety of data, such as temperature, grain moisture and 3D imagery within the bin to detect foreign material and survey grain condition — information the farmer can use to quickly address any issues before they become problems and protect grain quality, maximizing their income.

With more than a million grain silos on farms across the U.S., there is massive market potential for the Grain Weevil.

“There are 12 million bushels of grain within a day’s drive of my hometown, Aurora, (Nebraska),” said Chad Johnson. “The Weevil could also work in commercial facilities and with specialty crops, like edible beans and nuts. There are different use cases for both grain and non-grain applications.”

The technology has sparked investment and honors from across the country, including winning the Farm Bureau Ag Innovation Challenge, the Lemelson-MIT Student Prize for Collegiate Inventors in the “Eat It!” category and the audience favorite honor at the Dartmouth College Tuck School of Business Virtual Summit on AgTech, along with securing a $1.6 million series seed investment round led by Invest Nebraska.

With additional resources, the Johnson team said they’d like to add talent to their staff and scale up Grain Weevil production.

“Years down the road, we hope to never see ladders attached to grain bins,” said Chad Johnson. “All the tasks can be done by the Grain Weevil with zero accidents and deaths. There’s going to be a robot in every grain bin eventually, and we hope it’s a Grain Weevil.”

 

CORRAL TECHNOLOGIES

Innovative technology is also expanding in the livestock sector. UNL graduate and Kearney, Nebraska, native Jack Keating is putting his mechanical engineering education to work on his family’s cattle ranch in northern Nebraska.

“Growing up, I spent a lot of time with my dad on fencing,” Keating said. “It’s a tough job, and I thought there has to be a better way. My dad said, ‘Wouldn’t it be great if there was invisible fencing for cattle?’ and that’s what started the idea.”

Effective pasture management is an important part of ranching, both for profitability and sustainability. To avoid overgrazing, livestock need to be rotated through a system of pastures — a manual process that is labor-intensive and hazardous. Studies show that livestock handling causes up to a quarter of all farm injuries, not including injuries involved with fencing, such as cuts, amputations and electrocution.

Keating described how the company’s technology works. “It started out as a collar-and-ear-tag system,” he said. “But to make the batteries last longer, we switched to an all-collar system that emits a small electrical stimulation — about the same level used in electronic fencing collars worn by dogs — to define pasture boundaries.”

The system includes mapping software, which can be used on a phone, computer or tablet, to create new fences across pastures, maximizing pasture grazing for any operation and accelerating cattle weight gain.

“Using Corral Technologies, a rancher knows their cattle are located where they are supposed to be. They can move cattle from one spot to another with the click of a button and create grazing plans to optimize pasture utilization,” Keating said. “These are benefits on top of the time and cost saved from manually managing fence lines, as well as protecting the health and safety of the ranchers.”

Keating credits The Combine with taking his idea from notes and drawings to actual product development and a business plan.

“I just knew what I wanted the system to do, but The Combine helped me understand the business framework and connected me to partners who shared input and saw the potential for this to be more than just a fencing product,” he said.“I’ve heard from ranchers across the country. They are so receptive to the system. So really, the biggest challenge has been on the development side — finding an affordable, effective and reliable mechanism for the collars.”

Last year, Corral Technologies was a grand-prize winner in the UNL College of Business New Venture Competition, an annual business pitch contest funded by private support. Corral received a $25,000 grant. The fledgling company also received $150,000 from the Nebraska Prototype Grant Program and was accepted into phase one of the AgLaunch Accelerator Program.

In the future, Keating said he sees Corral Technologies as a global system. “Our mission is to help ranchers everywhere have more profitable enterprises and safer processes,” he said. “But I see us as being not only a hardware company but also getting more into the software side as well, where we’re a full ranch management platform.”

The opportunities aren’t limited to cattle.

“There are huge opportunities in dairy cattle, backgrounding operations, seedstock operations, goats and sheep,” Keating said. “We can expand out into these other sectors. A lot of people quantify the benefits in dollars, but think about the benefits in terms of improved health and safety when you’re not digging post holes, running fence or working closely with animals weighing over a ton.”

••••

These companies show the impact that can be made through Nebraska-bred ingenuity, education, collaboration and financial support. Locally developed agriculture technology can lead to global solutions — filling dinner plates from Chadron to Cameroon and promoting a better quality of life, while conserving the state’s vital natural resources.

Charting a Course to Survival

By Ed Rider

Cutting-edge Clinical Trials Provide New Hope for Early Detection of Pancreatic Cancer

“You have pancreatic cancer.”

These four words are among the most devastating a person will ever hear. The difficulty of diagnosing cancer of the pancreas early makes it one of the most lethal and aggressive types of cancer — the third leading cause of cancer deaths in the United States. These individuals have just a 10% chance of living beyond five years. Most are diagnosed with stage 4 cancer and have little hope of long-term survival.

On average, 115 Americans die from this dreadful disease every day.

“Jeopardy” host Alex Trebek and baseball Hall of Famer Bob Gibson both died from pancreatic cancer about a month apart in the fall of 2020. Every year, more than 60,000 people in the United States are faced with a similar diagnosis — people like Linda Kimball, the owner of Old School Clipper, a men’s barber shop in Atlantic, Iowa.

“I was in shock and a little scared because I knew that it was a bad cancer to have,” Kimball said.

PANCREATIC CANCER CENTER OF EXCELLENCE

Despite the dismal outlook for survival, researchers and clinicians at the University of Nebraska Medical Center and its clinical partner, Nebraska Medicine, believe pancreatic cancer can be detected in its earliest stages. That belief is so strong that in 2018, the University of Nebraska Board of Regents approved establishing the Pancreatic Cancer Center of Excellence at the Fred & Pamela Buffett Cancer Center, which celebrates its five-year anniversary this summer.

James Armitage, M.D., and Shirley Young both lost their spouses to pancreatic cancer. Jim Young, former chair of Union Pacific Railroad, died in 2014, two years after his diagnosis. Nancy Armitage died 16 months after her diagnosis of pancreatic cancer.

“It’s hard to describe how much this disrupts your life,” said Armitage, the Joe Shapiro Professor of Medicine in UNMC’s division of oncology and hematology and a cancer physician at Nebraska Medicine. “I went to talk to Shirley’s family about developing a pancreas cancer program, and she understood the situation.”

The result was the development of the Pancreatic Cancer Center of Excellence, which features a comprehensive program of research and care. Sunil Hingorani, M.D., Ph.D., an accomplished and internationally recognized pancreas cancer researcher and clinician, has been named the inaugural recipient of the Nancy Armitage Pancreas Cancer Clinical Research Presidential Chair and the first director of the Pancreatic Cancer Center of Excellence at UNMC and Nebraska Medicine.

Dr. Hingorani’s research success is well documented. He helped develop a model to accurately mimic human pancreas cancer from its precancerous inception to its advanced stages.

THE PATH TO BETTER OUTCOMES

Kelsey Klute, M.D., assistant professor of internal medicine at UNMC’s division of oncology and hematology and a gastrointestinal medical oncologist at Nebraska Medicine, has treated more than 300 patients with pancreatic cancer, most of whom had advanced disease. Klute said that UNMC’s world-class researchers and clinicians are working diligently to find new ways to detect pancreatic cancer earlier through four clinical trials and a recently developed program in early detection — initiated by Tony Hollingsworth, Ph.D., the Hugh & Jane Hunt Chair in Cancer Research at UNMC — that screens family members with an inherited risk for developing this cancer.

Klute said she and her colleagues hope to expand the availability of clinical trials at UNMC and Nebraska Medicine. She said she is confident the trials, which will focus on early detection, will help lead to increased survival of the disease.

“Clinical trials are our best way to improve survival not only for patients diagnosed with pancreas cancer over the next five or 10 years, but also for patients facing pancreas cancer today,” Klute said. “Their best chance at beating the status quo is by enrolling in a clinical trial.”

ROAD TO RECOVERY

Kimball never considered in March 2021 that she might have pancreatic cancer when she began to experience pain in her stomach that radiated to her back. Although she had developed acid reflux disease, high blood pressure and Type 2 diabetes in her 50s, she considered herself to be healthy for a woman in her early 70s. Thinking her acid reflux medication was no longer working, she went to see her physician in Atlantic. Additional tests at the Fred & Pamela Buffett Cancer Center revealed pancreatic cancer.

“I went into it thinking, ‘OK, it’s stage 1. Let’s get it fixed,’” Kimball said. “I just decided that I was going to take things one day at a time because I wasn’t ready to lie down and die.”

Klute presented Kimball with the opportunity to take part in a clinical trial that incorporated a heart failure medication called digoxin with FOLFIRINOX, a standard chemotherapy drug. Kimball said she jumped at the opportunity.

“I had no reservations once Dr. Klute explained that this was not a new medication, that it had been around for years and had been used for heart conditions,” Kimball said.

The trial included eight rounds of chemotherapy, each consisting of six hours of treatment at the Fred & Pamela Buffett Cancer Center and another 48 hours of treatment at home. The process was repeated every two weeks. Six weeks after completing this treatment regimen, Kimball underwent Whipple surgery, a complex, eight-hour procedure to remove the head of the pancreas, where most cancerous tumors are located. After recovering from surgery, Kimball completed four more rounds of chemotherapy independent of the trial.

Despite some lingering effects from the chemotherapy, Kimball is feeling better about her prognosis. On Dec. 30, Kimball received news that her most recent CT scan showed no signs of cancer.

“At this point, my body is still healing. I’m getting stronger every day,” she said.

All the Right Moves

By Susan Houston Klaus

How the UNO Pitching Lab Is Helping Athletes Improve Their Games

The digital images generated in the University of Nebraska at Omaha Department of Biomechanics might prompt a double take. Human skeletons appear to be pitching a baseball or softball, spiking a volleyball or swinging a golf club. But these bundles of bones are actually living, breathing athletes — from UNO, the local community, the region and the country.

They’ve come to the UNO Pitching Lab in the Biomechanics Research Building for movement assessments designed to improve their performance and prevent injuries from taking them out of the game. It’s the first time the department has combined biomechanics, athletic training and data gathering to benefit the athletic community. And like other unique programs happening in the Biomechanics Research Building, it’s giving students experiences they wouldn’t find anywhere else.

The Biomechanics Research Building garners envy around the world for both its people and its equipment, said Jeff Kaipust, UNO’s assistant director for biomechanics. Opened in 2013 and expanded in 2019, the building represents the generosity of Nebraskans, particularly the Ruth and Bill Scott family, who provided the lead donations for the building’s construction and expansion, and the support of the UNO administration and University of Nebraska System.

“None of the wonderful things we do in UNO Biomechanics would have been possible without private support, especially from the Ruth and Bill Scott family,” said Nick Stergiou, Ph.D., assistant dean and director of the UNO Division of Biomechanics and Research Development.

“This support is fundamental for construction of our facilities,” Stergiou said. “It is also essential for retaining and attracting talented young scientists who work in the pitching lab.”

Together, those elements have created a place that puts a high value on collaboration — a place where, Kaipust said, “one lab doesn’t belong to one researcher; every space in our facility is shared.”

The lab is populated by people from around the world with all kinds of expertise, including in mathematics, engineering and kinesiology.

“From the brain to the individual muscles to the different properties of the ligaments, tendons and bones, we’re just trying to solve interesting problems on the way we move,” he said.

The idea for the pitching lab started with an athlete.

Tyler Hamer is a former NCAA Division I pitcher who played at the University of Illinois before transferring to UNO for his last two seasons. As he was completing his master’s degree in biomechanics at UNO in 2019, he mulled over his next move.

“As a player growing up, a pitcher in high school and also in college, baseball’s been a lot of who I was and who I still am now,” he said.

He wondered if it was possible to pursue a doctorate with his dissertation focused on baseball pitching. Hamer talked it over with his faculty adviser, Brian Knarr, Ph.D., an associate professor in the UNO Department of Biomechanics. For a decade, Knarr has been doing his own research on understanding how people move, how injuries can be prevented and how to optimize rehabilitation from an injury. He’s also a lifelong baseball fan.

With Knarr’s support, Hamer outlined an idea for a lab focused on the unique needs of athletes. He tested the system out on himself, again stepping on the mound to deliver pitch after pitch — this time, in the name of scientific research. Soon, the lab had the interest of others on campus.

That included Adam Rosen, Ph.D., and Sam Wilkins, Ph.D., at the UNO School of Health and Kinesiology. Both have been Division I baseball athletic trainers; now they train the trainers who work with UNO athletes and bring a clinical aspect to the lab. Hamer and the team also got buy-in — and an old pitching mound they reengineered to use in the lab — from UNO baseball coach Evan Porter.

The pitching lab officially hosted its first subjects in October 2019, bringing in UNO Baseball pitchers. They’ve returned regularly to check their progress. Porter said players have tweaked their movements and improved their velocity on the mound. But there’s also the unmeasurable part of the assessment he’s glad they have access to. Catching movements that may lead to injuries is crucial to preventing them and staying in the game. Having that information gives them added confidence as athletes, Porter said.

“It provides them with more knowledge about how their bodies work, how their mechanics work, and that leads to better tendencies, better performances and more wins, hopefully, for the Mavericks for the long term,” Porter said.

The collaboration among biomechanics, athletic training and the athletes they serve has been valuable for biomechanics as a program and for its students, said Knarr.

“It’s something that is incredibly attractive for students coming into the program,” Knarr said. “We’ve seen increases in recruiting and increases from the student body to come to our program to work with our athletes, to work with our faculty doing the science.”

Students also get a tremendous opportunity to work with athletes at an elite level, he said.

“Not many places in the country and across the world really have the opportunity to work with high-level athletes,” Knarr said. “Often, they’re either on professional teams or they’re siloed off in their academic or athletic programs. But some of the best opportunities to learn and to understand the sport are to work with athletes that are great at that sport.”

Baseball assessments were just the beginning for the lab.

In the past couple of years, the lab has expanded to include testing for UNO athletes in softball, volleyball, golf, swimming and diving, and men’s soccer, as well as players of middle-school age and up from the greater community. The lab has developed a reputation not only as an assessment destination, but also a learning resource for local students. Athletes with their eyes on the Major League Baseball draft have also made the trip from around the country to get advice on how to improve their performance and throwing velocity.

Marriah Buss recently visited the lab with her UNO Volleyball teammates for an assessment. An outside hitter, she’s been a standout on the court for years: In high school, she finished her years at Lincoln Lutheran with the second-most kills in Nebraska history. So, a particular finding from her assessment was more than a little surprising.

“One thing we learned about me is I have really bad shoulder mobility,” she said. “So, we’re wondering how I’m able to hit the ball, and how I’m able to hit it hard. Through the biomechanics testing, we learned it’s not through my shoulder that I’m hitting the ball, but it’s because of my hips, how they rotate and the speed at which they rotate.”

Buss said she was “just really shocked” by the information.

“Now I know that by working out my hips, it will improve my arm swing and how well I’m hitting the ball,” she said. “It’ll definitely become something I’m way more focused on now than I was before.”

Buss is looking forward to putting the newfound knowledge to work so she’s even more powerful when the season begins again in late August.

For Hamer, research in the lab has provided a bigger view of where his career may lead. In October 2021, he joined biomechanists from UNO Pitching Lab collaborator Wake Forest University in the Dominican Republic at the MLB International Combine in Santo Domingo. There, he operated the biomechanics pitching lab, collecting data for MLB teams to review for the draft season. His paper, co-authored with Rosen, was published in the Orthopaedic Journal of Sports Medicine in March 2021.

Those experiences wouldn’t have been possible without those who originally put UNO Biomechanics on the map, Hamer said. “It’s really just the hard work that happened before I ever arrived here that’s allowed me and others working in the lab to make it what it is today,” he said. Hamer said, ever since he started playing baseball, he’s wanted to make it to the majors. Today, his work in the lab has helped him achieve that dream — just not in the way he imagined.

What’s next for him?

“It’s just kind of seeing where life takes me and just going each day as best as I can,” he said. “I’ve always been a believer in hard work, and if you work as hard as you want to, you can make anything happen.”

The Ties That Bind

By Robyn Murray

UNK, UNMC Work to Bring More Medical Professionals to Rural Nebraska

When Sandra Bresnahan, M.D., was a child, she often came with her parents to doctor appointments. Her parents were immigrants from Mexico and didn’t speak much English. So they needed her to explain their symptoms to the doctor and translate what was told to them.

“As a young kid, that’s kind of hard,” said Bresnahan, who now works as a family physician at Lexington Regional Health Center. “Kids should be sheltered from having to do that or knowing what the health issues of their parents are, because it creates anxiety that they don’t need growing up.”

Bresnahan is a graduate of the University of Nebraska at Kearney and the University of Nebraska Medical Center. She grew up in Lexington, a town of about 10,000 people in central Nebraska. As with many small Nebraska towns, Lexington is becoming more diverse. The town’s Hispanic population has boomed in recent years as immigrants have been drawn to work at local meatpacking plants. That means more and more Lexington patients need physicians who can speak Spanish.

“We tend to relate to people that are similar to us,” Bresnahan said. “For somebody, if they have a doctor that speaks Spanish, that understands their cultural beliefs, it does make them feel a little bit more understood or safer in that environment.”

Getting Bresnahan to practice as a physician in her home community was a coup for Lexington. Lexington Regional Health has kept tabs on Bresnahan since high school, when they first learned she was interested in medicine.

“[We said,] ‘Hey, we definitely want to follow this person and see where things go,’” said Francisca Acosta-Carlson, M.D., the chief medical officer at Lexington Regional Health Center. “And when she ended up getting into medical school, there was definitely a bigger push for recruiting her.”

 

But Lexington’s need for Spanish-speaking physicians is just one piece of a far more complex puzzle. Rural towns across Nebraska are facing dire shortages of all types of medical professionals. According to a 2020 study by the Nebraska Area Health Education Center Program and UNMC, 14 of Nebraska’s 93 counties do not have a primary care physician; 16 counties have no dentists; 17 have no pharmacists; and the north-central region of the state has virtually no occupational therapists, speech-language pathologists or medical nutrition therapists. The study said Nebraska’s population shifts are exacerbating the problem, and the result is growing inequity and unmet health care needs.

Part of the challenge is it can be difficult to convince people to move to a small town — particularly physicians and other medical professionals who may be eyeing big-city opportunities and need to ensure they can pay back hefty medical school tuition loans. But UNK and UNMC are committed to changing the status quo.

In 2010, the two teamed up to establish the Kearney Health Opportunities Program. KHOP offers students interested in health care careers a full-tuition scholarship to attend UNK and guaranteed admission to UNMC if all requirements are met. Currently, more than 100 UNK students are receiving their pre-professional training in one of 10 medical fields. In 2015, the UNMC-UNK Health Sciences Education Complex opened its doors, offering start-to-finish programs in nursing and allied health professions on campus in Kearney. These programs have proven success based on the 50/50 maxim: 50% of graduates find a job within 50 miles of where they completed their residencies.

“If we want health professionals to practice in rural communities, we have to train them in rural communities,” said Nicole Carritt, MPH, director of Rural Health Initiatives at UNMC.

The benefit of keeping medical professionals in rural communities is multifold. Not only do small towns need the services those practitioners provide, but they also need their economic impact.

“An advanced practice registered nurse contributes about $250,000 annually to a local economy,” Carritt said. “And when we’re talking about a physician, we’re talking about $1.3 million annually. So they’re certainly important in increasing access to care and the health of the population, but also to the economic viability of our rural communities.”

Highly educated graduates also become leaders in their communities, taking on volunteer roles or sitting on boards. Andy Craig, M.D., is a family physician at Kearney County Health Services in Minden. He grew up in Minden and said he always wanted to be a physician.

“We had a family physician I really looked up to,” Craig said. “So even as a child, I knew that I wanted to be a physician.”

Craig got his bachelor’s degree at UNK and enrolled in KHOP in one of the program’s first cohorts of students. He said his experience there helped him succeed both in Kearney and Omaha, where he completed medical school and his residency at UNMC.

“Looking back on that experience, it was so positive,” he said. “When your aspirations are to do something [that requires another four years of coursework], you have people that are so supportive, people that want to push you to do your best, and people that care about your success.”

It also helped that his younger brother, Cade, was following in his footsteps.

“It’s not something I head-locked him about or anything,” Craig joked, “but I always thought it would be awesome to work together.”

Cade Craig, M.D., attended UNK four years after his older brother and followed him to medical school in Omaha after receiving his bachelor’s degree. He said when his brother started talking about going into medicine in seventh grade, the idea just stuck, and now he feels fortunate they get to work together in the same clinic in their hometown.

“Medicine is kind of a team sport nowadays,” Cade Craig said. “Especially with complex cases, having colleagues that you trust and value to discuss the findings and to see what their thoughts are based on that data is pivotal to being able to really take good care of people.”

Cade Craig said practicing in a rural community has many benefits, including the variety general physicians experience as opposed to specialists. Andy Craig agreed and said the relationships physicians build with their patients are what make the work fun.

“Building those relationships among generations of families is really a joy,” he said. “And it really does provide a more holistic opportunity to care for the patient because you know things that are going on in their lives — their stressors, their joys. It allows you to care for the patient in a better way because you know what’s going on behind the scenes.”

The Craigs are living out their dream, and they wouldn’t have it any other way. But their careers might not have gone the way they did. They each spent seven years studying and completing their residencies in Omaha, and as Carritt said, “life happens” when people move away. Sometimes it’s tough to come back.

“Once you make that step, sometimes it’s really difficult to go back,” Carritt said. “You’re exposed to new things; you meet folks. The reality is, the closer that we can keep them to home and where we want them to practice, the more likely they are to stay in our rural communities.”

UNK and UNMC work hard to ensure the ties that bind students to their rural communities are nurtured throughout their educational careers, whether they are in Kearney or Omaha, said Peggy Abels, director of health sciences at UNK. KHOP students are grouped together in learning communities; they live together and form connections that last beyond graduation, and UNMC provides opportunities for rural rotations whenever possible.

But not only can studying in Omaha draw students away from their rural roots, the prospect of moving to a big city can also be a deal breaker for some students considering health care careers.

“Forty percent of our students are first-generation students,” Abels said. “For a lot of them, to move to a city with several stoplights is kind of a monumental move when they start college.”

Medical school is also one of the most challenging educational experiences, and leaving a support network can make it that much more daunting.

Bresnahan, who was also a KHOP student, said she would have loved the opportunity to attend medical school within a short driving distance from home.

“Medical school is really overwhelming,” she said. “I would try to come back as much as I could. But with how much work there is, it was really hard to even come back on the weekends. So it would have been nice to just be close to home.”

UNK and UNMC are working to expand their collaboration to create more opportunities for future physicians, pharmacists, public health professionals and others to complete their studies closer to home. Those efforts were supported tremendously when Nebraska lawmakers approved $60 million during the spring legislative session to help fund the UNK-UNMC Rural Health Education Building, which will cost $85 million in total. But the work is not done yet. Private support will be crucial to raise an additional $25 million needed to complete the project, and collaboration will be key to its success.

“There’s not one piece of that puzzle that’s more important than the other,” Carritt said. “It’s not the resources or the community or the academic system. We all have to kind of work in concert to problem-solve and keep our finger on the pulse of what’s happening.”