Purpose: As healthcare evolves to consider the psychosocial effects of injury and disease on patient well-being, attention has turned to the impact of the patient-provider relationship. One foundational construct, the working alliance, emphasizes an emotional bond, agreement on goals, and collaboration on tasks between patient and provider. Despite emphasis on a working alliance in healthcare research, a conceptual understanding of the components of the athletic trainer-patient relationship in athletic training remains largely unexplored. The purpose of this research was to learn how athletic trainers develop and utilize the working alliance with patients.

Methods: This was a grounded theory qualitative study. Six collegiate athletic trainers (3 males, 3 females; athletic training experience = 4.33 ± 1.03 years) employed at institutions participating in NAIA (1), or NCAA athletic divisions D1 (2), D2 (1), D3 (2) were purposefully selected to allow for maximum variation. Two semi-structured 1-hour video-conference interviews were conducted with each participant. Interviews were audio-recorded and transcribed. Data was analyzed and coded inductively to inform categories, sub-categories, properties and dimensions. Trustworthiness was established with prolonged engagement in the data, member checks, and use of an inquiry auditor.

Originality: Athletic trainers have a vested interest in supporting holistic patient-centered care. Currently, there is no model unifying athletic training professional practice with the concept of a working alliance. Generating understanding of a working alliance in athletic training may encourage appreciation of its role in treatment and rehabilitation and provide athletic trainers new methods to enhance patient relationships. This research aimed to achieve conceptual clarity and advance understanding of the working alliance. It also aimed to connect athletic trainers with new ways to enhance therapeutic relationships and patient outcomes to enrich care across the discipline.

Significance: This study illustrates a working alliance construct in athletic training, clarifying the suggestion that a working alliance may be universally applicable. Poor relationships between athletic trainers and patients can present a barrier to therapeutic outcomes, while athletic trainers’ skill in effectively building relationships can overcome such barriers. Connecting athletic trainers with skills to establish connection and trust, collaborate with patients can align athletic trainers with patient-centered approaches. Confidence integrating these skills into professional practice can also improve working alliances. Classroom integration of rapport-building skills, counseling techniques, and interpersonal communication proficiency can enhance students’ clinical learning and patient care experiences prior to professional practice. This can promote holistic patient-centered care and enhance professional capability. Moreover, skills in counseling, interpersonal communication, and relationship development are inherent to the preparation of counselor educators and counselors. Integrating skills training across disciplines increases skill breadth and application and arms athletic trainers with knowledge that can help them best meet patient needs.

Halogen bonds and their applications in chemistry and biochemistry has become one of the fastest growing research topics in the past decade. Much of this growth is attributed to elegant computational and solid-state studies, whereas solution data has lagged. This research advances the fundamental understanding of organic halogen bonding by developing a bidentate pyridinium halogen bond receptor and the nearly isostructural hydrogen bonding control molecule to study in the solution and solid phases. Specifically, this study investigates the intramolecular rigidification of halogen bond receptor via hydrogen bonding. The synthesis, crystal structures and preliminary binding properties of a new class of charged bidentate halogen bonding organocatalysts will be presented.

Many climate models predict increasing atmospheric carbon dioxide (CO₂) concentrations will increase the amount of carbon (C) terrestrial ecosystems can store. Higher levels of C storage in terrestrial ecosystems may slow the pace of climate warming caused by human activities. Nutrients must be available in sufficient quantities to support increased C storage, however, and when these predictions are adjusted for their availability they are muted or even reversed, with terrestrial ecosystems releasing CO₂ instead of storing more C. Therefore, an increase in productivity and C storage levels would require new nutrient inputs or an increase in the rates of nutrient recycling– or reuse – within terrestrial ecosystems. The two main nutrients that limit C storage in terrestrial ecosystems are nitrogen (N) and phosphorus (P). Multiple pathways of new N inputs exist and there is some evidence that climate warming could increase N recycling rates. By contrast, P inputs to ecosystems are very low and temperature effects on P recycling rates remain poorly understood. Under current conditions, recycled P supports more than half of P demand for the growth of tropical rain forests, which are responsible for a disproportionately large share of C storage for the size of their land mass. Future increases in C storage would require elevated P recycling rates to keep up with elevated demand. To test the effects of temperature on P recycling rates, we incubated soils from two tropical rain forest sites at a range of temperatures below and above the average annual temperature for each site, respectively. We measured P recycling rates and the activities of the enzymes responsible for this recycling process. We predicted that rates of P recycling would increase with temperature because enzymatic recycling processes tend to be sensitive to temperature increases.

The rate of P recycling increased with temperature at both sites, but only significantly so when temperatures were at least 10^oC greater than the site average annual temperature. The P recycling rate response to temperature was stronger at the site with less P. Even though the direct predictions of global climate warming only predict 3-5^oC temperature increases by 2100, our results suggest that ecologically relevant increases in P recycling rates in tropical rainforests likely require temperature increases much greater than those predicted for human caused climate warming. Therefore, while terrestrial ecosystems may be able to overcome potential nutrient constraints to C storage by recycling nutrients more quickly, our preliminary results suggest that climate warming driven increases in nutrient recycling rates are insufficient to meet the future nutrient demands of elevated C storage.

Cities and towns across the planet are leveraging the internet and digital tools to deliver power and information to their citizens. How are Montana's cities and towns keeping up? This first-of-it's-kind research (for Montana) looks into the extent of digital development across 30 Montana city governments.

REVIEWING THE USE OF PHYSICAL DIAGNOSTIC TESTING METHODS AND DETECTION OF MENISCAL TEARS

Meniscal tears are the most common orthopedic pathology of the knee and the most common indication for knee surgery for the adult population. The meniscus is a cartilaginous structure in the knee joint that functions to absorb forces in the knee and provide stability, lubrication, and congruity to the joint. Physical diagnostic testing is used to confirm diagnosis in the clinical evaluation of this injury, but many of the known physical diagnostic tests have low sensitivity and specificity when performed alone. There is substantial need for reliable and accurate physical diagnostic testing for the clinical athletic trainer to use in diagnosing meniscal tears. This literature review examined the common physical diagnostic tests used by clinicians, including the Apley’s test, Thessaly test, McMurray’s test, and joint line tenderness and the effectiveness of the tests in accurately detecting meniscal tears. Sensitivity, specificity, and likelihood ratios will be compared across physical diagnostic tests to make recommendations for the practicing clinician that can be used to diagnose meniscal tears in patients.

The game of lacrosse is one of the fastest growing sports in the United States today, with increases in participation of up to 80% in the past decade. This increase in participation has led to an increase in concussions diagnosed for both men’s and women’s lacrosse. With the number of diagnosed concussions on the rise, there is an increased reliance on trained medical professionals, coaches, parents and athletes to help in the recognition of symptoms. Many concussions still go unreported or undiagnosed either on purpose or as a function of inadequate medical coverage and knowledge of signs and symptoms by coaches, parents and athletes. Currently every state has some form of concussion legislation and are working towards improving the laws surrounding management of concussion as well as the educational requirements for medical professionals, coaches, parents, athletes. There is minimal evidence to suggest that educational materials and legislation impact overall athlete safety or the ability to recognize a symptomatic athlete. However, through further development of legislation and educational materials we can impart a change in the way we view concussion as a society, giving legitimacy to concussions as a true injury. The current study used a descriptive survey to examine concussion knowledge level of middle school and high school lacrosse coaches for men’s and women’s lacrosse. The results will be utilized to develop educational materials for coaches and impact state legislation surrounding concussion.

Mitochondria are responsible for the vast majority of energy metabolism in healthy cells and this is often considered their primary function. However, their role routinely changes in tumor cells where mitochondrial metabolism is no longer the major pathway used to produce energy; this shift in metabolism has been named the “Warburg effect”. This metabolic reprogramming has been suggested to also suppress another function of mitochondria in cells where they act as the gatekeeper to the intrinsic pathway of apoptosis, also known as programmed cell death. In order for tumor cells to survive, they must evade apoptosis and this is often referred to as a “hallmark of cancer”. With this in mind, targeting mitochondria for treatment of cancer is an emerging strategy suggested by several high impact reviews as a route to develop more selective therapies. Mitochondria possess their own separate genome, and mutations in mitochondrial DNA (mtDNA) are associated with various diseases including cancer. One strategy for inducing apoptosis in tumor cells involves disrupting transcription and/or replication of mtDNA. In the past decade, much research has been focused on a tertiary structure formed by DNA known as a guanine-quadruplex. Quadruplexes found in nuclear DNA have been demonstrated previously to effect expression of oncogenes and to inhibit telomerase activity, both of which contribute to the pathology of cancer. More recently however, quadruplexes have also been shown to form in mtDNA and are suspected to play a major role in mitochondrial genome homeostasis. A region of mtDNA known as conserved sequence block II (CSB II) has been reported to form a hybrid quadruplex (HQ) and to act as a switch that halts transcription, allowing formation of primers and initiation of mtDNA replication. Deletions in mtDNA have also been shown to occur in close proximity to quadruplexes and these structures are believed to act as “breakpoints”, or regions of increased DNA instability. These reports in the literature have informed the development of a novel class of antitumor compounds, the anthracenyl isoxazole amides (AIMs), which we have reported previously to inhibit the growth of SNB-19 glioblastoma cells at low micromolar to high nanomolar concentrations (10’BiPhenOxy AIM IC₅₀ = 0.67 µM). The AIMs were originally designed to target quadruplexes found in nuclear DNA, however our laboratory has demonstrated that the majority of the AIMs do not enter the nucleus and rather concentrate in the mitochondria of SNB-19 cells. This has lead us to begin examining potential quadruplex targets found in mtDNA. Using a previously published quantitative PCR assay, we have shown the AIMs cause an increase in mtDNA damage following treatment at multiple time-points (3, 6, 12, & 24 hours) preceding the induction of apoptosis. Our laboratory is also working to crystallize the CSB II HQ in the presence and absence of the AIMs. This work will allow us to develop a structure-activity relationship to aid in further synthetic refinement of the AIMs to selectively target the CSB II HQ as a method to prevent mtDNA replication and induce apoptosis in tumor cells.

In organic chemistry, catalysis (speeding up a chemical reaction) has largely been dominated by Lewis and Brønsted acids. While effective, these additives are also usually toxic, reactive, and environmentally unfriendly. Organocatalysts provide an alternative way to increase reaction rates. By appending hydrogen bond donors to a carbon scaffold, organocatalysts can have activity similar to Lewis and Brønsted acids without the negative side effects. Consequently, the field of organocatalysis has been steadily growing for the last twenty years. Chemists can increase preferable traits in their catalyst such as enantioselectivity, solubility, and activity by modifying. These are laudable goals for catalysis research, as they have provided us with many organocatalysts that work well. However, some of the fundamentals are still incompletely understood. With a better understanding of the basics, more efficient and better designed organocatalysts can be developed. The research presented here describes progress towards understanding some of these basic features.

The fundamental question being asked here is: what is the optimal binding geometry of a substrate in the active site of a hydrogen bonding organocatalyst? In other words, what is the best orientation for chemicals to have relative to an organocatalyst? Enzymes (biological catalysts) form hydrogen bonds with planar molecules to increase their reactivity. Ideal hydrogen bonds would be formed in the same plane. However, published research has shown that most enzymes form hydrogen bonds orthogonal to the plane (with a large portion shifted as far as ninety degrees). The chemistry performed by these biological molecules is much more advanced than anything developed in a lab, so trying to emulate their methods could result in a better organocatalyst. The hypothesis is: forming hydrogen bonds orthogonal to planar molecules will improve the performance of organocatalysts. To test this hypothesis, urea was chosen as our scaffold. Substituted ureas have been used extensively as organocatalysts, making them an appropriate choice for this study. By modifying the molecular periphery of urea, the three-dimensional space around the active site can be controlled. Put simply, the urea can have things dangling off it that will force chemicals into a specific orientation. These ureas can be made using basic organic synthesis. A variety of techniques were utilized to study how they interact with other chemicals. Crystals of the urea and planar molecule were grown and subjected to x-ray diffraction. This illuminated the orientation in the solid state. ¹H NMR spectroscopy was used to characterize novel compounds and monitor reactions to determine rate constants. By investigating the system in the solid and solution phases, the hypothesis can begin to be validated.

For fourteen years, Us magazine’s “Stars—They’re Just Like Us” has captured celebrities buying lettuce or charging an iPhone, conflating their lives with those of “everybody else,” and manifesting a microcosm of a pervasive, more general attitude: “Everything—It’s Just Like Us.” Even fictional “aliens,” however repulsive or ethereal the embodiment, mirror human traits. The alien-as-self perpetuates the status quo, maintaining division along existing lines in the global human population. The conspicuous absence of the genuinely unknown—in fictions purporting to imagine just that—parallels ongoing failure to tackle ecological problems on a global scale. Polish author Stanislaw Lem’s Solaris (1961), The Invincible (1964), and Fiasco (1986), and Jeff VanderMeer’s 2014 Southern Reach trilogy, are linked as rare exceptions, in which alien presence is so unfamiliar that the degree to which it may be labeled a “lifeform” remains in question. In 2006, Lee Rozelle coined an “ecosublime,” arguing for ecocritiques generated from “the awe and terror of a heightened awareness of the ecological home.” Here, a reading of Lem and VanderMeer calls for a return to the Kantian sublime: the turn to reason renovated to demand mastery over self rather than other. The humanizing of the nonhuman, as in the fictive “alien,” represents a form of colonization in which human psychology expands to inhabit the entire environment. If this norm is the path to the “cozy catastrophe,” a thriving sub-genre of post-apocalyptic fiction in which the “end of the world as we know it” looks a lot like mythic places in narrative history, the robustly alien in Lem and VanderMeer revises the story of ecological agency that puts everything in human hands, for better or worse.

Humans slather, spray, mist, and cleanse their bodies with personal care products like lotion, hairspray, cologne, and shampoo every day. Our cupboards are stocked full of them, but few of us understand what is in those jars and bottles. We trust that if it’s on the shelf at the store, it’s safe. However, this is not always the case, and many personal care products contain chemicals that are harmful to human and environmental health.

My multi-disciplinary Environmental Studies thesis project combines evidenced-based research, interviews, nonfiction narrative, and science communication to create a book manuscript intended to educate general consumers about the harmful ingredients found in everyday products in their homes. The book project motivates readers to make changes in their own homes and on store shelves.

The chapter I will present focuses on the question: What is “Fragrance?” Although the term “fragrance” is found on the labels of virtually every personal care product, this term can be a catchall for more than 50 chemicals ingredients. This is because of a federal loophole that exempts trade secret ingredients from listing. However, toxic ingredients often hide behind the guise of “fragrance. My presentation will unpack “fragrance” by describing the history of perfume, federal policy, toxicological profiles of key ingredients, and by reading from the manuscript.

College students evidence higher rates of depression and suicide than the general population (Alschuler et al., 2008; Benton et al., 2003), making novel interventions and methods for increasing engagement with depression care necessary. Suicide is the second leading cause of death for young people in the United States, and Montana consistently ranks among the top five states for highest rate of suicide in the country (American Association of Suicidology, 2014). Student health centers based on college campuses in states like Montana present a unique window for reaching students who may have previously had limited access to mental health care in rural settings. In fact, most people—college students included—seek help for mental health issues through primary care (Strosahl, 1998; Bount, 1998), which places this setting in a unique position to reach students with mental health concerns who may not actively be seeking treatment, but who would benefit from it (ACHA 2010). Despite its potential promise as one path to improved college student population health, the rates of universal screening for depression and related conditions in student health primary care settings are currently unknown (Shepardson & Funderburk, 2014). Although universal depression screening has potential to increase the identification and treatment of depression, disagreement exists over its utility and cost-benefit analysis (Mitchell et al., 2009; Joffres et al., 2014). The present survey examined the prevalence of universal depression screening among primary care student health centers in Montana colleges and universities. The survey was sent electronically to student health center and medical directors of 11 public 2- and 4-year colleges and universities across Montana. Nine respondents (81.8%) completed the survey, and of those, 66.7% reported having a student health center on campus. Of those with a student health center, 66.7% reported currently universally screening for depression in primary care. Other components of universal screening for depression and student health center characteristics were examined in the survey, including degree of healthcare integration and barriers or reasons for not screening. The top reason identified for not screening was concern about how to accommodate more mental health referrals with positive depression screens, as there is already a waiting list for mental health services. Schools the reported universal screening also described ‘helpful practices’ in implementing screening protocols, with one of the top examples being use of an electronic medical record. The survey results have been sent to the Montana Suicide Prevention Task Force to help guide their recommendations to the Montana Board of Regents. Our results will advance clinic and policy conversations about the use and utility of universal depression screening in student health centers across Montana.

Abstract: This professional paper addresses the implementation of concussion policy for the YMCA of Missoula. Specifically, evaluating concussion policy throughout the United States and determining key aspects of implementation. Evaluating the role of all people who that are influenced by concussion policy is imperative to developing a sound policy. Athletes, parents, coaches and health care providers each play essential roles when considering the effectiveness of policy implementation. While exploring varying concussion policies and research, this professional paper recognizes each of these essential aspects and incorporates them into the final Concussion Policy by the YMCA of Missoula.