Hypoplastic Left Heart Syndrome is a congenital heart defect in which the left chambers of the heart are underdeveloped and, if left untreated within the first week of birth, is a fatal condition. Via personal interviews, extensive research on the progression of neonatal intensive care through the Ridge Collection in the advent of modern medicine, and analysis of shared stories of loss, this creative project will recount the medical journey of my younger sister, Kathleen, one of the oldest individuals living with this rare heart defect. Narrative medicine weaves the emotional with the scientific, vividly illustrated in my sister’s condition and the unwavering community that has navigated the unknowns alongside her. This work of creative nonfiction will address the following aspects of medical ethics with regard to neonatal intervention: first, unpacking the parameters of a life “worth” living; second, elucidating the relationship between quality of life and letting go specifically when the pressure of such high-stakes decisions is placed upon emotionally distraught parents; and third, when applicable, examining legal and ethical implications of technological advancements in Western medicine as they pertain to prolonging life. Though a niche story within the scientific realm, this is an uncertain and complex experience that warrants further exploration.

Throughout the fall of 2019, I have created a video documentary in partnership with the New Directions gym on the campus of University of Montana. This is a specific location for patients currently undergoing treatment at the University's physical therapy clinic to perform their prescribed exercise in an assisted and supervised manner. Because the clinic is one of the only clinics in the area that focuses on nervous system ailments - strokes, spinal cord injuries, brain injuries, amputations, etc. - the patients there typically have something in that list. The patients’ difficulties, although surely difficult, are not overshadowed by their motivation and will to continue and improve with every visit. Specifically speaking, my project focuses on the impact that spinal cord injuries may have on an individual, and I have worked closely with a cast of both patients and physical therapists to help create it. I have interviewed the patients on camera, asking them to share their stories to a broad audience, and have followed up with the physical therapists to demonstrate how effective rehabilitation can be when people are diagnosed with the complicated condition of a spinal cord injury. This project will serve a dual purpose: allow me to creatively produce a research-oriented and thoughtful visual piece while simultaneously learning more about my future career, physical therapy. The primary external purpose, adding on to that, is that people in the general public will then become more aware of the vulnerability, strength, and persistence of people living with such a condition.

Clandestinely established in 1958 by candy tycoon Robert Welch after the death of Joseph McCarthy, the John Birch Society had a significant presence in Montana, particularly eastern Montana and the Bitterroot Valley, throughout the 1960s. Correspondence from this time between U.S. Senator Mike Mansfield and his Montana constituents is rife with examples of attempts by society members to root out the subversive communist plots that they saw existing in even the most routine elements of community life. Broadly, this paper will serve as an exploratory essay of the origins of the group in Montana. Anyone acquainted with the John Birch Society, mocked and satirized as it often was in mainstream discourse throughout its heyday in the 1960s, might very well marvel at the fact that ideas propagated by a “lunatic fringe” group managed to wend their way into institutions like the National Security Council and the Oval Office circa 2017. Yet the Society is survived by more than its ideas – it is still an actively-recruiting organization dedicated to the credo of “less government, more responsibility.” Granted, its founding obsession with rooting out subversive communist plots in all levels of government and elements of community life is long gone, but some of its twenty-first century goals will seem familiar to anyone parsing various ideologies espoused by both the present-day Republican Party and the Trump White House. It may come as little surprise to followers of Montana politics that the group once had a significant presence in the Treasure State. By examining the collections and constituent correspondence of Montana politicians Mike Mansfield and Arnold Olsen as well as records from KGVO Radio, the Montana Attorney General’s Office, and the Educational Cooperative Publishing Company of Montana, this paper explores the Society’s origins and influence in areas such as eastern Montana and the Bitterroot Valley throughout the 1960s and early 1970s. How did right-wing extremism affect education and academic freedom in Montana? How did the national spread of Birchism, Cold War conspiracy culture and the politics of division play out on the local level in Montana communities? What impact did the Society have on state government? What connections, if any, were drawn between (waning) behemoths such as the Anaconda Company and the Montana Power Company and sponsored Birchist activity? These are some of the questions that an examination of these archival collections brought to light. Although the hotbed of Birch activity in Montana was located in eastern Montana and the Bitterroot Valley, letters about the Society – both favorable and unfavorable – reached Mansfield and Olsen from all over Big Sky Country: Libby, Kalispell, Hot Springs, Missoula, Helena, Great Falls, Bozeman, Billings, and elsewhere. By the 1970s, stories about the John Birch Society had largely disappeared from Montana headlines, but reverberations of its effects can arguably still be felt in communities around the state today.

Context: Compared to men, female athletes are up to ten times more likely to rupture their anterior cruciate ligament while playing soccer, a major stabilizer in the knee. These athletes undergo anterior cruciate ligament reconstruction (ACLR) and return-to-play (RTP) rehabilitation protocols; however, previous research on RTP has been limited to addressing individual underlying factors. This systematic review aims to use a more holistic approach and provide insights on which factors affect the overall RTP timeframe of female soccer athletes post ACLR, and in turn provide healthcare professionals with more certainty in return-to-play timeframes in female soccer players. Methods: A systematic literature search was completed in October 2019 via the PubMed database. The search utilized the PRISMA guidelines and used the following keyword combinations: “ACL” or “Anterior Cruciate Ligament”, “ACLR” or “Anterior Cruciate Ligament Reconstruction”, “Soccer” or “European Football” or “Football”, “Women” or “Female”, “Return To Sport” or “RTS”, “Return To Play” or “RTP”, “Return To Activity” or “RTA”. Articles excluded from the final analysis focused on ACL revision surgery, only included male participants, or if RTP timeframe post ACLR was not reported. Average and range of time to return to sport, average and range of time to return to competition, age at time of injury, and underlying factors such as motivation to RTP, hormonal levels, injury mechanism, graft choice, and rehabilitation protocols were extracted from the final selection of articles when available. This review was limited by performing the original search in a single research database. Results: Of the 29 records identified through database searching, five studies were included in this qualitative synthesis. A total of 649 knees were examined across all five studies. All records included in the final analysis reported RTP timeframe in some form or manner, along with factors influencing RTP. Multiple studies differentiated returning to play (practice) and returning to competition. Average time to return-to-play and return-to-competition were 7.3 and 9.3 months, respectively. The reported time to return to play and competition varied between studies, ranging between 5.5-9.0 and 6.1-12 months, respectively. Factors appearing to influence the timeframe of RTP the most included rehabilitation program, graft selection used to repair the torn ligament, and motivation to return to sport. Conclusions: The timeframe of RTP in female soccer players who have undergone ACLR varies with a number of factors contributing to intraindividual differences. The RTP timeframe appeared to be accelerated with specific factors such as utilizing autografts during ACLR and if the rehabilitation plans included exercises to oppose knee valgus motion. Future research should focus on improving the understanding of how motivation, rehabilitation plans, and graft selections influence RTP timeframe in female soccer players.

Context: Athletes who sustain an injury may experience depression, anxiety, tension, fear, and low self-esteem due to being taken out of their sport and changing their daily activities. These acute and chronic emotional or mood disturbances are common and highly studied in concussion patients; however, acute consequences of concussions are not as well understood. This review will seek to clarify the understanding of acute mood disturbances and depressive symptoms post-concussion in a physically active population based on the current available literature. This will provide information for healthcare providers to use in athletes’ return to play decisions and follow-up care post-concussion. This information also allows better understanding and education available to athletes, parents, coaches, teachers, school administrators, and many other people who play integral roles in athletes’ healing after a concussion. Methods: A systematic literature search was completed in October 2019 via the PubMed database to include articles published between 2004 and 2019. The search utilized the PRISMA framework used the following keyword combinations: (depression OR suicide OR apathy) AND (MTBI OR "Mild traumatic brain injury" OR concussion) AND ("acute phase" OR "short-term" OR "short term" OR "early"). Articles were included in the final analysis if: completed on an athletic or physically active population, evaluated depressive symptoms after a concussion was sustained, and were not completed on elderly patients. Year published, level of evidence, participant demographics, patient outcomes, and various depression and mood scale scores were extracted from the final selection of articles. The present study was limited by utilizing a single research database. Results: Of the 203 articles identified through the database search, 13 studies were included in this review. Main themes across the collection of studies included depression, anxiety, and irritability and mood liability. Four studies identified depressive symptoms with comorbid anxiety symptoms and eight studies identified comorbidities or measured total mood disturbances in addition to depression. Further, two studies identified mood lability and irritability as specific depressive symptoms post-concussion. Four studies compared concussed patients to non-concussed patients and musculoskeletal patients and had conflicting results on whether concussion patients experienced depression symptoms longer or worse than non-concussion patients. Conclusions: Rates of depression, anxiety, irritability, and mood lability are significantly greater in the acute phase of concussion recovery; however, these rates do not necessarily have an impact on return to play decisions except when severely impacting a patient’s ability to perform in the classroom or social settings. In many cases, these symptoms reduced approximately two weeks post-concussion. This systematic review demonstrated the relationship between concussions, psychological symptoms, and post-concussion outcomes. These data provide rationale for better psychological screening tests in baseline and post-concussion testing. Future research is necessary to determine the utility of waiting to return athletes to play until after psychological symptoms have returned to baseline levels.