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1D Crustal Velocity Model for West-Central Montana

Courtenay Jo Duzet, University of Montana, Missoula
Michael C. Stickney, Montana Tech

Western Montana is home to a significant amount of continuous, complex seismic activity due to the fact that the region lies within the Intermountain Seismic Belt (ISB). The ISB is a 100 km wide seismic belt that stretches along western Montana, reaching from Yellowstone National Park to northwest Montana, and is responsible for much of the state’s seismic activity. Like many seismically active areas, Western Montana’s earthquakes are best studied through the use of seismographs. Data from these instruments can be used to create crustal velocity models for an area within the seismic network. Velocity models are powerful tools that effectively describe seismic velocity as a function of depth and are used to enhance our understanding of an area’s crustal structure, crustal stress conditions, and earthquake hypocenter locations. In areas that are seismically active, it’s important that these models are updated regularly. However, the velocity model currently in use for Western Montana was last updated in 2003. This is because, even though Montana experiences numerous earthquakes every year, many of these earthquakes are low in magnitude, averaging from M 1.0 - M 3.5. These low magnitude earthquakes do not typically produce enough data to create or update velocity models. Oftentimes, we require much larger events (≥ M 5.0), ideally with a strong aftershock sequence. Historically, for western Montana, such events are intermittent and sometimes decades apart. We will derive a new 1-D crustal velocity model for west-central Montana by analyzing seismic-phase arrivals from the M 5.8, 6 July 2017 earthquake that occurred 11 km southeast of Lincoln, Montana, and hundreds of aftershocks that followed over a three-year period (2017-2020). The 2017 Lincoln earthquake was the largest event above M 5.5 to occur in western Montana in over half a century, the last being the 1959 M 7.3 Hebgen Lake earthquake in southwestern Montana. To determine the velocity model, we manually retrieve continuous seismic data recorded by broadband stations in the University of Montana Seismic Network, which have been strategically deployed to study the Lincoln aftershock sequence, supplemented by telemetered data from the Montana Regional Seismic Network. To constrain the model, we invert phase arrivals from several hundred well-recorded earthquakes (>20 phase arrivals) using the software program VELEST. The final model will characterize the crustal velocity structure appropriate to an area in western Montana of about 5000 km2. Due to western Montana’s proclivity towards infrequent, high-magnitude earthquakes, the 2017 Lincoln event has provided a prime opportunity to collect quality seismic data that will allow us to create a much-needed crustal velocity model for this seismically active region of Montana. Not only will developing a new, regional crustal velocity model advance earthquake science in Montana, but this will also be the first model derived specifically for the west-central region of the state, as the current velocity model is most appropriate for southwestern Montana. With our model, we will be able to provide the first accurate crustal velocity structure and method to locate hypocenters for the west-central region.

Assessing Effectiveness of Using a Moist Heat Pack Prior to Single Leg Vertical Jump Performance

TediJo Todd, The University Of Montana
Sola Yeager, The University Of Montana
Katlyn Norton, The University Of Montana

Context: Thermotherapy techniques, such as moist heat pack (MHP), produce increased circulation and metabolism, decreased pain, decreased muscle spasm, and decreased tissue stiffness. An increase in muscle elasticity causes an increase in flexibility, which can lead to an increase in range of motion. However, there is limited research directly related to the effect of MHP on functional performance since much of the research is indirectly associated with flexibility and range of motion. Therefore, the purpose of this study was to explore and assess the effectiveness of a moist heat pack on single leg vertical jump performance. Methods: A convenience sample of five healthy, college-aged students were selected for this study (2 females, 3 males; average age 23 + 4 years, height 68 ±4 inches, and weight 198 + 4 lbs). A repeated measures design was used whereby subjects completed two separate trials with a week between each trial. The two trials included a 10-minute treatment of MHP on the subject’s dominant limb or a 10- minute control trial consisting of laying prone on a treatment table for 10 minutes. Single leg vertical jump on the subject’s dominant leg was recorded using the Just Jump! Just Run! Mat before and after each trial. Three measurements were obtained and an average was recorded. Treatment order was randomized and spaced out a week apart. Microsoft Excel was used to calculate descriptive statistics for each participant’s height, weight, and age along with their vertical jump measurements. A 2 x 2 (trial x time) repeated measures ANOVA using SPSS v26.0 was used to calculate mean difference between the control and moist heat pack trial. Significance was set a priori at p = 0.05. Results: The 2 x 2 repeated measures ANOVA revealed no statistical difference between the moist heat pack and control groups on vertical jump performance (p = 0.15). While there was a trend for both groups' vertical jump to slightly improve after both interventions, a main effect for time was not demonstrated. Conclusion: Applying MHP on hamstrings prior to vertical jump does not significantly improve performance. The results of this study suggest that a passive warm up may not be the best modality of choice when preparing for power production movements. Athletes who regularly apply a MHP to soft tissue in an effort to boost performance may want to consider engaging in a more active warm up or alternative modality to warm the tissue prior to performance. Word Count: 404

Common Lower Extremity Injury Sites Among Service Members and Combat Sport Athletes: A Systematic Review

Luke Joseph McCarthy, University of Montana
Tyler Hansen, University of Montana

Title: Common Lower Extremity Injury Sites Among Service Members and Combat Sport Athletes: A Systematic Review Luke McCarthy, Tyler Hansen, Shane Murphy Purpose: Athletic training services continue to expand into nontraditional settings, with a substantial growth in treating military service members and combat sport athletes (e.g., tae kwon do, MMA, karate). Although more athletic trainers are asked to work with these populations, location and frequency of injuries within these populations is not widely disseminated in athletic training education curriculum. This systematic review was conducted to discover if common injury sites exist between service members and combat sport athletes. We hypothesized that the two cohorts shared many common injury sites, though the mechanism of injury would likely be different. Methods: A systematic review of studies between 2008 and 2020 were examined via PubMed in October of 2020. Key words used in the search include population (e.g. military OR martial arts OR MMA), anatomical area (e.g., lower extremity OR LE), and injury occurrence rate; returning 76 articles. Two independent reviewers utilized a PRISMA flowchart to select the articles to be included in the final analysis. The level of evidence was initially assessed for all included articles, with no uncontrolled cohort studies, case series, or expert opinions being included in the final analysis. Studies that did not identify injury sites were excluded, with only studies providing lower extremity injury site and frequency being selected. Injury site and frequency were extracted from articles focusing on either service members or combat sport athletes. Originality: This research is novel, in that it provides athletic trainers in these emerging settings the ability to forecast what injuries they are most likely to encounter, given the setting (e.g., training, competition, and combat). Each of these settings, as well as the age and skill level of the athletes involves different injury types (chronic versus acute). During the systematic review, there were no articles found comparing military service members and combat sport athletes. Significances: As more athletic trainers begin working in these emerging settings, knowledge about how each cohort sustains their injuries will be important. Being able to treat injuries when they occur, as well as prevent injuries from happening, will reduce the amount of time lost to rehabilitation. This increased time in rehabilitation translates to increased medical costs and strain on our healthcare system as a whole. Preventing injuries will reduce medical spending both for the individual athletes and for the federal/state government, in the case of service members. Service members and combat sport athletes sustain lower extremity injuries at both the ankle and knee; however, they differ in general mechanism. Due to the stresses of prolonged load carriage versus forceful striking, clinicians will face unique challenges working with either population. By understanding the environment service members and combat athletes are operating in, athletic trainers can have necessary supplies on hand for treatment of acute injuries, as well as plans to rehabilitate chronic injuries. Future research should focus on methods of reducing acute injuries in combat sports and more effective chronic injury prevention among service members.

Comparing Skin temperature rewarming times between cold water immersion and crushed ice packs

Jason Ryan Nielsen
Nicholas Verlanic, University of Montana, Missoula

Comparing Skin Temperature Rewarming Times between Cold Water Immersion and Crushed Ice Packs

Verlanic, N, Nielsen, J, Moody, V. University of Montana

Context: Cryotherapy techniques are commonly used to reduce the rate of secondary injury by decreasing the metabolic rate, which in turn decreases the rate at which nearby uninjured tissues become hypoxic. Cryotherapy is also effective at controlling pain in acute and subacute injuries because of the numbing effect that it provides. This provides clinicians the opportunity to begin implementing rehabilitative exercises without inducing pain. The purpose of this study was to compare skin temperature following two common cryotherapy treatments: cold water immersion and crushed ice bag. We wanted to compare the difference in acute skin temperature drop immediately following treatment, and to determine the length of time skin temperature remained depressed to produce analgesic effects.

Methods:

A convenience sample of seven healthy, college-aged students were selected for this study (2 males, 5 females; average age 22 + 1 years, height 66 ±3 inches, and weight 150 + 14 lbs). A repeated measures design was used whereby subjects completed both trials with a week between each trial. The two trials included a 30-minute treatment of a crushed ice pack or a 10- minute cold water immersion. Subjects were asked to stay seated while baseline skin temperatures were recorded using a Ryobi Infrared thermometer. Skin temperatures were recorded over the sinus tarsi of each subject’s ankle before and after each trial and at 5 and 10- minutes post treatment. Three measurements were obtained and an average was recorded. Treatment order was randomized and spaced out a week apart. Microsoft Excel was used to calculate descriptive statistics for each participant’s height, weight, and age along with their skin temperature measurements A 2 x 4 (trial x time) repeated measures ANOVA using SPSS v26.0 was used to calculate mean difference in skin temperature immediately after treatment, 5- minutes post and 10- minutes post between cold water immersion and crushed ice pack. Significance was set a priori at p = 0.05.

Results: A 2 x 4 repeated measures ANOVA revealed no statistical significance (p=0.204). However, there was a main effect for time whereby all trials resulted in similar amounts of skin temperature cooling (p = 0.00). Follow up comparisons for each time point were conducted and revealed no statistical significance in baseline skin temperatures (p=0.815) or skin temperature following each intervention immediately after treatment (p= 0.560), 5 minutes after (p=.452) and 10 minutes after (p=0.622) suggesting each modality cooled skin temperature similarly.

Conclusion: Our study showed that there is no significant difference between the crushed ice pack and cold water immersion with both effectively decreasing skin temperature. Both modalities reached therapeutic range achieving analgesia; however, the effects were short-lived demonstrating tissue rewarming outside the therapeutic range within 5 minutes following treatment.

Evaluating the use of Environmental Tracers to Reduce the Conceptual-Geologic Uncertainty of Hydrogeologic Models

Andrew Nordberg

We investigate methods to reduce uncertainty in the conceptual-physical structure of groundwater flow and transport models using naturally occurring environmental tracers. We take a novel approach to assess this uncertainty by calibrating hydrogeologic models derived from alternate conceptualizations of subsurface structure using environmental tracer data and reactive transport code. From borehole data at a site near Riverton, Wyoming, two deterministic conceptual models based upon different hypotheses of the physical structure were created. In the first model, two permeable stratigraphic layers are separated by a continuous silty-clay confining unit. In the second model, the two permeable stratigraphic layers are separated by a discontinuous confining unit with lens-like deposits. Both alternatives use the known thickness at borehole locations; the continuous layer assumes the mean thickness where unknown; and the extent of lens-like deposits is approximated by correlation lengths collected from geostatistical software. These conceptual models are translated into numerical code MODFLOW 2005 and assigned common site-specific boundary conditions. For each alternative, MT3DMS was used to simulate transport of chlorofluorocarbons (CFC’s), Sulfur-hexafluoride (SF6) and tritium (3H) concentrations through the subsurface. The difference between simulated concentrations of each alternative can be compared to the analytical detection limit, where differences greater than approximately 5% would indicate that these natural tracers can be used to elucidate uncertain geologic structures of this type. With these tools, hydrogeologists and forecast analysts can better assess uncertainty of alternate subsurface conceptualizations and confidently make informed decisions.

Exploring the Influence of Patient Position During Mechanical Traction on Lumbar Mobility

Isabela Ortman, University of Montana, Missoula
Kevin Garifi, University of Montana, Missoula
Valerie Moody, University of Montana, Missoula

Exploring the Influence of Patient Position During Mechanical Traction on Lumbar Mobility Ortman, I, Garifi, K, Moody, V. University of Montana Context: Mechanical traction uses a motorized device to apply a selected traction force to slowly elongate the spine. Research demonstrate the ability of sustained distraction forces to increase the length of spinal tissues by creep and hysteresis, with effects remaining longer in tissues of older individuals. There are three primary positions that a patient can be in for mechanical lumbar traction: supine, prone, and 90/90. The choice of position is driven by patient comfort, however, there might be differences in effectiveness based on resting lumbar curvature. The purpose of this study was to compare the effects of supine, prone, and 90-90 mechanical traction on lumbar mobility. Methods: A convenience sample of four healthy adults were selected for this study (2 females, 2 males; average age 23 + 2 years, height 69 ±4 inches, and weight 224 + 17 lbs). A repeated measures design was used whereby subjects completed three separate trials with a week between each trial. The three trials included 3 separate lumbar mechanical traction treatments in either a supine, prone, or 90-90 (hip flexion, knee flexion) position for 15 minutes. Lumbar flexion, extension, right lateral lumbar flexion (RLLF) and left lateral lumbar flexion (LLLF) was measured with a standard 12-inch goniometer before and after each trial. Three measurements were obtained and an average was recorded. Treatment order was randomized and spaced out at least a week apart. Microsoft Excel was used to calculate descriptive statistics for each participant’s height, weight, and age along with lumbar flexion, extension, RLF, and LLF. Separate 2 x 3 repeated measures ANOVA using SPSS v26.0 was used to calculate the mean difference in lumbar ROM between the supine, prone, and 90/90 trials for lumbar flexion, lumbar extension, RLLF, and LLF. Significance was set a priori at p = 0.05. Results: A 2 x 3 (time x trial) repeated measures ANOVA revealed no statistical significance between patient positions during traction (prone, supine, 90/90) for lumbar flexion (p=0.813), extension (p=0.146), RLLF (p=0.170), and LLLF (p=0.107). The main effect for time was noted for lumbar extension (p=0.004), where a further analysis revealed a significant difference between the supine and 90/90 position (p=0.037). However, a trend for an improved lumbar range of motion was noted across all three positions after receiving mechanical traction. Conclusion: The primary finding of our study was a trend of increased lumbar ROM following mechanical traction, regardless of position. Statistically significant improvement in lumbar extension was seen, but a large standard deviation in this measurement adds caution to clinical interpretation. Additional research is needed to support the clinical use of traction to improve lumbar ROM absent of symptomatic lumbar pathology. Word Count: 437

Genetic and seasonal contributions to variability in vitamin D levels among American Indians

Jack W. Staples, Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT
Erica L. Woodahl, Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT
Erin E. Ellerbeck, Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT
Rachel Dalton, Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT
Kathleen M. George, Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT
Genevieve Krause, Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT
Tianna Leitch, Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT
Kenneth E. Thummel, Department of Pharmaceutics, University of Washington, Seattle, WA
LeeAnna I. Muzquiz, Tribal Health Department, Confederated Salish and Kootenai Tribes, St. Ignatius, MT
Matthew G. McDonald, Department of Pharmaceutics, University of Washington, Seattle, WA
Deborah A. Nickerson, Department of Genome Sciences, University of Washington, Seattle, WA

Purpose: Vitamin D is an essential hormone in maintenance of calcium and phosphate homeostasis for adequate bone mineralization with roles in the immune system as well. Sources of vitamin D include natural synthesis in the skin upon ultraviolet B (UVB) radiation, dietary intake from plant and animal sources, and supplementation. Vitamin D levels, measured by the primary circulating vitamin D metabolite, 25-hydroxyvitamin D (25(OH)D), are variable across individuals due to latitude, season, diet, gender, disease states, medication use, and genetics. Populations living at northern latitudes (~400N) such as American Indians of the Confederated Salish and Kootenai Tribes (CSKT) are at increased susceptibility of having lower vitamin D levels in the winter months because there is decreased UVB exposure. There are currently no published data that exist on the genetic and seasonal influence on vitamin D status in CSKT people. Methods: We recruited 472 research participants from the Confederated Salish and Kootenai Tribes (CSKT) (185 male and 287 female; 18 years or older) at various sites in the Flathead Reservation in western Montana. Demographic factors were collected (e.g., age, body mass index, and gender). Genomic DNA and plasma were isolated from whole blood. We sequenced 12 candidate genes: 7-dehydrocholesterol reductase (DHCR7), calcium-sensing receptor (CASR), cubulin (CUBN), cytochrome P450 enzymes (CYP2R1, CYP27B1, CYP24A1, and CYP3A4), retinoid X receptors (RXR alpha, beta, and gamma), sulfotransferase family 2A member 1 (SULT2A1), UDP-glucuronosyltransferase family 1A3 and 1A4 (UGT1A3 and UGT1A4), vitamin D binding protein (GC), and vitamin D receptor (VDR). We also measured circulating levels of vitamin D and metabolites: vitamin D3 and vitamin D2, 25-hydroxyvitamin D [25(OH)D3 and 25(OH)D2], 1,25-dihydroxyvitamin D3 and D2 [1,25(OH)2D3 and 1,25(OH)2D2], 24R,25-dihydroxyvitamin D3 [24R,25(OH)D3], and 4-b,25-dihydroxyvitamin D3 [4b,25(OH)2D3]. Candidate genes were resequenced with Illumina next generation sequencing technology and vitamin D and metabolites were quantitated with liquid chromatography mass spectrometry (LC-MS/MS). The data we collected was summarized using a pipeline state of the art bioinformatics software. Originality: This research addresses the need for increased inclusion of American Indian and Alaska Natives in precision medicine health research. We have characterized genetic variation in vitamin D endocrinology genes and seasonal variability in vitamin D and vitamin D metabolite levels for the first time in CSKT people. Significance: We observed known and novel genetic variation in the CSKT population based on the presence or absence of genetic variants in the National Center for Biotechnology Information (NCBI) Single Nucleotide Polymorphism Database (dbSNP). We observed clinically relevant genetic variants that are associated with disease and variability in response to medication based on presence in the NCBI ClinVar and Pharmacogenomics Knowledge Base (PharmGKB) databases. Vitamin D and metabolite levels varied in a seasonal, fluctuating way, as expected, with lowest levels in January, February, and March months and highest levels in June, July, and August months. A significant percentage of CSKT participants had measured vitamin D levels below sufficiency (~43%). We will use these data to design an interventional strategy to address the low vitamin D levels we observed in CSKT people.

Increasing Range of Motion of the Elbow Considering Optimal Patient Positioning during Ultrasound Treatment

Alexis M. Mower
Karly Niemann

Poster Presentation Abstract Submission

Increasing Range of Motion of the Elbow Considering Optimal Patient Positioning during Ultrasound Treatment

Mower, L, Niemann, K, Moody, V. University of Montana

Context: Ultrasound uses inaudible, high-frequency vibrations to promote blood flow to injured tissue and improve tissue extensibility. Previous studies suggest that a stretching window, albeit brief, follows an ultrasound treatment, maximizing improvement in tissue extensibility. There is currently minimal evidence supporting the idea that applying a stretch during an ultrasound treatment facilitates improvement in joint mobility. The purpose of this study was to compare positioning of the elbow in a stretched and a relaxed position during an ultrasound treatment to determine which produced greater improvements in elbow mobility.

Methods: A convenience sample of seven healthy adults were selected for this study (2 females, 3 males; average age 26 + 8 years, height 68 ±4 inches, and weight 180 + 6 lbs). A repeated measures design was used whereby subjects completed two separate trials with a week between each trial. The two trials included vigorous heating ultrasound treatment for 5 minutes on the subject’s right elbow in either a stretched position or relaxed position. Elbow extension was measured with a standard 12-inch goniometer before and after each trial. Three measurements were obtained and an average was recorded. Treatment order was randomized and spaced out a week apart. Microsoft Excel was used to calculate descriptive statistics for each participant’s height, weight, and age along with elbow extension. A 2 x 2 (trial x time) repeated measures ANOVA using SPSS v26.0 was used to calculate mean difference between the stretched and relaxed position trial. Significance was set a priori at p = 0.05.

Results: A 2 (time) x 2 (trial) repeated measures ANOVA revealed no statistical difference between the resting and stretched positions while delivering ultrasound (p=0.76); however, there was a main effect for time (p=0.00), where both trials demonstrated improved elbow extension range of motion. Follow up trial comparison demonstrated statistical significance, p = 0.033, where the stretched trial on average improved elbow range of motion 1.5 degrees more than the resting trial.

Conclusion: Our study showed that there was no statistical difference between the relaxed and stretched positions while delivering ultrasound treatment. For all participants, both positions produced an increase in elbow range of motion with vigorous heating using ultrasound; however, it was unclear if the ultrasound treatment itself or the gravity dependent position of the joint influenced the study outcomes.

Word Count: 380

Investigating the Transferability of Landslide Hazard Assessments

Gina Belair

Landslides have the potential to cause substantial loss of life and damage to infrastructure. To minimize the damage incurred, landslide hazard assessments are conducted to determine areas of potential mass movements. The majority of advancements in landslide hazard assessment are implemented in a narrow set of circumstances, and their transferability to other regions is largely untested. This study follows the methodology of Kritikos et al. (2015) who investigated the transferability of co-seismic landslide relationships from well-studied regions to regions without accurate landslide locations. The results from Kritikos et al. (2015) provide evidence that statistical relationships formed from training data in multiple regions can accurately predict the occurrence of co-seismic landslides in regions that were not used in training. This study investigates whether these results can be generalized to shallow landslides that were not caused by seismic activity. We focus on three diverse regions in Utah, Washington, and the Apennine Mountains of Italy. Logistic regression (LR) and frequency ratio (FR) methods were used to determine relationships between landslide occurrence and DEM (digital elevation model)-derived contributing factors. Models will be created using 70% of the data for each individual region, each pairwise combination of regions, and the combination of all three regions. Relative operating characteristic (ROC) curves will be used to assess the efficacy of the models [3]. The ROC curve is defined as the true-positive proportion versus the false positive proportion [3]. For landslide hazard assessments, areas under this curve (AUROC) from 1-0.9 are considered excellent, 0.8-0.9 are considered very good, and 0.7-0.8 are good [1]. Preliminary studies using the contributing factors of elevation, slope, aspect, curvature, and topographic position index derived from a 30-meter DEM show promising results. Validation AUROCs were found to be greater than 0.7 for LR and FR in the Utah region, Washington region, Italian region, and the combined Utah & Washington region. If models created using data from multiple regions can be used to predict landslide occurrence in dissimilar regions, it would allow hazard scientists to conduct studies in places without accurate landslide catalogs. Only using factors derived from a 30-m resolution DEM, which is globally available, also increases the importance of this study. Many communities with high landslide risk do not have resources to employ methods that require high levels of expertise and high-resolution data. Although this study has the potential to oversimplify a very complicated system, it can be used as a first-order approach in regions that lack data and resources. [1] Abedi Gheshlaghi, H., & Feizizadeh, B. (2017). An integrated approach of analytical network process and fuzzy based spatial decision making systems applied to landslide risk mapping. Journal of African Earth Sciences, 133, 15–24. https://doi.org/10.1016/j.jafrearsci.2017.05.007 [2] Kritikos, T., Robinson, T. R., & Davie, T. R. H. (2015). Regional coseismic landslide hazard assessment without historical landslide inventories: A new approach. Journal of Geophysical Research: Earth Surface, 120, 711–729. https://doi.org/10.1002/2014JF003224 [3] Swets, J. A. (1988). Measuring the Accuracy of Diagnostic Systems. Science, 240(4857), 1285–1293.

Pharmacogenetic Testing Implementation in a Rural Pediatric Psychiatric Hospital

Tianna Leitch, University of Montana, Missoula
Shayna Killam, University of Montana, Missoula
Kirk Katseanes, University of Montana, Missoula
Karen Brown, University of Montana, Missoula
Corbin Schwanke, Shodair Children's Hospital and Medical Genetics Facility
Abdallah Elias, Shodair Children’s Hospital and Medical Genetics Facility
Susan Trinidad, University of Washington, Seattle

Pharmacogenomics is the study of how patients’ genes may affect their response to certain medications. Pharmacogenetic testing enables clinical providers to individualize patient therapies and improve outcomes in clinical settings. Successful implementation strategies for pharmacogenetic testing, however, have been limited to major academic medical centers and large health care systems. By contrast, rural, community-based health systems, common in a state like Montana, have been slow to implement these advancements, threatening to exacerbate existing healthcare disparities. In the field of psychiatry, the effective management of patient medications is of the upmost concern, and pharmacogenetic testing may help clinicians to guide and individualize drug therapy. Shodair Children’s Hospital, the only facility in Montana that provides inpatient and outpatient pediatric psychiatric services, is interested in partnering with the University of Montana Precision Medicine Project to develop a pharmacogenetic testing program utilizing telehealth consultation services and virtual access. In order to create an implementation model that can ensure equitable access to pharmacogenetics for patients living throughout Montana, our research team conducted a qualitative analysis to determine facilitators and barriers at Shodair Hospital for a pharmacogenetic testing implementation effort.

We conducted semi-structured interviews (n = 21) with key stakeholders (e,g, providers, staff, and administrators) at Shodair to identify barriers and facilitators for pharmacogenetic implementation. Interviews were analyzed for common themes using a qualitative analysis software program. Researchers then independently reviewed transcripts, developed a codebook, and extensively revised and evaluated common themes among participants.

Shodair participants perceived pharmacogenetic testing as a potentially beneficial clinical decision-making tool given the unique medication management challenges facing practitioners in pediatric psychiatry. Participants had clear goals and expectations for a pharmacogenetic implementation effort and common needs included education and resources for both providers and patients, protocols for ordering and utilizing the services, as well as a focus on pre-emptive testing in outpatient facilities. Several practitioners identified pharmacists as the primary champions for integration of pharmacogenetic testing into treatment decisions and cited access to pharmacogenetic experts at the University of Montana as a key factor in effective implementation. Overall, Shodair participants were enthusiastic regarding the utility of pharmacist-lead telehealth consultations and resources provided through a centralized service at the University of Montana. Participants described the opportunity to serve as a leader in pharmacogenetic implementation in rural settings as a positive outcome for patients across the state, and felt it aligned with the mission of the institution.

The themes generated from these interviews will provide a framework for implementing a pharmacogenetics delivery model for additional early adopter sites throughout the state of Montana, as well as identifying innovative solutions to ensure access to advancements like pharmacogenetics and precision medicine for patients living in rural communities. This project provided critical insight into the range of potential barriers to a clinical implementation effort, and opportunities for the further expansion of pharmacogenetic testing and precision medicine services across the state of Montana.

Reliability of Urge-to-Cough (UTC) Testing

Jane Reynolds
Sarah Campbell

Reliability of Urge-to-Cough (UTC) Testing Abstract Researchers who study chronic cough rely on multiple measures to gauge if an intervention is working to reduce coughing. An assessment called Urge-to-Cough (UTC) testing has been proposed to determine a patient’s sensitivity to stimuli that commonly trigger coughing in patients with cough hypersensitivity (e.g., strong scents, projecting the voice). If reliable, UTC testing can be used in clinical and research scenarios to determine if a patient’s cough sensitivity is changing in response to an intervention. In this study, up to 25 patients referred for a chronic cough evaluation with a speech-language pathologist will be recruited. Participants will complete UTC testing during two separate sessions before beginning cough therapy. Patients will be exposed to safe stimuli for up to 15 seconds (e.g. smelling perfume or household cleaning products) and will complete vocal tasks (e.g. reading out loud). After performing each task, patients will rate their “urge-to-cough” sensation (i.e. the perceived strength of the feeling that they need to cough) using a 10-point Likert scale. The researchers will record the reported UTC as well as the number of coughs produced in association with the trial. Results from the two testing opportunities will be analyzed to determine the reliability of UTC Testing. We hypothesize UTC testing is a reliable assessment of a patient’s cough sensitivity and is therefore a useful clinical and research tool. Keywords: chronic cough; Urge-to-Cough; reliability

The Effectiveness of Prescribed Physical Activity for the Treatment of Post-Concussive Symptoms in an Athletic Population: A Systematic Review.

Kayla B. Schmidt, University of Montana, Missoula
Nicholas Costa, University of Montana, Missoula

Mild traumatic brain injuries, otherwise known as concussions, are a low level brain injury that results from blunt force trauma to the head and cause injury to neurons. There are an estimated 1.6-3.8 million sports-related concussions and traumatic brain injuries a year in the United States. Currently, there is a lack of gold standard in the management and treatment of concussion symptoms. Most practices call for rest until symptoms subside, followed by a return to play protocol. Physical activity has been linked to increased brain derived neurotrophic factor (BDNF), which can increase neuron repair. Along with this, other symptoms of a concussion such as headaches, have been observed to decrease in other populations due to an exercise. The objective of this systematic review was to determine if low levels of physical activity are a viable treatment for concussions and what its effect is on the return to play timeline and symptom scores. The search engine PubMed was used as the source to search for articles pertaining to the research question. Studies were selected if they included athletes that sustained a diagnosed concussion and used exercise as a treatment. The age of participants was not limited and all studies were published in English. Studies that discussed non-sport concussions were excluded. All available studies were screened and data was extracted by 2 independent reviewers. The search returned 168 records and 6 met all inclusion criteria to be included in this review. All included studies used physical activity as a treatment and all reported improvement. Outcome measurements looked at (1) symptom scores following a PCSS like survey and (2) recovery period reported. Time to recovery ranged from 21 to 84 days with symptom scores decreasing overtime. The groups undergoing prescribed physical activity had a greater decrease in symptoms when compared to the control groups. This systematic review takes a look at a newer way of managing concussions and summarizes the findings. With physical activity being a newer way of managing concussions, very few systematic reviews have been written thus far. In conclusion, physical activity as a means of reducing return to play duration and symptom scores in concussed athletes is viable. By using prescribed physical activity as a management strategy in concussions, it is possible that the return to play timeline could be decreased. We can connect a decrease in symptoms at a faster rate to a shorter return to play time. Clinically, this may be applied in an athletic training setting, where concussions are prevalent. Future research should include a timeline to returning to activity with prescribed physical activity following a concussion.

Using multiple environmental tracers to quantify field-scale hydrodynamic dispersion and reduce parameter uncertainty in reactive transport models.

Casey L. Kleppel, University of Montana, Missoula

In this study, we seek to reduce parameter uncertainty in groundwater modeling systems, particularly in reactive transport models, by developing a new technique to quantify field-scale hydrodynamic dispersion using anthropogenic environmental tracer concentrations and numerical groundwater modeling. We generate a series of synthetic aquifer fields using known heterogeneous aquifer parameters to model spatial variability using known atmospheric tracer datasets to determine if a single, unique value of dispersion can be applied field-wide. The atmospheric data is comprised of publicly available Chlorofluorocarbons (CFC11, CFC12, CFC113) and Sulfur-hexafluoride (SF6) concentration atmospheric data. A 2D heterogeneous synthetic truth aquifer developed using synthetic Gaussian simulations is compared with 2D homogeneous synthetic aquifers with varying hydrodynamic dispersion values. Breakthrough curves of tracer concentrations, and ratios thereof, through our synthetic aquifers over time are fit to curves produced through our heterogeneous truth model to assess whether a single field-scale dispersivity value can be adequately identified. The same methodology is applied to 3D simulations to assess the ability to estimate reasonable field-scale hydrodynamic dispersion coefficients in a 3D flow field. To evaluate the accuracy of our method, we compare the observed tracer-derived dispersivity values to dispersivity values calculated from theoretical estimates. This new method of utilizing multiple environmental tracers over a limited time series could be an easy, inexpensive, and effective solution in quantifying field-scale hydrodynamic dispersion and reduce parameter uncertainty in groundwater/contamination transport models.