eScholarship@UMassChan
eScholarship@UMassChan is a digital archive for UMass Chan Medical School's research and scholarship, including journal articles, theses, datasets and more. We welcome submissions from our faculty, staff, and students. eScholarship@UMassChan is a service of the Lamar Soutter Library, Worcester, MA, USA. See also our open access journal publishing services.
Questions? See the Help menu or contact escholarship@umassmed.edu.
Communities in eScholarship@UMassChan
Select a community to browse its collections.
Recent Publications
Publication Metadata only Relationship between substance use and socio-behavioral drivers of poor ART adherence among young people with HIV in Zambia(2026-01-07)Despite improved access to antiretroviral therapy (ART) in Zambia, adherence among young people with HIV (YPHIV) remains suboptimal, compromising treatment effectiveness. YPHIV face unique developmental and socio-behavioral challenges including HIV-related stigma, depression and substance use, which further undermine consistent ART adherence. Alcohol and drug use impair cognitive and emotional functioning, increasing the likelihood of disrupted medication routines. This study applied the Hierarchical Model of Medication Adherence (HMMA) to examine how individual, social and structural factors influence ART adherence among YPHIV in Zambia. A qualitative descriptive design was employed using six focus group discussions (FGDs) with 48 purposively selected participants aged 18-24 years, all reporting <80% adherence and recent substance use. Data were audio-recorded, transcribed verbatim and thematically analyzed. HIV-related stigma, mental health distress and negative healthcare experiences were key drivers of substance use. Substance use impaired adherence by causing forgetfulness and other factors. Depression and emotional exhaustion also emerged as major contributors to substance use and poor adherence. The study offers novel, context-specific insights into the multilevel drivers of poor adherence among Zambian youth aged 18-24. Findings highlight the need for youth-centred interventions that address stigma, mental health and substance use to improve ART adherence and health outcomes.Publication Open Access An expanded registry of candidate cis-regulatory elements(2026-01-07)Mammalian genomes contain millions of regulatory elements that control the complex patterns of gene expression. Previously, the ENCODE consortium mapped biochemical signals across hundreds of cell types and tissues and integrated these data to develop a registry containing 0.9 million human and 300,000 mouse candidate cis-regulatory elements (cCREs) annotated with potential functions. Here we have expanded the registry to include 2.37 million human and 967,000 mouse cCREs, leveraging new ENCODE datasets and enhanced computational methods. This expanded registry covers hundreds of unique cell and tissue types, providing a comprehensive understanding of gene regulation. Functional characterization data from assays such as STARR-seq, massively parallel reporter assay, CRISPR perturbation and transgenic mouse assays have profiled more than 90% of human cCREs, revealing complex regulatory functions. We identified thousands of novel silencer cCREs and demonstrated their dual enhancer and silencer roles in different cellular contexts. Integrating the registry with other ENCODE annotations facilitates genetic variation interpretation and trait-associated gene identification, exemplified by the identification of KLF1 as a novel causal gene for red blood cell traits. This expanded registry is a valuable resource for studying the regulatory genome and its impact on health and disease.Publication Metadata only The PRogram In Support of Moms (PRISM): Increasing obstetric practice capacity to implement the depression care pathway(2026-01-02)BACKGROUND: Perinatal depression is common yet undertreated. The Massachusetts Child Psychiatry Access Program (MCPAP) for Moms is a state-wide program to improve access to perinatal depression care by providing training, consultation, and referrals to healthcare professionals serving perinatal women. The PRogram In Support of Moms (PRISM) includes MCPAP for Moms plus practice-level implementation support. This cluster randomized controlled trial compared MCPAP for Moms vs. PRISM in implementation of the perinatal depression care pathway, inclusive of screening, assessment, treatment, follow-up and monitoring, and transition of care. METHODS: Ten obstetric practices were randomized to MCPAP for Moms or PRISM. We abstracted medical record data for perinatal individuals enrolled in the study with elevated depression symptoms (n = 294). Generalized linear mixed-effects models, accounting for clustering of practices, compared post-intervention implementation of the depression care pathway. We also examined changes in implementation via practice leadership surveys. RESULTS: Patients in PRISM practices were more likely to be screened for bipolar disorder (OR = 385.0, p = .001), have treatment engagement documented (OR = 2.8, p = .011), receive follow-up monitoring (OR = 4.0, p = .003), and receive a transition of care plan (OR = 2.7, p = .016). Patients in PRISM practices were more likely to be identified as having perinatal depression (OR = 2.3, p = .001). Practice leadership reported greater increase in capacity to address perinatal depression in PRISM practices (3.7 points, p = .005). CONCLUSIONS: PRISM was associated with greater depression care pathway implementation and improved identification of patients with perinatal depression. In order to help implement new initiatives (i.e. bipolar disorder screening) aligned with the depression care pathway, practice-level assistance may be needed.Publication Metadata only Multi-modal choroid plexus pathology in aging and Alzheimer's disease [preprint](2026-01-01)Brain barriers, cerebrospinal fluid (CSF) dynamics, and peripheral factors are implicated as significant contributors to Alzheimer's disease (AD). The choroid plexus (ChP) is a blood-brain interface that produces CSF and forms the blood-CSF barrier. However, how ChP pathology develops across the lifespan and contributes to AD has not been systematically characterized. Here, we report a multi-modal ChP atlas integrating single-nucleus transcriptomics from 49 individuals, AI-assisted quantitative histopathology across >500 postmortem samples age 16 to 105, spatial transcriptomics, and functional studies in 5xFAD mice. We identify fibrosis, calcification, and macrophage abnormalities as hallmarks of ChP aging, with AD pathology conferring additional effects, including expansion of a pro-inflammatory fibroblast-macrophage signaling niche. In 5xFAD mice, macrophage dysfunction is associated with impaired epithelial barrier maintenance and repair. Together, these data provide a foundational resource for understanding ChP dysfunction in aging and AD and propose the macrophage-fibroblast-epithelial barrier axis as a driver of ChP pathology.Publication Metadata only