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.
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Recent Publications
Publication Open Access Inflammatory markers in the emergency department and PTSD symptoms in the AURORA Study: A longitudinal cohort study(2026-05-08)BACKGROUND: Systemic inflammation is hypothesized to contribute to post-traumatic stress disorder (PTSD) vulnerability. Few studies have examined inflammation shortly after trauma as a predictor of later PTSD symptoms. We examined whether inflammation from the emergency department (ED) post-trauma is associated with PTSD symptom severity over the following 6 months. METHODS: Our sample included 742 AURORA participants, a longitudinal cohort of patients in 29 EDs across the United States after a traumatic stressor, followed up to 6 months. Plasma cytokines were assessed from a study blood draw in the ED: an inflammatory index (standardized sum of generally pro-inflammatory markers interleukin [IL]-6, IL-8, tumor necrosis factor alpha [TNF-α], interferon gamma [IFN-γ]), and generally anti-inflammatory IL-10. PTSD symptoms were self-reported at 2 weeks, 8 weeks, 3 months, and 6 months post-ED. Covariate-adjusted repeated-measures regressions estimated associations between inflammation and PTSD symptoms, overall and sex-stratified. RESULTS: Among 742 participants (age = 40.0 [13.7]; 479 [64.6%] female), PTSD symptoms were elevated then modestly decreased over follow-up. Higher ED inflammation was associated with higher PTSD symptoms across follow-up (standardized symptoms = 0.05, 95% CI: 0.01-0.09), adjusted for potential confounders. Higher pro-inflammatory index levels and IL-6, IL-8, and TNF-α were associated with higher PTSD symptoms in males only, while higher IL-10 was associated with higher PTSD symptoms in females only. CONCLUSIONS: Pro-inflammatory levels shortly after traumatic stress are associated with heightened PTSD symptoms, particularly among males. Inflammatory markers may prove useful additions to prediction models for PTSD following trauma, with attention to sex differences.Publication Metadata only Geographic Variation in Missing Race and Ethnicity Data in Minimum Data Set 3.0(2026-05-08)BACKGROUND: Race and ethnicity measures in administrative data can vary geographically. The extent of this challenge in US nursing homes is not well described. OBJECTIVES: To describe geographic variation in missing race and ethnicity data in the Minimum Data Set (MDS) 3.0 and Medicare claims, and to compare discrepancies across data sources. RESEARCH DESIGN: Cross-sectional study. SUBJECTS: Medicare beneficiaries with MDS 3.0 records between 2014 and 2018. The Medicare Beneficiary Summary File provided demographic information. MEASURES: Missingness of MDS race and ethnicity data by state, and misclassification of Medicare race and ethnicity enrollment database (EDB) and Research Triangle Institute (RTI) variables compared with MDS. We calculate the sensitivity, specificity, and positive predictive value of the EDB and RTI variables relative to the MDS. RESULTS: Among 18.1 million nursing home residents pooled across 2014-2018, geographic variation in missing race and ethnicity in the MDS 3.0 ranged from 1.2% to 14.7%. Compared with MDS, misclassification of residents classified as Hispanic in MDS ranged from 48.1% to 89.2% for EDB and 0.5% to 44.8% for RTI. Misclassification of residents classified as Asian American/Pacific Islander in MDS ranged from 29.4% to 77.2% for EDB and 12.7% to 65.4% for RTI. Misclassification of residents classified as Black ranged from 0% to 14.2% for EDB and 0% to 16.2% for RTI. Overall, the RTI variables provided better sensitivity and specificity of race and ethnicity than the EDB. CONCLUSION: Missing race and ethnicity data in the MDS varies geographically, as do discrepancies between MDS and EDB and RTI variables. Thoughtful consideration of these issues is recommended when handling missing MDS race and ethnicity data.Publication Embargo Hospice Enrollment Among Medicare Beneficiaries Hospitalized for Chronic Obstructive Pulmonary Disease(UMass Chan Medical School, 2026-05-07)Rationale: Chronic obstructive pulmonary disease (COPD) is associated with substantial morbidity and mortality, reduced quality of life, and high rates of acute care utilization, particularly near the end of life. Although hospice services improve quality of life for patients and caregivers and reduce acute care use, hospice remains underutilized among patients with COPD. Further research is needed to identify factors associated with hospice enrollment in this population. Objectives: To describe the use of hospice following a COPD hospitalization and to identify patient- and hospital-level factors associated with enrollment Methods: We performed a retrospective cohort study using claims data from Medicare fee-for-service beneficiaries hospitalized for a COPD exacerbation in 2014 at 2,650 U.S. acute care hospitals. Our primary outcome was hospice enrollment within 30-days of hospital discharge. We used a hierarchical logistic regression model with hospital-level random effects, adjusting for both patient- and hospital-level variables, to identify factors independently associated with hospice enrollment. Model estimates were used to calculate hospital-specific risk-standardized hospice enrollment rates. The contribution of hospital-level effects to the likelihood of hospice enrollment was quantified using the median odds ratio (MOR). Results: 234,540 patients were included in the analysis, of whom 12,695 (5.4%) enrolled in hospice within 30 days of hospital discharge. Receipt of invasive (aOR 2.66, 95% confidence interval [CI] 2.49-2.84) and non-invasive ventilation (aOR 2.64, 95% CI 2.51-2.78) during the index admission, presence of metastatic cancer (aOR 2.49, 95% CI 2.33-2.65) and use of supplemental oxygen prior to admission (aOR 1.47, 95% CI 1.41-1.52) were the factors most strongly associated with hospice enrollment. Risk-standardized rates of hospice enrollment ranged from 2.9% to 13.3%. Larger hospitals, those in urban areas, and hospitals in the South had higher risk-standardized rates of hospice enrollment than their counterparts. The hospital median odds ratio was 1.45 (95% CI 1.41-1.49) comparable to several patient-level factors associated with hospice enrollment. Conclusions: Among Medicare beneficiaries hospitalized for COPD, approximately 1 in 20 patients enroll in hospice in the month following a COPD hospitalization. Despite adjustment for individual-level differences among patients, substantial variation in hospice enrollment rates remains, suggesting that unmeasured hospital factors contribute to hospice utilization. Additional research is needed to identify strategies to increase hospice use among this patient population.Publication Metadata only Antidepressant Use Among US Nursing Home Residents With Dementia(2026-05-06)BACKGROUND: In 2024, 6.9 million Americans lived with Alzheimer's disease and related dementias (ADRD), with nursing homes serving as a major site of care. Antidepressants are the most prescribed psychotropic medications among nursing home residents with ADRD, yet detailed information on prescribing patterns, potential indications, and associated resident and facility characteristics remain limited. METHODS: Using 2018 minimum data set 3.0 assessments linked to Medicare claims, we conducted a cross-sectional study of long-stay nursing home residents aged ≥ 65 years with ADRD who were continuously enrolled in Medicare fee-for-service for 120 days before their annual assessment. We described usage by drug class and type and compared characteristics of users versus non-users overall and by potential indications: depression, anxiety, pain, and insomnia. RESULTS: Among 232,543 residents with ADRD, 51.6% used antidepressants. Fewer than 5% had moderate or severe depressive symptoms (PHQ-9 ≥ 10). Use was highest among residents with depression or anxiety (69.5%), pain (61.9%), and insomnia (60.0%). Among those without these conditions, 14.1% were prescribed antidepressants. SSRIs were the most prescribed class (60.7%) overall. Citalopram, mirtazapine, sertraline, and trazodone were the most common medications. Residents with any current level of depression severity were more likely to use antidepressants compared to those without symptoms, whereas all levels of cognitive impairment were associated with lower use compared with cognitively intact residents with ADRD. Polypharmacy was strongly associated with increased use, while diabetes, heart failure, and stroke were associated with reduced use. CONCLUSIONS: Antidepressants were frequently prescribed to residents with ADRD despite limited documentation of active depressive symptoms. Limitations in accurately capturing depressive symptoms in nursing home records, including underreporting by residents due to cognitive impairment and reliance on staff observation rather than self-report, may contribute to apparent discordance between symptoms and prescribing. Further research should evaluate treatment appropriateness, deprescribing opportunities, and risk-benefit balance of chronic treatment in this population.Publication Metadata only Control of viral envelope glycoprotein function revealed by single-molecule imaging(2026-05-06)Viral envelope glycoproteins catalyze membrane fusion during entry into cells. Envelope glycoprotein function has traditionally been viewed through the lens of kinetic control, where environmental cues like pH trigger irreversible refolding from the pre-fusion conformation to the post-fusion conformation. Single-molecule Förster resonance energy transfer (smFRET) imaging has revealed an additional layer of thermodynamic control that governs the conformational dynamics of envelope glycoproteins in their pre-fusion form. smFRET studies of the envelope glycoproteins from HIV-1, SARS-CoV-2, MERS-CoV, Ebola virus, and influenza A virus demonstrate that these glycoproteins dynamically sample an ensemble of pre-fusion conformations whose relative stabilities respond to pH, receptor binding, ions, and host proteases. This thermodynamic tuning precedes the kinetically controlled transition that promotes membrane fusion. Collectively, smFRET imaging has transformed our understanding of viral entry, illustrating how the pre-fusion energy landscape of envelope glycoproteins is tuned by the host environment to maintain viral fitness.