• 10 Years of Impact: A Literature Review of Chapter 58 of the Acts of 2006

      Seifert, Robert W.; Love, Kelly (2016-04-12)
      This fact sheet presents a summary of the effects of Chapter 58 of the Acts of 2006, "An Act Providing Access To Affordable, Quality, Accountable Health Care," as reported in the many studies that have focused on Massachusetts’ reform. This high-level review summarizes the findings in various categories, including insurance coverage, access to care, health care utilization, and affordability for consumers. The authors also developed a full bibliography as a companion to the fact sheet.
    • 12 versus 24 h bed rest after acute ischemic stroke thrombolysis: a preliminary experience

      Silver, Brian; Moonis, Majaz; Henninger, Nils; Goddeau, Richard P. Jr; Jun-O'Connell, Adalia H.; Hall, Wiley R.; Muehlschlegel, Susanne; Carandang, Raphael A.; Osgood, Marcey (2019-12-05)
      BACKGROUND: The practice of > /=24 h of bed rest after acute ischemic stroke thrombolysis is common among hospitals, but its value compared to shorter periods of bed rest is unknown. METHODS: Consecutive adult patients with a diagnosis of ischemic stroke who had received intravenous thrombolysis treatment from 1/1/2010 until 4/13/2016, identified from the local ischemic stroke registry, were included. Standard practice bed rest for > /=24 h, the protocol prior to 1/27/2014, was retrospectively compared with standard practice bed rest for > /=12 h, the protocol after that date. The primary outcome was favorable discharge location (defined as home, home with services, or acute rehabilitation). Secondary outcome measures included incidence of pneumonia, NIHSS at discharge, and length of stay. RESULTS: 392 patients were identified (203 in the > /=24 h group, 189 in the > /=12 h group). There was no significant difference in favorable discharge outcome in the > /=24 h bed rest protocol compared with the > /=12 h bed rest protocol in multivariable logistic regression analysis (76.2% vs. 70.9%, adjusted OR 1.20 CI 0.71-2.03). Compared with the > /=24 h bed rest group, pneumonia rates (8.3% versus 1.6%, adjusted OR 0.12 CI 0.03-0.55), median discharge NIHSS (3 versus 2, adjusted p = .034), and mean length of stay (5.4 versus 3.5 days, adjusted p = .006) were lower in the > /=12 h bed rest group. CONCLUSION: Compared with > /=24 h bed rest, > /=12 h bed rest after acute ischemic stroke reperfusion therapy appeared to be similar. A non-inferiority randomized trial is needed to verify these findings.
    • (18)F-VC701-PET and MRI in the in vivo neuroinflammation assessment of a mouse model of multiple sclerosis

      Belloli, Sara; Zanotti, Lucia; Murtaj, Valentina; Mazzon, Cristina; Di Grigoli, Giuseppe; Monterisi, Cristina; Masiello, Valeria; Iaccarino, Leonardo; Cappelli, Andrea; Poliani, Pietro Luigi; et al. (2018-02-05)
      BACKGROUND: Positron emission tomography (PET) using translocator protein (TSPO) ligands has been used to detect neuroinflammatory processes in neurological disorders, including multiple sclerosis (MS). The aim of this study was to evaluate neuroinflammation in a mouse MS model (EAE) using TSPO-PET with (18)F-VC701, in combination with magnetic resonance imaging (MRI). METHODS: MOG35-55/CFA and pertussis toxin protocol was used to induce EAE in C57BL/6 mice. Disease progression was monitored daily, whereas MRI evaluation was performed at 1, 2, and 4 weeks post-induction. Microglia activation was assessed in vivo by (18)F-VC701 PET at the time of maximum disease score and validated by radioligand ex vivo distribution and immunohistochemistry at 2 and 4 weeks post-immunization. RESULTS: In vivo and ex vivo analyses show that (18)F-VC701 significantly accumulates within the central nervous system (CNS), particularly in the cortex, striatum, hippocampus, cerebellum, and cervical spinal cord of EAE compared to control mice, at 2 weeks post-immunization. MRI confirmed the presence of focal brain lesions at 2 weeks post-immunization in both T1-weighted and T2 images. Of note, MRI abnormalities attenuated in later post-immunization phase. Neuropathological analysis confirmed the presence of microglial activation in EAE mice, consistent with the in vivo increase of (18)F-VC701 uptake. CONCLUSION: Increase of (18)F-VC701 uptake in EAE mice is strongly associated with the presence of microglia activation in the acute phase of the disease. The combined use of TSPO-PET and MRI provided complementary evidence on the ongoing disease process, thus representing an attractive new tool to investigate neuronal damage and neuroinflammation at preclinical levels.
    • 1801: Patient-Specific Markers Associated with the Risk of Alcohol Withdrawal in the Trauma Population

      Li, Irene; Forni, Allison; Carpenter, Dawn; Menard, Alexander; Rossetti, Victoria; Emhoff, Timothy A.; Lilly, Craig M. (2019-01-01)
      Learning Objectives: Alcohol withdrawal syndrome (AWS) and delirium tremens (DTs) have been reported as a complication following traumatic injury, at rates of 0.88% and 0.10%, respectively. AWS among trauma patients is associated with an increased length of hospital stay, mechanical ventilation, and aspiration pneumonia. There is minimal literature about the optimal screening tool to predict and stratify trauma patients at risk for AWS. Additionally, there has been increased interest in the use of phenobarbital as a management strategy for AWS. The purpose of this systematic review were to evaluate screening tools to identify trauma patients who are most likely to develop AWS, and assess phenobarbital dosing strategies for prophylaxis of AWS. Methods: A literature search was performed in PubMed/MEDLINE. The initial search yielded 1072 articles from which non-English and duplicate articles were removed. The remaining 974 articles underwent blinded review with an interprofessional team. Twenty articles were included in the final analysis. These studies were assessed for level of evidence using the Grading of Recommendations Assessment, Development and Evaluation tool (GRADE). Results: Twenty articles were included in the final analysis with eleven reviewing tools and nine reviewing phenobarbital dosing strategies. CAGE and brief MAST were the most commonly used questionnaires for adults with blunt or penetrating trauma. Other factors associated with the development of AWS and DTs include male gender, age, and blood alcohol level. Laboratory biomarkers such as elevated AST and MCV are associated with alcohol use among trauma victims. While phenobarbital has been evaluated for management of AWS and DTs, none of the studies utilized phenobarbital in the prevention of AWS or DTs. Conclusions: Further investigation into the predictive ability of a screening tool that combines a short questionnaire, laboratory values, and patient demographics to predict and stratify the risk of AWS and DTs in the adult trauma population is warranted. Additional research is needed to identify pharmacologic strategies for prophylaxis of AWS and DTs.
    • 19F MRI Imaging of Polymer Nanogels Aided by Improved Segmental Mobility of Embedded Fluorine Moieties

      Munkhbat, Oyuntuya; Canakci, Mine; Zheng, Shaokuan; Hu, Weiguo; Osborne, Barbara; Bogdanov, Alexei A.; Thayumanavan, S. (2018-12-18)
      Using fluorinated probes for 19F MRI imaging is an emerging field with potential utility in cellular imaging and cell tracking in vivo, which complements conventional 1H MRI. An attractive feature of 19F-based imaging is that this is a bio-orthogonal nucleus and the naturally abundant isotope is NMR active. A significant hurdle however in the 19F MRI arises from the tendency of organic macromolecules, with multiple fluorocarbon substitutions, to aggregate in the aqueous phase. This aggregation results in significant loss of sensitivity, because the T2 relaxation times of these aggregated 19F species tend to be significantly lower. In this report, we have developed a strategy to covalently trap nanoscopic states with an optimal degree of 19F substitutions, followed by significant enhancement in T2 relaxation times through increased segmental mobility of the side chain substituents facilitated using stimulus-responsive elements in the polymeric nanogel. In addition to NMR relaxation time based evaluations, the ability to obtain such signals are also evaluated in mouse models. The propensity of these nanoscale assemblies to encapsulate hydrophobic drug molecules and the availability of surfaces for convenient introduction of fluorescent labels suggest the potential of these nanoscale architectures for use in multi-modal imaging and therapeutic applications.
    • 2010 K12 Awardees: Overview of Research Projects

      Cutrona, Sarah L.; Santry, Heena P. (2014-01-29)
      Two UMCCTS Clinical Research Scholars (K awardees) describe their research projects and professional growth as junior faculty: - Sarah Cutrona on "Electronic Transmission of Health Information across Networks" - Heena Santry on "Career Development for an Academic Acute Care Surgeon and Acute Care Surgery Practice Patterns: A Tale of Two Complexities"
    • 2013 State of the Science Conference Proceedings: Tools for System Transformation for Young Adults with Psychiatric Disabilities

      Davis, Maryann (2014-03-25)
      In 2013, the Learning and Working During the Transition to Adulthood Rehabilitation Research & Training Center, UMass Chan Medical School, successfully conducted a state of the science conference, “Tools for System Transformation for Young Adults with Psychiatric Disabilities.” The conference was held at Georgetown University National Technical Assistance Center for Children’s Mental Health on September 24-25th, 2013. We had two goals for this conference. Our first goal was to share and discuss the current state of research knowledge regarding practice and policy supports for strong educational and employment outcomes in young adults (ages 18-30) with psychiatric disabilities. Our second goal was to engage all attendees in prioritizing the knowledge that future research should address, to guide these systems’ efforts, to better launch and support these young adults’ long-term careers. The proceedings herein include all conference papers and responses as well as final considerations for the future research directions in education, employment and policy and practice. For more information, please visit our website: https://umassmed.edu/TransitionsACR/publication/conferences/state_of_the_science_conference/
    • 2013-2015 Connecting Consumers with Care Grant Area Evaluation

      Gurewich, Deborah; Cabral, Linda M.; Sefton, Laura A. (2016-06-01)
      This report includes findings from the evaluation of the 2013-2015 Connecting Consumers with Care grant program. The goals of the evaluation were to 1) assess progress made on select outreach and enrollment measures, 2) describe the practices grantees adopted to reach and enroll consumers in health insurance, and 3) characterize efforts and challenges in defining, promoting, and evaluating consumer self-sufficiency.
    • 2015 Vermont Health Benefits Survey

      London, Katharine; Ohler, Tamara; Animashaun, Abby; Behl-Chadha, Bittie; Hillerns, Carla; Fish, Susan; Lei, Pei-Pei (2015-06-01)
      The Vermont Agency on Administration contracted with UMass Medical School to conduct a survey of Vermont employers regarding the health benefits they provide to employees. A total of 7,516 Vermont firms were invited to respond to an online survey; of these, 2,688 completed surveys (36 percent); 2,582 surveys (34 percent) were analyzed in this report. The report presents responses only from firms with 3 or more employees. These 2,582 analyzed surveys represent approximately 12 percent of all Vermont firms and 24 percent of all firms with 3 or more employees. While policymakers often focus on averages, the survey findings point to considerable variation in health insurance benefits offered, enrollment, and cost. Half of all responding firms offer health insurance, but offer rates, eligibility requirements, plan design, employer cost, and employee cost varywidelyby firm size, county, industry, and coverage type. For example, one-fourth of respondents cover 100 percent of their employees’ health insurance premium, while a third of respondents contribute less than 70percent of premium costs.
    • 2016 UMCCTS Research Retreat Poster Session

      Carlin, Robert (2016-05-20)
      Poster Session at the 6th annual UMCCTS Research Retreat, held Friday, May 20, 2016 at UMass Medical School, Worcester, MA.
    • 2016 UMCCTS Research Retreat Poster Session

      Carlin, Robert (2016-05-20)
      Poster Session at the 6th annual UMCCTS Research Retreat, held Friday, May 20, 2016 at UMass Medical School, Worcester, MA.
    • 2016 UMCCTS Research Retreat Poster Session

      Carlin, Robert (2016-05-20)
      Poster Session at the 6th annual UMCCTS Research Retreat, held Friday, May 20, 2016 at UMass Medical School, Worcester, MA.
    • 2016 UMCCTS Research Retreat Poster Session

      Carlin, Robert (2016-05-20)
      Poster Session at the 6th annual UMCCTS Research Retreat, held Friday, May 20, 2016 at UMass Medical School, Worcester, MA.
    • 2017 AAAEM Benchmarking Survey: Comparing Pediatric and Adult Academic Emergency Departments

      Rathlev, Niels K.; Holt, Nate M.; Harbertson, Cathi A.; Hettler, Joeli; Reznek, Martin A.; Tsai, Shiu-Lin; Lopiano, Kenny K.; Bohrmann, Tommy; Scheulen, James J. (2020-01-21)
      OBJECTIVES: The Academy of Administrators in Academic Emergency Medicine Benchmark Survey of academic emergency departments (EDs) was conducted in 2017. We compared operational measures between pediatric and adult (defined as fewer than 5% pediatric visits) EDs based on survey data. Emergency departments in dedicated pediatric hospitals were not represented. METHODS: Measures included: (1) patient volumes, length of stay, and acuity; and 2) faculty staffing, productivity, and percent effort in academics. t Tests were used to compare continuous measures and inferences for categorical variables were made using Pearson chi test. RESULTS: The analysis included 17 pediatric and 52 adult EDs. We found a difference in the number of annual visits between adult (median, 66,275; interquartile range [IQR], 56,184-77,702) and pediatric EDs (median, 25,416; IQR, 19,840-29,349) (P < 0.0001). Mean "arrivals per faculty clinical hour" and "total arrivals per treatment space" showed no differences. The proportion of visits (1) arriving by emergency medical services and (2) for behavioral health were significantly higher in adult EDs (both P < 0.0001). The mean length of stay in hours for "all" patients was significantly longer in adult (5.4; IQR, 5.0-6.6) than in pediatric EDs (3.5; IQR, 2.9-4.3; P = 0.017). A similar difference was found for "discharged" patients (P = 0.004). Emergency severity indices, professional evaluation and management codes, and hospitalization rates all suggest higher acuity in adult EDs (all P < 0.0001). There were no differences in mean work relative value units per patient or in the distribution of full time equivalent effort dedicated to academics. CONCLUSIONS: In this cohort, significant differences in operational measures exist between academic adult and pediatric EDs. No differences were found when considering per unit measures, such as arrivals per faculty clinical hour or per treatment space.
    • 2018 State-of-the-Science Conference Proceedings: Executive Summary

      Davis, Maryann (2019-02-22)
      This is the Executive Summary for the Learning and Working During the Transition to Adulthood Rehabilitation Research & Training Center's 2018 State-of-the-Science Conference Proceedings. For more information and the full conference proceedings, please visit our website at https://umassmed.edu/TransitionsACR/publication/conferences/state_of_the_science_conference/".
    • 30-year trends in heart failure in patients hospitalized with acute myocardial infarction

      McManus, David D.; Chinali, Marcello; Saczynski, Jane S.; Gore, Joel M.; Yarzebski, Jorge L.; Spencer, Frederick A.; Lessard, Darleen M.; Goldberg, Robert J. (2011-02-01)
      Despite significant advances in its treatment, acute myocardial infarction (AMI) remains an important cause of heart failure (HF). Contemporary data remain lacking, however, describing long-term trends in incidence rates, demographic and clinical profiles, and outcomes of patients who develop HF as a complication of AMI. Our study sample consisted of 11,061 residents of the Worcester (Massachusetts) metropolitan area hospitalized with AMI at all greater Worcester hospitals in 15 annual study periods from 1975 to 2005. Overall, 32.4% of patients (n = 3,582) with AMI developed new-onset HF during their acute hospitalization. Patients who developed HF were generally older, more likely to have pre-existing cardiovascular disease, and were less likely to receive cardiac medications or undergo revascularization procedures during their hospitalization than patients who did not develop HF (p <0.001). Incidence rates of HF remained relatively stable from 1975 to 1991 at 26% but decreased thereafter. Decreases were also noted in hospital and 30-day death rates in patients with acute HF (p <0.001). However, patients who developed new-onset HF remained at significantly higher risk for dying during their hospitalization (21.6%) than patients who did not develop this complication (8.3%, p <0.001). Our large community-based study of patients hospitalized with AMI demonstrates that incidence rates of and mortality attributable to HF have decreased over the previous 3 decades. In conclusion, HF remains a common and frequently fatal complication of AMI to which increased surveillance and treatment efforts should be directed.
    • 30-year trends in patient characteristics, treatment practices, and long-term outcomes of adults aged 35 to 54 years hospitalized with acute myocardial infarction

      Tisminetzky, Mayra; McManus, David D.; Gore, Joel M.; Yarzebski, Jorge L.; Coles, Andrew H.; Lessard, Darleen M.; Goldberg, Robert J. (2014-04-01)
      Much of our knowledge about the characteristics, clinical management, and postdischarge outcomes of acute myocardial infarction (AMI) is derived from clinical studies in middle-aged and older subjects with little contemporary information available about the descriptive epidemiology of AMI in relatively young men and women. The objectives of our population-based study were to describe >3-decade-long trends in the clinical features, treatment practices, and long-term outcomes of young adults aged 35 to 54 years discharged from the hospital after AMI. The study population consisted of 2,142 residents of the Worcester (Massachusetts) metropolitan area who were hospitalized with AMI at all central Massachusetts medical centers during 16 annual periods from 1975 to 2007. Our primarily male study population had an average age of 47 years. Patients hospitalized during the most recent decade (1997 to 2007) under study were more likely to have a history of hypertension and heart failure than those hospitalized during earlier study years. Patients were less likely to have developed heart failure or stroke during their hospitalization in the most recent compared with the initial decade under study (heart failure 13.7% and stroke 0.7% vs 20.9% and 2.0%, respectively). One- and 2-year postdischarge death rates also decreased significantly between 1975 to 1986 (6.2% and 9.0%, respectively) and 1988 to 1995 (2.6% and 4.9%). These trends were concomitant with the increasing use of effective cardiac therapies and coronary interventions during hospitalization. The present results provide insights into the changing characteristics, management, and improving long-term outcomes of relatively young patients hospitalized with AMI.
    • 3D Printing Exhibit at 2017 UMCCTS Research Retreat

      7th annual UMass Center for Clinical and Translational Science Research Retreat held Tuesday, May 16, 2017 at UMass Medical School,Worcester, MA.
    • 4-D Reconstruction With Respiratory Correction for Gated Myocardial Perfusion SPECT

      Qi, Wenyuan; Yang, Yongyi; Song, Chao; Wernick, Miles N.; Pretorius, P. Hendrik; King, Michael A. (2017-08-01)
      Cardiac single photon emission computed tomography (SPECT) images are known to suffer from both cardiac and respiratory motion blur. In this paper, we investigate a 4-D reconstruction approach to suppress the effect of respiratory motion in gated cardiac SPECT imaging. In this approach, the sequence of cardiac gated images is reconstructed with respect to a reference respiratory amplitude bin in the respiratory cycle. To combat the challenge of inherent high-imaging noise, we utilize the data counts acquired during the entire respiratory cycle by making use of a motion-compensated scheme, in which both cardiac motion and respiratory motion are taken into account. In the experiments, we first use Monte Carlo simulated imaging data, wherein the ground truth is known for quantitative comparison. We then demonstrate the proposed approach on eight sets of clinical acquisitions, in which the subjects exhibit different degrees of respiratory motion blur. The quantitative evaluation results show that the 4-D reconstruction with respiratory correction could effectively reduce the effect of motion blur and lead to a more accurate reconstruction of the myocardium. The mean-squared error of the myocardium is reduced by 22%, and the left ventricle (LV) resolution is improved by 21%. Such improvement is also demonstrated with the clinical acquisitions, where the motion blur is markedly improved in the reconstructed LV wall and blood pool. The proposed approach is also noted to be effective on correcting the spill-over effect in the myocardium from nearby bowel or liver activities.
    • 4D non-local means post-filtering for cardiac gated SPECT

      Song, Chao; Yang, Yongyi; Pretorius, P. Hendrik; King, Michael A. (2017-12-28)
      Cardiac gated images often suffer from increased noise in single photon emission computed tomography (SPECT) due to reduced data counts compared to non-gated studies. We investigate a spatiotemporal post-processing approach based on a non-local means (NLM) filter for suppressing the noise in gated SPECT images. In this filter, the output at a voxel location is computed from a weighted average of voxels in its 4D neighborhood, wherein the filter coefficients are adjusted according to the similarity level in the local image pattern of individual voxels with respect to the output voxel. This adaptive property allows the filter to achieve noise reduction while avoiding excessive blur of the heart wall. In the experiments, we first evaluated the accuracy of the proposed NLM filtering approach using simulated SPECT imaging data. We then demonstrated the approach on eight sets of clinical acquisitions. In addition, we also explored the robustness of the NLM filter with imaging dose reduced by 50% in these clinical acquisitions. The quantitative results show that 4D NLM filtering could effectively reduce the noise level in gated images, leading to more accurate reconstruction of the myocardium. Compared to spatial filtering alone, using temporal filtering in NLM could reduce the mean-squared-error of the myocardium by 55.63% and improve the LV resolution by 19.92%. It could also improve the visibility of perfusion defects in gated images. Similar results are also observed on the clinical acquisitions both at standard dose and at 50% reduced dose. The 4D NLM results are also found to be comparable to that of a motion-compensated 4D reconstruction approach which is computationally more demanding.