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 Adapting an Anxiety Sensitivity Intervention for Perinatal Mental Health: Development of a Digital Intervention(2025-07-11)Introduction: The goal of this study was to adapt an anxiety sensitivity intervention for mobile health delivery to perinatal populations experiencing economic marginalization. Methods: A community-engaged and user-centered design approach informed the prototype of Reaching Calm. We conducted "think-aloud" interviews with perinatal individuals (n=15) experiencing elevated anxiety and economic stressors. Acceptability and usability were assessed with the Treatment Evaluation Inventory Short Form (TEI-SF) and System Usability Scale (SUS), respectively. We used rapid qualitative analysis to analyze interviews and the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to characterize adaptations. Results: Mean TEI-SF and SUS scores were 4.3 and 88.0, respectively. Participants reported the content was helpful, values consistent, addressed cultural norms, and elicited feelings of reassurance. Recommendations included additions to content and options for customization. Adaptations included modifications to context and content. Conclusions: Findings suggest high acceptability and usability. Community-engaged, user-centered design may enhance digital intervention acceptability for perinatal individuals.Publication Association between Time and Severe Hypoperfusion with Risk of Hemorrhagic Transformation in Stroke Patients(2025-07-10)Introduction: Perfusion imaging studies show a substantially increased risk of hemorrhagic transformation (HT) in severely hypoperfused tissue. Preclinical evidence indicates that ischemic damage is influenced not only by the degree of hypoperfusion but also by the duration of exposure to that hypoperfused state. We aim to investigate the association of time and severe hypoperfusion with parenchymal hematoma (PH) in ischemic stroke and explore whether there is a combined effect of the two variables on PH. Methods: Data are from the ESCAPE-NA1 trial, which evaluated the effect of nerinetide in large vessel occlusion patients treated with thrombectomy. This study included patients with some degree of recanalization (expanded Thrombolysis in Cerebral Infarct [eTICI] >0) and available baseline CT perfusion. Severe hypoperfusion was defined as at least 1mL volume of relative cerebral blood flow (rCBF)<20%. We assess 24-hour imaging for the presence of PH, according to Heidelberg bleeding criteria. Univariable and multivariable logistic regression analyses, including interaction terms, were used to assess the effect of time and severe hypoperfusion on outcomes. Results: Out of 1105 patients from ESCAPE-NA1, 396 (35.8%) were included. The median age was 70 years (IQR=59.8-79.2), 202 (51%) were females, and 50 (12.6%) experienced PH. Onset-to-imaging time (adjusted OR 1.04 [95%CI=1.01-1.06] per 15-minute increase) and the presence of severe hypoperfusion (adjusted OR 2.87 [95%CI=1.47-5.63]) were the only variables associated with PH in multivariable analysis. No significant interaction effect of time and severe hypoperfusion on PH was found. The presence of severe hypoperfusion had a negative predictive value of 98% and a positive predictive value of 39.4% for predicting PH in patients presenting within three hours and after six hours from symptom onset, respectively. Conclusion: Both severe hypoperfusion and time affect the risk of hemorrhagic transformation. However, the interaction between these two variables was not statistically significant, indicating that their effects on hemorrhagic transformation risk are not dependent on each other. Analyzing these variables may help identify patients with a leaky, severely compromised blood-brain barrier in the ischemic core-a "leaky core."Publication A Mind-Blowing Ingestion: Intentional Plastic Explosive Consumption Resulting in Seizures(2025-07-10)Introduction: C4 is a plastic explosive commonly used in military applications, and is predominantly composed of cyclonite or RDX (Royal Demolition Explosive). C4 toxicity is a documented but not commonly known cause of altered mental status and recurrent seizures. Case reports: We describe two cases of military personnel who ingested C4 as part of a hazing ritual who presented to the emergency department with witnessed seizure, tremor and petechial rash. One of the patients had a second witnessed seizure within hours of ingestion. They were treated with intravenous benzodiazepines acutely, then with levetiracetam for 48 hours. Both patients were observed in the intensive care unit and discharged with no neurologic sequelae. Discussion: C4 is a common military-grade explosive containing cyclonite which functions as a non-competitive, reversible GABAA antagonist and a rare but clinically significant cause of altered mental status and seizures when ingested. Management is primarily supportive with airway protection and treatment with GABAergic medication.Publication MOCHA Moving Forward: findings and lessons learned from implementing a community-based chronic disease prevention study with middle-aged black men(2025-07-09)Objectives: Black men in the U.S. experience disproportionately high rates of diabetes, cardiovascular disease, and prostate cancer - conditions closely linked to chronic stressors such as racial discrimination, economic precarity, and gender role strain. In response, the Men of Color Health Awareness (MOCHA) program was developed to promote the physical, mental, social, and spiritual well-being of men of color through culturally grounded discussions on structural violence, coping, and masculinity. This paper presents findings and key implementation lessons from the MOCHA Moving Forward study, which tested two intervention models: the original MOCHA program (MO) and MOCHA+, an enhanced version incorporating culturally adapted narrative dialogue. Design: This community-academic feasibility trial randomized 210 men aged 35-70 into MO or MOCHA+ groups. Both participated in a 10-week program focused on stress and chronic disease prevention. Results: Among participants who completed the program, statistically significant reductions were found in self-reported stress, BMI, anxiety, and depression in the MO group. When combining MO and MOCHA+ participants, reductions in stress and BMI remained significant. However, high attrition and loss to follow-up (final sample: 38) posed challenges to feasibility and scalability. Conclusion: Despite retention challenges, findings suggest MOCHA is a promising intervention for stress and chronic disease risk reduction among men of color. The significant outcomes observed among completers highlight the program's potential and provide critical insights for improving the feasibility of future community-based interventions. Future research should explore scalable adaptations and further refine MOCHA's culturally tailored content to better support structurally marginalized populations.Publication Measuring Burnout in Pediatric ICU Nurses: Development and Pilot Validation of a PICU RN Burnout Scale(UMass Chan Medical School, 2025-07-09)Background. Burnout among Pediatric Intensive Care Unit (PICU) nurses is a significant issue. Existing Burnout scales are limited and fail to address factors like moral distress and resource constraints or the emotionally frought nature of pediatric critical care. There is a need for a more specific tool to assess burnout in PICU nurses, which often exceeds 50%. Objectives. This study aimed to develop and validate the first PICU RN Burnout Scale, designed to assess burnout specific to PICU nursing practice. Methods. A cross-sectional, observational design was used to pilot the PICU RN Burnout Scale nationwide. Validity was assessed through comparison with the MBI and McCloskey/Mueller Satisfaction Scale. Reliability was measured using Cronbach’s alpha, and factor structure was evaluated via Exploratory Factor Analysis (EFA). Results. Seventy-one nurses participated. EFA revealed a three-factor structure: Peer Incivility, Psychophysical Stress, and Leadership Support, explaining 74% of the variance. The scale showed excellent internal consistency (α = 0.93) and moderate concurrent validity with the MBI (ρ = 0.56, p < 0.001). Discriminant validity was confirmed with a negative correlation (ρ = -0.61, p < 0.001) with the McCloskey-Mueller Scale. Conclusions. The PICU RN Burnout Scale offers a tailored assessment of burnout, addressing unique stressors not captured by the MBI. It demonstrated strong reliability and validity, suggesting its utility in identifying burnout in PICU nurses. Further research is needed to validate the scale and inform targeted future interventions.