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 Naloxone Administration in Relation to Fentanyl, Xylazine, CNS Depressants, and Stimulants Exposure After Suspected Opioid Overdose: A Pilot Study(2026-04-03)OBJECTIVES: In this pilot, observational study, we characterized naloxone doses individuals received after suspected opioid overdoses in comparison to concentrations of fentanyl, xylazine, central nervous system (CNS) depressants, and stimulants detected in their blood. METHODS: Adults (≥ 18 years old) with suspected opioid overdose presenting to two academic urban US emergency departments (EDs) were recruited between October 2022 and January 2025. Naloxone parenteral equivalents administered prior to ED arrival were compared to fentanyl and xylazine as well as to CNS depressant (e.g., benzodiazepines) and stimulant (e.g., cocaine) blood concentrations. RESULTS: Of the 106 participants, 72% had detectable concentrations of fentanyl; 49% xylazine; 44% CNS depressants; and 74% stimulants. Total mean naloxone parenteral equivalents administered were 3.45 mg (SD 2.13), median 4.0 (IQR 2-4), and mean first dose was 1.98 (SD 1.1), median 2.0 (IQR 2-2). Xylazine concentrations increased moderately as fentanyl concentrations increased (Spearman ρ = 0.45, p < 0.001). Participants whose fentanyl concentrations were in the 4th quartile had received more naloxone (4.67 mg) than those with fentanyl concentrations in the 3rd, 2nd, and 1st quartiles (4.67, 3.22, and 2.74 mg of naloxone, respectively) (p < 0.01 for all comparisons). Of the 52 participants exposed to xylazine, those with xylazine concentrations in the 4th quartile generally had received more naloxone (5.03 mg) than those in the 3rd, 2nd, and 1st xylazine quartiles (3.35, 2.92, and 3.27 mg of naloxone, respectively), but these comparisons did not reach statistical significance (p > 0.05). CONCLUSIONS: The typical dose of naloxone needed in suspected opioid overdoses within a fentanyl endemic area was 4 mg. This dose was similar when xylazine co-exposure occurred, although it tended to be higher with higher xylazine concentrations detected. However, fentanyl was also present at higher levels when greater amounts of xylazine were present.Publication Open Access UMCCTS Newsletter, April 2026(UMass Chan Medical School, 2026-04-01)This is the April 2026 issue of the UMass Center for Clinical and Translational Science Newsletter containing news and events of interest.Publication Metadata only "We're All in This Together": A Mixed-Methods Study of Provider and Patient Perceptions of Emergency Care for Opioid Use Disorder(2026-04-01)AIMS: To compare attitudes and perceptions towards opioid use disorder among people with opioid use disorder and emergency providers, describe interactions between the two groups, and identify barriers to providing and receiving care. DESIGN: Mixed methods observational study. METHODS: Participants were recruited from an academic, tertiary care hospital and a community-based harm reduction agency in New England. Emergency healthcare providers (nurses, physicians, and paramedics) and adult people with opioid use disorder were enrolled. Electronic surveys were administered to providers, and semi-structured interviews were conducted with people with opioid use disorder and a subset of providers. Descriptive statistics were calculated for surveys, and directed content analysis was used to analyse semi-structured interviews. RESULTS: Sixty-eight providers completed the survey, 11 of whom also completed a semi-structured interview. Twenty-two people with opioid use disorder completed the semi-structured interview. Both providers and people with opioid use disorder agreed that addiction is a disease; however, opinions differed on the extent to which personal choice played a role in the onset of opioid use disorder. Participants described how factors such as experiencing homelessness, alongside other personal or familial challenges, contributed to ongoing substance use and presented barriers to accessing healthcare. There was discordance in priorities between providers and people with opioid use disorder, which often drove conflict and perceived stigma. Both groups described physical and emotional trauma from prior interactions, which shaped expectations of future interactions and biases towards each other. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Educational initiatives should arm providers not only with clinical knowledge about opioid use disorder but with skills to recognize implicit biases, navigate unique barriers related to social determinants of health, and effectively deploy shared decision-making techniques. Healthcare organizations should provide support for trauma that emergency care providers are exposed to in caring for people with opioid use disorder. REPORTING METHOD: Consolidated criteria for reporting qualitative studies (COREQ)-32 item checklist. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.Publication Metadata only Suicidal Behavior Patterns and Correlates in High-Risk Adults After Emergency Department Discharge: A One-Year Prospective Study(2026-04)INTRODUCTION: The time following emergency department (ED) discharge is a high-risk period for suicidal behavior. This study examined correlates of suicidal behavior patterns over one-year follow-up among adults presenting to the ED with active suicidal thoughts and behaviors. METHODS: Participants were n = 863 adults presenting to the ED with active suicidal thoughts and behaviors followed for one year post-discharge. Participants were categorized into four suicidal behavior groups: none (no suicidal behavior at baseline or follow-up), worsening (no suicidal behavior at baseline but at follow-up), improving (suicidal behavior at baseline but not follow-up), or persistent (suicidal behavior at both timepoints). We used binary logistic regression models to compare persistent versus improving and worsening versus none groups to examine factors that distinguished groups with the same baseline but different follow-up suicidal behavior. RESULTS: The most common suicidal behavior patterns were none (52.7%, n = 455) or improving (24.7%, n = 213). Risky alcohol use and previous psychiatric inpatient hospitalization distinguished participants in the worsening group from the none group. None of the factors distinguished the improving from the persistent group. CONCLUSIONS: Individuals with active suicidal ideation, alcohol use, and past psychiatric inpatient hospitalization may require additional support following ED discharge to prevent future suicide attempts.Publication Metadata only Modulating Micrococcal Nuclease-Triggered Antibiotic Releases for One-Stage Revisions of -Infected Prostheses(2026-03-31)Periprosthetic joint infections caused by () pose significant health risks and economic burdens. Following revisions of infected arthroplasty prostheses, the reinfection rate can be as high as 30%. We previously developed hydrogel coatings for intramedullary metallic pins where vancomycin or ampicillin was covalently attached through an oligonucleotide linker cleavable by micrococcal nuclease secreted by . When these pins were implanted in -inoculated rat femoral canals, the on-demand release of antibiotics from the coating prevented infections from developing. Here, we test the hypothesis that a combination coating with rapid and more sustained -triggered antibiotic releases could mitigate infections following one-stage revisions of previously infected prostheses. We implemented varying degrees of phosphorothioate modification of the oligonucleotide linker tethering ampicillin to the coating to achieve rapid and more sustained on-demand antibiotic releases. We first demonstrated that rat femoral infections, established by the inoculation of 200 CFU at the time of uncoated primary intramedullary pin insertion, could not be resolved after one-stage revision without a proper pin coating, consistent with clinically observed challenges. However, bacterial burdens were significantly reduced following a one-stage revision with intramedullary pins coated with ampicillin-releasing coatings, with the combination of rapid and more sustained releases proving the most effective. When the combination coating was augmented with a single systemic vancomycin injection at the time of revision, infection was eradicated, outperforming local or systemic treatment alone and achieving unprecedented revision outcomes.