University Of Massachusetts Medical School Research Articles

Profile of Raúl Padrón

Over the past four decades, structural biologist Raul Padron has elucidated muscle contraction at the molecular and atomic level using a model system that he and his colleague Roger Craig developed: tarantula skeletal muscle. Padron’s research on how skeletal muscle thick filaments relax and become activated is helping to inform the molecular pathogenesis of human muscle diseases. For such advances, Padron was elected as an international member of the National Academy of Sciences (NAS) in 2018; later, he emigrated to the United States due to his native Venezuela’s ongoing political crisis. Now a professor at the University of Massachusetts Medical School, Padron answers longstanding questions in his Inaugural Article (1) concerning striated muscle contraction that shed light on its underlying mechanisms in invertebrates and vertebrates. Raul Padron. Image credit: Marie Craig (photographer). Padron was born in Caracas to a concert pianist mother and pharmacologist and microbiologist father. Through his mother he gained a strong work ethic. He was also greatly influenced by his father, who maintained a home laboratory. “I still remember my surprise when he showed me paramecia swimming under a microscope,” Padron says. “Soon, I started raising yeast on chicken soup to see them under magnification.” When he was 11 years old, Padron was permitted to have a separate laboratory, where he did chemistry and biology experiments and built electronic equipment. He attended San Ignacio High School in Caracas, where mathematician Angel Urmeneta and biologist Raphael Bredy reinforced his academic interests. In 1966, Bredy suggested that Padron visit the Venezuelan Institute for Scientific Research (IVIC). During the visit, he met biochemist Karl Gaede, whose laboratory he joined at age 16. Padron says, “Under Gaede’s advice, I decided to study electrical engineering at the Central University of Venezuela, as he thought this would provide a good background for a …

‘Adulting’ Is Hard: Understanding the College-to-Career Transition and Supporting Young Adults’ Emotional Wellbeing

The transition from college to career includes many challenges, such as adjusting to a professional environment, the high costs of student loan repayment and independent living, and changes in social support networks. Many of these challenges affect a young person’s emotional wellbeing; however, limited attention has been paid in the literature or at the practice level to the emotional wellbeing of college graduates as they transition from college to career. To address this underrecognized issue, investigators from The Jed Foundation (JED), a leading nonprofit organization with a mission to protect the emotional health and prevent suicide among teens and young adults, and the Transitions to Adulthood Center for Research (Transitions ACR) at the University of Massachusetts Medical School collaborated on a study to better understand the experiences of young adults during the college-to-career transition and how these experiences effect emotional wellbeing.

Adapting Open Dialogue for Early-Onset Psychosis in Latvia: Barriers and Facilitators

Abstract Open Dialogue (OD) is the Finnish crisis intervention approach based on an open dialogue involving various professionals and a trusted person of the patient. This publication has demonstrated both clinical and economic benefits from the implementation of the principles of OD. The implementation of this approach was started in Latvia in cooperation with Dr. D. Ziedonis from the Department of Psychiatry, University of Massachusetts Medical School (today working at University of California San Diego), by translating into Latvian “The Key Elements of Dialogic Practice in Open Dialogue” and carrying out expert consensus panel discussions on the barriers and facilitators of the approach. The obstacles are linked with the lack of education in family therapy, lack of resources, possible problems of cooperation among professionals, and the existing standard practice where there are no active home visits in crisis situations. At the same time, positive elements that are close to Latvian psychiatry can be observed in the OD approach, for instance, the importance of a clinical conversation and listening to the points of views of family members encourage psychiatrists in Latvia to use this approach. The setting of OD could be community-based mental health centres as well as inpatient psychiatric departments dealing with acutely psychotic patients. OD can be a valuable addition and alternative in the case of new psychotic patients when treatment with medications is not efficient, and the patient is not favourably disposed to the use of medications, but nevertheless is seeking help.

Editorial introductions

Current Opinion in Endocrinology and Diabetes was launched in 1994, with Obesity added to the title in 2007. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of endocrinology and diabetes are divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Wendy KuohungWendy KuohungWendy Kuohung is the Director of the Division of Reproductive Endocrinology at Boston Medical Center and an Associate Professor of Obstetrics and Gynecology at the Boston University School of Medicine, USA. Dr Kuohung received her medical degree from the Yale University School of Medicine, USA. She completed her residency in obstetrics and gynecology at Boston University Medical Center, USA and fellowship training in reproductive endocrinology and infertility at Brigham and Women's Hospital, USA. Dr Kuohung is a Reproductive Scientist Development Program scholar and has received several NIH research grants since 2003. She received the BUSM Resident Award for Excellence in Teaching in Ob/Gyn in 2001 and the Harvard Medical School Teaching Award in Reproductive Endocrinology in 2003. She has published numerous peer-reviewed publications and chapters. Her research interests lie in infections of the placenta and reproductive tract, and she has clinical expertise in advanced minimally invasive gynecologic surgery, female infertility, and fertility preservation. In addition to Boston University Medical Center, her practice sites include Boston IVF in Waltham, MA, USA. Katherine L. RotkerKatherine L. RotkerKatherine L. Rotker is a board-certified urologist and assistant professor of Urology at the University of Massachusetts medical school, USA. She completed both her residency training and fellowship at Brown University, USA, and specializes in male infertility, andrology and men's health. She has published in the areas of hypogonadism and fertility preservation. She also has a special interest in gender bias and has published extensively in this area including “Addressing Patient Gender Bias Toward Trainees in the Field of Andrology”, “What's Gender Got to Do With It: Difference in the Proportion of Traditionally Female Cases Performed by General Urologists of Each Gender” and “Gender Disparities in Industry Payments to Urologists.”

Smoking Cessation App That Teaches Acceptance Shows Promise

Smoking Cessation App That Teaches Acceptance Shows Promise

First person profile: William Sellers, MD: Dr. Sellers has helped to shape the field of cancer genomics and, alongside his colleagues, is working toward its ultimate goal-to move from therapy to cure.

First person profile: William Sellers, MD: Dr. Sellers has helped to shape the field of cancer genomics and, alongside his colleagues, is working toward its ultimate goal-to move from therapy to cure.

DMD & BMD – CLINICAL: P.43 Patient and family centric care for Duchenne and Becker muscular dystrophy: towards the IPU (Integrated Practice Unit) model

Patients with Duchenne and Becker muscular dystrophy (DBMD) have multisystem care needs for motor, cardiac, pulmonary, neurobehavioral health problems and bone and endocrine co-morbidities from glucocorticoid therapy. Carrier moms and sisters are at risk for cardiomyopathy. The Duchenne program at University of Massachusetts Medical School was established to overcome the coordination challenges of function-based specialist care groups. Lack of an integrated care management framework results in fragmented care and suboptimal outcomes. Our IPU care model for DBMD is centered on a coordinated, team-based, integrated approach that spans the full cycle of care and features a core team with the full range of medical expertise and technical skills needed to address all the care needs of patients and carriers with DBMD. The team is led by a neuromuscular physician who functions as the team captain to oversee the care process. Other elements of the DBMD IPU care model include: team meetings to oversee care processes and coordinate patients' care plans; responsibility for the full cycle of care for the multi-systemic health problems from infancy to adulthood by pediatric and adult providers – encompassing outpatient, inpatient and rehabilitative care, and allied health care needs, patient and family education via program website and patient portals with EHR, phone calls and emails for post visit follow up care, care coordination with primary and local care providers for DBMD specific care considerations; tracked outcomes (clinical outcomes with PROM and EHR based program registry, financial outcomes with costs and revenue); and a single administrative and scheduling structure with a dedicated clinic business plan. A primary challenge to establishing an IPU is cost of staff efforts, due to current insurance approaches to reimbursement. Cost effectiveness and budget impact studies are needed to assess the potential for value or outcome-based financing for IPU models of care.

Provider Perceptions of a Humanizing Intervention for Health Care Workers—A Survey Study of PPE Portraits

ContextReports from patients and health care workers dealing with coronavirus disease 2019 (COVID-19) underscore experiences of isolation and fear. Some of this experience results from the distancing effect of masks, gloves, and gowns known as personal protective equipment (PPE). One approach to bridging the divide created by PPE is the use of PPE portraits, postcard-sized pictures affixed to PPE. ObjectivesOur confidential electronic mail-based survey aimed to quantify provider attitudes toward PPE portraits. MethodsPPE portraits were piloted at an academic safety-net health system experiencing a COVID-19 patient surge during April–May 2020, necessitating use of full PPE for COVID-positive patients and surgical masks in all hospital settings. Our survey assessed staff exposure to PPE portraits, attitudes toward PPE portraits, and potential program expansion. For staff wearing PPE portraits, we also assessed perceptions of interactions with other staff and patients/families and impact on personal well-being. The University of Massachusetts Medical School's Institutional Review Board designated this as a quality improvement project (#H00020279). ResultsMore than half of survey respondents (n = 111 of 173; 64%) reported exposure to PPE portraits. Attitudes toward PPE portraits were positive overall, with agreement that PPE portraits were a good idea (89%), improved provider mood (79%), enhanced perception of team connection (72%), and more positive among those who reported exposure. Open-ended responses (n = 41) reinforced positive survey data and also raised concerns about infection control (n = 6), cost/logistics (n = 5), and provider vulnerability (n = 3). ConclusionProviders report that PPE portraits may represent a positive patient-centered idea that helps reassure patients, is well received by interdisciplinary staff, and may enhance patient and team interactions. Potential adaptations to address concerns include photo pins and donor/patient and family experience department support for costs.

Accelerated Graduation and the Deployment of New Physicians During the COVID-19 Pandemic.

The COVID-19 pandemic has presented unprecedented challenges and opportunities for medical schools in the United States. In this Invited Commentary, the authors describe a unique collaboration between the University of Massachusetts Medical School (UMMS), the only public medical school in the state; the University of Massachusetts Memorial Medical Center (UMMMC); and the Commonwealth of Massachusetts. Through this partnership, UMMS was able to graduate fourth-year medical students 2 months early and deploy them to UMMMC to care for patients and alleviate workforce shortages during the COVID-19 surge, which peaked in Massachusetts in April 2020. The authors describe how they determined if students had fulfilled graduation requirements to graduate early, what commencement and the accompanying awards ceremony looked like this year as virtual events, the special emergency 90-day limited license these new graduates were given to practice at UMMMC during this time, and the impact these new physicians had in the hospital allowing residents and attendings to be redeployed to care for COVID-19 patients.

Sleep medicine education in US and Canadian orofacial pain residency programs: Survey outcomes

The role of the dentist in the field of sleep medicine has grown significantly over the past few decades. This applies not only to the management of sleep disorders but also to the screening of those patients who may be at risk of developing a sleep disorder and the need to proceed with a thorough clinical interview, examination, and referral to a sleep physician when appropriate. Now more than ever, this requires education in dental schools about sleep, sleep disorders, the relationship between sleep and pain, and the management options. Dr. Moreno-Hay is an assistant professor and the program director, orofacial pain, Department of Oral Health Sciences, College of Dentistry, University of Kentucky, Lexington, KY. Dr. Hernández is an associate clinical professor, Oral Medicine Graduate Program, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada. Dr. Mulet is an adjunct assistant professor and an associate program director, Orofacial Pain Graduate Program, School of Dentistry, University of Minnesota, Minneapolis, MN. Dr. Villalon is a visiting faculty member, Department of Orofacial Pain, School of Dentistry, University of California, Los Angeles, Los Angeles, CA. Dr. Alonso is an assistant professor and the director, orofacial pain, Department of Anesthesiology, Duke University, Durham, NC. Dr. Lockerman is an instructor of surgery, University of Massachusetts Medical School, Worcester, MA, and a clinical instructor in orofacial pain, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. Dr. Bailey is a visiting instructor, Department of Orofacial Pain and a co-director of sleep medicine miniresidency, School of Dentistry, University of California, Los Angeles, Los Angeles, CA.

University of Massachusetts Medical School.

University of Massachusetts Medical School.

Discussion: Low Complication Rates Using Closed-Incision Negative-Pressure Therapy for Panniculectomies: A Single-Surgeon, Retrospective, Uncontrolled Case Series.

Worcester, Mass. From the Division of Plastic Surgery, University of Massachusetts Medical School. Received for publication December 13, 2019; accepted March 27, 2020. Disclosure:The authors have no financial interest to declare in relation to the content of this Discussion or of the associated article. Giorgio Giatsidis, M.D., Ph.D., Division of Plastic Surgery, University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, Mass. 01655, [email protected], Twitter: @drgiatsidis, @ggiatsidis

Women's Experiences with a Mindful Eating Program for Binge and Emotional Eating: A Qualitative Investigation into the Process of Change.

Objectives: Mindfulness-based interventions (MBIs) have been shown to reduce engagement in disordered eating behaviors, although how these interventions engender change remains unclear. The objective of this exploratory qualitative study was to describe the experiences and perceived attitudinal and behavioral changes of women participating in a mindful eating program. Design: Focus group discussions were held with women participating in a community-based mindful eating program for binge and emotional eating. A semistructured interview guide was used to explore participants' conceptualizations of mindfulness-based attitudinal and behavior change, as related to food, eating, and body image. The focus group discussions were audio-recorded, transcribed, and analyzed using thematic analysis to identify salient concepts. Settings/Location: Focus group discussions were held at the Center for Mindfulness at the University of Massachusetts Medical School (UMMS) (United States). Participants: A sample of nine women who were enrolled in the mindful eating program at UMMS for problems with self-reported binge and/or emotional eating participated in this study. Results: Four themes were constructed that described a process of mindfulness-based behavior change, including (1) Learning Through Self-Awareness, (2) Self-Empowerment, (3) Mindful Choice-Making, and (4) Resilient Self-Care. An overarching description of the participants' perceived attitudinal and behavior changes was developed: "unforced freedom of choice, emerging from embodied awareness." Conclusions: These findings suggest that MBIs reduce may disordered eating behaviors through empowering women to make positive choices about food, eating, and coping, without focusing on weight control. Future research is needed to examine whether these findings replicate in larger and more diverse samples, and how they can be used to optimize and implement eating-specific MBIs in community-based settings.

Barbara E. Waud, M.D. (1931–), an early woman clinician scientist and professor of anesthesiology at University of Massachusetts Medical School

After the first successful public demonstration of modern anesthesia in 1846, most female anesthetists were nurses by trade since none were yet allowed to attend medical school to become physicians. The turn of the twentieth century, however, brought about greater opportunity for female physician-anesthetists. We explore the life and career of Barbara E. Waud (1931–), a pioneering woman physician and researcher in the field of anesthesiology. Waud chose to pursue a career in medicine at a time when most women did not even attend college, and for most of her training and practice, she was the only woman in her department. Personal interviews with Waud, her daughter, and her colleagues highlight her rebellious and resilient nature that helped her overcome the obstacles put forth by male colleagues, and the judgment she received from female acquaintances for being a working mother. Waud's impressive career of dedicated clinical practice and ground-breaking research spanned four decades and inspired generations of physicians.

National Institutes of Health StrokeNet During the Time of COVID-19 and Beyond.

National Institutes of Health StrokeNet During the Time of COVID-19 and Beyond.

A newly designed uncovered biliary stent for palliation of malignant obstruction: results of a prospective study

BackgroundBiliary decompression can reduce symptoms and improve quality of life in patients with malignant biliary obstruction. Endoscopically placed stents have become the standard of care for biliary drainage with the aim of improving hepatic function, relieving jaundice, and reducing adverse effects of obstruction. The purpose of this study was to evaluate the performance characteristics of a newly-designed, uncovered metal biliary stent for the palliation of malignant biliary obstruction.MethodsThis post-market, prospective study included patients with biliary obstruction due to a malignant neoplasm treated with a single-type, commercially available uncovered self-expanding metal stent (SEMS). Stents were placed as clinically indicated for palliation of jaundice and to potentially facilitate neo-adjuvant chemotherapy. The main outcome measure was freedom from recurrent biliary obstruction (within the stent) requiring re-intervention within 1, 3, and 6 months of stent insertion. Secondary outcome measures included device-related adverse events and technical success of stent deployment.ResultsSEMS were placed in 113 patients (73 men; mean age, 69); a single stent was inserted in 106 patients, and 2 stents were placed in 7 patients. Forty-eight patients survived and/or completed the 6 month study protocol. Freedom from symptomatic recurrent biliary obstruction requiring re-intervention was achieved in 108 of 113 patients (95.6, 95%CI = 90.0–98.6%) at study exit for each patient. Per interval analysis yielded the absence of recurrent biliary obstruction in 99.0% of patients at 1 month (n = 99; 95%CI = 97.0–100%), 96.6% of patients at 3 months (n = 77; 95%CI = 92.7–100%), and 93.3% of patients at 6 months (n = 48; 95%CI = 86.8–99.9%). In total, only 5 patients (4.4%) were considered failures of the primary endpoint. Most of these failures (4/5) were due to stent occlusion from tumor ingrowth or overgrowth. Overall technical success rate of stent deployment was 99.2%. There were 2 cases of stent-related adverse events (1.8%). There were no cases of post-procedure stent migration, stent-related perforation, or stent-related deaths.ConclusionsThis newly designed and marketed biliary SEMS system appears to be effective at relieving biliary obstruction and preventing re-intervention within 6 months of insertion in the overwhelming majority of patients. The device has an excellent safety profile, and associated high technical success rate during deployment.Trial registrationThe study was registered on clinicaltrials.gov on 14 October 2013 and the study registration number is NCT01962168. University of Massachusetts Medical School did not participate in the study.

Jak Inhibitors Reverse Vitiligo in Mice but Do Not Deplete Skin Resident Memory T Cells

Jak Inhibitors Reverse Vitiligo in Mice but Do Not Deplete Skin Resident Memory T Cells

Geller takes office as APA president

Jeffrey Geller, M.D., M.P.H., began his one‐year term as president of the American Psychiatric Association (APA) at the conclusion of the APA Virtual Highlights Meeting, the APA announced in a news release April 29. At the same time, Vivian Pender, M.D., began her term as APA president‐elect. Geller is a professor of psychiatry at the University of Massachusetts Medical School. He is a staff psychiatrist at the Worcester Recovery Center and Hospital after serving seven years as its medical director. He has served in numerous APA leadership positions, including as Area 1 trustee and vice president of the APA board of trustees; member of the Committee on Psychiatric Diagnosis and Assessment, the Council on Advocacy and Public Policy and the APA Foundation Library and Archives Advisory Committee; and book review editor and column editor for Psychiatric Services.

A History of the APA Assembly from A (Alabama) to W (Wyoming)

A History of the APA Assembly from A (Alabama) to W (Wyoming)

Incorporating LGBTQ+ Inclusivity and Gender‐Neutral Considerations into Medical School Anatomical Education: First Steps

In recent years there has been increasing recognition of the need to incorporate diversity and inclusion into medical education both in the material taught and the teaching environment, in order to develop and support a more diverse and inclusive student body, professional workforce and patient population. Additionally, it is vital to build a comprehensive understanding of related biological phenomena, and to address gaps in medical knowledge that have arisen due to a historical lack of LGBTQ+ concepts in research. The question of how to do this appropriately in anatomical education and the role of anatomists in this has been a source of interest and debate. Most can agree that terminology and basic concepts surrounding sex and gender are made concrete in the first year of medical school with anatomists playing a key role in these early discussions. With this in mind, we began to create a short presentation and supplementary materials to be provided to medical students during their introduction to the anatomy course. The goal of these materials was to define terminology and highlight the importance of incorporation of LGBTQ+ inclusivity and gender‐neutral considerations into their learning. Additionally, this presentation models respectful language for future discussions of LGBTQ+ staff, students, patients, and academic research. Here, we describe some of the specific challenges to the creation of these focused learning materials and their integration into the anatomy curriculum, including attracting decision‐making stakeholders, student interest, and retention versus momentum. Version 1.0, consisting of a short PowerPoint presentation and a glossary handout was presented to students in the first week of the Development, Structure and Function course at the University of Massachusetts Medical School. The results of student review confirmed their interest in these topics but highlighted the most effective way to stress the importance of this subject is to include it in testing materials. Based on this, the Educational Materials Collection (EMC) was expanded to include a growing MCQ bank. Additionally, materials diving deeper into gender history and bias have been included. Leveraging the power of social media to overcome geographical limitations, Version 2.0 of the lecture and supplementary materials have been shared with anatomical educators worldwide. We will continue to build inclusive and gender‐neutral language into all aspects of the anatomical curriculum and develop training for visiting clinical educators. We plan to continue the dissemination, while also expanding the materials to include more clinical correlates, as well as materials for all levels and fields of anatomical education.