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Sex and race-ethnicity influences on opioid overdose deaths among veterans diagnosed with opioid use disorder between 2016 and 2021
No full textObjective: Given increases in opioid overdose rates, and policy changes expanding access to medications for OUD, during the COVID-19 pandemic, we sought to understand how the opioid overdose epidemic impacted veterans with opioid use disorder (OUD), from 2016 to 2021.
Method: We examined the prevalence and trends in opioid overdose deaths, and age at death, from 2016 to 2021, by sex and race/ethnicity among veterans with OUD enrolled in the Veterans Health Administration (VHA). We calculated the multiplicative and additive interactions between sex and age, and opioid overdose death.
Results: 203,950 veterans enrolled in VHA from 2016 to 2021 had an OUD; 16 % (n = 32,640) died during this period. Opioid overdose contributed to 17.42 % (n = 5686) of all deaths. Although the total number of overdose deaths rose each year, the relative risk of dying from an opioid overdose decreased. Of those who died, veterans, ages 18-29 were significantly more likely to die of an opioid overdose than veterans over the age of 40. Female veterans were significantly more likely to die from an opioid overdose, with this risk manifesting significantly earlier and faster when compared to male veterans of the same age. Black and Asian veterans were significantly more likely to die by opioid overdose than White veterans.
Conclusions: Despite an overall decrease in relative risk of opioid overdose death during the first two years of the COVID-19 pandemic (2020-2021) there was a significant increase in risk of opioid overdose death among female and racial and ethnic minority veterans with OUD.No embarg
Machine learning-assisted event classification in cadmium zinc telluride positron emission tomography detectors leveraging entanglement-informed angular correlations
Get PDFGamma-positron imaging with tracers that emit a prompt γ (> 511 keV) is vulnerable to Compton down-scatter leaking into the 511-keV window and mimicking true annihilation pairs. Conventional Positron Emission Tomography (PET) systems reconstruct annihilation events without leveraging that the two 511-keV photons are not only orthogonally polarized but also produced in a Bell-entangled state. The polarization correlations of this entanglement imprint themselves in Compton scattering kinematics, particularly the relative azimuthal scattering angle ([Formula: see text]), offering a physics-informed handle for event discrimination. We present a machine-learning framework that exploits these quantum-encoded features to resolve true lines of response (LORs) and reject random coincidences in a dual-panel cadmium zinc telluride (CZT) system. Detected events were categorized into one-photoelectric (1P) and Compton (1C) interaction patterns, yielding four candidate interaction sequences per event. Each event was represented as a 4 × 21 feature matrix comprising spatial coordinates, energy deposits, and angular descriptors, including [Formula: see text] and polar scattering angle θ. Feature ablation with five-fold cross-validation revealed that the combination of energy and [Formula: see text] provided the highest discriminative power (Area Under the Receiver Operating Characteristic Curve (ROC-AUC) 0.87-0.95), followed by energy alone (ROC-AUC 0.85-0.95), while inclusion of spatial coordinates with energy and [Formula: see text] ranked third, achieving consistent performance across folds (ROC-AUC 0.81-0.91). These results demonstrate that incorporating entanglement-sensitive angular features into learning pipelines can suppress prompt contamination while preserving true LORs in a gamma-positron imaging system.No embarg
Digital detection of craving and stress for individuals in recovery from substance use disorder: A qualitative study
Get PDFAims: This study aims to 1) categorize experiences with stress and craving during substance use disorder (SUD) treatment, 2) explore perceptions of both clients and treatment providers towards a digital detection system for stress and craving during recovery, and 3) identify barriers and facilitators to adopting this technology during SUD treatment.
Methods: This was a qualitative study of people in recovery from SUD (clients) and healthcare providers from outpatient treatment facilities in the northeast United States. Clients were asked to use a digital health tool that detects physiological biomarkers of stress and craving (RAE Health) for 30 days alongside their usual treatment and to engage in a semi-structured interview upon completion. Providers were asked to participate in a one-time focus group.
Results: Thirty-one clients completed a semi-structured interview, and eleven providers participated in two focus groups. Four core themes emerged from the qualitative data: categorization of experiences with stress and craving, perceptions of digital detection systems, perceived barriers and facilitators of the system, and desired features of the system. Overall, client and provider perception were positive, and acceptability of the digital health tool was high.
Conclusions: A digital detection system for stress and craving during SUD recovery was perceived favorably by both clients and providers, with clients citing heightened awareness and providers citing opportunities for personalized care as promising use cases. Future iterations of digital health systems for this population should consider the ideal "dose" of the intervention to maximize benefit.No embarg
Association of Language Barriers and Depression Among Latino and Non-Latino White US Nursing Home Residents
No full textObjectives: Despite recent demographic shifts, little is known about the association between race/ethnicity, language barriers, and mental health among US nursing home residents. We aimed to quantify the relationship between Spanish language barriers and depression in US nursing homes.
Design: Cross-sectional study.
Setting and participants: Latino and non-Latino White adults aged ≥50 years newly admitted to US nursing homes.
Methods: Using national 2022 Minimum Data Set 3.0, we identified 19,780 Latino newly admitted residents who wanted or needed a Spanish interpreter to communicate with a physician or health care staff, and residents without need for interpreter (n = 56,969 Latino residents, 812,456 non-Latino White residents). A clinical depression diagnosis and self-reported Patient Health Questionnaire (PHQ-9) scores ≥10 for moderate/severe depressive symptoms were evaluated using multivariable log binomial models.
Results: Our sample was mostly female, and ≥75 years. Depression prevalence was 29.5% and 31.5% for Spanish and English-speaking Latino residents, respectively, and 36.0% for English-speaking non-Latino White residents; moderate/severe depressive symptoms were reported in 17.5% and 15.9% for Spanish and English-speaking Latino residents, respectively, and 15.6% for English-speaking non-Latino White residents. Antidepressant use was common (lowest: 32.2% Spanish-speaking, Latino residents; highest: 43.2% non-Latino White residents); psychotherapy was received by <2%, in all language groups. Compared with English-speaking non-Latino White residents, the prevalence of clinically diagnosed depression was lower among Latino residents [Latino residents adjusted prevalence ratio (aPR), 0.93; 95% CI, 0.92-0.95], and among Latino residents, lower among those who spoke Spanish than English (aPR, 0.95; 95% CI, 0.93-0.98), with similar patterns for moderate/severe depressive symptoms [aPR (Latino residents vs non-Latino White residents), 0.93; 95% CI, 0.91-0.95; aPR (Spanish-speaking vs English-speaking Latino residents), 0.95; 95% CI, 0.91-0.99].
Conclusions and implications: Latino residents newly admitted to nursing homes appear to have less clinically diagnosed depression and are less likely to report moderate/severe depression. Language barriers in nursing homes should be addressed to help meet the needs of residents from ethnic minority populations.No embarg
Incidence and Clinical Relevance of Echocardiographic Visualization of Occult Ventricular Fibrillation: A Multicenter Prospective Study of Patients Presenting to the Emergency Department After Out-of-Hospital Cardiac Arrest
No full textStudy objectives: Ventricular fibrillation (VF) is traditionally identified on ECG but echocardiography can visualize myocardial fibrillation. The prevalence and importance of occult VF defined as a nonshockable ECG rhythm but VF by echocardiography is unknown.
Methods: In this multicenter, prospective study, emergency department patients presenting following out-of-hospital cardiac arrest were eligible for inclusion if echocardiography and ECG were performed simultaneously. Recorded echocardiography and ECG were interpreted separately by physicians blinded to all patient and resuscitation information. The primary outcome was percentage of occult VF. The secondary outcomes included survival to hospital discharge, termination of defibrillated VF, and return of spontaneous circulation (ROSC). Termination of VF is described as a postdefibrillation change in ECG rhythm to a nonshockable rhythm. Multivariate modeling accounted for confounding variables.
Results: Of 811 patients enrolled, 5.3% (95% confidence interval [CI] 3.9 to 7.1) demonstrated occult VF. An additional 24.9% (95% CI 22.1 to 28.0) demonstrated ECG VF. Of the patients with occult VF, 81.4% demonstrated ECG pulseless electrical activity (PEA) and 18.6% demonstrated ECG asystole. Occult VF was less likely to be defibrillated compared with ECG VF. Defibrillation was not significantly more likely to terminate occult VF (75.0% vs 55.6%; odds ratio [OR], 2.3; 95% CI 0.42 to 15.24). ROSC was not statistically different for occult VF compared with ECG VF (39.5% vs 24.8%; OR, 2.26; 95% CI 0.87 to 5.9). Survival to hospital discharge was no different for patients with occult VF compared with ECG VF (7.0% vs 5.4%; OR, 3.6; 95% CI 0.63 to 19.2) despite fewer defibrillation attempts for patients with occult VF.
Conclusion: Occult VF was seen in 5.3% of patients following out-of-hospital cardiac arrest. Recognizing and treating occult VF who otherwise would have been treated as PEA or asystole led to survival outcomes indistinguishable to traditionally recognized VF.No embarg
Previsit Preparation for Shared Decision-Making in Lung Cancer Screening in Primary Care Using a Paper Decision Aid and an Automated Text Messaging Program: Quasi-Experimental Pilot Study
Get PDFBackground: Patient-provider discussions and shared decision-making (SDM) are essential for tailoring lung cancer screening (LCS) decisions to individual patients. However, the implementation of SDM in primary care settings is challenging. Innovative approaches are needed to reach and prepare patients eligible for LCS for SDM in primary care settings and increase LCS uptake.
Objective: We piloted previsit preparation comparing 2 strategies: a paper decision aid (DA; DA group) and an enhanced comparator strategy consisting of the paper DA plus an automated text message program (DA+TM group) designed to promote patient-provider LCS discussions. We explored feasibility and gathered preliminary data on its potential effects on LCS discussions, decision-making, and LCS uptake in primary care settings.
Methods: In a sequential quasi-experimental pilot study, we recruited patients who were eligible for LCS in a single academic health care system. Prior to an upcoming visit, participants in both groups received a paper-based DA by mail. In the DA+TM group, participants also received a series of automated text messages to help them prepare for their LCS discussions. We monitored participant recruitment and retention, as well as patient engagement in DA and text messages. In exploratory analyses, we assessed patient-provider discussion of LCS, SDM, patient knowledge, decision conflict at baseline and in follow-up telephone surveys, and LCS completion measured by electronic health records.
Results: We enrolled and included 48 participants (DA group=19 and DA+TM group=29) in the final analysis. Participants were predominantly White, with a median age of 61.0 (IQR, 57.0-65.0), and 58% (28/48) of them were female. Engagement was high in both groups. LCS knowledge significantly improved in the DA+TM group (4.5 baseline vs 6.0 follow-up; P=.003), while there was no change in the DA group (5.0 baseline vs 5.0 follow-up, P=.23). Median LCS knowledge change from baseline to follow-up was 0.5 (IQR -1.0 to 2.5) in the DA group and 1.5 (IQR 0-3.0) in the DA+TM group (P=.24). Decision conflict in both groups significantly decreased (DA group: 37.5 baseline vs 0 follow-up, P<.001; DA+TM group: 50.0 baseline vs 20.0 follow-up, P=.003). The median SDM process score (a measure of SDM) was 3.0 (IQR 1.5-4.0) in the DA group and 2.0 (IQR 1.0-3.0) in the DA+TM group (P=.11). The LCS completion rates were 5% (1/19) in the DA group and 31% (9/29) in the DA+TM group at 3 months (P=.07), and 26% (5/19) in the DA group and 34% (10/29) in the DA+TM group at 6 months (P=.75).
Conclusions: Previsit preparation was feasible in primary care settings. An enhanced, text message-based strategy has the potential to reach and engage broader LCS-eligible populations and prepare patients for LCS discussions with their primary care providers, which may ultimately improve informed decision-making and LCS uptake.No embarg
AAV9 Gene Therapy in GM1 Gangliosidosis Type II: A Phase 1/2 Trial [preprint]
Get PDFThis article is a preprint. Preprints are preliminary reports of work that have not been certified by peer review.Background: GM1 gangliosidosis, caused by biallelic variants in GLB1, results from deficiency of lysosomal β-galactosidase, the enzyme primarily responsible for degradation of GM1 ganglioside. This progressive neurodegenerative disease is uniformly fatal with no approved therapies, but preclinical studies utilizing gene therapy have shown promising results.
Methods: This phase 1-2 open label dose escalation study utilized a single intravenous administration of adeno-associated virus serotype 9 (AAV9) encoding β-galactosidase in the first nine enrolled Type II GM1 gangliosidosis participants. The primary endpoint was safety after 3 years; secondary and exploratory efficacy outcomes included cerebrospinal fluid (CSF) GM1 ganglioside and β-galactosidase, clinical assessments, and neuroimaging changes.
Results: One serious adverse event was attributed to the vector, i.e., vomiting requiring rehospitalization for IV hydration. Serum aspartate and alanine aminotransferase levels increased following gene transfer but returned to baseline by 18 months. Per protocol analysis found stability in Vineland Expressive Communication and Gross Motor and significant declines in Fine Motor and Receptive Communication. Median CGI-Improvement scores at 2 and 3 years after gene transfer were "minimally improved" or "no change". CSF β-galactosidase increased and GM1 ganglioside decreased in all participants. MRI showed improved myelination by differential tractography and declines in cerebral atrophy. MRS showed reduced loss of N-acetylaspartate+N-acetylaspartyl glutamate (NAA) compared with historical controls.
Conclusions: A single IV infusion of AAV9 encoding β-galactosidase was well-tolerated among the first nine Type II GM1 gangliosidosis participants. Secondary and exploratory outcomes suggested improvements in biochemical markers and neuroimaging and stabilized or reduced rates of developmental deterioration (NCT03952637).No embarg
UMCCTS Newsletter, April 2025
Get PDFThis is the April 2025 issue of the UMass Center for Clinical and Translational Science Newsletter containing news and events of interest.Supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grants UL1 TR001453, TL1 TR001454 and KL2 TR001455.No embarg
Homosexuality-related stigma and sustained viral suppression among men who have sex with men living with HIV in Vietnam
No full textHomosexuality-related stigma is associated with increased HIV risk behaviours among men who have sex with men (MSM) in low- and middle-income countries, but its impact on HIV treatment outcomes is less well understood. We examined the relationship between homosexuality-related stigma and failure to achieve sustained viral suppression among MSM on antiretroviral therapy (ART) in Hanoi, Vietnam. Between 2017 and 2020, 292 MSM were diagnosed with HIV in a prospective study. Socio-demographic, behavioural, homosexuality-related stigma, and HIV treatment data were collected. Multivariable Cox regression models examined associations between enacted, perceived, internalized, overall homosexuality-related stigma, and failure to achieve sustained viral suppression. Among 226 MSM on ART for ≥ 180 days (median age 24 years; median ART duration 23 months), 197 (87.2%) achieved sustained viral suppression. High overall stigma was reported by 86 men (38.1%), including enacted (26.1%), perceived (20.8%), and internalized (25.2%) stigma. After adjusting for potential confounders, no significant associations were found between enacted, perceived, internalized, or overall homosexuality-related stigma and sustained viral suppression. We observed a high level of homosexuality-related stigma and sub-optimal sustained viral suppression in this sample of MSM on ART. Targeted interventions are needed to decrease stigma and improve treatment outcomes for MSM living with HIV in Vietnam.No embarg
Exploring Perceived Social Support in Family Caregivers of Children with Medical Complexity
Get PDFPurpose: To describe the relationship between perceived social support (PSS) for family caregivers of children with medical complexity (CMC) and potential predictors.
Specific Aims: 1) To examine between group (race and ethnicity) differences in PSS for CMC family caregivers; 2) To describe the association between PSS and SDoH risk for CMC family caregivers; 3) To evaluate an explanatory model for CMC family caregiver PSS using SDoH risk and factors associated with the child’s degree of medical complexity.
Framework: Critical Caring Theory undergirded this study.
Design: This cross-sectional, correlational study conducted at a pediatric hospital randomly then purposefully recruited 91 CMC family caregivers of eligible CMC . The Social Provisions Scale (SPS) and PRAPARE® Tool were electronically distributed to measure PSS and SDoH risk, respectively. Additional survey items and EMR extraction collected caregiver demographics and child complexity variables. Analysis included descriptive statistics, ANOVA, Pearson correlation, and linear regression.
Results: Small group sizes limited analysis of racial and ethnic differences in PSS. SPS and PRAPARE® scores were moderately negatively associated (Pearson r= -.418, p <.001). SDoH risk, stress, and caregiver gender remained significant predictors in the final explanatory regression model, explaining 27.8% of the variance in PSS (p <.001). No child complexity factors were significant predictors of PSS.
Conclusion: The negative association between PSS and both caregiver stress and SDoH risk suggests the importance of using a family-centered care model that includes assessing environmental (SDoH) and caregiver (stress) factors when planning social support-based interventions for CMC caregivers.6 months12/28/202