Research

Moussadek’s project aims to help physicians prevent suicide by identifying and intervening in patients’ self-harming behavior, which is an upstream risk for later suicide attempts. Self-harming behaviors are acts that someone does with intent to hurt, but not kill, themselves. These can include intentional self-poisoning, cutting, and burning. While mental health professionals are typically trained to identify these behaviors, other health care professionals may not feel prepared, Moussadek said.

To address these deficits, Moussadek developed a learning module with a screening tool providers can use to identify self-harming behaviors among their patients, resources to guide interventional planning, and a script for broaching a potentially difficult conversation with a patient suspected of expressing self-harming behaviors. It also includes clinical scenarios that model patients who are self-harming and instructional quizzes that assess providers’ preparedness for recognizing suicidal ideation.

After piloting the toolkit with local primary care providers, Moussadek aims to solicit feedback to assess its utility in a family medicine setting and devise a dissemination plan for statewide distribution. Ultimately, Moussadek hopes to provide the toolkit as a free resource for health care practices nationally.

Moussadek's project received funding support through the Four Pines Fellowship in Suicide and Self-Harm Prevention. 

Avery Campbell

Hepatocyte Growth Factor and Risk of Cognitive Impairment in Black and White Americans

Growing up in North Carolina, Avery Campbell knew many people affected by stroke and cognitive impairment. The southeastern region of the U.S. is known as the “stroke belt” because of the high incidence of stroke and related cardiovascular disease. Residents of the stroke belt also face greater risk of cognitive impairment. For Campbell, this is personal: His maternal grandmother suffered a stroke, and both paternal grandparents had severe dementia.

“It was devastating to our family,” Campbell said, “and stories like mine will only become more common. The prevalence of cognitive impairment is expected to balloon with increasing life expectancy, and it disproportionately affects minoritized communities.”

For his research project, Campbell investigated cognitive impairment among Black versus White adults, among pre- versus post-menopausal women, and among men younger than versus older than age 55. He focused on a unique biomarker called hepatocyte growth factor (HGF), which plays a role in organ and vascular repair after injury. In the brain, HGF signaling exerts neuroprotective effects. HGF level correlates with injurious inflammatory conditions like vascular disease, and a higher HGF level has been associated with future risk of stroke.

Campbell examined data from an ongoing national study, Reasons for Geographic and Racial Differences in Stroke (REGARDS). Funded by the National Institutes of health, this longitudinal observational study follows more than 30,000 Black and White Americans to understand why southerners and Black Americans have higher rates of stroke and related diseases that affect brain health. Campbell used HGF measurements in a nested case-control study of 1000 REGARDS participants, half with cognitive impairments and half without.

Campbell hypothesized that the association of HGF with cognitive impairment is greater in Black than White adults, greater among younger than older men, and greater in premenopausal than postmenopausal women. Using the REGARDS data, he created regression models to test each hypothesis.

“We know that menopause alters vascular biology. I am wondering if HGF signaling is part of that alteration, and if there is a way we can modify that pathway, with a drug or an antibody, to reduce the risk of developing cognitive impairment,” Campbell said. “Identifying and characterizing the relationship between HGF and cognitive impairment is the first step towards exploring its utility in prevention, prognostication, and treatment.”

Campbell's project received funding support from the Cardiovascular Research Institute of Vermont.

Before attending medical school, Tyler Hastings worked as an advanced emergency medical technician in Utah. It disturbed him that so many of the patients he transported to the hospital emergency department (E.D.) were experiencing mental illness events that could have been resolved on-site, rather than in the hospital.

“Mental illness is on the rise everywhere, among all age groups,” Hastings said. “People see a family member or friend experiencing an episode and they don’t know what to do, so they call 9-1-1. The ambulance can’t just leave the person there, so we taxi them to the E.D. It’s straining for the patient, the family, and for the E.D. staff who may have seen the same patient previously for the same thing.” The costs of ambulance transport and E.D. care create additional burdens for patients and their families.

To help change this pattern, Hastings evaluated training of emergency medical technicians (EMTs) and paramedics in Vermont regarding encounters involving patients with mental illness and the resources available to treat those patients on-site. Hastings worked with Vermont Emergency Medical Services (EMS) Office to recruit EMTs and paramedics for interviews. He developed interview questions to assess their opinions on current protocols involving care of patients with mental health concerns and whether they feel their training has prepared them to care for patients with psychological conditions. After the interviews, Hastings compiled the responses and looked for gaps in scope and ability of EMS providers, and he presented his findings to the Vermont EMS Office.

Hastings’ goal is to catalyze change locally, and spark interest nationally. “Advancements have been made in other areas of emergency care — cardiac arrest, stroke, bleeding — but mental health is a gray area,” he said. “With recent uptrends in mentally ill patients, I’m hoping to see that EMTs are well-equipped to treat them.”

Hastings' project received support from the UVM Department of Emergency Medicine.

Muhammad Haaris Zeb

Supporting Health Care Provider’s Culturally Appropriate Assessment and Response to Mental Health Challenges in Afghanistan Refugee Populations in Vermont

Mental health and suicide are difficult topics for many people, but in certain cultures, these subjects are taboo. Within many central Asian cultures, talking about one’s suicidal feelings is frowned upon, so individuals who need help typically hide their feelings.

Muhammad Zeb understands this well. His uncle passed away from suicide last summer, and his family, who are Pakistani, avoided talking about what happened. “It was a big lesson for me. This is a problem that can happen to anyone, and we must not push it under the rug,’” Zeb said.

At UVM, Zeb has an opportunity to examine this issue and make a difference for Afghan refugees. An increasing number of individuals forced to flee their homelands are resettling their lives in Vermont and, in the past two years, waves of Afghani refugees emigrated to the Burlington region. Post-traumatic stress, social isolation, racism, unemployment, and language barriers elevate refugees’ risk for depression and suicidal ideation. Their cultural-based reluctance to talk about these feelings, however, makes it difficult for health care providers to respond.

“A lot of refugees aren’t literate, so existing screening methods done in the primary care office are useless,” Zeb said. “The language on screening forms may not be familiar, or the patient may be scared to check boxes because they fear it creates an issue for their staying in the U.S.” Afghani and Pakistani cultures parallel, and Zeb is well-positioned to support Vermont health care providers in understanding Afghani patients’ fears.

For his project, Zeb developed an educational resource for health care providers who work with Afghan refugees. He began by assessing gaps in mental health resources and identifying cultural barriers among Afghanistan refugees, via literature reviews and interviews with experts in the field of refugee care. With this information, Zeb designed an interactive, web-based, educational module to serve as an introduction to mental health and intentional self-harm for providers working with Afghan refugees. The resource aims to assist providers who are unfamiliar with Afghan cultural norms to promote culturally appropriate care.

After testing the effectiveness of the module with health care providers and community representatives who engage with refugee populations in health care settings, Zeb will incorporate feedback to produce a final version of the module.

Zeb's project received funding support from the Four Pines Fellowship in Suicide and Self-Harm Prevention.

Wendy Memishian

Cerebral Blood Flow Autoregulation in Adult Offspring from Preeclamptic Rats and the Effects of Sevoflurane

Wendy Memishian feels at home in a laboratory working with instruments and animals. While an undergraduate biology major at Bates College, Memishian investigated the physiology of respiration in embryonic quail, measuring changes in their breath while she adjusted oxygen levels inside egg-infusing respirators. Post-graduation, she conducted cancer research with mice. Now, she wants to know more about brains and cardiovascular systems.

For her research, Memishian investigated cerebral blood flow autoregulation — the ability of brain blood vessels to maintain blood flow over a range of blood pressures — during surgery under a commonly used anesthetic called sevoflurane.

Preeclampsia is a serious hypertensive disorder of pregnancy with long-term cardiovascular effects for mothers and offspring across their lifespan, including organ damage and increased risk of stroke and hypertension. Preeclampsia pregnancies affect one in seven hospital deliveries, representing 16 percent of human births. It is known that sevoflurane affects cerebral blood flow autoregulation. In most people, this is easy to control, said Memishian, but in adults born from preeclamptic mothers, sevoflurane can cause cerebrovascular dysfunction that persists into adulthood. The impacts are poorly understood.

To examine the impacts, Memishian performed surgery on model adult rats born from preeclamptic mothers. She used sevoflurane anesthesia and provided ventilation to maintain a normal oxygen input and carbon dioxide output. As she administered a drug to increase blood pressure, she monitored blood pressure and oxygen levels.

Memishian wrapped up her summer project by analyzing the data, writing a report, and preparing a poster for a presentation. She’s not finished with the research, however: She intends for this to be a longitudinal project she will continue going forward. This fall, she will perform post-surgery analysis, comparing brain blood flow between preeclamptic and non-preeclamptic offspring, and she will work toward getting her research published and presenting at a national conference.

Memishian's project received support from the Cardiovascular Research Institute of Vermont.

Susanna Schuler

Connectional Silence in Telemedicine-Facilitated Palliative Care Conversations

For her project, Susanna Schuler investigated palliative care conversations between clinicians and patients receiving dialysis treatments for kidney failure. Palliative care conversations take place when patients have serious illness, to help them think through important decisions and focus on what matters most to them.

“It’s not so common to have these conversations with patients with kidney disease. Dialysis is like a limbo stage, keeping them alive,” Schuler said, adding that, without dialysis, kidney failure patients pass in about two weeks. Dialysis acts like a synthetic kidney, filtering wastes and toxins from the blood. The three- to five-hour process occurs three to four times per week, and can leave patients feeling exhausted and powerless.

Schuler’s research followed prior studies that identified “connectional silence” within palliative care conversations and concluded that silent moments in conversations were associated with the patient feeling heard and understood, which is associated with better outcomes. Schuler’s project was novel, in that the conversations occurred during telemedicine visits, rather than in person. Her project aimed to provide insight into how serious illness conversations via telemedicine may be different, how patients receiving dialysis engage with palliative care, and how clinicians can support patients feeling heard and understood.

She examined videos in which palliative care clinicians spoke with the patients, whose ages ranged from 60-80 years old, while they received dialysis. She listened for pauses in their conversations and looked for gestures including smiling, leaning, nodding, and eye contact, which can facilitate connection and empathy.

Schuler concluded that patients enjoyed having meaningful conversations during dialysis treatment, and they felt heard and understood. “They seemed excited to have someone to talk to while getting dialysis,” she said, noting that the conversations touched on the patients’ thoughts about ending dialysis, which will lead to death. “For someone who has been on dialysis for many years, it is powerful for them to be able to make informed decisions for themselves.”

Schuler's project received support from the UVM Division of Nephrology.