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Introduction: Medicines are an important component of any health system. Even though the importance of medicines in the health system is indisputable, one of the major concerns remains the risk of adverse drug reactions when used by consumers. Adverse drug reactions place a burden on the healthcare system, usually as a result of complications requiring hospital admission or extended hospital admissions. In Africa, about 28.6% of adverse drug reactions reported in Africa were due to antiretroviral therapy. Recently, the adoption of the “test and treat” policy by the World Health Organisation increased the number of people receiving antiretroviral therapy. Therefore, this systematic review was conducted to explore the magnitude of antiretroviral therapy-related adverse drug reactions hospitalisations, and mortalities in the region, following the increase in people initiating therapy, and the implications to the service delivery component of the healthcare system. Methods: In March 2021, PubMed, EBSCOHost, and SCOPUS, databases were systematically searched for appropriate articles. The selection of articles was based on predefined inclusion and exclusion criteria. Data from included articles were extracted as per a set of defined criteria into a data extraction form. A meta-analysis was done using Stata package software 15.0 using Stata “metaprop” command. Results: The pooled prevalence of adverse drug reactions hospitalisations in all studies was 26.5% (95% confidence interval:18.4,35.4) and that of mortality was 6.1% (95% confidence interval:2.1,11.7). The most prevalent adverse reactions reported include hepatotoxicity, kidney injury, lactic acidosis, skin, neurologic, and hematologic reactions. The antiviral implicated, are non-nucleoside reverse transcriptase inhibitors, nucleoside/tide reverse transcriptase inhibitors, and protease inhibitors. The pediatric population was underrepresented as only two studies included pediatric patients. The economic impact of adverse reactions was impossible to estimate, as only one study reported on financial implications. Conclusion: Antiretroviral therapy-related adverse reactions hospitalisations and mortalities have a high prevalence in Africa. There are concerns about age-related morbidities and lifestyle diseases as risk factors related to adverse reactions. To adequately combat adverse reactions associated with antiretrovirals, African country health systems need multidisciplinary actions to strengthen strategies for prediction, identification, reporting, and prevention of adverse reaction occurrence.

Adverse reactions to the antiarrhythmic medication amiodarone are severe, potentially life-threatening, and not rare. One in three patients on long-term therapy experience elevated liver enzymes, and clinically apparent liver toxicity occurs in 1% of patients treated. We report the case of a 76-year-old patient with amiodarone-induced intrahepatic cholestasis and prolonged hyperbilirubinemia despite the discontinuation of the offending agent. Current research hypothesizes that amiodarone leads to hepatic injury both by direct hepatotoxicity and by increasing the likelihood of hepatocytes to create abnormal, toxic metabolites. Increased awareness of such an adverse effect can guide clinicians toward the possible underlying etiologies of prolonged jaundice.

Delusions of parasitosis are a rare psychiatric disorder in which the patient has a fixed, false belief of being infested with parasites. The disorder is classified as primary if no cause is identified or secondary if associated with general organic conditions, psychiatric illnesses, and drugs (substance induced). Several medications have been reported in association with delusions of parasitosis, including anti-parkinsonian medications, ciprofloxacin, cetirizine, doxepin, and others. Delusions of parasitosis have not been previously reported to be associated with gabapentin use. We present the case of a patient who developed delusions of parasitosis after been initiated on gabapentin treatment for neuropathic pain and complete disappearance of symptoms after the medication was discontinued.

The current study applies a newly proposed mechanical combination method along with four traditional mechanical combination methods to assessment center scoring. These comparisons were made for two job levels (Fire Lieutenant and Fire Captain). The study further assesses the level of adverse impact for the various methods at three cut-off scores. Results indicated that the new contingency-based scoring method was successfully implemented in the assessment center. Results were mixed regarding whether the contingencies developed for the two job levels were different. Further, results indicated that although the various combination methods were highly correlated as expected, there were clear distinctions in the decisions made based on the different combination methods. Specifically, the various combination methods resulted in different candidates comprising the qualifying cut-off ranks. Finally, results showed that the contingency-based method had less adverse impact overall when compared to the other four methods. Future research is proposed in addition to a discussion of the limitations of the study. The main limitation was a lack of criterion data.

Thesis advisor: Rebekah Levine Coley / Research on adverse childhood experiences (ACEs) has demonstrated the high prevalence rates of such experiences, with about 60% of individuals in national U.S. samples reporting one or more types of ACEs as children (Chapman et al., 2013; Finkelhor et al., 2015). Further, research has established robust links between ACEs and a range of negative behavioral and health outcomes in adulthood (Felitti et al., 1998; Hughes et al., 2017; Kalmakis & Chandler, 2015; Wang et al., 2020; Wang & Maguire-Jack, 2018; Wolff et al., 2018). Less is known about when potential negative consequences of ACEs exposure emerge. The few studies that have examined the relationship between ACEs and early outcomes have employed inconsistent modeling strategies which has left the functional form of the relationship unclear, which could lead to either under-or over-estimating the risk associated with various levels of ACEs exposure (Crouch et al., 2019; Hughes et al., 2017; Lanier et al., 2018; Wang et al., 2019). Further, these studies have not comprehensively examined the potential moderating role of socio-ecological factors like neighborhood context. Theoretical frameworks suggest neighborhood resources might buffer children from negative consequences associated with ACEs while exposure to neighborhood-level adversities might exacerbate negative consequences. In order to address these gaps, the currently study examined the functional form of the relationship between ACEs experienced in the first four years of life and kindergarten behavioral outcomes and tested the moderating role of neighborhood resources and neighborhood adversities in a large, nationally representative sample of young children drawn from the Early Childhood Longitudinal Study - Birth Cohort (ECLS-B; N ≈ 10,700) linked with neighborhood administrative data. Using inverse probability weighting to strengthen internal validity, numerous modeling strategies supported a linear relationship between early childhood ACEs and kindergarten behavioral outcomes. Greater ACEs exposure was associated with significantly lower prosocial skills and significantly higher externalizing behavior problems, with small effect sizes of 0.075 to 0.143 standard deviation shifts in behaviors for each additional ACEs exposure. Interaction models found that ACEs were significantly associated with behavioral consequences regardless of neighborhood context. Overall, the robust modeling strategies employed provide the strongest evidence to date of the significant, linear relationship between ACEs and early behavioral consequences. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

The scientific evidence required to make policy decisions that protect human health can be challenging to organize. Primary research is often silo-ed between different agency repositories, the pace of publication is unflagging and wide-spread interdisciplinary collaboration can be logistically difficult. Since 2012, the Organisation for Economic Co-operation and Development (OECD) adverse outcome pathway (AOP) framework has provided solutions for some of the challenges of supplying relevant and accessible scientific data for evidence-based decision-making. Development of AOPs is guided by a crowd-sourced approach in which progressions of adverse outcomes (AO) are distilled into pathways containing only the essential key events (KEs) and the causal key event relationships (KERs) that connect them. The framework has widely been adopted in the toxicology community and more recently projects have applied it to the radiation safety field. Presently, a collaborative effort aims to further expand the use of AOPs through creating a network linking exposure to the space exposome with resulting human health outcomes. The network contains four adverse non-cancer outcomes for which participants of future long-range space missions will be at risk. The work of this thesis has contributed to the construction of the space-health AOP network by accomplishing two main objectives. The first was the creation of a novel protocol for collecting a weight of evidence (WOE) that included the benefits of scoping review and artificial intelligence (AI) tools for literature screening. The scoping review WOE collection strategy was then deployed for collecting data across all four outcomes in the space-health network. The second objective was to identify KEs and KERs and summarize the WOE linking space exposure to one of the four AOs: vascular remodeling. In addition to summarizing the pathway, we have also highlighted important modulating factors and knowledge gaps in the WOE. This thesis work contributes to the future of the AOP framework by formulating a new development protocol and employing it in a novel regulatory context. Using the new protocol, this thesis has furthered biological understanding of the effects of space exposure on the cardiovascular system by collating mechanistic information across scientific disciplines to identify KEs and KERs in occurrence of vascular remodeling.

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The purpose of this qualitative phenomenological study was to investigate the perceptions of classroom-level educators regarding the application of trauma-informed instructional practices. This was achieved by evaluating educators' understanding of the influence of trauma on students, their level of familiarity with trauma-informed instructional practices, and their assessments of the effectiveness of these practices. Trauma refers to an individual's response to a single traumatic incident, a succession of traumatic events, or extended exposure to a traumatic event (SAMHSA, 2014). As awareness of the prevalence of childhood trauma has increased, it is acknowledged as a serious public health issue (Lang et al., 2015). Trauma-informed care is a strengths-based, victim-centered framework under which organizations recognize trauma, understand, and limit the potential long-term repercussions of exposure to traumatic experiences, even if an individual does not perceive trauma as influencing their behavior (Kubiak et al., 2017; Office for Victims of Crime, n.d.). Educators have a distinct advantage in identifying students' traumatic stress symptoms, which can directly affect social-emotional growth and academic achievement (Conley et al., 2014; Donisch et al., 2022). Schools play a crucial role in establishing settings that safeguard students against adverse childhood experiences (ACEs), cultivate resilience, and nurture a sense of belongingness (Conley et al., 2014; Hertz, 2020). Eight educators from one northeast Tennessee school district who provided general and special education instruction to students in PreK-12th grade participated in the study. Data collection consisted of one-on-one video conferencing interviews. The data were coded and analyzed to identify emerging themes, synthesized, and summarized (Creswell & Creswell, 2018). The following themes emerged: (a) increased awareness of trauma and ACEs, (b) desire for additional training, (c) diversity of adverse childhood experiences (ACEs) and trauma exposures, (d) perceived negative behaviors resulting from or masking trauma, (e) the significance of procedures and structure, (f) the need for supplementary resources, (g) the importance of relationship building, (h) importance of opportunities for success, (i) facilitation of individualized instruction, (j) increased empathy, (k) increased patience and self-awareness, and (l) emotional, physical, and mental stress.

Research examining Adverse Childhood Experiences (ACEs) has mostly focused on the long-term effects of these experiences on adult mental and physical health. Less attention has been focused on the impact of ACEs on college student satisfaction, dropout rates, and major choice. The overarching questions for the current study sought to further research by (1) assessing if there is a relationship between the ACE scores of college students and their mental and physical health, (2) if ACEs play a role in student satisfaction or desire to drop out, and (3) determining if there is a connection between students with high ACE scores and their major choice. Survey data was collected from a sample of East Tennessee State University students. Findings serve to improve our understanding of the topic and promote research for the future.