Growing evidence of the health risks associated with adverse childhood experiences (ACEs) has prompted public health and community initiatives to promote awareness, detection, and responses that are trauma informed. Nationwide programs to integrate trauma-informed care into education, health care, and child serving agencies, have thus far led to the proposal and advancement of trauma-informed policies and practices in many communities. While Mississippi agencies include trauma-specific intervention and training, statewide ACEs initiatives and relevant data are still limited. This project aimed to contribute to the larger goal of a statewide trauma-informed paradigm shift, by increasing ACEs awareness and developing recommendations for the integration of such research into programs aimed at serving vulnerable populations. Sixty-one child-serving professionals participated in adversity and resilience training (ART), a 3-hour workshop addressing childhood adversity, traumatic stress, resilience, and secondary traumatization. Outcomes measured were changes in trauma knowledge, trauma informed attitudes, attributions regarding difficult child-behaviors, and secondary trauma knowledge and self-care. Participants also provided ratings on a training evaluation survey. There were significant changes in trauma knowledge (F(1,22) = 6.418, p = .000, ηρ2 = .226) and trauma-informed attitudes (F(1,22) = 11.014, p = .003, ηρ2 = .334) between pre- and post-training. Training evaluations were generally positive (M = 4.61, SD = 0.13, on a 1 to 5 Likert scale). The current study contributes to the research an evaluation of a training intervention that offers feasible strategies for scalable training and assessment of outcomes.

Adverse childhood experiences, known as ACEs, have been shown to negatively impact an individual’s health as an adult. While efforts to decrease children’s exposure to these traumatic experiences are beneficial, they are not able to fully eliminate these experiences and do not address how to help children who have already been exposed. Resilience, which has been defined as managing and adapting to significant sources of trauma, has been thought to be a protective factor against the toxic stress of ACEs. While the relationship between ACEs and poor health outcomes has been established, the relationship between resilience and health outcomes is largely unknown.  This study seeks to determine the association between resilience scores on a validated resilience questionnaire and health outcomes in adolescents. Looking specifically at body mass index, blood pressure, and depression scores on a validated depression screen we hypothesize that higher resilience scores will be associated with better health outcomes. In addition, we examine the relationship between ACE scores and resilience scores. If this validated resilience instrument is able to help predict health outcomes, this can direct development of intervention programs to build resilience in those living in ACE-heavy environments. / Urban Bioethics

Throughout the past several decades, research regarding counselor resilience has shifted from a pathology-based to a strengths-based approach. As a result, researchers have moved away from primarily identifying risk factors and now focus on protective factors. Researchers have found that social supports serve as a protective factor in counselor resilience. However, there is a lack of understanding of how counselors receive that social support, specifically after a professional adverse event. Professional adverse events are common given the nature of counseling work. For example, undesirable occurrences such as client suicide, attempted suicide, life threatening illnesses, accidents, overdose, or loss of a child are considered professional adverse events. This study explored how ten professional counselors experienced social support following professional adverse events. Three themes emerged from these counselors' stories: difficulty seeking support, misplaced support, and acts of kindness. Implications for counselors include honoring both confidentiality and their own humanness, the cultivating co-regulating relationships, and reinforcing acts of kindness. Counselor educators and supervisors can foster counselor resilience by using the implications to teach counselors how to invite effective social support. / Doctor of Philosophy / Being a counselor can be both challenging and rewarding. Given the heavy caseloads and complexity of cases, it is common for counselors to experience adverse professional events. Research shows that protective factors serve as a buffer against stress. Social support is a protective factor that assists counselors in maintaining wellness and building resiliency. This study explored how professional counselors received support from interpersonal relationships following a professional adverse event. Findings from this study indicate the importance of counselors honoring their own humanness while protecting the client’s confidentiality, the importance of having co-regulating relationships, and the healing power of acts of kindness.

In order to ensure clean drinking water for all, it is crucial to understand potential upland stressors that compromise the quality of source waters treated by local community water systems (CWSs). Contamination associated with specific types of land cover can result in downstream water quality degradation, which may reduce the effectiveness of treatment by CWSs. Surface mining has been hypothesized as a source of drinking water degradation within the Central Appalachian region, which may result in adverse exposures and health disparities. The purpose of this study was to identify potential correlations between land cover and adverse birth outcomes (ABOs) through the application of watershed epidemiology, an emerging environmental health paradigm. Birth records for the Central Appalachian region were acquired from their respective state health departments from 2001 to 2015: each record contained the mother's street address, outcome variables, and covariates. Records were included in later analyses if they fell within an approximated CWS service area. Contributing land cover to each CWS was determined via previously delineated watersheds that relied on CWS intake points. A binomial generalized linear model was used to compare low birth weight (LBW), term low birth rate (tLBW), and preterm birth (PTB) incidence to CWS source watershed land cover, Safe Drinking Water Act (SDWA) violations, CWS size, and covariates related to the birth records. Source watershed mining and SDWA health based (HB) violations were significantly associated with greater risks for preterm birth (PTB) and low birth weight (LBW). Future work should be conducted to explore upstream flow impacts, address missing data in the birth records, and to more accurately represent CWS service areas to better characterize exposure. / Master of Science / Millions of individuals throughout the world are sickened by waterborne exposures every year. To ensure clean drinking water long-term, it is crucial to understand how human land cover might change the water quality of source watersheds, as this may impact the effectiveness of water treatment and increase adverse human health exposures. The goal of this effort is to understand whether land cover is linked to downstream adverse birth outcomes (ABOs) in Central Appalachia, a region of the United States previously associated with high disease incidence suspected to be partially linked to environmental exposure. Birth records were acquired for the years of 2001 to 2015 from four (VA, WV, TN, KY) respective state health departments. Each record contained the mother's address, outcome variables, and covariates (e.g., race, ethnicity). Births were located within approximate service areas for 140 surface water dependent community water systems (CWS) within the region. Data from each CWS, including weighted land cover proportions for their source watershed, were merged with the birth records according to approximate service areas. Statistical analysis suggested that higher source watershed levels of mining and urban development were associated with higher risks of preterm birth (PTB) and low birth weight (LBW). The number of health based (HB) violations associated with each CWS was also associated with both of these outcomes. Major limitations of this work include birth record data gaps and the lack of publicly available CWS service areas and/or water consumption rates, which does increase the risk of exposure misclassification.

Selection research often examines whether adverse impact can be reduced/eliminated from employment practices. Such research, however, largely ignores the influence of minority availability issues (i.e., the number of minorities who apply and the number of minorities who accept a job offer); three general factors comprise minority availability: the missing applicant problem, targeted recruitment and job refusal rates. As minority availability issues have not been systematically addressed in the broader literature, the purpose of this study was twofold: 1) to highlight the importance of and explicate a comprehensive description of their potential effects on adverse impact and 2) to demonstrate such effects through monte carlo simulations. Specifically, simulations were used to examine issues related to the level effects and covariance effects of minority availability on adverse impact. Therefore, an iterative process was used whereby minority availability factors were manipulated to produce combinations that meaningfully affect adverse impact; the goal was to conduct as many simulations as necessary to establish a reliable pattern of the effects of minority availability on adverse impact. Simulation results suggest minority availability issues can influence the detection of adverse impact. In fact, minority availability issues may hinder efforts to reduce adverse impact in some selection contexts. Implications of these results are discussed. / Ph. D.

The objective of this study was to determine the pharmacokinetics and tolerance of tulathromycin (Draxxin®; 2.5 mg/kg once) after intramuscular (IM), subcutaneous (SC), and slow intravenous (IV) administration to six adult horses. A three-phase design and 4-week washout period were used. Drug concentrations in blood and bronchoalveolar lavage (BAL) samples were determined by ultra-performance liquid chromatography tandem mass spectrometry and pharmacokinetic parameters calculated using noncompartmental analysis. Following SC and IM administration, all horses exhibited sweating, discomfort, and periods of recumbency. As signs were more severe after SC administration this route was only used in 3/6 horses. Intravenous administration of tulathromycin was well tolerated in all horses. Mean bioavailability was 99.4% IM and 115% SC. Mean maximum plasma concentration was 645 ng/ml IM and 373 ng/ ml SC. Mean half-life was 59.8 h, 54.8 h, and 57.9 h for IV, IM, and SC administration, respectively. Mean clearance was 3.25 ml/kg/min, and mean volume of distribution was 16.8 L/kg following IV administration. Drug was detectable in plasma and BAL samples for 120 h following all routes; however, adverse effects may prevent IM use and SC use is not recommended. Tulathromycin may be a practical and affordable antibacterial for use in adult equine patients. / Master of Science / In human and veterinary medicine, antibacterial drugs are a mainstay of treatment. Antibacterials have been used for almost 100 years to prevent microbial organism infection, and as a treatment once there is an established infection. Although there are multiple "classes" of antibacterials that have different spectrums of activity and mechanisms of action, antibacterial resistance has become increasingly prevalent over time. The increasing rate of antimicrobial resistance has led to recommendations that medical practitioners be more judicious in the use of these drugs and to prescribe antibacterials to patients only when necessary. In equine medicine, once an antibacterial is deemed necessary, there are additional considerations, including administration method, frequency of administration, and availability and cost of antibacterial drugs. Tulathromycin, a long-acting semi-synthetic macrolide, is an antibacterial that is approved for use in cattle and swine and may have utility for equine patients for a variety of conditions. This study in healthy adult horses demonstrated that tulathromycin was detectable in plasma and the respiratory tract for up to 5 days after single dose administration. Thus, tulathromycin may be a practical and affordable antibacterial for use in equine patients.

Adverse childhood experiences (ACEs) are associated with substance use problems, however, few studies have examined the mechanisms underlying this relationship. Research has found that cannabis use motives may mediate the association between ACEs and cannabis-related problems among young adults. However, research has not identified the affective components driving coping motives. Further, higher instances of ACEs predict an increased tendency to experience internalized shame. Coping with shame may be the mechanism linking ACEs to cannabis-related problems. Data were collected using Prolific, an online crowdsourcing platform. Participants were young adults (n = 155, 61.9% Female, 56.8% White) ages 18-29 years (M =22.8, SD = 3.01), who used cannabis in the past year. A serial mediation model examined whether cannabis use coping motives and shame mediate the association between ACEs and cannabis-related problems 6-months later. The overall model showed good fit to the data (χ2(8) =14.30, p=.07, CFI=.96, SRMR=.04, RSMEA=.07). There was a significant indirect effect from ACEs to cannabis-related problems (IND=0.06; 95% CI=0.01 to 0.16) through internalized shame and cannabis-use coping motives. The model accounted for 41% of the variance in cannabis-related problems. Findings suggest that individuals who reported greater ACEs were more likely to endorse cannabis-use coping motives, and this association was fully mediated by internalized shame. Coping motives in turn were associated with greater cannabis-related problems, and coping motives fully mediated the link between shame and problems. Interventions that target reduction in maladaptive affective responses to ACEs, such as shame may be a promising avenue for cannabis use disorder treatment.

Adverse Childhood Experiences (ACEs) are traumatic events that individuals experience in childhood that have been linked to problems with physical and mental health in adulthood (Felitti et al., 1998). Previous research suggests that ACEs are prevalent in almost two-thirds of youth regardless of location across the world and that when an individual experiences three or more ACEs, their quality-adjusted life expectancy is found to decrease (Carlson et al., 2019; Jia & Lubetkin, 2020). Although ACEs have been associated with negative outcomes, not all individuals who experience trauma exhibit problematic behavior and are considered to have high levels of resilience (Agaiba & Wilson, 2005; Charney, 2012). Positive Childhood Experiences (PCEs) are characterized as positive events in childhood that occur in children’s lives that serve as a buffer or prevent symptomology related to traumatic events. The purpose of this study was to examine the relationship between students’ self-reported exposure of ACEs, PCEs, and behavioral problems in the school setting. Furthermore, the study sought to investigate whether students’ positive experiences moderate the relationship between negative experiences and behavioral problems. Participants included 35 students from a middle and high school located in the Southeastern United States. Results indicated a significant positive relationship between exposure to ACEs and reported behavioral problems and suggest that ACEs positively predict students’ self-reported behavioral problems. Additionally, a significant negative relationship between PCEs and reported behavioral problems by students was found, and results suggest that PCEs negatively predict students’ behavioral problems. Results of the moderation analysis indicate that PCEs do not have a significant moderation effect between ACEs and behavioral problems. Results of the current study have implications for changing the current practices for universal screening of behavior in the school setting, particularly with the inclusion of ACEs within the screening process.

Thesis advisor: Jane Flanagan / Background: Preventable adverse events are an unfortunately frequent occurrence of pediatric health care. Disclosure of preventable adverse events to patients is a vital aspect of ethical and just practice. Pediatric nurses’ have a unique role as part of the clinical care team. Despite the prevalence of preventable adverse events and the impact of nurses, best practice for pediatric nurses during disclosure is not specified. In addition, it is unclear how pediatric patient and their family. This work provides a foundation for future nursing research and the development and identification of best practice for pediatric preventable adverse event disclosure. Methods: First, thorough review of existing literature identified gaps and key themes. Secondly, a cross-sectional survey shared via social media provided insight into the current policy, education, and pediatric nurses’ involvement in PAE. Lastly, pediatric nurses’ perspectives were unveiled via narrative interviews, adding the voice of nurses into the dialogue. Results: Pediatric nurses in the U.S. want the option to be present during disclosure to patients and their families. Currently, nurses are seldom present during disclosure and do not routinely receive disclosure training, nor do they have a policy to guide them through the process. While there has been a trend towards the use of interdisciplinary disclosure teams, it is unclear what role a nurse has. Conclusions: This exploratory work is foundational to understanding pediatric nurses and PAE disclosure and future research exploring best practice for policy, education, and practice are needed. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Yes / This paper investigates the influence that information asymmetry may possess upon the future volatility, liquidity, market toxicity and returns within cryptocurrency markets. We use the adverse selection component of the effective spread as a proxy for overall information asymmetry. Using order and trade data from the Bitfinex Exchange, we first document statistically significant adverse selection costs for major cryptocurrencies. Our results also suggest that adverse selection costs, on average, correspond to ten percent of the estimated effective spread, indicating an economically significant impact of adverse selection risk on transaction costs in cryptocurrency markets. We finally document that adverse selection costs are important predictors of intraday volatility, liquidity, market toxicity, and returns. / Türkiye Bilimler Akademisi. Grant Number: Outstanding Young Scientist.