Arsenite, a trivalent form of arsenic, is an element that occurs naturally in the environment. Humans are exposed to high dose of arsenite through consuming arsenite-contaminated drinking water and food, and the arsenite can accumulate in the human tissues. Arsenite induces oxidative stress, which is linked to metabolic disorders such as obesity and diabetes. Brown adipocytes dissipating energy as heat have emerging roles for obesity treatment and prevention. Therefore, understanding the pathophysiological role of brown adipocytes can provide effective strategies delineating the link between arsenite exposure and metabolic disorders. Our study revealed that arsenite significantly reduced differentiation of murine brown adipocytes and mitochondrial biogenesis and respiration, leading to attenuated thermogenesis via decreasing UCP1 expression. Oral administration of arsenite in mice resulted in heavy accumulation in brown adipose tissue and suppression of lipogenesis, mitochondrial biogenesis and thermogenesis. Mechanistically, arsenite exposure significantly inhibited autophagy necessary for homeostasis of brown adipose tissue through suppression of Sestrin2 and ULK1. These results clearly confirm the emerging mechanisms underlying the implications of arsenite exposure in metabolic disorders.

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The increase in the use of psychiatric medications among children and adolescents has brought attention to the overall safety of these medications and the evidence-based data for their use in this population. This review focuses on the ethical aspects of pediatric psychopharmacology and general guidelines for practice, especially for medical residents. Ethical issues, such as (1) the lack of a sound database on long-term efficacy and safety due to a limited number of clinical trials in this population, (2) the lack of knowledge about adverse events related to the off-label use of drugs, (3) an extensive level of complexity in prescription management for the pediatric population, and (4) challenges in decision-making regarding diagnosis and prescription due to difficulties in gathering and incorporating information from multiple sources, are discussed. This article also reviews clinical guidelines for pharmacological interventions and relevant landmark research projects (Treatment for Adolescents with Depression Study, Multimodal Treatment Study of Children with ADHD, and Treatment of Severe Childhood Aggression Study). The authors conclude that, in light of the continued shortage of child and adolescent psychiatrists, research and training policies as well as goals should focus on preparing clinicians and building mental health care systems that can deliver optimal services in this new reality. [ Psychiatr Ann . 2021;51(10):450–458.]

Background: One of the primary barriers to medication adherence is traversing a physical distance to a pharmacy to pick-up medications. There are few studies that have examined how socioeconomic factors affect patient medication adherence in the context of student-run free clinics (SRFC).  Low medication adherence leads to poorer patient outcomes, especially in patients with chronic diseases. Methods: This retrospective chart review aims to quantify the rate of medication adherence at this student-run free clinic using prescription pick-up rate and medication possession ratio (MPR). This study involved review of medication documentation in the electronic medical record (EMR) and charge reports of dispensed medications from the clinic’s community partner, OneWorld pharmacy. Prescriptions written for and picked up by Student Health Alliance Reaching Indigent Needy Groups (SHARING) patients between January 1, 2018, and May 31, 2020, were included for analysis. Medication adherence was calculated using MPR. Results: 1,396 prescriptions were written for 37 patients over the study period and 177 prescriptions (12.7%) were dispensed. The MPR for the patient population is 0.1128 (Standard Deviation (SD) = 0.36159). It took patients an average of 29.4 days (SD = 44.3) to pick-up medications after the prescription was sent. Discussion: At an off-campus pharmacy, SRFC patients had a low prescription pick-up rate and low medication adherence, with delayed time to prescription pick-up. Further investigations are needed to identify barriers to prescription adherence and improve adherence rates.

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