Psychological processes linking problematic smartphone use to sleep disturbance in young adults.

OBJECTIVES: With such high rates of sleep and mental health problems among undergraduate students, understanding potential antecedents of these interrelated problems has emerged as a critical area of examination. One potential factor underlying these problems is problematic smartphone use, which is defined as excessive phone use, impulse control problems related to the use, and negative consequences stemming from these behaviors. Accordingly, the current study sought to examine how relative changes in problematic smartphone use might impact college students' sleep disturbance via their psychological functioning (ie, psychological inflexibility and anxiety symptoms). METHODS: The 2-wave (baseline and 2-month follow-up) online sample consisted of 385 undergraduates (81% female; M = 20.0, SD = 1.6), who reported problematic smartphone use, psychological flexibility, anxiety symptoms, and sleep disturbance. RESULTS: Controlling for baseline levels of sleep hygiene, age, and gender, our model demonstrated a significant indirect effect from problematic smartphone use to sleep disturbance. Specifically, relative increases from baseline to the 2-month follow-up in students' problematic smartphone use predicted subsequent increases in psychological inflexibility, which predicted increases in anxiety symptoms, which, in turn, predicted increases in sleep disturbance. CONCLUSIONS: Given the ubiquity of college students' smartphone use, the potential for problematic use remains high. Results suggest that the negative consequences of problematic smartphone use not only can include college students' mental health but also their sleep. With such high levels of college students suffering from mental health and sleep problems, clinicians and college administrators should consider the potential sequelae of the problematic use of smartphones.

Dispositional mindfulness predicting psychological adjustment among college students: the role of rumination and gender.

OBJECTIVE: This study examined rumination as a mediator of the relationship between dispositional mindfulness (DM) and depression, loneliness, and anxiety, while considering gender as a moderator of these mediation models. PARTICIPANTS: Three hundred and nineteen undergraduate students (49.5% female; M = 18.90 years) participated with data collected from January 2018 to April 2019. METHODS: Self-report measures of DM, rumination, symptoms of anxiety and depression, loneliness, and social support were completed. RESULTS: Males scored significantly higher than females on DM, while females scored significantly higher than males on rumination and psychological distress. Rumination mediated the relationship between DM and all adjustment variables. The mediation model predicting depression was moderated by gender, showing stronger effects for females than males. CONCLUSION: Results support rumination as a mechanism underlying the association between DM and psychological adjustment and suggest that targeting both DM and rumination could maximize the effectiveness of mindfulness-based interventions for college students' well-being.

Rapid Community Innovation: a Small Urban Liberal Arts Community Response to COVID-19.

Stories of community resilience and rapid innovation have emerged during the global pandemic caused by COVID-19. As communities, organizations, and individuals have had to shift modalities during the pandemic, they have identified ways to sustain community well-being. Prior to COVID-19, colleges and universities were hailed as anchors of economic and social resilience and well-being for communities of place. In this light, this commentary highlights stories of rapid community innovation occurring at Hobart & William Smith Colleges in the Finger Lakes region of New York. A series of vignettes are presented showcasing lessons and on-going questions regarding rapid pivots, community values, and diversity and inclusion during (and after) the pandemic. Overall, these insights can inform future local collaborative development efforts post-COVID-19 between colleges/universities and their local community.

Accuracy and Efficiency of Deep-Learning-Based Automation of Dual Stain Cytology in Cervical Cancer Screening.

BACKGROUND: With the advent of primary human papillomavirus testing followed by cytology for cervical cancer screening, visual interpretation of cytology slides remains the last subjective analysis step and suffers from low sensitivity and reproducibility. METHODS: We developed a cloud-based whole-slide imaging platform with a deep-learning classifier for p16/Ki-67 dual-stained (DS) slides trained on biopsy-based gold standards. We compared it with conventional Pap and manual DS in 3 epidemiological studies of cervical and anal precancers from Kaiser Permanente Northern California and the University of Oklahoma comprising 4253 patients. All statistical tests were 2-sided. RESULTS: In independent validation at Kaiser Permanente Northern California, artificial intelligence (AI)-based DS had lower positivity than cytology (P < .001) and manual DS (P < .001) with equal sensitivity and substantially higher specificity compared with both Pap (P < .001) and manual DS (P < .001), respectively. Compared with Pap, AI-based DS reduced referral to colposcopy by one-third (41.9% vs 60.1%, P < .001). At a higher cutoff, AI-based DS had similar performance to high-grade squamous intraepithelial lesions cytology, indicating a risk high enough to allow for immediate treatment. The classifier was robust, showing comparable performance in 2 cytology systems and in anal cytology. CONCLUSIONS: Automated DS evaluation removes the remaining subjective component from cervical cancer screening and delivers consistent quality for providers and patients. Moving from Pap to automated DS substantially reduces the number of colposcopies and also achieves excellent performance in a simulated fully vaccinated population. Through cloud-based implementation, this approach is globally accessible. Our results demonstrate that AI not only provides automation and objectivity but also delivers a substantial benefit for women by reduction of unnecessary colposcopies.

The role of financial strain in college students' work hours, sleep, and mental health.

OBJECTIVE: To examine poor sleep quality as a potential mediator between college students' employment hours and depressive symptoms, and to examine if this mediation model might differ across students reporting different levels of financial strain. Participants: The sample was collected through a multi-site study during the Spring of 2019 and included 792 undergraduates (M = 20.1, SD = 1.9) in Upstate New York. Methods: Moderated mediation analyses based on cross-sectional self-report, online questionnaires. Results: Increased work hours predicted greater sleep disturbance, which, in turn, predicted more depressive symptoms. Compared to students in more comfortable financial situations, this mediation model only emerged for students reporting more financial strain and lower family socio-economic status. Conclusions: Student employment hours are a significant predictor of students' mental well-being when considering their potential impact on their sleep. Furthermore, students reporting higher levels of financial stress are most at risk of being impacted by this process.

Facets of dispositional mindfulness versus sources of social support predicting college students' psychological adjustment.

Objective: This study examined the relative contribution of five dispositional mindfulness (DM) facets and two aspects of social support along with sex in predicting psychological adjustment. Participants: Three hundred fifty-three undergraduates (72% female; M = 18.82 years) participated with data collected from September 2014 through March 2016. Methods: Self-report measures of DM, social support, perceived stress, and emotional well-being were completed. Results: Sex and higher scores on specific mindfulness facets (ie, nonreactivity, nonjudging) predicted lower stress and greater emotional well-being. Higher family support predicted lower stress, whereas friend support predicted greater emotional well-being. The mindfulness facets were stronger predictors of adjustment than the social support domains. Females reported higher perceived stress and lower emotional well-being than males, and males scored significantly higher on total mindfulness, nonjudging, and nonreactivity. Conclusions: Results have implications for mindfulness-based interventions with college students such that focusing on the nonjudging and nonreactivity facets may enhance effectiveness.

Clinical Evaluation of Human Papillomavirus Screening With p16/Ki-67 Dual Stain Triage in a Large Organized Cervical Cancer Screening Program.

Importance: As cervical cancer screening transitions from Papanicolaou cytologic screening to primary human papillomavirus (HPV) testing worldwide, effective triage tests are needed to decide who among the HPV-positive women should receive further diagnostic evaluation to avoid unnecessary colposcopies and biopsies. Objective: To evaluate the performance of the p16/Ki-67 dual stain (DS) and HPV16/18 genotyping for the triage of HPV-positive women. Design, Setting, and Participants: A prospective observational study was conducted within the cervical cancer screening program at Kaiser Permanente Northern California of 3225 HPV-positive women undergoing HPV and Papanicolaou cytologic testing with a valid DS result from September 16 to October 31, 2015, with follow-up through December 31, 2018. Exposures: Human papillomavirus screening with partial genotyping and cytologic triage compared with DS triage. Main Outcomes and Measures: Cervical intraepithelial neoplasia grade 3 or more severe (CIN3+) and grade 2 or more severe (CIN2+), diagnosed within 3 years after sample collection. Results: A total of 3225 women (mean [SD] age, 37.9 [11.3] years) participated in the study. For triage of HPV-positive women with partial genotyping, DS showed better risk stratification for CIN3+ than did Papanicolaou cytologic testing, with women with positive DS results having a higher risk than women with positive Papanicolaou test results for CIN3+ (218 of 1818 [12.0%; 95% CI, 10.5%-13.5%] vs 219 of 2128 [10.3%; 95% CI, 9.0%-11.6%]; P = .005). Similarly, DS showed better risk stratification for CIN3+ compared with Papanicolaou cytologic testing in HPV-positive women, irrespective of genotyping. The greatest reassurance against CIN3+ was observed in HPV16/18-negative women with negative DS results, with a risk low enough to extend retesting intervals. Dual stain triage strategies required substantially fewer colposcopies per detection of CIN3+ compared with Papanicolaou cytologic testing, with a 32.1% (859 of 2677) reduction of colposcopies compared with the currently recommended triage strategy of HPV screening with Papanicolaou cytologic testing. Results for CIN2+ were very similar. Conclusions and Relevance: Triage of HPV-positive women with DS was superior to Papanicolaou cytologic testing in this study, demonstrating equal immediate detection of precancerous lesions and substantially reduced referral to colposcopy. These findings suggest that DS can safely replace Papanicolaou cytologic testing as a triage strategy for primary HPV screening, and that retesting intervals in HPV16/18-negative women with negative DS results can be safely extended to 3 years.

Still lonely: Social adjustment of youth with and without social anxiety disorder following cognitive behavioral therapy.

Social experiences are an integral part of normative development for youth and social functioning difficulties are related to poor outcomes. Youth with anxiety disorders, and particularly social anxiety disorder, experience difficulties across many aspects of social functioning that may place them at risk for maladjustment. The goal of this paper was to compare social experiences of youth across anxiety diagnoses and examine whether treatment is helpful in improving social functioning. Ninety-two children (age 7-12 years; 58% male; 87.0% White) with a primary diagnosis of generalized anxiety disorder, separation anxiety disorder, and/or social anxiety disorder participated in cognitive behavioral therapy. At both pre- and post-treatment, children with social anxiety disorder self-reported greater loneliness than youth without social anxiety disorder, though levels of peer victimization and receipt of prosocial behavior were similar across groups. Parents reported greater social problems for youth with social anxiety disorder compared to those without social anxiety disorder. All youth experienced improved social functioning following treatment per child- and parent-reports. The results call for an increased focus on the social experiences of youth with anxiety disorders, and particularly loneliness, for children with social anxiety disorder. The results document ways that evidenced-based practice can improve social functioning for youth with anxiety disorders.

A model-based cluster analysis of social experiences in clinically anxious youth: links to emotional functioning.

Social difficulties are commonly associated with anxiety disorders in youth, yet are not well specified in the literature. The aim of this study was to identify patterns of social experiences in clinically anxious children and examine the associations with indices of emotional functioning. A model-based cluster analysis was conducted on parent-, teacher-, and child-reports of social experiences with 64 children, ages 7-12 years (M = 8.86 years, SD = 1.59 years; 60.3% boys; 85.7% Caucasian) with a primary diagnosis of separation anxiety disorder, social phobia, and/or generalized anxiety disorder. Follow-up analyses examined cluster differences on indices of emotional functioning. Findings yielded three clusters of social experiences that were unrelated to diagnosis: (1) Unaware Children (elevated scores on parent- and teacher-reports of social difficulties but relatively low scores on child-reports, n = 12), (2) Average Functioning (relatively average scores across all informants, n = 44), and (3) Victimized and Lonely (elevated child-reports of overt and relational victimization and loneliness and relatively low scores on parent- and teacher-reports of social difficulties, n = 8). Youth in the Unaware Children cluster were rated as more emotionally dysregulated by teachers and had a greater number of diagnoses than youth in the Average Functioning group. In contrast, the Victimized and Lonely group self-reported greater frequency of negative affect and reluctance to share emotional experiences than the Average Functioning cluster. Overall, this study demonstrates that social maladjustment in clinically anxious children can manifest in a variety of ways and assessment should include multiple informants and methods.

Evaluation of BBL CHROMagar VanRE for detection of vancomycin-resistant Enterococci in rectal swab specimens.

A study was performed on 517 surveillance rectal swabs to evaluate a selective and differential chromogenic medium, the BBL CHROMagar VanRE (CVRE), which enables recovery and identification of VanA- and VanB-containing Enterococcus faecium (ENFM) and Enterococcus faecalis (ENFS) isolates. Compared to BBL Enterococcosel agar, a bile-esculin-azide-vancomycin (BEAV) agar, the initial overall sensitivity, specificity, and positive and negative predictive values of CVRE for the detection of vancomycin-resistant ENFM and ENFS were 99.1% and 94.8% and 84.2% and 99.7%, respectively. Among our patient population, more vancomycin-resistant enterococci (VRE) were recovered with CVRE than BEAV.

Peer experiences of anxious and socially withdrawn youth: an integrative review of the developmental and clinical literature.

Prior research indicates that both anxious youth and socially withdrawn youth tend to experience challenges and difficulties in various aspects of their peer relationships and social functioning. While clinical psychology researchers have examined how anxiety relates to peer experiences using normative and clinically anxious samples, developmental psychologists have focused primarily on the peer experiences of shy and withdrawn children. Research from these two fields has progressed on related yet separate paths, producing similar results despite using different terminology and assessment techniques. The purpose of this review is to bring together the developmental and clinical bodies of literature on the peer experiences of anxious and socially withdrawn youth by identifying common themes and unique contributions of each discipline. Studies reviewed focus specifically on the peer constructs of acceptance, friendship, peer victimization, social skills, and social-cognitive processes. Limitations including methodological inconsistencies and insufficient examination of age-, gender-, and ethnicity-related issues are identified. Recommendations for future collaborations between developmental and clinical researchers as well as implications for interventions targeting the peer relations of anxious and withdrawn youth are discussed.

Factor structure and psychometric properties of the Multidimensional Anxiety Scale for Children in an African American adolescent sample.

The current study examined the psychometric properties and factor structure of the Multidimensional Anxiety Scale for Children (MASC) among a community sample of 118 African American students (58 females; ages 14-19 years; mean age = 15.79) in an urban, parochial high school. Adolescents completed the MASC and several other self-report measures of anxiety, perceived competence, and symptoms of ADHD. The original MASC total and subscale mean scores were comparable to data reported in previous studies utilizing community samples of youth, though measures of internal consistency were lower. Factor analytic results supported a three factor solution (i.e., social anxiety, physical symptoms, harm avoidance) which accounted for 23.84% of the variance. While there was overlap in the underlying structure of anxiety between the original MASC publication and the current sample, items reflecting separation anxiety did not emerge as a separate factor. As expected, the MASC total score was positively correlated with measures of anxiety and perceived competence but unrelated to measures of hyperactivity. This study represents an important first step toward establishing more comprehensive age, race, and gender norms for the MASC.

Factor structure and psychometric properties of the Children's Negative Cognitive Error Questionnaire with a clinically depressed adolescent sample.

The factor structure and psychometric properties of the Children's Negative Cognitive Error Questionnaire (CNCEQ) were examined with 427 adolescents ages 12 to 18 (193 boys) with current major depressive disorder. Results of confirmatory factor analysis supported a four-factor model comprised of three content area factors (i.e., social, academic, athletic) and a general factor. Internal consistencies ranged between .84 and .94 for the total and three content area scores. Girls scored significantly higher than boys on all factors, but no age differences on the factors were found. Convergent and discriminant validity of the CNCEQ were supported. Results did not support the original subscales organized by type of cognitive distortion (e.g., catastrophizing, overgeneralizing). Findings indicated that the CNCEQ would be a useful clinical tool for assessing cognitive symptoms within relevant domains of functioning (e.g., social, academic) of depressed youth.

Cognitive measures of adolescent depression: unique or unitary constructs?

The factor structure of several self-report questionnaires assessing depression-relevant cognitions frequently employed in clinical research was examined in a sample of 390 adolescents (M age = 14.54; 216 girls; 74% Caucasian) with current major depressive disorder enrolled in the Treatment of Adolescents with Depression Study. A four-factor solution resulted, accounting for 65% of the total variance. The factors were labeled (a) Cognitive Distortions and Maladaptive Beliefs, (b) Cognitive Avoidance, (c) Positive Outlook, and (d) Solution-Focused Thinking. Internal consistencies for the factor-based composite scores were .83, .85, .84, and .82, respectively. Girls endorsed more negative cognitions than boys on three of the four factors. Maladaptive cognitions were positively related to severity of depression and predicted treatment response. Taken together, findings indicated that there are four distinct domains of cognitions that are present among adolescents with depression that are tapped by several widely used self-report measures of cognitions.

Predictors of treatment response in pediatric obsessive-compulsive disorder.

OBJECTIVE: To examine predictors of treatment response in pediatric obsessive-compulsive disorder (OCD). METHOD: A literature review of psychotherapy (i.e., cognitive-behavioral therapy) and medication studies for pediatric OCD published from 1985 to 2007 was conducted using several databases. RESULTS: The literature search produced a total of 21 studies (6 cognitive-behavioral therapy, 13 medication, and 2 combination studies) that met specific methodological criteria. Across studies, the following nine predictors were examined: child sex, child age, duration of illness/age at onset, baseline severity of obsessive-compulsive symptoms, type of obsessive-compulsive symptoms, comorbid disorders/symptoms, psychophysiological factors, neuropsychological factors, and family factors. Among all of the studies, there was little evidence that sex, age, or duration of illness (age at onset) was associated with treatment response. Baseline severity of obsessive-compulsive symptoms and family dysfunction were associated with poorer response to cognitive-behavioral therapy, whereas comorbid tics and externalizing disorders were associated with poorer response in medication-only studies. CONCLUSIONS: Overall, there are limited data on predictors of treatment response for pediatric OCD. The majority of studies are plagued with methodological limitations and post hoc approaches. Additional research is needed to better delineate the predictors of treatment response in pediatric OCD with the goal of developing individualized treatment approaches.

Sleep-related problems among children and adolescents with anxiety disorders.

OBJECTIVE: The present study examined sleep-related problems (SRPs) among a large sample (n = 128) of youth with anxiety disorders (i.e., generalized, separation, and social). The frequency of eight specific SRPs was examined in relation to age, gender, type of anxiety disorder, anxiety severity, and functional impairment. The impact of pharmacological treatment (fluvoxamine versus pill placebo) in reducing SRPs also was examined. METHOD: As part of a large, double-blind, randomized, controlled trial (Research Units on Pediatric Psychopharmacology Anxiety Study Group), clinician and parent reports of SRPs were examined among children and adolescents, ages 6 to 17 years, before and after treatment. RESULTS: Eighty-eight percent of youth experienced at least one SRP, and a majority (55%) experienced three or more. Total SRPs were positively associated with anxiety severity and interference in family functioning. Significantly greater reductions in SRPs were found among children treated with fluvoxamine compared with placebo. CONCLUSIONS: These findings indicate that SRPs are commonly associated with childhood anxiety disorders and suggest a need for the assessment of and attention to these problems in research and clinical settings.

Gender role orientation and anxiety symptoms among African american adolescents.

The present study evaluated gender role theory as an explanation for the observed gender differences in anxiety symptoms among adolescents. Specifically, the relation between gender, gender role orientation (i.e., masculinity and femininity), self-esteem, and anxiety symptoms was examined in a community sample of 114 African Americans aged 14 to 19 (mean age 15.77; 57 girls). Results revealed that masculinity was negatively associated with anxiety symptoms whereas femininity was positively associated with anxiety symptoms. Gender role orientation accounted for unique variance in anxiety scores above biological gender and self-esteem, and self-esteem moderated the relation between femininity (but not masculinity) and overall anxiety symptoms. Consistent with research on children and Caucasians, findings supported gender role theory as a partial explanation for the observed gender disparity in anxiety symptoms among African American adolescents.

The prostate as a reservoir for HIV-1.

As the prostate can harbor bacterial and fungal pathogens, it was investigated as a reservoir for HIV. Nine men chronically infected with HIV participated in a crossover trial in which weekly semen samples were collected with and without previous prostate massage (PM). Six of the nine participants had undetectable seminal plasma(SP) HIV RNA in all samples without previous PM, but had detectable SP HIV RNA (> 25 copies/ml) in one to three samples collected after PM.