Wastewater Surveillance for Poliovirus in Selected Jurisdictions, United States, 2022-2023.

Wastewater testing can inform public health action as a component of polio outbreak response. During 2022-2023, a total of 7 US jurisdictions (5 states and 2 cities) participated in prospective or retrospective testing of wastewater for poliovirus after a paralytic polio case was identified in New York state. Two distinct vaccine-derived poliovirus type 2 viruses were detected in wastewater from New York state and New York City during 2022, representing 2 separate importation events. Of those viruses, 1 resulted in persistent community transmission in multiple New York counties and 1 paralytic case. No poliovirus was detected in the other participating jurisdictions (Connecticut, New Jersey, Michigan, and Illinois and Chicago, IL). The value of routine wastewater surveillance for poliovirus apart from an outbreak is unclear. However, these results highlight the ongoing risk for poliovirus importations into the United States and the need to identify undervaccinated communities and increase vaccination coverage to prevent paralytic polio.

Using low volume eDNA methods to sample pelagic marine animal assemblages.

Environmental DNA (eDNA) is an increasingly useful method for detecting pelagic animals in the ocean but typically requires large water volumes to sample diverse assemblages. Ship-based pelagic sampling programs that could implement eDNA methods generally have restrictive water budgets. Studies that quantify how eDNA methods perform on low water volumes in the ocean are limited, especially in deep-sea habitats with low animal biomass and poorly described species assemblages. Using 12S rRNA and COI gene primers, we quantified assemblages comprised of micronekton, coastal forage fishes, and zooplankton from low volume eDNA seawater samples (n = 436, 380-1800 mL) collected at depths of 0-2200 m in the southern California Current. We compared diversity in eDNA samples to concurrently collected pelagic trawl samples (n = 27), detecting a higher diversity of vertebrate and invertebrate groups in the eDNA samples. Differences in assemblage composition could be explained by variability in size-selectivity among methods and DNA primer suitability across taxonomic groups. The number of reads and amplicon sequences variants (ASVs) did not vary substantially among shallow (<200 m) and deep samples (>600 m), but the proportion of invertebrate ASVs that could be assigned a species-level identification decreased with sampling depth. Using hierarchical clustering, we resolved horizontal and vertical variability in marine animal assemblages from samples characterized by a relatively low diversity of ecologically important species. Low volume eDNA samples will quantify greater taxonomic diversity as reference libraries, especially for deep-dwelling invertebrate species, continue to expand.

A modeling pipeline to relate municipal wastewater surveillance and regional public health data.

As COVID-19 becomes endemic, public health departments benefit from improved passive indicators, which are independent of voluntary testing data, to estimate the prevalence of COVID-19 in local communities. Quantification of SARS-CoV-2 RNA from wastewater has the potential to be a powerful passive indicator. However, connecting measured SARS-CoV-2 RNA to community prevalence is challenging due to the high noise typical of environmental samples. We have developed a generalized pipeline using in- and out-of-sample model selection to test the ability of different correction models to reduce the variance in wastewater measurements and applied it to data collected from treatment plants in the Chicago area. We built and compared a set of multi-linear regression models, which incorporate pepper mild mottle virus (PMMoV) as a population biomarker, Bovine coronavirus (BCoV) as a recovery control, and wastewater system flow rate into a corrected estimate for SARS-CoV-2 RNA concentration. For our data, models with BCoV performed better than those with PMMoV, but the pipeline should be used to reevaluate any new data set as the sources of variance may change across locations, lab methods, and disease states. Using our best-fit model, we investigated the utility of RNA measurements in wastewater as a leading indicator of COVID-19 trends. We did this in a rolling manner for corrected wastewater data and for other prevalence indicators and statistically compared the temporal relationship between new increases in the wastewater data and those in other prevalence indicators. We found that wastewater trends often lead other COVID-19 indicators in predicting new surges.

Cyclical exacerbation of suicidal ideation in female outpatients: Prospective evidence from daily ratings in a transdiagnostic sample.

Suicide is a leading cause of death among females of reproductive age. The menstrual cycle is a plausible yet understudied trigger for acute suicide risk. Cross-sectional studies have demonstrated a greater frequency of suicide attempts and deaths in the weeks before and after the onset of menses compared to other cycle phases. Here, using prospective daily ratings, we examine the relationship between the cycle and suicidal ideation (SI) and related symptoms known to show a cyclical change in some patients (depression, hopelessness, guilt, rejection sensitivity, interpersonal conflict, anxiety, mood swings, and anger/irritability). Thirty-eight naturally cycling outpatients recruited for past-month SI reported SI severity and other symptoms across an average of 40 days. Participants were excluded for hormone use, pregnancy, irregular cycles, serious medical illness, and body mass index > 29.9 or < 18. Intraclass correlations ranged from .29 to .46, highlighting that most symptom variance lies within-person. Cyclical worsening of symptoms was evaluated using phase contrasts in multilevel models. Most symptoms, including SI, were significantly worse in the perimenstrual phase than in all other phases. Additionally, anger/irritability was higher in the midluteal than in the midfollicular phase, and several symptoms of depression were higher in the midfollicular than in the periovulatory phase. Otherwise, symptoms did not significantly differ between the midluteal, midfollicular, and periovulatory phases. Cycle phase predictors accounted for 25% of the within-person variance in SI. Females with SI may be at risk for perimenstrual worsening of SI and related symptoms. These findings highlight the importance of assessing the cycle phase for improved prediction of suicide risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Usability and social consequences of the early identification system as a universal screener for social, emotional, and behavioral risks.

The Early Identification System (EIS) was developed to overcome many of the usability challenges of school-based behavior screeners. Several prior studies have documented the technical adequacy of the EIS. The present study expanded this work by examining the use, relevance, values implications, and social consequence of EIS implementation in a sample of 54 K-12 schools and 23,104 students in the Midwestern United States. We found that nearly all schools, teachers, and students completed the EIS as planned. Schools used the data to provide universal, selective, and indicated services to a high percentage of students identified with risks as well as to plan professional development for educators based on the screening data. Seventy-nine percent of schools implemented the EIS system with high fidelity, and fidelity was unrelated to student demographic composition within schools. These findings suggest that the EIS may overcome many of the usability barriers that plague common behavior screeners. Limitations and implications for advancing the science of social consequence evaluation are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intensity of sample processing methods impacts wastewater SARS-CoV-2 whole genome amplicon sequencing outcomes.

Wastewater SARS-CoV-2 surveillance has been deployed since the beginning of the COVID-19 pandemic to monitor the dynamics in virus burden in local communities. Genomic surveillance of SARS-CoV-2 in wastewater, particularly efforts aimed at whole genome sequencing for variant tracking and identification, are still challenging due to low target concentration, complex microbial and chemical background, and lack of robust nucleic acid recovery experimental procedures. The intrinsic sample limitations are inherent to wastewater and are thus unavoidable. Here, we use a statistical approach that couples correlation analyses to a random forest-based machine learning algorithm to evaluate potentially important factors associated with wastewater SARS-CoV-2 whole genome amplicon sequencing outcomes, with a specific focus on the breadth of genome coverage. We collected 182 composite and grab wastewater samples from the Chicago area between November 2020 to October 2021. Samples were processed using a mixture of processing methods reflecting different homogenization intensities (HA + Zymo beads, HA + glass beads, and Nanotrap), and were sequenced using one of the two library preparation kits (the Illumina COVIDseq kit and the QIAseq DIRECT kit). Technical factors evaluated using statistical and machine learning approaches include sample types, certain sample intrinsic features, and processing and sequencing methods. The results suggested that sample processing methods could be a predominant factor affecting sequencing outcomes, and library preparation kits was considered a minor factor. A synthetic SARS-CoV-2 RNA spike-in experiment was performed to validate the impact from processing methods and suggested that the intensity of the processing methods could lead to different RNA fragmentation patterns, which could also explain the observed inconsistency between qPCR quantification and sequencing outcomes. Overall, extra attention should be paid to wastewater sample processing (i.e., concentration and homogenization) for sufficient and good quality SARS-CoV-2 RNA for downstream sequencing.

Financial stress and debt in clinical psychology doctoral students.

INTRODUTION: Few studies examine the financial burden of clinical psychology doctoral programs and its impact on achievements, stress, and mental health. OBJECTIVES: The current study sought to better understand students' financial stress and debt, and how financial stress may impact their mental health and the attainment of personal and professional milestones. METHOD: Students (N = 912) completed an online survey assessing demographics, sources of income and expenditures, mental health, and milestones. RESULTS: After accounting for yearly inflation, stipends have not kept pace with the average cost of living in the United States. Over one-third of students indicated that they had no expendable pretax income after paying for their education and typical living expenses. Additionally, over 80% reported acquiring additional debt in graduate school to offset their living expenses. Financial concerns were associated with delays in major life milestones (e.g., buying a car/house, getting married/starting a family, having children), as well as avoiding medical (34.2%) or mental (41.4%) health care, with 17.5% of participants experiencing a health crisis they could not afford while in graduate school. Financial stress was associated with an increase in time spent thinking about finances, higher rates of depression and anxiety symptoms, and decreased sleep. CONCLUSION: Many clinical psychology doctoral students experience financial stress and are often unable to afford basic educational, personal living, and health care expenses, likely worsening mental health. Academic programs and leadership are encouraged to increase student stipends, improve financial transparency, provide access to health care, and alleviate financial stress and debt.

Pregnancy options counseling.

PURPOSE OF REVIEW: This article reviews key aspects of pregnancy options counseling, and highlights how inappropriate counseling can create barriers to timely and safe abortion care. RECENT FINDINGS: Access to safe abortion services in the United States is increasingly constrained. One way to combat this hostile environment is to ensure that individuals presenting for care early in pregnancy have access to comprehensive and unbiased pregnancy options counseling. There are unfortunately many barriers to individuals receiving adequate pregnancy options counseling, and marginalized groups experience disproportionate effects of inappropriate counseling. Research shows that individuals desire appropriate pregnancy options counseling when seeking early pregnancy care, and that providers often serve as a barrier to this care. Provider miseducation and opposition to pregnancy options counseling, particularly as it concerns abortion care, creates challenges and delays for people seeking abortion services. Crisis Pregnancy Centers use misinformation to further these barriers to appropriate care. SUMMARY: Nondirective and patient-centered pregnancy options counseling is standard of care. People seeking pregnancy options counseling desire and deserve comprehensive and accurate information. Providers must not serve as barriers to safe and appropriate care. Increasing nondirective pregnancy options counseling research, education, and training is crucial to ensuring access to safe and appropriate abortion care.

Examining the validity of the Early Identification System - Student Version for screening in an elementary school sample.

As many as 1 in 5 youth in the United States experience social, emotional, and behavioral problems. However, many students with mental health concerns are unidentified and do not receive adequate care. The purpose of this study was to evaluate the factor structure, measurement invariance, and the concurrent and predictive validity of the Early Identification System-Student Report (EIS-SR), a screener for social, emotional, and behavioral problems, using a sample of over 5000 students from Grades 3 to 5. The EIS-SR was developed by using extant literature on the risk indicators that lead to social, emotional, and behavioral challenges among children and youth. As expected, seven subscales were identified as having adequate factor loadings. Furthermore, the measure was determined to be invariant across grade level (n = 5005), gender (n = 5005), and between Black and White students (n = 1582). The concurrent validity of the Internalizing Behavior, Attention and Academic Issues, Emotion Dysregulation, and School Disengagement subscales was supported by correlations with comparable subscales of the Behavior Assessment System for Children-3rd Edition (BASC-3; n = 382). Additionally, the EIS-SR subscales administered in the fall of the school year were predictive of important outcomes in spring, including attendance (n = 4780), disciplinary referrals (n = 4938), bully victimization (n = 4670), math academic achievement scores (n = 4736), and reading (n = 4772) academic achievement scores. The EIS-SR holds promise as a feasible and technically adequate screening tool for use in elementary schools.

Advances in Research on Adolescent Suicide and a High Priority Agenda for Future Research.

Suicide is the second leading cause of death for adolescents in the United States, yet remarkably little is known regarding risk factors for suicidal thoughts and behaviors (STBs), relatively few federal grants and scientific publications focus on STBs, and few evidence-based approaches to prevent or treat STBs are available. This "decade in review" article discusses five domains of recent empirical findings that span biological, environmental, and contextual systems and can guide future research in this high priority area: (1) the role of the central nervous system; (2) physiological risk factors, including the peripheral nervous system; (3) proximal acute stress responses; (4) novel behavioral and psychological risk factors; and (5) broader societal factors impacting diverse populations and several additional nascent areas worthy of further investigation.

Linking post-stressor interpersonal processes in adolescent girls' close friendships with acute HPA stress responses.

INTRODUCTION: For adolescent girls, close friendships may facilitate stress management and mitigate risk for internalizing psychopathology. However, little is known about how friendship processes may buffer (or potentially exacerbate) acute psychobiological responses to interpersonal stressors in ways that affect risk. METHODS: In a sample of 220 girls (ages 12-17 years) with a history of internalizing symptoms, this study investigated friendship dynamics following the Trier Social Stress Test (TSST) to evaluate associations between post-stressor friendship behaviors (expressions of vulnerability by the stressed teen; support offered by their close friend) and hypothalamic-pituitary-adrenal (HPA) axis stress responses. RESULTS: Multilevel regression modeling revealed that girls who displayed more pronounced cortisol reactivity expressed greater vulnerability to, and received greater support from, their close friend. Expressed vulnerability was associated with more efficient cortisol recovery. Close friend support was not significantly associated with cortisol recovery, nor did it influence the connection between expressed vulnerability and cortisol recovery. CONCLUSIONS: Findings suggest that HPA reactivity may prompt expressions of vulnerability to girls' close friends, and in this context, promote more efficient HPA recovery. Findings highlight the role friendship dynamics may play in HPA-related risk for internalizing symptoms and point to expressed vulnerability in adolescent girls' close friendships as a potential consideration for interpersonally-centered therapeutic approaches.

Evaluation of DNA extraction protocols from liquid-based cytology specimens for studying cervical microbiota.

Cervical microbiota (CM) are considered an important factor affecting the progression of cervical intraepithelial neoplasia (CIN) and are implicated in the persistence of human papillomavirus (HPV). Collection of liquid-based cytology (LBC) samples is routine for cervical cancer screening and HPV genotyping and can be used for long-term cytological biobanking. We sought to determine whether it is possible to access microbial DNA from LBC specimens, and compared the performance of four different extraction protocols: (ZymoBIOMICS DNA Miniprep Kit; QIAamp PowerFecal Pro DNA Kit; QIAamp DNA Mini Kit; and IndiSpin Pathogen Kit) and their ability to capture the diversity of CM from LBC specimens. LBC specimens from 20 patients (stored for 716 ± 105 days) with CIN values of 2 or 3 were each aliquoted for each of the four kits. Loss of microbial diversity due to long-term LBC storage could not be assessed due to lack of fresh LBC samples. Comparisons with other types of cervical sampling were not performed. We observed that all DNA extraction kits provided equivalent accessibility to the cervical microbial DNA within stored LBC samples. Approximately 80% microbial genera were shared among all DNA extraction protocols. Potential kit contaminants were observed as well. Variation between individuals was a significantly greater influence on the observed microbial composition than was the method of DNA extraction. We also observed that HPV16 was significantly associated with community types that were not dominated by Lactobacillus iners.

Mental health concerns and barriers to care among future clinical psychologists.

Few studies have examined the mental health of clinical psychology doctoral students, a unique group given their education and training in psychopathology, assessment, and intervention. Students (N = 912) completed an online survey assessing demographics, mental health, mental healthcare utilization, and barriers to care during graduate school. Nearly 25% of participants reported moderate to severe symptoms of anxiety, 20% reported moderate to severe symptoms of depression or suicidal intent (SI), and more than 10% reported a high risk of alcohol abuse or moderate to severe drug use during graduate school. In comparison to peers, ethnic minority and lesbian, gay, bisexual, transgender, and queer (LGBTQ+) participants reported more symptoms of depression and SI. LGBTQ+ participants reported more nonsuicidal self-injury and drug use. Participants also experienced significant barriers to receiving mental healthcare (e.g., financial difficulties, limited availability, insufficient time). Leadership is encouraged to prioritize the mental health of clinical psychology doctoral students, which may have implications on their service provision.

Clinical psychology PhD students' admission experiences: Implications for recruiting racial/ethnic minority and LGBTQ students.

AIM: The purpose of this study was to explore differences in the clinical psychology PhD program admissions experience (i.e., interviewing and decision-making) by race/ethnicity and lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity. METHODS: Participants were 803 students (24% racial/ethnic minority; 19% LGBTQ) enrolled in US clinical psychology PhD programs. Two-group comparisons tested for differences in admission experiences by race/ethnicity and LGBTQ identity. RESULTS: Racial/ethnic minority and LGBTQ students considered a programmatic commitment to diversity as more important in application decisions compared to non-Hispanic White and cisgender heterosexual students, respectively. LGBTQ students were more likely to be advised to not discuss personal information (e.g., sexual orientation) than cisgender heterosexual students. Racial/ethnic minority and LGBTQ students identified financial considerations and program outcomes as more important in their decision-making compared with non-Hispanic White and cisgender heterosexual students, respectively. CONCLUSION: Increasing funding and fostering authentic training environments should be prioritized in institutional conversations around recruiting racial/ethnic minority and LGBTQ trainees.

Effect of Tympanostomy Tube Placement on Intraoperative Auditory Brainstem Response.

BACKGROUND: Intraoperative auditory brainstem response (ioABR) testing under general anesthesia is commonly performed on children when sleep-deprived ABR and behavioral testing are not reliable or feasible. Several studies have reported potential confounding results when tube insertion is combined with ABR testing. PURPOSE: This article evaluates whether a temporary threshold shift (TTS) occurs following placement of tympanostomy tubes (TTs) in children who undergo ioABR testing. RESEARCH DESIGN: A case-control prospective study. Patients scheduled for combined TT and ioABR procedures were enrolled into this study. STUDY SAMPLE: Twenty children (38 ears), ranging in age from 6 months to 10.5 years, were enrolled. DATA COLLECTION AND ANALYSIS: ABR thresholds for tone bursts with center frequencies of 2 and 4 kHz were compared before and after tube insertion. The indication for surgery, comorbidities, and status of the middle ear were also recorded. A paired t-test was used to determine statistical significance. RESULTS: Data collection did not necessarily indicate suctioning and tube placement were causing a TTS; however, fluid present in the middle ear space prior to TT placement appeared to influence results. Although a paired t-test did not show statistically significant differences in ABR thresholds between groups of individuals with and without fluid and before and after tube placement, 50% of patients with mucoid fluid (two out of four patients) were noted to have 10 dB or greater worsening in ABR thresholds in two out of six ears. Twenty-nine percent of patients with serous fluid (two out of seven patients) were noted to have at least a 10 dB worsening in ABR threshold in 2 out of 10 ears. Further testing is needed to confirm these trends. CONCLUSION: This pilot study indicates that children with mucoid or serous fluid may experience worse ABR thresholds following TT insertion. ioABR testing immediately after TT tube placement and in the presence of middle ear fluid should be interpreted with caution. Additional studies with a larger sample size are needed to confirm these results.

How to study the menstrual cycle: Practical tools and recommendations.

Despite decades of research on the physiological and psychological effects of the menstrual cycle, studies have not sufficiently adopted consistent methods for operationalizing the menstrual cycle. This has resulted in substantial confusion in the literature and limited possibilities to conduct systematic reviews and meta-analyses. In order to facilitate more rapid accumulation of knowledge on cycle effects, the present paper offers a set of integrative guidelines and standardized tools for studying the menstrual cycle as an independent variable. We begin with (1) an overview of the menstrual cycle and (2) premenstrual disorders, followed by (3) recommendations and tools regarding data collection in cycle studies. These recommendations address selecting the appropriate study design and sampling strategy, managing demand characteristics, identifying a sample of naturally-cycling individuals, and measuring menstrual bleeding dates, ovarian hormones, and ovulation. We proceed with suggestions for (4) data preparation and coding of cycle day and phases, as well as (5) data visualization, statistical modeling, and interpretation of menstrual cycle associations. We also provide (6) recommendations for using menses start day and ovulation testing to schedule visits in laboratory studies and end with a (7) comprehensive summary and conclusion. Regardless of whether the influence of the menstrual cycle is of central interest in a study or should be controlled to accurately assess the effects of another variable, the use of these recommendations and tools will help make study results more meaningful and replicable.

Understanding When and Why Some Adolescent Girls Attempt Suicide: An Emerging Framework Integrating Menstrual Cycle Fluctuations in Risk.

The prevalence of suicidal thoughts and behaviors increases dramatically across the transition to puberty, particularly among adolescent girls. Yet we know little about why adolescent girls are at heightened risk, or when girls may be most likely to consider or engage in suicidal behavior. In this article, we outline evidence supporting a role for the menstrual cycle in the onset of and fluctuations in adolescent girls' suicide risk. This emerging framework outlines developmental (i.e., biological, social, and cognitive) characteristics that might place certain girls at higher risk (e.g., between-subjects factors), as well as potential mechanisms that occur during the perimenstrual phase of the menstrual cycle (i.e., within-subjects factors) that increase adolescent females' increased risk for suicide.

Comparative genetics of Enterococcus faecalis intestinal tissue isolates before and after surgery in a rat model of colon anastomosis.

We have recently demonstrated that collagenolytic Enterococcus faecalis plays a key and causative role in the pathogenesis of anastomotic leak, an uncommon but potentially lethal complication characterized by disruption of the intestinal wound following segmental removal of the colon (resection) and its reconnection (anastomosis). Here we hypothesized that comparative genetic analysis of E. faecalis isolates present at the anastomotic wound site before and after surgery would shed insight into the mechanisms by which collagenolytic strains are selected for and predominate at sites of anastomotic disruption. Whole genome optical mapping of four pairs of isolates from rat colonic tissue obtained following surgical resection (herein named "pre-op" isolates) and then 6 days later from the anastomotic site (herein named "post-op" isolates) demonstrated that the isolates with higher collagenolytic activity formed a distinct cluster. In order to perform analysis at a deeper level, a single pair of E. faecalis isolates (16A pre-op and 16A post-op) was selected for whole genome sequencing and assembled using a hybrid assembly algorithm. Comparative genomics demonstrated absence of multiple gene clusters, notably a pathogenicity island in the post-op isolate. No differences were found in the fsr-gelE-sprE genes (EF1817-1822) responsible for regulation and production of collagenolytic activity. Analysis of unique genes among the 16A pre-op and post-op isolates revealed the predominance of transporter systems-related genes in the pre-op isolate and phage-related and hydrolytic enzyme-encoding genes in the post-op isolate. Despite genetic differences observed between pre-op and post-op isolates, the precise genetic determinants responsible for their differential expression of collagenolytic activity remains unknown.