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The rapid proliferation of machine learning research using electronic health records to classify healthcare outcomes offers an opportunity to address the pressing public health problem of adolescent suicidal behavior. We describe the development and evaluation of a machine learning algorithm using natural language processing of electronic health records to identify suicidal behavior among psychiatrically hospitalized adolescents. Adolescents hospitalized on a psychiatric inpatient unit in a community health system in the northeastern United States were surveyed for history of suicide attempt in the past 12 months. A total of 73 respondents had electronic health records available prior to the index psychiatric admission. Unstructured clinical notes were downloaded from the year preceding the index inpatient admission. Natural language processing identified phrases from the notes associated with the suicide attempt outcome. We enriched this group of phrases with a clinically focused list of terms representing known risk and protective factors for suicide attempt in adolescents. We then applied the random forest machine learning algorithm to develop a classification model. The model performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. The final model had a sensitivity of 0.83, specificity of 0.22, AUC of 0.68, a PPV of 0.42, NPV of 0.67, and an accuracy of 0.47. The terms mostly highly associated with suicide attempt clustered around terms related to suicide, family members, psychiatric disorders, and psychotropic medications. This analysis demonstrates modest success of a natural language processing and machine learning approach to identifying suicide attempt among a small sample of hospitalized adolescents in a psychiatric setting.

Background The Food and Drug Administration's 2004 antidepressant warning was followed by decreases in antidepressant prescribing for youth. This was due to declines in all types of depression treatment, not just the intended changes in antidepressant prescribing patterns. Little is known about how these patterns varied by race/ethnicity. Method Data are Medicaid claims from four U.S. states (2002–2009) for youth ages 5–17. Interrupted time series analyses measured changes due to the warning in levels and trends, by race/ethnicity, of three outcomes: antidepressant prescription fills, depression treatment visits, and incident fluoxetine prescription fills. Results Prewarning, antidepressant fills were increasing across all racial/ethnic groups, fastest for White youth. Postwarning, there was an immediate drop and continued decline in the rate of fills among White youth, more than double the decline in the rate among Black and Latino youth. Prewarning, depression treatment visits were increasing for White and Latino youth. Postwarning, depression treatment stabilized among Latinos, but declined among White youth. Prewarning, incident fluoxetine fills were increasing for all groups. Postwarning, immediate increases and increasing trends of fluoxetine fills were identified for all groups. Conclusions Antidepressant prescription fills declined most postwarning for White youth, suggesting that risk information may have diffused less rapidly to prescribers or caregivers of minorities. Decreases in depression treatment visits help to explain the declines in antidepressant prescribing and were largest for White youth. An increase in incident fluoxetine fills, the only medication indicated for pediatric depression at the time, suggests that the warning may have shifted prescribing practices.

The Internet’s permeation into daily life has profoundly changed the practice of psychiatry with adolescents, who mobilize online social media and related technologies in their efforts to develop identity and “hang out” with peers. Technology offers both challenges and opportunities to mental health professionals working with teens. Practitioners will need a new skill-set, including keeping abreast of technological developments; professionally incorporating technology into clinical assessment and practice; identifying the negative impacts of technology on teens’ physical and mental health and the particular vulnerabilities of at-risk patients in a digital world; and guiding patients and parents about interventions. Particular patient factors related to race/ethnicity, gender and sexual orientation, mental health and trauma history, family culture, parenting style, and personality traits will need to be considered. This article provides an overview of the literature on adolescents and the Internet focusing on recent research on Internet and digital technologies used for social communication among youth.

Youth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many \"in-person\" coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use. This is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population. The participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple's daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores. A total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization. Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU.

Objective: The objective of this study was to explore the acceptability and feasibility of a therapeutic assessment protocol for the Screening and Support of Youth (SASY). SASY provides brief but comprehensive community-based screening and support for diverse youth in the community. Methods: SASY screening evaluates symptoms, functioning and clinical risk. The Kiddie Computerized Adaptive Test was used to evaluate seven different diagnoses and symptom severity. The Weiss Functional Impairment Rating Scale-Self was used to measure functional impairment. Measures were scored according to nationally developed norms. An algorithm was developed to aggregate symptom and function ratings into an overall score for clinical risk. The results are discussed with participants in a motivational interview designed to promote insight, followed by the opportunity for the participant to engage in an online intervention. Protocol changes necessitated by social distancing during the pandemic led to innovative methods including the use of a QR code for recruitment, integration of both online and offline participation, and expansion from in-person recruitment within the schools to virtual engagement with youth throughout the community. The final sample included disproportionately more Black or African American and Hispanic youth as compared to school and community statistics, suggesting that optimization of online and offline methods in research may facilitate the recruitment of diverse populations. Qualitative interviews indicated that the screening and feedback raised youth awareness of their wellbeing and/or distress, its impact on their functioning, and engagement with options for improved wellbeing. Conclusions: The emergence of innovative methods optimizing the advantages of both online and offline methods, developed as a necessity during the pandemic, proved advantageous to the feasibility and acceptability of community-based recruitment of at-risk, minoritized youth.

Problematic Internet use (PIU) preferentially affects youth development, particularly youth with psychiatric conditions. Studies attempting to understand PIU and its impact on adolescent mental health have been limited by cross-sectional design and self-report data. Even with a small sample size, digital phenotyping (DP) methodology can address these limitations through repeated sampling and collection of survey and sensor data through personal smartphones. This study pilots a 6-week DP protocol in 28 youth in mental health treatment in order to assess relationships between PIU, mood symptoms, and daily behaviors like smartphone engagement and daily travel in this high-risk population. Our results found shared associations between depression and PIU, where symptom severity of both worsened in the setting of decreased smartphone engagement. These clinically relevant findings indicate that, rather than uniformly worsening mental health, increased digital engagement may actually provide short-term relief from negative affect in youth with psychiatric comorbidities.

Conservation easements, a valuable tool in the conservationist's toolbox, have grown increasingly popular since the 1980s, when Congress introduced changes to the federal tax code making easement donations more financially attractive. And with deductions reaching hundreds of thousands, or even millions, of dollars, conservation easement deductions are big business. However, expanded incentives and loosened regulations invite abuse, especially when the tax implications are large and donated easements are hard to value. Valuation of real estate remains an inexact science, dependent on inconsistent appraisal methods and subjectivity. Conservation easements can be even more difficult to value than other easements because, by their very nature, they are often placed on a parcel of land with high idiosyncratic value. Thus, easement valuations can vary wildly and justifying a high valuation is not difficult. It should come as no surprise, then, that the Internal Revenue Service (IRS) has examined conservation easement valuations more closely in recent years. Taxpayers risk large fines while the IRS struggles to effectively identify and curb abuse. Both sides would benefit from greater predictability, and as the IRS continues its aggressive litigation, a solution is sorely needed. This Note examines in Part I conservation easements and valuation methods for federal conservation easement deductions. Part II explores recent challenges to taxpayer application of these methods and the problems with the current valuation system revealed by those cases. Finally, Part III first reviews recent proposed reforms to conservation easement deduction valuation as well as their shortfalls, and then introduces a recommendation that would simplify the valuation process as well as promote greater use of conservation easements.

This qualitative dissertation examined the challenges faced by high school religion teachers in Catholic education through interviews with 16 teachers from nine U.S. dioceses. The dissertation explored four key tensions the literature indicates have emerged in Catholic education since the Second Vatican Council: (1) balancing catechetical and academic approaches, (2) navigating the dual role of educator and minister, (3) reconciling prescribed curricula with diverse student needs, and (4) addressing training disparities and their impact on teacher morale.Beyond these tensions, teachers identified additional challenges absent from the literature. First, they noted that nurturing authentic faith is difficult when students fear judgment, display apathy, or adopt a transactional view of education. Some of these factors particularly hinder faith development among non-Catholic and non-religious students, participants noted. Second, expectations for religion classes are not always consistent among teachers, students, parents, and school and Church leaders. Third, teachers stressed that the classroom environment is as crucial as the course content, and they noted that they often strive to foster open discussions of faith in classes. Finally, teachers prioritize personal development over indoctrination, aiming to form good people rather than simply produce more Catholics.Participants indicated they employed various strategies to navigate the challenges they faced, from adapting instructional approaches to delivering engaging instructional content and supplementing training through independent study, mentorship, or concrete experiences. The findings underscore the adaptability of the 16 religion teachers who participated in the study and suggest areas for further research, including school leadership's perceptions of religious education, a teacher-informed review of The United States Council of Catholic Bishop's (USCCB's) Doctrinal Elements of Curriculum Framework, and student perspectives on religion courses. Strengthening collaboration among educators, administrators, and students could enhance the role of religious education in Catholic schools.

This paper is a collection of three articles on the topic of trust in online professional recommendations. Online professional recommendations are a prominent feature of Online Professional Networks (OPNs), which are used heavily by recruiters to find candidates to fill open positions. These recommendations are meant to validate the credibility of the user’s profile by offering first-hand accounts from other users who can provide their experience working with the user. However, these recommendations tend to be overly positive, full of superlatives, and lacking in any information regarding areas where the user needs to improve. Because of the functionality inherent to OPNs, users can choose which recommendations to make visible to the network and then hide any that they do not like. This amount of control afforded to the user creates credibility issues as recruiters are disposed to question the accuracy of the content. This unique feature of online recommendations makes them inherently different from traditional letters of recommendations, which have been studied in the past. In these articles, we first examine how the use of superlatives and the inclusion of information regarding a user’s weakness can affect the perceived trustworthiness of the recommender, and how that, in turn, affects the effectiveness and usefulness of the recommendation. In the second article, we examine how factors such as gender, gender stereotypes, and physical attractiveness may provide boundary conditions on the effects observed in the first study. The last article focuses on reinforcing the proposition that online and traditional recommendations are inherently different, confirming the need for future research to further study online recommendations and their impact on decision making in employment scenarios. Collectively, these articles introduce online professional recommendations to the field of academia and provide a foundation for future research upon which to build.