Michelle M Perfect

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• Elrokshsi, S., Bluez, G. P., Chin, C., Wheeler, M. D., Silva Torres, G. E., & Perfect, M. M. (2020). Differences in Sleep Architecture According to Body Mass Index in Children with Type 1 Diabetes. Diabetes.
• Perfect, M. M. (2014). The Relations of Sleep and Quality of Life to School Performance in Youth With Type 1 Diabetes. Journal of Applied School Psychology, 30(1), 7-28.
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  Abstract: This study examined parent and youth self-reports to test the hypothesis that perceived insufficient sleep duration, inconsistent sleep habits, reduced quality of life, less frequent blood glucose monitoring, and higher hemoglobin A1c would predict poorer school functioning among 50 youth with type 1 diabetes. The data suggested that a delay in bedtime on non-school nights compared with school nights was consistently related to lower grade point averages and lower reading, math, and writing test scores. Sleep duration on school nights related to writing performance and absences. Perceived disease burden predicted grade point averages and absences. These findings support the need for school psychologists to target sleep problems and quality of life in youth with diabetes as a way to help improve their school performance. © 2014 Copyright Taylor and Francis Group, LLC.
• Perfect, M. M., Levine-Donnerstein, D., Archbold, K., Goodwin, J. L., & Quan, S. F. (2014). The contribution of sleep problems to academic and psychosocial functioning. Psychology in the Schools, 51(3), 273-295.
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  Abstract: The current study examined the concurrent and longitudinal relations among sleep problems with academic and psychosocial functioning in a prospective cohort study, the Tucson Children's Assessment of Sleep Apnea study (TuCASA). Children were assessed between the ages of 6 and 11 years and again approximately 5 years later. Sleep disordered breathing was assessed via polysomnography and sleep duration, sleep consistency, excessive daytime sleepiness (EDS), and insomnia symptoms were evaluated via parental and self-report. Although regression models for sleep problems yielded minimum effect sizes in predicting standardized achievement scores, they jointly related to lower parent-reported grades and adolescent-reported school problems. Additionally, hierarchical multiple regression revealed that sleep parameters significantly predicted measures of psychosocial functioning with medium (Behavior Assessment Scales [BASC-2] Parent Report Form [PRF]-Behavioral Symptoms Index, Internalizing Behaviors Composite; Self-Report of Personality [SRP] Emotional Symptoms Index, Internalizing Behaviors, Personal Adjustment Composite) to small-medium effect sizes (BASC-2 PRF Externalizing Problems, Adaptive Skills Composites, BASC-2 SRP Inattention/Hyperactivity Composite) above and beyond sociodemographics and IQ. Similar findings occurred for BASC-2 subscales. Parent-reported current EDS and youth-reported insomnia symptoms were the most consistent contributors. School psychologists should screen for and treat or make referrals for sleep problems, taking into account chronicity and multiple informants' perspectives, to maximize academic intervention benefits. Copyright © 2014 Wiley Periodicals, Inc.
• Perfect, M. M., Archbold, K., Goodwin, J. L., Levine-Donnerstein, D., & Quan, S. F. (2013). Risk of behavioral and adaptive functioning difficulties in youth with previous and current sleep disordered breathing. Sleep, 36(4), 517-525B.
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  To examine the rates of behavioral and adaptive functioning difficulties among youth who never had sleep disordered breathing (SDB), had remitted SDB, had incident SDB, or had persistent SDB; and to determine if there were increased odds of behavioral difficulties among youth with varying SDB histories relative to those who never had SDB.
• Dix, T., Meunier, L. N., Lusk, K., & Perfect, M. M. (2012). Mothers' depressive symptoms and children's facial emotions: Examining the depression-inhibition hypothesis. Development and Psychopathology, 24(1), 195-210.
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  PMID: 22293004;Abstract: Vibrant expression of emotion is the principal means infants and young children use to elicit appropriate and timely caregiving, stimulation, and support. This study examined the depression-inhibition hypothesis: that declines in mothers' support as their depressive symptoms increase inhibit children's emotional communication. Ninety-four mothers and their 14- to 27-month-olds interacted in a university playroom. Based on microanalytic coding of discrete facial displays, results supported three components of the hypothesis. (a) As mothers' depressive symptoms increased, children displayed less facial emotion (more flat affect, less joy, less sadness, less negative). (b) Mothers' low emotional and behavioral support predicted children's low facial communication and mediated relations between mothers' depressive symptoms and children's infrequent emotion. (c) Children who were passive with mothers behaviorally expressed emotion infrequently. Children's passivity mediated relations between mothers' depressive symptoms and children's infrequent emotion displays. Contrary to modeling and contagion theories, mothers' facial displays did not mediate relations between their depressive symptoms and children's facial displays. Nor were the outcomes children experienced regulating their facial displays. Rather, findings suggest that, even when depressive symptoms are modest, young children inhibit emotion as mothers' depressive symptoms increase to withdraw from unresponsive mothers, which may adversely affect children's subsequent relationships and competencies. © Copyright Cambridge University Press 2012.
• Elkins, G. R., Fisher, W. I., Johnson, A. K., Kendrick, C., Koep, L., Bunn, J., & Perfect, M. (2012). Initial development of a brief measure of psychological distress1. Psychological Reports, 110(1), 218-226.
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  PMID: 22489387;Abstract: This paper addresses the preliminary development, construct validity, and psychometric properties of a brief self-report measure of psychological distress. 40 items were originally generated by doctoral level psychologists for use in the preliminary clinical sample. Inpatients from a psychiatric unit (N = 125) completed the items, and a principal-components analysis with a direct oblimin rotation was used to evaluate construct validity. The study indicated a four-factor solution, using the constructs of Depression, Hopelessness, Anxiety, and Anger, with good estimates of reliability. After evaluation of factor structure, item analyses, and reliability estimates, a redacted 19-item scale was identified. © Psychological Reports 2012.
• Perfect, M. M., & Jaramillo, E. (2012). Relations between resiliency, diabetes-related quality of life, and disease markers to school-related outcomes in adolescents with diabetes. School psychology quarterly : the official journal of the Division of School Psychology, American Psychological Association, 27(1), 29-40.
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  The current study examined the role that resiliency and diabetes quality of life play in school functioning and glucose control among adolescents with diabetes. Participants included 45 adolescents with diabetes who participated in a larger study evaluating the feasibility of a model of mental health screening, assessment, and referral/service coordination. We hypothesized that aspects of resiliency (e.g., self-mastery, optimism, interpersonal relations, emotional control) would be related to self-reported grades and glucose control Hemoglobin A1c (HbA1c). We also hypothesized that the relation between resiliency and HbA1c would be mediated by blood glucose monitoring. We found that self-mastery (i.e., the perception that one has the ability to overcome challenges and solve problems) predicted self-reported school grades. Fewer diabetes-related worries and parental reports of less school-related problems (e.g., absences, problems with teacher) also predicted better grades. Females and youth with less disruptive behaviors and higher levels of self-mastery were less likely to be viewed by parents as having problems in school. Self-mastery, in addition to later age of onset and more frequent blood glucose monitoring, predicted lower HbA1c. The mediational model could not be tested because the same components of resiliency that related to blood glucose monitoring did not relate to HbA1c. This study suggests that evaluation of positive attributes of adolescents, particularly the self-mastery component of resiliency, and consideration to the adolescents' perceptions of how diabetes affects their lives, may assist in understanding how these adolescents perform in school and manage their diabetes.
• Perfect, M. M., Patel, P. G., Scott, R. E., Wheeler, M. D., Patel, C., Griffin, K., Sorensen, S. T., Goodwin, J. L., & Quan, S. F. (2012). Sleep, glucose, and daytime functioning in youth with type 1 diabetes. Sleep, 35(1), 81-8.
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  STUDY HYPOTHESES: 1) Youth with evidence of SDB (total apnea-hypopnea index [Total-AHI] ≥ 1.5) would have significantly worse glucose control than those without SDB; 2) Elevated self-reported sleepiness in youth with T1DM would be related to compromised psychosocial functioning; and 3) Youth with T1DM would have significantly less slow wave sleep (SWS) than controls.
• Perfect, M. M., Patel, P. G., Scott, R. E., Wheeler, M. D., Patel, C., Griffin, K., Sorensen, S. T., Goodwin, J. L., & Quan, S. F. (2012). Sleep, glucose, and daytime functioning in youth with type 1 diabetes. Sleep, 35(1), 81-88.
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  PMID: 22215921;PMCID: PMC3242691;Abstract: Study Hypotheses: 1) Youth with evidence of SDB (total apnea-hypopnea index [Total-AHI] ≥ 1.5) would have significantly worse glucose control than those without SDB; 2) Elevated self-reported sleepiness in youth with T1DM would be related to compromised psychosocial functioning; and 3) Youth with T1DM would have significantly less slow wave sleep (SWS) than controls. Design: The study utilized home-based polysomnography, actigraphy, and questionnaires to assess sleep, and continuous glucose monitors and hemoglobin A1C (HbA1C) values to assess glucose control in youth with T1DM. We compared sleep of youth with T1DM to sleep of a matched control sample. Setting: Diabetic participants were recruited in a pediatric endocrinology clinic. Participants: Participants were youth (10 through 16 years) with T1DM. Controls, matched for sex, age, and BMI percentile, were from the Tucson Children's Assessment of Sleep Apnea study. Results: Participants with a Total-AHI ≥ 1.5 had higher glucose levels. Sleepiness and/or poor sleep habits correlated with reduced quality of life, depressed mood, lower grades, and lower state standardized reading scores. Diabetic youth spent more time (%) in stage N2 and less time in stage N3. Findings related to sleep architecture included associations between reduced SWS and higher HbA1C, worse quality of life, and sleepiness. More time (%) spent in stage N2 related to higher glucose levels/hyperglycemia, behavioral difficulties, reduced quality of life, lower grades, depression, sleep-wake behavior problems, poor sleep quality, sleepiness, and lower state standardized math scores. Conclusions: Sleep should be routinely assessed as part of diabetes management in youth with T1DM.
• Thomson, C. A., Morrow, K. L., Flatt, S. W., Wertheim, B. C., Perfect, M. M., Ravia, J. J., Sherwood, N. E., Karanja, N., & Rock, C. L. (2012). Relationship between sleep quality and quantity and weight loss in women participating in a weight-loss intervention trial. Obesity (Silver Spring, Md.), 20(7), 1419-25.
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  Evidence suggests that individuals who report fewer total hours of sleep are more likely to be overweight or obese. Few studies have prospectively evaluated weight-loss success in relation to reported sleep quality and quantity. This analysis sought to determine the association between sleep characteristics and weight loss in overweight or obese women enrolled in a randomized clinical trial of a weight-loss program. We hypothesized that in overweight/obese women, significant weight loss would be demonstrated more frequently in women who report a better Pittsburgh Sleep Quality Index (PSQI) Global Score or sleep >7 h/night as compared to women who report a worse PSQI score or sleep ≤7 h/night. Women of ages 45.5 ± 10.4 (mean ± SD) years and BMI of 33.9 ± 3.3 (n = 245) were randomized and completed PSQI at baseline and 6 months; 198 had weight change assessed through 24 months. At baseline, 52.7% reported PSQI scores above the clinical cutoff of 5. Better subjective sleep quality increased the likelihood of weight-loss success by 33% (relative risk (RR), 0.67; 95% confidence interval (CI), 0.52-0.86), as did sleeping >7 h/night. A worse Global Score at 6 months was associated with a 28% lower likelihood of continued successful weight loss at 18 months, but unassociated by 24 months. These results suggest that sleep quality and quantity may contribute to weight loss in intervention-based studies designed to promote weight control in overweight/obese adult women.
• Elkins, G., Fisher, W., Johnson, A., Marcus, J., Dove, J., Perfect, M., & Keith, T. (2011). Moderating effect of hypnoti zability on hypnosis for hot flashes in breast cancer survivors. Contemporary Hypnosis and Integrative Therapy, 28(3), 187-195.
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  Abstract: The objective of this study was to examine the potential role of hypnotizability as a moderator of effectiveness of a hypnosis intervention for reducing hot flashes in breast cancer survivors. Sixty women were randomized into either five weekly sessions of hypnosis or a wait list control condition. Nine of the participants dropped out of the study and 24 were randomized to the control condition. There were 27 participants who completed the hypnosis intervention and for whom hypnotizability was assessed. The frequency and severity of hot flashes were measured by daily diaries completed for one week at baseline and at the end of treatment. Hypnotizability was assessed by the Stanford Hypnotic Clinical Scale. Hot flash scores were reduced by 68% on average at the end of treatment. Sequential multiple regression was used to test whether hypnotizability moderated the effect of initial hot flash scores on post-test hot flash scores. The results suggest that the hypnosis intervention was more effective for participa nts who scored higher on measured hypnotizability. The moderating role of hypnotizability may be useful to consider in treatment of hot flashes with the hypnosis intervention. While this study was limited to breast cancer survivors it may clarify some of the complexity of the response to hypnosis. © 2011 British Society of Clinical and Academic Hypnosis.
• Perfect, M. M., & Morris, R. J. (2011). Delivering school-based mental health services by school psychologists: Education, training, and ethical issues. Psychology in the Schools, 48(10), 1049-1063.
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  Abstract: Consistent with the priority goals of the 2002 Future of School Psychology Conference, the National Association of School Psychologists' Blueprint for Training and Practice III advocates for school psychologists becoming "leading mental health experts in schools." In this regard, the present article reviews the prevalence and incidence of children's mental health problems in the schools, followed by a historical overview of the nature of school-based mental health services. We discuss education and training issues and related ethical and professional practice issues that focus on the ethics codes of the National Association of School Psychologists and the American Psychological Association that are associated with the delivery of mental health services by school psychologists. Recommendations are offered for graduate-level coursework and field experiences in the delivery of school-based mental health services, as well as future directions for research in this area. © 2011 Wiley Periodicals, Inc.
• Perfect, M. M., Tharinger, D. J., Keith, T. Z., & Lyle-Lahroud, T. (2011). Relations between Minnesota multiphasic personality inventory - A scales and rorschach variables with the scope and severity of maltreatment among adolescents. Journal of Personality Assessment, 93(6), 582-591.
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  PMID: 21999381;Abstract: This study examined preexisting Rorschach (Exner, 2001) and Minnesota Multiphasic Personality Inventory-A (MMPI-A; Butcher et al., 1992) profiles to determine if selected MMPI-A scales and Rorschach variables would jointly associate with the number and severity of maltreatment subtypes (physical abuse, sexual abuse, neglect, and emotional maltreatment) of 157 adolescents (ages 14-17) with documented maltreatment histories. The Maltreatment Classification System was used to systematically code the maltreatment attributes. Six Rorschach variables (MOR, PER, Afr, SumY, SumC', Human Content) were significantly correlated with the number of maltreatment subtypes, but none of the anticipated MMPI-A scales were related. MMPI-A Scale 7 and Rorschach variables Ego, MOR, and PER were jointly associated with physical abuse severity. MMPI-A Scale 0 and Rorschach variables MOR, PER, SumY, SumC', PTI, Human Content, and Texture jointly associated with sexual abuse severity. This study supports the potential for certain MMPI-A scales and Rorschach variables to reflect the impact of adolescents' maltreatment experiences in terms of the number and severity of types of maltreatment experienced. Because both instruments captured different aspects of adolescents' maltreatment experiences, clinicians should consider using both when evaluating the impact of maltreatment on adolescents. Copyright © Taylor & Francis Group, LLC.
• Elkins, G., Cook, T., Dove, J., Markova, D., Marcus, J. D., Meyer, T., Rajab, M. H., & Perfect, M. (2010). Perceived Stress Among Nursing and Administration Staff Related to Accreditation. Clinical Nursing Research, 19(4), 376-386.
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  PMID: 20601637;PMCID: PMC3907189;Abstract: Background: Nurses in hospital administration and management positions may experience workplace stress, which can have important consequences on the health and well-being. Purpose: The aim of this study was to examine the effects of perceived stress on nursing hospital management and administrative employees of a large health care organization before and after a review by The Joint Commission on the Accreditation of Healthcare Organizations. Methods: A total of 100 hospital employees were randomly selected to complete questionnaires assessing their perception of stress and its effect on their well-being before and after the site review. They were also asked to rate their subjective experience of sleep, anxiety, depression, and job satisfaction. Results: Perceived stress was significantly related to employees' increased health concerns, symptoms of depression and anxiety, interpersonal relationships, and job satisfaction (p = .003). Conclusions: Hospital accreditation reviews may increase perceived stress and appears to be related to emotional and physical well-being. Application: The implications include evidence there is a need for organizations to initiate corrective action to help nurses in administrative roles to cope with increased levels of job strain, minimize potential psychological and physiological consequences, and preserve job satisfaction. © The Author(s) 2010.
• Elkins, G., Marcus, J., Bunn, J., Perfect, M., Palamara, L., Stearns, V., & Dove, J. (2010). Preferences for hypnotic imagery for hot-flash reduction: A brief communication. International Journal of Clinical and Experimental Hypnosis, 58(3), 345-349.
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  PMID: 20509073;Abstract: The purpose of this brief report is to identify imagery preferences of women receiving hypnotherapy to alleviate hot flashes. As part of a larger study, 51 breast cancer survivors were asked to identify their own personal preferences for imagery for reducing hot flashes. Most of the participants identified personal imagery associated with coolness; none of the participants selected imagery for warmth or heat. The most widely used was imagery involving water associated with coolness (27.0%). It is recommended that clinicians using hypnosis for reduction of hot flashes attend to patients' preferences as specific imagery may moderate the effectiveness of hypnosis for hot flashes. Copyright © International Journal of Clinical and Experimental Hypnosis.
• Perfect, M. M., & Elkins, G. R. (2010). Cognitive-behavioral therapy and hypnotic relaxation to treat sleep problems in an adolescent with diabetes. Journal of Clinical Psychology, 66(11), 1205-1215.
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  PMID: 20865769;PMCID: PMC3907182;Abstract: Inadequate sleep among adolescents frequently contributes to obesity and reduced academic performance, along with symptoms of anxiety, depression, fatigue, and attention deficits. The etiological bases of sleep quality has been associated with both stress and sleep habits. These problems tend to be especially important for adolescents with diabetes as the effects of poor sleep complicate health outcomes. This case example concerns a 14-year-old adolescent girl with a history of type I diabetes and stress-related sleep difficulties. Treatment included cognitive-behavioral methods and hypnotic relaxation therapy. Results of this case example and other controlled research suggest that hypnotic relaxation therapy is well accepted, results in good compliance, and serves as a useful adjunctive to cognitive-behavioral intervention for sleep problems. © 2010 Wiley Periodicals, Inc.
• Perfect, M. M., Elkins, G. R., Lyle-Lahroud, T., & Posey, J. R. (2010). Stress and quality of sleep among individuals diagnosed with diabetes. Stress and Health, 26(1), 61-74.
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  Abstract: Several studies have suggested that stress and sleep may be related to diabetic disease progression. Cortisol is one physiological indicator of stress that has been well validated in previous research. The primary objectives of the present study were (1) to examine the experiences of stress among patients diagnosed with diabetes and (2) to evaluate the quality of sleep among these participants. Participants (mean age = 34.99 years) were 20 adolescents and adults with Diabetes Mellitus; 13 had Type 1 and 17 were female. Primary measures included actigraphy, the Pittsburgh Sleep Quality Index (PSQI), salivary cortisol and the Perceived Stress Scale (PSS). Participants reported a moderate amount of stress (mean PSS scores = 20.2), slept an average of 6.51 h and exhibited at least one clinical indicator of sleep disturbance. Objectively measured total sleep time was associated with awakening cortisol (r = 0.62, p = 0.004) and PSQI Global scores (r = -0.51, p = 0.021). Awakening cortisol and PSS scores were not associated with PSQI Global scores, but were related to specifi c self-reported sleep disturbances. Given the interacting physiological pathways of stress and sleep, both of which were evident in this small sample, these variables warrant further study. Copyright © 2009 John Wiley & Sons, Ltd.
• Perfect, M. M., Levine-Donnerstein, D., Swartz, N. E., Wheeler, L. E., & Amaya, G. M. (2010). Adolescents with Diabetes and Their Parents' Perceptions of Mental Health Screening, Assessment, and Feedback. Administration and Policy in Mental Health and Mental Health Services Research, 1-12.
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  Abstract: This study examined adolescents with diabetes and their parents' reactions to mental health screenings, assessments, and feedback. Most parents and adolescents did not report negative affect, but 15- and 16-year olds and referred adolescents showed greater levels of concern with assessment outcomes. Among those referred to mental health services, parents anticipated barriers in costs, insurance, and lack of qualified providers. Adolescents reported scheduling conflicts, time, and confidentiality concerns. Respondents perceived feedback as an important component of the clinical process and findings indicated a need for clinicians to incorporate psychosocial screenings and feedback in healthcare visits for adolescents with diabetes. © 2010 Springer Science+Business Media, LLC.
• Elkins, G. R., Ruud, C., & Perfect, M. (2008). Biobehavioral management of hot flashes in a 48-year-old breast cancer survivor. Collaborative Medicine Case Studies: Evidence in Practice, 177-185.
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  Abstract: Hot flashes are among the most severe and frequent menopausal symptom experienced by postmenopausal women and breast cancer survivors. In fact, over 66% of healthy menopausal women and 78% of women treated for breast cancer experience hot flashes. Kronenberg et al. described a hot flash as a transient episode of flushing, sweating, and a sensation of heat, often accompanied by palpitations and a feeling of anxiety, and sometimes followed by chills. The onset of a hot flash is sometimes preceded by an aura, but it often manifests itself suddenly. The initial symptoms typically included a rise in heart rate and peripheral blood flow. The sensation of a wave of heat spreads over a person's body, especially the upper body, causing him or her to sweat. Although there is a sensation of heat, evaporation of sweat from the forehead and chest results in a drop in temperature in these areas. As a result, the flash is sometimes followed by a chilled feeling. Several studies have identified hot flashes as the most frequently reported physiological and psychological experiences associated with menopause. Hot flashes can be severe and interfere with daily activities. For example, in a study examining the symptoms associated with hot flashes among breast cancer survivors, 89 of 102 women reported having severe hot flashes. Some physical symptoms included weakness, feeling faint, rapid heartbeat, and itching sensations. Over one third (37%) noted that the hot flashes interfered with their routines and disrupted their sleep. Thirty-seven percent of the women indicated that these hot flashes interfered with their daily activities and disrupted sleep. Pansini et al. reported similar symptom presentation of hot flashes and also identified headaches, irritability, palpitations, and vertigo as common symptoms. © 2008 Springer New York.
• Elkins, G., Marcus, J., Stearns, V., Perfect, M., Rajab, M. H., Ruud, C., Palamara, L., & Keith, T. (2008). Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors. Journal of Clinical Oncology, 26(31), 5022-5026.
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  PMID: 18809612;PMCID: PMC2652097;Abstract: Purpose: Hot flashes are a significant problem for many breast cancer survivors. Hot flashes can cause discomfort, disrupted sleep, anxiety, and decreased quality of life. A well-tolerated and effective mind-body treatment for hot flashes would be of great value. On the basis of previous case studies, this study was developed to evaluate the effect of a hypnosis intervention for hot flashes. Patients and Methods: Sixty female breast cancer survivors with hot flashes were randomly assigned to receive hypnosis intervention (five weekly sessions) or no treatment. Eligible patients had to have a history of primary breast cancer without evidence of detectable disease and 14 or more weekly hot flashes for at least 1 month. The major outcome measure was a bivariate construct that represented hot flash frequency and hot flash score, which was analyzed by a classic sums and differences comparison. Secondary outcome measures were self-reports of interference of hot flashes on daily activities. Results: Fifty-one randomly assigned women completed the study. By the end of the treatment period, hot flash scores (frequency x average severity) decreased 68% from baseline to end point in the hypnosis arm (P < .001). Significant improvements in self-reported anxiety, depression, interference of hot flashes on daily activities, and sleep were observed for patients who received the hypnosis intervention (P < .005) in comparison to the no treatment control group. Conclusion: Hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as reduced anxiety and depression, and improved sleep. © 2008 by American Society of Clinical Oncology.
• Auslander, B. A., Perfect, M. M., Breitkopf, D. M., Succop, P. A., & Rosenthal, S. L. (2007). Microbicides: Information, beliefs, and preferences for insertion. Journal of Women's Health, 16(10), 1458-1467.
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  PMID: 18062761;Abstract: Objectives: Microbicides are products in development to prevent sexually transmitted infection and HIV acquisition; they are not yet available to the public. We evaluated (1) where women would expect to seek information about microbicides, (2) factors that women think might affect microbicide effectiveness, and (3) women's anticipated preferences for timing and place of insertion and partner involvement. Methods: A cross-sectional face-to-face interview was administered to women aged 18-35 years (n = 126) recruited from a gynecology clinic in Galveston, Texas. Women were shown a microbicide surrogate and asked to complete a series of closed-ended questions focusing on demographics, expected sources of information on microbicides, perceived factors related to effectiveness, and preferences for timing and place of insertion and level of partner involvement. Univariate descriptive analyses were used to calculate means, medians, and frequencies. Results: Women's most cited anticipated sources of information for microbicides were physicians (89%), the package insert/box (86%), and pharmacists (70%). Approximately two thirds of the women believed that menstruation or taking other medicines and approximately one third believed that taking a bath/shower before intercourse or after intercourse or using birth control medication could limit effectiveness. Women anticipated preferring to insert the microbicide before intercourse (90%) and while in the bathroom (73%). Most (95%) anticipated telling their partners they planned to use a microbicide, and 38% anticipated having their partner insert the product for them. Conclusions: Women's beliefs about those factors that could limit effectiveness of micro bicides should be addressed as part of anticipatory guidance or in the package inserts. Partners likely will be involved in the use of microbicides; thus, education/marketing efforts should also incorporate partner beliefs and preferences. © 2007 Mary Ann Liebert, Inc.
• Auslander, B. A., Perfect, M. M., Succop, P. A., & Rosenthal, S. L. (2007). Perceptions of Sexual Assertiveness among Adolescent Girls: Initiation, Refusal, and Use of Protective Behaviors. Journal of Pediatric and Adolescent Gynecology, 20(3), 157-162.
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  PMID: 17561183;PMCID: PMC2077839;Abstract: Study Objective: We describe adolescent girls' perceptions of sexual assertiveness and examine the relationship of these perceptions with developmental and interpersonal variables. Design: Cross-sectional analysis. Setting: Participants were recruited from a school-based health clinic and local colleges, and through snowballing to participate in a 6-month study examining microbicide acceptability. Participants: 106 sexually experienced girls (ages 14 through 21 years). Methods: Girls described their demographics, sexual history, and romantic relationships and completed the Sexual Assertiveness Scale for Women (SAS-W), which assesses perceptions of sexual assertiveness: Initiation of Sex, Refusal of Unwanted Sex, and Pregnancy-STD Prevention. Results: Girls perceived themselves as asserting themselves between 50% and 75% of the time with their current or most recent partner. The Initiation subscale was not related to the other two subscales. In final models, girls with a prior pregnancy perceived themselves as initiating sex more than girls without a prior pregnancy. Having a greater number of lifetime partners was related to perceptions of less refusal, whereas greater number of partners, being sexually experienced longer, and engaging in more unprotected sex were related to perceptions of less implementation of preventive methods. None of the relationship variables were related to scores on any subscale. Conclusions: Most of these girls perceived themselves as sexually assertive. Given that sexual experience, not relationship factors, were related to perceptions of sexual assertiveness, the design of counseling messages should incorporate sexual experience. These messages should find effective ways to help girls both to communicate their sexual desires and to enhance their ability to protect themselves. © 2007 North American Society for Pediatric and Adolescent Gynecology.
• Short, M. B., Perfect, M. M., Auslander, B. A., Devellis, R. F., & Rosenthal, S. L. (2007). Measurement of microbicide acceptability among U.S. adolescent girls. Sexually Transmitted Diseases, 34(6), 362-366.
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  PMID: 17038964;Abstract: BACKGROUND AND OBJECTIVE: Topical microbicides will only be effective if they are acceptable to potential users. The purpose of this study is to develop a scale to evaluate characteristics and aspects of topical microbicides that are important to adolescent girls. STUDY DESIGN: Girls (n = 207) completed a questionnaire on perceptions of microbicide-like products. RESULTS: A principal components factor analysis with a varimax rotation produced a 6-factor solution. The mean factor scores suggested that girls saw the products positively. Age was positively correlated with "comparison to condoms" and "comfort while using" factor scores and inversely correlated with "negative impact on interpersonal relationships" factor score. Sexually transmitted infection (STI) history was related to higher scores on the "health benefits" and "pleasure" factors. Age, race/ethnicity, and STI history were not related to the other factor scores. CONCLUSION: The current scale shows promise in assessment of microbicide acceptability, and in general, girls expressed positive views about microbicides. © Copyright 2007 American Sexually Transmitted Diseases Association.
• Elkins, G., White, J., Patel, P., Marcus, J., Perfect, M. M., & Montgomery, G. H. (2006). Hypnosis to manage anxiety and pain associated with colonoscopy for colorectal cancer screening: Case studies and possible benefits. International Journal of Clinical and Experimental Hypnosis, 54(4), 416-431.
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  PMID: 16950684;Abstract: This study explored using hypnosis for pain and anxiety management in 6 colonoscopy patients (5 men, 1 woman), who received a hypnotic induction and instruction in self-hypnosis on the day of their colonoscopy. Patients' levels of anxiety were obtained before and after the hypnotic induction using Visual Analogue Scales (VAS). Following colonoscopy, VASs were used to assess anxiety and pain during colonoscopy, perceived effectiveness of hypnosis, and patient satisfaction with medical care. Hypnotizability was assessed at a separate appointment. The authors also obtained data (time for procedure, number of vasovagal events, and recovery time) for 10 consecutive patients who received standard care. Results suggest that hypnosis appears to be a feasible method to manage anxiety and pain associated with colonoscopy, reduces the need for sedation, and may have other benefits such as reduced vasovagal events and recovery time. Copyright © International Journal of Clinical and Experimental Hypnosis.
• Zubowicz, E. A., Oakes, J. K., Short, M. B., Perfect, M. M., Succop, P. S., & Rosenthal, S. L. (2006). Adolescents' descriptions of the physical characteristics of microbicide surrogates and experiences of use. Journal of Women's Health, 15(8), 952-961.
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  PMID: 17087619;Abstract: Purpose: Our purpose was to describe adolescent girls' perceptions of microbicide surrogates and experiences of use, including impact on sexual pleasure. Methods: Sexually experienced girls, 14-21 years, were recruited for a study examining microbicide acceptability. The girls were given vaginal moisturizers (gel or suppository) to use as if they were microbicides. Girls (n = 175) discussed their perceptions and experiences of use of these products in response to semistructured interviews. Girls were asked at weekly phone interviews about the impact of product use on their and their partners' sexual pleasure. These answers were averaged, and girls were categorized into those for whom the product predominantely made sex feel worse, better less than half the time, or better half the time or more. The relationship of demographics and sexual history to the impact on pleasure was evaluated. Results: Overall, participants were positive about their experience with the products. More girls preferred the gel. Specific concerns about the suppository included the wait period, texture, and messiness of self-insertion. Many liked the lubricating quality of both of the surrogates. Girls discussed messiness, leakage, clumping, and the difficulties in communicating with partners. Over half reported an increase in pleasure most of the time for themselves and their partners. None of the demographic and sexual history predictors were significantly related to impact on pleasure. Conclusions: Anticipatory guidance should help girls initiate and sustain use. Future research should examine the best way to accomplish counseling about microbicide use with adolescent girls. © Mary Ann Liebert, Inc.
• Perfect, M. M., Bourne, N., Ebel, C., & Rosenthal, S. L. (2005). Use of complementary and alternative medicine for the treatment of genital herpes. Herpes, 12(2), 38-41.
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  PMID: 16209859;Abstract: Conventional antiviral drugs have proven effectiveness for genital herpes; however, patients continue to use a variety of complementary and alternative medicine (CAM) treatments. Given that patients may be using these products, it is important that healthcare providers become familiar with the data regarding safety and efficacy. We have reviewed available scientific data on six commonly used treatments (echinacea, eleuthero, L-lysine, zinc, bee products and aloe). In addition, information about a number of other products is presented in tabular form. Currently, there are insufficient clinical data to be confident of the efficacy and safety of any of these products for the treatment of genital herpes. It is hoped that future clinical trials will be conducted with sufficient rigour to provide guidance to the patients using these products.
• Stark, K. D., Perfect, M., Simpson, J., Schnoebelen, S., & Glenn, R. (2004). Encouraging academic careers: One of many desirable career options for doctoral school psychologists. School Psychology Quarterly, 19(4), 382-397.
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  Abstract: The training environment of a graduate program can impact students' decisions about pursuing an academic position. This article describes the training environment at The University of Texas at Austin. Results of a survey of current students and graduates who have pursued academic careers are presented. Outcomes of the survey suggest that students are attracted to academia because of the variety of job responsibilities. Students who choose applied practice do so because they want to work directly with children, adolescents, and families. Students who choose either career path do so because of the desirable aspects of that career rather than because they are trying to avoid the undesirable aspects of the other career. Implications for training doctoral students who are interested in academic positions are discussed.
• Perfect, M. M. (2001). Examining communicative behaviors in a 3-year-old boy who is blind. Journal of Visual Impairment and Blindness, 95(6), 353-365.
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  Abstract: The communication patterns of a 3-year-old boy who is blind were observed during 35 videotaped classroom sessions to determine if his echolalic responses varied according to school activity and message category. The observations revealed that although C. M. was expressive with adults, he had difficulty communicating with his peers and in producing spontaneous speech in general.

Proceedings Publications

• Roveda, J. M., Slepian, M. J., Perfect, M. M., Quan, S. F., & Rahman, F. (2017, Feb). Embedded systems in Medical devices and their integration with medical data, EMR and Big Data. In International Conference on Biomedical and Health Informatics (BHI).
• Graham, P. M., Goldstein, M., David, B. M., Perlis, M. L., Perfect, M. M., Frye, S., Killgore, W., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Longitudinal analysis of sleep duration using actigraphy and sleep diary: Stability and agreement over 8-11 months. In SLEEP.
• Granados, K., Rojo-Wissar, D. M., Chakravorty, S., Prather, A., Perfect, M. M., Frye, S., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Adverse childhood exposures associated with adult insomnia symptoms. In SLEEP.
• Roveda, J. M., Perfect, M. M., Quan, S. F., Roveda, J. M., Perfect, M. M., & Quan, S. F. (2016, April 3-6). Modeling and Simulation for pediatric sleep and education performance correlations. In Spring Simulation Multi-Conference.

Case Studies

• Perfect, M. M., & Elkins, G. R. (2010. Cognitive-behavioral therapy and hypnotic relaxation to treat sleep problems in an adolescent with diabetes(pp 1205-15).
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  Inadequate sleep among adolescents frequently contributes to obesity and reduced academic performance, along with symptoms of anxiety, depression, fatigue, and attention deficits. The etiological bases of sleep quality has been associated with both stress and sleep habits. These problems tend to be especially important for adolescents with diabetes as the effects of poor sleep complicate health outcomes. This case example concerns a 14-year-old adolescent girl with a history of type I diabetes and stress-related sleep difficulties. Treatment included cognitive-behavioral methods and hypnotic relaxation therapy. Results of this case example and other controlled research suggest that hypnotic relaxation therapy is well accepted, results in good compliance, and serves as a useful adjunctive to cognitive-behavioral intervention for sleep problems.

Others

• Perfect, M. M. (2014, Jul). Evidence for a school-based sleep health education program?. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.
• Perfect, M. M., Levine-Donnerstein, D., Swartz, N. E., Wheeler, L. E., & Amaya, G. M. (2011, May). Adolescents with diabetes and their parents' perceptions of mental health screening, assessment, and feedback. Administration and policy in mental health.
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  This study examined adolescents with diabetes and their parents' reactions to mental health screenings, assessments, and feedback. Most parents and adolescents did not report negative affect, but 15- and 16-year olds and referred adolescents showed greater levels of concern with assessment outcomes. Among those referred to mental health services, parents anticipated barriers in costs, insurance, and lack of qualified providers. Adolescents reported scheduling conflicts, time, and confidentiality concerns. Respondents perceived feedback as an important component of the clinical process and findings indicated a need for clinicians to incorporate psychosocial screenings and feedback in healthcare visits for adolescents with diabetes.