Ocular Gene Therapy in a Patient with Dystrophic Epidermolysis Bullosa.

Dystrophic epidermolysis bullosa is a rare genetic disease caused by damaging variants in COL7A1, which encodes type VII collagen. Blistering and scarring of the ocular surface develop, potentially leading to blindness. Beremagene geperpavec (B-VEC) is a replication-deficient herpes simplex virus type 1-based gene therapy engineered to deliver functional human type VII collagen. Here, we report the case of a patient with cicatrizing conjunctivitis in both eyes caused by dystrophic epidermolysis bullosa who received ophthalmic administration of B-VEC, which was associated with improved visual acuity after surgery.

"It Will Always Feel Worse Because it Comes with That Added 'Betrayal'": Intersectionality Praxis and Black Young Women Survivors' Perspectives on Cultural Betrayal Trauma Theory.

Because of interlocking oppressions of racism and sexism (e.g. intersectionality), Black women's experiences of high rates of sexual violence are often ignored. A critical Black feminist framework, cultural betrayal trauma theory (CBTT) examines within-group violence in the Black community, which has compounding harm due to inequality. Though quantitative research has found support for CBTT, Black young women survivors' perspectives have not been examined. Therefore, the purpose of the current exploratory study was to engage in intersectionality praxis to qualitatively examine Black young women survivors' perspectives on CBTT through structured thematic analysis and coding based on theory. Respondents (N = 37; 18-30 years), provided their thoughts on CBTT following participating in a quantitative study. With most survivors in agreement that cultural betrayal in trauma is harmful, a key theme was community orientation in understanding both the harm and healing of cultural betrayal trauma. Black young women survivors' resonance with CBTT, as well as their recommendations for community-level solidarity and healing have important implications.

Nosocomial COVID-19: A Nationwide Spanish Study.

INTRODUCTION: SARS-CoV-2 is a highly contagious virus, and despite professionals' best efforts, nosocomial COVID-19 (NC) infections have been reported. This work aimed to describe differences in symptoms and outcomes between patients with NC and community-acquired COVID-19 (CAC) and to identify risk factors for severe outcomes among NC patients. METHODS: This is a nationwide, retrospective, multicenter, observational study that analyzed patients hospitalized with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from March 1, 2020, to April 30, 2021. NC was defined as patients admitted for non-COVID-19 diseases with a positive SARS-CoV-2 test on the fifth day of hospitalization or later. The primary outcome was 30-day in-hospital mortality (IHM). The secondary outcome was other COVID-19-related complications. A multivariable logistic regression analysis was performed. RESULTS: Of the 23,219 patients hospitalized with COVID-19, 1,104 (4.8%) were NC. Compared to CAC patients, NC patients were older (median 76 vs. 69 years; p < 0.001), had more comorbidities (median Charlson Comorbidity Index 5 vs. 3; p < 0.001), were less symptomatic (p < 0.001), and had normal chest X-rays more frequently (30.8% vs. 12.5%, p < 0.001). After adjusting for sex, age, dependence, COVID-19 wave, and comorbidities, NC was associated with lower risk of moderate/severe acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR]: 0.72; 95% confidence interval [CI]: 0.59-0.87; p < 0.001) and higher risk of acute heart failure (aOR: 1.40; 1.12-1.72; p = 0.003), sepsis (aOR: 1.73; 1.33-2.54; p < 0.001), and readmission (aOR: 1.35; 1.03-1.83; p = 0.028). NC was associated with a higher case fatality rate (39.1% vs. 19.2%) in all age groups. IHM was significantly higher among NC patients (aOR: 2.07; 1.81-2.68; p < 0.001). Risk factors for increased IHM in NC patients were age, moderate/severe dependence, malignancy, dyspnea, moderate/severe ARDS, multiple organ dysfunction syndrome, and shock; odynophagia was associated with lower IHM. CONCLUSIONS: NC is associated with greater mortality and complications compared to CAC. Hospital strategies to prevent NC must be strengthened.

Trust and betrayal in older adult financial exploitation.

OBJECTIVES: Although the knowledge base regarding the financial exploitation of older adults is expanding, work to understand the subpopulations of older adult financial exploitation victims and their experiences is greatly needed. This study uses betrayal trauma theory (BTT) as the foundation for conceptualizing the harm that arises from elder family financial exploitation. METHODS: The study uses a cross-sectional design to investigate group differences among a total sample of 95 community-dwelling older adults, 32 of the participants (33.7%) were older adult victims of family financial exploitation and the remaining 63 (66.3%) were victims of financial exploitation perpetrated by strangers. RESULTS: The group of older adults who were victims of elder family financial exploitation had significantly lower functional ability scores, higher stress and financial exploitation vulnerability scores and lost more money on average than those victimized by strangers. CONCLUSION: The present study provides support that BTT provides a valuable framework for understanding why older adult family financial exploitation victims are more vulnerable than victims of exploitation committed by strangers. Attention to this subgroup of financially exploited older adults will provide improved understanding of the unique challenges these victims face and inform prevention and intervention services.

It Hurts When You're Close: High Betrayal Sexual Trauma, Dissociation, and Suicidal Ideation in Young Adults.

Sexual trauma (e.g., rape), is associated with dissociation and suicidal ideation (SI). Sexual trauma is additionally harmful when perpetrated by a person(s) who is close or trusted (known as high betrayal). With young adulthood as a high-risk period for mental instability, the purpose of the current study is to examine the roles of high betrayal sexual trauma and dissociation in SI among young adults. Participants (N = 192) were college students who completed the 30-minute online survey. A multivariate analysis of variance (MANOVA) found that high betrayal sexual trauma was associated with dissociation and SI. Moreover, there was an indirect effect of high betrayal sexual trauma on SI through dissociation. Empirical implications include examining these associations longitudinally, with a focus on the impact of revictimization over time.

Trainee Perspectives on Relational Cultural Therapy and Cultural Competency in Supervision of Trauma Cases.

Supervision is a key part of training in clinical psychology. From my postdoctoral trainee perspective as a Black woman, I reflect on supervision in 1 of my predoctoral practicum at a community clinic where I worked with low-income women with trauma histories. With relational cultural therapy (e.g., Miller, 1976), my clinical supervision was in the feminist multicultural framework (Porter & Vasquez, 1997) and included the complexities of power in the supervisory relationship, openness, collaboration, and critical self-reflection (Arczynski & Morrow, 2017). Moreover, incorporating research perspectives (e.g., betrayal trauma theory, Freyd, 1996; cultural betrayal trauma theory, Gómez, 2018d; microaggressions, Sue, 2010) and cultural competency (Sue, 1978) created a rich learning environment. In this article, I detail 2 case studies to illustrate exchanges in supervision that positively impacted my professional development. In Case Study 1, my supervisor engendered identification of parallel processing through engaging in mutual empathy and relational reconnection regarding racial discrimination from a client. In Case Study 2, my supervisor used a collaborative approach in treatment planning for a Latina client who was in an abusive relationship. Based on these experiences, implications for supervisors include ongoing training in discrimination of diverse minorities and facilitating discussions in supervision about how trainees' and clients' respective societal statuses impact the therapeutic process (e.g., case conceptualizations, treatment planning). Implications for trainees include maintaining a processing journal, in which trainees reflect on their experiences including but not limited to cultural competency to be better prepared to discuss complex issues in supervision.

La supervisión es una parte clave de la formación en psicología clínica. Desde mi perspectiva de aprendiz postdoctoral como mujer negra, reflexiono sobre la supervisión en una de mis prácticas predoctorales en una clínica comunitaria donde trabajé con mujeres de bajos ingresos con antecedentes de trauma. Con la terapia cultural relacional (por ejemplo, Miller, 1976), mi supervisión clínica estaba en el marco multicultural feminista (Porter y Vásquez, 1997) e incluía las complejidades del poder en la relación de supervisión, apertura, colaboración y autorreflexión crítica (Arczynski & Morrow, 2017). Además, la incorporación de perspectivas de investigación (por ejemplo, la teoría del trauma de la traición, Freyd, 1996; la teoría del trauma de la traición cultural, Gómez, 2018c; las microagresiones, Sue, 2010) y la competencia cultural (Sue, 1978) crearon un rico ambiente de aprendizaje. En este manuscrito, detallo dos estudios de caso para ilustrar los intercambios en la supervisión que impactaron positivamente mi desarrollo profesional. En el Estudio de caso # 1, mi supervisor generó la identificación del procesamiento paralelo a través de la empatía mutua y la reconexión relacional con respecto a la discriminación racial de un cliente. En el Estudio de caso # 2, mi supervisor utilizó un enfoque colaborativo en la planificación del tratamiento para una cliente latina que estaba en una relación abusiva. En base a estas experiencias, las implicaciones para los supervisores incluyen capacitación continua en discriminación de minorías diversas y facilitar debates en supervisión sobre cómo los estados sociales respectivos de los alumnos y los clientes impactan el proceso terapéutico (por ejemplo, conceptualizaciones de casos; planificación del tratamiento). Las implicaciones para los alumnos incluyen mantener un diario de procesamiento, en el que los alumnos reflexionen sobre sus experiencias, incluidas, entre otras, la competencia cultural, para estar mejor preparados para debatir cuestiones complejas en la supervisión.

Understanding self-injury recovery: Views from individuals with lived experience.

OBJECTIVE: Nonsuicidal self-injury (NSSI) recovery has typically been conceptualized through the lens of formal frameworks or as the cessation of NSSI. These understandings, however, have been developed largely devoid of views from those with lived NSSI experience, who may offer novel and critical insights. To advance the conception of NSSI recovery, the current study elicited such views. METHODS: Two hundred and thirty-three emerging adults with a history of NSSI (77% female, mean age = 18.9 years), responded to open-ended questions regarding recovery. Results were thematically analyzed using an inductive approach. RESULTS: Responses yielded seven themes: (a) recovery is complete NSSI cessation; (b) recovery is more than cessation; (c) recovery involves lingering NSSI features; (d) recovery involves developing resilience; (e) recovery is a process; (f) evolution in understanding recovery; and (g) recovery is a subjective experience. CONCLUSION: Recovery seems to be multifarious, nonlinear, and subjective. Conceptual and clinical implications are discussed.

High Betrayal Adolescent Sexual Abuse and Nonsuicidal Self-Injury: The Role of Depersonalization in Emerging Adults.

Adolescent sexual abuse can interfere with healthy development. Sexual abuse that is perpetrated by close other(s)-high betrayal-can be additionally harmful, with sexual abuse being linked with dissociation and nonsuicidal self-injury (NSSI). Depersonalization, a dissociative subtype characterized by disconnection between oneself and one's body and/or thoughts, may further explain the role of dissociation in NSSI. The purpose of the current study was to: 1) isolate the impact of adolescent sexual abuse on NSSI; and 2) examine depersonalization as a pathway between high betrayal adolescent sexual abuse and NSSI. Participants (N = 192) were college students who completed online measures assessing sexual abuse, dissociation, and NSSI. While controlling for child sexual abuse and adult sexual abuse, adolescent sexual abuse predicted NSSI. Moreover, there was an indirect effect of high betrayal adolescent sexual abuse on NSSI through depersonalization, while controlling for child sexual abuse, adult sexual abuse, and medium betrayal (perpetrator: unclose other) adolescent sexual abuse. Findings from the current study have implications for relational cultural therapy as an evidence-informed treatment that highlights the relational harm of interpersonal trauma, while incorporating contextual elements, such as development of maladaptive coping strategies, into therapy.

High Betrayal Child Sexual Abuse and Hallucinations: A Test of an Indirect Effect of Dissociation.

Though hallucinations traditionally have been conceptualized as a central feature of psychosis, some hallucinations may be dissociative, with dissociation potentially contributing to hallucinations. Childhood trauma has been linked with dissociation and hallucinations. Betrayal trauma theory distinguishes abusive experiences based on closeness to the perpetrator. In the current study, we examined the indirect effect of dissociation on the relationship between high betrayal child sexual abuse (perpetrated by a close other) and hallucinations. Participants (N = 192) from a northwestern university in the United States completed self-report measures online assessing history of high betrayal child sexual abuse and current dissociation and hallucinations. Bootstrapping analyses indicated a significant indirect effect of high betrayal child sexual abuse on hallucinations through dissociation, 95% Confidence Interval (.16, .66). Through betrayal trauma theory, this study provides a non-pathologizing framework for understanding how dissociation and hallucinations may develop as natural reactions to the harm inherent in child sexual abuse perpetrated by a close other. These findings have clinical implications for relational models of healing for trauma survivors who are distressed by dissociation and hallucinations.

An intramembranous ossification model for the in silico analysis of bone tissue formation in tooth extraction sites.

The accurate modeling of biological processes allows us to predict the spatiotemporal behavior of living tissues by computer-aided (in silico) testing, a useful tool for the development of medical strategies, avoiding the expenses and potential ethical implications of in vivo experimentation. A model for bone healing in mouth would be useful for selecting proper surgical techniques in dental procedures. In this paper, the formulation and implementation of a model for Intramembranous Ossification is presented aiming to describe the complex process of bone tissue formation in tooth extraction sites. The model consists in a mathematical description of the mechanisms in which different types of cells interact, synthesize and degrade extracellular matrices under the influence of biochemical factors. Special attention is given to angiogenesis, oxygen-dependent effects and growth factor-induced apoptosis of fibroblasts. Furthermore, considering the depth-dependent vascularization of mandibular bone and its influence on bone healing, a functional description of the cell distribution on the severed periodontal ligament (PDL) is proposed. The developed model was implemented using the finite element method (FEM) and successfully validated by simulating an animal in vivo experiment on dogs reported in the literature. A good fit between model outcome and experimental data was obtained with a mean absolute error of 3.04%. The mathematical framework presented here may represent an important tool for the design of future in vitro and in vivo tests, as well as a precedent for future in silico studies on osseointegration and mechanobiology.

Shifting the focus: Nonpathologizing approaches to healing from betrayal trauma through an emphasis on relational care.

As the diagnosis and treatment of mental disorders has become increasingly medicalized (Conrad & Slodden, 2013), consideration for the relational nature of trauma has been minimized in the healing process. As psychiatrist R. D. Laing (1971) outlined in his essays, the medical model is an approach to pathology that seeks to find medical treatments for symptoms and syndromes based on categorized diagnoses. We argue that such a model implicitly locates the pathology of trauma within the individual instead of within the person(s) who perpetrated the harm or the social and societal contexts in which it took place. In this article, we argue that this framework is pathologizing insofar as it both prioritizes symptom reduction as the goal of treatment and minimizes the significance of relational harm. After providing a brief overview of betrayal trauma (Freyd, 1996) and the importance of relational processes in healing, we describe standard treatments for betrayal trauma that are grounded in the medical model. In discussing the limitations of this framework, we offer an alternative to the medicalization of trauma-related distress: relational cultural therapy (e.g., Miller & Stiver, 1997). Within this nonpathologizing framework, we highlight the importance of attending to contextual, societal, and cultural influences of trauma as well as how these influences might impact the therapeutic relationship. We then detail extratherapeutic options as additional nonpathologizing avenues for healing, as freedom to choose among a variety of options may be particularly liberating for people who have experienced trauma. Finally, we discuss the complex process of truly healing from betrayal trauma.

Collusion, torture, and inequality: Understanding the actions of the American Psychological Association as institutional betrayal.

The Hoffman Report (Hoffman et al., 2015) documented devastating information about the American Psychological Association (APA) and the profession of psychology in the United States, prompting a public apology and a formal commitment by APA to correct its mistakes (APA, 2015). In the current article, we utilize betrayal trauma theory (Freyd, 1997), including betrayal blindness (e.g., Freyd, 1996; Tang, 2015) and institutional betrayal (Smith & Freyd, 2014b), to understand and learn from APA's behaviors. We further situate this discussion in the context of inequality, both within APA and in American society generally. We detail how the impact of APA's institutional betrayals extended beyond the organization, its members, and the psychology profession, highlighting the potential for disproportionate harm to minorities, including those who were tortured; Muslims, Middle Easterners, Afghans, and non-Americans who were not tortured; and other minority individuals (Gómez, 2015d). Acknowledging, understanding, and addressing its institutional betrayals offers APA the opportunity to take meaningful corrective and preventive measures. We propose several institutional reparations, including making concrete changes with transparency and conducting self-assessments to inform further needed changes (Freyd & Birrell, 2013). By engaging in institutional courage, APA has the potential to grow into an ethical governing body that fulfills its mission to "advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives" (APA, 2016).

The relationship of psychological trauma and dissociative and posttraumatic stress disorders to nonsuicidal self-injury and suicidality: a review.

We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.

Self-injury and suicidality: the impact of trauma and dissociation.

In the growing research literature on nonsuicidal self-injury (NSSI) and suicidality (SA), there are many questions still unresolved about the role played by exposure to traumatic stressors (including but not limited to childhood maltreatment) and posttraumatic disorders (including dissociative features and disorders). In this special issue of the Journal of Trauma & Dissociation, a review article and 4 empirical studies attempt to provide additional insight into the relationship of traumatization and dissociation to NSSI and SA. The review article describes similarities and differences in the relationships that have been empirically documented between trauma exposure and posttraumatic stress or dissociative symptoms with NSSI versus SA and highlights the need for research to identify and test integrative clinical constructs, such as emotion dysregulation, in order to develop systematic risk, assessment, and intervention models. The empirical reports provide illustrative examples of conceptually and clinically integrated research on traumatic stress, dissociation, and NSSI and SA. Their findings offer a more nuanced picture of the potential role of different forms and degrees of dissociation in SA and NSSI and suggest that dissociation and emotion dysregulation may play a mediating role linking childhood maltreatment and adult or adolescent NSSI. In this introduction, we briefly summarize key points from the special issue articles and point out directions that their findings suggest for future research, including incorporating multiple predictors in studies of NSSI and SA, utilizing longitudinal studies to assess the etiology and course of NSSI and SA, and sampling diverse populations.

Quantifying Organic Cation Ratios in Metal Halide Perovskites: Insights from X-ray Photoelectron Spectroscopy and Nuclear Magnetic Resonance Spectroscopy.

The employment of metal halide perovskites (MHPs) in various optoelectronic applications requires the preparation of thin films whose composition plays a crucial role. Yet, the composition of the MHP films is rarely reported in the literature, partly because quantifying the actual organic cation composition cannot be done with conventional characterization methods. For MHPs, NMR has gained popularity, but for films, tedious processes like scratching several films are needed. Here, we use mechanochemical synthesis of MA1-x FA x PbI3 powders with various MA+: FA+ ratios and combine solid-state NMR spectroscopy (ssNMR) and X-ray photoelectron spectroscopy (XPS) to provide a reference characterization protocol for the organic cations' quantification in either powder form or films. Following this, we demonstrate that organic cation ratio quantification on thin films with ssNMR can be done without scraping the film and using significantly less mass than typically needed, that is, employing a single ∼800 nm-thick MA1-x FA x PbI3 film deposited by pulsed laser deposition (PLD) onto a 1 × 1 in.2, 0.2 mm-thick quartz substrate. While background signals from the quartz substrate appear in the 1H ssNMR spectra, the MA+ and FA+ signals are easily distinguishable and can be quantified. This study highlights the importance of calibrating and quantifying the source and the thin film organic cation ratio, as key for future optimization and scalability of physical vapor deposition processes.

Epistemic Oppression, Construct Validity, and Scientific Rigor: Commentary on Woo et al. (2022).

In this commentary, I highlight flaws in the article by Woo and colleagues (this issue) that undermine its credibility and utility as rigorous science that contributes to the field. I do so by discussing (a) the concept of epistemic oppression regarding the glaring exclusion of multiple germane bodies of research and (b) the importance of including construct validity within a psychometric article regarding the Graduate Record Examination (GRE). I conclude with a plea to the authors that the matter of anti-Black violence and murder, which they reference, is one to be taken respectfully, seriously, and somberly.

Diversity Wanted! Utilizing Transdisciplinary Scholarship on Structural Inequality to Educate Psychology Graduate Students.

Introduction: The scholarship of teaching and learning (SoTL) should promote diversity, equity, inclusion, and social justice for the next generation of psychologists. Statement of the Problem: I worry that the SoTL propagates an exclusionary field that becomes increasingly irrelevant in our diverse society given that graduate curricula largely exclude scholarship on structural inequality. Literature Review: I detail the process of graduate curricular changes in my current department, with a focus on my new required graduate course, Diversity, Systems, and Inequality. I utilize scholarship from law, sociology, philosophy, women and gender studies, education, and psychology. Teaching Implications: I provide the structure and content of the course-including syllabi and lecture slides-as well as modes of assessment that promote inclusivity and critical thinking. I detail how current faculty can learn to incorporate the content of this work into their own teaching and scholarship through weekly journal clubs. Conclusion: SoTL outlets can publish transdisciplinary, inclusive course materials regarding structural inequality, thus mainstreaming and amplifying such work for the benefit of the field and our world.

Violence victimization in Latina/o/x young adults: The multiplicative effects of cultural and high betrayal trauma.

Latinas/os/xs experience pervasive rates of interpersonal violence victimization while also experiencing frequent discrimination and societal trauma (e.g., hate crimes). Betrayal trauma theory and cultural betrayal trauma theory provide frameworks for examining the distinct harm of violence perpetrated by a close other and by a member of the same marginalized group(s), respectively. However, no known research has examined the concurrent impacts of both forms of betrayal among Latina/o/x young adults. The current study examined the unique and multiplicative effects of high betrayal trauma (i.e., violence perpetrated by a close other) and cultural betrayal trauma (i.e., violence perpetrated by someone of the same marginalized group(s)) on psychological and physical health symptoms in Latina/o/x young adults. Latina/o/x undergraduate students (N = 208) participated in a 60-minute online survey assessing violence victimization, psychological symptoms, and physical health. Rates of victimization (91.35%, n = 190) were high across differing forms of violence. Interactions of high betrayal trauma and cultural betrayal trauma were significant for psychological, physical, and anxiety symptoms. Although there were no significant simple effects, the pattern of results suggested that being assaulted by someone who shares one's Latina/o/x identity was more strongly associated with psychological and physical symptoms when participants had not been assaulted by someone with whom they were close. The current study highlights the importance of culturally competent therapy for Latina/o/x survivors that incorporates the interpersonal and cultural contexts of victimization.