Overall survival from tebentafusp versus nivolumab plus ipilimumab in first-line metastatic uveal melanoma: a propensity score-weighted analysis.

BACKGROUND: Tebentafusp demonstrated a superior overall survival (OS) benefit [hazard ratio (HR) 0.51] compared to investigator's choice (82% pembrolizumab) in a randomized, phase III trial (IMCgp100-202; N = 378) in untreated metastatic uveal melanoma (mUM). The 1-year OS rates for tebentafusp and pembrolizumab were 73% and 59%, respectively. In the single-arm GEM1402 (N = 52), the 1-year OS rate for nivolumab plus ipilimumab (N+I) in mUM was 52%. Due to limitations in conducting randomized trials in mUM, we compared OS on tebentafusp or pembrolizumab (IMCgp100-202) to N+I (GEM1402) in untreated mUM using propensity scoring methods. PATIENTS AND METHODS: Analyses were adjusted using propensity score-based inverse probability of treatment weighting (IPTW), balancing age, sex, baseline lactate dehydrogenase (LDH), baseline alkaline phosphatase, disease location, Eastern Cooperative Oncology Group status, and time from primary diagnosis to metastasis. OS was assessed using IPT-weighted Kaplan-Meier and Cox proportional hazard models. Sensitivity analyses using alternative missing data and weights methods were conducted. RESULTS: The primary IPTW analysis included 240 of 252 patients randomized to tebentafusp from IMCgp100-202 and 45 of 52 N+I-treated patients from GEM-1402. Key baseline covariates, including LDH, were generally well balanced before weighting. The IPTW-adjusted OS favored tebentafusp, HR 0.52 [95% confidence interval (CI) 0.35-0.78]; 1-year OS was 73% for tebentafusp versus 50% for N+I. Sensitivity analyses showed consistent superior OS for tebentafusp with all IPTW HRs ≤0.61. IPTW analysis of pembrolizumab versus N+I showed no significant difference in OS (HR 0.72; 95% CI 0.50-1.06). CONCLUSIONS: Tebentafusp was previously shown to provide an OS benefit compared to checkpoint inhibitors or chemotherapy in untreated mUM. Propensity score analysis demonstrated a similar OS benefit for tebentafusp compared with N+I. These data further support tebentafusp as the standard of care in previously untreated human leukocyte antigen (HLA)-A∗02:01+ adult patients with mUM.

Cultural humility and racial microaggressions in cross-racial clinical supervision: A moderated mediation model.

Cultural humility is important in supervision; however, studies have primarily sampled White supervisees. Racially and ethnically minoritized trainees experience microaggressions during their training, yet cross-racial supervision is less often studied. We examined a moderated mediation model to test whether the supervisory working alliance mediated the relationship between frequency of racial microaggressions and satisfaction with supervision, and whether the impact of racial microaggressions on the supervisee and supervisor cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance. In a sample of supervisees of color (N = 102; majority cisgender women, 86.2%, and heterosexual, 59.8%; 35.3% Black/African American, 28.4% Asian/Pacific Islander, 18.6% Hispanic/Latine) receiving clinical supervision from White supervisors, we found that racial microaggression frequency was negatively associated with satisfaction with supervision, and this relationship was fully accounted for by the supervisory working alliance. Racial microaggressions in supervision were found to be detrimental to the supervisory working alliance, which was then related to lower satisfaction with supervision. Further, racial microaggression impact and cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance; this relationship was strongest when racial microaggression impact was high and cultural humility was average or high. The social bond hypothesis suggests we are more likely to allow ourselves to be vulnerable when we assess cultural humility to be high. We posit that the observed moderation effect may be due to supervisees experiencing greater shock when experiencing racial microaggressions from supervisors whom they perceived to be culturally humble. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Chromosome-level genome sequence of the Genetically Improved Farmed Tilapia (GIFT, Oreochromis niloticus) highlights regions of introgression with O. mossambicus.

BACKGROUND: The Nile tilapia (Oreochromis niloticus) is the third most important freshwater fish for aquaculture. Its success is directly linked to continuous breeding efforts focusing on production traits such as growth rate and weight. Among those elite strains, the Genetically Improved Farmed Tilapia (GIFT) programme initiated by WorldFish is now distributed worldwide. To accelerate the development of the GIFT strain through genomic selection, a high-quality reference genome is necessary. RESULTS: Using a combination of short (10X Genomics) and long read (PacBio HiFi, PacBio CLR) sequencing and a genetic map for the GIFT strain, we generated a chromosome level genome assembly for the GIFT. Using genomes of two closely related species (O. mossambicus, O. aureus), we characterised the extent of introgression between these species and O. niloticus that has occurred during the breeding process. Over 11 Mb of O. mossambicus genomic material could be identified within the GIFT genome, including genes associated with immunity but also with traits of interest such as growth rate. CONCLUSION: Because of the breeding history of elite strains, current reference genomes might not be the most suitable to support further studies into the GIFT strain. We generated a chromosome level assembly of the GIFT strain, characterising its mixed origins, and the potential contributions of introgressed regions to selected traits.

Multicultural Streaming in Group Psychotherapy Supervision: Orientation to and Preparation for Culturally Humble Practice.

How do psychotherapy supervisors most effectively integrate issues and concerns about multiculturalism and social justice (MSJ) into the supervisory experience? Concrete examples of how to best address this integration are needed, and this article provides one such example. The authors propose multicultural streaming as one approach to orient supervisees about, and prepare them for, incorporation of MSJ matters into group supervision and to foster their evolving sense of culturally humble practice. This article defines multicultural streaming, presents a plan for its implementation at the group's outset, and identifies implementation guideposts for consideration. A set of cultural humility guidelines adapted for group supervision is also proposed for group facilitation. This perspective is presented with the hope of generating further discussion about integrating MSJ issues into the group supervisory experience.

Psychosocial predictors of eating classification in female athletes: From collegiate sport to retirement.

OBJECTIVE: Due to high prevalence, female athletes are considered a high-risk group for eating disorders (i.e., clinical ED = 2.0% to 19.9%; subclinical ED = 7.1% to 49.2%). Cross-sectional and longitudinal research have identified psychosocial factors that influence current and future disordered eating (e.g., appearance pressures, body satisfaction), but are limited in design (e.g., timeframe, active competitors). Quantitative evaluations of psychosocial predictors of female athletes' disordered eating in retirement are lacking. METHOD: The current study investigated the predictive ability of psychosocial risk factors (e.g., body dissatisfaction, negative affect) from Time1, when collegiate female athletes were actively competing, to Time2, 6 years later when the women were retired (N = 194; Mage = 25.75 years [SD = 1.19]). RESULTS: From Time1 to Time2, 23.5% of the women who were Healthy moved to the Disordered classification; 51% remained in Disordered. The full model for athletes who maintained their Disordered status correctly classified 76% of the athletes. Dietary intent, pressure to exercise and change appearance, body satisfaction, and internalization significantly predicted athletes' maintenance as Disordered. DISCUSSION: Early intervention efforts that address appearance pressures, body image, and healthful eating when athletes are actively competing are vital to help alleviate future distress, particularly in retirement.

The Psychotherapy Supervisor as an Agent of Transformation: To Anchor and Educate, Facilitate and Emancipate.

OBJECTIVE: The objective of this review was to answer the question, What do supervisors actually do in promoting transformative change in the beginning therapist supervisee? New therapist trainees, lacking treatment skills and a sense of "therapist identity," are prone to experience self-doubt, feel anxious and demoralized, and think of themselves as impostors. Psychotherapy supervision can be helpful and encouraging to beginning therapists in their process of development. METHODS: Using Mälkki and Green's concepts of liminality, edge emotions, and boundary confusion as framework, the author examines the pivotal role of the supervisor in striving to create a transformative supervision space. RESULTS: The author identifies and elaborates on three transformative streams of supervisory action-to anchor and ground, to educate and facilitate, and to liberate and emancipate. The constituents of each action stream are also identified. CONCLUSIONS: Psychotherapy supervisors serve foremost as agents of transformation, their chief objective being to actuate and actualize a transformative process of therapist development. The crucial processes by which supervisors achieve that transformative objective reside in the three streams of supervisory action. Accordingly, psychotherapy supervision is best conceptualized as a transformative learning pedagogy.

Multicultural Orientation in Psychotherapy Supervision: Cultural Humility, Cultural Comfort, and Cultural Opportunities.

As a complement to multicultural competence, the multicultural orientation (MCO) perspective has been proposed as a pragmatic way to enhance cultural understandings about psychotherapeutic dynamics, processes, and outcomes. Consisting of three core components-cultural humility, cultural comfort, and cultural opportunities-the MCO is considered relevant for both individual and group treatment. However, the MCO perspective has yet to be specifically applied to psychotherapy supervision. Because supervision often provides multicultural oversight for individual and group psychotherapy services, considering the ramifications of MCO for psychotherapy supervision (MCO-S) is important. In this article, the implications of MCO-S are reviewed, with attention given to the impacts of cultural humility, cultural comfort, and cultural opportunities on the supervisor-supervisee relationship. Case examples are provided to illustrate the ways in which MCO can affect the psychotherapy supervision process and outcome. Supervision research possibilities are also proposed.

Creating and Elaborating the Cultural Third: A Doers-Doing with Perspective on Psychoanalytic Supervision.

Although recognized as highly crucial to supervision practice (e.g., Tummala-Narra, 2004), culture has been addressed minimally in the psychoanalytic supervision literature. Calls to remedy that limitation have been made and making culture matter has been identified as a most pressing need for psychoanalytic supervision. But how then do we as supervisors go about doing that? How might we better position culture in, and make culture central to, our psychoanalytic supervisory conceptualization and conduct? We subsequently take up those questions, expanding upon our earlier proposals about cultural humility and the Cultural Third (Watkins and Hook, 2016) by (a) proposing a tripartite multicultural perspective (i.e., cultural humility-cultural comfort-cultural opportunities) as supervision sine qua non; (b) using recognition theory as a way to better understand that very process of Third creation and elaboration; and (c) providing a rupture/repair case example that shows efforts to create and build the Cultural Third in supervision. The Cultural Third is conceptualized as a product of doers-doing with so as to culturally learn together through "not knowing".

The American Orthopaedic Association's Own the Bone® database: a national quality improvement project for the treatment of bone health in fragility fracture patients.

The American Orthopaedic Association initiated the Own the Bone (OTB) quality improvement program in 2009. Herein we show that the data collected through this program is similar to that collected in other large studies. Thus, the OTB registry functions as an externally valid cohort for studying fragility fracture patients. INTRODUCTION: The American Orthopedic Association initiated the Own the Bone (OTB) quality improvement program in 2009 to improve secondary prevention of fragility fractures. In this study, we present a summary of the data collected by the OTB program and compare it to data from other large fragility fracture registries with an aim to externally validate the OTB registry. METHODS: The OTB registry contained 35,038 unique cases of fragility fracture as of September, 2016. We report the demographics, presenting fracture characteristics, past fracture history, and bone mineral density (BMD) data and compare these to data from large fragility fracture studies across the world. RESULTS: Seventy-three percent of the patients in the OTB registry were female, Caucasian, and post-menopausal. In 54.4% of cases, patients had a hip fracture; spine fractures were the second most common fracture type occurring in 11.1% of patients. Thirty-four percent of the patients had a past history of fragility fracture, and the most common sites were the spine and hip. The average femoral neck T-score was - 2.06. When compared to other studies, the OTB database showed similar findings with regard to patient age, gender, race, BMI, BMD profile, prior fracture history, and family history of fragility fractures. CONCLUSION: OTB is the first and largest multi-center voluntary fragility fracture registry in the USA. The data collected through the OTB program is comparable to that collected in international studies. Thus, the OTB registry functions as an externally valid cohort for further studies assessing the clinical characteristics, interventions, and outcomes achieved in patients who present with a fragility fracture in the USA.

The Supervision Pyramid: A Commonalities-Based Synthesis of Intervention, Relationship, and Person/Personhood.

Adapting the therapeutic pyramid to the supervision of psychotherapy, the author presents and describes the supervision pyramid-a simple meta-model of the broad conceptual organizers of the supervisor's contribution to the experience and outcomes of supervision. The supervision pyramid consists of three commonalities: supervisor skills and interventions, the supervisory relationship, and the supervisor's person and personhood. Those three commonalities converge to stimulate supervisee learning and relearning and client improvement and symptom reduction. The implications of this meta-model for supervision conceptualization and conduct and for supervisor training are briefly described.

Genetic variations in GPSM3 associated with protection from rheumatoid arthritis affect its transcript abundance.

G protein signaling modulator 3 (GPSM3) is a regulator of G protein-coupled receptor signaling, with expression restricted to leukocytes and lymphoid organs. Previous genome-wide association studies have highlighted single-nucleotide polymorphisms (SNPs; rs204989 and rs204991) in a region upstream of the GPSM3 transcription start site as being inversely correlated to the prevalence of rheumatoid arthritis (RA)-this association is supported by the protection afforded to Gpsm3-deficient mice in models of inflammatory arthritis. Here, we assessed the functional consequences of these polymorphisms. We collected biospecimens from 50 volunteers with RA diagnoses, 50 RA-free volunteers matched to the aforementioned group and 100 unmatched healthy young volunteers. We genotyped these individuals for GPSM3 (rs204989, rs204991), CCL21 (rs2812378) and HLA gene region (rs6457620) polymorphisms, and found no significant differences in minor allele frequencies between the RA and disease-free cohorts. However, we identified that individuals homozygous for SNPs rs204989 and rs204991 had decreased GPSM3 transcript abundance relative to individuals homozygous for the major allele. In vitro promoter activity studies suggest that SNP rs204989 is the primary cause of this decrease in transcript levels. Knockdown of GPSM3 in THP-1 cells, a human monocytic cell line, was found to disrupt ex vivo migration to the chemokine MCP-1.

Supervisor Allegiance as a Critical Construct: A Brief Communication.

Allegiance, long regarded as a significant variable in psychotherapy and psychotherapy research, has been ignored in the psychotherapy supervision literature. It is our contention that allegiance is similarly significant for psychotherapy supervision. In this brief communication, we define supervisor allegiance, consider its impact on supervision outcome, and highlight its role in the contextual supervision relationship model (a trans-theoretical model of the supervisory relationship).

Cultural Humility in Psychotherapy Supervision.

As a core component of multicultural orientation, cultural humility can be considered an important attitude for clinical supervisees to adopt and practically implement. How can cultural humility be most meaningfully incorporated in supervision? In what ways can supervisors stimulate the development of a culturally humble attitude in our supervisees? We consider those questions in this paper and present a model for addressing cultural humility in clinical supervision. The primary focus is given to two areas: (a) modeling and teaching of cultural humility through interpersonal interactions in supervision, and (b) teaching cultural humility through outside activities and experiences. Two case studies illustrating the model are presented, and a research agenda for work in this area is outlined.

The alliance in reflective supervision: a commentary on Tomlin, Weatherston, and Pavkov's critical components of reflective supervision.

What are the critical components of reflective supervision? In this commentary, I offer a complementary perspective on A.M. Tomlin, D.J. Weatherston, and T. Pavkov's (2014) seminal study about that very question. I consider their findings within the context of what we now know about the supervisory alliance-a highly robust, heuristic, and eminently practical construct that appears to capture the spirit of reflection, collaboration, and regularity at its best. Matters of alliance theory, practice, and research are briefly addressed, and effort is made to consider the implications of the supervisory alliance as fundamental, foundational, and quintessentially organizational for reflective supervision practice.

Psychotherapy supervision developments and innovations for the new millennium: contributions from the cutting edge.

What are some of the most recent, cutting-edge developments and innovations in psychotherapy supervision? And what is their particular significance for supervision now and into its future? In this special supervision issue of the American Journal of Psychotherapy, those questions are considered, and some compelling answers are provided. In what follows, I introduce this special journal issue: (a) define supervision and indicate its purposes; (b) summarize the contents of each innovative paper; and (c) accentuate the significance of each presented development/innovation. The papers contained in this issue boldly speak to supervision's future and provide exciting--and highly profitable--directions to pursue in forever making psychotherapy supervision a far more anchored, accountable, and educational experience.

Clinical supervision in the 21st century: revisiting pressing needs and impressing possibilities.

What are some of the most pressing needs currently confronting clinical supervision? In this paper, I give attention to that question. Drawing on two 1990 reviews for comparative purposes, I examine where supervision is now relative to four areas: (a) supervision training and practice; (b) measurement; (c) difference and diversity; and (d) research. Lines of advance, pressing needs, and potential remedies are considered across each area. Effort is made to accentuate the "robustly international" nature of clinical supervision and its increasing globalization.

The supervisory alliance: a half century of theory, practice, and research in critical perspective.

Over the course of psychotherapy supervision history, the supervisor-supervisee alliance has increasingly emerged as a variable of preeminent importance in the conceptualization and conduct of the supervision experience: It has come to be embraced as the very heart and soul of supervision. But after a half century, what evidence do we actually have to justify that highly favorable outlook afforded to the alliance? What do we really know about the supervisory alliance? What do we need to know about it? As we mark the first 50 years of supervisory alliance and look toward its future, I thought it might be useful to examine those questions and provide a current status report about the construct itself In what follows, I (a) describe the two supervisory alliance visions that have been (and remain) dominant in the supervision literature and (b) provide a review of 20 plus years of supervision alliance research. While the supervisory alliance has accumulated solid clinical support, its empirical support appears to be more tentative and less robust. I consider why that is so, identify some missing elements in the alliance research conducted thus far and propose possible remedies to move inquiry in this area forward.

Being and becoming a psychotherapy supervisor: the crucial triad of learning difficulties.

More than 40 years ago eminent psychiatrist Richard Chessick penned a classic, highly prescient psychotherapy supervision paper (that appeared in this journal) in which he identified for supervisors the crucial triad of learning difficulties that tend to confront beginning therapists in their training. These are (a) dealing with the anxiety attendant to the development of psychological mindedness; (b) developing a psychotherapist identity; and (c) developing conviction about the meaningfulness of psychodynamics and psychotherapy. In this paper, I would like to revisit Chessick's seminal contribution about the teaching and learning of psychotherapy and extrapolate his triad of learning difficulties to the process of teaching and learning supervision. The process of being and becoming a psychotherapist has been likened to a developmental journey, and similarly being and becoming a supervisor is increasingly recognized as a developmental journey that is best stimulated by means of didactic and practical experiences (i.e., supervision coursework, seminars, or workshops and the supervision of supervision). In what follows, I would like to explore how Chessick's crucial triad of learning difficulties can be meaningfully extrapolated to and used to inform the supervision training situation. In extrapolating Chessick's triad, beginning supervisors or supervisor trainees can be conceptualized as confronting three critical issues: (a) dealing with the anxiety and demoralization attendant to the development of supervisory mindedness; (b) developing a supervisory identity; and (c) developing conviction about the meaningfulness of psychotherapy supervision. This triadic conceptualization appears to capture nicely core concerns that extend across the arc of the supervisor development process and provides a useful and usable way of thinking about supervisor training and informing it. Each component of the triadic conceptualization is described, and some supervisor education intervention possibilities are considered.

The beginnings of psychoanalytic supervision: the crucial role of Max Eitingon.

Psychoanalytic supervision is moving well into its 2nd century of theory, practice, and (to a limited extent) research. In this paper, I take a look at the pioneering first efforts to define psychoanalytic supervision and its importance to the psychoanalytic education process. Max Eitingon, the "almost forgotten man" of psychoanalysis, looms large in any such consideration. His writings or organizational reports were seemingly the first psychoanalytic published material to address the following supervision issues: rationale, screening, notes, responsibility, supervisee learning/personality issues, and the extent and length of supervision itself. Although Eitingon never wrote formally on supervision, his pioneering work in the area has continued to echo across the decades and can still be seen reflected in contemporary supervision practice. I also recognize the role of Karen Horney-one of the founders of the Berlin Institute and Poliklinik, friend of Eitingon, and active, vital participant in Eitingon's efforts-in contributing to and shaping the beginnings of psychoanalytic education.