Dermatology's role in the fight against human trafficking: A report from the AAD Ad Hoc Task Force and call to action.

While the majority of American Academy of Dermatology members have some broad awareness of human trafficking, most are not aware of it in their communities or of the skin signs that could prompt identification of those being exploited, and have requested educational resources to assist patients affected by trafficking. The American Academy of Dermatology Ad Hoc Task Force on Dermatologic Resources for the Intervention and Prevention of Human Trafficking has been working to develop relevant resources, including an online toolkit on the American Academy of Dermatology website: https://www.aad.org/member/clinical-quality/clinical-care/human-trafficking.

Autonomy, power, and place: Ethical considerations at the intersections of substance use care, and the sex trade.

Substance use disorder (SUD) care among women in the sex trade poses multiple ethical challenges. We propose a framework with three lenses-autonomy, power, and place-that can inform and help improve more ethical clinical care for people who trade sex seeking SUD treatment. A relational perspective on autonomy, an analysis of power relations in the clinic, and a geographical analysis can inform how we create space for people with experience in the sex trade in substance use treatment facilities and beyond. We conclude with some practical applications of this framework, all while integrating a composite clinical vignette throughout our analysis. This analysis addresses a clinical and ethical gap in ways to provide better care for women in the sex trade, an understudied and chronically marginalized population deserving of care that meets them where they are.

Technique for Cephalometric Analysis of the Craniofacial Skeleton Following Facial Feminization Surgery.

Facial feminization surgery (FFS) is characterized by a series of relatively diverse procedures aimed at aligning skeletal and soft tissue facial appearance with one's experienced feminine gender. Although there are several well-described outcomes from surgical techniques, there is no standardized methodology to provide reliable analyses of postoperative FFS outcomes. This paper describes the first reliable and reproducible technique to accurately and consistently measure post-FFS changes to guide surgical planning to optimize patient outcomes.

In Vitro Selection Implicates ROP1 as a Resistance Gene for an Experimental Therapeutic Benzoquinone Acyl Hydrazone in Toxoplasma gondii.

Toxoplasma gondii is a globally distributed apicomplexan parasite and the causative agent of toxoplasmosis in humans. While pharmaceuticals exist to combat acute infection, they can produce serious adverse reactions, demonstrating a need for enhanced therapies. KG8 is a benzoquinone acyl hydrazone chemotype identified from a previous chemical screen for which we previously showed in vitro and in vivo efficacy against T. gondii However, the genetic target and mechanism of action of KG8 remain unknown. To investigate potential targets, we generated resistant T. gondii lines by chemical mutagenesis followed by in vitro selection. Whole-genome sequencing of resistant clones revealed a P207S mutation in the gene encoding rhoptry organelle protein 1 (ROP1) in addition to two lesser resistance-conferring mutations in the genes for rhoptry organelle protein 8 (ROP8) and a putative ADP/ATP carrier protein (TGGT1_237700). Expressing ROP1P207S in parental parasites was sufficient to confer significant (10.3-fold increased half-maximal effective concentration [EC50]) KG8 resistance. After generating a library of mutants carrying hypermutated rop1 alleles followed by KG8 pressure, we sequenced the most resistant clonal isolate (>16.9-fold increased EC50) and found independent recapitulation of the P207S mutation, along with three additional mutations in the same region. We also demonstrate that a rop1 knockout strain is insensitive to KG8. These data implicate ROP1 as a putative resistance gene of KG8. This work further identifies a compound that can be used in future studies to better understand ROP1 function and highlights this novel chemotype as a potential scaffold for the development of improved T. gondii therapeutics.

Engaging Survivors of Human Trafficking: Complex Health Care Needs and Scarce Resources.

Human trafficking, also known as modern-day slavery, is an egregious human rights violation associated with wide-ranging medical and mental health consequences. Because of the extensive health problems related to trafficking, health care providers play a critical role in identifying survivors and engaging them in ongoing care. Although guidelines for recognizing affected patients and a framework for developing response protocols in health care settings have been described, survivors' ongoing engagement in health care services is very challenging. High rates of disengagement, lost contact, premature termination, and attrition are common outcomes. For interventions to be effective in this marginalized population, challenges in engaging survivors in long-term therapeutic primary and mental health care must be better understood and overcome. This article uses the socioecological model of public health to identify barriers to engagement; offers evidence- and practice-based recommendations for overcoming these barriers; and proposes an interdisciplinary call to action for developing more flexible, adaptable models of care.

Clinically Available Medicines Demonstrating Anti-Toxoplasma Activity.

Toxoplasma gondii is an apicomplexan parasite of humans and other mammals, including livestock and companion animals. While chemotherapeutic regimens, including pyrimethamine and sulfadiazine regimens, ameliorate acute or recrudescent disease such as toxoplasmic encephalitis or ocular toxoplasmosis, these drugs are often toxic to the host. Moreover, no approved options are available to treat infected women who are pregnant. Lastly, no drug regimen has shown the ability to eradicate the chronic stage of infection, which is characterized by chemoresistant intracellular cysts that persist for the life of the host. In an effort to promote additional chemotherapeutic options, we now evaluate clinically available drugs that have shown efficacy in disease models but which lack clinical case reports. Ideally, less-toxic treatments for the acute disease can be identified and developed, with an additional goal of cyst clearance from human and animal hosts.

PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs.

BACKGROUND: Women who engage in sex work and use drugs (WSWUD) experience disproportionate HIV risks. Substance use treatment bridge clinics offer an opportunity to increase HIV pre-exposure prophylaxis (PrEP) delivery to WSWUD, but research on best practices is lacking. Therefore, we explored facilitators and barriers to PrEP across the PrEP care continuum in these settings. METHODS: Bridge clinic and affiliated harm reduction health service providers and WSWUD from Boston were recruited using passive and active outreach between December 2021 and August 2022. Participants were invited to take part in semi-structured phone or in-person interviews to explore HIV prevention and PrEP care experiences overall and within bridge clinic settings. Deductive codes were developed based on HIV risk environment frameworks and the Information-Motivation-Behavioral Skills model and inductive codes were added based on transcript review. Grounded content analysis was used to generate themes organized around the PrEP care continuum. RESULTS: The sample included 14 providers and 25 WSWUD. Most WSWUD were aware of PrEP and more than half had initiated PrEP at some point. However, most who initiated PrEP did not report success with daily oral adherence. Providers and WSWUD described facilitators and barriers to PrEP across the steps of the care continuum: Awareness, uptake, adherence, and retention. Facilitators for WSWUD included non-stigmatizing communication with providers, rapid wraparound substance use treatment and HIV services, having a PrEP routine, and service structures to support PrEP adherence. Barriers included low HIV risk perceptions and competing drug use and survival priorities. Provider facilitators included clinical note templates prompting HIV risk assessments and training. Barriers included discomfort discussing sex work risks, competing clinical priorities, and a lack of PrEP adherence infrastructure. CONCLUSION: WSWUD and bridge clinic providers favored integrated HIV prevention and substance use services in harm reduction and bridge clinic settings. Harm reduction and bridge clinic programs played a key role in HIV prevention and PrEP education for WSWUD. Effective behavioral and structural interventions are still needed to improve PrEP adherence for WSWUD.

The virtual doppelganger: effects of a virtual reality simulator on perceptions of schizophrenia.

Recent scholarship suggests that virtual environments can serve as effective proxies in battling implicit stereotypes. However, existing experimental research has rarely examined the effectiveness of virtual simulations of mental illnesses in inducing empathy to combat stereotypical responses. We report results from a 4-condition, between subjects experiment (N = 112), wherein participants were exposed to either a virtual simulation of schizophrenia, a written empathy-set induction of schizophrenia, a combination of both the simulation and written empathy conditions, or a control condition. The results indicated that the virtual simulation + empathy condition induced greater empathy and more positive perceptions toward people suffering from schizophrenia than the control or written empathy-set condition. Interestingly, the simulation-only condition resulted in the greatest desire for social distance whereas not significantly differing on empathy and attitude measures from either the written empathy or simulation + empathy conditions. We discuss the implications of the findings and recommend directions for future research.

Recognizing and responding to early psychosis: a qualitative analysis of individual narratives.

OBJECTIVE: The ways in which individuals recognize and respond to emerging psychotic illness remain poorly understood. This retrospective study explored when and how individuals recognized changes in themselves and responded to these changes. METHODS: This study used qualitative methods to explore when and how 15 individuals recognized changes and identified how they responded. Standardized information on the onset of psychosis was also collected. RESULTS: Themes relating to recognizing and responding to emerging psychosis were identified through qualitative analysis of interview transcripts. Themes included normalization, explanatory models, withdrawal, avoiding help, and coming to terms with psychosis. CONCLUSIONS: Participants recognized changes in themselves but tended not to understand the observed changes as part of a mental illness. Individuals avoided professional help because of stigma concerns and identified domains of recovery beyond the management of symptoms and medication. Qualitative methods offer a promising strategy for understanding subjective illness experience and suggesting psychosocial treatment approaches.

Uncharted Waters: Developing Mental Health Services for Survivors of Domestic Human Sex Trafficking.

In recent years, heightened attention has been paid to commercial sexual exploitation, including domestic human sex trafficking (HST), with mental health concerns named the most dominant health concern among survivors. Human sex trafficking is associated with significant and long-term mental health consequences. Research to date has emphasized ways to identify survivors in health care settings. Once identified, however, few specialized services are available to help survivors exit and recover. The current services infrastructure for HST has been compared to the disjointed social response to intimate partner violence before the women's movement helped develop a system of battered women's shelters. Although research has highlighted the need for a multidisciplinary and interagency response to HST, including mental health care, best practices have not yet been formulated. Furthermore, available services are fragmented across sectors. With psychology and psychiatry taking tentative steps to develop services for HST survivors, this article identifies six principles to help avoid a fragmented and potentially retraumatizing clinical and systemic response. The overarching goal is to design services that are flexible, accessible, trauma informed, survivor driven, responsive to stages of change, multidisciplinary, and enduring, especially given the centrality of healthy attachments and community in trauma recovery. Principles are derived from the limited available research on HST services and from examples of efficacious interventions for patient groups with similar characteristics. The discussion is also informed by composite clinical vignettes from a specialized clinic for adult survivors of HST, housed in a major teaching hospital. Finally, practice recommendations and strategies for building interdisciplinary collaborations are discussed.

The misattribution of salience in delusional patients with schizophrenia.

INTRODUCTION: Delusions may arise from abnormalities in emotional perception. In this study, we tested the hypothesis that delusional schizophrenia patients are more likely than non-delusional schizophrenia patients and healthy participants to assign affective meanings to neutral stimuli. METHODS: Unpleasant, pleasant, and neutral words were randomly presented to three subject groups--patients with schizophrenia with prominent delusions, patients with schizophrenia without delusions, and healthy participants. Participants performed three tasks: one in which they decided whether a letter string was a word or a non-word (lexical decision) and two affective classification tasks in which they judged whether words were 1) neutral or unpleasant, or 2) neutral or pleasant. RESULTS: While there were no significant between-group differences in lexical decision performance, patients with delusions showed selective performance deficits in both affective classification tasks. First, delusional patients were significantly more likely than non-delusional patients and healthy participants to classify words as unpleasant. Second, delusional patients took significantly longer than both other groups to correctly classify neutral words in both affective classification tasks. CONCLUSIONS: Taken together, these findings suggest that delusions are associated with the explicit misattribution of salience to neutral stimuli.

"Sexting" among U.S. adolescents: psychological and legal perspectives.

This article will discuss the phenomenon of "sexting" (i.e., the exchange of sexually explicit images between adolescents via cell phone) in the United States, with a particular focus on clinical and legal implications. Although sexting is frequently discussed in the popular press, there is virtually no scientific literature available on this topic. In contrast, the legal literature has discussed sexting more comprehensively due to the implications of child pornography statutes for the social response to involved youth. This article will consider sexting from a clinical and legal perspective, and recommend ways to understand and address this practice clinically with adolescent patients.

Evaluating the effects of eating disorder memoirs on readers' eating attitudes and behaviors.

OBJECTIVE: More than 50 individuals have published eating disorder (ED) memoirs. The current study was the first to test whether memoirs affect readers' eating attitudes and behaviors, and whether they normalize and/or glamorize EDs. METHOD: Fifty female undergraduates read an ED or control memoir. Before and afterward, participants completed the 26-item Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI) Drive for Thinness subscale, a measure of perceived ED symptom prevalence, and an Implicit Association Test (IAT) measuring associations between anorexia and glamour/danger. RESULTS: Participants in the ED condition did not demonstrate significant changes in the EAT-26, the EDI Drive for Thinness subscale, perceived symptom prevalence, or IAT associations compared with controls. Before reading, the EAT-26 and EDI Drive for Thinness subscale correlated positively with perceived symptom prevalence and strength of the IAT association between anorexia and glamour. CONCLUSION: ED memoirs appear to have little effect on undergraduates' eating attitudes and behaviors. Future research should investigate whether memoirs affect individuals with preexisting eating pathology, who may normalize and glamorize ED symptoms.