An Integrative Cognitive Model of Internalized Stigma in Psychosis

Background: Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory. Aims: The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis. Method: Previous literature is reviewed, critiqued and synthesized to develop the model. It draws upon previous social cognitive models of internalized stigma and integrates cognitive behavioural theory and social mentality theory. Results: This paper identifies key cognitive, behavioural and emotional processes that contribute to the development and maintenance of internalized stigma, whilst also recognizing the central importance of cultural context in creating negative stereotypes of psychosis. Moreover, therapeutic strategies to alleviate internalized stigma are identified. A case example is explored and a formulation and brief intervention plan was developed in order to illustrate the model in practice. Conclusion: An integrative cognitive model is presented, which can be used to develop individualized case formulations, which can guide cognitive behavioural interventions targeting internalized stigma in those who experience psychosis. More research is required to examine the efficacy of such interventions. In addition, it is imperative to continue to research interventions that create change in stigma at a societal level

Acute Inpatients’ Experiences of Stigma From Psychosis: A Qualitative Exploration.

Stigma is a common difficulty for those who experience psychosis as they are viewed as most dangerous, unpredictable, and least likely to recover. In particular, experiences of stigma are yet to be explored with inpatients admitted to psychiatric hospital. The aim of this study was to examine subjective experiences of stigma with acute psychiatric inpatients who experience psychosis. Twenty-five psychiatric inpatients with experiences of psychosis were interviewed using a semistructured interview measure to examine their subjective experiences of stigma. The interview schedule enquired about their experiences of stigma and discrimination and the personal impacts this has had. Thematic analysis was employed to analyze the qualitative data. The analysis identified 3 superordinate themes: ‘stigmatizing social environment and networks,’ ‘stigmatized person with psychosis,’ and ‘stigma interactions.’ These themes reflected experiences of stigma during the inpatient stay as well as in the community. A graphical representation of these themes and their interaction was developed. Stigma is a concern for acute psychiatric inpatients with psychosis. This concern should be explored in future research, and where appropriate addressed during admission to an acute psychiatric inpatient hospital

Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: A systematic narrative synthesis and meta-analysis

It is acknowledged that people with a schizophrenia-spectrum diagnosis experience higher levels of stigma compared to any other mental health diagnosis. As a consequence, their experience of internalised stigma is likely to be the most detrimental and pervasive. Internalised stigma interventions have shown some benefits in those who experience serious mental illness including those with a schizophrenia-spectrum diagnosis. A systematic narrative review and meta-analysis were conducted examining the efficacy of internalised stigma interventions for people with a schizophrenia-spectrum diagnosis. Randomised Controlled Trials, controlled trials, and cohort studies were included and assessed against quality criteria. The search identified 12 studies; 7 randomised controlled trials, 3 cohort studies and 2 controlled trials. A variety of psychosocial interventions were utilised with the majority employing Cognitive Behaviour Therapy (CBT), psychoeducation and social skills training. The core outcomes used to examine the efficacy of the intervention were internalised stigma, self-esteem, empowerment, and functioning. The meta-analysis revealed an improvement in internalised stigma favouring the internalised stigma intervention but was not significant (5 RCTs, n = 200). Self-efficacy and insight were significantly improved favouring the internalised stigma intervention. Internalised stigma interventions show promise in those with schizophrenia-spectrum diagnoses. Existing interventions have demonstrated small effects and employed small samples. Large scale RCTs are required to further develop the evidence base of more targeted interventions

Semi-structured Interview Measure of Stigma (SIMS) in psychosis: Assessment of psychometric properties

Stigma is a significant difficulty for people who experience psychosis. To date, there have been no outcome measures developed to examine stigma exclusively in people with psychosis. The aim of this study was develop and validate a semi-structured interview measure of stigma (SIMS) in psychosis. The SIMS is an eleven item measure of stigma developed in consultation with service users who have experienced psychosis. 79 participants with experience of psychosis were recruited for the purposes of this study. They were administered the SIMS alongside a battery of other relevant outcome measures to examine reliability and validity. A one-factor solution was identified for the SIMS which encompassed all ten rateable items. The measure met all reliability and validity criteria and illustrated good internal consistency, inter-rater reliability, test retest reliability, criterion validity, construct validity, sensitivity to change and had no floor or ceiling effects. The SIMS is a reliable and valid measure of stigma in psychosis. It may be more engaging and acceptable than other stigma measures due to its semi-structured interview format

Determination of stress state in deep subsea formation by combination of hydraulic fracturing in situ test and core analysis: A case study in the IODP Expedition 319

[1] In situ test of hydraulic fracturing (HF) provides the only way to observe in situ stress magnitudes directly. The maximum and minimum horizontal stresses, SHmax and Shmin, are determined from critical borehole pressures, i.e., the reopening pressure Pr and the shut-in pressure Ps, etc, observed during the test. However, there is inevitably a discrepancy between actual and measured values of the critical pressures, and this discrepancy is very significant for Pr. For effective measurement of Pr, it is necessary for the fracturing system to have a sufficiently small compliance. A diagnostic procedure to evaluate whether the compliance of the employed fracturing system is appropriate for SHmax determination from Pr was developed. Furthermore, a new method for stress measurement not restricted by the system compliance and Pr is herein proposed. In this method, the magnitudes and orientations of SHmax and Shmin are determined from (i) the cross-sectional shape of a core sample and (ii) Ps obtained by the HF test performed near the core depth. These ideas were applied for stress measurement in a central region of the Kumano fore-arc basin at a water depth of 2054?m using a 1.6?km riser hole drilled in the Integrated Ocean Drilling Program (IODP) Expedition 319. As a result, the stress decoupling through a boundary at 1285?m below seafloor was detected. The boundary separates new upper layers and old lower ones with an age gap of ~1.8?Ma, which is possibly the accretionary prism. The stress state in the lower layers is consistent with that observed in the outer edge of accretionary prism

The Pros and Cons of Plea Bargaining

The following is a transcript of a 2018 Federalist Society panel entitled The Pros and Cons of Plea Bargaining. The panel originally occurred on November 15, 2018, during the National Lawyers Convention in Washington, D.C. The panelists were: Hon. Stephanos Bibas, United States Court of Appeals, Third Circuit; Gregory Brower, Shareholder, Brownstein Hyatt Farber Schreck, LLP; Carissa Byrne Hessick, Anne Shea Ransdell and William Garland Buck Ransdell Jr. Distinguished Professor of Law, University of North Carolina School of Law; and Clark Neily, Vice President for Criminal Justice, Cato Institute. The moderator was the Honorable Lisa Branch of the United States Court of Appeals for the Eleventh Circuit

High precision noble gas measurements of hydrothermal quartz reveal variable loss rate of Xe from the Archean atmosphere

© The Author(s), 2022. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Broadley, M., Byrne, D., Ardoin, L., Almayrac, M., Bekaert, D., & Marty, B. High precision noble gas measurements of hydrothermal quartz reveal variable loss rate of Xe from the Archean atmosphere. Earth and Planetary Science Letters, 588, (2022): 117577, https://doi.org/10.1016/j.epsl.2022.117577.Determining the composition of the Archean atmosphere and oceans is vital to understanding the environmental conditions that existed on the surface of the early Earth. The analysis of atmospheric remnants in fluid inclusions trapped in Archean-aged samples has shown that the Xe isotopic signature of the Archean atmosphere progressively evolved via mass-dependent fractionation, arriving at a modern atmospheric composition around the Archean-Proterozoic transition. The mechanisms driving this evolution are however not well constrained, and it is not yet clear whether the evolution proceeded continuously or via episodic bursts. Providing further constraints on the evolution of Xe in the Archean atmosphere is hampered by the limited amounts of atmospheric gas trapped within fluid inclusions during mineral formation, which impacts the precision at which the Archean atmosphere can be determined. Here, we develop a new crush-and-accumulate extraction technique that enables the heavy noble gases (Ar, Kr and Xe) released from crushing large quantities of hydrothermal quartz to be accumulated and analysed to a higher precision than was previously possible. Using this new technique, we re-evaluate the composition of atmospheric gases trapped within fluid inclusions of 3.3 Ga quartz samples from Barberton, South Africa. We find that the Xe isotopic signature is fractionated by +10.3 ± 1.0‰u−1 (2 SE) relative to modern atmosphere, which is within uncertainty of, but slightly lower than, the previous determination of 12.9 ± 2.4‰u−1 for this sample (Avice et al., 2017). We show for the first time that the Kr/Xe ratio measured within Archean quartz samples is enriched in Xe compared to the modern atmosphere, demonstrating that the atmosphere has lost Xe since the Archean. This further reinforces the proposal of atmospheric escape as the primary mechanism for Earth's Xe loss. We further show that the atmospheric Kr/Xe and Xe isotope fractionation recorded in the Barberton quartz at 3.3 Ga is incompatible with a model describing atmospheric loss at a continuous rate under a constant fractionation factor. This gives credence to numerical models of hydrodynamic escape, which suggest that Xe was lost from the Archean atmosphere in episodic bursts rather than at a constant rate. Refining the evolution curve of atmospheric Xe isotopes using the new technique presented here has the potential to shed light on discrete atmospheric events that punctuated the evolution of the Archean Earth and accompanied the evolution of life.This study was supported by the European Research Council (PHOTONIS project, grant agreement No. 695618). This is CRPG contribution #2820

Whole-genome sequencing for national surveillance of Shiga toxin–producing Escherichia coli O157

Background. National surveillance of gastrointestinal pathogens, such as Shiga toxin–producing Escherichia coli O157 (STEC O157), is key to rapidly identifying linked cases in the distributed food network to facilitate public health interventions. In this study, we used whole-genome sequencing (WGS) as a tool to inform national surveillance of STEC O157 in terms of identifying linked cases and clusters and guiding epidemiological investigation. Methods. We retrospectively analyzed 334 isolates randomly sampled from 1002 strains of STEC O157 received by the Gastrointestinal Bacteria Reference Unit at Public Health England, Colindale, in 2012. The genetic distance between each isolate, as estimated by WGS, was calculated and phylogenetic methods were used to place strains in an evolutionary context. Results. Estimates of linked clusters representing STEC O157 outbreaks in England and Wales increased by 2-fold when WGS was used instead of traditional typing techniques. The previously unidentified clusters were often widely geographically distributed and small in size. Phylogenetic analysis facilitated identification of temporally distinct cases sharing common exposures and delineating those that shared epidemiological and temporal links. Comparison with multi locus variable number tandem repeat analysis (MLVA) showed that although MLVA is as sensitive as WGS, WGS provides a more timely resolution to outbreak clustering. Conclusions. WGS has come of age as a molecular typing tool to inform national surveillance of STEC O157; it can be used in real time to provide the highest strain-level resolution for outbreak investigation. WGS allows linked cases to be identified with unprecedented specificity and sensitivity that will facilitate targeted and appropriate public health investigations