Self-stigma in PTSD: Prevalence and correlates

Self-stigma is the internalization of negative societal stereotypes about those with mental illnesses. While self-stigma has been carefully characterized in severe mental disorders, like schizophrenia, the field has yet to examine the prevalence and correlates of self-stigma in post-traumatic stress disorder (PTSD). Thus, we assessed self-stigma in veterans diagnosed with PTSD and compared with veterans with schizophrenia. We further examined associations between PTSD, depressive symptoms and self-stigma in the PTSD sample. Data came from two larger studies of people with PTSD (n = 46) and schizophrenia-spectrum disorders (n = 82). All participants completed the Internalized Stigma of Mental Illness Scale (ISMIS). Results revealed that people with schizophrenia report more experiences of discrimination as a result of stigma than do those with PTSD, but these diagnostic groups did not differ for other subscales. In the PTSD group, feelings of alienation positively correlated with PTSD and depressive symptoms; other subscales positively correlated with depressive symptoms only. Taken together, results suggest a significant level of self-stigma exists among veterans with PTSD, and that self-stigma has an effect on PTSD and commonly comorbid symptoms, like depression. Future work should investigate whether current self-stigma interventions for other groups could be applicable for those with PTSD

Communication Services and Supports for Individuals With Severe Disabilities: Guidance for Assessment and Intervention

The National Joint Committee for the Communication Needs of People with Severe Disabilities (NJC) reviewed literature regarding practices for people with severe disabilities in order to update guidance provided in documents originally published in 1992. Changes in laws, definitions, and policies that affect communication attainments by persons with severe disabilities are presented, along with guidance regarding assessment and intervention practices. A revised version of the Communication Bill of Rights, a powerful document that describes the communication rights of all individuals, including those with severe disabilities is included in this article. The information contained within this article is intended to be used by professionals, family members, and individuals with severe disabilities to inform and advocate for effective communication services and opportunities

Willman 1 - a probable dwarf galaxy with an irregular kinematic distribution

We investigate the kinematic properties and stellar population of the Galactic satellite Willman 1 (Wil 1) by combining Keck/DEIMOS spectroscopy with KPNO mosaic camera imaging. Wil 1 is an ultra-low luminosity Milky Way companion. This object lies in a region of size-luminosity space (M_V ~ -2 mag, d ~ 38 kpc, r_half ~ 20 pc) also occupied by the Galactic satellites Bo\"otes II and Segue 1 and 2, but no other known old stellar system. We use kinematic and color-magnitude criteria to identify 45 stars as possible members of Wil 1. With a systemic velocity of v_helio = -12.8 +/- 1.0 km/s, Wil 1 stars have velocities similar to those of foreground Milky Way stars. Informed by Monte-Carlo simulations, we identify 5 of the 45 candidate member stars as likely foreground contaminants. We confirm a significant spread in the abundances of the likely Wil 1 red giant branch members ([Fe/H] = -1.73 +/- 0.12 and -2.65 +/- 0.12, [Ca/Fe] = -0.4 +/- 0.18 and +0.13 +/- 0.28). This spread supports the scenario that Wil 1 is an ultra-low luminosity dwarf galaxy rather than a star cluster. Wil 1's innermost stars move with radial velocities offset by 8 km/s from its outer stars and have a velocity dispersion consistent with 0 km/s, suggesting that Wil 1 may not be in dynamical equilibrium. The combination of the foreground contamination and unusual kinematic distribution make it difficult to robustly determine the dark matter mass of Wil 1. As a result, X-ray or gamma-ray observations of Wil 1 that attempt to constrain models of particle dark matter using an equilibrium mass model are strongly affected by the systematics in the observations presented here. We conclude that, despite the unusual features in the Wil 1 kinematic distribution, evidence indicates that this object is, or at least once was, a dwarf galaxy.Comment: AJ accepted version. The primary improvements are a detailed investigation of the membership probability (Section 3.4 and new Figures 6, 7 and 8) and the revised spectroscopic [Fe/H] and [Ca/Fe] measurements of the two brightest member stars. Conclusions are unchanged from the submitted versio

The Least Luminous Galaxy: Spectroscopy of the Milky Way Satellite Segue 1

We present Keck/DEIMOS spectroscopy of Segue 1, an ultra-low luminosity (M_V = -1.5) Milky Way satellite companion. While the combined size and luminosity of Segue 1 are consistent with either a globular cluster or a dwarf galaxy, we present spectroscopic evidence that this object is a dark matter-dominated dwarf galaxy. We identify 24 stars as members of Segue 1 with a mean heliocentric recession velocity of 206 +/- 1.3 kms. We measure an internal velocity dispersion of 4.3+/-1.2 kms. Under the assumption that these stars are in dynamical equilibrium, we infer a total mass of 4.5^{+4.7}_{-2.5} x 10^5 Msun in the case where mass-follow-light; using a two-component maximum likelihood model, we determine a similar mass within the stellar radius of 50 pc. This implies a mass-to-light ratio of ln(M/L_V) = 7.2^{+1.1}_{-1.2} or M/L_V = 1320^{+2680}_{-940}. The error distribution of the mass-to-light ratio is nearly log-normal, thus Segue 1 is dark matter-dominated at a high significance. Using spectral synthesis modeling, we derive a metallicity for the single red giant branch star in our sample of [Fe/H]=-3.3 +/- 0.2 dex. Finally, we discuss the prospects for detecting gamma-rays from annihilation of dark matter particles and show that Segue 1 is the most promising satellite for indirect dark matter detection. We conclude that Segue 1 is the least luminous of the ultra-faint galaxies recently discovered around the Milky Way, and is thus the least luminous known galaxy.Comment: 12 pages, 6 figures, ApJ accepte

Stroke in children with posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities (PHACE) syndrome: a systematic review of the literature.

Background and purposePHACE is an acronym for posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities. Several case reports of arterial ischemic stroke (AIS) in individuals with PHACE have been published, but risk factors for AIS in PHACE have not been clearly defined. The objective of this article is to review all cases of stroke in PHACE in children and describe clinical characteristics that may be associated with an increased risk of AIS.MethodsA literature and registry search was conducted to identify patients with PHACE who had experienced AIS. Data were analyzed to determine age of onset, presenting signs and symptoms, and clinical features among this cohort compared with PHACE without AIS.ResultsTwenty-two individuals with PHACE and AIS were identified. Imaging of the arteries of the head and neck was reported in 20 of 22. Narrowing or nonvisualization of at least 1 great cerebral vessel was present in 19 of 20 and of those, 15 had ≥ 2 vessels involved. Aortic arch anomalies were reported in 13 of 22 individuals.ConclusionsAplasia, hypoplasia, or occlusion of a major cerebral artery appears to be a significant risk factor for AIS in children with PHACE, especially when >1 vessel is involved or if there is coarctation of the aorta

Testing Adaptations of Cognitive-Behavioral Conjoint Therapy for PTSD: A Randomized Controlled Pilot Study with Veterans

Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) have well-documented relationship problems and many wish to include their intimate partners in treatment. This pilot study randomly assigned 46 couples (Veterans with clinician-administered PTSD scale confirmed PTSD diagnosis and their intimate partners) to one of two groups. The treatment group received a modified mindfulness-based version of cognitive-behavioral conjoint therapy for PTSD (CBCT; Monson & Fredman, 2012) that included all three phases of the mindfulness-based cognitive behavioral conjoint therapy (MB-CBCT). The control group received a modified version of CBCT that included communication skills training from Phases 1 and 2 of CBCT (CBCT-CS) without PTSD-specific content. Modified CBCT Phases 1 and 2 content was delivered to both groups during weekend retreats in multicouple group sessions. The postretreat protocol for MB-CBCT included nine individual couple sessions: a transition session following the retreat, and CBCT Phase 3. For CBCT-CS, two additional monthly multicouple group sessions reviewed communication skills. No statistically significant pre- to posttreatment differences were detected for primary outcomes between groups: Clinician-Administered PTSD Scale for Veterans (mean change difference, −1.4, 95% CI [−16.0 to 13.2]); Dyadic Adjustment Scale for Veterans (mean change difference, −1.0, 95% CI [−13.2 to 11.2]); and Dyadic Adjustment Scale for Partners (mean change difference, −0.4, 95% CI [−8.9 to 8.1]). However, within group pre- to posttreatment effect sizes were medium to large for both MB-CBCT and CBCT-CS on all three primary outcomes. Findings suggest that Veterans returning from recent conflicts and their partners may benefit from both modifications of CBCT

Twenty Years of Communication Intervention Research With Individuals Who Have Severe Intellectual and Developmental Disabilities

This literature review was conducted to evaluate the current state of evidence supporting communication interventions for individuals with severe disabilities. Authors reviewed 116 articles published between 1987 and 2007 in refereed journals meeting three criteria: (a) described a communication intervention, (b) involved one or more participants with severe disabilities, and (c) addressed one or more areas of communication performance. Many researchers failed to report treatment fidelity or to assess basic aspects of intervention effects including generalization, maintenance, and social validity. The evidence reviewed indicates that 96% of the studies reported positive changes in some aspects of communication. These findings support the provision of communication intervention to persons with severe disabilities. Gaps in the research were reported with recommendations for future research

Theories of International Regimes

Over the last decade, international regimes have become a major focus of empirical research and theoretical debate within international relations. This article provides a critical review of this literature. We survey contending definitions of regimes and suggest dimensions along which regimes vary over time or across cases; these dimensions might be used to operationalize “regime change.” We then examine four approaches to regime analysis: structural, game-theoretic, functional, and cognitive. We conclude that the major shortcoming of the regimes literature is its failure to incorporate domestic politics adequately. We suggest a research program that begins with the central insights of the interdependence literature which have been ignored in the effort to construct “systemic” theory.Governmen

Management of infantile hemangiomas during the COVID pandemic

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.The COVID‐19 pandemic has caused significant shifts in patient care including a steep decline in ambulatory visits and a marked increase in the use of telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk stratification to determine which infants need treatment and which can be managed with continued observation. For those requiring treatment, prompt initiation decreases morbidity and improves long‐term outcomes. The Hemangioma Investigator Group has created consensus recommendations for management of IH via telemedicine. FDA/EMA‐approved monitoring guidelines, clinical practice guidelines, and relevant, up‐to‐date publications regarding initiation and monitoring of beta‐blocker therapy were used to inform the recommendations. Clinical decision‐making guidelines about when telehealth is an appropriate alternative to in‐office visits, including medication initiation, dosage changes, and ongoing evaluation, are included. The importance of communication with caregivers in the context of telemedicine is discussed, and online resources for both hemangioma education and propranolol therapy are provided

PTPN11 mosaicism causes a spectrum of pigmentary and vascular neurocutaneous disorders and predisposes to melanoma

Phakomatosis pigmentovascularis (PPV) is a diagnosis which denotes the coexistence of pigmentary and vascular birthmarks of specific types, accompanied by variable multisystem involvement including central nervous system disease, asymmetrical growth and a predisposition to malignancy. Using a tightly phenotyped group and high depth next generation sequencing of affected tissues we discover here clonal mosaic variants in gene PTPN11 encoding SHP2 phosphatase as a cause of PPV type III or spilorosea. Within an individual the same variant is found in distinct pigmentary and vascular birthmarks and is undetectable in blood. We go on to demonstrate that the same variants can cause either the specific pigmentary or vascular phenotypes alone, as well as driving melanoma development within the pigmentary lesion. Protein conformational modelling highlights that while variants lead to loss of function at the level of the phosphatase domain, resultant conformational changes promote longer ligand binding. In vitro modelling of the missense variants confirms downstream MAPK pathway overactivation, and widespread disruption of human endothelial cell angiogenesis. Importantly, PTPN11-mosaic patients theoretically risk passing on the variant to their children as the germline RASopathy Noonan syndrome with lentigines. These findings improve our understanding of the pathogenesis and biology of naevus spilus and capillary malformation syndromes, paving the way for better clinical management