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The longitudinal rate and profile of cognitive decline in persons with stable, treated, and virally suppressed HIV infection is not established. To address this question, the current study quantifies the rate of cognitive decline in a cohort of virally suppressed HIV+ persons using clinically relevant definitions of decline, and determine cognitive trajectories taking into account historical and baseline HAND status. Ninety-six HIV+ (clinically stable and virally undetectable) and 44 demographically comparable HIV- participants underwent standard neuropsychological testing at baseline and 18-months follow-up. We described clinically relevant cognitive trajectories based on standard definitions of historical and baseline HAND status and cognitive decline. Historical, moderate to severe HAND was formally diagnosed at the start of the cART era in 15/96 participants based on clinical neurological and neuropsychological assessment. The same standard of care has been applied to all participants at St. Vincent's Hospital Infectious Disease Department for the duration of their HIV infection (median of 20 years). Relative to HIV- controls (4.5%), 14% of HIV+ participants declined (p = .11), they also scored significantly lower on the global change score (p = .03), processing speed (p = .02), and mental flexibility/inhibition (p = .02) domains. Having HAND at baseline significantly predicted cognitive decline at follow up (p = .005). We determined seven clinically relevant cognitive trajectories taking into account whether participant has a history of HAND prior to study entry (yes/no); their results on the baseline assessment (baseline impairment: yes/no) and their results on the 18-month follow up (decline or stable) which in order of prevalence were: 1) No HAND history, no baseline impairment, 18-month follow-up stable (39%), 2) No HAND history, baseline impairment, 18-month follow-up stable (35%), 3) History of HAND; baseline impairment, 18-month follow-up stable (9%) 4) No history of HAND, baseline impairment, 18-month follow-up decline (7%), 5) History of HAND, no baseline impairment, 18-month follow-up stable (3%), 6) No HAND history, no baseline impairment, 18-month follow-up decline (3%) 7) History of HAND, baseline impairment, 18-month follow-up decline (3%). There was no relationship between cognitive decline (taking into account historical and baseline HAND) and traditional HIV disease biomarkers. Despite long-term viral suppression, we found mostly subclinical levels of decline in psychomotor speed and executive functioning (mental flexibility and cognitive inhibition); well-established markers of HAND progression. Moreover, 57% of our cohort is undergoing slow evolution of their disease, challenging the notion of prevalent neurocognitive stability in virally suppressed HIV infection.

Abstract Background and Hypothesis Shame has been linked to the experience of psychosis, with implications for clinical outcomes, however, a meta-analysis of the relationship has not yet been conducted. This systematic review and meta-analysis aimed to examine the strength of the association between shame and psychosis, and any variations between clinical and non-clinical populations and shame type (internal vs external shame). Study Design Searches were conducted in CINAHL, EMBASE, PsycInfo, PubMed, Scopus, and Web of Science from the inception of the e-databases until July 2023. For inclusion, studies reported a quantitative association between psychosis and shame, or data that could be used to identify a relationship. From 11 372 unique retrieved records, 40 articles met the inclusion criteria and 38 were included in the meta-analyses. Study Results A significant large pooled estimate of the psychosis-shame association was identified (Zr = 0.36, [95% CI: 0.28, 0.44], P < .001), indicating that higher levels of shame were associated with greater severity of psychotic symptoms. The strength of the association was similar across clinical and non-clinical populations, however, differed by type of shame and psychosis symptom measured. External shame was strongly associated with paranoia suggesting possible confounding. Only a minority of studies met the highest quality criteria. Conclusions Shame is strongly associated with the severity of psychotic symptoms in clinical and non-clinical populations. Given the overlap with paranoia, measurement of external shame alone is not advised. Larger studies in clinical populations, with measures of a range of psychosis symptoms, are needed to better understand the relationship between shame and specific symptoms.

Accelerated long-term forgetting (ALF) is characterized by adequate recall after short, but not long delays. ALF is not detected by standardized neuropsychological memory tests. Currently, the prevailing conceptualization of ALF is of a temporal lobe seizure-related phenomenon. Nevertheless, Mayes and colleagues (2003) proposed that ALF may occur when any of the components of the brain network involved in long-term memory formation, or their interaction, is disrupted. This disruption does not have to be caused by temporal lobe seizures for ALF to occur. Here, we investigate this possibility in a group of school-age children who have sustained traumatic brain injury (TBI) (n = 28), as TBI typically disrupts the brain network that is important for long-term memory formation and recall. Healthy control children (n = 62) also participated. Contrary to the dominant conceptualization of ALF being a seizure-related phenomenon, children with TBI showed ALF. Sustaining a severe TBI and diffuse subcortical damage was related to ALF. Individually, 8 of the 13 children with severe TBI presented with ALF. ALF would remain undetected on standardized testing in six of these eight children. One child had the opposite pattern of dissociation, an impaired score on standardized testing, but an average long-term memory score. This is the first study, to our knowledge, to show ALF in patients with TBI, which has remained undiagnosed and untreated in this patient population. Our study also challenges the dominant hypothesis of ALF being a temporal lobe seizure-related phenomenon, and raises a possibility that short-term and long-term memory systems may be independent.

Imagining future events is thought to rely on recombination and integration of past episodic memory traces into future events. Future and past events contain episodic and nonepisodic details. Children with severe traumatic brain injury (TBI) were found to have impaired recall of past episodic (but not semantic) event details. Here, we examined whether severe TBI impairs construction of future events. Children with severe TBI (n = 15) and healthy controls (NC; n = 33) 1) completed tests of anterograde (narrative and relational) memory and executive skills, 2) recalled past events and generated future events, and 3) rated events' phenomenological qualities. Events were scored for episodic (internal) and semantic (external) details. The groups did not differ in generating details of future events, although children with TBI recalled significantly fewer past internal (but not external) events' details relative to NCs. Moreover, the number of past internal details relative to future internal details was significantly higher in the NC group, but not in the TBI groups. Significant correlations between past and future were found for 1) internal details in both groups and 2) external details in the NC group. The TBI group rated their events as being less significant than did the NC group. The groups did not differ on ratings of visual intensity and rehearsal. Our study has shown that children who have sustained severe TBI had impoverished recall of past, but not generation of future, events. This unexpected dissociation between past and future event construction requires further research.

Institutions commonly referred to as Magdalene laundries, or Magdalene asylums, have existed globally, from the eighteenth century until the late twentieth century. In Ireland, they operated from the mid-eighteenth century until 1996, when the last institution closed in Dublin. Initially understood as refuges for women engaged in transactional sex or vulnerable to sexual exploitation, in post-independence Ireland these institutions took on a more carceral role, forming part of a wider 'architecture of containment' for people judged to fall outside the social norms of the emerging Catholic Irish State. Although a growing literature on the Magdalene institutions has developed over the past twenty years, across a range of disciplinary approaches, this work has focused on describing or situating these institutions in wider historical, cultural and religious contexts, with less attention paid to women incarcerated in these institutions as producers of knowledge on their own experiences.To address this gap, this thesis undertakes the first secondary analysis to be conducted of eighty-one oral history interviews recorded by Justice for Magdalenes, as part of the Irish Research Council-Funded project, 'Magdalene Institutions: Recording an Archival and Oral History'. These were taken with women formerly incarcerated in these institutions, as well as others associated with this history. Situating its analysis of these interviews in relation to Miranda Fricker's theory of epistemic injustice, the thesis argues that women incarcerated in Magdalene institutions underwent processes of religiously-motivated discipline and penance intended to produce a particular type of religious, gendered subjectivity - a docile, productive body which no longer threatened the moral or social life of the newly formed Irish State. After leaving the institutions, these processes were replicated and maintained by wider cultural systems of symbolic and moral meaning, reflecting the powerful cultural form of the Catholic Church in post-Independence Ireland. As a result of this, women suffered a deep fear of making their highly stigmatised identities visible, and many existed in a state of silence and shame for decades. However, some were also able to draw on forms of agency which enabled them to construct knowledge of themselves and their experiences that were not defined in this way. Ways in which such agency found expression included a renegotiation of their identities through processes of respectability, and inhabiting 'caring' roles; as well as through the re-negotiation of their faith and involvement with the institutional Church. Alongside these oral history interviews, this thesis also examined more contemporary public responses to this history, to establish the extent to which processes such as inquiries, apologies, redress schemes and listening exercises address epistemic injustice experienced by these women.The thesis concludes by considering the value of this research for further work on the formation of religious subjectivity in other religious carceral institutions, such as religiously- run children's homes and reformatories in the UK and Australia, Mother and Baby homes in Ireland, and native assimilationist boarding schools in the USA and Canada. I also demonstrate the ways it contributes to work on epistemic injustice in religious contexts, asking how questions of power and communication impact on the nature of religious relationships. In paying close attention to the question of how institutions can develop epistemic virtues, I suggest that we must think in more collective terms and promote the development of epistemic communities of resistance if we are to meaningfully address the harms of epistemic injustice in these contexts.