Is that all there is? Self compassion and the imperfect life

This thesis describes my slow journey towards self compassion and how the discovery, nurturing and manifestation of self compassion has informed and enhanced work with clients and my relationships with colleagues, friends and family. Self compassion - the presence, absence, longing for and fear of - is the golden thread that runs throughout my research although I have not always seen it. My research was motivated by a deep and pervasive ‘unease’. Unease about the purpose and impact of my consulting work, unease about the choices I made as a mother, partner and colleague and unease about the quality of relationships I was part of. I started this inquiry by trying to make sense of this ‘unease’ and associating it most strongly with my work. I wondered whether engagement in work that was truly fulfilling might lessen the unease. However, as my inquiry progressed I saw how this striving to achieve what I defined as ‘good work’ (or ‘good parenting’, or ‘good relating’) fed and was fuelled by a set of core beliefs about myself and the world that contributed to not lessened my problematic patterns of relating and experiencing. I started to call these patterns vicious idealisation loops and in its final stages my inquiry became a search to discover how to lift up and out of vicious loops that seemed hard wired and permanent. As I became more interested in vicious loops I started to notice that many of my clients were also caught in similar patterns of striving, self criticism, disappointment and more striving. They frequently described themselves as perfectionists who never felt entirely satisfied with their achievements or the achievements of others. Thus alongside my story is the story of James, a client and a self defined ‘perfectionist’ caught in vicious loops of his own. James represented for me the voices of many corporate clients with whom I worked. The coaching I offered him over the course of a year illustrated how powerful and essential the qualities of self compassion are for those people whose ideals are beginning to crack and whose loops are losing energy and impact. Furthermore, the work I did with James enabled me to experiment with new compassionate practices for working intentionally and explicitly with this form of vicious looping in other areas of my consulting practice. My research evolved in distinct phases broadly corresponding to the stages of an action research cycle. The first three years were dominated by an inner inquiry that centred around the purpose and intent of my research and I now understand that the consulting ‘experiments’ I carried out during that time were in the service of clarifying that intent. My Initial insights in to the phenomenon of vicious idealisation looping emerged from this mostly first person inquiry working with autobiographical material and informed by clinical/psychotherapeutic, philosophical and spiritual schools of thought. As I worked with this material I paid attention to how the boundaries between disciplines and ways of knowing influence each other, overlap and merge. I also stayed alert to how these disciplines could usefully inform my management consulting practice. For example, I learned about self compassion through exploring the biological, evolutionary, psychological, spiritual, philosophical and neurophysiologic research and practical applications. Then, drawing from my own experience of compassionate practice, I adapted the work to create and integrate a compassionate leadership session in my teaching programmes. The parameters of postmodern constructivist research (in particular the imaginal approaches of an alchemical hermeneutic method) gave me space to experiment with a variety of research methods and encouraged me to integrate ‘knowing’ from across disciplines. By the time I entered my fourth year I knew that my original question ‘what is good work?’ had floated downstream. When, as a result of burnout, I had to let go of what I believed was ‘good’ research I simultaneously experienced an opening out or surrendering to my work. I didn’t know how to proceed so I waited and listened and in doing so I encountered further upstream a different question concerning the role and nature of self compassion. The discovery of self compassion enabled me to enter in to the darkest realms of my experience, explore the conflicts between my selves and emerge with new insight and faith. Self compassion also guided me as I started to write this thesis and my criteria for considering both ethics and quality in my work is adapted from the three components of self compassion – kind, mindful and connected. I ask: is this work kind, respectful and tolerant towards my self and others? Is this work mindful – can it lift out of the personal and give voice to what is emerging without judgment? Is this work connected to, relevant and useful to others? Throughout the four years I wrote, recorded, transcribed and filed my inquiry data. I kept a reflective journal, used free fall writing and dream recording to work with unconscious thoughts and wrote papers for discussion in my doctorate supervision groups to make sense of and invite feedback on my emerging ideas. Added to this were my client notes, write ups from consulting assignments, notes from supervision groups, audio transcripts from my therapy sessions, doctorate supervision, coaching and teaching and thousands of underlined sentences, margin notes and post-it markers in the hundreds of books and articles I read during this period. In the final year of my research, as I moved out of my own burnout experience with new insights, I was inspired to take my inquiry further afield. I used my own experience of disintegration and recovery to guide my evolving coaching and consulting practice. I paid close attention to how self compassion might be introduced as a practice to support my clients lift out of their own vicious loops and I sought feedback and wrote about the impact and implications of this work for organisations seeking employee development. This thesis concludes with a chapter drawing attention to the challenges inherent in working with vicious loops. I consider how a compassionate approach to persistence, relapse and resistance can nurture the courage and patience required to enter in to and stay with the frustrating and often imperceptible process of change and growth

Catalysing scale-up of maternal and newborn health innovations in Ethiopia

Scaling-up the innovation across a large geographical area as part of the Community Based Newborn Care package produced challenges, yet there have also been positive and enabling factors in Ethiopia. IDEAS wanted to understand what helps and what hinders the scale-up of community-based maternal and newborn health (MNH) innovations, both within and beyond implementation partner areas, and how scale-up can be catalysed. IDEAS and its partners carried out a case study of an MNH innovation in Ethiopia with its roots in the Community Based Interventions for Newborns in Ethiopia (COMBINE) project which enables Health Extension Workers (HEWs) to administer antibiotics to manage neonatal sepsis at community level. This was evaluated through a randomised controlled trial. The innovation was facilitated by Save the Children USA, through Saving Newborn Lives (SNL), and was initially implemented by HEWs and the Health Development Army in 19 districts ('woredas') of Ethiopia. From late 2013, the innovation was being scaled-up to 92 woredas as one of nine components of Phase One of the Ethiopian Government’s Community Based Newborn Care (CBNC) package. This summary presents evidence from the study and identifies both enablers and barriers to scale up and key actions needed to catalyse scale up

Self-assembling multidomain peptides tailor biological responses through biphasic release

Delivery of small molecules and drugs to tissues is a mainstay of several tissue engineering strategies. Next generation treatments focused on localized drug delivery offer a more effective means in dealing with refractory healing when compared to systemic approaches. Here we describe a novel multidomain peptide hydrogel that capitalizes on synthetic peptide chemistry, supramolecular self-assembly and cytokine delivery to tailor biological responses. This material is biomimetic, shows shear stress recovery and offers a nanofibrous matrix that sequesters cytokines. The biphasic pattern of cytokine release results in the spatio-temporal activation of THP-1 monocytes and macrophages. Furthermore, macrophage–material interactions are promoted without generation of a proinflammatory environment. Subcutaneous implantation of injectable scaffolds showed a marked increase in macrophage infiltration and polarization dictated by cytokine loading as early as 3 days, with complete scaffold resorption by day 14. Macrophage interaction and response to the peptide composite facilitated the (i) recruitment of monocytes/macrophages, (ii) sustained residence of immune cells until degradation, and (iii) promotion of a pro-resolution M2 environment. Our results suggest the potential use of this injectable cytokine loaded hydrogel scaffold in a variety of tissue engineering applications

Characterization of Telehealth Use in Veterans with Spinal Cord Injuries and Disorders

BACKGROUND: Individuals with spinal cord injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic functions, and secondary complications. Telehealth has the capacity to substantially transform healthcare delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here, we attempt to fill part of this gap. OBJECTIVE: To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D. DESIGN: Cross-sectional, descriptive project SETTING: Veterans Health Administration (VHA) facilities. Participants: 15,028 Veterans living with SCI/D whom received services from the VHA SCI/D System of Care. Intervention: Not applicable Outcome Measures: Frequency and characteristics associated with VHA telehealth utilization. Results: Of the 15,028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans over the age of 65 had lower odds (OR = 0.88, p \u3c 0.05, CI: 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, p \u3c 0.01, CI: 1.09-1.52), living in rural areas (OR =1.16, p \u3c 0.01, CI: 1.05-1.28), living greater distances away from the VHA (p \u3c 0.01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR=1.46, p \u3c 0.001, CI: 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network. Conclusion: There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population

NuMI Beam Monitoring Simulation and Data Analysis Status and Progress

With the Main Injector Neutrino Oscillation Search (MINOS) experiment decommissioned, muon and hadron monitors became an important diagnostic tool for the NuMI Off-axis v Appearance (NOvA) experiment at Fermilab to monitor the Neutrinos at the Main Injector (NuMI) beam. The goal of this study is to maintain the quality of the monitor signals and to establish correlations with the neutrino beam profile. And we carry out a systematic study of the response of the muon monitors to the changes in the parameters of the proton beam and lattice parameters. We report here on the progress of the beam data analysis and comparison with the simulation results

Restriction Fragment Length Polymorphism (RFLP) of the Internal Transcribed Spacer 1 (ITS1) region of cutaneous leishmaniasis causing Leishmania donovani in Sri Lanka

Objectives: To isolate PCR quality DNA from punch biopsy samples of 35 suspected cutaneous leishmaniasis (CL) lesions, carry out Internal Transcribed Spacer 1 (ITS1) PCR, analyse Restriction Fragment Length Polymorphism (RFLP), sequence of ITS1 region of 10 randomly selected patient samples and to determine the genetic variation among the causative parasites.Methods: Punch biopsies (3mm) from CL lesions (n=35) were taken and stored in NET buffer at -20C. DNA was extracted using a commercially available kit. ITS1 PCR was carried out using previously described primers. PCR products were digested with Haelll, run in a 1.7 % ethidium bromide gel and visualized under UV light. Same ITS1 PCR products of 10 randomly selected samples were sequenced commercially. Analysis of sequences was carried out with CLUSTALW2 multiple sequence analyzing software.Results: All 35 CL samples showed the same Leishmania donovani ITS1 RFLP pattern. The BLAST search confirmed that the 10 sequenced Sri Lankan strains belong to L. donovani. Multiple sequences analysis showed that Sri Lankan L. donovani strains are highly homogenous in the ITS1 regions. However, the Sri Lankan strains showed, few indels in the ITS1 region when compared with the L. donovani ITS1 sequences originated from India, Sudan and Ethiopia.Conclusions: Cutaneous leishmaniasis in Sri Lanka is still caused only by L. donovani and ITS1 region of the L. donovani strain of Sri Lankan origin is highly homogenous and conserved

Informed Decisions for Actions in Maternal and Newborn Health 2010–17 Report What works, why and how in maternal and newborn health

IDEAS is a measurement, learning and evaluation project based at the London School of Hygiene & Tropical Medicine (LSHTM). The project aims to find out “what works, why, and how” for maternal and newborn health in three low-resource settings in Nigeria, India, and Ethiopia. The IDEAS team includes 20 research and professional support staff, living in Abuja, Addis Ababa, London, and New Delhi, who have been working since 2010 with the Bill & Melinda Gates Foundation (the foundation) and with the foundation’s implementation partners

Interferon-gamma release assay (IGRA) conversion, reversion and implications for the diagnosis of latent tuberculosis infection using a multimodality approach: a retrospective, observational study within a central London TB centre

Introduction and Objectives Accurate diagnosis & management of latent tuberculosis infection (LTBI) among TB contacts is critical for both the health of infected individuals and prevention of disease transmission. Interferon gamma release assays (IGRAs) measure T cell release of interferon-gamma following stimulation by antigens not confounded by the BCG vaccination. The current NICE guidelines recommend their use following a positive TST. In addition some centres have moved to a single step IGRA test for LTBI. Our institution adopts a triple investigation approach comprising a chest radiograph (CXR), TST and IGRA on presentation followed by a rescreen if the TST & IGRA are discordant or if pulmonary contacts are screened prior to 6 weeks. The aim of our study was to evaluate the prevalence of IGRA conversion and reversion in rescreened asymptomatic TB contacts that attended our centre. Methods This was a retrospective, observational study carried out at a central London teaching hospital. The study population comprised 593 consecutive, adult TB contacts screened between 1 January 2008 and 31 December 2010. Data were collected through retrospective review of chest radiographs, TST & IGRA tests. Results Of 498 asymptomatic TB contacts screened, 460 had both an initial TST and IGRA performed (Abstract P13 figure 1). 81 (17.7%) contacts had discordant TST & IGRA results. 52 (64%) of these discordant cases had a positive TST & Negative IGRA; these patients would have been discharged under NICE guidelines however, our rescreen revealed 9 (17%) positive 2nd IGRAs that is, conversion. Three of these patients were under 35 and would therefore by eligible for chemoprophylaxis. Twenty-nine (36%) of the discordant cases had a negative TST and positive IGRA however, 8 (28%) of these IGRAs reverted to negative. It is important to note that if following a single-step IGRA screening protocol (ie, without a rescreen) these cases may have been commenced on chemoprophylaxis unnecessarily (four of these reversion cases were under the age of 35). Conclusions Our results show that adoption of either a sequential TST + ve/IGRA approach or single IGRA approach can result in a significant number of false negative LTBI diagnoses due to IGRA conversion. Conversely, we have also shown that an IGRA rescreen because of discordant TST/IGRA tests can improve LTBI diagnostic specificity and therefore reduce unnecessary chemoprophylaxis due to the effect of reversion

Brown Carbon from Photo-Oxidation of Glyoxal and SO2 in Aqueous Aerosol

Aqueous-phase dark reactions during the co-oxidation of glyoxal and S(IV) were recently identified as a potential source of brown carbon (BrC). Here, we explore the effects of sunlight and oxidants on aqueous solutions of glyoxal and S(IV), and on aqueous aerosol exposed to glyoxal and SO2. We find that BrC is able to form in sunlit, bulk-phase, sulfite-containing solutions, albeit more slowly than in the dark. In more atmospherically relevant chamber experiments where suspended aqueous aerosol particles are exposed to gas-phase glyoxal and SO2, the formation of detectable amounts of BrC requires an OH radical source and occurs most rapidly after a cloud event. From these observations we infer that this photobrowning is caused by radical-initiated reactions as evaporation concentrates aqueous-phase reactants and aerosol viscosity increases. Positive-mode electrospray ionization mass spectrometric analysis of aerosol-phase products reveals a large number of CxHyOz oligomers that are reduced rather than oxidized (relative to glyoxal), with the degree of reduction increasing in the presence of OH radicals. This again suggests a radical-initiated redox mechanism where photolytically produced aqueous radical species trigger S(IV)–O2 auto-oxidation chain reactions, and glyoxal-S(IV) redox reactions especially if aerosol-phase O2 is depleted. This process may contribute to daytime BrC production and aqueous-phase sulfur oxidation in the atmosphere. The BrC produced, however, is about an order of magnitude less light-absorbing than wood smoke BrC at 365 nm

Measurements of π±\pi^\pm, K±^\pm, p and pˉ\bar{\textrm{p}} spectra in proton-proton interactions at 20, 31, 40, 80 and 158 GeV/c with the NA61/SHINE spectrometer at the CERN SPS

Measurements of inclusive spectra and mean multiplicities of $\pi^\pm$, K$^\pm$, p and $\bar{\textrm{p}}$ produced in inelastic p+p interactions at incident projectile momenta of 20, 31, 40, 80 and 158 GeV/c ($\sqrt{s} =$ 6.3, 7.7, 8.8, 12.3 and 17.3 GeV, respectively) were performed at the CERN Super Proton Synchrotron using the large acceptance NA61/SHINE hadron spectrometer. Spectra are presented as function of rapidity and transverse momentum and are compared to predictions of current models. The measurements serve as the baseline in the NA61/SHINE study of the properties of the onset of deconfinement and search for the critical point of strongly interacting matter