Mindful Self-Compassion as an Antidote to Burnout for Mental Health Practitioners.

The objective of this correlational study was to explore the relationship between levels of self-compassion and burnout for currently practicing mental health practitioners (MHPs) in the United States. All professionals are vulnerable to burnout based on various types of organizational stressors, but burnout is of particular concern for health care service providers who may need to adopt a stance of detachment, or emotional distance, as relief from intense workloads, with clients. The data were collected through an online survey. Regression analysis found that scores from Neff's Self-Compassion Scale were a significant negative predictor of levels of MHP burnout, as assessed by Schaufeli et al.'s Burnout Assessment Tool, p < 0.001. The implication of this finding is that cultivating self-compassion appears to be a pragmatic self-care strategy for MHPs to mitigate the negative effects of burnout. More educational and occupational training in self-compassion practices as self-care should be provided to help protect the physical and emotional well-being of MHPs. The deleterious systemic effects of burnout make MHP self-care an ethical issue, along with the need to identify protective factors, prevention, and treatment of burnout.

The Relationship between Differentiation of Self and Psychological Adjustment to Separation.

Many individuals suffer negative mental health consequences such as anxiety and depression following separation from a romantic partner and/or co-parenting conflict due to divorce. Consequently, treating the psychological aftermath of divorce and partner separation remains a predominant concern for mental health practitioners. According to family systems theory, high interdependence and low differentiation of self are associated with a lessened capacity for managing anxiety or adapting to stressful events since intense emotions may inhibit the ability to cope. To assess the relationship between differentiation of self and psychological adjustment to separation, 84 divorced adults completed an online survey. Multiple regression analysis demonstrated that a model based on fusion with others, I-position, and emotional cutoff was a statistically significant predictor of lonely/negativity. Bivariate correlation analyses confirmed significant linear relationships between fusion with others, lonely/negativity, and co-parenting conflict. No differences between genders were found. There is a continuing need to develop interventions to address the negative consequences of divorce, help reduce emotional suffering, and encourage healthy co-parenting. Individuals struggling with psychological adjustment post-divorce, or those seeking education for managing the psychological effects of divorce and co-parenting, may benefit from counseling strategies that incorporate an assessment of differentiation of self and psychological adjustment to separation.

Resonance Microwave Measurements of an Intrinsic Spin-Orbit Coupling Gap in Graphene: A Possible Indication of a Topological State.

In 2005, Kane and Mele [Phys. Rev. Lett. 95, 226801 (2005)PRLTAO0031-900710.1103/PhysRevLett.95.226801] predicted that at sufficiently low energy, graphene exhibits a topological state of matter with an energy gap generated by the atomic spin-orbit interaction. However, this intrinsic gap has not been measured to this date. In this Letter, we exploit the chirality of the low-energy states to resolve this gap. We probe the spin states experimentally by employing low temperature microwave excitation in a resistively detected electron-spin resonance on graphene. The structure of the topological bands is reflected in our transport experiments, where our numerical models allow us to identify the resonance signatures. We determine the intrinsic spin-orbit bulk gap to be exactly 42.2 µeV. Electron-spin resonance experiments can reveal the competition between the intrinsic spin-orbit coupling and classical Zeeman energy that arises at low magnetic fields and demonstrate that graphene remains to be a material with surprising properties.

Probing Electron Spin Resonance in Monolayer Graphene.

The precise value of the g factor in graphene is of fundamental interest for all spin-related properties and their application. We investigate monolayer graphene on a Si/SiO_{2} substrate by resistively detected electron spin resonance. Surprisingly, the magnetic moment and corresponding g factor of 1.952±0.002 is insensitive to charge carrier type, concentration, and mobility.

Bedside leucocyte esterase reagent strips with spectrophotometric analysis to rapidly exclude spontaneous bacterial peritonitis: a pilot study.

BACKGROUND: Spontaneous bacterial peritonitis, a potentially fatal complication of cirrhotic ascites, is diagnosed when the polymorphonuclear leucocyte count in the ascitic fluid is>250/mm. Manual laboratory counting of ascitic polymorphonuclear leucocytes is, however, labour-intensive, costly, results in diagnostic delay and it is not available in all hospitals as part of the 'out-of-hours' service. Thus, a rapid diagnostic screening test for spontaneous bacterial peritonitis would be beneficial in this condition. An exciting new development in the diagnosis of spontaneous bacterial peritonitis is the use of bedside reagent strips; yet, concerns regarding the inherent subjectivity of result reading have prevented the widespread adoption of this technique in clinical practice. OBJECTIVE: To evaluate the combined use of a leucocyte esterase strip together with an objective portable spectrophotometric reading device in the diagnosis of spontaneous bacterial peritonitis when compared with standard manual laboratory polymorphonuclear leucocyte counting. METHODS: Nonselected cirrhotic patients undergoing diagnostic paracentesis had an ascitic sample sent for a conventional polymorphonuclear leucocyte count, Gram stain and culture. In addition, a sample was tested with a bedside Multistix 10SG reagent strip and the result was analysed by the Clinitek Status. The strip test was considered positive if it read anything other than negative (i.e. 'trace', '+1', '+2' or '+3'). RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the reagent strips to diagnose correctly spontaneous bacterial peritonitis when compared with the manual laboratory polymorphonuclear leucocyte count were 100, 91, 50, 100 and 92%, respectively. CONCLUSIONS: Bedside leucocyte esterase strips, spectrophotometrically read, can reliably exclude spontaneous bacterial peritonitis in patients with cirrhotic ascites. In our series, a negative strip result effectively ruled out this important condition, and suggests that the requirement for manual polymorphonuclear leucocyte counting in this setting could be removed.

Acquired copper deficiency following prolonged jejunostomy feeds.

A 19-year-old man who developed extensive oesophageal lye (Alkali) stricture and received long-term enteral nutrition (eight months) with a jejunostomy tube developed macrocytic anaemia (Hb: 41 g/L) with leucopenia (white blood cell [WBC]: 3.0 x 10(9)/L). The patient's serum vitamin B12, folate, iron and liver function tests were normal. Bone marrow examination revealed gross erythroid hyperplasia and cytoplasmic vacuolization of erythroid and myeloid elements. Further investigations revealed low serum copper (0.3 micromol/L) and ceruloplasmin concentrations (<30 mg/L) with marginally low normal serum concentration of red cell peroxidase (13 U/gHb), establishing the diagnosis of copper deficiency anaemia. The anaemia and leucopenia responded intermittently to intravenous copper therapy, but the serum copper concentration dropped when intravenous copper therapy was withdrawn. Enteral jejunostomy copper supplementation failed to maintain adequate serum copper concentrations. After stabilizing the general condition of the patient, a pharyngo-gastric anastamosis was performed and normal oral diet commenced, which restored normal serum copper concentration. This case report suggests that copper supplements in the form of copper sulphate are not adequately absorbed when administered through a jejunostomy tube.

Faecal calprotectin in the assessment of Crohn's disease activity.

BACKGROUND: Clinical and laboratory assessment of activity in Crohn's disease (CD) correlate poorly with endoscopic findings. Calprotectin is a calcium-binding protein abundant in neutrophil cytosol, and extremely stable in faeces. Faecal calprotectin (FC) is an excellent surrogate marker of neutrophil influx into the bowel lumen. AIM: To assess whether FC concentration from a spot stool sample reliably detects active inflammation in patients with CD. DESIGN: Cross-sectional comparative study. METHODS: Subjects had a previously confirmed diagnosis of CD and were suspected on clinical grounds to be in the midst of a relapse. Thirty-five entered the study; they underwent radiolabelled white cell scanning (WCS) and had a stool sample collected for calprotectin measurement on the same day. A Crohn's disease activity index (CDAI) was also calculated for each. The WCS scans were scored at six standard sites to give a mean total, 'extent', 'severity' and 'combined extent and severity' scores. RESULTS: FC was significantly and positively correlated with mean total (r = 0.73, p < 0.001), 'extent' (r = 0.71, p < 0.001), 'severity' (r = 0.64, p < 0.001) and combined 'extent and severity' WCS scores (r = 0.71, p < 0.001). A cut-off of faecal calprotectin > 100 microg/g gave a sensitivity of 80%, specificity of 67%, positive predictive value of 87% and a negative predictive value of 64% in identifying those with and without any inflammation on WCS. There was, however, no significant correlation between CDAI and mean total WCS score (r = 0.21, p = 0.24), nor between CDAI and FC (r = 0.33, p = 0.06). DISCUSSION: While the CDAI does not accurately reflect inflammatory activity in CD, a one-off FC reliably detects the presence or absence of intestinal inflammation in adult patients with CD, compared to WCS.

Tuberculous lesions in free-ranging white-tailed deer in Michigan.

Descriptions of the anatomical distribution of Mycobacterium bovis gross lesions in large samples of white-tailed deer (Odocoileus virginianus) are lacking in the scientific literature. This report describes the distribution of gross lesions in the 58 white-tailed deer that cultured positive for M. bovis among the 19,500 submitted for tuberculosis testing in Michigan (USA) in 1999. For the vast majority (19,348) of those tested, only the head was submitted; for others, only extracranial tissues (33) or both the head and extracranial tissues (119) were available. Among those deer that cultured positive, cranial gross lesions were noted most frequently in the medial retropharyngeal lymph nodes, although solitary, unilateral parotid lymph node lesions also were found. Extracranial lesions occurred most commonly in the thorax. The distribution of lesions largely agreed with the few existing case reports of the M. bovis in white-tailed deer, although gross lesions were also found in sites apparently not previously reported in this species (liver, spleen, rumen, mammary gland). Some practical issues that may assist future surveillance and public education efforts are also discussed.

Reducing maltreated children's reluctance to answer hypothetical oath-taking competency questions.

Before allowing child witnesses to testify, courts routinely require children to describe what would happen to them if they lied. However, young children often refuse to reason hypothetically if they view the premises as implausible or undesirable, and might be more willing to discuss the consequences of lying if they are asked about another child rather than themselves. On the other hand, children might view themselves as invulnerable to punishment, and therefore believe that whereas other children will be punished for lying, they will not be. In this study, 64 maltreated 5- and 6-year-old children were asked to describe the consequences of lying to three professionals (a judge, a social worker, and a doctor). Participants in the "self" condition were asked what would happen to them if they lied, whereas participants in the "other" condition were asked to describe what would happen to a story child if he or she lied. Asking children about "other" children increased responsiveness, and did not reveal perceptions of invulnerability. The results suggest that young children's understanding that they will be punished for lying may make them reluctant to discuss the consequences of lying, leading to underestimation of their oath-taking competency.

DXA body composition studies are not affected by extracellular water measurements using stable sodium bromide dilution.

Body composition studies using dual energy x-ray absorptiometry (DXA) are being increasingly reported in the literature. When DXA body composition measurements are combined with body water studies, stable bromide is often administered to measure extracellular water. Bromine attenuates x-rays significantly more than soft tissue and so could affect DXA body composition analysis. DXA scans were performed on 26 adults (12 F, 14 M) before and after the intravenous injection of 3 g sodium bromide (NaBr). No significant differences were noted pre- and post-NaBr infusion for whole-body fat mass, fat-free soft tissue mass and bone mineral content. These findings were supported by a simple mathematical analysis of the likely effect of the sodium bromide infusion. This showed that when 3 g NaBr was introduced into the body, the effect on fat mass estimates was expected to be marginally less than the precision of the DXA technique.

A two-compartment model for zinc in humans.

The oral absorption of zinc, from a test meal of minced beef, mashed potatoes and peas, have been measured in 19 healthy adults using the radiotracer 65Zn. The oral absorption, expressed as a percentage of the administered dose, was 20 +/- 5% (mean +/- 1 SD) in good agreement with previous results. In a subset of 9 subjects, tracer retention in whole body and whole blood was followed out to one year. The data were fitted to a simple two compartment model yielding total body zinc (TBZn), the zinc content in each of the 2 compartments and zinc turnover. The TBZn values ranged from 15.5 to 35.9 mmol while zinc turnover ranged from 0.043 to 0.073 mmol/d in keeping with results reported for significantly more complicated compartmental models applied to more comprehensive 65Zn tracer data sets. Additionally, TBZn correlated well with total body potassium, a measure of lean body mass, measured by whole body counting of the naturally-occurring potassium radioisotope, 40K. The zinc content of the more rapidly turning over compartment ranged from 3.2 to 5.6 mmol in reasonable agreement with exchangeable zinc pool estimations reported for short term studies using stable zinc isotopes. Therefore, the simple dataset and model employed in the present study yielded information on the short- and long-term behaviour of zinc compatible with both more complex radiotracer studies and analytically more demanding stable isotope studies.

Cadmium concentrations in human kidney in the UK: 1978-1993.

Almost 2700 samples of human renal cortex have been collected from throughout the UK over a 16 year period from 1978 to 1993. The mean Cd concentration was 19 micrograms g-1 and the median 16 micrograms g-1. Smokers were, on average, about 5 micrograms g-1 higher than non-smokers. Cd increased from low concentration in the young to a maximum of 23 micrograms g-1 in middle age followed by a decrease in old age. Subjects who had died of renal disease had lower Cd concentrations. Geographical variations in the UK are small and the concentrations appear to be static over the 16 year period. Some 3.9% of the population had Cd concentrations > 50 micrograms g-1, the critical level at which beta 2-microglobulin appears in urine.

Determination of low concentrations of potentially toxic elements in human liver from newborns and infants.

One hundred and fifty-seven liver samples from newborns and infants who had died from sudden infant death syndrome (SIDS) or other known causes have been analysed by ICP-MS for Ag, Cd, Co, Pb and Sb. The median concentrations found were: 15.4 (Ag), 2.9 (Cd), 15.9 (Co), 65.2 (Pb) and 1.8 (Sb) ng g-1 wet mass. There was no measurable difference in the concentrations of any of these elements between the SIDS and non-SIDS groups. The validity of the results was assessed by analysis of appropriate reference materials, interlaboratory comparison and isotope dilution analysis. The instrumental limits of detection were 0.25 (Ag), 0.14 (Cd), 0.21 (Co), 3.8 (Pb) and 0.38 (Sb) ng g-1 wet mass. The limits of detection of the method depend on the reagent blank and the extent of background contamination.

Reasoning about moral aspects of illness and treatment by preschoolers who are healthy or who have a chronic illness.

Our study evaluates the moral reasoning skills of healthy and chronically ill 3 and 4 year olds with respect to illness and treatment, by use of an interview technique that reduces verbal demands on the child. We presented children with pairs of scenarios comparing ill characters with characters acting immorally and characters being punished, as well as with pairs of scenarios comparing treated characters with characters acting immorally and characters being punished. We asked children to point to the character who did something "naughty." With the exception of the chronically ill 3 year olds, the children performed consistently above chance and did not confuse illness and immorality. Older and healthy children performed better than younger and chronically ill ones (differences were the result of differing receptive vocabulary skill levels). This research has implications for evaluating young children's reasoning abilities and suggests that medical professionals should use tools that reduce demands on children's verbal proficiency.

The influence of acromioclavicular joint morphology on rotator cuff tears.

A detailed anatomic study of 123 shoulders was performed to define the location of the acromioclavicular (AC) joint within the supraspinatus outlet and to determine the correlation of AC joint morphologic characteristics with the presence of full-thickness rotator cuff tears (RCTs). The presence, location, and extent of RCTs were first documented for each shoulder, and 2 anatomic landmarks consisting of the anterolateral acromial corner and the inferior midpoint of the AC joint were identified and their positions digitized in 3 dimensions to calculate outlet space and clearance and AC joint locations. High resolution x-ray films were then obtained to determine the extent of degenerative changes including the location and size of inferior osteophytes and joint space. These specimens were cleaned of all soft tissues, and additional measurements were made. All data were entered into a computerized database and analyzed with respect to age, sex, and the presence of RCT. Comparison of age-matched RCT versus non-RCT groups revealed no significant differences in the position of the AC joint within the supraspinatus outlet. When AC joint morphologic characteristics were compared with those of a nontear, age-matched group, no significant differences with regard to joint space narrowing were found, but significantly larger and greater number of osteophytes were identified on both sides of the joint in the RCT group. In conclusion, the position of the AC joint is fairly constant within the supraspinatus outlet and does not appear to predispose to RCTs. The morphology of the AC joint contribution of the tears seems to be acquired in nature rather than inherent in its location within the outlet.

Nickel metabolism in humans investigated with an oral stable isotope.

We report the results of the first complete study of nickel metabolism in human subjects using a stable nickel isotope (62Ni) as tracer. Four healthy adult subjects (two women and two men) fasted overnight before ingesting 10 microg 62Ni/kg body wt. Blood samples were drawn after fixed intervals of time and the total daily output of urine and feces was collected for the first 5 d after dose ingestion. 62Ni in plasma, urine, and feces was determined by isotope-dilution inductively coupled plasma-mass spectrometry with 61Ni. The direct measurement of the fecal excretion of the tracer allowed a reliable assessment of nickel absorption from the gastrointestinal tract and we found no evidence of the excretion of absorbed nickel via the gut. The percentage absorption calculated from the amount of 62Ni excreted in the feces ranged from 29% to 40%. Urinary excretion over 5 d ranged from 51% to 82% of the absorbed dose. Plasma 62Ni peaked between 1.5 and 2.5 h after ingestion and decreased by a factor of > 10 over the next few days. We observed low between-subject variability of nickel absorption and excretion. Confounding factors such as contamination and dietary intake of nickel, which hampered earlier measurements in subjects dosed with naturally abundant nickel, were eliminated by using the tracer isotope 62Ni.

Erythrocyte magnesium in elderly patients: not a reliable guide to magnesium status.

To assess body magnesium status in various illness states in older people by measurement of serum magnesium (S Mg) and erythrocyte magnesium (E Mg) and to explore the limitations of E Mg measurement. S Mg and E Mg were measured in 150 consecutive out-patients, mean age 77 years, and in 100 consecutive in-patient admissions, mean age 80 years. Results were analysed for different diagnostic groups S Mg was normally distributed for both in-patients and out-patients, mean values 0.79 mmol/l and 0.77 mmol/l respectively. In-patient E Mg concentrations were often higher but the distribution was considerably skewed, median 2.28 mmol/l, mean 2.35 mmol/l. Out-patient E Mg concentration followed a near normal distribution, median 2.32 mmol/l, mean 2.30 mmol/l. There was a significant correlation between E Mg and S Mg for out-patients, R = 0.29 (p < 0.001). In-patients with infections and pressure sores had significantly raised E Mg concentrations but normal or low S Mg. High E Mg concentrations in illness are likely to be due to alterations in characteristics of the erythrocytes themselves rather than an indication of body magnesium excess. E Mg concentrations in illness should be interpreted with caution.

Localization and pharmacological characterization of pigeon diazepam-insensitive GABAA receptors.

Transduction mechanisms associated with ligand binding at diazepam-insensitive subtypes of GABAA receptors remain largely unknown, but unique behavioral effects of ligands binding at these sites have been reported in pigeons. The present study further evaluated the pharmacological characteristics of diazepam-insensitive GABAA receptors in pigeon brain, using [3H]Ro 15-4513. Autoradiography detected diazepam-insensitive benzodiazepine sites on GABAA receptors in a number of brain regions, with the highest densities present in the olfactory bulb, hippocampus, thalamic nuclei and cerebellar granule cell layers, with densities of approximately 10-20% of total benzodiazepine receptor binding. Saturation analysis revealed significant densities (approximately 10% of total benzodiazepine receptor binding) of extracerebellar diazepam-insensitive benzodiazepine receptors in optic lobe, hippocampus, and brainstem compared to 27% in cerebellum. As reported for mammalian diazepam-sensitive benzodiazepine receptors, GABA (50 microM) generally increased the affinities of agonists and partial agonists, had little effect on the affinities of antagonists, and decreased the affinity of an inverse agonist for pigeon cerebellar diazepam-sensitive benzodiazepine receptors. GABA modulation of ligand binding to diazepam-insensitive benzodiazepine receptors was less than that observed for diazepam-sensitive sites, and no positive modulation was observed. These results demonstrate the presence of cerebellar and extracerebellar diazepam-insensitive benzodiazepine receptors in pigeon brain, with distribution patterns and pharmacology similar to those reported in mammals. The comparable central localization and pharmacological properties of drugs at diazepam-sensitive and -insensitive benzodiazepine receptors in pigeons and rats attests to the evolutionary conservation of GABAA systems.

Medicare prospective payment. One agency's response.

A Medicare prospective payment system (PPS) will have major operational implications for home care providers. Recent history has shown that health care providers' behavior is dramatically affected by the incentives inherent in new payment systems. One agency explains how it is changing its behavior in preparation for PPS legislation.