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Caring for the caregivers: Evaluation of the effect of an eight-week pilot mindful self-compassion (MSC) training program on nurses’ compassion fatigue and resilience
Nurses vicariously exposed to the suffering of those in their care are at risk of compassion fatigue. Emerging research suggests that self-compassion interventions may provide protective factors and enhance resilience. This pilot study examined the effect of an eight-week Mindful Self-Compassion (MSC) training intervention on nurses' compassion fatigue and resilience and participants' lived experience of the effect of the training.
This observational mixed research pilot study adopted an evaluation design framework. It comprised of a single group and evaluated the effects of a pilot MSC intervention by analyzing the pre- and post-change scores in self-compassion, mindfulness, secondary trauma, burnout, compassion satisfaction, and resilience. The sample of the nurses' (N = 13) written responses to the question, \"How did you experience the effect of this pilot MSC training?\" were also analyzed.
The Pre- to Post- scores of secondary trauma and burnout declined significantly and were negatively associated with self-compassion (r = -.62, p = .02) (r = -.55, p = .05) and mindfulness (r = -.54, p = .05). (r = -.60, p = .03), respectively. Resilience and compassion satisfaction scores increased. All variables demonstrated a large effect size: Mean (M) Cohen's d = 1.23. The qualitative emergent themes corroborated the quantitative findings and expanded the understanding about how MSC on the job practices enhanced nurses' coping.
This is the first study to examine the effect of a pilot (MSC) training program on nurses' compassion fatigue and resilience in this new area of research. It provides some preliminary empirical evidence in support of the theorized benefits of self-compassion training for nurses. However, further research, such as a Randomized Control Trial (RCT) with a larger sample size and a longitudinal study, is required to see if the benefits of self-compassion training are sustainable.
Journal Article
Cyberspace in peace and war
\"Cyberspace in Peace and War presents a comprehensive understanding of cybersecurity, cyberwar, and cyber terrorism. From basic concepts to advanced principles, Libicki examines the sources and consequences of system compromises, addresses how cybersecurity policies can strengthen countries defenses--leaving them less susceptible to cyberattack, and explores cybersecurity in the context of military operations, highlighting unique aspects of the digital battleground and strategic uses of cyberwar. He provides the technical and geopolitical foundations of cyberwar necessary to understand the policies, operations, and strategies required for safeguarding an increasingly online infrastructure.\"--Provided by publisher.
Book
Evaluation of the Lung Cancer Risks at Which to Screen Ever- and Never-Smokers: Screening Rules Applied to the PLCO and NLST Cohorts
Lung cancer risks at which individuals should be screened with computed tomography (CT) for lung cancer are undecided. This study's objectives are to identify a risk threshold for selecting individuals for screening, to compare its efficiency with the U.S. Preventive Services Task Force (USPSTF) criteria for identifying screenees, and to determine whether never-smokers should be screened. Lung cancer risks are compared between smokers aged 55-64 and ≥ 65-80 y.
Applying the PLCO(m2012) model, a model based on 6-y lung cancer incidence, we identified the risk threshold above which National Lung Screening Trial (NLST, n = 53,452) CT arm lung cancer mortality rates were consistently lower than rates in the chest X-ray (CXR) arm. We evaluated the USPSTF and PLCO(m2012) risk criteria in intervention arm (CXR) smokers (n = 37,327) of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). The numbers of smokers selected for screening, and the sensitivities, specificities, and positive predictive values (PPVs) for identifying lung cancers were assessed. A modified model (PLCOall2014) evaluated risks in never-smokers. At PLCO(m2012) risk ≥ 0.0151, the 65th percentile of risk, the NLST CT arm mortality rates are consistently below the CXR arm's rates. The number needed to screen to prevent one lung cancer death in the 65th to 100th percentile risk group is 255 (95% CI 143 to 1,184), and in the 30th to <65th percentile risk group is 963 (95% CI 291 to -754); the number needed to screen could not be estimated in the <30th percentile risk group because of absence of lung cancer deaths. When applied to PLCO intervention arm smokers, compared to the USPSTF criteria, the PLCO(m2012) risk ≥ 0.0151 threshold selected 8.8% fewer individuals for screening (p<0.001) but identified 12.4% more lung cancers (sensitivity 80.1% [95% CI 76.8%-83.0%] versus 71.2% [95% CI 67.6%-74.6%], p<0.001), had fewer false-positives (specificity 66.2% [95% CI 65.7%-66.7%] versus 62.7% [95% CI 62.2%-63.1%], p<0.001), and had higher PPV (4.2% [95% CI 3.9%-4.6%] versus 3.4% [95% CI 3.1%-3.7%], p<0.001). In total, 26% of individuals selected for screening based on USPSTF criteria had risks below the threshold PLCO(m2012) risk ≥ 0.0151. Of PLCO former smokers with quit time >15 y, 8.5% had PLCO(m2012) risk ≥ 0.0151. None of 65,711 PLCO never-smokers had PLCO(m2012) risk ≥ 0.0151. Risks and lung cancers were significantly greater in PLCO smokers aged ≥ 65-80 y than in those aged 55-64 y. This study omitted cost-effectiveness analysis.
The USPSTF criteria for CT screening include some low-risk individuals and exclude some high-risk individuals. Use of the PLCO(m2012) risk ≥ 0.0151 criterion can improve screening efficiency. Currently, never-smokers should not be screened. Smokers aged ≥ 65-80 y are a high-risk group who may benefit from screening. Please see later in the article for the Editors' Summary.
Journal Article
In harm's way : JFK, World War II, and the heroic rescue of PT 109
\"On August 2, 1943, [John] Kennedy's PT 109 [boat] and two others were on a night mission to ambush an enemy supply convoy when they were surprised by a massive Japanese destroyer. The unsuspecting Americans had only seconds to react as the Japanese captain turned his ship to ram directly into Kennedy's. PT 109 was cut in half by the collision, killing two of Kennedy's 12 crewmen and wounding several others in the explosion ... [This book] tells the ... story of what happened next as JFK fought to save his surviving crew members who found themselves adrift in enemy waters\"--Amazon.com.
Book
Fast response of cold ice-rich permafrost in northeast Siberia to a warming climate
The ice- and organic-rich permafrost of the northeast Siberian Arctic lowlands (NESAL) has been projected to remain stable beyond 2100, even under pessimistic climate warming scenarios. However, the numerical models used for these projections lack processes which induce widespread landscape change termed thermokarst, precluding realistic simulation of permafrost thaw in such ice-rich terrain. Here, we consider thermokarst-inducing processes in a numerical model and show that substantial permafrost degradation, involving widespread landscape collapse, is projected for the NESAL under strong warming (RCP8.5), while thawing is moderated by stabilizing feedbacks under moderate warming (RCP4.5). We estimate that by 2100 thaw-affected carbon could be up to three-fold (twelve-fold) under RCP4.5 (RCP8.5), of what is projected if thermokarst-inducing processes are ignored. Our study provides progress towards robust assessments of the global permafrost carbon–climate feedback by Earth system models, and underlines the importance of mitigating climate change to limit its impacts on permafrost ecosystems.
Siberian Arctic permafrost contains vast stores of carbon, the fate of which is dependent on the climate. Here the authors use models of future scenarios to show that under the direst climate changes up to 2/3 of the stored organic carbon could thaw.
Journal Article
Anticompetitive Effects of Common Ownership
Many natural competitors are jointly held by a small set of large institutional investors. In the U.S. airline industry, taking common ownership into account implies increases in market concentration that are 10 times larger than what is \"presumed likely to enhance market power\" by antitrust authorities.¹ Within-route changes in common ownership concentration robustly correlate with route-level changes in ticket prices, even when we only use variation in ownership due to the combination of two large asset managers. We conclude that a hidden social cost—reduced product market competition—accompanies the private benefits of diversification and good governance.
Journal Article
The selective eye : an architect's notebook
\"In this book David Martin takes us along on a life long journey of discovery that begins with his distinguished architectural legacy, and his early personal family and educational influences. He goes on to share his memorable visual and verbal impressions of his wide-ranging travels, through Asia, Europe, the American Southwest, Mexico, the Middle East, the South Pacific and the Caribbean. The journey concludes with valuable insights into the conception, design and realization process in architecture, the MADWORKSHOP Foundation, his distinguished career as a teacher, and his plans for the future\"-- Publisher's description.
Book
Meta-Analysis on Prevalence and Attribution of Human Papillomavirus Types 52 and 58 in Cervical Neoplasia Worldwide
To estimate the prevalence and attribution of two non-vaccine-covered HPV types (HPV52 and HPV58) across the world.
Meta-analysis on studies reported in English and Chinese between 1994 and 2012.
The pooled prevalence and attribution rates of HPV52 and HPV58 in invasive cervical cancers were significantly higher in Eastern Asia compared to other regions (HPV52 prevalence: 5.7% vs. 1.8-3.6%, P<0.001; HPV52 attribution: 3.7% vs. 0.2-2.0%; HPV58 prevalence: 9.8% vs. 1.1-2.5%, P<0.001; HPV58 attribution: 6.4% vs. 0.7-2.2%, P<0.001). Oceania has an insufficient number of studies to ascertain the prevalence of HPV52. Within Eastern Asia, the attribution of HPV58 to invasive cervical cancer was 1.8-fold higher than that of HPV52. Similarly, HPV52 and HPV58 shared a higher prevalence and attribution among cervical intraepithelial neoplasia in Eastern Asia. In contrast to the classical high-risk type, HPV16, the prevalence and attribution of HPV52 and HPV58 decreased with increasing lesion severity. Thus, HPV52 and HPV58 behave as an \"intermediate-risk\" type.
The attribution of HPV52 and HPV58 to cervical intraepithelial neoplasia and invasive cancer in Eastern Asia were respectively 2.5-2.8 and 3.7-4.9 folds higher than elsewhere. Changes in the attributed disease fraction can serve as a surrogate marker for cross-protection or type replacement following widespread use of HPV16/18-based vaccines. This unique epidemiology should be considered when designing HPV screening assays and vaccines for Eastern Asia.
Journal Article