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Maintaining cost-effective care while optimizing patient outcomes becomes more challenging because the complexity of health care increases. Numerous variables impact patient outcomes. The purpose of this article is to describe recent empirical literature regarding nurse-related variables that impact patient outcomes. Multiple variables are described, including the work environment, Magnet status, nurse–physician communication, job demands, staffing, level of education, years of nursing experience, and certification. Staffing remains the most consistent positive influence on patient outcomes.

Dasatinib (Sprycel) is a potent antitumor agent prescribed for patients with chronic myeloid leukemia (CML). To enable reliable quantification of dasatinib and its pharmacologically active metabolites in human plasma during clinical testing, a sensitive and reliable liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated. Samples were prepared using solid phase extraction on Oasis HLB 96-well plates. Chromatographic separation was achieved isocratically on a Luna phenyl-hexyl analytical column. Analytes and the stable labeled internal standards were detected by positive ion electrospray tandem mass spectrometry. The assay was validated over a concentration range of 1.00-1000 ng/mL for dasatinib and its two active metabolites. Intra- and inter-assay precision values for replicate QC control samples were within 5.3% for all analytes during the assay validation. Mean QC control accuracy values were within ± 9.0% of nominal values for all analytes. Assay recoveries were high (>79%) and internal standard normalized matrix effects were minimal. The three analytes were stable in human plasma for at least 22 h at room temperature, for at least 123 days at -20°C, and following at least six freeze-thaw cycles. The validated method was successfully applied to the quantification of dasatinib and two active metabolites in a human pharmacokinetic study.

Although recent biodiversity loss has been compared with cataclysmic mass extinctions, we still possess few indicators that can assess the extent or location of biodiversity loss on a global scale. The Convention on Biological Diversity (CBD) has mandated development of indicators that can meet the needs of monitoring biodiversity by 2010. To date, many indicators rely on unwarranted assumptions, secondary data, expert opinion and retrospective time series. We present a new biodiversity indicator, the Wildlife Picture Index (WPI) that targets medium and large-sized terrestrial birds and mammals in forested and savannah ecosystems that. The WPI is a composite indicator based on the geometric mean of relative occupancy estimates derived from camera trap sampling at a landscape scale. It has been designed to meet the needs of a CBD indicator while avoiding many of the pitfalls that characterize some CBD indicators. We present an example using 8 years of camera trap data from Bukit Barisan Selatan National Park, Indonesia to show that the WPI is capable of detecting changes in the rate of loss of biodiversity, a key requirement of a CBD indicator. We conclude that the WPI should be effective at monitoring top trophic levels in forest and savannah ecosystems using primary data and can fill the gap in knowledge about trends in tropical biodiversity.

The purpose of this study was to explore the experiences of Hmong patients on hemodialysis and the nurses working with them. Two midwestern Wisconsin hospitals with hemodialysis units were used as data collection sites. All registered nurses working in the hemodialysis units with Hmong patients were invited to participate. All of the Hmong patients on hemodialysis were also invited to participate. Cooperation and assistance was obtained by the Hmong community. The results indicated that nurses use a variety of methods to learn about Hmong culture on their own, but overall, they felt there was a lack of training for them on Hmong culture. They felt the Hmong patients on hemodialysis were less compliant with their medication regimen and dietary/fluid restriction but equally compliant with their hemodialysis treatment schedule compared to non-Hmong patients on hemodialysis. The nurses identified several barriers present among Hmong patients: transportation, finances, family support, depression, and anxiety. Cultural challenges identified in working with Hmong patients on hemodialysis included communication, Hmong beliefs about treatment, beliefs about illness, and fears about treatment. Hmong patients on hemodialysis described experiencing profound sadness, weakness, and uncertainty. They were sad that they had this chronic disease, that so much of their time was spent in dialysis, and that their lives were drastically changed. They described feeling fatigued and unable to participate in family, social, and clan activities. This also contributed to their sadness. Feelings of uncertainty and fear related to life, death, dialysis, the future, and kidney transplant were identified.

This report provides an exhaustive overview of the literature regarding the role protected areas play in reducing emissions from land use change, and sustaining ecosystem services that will be vital to reducing the vulnerability of humans to climate change. Section 3, Adaptation – The role of protected areas, looks at reducing the impacts of natural disasters, safeguarding water, addressing health issues and biodiversity conservation and maintaining ecosystem resilience.