Equitable sharing of benefits from tiger conservation: Beneficiaries' willingness to pay to offset the costs of tiger conservation.

Costs of large predator conservation may not be equitably distributed among stakeholders; these include farming communities, tourism business owners and visitors. Financial redistribution mechanisms based on accrued benefits and costs of conservation require relevant data unavailable in many locations. To address this, a contingent valuation method identified willingness to pay (WTP) among national park visitors and connected tourism business owners. Both groups derive benefit from government-funded conservation policies. The study was conducted in Bardia and Chitwan National Parks, Nepal 2017-2018; two locations world-renowned for tiger conservation. Local and international park visitors (N = 387) provided WTP for ongoing conservation via additional park entry fees. Tourism business owners (TBOs; N = 74) proximate to the parks stated their WTP for compensation funding provided directly to farmers. The majority (65%) of park visitors were willing to pay extra to support conservation (sample mean US$ 20) while 85 percent of TBOs supported their payment of funds for compensating farming communities (sample mean annual contribution being US$ 156). Valid WTP regression modelling found that visitor WTP was predicted by international travel costsand environmental organization affiliation. For TBOs indicating WTP, the amount to pay was predicted by annual net income from the tourism business. Application of study data indicates US$ 25 average increase to visitor park fees would maximise revenue and contribute a further US$ 495,000 available for conservation activities. Similarly, a flat-rate tariff on TBOs at the mean WTP amount would contribute more than double the annual budget available for farmer compensation (providing approximately US$ 43,000). More generally, the study findings are informative for policy-makers seeking equitable conservation outcomes while maintaining viable populations of critically endangered wild tigers. They should however be interpreted with caution given limitations of the sampling frame and method of data elicitation. Regardless, any policy decision effects require careful scrutiny to ensure desired outcomes are realized.

Assessing the conservation and enhancement value of revegetated strips on arthropod assemblages in a pasture landscape.

Examining population dynamics of arthropod communities in habitats neighboring arable lands is essential to understanding how agroecosystems can be engineered to enhance ecosystem services and contribute to sustainable intensification. Arthropods comprise the bulk of faunal biomass on farms, are taxonomically diverse, and are the main drivers of many ecosystem functions. This study aimed to compare arthropod assemblages in revegetated strips of native plants and exotic pastures, and examine taxa of beneficial arthropods in revegetated strips and adjacent pasture in early spring (September 2009) and mid-summer (December 2009-January 2010) on two farms in southeastern Gippsland, Victoria, Australia. Arthropod community assemblages were distinctly different between revegetated strips and adjacent pasture with the exception of functional groups in early spring. Several taxa of beneficial arthropods including Carabidae (ground beetles) and Syrphidae (hoverflies) were of similar abundance in the two habitats. Only Formicidae (ants) were of higher abundances in revegetated strips compared to adjacent pasture in both seasons. Five of the 10 ant genera present, seven spider families and Dolichopodidae flies (long-legged flies) were found exclusively in revegetated strips. Apidae (bees) and Tachinidae (tachinid flies) had higher abundances in revegetated strips compared to 80 m into the adjacent pasture in mid-summer. Lycosidae (wolf spiders) were more abundant along the edge of revegetated strips and 20 m into adjacent pasture compared to the center (core) of revegetated strips and 80 m into pasture. These results illustrate that beneficial arthropods use revegetated strips as refugia and that revegetated strips clearly enhanced biological conservation of arthropods in pasturelands. Relevance of findings to enhanced biological control is also discussed.

Clinical Performance Measures for Neurocritical Care: A Statement for Healthcare Professionals from the Neurocritical Care Society.

BACKGROUND: Performance measures are tools to measure the quality of clinical care. To date, there is no organized set of performance measures for neurocritical care. METHODS: The Neurocritical Care Society convened a multidisciplinary writing committee to develop performance measures relevant to neurocritical care delivery in the inpatient setting. A formal methodology was used that included systematic review of the medical literature for 13 major neurocritical care conditions, extraction of high-level recommendations from clinical practice guidelines, and development of a measurement specification form. RESULTS: A total of 50,257 citations were reviewed of which 150 contained strong recommendations deemed suitable for consideration as neurocritical care performance measures. Twenty-one measures were developed across nine different conditions and two neurocritical care processes of care. CONCLUSIONS: This is the first organized Neurocritical Care Performance Measure Set. Next steps should focus on field testing to refine measure criteria and assess implementation.

New Hampshire Nurse Practitioners Take the Lead in Forming an Accountable Care Organization.

In 2012, New Hampshire nurse practitioners (NPs), along with Anthem Blue Cross/Blue Shield, formed the first Patient Centered Shared Savings Program in the nation, composed of patients managed by nurse practitioners employed within NP-owned and operated clinics. In this accountable care organization (ACO), NP-attributed patients were grouped into one risk pool. Data from the ACO and the NP risk pool, now in its third year, have produced compelling statistics. Nurse practitioners participating in this program have met or exceeded the minimum scores for 29 quality metrics along with a demonstrated cost-savings in the first 2 years of the program. Hospitalization rates for NP-managed patients are among the lowest in the state. Cost of care for NP-managed patients is $66.85 less per member per month than the participating physician-managed patients. Data from this ACO provide evidence that NPs provide cost-effective, quality health care and are integral to the formation and sustainability of any ACO.

Reactions to driving cessation: a qualitative study of people with dementia and their families.

OBJECTIVES: A proportion of older people with mild dementia are safe to drive. However, driving cessation is recommended at some point as the disease progresses. Driving cessation can have significant psychological and social consequences on people with dementia and their carers. This paper aims to explore the psychosocial and adjustment issues following driving cessation for people with dementia and their supporters. METHOD: Participants and their supporters were interviewed within 1 month of driving-cessation advice, and again 6 months later. Issues associated with driving cessation were explored in semi-structured interviews. RESULTS: Seven participants and their supporters were recruited. This has generated a total of 22 transcripts for qualitative analysis including follow-up interviews. For those who could remember the details of driving cessation, most were unhappy with the decision. Carers who were supportive of driving cessation questioned the legality of it. Most participants minimised the impact of their driving cessation on their supporters. Most supporters were negatively affected by the decision. CONCLUSIONS: The preliminary findings highlight the need for a more comprehensive process for driving cessation in those with dementia, with closer links to regulatory bodies, and increased support for their families/carers.

Evaluating adherence to American Diabetes Association standards of care in diabetes and impacts of social determinants of health on patients at two nurse practitioner-owned clinics.

BACKGROUND: The COVID-19 pandemic created barriers in the management of type 2 diabetes mellitus (T2DM) and worsened social determinants of health (SDOH). A New Hampshire primary care office worked to adhere to T2DM standards of care and began screening for SDOH. This project assessed adherence to quality metrics, hemoglobin A1C, and SDOH screening as telehealth utilization decreased. LOCAL PROBLEM: A1C values have increased at the practice, especially since COVID-19. The practice also began screening for SDOH at every visit, but there was need to assess how needs were being documented and if/how they were addressed. METHODS: A retrospective chart review of patients with T2DM was performed. Demographic data and T2DM metrics were collected and compared with previous years and compared new versus established patients. Charts were reviewed to evaluate documentation of SDOH and appropriate referral. INTERVENTIONS: The practice transitioned from an increased utliization of telehealth back to prioritizing in-office visits. The practice also began routinely screening for SDOH in 2020; however, this process had not been standardized or evaluated. RESULTS: Adherence to nearly all quality metrics improved. Glycemic control improved after a year of nurse practitioner (NP) care, especially in new patients. All patients were screened for SDOH, but documentation varied, and affected patients had higher A1Cs, despite receiving comparable care. CONCLUSION: Nurse practitioners at this practice are adhering to American Diabetes Association guidelines, and A1C values improve under their care. Social determinants of health continue to act as unique barriers that keep patients from improving glycemic control, highlighting the need for individualized treatment of SDOH in T2DM care.

Potassium-competitive acid blockers: rethinking acid suppression for gastroesophageal reflux disease and Helicobacter pylori.

Gastroesophageal reflux disease (GERD) and Helicobacter pylori (H. pylori) infection are different disease states that are united by the core role of acid suppression in their management. In GERD, proton pump inhibitors (PPIs) have long been standard therapy based on abundant positive clinical trial data supporting their efficacy and safety. In H. pylori, PPIs are also a critical element of therapy in combination with 1 or more antibiotics to achieve and maintain a pH that maximizes the efficacy of therapy. Despite the considerable clinical success and widespread use of PPIs, room remains for agents with differentiated pharmacokinetic and pharmacodynamic profiles. The potassium-competitive acid blockers (PCABs) are mechanistically distinct from PPIs but are acid-stable and do not require activation of the proton pump by coadministration of food. In pharmacodynamic studies, these agents have shown greater durations of acid suppression above the critical threshold of pH 4 (for GERD) and pH 6 (for H. pylori), which have been shown to optimize therapeutic efficacy in these settings. These results have translated in clinical studies to similar and, in some cases, improved outcomes relative to PPIs in these disease states. This review summarizes current knowledge on the physiology of acid secretion, pathophysiology and management of GERD and H. pylori, and key characteristics and clinical trial data for PPIs and PCABs.

The UN Joint Group of Experts on the Scientific Aspects of Marine Environmental Protection (GESAMP) - An ocean science-policy interface standing the test of time.

Addressing the wide range of marine pollution problems facing the global ocean requires a continual transfer of credible, relevant and timely scientific information to policy and decision makers in coastal and ocean management. The United Nations GESAMP (Joint Group of Experts on the Scientific Aspects of Marine Environmental Protection) is a long-standing scientific advisory group providing such information on a wide range of marine topics and emerging issues of concern to ten UN Sponsoring Organizations. This paper presents an overview of GESAMPs operation and examples of its current work. The group's scientific output is often cited by national governments, inter-governmental groups, and a range of non-governmental groups. Given the growing concerns about ocean health and the impacts of many stressors in an era of climate change, the development of timely and effective ocean policy and decision making would benefit from wider recognition and application of GESAMPs work.

Use of ICS and Fast-Acting Bronchodilators in Asthma: Past, Present, and Future.

KEY TAKEAWAYS: Primary care practitioners (PCPs) play a key role in asthma management since most patients with asthma are treated in primary care settings. Despite continual advances in asthma care, important practice gaps remain, and the high burden of asthma exacerbations persists, with 43% of children with asthma and 41% of adults with asthma in the United States experiencing an asthma exacerbation in 2020. Uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, reliance on systemic corticosteroids (SCS) or short-acting beta2-agonist (SABA)-only therapy, and lack of patient adherence to anti-inflammatory maintenance therapies are challenges clinicians face today with asthma care. Inhaled corticosteroids (ICS) have been thought to have slow onset of action; however, recent data indicate that ICS onset of action on bronchial tissue is seconds to minutes through nongenomic effects. A large body of evidence supports the use of ICS + fast-acting bronchodilator treatments when used as needed in response to symptoms to improve asthma control and reduce rates of exacerbations. The symptoms that occur leading up to an asthma exacerbation provide a window of opportunity to intervene with ICS + fast-acting bronchodilators, potentially preventing the exacerbation and reducing the need for SCS. Incorporating patient perspectives and preferences when designing asthma regimens will help patients be more engaged in their therapy and may contribute to improved outcomes. In January 2023, a SABA-ICS combination rescue inhaler was approved by the US Food and Drug Administration (FDA) as the first asthma rescue inhaler for as-needed use to reduce the risk of exacerbations.

Beyond Blood Glucose and Blood Pressure Control in Type 2 Diabetes: Alternative Management Strategies to Prevent the Development and Progression of CKD.

Chronic kidney disease associated with Type 2 diabetes is linked to significant increase in morbidity, reduced quality of life, and early death. Current guidelines recommend targets for the management of hyperglycemia, hypertension, and dyslipidemia but there remains a residual risk of chronic kidney disease progression and adverse cardiovascular outcomes in patients with Type 2 diabetes. The 2022 consensus report from the American Diabetes Association and Kidney Disease: Improving Global Outcomes support the use of sodium-glucose co-transporter 2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists to improve kidney and cardiovascular outcomes. Coordination between those working in the primary care setting and those in endocrinology and nephrology clinics may optimize the prevention of chronic kidney disease progression in patients with Type 2 diabetes. Nurse practitioners, physician assistants, and primary care physicians play an important role in making timely patient referrals to kidney specialists. This article explores the use of novel therapies capable of reducing the risk of cardiovascular disease and chronic kidney disease progression beyond what can be achieved with control of blood glucose, blood pressure, and lipid levels. It also discusses the importance of monitoring at-risk patients to facilitate early diagnosis and initiation of effective kidney-protective therapy.[Media: see text][Figure: see text].

A practical guide to recognize, assess, treat and evaluate (RATE) primary care patients with chronic pain.

The management of patients with chronic pain is one of the most important issues In medicine and public health. Chronic pain conditions cause substantial suffering for patients, their significant others and society over years and even decades and increases healthcare utilization resources including the cost of medical care, loss of productivity and provision of disability services. Primary care providers are at the frontline in the identification and management of patients with chronic pain, as the majority of patients enter the healthcare system through primary care and are managed by primary care providers. Due to the complexity of chronic pain and the range of issues involved, the accurate diagnosis of the causes of pain and the formulation of effective treatment plans presents significant challenges in the primary care setting. In this review, we use the classification of pain types based on pathophysiology as the template to guide the assessment, treatment, and monitoring of patients with chronic pain conditions. We outline key methods that can be used to efficiently and accurately diagnose the putative pathophysiological mechanisms underlying chronic pain conditions and describe how this information should be used to tailor the treatment plan to meet the patient's needs. We discuss methods to evaluate patients and the impact of treatment plans over a series of consultations, with a particular focus on strategies to improve the patient's ability to self-manage their pain and related symptoms and perform daily functions despite persistent pain. Finally, we introduce the mnemonic RATE (Recognize, Assess, Treat, and Evaluate) as a general strategy that healthcare providers can use to aid their management of patients presenting with chronic pain.

The impact of nature-led recovery initiatives for individual and community health post disaster: a systematic literature review.

OBJECTIVES: The impact of disasters on individual and community health can be extensive. As such, there exists the need to establish recovery measures that provides support psychologically and with additional mental health services and resilience building for affected people and their communities. Nature-led recovery is one such approach that has the ability to positively impact the mental health of people and their communities after a disaster. Nature-led recovery focuses on the social, economic and environmental recovery through activities that connect people and their communities to nature and the natural environment with the aim to foster recovery after a disaster. Nature-led recovery initiatives support the connection of people with nature and the natural environment to support such recovery processes. This review considers both community and government-led responses pertaining to nature-led recovery. The aim of this review is to systematically explore the literature on the impact of nature-led recovery initiatives on individual and community health following a disaster. CONTENT: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) following a three-step process of planning, conducting and reporting the review. At least three authors reviewed all eligible articles. SUMMARY: There was significant methodological heterogeneity between the sources identified (n=9). A narrative synthesis identified five key themes; A symbol of loss; Nature: the provider; Fostering community connectedness; Spiritual and emotional nourishment; and Regeneration leads to recovery. OUTLOOK: The positive benefits from nature-led recovery initiatives provide an opportunity to promote community connectedness and resilience following a disaster. Further research is needed to explore the implementation and evaluation of these initiatives for community recovery.

Sodium and fluid management in acute brain injury.

Sodium and fluid management in the brain injured patient directly impacts cerebral edema and cerebral perfusion pressure. Sodium is a major determinant of neuronal size and therefore hyponatremia is aggressively avoided, as hypoosmolar states result in cerebral edema. Negative fluid balance is often avoided because resultant drop in cerebral perfusion pressure can contribute to cerebral ischemia, further inducing secondary neuronal injury. Patients with brain injury are at risk for disorders of sodium and fluid balance (eg, syndrome of inappropriate antidiuresis, cerebral salt wasting, and diabetes insipidus). Knowledge of normal homeostatic and brain regulatory volume mechanisms is necessary to avoid inducing further neuronal or systemic injury while trying to correct sodium and fluid disorders in brain injured patients. Osmotherapy is a common part of managing cerebral edema in neurocritical care units, but more studies are needed to establish practice guidelines.

Using multimedia to teach students essential skills.

The essential nursing skills team at the University of the West of Scotland's Hamilton Campus introduced a contemporary holistic integrated teaching approach in September 2010 to engage students with essential nursing skills (phase 1). This article explores how this approach was further developed by introducing media in the form of a video (phase 2). It also reports student and peer evaluation of the use of multimedia and preferred formats, with recommendations for further development.

Seeking Approval from Universities to Research the Views of Their Staff. Do Gatekeepers Provide a Barrier to Ethical Research?

A "gatekeeper" controls access to an organization; "gatekeeper approval" is often needed before external research can take place within an organization. We explore the need for gatekeeper approval for research with university staff employing, as a case study, a project which collected data in Australia. This case study addresses known issues, seemingly rarely addressed in the literature. The Human Research Ethics Committee (HREC)'s requirement for approval from individual universities to approach their staff brought significant consequences, exacerbated by the lack of university procedures for such approvals. Simultaneously, since invitations could legitimately be distributed via other avenues, such approval was superfluous. We recommend the HREC's blanket requirement for institutional approval instead be considered on a case-by-case basis depending on the risk of the research, and perhaps waived for low-risk research where participants are able to provide informed consent, and that universities establish processes to deal with requests from external researchers.

Evaluating the effect of COVID-19 on quality measures of patients with type 2 diabetes in two family nurse practitioner-owned clinics.

BACKGROUND: The COVID-19 pandemic necessitated lockdowns resulting in the disruption of access to primary care. A family nurse practitioner (NP)-owned practice shifted many visits to telehealth to provide care to all their patients including those with chronic illness . The purpose of this project was to evaluate the impact of the pandemic on selected diabetes quality measures and adherence to national diabetes guidelines in two previously well-performing NP-owned primary care clinics. LOCAL PROBLEM: Previous quality improvement studies demonstrated high performing metrics for their patients with type 2 diabetes mellitus (DM). The evaluation of the patients with type 2 DM was necessary to assess the care being delivered in the practice. METHODS: A retrospective record review and analysis of 179 patients older than 18 years was implemented during the early days of the pandemic. Demographic data, process, and outcome measures for diabetes care were collected and compared with previous data from 2013 to 2017 to identify gaps in care. INTERVENTIONS: Telehealth was implemented to deliver care to patients because of the lockdown. The evaluation of these metrics during the period where telehealth was being used to provide care was warranted to evaluate the status of patients with type 2 DM. RESULTS: Patients with type 2 DM receiving care with telehealth demonstrated worsening A1cs and other quality care measures, including fewer ophthalmology evaluations. CONCLUSION: While access to telehealth was important for these patients with type 2 DM, the findings demonstrated that the COVID-19 pandemic had a negative impact on diabetes quality measures. While these may have also reflected the challenges of adhering to lifestyle interventions during this stressful time, telehealth alone may not be an adequate delivery mechanism for primary care for those with type 2 DM.

Efficacy and safety of tanezumab, NSAIDs, and placebo in patients with moderate to severe hip or knee osteoarthritis and a history of depression, anxiety, or insomnia: post-hoc analysis of phase 3 trials.

Objective: Treatment outcomes for chronic pain can be poor in patients with depression, anxiety, or insomnia. This analysis evaluated the efficacy and safety of subcutaneous tanezumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and placebo in patients with osteoarthritis (OA) and a history of these conditions using data from three phase 3 studies.Methods: A post-hoc analysis of data from two pooled placebo-controlled studies and one NSAID-controlled study of subcutaneous tanezumab. All patients had moderate to severe knee or hip OA that was inadequately controlled with standard-of-care analgesics. Efficacy outcomes were least-squares mean change from baseline to Week 16 in Western Ontario McMaster Universities OA Index (WOMAC) Pain, WOMAC Physical Function, Patient's global assessment of OA, and EQ-5D-5L scores. Results were summarized for patients with and without a history of depression, anxiety, or insomnia at baseline.Results: 1545 patients were treated in the pooled placebo-controlled studies (history of depression, 12%; anxiety, 8%; insomnia, 10%; any, 23%) and 2996 in the NSAID-controlled study (16%, 11%, 13%, 28%, respectively). In groups with positive histories, 38-80% took antidepressant or anxiolytic medications at baseline. Within treatments, largely similar improvements in efficacy outcomes were observed in patients with and without a history of depression, anxiety, or insomnia; the types of treatment-emergent adverse events were similar.Conclusions: Patients with OA and a history of depression, anxiety, or insomnia did not appear to experience reduced efficacy outcomes or an altered safety profile in response to tanezumab or NSAID treatment as compared with those without. NCT02697773; NCT02709486; NCT02528188.

Measuring vital signs: an integrated teaching approach.

In September 2010, nurse lecturers at the University of the West of Scotland introduced a holistic, integrated teaching approach to engage students with essential nursing skills. This article discusses how the integrated approach was introduced and how it was used to teach students to measure vital signs. It also provides an evaluation of the approach and recommendations for further development.