Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework

Background: Antibiotics are extensively prescribed in intensive care units (ICUs), yet little is known about how antibiotic-related decisions are made in this setting. We explored how beliefs, perceptions and contextual factors influenced ICU clinicians’ antibiotic prescribing. / Methods: We conducted 4 focus groups and 34 semistructured interviews with clinicians involved in antibiotic prescribing in four English ICUs. Focus groups explored factors influencing prescribing, whereas interviews examined decision-making processes using two clinical vignettes. Data were analysed using thematic analysis, applying the Necessity Concerns Framework. / Results: Clinicians’ antibiotic decisions were influenced by their judgement of the necessity for prescribing/not prescribing, relative to their concerns about potential adverse consequences. Antibiotic necessity perceptions were strongly influenced by beliefs that antibiotics would protect patients from deterioration and themselves from the ethical and legal consequences of undertreatment. Clinicians also reported concerns about prescribing antibiotics. These generally centred on antimicrobial resistance; however, protecting the individual patient was prioritised over these societal concerns. Few participants identified antibiotic toxicity concerns as a key influencer. Clinical uncertainty often complicated balancing antibiotic necessity against concerns. Decisions to start or continue antibiotics often represented ‘erring on the side of caution’ as a protective response in uncertainty. This approach was reinforced by previous experiences of negative consequences (‘being burnt’) which motivated prescribing ‘just in case’ of an infection. Prescribing decisions were also context-dependent, exemplified by a lower perceived threshold to prescribe antibiotics out-of-hours, input from external team members and local prescribing norms. / Conclusion: Efforts to improve antibiotic stewardship should consider clinicians’ desire to protect with a prescription. Rapid molecular microbiology, with appropriate communication, may diminish clinicians’ fears of not prescribing or of using narrower-spectrum antibiotics

Harnessing learning biases is essential for applying social learning in conservation

Social learning can influence how animals respond to anthropogenic changes in the environment, determining whether animals survive novel threats and exploit novel resources or produce maladaptive behaviour and contribute to human-wildlife conflict. Predicting where social learning will occur and manipulating its use are, therefore, important in conservation, but doing so is not straightforward. Learning is an inherently biased process that has been shaped by natural selection to prioritize important information and facilitate its efficient uptake. In this regard, social learning is no different from other learning processes because it too is shaped by perceptual filters, attentional biases and learning constraints that can differ between habitats, species, individuals and contexts. The biases that constrain social learning are not understood well enough to accurately predict whether or not social learning will occur in many situations, which limits the effective use of social learning in conservation practice. Nevertheless, we argue that by tapping into the biases that guide the social transmission of information, the conservation applications of social learning could be improved. We explore the conservation areas where social learning is highly relevant and link them to biases in the cues and contexts that shape social information use. The resulting synthesis highlights many promising areas for collaboration between the fields and stresses the importance of systematic reviews of the evidence surrounding social learning practices.BBSRC David Phillips Fellowship (BB/H021817/1

Still Working With “Involuntary Clients” In Youth Justice

A lack of active participation from children and young people in the design and delivery of youth justice services has culminated in the effectiveness of the Youth Justice System being reduced. There has been little independent scrutiny and to add to that strategic direction on how children’s voices are or should be accessed in practice. In the light of this, the paper explores the various challenges associated with promoting the active participation of young people who have offended. More specifically, the paper explores the difficulties engaging those who are disengaged as such individuals may perceive the support on offer as unnecessary and intrusive. The paper argues that in order to reconcile a lack of engagement and feelings of disempowerment the priority should be throughout the Youth Justice System to involve young people in decision-making processes. Ideas will be put forward with regard to how youth justice practice could become more participatory and engaging particularly with regard to those who are ‘involuntary clients’ or in other words difficult to engage. There is a dearth of ‘hard’ empirical evidence on the effectiveness of participatory approaches in youth justice. However if work with young people who offend is innovative and bespoke to allow for young people’s voices to be heard practice could become more effective. But there needs to be the recognition that the ideas put forward in this paper are not ‘magic bullets’

Application of the random encounter model in citizen science projects to monitor animal densities

Abundance and density are vital metrics for assessing a species’ conservation status and for developing effective management strategies. Remote-sensing cameras are being used increasingly as part of citizen science projects to monitor wildlife, but current methodologies to monitor densities pose challenges when animals are not individually recognisable. We investigate the use of camera traps and the Random Encounter Model (REM) for estimating the density of West European hedgehogs (Erinaceus europaeus) within a citizen science framework. We evaluate the use of a simplified version of the REM in terms of the parameters’ estimation (averaged versus survey-specific) and asses it’s potential application as part of a large-scale, long-term citizen science project. We compare averaged REM estimates to those obtained via Spatial Capture-Recapture (SCR) using data from nocturnal spotlight surveys. There was a high degree of concordance in REM-derived density estimates from averaged parameters versus those derived from survey-specific parameters. Averaged REM density estimates were also comparable to those produced by SCR at 8 out of 9 sites; hedgehog density was 7.5 times higher in urban (32.3 km-2) versus rural (4.3 km2) sites. Power analyses indicated that the averaged REM approach would be able to detect a 25% change in hedgehog density in both habitats with >90% power. Furthermore, despite the high start-up costs associated with the REM method, it would be cost-effective in the long term. The averaged REM approach is a promising solution to the challenge of large-scale and long-term species monitoring. We suggest including the REM as part of a citizen science monitoring project, where participants collect data and researchers verify and implement the required analysis

Wild redfronted lemurs (Eulemur rufifrons) use social information to learn new foraging techniques

Recent research has claimed that traditions are not a unique feature of human culture, but that they can be found in animal societies as well. However, the origins of traditions in animals studied in the wild are still poorly understood. To contribute comparative data to begin filling this gap, we conducted a social diffusion experiment with four groups of wild redfronted lemurs (Eulemur rufifrons). We used a ‘two-option’ feeding box, where these Malagasy primates could either pull or push a door to get access to a fruit reward to study whether and how these two behavioural traits spread through the groups. During a pre-training phase, two groups were presented with boxes in which one technique was blocked, whereas two groups were presented with unblocked boxes. During a subsequent unconstrained phase, all four groups were confronted with unblocked boxes. Nearly half of the study animals were able to learn the new feeding skill and individuals who observed others needed fewer unsuccessful task manipulations until their first successful action. Animals in the two groups with pre-training also discovered the corresponding alternative technique but preferred the seeded technique. Interestingly, animals in the two groups without pre-training discovered both techniques, and one group developed a group preference for one technique whereas the other did not. In all groups, some animals also scrounged food rewards. In conclusion, redfronted lemurs appear to use social information in acquiring a novel task, and animals in at least in one group without training developed a group preference for one technique, indicating that they have the potential to develop behavioural traditions and conformity