Barriers and enablers of recognition and response to deteriorating patients in the acute hospital setting: A theory‐driven interview study using the Theoretical Domains Framework

Aim To explore barriers and enablers of recognition and response to signs of patient deterioration by nursing staff in an acute hospital. Design A theory‐driven interview study underpinned by the Theoretical Domains Framework of behaviour change. Methods Between 07/01/2019 and 18/12/2019 a purposive sample of registered nurses and healthcare assistants was recruited to participate in a semi‐structured (audio‐recorded) interview, to explore the determinants of seven specified behaviours of the afferent limb. Anonymised transcripts were deductively coded (using the 14 Theoretical Domains Framework domains as coding categories) and then extracts within each domain were inductively analysed to synthesise belief statements and themes. Prioritisation criteria from published literature were applied. Results Thirty‐two semi‐structured interviews were conducted. From 1,888 quotes, 184 belief statements and 66 themes were synthesised. One hundred and forty‐six belief statements, represented by 58 themes, met prioritisation criteria. Nine domains of the Theoretical Domains Framework were of high importance: Knowledge; Social, Professional Role and Identity; Beliefs about Consequences; Reinforcement; Intentions; Goals; Memory, Attention and Decision Processes; Environment, Context and Resources and Social Influences. Conclusions Barriers and enablers most likely to impact on nursing staff afferent limb behaviour were identified in nine domains of the Theoretical Domains Framework

Diel and seasonal patterns in activity and home range size of green turtles on their foraging grounds revealed by extended Fastloc-GPS tracking

An animal’s home range is driven by a range of factors including top-down (predation risk) and bottom-up (habitat quality) processes, which often vary in both space and time. We assessed the role of these processes in driving spatiotemporal patterns in the home range of the green turtle (Chelonia mydas), an important marine megaherbivore. We satellite tracked adult green turtles using Fastloc-GPS telemetry in the Chagos Archipelago and tracked their fine-scale movement in different foraging areas in the Indian Ocean. Using this extensive data set (5,081 locations over 1,675 tracking days for 8 individuals) we showed that green turtles exhibit both diel and seasonal patterns in activity and home range size. At night, turtles had smaller home ranges and lower activity levels, suggesting they were resting. In the daytime, home ranges were larger and activity levels higher, indicating that turtles were actively feeding. The transit distance between diurnal and nocturnal sites varied considerably between individuals. Further, some turtles changed resting and foraging sites seasonally. These structured movements indicate that turtles had a good understanding of their foraging grounds in regards to suitable areas for foraging and sheltered areas for resting. The clear diel patterns and the restricted size of nocturnal sites could be caused by spatiotemporal variations in predation risk, although other factors (e.g. depth, tides and currents) could also be important. The diurnal and seasonal pattern in home range sizes could similarly be driven by spatiotemporal variations in habitat (e.g. seagrass or algae) quality, although this could not be confirmed

Home ranges of bottlenose dolphins are habitat-and sex-specific

Characteristics of animals’ home ranges can vary between and within populations. This variability may result from different habitat characteristics and biological priorities such as mating strategies, prey availability and predation risk

Predictive habitat modelling of Indo-Pacific bottlenose dolphins (Tursiops aduncus) in South West Australia.

Animals prefer to use an area based on its physical environment (e.g., depth, slope, sea surface temperature, habitat type), food availability, protection from predators, suitability as a breeding or calving ground and lack of anthropogenic pressures. Detecting these critical areas and explaining the factors that influence habitat use and movements are important for conservation and management efforts of a species. Habitat modelling is a powerful tool for predicting distribution patterns and understanding the ecological and physical factors that determine these distributions. Several different modelling techniques are available. Models that are commonly used for marine mammal species include hypothesis testing, maximum entropy, multivariate statistical modeling and multivariate ordination and classification. In this study, the Indo-Pacific bottlenose dolphin (Tursiops aduncus) is used as a model species to investigate which habitat models perform best. Over the past four years research on abundance, distribution, social structure, foraging ecology and conservation genetics has been conducted on the study population in Bunbury, South West Australia. This project will continue to collect data for an additional three years using the same established techniques. The study area will be expanded to now cover an area of 475km2, extending offshore to 9.3 km. Greater coverage of the benthic habitat type and complexity will be recorded through an increased number of transect routes and validation points of the current habitat classifications (drop down camera ground truthing). Other relationships with dolphin distributions will also be considered for additional variables, for example, sea surface temperature, prey distribution and vessel density

Sex specific differences in the ranging patterns of Indo-Pacific bottlenose dolphins in southwest Australia

The analysis of ranging patterns is important to the understanding of species ecology, population dynamics and social and genetic structure. Ranging patterns are influenced by social systems, predation risk, foraging strategies and resource availability. Bottlenose dolphins display a high degree of variability in population structure among different geographic locations. In this study, we investigated differences in ranging patterns between adult male and female Indo-Pacific bottlenose dolphins (Tursiops aduncus) in a temperate environment in Bunbury, Western Australia. To achieve this, we conducted systematic boat-based surveys (n>530) along pre-determined transect lines throughout the 540 km2 study area. Photo-identification data were collected year-round over six consecutive years (2007-2013). More than 1280 dolphin groups were encountered, where over 440 dolphins were catalogued by distinctive fin markings and sex was determined for 55 males and 140 females through genetic analysis or visual observations. A sensitivity analysis was carried out to determine the minimum number of sightings required to most accurately portray range size. Results from minimum convex polygons and fixed kernel estimators revealed that adult males had larger ranges than females and several key areas for females were highlighted. We hypothesize that adult males range further in search for potential mates and that female range patterns are affected by ecological parameters, such as, availability of resources and protection from predators. The key areas identified may be of interest for conservation and management purposes

Hospital-acquired complications in intensive care unit patients with diabetes: A before-and-after study of a conventional versus liberal glucose control protocol

BACKGROUND: Critically ill patients with diabetes mellitus (DM) are at increased risk of in-hospital complications and the optimal glycemic target for such patients remains unclear. A more liberal approach to glucose control has recently been suggested for patients with DM, but uncertainty remains regarding its impact on complications. METHODS: We aimed to test the hypothesis that complications would be more common with a liberal glycemic target in ICU patients with DM. Thus, we compared hospital-acquired complications in the first 400 critically ill patients with DM included in a sequential before-and-after trial of liberal (glucose target: 10-14 mmol/L) vs conventional (glucose target: 6-10 mmol/L) glucose control. RESULTS: Of the 400 patients studied, 165 (82.5%) patients in the liberal and 177 (88.5%) in the conventional-control group were coded for at least one hospital-acquired complication (P = 0.09). When comparing clinically relevant complications diagnosed between ICU admission and hospital discharge, we found no difference in the odds for infectious (adjusted odds ratio [aOR] for liberal-control: 1.15 [95% CI: 0.68-1.96], P = 0.60), cardiovascular (aOR 1.40 [95% CI: 0.63-3.12], P = 0.41) or neurological complications (aOR: 1.07 [95% CI: 0.61-1.86], P = 0.81), acute kidney injury (aOR 0.83 [95% CI: 0.43-1.58], P = 0.56) or hospital mortality (aOR: 1.09 [95% CI: 0.59-2.02], P = 0.77) between the liberal and the conventional-control group. CONCLUSION: In this prospective before-and-after study, liberal glucose control was not associated with an increased risk of hospital-acquired infectious, cardiovascular, renal or neurological complications in critically ill patients with diabetes