Spatially clustered count data provide more efficient search strategies in invasion biology and disease control.

Geographic profiling, a mathematical model originally developed in criminology, is increasingly being used in ecology and epidemiology. Geographic profiling boasts a wide range of applications, such as finding source populations of invasive species or breeding sites of vectors of infectious disease. The model provides a cost-effective approach for prioritizing search strategies for source locations and does so via simple data in the form of the positions of each observation, such as individual sightings of invasive species or cases of a disease. In doing so, however, classic geographic profiling approaches fail to make the distinction between those areas containing observed absences and those areas where no data were recorded. Absence data are generated via spatial sampling protocols but are often discarded during the inference process. Here we construct a geographic profiling model that resolves these issues by making inferences via count data, analyzing a set of discrete sentinel locations at which the number of encounters has been recorded. Crucially, in our model this number can be zero. We verify the ability of this new model to estimate source locations and other parameters of practical interest via a Bayesian power analysis. We also measure model performance via real-world data in which the model infers breeding locations of mosquitoes in bromeliads in Miami-Dade County, Florida, USA. In both cases, our novel model produces more efficient search strategies by shifting focus from those areas containing observed absences to those with no data, an improvement over existing models that treat these areas equally. Our model makes important improvements upon classic geographic profiling methods, which will significantly enhance real-world efforts to develop conservation management plans and targeted interventions.

Addressing Biases in Patient Care with The 5Rs of Cultural Humility, a Clinician Coaching Tool.

Clinicians are called to care for patients with increasingly diverse backgrounds during vulnerable moments when gaining trust is imperative. Simultaneously, implicit or unconscious biases are omnipresent. Guidance for clinicians in addressing and curtailing implicit biases is a necessity to preserve provider resiliency while providing high-value, patient-centered care. However, tools to aid clinicians in this endeavor are unknown. The following article introduces The 5Rs of Cultural Humility (5Rs) as a coaching tool available to all clinicians, leaders, and administrators. It is a tool that brings awareness to the reality that everyone has implicit biases and provides a platform to address these biases through the use of cultural humility, mindfulness, and compassion. The tool encourages the clinician to become more aware of his or her decision-making and interactions with others. Each R includes an aim at reducing biases and a self-reflection question. The 5Rs are reflection, respect, regard, relevance, and resiliency. The framework of the 5Rs presents an approach for clinicians to explore more mindful interactions and enriching patient-provider interactions.

Addressing human-tiger conflict using socio-ecological information on tolerance and risk.

Tigers are critically endangered due to deforestation and persecution. Yet in places, Sumatran tigers (Panthera tigris sumatrae) continue to coexist with people, offering insights for managing wildlife elsewhere. Here, we couple spatial models of encounter risk with information on tolerance from 2386 Sumatrans to reveal drivers of human-tiger conflict. Risk of encountering tigers was greater around populated villages that neighboured forest or rivers connecting tiger habitat; geographic profiles refined these predictions to three core areas. People's tolerance for tigers was related to underlying attitudes, emotions, norms and spiritual beliefs. Combining this information into socio-ecological models yielded predictions of tolerance that were 32 times better than models based on social predictors alone. Pre-emptive intervention based on these socio-ecological predictions could have averted up to 51% of attacks on livestock and people, saving 15 tigers. Our work provides further evidence of the benefits of interdisciplinary research on conservation conflicts.

Unpacking the enabling factors for hand, cord and birth-surface hygiene in Zanzibar maternity units.

Recent national surveys in The United Republic of Tanzania have revealed poor standards of hygiene at birth in facilities. As more women opt for institutional delivery, improving basic hygiene becomes an essential part of preventative strategies for reducing puerperal and newborn sepsis. Our collaborative research in Zanzibar provides an in-depth picture of the state of hygiene on maternity wards to inform action. Hygiene was assessed in 2014 across all 37 facilities with a maternity unit in Zanzibar. We used a mixed methods approach, including structured and semi-structured interviews, and environmental microbiology. Data were analysed according to the WHO 'cleans' framework, focusing on the fundamental practices for prevention of newborn and maternal sepsis. For each 'clean' we explored the following enabling factors: knowledge, infrastructure (including equipment), staffing levels and policies. Composite indices were constructed for the enabling factors of the 'cleans' from the quantitative data: clean hands, cord cutting, and birth surface. Results from the qualitative tools were used to complement this information.Only 49% of facilities had the 'infrastructural' requirements to enable 'clean hands', with the availability of constant running water particularly lacking. Less than half (46%) of facilities met the 'knowledge' requirements for ensuring a 'clean delivery surface'; six out of seven facilities had birthing surfaces that tested positive for multiple potential pathogens. Almost two thirds of facilities met the 'infrastructure (equipment) requirement' for 'clean cord'; however, disposable cord clamps being frequently out of stock, often resulted in the use of non-sterile thread made of fabric. This mixed methods approach, and the analytical framework based on the WHO 'cleans' and the enabling factors, yielded practical information of direct relevance to action at local and ministerial levels. The same approach could be applied to collect and analyse data on infection prevention from maternity units in other contexts.