Is it time sociology started researching incompetence?

There appears to be a mismatch between apparent incompetence in the world and the amount of sociological research it attracts. The aim of this article is to outline a sociology of incompetence and justify its value. I begin by defining incompetence as unsatisfactory performance relative to standards. Incompetence is thus intrinsically sociological in being negotiated and socially (re)constituted. The next section foregrounds how widespread and serious incompetence is. This renders effective sociological understanding crucial to welfare. The article then systematically analyses uses of the term in the British Journal of Sociology (a good quality general journal) to assess the current state of research. This analysis fully confirms the neglect of incompetence as a research topic. The next section proposes suitable methods for preliminary incompetence research addressing distinctive challenges like the stigma of being incompetent. These sections then allow incompetence to be better contextualised by other contributing concepts like power, bureaucracy and meritocracy. The final section justifies suggestions about directions for future research.

Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts-A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa.

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

Talking Prose All These Years: Agent-Based Modeling as Process-Oriented Analysis.

This article considers the implications of an approach to computer simulation called agent-based modeling for process-oriented analysis. It argues that many theoretical and methodological debates found in the latter field can be effectively advanced by the former. The argument is presented and then extended using a ubiquitous agent-based model proposed to improve understanding of ethnic residential segregation. The argument has three strands. The first is that theoretical and methodological debates are unlikely to progress unless they can be "cashed out" empirically. The second is that agent-based modeling (and its distinctive methodology) has capabilities to do this that existing research methods lack and, in fact, that agent-based models are a natural way to represent "social process" as apparently conceived by process-oriented analysis. The third is that possibilities exist for productive synthesis between agent-based modeling and process-oriented analysis with the former clarifying, instantiating, and perhaps even testing notions of process developed by the latter.

Cet article se penche sur les répercussions d'une approche à la simulation par ordinateur appelée modélisation à base d'agents (ci-après MBA) pour l'analyse axée sur les processus (ci-après AAP). Il fait valoir que de nombreux débats théoriques et méthodologiques de ce dernier domaine peuvent faire progresser efficacement le premier. L'argument est présenté, puis élargi à l'aide d'une MBA généralisée proposée dans le but d'améliorer la compréhension de la ségrégation résidentielle ethnique. L'argumentation comporte trois volets. Le premier, c'est qu'il est peu probable que les débats théoriques et méthodologiques ne progressent, à moins qu'ils ne puissent être extirpés de manière empirique. Le deuxième, c'est que la MBA (et sa méthodologie distinctive) peuvent accomplir ce qui manque aux méthodes de recherche existantes, en fait, que la MBA est une façon naturelle de représenter le « processus social ¼ tel que le conçoit apparemment l'AAP. Le troisième, c'est que des possibilités existent pour une synthèse productive entre la MBA et l'AAP, et cette dernière clarifiant, instanciant et peut-être même mettant à l'épreuve les notions des processus élaborés par la première.

Moral and Contextual Dimensions of "Inappropriate" Antibiotic Prescribing in Secondary Care: A Three-Country Interview Study.

Overuse of broad-spectrum antibiotics in secondary care is a key contributor to the emergence and spread of antimicrobial resistance (AMR); efforts are focused on minimizing antibiotic overuse as a crucial step toward containing the global threat of AMR. The concept of overtreatment has, however, been difficult to define. Efforts to address the overuse of medicine need to be informed by an understanding of how prescribers themselves understand the problem. We report findings from a qualitative interview study of 46 acute care hospital prescribers differing in seniority from three countries: United Kingdom, Sri Lanka and South Africa. Prescribers were asked about their understanding of inappropriate use of antibiotics. Prescriber definitions of inappropriate use included relatively clear-cut and unambiguous cases of antibiotics being used "incorrectly" (e.g., in the case of viral infections). In many cases, however, antibiotic prescribing decisions were seen as involving uncertainty, with prescribers having to make decisions about the threshold for appropriate use. Decisions about thresholds were commonly framed in moral terms. Some prescribers drew on arguments about their duty to protect public health through having a high threshold for prescribing, while others made strong arguments for prioritizing risk avoidance for the patients in front of them, even at a cost of increased resistance. Notions of whether prescribing was inappropriate were also contextually dependent: high levels of antibiotic prescribing could be seen as a rational response when prescribers were working in challenging contexts, and could be justified in relation to financial and social considerations. Inappropriate antibiotic use is framed by prescribers not just in clinical, but also in moral and contextual terms; this has implications for the design and implementation of antibiotic stewardship interventions aiming to reduce inappropriate use of antibiotics globally.

Does Sociology Have Any Choice but to Be Evolutionary?

Historically, over the long run, evolutionary approaches have struggled in sociology with great effort being expended (sometimes purely rhetorically rather than scientifically) to criticize them or, even more radically, to rule them out of court altogether as "not sociological." This approach implies that such approaches are optional to the sociological project. By contrast, this article takes an opposing position and argues that sociology has no real alternative to evolutionary approaches in at least two key areas. First and foremost, we need an approach that can explain social organization without relying on implausible levels of deliberation (while still compatible with the, sometimes successful, exercise of reason). Secondly, we need an approach that is "properly" historical in being able to engage with both macro (structural) change and genuine novelty. This article not only discusses what is needed and why but also illustrates how such an approach could work using an Agent-Based Model (hereafter ABM).

Medical prescribing and antibiotic resistance: A game-theoretic analysis of a potentially catastrophic social dilemma.

The availability of antibiotics presents medical practitioners with a prescribing dilemma. On the one hand, antibiotics provide a safe and effective treatment option for patients with bacterial infections, but at a population level, over-prescription reduces their effectiveness by facilitating the evolution of bacteria that are resistant to antibiotic medication. A game-theoretic investigation, including analysis of equilibrium strategies, evolutionarily stability, and replicator dynamics, reveals that rational doctors, motivated to attain the best outcomes for their own patients, will prescribe antibiotics irrespective of the level of antibiotic resistance in the population and the behavior of other doctors, although they would achieve better long-term outcomes if their prescribing were more restrained. Ever-increasing antibiotic resistance may therefore be inevitable unless some means are found of modifying the payoffs of this potentially catastrophic social dilemma.

Developing agent-based models of complex health behaviour.

Managing non-communicable diseases requires policy makers to adopt a whole systems perspective that adequately represents the complex causal architecture of human behaviour. Agent-based modelling is a computational method to understand the behaviour of complex systems by simulating the actions of entities within the system, including the way these individuals influence and are influenced by their physical and social environment. The potential benefits of this method have led to several calls for greater use in public health research. We discuss three challenges facing potential modellers: model specification, obtaining required data, and developing good practices. We also present steps to assist researchers to meet these challenges and implement their agent-based model.