Cummings and Gove cannot reform Whitehall without reforming the Treasury

Dave Richards, Diane Coyle, Martin Smith, and Sam Warner explain why there is little that is novel in Gove and Cummings’s agenda for Whitehall reform. They argue that reformers would do well to consider why reform has been discussed for over 50 years but has yet to happen, and highlight that meaningful change will require Treasury reform

More austerity? The Treasury must act against the grain of its own history in responding to the COVID-19 crisis

Will austerity be repeated in the light of the ongoing pandemic? Sam Warner, Diane Coyle, Dave Richards and Martin Smith write that, while the evidence points to Rishi Sunak favouring belt tightening over exposing the public finances to further risk, this crisis underlines the need for fresh thinking within the Treasury, as well as for No.11 to engage more effectively beyond Whitehall

Role of Ultrasound-Guided Hemidiaphragm Sparing Brachial Plexus Block in the Morbidly Obese Patient

Patients with Grade III obesity pose unique challenges to the treating anesthesiologists. The challenges range from difficulty in intravenous cannulation to airway management. Regional anesthesia is advantageous over general anesthesia as it avoids airway manipulation, prevents reduction in functional residual capacity, and provides good postoperative analgesia. Regional anesthesia has its pitfalls like identifying the landmarks accurately and hemi diaphragmatic palsy following brachial plexus block. Hemi diaphragmatic palsy is poorly tolerated in grade III obese patients leading to increased peri-operative morbidity which undermines the advantages of regional over general anesthesia. Ultrasound-guided costoclavicular brachial plexus block(CCBPB) has the benefit of reduced hemi diaphragmatic palsy, avoiding pleural injury, and wider distribution of sensory blockade. Costoclavicular block has been administered to obese patients in the past with great success. We are reporting a successful case of ultrasound-guided costoclavicular brachial plexus block performed in an obese patient with a BMI of 51.56Kg/m2

The cost of dying exhibition: public, professional and political reactions to a visual exhibition depicting experiences of poverty at the end of life

Public health approaches to palliative care are internationally endorsed for their potential to improve the social determinants of dying such as energy costs, transport and housing. Enhancing public understanding of inequities in end of life experiences, which exist even in economically advanced countries, is vital if the value of public health approaches are to be endorsed and invested in. Visual exhibitions have a strong tradition of raising awareness and influencing public health discourse. The UK-based Cost of Dying exhibition (April–August 2023) presented real examples of how financial hardship and deprivation intersect with end of life experience through professional portraits, photovoice imagery taken by individuals at the end of their lives, and digital stories co-produced with bereaved relatives. Three iterations of the exhibition were displayed at public venues and a health conference. Evaluation methods comprised anonymous feedback cards (n=208), panel discussions and social media reactions. Thematic analysis was used to identify themes within the feedback. The emotional resonance of the exhibition was a key theme, with attendees expressing sadness, anger, empathy and hope. Visitors found the exhibition thought-provoking and expressed that it countered existing stereotypes about what it means to experience financial hardship at the end of life. The exhibition spurred calls for change, with some attendees questioning in what capacity they could help. Individuals with expertise in end of life care reported that the imagery validated their professional experiences. In conclusion, the Cost of Dying exhibition made visible the struggles endured by individuals confronting financial hardship and material deprivation at the end of life. Such exhibitions can challenge the traditional view of dying as a swift process taking place sequestered in institutions, revealing that it often unfolds over time and individuals may continue to live at home in the community, struggling with unmet needs and unresponsive state services

An Internet for Water: Connecting Texas Water Data

The Connecting Texas Water Data Workshop brought together experts representative of Texas’ water sectors to engage in the identification of critical water data needs and to discuss the design of a data system that facilitates access to and the use of public water data in Texas. Workshop participants identified “use cases” that list data gaps, needs, and uses for water data and answered questions on who needs data, what data do they need, in what form do they need the data, and what decisions need to be made about water in Texas. They described desires for future water data management and access practices and articulated key attributes of a comprehensive, open access, public water data information system. Next, steps were described to include a subset of workshop participants meeting regularly to further define the goals of a Texas public water data hub, develop a strawman of the hub’s structure, characterize several use cases, and facilitate development of pilot projects that demonstrate the value of connected public water data for improved decision making

Mixture-of-Depths: Dynamically allocating compute in transformer-based language models

Transformer-based language models spread FLOPs uniformly across input sequences. In this work we demonstrate that transformers can instead learn to dynamically allocate FLOPs (or compute) to specific positions in a sequence, optimising the allocation along the sequence for different layers across the model depth. Our method enforces a total compute budget by capping the number of tokens ($k$) that can participate in the self-attention and MLP computations at a given layer. The tokens to be processed are determined by the network using a top-$k$ routing mechanism. Since $k$ is defined a priori, this simple procedure uses a static computation graph with known tensor sizes, unlike other conditional computation techniques. Nevertheless, since the identities of the $k$ tokens are fluid, this method can expend FLOPs non-uniformly across the time and model depth dimensions. Thus, compute expenditure is entirely predictable in sum total, but dynamic and context-sensitive at the token-level. Not only do models trained in this way learn to dynamically allocate compute, they do so efficiently. These models match baseline performance for equivalent FLOPS and wall-clock times to train, but require a fraction of the FLOPs per forward pass, and can be upwards of 50\% faster to step during post-training sampling

Reduction of Na+ within a {Mg2Na2} Assembly

Ionic compounds containing sodium cations are notable for their stability and resistance to redox reactivity unless highly reducing electrical potentials are applied. Here we report that treatment of a low oxidation state {Mg2Na2} species with non‐reducible organic bases induces the spontaneous and completely selective extrusion of sodium metal and oxidation of the MgI centers to the more conventional MgII state. Although these processes are also characterized by a structural reorganisation of the initially chelated diamide spectator ligand, computational quantum chemical studies indicate that intramolecular electron transfer is abetted by the frontier molecular orbitals (HOMO/LUMO) of the {Mg2Na2} ensemble, which arise exclusively from the 3s valence atomic orbitals of the constituent sodium and magnesium atoms

Frequency of reporting on patient and public involvement (PPI) in research studies published in a general medical journal : a descriptive study

Objectives While documented plans for patient and public involvement (PPI) in research are required in many grant applications, little is known about how frequently PPI occurs in practice. Low levels of reported PPI may mask actual activity due to limited PPI reporting requirements. This research analysed the frequency and types of reported PPI in the presence and absence of a journal requirement to include this information. Design and setting A before and after comparison of PPI reported in research papers published in The BMJ before and 1 year after the introduction of a journal policy requiring authors to report if and how they involved patients and the public within their papers. Results Between 1 June 2013 and 31 May 2014, The BMJ published 189 research papers and 1 (0.5%) reported PPI activity. From 1 June 2015 to 31 May 2016, following the introduction of the policy, The BMJ published 152 research papers of which 16 (11%) reported PPI activity. Patients contributed to grant applications in addition to designing studies through to coauthorship and participation in study dissemination. Patient contributors were often not fully acknowledged; 6 of 17 (35%) papers acknowledged their contributions and 2 (12%) included them as coauthors. Conclusions Infrequent reporting of PPI activity does not appear to be purely due to a failure of documentation. Reporting of PPI activity increased after the introduction of The BMJ ’s policy, but activity both before and after was low and reporting was inconsistent in quality. Journals, funders and research institutions should collaborate to move us from the current situation where PPI is an optional extra to one where PPI is fully embedded in practice throughout the research process

Drug screening to identify compounds to act as co-therapies for the treatment of Burkholderia species

Burkholderia pseudomallei is a soil-dwelling organism present throughout the tropics. It is the causative agent of melioidosis, a disease that is believed to kill 89,000 people per year. It is naturally resistant to many antibiotics, requiring at least two weeks of intravenous treatment with ceftazidime, imipenem or meropenem followed by 6 months of orally delivered co-trimoxazole. This places a large treatment burden on the predominantly middle-income nations where the majority of disease occurs. We have established a high-throughput assay for compounds that could be used as a co-therapy to potentiate the effect of ceftazidime, using the related non-pathogenic bacterium Burkholderia thailandensis as a surrogate. Optimization of the assay gave a Z' factor of 0.68. We screened a library of 61,250 compounds and identified 29 compounds with a pIC50 (-log10(IC50)) greater than five. Detailed investigation allowed us to down select to six "best in class" compounds, which included the licensed drug chloroxine. Co-treatment of B. thailandensis with ceftazidime and chloroxine reduced culturable cell numbers by two orders of magnitude over 48 hours, compared to treatment with ceftazidime alone. Hit expansion around chloroxine was performed using commercially available compounds. Minor modifications to the structure abolished activity, suggesting that chloroxine likely acts against a specific target. Finally, an initial study demonstrates the utility of chloroxine to act as a co-therapy to potentiate the effect of ceftazidime against B. pseudomallei. This approach successfully identified potential co-therapies for a recalcitrant Gram-negative bacterial species. Our assay could be used more widely to aid in chemotherapy to treat infections caused by these bacteria