Functional imaging: is the resting brain resting?

It is often assumed that the human brain only becomes active to support overt behaviour. A new study challenges this concept by showing that multiple neural circuits are engaged even at rest. We highlight two complementary hypotheses which seek to explain the function of this resting activity

A Bayesian space–time model for clustering areal units based on their disease trends

Population-level disease risk across a set of non-overlapping areal units varies in space and time, and a large research literature has developed methodology for identifying clusters of areal units exhibiting elevated risks. However, almost no research has extended the clustering paradigm to identify groups of areal units exhibiting similar temporal disease trends. We present a novel Bayesian hierarchical mixture model for achieving this goal, with inference based on a Metropolis-coupled Markov chain Monte Carlo ((MC) 3 ) algorithm. The effectiveness of the (MC) 3 algorithm compared to a standard Markov chain Monte Carlo implementation is demonstrated in a simulation study, and the methodology is motivated by two important case studies in the United Kingdom. The first concerns the impact on measles susceptibility of the discredited paper linking the measles, mumps, and rubella vaccination to an increased risk of Autism and investigates whether all areas in the Scotland were equally affected. The second concerns respiratory hospitalizations and investigates over a 10 year period which parts of Glasgow have shown increased, decreased, and no change in risk

The heavy load: addressing creosote and large debris in the Salish Sea

Remnant creosote treated wood products and other large marine debris are major contributing factors to decreased ecosystem health within the Salish Sea. The wood preservative creosote is a known carcinogen and a significant source of polycyclic aromatic hydrocarbons (PAH). These chemicals persist in sediments and lead to increased forage fish spawn mortality. PAH impacts are amplified through bioaccumulation and directly impact native salmon runs and resident Orca Whales. There is an estimated 650,000 gallons of creosote currently leaching from the remaining 16,000 creosote treated pilings. The hazardous and technical nature of removing creosote logs and large debris does not lend itself to the capabilities of most state and local agencies, community groups, NGO’s, and other volunteer-based removal efforts. In response, the Washington Department of Natural Resources (DNR) Aquatic Lands Restoration Program has developed a program to partner with these groups and eradicate creosote from the Salish Sea while providing rapid response and removal of large debris. Through a broad network of partnerships, specialized equipment, and training, the DNR has become the lead entity for creosote and large debris removal and disposal throughout the state. Since 2004, the DNR has developed Best Management Practices for removal by land, sea, and air. To date, the program has removed over 52 million pounds of marine debris and 296,922 sq. /ft. of overwater structures. With an estimated 35 million pounds of creosote remaining in the ecosystem, the DNR is exploring new technology and partnerships to reach new shoreline property owners and respond to reports of debris from the public

The Decisions and Ideal Points of British Law Lords

Policy-sensitive models of judicial behaviour, whether attitudinal or strategic, have largely passed Britain by. This article argues that this neglect has been benign, because explanations of judicial decisions in terms of the positions of individual judges fare poorly in the British case. To support this argument, the non-unanimous opinions of British Law Lords between 1969 and 2009 are analysed. A hierarchical item-response model of individual judges’ votes is estimated in order to identify judges’ locations along a one-dimensional policy space. Such a model is found to be no better than a null model that predicts that every judge will vote with the majority with the same probability. Locations generated by the model do not represent judges’ political attitudes, only their propensity to dissent. Consequently, judges’ individual votes should not be used to describe them in political terms

Hand hygiene techniques:Still a requirement for evidence for practice?

Introduction Two hand hygiene techniques are promoted internationally: the World Health Organisation’s 6 step and the Centre for Disease Control’s 3 step techniques; both of which may be considered to have suboptimum levels of empirical evidence for use with alcohol based hand rub (ABHR). Objectives The aim of the study was to compare the effectiveness of the two techniques in clinical practice. Methods A prospective parallel group randomised controlled trial (RCT) was conducted with 1:1 allocation of 6 step versus the 3 step ABHR hand hygiene technique in a clinical setting. The primary outcome was residual microbiological load. Secondary outcomes were hand surface coverage and duration. The participants were medical and nursing participants (n=120) in a large teaching hospital. Results The 6 step technique was statistically more effective at reducing the bacterial count 1900cfu/ml (95% CI 1300, 2400cfu/ml) to 380cfu/ml (95% CI 150, 860 cfu/ml) than the 3 step 1200cfu/ml (95% CI 940, 1850cfu/ml) to 750cfu/ml (95% CI 380, 1400cfu/ml) (p=0.016) but even with direct observation by two researchers and use of an instruction card demonstrating the technique, compliance with the 6 step technique was only 65%, compared to 100% compliance with 3 step technique. Further those participants with 100% compliance with 6 step technique had a significantly greater log reduction in bacterial load with no additional time or difference in coverage compared to those with 65% compliance with 6 step technique (p=0.01). Conclusion To our knowledge this is the first published RCT to demonstrate the 6 step technique is superior to the 3 step technique in reducing the residual bacterial load after hand hygiene using alcohol based hand rub in clinical practice. What remains unknown is whether the residual bacterial load after the 3 step technique is low enough to reduce risk of transmission from the hands and whether the 6 step technique can be adapted to enhance compliance in order to maximise reduction in residual bacterial load and reduce duration

Approaching zero : temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus

A restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. Monthly consumption of nine antibiotics was monitored in defined daily doses (DDDs) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. Hospital-acquired Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum -lactamase (ESBL)- producing coliform cases per month/1000 pt-bds were identified and reviewed throughout the hospital. Between the first and final 6 months of the study, average monthly consumption of ceftriaxone reduced by 95% (from 46.213 to 2.129 DDDs/1000 pt-bds) and that for ciprofloxacin by 72.5% (109.804 to 30.205 DDDs/1000 pt-bds). Over the same periods, hospital-acquisition rates for C. difficile reduced by 77% (2.398 to 0.549 cases/1000 pt-bds), for MRSA by 25% (1.187 to 0.894 cases/1000 pt-bds) and for ESBL-producing coliforms by 17% (1.480 to 1.224 cases/1000 pt-bds). Time-lag modelling confirmed significant associations between ceftriaxone and C. difficile cases at 1 month (correlation 0.83; P < 0.005), and between ciprofloxacin and ESBL-producing coliform cases at 2 months (correlation 0.649; P = 0.002). An audit performed 3 years after the policy showed sustained reduction in C. difficile rates (0.259 cases/1000 pt-bds), with additional decreases for MRSA (0.409 cases/1000 pt-bds) and ESBL-producing coliforms (0.809 cases/1000 pt-bds). In conclusion, banning two antibiotics resulted in an immediate and profound reduction in hospital-acquired C. difficile, with possible longer-term effects on MRSA and ESBL-producing coliform rates. Antibiotic stewardship is fundamental in the control of major hospital pathogens

Digital Weberianism: Bureaucracy, Information, and the Techno-rationality of Neoliberal Capitalism

The social infrastructures that constitute both public and private administration are increasingly entangled with digital data, big data, and algorithms. While some argue that these technologies have blown apart the strictures of bureaucratic order, we see more subtle changes at work. We suggest that far from a radical rupture, in today's digitising society, there are strong traces of the logic and techniques of Max Weber's bureau; a foundational concept in his account of the symbiotic relationship between modernity, capitalism and social order

The Impact of Short Breaks on Families with a Disabled Child: Report One of the Quantitative Phase

This document reports on a cross-sectional sample of families with a disabled child using short breaks in England; it describes the characteristics of children and families using short breaks, the nature and quantity of the short breaks they are using, their experiences of and satisfaction with short breaks and which factors are associated with a range of outcomes for family carers, disabled children and their siblings. This report uses both quantitative data derived from standardised questions and qualitative data from family members’ written responses to open-ended questions in the survey instruments

The impacts of short break provision on disabled children and families: an international literature review

For over 30 years, short breaks have been part of the landscape of support provision for families with a disabled child. Historically, the term ‘respite care’ has been used in much of the research literature concerning short breaks for families with a disabled child. However, ‘short breaks’ has become the preferred term, partly due to the negative connotations of family carers requiring ‘respite’ from their children, and partly because short breaks now encompass a much wider range of supports than out-of-home placement in specialist residential facilities (Cramer and Carlin, 2008). As such, the term ‘short breaks’ will be used throughout this review, with the exception of direct quotes from research studies where the term ‘respite’ is used by study participants or study authors