The Scientific Advisory Committee on Nutrition (SACN) provides independent advice on nutrition and related health matters to UK government organisations. In keeping with its commitment to openness and transparency, SACN follows a set ‘Framework’ to ensure a prescribed and consistent approach is taken in all its evidence evaluations. Following an update of the SACN Framework in 2020, which addressed some straightforward issues, the SACN Framework subgroup was established in 2021 to consider more complex matters that were not addressed in the 2020 update. The SACN Framework subgroup considered 4 main topics for update: 1) the different types of evidence evaluations produced by SACN, 2) interpretation of statistical data, 3) tools for assessment of study quality, 4) tools to assess the certainty of a body of evidence for exposure-outcome relationships. The Framework subgroup agreed clear definitions and processes for the different types of evidence evaluations produced by SACN and agreed that interpretation of p values should be informed by consideration of study size, power and methodological quality. The subgroup recommended use of the AMSTAR 2 tool for quality assessment of evidence from systematic reviews and use of the GRADE approach to assess the certainty of evidence. The updated Framework was published in January 2023. This was followed by publication of a further update in October 2024. As a ‘living’ document, the Framework will be subject to regular review by the Framework subgroup and continue to evolve in line with best practice.

Background: Meningiomas can lead to significant morbidity and mortality and have recurrence potential despite their benign classification. The precise location of the recurrence has not been delineated. The objective of this study was to determine any spatial clustering of recurrence for surgically treated Grade 1 meningiomas. Methods: Patients diagnosed with Grade 1 meningiomas and treated with surgical resection with recurrence were reviewed. Patient demographics, presentation, extent of resection, time to recurrence, and location were established by medical records. Outcomes were the time to recurrence and location relative to the original surgical bed. Results: Among the 42 cases that met the study inclusion criteria, 12 were male and 30 were female. The mean age at treatment was 49.7 years, and the mean years until recurrence was 5.2 years. 33 (68.8%) tumours recurred locally, 12 (25.0%) recurred at the periphery (<1cm of the surgical bed), and 3 (6.3%) recurred distal to the resection site. Conclusions: A sizeable portion of cases may benefit from therapy directed beyond the resection margin. It may be more successful to prevent recurrence in these patients by performing a more aggressive resection of the dural attachment surrounding the tumour and/or focusing adjuvant therapy on the area surrounding the resection cavity.

Objectives: Over the past 2 years, many infection prevention and control (IPC) resources have been diverted to manage the COVID-19 pandemic. Its impact on the incidence of antimicrobial-resistant organisms has not been adequately studied. We investigated the impact of the pandemic on the incidence of carbapenem-resistant Enterobacterales (CRE) in Singapore. Methods: We extracted data on unique CRE isolates (clinical and/or surveillance cultures) and patient days for 6 public hospitals in Singapore from the carbapenemase-producing Enterobacteriaceae (CaPES) study group database, and we calculated the monthly incidence of CRE (per 10,000 patient days). Interrupted time-series (ITS) analysis was conducted with the pre–COVID-19 period defined as before February 2020, and the COVID-19 period defined as after February 2020. Statistical analyses were performed using Stata version 15 software. Results: From January 2017 to March 2021, 6,770 CRE isolates and 9,126,704 patient days were documented. The trend in CRE monthly incidence increased significantly during the pre–COVID-19 period (0.060; 95% CI, 0.033–0.094; P < .001) but decreased during the COVID-19 period (−0.183; 95% CI, −0.390 to 0.023; P = .080) without stepwise change in the incidence (−1.496; 95% CI, −3.477 to 0.485; P = .135). The trend in monthly incidence rate of CRE clinical cultures increased significantly during the pre–COVID-19 period (0.046; 95% CI, 0.028–0.064; P < .001) and decreased significantly during COVID-19 period (−0.148; 95% CI, −0.249 to −0.048; P = .048) with no stepwise change in the incidence (−0.063; 95% CI, −0.803 to 0.677; P = .864). The trend in monthly incidence rate of CRE surveillance cultures decreased during the pre–COVID-19 period (−0.020; 95% CI, −0.062 to 0.022; P = .341) and the COVID-19 period (−0.067; 95% CI, −0.291to 0.158; P = .552) without stepwise change in the incidence (−1.327; 95% CI, −3.535 to 0.881; P = .233). Conclusions: The rate of CRE in clinical cultures decreased during COVID-19 but not the rate in surveillance cultures. Further studies are warranted to study the impact of COVID-19 on CREs.

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Faraday complexity describes whether a spectropolarimetric observation has simple or complex magnetic structure. Quickly determining the Faraday complexity of a spectropolarimetric observation is important for processing large, polarised radio surveys. Finding simple sources lets us build rotation measure grids, and finding complex sources lets us follow these sources up with slower analysis techniques or further observations. We introduce five features that can be used to train simple, interpretable machine learning classifiers for estimating Faraday complexity. We train logistic regression and extreme gradient boosted tree classifiers on simulated polarised spectra using our features, analyse their behaviour, and demonstrate our features are effective for both simulated and real data. This is the first application of machine learning methods to real spectropolarimetry data. With 95% accuracy on simulated ASKAP data and 90% accuracy on simulated ATCA data, our method performs comparably to state-of-the-art convolutional neural networks while being simpler and easier to interpret. Logistic regression trained with our features behaves sensibly on real data and its outputs are useful for sorting polarised sources by apparent Faraday complexity.

Gonorrhoea cases in women have been rising in Australia in the 2010s but the cause of the increase is not well understood. This cross-sectional study aimed to describe the characteristics of genital gonorrhoea infection in women attending the Melbourne Sexual Health Centre, Australia. Gonorrhoea cases were diagnosed by nucleic acid amplification test (NAAT) and/or culture. Genitourinary specimens were obtained in 12 869 clinic visits in women aged 16 years or above between August 2017 and August 2018. Genital gonorrhoea was detected in 142 (1.1%) of the visits. Almost half of the cases were asymptomatic, 47.9% [95% confidence interval (CI) 39.8–56.1%]; yellow, green or pus-like vaginal discharge was present in 11.3% (95% CI 7.0–17.6%) and other genital symptoms in 40.8% (95% CI 33.1–49.1%) of the cases. The mean time between last sexual contact and onset of symptoms was 7.3 days and between the onset of symptoms to presentation to the clinic was 12.1 days. Half of the cases of genital gonorrhoea among women are asymptomatic and these cases would have been missed by testing of only symptomatic women. Further epidemiological and behavioural research is required to understand the temporal changes in sexual practices among women in Australia.

This paper presents Parallel World Framework as a solution for simulations of complex systems within a time-varying knowledge graph and its application to the electric grid of Jurong Island in Singapore. The underlying modeling system is based on the Semantic Web Stack. Its linked data layer is described by means of ontologies, which span multiple domains. The framework is designed to allow what-if scenarios to be simulated generically, even for complex, inter-linked, cross-domain applications, as well as conducting multi-scale optimizations of complex superstructures within the system. Parallel world containers, introduced by the framework, ensure data separation and versioning of structures crossing various domain boundaries. Separation of operations, belonging to a particular version of the world, is taken care of by a scenario agent. It encapsulates functionality of operations on data and acts as a parallel world proxy to all of the other agents operating on the knowledge graph. Electric network optimization for carbon tax is demonstrated as a use case. The framework allows to model and evaluate electrical networks corresponding to set carbon tax values by retrofitting different types of power generators and optimizing the grid accordingly. The use case shows the possibility of using this solution as a tool for CO2 reduction modeling and planning at scale due to its distributed architecture.

A Philips EM-200 electron microscope has been modified to incorporate two electron guns as described by Ong and Gold, for operation in the conventional (TEM) and scanning (SEM) mode.

The second gun, the SEM gun, is mounted below the viewing chamber and uses the imaging system of the microscope as the probe forming electron optic. The electrons follow essentially the same path as the image forming electrons for TEM, only in the opposite direction.

The modifications to the microscope column are designed to provide the space for the scanning coil assembly, the various detectors, and the second gun. A spacer is located above the objective lens to house the transmission electron detector, another spacer, below the objective lens, incorporates the scanning coil and a secondary electron detector.

Many biological processes are partitioned among organs and tissues, necessitating tissue-specific or organ-specific analysis (particularly for comparative -omics studies). Standardised techniques for tissue identification and dissection are therefore imperative for comparing among studies. Here we describe dissection protocols for isolating six key tissues/organs from larvae of the Asian longhorned beetle, Anoplophora glabripennis (Motschulsky) (Coleoptera: Cerambycidae): the supraoesophageal ganglion, posterior midgut, hindgut, Malpighian tubules, fat body, and thoracic muscle. We also describe how to extract haemolymph and preserve whole larvae for measurements such as protein, lipid, and carbohydrate content. We include dissection protocols for both fresh-killed and previously frozen specimens. Although this protocol is developed for A. glabripennis, it should allow standardised tissue collection from larvae of other cerambycids and be readily transferrable to other beetle taxa with similar larval morphology.

Background: Hemolysis of blood samples is the leading cause of specimen rejection from hospital laboratories. It contributes to delays in patient care and disposition decisions. Coagulation tests (prothrombin time/international normalized ratio [PT/INR] and activated partial thromboplastin time [aPTT]) are especially problematic for hemolysis in our academic hospital, with at least one sample rejected daily from the emergency department (ED). Aim Statement: We aimed to decrease the monthly rate of hemolyzed coagulation blood samples sent from the ED from a rate of 2.9% (53/1,857) to the best practice benchmark of less than 2% by September 1st, 2019. Measures & Design: Our outcome measure was the rate of hemolyzed coagulation blood samples. Our process measure was the rate of coagulation blood tests sent per 100 ED visits. Our balancing measure was the number of incident reports by clinicians when expected coagulation testing did not occur. We used monthly data for our Statistical Process Control (SPC) charts, as well as Chi square and Mann-Whitney U tests for our before-and-after evaluation. Using the Model for Improvement to develop our project's framework, we used direct observation, broad stakeholder engagement, and process mapping to identify root causes. We enlisted nursing champions to develop our Plan-Do-Study-Act (PDSA) cycles/interventions: 1) educating nurses on hemolysis and coagulation testing; 2) redesigning the peripheral intravenous and blood work supply carts to encourage best practice; and 3) removing PT/INR and aPTT from automatic inclusion in our electronic chest pain bloodwork panel. Evaluation/Results: The average rate of hemolysis remained unchanged from baseline (2.9%, p = 0.83). The average rate of coagulation testing sent per 100 ED visits decreased from 41.5 to 28.8 (absolute decrease 12.7 per 100, p < 0.05), avoiding $4,277 in monthly laboratory costs. The SPC chart of our process measure showed special cause variation with greater than eight points below the centerline. Discussion/Impact: Our project reduced coagulation testing, without changing hemolysis rates. Buy-in from frontline nurses was integral to the project's early success, prior to implementing our electronic approach – a solution ranked higher on the hierarchy of intervention effectiveness – to help sustainability. This resource stewardship project will now be spread to a nearby institution by utilizing similar approaches.

Background: Focal cortical dysplasias (FCDs) are congenital structural abnormalities of the brain, and represent the most common cause of medication-resistant focal epilepsy in children and adults. Recent studies have shown that somatic mutations (i.e. mutations arising in the embryo) in mTOR pathway genes underlie some FCD cases. Specific therapies targeting the mTOR pathway are available. However, testing for somatic mTOR pathway mutations in FCD tissue is not performed on a clinical basis, and the contribution of such mutations to the pathogenesis of FCD remains unknown. Aim: To investigate the feasibility of screening for somatic mutations in resected FCD tissue and determine the proportion and spatial distribution of FCDs which are due to low-level somatic mTOR pathway mutations. Methods: We performed ultra-deep sequencing of 13 mTOR pathway genes using a custom HaloPlexHS target enrichment kit (Agilent Technologies) in 16 resected histologically-confirmed FCD specimens. Results: We identified causal variants in 62.5% (10/16) of patients at an alternate allele frequency of 0.75–33.7%. The spatial mutation frequency correlated with the FCD lesion’s size and severity. Conclusions: Screening FCD tissue using a custom panel results in a high yield, and should be considered clinically given the important potential implications regarding surgical resection, medical management and genetic counselling.

Background: We assessed long-term health-related quality of life (HRQoL) and functioning in adults receiving onabotulinumtoxinA for CM. Methods: Interim analysis of multicentre, prospective, observational study in adults naïve to botulinum toxin (NCT02502123). Mean change from baseline in Migraine-Specific Quality of Life (MSQ) score (primary); healthcare resource utilization (HRU) and work productivity (secondary) assessed in patients receiving 4 of 7 onabotulinumtoxinA treatments (Tx4; ~10 months). Results: Across treatments (baseline, n=196, post-Tx2, n=173, post-Tx4, n=137), the mean (SD) between-session interval and onabotulinumtoxinA dose was 13.1 weeks and 170.4 (17.2) U, respectively. MSQ scores increased significantly (P<0.0001) (baseline to post-Tx4; all role function domains). Patient percentages declined from baseline to post-Tx2 and post-Tx4 for emergency room visits (17.3%; 9.3%; 6.6%), hospital admissions (3.6%; 2.9%; 1.5%), and headache-related diagnostic testing (35.9%; 15.9%; 8.1%). The percentages of patients employed at baseline (73.5%) and post-Tx4 (72.3%) were similar. Hours worked increased slightly from baseline to post-Tx4 (28.0 [SD=15.4]; 29.4 [SD=16.0]). Headache-related missed work hours decreased (5.9 [SD=9.5]; 2.5 [SD=5.9]). Patients reported less headache-related impact on work productivity from baseline to post-Tx4 (5.4 [SD=2.1] vs 3.9 [SD=2.6]) and ability to perform daily activities (6.1 [SD=2.1] vs 4.2 [SD=2.8]). Conclusions: OnabotulinumtoxinA for CM improved HRQoL and work productivity and reduced HRU.