Malnutrition from poor diet is a persistent issue in Sri Lanka, especially among women and children. High rates of undernutrition and micronutrient deficiencies are documented among rural poor communities(1). Household food production may enhance maternal and child nutrition directly by increasing access to diverse foods and indirectly by providing income to diversify diets(2). This study explores the cross-sectional relationship between household food production and individual dietary diversity among women aged 18-45 years and children aged 2-5 years in Batticaloa district, Sri Lanka. We randomly selected 450 low-income mother-child pairs receiving a Samurdhi subsidiary, having a home garden. Through face-to-face interview, we gathered information on the types of crops grown and livestock reared in the preceding 12 months. Production quantity and utilization were also detailed. Additionally, socio-demographic information and market access were obtained. To measure women’s dietary diversity (DD), we used a scale based on 10-food groups and a 7-food group scale for children. Women who consumed five or more food groups were defined as meeting the Minimum Dietary Diversity of Women (MDD-W), whereas children who consumed of four or more food groups met the minimum standards. Multiple linear regression and binary logistic regression were used to identify the factors predicting individual DD. Complete data for 411 pairs were analysed. The results showed, only 15.3% of the women met MDD-W, with a mean DDS of 3.3 (SD = 1.2). Children had a mean DDS of 3.3 (SD = 1.2), and 41.1% of them met the minimum diversity. Regression analysis indicated that growing leafy vegetables was positively associated with increased dietary diversity of women (β = 0.337; 95% CI: 0.13, 0.54; p = 0.001) and children (β = 0.234; 95% CI: 0.05, 0.42; p = 0.013) but not with meeting the minimum diversity. Moreover, monthly income above 35,000 LKR, higher education level, a secondary income source andfood security were also positively associated with women’s DD. Conversely, living further away from the main road reduced the women’s DD. Interestingly, livestock ownership was only associated with women meeting the MDD-W, but not for children. For children, monthly income was a strong predictor of DD and meeting minimum diversity. Surprisingly, living far from the market was associated with increased DD in children (β = 0.018; 95% CI: 0.01, 0.03; p = 0.013), while distance to main road had a similar effect as in women. Notably, selling their produce at the market contributed to meeting the minimum dietary diversity in children (β = 0.573; 95% CI: 0.14, 1.02; p = 0.013). These findings suggest that enhancing household food production could play a crucial role in improving dietary diversity and addressing malnutrition, particularly in rural Sri Lankan communities, and potentially in other similar settings.

Micronutrient malnutrition is a public health concern in many developing countries including Sri Lanka. Rural poor households are more vulnerable to micronutrient malnutrition due to their monotonous rice-based diet, which lacks dietary diversification(1). Despite the potential of home gardens on increased food access and diversity, their contribution to household dietary diversity remains unclear. This study aimed to investigate the impact of home gardens on diet diversity among rural Sri Lankan households. Low-income households with children under five were randomly selected from the Samurdhi beneficiary list, and 450 households having a home garden agreed to be interviewed. We collected information on types of crops and livestock produced over the past 12 months and their utilisation. We also collected the socio-demographic characteristics of the households. We measured household dietary diversity using the Household Dietary Diversity Score (HDDS) based on FAO guidelines. Multiple linear regression was used to identify the predictors of HDDS. Complete data sets were only available for 411 households and were included in the analysis. The HDDS ranged from 3 to 10 with a mean of 6.4 (±1.37 SD) indicating a moderate level of dietary diversity. However, only 20.4% of the households met the adequacy threshold, which is higher than the third quartile(2). Cereals, and fats and oils were the only food groups consumed by all the households. Although many households produced fruits (67.2%) and reared livestock (48.2%), the consumption of these groups were the lowest among the 12 food groups. Predictors of HDDS included monthly household income which had a strong positive relationship, especially earnings above 35,000 LKR (β = 1.02; S.E = 0.246; p = 0.000). Surprisingly, living far from the market was associated with increased HDDS (β = 0.026; S.E = 0.008; p = 0.004). Conversely, living further away from the main road reduced the HDDS (β = −0.133; S.E = 0.049; p = 0.007). Growing staples reduced the HDDS (β = −0.395; S.E = 0.174; p = 0.023), whereas growing leafy vegetables increased the diet diversity (β = 0.394; S.E = 0.154; p = 0.010). Selling homegrown products also increased HDDS (β = 0.276; S.E = 0.136; p = 0.043). However, other covariates such as the education level of the female adult, household food security status, home garden yield (kg), and livestock richness, which showed significant correlation in the bivariate analysis did not significant in the multiple regression analysis. Although all households in this district engage in some form of home gardening, 79.6% of households did not have adequate dietary diversity. There is a need to understand how home gardens can better contribute to dietary diversity.

We examine a variant of ultimatum bargaining in which principals may delegate their proposal decision to agents hired from a competitive market. Contrary to several prior studies, we find that when principals must use agents, the resulting proposals are significantly higher than when principals make proposals themselves. In reconciling our results with prior findings, we conclude that both the rejection power afforded to responders and the structure of principal-agent contracts can play significant roles in the nature of outcomes under delegated bargaining.

Background: Frailty and sarcopenia predict worse surgical outcomes among spinal degenerative and deformity-related populations; this association is less clear in the context of spinal oncology. Here, we identified frailty and sarcopenia tools applied in spinal oncology and appraised their clinimetric properties. Methods: A systematic review was conducted from January 1st, 2000, until June 2022. Study characteristics, frailty tools, measures of sarcopenia, component domains, individual items, cut-off values, and measurement techniques were collected. Clinimetric assessment was performed according to Consensus-based Standards for Health Measurement Instruments. Results: Twenty-two studies were included (42,514 patients). The three most employed frailty tools were the Metastatic Spine tumor Frailty Index (MSTFI), Modified Frailty Index-11 (mFI-11), and the mFI-5. The three most common sarcopenia measures were the L3-Total Psoas Area (TPA)/Vertebral Body Area (VBA), L3-TPA/Height2, and L3-Spinal Muscle Index (L3-Cross-Sectional Muscle Area/Height2). Frailty and sarcopenia measures lacked content and construct validity. Positive predictive validity was observed in select studies employing the HFRS, mFI-5, MSTFI, and L3-TPA/VBA. All frailty tools had floor or ceiling effects. Conclusions: Existing tools for evaluating frailty and sarcopenia in surgical spine oncology have poor clinimetric properties. Here, we provide a pragmatic approach to utilizing existing frailty and sarcopenia tools, until more clinimetrically robust instruments are developed.

We performed a literature review to describe the risk of surgical-site infection (SSI) in minimally invasive surgery (MIS) compared to standard open surgery. Most studies reported decreased SSI rates among patients undergoing MIS compared to open procedures. However, many were observational studies and may have been affected by selection bias. MIS is associated with reduced risk of surgical-site infection compared to standard open surgery and should be considered when feasible.

We evaluated diagnostic test and antibiotic utilization among 252 patients from 11 US hospitals who were evaluated for coronavirus disease 2019 (COVID-19) pneumonia during the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant pandemic wave. In our cohort, antibiotic use remained high (62%) among SARS-CoV-2–positive patients and even higher among those who underwent procalcitonin testing (68%).

Spatially resolved transcriptomics (SRT) is a growing field that links gene expression to anatomical context. SRT approaches that use next-generation sequencing (NGS) combine RNA sequencing with histological or fluorescent imaging to generate spatial maps of gene expression in intact tissue sections. These technologies directly couple gene expression measurements with high-resolution histological or immunofluorescent images that contain rich morphological information about the tissue under study. While broad access to NGS-based spatial transcriptomic technology is now commercially available through the Visium platform from the vendor 10× Genomics, computational tools for extracting image-derived metrics for integration with gene expression data remain limited. We developed VistoSeg as a MATLAB pipeline to process, analyze and interactively visualize the high-resolution images generated in the Visium platform. VistoSeg outputs can be easily integrated with accompanying transcriptomic data to facilitate downstream analyses in common programing languages including R and Python. VistoSeg provides user-friendly tools for integrating image-derived metrics from histological and immunofluorescent images with spatially resolved gene expression data. Integration of this data enhances the ability to understand the transcriptional landscape within tissue architecture. VistoSeg is freely available at http://research.libd.org/VistoSeg/.

Background: Frailty is increasingly recognized for an association with adverse events, mortality, and hospital discharge disposition among surgical patients. The purpose of this study was to describe how spinal surgeons conceptualize, define, and assess frailty in the context of spinal metastatic disease (SMD). Methods: We conducted an international, cross-sectional, 33-question survey of the AO Spine community. The survey was developed using a modified Delphi technique and was designed to elucidate preoperative surrogate markers of frailty in the context of SMD. Responses were ranked using weighted averages. Consensus was defined as ≥ 70% agreement among respondents. Results: Results were analyzed for 312 respondents (86% completion rate). Study participants represented 71 countries. Most respondents informally assess frailty in patients with SMD by forming a general perception based on clinical condition and patient history. Consensus was attained regarding the association between 14 clinical variables and frailty. Severe comorbidities, systemic disease burden, and poor performance status were most associated with frailty; severe comorbidities included high-risk cardio-pulmonary disease, renal failure, liver failure, and malnutrition. Conclusions: Surgeons recognized frailty is important but commonly evaluate it based on general clinical impression rather than using existing frailty tools. We identified preoperative surrogate markers of frailty perceived as most relevant in this population.

Diagnosing the evolution of laser-generated high energy density (HED) systems is fundamental to develop a correct understanding of the behavior of matter under extreme conditions. Talbot–Lau interferometry constitutes a promising tool, since it permits simultaneous single-shot X-ray radiography and phase-contrast imaging of dense plasmas. We present the results of an experiment at OMEGA EP that aims to probe the ablation front of a laser-irradiated foil using a Talbot–Lau X-ray interferometer. A polystyrene (CH) foil was irradiated by a laser of 133 J, 1 ns and probed with 8 keV laser-produced backlighter radiation from Cu foils driven by a short-pulse laser (153 J, 11 ps). The ablation front interferograms were processed in combination with a set of reference images obtained ex situ using phase-stepping. We managed to obtain attenuation and phase-shift images of a laser-irradiated foil for electron densities above ${10}^{22}\;{\mathrm{cm}}^{-3}$. These results showcase the capabilities of Talbot–Lau X-ray diagnostic methods to diagnose HED laser-generated plasmas through high-resolution imaging.

The use of farrowing crates is increasingly questioned from an animal welfare point of view. Even so, since a number of attempts to develop loose farrowing systems have been unsuccessful, leading to high levels of piglet mortality due in the main to crushing, many farmers remain sceptical as to whether or not alternative systems can be viable. On the other hand, several European countries have introduced legislation requiring loose farrowing systems, thus promoting research into this type of housing and allowing for performance studies based on large samples of commercial farms. As a consequence of these recent developments, we think it timely to reconsider the evidence available on loose farrowing systems. In our review, we first address the normal peri-parturient behaviour of domestic pigs, as well as studies comparing behaviour and stress physiology in sows kept in both crates and loose systems during farrowing. We then review approaches taken to develop alternative farrowing systems in different countries, and focus lastly on pen, piglet and sow characteristics that contribute to piglet survival in loose farrowing systems. Taking scientific evidence as well as practical experience into account, we conclude that piglet mortality in loose farrowing systems need not exceed that of crate systems. To obtain good performance results, sows due to farrow should be kept individually in sufficiently large pens, structured for preference into a nest area and an activity area. Furthermore, both management and breeding aspects, resulting in high piglet viability and good maternal behaviour, are essential to achieve high production in loose farrowing systems.

Crating sows in farrowing systems greatly restricts their normal behaviour, which is usually justified by the assumption that piglet mortality is higher with loose-housed sows. Based on experiments showing that this is not the case, farrowing crates were banned in Switzerland in 1997. Since then, many farms have introduced loose farrowing systems, enabling a comparison of piglet mortality in farrowing systems with and without crates based on a large sample size. Data of a sow-recording scheme (UFA2000) were analysed using generalised linear mixed-effects models with an underlying Poisson distribution. In 2002 and 2003, the average total piglet mortality on 173 farms (n = 18,824 litters) with loose farrowing systems amounted to 1.40 piglets per litter and did not differ from that of 482 farms (n = 44,837 litters) with crates (1.42 piglets per litter). Nevertheless, the number of crushed piglets was significantly higher in pens with loose-housed sows (0.62 versus 0.52 piglets per litter), whereas the number of piglets that died for other reasons was significantly higher in crates (0.78 versus 0.89 piglets per litter). Total piglet mortality was influenced by litter size at birth, age of the sow and season. Consequently, evaluation of the reproductive data of commercial farms shows that no more piglet losses occur in loose farrowing pens, common nowadays in Switzerland, than in farrowing pens with crates, and that litter size at birth is the main influence on piglet losses.

Morally challenging decisions tend to be perceived as difficult by decision makers and often lead to post-decisional worry or regret. To test potential causes of these consequences, we employed realistic, morally challenging scenarios with two conflicting choice options. In addition to respondents’ choices, we collected various ratings of choice options, decision-modes employed, as well as physiological arousal, assessed via skin conductance. Not surprisingly, option ratings predicted choice, such that the more positively rated option was chosen. However, respondents’ self-reported decision modes also independently predicted choice. We further found that simultaneously engaging in decision modes that predict opposing choices increased decision difficulty and post-decision worry. In some cases this was related to increased arousal. Results suggest that at least a portion of the negative consequences associated with morally challenging decisions can be attributed to conflict in the decision modes one engages in.

Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, “asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.