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Faith-based missions have played a large role in surgical care delivery in low- and middle-income countries (LMIC). As global surgery is now an academic discipline, this pilot study sought to understand how different faith ideologies influence surgeon motivations and subsequent culture of the global surgery landscape. Interviews were conducted with North American surgeons who pursue global surgery significantly in their career. Points of discussion included early influences, obstacles, motivations, philosophy and approach to global surgery work, and experiences with faith-based (FBO) and non-faith-based organizations (NFBO). Notes were transcribed and thematic analysis performed. Sixteen surgeons were interviewed (11 men, 5 women, ages 39–75 years-old). Surgeons had worked in 32 countries with FBO and NFBO in intermittent or long-term capacity. Religious upbringing and current affiliations included Atheism, Protestant Christianity, Catholicism, Hinduism, Judaism, Mormonism, Islam, and nonreligious spirituality. Early influences included international upbringing (n = 7), emphasis on service (n = 9), and exposure to the religious mission concept (n = 6). The most common core motivation among all participants was addressing disparities (n = 10). Some believed that FBO and NFBO have different goals (n = 4), and only surgeons identifying with Christianity believed the goals are similar (n = 3). Participants expressed that FBO are exclusive (n = 4) and focused on proselytization (n = 6) while NFBO are humanitarian (n = 3) but less integrated into the community (n = 4). Global surgeons have shared early influences, obstacles, and desire to address disparities. Perceptions of FBO and NFBO differed based on religious background. This pilot study will inform future studies regarding the collaborations of FBO and NFBO to improve global surgical care.

Introduction There is a shortage of data on intimate partner and interpersonal violence in sub-Saharan Africa. We, therefore, sought to characterize patterns of sex-based risk of in-home interpersonal violence in Malawi. Methods We performed a retrospective analysis of the Kamuzu Central Hospital Trauma Registry data from 2009 to 2017 on adult patients presenting the emergency room following assault. Data variables collected include basic demographics, injury characteristics, and outcomes. We performed a bivariate analysis for covariates based on sex and Poisson regression analysis to estimate the risk of domestic violence and sex-based mortality. Results The in-home assault interpersonal violence was 37.1% (n = 10,854) of the total assault cohort and 37.4% (n = 4056) were female. Women were more likely to be assaulted at home (n = 4065, 69.6%)compared to men. The overall prevalence of in-home interpersonal violence over eight years was 9.09%, with the prevalence in men and women being 7.85 and 12.38%, respectively. Women injured following in-home interpersonal violence assaults were less severely injured. Women were more likely to be injured following slaps, punches, or kicks (n = 950, 41.2%) and men were more likely to be injured by an object, 41.0% with a blunt object (n = 1658) and 37.9% by a knife or another sharp object (n = 1532). For patients experiencing in-home interpersonal violence, overall mortality is 1.8% and 0.5% for men and women, respectively (p, African relevance • In-home interpersonal violence is a global phenomenon • There is a higher incidence on women than in men at 12.38 and 7.85 %, respectively • We show a higher mortality following in home interpersonal violence in men. • The prevalence of in home interpersonal violence is likely underestimated.

The true incidence of congenital anomalies in sub-Saharan Africa is unknown. Owing to complex challenges associated with congenital anomalies, many affected babies may never present to a health facility, resulting in an underestimation of disease burden.Interviews were conducted with Ugandans between September 2018 and May 2019. Responses from community members versus families of children with congenital anomalies were compared.A total of 198 Ugandans were interviewed (91 family members, 80 community members). All participants (N = 198) believed that seeking surgical care would lead to poverty, 43% (n = 84) assumed fathers would abandon the child, and 26% (n = 45) thought a child with a congenital anomaly in their community had been left to die. Causes of anomalies were believed to be contraceptive methods (48%, n = 95), witchcraft (17%, n = 34), or drugs (10%, n = 19). Of family members, 25 (28%) were advised to allow the child to die. Families with affected children were more likely to have a lower income (P.001), believe anomalies could be treated (P = .007), but thought that allowing the child to die was best for the family (32% vs 9%; P.0001). Monthly household income50,000 Uganda shillings ($13 United States dollars) was a significant predictor of the father leaving the family (P = .024), being advised to not pursue medical care (P = .046), and believing that God should decide the child's fate (P = .047).Families face significant financial and social pressures when deciding to seek surgical care for a child with a congenital anomaly. Many children with anomalies may die and never reach a health facility to be counted, thus contributing to a hidden mortality.

Modern global surgery, which aims to provide improved and equitable surgical care worldwide, is a product of centuries of international care initiatives, some borne out of religious traditions, dating back to the first millennium. The first hospitals ( xenodochia) were established in the 4th and 5th centuries CE by the early Christian church. Early “missions,” a term introduced by Jesuit Christians in the 16th century to refer to the institutionalized expansion of faith, included medical care. Formalized Muslim humanitarian medical care was marked by organizations like the Aga Khan Foundation and the Islamic Association of North America in the 20th century. Secular medical humanitarian programs developed in the 19th century, notably with the creation of the International Committee of the Red Cross (1863) and the League of Nations Health Organization (1920) (which later became the World Health Organization [1946]). World War II catalyzed another proliferation of nongovernmental organizations, epitomized by the quintessential humanitarian health provider, Médecins Sans Frontières (1971). “Global health” as an academic endeavor encompassing education, service, and research began as an outgrowth of departments of tropical medicine and international health. The American College of Surgeons brought a surgical focus to global health beginning in the 1980s. Providing medical care in distant countries has a long tradition that parallels broad themes in history: faith, imperialism, humanitarianism, education, and service. Surgery as a focus of academic global health is a recent development that continues to gain traction.

Accurately mapping individual tree species in densely forested environments is crucial to forest inventory. When considering only RGB images, this is a challenging task for many automatic photogrammetry processes. The main reason for that is the spectral similarity between species in RGB scenes, which can be a hindrance for most automatic methods. This paper presents a deep learning-based approach to detect an important multi-use species of palm trees (Mauritia flexuosa; i.e., Buriti) on aerial RGB imagery. In South-America, this palm tree is essential for many indigenous and local communities because of its characteristics. The species is also a valuable indicator of water resources, which comes as a benefit for mapping its location. The method is based on a Convolutional Neural Network (CNN) to identify and geolocate singular tree species in a high-complexity forest environment. The results returned a mean absolute error (MAE) of 0.75 trees and an F1-measure of 86.9%. These results are better than Faster R-CNN and RetinaNet methods considering equal experiment conditions. In conclusion, the method presented is efficient to deal with a high-density forest scenario and can accurately map the location of single species like the M flexuosa palm tree and may be useful for future frameworks.

In cotton cultivars, an insect that causes irreversible damage is the Spodoptera frugiperda, known as the fall armyworm. Since the visual detection of plants is a burdensome task for human inspection, the spectral information related to plant damage, registered on a spectral scale, can be useful. These measurements, associated with machine learning techniques, produce useful information for a rapid and non-invasive inspection method development. To contribute to this gap fulfillment, this paper proposes a machine learning framework to model the spectral response of cotton plants under the attack of the fall armyworm. Additionally, a theoretical model is presented, built from the results of the machine learning analysis, to infer this damage with up-to-date orbital sensors. The data was composed of the reflectance measurements collected at a cotton field with control plants and plants submitted to Spodoptera frugiperda damage. Their spectral response was recorded with a hand-held spectroradiometer ranging from 350 to 2,500 nm, for eight consecutive days. Different machine learning models were evaluated and the overall best model was defined by accuracies comparisons on a testing-set. A ranking approach was adopted based on the model accuracy, returning the most contributive wavelengths for the classification. Sequentially, an unsupervised neural network (Self-Organizing Map - SOM) was implemented to reduce data-dimensionality and assist in the definition of important spectral regions. The regions were associated with the spectral bands of the two sensors (OLI and MSI) and a theoretical model using a band simulation process with the overall best machine learning model was proposed. The results indicated that the Random Forest (RF) algorithm is the most suitable to predict cotton-plants damaged by insects and that the last day of analysis (8th day) was better to separate it, with F-measure equals 0.912. The ranking approach combined with the SOM method indicated the spectral regions at the red to near-infrared (650 to 1,350 nm) and shortwave infrared (1,570 to 1,640 nm) as the most important regions to the analysis. The proposed theoretical model simulated with the OLI and MSI sensor-bands returned an F-Measure of 0.865 and 0.886, respectively. In conclusion, this framework can be used to map cotton-plants under insect-attack. The theoretical model presents high accuracy to infer the insect-damaged on cotton plants based on multispectral bands from other sensors, being a useful tool for future research that intends to evaluate it in other areas and at different field scales.

In the setting of the immense social, political, medical, and cultural challenges of last year, medicine has been made acutely aware of its participation in inequity and in response offers allyship as a framework for clinicians to pursue change, using tools already apart of the practice of medicine. Allyship in the workplace can be summarized as a strategic mechanism used by individuals to become collaborators who fight injustice and promote equity through supportive personal relationships and public acts of sponsorship and advocacy. The idea of allyship may be intimidating, particularly for practitioners and leaders who do not belong to the communities they endeavor to support. But as the article unpacks, practitioners need not look any further for how to be allies than what they practice every day: lifelong learning; humility in complications; an expectation of imperfection; and, bound together with those who suffer, persistence in the pursuit of healing.

Background Surgeons are at risk of burnout and depression, which can lead to medical errors, inefficiency, exhaustion, conflicts, and suicide. Significant challenges exist in sub-Saharan Africa that may increase the prevalence of burnout and depression, but no formal evaluation has identified stressors specific to this environment. Methods A survey was distributed to all members of the College of Surgeons of East, Central, and Southern Africa (COSECSA). Burnout, depression, and stressors were assessed with validated measures: Maslach Burnout Inventory for Medical Personnel, Patient Health Questionnaire (PHQ) 9, and Holmes-Rahe Life Stress Inventory. Results There were 131 participants (98 African and 33 non-African surgeons). The incidence of moderate to severe depression was 48% (n = 63), and the incidence of burnout was as high as 38% (n = 48). There were no significant differences between African and non-African surgeons in marital status, number of children, partners in practice, or distribution of time. More African surgeons experienced birth of a child (18% versus 3%, P = 0.04) but had less workplace conflict (7.1% versus 10.7%, P = 0.045) than non-African surgeons. African surgeons more consistently felt they were positively influencing others (P = 0.008), enjoyed working with patients (P = 0.009), and were more satisfied (P = 0.04). For all surgeons, predictors of increased PHQ-9 depression were serious professional conflict (P = 0.02), difficulty accessing childcare (P = 0.04), and racial discrimination (P = 0.003). In the Maslach model, predictors of burnout were difficulty accessing childcare (P = 0.05) and denial of promotion based on gender (P = 0.006). Conclusions Burnout and depression in surgeons practicing in East, Central, and Southern Africa are substantial. Despite significant challenges, African surgeons tended to have a more positive outlook on their work. Improvements can be made to reduce burnout and depression by focusing on work conditions, equality of promotion opportunities, workplace conflict management, childcare support, and increasing the numbers of surgeons in practice.

The metacognitive model of generalized anxiety disorder (GAD) suggests that positive and negative beliefs about worry contribute to pathological worry. This study explores the relationship between metacognition and worry in youth aged 12–17 years. The sample consisted of 81 anxiety-disordered youth, with 70 mothers included, and 42 non-clinical controls, with 40 mothers included. Metacognitive beliefs were associated with emotional symptoms. Both GAD and non-GAD youth, and anxious and anxious/depressed youth, reported higher metacognitive beliefs compared to non-clinical controls, but there were no differences in metacognition between emotional disorders. There was no significant association between age and metacognition, and there were no gender differences in metacognition. These results provide partial support for using the metacognitive model of GAD to understand worry in young people.

This study tested if training can normalize atypical passive auditory event-related potentials in the N1-P2 time window in children with specific reading disability (SRD) or specific language impairment (SLI). Children with SRD or SLI and untrained controls were tested for their behavioral responses and N1-P2 windows to tones, backward-masked tones, vowels, and consonant-vowels. Children with SRD or SLI with poor behavioral responses to one of these sounds trained to discriminate that sound for 30 minutes a day, 4 days a week, for 6 weeks. Post-training measures revealed that training normalized atypical behavioral responses but not atypical N1-P2 windows.

This study tested if children with specific language impairment (SLI) or children with specific reading disability (SRD) have abnormal brain responses to sounds. We tested 6- to 12-year-old children with SLI (N =19), children with SRD (N =55), and age-matched controls (N =36) for their passive auditory event-related potentials (ERPs) to tones, rapid tones, vowels and consonant-vowels. Thirty-eight percent of the children with SLI or SRD had less typical passive auditory ERPs in the N1-P2 window to sounds in general, rather than to tones, rapid tones, vowels or consonant-vowels specifically. The ERPs of these children were significantly 'flatter' in the N1-P2 region than normal. All the children with flatter ERPs in the N1-P2 region had poor non-word reading. A subgroup of these poor non-word readers also had poor non-word repetition. These findings support the hypothesis that impaired auditory processing is a causal risk factor for both SLI and SRD.

Sixty-five children with specific reading disability (SRD), 25 children with specific language impairment (SLI), and 37 age-matched controls were tested for their frequency discrimination, rapid auditory processing, vowel discrimination, and consonant-vowel discrimination. Subgroups of children with SRD or SLI produced abnormal frequency discrimination (42%), rapid auditory processing (12%), vowel discrimination (23%), or consonant-vowel discrimination (18%) thresholds for their age. Twenty-eight of these children trained on a programme that targeted their specific auditory processing deficit for 6 weeks. Twenty-five of these 28 trainees produced normal thresholds for their targeted processing skill after training. These gains were not explained by gains in auditory attention, in the ability to do psychophysical tasks in general, or by test-retest effects. The 25 successful trainees also produced significantly higher scores on spoken language and spelling tests after training. However, an untrained control group showed test-retest effects on the same tests. These results suggest that auditory processing deficits can be treated successfully in children with SRD and SLI but that this does not help them acquire new reading, spelling, or spoken language skills.

Worry is a common phenomenon in children and adolescents, with some experiencing excessive worries that cause significant distress and interference. The metacognitive model of generalized anxiety disorder (Wells 1995, 2009) was developed to explain cognitive processes associated with pathological worry in adults, particularly the role of positive and negative beliefs about worry. This review evaluates the application of the model in understanding child and adolescent worry. Other key issues reviewed include the link between cognitive and metacognitive development and worry, and the measurement of worry and metacognitive worry in young people. Implications of these findings and directions for future research are discussed.