OBJECTIVEDespite recently heightened advocacy efforts relating to pregnancy and family leave policies in multiple surgical specialties, no studies to date have described female neurosurgeons’ experiences with childbearing. The AANS/CNS Section of Women in Neurosurgery created the Women and Pregnancy Task Force to ascertain female neurosurgeons’ experiences with and attitudes toward pregnancy and the role of family leave policies.METHODSA voluntary online 28-question survey examined the pregnancy experiences of female neurosurgeons and perceived barriers to childbearing. The survey was developed and electronically distributed to all members of the American Association of Neurological Surgeons and Congress of Neurological Surgeons who self-identified as female in February 2016. Responses from female resident physicians, fellows, and current or retired practicing neurosurgeons were analyzed.RESULTSA total of 126 women (20.3%) responded to the survey; 57 participants (49%) already had children, and 39 (33%) planned to do so. Participants overwhelmingly had or planned to have children during the early practice and senior residency years. The most frequent obstacles experienced or anticipated included insufficient time to care for newborns (47% of women with children, 92% of women planning to have children), discrimination by coworkers (31% and 77%, respectively), and inadequate time for completion of board requirements (18% and 51%, respectively). There was substantial variability in family leave policies, and a minority of participants (35%) endorsed the presence of any formal policy at their institution. Respondents described myriad unique challenges associated with pregnancy and family leave.CONCLUSIONSPregnancy and family leave pose significant challenges to the recruitment, retention, and advancement of women in neurosurgery. It is thus imperative to promote clear family leave policies for trainees and practitioners, address discrimination surrounding these topics, and encourage forethought and flexibility to tackle obstacles inherent in pregnancy and the early stages of child rearing.

Diarrheal disease and environmental enteropathy are serious public health concerns in low-income countries. In an effort to reduce enteric infection, researchers at the University of Virginia developed a new point-of-use (POU) water treatment technology composed of silver-impregnated porous ceramic media. The ceramic is placed in a 15 L plastic container of water in the evening and the water is ready to drink in the morning. The purpose of this study was to assess field performance and local acceptance of technology in two communities in Limpopo Province, South Africa, and one community in Dodoma Region, Tanzania. Performance was determined by coliform testing of treated water. Acceptance was determined using data from 150 household surveys and a nine-day structured observational study at a local primary school. At the primary school, 100% of treated water samples had no detectable levels of total coliform bacteria (TCB) in buckets filled by researchers. For all treated school buckets, 74% of samples achieved less than or equal to 1 CFU/100 mL and 3.2 average log reduction of TCB. Laboratory experiments with highly contaminated water diluted to lower turbidity achieved 4.2 average log reduction of TCB. Turbid water (approximately 10 NTU) only achieved 1.1 average log reduction of TCB; turbidity and organic material may have interfered with disinfection. The Tanzania primary school (deep groundwater source) had less turbid water and achieved 1.4 average log reduction of TCB; however, it did have high chloride levels that may have interfered with silver disinfection. The surveys revealed that the majority of people retrieve, store, and dispense water in ways that are compatible with the new technology. The willingness-to-pay study revealed potential customers would be willing to pay for the technology without subsidies. The results of this study indicate that this novel silver-impregnated ceramic POU water treatment technology is both effective and appropriate for use in the study communities.

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Introduction For over 30 years, the USNS Mercy hospital ship has provided surgical care on multiple humanitarian aid and disaster relief missions. During these missions, surgical support varies according to host nation needs, and the operative treatment of cancer patients remains controversial. We report the number of incidentally discovered surgical oncologic cases treated aboard the USNS Mercy on four missions and discuss challenges regarding oncologic care on these missions. Materials and Methods Between 2008 and 2016, operative cases and surgical pathology results from four multinational humanitarian missions were analyzed according to organ system, patient’s geographic location, and diagnosis. Primary outcomes were total number and proportion of malignant cases, analyzed yearly and over all four missions. Secondary outcomes were malignant diagnoses by organ system and host nation health capacities (based on indicators from the WHO). Results A total of 2,767 operations were performed during 18 port visits in 8 countries in Southeast Asia. In total, 1,193 pathology specimens (surgical biopsies, fine needle aspirations, etc.) were obtained. Overall malignancy rate across all organ systems was 9%. Yearly malignancy rates ranged from 2% to 13%. The highest malignancy rates were found in thyroid (33%), breast (20%), and parotid and salivary gland cases (19%). All host nations had operational strategies for cancer in place (n = 8, 100%), but few had national infrastructures to treat noncommunicable diseases (n = 2, 25%). Conclusions Despite current policies to screen out cancer patients on USNS Mercy missions, 9% of surgical biopsies were malignant. Cancer management during these missions presents a unique challenge because of limited resources for surgery, chemoradiotherapy, and follow-up care. Contingency plans must be considered to provide completion of care for these patients whose cancers are discovered incidentally. Furthermore, an understanding of host nation capabilities in relation to medical and surgical care is crucial to providing treatment in resource-limited areas.

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