Fellowship Program Research Articles

Implementation of a Virtual Pulmonary Physiology Course in Latin America.

Knowledge of respiratory physiology is essential for the diagnosis and treatment of respiratory diseases. During the coronavirus disease (COVID-19) pandemic, face-to-face education was inadequate, leading to the implementation of virtual programs for pulmonary fellows from Latin America. This study describes our experience with the implementation of a virtual education program involving pulmonary function tests (PFTs) for pulmonary fellows in Latin America. A learning program on PFTs was designed by the Department of Respiratory Physiology at the National Institute of Respiratory Diseases in Mexico City, and fellows in pulmonology were invited to participate in the program by their academic professors. The program was performed virtually on an online platform over 3 months. The topics covered included respiratory mechanics, gas exchange, and cardiopulmonary exercise tests. Students were asked to complete an evaluation before and after each lecture as well as before and after the entire course. A total of 205 fellows from 12 countries participated in the course, and fewer than 50% completed assessments before and after the course. The results showed that fellows had relatively high initial knowledge of oxygen desaturation and cardiopulmonary exercise tests, whereas relative deficiencies were found in maximal respiratory pressure and bronchial challenge tests. The highest grade was in the spirometry test, whereas the lowest was in the bronchial challenge test. Overall, the fellows demonstrated improved performance in the post-course evaluations. Virtual education in PFTs is feasible and can have a positive impact on the training of pulmonary fellows from Latin America.

SAMHSA reinstates CSAP Prevention Fellowship program

One of the substance use disorder (SUD) workforce tools to die during the Trump administration was the CSAP (Center for Substance Abuse Prevention) Prevention Fellowship Program, run by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Evaluation of an Educational Scholarship Fellowship Program for Health Professions Educators.

Historically, the requirement to produce scholarship for advancement has challenged health professions educators heavily engaged in teaching. As biomedical scientists or healthcare practitioners, few are trained in educational scholarship, and related faculty development varies in scope and quality across institutions. Currently, there is a need for faculty development and mentoring programs to support the development of these skills. The International Association of Medical Science Educators (IAMSE) established the Medical Educator Fellowship (MEF) Program to foster health professions educational scholarship. MEF addresses the following: curriculum design, teaching methods and strategies, assessment, educational scholarship, and leadership. Participants receive mentorship and faculty development, and complete an educational scholarship project. Using a logic model, we conducted a retrospective program evaluation with data from Program records, database searches, graduate surveys, and focus groups. Over 14years, MEF graduated 61 participants with diverse terminal degrees from five continents and six academic program areas. Graduate survey responses indicated enhanced post-Program skills in all focus areas, that the majority would recommend MEF to a colleague, and that mentorship, networking, and professional development were strengths. Focus group outcomes indicated professional growth, increased confidence, and increased sense of community. MEF addresses health professions educators' need for faculty development and mentorship in educational scholarship. Evaluation outcomes suggest that MEF effectively enhanced perceived skills across focus areas. Similar programs are essential to support faculty who dedicate significant time to teaching. Organizations like IAMSE can demonstrate the value of educational scholarship and positively impact health professions educator careers by supporting such programs.

Analysis of National Resident Matching Program for Radiology Fellowships: Factors Affecting Program Fill Rates

PurposeThe National Resident Matching Program (NRMP) is used by an increasing number of diagnostic radiology (DR) residents applying to subspecialty fellowships. Data characterizing match outcomes on the basis of program characteristics are limited. The aim of this study was to determine if fellowship or residency size, location, or perceived reputation was related with a program filling its quota. MethodsUsing public NRMP data from 2004 to 2022, DR residency, breast imaging (BI), musculoskeletal imaging (MSK), interventional radiology (IR), and neuroradiology (NR) fellowship programs were characterized by geography, DR and fellowship quota, applicants per position (A/P), and reputation as determined by being an Aunt Minnie best DR program semifinalist, Doximity 2021-2022 top 25 program, or U.S. News & World Report top 20 hospital. The DR program’s reputation was substituted for fellowships at the same institution. A program was considered filled if it met its quota. ResultsThe 2022 A/P ratios were 1.02 for IR, 0.83 for BI, 0.75 for MSK, and 0.88 for NR. IR was excluded from additional analysis because its A/P was >1. The combined BI, MSK, and NR fellowships filled 78% of positions (529 of 679) and 56% of programs (132 of 234). Factors associated with higher program filling included Doximity top 25 program, Aunt Minnie semifinalist, and U.S. News & World Report top 20 hospital affiliation (P < .001 for all); DR residency quota greater than 9, and fellowship quota of three or more (P < .01). The Ohio Valley (Ohio, western Pennsylvania, West Virginia, and Kentucky) filled the lowest, at 39% of programs (P = .06). ConclusionsLarger fellowship programs with higher perceived reputations and larger underlying DR residency programs were significantly more likely to fill their NRMP quota.

A Collaborative and Multidisciplinary Nurse Residency and Fellowship Program

A Collaborative and Multidisciplinary Nurse Residency and Fellowship Program

Task Oriented Assessment of Clinical Skills (TOACS): A Modified Form of OSCE.

College of Physicians and Surgeons, Pakistan (CPSP) is a premier postgraduate medical institution of the country. It introduced Objective Structured Clinical Examination (OSCE) in the 1990s, and later came up with its modified form known as Task Oriented Assessment of Clinical Skills (TOACS). This modified assessment has been incorporated in clinical examinations of its majority fellowship programmes. Despite the use of TOACS for so many years at CPSP, it is surprising to note that this form of assessment does not appear in the literature. The objective of this viewpoint is to describe the rationale for the development of TOACS and to compare its structure and functions with OSCE. Key Words: Medical education, Assessment, Objective Structured Clinical Examination, Interactive, Task Oriented Assessment of Clinical Skills.

P300 or CBP are required for calorie restriction-mediated enhancement of skeletal muscle insulin sensitivity

A calorie-restricted diet robustly improves skeletal muscle insulin sensitivity and is a cornerstone lifestyle intervention for preventing and treating clinical hyperglycemia. While studies demonstrate that insulin-stimulated activation of phosphatidylinositol 3-kinase (PI3K) and RAC-beta serine/threonine-protein kinase (AKT2) are fundamental to enhanced muscle insulin sensitivity after calorie restriction (CR), the downstream signaling steps remain to be fully elucidated. We have previously demonstrated that the lysine acetyltransferases, E1A binding protein (p300) or cAMP response element binding protein binding protein (CBP) are required for insulin-stimulated glucose uptake by skeletal muscle, at both sub-maximal and maximal concentrations of insulin. Moreover, p300/CBP are phosphorylated by AKT, which increases their acetyltransferase activity. Considering these findings together, the objective of this study was to determine whether p300 or CBP are required for the ability of CR to enhance skeletal muscle insulin sensitivity. We hypothesized that combined inhibition of p300 and CBP acetyltransferase activity would prevent CR-induced enhancement of skeletal muscle insulin sensitivity. To address this objective, 8-week-old male C57BL/6NJ mice were either fed ad libitum (AL; n=16) or were fed a CR diet (60% of AL intake; n=16) diet for 20 days. Then, an ex vivo [3H]-2-deoxyglucose (2DOG) approach was used to assess basal and insulin-stimulated (60μU/mL [0.36nM]) 2DOG uptake in paired extensor digitorum longus (EDL) and soleus from fasted (4 h) mice. To define the role of p300/CBP acetyltransferase activity, paired muscles from AL- or CR-fed mice were pre-incubated for 60 minutes with either DMSO (experimental control; n=8/dietary group [AL-DMSO, CR-DMSO]) or the p300/CBP acetyltransferase activity inhibitor, ip300w (25mM; n=8/dietary group [AL-ip300w, CR-ip300w]). As expected, insulin-stimulated 2DOG uptake (i.e. Insulin 2DOG minus basal 2DOG) in DMSO incubated muscles was ~2.3-fold and ~3.3-fold higher in the soleus and EDL, respectively, from CR- vs. AL-fed mice. Remarkably, ip300w not only blocked insulin-stimulated 2DOG uptake in AL-fed mice, but it also abrogated the insulin-sensitizing effects of CR on muscle insulin sensitivity. To further define the importance of p300 and CBP to CR-induced enhancement of skeletal muscle insulin sensitivity, we studied mice with tamoxifen-inducible and skeletal muscle-specific knockout of CBP and heterozygous (HZ) loss of p300 (referred to as, i-mCKO/PHZ) or knockout of p300 and HZ loss of CBP (referred to as, i-mPKO/CHZ). In these mice, the AL diet or 20 days of CR was initiated 3 weeks after ~10 week-old mice were dosed with tamoxifen (5 consecutive days, 2 mg/day); Cre recombinase-negative littermates, who were also dosed with tamoxifen, were the experimental controls (referred to as wildtype [WT]). Interestingly, oral glucose tolerance and EDL insulin sensitivity were comparably enhanced by CR in WT and both i-mCKO/PHZ and i-mPKO/CHZ mice, thus suggesting that just one allele of p300 or CBP is suffcient for CR to enhance skeletal muscle insulin sensitivity. Taken together, these results demonstrate that p300 or CBP are essential for the ability of calorie restriction to enhance skeletal muscle insulin sensitivity. This work was supported by a grant from the National Institutes of Health (R56 DK1311211), and the Dr. Maryam Ahmadian Memorial Summer Fellowship Program (L.M.L.) and the UC San Diego Medical Scientist Training Program (L.S.F.). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

D67. Growing Pains to Collaborative Gains: A Longitudinal Evaluation of a Multi-decade Clinical Research Fellowship Program

D67. Growing Pains to Collaborative Gains: A Longitudinal Evaluation of a Multi-decade Clinical Research Fellowship Program

Myotube growth is associated with cancer-like metabolic reprogramming and is limited by phosphoglycerate dehydrogenase and pyruvate kinase M2

Skeletal myofiber size and oxidative metabolism are inversely related. Glycolytic fast type myofibers are larger than high high oxidative, slow type myofibers. Paradoxically, despite their lower capacity for protein synthesis (lower myonucluar density and RNA content), glycolytic, low oxidative are more responsive to an anabolic stimulus. We hypothesized that glycolytic myofibers may make use of a Warburg-like metabolic reprogramming in response to an anabolic stimulus. The Warburg effect links growth and glycolysis in tumor cells to generate glycolytic intermediates for synthesis of nucleotides and amino. The aim of this study was to test whether a similar ‘glycolysis-for-anabolism’ metabolic reprogramming also occurs in post-mitotic, hypertrophying myofibers. For this purpose, we first induced C2C12 myotube hypertrophy with IGF-1. We then added 14C glucose to the differentiation medium and measured radioactivity in isolated protein and RNA to establish whether 14C had entered anabolism. We found that especially protein became radioactive, suggesting a glucose → glycolytic intermediates → non-essential amino acid(s) → protein series of reactions, the rate of which was increased by IGF-1. Next, to investigate the importance of glycolytic flux and non-essential amino acid synthesis for myotube hypertrophy, we exposed C2C12 and primary mouse myotubes to the glycolysis inhibitor 2-Deoxy-D-glucose (2DG). We found that inhibiting glycolysis lowered C2C12 and primary myotube size. Similarly, siRNA silencing of PHGDH and PKM2, key enzymes of the Warburg-like metabolic reprogramming, reduced C2C12 and primary myotube growth; whereas retroviral PHGDH overexpression increased C2C12 myotube size. Together these results suggest that glycolysis is important for hypertrophying myotubes, which reprogramme their metabolism to facilitate anabolism, similar to cancer cells. Brendan M. Gabriel was supported by fellowships from the Novo Nordisk Foundation (NNF19OC0055072) &amp; the Wenner-Gren Foundation, an Albert Renold Travel Fellowship from the European Foundation for the Study of Diabetes, and an Eric Reid Fund for Methodology from the Biochemical Society. Abdalla D. Mohamed was funded initially by Sarcoma UK (grant number SUK09.2015), then supported by funding from Postdoctoral Fellowship Program (Helmholtz Zentrum München, Germany), and currently by Cancer Research UK. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Beneficial Effects of Mild Hyperuricemia in Salt-Sensitive Hypertension

Hyperuricemia (HrU) or increased plasma uric acid (UA) is associated with worsening hypertension (HTN) and kidney damage. Paradoxically, UA is also known to be an endogenous antioxidant. Some studies suggest that only HrU with crystals, but not asymptomatic HrU promotes the progression of these diseases. We hypothesized that mild asymptomatic HrU is beneficial in controlling the progression of salt-sensitive (SS) HTN. Due to sex differences in urate handling and SS HTN, we used both male and female Dahl SS rats in this study. Radiotelemetry was used to measure blood pressure and various approaches, including RNA-Seq, were employed to assess kidney injury and identify potential molecular mechanisms. Mild HrU was induced using 2% oxonic acid in the diet, a uricase inhibitor that prevents the breakdown of UA further into more soluble allantoin. Groups: 1-2) male and female 4% NaCl high salt (HS) diet; 3-4) male and female HS + 2% oxonic acid (HS/oxo) diet. After 3 weeks, in response to oxonic acid supplementation, both sexes showed a significant increase of UA in plasma compared to their respective HS-only controls (Males: 0.63 ±0.07 vs. 2.17 ±0.34; Females 0.78 ±0.15 vs. 2.04 ±0.35 mg/dl, HS vs. HS/oxo). Interestingly, only male HS/oxo rats showed a significant increase in uricosuria (Males: 0.23 ±0.03 vs. 0.45 ±0.06; Femaels: 0.26 ±0.06 vs. 0.26 ±0.001 UA/Cre, HS vs. HS/oxo). Moreover, the mild HrU was associated with a significant attenuation of the progression and magnitude of the mean arterial pressure in male but not female rats (Males: 157 ±3 vs. 136 ±3; Females: 155 ±6 vs. 154 ±5 mmHg, HS vs. HS/oxo). Xanthine oxidase (XO) is one of the enzymes that produce UA, and its activity has been shown to affect HTN as well. Therefore, we examined the level of XO activity in the plasma after the treatment. While there was no difference in the activity based on the diet within each sex, females had significantly lower levels of XO activity compared to males in each of the diets. To further investigate the beneficial phenotype seen in male rats, we evaluate changes in the progression of renal pathology. The HS/oxo group compared to the HS group had a lower kidney weight/body weight ratio and lower protein cast accumulation, indicating lower kidney damage. RNA-Seq analysis showed that the attenuated HTN phenotype was associated with an increased expression in Mas1 (MAS receptor), Klk-1 (Kallikrein-1), and Pcsk6 (PCSK6 enzyme) which can all lead to the activation of different vasodilatory pathways. Our study showed that in male but not female Dahl SS rats, asymptomatic mild HrU accompanied by hyperuricosuria ameliorates the progression of SS HTN and protects kidneys from further damage. This work is supported by the American Society of Nephrology Ben J. Lipps Research Fellowship Program (Dimitrios G. Oreopoulos Research Fellowship Award to L.V.D.). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

A 15-Year Analysis of Supply and Demand for Hematology and Oncology Training in the United States.

There is a paucity of research on the supply of the hematology and oncology workforce despite projected shortages in the United States Over the past 15 years of the hematology and oncology match (HOM), we hypothesized that there would be more growth in the number of training positions relative to applicants, higher match rates for US allopathic graduates relative to non-US allopathic graduates, and fewer applicants matching at their top fellowship choices. This was a national, retrospective cohort study of all applicants in the HOM (2009-2023). Match rates and applicant-to-training position ratios were calculated and compared over time with Pearson tests. Growth in the number of annual training positions (426-708; 66% increase) exceeded growth in the number of interested applicants (706-945; 34% increase; P < .001). Annual applicant-to-training position ratios decreased from 1.7 to 1.3 (r = -0.813; P < .001). Match rates increased over the study period for both US allopathic graduates (79%-88%; r = 0.761; P = .001) and non-US allopathic graduates (45%-63%; r = 0.801; P < .001). During each year, match rates for US allopathic graduates exceeded those for non-US allopathic graduates (P < .001). From 2018 to 2023, US allopathic graduates (83%) had higher match rates than US osteopathic graduates (60%) and international medical graduates (50%; P < .001). The percentage of applicants that matched at one of their top three fellowship choices increased from 53% to 60% (r = 0.480; P = .070). Fewer available annual training positions went unfilled over the study period (3%-0.3%; r = - 0.870; P < .001). Match rates have increased in the HOM but remain competitive especially for non-US allopathic graduates. Future investigation is needed to understand disparities in match outcomes by additional applicant and fellowship program characteristics. Ongoing surveillance of HOM outcomes remains critical given the projected shortages in the US hematology and oncology workforce.

The Endeavour scholarships program in the era of the Asian century: promise unfulfilled

PurposeThe Australian Government has long used its international scholarship programs as an instrument of soft power in international diplomacy. The paper examines an international scholarship program and its role in Australia’s soft power efforts during a period in recent history.Design/methodology/approachThe Australia in the Asian Century White Paper of 2012 is used as a lens to reveal how the Australian Government viewed the role of international scholarship programs in international diplomacy at a specific point in the recent past, and compares it with research revealing what was contemporaneously happening with one key government-funded scholarship program.FindingsThis paper is based on a comprehensive case study of the Australian Government’s Endeavour Scholarships and Fellowships program (2004–2019). Endeavour was an ambitious and expensive merit-based program with 6,600 recipients in numerous and diffuse sub-categories. The program was complex and cumbersome and lacked clear priorities, particularly in its lack of geographic focus. It missed opportunities to connect with the political zeitgeist, largely due to opaque priorities and inadequate evaluation regimes which focused entirely on outcomes for individual recipients rather than on relationships for Australia.Originality/valueThis research draws on the first academic study of the Endeavour program. Other scholarship programs (for example Australia Awards and the New Colombo Plan) have attracted considerable scholarly interest. The Endeavour research provides an additional counterpoint for studies of Australian scholarship programs and their contribution to international diplomacy. It is timely to consider this in 2024 when Australia is putting a new focus on its investment in international scholarships.

Reversing food-land relationships in the city: Insights from the Seeding East Buffalo Fellowship Program

The Seeding East Buffalo Fellowship (SEBF) pro­gram, co-founded by community and academic organizations from Buffalo, NY in 2022, supported residents in Buffalo’s Black neighborhoods to grow their own food, emerge as urban agriculture (UA) leaders, and engage in and advocate for UA policy. This article reflects on the lessons learned from this pilot program. The authors, all of whom are either co-founders or team members of the SEBF program, drew from field notes and qualitative interviews with SEBF growers in this article. Key lessons for policy change are that programs must be rooted in the community’s history, pedagogical strategies must be tailored to the local context, and long-term relationships must be fostered. . . .

American Society of Nephrology Kidney Tutored Research and Education for Kidney Scholars (TREKS) Program: A 10-Year Interim Analysis.

In response to decreasing numbers of individuals entering into nephrology fellowships, the American Society of Nephrology launched Kidney Tutored Research and Education for Kidney Scholars (TREKS) to stimulate interest in nephrology among medical students, graduate students, and postdoctoral fellows. The program combines a 1-week intensive exposure to kidney physiology with a longitudinal mentorship program at the participants' home institutions. Ten years in, an analysis was conducted to assess its effectiveness. We surveyed participants to assess their opinions regarding nephrology before and after the course and followed them longitudinally to determine their career choices. TREKS applicants who were not selected to participate were used as a comparison group. Three hundred eighty-one people participated in the program, and 242 completed the survey. After TREKS, both medical students and graduate students showed increased interest in nephrology, with rank scores of 5.6±0.2 before to 7.5±0.1 after the course for medical students (mean±SD, n =189, P = 0.001) and 7.3±0.3 to 8.7±0.3 ( n =53, P = 0.001) for graduate students. In long-term follow-up, TREKS medical students chose a nephrology pipeline residency at a higher rate than medical students overall (57% versus 31%, P = 0.01) and TREKS applicants who did not participate (47% versus 31%, P = 0.04). Nephrology fellowship rates for these groups exceeded the general population but did not significantly differ between TREKS participants and applicants. Doctor of Philosophy students and postdoctoral TREKS participants had a higher rate of participation in nephrology research compared with TREKS applicants (66% versus 30%, P = 0.01). In summary, the American Society of Nephrology Kidney TREKS program has demonstrated that it can increase interest in nephrology in the short term and increase the number of individuals going into nephrology careers. This long-term effect is most evident in Doctor of Philosophy students and postdoctoral participants. Further study is needed to assess the impact of TREKS on enrollment in nephrology fellowship programs.

Between &amp; Betwixt: Considerations of Cross-Organizational Readiness in University/Public School Partnership

University partnerships with public schools are an innovative opportunity to marry research and practice. One such endeavor was the Heinz Fellows Program at the Center for Urban Education in the School of Education at the University of Pittsburgh. The Heinz Fellows Program existed at the intersection of community engagement, public school praxis, and university collaboration, with a pursuit of equity and justice. Yet, despite four years of programming, significant investment from philanthropy, and deep commitment from the university and public-school partners, much of the services and activities were not sustained beyond the conclusion of the program. What has remained, though, are salient lessons about the preparatory work each organization must engage in prior to collaboration. A public school is an inherently complex organization, while a university is also complex, but in substantially different ways. Thus, to bridge the chasm, both organizations must participate in self-reflection about their readiness, resources, and right constituents to implement, evaluate, and sustain the collaboration. The article offers a robust framework to consider cross-organizational collaborative readiness and to guide future university/public school partnerships into sustainability.

Pediatric Emergency Medicine Ultrasound Fellowship Programs.

Point of care ultrasound (POCUS) has undergone important growth in the field of Pediatric Emergency Medicine (PEM) in the last 14 years and is recognized as a critical diagnostic tool in the care of ill and injured children. The first PEM POCUS fellowship was established in 2010. Now, there are currently 30 ultrasound fellowships that offer training to PEM physicians. In 2014, 46 PEM POCUS leaders established the P2 (PEM POCUS) Network (www.P2network.org). This serves as a platform for sharing expertise, building research collaborations, and offering mentorship in the use of POCUS in PEM. In 2019, a multinational group of experts in PEM POCUS published the first consensus guidelines for prioritizing core applications of POCUS, which are fundamental to PEM fellowship training 1. In 2022, the international research priorities for PEM POCUS were published 2. In the same year, the development of a consensus-based definition of focused assessment with sonography for trauma (FAST) in children was established 3.

Training in obstetrics and gynecology between reality and vision: results of a JAGO–NOGGO survey in 601 physicians (NOGGO—Monitor-12 trial)

PurposeThe primary objective of this study was to establish a benchmark by collecting baseline data on surgical education in obstetrics and gynecology in Germany, including factual number of operations performed.Materials and methodsA nationwide anonymous survey was conducted in Germany between January 2019 and July 2019 utilizing a specially designed questionnaire which addressed both residents and senior trainers.ResultsA total of 601 participants completed the survey, comprising 305 trainees and 296 trainers. The trainees reported performing a median of 125 non-obstetric surgeries (IQR: 41–332) and 75 obstetric procedures (IQR: 27–168) independently. While most last-year residents managed to meet the targeted numbers for minor surgical procedures outlined in the logbook, they fell short of achieving the required numbers for major operations, such as hysterectomies or more complex laparoscopies. Although both trainees and trainers emphasized the significance of surgical training, the overall quality of the training was rated poorly, particularly by trainees. This was attributed to a high proportion of administrative tasks and a deficiency in teaching time within the operating theater. External fellowship and mentoring programs, as well as the implementation of regular, centralized reviews of residency training, were identified as potentially beneficial by both trainees and trainers.ConclusionThe findings of this survey should serve as a wake-up call both within and outside of Germany, highlighting the importance of comprehensive and structured surgical training to enhance long-term patient care and increase satisfaction among obstetrics and gynecology trainees.

Relationship between sustainable development indicators and SMEs’ development indicators: Evidence from the EU countries

This study aims to identify whether achieving sustainable development goals influences SMEs’ development and assess its degree. The dataset on SMEs’ development indicators and SDGs 2, 8, 9, 12, and 13 for the panel of EU-27 countries in 2011–2020 was collected using Eurostat and OECD datasets. Breusch and Pagan Lagrangian multiplier test for pooled OLS/panel data random effects and Hausman test for fixed/random effects were utilized. The results were in favor of random effect GLS regression for SDG2 models, SDG9 models, and SDG12-13 (Model 1) and fixed effect GLS regression for SDG8 models and SDG12-13 (Model 2), respectively. Based on bibliometric analyses using VOSViewer 14 and a comprehensive literature review, 19 independent variables have been selected from the “Sustainable development indicators” catalog covering five sustainable development goals; SMEs’ turnover and SMEs’ employees employed are used as the dependent variables to reflect SMEs’ development. The empirical evidence suggests a significant relationship between individual sustainable development and SMEs’ development indicators. It was found that all seven sustainable development indicators of SDG 2 (Zero hunger) and SDG 12 (Responsible consumption and production) have a significant relationship with the indicators of SMEs’ development. Instead, only a part (8 out of 13) of the sustainable development indicators of SDG 8 (Decent work and economic growth), SDG 9 (Industry, innovation and infrastructure), and SDG 13 (Climate action) have a significant relationship with two or one of the SMEs’ development indicators. Therefore, achieving sustainability goals stimulates the development of SMEs itself. AcknowledgmentThis study is supported by the British Academy’s Researchers at Risk Fellowships Program (Award Reference: RaR\100673).

Forensic Psychiatry Education in Child and Adolescent Psychiatry (CAP) Fellowship: Results from a Multi-site Survey.

This study examined the current state of forensic education among child and adolescent psychiatry (CAP) fellowship programs, regarding specific forensic topics, teaching resources, methods, and experiences. The authors aimed to gather and analyze this data to assess the need for additional standardization of forensic psychiatry education in CAP fellowship, such as broader access to resources, and/or inform the development of a standardized curriculum, including milestones, in child and adolescent forensic psychiatry. The authors collaboratively developed a survey instrument on child and adolescent forensic psychiatry education, which was then sent to 135 accredited CAP fellowship programs. The items included in the survey instrument were designed based on literature review, expert consensus, and a 1992 American Association of Directors of Psychiatric Residency Training survey on teaching ethics and forensic psychiatry. Completed response data was returned by 25 of the 135 programs surveyed. Complete responses came primarily from academic institutions (52% public, 36% private) with small- or medium-sized programs (1-12 total fellows, 88%; 11-29 faculty members, 56%). Programs reported on CAP forensic rotation sites, faculty members' level of expertise and involvement in forensic CAP, common forensic topics and experiences offered, and programs' attitudes towards specific topics and experiences. Child and adolescent psychiatrists must gain a clear understanding of the essential components of CAP forensic psychiatry during CAP fellowship, to mitigate discomfort when interacting with the legal system and meet the rising need for forensic CAP expertise across systems and structures impacting youth populations.

Pediatric anesthesiology in Brazil, Chile, and Mexico.

Latin America comprises an extensive and diverse territory composed of 33 countries in the Caribbean, Central, and South America where Romance languages-languages derived from Latin are predominantly spoken. Economic disparities exist, with inequitable access to pediatric surgical care. The Latin American Surgical Outcomes Study in Pediatrics (LASOS-Peds), a multi-national collaboration, will determine safety of pediatric anesthesia and perioperative care. Below, we provide a descriptive initiative to share how pediatric anesthesia in Brazil, Chile, and Mexico operate. Theses descriptions do not represent all of Latin America. Brazil an upper middle-income country, population 203 million, has a public system insufficiently resourced and a private system, resulting in inequitable safety and accessibility. Surgical complications constitute the third leading cause of mortality. Anesthesiology residency is 3 years, with required rotations in pediatric anesthesia; five hospitals offer pediatric anesthesia fellowships. Anesthesiology is a physician-only practice. A Pediatric Anesthesia Committee within the Brazilian Society of Anesthesiology offers education through seasonal courses and workshops including pediatric advanced life support. Chile is a high-income country, population 19.5 million, the majority cared for in the public system, the remainder in university, private, or military systems. Government efforts have gradually corrected the long-standing anesthesiology shortage: twenty 3-year residency programs prepare graduates for routine pediatric cases. The Chilean Society of Anesthesiology runs a 1-month program for general anesthesiologists to enhance pediatric anesthesia skills. Pediatric anesthesia fellowship training occurs in Europe, USA, and Australia, or in two 2-year Chilean university programs. Public health policies have increased the medical and surgical pediatric specialists and general anesthesiologists, but not pediatric anesthesiologists, which creates safety concerns for neonates, infants, and medically complex. Chile needs more pediatric anesthesia fellowship programs. Mexico, an upper middle-income country, with a population of about 126 million, has a five-sector healthcare system: public, social security for union workers, state for public employees, armed forces for the military, and a private "self-pay." There are inequities in safety and accessibility for children. Pediatric Anesthesiology fellowship is 2 years, after 3 years residency. A shortage of pediatric anesthesiologists limits accessibility and safety for surgical care, driven by added training at low salary and hospital under appreciation. The Mexican Society of Pediatric Anesthesiology conducts refresher courses, workshops, and case conferences. Insufficient resources and culture limits research.