Globalization in Pediatric Surgical Training: The Benefit of an International Fellowship in a Low-to-Middle–Income Country Academic Hospital

Objective A relative oversupply of pediatric surgeons led to increasing difficulties in surgical training in high-income countries (HIC), popularizing international fellowships in low-to-middle–income countries (LMIC). The aim of this study was to evaluate the benefit of an international fellowship in an LMIC for the training of pediatric surgery trainees from HICs. Methods We retrospectively reviewed and compared the prospectively maintained surgical logbooks of international pediatric surgical trainees who completed a fellowship at Chris Hani Baragwanath Academic Hospital in the last 10 years. We analyzed the number of surgeries, type of involvement, and level of supervision in the operations. Data are provided in mean differences between South Africa and the respective home country. Results Seven fellows were included. Operative experience was higher in South Africa in general (Δx̅ = 381; 95% confidence interval [CI]: 236–656; p < 0.0001) and index cases (Δx̅ = 178; 95% CI: 109–279; p < 0.0001). In South Africa, fellows performed more index cases unsupervised (Δx̅ = 71; 95% CI: 42–111; p < 0.0001), but a similar number under supervision (Δx̅ = –1; 95% CI: –25–24; p = 0.901). Fellows were exposed to more surgical procedures in each pediatric surgical subspecialty. Conclusion An international fellowship in a high-volume subspecialized unit in an LMIC can be highly beneficial for HIC trainees, allowing exposure to higher caseload, opportunity to operate independently, and to receive a wider exposure to the different fields of pediatric surgery. The associated benefit for the local trainees is some reduction in their clinical responsibilities due to the additional workforce, providing them with the opportunity for protected academic and research time.

Implications of Climate Change on Erosion Dynamics and Sediment Connectivity in Semi-arid Ecosystem

&lt;p&gt;In semi-arid ecosystems, basin elevation and hillslope aspect play an important role in the distribution of plant type and density. In general, north-facing aspects host mesic and denser vegetation than south-facing aspects where host xeric plants. Beside aspect, elevation plays a dominant role in vegetation distribution. The Upper Rio Salado Basin, in central New Mexico, hosts shrublands and grasslands at lower elevations and forests at higher elevations. The geomorphometric analysis shows that forest areas are steeper than the grasslands and shrublands. Shrub encroachment in the region and the increase in global temperatures may lead to the replacement of forests by shrublands and the transition from a resource-conserving ecosystem to a leaky (non-conserving) ecosystem on the north-facing aspects which is similar to current south-facing aspects. The preliminary results show these transitions will lead to emerging hotspot areas in erosion. These erosion&amp;#173;-prone zones should be monitored in future for sustainable management.&lt;/p&gt;&lt;p&gt;This study has been produced benefiting from the 2232 International Fellowship for Outstanding Researchers Program of the Scientific and Technological Research Council of Turkey (TUBITAK) through grant 118C329. The financial support received from TUBITAK does not mean that the content of the publication is approved in a scientific sense by TUBITAK.&lt;/p&gt;

Misperceptions and Identities Mis-taken: Interpreting Various Hostilities Encountered by Moravians in Colonial New York and Pennsylvania

This essay integrates Moravian studies, missiology and historical theology. It begins with a brief survey of the historiography of Moravian missions in colonial North America. It then surveys various reasons for periodic hostility against Moravians in New York and Pennsylvania between roughly 1740 and 1790. It recovers the ethnic and cultural diversity, prejudices and defensive actions of colonists that were a significant component of life in these contested spaces and turbulent times, thus demonstrating that so-called ‘religious’ persecution remains a complicated phenomenon. It suggests Moravians might have avoided certain instances of misperception and consequent ‘persecution’ had they adapted themselves culturally in ways they did not. Moravians were often perceived by other colonial Europeans as a threat to the security and stability of developing locales, and remained largely on the social periphery in colonial North America as a consequence of being both wrongly and rightly understood. As an international and transnational religious community pursuing its own global dispersal for the sake of mission, Moravian political neutrality and perceived ‘foreignness’ was misunderstood in times of war by English and Dutch colonists, especially, as sympathy for the enemy or even evidence of espionage, though the religious and secular fear of their being Catholic seems to have been eventually resolved. Because Moravians in the British colonies fraternised with Native Americans for the sake of mission and were part of an international fellowship also befriending Caribbean slaves, they were sometimes slandered by colonists who feared them as instigators of rebellion by these marginalised populations. Finally, the Moravian sense of being set apart by God from the broader society and called to suffer for the sake of their righteous difference and gospel influence, when acted upon, provoked hostility from colonists who perceived them as a threat to local balances of power, denominational order or family cohesion.