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Background: Young‐onset diabetes (YOD) is characterised by unique diagnostic and management challenges more pronounced in resource‐limited settings like Sri Lanka. Aims: We aimed to ascertain the prevalence, patterns and characteristics of YOD in Sri Lanka and describe the state of care. Methods: Retrospective review of baseline data of all patients enrolled in the prospective multicentre Database for Young‐Onset Diabetes, Sri Lanka (DYOD‐SL), was performed, from April 2021 to April 2023. Results: A total of 2531 patient data were included from 28 centres island‐wide. Females were 57.6%. The median age was 20 years (interquartile range (IQR) 17, 23), and the age at diagnosis was 15 years (IQR 12, 18). Type 1 diabetes (T1D) was the commonest (57.6%), followed by Type 2 diabetes (T2D) at 34.3%. Younger age at disease onset (p < 0.001), lower BMI (p < 0.001), and diabetic ketoacidosis (DKA) at presentation (p < 0.001) favoured T1D. In the total cohort, the median HbA1c was 9.8% (IQR 7.8, 12.1) with younger patients having poorer control (p = 0.001). Prevalence of nephropathy was 8.1%, retinopathy was 6.6%, neuropathy was 4.1%, moderate–high‐risk diabetic foot disease was 1.9%, and macrovascular complications were 0.5%. Hypertension and dyslipidaemia occurred in 2.7% and 14%, respectively. Among patients > 18 years, overweight and obese were 22.2% and 10.4%. Corresponding prevalence in the 5–18‐year age group was 20% and 14.7%. Among the insulin users (76%) in the total cohort, the majority (64.7%) were on premixed‐based insulin regimens delivered by syringes. Self‐monitoring of blood glucose (BG) was reported in 71.3% of the total population. None were on continuous/flash glucose monitoring or insulin pumps. Conclusion: T1D was the commonest subtype of YOD in this hospital‐based population. However, T2D was notably higher and is of significant concern. Overall, suboptimal glycaemic control and high rate of complications were noted along with substandard insulin regimens and BG monitoring. [ABSTRACT FROM AUTHOR]

The pollution and contamination by arsenic (As) in the water resources is a worldwide concern due to its adverse toxic effects on the environment and public health. The current study aimed to investigate arsenic levels in the groundwater system with the possible health risk, and sustainable mitigation strategies. The data on arsenic in the water system were collected from the Web of Science and Scopus databases. The published data showed that arsenic concentration (0.0002–19.0 mg/kg) in the water system in Bangladesh was higher than the permissible standards and data from other countries, indicating severe contamination of water resources by arsenic. The study concluded that the water resource in Bangladesh is not safe for human consumption. The review has also identified the research gaps in various strategies for controlling the arsenic problem and their impact on the ecosystems. The present study suggested future research directions on sustainable intervention, impacts assessment of arsenic on humans, and formulating existence policy that helps to combat arsenic contamination. [ABSTRACT FROM AUTHOR]

Objective: To reflect upon the evolution of global surgical care in lower and middle income countries (LMICs) through the analysis of healthcare delivery models and our senior author's personal experiences to implement an advanced model of effective cleft care in the developing world. Materials and Methods: A thorough literature review was conducted on the need for cleft care in the developing world and how international organizations have responded. We analyzed the types of healthcare delivery models, delineating between those addressing immediate operations versus models emphasizing long-term healthcare investments through local infrastructure and primary care system expansion. We also highlight our senior author's experiences, a craniofacial-trained plastic surgeon who has worked with a local cleft organization in Austin, Texas and undergone individual mission trips to El Salvador for over a decade. Results: In the United States, outcomes in cleft care have improved due to subspecialization and multi-disciplinary care. We believe that the combination of high-level surgical care and a coordinated team approach are the two most important determinants of good cleft outcomes and pillars of what we are trying to uphold in our model in El Salvador and the developing world. Implementation of a model named the Oblique Model, which achieves synergy between immediate and lasting investments while ensuring trusting partnerships, can enrich LMICs to build sustainable local healthcare delivery services, benefiting local communities through addressing the cleft care continuum from lip/palate treatment to orthodontics and orthognathic surgery. Conclusion: Global surgical care has undergone significant changes in recent decades. To respond to the rising need for cleft care in LMICs and ensure optimal outcomes, implementation of a model that encompasses multidisciplinary care, subspecialization, culturally sensitive discussion, partnership, and fellowship style training in both the first world and host countries is crucial for optimizing craniofacial care. [ABSTRACT FROM AUTHOR]

Global events of recent years indicate that it is the turn of the Developing World to take the lead in international relations. China, which positions itself as the «largest developing country», a «member of the Global South», but at the same time a «responsible world power», cannot stay away from this trend. The article examines the reasons for the recent rise of the Developing World to the forefront of international life, which include: the cumulative economic growth of the South, the increase in its political importance in the balance of power on the world stage, the growth of self-esteem of the South, whose stance, being consonant with the interests of the East, contributes to the loss of the West's ability in dictating conditions to the world majority, etc. In addition, the author considers important to determine the semantic content of the terms «Global South», «third world», «developing world» for a better understanding of the essence of the great global phenomenon that these definitions have denoted at different times. It seems that these definitions not only reflect the realities of the times that gave birth to them, but also undergo internal upgrade, becoming not just a «signboard», but also a characteristic of the phenomenon they designate. The main burden of the article falls on the analysis of the Chinese factor in the modern evolution of the Global South. It is characterized through the prism of why the importance of the South for China is growing and how Beijing is trying to provide relations with «southern» countries with additional qualitative support. The article also attempts to identify new challenges facing China in the processes of its further «rooting» in the Developing World. The article ends with a number of conclusions, among which is the author's opinion on whether the reformatting of relations between China and the Global South is taking place as a reaction to an increase in its global weight, or whether they are «simply» undergoing a stage of timely optimization.

The populations in countries that have the highest number of individuals with chronic kidney disease (CKD) are the low and middle-income countries which are ethnically diverse. The regional and international data highlighting the need for continuous monitoring of renal function warrants that such countries use equations that give the best estimates of glomerular filtration rate for their settings. While chronic disease conditions such as diabetes and hypertension are the main conditions associated with CKD in adult populations and complicated urinary tract infections and congenital anomalies in the kidney and the urinary tract in the young, the management of patients with CKD at any age can be impacted by medical and non-biological factors. This communication seeks to posit issues that may be germane to consider when using the CKD-EPI 2021 equations in the adult and young adult populations. These equations, by excluding the race factor, have put the spotlight on the relevance of the cultural and economic context concerning the management of renal patents. The social determinants of health, how an individual defines their gender, the cultural acceptance of such or the lack thereof, factors influencing the choice of the test, communication, and technology among others may all affect renal care. These issues together may have a greater impact on renal patient care and outcome than racial disparity. While the racial divide may have been a driver for differential treatment in developed nations with different ethnic groups they may be less so when compared with more homogenous populations. [ABSTRACT FROM AUTHOR]

Researchers based in poorer countries typically face major challenges in publishing their work in international journals, compared to those faced by researchers in the wealthier countries of Europe and North America. This paper studies this issue based on the experience of papers submitted to the Review of Development Economics, an important international development economics journal. It presents an analysis of submissions and success in publication, based on the fortunes of all papers submitted to the journal between 2015 and April 2022, disaggregated by the country in which the corresponding author is based. Authors based in low and middle income countries accounted for 33% of publications in this period, though they accounted for 61% of the submissions received. A main factor was that these papers were significantly less likely to be sent for review by the journal; if reviewed, they were also less likely to be accepted than papers from authors in high income countries, though that differential is much less stark. This analysis is presented in the interests of transparency and to encourage discussion, but also to raise issues the journal needs to address. The paper finishes by reviewing, based on co‐editor experience over this period, issues and potential responses. [ABSTRACT FROM AUTHOR]

Ahead of a United Nations meeting on the global challenge of drug-resistant infections, Nature asked health-care experts in emerging economies to describe what would address the issue in their country or region most effectively. [ABSTRACT FROM AUTHOR]

Background: 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. Objective: 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. Descriptions and Conclusions: 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. [ABSTRACT FROM AUTHOR]

Background: American pediatric anesthesiologists have a long history of international volunteerism. However, the US healthcare system also benefits from the contributions of a large number of physicians who come from other nations to work within its borders. Despite this fact, little is known about the contribution of international medical graduates (IMG) to the pediatric anesthesiology subspecialty. Aims: To characterize the contribution of IMG to the field of pediatric anesthesiology in the United States, and to elucidate the geographic and demographic distribution of their national origins so as to understand the movement of skilled personnel between countries. Methods: Online physician directories of American children's hospitals were searched, and anesthesiologists were recorded for their national origin of medical education. International graduates were reported as a percentage of the pediatric anesthesiology workforce. Those attending medical colleges catering to American students ("offshore" medical schools) were analyzed separately from other IMGs. The cohort of non‐offshore IMGs were analyzed for national and continental origins, and by national level of economic development. Results: Of 1979 anesthesiologists analyzed, 397 attended medical school outside the United States, with 58 being from offshore schools. The remaining 338 represented 17.1% of the total pediatric anesthesiology workforce. They came from 58 countries on six continents. Of those, 65.1% attended medical school in low‐ and middle‐income countries. Conclusions: International medical graduates, disproportionately from low‐ and middle‐income countries, compose a large proportion of the US Pediatric Anesthesiology workforce. While these clinicians play a vital role in providing care for American children, the potential impacts of skilled physician loss on their nations of origin must also be considered. [ABSTRACT FROM AUTHOR]

Background and Objectives: This educational review outlines the current landscape of pediatric anesthesia training, care delivery, and challenges across Canada, Barbados, and the United States. Descriptions and Conclusions: Approximately 5% of Canadian children undergo general anesthesia annually, administered by fellowship‐trained pediatric anesthesiologists in children's hospitals, general anesthesiologists in community hospitals, or family practice anesthesiologists in underserved regions. In Canada, the focus is on national‐level evaluation and accreditation of pediatric anesthesia fellowship training, addressing challenges arising from workforce shortages, particularly in remote areas. Barbados, a Caribbean nation, lacks dedicated pediatric hospitals but has provided pediatric anesthesia since 1972 through anesthetists with additional training. Challenges in its development, common to low‐middle‐income countries, include inadequate infrastructure and workforce shortages. Increased awareness of pediatric anesthesia as a sub‐specialty could enhance perioperative care for Barbadian children. Pediatric anesthesia encompasses various specialties in the United States, with pediatric anesthesiologists playing a foundational role. Challenges faced include recruitment and retention difficulties, supply‐chain shortages, and the proliferation of anesthesia sites, all impacting the delivery of modern, high‐quality, and cost‐effective patient care. Collaborative efforts at national and organizational levels strive to improve the quality and safety of pediatric anesthesia care in the United States. [ABSTRACT FROM AUTHOR]

Introduction and history: In Mongolia, pediatric anesthesia has advanced during the past 25 years through expanded, standardized education programs and international collaboration. Pediatric anesthesia is a recognized specialty, covering all surgical services, including cardiac and transplant, using physicians and nurses. Training: The pediatric anesthesia fellowship is 6 months after 2 years of residency; pediatric nurse anesthesia training is 6 months. Conclusion: As a Low‐ and Middle‐Income Country (LMIC) with low population density and extreme weather, the challenges include insufficient equipment, supplies, and clinician numbers, matching few clinicians to many varied patient locations, and covering surgical emergencies over distance and weather. In Thailand, education and training in pediatric anesthesia remain a focus: Pediatric anesthesia is an official subspecialty, the fellowship is accredited, using a competency‐based curriculum with milestones of Direct Observation of Procedural Skills and Entrusted Professional Activities. The Bangkok Anesthesia Regional Training Center (BARTC)‐Pediatrics, jointly sponsored by the World Federation of Societies of Anesthesiologists (WFSA) and the Society for Pediatric Anesthesia (SPA), have expanded training to anesthesiologists worldwide. Challenges include difficulty balancing service workload and education, as well as attracting pediatric anesthesia fellows due to the strong private sector job market. [ABSTRACT FROM AUTHOR]

A much-cited statistic about how much of the world’s biodiversity is under Indigenous stewardship is unsupported — and could harm the cause it is meant to support. [ABSTRACT FROM AUTHOR]

Four Latin American researchers reflect on their experiences bridging the gap between science and policy in the region. [ABSTRACT FROM AUTHOR]

Introduction: Nearly three quarters of the suicides occur in developing world, however few evidenced-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department. Methods: This study reports the preliminary training phases of a pilot implementation trial in the emergency department to evaluate the program. The approval was obtained from the Nepal Health Research Council (Approval no. 447/2021 P), and the Kathmandu University School of Medical Sciences Institutional Ethical Review Board (Approval no. 237/2021) and Yale University IRB (Protocol ID 2000029480). Implementation assessments included suicide screening acceptability, appropriateness, confidence, system priority, and myth knowledge of staff. Implementation strategies were selected, decolonized, and preliminarily trained followed by phased supportive coaching to initiate the screening package. We designed the implementation package through co-design staff focus groups and embedded ethnography. Results: Co-design focus groups (n=8) occurred with staff and leadership. We trained 26 (76.47%) the staff on the Nepali suicide screening tool followed by supported phased initial screening over two months. Implementation assessments demonstrated increased scores on appropriateness, confidence, system priority, and myth knowledge. The implementation package included key strategies to be deployed over six months. The embedded ethnographic observations revealed barriers to effective implementation, such as anticipated stigma, reluctance to engage families, and distrust in referral processes. Conclusions: The pilot study demonstrated that training improves staff appropriateness, confidence, system priority, and myth knowledge. Despite initial barriers, co-designed strategies and phased coaching facilitates screening uptake, highlighting the program's potential for sustainable implementation.

Compared with cross-border refugees, people who are internally displaced receive little attention — despite their dire health needs. [ABSTRACT FROM AUTHOR]

African researchers piloted a slew of innovative, low-cost programmes for addressing the troubling shortage of mental-health professionals on the continent. Now the rest of the world is taking notice. [ABSTRACT FROM AUTHOR]

Researchers across the continent are using artificial intelligence to design bespoke solutions for health, development and more. [ABSTRACT FROM AUTHOR]

Will a growth in postdoctoral positions across Africa cause bottlenecks, replicating the career-progression challenges faced by scientists elsewhere? [ABSTRACT FROM AUTHOR]

Proficiency in English is pivotal for leveraging information and communication technologies, but it holds even greater significance in the realm of generative artificial intelligence (GAI), which is poised as the next digital frontier. However, the dominance of English in benchmarks and training data for large language models (LLMs) exacerbates challenges for individuals and organizations in the developing world, predominantly non-English speakers. Despite the commendable performance of GAI in select developed languages like French, Spanish, and Japanese, it struggles to deliver comparable results in low-resource languages (LRLs) such as Bengali, Hindi, and Swahili. These languages, deprived of adequate online content, face obstacles in training specialized models due to script complexities and limited lexical resources. While countries like Japan and Iceland offer promising models for addressing linguistic challenges, the road ahead necessitates collaborative efforts to develop LLMs tailored for LRLs and rectify linguistic inaccuracies, ensuring inclusive and equitable AI development. [ABSTRACT FROM AUTHOR]

The paper aims at bringing out the cultural, economic, and political importance that Khadi has for India from pre-colonial times, during the colonial rule and after independence till the present times. The paper brings out Khadi's potential in rural development by solving the pressing concerns of unemployment and working conditions in developing countries like India. In spite of this, Khadi's potential at rural development is subsided by the contemporary threats the industry faces due to the different agents of neoliberalism, discussed in the paper. The questionnaire report on workers collected at the Cheriyakonni production unit and information collected at the District Project Office Trivandrum; brings out that rural women are the largest workforce victims of these threats, as the industry is slowly showing signs of degradation. Methodology: The research paper is based on both quantitative and qualitative data analysis. Data is collected from Kerala Khadi and Village Industries Board (KVIB) Project Office Thiruvananthapuram through interviews. Questionnaire is conducted on workers of Cheriyakonni Production Unit, Thiruvananthapuram that operates under the board. [ABSTRACT FROM AUTHOR]

Considering the lack of data from Iraq on the challenges faced by academics regarding academic advancement, we aimed to explore the main challenges faced by academic faculty members in Iraq in achieving academic advancement and promotion. A cross sectional 24-item Google form survey was shared via social media; 130 Iraqi academics responded. Lack of research funding and poor research infrastructure were the most common barriers for academic advancement. Most academics agreed that the cost of promotion requirements is considered a lot compared to their income. This is the first study that has explored this issue in Iraq and suggests future strategies to overcome these barriers. [ABSTRACT FROM AUTHOR]

Gene therapies will become more affordable everywhere only if they are developed and manufactured in the regions of the world most in need of them. [ABSTRACT FROM AUTHOR]

Scholarships and soft power among reasons for increasing numbers, but graduates return with mixed reviews. [ABSTRACT FROM AUTHOR]

Residential Child and Youth Care in a Developing World (2016 – 2020) is a unique insight into global residential child and youth care practice, which emphasises that the usually negative Western literature perspective that many of us read about is not the experience of the majority of those involved in care, whether as participants or workers. Rather, we are offered glimpses into residential care practices in geographies that are often unfamiliar and not often included in the surrounding discourse.

We consider the relationships between multidimensional and monetary poverty indices in international and national poverty profiles, and empirically explore the consequences of identifying poor people relying on a combination of both approaches. Taking first a cross-country perspective, focusing on 90 countries in the developing world, we corroborate that the incidence of poverty by money metrics and the global Multidimensional Poverty Index, a non-monetary measure of poverty, are correlated. Digging deeper, we use microdata from six countries—Bolivia, Brazil, Ecuador, Ethiopia, Ghana, and Uganda—to study the joint densities of monetary and multidimensional welfare and the poverty identification mismatches for a comprehensive array of poverty line pairs. Mismatches are important, particularly in the poorer countries. Although mismatches could be avoided by combining both approaches in a dual cutoff-based poverty measure, the choice of the monetary poverty line remains a considerable issue as it changes the nonmonetary composition of poverty. [ABSTRACT FROM AUTHOR]

Researchers in the developing world navigate many roadblocks when partnering with the global north, but the benefits can be wide-reaching. [ABSTRACT FROM AUTHOR]

Computational models that require very little data could transform biomedical and drug development research in Africa, as long as infrastructure, trained staff and secure databases are available. [ABSTRACT FROM AUTHOR]

There is little data available on the long-term outcomes of mechanical valve replacement from the developing world. The aim of this study was to determine long-term survival and outcomes following mechanical valve replacement with the TTK Chitra valve at a single Indian centre. A clinical observational study was conducted in a cohort of 2272 consecutive patients who had undergone mechanical valve replacement with the TTK Chitra Heart Valve between 2001 and 2020. Follow-up was 89.3% complete with a mean follow-up of 7.1 (SD 5) years. The primary end point was survival. Regression and life table analyses were used to determine population survival and attributable risk. Secondary end points were reintervention and valve-related complications. Overall actuarial survival was 82.3 (SD1) %, 70.7 (SD1) %, and 61 (SD2) % at 1, 5, and 10 years, respectively, lower than published data in comparable patients from the developed world. Actuarial freedom from prosthetic valve dysfunction was 99 (SD1) %, 96.3 (SD1) %, and 96 (SD1)% at 1, 5, and 10 years, respectively. Freedom from reintervention was 91.2 (SD1) %, 90.4 (SD1) %, and 90 (SD1) % at 1, 5, and 10 years, respectively. Actuarial freedom from major adverse prosthesis–related events was 83% (SD0.8) %, 66.9 (SD1) %, and 50.1 (SD1.7) % at 1, 5, and 10 years, respectively, and actuarial freedom from major haemorrhage was 85.5 (SD0.7) %, 70.7 (SD1) %, and 57.3 (SD1.7) % at 1, 5, and 10 years, respectively. The TTK Chitra valve continues to remain the preferred prosthesis of choice for many patients in India, and the developing world by virtue of performance, durability, and cost; however, long-term valve care continues to plague the real benefits and outcomes it has to offer. [ABSTRACT FROM AUTHOR]