Group Practice Research Articles

A Comparative Study on the Impact of Gratitude on Well-Being among Youth and Adult Populations

Gratitude's impact on the welfare of young and old populations is primarily examined in this research paper. Gratitude, one of the multi-dimensional responses towards emotional behavior, has attracted a great deal in positive psychology for its capability to produce better mental health and quality well-being. The goal of this study is to analyze and contrast the impact of gratitude on subjective well-being, life satisfaction, and psychological resilience in two different age groups. This study uses a mixed-methods design, integrating quantitative and qualitative interviews to obtain detailed data. All participants from youth and adult age groups practice gratitude interventions, reflective exercises, as well as self-report measures. Such quantitative analyses use statistical comparisons of pre- and post-intervention well-being scores to shed light on any potential age variations in the performance of gratitude practices. The subjective perception of gratitude and its impact on overall well-being is also reflected by qualitative data, which emerged from in-depth interviews. The research takes into account situational variables including life events, social ties, and cultural elements that contribute to gratitude expression among different age groups. The results add to the literature on positive psychology by highlighting possible differences in efficacy, which may be related to the age cohort. These findings have implications beyond the application of targeted well-being interventions designed for youth and adult populations concerning their individual needs, bringing a more profound understanding of the role gratitude plays in ensuring mental health satisfaction is achieved. Keywords: Gratitude, Well-being, Age groups, Positive psychology, Intervention

Successful Screening of Undiagnosed Psoriatic Arthritis in Primary Care Utilising Digital Interventions Within a Quality Improvement Programme

Background: Despite the advancements in the management of psoriasis (PsO) and psoriatic arthritis (PsA), there remains a significant delay to diagnosis of PsA. National guidelines recommend regular screening of patients with PsO for PsA. The aim of this study was to increase the screening of patients with PsO, and reduce the delay to diagnosis in PsA. Methods: A retrospective baseline audit was conducted in patients with PsO attending a large general practice (Brookside Group Practice, Reading, UK) between November 2022–April 2023. In the follow-up stage between May–November 2023, a digital Egton Medical Information System (EMIS; Emis Health, Rawdon, Leeds, UK) web template, using the Psoriasis Epidemiology Screening Tool (PEST) questionnaire was implemented. The number of patients with PsO screened for PsA, and the number of newly diagnosed PsA cases, were recorded. Results: At baseline, 15 patients with PsO were identified, and none had PsA screening done. In the follow-up phase, 28 patients coded for PsO were identified. There was an increase in the number of patients screened for PsO from 15 to 28, representing an increase of 87% from baseline. From the follow-up group, 12 (43%) patients were screened for PsA. These patients were referred to the specialist clinic, and seven (58%) had confirmed PsA. This represented a population of patients with previously undiagnosed PsA within the general practitioner (GP) surgery. Conclusions: The authors have successfully implemented an integrated and interactive digital screening tool for PsA within the GP system. This has led to an increase in the detection of patients with PsA. This practical and effective approach is in line with national guidelines for early detection, to prevent long-term damage and disability from PsA.

Successful Screening of Undiagnosed Psoriatic Arthritis in Primary Care Utilising Digital Interventions Within a Quality Improvement Programme

Background: Despite the advancements in the management of psoriasis (PsO) and psoriatic arthritis (PsA), there remains a significant delay to diagnosis of PsA. National guidelines recommend regular screening of patients with PsO for PsA. The aim of this study was to increase the screening of patients with PsO, and reduce the delay to diagnosis in PsA. Methods: A retrospective baseline audit was conducted in patients with PsO attending a large general practice (Brookside Group Practice, Reading, UK) between November 2022–April 2023. In the follow-up stage between May–November 2023, a digital Egton Medical Information System (EMIS; Emis Health, Rawdon, Leeds, UK) web template, using the Psoriasis Epidemiology Screening Tool (PEST) questionnaire was implemented. The number of patients with PsO screened for PsA, and the number of newly diagnosed PsA cases, were recorded. Results: At baseline, 15 patients with PsO were identified, and none had PsA screening done. In the follow-up phase, 28 patients coded for PsO were identified. There was an increase in the number of patients screened for PsO from 15 to 28, representing an increase of 87% from baseline. From the follow-up group, 12 (43%) patients were screened for PsA. These patients were referred to the specialist clinic, and seven (58%) had confirmed PsA. This represented a population of patients with previously undiagnosed PsA within the general practitioner (GP) surgery. Conclusions: The authors have successfully implemented an integrated and interactive digital screening tool for PsA within the GP system. This has led to an increase in the detection of patients with PsA. This practical and effective approach is in line with national guidelines for early detection, to prevent long-term damage and disability from PsA.

Abstract PO2-29-04: An AI-based safeguard process to reduce aggressive missed cancers in dense breasts at screening mammography

Abstract Background: Dense breast tissue makes cancerous lesions difficult to identify on mammograms, resulting in many cancers missed at screening in patients with dense breasts. These missed cancers are then only diagnosed once they have grown to the point they can be more easily distinguished from the surrounding dense tissue. Dense breast tissue is more common in younger women, for whom early detection and diagnosis could lead to fewer years of life lost. This challenge motivated the FDA’s decision this year to require breast density to be included in patient reports, but notification does not solve the problem that these cancers are still often missed. Missing aggressive, fast growing cancers is particularly worrisome given they are more likely to progress to a stage where they are difficult to treat by the time they are detected in the future. Methods: A prospective study was conducted at one group practice of 6 radiologists over the course of 12 months to test a safeguard process to detect missed cancers so they could be treated more readily. AI software (Saige, DeepHealth, Inc.) was used to flag the most suspicious screening mammography exams that had not been recalled for work-up by an initial interpreting radiologist. An expert breast imager performed a safeguard review of each exam flagged. If the expert decided a recall was warranted, she would consult with the initial interpreting radiologist to decide if the patient should be recalled for further (diagnostic) imaging. Data was collected for each breast cancer diagnosed during this period. Patient data included breast density, age, and race. Cancer follow up data included pathology classification, hormone status, grade, staging, and Ki67 score. Aggressive cancers were identified as those with high grade (Grade 3), high Ki67 ( >=20%) or clinical stage of IIA or greater. A comparison was performed between cancers detected by the original interpreting radiologist and those detected through the safeguard process. Results: During the study period, 40,532 mammograms were obtained and 2,296 were flagged for safeguard review. The safeguard review led to 130 additional patient recalls and 41 additional cancer diagnoses. In women with dense breast tissue, 103 cancers were detected by routine interpretation and an additional 18 cancers (17.5%) detected through the safeguard process. In women without dense breast tissue, 116 cancers were detected by routine interpretation and 23 additional cancers were detected through the safeguard process. The cancers detected through the safeguard process included a larger percent of aggressive cancers (34.1% vs 30.6%, p=0.66) and more than double the percent of triple-negative cancers (9.8% vs 4.1%, p=0.13), though these differences were not statistically significant. The cancers detected through the safeguard process were from patients with similar demographics (age and race) to those whose cancers were detected by the interpreting radiologist. Conclusion: The AI-driven safeguard process results in a significant increase in breast cancers that would have been missed in patients with dense breast tissue. Many of the additional cancers were aggressive with almost 10% being triple-negative cancers. Without the safeguard process those aggressive cancers would not likely have been diagnosed until the next screening cycle in 1-2 years when treatment would likely have been less effective and outcomes poorer. Citation Format: Bryan Haslam, Jiye Kim, A. Gregory Soresen. An AI-based safeguard process to reduce aggressive missed cancers in dense breasts at screening mammography [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-29-04.

Physician Group Practices Accrued Large Bonuses Under Medicare's Bundled Payment Model, 2018-20.

The Bundled Payments for Care Improvement Advanced Model (BPCI-A), a voluntary Alternative Payment Model for Medicare, incentivizes hospitals and physician group practices to reduce spending for patient care episodes below preset target prices. The experience of physician groups in BPCI-A is not well understood. We found that physician groups earned $421million in incentive payments during BPCI-A's first four performance periods (2018-20). Target prices were positively associated with bonuses, with a mean reconciliation payment of $139 per episode in the lowest decile of target prices and $2,775 in the highest decile. In the first year of the COVID-19 pandemic, mean bonuses increased from $815 per episode to $2,736 per episode. These findings suggest that further policy changes, such as improving target price accuracy and refining participation rules, will be important as the Centers for Medicare and Medicaid Services continues to expand BPCI-A and develop other bundled payment models.

Effect of a physical education program in early childhood education on the performance of fundamental movement skills based on teaching styles: divergent discovery and practical

Background and Study Aim. Various proposals suggest that Physical Education classes (PE) should prioritize the development of fundamental movement skills (FMS), particularly in preschool children. Despite the crucial nature of mastering FMS, there is a paucity of evidence regarding the impact of PE classes on FMS development. The primary objective of this study is to investigate the effect of a physical education program on the performance of preschool students with varying levels of development in fundamental movement skills, employing divergent discovery and practical teaching styles. Material and Methods. Seventy-seven children (35 boys), aged between 4.5 and 6 years were divided into three groups: Control Group (CG) with 25 participants, Divergent Discovery Group (DDG) with 24 participants, and Practice Group (PG) with 28 participants. The intervention program spanned six months, with two 50-minute classes per week for the experimental groups. Conversely, the control group participated in the Classroom Program proposal. All three groups underwent the TGMD-3 motor test. Performance measurement involved the sum of the raw score in the locomotor and object control classes. Results. The findings revealed that the Control Group, Divergent Discovery Group, and Practice Group exhibited improved FMS performance from pre to post. Concerning intergroup differences, no significant disparities were observed in the pre-test. However, post-intervention results indicated that both the Divergent Discovery Group and Practice Group demonstrated superior FMS performance compared to the Control Group. Conclusions. Physical Education classes for Early Childhood Education play a crucial role in fostering significant effects on children's motor development when offered in an appropriate context and through a systematically structured intervention.

Isotopic evidence of high reliance on plant food among Later Stone Age hunter-gatherers at Taforalt, Morocco.

The transition from hunting-gathering to agriculture stands as one of the most important dietary revolutions in human history. Yet, due to a scarcity of well-preserved human remains from Pleistocene sites, little is known about the dietary practices of pre-agricultural human groups. Here we present the isotopic evidence of pronounced plant reliance among Late Stone Age hunter-gatherers from North Africa (15,000-13,000 cal BP), predating the advent of agriculture by several millennia. Employing a comprehensive multi-isotopic approach, we conducted zinc (δ66Zn) and strontium (87Sr/86Sr) analysis on dental enamel, bulk carbon (δ13C) and nitrogen (δ15N) and sulfur (δ34S) isotope analysis on dentin and bone collagen, and single amino acid analysis on human and faunal remains from Taforalt (Morocco). Our results unequivocally demonstrate a substantial plant-based component in the diets of these hunter-gatherers. This distinct dietary pattern challenges the prevailing notion of high reliance on animal proteins among pre-agricultural human groups. It also raises intriguing questions surrounding the absence of agricultural development in North Africa during the early Holocene. This study underscores the importance of investigating dietary practices during the transition to agriculture and provides insights into the complexities of human subsistence strategies across different regions.

The Ponto de Partida Group: Theatre and Music unite Communities in a Restored Silk Factory in Barbacena

Based on concepts from Nogueira and Cruz, Bezelga, and Menezes, this article examines the practices of the theatre group which is based in a former silk factory in Barbacena, helping to make these listed buildings sustainable. After the factory closed government agencies took over the buildings. However, in the 1990s, the buildings were unoccupied until taken over by the Ponto de Partida Group in 1998. To restore the deactivated industrial heritage, the group involved the community of Barbacena in fund-raising and competitions, moving into Pavilion 1 in 2004. After the restoration of Pavilion 2, Bituca Music University was opened there, a tribute to the musician Milton Nascimento. Finally, the group established a community library in Pavilion 3.

Application of Narrative Therapy in a Social Work Group of Caregivers with Mental Health Disorders

Social workers from China found in their community service and interview: Caregivers of individuals with people with mental disorders Lack of sense of meaning in life. They showed simple narration content, narration style, pessimism, low identity recognition. Caregivers think Causing their life stress, family economic difficulties. the psychological pressure is because of their have a mental illness person in. family. Social workers follow the concept of helping people to help themselves, hoping to improve the sense of meaning of life for these caregivers and change their perception. Thirty family carers of the mentally disabled have been chosen to receive life narration treatment in a social work group. this is the main content of social work practice research. In practice, Social worker which has adopted various kinds of narration methods such as life narration, sand table narration, story narration, drawing narration, etc. The practice of This social work group helps carers discover their life meaning from the experiences of care mental illness. this is a valuable practice of social work service for families with mental disorder. This is done with application value of promotion.

Translating assessment for learning to work in groups of students with intellectual disabilities

ABSTRACT The potential of using Assessment for Learning (AfL) is well established, but studies of AfL practice in groups of students with intellectual disabilities (ID) are rare. The respondents in this study were assistants and teachers working in compulsory school for students with ID. In a two-year project they had worked with translating five AfL key strategies (KSs) to fit their context. The study aimed at exploring this translation to depict the use of AfL KSs in the classes of students with ID and reveal opportunities and challenges. The AfL KSs were used to structure interviews and classroom observations, and an ensuing thematic data analysis. The overall conclusion confirms the potential of using AfL in this context. Three themes depict the overall use of AfL: a whole-class focus, a team approach, and the integrated use of the AfL KSs. Various themes characterise the implementation of each KS, and the opportunities and challenges. The findings implicate benefits for the students, and advantages as well as concerns for the staff. The findings are expected to be of value inside and outside the study’s context. The study demonstrates how contextual variation can contribute to new insights and questions for the AfL research field.

An Effective Program to Reduce Malpractice Claims and Payments in a Large Orthopaedic Practice.

High reliability in health care requires a balance between intentionally designed systems and individual professional accountability. One element of accountability includes a process for addressing clinicians whose practices are associated with a disproportionate share of patient complaints. This study aimed to evaluate the impact of the Patient Advocacy Reporting System (PARS), a tiered intervention model to reduce patient complaints about clinicians. A retrospective cohort study was conducted involving a southeastern U.S. orthopaedic group practice. The study assessed the implementation of the PARS program and subsequent malpractice claims from 2004 to 2020. The implementation of PARS was associated with an 83% reduction in malpractice claims cost per high-risk clinician after intervention (p = 0.05; Wilcoxon rank sum test). The overall practice group experienced an 87% reduction in mean annual claims cost per clinician (p = 0.007; segmented regression). The successful adoption required essential elements such as PARS champions, peer messengers, an Office of Patient Affairs, and a clear statement of practice values and professionalism expectations at the time of onboarding. The PARS program was successfully adopted within a surgical specialty group as a part of ongoing risk prevention and management efforts. The period following PARS was associated with a retrospectively measured reduction in malpractice claim costs. The PARS program can be effectively implemented in a large, single-specialty orthopaedic practice setting and, although not necessarily causal, was, in our case, associated with a period of reduced malpractice claim costs. We have learned in previous research that there are clear links between professionalism and patient outcomes (e.g., surgical complications), but agree that the focus here on medical malpractice is not directly clinical.

Solutions for Addressing the Dermatologist Shortage in Rural Canada: A Review of the Literature.

In Canada, there is a maldistribution of dermatologists, with as many as 5.6 dermatologists per 100,000 population in urban areas and as low as 0.6 per 100,000 in rural areas. Considering trends of dermatologists to work in group practices in urban areas, and the low number of rural dermatologists, one solution may be to incentivize dermatologists to practice rurally. Several solutions using the following themes are discussed: dermatology program-specific incentives, dermatology practice-specific incentives, and other indirect incentives. The low number of dermatologists in rural areas in Canada is concerning and has negative consequences for access to care for patients in rural areas, ultimately resulting in worse patient outcomes. Future research is needed to evaluate the impact of these initiatives and assess future access to dermatological care.

Two-year follow-up of a clustered randomised controlled trial of a multicomponent general practice intervention for people at risk of poor health outcomes

BackgroundThis study was a two-year follow-up evaluation of health service use and the cost-effectiveness of a multicomponent general practice intervention targeted at people at high risk of poor health outcomes.MethodsA two-year follow-up study of a clustered randomised controlled trial was conducted in South Australia during 2018–19, recruiting 1044 patients from three cohorts: children; adults (aged 18–64 years with two or more chronic diseases); and older adults (aged ≥ 65 years). Intervention group practices (n = 10) provided a multicomponent general practice intervention for 12 months. The intervention comprised patient enrolment to a preferred general practitioner (GP), access to longer GP appointments and timely general practice follow-up after episodes of hospital care. Health service outcomes included hospital use, specialist services and pharmaceuticals. The economic evaluation was based on quality-adjusted life years (QALYs) calculated from EuroQoL 5 dimensions, 5 level utility scores and used an A$50,000 per QALY gained threshold for determining cost-effectiveness.ResultsOver the two years, there were no statistically significant intervention effects for health service use. In the total sample, the mean total cost per patient was greater for the intervention than control group, but the number of QALYs gained in the intervention group was higher. The estimated incremental cost-effectiveness ratio (ICER) was A$18,211 per QALY gained, which is lower than the A$50,000 per QALY gained threshold used in Australia. However, the intervention's cost-effectiveness was shown to differ by cohort. For the adult cohort, the intervention was associated with higher costs and lower QALYs gained (vs the total cohort) and was not cost-effective. For the older adults cohort, the intervention was associated with lower costs (A$540 per patient), due primarily to lower hospital costs, and was more effective than usual care.ConclusionsThe positive cost-effectiveness results from the 24-month follow-up warrant replication in a study appropriately powered for outcomes such as hospital use, with an intervention period of at least two years, and targeted to older people at high risk of poor health outcomes.

Cracks within capitalism: Alternative rental practices and a politics of care among small-building owners in Chicago

ABSTRACT The United States is currently in the fourth decade of an ongoing, and worsening, affordable housing crisis, due in part to neoliberal financialization and the retrenchment of social safety net programs. Research has illuminated the role that landlords play in maintaining, and profiting, from this neoliberal turn in the housing market. Meanwhile, low-income renters and other marginalized people have engaged in strategic resistance and activism, drawing on a politics of community care and collectivism that runs counter to neoliberal market ideology. It is within this wider context—a housing market where neoliberal and collective care politics clash—that I analyze the viewpoints and rental practices of a unique group of housing market actors: resident landlords, or people who live in the same buildings as their tenants. Among a wider sample of 52 owner-occupants, I interviewed 22 owners who held anti-oppression viewpoints, and who attempted to put their politics into practice by adopting atypical rental practices. Drawing on Black radical and feminist traditions in urban political economy, I theorize these activities as political decisions that created sites of opportunity, where building owners and residents attempted to reconfigure their relationships under capitalism, providing a window into possibilities for more caring housing arrangements.

Gene pool preservation across time and space In Mongolian-speaking Oirats.

The Oirats are a group of Mongolian-speaking peoples residing in Russia, China, and Mongolia, who speak Oirat dialects of the Mongolian language. Migrations of nomadic ethnopolitical formations of the Oirats across the Eurasian Steppe during the Late Middle Ages/early Modern times resulted in a wide geographic spread of Oirat ethnic groups from present-day northwestern China in East Asia to the Lower Volga region in Eastern Europe. In this study, we generate new genome-wide and mitochondrial DNA data for present-day Oirat-speaking populations from Kalmykia in Eastern Europe, Western Mongolia, and the Xinjiang region of China, as well as Issyk-Kul Sart-Kalmaks from Central Asia, and historically related ethnic groups from Altai, Tuva, and Northern Mongolia to study the genetic structure and history of the Oirats. Despite their spatial and temporal separation, small current population census, both the Kalmyks of Eastern Europe and the Oirats of Western Mongolia in East Asia are characterized by strong genetic similarity, high effective population size, and low levels of interpopulation structure. This contrasts the fine genetic structure observed today at a smaller geographic scale in traditionally sedentary populations, and is conditioned by high mobility and marriage practices (traditional strict exogamy) in nomadic groups. Conversely, the genetic profile of the Issyk-Kul Sart-Kalmaks suggests a distinct source(s) of genetic ancestry, along with indications of isolation and genetic drift compared to other Oirats. Our results also show that there was limited gene flow between the ancestors of the Oirats and the Altaians during the late Middle Ages. Source of the yurt image: https://www.vecteezy.com/free-vector/yurt .

'Acceleration' of the food delivery marketplace: Perspectives of local authority professionals in the North-East of England on temporary COVID regulations.

In January 2021, we assessed the implications of temporary regulations in the United Kingdom allowing pubs and restaurants to operate on a takeaway basis without instigating a change of use. Local authorities (LAs) across the North-East of England were unaware of any data regarding the take-up of these regulations, partially due to ongoing capacity issues; participants also raised health concerns around takeaway use increasing significantly. One year on, we repeated the study aiming to understand the impact of these regulations on the policy and practice of key professional groups. Specifically, we wanted to understand if LAs were still struggling with staff capacity to address the regulations, whether professionals still had public health trepidations, and if any unexpected changes had occurred across the local food environment because of the pandemic. We conversed with 16 public health professionals, planners and environmental health officers across seven LAs throughout the North-East of England via focus groups and interviews. Data collated were analysed via an inductive and semantic, reflexive-thematic approach. Through analysis of the data, three themes were generated and are discussed throughout: popular online delivery services as a mediator to increased takeaway usage; potential long-term health implications and challenges; continued uncertainty regarding the temporary regulations. This paper highlights important changes to local food environments, which public health professionals should be aware of, so they are better equipped to tackle health inequalities across urban and sub-urban areas.

Intimacy as a competency: information-seeking practices in (marriage) migration online support groups

This article explores the use of online social networks for seeking and sharing information about marriage migration. In Europe, since the 1990s, this migration has faced heightened scrutiny. Laws and administrative practices have added complexity to immigration procedures. Manifold screening methods gauge the authenticity of relationships aligning with the host nation’s concept of a suitable family for integration. In this context, informal self-help groups emerged to offer support to those facing burdensome formalities and local administrative intricacies. Based on extensive qualitative fieldwork, this article examines the significance of these support groups, drawing on the concept of intimacy as a shared competency. Here, intimacy is conceived as an active relational skill that counterbalances the limitations of migration policies. The analysis transcends the division between online and offline modes of living, shedding new light on intimacy and extimité – the sharing of one’s intimate self with others for validation – in doing family.

Practitioners' experiences of delivering parenting interventions remotely: A mixed‐methods study

AbstractGroup Stepping Stones Triple P (GSSTP), is an evidence‐based intervention for parents of children with intellectual disability that aims to improve child behavioural difficulties. GSSTP was designed to be delivered face‐to‐face, but during the COVID‐19 pandemic some services started delivering it remotely. The evidence base for remote intervention is growing, but few studies have focused on the experiences of practitioners delivering the interventions and the consequences of their service provision. We aimed to explore UK practitioners' experiences of delivering remotely GSSTP. The objectives were to identify the advantages and disadvantages of remote GSSTP, to determine whether adjustments were made to enable delivery, and to assess perceived acceptability. Participants were identified using consecutive sampling from the Triple P UK practitioner network. Eleven practitioners, who had experience of delivering GSSTP remotely and face‐to‐face, reported their experiences in an online survey. Ten participants also took part in semi‐structured interviews. Interviews were transcribed verbatim and analysed using thematic analysis. According to 55% of practitioners, parent attendance had increased with remote delivery, and 73% of practitioners found remote GSSTP equally or more effective than face‐to‐face. Survey findings about managing parent engagement remotely were mixed and building rapport with patients was considered equally or more difficult remotely. The key themes from the thematic analysis were the practitioners' ‘sincere enthusiasm’ over the advantages of the remote GSSTP provision, the ‘person‐centered strategies’ that characterised their practice, the emergence of ‘remote delivery as the way forward’ for parenting services and finally, the ‘challenges of remote delivery’. Remote GSSTP was perceived to be acceptable to participants and practitioners; the advantages of remote delivery appeared to outweigh the disadvantages. Practitioners reported strategies to prompt engagement and recreate group interactions in the remote setting that could be integrated in the practice of other group parenting providers.

A Preliminary Investigation of the Effectiveness of Quizizz on Vocabulary Acquisition Between Individual and Group Practices in Chinese as a Foreign Language High School Classes in the U.S.A.

A Preliminary Investigation of the Effectiveness of Quizizz on Vocabulary Acquisition Between Individual and Group Practices in Chinese as a Foreign Language High School Classes in the U.S.A.

Private property arrangement within community forest: a case of Raktamala forest user group

This article briefly outlines individually distributed plot based forestry practices of a forest user group (FUG) in eastern Terai of Nepal. Forest users have adopted this system to enhance livelihoods impacts of forest, although there is no explicitly designed national policy and legislation to support it. Raktamala Community forest user group, which is located in the eastern Terai district of Saptari, is one that has been practicing this type of system. Most of 620 households affiliated to the group use about a half of the 350 hectares of community forests as individually-owned forest plots.