Working Group Research Articles

Possible sarcopenia and risk of chronic kidney disease: a four-year follow-up study and Mendelian randomization analysis

ABSTRACT Introduction Chronic kidney disease (CKD) is a common risk factor for sarcopenia. However, whether sarcopenia increases the risk of CKD remains unclear. To investigate the longitudinal and causal associations between possible sarcopenia and CKD, this study was performed. Methods Possible sarcopenia was defined according to the Asian Working Group for Sarcopenia in 2019. Participants aged ≥ 40 years were recruited from the baseline survey of the China Health and Retirement Longitudinal Study and followed up for four years. Binary logistic regression was used to evaluate the cross-sectional and longitudinal associations between possible sarcopenia, low muscle strength, low physical performance and CKD. Propensity score matching was used to balance the intergroup differences. Subgroup and interactive analyses were adopted to identify potential interactive effects. Mendelian Randomization analysis was used to assess the causal association between appendicular lean mass (ALM) and CKD. Results After data cleansing, a total of 7296 participants were included in the baseline survey. In the cross-sectional analyses, the odds ratios (ORs) of prevalent CKD were 1.50 (95% CI = 1.23–1.84, p < 0.001) for possible sarcopenia, 1.37 (95% CI = 1.10–1.70, p < 0.01) for low muscle strength and 1.42 (95% CI = 1.16–1.74, p < 0.001) for low physical performance in the full models. No significant interaction effects of covariates were detected (all P for interaction > 0.05). After four years of follow-up, an increased risk of incident CKD was also observed in participants with possible sarcopenia (OR = 1.66, 95% CI = 1.13–2.44, p = 0.010) and low physical performance (OR = 1.69, 95% CI = 1.16–2.45, p = 0.006), but not in participants with low muscle strength (OR = 1.19, 95% CI = 0.75–1.88, p = 0.469). In the Mendelian Randomization analysis, the inverse variance weighted estimator showed that a 1-standard deviation increase of genetically predicted ALM was associated with a lower risk of CKD (OR = 0.92, 95% CI = 0.85–0.99, p = 0.035). All the sensitivity analyses supported the main findings. Conclusions Possible sarcopenia is an independent risk factor for CKD and may serve as a predictor of CKD for early identification and intervention.

Implementation of team based learning for MBBS students – An innovative teaching learning method in medical education

Team-Based Learning (TBL) is an educational approach that enhances student engagement through individual assessments and collaborative group work. It is an effective and structured form of small group learning adaptable to large classroom settings. TBL ensures student accountability through various stages, including pre-class preparation, readiness assurance tests, problem-solving exercises, and immediate feedback. This study aims to implement and assess the efficacy of the TBL strategy among MBBS students in a large group teaching environment. The pilot study adopted a TBL approach, involving steps such as pre-class preparation with PDF materials and a WhatsApp video guide issued a week prior, individual and team readiness assurance tests (iRAT and tRAT) conducted via Google Forms and hard copy MCQs, clarification sessions on MCQs and relevant medical topics, and collaborative learning through case scenarios related to Type 2 diabetes. Discussions and conclusions were facilitated by the faculty, followed by immediate and scheduled feedback using Google Forms. Statistical analysis was performed using an unpaired t-test to compare iRAT and tRAT scores. The study gathered 133 responses from the first batch and 140 from the second batch of first year MBBS students. The analysis revealed significant improvements in scores from iRAT to tRAT, indicating the effectiveness of TBL in enhancing student learning outcomes. Feedback from the students showed high levels of engagement and interest in the learning process, with over 98% in both batches finding the TBL approach interesting and interactive. The findings suggest that TBL is a valuable and effective educational strategy that improves learning outcomes and fosters collaborative learning among students.

A qualitative study of students’ lived experience and perceptions of using ChatGPT: immediacy, equity and integrity

ABSTRACT The lived experience of students in their interaction with ChatGPT is underexplored. We conducted qualitative, semi-structured interviews with management students, who recently graduated, to explore their lived experiences and perceptions of using ChatGPT during their studies. Insights gained from the thematic analysis indicate positive perceptions of individual use of ChatGPT. Perceptions were mixed in relation to peers’ use of ChatGPT, especially during group work, where members’ “inappropriate” use of ChatGPT can lead to academic misconduct affecting all group members. Three themes emerged from our analysis: immediacy, equity, and integrity. The use of ChatGPT is driven by its immediate reassurance and validation properties, and for its potential to augment performance and creativity. Participants expressed concerns regarding equitable access to software and the risk of devaluing future degrees in the eyes of employers. Integrity was seen and articulated as problematic in the absence of institutional transparency and clear policy. These findings inform our discussion and recommendations – for the use of ChatGPT by students; for learning and teaching at module and programme level; and for policy development. The study contributes to the growing body of literature related to ChatGPT in higher education and emphasises the need to focus on student voice first.

A History of International Engagement in the Council for Exceptional Children Since 1980. Part 1: Organizational Components

Abstract Is the Council for Exceptional Children (CEC), arguably the largest professional organization in exceptional education in the world, international or not? What does it mean to be international? An integrative literature review of primary sources of CEC news articles, reports of initiatives and workgroups, and columns in CEC publications that provided records of the Council’s internationally related thinking and activities involving countries outside the United States and Canada was conducted to reconceptualize CEC’s international nature since 1980. In this article, we report the findings from these sources that provide evidence of international aspirations and activities at times for six organizational components of CEC—mission and vision, policy, units, committees, work groups, and membership. There were instances of international thinking and efforts in these components. Both are necessary for meaningful international engagement, as neither is sufficient on its own. Our results suggest, though, that each may have been wanting. Recommendations are provided on how CEC can increase its global engagement through these elements.

Malnutrition and cachexia may affect death but not functional improvement in patients with sarcopenic dysphagia.

To investigate whether two factors, malnutrition and cachexia, affect swallowing function, activities of daily living (ADL), and death in sarcopenic dysphagia. Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia Database, 271 met the study eligibility criteria in a retrospective cohort study. Patients were divided into four groups based on whether they had cachexia according to the Asian Working Group for Cachexia (AWGC) criteria and malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Multivariate analyses were performed to investigate the differences in changes in the Food Intake LEVEL Scale (FILS) and Barthel Index (BI) and death after follow-up between the malnutrition and cachexia group and the other groups. The mean age was 83.7 ± 8.3years, 119 (44%) were men and 152 (56%) were women. The median FILS at baseline was 7 and the median BI was 25. A total of 120 (44%) had malnutrition only, 54 (20%) had neither cachexia nor malnutrition, 12 (4%) had cachexia only, and 85 (31%) had both cachexia and malnutrition. Multivariate analyses showed no significant difference between the change in BI (P = 0.688) and the change in FILS (P = 0.928) between the malnutrition and cachexia group and the other groups; however, death increased significantly (P = 0.010). Some patients diagnosed with cachexia were not malnourished, although many patients with cachexia were malnourished. While patients with both cachexia and malnutrition did not show significant improvement in ADL and swallowing function compared with patients without both conditions, the number of deaths increased significantly.

Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Adults with Epilepsy: The International Consortium for Health Outcomes Measurement Consensus Recommendations.

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. Therefore, the International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy and their representatives to develop minimum sets of standardized outcomes and outcomes measurement methods for clinical practice that support patient-clinician decision-making and quality improvement. Consensus methods identified 20 core outcomes. Measurement tools were recommended based on their evidence of strong clinical measurement properties, feasibility, and cross-cultural applicability. The essential outcomes included many non-seizure outcomes: anxiety, depression, suicidality, memory and attention, sleep quality, functional status, and the social impact of epilepsy. The proposed set will facilitate the implementation of the use of patient-centered outcomes in daily practice, ensuring holistic care. They also encourage harmonization of outcome measurement, and if widely implemented should reduce the heterogeneity of outcome measurement, accelerate comparative research, and facilitate quality improvement efforts.

Decent Work Profiles of Korean Workers: Antecedents and Outcomes of Profile Membership

Recent research has explored profiles of decent work based on the Psychology of Working Theory. However, such investigations have rarely been attempted in Korea. This study applied latent profile analysis to discover decent work profiles and their relationships with antecedents and outcomes. Among 605 Korean workers, five distinct profiles emerged: indecent (7.9%), low safety and healthcare access (34.9%), average (38.1%), decent (13.7%), and value-dominant but low rest (5.4%). Higher subjective social status and work volition were associated with the decent work group, whereas women and individuals with less education were linked to work characterized by greater vulnerability. Furthermore, satisfaction with work needs, job, and life varied significantly across these profiles. The decent work group generally exhibited the highest satisfaction, whereas the indecent work group had the lowest. The low-safety and healthcare access work group tended to exhibit higher satisfaction levels than the indecent work group, but lower levels than the average work group. The v alue-dominant but low-rest work group exhibited life satisfaction comparable to the decent work group. The findings of this study highlight the distinctive characteristics of the working conditions in South Korea. Based on these results, we discuss theoretical and practical implications.

An exploration of generativity in faculty group processes in post-secondary.

Like most organizations, a university needs to plan for its success. The environment in which universities operate continues to shift and change consequent to economic realities, changing demographics, changes in technology, and most recently a global pandemic. Planning in higher education must be creative and responsive to address multifaceted demands. To sustain post-secondary education, institutional leaders need to develop skill sets that promote effective dialogue, group work, and generativity within internal organizations. Concepts of leadership for the 21st century shift focus away from the previous approaches of making incremental improvements to already existing processes toward discovering possibilities, exploring potential innovations, and generating actions (Burgess &amp; Newton, 2015; Webber, 2016). Building on existing frameworks for understanding generativity in group work and planning, this study sought to understand generative processes and conversations that compel people to act upon thoughts and feelings arising from social interactions. A descriptive study design was utilized to explore and summarize the experiences of faculty involved in three different group planning processes: brainstorming (Osborn 1953, 1957, 1963), a force field analysis (Lewin, 1947), and a variation of an appreciative inquiry process (Cooperrider &amp; Srivastva, 1987). The development of a generative conversations survey tool focused on how the faculty participants perceived the qualities of their experiences. A key outcome of the research was the creation of a set of recommendations for thinking about the design of group sessions and meetings that can transmethodologically enhance chances for generative results.

PROJECT OF A DASHBOARD FOR BRAZILIAN CENTERS AFFILIATED WITH CENTER FOR INTERNATIONAL BLOOD AND MARROW RESEARCH

Since the first hematopoietic stem cell transplantation (HSCT) was performed at the Federal University Hospital (Curitiba, PR) in 1979, the number of centers offering this modality of treatment has increased. However, accessing comprehensive HSCT outcomes has become a challenge due to lack of an official Brazilian registry. The partnership between the Brazilian Cellular Therapy and Bone Marrow Transplant Society (SBTMO) and the Center for International Blood and Marrow Research (CIBMTR) was an important milestone in the establishment of the HSCT Brazilian registry (HSCTBR). By using CIBMTR’s Data Back to Center (DBtC) tool, we have gained insights into HSCT outcomes through the Brazilian Summary Slides. While understanding the country's transplant scenario is crucial, it is equally important for each center to assess their own outcomes. In order to help the Brazilian centers with the CIBMTR, the data manager of SBTMO working group has developed a business tool solution to facilitate this important task.

Me, us and IT

The adoption and pedagogical use of technologies such as virtual worlds to support teaching and learning, and research in higher education involves a complex interplay of technical, organisational and personal factors. In this paper, eighteen educators and researchers provide an overview of how they perceive a virtual world can be used in education from the perspective of themselves as individuals ‘me’, their educational organisations and as members of the Australian and New Zealand Virtual Worlds Working Group (VWWG) community of practice ‘us’, as well as the complex technology that underpins this learning environment ‘IT’. Drawing on Linstone’s (1981, 1984) Technical, Organisational and Personal (TOP) multiple perspective concept as the framework for analysis, the authors discuss their perspectives of how the personal, organisational and technical aspects of teaching through the use of virtual worlds have impacted on their teaching and research in higher education. The potential of employing the TOP framework to inform future research into the use of technologies such as virtual worlds in teaching and learning is explored.

Association of low muscle mass with cognitive function and mortality in USA seniors: results from NHANES 1999–2002

BackgroundSarcopenia and cognitive impairment have been linked in prior research, and both are linked to an increased risk of mortality in the general population. Muscle mass is a key factor in the diagnosis of sarcopenia. The relationship between low muscle mass and cognitive function in the aged population, and their combined impact on the risk of death in older adults, is currently unknown. This study aimed to explore the correlation between low muscle mass and cognitive function in the older population, and the relationship between the two and mortality in older people.MethodsData were from the National Health and Nutrition Examination Survey 1999–2002. A total of 2540 older adults aged 60 and older with body composition measures were included. Specifically, 17–21 years of follow-up were conducted on every participant. Low muscle mass was defined using the Foundation for the National Institute of Health and the Asian Working Group for Sarcopenia definitions: appendicular lean mass (ALM) (< 19.75 kg for males; <15.02 kg for females); or ALM divided by body mass index (BMI) (ALM: BMI, < 0.789 for males; <0.512 for females); or appendicular skeletal muscle mass index (ASMI) (< 7.0 kg/m2 for males; <5.4 kg/m2 for females). Cognitive functioning was assessed by the Digit Symbol Substitution Test (DSST). The follow-up period was calculated from the NHANES interview date to the date of death or censoring (December 31, 2019).ResultsWe identified 2540 subjects. The mean age was 70.43 years (43.3% male). Age-related declines in DSST scores were observed. People with low muscle mass showed lower DSST scores than people with normal muscle mass across all age groups, especially in the group with low muscle mass characterized by ALM: BMI (60–69 years: p < 0.001; 70–79 years: p < 0.001; 80 + years: p = 0.009). Low muscle mass was significantly associated with lower DSST scores after adjusting for covariates (ALM: 43.56 ± 18.36 vs. 47.56 ± 17.44, p < 0.001; ALM: BMI: 39.88 ± 17.51 vs. 47.70 ± 17.51, p < 0.001; ASMI: 41.07 ± 17.89 vs. 47.42 ± 17.55, p < 0.001). At a mean long-term follow-up of 157.8 months, those with low muscle mass were associated with higher all-cause mortality (ALM: OR 1.460, 95% CI 1.456–1.463; ALM: BMI: OR 1.452, 95% CI 1.448–1.457); ASMI: OR 3.075, 95% CI 3.063–3.088). In the ALM: BMI and ASMI-defined low muscle mass groups, participants with low muscle mass and lower DSST scores were more likely to incur all-cause mortality ( ALM: BMI: OR 0.972, 95% CI 0.972–0.972; ASMI: OR 0.957, 95% CI 0.956–0.957).ConclusionsLow muscle mass and cognitive function impairment are significantly correlated in the older population. Additionally, low muscle mass and low DSST score, alone or in combination, could be risk factors for mortality in older adults.

Cervical cancer prevention in Burkina Faso: a stakeholder’s collaboration for the development of awareness messaging

BackgroundCervical Cancer stands as the second leading cause of both incident female cancers and deaths in Burkina Faso. Unfortunately, the prevention, early detection, and care of cervical cancers are suboptimal at individual, institutional, and national levels. In October 2023, we organized a stakeholder’s workshop to develop cervical cancer awareness messaging for disease control in the country.MethodsA one-text workshop was organized with stakeholders working toward improving health in general or women’s health and well-being. A participatory, learning, and adaptive approach was used to facilitate discussions and activities, ensuring the contribution of all participants. Contextual evidence-based and empirical elements about cervical cancer burden and preventive strategies were presented to the participants by key informants. These served as the foundation for a collaborative formulation of messaging content that aimed at raising awareness about cervical cancer.ResultsSixty-two participants from 28 organizations attended the workshop. They work mainly at local and international non-governmental organizations, civil society organizations, universities, university hospitals, research centers, and the Ministry of Health. During the first and second days of the workshop, the participants explored cervical cancer data, its preventive and treatment options available in Burkina Faso, communication strategies for behavioral change, and determinants of the use of prevention and health promotion services. During the following three days, 3 working groups were formed to define strategies, and key messages adapted to diverse tools and targeted audiences. All information was validated during plenary sessions before the end of the workshop and available to all participants and their organizations for cancer awareness activities.ConclusionUpon conclusion of the workshop, the participants provided insightful information for the development of cervical awareness messaging in Burkina Faso. They formed the first community of practice to serve as a dynamic platform for implementation, monitoring, evaluation, and continued learning activities.

The Histological and Biochemical Assessment of Monoiodoacetate-Induced Knee Osteoarthritis in a Rat Model Treated with Salicylic Acid-Iron Oxide Nanoparticles

Iron oxide nanoparticles (IONPs) represent an important advance in the field of medicine with application in both diagnostic and drug delivery domains, offering a therapeutic approach that effectively overcomes physical and biological barriers. The current study aimed to assess whether oral administration of salicylic acid-functionalized iron oxide nanoparticles (SaIONPs) may exhibit beneficial effects in alleviating histological lesions in a murine monoiodoacetate (MIA) induced knee osteoarthritis model. In order to conduct our study, 15 Wistar male rats were randomly distributed into 3 work groups: Sham (S), MIA, and NP. At the end of the experiments, all animals were sacrificed for blood, knee, and liver sampling. Our results have shown that SaIONPs reached the targeted sites and also had a chondroprotective effect represented by less severe histological lesions regarding cellularity, altered structure morphology, and proteoglycan depletion across different layers of the knee joint cartilage tissue. Moreover, SaIONPs induced a decrease in malondialdehyde (MDA) and circulating Tumor Necrosis Factor-α (TNF-α) levels. The findings of this study suggest the therapeutic potential of SaIONPs knee osteoarthritis treatment; further studies are needed to establish a correlation between the administrated dose of SaIONPs and the improvement of the morphological and biochemical parameters.

Evaluating sarcopenia prevalence and SARC-F effectiveness in elderly Spanish women with RA: a comparative study of EWGSOP criteria

IntroductionThe European Working Group on Sarcopenia in Older People (EWGSOP) has put forward two key proposals for diagnosing sarcopenia: the EWGSOP1 in 2010 and the EWGSOP2 in 2019. These proposals are currently the most widely used guidelines for diagnosing sarcopenia. However, data on the prevalence of sarcopenia in patients with rheumatoid arthritis (RA) based on EWGSOP criteria are limited. This study aimed to: (a) establish the prevalence of sarcopenia in an elderly Spanish cohort of women with RA using both EWGSOP1 and EWGSOP2 criteria; and (b) evaluate the effectiveness of the SARC-F questionnaire in detecting sarcopenia.MethodsIn this observational, cross-sectional study, 67 women aged over 65 years who met the ACR 2010 criteria for RA were consecutively recruited from a tertiary university hospital. Assessments included: (a) demographic and anthropometric data; (b) RA-related variables (disease history, analytical evaluation, activity, disability, quality of life); and (c) sarcopenia-related variables (muscle strength, gait speed, skeletal muscle mass, and SARC-F questionnaire). The prevalence of sarcopenia was determined using both EWGSOP1 and EWGSOP2 criteria. Furthermore, the effectiveness of the SARC-F questionnaire for detecting sarcopenia were calculated.ResultsThe prevalence of sarcopenia was 43% according to the EWGSOP1 criteria and 16% according to the EWGSOP2 criteria. Patients diagnosed with sarcopenia based on the latter criteria also met the EWGSOP1's criteria for sarcopenia. Agreement between the two sets of EWGSOP criteria was poor. The SARC-F questionnaire demonstrated an inherently high sensitivity (100%) as well as good specificity (75%) and diagnostic accuracy (79%) in detecting sarcopenia according to EWGSOP2 criteria.ConclusionsThe prevalence rate of sarcopenia among elderly Spanish women with RA varies significantly depending on whether EWGSOP1 or EWGSOP2 criteria are applied. The SARC-F questionnaire is effective for predicting sarcopenia when used in conjunction with the EWGSOP2 criteria, which is currently the most accepted standard in clinical practice.

Characteristics and prognostic impact of cancer cachexia defined by the Asian Working Group for Cachexia consensus in patients with curable gastric cancer

BackgroundCachexia is prevalent in cancer patients. The conventional diagnostic criteria for cachexia are often based on Western evidence, lacking consensus for Asian populations. This study aims to compare Asian Working Group for Cachexia (AWGC) criteria with Fearon's criteria, assessing their differences in population characteristics and prognostic impact. MethodsThe clinical data of patients who underwent radical gastrectomy between 2013 and 2019 were prospectively collected. Cachexia diagnosis involves the utilization of either AWGC criteria and the previous international consensus proposed by Fearon et al. A scoring model is established based on the optional criteria according to the AWGC criteria. Univariate and multivariate logistic and Cox regression analysis were conducted to determine the independent effect factors for postoperative complications and overall survival. ResultsIn a total of 1330 patients, 461 met AWGC cachexia criteria and 311 met Fearon’s criteria. Excluding 262 overlapping cases, those diagnosed solely with AWGC-cachexia had higher age and lower BMI, albumin, hemoglobin, and handgrip strength compared to those by Fearon's criteria alone. AWGC-cachexia independently increased the risk of postoperative complications, whereas Fearon's criteria did not. Patients with AWGC-cachexia also exhibited shorter overall survival than Fearon's criteria. The AWGC-based cachexia grading system effectively stratifies the risks of postoperative complications and mortality. ConclusionsThe AWGC criteria is more effective in diagnosing cancer cachexia in the Asian population and provide better prognostic indicators.

Synthesis of the European ALARA network 20th workshop ‘ALARA for interventional radiology and nuclear medicine’

The European as low as reasonably achievable(ALARA) network regularly organises workshops on topical issues in radiation protection (RP). The topic of the 20th workshop was: ‘ALARA for interventional radiology (IR) and nuclear medicine (NM)’. The objective was to examine the challenges faced when applying the optimisation principle (ALARA) in IR and NM and to consider how ALARA could be better implemented for patient and staff exposures. This memorandum provides a synthesis of the workshop sessions, and recommendations coming from the working groups discussion. Parallels are drawn with the recommendations arising from the 13th EAN workshop on ‘ALARA and the medical sector (2011)’ to consider how the optimisation challenges in IR and NM have evolved over the past decade. Current levels of exposure are presented along with operational practice and the challenges and opportunities for improvement, both in monitoring and practice. Whilst RP challenges remain, the application of ALARA appears more established in IR compared with experiences reported in 2011. The application of ALARA to emerging technologies in the NM setting is in need of further development to ensure that RP is considered at all stages in the development process of new radiopharmaceuticals. Besides the obvious technical and operational aspects, the importance of education and training, human factors and broadly the RP ‘culture’ were deemed fundamental to the success of the application of ALARA and where further emphasis is needed. All concerned parties, medical physics experts (MPEs), radiation protection experts, clinical staff, manufacturers and regulators have a role to play in the application of ALARA and this is discussed in the memorandum. Many of the recommendations from the 13th EAN workshop remain applicable today and overlap with the recommendations arising from the 20th workshop. This should prompt attention given that the use of IR and the development of novel radiopharmaceuticals for NM is only anticipated to increase with time.

Methodology for adapting a co-created early childhood development intervention and implementation strategies for use by frontline workers in India and Guatemala: a systematic application of the FRAME-IS framework

ABSTRACT There is little evidence on optimizing the effectiveness and implementation of evidence-based early childhood development (ECD) interventions when task-shifted to frontline workers. In this Methods Forum paper, we describe our adaptation of the International Guide for Monitoring Child Development (GMCD) for task-shifting to frontline workers in Guatemala and India. In 2021–2022, implementers, trainers, frontline workers, caregivers, and international GMCD experts collaborated to adapt the GMCD for a task shifted implementation by frontline workers. We used an eight-step co-creating process: assembling a multidisciplinary team, training on the existing package, working groups to begin modifications, revision of draft modifications, tailoring of visual materials and language, train-the-trainers activities, pilot frontline worker trainings, final review and feedback. Preliminary effectiveness of adaptations was evaluated through narrative notes and group-based qualitative feedback following pilot trainings with 16 frontline workers in India and 6 in Guatemala. Final adaptations included: refining training techniques to match skill levels and learning styles of frontline workers; tailoring all visual materials to local languages and contexts; design of job aids for providing developmental support messages; modification of referral and triage processes for children in need of enhanced support and speciality referral; and creation of post-training support procedures. Feedback from pilot trainings included: (1) group consensus that training improved ECD skills and knowledge across multiple domains; and (2) feedback on ongoing needed adjustments to pacing, use of video-based vs. role-playing materials, and time allocated to small group work. We use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) framework to document our adaptations. The co-creating approach we use, as well as systematic documentation of adaptation decisions will be of use to other community-based early childhood interventions and implementation strategies.

Dreamtelling: The value of dreaming and sharing dreams in relations: Part I: From collective preoccupations to shared dreaming

This article looks at the group approach to shared dreams following previous publications, including Dreams In Group Psychotherapy: Theory and Technique (Neri et al. 2002) and further papers1, and a natural extension to a 2022 publication (Friedman, 2022). One innovative perspective is the notion that it is often a ‘collective preoccupation’ which starts a group’s shared elaboration process (dreaming), which to begin with is transmitted through interpersonal and transpersonal communication to a delegated dreamer. Another new perspective is to view dreaming (mental digestion) as the main process of a revised four step ‘dream cycle’. The dream cycle goes from collective preoccupation, through personal dreaming, then through an inner narrative, followed by a potentially shared relational elaboration. This helps to understand that ‘dreamtelling’ is only the fourth step in the shared process of mental ‘digestion’ of peoples’ excessive threats/excitements. In Part I I describe the central approach to a shared dream in group analysis as ‘personal responses first’, meaning the predilection of a free-floating discussion of a dream, involving the whole group’s conscious and unconscious mirroring and resonance, while postponing traditional interpretation. Dreams should be understood as both the result and the motor of group processes. Through the joint elaboration of collective preoccupations, dreams that are shared can contribute to the reciprocal healing of relation disorders and dysfunctional relational patterns. I will describe the four-step ‘dream cycle’, which changes the location of mental digestion. By putting transpersonal and interpersonal communication into action, the individual’s and the group’s mind develops (Köhncke and Mies, (2012)). In the final phase, preoccupying situations and conflictual emotions in dreams are elaborated by free discussion, ‘personal responses first’ which is ‘open communication’ in relational configurations in the ‘society of individuals’ (Elias,1939). This process, which I call ‘dreamtelling’, describes discourse (Schlapobersky, 1993) with potential partners who will ‘(re)dream the dream’, and offer further digestion of the collective preoccupation. A series of clinical vignettes discuss notions such as ‘the location of elaboration’ moves in the relations, e.g. ‘dreaming for others’ and ‘delegation’ as well as the notion of an ‘inner group’ and the unconscious communication between dreamers and listeners. In Part II, I provide deeper exploration of a clinical example in group-analytic group therapy, describing group work with a dream. The uniqueness of the group-analytic approach to the dream’s contents and its communicative aspect will be stressed. Requests for containment preoccupy relations and participants and should be differentiated during the discourse of ‘dreamtelling’.

A Structured Review of Research‐Informed Instructional Strategies to Support CPA Enabling Competencies in Future Accountants*

ABSTRACTCPA enabling competencies underpin the human skills and professional values that all future accountants should possess. Nevertheless, to date, the discourse is limited within the scholarship of teaching and learning on how to best inculcate these competencies in future accountants. This study attempts to spark such a discourse by conducting a structured literature review (SLR) of the research‐informed instructional strategies to foster CPA enabling competencies, skills, and values in future accountants, and outlines future research opportunities. The findings indicate that the CPA competency “acting ethically and demonstrating professional values” can be engrained in future accountants using business cases and targeted courses/lessons in accounting classrooms. “Leading” is best taught through targeted courses/lessons. “Collaboration” can be gained through team‐based learning (group work) and software. “Managing self and others” can be engrained through a strategic course setup. “Adding value” can be achieved by experiential learning. “Solving problems” can be facilitated through in‐class activities that specifically target critical thinking skills. Finally, “communication” is facilitated with writing tasks and software. The top five research‐informed teaching tools that advance CPA enabling competencies are collegial tools (i.e., group work, peer review, and writing prompts), software, business cases, experiential tools, and targeted courses/lessons. In the future, an in‐depth SLR should be conducted on each of the five research‐informed teaching tools for their integration within accounting classrooms.

Ten missteps in the management of inflammatory bowel disease in Asia: An expert report by the Asian Pacific Association of Gastroenterology Working Group on Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is rapidly emerging in the Asia Pacific region. However, there are many challenges in the diagnosis and management of this condition. The Asian Pacific Association of Gastroenterology (APAGE) Working Group on IBD conducted a round table meeting to identify 10 common mistakes in the management of IBD in Asia. To summarize, many physicians still over rely on a definitive histological diagnosis before starting treatment and do not fully establish disease extent such as perianal and proximal gastrointestinal involvement in Crohn's disease (CD) or extent of involvement in ulcerative colitis (UC). It is also essential to actively look for evidence of extra-intestinal manifestations, which may influence choice of therapy. In terms of conventional therapy, underuse of topical 5 aminosalicylates (5-ASAs) in UC and inappropriate dosing of corticosteroids are also important considerations. Acute severe UC remains a life-threatening condition and delay in starting rescue therapy after inadequate response to intravenous steroids is still common. Anti-tumor necrosis factors should be considered first line in all cases of complex perianal fistulizing CD. Most patients with IBD are on potent immunosuppressive therapy and should be screened for latent infections and offered vaccinations according to guidelines. Under-recognition and management of significant complications such as anemia, osteoporosis, malnutrition, and thromboembolism should also be addressed. Colonoscopy is still not properly performed for dysplasia/cancer surveillance and for evaluating post-op recurrence of CD. Another common misstep is inappropriate withdrawal of medications during pregnancy leading to increased complications for the mother and the newborn.