Working Group Research Articles

Modulation of the Association Between Corticospinal Tract Damage and Outcome After Stroke by White Matter Hyperintensities.

Motor outcomes after stroke relate to corticospinal tract (CST) damage. The brain leverages surviving neural pathways to compensate for CST damage and mediate motor recovery. Thus, concurrent age-related damage from white matter hyperintensities (WMHs) might affect neurologic capacity for recovery after CST injury. The role of WMHs in post-stroke motor outcomes is unclear. In this study, we evaluated whether WMHs modulate the relationship between CST damage and post-stroke motor outcomes. We used data from the multisite ENIGMA Stroke Recovery Working Group with T1 and T2/fluid-attenuated inversion recovery imaging. CST damage was indexed with weighted CST lesion load (CST-LL). WMH volumes were extracted with Freesurfer's SAMSEG. Mixed-effects beta-regression models were fit to test the impact of CST-LL, WMH volume, and their interaction on motor impairment, controlling for age, days after stroke, and stroke volume. A total of 223 individuals were included. WMH volume related to motor impairment above and beyond CST-LL (β = 0.178, 95% CI 0.025-0.331, p = 0.022). Relationships varied by WMH severity (mild vs moderate-severe). In individuals with mild WMHs, motor impairment related to CST-LL (β = 0.888, 95% CI 0.604-1.172, p < 0.001) with a CST-LL × WMH interaction (β = -0.211, 95% CI -0.340 to -0.026, p = 0.026). In individuals with moderate-severe WMHs, motor impairment related to WMH volume (β = 0.299, 95% CI 0.008-0.590, p = 0.044), but did not significantly relate to CST-LL or a CST-LL × WMH interaction. WMHs relate to motor outcomes after stroke and modify relationships between motor impairment and CST damage. WMH-related damage may be under-recognized in stroke research as a factor contributing to variability in motor outcomes. Our findings emphasize the importance of brain structural reserve in motor outcomes after brain injury.

Towards Consistency in Pediatric Brain Tumor Measurements: Challenges, Solutions, and the Role of AI-Based Segmentation.

MR imaging is central to the assessment of tumor burden and changes over time in neuro-oncology. Several response assessment guidelines have been set forth by the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working groups in different tumor histologies; however, the visual delineation of tumor components using MRIs is not always straightforward, and complexities not currently addressed by these criteria can introduce inter- and intra-observer variability in manual assessments. Differentiation of non-enhancing tumor from peritumoral edema, mild enhancement from absence of enhancement, and various cystic components can be challenging; particularly given a lack of sufficient and uniform imaging protocols in clinical practice. Automated tumor segmentation with artificial intelligence (AI) may be able to provide more objective delineations, but rely on accurate and consistent training data created manually (ground truth). Herein, this paper reviews existing challenges and potential solutions to identifying and defining subregions of pediatric brain tumors (PBTs) that are not explicitly addressed by current guidelines. The goal is to assert the importance of defining and adopting criteria for addressing these challenges, as it will be critical to achieving standardized tumor measurements and reproducible response assessment in PBTs, ultimately leading to more precise outcome metrics and accurate comparisons among clinical studies.

Editorial: Immersive media in connected health—volume II

Immersive media, particularly Extended Reality (XR), is at the forefront of revolutionizing the healthcare industry. Healthcare provides XR with “silver bullet” use cases that add value and societal effect to the technology. Healthcare interventions frequently require imaging or visualization to be applied correctly, and the sensation of presence that XR can provide is crucial as a training aid for healthcare learners. From anatomy to surgical training, multimodal immersion in the reality of a medical situation increases the impact of an XR resource compared to the usual approach. Thus, healthcare has become a specialized focus for the immersive media sector, with a multitude of development and research underway. This research subject, which followed on from the previous one, yielded an eclectic group of works spanning the gamut of immersive media applications in healthcare. The underlying theme in these works remains a consistent focus on calibrating, validating, verifying, and standardizing procedures, instruments, and technologies in order to constantly rigorously streamline the means and materials that will integrate immersive technologies in healthcare. In that spirit, we share the findings from this research topic as a motivator for rigorous and evidence-based use of immersive media in digital and connected health.

Race, Ethnicity and Nationality in Sociology

Abstract It aims to understand what makes people similar to others, different from some, and unique to themselves. However, there is room for research in personality to more thoughtfully consider culture, race, and ethnicity in order to better understand individual differences in people’s patterns of thinking, feeling, and behaving. High impact personality journals rarely include such factors into the interpretation of results, and cross-cultural and ethnic minority publications are limited within the discipline. non-exhaustive overview of how culture, race, and ethnicity are examined in relation to personality, showing that: (1) social structures continue to be neglected in the research, (2) we can learn from research being conducted in neighboring areas, and (3) valuable work is already being done within personality psychology. We offer recommendations that emphasize community based participatory research methods, combined etic-emic approaches, and contextualizing research findings to improve the consideration of culture, race, and ethnicity in personality research. It is argued that the connection between race and ethnic categories is more fundamental, and yet the connection between fighting racism and ethnic pluralism is more problematic than this position implies. Ethnicity and racism are different but connected discourses for articulating collectivity and belongingness, and serve diverse political projects which include those of class and nation building. Their understanding as concrete social relations however, requires attending to gender and class processes and the state., and national identities are salient uniting but also stratifying forces in people’s lives and across societies. and attitudes toward immigration and political trust among different racial and ethnic groups. how and why social inequalities are structured and sustained between different groups in education, work, health, and resource distribution, among other realms of life. as well as Reflecting on the idea of “Race” and the normative significance of race relations is an essential part of the enterprise of political philosophy. The principal goal is to think systematically about whether, and if so how, race should figure in our evaluation of institutional arrangements and power relations, in our treatment of each other within civil society, and in our self-conceptions and group affiliations. This article discusses the idea of race, racism, racial discrimination and social justice, responding to racial injustice, and racial identity and community. The Institute of Development Studies (IDS) has also made important contributions to this literature and its application to development studies. First, theoretical effort is required to unpack how ethnicity intersects with other forms of identity. Second, as demonstrated by IDS' contributions, further research is required on the impacts of ethnicity upon development and vice versa. the argument that philosophy is limited and cannot carry out a constructive task that goes beyond that of other disciplines of learning; and whether a metaphysics of race and ethnicity in particular is a descriptive or prescriptive enterprise. Finally, he considers an effective set of conditions for race, ethnicity, and nationality.

Learning Sequence “Learning | Growing | Working”: A Helpful Approach to Facilitate the Entry into the IT Faculty

Virtual teams and digital collaborative work have become an integral part of modern university teaching. The demand for suitable methods for group formation in virtual formats has increased, not least due to Covid-19. Even though students at the university have become more confident in using digital exchange options during this time, it has become apparent in recent semesters that first-year students in particular need support during the transition into higher education, with the learning process and with virtual group work. This paper describes how the digital self-oriented learning approach called the learning sequence “Learning | Growing | Working” was set up and used on the LMS platform Ilias, and how it supports students in learning alone and in groups, collaborating online, building group cohesion, pursuing goals and learning to network. The sequence focuses on intensive exchange and networking. The learning sequence has been designed for first-semester students as a twelve-week guided group focusing in different tools and methods to support students in these subjects. The research methodology used to evaluate and analyse the outcomes of the learning sequence was the observational method, the empirical evaluation of the behaviour and constant comparison approach of the structured collected observation notes and responses of the participants. The results indicate positive outcomes, showing growth in goal setting, networking capabilities, attitudes towards learning, and critical reflection. Both participants and project stakeholders recognise the potential of the sequence to support students' personal development. Strategies for future implementation are suggested to enhance the learning experience. Among others, clear guidance on goal setting, emphasising non-academic goals for motivation and maximising engagement within the allotted time, facilitating discussions on interesting topics and addressing group dynamics challenges were observed as suggested approaches.

Cognition as mediator of pulmonary function and risk of sarcopenia among older adults

BackgroundThe relationship between lung function and sarcopenia remains ambiguous. The primary aim of this study was to investigate the potential association between lung function and sarcopenia in the older adults, as well as to examine the mediating role of cognitive function in this relationship.MethodsThe participants were selected from a nationally representative population-based cohort in China. The peak expiratory flow (PEF) measurement was used to evaluate the lung function in older persons. The sarcopenia was diagnosed using the guidelines of the Asian Working Group for Sarcopenia (AWGS) in 2019. The Cox proportional hazard model was utilized to perform primary analyses of the relationship between PEF and sarcopenia. The mediating effect of cognitive function was evaluated using the counterfactual mediation method.ResultsThis cohort study included 4,011 older adults (average age, 66.6 years; 53.3% males). During a follow-up period of 3.86 years, 349 individuals were diagnosed with sarcopenia. After adjusting for potential confounders, each one-standard-deviation increase in PEF was associated with a 28% reduction in the risk of sarcopenia (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.63, 0.80). There was a significant mediation of cognition for the association between PEF and incident sarcopenia, and the proportion mediated was 12.2% (95% CI: 4.5%, 23.1%).ConclusionsOlder adults with impaired lung function are more likely to develop sarcopenia. Nevertheless, cognition can explain only a small portion of this association. Thus, other potential pathways between lung function and sarcopenia must be elucidated.

The FIRE-IN project: Tsunami-risk related practitioner challenges and 3rd cycle overall results

This article summarizes the methodology for the identification of practitioners’ challenges, in the context of the H2020 funded project FIRE-IN (Fire and Rescue Innovation Network) activities. The project consisted of five thematic areas or “Thematic Working Groups”, as they are called, i.e., Search and Rescue Emergency Response, Structure Fires, Landscape Fires Crisis Mitigation, Natural Hazard Mitigation and Chemical Biological Radiological Nuclear and Explosives, and three iterations, each one including the identification of capability challenges, the screening for solutions, that can potentially address these challenges, and the request for ideas regarding future innovations that will complement already existing ones and will assist in covering capability gaps. This article focuses on the natural hazard mitigation working group and tsunamis in the Mediterranean region as a case study for the 3rd and last iteration of the project. The scenario of a tsunami occurrence in the Mediterranean is the basis for the FIRE-IN 3rd cycle workshop, as an indicative example of a high impact – low probability event, which aims to identify practitioners’ Future Common Capability Challenges in Europe. The current status of the tsunami hazard in Europe, national and international tsunami risk mitigation measures and procedures and operational experience from recent events are also discussed. Focus is provided on the natural hazard mitigation and tsunami related practitioners’ challenges, while results from the FIRE-IN request for ideas process and the interaction between practitioners, researchers and industry are also discussed. The aim is to present practitioners’ current and future capability challenges , one of the main outcomes of the FIRE-IN project, and to provide further guidelines to stakeholders of disaster management towards a safer Europe, mainly, through preparedness and adaptation for stronger and resilient societies.

Teachers’ perceptions of implementing digital multimodal composing in tertiary classrooms: Voices from Chinese EFL teachers

AbstractIn language education, digital multimodal composing (DMC) pertains to a new literacy practice in which students use digital tools to produce texts incorporating multiple semiotic modes. Despite that many scholars advocate for implementing DMC in language classrooms, it remains marginal in mainstream classrooms, with scant attention being paid to teachers’ perceptions concerning the use of DMC. Situated in Chinese universities, this research probes into the perspectives of five English teachers on implementing DMC as a pedagogical innovation. The analysis of data collected from multiple sources reveals that the teachers perceived DMC positively due to its affordances for students, namely, cultivating digital and multimodal literacies, improving speaking and writing abilities, fostering collaboration and communication skills, and enhancing learning interest and motivation. Teachers themselves harvested benefits regarding deeper insights into students’ learning potentials, enhanced digital literacies, a novel avenue for academic research, and an innovative teaching method. Nonetheless, the teachers expressed concerns about time constraints, students’ engagement in group work, potential plagiarism, assessment of students’ videos, and the long‐term effect of DMC on students’ writing performance. Based on the findings, this research provides implications for integrating curriculum innovations like DMC into conventional curricula.

Stakeholder engagement to introduce a standardised register for improved inpatient care of newborns and sick children in Bangladesh.

Despite a global decrease of 59% in under-five mortality rates from 1990 to 2021, child survival remains a pressing issue. This holds true for Bangladesh, as well. In response, the Government of Bangladesh introduced a standardised register for strengthening the inpatient management of newborns and sick children in 2021. We employed a comprehensive four-phase stakeholder engagement process to implement an inpatient register for newborns and sick children. The first stage included identifying and prioritising potential stakeholders at the national and district levels. We identified eight organisations involved in newborn and child health and selected 24 participants from various other sectors for workshops aimed at raising awareness about the register's introduction. These stakeholders also participated in the register's design, development strategies planning, and implementation phases. These phases were led by the 'National Newborn Health and IMCI programme' with support from various partners. A technical working group reviewed existing registers and helped prepare training materials. Feedback from each workshop was crucial in finalising the register. The Government of Bangladesh has recognised the need for an indoor register for newborns and sick children, which was to be established in collaboration with development partners. This initiative can enhance the quality of care for sick children and increase service provider accountability. Due to its successful implementation, it will continue to be used in the Kushtia and Dinajpur districts, with plans for a nationwide scale-up. The Government has allocated funds in the next health sector programme for orientation and register printing. A strengths, weaknesses, opportunities, and threats (SWOT) analysis of the stakeholder engagement process highlighted strengths such as a context-specific approach and collaborative engagement, as well as challenges such as time resource requirements. Implementing an inpatient register for newborns and sick children through stakeholder engagement can effectively improve child health care services. Aside from challenges such as resource intensiveness and stakeholder commitments, success depended on the organising authority's expertise in relationship building, budget allocation, time management, and workforce dedication. Therefore, strategic planning, staff recruitment, networking, and budgeting are crucial for successful stakeholder engagement and health care initiatives.

A one health approach for monitoring antimicrobial resistance: developing a national freshwater pilot effort

Antimicrobial resistance (AMR) is a world-wide public health threat that is projected to lead to 10 million annual deaths globally by 2050. The AMR public health issue has led to the development of action plans to combat AMR, including improved antimicrobial stewardship, development of new antimicrobials, and advanced monitoring. The National Antimicrobial Resistance Monitoring System (NARMS) led by the United States (U.S) Food and Drug Administration along with the U.S. Centers for Disease Control and U.S. Department of Agriculture has monitored antimicrobial resistant bacteria in retail meats, humans, and food animals since the mid 1990’s. NARMS is currently exploring an integrated One Health monitoring model recognizing that human, animal, plant, and environmental systems are linked to public health. Since 2020, the U.S. Environmental Protection Agency has led an interagency NARMS environmental working group (EWG) to implement a surface water AMR monitoring program (SWAM) at watershed and national scales. The NARMS EWG divided the development of the environmental monitoring effort into five areas: (i) defining objectives and questions, (ii) designing study/sampling design, (iii) selecting AMR indicators, (iv) establishing analytical methods, and (v) developing data management/analytics/metadata plans. For each of these areas, the consensus among the scientific community and literature was reviewed and carefully considered prior to the development of this environmental monitoring program. The data produced from the SWAM effort will help develop robust surface water monitoring programs with the goal of assessing public health risks associated with AMR pathogens in surface water (e.g., recreational water exposures), provide a comprehensive picture of how resistant strains are related spatially and temporally within a watershed, and help assess how anthropogenic drivers and intervention strategies impact the transmission of AMR within human, animal, and environmental systems.

Future of durum wheat research and breeding: Insights from early career researchers.

Durum wheat (Triticum turgidum ssp. durum) is globally cultivated for pasta, couscous, and bulgur production. With the changing climate and growing world population, the need to significantly increase durum production to meet the anticipated demand is paramount. This review summarizes recent advancements in durum research, encompassing the exploitation of existing and novel genetic diversity, exploration of potential new diversity sources, breeding for climate-resilient varieties, enhancements in production and management practices, and the utilization of modern technologies in breeding and cultivar development. In comparison to bread wheat (T. aestivum), the durum wheat community and production area are considerably smaller, often comprising many small-family farmers, notably in African and Asian countries. Public breeding programs such as the International Maize and Wheat Improvement Center (CIMMYT) and the International Center for Agricultural Research in the Dry Areas (ICARDA) play a pivotal role in providing new and adapted cultivars for these small-scale growers. We spotlight the contributions of these and others in this review. Additionally, we offer our recommendations on key areas for the durum research community to explore in addressing the challenges posed by climate change while striving to enhance durum production and sustainability. As part of the Wheat Initiative, the Expert Working Group on Durum Wheat Genomics and Breeding recognizes the significance of collaborative efforts in advancing toward a shared objective. We hope the insights presented in this review stimulate future research and deliberations on the trajectory for durum wheat genomics and breeding.

Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix

Cervical cancer continues to be a public health concern, as it remains the second most common cancer despite screening programs. It is the third most common cause of cancer-related death for women, and the majority of cases happen in developing nations. The standard treatment for locally advanced cervical cancer involves the use of external beam radiation therapy, along with concurrent chemotherapy, followed by an image-guided adaptive brachytherapy (IGABT) boost. The five-year relative survival rate for European women diagnosed with cervical cancer was 62% between 2000 and 2007. Updated cervical cancer treatment guidelines based on IGABT have been developed by the Gynecological working group, which is composed of the Group Européen de Curiethérapie–European Society for Therapeutic Radiology and Oncology. The therapeutic strategy makes use of three-dimensional imaging, which can be tailored to the target volume and at-risk organs through the use of computed tomography or magnetic resonance imaging. Under anaesthesia, the brachytherapy implantation is carried out. Ultrasonography is utilised to assess the depth of the uterine cavity and to facilitate the dilation of the uterine canal during the application insertion. In this study, we examine data from the international literature regarding the application of ultrasound in cervical cancer brachytherapy.

The role of atmospheric CO2 in controlling sea surface temperature change during the Pliocene

Abstract. We present the role of CO2 forcing in controlling Late Pliocene sea surface temperature (SST) change using six models from Phase 2 of the Pliocene Model Intercomparison Project (PlioMIP2) and palaeoclimate proxy data from the PlioVAR working group. At a global scale, SST change in the Late Pliocene relative to the pre-industrial is predominantly driven by CO2 forcing in the low and mid-latitudes and non-CO2 forcing in the high latitudes. We find that CO2 is the dominant driver of SST change at the vast majority of proxy data sites assessed (17 out of 19), but the relative dominance of this forcing varies between all proxy sites, with CO2 forcing accounting for between 27 % and 82 % of the total change seen. The dearth of proxy data sites in the high latitudes means that only two sites assessed here are predominantly forced by non-CO2 forcing (such as changes to ice sheets and orography), both of which are in the North Atlantic Ocean. We extend the analysis to show the seasonal patterns of SST change and its drivers at a global scale and at a site-specific level for three chosen proxy data sites. We also present a new estimate of Late Pliocene climate sensitivity using site-specific proxy data values. This is the first assessment of site-specific drivers of SST change in the Late Pliocene and highlights the strengths of using palaeoclimate proxy data alongside model outputs to further develop our understanding of the Late Pliocene. We use the best available proxy and model data, but the sample sizes remain limited, and the confidence in our results would be improved with greater data availability.

Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Infants, Children, and Adolescents 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. 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 outcome measurement methods for clinical practice. Using modified Delphi consensus methods with consecutive rounds of online voting over 12 months, a core set of outcomes and corresponding measurement tool packages to capture the outcomes were identified for infants, children, and adolescents with epilepsy. Consensus methods identified 20 core outcomes. In addition to the outcomes identified for the ICHOM Epilepsy adult standard set, behavioral, motor, and cognitive/language development outcomes were voted as essential for all infants and children with epilepsy. The proposed set of outcomes and measurement methods will facilitate the implementation of the use of patient-centered outcomes in daily practice.

European Stroke Organisation (ESO) Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke.

Patent foramen ovale (PFO) is frequently identified in young patients with cryptogenic ischaemic stroke. Potential stroke mechanisms include paradoxical embolism from a venous clot which traverses the PFO, in situ clot formation within the PFO, and atrial arrhythmias due to electrical signalling disruption. The purpose of this guideline is to provide recommendations for diagnosing, treating, and long-term managing patients with ischaemic stroke and PFO. Conversely, Transient Ischaemic Attack (TIA) was not considered an index event in this context because only one RCT involved TIA patients. However, this subgroup analysis showed no significant differences between TIA and stroke outcomes. The working group identified questions and outcomes, graded evidence, and developed recommendations following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the European Stroke Organisation (ESO) standard operating procedure for guideline development. This document underwent peer-review by independent experts and members of the ESO Guideline Board and Executive Committee. The working group acknowledges the current evidentiary gap in delineating an unequivocal diagnostic algorithm for the detection of PFO. Although transoesophageal echocardiography is conventionally held as the most accurate diagnostic tool for PFO identification, its status as the 'gold standard' remains unsubstantiated by rigorously validated evidence. We found high-quality evidence to recommend PFO closure plus antiplatelet therapy in selected patients aged 18-60 years in whom no other evident cause of stroke is found but a PFO (i.e. PFO-associated stroke). The PASCAL classification system can be used to select such candidates for PFO closure. Patients with both a large right-to-left shunt and an atrial septal aneurysm benefit most from PFO closure. There is insufficient evidence to make an evidence-based recommendation on PFO closure in patients older than 60 and younger than 18 years. We found low quality evidence to suggest against PFO closure in patients with unlikely PFO-related stroke according to the PASCAL classification, except in specific scenarios (Expert Consensus). We suggest against long-term anticoagulation in patients with PFO-associated stroke unless anticoagulation is indicated for other medical reasons. Regarding the long-term AF monitoring after PFO closure, the working group concluded that there remains significant uncertainty regarding the risks and benefits associated with the use of long-term cardiac monitoring, such as implantable loop recorders. This document provides additional guidance, in the form of evidence-based recommendations or expert consensus statements, on diagnostic methods for PFO detection, and medical management after PFO closure.

A NEGLECTED RARE DISORDER: IGG4 RELATED DISEASE

Abstract IgG4–related disease (IgG4–RD) is an autoimmune disorder characterized by infiltration of plasma cells with IgG4. Almost any organ could be affected. Common presentations include lung manifestation, autoimmune pancreatitis, retroperitoneal fibrosis and tubulointerstitial nephritis. Cardiovascular involvement is less frequent. Corticosteroids are first line therapy, with or without anti–rheumatic drugs. Long–term prognosis of IgG4–RLD remains unknown. We present the case of a 65–years old woman, with a previuos diagnosis of IgG4–RD with mediastinal involvement. In the meantime she was recovered for pyelonephritis with high fever and positive blood coltures (S. hominis). We were called to perform a transthoracic echocardiogram to rule out infective endocarditis. The exam showed normal size of cardiac chambers, normal biventricular systolic function, absence of relevant valvular disease. In apical view we noticed a hyperechogenic ovalar imagine in the right atrium, not visible in all the projections. A first differential diagnosis included a mass with site of implantation at the top of the right atrium or something external but contiguous to heart structures. To clear this doubt the patient performed a thoracic CT with stunning results. The CT highlighted parietal encasement of chardiac structures and, particularly, of the superior vena cava at the confluence in right atrium, explaining the image we saw with transthoracic echo. The exam also showed encasement of ascending aorta, aortic arch and descending aorta with maximum thickness of 18 mm. CT also reported encasement of right pulmonary arthery. The CT highlighted a progression of the disease with indication to more aggressive therapy. In fact IgG4–RD of the cardiovascular system results in serious complications that need to be recognized and treated. Aortic involvement in IgG4–RD is extremely rare and tipically affects the infrarenal abdominal aorta. Cardiovascular IgG4–RD could also lead to aortitis, medium–vessel arteritis, pulmonary vascular disease, phlebitis, valvulopathy, pericarditis and myocardial disease. These forms of Igg4–RD are often underdiagnosed as clinical presentations is similar to cardiovascular disease due to more common aetiologies. Regarding our case the patient began methotrexate based on the results of the CT. This was a really interesting case for our working group to deepen this little–known disease. “The eyes see only what the mind is prepared to comprehend”.

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.

Ten tips from the Swiss working group on sustainable nephrology on how to go green in your dialysis unit

Abstract The healthcare system and particularly renal replacement therapy has a significant carbon footprint adding to global warming and extreme weather conditions. Improving sustainability has become the focus of national and international working groups. Many reviews underline the need for improvement of sustainability in nephrology, in particular dialysis, and provide recommendations on how to reduce waste, energy, and water consumption. However, how to implement these recommendations, and where to start, is not always clear. This paper summarizes discussions within the ‘working group on sustainable nephrology’ of the Swiss Society of Nephrology. We do not provide a detailed review of the topic but instead present a practical 10 points action plan to help health care workers in nephrology make a start and improve the carbon footprint of their dialysis centers. We emphasize the importance of ongoing research, cooperation and dialogue and welcome additional ideas from the wider renal community.