Active Participants Research Articles

The primary reason 20% of young people use cannabis and alcohol is to get to sleep, according to a recent study. Of the 1,473 respondents in the study, with a mean age of 24, 22.4% used cannabis to sleep, and 7.2% used alcohol to sleep. Among those who used cannabis in the past year, 41.4% used it to sleep. Among those using alcohol in the past year, 8.6% used it to sleep. Among those who used both substances in the past year, 42.1% used cannabis to sleep, 10.9% used alcohol to sleep, and 7.1% used both substances to sleep. Data came from the 2022‐2023 Monitoring the Future (MTF) Panel Study collected from adults ages 19 to 30. MTF is funded by the National Institute on Drug Abuse (NIDA) and annually surveys nationally representative samples of 12th‐grade students. A subsample from each cohort is selected for the MTF Panel, with participation starting at age 19 or 20, and then biennially through age 29 or 30. The response rate was 51.5% of active participants and 34.5% of all selected 12th graders. Women were more likely than men to use cannabis for sleep. Black respondents were more likely than White respondents to use alcohol to sleep. The researchers concluded that raising clinicians' awareness about the common intersection of substance use and sleep problems among young adults should be used for screening and offering interventions for these health risks. “Cannabis and Alcohol Use to Initiate Sleep Among Young Adults” is by Megan E. Patrick, Ph.D. and colleagues, was published online October 13 in JAMA Pediatrics , and was funded by NIDA

This article offers a critical reappraisal of contemporary research at the intersection of aging, technology, and travel, drawing on tourism studies and interdisciplinary advancements in assistive technology, human factors engineering, and public health. It identifies key conceptual gaps in how tourism and hospitality have addressed the evolving needs, capacities, and aspirations of older travelers. In response, we propose a forward-looking research agenda organized around three value domains—experiential, well-being, and business—that collectively frame technology not as a set of tools, but as a transformative medium for inclusive, adaptive, and meaningful design. By positioning senior travelers as active participants and catalysts for innovation, this work advances a shift from compliance or accommodation driven solutions to a senior-centered ontological stance. Together, the reappraisal and agenda aim to enrich theoretical discourse and catalyze interdisciplinary collaboration.

Background Dating applications, or “dating apps,” are widely used by sexual minority men (SMM) to form social and sexual connections. These platforms support intimacy, identity expression, and community engagement but have also been linked to sexual health risks and psychological distress. Although research on dating app use is growing, studies remain limited. This study examines dating app use, tribe identity, and sexual health behaviors in a sample of U.S. SMM. Methods A total of 549 gay and bisexual men aged 18–50 years completed an online survey and were recruited via Qualtrics Survey Panels, assessing dating app use, tribe identity, sexual activity, condom use, and awareness and use of pre-exposure prophylaxis (PrEP). Descriptive statistics explored patterns of digital engagement, identity expression, and sexual health behaviors. Results Most participants (69.4%) reported using dating apps, primarily for casual sex (46.3%). Among sexually active participants, 39.9% did not use condoms during their last sexual encounter. Only 17.8% of those aware of PrEP were currently using it, and 33.5% had never heard of it. Tribe identity was diverse but not universal; 32.1% reported no affiliation, while others identified with groups such as “Clean-cut,” “Bear,” and “Jock,” revealing potential links to appearance-based norms and sexual decision-making. Conclusion Dating app use may influence both health behaviors and digital communication patterns among sexual minority men. Our findings underscore the need for inclusive, culturally responsive interventions that address gaps in sexual health knowledge while also considering how digital discourse and platform design shape communication, perception, and engagement.

The chemical structure of natural organic matter (NOM) is known to influence its removal during coagulation, yet the underlying molecular-scale mechanisms remain elusive. This has limited the rational design of advanced water treatment processes. Here, we reveal a previously overlooked mechanism, the cation-π interaction, as a key driver for the efficient removal of aromatic organic matter. Using model compounds with and without a benzene ring (benzoate/phthalate vs acetate), we demonstrate that the benzene ring is not merely a passive scaffold but an active participant in coagulation. It acts as an initial anchor, attracting trivalent metal ions via strong cation-π interactions. This initial attraction then facilitates a more stable, secondary binding as functional groups (e.g., -COOH and -OH) on the ring chelate with the metal ions, ultimately promoting floc growth. This dual-binding mechanism, supported by spectroscopic and microscopic evidence, explains how the presence of a benzene ring participates in metal ion hydrolysis and floc formation, leading to significantly improved coagulation performance. This finding highlights the critical role of aromatic structures in the coagulation process and provides a new theoretical foundation for optimizing coagulants to achieve the selective and efficient removal of specific aromatic pollutants.

The increasing demand for healthcare services and personnel necessitates new ways of organising care delivery. Digital home monitoring, which enables remote communication and follow-up between healthcare professionals and patients through digital tools, is one such approach. Although these solutions are being implemented in hospital contexts, there is limited knowledge about how healthcare professionals experience digital home monitoring in their everyday practice. This study therefore explores healthcare professionals' experiences of digital home monitoring in hospital settings and examines its implications for responsibilities and task distribution. The socio-technical model Leavitt's Diamond served as the theoretical perspective in this study. Semi-structured interviews with six healthcare professionals from three Norwegian hospitals. Data was analysed using inductive systematic text condensation by Malterud. The COREQ checklist was used. Three categories emerged from the material: the patient as an active participant; healthcare professionals' adaptation to technological innovation, and the relationship between healthcare professionals and patients. The findings indicate digital home monitoring as resource-efficient, enabling closer patient follow-up and contributing to preventive care. The participants highlighted the importance of sustaining trust-based relationships with the patients, which can enhance the quality of patient follow-up. The study suggests that the transition to digital home monitoring is closely linked to how technological changes influence professional roles, competencies and the organisation of tasks, reflecting the interdependence between technology, tasks, structure and actors described in Leavitt's Diamond. Ensuring adequate training, organisational support and resources may facilitate smoother integration of digital solutions and improved outcomes for both patients and healthcare professionals. Future research should focus on the experiences of healthcare professionals with digital home monitoring in hospital settings, emphasising how these digital tools influence clinical workflows, patient engagement and the broader organisational context in healthcare.

Introduction: Women treated for breast cancer (BC) often experience declines in exercise capacity and cardiac function which increases their heart failure risk. Physical activity (PA) participation during BC treatment may prevent these declines, but the long-term impacts of PA on exercise capacity and cardiac function in BC survivors are unknown. Research Question: This study evaluated PA participation prior to initiating BC treatment through 24-month follow-up and tested if women who reported being physically active had better exercise capacity and cardiac function relative to inactive women. Methods: Women with stage I-III BC (n=236) were enrolled in a multi-site prospective cohort study conducted through the Wake Forest NCORP Research Base (NCT02791581). Participants were categorized as active, moderately active, or inactive from self-reported PA surveys. Exercise capacity was determined by 6-minute walk distance (6MWD) and cardiac function [left ventricular ejection fraction (LVEF) and LV mean circumferential strain, LV strain] was measured by cardiac magnetic resonance imaging prior to BC treatment and then at 3-, 12- and 24-month follow-up. Analyses were adjusted for age, BMI, race, fatigue, comorbidities, and BC treatment. Results: Participants average (±SD) age was 56±11 years, 76% were White, and 52% were diagnosed with stage II BC. PA participation declined from baseline to 3-month follow-up but increased to baseline levels at 12- and 24-month follow-up. At baseline, active and inactive participants had similar exercise capacity (mean difference ± SE=17.4±10.4 m, p=0.21), LVEF (0.76±0.60, p=0.41), and LV strain (-0.71±0.87, p=0.69). 6MWD declined from baseline to 3-months among inactive participants only (-21.9±8.5 m, p=0.01). Active participants had higher exercise capacity relative to inactive participants at 3-months (42.5±11.3 m, p<0.001), 12-months (39.2±10.3 m, p<0.001), and 24-months (31.2±10.9 m, p=0.01) follow-up. LVEF and LV strain were similar between active and inactive participants throughout follow-up. Conclusions: Over 24 months, physically active women with BC maintained a higher submaximal exercise capacity compared to inactive individuals while cardiac function was similar between the groups. These data suggest that maintaining PA during BC treatment is important for preserving submaximal exercise capacity long-term, which reflects the ability to perform activities of daily living in BC survivors.

Introduction: High-Fidelity (Hi-Fi) Simulation is essential in medical education, offering realistic clinical training in safe environments. However, the intensive resource requirements of specialised equipment, dedicated simulation suites, and trained instructors frequently limit students’ hands-on participation [1]. Many learners consequently spend most simulation sessions as passive observers. This study examines whether active participation in Hi-Fi Simulation leads to better performance in subsequent emergency scenarios compared to observation alone, while also investigating knowledge retention over time. Methods: A longitudinal study was conducted with seven final-year medical students at a district general hospital. Participants first completed four emergency scenarios (DKA, sepsis, hyperkalaemia, major haemorrhage), actively managing one case while observing peers in others. Three months later, all students repeated the same scenarios using immersive VR technology. Performance was assessed through a validated scoring system evaluating clinical knowledge, procedural skills, decision-making, teamwork and time management. Results: Active participants consistently outperformed observers by an average of 20% in VR simulations. The most significant differences appeared in time critical decision making and complex clinical reasoning. Active learners also demonstrated superior procedural accuracy and showed greater confidence during VR scenarios. These benefits persisted across the three-month interval between sessions. Discussion: Our findings strongly support prioritising active participation in simulation training, even if this means covering fewer scenarios. This perhaps highlights a limitation in traditional Hi-Fi Simulation, with students spending more time in observational learning than participating. Using simulation as a tool meets the need of undergraduate students by increasing their knowledge and confidence during active participation. Future research should investigate the translation of simulation performance gains to real clinical outcomes. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Background: Achieving adequate blood pressure (BP) control is challenging for patients and clinicians given the episodic nature of clinical encounters, high patient volumes, and silent nature of the disease. Digital hypertension (HTN) management solutions aim to improve BP control though the effectiveness of each digital component within a multicomponent intervention is unknown. Question: What are the independent and short-term effects of tailored push notifications on physical activity (PA) levels and sodium intake amongst patients with HTN? Methods: The myBPmyLife study was a 6-month randomized clinical trial of patients with HTN recruited from an academic medical center and federally qualified health centers. Both the intervention and enhanced usual care arms received a Fitbit Versa 2 and Bluetooth-connected BP monitor. At 6 months, the mobile health intervention increased step count and reduced sodium intake though it did not reduce systolic BP compared to enhanced usual care. A core of the intervention included micro-randomized push notifications which were randomly delivered at four daily time points and focused on increasing PA and reducing dietary sodium intake. Our primary outcome was step count 60 minutes after a PA notification and lower sodium food choices 24 hours after a dietary notification. Analyses used centered and weighted least squares method to estimate treatment effects. Results: 298 participants were randomized to the intervention arm, of whom 287 were available for the micro-randomized analysis. Participants were randomized at 187,517 time points, which led to 0.96 (SD 0.86) push notifications/day (50.4% [SD 0.4]) PA and 49.8% [SD 0.4] dietary). Participants’ mean age was 59.5 (SD 13.5) years, 137 (47.7%) were women, and 210 (73.2%) White. PA notifications did not increase step count in the subsequent 60 minutes (Estimate 1 . 01, 95% CI 0 . 98 – 1 . 04; p=0 . 40; Figure 1) though may be more effective in less active participants (Estimate 1.04, 95% CI 1.00 – 1.08; p=0.03). Similarly, dietary notifications did not impact the number of lower sodium food choices in the subsequent 24 hours (Estimate 0 . 93, 95% CI 0 . 83 – 1 . 04; p=0 . 23), though did increase mobile application engagement (Figure 2). Conclusions: A mobile health intervention improved step counts and sodium intake over 6 months in patients with HTN. Tailored push notifications did not impact short-term PA or dietary sodium intake, though they did improve intervention engagement.

This article presents an analysis of contemporary scientific sources concerning the structure and function of the individual layers of intact skin, the mechanisms involved in its healing following acute injury, and the role of major cell types in this regenerative process. It has been established that the skin not only serves a protective barrier function but also actively participates in neuroimmune and endocrine regulatory processes. Structurally, the skin comprises three main layers: the epidermis, dermis, and subcutaneous tissue, each consisting of specialized cell types that contribute to its integrity and function. The healing of an acute skin wound is a complex, multi-stage biological process encompassing four distinct phases: hemostasis, inflammation, proliferation, and remodeling. The hemostasis phase, which lasts from a few seconds to several hours, involves primarily platelets and erythrocytes. This is followed by the inflammatory phase, which typically lasts 1 to 3 days and is characterized by the involvement of neutrophils, monocytes, and both circulating and dermal macrophages. The resolution of inflammation transitions into the proliferative phase, which spans approximately 4 to 21 days. This stage is marked by the active participation of endothelial cells, keratinocytes, fibroblasts, myofibroblasts, and pericytes, all of which contribute to tissue regeneration and neovascularization. The final and longest phase is tissue remodeling, which can extend from 21 days up to one year. Key cellular players during this stage include fibroblasts and myofibroblasts, which are crucial for extracellular matrix reorganization and scar formation. It is important to note that each phase of wound healing is regulated and supported by a wide array of biologically active compounds, such as cytokines, growth factors, and chemokines, secreted by the aforementioned cell types. These molecular mediators coordinate cellular responses and facilitate the transition between healing stages. In summary, acute skin wound healing is a highly orchestrated and dynamic process involving the interplay of various cell types and bioactive molecules, each contributing to the successful restoration of skin integrity.

Introduction: Cardiometabolic conditions, including heart disease (ischemic heart disease or heart failure; HD) and diabetes mellitus (DM), are associated with accelerated functional decline in older adults. The combined presence of both conditions, cardiometabolic multimorbidity (CMM), may pose compounded risk, yet little is known about how this relationship varies by physical activity (PA), sex, and race/ethnicity. Objective: To compare two-year functional decline among older adults with CMM, HD-only, DM-only, and controls, and to assess the moderating effect of PA, sex, and race/ethnicity on the association between CMM and physical function in a nationally representative sample. Methods: We conducted a longitudinal secondary analysis of the 2021-2023 National Health and Aging Trends Study (NHATS, 2021-2023) including 360 community-dwelling older adults. Physical function was assessed using the Short Physical Performance Battery (SPPB). PA was measured via wrist-worn accelerometers and defined as average daily minutes above thresholds for moderate (≥3268 counts/min) and vigorous (≥7890 counts/min) activity. Participants were grouped as HD-only, DM-only, CMM, or neither. Survey-weighted descriptive statistics, linear/logistic regressions, and generalized estimating equation (GEE) tested associations and moderation effects, adjusting for demographic and clinical variables. Analyses were conducted using Stata and R. Results: At baseline, DM and CMM groups had higher BMI and waist circumference, and included fewer females and more non-white participants than controls. While all groups declined in SPPB and PA over time, the DM group experienced a significantly greater decline than controls. Active participants had significantly higher SPPB scores than non-active participants (β = 1.05, 95% CI [0.64, 1.46], p < .001). However, in the HD group, PA benefits were attenuated. In the DM group, females scored lower than males (interaction β = −1.20, 95% CI [−2.27, −0.14], p = .027), and non-white participants had lower scores than controls (β = −0.73, 95% CI [−1.45, −0.01], p = .046). Conclusions: Older adults with DM and CMM had worse function and greater decline, especially among non-active individuals, women, and non-white participants. While PA was generally protective, its effects varied by disease group, supporting the need for tailored interventions in cardiometabolic populations.

Introduction: On-call respiratory physiotherapy is provided by NHS Trusts for acutely unwell patients outside of normal working hours [1]. Training is provided before undertaking on-call duties. However, many physiotherapists find on-call situations stressful and report a lack of confidence to undertake these duties. Simulation provides a safe learning environment to develop on-call skills, when supported by trained faculty [2]. Access to faculty training is needed [3]. Therefore, a national course was developed for experienced physiotherapists looking to develop their skills as simulation faculty. It was aimed at participants with limited experience as simulation faculty, wanting to develop an on-call simulation provision at their institution. Methods: A team of physiotherapy and simulation faculty experts designed a one-day course. Participants completed all six modules of the national “Becoming Simulation Faculty” E-Learning programme as pre-learning. The course included discussions about educational theories, scenario design, psychological safety and debriefing models. In a round-robin format supported by a mentor, participants ran an on-call scenario (prebrief to debrief), were active participants or observers, and supported a meta-debrief discussion. Quantitative and qualitative data from pre- and post-course questionnaires were collected and analysed. Results: The course ran three times in England (n=2) and Northern Ireland (NI) (n=1). 66 learners completed the course, from a wide geographical range (Figure 1). Pre-course findings: • Respondents with no simulation experience as a learner: 35%(England); 77% (NI) • Respondents with no simulation faculty training: 65% (England); 94% (NI) • On-call simulation training being delivered at participant organisation: 67% (England); 12% (NI) Two main themes about why participants attended the training were generated: “To set up or support an on-call simulation service, and/or to utilise existing simulation resources” and “Build knowledge and confidence in simulation methods (including technology, scenario writing, debriefing, evaluation)”. With a third theme in the England courses: “Collaboration/ sharing best practice/ improving existing services/ standards”. Post-course findings: All respondents (89% response rate) rated the course as Excellent (78%) or Good (22%), with positive themes regarding “the practical aspects of the course” and the “peer and experienced faculty discussions”. Participants wanted more training on “scenario writing”, “debriefing” and “advanced methods”. Discussion: This course highlighted the need for faculty training within respiratory physiotherapy to meet current simulation standards. It was well received. Further work is needed to explore support for sustainable faculty training in the physiotherapy workforce. Research to explore the impact of this course and on-going workforce training needs within simulation is underway. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

HIV self-testing (HST) is a user-controlled approach to increasing HIV testing and status knowledge, the gateway to biomedical prevention and treatment. HST is a promising option for key populations facing stigma-related barriers to testing in primary and specialty (e.g., HIV, substance use) healthcare clinics. We conducted a pilot efficacy trial of AEGIDA, a 4-session intervention designed for women who exchange sex and use substances, in Kazakhstan, where there is a growing HIV epidemic. Between November 2022 and August 2023, we used community-engaged approaches to recruit and screen 305 HIV-negative cisgender and transgender women (47% eligible). Ninety participants were enrolled and randomized in a 2:1 assignment to the active (AEGIDA) or a time-attention control (didactic self-screening information) condition with 6 months of follow-up. AEGIDA's theoretically grounded sessions included evidence-based techniques to reduce internalized intersectional stigma and build HST skills to increase HIV testing (e.g., motivational interviewing, peer education, and cognitive restructuring). Sessions were delivered face-to-face and via videoconference, with a closed Instagram page for active condition participants to access content on demand. The intent-to-treat analysis found that participants randomized to AEGIDA were over 4 times more likely to complete a recent HIV test (1 + test in the prior three months; aOR = 4.08, 95% CI: 1.22,13.62) at 6-month follow-up compared to control participants. The intervention had no significant impact on consistent HIV testing (1 + test per three months over the six-month follow-up period; aOR = 2.02, 95%CI: 0.69-5.88). Overall, the AEGIDA intervention demonstrated feasibility and acceptability, and preliminary efficacy to increase recent HIV testing. NCT Information NCT06150937.

This study examines existing Swedish population data to investigate the evolving role of men in providing informal care for older adults, challenging the persistent stereotype of men’s limited participation. Our findings consistently show that men in Sweden are active and significant participants in a wide range of caregiving tasks. This involvement is profoundly shaped by the Swedish welfare state and cultural emphasis on gender equality, rather than solely by individual caring masculinities. We argue that the high involvement of Swedish men is a normatively supported outcome of a specific welfare structure. By critically questioning frameworks like caring masculinities and feminist ethics of care, which can inadvertently exclude men’s perspectives, we call for a re-evaluation of how male caregiving is theorized and measured globally. Recognizing these gendered patterns within their societal context is crucial for developing inclusive and equitable policies that support all caregivers.

Effect of Limited Ankle Dorsiflexion on Lower Limbs and Trunk Kinematics During Squatting.

Telemonitoring in patients with COPD: A prospective study with results from the AIRE project.

Iron-Skin Axis: Exploring the Interplay between Iron Homeostasis and Skin Disorders.

Preference-based controlled design: toward increased patients' engagement, efficiency and external validity of cardiovascular clinical trials.

The implementation of guidance services for students at junior high schools under the auspices of MGBK Palu has been observed to be suboptimal, with the forms of service and innovation implemented by guidance counsellors proving ineffective. The main problems with the service partners include: the optimisation of processes and innovations in guidance services for students is not yet optimal; guidance counsellors at junior high schools under the auspices of MGBK Palu are not yet fully aware of the procedures for implementing self-control group guidance in overcoming loneliness. This service aims to provide guidance counsellors with the understanding, skills and abilities to carry out their services at school. The participants of this community service activity were 20 junior high school guidance counsellors who are members of the Palu City Junior High School MGBK. The core activities were carried out over 1 day of socialisation and 3 months of mentoring. The stages of implementation of this community service were through socialisation and mentoring. The results of community service showed that the level of competence of teachers at the community service partner location increased in the implementation of guidance services. The implications of community service were seen in the implementation of socialisation, the utilisation of services by guidance counsellors, innovations in implementing guidance counselling services, and the evaluation of activities after the implementation of community service by partners.

Fibroblasts have been canonically considered as extracellular matrix organizing cells but are now recognized as active participants in immune regulation and tissue homeostasis. In the context of fibrosis, fibroblasts are a well-understood contributor to global morbidity and mortality across cardiac, pulmonary, renal, and hepatic tissue. Beyond this, the fibroblast is a key contributor to barrier immunity and stem cell niche formation and a determinant of vascular permeability, yet it is also capable of lymphocyte homeostasis in the context of lymphoid tissue regulation. Here, we explore the role of fibroblasts across acute and chronic inflammation and their relationship to innate and adaptive immune elements, through the lens of immune-mediated inflammatory diseases. Together, the diversity of fibroblast functions presents a therapeutic challenge, but one with the potential to restore inflamed tissue to health. We discuss novel approaches driven by technological developments that now make immunotherapeutic interventions targeting fibroblasts increasingly possible.

Red blood cells (RBCs), which are enucleated and mitochondria-deficient, have traditionally been considered essential for gas exchange and systemic metabolic regulation. Here, an unrecognized role for RBCs in promoting lung cancer progression is identified. In a cohort of 226 lung cancer patients and 239 healthy controls, significantly elevated levels of miR-93-5p are observed in RBCs and RBC-derived exosomes, but not in plasma, with higher levels correlating with advanced stage and poor prognosis. Functional assays demonstrate that RBC-derived exosomal miR-93-5p is transferred to tumor cells, where it suppresses PTEN and enhances proliferation, migration, and invasion. Conversely, exosomes released by lung cancer cells deliver miR-93-5p to RBCs, thereby augmenting its abundance within RBCs. Inhibition of miR-93-5p or restoration of PTEN abrogates these effects. In both subcutaneous and orthotopic mouse models, RBC-derived exosomal miR-93-5p accelerates tumor growth and reduces survival, whereas therapeutic delivery of antisense oligonucleotides targeting miR-93-5p suppresses tumor burden, reduces metastasis, and prolongs survival. Together, the novel function of RBCs as active participants in tumorigenesis is reported through exosomal transfer of oncogenic miR-93-5p, establishing a bidirectional tumor-RBC-tumor communication axis that promotes malignancy and offers new diagnostic and therapeutic opportunities in lung cancer.