Continued Participation Research Articles

A study protocol for a mixed-method environmental scan of contextual factors that influence lung cancer screening adherence.

The efficacy of lung cancer screening (LCS) to reduce lung cancer specific mortality is heavily dependent on adherence to recommended screening guidelines, with real-world adherence rates reported to be drastically lower than rates described in clinical trials. There is a dearth in the literature on reminder processes and clinical workflows used to address adherence and robust data is needed to fully understand which clinical set-ups, processes, and context enhance and increase continued LCS participation. This paper describes a protocol for an environmental scan of adherence and reminder processes that are currently used in LCS programs across the United States. This study will triangulate data using a 3-step explanatory sequential mixed methods design to describe mechanisms of current adherence and reminder systems within academic and community LCS programs to pinpoint clinic or system barrier and facilitator combinations that contribute to increased adherence. In step 1, surveys from a nationally representative sample of LCS programs will yield quantitative data about program structure, volume, and tracking/reminder processes and messages. After completion of the survey, interested LCS program personnel will be invited to participate in an in-depth interview (step 2) to explore current processes and interventions used for adherence at the participant and program level. Finally, in step 3, triangulation of quantitative and qualitative data will be completed through qualitative comparative analysis to identify combinations of components that affect higher or lower adherence. This research advances the state of the science by filling a gap in knowledge about LCS program characteristics and processes associated with better adherence which can inform the development and implementation of interventions that are scalable and sustainable across a wide variety of clinical practice settings.

Continuous lattice oxygen participation of NiFe stack anode for Sustainable water Splitting

Non-noble anode catalysts exhibit insufficient activity and stability for anion exchange membrane water electrolysis (AEMWE). Accordingly, we propose an electrolyte additive strategy involving NiFe-layered double hydroxide. In situ Raman spectroscopy and 18O isotope labeling experiments reveal that Fe ions in the electrolyte change the oxygen evolution reaction mechanism from adsorbate evolution to the lattice oxygen participation mechanism (LOM). These Fe ions continuously refill Fe vacancies owing to facile metal dissolution via the LOM. In a unit cell, we achieve an excellent cell voltage of 1.73 V and energy conversion efficiency (ECE) of 69.4 % at 3.0 A cm−2, meeting the target set by the U.S. Department of Energy (1.80 V and 69.0 % ECE). Our optimized membrane electrode assembly enhances the cell activity (1.567 V at 1.0 A cm−2; ECE = 76.5 %) and stability (0.125 mVcell h−1 at 0.5 A cm−2 for 500 h) with a 100 cm2 AEMWE stack.

Self-help groups for people with migration experience

Abstract Background Self-help groups as voluntary associations of people to jointly cope with illnesses or psychological problems are sometimes regarded as the fourth pillar of the health care system. Still, so far people with migration experience do not resp. less participate in self-help groups in Austria. The project aimed therefore on identifying related obstacles and solutions. Methods A mixed-methods approach was chosen: a systematic literature search; interviews, focus groups and workshops; including people with migration experience and experts. A concept for self-help groups was delevoped in a participatory way, piloted in Vienna and evaluated. Results The study confirmed, that the concept of self-help groups as they are usually implemented in Austria is not known among people with migration experience. But there is a great need for exchange among those with a chronic illness or their relatives. Success factors and obstacles are mainly related to the access to people with a migration experience and the way how such self-help groups are set up. Much time needs to be invested in developing a common understanding of the concept of a self-help group and in maintaining contacts. However, despite the of the personal benefit, the often stressful life situation of people with migration experience is an obstacle for continuous participation or even initiating a self-help group oneself. Conclusions The project showed, that, although the concept of self-help groups is often not known, people with a migration experience can benefit from it. But more support is needed than is usually provided by the established self-help organisations. A change in the understanding of self-help groups on the one hand and integrating such activities in services/associations working with migrants on the other hand could improve the access for people with migration experience to this important pillar of the health care system. Key messages • Several obstacles hinder people with migration experience in participating in self-help groups in Austria, e.g. the concept itself is unknown to them. • Implementing a specific concept for self-help groups with support by professionals can facilitate the access of this population group to an important part of the health care system.

Formalizing the role of community key individuals in Utrecht, the Netherlands

Abstract Issue The disconnect between (underserved) communities and governmental bodies in Utrecht, The Netherlands, has led to uneven access to (essential) healthcare services, increasing health inequalities. This gap is often bridged by key community individuals, whose roles have historically been informal. Key individuals are often seen as volunteers who are necessary to gain access to certain communities but are rarely seen as equals in a project team, resulting in mistrust and reduced collaboration on the long term on the side of the key individuals. Description of the problem This practice describes the start of a new foundation in Utrecht that formalizes and compensates key individuals’ roles in public (health) projects. The aim was to empower them and to encourage continued participation. Effects In 2024, the foundation supported key individuals in three government projects, including a childhood vaccination awareness campaign. Interviews revealed that key individuals felt more empowered and equally valued compared to other project members. They also felt a strong responsibility for project success. However, some noted that formal structures could be restrictive. The government felt more convenience working with a formal foundation. Lessons Empowering key individuals is crucial for effective collaboration in public health. There needs to be a balance between formal structures and the flexibility of informal approaches to prevent barriers for key individuals to participate in government projects. Key messages • Formalizing key individual roles enhances public health interventions. • Fair compensation to key individuals fosters sustainable collaboration.

What they live for: Adaptive strategies of Virginia’s small-scale commercial fishermen in a changing industry

Small-scale commercial fishing communities around the world are facing a number of social, ecological, and economic challenges that are likely to persist or increase in prevalence with ongoing environmental changes and competing uses of marine resources. This research uses semi-structured interviews to assess the impacts of varying economic, ecological and social changes on individual decision-making and resilience in Virginia’s small-scale commercial fishing industry. Similar to nationwide trends, Virginia’s small-scale commercial fishing industry has shifted in response to changes in management, species abundance, and participation with impacts on social identities and cultural norms, job satisfaction, resource dependence, and the future of the commercial fishing industry. As a means of coping with the inherent volatility of commercial fishing, fishermen have implemented adaptation strategies, including diversification within and outside of commercial fishing, that enable continued participation in the commercial fishing industry. Interviews reveal that Virginia’s small-scale commercial fisheries are deeply embedded within the social identities of fishermen and fishing communities in the state. Therefore, it is valuable to managers and researchers to consider the economic and societal consequences associated with declines in small-scale commercial fisheries and more importantly, to understand why these declines are occurring. Managers can expand on these results to create workforce development strategies that ensure the long-term sustainability of Virginia’s commercial fishing industry and preserve the commercial fishing livelihood for the future.

Smartphones: A Catalyst for Tobacco Control Training in India

The tobacco crisis confronting low- and middle-income countries (LMICs) requires scale-up of effective tobacco control programs, such as Tobacco Free Teachers-Tobacco Free Society (TFT-TFS). We previously demonstrated the efficacy of TFT-TFS in increasing tobacco use cessation among teachers and schools’ adoption of tobacco control policies in Bihar, India. To scale TFT-TFS, we are now pioneering a smartphone-based mobile learning strategy to train principals (or their designees) in Madhya Pradesh to implement and monitor TFT-TFS in schools. Research underscores the transformative potential of mobile learning: a flexible, scalable, and cost-effective alternative to in-person training methods. Our study is a unique opportunity to test a training approach that could have implications for wider and more efficient delivery of other public health programs. The strategic use of gamification and digital storytelling enhances the TFT-TFS mobile training app. Gamification mechanics—including points, leaderboards, and digital badging—foster a dynamic learning environment to enhance learning outcomes. This approach propels continuous participant engagement toward understanding and implementation of TFT-TFS’s six monthly themes and four program components. The TFT-TFS smartphone training program weaves in elements of Indian culture, notably the symbolic use of colors and kites. The Indian kite festival celebrates communal harmony through healthy competition. Similarly, the app employs the idea of school kites, which are divided into six blank segments corresponding to the TFT-TFS monthly themes. Participants navigate each module, engaging with animated videos, digital assessments, and interactive activities. Upon a principal’s successful completion of each monthly theme’s program components, the school’s kite receives a new color, unlocking the subsequent theme. The TFT-TFS smartphone training showcases a unique interactive mobile learning application that integrates gamification and tests how to scale up an effective tobacco control program in schools in India and other LMICs. The TFT-TFS smartphone-based training app may also have relevance to other public health-related training efforts in resource-constrained areas.

The Unsung Propagandists

As the nation rallied its resources for wartime in 1942, the Office of War Information (OWI) assumed a pivotal role in disseminating information related to the war and aimed at mobilizing the American populace. Within the organizational framework of the OWI, a small cohort of pioneering women ascended to leadership positions, challenging prevailing gender norms and reconfiguring the narrative surrounding women's wartime engagement. Classified after the war’s end, their records are now part of the 7,112 boxes that encompass the totality of the OWI’s records, now housed in the National Archives. An exploration of the documents of these women, including correspondence, published work, and other internal records, paints the picture of their continuous participation and influence which resulted in some of the most visible domestic propaganda campaigns of the Second World War. Previous scholarship, while plentiful in the exploration of the domestic roles of women during the war, fails to acknowledge the directorship of these women in their efforts to rally national support for not just female recruitment, but other facets of wartime activity. Through an in-depth examination of archival materials collected from the OWI, this research seeks to contribute to a nuanced understanding of female contributions on the American home front.

Joining alone: factors that influence the musical participation of young adults after leaving school

Abstract When young people leave the musical world of their school environment, a lack of clear routes into adult musical engagement brings a risk of wasted ability, motivation and enjoyment, which arguably undermines the value of music education. This study explored the factors that influence continued musical participation among young British adults who had been actively engaged in school music. Musical participation is defined in this research as group music-making in either a formal or informal setting. Participants (n = 102) completed an online questionnaire or were interviewed (n = 6) about their past and present musical experiences along with future expectations for music-making. The stark headline finding was that while 87% of participants had intended to continue with music-making beyond school, only 48% had found groups to join. Nonetheless, 78% expected to continue with music-making in the future. Our research therefore suggests that any break from musical participation need not be permanent for individuals who have established strong musical identities through their early experiences. To conclude, we present a model of lifelong musical participation that illustrates the influences, motivations and choices that contribute to sustained musical engagement.

Deviance, Discourses, and Everyday Rationalities of Sports Betting in Singapore

ABSTRACTMore liberal regulations and technological advances have spurred the growth of sports betting around the world. Given its long‐standing association with various social ills, how do sports bettors justify their gambling activities? This paper looks into the guiding principles and everyday practices of sports betting participants in Singapore. Based on qualitative research, it argues that sports bettors distinguish their activities by following a distinctive rationality that we call “benevolent play.” This concept refers to gambling practices where goodwill and charity serve as a justification for the potential of losing their bets and for their continued participation in sports betting. Apart from latching on the use of regulated gambling by state‐affiliated agencies to support development programs and charitable causes, benevolent play also emphasizes the sense of agency (football knowledge) and emotional investment (“play”) that sports bettors wage on their teams and communities. Generally, this study will contribute to the understanding of gambling culture and the larger discussions on deviance and social control.

Parallel Attention-Driven Model for Student Performance Evaluation

This study presents the development and evaluation of a Multi-Task Long Short-Term Memory (LSTM) model with an attention mechanism for predicting students’ academic performance. The research is motivated by the need for efficient tools to enhance student assessment and support tailored educational interventions. The model tackles two tasks: predicting overall performance (total score) as a regression task and classifying performance levels (remarks) as a classification task. By handling both tasks simultaneously, it improves computational efficiency and resource utilization. The dataset includes metrics such as Continuous Assessment, Practical Skills, Presentation Quality, Attendance, and Participation. The model achieved strong results, with a Mean Absolute Error (MAE) of 0.0249, Mean Squared Error (MSE) of 0.0012, and Root Mean Squared Error (RMSE) of 0.0346 for the regression task. For the classification task, it achieved perfect scores with an accuracy, precision, recall, and F1 score of 1.0. The attention mechanism enhanced performance by focusing on the most relevant features. This study demonstrates the effectiveness of the Multi-Task LSTM model with an attention mechanism in educational data analysis, offering a reliable and efficient tool for predicting student performance.

Ascending past constraints through immersion into the social worlds of climbing gyms

Gyms are community hubs centered around physical activity and in recent years indoor climbing gyms have witnessed unprecedented growth globally as the sport has moved from extreme to the mainstream. As the sport continues to grow, the industry seeks to understand how to both keep new climbers and progress climbers already invested in the sport. The study sought to understand how individuals encountered and negotiated constraints as they became progressively immersed into the social worlds of the activity. Interviews were conducted with indoor rock climbers in Australia and Canada ranging in experience and social world progression (N = 27). The findings revealed the nature of constraints and the ways in which individuals negotiated them evolved as they become more immersed into the social community of climbing. Practically, this research provides the climbing industry with insight on how to assist in creating and maintaining climbing communities to foster continued participation.

A History of Community Based Initiatives that Led to Crop Improvement and Protection in the Canadian Prairies

From the early days of agricultural production in the 1800s through to the present day, farmers, agronomists, and other motivated people have worked to improve crop production through pest management and surveillance, selection of crop genotypes and agronomic innovations such as reduced and zero-tillage. These essential contributions also helped raise awareness of the practical problems that farmers have faced, of the potential solutions to those problems, and the problems that remain to be solved. In many cases, farmers have organized their efforts to support research to address agricultural challenges through commodity organizations who actively fund research, raise awareness of science, and encourage participation in activities such as pest monitoring and on-farm research trials. The future of a biovigilance approach to crop production depends on the continued participation of agricultural community members.

Lower-limb coordination changes following a 6-week training intervention that elicited enhancements to maximum velocity sprint performance.

Alterations to intra- and inter-limb coordination with improved maximal velocity performance remain largely unexplored. This study quantified within-day variability in lower-limb segmental coordination profiles during maximal velocity sprinting and investigated the modifications to coordination strategies in 15 recreationally active males following a 6-week period comprised of a multimodal training programme [intervention group (INT); n=7] or continued participation in sports (control group; n=8). The INT demonstrated a large decrease (effect size=-1.54) in within-day coordination profile variability, suggesting potential skill development. Thigh-thigh coordination modifications for the INT were characterised by an earlier onset of trail thigh reversal in early swing (26 versus 28% stride) and lead thigh reversal in late swing (76 versus 79% stride), rather than increases in overall time spent in anti-phase. Moreover, an increase in backward rotation of thigh relative to shank (effect size, 95% CIs: 0.75, 0.17 to 1.33) and shank relative to foot (0.76, -0.17 to 1.68) during late swing likely facilitated more aggressive acceleration of the limb, contributing to reduced touchdown distance and more favourable lower-limb configuration at initial ground contact. These novel findings provide empirical support for the role of longitudinal coordination modifications in improving maximal velocity performance.

Unveiling the Lasting Impact: A 15-Year Follow-Up of Short-Term Surgical Mission Experiences

IntroductionResident interest in global surgery has increased over recent years. Incorporating short-term surgical missions (STSMs) into training improves Accreditation Council for Graduate Medical Education (ACGME) competencies and aids in understanding of global health infrastructure. We aim to investigate the impact of STSM participation during residency on the desire for participation after residency, and barriers in doing so. MethodsEighteen general surgery residents who participated in STSM with the International Surgical Health Initiative from 2009 to 2017 were surveyed. An 18-question survey encompassing demographics, mission-specific data, ACGME competencies, current perspectives, barriers, and areas for improvement was distributed. ResultsThe group averaged 5.4 y out of residency and 89% (n = 16) completed the survey. Mean age was 38.5 y with a female predominance (62.5%). During residency, 10 (62.5%) participated in ≥ two STSMs and six (37.5%) participated in one STSM. On average, each resident performed 24 cases per mission. All reported that after their resident STSM experience, they were more inclined to participate as an attending. Twenty-five percent (n = 4) participated in STSMs after residency. Vacation, scheduling, and family factors were ranked the highest barriers. All ACGME competencies were felt to be significantly improved by STSMs. ConclusionsThis is the first long-term follow-up study of general surgery residents who participated in STSMs confirming that resident involvement increases desire for continued participation. Although 100% of residents wanted to participate as attendings, only 25% were successful in doing so. While operative experience is salient in surgical residency, there are other valuable experiences to be gained. Further work should focus on enhancing experiences and mitigation of barriers to continued participation in global humanitarian initiatives.

How do social interaction and group-level regulation shape task perceptions in collaborative learning task?

ABSTRACT This study explored patterns of social interaction and group-level regulation in terms of co- and socially shared regulation in collaborative learning and their relation to learners’ metacognitive task perceptions. 72 secondary school students performed collaborative physics tasks in small groups over multiple 90-minute sessions. Video recordings (∼148.5 h) of collaborative interactions and pre- and post- situated self-reports of learners’ task perceptions were collected. The collaborative sessions were clustered and collaborative interaction patterns were examined. Finally, learners’ task perceptions in the clusters were investigated. The results showed different collaborative interaction patterns and differences in learners’ task perceptions between the clusters. The main finding is that continuous active participation in socioemotional interactions alongside cognitive-focused interactions and appropriate group-level regulation of learning positively influence learners’ perceived task understanding. These findings add to current understanding of collaborative interactions as temporal processes and contribute to practical implications for supporting collaborative interactions to enhance metacognitive skills.

Between Choice and Coercion? The Processes of Increased Economic Vulnerability Among Low-Income Older Workers

ABSTRACT The social phenomenon of extended working age has been subject to broad scholarly and social policy interest, as part of such trends as the aging of the population, increased life expectancy, shortage of the labor force, and policy debates on pension reforms. A major question about extending working age, or working after retirement, is whether it is a matter of choice, taking control of one’s later life, or is coerced, part of entering the precariat. This study provides a nuanced examination of the social processes that direct labor market participation among older workers by conducting an analysis of in-depth interviews with 42 low-income older workers in Israel. The study exposed several institutional constraints that increase their economic vulnerability, demonstrating how interrelated structural factors related to the labor market, gender, and immigration shape the precarity of the life of older workers and coerce their continuous labor market participation. We conclude by emphasizing the responsibility of governments to ensure that older workers’ labor market participation truly represents their “choice and control,” rather than being a matter of coercion.

Unraveling Factors Influencing Local Willingness to Participate in Sustainable Komodo Conservation and Protected Area Tourism

Komodo National Park is at the forefront of balancing environmental conservation with the challenges and opportunities of sustainable tourism. This research delves into the attitudes and engagement levels of the local communities within Komodo's distinctive ecological context, aiming to unravel the factors that drive or hinder their involvement in sustainable tourism and conservation activities. Through Exploratory Factor Analysis, we distilled key influences on community engagement, followed by a K-Mean Cluster Analysis to segment the community by their involvement levels. Logistic Regression was then employed to explore the likelihood of continued participation in these initiatives. The analysis identified three primary factors affecting community participation: the degree of involvement in sustainable tourism activities, the extent of community and environmental involvement, and the level of awareness regarding tourism development policies. The Cluster Analysis illuminated diverse engagement patterns across demographic lines, revealing how differences in settlement type, income levels, marital status, gender, and age contribute to varied participation rates. Interestingly, the logistic regression pointed to a paradox where higher engagement in sustainable tourism correlates with a lower probability of future participation, hinting at possible sustainability fatigue among highly active community members. These intricate dynamics of community engagement in sustainable tourism within Komodo National Park, highlight the importance of tailored, demographic-specific approaches to foster inclusive participation in conservation efforts. The insights gained underscore the complexity of promoting sustainable tourism in sensitive ecological areas and offer critical recommendations for policymakers and conservation stakeholders aiming to enhance sustainable development in Komodo and similar settings globally.

Whole-genome sequencing for antimicrobial surveillance: species-specific quality thresholds and data evaluation from the network of the European Union Reference Laboratory for Antimicrobial Resistance genomic proficiency tests of 2021 and 2022.

As antimicrobial resistance (AMR) surveillance shifts to genomics, ensuring the quality of whole-genome sequencing (WGS) data produced across laboratories is critical. Participation in genomic proficiency tests (GPTs) not only increases individual laboratories' WGS capacity but also provides a unique opportunity to improve species-specific thresholds for WGS quality control (QC) by repeated resequencing of distinct isolates. Here, we present the results of the EU Reference Laboratory for Antimicrobial Resistance (EURL-AR) network GPTs of 2021 and 2022, which included 25 EU national reference laboratories (NLRs). A total of 392 genomes from 12 AMR-bacteria were evaluated based on WGS QC metrics. Two percent (n = 9) of the data were excluded, due to contamination, and 11% (n = 41) of the remaining genomes were identified as outliers in at least one QC metric and excluded from computation of the adjusted QC thresholds (AQT). Two QC metric correlation groups were identified through linear regression. Eight percent (n = 28) of the submitted genomes, from 11 laboratories, failed one or more of the AQTs. However, only three laboratories (12%) were identified as underperformers, failing across AQTs for uncorrelated QC metrics in at least two genomes. Finally, new species-specific thresholds for "N50" and "number of contigs > 200 bp" are presented for guidance in routine laboratory QC. The continued participation of NRLs in GPTs will reveal WGS workflow flaws and improve AMR surveillance data. GPT data will continue to contribute to the development of reliable species-specific thresholds for routine WGS QC, standardizing sequencing data QC and ensure inter- and intranational laboratory comparability.IMPORTANCEIllumina next-generation sequencing is an integral part of antimicrobial resistance (AMR) surveillance and the most widely used whole-genome sequencing (WGS) platform. The high-throughput, relative low-cost, high discriminatory power, and rapid turnaround time of WGS compared to classical biochemical methods means the technology will likely remain a fundamental tool in AMR surveillance and public health. In this study, we present the current level of WGS capacity among national reference laboratories in the EU Reference Laboratory for AMR network, summarizing applied methodology and statistically evaluating the quality of the obtained sequence data. These findings provide the basis for setting new and revised thresholds for quality metrics used in routine WGS, which have previously been arbitrarily defined. In addition, underperforming participants are identified and encouraged to evaluate their workflows to produce reliable results.

Brain-computer interface on wrist training with or without neurofeedback in subacute stroke: a study protocol for a double-blinded, randomized control pilot trial.

After a stroke, damage to the part of the brain that controls movement results in the loss of motor function. Brain-computer interface (BCI)-based stroke rehabilitation involves patients imagining movement without physically moving while the system measures the perceptual-motor rhythm in the motor cortex. Visual feedback through virtual reality and functional electrical stimulation is provided simultaneously. The superiority of real BCI over sham BCI in the subacute phase of stroke remains unclear. Therefore, we aim to compare the effects of real and sham BCI on motor function and brain activity among patients with subacute stroke with weak wrist extensor strength. This is a double-blinded randomized controlled trial. Patients with stroke will be categorized into real BCI and sham BCI groups. The BCI task involves wrist extension for 60 min/day, 5 times/week for 4 weeks. Twenty sessions will be conducted. The evaluation will be conducted four times, as follows: before the intervention, 2 weeks after the start of the intervention, immediately after the intervention, and 4 weeks after the intervention. The assessments include a clinical evaluation, electroencephalography, and electromyography using motor-evoked potentials. Patients will be categorized into two groups, as follows: those who will be receiving neurofeedback and those who will not receive this feedback during the BCI rehabilitation training. We will examine the importance of motor imaging feedback, and the effect of patients' continuous participation in the training rather than their being passive.Clinical Trial Registration: KCT0008589.

The associations between organized sport participation and physical fitness and weight status development during adolescence

ObjectivesWe are yet to understand how continuous participation in organized sports, dropout from organized sports, or complete non-participation affect adolescents' trajectories of physical fitness and body mass index (BMI). Thus, the aim was to examine longitudinal changes in cardiorespiratory and muscular fitness, and BMI between adolescents 1) who continued or started organized sport participation, 2) who dropped out, and 3) who never participated in organized sport or dropped out before adolescence. DesignLongitudinal observational study. MethodsOver four years (2017–2021), sport participation, cardiorespiratory and muscular fitness, and BMI data were collected annually from 963 participants (Mage = 11.25 ± 0.31). Latent growth curve models were utilized to examine levels (baseline) and slopes (rate of change) of BMI, cardiorespiratory, and muscular fitness in each sport participation group. ResultsFitness levels significantly varied among groups. Continuing sport participants exhibited the highest levels, non-participants the lowest. Both groups showed significant improvements in cardiorespiratory and muscular fitness over time. Dropouts had higher baseline fitness than non-participants but demonstrated no change in cardiorespiratory fitness over time and a significantly smaller increase in muscular fitness than the two other groups. BMI increased similarly in all groups, with non-participants starting at higher baseline levels. ConclusionsIndividuals who continually participated in sports maintained higher levels of fitness than individuals who did not participate in organized sports across adolescence. However, individuals who dropped out of organized sports, showed plateau in their fitness improvements, suggesting that the physical activity previously obtained through organized sports may not be replaced elsewhere.