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Process evaluation of a pragmatic, multicentre pilot Randomised Controlled Trial (RCT) in primary care: Tailored intervention for COPD and Co-morbidities by Pharmacists and Consultant Physicians (TICC PCP)

Chronic Obstructive Pulmonary Disease (COPD) is a growing global challenge. We undertook a process evaluation embedded within the Tailored Intervention at home for patients with moderate-to-severe COPD and Co-Morbidities by Pharmacists and Consultant Physicians (TICC PCP) pilot randomised controlled trial (RCT), which explored patient/stakeholder perceptions of the intervention, acceptability of trial procedures, and barriers/facilitators to intervention implementation. Semi-structured telephone interviews were conducted with intervention patients (20) and stakeholders (10); data were analysed thematically, conceptualised through Normalisation Process Theory. Patient perspectives compared based on socio-economic status (SES). Patients/stakeholders reported positive perceptions of the intervention/trial procedures. Pharmacists provided support across a range of health/social issues. Challenges related to: recruitment; workload/lone-working; managing patient complexity; and data collection. There were suggestions Pharmacists were able to undertake more actions to support patients from low SES areas. Overall, intervention and trial procedures were acceptable to patients and stakeholders. Findings support progression to full-scale RCT.

Factors associated with dyslipidemia among healthcare workers in a COVID-19-designated hospital in Hangzhou, Zhejiang, China: A retrospective cohort study from 2019 to 2022

Background This study investigated dyslipidemia and its relative factors among Chinese healthcare workers from 2019 to 2022. Method This retrospective cohort study was conducted from 2019 to 2022. The endpoints were dyslipidemia or the end of follow-up. Univariate Cox proportional hazard regression and LASSO regression models were used to select variables, and a multivariate Cox proportional hazard regression model was constructed to explore factors associated with dyslipidemia. Results 67 (9.2%) medical staff members were diagnosed with dyslipidemia, 106 (14.5%) resigned from the hospital, and 558 (76.3%) kept normal lipid files. Compared with healthcare workers with previous working time <10 years, the hazard ratios (HRs) of those with 10−20 years and ≥ 20 years of working experience were 0.34 (0.18–0.64) (P = 0.001) and 0.47 (0.26–0.85) (P = 0.01); compared with 0-day frontline working time, the HR of those with ≥ 30 days frontline working time was 0.38 (0.19–0.75) (P = 0.005). The HRs of TG, HDL, LDL, TBIL and HB were 3.14 (1.65–6.01) (P < 0.001), 0.20 (0.06–0.65) (P = 0.008), 2.93 (1.70–5.05) (P < 0.001), 1.06 (1.02–1.10) (P = 0.002) and 0.98 (0.97–0.99) (P = 0.04), respectively. Conclusion Healthcare workers with high frontline working time and longer previous working time were less likely to have dyslipidemia, while healthcare workers with high levels of TG, LDL, HB, TBIL, and low levels of HDL were more likely to have dyslipidemia. Supporting healthcare workers should be a priority for policymakers and hospital administrators.

Knowledge and attitudes towards Alzheimer’s disease among adult residents in Jiulongpo, Chongqing, China: A cross-sectional survey

Background The prevalence of Alzheimer’s disease (AD) continues to rise as the aging population increases, and the resulting cognitive decline severely affects patients’ quality of life. However, the public’s understanding of AD is markedly insufficient, which limits the effectiveness of early prevention and treatment. This study conducted a cross-sectional survey to assess the level of knowledge about AD among adult residents in Jiulongpo District, Chongqing, as well as their attitudes towards people with dementia, providing a basis for formulating targeted intervention strategies. Methods A cross-sectional survey was conducted in Jiulongpo, Chongqing, China, from September to October 2024. The self-reported questionnaire for participants included three parts: demographic information, the Alzheimer’s Disease Knowledge Scale (ADKS), and the Dementia Attitude Scale (DAS). Multiple linear regression analysis was used to identify the main factors influencing AD knowledge and attitudes. Results 1,362 respondents were surveyed, with 64.24% female. The age group of 40–64 has the largest number of people, accounting for 38.03%. The average ADKS score was 17.67 (standard deviation = 2.47), with individual item score rates ranging from 16.01% to 89.72% across the 30 items. The domains with the lowest ADKS score rates were “Caregiving” (43.40%) and “Symptoms” (52.25%). The average score on the DAS was 81.72 (standard deviation = 11.19). The score rates for the “Dementia knowledge,” “Positive social comfort,” and “Negative social comfort” dimensions of the DAS were 61.56%, 55.02%, and 56.38%, respectively. Residents aged 18–39, living in urban areas, with higher education or above, working in healthcare, having a higher income level, being unmarried, and having experience in Alzheimer’s Disease and Related Dementias (ADRD) knowledge training have a higher level of knowledge about AD and a more positive attitude towards it. Residents with family members suffering from ADRD have lower DAS scores than those without such family members. Conclusion People’s understanding of AD is limited, especially in the areas of “Caregiving” and “Symptoms”, and they hold a neutral attitude toward dementia. We recommend intensifying health education efforts on AD knowledge across different populations, particularly emphasizing the promotion of knowledge in weak areas, while also cultivating their friendly attitudes towards dementia patients.

The serum vitamin D levels alleviate the influence of dietary inflammation on frailty: A cross-sectional analysis in the U.S. older adults

Dietary inflammation (DI) and suitable vitamin D intake was associated with frailty. However, the possible mechanism that how DI affected frailty was still unclear. The current study aimed to explore the mediating association of vitamin D levels in the link between DI and frailty. A cross-sectional study of 1172 participants from the National Health and Nutrition Examination Survey (NHANES) database in 2011−2014 was conducted. DI was assessed by the Dietary Inflammation Index (DII), serum vitamin D level were assessed by serum 25-hydroxyvitamin D3 (25-(OH)D3), and frailty was assessed by 49-frailty index. The mediation package in R 4.3.3 was used to examine the mediating association of serum 25-(OH)D3 levels on the relationship between DII and frailty. The prevalence of frailty was 32.3%. DII was negatively correlated with 25-(OH)D3 (r = −0.131, P < 0.001), and positively related with frailty (r = 0.131, P < 0.001). 25-(OH)D3 was negatively associated with frailty (r = −0.073, P = 0.013). And the results showed that 25-(OH)D3 was a possible mediating association between DI and frailty, which explained 10.5% of the total effect (0.0004/0.0038). Improvements in DI and increased vitamin D levels may help alleviate frailty. People should pay more attention to the diet pattern of older adults.

EDTA tubes are suitable for insulin and C-peptide measurement in resource-limited settings and can be stored at room temperature for up to 24 hours

Introduction Insulin and C-peptide assessment are important in characterization and management of diabetes. However, their adoption and increased clinical use in low resource settings (LRSs) is partly hindered by logistical factors including supplies required for pre-analytical sample handling and limited infrastructure. We aimed to determine the effects of altered sample processing conditions on stability of insulin and C-peptide at the pre-analytical stage. Methods Random (non-fasted) blood samples were drawn from ten healthy (glucose range 4.1–8.0 mmol/L) participants. We investigated the mean % change from baseline of C-peptide and insulin in serum (plain tubes) vs plasma (K2EDTA tubes), centrifuged vs uncentrifuged, room vs cool box temperature on the stability of C-peptide and insulin up to 24 hours using Wilcoxon signed rank test. Results were considered clinically significant if the percentage change was > 10% and if the p-value was < 0.05. Results Eight patients were included in the final analysis, while two were excluded due to hemolysis. C-peptide and insulin levels stayed above 90% of the baseline concentration in K2EDTA tubes across all storage and processing conditions for up to 24 hours. In contrast, samples collected in plain serum tubes kept at room temperature and uncentrifuged, C-peptide and insulin levels decreased significantly to 51% (p = 0.006) and 62% (p = 0. 083) respectively, similarly insulin levels for centrifuged samples declined to 64% (p = 0.083). All iced and centrifuged serum samples remained above 90% of baseline concentration. Conclusions In resource-limited settings where insulin and C-peptide tests are limited to central laboratories and highly dependent on sample referral systems, these tests can be reliably measured without the need for immediate centrifugation or processing from samples collected in whole blood K2EDTA tubes uncentrifuged kept at room temperature and processed within 24hours.

Declining harbour seal abundance in a previously recovering meta-population

We present evidence that the abundance of harbour seals in the Kattegat-Skagerrak is in decline. Until recently, the Kattegat-Skagerrak harbour seal population has grown exponentially as it has recovered from historic over-hunting and two mass mortality events. This has provided an important case study for the influence of environmental factors on population growth. Over recent years, deteriorating average body condition and reduced pup counts in certain colonies have indicated that the population is under stress. At the same time, there has been an increase in hunting in the region which may compound existing environmental stressors. To determine trends in harbour seal abundance, we compile aerial survey data for the Kattegat-Skagerrak and South-Western Baltic Sea (S.W. Baltic) populations between the years 2003 and 2023. With parametric modelling, we find that a logistic growth model is the best fit for aerial survey data from the Kattegat-Skagerrak population, while an exponential growth model is the best fit for data from the smaller S.W. Baltic population. We determine trends by fitting non-parametric Generalised Additive Models (GAMs) to aerial survey data and calculating their first derivative. In the Kattegat-Skagerrak, we estimate an annual decline of – 408 individuals (SE = 242, CI95% = [- 882, 67]) at the end of the survey period. This decline represents approximately 3.3% of the estimated mean count in 2023. Rate of change remained positive in the separate S.W. Baltic population throughout the survey period at an estimated annual increase of 54 individuals (SE = 23, CI95% = [9,99]), representing approximately 3.9% of mean counts in 2023. We find that the final rate of change was zero or below zero in eleven out of twelve subregions (representing individual colonies) in the Kattegat-Skagerrak. Declining counts in the Kattegat-Skagerrak since the mid-2010s may be influenced by changes in haul-out behaviour as a result of increased population density or vessel traffic. Despite this, declines likely reflect real changes in seal abundance. Changes in abundance may be the result of well documented environmental degradation affecting prey availability and causing regionally lowered birth rates.

Knowledge and Perception of Medical Negligence in Medical Students

Introduction: Absence of reasonable care and skill, or willful negligence by medical practitioner in the treatment of a patient resulting in bodily/psychological injury or death of the patient is medical negligence. This survey was conducted to assess the knowledge and awareness of medical students and interns in a medical college. Materials & Methods: It is an observational cross-sectional study in which 306 IIIrd Professional M.B.B.S. Part-2 students & Interns participated in 10 multiplechoice questions based on different aspects of negligence in medical practice and its prevention. The data collected were tabulated and statistically analyzed to draw conclusions. Results: Out of 306 total respondents, 27.80% (n=85) had adequate knowledge, while 60.50% (n=185) had partial knowledge, and 11.80% (n=36) had poor knowledge. It was found that adequate knowledge was present in 36.41% (n=71) of IIIrd Professional M.B.B.S. Part-2 students, and 12.61% (n=14) of Interns. Conclusion: IIIrd Professional M.B.B.S. had better knowledge about medical negligence when compared to Interns showing labile memory of lessons taught in UG curriculum. A reasonable approach to tackle this issue could be to ensure better medico-legal training for medical students.

Selective activation of ipRGC modulates working memory performance

Intrinsically photosensitive retinal ganglion cells (ipRGCs) are known to be sensitive to short-wavelength light (460–480 nm; blue or cyan light) and to play a role in regulating physiological responses such as circadian rhythms. Previous studies have shown that exposure to blue light improves performance on working memory tasks compared with exposure to amber light. However, it remains unclear whether these cognitive benefits via light are attributable to integrated signals across ipRGCs and rod/cone or ipRGC alone. To address this, the present study investigates the specific contribution of ipRGCs to working memory performance using a silent substitution method that selectively manipulates ipRGC activity while minimizing the influence of LMS cone responses. Participants engaged in 1- and 2-back tasks under low- or high-ipRGC activation light, a metameric color perceived as magenta. Results showed that hit rate in the 2-back task was significantly higher under exposure to high-ipRGC light than to low-ipRGC light. Our overall findings provide direct evidence that isolated ipRGC activation, independent of perceptual blue or cone involvement, can modulate cognitive task processing.

Virtual Reality in Forensic Investigation: Exploring Applications and Advancements

At the present time, there is a growing body of scholarly study focused on the development of virtual worlds and scenarios that have the potential to provide entirely sensory-rich alternative adventures that incorporate tangible, visual, and audio aspects. Once implemented properly, these kinds of efforts have the potential to be quite effective. Through a comprehensive analysis of realistic virtual reality and its technological ingredients, the present investigation intends to investigate appropriate approaches for effectively recreating virtual crime scenes. In the area of forensic examination, the re-enactment of the scene of an incident is a crucial procedure that helps determine the order in which events occurred. Enhancing comprehension and achieving straightforward, high-quality monitoring are the main goals of legal criminal investigation documentation. However, traditional methods are not adequate regarding it thorough recreation for entire scene of crime. The incorporation of methods for visualising information in multiple dimensions facilitates the thorough analysis of various types of proof gathered at the scene of crime, hence aiding in the development of a cohesive story. Rather of being displayed on traditional computer screens, the content is delivered via immersive virtual reality (VR). A thorough recreation of a crime scene is made possible by the links between different evidence chains. This is achieved by the application of forensic tools and specialist knowledge to examine the sources of harm and identify those who may be at fault. When multidimensional imaging techniques are used to many kinds of criminal situations, it becomes possible to conduct a more thorough investigation and perform a range of insightful analyses, including accurate measurement

RETRACTED: TGEL-transformer: Fusing educational theories with deep learning for interpretable student performance prediction

With the integration of educational technology and artificial intelligence, personalized learning has become increasingly important. However, traditional educational data mining methods struggle to effectively integrate heterogeneous feature data and represent complex learning interaction processes, while existing deep learning models lack educational theory guidance, resulting in insufficient interpretability. To address these challenges, this study proposes the TGEL-Transformer (Theory-Guided Educational Learning Transformer) framework, which integrates multiple intelligence theory and social cognitive theory, featuring three innovations: a dual-channel feature processing module that integrates cognitive, affective, and environmental dimension features; a theory-guided four-head attention mechanism that models educational interaction dynamics; and an interpretable prediction layer that provides theoretical support for educational interventions. Using a dataset of 6,608 students, TGEL-Transformer achieved RMSE = 1.87 and R 2  = 0.75, outperforming existing methods with statistically significant improvements (p < 0.001) ranging from 1.1% against recent state-of-the-art models to 5.6% against transformer baselines. External validation on cross-cultural data (n = 480) demonstrated strong generalizability with R 2  = 0.683. Attention weight analysis revealed that teacher support (0.15), prior knowledge (0.15), and peer interaction (0.13) are key factors influencing learning outcomes. This study provides a theory-guided framework for educational data mining, offering data-driven support for personalized education and advancing intelligent education development.

Thanatomicrobiome and its Influence in Determination of Time Since Death: A Review

The thanatomicrobiome (thanatos, Greek for death) is a relatively new term and is the study of the microbes colonizing the blood, lymph, internal organs and orifices after death. Forensic investigations depend heavily on the postmortem interval (PMI), which measures the amount of time since death. Conventional approaches to PMI estimation frequently depend on both macroscopic and microscopic alterations in cadavers, which can be inaccurate and subject to several influences. A promising approach for PMI estimate has surfaced in recent years: the thanatomicrobiome, which is the community of bacteria that remain in the human body after death. This study aims to investigate the thanatomicrobiome signatures present in various visceral samples collected postmortem and assess their potential for accurate PMI estimation. Using high-throughput sequencing methods like metagenomics, microbial communities from various visceral samples taken from cadavers at certain times after death can create reliable thanatomicrobiome signatures for PMI estimation, law enforcement organisations and forensic professionals may be able to more precisely ascertain the time of death. This could improve the precision and dependability of forensic investigations. This article ensures a future in the advance forensic microbiology as a tool for forensic casework and contributing to the broader field of forensic science

Socio-demographic influence of food additives acceptance and avoidance among the Lebanese population: A cross-sectional study

Consumers’ exposure to food additives (FAs) through food consumption is becoming inevitable, triggering concerns about their safety. This study aims to evaluate the factors influencing food choices, the level of knowledge among Lebanese consumers about FAs, and the socio-demographic determinants of FAs acceptance and avoidance. A cross-sectional web-based study enrolling 601 participants was conducted online using the snowball technique. The questionnaire consisted of four parts, including the patient socio-demographic characteristics, knowledge about FAs’ definition and label content, the drivers of food choices, and FA acceptance and avoidance. Results showed varying levels of FAs knowledge across different age groups. Consumers indicated insufficient education about FAs (64.9%) and inadequate labeling (59.4%) are primary challenges in understanding food labels. Taste (75%) and price (62.2%) rather than FA content (29.3%) impacted food choices. Multivariate analysis showed that males were more likely to avoid FAs (β = 1.467, p = 0.016), as were university degree holders (β = 1.809, p = 0.012). Dieticians showed lower FA acceptance (β = −1.875, p = 0.031). The study highlights how socio-demographic factors and knowledge influence attitudes toward food adulteration, underscoring the need for targeted education, effective labeling policies, and further research on risk perception and behavioral change.

A Preliminary Study Investigating Class Characteristics in Gurumukhi Handwriting

India has been praised for its diversity, particularly in terms of cast, ethos, dialects, religion, and calligraphies. Brahmi characters are ancient India’s primevalscript system, dating back to the first millennium BCE. The Gurumukhi script is the eleventh most widely used script in the world. The Gurumukhi script is written from left to right and from top to bottom. The common beginnings of the scripts, as well as their divergence, are significant and critical. It is undeniably impossible for an auditor to be familiar with eachcalligraphy, specifically in a nation state like India, where languages and scripts vary greatly. The aim of this paperdefines the class and individual features of Gurumukhi scripts, laying the groundwork for calligraphy forensic testing.

Correction: Childhood infection burden, recent antibiotic exposure and vascular phenotypes in preschool children

A Systematic Study on Class Characteristics in the Malayalam Script

Background: The interrogation of whether a forensic manuscript examiner should provide estimation about composition on handwritten documents in a foreign linguistic has been debated since science’s inception. There is a distinct divide among the discipline’s experts, with some in favor of expressing opinion and the rest𿿿ercely opposed. Aim: The aim of this study describes the class and individual characteristics of Malayalam scripts, laying the groundwork for script forensic testing. Material and Method: When this subject is presented in the context of Indian linguistic diversity, a surveyor who is normally aware with a particular linguistic is challenged with the task of analyzing papers in more than eighteen dialects, all of which is extremely distinct from the others. Fifty samples in the Malayalam language collected for thorough analysis. The handwritten samples were gathered from several writers. The𿿿fty writers knowing the above languages were selected offer the samples in their own linguistic for the assessment.Result: The majority of symbols in the Dravidian scripts are cursive, with the exception of a few straight-line stroked signs. The writers highly endorse the motivation for document experts to examine these foreign scripts and offer a conclusive verdict after thoroughly evaluating the possibilities and constraints by examining documents. Conclusion: After a careful and thorough examination of handwritten samples, when comparing like with like, a document examiner who is unfamiliar with the script must know what each letter or𿿿gure is and where it appears

Intrinsic vs. extrinsic motivation in high school physical education: Which fuels adolescent achievement emotions better?

The purpose of this study was to examine the relationship between the intrinsic, extrinsic, and amotivation levels of high school students toward physical education and their emotions of achievement. The study was carried out in the fall semester of the 2024–2025 academic year, with 1399 students studying at various high schools in Turkey. Participants’ motivation levels were assessed using the “Motivation for Participation in Physical Education Lesson Scale,” and their achievement emotions were evaluated with the “Achievement Emotions Scale for Physical Education.” A cross-sectional design was used in the study and data were analysed using structural equation modelling. The findings showed intrinsic motivation strongly related to positive achievement emotions and negatively to negative ones. Extrinsic motivation was weakly correlated with positive achievement emotions and not significantly with negative ones. Amotivation negatively correlated with positive achievement emotions and positively correlated with negative ones. Students’ motivation and emotions are influenced by how well their basic psychological needs are met, according to self-determination and psychological needs theories. The support of intrinsic motivation in physical education is essential for their achievement emotions and well-being. Teachers must promote autonomy, competence, and relatedness in learning environments. Future studies should test these findings in various cultural contexts using various data sources and longitudinal designs. Exploring technological and cultural influences on motivation will add valuable information to the literature.

Characterization of the Mammalian Post-mortem Thanatomicrobiome: A Time and Temperature Based Approach using Culture Dependent and Independent Techniques

Introduction: The thanatomicrobiome (Thanatos, Greek for death) or the postmortem microbiomes have been recognized as a significant biomarker to determine time and whereabouts of host death. The number and abundance of each organ’s signature microbioata can be of utmost importance to forensic microbiologists as a novel data source for estimating post-mortem interval. Method: Fresh samples of Liver and Kidney of goat were taken and processed. Cultures were prepared and incubated at varying temperatures (37°C, 27°C, and 4°C) in both aerobic and anaerobic condition. After every 24hour, the plates were observed to examine the growth for isolation of microbial colonies. Results: The present finding focuses on the characterization of various thanatomicrobiome compositions across time, temperature and oxygen availability once the animal is passed out. Conclusion: In the present study it was found that increase in time after death leads to variation in bacterial culture in the internal tissues of body which helps in estimation of Post-mortem interval (PMI) in different conditions (such as aerobic and anaerobic), and at different storage temperature.

AI-augmented differential diagnosis of granulomatous rosacea and lupus miliaris disseminatus faciei: A 23–year retrospective pilot study

Granulomatous rosacea (GR) and lupus miliaris disseminatus faciei (LMDF) exhibit overlapping clinical features, making their differentiation challenging. While histopathological examination remains the gold standard, it is invasive and time-consuming, highlighting the need for non-invasive diagnostic approaches. This study evaluates artificial intelligence (AI)-based models for differentiating between GR and LMDF and assess their impact on clinician performance. This retrospective pilot study included 96 patients (62 GR, 34 LMDF) with histopathologically confirmed diagnoses. Neural network models, including convolutional neural networks and vision transformers (ViT), were applied to cropped lesion images while a transformer-based multiple instance learning (TransMIL) approach was used for whole-image analysis. Diagnostic accuracy was also compared between clinicians with and without AI assistance. ViT_base_patch16_224 achieved the highest accuracy (93.0%) and reliability (κ = 0.81) on cropped images, while the TransMIL reached 70% accuracy on whole images. AI augmentation significantly improved clinicians’ diagnostic accuracy from 64.7% to 70.3% (p = 0.0136), with the greatest improvement observed among general practitioners. Additionally, mean diagnostic time decreased from 10.7 to 6.4 minutes. These findings highlight the potential of AI models, particularly ViT, in facilitating the differential diagnosis of GR and LMDF. AI-augmented diagnosis improved accuracy and efficiency across all clinician expertise levels, supporting its integration as a complementary tool in dermatological practice.

Forensic Accounting and Fraud Detection: A Systematic Literature Review and Prevention Methods

The aim of this study is to identify the role of forensic- accounting-that plays a vital role in, detecting & preventing fraud as well as to address pertinent investigation concerns. “Accounting principles, theories and procedures are applied in forensic accounting to analyse the problems in a legal way and contain every field of accounting.-.”Forensic> accounting< is a specialised area of accounting which includes auditing and investigative analytical skills.[4] Forensic accounting is required because corporate crises are happening more frequently all over the world. Financial fraud poses the greatest threat to the economy, making forensic accountants and traditional auditors crucial. Therefore, this study looks into fraud detection methods and ways to prevent it. In order to recognise and identify the current literature on forensic accounting and its preventative techniques, this study used the Preferred Reporting Method for Systematic Literature Reviews (SLR). It has been determined from this research that very few studies have analysed forensic accounting employing SLR techniques. This study also completes an integrated analysis with a concentration on three distinct areas: forensic accounting frauddetection, fraud prevention, methods & policy implementation.

The challenge of participatory projects for physical activity promotion: What to scale and how to scale?

Background Scaling up participatory physical activity innovations is complex. Evidence on their nature and how they become embedded in health systems and policies is limited. This paper draws on four participatory research projects promoting physical activity among various populations and settings in Germany to explore their unique participatory innovations and strategies to scale-up. Methods Document analysis and focus group interviews (n = 15) were used for a retrospective case study analysis based on the WHO-ExpandNet framework. 19 scientists of the project teams under study were approached and recruited by the authors during their collaborative work within the Capital4Health consortium. We performed a deductive content analysis to identify the innovation(s) scaled up, the implementers responsible for the process, and the context in which it took place. Results The strategies employed differed depending on the intended scale-up direction: for the transfer to other sites (horizontal scale-up), projects usually scaled a participatory method; when working towards institutionalization at the systems level (vertical scale-up), they tended to scale specific actions for physical activity promotion, particularly those shown to be successful in the pilot phase of the projects. Overall, scale-up followed a strategic plan, but was continuously adjusted to setting-specific challenges and emerging opportunities. Discussion Scaling participatory methods for physical activity promotion may require significant resources. Previously developed pilot actions seem to lend themselves to scale-up more easily, but may compromise the level of participation intended by the original project design. Within participatory research, successful scale-up will require deciding whether an innovation is appropriate for the intended context, whether it can address complex problems like health equity, and whether reducing participatory elements for the sake of improved scalability is acceptable. Conclusion It is essential to develop novel theoretical concepts of scalability that account for the diversities identified within participatory projects observed in our study. The findings can guide future research on strategies to improve the effective implementation and scale-up or participatory physical activity innovations, ensuring that these remain adaptable and sustainable across various settings.