Parent-child skin carotenoid level and vegetable intake relationships in users of children's cafeterias in Japan.

Introduction: Studies on the relationship between parental and child dietary intakes are limited in Asian populations. Here, we examined parent-child relationships in skin carotenoid levels and vegetable intake in a Japanese community. Methods: The study participants were 58 children aged 6-15 years and 39 of their guardians (parents) using children's cafeterias. Skin carotenoid levels were measured using the Veggie Meter®, and the number of vegetable dishes (equivalent to a serving of 70 g) was evaluated using a self-administered questionnaire. Results: The mean (standard deviation; SD) skin carotenoid levels were 366.8 (74.0) in children and 315.0 (101.4) in parents. The partial correlation coefficient between parents' and children's skin carotenoid levels, adjusting for cafeteria, sex, parental dietary supplement use, and household financial status, was 0.38 (P = 0.02); after adjustment for smoking status and BMI, the positive correlation was attenuated (r = 0.25, P = 0.14). A positive correlation was observed between parents' and children's vegetable dish intake (r = 0.30, P = 0.02). Conclusion: This cross-sectional study identified a positive correlation between parent-child intake of vegetable dishes, accounting for potential confounders. However, the positive correlation observed between parent-child skin carotenoid levels may have been attenuated by internal factors such as smoking and obesity.

Dependency of crossover point on absorption changes in bilayer diffusion reflection measurements.

Significance: A better understanding of diffusion reflection (DR) behavior may allow it to be used for more noninvasive applications, including the development of in vivo non-damaging techniques, especially for medical topical diagnosis and treatments. Aim: For a bilayer opaque substance where the attenuation of the upper layer is larger than the attenuation of the lower layer, the DR crossover point ( C p ) is location where the photons coming from the bottom layer start affecting the DR. We aim to study the dependency of the C p on absorption changes in different layers for constant scattering and top layer thickness. Approach: Monolayer and bilayer optical tissue-like phantoms were prepared and measured using a DR system. The results were compared with Monte Carlo simulations. Results: There is an agreement between the experiments and the simulations. C p correlates with the square root of the absorption coefficient ratio of the lower layer to the top layer. Conclusion: The experimental findings support and validate the theoretical prediction describing the dependency of the C p on the square root of the ratio of the layers' absorption coefficients. In addition, a secondary breaking point is suggested to be observed experimentally at the entrance to the noise area.

Interdisciplinary reflection by higher education academics using teaching squares: A scoping review.

OBJECTIVE: To explore the use of teaching squares by interdisciplinary Higher Education (HE) academics when engaging in a cycle of teaching reflection. DESIGN: A scoping review of published and unpublished research between 2012 and 2022. DATA SOURCES: Systematic search of ten (10) electronic databases and hand searching of reference lists identified 13 studies for review. REVIEW METHODS: Studies were included if reflection was undertaken on teaching and involved the disciplines of Nursing, Midwifery, Pharmacy, and Biomedical Sciences. The data were extracted and charted and presented using the Patterns, Advances, Gap, Evidence for practice and Research [PAGER] framework. RESULTS: The main theme identified in the review was that teaching squares led to the development of improved pedagogical skills. This skills improvement was facilitated by the creation of positive academic relationships formed by undertaking interdisciplinary observation, reflection and other serendipitous events. HE academics gained positive benefits from this process, especially those newly transitioning into academia. Some examples of these benefits included increased awareness of one's own teaching practice, deeper understanding of the student experiences and the HE academic feeling less isolated and more reassured about their teaching. Undertaking interdisciplinary reflection led to the development of social capital, resulting in increased confidence. This was evident by the development of new professional relationships from increased networking opportunities external to the faculty in which the HE academic was located. The culture within each context served as either a barrier or facilitator to engaging in reflection. We also noted there were a variety of ways in which reflection was being undertaken, with new insights gained during COVID-19. CONCLUSION: This scoping review explored the current published literature on reflection on teaching undertaken by HE academics within Nursing, Midwifery, Pharmacy and Biomedical Science disciplines. The key outcomes for the interdisciplinary stakeholders were increased levels of confidence, learning of new ways of teaching, and insight into the student experience by undertaking interdisciplinary reflection. From a faculty perspective this is meant there was an increase of social network development and provided higher levels of social capital, especially for those transitioning into academia. The pandemic led to an increased reliance on reflection of virtual reflection, which may become the norm. Further research is required to explore the experiences and perceptions of reflection for this cohort of HE teachers.

Superconductivity of Co-Doped CaKFe4As4 Investigated via Point-Contact Spectroscopy and London Penetration Depth Measurements.

The iron-based superconductors (IBSs) of the recently discovered 1144 class, unlike many other IBSs, display superconductivity in their stoichiometric form and are intrinsically hole doped. The effects of chemical substitutions with electron donors are thus particularly interesting to investigate. Here, we study the effect of Co substitution in the Fe site of CaKFe4As4 single crystals on the critical temperature, on the energy gaps, and on the superfluid density by using transport, point-contact Andreev-reflection spectroscopy (PCARS), and London penetration depth measurements. The pristine compound (Tc≃36 K) shows two isotropic gaps whose amplitudes (Δ1 = 1.4-3.9 meV and Δ2 = 5.2-8.5 meV) are perfectly compatible with those reported in the literature. Upon Co doping (up to ≈7% Co), Tc decreases down to ≃20 K, the spin-vortex-crystal order appears, and the low-temperature superfluid density is gradually suppressed. PCARS and London penetration depth measurements perfectly agree in demonstrating that the nodeless multigap structure is robust upon Co doping, while the gap amplitudes decrease as a function of Tc in a linear way with almost constant values of the gap ratios 2Δi/kBTc.

Servant leadership and employee voice behavior: the role of employee work reflection and employee proactive personality.

Despite the recent proliferation of scholarly investigations on servant leadership, clarity remains elusive regarding the specific mechanisms and conditions underpinning employee cognitive processes and their responses to servant leadership. Drawing upon social cognitive theory, proposes a moderated mediation model tested through a time-lagged field data from 489 employees in Study 1 and an experimental data in Study 2. We found that servant leadership indirectly enhances employee voice behavior through increased employee work reflection. Additionally, we considered employee proactive personality as a boundary condition for the positive effect of servant leadership. Our results show that servant leadership prompts employee work reflection only when the level of employee proactive personality is high, which in turn increases employee voice behavior. This study presents significant theoretical and practical implications through the integration of social cognitive theory with servant leadership research.

Post-simulation debriefing as a stepping stone to self-reflection and increased awareness - a qualitative study.

BACKGROUND: The voice of the students should be engaged in simulation curriculum development. Involving the students in the development of debriefing strategies might result in a deeper understanding of learning. However, few studies have investigated the students' perspectives on debriefing strategies. The aim of the study was to explore nursing students' perspectives on the post-simulation debriefing. METHODS: An explorative, descriptive design with a qualitative approach was used. Data were collected in December 2017 and May 2018 through focus group interviews with undergraduate nursing students in Norway immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing degree. Data were analysed using systematic text condensation. RESULTS: Thirty-two nursing students participated in the study. The data analysis identified two main categories. The category 'Facilitator as a catalyst for reflection' illustrated the facilitator's multifaceted and vital role in initiating and guiding the students' reflection process in the debriefing. The category 'A process towards increased awareness' encompasses the students' guided process of acquiring new insight into their professional development, and how they put parts together to see the wholeness in what was simulated. CONCLUSIONS: This study provides knowledge to facilitators regarding nursing students' perspectives on facilitating reflection and learning during debriefing discussions. The facilitator's multifaceted role in guiding the students' reflections and their process of acquiring new insight into their professional development were identified as critical to learning during debriefing.

Monitoring canopy SPAD based on UAV and multispectral imaging over fruit tree growth stages and species.

Chlorophyll monitoring is an important topic in phenotypic research. For fruit trees, chlorophyll content can reflect the real-time photosynthetic capacity, which is a great reference for nutrient status assessment. Traditional in situ estimation methods are labor- and time-consuming. Remote sensing spectral imagery has been widely applied in agricultural research. This study aims to explore a transferable model to estimate canopy SPAD across growth stages and tree species. Unmanned aerial vehicle (UAV) system was applied for multispectral images acquisition. The results showed that the univariate model yielded with Green Normalized Difference Vegetation Index (GNDVI) gave valuable prediction results, providing a simple and effective method for chlorophyll monitoring for single species. Reflection features (RF) and texture features (TF) were extracted for multivariate modeling. Gaussian Process Regression (GPR) models yielded better performance for mixed species research than other algorithm models, and the R 2 of the RF+TF+GPR model was approximately 0.7 in both single and mixed species. In addition, this method can also be used to predict canopy SPAD over various growth stages, especially in the third and fourth stages with R 2 higher than 0.6. This paper highlights the importance of using RF+TF for canopy feature expression and deep connection exploration between canopy features with GPR algorithm. This research provides a universal model for canopy SPAD inversion which can promote the growth status monitoring and management of fruit trees.

Reflection impulsivity in patients with panic disorder.

BACKGROUND: Individuals with panic disorder (PD) often exhibit a proclivity to conclude that an imminent catastrophe looms, drawing such conclusions from limited physical information. Reflection impulsivity, characterized by decision-making without adequate information, likely affects this bias. This study examines the relationship between reflection impulsivity and self-report impulsive features in individuals with PD. METHODS: Fifty patients with PD and 50 healthy controls (HC) participated to this study. Reflection impulsivity was assessed using the Information Sampling Task (IST), while trait impulsivity was measured using the Barratt Impulsiveness Scale (BIS). Participants also completed the Beck Anxiety Inventory, Panic and Agoraphobia Scale (P&A), and Anxiety Sensitivity Index-3 (ASI-3). RESULTS: Individuals with PD exhibited higher reflection impulsivity compared to HC. Increased reflection impulsivity correlated positively with PD severity as assessed by the P&A and cognitive concerns measured by ASI-3. No significant correlations were found with physical or social concerns. PD patients had higher BIS scores than HC. Higher trait impulsivity was linked to recurrent emergency department visits among PD patients. DISCUSSION: The findings of this study reveal the notion of increased impulsivity among individuals with PD and its relationship with cognitive concerns, as well as recurrent visits to the emergency department stemming from panic attacks.

Developing and Implementing a Diversity, Equity, and Inclusion Curriculum Self-reflection Process at a School of Public Health.

We critically reviewed the motivations, processes, and implementation methods underlying a faculty-driven diversity, equity, and inclusion (DEI) curriculum self-reflection project in the Rutgers School of Public Health. This case study offers guidance on a curriculum self-reflection tool that was developed through the school's Curriculum Committee to promote DEI throughout the school's curricula. We review the key steps in this process and the unique aspects of developing and implementing such evaluations within higher education. The study draws on faculty experience, was informed by students and staff within the Curriculum Committee, and builds on existing knowledge and tools. A flexible 6-step framework-including guiding principles and strategic approaches to planning, developing, and implementing a DEI curriculum self-assessment-is provided to assist instructors, curriculum committees, DEI groups, and academic leaders at schools of public health interested in refining their courses and curricula. Academic units experience contextual challenges, and while each is at a different stage in curriculum reform, our findings provide lessons about integrating the assessment of DEI in school curriculum in a systematic and iterative way. Our approach can be applied to diverse academic settings, including those experiencing similar implementation challenges.

An evidence-informed pedagogical approach to support professional identity formation in medical students: AMEE Guide No. 171.

There is a long and impressive scholarly history evidencing why it is important to address professional identity formation (PIF) in medical curricula. In this AMEE Guide, the authors present an evidence-informed pedagogical approach to assist educators in developing educational practices to foster a healthy PIF in medical students. The authors first describe the theoretical framework that underpin this approach. At the core of this framework is the recognition that, for a healthy PIF, students need to become aware that they have the autonomy, but also responsibility, to form their professional identity in a way that fits both their personality and their (future) professional role. In other words, students need to learn to navigate the interplay between socialization and subjectification. Next, the authors outline the six-step structure of their pedagogical approach, designed to help students: (1) undergo a PIF-related experience, (2) observe their responses to the experience, (3) externalize their reflections, (4) share their reflections, (5) broaden their perspective, and (6) explore their freedom of choice through experimentation. The authors also describe six conducive conditions to facilitate the implementation of the pedagogical approach. These conditions include (1) creating a setting that enables students to slow down, (2) adopting a longitudinal approach, (3) making it part of the formal curriculum, (4) refraining from grading, (5) establishing an interdisciplinary expert team, and (6) providing teacher training. The authors conclude that the theoretical framework leads to a coherent and consistent pedagogical approach that, when implemented according to the conducive conditions, enables students to gradually internalize the reflective process and help them to cultivate a reflective attitude towards their PIF.

Linking Self-Esteem to Problematic Mobile Phone Use: A Moderated Mediation Model of Fear of Missing Out and Ruminative Subtypes.

Low self-esteem has been identified as a risk factor for problematic mobile phone use (PMPU). However, the magnitude of self-esteem's effect on PMPU varied across different studies. Drawing on the Interaction of Person-Affect-Cognition-Execution model and the response styles theory, this study developed a moderated mediation model to investigate the mediating role of fear of missing out (FoMO) and the moderating roles of ruminative subtypes (i.e., brooding and reflection) in the relationship between self-esteem and PMPU. We conducted a cross-sectional survey among 806 undergraduate students (Mage = 19.35 years, SD = 1.18) using the convenience sampling method. Results showed that self-esteem was negatively associated with PMPU. Mediation analysis revealed that the association between self-esteem and PMPU was mediated by FoMO. Furthermore, moderated mediation analyses revealed that the mediating effect of FoMO was moderated by both brooding and reflection, such that the indirect effect became stronger for individuals with higher levels of brooding/reflection. These findings add to previous research by shedding light on how (i.e., mediation) and under what conditions (i.e., moderation) self-esteem is associated with PMPU and have implications for early prevention and intervention of individual PMPU.

An efficient improved parrot optimizer for bladder cancer classification.

Bladder Cancer (BC) is a common disease that comes with a high risk of morbidity, death, and expense. Primary risk factors for BC include exposure to carcinogens in the workplace or the environment, particularly tobacco. There are several difficulties, such as the requirement for a qualified expert in BC classification. The Parrot Optimizer (PO), is an optimization method inspired by key behaviors observed in trained Pyrrhura Molinae parrots, but the PO algorithm becomes stuck in sub-regions, has less accuracy, and a high error rate. So, an Improved variant of the PO (IPO) algorithm was developed using a combination of two strategies: (1) Mirror Reflection Learning (MRL) and (2) Bernoulli Maps (BMs). Both strategies improve optimization performance by avoiding local optimums and striking a compromise between convergence speed and solution diversity. The performance of the proposed IPO is evaluated against eight other competitor algorithms in terms of statistical convergence and other metrics according to Friedman's test and Bonferroni-Dunn test on the IEEE Congress on Evolutionary Computation conducted in 2022 (CEC 2022) test suite functions and nine BC datasets from official repositories. The IPO algorithm ranked number one in best fitness and is more optimal than the other eight MH algorithms for CEC 2022 functions. The proposed IPO algorithm was integrated with the Support Vector Machine (SVM) classifier termed (IPO-SVM) approach for bladder cancer classification purposes. Nine BC datasets were then used to confirm the effectiveness of the proposed IPO algorithm. The experiments show that the IPO-SVM approach outperforms eight recently proposed MH algorithms. Using the nine BC datasets, IPO-SVM achieved an Accuracy (ACC) of 84.11%, Sensitivity (SE) of 98.10%, Precision (PPV) of 95.59%, Specificity (SP) of 95.98%, and F-score (F1) of 94.15%. This demonstrates how the proposed IPO approach can help to classify BCs effectively. The open-source codes are available at https://www.mathworks.com/matlabcentral/fileexchange/169846-an-efficient-improved-parrot-optimizer.

Multitasking Integrated Metasurface for Electromagnetic Wave Modulation with Reflection, Transmission, and Absorption.

Accommodating multiple tasks within a tiny metasurface unit cell without them interfering with each other is a significant challenge. In this paper, an electromagnetic (EM) wave modulation metasurface capable of reflection, transmission, and absorption is proposed. This multitasking capability is achieved through a cleverly designed multi-layer structure comprising an EM Wave Shield Layer (ESL), a Polarization Modulation Layer (PML), and a Bottom Plate Layer (BPL). The functionality can be arbitrarily switched by embedding control materials within the structure. Depending on external excitation conditions, the proposed metasurface can realize reflection-type co-planar polarization to cross-polarization conversion, transmission-type electromagnetically induced transparency-like (EIT-like) modes, and broadband absorption. Notably, all tasks operate approximately within the same operating frequency band, and their performance can be regulated by the intensity of external excitation. Additionally, the operating principle of the metasurface is analyzed through impedance matching, an oscillator coupling model, and surface current distribution. This metasurface design offers a strategy for integrated devices with multiple functionalities.

Separating Surface Reflectance from Volume Reflectance in Medical Hyperspectral Imaging.

Hyperspectral imaging has shown great promise for diagnostic applications, particularly in cancer surgery. However, non-bulk tissue-related spectral variations complicate the data analysis. Common techniques, such as standard normal variate normalization, often lead to a loss of amplitude and scattering information. This study investigates a novel approach to address these spectral variations in hyperspectral images of optical phantoms and excised human breast tissue. Our method separates surface and volume reflectance, hypothesizing that spectral variability arises from significant variations in surface reflectance across pixels. An illumination setup was developed to measure samples with a hyperspectral camera from different axial positions but with identical zenith angles. This configuration, combined with a novel data analysis approach, allows for the estimation and separation of surface reflectance for each direction and volume reflectance across all directions. Validated with optical phantoms, our method achieved an 83% reduction in spectral variability. Its functionality was further demonstrated in excised human breast tissue. Our method effectively addresses variations caused by surface reflectance or glare while conserving surface reflectance information, which may enhance sample analysis and evaluation. It benefits samples with unknown refractive index spectra and can be easily adapted and applied across a wide range of fields where hyperspectral imaging is used.

How Does the Powder Mixture of Ibuprofen and Caffeine Attenuate the Solubility of Ibuprofen? Comparative Study for the Xanthine Derivatives to Recognize Their Intermolecular Interactions Using Fourier-Transform Infrared (FTIR) Spectra, Differential Scanning Calorimetry (DSC), and X-ray Powder Diffractometry (XRPD).

Molecular interactions between active pharmaceutical ingredients (APIs) and xanthine (XAT) derivatives were analyzed using singular value decomposition (SVD). XAT derivatives were mixed with equimolar amounts of ibuprofen (IBP) and diclofenac (DCF), and their dissolution behaviors were measured using high-performance liquid chromatography. The solubility of IBP decreased in mixtures with caffeine (CFN) and theophylline (TPH), whereas that of DCF increased in mixtures with CFN and TPH. No significant differences were observed between the mixtures of theobromine (TBR) or XAT with IBP and DCF. Mixtures with various molar ratios were analyzed using differential scanning calorimetry, X-ray powder diffraction, and Fourier-transform infrared spectroscopy to further explore these interactions. The results were subjected to SVD. This analysis provides valuable insights into the differences in interaction strength and predicted interaction sites between XAT derivatives and APIs based on the combinations that form mixtures. The results also showed the impact of the XAT derivatives on the dissolution behavior of IBP and DCF. Although IBP and DCF were found to form intermolecular interactions with CFN and TPH, these effects resulted in a reduction of the solubility of IBP and an increase in the solubility of DCF. The current approach has the potential to predict various interactions that may occur in different combinations, thereby contributing to a better understanding of the impact of health supplements on pharmaceuticals.

The role of pulse wave analysis indexes for critically ill patients: a narrative review.

Objective.Arterial pulse wave analysis (PWA) is now established as a powerful tool to investigate the cardiovascular system, and several clinical studies have shown how PWA can provide valuable prognostic information over and beyond traditional cardiovascular risk factors. Typically these techniques are applied to chronic conditions, such as hypertension or aging, to monitor the slow structural changes of the vascular system which lead to important alterations of the arterial PW. However, their application to acute critical illness is not currently widespread, probably because of the high hemodynamic instability and acute dynamic alterations affecting the cardiovascular system of these patients.Approach.In this work we propose a review of the physiological and methodological basis of PWA, describing how it can be used to provide insights into arterial structure and function, cardiovascular biomechanical properties, and to derive information on wave propagation and reflection.Main results.The applicability of these techniques to acute critical illness, especially septic shock, is extensively discussed, highlighting the feasibility of their use in acute critical patients and their role in optimizing therapy administration and hemodynamic monitoring.Significance.The potential for the clinical use of these techniques lies in the ease of computation and availability of arterial blood pressure signals, as invasive arterial lines are commonly used in these patients. We hope that the concepts illustrated in the present review will soon be translated into clinical practice.

Reflections on co-creating a model for the value assessment of artificial intelligence technologies.

AIMS: A multidisciplinary group of experts and patients developed the Model for ASsessing the value of Artificial Intelligence (MAS-AI) to ensure an evidence-based and patient-centered approach to introducing artificial intelligence technologies in healthcare. In this article, we share our experiences with meaningfully involving a patient in co-creating a research project concerning complex and technically advanced topics. METHODS: The co-creation was evaluated by means of initial reflections from the research team before the project started, in a continuous logbook, and through semi-structured interviews with patients and two researchers before and after the active co-creation phase of the project. RESULTS: There were initial doubts about the feasibility of including patients in this type of project. Co-creation ensured relevance to patients, a holistic research approach and the debate of ethical considerations. Due to one patient dropping out, it is important to foresee and support the experienced challenges of time and energy spent by the patient in future projects. Having a multidisciplinary team helped the collaboration. A mutual reflective evaluation provided insights into the process which we would otherwise have missed. CONCLUSIONS: We found it possible to create complex and data-intense research projects with patients. Including patients benefitted the project and gave researchers new perspectives on their own research. Mutual reflection throughout the project is key to maximise learning for all parties involved.

Natural variation in photosynthetic electron transport of wheat flag leaves in response to dark-induced senescence.

Early leaf senescence affects photosynthetic efficiency and limits growth during the late production stage of winter wheat (Triticum aestivum). Natural variation in photosystem response to senescence represents a valuable resource for improving the aging traits of flag leaves. To explore the natural variation of different phases of photosynthetic electron transport in modern wheat cultivars during senescence, we exposed the flag leaves of 32 wheat cultivars to dark conditions to induce senescence process, and simultaneously measured prompt fluorescence and modulated 820 nm reflection. The results showed that the chlorophyll content, activity of PSII donor side, PSI and electron transfer between PSII and PSI were all decreased during dark-induced senescence, but they showed different sensitivity to dark-induced senescence. Furthermore, natural variation in photosynthetic parameters among the 32 wheat cultivars were also observed and showed by variation coefficient of the different parameters. We observed that PSII and PSI activity showed less sensitivity to dark-induced senescence than electron transfer between them, while PSII and PSI activity exhibit greater natural variation than electron transport between PSII and PSI. It suggests that Cytb6f might degrade faster and have less variation than PSII and PSI during dark-induced senescence.

Gambling habits and Probability Judgements in a Bayesian Task Environment.

Little is known about how gamblers form probability assessments. This paper reports on a preregistered study that administered an incentivized Bayesian choice task to n = 465 self-reported gamblers and non-gamblers. The task elicits subjective probability assessments and allows one to estimate the degree to which distinct information sources are weighted in forming probability assessments. Our data failed to support our main hypotheses that experienced online gamblers would be more accurate than non-gamblers in estimating probabilities, that gamblers experienced in games of skill (e.g., poker) would be more accurate than gamblers experienced only in non-skill games (e.g., slots), that accuracy would differ by sex, or that information sources would be weighted differently across different participant groups. Exploratory analysis, however, revealed that gambling frequency predicted lower Bayesian accuracy, while cognitive reflection predicted higher accuracy. The decline in accuracy linked to self-reported gambling frequency was stronger for female participants. Decision modeling estimated a decreased weight place on new evidence (over base rate odds) for those participant groups who showed decreased accuracy, which suggests that a proper incorporation of new information is important for probability assessments. Our results link online gambling frequency to worse performance in the critical probability assessment skills that should benefit gambling success (i.e., in skill-based games). Additional research is needed to better understand the mechanism linking reported gambling frequency to probability assessment accuracy.

Facilitating co-research: lessons learned from reflection forms within three participatory action research projects.

BACKGROUND: Mutual learning and shared decision-making are key elements of Participatory Action Research (PAR), highlighting the important role of the facilitator to support this. This study aims to illustrate how a facilitator can contribute to successful PAR sessions based on the reflection of three PAR projects. METHODS: Participatory sessions took place with adolescents for 3-4 school years. After each session (n = 252 sessions across three projects), facilitators filled in a reflection form that assessed the group process and their facilitating role. Facilitators independently coded a selection of 135 reflection forms partly deductive and partly inductive based on core PAR principles derived from a pragmatic literature search. RESULTS: A well-prepared session - for example, including active and creative participatory methods and a clearly stated goal - contributed to efficiency and the necessary flexibility. Making agreements, making sure everyone is heard and taking 'fun-time' appeared important for creating and maintaining a safe, functional and positive atmosphere. Finally, facilitators needed to encourage co-researchers to take the lead and adapt to the group dynamics, to ensure ownership and shared decision-making. CONCLUSION: In-depth qualitative analyses of a standardized reflection form used in three different PAR projects resulted in various lessons to support facilitators in collaborating with co-researchers in PAR projects.