Analysis Ofthe Data Research Articles

Exploring the impact of supply chain integration and agility on commodity supply chain performance

The aim of this research was to explore the influence of supply chain integration (SCI) on commodity supply chain performance (SCP) with the mediating role of supply chain agility (SCA). The research methodology employed a correlational approach using structural equation modeling. 131 employees from active companies in the agricultural commodity supply chain (SC) sector in Iran participated in the study. Analysis of the data was carried out utilizing Partial Least Squares Structural Equation Modeling (PLS-SEM) employing SMARTPLS software. The results indicate that customer integration (CI), supplier integration (SI), and internal integration have a positive and significant impact on SCA and commodity SCP. Additionally, the influence of SCA on commodity SCP is positive and significant. SCA plays a positive and significant mediating role in the impact of CI, SI, and internal integration on commodity SCP. Therefore, it can be concluded that companies that possess CI, SI, and internal integration in their commodity SC process demonstrate more satisfactory performance in the commodity SC.

A Quantitative Analysis of the Determinant Factors of Job Satisfaction among Albanian Elementary School Teachers

The quantitative assessment of job satisfaction among Albanian Elementary School Teachers, identification of determinant factors and ranking them are objectives of this study. Descriptive analysis and Exploratory Factorial analysis of the data obtained from interviews of 205 teachers showed that referring to Job satisfaction Albanian Elementary School Teachers are classified at "Good" level. The intrinsic motivation factors have a greater effect than the extrinsic/hygiene factors on teachers' job satisfaction. To increase the teachers`job satisfaction are necessaries the changes in reward policies, reduce the number of pupils in the class, more effectively organize the teachers` workload in classroom and outside school.

Children and Practitioners as Truth Seekers and Truth Tellers: Innovative, Counter-Hegemonic Approaches to Evaluating National Inclusion Policies

This paper describes and defends the counter-hegemonic methods applied to the investigation of a high-profile national policy for Early Education and Care (ECCE) in Ireland. The policy, the Access and Inclusion Model (AIM) seeks to ensure the full inclusion and meaningful participation of children with disabilities in mainstream, state funded ECCE. It makes a significant contribution to data and debate on how research about inclusion can become inclusion in the context of policy evaluation. The design of the policy evaluation included surveys, in depth interviews and qualitative case studies of pre-schools and children supported by AIM which were deliberately designed to be counter-hegemonic through the recruitment of practitioners as co-researchers (as expert representatives within a feminised workforce), and the use of a participative method of elicitation that sough the perspectives and lived experiences of inclusion among fourteen children supported by AIM. This method was multi-modal mapping. With a focus on these counter-hegemonic elements, the paper poses questions about how the approach was counterhegemonic in terms of its theoretical underpinning, practical approach, and outcomes. Thematic analysis of the data collected by practitioner researchers for the child case studies showed that the approach did achieve counter-hegemony through the achievement of redistribution, representation, and recognition in both the enactment of the research, and in the reporting of children’s lived experience in the study as a whole. However, the extent of counter-hegemony achieved was limited when practitioner researchers were unable to deploy the multi-modal mapping method because of limited time, or because the child was not a speaker of English or was as yet, non-speaking. In a context where policy makers have a preference for positivist and rationalist approaches to evaluating the impact of policies, we assert that research about policies for inclusion, should be enacted as inclusion and social justice through the deliberate deployment of participatory and counter-hegemonic methods. We also assert that multi-modal mapping holds particular promise for researching the lived experience of inclusion and participation from the perspective of children and argue that more work needs to be done on developing these methods so that they are effective with all children, including those who are non-speaking. Finally, we posit that Fraser’s triune model of social justice can be applied as a benchmark for designing and evaluating counter-hegemonic modii and outcomes.

Coated Microneedle System for Delivery of Clotrimazole in Deep-Skin Mycoses

Mycoses of the skin are infectious diseases caused by fungal microorganisms that are generally treated with topical agents. However, such therapy is often ineffective and has to be supported by oral use of active substances, which, in turn, can cause many side effects. A good alternative for the treatment of deep-skin mycoses seems to be microneedles (MNs). The aim of this research was to fabricate and evaluate the properties of innovative MNs coated with a hydrogel as potential carriers for clotrimazole (CLO) in the treatment of deep fungal skin infections. A 3D printing technique using a photo-curable resin was employed to produce MNs, which were coated with hydrogels using a dip-coating method. Hydrogels were prepared with carbopol EZ-3 Polymer (Lubrizol) in addition to glycerol and triisopropanolamine. Clotrimazole was introduced into the gel as the solution in ethanol or was suspended. In the first step of the investigation, a texture analysis of hydrogels was prepared with a texture analyzer, and the drug release studies were conducted with the use of automatic Franz diffusion cells. Next, the release profiles of CLO for coated MNs were checked. The last part of the investigation was the evaluation of the antifungal activity of the prepared systems, and the inhibition of the growth of Candida albicans was checked with the diffusion and suspended-plate methods. The texture profile analysis (TPA) for the tested hydrogels showed that the addition of ethanol significantly affects the following studied parameters: hardness, adhesiveness and gumminess, causing a decrease in their values. On the other hand, for the gels with suspended CLO, better spreadability was seen compared to gels with dissolved CLO. The presence of the active substance did not significantly affect the values of the tested parameters. In the dissolution study, the results showed that higher amounts of CLO were released for MNs coated with a hydrogel containing dissolved CLO. Also, microbiological tests proved its efficacy against fungal cultures. Qualitative tests carried out using the diffusion method showed that circular zones of inhibition of fungal growth on the plate were obtained, confirming the hypothesis of effectiveness. The suspension-plate technique confirmed the inhibitory effect of applied CLO on the growth of Candida albicans. From the analysis of the data, the MNs coated with CLO dissolved in hydrogel showed better antifungal activity. All received results seem to be helpful in developing further studies for MNs as carriers of antifungal substances.

Prognostic Significance of Baseline Neutrophil to Lymphocyte Ratio and Lymphocyte to C-reactive Protein Ratio in COVID-19 Patients

Objective: Neutrophil-to-lymphocyte and lymphocyte-to-C-reactive protein ratios are important prognostic indicators for disease severity measurement among coronavirus patients. To predict the disease severity, CURB-65 scores, and outcome after 14 days of admission using two proxy biomarkers (neutrophil lymphocyte and lymphocyte C-reactive protein ratios) in COVID-19 patients.
 Methodology: A prospective study was done at the Department of Medicine, Pakistan Ordinance Factory (POF) hospital, Wah Cantt, Pakistan, from April to August 2022. A total of 123 coronavirus patients were included. Patients with clinical manifestations, decreased lymphocyte and leukocyte counts, imaging characteristics of pneumonia, etiological evidence of a positive real time PCR test of blood or respiratory samples, and viral gene sequencing similar to known COVID-19 were measured. Patients underwent laboratory measurements and imaging analysis for biomarker indications. The analysis of the data was conducted using SPSS version 23.
 Results: The patients mean age was 53.83±16.2 years. Among 123 COVID-19 patients, 80 (65%) were males and 43 (35%) were females. It was found to have high NLR and low LCR in severe disease (p = 0.05, p = 0.01). NLR and LCR showed 11% variance for disease severity (β = 0.143, p = 0.00, and β = -0.293, p = 0.01). NLR and LCR showed 29% variance for CURB 65 scores (β = 0.48, p = 0.634, and β = -0.159, p = 0.08). NLR and LCR showed 22% variance for outcome after 14 days of admission (β=-0.53, p=0.562, & β=-0.132, p=0.149).
 Conclusion: Neutrophil to lymphocyte and lymphocyte to C-reactive protein ratios are effective prognostic biomarkers for measuring the severity of disease in COVID-19 patients. High neutrophil-to-lymphocyte and low lymphocyte-to-C-reactive protein ratios significantly predict disease severity.

Cyanide Trapping of Iminium Ion Reactive Metabolites: Implications for Clinical Hepatotoxicity.

Reactive metabolite formation is a major mechanism of hepatotoxicity. Although reactive electrophiles can be soft or hard in nature, screening strategies have generally focused on the use of glutathione trapping assays to screen for soft electrophiles, with many data sets available to support their use. The use of a similar assay for hard electrophiles using cyanide as the trapping agent is far less common, and there is a lack of studies with sufficient supporting data. Using a set of 260 compounds with a defined hepatotoxicity status by the FDA, a comprehensive literature search yielded cyanide trapping data on an unbalanced set of 20 compounds that were all clinically hepatotoxic. Thus, a further set of 19 compounds was selected to generate cyanide trapping data, resulting in a more balanced data set of 39 compounds. Analysis of the data demonstrated that the cyanide trapping assay had high specificity (92%) and a positive predictive value (83%) such that hepatotoxic compounds would be confidently flagged. Structural analysis of the adducts formed revealed artifactual methylated cyanide adducts to also occur, highlighting the importance of full structural identification to confirm the nature of the adduct formed. The assay was demonstrated to add the most value for compounds containing typical structural alerts for hard electrophile formation: half of the severe hepatotoxins with these structural alerts formed cyanide adducts, while none of the severe hepatotoxins with no relevant structural alerts formed adducts. The assay conditions used included cytosolic enzymes (e.g., aldehyde oxidase) and an optimized cyanide concentration to minimize the inhibition of cytochrome P450 enzymes by cyanide. Based on the demonstrated added value of this assay, it is to be initiated for use at GSK as part of the integrated hepatotoxicity strategy, with its performance being reviewed periodically as more data is generated.

International Migration Framing in the Global Times (2012–2022): Constructing Identity Narrative About the Self and the Other

This article addresses a research gap in the studies of international migration discourse in China's mass media. The focus on the Global Times, a Chinese Communist Party-owned commercialised newspaper famous for its nationalist discourse, elucidates how news about this global issue is used to construct China's identity narrative. The empirical part includes the analysis of the data spanning a decade (2012–2022) collected from the Global Times. It is studied with the help of computational text analysis tools, including topic modelling that is used to identify frames in the coverage of international migration. The analysis reveals that the Global Times devotes disproportionate attention to migration-related political, security, and socio-economic problems in the West, reproducing elements of the mainstream discourse in the Western media. Such overrepresentation, coupled with the selective coverage of China's own experience with international migration is used to emphasise the weaknesses of the Other in contrast to the stable Self.

Entrepreneurship ethics and its contribution to sustainable development goals

Purpose Research done to date has produced a wide range of perspectives that center on the junction between the specific function and responsibility of the entrepreneur when applying ethical dimensions to the field of entrepreneurship. By combining a bibliometric analysis with the literature review, the purpose of this paper is to provide an overview of entrepreneurship ethics and its contribution to sustainable development goals, along with future research directions on the topic of entrepreneurship and ethics. Design/methodology/approach The research looked for literature based on entrepreneurship ethics from the Dimension database. The authors accumulated 2,279 articles for the period of 2002–2022 for analysis. The authors used bibliometric analysis for analyzing the topic with the use of VosViewer and Excel. Findings By combining a bibliometric analysis with a literature review, this study aimed to provide an overview of the ethics and entrepreneurship and contribution to sustainable development goals. The most influential author and journal are Vanessa Ratten and the Journal of Business Ethics, respectively. The top sustainable development goals (SDGs) being contributed by entrepreneurship ethics are SDG4, SDG8, SDG16, SDG11 and SDG3. By contrasting these two interpretations, the authors have demonstrated that the entrepreneurship environment involves various ethical issues connected to personal, organizational and societal sectors. Research limitations/implications The current study may serve as a general guideline for future investigation into this topic. Practical implications Regarding the practical ramifications, the findings can help entrepreneurs who are preparing to launch a business or are already doing so. The findings provide a comprehensive framework of success variables that must be considered to improve the venture’s performance. Originality/value This study’s originality is from presenting a structured and in-depth literature review that describes the current state of entrepreneurship ethics and its contribution to sustainable development goals. A complete analysis of the data gathered on entrepreneurship ethics is offered to establish that it is sustainable.

A new dressing system for accelerating wound recovery after primary total knee arthroplasty: a feasibility study.

Currently, postoperative wound infection and poor healing of total knee arthroplasty have been perplexing both doctors and patients. We hereby innovatively invented a new dressing system to reduce the incidence of postoperative wound complications. We enrolled 100 patients who received primary unilateral total knee arthroplasty and then applied the new dressing system. The data collected included the number of dressing changes, postoperative hospital stay, Visual Analogue Scale score (VAS), the Knee Society Score (KSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), ASEPSIS scores, The Stony Brook Scar Evaluation Scale (SBSES), wound complications, dressing cost, the frequency of shower and satisfaction. Subsequently, a statistical analysis of the data was performed. Our findings demonstrated the average number of postoperative dressing changes was 1.09 ± 0.38, and the average postoperative hospital stay was 3.72 ± 0.98 days. The average cost throughout a treatment cycle was 68.97 ± 12.54 US dollars. Collectively, the results of VAS, KSS, and KOOS revealed that the pain and function of patients were continuously improved. The results of the four indexes of the ASEPSIS score were 0, whereas the SBSES score was 3.58 ± 0.52 and 4.69 ± 0.46 at two weeks and one month after the operation, respectively. We observed no wound complications until one month after the operation. Remarkably, the satisfaction rate of the patients was 91.85 ± 4.99% one month after the operation. In this study, we invented a new dressing system for surgical wounds after total knee arthroplasty and further confirmed its clinical feasibility and safety. ChiCTR2000033814, Registered 13/ June/2020.

Well-being of the students – What matters?

Anxiety disorders are highly prevalent globally and it is much more prevalent among adolescents because of their exposure to a variety of stressors. Research shows that emotional and biopsychosocial well-being changes over the course of their schooling, with a general increase in anxiety, highlighting the need to further investigate the risk factors that contribute to worry and anxiety symptoms among college student populations. In Mauritius, there has been a rise in the number of adolescents who are recipients of psychiatric treatments at the local government hospitals as well as an increase in the number of cases reported to the school authorities. The present study aimed to identify the causal factors of anxiety among adolescents, and its effects in the educational context. Further, the role of educational social workers in overcoming anxiety was explored and the aim was achieved using the exploratory approach. A focus group discussion using a semi-structured questionnaire was conducted with ten (10) people including educational social workers and educational psychologists recruited through convenience sampling. A thematic analysis of the data shows academic anxiety as an emerging factor, followed by bullying and lastly, family issues. The findings revealed impacts at the school level such as students’ inability to concentrate in class, non-participative and also showing emotional distress. While educational social workers provide counselling to students and parents, a need for teacher empowerment and peer counselling are proposed as future avenues.

The effects of visual art therapy on adults with depressive symptoms: A systematic review and meta-analysis.

Depression constitutes a pervasive global mental health concern and stands as a principal determinant of elevated suicide rates worldwide. Recent empirical investigations have showcased the significant potential of visual art therapy (VAT) in ameliorating symptoms among individuals with depression. Nevertheless, specific studies have yielded findings marked by inconclusiveness, underscoring the imperative need for further research to comprehensively establish its efficacy. This study is a systematic review and meta-analysis of extant research, to ascertain the efficacy and effect size of VAT as an intervention for adults with depressive symptoms. A comprehensive search was conducted across 10 databases. The search encompassed articles published from the inception of these databases up until October 18, 2023. Two researchers screened the literature in accordance with inclusion and exclusion criteria and performed a thorough quality assessment. The original data and the data obtained from the literature were extracted for further analysis. The statistical analysis of the data was performed using Stata 17.0 software. fifteen studies were included, encompassing a total of 932 participants. The outcomes of meta-analysis unveiled a statistically significant effect of VAT in diminishing depressive symptoms among adults (SMD = -0.73; 95% CI, -1.07 to -0.39; p < 0.001; 15 randomised controlled trials (RCTs); low-quality evidence). The subgroup analysis indicated that VAT exhibited heightened effectiveness among adults below 65 years of age, with interventions lasting ≤12 weeks demonstrating superior efficacy. Additionally, sensitivity analysis underscored the robustness and reliability of the findings. VAT appears to alleviate depressive symptoms among adults. Existing research indicates that the effectiveness of VAT is influenced by factors, such as intervention population characteristics and intervention duration. However, to comprehensively probe the efficacy of VAT, future studies should strive for larger sample sizes, multicentre collaborations, and long-term follow-ups.

Supersingular curves of genus four in characteristic two

We describe the intersection of the Torelli locus j ( M 4 c t ) = J 4 j(\mathcal {M}_4^{ct}) = \mathcal {J}_4 with Newton and Ekedahl-Oort strata related to the supersingular locus in characteristic 2. We show that the locus of supersingular Jacobians S 4 ∩ J 4 \mathcal {S}_4\cap \mathcal {J}_4 in characteristic 2 is pure of dimension three. One way to obtain that result uses an analysis of the data of smooth genus four curves and principally polarized abelian fourfolds defined over F 2 \mathbb {F}_2 , and another involves a more careful study of some relevant Ekedahl-Oort loci.

[Bedside-teaching on dementia and delirium: Development, implementation, and evaluation in an acute care hospital].

Bedside-teaching on dementia and delirium: Development, implementation, and evaluation in an acute care hospital Abstract: Background: Demographic change and the accompanying increase in people with dementia and delirium in acute care hospitals pose growing challenges for nurses in acute care wards. Objective: Pilot implementation and evaluation of knowledge gain and implementation of previously defined critical behaviors. Method: Implementation of the training by APNs. Parallel evaluation of the training along the New World Kirkpatrick model using questionnaires and non-participant observation. Analysis of the data using descriptive statistics. Results: The training itself was well evaluated by the participants. It showed an increase in knowledge of the participants in the main topic categories. The targeted critical behaviors were implemented for the most part. There are deficiencies in the mapping of interventions in the nursing care process. Conclusion: The training concept is suitable to give nurses confidence in dealing with people with dementia and delirium. Continuous support in practice is needed to maintain the interventions in the long term and sustainably in everyday life.

'Acceleration' of the food delivery marketplace: Perspectives of local authority professionals in the North-East of England on temporary COVID regulations.

In January 2021, we assessed the implications of temporary regulations in the United Kingdom allowing pubs and restaurants to operate on a takeaway basis without instigating a change of use. Local authorities (LAs) across the North-East of England were unaware of any data regarding the take-up of these regulations, partially due to ongoing capacity issues; participants also raised health concerns around takeaway use increasing significantly. One year on, we repeated the study aiming to understand the impact of these regulations on the policy and practice of key professional groups. Specifically, we wanted to understand if LAs were still struggling with staff capacity to address the regulations, whether professionals still had public health trepidations, and if any unexpected changes had occurred across the local food environment because of the pandemic. We conversed with 16 public health professionals, planners and environmental health officers across seven LAs throughout the North-East of England via focus groups and interviews. Data collated were analysed via an inductive and semantic, reflexive-thematic approach. Through analysis of the data, three themes were generated and are discussed throughout: popular online delivery services as a mediator to increased takeaway usage; potential long-term health implications and challenges; continued uncertainty regarding the temporary regulations. This paper highlights important changes to local food environments, which public health professionals should be aware of, so they are better equipped to tackle health inequalities across urban and sub-urban areas.

Association of Combined Per- and Polyfluoroalkyl Substances and Metals with Chronic Kidney Disease

Background: Exposure to environmental pollutants such as metals and Per- and Polyfluoroalkyl Substances (PFAS) has become common and increasingly associated with a decrease in the estimated Glomerular Filtration Rate (eGFR), which is a marker often used to measure chronic kidney disease (CKD). However, there are limited studies involving the use of both eGFR and the urine albumin creatinine ratio (uACR), which are more comprehensive markers to determine the presence of CKD and the complexity of pollutant exposures and response interactions, especially for combined metals and PFAS, which has not been comprehensively elucidated. Objective: This study aims to assess the individual and combined effects of perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), Cadmium (Cd), Mercury (Hg), and Lead (Pb) exposure on CKD using data from the National Health and Nutritional Examination Survey (NHANES) 2017–2018. Methods: We employed the use of bivariate logistic regression and Bayesian Kernel Machine Regression (BKMR) in our analysis of the data. Results: Logistic regression results revealed a positive association between PFOA and CKD. Our BKMR analysis revealed a non-linear and bi-phasic relationship between the metal exposures and CKD. In our univariate exposure–response function plot, Cd and Hg exhibited a U and N-shaped interaction, which indicated a non-linear and non-additive relationship with both low and high exposures associated with CKD. In addition, the bivariate exposure–response function between two exposures in a mixture revealed that Cd had a U-shaped relationship with CKD at different quantiles of Pb, Hg, PFOA, and PFOS, indicating that both low and high levels of Cd is associated with CKD, implying a non-linear and complex biological interaction. Hg’s interaction plot demonstrated a N-shaped association across all quantiles of Cd, with the 75th quantile of Pb and the 50th and 75th quantiles of PFOA and PFOS. Furthermore, the PIP results underscored Cd’s consistent association with CKD (PIP = 1.000) followed by Hg’s (PIP = 0.9984), then PFOA and PFOS with a closely related PIP of 0.7880 and 0.7604, respectively, and finally Pb (PIP = 0.6940), contributing the least among the five environmental pollutants on CKD, though significant. Conclusions: Our findings revealed that exposure to environmental pollutants, particularly Hg and Cd, are associated with CKD. These findings highlight the need for public health interventions and strategies to mitigate the cumulative effect of PFAS and metal exposure and elucidate the significance of utilizing advanced statistical methods and tools to understand the impact of environmental pollutants on human health. Further research is needed to understand the mechanistic pathways of PFAS and metal-induced kidney injury and CKD, and longitudinal studies are required to ascertain the long-term impact of these environmental exposures.

Effect of cognitive behavioral therapy on pain, knee function, and psychological status in patients after primary total knee arthroplasty: a systematic review and meta-analysis

ObjectiveThe clinical efficacy of cognitive behavioral therapy (CBT) after Total knee arthroplasty (TKA) is still controversial, and the purpose of this meta-analysis was to evaluate the effect of CBT on pain, knee function, and psychological status of patients after TKA.MethodsWe systematically searched electronic databases such as CNKI, CBM, VIP, PubMed, Cochrane Library, and EMBASE for randomized controlled studies up to February 30, 2023. Screening against inclusion criteria to select valid studies and extract data. The quality of included studies was evaluated by the Cochrane Collaboration risk-of-bias 2 (RoB 2) tool for randomized trials. Statistical analysis of the data from this study was carried out using Stata 15.1 software.ResultsFinally, our meta-analysis incorporated seven randomized controlled studies of high quality, including 608 patients. The findings of the meta-analysis demonstrated a noteworthy decrease in kinesiophobia levels during the early postoperative phase in the CBT group as compared to the usual care group (WMD = -6.35, 95% CI: -7.98 to -4.72, Z = 7.64, P < 0.001). However, no statistically significant difference between the CBT and usual care groups in terms of postoperative pain as well as knee function.ConclusionCBT may effectively reduce the level of kinesiophobia in the short term after TKA, but did not significantly relieve knee pain or improve knee function.

What Are and What Are Not Extrema Points? Examining Definitions and Examples

AbstractThis paper reports on five secondary school mathematics prospective teachers’ conceptions of extreme point. The analysis of the data addressed students’ definitions, examples, and evaluation of given examples, with special attention to the related domain. Written assignments and individual interviews uncover salient, erroneous concept images regarding what is and what is not an extreme point. Participants viewed extrema points as points that necessarily satisfy f′ = 0 or as points that are always at a “change in monoticity” of the function. The topic “extreme points” is both an aim and a mean to address broader issues related to mathematical definitions, examples, and nonexamples. We conclude with possible next-step ideas.

Hysterosalpingo-foam sonography versus hysterosalpingography during fertility work-up: an economic evaluation alongside a randomized controlled trial.

What are the costs and effects of tubal patency testing by hysterosalpingo-foam sonography (HyFoSy) compared to hysterosalpingography (HSG) in infertile women during the fertility work-up? During the fertility work-up, clinical management based on the test results of HyFoSy leads to slightly lower, though not statistically significant, live birth rates, at lower costs, compared to management based on HSG results. Traditionally, tubal patency testing during the fertility work-up is performed by HSG. The FOAM trial, formally a non-inferiority study, showed that management decisions based on the results of HyFoSy resulted in a comparable live birth rate at 12 months compared to HSG (46% versus 47%; difference -1.2%, 95% CI: -3.4% to 1.5%; P = 0.27). Compared to HSG, HyFoSy is associated with significantly less pain, it lacks ionizing radiation and exposure to iodinated contrast medium. Moreover, HyFoSy can be performed by a gynaecologist during a one-stop fertility work-up. To our knowledge, the costs of both strategies have never been compared. We performed an economic evaluation alongside the FOAM trial, a randomized multicenter study conducted in the Netherlands. Participating infertile women underwent, both HyFoSy and HSG, in a randomized order. The results of both tests were compared and women with discordant test results were randomly allocated to management based on the results of one of the tests. The follow-up period was twelve months. We studied 1160 infertile women (18-41 years) scheduled for tubal patency testing. The primary outcome was ongoing pregnancy leading to live birth. The economic evaluation compared costs and effects of management based on either test within 12 months. We calculated incremental cost-effectiveness ratios (ICERs): the difference in total costs and chance of live birth. Data were analyzed using the intention to treat principle. Between May 2015 and January 2019, 1026 of the 1160 women underwent both tubal tests and had data available: 747 women with concordant results (48% live births), 136 with inconclusive results (40% live births), and 143 with discordant results (41% had a live birth after management based on HyFoSy results versus 49% with live birth after management based on HSG results). When comparing the two strategies-management based on HyfoSy results versus HSG results-the estimated chance of live birth was 46% after HyFoSy versus 47% after HSG (difference -1.2%; 95% CI: -3.4% to 1.5%). For the procedures itself, HyFoSy cost €136 and HSG €280. When costs of additional fertility treatments were incorporated, the mean total costs per couple were €3307 for the HyFoSy strategy and €3427 for the HSG strategy (mean difference €-119; 95% CI: €-125 to €-114). So, while HyFoSy led to lower costs per couple, live birth rates were also slightly lower. The ICER was €10 042, meaning that by using HyFoSy instead of HSG we would save €10 042 per each additional live birth lost. When interpreting the results of this study, it needs to be considered that there was a considerable uncertainty around the ICER, and that the direct fertility enhancing effect of both tubal patency tests was not incorporated as women underwent both tubal patency tests in this study. Compared to clinical management based on HSG results, management guided by HyFoSy leads to slightly lower live birth rates (though not statistically significant) at lower costs, less pain, without ionizing radiation and iodinated contrast exposure. Further research on the comparison of the direct fertility-enhancing effect of both tubal patency tests is needed. FOAM trial was an investigator-initiated study, funded by ZonMw, a Dutch organization for Health Research and Development (project number 837001504). IQ Medical Ventures provided the ExEm®-FOAM kits free of charge. The funders had no role in study design, collection, analysis, and interpretation of the data. K.D. reports travel-and speakers fees from Guerbet and her department received research grants from Guerbet outside the submitted work. H.R.V. received consulting-and travel fee from Ferring. A.M.v.P. reports received consulting fee from DEKRA and fee for an expert meeting from Ferring, both outside the submitted work. C.H.d.K. received travel fee from Merck. F.J.M.B. received a grant from Merck and speakers fee from Besins Healthcare. F.J.M.B. is a member of the advisory board of Merck and Ferring. J.v.D. reported speakers fee from Ferring. J.S. reports a research agreement with Takeda and consultancy for Sanofi on MR of motility outside the submitted work. M.v.W. received a travel grant from Oxford Press in the role of deputy editor for Human Reproduction and participates in a DSMB as independent methodologist in obstetrics studies in which she has no other role. B.W.M. received an investigator grant from NHMRC GNT1176437. B.W.M. reports consultancy for ObsEva, Merck, Guerbet, iGenomix, and Merck KGaA and travel support from Merck KGaA. V.M. received research grants from Guerbet, Merck, and Ferring and travel and speakers fees from Guerbet. The other authors do not report conflicts of interest. International Clinical Trials Registry Platform No. NTR4746.

COVID-19 Vaccine decision-making: trust among the transgender and disability communities in India

ABSTRACT Background Historical marginalisation and ongoing trust deficits in health and government systems shape present-day vaccine perceptions among marginalised communities. This paper sought to understand the role of trust in decision-making about COVID-19 vaccine uptake in the transgender and disability communities in India. Methods Using a participatory approach we interviewed 24 community representatives, identifying themselves as transgender individuals or as persons with disability, and 21 key informants such as vaccine programme managers, vaccine providers, and community advocates. We undertook an inductive thematic analysis of the data using a socio-ecological model. Results Fear of side effects in relation to specific needs of the two communities and mistrust of systems involved in vaccination shaped four different pathways for vaccine decision-making. Mistrust of systems was influenced by past negative experiences with the health system, creating contexts in which information and misinformation are shared and interpreted. Participants negotiated their doubts about safety and mistrust of systems by interacting with different sources of influence showing patterns of decision-making that are dynamic, context-dependent, and intersectional. Conclusion These findings will help in determining the content, strategies and approaches to equitable vaccine communication for these two communities. The two communities ought to be included in vaccine trials. Vaccine information must respond to the specific needs of these two communities which could be enabled by collaboration and engagement with community members and influencers. Finally, long-term investment towards the needs of marginalised communities is vital to dismantle cycles of marginalisation and distrust and in turn improve vaccine acceptance and uptake.

Teachers' Levels of Professional Commitment

The aim of the study is to examine whether the levels of teachers' commitment to the profession differ according to various variables. Survey model, one of the quantitative research methods, was used in the research. The sample of the research consists of 608 teachers working in primary, middle and high school schools affiliated to the Ministry of National Education in Yakutiye, Palandöken and Aziziye districts of Erzurum province. As a data collection tool in the research; 'The Personal Information Form' and 'The Teachers’ Professional Engagement Scale’ were used. In the analysis of the data, descriptive analyzes, Mann-Whitney U test and Kruskal-Wallis H test were used. It was seen that the teachers' level of commitment to the profession did not show a significant difference according to the variables of age, marital status, professional seniority and graduated faculty, but showed a significant difference according to the variables of gender and teaching level. It has been obtained that the teachers' level of commitment to the profession is very high. It has been determined that female teachers have higher levels of commitment to the profession. It has been concluded that primary school teachers' level of commitment to the profession is higher than that of high school teachers. There was no significant difference according to age, marital status, professional seniority and graduated faculty variables.