Global warming, exacerbated by greenhouse gas emissions from non-green product manufacturing, necessitates a shift towards green production to safeguard ecosystems and finite resources. The United Nations Environment Programme emphasizes the importance of environmental considerations in corporate ESG criteria. Despite the higher costs of designing and manufacturing green products, which deter some companies and lead to greenwashing, efforts persist to promote sustainable goods. This study explores enhancing consumer repurchase intentions for green products through social media marketing, emphasizing green values, environmental concerns, brand image, and involvement. Findings reveal social media's role in boosting these factors, thus encouraging green repurchases. Insights are valuable for green businesses, social media groups, environmental agencies, and future research.

Recurrent respiratory papillomatosis (RRP) is a non- malignant disease, characterized by the production of wart-like growths in respiratory tract, affecting both young and adults (Juvenile-Onset Recurrent Respiratory Papillomatosis, JORRP and Adult-Onset Recurrent Respiratory Papillomatosis, AORRP, respectively). Infection caused by Human Papillomavirus (HPV) is known as the main factors involved in RRP development. Complications of RRP may rarely occur, including lung involvement and malignant transformation. The present systematic review was aimed to evaluate the prevalence of severe complications, as lung involvement and lung tumor in JORRP and AORRP patients, following the guideline for reporting systematic reviews and meta-analysis (PRISMA Statement). Among the 378 studies were found on PubMed and Scopus using the following MESH terms “recurrent respiratory papillomatosis and lung tumor” and “pulmonary tumor and recurrent respiratory papillomatosis”. Basing on inclusion and exclusion criteria, a total of 11 studies were included in the systematic review. We found a pooled prevalence of 8% (95% CI:4%-14%; I2: 87.5%) for lung involvement in RRP patients. In addition, we found a pooled risk difference of 5% in lung involvement between JORRP and AORRP (95% CI: -7%-18%; I2 :85.6%, p-value: 0.41). Among patients with lung involvement, we observed a pooled prevalence of lung tumor of 4% (95% CI:1%- 7%; I2: 67.1%), and a pooled prevalence mortality for this group of 4% (95% CI:2%-6%; I2: 0%). Overall, the positivity rate for HPV-6 and -11 in patients with RRP was 91%. Considering only cases with pulmonary involvement, the pooled prevalence for HPV 11 was 21% (95% CI: 5%-45%; I2: 77.2%). Our results evidenced a low/middle risk of pulmonary involvement and lung tumor in JORRP and AORRP patients, with an increased risk for HPV-11 positive patients. Further studies should be performed to improve knowledge and adopt preventive measures to contrast the progression to severe diseases in RRP patients.

This article considers the basic psychological needs theory and tries to determine how much autonomy support from a coach is required for basic psychological needs and how autonomy, competence, relatedness, and the psychological motivational climate can explain task and ego involvement in a group of young elite ice hockey players. Our three hypotheses were as follows: autonomy support from the coach will have an impact on motivational involvement, all three basic needs will have an impact on motivational involvement, and motivational involvement will be explained by the motivational climate. A total of 175 male elite ice hockey players from Norway, ranging in age from 15 to 18 years old, answered questionnaires about autonomy support, perceived motivational climate, achievement goal orientation, and basic psychological needs. A multiple regression analysis was run to predict ego–task involvement using autonomy support from the coach, the need for autonomy, the need for competence, the need for relatedness, the task climate, and the ego climate. The only two variables that statistically significantly predicted ego–task involvement were autonomy support from the coach and the ego climate. The analysis revealed that the athletes had a higher score on task than ego involvement, but when this was transformed into two variables (high and low) for task and ego involvement, we found that most players scored high for both task and ego involvement. We found that autonomy from the coach had a positive relationship with a high score for players on both task and ego involvement. We also found that the three basic psychological needs had no impact on the motivational involvement of the athletes. Lastly, we found that the ego climate had an impact on the motivational involvement. There was a positive relationship between a high score for the ego climate and a high score for both ego and task involvement.

The main goal of this paper is to address how quickly and to what extent are international organizational cultures, brought by the world companies after the process of privatization, being implemented in a single monolithic culture. For this purpose was adopted and applied Denison model of organizational culture, which has been chosen because it emphasizes the need for balance between requirements for organization’s stability demands and its required flexibility. Considering that a different organizational culture reflects systematic change of an entire organization, this paper focuses on exploring the differences in culture dimensions among companies in domestic and foreign ownership in Serbia. A sample of 1000 employees was statistically processed. Changes in organizational culture tend to be relatively slow. The results confirm that organizational culture is a complex working environment, concerning organizational values, which represents a fundamental element of organizations. Given that the process of company ownership changes occurred fifteen years prior to the research implementation, obtained results show effects of interaction between national and organizational culture in this, relatively short, period of time. Obtained results can be generalized to countries that are passing or have recently passed a transition, and are similar in cultural characteristics.

Amyloidosis is due to deposition of an excessive amount of protein in many parenchymal tissues, including myocardium. The onset of cardiac Amyloidosis (CA) is an inauspicious prognostic factor, that can lead to sudden death. We retrospectively analyzed 135 patients with systemic amyloidosis, admitted to our ward between 1981 and 2019. Among them, 54 patients (46.30% F / 53.70% M, age 63.95±12.82 years) presented CA at baseline. In 53 patients, there was associated with multiorgan involvement, while in one there was primary myocardial deposition. As control group, we enrolled 81 patients (49.30% F / 50.70% M, aged 58.33±15.65) who did not meet the criteria for CA. In 44/54 of patients CA was associated with AL, 5/54 with AA, 3/54 of patients with ATTR, in 1/54 AL was related to hemodialysis and 1/54 to Gel-Amyloidosis. The most common AL type was IgG (28/44); less frequent forms were either IgA (7/40) or IgD (2/40), while seven patients had a λ free light chain form. The 32 AL with complete Ig were 31 λ-chain and just one k-chain. CA patients presented normal BP (SBP 118.0±8.4 mmHg; DBP 73.8±4.9 mmHg), while those with nCA had increased proteinuria (p=0.02). TnI and NT-proBNP were significantly increased compared to nCA (p= 0.031 and p=0.047, respectively). In CA patients we found an increased LDH compared to nCA (p=0.0011). CA patients were also found to have an increased interventricular septum thickness compared to nCA (p=0.002), a decreased Ejection Fraction % (p=0.0018) and Doppler velocity E/e’ ratio (p=0.0095). Moreover, CA patients were seen to have an enhanced right atrium area (p=0.0179), right ventricle basal diameter (p= 0.0112) and wall thickness (p=0.0471) as compared to nCA, as well as an increased inferior cava vein diameter (p=0.0495). TAPSE was the method chosen to evaluate systolic function of the right heart. In CA subjects very poor TAPSE levels were found compared to nCA patients (p=0.0495). Additionally, we found a significant positive correlation between TAPSE and lymphocyte count (r=0.47; p=0.031) as well as Gamma globulins (r=0.43, p=0.033), Monoclonal component (r=0.72; p=0.047) and IgG values (r=0.62, p=0.018). On the contrary, a significant negative correlation with LDH (r=-0.57, p=0.005), IVS (r=-0.51, p=0.008) and diastolic function evaluated as E/e’ (r=-0.60, p=0.003) were verified. CA patients had very poor survival compared to controls (30 vs. 66 months in CA vs nCA, respectively, P=0.15). Mean survival of CA individuals was worse also when stratified according to NT-proBNP levels, using 2500 pg/mL as class boundary (174 vs. 5.5 months, for patients with lower vs higher values than the median, respectively p=0.013). In much the same way, decreased right heart systolic function was correlated with a worse prognosis (18.0 months median survival, not reached in subjects with lower values than 18mm, p=0.0186). Finally, our data highlight the potential prognostic and predictive value of right heart alterations characterizing amyloidosis, as a novel clinical parameter correlated to increased LDH and immunoglobulins levels. Overall, we confirm the clinical relevance of cardiac involvement and propose that right heart evaluation may be considered as a new marker for clinical risk stratification in patients with amyloidosis.

In this dynamic 21st Century global economy, managers of insurance companies cannot afford to ignore the involvement of their employees in strategic change programmes. The employee's voice in strategic change programmes is now a prerequisite for organizational performance. This study seeks to determine the effect of employee involvement in strategic change programmes through participation in decision-making, teamwork, communication, creativity, and innovation. The research approach used was quantitative to collect data from 115 respondents using a 5-point Likert scale questionnaire. The study employed the multiple regression method to analyse data using the IBM SPSS V28 software. All five constructs of employee involvement had a significant effect on the performance of insurance companies in Zimbabwe. The study findings will convince top managerial leaders of the insurance industry to acknowledge and appreciate the importance of involving employees in strategic change programmes. Besides, industry regulatory authorities can advocate for policies that encourage employee involvement in decision-making.

Sado island in Niigata prefecture is among the first GIAHS designated sites in Japan and among developed countries worldwide. Recent studies have pointed out the need to incorporate culture and farmer opinions to further strengthen GIAHS inclusivity in rural farming. In connection to this, the study explored whether farmer visibility, which is highlighted by GIAHS designation, actually translates to farmers’ actual perception of GIAHS involvement. A survey was conducted among Sado island farmers to determine their knowledge and perception of their GIAHS involvement, in connection to their perspectives on youth involvement, Sado island branding, and tourism management. Results showed that 56.3% of Sado island farmers feel uninvolved or unsure towards GIAHS, which is in stark contrast with the prevalent farming method in the area which is special farming (complies with GIAHS regulations). Further analyses revealed that farmers who feel that GIAHS does not promote youth involvement, Sado island branding, and tourism management have higher predisposition to perceive themselves as uninvolved towards GIAHS. This study highlights the need for careful reevaluation and integration of farmer insights and needs to the current GIAHS implementation in Sado island and in other GIAHS as well.

Education plays an essential role in the acquisition of knowledge and skills. School is the place where children’ attitudes, interests, and habits are developed. More involved and supportive a parent is towards their adolescent the higher self-esteem they will gain allowing the adolescent to feel confident and focused during school. Parents therefore enroll their children in schools that can give them expected quality of lives. The main core objective for this study was to determine the parental influence on students’ academic performance - A case study of Debre Berhan General Secondary School. A total of 118 students were included in the present study using simple random sampling technique from the total students (2367). Cross-sectional design was appropriate for this study. Primary source of data was employed collected from students. Descriptive and inferential statistics were applied. For statistical analysis SPSS 20 was used at 5% level of significance. Descriptive statistics results indicate that the average mark of students was with minimum and maximum value of 47 and 94 respectively. Multiple regression models showed that Income level, Rate of money given to satisfy basic and educational materials, Parent’s occupation, Family size, Parent’s educational level, and Parent’s way of giving motivation were found to be a significant effect on academic performance of students at 5% level of significance at study area. However, sex of students, age of students and grade level of students were not found to be significant effect to academic performance at study area. Overall model is statistically significance for the data. All the assumption of regression analysis was satisfied. Normality, Constant variance, absence of multicolinearity, linearity and absence of autocorrelation were satisfied due to formal tests and diagnostic plots. Study recommended the need for programs related to improvement of mother and father education for caring child in appropriate success of their education and also parents should allocate time to visit schools and establish good relationship and discussion about their children’s academic progress in according to way of motivation to learn actively in school.

This literature review focuses on the development of an ontology for public policy problems in Ethiopia. The study aims to provide a structured representation of concepts, relationships, and knowledge specific to the Ethiopian policy context. The research follows a systematic ontology development process that incorporates domain-specific knowledge and stakeholder involvement.The review begins by describing the steps involved in the ontology development process, including problem identification and scoping, requirement analysis, ontology modeling, and stakeholder involvement. It emphasizes the importance of engaging policymakers, subject matter experts, and researchers throughout the process to validate the ontology and ensure its relevance and effectiveness in addressing Ethiopian policy problems.The application of the developed ontology to specific policy problems is then discussed. Examples include agricultural policy analysis, healthcare policy evaluation, and education policy planning. The review highlights how the ontology can support policy analysis, decision-making, and evaluation by capturing relevant concepts, simulating policy scenarios, and assessing policy impacts.Furthermore, the review identifies potential challenges and limitations in the ontology development process, such as data availability, expert knowledge engagement, and the evolving policy landscape. These challenges need to be addressed to ensure the ontology's accuracy and usability in addressing Ethiopian policy problems.Finally, the review provides suggestions for further research and improvement, such as integrating the ontology with data sources, fostering collaborative ontology development, exploring semantic reasoning and inferencing techniques, and promoting interoperability and standardization. These suggestions aim to enhance the ontology's capabilities and its contribution to the field of ontology development for public policy problems.In conclusion, the development of an ontology for public policy problems in Ethiopia offers a valuable tool for policymakers, researchers, and stakeholders to understand, analyze, and address complex policy challenges. The ontology's relevance and applicability to the Ethiopian context, stakeholder involvement, and support for policy analysis make it a significant contribution to the field of ontology development for public policy.

Βottom-up management in catchment scale is deemed as the determinant way to avoid the conflict of the water users through the participation of stakeholders, strategy co-shaping and solutions co-creation. Water management cannot be one-dimensional but demands cross sectoral coop-eration. Usually, the difficulty lies in proper stakeholder training and their opinion inclusion, using a quantifiable manner in water management. The Laspias River watershed occupies an area of 221.8 km2, belonging to the River Basin District of Thrace and it is characterized by intense agricultural and industrial activity. Complying with the augmented water needs and pollution loads by respecting stakeholders’ opinion, this research aims to utilize a hybrid intuitionistic fuzzy multi-criteria-based methodology. It is a common difficulty to deal with supplier selection in resources management since it is a typically decision-making problem encompassing multiple (several conflicting) criteria, on which stakeholder’s opinions are usually imprecise and in a rather qualitative form. Therefore, the proposed method provides the mathematical tool to move into more comprehensive decisions with the public involvement. The weights are produced based on the stakeholder’s opinion. The alternatives’ ranking is achieved based on the fuzzified intuition-istic version of Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) and problems’ mitigation solutions’ hierarchy is achieved.

Based on the traditional Chinese cultural belief of "male breadwinner, female homemaker," as well as the systemic and interactive characteristics of families, this study aims to explore the influence of maternal gatekeeping behavior on the quality and quantity of paternal parenting, as well as adolescent aggressive behavior. A total of 483 seventh-grade students completed questionnaires on maternal gatekeeping behavior, paternal involvement, parenting styles and aggressive behavior. Latent profile analysis identified four parenting combinations: positive, negative, mixed, and neglectful. Adolescents under negative parenting exhibited the highest aggression, while those under positive and neglectful parenting showed the least aggression. Maternal gatekeeping behavior correlated with paternal negative parenting and adolescent aggression. Paternal negative parenting mediated the relationship between maternal gatekeeping and aggression, while paternal involvement moderated this relationship. These findings highlight the role of parental interaction in adolescent behavior and support family-based interventions.

Abstract: Perihilar cholangiocarcinoma (phCC) is the most common type of cholangiocarcinoma, accounting for approximately 60 % of cases, followed by the distal and then the intrahepatic forms. There is not a staging system that allows comparation of all series and extract some conclusions to increase the long-survival rate in this dismal disease. The extension of the resection, which theoretically dependes on the type of phCC, is not closed subject. As surgery is the only known way to achieve a cure, many aggressive approachs have been adopted. Despite extended liver resections and even vascular resections, margins are positive in around one third of patients. In the past two decades, with advances in diagnostic and surgical techniques, the surgical outcomes and survival rates have gradually improved, although variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Extended hepatectomies and portal vein resection even right hepatic artery reconstruction for the left side tumors are frequently needed. Salvage procedures when arterial reconstruction is not feasible, as well as hepatopancreatoduodenectomy, are still under evaluation too. In this article, we discuss the aggressive surgical approach to phCC focused on vascular resection. Disparate results on the surgical treatment of phCC made it impossible to reach clear-cut conclusions.

This study explored father involvement as a social determinant of child health within the context of macro-environmental changes in Mongolia. Using data for children aged 3-4 from UNICEF’s Multiple Indicator Cluster Surveys, this cross-sectional analysis examined the association between father presence and engagement with child health and educational outcomes. Multivariate regression modeling was employed to identify associations between father presence, engagement, and child outcomes including fever, respiratory illness, diarrhea and preschool attendance. In unadjusted analyses, father engagement was associated with higher odds of pre-school attendance (OR=1.12; 95% CI 1.04-1.20) but not with child illness (OR=1.04; 95% CI 0.95-1.14). Father engagement was no longer associated with pre-school attendance after controlling for potentially confounding variables (ORadj = 0.95; 95% CI 0.88-1.03). Unadjusted and adjusted analyses showed that father presence was not associated with acute illness or preschool attendance. Results also suggest that a larger proportion of children were engaged in activities by their mother compared to their father or other adults. Data indicate that father presence and engagement were not associated with child illness or pre-school attendance. Factors such as maternal education, household wealth, and region of residence are stronger predictors of preschool attendance and should continue to be considered for promoting child health and development in Mongolia.

As governments in various countries and regions issue tourism-friendly policies in the post-pandemic period, the voices for tourism consumption recovery and innovative transformation have attracted great attention. Many scholars, experts and industry professionals in the field of festivals are actively exploring efficient solutions for festival marketing and sustainability. It is worth rethinking tourists’ consumption psychology and perceived image toward exiting festival products as well as the antecedents that affect festival loyalty. The Qingdao International Beer Festival, as one of the most influential festivals in China, was selected as the research case for this study. The main goal of this study was to investigate festival consumption promotion mechanism by proposing a conceptual framework in which the associations from destination familiarity and product familiarity to loyal intentions (re-patronage and recommendation) were examined, with mediators of overall festival image, perceived value and overall satisfaction. Furthermore, the moderating role of visitor involvement in the proposed framework was also adequately demonstrated. The research findings are expected to provide a significant reference for the recovery and competitiveness improvement of the entire festival industry.

Long-term care (LTC) settings are increasingly used for palliative care in Japan. This study aimed to assess the proportion of LTC settings that provide palliative care services for older clients with advanced dementia in Japan and the trends across the types of settings. A nationwide questionnaire survey was conducted between November 2022 and January 2023, targeting 1,000 geriatric hospitals (GHs), 1,000 geriatric health services facilities (GHSFs), and 1,000 home nursing care stations (HNCSs). The palliative care practices for older patients with advanced dementia and their families in the agencies were assessed. Less than half of the GHs supported family participation or the spiritual needs of their older clients with dementia, while many had access to pain and symptom assessments and analgesic prescriptions by physicians. Less than half the GHSFs used pain assessment tools, assessed and supported family caregivers' pain and distress, and supported family participation in palliative care. More than 80% of the HNCSs practiced most of the listed palliative care. Current palliative care practices for older adults with dementia vary among GHs, GHSFs, and HNCSs. This emphasizes the need for targeted approaches to improve the provision of palliative care for patients with dementia across LTC settings in Japan.

Moral observer-licensing happens when people condone others’ morally questionable conducts due to their history of moral behaviors. We investigated in four studies (N = 808) this phenomenon in the context of cyberspace and its contributing factors and boundary conditions. Study 1 determined what participants perceived as typically moral and immoral behaviors in cyberspace. Then in Study 2, participants condemned less a story character’s online immoral behavior when they were informed of the character’s prior online moral behavior than when they were not, which indicates moral observer-licensing in cyberspace. Study 3 confirmed the presence of moral observer-licensing in cyberspace and further demonstrated that a character’s prior moral or immoral behavior online respectively reduces or intensifies the negativity of the character’s subsequent immoral behavior. Finally, Study 4 showed that participants who identified with the victim in a hypothetical scenario showed less forgiveness and more condemnation of a character’s immoral behavior than those who identified with the perpetrator or the bystander. These findings are of theoretical and practical significance for our understanding of cyber ethics.

Parent education programs, offered via family-school partnerships, offer an effective means for promoting the mental health and educational functioning of children and adolescents at a whole-of-school level. However, these programs often have low uptake. This study aimed to identify strategies for increasing the uptake of parent education programs within preschool and school settings. A three-round Delphi procedure was employed to obtain expert consensus on strategies that are important and feasible in educational settings. First, thirty experts rated statements identified from the literature and a stakeholder forum. Next, experts re-appraised statements, including new statements generated from the first round. Ninety statements were endorsed by ≥ 80% of the experts. Primary themes include strategies for program selection, strategies for increasing the accessibility of programs and the understanding of educational staff on parent engagement and child mental health, strategies for program development, promotion, and delivery, as well as strategies for increasing parent and community engagement. This study offers a set of consensus strategies for improving the uptake of parent education programs within family-school partnership.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder but kidneys are not the only organs involved in this systemic disorder. Individuals with the condition may display additional manifestations beyond the renal system, involving liver, pancreas and brain in the con-text of cystic manifestations, while vascular system, gastrointestinal tract, bones, and cardiac valves in the context of non-cystic manifestations. Despite kidney involvement remain the main feature of the disease, thanks to new generation therapies, early diagnosis and better management of kidney related problems, a new wave of complications must be faced from clinicians who treated polycystic patients. Involvement of the liver represents the most prevalent extrarenal manifestation and grows importance in symptom burden and quality of life. Vascular abnormalities are a key factor for patients’ life expectancy and there’s still de-bate whether to screen or not to screen all patients. Arterial hypertension is often the earliest onset among polycystic patients leading to frequent cardiovascular complications. Although cardiac valvular abnormali-ties is a frequent complication, it rarely leads to relevant problems in the clinical history of polycystic pa-tients. One of the new relevant aspects concern bone disorders, that can exert a considerable influence on the clinical course of these patients. This review aims to provide the “state of art” among extrarenal mani-festation of ADPKD.

This paper describes a research project carried out in an Italian public school to assess whether parents were willing to take part in food procurement decisions, as well as their ability to accurately predict what foods children would pick at school lunch and their propensity to support sustainable food choices made by the school. The methodology included a questionnaire to 500 parents and an in-depth study of 138 child/parent pairs. The study comprised: (i) presentation of an innovative recipe in the weekly menu of the school canteen; (ii) meal observations of children’s intake at school lunch during the week of the menu modification; (iii) collection of both parents’ and children’s reports on their choices of recipes from the modified weekly menu. The results are commented in light of two important changes that have recently affected Italian public school food procurement: the opening of school canteens to lunches brought from home and the measures adopted since 2020 to contain the Covid-19 pandemic. Both events go in the direction of delegating to parents the multifaceted role of the school in the food arena. The article concludes that the results of the study should discourage this approach.

The time required to reach a correct diagnosis is one of the most important problems for rare disease (RD) patients. Diagnostic delay can be intolerably long, to the point that it is usually described as a “diagnostic odyssey” and, sometimes, a diagnosis might never occur. The International Rare Disease Research Consortium proposed, as ultimate goal for 2017-2027, to enable all people with a suspected RD to be diagnosed within one year if the disorder is known, and to enter a globally coordinated diagnostic and research pipeline for the unsolved cases. In-depth analysis of the genotype through next generation sequencing, together with a standardized in-depth phenotype description and sophisticated high-throughput approaches, have been applied as diagnostic tools to increase the chance of a timely and accurate diagnosis. This approach is very fruitful as, according to the Orphanet database, from 2010 to March 2017 more than 600 new RDs have been described and about 3600 genes linked to RDs have been identified. However, combination of -omics and phenotype data and international sharing of this information raise ethical concerns. Values to be assessed include not only patient autonomy but also family implications, beneficence, non-maleficence, justice, solidarity and reciprocity, which must be respected and promoted and, at the same time, balanced among each other. In this work we suggest that, to maximise patients involvement in the search for a diagnosis and identification of new causative genes, undiagnosed patients should have the possibility to: 1) actively participate in the description of their phenotype; 2) choose the level of visibility of their profile in matchmaking databases; 3) express their preferences regarding return of new findings, in particular which level of Variant of Unknown Significance (VUS) significance should be considered relevant to them. The quality of the relation between individual patients and physicians, and between the patient community and the scientific community is critically important for making the best use of available data and combining efforts in the search for matches with similar cases worldwide that will help to solve unsolved cases. The contribution of patients to collecting and coding data comprehensively is critical for efficient use of data downstream of data collection.

Due to the upward trend in the globalization of sustainability issues and the intense competitive environment, it is evident that higher education institutions need new strategic approaches to succeed. To this end, the inquiry for this paper has been made into the debate about student relationship management. Going through the literature indicates that institutions have mainly perceived the concept as a technological initiative for solving the problems in individual domains, accompanied by uncoordinated efforts. Thus, the aims of this study are to theoretically present critical success factors of this strategic approach and to empirically examine the recognized factors. To do so, confirmatory factor analysis that is a quantitative analytic method was performed. The results and analyses revealed that there has been a significant correlation between the four critical success factors including knowledge management, student relationship management technology, student orientation, and employees’ involvement. It was also found that these factors are significantly correlated with the construct of student relationship management success. The findings have consequently highlighted that in addition to the technological tool, the role of knowledge management, employees’ involvement, and student orientation appeared to be particularly important for the implementation of the application.

STUDY QUESTION: Which are the main research interests among patients of assisted reproductive technologies (ART)? SUMMARY ANSWER: Patients identified as research priorities that deserve further investigation: success rates and risks of ART, side-effects of treatments, resources to cope with infertility, effectiveness of alternative therapies, lifestyle habits to protect fertility, oocyte quality and ovarian reserve, and causes of genetic or hereditary infertility. WHAT IS KNOWN ALREADY: The involvement of patients and caregivers in setting research agendas in medicine has gathered significant momentum in the last decade. Patients’ involvement in setting research priorities offers several benefits: improved patient knowledge and awareness of their condition; greater understanding of the medical professionals of the impact of the condition on patients’ quality of life; reduced costs associated with redundant research activities. This is may be also applicable to research in infertility and ART, where patients’ interests have never been explored before. STUDY DESIGN, SIZE, DURATION: This is a cross-sectional study that consists of an anonymous online survey, which was sent up to three times to 2112 patients from 11 fertility centers in 5 countries between January-December 2018. The study design was based on the James Lind Alliance priority setting partnership model, which comprises the identification of patients groups, the exploration of the research agenda, the analysis of collected data and identification of priorities. PARTICIPANTS/MATERIALS, SETTING, METHODS: Overall, 2112 patients were contacted, and 945 surveys were answered (RR: 44.7%). Patients were asked to identify research questions relevant to them in the areas of infertility causes and prevention, fertility treatments (medication and ART), and the emotional aspects of infertility. Answers were categorized in topics and ranked by frequency. A long list of the top-30 research topics was extracted from the aggregate results, from which, a short list of the top-10 research topics was created. At the end, 10 research questions related to each of the 10 research topics were constructed, based on the answers given by patients. MAIN RESULTS AND THE ROLE OF CHANCE: Female (845, 89.4%) and male (100, 10.6%) patients were included. The mean age of patients was 37.8 (SD 1.74). Most of the patients did not have children at the time of the survey (523, 59%), while 51 (5.7%) were pregnant. Sixty (6.3%) patients did not start treatment, 579 (61.3%) were performing a treatment with their own gametes and 304 (32.2%) were treated through gamete donation. Patients were mainly interested in the effectiveness of ART -especially per clinical profile-, side effects of drugs, protection of fertility and prevention of infertility –especially through diet and exercise-, and psychological aspects of the infertility journey. The top-10 research questions (and weight) obtained were: 1) What are the side-effects of ART treatments? (41.6%); 2) What are the most effective methods to cope with infertility from the psychological point of view? (37.2%); 3) What effects could diet have on fertility? (25.9%); 4) What are ART success rates per clinical profile? (25.9%); 5) Are there habits and lifestyle factors that could prevent infertility? (20.0%); 6) What are the long-term risks associated to ART? (18.5%); 7) Are alternative therapies such as acupuncture, yoga, and meditation effective to treat/prevent infertility? (18.5%); 8) What is the impact of exercise on fertility? (15.4%); 9) How does oocytes quantity and quality affect fertility? (9.5%); 10) What are the genetic patterns or hereditary conditions causing/related to infertility? (9.5%). LIMITATIONS, REASONS FOR CAUTION: Although all respondents had attended a fertility center, not all of them were diagnosed as infertile (i.e. single women) and had started treatment at the time of response, while a few were pregnant; their priorities for research might have been influenced by their infertility journey. Also, all participants attended private fertility centers: areas of interest may be different in public settings. WIDER IMPLICATIONS FOR THE FINDINGS: Researchers and clinicians should keep in mind that, in addition to improvement of treatments’ success rates and side-effects, patients greatly value research on causes, prevention and emotional aspects of infertility. As their views might differ from those of medical professionals, patients’ voices should be incorporated in setting infertility research priorities.