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Background: The large-scale International Computer and Information Literacy Study (2018) has an interesting finding concerning Luxembourg teachers. Luxembourg has one of the highest reported level of technology-related resources for teaching and learning, but a relatively lower reported use of ICT in classroom practice. Methods: ICT innovation requires a high initial level of financial investment in technology, and Luxembourg has achieved this since 2015. Once the necessary financial investment in ICT technology has been made, the key question is what else matters to increase the use of ICT in teaching. To identify the relevant factors, we used the "Four in Balance" model, aimed explicitly at monitoring the implementation of ICT in schools. Results: Using data for 420 teachers in Luxembourg, we identify that within such a technology-driven approach to digitalization, teachers' "vision of ICT use in teaching," "level of expertise," and the use of "digital learning materials in class" are significant support factors. "Leadership and collaboration," in the form of an explicit vision of setting ICT as a priority for teaching in the school, also prove to be important. Conclusions: Through these findings, we show that the initial investment in school infrastructure for ICT needs to be associated in its implementation with teachers' ICT-related beliefs, attitudes, and ICT expertise.

STUDY QUESTION Are cumulative pregnancy rates better if supernumerary embryos are vitrified on Day 5/6 instead of Day 3? SUMMARY ANSWER The results do not show a significant difference in cumulative pregnancy rates between the Day 3 and Day 5/6 vitrification groups. WHAT IS KNOWN ALREADY Pregnancy and live birth rates following IVF or ICSI treatment are higher after extended embryo culture and blastocyst transfer (Day 5/6) compared to cleavage-stage (Day 3) transfer. Cumulative pregnancy rates from one oocyte retrieval (OR) cycle show no significant difference after fresh and frozen embryo transfers, but only one study has used vitrification for the cryopreservation of supernumerary embryos while four studies have used a slow freezing protocol. STUDY DESIGN, SIZE, DURATION Our prospective randomized controlled trial was performed in an academic centre between January 2018 and August 2020. Patients were randomized into vitrification Day 3 (n = 80) or Day 5/6 (n = 81) groups. The primary outcome was the cumulative ongoing pregnancy rate (cOPR), considering only the first pregnancy for each couple. The power calculation revealed that 75 patients were required in each group, when assuming a 50% cOPR with four embryo transfers in the vitrification Day 3 group vs two transfers in the vitrification Day 5/6 group. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients <38 years undergoing their first or second OR cycles were randomized at the start of the first cycle. Up to two cycles were included in the analysis. A fresh embryo transfer was performed on Day 3. Supernumerary embryos (with ≥6 cells, <25% fragmentation, and equal blastomeres) or blastocysts (with expansion grade ≥2 with inner cell mass and trophectoderm score A/B) were vitrified on Day 3 or Day 5/6, respectively, and then transferred at a later date. A time-to-event analysis was performed with the patient's first ongoing pregnancy as the event of interest and the number of embryo transfers as the time component. The statistical comparison was performed by a Cox proportional hazards model. Cumulative costs of vitrification on Day 3 vs Day 5/6 were explored and compared using Mann–Whitney U tests. MAIN RESULTS AND THE ROLE OF CHANCE By December 2021, 233 transfers (96 fresh and 137 frozen) in 77 patients were performed in the vitrification Day 3 group and 201 transfers (88 fresh and 113 frozen) in 77 patients were performed in the vitrification Day 5/6 group. The time-to-event analysis did not show a difference between the two arms with regard to the patient's first ongoing pregnancy as the primary study outcome (hazard ratio [HR] 1.25, 95% CI 0.82; 1.92, P = 0.30). The cumulative ongoing pregnancy rate after eight transfers (from one or two ORs) was 57% in the vitrification Day 3 group vs 58% in the vitrification Day 5/6 group. The median number of embryo transfers until a pregnancy was achieved was five vs four, respectively, in the vitrification Day 3 group vs the Day 5/6 group. Similar results were found for the secondary study outcome, i.e. clinical pregnancy with foetal heart rate (HR 1.19, 95% CI 0.78; 1.80, P = 0.41). The cumulative clinical pregnancy rate (cCPR) after eight embryo transfers was 62% in the vitrification Day 3 group vs 59% in the vitrification Day 5/6 group. The median number of transfers until a pregnancy was achieved was four in both groups. The healthcare consumption pattern differed between the two groups and we observed higher costs for the vitrification Day 3 group compared to the vitrification Day 5/6 group, although these differences were not statistically significant. LIMITATIONS, REASONS FOR CAUTION Although our power calculation revealed that only 75 patients were needed in each study group (β = 0.87, α < 0.05), the numbers were low. Also, different numbers of single and double embryo transfers were performed between the two groups, which may have affected the results. The cost analysis was performed on a subset of the patients and is therefore exploratory. WIDER IMPLICATIONS OF THE FINDINGS Our study shows no difference in the cumulative pregnancy rate nor costs after fresh and frozen embryo transfers of at most two sequential OR cycles between the Day 3 and Day 5/6 vitrification groups; however, obstetric and perinatal outcomes should be taken into account to determine the best strategy. STUDY FUNDING/COMPETING INTEREST(S) This study was funded as an investigator-sponsored study of S.D. by Merck nv/sa Belgium, an affiliate of Merck KGaA, Darmstadt, Germany, and by Gedeon Richter Benelux (PA18-0162). The authors declare no conflict of interest related to this study. TRIAL REGISTRATION NUMBER NCT04196036. TRIAL REGISTRATION DATE 15 January 2018. DATE OF FIRST PATIENT'S ENROLMENT 15 January 2018. [ABSTRACT FROM AUTHOR]

Digital game-based learning builds on the general characteristics of games. The incentive system (points, scores, stars, levels, and performance feedback) integrates design elements to keep a learner engaged. In the work described here, we investigated which elements of the incentive system design—rewards, penalties, or feedback—have the potential to trigger students' motivation to play the game. We used eye tracking of eight primary school children, aged 8–11 years, as they interacted with the incentive system of a mathematics game-based item and its specific design, followed by a semi-structured interview. Eye-tracking results show that students paid minimal visual attention to the incentive system during the game, regardless of their level of performance in the game or their age group. The feedback at the end of the game attracted more of their visual attention and provided a good opportunity to inform them about their performance. The semi-structured interviews revealed a high level of self-reported excitement about playing the game, mainly related to the design of the incentive system. Elements of the incentive system triggered students' wish for student-to-student competition, which has been shown in the literature on traditional tangible rewards to stifle intrinsic motivation under certain conditions. The results of this study show that the design of the incentive system has the potential to promote extrinsic motivation with the game through rewards and penalties, and open the reflection on its possible spillover effect on intrinsic motivation in digital game-based learning. [ABSTRACT FROM AUTHOR]