Effect of Departmental and Physician-Selected Interventions on Point-of-Care Ultrasound Documentation Completion.

Background Point-of-care ultrasound (POCUS) has been disruptive to many experienced emergency physicians as it requires competence in a new physical skill, real-time image interpretation, and navigation of novel software for submission to the electronic health record (EHR). Incomplete documentation of a performed POCUS study used for clinical decision-making represents a potential medicolegal liability, may expose the patient to repetitive or potentially unnecessary imaging, and is a missed opportunity for reimbursement. Identifying effective facilitators of ED POCUS documentation completion requires additional investigation. Methods In the first part of this mixed-methods study, eligible attending physicians were stratified into levels of use ("high"/"low"/"never") based on recent POCUS documentation performance. Semi-structured interviews were conducted with high and low utilizers to explore their perceptions of the POCUS submission workflow and their receptivity to various proposed interventions. Qualitative data were analyzed using a thematic analysis that explored perceived usefulness and usability. The second part of the study consisted of two intervention phases. First, physicians achieving minimum POCUS documentation numbers were rewarded with additional shift scheduling flexibility. In the second phase, the intervention that garnered the most interview support, daily documentation reminder emails, was implemented. The primary outcome was the individual POCUS documentation rates calculated as all studies submitted divided by all studies performed (submitted plus unsubmitted) per month. Provider-level monthly data was aggregated into a departmental rate. Results Interviews were conducted with 12 physicians, six from the highest and six from the lowest documentation quartiles. Both groups supported the same two proposed interventions: reminder emails ranked first, then monetary rewards ranked second. High utilizers emphasized the clinical utility of POCUS, whereas low utilizers expressed concerns over "double billing" and exposure to medicolegal liability with uncertain scan interpretations. For low utilizers, a documentation decision could be dependent on the performing resident physician's displayed confidence. Both groups voiced frustration with the need to use a separate program, Qpath (Telexy Healthcare, Inc, Maple Ridge, British Columbia, Canada), for POCUS documentation. During intervention phase one, the aggregate departmental documentation rate increased from 44.6% to 60.1% with the introduction of the schedule request incentive. This improvement was seen across all documentation quartiles. The departmental rate remained stable and did not improve further following the addition of the daily documentation reminder emails in intervention phase two. When reminder emails ceased yet the day-off request incentive continued, the departmental rate did not drop. Conclusions The implementation of a non-financial shift scheduling incentive correlated with the largest increase in departmental POCUS documentation rate. Interviewees incorrectly predicted that email reminders would be the most influential intervention highlighting a mismatch between physician perception and effective drivers of behavior change. Further investigation may focus on determining the size and longevity of the isolated impact of a schedule request incentive, as one might expect diminishing marginal utility.

Executive compensation and corporate sustainability: Evidence from ESG ratings.

Selecting A-share listed companies in Shanghai and Shenzhen, China, during the period of 2012-2021 as research subjects, this study examines the relationship and operational mechanisms between executive compensation and corporate ESG Ratings. It is found that executive compensation incentives can significantly enhance corporate ESG Ratings. This effect is achieved through promoting green innovation efficiency, enhancing environmental information disclosure, and improving financial performance. However, this positive impact weakens with an increase in management shareholding, but strengthens with a higher proportion of independent directors. When compensation exceeds appropriate levels, overcompensation leads to a decline in ESG Ratings. The significance of this study lies in revealing potential pathways for enhancing corporate sustainability through executive compensation incentives, while also emphasizing the importance of formulating appropriate compensation strategies.

Linking nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities with migration intent: Structural equation modeling.

AIMS: To investigate how nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities influence their intention to migrate. BACKGROUND: There is a preponderance of studies about nurse migration and its impact on the global nursing workforce. However, a critical gap remains about nursing students' intentions to migrate, particularly among developing countries like the Philippines. METHODS: Using a cross-sectional design, third- and fourth-year nursing students (n = 316) from the largest comprehensive university in Manila were conveniently recruited. Data were collected from November to December 2023 using five validated self-report scales. Descriptive (e.g., mean, standard deviation) and inferential statistics (e.g., Spearman rho, covariance-based structural equation modeling) were used to analyze data. RESULTS: The emerging model demonstrated acceptable model fit indices. Nursing students' professional identity (ß = 0.18, p = 0.043) and financial incentives (ß = 0.10, p = 0.046) significantly and positively influence the intention to migrate. The satisfaction with future career opportunities (ß = -0.12, p = 0.038) and clinical learning environment perception (ß = -0.15, p = 0.048) negatively influence the intention to migrate. These four predictors accounted for 4.60% of the total variance of intention to migrate. CONCLUSION: Nursing students' professional identity and financial incentives directly impact intent to migrate, whereas future career opportunities satisfaction and clinical learning environment inversely affect intent to migrate. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: This study underscores the imperative for nursing colleges and faculty to promote positive professional identity and provide a conducive clinical learning environment to develop sustainable nurses' migration policies.

Paying reviewers and regulating the number of papers may help fix the peer-review process.

The exponential increase in the number of submissions, further accelerated by generative AI, and the decline in the availability of experts are burdening the peer review process. This has led to high unethical desk rejection rates, a growing appeal for the publication of unreviewed preprints, and a worrying proliferation of predatory journals. The idea of monetarily compensating peer reviewers has been around for many years; maybe, it is time to take it seriously as one way to save the peer review process. Here, I argue that paying reviewers, when done in a fair and transparent way, is a viable solution. Like the case of professional language editors, part-time or full-time professional reviewers, managed by universities or for-profit companies, can be an integral part of modern peer review. Being a professional reviewer could be financially attractive to retired senior researchers and to researchers who enjoy evaluating papers but are not motivated to do so for free. Moreover, not all produced research needs to go through peer review, and thus persuading researchers to limit submissions to their most novel and useful research could also help bring submission volumes to manageable levels. Overall, this paper reckons that the problem is not the peer review process per se but rather its function within an academic ecosystem dominated by an unhealthy culture of 'publish or perish'. Instead of reforming the peer review process, academia has to look for better science dissemination schemes that promote collaboration over competition, engagement over judgement, and research quality and sustainability over quantity.

Financial incentives to motivate treatment for hepatitis C with direct acting antivirals among Australian adults (The Methodical evaluation and Optimisation of Targeted IncentiVes for Accessing Treatment of Early-stage hepatitis C: MOTIVATE-C): protocol for a dose-response randomised controlled study.

BACKGROUND: Untreated hepatitis C virus (HCV) infection can result in cirrhosis and hepatocellular cancer. Direct-acting antiviral (DAA) therapies are highly effective and have few side effects compared to older interferon-based therapy. Despite the Australian government providing subsidised and unrestricted access to DAA therapy for chronic HCV infection, uptake has not been sufficient to meet the global target of eliminating HCV as a public health threat by 2030. This study will offer people with HCV financial incentives of varying values in order to evaluate its effect on initiation of DAA therapy in primary care. METHODS: Australian adults (18 years or older) who self-report as having current untreated HCV infection can register to participate via an automated SMS-based system. Following self-screening for eligibility, registrants are offered a financial incentive of randomised value (AUD 0 to 1000) to initiate DAA therapy. Study treatment navigators contact registrants who have consented to be contacted, to complete eligibility assessment, outline the study procedures (including the requirement for participants to consult a primary care provider), obtain consent, and finalise enrolment. Enrolled participants receive their offered incentive on provision of evidence of DAA therapy initiation within 12 weeks of registration (primary endpoint). Balanced randomisation is used across the incentive range until the first analysis, after which response-adaptive randomisation will be used to update the assignment probabilities. For the primary analysis, a Bayesian 4-parameter EMAX model will be used to estimate the dose-response curve and contrast treatment initiation at each incentive value against the control arm (AUD 0). Specified secondary statistical and economic analyses will evaluate the effect of incentives on adherence to DAA therapy, virological response, and cost-effectiveness. DISCUSSION: This project seeks to gain an understanding of the dose-response relationship between incentive value and DAA treatment initiation, while maximising the number of people treated for HCV within fixed budget and time constraints. In doing so, we hope to offer policy-relevant recommendation(s) for the use of financial incentives as a pragmatic, efficient, and cost-effective approach to achieving elimination of HCV from Australia. TRIAL REGISTRATION: ANZCTR (anzctr.org.au), Identifier ACTRN12623000024640, Registered 11 January 2023 ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384923&isReview=true ).

Enhancing Surgical Task Adherence Through a Rewards-Driven Mobile Application: A Single-Arm Intervention Feasibility Study.

INTRODUCTION: Ensuring patients follow preoperative and postoperative instructions is vital for maximizing surgical success. This pilot study investigates the feasibility of using monetary incentives through a nudge engine application-based model of omnichannel communication to prompt adherence to preoperative and postoperative instructions. METHODS: Over a six-month period, we conducted a longitudinal study employing the TheraPay® Rewards app at Maimonides Medical Center in Brooklyn, United States. Our recruitment efforts targeted English and Spanish-speaking patients with smartphones through in-person visits and phone calls. Participants received a $15 credit on a gift card for each completed task. The tasks included preoperative validations such as obtaining primary care physician clearance, completing preoperative assessments, undergoing preoperative scans with accompanying compact disks (CDs), and discontinuing specific medications. Postoperative validations included attending postoperative visits, proper incision care, discontinuation of narcotics at three weeks, and initiation of the first physical therapy session. RESULTS: We enrolled 16 patients with a mean age of 59.5 years (SD 11.68), the majority being male (n = 10, 62.5%). Preoperatively, task completion rates ranged from 83% to 100%. Postoperatively, rates varied from 20% to 100%. Preoperative task adherence averaged at 98.7% (SD 2.2%), while postoperative adherence averaged 60% (SD 21%). CONCLUSION: Our study indicates that financial incentives delivered through a gamified approach effectively encourage patients to complete essential preoperative tasks, suggesting a promise for enhancing adherence. Nonetheless, the decrease in postoperative task adherence highlights the necessity for careful implementation. Future investigations should compare cancellation rates and outcome measures to gain deeper insights into the effectiveness of app-based incentives in improving surgical outcomes and patient adherence.

Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis.

Improving access to primary care physicians' services may help reduce hospitalizations due to Ambulatory Care Sensitive Conditions (ACSCs). Ontario, Canada's most populous province, introduced blended payment models for primary care physicians in the early- to mid-2000s to increase access to primary care, preventive care, and better chronic disease management. We study the impact of payment models on avoidable hospitalizations due to two incentivized ACSCs (diabetes and congestive heart failure) and two non-incentivized ACSCs (angina and asthma). The data for our study came from health administrative data on practicing primary care physicians in Ontario between 2006 and 2015. We employ a two-stage estimation strategy on a balanced panel of 3710 primary care physicians (1158 blended-fee-for-service (FFS), 1388 blended-capitation models, and 1164 interprofessional team-based practices). First, we account for the differences in physician practices using a generalized propensity score based on a multinomial logit regression model, corresponding to three primary care payment models. Second, we use fractional regression models to estimate the average treatment effects on the treated outcome (i.e., avoidable hospitalizations). The capitation-based model sometimes increases avoidable hospitalizations due to angina (by 7 per 100,000 patients) and congestive heart failure (40 per 100,000) relative to the blended-FFS-based model. Switching capitation physicians into interprofessional teams mitigates this effect, reducing avoidable hospitalizations from congestive heart failure by 30 per 100,000 patients and suggesting better access to primary care and chronic disease management in team-based practices.

Contingency Management for Drug Use Disorders: Meta-Analysis and Application of Tolin's Criteria.

Several professional organizations and federal agencies recommend contingency management (CM) as an empirically supported treatment for drug use disorder. However, the release of the "Tolin criteria" warrants an updated recommendation. Using this methodology, five meta-analyses (84 studies, 11,000 participants) were reviewed. Two meta-analyses were rated moderate quality, and three were rated low or critically low quality. Comparator conditions included active treatment, placebo, treatment as usual, and no treatment. The primary outcome was abstinence. Considering only the moderate quality meta-analyses, the effect of CM versus control on posttreatment abstinence was d = 0.54 [0.43, 0.64] and follow-up abstinence was d=0.08 [0.00, 0.16]. A "strong" recommendation was provided for CM as an empirically supported treatment for drug use disorder.

Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study.

BACKGROUND: Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear. OBJECTIVE: This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting. METHODS: We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ≥18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients' experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data. RESULTS: All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox-based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as "being watched" while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82%) to reminders linked to missed doses (7/39, 18%), citing the fact that tuberculosis medication is taken daily. CONCLUSIONS: The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care.

The impact of public demands on local environmental governance performance: Evidence from civil environmental complaints placed on leaders at different government levels in China.

The joint participation of multiple subjects is crucial for environmental governance. Using panel data for 273 Chinese cities during 2013-2019, this study investigates the impact and mechanism of public demands on environmental pollution. The results demonstrate that public demands measured by the number of environmental complaints placed on government leaders significantly reduce environmental pollution. Furthermore, increases in the rate and speed of government responses improve the effect of public demands on environmental governance. Public demands placed on provincial leaders reduce local environmental pollution to a greater extent than public demands placed on prefectural and county leaders. Province-level governments are more willing to consider public opinions and attach more importance to environmental governance; Prefecture-level governments prioritize province-level governments' attention to the environment when implementing environmental governance. Moreover, strong political ties between provincial and prefectural leaders and long tenures among prefectural leaders strengthen the pollution reduction effect of public demands placed on provincial leaders. The reduction effect of environmental complaints on pollution emission is more significant in cities with high level of Internet construction and environmental disclosure. Our results illustrate the role of public demands in environmental governance, offering a reference for developing effective environmental policies.

Using structured problem solving to promote fluid consumption in the prevention of urinary stones with hydration (PUSH) trial.

BACKGROUND: Structured Problem Solving (SPS) is a patient-centered approach to promoting behavior change that relies on productive collaboration between coaches and participants and reinforces participant autonomy. We aimed to describe the design, implementation, and assessment of SPS in the multicenter Prevention of Urinary Stones with Hydration (PUSH) randomized trial. METHODS: In the PUSH trial, individuals with a history of urinary stone disease and low urine output were randomized to control versus a multicomponent intervention including SPS that was designed to promote fluid consumption and thereby prevent recurrent stones. We provide details specifically about training and fidelity assessment of the SPS coaches. We report on implementation experiences related to SPS during the initial conduct of the trial. RESULTS: With training and fidelity assessment, coaches in the PUSH trial applied SPS to help participants overcome barriers to fluid consumption. In some cases, coaches faced implementation barriers such as variable participant engagement that required tailoring their work with specific participants. The coaches also faced challenges including balancing rapport with problem solving, and role clarity for the coaches. CONCLUSIONS: We adapted SPS to the setting of kidney stone prevention and overcame challenges in implementation, such as variable patient engagement. Tools from the PUSH trial may be useful to apply to other health behavior change settings in nephrology and other areas of clinical care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03244189.

Self-Selected Versus Assigned Target to Reduce Smartphone Use and Improve Mental Health: Protocol for a Randomized Controlled Trial.

BACKGROUND: Smartphones have become integral to people's lives, with a noticeable increase in the average screen time, both on a global scale and, notably, in India. Existing research links mobile consumption to sleep problems, poor physical and mental health, and lower subjective well-being. The comparative effectiveness of monetary incentives given for self-selected versus assigned targets on reducing screen time and thereby improving mental health remains unanswered. OBJECTIVE: This study aims to assess the impact of monetary incentives and target selection on mobile screen time reduction and mental health. METHODS: We designed a 3-armed randomized controlled trial conducted with employees and students at an educational institution in India. The study is conducted digitally over 12 weeks, including baseline (2 weeks), randomization (1 week), intervention (5 weeks), and postintervention (4 week) periods. We emailed the employees and students to inquire about their interest in participation. Those who expressed interest received detailed study information and consent forms. After securing consent, participants were asked to complete the initial survey and provide their mobile screen time during the baseline period. At the beginning of the intervention period, the participants were randomly allocated into 1 of 3 study groups in a 2:2:1 ratio (self-selected vs assigned vs control). Participants in the self-selected group were presented with 3 target options: 10%, 20%, and 30%, and they were asked to self-select a target to reduce their mobile screen time from their baseline average mobile screen time. Participants in the assigned group were given a target to reduce their mobile screen time from their baseline average mobile screen time. The assigned target was set as the average of the targets selected by participants in the self-selected group. During the intervention period, participants in the self-selected and assigned group were eligible to receive a monetary incentive of INR (Indian Rupee) 50 (US $0.61) per day for successfully attaining their target. Participants in the control group neither received nor selected a target for reducing their mobile screen time and did not receive any monetary incentives during the intervention period. All participants received information regarding the advantages of reducing mobile screen time. As an incentive, all participants would receive INR 500 (US $6.06) upon completion of the study and a chance to win 1 of 2 lotteries valued at INR 5000 (US $60.55) for consistently sharing their mobile screen time data. RESULTS: Currently, the study intervention is being rolled out. Enrollment occurred between August 21, 2023, and September 2, 2023; data collection concluded in November 2023. We expect that results will be available by early 2024. CONCLUSIONS: The monetary incentives and self-selected versus assigned targets might be effective interventions in reducing mobile screen time among working professionals and students. TRIAL REGISTRATION: AsPredicted 142497; https://aspredicted.org/hr3nn.pdf. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53756.

Low-Income Participants' Preference Between Financial Incentives for Behavioral Goals vs Weight Loss Targets and Associations With Behavioral Goal Adherence.

PURPOSE: Examine associations between whether participants' were matched to their preferred financial incentive design and behavioral goal adherence in a weight management intervention. DESIGN: Secondary quantitative analysis incorporating qualitative survey data. SETTING: Primary care clinics in socioeconomically disadvantaged communities in New York City and Los Angeles. SUBJECTS: 668 participants (mean age 47.7 years, 81.0% female, 72.6% Hispanic) with obesity were enrolled in the Financial Incentives foR Weight Reduction (FIReWoRk) intervention. MEASURES: We explored qualitatively participant's reasons for hypothetically choosing a behavioral goal-directed vs a weight loss outcome-based financial incentive program. Additionally, behavioral adherence to different goals was collected at the 6-month timepoint, categorized by match to preferred financial incentive design. ANALYSIS: Logistic regression was used to examine if participants with certain demographic and higher psychosocial factors were more likely to choose goal-directed over outcome-based incentives. Additionally, logistic regression was used to test for associations between preference and behavioral adherence, using incentive type as an interaction term. RESULTS: 60.2% of participants preferred the goal-directed incentive, with the majority stating that it was more structured. Married participants were more likely to prefer goal-directed incentives (OR = 1.57, CI = 1.06-2.33, P = .025). Moderation analysis revealed that participants who preferred goal-directed and were matched to goal-directed had greater rates of behavioral adherence for program attendance and self-weighing, but not dietary tracking and physical activity tracking, compared to those who preferred outcome-based and were matched to outcome-based. CONCLUSION: Receiving one's preferred incentive design may not play a strong role in behavioral goal adherence during financially incentivized weight loss interventions.

Short- and long-term effects of incentives on prosocial behavior: The case of ride vouchers to a blood collection agency.

This study addresses the challenge of low blood donation rates in developing countries by examining the effectiveness of a barrier-removal incentive-a one-day transportation voucher-to promote blood donation. Utilizing a longitudinal dataset of 23,750 donors from a Brazilian blood collection agency (BCA) collected between March 2018 and May 2020, we examine the short and long-term effects of this campaign on donation rates. Our results show that the incentive had a large positive influence on both donation attempts and successful donations on the day of the campaign. However, the short-term success of the intervention had an unintended consequence: the significant increase in prospective donors' waiting time at the BCA during the intervention day, which may help explain the negative impact on return rates in the 24-month follow-up. Despite these opposing outcomes, the net effect of the one-day blood donation incentive was still positive, offering valuable insights for BCAs aiming to enhance donor recruitment and retention strategies and emphasizing the need to balance immediate benefits with potential long-term impacts.

Rapid review on the incentives of digital health apps for physicians and psychotherapists: A German perspective.

Objective: The Digital Healthcare Act introduced the prescription of digital health applications under specific circumstances in 2019 in Germany. They are funded through the social security system. In market access of prescribed digital health applications, Germany is pioneering the market. There remains a gap in understanding the views of medical professionals on the incentives of using these applications. As prescription of digital health applications starts emerging in other European countries, we sought to generate an overview of incentives and barriers that affect the caregivers in their decision of promoting and prescribing them in Germany. Methods: A Rapid Review of the Web of Science database for the years 2017-2023 was performed using sensitive search strings. Two reviewers conducted a three-phase selection via title, abstract and full-text independently from each other. The quality of studies was assessed systematically by both reviewers. Both quantitative and qualitative studies with primary data were included, and study quality was assessed using a standardised form. Results: Out of 1643 initial results, 12 studies with information from 9302 physicians and psychotherapists were identified. Eight quantitative and four qualitative studies were included in the analysis. Key findings suggest that while between 40% and 60% of caregivers see relevant incentives mainly based on patients' benefits, 20-40% see relevant barriers. For the physicians' daily work, there were slightly more barriers than incentives identified in the quantitative synthesis. The qualitative studies revealed no relevant incentives that were not attributed to patients. Conclusion: While digital health solutions offer promising avenues for enhancing patient care, their acceptance among healthcare professionals hinges on addressing prevailing concerns. Continuous research and dialogues with the medical community are pivotal to harness the full potential of digital health applications in healthcare.

The substitution effect of financial and non-financial incentives at different income levels in physician recruitment: evidence from medical students in China.

BACKGROUND: Understanding how medical students respond to financial and non-financial incentives is crucial for recruiting health workers and attracting health talents in medical education. However, both incentives are integrated in working practice, and existing theoretical studies have suggested that various income levels may influence the substitution effect of both incentives, while the empirical evidence is lacking. Furthermore, little attention has been paid to the intrinsic motivation. This study aimed to explore the substitution effect of extrinsic incentives at different income levels, also taking intrinsic altruism into account. METHODS: We used the behavioral data from Zhang et al.'s experiments, which involved discrete choice experiments (DCEs) to assess the job preferences of medical students from six teaching hospitals in Beijing, China. The incentive factors included monthly income, work location, work environment, training and career development opportunities, work load, and professional recognition. Additionally, a lab-like experiment in the medical decision-making context was conducted to quantify altruism based on utility function. Furthermore, we separated the choice sets based on the actual income and distinguished the medical students on altruism. The willingness to pay (WTP) was used to estimate the substitution effect of incentives through conditional logit model. RESULTS: There was a significant substitution effect between non-financial and financial incentives. As income increased, non-financial incentives such as an excellent work environment, and sufficient career development became relatively more important. The impact of the increase in income on the substitution effect was more pronounced among individuals with higher altruism. Concerning the non-financial incentive work environment, in contrast to the growth of 546 CNY (84 USD) observed in the low-altruism group, the high-altruism group experienced a growth of 1040 CNY (160 USD) in the substitution effect. CONCLUSIONS: The increase in the income level exerted an influence on the substitution effect of non-financial incentives and financial incentives, especially in high-altruism medical students. Policymakers should attach importance to a favorable environment and promising career prospects on the basis of ensuring a higher income level. Medical school administrations should focus on promoting altruistic values in medical education, enhancing talent incentives and teaching strategies to encourage medical students to devote themselves to the medical professions.

A comparative study of factors influencing residents' waste sorting behavior in urban and rural areas of China.

Extensive research has been conducted on the waste sorting behavior (WSB) of residents, while it is the first time that the classification behavior of urban and rural residents is compared under the same theoretical framework in China. Based on questionnaire data from 478 urban and rural residents, structural equation modeling (SEM) was used to investigate the internal factors influencing the WSB by integrating the Theory of Planned Behavior (TPB) and the Norm Activation Model (NAM). Hierarchical regression analysis was utilized to investigate the moderating effect of external factors on the residents' intentions and behavior. The results show that the degree of deviation between rural residents' intentions and behavior is much larger than that of urban residents. Personal norms are the key factors affecting urban residents' waste sorting. In contrast, for rural residents, attitude is the most critical factor, but the influence of subjective norms is insignificant. In addition, we found that policy restraints and economic incentives significantly moderate the association between urban residents' sorting intention and behavior, with economic incentives having a better effect than policy restraints. In contrast, the impact of policy restraints on rural residents is better than that of urban areas. However, the moderating effect of economic incentives is insignificant for rural residents. The findings furnish the government with meaningful strategies to narrow the urban-rural waste management gap.