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Wandering is a symptom of dementia that can have devastating consequences on the lives of persons living with dementia and their families and caregivers. Increasingly, caregivers are turning towards electronic tracking devices to help manage wandering. Ethical questions have been raised regarding these location-based technologies and although qualitative research has been conducted to gain better insight into various stakeholders' views on the topic, developers of these technologies have been largely excluded. No qualitative research has focused on developers' perceptions of ethics related to electronic tracking devices. To address this, we performed a qualitative semi-structured interview study based on grounded theory. We interviewed 15 developers of electronic tracking devices to better understand how they perceive ethical issues surrounding the design, development, and use of these devices within dementia care. Our results reveal that developers are strongly motivated by moral considerations and believe that including stakeholders throughout the development process is critical for success. Developers felt a strong sense of moral obligation towards topics within their control and a weaker sense of moral obligation towards topics outside their control. This leads to a perceived moral boundary between development and use, where some moral responsibility is shifted to end-users., (© 2024. The Author(s).)

Background: Intervention trials promoting physical activity among older people frequently report low and unrepresentative recruitment. Better understanding of reasons for participation can help improve recruitment. This study explored why participants enrolled in the Coaching for Healthy Ageing (CHAnGE) trial, including how their decision was influenced by recruitment strategies. CHAnGE was a cluster randomised controlled trial testing the effectiveness of a healthy ageing program targeting inactivity and falls. Seventy-two groups of people aged 60+ were recruited from community organisations via informal presentations by the health coaches., Methods: We conducted a secondary thematic analysis of interview data from our wider qualitative evaluation in which 32 purposively sampled trial participants took part in semi-structured interviews about their experiences of CHAnGE. Data relating to recruitment and participation were analysed inductively to identify themes, then a coding framework comprising the core constructs from self-determination theory-autonomy, competence and relatedness-was used to explore if and how this theory fit with and helped to explain our data., Results: Recruitment presentations promoted the CHAnGE intervention well in terms of addressing value expectations of structured support, different forms of accountability, credibility, achievability and, for some, a potential to enhance social relationships. Participation was motivated by the desire for improved health and decelerated ageing, altruism and curiosity. These factors related strongly to self-determination concepts of autonomy, competence and relatedness, but the intervention's demonstrated potential to support self-determination needs could be conveyed more effectively., Conclusions: Findings suggest that recruitment could have greater reach using: 1. Strengths-based messaging focusing on holistic gains, 2. Participant stories that highlight positive experiences, and 3. Peer support and information sharing to leverage altruism and curiosity. These theory-informed improvements will be used to increase participation in future trials, including people in hard-to-recruit groups. They may also inform other physical activity trials and community programs., Competing Interests: The authors have declared that no competing interests exist.

Importance: Incentivizing research participation is controversial and variably regulated because of uncertainty regarding whether financial incentives serve as undue inducements by diminishing peoples' sensitivity to research risks or unjust inducements by preferentially increasing enrollment among underserved individuals., Objective: To determine whether incentives improve enrollment in real randomized clinical trials (RCTs) or serve as undue or unjust inducements., Design, Setting, and Participants: Two RCTs of incentives that were embedded in 2 parent RCTs, 1 comparing smoking cessation interventions (conducted at smoking cessation clinics in 2 health systems) and 1 evaluating an ambulation intervention (conducted across wards of the Hospital of the University of Pennsylvania) included all persons eligible for the parent trials who did not have prior knowledge of the incentives trials. Recruitment occurred from September 2017 to August 2019 for the smoking trial and January 2018 through May 2019 for the ambulation trial; data were analyzed from January 2020 to July 2020., Interventions: Patients were randomly assigned to incentives of $0, $200, or $500 for participating in the smoking cessation trial and $0, $100, or $300 for the ambulation trial., Main Outcomes and Measures: The primary outcome of each incentive trial was the proportion of people assigned to each recruitment strategy that consented to participate. Each trial was powered to test the hypotheses that incentives served neither as undue inducements (based on the interaction between incentive size and perceived research risk, as measured using a 10-point scale, on the primary outcome), nor unjust inducements (based on the interaction between incentive size and participants' self-reported income). Noninferiority methods were used to test whether the data were compatible with these 2 effects of incentives and superiority methods to compare the primary and other secondary outcomes., Results: There were a total of 654 participants (327 women [50.0%]; mean [SD] age, 50.6 [12.1] years; 394 Black/African American [60.2%], 214 White [32.7%], and 24 multiracial individuals [3.7%]) in the smoking trial, and 642 participants (364 women [56.7%]; mean [SD] age, 46.7 [15.6] years; 224 Black/African American [34.9%], 335 White [52.2%], and 5 multiracial individuals [0.8%]) in the ambulation trial. Incentives significantly increased consent rates among those in the smoking trial in 47 of 216 (21.8%), 78 of 217 (35.9%), and 104 of 221 (47.1%) in the $0, $200, and $500 groups, respectively (adjusted odds ratio [aOR] for each increase in incentive, 1.70; 95% CI, 1.34-2.17; P < .001). Incentives did not increase consent among those in the ambulation trial: 98 of 216 (45.4%), 102 of 212 (48.1%), and 92 of 214 (43.0%) in the $0, $100, and $300 groups, respectively (aOR, 0.88; 95% CI, 0.64-1.22; P = .45). In neither trial was there evidence of undue or unjust inducement (upper confidence limits of ORs for undue inducement, 1.15 and 0.99; P < .001 showing noninferiority; upper confidence limits of ORs for unjust inducement, 1.21 and 1.26; P = .01 and P < .001, respectively). There were no significant effects of incentive size on the secondary outcomes in either trial, including time spent reviewing the risk sections of consent forms, perceived research risks, trial understanding, perceived coercion, or therapeutic misconceptions., Conclusions and Relevance: In these 2 randomized clinical trials, financial incentives increased trial enrollment in 1 of 2 trials and did not produce undue or unjust inducement or other unintended consequences in either trial., Trial Registration: ClinicalTrials.gov Identifier: NCT02697799.

Recent evidence suggests that vaccination hesitancy is too high in many countries to sustainably contain COVID-19. Using a factorial survey experiment administered to 20,500 online respondents in Germany, we assess the effectiveness of three strategies to increase vaccine uptake, namely, providing freedoms, financial remuneration, and vaccination at local doctors. Our results suggest that all three strategies can increase vaccination uptake on the order of two to three percentage points (PP) overall and five PP among the undecided. The combined effects could be as high as 13 PP for this group. The returns from different strategies vary across age groups, however, with older cohorts more responsive to local access and younger cohorts most responsive to enhanced freedoms for vaccinated citizens., Competing Interests: The authors declare no competing interest., (Copyright © 2021 the Author(s). Published by PNAS.)

Based on the investigation of financial fairness perception and donation intention of individual donors in non-profit organizations (NPOs), this paper uses structural equation model to analyze the impact of individual donors' financial fairness perception on donation intention. The results show that individual donors' perceptions on financial result fairness, financial procedure fairness and financial information fairness all have positive impact on donation intention; among which the perception on financial result fairness only has direct impact on individual donation intention, while the perceptions on financial procedure fairness and financial information fairness have direct and indirect impact on individual donation intention., Competing Interests: These no potential competing interests in our paper. And all authors have seen the manuscript and approved to submit to your journal. We confirm that the content of the manuscript has not been published or submitted for publication elsewhere.

We argue that we should provide extra payment not only for extra time worked but also for the extra risks healthcare workers (and those working in healthcare settings) incur while caring for COVID-19 patients-and more generally when caring for patients poses them at significantly higher risks than normal. We argue that the extra payment is warranted regardless of whether healthcare workers have a professional obligation to provide such risky healthcare. Payment for risk would meet four essential ethical requirements. First, assuming healthcare workers do not have a professional obligation to take on themselves the risks, payments in the form of incentives would preserve autonomy in deciding what risks to take on oneself. Second, even assuming that healthcare workers do have a professional obligation to take on themselves the risks, payments for risk would create fair working conditions by avoiding exploitation. Third, payments for risk would make it more likely that public healthcare systems can discharge their institutional responsibility to provide healthcare in circumstances where healthcare workers may otherwise (perhaps legitimately) opt out. Fourth, payments for risk would guarantee an efficient healthcare system in pandemic situations. Finally, we address two likely objections that some might raise against our proposal, particularly with regard to incentives, namely that such payments or incentives can themselves be coercive and that they represent a form of undue inducement., (© 2021 The Authors. Bioethics published by John Wiley & Sons Ltd.)

We use survey data collected from 12,037 US respondents to examine the extent to which the American public believes that political motives drive the manner in which scientific research is conducted and assess the impact that such beliefs have on COVID-19 risk assessments. We find that this is a commonly held belief and that it is negatively associated with risk assessments. Public distrust in scientists could complicate efforts to combat COVID-19, given that risk assessments are strongly associated with one's propensity to adopt preventative health measures., Competing Interests: The authors have declared that no competing interests exist.

Abstract: In the last decade, many health organizations have embarked on a revolution in clinical communication. Using electronic devices, patients can now gain rapid access to their online clinical records. Legally, patients in many countries already have the right to obtain copies of their health records; however, the practice known as "open notes" is different. Via secure online health portals, patients are now able to access their test results, lists of medications, and the very words that clinicians write about them. Open notes are growing with most patients in the Nordic countries already offered access to their full electronic record. From April 2021, a new federal ruling in the United States mandates-with few exemptions-that providers offer patients access to their online notes (Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Available at: https://www.govinfo.gov/content/pkg/FR-2019-03-04/pdf/2019-02224.pdf#page=99). Against these policy changes, only limited attention has been paid to the ethical question about whether patients with mental health conditions should access their notes, as mentioned in the articles by Strudwick, Yeung, and Gratzer (Front Psychiatry 10:917, 2019) and Blease, O'Neill, Walker, Hägglund, and Torous (Lancet Psychiatry 7:924-925, 2020). In this article, our goal is to motivate further inquiry into opening mental health notes to patients, particularly among persons with serious mental illness and those accessing psychological treatments. Using biomedical ethical principles to frame our discussion, we identify key empirical questions that must be pursued to inform ethical practice guidelines., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Previous research shows that countries with opt-out consent systems for organ donation conduct significantly more deceased-donor organ transplantations than those with opt-in systems. This paper investigates whether the higher transplantation rates in opt-out systems translate into equally lower death rates among organ patients registered on a waiting list (i.e., organ-patient mortality rates). We show that the difference between consent systems regarding kidney- and liver-patient mortality rates is significantly smaller than the difference in deceased-donor transplantation rates. This is likely due to different incentives between the consent systems. We find empirical evidence that opt-out systems reduce incentives for living donations, which explains our findings for kidneys. The results imply that focusing on deceased-donor transplantation rates alone paints an incomplete picture of opt-out systems' benefits, and that there are important differences between organs in this respect., Competing Interests: The authors have declared that no competing interests exist.

Academic journals provide a key quality-control mechanism in science. Yet, information asymmetries and conflicts of interests incentivize scientists to deceive journals about the quality of their research. How can honesty be ensured, despite incentives for deception? Here, we address this question by applying the theory of honest signaling to the publication process. Our models demonstrate that several mechanisms can ensure honest journal submission, including differential benefits, differential costs, and costs to resubmitting rejected papers. Without submission costs, scientists benefit from submitting all papers to high-ranking journals, unless papers can only be submitted a limited number of times. Counterintuitively, our analysis implies that inefficiencies in academic publishing (e.g., arbitrary formatting requirements, long review times) can serve a function by disincentivizing scientists from submitting low-quality work to high-ranking journals. Our models provide simple, powerful tools for understanding how to promote honest paper submission in academic publishing., Competing Interests: We note that Simine Vazire is a member of the PLOS Board of Directors and that Leonid Tiokhin and Daniel Lakens are co-founders of Red Team Market. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Mandatory vaccination, including for COVID-19, can be ethically justified if the threat to public health is grave, the confidence in safety and effectiveness is high, the expected utility of mandatory vaccination is greater than the alternatives, and the penalties or costs for non-compliance are proportionate. I describe an algorithm for justified mandatory vaccination. Penalties or costs could include withholding of benefits, imposition of fines, provision of community service or loss of freedoms. I argue that under conditions of risk or perceived risk of a novel vaccination, a system of payment for risk in vaccination may be superior. I defend a payment model against various objections, including that it constitutes coercion and undermines solidarity. I argue that payment can be in cash or in kind, and opportunity for altruistic vaccinations can be preserved by offering people who have been vaccinated the opportunity to donate any cash payment back to the health service., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Relational aspects, such as involvement of donor's relatives or friends in the decision-making on participation in a research biobank, providing relatives' health data to researchers, or sharing research findings with relatives should be considered when reflecting on ethical aspects of research biobanks. The aim of this paper is to explore what the role of donor's relatives and friends is in the process of becoming and being a biobank donor and which ethical issues arise in this context. We performed qualitative analysis of 40 qualitative semi-structured interviews with biobank donors and researchers. The results show that relatedness to relatives or other types of close relationships played a significant role in the donors' motivation to be involved in a biobank, risk-benefit assessment, and decisions on sharing information on research and its results. Interviewees mentioned ethical issues in the context of sharing relatives' health-related data for research purposes and returning research findings that may affect their relatives. We conclude that the question of what information on family members may be shared with a biobank by research participants without informed consent of those relatives, and when family members become research subjects, lacks a clear answer and detailed guidelines, especially in the context of the introduction of the European Union's (EU) General Data Protection Regulation. Researchers in Latvia and EU face ethical questions and dilemmas about returning research results and incidental findings to donors' relatives, and donors need more information on sharing research results with relatives in the informed consent process., Competing Interests: The authors have declared that no competing interests exist.

Academic dishonesty is a common problem at universities around the world, leading to undesirable consequences for both students and the education system. To effectively address this problem, it is necessary to identify specific predispositions that promote cheating. In Polish undergraduate students (N = 390), we examined the role of psychopathy, achievement goals, and self-efficacy as predictors of academic dishonesty. We found that the disinhibition aspect of psychopathy and mastery-goal orientation predicted the frequency of students' academic dishonesty and mastery-goal orientation mediated the relationship between the disinhibition and meanness aspects of psychopathy and dishonesty. Furthermore, general self-efficacy moderated the indirect effect of disinhibition on academic dishonesty through mastery-goal orientation. The practical implications of the study include the identification of risk factors and potential mechanisms leading to students' dishonest behavior that can be used to plan personalized interventions to prevent or deal with academic dishonesty., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Incentivising vaccine consent form return may improve vaccine uptake and be seen as less coercive than incentivising vaccination itself. We assessed the acceptability of financial incentives in this context among adolescent females and explored potential mechanisms by which incentives might change behaviour., Design: Focus groups and analysis of free-text questionnaire responses., Methods: Study 1: 36 female secondary students in London (age 13-14) participated in six focus groups exploring the use of incentives in the context of vaccination. Data were analysed thematically. Study 2: was conducted to triangulate the findings of Study 1, by analysing free-text questionnaire responses from 181 female secondary students in London (age 12-13) reporting their opinion of incentivising consent form return. Data from Study 1 was also used to explore perceived potential mechanisms of action by which incentives might encourage consent form return., Results: Focus group participants had positive attitudes towards incentives, with 61% of free-text responses also expressing this. Most focus group participants thought that incentives would encourage consent form return (18% of free-text respondents spontaneously also mentioned this). While incentivising consent form return was seen as ethical, focus group participants who incorrectly thought that vaccine receipt was being incentivised raised concerns about bribery, although only 4% of free text respondents reported these concerns. Frequently raised mechanisms of action included incentives increasing engagement with, and the perceived value of consent form return., Conclusions: Adolescents had positive views of financially incentivising consent form return to promote vaccine uptake, although care must be taken to reduce misconceptions regarding what is being incentivised. Incentivising vaccination was seen as coercive, but incentivising actions that increase the likelihood of vaccination (i.e. consent form return) were not. Incentives may encourage adolescents to return consent forms by helping them engage with this behaviour or increasing its' perceived value., Competing Interests: The authors have declared that no competing interests exist.

Family planning programmes in India have historically been target-driven and incentive-based with sterilisation seen as a key component of controlling population growth. This opinion paper uses India as the backcloth to examine the ethics of using incentive policy measures to promote and secure sterilisations within communities. Whilst we acknowledge that these measures have some value in reproductive health care, their use raises specific issues and wider concerns where the outcome is likely to be permanent and life changing for the acceptor.

Trials are in development and underway to examine potential interventions for treatment and prophylaxis of coronavirus disease 2019 (COVID-19). How should we think about offering payment to participants in these trials? Payment for research participation is ethically contentious even under ideal circumstances. Here, we review 3 functions of research payment-reimbursement, compensation, and incentive-and identify heightened and novel ethical concerns in the context of a global pandemic. We argue that COVID-19 trial participants should usually be offered reimbursement for research-related expenses, and compensation for their time and effort, as for other types of research under usual circumstances. Given increased risk of undue influence against pandemic background conditions, incentive payment should be avoided unless essential to recruitment and retention in important trials whose social value outweighs this risk. Where essential, however, incentives can be ethically permissible, so long as reasonable efforts are made to minimize the possibility of undue influence., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Conditional cash transfer (CCT) is a compelling policy alternative for reducing poverty and improving health, and its effectiveness is promising. CCT programmes have been widely deployed across geographical, economic and political contexts, but not without contestation. Critics argue that CCTs may result in infringements on freedom and dignity, gender discrimination and disempowerment and power imbalances between programme providers and beneficiaries. In this analysis, we aim to identify the ethical concepts applicable to CCTs and to contextualize these by mapping the tensions of the debate, allowing us to understand the separate contributions as parts of a larger whole. We searched a range of databases for records on public health CCT. Strategies were last run in January 2017. We included 31 dialectical articles deliberating the ethics of CCTs and applied a meta-ethnographic approach. We identified 22 distinct ethical concepts. By analysing and mapping the tensions in the discourse, the following four strands of debate emerged: (1) responsibility for poverty and health: personal vs public duty, (2) power balance: autonomy vs paternalism, (3) social justice: empowerment vs oppression and (4) marketization of human behaviour and health: 'fair trade' vs moral corruption. The debate shed light on the ethical ideals, principles and doctrines underpinning CCT. These were consistent with a market-oriented liberal welfare regime ideal: privatization of public responsibilities; a selective rather than a universal approach; empowerment by individual entrepreneurship; marketization of health with a conception of human beings as utility maximizing creatures; and limited acknowledgement of the role of structural injustices in poverty and health. Identification of key tensions in the public health ethics debate may expose underpinning ideological logics of health and social programmes that may be at odds with public values and contemporary political priorities. Decisions about CCTs should therefore not be considered a technical exercise, but a context-dependent process requiring transparent, informed and deliberative decision-making., (© The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Importance: The strongest evidence for the effectiveness of Medicare's Hospital Readmissions Reduction Program (HRRP) involves greater reductions in readmissions for hospitals receiving penalties compared with those not receiving penalties. However, the HRRP penalty is an imperfect measure of hospitals' marginal incentive to avoid a readmission for HRRP-targeted diagnoses., Objectives: To assess the association between hospitals' condition-specific incentives and readmission performance and to examine the responsiveness of hospitals to condition-specific incentives compared with aggregate penalty amounts., Design, Setting, and Participants: This retrospective cohort analysis used Medicare readmissions data from 2823 US short-term acute care hospitals participating in HRRP to compare 3-year (fiscal years 2016-2019) follow-up readmission performance according to tertiles of hospitals' baseline (2016) marginal incentives for each of 5 HRRP-targeted conditions (acute myocardial infarction, heart failure, chronic obstructive pulmonary disease, pneumonia, and hip and/or knee surgery)., Main Outcomes and Measures: Linear regression models were used to estimate mean change in follow-up readmission performance, measured using the excess readmissions ratio, with baseline condition-specific incentives and aggregate penalty amounts., Results: Of 2823 hospitals that participated in the HRRP from baseline to follow-up, 2280 (81%) had more than 1 excess readmission for 1 or more applicable condition and 543 (19%) did not have any excess readmissions. The mean (SD) financial incentive to reduce readmissions for incentivized hospitals ranged from $8762 ($3699) to $58 158 ($26 198) per 1 avoided readmission. Hospitals with greater incentives for readmission avoidance had greater decreases in readmissions compared with hospitals with smaller incentives (45% greater for pneumonia, 172% greater for acute myocardial infarction, 40% greater for hip and/or knee surgery, 32% greater for chronic obstructive pulmonary disease, and 13% greater for heart failure), whereas hospitals with no incentives had increases in excess readmissions of 4% to 7% (median, 4% [percentage change for nonincentivized hospitals was 3.7% for pneumonia, 4.2% for acute myocardial infarction, 7.1% for hip and/or knee surgery, 3.7% for chronic obstructive pulmonary disease, and 3.7% for heart failure]; P < .001). During the study period, each additional $5000 in the incentive amount was associated with a 0.6- to 1.3-percentage point decrease, or up to a 26% decrease, in excess readmissions (P < .001). Regression to the mean explained approximately one-third of the results depending on the condition examined., Conclusions and Relevance: The findings suggest that improvements in readmission avoidance are more strongly associated with incentives from the HRRP than with aggregate penalty amounts, suggesting that the program has elicited sizeable changes. Worsened performance among hospitals with small or no incentives may indicate the need for reconsideration of the program's lack of financial rewards for high-performing hospitals.

Punishment aims to deter individuals' selfish behaviors, but it can occasionally backfire. Some scholars have proposed promoting prosocial behaviors using punishment that communicates positive social norms because it provides additional motivation. However, it is unclear which factors affect the norm expressive function of punishment. This study proposes that third-party punishment communicates more positive normative information, and thus, promotes more prosocial behavior in observers than does second-party punishment. Using dictator games, we investigated the effects of second-party punishment compared to third-party punishment of another's unfair sharing on observers' norm perceptions and subsequent sharing decision-making. Two experiments consistently found that third-party punishment was more effective than second-party punishment at inducing observers' beliefs that unfair distribution was unusual (descriptive norm) and unacceptable (injunctive norm). The altered descriptive but not injunctive norm perception further guided individuals' own sharing behaviors. Taken together, these results suggest that third-party punishment might be better than second-party punishment at decreasing selfish behaviors by shaping individuals' norm perceptions, especially descriptive norm perception, regarding the relevant behaviors., Competing Interests: The authors have declared that no competing interests exist.

Background: The sterile processing of surgical instruments and equipment is an essential part of surgical operations. Although clean instruments prevent infections, little is known about the departments that conduct this work. We sought to describe sterile processing departments (SPDs) and to identify factors impacting them., Methods: We analyzed data from 22 qualitative interviews of staff and managers and a quantitative benchmarking database., Results: Qualitative results indicated 4 primary factors impacting sterile processing work: (1) role and visibility, (2) relationships and communication with other departments and vendors, (3) staffing and management, and (4) technical problems and solutions. Quantitative analysis revealed significant differences in SPD responsibilities and scope., Discussion: Relationships with operating room staff were of paramount importance in the ability of the SPD to accomplish its job and in staff motivations and feelings. Differences in management practices, communication strategies, and problem-solving resources were also emphasized. Both quantitative and qualitative data showed concern for the role of the SPD in patient safety, particularly concerning practices such as the use of immediate-use steam sterilization., Conclusions: To more completely address adverse patient events and surgical patient safety, we must move toward examining the entire surgical process, including the vital role of SPDs., (Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Decision making requires consideration of both the benefits of a given choice and the costs, which can include risk, delay, and effort. Previous research has examined the developmental trajectory of adolescent decision making regarding risk and delay; however, the effects of effort on adolescent decision making remain largely unexplored. In the present study, we pilot tested a novel, developmentally-appropriate task designed to examine developmental differences in the willingness to expend effort during goal pursuit in adolescents (ages 13-16, n = 23) versus young adults (ages 18-23, n = 25). Self-reported reward responsivity correlated with task-related parameter estimates for effort and reward, providing evidence of task validity. Adolescents exhibited reduced sensitivity to physical effort costs compared to adults, effects which did not appear to be driven by differences in subjective task motivation or awareness of the effort requirements. These findings provide preliminary evidence that adolescence may be a time of increased willingness to expend effort during goal pursuit. Effort-based decision making is an understudied but exciting avenue for developmental research, as the willingness to engage in effortful pursuit of new experiences during adolescence may help to facilitate the path to independence., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Some fundamental biotechnologies hold unprecedented potential to eradicate many incurable diseases. However, in absence of regulations, the power of patent makes the future use of some important biotechnology in few institution's hands. The excessive patents restrict researcher access to the fundamental technologies. It generates concerns and complaints of deteriorating the public health and social welfare. Furthermore, intellectual curiosities, funding, respect among colleagues etc., rather than patents, are the real motivations driving a major ground-breaking discoveries in biotechnology. These phenomena reveal that some biotechnology patents are alienated from the purpose of patent system. Therefore, it is necessary to take some approaches to stop over-patenting these fundamental biotechnology inventions. This article proposes a model regulatory framework for controlling biotechnology patent alienating from the purpose of patent system.

Objective: To compare the expectations of urology trainees with the experience of practicing urologists., Methods: Residents, fellows, and practicing urologists were surveyed in 2018 regarding weekly work hours, number of hospitals covered, call nights per week, administrative workload relative to residency, annual net income, and time to pursue personal interests and hobbies. Urology trainees, defined as residents and fellows, were also surveyed regarding their expectations for clinical practice. The expectations of trainees were compared with the reported experience of practicing urologists using 1-tailed t test and chi-square analysis. Trainee expectations were also stratified by age, gender, training level, relationship status, and whether trainees had dependent children., Results: The expectations of 99 trainees were compared with the reported experience of 377 practicing urologists. Trainees expect to work more hours but less call nights per week than reported by practicing urologists while annual net income was either consistent or underestimated. Compared to practicing urologists, however, trainees appear to underestimate the administrative workload relative to residency and overestimate time to pursue personal interests and hobbies. Junior residents were more likely to underestimate administrative workload than senior residents and fellows., Conclusion: While the expectations of urology trainees for work hours and annual net income were fairly consistent with those reported by practicing urologists, trainees may underestimate administrative workload and overestimate time to pursue personal interests and hobbies., (Copyright © 2019 Elsevier Inc. All rights reserved.)

According to the mainstream conception of research involving human participants, researchers have been trained scientists acting within institutions and have been the individuals doing the studying, while participants, who are nonscientist members of the public, have been the individuals being studied. The relationship between the public and scientists is evolving, however, giving rise to several new concepts, including crowdsourcing and citizen science. In addition, the practice of gamification has been applied to research protocols. The role of gamified, crowdsourced citizen scientist is new in the domain of scientific research and does not fit into the existing taxonomy of researchers and participants. We delineate and explicate this role and show that, while traditional roles are governed by well-established norms and regulations, individuals engaged in gamified, crowdsourced citizen science-gamers-fall through the cracks of research protections and regulations. We consider the issues this raises, including exploitation and the absence of responsibility and accountability. Finally, we offer suggestions for how the current lack of appropriate norms may be rectified., (© 2019 The Hastings Center.)

In this paper, I present and criticize Ted Kaczynski's ("The Unabomber") theory that industrialization has been terrible for humanity, and that we should use any means necessary, including violent means, to induce a return to pre-industrial ways of living. Although Kaczynski's manifesto, Industrial society and its future, has become widely known, his ideas have never before been subject to careful philosophical criticism. In this paper I show how Kaczynski's arguments rely on a number of highly implausible philosophical premises. I further make the case that, although his theory as a whole should be rejected, Kaczynski raises a number of worries about technological development that ought to receive serious attention. Some of these worries have recently come to be shared by prominent defenders of human enhancement, including Nick Bostrom and Julian Savulescu. In the last section I indicate why I believe it is important that academic philosophers scrutinize ideas that motivate acts of violence., (© 2018 John Wiley & Sons Ltd.)

Background: Drug companies rely on their marketing activities to influence physicians. Previous studies showed that pharmaceutical companies succeeded to manage physicians prescribing behavior in developed countries. However, very little studies investigated the impact of pharmaceutical marketing strategies on prescribing pattern in developing countries, middle-eastern countries. The objective of this research was to examine the influence of drug companies' strategies on physicians' prescription behavior in the Lebanese market concerning physicians' demographic variables quantitatively. Moreover, this study tested whether Lebanese physicians considered gifts and samples acceptance as an ethical practice., Methods: Sampling was done by using a non-probability method. An online cross-sectional study was conducted through WhatsApp. A self-administered questionnaire survey was conducted during the months of February and March 2018. Cronbach's Alpha reliability coefficient was calculated. Data were statistically analyzed by using IBM SPSS statistics version 24 software. Chi-square and Cramer's v tests were used to finding sign correlation, and Spearman test was used to measure the strength and direction of a relationship between variables., Results: Results found that pharmaceutical marketing strategies are correlated to physicians' prescribing behavior. We demonstrated that the majority of the promotional tools tested were mostly or sometimes motivating physicians to prescribe promoted drugs. The major tools that physicians agreed to be mostly motivated by are visits of medical representatives and drug samples while sales calls made by pharmaceutical companies are the less influential tool. Regarding gift acceptance, this study demonstrated that physicians consider gifts' acceptance as a non-ethical practice. Results showed that most physicians use free samples to treat their patients. We demonstrated that there is a relationship between physicians' prescribing pattern and their age, gender and the location of practice., Conclusions: Findings of this study provided an insightful work, serving as one of the first humble steps in the imminent direction of merging this paper with the previous literature. From a managerial perspective, pharmaceutical marketing managers of drug companies can use the research findings to design better their strategies directed to the Lebanese physicians who can also benefit from the results obtained.

The percentage of protesters in contingent valuation surveys is substantial-about 20% across many studies. This paper seeks to clarify the motivations behind protest responses. In addition, the question whether the estimation of willingness to pay (WTP) is more biased by the exclusion or inclusion of protest bids is yet undecided. Methodological improvements are difficult for three reasons: motivations behind protest responses are largely unclear, definitions of protest differ between studies and often only participants who state a zero WTP are asked for their reasons. Our survey on farm animal welfare (n = 1335) provides detailed motivations, two definitions and includes debriefing of all participants for their WTP. We find that protest bids are not a refusal to answer, they are neither irrational nor driven by lack of understanding. Quite the contrary, a large part of participants is directly motivated by moral reasons. Furthermore, protest responses are not coupled to a zero WTP. In our sample, only 8% out of 32% protesting participants had a zero WTP. Only a small fraction of zero bids (0.4%) are true WTP-statements, i.e. respondents were satisfied with the status quo. This finding has important implications for existing WTP-estimates which might be biased. Finally, we provide detailed estimates of the WTP for animal welfare issues by including and excluding different types of protesters and outliers., Competing Interests: The authors have declared that no competing interests exist.

Citizen science, a diverse enterprise involving multiple processes, participants, and projects, challenges conventional approaches to thinking about science and the issues it raises. This commentary explores three key themes identified in the accompanying narratives. (1) Motivated volunteers may serve as novel resources for science, allowing projects to proceed in ways that are cheaper and more accessible than previously considered. (2) Traditional scientific approaches may be insufficient to even identify research questions, much less attempt to address issues. Citizen science may fill that gap. (3) Ethical concepts may have unique applications in this burgeoning field, both due to the emergence of novel ethical issues and to new categories of people, places, and things inherent in the conduct of citizen science. The commentary closes with suggestions for moving forward as citizen science becomes the norm rather than the exception.

Introduction: The most common and conceptually sound ethical concerns with financial incentives for research participation are that they may (1) represent undue inducements by blunting peoples' perceptions of research risks, thereby preventing fully informed consent; or (2) represent unjust inducements by encouraging enrollment preferentially among the poor. Neither of these concerns has been shown to manifest in studies testing the effects of incentives on decisions to participate in hypothetical randomized clinical trials (RCTs), but neither has been assessed in real RCTs., Methods and Analyses: We are conducting randomized trials of real incentives embedded within two parent RCTs. In each of two trials conducted in parallel, we are randomizing 576 participants to one of three incentive groups. Following preliminary determination of patients' eligibility in the parent RCT, we assess patients' research attitudes, demographic characteristics, perceived research risks, time spent reviewing consent documents, ability to distinguish research from patient care, and comprehension of key trial features. These quantitative assessments will be supplemented by semi-structured interviews for a selected group of participants that more deeply explore patients' motivations for trial participation. The trials are each designed to have adequate power to rule out undue and unjust inducement. We are also exploring potential benefits of incentives, including possible increased attention to research risks and cost-effectiveness., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective:  We have evaluated the prevalence of and the motivating factors behind the refusal to provide reproductive health services and the ethical knowledge of the subject among medical students from the Escola Bahiana de Medicina e Saúde Pública, in the state of Bahia, Brazil., Methods:  The present cross-sectional study involved 120 medical students. A questionnaire was utilized. The dependent variables were students' objections (or not) regarding three clinical reproductive health cases: abortion provided by law, contraceptive guidance to an adolescent without parental consent, and prescription of emergency contraception. The independent variables were age, gender, religion, ethical value, degree of religiosity, and attendance at worship services. Ethical knowledge comprised an obligation to state the reasons for the objection, report possible alternatives, and referral to another professional. Data were analyzed with χ 2 tests and t -tests with a significance level of 5%., Results:  Abortion, contraception to adolescents, and emergency contraception were refused by 35.8%, 17.5%, and 5.8% of the students, respectively. High religiosity ( p  < 0.001) and higher attendance at worship services ( p  = 0.034) were predictors of refusing abortion. Refusal to provide contraception to adolescents was significantly higher among women than men ( p  = 0.037). Furthermore, 25% would not explain the reason for the refusal, 15% would not describe all the procedures used, and 25% would not refer the patient to another professional., Conclusion:  Abortion provided by law was the most objectionable situation. The motivating factors for this refusal were high commitment and religiosity. A reasonable portion of the students did not demonstrate ethical knowledge about the subject., Competing Interests: The authors have no conflicts of interest to declare., (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)

People perceive morality to be distinctively human, with immorality representing a lack of full humanness. In eight experiments, we examined the link between immorality and self-dehumanization, testing both (a) the causal role of immoral behavior on self-dehumanization and (b) the causal role of self-dehumanization on immoral behavior. Studies 1a to 1d showed that people feel less human after behaving immorally and that these effects were not driven by having a negative experience but were unique to experiences of immorality (Study 1d). Studies 2a to 2c showed that self-dehumanization can lead to immoral and antisocial behavior. Study 3 highlighted how self-dehumanization can sometimes produce downward spirals of immorality, demonstrating initial unethical behavior leading to self-dehumanization, which in turn promotes continued dishonesty. These results demonstrate a clear relationship between self-dehumanization and unethical behavior, and they extend previous theorizing on dehumanization.

Current methods for diagnosing testosterone deficiency are inadequate. It is time to rethink how we determine who is a candidate for treatment, with a goal of helping our patients. Free testosterone appears more accurate than total testosterone., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

In clinical medicine, the moral obligation to care for the individual patient is absolute. Patient care means at least and by negative terms to minimize any risk of treatment. In this context, the question arises about the compatibility of clinical ethics and human biomedical research ethics. Or conversely, is there a common ground between the two? At the opposite end of the field between clinical ethics and biomedical research ethics is the proposal of an obligation to participate in biomedical research, which is argued for on the basis of biomedical knowledge being a public good available to the community as a whole. While patient accrual during a clinical investigation would certainly be facilitated by obligatory research participation, and the data obtained would be-at first sight-more representative for the population studied, the still feasible refusal to participate would be stigmatizing and as such detrimental for the patient-physician relation. This essay seeks to provide a reply to the titled question by focusing on aspects such as individual vs common medical claims, shared grounds between the two and an important document of medical research ethics, that is the Nuremberg code., (© 2018 Stichting European Society for Clinical Investigation Journal Foundation.)

: Participant safety and data integrity, critical in trials of new investigational drugs, are achieved through honest participant report and precision in the conduct of procedures. HIV prevention post-trial access studies in middle-income countries potentially offer participants many benefits including access to proven efficacious but unlicensed technologies, ancillary care that often exceeds local standards-of-care, financial reimbursement for participation and possibly unintended benefits if participants choose to share or sell investigational drugs. This case study examines the possibility that this combination of benefits may constitute an undue inducement for some participants in middle-income countries, where economic challenges are prevalent. A case study is presented of a single participant in a cohort of 382 participants who used concealment, fabrication and deception to ensure eligibility for a post-trial access study of an unlicensed HIV prevention technology at potential risk to her health and that of her fetus. A root cause analysis revealed her desire to access HIV prevention during an unplanned pregnancy with a partner whose faithfulness was in question. Researchers should consider implementation of systems to efficiently identify similar cases without inconveniencing the majority of participants TRIAL REGISTRATION NUMBER: NCT01691768., Competing Interests: Competing interests: One of the coauthors of this paper (DRW) chaired the Research Ethics Committee that reviewed the Centre for the AIDS Programme of Research in South Africa 008., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: Recent studies have identified parents and children as two target groups whom Big Food hopes to positively influence through its corporate social responsibility (CSR) strategies. The current preliminary study aimed to gain an in-depth understanding of parents and children's awareness and interpretation of Big Food's CSR strategies to understand how CSR shapes their beliefs about companies., Design: Community-based qualitative semi-structured interviews., Setting: New South Wales, Australia., Subjects: Parents (n 15) and children aged 8-12 years (n 15)., Results: Parents and children showed unprompted recognition of CSR activities when shown McDonald's and Coca-Cola brand logos, indicating a strong level of association between the brands and activities that target the settings of children. When discussing CSR strategies some parents and most children saw value in the activities, viewing them as acts of merit or worth. For some parents and children, the companies' CSR activities were seen as a reflection of the company's moral attributes, which resonated with their own values of charity and health. For others, CSR strategies were in conflict with companies' core business. Finally, some also viewed the activities as harmful, representing a deceit of the public and a smokescreen for the companies' ultimately unethical behaviour., Conclusions: A large proportion of participants valued the CSR activities, signalling that denormalising CSR to sever the strong ties between the community and Big Food will be a difficult process for the public health community. Efforts to gain public acceptance for action on CSR may need greater levels of persuasion to gain public support of a comprehensive and restrictive approach.

Objectives: In this study, we aim to review researchers' reporting practices of the ethics statement, financial incentives, and local ethical committees' profile in their clinical trials., Study Design and Setting: A systematic search was done through top-ranked 50 medical journals (Scimago Ranking) to retrieve 2,000 latest publications. Only primary clinical trials were included with no restriction to language or participants., Results: Among the 927 included trials, 14 trials (1.5%) did not report an ethical statement and two-third (63%) did not completely report the investigated components (Institutional Review eBoard approval, Helsinki Declaration, and informed consent). Moreover, 21 trials (2.26%) reported motivational incentives with the method and amount of payment for participants. Of them, 15 trials offered monetary incentives to participants in different forms. In the remaining six trials, the incentives were mainly medical benefits. Only one trial reported the profile or quality of local Institutional Review Board., Conclusion: A potential gap in the reporting practices of ethics statement and financial incentives was addressed in this review. Authors are urged to fully report all ethical components related to their study, including incentives and compensations plan. Medical journals are also recommended to implement further publication requirements concerning ethics reporting., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Across five experiments, we show that dehumanization-the act of perceiving victims as not completely human-increases instrumental, but not moral, violence. In attitude surveys, ascribing reduced capacities for cognitive, experiential, and emotional states to victims predicted support for practices where victims are harmed to achieve instrumental goals, including sweatshop labor, animal experimentation, and drone strikes that result in civilian casualties, but not practices where harm is perceived as morally righteous, including capital punishment, killing in war, and drone strikes that kill terrorists. In vignette experiments, using dehumanizing compared with humanizing language increased participants' willingness to harm strangers for money, but not participants' willingness to harm strangers for their immoral behavior. Participants also spontaneously dehumanized strangers when they imagined harming them for money, but not when they imagined harming them for their immoral behavior. Finally, participants humanized strangers who were low in humanity if they imagined harming them for immoral behavior, but not money, suggesting that morally motivated perpetrators may humanize victims to justify violence against them. Our findings indicate that dehumanization enables violence that perpetrators see as unethical, but instrumentally beneficial. In contrast, dehumanization does not contribute to moral violence because morally motivated perpetrators wish to harm complete human beings who are capable of deserving blame, experiencing suffering, and understanding its meaning., Competing Interests: The authors declare no conflict of interest.

Scientific and engineering innovation is vital for American competitiveness, quality of life, and national security. However, too few American students, especially women, pursue these fields. Although this problem has attracted enormous attention, rigorously tested interventions outside artificial laboratory settings are quite rare. To address this gap, we conducted a longitudinal field experiment investigating the effect of peer mentoring on women's experiences and retention in engineering during college transition, assessing its impact for 1 y while mentoring was active, and an additional 1 y after mentoring had ended. Incoming women engineering students ( n = 150) were randomly assigned to female or male peer mentors or no mentors for 1 y. Their experiences were assessed multiple times during the intervention year and 1-y postintervention. Female (but not male) mentors protected women's belonging in engineering, self-efficacy, motivation, retention in engineering majors, and postcollege engineering aspirations. Counter to common assumptions, better engineering grades were not associated with more retention or career aspirations in engineering in the first year of college. Notably, increased belonging and self-efficacy were significantly associated with more retention and career aspirations. The benefits of peer mentoring endured long after the intervention had ended, inoculating women for the first 2 y of college-the window of greatest attrition from science, technology, engineering, and mathematics (STEM) majors. Thus, same-gender peer mentoring for a short period during developmental transition points promotes women's success and retention in engineering, yielding dividends over time., Competing Interests: The authors declare no conflict of interest.

The Editors: Antonio Spanevello, Bruno Balbi, Francesco Fattirolli, Furio Colivicchi.This issue marks a change in the Editorial Board of Monaldi Archives for Chest Disease. We would like to take this opportunity to impart some news on the current status of the journal. Our submissions are increasing, citations to our papers are rising, and recognition of the journal is broadening. Overall, 2016 has been a good year for the journal. Several changes are being made and several more are coming soon. Yet, focussing on the results achieved only is not our main goal, hence we now direct our efforts toward reaching an even greater impact.

In this paper, I analyse the issue of conscientious objection in relation to cosmetic surgery. I consider cases of doctors who might refuse to perform a cosmetic treatment because: (1) the treatment aims at achieving a goal which is not in the traditional scope of cosmetic surgery; (2) the motivation of the patient to undergo the surgery is considered trivial; (3) the patient wants to use the surgery to promote moral or political values that conflict with the doctor's ones; (4) the patient requires an intervention that would benefit himself/herself, but could damage society at large., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Health incentive schemes aim to produce healthier behaviours in target populations. They may do so both by making incentivised options more salient and by making them less costly. Changes in costs only result in healthier behaviour if the individual rationally assesses the cost change and acts accordingly. Not all people do this well. Those who fail to respond rationally to incentives will typically include those who are least able to make prudent choices more generally. This group will typically include the least advantaged more generally, since disadvantage inhibits one's effective ability to choose well and since poor choices tend to cause or aggravate disadvantage. Therefore, within the target population, health benefits to the better off may come at the cost of aggravated inequity. This is one instance of a problem I name the Able Chooser Problem, previously emphasised by Richard Arneson in relation to coercive paternalism. I describe and discuss this problem by distinguishing between policy options and their effects on the choice situation of individuals. Both positive and negative incentives, as well as mandates that are less than perfectly effective, require some sort of rational deliberation and action and so face the Able Chooser Problem. In contrast, effective restriction of what options are physically available, as well as choice context design that makes some options more salient or appealing, does not demand rational agency. These considerations provide an equity-based argument for preferring smart design of our choice and living environment to incentives and mandates., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

It is common sense that costs and benefits should be carefully weighed before deciding on a course of action. However, we often disapprove of people who do so, even when their actual decision benefits us. For example, we prefer people who directly agree to do us a favor over those who agree only after securing enough information to ensure that the favor will not be too costly. Why should we care about how people make their decisions, rather than just focus on the decisions themselves? Current models show that punishment of information gathering can be beneficial because it forces blind decisions, which under some circumstances enhances cooperation. Here we show that aversion to information gathering can be beneficial even in the absence of punishment, due to a different mechanism: preferential interactions with reliable partners. In a diverse population where different people have different-and unknown-preferences, those who seek additional information before agreeing to cooperate reveal that their preferences are close to the point where they would choose not to cooperate. Blind cooperators are therefore more likely to keep cooperating even if conditions change, and aversion to information gathering helps to interact preferentially with them. Conversely, blind defectors are more likely to keep defecting in the future, leading to a preference for informed defectors over blind ones. Both mechanisms-punishment to force blind decisions and preferential interactions-give qualitatively different predictions, which may enable experimental tests to disentangle them in real-world situations., Competing Interests: The authors declare no conflict of interest.

Laboratory experiments have shown that parents who believe their child's abilities are fixed engage with their child in unconstructive, performance-oriented ways. We show that children of parents with such "fixed mindsets" have lower reading skills, even after controlling for the child's previous abilities and the parents' socioeconomic status. In a large-scale randomized field trial (N classrooms = 72; N children = 1,587) conducted by public authorities, parents receiving a reading intervention were told about the malleability of their child's reading abilities and how to support their child by praising his/her effort rather than his/her performance. This low-cost intervention increased the reading and writing achievements of all participating children-not least immigrant children with non-Western backgrounds and children with low-educated mothers. As expected, effects were even bigger for parents who before the intervention had a fixed mindset., Competing Interests: The authors declare no conflict of interest.

Visceral states like thirst, hunger, and fatigue can alter motivations, predictions, and even memory. Across 3 studies, we demonstrate that such "hot" states can also shift moral standards and increase dishonest behavior. Compared to participants who had just eaten or who had not yet exercised, hungry and thirsty participants were more likely to behave dishonestly to win a prize. Consistent with the specificity of motivation that is characteristic of visceral states, participants were only more likely to cheat for a prize that could alleviate their current deprived state (such as a bottle of water). Interestingly, this increase in dishonest behavior did not seem to be driven by an increase in the perceived monetary value of the prize. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Background: Health worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps., Purpose: To evaluate the effect of SCE interventions on health worker motivation and experiences with clients., Methods: The study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation., Results: Intrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while financial incentives were ranked lowest. Intervention health facilities that were assessed by female community groups (Coef. = 0.2720, p = 0.0118) and informal groups with organized leadership structures like Artisans (Coef. = 0.2268, p = 0.0368) associated positively with higher intrinsic motivation levels of staff., Conclusion: Community-based approach to health worker motivation is a potential complementary strategy that needs policy deliberation to explore its prospects. Albeit financial incentives remain critical sources of staff motivation, innovative non-financial approaches like SCE should complement the latter.

Background: Understanding the fine line between motivation and coercion in nursing education may offer insight into satisfaction and autonomy in young nursing students, leading to increased retention, effectiveness, and professionalism in the workplace., Purpose: To compare and analyze the concepts of motivation and coercion with application to nursing academia., Methods: Using the Walker and Avant method for concept analyses, definitions and defining attributes of motivation and coercion were identified, along with antecedents, consequences, and model cases for each concept. Comparison of the concepts noting comparative terms and notable differences are presented., Conclusions: The comparison of the concepts of motivation and coercion reveals the stark contrast in the consequences of motivational and coercive power interactions in creating professional, satisfied, and empowered nurses. Nurse educators should seek to identify the best ways to create autonomy, competence, and relatedness in their graduates while minimizing coercive power plays which foster distance and dependence. Miller., (© 2015 Wiley Periodicals, Inc.)