Sorting Behavior Research Articles

Evaluation of the household solid waste mandatory sorting policy in Shanghai: A 1-year public opinion survey.

Sustainable management of household solid waste (HSW) is an essential step in realizing the development of a circular economy (CE). However, for many developing countries, HSW sorting is evolving incrementally, and focusing on the intervention role of policy and the sorting behaviour of residents can help achieve sustainable waste management. This study aims to investigate the main determinants of residents' HSW sorting behaviour and how policy particularly contributes to it. Drawing upon the theory of planned behaviour (TPB) and incorporating experiences, a conceptual framework is tested on a sample of Chinese residents in Shanghai (n = 560, from November to December 2020) using structural equation modelling analysis. The empirical results show that experience and behavioural intention greatly influence HSW sorting behaviour. Moreover, the positive attitude of residents promotes the success of HSW sorting. Subjective norms and perceived behaviour control indirectly affect behavioural intention and behaviour via attitude. The findings of this study provide policymakers with critical factors for the successful implementation of HSW sorting. We also propose policy implications to maintain and improve sorting efficiency from the perspective of residents (education, communication and publicity), neighbourhood committees (degree and efficiency of supervision) and property management companies (good infrastructure, services and processes).

Design-Based Approach to Support Sorting Behavior of Food Packaging

It is widely acknowledged that environmental impacts from packaging waste depend on how consumers sort this waste fraction. In this research, “design for sustainable behavior” (DfSB) strategies are used to improve a cream packaging design that can support proper sorting of packaging waste as a sustainable behavior. The application of three DfSB strategies—“match”, “steer”, and “force”—was examined through circular interviews and practical experience with two groups of participants in Karlskrona, Sweden. Prototyping was used to provide a more realistic experiment and enhance communication during the interviews. The results show that consumer-packaging interaction during the usage phase is important to enhance proper sorting behavior. The results also show the potential of a user-centered design-based approach to study consumer-packaging interaction and to understand the challenges faced by users when sorting packaging waste. It also shows the possibility of packaging design to script consumer behavior and reveals details that are important when designing packaging that was not known. In this vein, packaging form, color, and haptic attributes are the most influential design attributes that can support packaging functionalities and script consumer sorting behavior.

Using Motivational Interviewing to Treat Hoarding Symptoms in a Rural-Dwelling Older Adult: A Case Study

IntroductionHoarding disorder is one of the few psychological disorders that increases in severity and prevalence in older adulthood. It is marked by maladaptive cognitions (e.g., distress parting with items others would discard) and behavioral patterns (e.g., avoidance of sorting/discarding items) that result in the problematic accumulation of items, typically referred to as clutter. Due to its various consequences for both the individual and society, hoarding disorder is a critical area of research for treatment development and refinement. MethodsThis is a case report of an older adult living in rural Mississippi who participated in a pilot study of a brief in-home intervention for hoarding disorder. Ms. T is a 61-year-old White woman with a psychiatric history of hoarding disorder and several psychiatric and medical comorbidities, including high blood pressure, diabetes, asthma, arthritis, obesity, and sleep apnea. She also reported an extensive history of head trauma, both in childhood and as an adult. At baseline, she reported high levels of distress during a sorting task and discarded 23% of items sorted. She also completed the NIH Toolbox Cognition Battery. She performed in the mildly to moderately impaired range on measures of working memory, processing speed, memory, and overall fluid intelligence. However, she performed in the average to above average range on measures of vocabulary, cognitive flexibility, oral reading, and overall crystallized intelligence. Ms. T received six one-hour long sessions of treatment using motivational interviewing (MI), a treatment approach that facilitates behavioral change through a focus on the patient's values and exploring discrepancy between their current behaviors and their desired goals (Miller & Rollnick, 2013). Session one involved an assessment of strengths, values, and goals. Ms. T then engaged in sorting practice, which involved sorting items from her home into keep and discard piles. Sessions 2-6 involved checking in on progress and engaging in sorting practice while using MI skills to facilitate motivation for behavioral change. Each week, she recorded number of days and average time spent sorting. ResultsFollowing treatment, Ms. T reported increased frequency and duration of sorting/discarding clutter independently between sessions. She also demonstrated decreases in reported sadness and somatic arousal associated with fear. Despite the brief nature of the intervention, Ms. T also indicated a slight decrease in overall negative affect and a slight increase in social satisfaction. Expanding on her self-identified strength of surviving and being resilient, Ms. T was able to overcome her feeling of being overwhelmed at initiating sorting and avoidance behaviors to consistently engage in sorting practice for the majority of each session. At post-assessment, she reported low to medium levels of distress during the sorting task and was able to discard 48% of items sorted, an increase of 25% from baseline. Ms. T consistently reported increased motivation driven by her desire to gain a fresh start after her traumatic past and provided her treatment progress with unique momentum that protected against attrition and encouraged continued compliance. ConclusionsMs. T presented externally as a typical hoarding disorder case; however, the psychosocial factors of the case created a unique set of barriers and protective factors. This case report discusses the interplay between the effectiveness of MI and the impact of external psychosocial factors (i.e., resilience within negative lifetime experiences, relational stress, and physical limitations) as they relate to Ms. T's treatment for her hoarding symptoms. Here, we illustrate the need for a more comprehensive approach to case conceptualization for older adults diagnosed with hoarding disorder.

Scalable, Highly Pure, and Diameter-Sorted Boron Nitride Nanotube by Aqueous Polymer Two-Phase Extraction.

Boron nitride nanotube (BNNT) has attracted recent attention owing to its exceptional material properties; yet, practical implementation in real-life applications has been elusive, mainly due to the purity issues associated with its large-scale synthesis. Although different purification methods have been discussed so far, there lacks a scalable solution method in the community. In this work, a simple, high-throughput, and scalable purification of BNNT is reported via modification of an established sorting technique, aqueous polymer two-phase extraction. A complete partition mapping of the boron nitridespecies is established, which enables the segregation of the highly pure BNNT with a major impurity removal efficiency of > 98%. A successful scaling up of the process is illustrated and provides solid evidence of its diameter sorting behavior. Last, towards its macroscopic assemblies, a liquid crystal of the purified BNNT is demonstrated. The effort toward large-scale solution purification of BNNT is believed to contribute significantly to the macroscopic realization of its exceptional properties in the near future.

RESIDENTS’ PERCEPTION ON WASTE SORTING ON THE KVARNER ISLANDS

Purpose – The aim of this paper is to empirically examine residents’ perceptions of waste sorting and to research whether residents’ behavior regarding waste sorting has an impact on the sustainable development of a tourist destination. Design – A questionnaire with four constructs was designed: attitudes towards waste sorting, perceived behavioral control, waste sorting behavior and sustainable development of a tourist destination. Data were collected from a sample of 579 residents of the Kvarner islands. Methodology – Univariate and multivariate statistical analysis were used for statistical analysis. Hypotheses were tested using PLS-SEM. Approach – The research was conducted on the Kvarner islands (Krk, Cres, Lošinj and Rab) in August and September 2022. Findings – Attitudes of residents towards waste sorting positively influence the behavior of residents of the Kvarner islands towards waste sorting. PBC also positively influences the behavior related to waste sorting. Residents’ behavior regarding waste sorting positively influences sustainable development in Kvarner islands. Originality of the research – Research on waste sorting concerning the residents of Kvarner islands is scarce. Therefore, this paper provides a rare insight into the theoretical and practical implications that are useful for destination development planners and destination management.

FUZZY ADAPTIVE CLUSTERING UNTUK MENGETAHUI PENGARUH FAKTOR LINGKUNGAN HIDUP TERHADAP TINGKAT KELUHAN KESEHATAN

Health is something that is very valuable for a person. Along with the development of life, there are more and more various health complaints. The purpose of this study was to determine the effect of environmental factors on the level of health complaints. The data analysis method uses a classification method, namely clustering using Fuzzy Adaptive Clustering (FAC). In this case, the number of clusters is determined, namely 3 clusters. Environmental factors with the largest average percentage value in cluster 1, namely ownership of garden or land infiltration and waste sorting behavior, and environmental factors with the smallest percentage in cluster 1 are porous infiltration holes, presence of perennials, and the habit of using used water for purposes other. Environmental factors with the largest average percentage in cluster 2, namely the presence of perennials and porous infiltration holes and environmental factors with the smallest percentage in cluster 2 are ownership of motorized vehicles, garden/soil infiltration and waste sorting treatment. While environmental factors with the largest average percentage in cluster 3 are infiltration wells, the habit of using used water for other purposes and ownership of motorized vehicles.

Waste sorting behaviors promote subjective well-being: A perspective of the self-nature association

As one of the most important pro-environmental behaviors, individuals’ waste sorting behaviors are positively associated with their subjective well-being. This relationship is usually explained by the “self-other association”, regarding waste sorting behaviors as pro-social deeds, thus elevating people’s positive self-perception and strengthening a sense of interpersonal relatedness. Distinct from the general “good deeds”, the ultimate beneficiary of waste sorting behaviors is the natural environment instead of other people, so the mechanism underlying the positive relationship between performing a general good deed and subjective well-being might not suffice to explain the positive association between waste sorting behaviors and subjective well-being. The current study proposed the “self-nature association” with the cognitive (i.e., environmental perception) and the affective (i.e., nature connectedness) pathways. Using a large sample national survey in China (N = 4,705), we confirmed the positive link between waste sorting behaviors and subjective well-being, and the dual pathway was verified by a parallel mediation analysis. The theoretical and practical values of the present work were further explicated.

Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China.

Improving type 2 diabetes (T2D) care is key to managing and reducing disease burden due to the growing prevalence of diabetes worldwide, but research on this topic, specifically from rural areas, is limited. This study uses standardized patients (SPs) to assess T2D care quality among primary care providers to access the healthcare system in rural China. Using multi-stage random sampling, health facilities, providers, and households were selected. SPs were used to evaluate providers' T2D care quality and a questionnaire survey was used to collect patient sorting behaviors from households. Logistic regression was used to explore factors correlated with T2D care quality. Provider referral and treatment rates were combined with patient sorting behaviors to assess the overall quality of T2D management by rural China's healthcare system. A total of 126 providers, 106 facilities, and 750 households were enrolled into this study. During SP interactions, 20% of rural providers followed the national guidelines for T2D consultation, 32.5% gave correct treatment, and 54.7% provided lifestyle suggestions. Multi-variable regression results showed that providers who had earned practicing certificates (β = 1.56, 95% CI: 0.44, 2.69) and saw more patients (β = 0.77, 95%: 0.25, 1.28) were more likely to use a higher number of recommended questions and perform better examinations, whereas providers who participated in online training were less likely to practice these behaviors (β = -1.03, 95%: -1.95, -0.11). The number of recommended questions and examination (NRQE) was the only significant correlated factor with correct treatment (marginal effect = 0.05, 95%: 0.01, 0.08). Throughout the rural healthcare system, 23.7% of T2D patients were treated correctly. The quality of T2D care in rural western China, especially throughout the consultation and treatment process during a patient's first visit, is poor. Online training may not improve T2D care quality and low patient volume was likely to indicate poor care quality. Further research is needed to explore interventions for improving T2D care quality in rural China's healthcare system.

Sonic hedgehog is basolaterally sorted from the TGN and transcytosed to the apical domain involving Dispatched-1 at Rab11-ARE.

Hedgehog proteins (Hhs) secretion from apical and/or basolateral domains occurs in different epithelial cells impacting development and tissue homeostasis. Palmitoylation and cholesteroylation attach Hhs to membranes, and Dispatched-1 (Disp-1) promotes their release. How these lipidated proteins are handled by the complex secretory and endocytic pathways of polarized epithelial cells remains unknown. We show that polarized Madin-Darby canine kidney cells address newly synthesized sonic hedgehog (Shh) from the TGN to the basolateral cell surface and then to the apical domain through a transcytosis pathway that includes Rab11-apical recycling endosomes (Rab11-ARE). Both palmitoylation and cholesteroylation contribute to this sorting behavior, otherwise Shh lacking these lipid modifications is secreted unpolarized. Disp-1 mediates first basolateral secretion from the TGN and then transcytosis from Rab11-ARE. At the steady state, Shh predominates apically and can be basolaterally transcytosed. This Shh trafficking provides several steps for regulation and variation in different epithelia, subordinating the apical to the basolateral secretion.

Influence of multi-dimensional environmental knowledge on residents' waste sorting intention: Moderating effect of environmental concern.

With the rapid increase in household waste, environmental degradation becomes more serious. It is imperative to promote waste sorting in China. This study proposes an extended KAB model to explore the impact mechanism of different dimensions of subjective environmental knowledge on urban residents' waste sorting intention. The study also explores the moderating role of environmental concern in the relationship between three types of subjective environmental knowledge and attitude toward waste sorting. Based on 308 valid questionnaires, through structural equation model, multiple regression analysis, and simple slope test, we found that system knowledge, action-related knowledge, and effectiveness knowledge all have positive impacts on residents' attitudes toward waste sorting, and effectiveness knowledge has the most significant impact. Meanwhile, environmental concern positively moderates the relationship between system knowledge, effectiveness knowledge, and attitude toward waste sorting. This study makes an important theoretical contribution to enrich the existing literature on residents' waste sorting behavior and provides theoretical insights for governmental waste sorting policy formulation at the practical level.

A comparative investigation of integral- and separable-dimension stimulus-sorting behavior.

Studies focusing on unsupervised categorization and sorting behavior have traditionally identified and empirically isolated a few select strategies frequently employed by observers, one-dimensional (SD), family resemblance (FR), and exclusive-or (XOR). To date, these investigations have mostly involved creating sets of multidimensional stimuli that directly contrast utilization of these strategies coupled with task or stimulus property manipulations to see their effects on categorization and sorting behavior. Currently, we extend on this methodological approach by having observers sort integral-dimension stimuli for two recently developed constrained unsupervised categorization tasks employing three-dimensional Boolean category structures. These structures instantiate six different sorting strategies, including the aforementioned SD, FR, and XOR strategies. Additionally, we connect the prevalence of the strategies observed across both tasks to previous investigations employing separable stimuli with the same tasks and underlying Boolean category structures. In comparison, our results indicate significant reductions in rule-like sorting behavior (SD or XOR) across multiple structures with the integral stimuli. Associated with this decrease in SD and XOR behavior was a corresponding increase in FR and FR-related sorting behavior. Finally, we assess how well generalized representational information theory and the simplicity model can account for the pattern of results across both experimental paradigms and stimulus sets. In general, a formal model derived from "GRIT" outperforms the simplicity model, accounting for nearly the entire range of unsupervised sorting behavior (SD, FR, XOR) observed across the separable and integral tasks.

Effects of concentrate starch level and free-choice provision of straw on performance, feeding behaviour and feed sorting of fattening lambs

The importance of forage in small ruminants’ behaviour is well known, but very few experimental studies have investigated the feeding behaviour of lambs offered ad libitum and as a free choice provision of concentrate and wheat straw. This experiment was conducted to investigate the effect of concentrate starch level on growth performance and behaviour, preference toward straw and rumen fermentation in lambs offered ad libitum forage and concentrate. Twenty-four Iranian Arabic male lambs (mean ± standard deviation; 18.8 ± 2 kg of BW) were used in a completely randomized design with 3 treatments (8 lambs per treatment) for a period of 84 days. Experimental treatments were included 3 levels of starch (27.1%, 35.4% and 43.6% of dietary dry matter (DM)) and wheat straw was offered as a free-choice provision. Total DMI was not different among treatments; however, intakes of straw (P < 0.01), peNDF (P = 0.003), water (P = 0.05), and ME (P = 0.005) linearly increased with increasing level of starch in the concentrates. The increased dietary starch concentration linearly increased total gain (P = 0.02), and average daily gain (P = 0.01), but linearly decreased feed conversion ratio (P = 0.02). Increasing starch in the concentrates linearly increased sorting for straw particles retained on the 19-mm sieve and tended to increase sorting for particles retained on the 8-mm sieve. In contrast, sorting against the fine particles was observed with increasing starch content of the concentrates. Eating time decreased linearly as the amount of starch in the diets increased. Time spent ruminating per kg DM and NDF intake linearly increased with increasing starch in the diet. Standing time increased linearly (P = 0.04) as starch content of the diets increased. Lambs fed low starch diet had higher pH values than medium starch (at 2, 4, and 6 h post-feeding) and high starch (at 0, 2, 4 and 6 h post-feeding) diets. These findings suggest that under free-choice provision of straw and concentrate lambs are able to adjust their sorting behaviour in favor of physically effective NDF and more forage intake with increasing concentrate starch level, which could be an adaptive response to attenuate low rumen pH.

Factors influencing the rate of sorted solid waste collection: An empirical analysis towards local management in Catalonia (NE Spain)

A study of the factors influencing waste sorting behaviours is crucial to assess the current urban waste management schemes and to determine additional, appropriate policies to put in place. While there exist many theoretical considerations on which factors determine the Sorted Municipal Solid Waste Collection (SMSWC) rates, these are sometimes ambiguous, and firm empirical confirmation is often lacking. The present study estimates econometric models based on a comprehensive set of longitudinal data for all 945 Catalonian municipalities from 2000 to 2019. We demonstrate and quantify geographic, demographic, socioeconomic, and policy design determinants of the SMSWC rates at a municipal level. New insights are obtained on the effects of geographic conditions, unemployment, and foreign population on waste management behaviours, sometimes in direct contradiction with earlier theoretical expectations. The empirical evidence suggests that active waste collection policies can serve to increase the rate of sorted waste collection rapidly enough to achieve the recycling goals set by the European Union legislation and the Spanish Waste Law. Additionally, the study highlights the importance of considering demographic trends and differences in waste sorting behaviour between social groups when tackling waste management issues. The main qualitative results are expected to be valid beyond the concrete case of Catalonia.

The Effects of Lengths of Flavin Surfactant N-10-Alkyl Side Chains on Promoting Dispersion of a High-Purity and Diameter-Selective Single-Walled Nanotube.

Flavin with defined helical self-assembly helps to understand chemical designs for obtaining high-purity semiconducting (s)-single-walled carbon nanotubes (SWNT) in a diameter (dt)-selective manner for high-end applications. In this study, flavins containing 8, 12, 16, and 20 n-alkyl chains were synthesized, and their single/tandem effects on dt-selective s-SWNT dispersibility were investigated at isomolarity. Flavins with n-dodecyl and longer chain lengths (FC12, FC16, and FC20) act as good surfactants for stable SWNT dispersions whereas n-octyl flavin (FC8) exhibits poor dispersibility owing to the lack of SWNT buoyancy. When used with small-dt SWNT, FC8 displays chirality-selective SWNT dispersion. This behavior, along with various flavin helical motifs, prompts the development of criteria for ‘side chain length (lS)’ required for stable and dt-selective SWNT dispersion, which also explains lS-dependent dt-enrichment behavior. Moreover, SWNT dispersions with flavins with dodecyl and longer lS exhibit increased metallic (m)-SWNT, background absorption-contributing carbonaceous impurities (CIs) and preferential selectivity of s-SWNT with slightly larger dt. The increased CIs that affect the SWNT quantum yield were attributed to a solubility parameter. Furthermore, the effects of flavin lS, sonication bath temperature, centrifugal speed, and surfactant concentration on SWNT purity and s-/m-SWNT ratio were investigated. A tandem FC8/FC12 provides fine-tuning of dt-selective SWNT dispersion, wherein the FC8 ratio governs the tendency towards smaller dt. Kinetic and thermodynamic assemblies of tandem flavins result in different sorting behaviors in which wide dt-tunability was demonstrated using kinetic assembly. This study highlights the importance of appropriate side chain length and other extrinsic parameters to obtain dt-selective or high-purity s-SWNT.

What Factors Affect Farmers' Levels of Domestic Waste Sorting Behavior? A Case Study from Shaanxi Province, China.

Waste sorting is a key element for solving the current predicament of rural waste management. In the pilot areas of China, farmers’ domestic waste sorting behavior (DWSB) varies significantly, whereas there are few studies exploring the mechanism of its formation. To fill this research gap, this study constructs a research model of the internal logic of farmers’ waste sorting levels (i.e., no sorting; sorting recyclable waste; sorting recyclable and kitchen waste; and sorting recyclable, kitchen, harmful, and other waste) by considering circumstantial constraints (social norms in external factors) and psychological behavioral antecedents (personal norms and group identity in internal factors). Based on pilot survey data from farmers in Shaanxi Province, China, the results of the ordered logit model indicate that social norms and personal norms were the most significant predictors of the level of DWSB, while group identity was found to have no significant influence. Furthermore, the results of the grouping regression analysis showed that personal norms had a positive moderating effect on the relationship between social norms and farmers’ DWSB. Therefore, a more positive social atmosphere, better education, and personal environmental moral responsibility for domestic waste sorting should be established to enhance their levels of waste sorting behavior.

Chewing activities, sorting behaviour and ruminal fermentation of lactating dairy cows fed diets with similar proportions of undigested neutral detergent fibre with wheat straw substituted for alfalfa hay, corn silage or both

Feeding behaviour and ruminal fermentation of dairy cows were evaluated when fed diets formulated to supply a similar proportion of undigested neutral detergent fibre (uNDF) after 30-h incubation (uNDF30), while wheat straw (WS) replaced for corn silage (CS), alfalfa hay (AH) or both. In a randomised block design, 32 multiparous Holstein cows (days in milk = 78 ± 11 d, milk production = 56 ± 6 kg/d) were used. AH and CS were the only forage sources in control diet (CSAH). WS was substituted for alfalfa hay (WSCS), CS (WSAH) or both (WSCSAH) on uNDF30 basis. Dry matter consumption from 6 to 24 h after feed delivery was lower in WSAH than in WSCS or CSAH. No difference existed in total time spent for eating (250 min/d), rumination (460 min/d) and chewing (710 min/d). Total concentration of volatile fatty acids (VFAs) in the rumen was not different between treatments but propionate proportion was lower for cows fed WSAH than CSAH diet (19.0 vs. 24.1 mM/100 mM). Ammonia nitrogen concentration in the rumen fluid was greater for WSAH than WSCS or CSAH. With combining uNDF288 and peNDF, peuNDF288 was calculated and its intake had the highest correlation with chewing time (r = −0.60), sorting index of particles retained on 8-mm sieve (r = 0.42) and rumen pH (r = 0.52). Forage replacement on uNDF30 basis resulted in a relatively similar response on feeding behaviours and ruminal fermentation and enabled to replace high-quality forages with low-quality forages in the dairy cow rations. Highlights Wheat straw (WS) was substituted for alfalfa hay (AH), corn silage (CS) or both on an uNDF30 basis. Treatments had small differences in chewing patterns and ruminal fermentation. Combination of uNDF288 and diet particle size improved correlation coefficient with chewing, long particle intake and rumen pH.

What influences urban residents’ intention to sort waste?: Introducing Taoist cultural values into TPB

To accelerate green and low-carbon development and improve resource utilization efficiency, China has proposed a waste sorting policy. However, the smooth development of waste sorting is affected by the cultural values of residents. Taoist culture is a unique form of traditional Chinese culture. Studying the influence of Taoist cultural values on Chinese residents' waste sorting behaviour is a meaningful strand of research. This study introduced Taoist cultural values into planned behaviour theory to expand the framework to explore the influencing factors of waste sorting in China. This study used structural equation model (SEM) to investigate the waste sorting behaviour of 655 residents in Tangshan, China. The main hypotheses of this paper are that attitude, subjective norms, perceived behaviour control, and Taoist cultural values can directly affect residents' behavioural intention to actively sort waste and that Taoist cultural values indirectly affect residents' behavioural intentions by affecting residents' psychological factors. Notably, the study confirmed that perceived behaviour control and behavioural intention can affect residents' waste sorting behaviour positively and significantly. Thus, the findings of this study suggest changing residents' waste sorting behaviour by emphasizing Taoist cultural values. To achieve this objective, we suggest that the government build a platform to guide and publicize Taoist cultural values, publicize the harmonious coexistence between humans and nature, and increase environmental protection awareness in the Chinese people. Finally, the study shows that an extended theory of planned behaviour (TPB) is suitable for research on residents’ waste sorting behaviour.

Can policy implementation increase public waste sorting behavior? The comparison between regions with and without waste sorting policy implementation in China

Waste threatens human health and the environment. Public participation, as an essential link in the whole waste management chain, is important for countries to achieve carbon neutrality and promote sustainable development. However, some countries are still in the initial stage of policy practice, for example, China's waste sorting policy is still in the pilot stage and has not yet covered the whole country. Therefore, it is necessary to understand whether waste sorting policy has a catalytic effect on public waste sorting behavior, and based on the Theory of Planned Behavior, knowledge and intention were proposed to have chain-mediating effect. With a large-sample national survey, we compared the differences in public waste sorting behavior between areas with and without waste sorting policies and examined the mechanism. Results showed that the public in areas with waste sorting policies participated more in actual waste sorting behavior than the public in areas without waste sorting policies, and the proposed effects of knowledge and intention were verified. The research results provide valuable insights for policymakers and stakeholders from multiple perspectives of policy implementation, policy instruments, and population differences.

Human Pluripotent Stem Cell-Derived Micropatterned Ectoderm Allows Cell Sorting of Meso-Endoderm Lineages.

The human developmental processes during the early post-implantation stage instruct the specification and organization of the lineage progenitors into a body plan. These processes, which include patterning, cell sorting, and establishment of the three germ layers, have been classically studied in non-human model organisms and only recently, through micropatterning technology, in a human-specific context. Micropatterning technology has unveiled mechanisms during patterning and germ layer specification; however, cell sorting and their segregation in specific germ layer combinations have not been investigated yet in a human-specific in vitro system. Here, we developed an in vitro model of human ectodermal patterning, in which human pluripotent stem cells (hPSCs) self-organize to form a radially regionalized neural and non-central nervous system (CNS) ectoderm. We showed that by using micropatterning technology and by modulating BMP and WNT signals, we can regulate the appearance and spatial distribution of the different ectodermal populations. This pre-patterned ectoderm can be used to investigate the cell sorting behavior of hPSC-derived meso-endoderm cells, with an endoderm that segregates from the neural ectoderm. Thus, the combination of micro-technology with germ layer cross-mixing enables the study of cell sorting of different germ layers in a human context.

Provider competence in hypertension management and challenges of the rural primary healthcare system in Sichuan province, China: a study based on standardized clinical vignettes

BackgroundImproving primary care providers’ competence is key to detecting and managing hypertension, but evidence to guide this work has been limited, particularly for rural areas. This study aimed to use standardized clinical vignettes to assess the competence of providers and the ability of the primary healthcare system to detect and manage hypertension in rural China.MethodsA multi-stage random sampling method was administered to select target health facilities, providers, and households. The clinical vignette script was developed to evaluate provider competence in managing first-visit patients with symptoms of hypertension. Logistic regression was used to explore the factors correlated with provider competence. Provider referral and management rates were combined with patients’ facility sorting behaviors to assess the ability of the rural healthcare system to manage hypertension in three policy scenarios.ResultsA total of 306 providers and 153 facilities were enrolled in our study. In the 306 clinical vignette interactions, 25.9% of providers followed the national guidelines for hypertension consultation. The correct diagnosis was achieved by only 10.1% of providers, and 30.4% of providers were able to prescribe the correct treatment. Multi-variable regression results showed that younger providers (OR = 0.85, 95%CI: 0.73, 0.98) and those who work in township health centers (OR = 4.47, 95%: 1.07, 18.67) were more likely to provide a correct diagnosis. In a free-selection scenario, 29.8% of patients with hypertension were managed correctly throughout the rural system. When all patients first visit village clinics, system-level correct management is reduced to 20.5% but increases to 45.0% when all patients first visit township health centers.ConclusionsRural primary care providers do not have enough competence to detect and treat hypertension cases in China to an acceptable degree. Policy constraints may limit the competence of the rural healthcare system. Research to improve detection and treatment competence in hypertension and optimize health policy is needed.