Fresh Agricultural Products Supply Chain Coordination and Volume Loss Reduction Based on Strategic Consumer.

The reduction of fresh agricultural product volume loss throughout the supply chain system is of high importance due to their perishable nature and impact on society, the economy, and environment. In this paper, three models for two-stage pricing, coordination, and volume loss reduction of the supply chain where third-party logistics service providers and retailers act as a Stackelberg leader and a follower for fresh agricultural products are developed, taking into account both volume loss during transport and quality loss in retail in the presence of strategic consumers. The following results are drawn from the contract for sharing revenues and service costs: (1) The supply chain achieve coordination and the products are healthier for consumers; (2) the coordination leads to a reduction in the three types of volume losses simultaneously only if the lowest marginal costs of the supply chain occur under certain conditions; and (3) the increase in the service sensitivity coefficient, the increase in the freshness discount coefficient under certain conditions, the decrease in the consumer benefit discount coefficient under certain conditions, and the decrease in the price sensitivity coefficient lead to an increase in the profit of the supply chain and a reduction in the three types of volume losses.

Postoperative mortality following multi-modality therapy for pancreatic cancer: Analysis of the SEER-Medicare data.

BACKGROUND AND OBJECTIVES: The objective of this study was to examine post-operative mortality for elderly pancreatic cancer patients treated with multi-modality therapy. METHODS: Surveillance Epidemiology and End Results (SEER) Medicare linked data were used to examine differences in mortality between patients who underwent pancreatectomy alone and those who had early (within 12 weeks) and late (after 12 weeks) adjuvant therapy (chemotherapy and/or radiotherapy). RESULTS: Among 4,105 patients who underwent pancreatectomy between 1991 and 2008, 1-year mortality (Odds Ratio [OR] = 0.71; P-value = 0.000; 95% Confidence Interval [CI]: 0.60-0.85) and 6-month mortality (OR = 0.44; P-value = 0.000; 95%CI: 0.35-0.53) following pancreatectomy were significantly lower in the group that underwent pancreatectomy with early adjuvant therapy. Late adjuvant therapy group also had lower 1 year (OR = 0.51; P-value = 0.000; 95%CI: 0.43-0.61) and 6 months (OR = 0.14; P-value = 0.000; 95%CI: 0.10-0.17) mortality, compared to surgery alone. CONCLUSIONS: Post-operative outcomes were better for patients treated with surgery with adjuvant therapy, with the late adjuvant therapy group having the best outcomes (lowest odds of 6 month and 1-year mortality following surgery). J. Surg. Oncol. 2017;115:158-163. © 2017 Wiley Periodicals, Inc.

[Industrial ecological development of Jilin Province, Northeast China based on structure optimization vision.] / 基于结构调整视角的吉林省产业生态化发展.

Based on the interactive coercing mechanism between the industrial system and the ecosystem, we evaluated Jilin's ecologicalization of industrial structure, employing the systematic ana-lysis method and the comprehensive index evaluation method, and explored the spatio-temporal cha-racteristics.The result showed that the ecological level of industrial structure as well as the industrial structure optimization and resource-environmental efficiency had been significantly improved in 2000-2013. The regional difference showed a trend of resource-environmental efficiency > industrial structure optimization > ecologicalization of industrial structure. Spatially, it demonstrated a "higher in west, lower in east" pattern, and at city scale, it showed a decreasing trend from the core (Changchun) to outside. According to the coordination of industrial structure optimization and resource-environmental efficiency, we categorized the nine cities in Jilin Province into four ecologica-lization types: high coordination type, low coordination type, economic development ahead, and ecological development ahead.

Rural-Urban Differences in Costs of End-of-Life Care for Elderly Cancer Patients in the United States.

PURPOSE: The objective of this study was to examine the rural-urban differences in Medicare expenditures on end-of-life care for elderly cancer patients in the United States. METHODS: We analyzed Medicare claims data for 175,181 elderly adults with lung, colorectal, female breast, or prostate cancer diagnosis who died in 2008. The end-of-life costs were quantified as total Medicare expenditures for the last 12 months of care including inpatient, outpatient, physician services, hospice, home health, skilled nursing facilities (SNF), and durable medical expenditure. Linear regression models were used to estimate rural-urban differences in log-transformed end-of-life costs and logistic regressions were used to estimate probability of service use, adjusting for demographics, socioeconomic status, and comorbidities. FINDINGS: On average, elderly cancer patients cost Medicare $51,273, $50,274, $62,815, and $50,941 in the last year for breast, prostate, colorectal, and lung cancer, respectively. Rural patients cost Medicare about 10%, 6%, 8%, and 4% less on end-of-life care than their urban counterparts for breast, prostate, colorectal, and lung cancer, respectively. Rural cancer patients were less likely to use hospice and home health, more likely to use outpatient and SNF, and they cost Medicare less on inpatient and physician services and more on outpatient care conditional on service use. CONCLUSIONS: The lower Medicare spending on end-of-life care for the rural cancer patients suggests disparities based on place of residence. A future study that delineates the source of the rural-urban difference can help us understand whether it indicates inappropriate level of palliative care and find effective policies to reduce the urban-rural disparities.

Historical development and future perspectives of Environmental Specimen Bank in China: a mini review.

Environmental problems as well as their related ecosystem stress and human health risk in China have raised wide concerns along with the rapid economic development in recent years. Numerous studies with a sharp increase in publication number have addressed the ubiquitous of anthropogenic chemicals in various environmental compartments and human tissues. However, very few data were available to clarify the temporal trend and to give the retrospective analysis of chemical pollution in China. Environmental Specimen Bank (ESB) is a system for the systematic collection and long-term storage of specimens, which has been established since the 1970s in developed counties and recognized as a fundamental complement for environmental monitoring and scientific research. Currently, the value of ESB is becoming more broadly recognized globally, and China is still at the early stage. This article described the history and status and put forwarded the future key points of Chinese ESB development for illustrating the intensive environmental changes in China and the world.

Quality of end-of-life care among rural Medicare beneficiaries with colorectal cancer.

BACKGROUND: Although previous research has documented rural disparities in hospice use, limited data exist on the roles of geographic access in different types of end-of-life indicators among cancer survivors. METHODS: Medicare claims data were used to identify beneficiaries with colorectal cancer who died in 2008 (N = 34,975). We evaluated rural-urban differences in ER visits 90 days before death, inpatient hospital admissions ≤90 days before death, intensive care unit (ICU) use ≤90 days before death, hospice care use at any time, and hospice enrollment <3 days before death. RESULTS: About 60% of beneficiaries in rural areas lived in counties with the 2 lowest socioecomonic levels compared to only 5.3% of beneficiaries in metropolitan areas. After adjusting for demographic factors and comorbidities, beneficiaries in rural counties had a lower number of ICU days (RR = 0.65) and were less likely to ever use hospice (OR = 0.78) compared to those in metropolitan counties. Beneficiaries from racial/ethnic minority groups, those with lower socioeconomic status, and those with a higher comorbidity index were less likely to ever use hospice but they tended to use ER, inpatient care, and ICU. CONCLUSIONS: Evidence for disparities due to geographic access and socioeconomic factors warrant increased efforts to remove systemic and structural barriers. Future research should focus on exploring and evaluating potential policy and practice interventions to improve the quality of life among elderly cancer survivors living in rural communities and those from socioeconomically disadvantaged backgrounds.

Disparities in end of life care for elderly lung cancer patients.

The objective of this study was to examine geographic and race/ethnic disparities in access to end of life care among elderly patients with lung cancer. The study sample consisted of 91,039 Medicare beneficiaries with lung cancer who died in 2008. The key outcome measures included the number of emergency room visits, the number of inpatient admissions and the number of intensive care unit (ICU) days in the last 90 days of life, hospice care ever used and hospice enrollment within the last 3 days of life. Medicare beneficiaries with lung cancer residing in rural, remote rural, and micropolitan areas had more ER visits in the last 90 days of life as compared to urban residents. Urban residents however, had more ICU days in the last 90 days of life and were more likely to have ever used hospice as compared to residents of rural, remote rural and micropolitan counties. Racial minority lung cancer patients had more ICU days, ER visits and inpatient days than non-Hispanic White patients, and also were less likely to have ever used hospice care or be enrolled in hospice in the last 3 days of life. Lung cancer patients with very low socioeconomic status (SES) were less likely to ever use hospice or be enrolled in hospice care in the last 3 days of life, as compared to those who had very high SES. Geographic, racial and socioeconomic disparities in end of life care call for targeted efforts to address access barriers for these groups of patients.

Age and rural residence effects on accessing colorectal cancer treatments: a registry study.

OBJECTIVES: To test the hypotheses that older patients with colorectal cancer (CRC) and rural patients are less likely to undergo surgery, radiation, and chemotherapy. STUDY DESIGN: Retrospective study. METHODS: A total of 6561 patients with CRC between January 1998 and December 2003 were identified by incident International Classification of Diseases for Oncology codes from the Nebraska Cancer Registry. In multivariate logistic regression analyses, we studied the association of age and residence county (rural vs urban and micropolitan) with each of 3 CRC treatments by anatomic site. RESULTS: After adjusting for patient demographics, insurance payer, ratio of providers to population, and cancer stage, patients with colon cancer living in micropolitan counties were more likely to receive chemotherapy than those living in rural counties (P <.001). Compared with patients aged 19 to 64 years, patients with colon cancer 85 years and older (P <.001) and patients with rectal cancer 75 years and older (P <.05) were less likely to undergo surgery. Patients with CRC 75 years and older were less likely to receive radiation, and patients with colon cancer 65 years and older and patients with rectal cancer 75 years and older were less likely to receive chemotherapy (P <.001 for both). CONCLUSIONS: In Nebraska, older patients with CRC were less likely to undergo surgery, radiation, and chemotherapy. Patients with colon cancer in rural counties were less likely to undergo chemotherapy than those in micropolitan counties. Decision makers need to consider issues of age and rural residence in patient access to CRC treatments.

[Factor decomposition and reduction effect on the changes of industrial wastewater discharge].

After describing the volume of industrial wastewater discharge, economic growth, economic space structure and industrial wastewater discharge intensity, the non-residue complete decomposition model was applied to analyze the effects of three economically factors, which were economic scale, discharge intensity and space structure, on the changes of industrial wastewater discharge quantitatively from 1981 to 2006 in China. Then industrial wastewater reduction effect was computed by use of H-P filter method. The main results could be summarized as follows: (1) The average annual growth of industrial wastewater discharge is 0.25 x 10(8) t, and the scale of economic development, the space structure and the industrial wastewater discharge intensity have different contributions to the change, being 25.9 x 10(8) t, - 25.5 x 10(8) t, -0.16 x 10(8) t respectively. (2) Accumulative quantity of industrial wastewater discharge reduction is 641.8 x 10(8) t from 1981 to 2006 in China. During this period, with the impact of macroeconomic policies, reduction gap has been fluctuating; however, total reduction gap is a positive number. It is to say that actual reduction volume is more than potential reduction one. (3) With the shift of time, potential reduction efficiency tends to increase firstly and then decline. (4) During 1982-1990 and 1997-2006, industry is high-pollution, while during 1991-1996, industry is low-pollution correspondingly.