Environmental regulatory intensity, green finance and corporate green sustainable development performance.

In the "14th Five-Year Plan" period, the emphasis is made on green and low-carbon initiatives, which has become a defining feature of China's development, and it is of great significance to help enterprises realize green and sustainable development under the guidance of environmental regulation to achieve the goal of "dual-carbon". At first, this research analyzes the decision-making process between the government and enterprises under environmental regulation using the evolutionary game model. Moreover, using the TOPSIS method, this paper constructs the indicators of corporate green sustainable development performance, and empirically examines the impact of the intensity of environmental regulation on the green sustainable development performance of enterprises based on the data of Chinese A-share listed enterprises from 2010 to 2022. A noteworthy positive correlation between the intensity of environmental regulation and the sustainable green development performance of enterprises is unveiled by the results. Mechanism tests suggest that the intensity of environmental regulation has a positive impact on the green sustainable development performance of enterprises through enhancing green finance and green technological innovation. Moreover, this effect tends to be more pronounced for enterprises that are in the mature life cycle, with green executive team, and high media attention. The research presented in this study contributes to establishing a novel theoretical foundation for corporate sustainable development.

Disparities in awareness and utilisation of National Essential Public Health Services between the floating population and the registered residents: a cross-sectional study in China.

OBJECTIVE: There are differences between the floating population and the registered population in the awareness and use of the National Essential Public Health Services (NEPHS) due to the influence of China's household registration system. The Equalization of Basic Public Health and Family Planning Services (EBPHFPS) policy aims to reduce disparities among populations by enhancing the migrant population's access to basic public health services. The aim of this study is to examine the relationship between the EBPHFPS targeted at the floating population and the disparities in access to and utilisation of NEPHS between registered residents and the floating population. DESIGN: A cross-sectional study. SETTING: 8 cities (regions, autonomous prefectures) in China. PARTICIPANTS: 13 998 floating population and 14 000 registered residents in eight cities (regions, autonomous prefectures) were included in the analysis. OUTCOME MEASURES: Three binomial variables, including awareness of NEPHS, acceptance of health education and establishment of health records, were used as outcome indicators to examine the relationship between the EBPHFPS and the disparities between the floating and registered populations. METHODS: A linear regression model, fairness gap calculation and propensity score matching were used to explore the associations. RESULTS: The areas that implemented EBPHFPS exhibited an 8.3% increase in awareness of the NEPHS (p<0.01) and a 4.0% increase (p<0.05) in the likelihood of individuals having received health education within the previous year compared with the areas without the policy implementation. In contrast to registered residents, however, the floating population still faces significant disparities in NEPHS awareness and utilisation. Compared with areas without the equalisation policy, the inequality of opportunity in health education of the floating population in implementation areas is significantly lower (p<0.01), whereas no significant difference is observed in the inequality of opportunity regarding NEPHS awareness among the floating population (p>0.1). The floating population in the pilot areas of the policy encountered greater disparities in the establishment of health records (p<0.01). CONCLUSIONS: Positive associations between the EBPHFPS policy and NEPHS awareness and utilisation among the floating population were demonstrated to some extent; however, the floating population was still confronted with a degree of inequality of opportunity. The government needs to develop target-oriented policies and a guaranteed mechanism to ensure access to NEPHS among the floating population.

Individual-Level Health Care Costs Attributable to Noncommunicable Diseases: A Longitudinal Study Based on the Older Adults in China.

Noncommunicable chronic diseases among the elderly population represent a significant economic burden in China. However, previous disease-related health cost studies lacked representation of older adults and comparability of the burden of multiple chronic diseases. The objective of this study was to determine the fraction of health care costs attributable to the 6 most prevalent chronic diseases and comorbidities in the sample of older adults. This study employed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with 3 waves in 2011, 2014, and 2018, and included 18 349 observations in total. Outpatient costs, inpatient costs, and total health care costs were included in this study. Based on a 2-part random effects model, the effect of chronic disease on health service utilization was first explored by constructing a dummy variable for whether or not to utilize health care, followed by estimation of attributable costs in the population with health care utilization. Among the older adults in the sample, hypertension, heart disease, cataracts, arthritis, stroke or Cerebrovascular disease (CVD) and chronic lung disease are the 6 most prevalent chronic conditions. The costs attributable to the 6 chronic diseases mentioned above were 36.00% of outpatient costs, 55.92% of inpatient costs, and 45.05% of total health care costs for older adults. Of these, heart disease, stroke or CVD, and chronic lung disease accounted for 22.11%, 13.24%, and 10.56% of total health care costs, respectively. Moreover, the proportion of health care costs attributable to chronic diseases was higher for older adults who were male, lived in urban areas, and had a lower level of education. The proportion of health care costs attributable to chronic diseases is substantial among older adults in China. Health care costs associated with chronic diseases can be decreased with well-targeted interventions and comprehensive access to health services.

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa.

INTRODUCTION: Voluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings. METHODS: Activity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings. RESULTS: VMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved $3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by $0.59 per client. 2wT would save $2.16 and $7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively. CONCLUSION: Quality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality.

Healthcare costs attributable to abnormal weight in China: evidence based on a longitudinal study.

BACKGROUND: The prevalence of abnormal weight is on the rise, presenting serious health risks and socioeconomic problems. Nonetheless, there is a lack of studies on the medical cost savings that can be attained through the mitigation of abnormal weight. The aim of this study was to estimate the impact of abnormal weight on healthcare costs in China. METHODS: The study employed a 4-wave panel data from China Family Panel Studies (CFPS) between 2012 and 2018 (11,209 participants in each wave). Inpatient, non-inpatient and total healthcare costs were outcome variables. Abnormal weight is categorized based on body mass index (BMI). Initially, the two-part model was employed to investigate the impact of overweight/obesity and underweight on healthcare utilisation and costs, respectively. Subsequently, the estimated results were utilised to calculate the overweight/obesity attributable fraction (OAF) and the underweight attributable fraction (UAF). RESULTS: In 2018, healthcare costs per person for overweight and obese population were estimated to be $607.51 and $639.28, respectively, and the underweight population was $755.55. In comparison to people of normal weight, individuals who were overweight/obese (OR = 1.067, p < 0.05) was more likely to utilise healthcare services. Overweight/obesity attributable fraction (OAF) was 3.90% of total healthcare costs and 4.31% of non-inpatient costs. Overweight/obesity does not result in additional healthcare expenditures for young people but increases healthcare costs for middle-aged adults (OAF = 7.28%) and older adults (OAF = 6.48%). The non-inpatient cost of underweight population was significantly higher than that of normal weight population (ß = 0.060,p < 0.1), but the non-inpatient health service utilisation was not significantly affected. CONCLUSIONS: Abnormal weight imposes a huge economic burden on individuals, households and the society. Abnormal weight in Chinese adults significantly increased healthcare utilisation and costs, particular in non-inpatient care. It is recommended that government and relevant social agencies provide a better social environment to enhance individual self-perception and promote healthy weight.

Social causation, social selection, and economic selection in the health outcomes of Chinese older adults and their gender disparities.

Background: The economic selection hypothesis, which argues that the initial economic situation determines both subsequent health and economic conditions, has been drawn into the debate on causation-selection issues. This study aims to construct a path model with self-rated health and depression score of older adults as health outcomes to measure and compare the social causation forces of wealth accumulation, social selection forces of adulthood health, and economic selection forces of childhood economics, and to examine their gender disparities. Methods: Data was obtained from a sample of 19613 older adults aged 45 years or above from the 2014 life history survey and the 2015 routine follow-up survey of the China Health and Retirement Longitudinal Study. Structural equation modeling analysis was conducted employing the full information maximum likelihood estimation method. Results: The presence of social causation, social selection, and economic selection were all statistically supported. In self-rated health, social selection forces held the dominant position, while social causation forces were comparable to economic selection forces. In depression score, social selection still exhibited stronger forces than economic selection, but social causation had forces close to social selection and greater than economic selection. The forces of the three hypotheses in self-rated health did not significantly change with gender, but social causation exerted mightier forces than economic selection within the male group, unlike the female group. The forces of economic selection in depression score were greater in females than males and no significant differences were observed among the forces of the three hypotheses in the female group. Conclusions: Social causation, social selection, and economic selection operate simultaneously on the self-rated health and depression score of older adults. However, the force magnitudes of the three hypotheses and/or their rankings differ by health outcomes and gender.

Switch of cell migration modes orchestrated by changes of three-dimensional lamellipodium structure and intracellular diffusion.

Cell migration plays important roles in many biological processes, but how migrating cells orchestrate intracellular molecules and subcellular structures to regulate their speed and direction is still not clear. Here, by characterizing the intracellular diffusion and the three-dimensional lamellipodium structures of fish keratocyte cells, we observe a strong positive correlation between the intracellular diffusion and cell migration speed and, more importantly, discover a switching of cell migration modes with reversible intracellular diffusion variation and lamellipodium structure deformation. Distinct from the normal fast mode, cells migrating in the newly-found slow mode have a deformed lamellipodium with swollen-up front and thinned-down rear, reduced intracellular diffusion and compartmentalized macromolecule distribution in the lamellipodium. Furthermore, in turning cells, both lamellipodium structure and intracellular diffusion dynamics are also changed, with left-right symmetry breaking. We propose a mechanism involving the front-localized actin polymerization and increased molecular crowding in the lamellipodium to explain how cells spatiotemporally coordinate the intracellular diffusion dynamics and the lamellipodium structure in regulating their migrations.

Microbial ecological clusters structured by environments drive maize residue decomposition at the continental scale.

Environmental factors (e.g., climate and edaphic factors) indirectly regulate residue decomposition via microbial communities. Microbial ecological clusters (eco-clusters) structured by specific environmental factors have consequences for ecosystem functions. However, less is known about how microbial eco-clusters affect residue decomposition, especially over broad geographic scales. We collected agricultural soils from adjacent pairs of upland and paddy fields along a latitudinal gradient from the cold-temperature zone to the tropical zone, and conducted a microcosm experiment with 13C-labelled maize residue to explore the continental pattern of maize residue-derived 13CO2 (RDC), and whether and how microbial eco-clusters drive and predict RDC. Results showed that RDC decreased with latitude in both upland and paddy fields. Further, we identified 21 well-defined eco-clusters according to microbial environmental preferences, which explained 51.15 % of the spatial variations in RDC. The eco-clusters of high-total annual precipitation (TAP), high-mean annual temperature (MAT), low-pH, and some low-nutrient-associated exerted a positive effect on RDC. These eco-clusters contained many taxa belonging to the Actinobacteriota, Firmicutes, and Sordariomycetes, and their relative abundance decreased with latitude. Upland soils displayed 2.40-fold of RDC over paddy soils. Low-pH and high-organic matter (OM) eco-clusters were found to be the most prominent predictors of RDC in upland and paddy fields, respectively. Finally, we constructed a continental atlas of RDC in both upland and paddy fields based on eco-clusters and high-resolution climate and soil data. Overall, our study provides important evidence that historical environment-shaped microbial eco-clusters can drive and predict residue decomposition, providing new insights into how environmental factors indirectly regulate residue decomposition.

Factors Associated with Maternal Healthcare Utilization Before and After Delivery Among Migrant Pregnant Women in China: An Observational Study.

Background: Effective healthcare utilization throughout pregnancy is essential in protecting mother and child health, but the maternal healthcare utilization and its associated factors among migrant women are still underexplored. Methods: The data came from the 2018 China Migrants Dynamic Survey. Our analysis included 6337 pregnant migrant women. Prenatal healthcare utilization comprises receiving at least 5 antenatal care (ANC) times and establishing the maternal health record within the first 12 weeks of pregnancy. Postnatal healthcare utilization refers to whether an individual received a postpartum visit and a physical health examination within 28 days and 42 days following delivery. A multivariate binary logit model was employed to investigate the factors related to maternal healthcare utilization. Results: 67.15% of the 6337 participants established health records within the first 12 weeks of pregnancy, and 88.35% received at least five ANC visits. 76.88% and 84.20% of migrant pregnant women received a postpartum visit and a health examination respectively. Age was positively correlated with receiving at least five ANC visits (OR:1.245, 95% CI: 1.038-1.493), a postpartum visit within 28 days (OR: 1.272, 95% CI: 1.107-1.460) and a physical examination within 42 days after delivery (OR=1.174, 95% CI: 1.002-1.376). Education, household income, health insurance and maternal health education were positively associated with prenatal and postnatal healthcare utilization (P<0.05). Number of Children negatively correlated with ANC times (OR: 0.742, 95% CI: 0.613-0.898) and receiving health examination after delivery (OR: 0.720, 95% CI: 0.610-0.849). Conclusion: There is still potential for improvement in the maternal healthcare utilization, particularly in postnatal healthcare. Strengthening the follow-up, focusing on those who are younger, have lower socioeconomic status, and are members of ethnic minorities, and continuing to strengthen maternal health education for them can promote the maternal healthcare utilization before and after delivery.

Inequality of opportunity in outpatient expenditure among the elderly with multimorbidity: evidence from China.

BACKGROUND: Inequality of opportunity (IOp) stemming from social circumstances exists in outpatient service utilization for the multimorbid elderly in China. However, little is known regarding the magnitude of the IOp and its composition. Therefore, this study aims to measure the IOp in outpatient expenditure and provide potential pathways for policy reform by assessing the contribution of each circumstance. METHODS: This study included 3527 elderly aged ≥ 65 years with multimorbidity from the Chinese Longitudinal Healthy Longevity Study conducted in 2017-2018. An ordinary least squares regression model was used to analyze the circumstance-influencing factors of outpatient expenditure. The parametric approach was performed to quantify the IOp in outpatient expenditure and the Shapley value decomposition method was employed to determine the contribution of each circumstance. By extracting heterogeneity in the residual of the circumstance-dependent equation of outpatient expenditure across circumstance groups divided based on cluster analysis, we captured the effect of unobserved circumstances. RESULTS: Except for pension and distance to health facilities, all the associations between circumstance and outpatient expenditure were statistically significant. The inequality caused by circumstances accounted for 25.18% of the total inequality. The decomposition results revealed that the reimbursement rate contributed 82.92% of the IOp, followed by education duration (4.55%), household registration (3.21%), household income (3.18%), pension (1.49%), medical insurance (1.26%), physical labor (0.99%), unobserved circumstances (0.86%), distance to health facilities (0.83%) and region (0.71%). CONCLUSIONS: The priority of policy enhancement is to effectively improve the outpatient reimbursement benefit for treating chronic diseases. Additional crucial actions include enhancing the health literacy of the multimorbid elderly to promote the shift from medical needs to demands and accelerating the construction of rural capacity for providing high-quality healthcare to the elderly with multimorbidity.

Balancing potato yield, soil nutrient supply, and nitrous oxide emissions: An analysis of nitrogen application trade-offs.

Potato has been promoted as a national key staple food to alleviate pressure on food security in China. Appropriate nitrogen (N) application rate is prerequisite and is crucial for increasing yield, improving fertilizer efficiency, and reducing N losses. In the present study, we determined the optimum N application rates by analyzing field trial data from the main potato producing areas of China between 2004 and 2020. We considered the equilibrium relationships between potato yield, N uptake, partial N balance (PNB), and N2O emission under different soil indigenous N supply (INS) scenarios. The results showed that N rate, INS, and their interactions all significantly affect potato yield and nutrient uptake increment. On average, N application increased potato yield and N uptake by 29.5 % and 56.7 %, respectively. The relationship between N rate and yield increment was linear-plateau, while the relationship between N rate and N uptake increment was linear-linear. Soil INS accounted for 63.5 % of total potato N requirement. Potato yield increment and nutrient uptake increment were exponentially negatively correlated with INS and had a significant parabolic-nonlinear relationship with the interaction of N fertilizer application rate and INS. PNB was negatively correlated with fertilizer N supply intensity as a power function. Based on our analysis, a N application rate of 166 kg N ha-1 was found to be sufficient when the target yield was <34 t ha-1. However, when the target yield reached 40, 50 and 60 t ha-1, the recommended N application rate increased to 182, 211, and 254 kg N ha-1, respectively, while ensuring N2O emissions low with an emission factor of 0.2 %. Our findings will help guide potato farming toward cleaner production without compromising environmental benefit.

Household Polluting Fuel Use and Frailty among Older Adults in Rural China: The Moderating Role of Healthy Lifestyle Behaviors.

This study worked to investigate the effect of household polluting fuel use (HPFU), as an indicator of household air pollution exposure, on frailty among older adults in rural China. Additionally, this study aimed to examine the moderating effect of healthy lifestyle behaviors on the aforementioned association. This study employed cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey, which conducted nationally representative sampling of older adults from 23 provinces in mainland China. The frailty index was calculated using 38 baseline variables that assessed health deficits through questionnaire surveys and health examinations. A total of 4535 older adults aged 65 years and above were included in our study, among whom, 1780 reported using polluting fuels as their primary household cooking fuel. The results of regression analyses and multiple robustness checks indicated a significant increase in the frailty index due to HPFU. This environmental health threat was more profound among women, illiterate individuals, and low-economic-status groups. Moreover, healthy dietary and social activities had significant moderating effects on the association between HPFU and frailty. HPFU can be regarded as a risk factor for frailty among older adults in rural China, with its effects exhibiting socio-economic disparities. The adoption of healthy lifestyle behaviors can alleviate the frailty associated with HPFU. Our findings underscore the significance of using clean fuels and improving household air quality for healthy aging in rural China.

Investigating the effects of organic amendments on soil microbial composition and its linkage to soil organic carbon: A global meta-analysis.

Understanding the dynamics of soil microbial communities responsible for soil element cycling is vital to understanding organic amendments' mechanisms in agricultural soil. However, several studies show inconsistencies in whether and how organic amendments affect the taxonomic composition of soil microbial communities compared to the application of sole chemical fertilizers. This first global meta-analysis demonstrated that organic amendments increased the bacterial diversity indices (Shannon and Chao1) but had no significant effect on fungal diversity indices. When considering both bulk and rhizosphere soils, only copiotrophic strategies such as Proteobacteria, Bacteroidetes, and Zygomycota phylum demonstrated a significant increase in response to organic amendments, mainly because the environment with a significant increase in nutrients content preferentially supports the growth of copiotrophic species after the use of organic amendments. Additionally, the factors influencing the response of different dominant microbial phyla to organic amendments varied. Besides soil pH, the effect of organic amendments on different microbial phyla was significantly influenced by soil texture, organic fertilizer type, crop type, and climate type, providing insights into the diverse responses of microbial communities to organic amendments under varying conditions. Organic amendments significantly increased soil organic carbon (SOC) content and enzyme activities related to nitrogen (N) and phosphorus (P) decomposition but had no significant effect on enzymes related to carbon (C) decomposition. Notably, the effect of organic amendments on the relative abundance of three dominant phyla (Mortierellomycota, Nitrospirae, and Firmicutes) was related to the effect on SOC, where the increase in the relative abundance of Firmicutes was significantly positively associated with the increase in SOC. This result has implications for understanding the relationship between the dynamics of microbial community composition and C turnover in agroecosystems.

Activity-assisted barrier crossing of self-propelled colloids over parallel microgrooves.

We report a systematic study of the dynamics of self-propelled particles (SPPs) over a one-dimensional periodic potential landscape U_{0}(x), which is fabricated on a microgroove-patterned polydimethylsiloxane (PDMS) substrate. From the measured nonequilibrium probability density function P(x;F_{0}) of the SPPs, we find that the escape dynamics of the slow rotating SPPs across the potential landscape can be described by an effective potential U_{eff}(x;F_{0}), once the self-propulsion force F_{0} is included into the potential under the fixed angle approximation. This work demonstrates that the parallel microgrooves provide a versatile platform for a quantitative understanding of the interplay among the self-propulsion force F_{0}, spatial confinement by U_{0}(x), and thermal noise, as well as its effects on activity-assisted escape dynamics and transport of the SPPs.

Career adapt-ability scale -short form: Validation among early career stage of Chinese university graduates.

The Career Adapt-Ability Scale (CAAS) is the favored method among researchers for measuring career adaptability. The 12-item version of CAAS-SF, which was made by Maggiori, Rossier, and Savickas based on a change to CAAS, has been slowly used by different groups in different countries and regions. As samples for the validation of the scale in this study, 571 Chinese university graduates in the early stages of their professions were chosen. Principal component analysis and confirmatory factor analysis suggest that CAAS-SF and CAAS have very similar psychological measurement features and factor structures. And the internal consistency of each subscale and total scale are equivalent to or greater than that of the CAAS assessment. These findings indicate that the CAAS-SF is a valid and reliable instrument for evaluating China's career adaptability. In addition, limitations, issues for further research, and suggestions are emphasized.

Long-term combined organic manure and chemical fertilizer application enhances aggregate-associated C and N storage in an agricultural Udalfs soil.

Little information is known on whether carbon (C) and nitrogen (N) immobilization is synchronized in different sizes of aggregates under different agricultural management practices. Carbon and N concentrations and the C/N ratios in different sizes of aggregates down to 40 cm depth were determined after long-term application of chemical fertilizers combined with manure or without manure in a wheat-rice cropping system. Manure application usually produced significantly (P < 0.05) higher C and N concentrations and lower C/N ratios in bulk soil and in different sizes of aggregates down to 20 cm depth than the other treatments, and the 1.5 MNPK treatment at 0-10 cm depth had the highest SOC concentration of 26.3 g/kg. The C and N concentrations in bulk soil and all aggregate fractions decreased markedly with increasing soil depth. Among water stable aggregates in all soil depths, the highest C (48.2-66.4%) and N (47.8-68.3%) concentrations as a percentage of SOC were found in the small macroaggregates (2000-250 µm, SM). Manure application significantly (P < 0.05) increased the mass and C and N concentrations of SM and SM fractions down to 20 depth. The mean C/N ratios of silt-clay within large and small macroaggregates (inter-SC) were 1.57 and 1.46 units lower than those of silt-clay particles, respectively, indicating that inter-SC had relative high N availability. Moreover, the C and N content of SM down to 40 cm depth tended to saturation with increasing C input rate. Overall, manure application effectively improved soil structure, SM were the dominant particles involved in soil C and N storage, and inter-SC were the main particles responsible for N availability.

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa.

Introduction: Voluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings. Methods: Activity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings. Results: VMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved $3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by $0.59 per client. 2wT would save $2.16 and $7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively. Conclusion: Quality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality.

Comparative assessment of environmental impacts, mitigation potentials, and economic benefits of rain-fed and irrigated apple production systems on China's Loess Plateau.

Although the repaid development of China's apple industry heavily depends on excessive fertilizer-water-pesticide (FWP) inputs, little information is available that systematically evaluates environmental impacts, mitigation potential, and economical benefits of apple production systems in China. In this study, life cycle assessment (LCA) was conducted to elucidate environmental risks and mitigation potentials of rain-fed and irrigated apple production systems on China's Loess Plateau based on survey data from 847 farmers, and economic benefits were analyzed simultaneously. Results showed that irrigated orchards caused more severe environmental risks associated with energy depletion (ED), global warming potential (GWP) and acidification potential (AP) than those in rain-fed orchards, whereas an opposite was true for eutrophication potential (EP), human toxicity potential (HTP), aquatic toxicity potential (ATP) and soil toxicity potential (STP). ED and GWP occurred primarily in the agricultural material stage, while AP, EP, HTP, ATP, and STP occurred mostly in the orchard management stage. Optimized FWP management can markedly mitigate environmental impacts in both irrigated and rain-fed orchard systems. Synthetic fertilizer, because of production and field-associated emissions, was the greatest contributor to environmental impacts of an apple production system. An environmental pollution index (EPI) that integrated environmental categories was highest in conventional irrigated orchards (0.946), followed by conventional rainfed orchards (0.857), and optimized irrigated orchards (0.459), and the lowest EPI was in optimized rainfed orchards (0.389). Economic analysis revealed that the benefits of rainfed orchards were higher than those of irrigated orchards because of higher apple prices and lower labor costs. Optimized FWP management sharply decreased input costs, thereby substantially increasing net income in irrigated and rain-fed apple orchards. Overall, severe environmental risk and large mitigation potential co-exist in rain-fed and irrigated apple orchards on China's Loess Plateau. Integrated soil-crop-market management potentially exhibited considerable environmental and economic advantages, thereby efficiently developing high-quality apple production.

Maintenance mechanisms of child restraint system use based on the health action process approach theory: Evidence from China.

OBJECTIVE: Adherence to the use of child restraint system (CRS) can greatly reduce child casualties in road traffic accidents. This study aims to develop the behavior maintenance model of CRS use based on the health action process approach (HAPA) theory to explore the maintenance mechanisms, suggesting appropriate intervention strategies. METHODS: Adopting the multi-stage stratified cluster random sampling method, a cross-sectional survey for guardians recruited from kindergarten and primary school was conducted using the questionnaire developed based on the HAPA theory in Nanjing, China, and 1135 valid samples were finally obtained. Rigorous analysis procedures of the partial least squares structural equation modeling (PLS-SEM) method were applied by using SmartPLS3.3.2 software. RESULTS: The results confirmed that action self-efficacy (ß = 0.479, P < 0.001) and negative outcome expectancy (ß = -0.187, P < 0.001) were valid predictors of intention in the non-intentional stage, intention (ß = 0.488, P < 0.001) and maintenance self-efficacy (ß = 0.334, P < 0.001) contributed significantly to action planning in the intentional stage, while action planning (ß = 0.470, P < 0.001) and recovery self-efficacy (ß = 0.256, P < 0.001) jointly determined behavior maintenance in the action stage. It was also revealed that action planning fully mediated the relation between intention and behavior maintenance (ß = 0.229, P < 0.001). CONCLUSION: Based on the above mechanisms, interventions aimed at the stages of non-intention, intention, and action should be designed and implemented, with the participation of the government, automobile dealers, and communities to promote the maintenance of improved CRS use behavior.

Soil aggregation is more important than mulching and nitrogen application in regulating soil organic carbon and total nitrogen in a semiarid calcareous soil.

Evaluating soil aggregation and microbial activities within soil aggregates contributes to understanding carbon (C) and nitrogen (N) cycling. Here we examined soil aggregate distribution, C and N pools, and extracellular enzymatic activities (EEAs) in soil aggregates after 16-year mulching (CT, no mulch; RF, plastic-mulched ridges and straw-mulched furrows; SM, straw mulch) and N fertilization (0, 120, and 240 kg ha-1). RF and SM significantly increased macroaggregate formation and aggregate stability (MWD, mean weight diameter) but N rate did not. Mulching had similar effects on aggregate-associated SOC (soil organic C) and TN (total N), with the order SM > RF > CT in macroaggregates and macroaggregate-occluded microaggregates. N input significantly increased TN in most cases, whereas its effect on SOC was only significant in SM. Notably, the majority of SOC and TN was isolated in the macroaggregate-occluded silt and clay fractions. SOC, TN, microbial biomass C (MBC), and microbial biomass N (MBN) decreased as aggregate-size decreased, whereas C- and N-acquiring enzymes varied greatly across aggregate fractions. Mulching had greater effects than N-fertilization on soil C and N pools and EEAs, whilst SM performed more beneficial effects than RF on SOC, TN, MBC, MBN, and EEAs. MBC rather than SOC was associated with MWD in bulk soil, while significant relations between MWD and SOC were observed in macroaggregates and macroaggregate-occluded microaggregates. Partial least squares path modeling illustrated that soil aggregation was the most important factor affecting SOC and TN, followed by mulching and N addition. Regression analysis further revealed that α-glucosidase and leucine aminopeptidase were major variables mediating SOC and TN dynamics at the aggregate scale. This study highlights the importance of macroaggregate-occluded microaggregate fraction sensitively evaluating soil C and N dynamics, and straw mulch can effectively increase soil aggregation and stabilization of C and N in semiarid areas with infertile soils.