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When and how to achieve a carbon peak is a concern for provincial regions within China under the context of achieving carbon neutrality in 2060. This study investigates the overall carbon peak environmental and resource impacts under current national targets and Shanghai's latest more aggressive carbon peak policy by using a dynamic multiple-region computable general equilibrium (CGE) model for the year 2030. Results show that (1) the national carbon peak and the more aggressive regional policy in Shanghai will result in energy consumption and carbon emissions decreases when compared to the business-as-usual scenario in most provinces; (2) although some cobenefits in water use reduction may occur in most provinces under the carbon policy scenarios, the results show positive and negative variations; (3) provincial level environmental and resources in transport, electricity, metal smelting and pressing, and agricultural production sectors are most influenced by Shanghai's aggressive carbon peak policy; and (4) the outsourced environmental and resource impacts from Shanghai to other provinces are very significant under Shanghai's aggressive carbon policy. These relevant results provide insights to facilitate broader governance decision-making for environmental resource nexuses while seeking an improved understanding of global sustainable development and climate governance.

China's overcapacities in manufacturing industries, including pollution-intensive industries, served as an important motivation of the Belt and Road Initiative (BRI). The popular Pollution Haven Hypothesis (PHH) therefore expects that the initiative will lead to the relocation of polluting industries from China to the recipients. Focusing on the implementation by local governments, we argue that actual outcomes of the BRI depend on the way local states and businesses respond to the BRI in accordance with their preferences. Through investigating industries’ actual responses to the BRI, we found that pollution-intensive industries have not relocated but rather expanded exports to the BRI countries. This has two implications: on the one hand, it alleviates the overcapacity issue in China and helps sustain the economic performance of the industry; on the other hand, it results in more pollution within Chinese borders and aggravates the environmental challenges facing the country.

We analyzed total organic carbon (TOC), total nitrogen (TN), and heavy metals in 58 sediment samples from the Laoshan Bay, China. TOC and TN results identified marine primary production as the dominant source for organic matter, and the weak correlations between TOC, TN, and heavy metals indicated the terrestrial origin of heavy metals. Cd showed insignificant correlations with other metals, which suggests that agriculture production is the main anthropogenic activity affecting the distribution of Cd. Pb contamination in past 50 years was likely to have occurred because of fossil fuel combustion. Despite

Psychological distress greatly impaired the psychological and physical well-being of lung cancer patients. Identification of protective and risk factors is a prerequisite of developing effective psychological treatment protocol. The study aims to determine the relationship of mindfulness and psychological distress and further clarify the mechanism of mindfulness against psychological distress through perceived stigma and social support among Chinese lung cancer patients. A cross-sectional survey study involving 441 valid Chinese lung cancer patients was conducted from September 2018 to August 2019. After all validated questionnaires that measured psychological distress, level of mindfulness, social support, and perceived stigma were returned by patients, we firstly performed correlation analysis to assess the associations between mindfulness, social support, perceived stigma, and psychological distress. Then structural equation modelling analysis was conducted to further clarify the mediating effects of perceived stigma and social support on the relationship between mindfulness and psychological distress. According to our hypothesis and further modification, our revised model adequately fits to data. Mindfulness (β = − 0.107, p = 0.008) and social support (β = − 0.513, p

Aim To investigate the effect of social support on psychological distress among Chinese lung cancer patients and clarify the mediating role of self‐esteem. Design A cross‐sectional descriptive correlational survey of 441 Chinese lung cancer patients was designed. Methods Self‐esteem was supposed to play a mediating role in the association between social support and psychological distress. We collected demographic information, the Distress Thermometer, Multidimensional Scale of Perceived Social Support and Rosenberg Self‐Esteem Scale. Results Our revised model demonstrated an acceptable fit to the data (χ 2 = 37.489, comparative fit index (CFI) = 0.965, Tucker‐Lewis index (TLI) = 0.926, root mean square error of approximation [RMSEA] = 0.099). Social support had a direct effect on self‐esteem and psychological distress, and self‐esteem had also a direct effect on psychological distress. Meanwhile, self‐esteem also partially mediated the relationship between social support and psychological distress among Chinese lung cancer patients.

BACKGROUND Yoga receive more attention from breast cancer patients, however its feasibility and efficacy during chemotherapy remains conflicting. We performed this systematic review to assess the effects of yoga on health-related quality, physical health and psychological health in breast cancer patients undergoing chemotherapy. METHODS A systematic search was conducted to retrieve randomized controlled trials (RCTs) which investigated the comparative efficacy of yoga versus comparators such as usual care among breast cancer patients for health-related quality, physical health and psychological health in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CNETRAL), Nursing and Allied Health Literature (CINAHL), Chinese Biomedical Literature (CBM) Database, China Science and Technology Journal (CSTJ) Database, China National Knowledge Infrastructure (CNKI), and Wangfang Database from inception to December 2018. The latest search was updated on September 2020. All analyses were completed using RevMan version 5.3. RESULTS Seven trials involving 693 breast cancer patients met inclusion criteria. Meta-analysis indicated a short-term improvement in fatigue [standard mean difference (SMD), -0.62; 95% confidence interval (CI), -1.17 to -0.07], sleep disturbance (SMD, -0.34; 95% CI, -0.55 to -0.12), depression (SMD, -0.50; 95% CI, -0.70 to -0.31) anxiety (SMD, -0.50; 95% CI, -0.70 to -0.31), and health-related quality of life (QoL) (SMD, 0.72; 95% CI, -0.12 to 1.56) in the yoga group; however beneficial medium- and long-term effects in fatigue, sleep disturbance were not identified. Moreover, qualitative analyses suggested that yoga was not associated with decreased adverse events (AEs) compared with control groups. CONCLUSIONS Yoga may benefit to reduce fatigue, depression and anxiety, improve sleep disturbance, and improve QoL in breast cancer patients receiving chemotherapy in the short-term; however, medium- and long-term effects should be further established owing to limitations.

With the relocation of heavy industries moving from downstream region to upstream and midstream regions in the Yangtze River Economic Belt (YREB), it is critical to encourage coordinated low carbon development in different regions within the YREB. This paper uncovers the evolution of CO2 emissions in different regions within the YREB for the period of 2000–2017. It decomposes regional CO2 emission changes using the temporal and cross-regional three-layer logarithmic mean Divisia index (LMDI) method. Besides, it decomposes industrial CO2 emission changes using the temporal two-layer LMDI method. The research results show that economic growth is the major driver for regional CO2 emission disparities. The mitigation drivers, such as energy intensity and energy structure, lead to a more decreased CO2 emission in the downstream region than in the upstream and midstream regions. In addition, it proposes several policy recommendations based upon the local realities, including improving energy efficiency, optimizing energy structure, promoting advanced technologies and equipment transfers, and coordinating the development in the upstream, midstream and downstream regions within the YREB.

ObjectivesTo explore the impact of population aging on the projected prevalence of obesity among Chinese adults in 2030.MethodsIn total, 71450 observations were extracted from the China Health and Nutrition Survey between 1991 and 2015.Population was projected to 2030 using a Bayesian hierarchical modeling method. Two different approaches were adopted to estimate and project the national prevalence of overweight/obesity from 1991 to 2030. One method assumed a constant population at the base year, while the other allowed the age and gender distributions vary in each year.ResultsOur projection indicated that approximately two-thirds of Chinese adults would be affected by overweight/general obesity in 2030, and more than 60% of Chinese adults will suffer from abdominal obesity in 2030. Ignoring population aging led to an underestimation of overweight, general obesity and abdominal obesity for women by 3.81, 0.06, and 3.16 percentage points (pp), and overweight and abdominal obesity among men by 1.67 and 0.53 pp, respectively; but the prevalence of general obesity among men will be overestimated by 2.11 pp. Similar underestimations were detected in the estimation from 1991 to 2015.ConclusionsEstimating and projecting the national prevalence of obesity using a constant population structure at the base line would cause significant underestimation if countries are undergoing rapid population aging.

The outbreak of COVID-19 has significantly increased consumers’ demands for online groceries, as well as healthy, safe, and better-quality food products. In China, certified food products are commonly perceived as safe and good-quality products. Therefore, this study investigated potential factors that influenced Chinese consumers’ online shopping intentions toward certified food during the COVID-19 crisis. An integrated model was proposed by combining the technology acceptance model (TAM) and the theory of planned behaviour (TPB) with the impact of COVID-19 (IOC). The empirical results of structural equation modelling analysis with 491 usable responses revealed that the proposed model showed a good model fit and satisfactory explanatory power (R2 = 53%) regarding consumers’ certified online food shopping intentions during the pandemic. The path analysis demonstrated that attitude, perceived behavioural control, perceived usefulness (PU), and IOC significantly affected consumers’ online purchase intentions of certified food. PU and perceived ease of use (PEOU) were important drivers of attitudes, and PEOU significantly influenced PU. Moreover, the IOC was significantly related to most factors, except subjective norms. These findings can be useful for detecting changes in consumer behaviour, and providing suitable strategic implications for stakeholders in the Chinese certified food sector during the current and post-pandemic eras.

Purpose The purpose of this paper is to investigate Chinese farmers’ adaptation behavior in the context of the rising cost of labor in agriculture. As the cost of labor increases, farmers will either reallocate their budget to different inputs or change the structure of agricultural production to maximize profit. Design/methodology/approach The Rural Fixed Point Observation data set between 2004 and 2010 is employed in the empirical analysis of this study. Both the compensated and uncompensated demand elasticities with respect to wages are estimated by adopting the translog cost function and the profit function. Findings The results show that labor input will drop down significantly as a response to rising wages. Land, fertilizer and intermediate inputs are net complements of labor, whereas machinery appears to be net substitute for labor. In addition, the authors also separate the expansion effect from the substitution effect and find that farmers will shift to grain production with intensive use of fertilizer and from wheat and corn to rice as a response to the rising cost of labor. Originality/value This study adopts the classical household model to incorporate various adaptation behaviors of farmers into one framework and decomposes the total effect of the rising cost of labor on input demand into an expansion effect and a substitution effect, which provides a better understanding of farmers’ adaptation behavior.

The relationship between farm size and production cost, especially inefficiency cost, has been a hotly debated topic for decades, but no general conclusion has been reached. This subject has particularly important implications for agricultural policies in China, which is in the course of rapid structural change. We decompose the production cost into frontier cost, technical inefficiency cost and allocative inefficiency cost with a primal system approach, and we demonstrate that technical inefficiency cost increases but allocative inefficiency cost decreases as farm size increases. In addition, large-scale farms gain the overall cost advantage due to their lower allocative inefficiency cost. We also find that a minimum purchase price higher than all farm costs impedes the enhancement of scale and masks the competitiveness of China. Moreover, the determinants of inefficiency costs imply that region-specific market imperfection holds a considerable explanatory power for the allocative inefficiency costs.

China is the largest energy consumer in the world. Identifying China's energy consumption pathways at sectoral levels provides critical information to support energy efficiency improvements, reduce total energy consumption and address issues of access and equity. This study evaluates China's energy footprint based on multi-regional input-output analysis at sectoral level from 1995 to 2009. The foreign and domestic dependency of China's energy footprint is investigated at sectoral level as well. The main results show that the percentage of China's energy footprint to the total global energy footprint increased from 7.6% in 1995 to 15.2% in 2009. China's sector c18, which relates to the sale of Motor Vehicles, Motorcycles and fuel, is the top energy consuming sector over the study period. At a sub-sectoral level, the dominant energy pathway contributing to c18 is China's sub-sectoral c17 (Energy supply sector); c8 (Energy refined sector); c12 (Metal sector); c11 (Other Non-Metallic Mineral sector); Korea's sectoral c9 (Chemical sector) and c8 (Energy refined sector) and Russia's sectoral c17 (Energy supply sector). In terms of dependency on other countries, China's energy footprint network depends most on Russia, USA and Germany.

Sectoral adjustment for China’s export is vital to transform the Chinese economic structure so that high-quality development can be achieved. However, it is unknown to what extent export restructuring will affect the national economy and carbon dioxide (CO2) emissions. This study quantifies the potential economic and CO2 emission impacts of export restructuring under various export structure patterns and climate policies scenarios by using a global computable general equilibrium (CGE) model. Results show that China’s export restructuring will lead to 0.5–0.7% increase of Gross Domestic Production (GDP) and 2.0–2.2% increase of consumption in 2030 under all the non-climate policy scenarios, although the export volume will decrease. Meanwhile, CO2 emissions per GDP and total employment will both decrease under all the scenarios. At the sectoral level, the transport equipment sector will increase significantly in output, employment and CO2 emissions, while the textile sector will suffer substantial output and employment losses. Considering the application of climate policies, the USA pattern has the highest GDP and is the most carbon efficient among the three export structures. China’s export restructuring will also increase global GDP and consumption by around 0.2% and 0.4%, respectively. Such results suggest that encouraging export of service, transport equipment and reducing export of textile would be effective for China’s economic development and CO2 emission reduction.

China's pharmaceutical industry has experienced a rapid growth and is now facing a great challenge of reducing its CO2 emission. However, a detailed study concerning its energy consumption and corresponding CO2 emission characteristics, including emission trajectory, spatial distribution and driving forces at the whole sectoral scale is still lacking. In order to fill these research gaps, this study first uncovers the CO2 emission trajectory of China's pharmaceutical industry and then identifies the key driving forces of its emission growth by utilizing an extended Logarithmic Mean Divisia Index (LMDI) method. The results show that the total emission increased from 23.03 Mt in 2000 to 55.34 Mt in 2016. The consumptions of electricity, raw coal and heat were three major CO2 emission sources. From the provincial perspective, the top 5 provinces emitted 51.77% of the total CO2 emission in 2016, of which Shandong province was the biggest emitter, followed by Jiangsu, Jilin, Inner Mongolia and Ningxia. The analysis of relevant driving forces reveals that production scale effect was the most prominent factor of CO2 emission growth and investment intensity also contributed to CO2 emission growth. Conversely, energy intensity and R&D efficiency were the main contributors of CO2 emission reduction. Mitigation measures are finally proposed by considering the Chinese realities, including improving pharmaceutical industrial structure, promoting cleaner production strategy, encouraging rational R&D and investment activities, optimizing energy structure and initiating capacity-building efforts.

China proposed the Belt and Road Initiative (BRI), an unprecedented development strategy in terms of scope and scale, to increase the connectivity with the rest of the world by infrastructure development and trade activities. Recently, more attention has been directed to the environmental implications of the international trade activities under this initiative, which contributes to the development of a green, i.e. environmentally friendly, partnership. This study examines the evolution of virtual water trade in relation to agricultural products between China and BRI countries during 2000-2016. The Logarithmic Mean Divisia Index (LMDI) method is adopted for uncovering the driving factors underlying the trade imbalance, as well as the major virtual water exports. Results reveal that China has experienced the shift from a net virtual water exporter to a net importer. At the regional level, Southeastern Asia and Southern Asia are the major net virtual water exporters to China, and Eastern Asia is the major importer. For the selected export countries, an increase in proportion of trade in relation to domestic production significantly contributes to their virtual water export, while water intensity could decrease virtual water export for most export countries. As for the driving forces behind the imbalance of virtual water trade, trade structure was an obvious positive effect, while the effects of water intensity, product structure, and trade scale shifted in favor of virtual water outflows from BRI countries to China in 2008. Massive global water loss has incurred, indicating the inefficiency of this partnership in relation to freshwater. A closer trade relationship is established between China and BRI countries, and relevant environment implications are identified. Policy implications are proposed in terms of trade structure, relationship of trade and domestic production, and international cooperation. This study provides valuable insights into the equity and sustainability of historic trade activities with respect to freshwater resources.

The market-oriented reform in China in the past 4 decades has greatly reshaped the consumption pattern in rural areas. In particular, farmers’ diets are more likely to depend on food market development such as food accessibility. This study investigates the role of food accessibility in the transition of dietary pattern in rural China by using the China Health and Nutrition Survey data (1997–2011) and whether food accessibility helps alleviate the deviation between farmers’ dietary pattern and the recommended dietary pattern according to China Food Pagoda 2016. The primary results indicate that food accessibility contributes to improvements in quality. In particular, food accessibility increases the consumption of oil and decreases the consumption of cereal, potatoes, and beans; fruits; vegetables; and salt. Further estimation finds evidence that along with increasing food accessibility, fruit is converging to the recommended dietary pattern in China Food Pagoda 2016, and the deviations of legumes, nuts, and oil are increasing. We also observe that the impact of food accessibility on dietary quality is stronger for those not engaged in agriculture production. Our study provides valuable implications for rural development and nutrition security in the developing world.

Gold production has brought serious environmental impacts on the natural ecosystem. Thus, it is critical to evaluate such impacts so that appropriate mitigation measures can be initiated. Derived from thermodynamics and systems ecology, emergy synthesis is one evaluation method widely used for environmental accounting. This study employs emergy-based indicators to evaluate gold ingot production based on regional data so that the holistic environmental performance of gold production in China can be examined. Sensitivity analysis on gold concentration, dominant contributors, labor & services is conducted so that more reliable results can be obtained. Results show that the total emergy (without labor & services) used for per gram gold ingot production was 9.63E + 13 sej, in which energy and chemicals were the dominant contributors. Specially, the unit emergy value of gold in the ground based on local gold enrichment was 3.67E + 12 sej/g. Results also indicate that gold production is extremely unsustainable because it’s heavily dependent on nonrenewable resources during its whole production life cycle. Finally, several recommendations were proposed to mitigate its overall environmental impacts by considering the local realities.

Metal production from mineral resources is crucial for economic development. However, most mining activities usually target short-term financial benefits, rather than long-term consideration on ecological sustainability. To better understand the impact of metal production, systematic evaluation methods should be applied to complement current economic accounting tools. Under such a circumstance, this study proposes an emergy-based metal production evaluation framework, taking a life cycle perspective from the formation of mineral deposit to the final production of metal. Ecosystem service loss, CO2 emissions, and emissions’ impact are quantified, evaluating the comprehensive performance of a lead and zinc production system in Yunnan Province of China. The results show that minerals contribute significantly to the formation of lead and zinc production; however, emergy received in terms of money substantially undervalues environmental work associated with production. Such a metal production system relies heavily on nonrenewable resources and put enormous pressures on local ecosystems. The beneficiation subsystem generates the highest negative impact per emergy output, followed by the smelting and refining subsystem and the underground mining subsystem. From climate change point of view, producing 1 ton of lead bullion leads to 1.79E+03 kg CO2eq. Electricity use contributes a dominated share to the total CO2 emission of all subsystems. In addition, lead recycling can greatly reduce the overall CO2 emission, indicating that it is necessary to build up a regional lead collection and recycling system. Finally, several policy suggestions are raised by considering the local realities, aiming to promote sustainable development of this industry.

Water embodied in traded commodities is important for water sustainability management. This study provides insight into China's water footprint and virtual water trade using three specific water named Green, Blue and Grey. A multi-region input-output analysis at national and sectoral analysis levels from the years 1995 to 2009 is conducted. The evolution and position of China's virtual water trade across a global supply chain are explored through cluster analysis. The results show that China represented 11.2% of the global water footprint in 1995 and 13.6% in 2009. The green virtual water is the largest of China's exports and imports. In general, China is a net exporter of virtual water during this time period. China mainly imports virtual water from the USA, India and Brazil, and mainly exports virtual water to the USA, Japan and Germany. The agriculture sector and the food sector represent the sectors with both the largest import and export virtual water quantities. China's global virtual water trade network has been relatively stable from 1995 to 2009. China has especially close relationships with the USA, Indonesia, India, Canada, Mexico, Brazil and Australia. Trade relations, resource endowment and supply-demand relationships may play key roles in China's global virtual water footprint network rather than geographical location. Finally, policy implications are proposed for China's long term sustainable water management and for global supply chain management in general. Keywords: Water footprint, Global supply chain, Cluster analysis, Virtual water trade, China

The agriculture sector is both a significant consumer of energy and water and a major source of environmental pollution and greenhouse gases. Soybean production (Glycine max) has experienced a fast growth and it is the fourth most widely cultivated crop, leading to serious environmental concerns. This study evaluates the energy, carbon, and water footprints of China’s soybean production so that key environmental impacts can be identified. To provide reliable results for decision-making, uncertainty analysis is conducted based on the Monte Carlo model. Results show that the impact on climate change, fossils depletion, ecosystem quality, human health, and resource was 3.33×103 kg CO2 eq (GSD2 = 1.87), 343.37 kg oil eq (GSD2 = 1.60), 6.18×10− 5 Species·yr (GSD2 = 1.81), 3.26×10− 3 DALY (GSD2 = 1.81), and 89.22 $ (GSD2 = 2.28), respectively. Freshwater ecotoxicity was the dominant contributor (77.69%) to the ecosystem quality category, while climate change (85.22%) was the dominant contributor to the human health category. Key factors analysis results show that diammonium phosphate and diesel, and on-site emissions from soybean production, were the major contributors to the overall environmental burden of soybean production. Several policy recommendations are proposed, focusing on trade structure optimization, technological improvements, and efficient resource use. Such policy recommendations provide valuable insights to those decision-makers so that they can prepare appropriate mitigation policies.

Objective To test the feasibility of image-guided Baha Attract implant surgery with mixed reality (MR) in the form of the HoloLens to visualize critical structures and facilitate precise Baha implant placement. Methods A cadaveric case study of bilateral Baha Attract implant approaches was conducted using Star Atlas MR three-dimensional (3D) medical interaction system guidance at the Otolaryngology Department of PUMCH, Beijing, China. The accuracy of visual surface registration was determined by the target registration error (TRE) between the predefined points on the preoperative 3D holographic Baha Attract implant model and the postoperatively reconstructed 3D model. Results Bilateral Baha Attract implantation was completed successfully for all four cadaveric heads using the Star Atlas MR 3D medical interaction system with the HoloLens. The preoperative 3D digital model characteristics (including bone quality and thickness and avoidance of cranial vessels, air cells, and cranial sutures) corresponded well with the 3D model of the actual implantation reconstructed postoperatively. The median TRE of our system was 2.97 mm (ranging from 1.98 to 4.58 mm) in terms of distance and 2.76 degrees (ranging from 0.59 to 6.4 degrees) in terms of angle. Conclusions Applying MR technology in the form of the HoloLens in Baha Attract implant surgery is feasible and could improve the accuracy of the surgery. The described MR system for Baha Attract implantation has the potential to improve the surgeon's confidence, as well as the surgical safety, efficiency, and precision.

BACKGROUND Oral mucositis is one of the most frequent, irreversible and distressing complications faced by head and neck cancer (HNC) patients undergoing radiotherapy. Several studies have investigated the role of honey in the prevention and alleviation of radiation-induced oral mucositis in HNC patients, however, a definitive conclusion has not yet been generated. We performed this updated systematic review and metaanalysis to determine whether honey can prevent and alleviate radiation-induced oral mucositis in HNC patients. METHODS We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and China National Knowledge Infrastructure (CNKI) through October 2019. We searched and selected literature, extracted data and assessed risk of bias accordingly, and then conducted statistical analyses with RevMan software version 5.3. RESULTS Seven trials involving 412 patients were included in the final analysis. Meta-analyses showed that honey did not decrease the incidence of radiation-induced oral mucositis [(relative risk (RR), 0.69; 95% confidence interval (CI), 0.40-1.18; P=0.18]; however, relieved the severity of oral mucositis (RR, 0.22; 95% CI, 0.13-0.38; P

Nutrition transition in China has a strong impact on dietary quality and health of Chinese consumers. This study developed the diet quality divergence Index (DQD), the divergence between real food consumption and the Chinese food pagoda 2016 (CFP), to measure the quality of diet in China. Using four waves of data (2004, 2006, 2009, and 2011) from China Health and Nutrition Survey (CHNS), this study shed light on the transition of diet quality for Chinese residents. Results indicate that the DQD generally decreased and Chinese diet quality improved during 2004&ndash, 2011. The divergence was mainly caused by over-consumption of legumes and nuts, and under-consumption of milk and milk products. Rising income and urbanization were positively correlated with diet quality for the people with low DQD. However, both of them had negative impacts on diet quality for those with high DQD. Females and rural residents held a lower DQD than their counterparts. The results also revealed that healthy food preference, education, dining at home, household size, proportions of teens (6&ndash, 17) and elders (over 64) in the families are positively correlated with Chinese diet quality. However, labor intensity, frequency of drinking alcohol, and smoking have negative impacts on diet quality. Moreover, higher DQD was found to be associated with increasing risks of overweight/obesity. Therefore, we suggest national healthy policies should pay more attention to nutrition education. It is also necessary to focus on populations with poor diet quality and to adopt measures to control drinking alcohol and smoking.

Simultaneous bilateral cochlear implantation is often seen as the gold-standard intervention for many people with bilateral deafness. However, this intervention is not as commonly performed in China. This paper presents the surgical technique and the peri- and postoperative safety results from simultaneous bilateral implantation and compares them with those from sequential bilateral implantation. Twenty nine children (aged 12‒18 months) met the inclusion/exclusion criteria and took part in this study. 10 participants received a unilateral cochlear implantation; 19 participants received simultaneous bilateral cochlear implantation. The same standard surgical technique (transmastoid facial recess approach with round window insertion) was used in all implantations. Safety was assessed via monitoring peri- and postoperative adverse events. The helpfulness of select surgical tools was assessed via questionnaire. No adverse events were reported for any participants. All queried surgical tools were helpful in all 244 recorded responses. Simultaneous bilateral cochlear implantation can be performed using the same surgical technique as unilateral implantation and poses no increased safety risk for children aged 1‒2 years.

The rapid economic and social development in the past decades has greatly increased the societal acceptance of divorce and non-marital pregnancies in China, which leads to a soaring number of single-parent children. This paper aimed to investigate the impact of having one parent absent on children&rsquo, food consumption and nutrition status. We extracted 1114 children from a longitudinal household survey data in China, all of which were observed twice. Using the Propensity Score Matching and Difference-in-Difference methods, we found that being raised by one parent does not have a negative effect on children&rsquo, s food consumption and nutrition intake. On the contrary, single-parent families tend to provide more food to their children as a compensation for the absence of one parent and this compensation effect offsets the negative impact caused by declined family income. Particularly, urban, rich families had stronger compensation effect than other families with low and middle incomes.

The zero-markup drug policy is an important component of the new round of Chinese health care reform that began in 2009 to promote the separation between medical and pharmaceutical services, reduce patients' medical burden, and improve the medical supply security system. Over the past 8 years, the zero-markup drug reform policy has been carried out in 4 pilot rounds (a policy diffusion model with Chinese characteristics) and has been promoted throughout the mainland China. At this critical point, it is necessary to review this policy systematically. Therefore, based on the literature, government documents, and interview records, this study analyzed the characteristics, progress, achievements, challenges, and recommendations of zero-markup drug reform by using the policy diffusion theory. The study found that zero-markup drug reform has completed its initial diffusion by use of the "policy experiment" method and has reduced drug prices and patients' burden to a certain extent. However, in the next phase of policy diffusion, the reform still requires adjustment and innovative measures to respond to future challenges. Generally speaking, as China's unique health care reform practice, the experience of zero-markup drug reform could be used as a reference for other countries to control drug prices, separate medical and pharmaceutical services, and establish a modern system of hospital operation.

Economic impact assessments of air pollution-related health effects from a sectoral perspective in China is still deficient. This study evaluates the PM 2.5 pollution-related health impacts of the road transport sector on China's economy at both national and provincial levels in 2030 under various air mitigation technologies scenarios. Health impacts are estimated using an integrated approach that combines the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) model, a computable general equilibrium (CGE) model and a health model. Results show that at a national level, the road transport sector leads to 163.64 thousand deaths per year, increases the per capita risk of morbidity by 0.37% and accounts for 1.43 billion Yuan in health care expenditures. We estimate 442.90 billion Yuan of the value of statistical life loss and 2.09 h/capita of work time loss in 2015. Without additional control measures, air pollution related to the transport sector will cause 177.50 thousand deaths in 2030, a 0.40% per capita increase in the risk of morbidity, accounting for 4.12 billion Yuan in health care expenditures, 737.15 billion Yuan of statistical life loss and 2.23 h/capita of work time loss. Based on our model, implementing the most strict control strategy scenario would decrease mortality by 42.14%, morbidity risk by 42.14%, health care expenditures by 41.94%, statistical life loss by 26.22% and hours of work time loss by 42.65%, comparing with the no control measure scenario. In addition, PM 2.5 pollution from the road transport sector will cause 0.68% GDP loss in 2030. At a provincial level, GDP losses in 14 out of 30 provinces far exceed the national rate. Henan (1.20%), Sichuan (1.07%), Chongqing (0.99%), Hubei (0.94%), and Shandong (0.90%) would experience the highest GDP loss in 2030. Implementing control strategies to reduce PM 2.5 pollution in the road transport sector could bring positive benefits in half of the Chinese provinces especially in provinces that suffer greater health impacts from the road transport sector (such as Henan and Sichuan).

Trade plays an important role in redistributing resources and also brings significant environmental impacts to involved countries. This relatively complex research domain of international trade and environmental burden shifts is informed through study of embodied environmental flows of products. Research trends to identify features of international trade embodied flows between 1997 and 2016 are determined through a bibliometric study. Research contribution of countries, authors, institutions and journals are described. Co-citation and network analyses are completed. Results show that there has been significant research interest increase on this topic. Given the interdisciplinary and global nature of this topic, increases in countries, author, and institutional collaborations has occurred. USA, China, the Netherlands, the United Kingdom and Norway were the top 5 countries with high academic influence, and country as USA and institution as Chinese Academy of Sciences has the largest number of collaborations, respectively. Embodied flows such as carbon emission and water are popular ones associated with international trade in the given period, and the most popular methodological tool is Input/Output Analysis. In addition, hotspots which extracted from keywords are analyzed, additional avenues of research are also discussed in this study.

Transport sector’s substantial contribution to global greenhouse gas emissions has made it a growing area of study and concern. In order to identify trends and characteristics of carbon emissions research in the transportation sector we conducted a Bibexcel and complex network analysis for the period 1997–2016. In addition, we identify critical themes and contributions of research articles using h-index, PageRank and cluster analysis. We report contribution of countries, authors, institutions and journals, as well as performance of citations and keywords. Co-citing situations between different countries, authors, and institutions are also analyzed using network analysis. Between 1997 and 2016 we found a rise in publications on carbon emissions in the transportation sector and increased cooperation between countries, authors, and institutions. Authors from the USA, China and United Kingdom published the most articles and articles with the highest academic influence. Tsinghua University from China is the leading institution in carbon emissions research in the transportation sector. The most widely published author and cited author is Dr. He. We conclude our analysis by analyzing keywords and trends to suggest critical topic areas of future research. The systematic approach undertaken in this study can be extended and applied to other research topics and fields.

The strong son preference tradition in China has been weakened by the rapid development in the cultural, economic, political, and social environment, which leads to a rather ambiguous picture regar...

International trade has accelerated the trend of globalization, giving consumers and countries the opportunity to reach new markets and products. However, it also brought negative externalities in the forms of pollution and environmental degradation. Plus, the large amounts of resource flows among different countries may aggravate resource depletion. Thus, it is necessary to uncover the embodied resource flows and corresponding environmental impacts so that sustainable trade policies can be raised. Under such a circumstance, this paper accounts environmental and resources footprints embodied in the China-EU trade for the year of 2008 by employing a multi-regional input-output model, including both the global and sectoral environmental and resource footprints which caused by the trade between China and the EU-27 countries. Research results show that from the global footprints perspective, the total environmental footprints of China and EU countries are 4.73 Gt and 4.53 Gt in 2008, respectively. The total resource footprints of China are 8.19E+07 TJ of energy, 0.66 Bha of land, 14.5 Gt of materials, and 1.47 Tm 3 of water, while such figures for EU countries are 1.17E+08 TJ of energy, 0.66 Bha of land, 12.1 Gt of materials, and 1.26 Tm 3 of water, respectively. The transfer trend of environmental and resources footprints between China and EU was also analyzed, indicating that EU countries caused 8.21 times of emission footprint than China's, and China provided 6.25 times of energy footprint, 16.76 times of land footprint, 12.26 times of material footprint, and 17.38 times of water footprint for EU countries' final consumption. In addition, the sectoral footprints between China and the five selected EU countries were analyzed. Finally, policy implications from environmental and resources management perspectives are proposed.

Due to different resource endowment, geographical features, culture and population sizes, different regions are facing different challenges and therefore need to adopt different strategies toward sustainable development. China’s Eastern, Central and Western provinces are taking different policies on international trade in order to boost their economy. This paper tries to investigate to what extent a province receives a trade advantage and the corresponding environmental resource flows by employing an emergy accounting method for the period of 1993–2012. Three emergy trade indicators (Exchange Emergy Ratio, Emergy Benefit Ratio and Opportunity Ratio) were calculated along with conventional monetary indicators, to describe the benefits and losses in trade over the investigated period. The results show that the total trade volume of each province increased, but the trajectory of growth has a clear regional disparity. Eastern provinces gained economic advantages during the investigated period, while western provinces did not. The key finding is that benefits in terms of resource availability and work potential are not always in line with monetary advantages. Foreign trade partners received more advantages than their Chinese counterparts although Eastern Chinese provinces performed much better than both Central and Western Chinese provinces. Policy suggestions are then raised so that more sustainable trade policies can be prepared by considering the local realities.

The rapidly aging population and increased number of elders living alone in rural China have raised concerns in that such elders are more vulnerable to unhealthy eating behaviors. Using data from four waves of the China Health and Nutrition Survey, we estimate the effects of living arrangements on eating behaviors of the elderly in rural areas. Results show that living arrangements are significantly associated with eating behaviors, in which elders living alone are the most disadvantaged compared with their counterparts (living with grandchildren only, living with adult children, or living with others). Specifically, elders living alone consume fewer cereals, vegetables and fruits, meat, eggs, and dairy products. This type of living arrangement lowers the dietary quality and eating frequency of their meals, leading to unhealthy diets. Further estimation finds evidence that household size and composition have significant effects on elders’ eating behaviors, namely, scale and spillover effects, explaining the differential eating behaviors of elders among different patterns of living arrangements.

Low-carbon energy technology innovation is increasingly recognized as an essential driver for mitigating the global climate change. Using the patent data from 31 Chinese provinces for the period of 2000–2017, this study develops an integrated methodological framework combining gravity model, Shapley decomposition method, index decomposition method and exploratory spatial data analysis to identify the spatial characteristics and its driving factors of China’s low-carbon energy technology (LCT) innovation. Three aspects are covered, including alternative energy production technology (AEPT), energy conservation technology (ECT) and nuclear power generation technology (NPGT). The results show that the gravity centers of the total LCT and AEPT patent applications moved toward China’s southwest, while those of ECT and NPGT patent applications moved toward China’s northeast and southeast, respectively. The northern coastal China was the main engine region for the gravity shifts of the total LCT patent applications and AEPT patent applications, while the southern coastal China was the top engine region driving the gravity shift of ECT patent applications. Both northern and southern coastal China played the major roles in driving the gravity shift of NPGT patent applications. Among four drivers, technology priority was the major driving factor for the increases of all types of low-carbon energy technology innovations in China’s eight regions, followed by economic scale and R&D efficiency, while the effect from R&D share was the smallest. All types of low-carbon energy technology innovations presented significant spatial dispersions at the provincial level. Most provinces presented Low-Low clustering in 2000 and 2017, while most coastal provinces transferred from Low-Low clustering in 2000 to High-Low clustering in 2017. Finally, some policy suggestions are proposed for China to promote LCT innovation.

Located in the far southeast China, Yunnan province has a unique position in terms of its biodiversity and resource endowment. However, this province is facing various challenges due to its fast development. In order to promote its sustainable development, an emergy accounting approach was employed to evaluate its sustainability for the year 2014. Temporal analysis of emergy-based indicators was also conducted to provide a holistic picture of Yunnan's economic performance. In addition, sensitivity analysis of dominant contributors was performed to improve the research reliability. Results show that the total emergy used for supporting Yunnan's economy was 1.24 × 1024 sej in 2014 and its economy highly relied on indigenous metals (45%) and minerals (23%), as well as fuels imported to Yunnan province (12%). Emergy-based indicators reflect that economy development in Yunnan province was highly dependent on the local ecosystem, far away from sustainable development. Policy recommendations were provided in order to improve its sustainable development, such as promoting circular economy, adjusting industrial structure, developing renewable energy based on local resource endowment, and promoting capacity-building activities.

Rising demand and constrained domestic production have challenged the meat consumption in China. To fill the gap between domestic demand and supply, China imports an increasing volume of meat produ...

The Chinese government has committed to reduce its carbon dioxide emissions per unit gross domestic product by 60–65% from 2005 levels by 2030. In order to achieve this commitment, various measures should be taken. Due to the complex relationship between carbon emission and economic development, it is critical to quantify the impacts of different measures. Under such a circumstance, this paper is to identify the effects of carbon tax on the sectoral competitiveness in Shanghai by 2030 under unequal imposition of carbon tax between Shanghai and the rest of China by using a two-region dynamic computable general equilibrium (CGE) model. Research results show that different carbon tax rates in different regions would affect GDP of Shanghai and the outcomes are different under different scenarios. In general, a lower carbon tax rate can lead to a higher output and these output changes could further influence the sectoral competitiveness. Under the tax44 scenario, sectors such as agriculture, textile, transport equipment, and electronics are the winners in Shanghai, with outputs increased by 2.02%, 1.47%, 1.08% and 3.05%, respectively; while food production, petrol oil, chemicals and non-metal are the losers, with outputs decreased by 2.02%, 0.87%, 0.03% and 2.39%, respectively. This study also reveals that price and scale effects are the key factors influencing the changes of sectoral outputs. Such findings provide useful insights to those policy makers to allocate appropriate carbon reduction targets to different regions.

Utilizing the 1995–2013 Harmonized System's six-digit agricultural product data for China, this study measures the dual margin contribution to export growth in China's agricultural products. Results show that contribution from the intensive margin has reached and been staying at a high level since 2007, providing new insight in explaining the deteriorating terms of trade in China's agricultural products. In light of this, an empirical analysis of the determinants of dual margins indicates that larger trading partners lead to less growth in exports of both new and existing products. Destination countries with higher labor productivities and lower fixed trade costs are China's target markets to convert intensive-margin-driven growth into extensive-margin-driven growth. In addition, the impact of relative labor productivity and free trade agreements on the intensive margin differs between primary and processed products due to their product characteristics. Au moyen des donnees a six chiffres du produit agricole pour la Chine provenant du Systeme harmonise de 1995–2013, cette etude mesure la double marge de contribution a la croissance, des exportations des produits agricoles chinois. Les resultats demontrent que la contribution provenant de la marge intensive a atteint et demeure elevee depuis 2007, fournissant de nouvelles explications aux termes de l′echange des produits agricoles chinois. Etant donne ces informations, une analyse empirique des determinants des doubles marges indique que les grands partenaires commerciaux menent a moins de croissance dans les exportations a la fois de produits nouveaux et existants. La Chine choisit comme cibles les pays de destination avec une productivite elevee de la main-d'œuvre et de faibles couts fixes de commerce pour convertir la croissance stimulee par les marges intensives en croissance stimulee par les marges extensives. Qui plus est, l'impact de la productivite relative de la main-d'œuvre et des accords de libre-echange sur les marges intensives differe des produits primaires aux produits transformes en raison des caracteristiques du produit.

Pork production in East Asia is declining due to African swine fever. The effects of this epidemic are modelled, predicting global meat price increases and lower food security in China.

Increasing dietary diversity is concurrent with an increasing prevalence of adiposity in China, but the association between these variables remains ambiguous. This study reveals an association between dietary diversity and body mass (underweight, overweight and obesity) in Chinese adults. Data from 17 825 participants (age, 18–65 years) were pooled from four survey waves (2004, 2006, 2009 and 2011) of the Chinese Health and Nutrition Survey. Anthropometric data and dietary intake information obtained through a 24-h dietary recall for 3 consecutive days were collected. Information on covariates, namely those regarding the socioeconomic status and lifestyle of each participant, were collected. The dietary diversity score (DDS) and entropy were used to represent dietary diversity. The association between dietary diversity and adiposity was analyzed by using multivariable-adjusted multinomial logistic regression. A positive association between dietary diversity and overweight was detected only in men (DDS: OR=1.09 (1.03–1.17); entropy: OR=1.60 (1.24–2.07)). The results were confirmed by analyzing the interaction between sex and diversity (DDS: OR=1.27 (1.17–1.37); entropy: OR=2.89 (2.11–3.89)). In contrast, no significant association was detected between dietary diversity and underweight/obesity (all P>0.05). Dietary consumption was compared between sexes to explain the different effects of dietary diversity on body mass in men and women. The results indicated that men typically had a higher consumption of meat (P

Family planning policy in China has resulted in a large number of one-child families. According to Becker’s “quantity-quality trade-off” theory there is an inverse relationship between the number of children in a family, and spending per child. We test whether this has led to significant differences in the height, weight and BMI of only-children compared with children with siblings in China using 4414 observations derived from four recent waves (2004, 2006, 2009, and 2011) of the China Health and Nutrition Survey. We use propensity score matching and instrumental variables to control for the possible endogeneity of the number of siblings. Results show that only-children are significantly heavier (1.88 %–3.86 %), and have higher BMI (2.59 %–3.50 %). Moreover, they are more likely to be obese than children with siblings (2.33 %–3.00 %). Further analysis shows that these differences in health outcomes might be attributable to higher consumption of animal-source food (23.90–27.13 g), a higher frequency of eating western fast food (0.48-0.70 times/3-month) and drinking sweetened soft drinks (0.29-0.36 times/month), a higher share of meals eaten away from home (4.67 %–5.31 %), and more sedentary activity (20.04–34.35 minutes/week) by only children. Our study indicates that the growing share of only children due to China’s family planning policies also contributes to the increasing prevalence of overweight and obesity in China. This policy has been eased in recent years, which might slow the increase in the prevalence of overweight and obesity and thus reduce the corresponding health burden for Chinese society as a whole.

The BRICS countries (Brazil, Russia, India, China and South Africa) are central to future global economic development. However, they are facing both environmental and natural resource stresses due to their rapid economic growth. This study examines the balance between economic benefits and cost of environmental emissions and resource usage in BRICS countries so that future sustainable development insights can be provided. The historical trends of carbon dioxide (CO2), sulfur dioxide (SO2), water, land, energy and material footprints of these countries from 1995 to 2015 are evaluated with a multi-regional input-output model. Also, whether a decoupling relationship exists between economic development, environmental emissions and resources consumption, is examined. In addition, whether environmental emissions and resource usage costs to obtain identical economic gains of these countries in global trade are explored. The major results show that in congruence with economic development, the average annual growth rates of footprint indicators ranged from 0.2% in 1995 to 9.8% in 2015. A decoupling effect did not occur for CO2 emissions or water consumption but did exist for other indicators. Global trade across the supply chain shows to achieve a unit of USD economic benefit from trade, BRICS countries tend to use relatively greater environmental emissions and resource consumption to high income countries, when compared to other income level countries. These emergent economies did receive relatively greater benefits per environmental emissions and resource usage cost from lower-middle and low-income countries.

Rising frequency of eating-away-from-home (EAFH) is suspected to be correlated with several non-communicable diseases. This study adopted the Chinese Health and Nutrition Survey (CHNS) 2009 data to investigate the association between being diagnosed with the metabolic syndrome (MetS) and EAFH at different ages. Results showed that the association between EAFH and MetS varied at different ages and differed for males and females. EAFH was positively associated with a higher risk of getting MetS for males, especially for those aged between 45 and 60, while it was negatively associated with the risk of getting MetS for young females (&lt, 45) (all p &lt, 0.05). In particular, EAFH was associated with a lower risk of getting high serum triglycerides (TGs), abdominal adiposity, elevated blood pressure, and impaired fasting blood glucose for young females, while higher risk of high serum TGs, abdominal adiposity, elevated blood pressure, and impaired fasting blood glucose for middle-aged males (all p &lt, 0.05). In addition, a higher frequency of EAFH was associated with a higher risk of abdominal adiposity and elevated blood pressure for older women, and a lower risk of elevated blood pressure, and impaired fasting blood glucose for younger men (all p &lt, 0.05). Our study implies that heterogeneous target strategies for preventing MetS in different subpopulation should be considered.

Fruits are an important part of a healthy diet. This article proposes a simple derivation from the gravity models to analyze the determinants of the quality of imported fruits in China between 1987 and 2012. The results indicate that there is a trade-off between quality and quantity. Price has a significant substitution effect on quality. The quality elasticity with respect to China’s per capita GDP is around 1.96. Rich countries tend to export high-quality fruits to China. Other characteristics of exporting countries such as population size, geographic factors, relative endowment of land, as well as regional trading arrangement also have some impact on the quality of imported fruits in China.