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The plethora of pathways leading to health problems of later life has made the causal assessment of widowhood on the health of older adults difficult. This research aimed to assess the short‐term impact of widowhood on the objective health of older adults and to the moderating role of community‐based care (CBC) in improving the health outcomes of older adults. In this study, the activities of daily living (ADLs) and number of hospitalisations of older adults were measured, and PSM‐DID models were conducted. Widowhood had a significant negative impact on the objective health of older adults. Widowed adults had higher ADL scores (B = 0.569, 95 percent CI: 0.295 to 0.844) and more hospitalisations (B = 2.551, 95 percent CI: 1.189 to 3.914) than nonwidowed adults. Meanwhile, CBC in urban areas can significantly reduce ADL scores (B = −0.154, SE = 0.082) and the number of hospitalisations (B = −1.402, SE = 0.348) in older adults, whereas CBC in rural areas can only significantly reduce ADL scores (B = −0.197, SE = 0.087). Taken together, there is an urgent need to focus on the health of widowed and older adults and to provide CBC in both urban and rural areas equally. [ABSTRACT FROM AUTHOR]

Introduction: Implementing integrated care for the aged population has been regarded as a mechanism to achieve healthy ageing. However, evidence from undeveloped nations has been scant. This study aims to explore the integrated care experience in Anhui and Fujian Province of China based on the Rainbow Model of Integrated Care (RMIC). Methods: The qualitative study was conducted in Anhui (in the middle area) and Fujian Province (in the eastern area) between May and September in 2018. The interviewees included twenty-eight policy makers working at departments of health and civil affairs at different levels and seventeen heads of medical and elderly care institutions. Results: The preliminary progress of integrated care in the sample cities of two provinces are mainly shown at solid policy basis by multiple key government agencies and political commitment achieved (system integration); preliminary coordination mechanism established between medical and elderly care institutions (organizational integration); consolidation of multi-disciplinary collaboration (professional integration); and reinforced role of family doctor teams for community-home dwelling elderly (service integration). Main challenges are also identified at insufficient inter-agency coordination, weak service capacity, lack of sustainable funding schemes, low level of information integration, and shortage of professional supply. Conclusion: Our findings provide a feasible path for other countries to strengthen integrated care for the aged population, particularly for those confronting rapid population ageing but with fragmented health care and elderly care systems. [ABSTRACT FROM AUTHOR]

Background: One of the most noticeable integrated care-related policies in China is the growth and proliferation of County-level Integrated Health Organizations (CIHOs), which take over a set of primary healthcare institutions to form an integrated delivery network in order to achieve an ordered hierarchical delivery system by strengthening primary care. Objectives: This paper presents emerging findings from an ongoing evaluation of the early impacts of the demonstrator site, Deqing CIHO, in Zhejiang Province, in order to examine the extent to which the implementation has achieved its core objectives: (1) establishing the hierarchical referral system, (2) capacity building of primary healthcare providers, and (3) reducing the costs. Design: This case study was conducted to determine institutional and managerial processes. Settings: Data were collected and analyzed at the CIHO and county level. A structured questionnaire was used for data collection. Primary and secondary outcome measures: Indicators were selected from the existing database of the county health system and arranged into three segments to assess (1) service utilization among each level of care; (2) capacity-building progress for primary care centers, (3) cost-related indicators for both levels of care. Results: Service utilization data show that one year after CIHO implementation, the proportion of patients who chose to get inpatient care outside of the county decreased from 27.3% to 24.5%. Hospital admissions were retrieved from outside the county, while service volume slightly shifted from hospitals to primary care sites. Capacitybuilding indicators for township health centers show that 6 out of 12 items showed better performance compared to the national average growth rate, and a moderated growth rate appeared in terms of per capita cost. Conclusion: Progress evaluation results from Deqing CIHO indicated some positive effects on three main outcomes, which reveal the potential of CIHOs in not only strengthening primary care but also controlling cost as a result of early implementation. Further emphases of evaluation are required to determine the impacts on the quality and experience of care that are estimated using claim-based data at the individual level. [ABSTRACT FROM AUTHOR]

• Parent material and cropping system had higher explanation to stratification. • Clay loam soils had a weaker stratification compared to sandy loam soils. • Rice–upland crop rotation commonly increased organic carbon stratification. • Terrain, climate, soil depth and inherent content also affected stratification. The stratification ratio (SR) is a good indicator of the quantitative evaluation of the soil nutrient variation with depth, which is inter-related with nutrient cycles and agricultural productivity. However, the effects of the parent material and cropping system on the SR of soil organic carbon (SOC) and total nitrogen (TN) have received little attention. The current study collected 444, 437, and 363 soil samples at the depths of 0–20, 20–40, and 40–60 cm, respectively, in subtropical southwest China, where the predominant parent materials are alluvial deposits, purple shales, and limestone and the cropping systems are rice–upland crop rotation, upland crop rotation, and rice monoculture. A two-way analysis of variance (two-way ANOVA) and a redundancy analysis (RDA) were applied to investigate the effects of the parent material, cropping system, topography, and climate on SOC and TN contents, and the corresponding SR (SR1, 0–20 cm:20–40 cm; SR2, 0–20 cm:40–60 cm). Results indicated that the parent material and cropping system were the main factors linked to the SR of the SOC and TN, whereas topography and climate seemed to have weaker effects on the SR in the agricultural landscape. Generally, alluvial deposit- and purple shale-derived soils presented higher SR than limestone-derived soils. Rice–upland crop rotation systems increased the SR compared to rice monoculture and upland crop rotation systems. Exceptions were observed in rice–upland crop rotation and rice monoculture systems under limestone. The study highlighted the efficient SR indicator in examining the SOC and TN depth distribution corresponding to the parent material and cropping system and is expected to provide valuable information regarding the optimization of the cropping pattern in different lithological regions, thereby enhancing agricultural productivity. [ABSTRACT FROM AUTHOR]

The application potential and environmental benefits of ground source heat pump (GSHP) systems have become the focal points of decarbonization in the building sector. Synchronized and scientific analysis of GSHP systems' environmental and economic performance, however, remains lacking. This study analyzes the application prospects of GSHP systems via a life cycle assessment-based life cycle costing method, and considers China's actual status quo. The internal and external annual costs of a GSHP system per square meter are $ 4.05 and $ 1.37, respectively. Electricity generation and steel production are key processes to improve the environmental performance of a GSHP system further. Compared with coal-based heating, a GSHP system can mitigate 65%–95% of the environmental impact and 85% of external costs, except for the metal depletion impact which is 1.5 times higher than that of coal-based heating. In Shandong Province, promoting GSHP systems can substitute up to 69.4% of the district heating area, which implies reductions in fossil depletion, greenhouse gas emissions, human health impact, ecosystem quality impact, and external costs by up to 2.37 × 1010 kg oil eq, 1.08 × 1011 kg CO 2 eq, 3.87 × 105 DALY, 1.18 × 103 Species. year, and $ 2.51 × 1010, respectively. In consideration of environmental and economic aspects, a GSHP system can exhibit benefits compared with coal-based heating after 2.34 years of operation. To improve the economic and environmental performance of GSHP systems, a series of recommendations on financial subsidies, renewable energy development, inter-regional power transmission, steel scrap utilization, and hydrogen reduction steelmaking is provided. • Environmental and economic feasibilities of a ground source heat pump were examined. • Electricity generation and steel production are the main contributors. • More than 65% of environmental impact and 85% of external costs can be mitigated. • A ground source heat pump shows its life cycle benefits after 2.34-years operation. • The application potential in the cities of Dongying, Yantai, and Qingdao is high. [ABSTRACT FROM AUTHOR]

[Display omitted] • A novel SBR-UMSR process was constructed to treat manure-free piggery wastewater. • The front-end SBR functioned as a COD remover to get an effluent with a COD/TN ≤ 1. • Partial nitrification – anammox process was well performed in the back-end UMSR. • Effective synchronous removal of COD and TN was achieved in the combined process. • COD, NH 4 +-N and TN in effluent all well met the strict discharge standard of China. A novel combined sequencing batch reactor (SBR) – up-flow microaerobic sludge reactor (UMSR) process was developed to treat manure-free piggery wastewater characterized by low COD/TN ratio and high NH 4 +-N. The front-end SBR was designed to get an effluent with COD/TN ≤ 1 by removing COD, allowing the back-end UMSR to practice anammox for the simultaneous removal of TN and NH 4 +-N. Fed with the raw piggery wastewater, the combined SBR-UMSR process was started up at 27℃ with a reflux ratio of 15:1 in the UMSR. After 230-days running, the removal of COD, TN, and NH 4 +-N in the combined SBR-UMSR process reached 78.41%,85.05%, and 92.21%, respectively. 50.22% of COD in the wastewater was removed in the SBR, while 87.11% of NH 4 +-N and 79.69% of TN were removed in the UMSR. Stoichiometry and bacterial function analysis revealed that the partial nitrification – anammox process was the dominant nitrogen removal approach in the UMSR. [ABSTRACT FROM AUTHOR]