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Importance: Lowering sodium intake reduces blood pressure and may reduce the risk of cardiovascular diseases. The use of reduced-sodium salt (a salt substitute) may achieve sodium reduction, but its effectiveness may be associated with the context of its use. Objective: To identify factors associated with the use of salt substitutes in rural populations in China within the Salt Substitute and Stroke Study, a large-scale cluster randomized trial. Design, Setting, and Participants: This sequential mixed-methods qualitative evaluation, conducted from July 2 to August 28, 2018, in rural communities across 3 provinces in China, included a quantitative survey, collection of 24-hour urine samples, and face-to-face interviews. A random subsample of trial participants, selected from the 3 provinces, completed the quantitative survey (n = 1170) and provided urine samples (n = 1025). Interview respondents were purposively selected from the intervention group based on their different ranges of urinary sodium excretion levels. Statistical analysis was performed from September 18, 2018, to February 22, 2019. Exposures: The intervention group of the Salt Substitute and Stroke Study was provided with the free salt substitute while the control group continued to use regular salt. Main Outcomes and Measures: Knowledge, attitudes, and behaviors regarding the use of the salt substitute were measured using quantitative surveys, and urinary sodium levels were measured using 24-hour urine samples. Contextual factors were explored through semistructured interviews and integrated findings from surveys and interviews. Results: A total of 1170 individuals participated in the quantitative survey. Among the 1025 participants with successful urine samples, the mean (SD) age was 67.4 (7.5) years, and 502 (49.0%) were female. The estimated salt intake of participants who believed that high salt intake was good for health was higher; however, it was not significantly different (0.84 g/d [95% CI, -0.04 to 1.72 g/d]) from those who believed that high salt intake was bad for health. Thirty individuals participated in the qualitative interviews (18 women [60.0%]; mean [SD] age, 70.3 [6.0] years). Quantitative and qualitative data indicated high acceptability of and adherence to the salt substitute. Contextual factors negatively associated with the use of the salt substitute included a lack of knowledge about the benefits associated with salt reduction and consumption of high-sodium pickled foods. In addition, reduced antihypertensive medication was reported by a few participants using the salt substitute. Conclusions and Relevance: This study suggests that lack of comprehensive understanding of sodium reduction and salt substitutes and habitual consumption of high-sodium foods (such as pickled foods) were the main barriers to the use of salt substitutes to reduce sodium intake. These factors should be considered in future population-based, sodium-reduction interventions.

The Medieval Climate Anomaly (MCA, AD950-1250) is the most recent warm period lasting for several hundred years and is regarded as a reference scenario when studying the impact of and adaptation to global and regional warming. In this study, we investigated the characteristics of temperature variations on decadal-centennial scales during the MCA for four regions (Northeast, Northwest, Central-east, and Tibetan Plateau) in China, based on high-resolution temperature reconstructions and related warm-cold records from historical documents. The ensemble empirical mode decomposition method is used to analyze the time series. The results showed that for China as a whole, the longest warm period during the last 2000 years occurred in the 10th–13th centuries, although there were multi-decadal cold intervals in the middle to late 12th century. However, in the beginning and ending decades, warm peaks and phases on the decadal scale of the MCA for different regions were not consistent with each other. On the inter-decadal scale, regional temperature variations were similar from 950 to 1130; moreover, their amplitudes became smaller, and the phases did not agree well from 1130 to 1250. On the multi-decadal to centennial scale, all four regions began to warm in the early 10th century and experienced two cold intervals during the MCA. However, the Northwest and Central-east China were in step with each other while the warm periods in the Northeast China and Tibetan Plateau ended about 40–50 years earlier. On the multi-centennial scale, the mean temperature difference between the MCA and Little Ice Age was significant in Northeast and Central-east China but not in the Northwest China and Tibetan Plateau. Compared to the mean temperature of the 20th century, a comparable warmth in the MCA was found in the Central-east China, but there was a little cooling in Northeast China; meanwhile, there were significantly lower temperatures in Northwest China and Tibetan Plateau.

We identified regional differences over China of winter temperature response to large volcanic eruptions with different latitudes and seasons from 1956 to 2005, and investigated atmospheric circulations for corresponding spatial patterns of winter temperature anomalies using reanalysis data and simulations by the Community Earth System Model. Both observations and simulations show that spatial patterns of winter temperature anomalies over China are related to the latitudes and seasons of the eruptions. Tropical volcanic eruptions during summer led to winter temperature decreases of 0.4–1.6 °C in eastern China due to the increase of height gradient. Winter volcanic eruptions led to extensive warming over Tibet. Following summer volcanic eruptions at low latitude, there were warm winters in eastern China because of a weak Siberian high. An anomalous southerly wind caused slight warming over most of China following winter eruptions. With the typical “trough–ridge–trough” at high latitude of the Northern Hemisphere, the winter temperature decreased in northeastern China and increased in western China following summer eruptions at mid-latitude. However, temperature generally increased after winter eruptions. For summer eruptions at high latitude, winter temperature showed a coherent decrease over northwest and east-central China due to an intensified Siberian High and East Asian trough. The widespread warming occurred over China because of the meridional circulation between 65°N and 45°N was weaker following winter volcanic eruptions.

BACKGROUND Salt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain. METHODS We conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia. RESULTS A total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P=0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P

Based on historical records and crop harvest scores extracted from historical documents, this study reconstructed the spatial-temporal distribution and severities of floods in the Yangtze-Huai River valley in 1823 and 1849. We also summarized the effects of the floods on society and identified government measures taken to cope with the floods in the context of the economic recession in the period of 1801–1850. The 1823 flood, which was caused by the heavy precipitation of the Meiyu period and typhoons, severely affected areas in the lower reaches of the Yangtze River. Meanwhile, the 1849 flood, triggered by long-term, high-intensity Meiyu precipitation in the middle and lower reaches of the Yangtze River, mainly affected areas along the Yangtze River. The 1849 disaster was more serious than the one in 1823. In the lower reaches of the Yangtze River, the 1849 flood caused the worst agricultural failure of the period 1730–1852. To deal with the disasters, the Qing government took relief measures, such as exempting taxes in the affected areas, distributing grain stored in warehouses, and transferring grain to severely afflicted areas. These relief measures were supplemented by auxiliary measures, such as exempting commodity taxes on grain shipped to disaster areas and punishing officials who failed to provide adequate disaster relief. The flood disasters disrupted the water system of the Grand Canal and forced the Qing government to transport Cao rice by sea beginning in 1826. This laid the groundwork for the rise of coastal shipping in modern China. With the economic recession of the 19th century, Chinese society was not as resilient to floods as it was in the 18th century. Compared to droughts, floods are more difficult to deal with and pose greater threats to infrastructure and to normal life and work in the cities.

This is an extended editors' commentary on the topical collection "Historical and recent change in extreme climate over East Asia", which collects a total of 15 papers related to the change and variability of extreme climate events in East Asia over the last few hundreds years. The extreme climate events are broadly classified into three categories: temperature and extreme warmth/coldness, precipitation and floods/droughts and western North Pacific typhoons. This commentary briefly summarizes the main findings presented in each paper in this topical collection, and outlines the implications of these findings for monitoring, detecting and modeling of regional climate change and for studying climate change impacts and adaptability. It also assesses the uncertainties of these studies, as well as the remaining knowledge gaps that should be filled in the future. One solid conclusion we can draw from these studies is that there was a marked decadal to multi-decadal variability of extreme climate events in East Asia in recent history, and the extreme events as observed during the last decades of the instrumental era were still within the range of natural variability except for some of those related to temperature. More severe and enduring droughts occurred in the early 20 th century or the earlier periods of history, frequently leading to great famines in northern China. Uncertainties remain in reconstructing historical extreme climate events and analyzing the early instrumental records. Further research could focus on the improvement of methodology in proxy based reconstruction of multi-decadal variations of surface air temperature and precipitation/drought, the recovery, digitization, calibration and verification of the early instrumental records, and the mechanisms of the observed multi-decadal variability of extreme climate in the region.

Based on historical records and scores of the grain harvest in the Qing Dynasty, we reconstruct the spatial–temporal distribution and disaster severities of drought and flood disasters in eastern China in 1751, and we summarize the social countermeasures to the disasters at that time. In the summer of 1751, the regions south of the Yangtze River in China experienced droughts, while northern China suffered floods caused by excessive rainfall. From 14 June to 11 August, the entire Zhejiang Province and its surrounding areas were impacted by droughts, resulting in the most serious crop failure in Zhejiang Province from the 18th to the nineteenth century. However, the floods in northern China did not seriously affect agricultural production. In response to the droughts, the government implemented relief measures such as exempting taxes in disaster areas, using raw grains in warehouses to help famine refugees, and transferring rice from bumper harvest areas to disaster areas. All the disaster relief measures provided Zhejiang Province with enough rice to feed 1.6325 million people for 1 year. In addition, the government also took some other measures to assist in disaster relief. The series of measures adopted by the government mitigated the impact of the drought on society, and the influence of the drought ended completely on 11 May 1752. This study improves our understanding the spatial–temporal distribution of a climatic disaster based on historical records, and it explores the adaptation of human society to climatic disasters.

Most estimates of Chinese regional Surface Air Temperatures since the late-19th century have identified two relatively warm periods – 1920s–40s and 1990s–present. However, there is considerable debate over how the two periods compare to each other. Some argue the current warm period is much warmer than the earlier warm period. Others argue the earlier warm period was comparable to the present. In this collaborative paper, including authors from both camps, the reasons for this ongoing debate are discussed. Several different estimates of Chinese temperature trends, both new and previously published, are considered. A study of the effects of urbanization bias on Chinese temperature trends was carried out using the new updated version of the Global Historical Climatology Network (GHCN) – version 4 (currently in beta production). It is shown that there are relatively few rural stations with long records, but urbanization bias artificially makes the early warm period seem colder and the recent warm period seem warmer. However, current homogenization approaches (which attempt to reduce non-climatic biases) also tend to have similar effects, making it unclear whether reducing or increasing the relative warmth of each period is most appropriate. A sample of 17 Chinese temperature proxy series (12 regional and 5 national) is compared and contrasted specifically for the period since the 19th century. Most proxy series imply a warm early-20th century period and a warm recent period, but the relative warmth of these two periods differs between proxies. Also, with some proxies, one or other of the warm periods is absent.

IntroductionCardiovascular diseases (CVDs) are the leading causes of death and disability worldwide. Reducing dietary salt consumption is a potentially cost-effective way to reduce blood pressure and the burden of CVD. To date, economic evidence has focused on sodium reduction in food industry or processed food with blood pressure as the primary outcome. This study protocol describes the planned within-trial economic evaluation of a low-sodium salt substitute intervention designed to reduce the risk of stroke in China.Methods and analysesThe economic evaluation will be conducted alongside the Salt Substitute and Stroke Study: a 5-year large scale, cluster randomised controlled trial. The outcomes of interest are quality of life measured using the EuroQol-5-Dimensions and major adverse cardiovascular events. Costs will be estimated from a healthcare system perspective and will be sought from the routinely collected data available within the New Rural Cooperative Medical Scheme. Cost-effectiveness and cost-utility analyses will be conducted, resulting in the incremental cost-effectiveness ratio expressed as cost per cardiovascular event averted and cost per quality-adjusted life year gained, respectively.Ethics and disseminationThe trial received ethics approval from the University of Sydney Ethics Committee (2013/888) and Peking University Institutional Review Board (IRB00001052-13069). Informed consent was obtained from each study participant. Findings of the economic evaluation will be published in a peer-reviewed journal and presented at international conferences.Trial registration numberClinicalTrials.gov Registry (NCT02092090).

It still remains uncertainty whether China’s future investment is conducive to carbon reduction of Belt and Road (B&R) region or not. Here, the possible impact of China’s investment was revealed by comparing the CO2 emissions of B&R region in different Chinese investment scenarios. The results showed that CO2 emissions of B&R region will cumulatively increase by 1973 Gt in 2018–2100 in the “No-Chinese Investment Scenario (NIS)”. Regionally, the India (IND), Middle East Central Asia (MECAsia), and Southeast Asia and its surrounding (SEAsia) has the largest increment. Comparing with the NIS, the CO2 emissions of B&R region will cumulatively decrease by 44.16 Gt and 79.48 Gt, respectively, in the “Business-as-usual Chinese Investment Scenario (BIS)” and “Strengthening Chinese Investment Scenario (SIS)”. Regionally, the cumulative CO2 emissions of all subregions will decrease in BIS and SIS, of which SEAsia and MECAsia have the largest decrement. Technique and structural effects of China’s investment have positive impact on cumulative CO2 emission reduction of B&R region, especially in the structural effect. The scale effect has the negative contribution, but it cannot neutralize the positive impact induced from technique and structural effects. As a result, China’s future investment is conductive to reducing CO2 emission of B&R region and holding the temperature increase below 2 °C.

Volcanic eruptions, climate changes and their influences on crop harvests and social development are of increasing concern in science communities. Using a dataset of crop harvest scores of southwest China from 1730 to 1910, which was derived from the memorials to the emperors in the Qing Dynasty of China, reconstructed climate proxies and the chronology of large volcanic eruptions occurring between 10°S and 15°N, we analysed possible relationships between crop harvests, climate changes and volcanic eruptions. In addition, some archives of policies and measures related to crops and social development extracted from the chronicles were used to analyse social resilience when faced with poor harvests. The results show that crop harvests in the study area generally increased with fluctuations when there were less low-latitude large volcanic eruptions from 1730 to 1810. However, from 1811 to 1910, volcanoes at low latitudes erupted more frequently, which contributed to concurrent low temperature and drought. Meanwhile, the crop harvests showed a step-down decrease during the following periods of 1810s, 1850s, 1870s and 1890s. Though, the local social system was certainly resilient in facing of such climate and agriculture disasters, i.e. the local society remained stable without significant famine, large-scale migration or social unrest until 1911. The strong resilience of local social systems owed largely to various relieving measures, such as, building barns, exempting or reducing local taxes, allocating farmland to immigrants, and central government dominated grain purchasing and distribution to alleviate disasters.

Exploring the impacts of climate change on agriculture is one of important topics with respect to climate change. We quantitatively examined the impacts of climate change on winter wheat yield in Northern China using the Cobb–Douglas production function. Utilizing time-series data of agricultural production and meteorological observations from 1981 to 2016, the impacts of climatic factors on wheat production were assessed. It was found that the contribution of climatic factors to winter wheat yield per unit area (WYPA) was 0.762–1.921% in absolute terms. Growing season average temperature (GSAT) had a negative impact on WYPA for the period of 1981–2016. A 1% increase in GSAT could lead to a loss of 0.109% of WYPA when the other factors were constant. While growing season precipitation (GSP) had a positive impact on WYPA, as a 1% increase in GSP could result in 0.186% increase in WYPA, other factors kept constant. Then, the impacts on WYPA for the period 2021–2050 under two different emissions scenarios RCP4.5 and RCP8.5 were forecasted. For the whole study area, GSAT is projected to increase 1.37°C under RCP4.5 and 1.54°C under RCP8.5 for the period 2021–2050, which will lower the average WYPA by 1.75% and 1.97%, respectively. GSP is tended to increase by 17.31% under RCP4.5 and 22.22% under RCP8.5 and will give a rise of 3.22% and 4.13% in WYPA. The comprehensive effect of GSAT and GSP will increase WYPA by 1.47% under RCP4.5 and 2.16% under RCP8.5.

This chapter reviews the historical climatology of China, with emphasis on records from the Ming (1368–1644 ce) and Qing (1644–1911 ce) periods. China’s historical climatology draws on documentary sources, including classical literature and chronicles, local gazettes, and central imperial archives. These contain both objective records of natural proxies and qualitative weather descriptions. Utilizing these sources, Chinese historical climatologists have generated regional and local temperature and precipitation series, as well as reconstructions of extreme events and their societal impacts.

Based on the reconstructed temperatures, precipitation changes, and occurrences of extreme climate events, together with historical records on fiscal deterioration, food crises, and the frequencies of popular unrest, rebellions and wars, we identified three principal ways in which climate change contributed to the collapse in the Ming dynasty. Firstly, cooling, aridification, and desertification during a cold period destroyed the military farm system, which was the main supply system for the provisioning of government troops on the northern frontiers; these impacts increased the military expenditure from 64 % of total government expenditure in 1548–1569 to 76 % in 1570–1589 and thus aggravated the national fiscal crisis that occurred during the late Ming dynasty. Secondly, climate deterioration (e.g., cooling, aridification, and an increase in the frequencies of frost- and drought-related disasters, etc.) led to a 20–50 % reduction in the per capita production of raw grain in most areas of China, which resulted in widespread food crises and exacerbated the vulnerability of social structures during the last several decades of the Ming dynasty. Thirdly, the severe droughts occurring in 1627–1643 were a key trigger to the peasantry uprising. These droughts also played a significant role to promote the peasantry uprising, especially reviving the peasantry troops by recruitment of famine victims when they nearly perished in 1633 and 1638, and severely disrupting the food supply for the government troops, resulting in the final defeat of the government troops by the peasantry troops. This study contributes to an understanding of the climate-related mechanisms behind the collapse of the Ming dynasty, and provides a historical case study that enhances our understanding of the nature of interactions between climate change and social vulnerability.

Drought/flood spatial patterns over eastern China under centennial cold and warm regimes were investigated. The 63-site yearly dry/wet grade data set derived from Chinese historical documents was used, together with an up-to-date 2000-year long temperature series reconstructed from synthesis of 28 temperature proxies in China. We defined the index of difference between drought and flood frequency to reconstruct the drought/flood spatial patterns for five cold periods (440-540, 780-920, 1390-1460, 1600-1700, and 1800-1900 CE) and four warm periods (650-750, 1000-1100, 1190-1290, and 1900-2000 CE). The results showed that there are no consistent patterns over eastern China among all cold/warm periods. However, for most warm periods, drought (flood) dominated north (south) of the Yangtze River. The ensemble mean drought/flood spatial patterns for all warm periods illustrated a dipole pattern with drought (south of 25°N)-flood (25°-30°N)-drought (north of 30°N), with the exception of flood in the Loess Plateau. For all cold periods, the ensemble mean drought/flood spatial patterns showed an east to west distribution, with flood east of 115°E and drought dominant west of 115°E, with the exception of flood between approximately110°E and 105°E. These differences in ensemble mean drought/flood patterns suggest that the probability of drought north of the Yangtze River and flood in the valleys of the XiangJiang and GanJiang rivers south of the Yangtze River is higher in warm periods than in cold periods.

We use principal component regression and partial least squares regression to separately reconstruct a composite series of temperature variations in China, and associated uncertainties, at a decadal resolution over the past 2000 yr. The reconstruction is developed using proxy temperature data with relatively high confidence levels from five regions across China, and using a temperature series from observations by the Chinese Meteorological Administration, covering the period from 1871 to 2000. Relative to the 1851–1950 climatology, our two reconstructions show four warm intervals during AD 1–AD 200, AD 551–AD 760, AD 951–AD 1320, and after AD 1921, and four cold intervals during AD 201–AD 350, AD 441–AD 530, AD 781–AD 950, and AD 1321–AD 1920. The temperatures during AD 981–AD 1100 and AD 1201–AD 1270 are comparable to those of the Present Warm Period, but have an uncertainty of ±0.28 °C to ±0.42 °C at the 95% confidence interval. Temperature variations over China are typically in phase with those of the Northern Hemisphere (NH) after 1000, a period which covers the Medieval Climate Anomaly, the Little Ice Age, and the Present Warm Period. In contrast, a warm period in China during AD 541–AD 740 is not obviously seen in the NH.

Lowering sodium intake with a reduced-sodium, added potassium salt substitute has been proved to lower blood pressure levels. Whether the same strategy will also reduce the risks of vascular outcomes is uncertain and controversial. The SSaSS has been designed to test whether sodium reduction achieved with a salt substitute can reduce the risk of vascular disease. The study is a large-scale, open, cluster-randomized controlled trial done in 600 villages across 5 provinces in China. Participants have either a history of stroke or an elevated risk of stroke based on age and blood pressure level at entry. Villages were randomized in a 1:1 ratio to intervention or continued usual care. Salt substitute is provided free of charge to participants in villages assigned to the intervention group. Follow-up is scheduled every 6 months for 5 years, and all potential endpoints are reviewed by a masked adjudication committee. The primary end point is fatal and nonfatal stroke, and the 2 secondary endpoints are total major cardiovascular events and total mortality. The study has been designed to provide 90% statistical power (with 2-sided α = .05) to detect a 13% or greater relative risk reduction for stroke. The power estimate assumes a primary outcome event rate of 3.5% per year and a systolic blood pressure difference of 3.0 mm Hg between randomized groups. Recruitment is complete and there are 20,996 participants (about 35 per village) that have been enrolled. Mean age is 65 years and 49% are female. There were 73% enrolled on the basis of a history of stroke. The trial is well placed to describe the effects of salt substitution on the risks of vascular disease and death and will provide important policy-relevant data.

We present statistically reconstructed mean annual winter (December–February) temperatures from the middle and lower reaches of the Yangtze River (24° N–34° N, 108° E–123° E within mainland China) extending back to 1736. The reconstructions are based on information regarding snowfall days from historical documents of the Yu-Xue-Fen-Cun archive recorded during the Qing Dynasty (1644–1911). This information is calibrated with regional winter temperature series spanning the period from 1951 to 2007. The gap from 1912 to 1950 is filled using early instrumental observations. With the reference period of 1951–2007, the 18th century was 0.76 °C colder, and the 19th century was 1.18 °C colder. However, since the 20th century, the climate has been in a warming phase, particularly in the last 30 yr, and the mean temperature from 1981 to 2007 was 0.25 °C higher than that of the reference period of 1951–2007, representing the highest temperatures of the past 300 yr. Uncertainty existed for the period prior to 1900, and possible causes of this uncertainty, such as physical processes involved in the interaction between temperature and snowfall days and changing of observers, are discussed herein.

Using 24 proxy temperature series, the rates of temperature change in China are analyzed at the 30- to 100-year scales for the past 2000 years and at the 10-year scale for the past 500 years. The results show that, at the 100-year scale, the warming rate for the whole of China in the 20th century was only 0.6 +/- 1.6A degrees C/100 a (interval at the 95% confidence level, which is used hereafter), while the peak warming rate for the period from the Little Ice Age (LIA) to the 20th century reached 1.1 +/- 1.2A degrees C/100 a, which was the greatest in the past 500 years and probably the past 2000 years. At the 30-year scale, warming in the 20th century was quite notable, but the peak rate was still less than rates for previous periods, such as the rapid warming from the LIA to the 20th century and from the 270s-290s to 300s-320s. At the 10-year scale, the warming in the late 20th century was very evident, but it might not be unusual in the context of warming over the past 500 years. The exact timing, duration and magnitude of the warming peaks varied from region to region at all scales. The peak rates of the 100-year scale warming in the AD 180s-350s in northeastern China as well as those in the 260s-410s and 500s-660s in Tibet were all greater than those from the mid-19th to 20th century. Meanwhile, the rates of the most rapid cooling at scales of 30 to 100 years in the LIA were prominent, but they were also not unprecedented in the last 2000 years. At the 10-year scale, for the whole of China, the most rapid decadal cooling in the 20th century was from the 1940s to 1950s with a rate of -0.3 +/- 0.6A degrees C/10 a, which was similar to rates for periods before the 20th century. For all regions, the rates of most rapid cooling in the 20th century were all less than those for previous periods.

The Yu-Xue-Fen-Cun (YXFC) is one of the government archives of the Qing Dynasty (1644-1911) in China. It records the beginning/ending dates, duration and rainfall infiltration depths into soil and snowfall accumulation for individual precipitation event By comparing YXFC with instrumental data, a set of criteria used to identify the rainy season was established. This set of criteria was used to reconstruct the initial/final dates and length of rainy season during 1736-1900 and 1955-2000 at three sites (including Taiyuan, Datong and Yulin) based on both YXFC records and instrumental data. The results show that there is evident inter-decadal variation in rainy season length, with periodicity of 16-20a, 30-40a and 50-60a. The length of the rainy season gradually increases before the mid-19th century and decreases afterward, and the length of rainy season in 1736-1840 is statistically significantly longer than that in 1955-2000. These findings suggest that the intensity of the East Asian Summer Monsoon (EASM) became weaker from the mid-19th century, reaching the weakest condition in 1955-2000 during the context of the past 260 years. (C) 2010 Elsevier Ltd and INQUA. All rights reserved.

Based on reconstructions of precipitation events from the rain and snowfall archives of the Qing Dynasty (1736-1911), the drought/flood index data mainly derived from Chinese local gazettes from 1736-2000, and the observational data gathered since 1951, the spatial patterns of monsoon rainbands are analyzed at different time scales. Findings indicate that monsoon rainfall in northern China and the middle-lower reaches of the Yangtze River have significant inter-annual (e.g., 5-7-yr and 2-4-yr) as well as inter-decadal (e.g., 20-30-yr and quasi-10-yr) fluctuation signals. The spatial patterns in these areas also show significant cycles, such as on a 60-80-yr time scale, a reversal phase predominates the entire period from 1736-2000; on a quasi-30-yr time scale, a consistent phase was prevalent from 1736 to 2000; and on a 20-yr time scale, the summer monsoon rains show different spatial patterns before and after 1870.

The rainy season is an important climate feature over Eastern China where anomaly in either its timing or length can lead to adverse economic and social consequences. Here, we illustrate that the records of daily precipitation description at Beijing and Shanghai contained in Memos-to-Emperor during the Qing Dynasty provide a unique source to extend the rainy season information to 1736. The information together with the instrument measurements since 1875 in both cities reveals significant inter-annual and decadal variations of the beginning and ending dates, and length of the rainy season. The analysis further reveals that, on the decadal time scale, the length of the rainy season increased in Shanghai since 1961 with more frequent extreme rainfall events, but decreased in Beijing since 1975 with persistent dry conditions. This pattern of changes was not seen in any other periods of the data, in particular during 1736-1820 when both cities showed an increase in the length of the rainy season.

Climate extremes, particularly the droughts sustaining over a prolonged period and affecting extended area (defined as “exceptional drought events”), can have long-lasting effects on economic and social activities. Here we use the Chinese drought/flood proxy data of the past five hundred years to identify the cases of exceptional drought events over eastern China (east of 105°E), and to study their spatial patterns and temporal evolutions. The associated circulations for the contemporary case are analyzed using available meteorological data. Possible linkage of these cases to climatic forcing and natural climate events is also explored. After considering the intensity, duration, and spatial coverage, we identified three exceptional drought events, which occurred in 1586–1589, 1638–1641, and 1965–1966 in chronological order. They were the most severe droughts of last five centuries in eastern China, with more than 40% of affected area and the drought center encountered a significant summer rainfall reduction (about 50% or more). These three droughts all developed first in North China (34–40°N), and then either expanded southward or moved to the Yangtze River Valley (27–34°N) and the northern part of the southeastern coastal area (22–27°N). For the 1965–1966 case, the significant reduction of summer precipitation was caused by a weakening of summer monsoon and an anomalous westward and northward displacement of the western Pacific subtropical high. Our analyses also suggest that these three exceptional drought events might be triggered by large volcanic eruptions and amplified by both volcanic eruptions and El Nino events.

Based on plant phenology data from 26 stations of the Chinese Phenology Observation Network of the Chinese Academy of Sciences and the climate data, the change of plant phenophase in spring and the impact of climate warming on the plant phenophase in China for the last 40 years are analyzed. Furthermore, the geographical distribution models of phenophase in every decade are reconstructed, and the impact of climate warming on geographical distribution model of phenophase is studied as well. The results show that (i) the response of phenophase advance or delay to temperature change is nonlinear. Since the 1980s, at the same amplitude of temperature change, phenophase delay amplitude caused by temperature decrease is greater than phenophase advance amplitude caused by temperature increase; the rate of phenophase advance days decreases with temperature increase amplitude, and the rate of phenophase delay days increases with temperature decrease amplitude. (ii) The geographical distribution model between phenophase and geographical location is unstable. Since the 1980s, with the spring temperature increasing in the most of China and decreasing in the south of Qinling Mountains, phenophases have advanced in northeastern China, North China and the lower reaches of the Changjiang River, and have delayed in the eastern part of southwestern China and the middle reaches of the Changjiang River; while the rate of the phenophase difference with latitude becomes smaller.

Background— Organizational and wider health system factors influence the implementation and success of interventions. Clinical Pathways in Acute Coronary Syndromes 2 is a cluster randomized trial of a clinical pathway–based intervention to improve acute coronary syndrome care in hospitals in China. We performed a qualitative evaluation to examine the system-level barriers to implementing clinical pathways in the dynamic healthcare environment of China. Methods and Results— A qualitative descriptive analysis of 40 in-depth interviews with health professionals conducted in a sample of 10 hospitals purposively selected to explore barriers to implementation of the intervention. Qualitative data were analyzed using the Framework method. In-depth interviews identified 5 key system-level barriers to effective implementation: (1) leadership support for implementing quality improvement, (2) variation in the capacity of clinical services and quality improvement resources, (3) fears of patient disputes and litigation, (4) healthcare funding constraints and high out-of-pocket expenses, and (5) patient-related factors. Conclusions— System-level barriers affect the ability of acute coronary syndrome clinical pathways to change practice. Addressing these barriers in the context of current and planned national health system reform will be critical for future improvements in the management of acute coronary syndromes, and potentially other hospitalized conditions, in China. Clinical Trial Registration— URL: http://www.anzctr.org.au/default.aspx . Register. Unique identifier: ACTRN12609000491268.

Background— Substantial evidence-practice gaps exist in the management of acute coronary syndromes (ACS) in China. Clinical pathways are tools for improving ACS quality of care but have not been rigorously evaluated. Methods and Results— Between October 2007 and August 2010, a quality improvement program was conducted in 75 hospitals throughout China with mixed methods evaluation in a cluster randomized, controlled trial. Eligible hospitals were level 2 or level 3 centers routinely admitting >100 patients with ACS per year. Hospitals were assigned immediate implementation of the American Heart Association/American College of Cardiology guideline based clinical pathways or commencement of the intervention 12 months later. Outcomes were several key performance indicators reflecting the management of ACS. The key performance indicators were measured 12 months after commencement in intervention hospitals and compared with baseline data in control hospitals, using data collected from 50 consecutive patients in each hospital. Pathway implementation was associated with an increased proportion of patients discharged on appropriate medical therapy, with nonsignificant improvements or absence of effects on other key performance indicators. Conclusions— Among hospitals in China, the use of a clinical pathway for the treatment of ACS compared with usual care improved secondary prevention treatments, but effectiveness was otherwise limited. An accompanying process evaluation identified several health system barriers to more successful implementation. Clinical Trial Registration— URL: http://www.anzctr.org.au/default.aspx . Unique identifier: ACTRN12609000491268.

Background: Average sodium intake and stroke mortality in northern China are both among the highest in the world. An effective, low-cost strategy to reduce sodium intake in this population is urgently needed. Objective: We sought to determine the effects of a community-based sodium reduction program on salt consumption in rural northern China. Design: This study was a cluster-randomized trial done over 18 months in 120 townships (one village from each township) from five provinces. Sixty control villages were compared to 60 intervention villages that were given access to a reduced-sodium, added-potassium salt substitute in conjunction with a community-based health education program focusing on sodium reduction. The primary outcome was the difference in 24-hour urinary sodium excretion between randomized groups. Results: Among 1,903 people with valid 24-hour urine collections, mean urinary sodium excretion in intervention compared with control villages was reduced by 5.5% (-14mmol/day, 95% confidence interval -26 to -1; p = 0.03), potassium excretion was increased by 16% (+7mmol/day, +4 to +10; p

Twenty-three published proxy temperature series over China spanning the last 2000 years were selected for an uncertainty analysis in five climate regions. Results indicated that, although large uncertainties are found for the period prior to the 16th century, high level of consistency were identified in all regions during the recent 500-years, highlighted by the two cold periods 1620s-1710s and 1800s-1860s, and the warming during the 20th century. The latter started in Tibet, Northwest and Northeast, and migrated to Central East and Southeast. The analysis also indicates that the warming during the 10-14th centuries in some regions might be comparable in magnitude to the warming of the last few decades of the 20th century which was unprecedented within the past 500 years. Citation: Ge, Q.-S., J.-Y. Zheng, Z.-X. Hao, X.-M. Shao, W.-C. Wang, and J. Luterbacher (2010), Temperature variation through 2000 years in China: An uncertainty analysis of reconstruction and regional difference, Geophys. Res. Lett., 37, L03703, doi: 10.1029/2009GL041281.

Based on observational data and Asian monsoon intensity datasets from China, the relationships between the East Asian winter monsoon index and winter temperature, the East Asian summer monsoon index and Meiyu precipitation over the middle and lower reaches of the Yangtze River, were analyzed. We found that the monsoon signals were reflected in the temperature and Meiyu precipitation variations. Thus, we used the reconstructed Meiyu precipitation and winter temperature series for the past 300 years and detected the summer/winter monsoon intensity signals using multi-taper spectral estimation method and wavelet analysis. The main periodicities of Meiyu precipitation and winter temperature, such as interannual cycle with 2-7-year, interdecadal-centennial cycles with 30-40-year and 50-100-year, were found. The good relationships between the East Asian summer and winter monsoons suggested that they were in phase at 31-year cycle, while out of phase at 100-year cycle, but with 20-year phase difference. In addition, the winter monsoon intensity may be regulated by the North Atlantic Oscillation, the Arctic Oscillation and the Atlantic Multidecadal Oscillation, and the summer monsoon is closely related to the signal intensities of the Pacific Decadal Oscillation.

Based on snow, rainfall and harvest archives records in the Qing Dynasty (1644-1911AD), the modem meteorological observation data, the annual winter mean temperature and seasonal precipitation series from 1736 to 2000 and the series of harvest in summer and autumn from 1730 to 1910 are reconstructed. Meanwhile, the characteristics of climate change and the relationship between climate change and harvest are analyzed by using the high-resolution data. The result shows: (1) Warm and cold changes in Xi'an have obvious inter-centennial fluctuation. Climate is relative warm in the 18th century and cold in the 19th century, but in the 20th century, climate turn to warm period with a rapid warming trend. (2) Precipitation changes have obvious inter-decadal fluctuation. It goes through six rainy periods and seven drought periods in Xi'an since 1736, in which the mean precipitation in the rainy periods is 16% more than that in droughty periods. (3) The coefficients between the precipitation from June to August and the harvest in autumn, and the precipitation during the period of September to May and the harvest in summer are remarkable. The relationship between inter-decadal temperature variations and harvests is significant too, which suggests that the long-term warm /cold change has important effects on harvest.