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This paper discusses whether the effect of campaign‐style enforcement can surpass the short term from the perspective of authority allocation. Based on the theory of authority allocation, we establish an explanatory framework for the impact of authority allocation on the effect of campaign‐style enforcement. We argue that, through authority allocation, the central government has both formal authority and real authority, which helps to extend the effect of campaign‐style enforcement beyond the short term. We empirically studied the regulatory compliance in China's environmental administrative talk from 2014 to 2016. Statistical findings supported by robustness checks confirm our theoretical hypotheses. Further analysis shows that campaign‐style enforcement can be more effective when local officials have longer tenure, higher levels of education, or older age. Our paper shows that authority recentralization on specific issues can bridge the conflict of policy goals between central and local governments, prolonging the effect of campaign‐style enforcement. [ABSTRACT FROM AUTHOR]

Clinical symptoms and inflammatory markers cannot reliably distinguish the etiology of CAP, and chest radiographs have abundant information related with CAP. Hence, we developed a context-fusion convolution neural network (CNN) to explore the application of chest radiographs to distinguish the etiology of CAP in children. This retrospective study included 1769 cases of pediatric pneumonia (viral pneumonia, n = 487; bacterial pneumonia, n = 496; and mycoplasma pneumonia, n = 786). The chest radiographs of the first examination, C-reactive protein (CRP), and white blood cell (WBC) were collected for analysis. All patients were stochastically divided into training, validation, and test cohorts in a 7:1:2 ratio. Automatic lung segmentation and hand-crafted pneumonia lesion segmentation were performed, from which three image-based models including a full-lung model, a local-lesion model, and a context-fusion model were built; two clinical characteristics were used to build a clinical model, while a logistic regression model combined the best CNN model and two clinical characteristics. Our experiments showed that the context-fusion model which integrated the features of the full-lung and local-lesion had better performance than the full-lung model and local-lesion model. The context-fusion model had area under curves of 0.86, 0.88, and 0.93 in identifying viral, bacterial, and mycoplasma pneumonia on the test cohort respectively. The addition of clinical characteristics to the context-fusion model obtained slight improvement. Mycoplasma pneumonia was more easily identified compared with the other two types. Using chest radiographs, we developed a context-fusion CNN model with good performance for noninvasively diagnosing the etiology of community-acquired pneumonia in children, which would help improve early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

[Display omitted] • MFA and LCA methods are combined to analyze Cu cycle and environmental impacts. • Six types of waste streams are investigated in relation to "Zero waste" strategies. • Reuse Cu from formal and informal collection is explored in Cu waste management. • Maximizing "Zero waste" options lead to 65% reduction of primary copper demand. • Maximizing "Zero waste" options lead to 55% reduction of total GHG emissions. To conserve resources and enhance the environmental performance, China has launched the "Zero waste" concept, focused on reutilization of solid waste and recovery of materials, including copper. Although several studies have assessed the copper demand and recycling, there is a lack of understanding on how different waste management options would potentially reduce primary copper demand and associated environmental impacts in China in the context of energy transition. This study addresses this gap in view of a transition to low-carbon energy system and the optimization of copper waste management combining MFA and LCA approaches. Six types of waste streams (C&DW, ELV, WEEE, IEW, MSW, ICW) are investigated in relation to various "Zero waste" strategies including reduction, reuse (repair, remanufacturing or refurbishment), recycling and transition from informal to formal waste management. Under present Chinese policies, reuse and recycling of copper containing products will lead to a somewhat lower dependency on primary copper in 2100 (11187Gg), as well as lower total GHG emissions (64869 Gg CO2-eq.) and cumulative energy demand (1.18x10^12 MJ). Maximizing such "Zero waste" options may lead to a further reduction, resulting in 65% potential reduction of primary copper demand, around 55% potential reduction of total GHG emissions and total cumulative energy demand in 2100. Several policy actions are proposed to provide insights into future waste management in China as well as some of the challenges involved. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 (COVID-19) is rapidly spreading inside China and internationally. We aimed to construct a model integrating information from radiomics and deep learning (DL) features to discriminate critical cases from severe cases of COVID-19 using computed tomography (CT) images. Methods: We retrospectively enrolled 217 patients from three centers in China, including 82 patients with severe disease and 135 with critical disease. Patients were randomly divided into a training cohort (n = 174) and a test cohort (n = 43). We extracted 102 3-dimensional radiomic features from automatically segmented lung volume and selected the significant features. We also developed a 3-dimensional DL network based on center-cropped slices. Using multivariable logistic regression, we then created a merged model based on significant radiomic features and DL scores. We employed the area under the receiver operating characteristic curve (AUC) to evaluate the model's performance. We then conducted cross validation, stratified analysis, survival analysis, and decision curve analysis to evaluate the robustness of our method. Results: The merged model can distinguish critical patients with AUCs of 0.909 (95% confidence interval [CI]: 0.859–0.952) and 0.861 (95% CI: 0.753–0.968) in the training and test cohorts, respectively. Stratified analysis indicated that our model was not affected by sex, age, or chronic disease. Moreover, the results of the merged model showed a strong correlation with patient outcomes. Significance: A model combining radiomic and DL features of the lung could help distinguish critical cases from severe cases of COVID-19. [ABSTRACT FROM AUTHOR]

Background: China's rapidly aging population has led to many challenges related to the health care delivery and financing. Since 2007, the Urban Residents Basic Medical Insurance (URBMI) program has provided financial protection for older adults living in urban areas not already covered by other health insurance schemes. We conducted a national level assessment on this population's health needs and health service utilization.Methods: Records for 9646 individuals over the age of 60 were extracted for analysis from two National Health Service Surveys conducted in 2008 and 2013. Multiple regression models were used to examine associations between socioeconomic factors, health needs and health service utilization while controlling for demographic characteristics and survey year.Results: Self-reported illness, especially non-communicable diseases (NCDs) increased significantly between 2008 and 2013 regardless of insurance enrollment, age group or income level. In 2013, over 75% of individuals reported at least one NCD. Outpatient services decreased for the uninsured but increased for those with insurance. Middle- and high-income groups with insurance experienced a higher increase in outpatient visits and hospital admissions than the low-income group. Forgone hospital admissions (defined as an admission indicated by a doctor but which was declined or not followed through by the patient) decreased. However, over 20% of individuals had to forgo necessary hospital admissions, and 40% of these cases were due to financial barriers. Outpatient visits and hospital admissions increased between 2008 and 2013, and insured individuals utilized more services than those without insurance.Conclusion: After the implementation of URBMI, health service utilization increased and forgone hospital admissions decreased, indicating the program helped to improve access to health services. However, there was still a marked difference in utilization among different income groups, with the high-income group experiencing the greatest increase. This factor calls for further attention to be given to issues related to equity. Prevalence of self-reported NCDs greatly increased among the study population between 2008 and 2013, suggesting that health insurance programs need to ensure they cover sufficient support for the treatment and prevention of NCDs. [ABSTRACT FROM AUTHOR]

In this paper, we develop a dynamic stock model and scenario analysis involving a bottom‐up approach to analyze copper demand in China from 2005 to 2050 based on government and related sectoral policies. The results show that in the short‐term, China's copper industry cannot achieve a completely circular economy without additional measures. Aggregate and per capita copper demand are both set to increase substantially, especially in infrastructure, transportation, and buildings. Between 2016 and 2050, total copper demand will increase almost threefold. Copper use in buildings will stabilize before 2050, but the copper stock in infrastructure and transportation will not yet have reached saturation in 2050. The continuous growth of copper stock implies that secondary copper will be able to cover just over 50% of demand in 2050, at best, even with an assumed recycling rate of 90%. Finally, future copper demand depends largely on the lifetime of applications. There is therefore an urgent need to prolong the service life of end‐use products to reduce the amount of materials used, especially in large‐scale applications in buildings and infrastructure. [ABSTRACT FROM AUTHOR]

Background: The Sustainable Development Goals (SDGs), adopted by all United Nations (UN) member states in 2015, established a set of bold and ambitious health-related targets to achieve by 2030. Understanding China's progress toward these targets is critical to improving population health for its 1.4 billion people.Methods and Findings: We used estimates from the Global Burden of Disease (GBD) Study 2016, national surveys and surveillance data from China, and qualitative data. Twenty-eight of the 37 indicators included in the GBD Study 2016 were analyzed. We developed an attainment index of health-related SDGs, a scale of 0-100 based on the values of indicators. The projection model is adjusted based on the one developed by the GBD Study 2016 SDG collaborators. We found that China has achieved several health-related SDG targets, including decreasing neonatal and under-5 mortality rates and the maternal mortality ratios and reducing wasting and stunting for children. However, China may only achieve 12 out of the 28 health-related SDG targets by 2030. The number of target indicators achieved varies among provinces and municipalities. In 2016, among the seven measured health domains, China performed best in child nutrition and maternal and child health and reproductive health, with the attainment index scores of 93.0 and 91.8, respectively, followed by noncommunicable diseases (NCDs) (69.4), road injuries (63.6), infectious diseases (63.0), environmental health (62.9), and universal health coverage (UHC) (54.4). There are daunting challenges to achieve the targets for child overweight, infectious diseases, NCD risk factors, and environmental exposure factors. China will also have a formidable challenge in achieving UHC, particularly in ensuring access to essential healthcare for all and providing adequate financial protection. The attainment index of child nutrition is projected to drop to 80.5 by 2025 because of worsening child overweight. The index of NCD risk factors is projected to drop to 38.8 by 2025. Regional disparities are substantial, with eastern provinces generally performing better than central and western provinces. Sex disparities are clear, with men at higher risk of excess mortality than women. The primary limitations of this study are the limited data availability and quality for several indicators and the adoption of "business-as-usual" projection methods.Conclusion: The study found that China has made good progress in improving population health, but challenges lie ahead. China has substantially improved the health of children and women and will continue to make good progress, although geographic disparities remain a great challenge. Meanwhile, China faced challenges in NCDs, mental health, and some infectious diseases. Poor control of health risk factors and worsening environmental threats have posed difficulties in further health improvement. Meanwhile, an inefficient health system is a barrier to tackling these challenges among such a rapidly aging population. The eastern provinces are predicted to perform better than the central and western provinces, and women are predicted to be more likely than men to achieve these targets by 2030. In order to make good progress, China must take a series of concerted actions, including more investments in public goods and services for health and redressing the intracountry inequities. [ABSTRACT FROM AUTHOR]

Research on the price fluctuation transmission of the carbon trading pilot market is of great significance for the establishment of China’s unified carbon market and its development in the future. In this paper, the carbon market transaction prices of Beijing, Shanghai, Tianjin, Shenzhen, and Guangdong were selected from December 29, 2013 to March 26, 2016, as sample data. Based on the view of the complex network theory, we construct a price fluctuation transmission network model of five pilot carbon markets in China, with the purposes of analyzing the topological features of this network, including point intensity, weighted clustering coefficient, betweenness centrality, and community structure, and elucidating the characteristics and transmission mechanism of price fluctuation in China’s five pilot cities. The results of point intensity and weighted clustering coefficient show that the carbon prices in the five markets remained unchanged and transmitted smoothly in general, and price fragmentation is serious; however, at some point, the price fluctuates with mass phenomena. The result of betweenness centrality reflects that a small number of price fluctuations can control the whole market carbon price transmission and price fluctuation evolves in an alternate manner. The study provides direction for the scientific management of the carbon price. Policy makers should take a positive role in promoting market activity, preventing the risks that may arise from mass trade and scientifically forecasting the volatility of trading prices, which will provide experience for the establishment of a unified carbon market in China. [ABSTRACT FROM AUTHOR]

This paper analyzes the relationship between the 1000-850-hPa layer perturbation potential energy (LPPE) as the difference in local potential energy between the actual state and the reference state and the East Asian summer monsoon (EASM) using reanalysis and observational datasets. The EASM is closely related to the first-order moment term of LPPE (LPPE1) from the preceding March to the boreal summer over three key regions: the eastern Indian Ocean, the subtropical central Pacific, and midlatitude East Asia. The LPPE1 pattern (−, +, +), with negative values over the eastern Indian Ocean, positive values over the subtropical central Pacific, and positive values over East Asia, corresponds to negative LPPE1 anomalies over the south of the EASM region but positive LPPE1 anomalies over the north of the EASM region, which lead to an anomalous downward branch over the southern region but an upward branch over the northern region. The anomalous vertical motion affects the local meridional circulation over East Asia that leads to a southwesterly wind anomaly over East Asia (south of 30°N) at 850 hPa and anomalous downward motion over 100°-120°E (along 25°-35°N), resulting in a stronger EASM, more kinetic energy over the EASM region, and less boreal summer rainfall in the middle and lower reaches of the Yangtze River valley (24°-36°N, 90°-125°E). These LPPE1 anomalies in the eastern Indian Ocean and subtropical central Pacific appear to be connected to changes in local sea surface temperature through the release of latent heat. [ABSTRACT FROM AUTHOR]

Copper demand in China is expected to grow considerably over the coming decades, driving energy use and environmental impacts related to copper production. To explore the environmental impacts of copper production in China, we used a variant of Life Cycle Sustainability Analysis that combined the Life Cycle Assessment methodology with the Chinese copper demand projections from 2010 to 2050. The results indicate that the environmental impacts of pyrometallurgical copper production are expected to increase more than twofold during this period and remain the largest contributor to the environmental footprint. Secondary copper production emits the least pollutions. Increasing the share of secondary copper production is the most environmental friendly option for copper production. To this end, China may focus on improving the classification of waste copper products and recycling infrastructure for end-of-life management. Hard coal use and production are crucial contributors to climate change in the context of copper production. Cleaning up copper production processes and improving energy efficiency would also help reduce environmental impacts. Energy transition can significantly reduce the environmental impacts of copper production, but it also can increase copper requirement.It does not visibly contribute to reduce human toxicity as well. Graphical abstract for the manuscript titled "Assessing the future environmental impacts of copper production in China: implications of the energy transition" (Manuscript ID JCLEPRO-D-19-16546). Image 1 • The environmental impacts of pyrometallurgical copper production will more than double from 2010 to 2050 and is the largest contributor to the environmental footprint. • Increasing the share of secondary copper production is the most environmental friendly option for copper production. • Hard coal production and use are crucial contributors to GHG emissions of copper production in China. • The energy transition can significantly reduce the environmental impacts of copper production, but also can increase copper requirement. [ABSTRACT FROM AUTHOR]

• Prior to implementation of the "Green Fence" policy, imported copper scrap was the major source of secondary copper production in China. • Chinese copper demand could be reduced in the second half of the century through effective measures to prolong product lifetime. • Towards the end of the century, secondary copper could satisfy the bulk of Chinese copper demand. • China could put major emphasis on its recycling industry and continue to import high-quality copper scrap instead of opting for restrictions or bans. Copper is widely used in buildings, transportation and home appliances, resulting in steadily increasing demand in China. From 2013 on, China has implemented the "Green Fence" policy to restrict copper scrap imports, which have affected and will continue to affect its future copper supply. To explore how China's copper demand can be met in the future, including the effects of the "Green Fence" policy change, in this paper a stock-driven approach is combined with a scenario analysis. We compare two scenarios (Continuity Policy, Circular Economy) and assess the influence of the "Green Fence" policy on each. We conclude that effective measures to prolong product lifetime could lead to a significant reduction in copper demand. Given the limited scope for domestic mining, China will still have to depend largely on imports of primary material in the form of concentrates and refined copper or, otherwise, put major emphasis on its recycling industry and continue to import high-quality copper scrap. In combination with the establishment of a state-of-the-art, efficient and environmentally friendly recycling industry, secondary copper could satisfy the bulk of Chinese copper demand and this could be an opportunity for China to transition to a more circular economy with regard to copper. [ABSTRACT FROM AUTHOR]

The incidence and mortality of cervical cancer, which mainly results from the infection of human papillomavirus (HPV) is significantly increasing in Xinjiang. According to the previous research, the incidence of HPV-68 in cervical cancer patients in Xinjiang is significantly higher than in other parts of China. HPV E6 and E7 oncoproteins play a crucial role in cervical cancer, and can be used as ideal targets for therapeutic vaccines. Therefore, we analyzed and identified the possible T-cell and B-cell dominant epitopes and various aspects of HPV-68 E6 and E7 oncoproteins, including the physicochemical properties, secondary and tertiary structures using a bioinformatic approach, which provided a basis for designing an effective HPV infection therapeutic vaccine. The results showed that E6 oncoproteins was an unstable and hydrophilic protein, while E7 oncoproteins was unstable and hydrophilic protein. The secondary structure of the E6 oncoproteins consisted of 45.57% alpha helixes, 14.56% extended strands, 4.43% beta turns and 35.44% random coils. The secondary structure of E7 oncoproteins consisted of 35.45% alpha helixes, 17.27% extended strands, 0.91% beta turns and 46.36% random coils. Moreover, our results identified 5 dominant T-cell epitopes and 6 dominant B-cell epitopes in the E6 oncoproteins structure and 5 dominant T-cell epitopes and 3 dominant B-cell epitopes in E7 oncoproteins. In conclusion, this study provides comprehensive biological information about the HPV-68 E6 and E7 oncoproteins, which will lay a theoretical foundation for multi-epitope vaccines against HPV infection. • Five dominant T cells epitopes and six dominant B cells epitopes in HPV-68 E6 oncoprotein structure were predicted. • Five dominant T cells epitopes and three dominant B cells epitopes in HPV-68 E7 oncoprotein structure were predicted. • The study would provid a basis for designing an effective HPV infection therapeutic vaccine for Uyghur women in China. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) prevalence is closely associated with poverty in China, and poor patients face more barriers to treatment. Using an insurance-based approach, the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients, particularly among the poor. This study aims to assess the program effects on service use, and its equity impact across different income groups. Methods: Data from 788 and 775 patients at baseline and final evaluation were available for analysis respectively. Inpatient and outpatient service utilization, treatment adherence, and patient satisfaction were assessed before and after the program, across different income groups (extreme poverty, moderate poverty and non-poverty), and in various program cities, using descriptive statistics and multi-variate regression models. Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts. Results: After program implementation, the hospital admission rate increased more for the extreme poverty group (48.5 to 70.7%) and moderate poverty group (45.0 to 68.1%), compared to the non-poverty group (52.9 to 64.3%). The largest increase in the number of outpatient visits was also for the extreme poverty group (4.6 to 5.7). The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other groups. Satisfaction rates were high in all groups. Qualitative feedback from stakeholders also suggested that increased reimbursement rates, easier reimbursement procedures, and allowance improved patients' service utilization. Implementation of case-based payment made service provision more compliant to clinical pathways. Conclusion: Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group, indicating improved equity in TB service access. The pro-poor design of the program provides important lessons to other TB programs in China and other countries to better address TB care for the poor. [ABSTRACT FROM AUTHOR]

The UN Sustainable Development Goals include ending the tuberculosis epidemic globally by 2030. China is a high burden country of both drug-susceptible and multidrug-resistant tuberculosis. This study examined China's progress in meeting the tuberculosis milestones and targets laid out by the WHO End TB Strategy, and analysed key health system challenges to be overcome towards ending the tuberculosis epidemic in China. We used estimates of tuberculosis incidence and number of tuberculosis deaths in China from the Global Burden of Disease Study 2016 to conduct current situation analysis and a projection for 2030. We also reviewed national strategy and implementation guidelines in relation to tuberculosis control in China. We conducted semi-structured qualitative interviews, including key-informant interviews with decision makers and policy implementers at national and provincial levels (n=4), and in-depth interviews with experts in tuberculosis control (n=3). Senior researchers invited participants to take part in interviews through personal contacts, and undertook the interviews after obtaining verbal consent from the participants. Thematic analysis was applied to identify themes and develop interpretations. Between 1990 and 2016, the estimated tuberculosis incidence declined from 156 cases per 100 000 individuals to 86 cases per 100 000 individuals, and the number of tuberculosis deaths decreased from 178 515 to 40 120, in China. The tuberculosis incidence was projected to drop to 62 cases per 100 000 individuals, and the number of tuberculosis deaths to drop to 17 218 by 2030, both above the WHO 2030 targets of an 80% reduction in tuberculosis incidence (17 cases per 100 000 individuals) and a 90% reduction in the number of tuberculosis deaths (4130), compared with 2015. Of the four key informants, three said that many patients with tuberculosis, particularly multidrug-resistant tuberculosis, suffered from catastrophic payment for tuberculosis care. Qualitative interviews also revealed several key health system challenges in the access to high quality and affordable tuberculosis care, including: (1) insufficient funding and workforce for tuberculosis control; (2) difficulty in scaling up new tuberculosis and multidrug-resistant tuberculosis diagnostic tools; (3) inefficient cooperation across anti-tuberculosis health facilities; and (4) inconsistency among health insurance policies, public hospital reforms, and tuberculosis control strategies. China cannot meet the End TB Strategy targets by 2030, unless synergistic tuberculosis control policies and strategies can be developed and implemented, and multi-sector cooperation can be improved to enhance the delivery of tuberculosis care. The Bill & Melinda Gates Foundation (grant number OOP1148464). [ABSTRACT FROM AUTHOR]

Background: This study, based on multicentre cohorts, aims to utilize computed tomography (CT) images to construct a deep learning model for predicting major pathological response (MPR) to neoadjuvant chemoimmunotherapy in non-small cell lung cancer (NSCLC) and further explore the biological basis under its prediction., Methods: 274 patients undergoing curative surgery after neoadjuvant chemoimmunotherapy for NSCLC at 4 centres from January 2019 to December 2021 were included and divided into a training cohort, an internal validation cohort, and an external validation cohort. ShuffleNetV2x05-based features of the primary tumour on the CT scans within the 2 weeks preceding neoadjuvant administration were employed to develop a deep learning score for distinguishing MPR and non-MPR. To reveal the underlying biological basis of the deep learning score, a genetic analysis was conducted based on 25 patients with RNA-sequencing data., Findings: MPR was achieved in 54.0% (n = 148) patients. The area under the curve (AUC) of the deep learning score to predict MPR was 0.73 (95% confidence interval [CI]: 0.58-0.86) and 0.72 (95% CI: 0.58-0.85) in the internal validation and external validation cohorts, respectively. After integrating the clinical characteristic into the deep learning score, the combined model achieved satisfactory performance in the internal validation (AUC: 0.77, 95% CI: 0.64-0.89) and external validation cohorts (AUC: 0.75, 95% CI: 0.62-0.87). In the biological basis exploration for the deep learning score, a high deep learning score was associated with the downregulation of pathways mediating tumour proliferation and the promotion of antitumour immune cell infiltration in the microenvironment., Interpretation: The proposed deep learning model could effectively predict MPR in NSCLC patients treated with neoadjuvant chemoimmunotherapy., Funding: This study was supported by National Key Research and Development Program of China, China (2017YFA0205200); National Natural Science Foundation of China, China (91959126, 82022036, 91959130, 81971776, 81771924, 6202790004, 81930053, 9195910169, 62176013, 8210071009); Beijing Natural Science Foundation, China (L182061); Strategic Priority Research Program of Chinese Academy of Sciences, China (XDB38040200); Chinese Academy of Sciences, China (GJJSTD20170004, QYZDJ-SSW-JSC005); Shanghai Hospital Development Center, China (SHDC2020CR3047B); and Science and Technology Commission of Shanghai Municipality, China (21YF1438200)., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

China has made profound progress in advancing universal health coverage (UHC) over the past two decades. New Cooperative Medical Scheme (NCMS) was initiated in 2003 to provide health insurance coverage to rural population. Its benefit packages and cost-sharing mechanism have changed significantly over time. This study aims to assess the impact of changing NCMS policies on NCMS enrollees' service utilisation, medical financial burden and equity between 2003 and 2013. Data are from China National Health Services Survey (NHSS) which is conducted every 5 years. We used the subsample of NHSS that were enrolled in NCMS in 2003, 2008 and 2013. From 2003 to 2013, we found increased service utilisation and an elimination of inequity in service utilisation with respect to income. Contradicting prior findings of increasing financial burden after the NCMS implementation, we identified significant protective effect of NCMS against financial risks, and a reduction in percentage of households with high medical expenditure in the middle-income and high-income quintiles. The rural residents from the low-income groups have high financial risk, therefore, should be the priority target for future reforms. In pursuit of UHC globally, many countries struggle to provide good coverage to the disadvantaged rural population and balance between the competing priorities of various UHC dimensions. Our trend analysis revealed China's two-stage approach with NCMS reform that first focused on expanding population coverage, then on service coverage and financial risk protection. This path could potentially be replicated in other middle-income and low-income countries to pave the way for UHC., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background : With support from the Gates Foundation, the Chinese Center for Disease Control and Prevention (China CDC) introduced a new financing model for tuberculosis (TB) care. This paper reviews the development of the associated financing policies and payment methods in three project sites and analyzes the factors impacting on policy implementation and outcomes. Methods : We reviewed policy papers and other relevant documents issued in the project sites. Semi-structured qualitative interviews were conducted with key stakeholders at provincial, city and county levels. Thematic analysis was applied to identify themes and develop interpretations. Results : The China CDC guideline proposed the introduction of a case-based payment based on TB treatment clinical pathways, increased reimbursement rates and financial assistance for the poorest TB patients. Contrary to expectations, TB patients with complications and/or comorbidities were often excluded from the program by hospitals that were concerned the cost of care would exceed the case-based payment ceiling. In addition, doctors frequently prescribed services and/or drugs beyond the coverage of the benefit package for those in the program. Consequently, actual reimbursement rates were low and poor patients still faced a heavy financial burden, though the utilization of services increased, especially by poorer patients. Qualitative interviews revealed three main factors affecting payment policy implementation. They were: hospital managers' concern on the potential for reduced revenue generation; their fear that patients would regard the service provided as sub-standard if they were not prescribed the full range of available treatments; and a lack of mechanisms to effectively monitor and support the implementation process. Conclusions : While the intervention had some success in improving access to TB care, the challenges of implementing the policy in what proved to be an unreceptive and often antagonistic context resulted in divergences from the original design that frustrated its aim of reducing the financial burden on patients.

The indirect carbon emission embodied in the intermediate input is also an important indicator of assessing a producer's carbon emissions. Structural analysis of indirect carbon emissions is helpful to understand the responsibilities between producers and pay efforts to key areas. The aim of this study is to analyze indirect carbon emissions embodied in intermediate input between sectors and explore the distribution structure of indirect carbon emissions flow network (namely, ICEFN). Based on the modified input-output model and complex network theory, this study constructed four directed and weighted ICEFNs with 28 sectors from 1997 to 2012. The results show that indirect carbon emissions between sectors are significantly higher than direct carbon emissions, accounting for nearly 70% of the total carbon emissions of China. Second, we analyzed the embodied carbon emission intensity (namely, ECI) of each sector. Although the ECI has been decreasing over time, the decrease has increasingly diminished, which indicates that the additional carbon emission reductions are more difficult. Third, we identified the key sectors which play different roles in the ICEFNs. Meanwhile, we studied the key paths which show more closed relationships between some sectors in ICEFNs. Finally, based on the above analysis, we made policy recommendations.

Background: In response to the high financial burden of health services facing tuberculosis (TB) patients in China, the China-Gates TB project, Phase II, has implemented a new financing and payment model as an important component of the overall project in three cities in eastern, central and western China. The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-for-service with a case-based payment approach. This study investigated changes in out-of-pocket (OOP) health expenditure and the financial burden on TB patients before and after the interventions, with a focus on potential differential impacts on patients from different income groups., Methods: Three sample counties in each of the three prefectures: Zhenjiang, Yichang and Hanzhong were chosen as study sites. TB patients who started and completed treatment before, and during the intervention period, were randomly sampled and surveyed at the baseline in 2013 and final evaluation in 2015 respectively. OOP health expenditure and percentage of patients incurring catastrophic health expenditure (CHE) were calculated for different income groups. OLS regression and logit regression were conducted to explore the intervention's impacts on patient OOP health expenditure and financial burden after adjusting for other covariates. Key-informant interviews and focus group discussions were conducted to understand the reasons for any observed changes., Results: Data from 738 (baseline) and 735 (evaluation) patients were available for analysis. Patient mean OOP health expenditure increased from RMB 3576 to RMB 5791, and the percentage of patients incurring CHE also increased after intervention. The percentage increase in OOP health expenditure and the likelihood of incurring CHE were significantly lower for patients from the highest income group as compared to the lowest. Qualitative findings indicated that increased use of health services not covered by the standard package of the model was likely to have caused the increase in financial burden., Conclusions: The implementation of the new financing and payment model did not protect patients, especially those from the lowest income group, from financial difficulty, due partly to their increased use of health service. More financial resources should be mobilized to increase financial protection, particularly for poor patients, while cost containment strategies need to be developed and effectively implemented to improve the effective coverage of essential healthcare in China.

Purpose: To identify MRI-based radiomics as prognostic factors in patients with advanced nasopharyngeal carcinoma (NPC). Experimental Design: One-hundred and eighteen patients (training cohort: n = 88; validation cohort: n = 30) with advanced NPC were enrolled. A total of 970 radiomics features were extracted from T2-weighted (T2-w) and contrast-enhanced T1-weighted (CET1-w) MRI. Least absolute shrinkage and selection operator (LASSO) regression was applied to select features for progression-free survival (PFS) nomograms. Nomogram discrimination and calibration were evaluated. Associations between radiomics features and clinical data were investigated using heatmaps. Results: The radiomics signatures were significantly associated with PFS. A radiomics signature derived from joint CET1-w and T2-w images showed better prognostic performance than signatures derived from CET1-w or T2-w images alone. One radiomics nomogram combined a radiomics signature from joint CET1-w and T2-w images with the TNM staging system. This nomogram showed a significant improvement over the TNM staging system in terms of evaluating PFS in the training cohort (C-index, 0.761 vs. 0.514; P < 2.68 × 10 -9 ). Another radiomics nomogram integrated the radiomics signature with all clinical data, and thereby outperformed a nomogram based on clinical data alone (C-index, 0.776 vs. 0.649; P < 1.60 × 10 -7 ). Calibration curves showed good agreement. Findings were confirmed in the validation cohort. Heatmaps revealed associations between radiomics features and tumor stages. Conclusions: Multiparametric MRI-based radiomics nomograms provided improved prognostic ability in advanced NPC. These results provide an illustrative example of precision medicine and may affect treatment strategies. Clin Cancer Res; 23(15); 4259-69. ©2017 AACR ., (©2017 American Association for Cancer Research.)