Uptake of maternal care and childhood immunization among ethnic minority and Han populations in Sichuan province: a study based on the 2003, 2008 and 2013 health service surveys.

BACKGROUND: China has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist. Ethnicity has become an important determinant of poor MCH outcomes, but little rigorous analytical work has been done in this area. To understand the socio-economic factors that explain ethnic variation in uptake of MCH care, we report the findings from an analysis in Sichuan province. METHODS: We linked data from the 2003, 2008 and 2013 National Health Service Surveys in Sichuan Province. The ethnic disparities in uptake of maternal care (completing 5 antenatal visits, giving birth in hospital and receiving a caesarean section) and childhood immunization (Bacillus Calmette Guerin (BCG), three doses of diphtheria (DPT) and measles immunization) were examined by geographical (Han district/county vs. ethnic minority county) and individual-based (Han women/children vs. ethnic minority women/children) comparisons. We also examined variation by distance to township and county hospitals, women's education, parity and age using weighted multilevel Poisson regressions with random intercept at district/county level. RESULTS: Ethnic inequalities in maternal care were marked, both at the geographical (district/county) and the individual level. The % of births in hospital was 90.7% among women in Han districts, compared to 83.3% among women living in Han counties (crude RR 0.93; 95% CI 0.75-1.15), 53.8% among Han women living in ethnic minority counties (crude RR 0.57; 95% CI 0.36-0.93), and 13.5% among ethnic minority women living in ethnic minority counties (crude RR 0.18; 95% CI 0.06-0.57). Adjusting the analysis for survey year, education, parity and distance to county level hospital weakened the association between geographical/individual ethnicity and uptake of maternity care, but associations remained remarkably strong. Coverage of childhood immunization was much higher than uptake of maternity care, and inequalities by ethnicity were much less pronounced. CONCLUSION: Lessons can be learned from China's successful immunization programme to further reduce inequalities in access to maternity care among ethnic minority populations in remote areas. Bringing the services closer to the women's homes and strengthening health promotion from the township to the village level may encourage more women to seek antenatal care and give birth in hospital

Additional file 1 of Social support and cognitive activity and their associations with incident cognitive impairment in cognitively normal older adults

Supplementary Material

Nitrogen use efficiency of terrestrial plants in China: geographic patterns, evolution, and determinants

Background: Plant nitrogen use efficiency (NUE) is an important ecological indicator that reflects the capacity of a plant to transform nitrogen into production, which is essential for further elucidating plant growth and terrestrial ecosystem productivity. Although there are a growing number of studies that address NUE changes at local scales, the variations of NUE over large spatial scales remain unclear. In this study, we analyzed the geographic patterns of NUE and explored its phylogenic and environmental drivers across 1452 species at 1102 sites in China. Results: NUE tended to decrease with latitude (r = − 0.56), whereas it increased with longitude (r = 0.54), and varied widely in different ecosystems and plant life forms. Furthermore, NUE was negatively correlated with plant foliar phosphorus concentration (r = − 0.53), soil pH (r = − 0.10), soil total phosphorus (r = − 0.13) and available phosphorus (r = − 0.05), but positively with the mean annual temperature (r = 0.32), annual precipitation (r = 0.27), and aridity index (r = 0.26). NUE was significantly altered with phylogeny and evolved toward a lower value (r = − 0.28), which may have been due to increasing nitrogen deposition and fixation in biogeochemical evolution. Overall, the combination of foliar phosphorus concentration, phylogeny, climate, and soil properties accounted for 52.7% of the total variations of NUE. In particular, foliar phosphorus concentration was the most important factor, whereas plant evolutionary history was second in contributing to NUE variations. Conclusions: Our study emphasizes the pivotal role of plant stoichiometry and phylogeny in nitrogen cycling and suggests incorporating them into earth system models to better understanding plant growth and nitrogen cycling in the context of environmental changes.ISSN:2192-170

Short-Term Effects of Climatic Variables on Hand, Foot, and Mouth Disease in Mainland China, 2008-2013: A Multilevel Spatial Poisson Regression Model Accounting for Overdispersion.

BACKGROUND:Hand, Foot, and Mouth Disease (HFMD) is a worldwide infectious disease. In China, many provinces have reported HFMD cases, especially the south and southwest provinces. Many studies have found a strong association between the incidence of HFMD and climatic factors such as temperature, rainfall, and relative humidity. However, few studies have analyzed cluster effects between various geographical units. METHODS:The nonlinear relationships and lag effects between weekly HFMD cases and climatic variables were estimated for the period of 2008-2013 using a polynomial distributed lag model. The extra-Poisson multilevel spatial polynomial model was used to model the exact relationship between weekly HFMD incidence and climatic variables after considering cluster effects, provincial correlated structure of HFMD incidence and overdispersion. The smoothing spline methods were used to detect threshold effects between climatic factors and HFMD incidence. RESULTS:The HFMD incidence spatial heterogeneity distributed among provinces, and the scale measurement of overdispersion was 548.077. After controlling for long-term trends, spatial heterogeneity and overdispersion, temperature was highly associated with HFMD incidence. Weekly average temperature and weekly temperature difference approximate inverse "V" shape and "V" shape relationships associated with HFMD incidence. The lag effects for weekly average temperature and weekly temperature difference were 3 weeks and 2 weeks. High spatial correlated HFMD incidence were detected in northern, central and southern province. Temperature can be used to explain most of variation of HFMD incidence in southern and northeastern provinces. After adjustment for temperature, eastern and Northern provinces still had high variation HFMD incidence. CONCLUSION:We found a relatively strong association between weekly HFMD incidence and weekly average temperature. The association between the HFMD incidence and climatic variables spatial heterogeneity distributed across provinces. Future research should explore the risk factors that cause spatial correlated structure or high variation of HFMD incidence which can be explained by temperature. When analyzing association between HFMD incidence and climatic variables, spatial heterogeneity among provinces should be evaluated. Moreover, the extra-Poisson multilevel model was capable of modeling the association between overdispersion of HFMD incidence and climatic variables

Thermodynamic and exergoeconomic analysis of a novel CO2 based combined cooling, heating and power system

In this paper, a novel combined cooling, heating and power (CCHP) system consisting of a supercritical carbon dioxide (sCO2) power cycle, a transcritical carbon dioxide (tCO2) power cycle with a carbon dioxide based refrigeration cycle, and a direct heating (DH) system is proposed. In the novel system, the waste heat from sCO2 power cycle is recovered by the tCO2 power cycle to generate additional power and drive the CO2 based refrigeration cycle to provide cooling for users, and the DH system further recovers the waste heat from the sCO2/tCO2 power cycle and the refrigeration compressor outflow to feed heat for users. Mathematical models are developed to conduct the thermodynamic and exergoeconomic analysis of the proposed CCHP system, and parametric studies on the effects of different key parameters on the system performance are carried out. Besides that, the optimization and comparative researches are performed to find out and compare the maximum system exergy efficiency and minimum total product unit cost for the proposed CCHP system and the stand-alone sCO2 system. The results indicate that for different users’ demands, the proposed CCHP system can obtain the best improvement by 12.01% for the system exergy efficiency and 5.14% for the total product unit cost, and the worst improvement by 10.83% for the system exergy efficiency and 4.12% for the total product unit cost, compared with the stand-alone sCO2 power cycle. These results confirm the obvious superiority in thermodynamic and economic performance of the proposed CCHP system under different users’ demands

Seasonal and Inter-Annual Variations of Carbon Dioxide Fluxes and Their Determinants in an Alpine Meadow

International audienceThe alpine meadow is one of the most important ecosystems on the Qinghai-Tibet Plateau (QTP) due to its huge carbon storage and wide distribution. Evaluating the carbon fluxes in alpine meadow ecosystems is crucial to understand the dynamics of carbon storage in high-altitude areas. Here, we investigated the carbon fluxes at seasonal and inter-annual timescales based on 5 years of observations of eddy covariance fluxes in the Zoige alpine meadow on the eastern Tibetan Plateau. We found that the Zoige alpine meadow acted as a faint carbon source of 94.69 ± 86.44 g C m −2 y −1 during the observation periods with large seasonal and inter-annual variations (IAVs). At the seasonal scale, gross primary productivity (GPP) and ecosystem respiration (Re) were positively correlated with photosynthetic photon flux density (PPFD), average daily temperature (Ta), and vapor pressure (VPD) and had negative relationships with volumetric water content (VWC). Seasonal variations of net ecosystem carbon dioxide (CO 2) exchange (NEE) were mostly explained by Ta, followed by PPFD, VPD, and VWC. The IAVs of GPP and Re were mainly attributable to the IAV of the maximum GPP rate (GPP max) and maximum Re rate (Re max), respectively, both of which increased with the percentage of Cyperaceae and decreased with the percentage of Polygonaceae changes across years. The IAV of NEE was well explained by the anomalies of the maximum CO 2 release rate (MCR). These results indicated that the annual net CO 2 exchange in the alpine meadow ecosystem was controlled mainly by the maximum C release rates. Therefore, a better understanding of physiological response to various environmental factors at peak C uptake and release seasons will largely improve the predictions of GPP, Re, and NEE in the context of global change

Conjugated Microporous Polymers‐Based Catalytic Membranes with Hierarchical Channels for High‐Throughput Removal of Micropollutants

Abstract Engineering a catalytic membrane capable of efficiently removing emerging organic microcontaminants under ultrahigh flux conditions is of significance for water purification. Herein, drawing inspiration from the functional attributes of lymphatic vessels involved in immunosurveillance and fluid transport with minimal energy consumption, a novel hierarchical porous catalytic membrane is engineered. This membrane, based on an innovative nitrogen‐rich conjugated microporous polymer (polytripheneamine, PTPA), is synthesized using an electrospinning coupled in situ polymerization approach. The resulting bioinspired membrane with hierarchical channels comprises a thin layer (≈1.7 µm) of crosslinked PTPA nanoparticles covering the interconnected electrospun nanofibers. This unique design creates an intrinsic microporous angstrom‐confined system capable of activating peroxymonosulfate (PMS) to generate 98.7% singlet oxygen (1O2), enabling durable and highly efficient degradation of microcontaminants. Additionally, the presence of a thin layer of mesoporous structure between PTPA nanoparticles and macroporous channels within the interwoven nanofibers enhances mass transfer efficiency and facilitates high flux rates. Notably, the prepared hierarchical porous organic catalytic membrane demonstrates enduring high‐efficiency degradation performance with a superior permeance (>95% and >2500 L m−2 h−1 bar−1) sustained over 100 h. This work introduces an innovative pathway for the design of high‐performance catalytic membranes for the removal of emerging organic microcontaminants

Estimated <i>RR</i> for province.

<p>Fig 3a. Estimated unadjusted spatial <i>RR</i> for provinces, Fig 3b. Estimated spatial structured <i>RR</i> for provinces, Fig 3c. Estimated random effects <i>RR</i> of avtemp for provinces, Fig 3d. Estimated spatial unstructured <i>RR</i> for provinces(Fig 3a <i>RR</i> generated from null multilevel model unadjustment for spatial correlated strucuture effects and climatic varialbes, Fig 3b–3d <i>RR</i> generated from final multilevel model adjustment for spatial correlated effects and climatic variables).</p

Time series plot of weekly HFMD cases and climatic variables of China, 2008–2013.

<p>Pcase (weekly reported cases of HFMD), avtemp (weekly average temperature (°C)), maxtemp (weekly maximum temperature (°C)), mintemp (weekly minimum temperature (°C)), rainfall (weekly average 20–20 hours rainfall (0.1 millimeters)), mavhmd (weekly average relative humidity (0.1%)), hsun (weekly average hours of sunshine (0.1hours)), mavwspeed (weekly average wind speed (meters per second)).</p