Medical service fragmentation is a common problem worldwide, and many countries have adopted integration to solve the difficulty. Contrary to developed countries, developing countries such as China must consider how to implement integration under a relatively weak medical foundation. This study aims to evaluate the effect of the \"Compact Union of County and Township Health Sectors\" policy on the medical service capacity of a typical integration model represented by Shanxi Province in China and determine the path the policy followed. By using Shanxi\'s county-level medical integration as a quasi-natural experiment, this study establishes a difference-in-differences model to investigate the effect of the policy using official data. A series of tests are conducted to verify the robustness of the result. Finally, the policy pathway is tested. The results show that the third-level surgeries and outpatient service utilization of leading hospitals and township institutions increased. Still, inpatient service utilization and fourth-level surgeries did not show a significant change in either type of institution. Moreover, the enhancement of leading hospitals\' service capacity comes mainly through improving asset efficiency and personal income, while the improvement of township institutions\' capacity comes primarily through increased personal income. Compact integration of county-level medical institutions can stimulate and improve service capacity by improving asset efficiency and personal income, even with a weak medical foundation. However, to achieve continuous service capacity improvement, the professional level of county-level institutions must be strengthened with a superior hospital\'s assistance, and personnel\'s enthusiasm for active innovation must be cultivated.

To analyze public perceptions of active aging in China on mainstream social media platforms to determine whether the \"14th Five Year Plan for the Development of the Aging Career and Older Adult Care System\" issued by the CPC in 2022 has fully addressed public needs.
The original tweets posted on Weibo between January 1, 2020, and June 30, 2022, containing the words \"aging\" or \"old age\" were extracted. A bidirectional encoder representation from transformers (BERT)-based model was used to generate themes related to this perception. A qualitative thematic analysis and an independent review of the theme labels were conducted by the researchers.
The findings indicate that public perceptions revolved around four themes: (1) health prevention and protection, (2) convenient living environments, (3) cognitive health and social integration, and (4) protecting the rights and interests of the older adult.
Our study found that although the Plan aligns with most of these themes, it lacks clear planning for financial security and marital life.

This study is aimed at investigating the asymmetric and time-frequency co-movements and the hedge or safe-haven properties of carbon efficient indices, the MSCI ACWI Sustainable Impact, and MSCI World EGS indices, in relation to technology and innovation-themed investments. In doing so, the ADCC-GJR-GARCH and wavelet coherence techniques are applied to a daily return series ranging from January 2019 to January 2023. Findings of the ADCC-GJR-GARCH model show negative and insignificant asymmetric linkage among underlying indices during the sample period. The S&P 500 carbon efficient index (CEI) acts as a strong hedge or safe-haven for technology and innovation-themed indices during tranquil and tumultuous periods. The MSCI ACWI Sustainable Impact, MSCI World EGS, and carbon efficient indices except for S&P 500 CEI exhibit weak hedge or safe-haven attributes. Wavelet coherence reveals negative (positive) co-movements between the thematic and carbon efficient indices in short-term (medium-term and long-term) horizons with consistent leading behavior of thematic indices to carbon efficient indices outcomes. It justifies the presence of short-lived hedging or safe-haven characteristics in the thematic domain for investors. These strong and weak hedge or safe-haven characteristics of low carbon and sustainability indices reveal that adding low carbon efficient and sustainable investments to a portfolio result in considerable diversification benefits for investors who tend to take minimal risk in both tranquil and tumultuous periods. The current findings imply that financial institutions, thematic investing companies, and governments need to encourage carbon efficient technology transfer and innovation-themed investments by increasing the fund allocations in underlying asset classes. Policy-making and regulatory bodies can encourage investors to make carbon-efficient and thematic investments and companies to issue carbon-efficient stocks or investments to safeguard social and economic risks during fragile periods. These investments can offer greater opportunities to combat the intensity of economic shocks on portfolios for responsible or sustainable investors.

Wheat grain production is a vital component of the food supply produced by smallholder farms but faces significant threats from climate change. This study evaluated eight environmental impacts of wheat production using life cycle assessment based on survey data from 274 households, then built random forest models with 21 input features to contrast the environmental responses of different farming practices across three shared socioeconomic pathways (SSPs), spanning from 2024 to 2100. The results indicate significant environmental repercussions. Compared to the baseline period of 2018-2020, a similar upward trend in environmental impacts is observed, showing an average annual growth rate of 5.88 % (ranging from 0.45 to 18.56 %) under the sustainable pathway (SSP119) scenario; 5.90 % (ranging from 1.00 to 18.15 %) for the intermediate development pathway (SSP245); and 6.22 % (ranging from 1.16 to 17.74 %) under the rapid economic development pathway (SSP585). Variation in rainfall is identified as the primary driving factor of the increased environmental impacts, whereas its relationship with rising temperatures is not significant. The results suggest adopting farming practices as a vital strategy for smallholder farms to mitigate climate change impacts. Emphasizing appropriate fertilizer application and straw recycling can significantly reduce the environmental footprint of wheat production. Standardized fertilization could reduce the environmental impact index by 11.10 to 47.83 %, while straw recycling might decrease respiratory inorganics and photochemical oxidant formation potential by over 40 %. Combined, these approaches could lower the impact index by 12.31 to 63.38 %. The findings highlight the importance of adopting enhanced farming practices within smallholder farming systems in the context of climate change. SPOTLIGHTS.

BACKGROUND: Government purchase of social forces to participate in old age care services can release the burden of social care. Current research on performance evaluation in this field mainly focussed on the establishment of appropriate evaluation indices. However, discussion on the policy implementation deviation is scarce. This study aimed to evaluate the performance of China\'s local government purchase of old age care services, analyse the characteristics of related policies and explore their deviation.
METHODS: The persons who participated in the Training of the Trainer (ToT) organized by the Red Cross Society were enrolled. The policy documents were obtained from the official websites. The K-means cluster was used to determine the project performance grades. We compared the project performance grades between service objects and undertakers with different characteristics utilizing the non-parametric test. Based on the framework of \'Collaborative Participation - Project Performance Objective\', we analysed the content of relevant policy aiding by NVivo 12.
RESULTS: Data of project performance were collected from 306 participants. The standardized mean score of the efficiency dimension was the lowest (0.70 ± 0.24). The projects were divided into four grades: poor (17.0%), average (27.5%), good (12.4%) and excellent (43.1%). There were statistically significant differences in project performance grades only between advanced ageing groups (Z = 2.429, P = 0.015). As well, the policy also mentioned that the services focus should be tilted towards the oldest old. The purchasers mainly involved the Ministry of Civil Affairs and Health management departments in the policy. Respite services were less mentioned in the responsibilities of the undertakers. The requirement for efficiency and effectiveness was mentioned in less than half of the policy documents.
CONCLUSIONS: Policy attention is needed for the responsibilities and functions of the intermediate purchasing force, as well as more precise directions and responsibilities of undertakers. The purchasers and undertakers should improve management abilities and capacity of old age care services and focus on associated factors to achieve the best marginal benefit. In addition, the embedded performance evaluation needs to be updated periodically to bridge the deviation between policy implementation and policy formulation.

Many countries have adopted higher-valent pediatric combination vaccines to simplify vaccination schedules and minimize health expenditures and social costs. However, China is conservative in the use of pediatric combination vaccines. By reviewing and synthesizing quantitative and qualitative data, in this commentary we identify gaps and challenges to combination vaccine use and make recommendations for promoting use of higher-valent pediatric combination vaccines in China. Challenges are in four dimensions: (1) legislation and regulation, (2) immunization schedule design, (3) vaccine awareness and price, and (4) research and development capacity. To optimize the use of combination vaccines to reduce vaccine-preventable disease burden, we make recommendations that address key challenges: (1) develop policies and regulations to strengthen enforcement of the Vaccine Administration Law and remove regulatory hurdles that hinder combination vaccine research and development, (2) establish an evidence-informed policy-making mechanism for combination vaccines, (3) resolve immunization schedule conflicts between monovalent and combination vaccines, and (4) implement effective interventions to increase vaccine awareness and reduce price.

Modeling and predicting forest landscape dynamics are crucial for forest management and policy making, especially under the context of climate change and increased severities of disturbances. As forest landscapes change rapidly due to a variety of anthropogenic and natural factors, accurately and efficiently predicting forest dynamics requires the collaboration and synthesis of domain knowledge and experience from geographically dispersed experts. Owing to advanced web techniques, such collaboration can now be achieved to a certain extent, for example, discussion about modeling methods, consultation for model use, and surveying for stakeholders\' feedback can be conducted on the web. However, a research gap remains in terms of how to facilitate online joint actions in the core task of forest landscape modeling by overcoming the challenges from decentralized and heterogeneous data, offline model computation modes, complex simulation scenarios, and exploratory modeling processes. Therefore, we propose an online collaborative strategy to enable collaborative forest landscape dynamic prediction with four core modules, namely data preparation, forest landscape model (FLM) computation, simulation scenario configuration, and process organization. These four modules are designed to support: (1) voluntary data collection and online processing, (2) online synchronous use of FLMs, (3) collaborative simulation scenario design, altering, and execution, and (4) participatory modeling process customization and coordination. We used the LANDIS-II model as a representative FLM to demonstrate the online collaborative strategy for predicting the dynamics of forest aboveground biomass. The results showed that the online collaboration strategy effectively promoted forest landscape dynamic prediction in data preparation, scenario configuration, and task arrangement, thus supporting forest-related decision making.

Scientific evidence regularly guides policy decisions1, with behavioural science increasingly part of this process2. In April 2020, an influential paper3 proposed 19 policy recommendations (\'claims\') detailing how evidence from behavioural science could contribute to efforts to reduce impacts and end the COVID-19 pandemic. Here we assess 747 pandemic-related research articles that empirically investigated those claims. We report the scale of evidence and whether evidence supports them to indicate applicability for policymaking. Two independent teams, involving 72 reviewers, found evidence for 18 of 19 claims, with both teams finding evidence supporting 16 (89%) of those 18 claims. The strongest evidence supported claims that anticipated culture, polarization and misinformation would be associated with policy effectiveness. Claims suggesting trusted leaders and positive social norms increased adherence to behavioural interventions also had strong empirical support, as did appealing to social consensus or bipartisan agreement. Targeted language in messaging yielded mixed effects and there were no effects for highlighting individual benefits or protecting others. No available evidence existed to assess any distinct differences in effects between using the terms \'physical distancing\' and \'social distancing\'. Analysis of 463 papers containing data showed generally large samples; 418 involved human participants with a mean of 16,848 (median of 1,699). That statistical power underscored improved suitability of behavioural science research for informing policy decisions. Furthermore, by implementing a standardized approach to evidence selection and synthesis, we amplify broader implications for advancing scientific evidence in policy formulation and prioritization.

Building a marine ecological security shelter (MESS) has become the main strategy to adapt marine ecological threats in China. As China\'s marine policy lacks a robust framework document, it is necessary to consider whether the policy system can effectively support the construction of MESS. However, the linkage between the construction measures of MESS and related policies is not clear. Therefore, the purpose of this paper is to clarify the concept of MESS and its connection with policy, by adopting the policy content analysis method to analyze the evolution process of MESS-related policy system. The legislative shortcomings and implementation obstacles of the MESS-related policy system are then summarized and discussed. The results show that from 1981 to 2021 the MESS-related policy system has been continuously improved. However, the policy system\'s support and guarantee capacity for building MESS still needs to be improved. (1) Due to the lack of basic laws and special laws, the coordination among governance subjects and among policies lacks legislative guarantee. (2) The construction of MESS continues the inter-regional and inter-department administrative barriers in collaborative governance of marine environment. To establish an effective collaborative governance model, it is essential to improve the governance structure and mechanism. (3) The government-led governance pattern faces the problem of mechanism failure. The command and control instrument accounts for more than 82%, and the public and enterprises lack strong policy guarantees to participate in marine governance. (4) The policy system\'s adaptability to emerging threats must be improved. Marine policies rarely involve emerging threats such as climate change and new pollutants. Meanwhile, the real-time supervision and monitoring mechanism is weak. The real-time supervision is only accounting for about 10%. Generally speaking, as a complex and long-term system engineering, the construction of MESS will inevitably encounter contradictions in politics, culture, and economy. China should deepen the construction of marine ecological civilization and form a governance concept based on ecosystems. Overall, this paper helps to understand the internal connection between MESS and policy comprehensively and provides a new perspective for improving China\'s marine governance capacity.

Child health is an important public health issue in China and the Chinese government always attached great importance to child health care. With the implementation of a series of medical and health reforms in China in recent decades, the status of child health improved year by year. Objectives This study aims to comprehensively evaluate if the measures implemented in the medical and health reforms effectively promoted the development of Chinese child health care in recent years and provide theoretical support for future decision-making on the policies of child health care in China. Methods A total of six indicators were selected from the China Health Statistics Yearbook. Based on the multi-criteria decision analysis (MCDA) algorithm, three different evaluation methods were applied in the study, which are the weighted technique for order preference by similarity to an ideal solution (TOPSIS) method, the weighted rank-sum ratio (RSR) method, and the fuzzy comprehensive evaluation (FCE). Each indicator\'s weight was calculated by the entropy weight methods objectively. The sensitivity analysis was conducted to validate the stability and accuracy of the rank results. Results The results indicated that the rank values of each year\'s child health care calculated by the different evaluation methods were not exactly the same, but the overall trend is consistent which is that child health care in China improved year by year from 2000 to 2020. The top 5 were ranked from 2016-2020 and the bottom 5 were ranked from 2000-2004. Conclusions The results indicated that the policies and measures implemented in the medical and health reforms, as well as improved sanitation conditions, availability of healthy food and water, etc., have jointly promoted the development of child health care in China in the past 20 years, providing a scientific theoretical basis for future policy-making to promote child health care.