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Jieying Wang,* Zhuoling Chen,* Yuni Xu, Wenhua Qiu, Shaowen Chen, Hua Pei, Yeteng Zhong Department of Clinical Laboratory, The Second Affiliated Hospital Hainan Medical University, Haikou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yeteng Zhong; Hua Pei, Department of Clinical Laboratory, The Second Affiliated Hospital Hainan Medical University, Haikou, People’s Republic of China, Email zhongyeteng@163.com; phzmh61@aliyun.comBackground: China has seen a drastic increase in the incidence of non-tuberculous mycobacteria (NTM) infection, which is a notable public health issue. Due to a lack of reliable epidemiological surveillance information, there is a need to gather accurate epidemiological and surveillance data, which can help clinicians effectively treat NTM patients. Moreover, drug susceptibility testing for NTM is not frequently performed in China. This retrospective study, therefore, determined the prevalence and resistance characteristics of NTM to provide a reference to control the NTM epidemic.Methods: Sputum, alveolar lavage fluid, and other respiratory specimens were collected from 3025 patients with suspected pulmonary tuberculosis attending The Second Affiliated Hospital of Hainan Medical University from January 2014 to December 2021. Strain identification and species distribution of NTM were performed by DNA chip technology and gene sequencing, and the drug resistance of NTM isolates was evaluated by calculating the minimum inhibitory concentration through antimicrobial susceptibility testing for NTM.Results: From 2014 to 2021, 373 strains of NTM were isolated and identified from respiratory specimens of 3025 suspected tuberculosis patients. Except in 2014, NTM-infected patients accounted for more than 10% of suspected tuberculosis patients in other years. The median age of patients with NTM infection was 62.0 years (53.0, 71.0), and the male-to-female ratio among these patients was 0.79:1. Among culture-positive strains, 12.3% (373/3040; 95% CI 11.1– 13.4%) were identified as NTM comprising forty species of NTM. The forty species of NTM included 23 slow-growing mycobacteria (SGM) and 17 rapidly-growing mycobacteria (RGM). Among the NTM isolates, 58.7% (219/373; 95% CI 53.7– 63.7%) were SGM and 41.3% (154/373; 95% CI 36.3– 46.3%) were RGM. M.avium complex(MAC)(41.3%; 95% CI 36.3– 46.3%) and M.abscessus complex (MABC)(33.2%; 95% CI 28.4– 38.0%) were the most frequently detected species, followed by M.simiae Complex (11.8%; 95% CI 8.5– 15.1%), M.fortuitum group (5.1%; 95% CI 2.9– 7.3%), and others. Drug sensitivity test results showed that most of the NTM isolates were susceptible to amikacin and clarithromycin with a drug resistance rate of less than 10%. However, clarithromycin could induce drug resistance, followed by linezolid and moxifloxacin, and their drug resistance rate was less than 50%.Conclusion: During 2014– 2021, the number of NTM isolates detected in the respiratory specimens of the study patients in The Second Affiliated Hospital of Hainan Medical University increased year by year. M. intracellulare is the most common pathogenic NTM species, and there is a high incidence of NTM infection on Hainan Island. Our findings might be of great importance for diagnosing and treating this patient population in Hainan.Keywords: Mycobacterium, non-tuberculous mycobacteria, pulmonary disease, drug resistance

Bias correction methods are based on the assumption of bias stationarity of climate model outputs. However, this assumption may not be valid, because of the natural climate variability. This study investigates the impacts of bias nonstationarity of climate models simulated precipitation and temperature on hydrological climate change impact studies. The bias nonstationarity is determined as the range of difference in bias over multiple historical periods with no anthropogenic climate change for four different time windows. The role of bias nonstationarity in future climate change is assessed using the signal-to-noise ratio as a criterion. The results show that biases of climate models simulated monthly and annual precipitation and temperature vary with time, especially for short time windows. The bias nonstationarity of precipitation plays a great role in future precipitation change, while the role of temperature bias is not important. The bias nonstationarity of climate model outputs is amplified when driving a hydrological model for hydrological simulations. The increase in the length of time window can mitigate the impacts of bias nonstationarity for streamflow projections. Thus, a long time period is suggested to be used to calibrate a bias correction method for hydrological climate change impact studies to reduce the influence of natural climate variability. HIGHLIGHTS The biases of GCM precipitation and temperature vary with time, due to natural climate variability.; The bias nonstationarity of precipitation plays a great role in future precipitation change, while the role of temperature bias is not important.; The bias nonstationarity of precipitation and temperature has great considerable impacts on future streamflow changes.

Objective Although the interferon-γ release assay (IGRA) has become a common diagnostic method for tuberculosis, its value in the diagnosis of tuberculosis in human immunodeficiency virus (HIV) seropositive patients remains controversial. Therefore, this systematically reviews the data for exploring the diagnostic value of IGRA in HIV-infected individuals complicated with active tuberculosis, aiming to provide a clinical basis for future clinical diagnosis of the disease. Methods Relevant studies on IGRA for diagnosing tuberculosis in HIV-infected patients were comprehensively collected from Excerpta Medica Database (EMBASE), Medline, Cochrane Library, Chinese Sci-tech Periodical Full-text Database, Chinese Periodical Full-text Database, China National Knowledge Infrastructure (CNKI) and China Wanfang Data up to July 2020. Subsequently, Stata 15.0, an integrated statistical software, was used to analyse the sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) to create receiver operator characteristic (ROC) curves. Results A total of 18 high-quality articles were selected, including 20 studies, 11 of which were related to QuantiFERON-TB Gold In-Tube (QFT-GIT) and nine to T-SPOT.TB. The meta-analysis indicated that the pooled sensitivity = 0.75 (95% CI 0.63–0.85), the pooled specificity = 0.82 (95% CI 0.66–0.92), PLR = 4.25 (95% CI 1.97–9.18), NLR = 0.30 (95% CI 0.18–0.50), DOR = 14.21 (95% CI 4.38–46.09) and the area under summary ROC curve was 0.85 (95% CI 0.81–0.88). Conclusion IGRA has a good diagnostic value and therefore can aid in the preliminary screening of active tuberculosis in HIV-infected individuals. Its diagnostic effectiveness can be improved by modifying and optimizing the assay design.

To balance the water demands of different departments and produce a win–win result for reservoir operation, a series of conflict-resolution methods have been developed to define the socio-optimal operation strategy for specific conflict problems. However, given the inherent uncertainty of reservoir operation brought by climate change, the compromised strategies selected by conflict-resolution methods can vary. Therefore, quantifying the impacts of climate change on the decision characteristics of conflict-resolution methods can help to address questions about whether conflict-resolution decisions are sustainable given unforeseen changes. In this study, the Yangtze River is regarded as study area. As a world-class hydropower project located on the midstream of Yangtze River, Three Gorges Hydroelectric Power Station can transfer plenty of water energy into electricity. To alleviate the ecological water shortage caused by hydropower operation, sustainable and balanced operation strategies considering the water demands of two departments needs to be studied. In the context of hydropower-environmental conflict-resolution management, the decision behaviors of two fuzzy social choice methods and four game-theoretical bargaining methods under 25 kinds of future climate scenarios are analyzed. Comparing the strategy selection results of different methods for a future period (2021–2082) shows that in all proposed climate scenarios, the decisions of the Nash bargaining method, alternating offer method, and unanimity fallback bargaining method in game-theoretical bargaining methods are more stable than other studied methods, which means that climate change affects the decision behaviors of these three methods slightly. In addition, balanced strategies selected by these three methods could formulate adaptable reservoir operation policies that would satisfy the interests of hydropower and environmental stakeholders equally, and avoid a very low satisfaction level of individual stakeholder and whole stakeholders in the water-conflict year. Therefore, against the background of an increasing demand for environmental protection, these three methods can provide socio-optimal strategies considering social and economic benefits for water resource management.

Conflict-resolution methods have been applied to water resources management to balance conflicting interests of stakeholders. Due to the climate change impacts on hydrologic processes, the strategy selections of conflict-resolution methods can be influenced, resulting in different selection rules for historical and future periods. This study aims to quantify the impacts of climate change on the strategy-selection rules of the conflict-resolution methods for better long-term strategic decision-making. The methodology of this study consists of climatic, hydrological, environmental and multi-objective optimization models, two fuzzy social choice methods (FSCMs) and four game-theoretical bargaining methods (GTBMs). The hydro-environmental conflict-resolution management in the Yangtze River of China is selected as the case study. The results show that the strategy selection of GTBMs is more stable and results in a better balance between hydropower and environmental objectives, compared to that of FSCMs. Moreover, considering climate change, under the appropriate environmental flow pattern, the stabilities of the strategy selections of FSCMs and GTBMs are slightly influenced, and the average satisfied degrees of both objectives obtained by FSCMs and GTBMs in the future period (2021-2080) are lower than those in the base period (1950-2012). The findings from this study provide guidance for hydro-environmental conflict-resolution management from a sustainable development perspective.

Objective Although the interferon-γ release assay (IGRA) has become a common diagnostic method for tuberculosis, its value in the diagnosis of tuberculosis in human immunodeficiency virus (HIV) seropositive patients remains controversial. Therefore, this systematically reviews the data for exploring the diagnostic value of IGRA in HIV-infected individuals complicated with active tuberculosis, aiming to provide a clinical basis for future clinical diagnosis of the disease. Methods Relevant studies on IGRA for diagnosing tuberculosis in HIV-infected patients were comprehensively collected from Excerpta Medica Database (EMBASE), Medline, Cochrane Library, Chinese Sci-tech Periodical Full-text Database, Chinese Periodical Full-text Database, China National Knowledge Infrastructure (CNKI) and China Wanfang Data up to July 2020. Subsequently, Stata 15.0, an integrated statistical software, was used to analyse the sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) to create receiver operator characteristic (ROC) curves. Results A total of 18 high-quality articles were selected, including 20 studies, 11 of which were related to QuantiFERON-TB Gold In-Tube (QFT-GIT) and nine to T-SPOT.TB. The meta-analysis indicated that the pooled sensitivity = 0.75 (95% CI 0.63–0.85), the pooled specificity = 0.82 (95% CI 0.66–0.92), PLR = 4.25 (95% CI 1.97–9.18), NLR = 0.30 (95% CI 0.18–0.50), DOR = 14.21 (95% CI 4.38–46.09) and the area under summary ROC curve was 0.85 (95% CI 0.81–0.88). Conclusion IGRA has a good diagnostic value and therefore can aid in the preliminary screening of active tuberculosis in HIV-infected individuals. Its diagnostic effectiveness can be improved by modifying and optimizing the assay design.

Hydropower generation is a common consideration for reservoir operations. Due to the characteristic of high dimensionality, multi-reservoir optimization for hydropower generation is challenging. Although the original water cycle algorithm (WCA) outperforms other metaheuristic optimization algorithms in solving constrained and unconstrained problems, it still gets trapped in the local optima in the case of some high-dimensional problems. For multi-reservoir optimization problems, this paper provides a modified WCA based on the diversity evaluation and chaos theory (DC-WCA) to avoid premature convergence. Six benchmark problems are examined using DC-WCA, WCA, improved chaos genetic algorithm (ICGA) and chaotic particle swarm optimization algorithm (CPSO) to evaluate the efficacy of DC-WCA. To investigate the application of DC-WCA for multi-reservoir optimization, a serially linked reservoir system located in the upper reach of the Yangtze river of China is used as a case study. After sensitivity analyses of the parameters, the four algorithms are used for long-term multi-reservoir optimization for hydropower generation. The optimization results show that 1) the annual hydropower generation optimized using DC-WCA is superior to those optimized using the other reported optimizers, and 2) the convergence rate of DC-WCA is faster than those of the other reported optimizers. This case study indicates that the application of DC-WCA for multi-reservoir optimization not only improves the calculation accuracy but also reduces computation time.

Sustainable transboundary water governance is often challenged by conflicts between agents, which necessitates the design of cooperative and self-enforcing alternatives to facilitate equitable water distribution. The Nash bargaining approach, which originated from game theory, could offer a good mathematical framework to simulate strategic interactions among involved agents by considering individual rational benefits. Given that river-sharing problems often involve multiple self-interested agents, the asymmetric Nash bargaining solution (ANBS) could be used to describe agents&rsquo, powers, as determined by disparate social, economic, and political as well as military status, and ensure win&ndash, win strategies based on individual rationality. This paper proposed an asymmetric bargaining model by combining multi-criteria decision making, bankruptcy theory, and the ANBS for water distribution in the transboundary river context. The Euphrates River Basin (ERB) with three littoral states was used as a case study. Turkey has the highest bargaining power in ERB negotiation since it dominates in terms of economic strength, political influence, and military capacity, whereas in the two downstream countries these aspects are limited due to their internal political fragmentation and weaker military status. The water satisfaction percentages of Turkey, Syria, and Iraq under the best alternative are 96.30%, 84.23%, and 40.88%, respectively. The findings highlight the necessity for synthetically considering the agent&rsquo, s disagreement utility and asymmetrical power when negotiating over water allocation.

The coordinated operation for hydropower generation in cascade reservoirs is critical to resolve the conflicts in hydropower needs between upstream and downstream reservoirs. Due to the individual rationality and collective rationality highlighted by game theory, we propose an integrated game-theoretical model to simulate the coordination behaviors among cascade reservoirs for hydropower generation. In the case study of a cascade-reservoir system in the Yangtze River of China, three operation models are compared and analyzed: the non-cooperative model, centralized model, and integrated game-theoretical model. The factors influencing the coordination efficiency of the integrated game-theoretical model are also explored in this study. The results indicate that the system’s hydropower generation obtained by the integrated game-theoretical model is closer to the ideal solution obtained by the centralized model compared to that obtained by the non-cooperative model. Moreover, individual hydropower generation in non-cooperation (rational individual gains) is guaranteed by the integrated game-theoretical model, which is neglected by the centralized model. Furthermore, the coordination efficiency of the integrated game-theoretical model is influenced by the water availability variation and regulation capacities of cascade reservoirs.