Background In October 2016, a senior high school student was diagnosed with sputum-smear positive [SS(+)] pulmonary tuberculosis (TB). We conducted an investigation of an outbreak in the school, including among students and teachers diagnosed with latent TB, who we followed until July 2019. Methods We defined latent TB infection (LTBI) as a tuberculin skin test (TST) induration of 15mm or larger; probable TB as a chest radiograph indicative of TB plus productive cough/hemoptysis for at least 2 weeks, or TST induration of 15mm or larger; and confirmed TB as two or more positive sputum smears or one positive sputum smear plus a chest radiograph indicative of TB or culture positive with M. tuberculosis. We conducted mycobacterial interspersed repetitive unit–variable number tandem repeat (MIRU-VNTR) typing based on 24 loci in the isolates. Results Between October 2016 and July 2019, we identified 52 cases, including nine probable, six confirmed, and 37 LTBI cases. The index case-student had attended school continuously despite having TB symptoms for almost three months before being diagnosed with TB. We obtained three isolates from classmates of the index case in 2016; all had identical MIRU-VNTR alleles with the index case. The LTBI rate was lower among students (7.41%, 30/405) than among teachers (26.92%, 7/26) (rate ratio [RR] = 0.28, 95% confidential interval [CI]: 0.13–0.57). Among the 17 students who had latent TB and refused prophylaxis in October 2016, 23.53% (4/17) became probable/confirmed cases by July 2019. None of the six teachers who also refused prophylaxis became probable or confirmed cases. Of the 176 students who were TST(-) in October 2016, 1.70% (3/176) became probable/confirmed cases, and among the 20 teachers who were TST(-), 1 became a probable case. Conclusions Delayed diagnosis of TB in the index patient may have contributed to the start of this outbreak; lack of post-exposure chemoprophylaxis facilitated spread of the outbreak. Post-exposure prophylaxis is strongly recommended for all TST-positive students; TST-negative students exposed to an SS(+) case should be followed up regularly so that prophylaxis can be started if LTBI is detected.

Introduction: During the past two decades, payments for ecosystem services (PES) program has become a popular conservation paradigm for realigning socioeconomic costs and benefits among different stakeholders. As billions of investment flows into the natural capital pool, there is growing interest to understand the ecological, economic, and social outcomes of PES programs. China is one of the countries that extensively implements PES programs. Although there is a growing interest to perform impact evaluation of China's massive PES programs, it is unclear that what existing literature has done, has not done, and should do in the future. Therefore, to guide further research and practices, we conduct a systematic review of studies on China's PES programs. Results: Our review shows that there are growing impact evaluation studies of PES programs in China. However, the spatial and ecosystem distributions of existing studies are quite uneven. Most case studies were poorly designed, rarely quantified, and evaluated without sophisticated methods. Among the three dimensions of ecological effectiveness, economic efficiency, and social equity, economic efficiency is the least studied. Discussion and Conclusion: We further discuss the challenges and opportunities and provide insights for future research. To improve the understanding and management of natural capital, we call for mainstreaming impact evaluation of ecosystem service policies in China and beyond following the state-of-art procedures.

China is the biggest provider of aquaculture products, and the industry is still growing rapidly. Further development of the sector will affect the provision of ecosystem services that maintain the livelihood of local populations. In particular, the current size and growth rate of China’s mariculture has raised many environmental concerns, but very few studies of this sector have been conducted to date. Here, we report the resource use in the production of six main Chinese mariculture products (Larimichthys crocea, Apostichopus japonicus, Haliotis spp., Laminaria japonica, Gracilaria spp., Porphyra spp.), taking the city of Ningde as a case study. We used the life cycle assessment framework and the Cumulated Exergy Demand indicator to quantify resource use, and implemented a Monte Carlo simulation where model uncertainty was included using various methods. The mean exergy demand values of the production of one live-weight ton of large yellow croaker, sea cucumber, abalone, laminaria, gracilaria, and porphyra are 106 GJ eq., 65 GJ eq., 126 GJ eq., 0.25 GJ eq., 1.55 GJ eq., and 0.98 GJ eq., respectively. For animal products, 45–90% of the impacts come from the feed requirements, while in seaweed production, 83–99% of the impacts are linked to the fuel used in operation and maintenance activities. Policies oriented toward efficient resource management in the mariculture sector thus should take the farm design, input management, and spatial planning of marine areas as the main targets to guide current practices into more sustainable ones in the future. Improvements in all those aspects can effectively increase resource efficiency in local mariculture production and additionally reduce other environmental impacts both locally and globally.

The effects of different doses of dexmedetomidine (Dex) anesthesia on inflammatory factors and hemodynamics in patients undergoing neurosurgery and its relationship with RSS scores are analyzed. A total of 102 patients who received neurosurgery in our hospital from March 2021 to March 2022 are selected. According to different intraoperative Dex dose, the enrolled patients are randomly divided into low-, medium-, and high-dose groups, 34 patients in each group. In this study, hemodynamic indexes, inflammatory factors, anesthesia effect, and the Ramsay sedation scale (RSS) score are compared in each groups. The experimental results show that in neurosurgery, compared with low-dose Dex, high-dose Dex can better maintain patients’ intraoperative hemodynamic parameters and effectively inhibit postoperative inflammatory response, but postoperative awakening time is also relatively prolonged, while medium-dose Dex can effectively control patients’ awakening time.