It is useful, for theoretical and practical reasons, to be able to specify functions for continuous abstinence over time in smoking cessation attempts. This study aimed to find the best‐fitting models of mean proportion abstinent with different smoking cessation pharmacotherapies up to 52 weeks from the quit date.R2 and Bayesian information criterion (BIC).We searched the Cochrane Database of Systematic Reviews to identify randomized controlled trials (RCTs) of pharmacological treatments to aid smoking cessation. For comparability, we selected trials that provided 12 weeks of treatment. Continuous abstinence rates for each treatment at each follow‐up point in trials were extracted along with methodological details of the trial. Data points for each pharmacotherapy at each follow‐up point were aggregated where the total across contributing studies included at least 1000 participants per data point. Continuous abstinence curves were modelled using a range of different functions from the quit date to 52‐week follow‐up. Models were compared for fit using R2 > 0.99, BIC < 17.0) to continuous abstinence curves from the target quit date in all cases except for varenicline, where a logarithmic function described the curve best . At 52 weeks, abstinence rates were 22.5% (23.0% modelled) for varenicline, 16.7% (16.0% modelled) for bupropion, 13.0% (12.4% modelled) for NRT and 8.3% (8.9% modelled) for placebo. For varenicline, bupropion, NRT and placebo, respectively, 55.9, 65.0, 62.3 and 56.5% of participants who were abstinent at the end of treatment were still abstinent at 52 weeks.Studies meeting our selection criteria covered three pharmacotherapies  and placebo. Power functions provided the best fit (Mean continuous abstinence rates up to 52 weeks from initiation of smoking cessation attempts in clinical trials can be modelled using simple power functions for placebo, nicotine replacement therapy and bupropion and a logarithmic function for varenicline. This allows accurate prediction of abstinence rates from any time point to any other time point up to 52 weeks. Continuous abstinence rates after initiation of a smoking quit attempt follow a negatively decelerating curve over time Results of clinical trials and cohort studies suggest that with unaided quit attempts, only approximately a quarter of those trying to quit remain abstinent for a week, fewer than one in 10 remain abstinent for 6 months and fewer than one in 20 remain abstinent at 1 year Some studies have specifically addressed the question of whether relapse rates increase when treatment is terminated. A recent synthesis of evidence from trials of varenicline showed a higher relapse rate from the end of 12 weeks of treatment to 24‐week follow‐up than for placebo Modelling the shape of continuous abstinence curves in smoking cessation is important for several reasons: (1) if the continuous abstinence curves follow a well‐defined and relatively simple mathematical formula, it would allow for prediction of abstinence rates from any time‐point to any future time‐point, which is important clinically and when assessing health impact What functions best characterize the shape of mean continuous abstinence curves over the first year following quit attempts in smoking cessation RCTs?Do these differ with different pharmacotherapies?When seeking to study continuous abstinence curves it is important to have high‐quality data with high follow‐up rates. Prospective cohort studies can provide valuable information, but often there are limitations with regard to loss to follow‐up and inconsistencies in treatment duration that make it difficult to make meaningful comparisons. With greater control over treatment conditions, higher retention rates and data collection occurring at multiple time‐points, randomized controlled trials (RCTs) provide an opportunity to examine continuous abstinence following pharmacological interventions for smoking cessation in greater detail. This study therefore aggregated data from high‐quality RCTs to describe the shape and parameters of mean continuous abstinence curves associated with different smoking cessation pharmacotherapies. Specifically, we aimed to address the following research questions:Details of our study search and selection procedure are provided in Fig. We included RCTs that compared continuous abstinence rates between pharmacological interventions, between one intervention and a placebo or between different pharmacotherapy doses and a placebo. We limited our search to articles published since 1990 because we considered trial reporting and conduct to have improved since then, with agreed reporting criteria for trials such as Consolidated Standards of Reporting Trials (CONSORT) being more widely used Due to the stringent criteria of Cochrane Reviews, all included RCTs were considered to be of acceptable standard. Studies awaiting assessments and ongoing studies were included where results were available.RCTs that met the criteria detailed above were extracted from the relevant Cochrane Reviews. From these trials we extracted information on sample size, pharmacotherapies used, length of pharmacotherapy intervention, start point of follow‐up, duration of follow‐up and the percentage of participants who were continuously abstinent over time in each condition from a given start point to each follow‐up point. Other data extracted from the trials included year of publication, year of trial start and country of origin.R2. To handle zero values in the case of power functions, the starting time‐point was 0.1 week, representing less than 1 day of abstinence. Model selection was confirmed by comparing the Bayesian information criterion (BIC) of each curve , with lower BIC values indicating better model fit.There was significant heterogeneity across study samples, methods and presentation of results. In order to standardize results for comparison across different pharmacotherapies while maximizing data available for the estimation of continuous abstinence curves, we selected studies that had used a 12‐week treatment programme; this was the modal and median duration of treatments in the 98 studies To check how far the relapse curves from the aggregated data matched within‐study changes in continuous abstinence rates over time, we superimposed lines between consecutive pairs of time‐points with each of the three largest studies, including where there were data available for additional time‐points for each pharmacotherapy, onto our continuous abstinence curves to assess whether the curves were a reasonable fit.Our search and selection procedure Fig.  identifiR2 > 0.99), while the best‐fitting curve for varenicline was logarithmic (R2 = 0.99). Equations for the best‐fitting curve for each pharmacotherapy are shown in Fig. R2 = 0.94), but it overestimated the 52‐week abstinence rate.Figure At the end of treatment, 45.1%  of participants treated with varenicline, 26.3% (24.6% modelled) of those treated with bupropion, 20.8% (20.2% modelled) of those treated with NRT and 16.2% (15.7% modelled) of those treated with placebo were still abstinent. By 52 weeks, abstinence rates had fallen to 22.5% (23.0% modelled) for varenicline, 16.7% (16.0% modelled) for bupropion, 13.0% (12.4% modelled) for NRT and 8.3% (8.9% modelled) for placebo. A total of 49.8% (55.9% modelled) of those treated with varenicline, 63.4% (65.0% modelled) of those treated with bupropion, 62.5% (61.3% modelled) of those treated with NRT and 51.5% (56.5% modelled) of those treated with placebo who were abstinent at the end of treatment were still abstinent at 52 weeks.Superimposing lines drawn between continuous abstinence rates from consecutive follow‐up points within the three largest studies for each pharmacotherapy showed a good fit to the modelled curves .There were sufficient data to enable reliable estimation of mean continuous abstinence rates for end of treatment (12‐week post‐quit date), 26‐ and 52‐week time‐points. The shape of the function relating these to time could best be modelled by power functions for placebo, NRT and bupropion and a logarithmic function for varenicline.Being able to describe continuous abstinence curves using a simple function, in theory, provides a basis for predicting relapse from one time‐point to any other time‐point. This is useful when one only has short‐term follow‐up data available, or when interpolating back from long‐term data. In UK stop‐smoking services, for example, it is common to use 4‐ or 12‐week abstinence rates in targets because limited resources make it impracticable to collect accurate longer‐term data. Unfortunately, there were not sufficient data to estimate continuous abstinence rates prior to 12 weeks, so it is possible that more complex functions during the treatment period may have been missed. However, we were able to provide precise estimates of mean relapse rates following end of treatment for the different pharmacotherapies.The finding that a single function starting at the quit date was able to capture abstinence rates at the end of treatment, as well as 26‐ and 52‐week abstinence rates, suggests that a single relapse process is in operation during and after treatment. This appears to conflict with studies suggesting that different processes may be in operation. However, it remains possible that different processes are in operation, but their combined effects remain the same. This is a topic that merits further investigation.We did not see evidence for a point of inflection in the curves at the end of treatment with the active pharmacotherapies, which also suggests that by 12 weeks from the quit date these pharmacotherapies have had whatever effect they are going to have. This accords with findings from trials with NRT which have not found clear evidence for a benefit of extending treatment beyond 12 weeks Of the four functions we fitted to the data, power functions provided the best fit for continuous abstinence from all treatments with the exception of varenicline, which was better described by a logarithmic curve. This difference was driven by the higher 12‐week abstinence rate observed in participants treated with varenicline. Methodological differences between trials of varenicline and other pharmacotherapies may account for at least some of this variance. Varenicline trials typically measure continuous abstinence from week 9 rather than from the target quit date, so the figure may be somewhat inflated, given that varenicline recruits smokers into abstinence for several weeks after the target quit date y value is infinite at x = 0 rather than 100%, so the starting point for time has to be a number above 0. We chose 0.1 weeks (representing less than 1 day) as a value close to 0, and this provided a very close fit to the data. However, a more mathematically sound function with a similar shape may be preferable. Finally, we limited follow‐up to 52 weeks because of the scarcity of data points after that point. Studies with longer‐term follow‐up have been conducted, and these suggest that approximately 30% of those who abstain for 52 weeks relapse at some point within the next 10 years This study had several limitations. First, there was substantial heterogeneity in trial methods and study samples which may have introduced noise to the data points. Secondly, there were only sufficient data to plot abstinence rates for 12, 24 and 52 weeks after the start of treatment. It would have been useful to have data available on a greater number of time‐points to incorporate into our continuous abstinence curves, particularly in the early weeks where relapse rates were very high. Thirdly, we were only able to include three pharmacotherapies and placebo in our analysis. There were insufficient data available on combination NRT and other popular and emerging pharmacological aids to smoking cessation, such as e‐cigarettes, nortriptyline and cytisine, and it is possible that the continuous abstinence curves associated with these treatments may differ from those observed here. Fourthly, we pre‐specified a small number of functions, and it may be that another function would be more appropriate. Although the fit of the selected function was very high, there was only a small number of follow‐up points. With more follow‐up points, a better‐fitting function might emerge. Fifthly, while a power function provided a very good fit in most cases, the In conclusion, this study indicates that a power function, or a function very close to it in shape, provides a very close fit to mean continuous abstinence from smoking in studies of smokers trying to quit using placebo, nicotine replacement therapy or bupropion. For varenicline, a logarithmic function appears to provide a better fit.J.B. has received unrestricted research funding from Pfizer, who manufacture smoking cessation medications. L.S. has received a research grant and honoraria for a talk and travel expenses from manufacturers of smoking cessation medications (Pfizer and Johnson & Johnson). R.W. undertakes research and consultancy for and receives travel funds and hospitality from manufacturers of smoking cessation medications . All authors declare no financial links with tobacco companies or e‐cigarette manufacturers or their representatives.Appendix S1 Excel file containing details of all studies considered for inclusion.Click here for additional data file.Appendix S2 Interactive graph showing abstinence rates with best‐fit curves estimated from continuous abstinence rates from RCTs of 12‐week treatment with smoking cessation pharmacotherapies.Click here for additional data file.Figure S1 Continuous abstinence rates with power curve for varenicline estimated from continuous abstinence rates from RCTs of smoking cessation.Figure S2 Continuous abstinence rates with best‐fit curves estimated from continuous abstinence rates from RCTs of 12‐week treatment with (A) bupropion, (B) varenicline, (C) nicotine replacement therapy and (D) placebo, with consecutive pairs of data points from the three largest studies for each treatment.Click here for additional data file.


In several behavioral psycholinguistic studies, it has been shown that concrete words are processed more efficiently. They can be remembered faster, recognized better, and can be learned easier than abstract words. This fact is called concreteness effect. There are fMRI studies which compared the neural representations of concrete and abstract concepts in terms of activated regions. In the present study, a comparison has been made between the condition-specific connectivity of functional networks (obtained by group ICA) during imagery of abstract and concrete words. The obtained results revealed that the functional network connectivity between three pairs of networks during concrete imagery is significantly different from that of abstract imagery (FDR correction at the significance level of 0.05). These results suggest that abstract and concrete concepts have different representations in terms of functional network connectivity pattern. Remarkably, in all of these network pairs, the connectivity during concrete imagery is significantly higher than that of abstract imagery. These more coherent networks include both linguistic and visual regions with a higher engagement of the right hemisphere, so the results are in line with dual coding theory. Additionally, these three pairs of networks include the contrasting regions which have shown stronger activation either in concrete or abstract word processing in former studies. The findings imply that the brain is more integrated and synchronized at the time of concrete imagery and it may explain the reason of faster concrete words processing. In order to validate the results, we used functional network connectivity distributions (FNCD). Wilcoxon rank-sum test was used to check if the abstract and concrete FNCDs extracted from whole subjects are the same. The result revealed that the corresponding distributions are different which indicates two different patterns of connectivity for abstract and concrete word processing. Also, the mean of FNCD is significantly higher at the time of concrete imagery than that of abstract imagery. Furthermore, FNCDs at the single-subject level are significantly more left-skewed or equally, include more strong connectivity for concrete imagery. Concrete features include features of an object/creature which are more imageable and give information about the physical properties, e.g., the neck of an animal. In contrast, abstract features are less imageable which are related to conceptual features of an object or animal, e.g., kind or cruel animal.There is some evidence which implies that processing of concrete features is faster, more precise, and less vulnerable to brain damage in compare with the processing of abstract features Paivio, . The facFunctional magnetic resonance imaging (fMRI) has been used for many years to study the brain through blood oxygen level dependent (BOLD) changes during various cognitive tasks. fMRI has been used in some studies to extract activated regions during the processing of concrete and abstract concepts and determine the differences between them. Previous studies reported different spatial localizations of abstract and concrete words processing   during concrete imagery affects functional connectivity among brain networks. To this aim, a non-parametric multivariate method based on group spatial Independent Component Analysis is utilized (ICA) . The study was approved by an institutional review board (IRB) of the Institute for Research in Fundamental Sciences (IPM). As requested by ethical committee all participants signed a written consent form prior to the beginning of the experiment session. The participants were instructed to close their eyes in the MRI scanner while they performed visual mental imagery guided by auditory commands given to them (in the Persian language) through an MR compatible headphone.14 healthy volunteers with no history of surgery, neurological or psychiatric disorder participated in the study (nine men and five women age 26.7 SD 1.3014) was significantly higher (p≅0) in compare with abstract words . Each animal name appeared equally often with each type of characteristics and appeared only once with each type of characteristics. Both animals and characteristics were presented in a random order. Figure The fMRI paradigm has two main blocks, and it is similar to the task which has been used in former studies . Functional MR images were acquired using echo planar imaging (EPI) sequence .Both structural and functional images were collected using a Siemens Trio Tim 3 T MRI scanner located in Imam Hospital in Tehran. T1-weighted anatomical images were collected for anatomical registration of the functional data. These images were acquired using a high resolution three-dimensional T1-weighted MPRAGE pulse sequence  toolbox  . As a result, the group spatial ICs were extracted from all subjects. Corresponding to every specific IC, each subject's time courses were extracted using back reconstruction technique  using visual inspection of all 35 ICs and excluded from further analysis.t-test was performed on these pairs of 12 by 1 vectors. There were 23 × (23−1)/2 = 253 connectivities to be tested for significance, so the FDR-adjustment  are spatially independent, but their temporal loadings may have a temporal correlation which is defined as functional network connectivity (FNC). As a result, the amount of FNC which has been proposed by Jafri et al.  could bet-test. This procedure revealed that the connectivity of three pairs (among 253 possible pairs) during the imagery of abstract characteristics was significantly different from that of concrete characteristics. These networks included ICs number 13 and 2 with p = 2.581 × 10−4; ICs number 21 and 8 with p = 1.974 × 10−4; and the ICs number 23 and 26 with p = 4.604 × 10−6 Figure Z>2 threshold. As mentioned before, every component is a functional network. In other words, anatomic regions which have fallen in the specific component are functionally connected. Notably, the connection between all of these three pairs of networks during the mental imagery of concrete characteristics is higher than that of abstract characteristics. This shows that these networks works more coherent during imagery of concrete characteristics than abstract imagery.After calculating an FNC matrix for every subject and for each block of abstract or concrete characteristics, the connectivity of all possible pairs of networks was compared between two conditions using a two-sided paired The boxplot in Figure The purpose of this study was to determine how different would be the functional network connectivity during the imagery of abstract characteristics compared to that of concrete characteristics. Previous imaging and behavioral studies which compared the abstract and concrete characteristics had indicated that the concrete words had been processed faster, remembered easier and learned earlier during development. Several neuroimaging studies have also shown there are specific brain regions (particularly in the right hemisphere) which are activated during concrete word processing with higher activation.t-test was used in order to compare the FNC between all possible combinations of 23 networks to address the doubt of whether the connectivity of the functional networks during abstract imagery is significantly different from that of concrete or not.Functional network connectivity is a method based on group spatial independent component analysis. This method provides a framework to evaluate the interaction between functional networks. Markedly, this method does not use any anatomical information about positions of voxels to infer the functional networks during abstract and concrete mental imagery. As a result, any consistent structure that has been emerged from the analysis must be driven by the structure in the data and not by prior hypotheses about specific functional organizations of abstract or concrete mental imagery or its anatomical parcellation. In this study, the FNC was performed on fMRI data during abstract and concrete word imagery tasks. Following by that, a two-sided paired q = 0.05). Findings suggest the existence of condition-specific functional connectivity pattern and strength which have been concluded based on whole brain group analysis. Specifically, the results indicate that the brain is more coherent during concrete word imagery and this result may explain the concreteness effect. In other words, stronger connections among functional networks could justify faster processing of concrete words in the brain. Figure Overall, findings show that the connectivity between three pairs of functional networks during abstract words imagery in contrast to concrete words is significantly different. Notably, in all cases, the connectivity among network pairs during concrete imagery is much higher . The statistics of word length (number of letters) for abstract and concrete words are .Thus, there was a small difference between the average word length of abstract and concrete words (p = 0.0322). However, it is noteworthy that since the stimuli are presented verbally (by audio) in the native language, number of syllables is more effective (in pronunciation and voice length) than the number of letters (which may be more considerable in written expressions), and number of the syllabus are matched in this study. Thus, the marginal difference in the average number of letters is unlikely to induce effect in brain response. Besides, the frequency of abstract and concrete words has not been compared in a quantitative manner. Nevertheless, the effect of these issues may be examined in the future studies with exactly matched stimuli.In order to compare the brain connectivity between concrete and abstract words, other psycholinguistic parameters are needed to be matched for two blocks in the paradigm. The concrete and abstract words were matched for number of syllables  and connectivity among all possible pairs is compared as well. After FDR correction, no pair with significantly different connectivity survived.To validate the results using an extra statistical baseline, the block of concrete word imagery data is divided into two parts  and the connectivity among all possible pairs is compared. After FDR correction, no pair is found with significant different connectivity. More precisely, all p≅0 indicated that the distributions of functional network connectivity which have been extracted from all subjects are different for the abstract and concrete imagery. One tail paired t-test at the 0.05 significance level was performed to see whether mean of whole brain integration  is higher during concrete imagery compared to abstract or not. Since the sample size of vectors  was relatively big; i.e., 3,036, even a small difference between the mean of the vectors may be significant. This is called practical significant problem, and that is the difference is statistically significant but practically. In order to avoid this problem, a random sample with a size of 500 from each vector was taken, and the hypothesis testing was performed on two resulted sample vectors. One tail paired t-test led to 3.5180 × 10−4p−value, so the null hypothesis is rejected and mean whole brain integration is higher at the time of concrete imagery. The paired t-test on 1, 000 different random samples of FNCD is repeated to check whether the result of the hypothesis testing is biased by the sampling randomness or not. The result shows the p-value is only 5 times higher than 0.05. So, the results are robust and mean of FNCD is higher over concrete word imagery.To validate this claim that the brain is more coherent at the time of concrete imagery, functional network connectivity distribution (FNCD) is evaluated. In the current dataset, there are The functional network distributions of abstract and concrete words imagery have been shown in Figure The distribution of functional network correlations the single subject level are reported in Figure To study the skewness of concrete and abstract FNCD quantitatively and more accurate, the skewness of abstract and concrete FNCD for every subject was calculated using sample skewness which defined as:n is the sample size, m3 the third moment and m3 is sample variance. In this way, two vectors (one for abstract and one for concrete) with the size of 12 × 1 for all subjects were calculated. In order to evaluate whether the concrete FNCDs are significantly left-skewed  compared to abstract, the one tail paired t-test at the 0.05 significance level was applied . This result suggests concrete FNCDs across subjects are significantly more left-skewed or equally more likely to include higher correlations in contrast to abstract FNCD.Where The boxplot in Figure t-test is applied 1,000 times on 1,000 different sample vectors with a size of 500. Result revealed that in 44% of times p < 0.05 . This implies that the difference between average functional network connectivity during abstract 1 and abstract 2 is not significant. The distributions of functional network connectivity for abstract 1 and abstract 2 sub-groups have been shown in Figure Also, a statistical baseline is provided for the whole brain integration analysis. To this aim, connectivity between all networks is calculated for each of abstract 1 and abstract 2 sub-groups which are two vectors with the size of 3,036. Again, in order to avoid practical significance problem, the paired p < 0.05 which means that the difference is not significant. The distributions of functional network connectivity for concrete 1 and concrete 2 words imagery have been shown in Figure This procedure also is performed for the concrete 1 and concrete 2 sub-groups, and just in 9% of times, the As can be seen from the results, the functional connectivity of brain networks is generally higher for imagery of concrete vs. abstract properties. This is consistent with other research which compared the brain activity between abstract and concrete imagery. These papers permutated the order of abstract and concrete blocks  would be a possible research direction. There are various methods including clustering algorithms and seed based methods available in order to study functional connectivity. In future studies, graph theoretical measures can be used to quantify the global pattern of connectivity strength and synchronization among brain networks and compare them between abstract and concrete imagery.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer AA and handling Editor declared their shared affiliation at the time of review.


This study aimed to psychometrically assess the HIV/AIDS items of MICS-6 in the Iranian population in the effort to collect valid and reliable data regarding the Iranian culture.This methodological study is a psychometric assessment of the HIV/AIDS items in the Multiple-Indicator Cluster Survey (MICS) as the AIDS module in MICS Round 6, which includes items on awareness and stigma in people aged over 15 and examines them for their HIV test history. First, the AIDS module was translated into Persian and then translated back into English; subsequently, the psychometric properties of the Persian version were assessed. The face, content and construct validities of this version were also evaluated. The test-retest and internal consistency estimates were also used to determine the instrument’s reliability, and the questionnaire was implemented in 200 samples from the target population as a pilot study.The validity of the instrument was confirmed with a CVR higher than 0.78 and a CVI of 0.79. The exploratory factor analysis was performed to confirm the validity of the five factors of the MICS-6. A high internal consistency was reported with a Cronbach’s alpha coefficient of 0.98 for the questionnaire as a whole and questionnaire has good validity and reliability.The Persian version of the AIDS module of the MICS-6 has satisfactory reliability and validity. The present findings are consistent with the results of other studies on the psychometrics of the international AIDS questionnaire. HIV/AIDS is among the major challenges of the modern era. According to statistics published at the end of 2017, 36.9 million people have been infected with this virus and 940000 have died due to AIDS-related causes in 2017 .At present, promoting public awareness and improving attitudes (in the 15–49 age group) with regard to the prevention of AIDS and increasing the percentage of young men and women who are fully aware of the routes of HIV transmission and do not accept any misconceptions about AIDS/HIV prevention are part of the national commitments and priorities of the AIDS programs established by the Ministry of Health and Medical Education .In response to the weaknesses existing in the current health information systems of countries, and in particular third-world countries, standard surveys have been designed, and the Multiple-Indicator Cluster Survey (MICS) is among these tools. The UN Children’s Fund has implemented the MICS since 1996 in six rounds and in more than 60 countries. Iran’s Multiple Indicator Demographic and Health Survey (IrMIDHS) has been carried out in Iran in 2010 and 2015 using the full scientific and executive capacity and potential of the country. The major indicators of the MDGs, regarded as the country’s international obligations, were prepared and reported based on these studies ,8. IrMIDIt is therefore essential to methodologically study the HIV/AIDS-related module of the IrMIDHS (containing items on awareness and stigma) in people aged 15 and over based on the Iranian culture. The present article showed the process of localization and psychometric assessment of this instrument for the measurement of DHS.The data collection tool used in this study was MICS-6. The English version of the questionnaire consists of 36 items about AIDS and has been developed to assess three areas, including awareness, stigma and the HIV test history throughout life. The items are answered with ‘yes’, ‘no’, or ‘I do not know’. MICS-6 is interpreted using the instructions given in relevant sources . The AIDFirst, the AIDS module of MICS-6 was translated into Persian. After the confirmation of the initial translation by the research team, the Persian questionnaire was distributed among an English-speaking person for re-translation into English. After receiving the English translation of the questionnaire, the two English versions were compared and the preliminary mistakes in translation and retranslation were resolved and the final Persian version was prepared for submission to experts and for the other psychometric steps.Quantitative and qualitative methods were used to determine the face validity of this questionnaire . For theTo determine the CVR, the questionnaire was sent to 15 experts asked to examine and score each item based on a three-part scale (ranging from ‘necessary’ to ‘unnecessary’). The CVR was then calculated based on the formula and its numerical value was determined using Lawshe’s table   .In the pilot study, all the 200 samples participated in the pilot psychometric study, including 104 female (52%) and 96 male (48%) samples, 141 married (70.5%) and 54 single samples (27%) and five widows/widowers (2.5%). The mean age of the subjects was 46.5 yr with a standard deviation of 15. Totally, 108 were employed (54%), 29 (14.5%) had incomes without a job, 29 (14.5%) were housewife, 24 (12%) were students and the rest did not fit into any of the categories.The present study was a psychometric assessment of the HIV/AIDS items of MICS-6 in the Iranian population and aimed to offer a standard, native and reliable questionnaire using the views of the target group and an expert panel and has used scientific psychometric methods to determine the reliability of the questionnaire. No articles were obtained on the psychometrics of the AIDS module of the MICS-6 in Iran or other countries with which to compare the present findings. In Iran, most research on AIDS-related awareness and stigma has been conducted with researcher-made tools and it is not possible to discuss them in this study due to their non-compliance with the required standards; for instance, the target group has been ignored in some surveys, the data provided in most of the studies are ambiguous and inadequate and the number of participants in the expert panel is considered low . NeverthSince most studies on the subject have not used a standard tool and have failed to assess the various dimensions of awareness and stigma regarding AIDS and have yielded incorrect data, it is impossible to make a cross-cultural comparison of the subject. The need for a native tool to measure public awareness and attitudes (in the 15–49 age group) regarding the prevention of AIDS is more pressing than before, and AIDS policy-makers should target the promotion of awareness and the elimination of stigma on this subject in different areas. The present study was therefore designed for the psychometric assessment of the AIDS module of MICS in Iran. This questionnaire is a standardized tool for assessing the dimensions of awareness and attitude toward HIV infection with factors including sexual transmission, non-sexual transmission, prevention, test history and stigma, and if localized, can be used as an appropriate tool in different cultures and communities. The limitations of this research include the difficulty of access to male samples for completing the questionnaire.The Persian version of the AIDS module of MICS-6 has appropriate reliability and validity. Use of present questionnaire with approved validity and reliability helps us to avoid re-perform a national study with heavy costs imposed on the health system and health policy-makers and facilitates the collection of accurate national data that can be compared with global data. Other modules of MICS-6 are recommended to also be psychometrically assessed and validated for applying in Iranian population.Ethical issues  have been completely observed by the authors.


A feature extraction methodology based on lamb waves is developed for the non-invasive detection and prediction of the gap in concrete–metal composite structures, such as concrete-filled steel tubes. A popular feature extraction method, partial least squares regression, is utilised to predict the gaps. The data is collected using the piezoelectric transducers attached to the external surface of the metal of the composite structure. A piezoelectric actuator generates a sine burst signal, which propagates along the metal and is received by a piezoelectric sensor. The partial least squares regression is performed on the raw sensor signal to extract features and to determine the relationship between the signal and the gap size, which is then used to predict the gaps. The applicability of the developed system is tested on two concrete-metal composite specimens. The first specimen consisted of an aluminium plate and the second specimen consisted of a steel plate. This technique is able to detect and predict gaps as low as 0.1 mm. The results demonstrate the applicability of this technique for the gap and debonding detection in concrete-filled steel tubes, which are critical in determining the degree of composite action between concrete and metal. Concrete-metal composite structures, such as concrete-filled steel tubes (CFSTs), constitute critical components of civil infrastructure such as columns, piles, bridge piers, railway decks and roofs . These cLamb wave techniques are conventionally used in different non-destructive testing applications ,11,12,13Various physical- and statistical-based techniques have also been used to extract damage sensitive features from lamb waves . One comMishra and Vanli  have useThe manuscript is organised as follows: Principle component analysis (PCA) is a popular multivariate statistical analysis method for dimensional reduction, which works by reducing the correlation between the variables. The transformed variable the data . PartialY. The variables in W, and then considers the linear regression model X [The chief objective of PLSR is to build a linear model art of X . The loalgorithm . The detIt should be noted that it is possible to estimate as many partial least square components as the rank of original matrix The instrumentation system consisted of two piezoelectric transducers, signal generation and data acquisition unit and a computer as shown in A reference signal was taken where the metal was directly touching the concrete block without any gap. Then, signals were obtained at gap values of 0.1, 0.2, 0.3 and 0.4 mm. Thin paper sheets were used to create desired spacing between metal and concrete. The gaps were measured using a Vernier calliper. Multiple measurements were taken at the reference position and at each gap, which was then averaged and the standard deviation was calculated. The PLSR regression was carried out on the raw signal to extract features and determine a relationship between the signal and the damage (gap) size.A photographic image of the experimental setup to detect the gap between the metal plate and concrete block is shown in The five-tone burst actuation signal is shown in A five-fold cross-validation was performed to measure the mean squared error of PLSR with different numbers of loading vectors. It can be seen from The gaps were predicted during different concrete curing stages using the aforementioned PLSR technique. The maximum standard deviation of the received signal at all gaps was determined to be 0.37. The higher standard deviation in some of the received signals was mainly due to the non-planarity of a metal plate. The predicted gaps vs. the actual gaps at 6 h, 24 h, 5 days and 28 days after concrete casting are shown in n is the number of points, x is the actual gap and y is the predicted gap at different stages of concrete setting.Next, the gaps were predicted in the composite structure composed of steel plate and concrete. The measurements were taken from fresh concrete (0 h) until 28 days at different stages of the concrete setting. The average standard deviation of the received signal at all gaps was determined to be 0.11. A PLSR-based method for the prediction of the gap in concrete-metal composite structures was proposed for the first time in this paper. This research expanded on previous principal component regression-based studies, wherein a more robust partial least squared regression-based method was utilised. This technique served a dual purpose of feature extraction and noise reduction. The developed technique utilised a single actuator and a single sensor attached to the external surface of the metal for non-invasive detection and prediction of gaps and debonding in composite structures. A gap width as small as 0.1 mm was predicted in concrete-based composite structures, with varying metal thickness. The detection and prediction of such minute gaps at an early stage enable one to take precautionary measures, preventing catastrophic failure of the structure. Moreover, the proposed technique can be utilised to detect debonding and delamination in diverse composite materials.


This study is focused on the experimental investigation of compressive strength and durability properties of lightweight concrete mixtures with fine expanded glass and expanded clay aggregates using different microfillers. The paper proposes the relationships between the compressive strength and density of concrete mixtures with different proportions of the lightweight aggregates mentioned above. The performed experimental studies have revealed the tendencies of possible usage of different amounts of fine lightweight aggregates and their combinations in the production of concrete mixtures depending on the demands of practical application. Following the requirements for structural concrete subjected to environmental effects, durability properties  of the selected concrete mixtures with expanded glass aggregate were studied. The results of the experimental investigations have shown that durability of tested concrete specimens was sufficient. The study has concluded that the mixtures under consideration can be applied for the production of structural elements to which durability requirements are significant. Over the past few decades, the increased use of lightweight concrete for the structural elements of tall or long-span buildings has become a more and more important aspect in the modern construction industry. Lightweight aggregate concrete (LWAC) is not a new material. For many years, traditional aggregates  have been replaced in concrete mixes with lightweight natural or human-made materials, or byproducts . HoweverThe strength of the concrete mixture depends on the properties of the applied aggregate and cement mortar matrix. One of the ways to increase the strength of concrete is to use a fine aggregate in a concrete mixture by completely replacing the coarse aggregate. This is commonly used in production of high- and ultrahigh-strength concrete mixtures . The app3 and 23–60 MPa [3 and 23.3–30.2 MPa [The results achieved after many years of research in this field have shown that expanded clay is one of the most useful aggregates for the structural concrete . Density3–60 MPa , respect3–60 MPa ,14 has b3–60 MPa . However30.2 MPa , respect30.2 MPa , up to f30.2 MPa  and ensuThe essential differences between expanded glass and expanded clay are due to their granulometry. In order to obtain a finer fraction of the expanded clay, it needs to be crushed. The use of crushed expanded clay aggregate (ECA) in the production of a concrete mixture is accompanied by higher water amount as well as a decrease in workability of the mix . With in2/kg) more than halves the expansion due to the alkali–silica reaction (ASR) [3 were produced and tested in order to determine ASR using a method similar to ASTM 1260 (1 M NaOH at 80 °C for 14 days) [3 did not meet the requirements for its relative expansion even using Aalborg white CEM I 52.5 R with Naeq—0.13%. Structural damage related to ASR is not characteristic of LWAC with the expanded clay aggregate. As can be seen, the ASR problem exists in products with EGA and Portland cement, and may occur differently in concrete of different composition or density.From the point of view of durability of concrete, the alkali–silica reaction (ASR) represents one of the most important damaging mechanisms resulting in significant maintenance and reconstruction costs . ASR occon (ASR) . Tuaum eon (ASR) . Similaron (ASR) ,25,26 th14 days) . The RILAnother aspect related to the durability of LWAC is the freeze–thaw resistance. The strength and water absorption properties of LWA can have a significant impact on the strength and freeze–thaw resistance of LWAC and is worse than that of normal-weight concrete . Jones aIn the present research, the investigation of lightweight concrete mixtures with fine expanded glass and expanded clay aggregates, as well as different microfillers such as silica fume and ground quartz sand, was carried out. The aim of the work was, first, to find out the relationships of the compressive strength and density using the low-fraction (0.5–1 mm) expanded glass aggregates and compare them with those obtained using expanded clay aggregates of larger fractions (2–4 mm) commonly used for structural lightweight concrete; then, to combine expanded glass and clay aggregates in various proportions while maintaining the uniform composition of the matrix mixture, and to observe the effect of proportions on compressive strength, density, and lightweight aggregate distribution in the mixture; and then to determine the influence of the expanded glass aggregate on the durability properties of the concrete mixture—alkaline corrosion and freeze–thaw resistance. The performed research is an additional step toward the development of lightweight concrete mixtures in order to increase their sustainable application in the construction industry.Cement:3; fineness (Blaine)—490 m2/kg; compressive strength after 28 days—61.1 MPa., K2O—1.07%, Na2O—0.10%.CEM I 52.5 R: density—3150 g/cmFine aggregate:washed sand (S) fraction 0/4;expanded glass LWA (EGA) fraction 0.5/1;expanded clay LWA Leca-S (ECA) fraction 2/4.Microfillers:2/kg; density—2605 kg/m3;ground quartz sand (GQS); fineness (Blaine)—479 m3; chemical composition (% by mass): SiO2—96.06; Al2O3—0.20; Fe2O3—0.05; C—0.60; CaO—0.25; MgO—0.40; K2O—1.20; Na2O—0.10; SO3—0.35.silica fume (MS), density—2216 kg/mSuperplasticizer:superplasticizer based on polycarboxylate ester —liquid;superplasticizer based on polyethylene glycol (No S2)—powder.Main characteristics of materials used in this study are presented below:The characteristics were obtained using techniques of the following standards: bulk density of LWA was determined according to LST EN 1097–3 , water al capacity Hobart-type mixer . Mixtures were produced in the following sequence. At the initial stage, all the necessary materials were weighed. Then, all components and powdery superplasticizer were added to the mixing vessel. Afterward, water and liquid superplasticizer were gradually added, following with further mixing to obtain a homogeneous consistency. The prepared mixture was poured into standard shape steel forms (70 mm × 70 mm × 70 mm) without additional vibration. The specimens were then covered with a film and cured for one day. After a day, the specimens were demoulded, put into polyethylene bags, and cured for 28 days in a chamber at 20 ± 1.0 °C and 95% relative humidity. During the test, 120 samples were formed in total.All concrete mixtures were mixed using a 12 Prisms were taken out of the chamber after 28 days of casting, their dimensions were measured, and the weight was fixed. The compressive strength of the specimens was determined by the compression-testing machine ALHPA-3–3000 S using at least four specimens and having taken their average values. The loading speed used in tests was 2400 N/s. The density of the air-dried specimens was determined by dividing the resulting weight from the volume calculated according to the measured specimen sizes. The density was determined according to the average density of the measured individual specimens.Alkaline corrosion of concrete samples was analysed using RILEM recommendations , while fThe research program was divided into two different stages. The effect of fine EGA on the structural LWAC density and compressive strength was investigated during the first stage. The results obtained were compared to ECA mixtures. The composition of the mixtures under consideration as well as the compressive strength and density of concrete after 28 days of curing are presented in 3. In mixtures with ECA, the compressive strength of LWA after 28 days varied from 43.8 to 109 MPa, and the density from 1588 to 2302 kg/m3. The compressive strength and density relationship of all specimens after 28 days of hardening is presented in The obtained results have shown that in BG mixtures with EGA, the compressive strength after 28 days of curing varied from 39.5 to 101 MPa. Accordingly, depending on the amount of replaced sand, the density varied from 1458 to 2278 kg/m3). When a W/C ratio is low and the amount of LWA increases, the rheological properties of concrete have a tendency to change. As shown in It can be seen from 3 and compressive strength classes [As can be seen from  classes  between 3. When comparing the influence of different LWAs and their possible combinations on the compressive strength and density in the reference mixture EGA0, lightweight aggregate was only expanded clay. In other mixtures (EGA5–EGA100) 5, 10, 20, 25, 50, 75, and 100% of the expanded clay were replaced with expanded glass. The numerical value of the specimen code provided in The unique research was carried out during the second stage. Expanded glass and expanded clay aggregates were mixed: the same total volume of LWA in a mixture was maintained and their interproportions were changed. The diameters of LWA used in the research differ approximately 4.0 times and the EGA 0.5/1 can fill the spaces between ECA 2/4. Their use together is a viable way to reduce the LWAC density and amount of cement. The composition of mixes with combined LWA is presented in cEGA0/fcEGA5...100f and density ρEGA0/ρEGA5...100 are shown in cEGA0f corresponds to the compressive strength of the concrete mix with ECA only and was taken as a reference value, whereas cEGA5...100f refers to the compressive strength of mixtures with an appropriate amount of EGA (from 5 to 100%); ρEGA0 is the density of the concrete mix with ECA only (reference density) and ρEGA5...100 is the density of mixtures with an appropriate amount of EGA.The relationship of the compressive strength and density for mixes with different amounts of ECA and EGA are presented in 3 to 1796 kg/m3 (5.6%) and compressive strength from 42.7 MPa to 53.6 MPa (25.5%). The slight increase in density can be explained by the addition of a small amount of EGA . The spherical-shaped EGA particles behave like bearings that reduce friction between rough-surface ECA that, in turn, reduces viscosity of the mixture. Due to this, the entrained air during mixing escapes easier, which might assist in formation of a denser matrix. Addition of a small amount of EGA makes LWA packing tighter, which might also affect the internal curing process due to more evenly distributed water in the matrix. On the other hand, smaller particles of the aggregate could fill the pores contained in the mixtures, resulting in a higher-density mixture. However, it should be noted that a relatively slight increase in density is offset by a significantly higher compressive strength. Subsequently increasing the amount of EGA up to 25% in the mixture, the density of the reference mixture EGA0 and the EGA25 mixture becomes equal and the compressive strength varies very slightly . A further increase of the amount of EGA in the mixture leads to a reduction in the strength and density of concrete. By increasing the EGA content in the mixture up to 50%, the compression strength decreases to 40.7 MPa (4.7%) and density decreases to 1680 kg/m3 (1.2%). In a mixture with 100% of EGA, the compressive strength decreases to 35.1 MPa (17.8%) and density to 1590 kg/m3 (6.5%). Since the total volume of LWA has not changed, the decrease in density occurs due to the decrease in the LWA weight with an increase of the amount of lower-density EGA in composition. Intermediate values of the compressive strength and density were obtained for the remaining mixtures.The results above show that having replaced 5% of the ECA volume by EGA (sample EGA5), the density of LWAC increased from 1700 kg/m3, which is 7% lower than the reference mixture of EGA0. In order to use mixtures with EGA for real structures, the durability properties, and in particular, alkali corrosion resistance, must be further evaluated. The research results of the durability of mixtures are presented in Chapters 4 and 5.Experimental studies of mixtures using different fine LWAs and their combinations have revealed the following trends. When concrete is used for a structural application that demands a higher compressive strength rather than a lower density, mixtures of EGA5, EGA10, and EGA20 may be used for the production of such concrete replacing ECA with EGA by 5, 10, and 20%, respectively. The compressive strength of these mixtures varies from 48 to 54 MPa, while the relative strength ranges from 1.12 to 1.26. When the compressive strength is not important, and the decisive factor is density , fine EGA is used as a lightweight aggregate in LWAC mixtures. The research results showed a density of 1590 kg/mPlacement in the matrix may vary when different LWA fractions are used. The structural analysis of samples using the MOTIC K-400 L digital microscope  with a video camera Pixera VSC was performed additionally to evaluate this effect. Samples EGA0 b,c reduc2Oeq in cement. It is calculated according to the formula: Na2Oeq = Na2O + 0.658 K2O [2Oeq = 0.10 + 0.658 × 1.07 = 0.804% (mass of cement). Two mixtures with ground quartz sand microfiller from the first stage of the study  properties of the selected mixtures was carried out. The ASR intensity in concrete depends on many factors, but the key parameter is the amount of Na.658 K2O . Low-alkhe study  were use2Oeq [2Oeq = 0.804%). In the present study, the mortar prisms (40 mm × 40 mm × 160 mm) were cast using the technique presented in Chapter 2. After casting, the prisms were stored for 24 h at 20 °C temperature and 95% relative humidity. After demoulding, the prisms were stored for 24 h in water at 80 °C. Afterwards, their initial length was measured. Three prisms were then submerged in the 80 ± 2 °C 1M NaOH solution for 28 days. The recommended duration of ASR tests is 14 days [The potential ASR in concrete was investigated using the accelerated mortar bar test and the RILEM AAR-2 method . No addi2Oeq  were not 14 days ; due to  14 days . RILEM [ 14 days  additionThe changes in the length of the prisms, determined experimentally, are shown in 2Oeq = 0.804%), LWAC specimens with fine EGA are affected by the ASR process to the same degree as the NWC specimens with sand aggregate. The studies carried out confirm that EGA in the LWAC mixtures can be applied without limitation related to ASR. Due to the lower EGA content, the same should apply to other LWAC mixtures analysed in this research.Data on the change in the length of the prisms show that after 28 days of testing, the limit value of elongation obtained experimentally for both mixtures ~0.045% does not exceed the threshold value of 0.075% recommended by RILEM  , the number of cycles increased the compressive strength evenly by 7.92%. The strength of control specimens with sand aggregate was 20.6% higher for mixtures with MS microfiller (B2) compared to mixtures with GQS (B1). This ratio slightly increased during freeze–thaw cycles. The strength of the B1 specimen has increased by 15.9% after 100 cycles of freezing compared to control specimens. Studies have shown that the durability of LWAC mixtures with expanded glass aggregate after 100 freeze–thaw cycles has been sufficient and can be applied for the production of structural elements  to which these effects are relevant.It was shown that in the case of the same composition of the cement matrix  and the same total volume of aggregates (sand and LWA), the compressive strength and density relationships for different mixes are practically the same. However, in the specimens with EGA, the GQS microfiller slightly increases the effect of density on the compressive strength. The latter effect is caused by the difference in the particle size of GQS and MS, resulting in different rheological properties of the mixtures under a constant amount of water. In this case, GQS microfiller is more effective than silica fume microfiller.3 to 1796 kg/m3). This increase in density could be due to the reduced viscosity of the mixture caused by the small amount of EGA that, in turn, might affect the internal curing process due to more evenly distributed water in the matrix. On the other hand, smaller particles of the aggregate could fill the pores contained in the mixture resulting in a higher density.Having replaced 5% of the ECA volume by EGA, the compressive strength has increased by 25.5% (from 42.7 MPa to 53.6 MPa) with a slight (up to 5.6%) growth in density of LWAC  were affected to the same extent by the alkali corrosion test as the reference NWC specimens having the same cement. After 28 days of testing, the same elongation of 0.045% was obtained for both LWAC and NWC mixtures, the elongation being below the threshold value of 0.075% as recommended by RILEM.Specimens made of fine EGA and low-alkali cement (NaIt was shown that the durability of LWAC mixtures with EGA after 100 freeze–thaw cycles has been sufficient. The compressive strength of samples with EGA after the frost resistance test increased by 7.9–8.8% compared to the strength before the test.


Antimicrobial stewardship program (ASP) is a distinguished method to improve the prescription and efficacy of antibiotics.The efficacy of ASP and conventional methods was compared to measure the effectiveness of meropenem (MPM) and vancomycin (VMN) antibiotics in pediatric patients.In an interventional quasi-experimental study, 135 children admitted in Children’s Hospital affiliated to University of Medical Sciences in time periods of 2014–2015 and 2015–2016 were assessed.t test, and Fisher’s exact test.The conventional and ASP methods in 2014–2015 and 2015–2016 were respectively utilized to provide the best antimicrobial therapy of MPM and VMN antibiotics in patient children. The data of mortality rate (MR), antibiotic prescription (AP), antibiotic dose (ADe), antibiotic duration (ADn), length of hospital stay (LOHS), and blood cultures (BCs) were compared across the years using the Chi square, independent The levels of MR, AP, ADe, ADn, LOHS, and positive BCs using the ASP method in 2015–2016 were significantly lower those of in 2014–2015 using the conventional one (p < 0.05).The ASP method versus conventional one with a better efficacy can be employed as an antibiotic administration guide for MPM and VMN in the therapy of patients in community-based hospitals. One of the most common therapeutic agents or active pharmaceutical ingredients prescribed in healthcare and medical services is antimicrobial drugs . It was There are several well-known ways to decrease the antibiotic resistance such as hand washing, disinfection of hands and hospital tools, prompted laboratory tests, continuous medical education, vaccination, preparation of antimicrobial resistance files, and use of antimicrobial stewardship program (ASP) method , 8. The The risk of antibiotic resistance versus the beneficial utilization of antibiotics should be balanced . The rouPublished literatures in pediatrics earlier demonstrated the optimistic effect of ASP implementation on the use of antimicrobial agents –31. HoweIn this interventional quasi-experimental study, 135 children  under treatment with MPM and VMN antibiotics in Children’s Hospital affiliated to University of Medical Sciences were eventually evaluated. The initial number of participants was 166. However, infants with a low birth weight or a LOHS lower than 1 week, birth at medical facilities other than NICUs, and having major congenital anomalies were excluded because most out-born infants after the first week of life were transferred and received variable nutritional feedings. In addition, several charts were missing key information, such as birth weight or discharge weight. Other exclusion criteria in this research were children referred to the surgery department and/or received antibiotics for prophylaxis. In general, 31 out of 166 people were excluded from the current study and , infection preventionists (IPs), clinical microbiologists, and two data scientists. From Saturday to Thursday, the ASP team officially inspects the primary instructions and applies daily and weekly usage arrangements of MPM and VMN. These antibiotics were purposefully prescribed according to the antimicrobial susceptibility patterns of clinical isolates or type of antibiotic-resistant infections, misapplication risk, and medical expenses. Besides, the ASP protocol incorporated pharmacist notification by personnel of clinical microbiology laboratory. After generating the real-time data collection, pharmacists present in the ASP team assessed each the documented order by evaluating the patient’s electronic medical record, subsequently issued some of key decisions/consultations after open communication with specialist physicians and sent a feedback to providers in terms of answers like stop, approve, and use of a sole antibiotic with a less/more dose.An electronic and validated checklist including demographic  and disease-related data were filled out for each patient and recorded in the pharmacy database. Clinical data included intensive care unit admission, disease type and intensity, antibiotic consumption history (such as receipt of past antibiotic therapy), ADe, ADn, LOHS, mortality, adverse effects, and results of bacterial cultures in MPM and VMN treatments, recommendations introduced by the ASP team about antibiotic prescription (AP) with a certain ADe, and patient’s agreement rate with consultations. The time difference (in day) between patient’s admission and discharge dates was considered as LOHS. The efficiency of used antibiotics against urinary tract infection (UTI), respiratory tract infection (RTI), and cerebrospinal fluid infection (CSFI) was respectively examined by the urine, tracheal, and cerebrospinal fluid (CSF) standard cultures. Gram staining from positive blood cultures was conducted to diagnose whether bacterial infections induced by Gram-positive cocci or by Gram-negative bacilli. The UTI was recognized from the clinical charts of all pediatric patients with substantial amounts of pathogens isolated in blood cultures. The UTI confirmation was also performed by checking their records to find the same pathogen in the urine and blood cultures, with pyuria by dipstick or sedimentary urine analysis and/or clinical symptoms  . The diat-student test and Chi square (χ2) or Fisher’s exact tests were performed to assess between-group differences for numerical and categorical variables, respectively. The significant level was set at p < 0.05.The data were statistically assessed using the analysis of variance (ANOVA) with SPSS software package, version 13.0 . The independent Figure The overall count of antibiotic prescriptions issued for the studied pediatric patients in time periods of 2014–2015 and 2015–2016 is given in Table Clostridium difficile with a reduced daily consumption dose (25.4%) and medical costs (15.2%). In the current study, the total dose of MPM and VMN was also reduced, but the calculation of costs was impossible.The ASP method is a comprehensive approach to reduce the burden of the antibiotic resistance problem. This method as a practical strategy can notably improve the pattern and amount of antibiotic prescriptions in different hospital wards . In thisSimilar to results of our study, Morril et al.  reportedIn conclusion, because the ASP compared to the conventional method showed a superior effectiveness for MPM and VMN antibiotics, a culture-guided ASP is seriously proposed to community-based local hospitals owing to the assurance of implementation and performance of a proper antimicrobial therapy. A significant reduction in antibiotic consumption also can highly promote patients’ satisfaction and their expectations by decreasing medical costs and long-term disability for patients. Although the present research was limited by its quasi-experimental design, the obtained results in pediatric patients along with the evaluation of care quality can be verified by conducting further studies with larger sample size and multi-center sampling. Furthermore, the efficiency and satisfaction with the available ASP may potentially improve the therapy optimization by incorporating a prospective audit-and-feedback intervention.


Sulphate corrosion of concrete is a complex chemical and physical process that leads to the destruction of construction elements. Degradation of concrete results from the transportation of sulphate compounds through the pores of exposed elements and their chemical reactions with cementitious material. Sulphate corrosion can develop in all kind of structures exposed to the corrosive environment. The mechanism of the chemical reactions of sulphate ions with concrete compounds is well known and described. Furthermore, the dependence of the compressive strength of standard cubic samples on the duration of their exposure in the sulphate corrosion environment has been described. However, strength tests on standard samples presented in the scientific literature do not provide an answer to the question regarding the measurement methodology and actual distribution of compressive strength in cross-section of reinforced concrete structures exposed to sulphate ions. Since it is difficult to find any description of this type of test in the literature, the authors undertook to conduct them. The ultrasonic method using exponential heads with spot surface of contact with the material was chosen for the measurements of concrete strength in close cross-sections parallel to the corroded surface. The test was performed on samples taken from compartments of a reinforced concrete tank after five years of operation in a corrosive environment. Test measurements showed heterogeneity of strength across the entire thickness of the tested elements. It was determined that the strength of the elements in internal cross-sections of the structure was up to 80% higher than the initial strength. A drop in the mechanical properties of concrete was observed only in the close zone near the exposed surface. There are considerable quantities of effluents generated in chemical laboratories with varied pH, which is the measure of acidity or alkalinity of an aqueous solution. Neutral solutions have a pH of approximately 7.0. Neutralisation of effluents is performed by mixing acidic and alkaline compounds  and by adding acidic or alkaline reagents. This takes place in various types of tanks. For neutralisation of laboratory effluents, reinforced concrete tanks are also used. The ratio of acidity and alkalinity is a critical factor in the chemistry of concrete . The comIn the literature, one may encounter the opinion that after 1989 the quality of reinforced concrete structures in Poland improved radically , but proConcrete corrosion not only affects laboratory tanks but develops in all kind of structures. Concrete durability is the constant subject of challenges in the fields of science, design and workmanship ,6. As a Recent studies on sulphate corrosion of concrete are mainly focused on the mechanism of the chemical reactions of sulphate ions with the concrete compounds ,14,15,162, the main reactant of the process  to the surface area of cross-section A [mm2] (6):The examined borehole materials were cut into samples of length equal to their diameter. Boreholes were cut thus obtaining samples with ϕ = h = 10.3 cm and ϕ = h = 5.0 cm. The strength of samples with ϕ = h = 10.3 is equivalent to the strength tested on cubic samples, side 15 cm ,41,42. Tcf [N/mm2]-passing wave velocity LC [km/s] according to the methodology described in the literature , x is a mass of SO42− in the tested sample of material.In order to confirm the salt formation in the concrete, a colorimetric semi-quantitative method has been used with the use of Merck test strips. Then, in order to determine the distribution of sulphate salts forming along the ultrasonic measurements, a gravimetric quantitative method has been used ,47,48,49Concrete samples were taken from the walls and ceiling in order to determine salt content. It turned out that chlorides were available in the concrete in acceptable quantities (maximum in sample 1–0.085% of weight of the concrete), sulphates in high quantities above 1.2% by weight of the concrete. No nitrates or nitrites were found in the concrete. In the next step quantitative determination of sulfates using gravimetric method has been undertaken. Tests have been performed on the internal surface of the tank walls, and across its thickness, at distances of 20, 50 and 100 mm from the surface under sulphate attack. Quantity of the sulphates has been calculated with use of the Equation (7). The results of the analysis are presented in 42− has been examined in the zone near the inner wall surface (above 1.52%), at a depth of 20 mm SO42− percentage concentration was 1.35%, reaching 0.55% at a depth of 50 mm and 0.31% at a distance of 100 mm from the inner tank wall surface.Performed quantitative analysis of sulphates on the thickness of the tested samples indicates their deep penetration and concentration in the entire cross-section of the walls. The highest concentration of SOSince the distribution of compressive strength across the thickness of reinforced concrete structures subject to sulphate corrosion from one side had not been tested so far, the authors performed such measurements using the ultrasonic method. In order to investigate the actual condition of concrete corrosion in the walls, three boreholes were made. The borehole location chosen was below the ceiling slab but in a manner ensuring that effluents did not overflow. The first and second borehole were made at the distance of 50 cm from the top wall edge, and the third borehole at the height of the top wall edge. Borehole No. 1 was of diameter 103 mm, and 2 & 3 diameter 50 mm. It was noted that on borehole No. 1 reinforcing meshes had moved towards the internal surface. For this reason, the thickness of lagging was reduced down to 10 mm and as a result of corrosion in the tested location 8 mm of concrete were missing, only a protective layer 2 mm thick  remainedcf is the compressive strength of concrete [N/mm2], and LC is the ultrasound longitudinal wave velocity [km/s]. The results of destructive tests, measured pulse velocities and strength values calculated with use of Equation (8) are presented in After the measurements of ultrasonic pulse velocities of the tested samples they have been cut and tested in uniaxial loading on strength machine. On that base a hypothetical scaling curve with the following Equation (8) was chosen:In this way, scaling curves established hypothetically were used to convert the rate of ultrasound wave in the given cross-section at the borehole height into concrete compression strength in this cross-section.t [μs], calculated wave velocities LC [km/s] and compressive strengths cf [N/mm2] in planes parallel to the surface of the boreholes are presented in Passing times The dependencies of compressive strength as a function of depth for the borehole No. 1 are shown in Similar tests were performed on boreholes No. 2 & 3 which broke and reinforcement was not cut, hence their length is less than the thickness of the tank wall. The results of tests performed on borehole No. 2 are shown in Core no 2 was broken at the reinforcement mesh at a depth of 75 mm from the external surface of the wall. On the tested (not damaged) fragment of the core the growing dependency of strength as a function of depth was established. The results from Results of tests performed on borehole No. 3 which was also broken in the middle of the tested section are shown in Core No. 3 was cracked at the reinforcement at a distance of 60 to 80 mm from the external surface of the wall. For this reason the tests were not performed in this part of the core. On the tested (not damaged) fragment of the core the growing dependency of strength as a function of depth was established. The results from The method of measuring ultrasonic wave velocity using spot heads presented in this paper allowed determination of the distribution of strength in the cross-sections of reinforced concrete elements exposed to sulphate corrosion . The observations presented in this study show that the compressive strength of concrete subjected to a gaseous, aggressive, sulphuric environment is variable across its thickness. Concrete strength is variable across the wall thickness, however initially it was expected that by moving towards the tank interior, the strength would decrease, and from all boreholes the growing dependence was obtained, what has been shown in 2 in the cross sections near the external, unexposed wall layers to 55 and 72 N/mm2 in the internal (exposed) cross sections of the walls. For the tested samples, this gives an increase in strength of 44% to 83% from its initial strength measured in the cross sections near the unexposed side of the structure. Sulphuric acid ions react with the cement compounds and the formation of gypsum leads to an increase in volume [Values of compressive strength of the samples taken from the tank walls show an increase in strength from 30–43 N/mmn volume ,18,50. Nn volume ,52,53. TUltrasound testing methodology allowed determination of the distribution of strength as a function of depth of concrete elements under sulphate attack.The compressive strength of the concrete exposed to sulphate attack from one side is variable across its depth.The experimentally tested distribution of compressive strength at the depth of the elements showed an upward trend in the entire cross section towards the surface subject to corrosion.A decrease of strength appears only in the destroyed, crumbled zone of the concrete structure. The destroyed zone of tested elements did not exceed a depth of 10 mm from the surface exposed to sulphates attack.In the presented research, the difference in concrete strength between cross sections near the exposed and unexposed sides varied from an increase of 44% (borehole No. 3) to 83% (borehole No. 1).2/24 hours, are important parameters characterizing anticorrosive coatings. Chemical resistance to various acids, alkalis or other compounds is tested for the specific aggressive compound at a given level.The performed tests indicate that gases may be a more corrosive environment, especially with high humidity, than liquids, therefore the coefficients of diffusion resistance or other permeability parameters, e.g., g/mIn the tested tank, sulphur-containing gas (hydrogen sulphide) easily penetrated through the thin bituminic layer, based on the measurements at a thickness of 0.97 mm, and in contact with cement and lime formed sulphates, considerable quantities of which were found in the concrete.Since the lagging thickness had decreased already down to 2 mm, danger exists not only for the concrete but also for steel. The rate of concrete corrosion in the tank is probably influenced by the concentration of the gases above the liquid. If the tank had a properly built gravity ventilation, the concrete damage process would be much slower, because relative air humidity in the tank would also be much lower with effectively running ventilation.Based on the case study and its analysis presented in this article, the following conclusions can be made:


This paper presents a concept of a Self-sensing Carbon Fiber Reinforced Polymer (SCFRP) system, which integrates the piezoceramic transducers with the common concrete strengthening materials, CFRP fabric. This integration provides the SCFRP fabric with the ability to monitor the structural health condition when the SCFRP fabric is applied on reinforced concrete structures. In order to validate the feasibility of this system, several three-point bending beam (3PBB) specimens were fabricated and tested before and after the specimens were reinforced with the proposed SCFRP fabric. In addition, the specimens with the low (C25) and high (C40) concrete grades were also experimentally investigated to evaluate the reinforced effectiveness of the SCFRP fabric. Finally, the experimental results demonstrate that the proposed SCFRP fabric can significantly improve the bearing capacity of the concrete structures, and provided the reinforced concrete structures with an ability of self-sensing their health condition. In recent years, various Fiber Reinforced Polymers (FRPs) have received much attention in the broad engineering community ,2,3,4. AThe use of CFRP offers civil engineers an attractive solution to structural strengthening. Compared to other conventional strengthening techniques, CFRP has the advantages of light weight, high mechanical strength, high resistance to corrosion, high durability, convenient in-situ application and nearly no influence on the structure ,14,15. EHowever, for the reinforced concrete structures, how to evaluate the strengthening quality and the subsequent working status of the CFRP-strengthened structures still faces lots of challenges during their service period. In recent years, increasing interests has developed in the adoption of smart sensing technologies for instrumentation within a variety of structural systems. For the intermediate crack debonding in FRP strengthened reinforced concrete structures, Ricardo et al.  developeStructural health monitoring (SHM) ,24,25, wIn this study, a novel Self-sensing Carbon Fiber Reinforced Polymer (SCFRP) fabric is developed to integrate the damage detection capability of PZT transducers with the strengthening ability of CFRP fabric. The first part of this paper introduces the detection principle and the specification of the SCFRP fabric. Several pairs of piezoceramic transducers, which had been integrated to the reinforced FRP materials, are surface-bonded on the host structure, and thus a piezoceramic-based active sensing system can be built to monitor the health condition of the FRP-reinforced concrete. In the study, several concrete beams with different strengths and reinforced with SCFRP fabric were prepared as the test specimen. A pair of piezoceramic transducers is bonded on the surface of the to-be-reinforced structure in the desired location before the CFRP fabric reinforcement. Then, three-point bending tests are applied on these specimens, and the stress waves propagated along the specimen are acquired and analyzed during the loading procedure. The wavelet packet energy algorithm is employed to analyze the received signal to discuss and evaluate the health condition of the reinforced structures. The novel SCFRP fabric is fabricated by integrating waterproofed PZT patches with the carbon fiber polymer fabric, taking advantage of the CFRP’s high strength and piezoceramic transducers’ active sensing capacity. Therefore, the cracks or debonding damage in the strengthened concrete structures can be detected with the help of novel SCFRP fabric by analyzing the propagation and attenuation characteristics of the stress waves between the pair of piezoceramic transducers located at desired location in the structures. The integrated PZT patches of the SCFRP fabric can be connected to the data acquisition device via BNC cables for data acquisition. Similar to the common CFRP strengthening material, the proposed SCFRP fabric integrated with the piezoceramic patches can also be used to strengthen the concrete structures by surface bonding them onto the host structures, as shown in In the practical applications, the proposed SCFRP fabric was employed to strengthen concrete structures following the conventional strengthening procedure. Then, a dataset of the stress wave signatures acquired from the SCFRP fabric of the strengthened structure was collected as the baseline when the strengthening work was finished. Thus, the health condition of the strengthened concrete structure in its service period can be monitored in real time by comparing the acquired wave response with the baseline. To quantitatively estimate the differences between the stress wave responses, the wavelet packet energy technique was employed here to build a monitoring index to evaluate the health condition of the structures ,62,63,64n-level wavelet packet decomposition into 2n signal sets {X1, X2, jX, where j is the frequency band . In this study, n = 5. jX can be further expressed as: m is the number of data samples in each signal set. Thus, the energy of the signal set can be calculated as:The sensor signal, S, is decomposed by Therefore, the total energy of the signal can be calculated by the summation of all the signal sets. The total energy of the signal can be expressed as:Therefore, the received signal can be characterized by using the energy value based on the wavelet packet energy analysis. In addition, the energy values calculated from the received signals under different working condition for the SCFRP-based strengthened concrete structure can also be easily compared. To validate the effectiveness of the SCFRP fabric technology in the area of the structural health monitoring and strengthening, several concrete beam specimens were first prepared in the laboratory, then a three-point bending test was conducted for the concrete specimens with and without the SCFRP fabric. In addition, two kinds of concrete specimens with different concrete grade (C25 and C40) were also prepared to investigate the influence of concrete strengthening. specimen 1: a C25 concrete beam without SCFRP fabric strengthening; specimen 2: a C25 concrete beam strengthened with SCFRP fabric; specimen 3: a C40 concrete beam without SCFRP fabric strengthening; and specimen 4: a C40 concrete beam strengthened with SCFRP fabric. As shown in In this study, three-point bending tests were carried out by a universal hydraulic testing machine (100T) to verify the feasibility of the proposed SCFRP fabric. For the convenient observation of the possible crack development during the test, the surface of the specimens was meshed, as shown in For the specimen beam with strengthening of SCFRP fabric, the SCFRP fabric with the piezoceramic transducers was surface bonded on the concrete specimen with the structural adhesive, as shown in In the study, a 100T capacity universal hydraulic testing machine was employed in the experiment to apply an axial compressive load on the specimen with the force-control. As shown in Following with strengthening operation of the SCFRP fabric, the PZT transducers were also surface bonded onto the SCFRP strengthened concrete specimen beams. Then, the PZT patches were connected with the data acquisition board (NI-6363), which was controlled by a laptop installed with the supporting software, as shown in For each test, a swept sine signal with the frequency band of 100 Hz to 400 kHz was employed as the excitation signal. The sampling frequency of the data acquisition is 2 MHz with a period of 0.5 s, which was sufficient to prevent or minimize the aliasing effects.Specimen 1: C25 concrete without SCFRP fabric strengthening (a) Following the procedure described above, the specimen with the concrete strength of C25 was first employed as the object for the three-point bonding test. In the experiment, the applied vertical load increased gradually with an interval of 10 kN, and finally reached to the maximum value of 53.5 kN. The load-time history and load-displacement relationship are shown in Similar to Then, the wavelet packet energy of each received signal was computed and is plotted, as shown in In the study, it is predicted that the decrease of the wavelet packet energy was caused by the occurrence and development of the crack, which significantly influences on the stress wave propagation between the pair of piezoceramic patches. With the increase of the applied load, the displacement increases and cracks start to appear and widen, which attenuates the stress wave propagation from the PZT actuator to the PZT sensor. For example, the occurrence of an initial crack at the load of 20 kN (as shown in Specimen 2: C25 concrete strengthened with SCFRP fabric(b) Then, the specimen of the concrete beam, which was fabricated with the C25 concrete and strengthened with the proposed SCFRP fabric, was investigated using the three-point bending test. Like the test procedure described above, a vertical load with an interval of 10 kN was applied to the specimen and finally the maximum load value of 76.6 kN was reached, as shown in For the specimen of C25 strengthened with the SCFRP fabric, with the help of structural adhesive layer, the SCFRP fabric and the concrete specimen work together to bear the outside applied load, thus the ultimate bearing capability of the strengthened concrete specimen is significantly improved. However, due to its low strength of the specimen concrete, the concrete protective cover firstly reach to its maximum bearing capability when compared with the CFRP fabric and adhesive layer, and then induce the debonding of the SCFRP fabric and finally induce the collapse of the whole structure, as shown in For this specimen, the SCFRP fabric integrated with a pair of PZT-based transducers was surface bonded on it. With the same excitation as described in the previous sections, the received stress wave signals were recorded and are plotted in In addition, the wavelet packet energy of the received signals were also computed, as shown in The changing trend of the wavelet packet energy presented in the figure clearly demonstrates the whole process of the specimen failure. For example, during the experiment, with a big sound, a significant crack was observed on the surface of the specimen when the applied axial load was increased from 20 kN to 30 kN. This abnormality can also be clearly presented in the figure with a suddenly drop for the wavelet packet energy. Then, with the load increased from 50 kN to 60 kN, a local debonding of the SCFRP fabric occurred at the outermost U-shape fabric. Similarity, this damage induces more serious attenuation for the stress wave propagation and a significantly drop was observed for the wavelet packet energy in the figure. Finally, the specimen was complete failure due to the debonding between the U-shaped CFRP strengthening fabric and the beam, which induces a minimum for the energy value. Thus, the working status and health condition of the SCFRP-strengthened concrete structures can be evaluated in some degree by observing the variation of the wavelet packet energy of the propagated stress wave. Therefore, the proposed self-sensing CFRP fabric integrated piezoceramic transducers not only strengthen the concrete structure to improve its bearing capability similar to the common CFRP material, but also monitor the health condition of the strengthened concrete structure at the same time. Specimen 3: C40 concrete without SCFRP fabric strengthening (c) To investigate the performance of the proposed SCFRP fabric for the concrete structures with different concrete strength, specimens were also fabricated with C40 concrete and tested in the study. At first, this specimen without strengthening was subjected to the vertical load following the procedure of three-point bending test. The applied load history and the load-displacement relationship are presented in For this kind of specimen, the stronger bearing capability due to the higher concrete strength can also be represented in Specimen 4: C40 concrete strengthened with SCFRP fabric(d) Finally, the C40 concrete specimen strengthened with the proposed SCFRP fabric was tested and investigated. In comparison to the specimen with concrete strength of C40 without strengthening, the bearing capacity of SCFRP fabric strengthened specimen increases from 120.95 kN to 139.8 kN, an improvement of 15.6%, which indicates that SCFRP strengthening fabric plays an important role in enhancing the bearing capacity of high-strength concrete structures. On the other hand, owing to the benefit of high-strength concrete, the bearing capacity of this kind of specimen also increased from 76.6 kN to 139.8 kN compared to the SCFRP strengthened specimen with C25 concrete. However, it should be noted that the failure modes of these two SCFRP strengthened specimen beams are not exact the same. From On the other hand, regardless of the high-strength or low-strength for the concrete, the SCFRP fabric integrated with the PZT transducer has the ability to monitor the health status of the concrete structures. In the experiment, a tiny crack was firstly observed at the load of 40 kN, and it was then further developed with the increase of the applied load until the SCFRP fabric reached to its maximum bearing capability, which will eventually result in the collapse of the entire specimen. From the Based on above analysis, the strengthening performance of the SCFRP fabric for these four different concrete specimens were also compared and analyzed, as shown in In this research, a novel self-sensing CFRP technology was developed to take advantages of the PZT transducers’ active sensing function and the CRFP’s strengthening capacity. The feasibility of the proposed technology to realize the health condition monitoring of the concrete structures was studied. Experimental results of the three-points bending tests clearly show that the relationship between the wavelet packet energy value and the integrity of the test specimen. However, the wave propagation and attenuation may also be influenced by some other factors, including noise, thermal stress, moisture, external stress, and sensor location, which may affect the final identification results. At the current stage, the study is more focused on the feasibility of the proposed SCFRP fabric to monitor the health condition of the concrete specimen. Implementation of developed SCFRP fabric to monitor the working condition of in-service concrete structures remains a future topic to study. Another future topic will be modelling the interface between the CFRP fabric and the concrete under an external load by using the fractal contact theory with the help of PZT transducers ,68. In aIn this paper, a novel Self-sensing Carbon Fiber Reinforced Polymer (SCFRP) fabric was developed to take advantages of piezoceramic transducers and the Carbon Fiber Reinforced Polymer (CFRP) strengthening materials in civil engineering. Thus, the developed SCFRP fabric has the ability to improve the structural bearing capability and simultaneously to realize the health condition monitoring of the strengthened structures. In order to validate the feasibility of the developed SCFRP concept, several specimens with or without the SCFRP fabric strengthening were fabricated and tested in the three-point bending configuration. In addition, the specimens with different concrete strength (C25 and C40) were also experimental investigated. A swept frequency test was applied for each specimen under different conditions and its corresponding stress wave response signals were collected and analyzed. At the same time, the wavelet packet energy technique was also employed to build a detection index to evaluate the changes of the received signals. Finally, the experimental results through comparison clearly show that the structural yield strength increases with the SCFRP fabric installation and the energy values of sensor signal decrease with crack development, which indicate that the developed novel SCFRP system has the ability to improve the bearing capability of strengthened concrete structures and to detect the occurrence and development of cracks in the structures. All these results demonstrate that the developed SCFRP fabric has a great potential in the structural strengthening with the self-sensing capacity for structural health monitoring for future civil engineering structures.