In Belgium, antibiotic resistance leads to approximately 530 deaths with a €24 million financial burden annually. This study estimated the impact of procalcitonin-guided antibiotic stewardship programs to reduce antibiotic consumption versus standard of care in patients with suspected sepsis. A decision analytic tree modelled health and budget outcomes of procalcitonin-guided antibiotic stewardship programs for patients admitted to the intensive care unit (ICU). A literature search, a survey with local clinical experts, and national database searches were conducted to obtain model input parameters. The main outcomes were total budget impact per patient, reduction in number of antibiotic resistance cases, and cost per antibiotic day avoided. To evaluate the impact of parameter uncertainty on the source data, a deterministic sensitivity analysis was performed. A scenario analysis was conducted to investigate budget impact when including parameters for reduction in length of ICU stay and mechanical ventilation duration, in addition to base-case parameters. Based on model predictions, procalcitonin-guided antibiotic stewardship programs could reduce the number of antibiotic days by 66,868, resulting in €1.98 million savings towards antibiotic treatment in current clinical practice. Antibiotic resistance cases could decrease by 7.7% (6.1% vs 9.2%) in the procalcitonin-guided setting compared with standard of care. The base-case budget impact suggests an investment of €1.90 per patient. The sensitivity analysis showed uncertainty, as the main drivers can alter potential cost savings. The scenario analysis indicated a saving of €1,405 per patient, with a reduction of 1.5 days in the ICU (14.8 days vs 12.8 days), and a reduction of 22.7% (18.1–27.2%) in mechanical ventilation duration. The associated sensitivity analysis was shown to be robust in all parameters. Procalcitonin-guided antibiotic stewardship programs are associated with clinical benefits that positively influence antimicrobial resistance in Belgium. A small investment per patient to implement procalcitonin testing may lead to considerable cost savings. Penicillium moulds were discovered as the first antimicrobial agents in 1928, antibiotics have enabled the treatment of formerly fatal diseases [Ever since the antimicrobial properties of chemicals secreted by the diseases . The ecodiseases , 4.Antibiotic treatment can be crucial in treating fatal diseases, such as sepsis . Sepsis To address the globally increasing incidence of AMR, antibiotic stewardship programs (ASPs) have been developed as part of country-specific action plans, derived from and in line with the World Health Organization’s global action plan , 13. ASPThe global overuse of antibiotics has led to the investigation of potential biomarkers to help distinguish between bacterial and viral infections and to improve ASPs in hospitals , 15. OneWhen new interventions are presented, it is important to outline not only the effectiveness of the new intervention, but also the budgetary impact. This is done through health economic evaluations to inform decision-makers, which will ultimately benefit the healthcare system . Health This budget impact analysis simulates the cost and clinical effectiveness of PCT-guided antibiotic stewardship versus standard of care (SoC) for all patients with suspected sepsis in the ICU. The analysis is based on previously published decision trees , 22, adaThe primary outcome was the budget impact per year on the Belgian healthcare system for both PCT-guided antibiotic stewardship and SoC. Secondary outcomes included antibiotic therapy duration and a reduction in the number of expected AMR infections per year.A literature review, structured as a PICO  search, was carried out in three online medical databases  to investigate the effectiveness of PCT versus SoC. The search strategy included articles written in English from 2017–2022. In addition, an expert survey was designed to obtain the Belgium-specific model input of PCT-guided antibiotic stewardship versus SoC, which could not be found in literature or elsewhere. The survey was conducted by each expert individually and collated to form a single conclusion.All base-case parameters with minimum and maximum values used for sensitivity analyses are presented in The annual cases of patients with sepsis in Belgium were obtained by request from FPS Public Health and based on the sum of four International Classification of Diseases-10 codes: A40, A41, O85, and P36 . The numData on hospital length of stay (LOS) for patients with sepsis were obtained from FPS Public Health . Using dThis study was based on previously published studies that performed health economic evaluations for PCT-guided antibiotic stewardship in various countries, , 22 and The reduction in antibiotic therapy duration was estimated to be 22.5% (range: 18.0–27.0%) based on a study by Gutiérrez-Pizarraya et al. . To calchttps://www.zotero.org/google-docs/?Y6l7lB [Several studies have estimated the percentage reduction in AMR due to PCT by using the proportion of AMR in the PCT and SoC settings, and the calculated reduction in antibiotic duration due to PCT-guided antibiotic stewardship /?Y6l7lB , 22, 30./?Y6l7lB , 22, 30.The cost of 12.8 hospital days for sepsis was €11,168.80, based on the APR-DRG-720 (APR-DRG code for sepsis) . Due to To evaluate the robustness of the results, a deterministic sensitivity analysis was performed. As the ±20% range of variability was applied, it was possible to rank the drivers of the results and summarize them in a top-down tornado diagram. The tornado diagram illustrates the univariate analysis where one parameter was altered to the extreme of its range of variability whilst all other parameters remained unchanged.In parallel to the base-case analysis, a scenario analysis was performed, based on published literature, to illustrate the potential budget impact of a reduction in hospital LOS and mechanical ventilation duration . A studyAccording to the study by Mewes et al. , the redThe results of the model-based analysis  indicateThe ten drivers impacting the sensitivity analysis  are reduThe scenario analysis considers the potential impact of PCT on LOS in the ICU and mechanical ventilation duration. The results indicate that a reduction of 1.46 days  per patient in the ICU due to PCT testing would save the Belgian healthcare system €45.80M per year. Furthermore, the model shows that the reduction in mechanical ventilation duration due to PCT testing may result in €4.20M savings. The budget impact per patient in this scenario analysis would reach €–1,405, thus suggesting that by implementing PCT as a tool for antibiotic stewardship, the Belgian healthcare system would save €49.90M per year .The deterministic sensitivity analysis , of the AMR is an emerging health issue associated with potentially life-threatening consequences and substantial clinical and financial burden . In the The objective of this model-based analysis was to analyze the budget impact of PCT as a tool for antibiotic stewardship compared to SoC for patients with suspected sepsis. To the best of our knowledge, this is the first budget impact analysis for this comparison in Belgium. The results indicated clinical benefits associated with PCT, such as a reduced exposure to antibiotics and a reduction in AMR infections. The results of the base-case analysis also indicated that a budget investment of €1.90 per patient is needed to implement PCT for patients with sepsis in the ICU. The Belgian healthcare system would need to invest €68,220 per year to implement PCT testing for patients with sepsis in the ICU. The scenario analysis predicted large budget savings associated with PCT, considering parameters such as reduction in LOS in the ICU and mechanical ventilation duration. When including the additional parameters, the Belgian healthcare system could potentially save up to €49.90M each year by following PCT-guided antibiotic treatment management. The base-case results were not robust based on the sensitivity analysis due to the influence of the key drivers on the outcome. For the scenario analysis, the results were found to be robust, as none of the drivers of the results altered the outcome.Clostridium difficile (C. diff) [C. diff infections, reduction in laboratory tests performed or productivity losses.There is a difference in the cost investment per patient from the base-case analysis to the study by Garay et al, of €1.90 versus $–101, respectively. One reason for this difference in budget impact is that this study did not assess the impact of PCT on C. diff) . FurtherC. diff) . TherefoC. diff) . Other rThe reason for not including additional parameters in the analysis is, by suggestion of clinical experts, that PCT should be considered an addition to the SoC for patients with suspected sepsis in Belgium, as PCT adds value over the use of C-reactive protein tests. Lastly, productivity loss is not in the scope of a healthcare system perspective in Belgium.One important limitation of this study was the lack of Belgian specific data on PCT testing and pricing, mainly due to the fact that the tests are not reimbursed. Consequently, published international literature was used as input parameters in the health economic model. Another limitation is the use of a fixed range of variation (±20%), as this does not reflect the true variabilities.By implementing the PCT-guided algorithm for patients with suspected sepsis in the ICU, healthcare benefits are expected to be generated, such as reduced antibiotic exposure, reduced AMR infections, which could help to prolong the effectiveness of antimicrobial treatments globally. Predicted by the decision analytic model, the improved treatment management for sepsis comes with a healthcare investment of €1.90 per patient. However, when considering the potential reduction in the LOS in the ICU and mechanical ventilation duration, savings of €1,405 per patient are expected. In conclusion, the implementation of PCT tests may add clinical benefit to patients with sepsis, and generate considerable savings in the Belgian healthcare system.


Aconitum carmichaelii Debx, is one of the widely used traditional Chinese medicines. Fuzi polysaccharides are considered the most bioactive compounds with immunomodulatory functions, however, the mechanisms have not been evaluated. This study aims to systematically investigate the effects of Fuzi polysaccharides on the gut microbiota and immune function using a mouse model immunosuppressed with cyclophosphamide.Fuzi, the dried root of +FOXP3+/CD4+ ratio was measured by flow cytometry.The short-chain fatty acid levels in cecal contents were measured by gas chromatography-mass spectrometry. The gut microbiota 16S rRNA gene were sequenced by next generation sequencing. The mRNA expression levels of NF-κB, IL-6, TNF-α, iNOS and COX-2 were measured using quantitative real-time polymerase chain reaction. The protein expression of occludin and zonula occludens-1 were analyzed by Western blot. The white blood cells were counted using automated hematology analyzer, and CD4Helicobacter, Anaerotruncus, Faecalibacterium, Lachnospira, Erysipelotrichaceae_UCG-003, Mucispirillum, and Mycoplasma, and increase the relative abundance of Rhodospirillales, Ruminococcaceae_UCG-013, Mollicutes_RF39, Ruminococcus_1, Christensenellaceae_R-7_group, and Muribaculaceae in the gut. Furthermore, Fuzi polysaccharides exhibited the function of increasing spleen and thymus indices and number of white blood cells and lymphocytes. Fuzi polysaccharides could reverse the decreased mRNA expression of NF-кB, IL-6, and iNOS, differentiation of CD4+FOXP3+ regulatory T cells as well as protein expression of occludin and zonula occludens-1 induced by cyclophosphamide. In addition, the mRNA and protein expression of cytokines were significantly correlated with the abundance of gut microbiota under Fuzi polysaccharides treatment. Collectively, the above results demonstrated that Fuzi polysaccharides could regulate inflammatory cytokines and gut microbiota composition of immunosuppressive mice to improve immunity, thereby shedding light on revealing the molecular mechanism of polysaccharides of traditional Chinese medicines in the future.Fuzi polysaccharides had the function of elevating the concentration of acetic acid, propionic acid, isobutyric acid, and n-butyric acid in the cecum. Meanwhile, Fuzi polysaccharides could decrease the relative abundance of   •Fuzi polysaccharides increase levels of short-chain fatty acids.•Fuzi polysaccharides regulate intestinal microbiota composition/distribution.•Fuzi polysaccharides increase number of white blood cells and lymphocytes.•Fuzi polysaccharides increase inflammatory cytokines and T cell differentiation.•Fuzi polysaccharides can improve immunity in immunosuppressed mouse models. The underlying diseases includes Human Immunodeficiency Virus (HIV) infection or malignancy  which affects the immune system producing secondary immunodeficiency, and various primary immunodeficiency syndromes such as severe combined immunodeficiency (SCID) with defects in T cells, B cells, and NK cells , especiaAconitum carmichaelii Debeaux, known as “Fuzi” in China, is a famous traditional Chinese medicine widely used to treat rheumatism, cardiovascular diseases, joint pain, syncope, and bronchial asthma .Traditional Chinese Medicine Scientific Research Project of the Hubei Provincial Health Commission (Grant No. ZY2019Q035), Central University Innovation Team Project , Shaanxi Province Key Research and Development Program , Special Project of Xi'an Science and Technology Plan Innovation Fund (Grant No. 2019KJWL04), and Shaanxi Aerospace Breeding Engineering Center Project (Grant No. 2021008).This research was funded by the The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


Corrosion-effected bond behavior between polyvinyl-alcohol-fiber-reinforced concrete and steel rebar under a chloride environment is the experimental subject studied in the present work. Twenty-four pull-out specimens are designed and subjected firstly to an accelerated corrosion test. The effects of polyvinyl alcohol fibers on the cracking behavior, chloride penetration of concrete members and the corrosion loss of steel rebars during the corrosion test are discussed. After this, these corroded specimens are subjected to a pull-out test. The failure mode, the bond-slip curves and the typical bond-stress values are measured during the test. The effects of polyvinyl alcohol fibers and corrosion loss on bond behavior between polyvinyl-alcohol-fiber-reinforced concrete and steel rebar are clarified. Results show that the polyvinyl-alcohol-fiber-reinforced concrete exhibits worse resistance to corrosion damage than plain concrete. The cracking width, chloride penetration depth in concrete and the corrosion loss of steel rebar are more serious for the specimens with more polyvinyl alcohol fibers. The polyvinyl alcohol fibers also negatively affect bonding in ascending branches for both the specimens, but improve the bonding in descending branches after peak stress in the case of splitting. In the present test, the bond strength of corrosive specimens is increased slightly and then decreases gradually with the deepening of corrosion loss. The failures of specimens change from pull-out to splitting-pull-out as the corrosion time exceeds 30 days. Compared with uncorroded specimens, the maximum degradation of bond strength is about 50.1% when the corrosion is increased from 0% to 15%. Polyvinyl alcohol (PVA) fiber is a kind of organic synthetic material, which has many advantages compared with other fiber materials. PVA fiber has high strength and ductility with a relatively high elastic modulus , outstanAt present, PVA fibers have been widely used in civil engineering such as in fiber-cement as asbestos replacement, Engineered Cementitious Composites (ECC), strengthening of enlarged section for concrete structures, and various kinds of shotcrete, which play a promising role in toughening and reducing cracking in concrete . MeanwhiExtensive works have been carried out to investigate the effect of corrosion on the bonding between concrete and rebar ,17,18. GIn this paper, an experimental test is proposed to study the corrosion-effected bond behavior between PVA-fiber-reinforced concrete and steel rebar under a chloride environment. In the subsequent sections, the paper carries out work on the following parts. In Twenty-four pull-out specimens were prepared in the present test, which were designed based on the Standard for Test Methods for Concrete Structures (GB 50152-1992) . All theThe factors considered in the tests included four fiber volume contents  and six salt solution immersive times . Designation of specimens was coded with two parts. The first part represents the content of PVA fibers. The second part indicates the immersive times where 0 d, 10 d, 20 d, 30 d, 40 d and 50 d stand for immersive times of 0 days, 10 days, 20 days, 30 days, 40 days and 50 days, respectively. For example, PVA0.2-20d means that the fiber volume content was 0.2% and the immersive time was 20 days.The concrete was mixed using ordinary Portland cement, river sand, coarse aggregate, water, polycarboxylate superplasticizer and PVA fibers. The cement utilized in the test was ordinary Portland cement of 42.5 grade. The maximum coarse aggregate size was 20 mm with continuous graded crushed stone. The fine aggregate is natural river sand, and its fineness modulus is 1.82 by sieving test. PVA fibers produced by Kuraray in Tokyo, Japan were employed in the test. The diameter and length were 39 μm and 12 mm, respectively. The elastic modulus and the tensile strength of the fibers were 42 GPa and 1.6 GPa. The tested yield strength and ultimate tensile strength of the steel rebar were 454 and 521 MPa, respectively.3. The water–cement ratio was 0.42. The contents of coarse aggregate and fine aggregate were 1092 kg/m3 and 619 kg/m3, respectively. The content of the water-reducing agent was 0.8% by weight of cement. The content of PVA fiber was the percentage of concrete volume.All specimens had the same mix proportions except the content of PVA fiber. The content of the cement was 485 kg/mIn the present test, the mixture was mixed with a forced mixer for 6 min. The fine and coarse aggregate were first dry mixed for 2 min. After that, water and water-reducing agent were pre-mixed and added into the mixture by 70% and mixed for 1 min. The PVA fibers were then dispersed gradually into the mixture and mixed thoroughly for 2 min. Finally, the remaining water and water-reducing agent were added the mixture, then mixed for another 1 min.After the mixing procedure was completed, tests were conducted on the fresh mixture to determine the fluidity of the concrete. The slumps were 180 mm, 102 mm, 45 mm and 12 mm for concrete mixtures with 0%, 0.2%, 0.4% and 0.6% PVA fibers, respectively. It was found that the slump decreased by about 43%, 75% and 93% when the fibers were increased from 0% to 0.6%. This indicated that the PVA fiber obviously affected the fluidity of the concrete. This is consistent with the results reported in previous research studies . This coPull-out specimens and some reserved samples with the same content of PVA fibers were cast using the same mixing batches, which were demolded after 24 h and cured in the room at 20 ± 2 °C and 95% relative humidity. At the age of 28 days, the reserved samples were subjected to a mechanical property test and the pull-out specimens were subjected to the accelerated corrosion (see detail in the following section). The compressive strength, splitting tensile strength and flexural strength were tested according to GB/T 50081-2019  and direThe electrochemical method was employed in the present study to accelerate the corrosion of specimens. Specimens were laid flat along the rebar on the corrosion tank and partially submersed in 5% sodium chloride solution. The stainless bar was connected with the negative terminal of the supply, and the steel rebar was connected with the positive terminal. The direct current flowed from the positive terminal to the rebar, and then through the saturated concrete and saline solution to the stainless bar, and finally back to the negative terminal. 2.Before the accelerated corrosion test, specimens were partially submersed in sodium chloride solution for 3 days to saturate the concrete. The solution was kept approximately 10 mm below the rebar and the ends of the specimens were coated with anti-rust oil to prevent the permeability of chlorine salts along the rebar–concrete interface. A constant current was applied with the corrosion current density of 300 µA/cmIn this study, the corrosion current and pH of the solution were monitored and adjusted twice a day to ensure that they were in a stable state. To ensure the effectiveness of the liquid at a constant concentration, the solution was renewed at weekly intervals. Moreover, corrosion of rebars could induce the cracking of concrete covers. Therefore, the cracking on concrete surfaces was observed and measured to investigate the restraint of PVA fibers on corrosion-induced concrete cracking.After accelerated corrosion, the specimens were subjected to a pull-out test, the test instrument is MTS-809 in the laboratory of Xiangtan University, the manufacturer of the instrument is the American MTS company , and the maximum axial force capacity is 100 kN. A special loading frame was designed in the present test, as shown in F is the measured pull-out force; d is the nominal diameter of steel bar; and L is the embedded length of the steel bar in concrete. Bond stress and slip discussed in the following sections were obtained based on the above method.The pull-out tests were monotonically loaded using a displacement-control mode at a speed of 1 mm/min. The experimental data, including pull-out force, relative slip and crack width were synchronously collected at the rate of 1 datum/s. The test was stopped as the splitting of specimens or the residual pull-out force trended to be constant. The measured slip between concrete and rebar at the free end was employed to represent the slip characteristic of the specimens. Additionally, the average bond stress along the embedded length of the rebar was used to represent the stress characteristic, which can be expressed ascρ is the actual corrosion loss of rebar; m1 is the mass of the original rebar; m0 is the mass of the corroded rebar.After the pull-out tests, the specimen was split along the direction of rebar and the rebar was taken out to measure the actual corrosion loss. The rebars were cleaned with oxalic acid solution and then neutralized with alkali. After drying, the corrosion region, i.e., the bond region, of the steel rebar was cut off. The mass of the cut rebar was measured by using an electronic scale with the precision of 0.01 g. The actual mass loss of the corroded rebar was calculated as follows:3 colorimetric method [3 solution with the concentration of 0.1 mol/L was evenly sprayed on the cutting faces of the concrete. The area penetrated by the chloride turned white, whereas the inner area turned brown, as shown in Besides that, the split specimen was employed to measure the penetration depth of chloride in PVA-reinforced concrete based on the AgNOc method . The splAccording the recommendations of the NT Build 492 , the meaIn the corrosion process, the electrical potential applied to the positively charged steel bars attracted negatively charged chloride ions from the salt solution into the concrete. When the chloride ions permeated into the surface of the steel rebar, the bar began to corrode. However, corrosion deteriorated the steel ribs and filled the concrete–steel interface with rust products . The expDetails of the maximum crack widths for corrosive specimens are shown in 2. Further, manual measuring errors during the weighting process of the rebar could also have caused the variation in corrosion loss.The corroded steel rebars were measured and the percentage of mass was computed using Equation (2), and the actual corrosion level is shown in Based on the test results, the PVA-fiber-reinforced concrete specimens exhibited relatively worse corrosion resistance in the chlorine salt environment compared with the specimen with 0% fiber content. The more PVA fiber, the higher the corrosion loss of rebar with the same corrosive time. For example, the increase in PVA fiber volume content from 0% to 0.2%, 0.4% and 0.6% in the PVA-15 series specimens increased the corrosion loss by about 9.6%, 1.9% and 2.3%, respectively. The corrosion loss of the specimens without the addition of PVA fibers was usually lower in the present test, which may be the reason why corrosion cracking did not occur. Therefore, the addition of the PVA fibers led to smaller and more closely spaced cracks in the concrete, resulting in reduced permeability resistance of the concrete.In this test, the chloride penetration depths were measured from the side of the concrete. The color rendering within the boundary range of the concrete surface was not measured, to eliminate the influence of the boundary effect. The results of the depth measurement are summarized in After that, the concrete was cut into flat pieces, for which the area of 50 × 50 mm was selected for image processing to observe the tiny holes on the concrete surface through Image-J software. Firstly, the picture of the concrete pieces was gray processed as shown in cρ, the bond stress at onset slip of free end τons, the maximum bond stress τmax and the slip corresponding to the maximum stress S0 are summarized in Test results of the pull-out specimens, including the failure mode, the actual corrosion level The specimens failed in three different modes: pull-out failure, splitting-pull-out failure and splitting failure. For the first one, the specimens failed gradually with the pull-out of the steel rebar without concrete cracking. For the second one, the specimens retained their integrity after the concrete splitting and the bond stress was not completely lost. For the third one, the specimens failed suddenly with the splitting of concrete accompanied by a loud crash. After that, the concrete members were completely broken apart. These three failure modes are shown in Failure modes of all specimens are summarized in The addition of PVA fibers shows a positive effect on the descending branches for specimens which failed in splitting-pull-out mode. After the curve has passed the peak load stress, the decline in bond stress can be effectively relieved with the increase in fiber content. Besides that, the residual stress was obvious for specimens with the addition of PVA fibers. The reasons should be attributed to the bridging effects of PVA fibers after the peak load stress of specimens, which effectively restrains the cracking and slows down the decrease in bond stress.Details about the comparison of bond strength for specimens with different fiber volume contents are summarized in The reason could be mainly attributed to the difference of the mechanical interlocking force between rebar and concrete. For cases with low corrosion levels, the positive effect was generated on bond properties because the slight corrosion of the steel bar improves the frictional resistance on the contact surface. However, with further increases in the corrosion level, the relative height of the ribs of the steel rebar gradually decreased. This caused the mechanical interlocking force between the concrete and the ribs of the rebar to significantly diminish. Besides that, cracking due to the volume expansion of the corrosion products reduced the confinement effect of the concrete. For the initial bonding stiffness of most specimens, however, the inflection point occurs at a higher corrosion level. The uneven corrosion of the rebar results in the corrosion damage on the upper surface being less than that on the lower surface. In this case, it could provide a certain friction at the beginning of the pull-out process. As the load increased, the friction was consumed and had no effect on the maximum bond stress. Therefore, the bond stress of all specimens initially increased slightly and then gradually decreased with further corrosion of the rebar.Details about the comparison of bond strength and slip corresponding to bond strength for specimens with different corrosive times are summarized in The PVA-fiber-reinforced specimens exhibited worse resistance to corrosion damage than plain specimens; the harmful fine pores in fiber concrete provide channels for chloride penetration. The maximum increment of crack width is about 66.7% in the present test for PVA-fiber-reinforced specimens. With the increase in the fibers, the corrosive cracking become more obvious.PVA fiber generally showed a negative effect on bond behavior, but a positive effect on the descending branches for the case with splitting failure. PVA fibers decreased both the initial bond stiffness and bond strength in the present test. The maximum decrement of bond strength was about 31.49%, for samples with PVA fiber contents of less than 0.6%. The lowest extension of crack width was about 0.7 mm with the addition of PVA fibers in the pull-out test, in which the PVA fibers can restrict the split-induced cracking and protect against the failure of specimen in a more ductile way.With the deepening of corrosion loss, the bond strength of corrosion specimens first slightly increased, and then gradually decreased. Compared with plain specimens, the maximum degradation of bond stress was about 50.1%, for which the corrosion level was 15%. Specimens with a greater corrosion level usually had a greater initial bonding stiffness, but lower bond strength than specimens with a high level after uneven corrosion.There are no forces between the PVA-fiber-reinforced concrete and the reinforcement in the chloride environment explored in this paper. In engineering practice, PVA-fiber-reinforced concrete is often in the load-bearing state received under the influence of the external environment; the rust characteristics in the load-holding state remain to be further analyzed and studied.This study experimentally investigated the bond behavior between PVA-fiber-reinforced concrete and steel rebar corroded under a chloride environment. The effects of PVA fibers and corrosion loss on bond behavior were clarified. The following conclusions may be drawn based on the present study:


Permeable pavements can decrease the volume of stormwater, thereby mitigating the risk of flooding and reducing the urban heat island effect. This study investigated the influence of incorporating granulated blast-furnace slag (GBFS), hydroxypropyl methylcellulose (HPMC), and polypropylene plastic textile fiber (PPTF) on the mechanical properties and water permeability of pervious concrete. Orthogonal tests were employed to conduct the analysis. The findings indicate that the pervious concrete with GBFS, HPMC, and PPTF (termed GBFS-HPMC/fiber pervious concrete) exhibited the highest cubic compressive strength, ultimate tensile strength, and flexural strength. These values were 25.22 MPa, 3.36 MPa, and 5.39 MPa, respectively. The standard deviations for cubic compressive strength, split tensile strength, flexural strength, water permeability coefficient, and porosity, as calculated using SPSS, were 1.57, 0.1, 1.17, 0.35, and 0.4, respectively. Scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) were used to analyze the microstructure and compositional combinations of the pervious concrete. The analyses revealed that the calcium-silicate-hydrate (C-S-H) gel, produced by GBFS hydration, enhanced the bonding within the interfacial transition zone (ITZ) and between the fibers and aggregates. Additionally, the anchoring and supporting effects of the PPTF in the matrix contributed to stabilizing the overall matrix structure. Lastly, a gray correlation analysis was applied to optimize the admixture. The findings indicate that following the optimization, the cubic compressive strength increased by 7.2%, splitting tensile strength by 2.1%, and flexural strength by 2.5%. In summary, the mechanical properties of pervious concrete improved after optimizing the admixture. In recent years, the expansion of urban regions and the concentration of populations has resulted in the reduction of vegetated areas and natural habitats due to the construction of residential buildings and traditional concrete pavements. This situation hinders the natural infiltration of rainwater into the soil. During intense precipitation episodes, drainage systems cannot expel water rapidly, leading to waterlogging events in low-lying urban zones ,2,3. ConPervious concrete serves as a sustainable paving material that effectively addresses the shortcomings of traditional concrete pavements. This material consists of a mortar layer enveloped by coarse aggregate, which is bonded to form a porous, honeycomb-like structure. This structure offers the advantages of both water permeability and acoustic noise reduction ,9,10. ThWith the promotion of China’s “dual-carbon” initiative, reducing carbon emissions to address climate change is the focal point of achieving overall energy-efficient and environmentally friendly development . As a keSlag can induce the “volcanic ash effect”, reacting with calcium hydroxide produced by cement hydration to form hydrated calcium silicate , hydrateThe preparation of pervious concrete necessitates less gelling material, resulting in weaker bonding. However, the inclusion of hydroxypropyl methylcellulose can extend the mixing and forming time, enhancing the cohesion of the mix to prevent segregation. This compound boasts exceptional thickening and water retention properties, effectively enhancing the bond between the gelling material and aggregates, thus improving mechanical properties . When ceIncorporating fibers can reduce the high brittleness and poor resistance to bending and deformation inherent in pervious concrete, thus, enhancing its mechanical properties. Polypropylene plastic textile fibers, known for their ease of dispersion, acid and alkali resistance, and high toughness, are a suitable reinforcement for pervious concrete, effectively inhibiting crack formation and propagation ,29,30. R4) orthogonal experiment with the objective of exploring the influence of the slag replacement rate, cellulose additive, and PPTF additive on the mechanical and water permeability properties of pervious concrete. The study examined the compressive strength, tensile strength, flexural strength, permeability coefficient, and porosity of GBFS-HPMC/fiber-reinforced concrete. Gray correlation analysis and principal component analysis were employed to determine the optimal GBFS replacement rate, HPMC admixture, and PPTF admixture to enhance the mechanical properties of GBFS-HPMC/fiber-reinforced concrete. To promote the usage of GBFS-HPMC/fiber pervious concrete in real-world projects, it is essential to provide a reference.Significant advancements have been made in the research of pervious concrete, both at the domestic and international levels. However, the constrained strength of pervious concrete limits its range of applications. Consequently, the current research focus centered on enhancing its mechanical properties while simultaneously considering the water permeability performance. Unlike previous studies that primarily examined individual materials, this paper presents a novel approach. This study devised a three-tier, four-variable L9  orthogonal table. The PPTF dosages were 1%, 0.3%, and 0.5%. This experiment employed an orthogonal test to study three influential factors: GBFS substitution rate (A), HPMC dosage (B), and PPTF dosage (C). The GBFS substitution rate was 15%, 20%, and 25%; the HPMC dosage was 0.1%, 0.15%, and 0.2% of the cementitious material; and the PPTF dosage was 0.1%, 0.3%, and 0.5%. The orthogonal design of the test is shown in In the process of specimen preparation, first coarse aggregate, sand, PPTF, and part of the water were added and mixed for 30 s, then GBFS and cement were added and mixed for 60 s. Finally, HPMC reinforcement was added, followed by the addition of the remaining water, and the mixture was mixed for an additional 120 s. Subsequently, a combination of manual pounding and static compression molding techniques was employed. For each group of specimen molding, twelve specimens measuring 100 mm × 100 mm × 100 mm and three nonstandard specimens measuring 100 mm × 100 mm × 400 mm were prepared. In total, 150 specimens were prepared. Following the removal from molds, a total of 150 specimens were obtained, which encompassed 12 nonstandard specimens measuring 100 mm × 100 mm × 400 mm. These specimens were allowed to undergo natural conservation for a duration of 28 days, commencing from the 24th hour. The process of specimen preparation and molding is depicted in Upon completion of the curing period, the cubic compressive strength, splitting tensile strength, and flexural strength were measured. A YAW-50000J compression–shear testing machine was used for loading. Tests for the porosity and water permeability coefficient were performed following the procedures outlined earlier.2), and The specimen was placed at the center of the bearing plate on the press, and a continuous and uniform load was applied with a loading speed of 0.5 MPa/s. The calculation formula is provided in Equation (1). As per the guidelines specified in GB/T50081-2019, titled “Concrete physical and mechanical properties test method standard” , the tes2), and The split compressive strength specimen was placed on the press support, and a continuous and stable load was applied at a rate of 0.015 MPa/s. The maximum load was recorded after the specimen fractured. The calculation formula is presented in Equation (2). In accordance with the standards outlined in GB/T50081-2019, “Concrete physical and mechanical properties test method standard” , the tesThe flexural strength specimen was placed on the press support and loaded at a rate of 0.05 MPa/s. The maximum load was recorded when the specimen fractured. The calculation formula is given in Equation (3). As specified in GB/T50081-2019, titled “Concrete physical and mechanical properties test method standard” , the tes2), Once the specimen reached the age of 27 days, it was immersed in water for 24 h. After 28 days of aging, the permeability coefficient test was conducted. The calculation formula is presented in Equation (4), and the testing equipment for permeability coefficient is shown in −3), and The specimen was placed in a container with water, ensuring the water level was more than 20 cm higher than the specimen size. An electronic scale was used to measure the suspended mass of the specimen in water, denoted as −1 to a minimum value of 4.98 mm·s−1. Similarly, the maximum and minimum porosity values recorded were 14.62% and 13.65%, respectively. After the incorporation of GBFS, HPMC, and PPTF, a notable decrease in the permeability coefficient and porosity was observed. Despite this reduction, the values remained higher than those of the control group, which had a permeability coefficient of 6.35 mm·s−1 and a porosity of 14.89%. Nevertheless, all test groups met the stipulated specification requirements.The outcomes of the tests for the cubic compressive strength, split tensile strength, flexural strength, permeability coefficient, and porosity in the pervious concrete for both the test group and the control group are presented in The results of the permeability coefficient, cubic compressive strength, and splitting tensile strength tests were subjected to ANOVA and extreme variance analysis using SPSS. The results are presented in The analysis of variance revealed that both GBFS and PPTF had a significant impact on the pervious concrete, whereas HPMC showed no significant effect. The magnitude of influence of the three factors on the cubic compressive strength was ranked by extreme variance analysis as follows: PPTF (2.89 MPa) > GBFS (1.75 MPa) > HPMC (0.52 MPa), consistent with the variance analysis results. The trend of the GBFS substitution rate, HPMC admixture, and PPTF fiber admixture effects on the cubic compressive strength of the GBFS-HPMC/fiber permeable concrete is illustrated in 2 generated by cement hydration and accelerates the cement hydration process [As depicted in  process ,38. ThisThe cubic compressive strength increases initially with the increase in the HPMC dosage, reaching a maximum strength of 23.41 MPa at a dosage of 0.15%. During the mixing process, the -OH groups in HPMC react with water, forming hydrogen bonds. The molecules become entangled, creating a mesh structure . This stThe compressive strength gradually increased with the rise in the PPTF dosage, exhibiting increments of 6.51%, 12.22%, and 20.12% compared to the control group. The slope of the curve for an increase in the PPTF dosage from 0.3% to 0.5% was steeper than that for the increase in the fiber dosage from 0.1% to 0.3%. This observation confirms that a dosage of 0.5% PPTF significantly enhances the strength of pervious concrete. The fibers contribute to the overall densification of the pervious concrete and impede the propagation of cracks at the interface between the cementitious material and bonded aggregates . The speThe analysis of variance determined that PPTF is a significant factor, whereas GBFS and HPMC were found to be insignificant factors. Extreme variance analysis indicated the strength of influence on splitting tensile strength was PPTF (0.17 MPa) > GBFS (0.13 MPa) > HPMC (0.05 MPa). The trend of each factor’s influence on the splitting tensile strength is shown in As seen in The analysis of variance revealed both GBFS and PPTF as highly significant factors, while HPMC was found to be insignificant. The extreme variance analysis aligned with the variance results, demonstrating the strength of influence on the flexural strength as PPTF (0.31 MPa) > GBFS (0.21 MPa) > HPMC (0.09 MPa). The influence of each factor on flexural strength is illustrated in As observed in The analysis of variance revealed HPMC as a highly significant factor, GBFS as a significant factor, and PPTF as a nonsignificant factor in the permeability coefficient analysis. Similar results were obtained from the ANOVA based on porosity. The extreme variance analysis indicated the strength of influence on the permeability coefficient of the pervious concrete to be HPMC (0.58 mm/s) > GBFS (0.43 mm/s) > PPTF (0.28 mm/s). The influence on porosity followed the same order: HPMC (0.66%) > GBFS (0.57%) > PPTF (0.21%). The influence of each factor on the permeability coefficient and porosity is depicted in As illustrated in The micromorphologies of the C-0 and GHP-3 groups were observed through scanning electron microscopy (SEM), as depicted in 2. The internal structure was not dense enough due to the usage of only cement as the cementitious material. This resulted in more holes and cracks, as shown in 2, formed by the hydration of cement, along with the alkaline environment, leads to a secondary hydration reaction between GBFS and OH−. This resulted in the formation of part of AFt and AFm, as well as a substantial amount of C-S-H gel inside the permeable concrete. This gel reinforces the interface, resulting in a more compact structure that greatly improves the structural strength of permeable concrete, as shown in In the control group, the hydration products of the cement consisted of a small amount of acicular calcium alumina (AFt) and a large amount of flaky Ca(OH)The EDS energy spectrum analysis located hit points and depicted energy spectra, as shown in 2, AFt, and some AFm. GHP-3’s hydration product constituent elements in both regions were Ca, O, Al, and Si. The Si, Al, and Mg levels were higher than in C-0, with CaO, Al2O3, SiO2, and MgO indicating the presence of Ca(OH)2, AFt, and some AFm. This suggests the existence of AFt and a significant amount of C-S-H gel in this region.Hydration products in the control group’s constituent elements in both regions were Ca, O, and S. The O and Ca elements were predominant, with CaO, MgO, etc., indicating the presence of Ca(OH)The design of the orthogonal experiments effectively reduces the number of experimental groups, thereby significantly reducing the workload. Nevertheless, the results of the remaining experimental data remain unknown. Gray correlation analysis provides a quantitative method to describe and predict performance indicators across the entire system . The corThe calculation of the gray correlation coefficient is shown in Equation (6):Next, the performance indicators are subjected to SPSS factor analysis. The coefficients of each factor in the composite score model are normalized to obtain the weights. The weight calculation is shown in Equation (7):Gray correlation analysis  and prinThe weighting coefficients for the cubic compressive strength, splitting tensile strength, flexural strength, water permeability, and porosity were calculated as Gray correlation measures the strength of the correlation between different influencing factors and reference objects. A higher gray correlation indicates a stronger alignment between the trends in test results and the ideal experimental outcomes. This implies better overall performance within the experimental group. Based on these considerations, GHP-3 is determined to be the best experimental scheme for comprehensive performance indexes.The dosage combination yielding the best combined performance index was analyzed by comparing the mean gray correlation for each dosage of every factor, as shown in The GHP-10 test group, consisting of GBFS-HPMC/fiber pervious concrete with the optimal GBFS replacement rate of 20%, HPMC admixture of 0.20%, and PPTF admixture of 0.5% was chosen to evaluate the comprehensive performance indexes. New pervious concrete specimens were prepared using the best admixture determined through gray correlation analysis for both the GHP-10 and GHP-3 test groups. These specimens were then measured for five performance indices: cubic compressive strength, tensile strength, flexural strength, water permeability coefficient, and porosity. The final optimal admixture formulation was derived from these measurements. The data from both sets of programs are presented in This experiment explored the effects of GBFS, HPMC, and PPTF on pervious concrete’s mechanical properties from macrostructural and micromorphological perspectives. The 28-day cubic compressive strength, splitting tensile strength, and flexural strength of GBFS-HPMC/fiber pervious concrete reached the highest values of 25.22 MPa, 3.36 MPa, and 5.39 MPa, respectively. These values exceeded those of the control group by 25.29%, 11.26%, and 16.41%, respectively. Furthermore, the water permeability coefficient and porosity met specifications.The analysis of variance on mechanical properties revealed that PPTF exerted the most substantial influence, followed by GBFS, whereas HPMC had negligible effects. Conversely, the analysis of variance regarding water permeability properties emphasized HPMC as a significant influencing factor, while GBFS and PPTF had minor effects. This observation aligns with the results obtained from the extreme variance analysis. Based on comprehensive analysis, the optimal dosages for GBFS, HPMC, and PPTF to enhance compressive strength are 15%, 0.15%, and 0.5%, respectively. For split tensile strength and flexural strength, the recommended dosages of GBFS, HPMC, and PPTF are 20%, 0.15%, and 0.5%, respectively. To enhance water permeability, the recommended dosages of GBFS, HPMC, and PPTF are 15%, 0.2%, and 0.1%, respectively. SEM microstructure analysis has demonstrated that incorporating GBFS enhances the stability and compactness of the pervious concrete structure. This enhancement is attributed to the secondary hydration of GBFS, which results in the formation of C-S-H gel. This gel fills the pores and reinforces the fiber–aggregate interfacial transition zone. Energy spectroscopy analysis validated the effectiveness of the fibers by detecting the presence of AFt and a substantial amount of C-S-H gel in the GHP-3 test group.Finally, through gray correlation analysis and SPSS factor dimensionality reduction for admixture optimization, we obtained the optimal admixture proportions for GBFS-HPMC/fiber permeable concrete: a GBFS replacement rate of 20%, an HPMC volume admixture of 0.20%, and a fiber volume admixture of 0.5%. As a consequence of this optimization, the GBFS-HPMC/fiber pervious concrete exhibited a 7.2% increase in cubic compressive strength, a 2.1% increase in split tensile strength, and a 2.5% increase in flexural strength. Additionally, the permeability coefficient decreased by 5.5%, and porosity decreased by 3.6%. Notably, the optimized water permeability still complies with the specified requirements, thereby enhancing the material’s mechanical properties. These findings establish a theoretical foundation for the promotion and application of pervious concrete.


The advance in digital diagnostic technologies has significantly facilitated the detection of dental caries. Despite the increase in clinically available digital diagnostic aids for dental caries, there is yet to be a comprehensive summary of all available technology. This review aims to provide an overview of digital diagnostic aids for the clinical detection of dental caries, particularly those at an initial stage. Currently available digital diagnostic aids for caries detection can be classified into four categories according to the initial source of energy, including radiation-based aids, light-based aids, ultrasound-based aids, and electric-based aids. Radiation-based aids use ionizing radiation, normally X-ray, to produce images of dental structures. Radiation-based aids encompass digital bitewing radiography and cone beam computed tomography. Light-based aids employ light or laser to induce signals for the detection of the changes in the carious dental hard tissue. Common light-based aids include digital transillumination and light/laser-induced fluorescence. Ultrasound-based aids detect the signal of ultrasound waves to assess the acoustic impedance of the carious teeth. The ultrasound caries detector is an available ultrasound-based aid. Electric-based aids assess the changes in the electric current conductance or impedance of the teeth with caries. Available electric-based aids include electrical conductance measurement and alternating current impedance spectroscopy. Except for these clinically available digital diagnostic aids, many digital diagnostic aids for caries detection are still under development with promising results in laboratory settings. Dental caries, commonly known as tooth decay, is notably one of the most prevalent chronic diseases . It is tUndetected initial caries that later develop into deeper carious lesions might contribute to the high global prevalence of caries . The curThe most common and conventional method of detecting early caries is the visual-tactile technique . This apDue to the limitations of conventional caries detection approaches, the demand for novel caries detection approaches has emerged. Various technologies have been developed, particularly novel digital diagnostic aids that can identify lesions at an early stage. Digital aids are devices that utilize digital data for caries diagnosis and have become increasingly popular in various industries. Consequently, this review aims to provide an overview of digital diagnostic aids for the clinical detection of initial dental caries.A comprehensive literature search was performed using keywords ((early caries) OR ) AND  OR (light) OR (laser) OR (fluorescence) OR (transillumination)) AND ((Detection) OR (Assessment)) on the Pubmed, Scopus, and Web of Science databases. The keywords were chosen after an initial screening of articles related to digital diagnostic aids for caries. Several keywords including “light”, “laser”, “fluorescence”, and “transillumination” were found to be recurring in most articles. We have also included studies targeting early caries or initial lesions as this type of caries is the most difficult to detect and digital aids would be most useful in this case. Studies published on and before 31 December 2022 were selected and retrieved.A total of 1666 results were retrieved with 577 papers in Pubmed, 481 publications in Web of Science, and 608 publications in Scopus. After removing duplicates, 650 publications were included for further assessment. The titles and the abstracts of the studies were screened to include studies on digital diagnostic aids for the detection and assessment of dental caries . The artThe literature search identified 190 articles discussing various digital diagnostic aids that can be used for initial dental caries detection. Several digital diagnostic aids are clinically applicable with commercial products available . These dApart from these clinically available digital diagnostic aids, many digital aids for dental caries are still under development. These include optical coherent tomography, laser-induced thermal imaging, laser-induced acoustic spectroscopy, laser-induced breakdown spectroscopy, frequency-domain laser infrared photothermal radiometry, and modulated luminescence technology. Novel strategies that enhance the accuracy in the interpretation of the results of digital diagnostic aids are also under development. X-ray, which is a form of electromagnetic radiation with specific wavelengths ranging from 10 nm to 0.01 pm, was introduced in the 1890s for the detection of dental caries . Over tiDigital bitewing radiography uses photographic film or digital detectors to capture images when X-rays interact with the emulsion on the film . DigitalThe accuracy of digital bitewing radiography varies largely, as reported by clinical studies on permanent teeth. Bitewing radiographs have a sensitivity of 0–0.93 ,20,21 anDental cone beam-computed tomography (CBCT) utilizes a cone or pyramid-shaped X-ray beam with mostly flat panel detectors to construct three-dimensional high-resolution images that can be viewed in frontal, sagittal, and axial planes . CBCT caThe accuracy of CBCT in detecting dental caries has shown considerable variability across different studies in the literature. Several in vitro studies showed that CBCT did not provide superior diagnostic accuracy in detecting enamel and dentine caries when compared with bitewing radiography ,26,27. NLight-based diagnostic aids employ various types of light or laser to generate signals and detect the changes of signals in carious teeth. Three major categories of light-based diagnostic aids are now available, including digital transillumination, light-induced fluorescence, and laser-induced fluorescence.Transillumination is a technique of transmitting light through body tissues and assessing the density and composition of the tissue through the intensity of light . CariousDigital transillumination is especially useful when detecting approximal caries . DigitalMost of the studies on the accuracy of digital transillumination were performed on proximal caries. Digital transillumination showed sensitivity at 0.44–0.991 and specificity at 0.61–0.941 when detecting proximal caries in clinical studies ,37. Light with various wavelengths has been used to induce fluorescence in caries lesion, including ultraviolet light 100–400 nm), the green–yellow end of the visible light (370 nm), the blue–violet end of the visible light (400–450 nm), and near-infrared light  ,39,40. F0 nm, theLight-induced fluorescence can be applied to multiple surfaces of the carious tooth, including the occlusal surface, the buccal/lingual surface, or the proximal surface with reasonable interproximal space. It enables the quantification of the mineral loss in the caries lesion by capturing the average loss of fluorescence in carious tooth tissues compared with sound enamel and converting the loss of fluorescence into mineral density ,44. It aClinical studies on the diagnostic accuracy of light-induced fluorescence are mostly based on devices that employed the blue–violet end of the visible light spectrum 400–450 nm). The accuracy of diagnostic aids adopting blue–violet light-induced fluorescence varies with the sites for detection. The sensitivity and specificity for occlusal caries were reported to be 0.26–0.92 and 0.41–0.1, respectively 0 nm. The,46. For Laser-induced fluorescence employs a red-light laser at a wavelength of greater than 655 nm to stimulate fluorescence in carious tissues . Laser iLaser-induced fluorescence can detect carious lesions from various sites of the tooth, including occlusal surfaces, smooth surfaces, and proximal surfaces. It can estimate the depth of the carious lesion and display a value from 0 to 99, in which lower scores indicate healthy tissues and higher scores reflect the need for restorative treatment ,51. It sPrevious studies found that laser fluorescence presented a sensitivity value of 0.48–1 and a specificity value of 0.2–1 ,46,52,53The use of electricity to detect caries was first proposed by Emile Magitot in 1878 . ElectriThe electrical conductance measurement device uses a single, fixed-frequency alternating current to measure the electrical conductance of a carious tooth . The meaThe electrical conductance measurement device allows for the detection of both non-cavitated and cavitated caries lesions on occlusal, proximal, and smooth surfaces. Since the reading correlates to the loss of minerals and increased porosities, electrical conductance measurement enables the assessment of caries severity with a quantitative approach. Moreover, this diagnostic aid can differentiate caries and stains, which visual and fluorescence methods may pick up on . HoweverResearch on electrical conductance measurement is limited . An in vAlternating current impedance spectroscopy measures the impedance or the resistance of the teeth to alternating current. This detection method utilizes multiple frequencies of electricity to produce a spectrum of values, providing more information on the physical and chemical properties of a tooth . A sensiUltrasound has been introduced into dentistry as a diagnostic tool for caries detection by detecting the difference between sound and demineralized hard tissue through the sonic conductivity of longitudinal ultrasonic waves. It utilizes ultrasonic waves which can be transmitted on smooth, flat, or curved hard tissue surfaces. Ultrasound-based diagnostic aids have been developed into a prototype as ultrasonic caries detector. Ultrasonic Caries DetectorThe ultrasonic probe of the ultrasonic caries detector can be placed at a certain angle to detect caries lesions, particularly approximal carious lesions ,61. UltrThe accuracy of ultrasonic caries detectors was reported in a limited number of studies. Its sensitivity and specificity value for approximal caries were reported to be 0.82 and 0.75, respectively .Although several digital diagnostic aids are available, all of them present certain levels of limitation and cannot be applied in all scenarios. Moreover, none of them have presented an ideal performance in detecting dental caries, especially for caries in an early stage. Therefore, many novel digital diagnostic aids for dental caries are under development. The following digital diagnostic aids have the potential for clinical use, but currently no mature products are available. Optical coherence tomography (OCT) produces two or three-dimensional images based on the tissue’s optical absorption and scattering properties . The imaSwept-source (SS-)OCT can be used for caries detection. It has increased image resolution, speed of imaging, and sensitivity compared with traditional OCT systems . A near-Apart from the laser-induced fluorescence, lasers can be used to induce other signals for caries detection. A laser can induce thermal signals, acoustic signals, photonic signals, etc., on the tooth surface to facilitate caries detection. Thermal imaging technology is based on the principle that the degree of porosities in a carious lesion affects the amount of water stored in a tooth and, therefore, its temporal profile . The temPhotothermal radiation (PTR) utilizes modulated thermal infrared response, also known as the black body or Plank radiation, which results from a specimen that is repeatedly irradiated. The emitting black body or Plank radiation is the thermal electromagnetic radiation within or surrounding that specimen when it is in thermodynamic equilibrium with its environment. It has a specific constant and intensity that depends solely on the temperature of the specimen. When the specimen absorbs radiation energy, it is converted into thermal energy which can be observed as a change in temperature of the specimen surface. This energy conversion can be measured by an infrared detector using the PTR signal . Recent Frequency-domain laser infrared photothermal radiometry and modulated luminescence technology (FD-PTR/LUM) can detect pit and fissure caries up to 5 mm below a tooth surface. According to an in vitro study, this technology can effectively differentiate between sound teeth surfaces or lesions on the outer half of enamel and lesions extending to the middle of the enamel or deeper . StudiesCaries detection can be achieved via laser-induced breakdown spectroscopy (LIBS) with neodymium-doped yttrium aluminium garnet (Nd: YAG) laser. This approach analyses the spectral changes of element contents in a tooth sample, typically in enamel. Enamel consists of matrix elements such as calcium and phosphorus in the form of hydroxyapatite and non-matrix elements, such as potassium, magnesium, zinc, and carbon. . Each elLaser-induced acoustic spectroscopy can evaluate dental hard tissue’s properties and thickness for the diagnosis of dental caries. When a tooth is irradiated with a pulse laser, the laser energy would be absorbed leading to an increase in localized temperature and thermal expansion, causing the excitation of acoustic waves . A decayNovel strategies that enhance the accuracy in the interpretation of the results of digital diagnostic aids have also been developed. These diagnostic interpretation aids were applied based on the caries-detecting results of the digital diagnostic aids. For example, automatic exposure compensation (AEC) is an ancillary digital tool to improve image quality and the accuracy of diagnosis for digital intraoral radiographs ,81. ArtiWhile this review provides a comprehensive overview of the various digital diagnostic aids clinically available for the detection of dental caries, its limitations should be addressed.Many clinically available digital caries diagnostic aids are recently developed and there is still limited clinical data with regards to their diagnostic accuracy and the potential impact on clinical application such as patient experience and satisfaction. The financial and practical implications of adopting these diagnostic aids were not fully discussed as well. It is very much anticipated that further research can be conducted to develop and test efficient and effective caries diagnosis in the future.This review focuses on the introduction of digital diagnostic aids and their clinical application. It should be noted that some strategies that enhanced the accuracy in the interpretation of the results of the digital diagnostic aids has also been developed. For example, automatic exposure compensation (AEC) is an ancillary digital tool to improve image quality and the accuracy of diagnosis for digital intraoral radiographs ,81. ArtiDigital diagnostic aids for dental caries detection have been evolving. Radiation-based aids, light-based aids, ultrasound-based aids, and electric-based aids are now available as digital diagnostic aids for dental caries detection. These available digital diagnostic aids present advantages and certain levels of limitation. They facilitate caries detection for clinicians by acting as supplementary approaches to conventional caries detection. However, none of them have presented an ideal performance in detecting dental caries, especially for caries in an early stage. Therefore, various novel digital diagnostic aids for dental caries are under development and show potential for clinical application. Furthermore, this review aims to allow clinicians a more comprehensive review of currently available digital diagnostic aids, and to acknowledge and compare various listed novel technologies to facilitate easier early caries detection, and the subsequent prevention of dental caries.


In the era of antibiotic overuse and increasing antibiotic resistance, there is a gap in evidence regarding antibiotic stewardship, and in particular, perioperative antibiotic prophylaxis after urethral reconstruction. The aim of this systematic review was to evaluate the effectiveness and relevance of postoperative antibiotic prophylaxis after male pediatric and adult urethral reconstruction. An online search of MEDLINE database via PubMed was performed. The systematic review was registered in PROSPERO (CRD42022348555) and was conducted according to the PRISMA guidelines and AMSTAR 2 checklist. A narrative synthesis of included studies was performed. After the screening of 1176 publications, six studies regarding antibiotic prophylaxis after hypospadias reconstruction and two studies regarding antibiotic prophylaxis after urethroplasty in adults were eligible to be included in the systematic review. All but one of the studies on hypospadias repair showed no benefit from postoperative antibiotic prophylaxis. The level of evidence on postoperative antibiotic prophylaxis after urethroplasty in adults is low. Neither of the two studies included in the review showed a benefit from antibiotic use. Postoperative prophylaxis after hypospadias repair is not effective in preventing urinary tract infections and wound infections. It seems that the use of postoperative prophylaxis after urethroplasty in adults is also not beneficial, but there is a high need for high-quality scientific data. Urethral stricture disease (US) is a common urological condition in men. Although rigorous epidemiologic data is sparse, the existing papers report an incidence varying between 0.6 and 1.4 percent. Urethral strictures can occur throughout the entire length of the urethra but mainly involve the anterior urethra and, in particular, the bulbar segment. Reconstructive urethral surgery is the gold standard in the treatment of US in males as well as other urethral abnormalities such as urethrocutaneous fistulae, diverticula, and congenital defects, including hypospadias . EndolumThere is proof that up to 50% of prescribed antibiotics are used unnecessarily or inadequately . AdditioUrinary tract infection (UTI) and wound infection are common after urethroplasty and may lead to surgical failure or distant complications . Thus, bThe systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Cochrane Handbook for Systematic Reviews of Interventions. The study protocol was registered with PROSPERO (CRD42022348555).antibiotics OR anti-bacterial agents OR antibiotic prophylaxis OR urinary tract infection OR wound infection) AND . The search included articles without time limitations. Only publications in English were considered and evidence was limited to human data. Moreover, all references within retrieved articles were screened for additional relevant articles.A systematic search was conducted independently by two authors (Ł.B. and M.R.) through the PubMed electronic database according to the PRISMA statement . The lasThe inclusion criteria for this systematic review were as follows: randomized controlled trial, prospective or retrospective cohort study, male urethral reconstruction, and full-text publication in English. Reviews, case reports, letters to the editors, conference abstracts with no full text, and commentaries were excluded.After the removal of duplicates, two authors (Ł.B. and M.R.) independently evaluated the titles and abstracts of the retrieved records. All potentially eligible studies were evaluated as full text if available. Disagreements were resolved by consultation with the senior author (M.S.).After the screening of 1176 publications, eight were eligible to be included in this systematic review. Six studies assessed postoperative antibiotic prophylaxis after hypospadias repair . The stuPostoperative antibiotic prophylaxis after urethroplasty was a subject of two studies . Both stIn the face of growing antibiotic resistance, every possible effort should be made to promote adequate and reasonable use of antimicrobial therapy. Single-dose periprocedural antibiotic prophylaxis is currently recommended for all patients undergoing open urological surgery . HoweverA Cochrane review of antibiotic prophylaxis for short-term urinary catheter bladder drainage points out that there is a limited data suggesting a reduced rate of bacteriuria and symptomatic UTI in surgical patients receiving antibiotic prophylaxis who undergo bladder drainage for at least 24 h postoperatively . Also, mWe were able to bring to light fairly strong evidence regarding the use of postoperative antibiotic prophylaxis after hypospadias repair in children. According to Hsieh et al., pediatric urologists in the US employ antibiotic prophylaxis in clinical practice at significantly different rates . In hypoWithin the topic of postoperative antibiotic prophylaxis after urethroplasty, we only found two studies evaluating infectious complications. Neither of them was a randomized trial, so the level of evidence is low. Antibiotic prophylaxis was not reported to reduce the rate of UTI or wound infection in any of the studies. However, even patients in the “no postoperative antibiotic prophylaxis” groups received antibiotics around the time of catheter removal. The duration of catheterization after urethroplasty is a matter of debate ,36, yet It is also worth mentioning that we currently do not have reliable data on the possible effect of postoperative antibiotic prophylaxis after urethroplasty on the recurrence of US or patient-reported treatment satisfaction after surgery. None of the studies enclosed in the systematic review assessed the possible effect of antibiotic prophylaxis on stricture recurrence. On the other hand, preoperative bacteriuria may increase the risk of recurrence, according to the study by Roehrborn et al. . It is nIn conclusion, the administration of postoperative antibiotic prophylaxis after pediatric hypospadias repair does not result in additional reduction of complications and should, therefore, not be routinely used. The postoperative antibiotic prophylaxis after urethral reconstruction in adults does not seem to be beneficial in terms of preventing UTIs and wound infections; however, the quality of evidence in this topic is low. Therefore, there is a great need for high-quality scientific data such as a randomized trial that could unequivocally assess the appropriateness of postoperative antibiotic prophylaxis in the prevention of UTIs, postoperative wound infections, and most importantly, their impact on urethral stricture recurrence and treatment satisfaction.


However, it is worth noting that the addition of too many fibers also had a negative effect on the strength of the rubber concrete. Additionally, the scanning electron microscopy (SEM) results indicated that the fibers restricted the formation of microcracks in the microstructure and curtailed the brittleness of the concrete. This study can provide a valuable reference for the application of environmentally friendly material fibers in recycled aggregate concrete.Rubber concrete (RC) is a new type of concrete that is currently receiving a lot of attention, solving serious pollution problems by grinding waste tires into granules and adding them to concrete. However, rubber concrete has deficiencies in mechanics and durability, and has been reinforced by adding fibers in many studies. In this study, the mechanical and durability properties of rubber concrete with added polypropylene and basalt fibers (PBRC) were investigated in a series of experiments including apparent morphology, mass, static compressive and tensile tests, ultrasonic non-destructive testing, and scanning electron microscope (SEM) tests under coupled environments of sulfate attack and freeze–thaw. The results showed that the mass loss rate of RC and PBRC gradually increased with the number of freeze–thaw cycles, with more pits and cement paste peeling from the specimen surface. Moreover, the compressive and splitting tensile strengths of RC and PBRC groups exhibited distinct trends, with the former group showing a lower residual strength relative to the latter. The residual compressive strength of the RC group was only 69.4% after 160 freeze–thaw cycles in 5% MgSO Concrete is one of the most widely used building materials in the world and consumes a huge amount of resources every year . At the For the construction industry, using rubber to improve the inherent properties of concrete is an effective method. The results show that rubber concrete is superior to ordinary concrete in impact resistance ,6, chlor3 PVA fiber increases splitting tensile strength and cracking resistance. Recently, researchers have conducted extensive studies on composite fiber and crumb rubber concrete to explore the synergistic effect between them. Alwesabi [Therefore, mitigating the reduction in the mechanical properties of concrete can maximize the benefits of adding rubber to concrete. The use of fibers helps to improve the properties of concrete, which can compensate for the reduction in mechanical properties due to the addition of high percentages of rubber ,18,19. WAlwesabi  used a mAlwesabi  introducAlwesabi  evaluate3 significantly improved the frost resistance of concrete without reducing the compressive strength and elastic modulus. Mohajerani [At the same time, as a building material, concrete durability research cannot be ignored, especially the damage to buildings under freeze–thaw erosion conditions ,25,26. Mhajerani  believedhajerani  found thThis study aims to improve the salt freeze–thaw resistance of rubber concrete by adding polypropylene and basalt mixed fibers. The slow freezing experiment method was used to study the apparent deterioration, mass loss rule, mechanical property change, and loss degree analysis of fiber-reinforced rubber concrete under the sulfate freeze–thaw coupling environment. Finally, the influence of fibers on the properties of concrete at the microscopic level was analyzed by scanning electron microscopy (SEM). This research is helpful to improve the utilization degree of solid waste in concrete, which is of great significance to environmental protection and natural resource conservation.3, an apparent density of 2570 kg/m3, and a mud content of <1.0%. The particle size curves of coarse and fine aggregates are given in 3 and a water-reducing rate of 27.4%. The chemical composition of the cement is given in 3. The basalt fiber (BF) is produced by Shanxi Xuanwu Company, with a length of 18 mm. The polypropylene fiber (PPF) is produced by Xinya Construction Technology Company and is in the shape of a bundled monofilament with a length of 10 mm. The specific image of the fiber is shown in Coarse aggregate is continuously graded crushed stone with a particle size of 5–20 mm, and the mud content is less than 0.2%. The fine aggregate is natural river sand with a fineness modulus of 2.52, a bulk density of 1450 kg/mThe concrete used in the test adopts the same water–cement ratio. According to the “Common Concrete Mix Proportion Design Regulations”, after many laboratory trials, W/B = 0.383 is finally determined. The concrete foundation mix ratio is given in 2 solution at (20 ± 2) °C for 28 days.The concrete used in the test was mixed by a horizontal mixer, and the flow chart of the preparation of the concrete specimens is shown in (1)2 solution, rinsed with clean water, grouped, and numbered, and the initial mass and wave velocity of the specimens were measured, both of which should be wiped off with a wrung-out wet towel before starting the subsequent operation, and finally the apparent form of each group of specimens was photographed and recorded.The concrete specimens cured for 28 days were taken out from the saturated Ca(OH)(2)2SO4 solution and 5% MgSO4 solution, and install a heating device to ensure that the liquid temperature of the concrete specimens immersed in the water tank during the thawing period is maintained in the range of 18–20 °C, as shown in Prepare several water tanks, pour in a certain amount of water, 5% Na(3)In the “Slow freezing method” freezing test, using 100 mm × 100 mm × 100 mm cubic specimens, the number of freeze–thaw cycles is set to 40 times, 80 times, 120 times, and 160 times in a turn. Each cycle uses 8 h freezing + 4 h thawing, freezing in the freezing test chamber maintains the temperature in the range of −20~−18 °C, and the freezing and thawing process of temperature conversion control takes 30 min to complete, as shown in (4)After each completion of 20 cycles, the weighing of specimens was carried out. Wave velocity, appearance, and mechanical tests (compressive test and splitting tensile test) were carried out promptly after the completion of the predetermined number of cycles, the damaged specimens were collected after the mechanical tests, and samples were made for SEM tests.(1) Compressive testConcrete cube compressive strength test and splitting tensile strength test, both using the side length of 100 mm cube specimen. The loading apparatus is a WAW-1000 microcomputer-controlled electro-hydraulic servo universal testing machine, using displacement as the speed control index of loading, the loading rate of the compressive strength test is 3 mm/min, and the preload force is set to 500 N; the loading rate of the splitting tensile strength test is 1 mm/min, and the preload force is set to 50 N. The formulae for calculating the compressive strength and splitting tensile strength of concrete are given below.F is the peak load when the concrete specimen is damaged, N; A is the compressive area of the concrete specimen, A is the compressive area of the concrete specimen, mm2; and F—breaking load, N; A—the area of splitting surface, mm2 (2).(2) Non-destructive testingThe damage to the concrete is analyzed by measuring the wave velocity of the specimen before and after the erosion freeze–thaw cycle with a non-metallic ultrasonic testing analyzer. In order to quantify the damage to the concrete specimens after erosion freeze–thaw cycles, the relative wave velocity n is the number of freeze–thaw cycles, n freeze–thaw cycles.(3) Mass lossThe mass loss rate of concrete under coupled erosion freeze–thaw action is calculated by Equation (5).n is the number of freeze–thaw cycles, 4 solution on the concrete, the most severe apparent damage was observed for the same specimens in the 5% MgSO4 solution, while the damage in clear water and 5% Na2SO4 solution was not significant. In order to show more visually the changes in the appearance of the concrete and to record the damage between every 40 freeze–thaw cycles, the changes in the appearance of the concrete specimens in 5% MgSO4 solution are given in Due to the dual erosive effect of magnesium and sulfate ions in the MgSO4 solution show pits of various sizes on the surface and a small amount of cement paste spalling at local locations, and that the erosion effect has become more pronounced with increasing fiber admixture for the three groups of specimens after P3B3. After 80 freeze–thaw cycles, the cement paste spalling on the concrete surface has increased, while the surface has become rough due to the exposure of sand particles, the number of pits has increased, and the volume of the original pits has increased, and especially on the upper surface of the specimen, more deep pits have been formed, but the coarse aggregate has not been exposed. After 120 freeze–thaw cycles, the surface of the concrete specimen has become rougher, the mortar particles have flaked significantly, even a small amount of coarse aggregate has been exposed and has slightly dropped, and the fibers have been gradually revealed. After 160 freeze–thaw cycles, the surface cement paste of the concrete specimens has produced a large area of spalling, the phenomenon of exposed coarse aggregate is significant, and the situation of falling corners has increased. However, at this time, the P3B3 group’s apparent form is still relatively intact; when the mixed fiber dosing is low, the specimen surface cement mortar layer spalling is more serious, while the high dose specimen surface pits show a serious situation.It can be observed in the figure that after 40 freeze–thaw cycles, the concrete specimens in 5% MgSOComprehensive analysis of the concrete surface damage and the incorporation of fibers shows that when the total amount of fibers is not large, it can effectively delay the surface cement paste and fine aggregate spalling, so that the apparent form of the test specimens remains more complete, including the P3B3 group. When the total amount of fibers is too large, the surface of the specimen is damaged more seriously and will be damaged prematurely.2SO4 solution, and 5% MgSO4 solution, as shown in Since the mass loss rate changes among R5, P1B1, and P4B4; P2B2 and P3B3; and P5B5 and P6B6 were all relatively similar, the three groups with the greatest variability were specifically selected as R5, P3B3, and P6B6, respectively, to plot the respective mass loss change curves under the action of freeze–thaw cycles in clear water, 5% Na4, the most severe erosion effect, the mass loss rates of R5, P3B3, and P6B6 in 5% MgSO4 were 2.62%, 2.04%, and 2.9%, respectively, and the P3B3 group was reduced by 28.4% and 42.1%, respectively. At the right admixture, the incorporated fibers make the concrete denser and less porous and due to the lack of open pores, the salt solution only penetrates in a shallow range below the concrete surface, and the content decays rapidly when the erosion ions enter the concrete interior. However, the agglomeration of fibers at large dosing levels and the agglomeration of polypropylene fibers float very easily, resulting in more severe damage to P6B6 compared to R5. Additionally, the mass loss rate of P3B3 is higher than in the experiments in clear water and 5% NaSO4 due to the double erosion of SO42− and Mg2+ in the MgSO4 solution.It can be observed from the figure that the mass loss rate of each group of specimens continues to rise as the number of freeze–thaw cycles increases. The mass loss is mainly due to the specimens being filled with water; when the internal pores are filled with water, and the temperature drops, the water freezes into ice and the volume expands to produce the freezing and swelling force, and with the repeated freeze–thawing, the cement paste on the surface of the specimens together with the sand and gravel aggregates begin to gradually fall off. In all three solutions, the mass loss rate of the P3B3 group was significantly lower than the other groups. After completing 160 freeze–thaw erosions in 5% MgSOFrom 2SO4 solution and 5% MgSO4 solution. Unlike in water, in 5% Na2SO4 solution and 5% MgSO4 solution, the concrete strength increased in the first period of the freeze–thaw cycle, which is due to the reaction between sulfate solution and cement hydration products to generate calcium alumina to fill some of the pores inside the concrete, while the hydration reaction in the concrete still continues, both of which greatly improve the compactness of the concrete structure, while the freeze–thaw damage at this time is relatively small, which is manifested as an increase in compressive strength macroscopically. After 160 freeze–thaw cycles, the compressive strength of the reference group R5 in water, 5% Na2SO4 solution, and 5% MgSO4 solution decreased by 21.35%, 24.76%, and 30.44%, respectively, with the most severe loss of compressive strength in 5% MgSO4 solution and the lowest rate of compressive strength loss in water. The P4B4 group had the highest residual rate of compressive strength after freeze–thaw cycling in both 5% Na2SO4 solution and 5% MgSO4 solution, reaching 83.49% and 80.16%, respectively.Freeze–thaw cycles and sulfate attack will lead to the formation and expansion of cracks, and the most important function of the fibers is to stop the cracks. The disorderly distribution of fibers and concrete matrix are closely bonded to play a suppressive role in the formation and expansion of cracks, while the fiber “bridging” role can also limit the expansion of pores, so incorporation of the fiber into concrete can effectively mitigate damage due to sulfate erosion and freeze–thaw cycles, delaying the damage to the concrete. However, in large amounts, the frost resistance and corrosion resistance of concrete are reduced, due to the fact that the positive effect of the fiber no longer exists, while the negative effects (such as fiber agglomeration) will increase the initial defects of concrete, aggravating the damage caused by sulfate attack and freeze–thaw cycles on the concrete.As can be seen from 2SO4 solution and 5% MgSO4 solution were similar. The tensile strength of concrete with suitable fiber content showed a significant increase, and the strength of P2B2 and P3B3 was higher than the other experimental groups, especially the control group R5, in the early and late stages of freeze–thaw cycles. After 160 freeze–thaw cycles in 5% MgSO4 solution, P2B2 and P3B3 improved by 69.7% and 56.7%, respectively, compared with the control group. In addition, under the condition of large fiber content, the splitting strength of the experimental group was still higher than the control group without fiber after 160 freeze–thaw cycles, which proved that the improvement of concrete splitting strength was significant with fiber. The addition of mixed fibers in concrete can play a role in transmitting force and absorbing energy, thus improving the tensile properties of concrete and avoiding stress concentration. Sulfate erosion and freeze–thaw cycles continue to produce many microcracks inside the concrete, and mixed fibers, due to their greater tensile strength and modulus of elasticity, can be bridged at the crack inhibition, crack generation, and expansion to improve the tensile strength and crack resistance of concrete.The splitting tensile strength patterns of concrete specimens in 5% Na2SO4 solution, and 5% MgSO4 solution. For the same specimens, the highest damage was found in 5% MgSO4 solution, followed by 5% Na2SO4 solution, and the lowest in water; for the same solutions, the specimens with the highest and lowest damage in water were R5 and P3B3, the specimens with the highest and lowest damage in 5% Na2SO4 solution were P6B6 and P3B3. The specimens with the smallest damage in 5% MgSO4 solution were P6B6 and P4B4, which roughly corresponded to the pattern of compressive strength loss and splitting tensile strength loss after 160 cycles. The P3B3 group with the smallest degree of loss had a loss of 0.058 after 160 freeze–thaw cycles in water, which was 62.3% lower than that of the R5 group (0.154). The addition of an appropriate amount of fibers can reduce the damage degree of concrete after experiencing coupled erosion freeze–thaw cycles, but it is worth noting that the excessive use of mixed fibers can also increase the loss degree. Taken together, group P3B3 demonstrates the optimum amount of mixed fibers to be added.The microstructure of the concrete was observed by scanning electron microscopy, and the images obtained are given in In this study, the effects of the number of freeze–thaw cycles, the type of erosion solution, and the mixed fiber content on the mass loss rate, apparent morphology, relative wave velocity, and mechanical properties of rubber concrete were investigated. In contrast to previous studies, different solution types and fiber types were mentioned. The following conclusions can be drawn.(1)4 solution, and the deterioration in clear water and 5% Na2SO4 solution is similar. Appropriate dosing of fibers can effectively prolong the occurrence of spalling in cement paste and fine aggregate on the surface. Nevertheless, an excessive total fiber dosage can aggravate surface damage of the specimens, causing premature failure.For the same specimen, under a certain number of freeze–thaw cycles, the apparent deterioration is most serious in 5% MgSO(2)With the increase in the number of freeze–thaw cycles, the mass loss rate of the specimens in each group showed an overall increasing trend, with a maximum of 2.87%. The mass loss rate of the P3B3 group was significantly lower than that of the other groups, which was only 2.03%. Adding fibers can increase the compactness of concrete, but when a large amount is added, the fibers agglomerate easily, resulting in quality loss.(3)The strength of the concrete decreased with the increase in the number of cycles, but the rubber concrete mixed with 0.2% BF and 0.1% PPF showed better residual compressive strength and splitting tensile strength due to the bridging effect and crack arresting effect of the mixed fibers 41.3 Mpa and 3.26 Mpa, respectively. However, with the continuous increase in fiber content, the mechanical properties showed the same deterioration trend.(4)The damage degree and strength loss rate of each specimen are relatively similar, and the damage degree under high fiber content is not decreasing but increasing compared with the reference group, and the damage degree is smaller with suitable fiber content. The degree of damage to concrete has a greater impact on the mechanical properties after freeze–thaw cycles, and the greater the degree of damage, the higher the strength loss.(5)The microstructure of the specimens after salt freeze–thaw cycles was observed by SEM. Fibers play a bridging role in the microstructure, which can prevent crack expansion and stress concentration. The contact between the fibers and the cement matrix is critical, and voids between the fiber bundles and the cement matrix can lead to fiber failure and affect the concrete performance.


Background: In 2021, the CDC awarded >$100 million to 62 state, local, and territorial health departments (SLTHDs) to expand antibiotic stewardship expertise and implement antibiotic stewardship activities in different healthcare settings. Our objective was to describe SLTHD antibiotic stewardship personnel and activities to characterize the impact of the funding. Methods: SLTHDs submitted performance measures, including quantitative and qualitative responses, describing personnel supporting antibiotic stewardship activities, types of activities, and healthcare facilities and professionals engaged from January through June 2022. A quantitative analysis of performance measures and qualitative thematic analysis of select narrative responses are reported. Results: Most SLTHDs  submitted performance measures. Among them, 37 (64%) reported identifying an antibiotic stewardship leader or coleader; most were pharmacists (57%) or physicians (38%) with infectious diseases training (68%) (Table 1). Of the remaining STLHDs, 20 reported barriers to identifying a leader or coleader, including hiring process delays and programmatic barriers (Table 2). SLTHDs reported 254 antibiotic stewardship activities; most reported activities involving multiple activity types (44%). Education and communication  was the most common single activity (30%), followed by antibiotic use tracking and reporting (13%), assessment of antibiotic stewardship implementation (8%), and action and implementation  (4%). The highest number of activities were implemented in multiple healthcare settings (35%), followed by acute care (21%), outpatient (18%), long-term care (17%), and other (9%) . SLTHDs reported engaging 4,970 healthcare facilities and 15,194 healthcare professionals in antibiotic stewardship activities across healthcare settings, to date, as part of this funding opportunity . Conclusions: Antibiotic stewardship funding to SLTHDs allowed for increases in capacity and expanded outreach to implement a variety of antibiotic stewardship activities across multiple healthcare settings. Sustaining STLHD antibiotic stewardship activities can help increase engagement and coordination with healthcare facilities, healthcare professionals, and other partners to optimize antibiotic prescribing and patient safety.Disclosure: None