The impermeable cover in urban area has been growing due to rapid urbanization, which prevents stormwater from being naturally infiltrated into the ground. There is a higher chance of flooding in urban area covered with conventional concretes and asphalts. The permeable pavement is one of Low-Impact Development (LID) technologies that can reduce surface runoff and water pollution by allowing stormwater into pavement systems. Unlike traditional pavements, permeable pavement bases employ open-graded aggregates (OGAs) with highly uniform particle sizes. There is very little information on the engineering properties of compacted OGAs. In this study, the moduli of open-graded aggregates under various compaction energies are investigated based on the Plate Load Test (PLT) and Light-Weight Deflectometer (LWD). Artificial Neural Network (ANN) and Linear Regression (LR) models are employed for estimation of the moduli of the aggregates based on the material type and level of compaction. Overall, the moduli from PLT and LWD steeply increase until the number of roller passes reaches 4, and they gradually increase until the number of roller passes becomes 8. A set of simple linear equations are proposed to evaluate the moduli of open-graded aggregates from PLT and LWD based on the material type and the number of roller passes. The rainfall pattern changes globally due to climate change, and therefore the rainfall can be much more intense than in the past. In addition, the impermeable cover in urban areas has been growing due to rapid urbanization ,2. OwingA permeable pavement has a surface layer that is in direct contact with the vehicle load. In addition, it has a base layer supporting the surface layer that disperses the vehicle load transmitted through the surface layer ,8,10. CoIn recent years, due to the implementation of mechanistic-empirical pavement design procedures (MEPDG) , modulusVarious studies regarding these devices or test methods have been conducted focusing on conventional road embankment construction materials. These studies have explored the feasibility of LWD, SSG, and DCP in compaction quality control during the construction based on laboratory or field experiments ,26,27,28v1 (primary strain modulus) and Ev2 (secondary strain modulus), respectively. The configuration of the test equipment is shown in The PLT is a test that evaluates the mechanical properties of the ground based on the relationship between the load and the settlement after applying a load through the rigid loading plate to the ground where the structure is installed. It is used to evaluate the stiffness of roads and the ground . The tesLWD is the elastic modulus evaluated using the LWD. The elastic modulus is one of the indicators of the stiffness of the ground. It is a method to evaluate the compaction of the ground. Compared to the PLT, this test method has the advantage of being a simple test method with a short test time and portability [LWD.The LWD measures modulus by dropping a falling weight at a certain height to its loading plate and measuring the maximum settlement of it. Etability . The conSeveral studies have been conducted using the PLT and LWD test to evaluate the modulus or compaction of conventional road base construction materials, which are dense-graded aggregates. Kim and Park  and Kim The modulus-based compaction quality control technique can be an effective means for evaluating the compaction quality of OGAs because it is difficult to measure the maximum dry density and on-site dry density of them. However, most research about modulus-based compaction quality control has been focused on the materials used in conventional road base materials, except for a few studies conducted by Choi  and ChoiThe base layer in a road pavement is installed directly below the surface layer, and it distributes the traffic load received from the surface layer . Since iIn the field test, three different kinds of OGAs were used: D40 (maximum particle size 40 mm), D25 (maximum particle size 25 mm), and D13 (maximum particle size 13 mm). These particle sizes approximately lie in a commonly used particle size range of the base materials of permeable pavements. The aggregates were prepared in an air-dried state with about 0.5% of water contents. D40 and D25 were mixed 1:1 to make D40 + D25, and D25 and D13 were mixed 1:1 to make D25 + D13. A backhoe was used for the mixing of the aggregate, and a backhoe bucket was used to measure the volume of those aggregates to be mixed. In the field test, a total of five types of aggregates were prepared as test materials and were used in the construction of the test site. The aggregate volume composition, basic properties, and particle size distribution of each material are shown in The test was planned as follows using the five aggregates described above. In order to investigate the change in the stiffness of the compacted aggregate layer depending on the number of roller passes performed using a compaction roller, a field testbed was constructed following the dimensions illustrated in LWD is the elastic modulus measured with the LWD test and Ev1 and Ev2 are the primary and secondary strain moduli, measured with the PLT test respectively. For each PLT, LWD tests were conducted twice, and therefore ELWD in the table is the average of two test results. There are five types of materials: D40, D40 + D25, D25, D25 + D13, and D13. Each of the materials is replaced with a numerical value of 1, 2, 3, 4, and 5, subsequently, to use as an input to the model. Areas A and B in The zone of influence of PLT is known as 1.5 to 2 times the diameter of the plate in the literatures based on experimental and numerical studies ,42. The v1, Ev2, and ELWD are plotted with respect to the number of roller passes and material type in v1 and Ev2 values steeply increase until the number of roller passes reaches 4. After 4 passes, Ev1 continues to increase with increasing number of roller passes with less steep rate, which was not the case for Ev2 and ELWD. During the first loading, the specimens are compressed and densified (or compacted), and therefore the second compression curve (or Ev2) is less sensitive to the number of roller passes. The first loading of the Plate Load Test also involves significant shear displacement, which does not happen during the second static loading or dynamic loading: Ev1 is more sensitive to the number of roller passes than Ev2 and ELWD overall. All three moduli, Ev1, Ev2, and ELWD, values nearly settle after the number of roller passes becomes 8. The number of roller passes 4, which is typically used in practice, may be an efficient number, but one may consider applying the number of roller passes 8 to achieve better stiffness for open-graded aggregates. The difference in measurements with LWD and PLT are due to different principles assumed for evaluation of the moduli. Therefore, the differences in measurement are owing to influence depth, loading rate, and the number of loading postulated for each evaluation method.The moduli EIt was attempted to evaluate the moduli of open-graded aggregates based on either ANN or Linear Regression ,46,47,48The human brain solves many problems that are difficult to solve using current information processing technologies. Studies have been performed to analyze and model the functional factors of the human brain that entail excellent thinking ability, memory, problem analysis, and solving ability ,51. MachThe data used to train the ANN were the material type, the number of roller passes, and the moduli measured via PLT and LWD. Two different ANN models, ANN1 and ANN2, were set and applied. The “ANN1” model entailed the material type and the number of roller passes as features (inputs), and the moduli evaluated via PLT and LWD as labels (outputs), as presented in LWD is the modulus from LWD, Ev1 and Ev2 are the moduli from PLT for loading and reloading, Nmat is the material type, and Nrp is the number of roller passes. On the other hand, the LR2 model formulates as follows:Simple LR models were implemented to account for the relationships between the features and labels which have been postulated in ANN1 and ANN2 models . ANN is Root mean square error (RMSE) values of the equations presented above are presented in The experimental data had a total of 80 sets, as presented in iM is the predicted, and iP is the baseline.RMSE (root mean square error) of the ANN and LR models were estimated to investigate overall performance of prediction of proposed models. RMSE is a statistical measure of the difference between the predicted and baseline, and can be equated as follows:LWD, Ev1, and E, the RMSE values for training (fitting) and testing (prediction) are quite close; during fitting and evaluation, the LR1 model produces similar level of errors. In the model ANN1, on the other hand, for ELWD and Ev2, the RMSE for testing is larger than that for training. When the testing RMSEs of two different models, ANN1 and LR1, are compared, RMSE of ANN1 is higher for ELWD, but RMSE of LR1 is higher for Ev1. One model is not necessarily superior to the other for prediction. The results of the model evaluations of ANN2 and LR2  or Intelligent Compaction (IC) refers to an innovative compaction technique which can perform field compaction simultaneously evaluating the stiffness of soil, and therefore compaction quality . There wThe modulus from the first loading curve of PLT was more sensitive to the number of roller passes than the moduli from the reloading curve of PLT and from LWD. It is due to the significant compressional and shear deformation that happens during the first loading of PLT, which does not appear during the reloading of PLT and dynamic loading of LWD.Overall, the moduli from PLT and LWD steeply increase until the number of roller passes reaches 4, and they gradually increase until the number of roller passes becomes 8. The number of roller passes 4, which is typically used in practice, may be an efficient number, but one may consider applying the number of roller passes 8 to achieve better stiffness for open-graded aggregates.The models that do have one less input (the modulus from LWD) actually performed a little better than the models with more inputs. When there is no good correlation between input and output , adding more input variables does not necessarily help the prediction of the model.A set of simple linear equations were proposed to evaluate the moduli of open-graded aggregates from PLT and LWD based on the material type and the number of roller passes. The predictions based on ANN models did not necessarily provide a better match with the baseline compared to LR models.The stiffness results of LWD and PLT and regression equations presented in this study may be taken as references when CCC operations are made in open-graded aggregates. The characteristics of open-graded aggregates of different sizes, shapes, and minerals should be further studied for reliable application of open-graded aggregates to the base of permeable pavements.In this study, the moduli of open-graded aggregates under various compaction energies were investigated based on PLT (Plate Load Test) and LWD (Light-Weight Deflectometer). Artificial Neural Network (ANN) and Linear Regression (LR) models were employed for estimation of the moduli of the aggregates based on the material type and level of compaction. The conclusions obtained are as follows:


In addition, the effects of the experiment parameters , heavy metal ion content , and the concentration of organics  acting on migration of ions and physiochemical properties of sediment, before and after electro-osmosis treatment were investigated. Mineral composition of the soil and its microscopic characteristics were analyzed by scanning electron microscopy. The results show that the 4.5% fulvic acid added in the sediment can enhance the migration ability of Cu2+ and Zn2+ ions through complexation, and simultaneously effectively reduce the formation of colloids with the average reductions of Cu2+ ions and Zn2+ ions being 28 and 11 mg/kg, respectively. While the dewatering capacity of the sediment with higher fulvic acid content is weaker, fulvic acid can effectively reduce the corrosion of the electrode during the electro-osmosis process, due to the film formed on the metal surface. Moreover, the fulvic acid in the organics can be combined with the aluminum and calcium produced by the hydration of the cement, delaying the hydration of the cement, while simultaneously decomposing the hydration product and hindering the hardening of the cement, thereby affecting and destroying the formation of the sediment’s structure and its strength.This study focuses on the treatment of heavy metal ions and achieving enhancement of river sediment, which is rich in organics. Fulvic acid was used as the main representative of organics in which to study the transfer of Cu Dredged sediment is a type of slurried waste dredged from the bed of rivers, lakes, estuaries, or coastal waters, usually featuring low strength and high compressibility. The dredging activities are normally performed to meet navigational needs or remove the contaminated deposits. With the rapid growth of Chinese industries, the annual production of sediment in China is up to 300 million tons and the number will continue to increase as reported ,2. The s2+, Pb2+, and Cu2+), cement hydration would be retarded. Organics such as fulvic acid can be bound to some potentially toxic elements (PTEs), such as Pb, Cd, Cu, and Cr through complexation, which results in the coexistence of heavy metals and organics [Various methods have been used to treat dredged sediment contaminated with heavy metals , which iorganics ,20,21. Oorganics ,25,26,27organics : electroorganics . HoweverThe adsorption retention capacity of heavy metal ions is dependent on ion species, ionic strength, pH, soil cation exchange capacity (CEC), organics, temperature, soil particle size, etc. ,30,31,322+, Zn2+) in the sediment treated by the electro-osmosis method, (2) to evaluate the effect of organics on the mechanical properties of the sediment treated by the S/S method. In the electro-osmosis tests, the Voltage and pH values were varied to assess the changes in heavy metal concentration and mechanical properties of sediment with various organics contents. In the S/S tests, the unconfined compression strength (UCS) test, a scanning electron microscope (SEM) test, and an X-ray deflectometer (XRD) test were conducted to elucidate the influence of organics contents on the strength and microstructure of solidified sediment.The objectives of this study were twofold: (1) to investigate the effect of organics (fulvic acid) on the migration of heavy metal ions  content of 2.5%. The particle size distribution of the sediment (size range: 0.3~5000 nm), which was determined using a Malvern Zetasizer NanoS90 laser particle size analyzer , is presented in The other basic properties of the sediment are summarized in Since the initial organics content in the sediment was relatively small, to evaluate the effects of organics on the effectiveness of electro-osmosis and solidification/stabilization (S/S), fulvic acid was used to represent organics and added to the sediment. For the solidification/stabilization method, the binder used was Portland cement with a 28-day compressive strength of 32.5 MPa.The electro-osmosis device was installed as in In addition, according to the investigation of the sediment characteristics of a river section heavily polluted by heavy metals in Ningbo city of China, the organics content was found to be about 7%. In the electro-osmosis experiment, 4.5% fulvic acid was added into the natural sediment, with an initial organics content of 2.5%. The test design is shown in 2O)n represents free metal ions in the solution, namely hydrated ions. L stands for fulvic acid molecule or charged ion; M(H2O)n−1L represents the complex that carries the metal ions, namely the coordination compound, and H2O represents the water molecule.Among them, Fulvic acid refers collectively to a set of organic acids, natural compounds, and components of the humus (CAS No. 479-66-3). They share a similar structure with humic acids, with differences being the carbon and oxygen contents, acidity, and degree of polymerization, molecular weight, and color. Fulvic acid is widely found in soil and water bodies  and sediment such as coal. In addition, fulvic acid is still a complexion agent with strong complexion ability, according to the complex reaction:2O) by removing the metal ion. The acid-substituted water group forms a fulvic acid complex with the metal ion for deposition.Equation (1) shows that the charged ion fulvic acid has a hydroxyl group, a carboxyl group and the likely complexes with a metal ion carried by a free water group, and the water group are released in the form of water  was used to carry out the unconfined compression strength (UCS) test. For different groups, an average of three strengths was used as the result of UCS. The experiment followed the procedure described in ‘JGJ/T 233-2011 Specification for mix proportion design of cement soil’. Following the UCS testing of each sample, adequate soil material in the middle of the cube sample was collected and dried for lead leaching and SEM tests.To investigate the effect of stabilization, a SEM analyzer Quanta 650FEG  and an X ray diffraction X’Pert PRO analyzer  were adopted to analyze the microscopic characteristics of the samples. Meanwhile, samples prepared for the test were milled and refrigerated, while those prepared for SEM testing were kept in absolute ethanol to prevent further reactions.As the reference group, the dewatering rate of group E0F45 remained at a stable and low level under 1.5 mL/h in the condition of no electricity, which indicates that the gravity field still plays a certain role in simulating one-dimensional horizontal dewatering electro-osmosis. In addition, it was observed during the experiment that the plasticity of the sediment became stronger after adding fulvic acid.+ ions near the anode (Equation (2)) and OH− ions near the cathode Equation (3):2O)n refers to a free metal ion in the solution, that is, a hydrated ion.The red dot line in After electro-osmosis treatment, the electroosmotic cathode showed no corrosion, while the electroosmotic anode was corroded to different levels. In addition, the electroosmotic anodes of different groups a, which As shown in The migration amount is an important indicator for measuring the effect of electro-osmosis ,48,49,50As shown in Nowadays, new electrode materials like electro-technical synthetic materials (EKG) are investigated in order to improve dewatering and prevent electro-osmosis during the process of electro-osmosis ,52. HoweIn order to investigate the migration of heavy metals by adding fulvic acid under dewatering electro-osmosis, the total amount of heavy metals in the sediment was analyzed for each set of measuring points from different positions of anode and electrode.2+ ions and Zn2+ ions from the anode electrode to the cathode electrode generally decreases, with the average reductions of Cu2+ ions and Zn2+ ions being 28 and 11 mg/kg, respectively. It indicates that the migration ability of Cu2+ ions under electro-osmosis is stronger than that of Zn2+ ions. At the same time, the average ion migration rate  of Cu2+ ions and Zn2+ doped with a fulvic acid group is 9.2% and 4.2%, respectively, and the non-doped fulvic acid group is 4.2% and 1.3%, respectively, which indicates that fulvic acid could effectively reduce the adsorption between heavy metal ions as well as soil particles, and increase the migration of heavy metal ions. For the Cu2+ content changes of groups C38F0 and C19Z19, C38F45 and E2F45, it was found that the Cu2+ reduction of groups C38F0 and C38F45 reached a minimum in the centre, between two electrodes. It may because heavy metal ions and OH− formed colloid, which greatly reduces the pore stranded anode, and causes poor dewatering in the centre of electro-osmosis equipment. Meanwhile, the complexation of fulvic acid can effectively reduce the generation of the colloid as shown in 2+ ions from the soil during electro-osmosis. The results showed that the incorporation of 0.5 mol/L of fulvic acid could result to a lead removal rate of 40.9% in the anode region. An et al. [2+ and Zn2+ contaminated kaolin, and the results showed that the removal rate of Cu2+ and Zn2+ ions reached 30%~80%. Zhao et al. [2+, Cd2+, and Pb2+ ions were 39.93%, 99.42%, and 39.36%, respectively.From above results, the fulvic acid is effective for the removal of heavy metal ions. With the treatment of electro-osmosis, the effect of organics on the migration of heavy metal ions is also proved by some researchers ,56,57,582+ and Zn2+ ions at the anode is 21% and 17%, respectively. Therefore, the method of electro-osmosis dewatering is suitable for repairing sediment with amount of heavy metals. As shown in 2+, Al3+, and Cu2+ in particular, and leading to their increased solubility in natural waters. Fulvic acid is believed to originate as a product of microbial metabolism, although it is not synthesized as a life-sustaining carbon. Meanwhile, the fulvic acid in the sediment can enhance the migration ability of Cu2+ and Zn2+ ions through complexation, and effectively reduce the formation of colloids. Fulvic acid can effectively reduce the corrosion of the electrode during electro-osmosis, but the dewatering capacity of the sediment with a higher fulvic acid content is weaker. On the other hand, the fluvic acid would combine with Al3+ and Ca2+ . When the concentration of CaO and OHsediment .From the micrographs of pores and hydration products, it can be inferred that organics have an influence on the inhibition of hydration reaction. The main reason is that fulvic acid can be combined with aluminum and calcium produced by cement hydration, delaying the progress of cement hydration, and simultaneously decomposing hydration products, hindering the hardening of cement, and thus affecting and destroying the formation of solidified soil structure and strength ,19,20,21The solidified soil was prepared by using sediment and a different amount of curing agent and 3% organics. The relationship between the 7 d strength of the solidified sediment, the 28 d strength, and the amount of the curing agent is shown in 2+, Zn2+ ion reduction repair. Meanwhile, the effects of the organics content on the characteristics of the solidified sediment were investigated. From the above research results, several conclusions can be summarized as follows:Fulvic acid can effectively reduce the corrosion of the electrode during electro-osmosis, but the addition of fulvic acid under a constant current results in a decrease in the dewatering rate of electro-osmosis. The energy consumption coefficient of the electroosmotic process in this study is controlled by the equivalent voltage, regardless of the type of electrolyte added. In addition, the experiment revealed that the gravity field still plays an important role in simulating one-dimensional horizontal dewatering electro-osmosis.2+, Cu2+) have less effect on the displacement and dewatering rate of sediment with electro-osmosis treatment, and the fulvic acid in the sediment can enhance the migration ability of Cu2+ and Zn2+ ions through complexation. In addition, the experimental study shows that the average reductions of Cu2+ ions and Zn2+ ions are 28 and 11 mg/kg, respectively, which indicates the migration capacity of Cu2+ ions in sediment is stronger than that of Zn2+ ions.The heavy metals (Zn2+, Zn2+ ions and soil particles through complexation, enhance the migration ability of Cu2+, Zn2+ ions, and effectively reduce the formation of colloids. Fulvic acid can effectively reduce the corrosion of electrodes during electro-osmosis; meanwhile, the sediment containing a high content of fulvic acid has a stronger plasticity and a weaker electro-osmosis dewatering capacity compared with ordinary sediment. Therefore, electro-osmosis treatment is not recommended for sediment with a high content of fulvic acid.The experimental results show that fulvic acid in sediment can reduce the adsorption between Cu2+ and Zn2+ ions in the short-time energization process is limited, so it is necessary to combine solidification treatment for heavy metal contained sediment.The electro-osmosis repair method has a better reinforcement effect on river sediment, but the migration of CuDuring the solidification process of river sediment, the fulvic acid in organics can be combined with aluminum and calcium produced by cement hydration, delaying the progress of cement hydration, simultaneously decomposing hydration products, hindering the hardening of cement, and thus affecting and destroying the formation of solidified sediment structure and strength.This study combined electro-osmotic dewatering and electric repair to treat river sediment, using the same equivalent voltage to carry out dewatering reinforcement and heavy metal Cu


The multidimensional evaluation of patients with chronic neck pain is important for planning the treatment program. The aim of this study was to investigate the validity and reliability of the Turkish version of the Neck Bournemouth Questionnaire (NBQ). The internal construct validity of the NBQ was examined by the fit of the data to the Rasch measurement model. External validity of the NBQ was evaluated by testing for expected associations of Rasch transformed NBQ score with the corresponding variables through the process of convergent validity. The reliability of the NBQ in terms of both internal consistency and test-retest reliability was assessed by the person separation index (PSI) and differential item functioning (DIF) by time effect.It was determined that the questionnaire has 2 factors. None of the items of Factor 1 (F1) and Factor 2 (F2) showed DIF. The reliability of F1  and F2  was good with Cronbach’s alpha and PSI. There was a good correlation between NBQ/F1 and the Neck Disability Index (NDI) (r = 0.673) and Neck Pain and Disability Scale (NPDS) (r = 0.709). Also, there was a correlation between NBQ/F2 and the Beck Depression Inventory (BDI) (r = 0.552) and Beck Anxiety Inventory (BAI) (r = 0.410).The Turkish version of the Neck Bournemouth Questionnaire is valid and reliable.  Neck pain is a health problem that nearly half of all individuals in the world experience at least once in their lifetime [1]. It is known that physical, behavioral, and mental health is adversely affected, the level of disability increases, and the level of health-related quality of life decreases significantly in patients with neck pain . The appropriate use of outcome measurements is very important to determine the most effective treatment program depending on the evaluation. While measurement questionnaires designed to assess pain, disability, and quality of life for patients with low back pain are relatively common, they are limited for patients with neck pain. For these reasons, the Neck Bournemouth Questionnaire (NBQ) was adapted by Bolton and Humphreys in 2002 from the Bournemouth Questionnaire, which was developed for low back pain [4]. The Turkish version of the Bournemouth Questionnaire, which was developed for patients with low back pain, has been shown to be valid and reliable [5]. The NBQ consists of 7 questions that examine the pain intensity, daily life activities, social activities, anxiety, emotional aspects of depression, kinesiophobia, and the ability to control pain. The items in the questionnaire are specific to patients with neck pain and each question evaluates a different parameter. In this context, the Neck Pain and Disability Scale (NPDS) [6], Neck Disability Index (NDI) [7], Beck Depression Inventory (BDI) [8], Beck Anxiety Inventory (BAI) [9], and Tampa Scale for Kinesiophobia Scale (TSK) [10] were used to evaluate the validity of the questionnaire. Because the items of the questionnaire are short and clear, it provides practicality for researchers and clinicians during the application. The NDI [11] and NPDS [12] are the most frequently used questionnaires for patients with neck pain. The advantages of the NBQ over the NDI and NPDS are the evaluation of anxiety, depression, and kinesiophobia, as well as being shorter, more practical, and more sensitive in measuring the time-dependent change of symptoms . There are 5 versions of this questionnaire  but there is no Turkish version available . Therefore, the aim of this study is to investigate the validity and reliability of the Turkish version of the NBQ.The study was approved by the Hacettepe University Noninvasive Clinical Research Ethics Committee (Ethics Committee Registration No: GO 17/844). Written permission was obtained from Jennifer E. Bolton on 18.09.2017 for the Turkish version of the NBQ formed by translation and cultural adaptation. One hundred and twenty-five patients (18–65 years old) with neck pain (at least for the previous 3 months) due to mechanical or cervical disc herniation were included in the study. The participants signed a consent form to be included in the study. Individuals who were illiterate, with malignant disease, with motor weakness due to the herniated cervical disc, or with loss of function due to disease were excluded from the study. For the test-retest study, there were 1–3 days between the first and second administration of the NBQ. For the test-retest reliability, 43 individuals were planned to be included, but during this time, the patients who had a change in the severity of their symptoms due to additional treatment were excluded and the study was completed with 40 individuals. The translation and cultural adaptation of the NBQ were carried out according to the guidelines established by Beaton et al., as follows:1st step-Translation: The translation of the NBQ was carried out by a physiotherapist and a linguist whose native language is Turkish and can speak English fluently as well. The two people who created the translation independently created two separate translation texts.2nd step-Synthesis: The two translators discussed each version and created a consensus version.3rd step-Back Translation: The questionnaire was translated back to English by two linguists whose native language was Turkish and could speak Turkish fluently.4th step-Expert Committee Review: Five physiotherapists with at least 2 years of experience in the field of low back and neck health and 2 native English speakers created an expert committee. The physiotherapists included in the committee have performed studies of validity and reliability in this field. The expert committee evaluated the translations in terms of cultural adaptation and conformity, and formed the prefinal version of the questionnaire.5th step-Pretesting: The last version of the questionnaire was applied as a pilot to 35 patients and it was determined by the expert committee that the questionnaire was understandable.For the external validity of the NBQ, questionnaires that are known to be valid and reliable in patients with neck pain were used. The NDI was developed to assess the level of disability in patients with neck pain. The NDI consists of 10 questions in total. The subsections of the NDI are designed to assess pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation [7]. The NPDS assesses factors such as pain severity, participation in social life, sleep, mood, driving, and stiffness in the neck. The NPDS consists of 20 questions in total [6]. The BDI was prepared to measure the individuals’ behaviors and thoughts specific to depression. In the BAI, the questions assess the tendency to anxiety. The BAI and BDI consist of 21 questions that are scored between 0 and 3 . The TSK includes injury/reinjury and fear-avoidance parameters in work-related activities. The TSK consists of 17 questions [10].Factor analysis was performed to assess the unidimensionality of the NBQ prior to continue with Rasch modeling. The internal construct validity of the NBQ was examined by the fit of the data to the Rasch measurement model [19], while the external validity of the NBQ was assessed by testing for expected associations of Rasch transformed NBQ score with the corresponding variables through the process of convergent validity. The Rasch analysis includes the sequential steps [20] of (i) rescoring of NBQ items showing disordered thresholds; (ii) after deletion of the misfit items, analysis for overall model and individual item fit; (iii) examination for differential item functioning (DIF) for sex, age (≤44/>44), body mass index (BMI ≤26/>26), and duration of pain (DP ≤48/>48); and (iv) test for local independency and unidimensionality. In terms of external validity, the association of Rasch transformed NBQ score with the NDI, NPDS, BDI, BAI, and TSK was analyzed by Spearman’s correlation coefficient.The reliability of the NBQ in terms of both internal consistency and test-retest reliability was examined by the person separation index (PSI) and DIF by time effect. The PSI [21], which is equivalent to Cronbach’s alpha [22] but has the linear transformation from the Rasch model, is a measure of internal consistency. Minimum Cronbach’s alpha values of 0.7 and 0.90 are suggested for group and individual use, respectively. For test-retest reliability of the NBQ, DIF was carried out to verify the invariance of item difficulty hierarchy across the first and the second assessment (DIF by time). Data were analyzed using RUMM2020 [23].A total of 125 chronic neck pain (CNP) patients, 102 females and 23 males, were included in the study. The sex-based distribution of the sociodemographic characteristics of all participants is shown in Table 1. Bartlett’s test was 420.929 and the KMO was 0.83. According to the KMO and Bartlett test results, the number of samples is sufficient for factor analysis and the sample of our study is also suitable for factor analysis. As a result of the factor analysis, two factors with eigenvalues of >1 explained 67.2% of the total variance. Considering the content of the questionnaire, it was decided to interpret it with two factors. When the rotated factor loads of the items were examined, Items 1, 2, 3, 6, and 7 were found to be included in Factor 1 (F1), while 4 and 5 were included in Factor 2 (F2). Interpretability of the NBQ was assessed by the percentage of incomplete questionnaires and the percentage of respondents reporting the best or worst score (ceiling and floor effect). Since none of the respondents had incomplete data for all the items of the NBQ, the floor (ceiling) effects were 0 (0%), 0 (1.6%), and 4.8% (0.8%) for the total, F1 subscale, and F2 subscale, respectively.Starting with 5 items, two items (Items 3 and 7) displayed disordered thresholds and thus the adjacent categories were collapsed together. Following this, all items were found to fit the model (given a Bonferroni adjustment fit level of 0.01) (Table 1). Overall mean item fit residual was 0.084 (standard deviation (SD) 1.158) and mean person fit residual was –0.451 (SD 1.193). Item-trait interaction was nonsignificant, supporting the invariance of items (chi-square: 5.62 (df = 5), P = 0.344). When DIF was tested for the variables mentioned above, none of the items showed DIF. The scale also satisfied the requirements of local independence and unidimensionality.The PSI was good (0.89), indicating the ability of the scale to differentiate between 4 groups of patients, and Cronbach’s alpha was 0.87. When the test-retest reliability was examined via DIF by time, none of the items showed DIF.When the targeting of the final 5-item NBQ/F1 was evaluated, the scale was well-targeted to the patients with a mean person score of –0.032 and mean item score of 0 .Starting with 2 items, Item 4 displayed disordered thresholds, thus necessitating the classification of adjacent categories together. Following this, both items were found to fit the model (given a Bonferroni adjustment fit level of 0.025) (Table 2). Overall mean item fit residual was 0.172 (SD 0.404) and mean person fit residual was –0.626 (SD 0.879). Item-trait interaction was nonsignificant, supporting the invariance of items (chi-square: 2.29 (df = 2), P = 0.318). When DIF was tested for the variables mentioned above, none of the items showed DIF. The scale also satisfied the requirements of local independence and unidimensionality.The PSI was good (0.77), indicating the ability of the scale to differentiate between 3 groups of patients, and Cronbach’s alpha was 0.78. When the test-retest reliability was examined via DIF by time, none of the items showed DIF.When the targeting of the final 2-item NBQ/F2 was evaluated, patients on average had lower “disability” levels (mean person score: –0.239) than the average difficulty of the scale items (mean item score: 0) .When the correlations of NBQ Rasch transformed scores with the NDI, NPDS, BDI, BAI, and TSK were examined, there was a positive correlation between NBQ/F1 and the NDI (r = 0.673), NPDS (r = 0.709), BDI (r = 0.338), BAI (r = 0.405), and TSK (r = 0.330). There was also a positive correlation between NBQ/F2 and the NDI (r = 0.359), NPDS (r = 0.458), BDI (r = 0.552), BAI (r = 0.410), and TSK (r = 0.223) (Table 3).As a result of this study, it was determined that the Turkish version of the NBQ, a suitable biopsychosocial model developed for patients with CNP, is valid and reliable. According to the results of the factor analysis, it was found that the questionnaire had a two-factor structure. F1 included items related to pain and function, and F2 included items related to anxiety and depression.Each item of the NBQ represents a different field. Each field represented can be affected by various parameters such as cultural characteristics, age, and pain duration. Since the content of the questionnaire is so rich, it is more appropriate to determine its validity and reliability by using a modern psychometric approach, Rasch analysis. The Rasch analysis allows the total score to be converted to the linear score. According to the factor analysis, it was determined that the two factors of the NBQ explain the total variance better, and when the content is examined, it was determined that the questionnaire has two factors. In the original article about the questionnaire published by Bolton et al. in 2002, the questionnaire was interpreted with a single-factor structure [4]. In the Italian version of the NBQ, published in 2014 by Geri et al., it was found that the questionnaire had a two-factor structure for the first time. Then, according to Rasch analysis of the Italian version of the NBQ, which was published by Geri et al. in 2015, it was determined that the NBQ had two factors. According to this study, items 1, 2, 3, 6, and 7 are included in F1 while items 4 and 5 are included in F2. F1 was defined as “pain and function” and F2 was defined as “anxiety and depression” . Our results are consistent with the studies published in the literature in the recent years. When the factor loadings of each item in the questionnaire are taken into consideration, items 1, 2, 3, 6, and 7 are included in F1 and items 4 and 5 are included in F2. Items 3, 4, and 7 displayed disordered thresholds. When we examine the contents of these items, we think that they have important contributions to the NBQ and it is necessary for the protection of the biopsychosocial aspect of the question.The internal consistency of the Turkish version of the NBQ was quite high . The PSI value (0.89) was also good. The high Cronbach’s alpha and PSI indicated that the variables in the study were homogeneous and the questionnaire was reproducible. In this study, according to personal differences such as sex, age, BMI, and duration of pain, no item showed DIF. This shows that the answers to the questions are not affected by these variables. In addition, the absence of time-dependent DIF also indicates that the test-retest reliability is high and the reliability does not change within a certain period of time. External construct validity is analyzed by valid and reliable scales and questionnaires for the individuals included in the study [25]. The NPDS, NDI, BDI, BAI, and TSK were used in our study and the highest correlation level was between the NPDS and NBQ. The reason for the strongest relationship between these two questionnaires is that both of the questionnaires are evaluating pain and function, as well as depression. However, although the content of the two questionnaires seems similar, the NBQ is richer in content in terms of anxiety and kinesiophobia [14]. The stronger relation of the NDI and NPDS with F1 of the NBQ indicates that these questionnaires assess pain and function rather than anxiety and depression. In addition, we think that the NBQ has a low-intermediate relationship with the TSK, BAI, and BDI and this is due to the fact that these questionnaires and scales are not specific to individuals having neck pain.According to Deyo et al., the ideal questionnaire is a short and practical one that minimizes the burden of data collection and analysis [26]. Based on our results, we think that the NBQ is an ideal questionnaire because it is short and practical, and it contains clear questions. It is known that the severity of symptoms associated with neck pain changes over time. For this reason, examining the NBQ results according to the time period is very important in terms of reflecting the clinical changes. As a result of our study, we also think that the NBQ contains all the parameters needed to evaluate the quality of life so it can give an idea about the quality of life of patients with CNP.In conclusion, Rasch analysis showed that the Turkish version of the NBQ is valid and reliable for patients with CNP. The NBQ is practical, comprehensible, and suitable for a biopsychosocial model. It is sensitive to time-dependent changes and it is a questionnaire that provides objective results for the planning and maintenance of clinical trials as well.The authors declare no conflict of interest. No funding has been received for this study.The study was approved by the Hacettepe University Noninvasive Clinical Research Ethics Committee (Ethics Committee Registration No: GO 17/844). All participants provided informed consent in the format required by the relevant authorities and/or boards.


The inclusions size was obviously reduced, but the number of inclusions was increased after adding rare earth. The morphology of inclusions changed from chain and strip to spherical. The size of rare earth inclusions was mostly about 2–5 μm, distributed and dispersed, and their elastic modulus was close to that of steel matrix, which was conducive to improving the structure continuity of steel. (2) The rare earth compound had a high melting point. As a heterogeneous nucleation point, the nucleation rate was increased and the solidification structure was refined. The grade of grain size of products was increased by 1.5 grades, which is helpful to improve the strength and plasticity of metal. (3) Rare earth Ce can inhibit the segregation of P element at the grain boundary and the precipitation of Fe(Nb+Ti)P phase. It can effectively increase the solid solution amount of P element in steel, improve the solid solution strengthening effect of P element in high-strength IF steel, and obtain a large proportion of {111} favorable texture, which is conducive to improving the stamping formability index r90 value.The influence of rare earth Ce on the deep stamping property of high-strength interstitial-free (IF) steel containing phosphorus was analyzed. After adding 120 kg ferrocerium alloy (Ce content is 10%) in the steel, the inclusion statistics and the two-dimensional morphology of the samples in the direction of 1/4 thickness of slab and each rolling process were observed and compared by scanning electron microscope (SEM). After the samples in each rolling process were treated by acid leaching, the three-dimensional morphology and components of the second phase precipitates were observed by SEM and energy dispersive spectrometer (EDS). The microstructure of the sample was observed by optical microscope, and the grain size was compared. Meanwhile, the content and strength of the favorable texture were analyzed by X-ray diffraction (XRD). Finally, the mechanical properties of the product were analyzed. The results showed that: (1) The combination of rare earth Ce with activity O and S in steel had lower Gibbs free energy, and it was easy to generate CeAlO The research shows that the shape and size of inclusions, the grain size, and the proportion of favorable texture all affect the stamping performance of the strip , the wetting tendency of crystal on inclusion surface was expressed by θ, and the wetting angle θ indicated the effectiveness of heterogeneous nucleation. The high surface activity of rare earth elements resulted in the decrease of interfacial tension, the increase of viscosity, the decrease of the wetting angle, and the production of smaller heterogeneous nucleation work . The fin2, Ce2O3, Ce2O2S, and CeAlO3 particles are relatively high, which can preferentially precipitate on the grain boundary, subgrain boundary, and dislocation line to hinder the grain boundary migration, stabilize the subgrain, slow down the process of dynamic recrystallization, static recrystallization, and grain growth, and obtain the rolled structure of grain refinement [In the HR process, due to the large rare earth atoms, the solid solution in the crystal was limited, and the distortion energy caused by dissolution in the crystal was far greater than that dissolved in the grain boundary area, so the rare earth elements will preferentially segregate in the grain boundary ,26. Howefinement ,27.As a result of the heredity of the structure, based on the fine grains, the smaller parent phase austenite was produced in the CA process, which provides favorable conditions for the next refinement of ferrite structure . The finThe excellent deep stamping properties of IF steel mainly come from its {111} texture. 2 = 45°) of strip steel detected in each rolling process. It can be seen that the sample2# polar density max values of texture in HR, CR, and CA processes were, respectively, 4.1, 13.3, and 7.9, which were greater than the sample1#  in corresponding processes. The tensile strength of body centred cube lattice (BCC) metal in <111> direction was the highest, so the deformation resistance in <111> direction was the largest, and the <111> direction of {111} texture was perpendicular to the plate surface, so this texture made the steel plate difficult to deform in the thick direction during stamping, making the r value larger. The more the {111} texture content was, the higher the strength was and the higher the plastic strain ratio r value was [alue was ,29. TherThe results show that ,36, beca90 value.Other studies show that  the atom90 value of the sample 2# was higher than that of the sample 1#. The high-strength IF steel containing phosphorus with added rare earth had a better deep drawing property. After rare earth addition, the inclusion size was reduced, the inclusion morphology was optimized, the solidification nucleation rate was increased, the as-cast and as-rolled grains were refined, and the strength and toughness of the strip were effectively improved by fine grain strengthening. Meanwhile, the solution strengthening effect of P element in high-strength IF steel was improved, a large proportion of {111} favorable texture was obtained, and the r90 value of the product was increased. The above results have certain guiding significance for improving the deep stamping property of high-strength IF steel and lightweight steel application.Based on the above analysis, according to the comparison results of the mechanical properties of the samples in (1)3, Ce2O2S, and Ce2O3. Meanwhile, the inclusion size decreased obviously, but the amount of inclusions increased. The morphology of inclusions changed from chain and strip to spherical. The size of rare earth inclusions was mostly about 2–5 μm, distributed and dispersed, and their elastic modulus was close to that of steel matrix, which is conducive to improving the structure continuity of steel.Based on the addition of rare earth in steel, the combination of Ce with activity O and S in the steel had lower Gibbs free energy, and it was easy to generate CeAlO(2)The rare earth compound had a high melting point. As a heterogeneous nucleation point, the nucleation rate was increased and the solidification structure was refined. Meanwhile, in the process of rolling heat treatment, rare earth can preferentially segregate grain boundaries to slow down grain growth. The addition of rare earth can improve the grain size rating of a continuous annealing strip by 1.5 grades, which is conducive to improving the strength and plasticity of strip.(3)90 value.Rare earth Ce can inhibit the segregation of P element at the grain boundary and the precipitation of Fe(Nb+Ti)P phase. It can effectively increase the solid solution amount of P element in steel, improve the solid solution strengthening effect of P element in high-strength IF steel, and obtain a large proportion of {111} favorable texture, which is conducive to improving the stamping formability index r


The relative risk value was RR = 1.15 (95% CI 1.03–1.28) for a 2-day lag. However, conclusive findings require the continuation of the study over longer observation periods.The main aim of this work is the estimation of health risks arising from exposure to ozone or other air pollutants by different statistical models taking into account delayed health effects. This paper presents the risk of hospitalization due to bronchitis and asthma exacerbation in adult inhabitants of Silesian Voivodeship from 1 January 2016 to 31 August 2017. Data were obtained from the daily register of hospitalizations for acute bronchitis  and asthma (J45–J46) which is governed by the National Health Fund. Meteorological data and data on tropospheric ozone concentrations were obtained from the regional environmental monitoring database of the Provincial Inspector of Environmental Protection in Katowice. The paper includes descriptive and analytical statistical methods used in the estimation of health risk with a delayed effect: Almon Distributed Lag Model, the Poisson Distributed Lag Model, and Distributed Lag Non-Linear Model (DLNM). A significant relationship has only been confirmed by DLNM for bronchitis and a relatively short period (1–3 days) from exposure above the limit value (120 µg/m Air quality in Poland is being continuously monitored with the State Environmental Monitoring system , as well3) and maximum daily 8-h mean concentration (120 µg/m3) [Ozone is often considered as a secondary type of ambient air pollutant, which is mostly related to its precursors’ emission  in the presence of solar light and high temperature in the summer period ,6. Previ0 µg/m3) ,9,10.Usually, time series are used to assess the impact of short-term human exposure on mortality or morbidity. Various types of mathematical models are used to model dependencies, taking into account the delay of the health effect. The most common are the Almon Distributed Lag Model , the PoiThe main aim of this work is estimation of health risk arising from exposure to ozone or other air pollutants by different statistical models taking into account delayed health effect. This paper presents the risk of hospitalization due to bronchitis and asthma exacerbation in adult inhabitants of the Silesian Voivodeship in the years 2016–2017.2 and a total population of N = 1,871,460 in 2016 [For the purpose of the study, secondary epidemiological data obtained from the daily hospitalization registry for acute bronchitis  and asthma  were taken into account while evaluating the short-term health effect of ozone exposure. Only hospitalizations concerning residents of the central area of the Silesian agglomeration  were included in the database. The surveyed agglomeration  includes 14 cities with an area of 3337 km3 (μg/m3) ozone concentrations measured on an hourly basis and 8-hourly average O3 (8 h) concentrations available at 2 automatic stations in the CAA agglomeration, in Katowice (Kossutha Street) and Zabrze (Curie-Skłodowska Street), were taken into account. Due to high correlation coefficients for measurements at both stations [Meteorological data and tropospheric ozone concentrations were obtained from the regional environmental monitoring database of the Provincial Inspector of Environmental Protection in Katowice . The 24-α = 0.05 is taken for statistical inference. The assessment of raw data on the level of pollution and meteorological conditions that cause the so-called photochemical smog is the starting point for the descriptive analysis presented here. The environmental factors are compared with the explained values t,y  in the distinguished periods to underline the delayed effect and to determine the maximum possible lag of the health effect L. The results are presented are as scatter charts.The descriptive and analytical statistical methods applied to estimate the health risk of people with delayed effects related to environmental exposures are taken into account in this paper. The general characteristics and available statistical methods limited to modeling with delayed effect are presented: the Almon Distributed Lag Model, the Poisson Distributed Lag Model, and Distributed Lag Linear and Non-Linear Model (DLNM). Available tools of the R package v.3.6.2 , were used ,16,17,18ty at the moment/day t, explained by linear combinations of functions of the variable t:xt by period l where l = 0,…,L, L—maximum lag with error The analysis of the exposure-response relation based on distributed lag models (DLM) is chosen, including the originally developed Almon’s method . In its tx on the expected value of ty, using the function (2) allows us to reduce the impact of collinearity of variables at the analyzed moment [Coefficients d moment ,16.(2)βtx at the explained variable ty lasts for at most L periods. The main problem, however, is the difficulty in choosing a degree of polynomial p and lack of interpretation of the impact of many variables. In case of difficulties in defining the p value, the use of Koyck transformation is proposed.In this model, it is assumed that the influence of the explanatory variable As the criterion of choosing a statistical model and, so, the degree of the polynomial and the maximum lag, the Akaike Information Criterion (AIC) is applied usually.ty at the moment/day t, explained by the linear combination of the i-th predictors functions t by period l, where l = 0,…,L, L—maximum lag, with error The model using properties of the Poisson distribution is apied because it is similar to the distribution of the explained variable . In its Due to the overdispersion of the model, if the residual deviation is greater than the number of degrees of freedom, the quasi-Poisson regression model is used. As the criterion of choosing a statistical model, and also the model fit indicator, the counterpart ofhe Akaike Information Criterion (AIC) is used—quasi-AIC.i = constΔx, while this risk is evaluated via formula (4).The advantage of the Poisson regression model is the ability to estimate the relative risk (RR) of the health effect with the increase of exposure by unit spline functions (splines) in the analysis of time-series data. In its general form, the model (5) is represented by the logarithm of the expected values ty at the moment/day t, explained by the linear combination of predictors t and splines t by the period l, where l = 0,…,L, L—maximum lag, with error Because of the limitations mentioned above, a new method is introduced that uses the The method is based on the Poisson model but the linearity is here partially replaced with nonlinear and delayed effects defined via spline functions. The method is originally implemented by Gasparrini A. and Armstrong B in the package R dlnm ,18,19,20The application of the DLNM model with delayed health effects creates opportunities to investigate the simultaneous impact of many factors throughout the period considered. Apart from 8 h ozone concentrations in the model, the following predictors are taken into account: Seasonality related to climatic seasons of the year, day of the week variability, temperature, relative humidity, and wind speed. Specifying the structure of health effect delays for environmental factors is based on spline functions. B-splines are used for temperature, humidity, and wind speed, and based on 3 interpolation nodes defined by the 10th, 50th, and 90th percentile, or 10th, 75th, and 90th percentile. The choice of functions depends on the quasi-AIC criterion. For the concentration of ozone, due to the values in time, a natural spline is adapted with 3 interpolation nodes given above. As in the previous models, the maximum lag of 21 days is taken. Besides, a natural spline is introduced for seasonality taking into account the division into 12 interpolation nodes resulting from climate changeability of 7 seasons over the year in the examined period of 1.67 years.3) in 2017, thus exceeding the permissible number of 25 days approved by the Ministry of Environment Regulation (OJ 2012 item 1031) [em 1031) .The daily pattern of eight-hour ozone concentrations and accompanying hospitalizations due to asthma and bronchitis during the summer season in 2017 is presented in 3 ozone concentration on the increase in the number of hospitalizations due to bronchitis and asthma . In addition to the eight-hour ozone concentration, the model took into consideration the seasonality associated with the astronomical season, the variability resulting from the day of the week and meteorological conditions . No significant effect of ozone concentration increase on the change in risk of hospitalization due to asthma or bronchitis at first 9 days was found . In the 3 concentration over the whole period (January 2016 to August 2017) reveals a strong impact of the concentration of the pollutant during the first days after exposure ), particulate matter less than 2.5 μm in diameter PM2.5 (RS = −0.59), sulfur dioxide SO2 (RS = −0.61), nitrogen dioxide NO2 (RS = −0.33), nitrogen oxides NOX (RS = −0.34), carbon monoxide CO (RS = −0.57) during the winter period.The relative risk assessment considering the delayed effect (by DLNM model) and 8 h Oexposure . An incr3) was exceeded by one unit (10 μg/m3) and persisted for 3 days. No significant increase in the risk of hospitalization was found for acute asthma  and the health effect expressed as a daily hospitalization rate due to bronchitis and asthma exacerbation. A significant relationship was confirmed only for bronchitis and a relatively short period (1–3 days) from exposure above the limit value (120 µg/m3). The relative risk value was RR = 1.15 (95% CI 1.03–1.28) for a 2-day delay.All presented models in this paper took into account the delay of the health effect of exposure to eight-hour tropospheric ozone concentrations and the associated meteorological conditions. The results indicate that the DLNM model provides the most sensitive analysis of the relationship between the increase of exposure by a unit (10 µg/mL (affecting the number of variables in the model) and the degree of polynomial p for approximation. The resulting system L of grade p equations requires a sufficiently large data set. The choice of initial conditions is possible due to the application of the model matching criterion, e.g., AIC. A certain limitation of this method is the possibility to assess the influence of only one environmental factor. Nevertheless, the discussed method of data analysis is used in environmental epidemiology works to assess the relationship between the concentration of air pollutants and mortality or hospitalization [In the case of the classic Almon model (1965), a linear dependence of successive predictive delays is used, which, on the one hand, makes it easier to estimate the number of events, but requires controlling the phenomenon of the autocorrelation of individual delays by using the polynomial function. This operation must be preceded by establishing initial conditions, including the maximum delay lization ,23.An alternative solution is the Poisson model based on the classic GLM  formula, using lags for explanatory variables. Its use in epidemiological studies is closely related to the shape of the distribution of explanatory variables, such as the number of health services or the number of deaths over time. This model enables multifactorial analysis, which makes it suitable for both environmental epidemiology and infectious diseases ,24. The The relatively newest DLNM method (2006) uses splined functions to define predictors which simplifies specifications of initial conditions for the analysis of relative risk. The model enables the multi-factor analysis and each of the predictors can be implemented by selecting appropriate functions sensitive to individual initial conditions by the quasi-AIC model fit criterion. The flexibility in defining the model and its easy interpretation encourage to use of this method in estimating health risk in environmental epidemiology. The inventors of the method, Armstrong and Gasparrini, demonstrated the significant influence of delayed effects of low and high temperature ranges at the increase of mortality in London in 1997–2012 ,26,27. Tn = 31 (93.9%) [n = 28 (84.8%), used the effect of delays in risk analysis. In this paper, we underline the applications of the methods presented in evaluation of delayed health effect of air pollution and meteorological conditions. The literature review points at frequent using of Distributed Lag Non-linear Models [A meta-analysis of the methods used in the analysis of time series for infectious diseases carried out in 2015 on a set of 33 international studies shows the predominant share of Poisson’s and quasi-Poisson’s regression,  (93.9%) . In 28  [In conclusion, it should be considered that the DLNM model with a delayed health effect is best used for further analyses of the causal relationship between daily ozone exposure and daily hospital admissions due to acute respiratory incidents. Authors of publications summarizing numerous studies in this area indicate that it is best to study short delays  because these longer delays are less frequently analyzed and it becomes impossible to compare the results obtained. Moreover, the results of the meta-analysis indicate that the increase in ozone concentration by 10 µg/m6–1.011) . In our 6–1.011) ,33,34. T6–1.011) . A posit6–1.011) . Another6–1.011) . An incr6–1.011) . Moreove6–1.011) . This pr6–1.011) ,37,38 an6–1.011) . Finally6–1.011) .3 was measured only at two measurement stations. Nevertheless, due to high values of correlation coefficients between concentrations of pollutants measured at other stations and close to homogeny character of the region in terms of urbanization and car traffic, data from Katowice station which had complete measurements of 8 h tropospheric ozone in the studied period was rather used. In the analysis of time series, measurements averaged up to 8 h are preferred, which is a good practice due to the relatively large daily air temperature amplitudes in the studied region. Despite the limitations mentioned above, it was found that the results are so interesting that it is worthwhile to present them to make it easier for future researchers to choose the right method for estimating potential health risks. Due to the change of climatic conditions and increasing public demand for reliable information about the risk, it is necessary to continue research using the presented models over longer periods.The study design is an ecological type and, according to its nature, is based on secondary epidemiological data. Therefore, certain biases related to the incorrect recording of the cause of hospitalization cannot be excluded. The basic limitation for an unambiguous conclusion is the relatively short observation period (from 1 January 2016 to 31 August 2017), resulting from the limitations of the previously-acquired database of the National Health Fund for the analysis of winter smog and its impact on health. Moreover, the available data only allow the analysis of the number of medical services provided in the whole CAA agglomeration without the possibility to assess the condition in individual districts or separately for gender and individual age groups. Another disadvantage is the method used to measure exposure to ozone; in the studied region OIt has been revealed that non-linear models and two-day lag delays gave the strongest and statistically significant response to the relationship between ozone concentrations and hospitalization due to bronchitis. In the case of asthma, no significant relationship was confirmed for the studied period. Clear conclusions require further studies with longer observation time.


In the present work the rheological, thermo-mechanical, microstructural, and wetting characteristics of cement mortars with recycled expanded polystyrene (EPS) were analyzed. The samples were prepared after partial/total replacement of the conventional sand aggregate with EPS having different grain size and size distribution. Lightness and thermal insulation were relevant features for all the bare EPS composites, despite the mechanical strengths. Specifically, EPS based mortars were characterized by higher thermal insulation with respect to the sand reference due to the lower specific mass of the specimens mainly associated with the low density of the aggregates and also to the spaces at the EPS/cement paste interfaces. Interesting results in terms of low thermal conductivity and high mechanical resistances were obtained in the case of sand-EPS mixtures although characterized by only 50% in volume of the organic aggregate. Moreover, sand-based mortars showed hydrophilicity (low WCA) and high water penetration, whereas the presence of EPS in the cement composites led to a reduction of the absorption of water especially on the bulk of the composites. Specifically, mortars with EPS in the 2–4 mm and 4–6 mm bead size range showed the best results in term of hydrophobicity (high WCA) and no water penetration in the inner surface, due to low surface energy of the organic aggregate together with a good particle distribution. This was indicative of cohesion between the ligand and the polystyrene as observed in the microstructural detections. Such a property is likely to be correlated to the observed good workability of this type of mortar and to its low tendency to segregation compared to the other EPS containing specimens. These lightweight thermo-insulating composites can be considered environmentally sustainable materials because they are prepared with no pre-treated secondary raw materials and can be used for indoor applications.  In recent years, the problems associated with waste management have become very relevant in the frame of a more sustainable model of development and consumption of new resources and energy ,4,5,6,7.In this work, lightweight cement mortars containing recycled expanded polystyrene (EPS) from the grinding of industrial scraps were prepared with partial or complete replacement of the standard sand aggregate in the mixture, with no addition of additives. A study on the rheological, thermo-mechanical, microstructural, and wetting properties of the samples was conducted. The effect of the aggregate size and size distribution was evaluated and a comparison with specimens based on conventional and/or normalized sand was carried-out. The aim was to realize an environmental, sustainable material with low specific mass and thermal insulating properties and characterized by high technical performances in term of hydrophobicity, low water absorption ,37,38,39These lightweight thermo-insulating composites can be considered environmentally sustainable materials for indoor non-structural artifacts because they are prepared with non-pre-treated secondary raw materials and with a cheap route since complex techniques of production are not required. These treatments and processes would, however, be more effective in the case of production on a larger scale. 3, 0.08–2 mm) was purchased by Societè Nouvelle du Littoral , whereas sieved sand was used as aggregate in three specific size fractions  [Cement mortars were prepared with CEM II A-LL 42.5 R ) . Normali 4–6 mm) ,47. Recy3. The reference was prepared with normalized sand  and name3), 2–4 mm (15 g/dm3) and 4–6 mm (10 g/dm3) bead size range and EPS2, EPS3, and EPS4 samples were obtained as reported in Total sand replacement was carried out with EPS grains in the 1–2 mm  of water onto the surface of each specimen, it was shown that the behavior of three representative points  summarized the behavior of all the drops. A Premier series dyno-lite (Taiwan) portable microscope and background cold lighting was used to study the time evolution of the drop, with a rate ranging of 30 frames per second. In the case of non- static drop, determined by water absorption, the image sequences were analyzed by Image J software  in order to measure the variation of the contact angle and of the drop height.An electron microscope FESEM-EDX Carl Zeiss Sigma 300 VP ) was used to characterize the morphology and the chemical composition of the samples which were applied onto aluminum stubs and sputtered with gold ) before the test. In this respect, the composition of the normalized sand was: C (4%), O (52%), Si (35%), Ca (2%), the composition of the sieved sand was: C (10%), O (45%), Ca (45%), polystyrene composition was: C (30%), O (70%), the composition of the cement paste was: C (4.2%), O (40%), Si (7.6%), Ca (44%), Fe (1.5%), Al (2.5%). Ultrapyc 1200e Automatic Gas Pycnometer, Quantachrome Instruments  was used for the porosimetric measurements and helium was used to penetrate the material pores.Flow data of the non-consolidated samples are reported in 3 of sand) which may induce aggregate segregation in a cement conglomerate. The lower fluidity of EPS3 (+126%) with respect to EPS2 (+174%) and EPS4 (+150%) is likely due to a better compaction of the aggregates in the mixture (better distribution of the granules), while in the case of the Sand/EPS specimen, the presence of the inorganic aggregate contributed to a reduction of fluidity (3. After substitution of 50% of the sand volume with EPS beads (Sand-EPS), an increase was observed of the mechanical strengths with respect to the EPS specimens. In fact, the flexural strength decrease was approximately 25% with respect to both references, while the compressive strength was 25%–30% lower than the references.The Sand sample showed a higher flow (+35%) with respect to the Normal sample due to the absence of finer aggregates. The EPS specimens were more fluid than both references and specifically with respect to the normalized mortar . This behavior may be ascribed to the low surface energy, the low roughness (smooth surface), the hydrophobic features (synthetic organic polymer) and the low density of the EPS particles , but the rupture was more gradual and the mortars containing 100% EPS volume did not show a separation of the two parts ,57. The From these results, it can be concluded that the bond between the EPS2 aggregate and the cement paste was weaker than the failure strength of the aggregate (poor EPS adhesion to the cement paste), while the bond between the EPS aggregate and the cement paste in EPS3 and EPS4 samples was stronger (better EPS adhesion to the cement paste) than the failure strength of the polystyrene granules ,60.This The lower specific mass of the EPS2 sample can be demonstrated by large voids at the ligand/aggregate interface, with length comparable to EPS beads and 20–30 micron width, this effect was ascribed to the mentioned poor adhesion of the beads to the cement paste A,B. ThisThe time variation of the flexural and compressive strengths of the Normal sample, of the EPS3 and Sand/EPS samples is reported in EPS based mortars showed lower thermal conductivities and diffusivities than the sand references . This reThe wetting characterization of the side surface  and of tThe wetting characterization of the EPS3 mortar, with EPS grains in the 2–4 mm (50%) and 4–6 mm (50%) bead size range, is reported in The wetting characterization of the fracture surface of the EPS4 mortar, with EPS grains in the 1–2 mm (25%), 2–4 mm (25%), and 4–6 mm (50%) bead size range, is reported in Wetting characterization of the fracture surface of the EPS2 mortar, with EPS grains in the 4–6 mm (100%) bead size range, is reported in Thus, EPS3 is the specimen with the lowest water drop absorption. This may be due to a more efficient organization of the aggregate particles with open spaces  between larger particles filled with smaller size EPS beads ,66, whicHence, once properly distributed in size, EPS beads can represent suitable aggregates in cement- based artifacts both for lightening/insulating and water proofing purposes. Such a double advantage arises from the peculiar combination of low density and low surface energy of this plastic matter as already shown by using other polymeric aggregates, such as granulated rubber from end-of-life tires .-EPS samples resulted in having more fluid than the references, in particular the sample characterized by EPS grains in the 2–4 mm (50%) and 4–6 mm (50%) bead size range (EPS3) had the most plastic with good particle distribution and cohesion between the ligand and the organic aggregates as also observed in microstructural and porosimetric detections. -The mechanical resistances of the EPS samples were lower with respect to the controls due to the lower specific mass. An increase of the strengths was observed with a stabilization after 45 days. At 60 days the values did not sensibly change thus demonstrating stability of the materials in consideration of the specific water curing/conservation conditions of the conglomerates. -The EPS based mortars showed lower thermal conductivities and diffusivities as compared to the references based on sand due to a lower density ascribed to the low density of the aggregates and to the spaces at the EPS/cement paste interface. -Interesting results in term of high mechanical resistances and low thermal conductivity were obtained in the case of sand-EPS mixtures. -Reference sand-based mortars showed hydrophilicity (low WCA) and high water penetration, particularly on the fracture surface of the composites, conversely to what was observed in the case of EPS samples which were generally more hydrophobic and less water absorbent. The best results (high WCA and negligible water penetration on the fracture surface) were obtained with the EPS3 sample. This property was ascribed to the low surface energy of the organic aggregate combined with its better particle distribution and compaction within the hydrophilic domains of the cement paste in the composite. -These lightweight thermo-insulating composites may be used in the building industry as non-structural components, with specific reference to indoor applications . Moreover, the conglomerates can be considered environmentally sustainable because they are prepared with secondary raw materials (recycled EPS) and are cost-effective because a cheap preparation route was used since the renewable aggregates were not pre-treated and a complex technique of production was not required.In the present work an investigation into the rheological, thermo-mechanical, microstructural and wetting characteristics of cement mortars containing recycled expanded polystyrene (EPS) was carried out. The samples were prepared after partial/total replacement of the conventional sand aggregate with EPS having different grain size and size distribution. The experimental results may be summarized as follows:


To investigate the effects of two kinds of surgical resection schemes, a conventional open surgical scheme and a thoracolaparoscopic esophagectomy surgical scheme, on operation-related clinical indexes, inflammatory cytokines and complications in elderly patients with esophageal cancer.A total of 100 elderly patients with esophageal cancer seen in the Department of Cardiothoracic Vascular Surgery, Renmin Hospital, Hubei University of Medicine, from June 2014 to June 2016 were enrolled and randomly divided into two groups, including a control group (50 patients) with a conventional open surgical scheme and an observation group (50 patients) with a thoracolaparoscopic esophagectomy surgical scheme. The operation time, the amount of bleeding during the operation, the incision length, the number of lymph nodes dissected, the hospitalization time, the HAMA scores and HAMD scores before and after the operation, the PSQI scores, SF-36 scores and levels of PCT, CRP and IL-6 after the operation, the recurrence and metastasis rates and the mortality at follow-up and the incidence of related complications of both groups were compared.The operation time, the amount of bleeding during the operation, the incision length and the hospitalization time in the observation group were significantly less than those in the control group (p<0.05). The number of lymph nodes dissected in the observation group was significantly higher than that in the control group (p<0.05). The HAMA scores and HAMD scores after the operation in the observation group were significantly lower than those in the control group and those before the operation (p<0.05). The PSQI scores and SF-36 scores after the operation in the observation group were significantly better than those in the control group and those before the operation (p<0.05). The levels of PCT, CRP and IL-6 after the operation in the observation group were significantly lower than those in the control group (p<0.05). The recurrence and metastasis rates at follow-up in the observation group were significantly lower than those in the control group (p<0.05). There was no significant difference in mortality at follow-up between the two groups (p>0.05). The complication incidence after the operation in the observation group was significantly lower than that in the control group (p<0.05).Compared with a conventional open surgical scheme, the thoracolaparoscopic esophagectomy surgical scheme possesses advantages in the treatment of elderly patients with esophageal cancer, including being a minimally invasive, simple operation, having a shorter recovery time, effectively relieving negative emotions, improving the quality of life, reducing the levels of inflammatory molecules and reducing the risk of related complications. The number of elderly patients with esophageal cancer accounts for 70% to 85% of the total number of patients with esophageal cancer.3Esophageal cancer is one of the most common malignant tumors of the digestive system and ranks 7In recent years, as endoscopic techniques have advanced and surgeons’ operational proficiencies continue to improve, a mini-invasive surgical treatment scheme represented by thoracolaparoscopic esophagectomy has been widely applied for the clinical treatment of patients with esophageal cancer,p>0.05).One hundred elderly patients with esophageal cancer hospitalized in Renmin Hospital, Hubei University of Medicine, from June 2014 to June 2016 were divided into two equal groups (50 patients per group) with a random number table, namely, a control group and an observation group. The control group consisted of 32 male patients and 18 female patients, 37 cases of squamous carcinoma and 13 cases of adenocarcinoma according to histopathological typing, and 3 cases of upper thoracic esophageal carcinoma, 37 cases of middle thoracic esophageal carcinoma, and 10 lower thoracic esophageal carcinoma according to tumor location, with ages ranging from 65 to 78 years (average age 71.32±5.66). The observation group consisted of 32 male patients and 18 female patients, 37 cases of squamous carcinoma and 13 cases of adenocarcinoma according to histopathological typing, and three cases of upper thoracic esophageal carcinoma, 37 cases of middle thoracic esophageal carcinoma, and 10 lower thoracic esophageal carcinoma according to tumor location, with ages ranging from 65 to 78 years (average age 71.32±5.66). There were no significant differences between the two groups in terms of these general characteristics .The patients of both groups received double-lumen tube intubation under general anesthesia. Patients in the control group underwent an open surgical scheme, including resection of the posterolateral right thorax, center of the superior stomach, and front side of the left sternocleidomastoid, excision of the tumor, and three-field dissection of lymph nodes, and the gastric tube was lifted to the neck to complete the anastomosis. Patients in the observation group received a thoracolaparoscopic esophagectomy surgical scheme; patients were put in left lateral position, a 1.5-2.0 cm incision was made at the seventh intercostal in the midaxillary line, and the mediastinum lymph nodes were first probed by means of a thoracoscope. Next, 1.0 cm incisions were made at the 6Record the time taken for surgery, intraoperative bleeding volume, length of the incision, number of dissected lymph nodes, and total length of hospital stay, and calculate the respective percentagesEvaluate the emotional status of the patients with HAMA scores and HAMD scores (the scores are positively related to the severity of depression and anxiety).5Evaluate the quality of life in patients with PSQI scores and SF-36 scores 5Detect inflammatory cytokine indexes including PCT, CRP, and IL-6 with a Roche Cobas c311 automatic biochemical analyzer.Perform a 12-month follow-up visit to record the number of patients who have had recurrence or metastasis and the number of patients who have died and calculate the respective percentages.Record the incidence of postoperative fat liquefaction, pulmonary infection, hoarseness, anastomotic fistula and arrhythmia and calculate the respective percentages.Statistical analysis: SPSS 20.0 software was employed for data analysis; for categorical data, Student’s t-test was employed, and results were reported as the mean ± standard deviation; for numerical data, the χ2 test was employed, and results were reported as percentages (%); α=0.05 was set as the significance cutoff.p<0.05); the number of dissected lymph nodes in the patients in the observation group was significantly more than that in the patients in the control group (p<0.05); The time taken for surgery, intraoperative bleeding volume, length of the incision, and total length of hospital stay in the observation group were significantly less than those in the control group (p<0.05); the number of dissected lymph nodes in the patients in the observation group was significantly more than that in the patients in the control group (p<0.05); The time taken for surgery, intraoperative bleeding volume, length of the incision, and total length of hospital stay in the observation group were significantly less than those in the control group (p<0.05). The postoperative SF-36 score of the patients in the observation group was significantly higher than that of the patients in the control group (p<0.05. The postoperative PSQI score of the patients in the observation group was significantly lower than that of the patients in the control group (p<0.05). The postoperative PCT, CRP and IL-6 levels of the patients in the observation group were significantly lower than those of the patients in the control group (p<0.05); there was no significant difference between the two groups in terms of survival (p>0.05). During the 1-year follow-up period, the rate of recurrence and metastasis of the patients in the observation group was significantly lower than that of the patients in the control group (p<0.05). The incidence of complications in the patients in the observation group was significantly lower than that in the patients in the control group ; the number of dissected lymph nodes in the patients in the observation group was significantly more than that in the patients in the control group (p<0.05), indicating that the thoracolaparoscopic esophagectomy surgical scheme largely reduced the operative wound and operative difficulty, promoted postoperative rehabilitation, and improved the effect of lymph node dissection.According to the results of this research, the time taken for surgery, intraoperative bleeding volume, length of the incision, and total length of hospital stay of the patients in the observation group were significantly less than those of the patients in the control group , indicating that treatment of elderly patients with esophageal cancer with the thoracolaparoscopic esophagectomy surgical scheme is helpful for relieving negative emotions in patients and improving patient sleep and overall quality of life, and the above mentioned advantages of the thoracolaparoscopic esophagectomy surgical scheme are closely related to the alleviation of the operative wound and postoperative pain and the reduction in recovery time.The postoperative HAMA score, HAMD score, PSQI score and SF-36 score of the patients in the observation group were significantly better than those of the patients in the control group and those before treatment (p<0.05), suggesting that the thoracolaparoscopic esophagectomy surgical scheme is significantly superior with respect to reducing the systemic inflammatory response and preventing postoperative infection during the treatment of elderly patients with esophageal cancer.12The postoperative PCT, CRP and IL-6 levels of the patients in the observation group were significantly lower than those of the patients in the control group (p<0.05). The incidence of complications in the patients in the observation group was significantly lower than that in the patients in the control group (p<0.05), indicating that the thoracolaparoscopic esophagectomy surgical scheme is helpful for further reducing the risk of long-term recurrence and metastasis and preventing the occurrence of complications after operation in the treatment of elderly patients with esophageal cancer. The thoracolaparoscopic esophagectomy surgical scheme is helpful for ensuring normal tension in surrounding tissue during separation of the base of the esophagus and increases the anatomic space exposed, which is of great significance for preventing accidental nerve injury and secondary hoarseness.p>0.05), which we believe to be related to the insufficient number of samples and the short follow-up time. As such, these findings need to be further verified in a controlled study on a larger scale.During the one year follow-up period, the rate of recurrence and metastasis in the patients in the observation group was significantly lower than that in the patients in the control group (In summary, the thoracolaparoscopic esophagectomy surgical scheme has the advantages of minimal invasiveness, ease of operation, and short postoperative recovery time and is superior to the open surgical scheme with respect to relieving negative emotions in patients, improving patient quality of life, reducing the inflammatory response, and helping reduce the risk of complications.TZand HJ designed this study, prepared this manuscript, and are responsible and accountable for the accuracy of the work.YW and CYM collected and analyzed clinical data.YW andDM significantly revised this manuscript.TZ and HJ contributed equally to this manuscript.