Adhesion due to intrauterine surgery such as septal resection associated with damaged endometrium can increase the risk of Asherman's syndrome. The main goal of treatment in this syndrome is to repair the damaged endometrium for creating a physiological pregnancy.To investigate the effect of intrauterine injection of hyaluronic acid on the prevention of Asherman's syndrome in women undergoing uterine septum resection.In this double-blind randomized clinical trial, 65 women undergoing the uterine septum resection were divided into two groups; the case group (n = 34) and the control group (n = 31). Immediately after the septal resection with a resectoscope, 1cc of hyaluronic acid gel in the case group and 1cc normal saline solution as a placebo in the control group was injected into the uterine cavity. After two months, existence of intrauterine adhesions in the both groups was examined by the hysteroscope and assessment of menstrual patterns, according to the American Society for Reproductive Medicine criteria. Our results showed that after intervention, the incidence of Asherman's syndrome in the control group was higher than the case group (p = 0.012). In the case group, only four women had poor adhesion (Asherman's syndrome) at the end of the study, while the rest of them were free of any adhesions in the uterine cavity. In the control group, however, only 19 were free of intrauterine adhesions and 12 had mild symptoms.The results of the study exhibited the hyaluronic acid capacity to reduce the risk of Asherman's syndrome in women with endometrial damage following a septal resection surgery. Asherman's syndrome, or intrauterine adhesion, is an acquired disease involving intrauterine adhesions that occur usually as a result of pregnancy, childbirth, infection, or uterine surgery such as myomectomy or correction of uterine abnormalities  (1-3). If the Asherman's syndrome causes infertility and amenorrhea, treatment is necessary. In such cases, surgical treatment is performed by cutting and removing the adhesions using hysteroscopic and laparoscopic methods. Complications of hysteroscopic surgery include bleeding, uterine perforation, and pelvic infection. However, in some patients, infertility is not treated even after the treatment of Asherman's syndrome (intrauterine adhesions) . The main goal of treatment in this syndrome is to repair the damaged endometrium as well as create a physiological condition suitable for pregnancy. Recently, drugs containing 100% hyaluronic acid have been used to treat adhesions.Hyaluronic acid is an organic compound also known as hyaluronan. Polymeric hyaluronic acid is composed of D-glucuronic acid and N-acetyl glucosamine. Hyaluronic acid chains can be composed of 25,000 units or more, and the molecular weight of these chains varies between 5,000 and 20 million daltons. Hyaluronic acid is made by an enzyme called hyaluronan synthase. At least three types of hyaluronan synthetic enzyme (HAS) are available to humans: HAS1, HAS2, and HAS3. Types 1 and 2 produce high molecular-weight hyaluronic acids while type three generates light hyaluronic acids. Hyaluronic acid is degenerated by an enzyme called hyaluronidase . Its anti-adhesive effect depends on the molecular weight and concentration of the product. The gel containing 100% hyaluronic acid, which is very sticky and acts as a mechanical barrier in the uterine cavity, prevents adhesion. Adhesions usually develop from the third to the fifth day after the surgery and the hyaluronic acid composition remains in place for seven days after which it is completely absorbed. Several studies have investigated the effect of hyaluronic acid compounds in preventing adhesions and the development of Asherman's syndrome following manipulation of the uterine cavity in animal and human models and have reported the capacity of the hyaluronic acid gel in keeping the uterine walls in place for 72 hr. Hysteroscopic studies have also shown a statistically significant decrease in the intrauterine adhesions a few months following the surgery (8-15).Due to the features mentioned for this compound, this study was designed and conducted to investigate the use of hyaluronic acid in the prevention of Asherman's syndrome in women undergoing uterine septum resection.This randomized double-blind clinical trial was performed on women, aged 15-45 yr, that were referred to the Shahid Sadoughi Hospital in Yazd, Iran for septal resection surgery between November and December 2019. Participants were primarily divided into two groups of case (n = 34) and control (n = 31) using random number tables. Our exclusion criteria comprised body mass index The sample size was estimated to be 80 (40 in each group), considering the significance level of 5%, the power of 80%, based on a previous similar article (16), and to reach the difference of 20% for the degree of adhesion in the two groups.All participants underwent uterine septal resection using a rectoscope. In the case group, 1(i) Mild: Involvement of (ii) Moderate: Involvement of 1/3-2/3 of the uterine cavity with delicate-to-moderate adhesions with most hypomenorrhea.(iii) Severe: Involvement of In the beginning of the study, basic characteristics of the participants including age, gravity, number of live births, abortion, stillbirth, and the menstrual pattern were recorded in the data collection form. Finally, the number of menstrual days and volume of menstrual bleeding before and after the intervention, as well as the incidence and severity of Asherman's syndrome was investigated and compared between the groups in terms of adhesion score.All participants were orally informed about the purpose of this study and the procedure thereof, and a written informed consent was obtained from each one of them prior to the study. In addition, the research proposal was reviewed and approved by the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran (Code: IR.SSU.MEDICINE.REC.1398.201).t test and Chi-square test between the two groups. The P-value Data were entered into the SPSS software, version 22 . The mean Of the 80 participants who initially entered into the study according to the mentioned inclusion and exclusion criteria, 9 from the case group and 6 from the control group, due to not referring at the time of follow-up were lost subsequently and, therefore, 65 women were included in the final analysis (34 in the case group and 31 in the control group) . No significant difference was observed between the two groups in terms of age, gravidity, number of miscarriages, and stillbirths (Table I).Additionally, the two groups were not significantly different as for menstrual patterns  before and after the intervention. The menstrual patterns of the participants in two groups were as follows: 21 (61.8%) women had a regular menstruation pattern in both groups, while 13 (38.2%) women in the case group and 10 (32.3%) in the control group had an irregular pattern (p = 0.40). In addition, in the two groups, the number of women with regular menstruation was higher than those with an irregular one. The volume of menstrual bleeding and the number of menstrual days before and after the intervention did not show a statistically significant difference between the two groups (Table II).As illustrated in Table II, the incidence of Asherman's syndrome in the case group receiving hyaluronic acid was significantly lower than the controls. In the case group, only four women had poor adhesion at the end of the study, while the rest of them were free of any adhesions in the uterine cavity (Asherman's syndrome). In the control group, however, only 19 were free of intrauterine adhesions and 12 had mild symptoms. None of the individuals in the case group reported any side effects of using hyaluronic acid .Uterine septum is one of the most common congenital abnormalities in women, associated with obstetric and fertility problems (17). In this study, the effect of hyaluronic acid intrauterine injection on the prevention of Asherman's syndrome in 65 women undergoing uterine septum resection was investigated. Evidenced by the results, intrauterine injection of hyaluronic acid reduced the incidence of Asherman's syndrome in the case group than the controls with no reported complications. Acunzo and co-workers in a randomized controlled trial identified that hyaluronic acid reduces the development of intrauterine adhesions following surgery and is likely to be associated with a reduction in severe adhesions (15). Hokker and colleagues also assessed the effect of hyaluronic acid on the prevention of Asherman's syndrome after dilatation and curettage (D & C). Their results revealed that the use of hyaluronic acid after D&C for abortion in women with at least one previous history of D&C reduces the incidence and severity of uterine adhesions but fails to eliminate the process of adhesion formation (18). Our study too, in line with this, indicated the significant effect of hyaluronic acid in reducing uterine adhesions. In a study by Guida and others performed on 130 patients in two groups (n = 65/each), the significant effect of hyaluronic acid after a three-month follow-up was observed in the intervention group. They described hyaluronic acid as a suitable and absorbable substance that provides an effective and safe strategy for improving women's health by reducing the need for re-intervention after hysteroscopic surgery (19). The two-month follow-up of the present study also confirms this claim. Furthermore, Mais and colleagues in their study on the reduction of postoperative adhesions with an injection of the hyaluronic gel after myomectomy with the laparoscopic method, being in line with the findings of the present study, reported that this method reduces the rate of adhesion and is safe and harmless (14).In a randomized clinical trial on 84 women, the effect of hyaluronic acid was examined after Asherman's syndrome treatment. A follow-up hysteroscopy, three months after the surgery showed a significant reduction in intrauterine adhesions subsequent to the hyaluronic acid injection (14%) compared with the control group (32%) (20). Our study also demonstrated a significant effect similar to the case group. Researchers also believe that hyaluronic acid can be helpful in preventing the side effects of traditional anti-adhesives such as IUDs or foley catheters . The results of the present study as well as several similar investigations reveal that the use of hyaluronic acid injected into the uterine cavity bears the potential to significantly prevent Asherman's syndrome in cases of endometrial damage.Intrauterine injection of hyaluronic acid in women under uterine septum resection can significantly reduce the risk of Asherman's syndrome and is a safe method for the prevention of Asherman's syndrome.The authors declare no conflict of interest with regard to the present study.


Air Pollution Prevention and Control Action Plan. Under the background of the 3 Year Action Plan to Fight Air Pollution (2018–2020), the pollution status of PM2.5, a typical air pollutant, has been the focus of continuous attention. The spatiotemporal specificity of PM2.5 pollution in the Chinese urban atmospheric environment from 2018 to 2020 can be summarized to help conclude and evaluate the phased results of the battle against air pollution, and further, contemplate the governance measures during the period of the 14th Five-Year Plan (2021–2025). Based on PM2.5 data from 2018 to 2020 and taking 366 cities across China as research objects, this study found that PM2.5 pollution has improved year by year from 2018 to 2020, and that the heavily polluted areas were southwest Xinjiang and North China. The number of cities with a PM2.5 concentration in the range of 25–35 μg/m3 increased from 34 in 2018 to 86 in 2019 and 99 in 2020. Moreover, the spatial variation of the PM2.5 gravity center was not significant. Concretely, PM2.5 pollution in 2018 was more serious in the first and fourth quarters, and the shift of the pollution's gravity center from the first quarter to the fourth quarter was small. Global autocorrelation indicated that the space was positively correlated and had strong spatial aggregation. Local Moran's I and Local Geti's G were applied to identify hotspots with a high degree of aggregation. Integrating national population density, hotspots were classified into four areas: the Beijing–Tianjin–Hebei region, the Fenwei Plain, the Yangtze River Delta, and the surrounding areas were selected as the key hotspots for further geographic weighted regression analysis in 2018. The influence degree of each factor on the average annual PM2.5 concentration declined in the following order: (1) the proportion of secondary industry in the GDP, (2) the ownership of civilian vehicles, (3) the annual grain planting area, (4) the annual average population, (5) the urban construction land area, (6) the green space area, and (7) the per capita GDP. Finally, combined with the spatiotemporal distribution of PM2.5, specific suggestions were provided for the classified key hotspots , to provide preliminary ideas and countermeasures for PM2.5 control in deep-water areas in the 14th Five-Year Plan.From 2013 to 2017, progress has been made by implementing the  Atmospheric particulate matter <2.5 μm in diameter (PM2.5) pollution has become a worldwide challenge, especially for some developing countries , 2. ChinAir Pollution Prevention and Control Action Plan (2013–2017) and the 3-year Action Plan to Fight Air Pollution (2018–2020). Since 2013, China has launched a series of initiatives aimed at PM2.5 pollution control, with remarkable achievements in the areas of coal-fired pollution and mobile source pollution control, and the air quality has advanced considerably. Compared with PM2.5 pollution in 2013, the annual average of PM2.5 in the Beijing–Tianjin–Hebei region, the Yangtze River Delta, and the Pearl River Delta declined by 40, 34, and 28%, respectively, in 2017  to characterize the geographical center of PM2.5 pollution and use Global Moran's I method for global autocorrelation analysis, to investigate the spatiotemporal distribution characteristics of PM2.5 from 2018 to 2020; (2) to identify the socioeconomic driving factors in the identified key hotspots by geographic weighted regression (GWR) analysis; (3) to classify the key hotspots by integrating the local autocorrelation analysis of pollution hotspots and the population density features, and to comprehensively provide feasible and targeted control measures, to provide evidence for the air pollution control of Chinese cities.http://106.37.208.233:20035/). Most of the 366 cities have established national air quality monitoring stations, and most of the stations are in urban areas. Each monitoring station has a monitoring system according to Technical Specifications for Installation and Acceptance of Ambient Air Quality Continuous Automated Monitoring System for PM10 and PM2.5 (HJ655-2013) to measure the concentration of fine particles per hour and per day. According to the ground monitoring data provided by the air quality monitoring station, first, some outliers  were removed. Second, the daily average of PM2.5 is calculated only when the effective hourly data of the day is more than or equal to 20 h , provincial statistical yearbooks (http://www.stats.gov.cn/tjgz/wzlj/dftjwz/), and some urban statistical bulletins.As for economic factor data, based on the Delphi method and available studies , a totalThis study revealed the spatial migration process of PM2.5 by the concept and calculation method of the gravity center in physics. Moreover, the study also characterized the geographical center of PM2.5 pollution by the gravity model. The X and Y coordinates of the PM2.5 pollution center in China are defined as:n; the grid number is represented by i; Xi and Yi represent the longitude and latitude of the geometric center of the grid whose number is i, respectively; Si represents the area of the grid i; and Wi represents the AM of the PM2.5 of the grid i (μg/m3).where Spatial correlation refers to the correlation of the same variable at different locations . A variap-value is considered an indicator to determine the reliability of Moran's I. When the p-value of Moran's I is lower than 0.05, spatial econometrics and GWR can be applied. Otherwise, the application of spatial econometrics or GWR is unreasonable. Therefore, the GWR model is used to calculate the coefficients (R) and local regression coefficients for each city in the study area, and these coefficients are then mapped to show spatial variability.The change in PM2.5 may be related to industrial activities and human life. Considering the potential multicollinearity between these socio-economic factors, the variance inflation factor (VIF) is usually used for screening. Independent variables with VIF values of more than 10 should be removed before using GWR. The The GWR model is shown as follows:yi represents the concentration of air pollutants in city i, μg/m3;  represents the geographical location of city i; β0 represents the concept of city i; βk represents the local regression coefficient of meteorological factor k; xik represents the value of the corresponding meteorological factor in city i; and εi represents the residual of city i. The local regression coefficient is calculated as follows:where  represents the local regression coefficients in cities; x represents the meteorological factor matrix; xT is the transposition matrix of X; w is the spatial weight matrix; y means the matrix of air pollutants; k means the number of meteorological factors; and n represents the number of samples.where β3. The number of Chinese cities in different PM2.5 content intervals was counted, as shown in 3 was the smallest, which was zero. As the years progressed, the number of cities in the range of the annual PM2.5 concentration gradually increased. The number of cities with a PM2.5 concentration in the range of 25–35 μg/m3 increased from 34 in 2018 to 86 in 2019 and 99 in 2020. The number of cities with a PM2.5 concentration in the range of 35–55 μg/m3 also showed an increasing trend. The average annual concentration of PM2.5 in the range of 55–75 μg/m3 showed a significant decreasing trend, from 103 in 2018 to 61 in 2019 and 14 in 2020. This indicated that the air quality was getting better year by year. In the range of the annual PM2.5 concentration above 75 μg/m3, the number of cities was seven in 2018, one in 2019, and two in 2020, indicating that the overall trend of pollution was decreasing. Through the above analysis, PM2.5 pollution has improved year by year from 2018 to 2020, thanks to policy support; policies have effectively promoted the improvement of air quality.According to the provisions of GB3095-2012 , limitinAccording to the statistical analysis of the geographical locations of the national PM2.5 pollution centers in 2018–2020 , the polThe AM distribution map of PM2.5 from 2018 to 2020  shows thAccording to the annual evolution trend, PM2.5 pollution in 2018–2020 was improving year by year. On the whole, there were few areas with serious pollution, and the spatial distribution also showed certain regularity. However, due to the impact of the pandemic from 2019 to 2020, there were some uncertain factors. Therefore, this study selected the PM2.5 pollution status of Chinese cities in 2018 as the main research object for further specific analysis.3 in the first quarter were mainly distributed in Xinjiang, such as Kashgar, Hotan, Turpan, and Urumqi, as well as Baoding, Weifang, Suihua, Shijiazhuang, and Zaozhuang. There are two main sources of PM2.5. In terms of climate, the rainfall in the first quarter was less than in other quarters. Thanks to warmer weather and increased rain, fine particles can be washed away, and the PM2.5 concentration then goes down in the second quarter. In the third quarter, only the PM2.5 concentration near Hotan in Xinjiang was >75 μg/m3, and the pollution in the Beijing–Tianjin–Hebei region was serious. In the fourth quarter, the weather turned cold, the northern region began to heat up, and the pollution in northern China was serious.The geographical location of the PM2.5 pollution center in the four quarters of 2018 was statistically analyzed. It can be seen from P-value was <0.05, so the data had analytical significance. The Z-value was 73.941729, much more than 1.96, which proved that Global Moran's I meets the test conditions. There was a significant spatial agglomeration phenomenon in the AM distribution of PM2.5 in Chinese cities in 2018.According to the analysis results , Global Local autocorrelation analysis was used to study the distribution of PM2.5 in local areas. Local Moran's I (GeoDa mapping) and Local Geti's G (ArcGIS mapping) were used, and the clustering maps of the local indicators of spatial association were obtained. Zhang and Zhang  comparedAccording to Human activity is one of the important factors affecting PM2.5 . Frequen2. The hotspots with a population density of more than 400 people/km2 were considered Area A, 200–400 people/km2 were considered Area B, 50–200 people/km2 were considered Area C, and the hotspots with a population density of fewer than 50 people/km2 were considered Area D. The results are shown in The population density level could be divided into gathering area, transition area, less sparse area, and severely sparse area, and the corresponding population density of each area is 400, 200–400, 50–200, and <50 people/kmCombined with the population density map and the distribution of hotspots, through local autocorrelation analysis, the Beijing–Tianjin–Hebei region, the Fenwei Plain, the Yangtze River Delta, and the surrounding areas were selected as the key hotspots for GWR analysis.3) was analyzed as a dependent variable. Before the GWR analysis, the VIF test should be preprocessed first to remove the indicators with VIF values of more than 10 to avoid collinearity affecting the experimental results. Then, the remaining usable indicators were the annual average population , urban construction land area (square kilometers), per capita GDP (Chinese yuan), GDP growth rate (%), the proportion of the primary industry in the GDP, the proportion of the secondary industry in the GDP, the employees (people) of the primary industry , the employees (people) of the secondary industry, the employees (people) of the tertiary industry, the proportion of the employees of the primary industry, the proportion of the employees of the secondary industry, the proportion of the employees of the tertiary industry, the green space area (hectare), the ownership of civilian vehicles , and the annual grain planting area .A total of 18 indicators were chosen as independent variables in this study. The average annual concentration of PM2.5 , urban construction land area (square kilometers), the per capita GDP (Chinese yuan), the proportion of the secondary industry in the GDP, the green space area (hectares), the ownership of civilian vehicles , and the annual grain planting area . The spatial distribution of the regression coefficients of these factors is shown in From As can be seen from According to It can be seen from It can be seen from 3. The per capita GDP was negatively correlated with PM2.5 concentration. With the rapid economic development of the city, the government should pay attention to the sustainable development of the environment and reduce air pollution.It can be seen from It can be seen from the above analysis that the seven factors selected in this study had different effects on the average annual PM2.5 concentration. Comparing the average absolute value of the correlation coefficient, the influence degree of each factor on the average annual PM2.5 concentration decreased in the following order: the proportion of the secondary industry in the GDP, the ownership of civilian vehicles, the annual grain planting area, the annual average population, the urban construction land area, the green space area, and the per capita GDP. The proportion of the secondary industry in the GDP has a great influence on PM2.5 concentration. In some areas, the proportion of the secondary industry in the GDP is high, so pollution emissions are serious. It is necessary to accelerate the transformation of the urban economic structure and increase the proportion of the tertiary industry in the economic structure. At the same time, it is necessary to change the urban economic structure, reduce the proportion of the secondary industry, avoid the excessive aggregation of the same type of secondary industry in the region, and improve the current situation of environmental pollution. In Shaanxi Province, attention should be paid to air pollution in urban construction; strict regulations should be made on the air standards for construction, and a supervision system should be implemented to ensure that air pollution caused by construction is controlled within a reasonable range. At the same time, attention should be paid to air pollution caused by automobile exhaust emission pollution and crop planting. The number of cars should be further controlled, green travel should be promoted, penalties should be strengthened for vehicles with unqualified emissions, supervision should be strengthened in agriculture, and straw burning should be strictly prevented. Good economic conditions are the basis for effective environmental protection, so it is urgent to accelerate the high-quality growth of regional GDP. At the same time, expanding the green space in various regions helps reduce air pollution. Because of the differences in atmospheric resource endowments and the functional positioning of each region and its cities, it is recommended to establish a regional classification management system and ecological compensation strategy.As mentioned above, PM2.5 pollution has improved year by year from 2018 to 2020 and there was a significant spatial agglomeration phenomenon in the AM distribution of PM2.5 in Chinese cities. According to the local autocorrelation analysis of pollution hotspots, integrated with the population density map , the keyAt the same time, the seasonal characteristics of PM2.5 pollution were also worthy of attention. Considering that different cities have different roles and different sensitivities to different socioeconomic driving factors, it is urgent to establish clear transfer compensation policies for haze control cooperation between cities in the first and fourth quarters. In addition, the analysis of pollution centers in the four quarters of 2018 showed that the pollution centers were located in the Huanggang, Anqing, Jiujiang, and Shangrao areas, and the government should focus on the coordinated planning and management of the environmental economy in the above areas. Moreover, the air pollution in the heating period in the north was serious. To build a coal-free area and achieve the goal of clean heating, it is necessary to eliminate the high emission of boilers, reform the gas boilers, strengthen the source management, and strictly control the amount of coal used.PM2.5 pollution has improved year by year from 2018 to 2020. There was a significant spatial agglomeration phenomenon in the AM distribution of PM2.5 in Chinese cities. Based on the local autocorrelation analysis of pollution hotspots and population density features, the Beijing–Tianjin–Hebei region, the Fenwei Plain, the Yangtze River Delta, and surrounding areas were selected as the key hotspots for GWR analysis. The influence degree of each socioeconomic determinant on the average annual PM2.5 concentration decreased in the following order: the proportion of the secondary industry in the GDP, the ownership of civilian vehicles, the annual grain planting area, the annual average population, the urban construction land area, the green space area, and the per capita GDP. Based on the local autocorrelation analysis of pollution hotspots, when integrated with the population density map, the key hotspots were divided into three areas: Area A (63 cities), Area B (30 cities), and Area C (16 cities). Finally, the targeted management policies of each hierarchical area were proposed according to the characteristics of the driving forces of sensitive pollution in each city as well as the roles of each city, combined with the seasonal characteristics of pollution. The cities in Area A should update the joint industrial layout with the surrounding cities to optimize their economic and energy structure. Cities in Area B should consider transitioning to eco-tourism, eco-agriculture, and other green industries to maintain people's livelihoods. Cities in Area C should accelerate the growth of the per capita regional GDP. Cities in Area D should implement more afforestation to increase the coverage of green plants, which would improve pollution. Moreover, the quarterly pollution focus should be on the coordinated planning and management of the environment and economy in the above-mentioned areas. At the same time, air pollution was serious during the heating season in the north, so the government should strengthen source management and strictly control the amount of coal used.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.MZ: writing—original draft preparation and data analysis. JG and YZ: data analysis. XC: methodology, reviewing, and revision. All authors contributed to the article and approved the submitted version.This study was supported by the Humanities and Social Science Research Youth Project funded by the Ministry of Education of China (18YJCZH021), Fundamental Research Funds for the Central Universities from Zhongnan University of Economics and Law (202211412 and 202211413).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The objective of this study was to establish a baseline of current use in practice of the Canadian Occupational Performance Measure (COPM) by consulting 33 expert French occupational therapists, who trained in this method between 2012 and 2017 and use of the COPM with their clients. The areas of health intervention are pediatrics, psychiatry, neurology, and geriatrics. An email invitation to participate in the research was therefore sent to 113 occupational therapists. We received 33 responses.  A novel mixed method study combined a Delphi method with a lexical analysis of experts' responses and principal component analysis (PCA). Discussion. The COPM was clearly identified as a tool that supports occupational therapy clinical reasoning, facilitates team decision-making for care pathways, and enables people with disabilities and health conditions to make decisions for their care.  In the last Delphi round, the consensus of the expert group was attained on 31 benefits and 1 limitation, confirming the generally positive influence of the COPM in French health services.  The Delphi study revealed that the COPM appears to be well adapted to French culture and should be widely incorporated into preregistration training. Human beings need to engage in activities to maintain and develop their abilities, their life in society, and their health. Occupational therapists' principal goal is to support people to engage in meaningful occupations, especially when they have disabilities or health conditions . The CanIn France, the use of the CMOP-E has been widely integrated into occupational therapy practice via Continual Professional Development (CPD) training. However, to date, no studies on the use of this tool by occupational therapists have been carried out. The objective of this research is to participate in the change in practice in France towards an approach client-centered and occupation-centered. The operational objective is to establish a baseline of the use of the COPM with a group of expert occupational therapists who were trained between 2012 and 2017 and are considered an expert in this study, with any occupational therapist who has completed an additional 28 hours of training of COPM, use of the COPM with their clients, and the concept of habilitation. This study enabled us to identify the benefits and limitations of the use of the practice of COPM, based on the feedback of a group of expert occupational therapists in France. The results of this study may be a response to the health department's request to participate in individualized health coaching  and to eThe Delphi technique  is a resThe selection criteria for this study were as follows: state qualified occupational therapists in France, completion of CPD training of 28 hours training in the use of CMOP-E between 2012 and 2017, regularly use of the COPM with their clients , French-speaking, and no connection to political group or commercial companies to avoid external influence and pressure. It was not required to be used systematically COPM for each client to take the context in France and the predominantly disease-centered approach. The participants were recruited by email from a list of occupational therapists having completed CPD at the French national occupational therapy association. The first consent to participate in the research was sent through the ANFE association in a confidential manner. An email invitation to participate in the research was therefore sent to 113 occupational therapists, who had completed COPM training. The areas of health intervention are pediatrics, psychiatry, neurology, and geriatrics. In all, there were 33 positive responses (29.2% response rate) that were received from a wide range of participants across France.The Delphi technique begins with an open question, which is the essential starting point for the process of exploring the problem . This stn = 26) were women and 21% (n = 7) were men. In all, 72.7% (n = 24) of the occupational therapists had completed state registered occupational therapy training before 2010, and 27.3% (n = 9) completed it after the program reforms of 2010. In relation to domains of practice, 42.4% (n = 14) practiced in postdischarge and rehabilitation, 42.4% (n = 14) in the community, 39.4% (n = 13) in independent practice, and 6% (n = 2) in mental health. 45.4% (n = 15) practiced in pediatrics, 78.7% (n = 26) with adults, and 42.4% (n = 14) with seniors. The year of CPD training in CMOP-E and the use of the COPM were thus as follows: 2012 , 2013 , 2014 , 2015 , 2016 , and 2017 . The occupational therapists were from different regions in France. The average caseload numbers per year for this group of 33 occupational therapists were 68. All 33 occupational therapists participated in the three rounds of consultation  of benefits was created using the first body of data  . It was The limitation word cloud relies on the same principles of frequency of words in the text. For the first round, the initial body of data for limitations is 869 words from 33 questionnaires . The cluAll 33 experts participated in the second round of consultation. The consensus was 80% agreement. The data are presented in order of importance according to the frequency of responses obtained. Occupational therapists identified 32 interests  and onlyPrincipal component analysis (PCA) revealed that although the occupational therapists participating in the Delphi study were largely in agreement over the items (51/78), three groups of experts could be differentiated from each other . FollowiGroup E1 (17/33): limitations brought this group of occupational therapists together. In this group, they were more or less in accord about the limitations of the COPM, with regard to the organizational systems of French health institutions (D2) and the lack of knowledge of rehabilitation models centered on the client, rather than the pathology . Compliance of the patient with the rating system (D11) or difficulty in understanding the scales (D9), and the rating system being difficult for the occupational therapists to explain, was also limitations for these practitioners. Patients' limited abilities were highlighted by this group of experts, particularly around issues of carrying out the COPM due to difficulties of cognition and denial on the part of the patient .Group E2 (4/33): this group of occupational therapists highlights both the strengths of the scale as a tool to reevaluate the benefits of the rehabilitation program (A23) and also the COPM's framework guiding the interview (A27). For this group, the COPM has value in identifying the role of the occupational therapist within a team (A22) as well as providing elements that contribute to team's decision-making for treatment objectives (A31). Lastly, the scale enables the client to autoevaluate (A13), puts forward the perspective of the client (A4), encourages discussion (A6), and puts responsibility firmly with both the patient and the occupational therapist (A17).Group E3 (12/33): the occupational therapists in this group were disappointed with the lack of current French research on COPM. For them, the doctor's (D19) and the team's  approaches could be viewed as limitations. Lack of knowledge around the work carried out by occupational therapists (D20) and determination that the focus should be on rehabilitation (D23) were combining factors for this group in terms of understanding the COPM. In contrast, they also felt that the scale gives meaning to the work carried out by occupational therapists (A46), facilitates a psychosocial approach (A45), and encourages team-working (A44) and joint goal setting (A27).n = 27). This element is linked to the benefits of moving away from a system of reasoning based on pathology, with 72.7% (n = 24) in complete agreement 18.2% (n = 6) in agreement. The use of the COPM encourages a psychosocial approach for 87.9% (n = 29). The second group of benefits highlights the COPM as an interview that facilitates the capture of the patient's voice 97.0% (n = 32), giving space for the person to express their wishes 87.9% (n = 29), encourages discussion 87.9% (n = 29), gives the person a leading voice 90.9% (n = 30), and also takes into account the person's environment 84.8% (n = 28). The third group of benefits was centered around the possible impact on the person by encouraging their engagement and their engagement 97.0% (n = 32). Here, we found evidence of the principal objectives of the COPM: identifying the specific difficulties of the person 97.0% (n = 32) and enabling to understand the daily difficulties of the person interviewed 93.9% (n = 31). For 90.9% (n = 30), the COPM facilitates habilitation for the person interviewed and the therapist, as well as negotiation between them 93.9% (n = 31). The fourth group of benefits is centered around the operational side of the measure; notably evaluating performance and satisfaction is important for 97.0% (n = 32) of the occupational therapists participating in this study, and the COPM enables them to put in place negotiated goals and gives the client the power to decide on their goals 93.9% (n = 31). This tool was highlighted as being effective in measuring outcomes of the intervention 93.9% (n = 31) and for reevaluation 90.9% (n = 30). For 97.0% (n = 32) of the participants, the measure facilitates the formulation of an occupational therapy diagnosis, provides a strong argument for team decision making 90.9% (n = 30), and supports team working 84.8% (n = 28). The final group of benefits is linked to habilitation, in that the COPM promotes habilitation for the person and the therapist, to varying degrees of “completely agree” 51.5% (n = 17) and “agree” 39.4% (n = 13). Habilitation is also associated with several other elements for the participants, specifically concerned with the fostering or encouragement of negotiation between the client and the occupational therapist 93.9% (n = 31), taking a decision 97.0% (n = 32) and decision-making for clients 90.9% (n = 30). For all experts 100% (n = 33), the use of the COPM can provide meaning to the occupational therapists' practice in their work with 60.6% (n = 20) in complete agreement and 33.3% (n = 11) in agreement. Finally, for 87.9% (n = 29), the use of the COPM supports a psychosocial approach.From the second round, all 33 occupational therapists agreed on the benefits of the COPM, whilst having different ideas on the limitations. The graph of items shows some heterogeneity in opinion with regards to limitations. Consensus in the second round of the Delphi survey evidences five groups of benefits. The first group of benefits is in relation to the use of the COPM as a tool to showcase an approach centered on occupation, 81.8% (n = 19) (“completely agree”) and slightly less 24.2% (n = 8) (“agree”). Problems in relation to attention, understanding, and significant behavioral difficulties are obstacles in the use of the COPM 84.8% (n = 28), accompanied by a perception that communication difficulties can present a barrier 87.9% (n = 29). French institutional systems are highlighted as a barrier to the use of this tool 81.8% (n = 27), with a lack of knowledge of the model gained from preregistration training also being underlined as a difficulty, 45.5% (n = 15) completely agreed and 21.2% (n = 7) agreed.In terms of limitations, lack of insight and denial figured highly 57.6% , which enabled the PCA-based definition of the three expert groups during the second round, were set aside due to a consensus below 80%. Thereby, the influence of these group-specific lines of thinking was eliminated in the PCA analysis of the third-round results, that represent accordingly the influence of less discriminative items. But although being less distinctive (highest vector length < 0.5  comparednd round ), they cnd round . In factnd round . In factnd round , three gThe objective of this study was to establish a baseline of current use in practice of the COPM by consulting 33 expert French occupational therapists. The PCA analysis revealed the occupational therapists' predominant themes in thinking based on their responses in the second and third rounds of the Delphi study. The results are discussed below in the context of the respective international literature.The PCA analysis from the second round permitted the classification of the experts, corresponding to three different profiles in groups E1, E2, E3:Group E1 (17/33) mirrored the institutional and conceptual limitations that can be found in the French health sector. Indeed, the CMOP-E appears to be an indispensable model for occupational therapy practice in Anglo-Saxon countries  but struThe stance of group E2 (4/33) revealed a commitment to using the COPM, highlighting the importance of the principles of this method that are widely cited in the literature . AccordiGroup E3 (12/33) highlighted the lack of compelling evidence in the French language and the paucity of studies in France on this subject. Groups E3 and E1 are linked in their perceived difficulties in taking a client-centered occupational approach in the face of issues related to organization, institutions, and acceptance on the part of interprofessional health teams to adopt a change of their practice model. Progression in Canadian health and social care policies proves the importance of solid evidence, results and analysis, and models of occupational therapy practice that promote well-being, habilitation, and justice founded on occupation . By cleaIn addition, the PCA analysis from the third Delphi round brought out three profiles of participants experts EI, EII, and EIII that are described in the following:EI, the largest group, composed of 25/33 individuals, agreed with all items retained from the second round, i.e., 31 benefits as well as 5 limitations, and presents thereby the most complete consensus profile on the use of the COPM in France. Most discriminating with respect to the other groups was that EI did not reject any limitation. Thus, for this large part of experts, institutional systems, and lack of knowledge of client-centered, occupational models can be barriers to the use of the COPM in France.Group EII, composed of 6 individuals, is distinguished from group EI by a disagreement on four out of five limitations. Institutional systems and lack of knowledge about the model are not held to be limitations for this group. These limitations may impact less when an occupational therapist works in private or independent practice, or in an institution that is already structured around the values of the CMOP-E model. Further, for clients who have a lack of insight or denial, Phipps and Richardson's study  supportsn = 2) is distinguished from the other groups by rejecting the four limitations from group EII and in rejecting the idea that the COPM creates an environment where giving a voice to the person and enabling expression of desires is possible. Law et al. [Group EIII n =  is distin = 32) of the occupational therapists were in agreement with the occupational aspects of the tool (A1). In fact, increasing research in occupational science puts forward tangible evidence of the effectiveness of occupational therapy practice [n = 32) of the experts agreed that the COPM brings meaning into the practice of occupational therapy (A46). Morrison et al. [The only limit that has been retained is disorders related to attention, comprehension, or behavior D14). In fact, a literature review shows that the COPM is not well adapted for clients who have difficulties in planning ahead, in decision-making for themselves or others . Studiespractice . In all,n et al.  reviewedn et al. . For the. In factn et al.  demonstrThe anonymity demanded by the Delphi technique protocols did not allow us to identify the experts between each stage, and hence it was not possible to deepen the PCA analysis to study, for example, the progression of opinions of each occupational therapist through the three Delphi rounds. An adapted form of the Delphi method could be envisaged, in order to study not only group consensus but also the individual's positions taken in relation to the questions posed and their progression through each stage.Finally, with respect to interprofessional collaborations, it would be interesting to assess whether outcome measures used by other professionals could be complementary to the COPM or whether the joint use of common tools could be relevant. In France, the COPM is an outcome measure requiring CPD training, available only to occupational therapists. What about other tools from other professionals? If the COPM is pertinent for the development of interprofessional treatment planning, then could this method not be the single assessment for the interprofessional team? And the occupational therapist therefore be a coordinator of occupational issues on behalf of the client?The results of this Delphi study and the analysis of the principal components demonstrate a consensus of occupational therapists on the benefits and limitations of the use of the COPM in France. The consensus of these experts shows that the use of the COPM within the French health system has many advantages and few disadvantages. Therefore, there appears to be neither a significant obstacle to expanding the use of this method nor significant differences in the use of this measure in Canada or Anglo-Saxon countries. This outcome measure fosters an approach centered on the person and their caregivers by determining the range of problematic occupations and the objectives which provide the key elements of the treatment plan. The COPM gives occupational therapist the opportunity to use a reliable tool to establish objectives and rehabilitation plans in the interprofessional teams. This interview provides space for the client, enabling them to actively collaborate and participate in their rehabilitation process. However, it seems crucial to invest more into research and into the dissemination of information about the strong evidence for the use of the COPM, in order to increase health sector knowledge of the tool, that of the occupational therapy client-centered approach and of occupational science. An emphasis on the training of occupational therapists in the use of the tool is imperative both in preregistration and CPD training. The validation of the specific role of occupational therapy in relation to coordination and rehabilitation needs to be reinforced, as well as increased knowledge on the concept of habilitation as elucidated in the Canadian Model of Occupational Performance and Engagement (CMOP-E). This model and its outcome measure focus interventions on occupation, a central tenet for occupational therapists internationally and increasingly in French speaking countries. This research should be followed by complementary studies focused on the use of the COPM in French-speaking countries, the study of its effects on the practice of the occupational therapist, and the development of occupations for the client.


This study aims to investigate the performance evolution and mechanism of asphalt under action of chloride salt erosion. Asphalt samples soaked with five different snow melting chloride salt concentrations were taken as the research object. Then, the high-temperature performance, low-temperature performance, temperature sensitivity and asphalt–aggregate adhesion property of asphalt samples were carried out. Additionally, Fourier transform infrared spectroscopy (FTIR) was used to explore the mechanism of chloride salt erosion on asphalt. Test results showed the linear variation relationships of high-temperature performance, low-temperature performance and temperature sensitivity with chloride salt concentrations. The high-temperature performance of asphalt would be improved by chloride snowmelt salt. With the increase in the chloride salt solution concentration, the low-temperature performance of asphalt became worse, and the temperature sensitivity increased. Moreover, after the effect of the chloride salt solution, the asphalt–aggregate adhesion property decreased with the increase in the chloride salt solution concentration. It is necessary to control the amount of chloride snowmelt salt in the actual snow removal projects. Finally, based on Fourier transform infrared spectroscopy, the mechanism of chloride salt erosion on asphalt was preliminarily explored. With the increase in the chloride salt solution concentration, the proportion of light components  in asphalt decreased, and the proportion of heavy components  with good thermal stability increased. Asphalt pavement has good skid resistance, low noise and excellent friction resistance, which has been applied as the main structure of expressway pavement in China ,2,3. HowThe method of spreading deicing salt, a snow melting agent with the function of quick deicing and snow melting, could be considered an effective method to solve the problem of traffic jams and prevent the pavement from continuing to freeze ,20. The The influence of salt erosion on asphalt material is not only reflected in the macro performance of asphalt mixture, but also reflected in the performance change of asphalt itself. Zhang et al. studied the influences of salt erosion conditions on the asphalt binder by using a four fractions test and atomic force microscopy, and they found that the main reason for the performance degradation of an asphalt binder is that the chemical composition of the asphalt binder changed under the action of salt erosion, resulting in the phenomenon of salt aging. At the same time, the freeze–thaw cycle test of a salt solution was simulated . Zhang ePI) is used to evaluate the temperature sensitivity of asphalt. In addition, the asphalt–aggregate adhesion property is evaluated, and the mechanism of chloride salt erosion on asphalt is preliminarily explored by Fourier transform infrared spectroscopy (FTIR). The analysis and results of this study could provide some references for the snow melting project by spreading deicing salt, a snow melting agent.Considering the problem that the existence of salt would bring continuous negative effects to asphalt pavement, this study aims at analyzing the performance evolution and mechanism of asphalt under action of chloride salt erosion. Asphalt samples soaked with different snow melting chloride salt concentrations are taken as the research object. The softening point and viscosity are used to evaluate the high-temperature performance of asphalt, the ductility and equivalent brittle point are used to evaluate the low-temperature performance, and the penetration index  , which meets the requirements of Chinese specification “Technical specifications for construction of highway asphalt pavements” (JTG F40-2004) . The detThis study used sodium chloride snow melting salt to investigate the influence of chloride salt concentration on the performance of asphalt. Following the Chinese specification of “Salt of ice and snow melting for road” (GB/T 23851-2009) , the disIt can be seen from The interaction between asphalt and chloride salt solution is a slow and long process. In order to speed up the interaction rate of these two substances, increasing temperature is usually used to accelerate their interaction. In this study, the high temperature boiling method was used to prepare asphalt samples following the previous study . The speStep 1:Chloride salt solutions with different concentrations  were poured into the crucible for heating and boiling, then the heated asphalt with a molten state were poured into the chloride salt solutions and boiled for 3 min.Step 2:The surface of the prepared porcelain basin was evenly smeared with isolation agent, and the boiled asphalt was taken out and placed in the porcelain basin and marked.Step 3:The porcelain basin containing asphalt was placed on the electric stove at 120~130 °C to separate moisture from the asphalt until the asphalt is not foamed.−1 Pa·s, while the viscosity of asphalt would be as high as 1011 Pa·s in the severe cold condition. In general, the road surface temperature is very high in summer in China, so the viscosity of asphalt at 135 °C (T0625-2011) [The ability of asphalt to resist high temperature deformation is usually known as high-temperature stability. In the current test specification “Standard test methods of bitumen and bituminous mixtures for highway engineering” (JTG E20-2011) , the bal25-2011)  is regar25-2011) .1.2 (T0604-2011) [The crack problem of asphalt pavement has attracted extensive attention; the main reason for this problem is the lack of low-temperature crack resistance of the asphalt mixture . Asphalt04-2011)  can be uPI [PI of asphalt is used to evaluate the temperature sensitivity of asphalt. The PI value could be calculated by three or more penetration values of asphalt tested under different temperature conditions according to the specified method (T0604-2011) of “Standard test methods of bitumen and bituminous mixtures for highway engineering” (JTG E20-2011) [PI value, the smaller the temperature sensitivity of asphalt.As a kind of typical temperature-sensitive material, the temperature change has a significant impact on the performance of asphalt. As for the index of temperature sensitivity of asphalt, the most representative parameters are penetration–viscosity index (PVN), viscosity–temperature index (VTS) and PI . In this20-2011) . The greWater damage is the main early damage form of asphalt pavement among the common distresses in China. The existence of water will destroy the bonding interface between the asphalt and aggregate, which leads to the asphalt film falling off from the aggregate surface, and then the road performance of asphalt pavement will be decreased . At presInfrared spectroscopy (IR) can react with the molecular structure of materials, which can effectively detect the structure of complex molecules ,35. In t800, which can also be used to evaluate the high-temperature performance of asphalt. The equivalent softening point T800 can be calculated by extending the fitting linear penetration–temperature line at the intersection of penetration value 800 in the nomograph with three or more penetration values of asphalt under different temperature conditions. The calculation equation is listed in the Equation (1). The calculated equivalent softening point T800 of asphalt with different chloride salt concentrations are plotted in K is the fitted constant in the regression equation of penetration–temperature, and APlg is the fitted coefficient in the regression equation of penetration–temperature. The fitting results are listed in According to the ball and ring method (T0606-2011) of Chinese specification (JTG E20-2011), the measured softening point results of asphalt with different chloride salt concentrations are plotted in 800 of asphalt samples soaked in the chloride salt solution are significantly higher than those of the dry asphalt sample. In 800 of the asphalt sample after soaking in water and chloride salt solution with various concentrations increased by 0.4%, 1.8%, 2.6%, 3.7% and 4.3%, respectively. Both the softening point and equivalent softening point show linear relationships with the increase in chloride salt concentration. The variation of the softening point and equivalent softening point with different chloride salt concentrations shows that under the effect of chloride snowmelt salt, the softening point of asphalt would increase, and the greater the chloride salt solution concentration is, the larger the change range of the softening point is, which indicated that the high-temperature performance of asphalt would be improved by chloride snowmelt salt.It can be seen from For these reasons, on the one hand, due to the change of asphalt components, with the increase in the chloride salt solution concentration, the proportion of light components  in asphalt decreases, and the proportion of heavy components  with good thermal stability increases, which would lead to the increase in high-temperature performance of asphalt. On the other hand, the chloride ions in the chloride salt solution exist in the form of crystals among asphalt molecules and increase the molecular weight of asphalt. At this time, asphalt molecules need to overcome more resistance while moving. In addition to the heat absorbed by asphalt molecules, chloride ions would share part of the heat. Then, with the increase in the chloride salt solution concentration , the asphalt heating system including the chloride salt solution could bear more heat, resulting in a better high-temperature performance of asphalt.In order to further analyze the influence of chloride snowmelt salt on the high-temperature performance of asphalt, in addition to the softening point, the viscosity of asphalt at 135 °C were also measured according to T0625-2011 of Chinese specification (JTG E20-2011). The viscosity variation of asphalt at 135 °C with different chloride salt concentrations is shown in 2 of 0.930. When the chloride salt solution concentration increases from 0% to 24%, compared with the control group (Group No. 0), the viscosity at 135 °C of asphalt samples increase by 5.2%, 7.9%, 12.1%, 14.1% and 17.9%, respectively. The viscosity variation trend also indicates that the high-temperature performance of asphalt sample has been improved by chloride snowmelt salt. Due to the existence of chloride ions in asphalt molecules, in the Brookfield viscometer test, the change of asphalt composition  requires the rotor to overcome a greater intermolecular force in order to maintain a fixed speed. Therefore, there is an increasing viscosity value of asphalt, and the viscosity increasement in asphalt will increase with the increase in the chloride solution concentration.As can be seen from 2 of 0.966. Compared with the control group (Group No. 0), the ductility at 10 °C of the asphalt sample decreases by 9.2%, 13.6%, 17.2%, 23.3% and 27.6% when the chloride salt solution concentration increases from 0% to 24%, respectively. The ductility variation of asphalt depends on the chloride salt solution concentration. The ductility at 10 °C of the asphalt soaked in a higher concentration of chloride salt solution is significantly lower than that of the control group .According to the experimental method (T0605-2011) of Chinese specification (JTG E20-2011), the measured ductility results at 10 °C of asphalt with different chloride salt solution concentrations are plotted in The main reason for such ductility variation of asphalt with different chloride salt solution concentrations is that the chloride ions in the chloride salt solution process crystals with large sizes among asphalt molecules, leading to materials being easier to break, and the chloride salt ions will block the links between asphalt molecules, which makes asphalt easier to break in the ductility test. With the increase in the chloride salt solution concentration , the low-temperature performance of asphalt becomes worse. In addition, with the increase in the chloride salt solution concentration, the asphalt components gradually change, the proportion of heavy components  increases, while the proportion of light components  with good plasticity in asphalt decreases, which would lead to a worse ductility of asphalt. Moreover, the ductility at 10 °C of the asphalt is generally required no less than 200 mm. According to the ductility result in 1.2, which can also be used to evaluate the low-temperature performance of asphalt. The equivalent brittle point T1.2 is also calculated by extending the fitting linear penetration–temperature line at the intersection of penetration value 1.2 in the nomograph with three or more penetration values of asphalt under different temperature conditions. The corresponding calculation equation is listed in the Equation (2).When the penetration of asphalt is 1.2 (0.1 mm), the corresponding temperature is known as the equivalent brittle point T1.2 of asphalt with different chloride salt concentrations are plotted in 1.2 of asphalt sample presents a linear relationship with the increase in the chloride salt solution concentration, in which R2 of 0.966. Similarly, the chloride ions in the chloride salt solution contain crystals with large sizes among asphalt molecules, which have poor plasticity. Due to the change of asphalt components, the equivalent brittle point T1.2 of asphalt decreases with the chloride salt solution concentration.According to the fitting parameters in PI is listed in the Equation (3), which is used to evaluate the temperature sensitivity of asphalt.According to the experimental method (T0604-2011) of Chinese specification (JTG E20-2011), the penetration values at 15 °C, 25 °C and 30 °C of asphalt could be measured. Then, the measured penetration–temperature result is fitted by a linear function. Following the T0604 in JTG E20-2011, the calculation equation of PI of asphalt with different chloride salt concentrations are plotted in 2 of 0.932, which indicates that the higher the chloride salt solution concentration, the greater the PI value of asphalt, and the better the temperature sensitivity. The reason is that: after the action of chloride salt solution, the composition of asphalt changes; that is, the proportion of light components  in asphalt decreases, and the proportion of heavy components  with good thermal stability increases. Besides, with the increase in the chloride salt solution concentration, the content of resin and asphaltene in asphalt samples will be further increased, so the temperature sensitivity of asphalt will be reduced. Moreover, the chloride ions in the chloride salt solution exist in the form of crystals among asphalt molecules; when the asphalt heating system including chloride salt solution absorb heat to move, the chloride ions would share part of the heat.Following the fitting parameters in The boiling method was adopted in this study to evaluate the adhesion property between asphalt and aggregate according to T0616-2011 of JTG E20-2011 (similar to ASTM D3625). The limestone aggregates were used in this study, the corresponding geological nature and some characteristics have been introduced in the previous study . The aspIt can be seen in 2) at 2918 cm−1, symmetric stretching vibration of methylene (CH2) at 2850 cm−1, skeleton vibration of benzene ring near 1460 cm−1, shear vibration of methyl (CH3) near 1378 cm−1, and benzene ring substitution area of in the wavenumber range of 900~500 cm−1. The addition of chloride salt has a great influence on the absorption peak near 1600 cm−1 characterizing aromatic fraction and the benzene ring substitution area, which would be also the main reason for the performance change of asphalt caused by chloride salt addition.Fourier transform infrared spectroscopy (FTIR) was used to test asphalt samples soaked in different chloride salt solution concentrations to analyze the action mechanism of chloride salt on asphalt. The FTIR results of asphalt varying with different chloride salt concentrations is shown in PI is used to evaluate the temperature sensitivity of asphalt. In addition, the asphalt–aggregate adhesion property is evaluated, and the mechanism of chloride salt erosion on asphalt is preliminarily explored by Fourier transform infrared spectroscopy (FTIR). The conclusions are as follows:The linear variation relationships of the softening point, equivalent softening point and viscosity with chloride salt concentrations showed that the high-temperature performance of asphalt would be improved by chloride snowmelt salt.According to the ductility and equivalent brittle point, with the increase in the chloride salt solution concentration , the low-temperature performance of asphalt becomes worse, and the chloride salt solution concentration should be recommended as less than 12~18%.The temperature sensitivity of asphalt presents an increasing linear relationship with the increase in the chloride salt solution concentration, and the temperature sensitivity increases by soaking in chloride salt solution concentration.After the effect of the chloride salt solution, the asphalt–aggregate adhesion property decreases with the increase in the chloride salt solution concentration. It is necessary to control the amount of chloride snowmelt salt in the actual snow removal projects.Based on Fourier transform infrared spectroscopy, the main reason for the performances of asphalt caused by chloride salt might be attributed to the change of asphalt components. With the increase in the chloride salt solution concentration, the proportion of light components  in asphalt decreases, and the proportion of heavy components  with good thermal stability increases.This study takes the asphalt samples soaked with different snow melting chloride salt concentrations as the research object. The softening point and viscosity are used to evaluate the high-temperature performance of asphalt, the ductility and equivalent brittle point are used to evaluate the low-temperature performance, and the In future work, the influence of this salt contents variations along time  would be evaluated. Meanwhile, further study will carry out the characterization tests (such as SEM or TEM) for the used materials, and the rheological property test of asphalt.


During the first peak of the COVID-19 pandemic, the activity of Emergency Departments worldwide changed dramatically, focusing on diagnosis and care of the Sars-Cov-2 associated disease. These major changes also involved the activity of the Emergency Radiology Department (ERD). This study aimed to analyse the impact of the COVID-19 pandemic on imaging studies, both in terms of the amount, frequency and subspecialty of different imaging modalities requested to the ERD of the Maggiore della Carità Hospital in Novara .To this end, our observational study took into account the imaging studies requested by the emergency department during three-time spans. These were defined as phase 0 (pre-pandemic), phase 1 (pandemic peak with complete lockdown) and phase 2 , as derived from Italian urgent decrees by the President of the Council of Ministers (DPCM) which established the duration and entity of the lockdown measures throughout the pandemic. The dataset was processed and then compared with Pearson’s chi-squared test.During the pandemic peak, our data showed a significant drop in the total number of studies requested and a significant rise in computed tomography (CT) studies. In particular, a statistically significant increase in chest CT studies was found, probably due to the high sensitivity of this imaging method in identifying pulmonary involvement during respiratory tract infection of possible viral etiology (SARS-Cov-2). Moreover, we observed a statistically significant decrease of X-ray (XR) and ultrasound (US) studies during phase 1 compared to phase 0 and phase 2 probably due to a reduction in the numbers of ER visits for minor traumas given the mobility restrictions and people hesitancy in visiting the ER due to fear of contagion.We can conclude that the activity of the ERD was heavily impacted by the SARS-Cov-2 pandemic. Further studies will be needed to estimate the impact of the pandemic on public health in terms of excess mortality related to delayed diagnosis and care of non-COVID diseases. During the COVID-19 pandemic, the whole province of Novara was significantly affected. Being at the border with Lombardy, the most affected region in Italy so far. Until 24/06/2020, the province of Novara had 2780 confirmed COVID-19 cases out of a total of 31,276 cases for the Piedmont region . During the pandemic, the activity of the whole Radiology department was necessarily reshaped, in line with regional and national provisions, and in the same way as other main hospitals, such as in Milan .A significant reduction of the number of MSK X-ray studies was also identified during the COVID-19 outbreak. In particular, the percentage of such studies dropped from 36.71% of overall studies in phase 0 to 20.71% during phase 1 and failed to return to the baseline during phase 2 (32.8%). Variations in the frequency of conventional radiology studies are summarized by Fig. Last but not least, data about the amount of studies that were congruent with the clinician’s query turned out to be statistically significant: the percentage of studies congruent with the clinician’s query turned out to be 37.18% during phase 1, while it was 26.78% in phase 0 and 26.28% in phase 2. No statistically significant difference was found between the amount of studies congruent with the clinician’s query in phase 0 and in phase 2, suggesting that this parameter went back to normal after the acute phase of the outbreak , likely due to high amount of chest CT scans positive for interstitial pneumonia in that timeframe, coupled with the sharp increase of chest CT requests.This reduction in the overall number of studies in the ERD, with the notable exception of chest CTs, might have been due to the public’s hesitancy in accessing the ER. Hospitals might have been perceived as a very dangerous place in terms of the risk of contracting the Sars-nCov-2 infection. It could be interesting to further elaborate on this theme by administering a questionnaire to a representative sample of the general population relating to their feelings regarding visits to the hospital during the different phases of the pandemic and during the same timeframe of 2019.


The aim of this work is preparation and investigation of copper conductive paths by printing with a different type of functional ink. The solutions based on copper-containing complex compounds were used as inks instead of dispersions of metal nanoparticles. Thermal characteristics of synthesized precursors were studied by thermogravimetry in an argon atmosphere. Based on the comparison of decomposition temperature, the dimethylamine complex of copper formate was found to be more suitable precursor for the formation of copper layers. Structure and performance of this compound was studied in detail by X-ray diffraction, test of wettability, printing on flexible substrate, and electrical measurements. The use of printing in electronics manufacturing is attracting increasing attention in the field of materials science and technology ,2,3,4. UThis technology includes three main stages: preparing materials for printing, printing, and post processing . Conduct2O, CuO), which strongly hinder mutual diffusion of Cu atoms between the particles and reduce the formation of percolation paths, and it leads to low conductivity of printed patterns (OOCH)2 was prepared by dissolving 1 g of copper formate Cu(OOCH)2 in 2 mL of 25% aqueous ammonia solution.Ammonia complex of copper formate [Cu(NH(3)2H6NH)2](OOCH)2 was prepared by dissolving 1 g of copper formate Cu(OOCH)2 in 2 mL of 33% aqueous solution of dimethylamine.Dimethylamine complex of copper formate (OOCH)2 (B) and [Cu(C2H6NH)2](OOCH)2 (C) compounds.Thus, the results of EDX analysis correlate well with the results of Raman and DTA data and allows us to provide assumptions about the mechanism of copper reduction. A noticeable decrease in the copper reduction temperature depends on the composition of the complexing agent, due to the influence of nitrogen on the copper reduction process, which acts as a bridge for the transfer of an electron from hydrogen of a formate anion to copper, showing, in fact, a catalytic reaction mechanism. To confirm this mechanism, we calculated Mulliken atomic charges and thermodynamic potentials of reactions by the DFT method with the B3LYP/6-311++G functional. 2, which the oxide CuO produces upon heating, and when a dimethylamine molecule is used as a ligand, the probability of primary reaction (1) increases.As can be seen from the Thus, due to the lowest decomposition temperature, the dimethylamine complex of copper formate is the most preferable precursor for the formation of copper layers; therefore, this compound was chosen as the object of our further research.To study the structure and composition of degradation products of the copper dimethylamine complex, we obtained X-ray diffraction patterns of the complexes processed at 120, 140, and 160 °C for 10 min and they are shown in As can be seen from the diffraction patterns, an increase in the temperature of processing of the copper complex leads to a noticeable increase in the proportion of by-products in the form of copper oxides, which strongly hinder mutual diffusion of Cu atoms between the particles and reduce the formation of percolation paths, and it leads to low conductivity of printed patterns. At a temperature of 120 °C, copper peaks appear clearly. Oxide peaks are hardly observed, however, there appears to be a noisier character of the background curve, which is probably due to the content of residual copper complex in the form of amorphous inclusions. Thus, a temperature of 120–130 °C can be considered optimal for post-processing of the ink based on the dimethylamine complex.The ink was prepared by dissolving dimethylamine complex in dimethyl sulfoxide at a concentration of 300 mg/mL.The choice of the solvent is conditioned by a number of its advantages, including inactivity in relation to the ink components, the optimal boiling point (190 °C) ensuring stability preventing premature ink drying, and viscosity of 2 mPa·cm  being optimal for inkjet technology. In addition, we investigated the degree of wetting of glass and plastic surfaces , which iThe measurements show that dimethyl sulfoxide exhibits the glass surface wetting ability comparable to that of water, due to a certain polarity of the molecules in its composition, while the plastic surface wetting ability is noticeably different—the wetting angle of DMSO on plastic is noticeably smaller than that of water. This effect is conditioned by the affinity of the solvent and the substrate.The ink was printed using an EPSON 110 inkjet printer. Before use, the ink was pre-filtered with a syringe filter with a pore size of 0.5 μm. Printing was carried out on the surface of a flexible polymer film, and it became possible at a rather low post-processing temperature of the printed ink. The scanning electron microscope (SEM) images c,d show The main functional characteristic of copper-based printed layers is conductivity, and its values are presented in The right curve shows conductivity versus post-processing temperature of the printed ink. At low temperatures (60–70 °C), resistance is high—about 2–3 powers of Ohm per square. At these temperatures, ink can be found in the form of complex compounds and exhibit predominantly ionic conductivity. As the temperature increases, there is a noticeable decrease in resistance associated with the appearance of electronic conductivity of the formed metal. However, an increase in temperature above 130–140 °C is accompanied by an increase in resistance of the formed layers, due to an increase in the proportion of by-products in the form of copper oxides, which greatly reduce the number of percolation paths, and it leads to low conductivity of the printed patterns.In the course of the research, we obtained the ink based on copper-containing organometallic compounds for the formation of conductive elements of circuits by ink-jet printing. The process of copper reduction from the organometallic complex and the growth of copper grains begins at temperatures above 110 °C and finishes completely at 130 °C, which is acceptable for the formation of electrically conductive paths on most of flexible polymeric materials. As an example, thin conductive copper paths were formed on a PET plastic film using a standard EPSON 110 inkjet printer.


The results may improve our understanding of the evolution of development in changing environments.Trait covariation during multiphasic growth is of crucial significance to optimal survival and reproduction during the entire life cycle. However, current analyses are mainly focused on the study of individual traits, but exploring how genes determine trait interdependence spanning multiphasic growth processes remains challenging. In this study, we constructed a nonlinear mixed mapping framework to explore the genetic mechanisms that regulate multiphasic growth changes between two complex traits and used this framework to study stem diameter and stem height in forest trees. The multiphasic nonlinear mixed mapping framework was implemented in system mapping, by which several key quantitative trait loci were found to interpret the process and pattern of stem wood growth by regulating the ecological interactions of stem apical and lateral growth. We quantified the timing and pattern of the vegetative phase transition between independently regulated, temporally coordinated processes. Furthermore, we visualized the genetic machinery of significant loci, including genetic effects, genetic contribution analysis, and the regulatory relationship between these markers in the network structure. We validated the utility of the new mapping framework experimentally  Mapping the genetic architecture of complex traits is a subject of long-standing interest and a formidable challenge in modern biology  model May, , which wPopulus. This family was generated by crossing an eastern cottonwood (Populus deltoides) clone I-69, introduced to China in the 1970s  clone I-45 as the male parent. This cross is equivalent to a backcross at the species level. This family was planted in 1984 for 24 years in a uniform site at Zhangji Forest Farm, Xuzhou, Jiangsu, China. 2-like intercross markers. For a testcross marker, one of the parents is heterozygous and the other is homozygous, and the intercross marker is derived from two heterozygous parents.Xu et al.  reportedStem growth in Populus trees experiences multiple phases of development including juvenile, mature, and senescence Bond, . In the Several classical nonlinear growth equations, such as those of Gompertz  and D(t) represent the growth of quantitative traits of height and diameter of trees at age t; H1(t) and D1(t) represent growth during the juvenile phase; and H2(t) and D2(t) represent the growth in adulthood.where In nature, the interactive relationship between diameter and height can promote or hinder the growth of another trait. The synergistic effect of stem height and radial growth is conducive to the survival and reproduction of trees. However, when resources are in short supply, height growth and diameter growth achieve a trade-off of resource competition  and D2(t) satisfying the following two equations:However, when poplar reaches the maturity period of development, the growth patterns of diameter and height change, which can be described by growth equations without interacting parts , ⋯ , yi1(T)) and yi2 = (yi2(1), ⋯ , yi2(T)) represent phenotypic data of time-related traits 1 (height) and 2 (diameter), respectively. The composite growth characteristics composed of two traits approximately obey the bivariate normal distribution, where the time-dependent mean value and the symmetric covariance matrix (2T × 2T) are, respectively, expressed asWe consider the multiphasic growth of height and diameter as a whole according to the NGE and detect how QTLs controlled the overall growth curve from the perspective of system mapping, as well as the regulation of phase transition by QTLs , where θ represents the growth parameters. The joint probability density function of n sample trees constitutes the likelihood function as follows:The elements on the diagonal inΣ are the variance matrix for each trait, and the nondiagonal elements are the covariance matrix between a pair of traits. The joint density function of the two-dimensional normal vectors is of the formIt is assumed that the multiphasic growth of the two traits is controlled by a set of QTLs located on the linkage map. J kinds of genotypes are on the assumed QTL, and the time-dependent mean values of the samples differ among genotypes:fj. On the assumed specific QTL, the number of samples with genotype j is nj, satisfying The joint density function of the genotype is denoted by jH, KjH1, βjH←D, αjD, KjD1, βjD←H, KjH2, pjH, qjH, KjD2, pjD, qjD) instead of directly estimating 2T mean values. By comparing the genotype-dependent differences in this parameter set, we can determine whether the QTL affects multiphasic growth.According to the multiphasic growth function of the NGE, we can estimate the mean vector through a set of parameters  at time t:In addition, we use a highly efficient structured antedependence (SAD) (1) statistical model, which was proposed by Zhao et al. , to reprt1 and t2 is expressed asThe covariance between The fixed innovation variance between different time points is represented by parameter ρ, and the covariance between the two traits at different time points is expressed asL0 and L1 are consistent, which can improve the operation efficiency of the model with little loss of precision. The maximum likelihood estimation of parameters in the mean and covariance structure of the QTL detection model is performed by applying the expectation maximization (EM) algorithm  correction based on the Benjamini and Hochberg method was performed on each p-value to control the proportion of false positives within a certain range.At the set test level α, if LR belongs to the rejection domain, we reject the null hypothesis We can further examine how QTLs control the multiphasic growth of the two traits and the characteristics in different phases. Based on the following hypotheses, we can detect whether the QTL regulates the interaction growth of stem height and diameter in the first phase:and whether the QTL controls the growth of the two traits in the second phase by formulating the following hypotheses:KH1 and KD1 of the independent growth of the two traits in the first phase, the total asymptotic growth with respect to the interaction, and the asymptotic growths KH2 and KD2 in the second phase. In addition, the independent growth rate of the first phases αH and αD, and the interaction relationships βH←D and βD←H of the first phase can also be tested. The initial growth values pH and pD and growth rates qH and qD of the second phase can also be tested. The phase transition time was determined by examining the differences in parameters with respect to genotypes.According to the biological significance of the parameter, we can also test whether QTLs control the asymptotic growths R2  to fit the diameter and height growth data compared with monophasic, diphasic, and triphasic logistic models. In R2 . As showObviously, the fitting results of the NGE can be divided into two parts; the first stage of which includes potential independent growth and interaction growth. jH, KjH1, βjH←D, αjD, KjD1, βjD←H, KjH2, pjH, qjH, KjD2, pjD, qjD). The description of how a QTL affects the multiphasic growth and intrinsic interaction of traits can be characterized from genome-wide information based on a series of hypothetical tests. We performed FDR correction on the p-value results of all the SNPs and determined the critical thresholds as 10−40 and 10−50 after Bonferroni correction for testcross SNPs and intercross SNPs, which are strict detection levels. The Manhattan plots of the corrected p-values derived from test statistic values are shown in GATA12 gene, which is a member of the GATA family of transcription factors. A set of significant SNPs are closely distributed in the same region of chromosomes, such as chromosomes 5, 8, and 9, residing within the same gene. For instance, SNPs 79,620, 79,624, and 79,625 are highly linked on chromosome 8, located within the region of the OASA1 gene, which encodes the synthesis of anthranilate synthase. p-values, and annotated candidate genes. The joint process of multiphasic growth is regarded as a whole system, containing interactions between traits in the first phase and growth characteristics. By regressing the genotype-related growth trajectory of stem diameter and stem height, the differences in genotypes are expressed in the NGE parameters  for 24 years by quantifying the dynamic genetic contribution of markers to growth. The PVE of these loci for stem height growth was significantly smaller than the PVE for diameter. A basic hierarchical cluster analysis was performed for the PVE of all significant SNPs over time, which was divided into two stages and represented by tags with different colors. Of the observed 24 years of growth, the first phase of stem height growth was the first 6 years, and the remaining 18 years belonged to the second phase. The first phase of diameter growth was the first 12 years, and years 12–24 represented the second phase . CompareAmong the significant loci, the PVE of the same SNP for the two traits was different. For example, the genetic contribution of SNPs 17,787, 86,065, 73,524, 87,023, 28,821, and 102,765 to the growth of stem height was relatively substantial, while the genetic contribution of SNPs P28821 and 73,524 to the growth of stem diameter was the lowest among all the SNPs. In addition, SNP 77,477, with a low genetic contribution to stem height, had a PVE of 10% in diameter. The genetic contribution of some SNPs, such as 28,821 and 73,524, is mainly expressed in the growth of one trait. However, some SNPs, such as 17,787 and 102,765, make strong genetic contributions to both stem diameter and stem height, indicating that the same significant SNP affects the growth of tree height and diameter in different ways, thus revealing the pleiotropy of genes.The growth of stem height and diameter is determined jointly by genetic effects of 26 testcross SNPs and 39 intercross SNPs as well as epistatic effects among them. According to the potential differential relationship of significant SNPs, we established a genetic network to characterize how these SNPs interact with each other to regulate the growth in diameter and height. In both the height and diameter network structures, most SNPs receive directional epistasis from other SNPs; they are activated or inhibited by other SNPs and play passive roles. Only a few significant SNPs called key QTLs were found to be in the pivotal dominant position of regulation in the genetic network, which had a strong potential to influence other QTLs with major outward links. Three SNPs, intercross SNP 48,833, intercross SNP 48,971, and testcross SNP 86,976, were the key QTLs in the stem height genetic network, and the directed links from them accounted for 27.17, 28.26, and 17.39% of all pairwise links, respectively . The keyThe advantage of our NGE mapping approach lies in its capacity to analyze the genetic control of SNPs with significant effects on multiphasic growth, which can be tested by hypotheses based on related growth parameters. Here, we chose the representative testcross SNP 137,076 to interpret its genetic influence on growth in different phases of diameter and height. Both genotypes AG and AA in SNP 137,076 show that the growth of stem diameter benefits from stem height, and that stem height growth is deleteriously affected by diameter growth. This can be found from a similar form of overall growth and independent growth for stem height but greater overall growth relative to independent growth for stem diameter. The phase transition time of stem height occurs earlier than that of stem diameter. The two genotypes at this locus have similar control over the multiphasic growth of the two traits but different patterns in the growth details.As shown in The influence of SNP 137,076 on the growth of the two traits is reflected in the temporal variation of the genetic effect, which also shows the characteristics of periodic change consistent with the growth curves. For stem height, the net genetic effect increases during the first 6 years and then decreases. During the juvenile phase, the overall genetic effect and the independent growth genetic effect show similar change patterns to the net effect, and then they level off at 12 years of age. The effect value of the independent growth is greater than that of the overall growth effect. The change in the interaction genetic effect shows a lag, beginning to rise at 5 years of age, and slowly declines until it stabilizes 12 years later. The genetic effect curve of the early adult phase gradually increased during years 1–12 and then decreased, which was related to the early growth of the second phase of stem height . We analH2are utilized: 0.05 and 0.1. It is assumed that the growth of the two traits of trees is regulated by a set of QTLs in the genome. The simulation scale is 1,000 testcross genetic markers, and the phenotypic data are determined by one of the QTLs. In each simulation case, the proportion of simulation iterations of meaningful QTLs screened out of 100 repeated simulation experiments is the mapping accuracy (power), which is calculated and shown in H2= 0.05, although the accuracy was only 0.49 when the sample size was 66, it significantly improved to 0.82 when the size was increased to 100. When the sample size was 200, the accuracy of the two heritability levels reached 1. The results show that the NGE achieves good accuracy in selecting QTLs for multiphasic growth and is suitable for large sample size data analysis.To verify further the statistical characteristics and mapping accuracy of the NGE, we conducted a simulation analysis based on the real growth data of tree diameter and height over 24 years under different sample size and heritability conditions. Among them, the sample size is the number of simulated samples; namely, n = 66 , 100, and 200. Heritability is the proportion of genetic variance in the simulated phenotypic variance, and two levels of n = 66 , 100, and 200 and heritability levels of H2= 0.05 and 0.1 are simulated with 1,000 genetic markers and phenotypic data. At this point, the proportion of the simulation times of QTLs screened out to the number of 100 simulations is the false positive probability. The false positive rate (FPR) of QTL detection based on the NGE is small (< 0.11), indicating that the NGE has reasonably high specificity even under the conditions of large sample size and heritability . At a certain heritability level, the accuracy of QTL mapping based on the NGE is affected by the number of genetic samples, indicating that the model is more suitable for QTL detection with large sample size.According to the QTL mapping accuracy and false positive probability in a series of different thresholds, we express ROC curves for different simulated sample sizes. The area under the ROC curve (AUC) was calculated to assess the accuracy of QTL mapping of the NGE . Under sH2 = 0.05 and 0.1, with sample sizes of n = 66, 100, and 200. The two genotypes are expressed as AA and Aa. The maximum likelihood estimation of NGE parameters  of simulated data is obtained by the fourth-order Runge–Kutta, EM, and Nelder–Mead algorithms. The parameter estimation results are shown in We perform 100 simulation calculations based on the NGE parameters of the two genotypes of a significant QTL at the heritability levels of Among the estimated parameters of 100 groups of simulation data obtained under the six kinds of simulation conditions, we select several groups of parameters with better effects to produce the overall growth curves and growth curves of two phases of two interaction traits. The trends of the estimated curves of different simulation scales are consistent with those of the real curves , 9, whicThe phase transition during tree growth is the internal mechanism for optimal development and reproduction. At the same time, it should not be ignored that phased development is not characterized by organ morphology and growth morphology independence, but there is a correlation between each morphology. For example, in the relationship between biomass yield and shrub growth traits, increasing the number of stems would reduce the average stem diameter but not the average stem length of plants  analysis shows that the most significant SNPs can be annotated to genomic regions of candidate genes that encode particular biological processes . We findThe competitive or cooperative relationship between stem height and diameter is present throughout the growth history of trees, although it may take different forms during different phases and is sometimes not obvious. Our Lotka-Volterra-based interaction model can be extended to different phases of growth, describing complete tree growth and development and the interaction of traits within them. In addition, the overall multiphasic growth system of trees does not include only the interaction between the two traits. For example, the stem growth of trees also includes the growth of some lateral organs and branches in addition to the height and diameter of the stem. The compound phase growth model can be extended from a two-dimensional to a multidimensional model to conduct a comprehensive overall analysis of tree growth, although this expansion will greatly increase the complexity of the model and the difficulty of parameter estimation.In the actual growth process, studies have shown that, in addition to endogenous regulatory factors, developmental genetic programs that control the transition between different phases of organisms are also regulated by environmental stimuli  (XZ) and the National Natural Science Foundation of China (grant no: 11501032) (X-YZ). This study is partially supported by the Japan Society for the Promotion of Science (grant no: 19K03613) (QF).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.