Showing the advantages and disadvantages of NIV use in intensive care unit.
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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"1618",leadTitle:null,fullTitle:"Topics in Magnetohydrodynamics",title:"Topics in Magnetohydrodynamics",subtitle:null,reviewType:"peer-reviewed",abstract:"To understand plasma physics intuitively one need to master the MHD behaviors. As sciences advance, gap between published textbooks and cutting-edge researches gradually develops. Connection from textbook knowledge to up-to-dated research results can often be tough. Review articles can help. This book contains eight topical review papers on MHD. For magnetically confined fusion one can find toroidal MHD theory for tokamaks, magnetic relaxation process in spheromaks, and the formation and stability of field-reversed configuration. In space plasma physics one can get solar spicules and X-ray jets physics, as well as general sub-fluid theory. For numerical methods one can find the implicit numerical methods for resistive MHD and the boundary control formalism. 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\r\n\tField programmable array (FPGA) is a programmable device that uses prebuilt logic blocks and routing resources to implement the system without adding additional fabrication steps. The reconfigurable system has applications in computational acceleration and prototyping application-specific integrated circuits (ASIC). The final design of ASIC or processor using FPGA will be continue reprogrammed until we have a bug-free design. The demand for FPGA is expected to increase continuously due to increased adoption of FPGA in areas of enterprise businesses as well as ASIC design because they can be dynamically reprogrammed. The optimized FPGAs are more power-efficient than running equivalent workloads on a CPU. The combination of versatility, efficiency, and performance of FPGAs make the design process more data at a lower total cost of ownership (TCO). Seeing the numerous application of FPGAs irrespective of the domain, it is necessary to understand FPGA in-depth in terms of architecture and applications.
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Lemaster",authors:[{id:"115812",title:"Dr.",name:"Richard",middleName:null,surname:"Lemaster",fullName:"Richard Lemaster",slug:"richard-lemaster"}]},{id:"34939",title:"Multi-Scale Deconvolution of Mass Spectrometry Signals",slug:"multi-scale-deconvolution-of-mass-spectrometry-signals",signatures:"M’hamed Boulakroune and Djamel Benatia",authors:[{id:"114268",title:"Dr.",name:"M'Hamed",middleName:null,surname:"Boulakroune",fullName:"M'Hamed Boulakroune",slug:"m'hamed-boulakroune"},{id:"137062",title:"Prof.",name:"Djamel",middleName:null,surname:"Benatia",fullName:"Djamel Benatia",slug:"djamel-benatia"}]},{id:"34954",title:"Wavelet Theory and Applications for Estimation of Active Power Unbalance in Power System",slug:"wavelet-theory-and-applications-for-estimation-of-active-power-unbalance-in-power-system-",signatures:"Samir Avdakovic, Amir Nuhanovic and Mirza Kusljugic",authors:[{id:"104339",title:"MSc.",name:"Samir",middleName:null,surname:"Avdakovic",fullName:"Samir Avdakovic",slug:"samir-avdakovic"},{id:"112941",title:"Dr.",name:"Amir",middleName:null,surname:"Nuhanovic",fullName:"Amir Nuhanovic",slug:"amir-nuhanovic"},{id:"119535",title:"Prof.",name:"Mirza",middleName:null,surname:"Kušljugića",fullName:"Mirza Kušljugića",slug:"mirza-kusljugica"}]},{id:"34955",title:"Application of Wavelet Transform and Artificial Neural Network to Extract Power Quality Information from Voltage Oscillographic Signals in Electric Power Systems",slug:"application-of-wavelet-transform-and-artificial-neural-network-to-extract-power-quality-information-",signatures:"R. 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Arya, Z. Jane Wang and Rabab K. Ward",authors:[{id:"61570",title:"Prof.",name:"Jane",middleName:null,surname:"Wang",fullName:"Jane Wang",slug:"jane-wang"},{id:"105131",title:"Dr.",name:"Ehsan",middleName:null,surname:"Nezhadarya",fullName:"Ehsan Nezhadarya",slug:"ehsan-nezhadarya"},{id:"113410",title:"Prof.",name:"Rabab",middleName:null,surname:"Ward",fullName:"Rabab Ward",slug:"rabab-ward"}]},{id:"34967",title:"Signal and Image Denoising Using Wavelet Transform",slug:"wavelet-signal-and-image-denoising",signatures:"Burhan Ergen",authors:[{id:"108330",title:"Prof.",name:"Burhan",middleName:null,surname:"Ergen",fullName:"Burhan Ergen",slug:"burhan-ergen"}]},{id:"34968",title:"A DFT-DWT Domain Invisible Blind Watermarking Techniques for Copyright Protection of Digital Images",slug:"a-dft-dwt-domain-invisible-blind-watermarking-techniques-for-copyright-protection-of-digital-images",signatures:"Munesh Chandra",authors:[{id:"116549",title:"Dr.",name:"Munesh Chandra",middleName:null,surname:"Trivedi",fullName:"Munesh Chandra Trivedi",slug:"munesh-chandra-trivedi"}]},{id:"34969",title:"The Wavelet Transform as a Classification Criterion Applied to Improve Compression of Hyperspectral Images",slug:"the-wavelet-transform-as-a-classification-criterion-applied-to-improve-compression-of-hyperspectral-",signatures:"Daniel Acevedo and Ana Ruedin",authors:[{id:"116699",title:"Dr.",name:"Daniel",middleName:null,surname:"Acevedo",fullName:"Daniel Acevedo",slug:"daniel-acevedo"},{id:"147338",title:"Dr.",name:"Ana",middleName:null,surname:"Ruedin",fullName:"Ana Ruedin",slug:"ana-ruedin"}]},{id:"34970",title:"Robust Lossless Data Hiding by Feature-Based Bit Embedding Algorithm",slug:"robust-lossless-data-hiding-by-feature-based-bit-embedding-algorithm",signatures:"Ching-Yu Yang",authors:[{id:"108851",title:"Dr.",name:"Ching-Yu",middleName:null,surname:"Yang",fullName:"Ching-Yu Yang",slug:"ching-yu-yang"}]},{id:"34971",title:"Time-Varying Discrete-Time Wavelet Transforms",slug:"time-varying-discrete-time-wavelet-transforms",signatures:"Guangyu Wang, Qianbin Chen and Zufan Zhang",authors:[{id:"111686",title:"Prof.",name:"Guangyu",middleName:null,surname:"Wang",fullName:"Guangyu Wang",slug:"guangyu-wang"}]},{id:"34972",title:"Optimized Scalable Wavelet-Based Codec Designs for Semi-Regular 3D Meshes",slug:"optimized-scalable-wavelet-based-codec-designs-for-semi-regular-meshes-",signatures:"Shahid M. Satti, Leon Denis, Ruxandra Florea, Jan Cornelis, Peter Schelkens and Adrian Munteanu",authors:[{id:"19077",title:"Dr.",name:"Adrian",middleName:null,surname:"Munteanu",fullName:"Adrian Munteanu",slug:"adrian-munteanu"},{id:"111052",title:"Mr.",name:"Shahid",middleName:null,surname:"Satti",fullName:"Shahid Satti",slug:"shahid-satti"},{id:"113669",title:"Mr.",name:"Leon",middleName:null,surname:"Denis",fullName:"Leon Denis",slug:"leon-denis"},{id:"113673",title:"Ms.",name:"Ruxandra",middleName:null,surname:"Florea",fullName:"Ruxandra Florea",slug:"ruxandra-florea"},{id:"113676",title:"Prof.",name:"Peter",middleName:null,surname:"Schelkens",fullName:"Peter Schelkens",slug:"peter-schelkens"},{id:"113677",title:"Prof.",name:"Jan",middleName:null,surname:"Cornelis",fullName:"Jan Cornelis",slug:"jan-cornelis"}]},{id:"34973",title:"Application of Wavelet Analysis for the Understanding of Vortex-Induced 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Baleanu",coverURL:"https://cdn.intechopen.com/books/images_new/1861.jpg",editedByType:"Edited by",editors:[{id:"105623",title:"Dr.",name:"Dumitru",surname:"Baleanu",slug:"dumitru-baleanu",fullName:"Dumitru Baleanu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"81553",title:"Non-Invasive Ventilation in Acute Hypoxemic Respiratory Failure",doi:"10.5772/intechopen.104720",slug:"non-invasive-ventilation-in-acute-hypoxemic-respiratory-failure",body:'Brief History: Till mid-20th century Non-invasive Ventilation (NIV) was the mainstay of mechanical ventilatory assistance and it was delivered by negative pressure devices such as the “iron lung” that was used predominantly for poliomyelitis patients with respiratory paralysis. Ironically when its demand and supply suffered during the polio epidemic in Denmark in 1952, there was a transition to positive pressure mechanical ventilation via translaryngeal cuffed endotracheal tubes.
Curiass/shell is a shell or a cage which surrounds the chest and is then connected to a portable ventilator. Raincoat or Poncho is a tight fitting suit which is connected through the means of hoses to a portable ventilator. Rocking bed is another method for providing negative pressure ventilation which induces diaphragmatic motion by placement of the patient on a bed which rocks rapidly flat to upright while the contents of abdomen shift. A pneumobelt is a belt with a bladder which can inflate and deflate with air in a cyclic pattern. The diaphgram moves in response to changes in the intraabdominal pressure. Another form of negative pressure ventilation is a pneumowrap.
It was not until the 1980s with the development of nasal masks for continuous positive airway pressure, used for the treatment of obstructive sleep apnea, that there was a renewed interest in NIV and specifically non-invasive positive pressure ventilation.
Principles of NIV: Non-invasive ventilation (NIV) refers to the use of ventilatory methods without the use of an endotracheal tube or a tracheostomy tube which are artificial invasive methods. NIV provides ventilation through the use of a mask of similar device to the patient’s upper airway (Figure 1). This technique is significantly different from the invasive ones which bypass the upper airway of the patient through the use of a laryngeal mask, tracheal tube or tracheostomy. Initially non-invasive ventilation through the use of masks was used in neuromuscular disorders to provide ventilatory support in the night in view of hypoventilation. This was followed by use of non-invasive ventilation used nocturnally in cases of chronic obstructive pulmonary disease leading to an improvement in the muscle strength of respiratory muscles [1]. Ultimately, NIV delivered through masks turned out to be of utmost benefit and was used as a method of standard ventilation in cases of chronic hypercapnic respiratory failure which could be due to deformities of the chest, neuromuscular disorder or impaired central respiratory drive. Few years later NIV was started to be used in respiratory failure due to lung pathologies rather than respiratory pump failures. Since then, NIV has evolved immensely with a widespread application in the Intensive Care Units.
Principle of NIV is application of any technique to augment alveolar ventilation without use of conduit access to airway and using interfaces at nose, mouth or both to deliver compressed air ± oxygen to lungs to improve efficiency of physiological pump.
Currently NIV is also being used in about 20 to 30 percent of acute hypoxic respiratory failure. NIV has even been used in cases of acute respiratory distress syndrome with an alarming success rate of more than 50 percent with improvement being more predominant in the patients whose oxygenation had improved promptly. The advantages and disadvantages of NIV use in intensive care unit have been shown in Table 1.
Advantages | Disadvantages |
---|---|
Airway defense mechanism is well preserved | Claustrophobic mask |
Intermittent use of ventilation | Cannot be used in uncooperative patients |
Patient is able to eat food (Less chances of hypoglycemia) and communicate properly | Time consuming for the health care staff as gas exchange correction requires time in NIV |
Physiotherapy can be given easily | No protection of airway |
Comfortable for the patient when compared to invasive ventilation | Difficult to provide suction as direct access to the bronchial tree is not present |
Reduced requirement for sedation | Irritation to the eye |
Avoidance of chances of intubation | Needs to be constantly checked for air leaks |
Showing the advantages and disadvantages of NIV use in intensive care unit.
For the effectiveness of NIV a proper interface is very important, which include variety of masks. These masks include the
Oronasal or full-face mask,
Nasal mask,
Nasal “pillows” consisting of soft pledgets inserted directly into the nostrils,
Mouthpieces held in place by lip seals resembling a snorkel,
Total face mask resembling a plastic hockey goalie’s mask, and
The helmet (fits over the entire head).
Advantages and disadvantages of interface -
Some degree of air leak either through the mouth or around the mask is common however it can be minimized with proper education and cooperation from the.
The full-face mask interferes with speech, expectoration, and eating and it carries the risks of claustrophobia, aspiration, and rebreathing when compared to the nasal mask.
Dentures should be left in place to optimize the fitting of the mask.
The nasal mask requires patent nasal passages and mouth closure to minimize air leaks.
Positive pressure ventilation delivers either a tidal volume which is either at a supra-atmospheric pressure or at a preset volume which leads to the inflation of the lungs. Exhalation is itself a passive event; it relies on the elastic recoil of the lungs for the deflation of the lung until equilibrium is attained with the pressure of atmosphere or PEEP.
It is the most commonly utilized mode of NIV in the present time, where the interface with the patient can be in the form of a full face mask, a nasal mask or a nasal pillow.
Benefits of positive pressure ventilation are as follows includes avoidance of intubation and other risks as well as complications which are associated with it. There is also preservation of swallowing along with speech and cough reflex which is beneficial for the patient. There is improvement in the exchange of gas and reduction in the word of breathing through resting of the muscles of respiration.
Candidates for positive pressure ventilation are all the patients with respiratory failure irrespective of the type of respiratory failure and it’s type. Patients with acute exacerbation of chronic obstructive pulmonary disease, acute pulmonary edema, pneumonia and exacerbation of bronchial asthma, cystic fibrosis or intrinsic lung disease can be managed with positive pressure ventilation.
Portable ventilators are utilized in order to provide continuous positive airway pressure (CPAP) or BIPAP. CPAP is used to deliver a pressure which is constantly set during inspiration as well as expiration which leads to an increase in the functional residual capacity resulting in improvement of oxygenation, however, it is not strictly a form of ventilatory assistance. Contraindication for the use of positive pressure ventilation is uncooperative patient, patient having a copious amount of secretions where airway protection is not possible, patient with unstable hemodynamics and patients with decreased mental state.
BIPAP is used to provide positive airway pressure in a manner which is biphasic. There is an inspiratory positive airway pressure (IPAP) which is set for inspiration and a lower expiratory positive airway pressure (EPAP) which is set for expiration. Difference obtained from subtracting EPAP from IPAP yields the degree of ventilatory assistance.
EPAP provides a dual benefit by ensuring proper flow in order to flush carbon dioxide from the single tube of ventilator and avoiding rebreathing along with increasing functional residual capacity and opening up the upper airway to prevent apnea as well as hypopnea. It also counterbalances the intrinsic positive end expiratory pressure in patients suffering from chronic obstructive pulmonary disease.
A portable ventilator can be used to initiate NIPPV. First, there needs to be setting up of volume targeted strategy and the tidal volumes need to be higher than in invasive ventilation. A tidal volume of 10 to 15 cc/kg is used. This can compensate for the leak of air through the mouth as well as around the mask. Respiratory rate can be decided and chosen as in standard ventilation. Adequacy of ventilation/oxygenation should be checked through the means of arterial blood gas. Tidal volume or respiratory rate can be increased if the minute ventilation needs to be increased. Similarly, in an over ventilated lung, respiratory rate or tidal volume may be decreased. Oxygen supplementation is provided in line with the circuit.
BiPAP uses a pressure targeted strategy for ventilation. Inspiratory pressure or IPAP can be chosen from 8 to 20 cm H2O pressure. It can be thought of as pressure support. As the pressure increases it will be more uncomfortable for the patient. Generally, BiPAP is started between a range of 8 to 11 cm H2O.Expiratory pressure or EPAP is set at 3 to 5 cm H2O.It can be thought of as PEEP. Difference obtained from subtracting EPAP from IPAP is the amount of support being provided to the patient. In case the patient required further ventilation, IPAP level can be increased gradually. A back up rate can be set by the ventilator rate which can be chosen as a value below the patient’s spontaneous rate to assure that the patient does not develop apnea. A higher ventilator rate may be chosen in order to prevent periods of prolonged apnea and in order to allow resting of the respiratory muscles. If there needs to be improvement in oxygenation, amount of oxygen can be increased in the circuit or EPAP level may be increased. An Increase in EPAP level leads to decrease in tidal volume. To counter this, IPAP level can be increased in the same increment as the increase in EPAP.
Before Weaning one must consider to check if the patient has improved oxygen saturation at low flow oxygen rate, respiratory rate of below twenty four breaths per minute and ensure that there is interruption of positive pressure ventilation for short duration of time to ensure talking, eating, drinking and assess tolerance and gradually increase these pauses.
Drawbacks in the use of positive pressure ventilation are difficulties arising from the discomfort of the mask, headgear or straps and air leaks. Patients also complain of nasal pain, erythema or breakdown of skin due to use of mask. There can also be nasal congestion or dryness as well as ulceration of the nasal bridge with long duration of mask usage. Eye irritation due to air leak blowing into the eyes, gastric distention and aspiration are other few problems encountered in the use of positive pressure ventilation.
It is important to remember that NIPPV when initiated can induce anxiety in the patients making them uncomfortable. In order to make the patients acclimatized to the technique of NIPPV the patients require a 1:1 assistance by respiratory therapist who also makes fine adjustments in the flow rates and pressures depending on the requirement of the patient. On an average it may take about an hour for patient to become comfortable with NIPPV. IT is crucial to monitor the respiratory rate, heart rate as well as arterial blood gas to detect the effectiveness of NIPPV in correcting acute respiratory failure. At any point, if the patient deteriorated on NIPPV, conversion to endotracheal tube in order to ensure proper oxygenation should be considered.
Negative pressure ventilation works of the mechanism of delivering pressure which is sub-atmospheric resulting in the expansion of the chest and air being drawn into the lungs through the nose and mouth. When the pressure which is around the chest wall returns to normal pressure of the atmosphere there shall be passive expiration. Negative pressure ventilation endeavors to mimic normal breathing mechanics.
Methods for providing negative pressure ventilation include iron lung which was used primarily in the epidemic of polio in the era of 1950’s.Curiass/shell is a shell or a cage which surrounds the chest and is then connected to a portable ventilator. Raincoat or Poncho is a tight fitting suit which is connected through the means of hoses to a portable ventilator. Rocking bed is another method for providing negative pressure ventilation which induces diaphragmatic motion by placement of the patient on a bed which rocks rapidly flat to upright while the contents of abdomen shift. A pneumobelt is a belt with a bladder which can inflate and deflate with air in a cyclic pattern. The diaphgram moves in response to changes in the intraabdominal pressure. Another form of negative pressure ventilation is a pneumowrap.
Indications for negative pressure ventilation include chronic respiratory failure secondary to neuromuscular disease- polio, muscular dystrophy. Generally used for nocturnal ventilatory support, with the patient breathing spontaneously during the day. Negative pressure ventilation has also been used in acute respiratory failure, there are 2 different studies which examined the use of the iron lung and poncho wrap (respectively) in COPD patients with acute respiratory failure. Both studies demonstrated the effectiveness of negative pressure ventilation to correct CO2 retention.
Drawbacks encountered with negative pressure ventilation are worsening of obstructive sleep apnea, problems with correct fitting as well as portability issues. Attendants are often required for the application and removal of the device making the process troublesome for the patients. For the use of negative pressure ventilation the patients must sleep in supine position only making it difficult to use.
Respiratory failure is one of the most common cause leading to admission in intensive care unit and is the concluding pathway of a wide range of diseases with differing pathophysiologies.
A mechanism-based approach enables the clinician to identify the most likely cause for the respiratory failure and to treat appropriately.
Hypercapnic respiratory failure - Ventilatory failure and is recognized by an elevated PaCO2 above normal. Patient usually have respiratory pump failure with lungs which are normal or ventilatory failure as a consequence of airway disease or extremely severe lung parenchymal disease with normal lungs or as a consequence of airways disease or very severe parenchymal lung disease.
Hypoxemic respiratory failure - Failure of gas exchange is characterized as hypoxemia (PaO2 less than 60 mm Hg), with or without the widening of gradient between the alveoli and artery. Most of the patients suffering from this type of respiratory failure have a shunt physiology or mismatch of ventilation-perfusion (V/Q) as the primary mechanisms of hypoxemia. Most of these patients have abnormalities detected on chest x-ray.
Mixed respiratory failure with multiple components of various pathophysiologies which can result in hypoxemia as well as hypercarbia.
Type 4 respiratory failure occurs in patients who are postoperative having normal lungs with normal respiratory pump who are either sedated or paralyzed or have metabolic demands which exceed the patient’s ability to compensate. This is seen commonly in patients suffering from intensive metabolic abnormalities such as metabolic acidosis or sepsis.
Main component is The alveolar–arterial oxygen gradient = PAO2 – PaO2. The normal value is between 10 and 15 mm Hg and is influenced by age, i.e. increases by approximately 3 mm Hg every decade after the age of 30 years. For an FiO2 = 21%, it should be 5 to 25 mm Hg and for an FiO2 = 100%, it should be <150 mm Hg. Hypoxemic respiratory failure with a widened alveolar–arterial oxygen gradient is caused by V/Q mismatching or shunt pathophysiology. Hypoxemia due to V/Q mismatch improves with supplemental oxygen, while no improvement in cases with shunt.
Disease which result in the flooding of airspace, complete or partial collapse of the lung, pulmonary vascular abnormalities or airway disease are the common source of hypoxemic respiratory failure.
Principles for managing the patients suffering from hypoxemic respiratory failure mainly include:-
Rapid re-establishing of optimal arterial saturation which commonly necessitates the need of intubation and mechanical ventilation.
By and large, the patients having infiltrates in the lungs respond less well to non-invasive ventilation.
Using optimal amount of positive end-expiratory pressure ensures the reduction of FiO2 levels to non-toxic levels (FiO2 less than 60 percent).
Using a strategy with low tidal volume along with permissive hypercapnia in patients suffering from acute respiratory distress syndrome or acute lung injury.
Providing general supportive care to the patient in the intensive care unit while there is resolution of patient’s pulmonary pathology.
Due to increased alveolar arterial gradient with V/Q mismatch
Airway disease- Chronic Obstructive Pulmonary Disease, Asthma, Cystic Fibrosis, Bronchiolitis Obliterans Syndrome
Interstitial lung disease- Interstitial Pulmonary Fibrosis, Sarcoidosis, Interstitial pneumonia e.g. Covid 19 pneumonia
Alveolar filling – Pulmonary Edema, Left heart failure, Acute Lung Injury/Acute Respiratory Distress Syndrome, Pneumonia, Trauma, Contusion, Alveolar hemorrhage/proteinosis, Transfusion Related Acute Lung Injury, Acute interstitial pneumonitis, Acute eosinophilic pneumonia, Bronchiolitis Obliterans Organizing Pneumonia/Cryptogenic Organizing Pneumonia, Aspiration, Upper airway obstruction, Near drowning
Pulmonary vascular disease – Thromboembolism, Fat embolism
Due to increased alveolar arterial gradient with Shunt
Same as causes of alveolar filling
Atelactesis – Post operative, Immobility
Intra pulmonary vascular shunt- Pulmonary arteriovenous malformation, Hepatopulmonary syndrome
Intracardiac shunt – Patent foramen ovale, Atrial septal defect, Ventricular septal defect
Oxygen to improve hypoxia in acute hypoxic failure appears to be standard of care and in 2005 it was shown that NIV is better than oxygen in improving PaO2/FiO2 by unloading of respiratory muscles [2]. In Earlier studies it was shown when used appropriately NIV is as effective as invasive mechanical ventilation in improving PaO2/FiO2 by Antonellii et al. thereby avoiding all complications related to endotracheal intubation and related ventilation [3]. But the most important aspect of success versus failure of NIV in acute hypoxic respiratory failure is ‘Timing of initiation vis a vis progression of inciting disease as well as severity of respiratory failure” [4]. In Acute Hypoxic Respiratory Failure, NIV needs to be initiated for mild to moderate hypoxia and before the disease has progressed (a) as window of opportunity to use NIV is narrow (b) as once disease has progressed IMV is indicated.
Failure of NIV in acute hypoxic respiratory failure needs to be identified early to prevent higher mortality. Meta-analysis of NIV use in ALI/ARDS showed intubation rate of 46% (30–86%) and mortality of 35% (19–69%) and these widely variable results indicate that different diseases states causing hypoxic respiratory failure as well as baseline characteristics of individual patients along with threshold of intubation of the centre contribute to success or failure of NIV [5]. But studies are clear that milder is the hypoxia, lesser are the chances of failure indicating baseline PaO2 is one of the determinant of NIV outcome [6]. Further studies also showed earlier is the better as disease has potential for reversibility. Immunosuppressed patients also showed good success rates with use of NIV in acute hypoxic respiratory failure [7]. Hence, use of NIV in acute hypoxic respiratory failure is indicated as follows [8]:
Level 1: in acute cardiogenic pulmonary edema as well as immunocompromised patients with acute hypoxic respiratory failure.
Level 2: evidence is to use in post-operative hypoxic respiratory failure, COPD with community acquired pneumonia as well as to prevent hypoxic failure in acute severe asthma. However NIV in severe community acquired pneumonia without any underlying comorbidity to support use of NIV needs to be used with caution as in to prevent Extubation failure. Also in patients with do not intubate or resuscitate orders.
Level 3: in patients with thoracic trauma, upper respiratory tract obstruction, partial upper airway obstruction as well as treatment in acute severe asthma but with caution to use in severe ARDS.
Level 4: In very elderly (>75 years), obesity hypoventilation syndrome and in IPF with caution.
Rationale of using NIV in acute hypoxic respiratory failure is that the primary or secondary lung failure, both lead to acute hypoxia which can be either due to abnormality in the exchange of gas or failure of the respiratory pump which leads to increase in minute ventilation, this is reversed by the use of NIV (Figure 2).
Rationale of using NIV in acute hypoxic respiratory failure.
Modes of bi-level NIV used in hypoxic respiratory failure are defined by triggering: S-Spontaneous (a. patients efforts only triggering NIV), S/T- Spontaneous timed (b. patient’s own as well as timed triggering to give back up RR in case patient has irregular and slow breathing pattern to safe guard adequate ventilation, misses a breath (Figure 3).
Showing modes of bi-level NIV used in hypoxic respiratory failure (spontaneous and spontaneous timed).
Helmet ventilation is the most secure form of NIV in severely hypoxic patients but claustrophobia may prohibit its use. It can be used in severe hypoxic respiratory failure and it’s use in Covid 19 pneumonia and ARDS showed favorable results vis a vis oxygen therapy. However, cardiac instability is contraindication.
NIV is also used to support interventional procedures in patients with hypoxia while doing bronchoscopy or transesophageal Echocardiography.
However, in contrast to use of NIV in hypercapnic respiratory failure in hypoxic respiratory failure one needs to look beyond lungs into systemic component of disease process e.g. shock, acidosis, multi organ failure, etc. as these situations will favor invasive mechanical ventilation.
70% of failures of NIV occur within 48 hours, indicating need for intensive monitoring and identifying features of early failure proactively (Figure 4).
Identify failing NIV early by bedside monitoring worsening of clinical features, gas exchange parameters and primary disease causing hypoxia.
It has been shown that delaying intubation in such cases increases mortality and adds no benefit. Most common cause of failure is inability to correct hypoxia in 2/3rd of failed NIV’s followed by intolerance, progression of disease with hemodynamic instability. Changing NIV machine to guaranteed volume mode (AVAP’s or iVAP) can help to improve tidal volume and hypoxia. Hence all such cases should be managed in ICU settings only. Intolerance can be managed by using different types of masks or correcting into leaks. Use of sedation is strictly under observation with full facility and readiness to intubate.
NIV has penetrated deeply into the roots of medical management even in rural health facilities of India where a study conducted in rural India concluded that [9]:
NIV is able to reduce the mortality and endotracheal intubation through the improvement of the outcome of patients.
NIV in selected group of patients is the modality of treatment of acute hypoxemic respiratory failure.
Close monitoring should be ensured to depict the patient’s response in order to take the decision of intubation on time.
Early introduction of NIV can help in the reduction of intubation rates and the subsequent complications as well as nosocomial infections associated with intubation.
Covid 19 pandemic caused devastation across the world with hospitalization in 5–15% and 5% requiring ICU due to severe and critical hypoxic failure. Secondary to severe covid pneumonia and ARDS. NIV has been used from the beginning of pandemic with China reporting NIV works well and results were similar to that of HFNC in Covid 19. They also reported no nosocomial outbreaks of Covid 19 infection in health cares in ICU units which used NIV. Europe started using CPAP with variable success rates as well as concerns. Initial reports of NIV use in Covid 19 showed that CPAP trial succeed in 40% when used in those requiring >15 L/min of O2 by non-rebreathing mask with baseline SpO2/FiO2(SFR) of >110, RR > 30/min and NLR > 8. Repeat SFR at 30–120 min improved in all patients but cut off of SFR 180 was the best predictor of success or failure of CPAP trial but patients who failed had high mortality (38%) [10]. Intubation rates and mortality in Covid 19 patients who received NIV was similar to the group which received HFNC. European Respiratory Society Living Guideline for management of Covid 19 has recommended use of NIV with helmet or full face mask to treat acute hypoxic respiratory failure secondary to coronavirus infection provided there is no immediate indication for IMV [11]. But caution must be exercised in close monitoring to identify signs of NIV failure in Covid pneumonia. There have been reports of full recovery in COVID-19 patients even after extensive lung involvement by judicious noninvasive ventilation strategies linked with prone ventilation [12, 13, 14].
Keeping in mind the human factors of comfort, humidification and warming of inspired air are essential in creating an effective oxygenation system (Figure 5). Basic components of high flow nasal cannula (HFNC) include a flow generator providing gas flow rates up to 60 liters per minute, an air-oxygen blender that achieves escalation of FIO2 from 21–100% irrespective of flow rates, and a humidifier that saturates the gas mixture at a temperature of 31 to 37 C [15]. To minimize condensation, the heated humidified gas is delivered via heated tubings through a wide-bore nasal prong. In this system all settings are controlled independently, so maximum delivery of oxygen thence better outcome.
Showing high flow nasal cannula used for hypoxic respiratory failure.
Mechanism responsible for high efficacy includes Physiological dead space (which accounts for approximately one-third of the tidal volume of breathing) washout of waste gasses including carbon dioxide (CO2), Decreased respiratory rate, Positive end-expiratory pressure, Increased tidal volume and Increased end-expiratory volume.
It creates a positive end-expiratory pressure to the lower airways in addition to providing positive pressure support to the nasopharynx.
It applies a splinting force to keep alveolar airways from collapsing under increased surface tensile stresses during exhalation.
This allows for improved alveolar recruitment, increasing the effective available surface area within the lungs for gaseous diffusion both to and from the blood.
It has taken over low-flow nasal cannula as later blows cool, dry air directly into the nasal passages which leads to drying of the mucosa, irritation, epistaxis, and cracking of the tissue barriers. This causes, uncomforted and restlessness in the patients thence poor adherence to therapy.
Now a days high-flow nasal cannula systems are having inbuilt warming and humidification systems which provides humidified and body temperature air that is non-irritating to the mucosa, increasing patient comfort.
There is increasing evidence of clinical application of HFNC in Acute hypoxemic respiratory failure, Post-surgical respiratory failure, Acute heart failure/pulmonary edema, Hypercapnic respiratory failure, COPD, Pre and post-extubation oxygenation, Obstructive sleep apnea, Do not intubate the patient and so on.
Hence, Non-Invasive Ventilation (NIV) is a useful tool for pulmonary diseases including acute hypoxic respiratory failure which has penetrated deeply into the routes of India with a vast scope of usage and advantages. A proper monitoring while the patient is on NIV ensures early pick up of NIV failure helping in the proceeding of appropriate corrective steps.
“The authors declare no conflict of interest.”
IntechOpen publishes different types of publications
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Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Usually, the voice is not the main focus of the speech-language pathology therapy with individuals with hearing loss, but its deviations can represent such a negative impact on this population that it can interfere on speech intelligibility and crucially compromise the social integration of the individual. The literature vastly explores acoustic and perceptual characteristics of children and adults with hearing loss. Voice problems in individuals with this impairment are directly related to its type and severity, age, gender, and type of hearing device used. While individuals with mild and moderate hearing loss can only present problems with resonance, severely impaired individuals may lack intensity and frequency control, among other alterations. The commonly found vocal deviations include strain, breathiness, roughness, monotone, absence of rhythm, unpleasant quality, hoarseness, vocal fatigue, high pitch, reduced volume, loudness with excessive variation, unbalanced resonance, altered breathing pattern, brusque vocal attack, and imprecise articulation. These characteristics are justified by the incapability of the deaf to control their vocal performance due to the lack of auditory monitoring of their own voice, caused by the hearing loss. Hence, the development of an intelligible speech with a good quality of voice on the hearing impaired is a challenge, despite the sophisticated technological advances of hearing aids, cochlear implants and other implantable devices. The purpose of this chapter is therefore to present an extensive review of the literature and describe our experience regarding the evaluation, diagnosis, and treatment of voice disorders in individuals with hearing loss.",book:{id:"4654",slug:"update-on-hearing-loss",title:"Update On Hearing Loss",fullTitle:"Update On Hearing Loss"},signatures:"Ana Cristina Coelho, Daniela Malta Medved and Alcione Ghedini\nBrasolotto",authors:[{id:"174260",title:"M.Sc.",name:"Ana Cristina",middleName:null,surname:"Coelho",slug:"ana-cristina-coelho",fullName:"Ana Cristina Coelho"},{id:"174643",title:"Dr.",name:"Alcione",middleName:null,surname:"Brasolotto",slug:"alcione-brasolotto",fullName:"Alcione Brasolotto"},{id:"174644",title:"MSc.",name:"Daniela",middleName:null,surname:"Medved",slug:"daniela-medved",fullName:"Daniela Medved"}]},{id:"49005",doi:"10.5772/60836",title:"Endoscopic Criteria in Assessing Severity of Swallowing Disorders",slug:"endoscopic-criteria-in-assessing-severity-of-swallowing-disorders",totalDownloads:2016,totalCrossrefCites:3,totalDimensionsCites:6,abstract:null,book:{id:"4545",slug:"seminars-in-dysphagia",title:"Seminars in Dysphagia",fullTitle:"Seminars in Dysphagia"},signatures:"Farneti Daniele and Genovese Elisabetta",authors:[{id:"172879",title:"Dr.",name:"Daniele",middleName:null,surname:"Farneti",slug:"daniele-farneti",fullName:"Daniele Farneti"},{id:"175419",title:"Dr.",name:"Elisabetta",middleName:null,surname:"Genovese",slug:"elisabetta-genovese",fullName:"Elisabetta Genovese"}]},{id:"33864",doi:"10.5772/33569",title:"The Mongolian Gerbil as a Model for the Analysis of Peripheral and Central Age-Dependent Hearing Loss",slug:"the-mongolian-gerbil-as-a-model-for-the-analysis-of-peripheral-and-central-age-dependent-hearing-los",totalDownloads:2355,totalCrossrefCites:3,totalDimensionsCites:6,abstract:null,book:{id:"1393",slug:"hearing-loss",title:"Hearing Loss",fullTitle:"Hearing Loss"},signatures:"Gleich Otto and Strutz Jürgen",authors:[{id:"96191",title:"Dr.",name:"Otto",middleName:null,surname:"Gleich",slug:"otto-gleich",fullName:"Otto Gleich"},{id:"96195",title:"Prof.",name:"Jürgen",middleName:null,surname:"Strutz",slug:"jurgen-strutz",fullName:"Jürgen Strutz"}]}],mostDownloadedChaptersLast30Days:[{id:"63699",title:"Management of the Complications of Maxillary Sinus Augmentation",slug:"management-of-the-complications-of-maxillary-sinus-augmentation",totalDownloads:7784,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Dental implant rehabilitation of the posterior maxillary region has always been a challenging issue due to both alveolar ridge atrophy and sinus pneumatization. Maxillary sinus augmentation is a well-known and predictable procedure in vertical deficiencies of the posterior maxilla. To date, various techniques have been described based on the physiology of intrasinus bone repair to obtain better outcomes. Nevertheless, these procedures could also be associated with several intra- and postoperative complications such as perforation of the sinus membrane, hemorrhage, infection, graft resorption, and loss of the graft or implants. The aim of this chapter is to review the contemporary methods for maxillary sinus augmentation and to present both recommendations for prevention and management of the associated complications.",book:{id:"7245",slug:"challenging-issues-on-paranasal-sinuses",title:"Challenging Issues on Paranasal Sinuses",fullTitle:"Challenging Issues on Paranasal Sinuses"},signatures:"Alper Sindel, Mehmet Mustafa Özarslan and Öznur Özalp",authors:[{id:"244837",title:"Dr.",name:"Alper",middleName:null,surname:"Sindel",slug:"alper-sindel",fullName:"Alper Sindel"},{id:"244918",title:"Dr.",name:"Mehmet Mustafa",middleName:null,surname:"Özarslan",slug:"mehmet-mustafa-ozarslan",fullName:"Mehmet Mustafa Özarslan"},{id:"244919",title:"Ms.",name:"Öznur",middleName:null,surname:"Özalp",slug:"oznur-ozalp",fullName:"Öznur Özalp"}]},{id:"55472",title:"Paranasal Sinus Anatomy: What the Surgeon Needs to Know",slug:"paranasal-sinus-anatomy-what-the-surgeon-needs-to-know",totalDownloads:5644,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"Performing a smooth and clean sinus surgery goes hand in hand with a perfect understanding of the nasal and paranasal anatomy. Within this chapter, the paranasal and related structures surgical anatomy will be extensively reviewed, with emphasis on the anatomical landmarks and the normal anatomical variations, which have a significant impact on the function, pathology, and surgical procedures of the paranasal sinuses.",book:{id:"5911",slug:"paranasal-sinuses",title:"Paranasal Sinuses",fullTitle:"Paranasal Sinuses"},signatures:"Abdulmalik S. Alsaied",authors:[{id:"199716",title:"Dr.",name:"Abdulmalik",middleName:"Saad",surname:"Alsaied",slug:"abdulmalik-alsaied",fullName:"Abdulmalik Alsaied"}]},{id:"69430",title:"Concurrent Rhinoplasty and Endoscopic Sinus Surgery",slug:"concurrent-rhinoplasty-and-endoscopic-sinus-surgery",totalDownloads:1180,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Combining rhinoplasty and endoscopic sinus surgery (ESS) was first reported in 1991 by Sheman and Matarasso. Since then, many authors have documented a large series showing the overall efficacy of combining the two procedures. The focus of this manuscript is to document the author’s recent experience with combining rhinoplasty and endoscopic sinus surgery and highlight the changes that have occurred during the author’s 2-years experience. A retrospective data review was performed on 53 (31 females and 22 men, age range 16–55 years) patients who underwent combined rhinoplasty and ESS between January 2016 and December 2018 at Pantai Hospital Kuala Lumpur by the same surgeon. The mean age was 31.8 years. All patients had severe nasal obstruction with chronic rhinosinusitis and were followed up for a minimum of 6 months post-surgery and underwent ENT workup, which included history, office rigid endoscopy, CT scans of paranasal sinuses and preoperative photography. Initially, the ESS was performed followed by the open rhinoplasty with or without osteotomy. The ESS consisted of middle turbinate reduction [15/53 (28.3%)], maxillary antrostomy [36/53 (67.9%)], ethmoidectomy [38/53 (71.6%)], frontal sinusotomy [7/53 (13.2%)], and sphenoidotomy [9/53 (16.9%)]. Most of the sinus symptoms resolved postoperatively with 47 (88.6%) of 53 patients describing their improvement as significant. Fifty (94.3%) of 53 patients stated that they would recommend the concurrent procedure. The benefits of these advances are illustrated by a review of the literature with good results (functional and cosmetic) and minimal complications.",book:{id:"7062",slug:"rhinosinusitis",title:"Rhinosinusitis",fullTitle:"Rhinosinusitis"},signatures:"Balwant Singh Gendeh",authors:[{id:"67669",title:null,name:"Balwant Singh",middleName:null,surname:"Gendeh",slug:"balwant-singh-gendeh",fullName:"Balwant Singh Gendeh"}]},{id:"49574",title:"Classification of Hearing Loss",slug:"classification-of-hearing-loss",totalDownloads:5347,totalCrossrefCites:9,totalDimensionsCites:13,abstract:"Hearing loss is the partial or total inability to hear sound in one or both ears. People with hearing loss make up a significant 5.3% of the world’s population. The audiogram is an important tool used to determine the degree and type of hearing loss. This chapter presents hearing loss classification, which can aid in clinical diagnosis and help in finding appropriate therapeutic management. Hearing loss is classified based on ear anatomy, type of hearing loss, degree of the disease, and configuration of the audiogram. When the hearing loss is fully characterized, appropriate medical intervention can be assigned.",book:{id:"4654",slug:"update-on-hearing-loss",title:"Update On Hearing Loss",fullTitle:"Update On Hearing Loss"},signatures:"Waleed B. Alshuaib, Jasem M. Al-Kandari and Sonia M. Hasan",authors:[{id:"174550",title:"Prof.",name:"Waleed",middleName:null,surname:"Alshuaib",slug:"waleed-alshuaib",fullName:"Waleed Alshuaib"},{id:"174551",title:"MSc.",name:"Jasim",middleName:null,surname:"Al-Kandari",slug:"jasim-al-kandari",fullName:"Jasim Al-Kandari"},{id:"174552",title:"Dr.",name:"Sonia",middleName:null,surname:"Hasan",slug:"sonia-hasan",fullName:"Sonia Hasan"}]},{id:"56237",title:"Caffeine and Meniere’s Disease",slug:"caffeine-and-meniere-s-disease",totalDownloads:1746,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Meniere’s disease is characterized by recurrent vertigo, fluctuating hearing loss, and persistent tinnitus. Caffeine consumption in modern society is a widespread and culturally accepted habit; however, there is no consensus about its mechanism of action in various organs and systems, including the auditory and vestibular. The few clinical studies have shown that abstention from caffeine has little effect in patients with Meniere’s disease, both in relation to vertigo, tinnitus and hearing loss.",book:{id:"5454",slug:"up-to-date-on-meniere-s-disease",title:"Up to Date on Meniere's Disease",fullTitle:"Up to Date on Meniere's Disease"},signatures:"Alleluia Lima Losno Ledesma, Monique Antunes de Souza\nChelminski Barreto and Carlos Augusto Costa Pires de Oliveira",authors:[{id:"68849",title:"Prof.",name:"Carlos Augusto C. P.",middleName:null,surname:"Oliveira",slug:"carlos-augusto-c.-p.-oliveira",fullName:"Carlos Augusto C. P. Oliveira"},{id:"175482",title:"Dr.",name:"Monique",middleName:null,surname:"Barreto",slug:"monique-barreto",fullName:"Monique Barreto"},{id:"194400",title:"Dr.",name:"Alleluia",middleName:"Lima",surname:"Losno Ledesma",slug:"alleluia-losno-ledesma",fullName:"Alleluia Losno Ledesma"}]}],onlineFirstChaptersFilter:{topicId:"192",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:320,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:133,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:16,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:5,paginationItems:[{id:"91",title:"Sustainable Economy and Fair Society",coverUrl:"https://cdn.intechopen.com/series_topics/covers/91.jpg",isOpenForSubmission:!0,annualVolume:11975,editor:{id:"181603",title:"Dr.",name:"Antonella",middleName:null,surname:"Petrillo",slug:"antonella-petrillo",fullName:"Antonella Petrillo",profilePictureURL:"https://mts.intechopen.com/storage/users/181603/images/system/181603.jpg",biography:"Antonella Petrillo is a Professor at the Department of Engineering of the University of Naples “Parthenope”, Italy. She received her Ph.D. in Mechanical Engineering from the University of Cassino. Her research interests include multi-criteria decision analysis, industrial plant, logistics, manufacturing and safety. She serves as an Associate Editor for the International Journal of the Analytic Hierarchy Process. She is a member of AHP Academy and a member of several editorial boards. 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Her focus is on quality, innovation, leadership, and personalised learning. She works primarily at the strategic and policy levels, both nationally and internationally, and with key international organisations. She is committed to promoting and improving OFDL in the context of SDG4 and the future of education. Ossiannilsson has more than 20 years of experience in her current field, but more than 40 years in the education sector. She works as a reviewer and expert for the European Commission and collaborates with the Joint Research Centre for Quality in Open Education. Ossiannilsson also collaborates with ITCILO and ICoBC (International Council on Badges and Credentials). She is a member of the ICDE Board of Directors and has previously served on the boards of EDEN and EUCEN. Ossiannilsson is a quality expert and reviewer for ICDE, EDEN and the EADTU. She chairs the ICDE OER Advocacy Committee and is a member of the ICDE Quality Network. 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He got his Ph.D. in Animal Ecology at Umeå University in Sweden in 1998. He conducted postdoc research in stream ecology at the University of California at Santa Barbara in the USA. After that, he was a postdoc research fellow at the University of British Columbia in Canada to do research on large-scale stream experimental manipulation and watershed ecological survey in temperate rainforests of BC. He was a faculty member at the University of Hong Kong to run ecological research projects on aquatic insects, fishes, and newts in Tropical Asian streams. He also conducted research in streams, rivers, and caves in Texas, USA, to study the ecology of macroinvertebrates, big-claw river shrimp, fish, turtles, and bats. Current research interests include trophic flows across ecosystems; watershed impacts of land-use change on biodiversity and ecosystem functioning; ecological civilization and water resource management; urban ecology and urban/rural sustainable development.",institutionString:null,institution:{name:"Soochow University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"95",title:"Urban Planning and Environmental Management",coverUrl:"https://cdn.intechopen.com/series_topics/covers/95.jpg",isOpenForSubmission:!0,annualVolume:11979,editor:{id:"181079",title:"Dr.",name:"Christoph",middleName:null,surname:"Lüthi",slug:"christoph-luthi",fullName:"Christoph Lüthi",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRHSqQAO/Profile_Picture_2022-04-12T15:51:33.png",biography:"Dr. Christoph Lüthi is an urban infrastructure planner with over 25 years of experience in planning and design of urban infrastructure in middle and low-income countries. He holds a Master’s Degree in Urban Development Planning from the University College of London (UCL), and a Ph.D. in Urban Planning & Engineering from TU Berlin. He has conducted applied research on urban planning and infrastructure issues in over 20 countries in Africa and Asia. In 2005 he joined Eawag-Sandec as Leader of the Strategic Environmental Sanitation Planning Group. 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"243698",title:"Dr.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:null,institution:null},{id:"7227",title:"Dr.",name:"Hiroaki",middleName:null,surname:"Matsui",slug:"hiroaki-matsui",fullName:"Hiroaki Matsui",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",country:{name:"Japan"}}},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"90",type:"subseries",title:"Human Development",keywords:"Neuroscientific research, Brain functions, Human development, UN’s human development index, Self-awareness, Self-development",scope:"