Radon‐222 levels in dwellings of some European countries [18].
\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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Radon is a major contributor to the ionizing radiation dose received by the general population [1].
Most terrestrial materials contain 238U and radon gas emitters from these materials, since 222Rn is a decay product of Ra‐226, which in turn is taken from the longer lived prior U‐238. Concentrations of 238U and 226Ra in some terrestrial materials such as alum shale and black shale are high. Certain granites are typical of radioactivity‐bearing natural materials, but it is always feasible to find natural radioactivity‐rich bedrocks of different kinds such as construction materials. Construction materials that used as building materials are sources of indoor airborne radioactivity and external radiation from the decay series of uranium in buildings [2].
Short‐lived radioelement outcomes from radon are the most important contributors to human exposure to ionizing radiation from natural sources. This contribution represents 50% of the total annular human dose. The parameters such as relative humidity, airflow, type of building materials, indoor‐outdoor temperatures and ventilation rate as well as geological formations affect indoor radon concentrations. It is important to estimate the impress and contribution of the different building materials that can deed as Rn sources or Rn absorber inside of buildings for residence and work.
According some reports, the granite stones have a higher radon exhalation rate than other terrestrial materials on average [3–6].
The most abundant of plutonic rock in mountain belts and continental shield areas were made by granite stones. Types of batholith stones that may in dwell thousands of (km2) are usually intimately associated with granodiorite, quartz, gabbro and diorite. They are scratch resistant and extremely durable; their hardness lends themselves for the stone to be mechanically polished to a high gloss finish. They mainly contain of large grains of potassium, sodium feldspars and quartz. Granite is a plutonic rock in which quartz makes up between 10 and 50% of the felsic components and alkali feldspar accounts for 65–90% of the total feldspar content. Applying this definition requires the mineral identification and quantification abilities of a competent geologist. Other components of granites stones are hornblende and mica. A typical granite rock, in chemical view, is composed of 5% soda (NaHCO3), 5% potassium oxide (KO2), 12% aluminium (Al), 75% silica (SiO2), as well as lime (CaO), iron (Fe), magnesia (Mg(OH)2) and titanium (TiO2) in minor quantities.
In general, it was widely believed that granite stones were formed mostly from magmatic differentiation of basaltic magma. The evidence of this exegesis was considered to indicate a metamorphic origin [7].
Figure 1 illustrates the generalized mineral composition of igneous rocks. Granites and rhyolites (compositionally equivalent to granite but of a fine grain size) are composed mainly of orthoclase feldspar, quartz, plagioclase feldspar, mica and amphibole.
Granite composition diagram.
In nature, two types of radioactivity sources including technologically enhanced naturally occurring radioactive materials (TENORMs) and naturally occurring radioactive materials (NORMs) consist of materials, usually industrial wastes or by‐products enriched with radioactive elements found in the environment, such as U, Th and K and any of their decay products, such as Ra and Rn. All natural products with terrestrial origin, especially granite stones, sand and minerals, include trace amounts of some NORM radioactive elements that can produce measurable amounts of radiation and sometimes Rn‐222. This includes all concrete products, clay bricks, most non‐plastic plates and dishes, coal and the fly ash produced in coal‐fired power plants, natural gas (contains Rn), phosphate fertilizers used in your arable land (all contain K and small amounts of U and Th) and the vegetables grown using those fertilizers. All glasses made by using silica (even wine glasses, eye glasses, windows, mirrors, etc.) and granite stone too. Figure 2 shows the percentage of radon source in residential place. As seen in figure, only 2.5% of radon gas is released from building materials, whereas granite building material has highest contribution to radon exhalation rate among other materials.
Radon source contribution in residential places.
A fraction of the radon activity produced by decay of 226Ra in building materials enters buildings by diffusion. The area exhalation rate can be expressed as
which is an equation very similar to that related to soil, the only difference being the introduction of a hyperbolic term to account for the fact that diffusion takes place in a medium of finite thickness.
In this equation
The mass activity exhalation rate expressed in Bq kg−1 s−1 and defined as
is the quantity usually determined in laboratory measurements. The area exhalation rate from a wall or a floor made of building material of half‐thickness
The rate of entry of radon resulting from exhalation from building materials may be expressed as
where
Radon‐222 concentration can be measured by calculation of exhalation rate from material surface. We offer two different methods to calculate the radon‐222 concentration in building materials: passive method and active method.
In theoretical view, we consider a defined model. In this model, we assume that the release from materials brought into the room is negligible and radon gas is homogeneously mixed with the room air. Then, the concentration in a room can be found by solving the following equation:
where
This value range is among 0.1 h−1 and 3 h−1for residence as air exchange rate value of 0.5 h−1 is suggested for residential mechanical ventilation systems (MVSs) according by UNSCEAR report [8]. The value
From the measured values of 226Ra concentration, the radon exhalation rate per unit area can be calculated by
where
The presence of water in building materials alters the transport condition; therefore, the above equation is valid only for dry conditions [12].
The activity concentration and indoor γ‐ray radiation dose rate are calculating for a rectangular source shape with uniform density. The external γ‐ray dose rate is calculating in the middle of a standard room with dimension (5.0 m × 4.0 m × 2.8 m) by summing the separately calculated γ‐ray dose rates caused by walls and floor. The specific indoor dose rates depended on a large wall thickness and density of materials. It does not depend on the position in the room and dimensions of the room [13].
The density of granites stones is calculating by the experimental method in laboratory. This value approximately is 2580 kg m−3, on average. The granite in markets is usually 3.0 cm thick and (30.0 cm × 50.0 cm) dimension. Also, the dose rate conversion factor is calculated by calculations based on the point kernel integration method for floor covered with 3.0 cm thick granite [14]. The free‐in‐air absorbed dose value in the middle of the room can be expressed as [10]
where
The collected samples are pulverized, sieved through 0.2 mm mesh, sealed in standard 1000‐ml Marinelli beakers, dry‐weighed and stored for 4 weeks before counting in order to allow the reaching of equilibrium between 226Ra and 222Rn and its decay products. It is assumed that the radionuclides in equilibrium, i.e. the activity of each daughter, were equal to the initial isotope of the series.
The γ‐ray spectra of the prepared samples are measured using a γ‐detector. This detector is a typical high‐resolution γ spectrometer based on a coaxial P‐type shielded high purity germanium (HPGe) detector. Efficiency of this detector is 80%with a relative photopeak and energy resolution is 1.80 keV full-width at half-maximum (FWHM) for the 1332 keV γ‐ray spectra of 60Co, coupled to a high count‐rate multi‐task 16k multi‐channel analysis (MCA) card. Also, the Gamma‐2000 commercial software is used for data analysis. For sample counting, each sample is put into the lead shielding container of the HPGe detector and measured for a collect time of 24 hours. Prior to the samples measurement, the environmental background γ‐radiation at the counting place site is determined with a blank Marinelli beaker under identical measurement conditions. It is later subtracted from the measured γ‐ray spectra for each sample. The 232Th, 238U, 226Ra and 40K activity concentrations are calculated for each of the measured samples together with their corresponding total uncertainties. 232Th activity concentration are measured by taking the mean activity of photopeaks of the decay nuclides 228Ac (968, 911 and 338 keV) and 212Pb (238 keV). On the other hand, 226Ra activity concentrations are calculated from the activity of its short‐lived daughter’s radionuclide 214Pb at 351 and 295 keV and 214Bi at 609.6 keV. Activity concentrations of 40K are determined directly from its gamma emission at 1460 keV [17].
To compare results of uncertainty, standard materials such as soil‐375 and RGK‐1 (K2SO4), RGU‐1 (U‐ore) and RGTh‐1 (Th‐ore) are used, and all obtained results in accordance are completed. The activity levels of 226Ra and 232Th in soil‐375 are 424, 20 and 20.5 Bq kg−1, respectively. Also, activity levels of 40K in RGK‐1, 238U in RGU‐1, 232Th in RGTh‐1 are 14,000, 4940, 3250 Bq kg−1, respectively.
For lower limit of detection (LLD), 96% confidence is calculated using a relation of LLD = 4.66(Fc)½, where Fc is the Compton background in the region of the selected gamma‐ray spectrum.
Figure 3 shows a type of high purity germanium detector (HPGe) set‐up and accessories parts.
A high purity germanium detector (HPGe) set‐up used in the passive method.
To measure radon‐222 gas in the active measurement method, an alpha GURD model PQ‐2000 detector is used. This device works based on the passing of radon‐222 gas from a filter to an ionization chamber. Rn‐222 surveys are carried out in a special cubic chamber (70 × 50 × 60 cm) with different changeable walls. The walls have different covering materials on the internal surfaces. One set of floor is covered with the most common granite stones. Each sample is put into a special cubic chamber in floor and half walls and measuring for an accumulating time of
Schematic diagram showing the radon exhalation measurements of granite samples by the active setup method [
where
The level of Rn‐222 activity concentrations in dwellings approximately is normal, with a trend for high concentrations to lie above those predicted by this distribution. According to the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR 2000) [15], the worldwide concentration and population‐weighted values of these parameters for dwellings is found to be 25 and 2.5, respectively. Rn‐222 concentrations in dwellings are variable between countries because of differences in climate and geology, in techniques and construction materials and in domestic customs. The arithmetic means of radon concentration level for countries various from 12 to 140 Bq m−3. Rn‐222 activity concentration levels for some European countries are given in Table 1 [18].
Country | Number of houses sampled | Period of exposure | Duration of exposure | Sample characteristics | Radon‐222 concentration (average) (Bq m−3) |
---|---|---|---|---|---|
Belgium | 300 | 1984–1990 | 3 months to 1 year | Population‐based (selected acquaintances) | 48 |
Czechoslovakia | 1200 | 1982 | Random grab sampling | – | 140 |
Demark | 496 | 1985–1986 | 6 months | Random | 47 |
Finland | 3074 | 1990–1991 | 1 year | Random | 123 |
France | 1548 | 1982–1991) | 3 months (using open alpha track detectors) | Biased (not stratified) | 85 |
Germany | 7500 | 1978–1984 1991–1993 | 3 months 1 year | Random | 50 |
Greece | 73 | 1988 | 6 months | — | 52 |
Hungary | 122 | 1985–1987 | 2.5 years | Preliminary survey | 55 |
Ireland | 1259 | 1985–1989 | 6 months | Random | 60 |
Italy | 4866 | 1989–1994 | 1 year | Stratified random | 75 |
Luxembourg | 2500 | 1991 | – | – | 65 |
Netherlands | 100 | 1982–1984 | 1 year | Random | 29 |
Norway | 7525 | 1987–1989 | 6 months | Random | 60 |
Portugal | 4200 | 1989–1990 | 1–3 months | Volunteers in a selected group (high school students) | 81 |
Spain | 2000 | Winter of 1988–1989 | Grab sampling | Random | 86 |
Sweden | 1360 | 1982–1992 | 3 months in heating season | Random | 108 |
Swaziland | 1540 | 1982–1990 | 3 months (mainly in winter) | Biased (not stratified) | 70 |
United Kingdom | 2093 | 1986–1987 | 1 year | Random | 20.5 |
Radon‐222 levels in dwellings of some European countries [18].
The rate of entry of radon from the floor and the ceiling of the reference house would amount to about 6 Bq m−3 h−1, while the contribution from the external walls would be about 0.4 Bq m−3 h−1. The contribution from radon exhalation from the building materials to the radon concentration in the reference house is thus estimated to be 6.4 Bq m−3 h−1, if the air exchange rate is taken to be 1 h−1 [12].
Considerably greater values of the rate of entry of radon are expected to be obtained when building materials with high 226Ra concentrations and normal emanating power are extensively used. Examples of such building materials are granite, Italian tuff and alum‐shale lightweight concrete. Among these materials, Swedish alum‐shale lightweight concrete has the highest 226Ra concentrations (about 1300 Bq kg−1 on average) and probably the highest 222Rn mass exhalation rate (440 μBq kg−1 s−1). Assuming a density of 2000 kg m−3 and a diffusion length of 7.4 × l0−2 m with 0.2 m thick slab of 100 m2 would lead to a rate of entry of radon of about 80 Bq m−2 h−1 in the reference house [16].
Techniques for reducing the radon entry rate due to exhalation from building materials have been investigated. In Sweden, aluminium foil has been applied to the walls of houses built with aerated concrete based on alum shale; the results showed a 50% reduction in the radon entry rate. In the United States, various radon sealants have been tested under conditions representative of normal construction conditions. The radon exhalation rate was reduced from 20 to 80% depending on the surface coating used. Because of the trapping of radon decay products in the wall, there is a relatively small increase in the external gamma dose rate. It was also noted that any cracks that later developed in a sealant such as paint may lead to leaks that negate a large portion of the sealing effectiveness of the paint. Similarly, the radon exhalation rate from any unpainted areas may be increased as they offer to radon a path of least resistance in comparison with painted areas. Radon‐222 source with characteristics for building materials is shown in Table 2 [12].
Material | Country | Number of sampling | Radon‐222 mass exhalation rate (μBq kg−1 s−1) |
---|---|---|---|
Heavy concrete | USSR | 18 | 3.2 |
Light weight concrete | USSR | 19 | 4.1 |
Ordinary concrete | Sweden | 3 | 11–31 |
Aerated concrete based on alum shale | Sweden | 1 | 580 |
Alum‐shale concrete | Denmark | 1 | 440 |
Fly‐ash concrete (4%) | USA | 8 | 10 |
Fly‐ash concrete Greece | Greece | 4 | 6.4–20 |
Concrete | Hungary | 100 | 7.8 |
Concrete | Denmark | 4 | 4.7 |
Concrete | Norway | 137 | 9.5–16 |
Concrete | Greece | – | 2.9–5 |
Concrete | USA | 50 | 2.5–20 |
(Adopted reference value) | – | – | 10 |
Red brick | USSR | 12 | 1.6 |
Red brick | Hungary | 200 | 3.9 |
Red brick | Poland | 3 | 18 |
Red brick | USA | 6 | 1 |
Brick | Denmark | 2 | 0.17 |
Brick | Norway | 18 | 4.2 |
Brick | Greece | 5 | 0.3–7.5 |
Silicon brick | Poland | 3 | 1.8 |
Adobe brick | USA | 2 | 3.5 |
(Adopted reference value) | – | – | 2 |
Gypsum | USA | 12 | 6.3 |
Gypsum board | Denmark | 1 | 0.23 |
By‐product gypsum (apatite) | Poland | 1 | 2.6 |
Clay aggregate | Norway | 12 | 5.2 |
Storage rock | USA | 9 | 5 |
Wood | USA | 2 | 0.2 |
Sand | USA | 2 | 12 |
Sand | USA | 2 | 3 |
Gravel | USA | 4 | 2.2 |
Radon‐222 source with characteristics for building materials [12].
The author would like to thank Iran’s Association of Manufacturers, which provided the original granite materials from which the samples were prepared also gave the useful information about their origin.
Tetanus is an acute, potentially fatal disease that is characterized by generalized increased rigidity and convulsive spasms of skeletal muscles. It is caused by a neurotoxin released by
The
The diagnosis of tetanus is clinical. History of vaccination, physical examination, signs and symptoms of muscle spasm, rigidity and pain are pointers to presence of tetanus. There are currently no confirmatory laboratory tests. The triad of muscle rigidity, muscle spasms and autonomic instability indicates the presence of the disease.
On the basis of clinical findings, four different forms of tetanus have been described.
Generalised tetanus
Localised tetanus
Cephalic tetanus
Neonatal tetanus
Generalized tetanus is the most common form of tetanus accounting for up to 80% of reported cases. It attacks muscles throughout the entire body. Generalized tetanus attacks and inhibits mostly the motor neurons of the CNS and later the neurons of the ANS as well thereby presenting with a descending pattern with uncontrollable muscle contraction affecting muscles of the face and jaw (trismus or locked jaw) being the first sign followed by stiffness of the neck, difficulty in swallowing, and rigidity of abdominal muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and can last for several minutes. Spasms continue for 3–4 weeks. Complete recovery may take months.
Localized tetanus is an uncommon form of the disease in which patients have persistent contraction of muscles in the same anatomic area as the injury. It is most commonly confined to the extremities. These contractions may persist for many weeks before gradually subsiding. Localized tetanus may precede the onset of generalized tetanus but is generally milder.
Cephalic tetanus is rare, and results from head injuries or otitis media in which
Neonatal tetanus is a form of generalized tetanus that occurs in newborn infants born without protective passive immunity because the mother is not immune. It results in high mortality in developing countries and is responsible for up to 50% of death due to tetanus. The infection usually arises from contamination of the umbilical cord during unsanitary delivery practices, absent maternal vaccination and unhygienic cultural practices such as the application of cow dung to the umbilical stump during the neonatal period. In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days [4].
Generally, symptoms of tetanus can be summarized to include neck stiffness, sore throat, dysphagia and trismus. Muscle spasms are extremely painful and can cause tendon to rupture, joint dislocation and bone fractures. Spasm that extends to the facial muscles causes the typical facial expression known as
The complications of tetanus result from muscle spasm, autonomic dysfunction, and prolonged critical illness. All systems of the body are involved.
Life threatening complications from involvement of the respiratory system include but not limited to apnoea, hypoxia, respiratory failure, laryngeal spasm, atelectasis, aspiration pneumonitis, etc. Prolonged ventilation may lead to ventilator associated pneumonia (VAP) and complications from tracheostomy e.g. tracheal stenosis. Breathing problems occur from tightening of vocal cords and muscle rigidity.
The cardiovascular complications are from autonomic dysfunction and are the most serious complications. These include tachycardia, hypertension, ischaemia, hypotension, bradycardia, tachyarrhythmias, bradyarrhythmias, Asystole, heart failure. The pathogenesis is said to be due excessively high levels of circulating catecholamines.
Other complication related to the renal and gastrointestinal systems include; high output renal failure, Oliguric renal failure from rhabdomyolysis, urinary stasis, urinary tract infection, gastric stasis, ileus, diarrhoea, haemorrhage. Thromboembolism and skin breakdown has been reported. Dislocation of the temporomandibular and shoulder joints have also been reported. Sepsis with multiple organ failures can also occur with the progression of the disease.
The Ablett classification of severity is the most commonly used grading system. It grades tetanus infection from mild (Grade I) to very severe (Grade IV) [6]. Prognosis is assessed using the Phillips score and the Dakar score. Both these scoring systems are relatively straightforward schemes which take into account the incubation period and the period of onset as well as presence of neurological and cardiac manifestations. The Phillips score also factors in the state of immune protection (Tables 1–4).
Grade | Characteristics |
---|---|
Grade 1 (mild) | Mild trismus, general spasticity, no respiratory compromise, no spasms, no dysphagia |
Grade 2 (moderate) | Moderate trismus, rigidity, short spasms, mild dysphagia, moderate respiratory involvement, ventilatory frequency >30 |
Grade 3 (severe) | Severe trismus, generalized rigidity, prolonged spasms, severe dysphagia, apnoeic spells, pulse >120, ventilatory frequency >40 |
Grade 4 (very severe) | Grade 3 with severe autonomic instability involving the cardiovascular system Severe hypertension and tachycardia, alternating with relative hypotension and bradycardia, either of which may be persistent |
Ablett classification of severity.
Prognostic factor | Score 1 | Score 0 |
---|---|---|
Incubation period | <7 days | >7 days or unknown |
Period of onset | <2 days | >2 days |
Entry site | Umbilicus, burn, uterine, open fracture, surgical wound, intramuscular injection | All others plus unknown |
Spasms | Present | absent |
Fever | >38.4°C | <38.4°C |
Tachycardia | Neonate > 150 beats/min Adult > 120 beats/min | Neonate < 150 beats/min Adult < 120 beats/min |
Total score |
Prognostic scoring systems in tetanus: Dakar score.
Score | Severity | Mortality |
---|---|---|
0–1 | Mild | ˂10% |
2–3 | Moderate | 10–20% |
4 | Severe | 20–40% |
5–6 | Very severe | ˃50 |
Total score, severity and disease prognosis.
Incubation time: | |
---|---|
<48 h | |
2–5 days | 4 |
5–10 days | 3 |
10–14 days | 2 |
>14 days | 1 |
Site of infection: | |
Internal and umbilical | 5 |
Head, neck, and body wall | 4 |
Peripheral proximal | 3 |
Peripheral distal | 2 |
Unknown | 1 |
State of protection: | |
None 10 | 10 |
Possibly some or maternal immunisation in neonatal patients | 8 |
Protected > 10 years ago | 4 |
Protected < 10 years ago | 2 |
Complete protection | 0 |
Complicating factors: | |
Injury or life threatening illness 10 | 10 |
Severe injury or illness not immediately life threathening | 8 |
Injury or non-life threatening illness 4 | 4 |
Minor injury or illness 2 | 2 |
ASA grade 1 | 0 |
Total |
Prognostic scoring systems in tetanus: Phillips score.
Mild ˂9, moderate 9–16, severe ˃16.
There is currently no treatment for tetanus. Management of the disease requires an emergency and long term supportive care. Three strategic principles apply however apply.
Neutralization of the toxin that is already in the body
Destroying the organisms in the body to prevent further toxin release
Minimizing the effects of the toxin already in the body
Intravenous human tetanus immunoglobulin (HTIG) 150 units/kg intramuscularly is used to neutralize free circulating toxin before it binds to neuronal cell membrane. The HTIG is an effective therapy and it is given as soon as the diagnosis of tetanus is considered. There is available an intravenous preparation of 5000–10,000 IU. HTIG is a specific solvent-detergent-treated plasma derived product obtained from donors immunized with tetanus toxoids. An initial skin sensitivity testing using a dose of 3000–6000 units intramuscularly is given. This drug does not neutralize intracellular toxin which is already fixed to the nerve terminals. HTIG is contraindicated in patients with history of anaphylactic reaction to the active substance or to any of the component of the product. Also patients with deficiency of mmunoglobulin A and the intramuscular test dose is contraindicated in those with severe thrombocytopenia or any coagulation disorder.
Respiratory failure has been identified as the commonest direct cause of death from tetanus in the less developed world. This may not be unconnected with lack of ventilator support where it is needed. The Intensivist should anticipate patients at risk of hypoxia and airways obstruction, aspiration hypoventilation, pneumonia, and respiratory arrest. Such patients should be closely monitored and connected to ventilator support as soon as possible. Early airways protection initially with endotracheal tube or tracheostomy is often needed. Ventilator modes used depends on complexity of the ventilators available in the intensive care unit. In the early stages of the disease when rigidity and spasm are prominent, sedation, analgesia and muscular paralysis are required to allow for controlled mandatory ventilation. This mode usually provides rest to the already fatigue muscles of respiration. It is important to note that the controlled mandatory ventilation mode is used only when necessary. Poor lung compliance and oxygenation due to muscular rigidity or pulmonary complications may be overcome by a combination of pressure controlled ventilation and positive end expiratory pressure (PEEP). In the later stages of the disease, modes of ventilation that allow spontaneous ventilation (synchronised intermittent mandatory, continuous positive airway pressure and biphasic positive airway pressure ventilation) are generally preferred and may optimize the respiratory pattern, reduce sedation requirements, minimise muscle wastage, and reduce the likelihood of acquired critical illness neuropathy or myopathy. Mechanical ventilation is better and more comforting for the patient if a tracheostomy is given early. Tracheostomy increases patients comfort, reduced dead space and airway resistance with reduced risk of airway trauma especially in patients convulsing. Endotracheal intubation has been associated with more complications such as subglottic stenosis, vocal cord immobility, laryngeal granuloma, need for deeper sedation when compared to tracheostomy and higher mortality rate. Sedation is an essential component of the management of tetanus patients being ventilated in ICU. It is required to relieve the discomfort and anxiety caused by airway manipulation, ventilation, suction and physiotherapy. Sedation can also minimize agitation yet maximize rest and appropriate sleep. Analgesia is an almost universal requirement for ventilated patients. Combination of opioids and benzodiazepines used for controlling seizures in tetanus gives a good outcome. Adequate sedation and analgesia ameliorates the stress response to tracheal intubation and mechanical ventilation.
Metronidazole is used to destroy the organisms in the body. It diffuses into the organism and inhibits its protein synthesis by interacting with DNA and causes loss of helical DNA structure. A dose of 30–40 mg/kg/day in three divided doses for children and 0.5 g three times daily for up to 10 days is recommended. Other drugs that are effective include Penicillin G (100,000–200,000 IU/kg/day intravenously, given in four divided doses). Macrolides such as erythromycin given as 30–50 mg/kg/day in three divided doses for children and 0.5 g/kg/day in three divided doses for adults has shown effectiveness. Tetracyclines, clindamycin, cephalosporins and chloramphenicol are also effective. To reduce further bacterial load and toxin, if a wound responsible for tetanus is clear, thorough cleaning of infected site with extensive surgical debridement is recommended if patient is stable. Surgical debridement helps to eradicate spores and necrotic tissues which could lead to conditions ideal for germination. To reduce the risk of releasing tetanospasmin into the bloog stream, it is advised that wound manipulation should be delayed until hours after administration of antitoxin.
Circulating tetanus toxins cause muscle rigidity, spasm and autonomic instability. Treatment of rigidity and spasm is very effective in preventing exhaustion, respiratory failure, aspiration pneumonitis and dysphagia. Spasm and rigidity can be treated effectively with sedation and limiting unnecessary stimulation. Benzodiazepine along or in combination with other drugs such as anticonvulsants have been used with great successes. The first line of treatment is the benzodiazepines.
Diazepam one of the derivative of benzodiazepines and is very effective in tetanus management. It acts by increasing GABA agonism through resistance to endogenous inhibitors of the GABAA receptor. The benefits of diazepam are as anti-convulsant and muscle relaxant that acts to control rigidity and muscle spasms. In addition, diazepam has sedative and anxiolytic effects. Large doses up to 100 mg/h can be administered and may cause mild respiratory depression.
Midazolam, also a benzodiazepine can be used in the absence of Diazepam. It is however relatively short-acting. Morphine can be equally efficacious and is usually used as an adjunct to benzodiazepine sedation.
Propofol has also been used successfully with rapid recovery occurring once the infusion is stopped however, in order to achieve adequate plasma concentrations to relieve muscle rigidity, mechanical ventilation is necessary.
In a patient with tetanus on mechanical ventilation, neuromuscular blocking agents can be used to control the muscle spasm if it continues despite the use of sedatives. Vecuronium is a short-acting neuromuscular blocker. It has minimal cardiovascular effects and does not release histamines. The use of pancuronium and atracurium is not recommended because pancuronium causes tachycardia while atracurium causes bradycardia and hypotension which may trigger mortality in the patient with tetanus. Newer agents such as pipercuronium and rocuronium are long acting and provide good haemodynamic stability they are however expensive compared with older drugs.
Anticonvulsants such as phenobarbitone, (which enhances GABA activity) and phenothiazine such as and chlorpromazine may be used to provide additional sedation. When sedation alone is inadequate, neuromuscular blocking agents and intermittent positive pressure ventilation may be required, usually for a prolonged period.
Baclofen is a structural analogue of GABAB receptor agonist that inhibits pre-synaptic acetylcholine release and synaptic medullar reflexes. These effects help in an anti-spastic action. They act by lowering calcium permeability in primary afferents. Intrathecal administration of 500-2000μg daily of baclofen had caused decrease muscle spasm in generalised tetanus [7].
Circulatory collapse is a major cause of mortality in tetanus and this is caused by autonomic instability. Sudden cardiac arrest is common and is thought to be precipitated by a combination of high catecholamine levels and the direct action of the tetanus toxin on the myocardium. Prolonged sympathetic activity may end with profound hypotension and bradycardia. Parasympathetic over activity may lead to sinus arrest. Direct damage to the vagal nucleus by the tetanus toxin has been implicated. Sedation with Benzodiazepines, anticonvulsant medication and morphine is the first line maneuver to control autonomic instability and also magnesium sulphate has been used as a preventive measure with success.
Magnesium sulfate is a pre-synaptic neuromuscular blocker. It inhibits catecholamine release from nerves and adrenal medulla and also reduces receptor responsiveness to released catecholamines, anticonvulsants, and vasodilators. Magnesium sulphate is a calcium antagonist in the myocardium and neuromuscular junction and inhibits the release of parathyroid hormone thereby decreasing calcium levels. Doses are initiated with loading dose 75–80 mg/kg in 30 min and followed by 2 g/h in patients under 60 years and 1 g/h for patients over 60 years. Morphine is very useful in maintaining cardiovascular stability. The mechanism of action of morphine includes replacement of endogenous opioids, reduction of sympathetic reflex activity and histamine release [8]. Phenothiazine especially chlorpromazine which acts as anticholinergic and α adrenergic antagonism also play a role in maintaining cardiovascular stability and used as a sedative.
B-blockade, although theoretically useful to control episodes of hypertension and tachycardia, is associated with sudden cardiovascular collapse, pulmonary oedema and death.
Patients with tetanus suffer weight loss due to several factors. These include inability to swallow, autonomic induced alterations in gastrointestinal function, increased metabolic rate due to pyrexia and muscular activity from convulsion and seizure. Nutrition should therefore be established as early as possible. Due to trismus, oral feeding is not possible. Nasogastric tube should be passed as early as possible to commence feeding. High caloric nutritional supplement is required to meet the high metabolic demand of tetanus. Parenteral nutrition is preferred but it is expensive and majority of tetanus patients are from a poor socio-economic status.
Nosocomial infection such as VAP is common among critically ill patients that are ventilated. The prevalence of VAP is a common indicator for safety and quality of care in critically ill patients admitted to the ICU. This is associated with increased mortality among ventilated patients. Measures taken to prevent VAP include strict hand hygiene with alcohol solutions before airway management, continuous aspiration of subglottic secretions, oral hygiene with chlorhexidine, semi recumbent positioning of patients where possible and selective decontamination of the digestive tract or selective oropharyngeal decontamination.
Venous thromboembolism (VTE) is a common and major complication in the critically ill patients. The use of intermittent pneumatic compression or graduated compression stockings with regular turning of patient help to prevent thromboembolism.
Other supportive measures foot drop splint to prevent ankle contracture, limb and chest physiotherapy, regular turning of patient or use of air/water mattress to prevent decubitus ulcer, care of the patient should be in dark room with minimal stimulus and psychosocial support.
The effective method of preventing tetanus is by immunization with tetanus toxoid containing vaccines. The vaccine is cheap, effective and safe for all age groups. In children, three doses are given from as early as six weeks of life and repeated at intervals of 4 weeks. It is also advised that three booster doses are given to confer lifelong immunity. It is also administered to pregnant women during pregnancy as a part of ante natal care package and also women in the reproductive age groups. To maintain high level of protection, individuals with cuts and open wound are given the tetanus toxoid containing vaccine [9].
Tetanus is a vaccine preventable disease but it has remained a public health problem in developing countries mostly due to poor vaccine coverage, poverty and low levels of education. All wounds other than clean minor ones should be considered tetanus prone therefore, HTIG should be considered. The diagnosis of tetanus is clinical and it can be fatal if missed. The mortality rate of tetanus is high and prolonged ICU care may be required. The outcome depends on early diagnosis, identification and management of complications and a good supportive care which the patient receives.
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Exoplanet characteristics and their comparison to Solar System planets are provided as well as general detection methods and planned probes to gather additional data.",book:{id:"10210",slug:"solar-system-planets-and-exoplanets",title:"Solar System Planets and Exoplanets",fullTitle:"Solar System Planets and Exoplanets"},signatures:"Joseph Bevelacqua",authors:[{id:"115462",title:"Dr.",name:"Joseph",middleName:"John",surname:"Bevelacqua",slug:"joseph-bevelacqua",fullName:"Joseph Bevelacqua"}]},{id:"65725",title:"On the Deviation of the Lunar Center of Mass to the East: Two Possible Mechanisms Based on Evolution of the Orbit and Rounding Off the Shape of the Moon",slug:"on-the-deviation-of-the-lunar-center-of-mass-to-the-east-two-possible-mechanisms-based-on-evolution-",totalDownloads:1032,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"It is known that the Moon’s center of mass (COM) does not coincide with the geometric center of figure (COF) and the line “COF/COM” is not directed to the center of the Earth, but deviates from it to the South-East. 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With its low gravity, slingshot effect relative to Earth, on-site resources and relative proximity to Earth in the solar system, the renewed space race is effectively returning first to the Moon. A psychological bridge to enlarge our civilization with a permanent bridge to our natural satellite. The development of this Earth-Moon system, requires enormous amount of finances, energy, science, technology, but over all, opportunities. This chapter deals with the efforts and the mental changes that may eventually result from all of these changes.",book:{id:"10955",title:"Lunar Science - Habitat and Humans",coverURL:"https://cdn.intechopen.com/books/images_new/10955.jpg"},signatures:"Yann-Henri Chemin"},{id:"81141",title:"Modeling Radiation Damage in Materials Relevant for Exploration and Settlement on the Moon",slug:"modeling-radiation-damage-in-materials-relevant-for-exploration-and-settlement-on-the-moon",totalDownloads:32,totalDimensionsCites:0,doi:"10.5772/intechopen.102808",abstract:"Understanding the effect of radiation on materials is fundamental for space exploration. Energetic charged particles impacting materials create electronic excitations, atomic displacements, and nuclear fragmentation. Monte Carlo particle transport simulations are the most common approach for modeling radiation damage in materials. However, radiation damage is a multiscale problem, both in time and in length, an aspect treated by the Monte Carlo simulations only to a limited extent. In this chapter, after introducing the Monte Carlo particle transport method, we present a multiscale approach to study different stages of radiation damage which allows for the synergy between the electronic and nuclear effects induced in materials. We focus on cumulative displacement effects induced by radiation below the regime of hadronic interactions. We then discuss selected studies of radiation damage in materials of importance and potential use for the exploration and settlement on the Moon, ranging from semiconductors to alloys and from polymers to the natural regolith. Additionally, we overview some of the novel materials with outstanding properties, such as low weight, increased radiation resistance, and self-healing capabilities with a potential to reduce mission costs and improve prospects for extended human exploration of extraterrestrial bodies.",book:{id:"10955",title:"Lunar Science - Habitat and Humans",coverURL:"https://cdn.intechopen.com/books/images_new/10955.jpg"},signatures:"Natalia E. Koval, Bin Gu, Daniel Muñoz-Santiburcio and Fabiana Da Pieve"},{id:"80241",title:"The Evolution of the Moon’s Orbit Over 100 Million Years and Prospects for the Research in the Moon",slug:"the-evolution-of-the-moon-s-orbit-over-100-million-years-and-prospects-for-the-research-in-the-moon",totalDownloads:66,totalDimensionsCites:0,doi:"10.5772/intechopen.102392",abstract:"As a result of solving the problem of interaction of Solar-system bodies, data on the evolution of the Moon’s orbit were obtained. These data were used as the basis for the development of a mathematical model for the Moon representing its motion over an interval of 100 million years. A program of exploration of the Moon with the aim of creating a permanent base on it is outlined. Such a base is intended for exploring the Earth, the Sun, and outer space.",book:{id:"10955",title:"Lunar Science - Habitat and Humans",coverURL:"https://cdn.intechopen.com/books/images_new/10955.jpg"},signatures:"Joseph J. Smulsky"},{id:"80217",title:"Educational and Scientific Analog Space Missions",slug:"educational-and-scientific-analog-space-missions",totalDownloads:95,totalDimensionsCites:0,doi:"10.5772/intechopen.101392",abstract:"Analog space missions in Poland include international scientific, technological, and business projects designed and realized by a private research company Analog Astronaut Training Center Ltd. (AATC) devoted to the future Moon and Mars exploration. Growing experience in educational aspect of the training as well as continuous development of the habitat and its professional space science laboratory equipment correspond to increased interest of educational organizations, universities, and individual students. We serve unique practical platform for space engineering, space master, and even space doctoral theses. In addition to a wide range of training courses offered for future astronauts, for example, diving, skydiving, rocket workshops, and stratospheric missions, AATC provides a private laboratory to simulate the space environment. It carries out scientific experiments focused on biology and space medicine, as well as addressing several multidisciplinary issues related to the Moon and Mars exploration, including space mining. The main goal of each our analog simulation is to get publishable results, what means that our analog astronauts obtain not only certification of completion of the training but also ability to continue studies and to perform it individually. This chapter summarizes methodology used by us, didactic tools, and obtained results for both educational and scientific analog simulations.",book:{id:"10955",title:"Lunar Science - Habitat and Humans",coverURL:"https://cdn.intechopen.com/books/images_new/10955.jpg"},signatures:"Agata Maria Kołodziejczyk and M. Harasymczuk"},{id:"79544",title:"Regolith and Radiation: The Cosmic Battle",slug:"regolith-and-radiation-the-cosmic-battle",totalDownloads:132,totalDimensionsCites:0,doi:"10.5772/intechopen.101437",abstract:"This chapter discusses regolith utilization in habitat construction mainly from the point of view of radiation protection of humans on missions of long duration. 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He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. 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He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. 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Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. He has served as guest editor for a number of special issues of peer-reviewed international journals.",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:6,paginationItems:[{id:"82526",title:"Deep Multiagent Reinforcement Learning Methods Addressing the Scalability Challenge",doi:"10.5772/intechopen.105627",signatures:"Theocharis Kravaris and George A. 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He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. 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He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. 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Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:'"Politechnica" University Timişoara',institution:null},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:null,institution:null},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"417317",title:"Mrs.",name:"Chiedza",middleName:null,surname:"Elvina Mashiri",slug:"chiedza-elvina-mashiri",fullName:"Chiedza Elvina Mashiri",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"352140",title:"Dr.",name:"Edina",middleName:null,surname:"Chandiwana",slug:"edina-chandiwana",fullName:"Edina Chandiwana",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"342259",title:"B.Sc.",name:"Leonard",middleName:null,surname:"Mushunje",slug:"leonard-mushunje",fullName:"Leonard Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"347042",title:"Mr.",name:"Maxwell",middleName:null,surname:"Mashasha",slug:"maxwell-mashasha",fullName:"Maxwell Mashasha",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"2941",title:"Dr.",name:"Alberto J.",middleName:"Jorge",surname:"Rosales-Silva",slug:"alberto-j.-rosales-silva",fullName:"Alberto J. Rosales-Silva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"437913",title:"Dr.",name:"Guillermo",middleName:null,surname:"Urriolagoitia-Sosa",slug:"guillermo-urriolagoitia-sosa",fullName:"Guillermo Urriolagoitia-Sosa",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"435126",title:"Prof.",name:"Joaquim",middleName:null,surname:"José de Castro Ferreira",slug:"joaquim-jose-de-castro-ferreira",fullName:"Joaquim José de Castro Ferreira",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Aveiro",country:{name:"Portugal"}}},{id:"437899",title:"MSc.",name:"Miguel Angel",middleName:null,surname:"Ángel Castillo-Martínez",slug:"miguel-angel-angel-castillo-martinez",fullName:"Miguel Angel Ángel Castillo-Martínez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"289955",title:"Dr.",name:"Raja",middleName:null,surname:"Kishor Duggirala",slug:"raja-kishor-duggirala",fullName:"Raja Kishor Duggirala",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jawaharlal Nehru Technological University, Hyderabad",country:{name:"India"}}}]}},subseries:{item:{id:"12",type:"subseries",title:"Human Physiology",keywords:"Anatomy, Cells, Organs, Systems, Homeostasis, Functions",scope:"Human physiology is the scientific exploration of the various functions (physical, biochemical, and mechanical properties) of humans, their organs, and their constituent cells. The endocrine and nervous systems play important roles in maintaining homeostasis in the human body. Integration, which is the biological basis of physiology, is achieved through communication between the many overlapping functions of the human body's systems, which takes place through electrical and chemical means. Much of the basis of our knowledge of human physiology has been provided by animal experiments. Because of the close relationship between structure and function, studies in human physiology and anatomy seek to understand the mechanisms that help the human body function. The series on human physiology deals with the various mechanisms of interaction between the various organs, nerves, and cells in the human body.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/12.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11408,editor:{id:"195829",title:"Prof.",name:"Kunihiro",middleName:null,surname:"Sakuma",slug:"kunihiro-sakuma",fullName:"Kunihiro Sakuma",profilePictureURL:"https://mts.intechopen.com/storage/users/195829/images/system/195829.jpg",biography:"Professor Kunihiro Sakuma, Ph.D., currently works in the Institute for Liberal Arts at the Tokyo Institute of Technology. He is a physiologist working in the field of skeletal muscle. He was awarded his sports science diploma in 1995 by the University of Tsukuba and began his scientific work at the Department of Physiology, Aichi Human Service Center, focusing on the molecular mechanism of congenital muscular dystrophy and normal muscle regeneration. His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). His opinion is to attenuate sarcopenia by improving autophagic defects using nutrient- and pharmaceutical-based treatments.",institutionString:null,institution:{name:"Tokyo Institute of Technology",institutionURL:null,country:{name:"Japan"}}},editorTwo:{id:"331519",title:"Dr.",name:"Kotomi",middleName:null,surname:"Sakai",slug:"kotomi-sakai",fullName:"Kotomi Sakai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000031QtFXQA0/Profile_Picture_1637053227318",biography:"Senior researcher Kotomi Sakai, Ph.D., MPH, works at the Research Organization of Science and Technology in Ritsumeikan University. She is a researcher in the geriatric rehabilitation and public health field. She received Ph.D. from Nihon University and MPH from St.Luke’s International University. Her main research interest is sarcopenia in older adults, especially its association with nutritional status. Additionally, to understand how to maintain and improve physical function in older adults, to conduct studies about the mechanism of sarcopenia and determine when possible interventions are needed.",institutionString:null,institution:{name:"Ritsumeikan University",institutionURL:null,country:{name:"Japan"}}},editorThree:null,series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},editorialBoard:[{id:"213786",title:"Dr.",name:"Henrique P.",middleName:null,surname:"Neiva",slug:"henrique-p.-neiva",fullName:"Henrique P. 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