Top 10 countries with technically recoverable shale oil and shale gas resources [6].
\\n\\n
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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:"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"},{slug:"intechopen-identified-as-one-of-the-most-significant-contributor-to-oa-book-growth-in-doab-20210809",title:"IntechOpen Identified as One of the Most Significant Contributors to OA Book Growth in DOAB"}]},book:{item:{type:"book",id:"7908",leadTitle:null,fullTitle:"Emergency Medicine and Trauma",title:"Emergency Medicine and Trauma",subtitle:null,reviewType:"peer-reviewed",abstract:'From prehospital evaluation to management in the emergency department,"Emergency Medicine and Trauma" provides easily accessible information on the evaluation, diagnosis, and management of trauma care. Recognition of the multidisciplinary nature and complexity of trauma care, especially the philosophy of a teamwork approach, must be an integral part of trauma management. To help make logical diagnoses and treatment plans , you will learn: The use of a structured and prioritized approach to critically ill and injured patients according to the clinical need and assessment of acuity level; How to establish resuscitation (management) priorities in a multiply injured patient; How to demonstrate the ability to adopt a holistic (multidisciplinary, biopsychosocial) approach to trauma patients. The role of the emergency department and its staff in major incidents, to understand planning and be prepared for major incidents. This book is designed not only for emergency medical providers but also for \nmedical students.',isbn:"978-1-78985-094-9",printIsbn:"978-1-78985-093-2",pdfIsbn:"978-1-83962-231-1",doi:"10.5772/intechopen.77738",price:100,priceEur:109,priceUsd:129,slug:"emergency-medicine-and-trauma",numberOfPages:98,isOpenForSubmission:!1,isInWos:1,isInBkci:!1,hash:"4d0e9d0c91eff59a61e29cd67cbb036b",bookSignature:"Ozgur Karcioglu and Müge Günalp Eneyli",publishedDate:"October 2nd 2019",coverURL:"https://cdn.intechopen.com/books/images_new/7908.jpg",numberOfDownloads:6126,numberOfWosCitations:1,numberOfCrossrefCitations:1,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:1,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:3,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"January 8th 2019",dateEndSecondStepPublish:"February 27th 2019",dateEndThirdStepPublish:"April 28th 2019",dateEndFourthStepPublish:"July 17th 2019",dateEndFifthStepPublish:"September 15th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"221195",title:"Prof.",name:"Ozgur",middleName:null,surname:"Karcioglu",slug:"ozgur-karcioglu",fullName:"Ozgur Karcioglu",profilePictureURL:"https://mts.intechopen.com/storage/users/221195/images/system/221195.jpeg",biography:"In 1994, I started residency in Dokuz Eylul University Medical School, Department of Emergency Medicine. I completed Fellowship Program in International EM in Pennsylvania State University (2005). I have served as the chairman of the department in DEU (2005-2007). I have been in charge of the ED of Bakirkoy Research and Training Hospital (2007-2009), and then faculty member in Acıbadem University (2009-15).\nI have served as a founder and a board member of The Emergency Medical Association of Turkey (2007-2009). 159 articles of mine were published in international journals. I have contributed in six books as editor, and authored 40 chapters. I’m serving as a member of The Editorial Board or as a section editor in a number of indexed journals. I’m also an instructor of the AHA-based Basic and Advanced Cardiac Life Support Course.",institutionString:"University of Health Sciences",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"4",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"270295",title:"Dr.",name:"Muge",middleName:"Gunalp",surname:"Eneyli",slug:"muge-eneyli",fullName:"Muge Eneyli",profilePictureURL:"https://mts.intechopen.com/storage/users/270295/images/10330_n.jpg",biography:"Dr. Günalp finished her residency in March 2004 at the Hacettepe University School of Medicine. She has been working as\na clinical instructor in the Department of Emergency Medicine,\nUniversity of Ankara, since. She has participated in emergency trauma care courses as an instructor since 2004. She also\norganized an advanced cardiac life support course in Turkey\nas a director between 2009 and 2012. At Ankara University\nSchool’s Department of Emergency Medicine she prepared a project to the EU\ncalled “Improving the Research Potential of Medical School of Ankara University\non Trauma Management System” for the Seventh Framework Programme (FP7)\nRegpot-2008-1. She also participated in this project as project manager. She participated in a core instructor course and became a BLS and ACLS instructor.",institutionString:"Ankara University School of Medicine",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1009",title:"Pre-Hospital Emergency Medicine",slug:"emergency-medicine-pre-hospital-emergency-medicine"}],chapters:[{id:"68200",title:"Pre-Hospital and Trauma Care to Road Traffic Accident Victims: Experiences of Residents Living along Accident-Prone Highways in Ghana",doi:"10.5772/intechopen.86118",slug:"pre-hospital-and-trauma-care-to-road-traffic-accident-victims-experiences-of-residents-living-along-",totalDownloads:979,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Road traffic accidents (RTAs) and associated injuries are a major public health problem in developing countries. The timely emergency pre-hospital care and subsequent transportation of accident victims to the health facility may help reduce the accident and injury outcomes. Available evidence suggests that RTA victims stand a greater chance of survival if attended to and cared for in a timely manner. This exploratory qualitative study set out to explore the experiences of residents of 12 communities along the Kasoa-Mankessim highway in Ghana (an accident-prone highway) in administering emergency pre-hospital care to RTA victims. We utilised data from a purposive sample of 80 respondents (i.e., people who have ever attended to RTA victims) from the communities through structured interview schedules. We found that the majority of the respondents had little knowledge and/or professional training in first-aid and emergency pre-hospital care to RTA victims. The skills and knowledge exhibited were gained through years of rescue services to RTA victims. The “scoop and run” method of first-aid care was predominant among the respondents. We recommend regular community member (layperson first responder) sensitisation and training on emergency pre-hospital care for RTA victims.",signatures:"Enoch F. Sam, David K. Blay, Samuel Antwi, Constance Anaafi and Juliet A. Adoma",downloadPdfUrl:"/chapter/pdf-download/68200",previewPdfUrl:"/chapter/pdf-preview/68200",authors:[{id:"271240",title:"Dr.",name:"Enoch F.",surname:"Sam",slug:"enoch-f.-sam",fullName:"Enoch F. Sam"},{id:"284406",title:"Mr.",name:"David K",surname:"Blay",slug:"david-k-blay",fullName:"David K Blay"},{id:"284407",title:"Mr.",name:"Samuel",surname:"Antwi",slug:"samuel-antwi",fullName:"Samuel Antwi"},{id:"284408",title:"Ms.",name:"Constance",surname:"Anarfi",slug:"constance-anarfi",fullName:"Constance Anarfi"},{id:"284587",title:"Ms.",name:"Juliet",surname:"Asum",slug:"juliet-asum",fullName:"Juliet Asum"}],corrections:null},{id:"67220",title:"Triage",doi:"10.5772/intechopen.86227",slug:"triage",totalDownloads:995,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"During austere conditions when there is a large demand on healthcare services and the resources are limited for different reasons, there should be a special way of managing patients and victims in order to make the most benefit to the community. Trial of first come, first served will lead to losing most of the seriously injured patients because they will reach late if they reached a healthcare facility. In addition, day-to-day work protocols with full resources also are not the optimum to offer for the whole community during a major incident. Triage has been created and evolved in military medical services to face mass casualty with limited resources and then transferred to civilian life to deal with mass casualty incidents. Applying triage to patients created some interference with medical bioethics if those applied on individual bases, but if applied in the whole picture of state or country, we can understand its rations.",signatures:"Abdulnasir F.H. Aljazairi",downloadPdfUrl:"/chapter/pdf-download/67220",previewPdfUrl:"/chapter/pdf-preview/67220",authors:[{id:"229291",title:"Dr.",name:"Abdulnasir F.H.",surname:"Al-Jazairi",slug:"abdulnasir-f.h.-al-jazairi",fullName:"Abdulnasir F.H. Al-Jazairi"}],corrections:null},{id:"67641",title:"Prehospital Emergency Care in Acute Trauma Conditions",doi:"10.5772/intechopen.86776",slug:"prehospital-emergency-care-in-acute-trauma-conditions",totalDownloads:1144,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"It is well known at this moment that a systems and systematic approach to trauma care cases is ideal. The prehospital controversies of in-the-field care in trauma cases, resuscitation, and transport, ground or air, are still debated. The most controversial is rapid transport to definitive care (“scoop and run”) versus field stabilization in trauma, which remains a topic of debate and resulted in great variability of prehospital policy. Emergency medical services, including ground and air transportation, significantly extend the reach of tertiary care facilities, leading to rapid transport of critically ill patients. Emergency medical services (EMS) providers are the first link to a trauma care system, and trauma triage made by EMS personnel is also a very important factor in a good outcome of trauma patients. The assessment of patient and the treatment delivered by the first medical crew could have a large impact over the clinical evolution and output of trauma patient; that way, it is necessary to apply a systematic approach in this pathology, guided by clear and simple-to-follow recommendations applied on the scene. Recent review of the literature on helicopter emergency medical services (HEMS) showed an overall benefit of 2.7 additional lives saved per 100 HEMS activations.",signatures:"Tudor Ovidiu Popa, Diana Carmen Cimpoesu and Paul Lucian Nedelea",downloadPdfUrl:"/chapter/pdf-download/67641",previewPdfUrl:"/chapter/pdf-preview/67641",authors:[{id:"201934",title:"Prof.",name:"Carmen Diana",surname:"Cimpoesu",slug:"carmen-diana-cimpoesu",fullName:"Carmen Diana Cimpoesu"},{id:"203237",title:"Associate Prof.",name:"Tudor Ovidiu",surname:"Popa",slug:"tudor-ovidiu-popa",fullName:"Tudor Ovidiu Popa"},{id:"296801",title:"Dr.",name:"Paul Lucian",surname:"Nedelea",slug:"paul-lucian-nedelea",fullName:"Paul Lucian Nedelea"}],corrections:null},{id:"68241",title:"Treatment Toxicity: Radiation",doi:"10.5772/intechopen.88192",slug:"treatment-toxicity-radiation",totalDownloads:781,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Radiation exposures, both intentional and unintentional, have influence on normal tissue function. Short-term and long-term injuries can occur to all cell systems of both limited and rapid self-renewal potential. Radiation effects can last a lifetime for a patient and can produce complications for all organs and systems. Often invisible at the time of exposure, the fingerprints for cell damage can appear at any timepoint after. Health-care providers will need comprehensive knowledge and understanding of the acute and late effects of radiation exposure and how these interrelate with immediate and long-term care.",signatures:"Thomas J. FitzGerald, Maryann Bishop-Jodoin, Fran Laurie, Matthew Iandoli, Ameer Elaimy, James Shen, Peter Lee, Alexander Lukez, Lakshmi Shanmugham, Beth Herrick, Jon Glanzman and David Goff",downloadPdfUrl:"/chapter/pdf-download/68241",previewPdfUrl:"/chapter/pdf-preview/68241",authors:[{id:"241806",title:"Dr.",name:"Thomas J.",surname:"FitzGerald",slug:"thomas-j.-fitzgerald",fullName:"Thomas J. FitzGerald"},{id:"303607",title:"Dr.",name:"Ameer",surname:"Elaimy",slug:"ameer-elaimy",fullName:"Ameer Elaimy"},{id:"303608",title:"Mr.",name:"James",surname:"Shen",slug:"james-shen",fullName:"James Shen"},{id:"303610",title:"Mr.",name:"Peter",surname:"Lee",slug:"peter-lee",fullName:"Peter Lee"},{id:"303611",title:"Mr.",name:"Alexander",surname:"Lukez",slug:"alexander-lukez",fullName:"Alexander Lukez"},{id:"303613",title:"Dr.",name:"Lakshmi",surname:"Shanmugham",slug:"lakshmi-shanmugham",fullName:"Lakshmi Shanmugham"},{id:"303614",title:"Dr.",name:"Jonathan",surname:"Glanzman",slug:"jonathan-glanzman",fullName:"Jonathan Glanzman"},{id:"308546",title:"Ms.",name:"Maryann",surname:"Bishop-Jodoin",slug:"maryann-bishop-jodoin",fullName:"Maryann Bishop-Jodoin"},{id:"312407",title:"Dr.",name:"Fran",surname:"Laurie",slug:"fran-laurie",fullName:"Fran Laurie"},{id:"312408",title:"Dr.",name:"Matthew",surname:"Iandoli",slug:"matthew-iandoli",fullName:"Matthew Iandoli"},{id:"312409",title:"Dr.",name:"Beth",surname:"Herrick",slug:"beth-herrick",fullName:"Beth Herrick"},{id:"312410",title:"Dr.",name:"David",surname:"Goff",slug:"david-goff",fullName:"David Goff"}],corrections:null},{id:"68195",title:"Vascular Trauma",doi:"10.5772/intechopen.88285",slug:"vascular-trauma",totalDownloads:1265,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Trauma is a leading cause of death and disability in young adults in developed countries with the high impact on future patient quality of life and productivity. The traumatic injury of the vessels is one of the most dangerous types of injury, requiring a fast and reliable diagnosis and, in vast majority of cases, immediate surgical treatment. In this chapter, the authors describe various types of vascular injuries according to injury types and locations. The prehospital care algorithms in patients with vascular trauma are proposed with the emphasis on bleeding control techniques and transportation technique to the nearest hospital. In the next subsection, the various peripheral vascular injuries of specific body areas are described. The truncal vessel trauma is discussed in the next subsection, focusing on fast diagnosis and decision on surgery. In the last subsection, a problem of iatrogenic vascular injury is described due to a rapid increase of minimally invasive techniques in which a vascular injury, as a complication of therapy, may occur.",signatures:"Krzysztof Szaniewski, Tomasz Byrczek and Tomasz Sikora",downloadPdfUrl:"/chapter/pdf-download/68195",previewPdfUrl:"/chapter/pdf-preview/68195",authors:[{id:"233455",title:"Ph.D.",name:"Krzysztof",surname:"Szaniewski",slug:"krzysztof-szaniewski",fullName:"Krzysztof Szaniewski"},{id:"308517",title:"Dr.",name:"Tomasz",surname:"Byrczek",slug:"tomasz-byrczek",fullName:"Tomasz Byrczek"},{id:"308519",title:"Dr.",name:"Tomasz",surname:"Sikora",slug:"tomasz-sikora",fullName:"Tomasz Sikora"}],corrections:null},{id:"67559",title:"Nail Trauma",doi:"10.5772/intechopen.86697",slug:"nail-trauma",totalDownloads:962,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"The nails are important elements of the finger, not only aesthetically, but also for its functionality. Not only to protecting the tip of the finger helps us but also to perform meticulously fine dexterity activities. Due to the high incidence of nail injuries seen in a trauma emergency service, it is essential to know, at least, basic aspects of the anatomy and physiology of the nail and what should be the appropriate treatment based on the injury presented by the patient. Injuries such as subungual hematomas are resolved in short time, however, more complex lesions require minor surgical intervention to obtain good results. In this chapter, additionally to reviewing the anatomy-physiological aspects of the nail, the principles of treatment of nail traumas are detailed.",signatures:"Rebeca Astorga Veganzones",downloadPdfUrl:"/chapter/pdf-download/67559",previewPdfUrl:"/chapter/pdf-preview/67559",authors:[{id:"296751",title:"Mrs.",name:"Rebeca",surname:"Astorga Veganzones",slug:"rebeca-astorga-veganzones",fullName:"Rebeca Astorga Veganzones"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"7111",title:"Poisoning in the Modern World",subtitle:"New Tricks for an Old Dog?",isOpenForSubmission:!1,hash:"08164f9300bc6bf4900c9166d960278b",slug:"poisoning-in-the-modern-world-new-tricks-for-an-old-dog-",bookSignature:"Ozgur Karcioglu and Banu Arslan",coverURL:"https://cdn.intechopen.com/books/images_new/7111.jpg",editedByType:"Edited by",editors:[{id:"221195",title:"Prof.",name:"Ozgur",surname:"Karcioglu",slug:"ozgur-karcioglu",fullName:"Ozgur Karcioglu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6662",title:"Trauma Surgery",subtitle:null,isOpenForSubmission:!1,hash:"9721b9ac98bf237058cafd0a0303bdbc",slug:"trauma-surgery",bookSignature:"Ozgur Karcioglu and Hakan Topacoglu",coverURL:"https://cdn.intechopen.com/books/images_new/6662.jpg",editedByType:"Edited by",editors:[{id:"221195",title:"Prof.",name:"Ozgur",surname:"Karcioglu",slug:"ozgur-karcioglu",fullName:"Ozgur Karcioglu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8266",title:"Cardiac Diseases and Interventions in 21st Century",subtitle:null,isOpenForSubmission:!1,hash:"186b2840cf326729108f409cd8f30bcc",slug:"cardiac-diseases-and-interventions-in-21st-century",bookSignature:"Ozgur Karcioglu",coverURL:"https://cdn.intechopen.com/books/images_new/8266.jpg",editedByType:"Edited by",editors:[{id:"221195",title:"Prof.",name:"Ozgur",surname:"Karcioglu",slug:"ozgur-karcioglu",fullName:"Ozgur Karcioglu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"802",title:"Severe Sepsis and Septic Shock",subtitle:"Understanding a Serious Killer",isOpenForSubmission:!1,hash:"7ac9a759048ec9ec47c283813a4131cc",slug:"severe-sepsis-and-septic-shock-understanding-a-serious-killer",bookSignature:"Ricardo Fernandez",coverURL:"https://cdn.intechopen.com/books/images_new/802.jpg",editedByType:"Edited by",editors:[{id:"76827",title:"Dr.",name:"Ricardo",surname:"Fernandez",slug:"ricardo-fernandez",fullName:"Ricardo Fernandez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2583",title:"Sepsis",subtitle:"An Ongoing and Significant Challenge",isOpenForSubmission:!1,hash:"85121c8c358a97497c254ca2832be903",slug:"sepsis-an-ongoing-and-significant-challenge",bookSignature:"Luciano Azevedo",coverURL:"https://cdn.intechopen.com/books/images_new/2583.jpg",editedByType:"Edited by",editors:[{id:"72846",title:"Prof.",name:"Luciano",surname:"Azevedo",slug:"luciano-azevedo",fullName:"Luciano Azevedo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5202",title:"Extracorporeal Membrane Oxygenation",subtitle:"Advances in Therapy",isOpenForSubmission:!1,hash:"f7c8f9c0cf1cf50455fba7e2607e9268",slug:"extracorporeal-membrane-oxygenation-advances-in-therapy",bookSignature:"Michael S. 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Ross and Leonardo G. Montilla",dateSubmitted:"November 6th 2018",dateReviewed:"December 12th 2018",datePrePublished:"February 5th 2019",datePublished:"September 4th 2019",book:{id:"8633",title:"Novel Diagnostic Methods in Ophthalmology",subtitle:null,fullTitle:"Novel Diagnostic Methods in Ophthalmology",slug:"novel-diagnostic-methods-in-ophthalmology",publishedDate:"September 4th 2019",bookSignature:"Anna Nowinska",coverURL:"https://cdn.intechopen.com/books/images_new/8633.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"261466",title:"Dr.",name:"Anna",middleName:"Karolina",surname:"Nowińska",slug:"anna-nowinska",fullName:"Anna Nowińska"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"274007",title:"Prof.",name:"Mandi D.",middleName:null,surname:"Conway",fullName:"Mandi D. 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\r\n\tPalm oil has accounted for more than a quarter of a percentage of the oils produced from oil crops around the world. This is essentially an edible vegetable oil that comes from the fruit of oil palm trees bearing the scientific name Elaeis guineensis. Oil palm trees are native to Africa but were brought to South-East Asia just over 100 years ago as an ornamental tree crop. It is also used in food products, detergents, cosmetics, and, to a small extent, biofuel. There are many books out there that focus on various industrial aspects of palm oil. The agricultural aspects appear to be well covered in detail as well. Thus, this book is positioned to serve as an update to the chemical, processing, and functional properties of palm oil, providing an overview of the current status and also projecting the future of the palm oil industry based on these recent findings.
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Along with the promise of increased production comes the real threats of surface water and groundwater pollution. An additional threat is posed by the release of methane, a potent greenhouse gas. Modern hydrofracking combines horizontal drilling through thousands of feet of hydrocarbon-bearing rock with a formation fracturing injection of high-pressure fracking fluid. The fracking fluid is both the elixir that unlocks the tightly held hydrocarbons and the source of potential pollution. It is a mixture of millions of liters of water under extreme pressure to fracture the rock, sand grains to prop the new fractures open, lubricants to decrease friction and better deliver the pressurized water to the rock, and toxic chemicals to prevent microbial growth. There is a worldwide debate related to the environmental impact of hydrofracking causing some countries to ban the practice, and some countries to declare a moratorium on hydrofracking. Even in the USA, where hydrofracking was invented, there are states and even counties within states that have banned hydrofracking.
One of the many risks and concerns of hydrofracking is methane releases and its impact on climate change, but the biggest concern expressed in both the popular press and scientific journals is the contamination of groundwater. One aspect of the debate related to the contamination of groundwater to be explored in this chapter in more detail is the argument that the hydrofracking is happening kilometers below the ground level, and therefore the hydrofracking layer is separated from usable aquifer layers by more than a 1000 meter of impermeable bedrock. In this chapter the authors will lay out the history of hydrofracking and the technological improvements that have optimized the process. The authors will describe the real and perceived threats to the environment and communities within the path of the hydrofracking boom.
What is called hydrofracking in the popular vernacular is actually two technologies. It is a combination of horizontal drilling and high-volume hydraulic fracturing. The first is horizontal drilling, in which the well drills horizontally through the oil- or gas-bearing rock layer. The second is high-volume hydraulic fracturing in which highly pressurized water is used to fracture the oil- or gas-bearing rock formation and sand transported with the high-pressure water props the fractures open.
Neither is an entirely new technology. Directional drilling was used to drill for offshore oil in southern California in the 1920s. Drillers would drill vertically from an onshore location and then cause the drill bit to angle west to tap formations below the ocean [1]. From that time the technology has steadily advanced until the present day where drillers have excellent control of the depth and angle of the turn from vertical, the ultimate depth of the horizontal portion, and the 3D orientation of the drilling.
Horizontal drilling followed by high-volume hydraulic fracturing is an expensive, heavy technology, potentially polluting activity, so why has it become popular? Comparing the process to conventional drilling explains the overwhelming benefits of the technique in the appropriate geologic setting.
In a conventional oil or gas production setting, a well would be advanced from the ground surface vertically down through overlying sediment and rock layers and ultimately through the oil- or gas-bearing formation. Typically, the target would be an oil- and/or gas-bearing sandstone or limestone layer of rock possibly tens to hundreds of feet thick. The portion of the well casing within the hydrocarbon-rich zone would be perforated or screened. The relatively large pores in the sandstone or limestone would allow the fluid to flow toward the well.
The limits to fossil fuel production in such a well are the thickness of the formation that is screened, tens to hundreds of feet, and the ability of the hydrocarbons to flow through the solid rock. To glean natural gas or oil from a shale formation offers a unique challenge due to the size of the rock’s pores. Normally, reservoir rocks have pore throat openings in the range of 2 μm or more. Hydrocarbon-rich shales have pore throat openings in the range of 0.1–0.005 μm [2].
These inherent limits on production of hydrocarbons from shale are overcome with the combination of horizontal drilling and high-volume hydraulic fracturing. In this technique, a well is drilled vertically down to a few hundred feet above the top of the reservoir rock then bored in an arc towards horizontal, then continuing as a horizontal borehole. The horizontal borehole is positioned to be somewhere in the middle of the depth of the reservoir rock and extended thousands of feet horizontally through the formation. The entire length of the horizontal borehole through the reservoir rock will eventually be screened and open for hydrocarbon flow. To overcome the low pore size and porosity of the shale, portions of horizontal well casing will be perforated, and then the rock surrounding the well bore will be fractured using high-pressure water. The fracturing creates interconnected secondary porosity that allows hydrocarbons to flow toward the thousands of feet of horizontal well. This combination of horizontal drilling and high volume hydraulic fracturing is what has converted shale gas into a recoverable resource.
The rapid rise of combined horizontal drilling and high-volume hydraulic fracturing has opened up large, previously unavailable natural gas and oil resources within the lower 48 states of the USA. The opening-up of unconventional “tight gas” formations to exploration and production has greatly increased estimates of technically recoverable US shale gas reserves. Geologists at the US Geological Survey, US Energy Information Administration, as well as in academic settings and energy producers have known the vast natural gas resource locked within the tight shale formations. It is only with the development of horizontal drilling and the perfection of hydrofracking that portions of this resource have been converted to proven reserves, that is, portions of the resource that are able to be economically extracted. Figure 1 shows the increase in shale gas as a percentage of all natural gas produced in the USA between 2000 and 2015 and indicates the dramatic rise from less than 3% of US natural gas production in 2003 to over 65% of US natural gas production in 2015.
Natural gas production in the USA in billion cubic feet per day (2000–2015) [
The technological revolution that has increased US natural gas production in the USA has spilled over into and dramatically increased US oil production as well. Oil exploration and extraction are a mature industry in the USA, having begun in the 1860s. US oil production, as well as US proven reserves, had been in a long-term steady decline since 1970. That decline was reversed in 2008, and since 2014 more than half of the oil production in the USA comes from hydrofracked wells. In fact US oil production increased from under 5 million barrels per day in 2008 to over 9 million barrels per day in 2015, and the US Energy Information Administration projects that US oil production will reach 10 million barrels per day by 2018 [3].
The technological revolution that has transformed the oil and gas proven reserve and production story in the USA is beginning to affect production worldwide. The US Energy Information Administration has found that tight shale gas and tight shale oil resources are distributed around the world (Figure 2).
Basins with assessed shale oil and shale gas formations [
Countries with the highest technically recoverable tight shale oil and shale gas, as shown in Table 1, are found on every inhabited continent. The US Geological Survey has estimated that the technically recoverable shale gas represents a 47% increase in the world’s total technically recoverable natural gas and that the technically recoverable shale oil represents an 11% increase [4]. The capital and know-how intensive hydrofracking revolution has only begun in a handful of countries, most notably China, Argentina, Mexico, and Algeria.
Top 10 countries with technically recoverable shale oil and shale gas resources [6].
In terms of aquifers, hydrofracking presents two threats: it uses too much water, and the water it uses becomes polluted and unfit for any other use. This section will address the threat hydrofracking poses to water resources due to imposing a new demand on already stretched water resources. Hydraulic fracturing as a technology is well known as a water hog. The volume of water used per well depends on the length of the horizontal borehole and the formation, but it is not unheard of for a single well to use 20 million liters. This is a consumptive use of water, in that once the hydrofracking chemicals are added and the water is injected into the subsurface, it cannot be reused. For perspective, consider that 20 million liters of sufficient water to meet the basic needs and few health concerns arise for approximately 200,000–400,000 people, according to the World Health Organization [7]. And, that is just the water used for a single well!
As with the most water resource problems, the geographic distribution of available water resource and water need may not align. A look at the hydrofracking experience in the USA is illustrative. Some shale gas formations underlie areas of abundant water, such as the Marcellus shale and Utica shale in the Northeastern USA. This area is well supplied with rivers, lakes, and abundant groundwater. The area is humid and receives on the order of 100 cm of precipitation annually. In contrast the Uinta-Piceance Province in Colorado, located in the Western USA, is located mainly in an area of high desert. The waters of the Colorado River are already over allocated, yet energy companies have secured over a million acre-feet (1.25 billion cubic meters) of water rights. Many of the shale gas formations poised to make a significant contribution to the world’s natural gas production are also found in areas already experiencing water stress.
The World Resources Institute reports that China, India, Pakistan, Mexico, and South Africa are among the top 20 countries in the world in terms of shale gas potential, but each may have insufficient unallocated water to develop this resource [8]. Currently, farmers in China, India, and Pakistan use tube wells and electric pumps to pull 400 billion cubic meters of groundwater out of aquifers annually. This volume exceeds recharge by an estimated 170 billion cubic meters per year [9]. The three countries combined are responsible for more than half of the world’s agricultural use of groundwater. Water is in such short supply near major cities in parts of Asia that untreated sewage is used to irrigate crops. It is estimated that a quarter of all of Pakistan’s vegetables are irrigated with sewage. These are not countries with excess water waiting to be used for hydrofracking! Table 2 lists 20 countries with the largest technically recoverable shale gas resources by average exposure to baseline water stress over shale play area.
Extremely high | High | Medium to high | Medium to low | Low |
---|---|---|---|---|
Pakistan (105) | China (1115) | USA (567) | Argentina (802) | Australia (437) |
Mexico (545) | Paraguay (75) | Canada (573) | Russia (287) | |
S. Africa (390) | Poland (148) | Brazil (245) | ||
India (96) | France (137) | Venezuela (167) | ||
Ukraine (128) | Columbia (55) |
Baseline water stress over shale play area.
Estimated shale gas in trillion cubic feet in brackets. Data source: [8].
If a significant shale gas resource exists in a water short area, the problem is likely not that there will be insufficient water to develop the lucrative natural gas resource. The problem is more likely that the water for hydrofracking will be diverted from some of the use. There will be winners and losers.
One country to consider is China. It is estimated that China has twice the shale gas resource of the USA, over 1100 trillion cubic feet. This is enough to be a significant factor in China’s transition toward a cleaner energy future. China currently uses coal to provide 62% of its total energy output [10]. It has been said that shale gas on its worst day is better than coal on its best day; so to any extent possibility, a transition from coal to shale gas could be a positive development. Shale gas, photovoltaics, and wind power will likely all be part of the mix used to wean China away from coal as it strives to meet its obligations under the Paris agreement.
China is the world’s most populous country. In his book
Some of China’s potential shale gas fields underlie areas already experiencing water stress. The statement of [12] indicates that fracking in the Sichuan Basin will compete with domestic water needs in an area that is already water stressed, but the specter of additional desertification and diversion of water for hydrofracking has not deterred multinational oil and gas companies. Chinese energy companies Sinochem, Sinopec, and CNOOC have invested in US shale gas operations such as Chesapeake Energy partly to gain access to hydrofracking experience. Major western energy companies including ExxonMobil and Chevron have initiated joint ventures in Chinese shale gas. The US shale gas boom in formations such as the Bakken in Texas and the Marcellus in Pennsylvania has taken place in nearly horizontal, relatively shallow formations. Many of China’s most promising formations are deeper and in more complex geology, indicating that it will take even more water per well to successfully frack the formations [13].
Figures 3 and 4 show current water scarcity in China and shale gas plays in China, respectively. Development of shale gas basins in the northern area in particular will compete with other uses for scarce water. Both the Bohai Bay Basin and the Ordos Basin are found in areas already classified as under extreme water scarcity. Population will grow, industry will expand, and agriculture will struggle to keep up with growing food demand; each of these areas will continue to be at least as water short as they are presently.
China’s annual water resources per capita (m3) by province (2003–2010 average) [
China’s shale gas distribution [
A rather extreme case of competition between current water demand and the coming demand from hydrofracking is illustrated by Algeria. Algeria is estimated to have the third largest reserve of technically recoverable shale gas in the world, after China and Argentina. Its two significant shale gas formations are the Frasnian Shale and the Tannezuft Shale. These are found in multiple basins throughout the southern portion of the country [14]. Algeria is dependent on domestic gas production for energy. More than 60% of Algeria’s energy needs are currently met with domestic production of conventional gas, but the output has been declining. Algeria will not be able to leave the shale gas in the ground.
Few countries on earth are as dry as Algeria. Over 80% of the country is located within the Sahara desert. Only the northern coastal portion of the country is temperate, but it becomes hotter and dryer away from the coast and the coastal mountains. The majority of the country located above the shale gas formations receives little to no rainfall. Annual precipitation is less than 10 cm per year for the majority of the country. Except for the coastal area, all surface water is ephemeral, with wadis draining to sebhkas—closed internal basins with high evaporation [17].
Figure 5 shows annual precipitation in Algeria. Figure 6, showing the location of shale gas basins in Algeria, indicates that all of the resource exists in areas of the country that receive less than 10 cm of precipitation annually. The population away from the coastal areas is entirely dependent on water pumped from deep aquifers. In that there is no recharge, they are essentially mining their non-renewable groundwater from aquifers below the Sahara. The aquifers used for water supply include moderate to high permeability unconsolidated material, sedimentary rock layers, and karst rock layers.
Annual precipitation in Algeria [
Location of shale gas basins in Algeria [
Algerians concerned for their water resources have already staged demonstrations and sit-ins. Their concerns range from water availability to pollution from fracking. Algerians living in areas above shale gas reserves rely on sole source aquifers, that is, aquifers that are their only source of drinking water, so their fears are well justified.
Another country where concerns over water availability (Figure 7) for hydrofracking are real and justified is Mexico. Mexico is the eleventh most populous country on earth, with over nearly 125 million people. Mexico has the second largest economy in Latin America after Argentina. Petroleum was discovered in Mexico in the nineteenth century, and production and export began in the 1890s. Petroleum has played a major part in the economy since at least 1980 and currently contributes about 35% of the country’s GDP (CIA). It is estimated that Mexico has nearly 600 trillion cubic feet of shale gas, the sixth largest in the world.
Annual precipitation in Mexico [
Mexico is an arid country with large and growing water shortage issues. The Sonoran Desert and the Chihuahuan Desert are both found in the northern part of the country. The water shortage in 2012 led to failure of pasture land and the starvation of some 350,000 heads of cattle in the northern state of Chihuahua [18].
In some areas development of Mexico’s shale gas resource (Figure 8) could be limited by water availability, or water already allocated to irrigation and human needs could be in danger of being diverted. Mexico’s shale gas is found in the Burgos Basin and Sabinas Basin in the relatively dry north and in the Tampico and Veracruz basins along the Gulf of Mexico (shaded in orange) (Figure 8). The Burgos is an extension of the Eagle Ford Formation that has been so successfully developed in Texas (Figure 8). The western portion is the La Casita area shown on straddles the Chihuahuan desert.
Location of shale gas basins in Mexico [
The Burgos and Sabinas lie below the watershed of the Rio Grande, a river system that drains one-tenth of the US territory and 40% of Mexico. The flow of the Rio Grande is used entirely for irrigation and dries entirely during the summer months [9]. Agriculture in the area is increasingly dependent on groundwater pumping, and fields are being abandoned due to salt buildup. Less than 500 cubic meters of water per person per year is available in the Rio Grande watershed. Clearly, supplying millions of liters of water for each hydrofracked well will have dire water resource consequences.
South Africa, located on the southern tip of the continent, is the 26th largest country in the world and the 25th most populous one. It is a developing country, with a GDP per capita near the world median [20]. Petroleum production has played little to no role in the county’s economy to date. It has been estimated that the Karoo Basin hold as much as 13 trillion cubic feet of shale gas [21].
South Africa is a relatively dry country, with more than half of the country classified as hot desert, cold desert, hot semiarid, or cold semiarid. Demand exceeds reliable yield in 11 of the country’s 19 water management areas. The Orange and Limpopo watersheds cover the areas of potentially recoverable shale gas. These watersheds can supply only 500 to 1000 cubic meters of water per person on an annual basis. Nearly all groundwater in the shale gas areas is already under license for use. The proximity of the shale gas areas to low precipitation regions of South Africa can be seen in Figures 9 and 10.
Annual precipitation in South Africa [
Location of shale gas basins in South Africa [
South Africa already struggles to supply water to agriculture, domestic use, and industry. Growing population and an increase in standard of living will continue to increase the growth in demand. Much of the population in areas overlying South Africa’s shale gas resources is fully dependent on groundwater.
Hydraulic fracturing may seem like a simple and straightforward process until one becomes aware of the complex chemistry of the fracking fluid and the necessary complexity based on the number of problems that must be overcome. One way to understand the chemical additives is to consider the problems that must be overcome to fracture thousands of feet of source rock located thousands of feet underground.
The main challenge of hydraulic fracturing is to create deep fractures in solid rock that is confined by the pressure associated with great depth. To accomplish this water is forced at high pressure through perforations in the well pipe. Pressures can be as high as 15,000 psi. In a horizontal well that is thousands of meters long, the fracking process is accomplished in multiple shorter sections.
This process uses vast quantities of water. In the USA it has been found that some wells use as little as 10,000 liters, but more typically wells are using in the range of 1 to 10 million liters, with some wells using more than 35 million liters. More important than the water use itself is the fact that the water use is consumptive, in that most of the water used to hydrofrack a well is lost within the fracked formation. The water that does return to the surface through the production well is too contaminated to be reused.
The water is only able to fracture rock if it is delivered at extremely high pressures. Pumps at the surface must not only pressurize the water but also deliver that pressure vertically and then horizontally through thousands of feet of pipe to the portion of the formation being fractured. This involves overcoming the frictional resistance to flow. This could not be accomplished without chemical friction reducers. Currently, organic polymers are most often used, but historically petroleum distillates were the friction reducer of choice.
Hydrofracking generally is used on deep targets, usually at least a kilometer below the ground surface. If hydrofracking was done with water alone, the newly created fractures would collapse as soon as the applied pressure decreased due to the weight of the overlying rock. Hydrofrackers use proppants to prop the fractures open. Proppants need to be strong enough not to fracture or be crushed during the fracking process or during the producing life of the well. By far the most common proppant used in the USA to date is so called “white” sand. White sand is high-purity silica sand with few other minerals. This gives the sand its light color and relatively uniform chemical and physical properties. Prior to use the sand is washed and sieved to produce a more uniform size distribution. Multiple sizes are used, with smaller particles injected first to infiltrate farthest into the newly fractured bedrock and larger sand particles used near the end of the process to better match the larger aperture near the well. The volume of sand used in the hydrofracking industry is considerable. The US Geological Survey reports that sand and gravel production in the USA more than doubled between 2010 and 2014, with more than 70% of the total 2014 sand production being used by the hydrofracking industry! [23].
Sand is not the only proppant. Ceramic proppants of various formulations allow for a more uniform manufactured proppant with specific beneficial properties. Ceramic proppant can be manufactured with properties that make them better than sand, such as higher sphericity, more uniformity of size, and more crush resistant. Formations hydrofracked with ceramic proppants have higher conductivity than those propped with sand. Many other materials have been used as proppants including resin-coated sand, resin-impregnated crushed walnut shell, and thermoplastics.
Proppants by their nature are inert and nonpolluting, but not without environmental impact. The landscape of rural Wisconsin is being transformed by mines that provide roughly 9000 truckloads of fracking sand per day [24].
Sand or ceramic proppants are more than twice as dense as water. Gelling agents and cross-linking polymers are added to the fracking fluid to increase the water’s density and help keep the proppants suspended. Various guar formulations are the typical gelling agents. This is the same plant-based material seen as an emollient on processed food. Other plant-based gelling agents are used as well.
The polymers and organic material described in Sections 6.1 and 6.3 keep proppants in solution, adjust the water’s density, and decrease friction, making fracking possible. These same chemicals can then restrict the flow of natural gas out of the formation by clogging the newly created fractures and lowering the conductivity of the fractured rock. Therefore, an additional additive breaks these chemicals up into smaller molecules that will not clog the fractures. These “breakers” are usually enzymes that cut the organic chemicals into smaller pieces.
Additional chemical additives include pH adjusters, corrosion inhibitors, clay stabilizers, scale inhibitors, and metal precipitation inhibitors that are added to the hydrofracking fluid. In general these prevent mineral precipitates and particulates from clogging fractures and inhibiting flow in the well.
Many of the additives in hydrofracking solution, including the breaker, surfactant, gelling agent, cross-linkers, surfactants, and friction reducers, are organic chemicals. All of these are substrates for microorganisms to feed on. Proliferation of microorganisms creates biomass. The biofilm on surfaces made up of living and dead microbes can lower porosity and gas permeability by lowering the fracture aperture. This is the same effect seen in bioremediation of aquifers where the stimulation of the native flora choke off conductivity. Biocide is added to fracking fluid to prevent this counterproductive effect.
Among all the chemicals used to formulate hydrofracking fluid, it is the biocides that are of most concern for water quality. Fewer than 20 biocides have been identified as more or less commonly used in the hydrofracking industry. Among the most common are glutaraldehyde, dibromonitrilopropionamide (DBNPA), tetrakis(hydroxymethy)phosphonium sulfate, and chlorine dioxide [25]. These biocides are toxic to microorganism, and some are quite toxic to aquatic fauna. They have low toxicity for mammals. Although they are not acutely toxic to mammals, some are toxic during long-term exposure or possess carcinogenicity or mutagenicity.
How do these hydrofracking chemicals get into the hydrosphere, and how do they become a threat to water resource quality? Chemicals must be transported to the site by rail or truck so accidents are of course a threat to surface water quality. Hydrofracking fluids are generally mixed on site and stored in railroad tank cars or in lined storage lagoons. It is not uncommon for lagoons lined with geotextile to leak at the geotextile seams or from punctures, so this could be a threat to shallow aquifers.
Once fully mixed hydrofracking fluid is injected into the target formation. Fluids travel first down through the vertical well and then into the horizontal portion being hydrofracked. Improperly cased and grouted wells could leak into shallow aquifers during high-pressure injection of the fracking fluid. Hydrofracking opponents in the USA have claimed that hydrofracking of shale gas formations can cause fractures to extend upward from the target shale formation, allowing fracking fluid to reach freshwater aquifers above. This is likely not a realistic fear. Freshwater aquifers are generally found within a few hundreds of meters of the ground surface. Shale gas formations that could be subject to hydrofracking are generally found thousands of meters below the ground, and the pressures used to hydrofrack are incapable of creating fractures of the length that would be required to reach a freshwater aquifer. It is possible however for hydrofracking fluid to flow upward through existing faults or abandoned wells.
There have been wide ranges reported, but between a quarter and half of the hydrofracking fluid injected to break the shale returns to the surface as flow-back subsequent to the frack. This hydrofracking fluid wastewater returns to the surface to the wellhead where it is collected. Wastewater can be treated onsite, treated offsite, treated and reused as hydrofracking fluid, or disposed of in a deep brine aquifer. This presents a number of additional opportunities for pollution of surface water or aquifers.
Hydrofracking wastewater that is treated offsite or treated and reused as hydrofracking fluid must be transported and so again poses the threats associated with transporting chemical-laden water. Wastewater treated onsite and then disposed of to a surface water body may not be sufficiently treated and could still contain some chemicals not removed by the treatment process. Injecting wastewater into a deep brine aquifer again presents the hazard of leakage from improperly cased or grouted wells.
Hydraulic fracturing operations cause earthquakes. The USGS has reported a sharp increase in the number of potentially damaging earthquakes, those with a magnitude of three or larger in the Central and Eastern USA due to hydrofracking operation. There has been a 50-fold increase in M3+ quakes from an average of roughly 20 per year to over a thousand in 2015.
The realization that high-pressure injection of fluids into the deep subsurface can cause earthquakes is not new. In 1967 David Evans, a consulting geologist in Colorado, noted a correlation between injection volumes at a US Army hazardous waste injection well located at the Rocky Mountain Arsenal and earthquake frequency. His figure showing the correlation (Figure 11) became a staple of college-level geology textbooks. It was determined that the injection of wastes into the nearly 4000 feet deep well decreased frictional resistance to faulting. “The mechanism by which the fluid injection triggered the earthquakes is the reduction of frictional resistance to faulting, a reduction which occurs with increase in pore pressure” [26]. Disposal of waste fluids by injection into a deep well has triggered earthquakes near Denver, Colorado [26].
Correlation between the number of earthquakes and the volume of fluid injected [
It should be obvious to all readers that the injection of millions of gallons of highly pressurized hydrofracking fluid into each well contributes to the notable increase in induced seismicity reported by the US Geological Survey. Less obvious is the reinjection of brine wastewater that is produced from the formation along with the hydrocarbons after hydrofracking.
So, should we hydrofrack? On the positive side of the ledger, we need resources for an energy-hungry world. Although the Paris accords require countries to limit greenhouse gas emissions worldwide, fossil fuel consumption will continue to increase for decades. Also, on the positive side is that as we increase shale gas usage we have the opportunity to decrease the usage of coal for electricity production. Also, on the positive side of the ledger is the fact that shale gas production and export provide hard currency for exporting countries, some of which are in the developing world.
There are also significant considerations on the negative side of the ledger. It is an unassailable fact that hydrofracking will consumptively use vast volumes of freshwater, and a great deal of that usage will occur in regions already short on water resources. Pollution of water resources both in surface water and in aquifers due to hydrofracking is a reality. If we could hydrofrack the world’s shale gas resource without human error, without equipment failure, and without any shortcuts taken to increase profits, then our freshwater resources would likely be safe from chemical pollution due to fracking!
Also, on the negative side of the ledger is the fact that methane is a significantly more potent greenhouse gas than carbon dioxide. Methane leaks during drilling, production, transportation, processing, distribution, and usage, and the effect these will have on the environment should be considered. Climate change caused by methane leaks will affect precipitation, surface water availability, and ultimately the recharge of our aquifers.
We will develop our shale gas resource through the marriage of horizontal drilling and high-volume hydrofracking. The shale gas is simply too valuable and too tempting to leave in the ground. It is reasonable to accept that hydrofracking will have a negative effect on water availability and water quality.
Hemophilia is a disease that has a frequency of approximately 1 in 10,000 births. It has an X-linked transmission, and it consists in a bleeding disorder due to the deficiency of clotting factor VIII (hemophilia A) or factor IX (hemophilia B). Hemophilia is a genetic or acquired disease that leads to spontaneous and recurrent bleedings, which affect the joints and muscles, thus determining chronic damage to the cartilage which will lead to joint disease and hemophilic arthropathy.
There are two major types of hemophilia: type A and type B. These disorders are X-linked and consist in hemorrhages, resulting from diminished levels of clotting factors VIII and IX. Type A is 5–6 times more frequent than type B. This pathology affects in a symptomatic manner only male patients and is characterized by excessive bleeding, which is installed rather spontaneously or after minimal incidents, and is difficult to stop [1].
Hemophilia is a chronic condition that requires a substitution treatment with the defective factor. Its severity varies accordingly to the residual factor level. It is classified as severe (when the clotting factor activity is less than 1%), moderate (1–5%), and mild (6–40%).
If not treated hemophilic patients, especially those with very low clotting factor activity and severe disease, have recurrent disabling and life-threatening bleeding episodes. Using prophylactic factor therapy may diminish bleeding; therefore these novel therapies have changed the prognosis of hemophilic patients, providing increased life expectancy and better quality of life [2, 3, 4].
Even though hemophilic patients were initially thought to have a low incidence of atherothrombotic complications, it is now clear that atherothrombotic events occur.
Limited data suggest that hemophilia is not protective against atherosclerosis and thrombosis, but this theory is still to be studied in men with severe forms of hemophilia without other CVD risk factors, such as active HIV infection [5].
The most common manifestation of hemophilia is represented by bleeding. The severity of hemorrhages is correlated with the plasmatic level of clotting factors. Therefore, there are patients with mild or minor hemophilia that may not bleed excessively until they undergo a surgical intervention or after a trauma.
The accurate diagnostic of hemophilia is mandatory for an optimal management. Hemophilia should be suspected in patients with early bruising in childhood, with excessive hemorrhages after trauma or surgical intervention, or in patients with spontaneous bleeding.
Patients with hemophilia need a complex therapeutical management. The most important aim is to administrate the deficient clotting factor so that bleedings are terminated or prevented. If an acute bleeding occurs, it is important to treat it in the first 2 hours.
In order to ease the appropriate management, all patients should carry upon them accessible identification information such as diagnosis, severity of bleeding disorder, type of treatment product that should be used, and contact information.
The patients with hemophilia should benefit from a comprehensive care treatment provided by a team of specialists. This type of care should increase the quality of life while reducing morbidity and mortality.
Hemophilic patients should benefit from fitness and physical activity therapy, in order to obtain normal neuromuscular development, coordination, healthy body weight, and appropriate self-esteem [6].
Adjunctive therapy should be provided consisting in physiotherapy, antifibrinolytic drugs, and certain COX-2 inhibitors in order to soothe the pain.
Prophylactic factor replacement therapy should be administrated so that bleeding and joint destruction is prevented, thus preserving a normal musculoskeletal function.
Surgery is required for complications related to hemophilia or for unrelated disease. The surgical treatment should be done in a comprehensive treatment center for hemophilia [7, 8].
In the majority of cases (90%), the bleeding episodes in hemophilic patients occur in the joints, thus leading to hemarthrosis. From all these bleedings, the most affected joints are the knees, elbows, and ankles. The affected articulation is usually swollen, held in flexion, the mobility being very restricted and painful.
If the deficient clotting factor is given quickly, the hemorrhages can be controlled, and the episode can benefit from conservative orthopedic treatment without long-term complications.
If the bleeding persists or if hemorrhages reoccur, the presence of blood in the joint may lead to apoptosis of the chondrocytes. When there is too much blood present, the synovial membrane will become hypertrophic as it tries to reabsorb the blood. From that moment a vicious circle of chronic synovitis develops thus leading to join destruction and to hemophilic arthropathy [9, 10] (Figure 1).
Modifications of hemarthrosis in hemophilia [
The hypertrophic synovial membrane consists of villous formation with increased vascularization and chronic inflammatory process. Hemophilic children will have hypertrophic epiphyseal growth plates. This bone hypertrophy can determine length discrepancies and modifications in contour and angular deformities. Further destruction of the cartilage may appear if the inflammatory and hemorrhagic process is not controlled. When the synoviocytes are destroyed, they release lysosomal enzymes that promote further cartilage destruction and promote chronic inflammation. As the modifications progressively occur and the cartilage of the joint degrades, the joint function diminishes, and there are limited and painful movements [12, 13, 14].
The apparition of hemarthrosis is the most frequent and unfavorable clinical expression of a hemorrhage in a hemophilic patient; it has an incidence of 75%. It usually appears between 1 and 5 years; if it does occur after 10 years, it is usually due to a mitigated condition. The other symptoms that may appear are relapses. The trigger is represented by a trauma which is very frequently unnoticeable. The most affected joints are in a decreasing order as follows: knees (36%), ankle (30%), elbow (23%), hand (6%), shoulder (3%), and hip (2%) [15, 16].
Hemarthrosis usually affects only one joint, but sometimes the bleeding may be present in both joints, but the lesions are not symmetric. Relapses usually affect the same articulation. Each bleeding episode determines disorders of the joint, thus creating a predisposition for a relapse. The joint structures will weaken, the muscles become atrophic and develop fibrosis thus the join functionality becomes mechanics deficient. In order to bleed less, the synovial will become hypertrophic and will have an increased vascularization, and this mechanism will lead to a vicious circle. From this moment on, a chronic condition begins and is called “hemophilic arthropathy.” This complication advances slowly during time and induces severe modification of the joint with ankylosis. Some experimental studies have proven that a major hemarthrosis induces in the cavity of the joint a dense inflammatory process, while the local tissues change their color and become brownish as a result of the hemosiderin deposits that are due to the erythrocyte damage. The vessels become hyperplasic, thus creating brittle vessels, which are prone to bleeding, therefore inducing a vicious circle: bleeding-vascular hyperplasia-bleeding [11, 17, 18].
The surface of the articulation roughens and pannus is formed. The bone located in the subchondral region becomes dysmorphic. After 30 days the erosions present in the cartilage and bone are obvious.
Different studies have proven that the affected joints are an important factor in inducing cartilage destruction in hemophilic patients. Different authors showed that the presence of iron in the intra-articular blood induces molecular modifications that can offer an explanation for the cellular proliferation in the synovial membrane (synovitis).
Valentino et al. proved in an experimental study that the bleeding that results from a controlled trauma causes joint swelling, synovitis, and hemophilic arthropathy.
In order to alleviate these complications, substitutive treatment with deficient coagulation factor applied from a young age (primary prophylaxis) represents the best therapeutic conduct. Even though primary prophylaxy with the deficient clotting factor is given despite, some patients still have intra-articular hemorrhages, as a result of an insufficient dose of coagulation factor or due to a diminished adherence to the therapy, while other hemophilic patients may present sub-clinically manifested hemarthroses [19, 20].
If continuous prophylactic therapy with clotting factors is provided, the natural course of the arthropathy can be slowed down. One of the most threatening complications of the therapy with clotting factors is the apparition of alloantibodies that are directed against the exogenous molecules of clotting factor. This complication appears in one third of the patients, and it increases the likelihood to develop an uncontrolled bleeding [20, 21].
There has been a new drug developed for the treatment of hemophilic patients. It is called emicizumab, and it is a recombinant antibody that brings activated factor IXa and factor X into an adequate conformation that will lead to the activation of factor X and therefore will mimic the cofactor function of factor VIIIa. A subcutaneous injection with emicizumab that is given once weekly proves to be an efficient method to prevent bleeding in the majority of type A hemophilic patients with inhibitors to factor VIII. Even more the prevention of bleeding has been observed in 66% of patients without inhibitors to factor VIII.
The administration of plasmatic factor VIII has better clinical results in type A hemophilic patients than the transfusion with plasma. The side effects are linked to viral infections transmission such as hepatitis B, C, or HIV; therefore it is better to use in clinical practice recombinant clotting factors that are associated with a diminished risk of viral transmission. In order to have safer products, there have been more modern generations of recombinant factor VIII (rFVIII) developed, the viral transmission being much lower with each new generation of compounds. The first generation had a human serum albumin in order to stabilize the product. The second-generation compounds have no albumin in their composition, but proteins from humans or animals were still allowed in the process of cell culture. The third-generation compounds have eliminated animal and human proteins, but contain murine monoclonal antibodies, which are still used for the purification of rFVIII. It was proven that the elimination of the middle portion (domain B) of the wild-type FVIII did not diminish the clotting activity. It was also shown that the full-length protein had similar effects. These findings helped to discover the recombinant FVIII with deletion of the B domain called moroctocog alfa [21, 22].
ReFacto® is a recombinant clotting factor VIII which has a B-domain deletion (moroctocog alfa). It has a molecular weight of about 170,000 Da and contains1438 amino acids.
ReFacto has a similar functionality as endogenous clotting factor VIII. When given to a patient with hemophilia, factor VIII will bind to the patient’s intrinsic von Willebrand factor. When activated factor VIII becomes a cofactor for activated factor IX, thus catalyzing the activation of factor X. The activated factor X will subsequently transform prothrombin in thrombin. The latter will transform fibrinogen in fibrin, thus forming the red clot. When giving substitution treatment, the levels of factor VIII increase, and the deficiency is temporarily corrected, thus leading to a diminishment in bleeding episodes [1, 23].
We analyzed five patients with hemophilia type A, aged between 35 and 62 years. Two of them had a severe form of hemophilia with factor VIII less than 1%, while the other three had a moderate form with factor VIII ranging between 1 and 5%. All of them described intense pain as a result of functionally chronic knee arthropathies. Thus, the lesions had an indication of endoprosthesis and total knee repair. These orthopedic interventions were done by a multidisciplinary team, formed by hematologists, orthopedists, and intensive care staff (Figure 2).
TKR for severe hemophilic osteoarthritis.
The orthopedic surgeries were realized after a rigorous hematological control, offered through the national protocol for hemophilia. Therefore, all patients received the necessary amount of substation therapy with clotting factor. During the surgery and in the postprocedural surveillance period, the patients had their blood count, hemostasis, and transfusion requirements very thoroughly assessed. Also, other postsurgical complications were routinely searched (Figure 3).
(A–H) Severe axial deformity. Genu varum in severe hemophilic arthropathy. (A–B) Preoperative X-rays. (C–D) Severe genu varum clinically and radiologically. (E–F) Postoperative X-rays. (G–H) Clinical view of the knee with axis restored and wound healed.
The postsurgical evolution of these patients was favorable, with similar hemostatic profile as the non-hemophilic patients. Only one patient had increased bleeding times, as his clotting profile associated also a factor VII deficiency, thus requiring blood transfusion.
After the administration of Moroctocog alpha substitution treatment, all five patients had a normal clotting profile, thus requiring thromboprophylaxis with LMVH (enoxaparin) in order to prevent VTE. An important aspect to be noted refers to the fact that the amount of bleeding did not correlate with the levels of residual factor. Even more, we noted no differences regarding the volume of blood drained after the surgery between patients with moderate or severe hemophilia. The elderly patients had similar outcomes with young patients with favorable postoperative prognosis, consisting in diminishment of joint pain, improvement in functionality, and increased quality of life. We thus concluded that older age is not a contraindication for complex surgical intervention.
The systemic substitutive treatment was very efficient and normalized the clotting profile of the patients. Therefore, the surgical hemostasis was done without using topical agents such as bio surgical gels or foams. Even more the intrasurgical bleeding of these patients was similar with the hemorrhage seen in patients without the diagnosis of hemophilia. The monitorization of the clotting profile of the patients was thoroughly done by a hematologist trained in treating hemophilic patients requiring elective surgeries. The administration of the substitution therapy followed the guidelines described in the National Protocol of Hemophilia. The clotting profile was monitored daily, and the results showed a normal hemostasis after the administration of treatment. That is why we decided to give low-molecular-weight heparin in these patients, as the risk of thromboembolic events increased after the normalization of the hemostasis, due to the associated risk factors (age, sedentarism, obesity, cardiovascular disease). We chose to give enoxaparin once daily in a 1 mg/kg dose, and the clinical and paraclinical results were favorable.
Pruthi et al. published a paper in 2000 regarding the use of thrombophylaxy in patients with hemophilia. They presented the case of a patient with moderate hemophilia B, who underwent treatment with factor IX concentrate in order to realize a total hip replacement for a hip fracture and developed venous thromboembolism in the operated limb after the intervention. The thrombophilia screening detected the presence of a heterozygous type of factor V Leiden mutation [24]. Therefore, the authors concluded that presurgical screening for thrombophilia is useful in hemophilic patients who had a previous history of VTE. Another research realized by Mannucci the same year suggested that all patients with thrombophilia should receive short-term therapy with LMWH if they are exposed to significant risks such as prolonged immobilization or surgery [25].
Later in 2004, Dargaud et al. suggested that hemophilic patients should not routinely receive thromboprophylaxis as there are not enough studies, but they also added that hemophilia per se does not protect against venous thromboembolism. The conclusion of this study was that specific cases with increased risk of thrombosis should receive therapy with LMWH [26]. In 2006 Butcher and Pasi reported the case of a patient with hemophilia A, who developed an episode of massive pulmonary embolism after major pelvic surgery. Thus, they concluded that thromboprophylaxis in selected hemophilic patients is very important [27].
Another research done by Uprichard et al. in 2012 included 13 patients with total kidney replacement, from which 11 had hemophilia B. They received mechanical thromboprophylaxis, and one also received pharmacological treatment. The results were satisfying as no patient suffered VTE [28].
In 2012, Uprichard et al. analyzed a series of 13 TKRs in 11 patients with hemophilia B, who received mechanical thromboprophylaxis, and 1 also received pharmacological thromboprophylaxis. No patients suffered VTE [29].
On the other hand, another study realized by Krekeler et al. in 2012 analyzed 105 interventions, 90 of them being major orthopedic surgeries and 15 minor surgeries. The authors did not find any case of VTE even though therapy with LWMH wasn’t given after the surgery. In the same year Ozelo arrived as the same conclusion as Butcher and Pasi. Another research from 2013 done by Berntorp stated that in case of elderly patients diagnosed with hemophilia or patients with von Willebrand disease, a rigorous assessment of the risk and benefit of thromboprophylaxis in the patients who underwent major orthopedic surgery should be realized.
Ozelo et al. proved that the use of graduated compression stockings and early mobilization is sufficient in preventing VTE in the majority of patients. Thus, the administration of anticlotting therapies should be taken into account just for patients that have strong additional risk factors for thrombosis. Contrary, patients with hemophilia treated with inhibitors should not receive pharmacological thromboprophylaxis. Patients with von Willebrand disease, who receive replacement therapy with factor concentrates and who underwent surgical procedures, should have a strict monitorization of FVIII plasma levels, and thrombophylaxy should be taken into account if there are other thrombotic risk factors [30, 31, 32].
The best therapy for hemophilic patients consists in doing primary prophylaxy so joint bleeding and other complications are prevented. Even though orthopedic surgeries in these patients are associated with increased risk of complications such as infections and hemorrhages, they can increase significantly the joint mobility and life quality if they are realized in specialized centers with hematological support. Moroctocog alfa is an efficient substitutive treatment that manages to normalize the hemostatic profile of patients. Therefore, it is recommended to provide prophylactic antithrombotic therapy after the orthopedic interventions.
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\\n\\nFINANCIAL AND MATERIAL
\\n\\nNON-FINANCIAL
\\n\\nAuthors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\\n\\nAcademic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
\\n\\nAll Authors, Academic Editors, and Reviewers are required to declare all possible financial and material Conflicts of Interest in the last five years, although it is advisable to declare less recent Conflicts of Interest as well.
\\n\\nEXAMPLES:
\\n\\nAuthors should declare if they were or they still are Academic Editors of the publications in which they wish to publish their work.
\\n\\nAuthors should declare if they are board members of an organization that could benefit financially or materially from the publication of their work.
\\n\\nAcademic Editors should declare if they were coauthors or they have worked on the research project with the Author who has submitted a manuscript.
\\n\\nAcademic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
\\n\\nPolicy last updated: 2016-06-09
\\n"}]'},components:[{type:"htmlEditorComponent",content:"In each instance of a possible Conflict of Interest, IntechOpen aims to disclose the situation in as transparent a way as possible in order to allow readers to judge whether a particular potential Conflict of Interest has influenced the Work of any individual Author, Editor, or Reviewer. IntechOpen takes all possible Conflicts of Interest into account during the review process and ensures maximum transparency in implementing its policies.
\n\nA Conflict of Interest is a situation in which a person's professional judgment may be influenced by a range of factors, including financial gain, material interest, or some other personal or professional interest. For IntechOpen as a publisher, it is essential that all possible Conflicts of Interest are avoided. Each contributor, whether an Author, Editor, or Reviewer, who suspects they may have a Conflict of Interest, is obliged to declare that concern in order to make the publisher and the readership aware of any potential influence on the work being undertaken.
\n\nA Conflict of Interest can be identified at different phases of the publishing process.
\n\nIntechOpen requires:
\n\nCONFLICT OF INTEREST - AUTHOR
\n\nAll Authors are obliged to declare every existing or potential Conflict of Interest, including financial or personal factors, as well as any relationship which could influence their scientific work. Authors must declare Conflicts of Interest at the time of manuscript submission, although they may exceptionally do so at any point during manuscript review. For jointly prepared manuscripts, the corresponding Author is obliged to declare potential Conflicts of Interest of any other Authors who have contributed to the manuscript.
\n\nCONFLICT OF INTEREST – ACADEMIC EDITOR
\n\nEditors can also have Conflicts of Interest. Editors are expected to maintain the highest standards of conduct, which are outlined in our Best Practice Guidelines (templates for Best Practice Guidelines). Among other obligations, it is essential that Editors make transparent declarations of any possible Conflicts of Interest that they might have.
\n\nAvoidance Measures for Academic Editors of Conflicts of Interest:
\n\nFor manuscripts submitted by the Academic Editor (or a scientific advisor), an appropriate person will be appointed to handle and evaluate the manuscript. The appointed handling Editor's identity will not be disclosed to the Author in order to maintain impartiality and anonymity of the review.
\n\nIf a manuscript is submitted by an Author who is a member of an Academic Editor's family or is personally or professionally related to the Academic Editor in any way, either as a friend, colleague, student or mentor, the work will be handled by a different Academic Editor who is not in any way connected to the Author.
\n\nCONFLICT OF INTEREST - REVIEWER
\n\nAll Reviewers are required to declare possible Conflicts of Interest at the beginning of the evaluation process. If a Reviewer feels he or she might have any material, financial or any other conflict of interest with regards to the manuscript being reviewed, he or she is required to declare such concern and, if necessary, request exclusion from any further involvement in the evaluation process. A Reviewer's potential Conflicts of Interest are declared in the review report and presented to the Academic Editor, who then assesses whether or not the declared potential or actual Conflicts of Interest had, or could be perceived to have had, any significant impact on the review itself.
\n\nEXAMPLES OF CONFLICTS OF INTEREST:
\n\nFINANCIAL AND MATERIAL
\n\nNON-FINANCIAL
\n\nAuthors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\n\nAcademic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
\n\nAll Authors, Academic Editors, and Reviewers are required to declare all possible financial and material Conflicts of Interest in the last five years, although it is advisable to declare less recent Conflicts of Interest as well.
\n\nEXAMPLES:
\n\nAuthors should declare if they were or they still are Academic Editors of the publications in which they wish to publish their work.
\n\nAuthors should declare if they are board members of an organization that could benefit financially or materially from the publication of their work.
\n\nAcademic Editors should declare if they were coauthors or they have worked on the research project with the Author who has submitted a manuscript.
\n\nAcademic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
\n\nPolicy last updated: 2016-06-09
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These types of samples are very useful for sensor application, battery applications, electronic applications, and automotive applications.",book:{id:"9247",slug:"mineralogy-significance-and-applications",title:"Mineralogy",fullTitle:"Mineralogy - Significance and Applications"},signatures:"I.C. Sathisha, K. Manjunatha, V. Jagadeesha Angadi, B. Chethan, Y.T. Ravikiran, Vinayaka K. Pattar, S.O. Manjunatha and Shidaling Matteppanavar",authors:[{id:"266255",title:"Dr.",name:"Veerabhadrappa",middleName:null,surname:"Jagadeesha Angadi",slug:"veerabhadrappa-jagadeesha-angadi",fullName:"Veerabhadrappa Jagadeesha Angadi"},{id:"321561",title:"Dr.",name:"I.C.",middleName:null,surname:"Sathisha",slug:"i.c.-sathisha",fullName:"I.C. Sathisha"},{id:"321562",title:"Dr.",name:"K.",middleName:null,surname:"Manjunatha",slug:"k.-manjunatha",fullName:"K. Manjunatha"},{id:"321564",title:"Dr.",name:"B.",middleName:null,surname:"Chethan",slug:"b.-chethan",fullName:"B. 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In fact, under some specific conditions the NCMs could be used either as effective adsorbent material or alternative source of minerals. This chapter presents an outline of a general review of factors that affect the application ability of NCMs and a descriptive analysis of NH4+ and REE adsorption behavior and extraction of rare earth elements (REE) by an ion-exchange with NH4+ ions onto NCMs. Clays and NCMs both effectively remove various contaminants from aqueous solution and serve as alternative sources of minerals, as extensively discussed in this chapter. This review compiles thorough literature of current research and highlights the key findings of adsorption (NH4+ and REE) that use different NCMs as adsorbents or alternative sources of minerals (i.e., REE). The review confirmed that NCMs excellently remove different cations pollutants and have significant potential as alternative source of REE. 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This chapter focuses on the chemical synthetic methods, magnetic and luminescent properties, including the biomedical applications of iron oxide nanomaterials and luminescent magnetic iron oxide-based nanocomposite materials. The influences of functionalizing with short ligands such as dopamine and L-cysteine on the magnetic properties of synthesized nanoparticles are described. The chapter contains some data on necessary reagents and protocols for bioconjugation aimed at cell culture and step by step the MTT assays used to evaluate cytotoxicity are also presented. In the final section of the chapter, we focus on the biomedical applications specifically for diagnosis and treatment of breast cancer treatment. 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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"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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