Performance aspects.
\r\n\t1. To draw spotlight on recent studies and research concerned with the regeneration process in animal kingdom and models with emphasis on the cellular origins of regeneration.
\r\n\t2. Then, we will be dealing with the reasons for the differences in the regenerative capacity of animals on many levels, including the molecular mechanism, gene expression, epigenetic regulation, common elements affecting regeneration and comparing their contributions to regeneration.
\r\n\t3. To provide new insights into how to promote regeneration in mammals.
The Lean Six Sigma (LSS) quality enhancement approach has obtained recognition in the previous few years as more and more corporations affirm its effectiveness in developing their bottom lines and shareholders (i.e., [1]). Companies need to focus on creating Lean Six Sigma projects that are aligned to the business needs (i.e., process improvement, efficiency, profits, customer loyalty, and reliability). Customers increasingly require on the quality of the supplied product which leads companies to strive excellence or at least to strive for perfection in order to satisfy more customers [2].
Lean Six Sigma is recognized as a combination of Lean and Six Sigma. It is “a business strategy and methodology that increases process performance resulting in enhanced customer satisfaction and improved bottom line results” [3]. It is considered as a strategic issue of quality improvement based on the increase of process capability and the development of company performance [2].
As we have just seen, many important questions have recently been raised in the Lean Six Sigma field and performance. Thus, the purpose of this Chapter is to investigate in the second Section the multidimensional aspect of performance and measurement dimensions. The Section 3 provides more details concerning Lean Six Sigma metrics and key steps for its best implementation. Section 4 represents discussion and conclusions. Section 5 stresses the managerial implications and future direction of Lean Six Sigma.
The performance concept has been the focus of abundant studies, investigations, and articles and is extensively renowned. Thus, various definitions and explanations have been addressed in this issue (i.e., [4]). The next subsection provides extra details concerning the multidimensional performance concept.
Much confusion exists on the performance concept as [4] attempt to explain. The first explanation would be is that the performance is a construct, not a concept. The identification of all the variables related to the performance field allows the first clarification of construct (i.e., [5]). Performance is defined as “the art of doing the right things right” [6]. Briefly, it means the act of drawing the best of the available resources of the company to achieve its goal.
The performance concept is distinctly assimilated to efficacy, competitive capacity, efficiency, performance, and productivity. Venkatraman and Ramanujam [7] propose to represent the performance in three levels (financial, operational, and organizational performance). In this proposal they stress the idea of intermediate measurement of performance and distinct measures used according to the objectives pursued (see [7]).
An important number of researches converge in the notion that the performance has a global sense and implies efficiency and effectiveness (i.e., [8]). An organization is successful if it accomplishes its goals (effectiveness) using a minimum of resources (efficiency). Seashore and Yutchman entirely define organizational effectiveness from this perspective as “the ability to exploit its environment in the acquisition of scarce and valued resources to sustain its functioning” (see [9]).
From a strategic point of view, performance can be defined as the ability of an organization to implement its strategy. The purpose of the performance is to improve the torque value—cost [10].
Given the rising interest accorded to study the performance measurement systems as tools for successful strategy integration, this part offers definitions of performance measurements, dimensions, and indicators. The performance measurement is defined as “the process of quantifying the efficiency and effectiveness of past actions” [11]. However, Moullin considers it as “the process of evaluating how well organizations are managed and the value they deliver for customers and other stakeholders” [12].
Neely et al. provided an important distinction between these three terms: a performance measurement, a performance measure, and a performance measurement system (see [11]). More clarifications are offered in Table 1.
Grafton et al. provide a constructive work assessing the role of performance measurement and evaluation in building organizational capabilities and performance. The results suggest to encourage managers to employ both the multiple financial and nonfinancial performance indicators increasingly included in current performance measurement systems (in [13]).
Therefore, the performance measurement refers to the use of a multidimensional set of performance measures which include financial measures and nonfinancial measures. Financial performance is generally defined as the use of outcome-based financial indicators that are assumed to reflect the fulfillment of the economic goals of the firm, and nonfinancial performance measures are often used for performance evaluation.
The manner on which the authors perceived and measured the organizational performance is different. Arumugam et al. measured organizational performance based on quality performance specifically the quality of product and service, customer relations, customer satisfaction with product quality, and level of quality performance relative to industry norms (see [14]).
Deshpande focused on supply chain performance and organizational performance, outlining the financial and market components and customer satisfaction dimensions. The financial and market performance is determined by reference to market share, return of total assets, and annuals sales growth (see [15]).
Several works have treated the organizational performance dimensions; for example, Venkatraman and Ramanujam [7] identify three dimensions of firm performance:
The financial performance: it contains criteria such as sales, turnover growth, profitability (return on investment, return on sales, and return on equity capital), profit by shares, the market value of the company, or the cost of asset replacement.
The economic performance: it incorporates chiefly marketing measurements such as market shares, new products introduction, products quality, or marketing effectiveness.
The organizational effectiveness: it consists of internal criteria having an overall image of organizational performance (see [7]).
The link between quality management practices and organizational performance is the focus of various studies (i.e., [16]). The results of these studies designated that there are a variety of measures (i.e., organizational performance, corporate performance, business performance, operational performance, financial and nonfinancial performance, innovation performance, and quality performance).
Based on the work of Scodanibbio, the key components of company’s performance are highlighted in six elements which are commercial performance, operational performance, innovation performance, financial performance, economical performance, and cultural performance (see [17]). More explanations are provided in Table 2.
Performance | |
---|---|
Performance measurement | Defined as the process of quantifying the efficiency and effectiveness of action. It refers to the use of a multidimensional set of performance measures. It includes both financial and nonfinancial measures [1] |
Performance measure | “Defined as a metric used to quantify the efficiency and/or effectiveness of action” |
Performance measurement system | “Defined as the set of metrics used to quantify both the efficiency and effectiveness of actions” |
Performance aspects.
Key performance components (KPC) | |
---|---|
Commercial performance | Market penetration—market share/expansion
|
Operational performance |
|
Innovation performance |
|
Financial performance |
|
Economic performance |
|
Cultural performance |
|
The performance indicator has been the subject of numerous researches. Based on this literature review, the performance indicators acquired various definitions. Berrah et al. offered a performance indicator a quantitative aspect. It is considered as a quantitative data expressing the effectiveness and/or efficiency of all or part of a system (in [18]).
Performance indicators synthesize in qualitative or quantitative terms, some information to sit judgment on the performance evaluation:
Indicator of objectives (or lagging [19]) that control the best achievement of strategic objectives
Indicators on the stock variables and action plans (or leading [19]), which provide information on the means used to achieve these strategic objectives
Through there is an extensive literature review of performance measures, different indicators used for measuring organizational performance some of these are identified in Table 3.
Author(s) | Measure | Indicators |
---|---|---|
[20] | Organizational efficiency Organizational effectiveness | Return on assets Share of deposits |
[21] | Organization performance | Financial performance Operational performance Product quality |
[22] | Operational performance Organizational performance | Internal operation performance Productivity improvement Financial and nonfinancial measures |
The main components of company’s performance.
Performance metrics has been the focus of diverse studies in different fields. The present section highlighted the key Lean Six Sigma metrics presented in the literature.
Lean Six Sigma focuses on metrics; it is a combination of set of statistical tools as DMAIC of Six Sigma employed in order to define, analyze, measure, improve, and control process variability as presented in Table 4 and critical-to-quality (CTQ) (Lean) for customer requirement [23].
Steps | Objectives/tasks | Expected result | Main tools |
---|---|---|---|
Define |
|
|
|
Measure |
|
|
|
Analyze |
|
|
|
Improve |
|
|
|
Control |
|
|
|
The DMAIC steps and tools.
The basic objective of Lean Six Sigma method is the implementation of measurement strategy focused on reducing the process variability and improving the projects to meet the customer requirement. This is realized through the combining of Lean and Six Sigma.
The main concepts of Lean Six Sigma are highlighted by Devane in these principal points: (1) the voice of the customer and “CTQ ,” (2) Six Sigma metric, (3) elimination of waste and nonvalue added activities, (4) process, (5) unintended variation which is the enemy, (6) value streams, and (7) “DMAIC” improvement process (see [24]).
The DMAIC structure with five modalities for intervention (define, measure, analyze, improve, control) is used to specify the problem of process variability to put the suitable solution in order to achieve a company performance.
We can give the example of some techniques related to Lean Six Sigma tools: “CTQ” companies focus on what the customer want by reducing wastes and nonvalue added activities in production process. Failure mode and effect analysis (FMEA) necessitates a step-by-step approach to identify all the possible failures in the design, manufacturing, product, or services. The aim of the FMEA is to adopt actions of removing or diminishing failures, beginning with the highest-priority ones, the suppliers, inputs, process, outputs, and customers (SIPOC), which is normally used throughout the defined stages of a process improvement project, as it helps to obviously understand the purpose and the scope of a process; a Pareto chart is defined as a series of bars whose heights reflect the frequency or impact of problems which are classified in descending order.
Based on diverse researches studies as [25], we have selected these principal tools of Lean Six Sigma illustrated in Table 5.
Lean Six Sigma main tools | Literature review |
---|---|
CTQ | [25, 26] |
FMEA | [26] |
Control charts | [25, 26] |
DoE | [27] |
Pareto analysis/charts | [25, 26] |
Taguchi methods | [27] |
Measure capability | [26] |
Regression analysis | [27] |
Correlation studies | [25] |
Process mapping, flow chart, SIPOC model | [26, 27] |
Brainstorming | [25] |
Root cause analysis | [26] |
SPC | [25] |
Capability index | [25, 26] |
Probability plot | [25, 27] |
Cause and effect matrix | [26, 27] |
Descriptive statistics | [27] |
Project selection and assessment matrix | [27] |
Before starting the Six Sigma implementation, it will be important to know these precious aspects mentioned as the antecedents of its implementation. It is necessary to create an encouraging environment and platform to succeed in its implementation.
The visions and point of view of authors concerning the success in implementing Lean Six Sigma are varied and valuable [28]. Jones et al. stressed the importance of strategy adopted, and the success of any organization is directly related to the effectiveness in implementation of Lean Six Sigma (in [29]).
The implementation of project should meet the objectives of firms and their ability to execute it. The project succeeds when it is able to achieve its goals. The objective of the Lean Six Sigma programs in any organization is the “project.”
The importance of roadmap of project, process mapping, and team responsibilities explains the success of integrating such method. Indeed, the project charter identification, planning, and integrating steps, tasks, and recurrent milestones help to maintain track of progress and adjustment as required. Also, it creates a sort of dynamism for the project team.
Regarding the specificity of the project and its requirement, the focus is to answer these questions: “what,” “who,” “how,” “when,” and “how much.” “What” refers to the customer needs. The higher the requirements are identified, the higher the probability of success will be. “Who” designs the allocation of the resources to achieve the project. “How” is the technological need that will convene to the “what” of the customer. “How” is very decisive to the project because if a connection between the project and the customer’s expectations does not exist, there will be a gap in anticipations. “When” identifies “the schedule” and the tools of project management.
Montgomery and Woodall affirm that in “Aligning projects with both business-unit goals and corporate-level metrics helps ensure that the best projects are considered for selection strategic business objectives” (see [30]).
Tenera and Pinto’s work provides a project management improvement of Lean Six Sigma in order to facilitate its development by reducing the potential problems (see [31]). One of the chief challenges of Lean Six Sigma implementation program is to succeed in the selection of the organization project, insuring the suitable identification of the critical-to-quality characteristics.
It is important to know that Lean Six Sigma is not only a quality method for improving process and reducing costs. It is also an approach for engaging and implicating all the employees to achieve business goals, as well as to learn how to improve the effectiveness and efficiency of the company. Thus, this quality method develops the empowerment of employees and the share of responsibilities.
The Lean Six Sigma has positive repercussions in different levels, as social (company social responsibilities) and financial (boost of returns and profits) impact, employee empowerment (continuous training and culture), process improvement (reduce of process variability, wastes, defects), amelioration of product quality and efficiency, enhancement of customer satisfaction, and amelioration of competitiveness and brand image.
Furthermore, the assessment of Lean and Six Sigma link is important and has been the focus of diverse studies. Indeed, Lean Six Sigma or just-in-time goal aims to reduce as maximum as possible the stocks and outstandings. However, the Six Sigma objective is to eliminate variations and have as output coherent finished products without defects. It seeks to identify the defects, determine the causes, and eliminate them. Thus, we can state that both methods are complementary and independent. Undeniably, a process can be Lean, but it has a rate of change at the output, or it can have a rate of change at the output under control and is not Lean. Consequently, the Lean Six Sigma crosses simultaneously the Lean and Six Sigma advantages which give it a major substance.
This chapter is a prerequisite to understand the Lean Six Sigma specificities. It started by a brief explanation of performance concept, dimensions, and indicators in order to facilitate the second section, the assessment of the link between performance and Lean Six Sigma metrics.
Section 3 outlines the main Lean Six Sigma tools, objectives, and impact. It allows the improvement of the process capability by reducing defects and wastes which consequently impact positively on the company performance, outcomes, customer satisfaction, and loyalty. Also, it offers a highlight of the success steps for Lean Six Sigma project integration.
Studying the link between Lean Six Sigma and performance is precious. In terms of assessing the impact of Lean Six Sigma on organizational performance or in order to assess the factors that affect the company business performance, it is not advised to presume these factors on the financial evidence but to focus in the other factors that can have a relevant impact on Lean Six Sigma outcomes.
The originality of this chapter resides on its focus on the surroundings of Lean Six Sigma. Hence, regarding the lack of academics and empirical studies investigating in depth the real features of Lean Six Sigma, this chapter offers the chance of stressing the advantages and illuminating the Lean Six Sigma-specific concepts and tools.
From a managerial point of view, revealing a brief distinction between Six Sigma, Lean, and Lean Six Sigma can facilitate the decision for professionals hesitating to implement such methods within their quality management system. Also, the LSS is an available quality method in both manufacturing and service companies (as healthcare, financial, engineering) which attract the interest of the executives in the effectiveness way of Lean Six Sigma project integration in diverse sectors.
The implications of Lean Six Sigma are varied and touch diverse stages and area as well as the internal and external environment. Generally, it has positive repercussions on the product quality, enhancing customer satisfaction, faithfulness, and consistency, improving the business incomes, competitiveness, ameliorating its image, and bringing new stakeholders and investment.
This chapter can be a useful support for future researches interested in this filed. Therefore, future studies can focus in the assessment of LSS challenges and weakness in diverse sectors or develop comparative studies between LSS and other quality methods as Six Sigma, in order to seek out their similarities, dissimilarities, or complementarity.
The impact of brain aging on cognition is far from uniform, ranging from perfect fitness to cognitive impairment. The prevalence of dementia is estimated to increase from 57.4 million in 2019 to 152.8 million in 2050 [1], thus representing a major public health problem. Still, evidence shows that more than one-third of all cases of dementia could be prevented or modified by changes in lifestyle, correction of risk factors, and specific therapeutic interventions [2, 3, 4, 5]. In fact, despite the absence of pharmacological treatment for degenerative diseases, such as Alzheimer’s disease (AD), it is known that vascular risk factors increase the likelihood of cognitive decline. Simple measures, the control of hypertension, for instance, may revert cognitive impairment and reduce conversion to dementia [6]. Likewise, healthy lifestyle patterns, physical exercise, and intellectual and social enrichment may improve performance and change the biomarker trajectories of individuals classified as cognitively impaired [7, 8, 9].
Promoting the presence of protective factors throughout life may help to cope with the negative consequences of pathology through resilience or resistance mechanisms. The term “resistance” refers to the notion of avoiding pathology (i.e., being free from significant AD pathology) in the sense that it is inferred from an observed absence or lower level of dementia-associated brain injury, relative to an expected greater frequency or severity based on age, genetic factors, or other individual characteristics. On the other hand, “resilience” is mostly used in the sense of coping with pathology (i.e., remaining cognitively intact despite significant AD pathology) and is inferred from the observation of a higher than expected cognitive functioning related to the level of brain injury [10, 11]. While the first is linked to an absence or delay of brain changes (“brain maintenance”), the latter is closely associated with the concept of the reserve, which can be measured or inferred either as brain structural and/or physiological premorbid capacity [11, 12].
The construct of reserve firstly emerged to describe patients with extensive destruction of nervous tissue following brain damage but not the expected level of functional changes [13]. It was then proposed that larger brains, with greater weight and a larger number of neurons, could have protective effects on the cognitive decline due to a higher “brain reserve” capacity [14]. Years later, Stern [15] defined the concept of Cognitive Reserve (CR) as the brain’s ability to optimize and maximize performance through the differential recruitment of brain networks or the use of alternative cognitive strategies to cope with brain dysfunction. Stern’s proposal claims that the mechanisms underlying CR are active processes by which the brain tries to compensate for the neural loss. These processes can be influenced by the interaction between innate factors (e.g., in utero or genetically determined) and, mainly, lifelong experience (e.g., intelligence, education, occupation, physical exercise, leisure activities, or social involvement). In contrast, the passive models propose that response to neural damage is related to brain size or the number of synapses (brain reserve), which can affect the threshold for clinical expression [16]. Brain reserve and CR are not mutually exclusive in the sense that brain reserve does not protect against the accumulation of pathology, but it does protect against its negative effects [17]. Instead, they influence each other—life experiences and the involvement in stimulating cognitive activities can modify brain anatomy (i.e., neurogenesis, angiogenesis, and resistance to apoptosis) and positively regulate compounds that promote neural plasticity [18].
The concept of CR has progressively evolved in such a way that it is now central in the literature on normal and pathological aging, notwithstanding the theoretical pitfalls and methodological controversies generated by years of studies and reserve-associated concepts. The most striking challenges are the absence of an operational definition of CR and the lack of clarification of its neural bases, the relationship between the brain and CR, and which factors affect brain reserve [19]. Making an effort to overcome these difficulties, a consensus report tried to clarify CR terminology [17] by claiming “resilience” as an umbrella concept that describes the process of coping with age- and disease-related changes, which includes multiple reserve related-concepts, such as brain reserve, brain maintenance, and CR.
Normal aging is characterized by several brain changes at the morphometric and functional level, and associated neuropsychological changes, that are particularly relevant in the frontal lobes on which Executive Functions (EF) heavily depend upon [20]. Among other areas of cognition, EF play a critical role in everyday life, allowing individuals to plan ahead, focus attention, and switch between tasks, hence maintaining effective levels of independent functioning. Variable EF trajectories include development into early adulthood and decline into older age, associated with structural and functional changes in the prefrontal cortex [21]. Despite this age-related decline, EF also assumes an important role in maintaining global cognitive efficiency in the late period of life, thanks to a higher CR [22].
There is considerable interest in understanding the processes underlying cognitive decline (and whether they result from specific or general impairments that reflect different patterns and different pathological processes) but also in how the brain actively copes with these deleterious effects on EF so functional independence can be maintained. Next in this chapter, we will review evidence that focuses on certain socio-behavioral CR proxies (e.g., education, occupational complexity, leisure activities, and social involvement), how they may help to cope with age-related changes and brain pathology, and how they relate with EF. Further, differences between “active” versus “passive” models of reserve and the underlying CR mechanism (“neural reserve” vs. “neural compensation”) are described.
One of the major limitations of the CR construct is that it can hardly be measured directly. Three methods are usually used to quantify and measure it—(a) socio-behavioral indicators, (b) residual approach, and (c) functional neuroimaging studies [17]. Hence, studies should include not only measures of the status of the brain (reflecting brain alteration or pathology), but also clinical or cognitive performance (consequences of brain damage), and socio-behavioral indicators (e.g., an index of life-long experience/premorbid capacity) when assessing the role of CR. The goal is to be able to predict an individual’s cognitive performance through the interaction between the proposed CR factors and the state of the brain/pathology.
Several studies have shown that CR proxies may decrease the rate of conversion to dementia in subjects with identical degrees of the pathological burden of AD [23, 24], and even have a protective role against the cognitive impairment associated with brain white-matter changes (WMC) or higher ventricular volume [25, 26] delaying the onset of clinical deficits [27]. Understanding the role of these proxies on the prediction of cognitive trajectories serves a two-fold objective, either it is disease prevention or disease diagnosis.
Different CR proxies have been identified [28], but recent systematic reviews indicate that education, occupational attainment, leisure activities, and social involvement are the most common indicators [29, 30, 31].
The number of years of formal education is the most consistently used across studies. A protective effect of education for age-associated cognitive decline appears to result in higher levels of CR [30, 32]. This is supported by strong positive associations between the number of years of formal education and crystallized measures (e.g., vocabulary) and EF, explaining, in the latter case, even more variance than age itself [33, 34, 35], compared with fluid abilities, such as processing speed, memory, or visuospatial abilities [34, 36, 37]. Robust scientific evidence also supports that lower-educated individuals are more likely to suffer from dementia in a wide range of settings [38]. For example, Contador et al. [39] found that living in a rural area (early and mid-life stages) increased the likelihood of dementia, with the risk being particularly high in people with low education. However, the effect of education on age-related cognitive changes remains controversial [40]. Kremen et al. [41] sought to demonstrate that the impact of CR factors is primarily downstream of intellectual capacity. These researchers concluded that brain development is substantial during childhood and adolescence and that further education from the age of 20 years would contribute much less to brain development. Moreover, it should be considered that the quality of the educational experience is not the same for all individuals, which may influence its potential impact as a CR proxy.
The protective effect of education not only mediates the transition between normal and pathological aging but also between stages of cognitive impairment. Based on the hypothesis that less automatized cognitive domains (or those that did not achieve proper consolidation throughout life) may deteriorate sooner than more consolidated ones, a recent retrospective study aimed to investigate whether education modifies the profile of cognitive/executive performance (i.e., sustained and divided attention, inhibitory control, working memory, verbal, motor and graphomotor fluency, planning, abstract reasoning, and episodic memory) in Mild Cognitive Impairment (MCI). It was found that despite a similar pattern of cognitive decline in both higher and lower education groups, patients with higher education revealed a trend toward a higher proportion of abnormal performances (≤ −1.5 standard deviation on age- and education-adjusted normative scores) and a steeper decline in measures of sustained attention and episodic memory [42]. These findings suggest that patients with higher levels of education have a higher CR because they show a more pronounced decline in executive control that does not reflect differences in clinical disease staging [35, 43, 44]. On the opposite extreme of educational level, elderly illiterate subjects may be more vulnerable to cognitive decline and dementia, due to the lack of the protective effect of education [45, 46, 47, 48, 49].
It is worth noting that, although education is usually measured by the number of years of formal education, there may be other indicators that better capture its true impact. In a recent prospective longitudinal cohort study on aging and cognition, which recruited and followed 275 healthy community subjects seen in primary care settings, with 50 years or older, over a 5-year period, investigators found that being male, older, and with a lower age- and education-adjusted z-scores on divided attention/mental flexibility measures were significant independent predictors of cognitive impairment 5 years later. Moreover, vocabulary emerged as a stronger predictor of cognitive stability or decline than education, independently of their correlation [50]. This highlights the relevance of this measure by reflecting more accurately the degree of cognitive stimulation and intellectual enrichment that may account for subtle differences between subjects at the same educational level, particularly relevant in overall low-literacy populations.
Occupational and leisure activities may also have markedly significant protective effects on cognitive decline and dementia, especially for individuals whose jobs involve social interaction [51]. In fact, it is known that engagement in mentally stimulating activities throughout life may promote neural connectivity [52]. With respect to occupational activity, cognitively demanding work conditions are associated with a decreased risk of cognitive decline in older adults [53]. Middle-aged people at risk for AD (decreased hippocampal volume and increased brain atrophy) with greater occupational complexity (e.g., involving complex social interactions) maintained a similar level of cognitive performance as those with less pathology [51, 54]. However, since higher levels of education are usually associated with jobs that are more cognitively demanding, whether or not the protective effect of education is independent of the levels of work complexity in middle age remains controversial [55, 56]. Moreover, a synergistic effect of low education and occupation on the risk of developing AD was described by Stern et al. [57], particularly when it is combined with cognitively demanding work activity in adulthood [55, 57]. For instance, some studies indicate that level of literacy is a more accurate measure of CR than years of education [58], especially in those individuals from disadvantaged groups or with null/low educational attainment [39, 59]. Regarding involvement in leisure activities, it has also been associated with a reduced risk of AD [60, 61] and protective effects against cognitive decline [62, 63].
There seems to be evidence that lifestyle and the environment effectively regulate cognitive aging and that this regulation may be particularly relevant in the hippocampal-mediated memory functions in mammals. Although the causal nature of this relationship has not yet been established [64], studies in animal models seem to indicate that it may exist, but more clinical studies are needed to specifically understand how social involvement and integration can be used to prevent cognitive decline. Additionally, the mechanisms underlying this relationship seem to indicate a relevant role for growth factors, neuroinflammation, and neurogenesis processes. In this context, physical activity, for instance, has been identified as inducing neurogenesis due to its benefits on structural and functional plasticity in hippocampus-dependent learning and memory tasks. Accordingly, maintaining an active social life at older ages can improve CR and benefit cognitive function. This is especially relevant since some aspects, such as education or occupational complexity, developed at a young age and middle age cannot be modified. Social activity can contribute to an increased reserve even in a more advanced stage of life, with gains in cognitive performance. In fact, living alone was significantly associated with an increase in cognitive complaints and a significant predictor of future cognitive decline in specific linguistic/executive measures, such as verbal fluency over a 5-year follow-up [33, 65, 66]. Social interactions can be viewed as natural forms of cognitive stimulation and may play a relevant part in the stimulation of language skills, whereas living alone would represent a relative cognitive deprivation situation, with reduced cognitive stimulation and lower CR [67, 68]. Interventions that reduce social isolation at a more advanced stage can benefit cognitive function both directly and indirectly by building reserve, especially in individuals with low CR in middle age. This aspect has important implications for interventions suggesting that combating social isolation can contribute to a healthier cognition [69].
Traditionally, late-mature regions, such as the frontal lobes, are considered especially vulnerable to normal age changes, inspiring theories of cognitive aging, such as the “last in, first-out” or “retrogenesis” hypothesis. This hypothesis considers an anteroposterior gradient of age vulnerability, which explains the decline in EF often observed in healthy older adults [70].
Executive functions, such as processing speed, working memory, inhibitory control, top–down suppression, or shifting ability, are shaped by education and by other CR proxies. A decline in executive performance has been shown to be associated with low performance in activities of daily living and to predict conversion from MCI to dementia [71, 72]. Moreover, EF are known to be sensitive to damage in other parts of the brain, such as subcortical white matter changes [34], thalamic nuclei, the limbic system, and basal ganglia [73] apart from prefrontal lobe damage.
The perspective that age-related cognitive decline emerges when a person is no longer able to compensate for the reduced functioning of the primary brain structures and circuits, is largely supported in the literature. Relevant conceptual models have emerged over the last 20 years, aiming to describe and understand brain reorganization in response to age-related changes and brain injury. Older adults may use alternative networks to aim for the same level of functioning as younger individuals, which can represent a mechanism of neural compensation [74, 75]. The “Scaffolding Theory of Aging and Cognition” (STAC) model proposed by Park and Reuter-Lorenz [76] claims the recruitment of additional circuits as a way to strengthen the declining structures whose functioning has become inefficient. These strategies lose efficiency in the aged brain and are eventually no longer accessible when there is cerebral pathology, as in the case of AD. The “normalcy-pathology homology” phenomenon suggests that there are regions more vulnerable to age-related changes and that this age vulnerability renders them more susceptible to additional pathological AD-related changes. This is particularly clear in frontotemporal regions where the elderly, even with a low risk of AD, present prominent cortical reductions [70].
The Cognitive Reserve framework suggests that individual differences in cognitive performance are based on more efficient recruitment of brain networks (neural reserve) or the enhanced ability to recruit alternate (compensation) brain networks [15, 77]. Regarding neural reserve, it is postulated that inter-individual variability related to the efficiency, capacity, or flexibility of the brain networks will influence how the healthy brain can deal with the demands imposed by the emergence of brain injuries or pathologies. The neural reserve allows healthy young individuals with greater CR to solve tasks more efficiently and more capably and, in turn, may better confront the disruptions imposed by brain pathology due to the increased flexibility of brain networks. Neural compensation concerns task-related activation, a mechanism that only appears when new resources are needed to maintain or improve performance due to changes in the brain structure. Hence, neural compensation is a mechanism usually referring to people who have brain pathology [15, 77]. The degree of compensation can also vary in individuals in terms of expression and effectiveness. In fact, neural compensation refers to inter-individual variability to compensate for the disruption of standard processing networks. In this situation, brain structures or networks that are not normally used by individuals with intact brains become activated. Both neural reserve and neural compensation support CR, with compensation being the most common mechanism in more advanced stages of the aging spectrum [78].
As previously stated, individuals with higher CR can maintain a more efficient and capable network or compensate advantageously in the face of a comparable amount of brain pathology [79]. Accordingly, Scarmeas et al. [80], using a set of memory tasks, identified brain regions where systematic relationships between CR and brain activation differed as a function of aging. Thus, when facing certain tasks, young and older people activate similar brain regions but as the difficulty of the memory task increased the magnitude of activation was often higher in older individuals, suggesting more efforts to achieve a comparable level of performance, which can be related to network efficiency. In addition, the older adults recruited additional regions of the brain not used by young people while performing certain memory tasks, which can represent a form of active neural compensation [80]. A similar pattern of compensation was also found when comparing old adults schooled later in life with old adults schooled at the proper age, in a memory recognition task using Magnetoencephalography (MEG), and the first ones displayed additional activations to keep the level of performance [81].
In the last few decades, scientific studies have tried to capture the “neural implementation” of CR through functional neuroimaging [78]. This approach seeks to identify resting state or task-related functional activation brain networks that may underlie CR. Potentially, the expression of these networks may be associated with the influence of CR proxies, moderating the effect of brain changes on cognition. If these networks were identified through functional neuroimaging research methods (not properly used in clinical practice), their degree of manifestation would be a more direct measure of CR than other types of proxies [17]. Tucker and Stern [37] suggested that there may be at least one “generic CR network” that can be activated during the performance of many tasks, explaining how CR protects against brain pathology, which seems to be a promising line of future investigation [17].
A recent systematic review indicates that a resting-state network, implicating medial temporal regions and cingulate cortex (anterior or posterior), is associated with neural reserve, whereas frontal regions and the dorsal attentional network (DAN), activated during the cognitive engagement, are related to neural compensation [78]. Task-related studies have found a positive correlation between CR proxies (mostly premorbid IQ and education) and higher frontal activity in healthy older adults compared to young adults [82, 83, 84, 85]. Moreover, a positive association between CR (i.e., education-occupation attainment, premorbid IQ , and leisure activities) and frontal activity in MCI and AD patients compared to healthy older adults has been found [86, 87].
The mechanisms on which the function and resilience of large-scale brain networks are based are still poorly understood. Early lifespan environmental influences can contribute to understanding phenomena such as reserve, as, at least partially, to determine the variance of the underlying structural network. This may have implications for global and regional network controllability. A dynamic network theory can be crucial for advancing the understanding of the resilience of the human brain, reinforcing the need for a spatiotemporal analysis in complex systems [88]. In fact, the human capacity to perform a variety of tasks seems to be associated with cognitive control networks, specifically the frontoparietal control network (FPN) in the left posterior parietal cortex. The adaptability of this network, whose global connectivity pattern seems to change more than other networks, and the connectivity patterns that can be used to identify task performance, point to the importance of this network in cognitive control and task performance. It seems to be possible through “flexible hubs,” that is, regions that quickly update their connectivity pattern according to task demands [89].
This greater variability in FPN connectivity, both between networks and between tasks, supports the notion that this network implements core flexible hubs, allowing cognitive control across various and distinct tasks [89]. This is especially relevant for this chapter’s purpose as the existence of this control network appears to be crucial for reserve. Specifically, one of its hubs, the left frontal cortex (LFC, covering BA 6/44) [90, 91], is a likely candidate for the neural implementation of CR. The resting-state connectivity of that LFC hub region had previously been associated with protective factors such as high IQ and high cognitive performance. Concretely, it had already been demonstrated that the lateral prefrontal cortex (LPFC) is a hub region with an especially high global connectivity but, more than that, it has been shown that this global connectivity could predict the fluid intelligence of individuals, appearing to be a global hub connector [92]. This level of the organization thus appears to be especially relevant for understanding the brain and CR that involve distributed circuits and complex psychological constructs.
Global connectivity of the LFC hub (close to the Broca area), in resting-state fMRI, is associated with more years of education (CR proxy) and with milder effects of FDG-PET hypometabolism on memory performance in prodromal AD [91]. This can be important for instance in the selection of participants for intervention trials since MCI patients with higher CR seem to have a higher likelihood to benefit from a cognitive intervention [93].
Increased frontoparietal activation may reflect a compensatory mechanism, helping to protect memory task performance in early-stage AD. Additionally, increased global connectivity of LFC can support frontoparietal increased activation and that is associated with CR, moderating the association between AD neuropathology and cognitive decline, and helping to maintain better memory performance [90]. In a task-related fMRI study, the authors tried to understand if LFC hub connectivity during an episodic memory task was associated with a reserve in aging and MCI. More years of education were associated with increased LFC connectivity during memory processing, and increased LFC connectivity was associated with a higher reserve in the memory domain. This result pattern was found in controls and MCI groups, which was interpreted as suggestive that connectivity of a key hub of the frontoparietal control network contributes to reserve in both normal and pathological aging. This conclusion reinforces that LFC is a good candidate for the neural basis of reserve and that a higher LFC connectivity may be a long-lasting trait that is influenced by environmental stimuli, namely education [91]. In fact, CR, being the result of multiple and distinct stimulations, involves connectivity between different tasks and domains. Consistently with this, the LFC (BA 6/44) ranks among the top 5% of brain regions in terms of number of connections in the brain, being high and globally connected to the rest of the brain and is a key connector hub between different functional networks [91]. Taken together the results seem to point out that the cognitive control network, particularly LFC, works as a hub of the frontoparietal control network, which is associated with greater reserve. Later work showed that education is associated with better performance on memory tasks thanks to greater efficiency of functional networks, clearly demonstrating the effects of education on DMN/DAN small-worldness, mediated via LFC connectivity, and reinforcing its role as a neural basis of the reserve [94].
Moreover, evidence also shows that education facilitates the brain’s ability to form segregated functional groups of networks, with stronger signals in parietal and occipital regions [95]. This fact reinforces the perspective that more years of schooling trigger a more specialized use of neural processing. However, CR (residual variance in memory and general executive functioning) was also associated with higher global network efficiency (i.e., functional integration). In this sense, this study corroborates that CR is associated both with increased functional connectivity and better organization of the network topology.
The protective role of higher global functional connectivity in the FPN and higher local connectivity between the salience network (anterior cingulate cortex) and medial frontal cortex can significantly mitigate the impact of white matter lesions on EF [96], emphasizing the role of the cognitive control network as a neural substrate for CR. As pointed out by the authors, both the salience and the FPN are important cognitive control networks, that are crucial for appropriate brain functioning, with the FPN flexibly regulating the activity of other networks and the salience network integrating inputs from different sources. Their results reinforce the notion that cognitive control networks may play a role in brain resilience mechanisms with increased connectivity being linked to better cognition.
Overall, these findings suggest that greater activity of frontal regions, namely via LFC connectivity, is a potential component of functional networks underlying neural compensation. Conversely, MTL regions, which are known to be critical for the conversion from MCI to AD, may reflect the capacity of the neural reserve [97, 98].
The understanding of the mechanisms involved with successful aging is far from straightforward and the growing number of publications in this field shows the interest of the scientific community to understand the importance of complex related concepts in its promotion. In this chapter, we focused on several socio-behavioral CR proxies identified as protective factors against cognitive decline and dementia and how they impact EF by means of neural compensation mechanisms related to the increased functional activity of the frontal lobe.
The relationship between CR proxies and the maintenance of cognitive efficiency in the context of age-related changes/brain pathology is dynamic. Not only do the skills, social involvement, and occupational attainment developed throughout life have a mediating role in improving neural connections (i.e., in terms of activation, flexibility, and efficiency), but also this enhancement of brain connectivity patterns expresses itself in better cognitive performance. Despite its vulnerability to the effects of senescence, the frontal lobes play a key role in CR allowing for the preservation of the overall cognitive function by means of enrichment of EF (e.g., planning, sequencing, inhibitory control, abstract reasoning) via a higher CR. Indeed, people with high CR show an advantage in the use of these more developed EF, thus increasing frontal lobe activity. The use of alternative task-relevant circuits compensates for effectiveness (e.g., MTL, especially relevant for memory and selectively affected in AD) thus mitigating the clinical expression of dementia. In this compensation mechanism, DAN and FPN networks are particularly relevant, with a sub-region in the LFC being identified as a potential candidate for a neural marker of CR.
Several caveats still, however, need to be fully addressed. First and foremost, it is unclear how CR proxies may specifically influence different aetiologies of dementia and modulate different cognitive trajectories. Second, EF cannot have a double role as an age−/pathology-dependent measure and as a factor that changes the relationship. As a consequence, all EF may not be appropriate measures for CR, since it is not stable throughout life and is vulnerable to age-related changes. Thus, according to the gain/loss hypothesis, one should carefully select aspects of EF that are robust and resistant to aging, in order to include them as components of CR. Stern et al. [99] considered that this approach should be better explored in the future, despite currently presenting some limitations that are difficult to overcome. From the outset, the fact that the brain measures used to predict cognition only partially capture brain pathology or physiology and different lifestyles cannot be explained by known brain predictors can lead to a high risk of including many aspects that are not reserved. Third, the differential impact of CR depending on the demographic characteristics of the population or discrepancies in measuring CR measures or outcomes (i.e., cognitive or functional) needs to be addressed as well. In fact, precise operational definitions of CR and other related theoretical constructs are needed. Advances in multimodal imaging, preferably longitudinal studies, will allow a better understanding of the neural mechanisms underlying CR. Future work should focus on the design of studies that will help to clarify the relationship between CR proxies and brain reserve, as well as improve their measurement. These studies will make it possible to improve and integrate the existing conceptual models of the moderation of CR in cognitive performance. Further, it is expected that the contribution of these investigations could lead to objective guidelines and strategies for the development of differentiated, validated, and accessible intervention programs aimed to provide more functionality and better quality of life in older adults [17].
If the existence of a compensatory capacity in individuals with a high CR seems to be clear, it is consensual that it is still not entirely clear what reserve consists of in neural terms. Potential candidates have been proposed but the discovery of this neural basis is particularly relevant as, in addition to traditional cognitive and psychosocial stimulation techniques, it could also open doors to more direct brain stimulation allowing the use of a whole arsenal of new non-invasive brain stimulation technologies which is predicted to have increasing importance in intervention.
This work is financially supported by the National Funds through FCT—Fundação para a Ciência e a Tecnologia, I.P., under the project UIDB/04279/2020. The authors thank the Centre for Interdisciplinary Research in Health and Católica Research Centre for Psychological, Family & Social Wellbeing, Universidade Católica Portuguesa for their support.
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One challenge comes from the changing perceptions of what learning is all about. The second challenge comes from new learning opportunities that technology now affords. Constructivism, interpretivism, and computing technology, separately and often together, have redesigned the conception of the challenges and opportunities of learning, and brought about new learning possibilities for almost all teaching and learning situations, including traditional classroom teaching, distance learning, and self-learning. Computer-supported learning environments could have good problems that will stimulate students to explore and reflect on their knowledge construction. Students who cannot afford higher education are discouraged from seeking or completing a degree. Distance learning-based programs could increase access for students to higher education, whereas open and distance-learning programs may be difficult to implement in the laboratory sciences, but they have real potential to maximize the use of technology.",book:{id:"6533",slug:"trends-in-e-learning",title:"Trends in E-learning",fullTitle:"Trends in E-learning"},signatures:"Vimbi Petrus Mahlangu",authors:[{id:"196797",title:"Prof.",name:"Vimbi",middleName:"Petrus",surname:"Mahlangu",slug:"vimbi-mahlangu",fullName:"Vimbi Mahlangu"}]},{id:"59935",doi:"10.5772/intechopen.74843",title:"The Challenges of E-learning in South Africa",slug:"the-challenges-of-e-learning-in-south-africa",totalDownloads:2610,totalCrossrefCites:11,totalDimensionsCites:19,abstract:"The University of South Africa (UNISA) is the largest open distance e-learning (ODeL) university in the continent of Africa, with a student headcount more than 300,000. Over two decades after the transition from apartheid to democracy, vast inequalities across race, class, gender and socio-economic status persist in South Africa, with the majority of the African people being the most affected. Demographically, the African people constitute about 80.8% of the country’s total population, compared to whites, who constitute a meagre 8.8%, yet African households carry the highest burden of poverty, living way below the official poverty line of $1.90/day as determined by the World Bank and other international agencies. This chapter explores these inequalities and ponders on the role of e-learning for this poorest section of society in a country where modern technological devises in the form of information and communication technologies (ICTs) and access to the Internet are perceived to be ubiquitous. South Africa’s Department of Higher Education and Training (DHET) commits to “an expansion of open and distance education and the establishment of more ‘satellite’ premises where universities or colleges provide classes at places and times convenient to students (including in rural areas)”. This chapter also explores the role of UNISA in the provision of distance learning through structured and sustainable e-learning.",book:{id:"6533",slug:"trends-in-e-learning",title:"Trends in E-learning",fullTitle:"Trends in E-learning"},signatures:"Moeketsi Letseka, Matsephe Martha Letseka and Victor Pitsoe",authors:[{id:"187812",title:"Prof.",name:"Victor",middleName:"Justice",surname:"Pitsoe",slug:"victor-pitsoe",fullName:"Victor Pitsoe"},{id:"195883",title:"Dr.",name:"Matsephe M.",middleName:null,surname:"Letseka",slug:"matsephe-m.-letseka",fullName:"Matsephe M. 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A survey captures responses on their technological, lifestyle and learning preparedness for the ELS to produce an e-readiness score. A modified DeLone and McLean model evaluates the impact of their level of e-readiness during their use of the ELS. Identifying where and when students have difficulties, pinpointing their deficits or recommending the more appropriate modality could help students achieve a positive course outcome.",book:{id:"6533",slug:"trends-in-e-learning",title:"Trends in E-learning",fullTitle:"Trends in E-learning"},signatures:"Glenda H. E. Gay",authors:[{id:"225677",title:"Dr.",name:"Glenda",middleName:"H. E.",surname:"H.E. Gay",slug:"glenda-h.e.-gay",fullName:"Glenda H.E. 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As a result, we identified adverse conditions that were an obstacle to the application of the original technique. We then adapted the technique to make it applicable in an OSS project. We can conclude that was not easy to recruit OSS users and developers to participate in technique application.",book:{id:"6533",slug:"trends-in-e-learning",title:"Trends in E-learning",fullTitle:"Trends in E-learning"},signatures:"Lucrecia Llerena, Nancy Rodriguez, Mayra Llerena, John W. Castro\nand Silvia T. Acuña",authors:[{id:"231253",title:"M.Sc.",name:"Lucrecia",middleName:null,surname:"Llerena",slug:"lucrecia-llerena",fullName:"Lucrecia Llerena"},{id:"231767",title:"MSc.",name:"Nancy",middleName:null,surname:"Rodriguez",slug:"nancy-rodriguez",fullName:"Nancy Rodriguez"},{id:"231769",title:"Dr.",name:"John W.",middleName:null,surname:"Castro",slug:"john-w.-castro",fullName:"John W. 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Prior studies carried out by researchers confirm that technology utilization and adoption in education undeniably helps teachers and learners in the teaching and learning process. This chapter serves as a stepping stone to support teachers to do better in utilizing and adopting technology in education to a certain extent as an alternative of overlooking their thoughts, efforts and desires in blindly trying to vie with the swift change of technology in education in this epoch. Hence, this chapter discusses technology in education, the roles of technology in education, factors associated with technology utilization and adoption in education and the factors that limit the proper utilization and adoption of technology in education.",book:{id:"7803",slug:"the-role-of-technology-in-education",title:"The Role of Technology in Education",fullTitle:"The Role of Technology in Education"},signatures:"Aliyu Mustapha, Abdulkadir Mohammed, Abdullahi Raji Egigogo, Abdullahi Abubakar Kutiriko and Ahmed Haruna Dokoro",authors:[{id:"284060",title:"M.Sc.",name:"Aliyu",middleName:null,surname:"Mustapha",slug:"aliyu-mustapha",fullName:"Aliyu Mustapha"},{id:"294267",title:"Dr.",name:"Abdulkadir",middleName:null,surname:"Mohammed",slug:"abdulkadir-mohammed",fullName:"Abdulkadir Mohammed"},{id:"294268",title:"MSc.",name:"Abdullahi",middleName:null,surname:"Raji Egigogo",slug:"abdullahi-raji-egigogo",fullName:"Abdullahi Raji Egigogo"},{id:"294270",title:"MSc.",name:"Abdullahi",middleName:null,surname:"Abubakar Kutiriko",slug:"abdullahi-abubakar-kutiriko",fullName:"Abdullahi Abubakar Kutiriko"},{id:"294272",title:"MSc.",name:"Ahmed",middleName:null,surname:"Haruna Dokoro",slug:"ahmed-haruna-dokoro",fullName:"Ahmed Haruna Dokoro"}]}],mostDownloadedChaptersLast30Days:[{id:"60465",title:"The Good, the Bad, and the Ugly of Distance Learning in Higher Education",slug:"the-good-the-bad-and-the-ugly-of-distance-learning-in-higher-education",totalDownloads:5052,totalCrossrefCites:18,totalDimensionsCites:31,abstract:"The chapter deals with opportunities and challenges of distance learning in higher education. One challenge comes from the changing perceptions of what learning is all about. The second challenge comes from new learning opportunities that technology now affords. Constructivism, interpretivism, and computing technology, separately and often together, have redesigned the conception of the challenges and opportunities of learning, and brought about new learning possibilities for almost all teaching and learning situations, including traditional classroom teaching, distance learning, and self-learning. Computer-supported learning environments could have good problems that will stimulate students to explore and reflect on their knowledge construction. Students who cannot afford higher education are discouraged from seeking or completing a degree. 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South Africa’s Department of Higher Education and Training (DHET) commits to “an expansion of open and distance education and the establishment of more ‘satellite’ premises where universities or colleges provide classes at places and times convenient to students (including in rural areas)”. This chapter also explores the role of UNISA in the provision of distance learning through structured and sustainable e-learning.",book:{id:"6533",slug:"trends-in-e-learning",title:"Trends in E-learning",fullTitle:"Trends in E-learning"},signatures:"Moeketsi Letseka, Matsephe Martha Letseka and Victor Pitsoe",authors:[{id:"187812",title:"Prof.",name:"Victor",middleName:"Justice",surname:"Pitsoe",slug:"victor-pitsoe",fullName:"Victor Pitsoe"},{id:"195883",title:"Dr.",name:"Matsephe M.",middleName:null,surname:"Letseka",slug:"matsephe-m.-letseka",fullName:"Matsephe M. 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Everyday, e-learning environments bring out new antagonistic concepts. As these new concepts rapidly entered our lives, they began to become indispensable materials in the field of education. New e-learning environments are being used as platforms that are related to each other. They essentially support the concept of e-learning.",book:{id:"6533",slug:"trends-in-e-learning",title:"Trends in E-learning",fullTitle:"Trends in E-learning"},signatures:"Fatih Çağatay Baz",authors:[{id:"241866",title:"Dr.",name:"Fatih Çağatay",middleName:null,surname:"Baz",slug:"fatih-cagatay-baz",fullName:"Fatih Çağatay Baz"}]},{id:"66544",title:"Factors Affecting the Utilization and Adoption of Technology in Education",slug:"factors-affecting-the-utilization-and-adoption-of-technology-in-education",totalDownloads:1039,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"Education is vital in any type of society for the conservation of lives of its associates and the preservation of the public formation. 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An example of an electric power system is the network that supplies a region’s homes and industry with power. Due to the complexity and nonlinearity of the power system, hand calculations may be very complicated in some cases, especially when the number of buses or inputs is very large. Here comes the role of software for convergence, time saving, and accuracy. 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His fields of interest are anterior segment disease, keratoconus, glaucoma, corneal dystrophies, and cataracts. His research topics include\nintraocular lens power calculation, eye modification induced by refractive surgery, glaucoma progression, and validation of new diagnostic devices in ophthalmology. \nHe has published more than 100 papers in international and Italian scientific journals, more than 60 in journals with impact factors, and chapters in international and Italian books. He has also edited two international books and authored more than 150 communications or posters for the most important international and Italian ophthalmology conferences.",institutionString:'University of Campania "Luigi Vanvitelli"',institution:{name:'University of Campania "Luigi Vanvitelli"',institutionURL:null,country:{name:"Italy"}}}]},{type:"book",id:"7560",title:"Non-Invasive Diagnostic Methods",subtitle:"Image Processing",coverURL:"https://cdn.intechopen.com/books/images_new/7560.jpg",slug:"non-invasive-diagnostic-methods-image-processing",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Mariusz Marzec and Robert Koprowski",hash:"d92fd8cf5a90a47f2b8a310837a5600e",volumeInSeries:3,fullTitle:"Non-Invasive Diagnostic Methods - Image Processing",editors:[{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null}]},{type:"book",id:"6843",title:"Biomechanics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6843.jpg",slug:"biomechanics",publishedDate:"January 30th 2019",editedByType:"Edited by",bookSignature:"Hadi Mohammadi",hash:"85132976010be1d7f3dbd88662b785e5",volumeInSeries:4,fullTitle:"Biomechanics",editors:[{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",institutionURL:null,country:{name:"Canada"}}}]}]},openForSubmissionBooks:{paginationCount:3,paginationItems:[{id:"11570",title:"Influenza - New Approaches",coverURL:"https://cdn.intechopen.com/books/images_new/11570.jpg",hash:"157b379b9d7a4bf5e2cc7a742f155a44",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 10th 2022",isOpenForSubmission:!0,editors:[{id:"139889",title:"Dr.",name:"Seyyed Shamsadin",surname:"Athari",slug:"seyyed-shamsadin-athari",fullName:"Seyyed Shamsadin Athari"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11569",title:"Bacterial Sexually Transmitted Infections - New Findings, Diagnosis, Treatment, and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/11569.jpg",hash:"069d6142ecb0d46d14920102d48c0e9d",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 31st 2022",isOpenForSubmission:!0,editors:[{id:"189561",title:"Dr.",name:"Mihaela Laura",surname:"Vica",slug:"mihaela-laura-vica",fullName:"Mihaela Laura Vica"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11568",title:"Staphylococcal Infections - Recent Advances and Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11568.jpg",hash:"92c881664d1921c7f2d0fee34b78cd08",secondStepPassed:!1,currentStepOfPublishingProcess:2,submissionDeadline:"July 8th 2022",isOpenForSubmission:!0,editors:[{id:"59719",title:"Dr.",name:"Jaime",surname:"Bustos-Martínez",slug:"jaime-bustos-martinez",fullName:"Jaime Bustos-Martínez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{},subseriesFiltersForOFChapters:[],publishedBooks:{},subseriesFiltersForPublishedBooks:[],publicationYearFilters:[],authors:{paginationCount:301,paginationItems:[{id:"116250",title:"Dr.",name:"Nima",middleName:null,surname:"Rezaei",slug:"nima-rezaei",fullName:"Nima Rezaei",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/116250/images/system/116250.jpg",biography:"Professor Nima Rezaei obtained an MD from Tehran University of Medical Sciences, Iran. He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. 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