\r\n\tAtherosclerosis is a systemic disease. Some 60% of patients with peripheral artery disease will have ischaemic heart disease, and 30% have cerebrovascular disease. Within five years of diagnosis, 10-15% of patients with intermittent claudication will die from cardiovascular disease. Therefore, management begins with the identification and modification of risk factors that are common to peripheral artery disease, heart disease, and stroke. Treatment goals include reducing cardiovascular risk and improving functional capacity. Revascularization is indicated for persistent symptoms. \r\n\tThe main objective of the book is to deal with peripheral arterial disease in the most diverse aspects. Addressing issues such as pathophysiology, signs and symptoms, clinical aspects, treatment, and prognosis. \r\n\t
",isbn:"978-1-80355-532-4",printIsbn:"978-1-80355-531-7",pdfIsbn:"978-1-80355-533-1",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"80be3d16e4c8f89f3501ed408729f695",bookSignature:"Prof. Ana Terezinha Guillaumon, Dr. Daniel Emilio Dalledone Siqueira and Dr. Martin Geiger",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11872.jpg",keywords:"Atherosclerotic Disease, Revascularization, Vascular Surgery, Lower Limb, Critical Limb Ischemia, Tibial Artery, Fibular Artery, Ultrasonography, Doppler, Contrast-Enhanced Ultrasonography, Ankle-Brachial Index, Bypass Femoropopliteal, Angioplasty, Stent.",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 1st 2022",dateEndSecondStepPublish:"June 10th 2022",dateEndThirdStepPublish:"August 9th 2022",dateEndFourthStepPublish:"October 28th 2022",dateEndFifthStepPublish:"December 27th 2022",remainingDaysToSecondStep:"22 days",secondStepPassed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Full professor and head of vascular and endovascular surgery service at UNICAMP, with 150 journal papers published in vascular surgery journals, ongoing research in organ, tissue, and lower limb ischemia and reperfusion, and member of the Brazilian Society of Vascular Surgery - SBACV.",coeditorOneBiosketch:"Researcher experienced in general, vascular, and endovascular surgery, affiliated with the State University of Campinas and the Santa Casa de Misericórdia Hospital in Curitiba. 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\n
1. Introduction
\n
The Industry 4.0 or Fourth Industrial Revolution is a new and imminent industrial model characterized as advanced manufacturing. What most differentiates this new industry model from the three previous industrial revolutions is the integration of its components. These are represented by people and their human work, machines and equipment, and technologies. Industry 4.0’s internal environment is more integrated, agile, accurate, synchronized, and encourages external stimuli to arrive and be received in the same way.
\n
This new industrial model is also known for its high technological, virtual and digital positioning. Existing technologies in industry 4.0 are not necessarily new, what changes is the integration between them, allowing the industry to behave dynamically and quickly respond to internal and external needs. In the context of production, these technologies enable production processes to be more efficient, lean and faster.
\n
In industry 4.0 as well as in today’s industries, care for the environment, proper and conscious use of natural resources, optimization of physical resources used, waste generation and reuse, and the search for no waste must also be strictly observed. Industry 4.0 Environmental Management is as relevant an area as all of its innovative potential, as it must set guidelines, supervise actions and monitor processes so that they are consistent with an environmentally sound and truly sustainable industrial profile.
\n
The aforementioned industry 4.0 technologies are strong supports for Environmental Management 4.0. The technological potential of the new industrial model is one of the key aspects that allow industry 4.0 to be known as a truly sustainable manufacturing model. Its technologies working in an integrated way, allows not only the environmental management process to be more solid, but the industrial activity itself in all its processes. These become more virtualized, lean, accurate and made on demand.
\n
From this explanatory context, the purpose of this chapter is to present the potential of the industry’s 4.0 leading technologies for their respective Environmental Management. For this, five next sections are distributed in such a way that the first one refers to the presentation of industry 4.0, the second one refers to the presentation of their respective technologies, while the third one refers to environmental management in industry 4.0, the fourth refers to the potential of technologies for environmental management 4.0, and lastly, the fifth refers to the main challenges for environmental and sustainable beneficiation through the use of technologies 4.0.
\n
\n
\n
2. Industry 4.0
\n
The term Industry 4.0 was first mentioned in the German language during the “Hannover Fair” event in 2011 in Germany, and came up as a proposal for the development of a new concept of German economic policy that is based on high technology strategies, which symbolize the beginning of the so-called Fourth Industrial Revolution [1, 2]. Thus, as of 2011, scientific publications on industry 4.0 began to emerge, increasing exponentially around 2013. And many scholars, researchers and business professionals have paid attention to the new industrial model and its potential technologies.
\n
The industry 4.0 is an imminent advanced manufacturing model characterized by a comprehensive set of technologies that streamline industrial performance, making it more integrated, virtual, digital, with excellent response time to internal and external stimuli, and especially with exemplary environmental and sustainable behavior. The industry 4.0 itself includes a set of six design principles that intrinsically include technologies. Such principles are named Decentralization, Virtualization, Interoperability, Modularity, Real-Time Capability and Service Orientation.
\n
One of the peculiarities of the industry 4.0 is its integration capability. The author [3] presents the fundamental and interdependent presence of two value chains, horizontal and vertical. \nFigure 1\n presents the first value chain, the horizontal, together with their respective elements.
\n
Figure 1.
Horizontal value chain in Industry 4.0. Source: adapted from [3].
\n
The digitization process is on its way to both horizontal and vertical value chains. The horizontal value chain digitization works to integrate and optimize the flow of information and goods from the customer through their own company to the supplier, and so the information comes back again. This process involves the integration and proactive control of all internal areas of the company, such as planning, purchasing, production and logistics. The process also includes all external value chain partners who are key participants in meeting customer demand requirements and fulfilling the requested services [3]. \nFigure 2\n shows the vertical value chain with its respective members.
\n
Figure 2.
Vertical value chain in Industry 4.0. Source: adapted from [3].
\n
The digitizing the vertical value chain, on the other hand, is associated with ensuring a flow of sales data and information through product development for manufacturing and logistics. The quality and flexibility can be increased and costs reduced through the precise and optimal connection of manufacturing systems and their respective failure prevention, thus cooperating with better analytical skills [3].
\n
\n
\n
3. Industry 4.0 technologies
\n
The industry 4.0 itself encompasses an extensive set of technologies with broad innovative potential due to their integration. Such technologies are perceived by some industry scholars or professionals as tools or pillars, or industry 4.0 principles. This is because there is a need for more publications to be done in order to properly name each of the industry 4.0 components. In this section, key industry 4.0 technologies are presented in subsections.
\n
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3.1 Cyber-physical systems
\n
One of the most significant advances in the development of information and communication technologies is represented by Cyber-Physical Systems (CPS). These are computational collaboration systems that are in strong connection with the surrounding physical world and its respective active processes while providing and utilizing data access services as well as data processing available on the Internet [4]. The CPS integrate the relationship with people, data and information, machines and equipment, in order to streamline the process of receiving and sharing data and information, analysis and interpretation, and decision making.
\n
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3.2 Cloud manufacturing
\n
Cloud manufacturing (CMfg) is a research field that integrates cloud computing (CC) and traditional product design and manufacturing. CMfg is a service-oriented product development model in which consumers are able to design and make products through the use of information technology and online manufacturing resources [5]. In this way, CMfg cooperates with the customization of products made on demand directly deliberated by the customer.
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3.3 Big Data analytics
\n
Some scholars use the term Big Data analytics (BDA) to emphasize the process and tools used to extract insights from Big Data. In essence, BDA includes not only the organization on which data analysis is performed, but also the elements that make up the tools, the infrastructure and the means to visualize and present insights [6]. Thus BDA presents a stronger structure for receiving, archiving, analyzing and sharing data and information, enabling more concrete decision making based on real information and properly organized and treated.
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3.4 Augmented reality
\n
The augmented reality (AR) is defined as a computer graphics technique that transforms the real environment into a digital environment also using virtual objects in the real world [7]. The AR has several possibilities of use in different areas, either in the transmission of knowledge, in the performance of work activities, in the elaboration of products, in the deliberation of logistic routes, among many other applications.
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3.5 Smart sensors
\n
The Smart Sensors (SS) are one of the key elements of the future smart grid, as it enables remote monitoring at each specific point on a network to assess real-time system performance and to find likely errors [8, 9]. This technology enables the industry to better respond to internal and external needs for adaptation or change at a given point in the network.
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3.6 Location detection
\n
The location detection systems are designed to make it easier to identify the respective location of a user or a particular object in a physical space. However, the systems come in different varieties, some requiring users to have tags with identification that is viewed through fixed and calibrated fixed sensors. There are systems that provide object tracking anonymously, while some adopt fixed infrastructure (WiFi or Bluetooth). Location detection systems differ in aspects such as extent, area coverage, accuracy and cost [10]. While these systems differ at these points, regardless of the breadth of their potential, they enable the industry to have greater control over its resources and processes so that they are always optimized and directed to the right location.
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\n
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3.7 Industrial Internet of Things
\n
The industrial Internet of Things (IIoT) is a system that involves intelligent networking, cyber-physical systems, cloud computing platform that allows access, collection and evaluation of communications, and also enables the industry to exchange data, such as processes, products and services, in real-time, thus generating the optimization of production value [11]. Thus, IIoT is also one of the key technologies responsible for ensuring the integration of data and communications across the industry and beyond, in constant exchange of information with the stakeholders involved.
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3.8 Additive manufacturing
\n
The additive manufacturing (AM) is a technique that aims to bring together a wide variety of complex geometries and structures from three-dimensional (3D) model data. The process consists of printing successive layers of materials that are formed on top of each other. The AM involves various methods, materials and equipment, and has evolved over the decades and has the ability to transform manufacturing and logistics processes. The AM has been widely applied in a variety of industries including biomechanics, prototyping and construction [12]. This technology uses different materials for different purposes, for which aspects such as capacity, durability, consistency, limitations, and contact with other possible types of materials must be observed.
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4. Environmental Management in Industry 4.0
\n
The pace of technological progress opens space for reflection on its impacts not only on the economy, but also on society and the environment. Beginning with the Stockholm Conference in 1972, several meetings are held around the world to discuss environmental issues. Over the years there is a clash between the perspectives of industrial production, economic expansion and sustainable development. In addition to the use of water and energy, extraction of raw materials and exploitation of soil, there is a huge amount of waste generated [13].
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The Environmental Management of traditional industries or industries 3.0 is very effective in its guidelines, supervisions and actions. However, traditional industry models do not allow complete and satisfactory environmentally sound and sustainable industry performance. These still have their processes that use many natural resources, which are sometimes over-harvested, the level of waste can still be considered high, the reuse of production resources does not occur effectively, as well as the reverse logistics process, among many other points that do not allow the industry to have a sustainable behavior.
\n
The organizations seeking to perform well in sustainability actions must be ready to present the results of their practices to society and the market. To this end, the main mechanism used by corporations is the annual sustainability report. Through indicators, sustainability reports present the results of companies in the environmental, social and economic dimensions in a given year. This type of document contributes to broadening communication and relationships about these dimensions among key participants in the business environment in which the company is a part [14]. \nTable 1\n presents the aspects of environmental performance in the sustainability indicator proposed by [15].
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Aspects of environmental performance
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Water utilization
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Decrease in total water consumption
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Increase in percentage of recycled water utilization
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Material utilization
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Decrease of material intensity
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Decrease in raw material utilization percentage
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\n
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Increased use of recycled/remanufactured/reused material
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Decrease in percentage use of hazardous materials
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\n
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Energy utilization
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Decrease in total energy consumption
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\n
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Increase in percentage of renewable energy utilization
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Increased percentage of energy saved
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Waste
\n
Decrease in total waste generated
\n
\n
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Increased level of recyclable/remanufactured/reusable waste
\n
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Decrease in percentage of waste brought to landfills
In addition to the environmental performance aspects of the author’s sustainability indicator [15], those proposed by [16] in \nTable 2\n are presented.
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Aspects of the environmental dimension
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Natural resources
\n
Water use (m3/year)
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Recycled water rate (%)
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Land use (m2)
\n
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Environmental legislation and compliance
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Environmental accidents (No./year)
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Cost for environmental, health and safety compliance ($/year)
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Energy
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Energy utilization (kWh)
\n
\n
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Idle energy loss rate (%)
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Renewable energy fraction (%)
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Material
\n
Material used per production unit (kg/piece or m3/piece)
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Scrap rate (%)
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Process scrap rate (%)
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Quantity of material reused or recycled (%)
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Use of packaging material (kg/year or m3/year)
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Use of additive processes (kg/year or m3/year)
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Quantity of recycled process additives (%)
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Waste and emissions
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Waste (kg)
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Hazardous waste (kg)
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Emission of ozone-depleting substances (kg)
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Emission of greenhouse gases (kg)
\n
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\n
Emission of other environmental gases (kg)
\n
\n\n
Table 2.
Aspects of the environmental dimension (continuation).
It is necessary to reflect on past actions and consequences and establish new relationships with the environment [10]. One of the goals set in 2015 by the United Nations (UN) in the 2030 Agenda for Sustainable Development is to promote modernization, including in industries with the aim of making them inclusive and sustainable with an increasingly efficient use of resources and implementation of technologies in industrial processes so that they become cleaner [17].
\n
In this positive context, Environmental Management in industry 4.0 can count on its excellent ability to establish plans, deliberate on projects, grant or withdraw permits, verify processes and to monitor results, it can still use a wide range of integrated technologies that cooperate together for exemplary environmental and sustainable performance, which still has lower costs and expenses and increased industrial profitability.
\n
Since industry 4.0 has a strengthened environmental and sustainable awareness, along with the use of its potential technologies, the acquisition of natural resources and all energy efficiency is done according to need and demand, without exaggeration. Thus, spending on the acquisition of productive inputs tends to decrease or, at least, to control, since the right and necessary volume of a certain resource to be used in production is being acquired. As well as the operating costs of generators, central computers, virtual and digital devices, machines, equipment, they are also reduced as they are activated at the right time and as there is a need to remain active. The minimal waste generated can also cease to be a cost to industry if it is reused as a new material to be integrated into other products, or even as a raw material for the construction of tools that assist in the production, or being the fuel for it, for some specific types of industry.
\n
In addition to reducing costs and expenses, the environmental and sustainable behavior of industry 4.0 can increase its profitability. Industries in the same segmentation can create a network of partnerships in which the acquired resources that will no longer be used in production are passed on to other industries that need them, rather than rendering them useless or lost in industrial storage, leading to expenses and losses. Similarly, the use of machines and equipment can be shared across industries 4.0. This consists in sharing the operating capacity of industries and is a way of providing services to each other so that the supplying industry has the benefit of keeping its machinery running and generating volatile revenue when it is not operating in the industry from which it operates. At the same time, the industry using the machinery maintains its productive activity without interruption or loss of demand.
\n
The interconnection of value generation networks in industry 4.0 provides new opportunities for the consolidation of closed-loop product lifecycles and industrial symbiosis. The network interconnection enables efficient coordination of water, energy, material and product flows throughout product life cycles, as well as between different factories. The closed-loop product lifecycles help keep products in life cycles with various phases of use, with remanufacturing or reuse between them. The industrial symbiosis describes the cooperation between different factories to gain a competitive advantage by trading and exchanging water, energy, materials and products [18] as well as smart data at the local level [19].
\n
The approach to sustainable product design in industry 4.0 focuses on designing closed product lifecycles, enabling specific product reuse and remanufacturing or applying cradle-to-cradle principles. Different design approaches also focus on seeking consumer well-being. These concepts can be supported by applying identification systems, such as to recover cores for remanufacturing, or by applying new services that are additional to the product to achieve a higher level of customer well-being [20].
\n
The transformations presented by industry 4.0 revolutionize the forms of commercialization and promote behavioral changes in the consumption and production spheres, and mainly, can cooperate for the structuring and formation of more sustainable business models [19]. Constantly these new technologies impact sectors such as health, energy and construction, and are configured in a junction of intelligent processes that originate products and services whose goal is to provide comfort and quality of life associated with the management of existing resources [21].
\n
\n
\n
5. Technology potential for Environmental Management 4.0
\n
The industry 4.0 just like every business organization, and every individual themselves, needs to have a strong environmental awareness. The difference with this new industrial model is that it can utilize an available set of technologies that enable it to have more environmentally consistent, clean and efficient industrial performance. \nFigure 3\n presents industry 4.0 technologies, demonstrated by using points, which have high potential favorable to Environmental Management 4.0. Each of the points is described subsequently.
\n
Figure 3.
Potential Technologies for Environmental Management in Industry 4.0. Source: Elaborated by the authors.
\n
\n
5.1 Cyber-physical systems
\n
The cyber-physical systems (CPS) are relevant agents for Environmental Management because they can receive production planning, stipulate production steps, provide data on resource utilization and production inputs, and manage them throughout the manufacturing process. The CPS can meet production schedules by receiving and providing real-time data and information, and can change any production step as needed.
\n
Thus, the use of resources, mainly natural, is made more consciously and only in accordance with the need for integration in the production of the product. Similarly, less waste can be generated because the right materials are being used to the right extent and as needed. Because they are connected to the internet, and are the industry’s leading interconnectors making it a network system, any changes that need to be made, the CPS can communicate it through notices to computer systems and mobile devices and perform autonomous (when programmed) or allowed (when coordinated by people), the necessary changes in the production process.
\n
\n
\n
5.2 Cloud manufacturing
\n
The cloud manufacturing (CMfg) is another potential agent for the consolidation of strong Environmental Management 4.0. This technology is responsible for receiving, storing, processing, presenting and sharing production data and information. Through this technology, not only the stimuli of the internal environment are treated, but also the external ones. Due to its service orientation feature, any minor change or need to adjust customer orders, notifications are sent and presented in systems to those responsible for a given production step.
\n
The industry 4.0 has a high ability to offer customization to its customers’ orders. By making it possible for customers to follow up the production steps of a product, they may or may not suggest modifications. This, in a traditional industry, could result in a vast amount of waste of resources, materials, energy efficiency, leading to waste and waste. However, with CMfg, it is possible to have the product planning to be executed, and thus acquire the necessary inputs. If any product change is requested by the customer, after systemic analysis, production can be changed without significant waste of resources, materials and efficiency, and other materials that can be used can be integrated into the production process, resulting in optimization of resources.
\n
\n
\n
5.3 Big Data analytics
\n
The Big Data analytics (BDA) stores and analyzes all industry data. Its potential for Environmental Management 4.0 is to group, analyze and provide relevant data and information on existing resources, resources used, machine functionality, energy efficiency, waste generation, waste utilization and pollution levels emitted. The BDA can provide historical information on a possible resource already used in the production of the same good, which may be reused. It can also notify, by systems, the lack of a certain resource for production, or even the breakdown of some machine, causing the production process to be interrupted.
\n
With access to CMfg information, the BDA can suggest changes in the specificities of the production process. With these and other possibilities, the BDA serves as a warning of opportunities and correction needs, as well as its high capacity for storing data and information. Thus, any opportunity to improve production capacity by using fewer resources or taking advantage of fewer machines functionality, or by alerting to the misuse of a resource or material aimed at producing a good, or even the activity of a broken machine, can be notified by BDA, making it an environmentally active contributor.
\n
\n
\n
5.4 Augmented reality
\n
The augmented reality (AR) cooperates effectively with Environmental Management 4.0 because it can advise on planning before it comes to fruition, simulations of what is to be implemented, and the need for corrections even at a distance, or from different locations. It also contributes to the training and capacity building processes, imparting knowledge and teachings to employees about environmentally sound and sustainable actions through the visualization of real projections. It helps in the loading and unloading routes, so that truckers are better advised as to where they need to arrive, so that they are directed to the right location, without errors or deviations in the route and possible increase of pollutant emissions by their vehicles. The AR also cooperates with the monitoring of production operations, allowing to check failures, breaks, interruptions or errors in the production lines, among many other relevant functions.
\n
With AR, plans can be prepared and viewed virtually before they are even directed, so any planning errors can be fixed before resources are acquired or triggered unnecessarily. The simulations that AR makes possible allow engineers, technicians, operators and designers to be able to check product-wide compliance and modification needs before they are produced. The AR still allows points that are distinct or distant from the industry site to be viewed virtually, so that the reality of a given point can be known even in real-time, thus streamlining the decision making process to perform actions or repairs.
\n
\n
\n
5.5 Smart sensors
\n
The smart sensors (SS) are a type of technology that informs systems for employee viewing of possible errors or non-conformities whether in materials, products, machines, steps or production lines, and can measure levels of waste or pollution generated.
\n
The SS is a technology that can send these notifications to employees through systems on machines, central computers, or mobile devices and can take no further action, or can act, when so programmed, autonomously. The SS may receive an initial configuration of acceptable indices distributed at different scales, and when nonconformity that exceeds such ranges occurs, the SS may notify employees or take action that the production process is not erroneous at any stage, resulting in negative results for the environment.
\n
\n
\n
5.6 Location detection
\n
The location detection is a technology commonly used with the tag system. When you know the right location of machines and equipment, products in the production stage, finished products, a lot of time, accuracy, reduced waste generation and pollutants are gained throughout the industry.
\n
The location detection helps resources that should be on the production line be easily located without wasting a lot of time and energy efficiency on running machines. Just as production-stage batches stored in temporary inventories do not need to be redone because they are not found, as well as completed batches need not be stopped in inventories generating industry costs and customer dissatisfaction, or even risk being confused with lots that have failed.
\n
With location detection the industry becomes more agile and accurate, reducing waste generation due to local verification errors. Also logistics can prevent wrong deliveries and cargoes by mistake in defining the correct location to arrive.
\n
\n
\n
5.7 Industrial Internet of Things
\n
The industrial Internet of Things (IIoT) connects data and information from all areas of the industry and beyond with the stakeholders involved. The IIoT allows us to identify reversible or non-reversible machine and equipment failures, sensor and system problems, production disruption, changing customer demand requirements, stakeholder service opportunities, and many other possibilities.
\n
Thus, the IIoT is a valuable technology for Environmental Management 4.0 because it can prevent the loss of a production machine or equipment because the hazardous situation has not been verified before, thus generating waste to the environment. Likewise, it can quickly verify that sensors and systems are not working properly and cannot perceive the improper use of a specific feature in a product, which could lead to loss of feature and product, leading to lost feature extraction and residue to the environment by the nonconforming product.
\n
The IIoT also cooperates by informing customers of changing orders, so that the necessary resources and adjustments are handled carefully to avoid waste. Through IIoT, a network of industries can remain interconnected, so that with active communication, opportunities for offering and acquiring service claims can be observed and embraced, making it possible for an industry to need machinery that you do not own but can make available is to avoid buying machinery so that they will not be spare in this industry.
\n
\n
\n
5.8 Additive manufacturing
\n
The additive manufacturing (AM) is a technology that has a high degree of innovation in the use of resources in production. The AM’s main contribution to Environmental Management 4.0 is that it can use other types of materials that are not necessarily taken from nature for the manufacture of various types of products.
\n
With AM, some industry segments can switch production of their products using materials that do not come directly from nature, or that are biodegradable, or even edible, for some very specific types of industry. In this way the industry can achieve a more environmentally correct behavior regarding the acquisition of productive inputs.
\n
In terms of waste generation, the AM can use materials that have been non-conforming or spare in the industry and make them viable to produce new products that integrate them rather than selecting materials to be extracted or prefabricated, eliminating irregular ones causing negative environmental results.
\n
\n
\n
\n
6. Challenges for environmental and sustainable beneficiation through technologies 4.0
\n
The industry 4.0 technologies are very relevant to the environmental and sustainable commitment of industries. However, they do require a lot of observation and care in their correct implementation planning, operation, maintenance and discard. If all of these are not well analyzed prior to their realization, they can have an effect contrary to the environmentally correct and sustainable industrial positioning.
\n
The Industry should be aware that technologies require continuous monitoring in order to ensure their full and effective use and no harm to the environment. \nTable 3\n presents the key challenges for the environmental and sustainable beneficiation of each of the industry’s 4.0 technologies.
\n
\n
\n
\n\n
\n
Technologies 4.0
\n
Main challenges
\n
\n\n\n
\n
Cyber-physical systems
\n
Cost considered still high for acquisition
\n
\n
\n
Installation in suitable places considering space and distance
\n
\n
\n
Need to connect to all machines throughout the production area
\n
\n
\n
Need to connect to all systems and sensors in the production area.
\n
\n
\n
Be connected in real-time to the whole productive area
\n
\n
\n
Pass by constant and periodic maintenance
\n
\n
\n
Cloud manufacturing
\n
Have ample data and information storage capacity
\n
\n
\n
Receive, archive and share data and information in real-time
\n
\n
\n
Be connected in real-time to industry computers, systems and machines
\n
\n
\n
Be connected in real-time with stakeholder demands
\n
\n
\n
Big Data analytics
\n
Have ample data and information storage capacity
\n
\n
\n
Receive, combine, analyze, archive and share data and information in real-time
\n
\n
\n
Be connected in real-time to industry computers, systems and machines
\n
\n
\n
Have historical information and records of changes made
\n
\n
\n
Be connected in real-time with the needs and changing demands of stakeholders
\n
\n
\n
Augmented reality
\n
Have interconnected auxiliary devices of adequate amplitude
\n
\n
\n
Have discipline in strictly necessary uses
\n
\n
\n
Be connected with systems and sensors for assisted production operations
\n
\n
\n
Have internet connectivity for use in different parts of the industry or in another location.
\n
\n
\n
Have internet connectivity for use in different parts of the industry or in another location that require direct interaction through communication
\n
\n
\n
Smart sensors
\n
Have space and distance required for correct performance
\n
\n
\n
Be connected to internet in real-time
\n
\n
\n
Be connected to systems in real-time
\n
\n
\n
Be connected to each other and machines in real-time
\n
\n
\n
Have the machines integrated performance capability
\n
\n
\n
Location detection
\n
Be properly and accurately installed in machinery and equipment
\n
\n
\n
Be connected to internet in real-time
\n
\n
\n
Be connected to systems in real-time
\n
\n
\n
Act together with smart sensors
\n
\n
\n
Industrial Internet of Things
\n
Capacity installation on all machines, sensors and systems
\n
\n
\n
Be included on all central computers and mobile devices
\n
\n
\n
Receive, combine, share and notify industry internal and external stimuli
\n
\n
\n
Be included in partnering and service network systems from other industries
\n
\n
\n
Additive manufacturing
\n
Consider the best materials use option in the manufacture of a product
\n
\n
\n
Consider the need for resistance of the material to be used in the manufacture of the product
\n
\n
\n
Consider the use of waste generated as material for manufacturing
\n
\n
\n
Deliberate the ideal ways of disposing of the product when no longer used
\n
\n
\n
Control manufacturing according to need and demand, always considering the impacts on the environment
\n
\n\n
Table 3.
Main challenges for environmental and sustainable beneficiation through Technologies 4.0 (continuation).
Source: Elaborated by the authors.
\n
The industry 4.0 technologies are relevant contributors to environmental management, if properly and jointly used. One action of a given technology needs the cooperation of the other in order for efforts to complement and consolidate effectively.
\n
\n
\n
7. Conclusion
\n
In this chapter we have presented the industry 4.0 and its main technologies, so that its integrated structure and all the technological possibilities that the new industrial model includes are described. The context of Environmental Management in industry 4.0 was also presented, denoting the cooperation of the set of technologies 4.0 for environmentally sound and sustainable performance. Then, the potentials of each technology for Environmental Management 4.0 were presented, and finally, their respective challenges for environmental and sustainable beneficiation.
\n
It can be noted that industry 4.0 is a model that uses the foundations of other industrial revolutions that occurred previously, but with greater innovation and integration. The Environmental Management 4.0 is disruptive because it can fully integrate the capabilities of the extensive set of technologies available to achieve systemic behavior that is more directed toward effective practices of consciously sourcing inputs, correct and accurate use as needed and demanded, less waste generation and reuse, quick perception of failures and corrections, real-time contact with stakeholders, among many other possibilities. However, as in traditional industries, excellent environmental and sustainable behavior requires awareness and collective action, and in the case of technologies 4.0, understanding and systemic actions.
\n
\n\n',keywords:"Industry 4.0, sustainable manufacturing, advanced manufacturing, Environmental management 4.0, Technologies 4.0",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/70130.pdf",chapterXML:"https://mts.intechopen.com/source/xml/70130.xml",downloadPdfUrl:"/chapter/pdf-download/70130",previewPdfUrl:"/chapter/pdf-preview/70130",totalDownloads:793,totalViews:0,totalCrossrefCites:1,totalDimensionsCites:3,totalAltmetricsMentions:0,impactScore:1,impactScorePercentile:62,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"June 24th 2019",dateReviewed:"October 14th 2019",datePrePublished:null,datePublished:"March 25th 2020",dateFinished:"November 20th 2019",readingETA:"0",abstract:"The Industry 4.0 is a new industrial model characterized by excellent productive, procedural, and environmental performance. This new industry is perceived as a truly sustainable manufacturing model. And one of the aspects that most contributes to this insight is the extensive set of largely innovative technologies in the industry 4.0. Largely because such technologies are not necessarily unheard of, what changes is the integration between them in the context of industry 4.0. From this explanatory context, the purpose of this chapter is to present the full potential of industry’s 4.0 leading technologies for their highly effective Environmental Management. Thus, it is possible to understand how integrated technologies cooperate together for an environmentally sound and sustainable positioning of industry 4.0 in all its areas. The industry 4.0 has a more conscious use of natural resources, less waste, processes are leaner and the life cycles of its machines and equipment are longer. All these factors together with the technologies, contribute for the Environmental Management 4.0 to be disruptive in relation to the still industries 3.0. The chapter also presents the main challenges for the industry’s 4.0 environmentally sound and sustainable performance through its technologies.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/70130",risUrl:"/chapter/ris/70130",book:{id:"9426",slug:"industry-4-0-current-status-and-future-trends"},signatures:"Ana Claudia Pereira Carvalho, Ana Paula Pereira Carvalho and Núbia Gabriela Pereira Carvalho",authors:[{id:"308607",title:"Ms.",name:"Núbia",middleName:"Gabriela Pereira",surname:"Carvalho",fullName:"Núbia Carvalho",slug:"nubia-carvalho",email:"nubia.carvalho@usp.br",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/308607/images/8908_n.jpg",institution:null},{id:"308902",title:"Ph.D. Student",name:"Ana Paula",middleName:"Pereira",surname:"Carvalho",fullName:"Ana Paula Carvalho",slug:"ana-paula-carvalho",email:"appc.engambiental@gmail.com",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/308902/images/13677_n.jpg",institution:{name:"Federal University of São Carlos",institutionURL:null,country:{name:"Brazil"}}},{id:"308903",title:"Ph.D. Student",name:"Ana Claudia",middleName:"Pereira",surname:"Carvalho",fullName:"Ana Claudia Carvalho",slug:"ana-claudia-carvalho",email:"anaclaudiaengamb@gmail.com",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/308903/images/13636_n.jpg",institution:{name:"Federal University of São Carlos",institutionURL:null,country:{name:"Brazil"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Industry 4.0",level:"1"},{id:"sec_3",title:"3. Industry 4.0 technologies",level:"1"},{id:"sec_3_2",title:"3.1 Cyber-physical systems",level:"2"},{id:"sec_4_2",title:"3.2 Cloud manufacturing",level:"2"},{id:"sec_5_2",title:"3.3 Big Data analytics",level:"2"},{id:"sec_6_2",title:"3.4 Augmented reality",level:"2"},{id:"sec_7_2",title:"3.5 Smart sensors",level:"2"},{id:"sec_8_2",title:"3.6 Location detection",level:"2"},{id:"sec_9_2",title:"3.7 Industrial Internet of Things",level:"2"},{id:"sec_10_2",title:"3.8 Additive manufacturing",level:"2"},{id:"sec_12",title:"4. Environmental Management in Industry 4.0",level:"1"},{id:"sec_13",title:"5. Technology potential for Environmental Management 4.0",level:"1"},{id:"sec_13_2",title:"5.1 Cyber-physical systems",level:"2"},{id:"sec_14_2",title:"5.2 Cloud manufacturing",level:"2"},{id:"sec_15_2",title:"5.3 Big Data analytics",level:"2"},{id:"sec_16_2",title:"5.4 Augmented reality",level:"2"},{id:"sec_17_2",title:"5.5 Smart sensors",level:"2"},{id:"sec_18_2",title:"5.6 Location detection",level:"2"},{id:"sec_19_2",title:"5.7 Industrial Internet of Things",level:"2"},{id:"sec_20_2",title:"5.8 Additive manufacturing",level:"2"},{id:"sec_22",title:"6. Challenges for environmental and sustainable beneficiation through technologies 4.0",level:"1"},{id:"sec_23",title:"7. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'\nLee J. Industry 4.0 in Big Data environment. German Harting Magazine. 2013;26:8-10\n'},{id:"B2",body:'\nMosconi F, editor. The New European Industrial Policy: Global Competitiveness and the Manufacturing Renaissance. London, England: Routledge; 2015. 230p. DOI: 10.1430/84080:y:2016:i:2:p:367-369\n'},{id:"B3",body:'\nKoch V, Kuge S, Geissbauer R, Schrauf S. Industry 4.0—opportunities and challenges of the industrial internet. Strategy& - Formerly Booz & Company - PwC. 2014;13:1-52\n'},{id:"B4",body:'\nMonostori L, Kádár B, Bauernhansl T, Kondoh S, Kumara S, Reinhart G, et al. Cyber-physical systems in manufacturing. CIRP Annals - Manufacturing Technology. 2016;65:621-641. DOI: 10.1016/j.cirp.2016.06.005\n'},{id:"B5",body:'\nWu D, Rosen D, Schaefer D. Cloud-based design and manufacturing: Status and promise. In: Schaefer D, editor. Cloud-Based Design and Manufacturing (CBDM). Cham, Switzerland: Springer; 2014. pp. 1-24. DOI: 10.1007/978-3-319-07398-9_1\n'},{id:"B6",body:'\nMikalef P, Pappas I, Krogstie J, Giannakos M. Big Data analytics capabilities: A systematic literature review and research agenda. Information Systems and e-Business Management. 2018;16:547-578. DOI: 10.1007/s10257-017-0362-y\n'},{id:"B7",body:'\nCeruti A, Marzocca P, Liverani A, Bil C. Maintenance in aeronautics in an Industry 4.0 context: The role of augmented reality and additive manufacturing. Journal of Computational Design and Engineering;6:516-526. DOI: 10.1016/j.jcde.2019.02.001\n'},{id:"B8",body:'\nMorales-Velazquez L, Romero-Troncoso J, Herrera-Ruiz G, Morinigo-Sotelo D, Osornio-Rios R. Smart sensor network for power quality monitoring in electrical installations. Measurement: Journal of the International Measurement Confederation. 2017;103:133-142. DOI: 10.1016/j.measurement.2017.02.032\n'},{id:"B9",body:'\nTang T, Ho A. A path-dependence perspective on the adoption of internet of things: Evidence from early adopters of smart and connected sensors in the United States. Government Information Quarterly. 2019;36:321-332. DOI: 10.1016/j.giq.2018.09.010\n'},{id:"B10",body:'\nCoyle L, Neely S, Nixon P, Quigley A. Sensor aggregation and integration in healthcare location based services. In: Pervasive Health Conference and Workshops; 29 November–1 December 2006. Innsbruck, Austria: IEEE; 2006. pp. 1-4\n'},{id:"B11",body:'\nBoyes H, Hallaq B, Cunningham J, Watson T. The industrial internet of things (IIoT): An analysis framework. Computers in Industry. 2018;101:1-12. DOI: 10.1016/j.compind.2018.04.015\n'},{id:"B12",body:'\nNgo T, Kashani A, Imbalzano G, Nguyen K, Hui D. Additive manufacturing (3D printing): A review of materials, methods, applications and challenges. Composites Part B Engineering. 2018;143:172-196. DOI: 10.1016/j.compositesb.2018.02.012\n'},{id:"B13",body:'\nFernandes I. A manufatura avançada sob a ótica da sustentabilidade: Estudo utilizando o enfoque meta-analítico. In: XXXVII Encontro Nacional de Engenharia de Produção; 10–13 October 2017. Joinville, Brasil: ABEPRO; 2017. pp. 1-22\n'},{id:"B14",body:'\nNakagawa M. A sustentabilidade na estratégia de negócio das empresas brasileiras [thesis]. São Paulo: Pontifícia Universidade Católica de São Paulo; 2012\n'},{id:"B15",body:'\nSingh S, Olugu E, Musa S. Development of sustainable manufacturing performance evaluation expert system for small and medium enterprises. Procedia CIRP. 2016;40:608-613. DOI: 10.1016/j.procir.2016.01.142\n'},{id:"B16",body:'\nWinroth M, Almström P, Andersson C. Sustainable production indicators at factory level. Journal of Manufacturing Technology Management. 2016;27:842-873. DOI: 10.1108/JMTM-04-2016-0054\n'},{id:"B17",body:'\nNações Unidas no Brasil (ONU BR). Transformando Nosso Mundo: A Agenda 2030 para o Desenvolvimento Sustentável [Internet]. 2015. Available from: https://nacoesunidas.org/pos2015/agenda2030/ [Accessed: 21 August 2019]\n'},{id:"B18",body:'\nChertow M. Uncovering industrial symbiosis. Journal of Industrial Ecology. 2007;11:11-30. DOI: 10.1162/jiec.2007.1110\n'},{id:"B19",body:'\nStock T, Seliger G. Opportunities of sustainable manufacturing in Industry 4.0. Procedia CIRP. 2016;40:536-541. DOI: 10.1016/j.procir.2016.01.129\n'},{id:"B20",body:'\nLarsson T, Larsson A, Leifer L, Kobayashi H. Design for Wellbeing [Internet]. 2015. Available from: https://www.designforwellbeing.org [Accessed: 22 August 2019]\n'},{id:"B21",body:'\nNoronha M, Valente L, Rodrigues J, Bento L. Sustentabilidade 4.0. In: Congresso Internacional em Artes, Novas Tecnologias e Comunicação (CIANTEC 2018); 12–14 October 2018. São Paulo, Brasil: Pomello Digital; 2018. pp. 207-212\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Ana Claudia Pereira Carvalho",address:"acpc@ufscar.br",affiliation:'
Federal University of São Carlos (UFSCar), Brazil
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\n
1. Introduction
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Patients with amputations can be found living fulfilled lives. We have all seen them running marathons, in the Olympics, surfing, climbing Mount Everest and even as an MLB pitcher. However, most just want to lead normal lives and be the best parents, siblings, friends, or co-workers they can be. They want to return to their job and function in their daily lives as they did before. Recovery from an amputation is not immediate and takes significant time. Recovery time from amputation is usually prolonged. Wound healing is done in 4–8 weeks, but the prolonged mental, emotional, and physical recovery afterwards takes much longer and will be different for everyone. One of the limiting factors for recovery from an amputation is pain.
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In looking at data from the Amputee Coalition, there are 185,000 in the United States every year. This means that an average of two million people is living with an amputated extremity in the United States alone [1, 2, 3]. Other data to consider is just as alarming; globally, there are 1 million amputations annually. This is an estimated 1–2 amputation per minute. Lower limb amputations are the most common, with most being due to vascular disease. 85% of lower limb amputations are preceded by a foot ulcer. About half of the people with diabetes who get a lower limb amputation will receive a second amputation [4]. African American populations are four times more likely to get an amputation than Caucasian [5]. Around a third of these patients have persistent depression and anxiety after their amputation [6]. Financially, it is noted that amputees have higher healthcare costs and if the amputation was related to vascular disease higher mortality [7].
\n
All these factors can lead to an unknown fear for a patient undergoing an amputation. Understanding the cause of an amputation first is paramount. This can help guide a plan for better pain control in the perioperative period. The main causes of amputation are progression of disease processes such as peripheral vascular disease (82%) including ischemia and thrombosis. Diabetes and infections such as osteomyelitis and gangrene that is unresponsive to antibiotic treatment. The second major cause is trauma (16.4%). This has a high predominance in upper extremity amputations. Lower extremity amputations with trauma can also be seen with severe fractures that do not heal and frost bites as other causes. Finally, surgical removal of malignancies (0.9%) can result in amputations in upper or lower extremities depending on the location and type of the tumor and growth. Congenital malformations (0.8%) make up the final list for amputation categories [1, 2].
\n
It is important as we consider the cause of the amputation and perioperative pain control, we also factor in the amount of time each patient had before surgery for their amputation decision. A diabetic patient that had a long time to make a decision for an amputation may have had considerable time to go through the stages of grief and accept the amputation as opposed to a trauma that did not have this time. Other things to consider are support system that the patient has at home. As discussed, wound healing is brief, but psychological healing will take longer in most and require repeated support and reminders to the patient to keep moving in a positive direction [8]. In addition to medical management, these patients will need pain-coping strategies and too many these may be a new technique for them in a life altering situation.
\n
\n
\n
2. Pain classification with an emphasis on amputees
\n
Amputation patients have a variety of different pain to consider when treating them in the perioperative setting. The broad classification of this pain is post-amputation pain. However, further classifying it in four categories helps to better understand each pain and how it originates. They are acute post-operative pain, phantom sensations, residual limb pain and phantom limb pain [2, 3].
\n
Acute post-operative pain is the pain that most surgical patients experience after any surgery. It is the pain at the surgical incision site related to surgical trauma, swelling and tissue damage. This is usually reported as sharp and stabbing by patients due to nociceptive afferent nerve supply at the surgical site. Patient can also report muscle spasms related to the immobility of the limb or the compression dressing or brace applies to the amputation site after surgery [2, 9, 10].
\n
Phantom sensations are the non-painful sensations arising from the amputated extremity. This is reported by 75% of patients 4 days after the amputations and higher at 6 months. This can be perceived as movement of the prior extremity or portion of the extremity (i.e. toe or finger). The patient can also note temperature changes or position changes or the missing limb. This has also been noted in mastectomies, dental extractions, and enucleations as well, and can also be seen in spinal cord injuries. Many of the phantom sensations are mild and decline but some patients have some degree persistent sensations indefinitely. There are a few patients in whom these sensations progress to severe pain and become problematic, leading to residual limb pain or phantom limb pain. There are reports of phantom sensations that do fade away and they appear to do this in a progressive fashion called telescoping. This is most common in upper extremity amputations where the phantom sensations continue to decrease such that eventually the patient is left with a sensation of the hand on the stump alone instead of distal [2].
\n
Residual limb pain (stump pain) is the pain localized to the remained affected body segment and can be present for years. Residual limb pain can be of many different modalities as it can be described as deep tissue pain, superficial incision pain and neuropathic in nature. 75% of patients will experience a component of this chronically after surgery [11]. Neuropathic pain will be described as burning and electric in nature. Some patient may even become hyperalgesia or have allodynia on the stump site. This may lead to difficulty with prosthetic fitting for the patient. This pain is usually noted early in recovery. There are causes of increased stump pain: infection, stump neuroma, heterotopic ossification [9]. These should be assessed with prolonged or increased stump pain as these are easily treatable. Infection is not uncommon in these patients due to high prevalence of diabetes and peripheral vascular disease. This should be assessed and treated with antibiotics accordingly to prevent sepsis and wound dehiscence. Stump neuromas occur when the severed nerve at the amputation site have an inflammatory mediated immune reaction. This can cause pain, but it can also cause unmyelinated A and C fibers to form around the nerve. Neuromas develop over time and usually are characterized by point pain on the stump and sensory changes. Heterotopic ossifications usually occur later after amputation as well. These are calcium deposits that occur in the soft tissue of the stump. These ossifications occur much higher in traumatic amputations. There is some association with traumatic brain injury and the risk of this occurrence as well [2, 3, 12].
\n
Phantom limb pain was first described in 1462 by French Surgeon, Ambrose Pare’ [13]. However, it was not until 1871 that Silas Weir Mitchell, a Civil War surgeon, called this phenomenon “phantom limb” [2, 13]. Phantom limb pain is an unpleasant or painful feeling in the amputated extremity. 45–85% of patients from amputations can suffer from phantom limb pain [9]. This can have neuropathic components with burning and electrical shooting pain and nociceptive components of dull, aching, crushing and cramping pain [13]. There are two times of onset for this pain. One is usually early after amputation in the first month and the second can occur a year after amputation. The further out a patient is from amputation the less likely they will experience this. However, if a patient does begin to experience this, it can last for years. Phantom limb pain does not always have to occur alone and usually occurs with residual limb pain. While residual limb pain may be bothersome early on, phantom limb pain persists and become more bothersome later and tends to last longer. Risk factors for development or prolonging phantom limb pain are found in Table 1 [1, 2, 3, 12, 13].
\n
\n
\n\n
\n
1. Female gender
\n
\n
\n
2. Elevated pre-amputation pain
\n
\n
\n
3. Upper extremity
\n
\n
\n
4. Increasing age
\n
\n
\n
5. Bilateral amputation
\n
\n
\n
6. Traumatic amputation
\n
\n
\n
7. Stump healing
\n
\n
\n
8. Disease states such as fibromyalgia, migraines, Raynaud’s, IBS, irritable bladder, depression, and anxiety
\n
\n
\n
9. Poor social support
\n
\n
\n
10. High expectations
\n
\n
\n
11. Poor coping strategies
\n
\n\n
Table 1.
Risk factors for developing or prolonged phantom limb pain.
\n
\n
\n
3. Pain signal transmission
\n
To understand how to treat the pain from amputations, we should first take a moment to review how painful stimulation is transmitted through the body (see Figure 1). The human body receives signals from various inputs. If something painful happens to the body such as surgical insult, the damage is registered by nociceptors in the periphery. The distal nerve fibers coalesce and become peripheral nerves. There are pain receptors that present on the neuron and it is connected by an axon to the spinal cord. Transmission from peripheral nerve to dorsal column is obtained by different nerve fibers. These include: A-alpha fibers, the A-beta fibers, the A-delta fibers, and the C fibers. Pain travels on two different nerve fibers: A-delta and C-fibers. A-delta fibers are large myelinated fibers that carry sharp pain, whereas C-fibers are small and unmyelinated fibers that produce dull, slow spreading pain. This signal arrives to the dorsal horn and then travels up via neurotransmitters to the brain. There are a variety of neurotransmitters from the spinal cord to the thalamus. For pain, the most important to consider are Substance P which is an excitatory neurotransmitter for second order neurons in the dorsal horn. This neurotransmitter has been shown to sensitize nociceptors. In addition to pain, Substance P also related to inflammation, cell growth, vasodilation and even mood regulation. Glutamate is also a primary neurotransmitter for pain. It is the main excitatory neurotransmitter in the body. In the brain, glutamate receptors can be both pro-nociceptive as well as anti-nociceptive. This leads to many pain therapies constructed at glutamate. This is used for central sensitization in chronic pain patients [14]. Once in the dorsal horn, the second order neurons connect with thalamus and other various areas. These can include the somatosensory cortex (physical sensation), limbic system (emotion) and frontal cortex (upper level thinking). This allows a patient to feel and react with pain not just physically but emotionally as well [15].
\n
Figure 1.
Path pathways.
\n
Let us revisit how the various pain pathways are affected during amputation. Phantom pain sensations likely result from changes in the somatosensory cortex. This causes afferent nociceptive stimulation from body parts near the amputation sites (such as face for upper extremity amputation or bladder for lower extremity amputation). Due to this reorganization in the somatosensory cortex and stimulation input, the phantom sensations occur [2, 9].
\n
Peripheral nerves likely play a large role in the phantom limb pain and residual limb pain. Damage to distal nerve endings and axons causes inflammation and alteration in neurotransmission along the usual pain pathway. The distal nerve endings will begin to regenerate but there will be non-functional axons, changes in sodium and potassium channels and different input from the spinal cord. Neuromas can form here as discussed previously. This can also result in higher pain due to more catecholamines in circulation due to increased sympathetic discharge [2, 9].
\n
There are also spinal cord changes in the dorsal horn related to pain after amputation. The peripheral nerves are no longer able to send the usual signals along the axons to the spinal cord. The brainstem reticular areas therefore do not send inhibitory sensory transmission, so the dorsal horn receives input from this body part as high sensory feedback resulting in pain transmission [1, 2, 9].
\n
These changes in the peripheral and spinal cord need to be considered as we are thinking about treating each patient for amputation pain.
\n
\n
\n
4. Protocol for perioperative caring for amputation patients
\n
It is well understood that effective control of acute post-amputation pain results in decreased risk of development of residual and phantom limb pain [16]. Perioperative plans need to set up within a multi-disciplinary team, ideally involving surgeon, anesthesia, in-patient acute pain teams, pharmacy, physical therapy, occupational therapy, nutrition, and social work to name a few. The pre-operative optimization is essential to control of acute post-amputation pain and help decrease the risk of development of chronic and phantom pain to help these amputation patients have the best chance for better pain control post-amputation. Thorough pre-operative evaluation is needed to look at co-medical conditions that can be optimized. The patient’s nutrition should be optimized for wound healing as well. Physical therapy and occupational therapy should work with the patient before surgery to improve physical status prior to surgery and make post-operative recovery more successful. Patient should have a pre-operative discussion about post-operative pain management and expectations. This will allow goal setting and help with anxiety the patient may be experiencing.
\n
Patients who struggle with high pain scores prior to amputation may have an elevated risk of developing chronic pain [17]. Thus, aggressive multimodal analgesic therapy instituted pre-operatively and early in the post-operative period could be beneficial in reducing the incidence of chronic pain. One study found that the presence of depressive symptoms was also a predictor of increased intensity of chronic pain in amputees [18]. Thus, it may be worthwhile to address these symptoms prior to elective amputation surgery. Patients with a complex history of chronic pain disorders and/or patients having high baseline daily opioid requirements (> 80 mg oral morphine equivalents) should be further selected to undergo a pre-operative appointment with a pain specialist. This appointment should ideally take place around 4 weeks prior to elective amputation with the goal to optimize the patient’s pain regimen pre-operatively, by maximizing non-opioid modalities and reduction of daily opioid consumption if possible. This is done to improve response to opioid therapy in the immediate post-operative period. Thorough patient education and compassionate counseling also play a key role in developing a team relationship with the patient [19, 20]. See Figure 2 for full protocol.
\n
Figure 2.
Protocol for amputation pain management.
\n
\n
\n
5. Nerve blockade
\n
The current standard of care is pre-operative nerve blockade to prevent peripheral sensitization leading to future onset of phantom limb pain. Successful outcomes necessitate effective communication between the surgeon, anesthesiologist, and the various teams involved in the post-operative rehabilitation of the patient. A consultation with the Acute Pain Service or similar entity that performs peripheral nerve blockade pre-operatively and then follows the patient during their post-operative inpatient course is an important factor in the success in early prevention of acute and chronic pain for these patients.
\n
Most patients that arrive for amputations should be evaluated to receive pre-operative peripheral nerve blocks. If this cannot be done pre-operatively, patients can be evaluated post-operatively for a nerve block. If patients do not require post-operative anti-coagulation that will preclude a continuous peripheral nerve catheter, this would be the preferred nerve block for these patients as this will help with prevention phantom limb pain and chronic post-operative pain [3]. This can be utilized for 3–5 days. Continuous nerve catheter infusions have been found to decrease post-operative morphine requirements [21]. However, in addition, there are other factors that may preclude continuous peripheral nerve catheter placement such as infection, and patient factors. If this is the case, single shot peripheral nerve blocks may be utilized. Interestingly, a systematic review and meta-analysis found no difference in pain scores at 24 hours between patients that received a nerve block and those that did not [22]. However, this study did not look at chronic pain in these patients which is the important component that these nerve blocks are used for [9].
\n
It is important to understand the anatomy of the amputation site to have successful nerve block placement. For example, a below the knee amputation will rely heavily on a sciatic nerve blockade whereas an above the knee amputation will need blockade of both femoral and sciatic nerves for successful pain control and help with peripheral sensitization for the patient [9]. For upper extremity amputations, a forearm amputation will be lower in the brachial plexus than an above the elbow amputation or shoulder disarticulation. Tourniquet site is also paramount when planning peripheral nerve block placement. If the catheter is in the surgical site or tourniquet site, there is a risk for dislodgement. It is important to remember this with placement and keep the securement of catheter out of the surgical field. This will take good communication between anesthesia provider and surgeon to achieve this effectively.
\n
It should be noted that epidural blockade may also be used for lower extremity amputation, especially if it will be a bilateral lower extremity amputation. There are studies that show pre-operative epidural placement in amputation patients prevent phantom limb pain due to stopping nociceptive input to the spinal cord [3]. There is no comparison of epidural to peripheral nerve catheters for lower extremity amputations, but on a practically note, peripheral nerve blockade will allow better mobilization and participation in physical therapy [3]. In addition, peripheral nerve block does not have the hemodynamic affects that epidural blockade can have [23].
\n
\n
\n
6. Pharmacology
\n
\n
6.1 Opioids
\n
Opioids remain a favored therapy for pain after surgery. They bind to Mu receptors in peripheral and central nerves as an agonist fashion to produce analgesia. They also can affect phantom limb pain by reducing cortical reorganization [10]. There is a wide variety to choose from post-operatively as they come in intravenous and oral formulation. Usually initially a parenteral opioid therapy with a patient-controlled analgesia (PCA) is started on post-operative day (POD) zero. Once the patient is tolerating a diet, the PCA is weaned down incrementally and oral opioid therapy is instituted. For opioid tolerant patients, we attempt to calculate their total daily morphine equivalent requirement and base our starting oral dose based on that. The goal is to wean off the PCA completely by 48 hours, coinciding with the discontinuation of other intravenous infusion [10].
Ketamine has been studied for post-operative pain. It has been shown that the use of this medication lowers the opioid requirements and reverses opioid tolerance needed for acute post-operative pain [24]. Ketamine is a noncompetitive NMDA receptor antagonist that targets primarily in the brain and spinal cord. The NMDA receptor is important for synaptic plasticity, central sensitization, amplification of pain signals and opioid tolerance. For amputations, it lowers the dorsal horn sensitization and stops the events that may lead to phantom limb pain and residual limb pain. Important to note, it will not prevent phantom limb pain but will reduce risks of phantom limb pain and residual limb pain [9]. Ketamine has also been shown to have anti-inflammatory properties which may be effective in the early pre-operative phase. Ketamine infusions can be started in the operating room and continued for 2–3 days post-operatively. Studies show low does ketamine infusions do reduce opioids immediately post-op but there was not a significant reduction in immediate post op pain ratings [2, 3, 10].
\n
\n
\n
6.3 Gabapentinoids
\n
Gabapentin and pregabalin are both anti-convulsant that inhibit alpha 2-delta subunit of voltage-gated calcium channels. They are structural like GABA neurotransmitter, but they are unable to bind to any GABA receptors. In addition to the use with seizures, it has been used for chronic pain, especially neuropathic in nature. Dosages must be titrated slowly, and results are not seen immediately. These doses also must be adjusted for patients with impaired renal function with the help of a pharmacist [25, 26]. However, some studies claim that its efficacy to treat phantom limb pain is inconclusive and limited by dose dependent side effects like somnolence and dizziness [2]. There are other studies more recently that show promise of administration of gabapentinoids for reducing chronic post-surgical pain and this can be exploited to amputees as well [3, 9, 10].
\n
\n
\n
6.4 Acetaminophen
\n
Acetaminophen’s exact mechanism of action is not well understood, but it is thought to reduce the production of prostaglandins in the brain. Prostaglandins are chemicals that cause inflammation and swelling. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. Acetaminophen administration to amputation patients will help with inflammation and an adjunct to help with post-surgical nociceptive pain, which has been shown to decrease opioid requirements. Acetaminophen dosages will be lowered in patients with pre-existing liver disease [27]. This will be the most beneficial in the early pre-operative phase. It may be especially beneficially to start prior to the amputation as part of a pre-emptive analgesia. This is thought to protect the central nervous system from noxious insults which result in the patient getting hyperalgesia and allodynia [10, 28].
\n
\n
\n
6.5 NSAIDs
\n
NSAIDs work by inhibiting the activity of cyclooxygenase enzymes (COX-1 or COX-2). By blocking the Cox enzymes, many prostaglandins are not made. This means that there is less swelling and less pain. Most NSAIDs block both Cox-1 and Cox-2 enzymes. For pain, this specifically looks at enzymes that work with prostaglandins for inflammation. Like acetaminophen, these medications work well in the acute perioperative phase for nociceptive pain and reducing opioid requirements. Their use can be limited due to post-operative bleeding concerns. Usually these medications do not help with chronic post amputation pain or phantom limb pain. A short course may be suitable for some patients that have normal renal function; however, we do not advocate for chronic NSAID therapy due to the risks of gastrointestinal bleeding and renal toxicity [10, 23, 29].
\n
\n
\n
6.6 Muscle relaxants
\n
As discussed earlier, acute post-operative pain can have spasmodic pain proximal to the stump site, likely due to tissue inflammation. This can also be present with residual limb pain in some patients. There are a variety of muscle relaxants that can be tried for a short period of time [30]. If the patient is on opioids, would be cautious of adding a benzodiazepine for muscle relaxant. There is a lack of adequate literature supporting the use of muscle relaxants for post amputation pain.
\n
\n
\n
6.7 Tri-cyclic antidepressants and selective norepinephrine reuptake inhibitors
\n
Anti-depressants are commonly prescribed for chronic neuropathic pain and coexisting depression that accompanies it. These medications work by inhibiting serotonin-epinephrine uptake blockade, NMDA receptor antagonism and sodium channel blockade. These medications have not been shown to work effectively in phantom limb pain in studies. These are not usually done in the perioperative setting as they require careful titration over weeks to months which is better done as outpatient therapy. Side effects of opioids and other modalities may warrant a small dose trial in the perioperative setting to help with uncontrolled acute or phantom limb pain [9, 10, 31].
\n
\n
\n
6.8 Calcitonin
\n
Calcitonin is a hormone secreted by thyroid gland in parafollicular cells. Unlike the parathyroid hormone, its job is to reduce calcium in the blood. There are synthetic forms of this used for chronic pain syndromes. The exact pain mechanism of action is unknown. There are mixed results of phantom limb pain [10]. The greatest benefit has been shown when it is administered early in the perioperative period; usually within the first 7 days [32]. There are reports of complete resolution of phantom limb pain with its use [9].
\n
\n
\n
\n
7. Therapeutic modalities
\n
There are many additional modalities that may be of benefit to amputee patients after the initial perioperative period to help with phantom limb pain and residual limb pain. Many of these involve experienced providers and therapists [2, 10, 12, 33, 34, 35, 36]. These are summarized in Table 2.
\n
\n
\n\n
\n
1. Desensitization techniques
\n
\n
\n
2. Mirror therapy
\n
\n
\n
3. Massage
\n
\n
\n
4. TENs
\n
\n
\n
5. Exercise
\n
\n
\n
6. Hot/cold therapy
\n
\n
\n
7. Biofeedback
\n
\n
\n
8. Peripheral nerve stimulation
\n
\n
\n
9. Prolonged peripheral nerve blockade
\n
\n
\n
10. Sympathetic nerve blocks
\n
\n
\n
11. Deep brain stimulators
\n
\n
\n
12. Spinal cord stimulators
\n
\n
\n
13. Neurolysis
\n
\n\n
Table 2.
Therapeutic modalities for chronic amputee limb pain.
\n
\n
\n
8. Conclusions
\n
As patient’s present for amputations, it is important to remember the care for these patients needs to be multi-disciplinary to prevent chronic pain. If perioperative pain plans are developed early and worked on as a team, the patient will benefit the most and have the best chance for success at not having long-term phantom limb pain and/or residual limb pain which adversely impact their quality of life. Psychological preparation is paramount but may not always be accomplished if amputation is needed in emergent or traumatic fashion. These patients can still be cared for effectively in a modified format with high success rate if early post-operative intervention is achieved.
\n
\n\n',keywords:"amputation, phantom pain, neuropathic pain",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/73273.pdf",chapterXML:"https://mts.intechopen.com/source/xml/73273.xml",downloadPdfUrl:"/chapter/pdf-download/73273",previewPdfUrl:"/chapter/pdf-preview/73273",totalDownloads:761,totalViews:0,totalCrossrefCites:0,dateSubmitted:"June 4th 2020",dateReviewed:"September 1st 2020",datePrePublished:"September 21st 2020",datePublished:"March 24th 2021",dateFinished:"September 21st 2020",readingETA:"0",abstract:"Considerable number of new amputations yearly in the United States and internationally represent considerable population experiencing pain that is not just acutely from surgical insult but chronically that is related to phantom limb pain and residual limb pain. This chronic pain can last from weeks to years in these patients and lead to other debilitation such as depression, anxiety and even opioid addiction. Early interventions help lessen long-term pain for these patients. These interventions include nerve blockade as well as multi-modal therapy. Understanding the pathophysiology of the pain experienced by these patients will better allow any provider to care for these patients effectively and help alleviate chronic pain in the long term.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/73273",risUrl:"/chapter/ris/73273",signatures:"Melinda S. Seering and Sangini Punia",book:{id:"9483",type:"book",title:"Pain Management",subtitle:"Practices, Novel Therapies and Bioactives",fullTitle:"Pain Management - Practices, Novel Therapies and Bioactives",slug:"pain-management-practices-novel-therapies-and-bioactives",publishedDate:"March 24th 2021",bookSignature:"Viduranga Yashasvi Waisundara, Ines Banjari and Jelena Balkić",coverURL:"https://cdn.intechopen.com/books/images_new/9483.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-897-6",printIsbn:"978-1-83880-026-0",pdfIsbn:"978-1-83880-898-3",isAvailableForWebshopOrdering:!0,editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"323090",title:"Dr.",name:"Melinda S.",middleName:null,surname:"Seering",fullName:"Melinda S. Seering",slug:"melinda-s.-seering",email:"melinda-seering@uiowa.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"329349",title:"Dr.",name:"Sangini",middleName:null,surname:"Punia",fullName:"Sangini Punia",slug:"sangini-punia",email:"sangini-punia@uiowa.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Pain classification with an emphasis on amputees",level:"1"},{id:"sec_3",title:"3. Pain signal transmission",level:"1"},{id:"sec_4",title:"4. Protocol for perioperative caring for amputation patients",level:"1"},{id:"sec_5",title:"5. Nerve blockade",level:"1"},{id:"sec_6",title:"6. Pharmacology",level:"1"},{id:"sec_6_2",title:"6.1 Opioids",level:"2"},{id:"sec_7_2",title:"6.2 N-Methyl-D-Aspartate (NMDA) Receptor Antagonists",level:"2"},{id:"sec_8_2",title:"6.3 Gabapentinoids",level:"2"},{id:"sec_9_2",title:"6.4 Acetaminophen",level:"2"},{id:"sec_10_2",title:"6.5 NSAIDs",level:"2"},{id:"sec_11_2",title:"6.6 Muscle relaxants",level:"2"},{id:"sec_12_2",title:"6.7 Tri-cyclic antidepressants and selective norepinephrine reuptake inhibitors",level:"2"},{id:"sec_13_2",title:"6.8 Calcitonin",level:"2"},{id:"sec_15",title:"7. Therapeutic modalities",level:"1"},{id:"sec_16",title:"8. Conclusions",level:"1"}],chapterReferences:[{id:"B1",body:'\nKuffler DP. Origins of phantom limb pain. Mol Neurobiol 2018;55:60-69.\n'},{id:"B2",body:'\nHsu E, Cohen SP. Postamputation pain: Epidemiology, mechanisms, and treatment. J Pain Res 2013;6:121-136.\n'},{id:"B3",body:'\nSrivastava D. Chronic post-amputation pain: Peri-operative management - review. Br J Pain 2017;11:192-202.\n'},{id:"B4",body:'\nGlaser JD, Bensley RP, Hurks R et al. Fate of the contralateral limb after lower extremity amputation. J Vasc Surg 2013;58:1571-1577.e1.\n'},{id:"B5",body:'\nBuckenmaier CC, 3rd, Kwon KH, Howard RS et al. Double-blinded, placebo-controlled, prospective randomized trial evaluating the efficacy of paravertebral block with and without continuous paravertebral block analgesia in outpatient breast cancer surgery. Pain Med 2010;11:790-799.\n'},{id:"B6",body:'\nHawamdeh ZM, Othman YS, Ibrahim AI. Assessment of anxiety and depression after lower limb amputation in jordanian patients. Neuropsychiatr Dis Treat 2008;4:627-633.\n'},{id:"B7",body:'\nde Mestral C, Hsu AT, Talarico R et al. End-of-life care following leg amputation in patients with peripheral artery disease or diabetes. Br J Surg 2020;107:64-72.\n'},{id:"B8",body:'\nMcKechnie PS, John A. Anxiety and depression following traumatic limb amputation: A systematic review. Injury 2014;45:1859-1866.\n'},{id:"B9",body:'\nNeil M. Pain after amputation. BJA Education 2016;16:107-112.\n'},{id:"B10",body:'\nKuffler DP. Coping with phantom limb pain. Mol Neurobiol 2018;55:70-84.\n'},{id:"B11",body:'\nJensen TS, Krebs B, Nielsen J, Rasmussen P. Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain 1983;17:243-256.\n'},{id:"B12",body:'\nUustal H, Meier RH, 3rd. Pain issues and treatment of the person with an amputation. Phys Med Rehabil Clin N Am 2014;25:45-52.\n'},{id:"B13",body:'\nWeeks SR, Anderson-Barnes VC, Tsao JW. Phantom limb pain: Theories and therapies. Neurologist 2010;16:277-286.\n'},{id:"B14",body:'\nSwaran Singh TS, Wikle, J. & Rastogi, R. Multifactorial pathophysiology. In: Abd-Elsayed A. Pain: A review guide. Cham Switzerland: Springer Nature Switzerland, 2019.\n'},{id:"B15",body:'\nZaky S, Zaky, C., and Abd-Elsayed, A. Anatomy of the nervous system. In: Abd-Elsayed A. Pain: A review guide. Cham, Switzerland: Springer Nature Switzerland, 2019.\n'},{id:"B16",body:'\nKaranikolas M, Aretha D, Tsolakis I et al. Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: A prospective, randomized, clinical trial. Anesthesiology 2011;114:1144-1154.\n'},{id:"B17",body:'\nHanley MA, Jensen MP, Smith DG, Ehde DM, Edwards WT, Robinson LR. Preamputation pain and acute pain predict chronic pain after lower extremity amputation. J Pain 2007;8:102-109.\n'},{id:"B18",body:'\nEphraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: Results of a national survey. Arch Phys Med Rehabil 2005;86:1910-1919.\n'},{id:"B19",body:'\nRetreived from:\nHttps://www.Cdha.Nshealth.Ca/amputee-rehabilitation-musculoskeletal-program/patients-families-amputee-rehabilitation/coping-your-.\n'},{id:"B20",body:'\nService UKNH. Retreived from:Https://www.Nhs.Uk/conditions/amputation/. 2020.\n'},{id:"B21",body:'\nAyling OG, Montbriand J, Jiang J et al. Continuous regional anaesthesia provides effective pain management and reduces opioid requirement following major lower limb amputation. Eur J Vasc Endovasc Surg 2014;48:559-564.\n'},{id:"B22",body:'\nBosanquet DC, Glasbey JC, Stimpson A, Williams IM, Twine CP. Systematic review and meta-analysis of the efficacy of perineural local anaesthetic catheters after major lower limb amputation. Eur J Vasc Endovasc Surg 2015;50:241-249.\n'},{id:"B23",body:'\nDe Jong R, Shysh AJ. Development of a multimodal analgesia protocol for perioperative acute pain management for lower limb amputation. Pain Res Manag 2018;2018:5237040.\n'},{id:"B24",body:'\nBell RF, Kalso EA. Ketamine for pain management. Pain Rep 2018;3:e674.\n'},{id:"B25",body:'\nO’Connor AB, Dworkin RH. Treatment of neuropathic pain: An overview of recent guidelines. Am J Med 2009;122:S22–S32.\n'},{id:"B26",body:'\nDworkin RH, O’Connor AB, Backonja M et al. Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain 2007;132:237-251.\n'},{id:"B27",body:'\nMartinez V, Beloeil H, Marret E, Fletcher D, Ravaud P, Trinquart L. Non-opioid analgesics in adults after major surgery: Systematic review with network meta-analysis of randomized trials. Br J Anaesth 2017;118:22-31.\n'},{id:"B28",body:'\nSyal K, Goma M, Dogra RK, Ohri A, Gupta AK, Goel A. “Protective premedication”: A comparative study of acetaminophen, gabapentin and combination of acetaminophen with gabapentin for post-operative analgesia. J Anaesthesiol Clin Pharmacol 2010;26:531-536.\n'},{id:"B29",body:'\nMelsom H, Danjoux G. Perioperative care for lower limb amputation in vascular disease. Continuing Education in Anaesthesia Critical Care & Pain 2011;11:162-166.\n'},{id:"B30",body:'\nKetz AK. The experience of phantom limb pain in patients with combat-related traumatic amputations. Arch Phys Med Rehabil 2008;89:1127-1132.\n'},{id:"B31",body:'\nPilowsky I, Hallett EC, Bassett DL, Thomas PG, Penhall RK. A controlled study of amitriptyline in the treatment of chronic pain. Pain 1982;14:169-179.\n'},{id:"B32",body:'\nHall N, Abd-Elsayed, A, & Eldabe, S. Phantom limb pain. In: Abd-Elsayed A. Pain: A review guide. Cham, Switzerland: Springer Nature Switzerland, 2019.\n'},{id:"B33",body:'\nKaur A, Guan Y. Phantom limb pain: A literature review. Chin J Traumatol 2018;21:366-368.\n'},{id:"B34",body:'\nBorghi B, D’Addabbo M, White PF et al. The use of prolonged peripheral neural blockade after lower extremity amputation: The effect on symptoms associated with phantom limb syndrome. Anesth Analg 2010;111:1308-1315.\n'},{id:"B35",body:'\nRauck RL, Cohen SP, Gilmore CA et al. Treatment of post-amputation pain with peripheral nerve stimulation. Neuromodulation 2014;17:188-197.\n'},{id:"B36",body:'\nHerrador Colmenero L, Perez Marmol JM, Martí-García C et al. Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: A systematic review. Prosthet Orthot Int 2018;42:288-298.\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Melinda S. Seering",address:"melinda-seering@uiowa.edu",affiliation:'
'}],corrections:null},book:{id:"9483",type:"book",title:"Pain Management",subtitle:"Practices, Novel Therapies and Bioactives",fullTitle:"Pain Management - Practices, Novel Therapies and Bioactives",slug:"pain-management-practices-novel-therapies-and-bioactives",publishedDate:"March 24th 2021",bookSignature:"Viduranga Yashasvi Waisundara, Ines Banjari and Jelena Balkić",coverURL:"https://cdn.intechopen.com/books/images_new/9483.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-897-6",printIsbn:"978-1-83880-026-0",pdfIsbn:"978-1-83880-898-3",isAvailableForWebshopOrdering:!0,editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. 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Its proper electronic band structure, surface chemistry and hydrophilic nature provide a reactive surface for interfacing with different organic and inorganic photon capturing materials in photovoltaics. Here, we review its enabling role in incorporating two special materials toward biophotovoltaics, including photosynthetic protein complexes extracted from plants and plasmonic nanoparticles (e.g., gold or silver nanoparticles), which interplay to enhance the absorption and utilization of sun light. We will first give a brief introduction to the TiO2 photoanode, including preparation, optical and electrochemical properties, and then summarize our recent research and other related literature on incorporating photosynthetic light harvest complexes and plasmonic nanoparticles onto anatase TiO2 photoanodes as a means to tap into the charge separation, electron and energy transfer, and photovoltaic enhancements in the bio-photovoltaics.",signatures:"Yiqun Yang and Jun Li",authors:[{id:"202682",title:"Prof.",name:"Jun",surname:"Li",fullName:"Jun Li",slug:"jun-li",email:"junli@ksu.edu"},{id:"206089",title:"Dr.",name:"Yiqun",surname:"Yang",fullName:"Yiqun Yang",slug:"yiqun-yang",email:"yangyiqun8682@gmail.com"}],book:{id:"6407",title:"Application of Titanium Dioxide",slug:"application-of-titanium-dioxide",productType:{id:"1",title:"Edited Volume"}}},{id:"58455",title:"Dielectrophoresis-Assisted Pathogen Detection on Vertically Aligned Carbon Nanofibers Arrays in a Microfluidic Device",slug:"dielectrophoresis-assisted-pathogen-detection-on-vertically-aligned-carbon-nanofibers-arrays-in-a-mi",abstract:"In this chapter, we focus on utilizing nanoelectrode arrays fabricated with vertically carbon nanofibers (VACNFs) for pathogen detection based on a “point-and-lid” dielectrophoretic device in a microfluidic channel. This technique is utilized to concentrate particles from the bulk flow and detect pathogens based on fluorescence, surface-enhanced Raman spectroscopy (SERS) and impedance measurements. The advantage of VACNFs is their ultrasmall diameter (~100 nm) and the high aspect ratio (50:1). When coupled with a macroscopic indium tin oxide (ITO) electrode, it produces a large electric field gradient (∇E2 = ~1019 − 1020 V2 m−3) which is harnessed for pathogen detection based on dielectrophoresis. Several noninfectious pathogens including bacteria Escherichia coli DHα5, inactivated vaccinia virus (species: Copenhagen strain, VC-2), and Bacteriophage T4r were utilized as model species to study the size effect and kinetics of dielectrophoretic capture in this study. The comparable size of the nanoelectrode produced strong interaction with virus particles, generating striking lightning capture patterns and high detection sensitivity. The dielectrophoretic capture at the nanoelectrode arrays is successfully integrated with a portable Raman probe as a microfluidic chip for ultrasensitive detection of bacteria E. coli DHα5 using SERS-tagged gold nanoparticles co-functionalized with specific antibodies.",signatures:"Foram Ranjeet Madiyar, Omer Farooq and Jun Li",authors:[{id:"202682",title:"Prof.",name:"Jun",surname:"Li",fullName:"Jun Li",slug:"jun-li",email:"junli@ksu.edu"},{id:"222737",title:"Dr.",name:"Foram",surname:"Madiyar",fullName:"Foram Madiyar",slug:"foram-madiyar",email:"madiyarf@erau.edu"},{id:"230660",title:"Prof.",name:"Omer",surname:"Farooq",fullName:"Omer Farooq",slug:"omer-farooq",email:"farooqm@erau.edu"}],book:{id:"6319",title:"Biosensing Technologies for the Detection of Pathogens",slug:"biosensing-technologies-for-the-detection-of-pathogens-a-prospective-way-for-rapid-analysis",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"67211",title:"Dr.",name:"Jenny",surname:"Murase",slug:"jenny-murase",fullName:"Jenny Murase",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/67211/images/1985_n.jpg",biography:"Dr. Jenny Eileen Murase is an Assistant Clinical Professor of Dermatology at the University of California, San Francisco, and the Director of Phototherapy for the Palo Alto Foundation Medical Group. Dr. Murase received her medical degree from the University of California, Irvine; she received the Dean’s award and was the first graduate with distinction in clinical research. Board certified in dermatology, she is currently the editor of the Women’s Dermatologic Society. Active in clinical research and teaching, she was voted by the UCSF dermatology residents best dermatology instructor among the adjunct clinical faculty in 2010. Course director at the American Academy of Dermatology Annual meeting the past four years, she serves on the AAD Needs Assessment and Educational Program Evaluation Committee Task Force and the Professional Expert Evaluation Review Program. Dr. Murase has coauthored more than 40 peer-reviewed book chapters and articles, and actively reviews for five major dermatology journals.",institutionString:null,institution:{name:"University of California, San Francisco",institutionURL:null,country:{name:"United States of America"}}},{id:"163884",title:"Prof.",name:"Luca",surname:"Marchiol",slug:"luca-marchiol",fullName:"Luca Marchiol",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Udine",institutionURL:null,country:{name:"Italy"}}},{id:"185599",title:"Dr.",name:"Simone",surname:"Sprio",slug:"simone-sprio",fullName:"Simone Sprio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"202041",title:"Dr.",name:"Alessandro",surname:"Mattiello",slug:"alessandro-mattiello",fullName:"Alessandro Mattiello",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"202835",title:"Ms.",name:"Megha",surname:"Trivedi",slug:"megha-trivedi",fullName:"Megha Trivedi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Michigan Medical School",institutionURL:null,country:{name:"United States of America"}}},{id:"202983",title:"Dr.",name:"Simón",surname:"Navarro",slug:"simon-navarro",fullName:"Simón Navarro",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Murcia",institutionURL:null,country:{name:"Spain"}}},{id:"202988",title:"Dr.",name:"Nuria",surname:"Vela",slug:"nuria-vela",fullName:"Nuria Vela",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Católica San Antonio de Murcia",institutionURL:null,country:{name:"Spain"}}},{id:"202989",title:"Dr.",name:"José",surname:"Fenoll",slug:"jose-fenoll",fullName:"José Fenoll",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"206059",title:"Dr.",name:"Gabriel",surname:"Pérez-Lucas",slug:"gabriel-perez-lucas",fullName:"Gabriel Pérez-Lucas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Murcia",institutionURL:null,country:{name:"Spain"}}},{id:"206089",title:"Dr.",name:"Yiqun",surname:"Yang",slug:"yiqun-yang",fullName:"Yiqun Yang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{},components:[]},successStories:{items:[]},authorsAndEditors:{filterParams:{},profiles:[{id:"6700",title:"Dr.",name:"Abbass A.",middleName:null,surname:"Hashim",slug:"abbass-a.-hashim",fullName:"Abbass A. 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He first worked as a consultant at Vodafone-Spain. From 2004 to 2011, he was a Research Assistant with the Communications Engineering Department at the University of Málaga. In 2011, he became an Assistant Professor in the same department. From 2012 to 2015, he was with Ericsson Spain, where he was working on geo-location\ntools for third generation mobile networks. Since 2015, he is a Marie-Curie fellow at the Denmark Technical University. 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