Sample size calculation techniques are provided.
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"8626",leadTitle:null,fullTitle:"Parkinson's Disease and Beyond - A Neurocognitive Approach",title:"Parkinson's Disease and Beyond",subtitle:"A Neurocognitive Approach",reviewType:"peer-reviewed",abstract:"Parkinson's Disease and Beyond - A Neurocognitive Approach aims to bring together in a single publication the knowledge of diagnosis and characterization of the clinical and neuropsychological profile in Parkinson's disease. The strong impulse to research this topic has produced in recent years a large literature that documents the high level of complexity of the issue. Due to this complexity, a reasoned multidimensional analysis able to integrate expertise of different disciplines (neurology, neuropsychology, neuroradiology, and neuroscience) is necessary. This book offers an excellent synopsis of perspectives, methods, empirical evidences, and international references. It represents an extraordinary opportunity to target challenging unmet needs and to outline new horizons in Parkinson's disease research.",isbn:"978-1-83880-869-3",printIsbn:"978-1-83962-648-7",pdfIsbn:"978-1-83880-870-9",doi:"10.5772/intechopen.79277",price:100,priceEur:109,priceUsd:129,slug:"parkinson-s-disease-and-beyond-a-neurocognitive-approach",numberOfPages:84,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"7407cfb0a38d3c1b8dd1c578c804fc8d",bookSignature:"Sara Palermo, Mario Stanziano and Rosalba Morese",publishedDate:"June 19th 2019",coverURL:"https://cdn.intechopen.com/books/images_new/8626.jpg",numberOfDownloads:5500,numberOfWosCitations:0,numberOfCrossrefCitations:6,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:8,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:14,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 4th 2018",dateEndSecondStepPublish:"September 3rd 2018",dateEndThirdStepPublish:"November 2nd 2018",dateEndFourthStepPublish:"January 21st 2019",dateEndFifthStepPublish:"March 22nd 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"233998",title:"Ph.D.",name:"Sara",middleName:null,surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo",profilePictureURL:"https://mts.intechopen.com/storage/users/233998/images/system/233998.png",biography:"Sara Palermo has an MSc in clinical psychology and a PhD in experimental neuroscience. She is specialty chief editor of Frontiers in Psychology, Neuropsychology, and scientific director of the Italian National Institute of Philanthropy, Filantropolis. She is a member of the Italian Society of Neuropsychology, the Italian Association of Psychogeriatrics, the Italian Society of Neurology for Dementia, and the Society for Interdisciplinary Placebo Studies. She was a member of the European Innovation Partnership on Active and Healthy Ageing (EIP AHA), for which she was involved in Action Group A3: Action for Prevention of Functional Decline and Frailty. Dr Palermo works as a researcher at the Department of Psychology - University of Turin (Italy) and as Scientific Consultant at the Fondazione IRCCS, Istituto Neurologico Carlo Besta (FINCB), Milan, Italy.",institutionString:"University of Turin, Italy & The Foundation of the Carlo Besta Neurological Institute IRCCS",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"6",totalChapterViews:"0",totalEditedBooks:"5",institution:{name:"University of Turin",institutionURL:null,country:{name:"Italy"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"260481",title:"Dr.",name:"Mario",middleName:null,surname:"Stanziano",slug:"mario-stanziano",fullName:"Mario Stanziano",profilePictureURL:"https://mts.intechopen.com/storage/users/260481/images/system/260481.jpg",biography:"Mario Stanziano is a physician, currently resident in Diagnostic Imaging at the University of Milan, cooperating with the Brain Imaging Center and the Trauma Center of Turin. He has been working with the neural network morphology lab of the University of Naples Vanvitelli in the Human Anatomy Department. As a neuroimager he is actively engaged in the study of normal and pathological brain connectivity both under functional and structural perspectives. In particular, he is studying structuro-functional magnetic resonance imaging features of neurological disorders characterised by consciousness impairment in its broadest sense.",institutionString:"Radiology Institute, University of Turin",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Turin",institutionURL:null,country:{name:"Italy"}}},coeditorTwo:{id:"214435",title:"Dr.",name:"Rosalba",middleName:null,surname:"Morese",slug:"rosalba-morese",fullName:"Rosalba Morese",profilePictureURL:"https://mts.intechopen.com/storage/users/214435/images/system/214435.jpg",biography:"Rosalba Morese, born in Italy, holds a bachelor\\'s degree in psychology at the University of Parma and a Ph.D. in neuroscience at the University of Turin. She aims to develop new techniques and approaches in cognitive science and social neuroscience. She is an expert in experimental neuroscience, neuroeconomics, psychophysiology, and cognitive and social neuroscience. She performs neuroimaging studies in social contexts in order to investigate neural correlates involved during social interactions, such as, social exclusion, social support, empathy, communicative intention, social decision-making, in-group and out-group settings, etc. She currently works at Università della Svizzera italiana, Lugano, Switzerland.\n\nFor more information: http://usi.to/xuj",institutionString:"Faculty of Biomedical Sciences",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"8",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"Universita della Svizzera Italiana",institutionURL:null,country:{name:"Switzerland"}}},coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1053",title:"Cognitive Psychology",slug:"cognitive-psychology"}],chapters:[{id:"67127",title:"Introductory Chapter: Targeting Unmet Needs in Parkinson’s Disease",doi:"10.5772/intechopen.86396",slug:"introductory-chapter-targeting-unmet-needs-in-parkinson-s-disease",totalDownloads:892,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"Sara Palermo, Rosalba Morese and Mario Stanziano",downloadPdfUrl:"/chapter/pdf-download/67127",previewPdfUrl:"/chapter/pdf-preview/67127",authors:[{id:"233998",title:"Ph.D.",name:"Sara",surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo"},{id:"214435",title:"Dr.",name:"Rosalba",surname:"Morese",slug:"rosalba-morese",fullName:"Rosalba Morese"},{id:"262793",title:"Dr.",name:"Mario",surname:"Stanziano",slug:"mario-stanziano",fullName:"Mario Stanziano"}],corrections:null},{id:"64411",title:"Mitochondrial KATP Channel and Dopaminergic Vulnerability Neurons in Parkinson’s Disease",doi:"10.5772/intechopen.81862",slug:"mitochondrial-k-sub-atp-sub-channel-and-dopaminergic-vulnerability-neurons-in-parkinson-s-disease",totalDownloads:1154,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The motor deficiency control commonly characterizes Parkinson’s disease (PD), resulting in impairment of neuromuscular command, because of basal ganglia nuclei degeneration and late formation of Lewy’s bodies in the remaining dopaminergic (DA) neurons. Motor signals are triggered in high cortical motor areas and go toward the midbrain regions, where the final tuning movement takes place. PD is characterized primarily by the death of dopaminergic neurons in the regions known as substantia nigra compacta (STNc). Mutations in a couple of genes, such as Parkin1 and DJ1, correspond to the usual familial form of the disease, due to its association with oxidative stress and depolarization of mitochondrial membrane. However, this form does not explain the selective pattern of apoptosis between the neuronal dopaminergic areas of midbrain regions. In this chapter, we are putting forward the hypothesis of oxidative stress and mitochondrial changes as the apparent most relevant cause in PD, as well as the neuroprotective role played by Kir6.2, a potassium-ATP channel and calcium voltage-gated v1.3.",signatures:"Gesivaldo Santos, Julita Maria Pereira Borges, Marcos Avilla-Rodriguez, Érika Pereira Rubio, Cattiúscia Batista Bromochenkel, Djalma Menezes Oliveira, Jane Lima dos Santos, Rosane Moura Aguiar, Milena Mascarenhas Ferraz, Silvana Batista Gaino, Francisco Capani and George E. Barreto",downloadPdfUrl:"/chapter/pdf-download/64411",previewPdfUrl:"/chapter/pdf-preview/64411",authors:[{id:"120703",title:"Dr.",name:"Francisco",surname:"Capani",slug:"francisco-capani",fullName:"Francisco Capani"},{id:"125352",title:"Dr.",name:"George E.",surname:"Barreto",slug:"george-e.-barreto",fullName:"George E. Barreto"},{id:"214511",title:"Ph.D.",name:"Gesivaldo",surname:"Santos",slug:"gesivaldo-santos",fullName:"Gesivaldo Santos"},{id:"215965",title:"Dr.",name:"Marcos",surname:"Avilla-Rodriguez",slug:"marcos-avilla-rodriguez",fullName:"Marcos Avilla-Rodriguez"},{id:"278028",title:"Dr.",name:"Julita Maria Pereira",surname:"Borges",slug:"julita-maria-pereira-borges",fullName:"Julita Maria Pereira Borges"},{id:"278260",title:"Prof.",name:"Djalma Menezes",surname:"Oliveira",slug:"djalma-menezes-oliveira",fullName:"Djalma Menezes Oliveira"},{id:"278263",title:"BSc.",name:"Érika Pereira",surname:"Rubio",slug:"erika-pereira-rubio",fullName:"Érika Pereira Rubio"},{id:"278320",title:"Prof.",name:"Jane Lima",surname:"dos Santos",slug:"jane-lima-dos-santos",fullName:"Jane Lima dos Santos"},{id:"278323",title:"B.Sc.",name:"Cattiúscia",surname:"Batista Bromochenkel",slug:"cattiuscia-batista-bromochenkel",fullName:"Cattiúscia Batista Bromochenkel"},{id:"298983",title:"Dr.",name:"Rosane Moura",surname:"Aguiar",slug:"rosane-moura-aguiar",fullName:"Rosane Moura Aguiar"},{id:"298984",title:"Dr.",name:"Silvana Batista",surname:"Gaino",slug:"silvana-batista-gaino",fullName:"Silvana Batista Gaino"},{id:"298986",title:"Dr.",name:"Milena Mascarenhas",surname:"Ferraz",slug:"milena-mascarenhas-ferraz",fullName:"Milena Mascarenhas Ferraz"}],corrections:null},{id:"63549",title:"The Causative and Curative Roles of Brain-Derived Neurotrophic Factor in Parkinson’s Disease",doi:"10.5772/intechopen.81215",slug:"the-causative-and-curative-roles-of-brain-derived-neurotrophic-factor-in-parkinson-s-disease",totalDownloads:1376,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Parkinson’s disease (PD) is characterized by the activation of degenerative and inflammatory processes in brain circuits that control movement and, according to the degree of progression of the damage, can cause neuropsychological disorders such as cognitive dysfunction. Changes in gene expression profile or post-translational modifications in secretory proteins such as neurotrophic factors could define the disease progression. Brain-derived neurotrophic factor (BDNF) is relevant, because it not only participates in neuronal survival, neurotransmission, dendritic growth and cellular communication but also in disease progression. In this chapter, considering both experimental evidences and clinical reports, the authors will analyze the contribution of BDNF as one of the causes of neurodegeneration and neuroinflammation; discuss the participation of this neurotrophic factor in the development of cognitive dysfunction, and finally the scope of novel BDNF-based therapies for PD.",signatures:"Daniel Hernandez-Baltazar, Rasajna Nadella, Tamara Cibrian-Llanderal, Abraham Puga-Olguín, Abril Alondra Barrientos-Bonilla, Laura Mireya Zavala-Flores, Arnulfo Villanueva-Olivo, Aurora Sanchez-Garcia, Maria de Jesús Rovirosa-Hernández and Jesus Daniel Rembao-Bojorquez",downloadPdfUrl:"/chapter/pdf-download/63549",previewPdfUrl:"/chapter/pdf-preview/63549",authors:[{id:"98494",title:"BSc.",name:"Aurora",surname:"Sánchez-García",slug:"aurora-sanchez-garcia",fullName:"Aurora Sánchez-García"},{id:"174651",title:"Dr.",name:"Abraham",surname:"Puga-Olguín",slug:"abraham-puga-olguin",fullName:"Abraham Puga-Olguín"},{id:"209886",title:"Dr.",name:"Tamara",surname:"Cibrian-Llanderal",slug:"tamara-cibrian-llanderal",fullName:"Tamara Cibrian-Llanderal"},{id:"210173",title:"Dr.",name:"Daniel",surname:"Hernandez-Baltazar",slug:"daniel-hernandez-baltazar",fullName:"Daniel Hernandez-Baltazar"},{id:"219107",title:"Dr.",name:"Rasajna",surname:"Nadella",slug:"rasajna-nadella",fullName:"Rasajna Nadella"},{id:"219108",title:"Dr.",name:"Maria De Jesus",surname:"Rovirosa-Hernandez",slug:"maria-de-jesus-rovirosa-hernandez",fullName:"Maria De Jesus Rovirosa-Hernandez"},{id:"219110",title:"Dr.",name:"Laura Mireya",surname:"Zavala-Flores",slug:"laura-mireya-zavala-flores",fullName:"Laura Mireya Zavala-Flores"},{id:"263916",title:"Dr.",name:"Abril Alondra",surname:"Barrientos-Bonilla",slug:"abril-alondra-barrientos-bonilla",fullName:"Abril Alondra Barrientos-Bonilla"},{id:"264090",title:"Dr.",name:"Arnulfo",surname:"Villanueva-Olivo",slug:"arnulfo-villanueva-olivo",fullName:"Arnulfo Villanueva-Olivo"},{id:"271563",title:"Dr.",name:"Jesus Daniel",surname:"Rembao-Bojorquez",slug:"jesus-daniel-rembao-bojorquez",fullName:"Jesus Daniel Rembao-Bojorquez"}],corrections:null},{id:"64517",title:"Neuroimaging in Parkinson Disease",doi:"10.5772/intechopen.82308",slug:"neuroimaging-in-parkinson-disease",totalDownloads:1198,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Over many decades, neuroimaging which included structural, functional and molecular modalities—have provided invaluable insights into the mechanisms underlying Parkinson disease (PD). These studies have shown changes in brain structure and metabolic activity. Although it is now considered to be complex, still neuroimaging modalities are recommended for routine use in clinical practice. Special sequences such as susceptibility weighted and proton density sequences are recommended for characterization. Now, the world is switching more towards the deep brain stimulation so the neuroimaging also helps in pretreatment planning and post treatment complications assessments. This chapter discusses the radiological anatomy, sequencing and imaging appearances. It will also discuss new approaches with potential applicability to clinical practice.",signatures:"Roohi Mohammad and Fatima Mubarak",downloadPdfUrl:"/chapter/pdf-download/64517",previewPdfUrl:"/chapter/pdf-preview/64517",authors:[{id:"138863",title:"Dr.",name:"Fatima",surname:"Mubarak",slug:"fatima-mubarak",fullName:"Fatima Mubarak"},{id:"279690",title:"Dr.",name:"Roohi",surname:"Mohammad",slug:"roohi-mohammad",fullName:"Roohi Mohammad"}],corrections:null},{id:"67157",title:"Levodopa-Induced Dyskinesias and Dyskinesias-Reduced-Self-Awareness in Parkinson’s Disease: A Neurocognitive Approach",doi:"10.5772/intechopen.86384",slug:"levodopa-induced-dyskinesias-and-dyskinesias-reduced-self-awareness-in-parkinson-s-disease-a-neuroco",totalDownloads:880,totalCrossrefCites:3,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Levodopa-induced dyskinesias are one of the most common disabling motor complications in advanced Parkinson’s disease. The subjective perception of motor impairment is a clinical phenomenon that needs to be adequately analyzed. Indeed, the determination of patient dyskinesias-reduced-self-awareness (DRSA) and of its relationship to daily dysfunction is an important aspect of the debate on the gold standard for treatment. As the association with executive dysfunction is a matter of debate and we hypothesize it plays an important role in DRSA, we analyzed metacognitive abilities related to action monitoring and other factors, such as response-inhibition and “Theory of Mind,” which represent a novel explanation of the phenomenon. Moreover, we investigated whether and how a dysfunction in action monitoring related to the cingulo-frontal-ventral striatal circuit would be associated with DRSA using an event-related Go-NoGo fMRI experiment. 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Most of the strategic sales and marketing decisions are taken by processing these data. For example, strategies such as cross-sell, up-sell, or risk management are being created as a result of processing the customer data. Because of the increasing number of customers and the need for a higher processing capacity, it has made it more difficult to identify the customer requirements in a rapid and accurate way and to present solution recommendations. Innovative data mining applications and techniques are required to solve this issue [1].
The market basket analysis is one of the data mining methods applied to identify the pattern which is found in product ownership data of customers. Thanks to this analysis, a pattern among the products frequently bought together by the customers can be established. The obtained pattern plays an active role in developing cross-sell and up-sell strategies.
Market basket analysis consists of two main processes. These are clustering and association processes, respectively. The clustering process involves grouping of similar customers in terms of clusters. Thus, those customers which should be examined in the same category will be identified. During the association process, commonness in buying behavior of customers through a selected cluster is being identified, assuming that clustered customers having similar characteristics would demonstrate similar buying behaviors.
As the banking databases have grown up to a very high volume, the association process has become a very costly process in terms of time and memory consumption. In order to improve the time and memory performance, sampling process should be included in the previous phase of association.
In this regard, a sample which involves less observations in comparison to the whole data is used. We use the term “space” to refer the whole data set. In case the representation capability of the obtained sampling is high, loss of data is minimized, and the association process is realized through the sample instead of the space itself. Thus, less data shall be processed, and association rules (ARs) shall be obtained faster by consuming less memory.
As the subject of this book chapter was focused onto the banking data, customer segmentation conducted by the bank data was accepted as the clustering. As a result of the segmentation, clusters created by similar customers were used as input of sampling.
In this chapter, sample creation methods, techniques to find ideal sampling size, the space representing capability of these samples generated by these techniques, and association rules discovered through these samples were examined, respectively. Association rules obtained from both the space and sample were used to verify the sampling process. Besides, the spared amount in terms of time consumption was calculated.
This book chapter was organized as follows: Section 2 explains the studies toward deriving association rules through the space and sampling. Section 3 explains the parameters required to obtain association rules and the Apriori algorithm. Section 4 contains parameters to create the sample, sample creation methods, and the techniques used to calculate the sample size. Section 5 examines association rules obtained from the space and the sample and the results showing the representation capability of the sample for the respective space and the results showing rewards in terms of time consumption. Section 6 gives an overview and concludes the chapter.
In association rule mining, first the item sets, which are found together frequently, are found, and then the rules are obtained from these item sets.
Association algorithms are classified according to characteristics of the obtained item sets. In early studies Agrawal-Imielinski-Swami (AIS) algorithm which was allowed to find wide item sets was used, and then algorithms were found such as Apriori, which were used frequently now and which were able to process the bigger data sets faster [2].
The mutual usage of association discovery and sample creation methods is not a new approach. Sample creation studies toward association detection have begun with papers demonstrating mathematically that it was possible to create a sample which maintained the characteristics of the space. The following studies involved several techniques calculating the optimal number of observations [3, 4, 5, 6, 7].
At the beginning of the sample size detection studies, the data to be sampled were not considered; they have tried to determine the sample size using parameters not depending on the data such as margin of error, minimum support, and minimum confidence [3]. In current studies, formulas (using variables such as maximal process length or Vapnik-Chervonenkis (VC) size of the data cluster) considering the data characteristics have appeared [4, 5, 6, 7]. There exists a number of studies focusing on how the management of metadata of big data sets are provided in a distributed computing setting [8, 9, 10, 11]. Moreover, there exists a number of studies that are conducted in the field of information systems for managing distributed data storage platforms [12, 13, 14, 15, 16]. Unlike these studies, this chapter focuses on extracting meaningful information, i.e. association rules, from the big data sets. Initial results of the experimental studies, covered in this chapter, were reported in a previous study [17]. Sections 3 and 4 give detailed information on association detection and sample creation methods, respectively, and explain the techniques used in this study.
In data mining, it is used to determine the pattern found among the association algorithms and observations [2, 18, 19]. In case any organization’s transaction database is discussed, an analogy can be established between the observations and customers and between areas where a pattern is tried to be found and the bought products. Patterns obtained by association algorithms are processed to obtain association rules.
Association rules may be defined as follows: let us call each subset of products within the database an “itemset,” and let us call each set of products purchased together by the customer a “transaction.” The support count of any itemset is defined as the number of transactions associated with the items in the set within the database. The support indicates the ratio of support count to the number of transactions within the database. The itemset which meets the minimum support requirement is called the frequent itemset (FI).
For example, if a database with 10 transactions contains product A in 3 different transactions, then the product A’s support count is 3, and its support is 0.3. In case the minimum support is defined by a value lower than 0.3, then the product A will be classified as FI.
There are several algorithms deriving FI using the transactions within the database [2, 18]. In this chapter, Apriori algorithm was preferred due its ability of deriving all itemsets within the space. This algorithm derives primarily candidate itemsets starting with one-element itemset from the database. Those providing minimum support from candidate itemsets are filtered and recorded as FI. New candidate itemsets are created from the FI obtained in the previous step by increasing the number of elements. In each step, the candidate itemsets are passed through a minimum support test, and the algorithm continues until no FI with k-elements can be generated.
Among the elements of the FI obtained from the database, it is possible to derive association rules in A- > B format. Then, AR’s support gets equal to AUB itemset support. The confidence is defined as the ratio of AUB itemset support to the A itemset support. AR should meet the minimum confidence requirement specified by the customer [2].
Assuming that A - > B rule has a support of s and the confidence of
To find out all ARs within the database, a rule mining algorithm is applied to each FI obtained. Candidate rule combinations are created for rule mining among all subsets of a selected FI in A - > B format. Those providing minimal confidence from candidate rules are filtered and recorded as association rule.
Sample creation is the process of creating a subset containing the characteristics of a data set. The subset created through sampling is expected to represent the data set (space). In traditional statistical methods, the similarity of two data sets is measured by either χ2 test or Kolmogorov–Smirnov (K-S) test.
In this study, these tests were utilized, in order to measure the similarity of the created sample in comparison with its space. A comparison was conducted through p values (the probability
Sample creation is discussed under two topics, i.e., sample creation methods and sample size determination techniques. Sample creation methods are explained in Chapter 4.1 and sample size determination techniques explained in Chapter 4.2.
When creating samples from the space, it is possible to use several sample creation methods. These methods are classified according to the selection of observations from the space. The main sample creation methods are as follows:
The observations within the space are selected without following a specific routine. The selection probability of each observation is equal.
This is used where the observations within the space can be divided into groups. The samples are created maintaining the ratio between the number of observations of groups within the space and the total number of observations. The selection probability of each observation in the same stratus is equal.
This is used where the observations within the space can be divided into groups. After the groups are determined, they are selected using the simple random sampling method. All observations within selected groups are included into the sample.
This is used where the observations within the space can be divided into groups. After the groups are determined, groups are selected by the simple random sampling method. Unlike cluster sampling, observations to be selected from groups are determined by the simple random sampling method.
Among the mentioned methods, the simple random sampling method stands up by its high speed. As the methods, which require creation of groups within the space and sorting of observations, need a pre-analysis, their time consumption is more than the simple random sampling method.
The expected parameter in sample creation methods is the size of the sample to be created. When the optimal sample size is calculated, a number which will not decrease its space representing capability should be found. Under association detection algorithms, it is important to derive all FIs and ARs within the space from the sample. In this study, techniques specialized on association detection algorithms have been examined from those developed for sample size determination [3, 4, 5, 7]. Sample size determination techniques are divided into two groups to minimize the FI and AR loss.
When the association algorithms will be run using the same parameters, support and confidence values calculated from the sample appear to be different than their counterparts calculated from the space. This margin of error is measured using two different methods. When calculating absolute margin of error, the absolute value of the difference between values from the space and the sample is considered. The relative margin of error is calculated by dividing absolute margin of error into the value within the space. In Table 1, the lines containing “absolute” at the “type of technique” column aim at reducing absolute margin of error, while those containing “relative” aim to minimize relative margin of error.
Sample size calculation techniques are provided.
Minimal sample size can be determined in terms of accuracy
All examined techniques are shown in Table 1 with suggested formulas and type of formula. The values found through the techniques determine the minimum number of transactions required for sample creation. The number of transactions which are equal to the values found is selected from the space by the preferred sample creation method.
Sample size determination techniques determine the minimum number of transactions required for sample creation. The number of transactions which are equal to the values found is selected from the space by the preferred sample creation method.
The complexity of the space is calculated theoretically using the Vapnik-Chervonenkis size [20]. Assuming that the transactions within the database are sorted according to their number of elements and that the “number of transactions” and “number of elements” are plotted on the coordinate system, the d-index value would correspond to the edge length of the largest square.
In this study, we use a d-index algorithm, which does not seek a sorting requirement among the transactions, and it calculates
The tests were performed on product ownership data of banking customers. Statistical studies’ code development was performed on the widely used R programming language.
When tests were performed, the steps below were followed:
Determine the sample size utilizing various techniques
Create three different samples for each technique using the simple random sampling method
Compare the representability of the space for the obtained sample examination with
Use the Apriori algorithm included in the
Calculate the absolute error in support and trust values, and compare the results with those obtained from the space
Compare the duration of obtaining AR and the duration of sample creation. Generate AR from the sample
Theoretically, it is expected that the samples in various sizes obtained from FI and AR results are tuned with the results from the space, that there is a correspondence between representability and absolute error, and that the duration of transactions made on the sample and the memory consumption reduce.
To accelerate the test processes, instead of 143 products of the bank, 10 different product groups were determined, and the association between those groups was examined. The utilized banking data is a matrix including 1,048,575 customers and an ownership status of customers about 10 different product groups. The lines represent customers and the columns represent product groups. In case the customer owns a product, the intersection of that line-column indicates 1, otherwise 0. In these tests the following parameters were used: accuracy
Table 2 shows varying sample sizes corresponding to varying minimum confidence values. Because γ was not used as a parameter in formulas Toivonen, Chakaravarthy FI-absolute, Chakaravarthy AR-absolute, Riondato FI-absolute, and Riondato FI-relative, there are no variations in calculated sizes.
Calculated sample sizes based on varying minimum trust values are provided.
Techniques where the calculated size is larger than the space were not used at the sample creation step.
When Table 2 was examined in detail, it is obvious that the sizes obtained from the techniques Chakaravarthy FI-absolute, Chakaravarthy AR-absolute, Riondato FI-relative, and Riondato AR-relative are larger than the space (1,048,575). As the aim was to reduce the data set, these techniques were not examined in the following tests. In order to minimize the error due to simple random sampling method, three samples were created for each of the Zaki, Toivonen, Riondato FI-absolute, and Riondato AR-absolute techniques.
Table 3 shows average
p values calculated from χ2 and K-S tests were provided based on minimum trust values.
All the techniques were found to be similar to the space.
FIs and their corresponding ARs were determined from the samples created using Apriori algorithm. To measure the similarities of FIs and ARs, absolute error was calculated through support and trust values. Zaki and Toivonen techniques were inadequate to determine all FIs and ARs existing in the space for the value γ = 0.1. Because a loss of rule was undesirable, we have observed that these two techniques were not suitable to sample creation and time consumption tests were not examined. By calculating the error by substituting incomplete values with 0, the results on Table 4 were obtained. As expected, where absolute support error was high, an also high-confidence error was found.
Average support and trust absolute error generated based on varying minimum trust values are provided.
Techniques where AR loss was experienced were not tested in terms of running time.
In a comparative review of Tables 3 and 4, no relation was detected between support and confidence errors by the results obtained from χ2 and K-S tests. We have noticed that traditional statistical measurements were inadequate in measuring the representability of the sample which was created for association mining.
In Table 5, durations until creation of AR are provided for the space and created samples. While the duration from sample creation until obtaining the AR was provided for the space, the time required for sample size determination, total average time required for sample creation, and obtaining the AR by simple random sampling method were provided for the samples. As expected, the time performance of all techniques for each value γ was found better than the space. Even more benefits are expected by using actually 143 different products instead of 10 product groups in these tests.
The time until rule mining based on varying minimum trust values γ was given in seconds.
Techniques where AR loss was experienced were not tested in terms of running time.
FI and AR results of the samples were compared to those generated from the space. Within the space, the mostly encountered depository (D) product has a ratio of 94%, credit card (CC) product has 11%, and installment loan (IL) product has 8%. These products are found together within the space by a ratio of 2.3%. In spite of this low support value, three different rules with high confidence were derived. “CC, IL → D” rule was derived, and eventually, it was observed that 92% of people who have bought CC and IL also have bought D. According to another derived rule “IL, D -> CC,” it was discovered that 31% of people who bought CC and D also bought IL. It was also found through another rule CC, D - > IL that 28% of people who bought IL and D also bought CC. These rules could not be derived from the techniques Zaki and Toivonen, and information loss was experienced. Therefore, these techniques are not suitable on sample creation for association mining. As expected, when sample size increased, the obtained absolute error in results decreased.
The utilized banking data contains information about customers and the product groups of their owned products. In other words, instead of products owned by customers, banking product groups were used. This was preferred to reduce the data set sparsity and to accelerate the test speeds. So, it was observed that even tests on the space did not take longer than 2 seconds. Whenever the advantages in terms of duration seem to be in the order of seconds, tests to be conducted with a data set containing more products (or product groups) will show decisive advantages.
Because AR mining process through the space takes a long time, we have aimed at determining a smaller sized sample representing the space and AR mining through that sample. For this purpose, in this book chapter, we have investigated for techniques which provide an ideal sample size specialized on association mining.
The samples were created using the simple random sampling method, and three different samples were obtained per technique. We have tried to prevent a potential noise in our results by creating multiple samples.
The similarity of samples to the space was measured by the χ2 test and K-S test. It was obvious that after both tests the obtained values for association mining were inadequate in measuring the representability of samples. In those tests, no relationship was found among support and confidence error values. We consider that the probability of tests giving biased outputs and the inadequacy of suggested sample sizes in measuring were the reasons for having these results.
The results indicate that the duration of AR generation within the space was compared to the total time of sample size determination, sample creation, and AR generation through the sample. It was observed that each technique was better performing in terms of space results. Riondato FI-absolute and Riondato AR-absolute techniques have given good results based on calculated absolute error values. When smaller sample size and less time consumption criteria were considered, Riondato FI-absolute technique becomes favorable.
In future studies, the data set shall be renewed in this regard, and other sample methods will also be applied. Besides, results which might be related to a single data set shall be extended with tests to be performed on another data set, and the results shall be cross-checked.
Digital Health (DH) is an evolving multidisciplinary scientific field that seeks to monitor medical problems while also preventing new ones with the ultimate aim of improving the overall quality of health [1, 2]. These means of information technology can be applied through mobile health (mHealth), telehealth/telemedicine, activity trackers, personal wearables, and remote monitoring, and represent an interplay of the art and science of medicine to achieve overall improvement in health [2]. Due to its broad nature, DH is usually used interchangeably with health information technology (HIT).
Electronic-health or E-Health is characterized by an intersection of public health, medical informatics, the business of healthcare, information science, and health services to achieve better health for users [3]. The term comprises both technical aspects like hardware, software, and internet broadband and social elements centered on the way of thinking and networked global effect through information technology [3].
Big data refers to an enormous data set existing as either structured (organized), unstructured (unorganized), or mixed [4, 5]. These characteristics have been described as the paradigm of 4 “Vs:” volume, velocity, variety, and veracity [4, 6, 7, 8]. Generally, about 2.5 quintillion bytes of data are created every day worldwide and it is rather amazing that 90% of it was created in the past 5 years [9].
Sources of big data span a wide spectrum including posts from social media sites to sensors and navigation devices. It is a big challenge to determine the amount of data generated yearly by the healthcare industry due to the complex nature of healthcare data with heterogeneous sources and structures [10]. Healthcare data sources include electronic health record data (EHR), prescription compliance and refill rate, personal activity tracking devices, laboratory data, cell phone-based geographical monitoring, and remote telemedicine monitoring. About 500 petabytes of data were generated by electronic medical records alone in 2012 and it is expected to reach 25,000 petabytes by the end of 2020 [11]. The various methods/processes of big data analysis are referred to as analytics.
Many factors are responsible for our contemporary adoption and application of big data and DH. The greatest driving force is the dynamic state of computer power relative to it cost of acquisition rightly predicted by Moore’s law. It states that computer power (in terms of speed and memory storage) will double every two years at the same price. In 1956, you would have had to pay $10 million for one gigabyte of storage. In 1981, the cost of a gigabyte was $ 300,000 and by the year 2000, it had dropped to $10. In 2010, the price of storing a gigabyte of data dropped to just 10¢ [12].
Another technology-based driver is the advent of cloud computing. This is the process of utilizing remote computer networks via the internet to manage, process, store, and manipulate data rather than utilizing the local or personal computer connected to the network. This phenomenon allowed for an exponential increase in the capacity of local computers, hence serving as a driver for the “internet of things,” or the interconnectivity between various devices embedded with electronics, software, and sensors. Its ability to impact all major players in the healthcare industry, including the patient, healthcare provider, healthcare regulators, payers, and vendors, has been described as the Internet of Medical Things (IoMT) [13].
Another driver of big data application and DH is the advancement in genomic medicine and gene therapy [13]. Gene mapping and sequencing is an integral part of big data as it utilizes various bioinformatics processes for interpretation and storage.
The most important factor remains the paradigm shift in the role of the patient as a “consumer” of health services. Patients seek to better manage their health by playing active roles through information gathering on the internet and especially via social media networks [14]. One in three Americans has gone online to investigate a medical condition [15]. Another important factor is the changing demographics of the aging population and prevalence of chronic diseases leading to escalating cost of healthcare. In fact, the cost of chronic diseases accounts for up to 75% of healthcare cost in the US [16].
DH innovations have shown some promising results as a means of achieving efficient and cost effective care without compromising quality of care [17]. The mandate from regulators to shift from a volume- to value-based reimbursement model is a testament to the fact that the shift to reward quality, efficiency, and collaborative care is here to stay [18]. The incentive for hospitals to adopt meaningful use of digital technology due to the Health Information Technology for Economic and Clinical Health (HITECH) act, enacted as part of the American Recovery and Reinvestment Act of 2009 [19], resulted in widespread adoption of electronic health records system in the US.
Data is the foundation of DH. Data science is the term used to describe the scientific study of the creation, validation, and transformation of data to create meaning [20]. It is composed of multiple disciplines like statistics, mathematics, and computer science (Figure 1). Data science is an overarching field that underlies many DH innovations like artificial intelligence (AI), machine learning (ML), deep learning, reinforcement learning, and data mining (Figure 2) [21].
Data science as a multidisciplinary field of study. Diagram reprinted with permission from Robert (Bob) Hoyt, MD, FACP, FAMIA, ABPM-CI.
Relationship between data science, artificial intelligence, and machine learning. Diagram reprinted with permission from Robert (Bob) Hoyt, MD, FACP, FAMIA, ABPM-CI.
ML is a sub-discipline of AI that uses algorithms to identify patterns in data, as such giving computers the ability to learn without being explicitly programmed to create predictive models based on training data and validated on test data.
Data mining refers to the discovery of patterns in large data sets with methods at the intersection of unsupervised learning, traditional statistics, and database systems [22]. Predictive analytics involves learning from historic data to predict likely future outcomes with an expressed degree of certainty. Clinical decision support (CDS) programs are systems set up to augment clinicians in their day-to-day complex decision-making processes [23].
All the factors driving DH and HIT are geared towards a paradigm shift from our present state of “sick care” to “high value healthcare” [24]. Healthcare value definition is rather challenging because of its complex ecosystem with many different stakeholders and their associated conflicting goals and expectations [25].
Nevertheless, the meaning which most stakeholders can relate to is the concept of value in healthcare as outcome (rate of quality outcome) per cost needed to achieve a result [26]. It is represented mathematically as quality/cost and is the extent to which our health interventions achieve desired health outcomes that are consistent with evidence-based knowledge [27]. Essentially, it is healthcare which is cost effective and efficient, safe, patient-centered, and equitable, with the aim of achieving the best outcome in terms of morbidity and mortality [28, 29].
Patient safety on the other hand is the foundation of quality care. The Institute of Medicine (IOM) believes that health quality is indistinguishable from Patient safety [30, 31]. I will define patient safety as a system of care delivery that prevents errors built on a culture that learns from previous mistakes. In simple terms, it is a system that functions to avoid harm to patients [32]. And healthcare quality will be analyzed in the context of the quadruple aim of quality improvement [33].
The quadruple aim is a compass to optimizing health system performance which is made up of four components: improving health outcome and experience of care, improving population health, improving healthcare cost, and improving staff engagement.
To overcome the inefficiencies of the healthcare sector in the US, healthcare organizations are encouraged to adopt methodologies like the lean or six sigma methodology that has a track record of optimizing systems in other sectors. Lean methodology involves processes put in place to reduce waste in every procedure, process, and task based on an ongoing system of improvement and learning, and focuses on eliminating waste by avoiding efforts that do not add value to the patient [34]. Six sigma, on the other hand, is a metric-driven system used to reduce medical errors, defects, and variations in output by applying the following: design, measure, analyze, improve, and control (DMAIC) [35].
Examples of successful applications include reducing time to life saving procedure like door-to-balloon time in cardiac catherization, unnecessary antibiotics prescriptions, turnaround time for pathology reports, and clinic wait times, and streamlining electronic payment for vendors [35, 36]. Optimized symptoms that run efficiently can maximize the output of DH technologies [37].
The US spends up to 17.6% of its GDP on healthcare which is far more than that of all the other developed nations combined at 9%. Despite this amount of spending, the US ranks poorly in the World Health Organization’s ranking of health system performance [38]. The public health improvement goals of the quadruple aim correspond with the goal of contemporary medicine which involves the need to achieve cost-efficient quality health through participatory and personalized medicine, ultimately ensuring optimum predictive and preventive medicine [37].
The last component of the quadruple aim is provider satisfaction and engagement. Healthcare quality can hardly be achieved without an engaged healthcare workforce. Burnout involves a state of emotional exhaustion (with or without physical fatigue) and powerlessness to change the status quo [39, 40, 41]. Up to 60% of healthcare providers experience one or more symptoms of burnout in the US [42, 43] and suicide rate amongst physicians in the US is higher than those of the general population [39]. Multiple factors are responsible for burnout which include high data and information volumes and changes in the healthcare model including a shift from volume- to value-based care [40].
Even cutting-edge EHR functionalities involving AI/ML for predictive clinical decision support are potential sources for provider dissatisfaction and burnout due to lack of regulation mandated user-centered design approach in their product development [44, 45].
The 4th Industrial Revolution is philosophical and ideological construct by the world economic forum which postulates on how digital, physical, and biological technology have uniquely combined together in our contemporary world creating new opportunities and challenges [41].
The first Industrial Revolution was powered by steam in the 18th century, the 2nd powered by electricity in the 19th century, and the 3rd in the 20th century powered by technology [46]. Although the 4th Industrial Revolution is considered by many as a direct extension of the 3rd, the 4th differs due to the unprecedented volume and velocity of data in addition to enhanced global interconnectivity [47].
To reap the potential benefits in the 4th Industrial Revolution, it is imperative for the healthcare sector to adopt practices like the agile methodology with the ability to “fail fast” while learning quickly in an iterative manner to achieve the desired state of healthcare quality [48].
The peer reviewed articles reviewed for this chapter were obtained from a broad literature search performed in PubMed, and Google scholar. Search terms included; “4th industrial revolution”, “digital health” “quality improvement”, “Digital health and patient safety”, “applications of digital health for healthcare quality”, “Digital health security”, “Regulation of digital health”. Due to the relative novelty of digital health and the 4th industrial revolution, other sources of relevant information like digital health magazines, quality improvement magazines and health informatics websites were also refer referenced.
The full potential of DH remains unquantifiable at this juncture mainly because of a shortage of well-conducted evaluation studies showing evidence of value added by new tools, especially those involving AI/ML [49, 50]. The rapid acceleration of DH methods and overall geometric advancement is such that any novel technology is almost outdated upon arrival. Despite all these setbacks in the application of DH, there have been some notable applications which have shown some promising results.
Remote patient monitoring involves patient data collection by appropriate providers with data either patient reported or automatically collected via apps, sensors, and any other specific gadget (glucose meters, blood pressure cuffs, or scales). This produces a vast amount of real-time data which is usually beyond the analytic capacity of the healthcare provider, creating an excellent scenario for predictive analysis of the data using ML and similar tools [51, 52].
ML analysis of bidirectional remote monitoring and EHR data has potential to provide great insights on the overall quality of individual patient care [51]. Remote monitoring has successfully been applied to diseases like congestive heart failure management (resulting in a 30% reduction in admission) [44] and diabetes management (resulting in better glycemic control compared to standard of care) [53].
Utilizing standardized risk scores and predictive analysis, some organizations have been able to predict patients that are likely to be readmitted to the hospital within 30 days after discharge [54]. Apart from the mortality benefits to the patients, the institution is also able to benefit financially as they avoid significant penalties associated with readmissions imposed by Medicare under the Medicare’s Hospital Readmissions Reduction Program (HRRP) [55].
Algorithms that predict the likelihood of hospitalized patients to develop acute kidney injury during their index hospital stay have been successfully developed as well [56]. Additionally, significant reduction in sepsis mortality by algorithms leveraging the patient’s data in the EHR to predict severe sepsis have also been achieved [57].
An algorithm developed using EHR data was able to predict suicide risk in individuals better than traditional clinical methods [45]. Predictive analytics tools continue to demonstrate their role in the overall reduction of in-hospital adverse events [58].
The use of CDS in antibiotics choice has been shown to significantly increase antibacterial susceptibility, thereby reducing the need for broad-spectrum antibacterial agents and the risk of antibiotic resistance [59].
Considering the complexity of cancers, the vast amount of knowledge released daily, and expansion of treatment options, the incorporation of genomic data in treatment modality all make it very challenging for clinical oncologist to choose the best personalized therapy [47]. CDS in oncology have shown some potential with assisting clinicians to navigate the challenges inherent in treatment modalities and have performed similar to multidisciplinary tumor boards [60].
The risk of failure in predictive analytics and CDS can result in significant patient harm, hence why mitigation of risk and human oversight is still an essential part of their deployment.
Predictive analytics have been used to accurately identify patients likely to skip appointments without advanced notice [61]. Additionally, they have been successfully used to anticipate peak and low utilization periods by mining previous utilization data [62]. This knowledge assists leadership in planning for changes in volume so they are ready with corresponding resources required to navigate changes in volume. Other proven applications of AI/ML include automation of invoice processing, correct coding for reimbursement, and processing of insurance denials and claims [51].
The optimal state of public health of a nation should emphasize predictive and preventive care in addition to easy and equitable access to healthcare to improve overall mortality and morbidity. While the US health system falls short of these public health essentials in comparison to other developed nations, DH application has shown some promising outcomes [57].
Individual risk for developing chronic disease can be ascertained with a high degree of certainty. Integrative genetic profile has been applied successfully to determine high risk of diabetes mellitus type 2 in an individual who did not have common risk factors like obesity and family history [63].
Direct-to-consumer genetic testing for risk factors of diseases are also gaining traction with commercialized proteomic analysis testing kit for diseases like Alzheimer’s disease [53]. Utilizing proteomic analysis of specific blood proteins was able to a determine if a lung nodule was benign with 90 percent accuracy during screening [64].
Similar DH based programs can assist with opioid epidemics as they have been proven to result in a 30% reduction in statewide opioid prescriptions [65, 66, 67]. Another promising application involves the development of opioid abuse risk profiles of patients using ML model and EHR data to predict patients who are prone to future abuse and overdosage [68].
The healthcare provider shortage coupled with the increasing aging population are factors that exacerbate healthcare access and inequity across the nation [54]. This shortage of healthcare providers and lack of access to health is worse in rural areas where 65% of non-metropolitan counties lack psychiatrists and 45% are without psychotherapists [55]. Telemedicine has shown strong evidence as a means of increasing access to mental healthcare in rural areas by providing effective treatment for mental health conditions, improving medication adherence, and effective follow up and continuity of care [69]. AI-powered chat bots can be used for initial triage based on symptoms and an expert engine can determine type and nature of visit necessary (either a virtual check-in or a face-to-face visit).
The US Government’s 21st Century Cure Act prioritized improvement in HIT, including interoperability, patient access to their health records, and improved regulatory oversight for DH [56]. As part of the Cures Act, the Food and Drug Administration (FDA) Center for Drug Evaluation and Research (CDER) has adopted analytics methodologies like “in silico” testing. This is particularly important in diseases where the smaller patient sample sizes is often a limitation of their clinical trials [70].
Despite the excitement which comes from the potential of DH for quality improvement, challenges exist. Not considering these challenges is akin to chasing “shiny objects” with potential for negative and adverse consequences both in the short and long term.
Interoperability is the ability of different information systems to access, exchange, and cooperatively use data in a coordinated manner, within and across organizational and regional boundaries, to provide timely and seamless portability of information for optimal healthcare [57]. The healthcare data ecosystem in the US is highly fragmented with different EHR systems as a repository of patient data. These disparate EHR systems are not connected and as such their lack of interoperability is a huge set back and operational burden to DH implementation for patient safety.
The lack of consensus evaluation standards in DH is also a barrier to determining the value added [71]. The world of biomedical sciences is accustomed to the traditional randomized control trials as a gold standard for evaluation. Unfortunately, this is not always a practical option for most DH applications due to variation in input data and a lack of stability of deliverables needed to quantify outcomes in RCT [72]. Although various evaluation framework exists across the industry, no consensus standards have been generally accepted across board [73]. Thus, we have no standardized method of determining the effectiveness of the over 300,000 medical apps available [71].
Most stakeholders consider DH a singular fix for the inefficiencies in healthcare [74]. But, for any DH innovation to be successful, design and implementation need to be compatible with all elements of the system engineering initiative for patient safety (SEIPS) model [75]. The elements to consider in this model include consideration of persons involved and their peculiarities, available technology and tools for success, organizational culture, type of tasks, environmental layout, care and information process/flow, and patient outcomes.
This lack of overall socio-technical consideration manifests as the absence of stakeholder input in the development of new DH tools, consequently leading to poor usability of the DH tool like the EHR, which is a significant contributor to provider burnout and inefficiency [76]. Additionally, the low usability of EHR increases the cognitive load of the healthcare provider, which contributes significantly to medical error [77].
Lack of overall consideration in the context of the socio-technical landscape increases the chances of unexpected consequences like creating workarounds in the EHR with a negative impact on patient safety [78].
Government and regulatory agencies struggle to provide a clear-cut regulatory pathway for DH tools. Restrictions and barriers to telemedicine adoption like provider portability of license to practice across state lines, geographical restrictions, and specifics about reimbursement parity still exist and have only been temporarily lifted during the 2019–2020 COVID-19 pandemic [79]. The lack of consistent regulations of proliferating medical apps prevents a high risk to patient safety [80].
Innovations in most healthcare organizations in the US are driven by the need to meet basic regulatory compliance metrics and financial viability (bottom line). Healthcare leadership are more concerned about the bottom line while regulators are mostly concerned about patient safety. Patients are concerned about convenience of service and safety.
Another important issue with DH and big data is the constant threat to healthcare data integrity and security. These occur in the form of hacking, malware, unauthorized access, and data theft. In 2019, almost 41 million medical records were affected by healthcare data breaches, mostly through hacking and ransomware attacks [81]. The average cost of these breaches to affected healthcare organizations was about $6.5million [82].
Presently, resources (infrastructure, expertise, and personnel) required to utilize DH/big data are not available to all and confer a competitive advantage to those who possess them. The resulting disparity and its consequences are contrary to the outcome we seek from DH innovations. Nearly half of the world’s population do not have reliable internet access. This phenomenon is well known and described in the literature as the “digital divide” [64].
Explainability describes the degree of transparency and traceability of the outcome of any AI/ML model [83]. This is particularly important because of the non-linear, highly nested structure of complex algorithms, which makes us unaware of how they arrive at their conclusion or output [65]. This characteristic, described as the “black box” phenomenon, represents a huge setback in the application of AI/ML in healthcare [66]. This is mainly due to the sensitive nature of health operations and its low tolerance for lack of transparency in decision making. Thus, those who develop AI tools must involve primary stakeholders and decision makers from the beginning to assist with transparency and adoption by end users.
Predictive analytics and model development rely heavily on not just high volume data but also high quality data. Unfortunately, most available healthcare data are unstructured and interspersed with artifacts/“noise” which increases the chances of spurious model output even in the setting of a near-perfect model [84].
Adversarial attacks are either targeted or non-targeted inputs uniquely engineered to cause mis-classification and fool an AI model to produce an incorrect output [67]. This tendency for adversarial attacks in medical AI applications is due to the inherent monetary incentive for fraud in healthcare as an industry with more than three trillion-dollar annual expenditure [68]. A second reason is the technical vulnerability of the models in healthcare.
In an ethnically diverse nation like the US, an excellent AI/ML output can only be achieved if the training data utilized are equally diverse. If there is no conscious effort to ensure diversity of training data, the algorithm would be propagating the conscious and subconscious bias that exists in our society [85]. An example is an algorithm developed to detect malignant melanoma.
Malignant melanoma is treatable if detected earlier and ML algorithm can aid in early detection. However, the algorithm is at risk of bias and disparity already grounded in our society due to the lack of adequate representation of people of color/darker skin tone in training data [85]. This limitation can hinder the utility of the algorithm for people of color. Presently, most ML programs like the International Skin Imaging Collaboration Project source their training dataset mostly from fair skinned populations in the US, Australia, and Europe [85].
Other manifestations of propagated bias include: fit bits® produces inaccurate heart rate in people of color [86] and biases and mislabeling of facial recognition software with algorithm output of people of Asian descent represented as blinking facial images [69]. The risk here is the tendency to worsen all our societal ills like health disparity, inequality, gender bias, and racism, which are all hindrances to quality public health for all.
ML algorithms are only as good as the quality of their training data set. Unexpected data points and sudden changes in pre-defined events will likely result in poor performance. This lack of initiative of the ML/AI algorithm is coupled with a lack of empathy displayed in a human-to human healthcare interaction, representing a setback for patient satisfaction.
There exists a lot of ethical dilemmas in the application of ML tools which cannot be ignored. One of the dilemmas we face is the need for disclosure whenever ML tools are used in direct patient care [87]. In most of these applications, patients are not aware that the care from their clinician is augmented by ML algorithms even when the effectiveness of these algorithms are yet to be proven [70]. There is still no consensus amongst providers and patients alike regarding the right ethical approach to tackle this issue.
Evaluation of DH tool/intervention is the objective and systemic assessment of a DH intervention/tool with the sole purpose of determining the efficacy, efficiency, impact, sustainability, and extent to which pre-set specific objectives are met. According to the World Health Organization, “evaluation asks whether the DH tool/project is doing the right things, while monitoring asks whether the DH tool/project is doing things right.” [88]. Although monitoring and evaluation (M&E) are distinct entities, they are usually addressed simultaneously from pre-prototype/prototype stage through the pilot and demonstration/display of tool up to the stage of scale up.
The first stage of M&E is to identify the stage of maturity of the tool. This determination will play into the methodology/framework utilized for M&E.
After identifying the stage of maturity of tool, the next step would be to ascertain concrete baseline expectations of the tool and define appropriate claims based on stage of maturity of the DH tool. The usability of the tool is an important measure that should be evaluated in all the stages of maturity from early to late stages. It is also important to set expectations in relation to time to deliverables to guide M&E activities. A tool being developed to shorten wait time at the clinic should get input from patients about their pain points while setting M&E standards.
The next steps is to define the M&E framework to guide the process. There are well-established frameworks for M&E published in the literature; however, I favor structures that are result oriented [73, 88]. To strengthen the evaluation framework, it should be developed through a stakeholder consultative process and reviewed as needed during the life cycle of the project.
The next step is to determine who will be carrying out these M&E activities, how many resources will be required, and the time-based deliverables expected from the team in charge.
Considering the degree of rapid transformation and dynamism we are experiencing with the 4th Industrial Revolution, only organizations positioned to adapt will succeed. This adaptation requires that all stakeholders learn new skill sets as we navigate this transformation.
Government regulatory oversight teams are needed to craft rules/policies to regulate broad DH principles like security, privacy/disclosures of DH tools, fairness and equity of implementation, and avoidance of bias in implementation. The regulatory rigors placed before approval of DH tools should be based on the level of risk of a DH tool in the event of failure, determined by a baseline failure mode and effect analysis.
Government mandates should ensure that DH tools maintain a well laid out process for human oversight of implementation no matter how “perfect” the tool may be.
Professional organizations can assist with navigating complexities as it relates to specific requirements for M&E of DH tools developed for their subsections. Once general overall policies are established by the government or regulatory agencies to address fundamental societal issues to ensure quality and safety of DH, expert organizations can help narrow down these policies to suit their subsection of the healthcare ecosystem.
Payers are responsible for processing patient eligibility, enrollment, claims, and payment of healthcare services. In the US, payers exists as either governmental (Medicare/Medicaid) or private entities. A testament to the fragmented nature of the US healthcare system is the fact it has more than 900 healthcare payers as of 2020 [89]. These entities have a significant influence on how healthcare is delivered in the US based on their reimbursement schemes. As part of their basis for reimbursement of any healthcare service which has been augmented by DH, they should mandate standardized M&E of the tools to justify compensation; it is equally important to be wary of mandates that would stifle innovation.
Healthcare vendors ranging from device and pharmaceutical manufacturers to core HIT and analytics developers and entrepreneurs are numerous; in fact, there are more than 370 HIT-specific vendors in the US as of 2020 [90]. Vendors also have a role to play in ensuring that DH tools do not only offer novelty but also have an in-built yardstick for evaluating their comparative effectiveness for objective assessment of their overall impact upon implementation.
Considering that these centers are the avenue for implementation of most DH tools, they must insist on implementing DH tools with a track record of adding value to patient safety and improving healthcare quality. In the event the DH tool intended for use is novel with no track record, the organization should demand a concrete basis and claims for M&E. This will assist with an objective comparison of the impact of a new tool with the status quo.
Healthcare providers are often laggards and usually conservative in the adoption of new tools, as consequences of failure are very high with regards to patient safety [91]. Nevertheless, the 4th Industrial Revolution permeates all sectors of healthcare and healthcare providers are directly impacted. They must actively learn how to become an information specialist and ask the right questions about a potential DH tool to be implemented [92]. Considering that they will be utilizing these tools to make important decisions about patients and their safety, it is important they are well equipped with the knowledge of how to evaluate and monitor the DH tools for optimal healthcare quality.
Patients and caregivers are the ultimate intended beneficiaries of DH tools, as any failure of DH tool implemented will have an adverse consequence on their safety and quality of health [93]. In this new dispensation, they must prompt their healthcare providers to ask the right questions from the DH tools’ developers. Patients and caregivers should understand that, as we progress further into the 4th Industrial Revolution, these DH tools will increasingly play an essential role in decisions about their care directly or indirectly.
The quadruple aim describes healthcare value as improved health outcomes, increase patient satisfaction, reduced costs, and healthcare provider satisfaction/fulfillment. DH tools have shown potential in improving healthcare quality and achieving the quadruple aim, such as promoting behaviors like healthy eating and smoking cessation, improving outcome in people with chronic conditions like cardiovascular diseases, and increasing health access through telemedicine and remote monitoring [72, 94].
Although there are demonstrated impact of DH tools in healthcare quality, it is still not an overall fix able to transition us from our state of sick care to optimum healthcare quality alone. Its applications and implementation are filled with many limitations presently hindering the achievement of its full potential in healthcare quality improvement. We cannot figure out how effective a tool is without a pre-defined basis on how to ascertain its effectiveness. Presently the evaluation and performance measurement in healthcare is costly, redundant, and labyrinthine [78].
DH tools are only part of the solution and not an ultimate solution. As such every DH tool implementation should be considered in the context of the overall socio-technical ecosystem. All innovations should be based on stakeholders’ input right from the start of conception. No matter how effective a piece of technology is, if it is implemented in a poorly optimized system, it will likely result in failure.
Navigating the 4th Industrial Revolution requires that all stakeholders play an active role in this transition. No doubt it brings forth many possibilities for healthcare quality improvement; however, in the absence of evaluation standards and a systematic approach to its implementation, we risk being immersed in hype born out of the hope of an elusive better outcome. DH tools are key components in achieving value in healthcare, but it is not the destination and neither is it the goal, but rather a catalyst in the process of obtaining the ultimate goal of the quadruple aim.
The author declares no conflict of interest.
Abbreviation | Meaning |
---|---|
DH | Digital Health |
mHealth | Mobile Health |
HIT | Health Information Technology |
IoMT | Internet of Medical Things |
HITECH | Health Information Technology for Economic and Clinical Health |
ML | Machine learning |
AI | Artificial Intelligence |
DMAIC | Design, Measure, Analyze, Improve, and Control |
GDP | Gross Domestic Product |
HER | Electronic Health Record |
HRRP | Medicare’s Hospital Readmissions Reduction Program |
CDS | Clinical Decision Support |
FDA | Food and Drug Administration |
M&E | Monitoring and Evaluation |
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These are used to engage catchment managers who can prioritise areas for potential deployment of NFM measures, where more detailed modelling may be targeted. We then demonstrate a framework applying the semi-distributed Dynamic TOPMODEL in which uncertainty plays an integral role in the decision-making process.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Barry Hankin, Peter Metcalfe, David Johnson, Nick A. 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In this chapter, factors affecting flash flood, possible options of basic input parameters in one- and two-dimensional hydrological models in data sparse environment, some case studies and uncertainty in hydrological modelling were discussed. This discussion will help the readers to understand the flooding factors, selection of input parameters in data sparse environment, a brief insight of one- and two-dimensional hydrological models and uncertainties in their input and model parameters and model structures.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Mohd Talha Anees, Khiruddin Abdullah, Mohd Nawawi Mohd\nNordin, Nik Norulaini Nik Ab Rahman, Muhammad Izzuddin Syakir\nand Mohd. Omar Abdul Kadir",authors:[{id:"11196",title:"Dr.",name:"Khiruddin",middleName:null,surname:"Abdullah",slug:"khiruddin-abdullah",fullName:"Khiruddin Abdullah"},{id:"151303",title:"Prof.",name:"Nik Norulaini",middleName:null,surname:"Ab Rahman",slug:"nik-norulaini-ab-rahman",fullName:"Nik Norulaini Ab Rahman"},{id:"151344",title:"Prof.",name:"Mohd Omar",middleName:null,surname:"Ab Kadir",slug:"mohd-omar-ab-kadir",fullName:"Mohd Omar Ab Kadir"},{id:"201647",title:"Mr.",name:"Mohd Talha",middleName:null,surname:"Anees",slug:"mohd-talha-anees",fullName:"Mohd Talha Anees"},{id:"203217",title:"Prof.",name:"Mohd Nawawi",middleName:null,surname:"Mohd Nordin",slug:"mohd-nawawi-mohd-nordin",fullName:"Mohd Nawawi Mohd Nordin"},{id:"203218",title:"Dr.",name:"Muhammad Izzuddin",middleName:null,surname:"Syakir Ishak",slug:"muhammad-izzuddin-syakir-ishak",fullName:"Muhammad Izzuddin Syakir Ishak"}]},{id:"55735",doi:"10.5772/intechopen.69139",title:"Understanding Flood Risk Management in Asia: Concepts and Challenges",slug:"understanding-flood-risk-management-in-asia-concepts-and-challenges",totalDownloads:1991,totalCrossrefCites:6,totalDimensionsCites:12,abstract:"In this chapter, an attempt is made to review the behavior of flood in Asian region and mechanism of flood risk management adopted among Asian nations. Flood is the most frequent natural disaster at present and vulnerability is widespread across the globe. Though, Asian region is on a knife-edge. Distribution of natural disasters in Asia followed by economic damage and human killing is illustrated in this chapter. In addition, discourse of China, Pakistan, India, Bangladesh, Indonesia, Nepal, Vietnam, and Sri Lanka on flood risk management is examined. Flood risk management policies framed by these nations over the period of time are synthesized. Research and investment on forecasting, planning, preparedness, assessment, evaluation, and mitigation of flood risk are explained. This synthesis can present a pathway for better response and flood management for debated Asian countries through filling the identified policy gaps. This chapter also urges a need of holistic and inter-countries research and cross country analysis followed by increased funding for sustainable management of risk.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Saleem Ashraf, Muhammad Luqman, Muhammad Iftikhar, Ijaz\nAshraf and Zakaria Yousaf Hassan",authors:[{id:"202027",title:"Dr.",name:"Muhammad Saleem",middleName:null,surname:"Ashraf",slug:"muhammad-saleem-ashraf",fullName:"Muhammad Saleem Ashraf"}]},{id:"72571",doi:"10.5772/intechopen.93069",title:"Challenges and Technical Advances in Flood Early Warning Systems (FEWSs)",slug:"challenges-and-technical-advances-in-flood-early-warning-systems-fewss-",totalDownloads:726,totalCrossrefCites:3,totalDimensionsCites:7,abstract:"Flood early warning systems (FEWSs)—one of the most common flood-impact mitigation measures—are currently in operation globally. The UN Office for Disaster Risk Reduction (UNDRR) strongly advocates for an increase in their availability to reach the targets of the Sendai Framework for Disaster Risk Reduction and Sustainable Development Goals (SDGs). Comprehensive FEWS consists of four components, which includes (1) risk knowledge, (2) monitoring and forecasting, (3) warning, dissemination, and communication, and (4) response capabilities. Operational FEWSs have varying levels of complexity, depending on available data, adopted technology, and know-how. There are apparent differences in sophistication between FEWSs in developed countries that have the financial capabilities, technological infrastructure, and human resources and developing countries where FEWSs tend to be less advanced. Fortunately, recent advances in remote sensing, artificial intelligence (AI), information technologies, and social media are leading to significant changes in the mechanisms of FEWSs and provide the opportunity for all FEWSs to gain additional capability. These technologies are an opportunity for developing countries to overcome the technical limitations that FEWSs have faced so far. This chapter aims to discuss the challenges in FEWSs in brief and exposes technological advances and their benefits in flood forecasting and disaster mitigation.",book:{id:"9983",slug:"flood-impact-mitigation-and-resilience-enhancement",title:"Flood Impact Mitigation and Resilience Enhancement",fullTitle:"Flood Impact Mitigation and Resilience Enhancement"},signatures:"Duminda Perera, Ousmane Seidou, Jetal Agnihotri, Hamid Mehmood and Mohamed Rasmy",authors:null},{id:"45003",doi:"10.5772/55472",title:"Impact of Hurricane Katrina on the Louisiana HIV/AIDS Epidemic: A Socio-Ecological Perspective",slug:"impact-of-hurricane-katrina-on-the-louisiana-hiv-aids-epidemic-a-socio-ecological-perspective",totalDownloads:1936,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"3507",slug:"natural-disasters-multifaceted-aspects-in-management-and-impact-assessment",title:"Natural Disasters",fullTitle:"Natural Disasters - Multifaceted Aspects in Management and Impact Assessment"},signatures:"William T. Robinson",authors:[{id:"161386",title:"Associate Prof.",name:"William",middleName:null,surname:"Robinson",slug:"william-robinson",fullName:"William Robinson"}]}],mostDownloadedChaptersLast30Days:[{id:"56370",title:"Flood Risk Management in Mexico",slug:"flood-risk-management-in-mexico",totalDownloads:1642,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Mexico receives an average annual rainfall of 740 mm, which are distributed in the hydrological cycle as follows: 72% evapotranspiration, 21% becomes runoff and 6% as aquifer recharge. Within the Mexican territory, exist a great diversity of climates and high spatial and temporal variability in water resources availability. In the period 2000–2015, damages from hydrometeorological phenomena in Mexico represented between 60 and 99% of total damages and losses at national level due to natural and socioorganizational events. Considering global climate change impact on the selection, design and implementation of flood control measures, represents a major challenge, since the level of certainty regarding its influence on the variables involved, remains insufficient. This chapter provides a description of the main elements directly linked to flooding in México, such as a high spatial and temporal variability in water resources availability and presence of tropical cyclones in both coasts and climate change. A brief summary of the main disasters caused by hydrometeorological phenomena, the annual cost of the damages, the main non‐structural measures for flood control and the intervention from the Mexican Institute of Water Technology in the use, development and spread of technology focused on flood risk management are also included.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Felipe I. Arreguín-Cortés and Claudia Elizabeth Cervantes-Jaimes",authors:[{id:"203037",title:"Dr.",name:"Felipe I.",middleName:null,surname:"Arreguin-Cortés",slug:"felipe-i.-arreguin-cortes",fullName:"Felipe I. Arreguin-Cortés"},{id:"204319",title:"M.Sc.",name:"Claudia Elizabeth",middleName:null,surname:"Cervantes-Jaimes",slug:"claudia-elizabeth-cervantes-jaimes",fullName:"Claudia Elizabeth Cervantes-Jaimes"}]},{id:"55369",title:"One- and Two-Dimensional Hydrological Modelling and Their Uncertainties",slug:"one-and-two-dimensional-hydrological-modelling-and-their-uncertainties",totalDownloads:2771,totalCrossrefCites:5,totalDimensionsCites:13,abstract:"Earth processes, which occur in land, air and ocean in different environment and at different scales, are very complex. Flooding is also a part of the complex processes, which need to be assessed accurately to know the accurate spatial and temporal changes of flooding and their causes. Hydrological modelling has been used by several researchers in river and floodplain modelling for flood analysis. In this chapter, factors affecting flash flood, possible options of basic input parameters in one- and two-dimensional hydrological models in data sparse environment, some case studies and uncertainty in hydrological modelling were discussed. This discussion will help the readers to understand the flooding factors, selection of input parameters in data sparse environment, a brief insight of one- and two-dimensional hydrological models and uncertainties in their input and model parameters and model structures.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Mohd Talha Anees, Khiruddin Abdullah, Mohd Nawawi Mohd\nNordin, Nik Norulaini Nik Ab Rahman, Muhammad Izzuddin Syakir\nand Mohd. Omar Abdul Kadir",authors:[{id:"11196",title:"Dr.",name:"Khiruddin",middleName:null,surname:"Abdullah",slug:"khiruddin-abdullah",fullName:"Khiruddin Abdullah"},{id:"151303",title:"Prof.",name:"Nik Norulaini",middleName:null,surname:"Ab Rahman",slug:"nik-norulaini-ab-rahman",fullName:"Nik Norulaini Ab Rahman"},{id:"151344",title:"Prof.",name:"Mohd Omar",middleName:null,surname:"Ab Kadir",slug:"mohd-omar-ab-kadir",fullName:"Mohd Omar Ab Kadir"},{id:"201647",title:"Mr.",name:"Mohd Talha",middleName:null,surname:"Anees",slug:"mohd-talha-anees",fullName:"Mohd Talha Anees"},{id:"203217",title:"Prof.",name:"Mohd Nawawi",middleName:null,surname:"Mohd Nordin",slug:"mohd-nawawi-mohd-nordin",fullName:"Mohd Nawawi Mohd Nordin"},{id:"203218",title:"Dr.",name:"Muhammad Izzuddin",middleName:null,surname:"Syakir Ishak",slug:"muhammad-izzuddin-syakir-ishak",fullName:"Muhammad Izzuddin Syakir Ishak"}]},{id:"55139",title:"Estimating Flood Quantiles on the Basis of Multi-Event Rainfall Simulation",slug:"estimating-flood-quantiles-on-the-basis-of-multi-event-rainfall-simulation",totalDownloads:1440,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter provides an insight into a new approach to estimating the flood quantiles based on rainfall-runoff modelling using multiple rainfall events. The approach is based on the prior knowledge about the probability distribution of annual maximum daily totals of rainfall in catchments, random disaggregation of the totals into hourly values and rainfall-runoff modelling. The new presented method called MESEF (Multi-Event Simulation of Extreme Flood) combines design event method based on single-rainfall event modelling and continuous simulation method used for estimating the maximum discharges of a given exceedance probability using rainfall-runoff models. The MESEF method considers varied moisture conditions in model catchment before the occurrence of rainfalls. To verify the efficiency of the proposed method, a comparison was carried out between the values of flood quantiles estimated by the MESEF method and the flood quantiles estimated by direct method. The proposed approach was tested in two catchments in the Upper Vistula River basin. The results of the MESEF method in both catchments were satisfactory; however, in order to verify its effectiveness, more research is needed within catchments of diverse features and landscape. Special attention should be paid to the proportion of moisture conditions that is a crucial factor in future use of the MESEF method in uncontrolled catchments.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Elżbieta Jarosińska and Katarzyna Pierzga",authors:[{id:"202772",title:"Ph.D.",name:"Elżbieta",middleName:null,surname:"Jarosińska",slug:"elzbieta-jarosinska",fullName:"Elżbieta Jarosińska"},{id:"202833",title:"MSc.",name:"Katarzyna",middleName:null,surname:"Pierzga",slug:"katarzyna-pierzga",fullName:"Katarzyna Pierzga"}]},{id:"55735",title:"Understanding Flood Risk Management in Asia: Concepts and Challenges",slug:"understanding-flood-risk-management-in-asia-concepts-and-challenges",totalDownloads:1990,totalCrossrefCites:6,totalDimensionsCites:12,abstract:"In this chapter, an attempt is made to review the behavior of flood in Asian region and mechanism of flood risk management adopted among Asian nations. Flood is the most frequent natural disaster at present and vulnerability is widespread across the globe. Though, Asian region is on a knife-edge. Distribution of natural disasters in Asia followed by economic damage and human killing is illustrated in this chapter. In addition, discourse of China, Pakistan, India, Bangladesh, Indonesia, Nepal, Vietnam, and Sri Lanka on flood risk management is examined. Flood risk management policies framed by these nations over the period of time are synthesized. Research and investment on forecasting, planning, preparedness, assessment, evaluation, and mitigation of flood risk are explained. This synthesis can present a pathway for better response and flood management for debated Asian countries through filling the identified policy gaps. This chapter also urges a need of holistic and inter-countries research and cross country analysis followed by increased funding for sustainable management of risk.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Saleem Ashraf, Muhammad Luqman, Muhammad Iftikhar, Ijaz\nAshraf and Zakaria Yousaf Hassan",authors:[{id:"202027",title:"Dr.",name:"Muhammad Saleem",middleName:null,surname:"Ashraf",slug:"muhammad-saleem-ashraf",fullName:"Muhammad Saleem Ashraf"}]},{id:"71247",title:"Dealing with Local Tsunami on Pakistan Coast",slug:"dealing-with-local-tsunami-on-pakistan-coast",totalDownloads:627,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Tsunami originating from a local source can arrive at Pakistan coastline within minutes. In the absence of a comprehensive and well-coordinated management plan, the fast-approaching tsunami might wreak havoc on the coast. To combat such a threat, a wide range of short- and long-term mitigation measures are needed to be taken by several government and private sector organizations as well as security agencies. Around 1000-km coastline is divided administratively into two provinces of Baluchistan and Sindh and further into seven districts. Most of the coastal communities were severely affected by an earthquake of magnitude 8+ on 28 November 1945 followed by a devastating tsunami. In contrast to the level of posed hazard and multiple-fold increase in vulnerabilities since then, the risk mitigation efforts are trivial and least coordinated. It is important to provide stakeholders with a set of prerequisite information and guidelines on standardized format to develop their organizational strategies and course of action for earthquake and tsunami risk mitigation in a well-coordinated manner, from local to the national level.",book:{id:"8979",slug:"tsunami-damage-assessment-and-medical-triage",title:"Tsunami",fullTitle:"Tsunami - Damage Assessment and Medical Triage"},signatures:"Ghazala Naeem",authors:[{id:"193736",title:"Ms.",name:"Ghazala",middleName:null,surname:"Naeem",slug:"ghazala-naeem",fullName:"Ghazala Naeem"}]}],onlineFirstChaptersFilter:{topicId:"665",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81241",title:"Physiological and Molecular Adaptation of Sugarcane under Drought vis-a-vis Root System Traits",slug:"physiological-and-molecular-adaptation-of-sugarcane-under-drought-vis-a-vis-root-system-traits",totalDownloads:21,totalDimensionsCites:0,doi:"10.5772/intechopen.103795",abstract:"Among various abiotic stresses, water is reported as a rare entity in many parts of the world. Decreased frequency of precipitation and global temperature rise will further aggravate the situation in future. Being C4 plant, sugarcane requires generous water for the proper growth. Plant root system primarily supports above-ground growth by anchoring in the soil and facilitates water and nutrients uptake from the soil. The plasticity and dynamic nature of roots endow plants for the uptake of vital nutrients from the soil even under soil moisture conditions. In sugarcane, the major part of root system are generally observed in the upper soil layers, while limited water availability shifts the root growth towards the lower soil layer to sustained water uptake. In addition, root traits are directly related to physiological traits of the shoot to cope up with water limited situations via reduction in stomatal conductance and an upsurge in density and deep root traits, adaptations at biochemical and molecular level which includes osmotic adjustment and ROS detoxification. Under stressed conditions, these complex interactive systems adjust homeo-statically to minimize the adverse impacts of stress and sustain balanced metabolism. Therefore, the present chapter deals with physiological and biochemical traits along with root traits that helps for better productivity of sugarcane under water-limited conditions.",book:{id:"11131",title:"Drought - Impacts and Management",coverURL:"https://cdn.intechopen.com/books/images_new/11131.jpg"},signatures:"Pooja Dhansu, Arun Kumar Raja, Krishnapriya Vengavasi, Ravinder Kumar, Adhini S. Pazhany, Ashwani Kumar, Naresh Kumar, Anita Mann and Shashi Kant Pandey"},{id:"79973",title:"Impacts of Drought on Homestead Plant Diversity in Barind Tract of Bangladesh",slug:"impacts-of-drought-on-homestead-plant-diversity-in-barind-tract-of-bangladesh",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.101885",abstract:"Homestead is a great place for household food access, diet, and nutrition. Drought affects homestead plant diversity and reduces production, availability, and diversity that lead toward less supply and consumption. Drought detains moisture and degrades the soil that supports plant growth. Homestead provides regular bread and income in the rural areas with an effective means for both economic and environmental well-being. People are getting a good amount of subsidiary income without any extra care and effort. In managing homestead land and drought, the household needs necessary technical and managerial training. In reducing drought effects to the homestead, action research needs to be carried out on available knowledge, effective practices, water management, and the adoption of local varieties and knowledge to develop effective homestead integration. Government initiatives, community engagement and not harming the environment, and efficient uses of water could be great solutions for the adverse effects of drought on the homestead plant diversity.",book:{id:"11131",title:"Drought - Impacts and Management",coverURL:"https://cdn.intechopen.com/books/images_new/11131.jpg"},signatures:"Md. Shafiqul Islam and Md. Nazrul Islam Mukul"},{id:"82110",title:"Hydrological Drought Index Based on Discharge",slug:"hydrological-drought-index-based-on-discharge",totalDownloads:28,totalDimensionsCites:0,doi:"10.5772/intechopen.104625",abstract:"Drought is a natural phenomenon causing disasters and its period of occurrence can be predicted in recent times based on several methods using the same or different variables. The prediction is usually associated with the climate interactions in the form of rainfall or discharge patterns which can be analyzed using the return period. Therefore, this research was conducted in four different stages of data acquisition and validation, drought analysis method based on the data, drought prediction method based on hydrology, and sample applications to determine the debit availability in other watersheds. Historical rainfall data converted to dependable rainfall at 80% probability were used as input for the rainfall-discharge analysis while the hydrological drought analysis was conducted using the drought threshold value. Moreover, the drought was predicted using an artificial neural network model while historical data were used to verify the hydrological character of the prediction model. The results of the analysis conducted were further used to predict the water balance in different river areas due to the fact that each area has a different hydrological character. Meanwhile, the watersheds used as case research showed that the model has reliability of up to 80%.",book:{id:"11131",title:"Drought - Impacts and Management",coverURL:"https://cdn.intechopen.com/books/images_new/11131.jpg"},signatures:"R. Rintis Hadiani, Bambang Suharto, Agus Suharyanto and Suhardjono"},{id:"81203",title:"Climate Change: A Real Danger to Human and Animal Survival",slug:"climate-change-a-real-danger-to-human-and-animal-survival",totalDownloads:42,totalDimensionsCites:0,doi:"10.5772/intechopen.103022",abstract:"Some countries in Southern Africa where hit by either a storm or cyclone or both in 2019 alone manifesting a changing climate. Infrastructure and cropping land was destroyed, both animal and human lives were lost due to the flooding events. Drought is a common phenomenon in this region, often occurring once in three years. This has affected food, feed and nutritional security of both humans and livestock. Saline soils unsuitable for agriculture, other animal and plant life are expanding fast due to insufficient precipitation. Soil degradation is on the rise, leaving soils with poor water holding capacity to support sustainable agriculture. Climate change is changing the environment and new pests and diseases for both crops and livestock are emerging. World governments, industries and general populace should find better ways of reducing air pollution by greenhouse gases which have a net effect of damaging the ozone layer and increasing atmospheric temperatures. At the same time, plant and animal breeding should aim at improving crop cultivars and animal breeds that resist to the constraints such as drought and heat stress brought by climate change. The human population is increasing at an alarming rate and need both food and nutritional security.",book:{id:"11131",title:"Drought - Impacts and Management",coverURL:"https://cdn.intechopen.com/books/images_new/11131.jpg"},signatures:"Godwill Makunde, Nation Chikumba, Walter Svinurai and Xavier Mhike"},{id:"81810",title:"Water Shortages: Cause of Water Safety in Sub-Saharan Africa",slug:"water-shortages-cause-of-water-safety-in-sub-saharan-africa",totalDownloads:26,totalDimensionsCites:0,doi:"10.5772/intechopen.103927",abstract:"This chapter highlights a high rate of water crisis across sub-Saharan Africa (SSA) despite its huge hydro-potential. Factors contributing to water stress include rainfall deficit and drought, increased water requirements, population growth, urbanization, and poverty. Coupled with the uneven distribution of water resources and mismanagement of water facilities, the gap between the demand for water and available supply has deepened. This has led almost half of the SSA population to drink water from unprotected sources. Moreover, many millions travel far distances and spend several hours daily to collect water. Children and women are mainly involved in water collection. The growing scarcity of water in Africa has a negative impact on economic growth. Besides, water shortages are at the heart of many social crises in SSA and have become directly or indirectly the first cause of death in Africa linked to waterborne diseases. The prevailing water-related diseases include malaria, typhoid fever, cholera, poliomyelitis, etc. To attain the African agenda 2063, national governments in SSA need a multidisciplinary approach integrating, supervising informal settlements of the population in urban and peri-urban areas; improving water storage capacity; increasing irrigation potential for agriculture; and having a good understanding of the epidemiology of waterborne diseases.",book:{id:"11131",title:"Drought - Impacts and Management",coverURL:"https://cdn.intechopen.com/books/images_new/11131.jpg"},signatures:"Chelea Matchawe, Patrice Bonny, Germaine Yandang, Huguette Cecile Yangoua Mafo and Bonglaisin J. Nsawir"},{id:"81584",title:"Reducing the Effects of Drought and Degradation of Agricultural Soils, in the Context of Climate Change, through the Application of Regenerative Ecological Technologies",slug:"reducing-the-effects-of-drought-and-degradation-of-agricultural-soils-in-the-context-of-climate-chan",totalDownloads:41,totalDimensionsCites:0,doi:"10.5772/intechopen.104446",abstract:"The agricultural sector has a limited capacity for expansion, consequently, deficient technologies based on the widespread use of synthetic chemicals have been implemented in the last decades, having a major negative impact on natural ecosystems, biodiversity, and environmental services. Desertification, land degradation, and drought, combined with human activity and environmental changes, cause important soil losses and a reduction in natural defenses against droughts and floods. The combined impact of climate change, land mismanagement and unsustainable freshwater use has long been affecting agricultural productivity, the most common cause being unsustainable land management practices. This chapter aims to briefly assess the most effective strategies for reducing the impact of climate change on agricultural crops, as well as to prevent or reverse the process of desertification and systematic loss in food quality and quantity. Regenerative management practices such as minimum tillage technologies, cover crops and mulching, inoculation with microorganisms, nutrients cycling, the balance of the organic fertilizers or foliar application help farmers in managing healthy soils, capable of growing rich and ecological crops without the use of chemical hazardous substances.",book:{id:"11131",title:"Drought - Impacts and Management",coverURL:"https://cdn.intechopen.com/books/images_new/11131.jpg"},signatures:"Eugen Popescu, Florin Nenciu and Valentin Nicolae Vladut"}],onlineFirstChaptersTotal:9},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. 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She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"117248",title:"Dr.",name:"Andrew",middleName:null,surname:"Macnab",slug:"andrew-macnab",fullName:"Andrew Macnab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}}]}},subseries:{item:{id:"88",type:"subseries",title:"Marketing",keywords:"Consumer Trends, Consumer Needs, Media, Pricing, Distribution, Branding, Innovation, Neuromarketing",scope:"