Frequency and associated factors of mental health disorders among healthcare workers in developing and developed countries.
\r\n\tDiagnosis and management of complications while on ECMO therapy and weaning to recovery or advanced therapies will be also discussed.
\r\n\r\n\tChapters focusing on specific patient populations, such as cardiogenic shock, thoracic organ transplantation, trauma, and neonates, Covid-19 syndrome, will provide insight into the particular challenges in dealing with the unusual problems of these very diverse groups.
\r\n\r\n\tThe goal of this book is to provide, thanks to the thorough contributions by known experts in the field, a framework for successful program development. Hopefully, this text will also inspire others to further advance this delicate field.
",isbn:"978-1-80356-549-1",printIsbn:"978-1-80356-548-4",pdfIsbn:"978-1-80356-550-7",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"254c18981115aeda50bdf71829902141",bookSignature:"Dr. Antonio Loforte",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11718.jpg",keywords:"Heart Failure, Cardiogenic Shock, Respiratory Failure, Circulatory Failure, End-Organ Dysfunction, VA-ECMO, VV ECMO, Central ECMO, ECMO Running, Weaning off ECMO, Adverse Events While on ECMO, Survival on ECMO",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 10th 2022",dateEndSecondStepPublish:"April 7th 2022",dateEndThirdStepPublish:"June 6th 2022",dateEndFourthStepPublish:"August 25th 2022",dateEndFifthStepPublish:"October 24th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"3 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Loforte is a dedicated and pioneering researcher in the surgical treatment of advanced heart failure in terms of LVAD, BVAD, ECLS, and TAH adoption in different clinical scenarios. He is a member of several professional organizations including the prestigious STS, ISHLT, ASAIO, EACTS, RHICS, SICCH, SITO, ELSO, and ESOT among others. His bibliography lists over 150 peer-reviewed original articles, 250 abstracts (communications) for international meetings, 20 book chapters, and 8 manuals.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"42172",title:"Dr.",name:"Antonio",middleName:null,surname:"Loforte",slug:"antonio-loforte",fullName:"Antonio Loforte",profilePictureURL:"https://mts.intechopen.com/storage/users/42172/images/system/42172.jpg",biography:"Dr. Loforte is currently staff surgeon and chair of the Mechanical Circulatory Support (MCS) program at the Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Italy. He completed his cardiothoracic surgery recidency at the University of Bologna, S. Orsola Hospital (Italy), at St. Antonius Ziekenhuis, Nieuwegein (the Netherlands) and the Deutsches Herzzentrum Berlin (Germany). He additionally joined the Michael E. DeBakey Department of Surgery, Division of Transplant and Assist Devices, in Houston, Texas, USA.\nDr. Loforte is a member of several professional organizations including the prestigious STS, ISHLT, ASAIO, EACTS, RHICS, SICCH, SITO, ELSO, ESOT among others. His bibliography lists over 150 peer-reviewed original articles, 250 abstracts (communications) for international meetings, 20 book chapters, and 8 manuals. He serves as a reviewer for 25 international journals and is part of the editorial board in 10 of them. He received a ‘European Ph.D. label’ in Organ Transplantation and ten international awards in Europe and USA.",institutionString:"Division of Cardiac Surgery, S. 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Most of large technical systems could be seen as a kind of network, for example: information, transport or electricity distribution systems. Networks are modelled as directed graphs with nodes, in which commodities and information media are being processed, and arcs as communication links (telecommunication channels, roads, pipelines, conveyors, etc.) for media transportation. Resources of networks could be divided into two classes: services (functionality resources) and technical infrastructures (hardware and software resources).
\n\t\t\tWe propose to analyse the network system from the functional and user point of view, focusing on business service realized by a network system (Gold et al., 2004). Users of the network system realise some tasks in the system (for example: send a parcel in the transport system or buy a ticket in the internet ticket office). We assume that the main goal, taken into consideration during design and operation, of the network system is to fulfil the user requirements. Which could be seen as some quantitative and qualitative parameters of user tasks.
\n\t\t\tNetwork services and technical resources are engaged for task realization and each task needs a fixed list of services which are processed on the base of whole network technical infrastructure or on its part. Different services may be realized on the same technical resources and the same services may be realized on different sets of technical resources. Of course with different values of performance and reliability parameters. The last statement is essential when tasks are realized in the real network system surrounded by unfriendly environment that may be a source of threads and even intentional attacks. Moreover, the real networks are build of unreliable software and hardware components as well.
\n\t\t\tIn (Avižienis et al., 2000) authors described basic set of dependability attributes (i.e. availability, reliability, safety, confidentiality, integrity and maintainability). This is a base of defining different dependability metrics used in dependability analysis of computer systems and networks. In this paper we would like to focus on more functional approach metrics which could be used by the operator of the network system. Therefore, we consider dependability of networks as a property of the networks to reliable process of user tasks, that is mean the tasks have to perform not only without faults but more with demanded performance parameters and according to the planned schedule.
\n\t\t\tWe propose to concentrate the dependability analyse of the networks on fulfilling the user requirements. Therefore, it should take into consideration following aspects:
\n\t\t\tspecification of the user requirements described by task demands, for example certainty of results, confidentiality, desired time parameters etc.,
functional and performance properties of the networks and theirs components,
reliable properties of the network technical infrastructure that means reliable properties of the network structure and its components considered as a source of failures and faults which influence the task processing,
process of faults management,
threads in the network environment,
measures and methods which are planned or build-in the network for elimination or limitation of faults, failures and attacks consequences; reconfiguration of the network is a good example of such methods,
applied maintenance policies in the considered network.
As a consequence, a services network is considered as a dynamical structure with many streams of events generated by realized tasks, used services and resources, applied maintenance policies, manager decisions etc. Some network events are independent but other ones are direct consequences of previously history of the network life. Generally, event streams created by a real network are a mix of deterministic and stochastic streams which are strongly tied together by a network choreography. Modelling of this kind of systems is a hard problem for system designers, constructors and maintenance organizers, and for mathematicians, too. It is worth to point out some achievements in computer science area such as Service Oriented Architecture (Gold et al., 2004, Josuttis, 2007) or Business Oriented Architecture(Zhu & Zhang, 2006) and a lot of languages for network description on a system choreography level, for example WS-CDL (Yang et al., 2006), or a technical infrastructure level, for example SDL (Aime et al., 2007). These propositions are useful for analysis of a network from the designer point of view and they may been supported by simulation tools, for example modified SSF.Net simulator (Zyla & Caban, 2008), but it is difficult to find a computer tools which are combination of language models and Monte Carlo (Fishman, 1996) based simulators.
\n\t\t\tThe chapter presents a step to a creation of a verbal and formal model of a net of services. It presents a generic approach to modelling performability (performance and reliability) properties of the services net. The Petri Nets will is used for the task realization process modelling. Moreover, an example of service net– the discrete transport system analysed by an event-driven simulator is presented.
\n\t\tWe can distinguish three main elements of any network system: users, services and technical resources. As it presented in the Figure 1 users are generating tasks which are being realized by the network system. The task to be realized requires some services presented in the system. A realization of the network service needs a defined set of technical resources. In a case when any resource component of this set is in a state "out of order" or "busy" then the network service may wait until a moment when the resource component returns to a state "available" or the service may try to create other configuration on the base of available technical resources.
\n\t\t\tTherefore, following problems should be taken into consideration:
\n\t\t\tTask mapping on business services and technical resources.
description and mapping a service net on existed net resources for each moment of its using;
a prognoses process of the service net behaviour in a real life conditions – definition and selection of measures;
finding relations between measures/criteria and functional, performance and reliability parameters of the service net;
evaluation methods of choose measures of the service net;
decision process of maintenance organization - decision steps as a reaction on appeared events, specially on threats;
definition of measures and criteria of decision steps - risk of threats, and evaluation of decision risk and its cost.
An illustration of problems connected with functional – dependability modelling of services networks is shown in Figure 2.
\n\t\tThe
The system is considered as a union of its hardware, management system and involved personnel (administrators, users, support services etc.), so the system states depend on the states of all these elements. The system transitions are consequences of events connected with execution of system tasks and jobs, system faults and system reactions to them, incidents, attacks and system responses etc., i.e. system events are observable occurrences which change states of the system.
\n\t\t\tBasic terms and a functional - dependability model of a services network (
The functional – reliability model (Zamojski, 2005) of computer system
The system events includes those connected with tasks realization, occurrence of incidents (faults, viruses, and attacks) and system reactions to them (hardware and information renewals). The system events are very often described by their time parameters which are collected in so called
A functional configuration \n\t\t\t\t
\n\t\t\t\t
where superscript
A functional – reliability model in the system engineering is regarded as a structured representation of the functions, activities or processes, and events generated inside of the considered system and/or by its surroundings. The system events may be divided into two main classes: functional events and reliable (together with maintenance) events. In practice this classification is very often difficult to be made because a system reaction on an event may involve a lot of functional or/and maintenance reactions. Therefore, it is better to create one common class of functional–reliable events, so called
If the functional – reliability model is built as the ST model then the set of the system states is determined by the states of all resources involved in tasks realized at the moment. The system resource allocations are dynamic, modified due to the incoming tasks, occurring incidents and system reactions (especially reconfiguration).
\n\t\tExemplar choreography
A
The functional – dependability model of a services network has to consider specificity of the network: nodes and communication channels, the ability of dynamic changes of network traffic (routing) and reconfiguration, and all other tasks realized by the network.
\n\t\t\t\tThe service network could be defined as a tuple:
\n\t\t\t\twhere:
\n\t\t\t\tMS – management system (for example - operating system),
The task \n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
The input task is define as the triple:
\n\t\t\t\twhere:
\n\t\t\t\tThe output task is define as the pair:
\n\t\t\t\twhere:
\n\t\t\t\tThe postulated results and chronicles are defined with assumed tolerance intervals (\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
The term service is understood as a discretely defined set of contiguously cooperating autonomous business or technical functionalities. Of course, a special mechanism to enable an access to one or more businesses and functionalities should be implemented in the system. The access is provided by a prescribed interface and is monitored and controlled according to constraints and policies as specified by the service description OASIS Organization for the Advancement of Structured Information Standards Home Page. http://www.oasis-open.org/home/index.php
The service \n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t\t
Because the services have to cooperate with other services than protocols and interfaces between services and/or individual activities are crucial problems which have a big impact on the definitions of the services and on processes of their execution.
\n\t\t\t\tA service may be realized on the base of a few separated sets of functionalities\n\t\t\t\t\t
\n\t\t\t\t\t
Hardware is considered as a set of hardware resources (devices and communication channels) which are described by their technical, performance, reliability and maintenance parameters. The system software is described in the same way.
\n\t\t\tThe management system of service network allocates the services and network resources to realized tasks, checks the efficient states of the services network, performs suitable actions to locate faults, attacks or viruses and minimize their negative effects. Generally the management system has two main functionalities:
\n\t\t\t\tmonitoring of network states and controlling of services and resources,
creating and implementing maintenance policies which ought to be adequate network reactions on concrete events/accidents. In many critical situations a team of men and the management system have to cooperate in looking for adequate counter-measures, for instance in case of a heavy attack or a new virus.
The maintenance policy is based on two main concepts: detection of unfriendly events (attacks, faults, failures) and network responses to them. In general the network responses incorporate the following procedures:
\n\t\t\t\tdetection of incidents and identification of them,
isolation of damaged network resources in order to limit proliferation of incident consequences,
renewal of damaged services, processes and resources.
It is hard to predict all possible events (for example all new demands for a task realization) or incidents (for example failures, faults, attacks or an end of a renewal procedure) in the services network, especially it is not possible to predict all possible attacks or men faults, so system reactions are very often "improvised" by the management system, by its administrator staff or even by expert panels specially created to find a solution for the existing situation. The time, needed for the renewal, depends on the incident that has occurred, the system resources that are available and the renewal policy that is applied. The renewal policy is formulated on the basis of the required levels of system dependability and on the economical conditions (first of all, the cost of downtime and cost of lost achievements) (Zamojski & Caban, 2006, Zamojski & Caban, 2007).
\n\t\t\t\tMaintenance policy is based on maintenance rules that are understood as chains of decisions about allocation of services and network resources (hardware, software, information and service staff) that are undertaken to keep the system operational after an incident. These rules are very often connected with small fragments of the system, for example; replacement of a machine (a processor) or communication links. These local operations may have impact on the whole network, e.g. if a communication channel is down for a few minutes, then rates of medium (data) traffic of the network may violently change (Zamojski & Caban, 2007).
\n\t\t\tThe set of system events is created by events connected with tasks realization, incidents occurrence (faults, viruses, and attacks) and system reactions (hardware and information renewals).
\n\t\t\tThe task realization process is supported by two-level decision procedures connected with selection and allocation of the network functionalities and technical resources. There are two levels of decision process: services management and resource management. The first level of decision procedure is connected with selection suitable services and creation a task configuration. Functional and performance task demands are the base for suitable services choosing from all possible network services. The goal of the second level of the decision process is to find needed components of the network infrastructure for each service execution and the next allocate them on the base their availability to the service configuration. If any component of technical infrastructure is not ready to support the service configuration then allocation process of network infrastructure is repeated. If the management system could not create the service configuration then the service management process is started again and other task configuration may be appointed. These two decision processes are working in a loop which is started up as a reaction on network events and accidences. On the beginning of a task realization procedure the task\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t
Petri Nets (Zhou & Kurapati, 1999) are a powerful and often used modelling tool. They allow to represent two aspects of a modelled system static and dynamic (thanks to the token evolution). A common definition of the Petri net is formulating as a triple:
\n\t\t\twhere:
\n\t\t\tP - set of places that represent deterministic states of processes, tasks, services, resources etc. of the considered system. The places are often complemented by tokens that are modeled abilities of these places.
T – set of transitions that represent net events characterized by conditions necessary to come them into firing. The transitions are often described by firing time and other probabilistic characteristics etc.
A – set of arches (directed and inhibited) that models routes on which events represented by tokens are passed by the net.
The Petri net model of a task realization in a services network.
A state of the net, described by marking (tokens localization in the places) represents sufficient conditions for arising new events of a net’s life. Net’s events may be divided into many classes, for example functional, reliable or maintenance events, deterministic or probabilistic ones etc. The mention classification depends on assumed criteria.
\n\t\t\tThe Petri net model of the ith task realization (\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t
There is a build-in system of monitoring and detection of unfriendly accidences like faults and failures (place P5). When such unfriendly accidence is discovered then a renewal process of the functional configuration is started (transition t5 and renewal time\n\t\t\t\t
The firing process of each transition is described by conditions (tokens in input places for the transition) which may occur with probabilities, for example a probability of a machine failure, and time duration of transition firing may be a probabilistic function, too. Of course a transition may be many times fired during a task realization, because net events may need to repeat bigger or smaller loops of the net. The Petri net model shown in the Figure 4 is reduced and presented only to show the main idea of the proposed modelling method which may be useful for evaluation of dependability measures of services networks.
\n\t\t\tReal time of the ith task realization \n\t\t\t\t
where:
\n\t\t\tSuch dependability measures as a probability that the real time duration of the i-th task may be defined and evaluated on the base of the Petri net models as:
\n\t\t\tAn example of service net could be a DTSCNTT - Discrete Transport System with Central Node and Time-Table (Walkowiak et al., 2007). This is a simplified case of the Polish Post transport system.
\n\t\t\tFollowing the definition (4) each elements of service net could be described as follows.
\n\t\t\tThe business service (BS) provided the Polish Post and therefore DTSNTT service net is the delivery of mails. The technical infrastructure (TR) consists of a set of nodes placed in different geographical locations and set of vehicles and timetable. There are bidirectional routes between nodes marked by lines. There is distinguished one node called central mode. Mails are distributed among nodes by vehicles.
\n\t\t\tEach vehicle is described by following functional and reliability parameters: mean speed of a journey, capacity – number of containers which can be loaded, reliability function and time of vehicle maintenance.
\n\t\t\tManagement system (MS) is defined by time table since vehicles distributing mails among system nodes operate according to the time-table exactly as city buses or intercity coaches. The time-table consists of a set of routes (sequence of nodes starting and ending in the central node, time of approaching each node in the route and the recommended size of a vehicle). The number of used vehicle, or the capacity of vehicles does not depend on temporary situation described by number of transportation tasks or by the task amount for example. It means that it is possible to realize the journey by completely empty vehicle or the vehicle cannot load the available amount of commodity (the vehicle is to small). Time-table is a fixed element of the system in observable time horizon, but it is possible to use different time-tables for different seasons or months of the year.
\n\t\t\tTo reduce the complexity of the model we have decided to model the containers not separate mails (Walkowiak & Mazurkiewicz, 2009). Therefore, the tasks (J) of sending mails is modelled as a random process of containers generation. Each generated container has a destination address. The central node is the destination address for all containers generated in the ordinary nodes. Where containers addressed to in any ordinary nodes are generated in the central node. The generation of containers is described by Poisson process. In case of central node there are separate processes for each ordinary node. Whereas, for ordinary nodes there is one process, since commodities are transported from ordinary nodes to the central node or in opposite direction. Postulated result of any task is to transport a container to the destination node within a given time limit.
\n\t\t\tThe process of any task realization could be described as follows. The container is generated in some node at a given time (according to Poisson process) and stored in the node waiting for the vehicle to be transported to the destination node. Each day a given time-table is realized, it means that at a time given by the time table a vehicle, selected randomly from vehicles available in the central node, starts from central node and is loaded with containers addressed to each ordinary nodes included in a given route. The loading is done in a service point. This is done in a proportional way. Since the number of service points is limited (parameter of the central node) and loading takes some time is there is no free service point vehicles has to wait in a queue. After loading the vehicle goes to a given ordinary node - it takes some time according to vehicle speed - random process and road length. After approaching the ordinary node the vehicle is waiting in an input queue if there is any other vehicle being loaded/unloaded at the same time. The containers addressed to given node are unloaded and empty space in the vehicle is filled by containers addressed to a central node. The operation is repeated in each node on the route and finally the vehicle is approaching the central node when is fully unloaded and after it is available for the next route. The process of vehicle operation could be stopped at any moment due to a failure (described by a random process). After the failure, the vehicle waits for a maintenance crew (if it is not available due to repairing other vehicles), is being repaired (random time) and after it continues its journey (Walkowiak & Mazurkiewicz, 2009).
\n\t\t\tAs suggested in the introduction the simulator tool for analysing DTSCNTT service net was developed. The tool was adopting the event simulation approach, which is based on a idea of event, which could be described by time of event occurring, type of event (in case of DTSCNTT it could be a vehicle failure) and element or set of elements of the system on which event has its influence. The simulation is done by analyzing a queue of event (sorted by time of event occurring) while updating the states of system elements according to rules related to a proper type of an event. (Walkowiak et al., 2007)
\n\t\t\tWe proposed for the case study analysis an exemplar DTSCNTT based on Polish Post regional centre in Wroclaw. We have modelled a system consisting of one central node (Wroclaw regional centre) and twenty two other nodes - cities where there are local post distribution points in Dolny Slask Province. The length of roads were set according to real road distances between cities used in the analyzed case study. The intensity of generation of containers for all destinations were set to 4,16 per hour in each direction giving in average 4400 containers to be transported each day. The vehicles speed was modelled by Gaussian distribution with 50 km/h of mean value and 5 km/h of standard deviation. The average loading time was equal to 5 minutes. There were two types of vehicles: with capacity of 10 and 15 containers. The MTTF of each vehicle was set to 2000. The average repair time was set to 5h (Gaussian distribution). (Walkowiak & Mazurkiewicz, 2009)
\n\t\t\tThe simulation time was set to 100 days and each simulation was repeated 10.000 times. We have calculated the dependability measure defined by (10), the probability that the duration time of a task (delivery of some container) will be longer then a given time limit using Monte-Carlo approach (Fishman, 1996). The achieved results are presented in Figure 5.
\n\t\tThe probability of containers to be transported within a given limit time.
We have given a verbal and formal model of a service net. The formal model consists of a tuple mathematical model and the Petri Nets one. We hope that the proposed Petri net model will be very useful in the synthesis process of the service net. Of course there are a lot problems with building the Petri net model of the real services net in which exist a large number of services and technical resources that are mapped to many concurrent realized tasks. We have also presented an exemplar case study of service net a discrete transport system service net – a simplified case of Polish Post transport system. It was analysed by a usage of a discrete transport system simulator.
\n\t\t\tWe plan to develop a simulation tool for a generic service nets with a functionality similar to presented discrete transport system simulator or BS.SSF simulator (Walkowiak, 2009) together with graphical tool for modelling and simulation. We also plan to use high level languages like for examples Business Process Modeling Notation (White & Miers 2008) for a graphical representation for specifying business processes in a workflow. We hope that it could be possible to map BPMN into a Petri net model or a general purpose service net simulator allowing to perform a service net dependability analysis.
\n\t\t“2020” has been a revolutionary year especially in terms of exploring new healthcare horizons. The voyage of the pandemic which started off with crises, disbelief, qualms and fears; with the advent of the vaccine, seems to be ending with revival, hope, insights and new acumens.
In its true sense, within a couple of months the world transformed into a global village attacked by a common enemy “The SARS COVID-19 virus” with healthcare workers (HCW) stepping into the battlefield, leading from front; few losing their lives while the others still struggling to get through the catastrophe. Although the unsung heroes are working nonstop under tremendous pressure, surely the effects of this struggle may take a long time to fade. Especially the psychological pressure, stress and burnout may leave long lasting effects such as post-traumatic stress disorder, anxiety and depression which may continue to shape their lives in the long term.
This chapter gives an insight into the psychological journey of the essential healthcare workers; doctors, nurses and paramedical staff who are selflessly working at the frontlines, caring for their patients while striving to protect themselves, their families and loved ones from the outbreak. The chapter discusses the psychological distress caused, its associated factors and the coping strategies developed. As the pandemic is still not over, with the long term efficacy of vaccine unknown and as the third wave is approaching, recommendations can be made for preventive measures to limit the damage.
The infection was first reported as a case series of patients with pneumonia in Wuhan, China in December 2019. Tracing back exposure, all the cases were found to have visited a seafood market in Wuhan. The virus identified as a new strain of Corona virus, was later named as COVID-19 [1]. More than 200 countries and around 500,000 population worldwide were affected within a short span on 3–4 months, while death attributable to COVID-19 globally was reaching more than 20,000 by the end of March 2020 [2]. Though the whole world seemed to be unprepared for the calamity, developing countries with fragile healthcare systems were more vulnerable to collapse [3]. With a mortality rate as high as 12% reported in industrialized countries, the general speculations were devastating [4, 5].
Soon, the xenophobia spread to communities, institutions, regional and international governance while all the hopes to address, control and prevent widespread damage from the infection were laid on scientists, public health and medical professionals. High expectations from healthcare workers (HCWs) who were themselves vulnerable and exposed, further complicated the situation especially in an overwhelming situation with resource constraints. Healthcare workers including front line physicians, nurses and paramedical staff combating at forefront were especially susceptible to get infected, taking the disease back home and infecting their family members. As the association of higher mortality with older age became evident, the senior health professionals and their families were even more concerned for the health of their loved ones [6, 7].
Due to unpreparedness, availability of personal protective equipment (PPE) was limited even for the healthcare professionals, let alone for the general population. Dearth of knowledge about nature of disease and its spread, further created mental pressure and psychological distress [3]. Institutions which were already overburdened and functioning beyond their limits, were unable to provide adequate support to the petrified HCWs.
The beginning of the pandemic was therefore taxing for the mental wellbeing especially of healthcare professionals. Various studies among frontline physicians, nurses, para medical and administrative staff, revealed a high prevalence of stress, anxiety and depression [8] as depicted in Table 1. Although most of the studies did not compare the prevalence of mental distress during COVID than the pre-COVID era, but generally there was an alarming frequency of stress, anxiety and depression during the pandemic [25]. A study found a higher likelihood of anxiety, depression and lower quality of life scores among HCWs involved in COVID response than those who worked in other areas [26]. Another study in Italy revealed that healthcare professionals who were working with COVID patients were twice as likely to seek psychological help during the pandemic, than those working in other areas [27].
Healthcare worker | Subjects | Country | Frequency | Associated factors/ predictors of depression/anxiety | |
---|---|---|---|---|---|
Developing countries | |||||
[3] Physicians | 389 | Pakistan | 43% physicians had depression |
| |
[6] HCW (Majority nurses) | 365 | Jordan | High fear score 40% extremely severe depression, 60% extremely severe anxiety 35% severely distressed |
| |
[9] Doctors, nurses and paramedics | 476 | South Asian countries | 25.7% prevalence of depression |
| |
[10] HCW | 908 | China | 16.63% moderate/severe anxiety 18.29%moderate/severe depression 24.50% concomitant moderate/severe anxiety and depression |
|
|
[11] HCWs (doctors, health assistants, auxiliary nurse-midwifery, nursing students posted in the wards, laboratory assistants, paramedics, staff nurses, sanitization workers, ward attendants, security guards and ambulance drivers) | 150 | Nepal | Prevalence of anxiety disorder was 37.3 %, 8% of the participants had depression Overall, 38 % of the participants, had at least one psychiatric illness | - | |
[12] Frontline medical imaging staff | 5331 | China | Frequency of anxiety disorders were 6.5% and higher than those of anxiety and depression in Chinese residents before the epidemic. | - | |
[13] Healthcare workers | 331 | Cameroon | Anxiety (41.8%) and depression (42.8%) |
| |
HCWs [14] | 433 | India | High-level stress in 3.7% Depressive symptoms requiring treatment and anxiety symptoms requiring further evaluation were 11.4% and 17.7% respectively |
| |
[15] HCWs | 1146 | India, Indonesia, Singapore, Malaysia and Vietnam | 4.5% screened positive for depression, 5.2% for anxiety India had the lowest prevalence of depression 0.8%, Indonesia 2.4% Singapore 4.7%, Vietnam 6.7% and Malaysia (14.3%). |
| |
[7] HCWs | 745 | Libya | 56.3% participants had depressive symptoms 46.7% had anxiety symptoms |
|
|
[16] Nurses | 2,014 | Wuhan, China | 14.3%, 10.7% and 91.2% nurses reported moderate to high levels of anxiety, depression, and fear | Mental health outcomes negatively correlated with
| |
[17] Frontline nurses | 325 | Philippines | 37.8% were found to have dysfunctional levels of anxiety |
| |
[18] Frontline nurses | 176 | Wuhan China | Mild, moderate and severe anxiety symptoms were found in 27.3%, 25%, and 25% |
| |
[19] Nurses | 441 | Iran | 40% had moderate to severe anxiety. |
| |
[20] Frontline nurses | 643 | Wuhan China | One-third (33.4%) reported anxiety | perceived stress and insomnia | |
[21] Nurses | 3,228 | Sichuan Province and Wuhan City | 47.1% depression |
| |
[22] Nurses | 586 | Eastern China | Frequency of anxiety and depression was 27.6% and 32.8%, respectively |
| |
[9] HCWs (majority Physicians) | 939 | Turkey | 77.6% reported depression 60.2% anxiety 50.4% had insomnia 76.4% distress symptoms |
| |
[10] healthcare workers | 218 | Italy | Prevalence of moderate to extremely severe symptoms in 8% for depression, 9.8% for anxiety, and 8.9% for stress. | Contributions of enhancement and suppression abilities and sensitivity to stressor context cues in predicting depression, anxiety determined. | |
[11] HCWs (hospital, midwifery and administrative staff) | 600 | Dublin, Ireland | 20.3% of HCWs had moderate to severe depression and 21.0% had moderate to severe anxiety. 37% felt limitation of activity contributed to psychological deterioration. Household tensions were reported by 14% with partners and 20% with other household members including children |
| |
[23] Neurosurgeons | 375 | 52 countries | 34% felt tense, 32.5 % unhappy and 14% had depression |
| |
[12] Nurses | 255 | UK | 21% moderate to severe or severe anxiety depression (17.2%,) 18.9% had a low or very low resilience score. | Younger nurses with less experience have higher levels of anxiety and depression and had lower resilience. | |
[13] Nurses | 1,005 | Italy | Prevalence of sleep disturbances, moderate anxiety and low self-efficacy was 71.4%, 33.23% and 50.65%, respectively | Females were more prone to sleep disturbances, anxiety and had lower levels of self-efficacy than male | |
[24] Nurses | 270 | Turkey | 85.6% had high anxiety levels | Area of work in COVID ICU and perception of insufficient income was associated with anxiety |
Frequency and associated factors of mental health disorders among healthcare workers in developing and developed countries.
As the infection built up its momentum and an epidemic transformed into a pandemic; there was an uneasiness among the medical professionals and other stakeholders. Fear of infection; especially spreading it to family members, long shifts in sub-optimal condition, lack of training and confidence created a vicious cycle of mistrust and negative professional attitude among physicians and nurses [28]. For example a study from china showed that mental health problems were more likely among nurses who regretted being in the field during the pandemic [29]. Another systematic review and meta-analysis showed high prevalence of anxiety and depression especially among female nurses [25].
Use of personal protective equipment (PPEs) by general population lead to an acute shortage and unavailability of masks and other PPEs for healthcare professionals, further complicating the situation. A lot of myths and false information were spread not only among the lay people but also the HCWs who were relying on news and social media for updates due to paucity of scientific data on the disease [3]. Stigmatization was therefore another factor associated with psychological distress and anxiety among HCWs [7]. In a nutshell, during the upsurge of the calamity, vulnerability to psychological distress was multifactorial and inevitable.
As the infection rapidly spread, the governments and health authorities experimented on various ways to contain and minimize spread of infection. Strict lock-downs were imposed and travel restricted, while standard operating procedures (SOPs) were formulated and implemented for essential services. Healthcare institutions and hospitals had to quickly devise a disaster plan, which included introducing secluded COVID clinics, emergency services, wards, high dependency units and intensive care units. Medical education came to a halt and post-graduate training was interrupted by special duties of medical and nursing trainees in COVID areas [30]. Other specialty doctors, nurses and paramedics were also trained to cover duties in COVID designated areas, as priorities shifted from non-emergency services to urgent care [23]. Elective surgeries and procedures were postponed and regular patient follow ups were deferred. On one hand this reduced the work load of healthcare workers offering services which were down the priority list; but physicians, nurses and paramedics on daily wages and incentives suffered financially. Private primary healthcare set-ups were closed to avoid unnecessary exposure of healthcare staff to infection while secondary and tertiary care hospitals dealt more with COVID and its associated emergencies. Follow up of patients with non-communicable diseases and elective surgeries were either deferred or the patients themselves opted to delay, due to fear of catching the virus. All procedures, laboratory work-up and diagnostic tests were also postponed, if risk of infection outweighed the benefits. Therefore, all the healthcare professionals offering non-essential services during the pandemic suffered financially.
This was indeed further taxing for HCWs working in private organization especially in developing countries, where insurance coverage and assistance from the government is minimal and often absent. Private institutions on the other hand were unable to cope up with the dipping revenue, which resulted in employers reducing salaries and forcing HCWs to take unpaid leaves [31].
The economic impact was generic for all other professions, in fact the intensity was even more for other professionals, with complete lock-downs, social isolation and closure of non-essential services. Therefore, the healthcare heroes had to fight back and make both ends meet with minimal support from other family members, especially during the initial surge of the pandemic. A study in Spain showed that frequency of suicidal ideation and behavior was high among COVID HCWs and the found to be associated with financial stress [32].
Moreover, in developing countries, unsatisfactory healthcare services even before the pandemic, provoked mistrust and apprehension among HCWs when they listened to horror stories from the media. The same was true for the best healthcare systems falling short to handle this overwhelming situation even in the developed world [33].
With mistrust and economical pressure building up, the gravity of situation was further worsened by an exponential increased risk of infection among the healthcare workers. Physicians, nurses and para medics suffered with worst infections. By the mid of 2020, more than 1.5 million infections and 1400 deaths were reported among HCWs. Infections were more common among women and nurses while majority males and doctors died of it. General practitioners and mental health nurses were the highest risk specialties for deaths. For HCWs over 70 years of age the death rate was 37 deaths per 100 infections. The Eastern Mediterranean region had the highest number of reported deaths per 100 infections [34]. Besides risk of infection, the news of colleagues and acquaintances succumbing to it worked as a double edged sword, increasing psychological distress leading to stress, anxiety and depression among HCWs [23]. Furthermore, a feeling of helplessness and hopelessness prevailed when skilled medical experts were not able to help their patients to recover due to absence of available literature or clear scientific evidence on effective treatments; the phenomena of “moral injury”, as mentioned elsewhere in the chapter; The clinical guidelines issued by various regulatory bodies in a crises situation were weak and incomplete. Also there were a lot of discrepancies, making decision making further difficult for physicians, hence creating chaos and distress. The factors leading to mental disorders among HCWs during the pandemic therefore, were dynamic; creating a vicious cycle of increasing challenges, stress, inability to cope and more misery (Figure 1).
Vicious cycle of psychological distress.
With the spread of infection, apprehension and fear was widespread among the general population. With an exponential increase in number of people getting infected, the panic was inevitable. This was especially evident in the developed countries, as the health systems though stable were not able to deal with the sudden surge of infected patients. While in the developing countries, an already fragile system with the overwhelming numbers reached to the verge of collapsing. As smaller scale healthcare set-ups were closed, tertiary care had to bear the brunt of all sorts of cases, from asymptomatic patients with anxiety to mild symptoms and severe symptoms, all reported in emergencies. This lead to overcrowding and hence compromising the quality of care. So much so that, a few private hospitals had to stop accepting new patients, due to unavailability of space in high dependency and intensive care units. This translated to a panic state among the general public. Hundreds of incidences of harassment and violence against healthcare workers were reported. Angry mobs went on to vandalize public and private properties on hospitals refusing to accept patients [35].
Misinformation and rumors spread all the wrong messages across non-medical people, further aggravating disbelief and mistrust. The “bad news” of the Pandemic was followed by a natural course of events. Initially, the public denied the presence of a new virus and labeled it as a “hoax perpetrated by a global cabal” and “a bio-weapon” [36]. Their illusions and imaginations went further wild when the healthcare authorities and professionals were unable to clarify their doubts with the little evidence and knowledge they themselves had about the disease. For example, initially it wasn’t clear if infected corpses were able to spread infection, so the staff were directed against handing over COVID infected corpses to relatives. This created doubts among the family already facing an emotional turmoil and rumors of political conspiracies spread, regarding hospitals tagging patients as “COVID infected” and retaining their dead bodies. Stigmatization against healthcare workers, COVID infected patients and medical infrastructure, therefore resulted in a high prevalence of violence, majority of which was directed against HCWs. Incidents of threats, physical and verbal assaults to the extent of HCW being shot were reported, especially in South-Asian and other developing countries [37]. The outcome was even worse with an already high frequency of burn out and psychosocial distress among HCWs [38]. With the healthcare system overburdened already at the peak of the pandemic, there was no time to for the government or healthcare authorities to respond to the hue and cries of HCWs.
When little was known about complications of infection among elderly age group, the retired doctors were asked to help with managing the crisis, especially in UK [36]. As researches were conducted and it became evident that older age group was more likely to have grave complications and high mortality, a lot of senior and experienced physicians either chose to stay away or asked by their organizations to minimize exposure. Those who continued to work, felt even more distress with the risk of being exposed. On the other hand, younger HCWs feared taking the infection home to their elderly family members, hence a few studies also showed an association of young age with anxiety and depression among HCWs. This was especially prevalent in countries where a joint family system still prevails [21, 24]. The gravity of dissatisfaction among healthcare workers, especially nurses can be gauged by studies which revealed that not only nurses wanted to change their profession after the pandemic, but in Turkey, nursing students were found to be suffering from anxiety associated with a negative perception of their profession and an unwillingness to practice their profession in future [39].
“Moral injury” is yet another form of psychological distress as a sequelae of actions, or the lack of them, which is against someone’s ethical code. This phenomena has been recently described in UK which is imposing a risk of psychological distress among HCWs, facing intense feelings of guilt due to the sub-optimal human resource and facilities available to deal with the suffering patients [40].
The overall situation was of resentment, hopelessness and dismay complicated by physical illness and rapid spread of infection among HCWs and their families, lead to an alarming frequency of mental health disorders like anxiety and depression among them.
Healthcare professionals are the main force on which foundation of healthcare system rests; hence eventually the government authorities and institutions realized the utmost importance of addressing their mental and physical wellbeing so that they can perform their duties in the most efficient manner. As the governments and healthcare authorities were able to consolidate their efforts, the need to address the psychological health of HCWs was felt. It was sensed that mental health of frontline healthcare workers required consideration, targeted prevention and intervention.
Positive messages were spread across by regulatory bodies, local governments, national and multinational organizations at all platforms, labelling healthcare workers as “heroes of the pandemic”. Encouraging slogans like “Not all heroes wear capes, some wear scrubs” [41] were circulated in media, thanking HCWs for their efforts and for facing the predicaments from the front. Measures were taken to stop misinformation by circulating the correct information through visual, print and social from authentic sources like government, societies, NGOs and regulatory bodies (Figures 2 and 3).
A message circulated by Centre of Disease Control (CDC).
A message circulated by World Health Organization (WHO).
Protocols were made and zero tolerance policy was implemented by local governments to protect the HCWs from violence. For example India made violence against HCWs, a non-bail able offence with an imprisonment for 7 years, while Sudan created a special police task force to protect them. In June, the International Committee of Red cross in collaboration with World health organization (WHO) published a checklist for HCWs including managers, practitioners and policy makers for addressing the issue of violence against HCWs, which included procedures for risk assessment, response and accountability towards those receiving care [37].
Religious scholars also played a role in giving out the right information and convincing people for compliance with protocols. Moreover positive religious coping among HCWs was shown to be a negative predictor of anxiety and depression, so opening up of religious centers like mosques and churches after the peak subsided, may have promoted better mental health and psychological tranquility [42].
Similarly, regulatory bodies, health authorities, local and international governance and organizations are providing mental health support is through organized efforts to promote psychological wellbeing of physicians and nurses, and the outcomes have been shown to be encouraging. In Italy for example guidelines were implemented for providing frontline HCWs with psychological support and providing strategies for coping stress. Also surveillance programs to screen and follow HCWs for mental health were devised [40].
Work stress was shown to be a positive predictor of poor mental health [43]. Therefore, strategies to promote mental wellbeing, such as balanced diet and physical activity, stress relaxation and recreational activities, frequent breaks between work shifts, socializing and expressing emotions were promoted and shown to be effective in reducing anxiety and depressive symptoms among nurses [44]. A considerate and mindful leadership who is able to communicate, educate and support nurses to practice competently and safely (physically and mentally) in the context of COVID-19 was also shown to reduce anxiety and encourage resilience hence positively impacting their mental health [45]. Even online learning sessions on emotional freedom techniques sessions was shown to help improve mental health outcomes among nurses [46].
In Italy, a multidisciplinary team of psychologists and occupational therapists teamed up to provide frontline healthcare workers with psychological care based on coping strategies for managing stress [40].
The covid −19 pandemic started off with uncertainties and fear of unknown. With the excessive physical, social and psychological burden, especially on the lives of healthcare professionals, the fear gradually evolved to chronic anxiety. The focus in the current state should be to direct efforts to break this cycle as anxiety is just at the verge of transforming to hopelessness, anguish and depression. This is evident from the fact that while initially HCWs hoped the pandemic to end in a couple of months, after a year majority are uncertain as to how long the calamity would continue.
It is therefore imperative to intervene at this stage when the mental health of communities at large, especially HCWs is evolving from qualms to fear, anxiety and anguish which can be detrimental and challenging to reverse at a later stage, leaving them with post-traumatic stress disorder and hence low productivity.
As it is said, “For everything that divides, the human spirit unites”. As a result of these efforts, as compared to the general public while the frequency of anxiety and depression was high among HCWs before the peak, it descended after the peak [47]. A better insight into the disease its prevention and treatment could also have helped alleviate the anxiety among the physicians.
In a span of a year the situation came in a recovery phase with better insight, while just as SOPs were eased off and things seemed to be normalized, we were approached by the 2nd and 3rd surge of infection. Therefore, the hopes are now based on being able to target prevention through vaccines. It is speculated that with the advent of the vaccine, the social distancing protocols could be eased off. Moreover, a herd immunity as in the case of other deadly infections like small pox and polio, could eliminate the infection from the globe. This would normalize life as in the pre-COVID era and hence the distress would come back to baseline. From another perspective, if the vaccine is ineffective or if the innate ability of the virus to mutate quickly translates to a futile vaccine, the consequences may be unwarranted. Therefore, it’s too early to relax, as putting guards down can still lead to another deadly wave of infection, further causing more stress and trauma to the HCWs.
Nearly every accomplishment in this world is a result of a goal identified in a moment of crises or to fill a need. As the scientists worked tirelessly to gather more knowledge about the disease and its prevention, effective management and treatment guidelines were published. Physicians were able to work out prognosis and probabilities of complications, hence were able to offer better treatment modalities and patient care. The knowledge and confidence translated into a positive outlook and less distress among physicians. Finally, the news of near availability of effective vaccine was a sigh of relief for most HCWs.
The uncertainty and qualms HCWs went through for more than a year was bound to inculcate doubts. Only 36% of the HCWs were sure to get the vaccine as soon as it was available, as shown by a survey in November 2020, with safety, efficacy and speed of development, “too good to be true” being major concerns [48] Other studies done to explore the readiness of HCWs to get vaccinated showed similar results, with senior HCWs more likely to take the vaccine immediately [49].
As education has been shown to be a predictor of vaccine uptake, it is more likely that in developing countries, the acceptability of vaccination would be lower than in developed nations. Yet, hopefully an insight into reduction in number of infected cases, hospital admissions and mortality will increase acceptability of the vaccine.
Currently, the available vaccines have shown to be effective with minimal adverse effects [50] and HCWs all around the world have been given the first priority for vaccination followed by the most vulnerable; the geriatric age group. There is still some apprehension and doubts, even among HCWs about efficacy of different available vaccines, yet the overall impression is reassuring, especially, when one can anticipate the situation to gradually revert to normal. Moreover, with immunity to the infection, socialization without worrying for contacting an infection and traveling for the sake of leisure, professional and academic development can be made possible, with just an evidence of vaccination. Certainly the inflated incidence of mental health issues among the healthcare workers can be taken care of with the magic, a simple vaccine can create.
Although the year was tough especially on the HCWs adversity provokes fear related behaviors and affects the mental health negatively. Yet, it brings out the best in oneself, raising the probability of rising beyond the situation, promoting self-actualization, self-realization and resilience.
Healthcare workers quickly became the frontline force to help the world deal with the pandemic. The epidemic which quickly transformed into a pandemic, started off with widespread uncertainties and xenophobia, with HCWs the most affected. The uncertainties within months became overwhelming at the peak of pandemic, when they were not only physically at risk but widespread infection brought much more psychological distress, because of expectations the world had from them. Quite a few lost their lives while others struggled to get through. Yet, as the chapters turned, the champions transformed themselves into more resilient and sturdy beings, with mindful leadership and other professionals helping them stay lucid. Governments need to help healthcare organizations, HCWs and their families to overcome financial set-backs, which would take time to stabilize post pandemic. With more insight into the dynamics of the interplay between physical, social, psychological and spiritual factors, we recommend that the efforts and interventions to promote well-being of healthcare workers should continue at local and international level. This will to prevent and limit the long term consequences of the trauma and helping them break the vicious cycle. More researches need to be focused on providing evidence to intervene and promote better mental health outcomes among HCWs as the vaccination produces herd immunity. The frequency and factors associated by anxiety and depression need to be assessed post-pandemic, so that the lessons learnt can be useful for the generations and pandemics to follow.
Although, at present, the battle continues with the 2nd, 3rd and now the 4th wave, but so does optimism, as we continue to believe that, “There was never a night or a problem that could defeat sunrise or hope”.
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Zhu",coverURL:"https://cdn.intechopen.com/books/images_new/6476.jpg",editedByType:"Edited by",editors:[{id:"139789",title:"Dr.",name:"Ivan",middleName:"X",surname:"Zhu",slug:"ivan-zhu",fullName:"Ivan Zhu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5979",title:"Solid Waste Management in Rural Areas",subtitle:null,isOpenForSubmission:!1,hash:"d64034d3934894e61dc6e29437feb55d",slug:"solid-waste-management-in-rural-areas",bookSignature:"Florin-Constantin Mihai",coverURL:"https://cdn.intechopen.com/books/images_new/5979.jpg",editedByType:"Edited by",editors:[{id:"175726",title:"Dr.",name:"Florin-Constantin",middleName:null,surname:"Mihai",slug:"florin-constantin-mihai",fullName:"Florin-Constantin Mihai"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5242",title:"Management of Hazardous Wastes",subtitle:null,isOpenForSubmission:!1,hash:"cc1f32b478098cdda6b946d14a02ad81",slug:"management-of-hazardous-wastes",bookSignature:"Hosam El-Din M. Saleh and Rehab O. Abdel Rahman",coverURL:"https://cdn.intechopen.com/books/images_new/5242.jpg",editedByType:"Edited by",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",middleName:null,surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2781",title:"Waste Management",subtitle:"An Integrated Vision",isOpenForSubmission:!1,hash:"757e7d80a747b79fc5578261f37357a4",slug:"waste-management-an-integrated-vision",bookSignature:"Luis Fernando Marmolejo Rebellon",coverURL:"https://cdn.intechopen.com/books/images_new/2781.jpg",editedByType:"Edited by",editors:[{id:"136115",title:"Dr.",name:"Luis Fernando",middleName:null,surname:"Marmolejo Rebellon",slug:"luis-fernando-marmolejo-rebellon",fullName:"Luis Fernando Marmolejo Rebellon"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:14,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"51924",doi:"10.5772/64145",title:"White-Rot Fungi and their Enzymes as a Biotechnological Tool for Xenobiotic Bioremediation",slug:"white-rot-fungi-and-their-enzymes-as-a-biotechnological-tool-for-xenobiotic-bioremediation",totalDownloads:2508,totalCrossrefCites:15,totalDimensionsCites:37,abstract:"A huge amount of hazardous organopollutants, often persistent and toxic, is produced annually over the world and may contaminate soil, water, ground water, and air. Being from various sources such as wastewater, landfill leachates, and solid residues, xenobiotics include phenols, plastics, hydrocarbons, paints, dyes, pesticides and insecticides, paper and pulp mills, and pharmaceuticals. Among biological processes for degradation of xenobiotics, fungal ones, being eco-friendly and cost cheap, have been investigated extensively because most of basidiomycetes are more tolerant to high concentrations of pollutants. Fungal bioremediation is a promising technology using their metabolic potential to remove or reduce xenobiotics. Basidiomycetes are the unique microorganisms that show high capacities of degrading a wide range of toxic xenobiotics. They act via the extracellular ligninolytic enzymes, including laccase, manganese peroxidase, and lignin peroxidase. Their capacities to remove xenobiotic substances and produce polymeric products make them a useful tool for bioremediation purposes. During fungal remediation, they utilize hazardous compounds, even the insoluble ones, as the nutrient source and convert them to simple fragmented forms. The aim of this chapter is to elucidate the ability of basidiomycetes to degrade xenobiotics. This is an overview to present the importance of extracellular enzymes for efficient bioremediation of a large variety of xenobiotics.",book:{id:"5242",slug:"management-of-hazardous-wastes",title:"Management of Hazardous Wastes",fullTitle:"Management of Hazardous Wastes"},signatures:"Mariem Ellouze and Sami Sayadi",authors:[{id:"182201",title:"Dr.",name:"Mariem",middleName:null,surname:"Ellouze",slug:"mariem-ellouze",fullName:"Mariem Ellouze"},{id:"182451",title:"Dr.",name:"Sami",middleName:null,surname:"Sayadi",slug:"sami-sayadi",fullName:"Sami Sayadi"}]},{id:"17588",doi:"10.5772/22381",title:"Delignification Process of Agro-Industrial Wastes an Alternative to Obtain Fermentable Carbohydrates for Producing Fuel",slug:"delignification-process-of-agro-industrial-wastes-an-alternative-to-obtain-fermentable-carbohydrates",totalDownloads:7243,totalCrossrefCites:13,totalDimensionsCites:34,abstract:null,book:{id:"325",slug:"alternative-fuel",title:"Alternative Fuel",fullTitle:"Alternative Fuel"},signatures:"Oscar Sánchez, Roció Sierra and Carlos J. Alméciga-Díaz",authors:[{id:"47504",title:"MSc",name:"Oscar",middleName:null,surname:"Sanchez",slug:"oscar-sanchez",fullName:"Oscar Sanchez"},{id:"56842",title:"Dr.",name:"Rocio",middleName:null,surname:"Sierra",slug:"rocio-sierra",fullName:"Rocio Sierra"},{id:"56843",title:"Dr.",name:"Carlos",middleName:"Javier",surname:"Almeciga-Diaz",slug:"carlos-almeciga-diaz",fullName:"Carlos Almeciga-Diaz"}]},{id:"40527",doi:"10.5772/50241",title:"Solid Waste Management in African Cities – East Africa",slug:"solid-waste-management-in-african-cities-east-africa",totalDownloads:16255,totalCrossrefCites:19,totalDimensionsCites:33,abstract:null,book:{id:"2781",slug:"waste-management-an-integrated-vision",title:"Waste Management",fullTitle:"Waste Management - An Integrated Vision"},signatures:"James Okot-Okumu",authors:[{id:"141924",title:"Dr.",name:"James",middleName:null,surname:"Okot-Okumu",slug:"james-okot-okumu",fullName:"James Okot-Okumu"}]},{id:"17589",doi:"10.5772/23176",title:"Performance and Emission Characteristics of Spark Ignition Engine Fuelled with Ethanol and Methanol Gasoline Blended Fuels",slug:"performance-and-emission-characteristics-of-spark-ignition-engine-fuelled-with-ethanol-and-methanol-",totalDownloads:12150,totalCrossrefCites:16,totalDimensionsCites:29,abstract:null,book:{id:"325",slug:"alternative-fuel",title:"Alternative Fuel",fullTitle:"Alternative Fuel"},signatures:"Ioannis Gravalos, Dimitrios Moshou, Theodoros Gialamas, Panagiotis Xyradakis, Dimitrios Kateris and Zisis Tsiropoulos",authors:[{id:"50923",title:"Prof.",name:"Ioannis",middleName:null,surname:"Gravalos",slug:"ioannis-gravalos",fullName:"Ioannis Gravalos"},{id:"57241",title:"Prof.",name:"Theodoros",middleName:null,surname:"Gialamas",slug:"theodoros-gialamas",fullName:"Theodoros Gialamas"},{id:"57242",title:"MSc.",name:"Panagiotis",middleName:null,surname:"Xyradakis",slug:"panagiotis-xyradakis",fullName:"Panagiotis Xyradakis"},{id:"57244",title:"Dr.",name:"Dimitrios",middleName:null,surname:"Kateris",slug:"dimitrios-kateris",fullName:"Dimitrios Kateris"},{id:"57245",title:"MSc",name:"Zisis",middleName:null,surname:"Tsiropoulos",slug:"zisis-tsiropoulos",fullName:"Zisis Tsiropoulos"},{id:"101768",title:"Prof.",name:"Dimitrios",middleName:null,surname:"Moshou",slug:"dimitrios-moshou",fullName:"Dimitrios Moshou"}]},{id:"17585",doi:"10.5772/21905",title:"Biodiesel Fuel Production by Enzymatic Transesterification of Oils: Recent Trends, Challenges and Future Perspectives",slug:"biodiesel-fuel-production-by-enzymatic-transesterification-of-oils-recent-trends-challenges-and-futu",totalDownloads:11095,totalCrossrefCites:14,totalDimensionsCites:27,abstract:null,book:{id:"325",slug:"alternative-fuel",title:"Alternative Fuel",fullTitle:"Alternative Fuel"},signatures:"Nevena Luković, Zorica Knežević-Jugović and Dejan Bezbradica",authors:[{id:"45320",title:"MSc",name:"Nevena",middleName:null,surname:"Lukovic",slug:"nevena-lukovic",fullName:"Nevena Lukovic"},{id:"57079",title:"Prof.",name:"Dejan",middleName:null,surname:"Bezbradica",slug:"dejan-bezbradica",fullName:"Dejan Bezbradica"},{id:"57080",title:"Dr.",name:"Zorica",middleName:null,surname:"Knežević-Jugović",slug:"zorica-knezevic-jugovic",fullName:"Zorica Knežević-Jugović"}]}],mostDownloadedChaptersLast30Days:[{id:"73517",title:"Agricultural Solid Wastes: Causes, Effects, and Effective Management",slug:"agricultural-solid-wastes-causes-effects-and-effective-management",totalDownloads:1672,totalCrossrefCites:5,totalDimensionsCites:15,abstract:"The role of the agricultural sector in human development and economic development cannot be overemphasized. Awareness for increased agricultural production is on the increase, arising from the need to feed the ever-increasing human population. Interestingly, almost all agricultural activities generate wastes, which are generated in large quantities in many countries. However, these wastes may constitute a serious threat to human health through environmental pollution and handling them may result in huge economic loss. Unfortunately, in many developing countries where large quantities of these wastes are generated, they are not properly managed because little is known about their potential risks and benefits if properly managed. There are studies that address some of the challenges of agricultural solid wastes as well as suggestions on how they can be properly managed. In this chapter, we intend to explore the major sources of agricultural solid wastes, their potential risks, and how they can be properly managed.",book:{id:"9873",slug:"strategies-of-sustainable-solid-waste-management",title:"Strategies of Sustainable Solid Waste Management",fullTitle:"Strategies of Sustainable Solid Waste Management"},signatures:"Isaac Oluseun Adejumo and Olufemi Adebukola Adebiyi",authors:[{id:"276527",title:"Dr.",name:"Isaac Oluseun",middleName:null,surname:"Adejumo",slug:"isaac-oluseun-adejumo",fullName:"Isaac Oluseun Adejumo"},{id:"328699",title:"Dr.",name:"O.A.",middleName:null,surname:"Adebiyi",slug:"o.a.-adebiyi",fullName:"O.A. Adebiyi"}]},{id:"64270",title:"Decentralization and Solid Waste Management in Urbanizing Ghana: Moving beyond the Status Quo",slug:"decentralization-and-solid-waste-management-in-urbanizing-ghana-moving-beyond-the-status-quo",totalDownloads:2097,totalCrossrefCites:4,totalDimensionsCites:10,abstract:"Waste management is competing with more pressing economic and social issues such as social protection programs, education, and health. The government of Ghana has therefore decentralized the waste management system in the country. With this development, local government authorities and private sector actors are now playing key roles in waste management in the country. This study sought to examine decentralized solid waste management in the Berekum and Dormaa Municipalities in the Brong Ahafo Region of Ghana. Specifically, it analyzed the involvement of the private sector in solid waste management, and the quality of waste management services in the two selected municipalities. Through a survey of 312 households, the study analyzed the performance improvement, regulatory policy, and sustainable service delivery of solid waste management in the municipalities. The study found that there were no mechanisms for full cost recovery to include majority of the residents, who patronize communal collection service. The study therefore recommends the adherence to normative standards and agreed rules, adoption, and use of appropriate cost recovery strategies for low-income groups as well as the restructuring of institutional arrangements to ensure user involvement and enforcement of legislation to improve municipal solid waste management in Ghana.",book:{id:"8580",slug:"municipal-solid-waste-management",title:"Municipal Solid Waste Management",fullTitle:"Municipal Solid Waste Management"},signatures:"Richard Kyere, Michael Addaney and Jonas Ayaribilla Akudugu",authors:[{id:"273978",title:"Ph.D. Student",name:"Michael",middleName:null,surname:"Addaney",slug:"michael-addaney",fullName:"Michael Addaney"},{id:"273981",title:"Mr.",name:"Richard",middleName:null,surname:"Kyere",slug:"richard-kyere",fullName:"Richard Kyere"},{id:"273982",title:"Dr.",name:"Jonas Ayaribilla",middleName:null,surname:"Akudugu",slug:"jonas-ayaribilla-akudugu",fullName:"Jonas Ayaribilla Akudugu"}]},{id:"65314",title:"Municipal Solid Waste Disposal in Mangrove Forest: Environmental Implication and Management Strategies in the Niger Delta, Nigeria",slug:"municipal-solid-waste-disposal-in-mangrove-forest-environmental-implication-and-management-strategie",totalDownloads:1062,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"Niger Delta is an oil rich region situated in the southern part of Nigeria. It is made up of nine states which hosts oil industries. There are a handful of businesses (super market, manufacturing companies, etc.) that service the over 40 million people living in the cities. This situation had led to the increase in solid waste in the city. Because of the problem of over population, and poor waste management strategies (e.g., lack of recycling habit and lack of equipment) the mangrove forest had become a dumping ground for waste. This action has impacted the health of aquatic and terrestrial organisms, and has created a public health disaster for citizens because of increase in heavy metal concentration up the food chain. This chapter therefore, identifies poverty, lack of planning, poor behavior and poor technology as key factors affecting effective waste management in the Niger Delta. It suggests that good waste management system can be worked out if there is coordination between research institution and government in the implementation of recommendation by research institutes. Attitudinal change is also necessary on the part of citizens and government to enable a healthy interaction for the purpose of managing waste effectively.",book:{id:"8580",slug:"municipal-solid-waste-management",title:"Municipal Solid Waste Management",fullTitle:"Municipal Solid Waste Management"},signatures:"Aroloye O. Numbere",authors:[{id:"215285",title:"Dr.",name:"Aroloye O.",middleName:null,surname:"Numbere",slug:"aroloye-o.-numbere",fullName:"Aroloye O. Numbere"}]},{id:"51114",title:"Overview of Hazardous Waste Management Status in Malaysia",slug:"overview-of-hazardous-waste-management-status-in-malaysia",totalDownloads:6244,totalCrossrefCites:4,totalDimensionsCites:14,abstract:"This chapter reviews the status of hazardous waste management in Malaysia. It highlights the sources of the hazardous waste, government policies on waste generation and management, the involvement of the stakeholders, and the various management procedures adopted in Malaysia. Currently, the manufacturing sector is the major contributor in hazardous waste generated in Malaysia. Other sectors that contribute include household, agriculture, medical, and other industrial sectors. Malaysian government’s resolve on human health protection and safeguarding the environment prompted various acts, regulations, and orders such as the popular Environmental Quality Act (EQA) 1974. The regulations made pursuant to the Environmental Quality Act have continuously improved to address the issues on the definition and classifications of hazardous waste and the management process in Malaysia. The management of hazardous waste in Malaysia is effectively growing as a result of continuous review of the regulations and enforcement of the acts. The stakeholders in the industries have also been active in keeping to the EQA regulations to keep the environment safe as much as possible.",book:{id:"5242",slug:"management-of-hazardous-wastes",title:"Management of Hazardous Wastes",fullTitle:"Management of Hazardous Wastes"},signatures:"Ogboo Chikere Aja, Hussain H. Al-Kayiem, Mesfin Gizaw Zewge and\nMeheron Selowara Joo",authors:[{id:"181768",title:"Dr.",name:"Ogboo Chikere",middleName:null,surname:"Aja",slug:"ogboo-chikere-aja",fullName:"Ogboo Chikere Aja"},{id:"181769",title:"Dr.",name:"Mesfin Gizaw",middleName:null,surname:"Zewge",slug:"mesfin-gizaw-zewge",fullName:"Mesfin Gizaw Zewge"},{id:"182433",title:"Mr.",name:"Meheron",middleName:null,surname:"Selowara Joo",slug:"meheron-selowara-joo",fullName:"Meheron Selowara Joo"},{id:"184186",title:"Prof.",name:"Hussain H.",middleName:null,surname:"Al-Kayiem",slug:"hussain-h.-al-kayiem",fullName:"Hussain H. Al-Kayiem"}]},{id:"40529",title:"Solid Waste Management in Malaysia – A Move Towards Sustainability",slug:"solid-waste-management-in-malaysia-a-move-towards-sustainability",totalDownloads:10112,totalCrossrefCites:11,totalDimensionsCites:25,abstract:null,book:{id:"2781",slug:"waste-management-an-integrated-vision",title:"Waste Management",fullTitle:"Waste Management - An Integrated Vision"},signatures:"Jayashree Sreenivasan, Marthandan Govindan, Malarvizhi Chinnasami and Indrakaran Kadiresu",authors:[{id:"154427",title:"Dr.",name:"Sreenivasan",middleName:null,surname:"Jayashree",slug:"sreenivasan-jayashree",fullName:"Sreenivasan Jayashree"}]}],onlineFirstChaptersFilter:{topicId:"146",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81027",title:"Evaluating Waste-to-Energy Technologies as a Waste Management Solution for Uganda",slug:"evaluating-waste-to-energy-technologies-as-a-waste-management-solution-for-uganda",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.101904",abstract:"Currently, the world generates 2.01 billion tonnes of waste annually and this is expected to increase to 3.401 billion tonnes of waste by 2050. The continual generation of waste is at the forefront of combating climate change because the waste generated is associated with GHG emissions among other environmental concern. Literature reports that developing countries are lagging the developed countries in waste management and yet these regions are expected to account for most waste generated by 2050. This chapter focuses on the application of Waste-to-Energy (WTE) Techniques in Uganda (developing country) as a way of managing waste, and recommends policies that the Government of Uganda could adopt from the UK to successfully implement these initiatives. The WTE technologies analysed are landfill gas recovery, anaerobic digestion, incineration, pyrolysis, and gasification. The chapter also reviews the current solid waste situation in Uganda with a comparative analysis of the technologies. Since Uganda is a low-income country, it is advised that the country enters Public-Private Partnerships where the developers build and own the technologies. The assessment is informed by literature and personal judgement. Recommendations are made to the GOU on how best to support stakeholders of WTE initiatives further areas of study are highlighted.",book:{id:"11083",title:"Hazardous Waste Management",coverURL:"https://cdn.intechopen.com/books/images_new/11083.jpg"},signatures:"Charlene Nagawa"},{id:"81415",title:"Application of the Sewage Sludge in Agriculture: Soil Fertility, Technoeconomic, and Life-Cycle Assessment",slug:"application-of-the-sewage-sludge-in-agriculture-soil-fertility-technoeconomic-and-life-cycle-assessm",totalDownloads:54,totalDimensionsCites:0,doi:"10.5772/intechopen.104264",abstract:"Disposal of sewage sludge, which is a by-product of wastewater treatment, has become one of the greatest challenges of the twenty-first century. Conversion of sewage sludge to a soil amendment can be performed by a broad spectrum of methods, which greatly differ by substrate/amendment composition, treatment time, and physicochemical conditions. The book chapter is focused on (i) environmental and legislative aspects of sewage sludge application in agriculture; (ii) risk factors related to the abundance of pathogens in sewage sludge and methods of SS hygienization; (iii) optimization of the use of SS-derived fertilizers. Application of sewage sludge in combination with mineral fertilizers positively influenced crop growth and soil microbiological activity. An environmental impact of sewage sludge related to its disposal to agricultural areas has been analyzed in terms of global warming, ecotoxicity, and other internationally recognized issues. Narrowly targeted measures may aggravate the situation. Some site-specific factors make sewage sludge unique, hence this specificity must be considered to predict the outcome of its treatment. Determination of these factors remains challenging. Therefore, the complexity of sewage sludge can be reduced by employing integrated biorefinery approaches that will result in circular bioeconomy and industrial ecology solutions.",book:{id:"11083",title:"Hazardous Waste Management",coverURL:"https://cdn.intechopen.com/books/images_new/11083.jpg"},signatures:"Olga Muter, Laila Dubova, Oleg Kassien, Jana Cakane and Ina Alsina"},{id:"81151",title:"Engineering Measures for Isolation and Sequestration of Heavy Metals in Waste as Safe Final Sink",slug:"engineering-measures-for-isolation-and-sequestration-of-heavy-metals-in-waste-as-safe-final-sink",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.102872",abstract:"The long-term safety management of hazardous substances is essential to the development of an environmentally sound resource circulation society. To achieve this, engineering measures to attenuate environmental risks in the isolation and sequestration of hazardous heavy metals are reviewed. From the standpoint of the isolation and sequestration of heavy metals from resource circulation, we assess the challenges in implementing immobilization technologies, constructing updated isolation structures, and controlling environmental conditions. It is also focused intensively on the (bio) chemical transformation behavior of heavy metals and its effect on the migration of the transformed materials in the environment. The contributions of solubilized and gasified metal components to emission into the environment are considered. The obtained results underscore the necessity of multiple barriers to retard and attenuate the migration of hazardous heavy metals. Innovative schemes for the isolation and sequestration of heavy metals will lead to higher levels of safety and environmentally sound resource circulation.",book:{id:"11083",title:"Hazardous Waste Management",coverURL:"https://cdn.intechopen.com/books/images_new/11083.jpg"},signatures:"Tomonori Ishigaki, Hiroyuki Ishimori, Hiroki Kitamura and Masato Yamada"},{id:"80616",title:"Technical Cooperation for Enhancing Infectious Healthcare Waste Management",slug:"technical-cooperation-for-enhancing-infectious-healthcare-waste-management",totalDownloads:62,totalDimensionsCites:0,doi:"10.5772/intechopen.102604",abstract:"Appropriate healthcare waste (HCW) management is crucial for preventing the spread of infectious diseases and ensuring public health. However, in many economically developing countries, HCW is often insufficiently segregated at sources and the hazardous infectious components are mixed with municipal solid waste, and directly disposed without any treatment, which poses great risk factors for healthcare institutes, waste management service providers, and the public. According to statistical cross-country analysis, the amount of HCW generation is expected to increase sharply in near future in developing countries. What can we do to improve the status of HCW management in developing countries and prevent the spread of infection? It is necessary to establish an effective HCW management system and strengthen its implementation capacity, especially in developing countries. When conducting international technical assistance for them to support the establishment of the HCW management system and capacity development, it is required to set the targets for technical assistance through conducting an assessment survey, analyzing problems, evaluating risks, supporting to formulate management plans, and provision of equipment. A diagnosis method for existing capacity and challenges is proposed for planning technical assistance. Experiences of technical assistance on HCW management in Palestine are presented as a case study.",book:{id:"11083",title:"Hazardous Waste Management",coverURL:"https://cdn.intechopen.com/books/images_new/11083.jpg"},signatures:"Mitsuo Yoshida"},{id:"80421",title:"Acrylamide: A Neurotoxin and a Hazardous Waste",slug:"acrylamide-a-neurotoxin-and-a-hazardous-waste",totalDownloads:105,totalDimensionsCites:0,doi:"10.5772/intechopen.102607",abstract:"Acrylamide is an organic water-soluble compound and a vinyl-substituted primary amide. It is well known for its toxic effects on humans. This chemical may lead to neurodegenerative disorders like Alzheimer’s and Parkinson’s. It is exposed to humans through diet, occupation, lifestyle and many environmental factors. Acrylamide is used in molecular laboratories and even in various manufacturing and processing industries. Acrylamide is formed in food cooked at high temperatures, and exposure to this chemical may cause damage to the nervous system. In this chapter the toxicity of acrylamide and its role as a hazardous waste are highlighted. The main topics of this study are occurrence, effects and toxicity caused by acrylamide and analysis of acrylamide induced neurotoxicity in rats. Furthermore, mitigation strategies involving acrylamide have been discussed.",book:{id:"11083",title:"Hazardous Waste Management",coverURL:"https://cdn.intechopen.com/books/images_new/11083.jpg"},signatures:"Prathyusha Cota, Sayantani Saha, Shailvi Tewari, Abhirami Sasikumar, M. 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He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. 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He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. 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He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. 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He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. 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Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Associate Prof.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/15648_n.jpg",biography:"Dr. Mohd Aftab Siddiqui is currently working as Assistant Professor in the Faculty of Pharmacy, Integral University, Lucknow for the last 6 years. He has completed his Doctor in Philosophy (Pharmacology) in 2020 from Integral University, Lucknow. He completed his Bachelor in Pharmacy in 2013 and Master in Pharmacy (Pharmacology) in 2015 from Integral University, Lucknow. He is the gold medalist in Bachelor and Master degree. He qualified GPAT -2013, GPAT -2014, and GPAT 2015. His area of research is Pharmacological screening of herbal drugs/ natural products in liver and cardiac diseases. He has guided many M. Pharm. research projects. He has many national and international publications.",institutionString:"Integral University",institution:null},{id:"333824",title:"Dr.",name:"Ahmad Farouk",middleName:null,surname:"Musa",slug:"ahmad-farouk-musa",fullName:"Ahmad Farouk Musa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333824/images/22684_n.jpg",biography:"Dato’ Dr Ahmad Farouk Musa\nMD, MMED (Surgery) (Mal), Fellowship in Cardiothoracic Surgery (Monash Health, Aust), Graduate Certificate in Higher Education (Aust), Academy of Medicine (Mal)\n\n\n\nDato’ Dr Ahmad Farouk Musa obtained his Doctor of Medicine from USM in 1992. He then obtained his Master of Medicine in Surgery from the same university in the year 2000 before subspecialising in Cardiothoracic Surgery at Institut Jantung Negara (IJN), Kuala Lumpur from 2002 until 2005. He then completed his Fellowship in Cardiothoracic Surgery at Monash Health, Melbourne, Australia in 2008. He has served in the Malaysian army as a Medical Officer with the rank of Captain upon completing his Internship before joining USM as a trainee lecturer. He is now serving as an academic and researcher at Monash University Malaysia. He is a life-member of the Malaysian Association of Thoracic & Cardiovascular Surgery (MATCVS) and a committee member of the MATCVS Database. He is also a life-member of the College of Surgeons, Academy of Medicine of Malaysia; a life-member of Malaysian Medical Association (MMA), and a life-member of Islamic Medical Association of Malaysia (IMAM). Recently he was appointed as an Interim Chairperson of Examination & Assessment Subcommittee of the UiTM-IJN Cardiothoracic Surgery Postgraduate Program. As an academic, he has published numerous research papers and book chapters. He has also been appointed to review many scientific manuscripts by established journals such as the British Medical Journal (BMJ). He has presented his research works at numerous local and international conferences such as the European Association for Cardiothoracic Surgery (EACTS) and the European Society of Cardiovascular Surgery (ESCVS), to name a few. He has also won many awards for his research presentations at meetings and conferences like the prestigious International Invention, Innovation & Technology Exhibition (ITEX); Design, Research and Innovation Exhibition, the National Conference on Medical Sciences and the Annual Scientific Meetings of the Malaysian Association for Thoracic and Cardiovascular Surgery. He was awarded the Darjah Setia Pangkuan Negeri (DSPN) by the Governor of Penang in July, 2015.",institutionString:null,institution:{name:"Monash University Malaysia",country:{name:"Malaysia"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. Dr. Khullar has a keen research interest in genetics of hypertension, and is currently studying pharmacogenetics of hypertension.",institutionString:"Post Graduate Institute of Medical Education and Research",institution:{name:"Post Graduate Institute of Medical Education and Research",country:{name:"India"}}},{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/223233/images/system/223233.png",biography:"Xianquan Zhan received his MD and Ph.D. in Preventive Medicine at West China University of Medical Sciences. He received his post-doctoral training in oncology and cancer proteomics at the Central South University, China, and the University of Tennessee Health Science Center (UTHSC), USA. He worked at UTHSC and the Cleveland Clinic in 2001–2012 and achieved the rank of associate professor at UTHSC. Currently, he is a full professor at Central South University and Shandong First Medical University, and an advisor to MS/PhD students and postdoctoral fellows. He is also a fellow of the Royal Society of Medicine and European Association for Predictive Preventive Personalized Medicine (EPMA), a national representative of EPMA, and a member of the American Society of Clinical Oncology (ASCO) and the American Association for the Advancement of Sciences (AAAS). He is also the editor in chief of International Journal of Chronic Diseases & Therapy, an associate editor of EPMA Journal, Frontiers in Endocrinology, and BMC Medical Genomics, and a guest editor of Mass Spectrometry Reviews, Frontiers in Endocrinology, EPMA Journal, and Oxidative Medicine and Cellular Longevity. He has published more than 148 articles, 28 book chapters, 6 books, and 2 US patents in the field of clinical proteomics and biomarkers.",institutionString:"Shandong First Medical University",institution:{name:"Affiliated Hospital of Shandong Academy of Medical Sciences",country:{name:"China"}}},{id:"297507",title:"Dr.",name:"Charles",middleName:"Elias",surname:"Assmann",slug:"charles-assmann",fullName:"Charles Assmann",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/297507/images/system/297507.jpg",biography:"Charles Elias Assmann is a biologist from Federal University of Santa Maria (UFSM, Brazil), who spent some time abroad at the Ludwig-Maximilians-Universität München (LMU, Germany). He has Masters Degree in Biochemistry (UFSM), and is currently a PhD student at Biochemistry at the Department of Biochemistry and Molecular Biology of the UFSM. His areas of expertise include: Biochemistry, Molecular Biology, Enzymology, Genetics and Toxicology. He is currently working on the following subjects: Aluminium toxicity, Neuroinflammation, Oxidative stress and Purinergic system. Since 2011 he has presented more than 80 abstracts in scientific proceedings of national and international meetings. Since 2014, he has published more than 20 peer reviewed papers (including 4 reviews, 3 in Portuguese) and 2 book chapters. He has also been a reviewer of international journals and ad hoc reviewer of scientific committees from Brazilian Universities.",institutionString:"Universidade Federal de Santa Maria",institution:{name:"Universidade Federal de Santa Maria",country:{name:"Brazil"}}},{id:"217850",title:"Dr.",name:"Margarete Dulce",middleName:null,surname:"Bagatini",slug:"margarete-dulce-bagatini",fullName:"Margarete Dulce Bagatini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217850/images/system/217850.jpeg",biography:"Dr. Margarete Dulce Bagatini is an associate professor at the Federal University of Fronteira Sul/Brazil. She has a degree in Pharmacy and a PhD in Biological Sciences: Toxicological Biochemistry. She is a member of the UFFS Research Advisory Committee\nand a member of the Biovitta Research Institute. She is currently:\nthe leader of the research group: Biological and Clinical Studies\nin Human Pathologies, professor of postgraduate program in\nBiochemistry at UFSC and postgraduate program in Science and Food Technology at\nUFFS. She has experience in the area of pharmacy and clinical analysis, acting mainly\non the following topics: oxidative stress, the purinergic system and human pathologies, being a reviewer of several international journals and books.",institutionString:"Universidade Federal da Fronteira Sul",institution:{name:"Universidade Federal da Fronteira Sul",country:{name:"Brazil"}}}]}},subseries:{item:{id:"23",type:"subseries",title:"Computational Neuroscience",keywords:"Single-Neuron Modeling, Sensory Processing, Motor Control, Memory and Synaptic Pasticity, Attention, Identification, Categorization, Discrimination, Learning, Development, Axonal Patterning and Guidance, Neural Architecture, Behaviours and Dynamics of Networks, Cognition and the Neuroscientific Basis of Consciousness",scope:"Computational neuroscience focuses on biologically realistic abstractions and models validated and solved through computational simulations to understand principles for the development, structure, physiology, and ability of the nervous system. 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