Mean WQIDinius scores for all the reservoirs.
\\n\\n
Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\\n\\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\\n\\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\\n\\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\\n\\nThank you all for being part of the journey. 5,000 times thank you!
\\n\\nNow with 5,000 titles available Open Access, which one will you read next?
\\n\\nRead, share and download for free: https://www.intechopen.com/books
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Preparation of Space Experiments edited by international leading expert Dr. Vladimir Pletser, Director of Space Training Operations at Blue Abyss is the 5,000th Open Access book published by IntechOpen and our milestone publication!
\n\n"This book presents some of the current trends in space microgravity research. The eleven chapters introduce various facets of space research in physical sciences, human physiology and technology developed using the microgravity environment not only to improve our fundamental understanding in these domains but also to adapt this new knowledge for application on earth." says the editor. Listen what else Dr. Pletser has to say...
\n\n\n\nDr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\n\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\n\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\n\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\n\nThank you all for being part of the journey. 5,000 times thank you!
\n\nNow with 5,000 titles available Open Access, which one will you read next?
\n\nRead, share and download for free: https://www.intechopen.com/books
\n\n\n\n
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\r\n\tElectromagnetic imaging is an emerging biomedical imaging modality, which when matured, might present an effective supplement to current imaging technologies for non-invasive assessment of functional and pathological conditions of tissues. This book aims to provide a state-of-art for the most relevant advancements in the development of electromagnetic sensing and imaging for non-invasive detection, by covering all aspects related to the design, modeling, and experimentation. The authors are welcome to submit original research and review articles reporting recent advances in the application of electromagnetic waves technologies in industry and bioengineering.
\r\n\r\n\tThe scope of this book will be the collection of new and/or review results exploring the use of electromagnetic waves for industrial and biomedical applications with particular focus on inclusion detection and medical treatment as well as a diagnostic tool for disease detection. Potential topics include but are not limited to the following: Electromagnetic sensing and imaging for industry applications, Electromagnetic sensing and imaging for biomedical applications, Microwave sensing and imaging , Non-invasive electromagnetic diagnostic tools, Usage of electromagnetic waves for probing organs and advanced MRI techniques, Theoretical modeling of electromagnetic wave propagation, Application of electromagnetic waves in advanced MRI techniques, RF sensors and coils, Biomaterials for wearable sensors, In vitro and in vivo testing.
",isbn:"978-1-83968-582-8",printIsbn:"978-1-83968-581-1",pdfIsbn:"978-1-83968-583-5",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"e57ef4b5bada0d966637cd303d76278f",bookSignature:"Distinguished Prof. Lulu Wang",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9878.jpg",keywords:"Electromagnetic Sensing, Imaging, Biomedical Applications, Electromagnetic Measurements, Conductivity, Electromagnetic Induction Tomography, Electric Impedance Imaging, Microwave Imaging, Biomaterials, RF Coils, Electromagnetic Scattering Problems, Integral Equations",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"August 26th 2020",dateEndSecondStepPublish:"November 3rd 2020",dateEndThirdStepPublish:"January 2nd 2021",dateEndFourthStepPublish:"March 23rd 2021",dateEndFifthStepPublish:"May 22nd 2021",remainingDaysToSecondStep:"3 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"With an M.E. (Hons.) and a Ph.D. degree from the Auckland University of Technology, New Zealand, Dr. Wang is the first author of over 60 peer-reviewed publications, received multiple national and international awards from various professional societies and organizations she is a member of (ASME, IEEE, AAAS, PSNZ, and IPENZ ).",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",slug:"lulu-wang",fullName:"Lulu Wang",profilePictureURL:"https://mts.intechopen.com/storage/users/257388/images/system/257388.jpg",biography:"Lulu Wang is a Full Professor of Biomedical Engineering at Shenzhen Technology University in China. She received the M.E. (First class Hons.) and Ph.D. degrees from the Auckland University of Technology, New Zealand, in 2009 and 2013, respectively. From 2013 to 2015, she was a Research Fellow with the Institute of Biomedical Technologies, Auckland University of Technology, New Zealand. In 2015, Dr. Wang became an Associate Professor of biomedical engineering with the Hefei University of Technology. In 2019, she became a Full Professor of biomedical engineering with the College of Health Science and Environmental Engineering, Shenzhen Technology University. Her research interests include medical devices, electromagnetic sensing and imaging, and computational mechanics. Over the past five years, Dr. Wang is the first author of 60 peer-reviewed publications, 2 ASME books, 7 book chapters, and 12 innovation patents. She has edited three books and two special issues of international journals. Dr. Wang is a member of ASME, IEEE, AAAS, PSNZ, and IPENZ. She has been an active scientific reviewer for numerous journals and international conferences. She received multiple National and International Awards from various professional societies and organizations.",institutionString:"Shenzhen Technology University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"20",title:"Physics",slug:"physics"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"259492",firstName:"Sara",lastName:"Gojević-Zrnić",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/259492/images/7469_n.png",email:"sara.p@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6835",title:"Computer Methods and Programs in Biomedical Signal and Image Processing",subtitle:null,isOpenForSubmission:!1,hash:"19f08ef15d97900c94dc8fb04f9afb5f",slug:"computer-methods-and-programs-in-biomedical-signal-and-image-processing",bookSignature:"Lulu Wang",coverURL:"https://cdn.intechopen.com/books/images_new/6835.jpg",editedByType:"Edited by",editors:[{id:"257388",title:"Distinguished Prof.",name:"Lulu",surname:"Wang",slug:"lulu-wang",fullName:"Lulu Wang"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8347",title:"Computer Architecture in Industrial, Biomechanical and Biomedical 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"51407",title:"Fuzzy Logic as a Tool for the Assessment of Water Quality for Reservoirs: A Regional Perspective (Lerma River Basin, Mexico)",doi:"10.5772/64265",slug:"fuzzy-logic-as-a-tool-for-the-assessment-of-water-quality-for-reservoirs-a-regional-perspective-lerm",body:'\nWater quality assessment traditionally has been measured by physical and chemical parameters and through the comparison of results of monitoring programs with the existing local guidelines. Only in some of these cases, the use of this methodology allows for a proper identification of contamination causes and may be essential for checking legal compliance; however, it does not readily give a global behaviour of the water quality in a basin [1].
\nWater quality indices have been used to translate large data sets on water quality into a single value representing a certain level of water quality [2]. The common denominator for all water quality indices is its ability to combine data from monitoring programs by means of a simple quality vector [3].
\nThe most common water quality constituents used in water quality indices include dissolved oxygen (DO), pH, temperature, faecal coliforms, turbidity, biochemical oxygen demand, chlorides, colour, nitrates, total phosphorus, and total solids [3, 4]. These parameters traditionally have been selected and qualified through the combined judgment of a panel of water quality experts within a region or country utilizing a set of questionnaires based on the Delphi system [5, 6].
\nWater quality indices are mainly used by water resource managers to communicate whether water is acceptable for its intended uses [3, 6–9], as well as to compare and identify trends between different watersheds or water bodies, and facilitate comparison among different sampling sites and/or events [1, 2, 10, 11].
\nIn addition to water uses (public water supply, agricultural irrigation, industrial, navigation, recreation, etc.), which are qualified by water quality indices, the services provided by water bodies, such as maintenance of groundwater level, balance of atmospheric gasses, climate regulation, and reduction of soil erosion, are extremely important to human welfare; however, their importance has decreased and is not considered in the assessment tools. There is evidence that many human dominated ecosystems have become highly stressed and dysfunctional [12].
\nThe evolution of water quality indices has been satisfactory in terms of water resources management because they were all developed for a specific set of goals such as rating the water use [13], communication tool, and decision-making managers [6], and they are based on criteria or standards (environmental benchmarks) that reflect the impairment of quality caused by the presence of pollutant/parameter considered in the water quality index (WQI).
\nHorton [14] is considered the pioneer in the design of water quality indices, and he proposed that various water quality characteristics could be integrated into an overall index. This first WQI was defined as a rating reflecting the composite influence on overall quality of a number of individual quality characteristics. After Horton, numerous indices have been developed that include different water quality characteristics, calculation methods, and different purposes. Dinius [6] proposed a geometric WQI qualifying until six water uses.
\nNumerous studies have used water quality indices to determine water quality in rivers [2, 3, 9, 15–20]. Recently, fuzzy theory has been used to design water quality indices and also to assess the water quality in rivers [21–25].
\nFew studies, much less at a regional level, have been conducted to assess the water quality in lakes or reservoirs in terms of a water quality index. In some cases, studies are available on trophic state development [26–29]. López [28] carried out a regional study in reservoirs of the Río Lerma basin, pointing out the existence of a trophic gradient from a regional perspective. Sedeño-Díaz and López-López [30] applied a geometric WQI to 10 reservoirs of the Río Lerma basin, and Shuhaimi-Othman et al. [31] carried out a study of the water quality changes of Chini Lake. Fuzzy synthetic evaluation [32] and fuzzy theory [33, 34] have been utilized for diagnostic of trophic state in reservoirs. None of these WQI has been developed from a gradient of environmental conditions inside a hydrologic basin which allows to compare the different water bodies inside the same region.
\nHuman population growth and changes in adjacent land use have increased the pollutant and nutrient inputs in the reservoirs, altering water quality and accelerating the eutrophication of reservoirs, lakes and watercourses. The Río Lerma basin with an extension of only 3% of the Mexican territory is the most important water system in the central plateau of Mexico. Likewise, urban areas, agricultural lands, and industrial centres located along its course are set to become one of the most densely populated and polluted regions in the country. This basin has experienced negative impacts due to human activities; it currently faces an imbalance between water demand and availability, primarily due to its natural water scarcity as well as uneven water quality distribution. The rapid urban and industrial growth among other economic and social factors has made this worse. Water needs have grown, water users are fiercely competing with each other and conflicts are emerging as a result. Hence, water quality has also deteriorated as urban and industrial effluents are often discharged without treatment. The Río Lerma basin is also considered as a centre for fish fauna endemism [2] and therefore is mandatory to take conservation measures.
\nTo overcome the water availability problem, numerous reservoirs have been built to satisfy the needs of the population. Cotler-Ávalos [35] indicates that at present there are 552 reservoirs in the basin. Therefore, it is important to have simple and easy-to-use tools to assess the water quality of the reservoirs and facilitate interpretation and decision making, since they are the main source of water to meet the needs of the population in that region. In this study, a water quality index (WQI) based on fuzzy logic was designed to assess and to compare the environmental condition of several reservoirs of the Río Lerma basin, using a selection of eight water quality characteristics.
\nThe aim of this section is not to expose the full fuzzy logic theory (FL); however, it is important to give a brief introduction. FL was introduced in 1965 by [36], and it is a mathematical tool for dealing with uncertainty as it is able to measure linguistic concepts or subjective words that are fundamentally imprecise, ambiguous or fuzzy [21, 37].
\nWe can ask what does a water quality index do with the FL. For several years, FL has been applied to design environmental indices because it solves complex situations such as ambiguity, subjective judgments, and interpretation of a complex set of multidimensional data [22, 37]. The results of a WQI are most often associated with different linguistic water quality categories (e.g. excellent, good, regular, or bad water quality). These linguistic variables use unclear boundaries, that is, these terms include a high degree of uncertainty. In addition, considerable vagueness is involved in the allocation of a water quality score for multiple uses inclusive of a specific use [11]. FL can be considered as a language that allows us to translate the uncertainty of natural language into mathematical expressions [11]. Thus, FL has been considered as a useful tool for modelling water quality as it is an alternate approach to problems where the goals and boundaries are diffuse or imprecise [24, 38].
\nFISs are based on the fuzzy set theory, which maps input values to output values [23, 38]. The input is called antecedent, while the output is known as consequent. Maps are outlined in the membership functions.
\nA membership function is a curve whose shape is defined by convenience [11, 38], and that defines how each point in the antecedent is mapped to a membership value in a range of 0–1 [21]. In FIS, different shapes of membership functions can be used, such as Gaussian, bell, trapezoidal and triangular, among others. Trapezoidal and triangular membership functions have the advantage of being asymmetric [39], but the gradient of values of membership develops over the same slope value.
\nIn concordance with [11, 38, 40, 41], a FIS consist of three main steps:\n
Fuzzification, is the process which changes a crisp input data to a fuzzy number expressed in a membership function, that is, the transformation of a numerical value of any water quality variable into a membership grade to a fuzzy set.
Evaluation of fuzzy decision through the system of linguistic If-Then rules which include the fuzzy operators to integrate the combined antecedents to the consequent.
Defuzzification, is the process to obtain a representative value of a fuzzy set, that is, the final crisp value that integrates all attributes of the multiple antecedents. There are different methods of defuzzification, the most common are centroid, mean of maxima, and bisector; however, it is very important to select an appropriate defuzzification method.
These fundamental three steps are imperative to obtain a successful FIS.
\nIn concordance with [38], there are at least six reasons to use models based on fuzzy rules and fuzzy sets: (a) they can be used to describe a large variety of nonlinear relations, (b) they tend to be simple, since they are based on a set of local simple models, (c) they can be interpreted verbally and this makes them analogous to artificial intelligence models, (d) they use information that other methods cannot include, (e) the fuzzy approach has a big advantage over other indices as they have the ability to expand and combine quantitative and qualitative data that express the water quality status, and finally, (f) FL can deal with and process missing data without compromising the final result.
\nWe studied 11 reservoirs with different water use (power generation, agriculture irrigation, drinking trough, recreational, and public supply) and different location within the Río Lerma basin (upper, middle, and lower reaches), all of them considered as hydrological priority systems by Mexican Environmental Authorities (Figure 1).
\nRío Lerma basin and location of reservoirs studied.
The upper Río Lerma includes the following reservoirs: Ignacio Ramírez (IR), Tepetitlán (TP), Trinidad Fabela (TF), and Tepuxtepec (TX). In the middle portion of Río Lerma are Ignacio Allende (IA), Potrerillos (PO), Umecuaro (U), Loma Caliente (LC), Carmen (CA), and Cointzio (CO), and finally, the reservoir studied in the lower Río Lerma was Wilson (W).
\nSome reservoirs are located in the headstreams of some Río Lerma tributaries (LC, U, TP, TF, PO), while others are close to urban or industrial centres (IA, CO, TX) or adjacent to agriculture and livestock areas (CA, W, IR). Nonetheless, they all sustain human influence of one kind or another.
\nWater quality for each reservoir was characterized by means of 19 parameters, four times in an annual cycle to determine the spatial and temporal variation in one year: dissolved oxygen (mg/L), water temperature (T, °C), Secchi disk transparency (SDT, m), chlorophyll a (Chl a, μg/L), turbidity (Turb, NTF), and specific conductance (Cond, μS/cm) were measured in situ with a Hydrolab DataSonde Surveyor 4, while biochemical oxygen demand (BOD, mg/L), total nitrogen (TN, mg/L), nitrates (NO3, mg/L), nitrites (NO2, mg/L), ammonia (NH4, mg/L), total phosphorus (TP, mg/L), ortho-phosphates (O-PO4, mg/L), total suspended solids (TSS, mg/L), and colour (C, Pt-Co units) were determined through Hach techniques with a Hach spectrophotometer DR2500. Alkalinity (Alk, mg/L), hardness (H, mg/L), and chlorides (Cl, mg/L) were determined by titration, and finally, total dissolved solids (TDS, mg/L) were measured with a TDS meter Hach model 44600.
\nA multivariate discriminants analysis (DA) was applied to water quality data to find trends and reservoirs sharing similar characteristics. Maximum, minimum, and median of all water quality parameters along 11 reservoirs were taken into account to select those parameters that should be incorporated in the FIS. Likewise, multiple regressions were carried out to find relationships among different parameters and to eliminate those with redundancy or without significance.
\nThe range of values for each selected parameter was considered by taking into account the absolute lowest and the absolute highest values in all the reservoirs and is expressed along the x-axis in the membership function curve.
\nThe membership functions were assigned using the Gaussian curve because is the shape that better reflects the semantic meaning of each parameter considering that increased or decreased water quality is not lineal.
\nLinguistic classification for each water quality parameter in the antecedent was considered only with three categories: Excellent, Medium, and Bad. In the case of water temperature, only two categories were used: Excellent and Not Excellent, since both low and high temperatures alter the physiology of organisms inhabiting the water of the reservoirs. The linguistic variables in the consequent output were considered as Unacceptable, Very Polluted, Contaminated, Regular Quality, Slightly Polluted, Good Quality, and Excellent.
\nDifferent defuzzification methods were tested (Bisector; Centroid; Large of Maximum, LOM; and Middle of Maximum, MOM) to select the best method.
\nIn addition, the water quality index proposed by [6] was computed for all the reservoirs to obtain a reference value of water quality (benchmark).
\nStatistical analyses were performed using the StatistiXL version 1.8. The Fuzzy Water Quality Index for the Río Lerma reservoirs was carried out using the Fuzzy Logic Design Toolbox of MATLAB V. R2013a.
\nAs a first approach, WQI proposed by [6] (WQIDinius) was computed for all the reservoirs to have a reference status of water quality. Mean values for each reservoir are show in Table 1 and Figure 14. The maximum value of WQI was in LC, a reservoir located in a headstream of a tributary of Río Lerma. The lowest score of WQI was detected in TX, which is located downstream of an urban and industrial zone. These results are the benchmark to compare the new water quality index.
\nReservoir | \nLC | \nU | \nTF | \nTP | \nPO | \nW | \nCO | \nIR | \nCA | \nIA | \nTX | \n
---|---|---|---|---|---|---|---|---|---|---|---|
WQI | \n79.9 | \n74.83 | \n71.54 | \n70.94 | \n69.84 | \n67.78 | \n67.21 | \n66.42 | \n62.82 | \n62.79 | \n62.49 | \n
Mean WQIDinius scores for all the reservoirs.
Scatter plot of the discriminant analysis of reservoirs based on their water quality attributes.
In order to select the environmental variables (water quality parameters) to be used in the setting of the new Fuzzy Water Quality Index for reservoirs of Río Lerma basin (FWQILerma), a DA was performed with the purpose to detect groups of reservoirs sharing water quality characteristics. In this sense, DA scatter plot showed a significant formation of four groups (Wilk’s Lambda = 15E-8, p < 0.001, Figure 2). Using box and whisker plots, we detect the environmental variables that typify the groups of reservoirs as follows:
\n\nGroup I:Reservoirs (U, LC, and Pot) with SDT > 0.5 m (Figure 3a), and the lowest concentration of TSS (Figure 3b), turbidity (Figure 3c), colour (Figure 3d), conductivity (Figure 3g), and TDS (Figure 3h).
\nGroup II:Reservoirs (Tepe and TF) with the lowest concentration of nutrients (nitrates and ortho-phosphates, Figures 3g and 3h, respectively).
\nGroup III:Reservoirs (Co and W) with the highest concentration of nitrates (Figure 3g), turbidity (Figure 3c), and colour (due the presence of clay, Figure 3d), and the lowest values of hardness (Figure 3i).
\nGroup IV:It includes the reservoirs IR, Car, IA, and Tepu, which shows the highest concentration of hardness (Figure 3i), TSS (Figure 3b), ortho-phosphates (Figure 3f), biochemical oxygen demand (Figure 3j), and the lowest values of SDT (Figure 3a).
\nBox and whisker plots of physicochemical variables that characterize each group of reservoirs according to DA.
Based on these groups, five variables were selected: (a) Secchi disk transparency, (b) conductivity, (c) nitrates, (d) ortho-phosphates, and (e) colour, with the following justification:
\nSecchi disk transparency: This is an important physical parameter in lentic systems because it has a close relationship with turbidity (physical and biological), the total suspended solids and colloidal particles. In several cases, there is a direct relationship with chlorophyll a content and therefore, in such cases, can be an indicator of biological productivity for lentic systems.
\nIn the Río Lerma basin, a relationship between SDT, turbidity, Chl a, and TSS data was determined for all the water bodies studied. The following expression summarizes the relationship among these parameters:
\nThus, we can consider only SDT measure as a representative parameter of Chl a, turbidity, and TSS — the last two are parameters that characterize the reservoirs according to DA.
\nThe membership function for SDT was obtained considering the minimum (0.07 m) and maximum value (1.5 m) of transparency detected in all the reservoirs (Figure 4).
\nMembership function for SDT.
Conductivity: The specific conductance or conductivity represents the salinity of water. It is a measure of the ability of water to conduct electrical current; likewise, conductance qualitatively reflects the status of inorganic pollution and is a measure of total dissolved solids and ionised species in the water [16, 19]. An empirical relationship between total dissolved solids and conductivity can be derived for any stream. High levels of dissolved and suspended solids in the water systems increase the biological and chemical oxygen demand, which deplete the dissolved oxygen levels in the aquatic systems. The levels of TDS in a broad sense reflect the pollutant burden of the aquatic system [16], and include the carbonates and sulphates that are considered in hardness measurements. Therefore, conductivity is an important parameter to be considered in the FWQILerma. The membership function was considered taking into account a range of values of conductivity from 0 to 700 μs/cm (Figure 5).
\nMembership function for conductivity.
Colour: Water colour is indicative of substances in solution or in colloidal suspension, but also is the result of interplay of light on suspended particulate materials together with such factors as bottom or sky reflection. Dissolved substances and particulate organic matter contribute to the colour and turbidity of natural waters. It is also indicative of algae blooms [7]. For the Río Lerma basin reservoirs, in addition to SDT, colour was considered as an important factor due the nature of the substrate, because colour varies according to the type of clays found in different regions of the basin independently of primary production due to algae. Reservoirs Co and W were those with the highest values of colour due to clays. The membership function of colour was determined considering a range of values from 0 to 700 Pt-Co units (Figure 6).
\nMembership function for colour.
Ortho-phosphates: They are the bioavailable chemical species of phosphorus for the aquatic organisms, which is the main reason for its consideration in this index. Still more than total phosphorus, this one can be in nonbioavailable dissolved inorganic forms for the organisms or in particulated form (like part of the aquatic organisms). Furthermore, ortho-phosphates are an indicator of the trophic state, as well as of municipal effluents and the agricultural runoff. The membership function was performed considering a range from 0 to 12 mg/L of ortho-phosphates (Figure 7).
\nMembership function for ortho-phosphates.
Nitrates: The nitrates are a chemical species of the nitrogen bioavailable to be used by the aquatic biota, mainly by the primary producers. Nitrates are a source of nitrogen present in water column that permits the aquatic biota to cover their nutritive needs of nitrogen. Likewise, it is an indicator related to the trophic state in lentic systems. The membership function was performed considering a range of values from 0 to 40 mg/L, taking into account all the reservoirs (Figure 8).
\nMembership function for nitrates.
Three additional variables were included in the FWQILerma: dissolved oxygen, water temperature, and ammonia, taking into account the following:
\nDissolved oxygen is one of the critical parameters for aquatic life support and the most frequently measured parameter in monitoring studies. This parameter represents the amount of oxygen that is available to aquatic organisms for metabolism/respiration and assimilation of food [42]. DO is an indicator of photosynthetic activity and the deoxygenation and reaeration factors such as water currents, temperature, wave action, and other disturbances at the reservoir surface results in a greater passage of the oxygen into solution. Membership function was based on the percentage of saturation of DO, taking into account that temperature and altitude are the principal factors that affect the concentration of DO, and that 100% represents the better condition of DO (Figure 9).
\nMembership function for DO.
Water temperature is an important parameter in water quality because it has a great relationship with the physiology of the aquatic organisms; in lentic systems, the temperature shows a gradient in the first metres of deep, and in certain reservoirs, a thermocline may occur. To determine a value of temperature, which represents an ideal value for the fish fauna and other aquatic organisms living in the Río Lerma basin, the mean value of temperature from 1975 through 1999 in the 17 monitoring stations (in all of the three portions of this basin) was considered as a satisfactory value; the data were taken from [2]. The 100% of membership (excellent) was adjusted on the mean value of water temperature in that period. Temperature values above or below the mean value were considered “Not Excellent” in a gradient of decrease or increase (Figure 10).
\nMembership function for water temperature.
Ammonia is considered because it is a chemical that participates in the cycle of nutrients (N) and is an indicator of organic pollution that is faster and easier to determine than the total and faecal coliforms. It is an indicator of faecal pollution and municipal wastewaters. Ammonia is excreted by animals and is produced during decomposition of plants and animals. Ammonia is an component in many fertilizers and is also present in sewage, storm water runoff, certain industrial wastewaters, and runoff from animal feedlots. Furthermore, ammonia can be toxic depending on the temperature and pH. In this sense, ammonia can be an excellent water quality indicator of organic pollution, mainly of domestic wastewater. The membership function was considered with a range from 0 to 1.6 mg/L, which were the values observed through all the reservoirs (Figure 11).
\nMembership function for ammonia.
Since eight water quality variables were used to perform the FWQILerma, it was necessary to conform a system of If-Then rules. The effect of the different water quality variables cannot be isolated because all of them occur simultaneously in the water. Then, a single rule must incorporate all the variables, and so all the rules. Thus, the FIS for FWQILerma was composed by 633 If-Then rules considering the eight water quality variables as the antecedent and seven linguistic categories in the consequent output.
\nExamples of inference rules for each category of the consequent output are:\n
If DO is bad, and NO3 is excellent, and DS is medium, and Specific Cond is excellent, and O-PO4 is excellent, and Colour is excellent, and Ammonia is excellent, and Temp is not Excellent, then WQI is Unacceptable.
If DO is medium, and NO3 is medium, and DS is bad, and Specific Cond is bad, and O-PO4 is bad, and Colour is bad, and Ammonia is bad, and Temp is excellent, then WQI is Very Polluted.
If DO is excellent and NO3 is bad, and DS is bad, and Specific Cond is medium, and O-PO4 is medium, and Colour is bad, and Ammonia is bad, and Temp is Excellent, then WQI is Contaminated.
If DO is excellent and NO3 is excellent, and DS is bad, and Specific Cond is medium, and O-PO4 is bad, and Colour is bad, and Ammonia is medium, and Temp is Not excellent, then WQI is Regular Quality.
If DO is excellent and NO3 is excellent, and DS is excellent, and Specific Cond is medium, and O-PO4 is medium, and Colour is medium, and Ammonia is medium, and Temp is excellent, then WQI is Slightly contaminated.
If DO is excellent and NO3 is excellent, and DS is excellent, and Specific Cond is excellent, and O-PO4 is medium, and Colour is medium, and Ammonia is Good Quality, and Temp is excellent, then WQI is Good Quality.
If DO is medium and NO3 is excellent, and DS is excellent, and Specific Cond is excellent, and O-PO4 is excellent, and Colour is excellent, and Ammonia is excellent, and Temp is excellent, then WQI is Excellent.
The consequent output is a crisp value as a result of defuzzification process, which is associated with the linguistic category in the consequent. Thus, the Input-Output map of the FIS for FWQILerma is depicted in Figure 12.
\nMap for fuzzy water quality index inference system.
As indicated above, different methods of defuzzification were tested, for which ANOVA was performed between the WQIDiniuis results and the scores obtained for FWQILerma with the application of the following defuzzification methods: Bisector, Centroid, LOM, and MOM. In this case, the best method was selected based on the minimum statistical difference between WQI proposed by [6] (benchmark) and defuzzification results. Figure 13 shows the box and whisker plot of the comparison between WQIDinius score and the scores of the different methods of defuzzification; LOM is the one with the smallest difference with WQIDinius; in fact, there is a total overlap. In this sense, LOM was selected as the method of defuzzification for FWQILerma.
\nBox and whisker plot representing the results of ANOVA of the application of different defuzzification methods compared with the benchmark WQIDinius.
WQI scores (±SD) of Río Lerma reservoirs, considering results of WQIDinius and FWQILerma.
Once the defuzzification method was selected, it is possible to compute the FWQILerma for all the reservoirs. Figure 14 shows the WQI scores for WQIDinius and FWQILerma. The best scores were obtained from LC, U, TP, and TF reservoirs, which are in headstreams.
\nIn order to identify the effectiveness of the FWQILerma, a validation process was carried out using five new water bodies located in different sites into the Río Lerma basin. Thus, two water bodies with an excellent water quality were selected: Nieves and Zacapu Lake; on the other hand, additional water bodies were selected with a regular water quality: Melchor Ocampo Reservoir, Pool Lake, and Solis Reservoir.
\nWhen the FWQILerma was applied to these water bodies, the first two showed a score of 86, and the other three obtained the score of 64, 64, and 62, respectively (Figure 15), showing that FWQILerma effectively reflects the water quality status in other water bodies of the same basin.
\nWQI scores for water bodies of validation.
The WQI have been an excellent tool to assess water quality using physicochemical approach. Historically, water quality indices have been applied by environmental agencies to take decisions about water management and conservation and to advise the water quality status to the public. Both regional (ecoregions) and basin approaches have proven to be the most successful tools for the assessment of water resources. In this case, the new FWQILerma is focused in assessing reservoirs located in the same basin, considering different water uses, surrounding land use, and their position into the basin. Like other WQI, their scores are into the range of 0–100, with the superior limit indicating an excellent water quality. Unlike other WQI that use 15–18 water quality variables, FWQILerma only uses eight. This is the first WQI that includes SDT as an important parameter, making measurement easier and cost-effective. It is an important issue in a basin with a high number of reservoirs.
\nFuzzy inference system has been used by other authors to design WQI for rivers [24, 38], but not in reservoirs or lakes. Liou and Lo [12] applied fuzzy set theory to evaluate trophic state in some reservoirs in China using the three typical parameters: total phosphorous, Chl a, and SDT.
\nBai et al. [11] and Mourhir et al. [23] proposed a river water quality index based on fuzzy logic, using six indicators and 15,625 and 86 rules, respectively. The fuzzy WQI proposed by [38] was set up with 27 water quality indicators (WQInd) and 96 fuzzy inference rules; while those proposed by [24] is composed of 9 variables and 3125 fuzzy rules. In this study, a multivariate analysis of discriminants and other statistic tools were employed to characterize the reservoirs and select the most important water quality variables; in this sense, FWQILerma was set up by eight water quality indicators and 633 inference rules.
\nWhile other authors have applied only one of the traditional methods of defuzzification: Centre of Gravity [21], Centroid [11, 21, 38], or MOM [41], this study analysed what could be the best defuzzification method, considering a benchmark. Thus, the best method for defuzzification was LOM. In this sense, comparison with other WQI as a benchmark was a process to know the range of water quality at which the reservoirs should be. In this study, we look for the match with the WQIDinius.
\nOcampo-Duque et al. [38] compared their FWQI with some impact indicators such as biochemical responses in fish, which matched with FWQI spatial data. Semiromi et al. [21] compared their FWQI with other indices using a set of independent data. In this study, FWQILerma was compared to WQIDinius to verify the range of scores and to select the best method of defuzzification, which is a part of the validation process. On the other hand, a set of other reservoirs into the Río Lerma basin was used to evaluate the applicability of this index in other water bodies whose water quality data were not used in the setting, that is, its potential use at the regional or basin levels was tested.
\nThus, FWQILerma scores were compatible with the water quality status assessed with the WQIDinius. This index showed that those reservoirs exposed to minimum impact (U, LC, TF, and TP) obtained the best scores, while those reservoirs closed to urban, industrial, or agricultural zones (W, TX, CO) displayed scores with a regular water quality.
\nWater Quality Indices are important tools to assess the status of water bodies considering the integrated measure of physical and chemical indicators that contribute to decision making.
In concordance with other authors, FL and FIS in this study resulted to be excellent tools to assess the water quality in water bodies.
FWQILerma shows to be consistent with WQIDinius.
FWQILerma proved to be an outstanding and robust tool to rate and take decisions about the water quality in reservoirs located in the Río Lerma basin since it reflected the water quality scores in the same range as other indices.
This index is believed to be cheaper because it uses only eight parameters, among them DO and conductivity are measured in the field using a probe (a very common equipment for water quality monitoring), and SDT is recorded with a single Secchi disk.
This index is one of the WQI specially configured to assess water quality in reservoirs.
Authors are thankful to Instituto Politécnico Nacional and CONACyT-SEMARNAT for financial support for the Project “Diagnóstico del estado trófico y calidad del agua de embalses de la cuenca del río Lerma, generación de un modelo regional. C01-0384.” (Assessment of trophic state and water quality of reservoirs of the Río Lerma Basin, generating a regional model.). Likewise, authors would like to thank to Ing. Mali Carol Uspango Becerro by editing the figures.
\nBariatric individuals not only present with specific medical complications and more prevalent risk factors for cardiovascular disease (CVD) and musculoskeletal (MSK) conditions, this population also has significantly greater potential for functional decline. Graded increase in activities of daily living (ADL) limitation was observed with increasing body weight [1]. Rehabilitation medicine approach to address the needs of a bariatric individual encompasses both ends of the management spectrum: to restore and prevent further deterioration of physical function associated or aggravated with excess body weight; as well as to enhance post-operative results with a sustainable weight management strategy.
\nThe rehabilitation medicine approach to function can be viewed from The International Classification of Functioning, Disability and Health (ICF) concept to better understand the interactive nature of a chronic health condition such as obesity and formulate a rehabilitation plan to address physical, psychological and socio-environmental barriers to bariatric-related disability [2, 3] (\nTable 1\n). Individualisation of care from all disciplines involved in the bariatric population to produce long-term sustainable results can also be deduced by understanding the dynamics of a disease process through this concept. We shall discuss the approaches to a bariatric evaluation, rehabilitation intervention and functional outcome in two parts with special focus on prehabilitation and peri-operative rehabilitation.
\nDomains affected | \nDescriptors | \n
---|---|
Body function | \nEnergy and drive function | \n
Weight maintenance functions | \n|
Activities and participation | \nHandling stress and other psychological demands | \n
Walking | \n|
Moving around | \n|
Looking after one’s health | \n|
Environmental factors | \nProducts of substances for personal consumption | \n
Immediate family | \n
Brief ICF Core set for Obesity [3].
Obesity affects physical, biopsychosocial aspects of an individual’s health and function. The complex nature may require rehabilitation interventions to be carried out in various settings to accommodate for different functional goals and engaging a multidisciplinary rehabilitation team to tap into different expertise to achieve the desired functional milestones. The bariatric individual presents with unique challenges to the treating team in both functional limitations and the approaches that can be employed to address these impairments and prevent further functional deterioration. The ICF highlights the domains that are affected by excessive weight: pain, cutaneous sensation, neuromusculoskeletal issues and movement difficulties as well skin issues due to difficulty in reaching during cleaning and toileting are the most commonly impaired function and complications leading to limitation in general tasks, mobility and poorer quality of life [1]. Concurrent presence of medical comorbidities can add up to tip the individual into compromised functional independence [1]. Common comorbidities related to obesity such as osteoarthritis of the weight bearing joints and cardiopulmonary conditions impacts severely on an individual’s functional reserves. Thus, the goal for bariatric rehabilitation program should include assisting the attainment of optimal weight reduction; to address current and potential medical complications especially metabolic syndrome, CVD and MSK conditions; to address functional limitations resulting from physical disabilities and improve quality of life through improving functional independence, self-confidence and empowering self-management.
\nSevere obesity with multiple comorbidities requires admission to medical facilities structurally adequate to assist in supporting and assisting individuals with excess body mass to transfer and mobilise with the use of bariatric- safe lifting devices, mobility equipment and transfer aids. Ideally these rehabilitation facilities are linked to a bariatric- dedicated medical and surgical specialities [4].
\nThe bariatric patients frequently develop medical complications that may run a protracted course [5]. Common medical complications readily noted at admission include:
Skin excoriations, rashes or ulcers in deep tissue folds with possibility of fungal infections.
Edema or fluid retention and venous congestion that causes feeling of limb heaviness or leading to diaphoresis-fluid leakage that renders the skin sensitive to shear forces, skin tears and infection.
Diabetes and respiratory problems including obesity hypoventilation syndrome or obstructive sleep apnoea.
These complications may indicate specialised nursing care or aids to protect during mobilisation. It may also preclude the use of some rehabilitation modalities i.e. hydrotherapy and priorities needs to be given to address medical conditions that delays resumption of weight bearing or therapeutic standing.
\nHospitalisation-related complications that tend to occur are mainly as a result of prolonged recumbency, also known as deconditioning. While deconditioning is not exclusive to bariatric population, its effects are more pronounced as bariatric individuals face challenges for immediate resumption of upright posture especially those who were admitted acutely for medical complications such as cardiopulmonary emergencies, following falls or exacerbation of musculoskeletal conditions leading to pain on weight bearing. Deconditioning can affect both physical and psychological domains as prolonged bed rest affects nearly all body systems. Specific to bariatric population these complications may entail a prolonged stay and protracted course of recovery:
Cardiovascular system: orthostatic hypotension and reduced exercise tolerance contributed by decreased cardiac output and resting tachycardia affecting sitting up, standing, transfers and physical activity participation.
Pulmonary system: orthostatic pneumonia or atelectasis resulting in hypoxemia and reduced tolerance to physical activity may complicate obesity hypoventilation syndrome or sleep apnoea.
Haematological system: deep venous thrombosis and pulmonary embolism may occur despite no lower limb neurological deficit as abdominal mass may compress on lower limb circulation and altered blood viscosity.
Musculoskeletal system: muscle atrophy causing weakness; leading to longer periods of non-weight bearing and increasing the risk of osteoporosis, joint stiffness and worsening posture. Especially of concern is weakness of extensor muscles needed to assume or assist to an upright position.
Gastrointestinal: constipation from lack of upright posture often complicate prescription diet plans due to the bloating sensation, abdominal discomfort and possibility of spurious diarrhoea complicating personal hygiene due to poor access to the perineal region combined with postural stasis that predisposes to the development of pressure ulcers.
Endocrine: impaired insulin response with hyperglycemia; gastrostasis leading to sensation of nausea and oesophageal reflux symptoms.
The result impacts on a bariatric individual’s functional reserves in terms of muscle power, balance, and coordination, jeopardising functional performance and results in the development of psychological sequelae as a direct result of deconditioning or from the loss of function it entails. Confusion and disorientation are part of the deconditioning constellation seen earlier on the bedrest period which can culminate in clinically significant anxiety and depression once the impact of functional loss sets in as self-care, leisure activities and gainful employment becomes challenging. Reconditioning as a rehabilitation goal will be discussed further in the prehabilitation section. Given the prospect of functional deterioration that can occur at an accelerated rate in the bariatric population due to inherent difficulties in mobilisation, special attention should be given to addressing factors that negate upright sitting and to promote lower limb weight bearing in cases that permit them as soon as possible. These include identifying at risk bariatric individuals with hip and knee replacements, paralysis, amputations, contractures, osteoporosis, respiratory and cardiac conditions, and skin conditions such as pressure ulcers. Availability of bariatric mobility aids such as hoists, tilt tables, chairs or wheelchairs and walking aids greatly assist in preventing the ill effects on deconditioning and translates to better cost-efficiency to prevent such deleterious complications rather than treatment of the aforementioned complications.
\nVarious models of bariatric rehabilitation exists to generally addresses 5 key factors: knowledge to empower action, goal-setting and self-care; beliefs surrounding causes and solutions to obesity; behavioural adaptation focusing on diet and physical activity, psychological coping strategies and adjustments of physical activity to include exercise, current functional capacity and that expected after bariatric surgery. A holistic model such as bio-psycho-social model explained via ICF helps to provide a multi-dimensional framework to evaluate the needs, identify the barriers and provide intervention or solutions to improve independence. Selection of the model to address such an individualistic experience such as function is paramount as the different considerations of the desired rehabilitation goals and outcomes of interest are given priority by different models [6]. The lack of obesity-specific outcome measures to quantify physical impairments and ADL limitations prevents stratification of bariatric individuals based on the magnitude of disability [7]. This is useful to establish as a threshold value for inpatient rehabilitation admission, and serves as an objective severity identification tool that impacts on the decision of appropriate rehabilitation setting and chart progress during rehabilitation. An example of such tool is the Obesity-related Disability Test (TSD.OC) developed by Donini et al. that aims to evaluate pertinent obesity- specific functional dimensions [8]. The main targets for bariatric rehabilitation are the cardiorespiratory, musculoskeletal and multi-systemic effects of deconditioning as described above. Strategies that reduce pain, increases strength and mobility as well as optimise functions can be delivered in various settings depending on the severity of obesity-induced disability. Inpatient rehabilitation facility offers an opportunity for more intensive rehabilitation input and caters well to bariatric clients admitted acutely for MSK or CVD that often runs a prolonged hospital stay and poorer functional recovery if left without rehabilitation input. The goals of inpatient rehabilitation are focused on attaining maximal functional independence for safe home discharge through improvements in strength, balance, and endurance coupled with initiation of CVD risk factor control and body weight reduction through dietary and physical activity prescription. An outpatient program may provide significant functional improvements in clients who can access both the centres and their lodging with appropriate means of transportation between them. This is attained by promoting increased pain-free joint range of motion, increasing muscle strength and cardiopulmonary endurance during functional activities. Concurrent efforts to optimise CVD risk factor and improve lean-to-fat mass ratio are also continued in the outpatient setting through education and individualised counselling on dietary and physical activity plan to maximise functional capacity despite excessive weight. Capodaglio et al. conducted a prospective 4-week inpatient bariatric rehabilitation with orthopaedic conditions consisting of strengthening and aerobic exercises adapted to the patient’s mobility; caloric restriction and nutritional education with psychological counselling [7]. The results exemplified that mild and severely disabled bariatric individuals with orthopaedic comorbidities can significantly experience functional improvements independent of the weight loss sustained; with the higher BMI and younger individuals showing the most functional gains. Similarly, Hanapi et al. employed an approach based on the cardiac rehabilitation model and resources for inpatient bariatric clients with CVD risk factors and orthopaedic comorbidities [9]. Employing adapted physical activity and exercise prescription, dietary modification, provision of psychological and social support, their approach successfully addressed weight, cardiometabolic profile optimisation prior to bariatric surgical intervention and conferring postoperative improvement in mood, dependency level, perceived physical and mental health during the postoperative phase with sustained functional capacity, endurance and quality of life up to 3 months post operatively.
\nAdmission planning for an inpatient rehabilitation stay is crucial to ensure logistic requirements, staffing ratio, bariatric-compliant equipment, administrative support and a mobilisation plan is developed as part of a function-centric rehabilitation plan. By definition, bariatric individuals include individuals whose weight exceeds or appears to exceed the identified safe working loads for equipment, lacks mobility or presents with challenges in manual handling [10, 11]. Moving and handling of bariatric clients can accentuate the risks of musculoskeletal injuries and excessive spinal loading in health care workers. Planning of staff and equipment reduces the risks associated with the care of bariatric patients. Safety of patients and health care workers can be enhanced by developing a movement and handling plan as each bariatric admission often presents with unique issues that require problem solving and an understanding of equipment or patient transfer procedures. Involvement of occupational health and safety representatives as well as risk reduction efforts can minimise unplanned situations that may differ between patients due to individuals’ risks, goals and resources available. Every aspect of patient- HCW interaction should be therapeutic from rehabilitation perspective including communication. Open discussion on equipment use and transfer techniques can lead the way to more serious discussions on dietary habits, adapting lifestyles and long-term functional goals. Education on the importance of physical activity and dietary management to aid weight loss and maintain functional independence helps boost motivation and compliance [9]. Discharge planning should include not just physical preparation of the destination. Consideration should be given to post-rehabilitation functional limitations that may require physical help or adaptive equipment as functional goals attainment may require repeated cycles of rehabilitation. Potential home modifications and long-term plans for adapted physical activity, dietary maintenance, psychological support, surveillance for relapses and complications as well as plans for higher functions such as return to work and driving should be discussed with the patients and their social support.
\nOutpatient bariatric rehabilitation continues the inpatient gains made with focus on long-term prevention of function and weight- gain relapse. The common impairments addressed are osteoarticular pain especially of the lower back and knees as well as joint malalignment. The effects of excessive weight on systemic inflammation, joint compression and premature degenerative disease of the joint can be offset by the role of adapted physical activity which is more pronounced in this setting to maintain compliance to caloric expenditure, CVD prevention and positive psychosocial reinforcement. A combination of both aerobic, resistance and flexibility exercises adapted to individual MSK conditions working on large muscle groups alongside dietary modification has led to improvement in CV biomarkers, fat loss and skeletal muscle gains conferring enhanced functional improvements in programs that include resistance exercises [12, 13]. In comparison to diet modification intervention alone, multimodal exercises program combined with diet interventions conferred lean mass sparing effect [14]. This is also evident in a systematic review of sarcopenic obesity treatment whereby excess fat mass and reduced lean mass impairs physical performance in which weight loss attained through exercise in combination with dietary intervention is the best treatment strategy that improves metabolic consequences of excess fat mass while preserving lean muscle mass and promotes functional recovery [15]. Aerobic exercises for caloric expenditure, reducing joint pain and controlling weight which is a risk factor of osteoarthritis as well as resistance exercise for strengthening of the joint supporting musculature and cartilage health reduces obesity-related joint conditions [16, 17]. As the client returns to the community, psychological support to sustain weight loss motivation and purpose as well as addressing stigma associated with excessive weight is equally important to ensure sustained functional and weight loss gains are maintained. Chronic pain and its effect on gait, psychical activity, participation and quality of life also needs to be addressed.
\nIn conclusion, bariatric rehabilitation addresses common medical comorbidities and obesity related MSK complications through multimodal rehabilitative and allied health interventions, including prescription exercises and diet modification to increase cardiopulmonary endurance and caloric expenditure while minimising fear of movement and joint pain. This in turn leads to progressive body weight reduction and improved comorbidities profile leading to better body composition and physical function capacity.
\nBariatric individuals often present with medical comorbidities arising from obesity-related changes or complications sustained from hospitalisation- related bedrest for acute medical crises. Functional impairments evident pre-operatively should be addressed to improve postoperative results and functional independence. The concept of deconditioning is discussed above- the bariatric individual runs a higher risk of developing deconditioning due to delayed weight bearing or resumption of an upright position. This is often multifactorial: common patient related factors such as sarcopenia, kinesiophobia, osteoarticular joint pain and exertional dyspnoea; logistic issues i.e. lack bariatric-safe equipment or staffs’ lack of ergonomic awareness are among easily amenable factors [18]. Deconditioning impacts the geriatric age group more [19]. Adapted exercises have been successful to prevent multisystem deconditioning from zero-gravity environment or from prolonged bed rest [20, 21]. Hanapi et al. demonstrated a 6-weeks bariatric surgery prehabilitation [9] consisting of patient education and prescription of therapeutic exercises, dietary modification and nutritional-behavioural counselling, the use of technological advancement to facilitate early non-weight bearing aerobic and resistance exercises that had successfully prepared the bariatric patients for the demands of the surgery as well as facilitated early post-operative mobilisation that has been purported to reduce post-surgical morbidity [22, 23]. This model adapted the principles of cardiac rehabilitation in formulating the evaluation, intervention and outcomes including risk-stratifying the bariatric surgery candidates for cardiovascular risk during exercise participation, quantifying exercise capacity for exercise prescription and addressing CVD risk factors that can complicate anaesthetic and post-operative care. Priorities were given to utilising adapted physical activity and early mobilisation to translate cardiorespiratory and musculoskeletal reserve improvements into functional mobility and independence in basic activities of daily living. This model along with other bio-psycho-social approaches have shown positive impact on long term functional capacity, endurance, dietary habits, weight loss and quality of life up between 3 to 12-month post-surgery [24].
\nIn the management of a complex, chronic condition such as obesity a multidisciplinary approach has consistently shown the best outcomes [25]. This approach however must be integrated into individual clinical complexity of each individual bariatric patient. An approach that entail evaluation with the intent to individualise treatment plan utilising multimodal treatment strategies i.e. diet, physical activity and functional rehabilitation, educational therapy, cognitive-behaviour therapy, drug therapy, and bariatric surgery will most likely ensure quality of weight loss, addressing the medical and psychiatric comorbidities together, psychosocial problems and physical disability [26]. Older bariatric patients may face a more challenging rehabilitation course due to age-related changes such as sarcopenia, muscular fatty infiltration which leads to strength reduction and diminishing exercise capacity; as well as external factors such as increased inertia from excessive mass causing imbalance, longer exposure to effects of obesity causing pronounced musculoskeletal degeneration and pain as well as more damage in the peripheral tissues [7]. Sarcopenic obesity in advanced age contributes to more dependence in ADL [27]. Muscular and mobility deterioration in combination contributes to exacerbate physiological changes associated with ageing. Thus, identification of such patients earlier prior to surgery is paramount to ensure successful outcomes following bariatric surgery.
\nThe economics of bariatric rehabilitation can be seen from 2 angles- in respect to functional restoration and from a long-term preventive viewpoint. Bariatric individuals who have undergone rehabilitation have shown functional improvement independent of the amount of weight lost, with more pronounced improvement in function observed in the severely disabled individuals [7]. This translates to earlier weight bearing, resumption of mobility and independence in self-care which in turns minimises the risk post-operative complications. Alongside improvement in muscular strength and lean mass, individuals who have undergone rehabilitation also had controlled CVD risk profiles, joint pain and reduced sedentary time conferring protection to future CVD in this high-risk group. However, to truly understand the cost–benefit effect of bariatric rehabilitation, long term outcomes expressed in multiple domains of function are needed to allow better understanding of the effect of different rehab interventions, optimal intensity and duration to therapeutic effect.
\nCapacity building in an organisation that caters for bariatric rehabilitation is essential to reduce personal risks to patients and staff as well as minimise disruption of bariatric rehabilitation services. This includes developing a bariatric rehabilitation pathway, continuous staff education and training and an audit of the outcomes from the pathway. A bariatric rehabilitation pathway details the appropriate facilities, staff and equipment are available at each stage of the bariatric individuals’ rehabilitation process from admission to outpatient facilities. Although this may incur short term increase in expenditure, the long term return of investment can be quantified through better morbidity and mortality reduction of the bariatric population regardless of conservative or surgical management approach chosen to suit individual medical and functional needs.
\nFormulation of an individually-tailored rehabilitation program based on each bariatric patients’ clinical complexity should be the priority to holistically manage such clients using a multidisciplinary team approach. Multidisciplinary teams offer the best post-operative outcomes [28], addressing quality of weight loss, medical and psychiatric comorbidities, psychosocial problems and physical disability [29]. To ensure a smooth transition from prehabilitation through postoperative rehabilitation, the physical, biopsychosocial model continues to be relevant and emphasis should be placed on preventing surgical-related complications, secondary prevention of CVD, addressing bariatric-related disabilities, psychological and socio-environmental barriers, enhancing physical function through adapted physical activities, education on nutritional management as well as implementation of sustainable weight management strategies.
\nThe post-bariatric surgery management will require coordinated care from a multidisciplinary team of healthcare providers starting from immediate post-op followed by long-term management. The integration of several medical specialties including clinical nutrition, endocrinology, psychiatry [1], rehabilitation medicine, as well as allied health professionals including physiotherapy, occupational therapy, and nursing should be included as part of the core management team. Each team member should provide detailed assessment of impairments, outline prevention strategies and provide solutions for disease management alongside implementation of a functional restoration program. A functional restoration program post-operatively should aim to not only achieve marked weight loss, but also prevention of weight regain, progression of obesity-associated comorbidities, restoration of physical functioning and increase health-related quality of life.
\nA post-op functional restoration program can be broadly grouped into two categories:
\nMedical
Nutritional management
Weight management
Comorbidities
Rehabilitation
Physical activity and exercise training
Psychosocial
The goal of weight loss procedures in general is to either reduce the amount of consumed calories (restrictive) per day or to alter the absorption of the fat (malabsorption) in the food one consumes. For restrictive procedures such as vertical banded gastroplasty (VBG) or laparoscopic adjustable gastric banding (LAGB), that has no malabsorption effect, the volume of food intake will be reduced overall, hence, some nutritional deficiencies may occur. Malabsorptive surgeries such as or biliopancreatic diversion (BPD), gastric sleeve (GS) or Roux-en-Y gastric bypass (RYGB) causes alterations in the intestinal tract and creates challenges in maintaining healthy levels of nutrients including proteins, vitamins and minerals as well as reduction in the absorption of calcium and iron [30].
\nManagement of these potential nutritional deficiencies is therefore paramount for patients undergoing bariatric surgery and strategies should be employed to compensate for food reduction or food intolerance to reduce the risk for clinically important nutritional deficiencies. Signs and symptoms of protein deficiency such as hair loss, fatigue and leg swelling should be monitored. Heber et al. recommended the nutritional management should include: an average of 60 – 120 g of protein daily in all patients to maintain a lean body mass during the weight loss and for the long term to prevent protein malnutrition and its effects, and this is especially important in those treated with malabsorptive procedures to prevent protein malnutrition and its effects [28].
\nLong-term vitamin and mineral supplementation is recommended in all patients undergoing bariatric surgery with those who have had malabsorptive procedures requiring potentially more extensive replacement therapy to prevent nutritional deficiencies [28]. Specific signs and symptoms of common vitamin and mineral deficiencies include bone pain (calcium), fatigue (iron, vitamin B12), brittle nails (zinc), poor wound healing (vitamin E), easy bruising (vitamin K), numbness and tingling in the hands and feet (vitamin B1). Deficiencies in fat-soluble vitamins A, D, E and K is expected therefore, it is essential for patients to take specially formulated vitamins (A, D, E, and K in water-soluble form). B-complex vitamins, iron, and calcium must also be supplemented at higher than daily recommended levels, because of the impact of the gastric bypass procedure on their absorption. Due to the body’s limited ability to a absorb calcium postoperatively and the acidic environment needed for absorption, a citrated form of calcium is recommended and taken in amounts that meet or exceed daily recommended levels [30]. For maximal absorption, elemental calcium supplements should be taken in divided doses not to exceed 500 mg, three times daily [30]. Iron deficiency is also very common after malabsorptive procedures and iron-fortified foods such as leafy greens, legumes, seafood, iron-fortified grains, red meat and poultry should be consumed on a regular basis. Routine laboratory testing of the iron stores postoperatively may be required with iron supplementation either orally or parenterally administered accordingly by the healthcare provider.
\nDumping syndrome may occur as a result of malabsorptive procedures such as RYGB where the food content empties into the small intestine faster than usual. Patients may experience symptoms such as abdominal cramping, nausea and vomiting due to the small intestine being unable to absorb the nutrients from food that have not been fully digested in the stomach. Reactive hypoglycaemia may also occur due to the large surge of insulin after “dumping”. Dietary changes is the mainstay of treatment for dumping syndrome. Avoidance of simple carbohydrates such as white flour and sugar, consumption of more complex carbohydrates such as whole grain and sources of protein such as fish, meat, beans, legumes and soy are recommended. Frequent loose stools is also a potential side-effect of malabsorptive procedures. It is critical that patients stay adequately hydrated to reduce the risk of dehydration. Lack of mobility may also predispose patients with regular soiling of the perineum to skin pathologies including development of pressure areas. Nutritional education is vital to the success of the surgery and prevention of complications. Regular follow-up and periodic monitoring of nutritional deficiencies postoperatively will be required for detection and correction. Lifelong supplementation of daily mineral, multivitamin and micronutrients must be considered.
\nFollowing weight loss surgery, patients may lose weight fairly rapidly at first, and then as time passes the weight loss becomes more gradual. Commonly, weight will stabilise at about 18 months after RYGB [30]. During these 18 months, weight loss can be erratic with alternating periods of significant weight loss followed by a plateau. Other than the loss of fat mass, there are many other factors that may contribute to the fluctuations in weight loss during the initial phase. This includes variations in water weight which is dependent upon the individuals’ hydration status, contents of the gastrointestinal tract, gain of muscle mass, or menstrual cycles [30].
\nSustainable weight loss strategies should include tailored exercise programs with monitoring of the exercise frequency and intensity to boost metabolic rate for a more rapid weight loss. A generic exercise program with lack of progressive targeted goals may lead to weight loss plateaus. Increase in physical activity and strength training will cause slower weight loss as the fat is replaced by muscle mass, which are denser tissues. This should not be perceived as a deterrent, but rather a positive trend that will lead to a leaner frame and stronger body. The recommended nutritional plan should be adhered to diligently to ensure adequate nutrition and muscle mass is maintained. Most weight regain or plateaus in weight loss boils down to eating habits. It is recommended that a patient eat several small meals a day with the ultimate goal of eating a regular diet in smaller amounts. Binge eating, snacking or grazing should be avoided as the extra calories will add up to the weight gain.
\nSeveral anatomic factors may influence weight loss, and this include the size of the gastric pouch which may change over time with the RYGB. As it enlarges over time, it will accommodate larger meals, causing a reduction in weight loss. Anostomotic dilatation between the stomach pouch and the intestine may also occur and this allows quicker emptying of the pouch, reducing its effect on satiety and potential weight loss [30] This is also the underlying reason why one should not drink during meals after gastric bypass as it will result in a more rapid transition of solid food from the gastric pouch, eliminating the effect on satiety resulting in ingestion of larger portions. The resultant change in anatomic structure after malabsorptive procedures such as the RYGB also alters the absorption of food with higher absorption of fats, thus reducing the benefit of the surgery [30]. Eating small meals high in protein may help mitigate this effect.
\nPlateaus and fluctuations in weight loss are to be expected throughout various phases post-surgery. Constant reassurance, providing patient education on the expected outcomes and exploring together the underlying causes of weight plateaus can increase understanding, avoid miscommunication, avert patient depression or frustration with the surgery. A regular exercise regimen and adherence to correct eating behaviour and nutritional intake may lead to greater outcome and a more sustainable long-term weight loss.
\nFrequently, patients undergoing bariatric surgery have associated comorbidities including Type 2 Diabetes Mellitus, cardiovascular disease, lipid abnormalities, fatty liver, degenerative joint disease, hypertension, gastroesophageal reflux disease, and obstructive sleep apnea with considerable impact on disability and quality of life. To reduce the likelihood of weight regain and to ensure that comorbid conditions are adequately managed, all patients should receive careful medical follow-up postoperatively. Monitoring postoperative glycaemic control should consist of achieving glycated HBA1c of 7% or less with fasting blood glucose no greater than 110 mg/dl and postprandial glucose no greater than 180 mg/dl [28]. Lipid abnormalities should be monitored and treated with lipid-lowering therapy that remain above desired goals should be continued. However due to the dramatic reductions in lipid levels, the doses of lipid-lowering drugs should be periodically evaluated [28]. Ideally, a multidisciplinary team should be in place before the operation is performed. The bariatric surgeon should be part of this comprehensive team that provides pre- and postoperative care. The inclusion of other medical specialties in the team including endocrinologists, gastroenterologists and rehabilitation physicians allow a more holistic approach for the treatment of patients with multiple comorbidities and associated impairments and disabilities.
\nSurgery-induced weight loss by itself was associated with a series of beneficial health effects, including increased objectively measured habitual physical activity and cardiorespiratory fitness [29]. Using a cardiac rehabilitation model is effective to cause significant improvement in bariatric individuals’ cardio-metabolic profile [31]. Hanapi et al. demonstrates the application of cardiac rehabilitation principle for post-bariatric surgery patients which include risk stratification through the use of submaximal exercise stress testing to objectively quantify the patient’s cardiovascular capacity for exercise participation, subsequent exercise prescription based on the individuals’ physical impairments and cardiovascular functioning, lifestyle modification to manage cardiovascular risk factors and translating the gains of cardiorespiratory and musculoskeletal fitness into more functional activities [9].
\nPostoperative exercise is imperative and remains the most important factor that can help a patient achieve long-standing and successful weight loss. Exercises can begin as early as day one postoperatively and short term and long term goals should be set early on and revised as activity and exercise capacity increases. The exercise program should incorporate muscle strengthening, physical endurance or aerobic exercises to improve cardiorespiratory fitness, balance training, functional mobility, musculoskeletal reconditioning, joint protection as well activity of daily living (ADL) training, tailored individually within the limit of patients’ cardiovascular capacity.
\nTo sustain weight loss, effective behaviour changes towards increasing energy expenditure through occupational, leisure time and planned physical activity needs to occur alongside dietary management [32]. Physical activity can be incorporated to daily activities which helps with caloric expenditure or decreasing the amount of sitting time or sedentary leisure activities. Education on the importance of physical activities to aid weight loss and maintain functional independence helps boost motivation and compliance. This ultimately affects their level of independence, quality of life and self-efficacy [9].
\nIn addition to loss of fat mass, there are other numerous benefits to exercise. These benefits include prevention of loss of muscle mass when losing weight rapidly after surgery, and improved overall weight loss. Exercise may also reduce a person’s appetite, increases immunity and reduces fatigue which may lead to improved self-confidence, and overall improved sense of well-being.
\nA substantial number of patients experience poor long-term outcomes following bariatric surgery which may be contributed by difficulty in making and sustaining changes in dietary intake and physical activity as well as post-surgery binge eating, which has also been associated with poorer weight outcomes [33]. A thorough preoperative assessment to evaluate patients’ understanding of the disease condition, identifying any misconceptions, assessing readiness and commitment to undergo a radical change in lifestyle and behaviour modification, as well identifying issues that may pose as barriers may be the key to a successful and sustainable weight management postoperatively. Sheets et al. recommend that preoperative assessment should include identifying patients strengths and weaknesses, educating patients thoroughly about postoperative changes including dietary intake and physical activity, coaching on lifestyle change strategies as well as offering specific recommendations to address any areas of concern [34]. The period post bariatric surgery is still a vulnerable time for most individuals as the reality sinks in as adjustment of behaviours and new habits take place. The need for continuous care and screening of psychosocial issues throughout both pre-and postoperative periods cannot be undermined. Screening for aberrant eating behaviours and depressive symptoms should be assessed whilst administering interventions to address emotional and psychological issues, behavioural modification strategies, increase compliance, and provide support [34]. It is the responsibility of each team member to detect or identify the presence of any psychological issues, and administer interventions through early referral to mental health professionals to improve outcomes of these individuals.
\nIntechOpen implements a robust policy to minimize and deal with instances of fraud or misconduct. As part of our general commitment to transparency and openness, and in order to maintain high scientific standards, we have a well-defined editorial policy regarding Retractions and Corrections.
",metaTitle:"Retraction and Correction Policy",metaDescription:"Retraction and Correction Policy",metaKeywords:null,canonicalURL:"/page/retraction-and-correction-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"IntechOpen’s Retraction and Correction Policy has been developed in accordance with the Committee on Publication Ethics (COPE) publication guidelines relating to scientific misconduct and research ethics:
\\n\\n1. RETRACTIONS
\\n\\nA Retraction of a Chapter will be issued by the Academic Editor, either following an Author’s request to do so or when there is a 3rd party report of scientific misconduct. Upon receipt of a report by a 3rd party, the Academic Editor will investigate any allegations of scientific misconduct, working in cooperation with the Author(s) and their institution(s).
\\n\\nA formal Retraction will be issued when there is clear and conclusive evidence of any of the following:
\\n\\nPublishing of a Retraction Notice will adhere to the following guidelines:
\\n\\n1.2. REMOVALS AND CANCELLATIONS
\\n\\n2. STATEMENTS OF CONCERN
\\n\\nA Statement of Concern detailing alleged misconduct will be issued by the Academic Editor or publisher following a 3rd party report of scientific misconduct when:
\\n\\nIntechOpen believes that the number of occasions on which a Statement of Concern is issued will be very few in number. In all cases when such a decision has been taken by the Academic Editor the decision will be reviewed by another editor to whom the author can make representations.
\\n\\n3. CORRECTIONS
\\n\\nA Correction will be issued by the Academic Editor when:
\\n\\n3.1. ERRATUM
\\n\\nAn Erratum will be issued by the Academic Editor when it is determined that a mistake in a Chapter originates from the production process handled by the publisher.
\\n\\nA published Erratum will adhere to the Retraction Notice publishing guidelines outlined above.
\\n\\n3.2. CORRIGENDUM
\\n\\nA Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\\n\\n4. FINAL REMARKS
\\n\\nIntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
\\n\\nIn the case of Retraction or removal of the Work, the publisher will be under no obligation to refund the APC.
\\n\\nThe general principles set out above apply to Retractions and Corrections issued in all IntechOpen publications.
\\n\\nAny suggestions or comments on this Policy are welcome and may be sent to permissions@intechopen.com.
\\n\\nPolicy last updated: 2017-09-11
\\n"}]'},components:[{type:"htmlEditorComponent",content:'IntechOpen’s Retraction and Correction Policy has been developed in accordance with the Committee on Publication Ethics (COPE) publication guidelines relating to scientific misconduct and research ethics:
\n\n1. RETRACTIONS
\n\nA Retraction of a Chapter will be issued by the Academic Editor, either following an Author’s request to do so or when there is a 3rd party report of scientific misconduct. Upon receipt of a report by a 3rd party, the Academic Editor will investigate any allegations of scientific misconduct, working in cooperation with the Author(s) and their institution(s).
\n\nA formal Retraction will be issued when there is clear and conclusive evidence of any of the following:
\n\nPublishing of a Retraction Notice will adhere to the following guidelines:
\n\n1.2. REMOVALS AND CANCELLATIONS
\n\n2. STATEMENTS OF CONCERN
\n\nA Statement of Concern detailing alleged misconduct will be issued by the Academic Editor or publisher following a 3rd party report of scientific misconduct when:
\n\nIntechOpen believes that the number of occasions on which a Statement of Concern is issued will be very few in number. In all cases when such a decision has been taken by the Academic Editor the decision will be reviewed by another editor to whom the author can make representations.
\n\n3. CORRECTIONS
\n\nA Correction will be issued by the Academic Editor when:
\n\n3.1. ERRATUM
\n\nAn Erratum will be issued by the Academic Editor when it is determined that a mistake in a Chapter originates from the production process handled by the publisher.
\n\nA published Erratum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n3.2. CORRIGENDUM
\n\nA Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n4. FINAL REMARKS
\n\nIntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
\n\nIn the case of Retraction or removal of the Work, the publisher will be under no obligation to refund the APC.
\n\nThe general principles set out above apply to Retractions and Corrections issued in all IntechOpen publications.
\n\nAny suggestions or comments on this Policy are welcome and may be sent to permissions@intechopen.com.
\n\nPolicy last updated: 2017-09-11
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"105746",title:"Dr.",name:"A.W.M.M.",middleName:null,surname:"Koopman-van Gemert",slug:"a.w.m.m.-koopman-van-gemert",fullName:"A.W.M.M. Koopman-van Gemert",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105746/images/5803_n.jpg",biography:"Dr. Anna Wilhelmina Margaretha Maria Koopman-van Gemert MD, PhD, became anaesthesiologist-intensivist from the Radboud University Nijmegen (the Netherlands) in 1987. She worked for a couple of years also as a blood bank director in Nijmegen and introduced in the Netherlands the Cell Saver and blood transfusion alternatives. She performed research in perioperative autotransfusion and obtained the degree of PhD in 1993 publishing Peri-operative autotransfusion by means of a blood cell separator.\nBlood transfusion had her special interest being the president of the Haemovigilance Chamber TRIP and performing several tasks in local and national blood bank and anticoagulant-blood transfusion guidelines committees. Currently, she is working as an associate professor and up till recently was the dean at the Albert Schweitzer Hospital Dordrecht. She performed (inter)national tasks as vice-president of the Concilium Anaesthesia and related committees. \nShe performed research in several fields, with over 100 publications in (inter)national journals and numerous papers on scientific conferences. \nShe received several awards and is a member of Honour of the Dutch Society of Anaesthesia.",institutionString:null,institution:{name:"Albert Schweitzer Hospital",country:{name:"Gabon"}}},{id:"83089",title:"Prof.",name:"Aaron",middleName:null,surname:"Ojule",slug:"aaron-ojule",fullName:"Aaron Ojule",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Port Harcourt",country:{name:"Nigeria"}}},{id:"295748",title:"Mr.",name:"Abayomi",middleName:null,surname:"Modupe",slug:"abayomi-modupe",fullName:"Abayomi Modupe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/no_image.jpg",biography:null,institutionString:null,institution:{name:"Landmark University",country:{name:"Nigeria"}}},{id:"94191",title:"Prof.",name:"Abbas",middleName:null,surname:"Moustafa",slug:"abbas-moustafa",fullName:"Abbas Moustafa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94191/images/96_n.jpg",biography:"Prof. Moustafa got his doctoral degree in earthquake engineering and structural safety from Indian Institute of Science in 2002. He is currently an associate professor at Department of Civil Engineering, Minia University, Egypt and the chairman of Department of Civil Engineering, High Institute of Engineering and Technology, Giza, Egypt. He is also a consultant engineer and head of structural group at Hamza Associates, Giza, Egypt. Dr. Moustafa was a senior research associate at Vanderbilt University and a JSPS fellow at Kyoto and Nagasaki Universities. He has more than 40 research papers published in international journals and conferences. He acts as an editorial board member and a reviewer for several regional and international journals. His research interest includes earthquake engineering, seismic design, nonlinear dynamics, random vibration, structural reliability, structural health monitoring and uncertainty modeling.",institutionString:null,institution:{name:"Minia University",country:{name:"Egypt"}}},{id:"84562",title:"Dr.",name:"Abbyssinia",middleName:null,surname:"Mushunje",slug:"abbyssinia-mushunje",fullName:"Abbyssinia Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Fort Hare",country:{name:"South Africa"}}},{id:"202206",title:"Associate Prof.",name:"Abd Elmoniem",middleName:"Ahmed",surname:"Elzain",slug:"abd-elmoniem-elzain",fullName:"Abd Elmoniem Elzain",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kassala University",country:{name:"Sudan"}}},{id:"98127",title:"Dr.",name:"Abdallah",middleName:null,surname:"Handoura",slug:"abdallah-handoura",fullName:"Abdallah Handoura",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Supérieure des Télécommunications",country:{name:"Morocco"}}},{id:"91404",title:"Prof.",name:"Abdecharif",middleName:null,surname:"Boumaza",slug:"abdecharif-boumaza",fullName:"Abdecharif Boumaza",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Abbès Laghrour University of Khenchela",country:{name:"Algeria"}}},{id:"105795",title:"Prof.",name:"Abdel Ghani",middleName:null,surname:"Aissaoui",slug:"abdel-ghani-aissaoui",fullName:"Abdel Ghani Aissaoui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105795/images/system/105795.jpeg",biography:"Abdel Ghani AISSAOUI is a Full Professor of electrical engineering at University of Bechar (ALGERIA). He was born in 1969 in Naama, Algeria. He received his BS degree in 1993, the MS degree in 1997, the PhD degree in 2007 from the Electrical Engineering Institute of Djilali Liabes University of Sidi Bel Abbes (ALGERIA). He is an active member of IRECOM (Interaction Réseaux Electriques - COnvertisseurs Machines) Laboratory and IEEE senior member. He is an editor member for many international journals (IJET, RSE, MER, IJECE, etc.), he serves as a reviewer in international journals (IJAC, ECPS, COMPEL, etc.). He serves as member in technical committee (TPC) and reviewer in international conferences (CHUSER 2011, SHUSER 2012, PECON 2012, SAI 2013, SCSE2013, SDM2014, SEB2014, PEMC2014, PEAM2014, SEB (2014, 2015), ICRERA (2015, 2016, 2017, 2018,-2019), etc.). His current research interest includes power electronics, control of electrical machines, artificial intelligence and Renewable energies.",institutionString:"University of Béchar",institution:{name:"University of Béchar",country:{name:"Algeria"}}},{id:"99749",title:"Dr.",name:"Abdel Hafid",middleName:null,surname:"Essadki",slug:"abdel-hafid-essadki",fullName:"Abdel Hafid Essadki",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Nationale Supérieure de Technologie",country:{name:"Algeria"}}},{id:"101208",title:"Prof.",name:"Abdel Karim",middleName:"Mohamad",surname:"El Hemaly",slug:"abdel-karim-el-hemaly",fullName:"Abdel Karim El Hemaly",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/101208/images/733_n.jpg",biography:"OBGYN.net Editorial Advisor Urogynecology.\nAbdel Karim M. A. El-Hemaly, MRCOG, FRCS � Egypt.\n \nAbdel Karim M. A. El-Hemaly\nProfessor OB/GYN & Urogynecology\nFaculty of medicine, Al-Azhar University \nPersonal Information: \nMarried with two children\nWife: Professor Laila A. Moussa MD.\nSons: Mohamad A. M. El-Hemaly Jr. MD. Died March 25-2007\nMostafa A. M. El-Hemaly, Computer Scientist working at Microsoft Seatle, USA. \nQualifications: \n1.\tM.B.-Bch Cairo Univ. June 1963. \n2.\tDiploma Ob./Gyn. Cairo Univ. April 1966. \n3.\tDiploma Surgery Cairo Univ. Oct. 1966. \n4.\tMRCOG London Feb. 1975. \n5.\tF.R.C.S. Glasgow June 1976. \n6.\tPopulation Study Johns Hopkins 1981. \n7.\tGyn. Oncology Johns Hopkins 1983. \n8.\tAdvanced Laparoscopic Surgery, with Prof. Paulson, Alexandria, Virginia USA 1993. \nSocieties & Associations: \n1.\t Member of the Royal College of Ob./Gyn. London. \n2.\tFellow of the Royal College of Surgeons Glasgow UK. \n3.\tMember of the advisory board on urogyn. FIGO. \n4.\tMember of the New York Academy of Sciences. \n5.\tMember of the American Association for the Advancement of Science. \n6.\tFeatured in �Who is Who in the World� from the 16th edition to the 20th edition. \n7.\tFeatured in �Who is Who in Science and Engineering� in the 7th edition. \n8.\tMember of the Egyptian Fertility & Sterility Society. \n9.\tMember of the Egyptian Society of Ob./Gyn. \n10.\tMember of the Egyptian Society of Urogyn. \n\nScientific Publications & Communications:\n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Asim Kurjak, Ahmad G. Serour, Laila A. S. Mousa, Amr M. Zaied, Khalid Z. El Sheikha. \nImaging the Internal Urethral Sphincter and the Vagina in Normal Women and Women Suffering from Stress Urinary Incontinence and Vaginal Prolapse. Gynaecologia Et Perinatologia, Vol18, No 4; 169-286 October-December 2009.\n2- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nFecal Incontinence, A Novel Concept: The Role of the internal Anal sphincter (IAS) in defecation and fecal incontinence. Gynaecologia Et Perinatologia, Vol19, No 2; 79-85 April -June 2010.\n3- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nSurgical Treatment of Stress Urinary Incontinence, Fecal Incontinence and Vaginal Prolapse By A Novel Operation \n"Urethro-Ano-Vaginoplasty"\n Gynaecologia Et Perinatologia, Vol19, No 3; 129-188 July-September 2010.\n4- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n5- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n6- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n7-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n8-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n9-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n10-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n11-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n12- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n13-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n14- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n15-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n\n16-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n17- Abdel Karim M. El Hemaly. Nocturnal Enureses: An Update on the pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecology/?page=/ENHLIDH/PUBD/FEATURES/\nPresentations/ Nocturnal_Enuresis/nocturnal_enuresis\n\n18-Maternal Mortality in Egypt, a cry for help and attention. The Second International Conference of the African Society of Organization & Gestosis, 1998, 3rd Annual International Conference of Ob/Gyn Department � Sohag Faculty of Medicine University. Feb. 11-13. Luxor, Egypt. \n19-Postmenopausal Osteprosis. The 2nd annual conference of Health Insurance Organization on Family Planning and its role in primary health care. Zagaziz, Egypt, February 26-27, 1997, Center of Complementary Services for Maternity and childhood care. \n20-Laparoscopic Assisted vaginal hysterectomy. 10th International Annual Congress Modern Trends in Reproductive Techniques 23-24 March 1995. Alexandria, Egypt. \n21-Immunological Studies in Pre-eclamptic Toxaemia. Proceedings of 10th Annual Ain Shams Medical Congress. Cairo, Egypt, March 6-10, 1987. \n22-Socio-demographic factorse affecting acceptability of the long-acting contraceptive injections in a rural Egyptian community. Journal of Biosocial Science 29:305, 1987. \n23-Plasma fibronectin levels hypertension during pregnancy. The Journal of the Egypt. Soc. of Ob./Gyn. 13:1, 17-21, Jan. 1987. \n24-Effect of smoking on pregnancy. Journal of Egypt. Soc. of Ob./Gyn. 12:3, 111-121, Sept 1986. \n25-Socio-demographic aspects of nausea and vomiting in early pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 35-42, Sept. 1986. \n26-Effect of intrapartum oxygen inhalation on maternofetal blood gases and pH. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 57-64, Sept. 1986. \n27-The effect of severe pre-eclampsia on serum transaminases. The Egypt. J. Med. Sci. 7(2): 479-485, 1986. \n28-A study of placental immunoreceptors in pre-eclampsia. The Egypt. J. Med. Sci. 7(2): 211-216, 1986. \n29-Serum human placental lactogen (hpl) in normal, toxaemic and diabetic pregnant women, during pregnancy and its relation to the outcome of pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:2, 11-23, May 1986. \n30-Pregnancy specific B1 Glycoprotein and free estriol in the serum of normal, toxaemic and diabetic pregnant women during pregnancy and after delivery. Journal of the Egypt. Soc. of Ob./Gyn. 12:1, 63-70, Jan. 1986. Also was accepted and presented at Xith World Congress of Gynecology and Obstetrics, Berlin (West), September 15-20, 1985. \n31-Pregnancy and labor in women over the age of forty years. Accepted and presented at Al-Azhar International Medical Conference, Cairo 28-31 Dec. 1985. \n32-Effect of Copper T intra-uterine device on cervico-vaginal flora. Int. J. Gynaecol. Obstet. 23:2, 153-156, April 1985. \n33-Factors affecting the occurrence of post-Caesarean section febrile morbidity. Population Sciences, 6, 139-149, 1985. \n34-Pre-eclamptic toxaemia and its relation to H.L.A. system. Population Sciences, 6, 131-139, 1985. \n35-The menstrual pattern and occurrence of pregnancy one year after discontinuation of Depo-medroxy progesterone acetate as a postpartum contraceptive. Population Sciences, 6, 105-111, 1985. \n36-The menstrual pattern and side effects of Depo-medroxy progesterone acetate as postpartum contraceptive. Population Sciences, 6, 97-105, 1985. \n37-Actinomyces in the vaginas of women with and without intrauterine contraceptive devices. Population Sciences, 6, 77-85, 1985. \n38-Comparative efficacy of ibuprofen and etamsylate in the treatment of I.U.D. menorrhagia. Population Sciences, 6, 63-77, 1985. \n39-Changes in cervical mucus copper and zinc in women using I.U.D.�s. Population Sciences, 6, 35-41, 1985. \n40-Histochemical study of the endometrium of infertile women. Egypt. J. Histol. 8(1) 63-66, 1985. \n41-Genital flora in pre- and post-menopausal women. Egypt. J. Med. Sci. 4(2), 165-172, 1983. \n42-Evaluation of the vaginal rugae and thickness in 8 different groups. Journal of the Egypt. Soc. of Ob./Gyn. 9:2, 101-114, May 1983. \n43-The effect of menopausal status and conjugated oestrogen therapy on serum cholesterol, triglycerides and electrophoretic lipoprotein patterns. Al-Azhar Medical Journal, 12:2, 113-119, April 1983. \n44-Laparoscopic ventrosuspension: A New Technique. Int. J. Gynaecol. Obstet., 20, 129-31, 1982. \n45-The laparoscope: A useful diagnostic tool in general surgery. Al-Azhar Medical Journal, 11:4, 397-401, Oct. 1982. \n46-The value of the laparoscope in the diagnosis of polycystic ovary. Al-Azhar Medical Journal, 11:2, 153-159, April 1982. \n47-An anaesthetic approach to the management of eclampsia. Ain Shams Medical Journal, accepted for publication 1981. \n48-Laparoscopy on patients with previous lower abdominal surgery. Fertility management edited by E. Osman and M. Wahba 1981. \n49-Heart diseases with pregnancy. Population Sciences, 11, 121-130, 1981. \n50-A study of the biosocial factors affecting perinatal mortality in an Egyptian maternity hospital. Population Sciences, 6, 71-90, 1981. \n51-Pregnancy Wastage. Journal of the Egypt. Soc. of Ob./Gyn. 11:3, 57-67, Sept. 1980. \n52-Analysis of maternal deaths in Egyptian maternity hospitals. Population Sciences, 1, 59-65, 1979. \nArticles published on OBGYN.net: \n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n2- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n3- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n4-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n5-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n6-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n7-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n8-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n9- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n10-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n11- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n12-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n13-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n14- Abdel Karim M. El Hemaly. Nocturnal Enureses: An Update on the pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecology/?page=/ENHLIDH/PUBD/FEATURES/\nPresentations/ Nocturnal_Enuresis/nocturnal_enuresis",institutionString:null,institution:{name:"Al Azhar University",country:{name:"Egypt"}}},{id:"113313",title:"Dr.",name:"Abdel-Aal",middleName:null,surname:"Mantawy",slug:"abdel-aal-mantawy",fullName:"Abdel-Aal Mantawy",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ain Shams University",country:{name:"Egypt"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:5681},{group:"region",caption:"Middle and South America",value:2,count:5161},{group:"region",caption:"Africa",value:3,count:1683},{group:"region",caption:"Asia",value:4,count:10200},{group:"region",caption:"Australia and Oceania",value:5,count:886},{group:"region",caption:"Europe",value:6,count:15610}],offset:12,limit:12,total:1683},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{sort:"qngrRaqGuveqFgrcChoyvfu"},books:[],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:9},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:18},{group:"topic",caption:"Business, Management and Economics",value:7,count:2},{group:"topic",caption:"Chemistry",value:8,count:7},{group:"topic",caption:"Computer and Information Science",value:9,count:10},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:5},{group:"topic",caption:"Engineering",value:11,count:14},{group:"topic",caption:"Environmental Sciences",value:12,count:2},{group:"topic",caption:"Immunology and Microbiology",value:13,count:5},{group:"topic",caption:"Materials Science",value:14,count:4},{group:"topic",caption:"Mathematics",value:15,count:1},{group:"topic",caption:"Medicine",value:16,count:63},{group:"topic",caption:"Nanotechnology and Nanomaterials",value:17,count:1},{group:"topic",caption:"Neuroscience",value:18,count:1},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:6},{group:"topic",caption:"Physics",value:20,count:2},{group:"topic",caption:"Psychology",value:21,count:3},{group:"topic",caption:"Robotics",value:22,count:1},{group:"topic",caption:"Social Sciences",value:23,count:3},{group:"topic",caption:"Technology",value:24,count:1},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:2}],offset:0,limit:12,total:null},popularBooks:{featuredBooks:[{type:"book",id:"9208",title:"Welding",subtitle:"Modern Topics",isOpenForSubmission:!1,hash:"7d6be076ccf3a3f8bd2ca52d86d4506b",slug:"welding-modern-topics",bookSignature:"Sadek Crisóstomo Absi Alfaro, Wojciech Borek and Błażej Tomiczek",coverURL:"https://cdn.intechopen.com/books/images_new/9208.jpg",editors:[{id:"65292",title:"Prof.",name:"Sadek Crisostomo Absi",middleName:"C. 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