Conduction parameters extracted using several methods for Si(100) p-MOSFETs at Vd = 50 mV [21].
\r\n\t
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Since, the field-effect transistor has taken several directions and is at the root of various devices such as the metal-oxide-semiconductor FET (MOSFET) [3], dual gate MOSFET [4], junction FET [5], high electron mobility transistor [6], four-gate transistor [7] and so on. Nevertheless, the most important parameter for all these devices is the mobility of the carrier flowing inside the channel. Their mobility, also known as their ability to move through the crystal, will define the electrical performances of the device. The mobility is consequently a paramount parameter, and its good knowledge is of prime importance to first understand the physics underlying the conduction mechanisms inside semiconductor devices and second to be able to model and simulate a single transistor and in turn more complex circuits. The mobility in field-effect transistors hinges on various physical and environmental parameters that we propose to investigate for MOSFETs fabricated on (100) and (110) silicon-oriented wafers.
In Section 2, the method to measure the mobility is briefly reviewed for different structures, while Section 3 investigates several methods to extract the conduction parameters such as the low field mobility in Si(100) and Si(110) p-MOSFETs. Thus, its modeling is presented in Section 4 for the same devices. Results regarding the impact of the channel direction and wafer orientation on the mobility are investigated in Section 5 while the impact of the temperature is reported in Section 6 for Si(110) n-MOSFETs. Recently, devices based on the majority carriers rather than the minority ones to generate the current showed promising results. A methodology to extract their mobility is presented in Section 7 and is applied to accumulation-mode Si(100) p-MOSFETs. Finally, Section 8 concludes the chapter.
The knowledge of the experimental mobility of carriers that are flowing inside the channel of a FET is essential for the development of semiconductor devices and in turn electronic circuits. The direct measurement of the effective mobility μeff is not possible, but its calculation is enabled through the measurement of the drain current Id—gate voltage Vg characteristic and of the gate-channel capacitance C as a function of the gate voltage. Both characteristics can be measured at Vd = 100 mV on a large gate transistor with at least a gate length L and gate width W above 50 μm in order to allow an accurate measurement of the capacitance. The substrate, source and drain electrodes are grounded, and the measurement of the capacitance is carried out on the gate electrode side at relatively low frequencies f between 1 and 100 kHz to neglect the serie resistances. Thus, the inversion charge Qinv per unit area is calculated from the C – Vg characteristic
The effective mobility μeff is finally calculated from
At this stage, the effective mobility can be plotted as a function of the carrier sheet density by dividing the inversion charge Qinv by the elementary charge q. It can also be plotted as a function of the transverse effective electric field Eeff that is calculated as follows:
where Qdep is the depletion charge per unit area, εSi is the dielectric constant of the silicon, ε0 is the permittivity of the vacuum, and η is a term referring to the averaging of the transverse electric field over the carrier distribution inside the conduction channel. In Eq. (3), the depletion charge Qdep is theoretically calculated from the doping concentration Nsub of the channel. It is expressed as follows:
with
being the bulk Fermi energy. In Eq. (5), kB is the Boltzmann constant, T is the temperature in Kelvin, and ni is the intrinsic carrier concentration. Takagi et al. [8] confirmed experimentally that in Eq. (3), η is equal to 1/3 for hole and to 1/2 for electron on Si(100) wafers [9]. Regarding Si(110) wafers, η is generally taken equal to 1/3 for both hole [3, 10] and electron [11].
Contrary to bulk transistors for which the methodology has been described previously, the substrate of transistors fabricated on silicon-on-insulator (SOI) wafers sometimes cannot be accessed and then cannot be grounded. The back-gate cannot be biased and can be floating as long as the applied gate voltage is large enough to neglect the impact of the back-gate [12]. The expression of the depletion charge Qdep given by Eq. (4) must be rearranged in Eq. (3) since the buried oxide is preventing the expansion of the depletion. If the depletion is expending deeper than the buried oxide, Qdep is given by qNsubtSOI where tSOI is the thickness of the SOI layer.
In the case of devices involving the majority carriers rather than the minority ones such as accumulation-mode transistors that will be studied in Section 7, the entire SOI layer is neutral when the accumulation layer is formed. The depletion charge Qdep in Eq. (3) must be removed, and the calculation is involving the sole accumulation charge Qacc [13, 14]. Eqs. (3) and (4) are rewritten as follows:
and
The knowledge of the conduction parameters is useful to model the drivability of a MOSFET and in turn simulate complex circuits. All extraction methods rely on the knowledge of the Id – Vg drain current-gate voltage characteristic measured for various gate lengths L and gate widths W.
The calculation procedures are based on the expression of the drain current in the linear region for a gate overdrive voltage Vg−Vth (Vth being the threshold voltage) greater than the drain voltage Vd (Vg−Vth>>Vd). In this range, the drain current Id is expressed as follows:
where Racc is the parasitic access resistances located at the source and drain contacts and Cox is the oxide capacitance. ΔW and ΔL are, respectively, the width and length gate channel reduction. In Eq. (8), the effective mobility μeff is generally replaced by the well known [15]:
where μ0 is the low field mobility and θ is the mobility attenuation factor.
Depending on the extraction method, it is possible to obtain the low field mobility μ0, the mobility attenuation factor θ, the parasitic access resistance Racc in series with the intrinsic resistance of the channel of the transistor, the channel width reduction ΔW and the channel length reduction ΔL.
Four different extraction methods have been used to extract the conduction parameters in p-MOSFETs fabricated on (100) silicon-oriented wafers. These methods are the Schreutelkamp method [16, 17], the interpolation method explained in Tsividis book [18], the Ghibaudo method [19] and finally the Ciofi method [20].
The Schreutelkamp method is based on Eqs. (8) and (9) and requires the calculation of intermediate parameters around a given gate overdrive voltage Vg−Vth that has been measured on several transistors featuring various gate length L for a given gate width W. A representation of this method is shown in Figure 1 for Vg−Vth = 1 V. Id−1 is plotted as a function of the gate length L, and the intersection with the vertical and horizontal axis is collected as shown in the inset of Figure 1. The low field mobility μ0 is extracted from the slope of the linear plot (1/Id)int/Lint versus (Vg – Vth)−1, while the mobility attenuation factor θ is obtained from the intersection with the vertical axis. On the other hand, the intersection of the plot Lint versus Lint/(1/Id)int with the vertical axis gives the channel length reduction ΔL, and the intersection with the horizontal axis gives the parasitic access resistance Racc. The extracted data according to the Schreutelkamp method on Si(100) p-MOSFETs are reported in Table 1. Note that the Schreutelkamp method does not allow the obtaining of the gate width reduction ΔW. The impact of the centered gate overdrive voltage Vg – Vth on the conduction parameters has been conducted. The results on the low field mobility μ0 and channel length reduction ΔL are shown in Figure 2. Both values are strongly decreasing when the gate overdrive voltage is increased until Vg – Vth = 0.8 V and are reaching a more stable behavior afterwards. For Vg – Vth < 0.8 V, the transistor is not working in the linear regime, and Eq. (8) is inaccurate, thus the fast drop. Additionally, the mobility model does not fit accurately the effective mobility, making the calculation even more inaccurate. For Vg – Vth > 0.8 V, the low field mobility μ0 is slightly increasing, while the channel length reduction ΔL is slightly decreasing. The reason is that even if Eq. (8) can be applied, Eq. (9) does not perfectly model the effective mobility. For each centered Vg – Vth, the parameters that are modeling the mobility are slightly changing in order to accurately fit the effective mobility according to the centered Vg – Vth. In turns, the channel length reduction ΔL and the low field mobility μ0 are not constant. An equivalent behavior has been also acknowledged when the mobility attenuation factor θ and the parasitic access resistance Racc have been plotted as a function of the centered gate overdrive voltage Vg – Vth.
Schreutelkamp | Interpolation | Ciofi | Ghibaudo | |
---|---|---|---|---|
μ0 (cm2/Vs) | 115 | / | 114 | 118 |
θ (V−1) | 0.31 | / | 0.348 | 0.359 |
Racc (Ω) | 98 | 106 | 68.9 | 67.41 |
ΔL (μm) | −0.1 | −0.128 | −0.121 | −0.13 |
ΔW (μm) | / | −0.352 | −0.322 | −0.331 |
Conduction parameters extracted using several methods for Si(100) p-MOSFETs at Vd = 50 mV [21].
Example of the procedure to obtain Lint and (1/Id)int for the centered Vg–Vth = 1 V in the frame of the Schreutlkamp method.
Evolution of the extracted low field mobility μ0 and channel length reduction ΔL as a function of the centered gate overdrive voltage Vg–Vth in the frame of the Schreutlkamp method.
Like the previous method, the one developed by Ghibaudo is also based on the same equations; however, the calculation requires the derivative of the Id – Vg curves for different gate length L and gate width W, that is the transconductance gm. Data measured around the threshold voltage are used. The plots Id/gm0.5 and gm−0.5 as a function of Vg – Vth allow the extraction of the intermediate parameters Gm and θ*, respectively, since Id/gm0.5 = (GmVd)0.5(Vg – Vth) and gm−0.5=(GmVd)−0.5[1 + θ*(Vg – Vth)]. Note that, the linear fittings are realized in the range Vg>Vth. The slope of the former fitting gives Gm, while the latter one allows the extraction of θ*. Thus, the intersection of the plot Gm versus W with the horizontal axis gives the gate width reduction ΔW, and the intersection of the plot Gm−1 versus L gives the gate length reduction ΔL. Finally, the mobility attenuation factor θ and the parasitic access resistances Racc are obtained from the plot θ* versus Gm since θ*=θ + GmRacc. θ* is the extrinsic mobility attenuation factor. The extracted parameters for Si(100) p-MOSFETs using the Ghibaudo method are reported in Table 1.
While the Ghibaudo method is making use of the derivative, the extraction method developed by Ciofi is based on the numerical analysis of the discretization of the Id – Vg characteristics and requires here as well the calculation of two intermediate parameters, K and H. They are extracted from the plot Vd/Id versus Vg – Vth for several gate lengths L and gate widths W since Vd/Id=K−1((Vg – Vth)−1 + H). H and K are related together by H=θ + KRacc, and the plot H versus K allows the obtaining of the mobility attenuation factor θ and the parasitic access resistances Racc. Plotting K−1 versus L and K versus W, respectively, gives the gate length reduction ΔL and the gate width reduction ΔW at the intersection with the horizontal axis. Data measured at relatively high gate overdrive voltage for Si(100) p-MOSFETs have been used, and the results of the Ciofi method are reported in Table 1. θ* versus Gm for the Ghibaudo method and H versus K for the Ciofi method have been plotted on the same Figure 3. The results in Figure 3 are almost identical for both methods, so are the units. In fact, K and Gm are the transconductance parameter and equals to μ0CoxW/L. Moreover, the similarity between both methods is obvious since θ + KRacc=H=θ*=θ + GmRacc. Note that, for both the Ghibaudo and the Ciofi methods, the knowledge of the threshold voltage Vth prior their implementation is not mandatory since the threshold voltage Vth can be extracted during the procedures described above.
Fitting of θ* = fg(Gm) for the Ghibaudo method and H = fc(K) for the Ciofi method to obtain the access the parasitic access resistance Racc and the mobility attenuation factor θ [
Even if the method is quite limited since the low field mobility μ0 and the mobility attenuation factor θ cannot be evaluated, the interpolation method proposed in the book by Tsividis has been still implemented for Si(100) p-MOSFETs and the results are reported in Table 1.
The four methods have been successfully employed to extract the conduction parameters although a disagreement is visible in regards to the parasitic access resistances Racc. The similarity between the Ciofi method and the Ghibaudo method leads to very similar data and in turn an undervaluation of the parasitic access resistances Racc when compared with the values obtained using the two other methods.
The extraction methods previously described have been implemented for p-MOSFETs fabricated on (110) silicon-oriented wafers in order to extract the conduction parameters. The results are reported in Table 2, and the extraction methods are consistent. Compared to Si(100) p-MOSFETs, the low field mobility μ0 for Si(110) p-MOSFETs is almost three times higher, confirming the superiority of the hole mobility on (110) silicon surface [22].
Schreutelkamp | Interpolation | Ciofi | Ghibaudo | |
---|---|---|---|---|
μ0 (cm2/Vs) | 303 | / | 285 | 281 |
θ (V−1) | 0.042 | / | 0.038 | X |
Racc (Ω) | 48 | 57.76 | 63 | X |
ΔL (μm) | −0.67 | −0.44 | −0.43 | −0.38 |
ΔW (μm) | / | −0.39 | −0.42 | −0.39 |
Conduction parameters extracted using several methods for Si(110) p-MOSFETs at Vd = 100 mV [21].
At the same time, the mobility attenuation factor θ is 10 times weaker for Si(110) p-MOSFETs, indicating that the degradation of the effective mobility might be much more pronounced for Si(100) p-MOSFETs. However, the main result is the impossibility to extract the parasitic access resistances Racc and the mobility attenuation factor θ with the Ghibaudo method, whereas the method has been successfully employed for Si(100) p-MOSFETs [23]. Indeed, as shown in Figure 4, whereas the extraction of Gm from Id/gm0.5 has been possible, and in turn the extraction of the low field mobility μ0, the gate length reduction ΔL and the gate width reduction ΔW, the linear fitting of gm−0.5 versus the gate voltage could not be done. Concerning the Schreutelkamp method, the same procedure as previously described has been carried out and a behavior similar to the one noticed for Si(100) p-MOSFETs has been acknowledged.
Plot of gm−0.5 as a function of the gate overdrive voltage Vg–Vth for transistors fabricated on Si(100) and Si(110) wafers. The linear fitting of the curve allows the extraction of the intermediate parameter Gm in the frame of the Ghibaudo method. L = 10 μm, Vd = 50 mV for Si(100) and Vd = 100 mV for Si(110) transistors.
The modeling of the hole mobility using Eq. (9) with the data reported in Table 1 (μ0 = 115 cm2/Vs and θ = 0.35 V−1) has been carried out and compared with the experimental data of the effective mobility for Si(100) p-MOSFETs. The result is reported with the dashed line in Figure 5 and demonstrates the great accuracy of the extraction method and of the model provided by Eq. (9) when the effective electric field Eeff is above 0.3 MV/cm. Below this value, the model is inaccurate since the effective mobility is limited by the Coulomb scatterings, scatterings that are not taken into account in Eq. (9). The conduction parameters (μ0 = 115 cm2/Vs, θ = 0.35 V−1, Racc = 70 Ω, ΔL = −0.33 μm, ΔW = −0.13 μm, Vd = 50 mV and W = 20 μm) have been implemented in Eqs. (8) and (9) to model the drain current Id in p-MOSFETs with different gate length L and the transconductance gm has been calculated afterwards. The results are shown in Figure 6 with the thick full lines. At the exception of Vg<Vth, the modeling is greatly fitting the experimental data for either Id or gm. The maximum of the transconductance gm cannot be estimated because Eq. (9) does not model the Coulomb scatterings mechanisms. A second simulation has been calculated without taking into account the parasitic access resistances Racc in Eq. (8), and the results are shown with the dashed line in Figure 6. The fact to neglect the parasitic access resistances Racc leads to a discrepancy between the model and the experimental data that is enhanced when the size of the device is shrinked.
Effective mobility μeff as a function of the effective electric field Eeff for Si(100) and Si(110) p-MOSFETs. The dashed lines report the modeling carried out with
Drain current Id (left) and transconductance gm (right) as a function of the gate overdrive voltage Vg–Vth for Si(100) p-MOSFETs featuring different gate length. The lines are the modeling carried out with μ0 = 115 cm2/Vs, θ = 0.35 V−1,
The modeling of the mobility has been carried out for the Si(110) wafers with the parameters obtained in Table 2. μ0 = 285 cm2/Vs and θ = 0.038 V−1 have been implemented in Eq. (9), and the result is shown with the dashed line in Figure 5 and does not provide a great accuracy like it was the case for Si(100) wafers. Nevertheless, the procedure has been moved forward, and the simulation of the drain current Id and the transconductance gm has been calculated with Eq. (8) and the following parameters: μ0 = 285 cm2/Vs and θ = 0.038 V−1, ΔL = −0.4 μm, ΔW = −0.4 μm and Racc = 60 Ω. The results for the drain current Id are shown with the dashed lines in Figure 7, while the results for the transconductance gm are shown in Figure 8 with the dashed lines. The modeling is accurate at first but strongly divert from the experimental data when the gate overdrive voltage is increased. The use of Eq. (9) does not give at all satisfactory agreement with the experiment, especially concerning the transconductance gm. The well-established model that is Eq. (9) cannot be used to simulate the mobility and thus the drivability of Si(110) p-MOSFETs. Other models [24, 25] have been implemented but did not give enough satisfactory results. Contrary to the (100) orientation for which the single phonon scattering mechanism is limiting the hole mobility over the working range, the hole mobility for the (110) orientation is limited by the Coulomb, phonon and surface roughness scatterings mechanism over the whole measurement range. Thus, a model able to take into account these three mechanisms is required. While Eq. (9), which models only the phonon scattering, is sufficient to simulate the Si(100) p-MOS transistors, a new model including all three scattering mechanisms is needed for the Si(110) wafers.
Drain current Id as a function of the gate overdrive voltage Vg–Vth for Si(110) p-MOSFETs featuring different gate length. The dashed lines are the modeling carried out with
Transconductance gm as a function of the gate overdrive voltage Vg–Vth for Si(110) p-MOSFETs featuring different gate length. The dashed lines are the modeling carried out with
µCoul = ACoulT−1EeffβCoul [26] with βCoul ≥ 0 and µsr=AsrEeff−2 [27] are simple ways to model the Coulomb scatterings and surface roughness scatterings, respectively. ACoul and βCoul are constants associated with the Coulomb scattering mechanism, while Asr is a constant associated with the surface roughness scattering mechanism. T is the temperature. Assuming that the effective electric field Eeff is proportional to the gate overdrive voltage Vg – Vth, the dependence of the several scattering mechanisms can be introduced into Eq. (9), which is already modeling the Coulomb scatterings mechanisms to finally give [21]
μ0 is the low field mobility. θ1 corresponds to the conventional mobility attenuation factor seen in Eq. (9) and is related to the contribution coming from the phonon scatterings. θ2 is a quadratic mobility attenuation factor related to the surface roughness scatterings. α is a parameter related to the Coulomb scatterings, while Aα equals to 1 and is introduced to maintain the uniformity of the unit system. As shown in Figure 6 with the full line, Eq. (10) greatly matches the experimental data. The fitting parameters are as follows μ0 = 280 cm2/Vs, θ1 = 0 V−1, θ2 = 0.05 V−2, and α = 0.04. The simulation of the drain current Id and the tranconductance gm has been carried out for Si(110) p-MOSFETs featuring different gate length by implementing Eq. (10) into Eq. (8). μ0 = 280 cm2/Vs, θ2 = 0.05 V−2, α = 0.04, ΔL = −0.4 μm, ΔW = −0.4 μm, Racc = 60 Ω, Vd = 100 mV and W = 20 μm. The results are reported with the full lines in Figures 7 and 8. The modeling of the drain current Id is greatly accurate even for short gate length. The modeling of the transconductance gm in Figure 8 is also fairly accurate. Both, the results regarding the drain current Id and the transconductance gm testify of the good agreement of Eq. (10). In Figure 8, it seems that the maximum of the transconductance gm, result of α the parameter related to the Coulomb scatterings, can be also calculated. This statement must be taken with care since the maximum of the transconductance is obtained for biases that do not correspond to the linear region, making Eq. (8) obsolete. Actually, the parameter α does not solely reflect the Coulomb scatterings. Indeed, the hole mobility in Si(110) wafers has a peculiar behavior in the form of the inter-subband phonon scatterings. Contrary to the acoustic phonon scatterings that are more and more limiting the mobility with an increase of the effective electric field, the inter-subband phonon scatterings have the specificity to decrease when the effective electric field is increased [21, 28] as sketched in Figure 5.
Inversion-mode fully depleted p- and n-channel silicon-on insulator (SOI) MOSFETs have been fabricated on bonded SOI (100) and (110) crystallographic silicon-oriented wafers. For each wafer, transistors with different channel directions were manufactured. The process flow has been entirely conducted in the clean room of the Fluctuation Free Facility at Tohoku University. 33-mm-diameter wafers have been used after cutting them from 8 inches wafers. The doping concentration has been adjusted to 1016 cm−3 by ion implantation. The thickness of the SOI layer was 50 nm, and the thickness of the buried oxide was 100 nm. Prior the formation of the 7.5-nm-thick gate oxide by radical oxidation [29] an alkali-free process [22, 30] able to keep the silicon surface flat was used. The roughness of the Si/SiO2 interface was further reduced by repeating several times the procedure radical oxidation–etching [31]. The procedure has been repeated two times for the Si(100) wafers and four times for the Si(110) ones and led to the same microroughness measured to 0.08 nm. The effective mobility has been measured according to the methodology presented in Section 2 at Vd = 50 mV. Measurements have been carried out on MOSFETs with a gate dimension of W = 100 μm and L = 100 μm.
The low field mobility μ0, the mobility attenuation factor θ, the gate length reduction ΔL, the gate width reduction ΔW and the parasitic access resistances Racc have been extracted for Si(100) n- and p-MOSFETs and are available in a previous paper by Gaubert et al. [32]. The Ghibaudo and Ciofi methods have been used. Figure 9 shows the effective mobility for hole and electron on Si(100) wafers. It is clear that n-MOSFETs own greater performances than p-MOSFETs since the mobility of the former ones is five times higher than the mobility of the latter ones. It is also clear that the channel direction has no impact on the mobility of the n-MOSFETs. However, a slight difference can be noticed for the hole, the highest mobility being measured for a channel along the <100> direction. The direction of choice for the electronic manufacturers is the <110> direction and an easy and costless way to slightly enhance performances of electronic devices would be to manufacture p-MOSFETs on Si(100) wafers with a channel following the <100> direction. The shift from the <110> direction for the <100> direction can give rise to a maximum enhancement of 10% of the drivability [12].
Electron and hole effective mobility μeff as a function of the effective electric field Eeff for Si(100) MOSFETs featuring a channel along the <110> (full lines) and <100> (dashed lines) directions.
It has been demonstrated in Section 3 that the extraction methods are difficult to set up for p-MOSFETs on Si(110) wafers. Nevertheless, the method proposed by Tsividis has been used for the Si(110) p-MOSFETs while the Ciofi and Ghibaudo method helped extract the conduction parameters for the Si(110) n-MOSFETs. The results are reported in a previous paper by Gaubert et al. [32]. The mobility in Si(110) p-MOSFETs is shown in Figure 10. The dependence with the channel is clearly visible. The highest mobility is obtained for a channel following the <110> direction, while the lowest one is obtained for a channel along the <100> direction. Furthermore, an increase in the mobility with the effective electric field can be noticed, especially for the <110> direction, where an increasing limitation by the phonon scatterings was expected. This behavior is caused by the inter-subband phonon scatterings as noticed in Section 4.2. The clear role played by the inter-subband phonon scatterings on limiting the mobility spans on a more visible way in Figure 10 than in Figure 5. The reason is the lower doping concentration of the devices studied in this section that consequently shifts the Coulomb scattering limited mobility to lower effective electric fields. The inter-subband phonon scatterings are explained by the small energetic separation between the two lowest heavy-hole-like subbands, which is favoring the inter-subband transitions assisted by the absorption of optical phonon. This behavior reaches its maximum for a channel along the <110> direction since the holes in this direction have the lowest mass [12].
Effective mobility μeff as a function of the effective electric field Eeff for Si(110) p-MOSFETs featuring a channel along several directions.
The Id – Vg curves for Si(110) n-MOSFETs have been measured, and the results are presented in Figure 11 along with the corresponding tranconductances gm. The larger drivability is ascribed to the <100> direction. From Ref. [32], the value of the attenuation factor θ for the Si(100) n-MOSFETs is 0.175 V−1, while the one obtained for the Si(110) n-MOSFETs is 0.6 V−1. The larger value for Si(110) wafers reflects an unusual degradation of the mobility that makes the drain current Id saturate and drop at high gate overdrive voltage Vg – Vth, as shown in Figure 11. The saturation and decrease in the drain current Id are more pronounced for the <100> direction and find its origin in the balance of the linear product (current is proportional to nμ) between the increase in the number of carriers n and the decrease in the mobility μ. As shown in Figure 11, the unusual consequence is a negative transconductance gm at high voltage. The mobility is shown in Figure 12. Like for the Si(110) p-MOSFETs and contrary to the Si(100) n-MOSFETs, there is a dependence between the mobility and the channel direction. The highest mobility is obtained for the <100> direction, and the lowest is obtained for the <110> direction, the opposite trend revealed for Si(110) p-MOSFETs. The surface roughness is limiting in more proportion the mobility of the transistors along the <100> direction and explains the more pronounced drop of the drain current Id shown in Figure 11.
Drain current Id (right) and transconductance gm (left) as a function of the gate overdrive voltage Vg–Vth for Si(110) n-MOSFETs featuring a channel along the <110> (full lines) and <100> (dashed lines) directions.
Effective mobility μeff as a function of the effective electric field Eeff for Si(110) n-MOSFETs featuring a channel along several directions.
It is well known that temperature has a major impact on the performances of MOSFETs. Every scattering mechanisms that are limiting the mobility have a specific response toward the change in temperature as Gaubert et al. demonstrated for Si(110) n-MOSFETs [33]. Contrary to p-MOSFETs fabricated on Si(110) wafers, the mobility of n-MOSFETs on this orientation is limited by the Coulomb scattering in the low range effective electric field, the phonon scattering in the middle range and finally the surface roughness scattering at high effective electric field. With the intention to understand the response of each scattering mechanisms taken individually to the temperature, a study has been conducted on Si(110) n-MOSFETs investigated in the precedent section. Transistors with a channel along the <100> direction have been studied for different temperatures from 213 to 473
Drain current Id (right) and transconductance gm (left) as a function of the gate voltage Vg for Si(110) n-MOSFETs measured at three different temperatures.
Effective mobility μeff as a function of the effective electric field Eeff for Si(110) n-MOSFETs measured at different temperatures. The several scattering mechanisms limiting the mobility have been also reported.
μCoul is the Coulomb-limited mobility, proportional to Eeffβ where β is a fitting parameter [34]. μPh is the phonon-limited mobility, generally proportional to Eeff−0.3 [11]. Finally, μSR is the surface roughness-limited mobility. It is proportional to Eeffγ [35] where γ is a fitting parameter generally found between −1 and −3. Quantities ACoul, APh and ASR are fitting parameters associated, respectively, with the Coulomb, Phonon and Surface roughness scattering mechanisms.
The results for the Coulomb scattering mechanisms μCoul are shown in Figure 15. The Coulomb-limited mobility μCoul is temperature dependant, and β is varying between 0.8 and 1.2. A point independent of the temperature is visible for an effective electric field around 3 × 103 V/cm. It corresponds to the crossing point visible on the Id – Vg curves of Figure 13 for Vg around 100 mV. Below that, point the temperature increases the energy of electron that are scattering less since the Coulomb interaction is weakening. Finally, results shown in Figure 15 and those reported by Gaubert et al. [33] showing an attenuation of the variation of ACoul with a decrease in the temperature suggests that the Coulomb-limited mobility μCoul might become independent of the temperature at low temperature. The results regarding the phonon-limited mobility μPh are shown in Figure 16. The phonon-limited mobility μPh is temperature dependant according to a T−1.3 law. Nevertheless, their ratio with the effective electric field remains unchanged with a change in temperature. The results regarding the surface-roughness-limited mobility μSR are shown in Figure 17. The surface-roughness-limited mobility μSR is temperature dependant. However, like for the Coulomb-limited mobility μCoul, the results at low temperature strongly suggest that the surface-roughness-limited mobility μSR becomes independent when the temperature is lowered down. Gaubert et al. [33] showed that ASR is converging towards a constant value for temperature lower than 200
Extracted Coulomb mobility μCoul as a function of the effective electric field Eeff for Si(110) n-MOSFETs measured at different temperatures.
Extracted phonon mobility μPh as a function of the effective electric field Eeff for Si(110) n-MOSFETs measured at different temperatures.
Extracted surface roughness mobility μSR as a function of the effective electric field Eeff for Si(110) n-MOSFETs measured at different temperatures.
To finish, the shift from the Si(100) wafers to the Si(110) wafers degrades the electron mobility as testified by results shown in Figures 9 and 12. The study of the mobility in Si(100) n-MOSFETs has been conducted in a similar way for 303
Even though making use of the majority carriers to generate the current [36, 37] is already known and has been investigated more than 40 years ago, this approach has recently gained interest, and recent studies have positioned the accumulation-mode MOSFETs as serious competitors [13, 14, 38–41] to take over the conventional transistors for future CMOS technologies. Scarce data have been published so far regarding the carrier mobility flowing inside an accumulation layer [14, 36], and a method to extract it from the conventional mobility measurement is proposed here since in accumulation-mode MOSFETs the conduction, and thus, the measured mobility involves the conduction inside the accumulation layer and the conduction occurring inside the SOI layer. Planar mode fully depleted silicon-on-insulator p-type MOSFETs on three different unibond p-type SOI (100) silicon oriented wafers have been fabricated in order to assess the mobility in an accumulation layer. The doping concentration of the SOI layer has been adjusted to 1015, 1016 and 2 × 1017 cm−3. A 7.5-nm-thick gate oxide has been formed by plasma oxidation after etching the SOI layer until reaching 50 nm. The mobility measurement method proposed in Section 2 has been followed with Qdep = 0. The results are shown in Figure 18. The mobility for the conventional inversion-mode p-MOSFETs has been reported for comparison and accurately follows the universal curve by Takagi et al. [8] at high effective electric field Eeff. While the results suggest that the mobility for the accumulation-mode devices possessing a doping concentration of 1015 and 1016 cm−3 is following the universal curve, it is clear that the one with a doping concentration of 2 × 1017 cm−3 does not. As expressed previously, the SOI layer is contributing to the total measured current, and in turn, it is included in the calculation of the mobility as presented in Eq. (2). It is also clear from Figure 19 that the calculation of Qacc is false in the case of accumulation-mode MOSFETs. Indeed, the impact of the SOI layer is clearly visible and must be removed to obtain C – Vg characteristics such as the one reported for an inversion-mode MOSFETs in Figure 19.
Experimental effective mobility μeff as a function of the effective electric field Eeff for accumulation- and inversion-mode Si(100) p-MOSFETs featuring different doping concentrations.
Experimental capacitance C as a function of the gate voltage Vg for accumulation- and inversion-mode Si(100) p-MOSFETs with a doping concentration Nd(a) = 2 × 1017 cm−3. The capacitance has been measured at Vd = 100 mV and a frequency f = 100 kHz.
The appropriate evaluation of the mobility must be conducted from the relevant data, the accumulation charge and the current generated exclusively by the accumulation layer. At the flat-band voltage Vfb, the SOI current reaches its maximum value and its subtraction from the Id – Vg curves give the current generated by the accumulation layer. Vbf is evaluated from the knowledge of the flat-band capacitance Cfb obtained from
where Cdeb is the Debye capacitance and can be easily calculated like Cox. Vfb is obtained with the help of the C – Vg curves shown in Figure 19. By turn, the maximum SOI current and SOI charge are evaluated, respectively, from the Id – Vg and Qacc – Vg curves and subtracted afterwards. The calculation of the effective mobility μeff and of the effective electric field Eeff has been conducted again for the three doping concentration, and the results are shown in Figure 20. All curves are now reaching the universal curve indicating that an accumulation layer has a universal behavior identical to the one seen for an inversion layer. The universal curve by Takagi et al. [8] is appropriate for both the inversion and accumulation layers. It is also confirming the rightfulness of η = 1/3 for the calculation of the effective electric field Eeff in Eq. (7) indicating again that the carriers in an accumulation layer are behaving in a similar way than the ones in an inversion layer with regard to the phonon and surface roughness scattering mechanisms as previously described by Chindalore et al. [42]. To finish contrary to the inversion layer, an early screening of the Coulomb scattering is occurring in the case of an accumulation layer, allowing the mobility in an accumulation layer to reach at first the bulk mobility before the phonon scatterings dominate [14, 43], thus the monotonically decrease in the mobility seen at low effective electric field Eeff in Figure 20.
Calculated effective mobility μeff inside the accumulation layer of accumulation-mode Si(100) p-MOSFETs featuring different doping concentrations as a function of the effective electric field Eeff.
These last results indicate that even if the mobility shown in Figure 18 for accumulation-mode MOSFETs with a doping concentration 1015 and 1016 cm−3 could have been interpreted as correct, are actually false owing to the contribution of the SOI layer.
In this chapter, we reviewed some of the main aspects of the mobility in field-effect transistors and especially for the (110) crystallographic silicon-oriented wafers. The mobility in p-MOSFETs on Si(110) wafers is limited by inter-subband scattering mechanism making its extraction by the means of the Ghibaudo method inappropriate and in turn its modeling inaccurate. A more adapted model relying on a physical approach has been developed. This new expression is incorporating the Coulomb, phonon and surface roughness scattering mechanism and is allowing a precise modeling of the drivability and transconductance in Si(110) p-MOSFETs. In addition, the study showed a clear dependency between the mobility and the channel direction for transistors fabricated on Si(110) wafers, while no impact has been noticed for conventional Si(100) wafers. The highest mobility has been revealed for a channel along the <100> direction for electron and along the <110> direction for hole. The study in temperature in Si(110) n-MOSFETs showed that the Coulomb and surface roughness scattering mechanisms are actually temperature dependent. More, the degradation of the electron mobility in Si(110) wafers has been explained by a substantial increase in the Coulomb and surface roughness scatterings than the phonon ones when compared with the Si(100) wafers. To finish, a methodology has been proposed and successfully employed to calculate the carrier mobility in the accumulation layer of newly developed accumulation-mode MOSFETs. The result showed afterwards that accumulation and inversion layers are behaving in a similar way in regard to the phonon and surface roughness scattering mechanism. Nevertheless, the mobility in an accumulation layer is monotonically decreasing from the bulk mobility when the electric field is increased, owing to an earlier screening of the carrier by the Coulomb scatterings.
Hepatorenal Syndrome (HRS) is an important condition for clinicians to be aware of in the presence of cirrhosis. In simple terms, HRS is defined as a relative rise in creatinine and relative drop in serum glomerular filtration rate (GFR) alongside renal plasma flow (RPF) in the absence of other competing etiologies of acute kidney injury (AKI) in patients with hepatic cirrhosis [1, 2, 3, 4, 5, 6, 7]. It represents the end stage complication of decompensated cirrhosis in the presence of severe portal hypertension, in the absence of prerenal azotemia, acute tubular necrosis or others. It is a diagnosis of exclusion [2]. The recognition of HRS is of paramount importance for clinicians as it carries a high mortality rate. Recent advances in understanding the pathophysiology of the disease improved treatment approaches, but the overall prognosis remains poor, with Type I HRS having an average survival under 2 weeks [3]. Generally speaking, AKI and renal failure in cirrhotic patients carry a very high mortality rate, with up to 60% mortality rate for patients with renal failure and cirrhosis and 86.6% of overall mortality rates of patients admitted to the intensive care unit [4, 5]. Of the various etiologies of renal failure in cirrhosis, HRS carries a poor prognosis among cirrhotic patients with AKI.
HRS continues to pose a diagnostic challenge. AKI is relatively frequent, seen in about 20% of patients with cirrhosis [8]. AKI can be either pre-renal, intrarenal or postrenal. Prerenal causes include hypovolemia, infection, use of vasodilators and functional due to decreased blood flow to the kidney, intra-renal such as glomerulopathy, acute tubular necrosis and post-renal such as obstruction. Patients with cirrhosis are susceptible to developing renal impairment. HRS may be classified as type 1 or rapidly progressive disease, and type 2 or slowly progressive disease. There are other types of HRS [9], but this chapter will focus on type 1 HRS and type 2 HRS. HRS is considered a functional etiology of AKI as there is an apparent lack of nephrological parenchymal damage. This is one of several possibilities of AKI in patients with both acute and chronic liver disease.
AKI is one of the most severe complications that could occur with cirrhosis. Up to 50% of hospitalized patients with cirrhosis can suffer from AKI, and as mentioned earlier an AKI in the presence of cirrhosis in a hospitalized patient has been associated with nearly a 3.5-fold increase in mortality [6].
The definition of HRS will be discussed in this chapter, but it is characterized specifically as a form of AKI that occurs in patients with advanced liver cirrhosis which results in a reduction in renal blood flow, unresponsive to fluids this occurs in the setting of portal hypertension and splanchnic vasodilation [7].
This chapter will discuss the incidence, definitions and management of HRS, focusing mainly on HRS type I and type II.
AKI is a common entity in cirrhotic patients at baseline. It is also commonly seen in general hospitalized patients, both with and without cirrhosis. This fundamentally means that a clinician should be able to distinguish various etiologies of AKI establish the reason for AKI in each cirrhotic patient so that management can be conducted appropriately.
As mentioned before, the frequency of AKI in patients with underlying liver pathology can be as high as 50%. One study looked at hospitalized patients with cirrhosis. Of these patients, 19% found to have an AKI, out of these 23% found to have HRS [10]. “The AKI was divided into pre-renal, intrinsic, and post-renal. Pre-renal injury was the most common form of AKI which represented 68% of patients with AKI. The pre-renal injury was usually volume responsive, while HRS is non-volume responsive. In most cases, the injury was volume responsive and therefore less likely HRS [11, 12]. Although HRS is not always the most common cause of renal impairment in cirrhosis; renal impairment itself is commonly seen as the frequency of AKI in cirrhosis can vary in the literature from approximately 15–40% [13, 14, 15].
The etiologies of AKI in cirrhosis vary, and the prognosis that each etiology carries also varies. One large prospective study found that hypovolemia and infections were in fact the most common culprits of AKI in cirrhosis, with HRS being identified in 13% of cases [16]. The definition of HRS is important as it can guide clinicians into decision making. For instance, if the etiology of an AKI in cirrhosis is reversible and will not cause significant long-term impairment, the urgency for immediate transplantation dissipates. Conversely, if there is the development of HRS, there may be urgent indication for transplantation.
While there are varying figures reported in the literature on the frequency of AKI in the cirrhotic population, it is evident that it is a common entity. Not all AKI in cirrhosis is considered HRS and defining HRS as the specific cause of renal impairment in cirrhosis represents another challenge for clinicians.
As stated previously, HRS is defined as renal impairment that occurs in patients who have clinically established cirrhosis or have significant liver impairment. The most widely used definition is the relative rise in creatinine and the relative drop in serum GFR and renal plasma flow in the absence of other causes of AKI like prerenal, renal or post-renal. Given its poor prognosis, HRS was formerly associated with the term terminal functional renal failure [17]. In theory, since there is no intrinsic kidney pathology, upon reversing the hepatic dysfunction either medically or via transplantation, there should be resolution of HRS. In intrinsic renal pathologies, this would not be the case. Before considering HRS, clinicians should rule out other competing etiologies.
Differentiating HRS from other etiologies of AKI in cirrhotic patients is clinically of high importance because of the pronounced difference in management and prognosis. Patients with liver cirrhosis are prone to have acute, subacute and chronic kidney disease through a variety of mechanisms. Clinicians should have a broad differential diagnosis when approaching patients with AKI as there is no definitive test for HRS yet [18]. It is therefore necessary to rule out other differential diagnosis before a diagnosis of HRS is made. Identification of risk factors and careful assessment of the renal system are the mainstay to make such a diagnosis.
Cirrhotic patients may have a certain level of renal insufficiency at baseline since some etiologies of cirrhosis can directly or indirectly lead to renal insufficiency. For instance, patients with non-alcoholic fatty liver disease have higher incidence of obesity and associated diabetes and diabetic nephropathy. Also, both glomerulonephritis and vasculitis can occur in patients with liver cirrhosis secondary to viral hepatitis [2]. These are just a few examples of how one pathology can affect both the hepatic and renal system.
Given the wide spectrum of possibilities, when approaching a renal impairment in a patient with cirrhosis, a systematic approach can be of benefit to clinicians to assess the nature of renal impairment. Causes of AKI and renal failure in cirrhotic patients can be summarized in four main categories.
This is usually due to hemorrhage related to gastrointestinal bleed or fluid loss associated with excessive diuresis or diarrhea induced by excessive laxatives use [19]. Also, can be secondary to different infectious etiologies including spontaneous bacterial peritonitis. In any of these cases, renal failure will occur soon after any of the mentioned hypovolemic events [16, 19]. Due to the fact that patients with worsening liver cirrhosis will have decreased intravascular volume and mean arterial resistance [17], hypovolemia should be considered as a frequent component of AKI in those patients [16]. The management of hypovolemia induced renal failure is to address the volume status.
By definition HRS is a purely functional disease and it does not induce renal parenchymal damage. However, any parenchymal renal disease can occur in both cirrhotic patients and non-cirrhotic patients. The presence of proteinuria, hematuria or both is associated with glomerular disease. Differentiating HRS from acute Tubular Necrosis (ATN) remains difficult. While the presence of muddy brown casts favors ATN, other urinary indexes like fractional excretion of sodium (FeNa) can be misleading due to the prolonged use of diuretics in cirrhotic patients. Granular casts can be seen in both ATN and HRS [19].
Drug-induced tubular/tubulointerstitial injury is a common cause of AKI especially with the consideration ill patients such as those with cirrhosis will inevitably need medications. There are various pathways and in which a drug can cause renal injury [20]. Some examples can include aminoglycosides, vancomycin, and even administration of contrast needed for imaging studies.
HRS is a diagnosis of exclusion based on the previously mentioned criteria. This chart simplifies the definition based on the criteria set forth by the International Ascites Club [21, 22].
The key factor in diagnosing HRS is the absence of improvement of kidney function despite discontinuation of potential nephrotoxic agents, and a trial of fluid repletion. Essentially HRS appears as a non-volume responsive pre-renal injury. This is why it is essential to rule out all other possible AKI systematically (Table 1).
AKI stage 1 is defined as the increase in serum creatinine (sCr) of >0.3 mg/dl within 48 hours or a > 50% percentage increase in sCr from a known or presumed baseline in the past 3 months which occurred within the past 7 days or urine volume < 0.5 cc/kg for 6 hours.
Changes in the definition of AKI in patients with cirrhosis has changed over time and has been replaced by the ICA (International Club of Ascites) AKI criteria [4, 23]. One of the most important changes was the removal of cutoff values of sCr for diagnosis of HRS in the setting of AKI, allowing earlier recognition and treatment of HRS.
Major diagnostic criteria include cirrhosis with ascites, presence of renal failure which helps differentiate HRS type I and HRS type II.
HRS type 1, renal failure is acute based on the KDIGO guidelines, increase in serum creatinine by ≥0.3 mg/dL within 48 hours; Increase in serum creatinine to ≥1.5 times baseline (i.e. 50% above baseline), which is known or presumed to have occurred within the prior 7 days; or urine volume < 0.5 mL/kg/h over a 6-hour period [23].
Type 2 HRS renal failure decline in renal function progresses more slowly, usually Cr >1.5. Diagnosis of HRS-type 2 be made either in the context of chronic kidney disease (CKD), that is, in a patient with cirrhosis and a GFR <60 ml/min per 1.73 m2 for >3 months (HRS-CKD) in whom other causes have been excluded, or in the context of AKI, defined as a renal dysfunction that does not meet criteria for AKI and lasts for less than 90 days.
KDIGO guidelines define CKD as abnormalities in kidney structure or function (GFR <60 ml/min/1.72 m2) that persist for more than 90 days, and acute kidney disease (AKD), as AKI or as abnormalities in kidney structure or function that persist for more than 90 days [9, 23].
A recent proposal in the European association for the study of the liver guidelines suggested that HRS-2 should be referred to as HRS-NAKI (hepato-renal syndrome non-acute kidney injury) [24]. This is due to many reasons. HRS 2 is poorly defined and is more of an assumption that chronic abnormalities in serum creatinine without a definite timeline, thus arriving at a new definition of HRS-2 is more challenging than expected.
It is proposed that the diagnosis of HRS-NAKI be made either in the context of CKD, that is in a patient with cirrhosis and a decrease in GFR greater than 3 months (HRS-CKD) or in the context of AKD, defined as a renal dysfunction that does not meet criteria for AKI and lasts for less than 90 days underlying factors such as diabetes, arterial hypertension causing nonalcoholic steatohepatitis which eventually lead to cirrhosis can simultaneously affect the kidneys causing CKD as well [23].
The new nomenclature may enable clinicians to define the presence of HRS-AKI superimposed on CKD in a patient with structural damage of the kidney, as evidenced by previous abnormal biopsy, renal ultrasonography or by significant proteinuria.
In the context of the new definition of HRS-AKI on CKD: HRS-AKI, there would be no evidence of chronic structural damage. For HRS-AKI on CKD in which there would be evidence of chronic structural damage such as chronic proteinuria and/or abnormal renal ultrasonography but with a high suspicion of HRS-AKI.
Other diagnostic criteria for hepatorenal syndrome include:
Failure of response to 48-hour volume expansion with albumin and discontinuation of diuretics.
Absence of current use of nephrotoxic medications.
Absence of macroscopic indication of structural kidney injury such as of proteinuria less than 500 mg per day, microhematuria (less than 50 red blood cells per high powered field) and normal kidney ultrasound [9, 21, 23] (Table 2).
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Although the definition of HRS appears straightforward, there are many clinical challenges to consider when making a diagnosis. For instance, the usefulness of creatinine measurement in patients with cirrhosis may be limited for many reasons such as assay interference with bilirubin, reduced creatinine production in liver failure patients, muscle wasting and malnutrition [25].
Also using the urine output in patients with cirrhosis is limited as it can affected by other factors, for example decreased urine can be a normal in hypovolemic patients as they retain sodium or it can be simply increased secondary to the use of diuretics, [26, 27] despite that urine output remain a factor to look for, as was demonstrated by, Amathieu et al. who showed that reduction in urine output is associated with worse prognosis and 3-fold increased in hospital mortality [28].
These are just a few examples of how clinicians must use sound judgment when attempting to make a diagnosis of HRS. As mentioned earlier, it is important to stratify causes as it would impact both management and possibly the urgency for transplantation.
Differentiating ATN and HRS can also pose a challenge to clinicians. Pre-renal azotemia represents the leading cause of AKI in patients with cirrhosis, good history and physical examination of patients warranted to exclude causes of hypovolemia as discussed above.
Urine studies have been also sought to be helpful, with structural etiologies such as ATN, tubular injury limits sodium reabsorption and fraction excretion of sodium (FENa) is increased, typically by greater than 2–3%, using these cutoffs has been challenging owing to the fact that all patients with advanced cirrhosis have chronic renal hypoperfusion and have an FENa less than 1%, even in the absence of AKI [29]. Other studies such as urinary sodium (less than 40 milliequivalents per liter), low urine osmolality are suggestive of ATN although their use in HRS has been limited.
The fraction excretion of urea (FEUrea) is superior to FeNA in differentiating AKI-HRS from ATN, obtaining such tests is very important in HRS as most patients with HRS are on diuretics. Urinary sodium is known to be affected by use of diuretic which can falsely elevate the urine sodium. That is one main reason why FeNa has been excluded from HRS definitions.
Novel urine biomarkers of tubular injury have long been sought to differentiate AKI-HRS and ATN in patients with cirrhosis [30].
There are many biomarkers released by tubular injury. Among these, NGAL has been the most widely studied biomarker in patients with cirrhosis and showed the greatest diagnostic accuracy in differentiating ATN from AKI-HRS [9]. Cut-off of 0.2% has been widely used in distinguishing HRS from ATN [9]. Urinary NGAL seems to be superior to plasma concentrations and performs better when measured after the two-day volume challenge recommended in the management of any AKI including HRS [31].
At the current time human studies rely on expert adjudication for differentiating ATN from AKI-HRS owing to the limited availability of renal biomarkers and restricted use of kidney biopsies in such a high risk population.
HRS is one of the many causes of AKI in individuals with both acute and chronic liver disease. After correctly making a diagnosis of HRS, clinicians must address the underlying etiology of HRS. Patients that develop usually have cirrhosis, alcoholic hepatitis, liver failure, or fulminant hepatic failure from any etiology. Management of HRS is usually supportive, with the definitive treatment being reversal of the underlying liver pathology. In several patients, this means liver transplantation.
First line treatment of supportive management for HRS is using vasoconstrictors in combination with albumin to combat splanchnic arterial vasodilation [32]. The goal of treatment is to improve hemodynamic dysfunction by combatting the decreased circulating volume and increasing mean arterial pressure. The most common vasoconstrictors used are vasopressin analogues (terlipressin), norepinephrine, and somatostatin analogues such as octreotide and midodrine.
The vasopressin analogue Terilpressin is noted to have a greater affinity for the vasopressin 1 receptors in the splanchnic bed, it has been found to improve kidney function in patients with HRS with a decreased incidence of ischemia as compared to vasopressin [33]. Studies have demonstrated that continuous administration of Terlipressin is better tolerated and associated with fewer adverse effects as compared to intermittent bolus administration [34]. Continuous infusion of terlipressin in an outpatient setting has also been reported to be an effective, safe option of HRS treatment as a bridge to transplant [35, 36]. Terlipressin is considered as the first treatment of choice of HRS in Europe. Despite this fact, it is not currently approved by the Food and Drug Administration for use in the United States and Canada as a clear benefit of treatment in HSR has not been established.
Terlipressin was proven to be more effective than placebo in treating HRS type 1 although terlipressin use was associated with more adverse events such abdominal pain, nausea, diarrhea and respiratory failure [37].
While Terilpressin is the traditional first choice for HRS, norepinephrine is another option clinician can use as vasoconstrictive therapy. One large meta-analysis looking at randomized control trials in HRS compared the efficacy of various constrictive therapies. Terlipressin did demonstrate the most effective pressor to reverse HRS, but had an increased risk of adverse events. Norepinephrine was nearly as efficacious as Terlipressin, and although it was not able to provide the survival benefit as Terlipressin did have a better safety profile [38, 39].
Albumin has a role in maintaining plasma oncotic pressure and detoxification. One of the few indications for albumin administration is HRS; with existing studies in the literature that report the efficacy of albumin in the treatment of HRS [40]. Although albumin has been proven to help in HRS, the optimal treatment dose has not yet been established in guidelines. One large meta-analysis study did demonstrate a benefit with albumin, but optimal treatment dose with albumin has yet to be established. The study did demonstrate that a cumulative dose predicts a successful response to therapy [41].
Current recommendation is to use both albumin with Terlipressin as it has been shown that it improves its beneficial effect when compared to using terlipressin alone or placebo [34, 42].
Transjugular intrahepatic portosystemic shunt (TIPS) is a treatment option for those patients who fail to respond to pharmacologic therapy. TIPS reduces portal pressures by placing a stent between the portal and hepatic vein. This decreases portal pressure and vascular resistance by reducing endothelin-1 [43, 44]. This procedure has shown to improve kidney function in patients with HRS with a reduction in serum blood urea nitrogen, serum creatinine, and urinary sodium excretion [45, 46]. Although the TIPS procedure does improve elements of HRS, it was shown that there is limited evidence of survival benefit in patients with HRS [47] in addition to risk of development of hepatic encephalopathy which remains the greatest concern for clinicians. This is due to the portosystemic bypass shunt which results in bypassing the livers detoxifying function.
Renal replacement therapy (RRT) is an option for patients with HRS who progress to kidney failure and is most commonly done in patients awaiting liver transplant, or those with an acute reversible event. The role of RRT remains unclear due to lack of survival benefits as similar short term and long-term survival rates have been demonstrated as compared with non RRT treated patients [48].
HRS is an important entity in liver transplantation. Firstly, many patients waiting for liver transplant will develop HRS. This is owing to the fact that the indication for liver transplant is often advanced cirrhosis or decompensated cirrhosis with ascites. These conditions may also predispose for HRS. The 1-year probability of developing HRS in the presence of ascites is 20%, and the 5-year probability is 40%. The patient population at highest risk of complications are those with fluid retention, which is seen in advanced and decompensated cirrhosis [49, 50].
Secondly, in patients who have HRS the therapies mentioned above such as vasoconstrictors are used often as a bridge to transplantation. Therapies discussed above including vasoconstrictors may help, but the definitive treatment in HRS patients is often a transplant. Aggressive supportive care is unable to improve the recovery of kidney function in less than 50% of patients with HRS [50].
The concept of addressing HRS with a Simultaneous Liver and Kidney Transplant (SLKT) would seem to address both organ dysfunctions. However, HRS has the potential to be reversed by liver transplantation alone, and thus SLKT is not routinely considered in HRS. As mentioned in earlier sections, HRS is associated with many renal pathologies and it is possible for patients with HRS to develop end-stage renal disease after liver transplant alone. Long wait times for liver transplantation has led to a rise in the incidence of pre-transplantation renal dysfunction. The prolonged HRS and long-term RRT can lead to permanent renal damage. The permanent renal injury may lead to a decline in renal function that may not be adequate after liver transplant alone [42, 50].
HRS is not an uncommon entity in cirrhotic patients. It remains a challenge both diagnostically and in terms of management. Although there are many causes of renal impairment in the setting of cirrhosis, HRS is unique as the kidneys do not have an organic injury; rather they are a victim of poor circulation seen in advanced liver disease. Any renal impairment has the potential to increase mortality in the cirrhosis population, but HRS in particular is endangering to patients. There are two common forms of HRS, type 1 and type 2, and they can be generally distinguished based on acuity. There appears to be promise in the ease of diagnosis, with the advent of possible biomarkers; however, the present diagnosis is one of exclusion and can often be of challenge for clinicians. The management is mostly supportive care, with albumin and pressor playing a prominent role. The definitive treatment is addressing the underlying liver pathology, which often means liver transplantation. In some instances, there may be a simultaneous transplantation of the kidney and liver.
HRS | hepatorenal syndrome |
GFR | glomerular filtration rate |
AKI | acute kidney injury |
ATN | acute tubular necrosis |
CKD | chronic kidney disease |
HRS-NAKI | hepato-renal syndrome non-acute kidney injury |
AKD | acute kidney disease |
FENa | fraction excretion of sodium |
FEUrea | The fraction excretion of urea |
RRT | Renal replacement therapy |
SLKT | Simultaneous Liver and Kidney Transplant |
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Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"198",title:"Physical Therapy",slug:"physical-therapy",parent:{id:"16",title:"Medicine",slug:"medicine"},numberOfBooks:3,numberOfSeries:0,numberOfAuthorsAndEditors:58,numberOfWosCitations:27,numberOfCrossrefCitations:32,numberOfDimensionsCitations:49,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicId:"198",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"7543",title:"Physical Therapy Effectiveness",subtitle:null,isOpenForSubmission:!1,hash:"96855ef0bdc30d253f8fd74aa6cfd363",slug:"physical-therapy-effectiveness",bookSignature:"Mario Bernardo-Filho, Danúbiada Cunha de Sá-Caputo and Redha Taiar",coverURL:"https://cdn.intechopen.com/books/images_new/7543.jpg",editedByType:"Edited by",editors:[{id:"157376",title:"Prof.",name:"Mario",middleName:null,surname:"Bernardo-Filho",slug:"mario-bernardo-filho",fullName:"Mario Bernardo-Filho"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6772",title:"Occupational Therapy",subtitle:"Therapeutic and Creative Use of Activity",isOpenForSubmission:!1,hash:"0f6de90c02282919494d6254e473defe",slug:"occupational-therapy-therapeutic-and-creative-use-of-activity",bookSignature:"Meral Huri",coverURL:"https://cdn.intechopen.com/books/images_new/6772.jpg",editedByType:"Edited by",editors:[{id:"171525",title:"Dr.",name:"Meral",middleName:null,surname:"Huri",slug:"meral-huri",fullName:"Meral Huri"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5711",title:"Occupational Therapy",subtitle:"Occupation Focused Holistic Practice in Rehabilitation",isOpenForSubmission:!1,hash:"38180e287b6cb09b8002b7ab485de2c2",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",bookSignature:"Meral Huri",coverURL:"https://cdn.intechopen.com/books/images_new/5711.jpg",editedByType:"Edited by",editors:[{id:"171525",title:"Dr.",name:"Meral",middleName:null,surname:"Huri",slug:"meral-huri",fullName:"Meral Huri"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:3,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"55163",doi:"10.5772/intechopen.68799",title:"Virtual Reality and Occupational Therapy",slug:"virtual-reality-and-occupational-therapy",totalDownloads:2642,totalCrossrefCites:4,totalDimensionsCites:6,abstract:"Virtual reality is three dimensional, interactive and fun way in rehabilitation. Its first known use in rehabilitation published by Max North named as “Virtual Environments and Psychological Disorders” (1994). Virtual reality uses special programmed computers, visual devices and artificial environments for the clients’ rehabilitation. Throughout technological improvements, virtual reality devices changed from therapeutic gloves to augmented reality environments. Virtual reality was being used in different rehabilitation professions such as occupational therapy, physical therapy, psychology and so on. In spite of common virtual reality approach of different professions, each profession aims different outcomes in rehabilitation. Virtual reality in occupational therapy generally focuses on hand and upper extremity functioning, cognitive rehabilitation, mental disorders, etc. Positive effects of virtual reality were mentioned in different studies, which are higher motivation than non‐simulated environments, active participation of the participants, supporting motor learning, fun environment and risk‐free environment. Additionally, virtual reality was told to be used as assessment. This chapter will focus on usage of virtual reality in occupational therapy, history and recent developments, types of virtual reality technologic equipment, pros and cons, usage for pediatric, adult and geriatric people and recent research and articles.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Orkun Tahir Aran, Sedef Şahin, Berkan Torpil, Tarık Demirok and\nHülya Kayıhan",authors:[{id:"172938",title:"Prof.",name:"Hulya",middleName:null,surname:"Kayihan",slug:"hulya-kayihan",fullName:"Hulya Kayihan"},{id:"183079",title:"Ph.D.",name:"Sedef",middleName:null,surname:"Şahin",slug:"sedef-sahin",fullName:"Sedef Şahin"},{id:"196848",title:"M.Sc.",name:"Orkun Tahir",middleName:null,surname:"Aran",slug:"orkun-tahir-aran",fullName:"Orkun Tahir Aran"},{id:"197159",title:"Mr.",name:"Tarık",middleName:null,surname:"Demirok",slug:"tarik-demirok",fullName:"Tarık Demirok"},{id:"197312",title:"M.Sc.",name:"Berkan",middleName:null,surname:"Torpil",slug:"berkan-torpil",fullName:"Berkan Torpil"}]},{id:"61806",doi:"10.5772/intechopen.78312",title:"Executive Functions and Neurology in Children and Adolescents",slug:"executive-functions-and-neurology-in-children-and-adolescents",totalDownloads:1759,totalCrossrefCites:3,totalDimensionsCites:5,abstract:"This chapter discusses the theoretical and methodological issues of creating a developmental perspective on executive function (EF) in childhood and adolescence. Focusing on school periods, this section outlines the development of the basic components of EF—inhibition, working memory, and attention. Cognitive and neurophysiological evaluations show that despite the emergence of EF in the first few years of life, it continues to grow significantly in childhood and adolescence. The components vary slightly according to their developmental sequence. The chapter links findings to long-standing developmental issues (i.e. developmental sequences and processes) and suggests the necessary research to establish a developmental framework covering early childhood throughout adolescence.",book:{id:"6772",slug:"occupational-therapy-therapeutic-and-creative-use-of-activity",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Therapeutic and Creative Use of Activity"},signatures:"Gokcen Akyurek",authors:[{id:"197265",title:"Dr.",name:"Gokcen",middleName:null,surname:"Akyurek",slug:"gokcen-akyurek",fullName:"Gokcen Akyurek"}]},{id:"55024",doi:"10.5772/intechopen.68463",title:"Occupational Therapy in Oncology and Palliative Care",slug:"occupational-therapy-in-oncology-and-palliative-care",totalDownloads:2699,totalCrossrefCites:1,totalDimensionsCites:4,abstract:"Cancer is a chronic disease that may occur in both children and adults. Occupational therapy focuses on the activity limitations and participation problems in their life. Oncology rehabilitation involves in helping an individual with cancer to regain maximum physical, psychological, cognitive, social, and vocational functioning with the limits up to disease and its treatments in an interdisciplinary team concept. These treatment options are associated with the risk of some side effects, including fatigue, pain, cognitive problems, decrease in bone density and muscle endurance, weight loss, and stress- or anxiety-related psychosocial problems. Occupational therapy approaches are a holistic view in a client center and use training in activities of daily living, assistive technology, education of energy conservation techniques, and management of treatment-related problems, such as pain, fatigue, and nausea. In palliative and hospice care, occupational therapists support clients with cancer by minimizing the secondary symptoms related to cancer and its treatments. At the end of life, occupational therapy offers to identify the roles and activities that are meaningful and purposeful to the client with cancer and try to determine the barriers that limit their performance. Clients with cancer who have childhood cancer or adult cancer can face problems about body structure and functions, activity, and participation, which may limit their participation to their daily life.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Sedef Şahin, Semin Akel and Meral Zarif",authors:[{id:"183079",title:"Ph.D.",name:"Sedef",middleName:null,surname:"Şahin",slug:"sedef-sahin",fullName:"Sedef Şahin"},{id:"183078",title:"Dr.",name:"Burcu Semin",middleName:null,surname:"Akel",slug:"burcu-semin-akel",fullName:"Burcu Semin Akel"},{id:"198859",title:"Dr.",name:"Meral",middleName:null,surname:"Zarif",slug:"meral-zarif",fullName:"Meral Zarif"}]},{id:"56049",doi:"10.5772/intechopen.69101",title:"Measurement of Participation: The Role Checklist Version 3: Satisfaction and Performance",slug:"measurement-of-participation-the-role-checklist-version-3-satisfaction-and-performance",totalDownloads:2823,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"Participation in society is an area of interest to both clinicians and population researchers. Measurement of participation is therefore important, yet differences in definition, in terms of both content and scope, have made general agreement on one instrument tool elusive. What is recognized is the need for a theoretically based tool that captures both the insider and the outsider perspective. The outsider perspective, inclusive of the generally held views of a society, supports the utility for aggregating population data, whereas the insider perspective provides the internally held views of an individual needed for client-centered treatment planning. The Role Checklist Version 3 modifies one of the most commonly used assessment tools in occupational therapy practice, has good preliminary psychometric properties, and is theoretically consistent with both the ICF and the Model of Human Occupation. The Model of Human Occupation is the most widely used theoretical model in occupational therapy. This chapter provides an overview of the theoretical development, empirical testing, and implications for use of this participation measure by occupational therapists along with implications for population researchers.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Patricia J. Scott, Kelsey McKinney, Jeff Perron, Emily Ruff and Jessica\nSmiley",authors:[{id:"195495",title:"Dr.",name:"Patricia J",middleName:null,surname:"Scott",slug:"patricia-j-scott",fullName:"Patricia J Scott"},{id:"208801",title:"Dr.",name:"Kelsey G.",middleName:null,surname:"McKinney",slug:"kelsey-g.-mckinney",fullName:"Kelsey G. McKinney"},{id:"208802",title:"Mr.",name:"Jeffrey M.",middleName:null,surname:"Perron",slug:"jeffrey-m.-perron",fullName:"Jeffrey M. Perron"},{id:"208803",title:"Dr.",name:"Emily G.",middleName:null,surname:"Ruff",slug:"emily-g.-ruff",fullName:"Emily G. Ruff"},{id:"208804",title:"Dr.",name:"Jessica L.",middleName:null,surname:"Smiley",slug:"jessica-l.-smiley",fullName:"Jessica L. Smiley"}]},{id:"55018",doi:"10.5772/intechopen.68315",title:"Psychomotor Therapy for Patients with Severe Mental Health Disorders",slug:"psychomotor-therapy-for-patients-with-severe-mental-health-disorders",totalDownloads:2274,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"Psychomotor therapy is defined as a method of treatment based on a holistic view of the human being that is derived from the unity of body and mind. Assessments (observation and/or evaluation) are essential to achieving concrete psychosocial objectives methodically. Psychomotor therapy uses movement, body awareness and a wide range of movement activities to optimize movement behaviour as well as the cognitive, affective and relational aspects of psychomotor functioning (i.e. the relationships between physical movements and cognitive and social-affective aspects). Consequently, the approach to this type of therapy integrates the physical, cognitive and emotional aspects of functioning in relation to the capacity of being and acting in a psychosocial context in order to achieve clearly defined goals in consultation with the patients. Psychomotor therapy framework consists of three different approaches: a health-related approach, a psychosocial approach and a psychotherapeutic approach, which can be embedded in several psychotherapeutic approaches. Through the implementation of both systematically planned evaluations and individually targeted interventions in group, the psychomotor therapist strives to broaden the general action competences and specific skills and to stimulate a positive self-image and personal well-being in balanced social relationships. Today, there is sufficient evidence that psychomotor therapy has a major contribution to both well-being and mental health of patients with severe psychiatric problems. In Flemish psychiatric hospitals, psychomotor therapy is imbedded in different treatment programmes. In this chapter, the theory behind this approach and some practical examples will be provided.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Michel Probst",authors:[{id:"196227",title:"Prof.",name:"Michel",middleName:null,surname:"Probst",slug:"michel-probst",fullName:"Michel Probst"}]}],mostDownloadedChaptersLast30Days:[{id:"55080",title:"Life Skills in Occupational Therapy",slug:"life-skills-in-occupational-therapy",totalDownloads:6079,totalCrossrefCites:4,totalDimensionsCites:1,abstract:"Occupational therapy is a health profession that uses the purposeful activities to achieve multiple and complex rehabilitation aims. The main goals of the occupational therapy are to support the reintegration of individuals in daily living skills as well as to increase their independence and autonomy. Interventions of occupational therapists have primarily focused on self-care, productivity, and leisure time activities. Since the life skills includes a wide range of abilities that enable a person to perform personal care and more complicated tasks such as traveling, shopping, community participation etc., occupational therapists provide life skills training programs to meet the needs of the clients. This chapter aims to contribute to the current understanding and practices of life skills from an occupational therapy perspective. The chapter starts with a brief discussion of the importance of life skills in occupational therapy. After this introduction, the first part takes a look at the definition of life skills and identifies core components of life skills. The second part describes assessment and interventions of life skills. The third one gives an overview about school life skills programs for children and adolescents. Finally, the last part explains some life skills programs in people with disadvantages.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Hatice Abaoğlu, Özge Buket Cesim, Sinem Kars and Zeynep Çelik",authors:[{id:"197551",title:"Dr.",name:"Hatice",middleName:null,surname:"Abaoğlu",slug:"hatice-abaoglu",fullName:"Hatice Abaoğlu"},{id:"205199",title:"Dr.",name:"Sinem",middleName:null,surname:"Kars",slug:"sinem-kars",fullName:"Sinem Kars"},{id:"205200",title:"Dr.",name:"Zeynep",middleName:null,surname:"Celik",slug:"zeynep-celik",fullName:"Zeynep Celik"},{id:"205203",title:"Ms.",name:"Özge Buket",middleName:null,surname:"Cesim",slug:"ozge-buket-cesim",fullName:"Özge Buket Cesim"}]},{id:"62493",title:"Occupational Therapy in Forensic Settings",slug:"occupational-therapy-in-forensic-settings",totalDownloads:2547,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"It is necessary for a person to comply with the expectations of society and the rules of law to which these expectations are secured. Offenders turn back to the community after the penalty was executed by isolating from society and some occupations. An occupational imbalance is seen in the individuals, during this penalty period and afterward, because of limited occupational participation. As an occupational being, this affects their physical, mental and psychological well-being. Imprisonment is an important practice in criminal law to punish criminals. This may be necessary for the protection of society from criminals, but successful integration into a community after exiting the prison is the most important factor in preventing recidivism. Occupational therapy focuses on health and well-being by using meaningful and purposeful occupations. Occupation involves any activity that people perform or participate in, such as giving care to themselves or others, working, learning, playing games, and interacting with others. From this perspective, the role of occupational therapists in forensic settings is to determine the abilities of these individuals to congregate their deprived freedoms and use them to train them for an independent and autonomous life; to provide a professional orientation, career counseling, and self-esteem; to gain some habits for physical, spiritual and moral life and to reinforce.",book:{id:"6772",slug:"occupational-therapy-therapeutic-and-creative-use-of-activity",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Therapeutic and Creative Use of Activity"},signatures:"Esma Ozkan, Sümeyye Belhan, Mahmut Yaran and Meral Zarif",authors:null},{id:"70122",title:"Parkinson’s Disease Rehabilitation: Effectiveness Approaches and New Perspectives",slug:"parkinson-s-disease-rehabilitation-effectiveness-approaches-and-new-perspectives",totalDownloads:2085,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Parkinson’s disease has been considered one of the most important and common neurodegenerative diseases in the world. Its motor and nonmotor signs determine a huge functional loss, leading the individuals to lose their independence. Although the treatment requires a pharmacological approach, physical therapy has confirmed its importance in this process. Today, neurorehabilitation is indispensable to increase many of the cardinal signs of the disease. Using traditional or technological approaches, physical therapy has reached good results in improving motor and nonmotor functions, as well as the quality of life of Parkinsonians. However, it is important to develop and to fortify the physical therapy approach so that we can provide stronger evidence about our practice.",book:{id:"7543",slug:"physical-therapy-effectiveness",title:"Physical Therapy Effectiveness",fullTitle:"Physical Therapy Effectiveness"},signatures:"Luciana Auxiliadora de Paula Vasconcelos",authors:[{id:"98546",title:"Dr.",name:"Luciana Auxiliadora",middleName:null,surname:"De Paula Vasconcelos",slug:"luciana-auxiliadora-de-paula-vasconcelos",fullName:"Luciana Auxiliadora De Paula Vasconcelos"}]},{id:"62210",title:"Occupational Therapy’s Role in the Treatment of Children with Autism Spectrum Disorders",slug:"occupational-therapy-s-role-in-the-treatment-of-children-with-autism-spectrum-disorders",totalDownloads:2761,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Occupational therapists (OT) offer a wide range of therapies for individuals with ASD on the basis of specific deficits and difficulties. This chapter explores the role that OT plays, and the expertise, in relation to the interdisciplinary team. In addition, it discusses and presents empirical support for several therapeutic approaches commonly used by OTs working with individuals with ASD.",book:{id:"6772",slug:"occupational-therapy-therapeutic-and-creative-use-of-activity",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Therapeutic and Creative Use of Activity"},signatures:"Bryan M. Gee, Amy Nwora and Theodore W. Peterson",authors:null},{id:"55049",title:"Community Participation in People with Disabilities",slug:"community-participation-in-people-with-disabilities",totalDownloads:2440,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Despite the fact that participation is an important building and a valuable target, the conceptualization, identification and measurement methods vary widely. This chapter tried to gain an insider’s perspective from the obstacles that summarize what meaning participation means, how to characterize it, and what prevents and supports participation. Participation is seen as a right and a responsibility attributed to and attributed to both the person and the community. Participation does not take place in a vacuum; the environment dynamically influences participation. The effects of this conceptual framework are discussed for change at the level of evaluation, research and systems to support the participation of the people with disability.",book:{id:"5711",slug:"occupational-therapy-occupation-focused-holistic-practice-in-rehabilitation",title:"Occupational Therapy",fullTitle:"Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation"},signatures:"Gokcen Akyurek and Gonca Bumin",authors:[{id:"32431",title:"Prof.",name:"Gonca",middleName:null,surname:"Bumin",slug:"gonca-bumin",fullName:"Gonca Bumin"},{id:"197265",title:"Dr.",name:"Gokcen",middleName:null,surname:"Akyurek",slug:"gokcen-akyurek",fullName:"Gokcen Akyurek"}]}],onlineFirstChaptersFilter:{topicId:"198",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:11,numberOfPublishedChapters:91,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:333,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:11,numberOfPublishedChapters:144,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:126,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:23,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:13,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"August 17th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:11,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). In addition to a number of research articles, he has written two books, Computational Intelligence: An Introduction and Fundamentals of Computational Swarm Intelligence.",institutionString:null,institution:{name:"Stellenbosch University",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. 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He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. 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He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. 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He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. 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He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. 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He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"117248",title:"Dr.",name:"Andrew",middleName:null,surname:"Macnab",slug:"andrew-macnab",fullName:"Andrew Macnab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. 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The emergence of any viral disease is hard to anticipate, which often contributes to death. A viral disease can be defined as an infectious disease that has recently appeared within a population or exists in nature with the rapid expansion of incident or geographic range. This series will focus on various crucial factors related to emerging viral infectious diseases, including epidemiology, pathogenesis, host immune response, clinical manifestations, diagnosis, treatment, and clinical recommendations for managing viral infectious diseases, highlighting the recent issues with future directions for effective therapeutic strategies.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11402,editor:{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. 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Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}},editorTwo:null,editorThree:null,series:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188"},editorialBoard:[{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",institutionString:null,institution:{name:"Grenoble Alpes University",institutionURL:null,country:{name:"France"}}},{id:"188219",title:"Prof.",name:"Imran",middleName:null,surname:"Shahid",slug:"imran-shahid",fullName:"Imran Shahid",profilePictureURL:"https://mts.intechopen.com/storage/users/188219/images/system/188219.jpeg",institutionString:null,institution:{name:"Umm al-Qura 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