\r\n\tGeothermal energy is recognized as a potential renewable energy source, immense and practically inexhaustible, with a solid technological maturity, clean, versatile, and useful to generate electricity, among other multiple applications. However, as in any transformation process, environmental and social impacts cannot be excluded.
\r\n\r\n\tThis book will compile scientific research from geothermal areas where environmental and social issues have been successfully addressed as an example of social, environmental, and economic equilibrium. Based on participatory monitoring as a strategy for social acceptance or corporate responsibility from a deep-rooted environmental ethic that has become a social commitment. This natural resource is very complex therefore, environmental and social knowledge and experience are of great importance for its further sustainable development.
",isbn:"978-1-80356-999-4",printIsbn:"978-1-80356-998-7",pdfIsbn:"978-1-83880-282-0",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"339e74c3bcb3c7725a830d8b41278ca1",bookSignature:"D.Sc. Zayre Ivonne González Acevedo and Dr. Marco Antonio García Zarate",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11933.jpg",keywords:"Engineering Developments, Gas Filters, Reinjection, Cascade Uses, Environmental Monitoring, Greenfield, Brownfield, Environmental Indicators, Environmental Impact Assessment, Environment and Social Acceptance, Social Engagement, Corporate Social Responsibility",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 12th 2022",dateEndSecondStepPublish:"June 21st 2022",dateEndThirdStepPublish:"August 20th 2022",dateEndFourthStepPublish:"November 8th 2022",dateEndFifthStepPublish:"January 7th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Pioneer researcher in the analysis of the environmental, social, and economic impact of Mexican geothermal zones, with more than 15 years of experience, and awarded her Ph.D. degree from the University of Heidelberg.",coeditorOneBiosketch:"A researcher in the analysis of the total environment and its impact on society, with more than 40 years of experience in the field and awarded his Ph.D. degree from the Autonomous University of Baja, California.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"260177",title:"D.Sc.",name:"Zayre Ivonne",middleName:null,surname:"González Acevedo",slug:"zayre-ivonne-gonzalez-acevedo",fullName:"Zayre Ivonne González Acevedo",profilePictureURL:"https://mts.intechopen.com/storage/users/260177/images/system/260177.jpg",biography:"Chemical Engineer on Environment (Dec 98), Technological Institute of Toluca, Mex. Chemical Engineer Master of Process Integration (Sep 02), University of Guanajuato. Gto. Mex. Dr.rer.nat. magna cum laude Environmental Geochemistry (July 06), University of Heidelberg, BW, Germany. Sabbatical Stay (Sept 19 - 20), Department of Renewable Resources, University of Alberta, Canada. \r\nResearcher in the Department of Environmental Studies. National Institute of Nuclear Research, Mex. (Oct 07-Dec 11). Researcher Geology Department, Center of Scientific Research and High Education of Ensenada, Baja California (Jan 12 up today). \r\nResponsible Work Package 9, “Environmental, Social and Economic Impacts of Enhanced and Super-Hot Geothermal Systems” in the GEMex project, “International Cooperation in Research and Development between Mexico and the European Union in Geothermal Energy”. Responsible specific project 25, “Sustainable Development and Environmental Impact Assessment of three Geothermal Exploration Zones with Exploitation Potential in Mexico”.",institutionString:"Center for Scientific Research and Higher Education at Ensenada",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Center for Scientific Research and Higher Education at Ensenada",institutionURL:null,country:{name:"Mexico"}}}],coeditorOne:{id:"260179",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"García Zarate",slug:"marco-antonio-garcia-zarate",fullName:"Marco Antonio García Zarate",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRXp9QAG/Profile_Picture_2022-04-01T07:16:47.jpg",biography:'Course of "Technical Specialization in Optical Laboratorian" at the Applied Physics Department of CICESE, with a scholarship from CONACYT from July 1980 to July 1981. Industrial Engineer, Technologic Institute of Ensenada 2010. Master of Science in Arid Zone Ecosystem Management at the Faculty of Sciences of the UABC, scholarship from CONACYT (August 2013), obtaining Honorable Mention and Ph.D. in Environment and Development at the Institute of Oceanographic Research of the UABC, scholarship from CONACYT achieving Honorable Mention (October 2016), Scholar Merit awarded by the UABC Ensenada Baja California Unit; February 2017. Teaching classes and workshops at undergraduate, master\'s, and industry levels, participation in disciplinary and multidisciplinary projects.',institutionString:"Center for Scientific Research and Higher Education at Ensenada",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Center for Scientific Research and Higher Education at Ensenada",institutionURL:null,country:{name:"Mexico"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"11",title:"Engineering",slug:"engineering"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"444315",firstName:"Karla",lastName:"Skuliber",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/444315/images/20013_n.jpg",email:"karla@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"10198",title:"Response Surface Methodology in Engineering Science",subtitle:null,isOpenForSubmission:!1,hash:"1942bec30d40572f519327ca7a6d7aae",slug:"response-surface-methodology-in-engineering-science",bookSignature:"Palanikumar Kayaroganam",coverURL:"https://cdn.intechopen.com/books/images_new/10198.jpg",editedByType:"Edited by",editors:[{id:"321730",title:"Prof.",name:"Palanikumar",surname:"Kayaroganam",slug:"palanikumar-kayaroganam",fullName:"Palanikumar Kayaroganam"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"117",title:"Artificial Neural Networks",subtitle:"Methodological Advances and Biomedical Applications",isOpenForSubmission:!1,hash:null,slug:"artificial-neural-networks-methodological-advances-and-biomedical-applications",bookSignature:"Kenji Suzuki",coverURL:"https://cdn.intechopen.com/books/images_new/117.jpg",editedByType:"Edited by",editors:[{id:"3095",title:"Prof.",name:"Kenji",surname:"Suzuki",slug:"kenji-suzuki",fullName:"Kenji Suzuki"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3828",title:"Application of Nanotechnology in Drug Delivery",subtitle:null,isOpenForSubmission:!1,hash:"51a27e7adbfafcfedb6e9683f209cba4",slug:"application-of-nanotechnology-in-drug-delivery",bookSignature:"Ali Demir Sezer",coverURL:"https://cdn.intechopen.com/books/images_new/3828.jpg",editedByType:"Edited by",editors:[{id:"62389",title:"PhD.",name:"Ali Demir",surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"872",title:"Organic Pollutants Ten Years After the Stockholm Convention",subtitle:"Environmental and Analytical Update",isOpenForSubmission:!1,hash:"f01dc7077e1d23f3d8f5454985cafa0a",slug:"organic-pollutants-ten-years-after-the-stockholm-convention-environmental-and-analytical-update",bookSignature:"Tomasz Puzyn and Aleksandra Mostrag-Szlichtyng",coverURL:"https://cdn.intechopen.com/books/images_new/872.jpg",editedByType:"Edited by",editors:[{id:"84887",title:"Dr.",name:"Tomasz",surname:"Puzyn",slug:"tomasz-puzyn",fullName:"Tomasz Puzyn"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"65946",title:"The Role of Pulmonary Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis",doi:"10.5772/intechopen.84283",slug:"the-role-of-pulmonary-rehabilitation-in-patients-with-idiopathic-pulmonary-fibrosis",body:'\nIdiopathic pulmonary fibrosis (IPF) is a chronic disease that affects exclusively the lung, with an unknown etiology and a fast-progressive irreversible evolution, therefore disabling the adult. For most of the patients, the average survival is approximately 3–5 years from diagnosis [1, 2]. With an unpredictable but progressive evolution (slower, stable, or accelerated decline from patient to patient), the disease is characterized by a chronic presence of symptoms, specifically the exertional dyspnea, low tolerance to effort, and the deterioration of the quality of life [1, 2, 3, 4]. The diagnosis of the disease is often delayed and not reported until advanced stages [5]. A hope to halt the progression of the disease occurred with the demonstration of the reduction in the functional decline of the new pharmacological agents, pirfenidone and nintedanib, without claiming to cure the disease [1, 2, 3, 4, 5]. IPF remains a life-threatening illness in which the patient is fighting for survival as long as possible, striving to cope with the symptoms and the noticeable fatigue. Given that this is a fatal disease, some of the needs identified in patients with IPF and their families are easy access to information and IPF specialists, the existence of more treatment methods, emotional support, and access to end-of-life care [3].
\nThe indication of pulmonary rehabilitation (PR) for patients with IPF came from the positive results stemming from the exercise training program (ETP) in COPD. Thus, numerous clinical studies performed on patients with IPF proved that their health and wellness could be improved, at least for short periods, through ETP which are personalized and supervised by specialists [2].
\nPulmonary rehabilitation program (PRP) is an evidence-based recommendation for the non-pharmacological treatment of patients with chronic pulmonary diseases, especially for COPD, but also for interstitial lung diseases [1, 4]. PRP must be included in the integrative treatment of IPF, taking into consideration the severity of the disease, high mortality during exacerbations, a modest response to new drugs, and accelerated deterioration of lung function.
\nThe usual interstitial pneumonia (UIP) pattern (fibrosis with collagen and matrix deposition, the presence of fibroblastic foci and alveolar collapse, pulmonary heterogeneous architectural distortion and honeycombing presence) determines the main pathophysiological changes in IPF: loss of lung volume, decreased lung compliance, abnormal pulmonary gas exchange with oxygen diffusion limitation, low mixed venous oxygen content, circulatory impairments, and alveolar ventilation/perfusion (V′A/Q′) mismatching [6, 7].
\nPulmonary function tests reveal restrictive pulmonary dysfunction, indirect signs of increased elastic recoil, and decrease in diffusion capacity for carbon monoxide (DLCO). Pulse oximetry and arterial blood gases reveal hypoxemia initially only during exercise and, in advanced cases, as well during resting [2, 7]. Patients with IPF have reduced maximal or peak oxygen uptake (V’O2peak), peak work rate, and submaximal exercise endurance [7].
\nThe progressive installation of morphophysiopathological changes is reflected in the clinical symptoms of patients. The exertional dyspnea is the first and most important symptom of IPF patients. The more advanced the disease, the more severe the dyspnea is. The patients tend to be less physically active and more depressed [8]. The level of dyspnea is strongly correlated with the exercise capacity, the quality of life, and mortality [1, 8, 9]. Other associated symptoms are fatigue, dry cough, chest discomfort, and leg pain. These symptoms are mild or inconsistent at the beginning of the disease, but they get worse over time and lead to an impairment of daily activities [10]. Symptomology and physical inactivity are directly related to depression, quality of life (QoL), and increased mortality [10, 11].
\nConsequently, the most important mechanisms that limit effort capacity and change the IPF patient’s lifestyle, into a sedentary one, are inefficient breathing mechanics, abnormal pulmonary gas exchange, circulatory impairment, and exercise-induced hypoxemia [1, 7, 12, 13]. In time, progressive exercise-induced hypoxemia leads to respiratory and skeletal muscle dysfunction [1, 7]. Non-pharmacological interventions must take into account these mechanisms and create programs that seek to influence the patients’ outcomes positively. PR is a safe and effective non-pharmacological treatment [14].
\nThe official ERS/ARS statement define pulmonary rehabilitation as “Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors” [11].
\nPR decreases dyspnea, improves exercise capacity, and helps to cope with functional activities of daily life in IPF patients, even though the significance of these benefits is smaller and lasts for less time than in other chronic lung disease like COPD [15, 16, 17, 18, 19, 20].
\n\n
Decreasing symptoms, especially dyspnea
Increasing effort capacity
Enhancing the quality of life, health, and wellness
Improving muscle strength and endurance
Maintaining joint mobility
Increasing tolerance to physical activity with the improved cardiometabolic and respiratory profile
Improving well-being and cognitive functions
Decreasing depression and anxiety
Offer social and psychological support with the possibility of occupational and group therapy
Promoting pro-healthy behaviors, with decreasing effort deconditioning
The adaptation of pulmonary rehabilitation programs for IPF started from those applied to patients with COPD. It is advised to take into account the pathophysiology mechanisms particular to IPF and the clinical particularities of these patients. Patients have a respiratory pattern of frequent, superficial, and rapid breaths that worsen during exercise [7, 17, 18]. The frequent association of pulmonary hypertension (PH) aggravates the symptoms [1, 4]. An explanation for the positive results of PRP could be that repetitive ventilator stimulus during physical training sessions increases chest expansion and secondary pleural elasticity and pulmonary compliance while also improving V’A/Q‘ mismatch, increasing V’O2peak [13, 23]. Also, deep breathing exercises with stretching and the training of respiratory muscles, including the diaphragm, can help to reduce dyspnea [20, 23, 24].
\nBefore entering into a PRP, patients with IPF need to be assessed by the multidisciplinary team regarding clinical and functional status, imaging, effort tolerance, quality of life, physical activities of daily living (PADL), the presence of comorbidities, needs, and expectations from the pharmacological treatment. The evaluation of comorbidities such as coronary arterial disease, systemic and pulmonary hypertension, right and left ventricle dysfunction, and arrhythmias during exercise is critical. The additional impairment of the cardiovascular system decreases the effort capacity and worsens dyspnea and prognosis of patients [1, 2, 25]. This complex assessment also has the role in determining the type, intensity, and results of the PRP.
\nDyspnea is the most significant and disabling symptom for IPF patients. It can be objectively identified before, in the end, and at any time within PRP and can modulate the intensity of exercise. In studies targeting PR in IPF, dyspnea is quantified using one of the following scales:
\nThe
The
The
The
It was shown that there are correlations between clinical dyspnea rating and exercise capacity, exercised gas exchange and exercise capacity, and SGRQ in patients with IPF [26, 29, 36].
\nThe minimal clinical important significant difference (MCID) for 6MWD varies with the author, but a change of approximately 30 m is considered to be significant in IPF patients [32, 41, 44, 45].
\nIn patients with advanced IPF, it is not always possible to perform cyclo-ergometry. Volitional fatigue or increased oxygen desaturation (SpO2 < 80%) is quickly reached, and dizziness or mental confusion may also occur within 10–12 min of effort [48]. The incremental exercise testing shows decreased aerobic capacity (V′O2peak ~ 62% from predicted) and reduced maximal achievable workload in ILD. Other changes in IPF patients such as inefficient ventilation, desaturation, gas exchange abnormalities, circulator, and skeletal muscle dysfunction are reported [2]. These changes provoke a downward spiral of hypoxia, limited exercise capacity, deconditioning, shallow breathing pattern, and pulmonary hypertension [48].
\nHRCT is the essential method to diagnose IPF. If the HRCT shows a pattern of usual interstitial pneumonia (UIP), this being the most characteristic to IPF, then its presence avoids invasive procedure such as lung biopsy. In the last few years, radiation-free techniques, such as the lung ultrasound, appear to be very sensitive in detecting fibrotic change or monitoring disease progression [50]. Imaging on HRCT is important and significant before a PRP, but its rehabilitation benefits are not assessed according to the initial findings.
\nIn
The PADL level is positively influenced by supervised PRP that lasts at least 7–8 weeks.
\nThe
The
The
In muscle strength assessment, types of muscular impairment refer to mass (of different anatomical sites: biceps, triceps, etc.), strength, endurance, and performance [69]. Peripheral muscle force measurement may be important in PRP for understanding the impact of the disease on muscle mass, identifying patients at risk for physical impairment, and identifying those who can benefit from the prescription of an individualized resistance training program. Peripheral muscular dysfunction is a consequence of sedentary lifestyle, adopted by patients to avoid the symptoms and systemic effects of the disease (inflammation, hypoxemia, nutritional deficiency, corticosteroid side effects, electrolyte imbalances). Commonly, quadriceps muscle dysfunction is used for the assessment of peripheral muscle strength. The tests that are used may be volitional (volitional techniques: identification of the maximum weight that the patient can lift, manual muscle testing with MRC scale, or by dynamometers: handheld and computerized) or non-volitional (electrical stimulation of involuntary muscle contraction). The quadriceps maximal isometric voluntary contraction (QMVC) or predictive formulas (different equations for predicting quadriceps muscle strength) are described in literature, especially in studies on patients with COPD [70, 71, 72]. It is considered that patients have quadriceps muscle weakness if the value is <80% of predicted [73]. Knee extensor and elbow flexor strength could be measured with handheld dynamometer [69].
\n\n
Basal value <250 m correlates with twofold increase in mortality, and if it is less than 207 m, patients have a more than fourfold greater mortality rate.
A decrease of SpO2 < 88% during 6MWT is marker for increased mortality.
A decrease in the walking distance within 6 months, greater than 50 m, would increase the mortality rate by three times.
A delayed heart rate return in 1 minute after the end of the 6MWD test and a variation <13 beats/min are strongly correlated with increased mortality.
IPF patients are highly sedentary, having a daily physical activity level which is 35% lower than healthy sedentary controls.
A value under 3.287 steps/day on accelerometers was associated with a poorer prognosis and three times higher risk for death for IPF patients.
Peripheral muscle dysfunction related with a decrease of the physical activity level of daily life and exercise limitation is associated with reduced survival.
PRP for IPF patients include several types of exercises, such as aerobic, resistance, flexibility, balance training, and respiration technique. Their selection is based on the everyday lifestyle of each patient, preferences, disease severity, and the advantages of where the PRP will take place:
“Inpatient” rehabilitation centers are a more appropriate method for the supervised exercise programs taking into account the symptoms and the risk of severe effort desaturation that may occur. The advantage is that during exercise sessions, patients are monitored for blood pressure, heart rate, SpO2, and symptoms, and the urgent treatment is available in case of complications [79, 80].
“Outpatient”-based programs take place in the patient’s home under the assistance of a healthcare professional with expertise in exercise training.
Combined programs start in a specialized structure and continues at home after the patients are familiar with the type and intensity of exercise [83].
PRP includes physical training, patient education, and nutritional and psychological support [11]. Regardless of the type of PRP, it is beneficial to start it as soon as possible. We will keep in mind that the intensity of rehabilitation depends on the severity of functional impairment and is personalized to each patient. The physical therapist starts from breath retraining and relaxing postures which increase chest expansion and relax the inspiratory muscles (Jacobson, Schultz technique). They reinforce proper breathing patterns (diaphragm) and include exercises that tonify respiratory and skeletal muscle (endurance and resistance) in order to increase patients’ exercise capacity [2].
\nThe main objective of these training programs is teaching patients how to perform a series of structured and repetitive exercises that improve or maintain their physical fitness and decrease the respiratory discomfort [82].
\nEducating patients about pursuing an active lifestyle even in the presence of IPF should be based on information about the types of exercises that can be performed, the regularity and duration of each session, and general instructions on how and what to follow through the program. During the follow-up with their patients, the doctor may be confronted with various questions, doubts, and anxiety from the patients. In the early stages of the disease, when the symptoms are not disabling, the patient’s motivation to follow a PRP is low. In advanced stages, the motivation is stronger because dyspnea limits exercise capacity and daily activities. According to several studies, the PRP with greatest benefits have 6–12 weeks programs, with 2–3 sessions per week of 30 minutes duration. The exercise intensity is determined by patients’ walking speed on 6MWD (starting at 70–80%), or by the maximum workload on cycle ergometer test (50–60% or more of peak WR on CPET for cycling), maximum heart rate (up to 80%), or on the intensity of symptoms on the Borg scale (to reach a score above 5–7). The effort intensity can also be calculated from an average heart rate ± 5 beats, obtained in the last 3 minutes of the effort test [2, 21, 33, 84].
\nA comprehensive training program should include several types of exercises: breathing and balance exercises, aerobic, endurance, and flexibility (stretching) [2, 12, 20, 33, 84].
\nFor increasing the endurance to effort, aerobic exercises can be used to train different muscle groups, depending on the patients’ preferences and physical resources. Aerobic exercises can include walking, stair climbing, treadmill walking, leg cycling, semi-recumbent cycling, or step climbing on an ergometer adapted for lower limbs [16]. Resistance training refers to the increase in muscle strength and can be achieved by performing repeated exercises for upper and lower limbs, arm raising, knee-extension, sit-to-stand, and strength training using elastic bands. In these types of exercises, the muscles work against an external force applied by a device from the physiotherapy room or against their own body weight. They can also use weights. These exercises are grouped in 2–4 sets, with 10–15 repetitions, followed by breaks of 45–60 s. Each set of exercises targets specific muscle groups [85]. These exercises are recommended due to the fact that IPF patients have reduced muscle mass, strength, and endurance, compared with healthy subjects. They develop atrophy and muscle weakness, especially in lower limbs [86, 87]. Stretching exercises are activities designed to maintain or increase joint mobility and muscle relaxation. Strength training targets major muscle groups of the upper and lower body. There is a wide range of exercises that could be applied by physiotherapist [88]:
Shoulder wheel
Multiple movements of shoulder by changing his position as abduction, externally rotates the shoulder, flexion, and extension
Sitting or standing biceps curls
Mid-back rowing
Shoulder flexion or extension
Sitting or standing chest presses and triceps extensions
Lower body exercises: standing hip abduction and extension
Seated knee flexion and extension
Internal and external rotations of the abducted shoulder with the elbow flexed 90 degrees
Wall push-ups
Chair squat
Dumbbells shoulder press
Dumbbells biceps curls
Dumbbells arm extension
Abdominal curl-ups
Seated single leg hamstring stretch
Standing quadriceps stretch
Chest stretch
Overhead reach stretch and wall cat stretch
For strength training there are three types of therapeutic bands that can be used: yellow, followed by red, and then green.
\nRespiratory muscle training or breathing exercises are extremely important, especially for patients with advanced disease, because they focus on diaphragm training, by teaching patients abdominal breathing techniques [79, 89].
\nThere are no strictly standardized protocols for the PRP, allowing an experienced physiotherapist to tailor the patient’s training structure in order to maximize the benefits.
\nThe structure of a rehabilitation program should be seen as a multistage process:
Firstly, the patient learns different types of exercise and different techniques, which can be divided into four categories (aerobic, endurance, flexibility, and breathing). Their intensity should be adapted to the severity of patient’s pulmonary impairment, typically 50–60% of the work peak rate for aerobic exercise and 70–80% of the walking speed in 6MWT for endurance exercises (bicycle, treadmill, walking). The program can start with breathing exercises or balance training, continued by aerobic exercise and resistance training. Exercises should primarily focus on increasing the strength and the muscle mass of the lower limbs and diaphragm. The interval technique can also be used, allowing the patient to rest between exercises. In patients who experience desaturations (SpO2 < 85%) during training, oxygen supplementation should be considered in order to maintain SpO2 above 88% [21]. During a program of 2–3 sessions/week, for 4–6 weeks, under the supervision of a physiotherapist, a patient can learn and become adequately trained to pass into the second phase.
In the continuation and improvement phase, subjects can progressively increase both the frequency (3–4 times/week), duration, and intensity of the sessions. The aerobic program can be extended to 20–50 min and can be performed at an intensity of 60–85% of the work peak rate. The resistance training can last between 20 and 30 min, with an intensity of 80–100% from the average walking speed obtained in the 6MWD test. Also, the programs recommend including 10–15 min of stretching and a minimum of 5 min of diaphragmatic or pursed lip breathing [90].
The maintenance phase is important for preserving the benefits of a PRP, for decreasing the anxiety and depression level, and for increasing the quality of life. It is recommended to maintain the types and the intensity of exercises that will lead to a level of fatigue between 5 and 7 on the Borg scale.
Each patient should be reassessed at 3–6 months, in terms of effort tolerance, quality of life, disease progression, and response to pharmacological treatment.
\nIn brief, a supervised training program for patients with IPF should recommend:
4–6 weeks, 2–3 sessions/week
Aerobic effort 20–40 min
Stretching 10–15 min
Breathing techniques 5–10 min
Adjusting the work intensity so it can be tolerable for the patient
Oxygen supplementation for patients who desaturate (SpO2 85–88%)
Intervals between exercises allowing better oxygenation
Patient reassessment at the end of the 6 weeks
In a comprehensive PRP, patient’s education begins from understanding the patient’s needs and providing detailed information regarding the nature and expected course of the disease, solutions for symptoms management, benefits and side effects of treatments (depression, anxiety, obesity, diabetes, cardiovascular disease), the indication of oxygen supplementation, energy conservation techniques, relaxation and recreation methods, stress management, coping techniques for anxiety and depression, smoking cessation, and solutions for the improvement of quality of life. Medical education sessions usually precede exercise training sessions. This will be individualized for each patient, ensuring optimal communication between the patient and the multidisciplinary team. Educational assessment begins with the identification of difficulties, focusing on the change of the health-related behavior. Goals need to be established in the short, medium, and long term, to increase the patient’s motivation to follow a PRP. Educational therapy plays a role in the relief of symptoms and quality of life improvement, optimizing the benefits of a PRP [11].
\nNutritional support refers to weight control and a balanced diet, with obesity or weight loss being associated with a poor prognosis. Adipose mass can be evaluated pre- and post-PR, using different skinfold calipers for the analysis of body composition by skinfold thickness measurements [91].
\nDue to the life-threatening course of the disease, the psychological support should be considered for each patient. The dialog among the patient, the patient’s family, and healthcare professionals can decrease the depression and anxiety in more than 50% of ILD patients [56].
\nStudies conducted support the beneficial effects of PR programs, at the end of which patients with IPF present [15, 19, 33]:
Improvement in functional capacity
Improvement in 6MWD results over SMD: 35.63 m (95% CI 16.02–55.23 m)
Improvement in V′O2 peak at 6WMD 1.46 mL/kg/min−1 (95% CI 0.54–2.39 mL/kg/min−1)
Increased physical activity levels (IPAQ)
Significant reduction in dyspnea: SMD −0.68 (95% CI −1.12 to −0.25)
Improvement in wellness and health-related quality of life, especially for those with severe disease SMD 0.59 (95% CI 0.14–1.03)
Increased muscular fitness
Quality of the evidence regarding the impact of PR programs in IPF patients after Dowman et al. [15]:
Change in 6-min walk distance—moderate ⊕⊕⊕⊝
Change in V′O2 peak uptake at cardiopulmonary exercise test—low ⊕⊕⊝⊝
Change in maximum ventilation cardiopulmonary exercise test—low ⊕⊕⊝⊝
Change in dyspnea score MMRC Dyspnea Scale—low ⊕⊕⊝⊝
Change in quality of life CRDQ (total score)—low ⊕⊕⊝⊝
Month survival—low ⊕⊕⊝⊝
A follow-up was performed 8–12 weeks after end of rehabilitation.
\nThe review used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) to evaluate the study results: “Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate” [15].
\nThe increase in effort capacity is directly related to training frequency, three to five sessions per week being optimal and fewer than two sessions being unlikely to produce meaningful change [92].
\nIt is considered that a PR has been beneficial if there has been an increase of more than 50 m at 6MWD test (31–81 m gained in PR in different clinical trials) and a minimum amount of physical activity at 200 METS-min/week [10 min × 4METS (moderate intensity in the IPAQ questionnaire) × 5 times/week. Longer programs and more frequent sessions (12 or more) appear to have a greater benefit; however these benefits can be lost after 3–6 months, if the training does not continue and patients fail to maintain an active lifestyle [11]. There are discrepancies in the outcome of the studies, in patients who have undergone a pulmonary rehabilitation program, discussing the responder or non-responder label depending on whether or not the walking distance of 6MWD or V′O2 has improved. Non-responders are considered patients whose result of 6MWT did not rise above or equal to 30 m after PR (30 m considered as MCID) [93]. Also, the responders had FEV1 and TLC raised after the rehabilitation program and significantly increased V′O2 peak, carbon dioxide output (VCO2), and minute ventilation (VE) in the 6MWT post-PR test, while non-responders showed greater desaturation during exercise [93].
\nThe different results of the studies can be explained by:
Training programs with differences in intensity, duration, and type of administration (inpatient/outpatient, supervised/unsupervised)
Small numbers of participants
Methodological limitation: methods of randomization (uncontrolled studies or nonrandomized, unblinded study)
Limitations of retrospective studies
Different control batches (other types of ILD, sham, etc.)
Patients entering PR at different stages of severity
Inclusion and exclusion criteria
No follow-up data after exercise training
Different outcomes
Conforming to the International Society for Heart and Lung Transplantation (ISHLT), this pulmonary transplantation is performed for a variety of advanced lung diseases, IPF, together with COPD, being the most common indication. However, in posttransplant survival, IPF is associated with the worst prognosis. For patients with IPF, transplantation and supplemental oxygen were the only treatments strongly recommended by the latest ATS consensus document. A transplant discussion is recommended from the moment the positive diagnosis is confirmed due to low survival [94, 95].
\nMedical and surgical interventions in transplants have progressed in the last few years. All of these lead to a changing demographic of patients undergoing lung transplantation, including older subjects with multiple comorbidities, respiratory failure, and even those who require bridging to transplantation [95]. To ensure a high rate of posttransplant survival, both in the short and long term, these patients must be physically and psychologically trained for this complex process. PRP plays an essential role in pulmonary transplantation, both by optimizing physical function prior to surgical intervention and by facilitating posttransplant recovery. Although these PRP are mandatory in most transplant centers, to date there is no international pulmonary rehabilitation guideline for this patient category [95].
\nPhysiotherapists working with lung transplant candidates and recipients need expertise both in general exercise training principles and in pre- and posttransplant rehabilitation, complications, oxygen titration, and side effects of medications. They should be able to adapt exercise programs according to the lung function changes and according to episodic illnesses (exacerbation) [95, 96].
\nPrior to transplant, patients should attend PRP and benefit from exercise training, aerobic, resistance, and flexibility, with or without oxygen support, in the tolerance limit. In early posttransplant period, mobility is advised even in ICU and in acute hospitalization, for the progression to independent function (transfers, walking, self-care, climbing stairs). In the next phase (1–6 month), they should gradually perform balance training, aerobic, resistance, and flexibility exercises, as tolerated. Oxygen can be supplemented to support exercise. In the long term (>6 months), patients should be included in home and community PR programs for maintaining and improving the benefits of this intervention [96]. All these aspects are the premises for a better prognosis and lower costs for the healthcare system.
\n\n
A multidisciplinary team that includes a respiratory specialist and a clinical psychotherapist should manage and supervise the inclusion in a PR program of patients with IPF and the structure and monitoring of the patients’ exercise training sessions.
In patients with severe IPF, it is preferred that programs are held in the hospital. In case programs are held at patient’s home, then high-intensity exercises that could lead to desaturation and worsening of symptoms should be avoided.
For long-term benefits, three to five sessions per week for a minimum of 6 weeks are optimal, less than two sessions being unlikely to produce significant change [92].
Initially, the interval training method is preferred, and in time, the duration of the exercises can be increased. A break and rest are mandatory when excessive fatigue and dyspnea appear [12].
The overall load increases gradually according to patient’s tolerance, the intensity of effort being adjusted to patients’ fatigue tolerance.
Additional oxygen can be used during exercise as it allows for an increased endurance and intensity of exercise levels [1].
Factors such as self-motivation, fear of adverse events, or comprehension may affect the ability to tolerate exercise training.
The pulmonary rehabilitation has become a clear indication as a non-pharmacological therapy for patients diagnosed with IPF. The benefits of pulmonary rehabilitation programs are reduced respiratory symptoms, especially dyspnea, and increased exercise tolerance and level of physical activity. All these lead to a lower level of anxiety and depression and therefore increased quality of life. These benefits are sustained in short term, 3–6 months. They can be maintained for a longer period if the patient has a responsible behavior and an active lifestyle.
\nThis is a brief overview of the main steps involved in publishing with IntechOpen Compacts, Monographs and Edited Books. Once you submit your proposal you will be appointed a Author Service Manager who will be your single point of contact and lead you through all the described steps below.
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In this context, this chapter presents key subjects while implementing a quality management system at materials science laboratories and some considerations on strategies for effectively implementing such systems.",book:{id:"5486",slug:"quality-control-and-assurance-an-ancient-greek-term-re-mastered",title:"Quality Control and Assurance",fullTitle:"Quality Control and Assurance - An Ancient Greek Term Re-Mastered"},signatures:"Rodrigo S. Neves, Daniel P. Da Silva, Carlos E. C. Galhardo, Erlon H.\nM. Ferreira, Rafael M. Trommer and Jailton C. Damasceno",authors:[{id:"20571",title:"Prof.",name:"Erlon H.",middleName:null,surname:"Martins Ferreira",slug:"erlon-h.-martins-ferreira",fullName:"Erlon H. 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The quality practices or quality management systems adopted by industries will further evolve due to the changes of quality concepts as time goes by. This chapter discusses the change of quality concepts and the related revolution of quality management systems in the past century. The quality concepts were gradually changed from the achievement of quality standards, satisfaction of customer needs, and expectations to customer delight. Since merely satisfying customers is not enough to ensure customer loyalty, the enterprises gradually focus on customers’ emotional responses and their delight in order to pursue their loyalty. The emotion of “delight” is composed of “joy” and “surprise,” which can be achieved as the customers’ latent requirements are satisfied. Thus, the concept of “customer delight” and the means to provide the innovative quality so as to meet the unsatisfied customers’ latent needs are elaborated on. Finally, a framework of innovation creation is developed that is based on the mining of customer's latent requirements. This outline will manifest the essential elements of the related operation steps.",book:{id:"5486",slug:"quality-control-and-assurance-an-ancient-greek-term-re-mastered",title:"Quality Control and Assurance",fullTitle:"Quality Control and Assurance - An Ancient Greek Term Re-Mastered"},signatures:"Ching-Chow Yang",authors:[{id:"11862",title:"Prof.",name:"Ching-Chow",middleName:null,surname:"Yang",slug:"ching-chow-yang",fullName:"Ching-Chow Yang"}]},{id:"62915",title:"Advanced Methods of PID Controller Tuning for Specified Performance",slug:"advanced-methods-of-pid-controller-tuning-for-specified-performance",totalDownloads:3528,totalCrossrefCites:12,totalDimensionsCites:18,abstract:"This chapter provides a concise survey, classification and historical perspective of practice-oriented methods for designing proportional-integral-derivative (PID) controllers and autotuners showing the persistent demand for PID tuning algorithms that integrate performance requirements into the tuning algorithm. The proposed frequency-domain PID controller design method guarantees closed-loop performance in terms of commonly used time-domain specifications. One of its major benefits is universal applicability for both slow and fast-controlled plants with unknown mathematical model. Special charts called B-parabolas were developed as a practical design tool that enables consistent and systematic shaping of the closed-loop step response with regard to specified performance and dynamics of the uncertain controlled plant.",book:{id:"6323",slug:"pid-control-for-industrial-processes",title:"PID Control for Industrial Processes",fullTitle:"PID Control for Industrial Processes"},signatures:"Štefan Bucz and Alena Kozáková",authors:[{id:"21933",title:"Ms.",name:"Alena",middleName:null,surname:"Kozakova",slug:"alena-kozakova",fullName:"Alena Kozakova"},{id:"213658",title:"Dr.",name:"Štefan",middleName:null,surname:"Bucz",slug:"stefan-bucz",fullName:"Štefan Bucz"}]},{id:"75699",title:"Data Clustering for Fuzzyfier Value Derivation",slug:"data-clustering-for-fuzzyfier-value-derivation",totalDownloads:302,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The fuzzifier value m is improving significant factor for achieving the accuracy of data. Therefore, in this chapter, various clustering method is introduced with the definition of important values for clustering. To adaptively calculate the appropriate purge value of the gap type −2 fuzzy c-means, two fuzzy values m1 and m2 are provided by extracting information from individual data points using a histogram scheme. Most of the clustering in this chapter automatically obtains determination of m1 and m2 values that depended on existent repeated experiments. Also, in order to increase efficiency on deriving valid fuzzifier value, we introduce the Interval type-2 possibilistic fuzzy C-means (IT2PFCM), as one of advanced fuzzy clustering method to classify a fixed pattern. In Efficient IT2PFCM method, proper fuzzifier values for each data is obtained from an algorithm including histogram analysis and Gaussian Curve Fitting method. Using the extracted information form fuzzifier values, two modified fuzzifier value m1 and m2 are determined. These updated fuzzifier values are used to calculated the new membership values. Determining these updated values improve not only the clustering accuracy rate of the measured sensor data, but also can be used without additional procedure such as data labeling. It is also efficient at monitoring numerous sensors, managing and verifying sensor data obtained in real time such as smart cities.",book:{id:"9976",slug:"fuzzy-systems-theory-and-applications",title:"Fuzzy Systems",fullTitle:"Fuzzy Systems - Theory and Applications"},signatures:"JaeHyuk Cho",authors:[{id:"329648",title:"Prof.",name:"JaeHyuk",middleName:null,surname:"Cho",slug:"jaehyuk-cho",fullName:"JaeHyuk Cho"}]},{id:"39778",title:"GPS and the One-Way Speed of Light",slug:"gps-and-the-one-way-speed-of-light",totalDownloads:3501,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"2387",slug:"new-approach-of-indoor-and-outdoor-localization-systems",title:"New Approach of Indoor and Outdoor Localization Systems",fullTitle:"New Approach of Indoor and Outdoor Localization Systems"},signatures:"Stephan J.G. 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The fact that each component of the function has different effects requires assigning different weight coefficients to these components. In this study, the Bees Algorithm (BA) is used to determine the weights. Using the multi-objective function in BA, it has been tried to determine the weights that reduce the current values together with the speed error. Three different PI controllers have been designed to compare the MPC method. The coefficients of one of these are tuned with BA. Good Gain Method and Tyreus-Luyben Method were used in the other two. As a result of experimental studies, it has been observed that MPC can control PMSM more smoothly and accurately than PI controllers, with weights optimized with BA. 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However, control strategies that use forecast modeling to estimate future CV values and use them in the feedback error have the potential to control as well as a feedback controller with no MV deadtime using the measured value of CV. This work evaluates and compares FBC algorithms using discrete-time forecast modeling when MV has a large deadtime. When a feedforward control (FFC) law results in a physically unrealizable (PU) controller, the common approach is to use approximations to obtain a physically realizable feedforward controller. Using a discrete-time forecast modeling method, this work demonstrates an effective approach for PU FFC. The Smith Predictor is a popular control strategy when CV has measurement deadtime but not MV deadtime. The work demonstrates equivalency of this discrete-time forecast modeling approach to the Smith Predictor FBC approach. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. 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. 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The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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