The ‘central eight’ criminal risk variables.
\r\n\tThe WHO classification in 2007; was based on the histogenesis and cell origin of the tumor. In the latest classification made in 2016; to better characterize the tumor and obtain better data on its prognosis; The combination of molecular and genetic biomarkers and histopathological features of the tumor was used. Despite all current treatment approaches, the median survival time is around 12 months in most GBM patients. Compared with the situation of some types of successfully treated cancers; the survival time of GBM patients is not at an acceptable level today. In the treatment of CNS tumors; surgery, chemotherapy, and radiation treatments (x-rays, gamma rays, electron and proton beams) are used. The therapeutic potential of chemotherapy; New strategies are needed to increase drug concentration at the diseased site, as this largely depends on the ability of the chemotherapeutic agent to achieve effective concentrations at tumor localization. Based on our better understanding of the genetic and molecular characteristics of CNS tumors; Targeted therapies, including vaccines, and treatment protocols such as immunotherapy are promising developments.
\r\n\r\n\tThis book supposes to be written by many authors who have an internationally honored place in their field to share their ideas about the treatment of CNS tumors. Surgery, Radiotherapy, Chemotherapy and Antiangiogenic Therapy Protocols, Immunotherapy, Molecular Therapy, Specific target-agents therapy with Nanoparticles and Gene Therapy for CNS tumors among the book chapters.
\r\n\tIn these sections; there are many practical pieces of information that can help the students who graduated from the Medicine Faculty and specialist doctors who are interested in Neurosurgery.
Human is a social being, which occupies in different ways to survive. Occupations are all of the daily activities in one’s life that make him who he is. Occupations are formed by cultural backgrounds and include all the tasks performed to fulfill the time and give life meaning. Occupational therapy is a treatment option for individuals with physical, mental or developmental conditions that focus on health and well-being by using meaningful and purposeful occupations for individuals for the development, improvement or maintenance of the essential skills needed to be successful in their environment [1].
\nForensic occupational therapy refers the occupational therapy service that assesses and makes interventions to the individuals with occupational problems in the criminal justice system [2]. The forensic settings can be variable and be challenging, but the main point here to pay attention is the holistic and humanistic view of occupational therapy which says that occupation is vital for human and is essential for health and well-being. From this view, forensic occupational therapy is the same as the mental health occupational therapy practice in some ways [3]. The main difference is the legal context and the restrictive correctional environment. The legal context is usually built upon deprivation of some occupations, and this alienates the individual to the occupation. Also, labeling and stigma affect reintegration to the community [4].
\nIn terms of the individual, occupational therapy is an important necessity for occupational participation and occupational balance. With these, occupational therapy prepares the person for community life and protects the individual from recidivism [5]. This is not the sole benefit of occupational therapy. Also, there are benefits for the community; reducing crime provides social well-being and also increases social welfare by contributing to the individual’s productivity activities, so that, forensic occupational therapy has dual aim both for the individual and the community.
\nThe forensic population is growing all over the world and brings challenges with this growing population [5, 6, 7, 8]. These challenges can depend on the person, environment and/or activity. The thing that should never be ignored is the legal context, and the therapists must consider the needs of individuals in the legal context [9].
\nOffenders’ rehabilitation is a multidisciplinary teamwork, and occupational therapy is a key part of the treatment and rehabilitation. The methods are similar to other mental health settings. The key focuses for the occupational therapists working in forensic settings are assessment, prevention of occupational deprivation, development of occupations to prevent recidivism, preparation for discharge and activities of daily living (ADLs), preparation to community and the vocational rehabilitation.
\nThis chapter describes the occupational therapy in forensic settings such as prisons, secure hospitals and community reintegration services. The chapter also discusses the assessments, models that can be used in forensic settings, interventions and challenges in forensic settings.
\nCorrectional administration is the reinstatement and retraining of a person’s antisocial behavior and feelings through confinement for treatment purposes. Correctional settings regulate the individual’s psychosocial status and provide health care service for the prisoners [10].
\nCorrectional settings are a way to facilitate the mental health recovery of the inmates. Since, many of the inmates have serious mental disorders, the forensic unit, of the correctional facility, plays an important part in their recovery. The unit reduces the risk associated with the inmates and facilitates their transition into the community or less restricted settings. However, the same results could be achieved with occupational therapists. The two main methods that are adopted by occupational therapists (OTs) are the reduction of occupation deprivation and increasing skills by occupational participation. Hence, the inmates are provided with an opportunity to play a purposeful and meaningful occupation in society [3].
\nPatients, who are admitted to the forensic units and get in contact with the criminal justice system as a consequence of their committed crimes, are detained in accordance with the country-specific mental health legislation. However, some patients are admitted due to severe behavioral issues.
\nThere are several types of correctional settings where charged offenders are held. The main institutions are forensic mental health settings, jails and prisons. Forensic mental health settings include the following: high secure units, medium secure units, low secure units, psychiatric/acute mental health units, community, forensic hostel, special hospital, acute unit of a forensic hospital, high-security section of a forensic hospital, sub-acute unit of a forensic hospital, consultation/liaison position in the community sector, tertiary mental health facility, extended forensic/psychiatric safe care and medium to high secure unit [11].
\nJails and prisons are the main correctional facilities since they are able to hold the greatest number of people. There are approximately 12 million jail admissions, which is approximately 19 times that of state and federal prisons [12].
\nJails and prisons served for different purposes; have restricted opportunities for rehabilitation; offer a similar grade of occupational deprivation, inadequate access to health services and poorly planned methods; are temporary in nature and lack systematic regulation and resources [13].
\nJails and prisons provide care for mentally disturbed offenders in ill-equipped correctional institutions. In particular, jails are used for temporary confinement and are usually lacking in mental health screenings and treatment received by inmates in jails is more limited. Prisons, however, might offer inmates the opportunity to access consulting service for substance abuse treatment even though the service delivery is generally insufficient [14].
\nJails serve as an introduction to the incarceration system. They are local correctional facilities operated by a city or country instead of the federal or state government. The main purpose of jails and prisoner distribution centers is to confine a person before and after court judgments and to filter prisoners to and from courts and other correctional facilities. Some people in jails have been sentenced, while others might be waiting to be convicted. Many individuals receive an imprisonment of less than 2 years [3].
\nJudgment is mostly a complex process of sentencing. In this respect, inmates in forensic settings might either be arraigned or experiencing the trial process.
\nPrisons are classified as high, medium and low security institutions that are typically used for convicted criminals who have been sentenced to at least a year of imprisonment in U.S. Federal Bureau of Prisons. In addition, depending on the severity of the crime, some individuals are sentenced to either state or federal prisons. However, compared to jails, prisons offer a far more stable environment for the inmates and restrict their interaction with society for longer periods of time [3].
\nThe primary purpose of prisons is to ensure public safety and the security of inmates. In addition to incarcerating criminals, prisons offer them programs to address their criminogenic needs related to education, substance abuse, employment and transition to the community.
\nBasic services in prisons involve intake and screening of psychotropic medicines and to provide occupational therapy services. Those services are substantially provided for prisoners to decrease their social isolation and increase their problem solving and adaptation skills, self-efficacy and self-esteem. The occupational therapy services also promote emotional regulation abilities and social and emotional skills in order for the inmate to deal with prison life and take this opportunity to improve on self-efficacy and occupational engagement [15].
High-security units: Individuals classified as high risk to public safety have been sentenced to life imprisonment and are receiving long term treatment, are housed in high-security prisons. The physical environment in these facilities consists of a number of physical and structural barriers between the facilities and the external environment of the institution.
In high-security prisons with highest number of staff, and both multiple and single cells, criminals remain in their cells or in an outer cage in the facilities’ yard. Each cell is equipped with a toilet, screwed to its floor, and prisoners are permitted up to three 10-min showers per week. Movement is firmly restricted and activity within the cellblock does not occur without other constraints, such as handcuffs, leg irons and corrective officer escorts [3]. Orientation can be considered as essential because it gives the staff the chance to be acquainted with the prisoners. The ward program focus areas, such as improving awareness of self, others and the environment; orientation to time, place and situation; probing cognitive abilities and teaching of new skills to improve leisure time use and psychomotor activation, should be maintained after discharge [16].
Medium-security prisons: Those institutions house individuals with a criminal background and requiring 2–5 years of treatment [17]. Medium-security prisons, where prisoners’ accessibility to prison gardens and exercise areas, libraries, showers and health services are high, offer far more opportunities in terms of interaction, movement and activity in-between prisoners [3]. Medium-security prisons usually have a wide diversity of work-oriented and treatment programs. Parole is more frequently granted in medium-security prisons and may be classified as supervised (always less than 1 h), limited (sent to wards for only 1 or 2 h), occupational therapy parole (join structured activities or subcontract work) and unlimited parole (mostly on weekends and during the week when they do not join specific rehabilitation activities).
Patients included in the rehabilitation process are integrated into community life by developing intellectual and emotional insight, self-care and self-expression skills and general work abilities. Furthermore, providing stress and anger management, psychoeducation and prevention programs for substance abuse in psychoeducation groups facilitates the patients/inmates return to society [16].
Low-security prisons: These facilities have windows and open spaces that allow the prisoners to move and interact freely within the environment. Even though low-security prisons are surrounded by double-rings, they have no prison fences or other secured perimeter and are often unpatrolled by armed guards. Since the inmates might work on agriculture, transport or conservation projects, they can provide training to the prison’s staff; in addition to meeting the labor force needs of other institutions [3].
In open wards (low or minimum-security prisons), during the therapeutic leave and discharge periods, greater priority is given to preparation of patient participation. Patients are expected to adhere to hospital rules and regulations, but are allowed to freely leave their wards and take the opportunity to practice skills acquired in the medium secure wards and joining educational training programs outside the health services [3].
The intensive life skills training program is comprised of communication, conflict management and criticism handling, problem-solving, money handling (budgeting, current price trends) and work-related skills (job seeking, application for a job, writing of curriculum vitae, work interviews through the use of role play). In addition, recreational activity program, and specific work skills-related programs are implemented to enhance psychosocial interactions [15, 16].
\nForensic psychiatric settings are generally located in secure units that rehabilitate individuals deemed unfit to stand trial or not criminally responsible. Those inmates pose a serious threat to either themselves or others because of severe mental illness. A forensic psychiatric setting provides treatment-based approaches with a view to rehabilitating patients while keeping the public safe. Patients, temporarily transferred from correctional facilities or incarcerated environment, are assessed and treated for mental illness in the facility that consists of secure, closed and open common units [17].
\nForensic psychiatric hospitals reintegrate patients systematically into the community with well-equipped and specialized clinical services, as well as an exhaustive range of vocational and rehabilitative programs. Treatment is typically long-term, in order to improve and safely stabilize patients’ mental well-being.
\nReentry centers are facilities that help inmates by offering structured and supervised residential settings just before or after their release. In addition to providing a permanent residence to the individuals, assistance in financial management and facilitating, their return to the society is also arranged. These centers might be especially useful, because the psychological adaptation required for offenders, with expansive criminal histories, returning to the community after a long period of imprisonment, can be particularly demanding.
\nA crucial component of community reentry centers is substance abuse management and mental health treatment and counseling. Growing prison populations are largely due to drug-related crime and drug abuse, but relatively few prisoners receive the appropriate treatment. In this respect, community-based correctional settings have launched out prison-based drug treatment programs during the past few years [3].
\nThere are two main models of psychology about correctional treatment. The risk, need and responsivity model (RNR model) was built up by Andrews and Bonta, and they describe the criminal risk variables named ‘central eight’ (Tables 1) [18]. Good lives model (GLM) is the other model which claims, that rather than addressing criminogenic needs, the focus of treatment should be on the enhancement offenders’ abilities to obtain primary human goods [19]. Purvis describes 11 primary human goods (Tables 2) [20].
\nThe ‘central eight’ criminal risk variables.
The ‘primary human goods’.
If it is examined the models, both are similar, but RNR Model is based on cognitive-behavioral and the GLM is based on humanistic philosophy. The GLM identifies 11 ‘primary human goods’ and RNR identifies ‘central eight’ which are inverse overlap. It can be said that GLM ‘primary human goods’ are inverse restatements of the ‘central eight’ risk factors, viewed from the lens of humanistic psychology [19]. Depending on these criminal risk factors, it is argued that the criminal procedure of the individual can be predicted and therefore the criminal procedure can be prevented by taking the necessary precautions. However, the RNR model is not compatible with occupational therapy outlook in the view of the possibility of irreversible risk factors and bias holding against the individual.
\nThe use of occupational therapy models in forensic rehabilitation focus on client-centered, holistic and occupation-focused practice with the approach of clinical reasoning based on individual preferences and needs. Normally, individuals engage in occupations which they prefer or want throughout their life; however, in secure environment situations, this ability of the individual can be limited or can be restricted by the individual’s mental health/disorder/learning disability, their perceived and their actual risks to themselves or others and institutional regulations, policies or legal restrictions. Individuals who need forensic rehabilitation face some participation limitations to all or a combination of activities and this can cause occupational deprivation additionally to the sense of hopelessness and poor mental health [6, 11, 15]. Moreover, community life skills and performing daily living activities and interaction with the environment of the individual can be limited. Therefore, group or individual occupational therapy programs often target basic living skills, self-care, vocational skills, adaptive coping strategies, creative arts and anger or stress management. The general aim of occupational therapy is to enable individual to experience occupational enrichment and achieve optimal occupational functioning. Occupational enrichment in forensic settings can be considered as both the goal and process of occupational therapy interventions, so evidence-based practice is very important [15].
\nOccupational therapy guideline recommendations show that Model of Human Occupation (MOHO) and its associated assessments are the most used occupational therapy model in forensic occupational therapy. The model was developed in the 1980s by Professor Gary Kielhofner and has had some revisions and collaborations until now. MOHO supports that human occupation is motivated, patterned and performed. Humans are conceptualized as three interrelated components: volition, habituation and performance capacity [16]. Also, environmental considerations are very important to increase the occupational participation of the individual having forensic occupational therapy and rehabilitation [15].
\nVolition presents the individual’s motivation for occupation and relates to individual’s motivation to participate to occupations combined with their self-belief and capacity to succeed which means personal causation. Motivation and personal causation can be affected by the individual’s mental health (such as depression, schizophrenia, personality disorder) or their perception of the reason and need for their admission. Therefore, the literature supports that it is important to establish the individual’s own goals to ensure treatment readiness. Some individuals can have complex occupational histories, which are situated within social tensions related to their antisocial or criminal occupations present lack of motivation to engage and participate activities they want and these individuals can view the environment as a barrier to participation in usual activities which can impact the individual’s mental health and well-being negatively. It is supported that volitional problems are likely to be highly relevant in the secure setting which can cause decrease in personal causation, difficulty in identifying or having unrealistic goals and an inability to and meaning or interest in activities [15, 16].
\nOccupational therapists have the skills and expertise to assess and engage people in those occupations which are meaningful and motivating. This requires a careful understanding and appreciation of what underlies the motivation and creating occupational opportunities like self-care, productivity and recreational activities. Occupational therapists also help people to identify and achieve their own hopes and aspirations such as vocational rehabilitation and work skills [15, 16].
\nHabituation refers the individual’s roles and behavior patterns consistent with his/her lifestyle. It presents automatically and effectively doing routine tasks related to their environment. Roles of the individual are responsibilities of the individual associated with personal identity, occupations and activities of daily life and extraordinary occupations. Individual with criminal lifestyles can have problems on participating prosocial roles with their daily routines and occupations [15, 16].
\nOccupational therapy interventions in secure environments help individual to participate in prosocial roles and occupations in an effort to live within society without resorting to previous criminal or new antisocial behaviors. The imposed legal and security restrictions in secure environments can mean that patients are unable to participate in their habitual or chosen occupations; this may be because such occupations are antisocial, or due to lack of resources, facilities or particular environments being available in secure settings. Often patients benefit from the structure, stability and consistency of admission [19].
\nFor occupational therapy interventions age, ethnicity and culture, finding the ‘right’ occupations that are culturally relevant, risk-managed and appropriate to the ‘typical’ forensic population can be challenging. The literature supports that not only redesigning lifestyle but also technological advances have an impact on the range of occupations that occupational therapist is able to offer to extend the inclusion level of the individual such as contemporary videogames and Nintendo® WiiTM additionally to participating actual sports and recreation activities [16].
\nAccording to the Model of Human Occupation, performance capacity is related to an individual’s adaptive interaction with the environment, and the ability to do activities provided by physical and mental components and the associated subjective experience. Occupationally restricted individuals have problems with occupational performance skills for independence in daily living. Moreover, performance skills may not be acquired or learned during transition from child to adult. Occupational therapists in secure environments have a major role to play in helping patients to develop, maintain or acquire new skills for successful community reintegration or transition to less secure settings, for example in the area of vocational rehabilitation. Occupational therapists can guide individuals to identify possible vocational areas such as study/education, voluntary or paid employment [16, 20, 21].
\nOccupational therapy interventions should help the individual to identify prevocational needs and sometimes individuals have not been or will not have a productive activity like working again and therefore the therapists need to help them to establish different prosocial, productive and meaningful occupations to increase health, wellbeing, occupational performance and general quality of life. For these reasons, it is important for occupational therapists to measure and follow the progress of the individual with outcome measures during daily living activities [17, 18, 21].
\nSocial and physical isolation of the individuals can cause problems to access their own complex occupational and environmental worlds. Being cut from own life can cause limitations over occupational choices and experience, so environmental changes and supports during activity performance can provide opportunities, constraints and demands to the individual. The literature supports that individuals in secure environments spend much of their time in passive leisure, personal care and rest occupations and occupational therapists are one of the core elements in increasing activity participation of the individual and develop occupations of their choice [15, 16]. Also, occupational therapists can facilitate the exploration of new or unknown occupations to increase positive life experiences of the individual.
\nAs it is given earlier, there is a great model need to understand the volition, habituation, performance skills, physical and social environments in which an individual’s occupation takes place. MOHO assists the understanding of occupation(s) and problems of occupation that occur in terms of volition, habituation, performance capacity and environmental context. This system-based model includes well-designed assessments, observational, self-report and interview schedules. One of the advantages of this model is that because of its extensive use in mental health settings; a forensic version of an assessment tool ‘Occupational Circumstances Assessment and Interview and Rating Scale’ was designed. But, the literature also supports that this tool is not the only one for the use of occupational therapists, and occupational therapists may find any particular model, or standardized assessment/outcome measures to support their interventions [4, 15, 16, 21, 22].The literature supports that the use of occupational therapy models in forensic mental health may increase evidence-based practice and help the professionals to show the effect of occupational therapy. As Model of Human Occupation is seen to be the most used occupational therapy model, models including environmental and individual issues such as psychological issues, desires, wants, activity performance and satisfaction from the activity performance can help the occupational therapist to plan more effective assessments and interventions. Although the literature is still limited; different occupational models such as KAWA model, creative ability model, PEOP (Person, environment, occupation, performance), the Canadian model of occupational performance and engagement and the individual placement and support model with can be effectively used with standardized assessments and outcome measures in various individuals, situations, cultures and environments in provision of occupational therapy services in a cost-effective way [6, 15, 16].
\nOccupational therapy process commences with contiguity between the offender and occupational therapy service. Collecting information about the person and making special evaluations is the first step in this process. Gathering information about the individual and special assessments helps to determine the problems and needs, as well as the reason for the intervention. It also allows for the setting of intervention targets and the determination of the intervention plan. In the process of occupational therapy, the intervention plan is followed by the implementation of the intervention. The intermediate evaluation may be needed to determine the effectiveness of the intervention or to reveal new intervention goals and plans. After intervention plans that have been modified or reorganized after the interim evaluation are applied, the intervention is assessed. As seen in the abovementioned occupational therapies process, information gathering and evaluation also play an important role in the intervention for forensic occupational therapy applications. In summary, an occupational therapist working with prisoners should use a three-stage assessment of initial assessment, interim evaluation and outcome measurement during the occupational therapy intervention process [15, 21].
\nOccupational therapy sees people as active and social entities and treats the person, his occupations and the environment holistically in order for the individual to achieve or regain well-being. It is also important to assess the individual as a whole in the information gathering and evaluation process for the creation of a suitable intervention plan [15] . According to the occupational therapy reference frame written by AOTA [15], personal factors include the individual’s values, interests, and spirituality as well as body structure and functions. Having knowledge about the boundaries and areas of internal energy in prisoners’ participation in occupations can be useful to guide activity preferences and motivation processes. The things that constitute the meaning of prisoners’ lives are values and beliefs they believe to be worth trying and taking the time. The occupational therapist in forensic setting desires recreates occupational identification of offenders who lose their roles by being isolated from the social environment. For this reason, it is very important to understand the value, relevance, strengths and limitations of the individual [4, 16, 22].
\nIt is also necessary to assess the sensory, motor and cognitive skills involved in the body structure and functions of the person in need to meet the occupation requirements they wish to perform. These skills can make or break an individual’s daily life. One point that should not be overlooked here is that during the process of occupational therapy collecting and evaluating information, the prisoner does not play a passive role, so the occupational therapist does not seem to be running a process alone. The occupational therapist and the prisoner are in the business association during the presentation of information, evaluation and outcome measures, and the prisoner is actively involved in this process.
\nOccupational therapists are aware that the occupational performance of an individual is influenced by factors related to the individual as well as by the performance patterns and the environment. Roles, routines, rituals, and habits constitute performance patterns [15]. Routines and habits allow the individual to perform his/her daily activities without thinking about how to move, without trying to remember. Occupational therapists working in forensic health services care about whether the prisoner has useful habits and routines for him. It is necessary to know how individuals spend their days and which routines they create from day to guide to get new routines and habits to use the time and energy more efficiently when the living conditions change [11]. Roles are the whole of the behaviors that an individual imposes on his/her responsibility, which is imposed by the environment and culture. Rituals are symbolic behaviors that are understood by social, cultural and spiritual values that shape the occupational identity of the individual. During the evaluations, the roles of the prisoner and the importance of these roles and the determination of meaningful rituals in the individual’s life provide significant benefits for the therapist’s intervention plan. Changes in location and time can also cause changes in the roles and rituals of individuals. The change in the role and ritual of the individual after conviction can cause occupational alienation in the individual. In the context of a forensic health service, acquisition of the prisoner’s new skills and habits, and the new roles and rituals that are well integrated with the environment make an important contribution to the occupational balance of the individual [3, 16, 23].
\nUnderstanding the environments in which occupational performance takes place, it is important for occupational therapists to understand the underlying effects of occupational participation. The environment includes dimensions related to physical, social (including individuals in the individual’s life) and policies, and at the same time creates a supportive or restrictive effect for the occupational adaptation of the individual. Situations such as an absence of freedom for the individual, individual secrecy, and the meaningful and socially acceptable occupations constitute a barrier to prisoners’ participation in their environment and occupation [15, 24]. Occupational therapists should also be thoroughly evaluating the environment of individuals who are establishing an intervention plan with prisoners applying to the occupational therapy service.
\nWe have already mentioned the preferred models for forensic occupational therapy applications. MOHO, one of these theories, includes structured and unstructured assessment and information gathering tools [3, 4, 11] for collecting and evaluating information about offenders. Some of those:
Occupational performance history interview (OPHI II)—A semi-structured measure of self-care and information about the individual’s life history;
Assessment of communication and interaction skills (ACIS)—evaluates three subdomain individuals, including the physical dimension of communication, information exchange, and relationships, in an occupational pattern or in a social group [25];
The Model of Human Occupation Screening Tool (MOHOST)—gives the client a holistic view of his or her motivation to achieve occupation, communication and interaction skills, occupation patterns and the individual’s process and motor skills as well as the environment. MOHOST also allows a highly effective assessment of the effectiveness of occupational therapy interventions [26];
Occupational Self-Assessment (OSA)—a method of assessment that reveals how the individual focuses on the occupational competence of the individual about his/her occupational adaptation, helping to shape the needs and values of the individual. OSA is a highly recommended assessment tool for evaluating forensic occupational therapy. Individuals are given a very wide list of daily occupations, individualists are asked to evaluate the occupations in their own eyes and the level of their own performance [26];
Occupational circumstances assessment interview and rating scale (OCAIRS-Forensic Mental Health Version)—the therapist has extensive content to get detailed information about the offender. It gives the individual an accurate and holistic view of occupational functionality. If the more fully involved the offender is in the evaluation process, the higher the participation in intervention practices [27, 28].
Evaluations such as Canadian occupational performance measurement, assessment of motor and process skill, independent living scale, and the role checklist are other measures preferred by occupational therapists [3, 24].
\nAnother assessment heading in the forensic occupational therapy process is risk assessment. When considering the evaluation processes mentioned earlier, a prisoner who has forensic settings should be considered as a means of risk assessment to determine the potential for another crime or previous crime. Occupational therapists take into account the risk assessment and management of risks posed by each client and to increase the occupational involvement of individuals by taking environmental precautions and managing them to manage risks in environments such as high-risk kitchens and workshops to improve individual skills as well as providing positive risk-taking opportunities to enhance the capabilities of both individuals.
\nCurrent risk factors such as age and gender, substance use status, criminal history and potential risk factors such as marital status, occupational participation level in the forensic setting, family support should be considered in the risk assessment. Occupational therapists pay attention to the influence of the person-environment-occupation interaction on the occupational adaptation of the individual. Occupational therapists can estimate the effects of individual’s personality and sociodemographic characteristics (physical, cognitive and psychological), their level of skill and the environmental risk factors, including interpersonal interaction, social support network, hospice environment, social security status on the possible risk factors. For this reason, they may play an active role in providing counseling to minimize the risks faced by prisoners and these risks’ adverse effects on occupational adaptation [3, 21].
\nAs already mentioned, offender rehabilitation in forensic settings is not different from other mental services. Intervention methods used by occupational therapists must include life skills development (such as ADLs, IADLs, and health management), occupational development, awareness (such as self-awareness and social awareness), self-management, skill-building (such as social, relationship, vocational skills), education etc.
\nThe GLM is a model that overlaps the humanistic point of view of occupational therapy. Although the GLM is a psychology-based model, it supports occupational therapies’ application models such as PEO, MOHO, CMOP and role acquisition model. Occupational therapists may develop interventions taking into account the GLM’s the primary human goods components. Some intervention recommendations based on the ‘primary human goods’ are given in Table 3.
Life: Life skills training is a commonly used occupational therapy intervention in mental health [30]. Offenders are at a higher risk for poverty, unemployment and difficulties in relationships. The life skills training interventions can focus on self-care, self-maintenance, intrinsic gratification, social contribution and interpersonal relatedness skills. The interventions must be client centered and the context must be well evaluated. While working with an offender, the balance of daily occupations should be kept in mind for a healthy lifestyle.
Knowledge: The development of interventions for improving self-awareness is very important in offenders’ rehabilitation. Self-awareness is the ability to recognize him/herself as an individual who is different from other individuals. Self-awareness is having a clear perception of personality, including strengths, weaknesses, thoughts, beliefs, motivation and emotions. The aim of the interventions is to gain a sense of self-worth. Facilitatory interventions, such as education, feedback, behavior therapy and psychotherapy have been recommended to a greater extent than compensatory interventions.
Excellence in work: The main problem of ex-offenders is employment to maintain their lives [31]. Unemployment concerns begin to increase still they are in prison. They face substantial barriers to many types of legal employment [32]. These barriers are poor basic skills, low self-esteem, a lack of recent work experience, employer discrimination, behavioral and health problems. Interventions must include prevocational training, job search skills, work-related practice and also work hardening.
Excellence in play: Recreational activities and hobbies are the enjoyable, activities that are restorative in which the clients’ choice and control often associated with leisure time. Recreational pursuits and hobbies are the power of life. The main aim of the therapeutic recreation is to enhance the patient’s quality of life and ability to participate in leisure and/or play. Also, it can improve social participation and social skills which is very important for the offenders.
Excellence in agency: Self-directedness is the ability to organize and adapt a behavior to achieve individual selected goals and values. Self-directedness includes the concept of an autonomous individual and concepts of personal integrity, self-respect, dignity, efficacy and feelings about one’s life [33].
Inner peace: Anger management problems affect all parts of a persons’ life. The goals of treatment are to increase the client’s resources for coping with stress and try to decrease the demands made on the client. Treatment is first achieved by increasing awareness of the client about the relationship between anger and stress and then increasing the effective use of the stress management techniques that the client is able to cope with [11, 34]. Anger management interventions begin with recognizing the triggers of anger. The client must take responsibility for his/her own change so that the problem can be solved. The second stage of the intervention is the awareness of the behaviors when the client is angry, such as, shouting, swearing, treating verbal, postural or gestures, abusive behaviors such as phone calls, messaging or other communication ways, harassments, emotional abuses or violent. Also in this stage, the therapist must help the client to identify times when his/her thoughts do not lead to logical or rational conclusions. The third stage is teaching specific skills to help the client to manage triggers for anger effectively, such as relaxation techniques, mindfulness and assertiveness.
Relatedness: Group interventions in which the family members and friends are engaged are suitable for relatedness [35]. The aim of the interventions must be establishing and maintaining relationships with others, resisting inappropriate social pressure, working in cooperation, preventing and resolving interpersonal conflict, asking for help when necessary [29].
Community: Deficits in social skills are often seen in forensic groups. Social skills training is the main intervention method for being active in a group [36]. For being in a group, it is also important to make responsible decision to identify and evaluate the problems correctly, making decisions based on ethical and social norms, to evaluate decisions in context, contribute to the welfare of society, accurately identify and evaluate problems, make decisions based on ethical and social norms, consider context in decisions, contribute to well-being of community [29]. Social skills training consists of learning activities that use behavioral techniques that enable individuals to acquire independent life skills for better functioning in their communities. Direct teaching, modeling, role playing, behavior rehearsal, and social reinforcement can be used during the interventions.
Spirituality: The spirituality is the ‘meaning and purpose in life, the life force or integrating aspect of the person and transcendence or connectedness unrelated to belief in a higher being’ in occupational therapy perspective [37] . The meaning of spirituality is different for everyone, can be participating a religion, visiting religious places (such as churches, mosques, synagogues etc.) regularly and can be different for some praying alone, yoga, meditation, being in the nature, walking and so on. There can be challenges about talking about the beliefs and spirituality with the client and that much of spiritual experience can be culturally influenced [37]. Motivation techniques can be used to find meaning and purpose in life.
Pleasure: Pleasure is one of the subjective experiences of the human need-based experiences to engage in occupations [38]. It influences productivity, restoration and being active to engage occupations [39]. Motivational and increasing self-esteem and confidence interventions can be used to improve pleasure.
Creativity: It is stated that ‘creativity is part of everyday practice; the use of creativity as a conscious approach; creativity involves risk-taking; creativity needs a supportive environment; and creativity is the use of expressive arts in therapy’ [40]. Especially creative arts increase the capacities of offenders, help to explore their own resources, assist them to locate hope and motivation, recognize their interconnectedness with others without external pressure to comply [41].
The ‘primary human goods’ | \nIntervention recommendations | \n
---|---|
Functional life skills Role development Independent living skills Literacy and education ADLs IADLs Health management Gender-specific issues Money management | \n|
Self-awareness Drug and alcohol awareness | \n|
Prevocational training Job search skills Work-related practice Vocational rehabilitation: work preparation, voluntary and paid work Work hardening | \n|
Recreational skills Time management | \n|
Anger management Stress management Problem solving skills Motivation | \n|
Self-management Increase self-esteem and confidence by promoting personal responsibility | \n|
Relationship skills Complex relationship building Facilitating development of supportive relationships Social skills | \n|
Social skills Social awareness Responsible decision-making Graded community engagement and one-to-one goal planning Empathy | \n|
Motivation | \n|
Motivation Increase self-esteem and confidence | \n|
Skills development Vocational activities include such as woodwork, crafts, graphics, horticulture | \n
Intervention recommendations in offender’s rehabilitation from the view of occupational therapy.
The main challenge is the context because of the complexity of the rules affecting the freedom of the offender and the occupational opportunities [7]. The heterogeneous client population is another challenging condition with in the context. Restricted daily living activities cause the loss of control and autonomy. Time use is another challenging factor, the lack of structured time use besides the loss of control and autonomy affects the client’s volitions, habits, and routines. Also, lack of opportunities for meaningful, individualized career choices for patients affects the client.
\nAlso, change, itself is a challenging condition. There are many factors that affect the daily living activities that are the volitions, habits of the individual and the environment. Therefore, it is not possible to catch the change in every environment. Even in a prison or in a secure hospital or a probation service, the offender has always an obligation and mostly a restricted occupational choice. Motivation or perceived lack of choice is an important challenge. Another challenge is the obligations dictate some occupations and this is not the individual’s choice. Occupational therapy is client-centered, but freedom deprivation is a challenge to make interventions. Occupational therapy is client-centered but freedom deprivation is a challenge to make interventions. Labeling and stigma are other challenging parts of the offenders’ participation in the occupations and the community.
\nKeeping the three justices—criminal justice, occupational justice and social justice—in a balance is the main aim of the offender’s rehabilitation and the most challenging part of the rehabilitation.
\nSince last decade, there has been a growing concern of the negative impacts of global climate change. In the last century, scientists believe that carbon dioxide (CO2) emission is has been the main component responsible for approximately three-quarters of global greenhouse gas emission. A roadmap developed to combat climate change has outlined 10 scalable solutions clustered into categories of social transformative, governance improvement, market and regulation-based solutions, technological innovation and transformation, and lastly natural and ecosystem management. While some proposed mitigation techniques focus on reduction of CO2 emission, Carbon Capture, Utilization and Storage (CCUS) technology can aim at achieving lower CO2 amount in the atmosphere by capturing and storing the anthropogenic gas in a geological storage. Geological storage of CO2 in depleted oil and gas reservoirs, deep saline reservoirs, unmineable coal seams or injected into active oil and gas reservoirs for Enhanced Oil Recovery (EOR) are currently a well-accepted method of storing CO2. For economic reasons, CO2 is being injected at the highest possible rates through limited number of wells. This could trigger injectivity-related issues due to complex interactions between CO2, brine and rock initiated in the aquifer. This makes CO2 injectivity not only a technical challenge but also an economic consideration.
This chapter presents a comprehensive discussion on how the various mechanisms contributed by the fluid-rock interactions during CO2 sequestration affect CO2 injectivity. The chapter begins by laying out the theoretical dimensions of CO2 sequestration. This is followed by a brief overview of different CO2 injectivity impairment mechanisms, focusing on the two main themes: salt precipitation and fines migration. The experimental findings from previous researchers have also been discussed and some findings remarks made. The insights gained from this study may be valuable to the rapidly expanding field of carbon sequestration.
Climate Change is now considered the greatest threat to global health and security. Greenhouse effect, which propels global warming, has been identified as the main driver of Climate Change. The rising of global temperature is intricately linked with many other environmental concerns such as fragile ecosystem, melting glaciers, increasing sea level, acidification of sea water and increased flooding and droughts [1]. This climate challenge is also affecting the social community which can lead to immigration and conflicts over borders and natural resources such as water. More importantly, it could severely threaten food security that may affect about 3 billion of poor people in terms of access to food supply. These series of concerns are recognized as climate change and it is well accepted that to prevent its occurrence, greenhouse gas emission has to be reduced significantly over the twenty-first century [2]. The gases which are mainly responsible for the greenhouse effect include methane, carbon dioxide (CO2), nitrous oxide, water vapor, and fluorinated gases.
CO2 generated mainly from anthropogenic activities is the largest contributor to global warming. By 2020, the concentration of CO2 in the atmosphere had risen to 48% above its pre-industrial level [3, 4]. An increase of 2°C above pre-industrial average temperature could induce serious negative impacts on the natural environment and human health. The Paris Agreement, which is the biggest international treaty on Climate Change is determined to limit global warming to about 1.5°C, compared to pre-industrial levels, with an ambitious goal to reach NetZero CO2 emission by 2050 [5, 6, 7].
The anthropogenic activities with highest carbon footprint include the burning of fossil fuel for power generation and the production of materials. Power generation from fossil fuels is responsible for over 70% of the global CO2 emissions [1]. Cumulatively, fossil fuel contributed about 84% of the World’s primary energy consumption by 2019 and the world is expected to rely heavily on fossil fuels for its energy needs, at least within the short to medium term. Another major source of CO2 emission is the production of materials with high carbon and energy footprint. The notable of such materials is Portland cement which is the main building material used in most countries in the world. Portland cement production is responsible for about 5% of global CO2 emission [8]. About 2% of the total global energy consumption is used to produce Portland cement. Widespread use of energy efficient power generators, investing in renewable energy, Carbon Capture, Utilization and Storage (CCUS) remains the best options for reducing CO2 emission from burning of fossil fuels and achieving a faster transition to green energy.
CCUS is considered a viable option to reduce CO2 emission, sustain exploration and production of fossil fuel for the short to medium term and eventually transition to a full green energy in the long term [9, 10]. Among the proposed CO2 emission reduction strategies, CCUS provides the highest emission reduction potential [11]. Generally, CCUS involves the (1) capture of CO2 from large industrial emission sources and direct air capture points (2) the transportation of the captured gas to utilization, conversion, or storage facilities and (3) the utilization of the gas as feedstock in industrial processes, conversion to other products or the injection of the gas into geological storage facilities. In terms of geological storage, the injected CO2 may be stored in depleted oil and gas reservoirs, deep saline reservoirs, unmineable coal seams or injected into active oil and gas reservoirs for Enhanced Oil Recovery (EOR) [12, 13].
CCUS system, although simple in concept, would require significant investment of capital, new technology and time [14]. Besides, many current policies also need to be revised and new legal and regulations framework has to be introduced that require support from local authorities, governments and international bodies [15]. Investigation by the International Energy Agency (IEA) have shown that CCUS can contribute up to about 14% reduction in global greenhouse gas emissions required to limit global warming to 2°C by 2050 [16].
Saline aquifer refers to a deep, large geological formation consisting permeable sedimentary or carbonate rock types that are saturated with formation water or brines, non-potable water, containing high concentration of dissolved salts [17]. It is buried under a layer of non- or low-permeability rocks that serve as a cap rock to prohibit the fluid flowing upwards to the surface. The saline aquifer can be located both onshore and offshore and normally found at depth greater (more than 800 metres) than aquifers that contain potable water [18]. Deep saline formations have enormous potential for CO2 storage in terms of volumetric storage capacity [19, 20]. On a global scale, deep saline reservoirs have the capacity to hold between 20 and 500% of the projected CO2 emissions by 2050 [9, 21, 22]. Thus, worldwide CO2 storage potential of deep saline reservoirs ranges from 400 to 10,000 Gt CO2. Deep saline aquifers, usually at depths between 700 and 1000 m, hold large quantities of high salinity formation brines [23].
Although the natural content of these reservoirs has no direct commercial value, the chemical composition of the formation brine makes them suitable for CO2 mineralization. In deep saline aquifers, the injected CO2 could be sequestered through hydrodynamic trapping where the gas is trapped beneath a caprock, residual trapping where the rock contains residual saturation of CO2, solubility trapping where the gas dissolves in the formation brine and mineral trapping where CO2 reacts with Ca, Fe or Mg to form stable carbonate precipitates [24, 25]. Lack of additional economic benefits except carbon tax incentives in some countries, makes CO2 storage in saline aquifers less attractive to the oil and gas industry.
CO2-EOR is a tertiary oil recovery technique where CO2 and usually other fluids such as water or brine is injected into the reservoir to achieve miscibility with the oil and recover residual oil. In addition to extraction of residual oil, the injected gas provides pressure support and could remain stored permanently after the recovery process. Under subsurface conditions, CO2 mixes with oil above a certain minimum miscibility pressure (MMP), reducing the capillary effect that retain the oil in place [26, 27, 28]. There are four main underlying mechanisms of CO2-EOR as outlined by Rojas and Ali [29] and Tunio et al. [30] which include (1) oil swelling; (2) reduction of oil viscosity; (3) reduction of oil and water density; and (4) extraction of oil components.
Alternative forms of CO2-EOR have been developed over the past years, including continuous CO2 injection, continuous CO2 injection followed by water, water-alternating gas (WAG) and WAG followed by gas or water [31, 32, 33]. To improve sweep efficiency, carbonated water injection has also been used as a viable alternative [34, 35]. Other emerging injection schemes include CO2 low salinity water alternating gas (CO2-LSWAG) injection under miscible CO2 displacement conditions [36, 37, 38]. Depleted oil and gas reservoirs are also attractive candidates for CO2 storage due to the potential to reuse some of the production equipment and geological data collected over the producing life of the reservoirs to lower exploration cost and reduce the risk associated with CO2 storage. It has been reported that depleted oil and gas reservoirs could hold about 45% of the projected CO2 emissions by 2050 [9].
The two main unconventional formations where CO2 injection is promising are coal seams and shale gas reservoirs. CO2 enhanced coalbed methane recovery (CO2-ECBM) has the potential to store large volumes of CO2 in deep unmineable coal seams while improving the efficiency of coal bed methane recovery [39, 40]. The injected CO2 displaces methane and remain sequestered in the coal seams as CO2 is preferentially adsorbed onto coal seams, thus releasing the coal bed methane which can then be produced as free gas [41]. Based on the simple assumption that, for every CH4 molecule, two molecules of CO2 can be stored, IEA-GHG [42] estimated that about 220 GT of CO2 could be stored in deep unmineable coal formations worldwide.
The potential to store CO2 in organic-rich gas shales is attracting increasing interest, especially in countries that have extensive shale deposits [43, 44, 45]. Although still in early-stage research, CO2 injection into organic-rich gas shales could provide dual benefits: an economic benefit from the incremental recovery of adsorbed methane, and an environmental benefit of secure CO2 storage.
A viable candidate for CCUS must meet a threshold well injectivity required to inject large volumes of CO2 at high injection rates through a minimum number of wells, adequate storage capacity to hold large volumes of CO2 and robust containment to permanently isolate the sequestered gas from the environment [16]. Storage capacity and well injectivity defines the storage potential of a geological storage facility [11, 46, 47].
Implementation of CCUS technology require accurate estimation of the pore space available in the reservoir rock to hold the injected CO2 [48, 49, 50, 51]. The storage capacity estimated can be of different levels of certainty and cost depending on the scale and resolution. The various CO2 trapping mechanisms in deep saline aquifers, namely structural and stratigraphic trapping, residual gas trapping, solubility trapping, mineral trapping and hydrodynamic trapping, which occur at different times during the storage, must be considered in the estimation to obtain a representative estimate [51]. Other parameters that affect the storage capacity include in situ pressure, injectivity, temperature, permeability, and rock compressibility.
The volume of CO2 that can be commercially sequestered in a reservoir within a specific period, using available technology, under current economic conditions, operating methods and governmental regulations has been termed the CO2 storage reserve [11, 48]. The USDOE [52] has developed a simplified model to quantify the storage capacity of deep saline formations which is given by:
In Eq. (1),
In Eq. (2),
Bachu et al. [54] have also proposed a model to estimate the theoretical CO2 storage capacity of depleted oil and gas reservoirs, based on the assumption that the entire pore space originally occupied by hydrocarbons can be filled by CO2 and that CO2 can be injected until the reservoir pressure reaches the original pressure of the virgin reservoir. These assumptions can be valid if the reservoir is not in contact with an aquifer or already flooded during secondary and tertiary recovery. For practical purposes, an effective storage capacity could be defined to incorporate other important parameters such as displacement efficiency, gravity effects, residual oil and water saturation, reservoir heterogeneity, rock-fluid interactions, and formation damage.
The injectivity of a reservoir measures the amount of CO2 an injection well can receive without fracturing the formation [11]. Well injectivity can be expressed with an injectivity index,
In Eq. (3),
Containment efficiency characterizes the assurance of containment of the injected CO2. The ultimate objective of a CCUS project is to permanently isolate the sequestered CO2 from the environment. Since formation water is denser than supercritical CO2, the CO2 plume tends to rise to the top of the reservoir, where it accumulates beneath the caprock. The containment efficiency of a geological trap is therefore strongly dependent on the seal potential or the ability of the caprock to confine the injected gas and prevent leakage into overlying formations and eventually back into the atmosphere [58]. The caprock must have the lateral extent and geomechanical strength to retain the full CO2 column height.
The integrity of the caprock could be compromised by mechanical deformation induced by pressure from CO2 injection or through geochemical CO2-rock-brine interactions which may dissolve or precipitate minerals to increase the permeability of the caprock [59]. Wells have also been identified as probable leakage pathways. Therefore, robust wellbore integrity is important to prevent leakage through wells.
CO2 injectivity impairment is a technical and economic constraint on geological storage of CO2 [12, 60, 61]. Under typical storage conditions, several factors could influence CO2 injectivity because of the complex interplay of chemical and physical phenomena in the reservoir, especially in the injection area of the wellbore [46, 62, 63]. The injection area of the wellbore has the highest flactuations of temperature, pressure and flux, making it one of the most important sections of the formation for well injectivity impairment analysis. Lombard et al. [64] identified three main mechanisms responsible for CO2 injectivity impairment: Geochemical, geomechanical and transport phenomena (Figure 1). Later Torsaeter et al. [65] did an extensive review on other CO2 injectivity impairment mechanisms that they recommend should be given close attention in addition to salt precipitation effects. The geochemical mechanisms involve CO2-brine-rock interactions, mineral dissolution, and precipitation. The transport effects include drying of the reservoir rock and fines mobilization. The geomechanical effects, which include borehole deformation has not been given enough research attention compared to the geochemical and transport mechanisms. These phenomena depend on the physical and chemical properties of injected CO2 which are in turn driven by reservoir conditions and rock properties.
CO2 injectivity impairment mechanisms (after Lombard et al., [
Mineral dissolution and salt precipitation are the two main geochemical CO2 injectivity impairment mechanisms [64]. The injected CO2 could dissolve in formation brine at the CO2-brine interface, altering the concentration of aquifer fluid, thus leading to precipitation. Regardless of rock composition, the progressive dissolution of CO2 in the brine (formation water) forms carbonic acid that leads to a reduction in pH to about 3–5 [66, 67]. The following reactions occur at the interface between both media
Interactions between CO2 and brine forms carbonic acid and then bicarbonates. In the presence of CaCO3, MgCO3 and FeCO3, the following reactions would lead to formation of water-soluble bicarbonates.
Moreover, the bicarbonates could react with cations in the rock and formation water to form stable carbonates which later could aggregate into small particles or form a scale on the pore walls [68, 69, 70]. CO2-brine-rock batch reaction under typical storage conditions have shown various amounts of dissolved minerals in solution [70, 71, 72, 73].
Wang et al. [74] investigated mineral dissolution and precipitation in dolomite samples saturated with carbonated water at 93
Under static conditions, mineral dissolution could increase rock permeability temporally as new pore spaces are etched and old pore channels could be widened [64]. However, mineral precipitates could aggregate into fine particles in the pore fluid which could form a scale on the pore walls and reduce the flow area.
Sokama-Neuyam et al. [80] conducted experiments to investigate the effect of mineral dissolution on CO2 injectivity using clay-rich Bentheimer Sandstone cores. The cores were flooded with carbonated water at 80 bar and 60°C with about 25 pore volumes (PV) of carbonated water at 0.25 mL/min. Pressure drop profiles recorded during the flooding is shown in Figure 2 and SEM-EDS analysis of effluent samples collected are shown in Table 1.
Pressure drop profile recorded during injection of carbonated water into a Bentheimer core at flow rate of 0.25 mL/min at 80 bar and 60°C [
Element | wt.% |
---|---|
O | 33.56 |
Fe | 7.78 |
Ni | 5.02 |
Na | 17.53 |
Mg | 0.74 |
Al | 2.53 |
Si | 0.35 |
Cl | 29.79 |
Ca | 2.52 |
Co | 0.17 |
Total | 100.00 |
EDS elemental analysis of effluent samples collected during carbonated water flooding into Bentheimer core.
Figure 2 shows a period of immiscible displacement, where pressure drop decreased sharply from about 0.1 bar to about 0.04 bar after the core was flooded with about 3 PV of carbonated water. As the displaced FW is replaced with the less dense carbonated water, the pressure drop falls sharply until carbonated water breakthrough at the effluent end of the core. Pressure drop was stabilized from about 3 PV to about 7 PV. In this period, the core is fully saturated with carbonated water, leading to stable flow. Unstable flow sets in from about 7 PV to the end of the test. In this period, the pressure drop is seen to rise sharply and fall to a rather haphazard behavior towards the end of the test. The EDS results in Table 1 shows the effluent sample is composed predominantly of Na (17.53%) and Cl (29.79) which are probably the components of the effluent brine. The results also reveal the presence of minerals such as Fe, Si, Al, Ni, and Co which were not present in the saturating brine and the injected carbonated water. Therefore, Fe, Si, Al, Ni, and Co were most likely dissolved from the Bentheimer core through the interaction of the carbonated water and the rock minerals. The EDS analysis show low amounts of Fe, Si, Al, Ni, and Co, because only few particles were likely to be washed out of the core.
Salt precipitation is an existing injectivity challenge in natural gas wells. Kleinitz et al. [81] reported field observation of severe halite-scaling during natural gas production. Similar field experiences have been reported during injection, storage and production of natural gas [82, 83, 84]. In the context of field CO2 injection, Baumann et al. [85] and Grude et al. [86] have reported evidence of salt precipitation effects in the Ketzin pilot reservoir and the Snøhvit field, respectively. More recently, Talman et al. [87] investigated drying and salt precipitation effects in a CO2 injection well at the Aquistore site. Downhole images taken from the injection well, together with recovered samples revealed that scales of salts have formed on the inside of the injection well.
Miri and Hellevang [12] identified the processes leading to salt precipitation as: (1) immiscible two-phase CO2-brine displacement; (2) vaporization of brine into the flowing CO2 stream; (3) capillary back-flow of brine towards the inlet; (4) diffusion of dissolved salt in the porewater; (5) gravity override of CO2; and (6) salt self-enhancing. While results from numerical modeling work reported by Roels et al. [88] suggested that precipitated salt could accumulate far from the wellbore, several research works [89, 90, 91] show that precipitated salt accumulates near the wellbore. Permeability impairment between 13 and 83% and porosity reduction between 2 and 15% have been reported from laboratory core-flood experiments [92, 93, 94, 95, 96, 97]. These experimental findings have been found to be consistent with theoretical and numerical simulations [61, 98, 99, 100].
Pruess and Muller [89] suggested that pre-flush of the injection region with freshwater could reduce salt precipitation. However, Kleinitz et al., [81] have shown that freshwater injection could not mitigate salt precipitation if the flow area is completely plugged by solid salt. Fresh water also has a high tendency to react with rock minerals, leading to other injectivity impairment challenges such as clay swelling.
Sokama-Neuyam [101] grouped the mechanisms of salt precipitation into two successive processes: salt cake development at the injection inlet and drying effects. Salt cake forms on the surface of the core inlet during early stages of brine vaporization prior to drying. As drying commences, salt precipitates into pore spaces in the dry-out zone.
Sokama-Neuyam [101] investigated the development of salt cake on the surface of the injection inlet. They flooded a Bentheimer sandstone saturated with about 120 g/L NaCl brine with about 100 PV of dry supercritical CO2 at a rate of 1 mL/min. Figure 3 shows photographs of the rock taken during inspection. In Figure 3A, we observe that no salt was formed at the core outlet. Figure 3B shows massive salt cake deposition at the core inlet and Figure 3C shows that the entire length of the core was still wet. They reported that salt cake formation at the injection inlet was caused by (1) High brine salinity and (2) Poor brine displacement at the injection inlet.
Photographs of Bentheirmer core after CO2 was injected at 1 mL/min into the core initially saturated with 120 g/L NaCl brine. (A) No salt cake observed at the core outlet. (B) Massive salt cake found at the injection inlet. (C) the entire core remains wet [
Furthermore, there are similarities between the increasing trend of injectivity impairment expressed by salt precipitation in Sokama-Neuyam [101] and those described by Yusof et al. [102, 103]. In their study, they examined the effects of brine salinity and brine type on CO2 injectivity changes. They found that the injectivity reduction increased almost linearly between 6 and 27.3% as the brine salinity increases from zero to 100,000 ppm. The increasing growth of salt precipitation which reduced the porosity and effective flow area was identified as the main cause of the downtrend of CO2 injectivity. It was also reported that the sandstone core saturated with monovalent salt such as NaCl and KCl was heavily impaired by salt precipitation as compared to the sandstone core filled by the divalent salt system (CaCl2). However, these findings may be somewhat limited by constant brine salinity of 30,000 ppm.
Moreover, to investigate the effect of drying, Sokama-Neuyam [101] flooded a Berea sandstone core initially saturated with NaCl brine with about 300 PV of supercritical CO2 at a rate of 1 mL/min until the core was completely dried. The permeability of the core after drying was measured and a relative injectivity index
Effect of drying and salt precipitation on CO2 injectivity. Injectivity impairment, β increased with decreasing CO2 injection rate.
From Figure 4, it was observed that CO2 injectivity was impaired by about 36% for drying rate of 1 mL/min. Injectivity impairment decreased from 36% to about 25% when drying rate was increased to 5 mL/min and remained practically unchanged when the drying rate was further increased to 10 mL/min. Several researchers [94, 96, 104, 105] have earlier reported CO2 injectivity impairment within a range (13–83%) that is in agreement with the these figures. During drying and brine vaporization, when the concentration of brine exceed supersaturation, salt precipitates into the pores in the dry-out region as also observed by Zuluaga et al. [106]. The deposited salts reduce the CO2 flow area, impairing permeability and injectivity.
As drying progresses, a saturation gradient is established which draws more brine into the dry-out region through capillary backflow. Capillary backflow of brine leads to more salt deposition in the dry-out region. The capillary backflow of brine increases with decreasing drying rate because at high CO2 injection flow rates, viscous forces overcome capillary forces. Therefore, less salts are precipitated in the dry-out region at high injection flow rates, inducing low injectivity impairment as observed in Figure 4. Injectivity impairment did not change when drying rate was further increased from 5 mL/min to 10 mL/min because at these injection flow rates, the resident brine is quickly swept out of the core, leaving out only immobile brine for salt precipitation.
During injection of dry supercritical CO2 into brine-saturated sandstone cores, the dry-out region close to the injection inlet, extends into the core as more CO2 is injected. The effect of extension of the dry-out zone on CO2 injectivity is vital for understanding the underlying mechanisms of brine vaporization and salt precipitation. Sokama-Neuyam et al. [107] conducted experimental and theoretical study to investigate the development of the dry-out zone and estimate the impact of extension of the dry-out region on CO2 injectivity. Figure 5 shows the impact of the advancing dry-out zone quantified by a dimensionless dry-out length,
The impact of the dry-out length (
To meet the global CO2 emission reduction target, large injection rates will be required. Thus, after salt precipitation, there is continuous injection of CO2 into the reservoir. The effect of drag forces on the deposited salt was studied by Sokama-Neuyam et al. [108]. A Berea core sample was initially vacuum saturated with FW and vaporized to complete dryness to precipitate salt into the pores. The liquid CO2 permeability of the core and pressure drop across two sections of the core were measured with a pressure-tapped core holder. The core was then flooded with about 150 PV of supercritical CO2 at a constant injection rate of 2.5 mL/min. During this period of CO2 injection, drag forces were expected to act on the precipitated salts. Permeability and pressure drop across the same sections of the core was measured after CO2 flooding. Figure 6 shows permeability change induced by the effect of drag forces on precipitated salts at varying injection rates.
The impact of CO2 injection flow rate on the effect of drag on permeability after salt precipitation. Permeability change is the difference between the core permeability after salt precipitation and before drag test and the permeability after drag test [
The net drag force exerted by supercritical CO2 on precipitated salts depends strongly on the volumetric injection flow rate (
CO2 alternating Low Salinity Water Flooding (CO2-LSWAG) is a promising EOR technique [37, 38, 109, 110]. Sokama-Neuyam et al. [97] investigated CO2 alternating low salinity water injection as a potential technique to mitigate salt precipitation effects on CO2 injectivity. After salt precipitation, a slug of diluent was injected to dissolve the precipitated salts, thus temporarily improving CO2 injectivity. The diluent used was low salinity water (LSW) which was prepared by diluting FW to lower brine salinity. Figure 7 shows injectivity improvement obtained as a function of mass fraction of salt (
Effect of diluent brine salinity on CO2 injectivity change induced by alternate injection of supercritical CO2 and LSW [
In general, CO2 injectivity improved from 8.66 to 31.62% when the mass fraction of salt in the diluent,
The mechanisms of fines migration and the impact of particle transport on the petrophysical properties of reservoir rocks have been previously researched. Khilar and Fogler [112] presented the mechanisms of colloidal and hydrodynamic induced release of fine particles in porous media. Muecke [113] investigated parameters controlling the movement of fine particles within the pore spaces. They identified the pH and salinity of formation brine, flow rate and temperature as some of the underlying parameters. Khilar and Fogler [114] asserted the existence of a critical salt concentration below which the pore fluid could weaken the Van der Waal’s forces holding fine particles to the pore walls. Gruesbeck and Collins, [115] investigated the effect of hydrodynamic forces on the release and transport of fines. They identified a minimum interstitial velocity for fines entrainment. The effect of two-phase flow and rock wettability on fines entrainment has been experimentally investigated by Sarkar and Sharma [116]. They found that, the wettability of the core could affect the extent and rate of permeability impairment induced by migratory fines. Analytical models have been developed by Sharma and Yortsos [117] to investigate the mechanisms of size exclusion and quantify the effect of particle entrapment on rock permeability. Many other studies of fines migration in porous media under various conditions have been reported [118, 119, 120]. A thorough analysis of formation damage induced by migratory fines can be found in Civan [121].
We have already discussed that geochemical CO2-brine-rock reaction could generate secondary minerals into the pore fluid [73, 122, 123]. In addition, CO2-brine interactions could alter the pH of formation fluid which could induce the release of formation fines from the pore walls [115, 124]. While flowing with the injected fluid, the mineral particles could clog pore channels and impair injectivity. Whether entrapment or piping of fines will dominate the flow depends on characteristics of the generated fine particles, the porous medium and the permeating fluid in which the particles are suspended [125, 126, 127]. Pore structure, the size and concentration of the minerals and the hydrodynamic and colloidal conditions of the suspending medium could also affect their impact on CO2 injectivity. Under radial flow conditions, plugging effects could be limited to the near well region where fluxes are highest.
The general mechanisms of fines mobilization in porous media have been well researched and understood. However, the unique properties of supercritical CO2 including its gas-like viscosity and liquid-like density [128] coupled with the expected high CO2 injection rates required to meet global emission reduction targets and the drying effect of supercritical CO2 makes fines mobilization under CO2 injection conditions a unique challenge that must be investigated separately. Adaptation and extension of previous general findings on fines migration is required to understand the mechanisms and impact of fines migration within the context of CO2 injection.
Sokama-Neuyam [80] conducted core-flood experiments to measure the effect of dissolution on injectivity. A Berea sandstone core sample with known permeability was initially saturated with FW, and then flooded with about 25 PV of carbonated water at 80 bar and 60°C at constant injection rate of 0.25 mL/min to release and mobilize fine particles in the rock. The permeability of the core after carbonated water flooding was measured, and injectivity impairment index,
Effect of injection flow rate on injectivity impairment induced by fines plugging. Injectivity impairment decreased with increasing carbonated water injection flow rate [
As injection flow rate is increased, the resident time of carbonated water in the rock is shortened. The number of fines generated will then decrease as the injection flow rate is increased. In addition, at high injection flow rate, hydrodynamic forces could lift smaller particles out of the core with the effluent fluid. The number of fines available to plug the rock, and therefore the chances of injectivity impairment, will reduce as carbonated water injection flow rate is increased. Up to 26% injectivity impairment was induced by mineral dissolution and fines mobilization during carbonated water injection into the Berea sandstone cores. Injectivity impairment decreased as injection flow rate was increased.
Sokama-Neuyam et al. [129] attempted to quantify and compare the individual effects of fines mobilization and salt precipitation on CO2 injectivity. Mono-disperse colloid solutions were used to represent the pore fluid containing particles after mineral dissolution. A Berea sandstone core sample was initially saturated with mono-disperse colloid solution with average particle size of 0.08 μm and particle concentration of 0.3 wt.% and flooded with about 40 PV of supercritical CO2 at 5 mL/min to complete dryness. The relative injectivity change, β, was calculated from the permeability of the core measured before and after it was exposed to mineral impairment. The experiment was repeated for particle concentrations of 0.5 and 1.0 wt.%. Figure 9 shows injectivity impairment induced as a function of composition of the pore fluid.
The relative impact of fines mobilization and salt precipitation on CO2 injectivity. Fines migration had a more severe impact on injectivity compared to salt precipitation [
In Figure 9, while salt precipitation reduced injectivity by about 26.8%, particle concentration of 0.3 wt.% impaired injectivity by 74.9% through fines mobilization. About 1.0 wt.% of particles in the pore fluid almost plugged the rock. When CO2 invades the pores, the mono-disperse particles could plug the narrow pore channels through bridging, surface deposition, or multi-particle blocking. As particle concentration increases, the distance between suspended particles shortens, enhancing multi-particle blocking of the invaded pores. On the other hand, precipitated salts coat the pore walls to reduce the flow area. While salt precipitation reduces the flow area, fines entrapment could plug and isolate the flow path, making them inaccessible to fluid flow. The results suggest that, under linear flow conditions, fines mobilization could induce severe CO2 injectivity impairment comparable to the impact of salt precipitation.
Preliminary theoretical studies suggests that fines mobilization could compound CO2 injectivity impairment induced by salt precipitation [80, 101]. After salt precipitation, the deposited salt reduces the pore spaces, increasing the jamming ratio of particles being transported in the flowing stream. A schematic diagram that summarizes the role of mineral dissolution, salt precipitation and fines migration mechanisms on CO2 injectivity impairment is shown in Figure 10. Salt precipitation increases the susceptibility of the rock to fines entrapment. Sokama-Neuyam et al. [131], developed a dynamic core-scale model based on experimental observations to investigate the coupled effect of fines mobilization and salt precipitation on CO2 injectivity. The effect of brine salinity, initial core permeability and the order of coupling were studied. Figure 11 shows injectivity impairment induced by the combined effect of particle entrapment and salt precipitation compared to the effect of only fines mobilization.
Schematic diagram of mineral dissolution, salt precipitation and fines migration mechanisms during CO2 injection into saline aquifer [
Effect of fines mobilization compared to coupled effect of salt precipitation and particle entrapment [
Generally, injectivity impairment induced by particle entrapment increases with average particle size in the inlet fluid,
Reviewing the previous works on CO2 injectivity has thrown up many questions in need of further investigation. Some of the highlighted concerns are as follows.
Most of previous studies that have been made in the context of CO2 storage have focused on salt precipitation. Little experimental work has been performed to better understand near-well rock compaction, impact of temperature and operational parameters (drilling mud, residual hydrocarbons in pores). To give research-based advice on injectivity loss it is necessary to take geology and geomechanics into account. These cannot be reliably assessed without studying radial flow of CO2 (both injection and backflow) under true subsurface stress conditions. Temperature issues should also be considered for the cases such as injection of cold CO2 with potential to fracture the near-well rock and thus increase the permeability.
Further work is required to enable direct pore-scale, real-time visualization of fluid-solid interactions with representative pore-geometry and realistic surface interactions between injectant, reservoir fluids and the formation rock.
Current research approach to understand the reaction mechanism of CO2-brine-rock for CO2 sequestration are mainly limited to pure CO2. However, due to high cost of gas purification, industrially sourced injection stream CO2 contain impurities such as SO2 which when dissolved in formation water will increase acidity beyond that of carbonic acid formed through CO2 dissolution alone and may also have different reaction mechanism towards rock minerals present in subsurface CO2 storage. Therefore, there is a need for a study to evaluate the effect of CO2 and impurities in brine solution on chemical and physical rock properties.
Majority of the dynamic CO2 injection experiments are conducted within a limited time considering the limitation of available equipment. Therefore, there is an argument among the researchers on the sufficient CO2 solubility into the brine and establishment of acidic environment that is critical in geochemistry study. Any future work to extend the CO2 exposure time is highly recommended to identify the extended scale accumulation, mineral dissolution, and fines migration problems.
Recent work on wettability during CO2 injection has focused on the wettability changes of glass micromodel and shows that with increasing ionic strength, contact angle increases with increasing residence time. However, with understanding that fine particles released during CO2 injection, may have not been exposed if the surface of the rock, its wettability may be slightly different or remain unaffected. Investigating the wettability of the released fines particles may provide insight on the behavior in which the fines particles migrate and accumulate.
When it comes to mechanical stability, initial studies have shown that cyclic injection and shut-in may influence borehole deformation. This is probably exacerbated if some drawdown is experienced upon shut in. Shut-in cycle frequency effect on the amount of borehole deformation should be studied in more detail.
Available field data and observation reports indicate the occurrence of injectivity loss. However, detail investigation analysis on the main issues that caused the problem is limited to certain fields. While there are more than 20 active fields worldwide, it should not be challenging to share their findings since the CO2 mitigation would require collaboration.
In this chapter, a review of the current literature indicates that dissolution, precipitation, and fines mobilization are the main mechanisms that cause CO2 injectivity impairments especially in deep saline reservoirs. Dissolution of carbonate minerals due to CO2-brine-rock reaction is dominant and could increase the porosity and permeability of sandstone core samples. On the other hand, detachment, precipitation of salt and clay minerals and deposition of fines particles would decrease the permeability and even clog the flow paths despite net dissolution. The effect of these two seemingly opposing processes on CO2 injectivity has been clearly demonstrated through numerous experimental studies supported by some field reports. However, the results are case dependent and lack generality in terms of quantifying the petrophysical damage.
There are many underlying parameters with positive and negative impacts on CO2 injectivity. It has been highlighted that injection scheme (flow rate, time frame), mineral composition (clay content, sensitive minerals), particulate process in porous media (pore geometry, particle, and carrier fluid properties), and thermodynamic conditions (pressure, temperature, salinity, CO2, and brine composition) have substantial effect on fines migration during CO2 injection. However, there is abundant room for further progress in determining the impact of different fluid-rock mechanisms on CO2 injectivity.
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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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