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More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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Significant advancement has been made recently, which not only provides insight in to the pathophysiology of the disease but also helps to discover new therapies to fight the deadly disease. If accurate diagnosis and typing are made early, effective or even curative therapies are available. Unfortunately, because of the rarity of the disease and its protean clinical manifestations, patients may be misdiagnosed, especially at early stage of the disease, and this could lead to missed opportunities to effective therapy. The aim of the book is to help readers become familiar with the clinical presentation of amyloidosis and to review the latest diagnostic and therapeutic development.",isbn:null,printIsbn:"978-953-51-1100-9",pdfIsbn:"978-953-51-7160-7",doi:"10.5772/46140",price:119,priceEur:129,priceUsd:155,slug:"amyloidosis",numberOfPages:250,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"666d7fe7d19d8ae8be3c9bcc06945cba",bookSignature:"Dali Feng",publishedDate:"June 12th 2013",coverURL:"https://cdn.intechopen.com/books/images_new/3344.jpg",numberOfDownloads:24579,numberOfWosCitations:10,numberOfCrossrefCitations:20,numberOfCrossrefCitationsByBook:2,numberOfDimensionsCitations:40,numberOfDimensionsCitationsByBook:2,hasAltmetrics:1,numberOfTotalCitations:70,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 24th 2012",dateEndSecondStepPublish:"May 15th 2012",dateEndThirdStepPublish:"August 19th 2012",dateEndFourthStepPublish:"November 17th 2012",dateEndFifthStepPublish:"December 17th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"157948",title:"Dr.",name:"Dali",middleName:null,surname:"Feng",slug:"dali-feng",fullName:"Dali Feng",profilePictureURL:"https://mts.intechopen.com/storage/users/157948/images/system/157948.jpg",biography:"Dr. Dali Feng was born in China, where he completed his medical school training. 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He is also an accomplished cardiovascular researcher, with publications of more than 60 abstracts, 40 original manuscripts and five books’ chapters.\n\nIn his spare time, he enjoys fishing, canoeing, and rollerblading.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1046",title:"Infectious Diseases",slug:"infectious-diseases"}],chapters:[{id:"44870",title:"“Amyloid” — Historical Aspects",doi:"10.5772/53423",slug:"-amyloid-historical-aspects",totalDownloads:3185,totalCrossrefCites:8,totalDimensionsCites:15,hasAltmetrics:0,abstract:null,signatures:"Maarit Tanskanen",downloadPdfUrl:"/chapter/pdf-download/44870",previewPdfUrl:"/chapter/pdf-preview/44870",authors:[{id:"158800",title:"Dr.",name:"Maarit",surname:"Tanskanen",slug:"maarit-tanskanen",fullName:"Maarit Tanskanen"}],corrections:null},{id:"42643",title:"Diagnosis of Amyloidosis",doi:"10.5772/52901",slug:"diagnosis-of-amyloidosis",totalDownloads:2054,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Cezar Augusto Muniz Caldas and Jozélio Freire de Carvalho",downloadPdfUrl:"/chapter/pdf-download/42643",previewPdfUrl:"/chapter/pdf-preview/42643",authors:[{id:"30432",title:"Dr.",name:"Jozélio",surname:"de Carvalho",slug:"jozelio-de-carvalho",fullName:"Jozélio de Carvalho"}],corrections:null},{id:"43676",title:"Cardiac Amyloidosis: Typing, Diagnosis, Prognosis and Management",doi:"10.5772/53763",slug:"cardiac-amyloidosis-typing-diagnosis-prognosis-and-management",totalDownloads:2009,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Glenn K. 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\r\n\tMass production companies are facing new challenges in the fourth industrial revolution that could have a major impact on their market position. Increasingly dynamic customer demand requires the implementation of new mass-production solutions to meet specific customer needs with the efficiency of mass production. Mass production is not only a technological challenge, but the related logistical solutions also play a major role in the improvement of efficiency. In addition to the automation and robotization of technological and logistical processes, the role of human resources in mass production cannot be neglected. Based on these facts, this book intends to contain studies that cover five major disciplines related to mass production. The first of these areas is the Sustainability of Mass Production Systems, which focuses on energy efficiency, greening, emission reduction, and the environmental impact of mass production. The second topic will cover the logistics and material handling processes of mass production from automation, supply chain design and operation, autonomous material handling, and logistics 4.0 solutions point of view. The third topic will include the main topics of technologies in mass production, while the fourth part will focus on the importance of human resources. The fifth part will include the state-of-the-art IT solutions for mass production.
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From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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To reach this goal, provider organizations and third-party payers in healthcare facilities are implementing a variety of innovative high-quality programs in areas such as primary care [2–4], mobile health [5], and family care [6]. Although these sophisticated services provide invaluable resources for patients, in many cases they operate as silos, therefore, sometimes creating a complicated web of separate services which patients have to decipher. The patient-centered medical home (PCMH) is intended as a systematic approach for organizing primary care to coordinate and integrate healthcare services to provide a seamless platform of high-quality care considering the full spectrum of a patients’ healthcare needs, with the goal to enhance patients’ experiences [7, 8]. The term “home” is meant to describe friendly, accessible, personal, and supportive health care which is provided by one healthcare team and through the coordination of care when needed [9].
\nCurrently, a variety of healthcare facilities and organizations have implemented different types of PCMH models [10–12]. Although there are several review papers that summarize the current design of PCMH models, implementation strategies, and latest evaluation results from pilot PCMH models [7, 13, 14], some topics are not discussed, such as the design of measurement tools to track the performance of PCMH implementation and the composition of PCMH teams. It was found that the Department of Veterans Affairs (VA), Veterans Health Administration (VHA) PCMH model, called Patient Aligned Care Team (PACT) model [15–17], includes innovative resources and tools to contribute to healthcare teams planning to develop a systematic approach to data-driven decision-making in healthcare transformation for future PCMH model. Integral to the success of the PACT model was the PACT Collaborative, which aided implementation.
\nThe goal of this chapter is to systematically review the existing designs of typical PCMH models, such as the scope of PCMH projects and implementation strategies, examine process monitoring and measurement tools, and outcomes from quality of care measures such as patient satisfaction and staff efficiency. In addition, the author will outline VHA’s realistic transformation opportunities and challenges in implementing PACT into their integrated healthcare systems on a national scale using the PACT Collaborative. The author will give examples of lessons learned by researchers, clinical staff, and policy partners during the early stages of PACT implementation which will be informative to other managed care or Accountable Care Organizations (ACOs) engaged in implementing PCMH models and may serve as a guideline to develop suitable models and implementation strategies for different healthcare organizations.
This review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards [18]. An electronic search was conducted through the PubMed database for papers relative to the PCMH model and collaborative healthcare models published from January 2000 to March 2013. The search strategy used the text keywords for patient centered or medical home and related concepts for eligible study designs. The included studies were published in English and indexed from database inception. The exact search strings are listed in Table 1, and details of the number of articles in each category are listed in Table 2. This search found 1559 articles published during this time period.
Collaborative model design | Key components |
---|---|
Customer population | |
Disease type | |
Improvement model | |
Learning session | |
Action period | |
Sustainability | |
Industrial engineer | |
Measurement tools/data analysis method | Change package |
Measurement tool | |
Process mapping | |
Voice of customer | |
Information technology | |
Electronic record | |
Outcomes | Care collaboration |
Access management | |
Practice redesign | |
Care integration | |
Hospital utilization | |
Patient satisfaction | |
Quality of care | |
Chronic disease | |
Team communication | |
Process efficiency | |
Cost savings |
Search terms used for article search.
Number of articles | ||
---|---|---|
1/1/2000 to present | 2010 to present | |
Patient-centered medical home model | 1559 | 569 |
Measurement tool | 8 | 3 |
Information technology | 618 | 199 |
Improvement model | 179 | 66 |
Learning session | 15 | 1 |
Action period | 11 | 0 |
Sustainability | 48 | 14 |
Voice of customer | 2 | 0 |
Care collaboration | 172 | 71 |
Access management | 108 | 54 |
Practice redesign | 25 | 15 |
Team communication | 94 | 37 |
Chronic disease | 170 | 73 |
Model design | 247 | 101 |
Electronic record | 39 | 20 |
Hospital utilization | 54 | 18 |
Patient satisfaction | 270 | 85 |
Quality of care | 587 | 248 |
Care integration | 101 | 45 |
Industrial engineer | 0 | 0 |
Change package | 1 | 0 |
Process efficiency | 25 | 5 |
Cost savings | 26 | 12 |
Number of articles in each category.
The titles and abstracts obtained from the electronic search were screened by reviewers independently to eliminate duplicates and exclude articles not related to PCMH models and those that are not based on patient centered or medical home models. A full-text review was performed on the remaining articles, and abstracts were selected for inclusion in this review based on the following specified criteria: (1) All the articles should be peer-reviewed; (2) All interventions should meet the definition of PCMH defined by Agency for Healthcare Research and Quality (AHRQ) [19]; and (3) Outcome evaluations should be data-driven and generated from practical implementation of the PCMH model. Since it was found that there was a lack of consistent definitions and nomenclature for PCMH, a manual reference review of relevant review articles was conducted and an additional four papers were identified. Overall, the search process resulted in a total of 48 articles in the final systematic review. The article selection process is shown in Figure 1.\x3c!-- Please check and approve the edit made in the sentence “The titles and abstracts…or medical home models.”
PCMH model article search results.
Based on the approach described in AHRQ’s “Methods Guide for Effectiveness and Comparative Effectiveness Reviews” [20], each paper was evaluated independently by two reviewers. Using the predefined criteria for methodological quality and adequacy of reporting for each study type, the quality of the study was judged in three levels: good, fair, or poor. Results of interest examined for PCMH effectiveness included key model components, data collection and analysis methods, performance measurement tools, quality improvement processes, care collaboration, and cost savings.
\nAs a new delivery model for primary care, the PCMH model provides comprehensive and coordinated care [21–23]. Systematic review results revealed various PCMH models are widely designed and verified by research institutes [17, 19], healthcare organizations [9, 24], clinical physicians [25–27], and other stakeholders [28–30]. Although most of the PCMH models share a similar mission to provide patient centered, comprehensive, and accessible care [31], there is substantial diversity not only in the scope of PCMH demonstration projects and patient types, but also in the implementation strategy at pilot sites.
\nMost of the PCMH models are natural extensions of overall healthcare management or area-wide quality improvement initiatives. For example, the PACT model focuses on access, care coordination and management, and practice redesign for primary care, which covers patient access [32, 33], healthcare business process redesign, and care organization problems. However, some models only focus on specific types of diseases. For example, chronic care collaborative models require long-term cooperation among cross-functional members [34–38]. Typical diseases of interest for chronic care collaborative include diabetes [39, 40] and cardiovascular diseases [41]. Furthermore, the complexity level of each disease is a vital factor for PCMH model design in these cases [42]. For those PCMH models which are developed to improve complex diseases, such as cancer care [43], it is important to enhance seamless cooperation among specialists [44, 45], primary physicians, nurses [29], pharmacists [46], and social workers [47].\x3c!-- Please check the following sentence “For those PCMH models which...” for clarity.
There are also considerations for implementing PCMH models to focus on other subsets of the population, such as women. For PACT model, this is certainly a worthy area of focus as women now represent the fastest growing segment of new VA users [48]. Women tend to also have complex healthcare needs, which may affect how VA care is organized, providers are trained, and how the VA can best deliver gender-sensitive primary care.
\nImplementation strategies vary widely across each healthcare system. Although each PCMH model has its unique objectives, a high-functioning interdisciplinary primary care teams are required as a critical component of the patient-centered medical home for them to collaborate. A core feature of PACT which showed huge promise for improving primary care at the VA was the creation of teamlets (small teams). A PACT teamlet required reorganization of primary care personnel into assumed new roles. It is a primary care team that generally consists of a primary care provider (MD, NP, PA), registered nurse care manager, clinical associate (LPN or medical assistant/health technician), an administrative associate (MA/MSA/health technician), and pharmacists, and they are integrated to provide on-site, in-office coordinated care [28, 30, 49]. The transformation into this team-based approach requires the following: (1) ensuring adequate staffing in all team roles, (2) devoting resources to in-depth training for all employees in communication and other skills needed to maximize team success, and (3) aligning the broader hospital system with PCMH decentralized, team-based approach [50, 51].
\nTeam-based model is a fundamental shift in the roles and relationships among clinical personnel. Therefore, it creates a need for a more nuanced team-based audit, since currently the ownership of clinical performance still rests largely with the provider, despite the move to more team-based health care [52]. The team-based model can also create an opportunity to mitigate any discontinuity of care due to residency transitions [53].
\nDuring the beginning stages of strategic planning for implementing VA’s PACT, top challenges faced by primary care directors were reviewed and included clinical informatics, chronic pain management, and care coordination [54]. In the early stages of implementation, several challenges were identified to move to the team-based approach including: (1) short-staffing undermined development of team-based working relationships; (2) lack of co-location of PACT members in clinic and difficulty communicating with residents when they were off-site hampered communication and; (3) limited clinic hours of part-time primary care providers and residents prevented clinicians to get the training and reinforcement of PCMH principles which delayed the team formation [55].
\nConsidering the many challenges to transitioning to a team-based approach, PACT’s implementation strategy consists of various supportive initiatives including a national face-to-face kickoff conference, American College of Physicians (ACP) Medical Home Builder survey, the Centers of Excellence learning centers, national conference calls, common metrics, and the PACT Collaborative [17].
\nSome non-VA PCMH models use similar steps as the PACT, whereas others used the following: (1) emphasizing the role of nurses in educating patients [56], (2) PCMH principles based on complexity, care-coordination activities, and techniques to measure family satisfaction [57], (3) patient-centered care plan (PCCP) document to enhance care for complex patients and change the relationships with health team members [58], and (4) the adoption of PDSA cycles in PCMH implementation in large primary care and multi-specialty medical groups [27].
\nCommunication among multiple stakeholders is regarded as one of the key factors to ensure high quality of care. PCMH projects normally involve cooperation of multiple stakeholders and some of the reported key communication barriers for clinicians when performing across-discipline consultations include as follows: (1) lack of effective standardized communication processes, (2) practice style differences, and (3) inadequate PC training [59]. Sharing of real-time information on the status and results of PCMH projects and integrating the instant feedback into decision-making are two key factors that contributed to the final achievement of each PCMH-based project. Multiple supportive technologies and methods are deployed to facilitate communication, such as conference calls,electronic communication, and group e-mails [9, 17]. In addition to these tools, PACT utilizes the Microsoft SharePoint™ platform to share all real-time information which records all the updates with version tracking of supporting documentation [9]. In addition, the collaborative initiative within PACT adapted the Institute for Healthcare Improvement (IHI) Breakthrough Series Collaborative model [60], to deploy a web-based communication platform to train team members (similar to an e-learning system) and web-based storyboards for teams to review the results [61]. Within PACT, there is also a “toolkit” used at VA facilities nationwide to support teams to share, download, and adopt information in order to more effectively implement PCMH principles and improve local performance on VA metrics [62]. The toolkit is an online repository of ready-to-use tools created by VA staff (physicians, nurses, and other team members). PACT team member perspectives on the toolkit ranged from enthusiastic to not having time to review the contents of the toolkit.
While PACT Collaborative utilizes “PACT Compass” metrics [63] from VHA’s information systems to organized broad domains, such as access, coordination of care, and continuity, most other PCMH implementation strategies dedicate considerable resources to direct practice support by helping the teams reorganize workflows and provide tools to enhance practice capacity. A Physicians Practice Connection-PCMH (PPC-PCMH) model categorizes the principles into different levels based on their priorities and gives a numeric score of 0–24 points to the performance [64]. Some measurement tools are web-based with data automatically collected by Health Information Technology (HIT) systems [65], such as electronic medical records [66, 67]. The traditional ways of data collection, such as direct observation [68], patient interview, internal survey [58, 69], and audio recording [33], are used to collect information about patients’ opinions.
\nMonthly and annual reports are utilized to track performance improvement and to compare the practice results of PCMH models. Some PCMH models invite clinical staff, such as physicians, to summarize the results of the medical treatment improvement by adopting the PCMH model [68]. In the PACT Collaborative, 250 medical teams from five regions were required to submit monthly performance reports to record a core set of metrics that assessed the program’s impact on access, continuity of care, patient engagement and satisfaction, panel management, coordination of care, and clinical improvement [17].
\nVoice of customer (VOC) analysis is a useful tool to collect information about the current state of the healthcare business process, identify the potential problems, define the overall improvement goals, and test the acceptance rate of PCMH model by end users. Several projects use customer surveys to gather data from multiple stakeholders and analyzed the results by some statistical algorithms, such as regression modeling and standard ordinary least squares [70]. As of March 2012, Veterans Affairs include questions in the Survey of Healthcare Experience of Patients (SHEP) [71] to help understand the Veterans’ satisfaction with VHA ambulatory care and to support assessment of VA’s initiative to provide Veteran-centered primary care through the implementation of PACT.
\nWhile the use of relevant performance measures is an effective guide for quality improvement in PCMH models, there is little information in the literature on staff perceptions of performance metric implementation in these PCMH settings. Based on research conducted in PACT, it was found that primary care staff perceived performance metrics as time-consuming and not consistently aligned with PACT principles of care. Also, they found that metrics were as follows: (1) not reflecting Veteran’s priorities, (2) represented an opportunity cost, (3) implemented with little communication or transparency, and (4) not well-adapted to team-based care. Based on this, it appears that there are gaps between the theory and reality of performance metric implementation, and these gaps should be considered when implementing a PCMH [72].
Quality of care is considered one of the most important indicators to judge the effects of new process improvement models. Christensen et al. [73] verified that the Walter Reed PCMH had reduced costs while at least maintaining, if not improving, access to and quality of care, and to determine whether access, quality, and cost impacts differed by chronic condition status. Henderson et al. [74] discussed the guiding principles of PCMH model to improve quality of care and demonstrated these principles with a case study from the experience of a care coordinator in a rural PCMH in Maine. Rosenberg et al. [75] reported on the experience of University of Pennsylvania Medical Center Health Plan as part of a large, integrated delivery and financing system of PCMH to improve access to high-quality care for more Americans at a lower cost.
\nPCMH models have the goal of improving the patients’ satisfaction and staff efficiency. Access management is one of the vital aspects that affected patient satisfaction. True et al. [22], identified successful strategies used by early adopters to overcome barriers to change the access management, which might increase patient satisfaction. Segel et al. [76] demonstrated that the patient-centered collaborative care model could improve discharge efficiency, staff communication, and patient satisfaction. However, the relative research to verify the performance improvement of medical staff members is lacking in comparison with the research that explored patient satisfaction. The patient satisfaction survey in the PACT model (SHEP) supported positive outcomes of patient access improvement [71]. Jaen et al. [32] evaluated patient relative outcomes, which included satisfaction with service relationship after implementing the PCMH model for more than 2 years.
PCMH models have the potential to reduce costs [77] and create optimal strategies for healthcare utilization. Based on the selected articles, the cost reduction analysis mainly focuses on emergency department utilization, inpatient admissions, and total costs. Adoption of the PCMH model has been shown to reduce patient waiting time, improve access to care, and reduce inappropriate emergency room care [78, 79, 80], especially for the elder group of patients. Domino et al. [81] described a case study to show the decrease in emergency department utilization for children with chronic and serious diseases. It is the intention of the VA to evaluate the impact of the medical home on admissions and emergency department use, both of which may serve as proxies for cost [17].Although the cost among PCMH patients was significant in the first few years and may be higher than non-PCMH patients considering the project cost [82], the expected projected reduction of cost of the PCMH model as the project is extended more long term is not discussed in detail within the articles.
In 2010, VHA (the largest integrated healthcare system in the United States, serving more than 8 million veterans) launched PACT (a national implementation of a PCMH model) to transform primary care delivery by improving the delivery of patient-centered care. PACT’s aim to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient driven and patient centered [83]. This national rollout of PCMH to all VA primary care practices in more than 150 medical centers and over 800 community-based outpatient clinics (in 900 primary care clinics nationwide, with 120 located in academically affiliated medical centers) aimed to offer accessible, comprehensive, and seamless care for meeting the customized needs and expectations of each Veteran [9, 84]. As a result, over 7000 primary care teams across the nation are in the process of transforming their operations.
\nThe PACT model (Figure 2) was designed to translate the PCMH model’s symbolic vision of a “home” into a tangible implementation plan where the roof and overarching goal are patient centeredness. The foundation of the home includes critical resources and the use of process improvement methodologies such as LEAN [85]. The three pillars of the PACT model are access, care management and coordination, and practice redesign. Each pillar represents a vital content area necessary to achieve a true patient-centered medical home and includes several primary and supporting measures to record the progress on each aim, summarized in Appendix 1.
PACT three-pillar model. Reproduced with permission [
VHA facilities that were most successful in implementation of the overarching goals have an internal capability for organizational learning and development [86], and deployable evidence-based quality improvement strategies that give teams the tools needed to adjust structures and processes to meet their goals [87]. In addition to the individual efforts being conducted at each facility, VHA used a collaborative learning model, PACT Collaborative [88], as a key approach to disseminate PACT concepts and changes, with the intention to successfully support the implementation goals of the PACT model in each facility.\x3c!-- Please check and approve the edits made in the sentence “In addition to the…PACT model in each facility.”
The PACT Collaborative is a learning environment based on the IHI Breakthrough Series Collaborative model [89] (Figure 3). Figure 4 illustrates the modifications, which are the addition of VHA national process improvement TAMMCS (vision, analysis, team, aim, map, measure, change, and sustain) along with the inclusion of 3 additional learning sessions [90] (Figure 4).
Institute for Healthcare Improvement (IHI) Breakthrough Series Collaborative Model.
PACT three-pillar model. Reproduced with permission [
The PACT Collaborative model was made up of five regional PACT Collaborative and approximately 250–350 individuals from 141 teams participated in six face-to-face learning sessions across 21 months, where learning sessions were adopted for exchanging ideas through peer-to-peer meetings and audio conferences, and training a sample of patients or caregivers from patients’ families with basic and necessary medical information. In each of the regions, there were industrial engineers (IEs) and coordinators from the Veterans Engineering Resource Centers to serve as coaching, teaching, and process improvement experts to collect data, track improvement progress, and make process improvement decisions [88]. This novel addition to the program brought an unparalleled level of quality improvement expertise. Their work involved problem analysis, aim definition, team creation, principle and measurement tool design, performance improvement with the combination of learning sessions and action periods, and Plan-Do-Study-Act (PDSA) [91] cycles.
\nWithin the PACT Collaborative, Excel-based measurement tools, PACT Compass (a consolidated combination of care quality measures) was used to track the overall PACT PCMH model from the national level to provide system-wide sharing of data and allowing performance improvement to be monitored at the team level [92].The performance measures in the collaborative were as follows: (1) PACT Collaborative participant surveys; (2) Coach Assessment Scores and Plan-Do-Study-Act (PDSA) data; and (3) PACT Compass (national measures to assess PACT implementation within VA healthcare system). At the end of the collaborative, most participants reported the PACT Collaborative was needed to implement PACT. Team members reported that involvement of the industrial engineers, use of the measurement tools, the change packages, and monthly reports improved teams’ performance from all perspectives related to access, care coordination, and knowledge gains by the teams [88]. Over 80% of the teams were successful in process improvement initiatives that increased the number of same-day appointments, increasing non-face-to-face care, and improving team communication [87].
Based on the results of the review, there is a significant opportunity to document the progress of PCMH projects and identify standard performance measurement indicators for PCMH models. If more standard performance measurement indicators are identified and used, future meta-analyses could be performed to distinguish the effects of the PCMH models in comparison with non-PCMH models or current practices. The PACT model, utilizing the PACT Collaborative, can serve as a guideline to develop suitable models and implementation strategies that include evaluation tools inherent to a successful PCMH model for healthcare organizations.
\nThe PACT model and a few other models from the review mentioned monthly reports and documentation to track the status of PCMH projects; however, there was no standard format for reports and many evaluations are not documented well enough to demonstrate the results of models, and often those that are documented can only identify non-generalizable outcomes [93]. The PACT model is unique in that the PACT Collaborative heavily utilized industrial engineers in partnership with clinicians as part of the core planning and project team to review monthly reports, analyze the results, and assist the faculty for further improvement suggestions. By employing such strategies as process mapping, VOC analysis, PDSA cycles, and a variety of communication techniques, the PACT model was able to document their progress and improve outcomes. Other PCMH models have had difficulty in implementation due to a lack of staff trained in the implementation methods and the burden of data collection [94].
\nAlthough the articles in this review did not uncover cost reductions associated with PCMH, recent research has discovered the actual cost savings occur once full implementation, versus partial implementation, of the model has been actualized [95]. To ensure the implementation results and improvement of quality care and collaboration efficiency, all stakeholders should have assessment methods to evaluate the performance and a road map to guide them to implement customized PCMH models into their facilities successfully. Data collection and analysis are important elements to summarize the achievements from previous steps, identify the valuable stories to share with other groups, and sustain the results to broader adoption fields. However, there is a need for a comprehensive theory to select key indicators which could evaluate the PCMH model. In addition, more efficient technologies to share and integrate real-time information about collaborative procedures are needed.
\nWhile PACT primary care personnel viewed PACT positively as a model, they reported insufficient staffing and low-functioning team members as barriers to achieve highly functioning teamlets [96]. In response to this, the PACT Collaborative could resolve these barriers with evaluation tools and team member training, as one study confirmed the Collaborative enabled care teams to achieve over 80% of their aims, increased the number of PDSAs through implementation to 93%, and was deemed necessary to implement PACT [88]. Additionally, team process and effectiveness measures had stronger associations with perceived improvements in teams’ abilities to deliver patient-centered care [97].
\nThe collaborative learning model may also be an effective way to leverage a small number of staff and personnel across a large patient population [88]. As such, specialty-care clinics could be converted to function as a PCMH as these clinics often continue to operate as silos within a large, integrated healthcare system and are still functioning with a wide variation in patients’ receipt of care [98]. Overall, the VA’s PACT model, and particularly the PACT Collaborative within this model, addresses many of the obstacles PCMH models face from implementation to evaluation and may serve as a benchmark for future PCMH planning in order to enhance future models.
A limitation of this review is that it excluded the collaborative models which are not patient centered or patient oriented. In the future, it could be an interesting area of research to compare similarities between models which are patient centered and those which are not patient centered.\x3c!-- Please check and confirm the hierarchy of the section headings and also check the order of the sections “Conclusion” and “Discussion.”
More research should also focus on the added patient values and return-on-investment of the PCMH models, particularly over a longer course of time. Another possible area for future research would be to build upon health information technology (HIT), such as electronic health record and electronic identification which could streamline the process of information exchange, and increase the patient’s access to health services. Although the current HIT can support many of the core principles of PCMH, it does not have all the functionalities to facilitate the model directly, which might be a potential research focus for healthcare-IT specialists.
\nIn summary, the PCMH model has been recognized as a promising solution to supply patients with advanced primary care service. There is a large variety in the scope of current PCMH projects, as well as in the design, implementation, and evaluation of these projects. The PACT model is a large, successful example of a national PCMH project, and along with the PACT Collaborative, could serve as a standard for future PCMH models to reference when determining their designs, implementation strategies, and evaluation techniques.
The author would like to thank Xiaoyu Ma, PhD for assisting with the literature search and serving as a second reviewer along with the author. Thanks are also given to Amanda Kovach for her assistance editing and proofreading the manuscript.
\nAim | Primary measure | Supporting measure |
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Access |
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Practice Redesign |
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Care Coordination and Management |
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Summary of the primary and supporting measures.
Asthma and COPD are two diseases related to eosinophils in which eosinophils are the main cause and journals have evidence an increase in their number in the blood with or without evidence of their activation. But at present, we do not know with certainty how much these cells participate in these diseases, beyond that the treatment of the underlying cause produces the resolution of eosinophilia in a “reactive” way. Eosinophil-related diseases are a spectrum of systemic diseases such as Asthma and COPD in pneumology area. Even within the principal diseases related to eosinophils, the location, type of tissue involved, and magnitude of eosinophilia vary greatly. Under inflammatory conditions, the number of circulating eosinophils or tissues can increase dramatically, with rapid development of eosinophilia and we can obtain in a simple laboratory test. In general, the number of eosinophils in the blood can provide useful information and considering the differential diagnosis and for the subsequent test of patients presenting with eosinophilia. Currently eosinophils has taken a very important role in the treatment of severe diseases, we know are so prevalent and increased morbidity and mortality in serious phases which produce a lower quality of life in patients, the treatment of eosinophilia currently in number of 300 cells in which is the criteria and the target to be treat. The best known and most used of all treatments for diseases related to eosinophils are corticosteroids, which decrease circulating and tissue eosinophils in a few hours, through mechanisms that include the direct activation of eosinophil program death. But, under certain circumstances, eosinophils can become resistant to these drugs or in the presence of high levels of eosinophil survival cytokines, such as IL-5 by example. With the administration of anti-IL-5 antibodies, such as mepolizumab or reslizumab the blood eosinophils typically decrease by at least 80% within a few days, without decreasing them much in the tissues, such as in the lower airways. Asthma, presumably due to the action of other eosinophil cytokines, such as GM-CSF, present in tissues. Comparatively, the administration of benralizumab, an anti-IL-5 antibody that acts on the IL-5 receptor, causes a much deeper and longer decrease in eosinophils, by activating antibody-dependent cellular cytotoxicity. Targeted treatment against eosinophils in eosinophilic asthma and eosinophilic COPD decreases exacerbations and could improve airway remodeling through mechanisms that are not fully known, and their effects on lung function are variable and decreasing symptoms in patients.
\nData from multiple studies in asthma and eosinophilic COPD suggest that they are safe long-term drugs despite the decrease in eosinophils over time, as well as being well tolerated. Eosinophils exist in virtually all vertebrates as part of the innate immune system, which underscores the important benefits they must provide to their guests. In humans, they are in normal ranges when their blood levels are <500 / μL, although this number can vary between 350 to 600 depending on the laboratory. Eosinophilia is defined when its number is>300/μL in the recent studies and guidelines [1, 2].
\nFor eosinophils to develop, a unique set of transcription factors is required, which if not present, do not develop (Figure 1). Similarly, the eosinophil lineage depends on the appearance of a specific receptor on its surface for IL-5. The expression on the cell surface of the IL-5 receptor is one of the first events for the development of the specific eosinophil lineage that occurs in the bone marrow, although recent data in rats suggest that another cytokine, the IL- 13, has a role in increasing the differentiation of eosinophils at a point “upstream” to that of IL-5. Although the source of IL-5 and IL-33 within the bone marrow necessary for the development of eosinophils is not known exactly, it is likely that T cells and certain innate lymphoid cells (CLI2) are the important sources, at least for IL-5 [2].
\nThe eosinophil.
Most of what is known about eosinophils in terms of their roles in health and homeostasis, comes from data obtained from animal studies. It is believed that eosinophils contribute a large amount of beneficial substances that help in the development, remodeling, and tissue repair. Their roles in innate and adaptive immune responses include the favorable influence on the development of immune cells, provide antibacterial, antifungal, and antiviral responses and help control glucose metabolism, myocyte regeneration, lean fat development and adiposity. Most of these functions have been demonstrated in animal models, so their reality in humans is uncertain. In addition, although the very important role of eosinophils during type 2 immune responses against helminths and other parasitic infections is considered almost dogmatic, their total certainty in humans is controversial because in many patients in pandemic parasitic infections we know have increase eosinophils and we do not the normal range in laboratory test and the main changes that decreasing of increasing (Figure 2). Therefore, despite the growing interest in knowing what eosinophils actually in the immune system and in disease circumstance, in the nest days we need to know and much remains to be investigated [3].
\nThe eosinophil cycle and function.
COPD and asthma have a pathogenic and pathophysiological basis easily differentiable in most cases. They also share a series of clinical similarities that often make their differentiation complex, especially in-patient smokers with a history of atopy and eosinophilia. But we have patients with combined symptoms and different phenotypic. The characteristics clinics shared by both diseases are based on inflammation and airway obstruction, now we know in certain papers that COPD is a fibrotic disease but when the patient have some allergic characteristics the disease is like an inflammatory problem and the eosinophils have a role in both. The incomplete reversible and progressive in COPD and variable and reversible in asthma. Also, the location of the inflammatory response in these pathologies also have differences, allowing to locate the predominant involvement of COPD in the peripheral airway and in the pulmonary parenchyma, in contrast to the respect of pulmonary parenchyma and panfocal airway involvement in asthma. The cell count obtained from bronchioalveolar lavage (BAL), induced sputum and bronchial biopsies in patients with COPD demonstrate the predominant presence of neutrophils, CD8 + T lymphocytes and abundant macrophages. In asthma, eosinophils, mast cells, CD4 + T cells and fewer macrophages meet in samples representative of the tracheobronchial tree, but there are some patients with paucigranulocitic phenotypic. Inflammatory mediators also differ, playing a predominant role leukotriene-B4 (LTB4), interleukin 8 (IL-8) and tumor necrosis factor alpha (TNF-α), among others, in the case of COPD, while in asthma have found multiple inflammatory variables, represented for histamine, leukotrienes and interleukins 4 and 5.
\nThe fraction of exhaled nitric oxide in patients with asthma is found increased, reflecting the greater eosinophilic inflammation. Thus, it seems reasonable to define a high Th2 patient profile in a non-invasive way by using indirect markers such as IgE > 100 IU and blood eosinophils>300 cells/microliter, or eosinophils in sputum>3%. Along these lines, a recent study has shown that eosinophilia together with elevated levels of periostin was the best predictor of improvement in lung function in COPD patients treated for three months with inhaled corticosteroids and LABA. However, it seems that a more integrative approach, which unites clinical features and molecular mechanisms, is the best way to identify disease sub phenotypes and individualized treatments. The fraction of exhaled nitric oxide is poor studied in COPD, and we know there is not a confinable test to follow a patient we do not have inflammation or have both [3].
\nIn December 2017, we published in the journal Respirar de ALAT, a manuscript of the study findings of 50 Mexican patients in the outpatient pulmonology clinic at the University Hospital of Puebla, Mexico, the results were prevalence of eosinophilia (74% women and 26% men). 50% associated with smoking and 50% with exposure to biomass. 36% presented representative eosinophilia which indicated the relevance of this marker taking into account that 50% of all the patients studied were in GOLD IVD stage. Tine and colleagues pointed out that blood eosinophils may have a paradoxical benefit for COPD patients; In patients with blood eosinophil counts of 2% or more versus patients with counts of less than 2%, better lung function, better quality of life, fewer symptoms and less comorbidities have been reported. It has also been shown that the risk of pneumonia, regardless of the use of inhaled steroids, is lower in patients with eosinophil blood counts of 2% or more. These facts suggest, the authors wrote, that the use of eosinophil-targeted therapies can actually be detrimental to COPD patients [4, 5].
\nThe Eosinophils nowadays are the most inflammatory status seen in asthma, in patients that have persistent eosinophilic airway inflammation is a severe status in some cases. Because these patients have neutrophilic or paucigranulocytic count and separate in allergic and nonallergic patients with severe symptoms. The pathways for eosinophil recruitment are quite distinct. Allergic eosinophilic asthma is driven by Th2 lymphocytes. Allergens, presented to naive CD4+ T cells by dendritic cells, induce differentiation toward Th2 cells, which produce IL4, IL5 and leading to IgE class to airway eosinophilia and mucous hypersecretion. In nonallergic eosinophilic asthma, epithelium-derived cytokines (IL25, IL33, TSLP) are released in response to air pollutants, microbes or glycolipids (Figure 3). These bind to receptors on type-2 innate lymphoid cells (ILC2s), activating them to produce the Th2-associated cytokines IL5 and IL13, which lead to eosinophilia, mucous hypersecretion and airway hyper-reactivity, in the majority of allergic asthma cases, the presence of eosinophils may be a secondary consequence of the allergic cascade that recruits them to the site of inflammation in the evolution of the disease. In some patients, however, particularly those with severe, non-allergic asthma the eosinophil may play a more central role, possibly initiating the disease or persistent disease or persistent symptoms, these patients are typically older women with comorbid nasal polyps, aspirin sensitivity and late-onset asthma concluded in a different phenotypic [5].
\nAllergic and non-allergic eosinophilic pathways in asthma.
In COPD, inflammation is more commonly associated with T helper 1 lymphocyte (Th1)-mediated immunity driven by neutrophils, often in response to bacterial colonization. However, as with asthma, COPD presents as a number of different clinical phenotypes and, in around 10–40% of patients, a degree of eosinophilic inflammation is present during stable state. We published some cases with severe COPD versus health patients in a asthma clinic in Puebla, and we describe that we do not know when is the time to take a eosinophils sample and make a different diagnosis in the clinic, the patients came to take a sample in stable state and have minor eosinophils cells like health people, and concluded like we need to know when is the better time to take a eosinophils sample. The cell senescence likely plays a pathophysiological role in COPD (Figure 4) particularly in relation to the release of cytokines other factors from senescent cells, many of which are also implicated in the pathogenesis of COPD [5].
\nRelationship between airway inflammation and bronchial abnormalities in COPD.
The most important point in this chapter is the utility of measuring blood eosinophils as a biomarker to treatment in stable or exacerbating COPD. Blood eosinophil levels can either be expressed as an absolute count (150 cells) or as a percentage, actually there are many groups that define them, like <2%, ≥2–<3%, ≥3–<4%, <150 cells·μL − 1, 150–<300 cells·μL − 1, ≥300–<400 cells and ≥ 400 cells were used in the post hoc analysis of WISDOM. 2020 guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) have recommended blood eosinophil counts ≥300 cells in stable COPD as the diagnostic criterion for initiating therapy with ICS/long-acting β-agonist (LABA). However, eosinophilia is defined, the utility of the measurement is limited by the stability of the measurement. People with COPD often start treatment with Dual Therapy (LABA/LAMA) some people use monotherapy in some patients, but in some group of patients continue use inhaled corticosteroids like added, sure measuring the number of eosinophils and concluded the people who will benefit with this kind of therapy. Some patients experience a worsening of their symptoms known as an exacerbation and the eosinophils maybe predict the risk of exacerbations that is so important for clinicians treating this patients, but there is a pooled analysis in 2020 with Singh et al. concluded that in a pooled analysis of 22,125 patients with COPD, do not find a clinically important relationship between baseline blood eosinophils count and exacerbation rate and is not a clinically useful predictor of future exacerbation risk, I think maybe we can use in worsening symptoms in a single time of the life of the patient, COPD is dynamic and heterogenic disease, maybe we can use in some cases in which the patient worsening symptoms [6].
\nThe utility of measuring blood eosinophils to guide therapy is likely to vary depending upon the clinical status of the patient, i.e. whether their COPD is stable, or they are experiencing an exacerbation. Now in press we have a manuscript that we can show in a cohort with severe COPD patients and healthy controls the blood eosinophils count do not change in a single sample and the count was similar in the same group in the same time. The evidence suggests that measuring, eosinophil levels to help guide therapy is useful with measuring eosinophils count to use ICS/LABA, and reduction the use of inhaled corticosteroids y some patients that do not need this treatment. In COPD we need to consider the eosinophil count to choose treatment [6].
\nAnti-IL5 therapies are a great promise in patients with eosinophilic asthma, and we do not know if is the same to COPD, suggesting that depletion of eosinophils may not be a valid target in COPD. An initial study using the anti-IL5R antibody, benralizumab, in COPD patients with elevated baseline sputum eosinophils (≥3%) demonstrated numerical improvements in exacerbation rates, SGRQ-C and the self-administered Chronic Respiratory Questionnaire (CRQ-SAS) scores, and FEV1 (fraction exhalation volume in 1 second) however, these improvements were not statistically significant. Mepolizumab significantly reduced sputum and blood eosinophil counts compared with placebo in COPD patients with raised baseline eosinophils but, again, these differences did not translate into significant between-group differences in lung function parameters, exacerbation rates, and health-related quality of life. The role of eosinophils in COPD is complex and the benefits observed with ICS (inhaled Corticosteroids) are likely related to their effects on cells or pathways that do not involve eosinophils. These results suggest a potential role for eosinophilic airway inflammation on COPD exacerbations, but also clearly underline the fact that further studies are needed to refine the patients who may benefit from eosinophil-targeted treatments in COPD. The Benefit–risk ratio of ICS in patients with COPD based on blood eosinophil level in stable disease with increasing eosinophils counts, the use of ICS may offer increased benefit by reducing COPD exacerbations and always have precaution for development a pneumonia. ICS use in patients with lower eosinophils counts is potentially associated with decreased benefit and increased risk of pneumonia. Celli comment that the possibility that an easily obtained biomarker such as peripheral blood eosinophil count may help determine a patient’s risk for certain outcomes and likelihood of responding to specific therapy is very appealing. However, as in many areas in life, “the devil is in the details”, and more data is needed before blood eosinophil levels can be used to identify a COPD phenotype amenable to specific immunomodulatory therapy [7].
\nPeter G. Gibson et al. described to consider are those that lower the count and could lead to a false-negative test for diagnosis of the eosinophilic phenotype. These include eating, exercise, medications, and the time of testing. Consuming a light meal was found to reduce blood eosinophils between 2 and 4 h after eating, with an average 23% reduction at 4 h (from 130 to 100 cells/μL). Exercise also reduces blood eosinophil counts. For example, a symptom-limited exercise test in COPD patients reduced blood eosinophils at 2 h, with normalization by 24 h. In Puebla, Mexico in 2019 we compared two groups of patients in Asthma and COPD clinic, this two groups were: One group of severe COPD patients [6] and other group healthy subjects [6] workers for the clinic, the age of the patient were 45–60 years and we found that the eosinophil count was similar in the COPD group and the control group. A study was carried out in the Asthma and COPD clinic of the City of Puebla in a Private Angeles Hospital, the presence of two groups of patients with COPD and another as a control group of health workers, and we obtained very interesting data from the account of the eosinophils in a stable state of the patients, since they came voluntarily on a normal and stable day to take the eosinophil count and what were our results: the following: 2 groups of patients with COPD 1 group with 6 patients and the second group with 8 healthy workers. The patients with COPD were severe but in a stable and controlled state and presented an eosinophil count between 144 to 240 cells, and the group of health workers with an eosinophil range between 102 and 192 cells. This finding in this small cohort of patients as a pilot study allows us to see that patients with severe COPD may have low eosinophil ranges because they are stable and controlled just like healthy workers and subsequently be able to use the eosinophil range in some exacerbation of patients who may present an increase in eosinophils and change the therapy, this small work carried out in a particular clinic allows us to conclude that serious patients who have a stable state really have eosinophils in the normal range and the increase of 300 cells is really a figure in which We can make changes in therapy, but on the other hand, in stable patients, it would not be appropriate to take hematic biometry in the stability consultations because it would not be case knowing that the eosinophil count remains normal and only in an exacerbation take them to determine changes in current therapeutics. We concluded that in asthma patients the eosinophil count is variable than the COPD patients [8, 9, 10].
\nAs described earlier in this chapter, eosinophils are in these times of progress in the treatment of asthma and COPD one of the important pillars at different stages of the disease, as described earlier, approximately 4 years ago we did not have a marker that we allow you to change our decisions in the therapy of these patients in the stable phase or in exacerbations, it seems that its use is very bleak in stable patients, but already established a little more scientific in its use in exacerbations, every patient shows us one of the possible use of eosinophils in the whole path of the disease either in a stable phase or in exacerbation. In the definition of the disease its integration is clearly not useful, as well as in the epidemiological phase, but not in the diagnostic phase where it can be important to emphasize the phenotypes in the two diseases such as in asthma: eosinophilic asthma and in COPD as eosinophilic COPD. In the clinic it has not contributed great importance and we do not think it is relevant to know eosinophilia to determine if it is asthma or COPD even the spirometry is still the most important pillar of the diagnosis. in the classification of the disease it is of the utmost importance to determine if it is stable or exacerbated, as well as in the treatment that is vital to start steroid treatment, we know in asthma it is the pillar treatment of the disease not so in COPD but it allows to differentiate those responders to corticosteroids. Eosinophils at present and thanks to studies we can clearly establish its use at the beginning of the use of some biological medication to those patients with severe or exacerbated disease, as you know the exacerbations are those that deteriorate the disease and give a poor prognosis. As biomarker for biological initiation it is vital, as it has also been demonstrated in its use in the follow-up of patients, as part of the response to the treatment already established. There are still unknowns about the use of these cells in stable patients, we are developing a writing of the results of a pilot work on the values of eosinophils in stable patients with serious disease and healthy patients, these results will be shortly where we can show that in the stable patient there is still controversy in the use of treatment in patients with eosinophilia [10].
\nAsthma and COPD are two chronic diseases linked to exacerbations and possible quality of life of patients, the introduction of eosinophils as biomarkers in the evolution of the disease has opened a promising panorama as a biomarker in the classification of patients, their severity, prognosis and presence of exacerbations. Eosinophilia in these diseases is a reality and as pulmonologists we have a duty to always carry out that scrutiny that allows us to characterize our patients and to prescribe the appropriate treatment always taking into account the possible use of biologists in patients with severe disease. Both asthma and COPD are complex, heterogeneous conditions comprising a wide range of phenotypes, some of which are refractory to currently available treatments. These phenotypes and identification of biomarkers with which to recognize to guide an appropriate treatment for researchers and clinicians. The potential of blood eosinophils nowadays has potential and much attention in medical research to choose the optimal and correct treatment. In asthma, the rationale for their use as such is more clearly defined, with several well-controlled studies demonstrating that patients with higher eosinophil counts are prone to more severe disease and poorer outcomes. As a result, new biologic therapies have been developed to tailor treatment to these patients. In COPD, high blood eosinophil counts may predict a favorable response to ICS on top of LABA/LAMA, especially in patients with a history of frequent exacerbations, but the exact position and the definition of clinically significant eosinophilia is need to be more studied for the use of blood eosinophils for the identification of patients who may benefit from targeted treatments (Table 1). the use of eosinophils in clinical practice in COPD needs to be evaluated in prospective studies before firm conclusion and demonstrated in stable patients [10]. Eosinophilic inflammation is a stable longitudinal phenotype in a substantial proportion of COPD patients, which can be predicted over 12 months by an initial blood level measurement. The need for biomarkers to identify patients who may benefit from treatments in airways disease. As more treatment options are becoming available, we need to research and choose the biomarkers like elements or activation states of eosinophilic inflammation and will support the selection of treatment we need to control the patient in asthma and COPD. These events are seasonal in nature and relate to bacterial etiology and considerate the weather to take the sample [11].
\nUtility | \nAsthma | \nCOPD | \n
---|---|---|
In definition | \n− | \n− | \n
In epidemiological decision | \n−/+ | \n− | \n
In diagnosis | \n+/− | \n− | \n
In clinic | \n+ | \n+ | \n
In classification | \n+ | \n− | \n
In exacerbations | \n+ | \n+ | \n
In treatment | \n++ | \n++ | \n
In biological treatment | \n+++ | \n+ | \n
Following | \n++ | \n+ | \n
Stable | \n+ | \n+/− | \n
Utility of eosinophil as a biomarker in clinic.
We believe financial barriers should not prevent researchers from publishing their findings. With the need to make scientific research more publicly available and support the benefits of Open Access, more and more institutions and funders are dedicating resources to assist faculty members and researchers cover Open Access Publishing Fees (OAPFs). In addition, IntechOpen provides several further options presented below, all of which are available to researchers, and could secure the financing of your Open Access publication.
",metaTitle:"Waiver Policy",metaDescription:"We feel that financial barriers should never prevent researchers from publishing their research. With the need to make scientific research more publically available and support the benefits of Open Access, more institutions and funders have dedicated funds to assist their faculty members and researchers cover the APCs associated with publishing in Open Access. Below we have outlined several options available to secure financing for your Open Access publication.",metaKeywords:null,canonicalURL:"/page/waiver-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"At IntechOpen, the majority of OAPFs are paid by an Author’s institution or funding agency - Institutions (73%) vs. Authors (23%).
\\n\\nThe first step in obtaining funds for your Open Access publication begins with your institution or library. IntechOpen’s publishing standards align with most institutional funding programs. Our advice is to petition your institution for help in financing your Open Access publication.
\\n\\nHowever, as Open Access becomes a more commonly used publishing option for the dissemination of scientific and scholarly content, in addition to institutions, there are a growing number of funders who allow the use of grants for covering OA publication costs, or have established separate funds for the same purpose.
\\n\\nPlease consult our Open Access Funding page to explore some of these funding opportunities and learn more about how you could finance your IntechOpen publication. Keep in mind that this list is not definitive, and while we are constantly updating and informing our Authors of new funding opportunities, we recommend that you always check with your institution first.
\\n\\nFor Authors who are unable to obtain funding from their institution or research funding bodies and still need help in covering publication costs, IntechOpen offers the possibility of applying for a Waiver.
\\n\\nOur mission is to support Authors in publishing their research and making an impact within the scientific community. Currently, 14% of Authors receive full waivers and 6% receive partial waivers.
\\n\\nWhile providing support and advice to all our international Authors, waiver priority will be given to those Authors who reside in countries that are classified by the World Bank as low-income economies. In this way, we can help ensure that the scientific work being carried out can make an impact within the worldwide scientific community, no matter where an Author might live.
\\n\\nThe application process is open after your submitted manuscript has been accepted for publication. To apply, please fill out a Waiver Request Form and send it to your Author Service Manager. If you have an official letter from your university or institution showing that funds for your OA publication are unavailable, please attach that as well. The Waiver Request will normally be addressed within one week from the application date. All chapters that receive waivers or partial waivers will be designated as such online.
\\n\\nDownload Waiver Request Form
\\n\\nFeel free to contact us at funders@intechopen.com if you have any questions about Funding options or our Waiver program. If you have already begun the process and require further assistance, please contact your Author Service Manager, who is there to assist you!
\\n\\nNote: All data represented above was collected by IntechOpen from 2013 to 2017.
\\n"}]'},components:[{type:"htmlEditorComponent",content:'At IntechOpen, the majority of OAPFs are paid by an Author’s institution or funding agency - Institutions (73%) vs. Authors (23%).
\n\nThe first step in obtaining funds for your Open Access publication begins with your institution or library. IntechOpen’s publishing standards align with most institutional funding programs. Our advice is to petition your institution for help in financing your Open Access publication.
\n\nHowever, as Open Access becomes a more commonly used publishing option for the dissemination of scientific and scholarly content, in addition to institutions, there are a growing number of funders who allow the use of grants for covering OA publication costs, or have established separate funds for the same purpose.
\n\nPlease consult our Open Access Funding page to explore some of these funding opportunities and learn more about how you could finance your IntechOpen publication. Keep in mind that this list is not definitive, and while we are constantly updating and informing our Authors of new funding opportunities, we recommend that you always check with your institution first.
\n\nFor Authors who are unable to obtain funding from their institution or research funding bodies and still need help in covering publication costs, IntechOpen offers the possibility of applying for a Waiver.
\n\nOur mission is to support Authors in publishing their research and making an impact within the scientific community. Currently, 14% of Authors receive full waivers and 6% receive partial waivers.
\n\nWhile providing support and advice to all our international Authors, waiver priority will be given to those Authors who reside in countries that are classified by the World Bank as low-income economies. In this way, we can help ensure that the scientific work being carried out can make an impact within the worldwide scientific community, no matter where an Author might live.
\n\nThe application process is open after your submitted manuscript has been accepted for publication. To apply, please fill out a Waiver Request Form and send it to your Author Service Manager. If you have an official letter from your university or institution showing that funds for your OA publication are unavailable, please attach that as well. The Waiver Request will normally be addressed within one week from the application date. All chapters that receive waivers or partial waivers will be designated as such online.
\n\nDownload Waiver Request Form
\n\nFeel free to contact us at funders@intechopen.com if you have any questions about Funding options or our Waiver program. If you have already begun the process and require further assistance, please contact your Author Service Manager, who is there to assist you!
\n\nNote: All data represented above was collected by IntechOpen from 2013 to 2017.
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The specific learning challenges discussed will focus on students who may have a specific learning disability (SLD). Legislation that brought about concepts such as response to intervention (RTI) is discussed in detail. The various levels of intensity of interventions, or tiers, provided to students are explained by more than one discipline. The new regulations guiding access to special education services are based on the identification, intervention, and close monitoring of student progress. The overarching goal of RTI is to provide support to students who may be experiencing difficulty, before they experience failure by falling too far behind their peers.",book:{id:"5878",slug:"learning-disabilities-an-international-perspective",title:"Learning Disabilities",fullTitle:"Learning Disabilities - An International Perspective"},signatures:"Kimberly A. Heinemann, Heather Bolanos and Jennifer S. Griffin",authors:[{id:"205622",title:"Mrs.",name:"Kimberly",middleName:null,surname:"Heinemann",slug:"kimberly-heinemann",fullName:"Kimberly Heinemann"},{id:"208681",title:"Mrs.",name:"Heather",middleName:null,surname:"Bolanos",slug:"heather-bolanos",fullName:"Heather Bolanos"},{id:"208691",title:"Mrs.",name:"Jennifer S.",middleName:null,surname:"Griffin",slug:"jennifer-s.-griffin",fullName:"Jennifer S. Griffin"}]}],mostDownloadedChaptersLast30Days:[{id:"57054",title:"Specific Learning Disabilities: Response to Intervention",slug:"specific-learning-disabilities-response-to-intervention",totalDownloads:2153,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"The content included in the current chapter centers around the screening and identification of students who experience learning challenges in an educational setting in the United States of America. The specific learning challenges discussed will focus on students who may have a specific learning disability (SLD). Legislation that brought about concepts such as response to intervention (RTI) is discussed in detail. The various levels of intensity of interventions, or tiers, provided to students are explained by more than one discipline. The new regulations guiding access to special education services are based on the identification, intervention, and close monitoring of student progress. The overarching goal of RTI is to provide support to students who may be experiencing difficulty, before they experience failure by falling too far behind their peers.",book:{id:"5878",slug:"learning-disabilities-an-international-perspective",title:"Learning Disabilities",fullTitle:"Learning Disabilities - An International Perspective"},signatures:"Kimberly A. Heinemann, Heather Bolanos and Jennifer S. Griffin",authors:[{id:"205622",title:"Mrs.",name:"Kimberly",middleName:null,surname:"Heinemann",slug:"kimberly-heinemann",fullName:"Kimberly Heinemann"},{id:"208681",title:"Mrs.",name:"Heather",middleName:null,surname:"Bolanos",slug:"heather-bolanos",fullName:"Heather Bolanos"},{id:"208691",title:"Mrs.",name:"Jennifer S.",middleName:null,surname:"Griffin",slug:"jennifer-s.-griffin",fullName:"Jennifer S. Griffin"}]},{id:"80202",title:"Depression, Suicidal Tendencies, Hopelessness, and Stress among Patients with Learning Disabilities",slug:"depression-suicidal-tendencies-hopelessness-and-stress-among-patients-with-learning-disabilities",totalDownloads:113,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Self-harm and suicide are most commonly observed in adolescents specially females in Asian countries and in western. The psychosocial predictors, along with hopelessness and non-suicidal injury (NSSI), have not been studied properly before. Therefore, there is a need to address these issues. The objective of the study was to ascertain the psychosocial and clinical features predicting suicide and NSSI in adolescents with major depression. Increased number of suicidality and impaired family function at entry is autonomously connected with a suicidal attempt. NSSI are connected at base line and apply additive effect on likelihood, one keeping on through treatment period. Poor family functions, as well as family problems and social problems, were the causative agents for adolescent’s high suicidality and NSSI. A history of NSSI treatment is a clinical marker for suicidality. The previous suicidal attempts should be evaluated in depressed juvenile patients as indicators of future suicidal intent and behavior. Both suicidal and NSSI adolescents during the therapy and after treatment endure to be depressed when they are engaged in study. Major causes of suicide among our study participants were lost friend(s), drug abuse, living alone, disturbed parental marriage, sexual abuse, and other domestic problems.",book:{id:"10910",slug:"learning-disabilities-neurobiology-assessment-clinical-features-and-treatments",title:"Learning Disabilities",fullTitle:"Learning Disabilities - Neurobiology, Assessment, Clinical Features and Treatments"},signatures:"Fahad Hassan Shah, Song Ja Kim, Laiba Zakir, Aqsa Ehsan, Sohail Riaz, Muhammad Sulaiman and Saad Salman",authors:[{id:"418086",title:"Dr.",name:"Saad",middleName:null,surname:"Salman",slug:"saad-salman",fullName:"Saad Salman"},{id:"439291",title:"Dr.",name:"Fahad Hassan",middleName:null,surname:"Shah",slug:"fahad-hassan-shah",fullName:"Fahad Hassan Shah"},{id:"439292",title:"Dr.",name:"Song Ja",middleName:null,surname:"Kim",slug:"song-ja-kim",fullName:"Song Ja Kim"},{id:"439293",title:"Dr.",name:"Laiba",middleName:null,surname:"Zakir",slug:"laiba-zakir",fullName:"Laiba Zakir"},{id:"439294",title:"Dr.",name:"Aqsa",middleName:null,surname:"Ehsan",slug:"aqsa-ehsan",fullName:"Aqsa Ehsan"},{id:"451112",title:"Dr.",name:"Sohail",middleName:null,surname:"Riaz",slug:"sohail-riaz",fullName:"Sohail Riaz"},{id:"451113",title:"Dr.",name:"Muhammad",middleName:null,surname:"Sulaiman",slug:"muhammad-sulaiman",fullName:"Muhammad Sulaiman"}]},{id:"79900",title:"Dyslexia, Dysgraphia and Dyscalculia: A Response to Intervention Approach to Classification",slug:"dyslexia-dysgraphia-and-dyscalculia-a-response-to-intervention-approach-to-classification",totalDownloads:182,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter provides a model for classification of dyslexia, dysgraphia and dyscalculia through analysis of the response of children to treatment. The model is discussed with reference to the types of multivariate treatment applied in a particular programme which works interactively online using an electronic data-base for linking functional difficulties in learning to treatment, and through this to firm diagnosis and classification. In applying the model, initial diagnosis of learning disabilities is treated as provisional, based on functional indicators as well as test data. Firm classification becomes possible through longitudinal assessment, analysis of response to multivariate intervention as well as response to specific programmes. Diagnosis can then be linked both to concessions as well as ongoing treatment.",book:{id:"10910",slug:"learning-disabilities-neurobiology-assessment-clinical-features-and-treatments",title:"Learning Disabilities",fullTitle:"Learning Disabilities - Neurobiology, Assessment, Clinical Features and Treatments"},signatures:"Charles Potter",authors:[{id:"93190",title:"Prof.",name:"Charles",middleName:null,surname:"Potter",slug:"charles-potter",fullName:"Charles Potter"}]},{id:"78359",title:"Self-Regulation, Self-Efficacy, and Learning Disabilities",slug:"self-regulation-self-efficacy-and-learning-disabilities",totalDownloads:345,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter will discuss the roles of self-regulation and self-efficacy in students with learning disabilities. The guiding conceptual framework is based in social cognitive theory. In this theory, self-efficacy is a key motivational variable and self-regulation is a means for persons to develop a sense of agency, or the belief that they can exert a large degree of control over outcomes in their lives. Following a description of the theory, research is presented showing the operation of self-regulation and self-efficacy in students with learning disabilities. Future research directions are suggested, and implications of theory and research for educational practice are discussed.",book:{id:"10910",slug:"learning-disabilities-neurobiology-assessment-clinical-features-and-treatments",title:"Learning Disabilities",fullTitle:"Learning Disabilities - Neurobiology, Assessment, Clinical Features and Treatments"},signatures:"Dale H. Schunk and Maria K. DiBenedetto",authors:[{id:"418379",title:"Prof.",name:"Dale H.",middleName:null,surname:"Schunk",slug:"dale-h.-schunk",fullName:"Dale H. 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He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. 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Her research interest is in antibiotic resistance, host-pathogen interaction, and therapeutics development for staphylococcal pathogens, mainly Staphylococcus aureus, which causes hospital-acquired infections. Currently, her research is mostly focused on the study of oral pathogens, particularly Staphylococcus spp.",institutionString:"Medical University of Gdańsk, Poland",institution:null},editorThree:null},{id:"4",title:"Fungal Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",isOpenForSubmission:!0,editor:{id:"174134",title:"Dr.",name:"Yuping",middleName:null,surname:"Ran",slug:"yuping-ran",fullName:"Yuping Ran",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9d6QAC/Profile_Picture_1630330675373",biography:"Dr. Yuping Ran, Professor, Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China. Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. 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He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. He also studies the use of medicinal plants for the control of infectious diseases as well as antimicrobial drug resistance.",institutionString:null,institution:{name:"University of Venda",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},{id:"6",title:"Viral Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",isOpenForSubmission:!0,editor:{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:20,paginationItems:[{id:"83065",title:"Interventions and Practical Approaches to Reduce the Burden of Malaria on School-Aged Children",doi:"10.5772/intechopen.106469",signatures:"Andrew Macnab",slug:"interventions-and-practical-approaches-to-reduce-the-burden-of-malaria-on-school-aged-children",totalDownloads:2,totalCrossrefCites:0,totalDimensionsCites:0,authors:[{name:"Andrew",surname:"Macnab"}],book:{title:"Malaria - Recent Advances, and New Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11576.jpg",subseries:{id:"5",title:"Parasitic Infectious Diseases"}}},{id:"82804",title:"Psychiatric Problems in HIV Care",doi:"10.5772/intechopen.106077",signatures:"Seggane Musisi and Noeline Nakasujja",slug:"psychiatric-problems-in-hiv-care",totalDownloads:1,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Future Opportunities and Tools for Emerging Challenges for HIV/AIDS Control",coverURL:"https://cdn.intechopen.com/books/images_new/11575.jpg",subseries:{id:"6",title:"Viral Infectious Diseases"}}},{id:"82827",title:"Epidemiology and Control of Schistosomiasis",doi:"10.5772/intechopen.105170",signatures:"Célestin Kyambikwa Bisangamo",slug:"epidemiology-and-control-of-schistosomiasis",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"New Horizons for Schistosomiasis Research",coverURL:"https://cdn.intechopen.com/books/images_new/10829.jpg",subseries:{id:"5",title:"Parasitic Infectious Diseases"}}},{id:"82817",title:"Perspective Chapter: Microfluidic Technologies for On-Site Detection and Quantification of Infectious Diseases - The Experience with SARS-CoV-2/COVID-19",doi:"10.5772/intechopen.105950",signatures:"Andres Escobar and Chang-qing Xu",slug:"perspective-chapter-microfluidic-technologies-for-on-site-detection-and-quantification-of-infectious",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"SARS-CoV-2 Variants - Two Years After",coverURL:"https://cdn.intechopen.com/books/images_new/11573.jpg",subseries:{id:"6",title:"Viral Infectious Diseases"}}}]},overviewPagePublishedBooks:{paginationCount:13,paginationItems:[{type:"book",id:"6667",title:"Influenza",subtitle:"Therapeutics and Challenges",coverURL:"https://cdn.intechopen.com/books/images_new/6667.jpg",slug:"influenza-therapeutics-and-challenges",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Shailendra K. 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He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. 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Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}]},{type:"book",id:"7123",title:"Current Topics in Neglected Tropical Diseases",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7123.jpg",slug:"current-topics-in-neglected-tropical-diseases",publishedDate:"December 4th 2019",editedByType:"Edited by",bookSignature:"Alfonso J. 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He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. 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He obtained a Master’s degree in Public Health and PhD in Public Health and Epidemiology. He has a background in Clinical Medicine and has taken courses at higher diploma levels in public health from University of Transkei, Republic of South Africa, and African Medical and Research Foundation (AMREF) in Nairobi, Kenya. Dr. Kasenga worked in different places in and outside Malawi, and has held various positions, such as Licensed Medical Officer, HIV/AIDS Programme Officer, HIV/AIDS resource person in the International Department of Diakonhjemet College, Oslo, Norway. He also managed an Integrated HIV/AIDS Prevention programme for over 5 years. He is currently working as a Director for the Health Ministries Department of Malawi Union of the Seventh Day Adventist Church. Dr. Kasenga has published over 5 articles on HIV/AIDS issues focusing on Prevention of Mother to Child Transmission of HIV (PMTCT), including a book chapter on HIV testing counseling (currently in press). 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He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"117248",title:"Dr.",name:"Andrew",middleName:null,surname:"Macnab",slug:"andrew-macnab",fullName:"Andrew Macnab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}}]}},subseries:{item:{id:"2",type:"subseries",title:"Prosthodontics and Implant Dentistry",keywords:"Osseointegration, Hard Tissue, Peri-implant Soft Tissue, Restorative Materials, Prosthesis Design, Prosthesis, Patient Satisfaction, Rehabilitation",scope:"