\r\n\tGlobalization does not represent a pure and generous process for humanity or other species, but rather it implies social exclusion and also provokes situations of vulnerability in groups of people, forced exclusion, and apartheid: poor job opportunities, lack of access to education, worse socio-sanitary conditions. Specifically, it can be said that social segregation entails the apartheid of social groups of different ages, genders, and ethnicities; these groups live a reality manifested through the deepening of poverty, in terms of increased vulnerability of the poor and groups with little economic, social, cultural, labor and health stability.
\r\n
\r\n\tThis book aims to talk about some topics that are neglected in the discourses of academic communities and political elites. The inequality process is deeply rooted among humans and is part of many people's lives in the form of modern apartheid, gender segregation, lack of health access, and cultural gap. All those structural inequality processes are the product of the biopower perpetuated and produced in the macrosystem, exosystem, mesosystem, and microsystem. For many people from the academy, the information-consuming public, and the society in general, it is a problem to talk about these processes, since they have either lost interest or have normalized the structural and social inequity. For this reason, we see it as transcendental to explain how this situation occurs from the most internal fibers to the most evident processes, intending to make it more visible and thus expose the situation for possible solutions.
",isbn:"978-1-83768-406-9",printIsbn:"978-1-83768-405-2",pdfIsbn:"978-1-83768-407-6",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"cefab077e403fd1695fb2946e7914942",bookSignature:"Ph.D. Yaroslava Robles-Bykbaev",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11473.jpg",keywords:"Wage Gap, Gender Segregation, Fundamental Human Rights, Health Access, Social Inequity Processes, Modern Apartheid, Resilience, Cultural Gaps, Globalization, Geopolitics of Social Inequality, Public Policies, Social Vulnerability",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 15th 2022",dateEndSecondStepPublish:"July 13th 2022",dateEndThirdStepPublish:"September 11th 2022",dateEndFourthStepPublish:"November 30th 2022",dateEndFifthStepPublish:"January 29th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"13 days",secondStepPassed:!1,areRegistrationsClosed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Dr. Bykbaev is a member of the UNESCO Chair of Politecnica Salesiana University. 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Dr. Bykbaev is an active member of the NODO Ecuadorian Network of Women Scientists (REMCI).",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"313341",title:"Ph.D.",name:"Yaroslava",middleName:null,surname:"Robles-Bykbaev",slug:"yaroslava-robles-bykbaev",fullName:"Yaroslava Robles-Bykbaev",profilePictureURL:"https://mts.intechopen.com/storage/users/313341/images/system/313341.jpg",biography:null,institutionString:"Politecnica Salesiana University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Politecnica Salesiana University",institutionURL:null,country:{name:"Ecuador"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"23",title:"Social Sciences",slug:"social-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"444316",firstName:"Blanka",lastName:"Gugic",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/444316/images/20016_n.jpg",email:"blanka@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. 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1. Introduction
The study of the fetal face may be performed during the early stages of gestation. Depending on the gestational age, we can identify various elements of anatomy, such as the orbits or the forehead, from the 12th week. Yet, after that time, we can easily identify and study the forehead, the nose, the lips, the ears, and the orbits of the fetus [1]. Prenatal recognition of facial abnormalities during pregnancy has many benefits. It can lead to the diagnosis of multiple genotypic syndromes and chromosomal anomalies. Also, it allows more adequate counseling and preparation of the parents. Considering that the sonographic assessment of the fetal face is a major part of the anatomic survey of the fetus, sagittal, axial, and coronal planes are used when examining the fetus.
The facial anomalies are divided into nose, orbit, lip, mandible, and palate anomalies. The US method may reveal also benign and less frequent anomalies, for example, lacrimal duct cysts, hemangiomas, and so on.
1.1. Sagittal planes
In order to assess the normality of the fetus profile, sagittal planes of the face are used (Figure 1).
Figure 1.
(A). Normal fetal profile at 12–13 weeks. (B). Schematic representation of the scanning planes to be used for obtaining axial and coronal views of the fetal face.
One of the US parameters used to obtain an exact measurement of the position of the anterior end of the maxilla to the forehead is the angle between the surface of the palate and the frontal bone examined in a mid-sagittal view of the fetal face, called the frontomaxillary facial angle [2]. This angle is increased in fetuses with trisomy 21, and it is believed that the reason for this is the hypoplasia or posterior displacement of the palate [2, 3].
Ears are well visualized in parasagittal scans tangential to the calvarium. In late gestation, significant details of the anatomy of the external ear can be seen.
1.2. Axial planes
Orbits may be visualized simultaneously, by means of an axial plane, slightly caudal to the one used to measure the biparietal diameter (Figures 2–4) [4].
Figure 2.
Axial scan passing through the orbits of a normal second trimester fetus.
Figure 3.
The interocular distance (IOD) and binocular distance (BOD) are demonstrated in this scan. The lens is visible inside the orbit.
Figure 4.
Axial scan of the lower fetal face demonstrating the upper lip and the anterior palate.
1.3. Coronal planes
Evaluation of the integrity of the facial anatomy is assessed by visualizing the eyelids, orbits, lips, forehead, and nose, whose nostrils usually appear as two little anechoic areas. For these features, coronal planes are more important than the previous one (Figure 5).
Figure 5.
A. Coronal anterior plane in a late first trimester (FT) fetus: The lens inside the corpus vitreum B. The tip of the nose, the alae nasi, and the columna are seen above the upper lip. The nostril typically appears as two little anechoic areas.
1.4. Fetal face profile
One of the most common “soft sonographic sings” providing essential clues of congenital syndromes [1] is the deviations from the proportions normally found during a sagittal fetal face examination (Figures 6, 7). Apert or Carpenter syndromes are ruled out by examining the bridge of the nose. [5] The cleft lip is excluded when the normal prominent lips are visible. [1]. As for micrognathia or prognathia, these can be noticed in the subjective abnormal appearance of the jaw [6].
Figure 6.
Sonographic pictures of fetal bossing forehead at 24 weeks of gestation. The postnatal aspect of the neonates with bossing forehead.
Figure 7.
Sagittal scan of a fetus at 13–14 weeks of gestation shows FT bossing forehead.
2. The fetal eyes
From the late FT or in the early second trimester onward, we should consider the visualization of the fetal orbit and lens. The orbits will appear as echolucent circles on the upper fetal face, whereas the lens will be visualized inside these structures, as circular hyperechogenic rings. These images can be obtained during almost all scans, beginning with the late first trimester. Any deviation from the relative size might suggest congenital malformations of the orbits and lens. To assess them, coronal and especially axial planes of the fetal head are the best approach.
2.1. Anomalies of the orbits
2.1.1. Hypertelorism
Definition: Hypertelorism is an increased interocular distance.
Embryology and pathogenesis: At the first stage of the development of the human embryo, the eyes are to be found laterally, like in animals with panoramic vision. As the pregnancy evolves, the fetal eyes migrate toward the midline, thus generating the conditions for the stereoscopic vision to develop (Figure 8).
Figure 8.
The facial structures development, represented schematically between the 5th and the 10th week of gestation. During the early stages, we can notice the primitive eyes on both sides of the cephalic pole. However, they move toward the median line as gestation goes on [7].
There are at least two theories as to why hypertelorism may appear. The first theory states that there are several mechanisms causing it: the forward migration of the first half of the eyes, a midline tumor, meningoencephalocele for instance, causing the second half, or skull bones with abnormal growth vectors. The second theory links a splanchnocranium, which presents an abnormal growth, to the undeveloped bones which derive from the first branchial arches [8].
Pathology: Three parameters are used to measure the fetuses’ ocular spacing: interpupillary distance, canthal distance, and interorbital distance. Hypertelorism is bilateral most of the times, with little incidents of unilateral cases associated with plagiocephaly and proboscis lateralis. Also, this condition is either isolated or accompanied by other malformations or clinical syndromes such as the median cleft syndrome and craniosynostoses. In craniosynostoses, hypertelorism syndromes such as Apert, Crouzon, and Carpenter are usually present [9].
Ultrasound diagnosis: Interorbital diameter is larger than 95th. The accuracy of ultrasound exam in the hypertelorism diagnosis has not been established.
Investigations: Detailed ultrasound examination for associated defects. Invasive testing for karyotyping and array.
Follow up: Standard follow-up in isolated cases. Any underlying syndrome antenatal care should be adjusted, considering the additional risk of the condition.
Delivery: Standard obstetric care and delivery.
Isolated: It is good, even if there might be esthetic implications in severe cases as well as impaired stereoscopic binocular vision. For these cases, there are several operative procedures such as canthoplasty, orbitoplasty, surgical positioning of the eyebrows, and rhinoplasty.
Syndromic: The prognosis of hypertelorism is usually poor, and it does have a risk of mental retardation. However, normal life span and normal intellect are to be expected in the case of medial facial cleft syndrome [8]. The esthetic aspect should not be underestimated.
Recurrence: Isolated: no increased risk of recurrence.
2.1.2. Hypotelorism
Definition: Hypotelorism is a decreased interorbital distance.
Prevalence: 1 in 20,000 births.
Etiology: Hypertelorism is almost always associated with other severe abnormalities, especially with the sequence of holoprosencephalic abnormality.
Embryology and Pathogenesis: Out of the mesenchymal mass there comes the craniofacial skeleton. This mass has two points of origin: the mesoderm and the neutral crest, the latter migrating to the region. The development of the median facial structures (forehead, nose, interorbital structures and upper lip) is closely linked to the forebrain differentiating process. It is possible that these two development steps are induced by the tissue, which lies between the prosencephalon and the stomodeum (the root of the primitive mouth), namely the prechordal mesenchyma. Thus, defects of the facial midline, for example, hypotelorism, are often linked to cerebral abnormalities, most often with holoprosencephaly. Hypotelorism can be found in association with trigonocephaly, microcephaly, Meckel syndrome and chromosome aberrations [10, 11].
Ultrasound diagnosis: It is based on the documentation of a reduced interocular distance. The interorbital diameter is lower than <5th and, together with the almost always present holoprosencephaly (Figure 9), is to be found among the midline migration defects; in this case, the hypotelorism can be extreme, as in cyclopia [10].
Figure 9.
Axial scan a fetus at 14–15 weeks with alobar holoprosencephaly.
Associated abnormalities: In half of the cases, we encounter chromosomal defects, especially trisomy 13, as well as genetic syndromes [9].
Investigations: A thorough ultrasound examination should be conducted, including neurosonography, in order to find associated defects as well as invasive testing for karyotyping and array.
Prognosis: The prognosis and the management are decided on the accompanying malformations. Usually, the prognosis is poor, with high levels of mortality. In cases with normal karyotype, there is a high risk of mental retardation, depending on the degree of holoprosencephaly.
Recurrence: Isolated: no increased risk. One percentage risk of trisomy and 13.25% risk of being part of an autosomal recessive condition [11].
2.1.3. Microphthalmia/Anophthalmia
Definition: Microphthalmia refers to the decreased size of the eyeball, whereas anophthalmia refers to absence of the eye. However, the pathologist should demonstrate not only the absence of the eye but also of the optic nerves, chiasma, and tracts.
Prevalence: While it is difficult to define, it accounts for 1 in 20,000 births, and for 4% of the cases of congenital inheritable blindness.
Etiology/Pathology: Microphthalmia is usually associated with other anomalies. Microphthalmia is either as a sporadic disorder or as a condition inherited with an autosomal dominant, recessive, or X-linked pattern. We use the term “cryptophthalmia” to define fused eyelids, a condition often associated [9, 10].
Ultrasound diagnosis: Microphthalmia and anophthalmia can be unilateral or bilateral. Diagnosis can be suspected by demonstrating an orbital diameter below the fifth percentile for gestational age (Figure 10). If the diagnosis is suspected, a thorough search for associated anomalies (microtia, micrognathia, syndactyly, camptodactyly, median cleft, feet abnormalities, such as rocker bottom and talipes, hemivertebrae, and congenital heart defects) should be performed.
Figure 10.
This picture shows a case of anophthalmia, prenatal and postnatal aspects.
Associated abnormalities: Chromosomal defects, especially trisomy 13, are found in more than 50% of the cases. The most common include: Goldenhar syndrome (1:3000 births), Fraser syndrome, Fryns syndrome and Meckel-Gruber [9].
Investigations: Besides detailed ultrasound, karyotyping and array should be offered. Also, a fetal brain MRI may be useful to diagnose abnormalities (e.g., the absence of the optic nerve).
Prognosis and obstetrical management: Isolated: good, with an altered life quality because of the esthetic aspect of the lesion: plastic surgery might be considered. Syndromic: prognosis is very poor. Management depends on the specific syndrome [11].
Recurrence: Isolated: no increased risk. Part of an autosomal recessive condition: 25%.
2.1.4. Dacryocystocele
Definition: Dacryocystocele is a congenital obstruction of the nasolacrimal duct, resulting in cystic dilatation of the proximal part of the duct. (Figure 11).
Figure 11.
Ultrasonographic aspect of the congenital dacryocystocele.
Prevalence: 1 in 4000.
Ultrasound diagnosis: Cyst (75% unilateral and 25% bilateral) between the lower part of the orbit and the nose. About 90% of the cases are due to delayed canalization of the lacrimal duct beyond 32 weeks gestation.
The differential diagnosis: includes an anterior cephalocele, hemangiomas, and dermoid cyst. Usually, hemangiomas have a solid appearance or multiple septae, and they are shown as exophytic lesions with an echogenicity, similar to the placenta. Among the complications of hemangiomas, we should include ulceration, bleeding, infection, and scar formation. The dermoid cysts have often a superolateral location. It is difficult to differentiate anterior cephaloceles from these lesions. If hydrocephaly is present, we should suspect a cephalocele [12, 13].
Associated abnormalities: Not associated with chromosomal or other abnormalities.
They resolve spontaneously in 78% of the cases by 3 months, 91% by 6 months, or during the third semester.
2.1.5. Cyclopia
Definition: Cyclopia is another type of anomaly, in which the fetus has only one single orbital fossa, with bulbs, eyelids and lacrimal apparatus fused to a variable degree. In many cases, there is one single eye or one partially divided eye, in a single orbit and arhinia with proboscis (Figure 12), [14, 15].
Figure 12.
A. Axial and sagittal scans of a fetus at 15 weeks of gestation show cyclopia and proboscis. B. Ethmocephaly—Postmortem demonstrating hypotelorism and proboscis.
Incidence: Cyclopia results from the incomplete cleavage of the prosencephalon into right and left hemispheres, a process which should be occurring between the 18th and the 28th day of pregnancy, and it is a lethal human malformation, relatively complex, but also quite rare. Moreover, holoprosencephaly occurs in 1/16,000 live births [16].
The etiology of this rare syndrome incompatible with life is still not known in detail, because most cases are sporadic, even if the implication of heterogeneous risk factors has been proven. Among risk factors, we include maternal diabetes (the only formally recognized environmental factor, with a 1% risk and a 200-fold increase in fetal holoprosencephaly), infections during pregnancy (TORCHs), active drugs during pregnancy physical agents (ultraviolet light), and chromosomal (mostly trisomy 13) and genetic causes (familial occurrences in twins and in consanguineous marriages [17].
In order to get the differential diagnosis of these cases, we must distinguish between ethmocephaly and cebocephaly. In other words, we must be able to trace extreme hypotelorism, arhinia and blinded proboscis located between the eyes as opposed to hypotelorism and a single nostril nose without midline cleft. In case the image shows united palatine and lacrimal bones, as well as no sign of nasal bones, maxilla and nasal septum, then the diagnosis is ethmocephaly [15].
2.1.6. Cataracts
Definition: any opacity of the eye lens.
The incidence of cataract is as follows: 1–6 newborn infants every 10,000 births [18] for congenital cataracts in newborn babies, whereas 8.3–25% is considered to be inherited.
Etiology: There are several ways in which a fetus might inherit congenital cataracts: autosomal dominant, autosomal recessive, or X-linked fashion. However, the most frequent and the strongest penetration is the autosomal dominant. A series of other complications are associated with cataracts: genetic syndromes, congenital infections, metabolic disorders, and chromosomal abnormalities. The genetic cause is present in 30% of the unilateral cataracts and in 50% of the bilateral ones [19].
During the examination of the fetal cataracts solid, either some echogenic discs or echogenicity areas within an echolucent orbit will be noticed (Figure 13), having either unilateral or bilateral opacity of the lens. Usually, the bilateral lesions are generally syndromic, with a poor prognosis; as for unilateral lesions, they are generally linked to a fetal infection. The genetic aspect of cataracts can be linked to microphthalmia.
Figure 13.
A. Sonographic pictures of fetal cataracts at 24 weeks of gestation. Coronal views of echogenic lens. B. The postnatal aspect of the lens.
Associated abnormalities: there is not any high risk of chromosomal abnormalities. It is in only 10% of the cases that genetic syndromes are found, and these include the chromosomal defects. In about 10% of the cases, genetic syndromes are found, and the most common include: Walker-Warburg syndrome and chondrodysplasia punctata. Only a fifth of the congenital cataracts cases are linked to infections such as rubella, toxoplasmosis, or CMV [20].
Investigations: ultrasound, karyotyping, array and TORCH.
Prognosis: Usually good for isolated cases. Postpartum ophthalmologic surgeries have good results, which do not affect the quality of life. Prognosis is quite poor for syndromic cataract, though.
3. The ear
The most frequent clinical characteristic in diagnosing the Down syndrome has been the short ear length. Sonographic studies implied that measurements of the short ear length could be a useful predictor of fetal anomalies. In late gestation, important details of the anatomy of the external ear became accessible. In good conditions for scanning, and using high-resolution systems, the helix, scaphoid fossa, triangular fossa, concha, antihelix, tragus, antitragus, intertragic incisure, and lobule are sometimes visualized [21].
4. The nasal bone and nostrils
A small nose is very commonly seen during postnatal examination of fetuses or neonates who also present trisomy 21 as well as for more than 40 other genetic problems. The nasal bone can be measured using a mid-sagittal profile for normal singleton fetuses between the 14th and 34th week of gestation. Thus, the length of the nasal bones increase from 4 mm at 14 weeks to 12 mm at 35 weeks gestation. A possible improvement in screening for trisomy 21 by examining the fetal nasal bone with ultrasound at 11–14 weeks of gestation has been considered [22].
4.1. Anomalies of the nose
4.1.1. Arhinia
Definition: Absence of the nose.
Etiology: Unknown. It can either be an isolated malformation or be part of a malformation complex, such as holoprosencephaly or mandibulofacial dysostosis (Treacher Collins syndrome) [23].
Embryology: Around the 6th week of gestation, the primitive nasal and oral cavities communicate freely using an opening, which will close progressively when the palate starts developing. When the lateral palatine processes fuse with the nasal septum in the middle, the oral and the two nasal cavities are formed and separated; this takes place around the 12th week of gestation. The external nose starts at the lower portion of the frontonasal prominence, merging on both sides with the maxillary processes (Figure 9). If the frontonasal prominence does not fully develop, the result is partial or complete nasal aplasia. This anomaly is part of a more complex spectrum of midfacial defects, which, in the holoprosencephalic sequence, are considered to appear from a primitive defect of the prechordal mesenchyma, the tissue responsible for the induction of both facial and cerebral structures [24, 25].
Prognosis depends on the associated anomalies; however, isolated arhinia is not life incompatible.
4.1.2. Proboscis
Definition: A proboscis is a trunk-like appendage, with one or two internal openings, and it is usually associated with the absence of the nose.
Incidence: Cyclopia and cebocephaly, two of the main conditions for a proboscis to be present, occur in 1:40,000 and 1:16,000 births, respectively [26].
Embryology: The presence of a proboscis is frequently associated with holoprosencephaly. Apparently, a primary disorder in the prechordal mesenchyma develops into an abnormal induction of the midfacial structures. If the nasal prominences develop abnormally, this may lead to a fusion of the olfactory placodes and to the formation of a proboscis [27].
Pathology and associated anomalies: Usually there is a single central opening in the proboscis, and it does not have any connection to the choanae. The ethmoid, the nasal conchae, and the nasal and lacrimal bones are absent. Usually, in cyclopia, ethmocephaly, and cebocephaly, the cleft of the lip and the palate are absent. The presence of a proboscis is seldom found in the absence of holoprosencephaly. In rare cases, a bilateral proboscis can be noticed [28].
Diagnosis: The diagnosis relies on the demonstration of a trunk-like structure, usually with a single central opening either occupying the normal position of the nose or hanging above the orbits [29] (Figure 8).
5. The tongue
Fetal macroglossia and microglossia are associated with several chromosomal defects.
5.1. Macroglossia
Prevalence: Depends on the underlying disorder (present in 97.5% of Beckwith-Wiedemann syndrome cases: incidence 0.73:10,000 live births, congenital hypothyroidism: incidence 2.5:10,000 live births) [30].
Etiology: If it is isolated, it is usually sporadic and it relates to the underlying disorder; there have been only two families with autosomal dominant transmission.
Pathogenesis: In cases of Beckwith-Wiedemann syndrome, it is part of the generalized visceromegaly probably secondary to fetal hyperinsulinism. The most common cause of Beckwith-Wiedemann syndrome is the uniparental paternal disomy, a result which was found using 11p15.5 markers. It is the same region in which the code for insulin-like hormones is found [30].
Diagnosis: Considering the imaginary line between the mandible and the maxilla on the sagittal scanning plane, the diagnosis is confirmed by the protruding tip of the tongue past that line; if we consider the axial scan, the diagnosis is confirmed by the protruding tip of the tongue past the lower lip.
Associated anomalies: It is diagnosed by prenatal ultrasound in cases of Beckwith-Wiedemann syndrome, in association with hydramnios (due to impaired fetal swallowing and possibly to increased urine production), omphalocele, nephromegaly, gigantism (sometimes hemihypertrophy), hepatomegaly, genital anomalies, cystic adrenal glands, and heart defects. In the absence of an omphalocele, a careful search for markers of trisomy 21 is indicated [31].
6. Anomalies of the lip and palate
Facial cleft
Synonyms: The Cleft lip and the cleft palate.
Definition: This term refers to a wide spectrum of lateral clefting defects, usually involving the upper lip (Figure 14), the palate (Figure 15) or both.
Figure 14.
2D and 3D ultrasonographic pictures of cleft lip.
Figure 15.
A. Sonographic pictures of the bilateral cleft palate (22 weeks of gestation). B. The postnatal aspect of the cleft palate.
Incidence: Facial clefting is the second most common congenital malformation, around 13% of all anomalies. It is usually encountered in 1 in 1000 live births; however, it can be higher for fetuses, many of them having other malformations as well. The occurrence of the cleft palate is 1 of 2500 white births, cleft lip being more common to boys, and cleft palate being more common to girls. In 50% of cases, both the lip and palate are affected, in 25% only the lip and in 25% only the palate. The condition is unilateral in 75% of cases (more common on the left side) and bilateral in 25% [1, 32].
Etiology: The cleft lip is one or more splits (clefts) in the upper lip, ranging from a small indentation in the lip to a split in the lip, which may extend up into one or both nostrils. In the clear majority of patients, the cleft lip (CL) and the cleft palate (CP) have a multifactorial etiology, including genetic and environmental factors. CL (with or without CP) and isolated CP are two different anomalies. CL-CP and isolated CP can be noticed as a component of a well-defined syndrome in 3% of the cases (syndromic) and in 97% of cases (nonsyndromic). CL-CP can develop either as a result of a multifactorial defect or the combination of an autosomal dominant with incomplete expressivity and penetrance (25%) or a sporadic disorder (75%). If the affected parent is the mother, the recurrence risk is decreased, and if it is the father, the recurrence risk is increased. The opposite is true for CL-CP. Chromosomal abnormalities are present in less than 1% of clefting abnormalities [33].
Embryology: The cleft lip results from the persistence of the grooves between the frontonasal, maxillary, and mandibular prominences and develops in about the 6th to 8th week of gestation, when the structures of the upper jaw do not fuse properly and the upper lip does not completely merge. The formation of the cleft is due to the collapse of the mesenchymal tissue under the groove [12]. At times, usually between the 7th and the 12th week of gestation, the cleft palate bones and tissues do not join totally during fetal growth. This leads to the nasal cavity, palate and upper teeth to be affected by the roof of the mouth that remains opened. The cleft palate varies in severity and type according to the place on the palate where the cleft occurs and whether the layers of the palate are affected completely. Sometimes, if some tissues cover the cleft, a milder form of cleft palate will not be visible. A more severe form of the cleft palate, the complete one, involves tissues from all layers of the soft palate, encompasses the hard palate as well, and it might continue to the lip and nose. From time to time, the cleft palate problems also include deformities of the nasal cavities [33].
Pathology: Facial clefts encompass a large spectrum of severity, from minimal defects, such as a bifid uvula, linear indentation of the lip, or submucous cleft of the soft palate, to large, deep, defects of the facial bones and soft tissues (Figure 16).
Figure 16.
Schematic representation of various types of the cleft lip and the cleft palate. (A) Normal, (B) Isolated cleft lip, (C) Unilateral cleft lip, maxilla and anterior palate, (D) Bilateral cleft lip, maxilla and anterior palate, (E) Isolated cleft palate, and (F) Bilateral cleft lip and palate [34].
Diagnosis: To set a diagnosis, both transverse and coronal planes can be used. The accuracy of ultrasound in detecting small lesions has not been established; however, color Doppler might be useful to demonstrate the flow across the palate in the case of the cleft palate. Diagnosis of isolated cleft palate is difficult. Diagnosis of the cleft lip and palate at 11–13 weeks gestation can be obtained using axial planes at the level of the bony palate. In rare cases, the retronasal triangle in a coronal view and the maxillary gap in the standard mid-sagittal view of the face may be helpful [35].
Associated anomalies: There have been found associated anomalies in 50% of the patients with isolated CP and 13% of those with CL-CP In cases of isolated CL or CP, the most frequent anomaly is clubfoot, whereas in cases of CL-CP, it is polydactyly. It is particularly important to notice the association with congenital heart disease [36].
Prognosis: If the defects are minimal, as is the case with the lineal indentations of the lips or submucosal cleft of the soft palate, surgical correction may not be required. If the defects are larger and cause esthetic, swallowing, and respiratory problems, then surgical correction is a must, and recent advances in surgical techniques have had good results. Anyhow, the prognosis depends primarily on the presence and type of associated anomalies [37].
The advisability of karyotype is controversial due to the low incidence of chromosomal anomalies in clefting defect. Fetuses should be delivered in a tertiary center because of the possibility of respiratory and feeding problems.
6.1. Median cleft lip
Synonyms: Complete median cleft lip, pseudomedian cleft lip, and premaxillary agenesis.
Definition: A quadrangular or triangular median defect of the upper lip, which could extend to the posterior of the nose (Figure 17) [38].
Figure 17.
Axial scan of the median cleft lip.
Incidence: Median cleft lip (MCL) is noticed in 0.2–0.7% of all cases of the cleft lip [39].
Embryology: The maxillary prominences are joined by the frontonasal prominence, from where the maxilla and the median region of the upper lip start (Figure 9). It is the exact area which is left underdeveloped or absent in the median cleft lip cases. There is a strong link between the development of the midline facial structures and the process by which the forebrain is differentiated. The prechordal mesenchyma, the tissue interposed between the prosencephalon, and the roof of the primitiva mouth (stomodeum) are likely to induce both events [40]. Cerebral anomalies, such as holoprosencephaly, are often linked with the midline abnormalities of the face.
Etiology and pathology: MCL is described only as part of two distinct syndromes: MCL with orbital hypotelorism, in itself a synonym for holoprosencephaly, and MCL with orbital hypertelorism. In the former case, the premaxillary bone, nasal septum, nasal bones, and crista galli are absent. The ethmoid bone (that set the interorbital distance) is hypoplastic. The secondary palate may or may not be involved. MCL with hypertelorism (also known as “median cleft face syndrome” or “frontonasal dysplasia”) is characterized by the presence of a bifid nose and cranium bifidum occultum, as well as of the premaxilla, while the brain is normal in most cases.
Diagnosis: The defect, involving both the upper lip and the palate, is better seen in axial scans of the palate (Figure 17). A useful hint in this process is the visualization of the tongue in a position within the oral cavity, which is higher than normal. The sonographer should be alerted to a possible pitfall in the diagnosis of MCL because sometimes the defect may be masked by the tongue, giving a false impression of an intact palate [41].
Prognosis and obstetrical management: Prognosis depends entirely on the association with other anomalies. MCL syndrome is associated in 80% of cases with normal intelligence. Radical cosmetic surgery is required. If alobar holoprosencephaly present, it is uniformly lethal [42].
6.2. Epignathus
Definition: A teratoma that arises from the oral cavity or pharynx.
Incidence: 2% of all pediatric teratomas occur in the nasopharyngeal area (including oral, tonsillar, and basicranial areas). The majority of cases occur in newborn [43, 44].
Pathology: Tumors arise mainly from the sphenoid bone; they rarely arise from other areas (the hard and soft palate, the pharynx, the tongue, and jaw). These tumors grow into the oral or nasal cavity or intracranially. Obstruction of the mouth is responsible for polyhydramnios. Most tumors are benign, consisting histologically of tissues derived from any of the three germinal layers. They can fill the mouth and airways and lead to acute asphyxia immediately after birth [44].
Ultrasound diagnosis: Solid tumor arising from the sphenoid bone, hard and soft palate, the pharynx, the tongue, and the jaw. The tumor may grow into the oral or nasal cavity or intracranially. Calcifications and cystic components may also be noticed. The differential diagnosis will include neck teratomas, encephaloceles, conjoined twins, and other tumors of the facial structures. Polyhydramnios (due to pharyngeal compression) is usually present.
Associated abnormalities: This is a sporadic condition, with no increased incidence of chromosomal defects or genetic syndromes; only 6% of these tumors have associated anomalies, and the facial ones being attributed to the mechanical effects of the tumor on developing structures [45].
Investigations: Scans every 4 weeks to monitor the growth of the tumor and assess the amniotic fluid. If polyhydramnios develops, amniodrainage may be balanced. Fetal MRI is recommended at 32 weeks to assess the spatial relation of the tumor to adjacent structures.
Prognosis: It depends on the size of the lesion and the involvement of vital structures. The lesions are usually very large, and the polyhydramnios associates a poor prognosis. The major cause of neonatal death is asphyxia due to airway obstruction. Surgical resection is possible at times. There are no reported cases of malignancies [46, 47, 48, 49].
Fetuses with large tumors are best delivered by cesarean section, and an expert pediatric team must be available to intubate of the infant.
7. Abnormalities of the mandible
7.1. Robin anomalad
Synonyms: Cleft palate, micrognathia and glossoptosis, and Pierre Robin syndrome.
Definition: This anomaly is associated with micrognathia and glossoptosis, with a posterior cleft palate or a high arched palate.
Etiology: In 40% of the cases, the anomaly is isolated and mostly sporadic, although sometimes familiar cases suggest both autosomal recessives and autosomal dominant patterns of transmission. It is most frequently seen in association with other anomalies or with recognized genetic and nongenetic syndromes [51].
Embryology: The mandible starts at the point in which the two mandibular prominences join to delimit the inferior part of the stomodeum. The fusion of the three palatine processes forms the palate. Finally, the frontonasal prominence creates the median, and the maxillary processes create the two lateral ones. It is apparent that the three components of this defect are related to one another. Possibly, an early hypoplasia of the mandible creates this defect, as it leads to the tongue being displaced toward the posterior region, which prevents the posterior palatine processes to close as they should in a normal situation [52].
Associated anomalies: The Robin anomaly is found as an isolated lesion in 39% of all patients. In 36%, one or more associated anomalies are present. In 25% of patients, a known syndrome is found.
Robin anomaly is to be suspected when polyhydramnios is associated with micrognathia (Figure 18). Congenital heart disease occurs in 10% of affected neonates, so fetal echocardiography is recommended [53].
Figure 18.
Sagittal scan a fetus at 13 weeks of gestation shows prominent forehead and retrognathia (polyploidy).
Prognosis: The Robin anomaly is a neonatal emergency in many cases. Glossoptosis may lead to the obstruction of the airways and suffocation.
It is mandatory that a pediatrician be present in the delivery room and be prepared to intubate the infant. Karyotype should be considered [54].
7.2. Otocephaly
Definition: Otocephaly is a grotesque anomaly, characterized by the absence or hypoplasia of the mandible, proximity of the temporal bones, and abnormal horizontal position of the ears. This malformation is considered to be the result of an improper development of the mandible, probably caused by a defect in the migration of the neural crest cells. The ears position themselves horizontally, with the lobules closer to the midline, most certainly because of either absence or extreme hypoplasia of the mandible (Figure 8).
The anatomic lesions range from ears closely opposed to the midline (synotia), agnathia, absence of the mouth to varying degrees of micrognathia and low set ears (melotia).
Otocephaly may be part of very severe malformation complexes, such as conjoined twins and holoprosencephaly [55].
Diagnosis: This anomaly is to be suspected when the jaw cannot be visualized and the ears are noticed in a very low position. Fetuses with extremely severe anomalies, such as anencephaly, holoprosencephaly, and cephaloceles, also present this defect. In cases of milder anomalies, it is difficult to distinguish the otocephaly from other conditions characterized by very low set ears, for instance Treacher Collins syndrome, during a prenatal ultrasound examination [57, 58].
Prognosis and obstetrical management: This condition is incompatible with life. Pregnancy termination could be offered any time in a pregnancy when a confident diagnosis is made [57].
8. The chin: Micrognathia-retrognathia or prognathia
Abnormal size of the chin, micrognathia and macrognathia, and abnormal length of the philtrum (short or long) are morphological features in numerous syndromes.
8.1. Micrognathia-retrognathia
Prevalence: 1: 1500 births.
Ultrasound diagnosis: Subjective finding of prominent upper lip and receding chin in the mid-sagittal view of the face (Figure 18). These findings might be due to micrognathia (short mandible) or retrognathia (backward displacement of the mandible). Severe micrognathia is associated with polyhydramnios (>25 weeks gestation), due to glossoptosis (normal tongue obstructing small oral cavity).
Associated abnormalities: Chromosomal abnormalities, mainly trisomy 18 and triploidy, are found in about 30% of cases. Any one of >50 genetic syndromes are found in most fetuses. Micrognathia is usually associated with >50 genetic syndromes, including Pierre-Robin anomaly, Treacher Collins syndrome, otocephaly [59].
Investigations: ultrasound including echocardiography, karyotyping and array.
Follow up: Ultrasound scans every 4 weeks to monitor growth and amniotic fluid.
Delivery: In hospital with facilities for neonatal intensive care, while a pediatrician is present in the delivery room and be prepared to intubate the neonate.
Prognosis: Neonatal mortality >80% due to associated abnormalities. In Pierre–Robin anomaly, the survival rate is good.
Recurrence: Genetic syndromes: 25–50%. Trisomies: 1%. Isolated: no increased risk of recurrence.
\n',keywords:"fetal face, facial malformation, ultrasound, prenatal diagnosis, congenital abnormalities",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/58770.pdf",chapterXML:"https://mts.intechopen.com/source/xml/58770.xml",downloadPdfUrl:"/chapter/pdf-download/58770",previewPdfUrl:"/chapter/pdf-preview/58770",totalDownloads:2240,totalViews:1025,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:2,impactScore:0,impactScorePercentile:9,impactScoreQuartile:1,hasAltmetrics:1,dateSubmitted:"May 30th 2017",dateReviewed:"December 12th 2017",datePrePublished:null,datePublished:"May 2nd 2018",dateFinished:"January 13th 2018",readingETA:"0",abstract:"Even at the early stages of gestation, the fetal face can be examined. There have been observations of the normal anatomy, such as orbits and the forehead, starting with the 12th week of gestation. However, nowadays, ultrasound equipment still cannot distinguish the soft tissues of the face, which are too thin. Yet, after the age of 14 weeks, we can easily examine the forehead, orbits, nose, lips, and ears. Recently, three-dimensional ultrasound (3D) images of the fetus can also be obtained. However, two-dimensional (2D) ultrasonographic (US) images are more easily, rapidly, efficiently, and accurately obtained. At the first stage of embryogenesis, the main part in the development of the fetal face is taken by the genetic factors. Later, the influence of the environment becomes more important. It is known that the outcome of chromosomal aberrations and of teratogenic factors is the facial malformation. Therefore, examining the facial dimorphism may get us useful hints in revealing chromosomal or genetic abnormalities. This chapter focuses on the fetal face anomalies more frequently found while performing the prenatal diagnosis. It is divided into anomalies of the orbits, nose, lip, palate, and mandible.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/58770",risUrl:"/chapter/ris/58770",book:{id:"6307",slug:"congenital-anomalies-from-the-embryo-to-the-neonate"},signatures:"Maria Șorop-Florea, Roxana-Cristina Dragușin, Ciprian Laurențiu\nPătru, Lucian George Zorilă, Cristian Marinaș, Virgiliu-Bogdan\nȘorop, Cristian Neamțu, Alina Veduța, Dominic Gabriel Iliescu and\nNicolae Cernea",authors:[{id:"212459",title:"Dr.",name:"Dominic",middleName:null,surname:"Iliescu",fullName:"Dominic Iliescu",slug:"dominic-iliescu",email:"dominic.iliescu@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"University of Medicine and Pharmacy of Craiova",institutionURL:null,country:{name:"Romania"}}},{id:"212490",title:"Dr.",name:"Dragusin",middleName:null,surname:"Roxana",fullName:"Dragusin Roxana",slug:"dragusin-roxana",email:"roxy_dimieru@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"University of Craiova",institutionURL:null,country:{name:"Romania"}}},{id:"212493",title:"Dr.",name:"Pătru",middleName:null,surname:"Ciprian",fullName:"Pătru Ciprian",slug:"patru-ciprian",email:"patru_ciprian@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"212494",title:"Dr.",name:"Șorop-Florea",middleName:null,surname:"Maria",fullName:"Șorop-Florea Maria",slug:"sorop-florea-maria",email:"laremyx@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"222056",title:"Dr.",name:"Cristian",middleName:null,surname:"Marinaș",fullName:"Cristian Marinaș",slug:"cristian-marinas",email:"cristi_marinas84@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"222057",title:"Dr.",name:"Lucian George",middleName:null,surname:"Zorila",fullName:"Lucian George Zorila",slug:"lucian-george-zorila",email:"zorilalucian@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"222058",title:"Dr.",name:"Bogdan Virgiliu",middleName:null,surname:"Sorop",fullName:"Bogdan Virgiliu Sorop",slug:"bogdan-virgiliu-sorop",email:"bogdansorop@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"222526",title:"Dr.",name:"Cristian",middleName:null,surname:"Neamțu",fullName:"Cristian Neamțu",slug:"cristian-neamtu",email:"drcristianneamtu@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"222699",title:"Prof.",name:"Nicolae",middleName:null,surname:"Cernea",fullName:"Nicolae Cernea",slug:"nicolae-cernea",email:"nicolaecernea@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_1_2",title:"1.1. Sagittal planes",level:"2"},{id:"sec_2_2",title:"1.2. Axial planes",level:"2"},{id:"sec_3_2",title:"1.3. Coronal planes",level:"2"},{id:"sec_4_2",title:"1.4. Fetal face profile",level:"2"},{id:"sec_6",title:"2. The fetal eyes",level:"1"},{id:"sec_6_2",title:"2.1. Anomalies of the orbits",level:"2"},{id:"sec_6_3",title:"2.1.1. Hypertelorism",level:"3"},{id:"sec_7_3",title:"2.1.2. Hypotelorism",level:"3"},{id:"sec_8_3",title:"2.1.3. Microphthalmia/Anophthalmia",level:"3"},{id:"sec_9_3",title:"2.1.4. Dacryocystocele",level:"3"},{id:"sec_10_3",title:"2.1.5. Cyclopia",level:"3"},{id:"sec_11_3",title:"2.1.6. Cataracts",level:"3"},{id:"sec_14",title:"3. The ear",level:"1"},{id:"sec_15",title:"4. The nasal bone and nostrils",level:"1"},{id:"sec_15_2",title:"4.1. Anomalies of the nose",level:"2"},{id:"sec_15_3",title:"4.1.1. Arhinia",level:"3"},{id:"sec_16_3",title:"4.1.2. Proboscis",level:"3"},{id:"sec_19",title:"5. The tongue",level:"1"},{id:"sec_19_2",title:"5.1. Macroglossia",level:"2"},{id:"sec_21",title:"6. Anomalies of the lip and palate",level:"1"},{id:"sec_21_2",title:"Facial cleft",level:"2"},{id:"sec_22_2",title:"6.1. Median cleft lip",level:"2"},{id:"sec_23_2",title:"6.2. Epignathus",level:"2"},{id:"sec_25",title:"7. Abnormalities of the mandible",level:"1"},{id:"sec_25_2",title:"7.1. Robin anomalad",level:"2"},{id:"sec_26_2",title:"7.2. Otocephaly",level:"2"},{id:"sec_28",title:"8. The chin: Micrognathia-retrognathia or prognathia",level:"1"},{id:"sec_28_2",title:"8.1. Micrognathia-retrognathia",level:"2"}],chapterReferences:[{id:"B1",body:'Benacerraf BR. Ultrasound of Fetal Syndromes. New York, London, Philadelphia, San Francisco: Churchill Livingstone.1998; pp. 83-223'},{id:"B2",body:'Sonek J, Borenstein M, Dagklis T, Persico N, Nicolaides KH. Frontomaxillary facial angle in fetuses with trisomy 21 at 11-13(6) weeks. 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Journal of Pediatrcis Child Health. 2003;39:474-476'},{id:"B25",body:'Cusick W, Sullivan CA, Rojas B, Poole AE, Poole DA. Prenatal diagnosis of total arhinia. Ultrasound Obstetrics Gynaecology. 2000;15:259-261'},{id:"B26",body:'Lim AS, Lim TH, Kee SK, et al. Holoprosencephaly: An antenatally-diagnosed case series and subject review. Annals of the Academy of Medicine, Singapore. 2008;37:594-597'},{id:"B27",body:'Chen CP, Shih JC, Hsu CY, Chen CY, Huang JK, Wang W. Prenatal three-dimensional/four-dimensional sonographic demonstration of facial dysmorphisms associated with holoprosencephaly. Journal of Clinical Ultrasound. 2005;33:312-318'},{id:"B28",body:'Chen CP, Chern SR, Lin CJ, Lee CC, Wang WA. Comparison of maternal age, sex ratio and associated anomalies among numerically aneuploid, structurally aneuploid and euploid holoprosencephaly. Genetic Counseling. 2005;16:49-57'},{id:"B29",body:'Papageorghiou AT, Avgidou K, Spencer K, Nix B, Nicolaides KH. Sonographic screening for trisomy 13 at 11 to 13 + 6 weeks of gestation. American Journal of Obstetrics and Gynecology. 2006;194:397-401'},{id:"B30",body:'Eckmann-Scholz C, Jonat W. 3-D ultrasound imaging of a prenatally diagnosed Beckwith-Wiedemann syndrome. Archives of Gynecology and Obstetrics. 2011;284:1051-1052'},{id:"B31",body:'O\'Connor C, Levine D. Case 49: Beckwith-Wiedemann syndrome. Radiology. 2002;224:375-378'},{id:"B32",body:'Walker SJ, Ball RH, Babcook CJ, Feldkamp MM. Prevalence of aneuploidy and additional anatomic abnormalities in fetuses and neonates with cleft lip with or without cleft palate: A population-based study in Utah. Journal of Ultrasound in Medicine. 2001;20:1175-1180'},{id:"B33",body:'Sohan K, Freer M, Mercer N, Soothill P, Kyle P. Prenatal detection of facial clefts. Fetal Diagnosis and Therapy. 2001;16:196-199'},{id:"B34",body:'Bianchi DW, Crombleholme TM, D\'Alton ME, Malone FD. 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The recurrence of a soft palate teratoma in a neonate: A case report. Head & Neck Oncology. 2013;5(2):16'},{id:"B50",body:'Printzlau A, Andersen M. Pierre Robin sequence in Denmark: A retrospective population-based epidemiological study. The Cleft Palate-Craniofacial Journal. 2004;41(1):47-52'},{id:"B51",body:'Selvi R, Mukunda Priyanka AR. Role of SOX9 in the etiology of Pierre-Robin syndrome. Iranian Journal of Basic Medical Sciences. 2013;16(5):700-704'},{id:"B52",body:'Jakobsen LP, Knudsen MA, Lespinasse J, et al. The genetic basis of the Pierre Robin sequence. The Cleft Palate-Craniofacial Journal. 2006;43(2):155-159'},{id:"B53",body:'Bronshtein M, Blazer S, Zalel Y, Zimmer EZ. Ultrasonographic diagnosis of glossoptosis in fetuses with Pierre Robin sequence in early and mid pregnancy. American Journal of Obstetrics and Gynecology 2005;193(4):1561-1564'},{id:"B54",body:'Smith MC, Senders CW. Prognosis of airway obstruction and feeding difficulty in the Robin sequence. International Journal of Pediatric Otorhinolaryngology. 2006;70(2):319-324'},{id:"B55",body:'Gekas J, Li B, Kamnasaran D. Current perspectives on the etiology of agnathia-otocephaly. European Journal of Medicine Genetics. 2010;53:358-366'},{id:"B56",body:'Iliescu D, Cara M, Tudorache S, Antsaklis P, Ceausu I, Paulescu D, Novac L, Cernea N, Antsaklis A. Challenges in sonographic detection of fetal major structural abnormalities at the first trimester anomaly scan. Donald School Journal of Obstetrics Gynecology. 2015;9(3):239-259. DOI: 10.5005/jp-journals-10009-1411'},{id:"B57",body:'Dragusin R, Florea M, Iliescu D, Cotarcea S, Tudorache S, Novac L, Cernea N. The contribution and the importance of modern ultrasound techniques in the diagnosis of major structural abnormalities in the first trimester. Current Health Sciences Journal. 2012;38:1'},{id:"B58",body:'Wagner JH, Hérbene JFM, Edward AJ, Jurandir PP. Agnathia-otocephaly: Prenatal diagnosis by two- and three-dimensional ultrasound and magnetic resonance imaging. Case report. Medical Ultrasonography. 2014;16(4):377-379'},{id:"B59",body:'Gull I, Wolman I, Merlob P, Jaffa AJ, Lessing JB, Yaron Y. Nomograms for the sonographic measurement of the fetal philtrum and chin. Fetal Diagnosis and Therapy. 2005 March–April;20(2):127-131'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Maria Șorop-Florea",address:null,affiliation:'
Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit, University Emergency County Hospital, University of Medicine and Pharmacy Craiova, Romania
Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit, University Emergency County Hospital, University of Medicine and Pharmacy Craiova, Romania
Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit, University Emergency County Hospital, University of Medicine and Pharmacy Craiova, Romania
'},{corresp:null,contributorFullName:"Lucian George Zorilă",address:null,affiliation:'
Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit, University Emergency County Hospital, University of Medicine and Pharmacy Craiova, Romania
Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania
'},{corresp:"yes",contributorFullName:"Dominic Gabriel Iliescu",address:"dominic.iliescu@yahoo.com",affiliation:'
Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit, University Emergency County Hospital, University of Medicine and Pharmacy Craiova, Romania
Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit, University Emergency County Hospital, University of Medicine and Pharmacy Craiova, Romania
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1. Introduction
Issues related to Industry 4.0 are constantly discussed among researchers, entrepreneurs, representatives of government agencies, and public organizations. Specifically, the impacts of the Industry 4.0 paradigm in the global and national economies, individual industries, employment, and capital markets are attracting more and more attention from economists. The global industrial environment has transformed dramatically in recent years as a result of technological advances and inventions. Industry 4.0 can be compared to three industrial revolutions that happened in the previous centuries and represent the most significant disruptive shifts in manufacturing as a result of technology advancements [1].
The advent of the steam engine accelerated the First Industrial Revolution, which began in Britain in the middle of the 18th century. The Second Industrial Revolution arose in Europe and the United States in the second mid-nineteenth century. This revolution had characterized by mass manufacturing and the substitution of chemical and electrical energy for steam. Many technologies and mechanization had been developed to meet the increased demand, allowing productivity to increase [2]. The Third Industrial Revolution was sparked by the creation of the Integrated Circuit (microchip). Using electronics and information technology to accomplish increased automation in manufacturing is a significant characteristic of this revolution, which arose in many industrialized countries around the world in the later years of the twentieth century [1].
Every industrial revolution centered around boosting productivity. The first three industrial revolutions had a significant impact on industrial operations, allowing for increased productivity and efficiency by utilizing innovative technological breakthroughs, such as steam engines, electricity, and digital technology [3]. Industry 4.0, which could ultimately be referred to as the fourth industrial revolution, is a highly complex framework that has been commonly debated and discovered. It has a significant impact on the industrial sector because it introduces relevant improvements related to smart and future factories. This developing Industry 4.0 concept is an umbrella term for a new industrial paradigm that includes Cyber-Physical Systems (CPS), the Internet of Things (IoT), the Internet of Services (IoS), Robotics, Big Data, Cloud Manufacturing, and Augmented Reality, etc. [4].
The adoption of these technologies, which will bring together the digital and physical worlds through embracing a set of future industrial developments, is essential in the development of further smart industrial processes. This adoption includes devices, machines, production modules, and products that can exchange information and control each other independently, resulting in a smart manufacturing environment [5]. This new approach will allow the improvement of productivity and efficiency, carrying enormous potential effects, and it will support a set of economic and social opportunities among the companies that are adopting this new manufacturing paradigm [1].
This chapter intends to provide clear insight into the current developments within Industry 4.0 phenomenon, due to the inconsistency within the existing literature, some stress positive effects of Industry 4.0, while others, negative ones. As a result, the purpose of our research is to provide a full explanation of the Industry 4.0 paradigm, as well as to determine whether or not it is appropriate for businesses, stockholders, and countries to adopt this new approach. This chapter gives a review of Industry 4.0 and definitions in the literature, as well as introduces a brief on Industry 4.0’s main components. Additionally, this chapter’s research methodology was based on papers related to Industry 4.0, which are the most recent and cited references. As well as this study differs from past studies in several aspects, as shown in 1) It conducts a comprehensive survey of all Fourth Industrial Revolution technologies or applications, whereas earlier literature focused on one or a few technologies. 2) It performs a case study of KUKA Corporation, a pioneer company in the manufacturing technologies and applications of the Fourth Industrial Revolution.
Thus, this chapter is structured in seven sections. After this introduction about the Industry 4.0 phenomenon. Section 2 answers the question “What is the industry 4.0?”, presenting two points: an overview or background about Industry 4.0, and provides a comprehensive definition of this concept, its visions. The key Industry 4.0 technology enablers or components of Industry 4.0 characteristics are described in Section 3, which is divided into ten parts. The characteristics of Industry 4.0 state in Section 4. Section 5 provides an analysis of the impacts and influence of this new industrial paradigm: industrial sector, business models and markets, work environment, work skills, economy and sustainability, the value chains, and supply chains. While Section 6 presents the key drivers and obstacles or barriers of the Industry 4.0 concept; also, this part presents a pioneering experience in implementing the applications of the Fourth Industrial Revolution technology “KUKA corporation.” Finally, Section 7 draws the main conclusions and findings of the Industry 4.0 vision and implications.
2. What is industry 4.0?
2.1 An overview of industry 4.0
There have been three earlier industrial revolutions that have resulted in a transformation in manufacturing patterns: mechanization via water and steam power, mass production in assembly lines, and automating through computer and information technology [6].
The first industrial revolution (Industry 1.0) was developed in the United Kingdom at the end of 18th century with the advent of water and steam power and mechanization of production. It was the most significant advancement in human productivity, which considerably aided mechanical production and greatly improved agriculture and trade. Where steam engines could be used for power. Developments such as the steamship or the steam-powered locomotive brought about further massive changes because humans and goods could move great distances in fewer hours [4]. Then, it was followed by the second one (Industry 2.0) at the beginning of 19th century which introduced the electrically powered machines and assembly line production, which is described as the period when mass manufacturing became the dominant style of production in general. The introduction of railways into the industrial system was assisted by steel mass manufacturing, which in turn assisted mass production [7]. The third industrial revolution (Industry 3.0) took a place in the 1970s by adopting electronics and devices within the machines, which led to developing automation and robots within the manufacturing process. Industry 3.0 developed with the introduction of the Digital Revolution, which is more well-known than Industry 1.0 and 2.0, since most people today are familiar with industries that rely on digital technology in production [4].
The Fourth Industrial Revolution is presently being implemented. This is also known as “Industry 4.0,” and it is defined by the use of information and communication technology in the industry. It is based on the Third Industrial Revolution’s advancements. Production systems using computer technology are enhanced by a network link and, in a sense, have a digital twin on the Internet. These enable communication with other systems as well as the production of data about themselves. This is the next phase in the automation of production [8].
All systems are connected, resulting in “cyber-physical production systems” and, as a result, smart factories, in which production systems, components, and people interact through a network and production is almost autonomous. When these enablers are combined, Industry 4.0 has the potential to offer some amazing improvements in manufacturing environments. Machines that can foresee faults and initiate maintenance operations on their own, for example, or self-organized logistics that adapt to unexpected changes in production are examples (Figure 1) [9].
Figure 1.
Represents a graphic illustration of the industrial revolutions overall. Source: Constructed by the author.
It also has the ability to alter people’s working habits. Individuals can be drawn into smarter networks by Industry 4.0, which might lead to more efficient working. The manufacturing environment’s digitization provides for more flexible means of providing the appropriate information to the right person at the right time. Maintenance personnel may now receive equipment documentation and service history more quickly and at the point of use, thanks to the growing usage of digital devices inside factories and out in the field. Maintenance personnel prefer to spend their time addressing issues rather than waste time looking for technical knowledge [10].
In a summary, Industry 4.0 is a game-changer in the industrial world. Manufacturing will alter as a result of digitization, including how things are manufactured and delivered, as well as how products are maintained and enhanced. As a result, it may legitimately claim to be the start of the fourth industrial revolution. Industry 4.0 is presently taking shape and its supporting technologies, such as the Internet of Things (IoT) and Cloud Manufacturing (CM), are, nevertheless, poorly defined, and under-researched.
2.2 Definition industry 4.0
Industry 4.0 is better known as the fourth industrial revolution and describes a future production system’s vision. The idea of Industry 4.0 was established by a group of professionals from several professions (such as business, politics, and academia) as part of an endeavor to integrate all manufacturing industries systems to achieve sustainability. The German government initially officially approved and implemented industry 4.0 for supporting automation in manufacturing, and for boosting German competitiveness in the manufacturing industry. Essentially, as a result of Industry 4.0, operations and manufactures will become further efficient and less expensive. These are accomplished through the simple interchange of information, integrated control of industrial goods and equipment, which work synchronously and intelligently in interoperability [11]. However, several researchers have different perceptions of the meaning of industry 4.0.
Kagermann, et al. [12] stress that industry 4 utilizes the power of communications technology and innovative inventions to boost the development of the manufacturing industry. Corresponding to Kagermann et al., the primary features of the industry 4.0 idea are characterized by three aspects: (1) horizontal integration, (2) vertical integration, and (3) end-to-end digital integration of engineering. Qin, Liu, and Grosvenor [13] emphasize that industry 4.0 encourages manufacturing efficiency by collecting data, making correct decisions. By using the most advanced technologies, the procedures will be easier. The interoperability operating ability to ensure a stable manufacturing environment. This overall consciousness gives Industry 4.0 the most important aspect of artificial intelligent functions.
The Fourth Industrial Revolution, 4IR, or Industry 4.0 conceptualizes rapid change to technology, industries, and societal patterns and processes in the 21st century due to increasing interconnectivity and smart automation [14]. Schwab pointed out that Industry 4.0 is one of the most important concepts in the development of global industry and the world economy, he accentuates that, Industry 4.0 is differentiated by a few characteristics of new technologies, the improvement in technologies is bringing significant effects on industries, economies, and governments’ development plans [15]. Industry 4.0 also denotes a social, political, and economic transformation from the digital age of the late 1990s and early 2000s to an era of embedded connection marked by widespread technological use (e.g., a metaverse). That, in comparison to humans’ inherent senses and industrial ability alone, we have constructed and are entering an augmented social reality [16].
Wang et al., [17] defined the fourth industrial revolution as the modern and more sophisticated machines and tools with advanced software and networked sensors that can be used to plan, predict, adjust, and control the societal outcome and business models. Thus, Industry 4.0 is an advantage to stay competitive in any industry. Also, Industry 4.0 can be perceived as a strategy for being competitive in the future. It is focused on the optimization of value chains due to autonomously controlled and dynamic production [18]. Furthermore, industry 4.0 is possible to indicate three future-relevant themes related to it, such as: dealing with complexity, capacity for innovation, and flexibility [19].
According to the concepts above, the majority of the researchers considered Cyber-Physical Systems (CPS), Internet of Things (IoT), Industrial Internet, and other topics to be part of Industry 4.0. Numerous authors also emphasized Industry 4.0 on the cost and profitability of recently created high-tech information and intelligent services. According to previous research on Industry 4.0, the early focus was mostly on the industrial manufacturing sector, but many industries are now adopting Industry 4.0, including automotive, engineering, chemical, and electronics. As a result, Industry 4.0 is aggregating existing ideas into a different value chain that leads to an improvement in transforming entire value chains of goods life cycles while developing innovative products in manufacturing, involving the connection of systems and things that create self-organizing and dynamic control within the organization.
Industry 4.0, often referred to as the fourth industrial revolution, is the vision or scenario of a future production process characterized by new levels of controlling, organizing, and transforming the entire value chain with the life cycle of products through three types of effective integration: horizontal, vertical, and end-to-end engineering integration, resulting in increased productivity and flexibility, the industry 4.0 leads to cost optimization and reduction [11]. The Cyber-Physical Systems (CPS), Internet of Things (IoT), artificial intelligence (AI), additive manufacturing, cloud computing, and other technologies are then combined to construct dynamic, real-time optimized, and self-organizing cross-company value networks. All of these components are necessary and integral to the futuristic Industry 4.0 concept.
3. Components of industry 4.0 and the key enabling technologies
Industry 4.0 is a complicated technical pattern characterized primarily by connection, integration, and industrial digitalization, highlighting the possibilities for integrating all components in a value-adding system. Digital manufacturing technology, network communication technology, computer technology, and automation technology are all included in this approach. Industry 4.0 technology breakthroughs are blurring the lines between the digital and physical worlds by merging human and machine agents, materials, products, production systems, and processes [20]. Industry 4.0 enables rapid technological advancements in a variety of areas; however, the emerging fourth industrial revolution is being shaped largely by the technical integration of Cyber-Physical Systems into manufacturing processes, as well as the use of the Internet of Things and Services in industrial processes [1]. As a result, this section gives a brief overview of each significant technology driver for Industry 4.0. It also is providing information on the basic components of Industry 4.0 or key technologies enablers for Industry 4.0, which consists of 10 components.
3.1 Cyber-physical system (CPS)
Cyber-Physical Systems (CPS) is the combination of computational and physical processes, which are essential components of Industry 4.0 implementations. They integrate imaging and control capabilities into the relevant systems. The ability of these systems to respond to any input generated is a key feature. They provide rapid control and verification of process feedback in order to generate predicted outputs. Bergera et al. (2016) defined cyber-physical sensor systems as part of cyberspace, special types of embedded systems, based on powerful software systems, enable integration in digital networks, and generate whole new system features [21]. Generally speaking, the evolution of a CPS is characterized by three phases. Identification technologies are included in first-generation CPS. Second-generation CPS is equipped with some sensors and actuators with a limited number of functions. In the third-generation CPS, data is kept and analyzed in addition to setting up the equipment. The CPS has many sensors and actuators and is meant to be network compatible. CPSs offer various features [19].
The CPS has several sensors and actuators and is meant to operate with a network. CPSs have features including quicker information access, preventative maintenance, pre-defined decision-making, and optimization processes. Also, CPS can boost consumers awareness and consciousness. Conversely, the CPS has certain security issues, which means that further usage will definitely result in increased dangers. It was pointed out that CPS equipment might cause disruptive societal changes since intelligent assistive or autonomous environments can cause mental illnesses, which can lead to bias toward new technology adoption and usage [21]. Cyber-Physical Systems have consisted of two key components: i) A virtual environment built through computer simulation of items and actions in the actual world, and ii) a network of objects and systems interacting with each other over the internet with a designated address [4].
3.2 Cloud systems (CS)
The term “cloud” is utilized for applications, for instance, remote services, color management, and performance benchmarking applications. It has taken remarkable attention from the IT community, and its role in other business areas will continue to grow. Machines, data management, and functionality will continue to transition away from traditional ways and toward cloud-based solutions as technology improves. The cloud enables significantly faster distribution than standalone systems, as well as quick upgrades, current performance models, and other delivery possibilities [19].
The industry has found a significant shift toward cloud solutions, which will continue to develop and represent a substantial challenge to traditional data storage methods. Cloud technology is the most basic online storage service that gives operational comfort with web-based apps that do not require any installation. Cloud computing refers to the process of storing all applications, programs, and data on a virtual server. It improves efficiency by guaranteeing those input suppliers, employees, and consumers have access to the same information at the same time [22]. Cloud Systems lower costs, simplify infrastructure, expand work areas, safeguards data, and allow for instant access to information. There are four types of the system, mainly: i) Public Cloud; ii) Private Cloud; iii) Hybrid Cloud (combination of public and private cloud); 4) Community Cloud (this refers to the co-operation of any service on the cloud with a few companies) [9].
Cloud systems are an excellent source of Big Data (which might be organized or unstructured) management solutions. Because traditional computers may not be capable of managing large amounts of data, using a cloud system to do the necessary analysis, would be much easier and more efficient. As a result, data analysis and cloud systems should be inescapable components of Industry 4.0. The integration of cloud-connected robots into everyday life, as well as their impact, is considerable [4].
3.3 Machine to machine (M2M) communication
Machine to machine (M2M), refers to the technology that allows direct communication between devices using any channel, wired or wireless. Machine-to-machine communication can include industrial instrumentation and personal communications [23]. M2M is also considered to be an essential component of Industry 4.0. Machine to machine (M2M) is a technology that allows devices to communicate directly with one another over any channel, wired or wireless. Machine-to-Machine Communication can include industrial instrumentation and personal networks. M2M is also considered to be an essential component of Industry 4.0. The apps are geared toward adding value to the enterprises by introducing alternative revenue streams and reducing operational costs [24].
Ackermann (2013) clearly states that M2M operations have to enable aspects with different networked organizations including i) Remote Service and Asset Information Management delivering, which provide information federation and lifecycle support. ii) Connected Vehicles, which creates relationships and interactions. iii) Smart Vending, which includes retail, supply chain, and associated sub-elements [4]. The M2M vision has raised a number of issues, including establishing smart settings, smart architecture, and a smart grid with wireless sensors, as well as developing a communication language between machines and humans, as well as between humans in different locations [23].
3.4 Internet of things and internet of services
The Internet of Things (IoT) is an emerging concept that combines various technologies and techniques, based on the interaction between physical things and the Internet. The advancement of technology in recent decades has enabled the Internet to be expanded into a new level known as “smart objects,” which is the foundation of an IoT vision, for this, the novel pattern consists in awarding ordinary things with intelligence, permitting them not only to accumulate information and cooperate with their surroundings, but also to be interrelated with other items, communicating information, and conducted a preliminary via the Internet. The growing interest in this field, which is widely regarded as one of the primary drivers of Industry 4.0, has produced the development of a number of visions and definitions for (IoT) [1].
The Internet of Things (IoT) refers to the interconnection of physical devices, cars, buildings, and other entities that are equipped with electronics, software, sensors, actuators, and network connections to gather and share data to create a smart manufacturing environment, also known as a smart factory [25]. Additionally, the concept of “The Internet of Services (IoS)” takes a similar approach to IoT but applies it to services rather than physical assets. The Internet of Services (IoS) idea will open up new prospects for the service sector by providing a commercial and technological foundation for the construction of business networks between service providers and clients [4].
The expansion of IoT in industrial contexts and value chains will give several opportunities for users, manufacturers, and businesses, having a significant influence in a variety of industries. The Internet of Things is breaking new ground, with a slew of new applications emerging around three key pillars: i) process optimization; ii) resource optimization, and iii) the building of sophisticated autonomous systems. IoT technology will continue to evolve and spread, allowing objects to become smarter, more dependable, and autonomous, allowing for the supply of higher-value products and services [1]. On the other hand, the effectiveness of Industry 4.0 depends upon existing network infrastructure, the intelligence, and human knowledge embedded into the system [22].
3.5 Smart factories or smart manufacturing
Smart factories or Smart manufacturing is a type of manufacturing that aims to improve concept creation, production, and product interactions by moving away from traditional methods toward automated and digitized systems. It aims to take advantage of advanced information and manufacturing technologies in order to operate and produce fully flexible production at the highest speed required [6].
“Dark factories,” “lights off factories,” and “unmanned factories” are all terms used to describe smart factories, this system is integrated with the small intervention of human beings. The individual is entering into these systems mainly in the problem-solving stages. The concept known as Lights out (dark) or unmanned factories nowadays is an automation and autonomy enhanced methodologies including equipment used in factories that actively operate the production [4, 26]. The most famous characteristic of dark factories is that they do need no human power. In unmanned factories, there is not enough time to enter the plant from the raw material to the exit from the factory. That is to say that in these factories, production is carried out entirely with robotic systems [18]. It is self-evident that smart factories will have the characteristics and procedures required by the Fourth Industrial Revolution. And these processes, which are of great importance to our future of production. Furthermore, the essential activity for generating a smart factory running under Industry 4.0 is integrating different other components together, such as big data, CPS, cloud, IoT, M2M, etc. [4]
There are many challenges that determine the formation of smart factories, such as the availability of energy and its supply, the efficiency of the labor, and the availability of the technological infrastructure necessary to shift toward smart factories. On the other hand, these factories will have a negative impact on existing employment and increase unemployment rates [7].
3.6 Big data and data mining
Big data is being generated continuously by everything in environments. Every digital process and social media exchange produce data. Systems, sensors, and mobile devices transmit those. Big data is arriving from multiple sources at an alarming velocity, volume, and variety. To extract meaningful value from big data, there is a need for optimal processing power, analytics capabilities, in addition to information management skills [4]. An abundance of heterogeneous data abounds in the world around us. Without properly applying data mining technology, it appears impossible to make this atmosphere keenly intelligent. With today’s automation, data mining can be supervised, unsupervised, or reinforcement learning. When executed in numerous layers in a hierarchical way, computer-assisted learning becomes more exact. Machine Learning is the process of automatically extracting features through supervised or unsupervised learning in a hierarchical fashion (ML) [27].
3.7 Intelligent robotics
Every day, new goods and systems emerge as a result of technological advancements. Flying automobiles, holographic television, and hundreds of electrical devices to be implanted into the human body are all possibilities [26]. Humanoid robots will be a part of everyday life in the not-too-distant future. Recent innovations have brought about skills that empower robots to control their environment. Artificial intelligence will contribute to the development of having robot teams cooperating and collaborating in achieving certain tasks defined for a specific purpose [28].
Implementing a collaborative robot in a factory will provide several benefits for the company, including i) preventing humans from performing repetitive, non-ergonomic, and dangerous work; ii) producing high-quality products with favorable cost–benefit ratios while also increasing productivity; and iii) increasing competitiveness in comparison to countries with cheap labor [29]. When a robot is used in a productive process, the benefits of the robot utilization are combined with the effort of an operator. There is no teamwork between the man and the robot on the first level. The workplace is totally shared between the man and the robot at the final level [30].
3.8 Augmented reality and simulation
Simulation, the data obtained and processed from big data and cloud systems can be used as a feed to a virtual model to evaluate all possible scenarios related to the product design, development, and production. Simulation is used broadly in business models to leverage the available real-time data and simulate the actual working world in a virtual ecosystem. Process testing and optimization through simulation permit people to decrease business changeover, risk, setup time, and enhance quality control for future processes and services, even before the implementation of adjustments in the actual physical world [22].
Simulation and augmented reality (AR) is a type of enhanced reality in which live direct or indirect views of physical real-world environments are augmented with computer-generated visuals projected on top of them. Industry 4.0 applications rely heavily on this technology. This innovative technology, which is critical to the industrial revolution, was created by combining real operations and simulation industries [4]. These strategies have a lot of advantages, especially when it comes to creating products and manufacturing processes. One of the cutting-edge technologies included in the Industry 4.0 trend is augmented reality, which is particularly useful in producing smart manufacturing functions [28].
3.9 Enterprise resource planning (ERP) and business intelligence
Enterprise resource planning (ERP) refers to information systems that are designed to integrate and efficiently employ all of an organization’s resources. An ERP software is a system that supports an organization in bringing together processes and data that are executed all over the processes (suppliers, production, stock, sales). ERP systems are able to provide an integrated approach to information use, to start forecasting and extracting information, which can use in various departments [4]. There is a connection between big data and Industry 4.0, Manufacturing Executive Systems (MES), cloud systems, and ERP are integrated. It is critical that all procedures in the design stage as well as the customer journey are compatible with the Industry 4.0 approach. The ERP process is also a vital component in this framework [28].
The idea of Industry 4.0 necessitates connection and collaboration criteria. End-user feedback is critical, as is providing immediate additional value to all interested parties. In order for personalization to be possible, network systems must be intelligent [22]. A telecom operator may be able to analyze network performance during fluctuations and use preventive scenarios to reduce client dissatisfaction. A well-structured ERP system can enable these characteristic features. ERP systems can help with Industry 4.0 implementations, especially as a result of the following advantages: i) Real-time data may be evaluated and allow for early detection; ii) ERP systems can provide sales and purchasing transparency; iii) ERP data may be used by mobile applications to communicate; iv) Optimum resource utilization may be achieved under varying job descriptions; v) Clients may be able to track their orders online and receive the necessary information quickly [4].
3.10 Smart virtual product development system (SVPD)
The Smart Virtual Product Development (SVPD) system is a product development decision support technology that saves, uses, and shares the experiential knowledge of previous decisional events in the form of SOEs. It was created to address the requirement for digital knowledge captured in smart manufacturing product design, production planning, and inspection planning. As a result, product quality and development time will be improved, as required by Industry 4.0 concepts [31].
4. Industry 4.0 characteristics
The core progress from traditional manufacturing toward Industry 4.0 concluded into four key features and characteristics [32]: (1) vertical networking of smart manufacture schemes; (2) horizontal integration through a new generation of global value chain networks; (3) through-life engineering across the entire value chain; and (4) the impact of exponential technologies.
4.1 Vertical networking of smart production
Industry 4.0′s first main characteristic is the vertical networking of smart manufacturing systems. Vertical integration in Industry 4.0 establishes a connection between the many levels of the industry, from the manufacturing floor up, via production monitoring, control, and supervision, quality management, operations, product management, processing, and so on. This interconnectedness across all corporate levels provides for a fluid, transparent data flow, allowing for data-driven strategic and tactical choices [20]. Hence, the main objective behind vertical networking is to utilize Cyber-Physical Production Systems (CPPSs), to enable industries to quickly respond to unexpected order changes resulting from demand fluctuations, equipment failure or stock shortage. Vertical networking improves an organization’s capacity to adequately adapt to changes in market requirements and benefit from new possibilities [22].
Furthermore, it makes it easier to link resources to goods and find supplies and parts at any time. Similarly, processing data, anomalies, and defects from various processing stages of the manufacturing line are automatically captured and registered, allowing for quick responses to order changes, quality variations, and even machinery breakdowns. As a consequence, waste is decreased, and resource efficiency, notably in terms of material usage, energy consumption, and human resources is improved [28].
4.2 Horizontal integration through a new generation of global value chain networks
In the Industry 4.0 concept, horizontal integration refers to the network of diverse processes, companies, and services that make up a product’s global value chain. This can be viewed at the production level as a total consolidation of all associated manufacturing processes. Vertical integration, on the other hand, refers to a high level of coordination between production and top management layers such as quality management, product management, and production control [33].
The horizontal integration in an Industry 4.0 enterprise occurs at different levels: production floor, multiple production facilities, and entire value chain. Each connected machine or production unit becomes a node with well-defined properties within the production network. These nodes continuously communicate their status to respond autonomously to dynamic production requirements cost-effectively and reduce system downtime through predictive maintenance . If an enterprise owns several production sites, the horizontal integration enables to share inventory levels and unexpected delays, and possibly redistribute work among owned facilities to respond to market demand fluctuations rapidly or increase the efficiency and speed of the production process. However, the most critical and global horizontal integration remains the integration across the entire value chain [12].
Industry 4.0 offers a highly automated and transparent collaboration across the complete value chain, using CPPSs, from the inbound assembly, packaging, storing, production, quality control, marketing, and sales, to outbound distribution, logistics, and retail services. The horizontal integration across all these activities creates a transparent value chain that is updated in real-time. Hence, this feature provides a high level of flexibility to respond more rapidly to changing market demands, shortcomings, and problems, facilitates the optimization of the production process, increases its efficiency, and reduces the generated waste [17]. Additionally, the fact that any part or product’s history is logged and can be accessed at any time ensures constant traceability, also known as “product memory” [19].
4.3 Through-life engineering across the entire value chain
Among the characteristics of the Fourth Industrial Revolution is also the impact of the ten components of the 4th Industrial Revolution “ten types of innovation,” Efficient management of innovation, and finally, Efficient life cycle management. These are shown below.
The “ten types of innovation” (Components of Industry 4.0). Industry 4.0 will enable integrated and cross-disciplinary engineering throughout the value chain, as well as throughout product and customer life cycles. Industry 4.0 applications are intended to ensure the traditional domain of product innovation. Innovation is not limited, innovation has traditionally been related mainly to product offerings, but it also has significant potential in areas such as company structures, processes, networks, and profit models, as well as customer-facing functions [5].
Efficient management of innovation. The digital transformation to industry 4.0 will make it possible to improve further the efficiency of innovation management in all the Components of Industry 4.0. Interactive and designed curricula make individualized learning achievable, thereby, speeding up strategic implementation and organizational development [34]. Industry 4.0 solutions in project portfolio management make it easier to track not only the return on investment (ROI) in innovation, but also to identify risks by utilizing global comparative project data for monitoring and remediation. Information technology can be utilized to speed up R&D in the field of product development [5].
Efficient life cycle management. The digital transformation industry 4.0 will allow essential data for life cycle management to be provided at any time and from any location. These data will include not just information and reports, but also the outcomes of big data processing, which will be used to develop appropriate early indicators using artificial intelligence (Al). Al will employ global cross-checking to determine the plausibility of developing suitable bases for data-driven decision-making. It will allow businesses to better understand and address the needs of their customers, as well as customize product cycles [5].
4.4 The impact of exponential technologies
Exponential technologies solutions. Corporate venture capital firms have a strong chance of profiting from disruptive innovation and exponential technology by investing in new trends early on. Corporate venture capital Investing in start-ups allows businesses to participate in the development of new products and services while also ensuring their long-term competitiveness. This type of investment allows for early and convenient access to new technologies. Companies must be given more leeway to “see around the next corner.” Only then can a new business region be formed, which will eventually become the company’s new heart. Companies’ survival may be jeopardized if such possibilities are neglected [2].
The learning organization. If companies are to fully use the promise of exponential technologies in making the digital transformation to industry 4.0, they must change into learning organizations. Exponential technology adoption and integration must be slow but continuous. Learning is essential for long-term organizational development. It is time to make a change that is not so counterproductive. New ideas, processes, and business sectors are most successful when they begin as a learning niche and eventually migrate to the center of the organization, establishing themselves as a new leading segment [5].
5. Effects of industry 4.0
Innovation and scientific advancements perform an essential role in businesses, sectors, and countries. However, the digital improvements and the increasing interconnectivity will bring additional challenges and upgrades to societies, since, Industry 4.0 (Ir 4.0) will significantly change the manufacturing systems in terms of design, processes, operations, and services. Industry 4.0 will lead to potential deep changes in a variety of fields outside of the industrial sector. Its influence and effect may be divided into six categories: (1) Industry sector, (2) Products and services, (3) Business models, entrepreneurship, and market competition, (4) Economies of nations, (5) Work environment, and (6) Skills development.
5.1 The impact of industry 4.0 on the industrial sector
The industry sector will be the first to feel the effects of Industry 4.0. This new industrial paradigm will usher in a vision of manufacturing that is decentralized and digitalized, with production elements that can autonomously govern themselves, trigger operations, and adapt to changes in their surroundings. Furthermore, the developing paradigm recommends fully integrating products and processes, altering industrial vision from mass production to mass customization, resulting in increased complexity [35]. Consequently, advanced technologies and the building of smart factories will have a significant impact on production processes and operations, providing for greater operational flexibility, and more efficient utilization of resources. Industry 4.0 will have a considerable effect on the production systems, supply chains, and industrial activities. This new paradigm is changing the current industrial landscape in three ways: (1) production digitization, (2) automation, and (3) integrating the manufacturing site to a larger supply chain. Industry 4.0, in this sense, entails complete network integration and real-time data sharing [1]. Productivity growth is at the core of each industrial revolution. The 4th industrial revolution, on the other hand, will influence the entire supply chain, from product creation and manufacturing to outbound logistics, in addition to enhancing productivity [36].
ROJKO, et al. (2020) used the vector autoregression model forecast for data from the manufacturing sector in the United States over the period (2008−2018) and concluded that, the share of manufacturing output and employment has declined, and that the manufacturing sector has reached a turning point, after which robotization can increase employment and labor productivity of workers while also stimulating further growth of their education levels. They concluded that the shift to Industry 4.0 has a significant impact on the growing demand for new knowledge and skills in order to boost productivity. As a result, anticipated growths of assessed manufacturing indicators imply that the negative effects of robotization in the recent past were only transient, as the Industry 4.0 age has begun. Nonetheless, further policies are needed to enable long-term industry development [37].
5.2 The impact of industry 4.0 on products and services
This new industrial paradigm has a significant impact on products and services. Rapid changes in the economic landscape and dynamic market demands have resulted in an increased demand for the development of more complicated and intelligent products in recent years [36]. Products will become increasingly modular and configurable, allowing for mass customization to match individual consumer needs [35]. As a result, Industry 4.0 is defined by the emergence of new products and services as embedded systems that can become attentive and interactive, be managed, and tracked in real-time, optimize the entire value chain, and provide pertinent information about their status throughout their lifecycle [37].
5.3 The impact of industry 4.0 on business models and market
In the previous few years, company models and markets have swiftly altered, and new inventive business models will emerge. In the context of Industry 4.0, the introduction of new disruptive technologies has altered the way products and services are sold and delivered, disrupting established enterprises, and introducing new business prospects and models [33]. As a result, value chains are becoming more responsive, as Industry 4.0 encourages integration between manufacturers and customers, allowing for closer customer connection and business model adaption to market demands. The rising digitalization of industrial production, combined with system integration and complexity, will result in the establishment of increasingly sophisticated and digital market models, boosting competitiveness by removing barriers between information and physical structures [1].
5.4 The impact of industry 4.0 on the work environment
Because of technological advancements, the workplace environment is changing fast, and Industrial revolution 4.0 is redefining jobs and key competencies. The most significant transition is the human-machine connection, which includes employee contact and a set of new collaborative work approaches [18]. The number of robots and intelligent technologies is growing, the real and virtual environments are merging, implying the existing work environment is undergoing a considerable transition [13].
The rising importance of human-machine interfaces will encourage interaction between production elements as well as the necessary communication between smart machines, smart products, and employees, which will be aided by CPS’ vision of IoT and IoS. As a result, ergonomic concerns should be considered in the context of Industry 4.0, and future systems should emphasize the relevance of workers. Job profiles, as well as work management, organization, and planning will be affected by the integration of Industry 4.0 in industrial systems and the rising deployment of new technologies [12]. In this scenario, the major task is to avoid technological unemployment by reframing present jobs and taking steps to adapt the workforce to the new jobs that will be generated [28].
5.5 The impact of industry 4.0 on skills development
One of the most significant fundamental factors for a successful acceptance and implementation of the Industry 4.0 framework is skill development, which will lead to demographic and societal changes. New competencies will be required in the future work vision, and it will be vital to provide opportunities for the acquisition of these abilities through high-quality training. This new industrial paradigm will have a significant impact on the labor market and professional roles, and it will be critical to ensure that more jobs are generated than are lost [26].
Interdisciplinary thinking will be vital, and outstanding abilities in social and technological domains will be desired. The new required competency sectors must be included in schooling. As a result of Industry 4.0’s rising automation of jobs, workers must be prepared to take on new responsibilities [28]. The same can be said for engineering education, which has a lot of promise in terms of training future professionals and informing them about new technical trends and opportunities, as well as managers who need to adapt their management strategies to meet changing market demands. Furthermore, in order to address Industry 4.0, more qualified personnel will be required in technological sectors [1].
In summary, Industry 4.0 has enormous potential in many areas, and its implementation will have an impact across the entire value chain, improving production and engineering processes, improving product and service quality, optimizing customer-organization relationships, bringing new business opportunities and economic benefits, changing educational requirements, and transforming the current work environment.
5.6 The impact of industry 4.0 on the economy
An economy can be inspired by the introduction of new models and emerging technological improvements. Digitization involves the convergence between physical and virtual worlds and will have a widespread impact in every economic sector [15]. This will be the primary driving force behind innovation, which will be crucial to productivity and costs of production, which is reflected in the competitiveness (companies, sectors, and nations) [17].
Industry 4.0 also, can transform existing relationships in the manufacturing process, allowing the manufacturing sector to join the information age by allowing communication at all stages of the manufacturing process. Some academics anticipate that Industry 4.0 would lead to new economic forms in the industry, agriculture, and services [3]. The majority of businesses expect a two-year payback on their Industry 4.0 investments, which leads to a considerable rise in investment in this area is likely, it’s reflected in economic growth [37].
On the other hand, some experts believe that Industry 4.0 will result in increased inequality due to its threat of disrupting labor markets. It is argued that the continuous growth in automation, robots, and computers will take the jobs of workers in many industries with the most worrying factor being the increased danger of the disappearance of low-skill/low-pay jobs which will cause a lot of challenges for the poor, which will lead to a rise in social tensions [37]. The most concerning fact in Industry 4.0 is that it is not only the transfer of labor from one sector of the economy to another but also the availability of technology that will replace human capital, in other words, taking people’s jobs. The technological revolution will also have an impact on topics such as material or ideological changes brought about by the introduction of new gadgets or systems, all of which will have an impact on redefining humanity’s culture [3].
In general, digitization and interconnection of industrial processes, lead to potentials in all three dimensions of sustainability. However, achieving long-term benefits of sustainability is accompanied by several challenges respectively, especially in the implementation phase of Industry 4.0 [38].
Referring to the economic perspective of Industry 4.0, transparency and interconnection of processes enable process optimization, resulting in increased efficiency, flexibility, quality, and customization. Industry 4.0 allows load balancing between smart manufacturing technologies, innovative value propositions, and increasing demand orientation. All these are enabling smart products, which boost a company’s competitiveness [39]. In the same regard, increasing process openness in intra- and inter-firm logistics can also be accomplished, lowering logistics costs. On the other hand, such procedures, as well as the adoption of Industry 4.0 in general, represent risks in terms of high investments and uncertain profitability [38]. Furthermore, manufacturers consider the transition to Industry 4.0 of their current business models to be difficult. Furthermore, Industry 4.0 necessitates the standardization of processes both within and between businesses. Due to their low degree of process standardization, more flexible but less automated manufacturing equipment, and resource limits, among other things, both undertakings, i.e., business model change and standardization, can become particularly problematic for SMEs [40].
Regarding the ecological dimension of sustainability, Industry 4.0 offers a number of advantages: transparency in demand and process enables for an intelligent task and process scheduling, resulting in lower energy use [38]. Furthermore, direct data linkage from product consumption back to design can improve manufacturing design, resulting in improved product lifecycle management, including recycling, as a result, Industry 4.0 aids in the identification and reduction of greenhouse gas emissions [40]. As a result, waste reduction and resource consumption can be improved. Reduced transportation operations and superfluous material flows can also be realized in logistics [25]. Furthermore, data openness across the entire supply chain can reduce the frequency of incorrect deliveries, wasteful waiting time, and damaged items. Decentralized production close to the point of consumption minimizes both logistics costs and environmental concerns [41]. Similarly, emerging manufacturing technologies such as additive manufacturing can aid in the reduction of waste in manufacturing and logistics processes, such as replacement parts [42].
Regarding the social dimension of Industry 4.0, several benefits for employees are named, such as improved human learning through intelligent assistance systems as well as human-machine interfaces that lead to increased employee satisfaction in industrial workplaces [8, 22]. However, current literature cannot provide a unified perspective on whether Industry 4.0 will cause an increase or decrease in employee numbers in the industry. In this regard, concrete numbers named differ to a large extent [3, 15]. In general, a further replacement of simple tasks is expected, whereas tasks such as monitoring, collaboration, and training will still be required [3]. Hereby, new job profiles with novel requirements for training and education are expected to emerge, mostly referring to decreasing importance of manual labor in contrast to IT skills. On the other hand, tasks that include planning and monitoring, as well as decision-making, could fall to autonomous systems, therefore, possibly replacing jobs in this area.
Regarding the social dimension of Industry 4.0, Several benefits for employees are mentioned, such as improved human learning through intelligent support systems and human-machine interfaces that lead to increased employee satisfaction in industrial environments [38]. However, the present research cannot agree on whether Industry 4.0 would result in an increase or decrease in the number of employees in the industry [25]. In general, easy jobs will be replaced further, while monitoring, collaboration, and training will continue to be required. It is possible that occupations in this field will be replaced [38]. As a result, implementing Industry 4.0 in an organization necessitates deliberate transformation activities, sometimes known as “digital transformation.” It necessitates new attitudes for dealing with digital transformation difficulties as well as a unified approach for staff qualification and acceptance [43].
5.7 The impact of industry 4.0 on value chains and supply chains (SC)
The fourth industrial revolution has a significant impact on supply chain interactions, which is mainly due to the exponential growth of sensible data and the widespread of digitalized processes [40]. To understand the impact of the adoption and exploitation of Industry 4.0 technologies on the value chains and supply chains (SC). Based on the review, the effect of Industry 4.0 implementation on the supply chains (SC) are identified as follows:
Agility and Customization. Industry 4.0 implementation enables real-time planning and control, permitting organizations to be flexible and agile in responding to rapidly changing conditions; for example, by faster reacting to changes in demand, supply, and prices, companies can reduce planning cycles and frozen periods [34]. Future events and trends, such as consumer behavior, delivery time, and industrial output, can be predicted using business analytics techniques. Real-time delivery routing and tracking also allow logistics operations to be more flexible, efficient, and agile [44].
Accuracy and Efficiency. Industry 4.0 technologies provide better decision-making by providing real-time, consistent, and accurate data. As a result, next-generation performance management systems will improve end-to-end visibility across the value chain. The data includes everything from key top-level performance metrics like customer service and order fulfillment to detailed process data like a truck position in the logistics network. The automation of physical tasks, planning, control, and information exchange processes improves supply chain (SC) efficiency. Automated technologies are used by a large number of businesses, particularly in their logistics operations [44]. Companies choose cross-company transportation optimization to optimize truck utilization and boost transport flexibility by cooperating and sharing facilities. The entire SC network design is constantly optimized to ensure that it is a perfect fit for business needs [34].
6. Key drivers and obstacles or barriers of industry 4.0
6.1 Key drivers of industry 4.0
Despite the rapid rise of Industry 4.0, research related to the identification of potential drivers and hurdles to its implementation are scarce. To better understand the motivations and challenges to the adoption and use of Industry 4.0 technologies, a literature review was conducted. The following are the primary drivers for Industry 4.0 implementation, as determined by the review:
Agility and Customization. Industry 4.0 implementation enables real-time planning and control, permitting organizations to be flexible and agile in responding to rapidly changing conditions; for example, by faster reacting to changes in demand, supply, and prices, companies can reduce planning cycles and frozen periods [34]. Future events and trends, such as consumer behavior, delivery time, and industrial output, can be predicted using business analytics techniques. Real-time delivery routing and tracking also allow logistics operations to be more flexible, efficient, and agile [44].
Accuracy and Efficiency. Industry 4.0 technologies provide better decision-making by providing real-time, consistent, and accurate data. As a result, next-generation performance management systems will improve end-to-end visibility across the value chain. The data includes everything from key top-level performance metrics like customer service and order fulfillment to detailed process data like a truck position in the logistics network. The automation of physical tasks, planning, control, and information exchange processes improves SC efficiency. Automated technologies are used by a large number of businesses, particularly in their logistics operations [44].
6.2 Applications of fourth industrial revolution
In this section, we introduce an overview of some applications of the Fourth Industrial Revolution. Also, we provide a case study for these applications by KUKA Group in many fields. KUKA is an international automation corporation based in Augsburg, Germany. As a world-class provider of intelligent automation solutions. In areas such as automotive, electronics, metal & plastic, consumer products, e-commerce/retail, and healthcare, KUKA provides everything from a single source: from robots and cells to completely automated systems and their networking [45].
The “Smart Factories” are automation solutions from KUKA, which is able to transport aircraft components around the production hangar with millimeter precision. The employees at the Airbus production plant move enormous A380 fuselage sections, weighing 90 tons and measuring 15 meters in length around a building the size of a football stadium. This is made possible by the KUKA omniMove mobile transport platform, a transport vehicle for heavy loads that is equipped with omnidirectional Mecanum wheels [46].
Similarly, using techniques such as Machine-to-Machine (M-2-M) and intelligent robots as applications from the KUKA company. Robot-based KUKA system technology for machine tool automation is used, among other things, for the loading and unloading of machines and supports elements of Industries 4.0 [47]. In the KUKA’s site in Augsburg, work 7 robots, which is a typical production environment at an international machine manufacturer [48].
Another application of industry 4.0 in the medical sector, automation solutions for greater efficiency in hospitals, in areas of diagnosis and surgery to therapy, KUKA robots meet the stringent requirements of the medical sector and are well-suited to a wide range of medical technology applications. For this, KUKA offers a wide range of medical high-tech products, ranging from robot-based help systems for surgery to assistive components for diagnosis or rehabilitation [45].
There are several applications for industry 4.0, for example, the KUKA corporation which works in the areas, for instance, smart factories, M-2-M, computing cloud, intelligent robots, e-commerce, and so on.
6.3 Key obstacles or barriers of industry 4.0
There are also some intimidating resisting forces, barriers, for implementing Industry 4.0 practices. These obstacles may be classified under the following business dimensions: Firstly, Financial constraints. Financial constraints are a fundamental issue in implementing Industry 4.0 in terms of developing sophisticated contemporary infrastructure and sustainable process improvements [28]. Secondly, the technical competency of the focal organization is the key focus that influences the scale of investment. The economic perspective, on the other hand, is still in its infancy; a lack of clarity about cost–benefit analysis and monetary rewards on digital investments is a critical issue for deploying Industry 4.0 [40].
Thirdly, Organizational nature. Other obstacles that businesses aiming to integrate Industry 4.0 technologies confront include insufficient research and development procedures, a lack of infrastructure, poor data quality, a lack of digital culture, and a lack of trust among partners [17]. Poor infrastructure and internet connectivity are significant impediments to any digital transformation or adoption [22]. As well as fourthly, Lack of management support and Resistance to change. Industry 4.0 transformative changes are fast-paced and necessitate proper skill development and training, which is difficult to do without a high degree of management support, which is the most important requirement for launching Industry 4.0. Industries are unsure and unfamiliar with the term Industry 4.0 and are ignorant of the benefits of digital transformation due to which there is reluctance in adopting it [22].
Additionally, Legal Issues. The big data transaction brings cybersecurity risk; therefore, privacy and security concerns must be considered when implementing Industry 4.0 [44]. Finally, Lack of policies and support from the government. In most nations, governments supply the infrastructure for the digital world (such as the internet and communication networks). However, there is a lack of a roadmap for transforming industrial infrastructure, owing to a lack of clarity (for example, the development of the 5G network and its benefits for Industry 4) about the implications of Industry 4.0 [22].
7. Conclusion
This study contributes to bridging the critical gap, by discussing the key components, characteristics, effects on many dimensions, drivers, barriers, and other implementation challenges of Industry 4.0, the fourth industrial revolution describes a future production system’s vision. Industry 4.0 is an inevitable revolution covering a wide range of innovative technologies, such as cyber-physical systems, RFID technologies, IoT, cloud computing, big data analytics, advanced robotics, smart factories, etc. The Industry 4.0 paradigm is transforming business in many industries, e.g., automotive, logistics, aerospace, and energy sectors, etc. Industry 4.0 realizes the development and integration of information and communication technologies into business processes. The capabilities or components of Industry 4.0 bring significant advantages to organizations, including customization of products, real-time data analysis, increased visibility, autonomous monitoring and control, dynamic product design and development, enhanced productivity, and competitiveness.
The key characteristic features of Industry 4.0 are collaboration and integration of schemes, both horizontal and vertical. In vertical integration, Information and Communication Technology (ICT) is integrated into various hierarchical levels of the organization, from floor-level control to production, operations, and management levels. This vertical integration networking empowers the use of components of Industry 4.0 for production to respond to demand disparity or the fluctuations in stock levels. In horizontal integration, ICT is used to exchange information between many players. Integration of these systems for a flawless collaboration, integration, and exchange of data with all the stakeholders is a complicated scenario. Implementation of Industry 4.0 apps support to reduce costs, improves productivity, efficiency, and flexibility, and enhance product customization.
Innovation and technological advancements perform an essential role in organizations, sectors, countries. However, the digital transformation improvements and the rising interconnectivity will bring new challenges to societies, since Industry 4.0 will significantly change the products and manufacturing systems regarding design, processes, operations, and services. Industry 4.0 uses several advanced tools and technologies, thus helping to redefine conventional industrial processes. Industry 4.0 has enormous potential effect in many areas, and its application will have an impact across the entire value chain, improving production and engineering processes, improving product and service quality, optimizing customer-organization relationships, bringing new business opportunities and economic benefits, changing educational requirements, and transforming the current work environment. Digitization and interconnection of industrial processes (Industry 4.0), leading to potentials in all three dimensions of sustainability.
There are several applications for industry 4.0, applied by the KUKA corporation which works in the areas, for instance, smart factories, M-2-M, computing cloud, intelligent robots, e-commerce, etc., these technologies or applications help the industry 4.0 to separate rapidly. On the other hand, there are also some barriers, for implementing Industry 4.0 practices. These obstacles may be classified into many business dimensions: financial constraints, technical competency of the focal, organizational nature, lack of management support and resistance to change, legal issues, lack of policies and support from the government.
\n',keywords:"industrial revolutions, components of industry 4.0, impacts of industry 4.0, industry 4.0 drivers, barriers of industry 4.0",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/80514.pdf",chapterXML:"https://mts.intechopen.com/source/xml/80514.xml",downloadPdfUrl:"/chapter/pdf-download/80514",previewPdfUrl:"/chapter/pdf-preview/80514",totalDownloads:134,totalViews:0,totalCrossrefCites:0,dateSubmitted:"November 22nd 2021",dateReviewed:"January 7th 2022",datePrePublished:"February 28th 2022",datePublished:null,dateFinished:"February 18th 2022",readingETA:"0",abstract:"This chapter aims to analyze the Industry 4.0 framework, identify the definition and drivers of the Industry 4.0 paradigm, discuss its potential effect, and determine obstacles of the Industry 4.0. For the research methodology, a critical literature review is performed, we relied on the recent studies related to industry 4.0. Findings – This study concluded that Industry 4.0 describes a future production system’s vision; it is an inevitable revolution and radical change, covering a wide range of innovative technologies, and all sectors. Industry 4.0 brings significant advantages to organizations, including real-time data analysis, increased visibility, autonomous monitoring, enhanced productivity, and competitiveness. The key features of Industry 4.0 are collaboration and integration of schemes, both horizontal and vertical. Innovation performs an essential role in organizations, sectors, countries. Industry 4.0 has enormous potential effect in many areas, and its application will have an impact across transforming the work environment. Industry 4.0 leads to potentials in three dimensions of sustainability. The KUKA corporation is an application for industry 4.0, for instance, smart factories, M-2-M, intelligent robots, etc., these technologies help industry 4.0 to separate rapidly. In contrast, there are some barriers, to implementing Industry 4.0 for example financial constraints, technical competency, organizational restraints.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/80514",risUrl:"/chapter/ris/80514",signatures:"FathyElsayed Youssef Abdelmajied",book:{id:"11263",type:"book",title:"Supply Chain - Recent Advances and New Perspectives in the Industry 4.0 Era",subtitle:null,fullTitle:"Supply Chain - Recent Advances and New Perspectives in the Industry 4.0 Era",slug:null,publishedDate:null,bookSignature:"Dr. Tamás Bányai, Dr. Ágota Bányai and Dr. Ireneusz Kaczmar",coverURL:"https://cdn.intechopen.com/books/images_new/11263.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-80355-373-3",printIsbn:"978-1-80355-372-6",pdfIsbn:"978-1-80355-374-0",isAvailableForWebshopOrdering:!0,editors:[{id:"201248",title:"Dr.",name:"Tamás",middleName:null,surname:"Bányai",slug:"tamas-banyai",fullName:"Tamás Bányai"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. What is industry 4.0?",level:"1"},{id:"sec_2_2",title:"2.1 An overview of industry 4.0",level:"2"},{id:"sec_3_2",title:"2.2 Definition industry 4.0",level:"2"},{id:"sec_5",title:"3. Components of industry 4.0 and the key enabling technologies",level:"1"},{id:"sec_5_2",title:"3.1 Cyber-physical system (CPS)",level:"2"},{id:"sec_6_2",title:"3.2 Cloud systems (CS)",level:"2"},{id:"sec_7_2",title:"3.3 Machine to machine (M2M) communication",level:"2"},{id:"sec_8_2",title:"3.4 Internet of things and internet of services",level:"2"},{id:"sec_9_2",title:"3.5 Smart factories or smart manufacturing",level:"2"},{id:"sec_10_2",title:"3.6 Big data and data mining",level:"2"},{id:"sec_11_2",title:"3.7 Intelligent robotics",level:"2"},{id:"sec_12_2",title:"3.8 Augmented reality and simulation",level:"2"},{id:"sec_13_2",title:"3.9 Enterprise resource planning (ERP) and business intelligence",level:"2"},{id:"sec_14_2",title:"3.10 Smart virtual product development system (SVPD)",level:"2"},{id:"sec_16",title:"4. Industry 4.0 characteristics",level:"1"},{id:"sec_16_2",title:"4.1 Vertical networking of smart production",level:"2"},{id:"sec_17_2",title:"4.2 Horizontal integration through a new generation of global value chain networks",level:"2"},{id:"sec_18_2",title:"4.3 Through-life engineering across the entire value chain",level:"2"},{id:"sec_19_2",title:"4.4 The impact of exponential technologies",level:"2"},{id:"sec_21",title:"5. Effects of industry 4.0",level:"1"},{id:"sec_21_2",title:"5.1 The impact of industry 4.0 on the industrial sector",level:"2"},{id:"sec_22_2",title:"5.2 The impact of industry 4.0 on products and services",level:"2"},{id:"sec_23_2",title:"5.3 The impact of industry 4.0 on business models and market",level:"2"},{id:"sec_24_2",title:"5.4 The impact of industry 4.0 on the work environment",level:"2"},{id:"sec_25_2",title:"5.5 The impact of industry 4.0 on skills development",level:"2"},{id:"sec_26_2",title:"5.6 The impact of industry 4.0 on the economy",level:"2"},{id:"sec_27_2",title:"5.7 The impact of industry 4.0 on value chains and supply chains (SC)",level:"2"},{id:"sec_29",title:"6. Key drivers and obstacles or barriers of industry 4.0",level:"1"},{id:"sec_29_2",title:"6.1 Key drivers of industry 4.0",level:"2"},{id:"sec_30_2",title:"6.2 Applications of fourth industrial revolution",level:"2"},{id:"sec_31_2",title:"6.3 Key obstacles or barriers of industry 4.0",level:"2"},{id:"sec_33",title:"7. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'Pereira AC, Romero F. A review of the meanings and the implications of the industry 4.0 concept. Procedia Manufacturing. 2017;13:1206-1214. DOI: 10.1016/j.promfg.2017.09.032'},{id:"B2",body:'Mukha D. Impact of industry 4.0 on global value chains, business models and foreign direct investment. Экономическаянаукасегодня. 2021;13:75-84. DOI: 10.21122/2309-6667-2021-13-75-84'},{id:"B3",body:'Mhlanga D. Artificial intelligence in the industry 4.0, and its impact on poverty, innovation, infrastructure development, and the sustainable development goals: Lessons from emerging economies? 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An overview of industry 4.0: Definition, components, and government initiatives. Journal of Advanced Research in Dynamical and Control Systems. 2018;10(14):1379-1387'},{id:"B31",body:'Ahmed MB, Sanin C, Szczerbicki E. Smart virtual product development (SVPD) to enhance product manufacturing in industry 4.0. In: Procedia Computer Science. Vol. 159. 2019. doi: 10.1016/j.procs.2019.09.398'},{id:"B32",body:'Aoun A, Ilinca A, Ghandour M, Ibrahim H. A review of Industry 4.0 characteristics and challenges, with potential improvements using Blockchain technology. Computers & Industrial Engineering; 2021;162:1-11. doi: 10.1016/j.cie.2021.107746'},{id:"B33",body:'Karnik N, Bora U, Bhadri K, Kadambi P, Dhatrak P. A comprehensive study on current and future trends towards the characteristics and enablers of industry 4.0. Journal of Industrial Information Integration. 2021;10:100294. DOI: 10.1016/j.jii.2021.100294'},{id:"B34",body:'Barreto L, Amaral A, Pereira T. Industry 4.0 implications in logistics: An overview. Procedia Manufacturing. 2017;13. DOI: 10.1016/j.promfg.2017.09.045'},{id:"B35",body:'Erol S, Jäger A, Hold P, Ott K, Sihn W. Tangible industry 4.0: A scenario-based approach to learning for the future of production. Procedia CIRP. 2016;54. DOI: 10.1016/j.procir.2016.03.162'},{id:"B36",body:'Roblek V, Meško M, Krapež A. A complex view of industry 4.0. SAGE Open. 2016;6(2). DOI: 10.1177/2158244016653987'},{id:"B37",body:'Rojko K, Erman N, Jelovac D. Impacts of the transformation to industry 4.0 in the manufacturing sector: The case of the U.S. The Organ. 2020;53(4). DOI: 10.2478/orga-2020-0019'},{id:"B38",body:'Müller JM, Kiel D, Voigt KI. What drives the implementation of industry 4.0? The role of opportunities and challenges in the context of sustainability. Sustainability (Switzerland). 2018;10(1). DOI: 10.3390/su10010247'},{id:"B39",body:'Mastos TD et al. Industry 4.0 sustainable supply chains: An application of an IoT enabled scrap metal management solution. Journal of Cleaner Production. 2020;269. DOI: 10.1016/j.jclepro.2020.122377'},{id:"B40",body:'Ghobakhloo M. The future of manufacturing industry: A strategic roadmap toward industry 4.0. Journal of Manufacturing Technology Management. 2018;29(6):910-936. DOI: 10.1108/JMTM-02-2018-0057'},{id:"B41",body:'Mastos TD et al. Introducing an application of an industry 4.0 solution for circular supply chain management. Journal of Cleaner Production. 2021;300. DOI: 10.1016/j.jclepro.2021.126886'},{id:"B42",body:'Nagy J, Oláh J, Erdei E, Máté D, Popp J. The role and impact of industry 4.0 and the internet of things on the business strategy of the value chain-the case of Hungary. Sustainability (Switzerland). 2018;10(10). DOI: 10.3390/su10103491'},{id:"B43",body:'Leonhardt F, Wiedemann A. Realigning risk Management in the Light of industry 4.0. SSRN Electronic Journal. 23 October 2015:1-22. DOI: 10.2139/ssrn.2678947'},{id:"B44",body:'Ghadge A, Er Kara M, Moradlou H, Goswami M. The impact of industry 4.0 on supply chains. Journal of Manufacturing Technology Management. 2020;31(4):669-686. DOI: 10.1108/JMTM-10-2019-0368'},{id:"B45",body:'Xu T et al. Dynamic identification of the KUKA LBR iiwa robot with retrieval of physical parameters using global optimization. IEEE Access. 2020;8. DOI: 10.1109/ACCESS.2020.3000997'},{id:"B46",body:'Carstensen J et al. Condition monitoring and cloud-based energy analysis for autonomous Mobile manipulation - smart factory concept with LUHbots. Procedia Technology. 2016;26. DOI: 10.1016/j.protcy.2016.08.070'},{id:"B47",body:'Maldonado-Ramirez A, Rios-Cabrera R, Lopez-Juarez I. A visual path-following learning approach for industrial robots using DRL. Robotics and Computer-Integrated Manufacturing. 2021;71. DOI: 10.1016/j.rcim.2021.102130'},{id:"B48",body:'Wuest T, Weimer D, Irgens C, Thoben K-D. Machine learning in manufacturing: advantages, challenges, and applications, Production & Manufacturing Research. 2016;4(1:)23-45. Retrieved from: https://www.tandfonline.com/doi/full/10.1080/21693277.2016.1192517'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"FathyElsayed Youssef Abdelmajied",address:"fathy.abdelmagid@fcom.bu.edu.eg",affiliation:'
Faculty of Commerce, Benha University, Cairo, Egypt
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Physical Sciences, Technology and Engineering Board
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Chemistry
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Ayben Kilislioglu - Department of Chemical Engineering Istanbul University, İstanbul, Turkey
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Goran Nikolic - Faculty of Technology, University of Nis, Leskovac, Serbia
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Mark T. Stauffer - Associate Professor of Chemistry, The University of Pittsburgh, USA
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Margarita Stoytcheva - Autonomous University of Baja California Engineering Institute Mexicali, Baja California, Mexico
Joao Luis Garcia Rosa - Associate Professor Bio-inspired Computing Laboratory (BioCom) Department of Computer Science University of Sao Paulo (USP) at Sao Carlos, Brazil
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Jan Valdman - Institute of Mathematics and Biomathematics, University of South Bohemia, České Budějovice, Czech Republic Institute of Information Theory and Automation of the ASCR, Prague, Czech Republic
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Earth and Planetary Science
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Jill S. M. Coleman - Department of Geography, Ball State University, Muncie, IN, USA
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İbrahim Küçük Erciyes - Üniversitesi Department of Astronomy and Space Sciences Melikgazi, Kayseri, Turkey
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Pasquale Imperatore - Electromagnetic Environmental Sensing (IREA), Italian National Council of Research (CNR), Naples, Italy
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Mohammad Mokhtari - Director of National Center for Earthquake Prediction International Institute of Earthquake Engineering and Seismology (IIEES), Tehran, Iran
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Engineering
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Narottam Das - University of Southern Queensland, Australia
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Jose Ignacio Huertas - Energy and Climate Change Research Group; Instituto Tecnológico y Estudios Superiores de Monterrey, Mexico
Likun Pan - Engineering Research Center for Nanophotonics and Advanced Instrument, Ministry of Education, Department of Physics, East China Normal University, China
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Mukul Chandra Paul - Central Glass & Ceramic Research Institute Jadavpur, Kolkata, India
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Stephen E. Saddow - Electrical Engineering Department, University of South Florida, USA
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Ali Demir Sezer - Marmara University, Faculty of Pharmacy, Department of Pharmaceutical Biotechnology, İstanbul, Turkey
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Krzysztof Zboinski - Warsaw University of Technology, Faculty of Transport, Warsaw, Poland
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Materials Science
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Vadim Glebovsky - Senior Researcher, Institute of Solid State Physics, Chernogolovka, Russia Expert of the Russian Fund for Basic Research, Moscow, Russia
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Jianjun Liu - State Key Laboratory of High Performance Ceramics and Superfine Microstructure of Shanghai Institute of Ceramics, Chinese Academy of Sciences, China
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Pietro Mandracci - Department of Applied Science and Technology, Politecnico di Torino, Italy
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Waldemar Alfredo Monteiro - Instituto de Pesquisas Energéticas e Nucleares Materials Science and Technology Center (MSTC) São Paulo, SP, Brazil
Toshio Ogawa - Department of Electrical and Electronic Engineering, Shizuoka Institute of Science and Technology, Toyosawa, Fukuroi, Shizuoka, Japan
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Mathematics
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Paul Bracken - Department of Mathematics University of Texas, Edinburg, TX, USA
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Nanotechnology and Nanomaterials
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Muhammad Akhyar - Farrukh Nano-Chemistry Lab. Registrar, GC University Lahore, Pakistan
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Khan Maaz - Chinese Academy of Sciences, China & The Pakistan Institute of Nuclear Science and Technology, Pakistan
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Physics
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Izabela Naydenova - Lecturer, School of Physics Principal Investigator, IEO Centre College of Sciences and Health Dublin Institute of Technology Dublin, Ireland
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Mitsuru Nenoi - National Institute of Radiological Sciences, Japan
\\n\\t
Christos Volos - Physics Department, Aristotle University of Thessaloniki, Greece
\\n
\\n\\n
Robotics
\\n\\n
\\n\\t
Alejandra Barrera - Instituto Tecnológico Autónomo de México, México
\\n\\t
Dusan M. Stipanovic - Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign
\\n\\t
Andrzej Zak - Polish Naval Academy Faculty of Navigation and Naval Weapons Institute of Naval Weapons and Computer Science, Gdynia, Poland
Petr Konvalina - Faculty of Agriculture, University of South Bohemia in České Budějovice, Czech Republic
\\n
\\n\\n
Biochemistry, Genetics and Molecular Biology
\\n\\n
\\n\\t
Chunfa Huang - Saint Louis University, Saint Louis, USA
\\n\\t
Michael Kormann - University Children's Clinic Department of Pediatrics I, Pediatric Infectiology & Immunology, Translational Genomics and Gene Therapy in Pediatrics, University of Tübingen, Tübingen, Germany
\\n\\t
Bin WU - Ph.D. HCLD Scientific Laboratory Director, Assisted Reproductive Technology Arizona Center for Reproductive Endocrinology and Infertility Tucson, Arizona , USA
\\n
\\n\\n
Environmental Sciences
\\n\\n
\\n\\t
Juan A. Blanco - Senior Researcher & Marie Curie Research Fellow Dep. Ciencias del Medio Natural, Universidad Publica de Navarra Campus de Arrosadia, Pamplona, Navarra, Spain
\\n\\t
Mikkola Heimo - University of Eastern Finland, Kuopio, Finland
\\n\\t
Bernardo Llamas Moya - Politechnical University of Madrid, Spain
\\n\\t
Toonika Rinken - Department of Environmental Chemistry, University of Tartu, Estonia
\\n
\\n\\n
Immunology and Microbiology
\\n\\n
\\n\\t
Dharumadurai Dhanasekaran - Department of Microbiology, School of Life Sciences, Bharathidasan University, India
Isabel Gigli - Facultad de Agronomia-UNLPam, Argentina
\\n\\t
Milad Manafi - Department of Animal Science, Faculty of Agricultural Sciences, Malayer University, Malayer, Iran
\\n\\t
Rita Payan-Carreira - Universidade de Trás-os-Montes e Alto Douro, Departamento de Zootecnia, Portugal
\\n
\\n\\n
Medicine
\\n\\n
\\n\\t
Mazen Almasri - King Abdulaziz University, Faculty of Dentistry Jeddah, Saudi Arabia Dentistry
\\n\\t
Craig Atwood - University of Wisconsin-Madison, USA Stem Cell Research, Tissue Engineering and Regenerative Medicine
\\n\\t
Oreste Capelli - Clinical Governance, Local Health Authority, Modena, Italy Public Health
\\n\\t
Michael Firstenberg - Assistant Professor of Surgery and Integrative Medicine NorthEast Ohio Medical University, USA & Akron City Hospital - Summa Health System, USA Surgery
\\n\\t
Parul Ichhpujani - MD Government Medical College & Hospital, Department of Ophthalmology, India
Amidou Samie - University of Venda, SA Infectious Diseases
\\n\\t
Shailendra K. Saxena - CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India Infectious Diseases
\\n\\t
Dan T. Simionescu - Department of Bioengineering, Clemson University, Clemson SC, USA Stem Cell Research, Tissue Engineering and Regenerative Medicine
\\n\\t
Ke Xu - Tianjin Lung Cancer Institute Tianjin Medical University General Hospital Tianjin, China Oncology
\\n
\\n\\n
Ophthalmology
\\n\\n
\\n\\t
Hojjat Ahmadzadehfar - University Hospital Bonn Department of Nuclear Medicine Bonn, Germany Medical Diagnostics, Engineering Technology and Telemedicine
\\n\\t
Miroslav Blumenberg - Department of Ronald O. Perelman Department of Dermatology; Department of Biochemistry and Molecular Pharmacology, Dermatology, NYU School of Medicine, NY, USA Dermatology
\\n\\t
Wilfred Bonney - University of Dundee, Scotland, UK Medical Diagnostics, Engineering Technology and Telemedicine
\\n\\t
Christakis Constantinides - Department of Cardiovascular Medicine University of Oxford, Oxford, UK Medical Diagnostics, Engineering Technology and Telemedicine
\\n\\t
Atef Mohamed Mostafa Darwish - Department of Obstetrics and Gynecology , Faculty of Medicine, Assiut University, Egypt Gynecology
\\n\\t
Ana Polona Mivšek - University of Ljubljana, Ljubljana, Slovenia Midwifery
\\n\\t
Gyula Mozsik - First Department of Medicine, Medical and Health Centre, University of Pécs, Hungary
\\n\\t
Shimon Rumelt - Western Galilee-Nahariya Medical Center, Nahariya, Israel Ophthalmology
\\n\\t
Marcelo Saad - S. Paulo Medical College of Acupuncture, SP, Brazil Complementary and Alternative Medicine
\\n\\t
Minoru Tomizawa - National Hospital Organization Shimoshizu Hospital, Japan Gastroenterology
\\n\\t
Pierre Vereecken - Centre Hospitalier Valida and Cliniques Universitaires Saint-Luc, Belgium Dermatology
\\n
\\n\\n
Gastroenterology
\\n\\n
\\n\\t
Hany Aly - Director, Division of Newborn Services The George Washington University Hospital Washington, USA Pediatrics
\\n\\t
Yannis Dionyssiotis - National and Kapodistrian University of Athens, Greece Orthopedics, Rehabilitation and Physical Medicine
\\n\\t
Alina Gonzales- Quevedo Instituto de Neurología y Neurocirugía Havana, Cuba Mental and Behavioural Disorders and Diseases of the Nervous System
\\n\\t
Margarita Guenova - National Specialized Hospital for Active Treatment of Haematological Diseases, Bulgaria
\\n\\t
Eliska Potlukova - Clinic of Medicine, University Hospital Basel, Switzerland Edocrinology
\\n\\t
Raymond L. Rosales -The Royal and Pontifical University of Santo Tomas, Manila, Philippines & Metropolitan Medical Center, Manila, Philippines & St. Luke's Medical Center International Institute in Neuroscience, Quezon City, Philippines Mental and Behavioural Disorders and Diseases of the Nervous System
\\n\\t
Alessandro Rozim - Zorzi University of Campinas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil Orthopedics, Rehabilitation and Physical Medicine
\\n\\t
Dieter Schoepf - University of Bonn, Germany Mental and Behavioural Disorders and Diseases of the Nervous System
\\n
\\n\\n
Hematology
\\n\\n
\\n\\t
Hesham Abd El-Dayem - National Liver Institute, Menoufeyia University, Egypt Hepatology
\\n\\t
Fayez Bahmad - Health Science Faculty of the University of Brasilia Instructor of Otology at Brasilia University Hospital Brasilia, Brazil Otorhinolaryngology
\\n\\t
Peter A. Clark - Saint Joseph's University Philadelphia, Pennsylvania, USA Bioethics
\\n\\t
Celso Pereira - Coimbra University, Coimbra, Portugal Immunology, Allergology and Rheumatology
\\n\\t
Luis Rodrigo - Asturias Central University Hospital (HUCA) School of Medicine, University of Oviedo, Oviedo, Spain Hepatology & Gastroenterology
\\n\\t
Dennis Wat - Liverpool Heart and Chest Hospital NHS Foundation Trust, UK Pulmonology
\\n
\\n\\n
Social Sciences and Humanities Board
\\n\\n
Business, Management and Economics
\\n\\n
\\n\\t
Vito Bobek - University of Applied Sciences, FH Joanneum, Graz, Austria
Joao Luis Garcia Rosa - Associate Professor Bio-inspired Computing Laboratory (BioCom) Department of Computer Science University of Sao Paulo (USP) at Sao Carlos, Brazil
\n\t
Jan Valdman - Institute of Mathematics and Biomathematics, University of South Bohemia, České Budějovice, Czech Republic Institute of Information Theory and Automation of the ASCR, Prague, Czech Republic
\n
\n\n
Earth and Planetary Science
\n\n
\n\t
Jill S. M. Coleman - Department of Geography, Ball State University, Muncie, IN, USA
\n\t
İbrahim Küçük Erciyes - Üniversitesi Department of Astronomy and Space Sciences Melikgazi, Kayseri, Turkey
\n\t
Pasquale Imperatore - Electromagnetic Environmental Sensing (IREA), Italian National Council of Research (CNR), Naples, Italy
\n\t
Mohammad Mokhtari - Director of National Center for Earthquake Prediction International Institute of Earthquake Engineering and Seismology (IIEES), Tehran, Iran
\n
\n\n
Engineering
\n\n
\n\t
Narottam Das - University of Southern Queensland, Australia
\n\t
Jose Ignacio Huertas - Energy and Climate Change Research Group; Instituto Tecnológico y Estudios Superiores de Monterrey, Mexico
Likun Pan - Engineering Research Center for Nanophotonics and Advanced Instrument, Ministry of Education, Department of Physics, East China Normal University, China
\n\t
Mukul Chandra Paul - Central Glass & Ceramic Research Institute Jadavpur, Kolkata, India
\n\t
Stephen E. Saddow - Electrical Engineering Department, University of South Florida, USA
\n\t
Ali Demir Sezer - Marmara University, Faculty of Pharmacy, Department of Pharmaceutical Biotechnology, İstanbul, Turkey
\n\t
Krzysztof Zboinski - Warsaw University of Technology, Faculty of Transport, Warsaw, Poland
\n
\n\n
Materials Science
\n\n
\n\t
Vadim Glebovsky - Senior Researcher, Institute of Solid State Physics, Chernogolovka, Russia Expert of the Russian Fund for Basic Research, Moscow, Russia
\n\t
Jianjun Liu - State Key Laboratory of High Performance Ceramics and Superfine Microstructure of Shanghai Institute of Ceramics, Chinese Academy of Sciences, China
\n\t
Pietro Mandracci - Department of Applied Science and Technology, Politecnico di Torino, Italy
\n\t
Waldemar Alfredo Monteiro - Instituto de Pesquisas Energéticas e Nucleares Materials Science and Technology Center (MSTC) São Paulo, SP, Brazil
Toshio Ogawa - Department of Electrical and Electronic Engineering, Shizuoka Institute of Science and Technology, Toyosawa, Fukuroi, Shizuoka, Japan
\n
\n\n
Mathematics
\n\n
\n\t
Paul Bracken - Department of Mathematics University of Texas, Edinburg, TX, USA
\n
\n\n
Nanotechnology and Nanomaterials
\n\n
\n\t
Muhammad Akhyar - Farrukh Nano-Chemistry Lab. Registrar, GC University Lahore, Pakistan
\n\t
Khan Maaz - Chinese Academy of Sciences, China & The Pakistan Institute of Nuclear Science and Technology, Pakistan
\n
\n\n
Physics
\n\n
\n\t
Izabela Naydenova - Lecturer, School of Physics Principal Investigator, IEO Centre College of Sciences and Health Dublin Institute of Technology Dublin, Ireland
\n\t
Mitsuru Nenoi - National Institute of Radiological Sciences, Japan
\n\t
Christos Volos - Physics Department, Aristotle University of Thessaloniki, Greece
\n
\n\n
Robotics
\n\n
\n\t
Alejandra Barrera - Instituto Tecnológico Autónomo de México, México
\n\t
Dusan M. Stipanovic - Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign
\n\t
Andrzej Zak - Polish Naval Academy Faculty of Navigation and Naval Weapons Institute of Naval Weapons and Computer Science, Gdynia, Poland
Petr Konvalina - Faculty of Agriculture, University of South Bohemia in České Budějovice, Czech Republic
\n
\n\n
Biochemistry, Genetics and Molecular Biology
\n\n
\n\t
Chunfa Huang - Saint Louis University, Saint Louis, USA
\n\t
Michael Kormann - University Children's Clinic Department of Pediatrics I, Pediatric Infectiology & Immunology, Translational Genomics and Gene Therapy in Pediatrics, University of Tübingen, Tübingen, Germany
\n\t
Bin WU - Ph.D. HCLD Scientific Laboratory Director, Assisted Reproductive Technology Arizona Center for Reproductive Endocrinology and Infertility Tucson, Arizona , USA
\n
\n\n
Environmental Sciences
\n\n
\n\t
Juan A. Blanco - Senior Researcher & Marie Curie Research Fellow Dep. Ciencias del Medio Natural, Universidad Publica de Navarra Campus de Arrosadia, Pamplona, Navarra, Spain
\n\t
Mikkola Heimo - University of Eastern Finland, Kuopio, Finland
\n\t
Bernardo Llamas Moya - Politechnical University of Madrid, Spain
\n\t
Toonika Rinken - Department of Environmental Chemistry, University of Tartu, Estonia
\n
\n\n
Immunology and Microbiology
\n\n
\n\t
Dharumadurai Dhanasekaran - Department of Microbiology, School of Life Sciences, Bharathidasan University, India
Isabel Gigli - Facultad de Agronomia-UNLPam, Argentina
\n\t
Milad Manafi - Department of Animal Science, Faculty of Agricultural Sciences, Malayer University, Malayer, Iran
\n\t
Rita Payan-Carreira - Universidade de Trás-os-Montes e Alto Douro, Departamento de Zootecnia, Portugal
\n
\n\n
Medicine
\n\n
\n\t
Mazen Almasri - King Abdulaziz University, Faculty of Dentistry Jeddah, Saudi Arabia Dentistry
\n\t
Craig Atwood - University of Wisconsin-Madison, USA Stem Cell Research, Tissue Engineering and Regenerative Medicine
\n\t
Oreste Capelli - Clinical Governance, Local Health Authority, Modena, Italy Public Health
\n\t
Michael Firstenberg - Assistant Professor of Surgery and Integrative Medicine NorthEast Ohio Medical University, USA & Akron City Hospital - Summa Health System, USA Surgery
\n\t
Parul Ichhpujani - MD Government Medical College & Hospital, Department of Ophthalmology, India
Amidou Samie - University of Venda, SA Infectious Diseases
\n\t
Shailendra K. Saxena - CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India Infectious Diseases
\n\t
Dan T. Simionescu - Department of Bioengineering, Clemson University, Clemson SC, USA Stem Cell Research, Tissue Engineering and Regenerative Medicine
\n\t
Ke Xu - Tianjin Lung Cancer Institute Tianjin Medical University General Hospital Tianjin, China Oncology
\n
\n\n
Ophthalmology
\n\n
\n\t
Hojjat Ahmadzadehfar - University Hospital Bonn Department of Nuclear Medicine Bonn, Germany Medical Diagnostics, Engineering Technology and Telemedicine
\n\t
Miroslav Blumenberg - Department of Ronald O. Perelman Department of Dermatology; Department of Biochemistry and Molecular Pharmacology, Dermatology, NYU School of Medicine, NY, USA Dermatology
\n\t
Wilfred Bonney - University of Dundee, Scotland, UK Medical Diagnostics, Engineering Technology and Telemedicine
\n\t
Christakis Constantinides - Department of Cardiovascular Medicine University of Oxford, Oxford, UK Medical Diagnostics, Engineering Technology and Telemedicine
\n\t
Atef Mohamed Mostafa Darwish - Department of Obstetrics and Gynecology , Faculty of Medicine, Assiut University, Egypt Gynecology
\n\t
Ana Polona Mivšek - University of Ljubljana, Ljubljana, Slovenia Midwifery
\n\t
Gyula Mozsik - First Department of Medicine, Medical and Health Centre, University of Pécs, Hungary
\n\t
Shimon Rumelt - Western Galilee-Nahariya Medical Center, Nahariya, Israel Ophthalmology
\n\t
Marcelo Saad - S. Paulo Medical College of Acupuncture, SP, Brazil Complementary and Alternative Medicine
\n\t
Minoru Tomizawa - National Hospital Organization Shimoshizu Hospital, Japan Gastroenterology
\n\t
Pierre Vereecken - Centre Hospitalier Valida and Cliniques Universitaires Saint-Luc, Belgium Dermatology
\n
\n\n
Gastroenterology
\n\n
\n\t
Hany Aly - Director, Division of Newborn Services The George Washington University Hospital Washington, USA Pediatrics
\n\t
Yannis Dionyssiotis - National and Kapodistrian University of Athens, Greece Orthopedics, Rehabilitation and Physical Medicine
\n\t
Alina Gonzales- Quevedo Instituto de Neurología y Neurocirugía Havana, Cuba Mental and Behavioural Disorders and Diseases of the Nervous System
\n\t
Margarita Guenova - National Specialized Hospital for Active Treatment of Haematological Diseases, Bulgaria
\n\t
Eliska Potlukova - Clinic of Medicine, University Hospital Basel, Switzerland Edocrinology
\n\t
Raymond L. Rosales -The Royal and Pontifical University of Santo Tomas, Manila, Philippines & Metropolitan Medical Center, Manila, Philippines & St. Luke's Medical Center International Institute in Neuroscience, Quezon City, Philippines Mental and Behavioural Disorders and Diseases of the Nervous System
\n\t
Alessandro Rozim - Zorzi University of Campinas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil Orthopedics, Rehabilitation and Physical Medicine
\n\t
Dieter Schoepf - University of Bonn, Germany Mental and Behavioural Disorders and Diseases of the Nervous System
\n
\n\n
Hematology
\n\n
\n\t
Hesham Abd El-Dayem - National Liver Institute, Menoufeyia University, Egypt Hepatology
\n\t
Fayez Bahmad - Health Science Faculty of the University of Brasilia Instructor of Otology at Brasilia University Hospital Brasilia, Brazil Otorhinolaryngology
\n\t
Peter A. Clark - Saint Joseph's University Philadelphia, Pennsylvania, USA Bioethics
\n\t
Celso Pereira - Coimbra University, Coimbra, Portugal Immunology, Allergology and Rheumatology
\n\t
Luis Rodrigo - Asturias Central University Hospital (HUCA) School of Medicine, University of Oviedo, Oviedo, Spain Hepatology & Gastroenterology
\n\t
Dennis Wat - Liverpool Heart and Chest Hospital NHS Foundation Trust, UK Pulmonology
\n
\n\n
Social Sciences and Humanities Board
\n\n
Business, Management and Economics
\n\n
\n\t
Vito Bobek - University of Applied Sciences, FH Joanneum, Graz, Austria
Denis Erasga - De La Salle University, Phillippines
\n\t
Rosario Laratta - Associate Professor of Social Policy and Development Graduate School of Governance Studies, Meiji University, Japan
\n
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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Liposuction is a procedure to improve the body contour and not a surgery to reduce weight, although recently people who have failed in their plans to lose weight look at liposuction as a means to contour their body figure. Tumescent liposuction of large volumes requires a meticulous selection of each patient; their preoperative evaluation and perioperative management are essential to obtain the expected results. The various techniques of general anesthesia are the most recommended and should be monitored in the usual way, as well as monitoring the total doses of infiltrated local anesthetics to avoid systemic toxicity. The management of intravenous fluids is controversial, but the current trend is the restricted use of hydrosaline solutions. The most feared complications are deep vein thrombosis, pulmonary thromboembolism, fat embolism, lung edema, hypothermia, infections and even death. The adherence to the management guidelines and prophylaxis of venous thrombosis/thromboembolism is mandatory.",book:{id:"6221",slug:"anesthesia-topics-for-plastic-and-reconstructive-surgery",title:"Anesthesia Topics for Plastic and Reconstructive Surgery",fullTitle:"Anesthesia Topics for Plastic and Reconstructive Surgery"},signatures:"Sergio Granados-Tinajero, Carlos Buenrostro-Vásquez, Cecilia\nCárdenas-Maytorena and Marcela Contreras-López",authors:[{id:"273532",title:"Dr.",name:"Sergio Octavio",middleName:null,surname:"Granados Tinajero",slug:"sergio-octavio-granados-tinajero",fullName:"Sergio Octavio Granados Tinajero"}]},{id:"30178",title:"Chest Mobilization Techniques for Improving Ventilation and Gas Exchange in Chronic Lung Disease",slug:"chest-mobilization-techniques-for-improving-ventilation-and-gas-exchange-in-chronic-lung-disease",totalDownloads:31193,totalCrossrefCites:0,totalDimensionsCites:5,abstract:null,book:{id:"648",slug:"chronic-obstructive-pulmonary-disease-current-concepts-and-practice",title:"Chronic Obstructive Pulmonary Disease",fullTitle:"Chronic Obstructive Pulmonary Disease - Current Concepts and Practice"},signatures:"Donrawee Leelarungrayub",authors:[{id:"73709",title:"Associate Prof.",name:"Jirakrit",middleName:null,surname:"Leelarungrayub",slug:"jirakrit-leelarungrayub",fullName:"Jirakrit Leelarungrayub"}]},{id:"46082",title:"Fecal Incontinence",slug:"fecal-incontinence",totalDownloads:3717,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"3835",slug:"fecal-incontinence-causes-management-and-outcome",title:"Fecal Incontinence",fullTitle:"Fecal Incontinence - Causes, Management and Outcome"},signatures:"Arzu Ilce",authors:[{id:"30672",title:"Dr.",name:"Arzu",middleName:null,surname:"Ilce",slug:"arzu-ilce",fullName:"Arzu Ilce"}]}],onlineFirstChaptersFilter:{topicId:"16",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81961",title:"Antioxidants as an Adjuncts to Periodontal Therapy",slug:"antioxidants-as-an-adjuncts-to-periodontal-therapy",totalDownloads:1,totalDimensionsCites:null,doi:"10.5772/intechopen.105016",abstract:"It has been established that periodontal diseases are related with the hyperactivity of neutrophils. Reactive oxygen species are produced mainly by neutrophils. In order to maintain the balance with reactive oxygen species, the need for antioxidants is increasing. As for supplements to the conventional periodontal therapy, different antioxidants have been applied in an attempt to provide new possibilities in the periodontal treatment. This chapter focused on recent studies that used different antioxidants as adjuncts to conventional periodontal treatments.",book:{id:"11567",title:"Dental Trauma",coverURL:"https://cdn.intechopen.com/books/images_new/11567.jpg"},signatures:"Sura Dakhil Jassim and Ali Abbas Abdulkareem"},{id:"82345",title:"Cannabis Medicines: Guidance for the Selection, Purchase and Supply for Clinical Trials",slug:"cannabis-medicines-guidance-for-the-selection-purchase-and-supply-for-clinical-trials",totalDownloads:1,totalDimensionsCites:null,doi:"10.5772/intechopen.105682",abstract:"Cannabis medicines are in demand from the public for treating a range of diseases and symptoms; however, clinicians are reluctant to prescribe these products because of limited evidence and prescribing information. To generate this evidence, quality clinical trials of cannabis medicines must be undertaken, yet their design is a complex, often uncharted territory, and involves the cooperation and sharing of knowledge of multiple stakeholders. Before designing a clinical trial, researchers require a clear understanding of the potential therapeutic benefit cannabis medicines may have, the form and formulation of the product, and the dose to be investigated. Researchers must also be aware of the applicable pharmaceutical regulations in the country or jurisdiction where the research is to be undertaken, as well as manufacturing or licensing regulations that may be imposed at the source of the cannabis product. Importantly, collaborations with industry are a key to the successful outcome of cannabis medicines clinical trials. Without funding and sponsorship of clinical trials, the ability to generate quality data will be limited and the evidence for cannabis medicines to be registered as therapeutics lacking. Collaborations between researchers, industry, and regulators, working together in sharing knowledge, are therefore critical to generate high quality cannabis medicines research.",book:{id:"11714",title:"Cannabinoids - Recent Perspectives and Applications in Human Health",coverURL:"https://cdn.intechopen.com/books/images_new/11714.jpg"},signatures:"Peter Galettis, John Barlow, Jaroslav Boublik, Stefania Capra, Rachel Galettis, Myfanwy Graham, Courtney Hill, Paul Mavor, Jasminka Nikolajevic-Sarunac, Rosemary Richards, Janet Schloss, Melinda Thompson, Linda Truong, Berzenn Urbi, Katrina Weston-Green and Aaron K. Wong"},{id:"82444",title:"Epigenomics in Malignant Pleural Mesothelioma",slug:"epigenomics-in-malignant-pleural-mesothelioma",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.105408",abstract:"Malignant pleural mesothelioma (MPM) is a tumor with a relatively low incidence, but whose carcinogenesis, for the most part, involves epigenetic factors that keep its heterogeneity and sometimes are a therapeutic target or an obstacle to the effectiveness of the newest treatments. This chapter summarizes the principal epigenetic dysregulation mechanisms involved in the MPM pathogenesis. The most studied mechanism is hypermethylation mediated by DNA methyltransferases (DNMTs) in different tumor suppressor genes, and the relation with asbestos fiber exposure, which represents the main risk factor. Physiopathology is related to chronic inflammation mediated by free radicals that produce chromosomal alterations, genomic instability, increased angiogenesis, and tumor invasion factors like EGFR, FGFR, TGF-B, and PDGF. Additionally, independent methylation pathways that produce gene silencing such as polycomb complex and SWI/SNF mutation are reviewed. Finally, other mechanisms are described such as hypomethylation with imprint loss and pro-oncogenic gene activation that induce immunological responses, as well as acetylation, deacetylation, and demethylation in the chromatin and histone context.",book:{id:"10831",title:"Mesothelioma - Diagnostics, Treatment and Basic Research",coverURL:"https://cdn.intechopen.com/books/images_new/10831.jpg"},signatures:"Aldo Manuel Alvarez Moran, Pablo Alejandro Ávila Sánchez, Jorge Alejandro Torres Ríos and Lorena Vega Castillo"},{id:"82383",title:"The Role of Immune Checkpoints in Cancer Progression",slug:"the-role-of-immune-checkpoints-in-cancer-progression",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.105628",abstract:"Immune checkpoint proteins are like two-faced swords that first act as gatekeepers of the immune system to protect the host from tissue damage. In contrast, these proteins can corroborate cancer progression by inhibiting tumor-specific immune responses. Here, we summarized the regulation and signaling cascade of immune checkpoints molecules (PD-1/PD-L1, CTLA-4, TIM3, TIGIT, LAG3, and BTLA), including their role in providing co-inhibitory signals for regulating T-cell response. The involvement of immune checkpoint molecules to drive cancer growth is elaborated with explanations about various anticancer strategies, such as (1) the overexpression of immune checkpoints in cancer cells, immune cells, or the surrounding environment leading to incapabilities of the tumor-specific immune response, (2) immune checkpoints interference to metabolic pathways then deplete nutrients needed by immune cells, (3) the interaction between immune checkpoints and regulatory T cells. Lastly, future challenges of immune checkpoint inhibitors are discussed briefly to get insight into their applicability in the clinical setting.",book:{id:"11278",title:"Regulatory T Cells",coverURL:"https://cdn.intechopen.com/books/images_new/11278.jpg"},signatures:"Rahmad Aji Prasetya and Devyani Diah Wulansari"},{id:"82331",title:"Diseases of Medicinal Plants Cultivated in Karnataka and Their Management",slug:"diseases-of-medicinal-plants-cultivated-in-karnataka-and-their-management",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.104632",abstract:"A broad spectrum of fungal diseases infecting selected 10 medicinal plants surveyed in Karnataka, India, was studied in the present research. We present a detailed review on previously reported as well as our present investigation’s details of fungal diseases, etiology, symptoms, and its management. Some of the commonly observed diseases are Anthracnose disease, Blight disease, Leaf spot, Root rot, Powdery mildew, Downy mildew, and Wilt disease. The detailed analysis of medicinal plants revealed that the medicinal plants are susceptible to diverse fungal phytopathogens. Therefore, sustainable management of the diseases is necessary for the successful cultivation of disease-free medicinal plants.",book:{id:"11299",title:"Medicinal Plants",coverURL:"https://cdn.intechopen.com/books/images_new/11299.jpg"},signatures:"P. Swetha and R. Sundararaj"},{id:"82455",title:"Effect of Family Education on Clinical Outcomes in Children with Asthma: A Review",slug:"effect-of-family-education-on-clinical-outcomes-in-children-with-asthma-a-review",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.105205",abstract:"Childhood asthma still imposes an enormous burden on children and their families. To the best of our knowledge, no study reviewed the literature on the effect of family asthma education on major asthma outcomes. This study aimed to explore the effect of family education programs on major asthma outcomes in children. Quasi-experimental studies and randomized controlled trials were conducted among children with asthma aged 6–18 years and their parents were included. Pub Med, Science Direct, and Trip databases were used to extract data published in English from 2010 to 2021. Twenty-two studies were reported in this review. It was demonstrated that family empowerment interventions were effective in improving the quality of life of children and their parents, asthma symptom control, and pulmonary function. Family education that was specific to medication improved medication adherence, inhalation technique, and asthma control. Family asthma education enhanced asthma management and family functioning. This approach should be a cornerstone of pediatric asthma therapy. It helps health care professionals to build a strong connection and trustful relationship with children with asthma and their families.",book:{id:"11722",title:"New Perspectives of Asthma",coverURL:"https://cdn.intechopen.com/books/images_new/11722.jpg"},signatures:"Maha Dardouri, Manel Mallouli, Jihene Sahli, Chekib Zedini, Jihene Bouguila and Ali Mtiraoui"}],onlineFirstChaptersTotal:717},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],testimonialsList:[]},series:{item:{id:"23",title:"Education and Human Development",doi:"10.5772/intechopen.100360",issn:null,scope:"
\r\n\tEducation and Human Development is an interdisciplinary research area that aims to shed light on topics related to both learning and development. This Series is intended for researchers, practitioners, and students who are interested in understanding more about these fields and their applications.
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She has been a faculty member at the University of California, Riverside in the School of Education since 2016. Her research focuses on translational studies to explore the reward system in ASD, as well as how anxiety contributes to social challenges in ASD. She also investigates how behavioral interventions affect neural activity, behavior, and school performance in children with ASD. She is also involved in the diagnosis of children with ASD and is a licensed clinical psychologist in California. 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He graduated from the Physics Department of the University of Crete and continued his post-graduate studies at the University Paris 7-Denis Diderot (D.E.A. in Didactic of Physics), University Paris 5-René Descartes-Sorbonne (D.E.A. in Science Education) and received his Ph.D. degree at the University Paris 5-René Descartes-Sorbonne (PhD in Science Education). His research interests include science education in early childhood, science teaching and learning, e-learning, the use of ICT in science education, games simulations, and mobile learning. 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Ben-Soussan leads international studies on training and neuroplasticity from neurophysiological and psychobiological perspectives. As a neuroscientist and bio-psychologist, she has published numerous articles on neuroplasticity, movement and meditation. She acts as an editor and reviewer in several renowned journals and coordinates international conferences integrating theoretical, methodological and practical approaches on various topics, such as silence, logics and neuro-education. 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\r\n\tIn order to scientifically address significant issues such as climate change, which puts into question our very survival as a species, the current pandemic with its massive physical, socio-economical, and psychological consequences, and the rise of AI which challenges our established economic structures, we need to ask insightful questions: What is truly human? How can humans develop further? The answers to these questions are necessary not only to find new solutions to the current challenges, but also to shape new visions of what can come next.
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\r\n\tNeuroscientific research linking brain functions has produced a perspective on human development that includes normal, impaired, and enhanced neurophysiological, emotional and cognitive functioning. Human development has been considered the very aim of education and of educative processes. Indeed, the capabilities built through educational training are included in the UN’s human development index, according to which such capabilities are the ultimate criteria to assess the development of a country, rather than economic growth alone. Yet a full understanding of what Human Development truly constitutes, remains open. For example, tackling the question of what distinguishes human beings from other animals, and what humans’ possible development trajectory might look like, calls for a multidisciplinary approach. Consequently, contributions to such an inquiry might come from very different scientific fields, ranging from cognitive neuroscience to socioeconomics. For instance, in the field of neuroscience, self-awareness—the most specific characteristic of human beings—has been investigated in connection with its neural correlates. Recent research points to self-awareness as the particular ability of our species, directly connecting it to our abstract thinking which in turn enables envisioning new possible futures and self-development
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\r\n\tTo achieve a broad, multidisciplinary perspective on possible human development, subjects will be considered through varied— yet related—approaches. We will provide a complex yet consistent framework through which we will explore a substantial amount and variety of theories and case studies. Our ultimate goal will be to produce useful indications for policy making in diverse contexts, assist teachers and parents with child development in an optimal way, and enhance theoretical and practical knowledge.
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