Mean age of target groups in the study population.
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IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
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\\n\\nNote: Edited in October 2021
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\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
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Due to the interdependency of Critical Infrastructures, companies, and the civil society their protection and management represent a significant challenge and, somehow, an opportunity.
The present contribution aims to support the understanding of the tangled pandemic scenario, studying the interdependencies between different sectors and their supply chain, proposing a model addressed to the complexity management for ensure the Business Continuity both of Critical Infrastructure and companies.
The Italian response to the crisis generated by the pandemic was observed, from the study of the impact of the crisis on Critical Infrastructures, to the response strategies, the remediation plans, passing through the reference standards on business continuity and supply chain (in the ISO family of standards).
The imposed lockdown has led to a forced acceleration of digitization, with the challenges and opportunities that could be derived from it.
The crisis management, supported by the experience generated by the avian influenza, together with the support tools provided by the Italian government has proved to be effective and efficient, also relaunching several SMEs through their productive conversion.
The human factor has become evident as the cornerstone of any service, from the provision of essential services falling within the competence of the Critical Infrastructures, which have involved a particular attention to the continuous security and business protocols to be followed, to the most disparate production sectors. It is also necessary to remember how the interconnection between the different sectors and services now characterizes our reality, and therefore how the so call “What-If Analysis” s fundamental in the development of decision support tools for crisis management. In this context is clear that resilience is founded on risk analysis and the drawing of recovery plans, together with measures for an increased control over the value chain.
Dealing with complexity and reducing uncertainty during 2020 crisis is a priority for Countries, Critical Infrastructures, and companies.
Complexity could represent a risk but also an opportunity to create a new competitive advantage.
Society is dependent on composed critical networks, becoming more complex as are strong interdependent both within and between infrastructure systems [1].
Nowadays, complexity and uncertainty assess the search for new and effective management strategies and methods. Embracing unpredictability and planning to adapt is crucial to manage the complexity that cannot be eliminated, although, it can be reduced to manageable levels. Complexity and vulnerability of Critical Infrastructure systems has been explored and assessed [2, 3].
Complexity is related with composite systems and problems that are dynamic, unpredictable, and multi-dimensional. It consists of a collection of interconnected relationships and parts. Unlike traditional “cause and effect” or linear thinking, complexity science is characterized by nonlinearity [4]. Complexity management needs to consider several layouts of complexity, in fact an IC or a company internal value chain is strongly dependent on external complexity.
For each area of complexity regulation, as avoidance and reduction related to causes, transfer, and division, exist several theories, approaches and methods.
Effective complexity management aim to develop an appropriate and effective incident response plan. Finally, complexity must be addressed proactively.
In fact, in such complex scenario, different actors (institutional and non) have responded to the crisis in multiple ways, according to the regulations issued. Moreover, these troubled times show how strategic and essential are some sectors.
In the crisis generated by the pandemic it has been confirmed that the daily life of the citizens depends on the reliability of the Critical Infrastructures (CI) to supply essential services such as energy and water. In recent years, Critical Infrastructure control systems have become more complex, with increasingly interconnected devices; a trend that will probably continue with the Internet of Things.
The need for increased resilience to resist extreme events of both natural and malicious origin has become more acute. With Critical Infrastructure continuously exposed to threats, especially cyber-attacks, there are severe security implications, most notably in the energy sector which is ranked as one of the most affected sectors with the highest incident costs [5]. Any attack of this nature is likely to have knock-on effects on a country’s overall economy and the lives of its citizens.
The pandemic, all in all, has had modest effects on the electrical service. Electricity consumption has been reduced by about 10% on average, but with a very uneven distribution on the Italian territory. Fortunately, the phenomenon has been well controlled and there have been no perceptible effects, but it is easy to imagine the consequences of possible inefficiencies. The effect of the pandemic could be very marked on geopolitical balances, in a context of possible tensions deriving from the rebalancing of the primary energy market and the challenge of the Fourth Industrial Revolution (4IR) [6].
The energy issue brings us back to the more general field of critical infrastructures: electricity and energy system, communication networks, infrastructures for the transport of people and goods (air, sea, rail and road), health system, economic-financial circuits, administrative and state organizations and bodies.
What happened on the Istituto Nazionale della Previdenza Sociale (the Italian Social Security), website is a symptom of a strong criticality in the Country System, where technical shortcomings make the fundamental rights of citizens even more vulnerable, and how IC and companies must equip themselves to manage crisis situations that are not predictable. For this reason there have been several episodes in Italy which have triggered the alarm by the Centro Nazionale Anticrimine Informatico per la Protezione delle Infrastrutture Critiche (CNAIPIC - National Anti-Crime Information Centre for the Protection of Critical Infrastructures).
In terms of crisis management, thanks to the experience of avian influenza (H5N1), which has highlighted how the human factor is the most valuable element for any company and as such must be safeguarded and protected, operators of critical infrastructure have been able to develop a series of effective initiatives, as demonstrated by the fact that no essential service, i.e. the supply of gas, water, electricity, transport, etc. has suffered interruptions or dysfunctions in recent months. And this despite the problems related to difficulties in supply, reduced mobility, the presence of staff in quarantine fiduciary and/or infected and considering the commitment of companies to safeguard the health of their workers.
This achievement is the result of an effort which in recent years has seen a significant change in the role of the security managers, which has shifted to the top management in order to bring strategic choices back to specific task forces capable of having a prompt impact on all levels of the company’s organization, being equipped with the financial and decision-making capacity appropriate to the criticality of the situation [7].
2020 long time crisis and consequent lock down were managed asking to every operators of critical services to maintain business continuity and to guarantee services if critical. This means that not only critical infrastructures at national level, but also critical infrastructures at regional or city or province level had to maintain operation, even having the supply chains partly or completely locked and also even having manpower partly or completely in smart working.
The Office of the Military Advisor of the Presidency of the Council, in consideration of the necessity to guarantee the essential services provided by Critical Infrastructures, has provided the precautionary principles, to which Critical Infrastructure Operators are required to comply in order to contain and contrast the spread of the pandemic, while ensuring the continuity of the supply of essential services, the operability of the facilities and the security of the personnel involved.
These lines suggest, first, a reduction in the number of staff working in situ by reducing activities to those that cannot be postponed for business continuity, and to review the maintenance programs, limiting them to those that cannot be postponed and postponing those that are not indispensable, promoting the adoption of smart working at all levels, necessary for the continuity of the service. The Precautionary Principles highlight the need to provide specific training and tools to operators to prevent and combat the threat of cybersecurity, the importance of which is growing today, to equipping all staff with adequate IT support, including the use of dedicated connections, VPN systems and anything else in order to ensure adequate levels of cybersecurity, including the issue of appropriate rules of conduct by staff working in smart working mode.
Furthermore, is required to prepare all the necessary measures related to sanitization.
The Companies are invited to organize the personnel involved in activities that cannot be postponed at the work sites or field operations in teams composed of the minimum number of people necessary for the safe execution of the various activities. The composition of each team, to increase its resilience, must not, where possible, change over time and specific procedural measures must be taken to avoid, or limit to a minimum, physical interaction between several teams.
With regard to the management of the control and management rooms, given that it is necessary to ensure their functionality in all conditions, it is recommended that all useful measures be taken to contain the pandemic; organizing the staff into several teams and adopting specific and more stringent safeguards for this type of personnel, for example, measures and/or adequately equipping several rooms, possibly in different locations, to allow the alternation of shifts in different rooms and/or sanitized each shift change [8]. Another taken measure was the “voluntary segregation”: the provision of temporary accommodation for groups of people who will operate in the control center for a period of not less than 14 days without physical contact with external personnel. The spaces to which such staff have access will be forbidden to those who do not implement voluntary segregation. To guarantee the continuous rotation of the activities, a second team of staff is set up at the same time, already in isolation at their homes.
Telespazio has set up a three-level system for its Space Center which, before entering the control room, requires a further period of voluntary quarantine within a camp facility located at the Fucino site [9].
The theme of cyber-security is particularly relevant in an increasingly interconnected world where threat vectors multiply and can affect the vulnerabilities of Critical Infrastructures. Moreover, the low level of cybersecurity preparedness of the country system is also reflected in low awareness among citizen-users.
In view of the above, we can say that for the management of emergencies and crises first of all it is necessary to develop a culture of security, supported by the necessary tools and strategies, also considering that we are moving towards the increasing digitalization of any area of the country. In order to do this we can combine the creation of high potential and distributed networks, to avoid in case of stress of infrastructure use, domino effects. It is not possible today to imagine an area of the country that is not covered by essential infrastructures and services that respond to adequate minimum levels of service delivery and security, especially cybersecurity.
It is therefore also essential to start a training process in line with the needs of the world of work and thus adapt to the new professions, together with a plan for the conversion of skills towards new professional qualifications [10].
A fundamental and new aspect of this crisis, which has led to a rethinking of the management of Critical Infrastructures, is that there was a clear “ day before” (in Italy between 10th and 11st March) and a lack of clarity in the “day after”. There is still the sensation of a prolonged crisis and the passage to a remote working that has reduced social relations. This situation has also led to a discontinuity in the visibility that the employer has towards his employees (with respect to how he is and what he feels) that had never been experienced before, while the knowledge of the human model is crucial.
When we make a reading of complexity, we consider a company (or a CI) and analyze it in all that is the flow of its value chain and we retrace all the places and moments of a not physiological complexity.
One type of challenge for Critical Infrastructure Protection is about the dependencies and interdependencies among different Critical Infrastructures [11].
In the context of this extremely long lock-down we had an enormous complexity of relations with suppliers and with those who had to remain in continuity and we would find in the re-opening a strong discontinuity, also in understanding for example the rules with which it was possible to re-open and the responsibilities (in fact, the provision of a suitable team that knows how to interpret the rules is also part of crisis management).
Italian SMEs have worked out an appropriate response strategy to the crisis caused by the 2020 pandemic.
Starting from the importance of the role of each individual entrepreneur, through the constant and daily collection of information on a formal and informal basis, it was possible to identify the strategic levers and focus on new core businesses, based on corporate liquidity, assets and resources.
It emerged that the creation of balanced strategic levers, the make/buy balance, together with the dialog with the stakeholders represented a fundamental element for the conception of a response strategy that represented an example of business resilience.
The crisis has certainly been, and still is, an opportunity to examine which lessons are learning for the future creation of resilience-oriented protocols [12].
There are many Italian companies that have reacted to the crisis by reconverting their production.
Phase two, co-existence with the pandemic, began on 4th May 2020. The Prime Minister’s Decree issued by the Government has made mandatory the use of the mask in closed places accessible to the public, such as public transport and shops. Wearing the mask is mandatory in all situations where “it is not possible to continuously guarantee a safe distance” [13].
Given the emergency and lack of access to this personal protective equipment, more and more companies have chosen to make a concrete contribution and boost their activities after the lockdown by aiming at the reconversion of production chains to manufacture masks. Initiatives that are born to make available the expertise and skills of entire sectors forced by the emergency and the upheaval of daily habits to rebuild their missions and restructure their short, medium- and long-term objectives.
Siare Engineering, an Emilian company specialized in the manufacture of lung ventilators (the unique company in Italy), at the outbreak of the emergency increased its production and changed its export market. In mid-March the company delivered 300 machines to the Civil Protection, originally destined for countries such as South Korea, India, the Philippines and Vietnam, its traditional clients. The company was supported by specialized Army technicians with the aim of producing over 2300 machines, tripling production. Siare Engineering’s efforts were supported by companies such as Ferrari, FCA and Magneti Marelli [14].
Grafica Veneta, a Paduan company active in the printing sector, has reconverted its production to produce 2 million masks. These products, even though they could not be intended for healthcare workers, provided (at a time of dramatic shortage) an initial protection to the population, and were distributed free of charge to the population by the Civil Protection and the Alpini (Italian Army’s mountain infantry).
Mestel Safety, a specialist in snorkeling and diving masks, deposited a patent at the beginning of March to transform this diving equipment into protective masks against contagion [15].
On 23rd March Confindustria Moda launched an adhesion campaign to make masks and PPE, to which 200 companies have immediately joined. A similar initiative was taken by CNA Federmoda. Some of the most important Italian fashion companies responded to the call, such as Armani, Calzedonia, Fendi, Gucci and Valentino.
Prada, on request of the Tuscany Region, has started the production of 80,000 white coats and 110,000 masks [16].
Toscano Alta Sartoria (ex Mabro) has promptly reconfigured its production starting, from March, to produce 3000–4000 masks per day [17].
A choice made also by Valigeria Roncato, a leading company in the sector in the production of luggage made in Italy, which has decided to make a strong contribution to the enduring battle at pandemic by converting its production lines for the production of long-lasting, non-disposable, washable and therefore reusable masks [18]. The core business of the Veneto industry responds to the urgent demand for protective masks that are becoming more and more indispensable.
These solidarity initiatives have been stimulated by the possibility to access incentives to activate the production and supply of medical devices and personal protective equipment (PPE) for the containment and fight against the epidemiological emergency.
And more: to deal with the pandemic, numerous measures have been taken to prevent and contain its expansion and its effects on the economic system. These are emergency measures issued at short distance from each other and linked to each other.
The financial support to SMEs has gone through interventions on the fiscal side, the suspension of the refund of loans, the public guarantee on those granted to companies that have suffered decreases in turnover, a fund for the promotion of Made in Italy, financing.
The objective was to prevent SMEs from shutting down due to lack of liquidity because of the emergency: according to Cerved the system could lose up to 650 billion in revenue between this year and the next.
In this picture, are extremely important the interventions to support the liquidity of the productive network, strongly strengthened by the Legislative Decree n. 23/2020 (so-called Liquidity Decree). This last measure has on one hand modified and on the other hand implemented the extraordinary measures introduced by Decree Law no. 18/2020. This is also thanks to the new regulatory framework for State aid, the EU Commission’s “State Aid Temporary Framework” [19], which has intervened in the meantime. On 14th April 2020, the European Commission authorized the extraordinary support aid schemes provided by Decree Law no. 23/2020. Further interventions to support the liquidity of companies are also contained in Decree-Law No 34 of the 2020.
The economic support measures for businesses adopted with the decrees of March–May 2020 (Decree-Law No 18/2020, Decree-Law No 23/2020 and Decree-Law No 34/2020) are essentially attributable to the following main lines of intervention: liquidity support; export and internationalization support; capitalization support and non-repayable grants; suspension of certain obligations and tax payments, as well as temporary relief on the fixed costs of electricity bills for low-voltage non-domestic users; interventions for companies in crisis, industrial reconversion and development contracts; protection of the national economic and business fabric through changes, some of which are temporary, to the exercise of special powers in sectors of strategic importance (so-called golden power).
Among the measures for companies in crisis, industrial reconversion and development contracts, the following interventions are highly important.
Decree Law No. 18/2020 refinanced the measure of development contracts by €400 million for 2020 (Article 80). The Ministero dello Sviluppo Economico (MISE) Directive of April 15th, 2020 provided for the allocation of resources.
Finally, it should be noted that Law Decree no. 18/2020 authorized the Extraordinary Commissioner for the Epidemiological Emergency to provide funding to companies producing medical devices and personal protective equipment, using INVITALIA as the entity managing the measure. To this end, expenditure of EUR 50 million for 2020 has been authorized (Article 5). The aid scheme was authorized by the EU Commission (on 22nd March 2020). The Ordinance of the Extraordinary Commissioner of 23rd March 2020 (published in the Official Journal on 24 March 2020) implemented the measure.
The resources were assigned to the granting of aid to investment programs aimed at increasing the availability of medical devices and personal protection equipment in the national territory through the expansion of the capacity and/or the reconversion of an existing production unit. The facilities consist of subsidized financing of up to 75% of eligible expenditure. The maximum amount of the facilities that can be granted, in terms of aid (intended as Gross Grant Equivalent), may not exceed 800,000 euros, in accordance with the European Commission Communication of 19th March 2020 - COM (2020) 1863 final - “Temporary Framework for State aid measures to support the economy in the current COVID-19 outbreak”.
Manufacturing masks, gowns, gels and disinfection products, plexiglass spacers, medical devices. These are some of the production reconversions following the pandemic of companies in most of the textile-fashion sector, but also plastics, chemicals, cosmetics, manufacturing, medical, graphics and printing [20].
For some sectors, textiles and chemicals, the new production is opening stable business opportunities in the post 2020 long time crisis, through new channels, which also open opportunities for professional integration.
More than two thirds of companies in the chemical sector, which in the emergency produced alcohol-based disinfectant gels for the hospital sector, are planning to permanently convert, but now intend to extend to direct sales to consumers.
And two thirds of the companies in the plastics sector, which have taken the opportunity to make plexiglass spacers to be installed in the companies, will not stop production. By virtue of a demand that is still expected to be sustained, moreover, more than half of the companies in the textile sector, which are now also aiming to create joint ventures with fashion companies, and almost all the companies in the print sector, which have activated new channels, will maintain active production of masks.
Not all companies, however, are planning to maintain the conversion once the normality is restored, with profound differences between sectors, due to the specificities of the productions.
These are mainly temporary reconversions, on the other hand, for fashion companies that have turned for a few weeks to the production of masks and gowns, as for those in the automotive, cosmetics, medical devices, and manufacturing sectors.
In addition to interventions aimed solely at conversion, the whole world of work has had to face the need to change and adapt to the new situation. Another example of resilience, together with the reconversion of the production of different companies, was the adoption of smart working.
There are data on the transition to remote working collected by Associazione Italiana Esperti Infrastrutture Critiche (AIIC) with the help of other companies. It became clear that before the crisis and therefore until 2019 in companies 71% of employees did not even know what remote working was. During the pandemic 97% of people said they had been working remotely all the time and 43% of people interviewed said they would continue to work remotely.
Regarding the impact on the IT budget: 30% of companies said that investments on the 2020 roadmap projects reset and/or moved to 2021 or suspended.
In contrast, 30% of companies stated that investments will continue without any impact on the 2020 roadmap projects.
Finally, 60% of companies say they still do not know how to proceed with the investments.
The company management, however, has the advantage of being able to provide incentives for sanitization and safety at work: for companies are introduced incentives for sanitization and increased safety at work, through the granting of a tax credit equal to 50% of expenses up to a maximum of 20 thousand euros, and contributions through the establishment of an Inail fund.
The pandemic emergency has not only produced a strong acceleration of digital transformation, smart working and strong demands related to logistics, but also interesting productive reconversions, together with the consciousness of the complex interrelation through different sectors and their supply chain.
For SMEs, the introduction of new products has often meant a real revolution in the business, but able to ensure continuity in production that would otherwise have stopped. Moreover, in case the reconversions are expected to be permanent, are requiring new professional figures to support the activity.
And, most of all, the emergency confirmed the relevance of the human factor.
Supply Chain Continuity Management (SCCM) must be considered as a necessary evolution of Business Continuity Management (BCM) models. SCCM is outlined in the ISO 22318 standard which is part of the group of standards for continuity management including ISO 22301, ISO 22313 Security and resilience (ISO 22318), and ISO 28000, which specifies the requirements for a security management system, including those aspects critical to security assurance of the supply chain. SCCM defines continuity in relation to external supplies, third parties or internal entities that play a supplier role in the context of the organization.
The simplified representation of the supply chain therefore provides a composite structure of internal and external suppliers (considering also the flexibility applicable to the relationships between the suppliers) that contribute to the operations of an organization and consequently of its customers.
If the relationship with suppliers is characterized by assets that are mainly intangible and movable and therefore related, for example, to the exchange of information or movable consumer goods, there will be greater control. An example in this sense, during the pandemic emergency management consisted in the possibility of maintaining relationships with suppliers through forms of smart working. This form of collaboration and coordination has been possible mainly between entities operating in sectors consisting of intangible assets such as professional, scientific and technical activities, financial and insurance activities, the activities of extraterritorial organizations, public administration and most professional services and, in general, all sectors that have not been affected by the suspension decrees.
In any case it will be necessary to have a management plan in case of crisis or incidents involving the supply chain.
The adoption of such measures will result in increasing control over the value chain in relation to an organization. In particular, the analysis carried out on the supply chain gives visibility to the mapping of interdependencies between different sectors allowing an analysis that goes beyond the single organization. Network analysis techniques could be combined with criticality and reliability metrics in order to produce composite methods that provide useful information to stakeholders [21].
As for ISO 22301, to plan the SCCM it will be necessary to carry out Impact Analysis activities with the individual suppliers involved, distinguishing critical suppliers from non-critical suppliers. For all relationships with critical suppliers, the guarantee of continuity can be determined by identifying a SCCM strategy to be agreed in transparency with these suppliers. Some strategic approaches may be:
Reducing dependence on a supplier: direct engagement of substitute suppliers for a specific service; increasing on-site stock holding; establishing alternative solutions.
Increasing resilience: loss mitigation; establishing mutual support policies with competitors.
Working with suppliers: creating partnerships with suppliers; setting performance standard; monitoring and dealing with suppliers to increase their resilience; including SCCM requirements in supplier contracts.
The direct effects of the suspension decrees concerned the sectors directly involved and all those sectors that had to sustain the labor shortage caused by the lockdown. While other sectors not directly involved in the suspension decrees, such as financial services or wholesale trade, or sectors more prone to targeted reconversions and the adoption of smart working strategies such as online trade or the fashion sector, were able to stem the direct impact of the emergency or even profit from it.
The Italian National Institute of Statistics in May 2020 has provided a wide range of data and information about the positioning and contribution of the sectors within the Italian production system.
The database is based on the Extended Statistical Register on Economic Performance of Enterprises (Frame-SBS), which contains individual data on all industrial and service enterprises active in the country (about 4.4 million units), supplemented with additional statistical registers that provide detailed information on the characteristics of the employment, as well as import and export enterprises. The data have been further integrated with indicators taken from Italian Accounting.
Considering the enterprises that are part of the universe of reference of the system of Structural Business Statistics (SBS), those that from May 4 are operating in sectors still formally suspended are about 800 thousand (19.1% of the total), with an employment weight of 15.7% on the total of the sectors of industry and market services (excluding the financial sector) [22].
By revising and analyzing the Istat dataset updated in May 2020 [23] with regard to the pandemic, it can be observed in the Figure 1 below that the unavailability of manpower has most directly affected the following sectors in percentage terms:
Other mining and quarrying activities; creative, artistic and entertainment activities; travel agency, tour operator and reservation services and related activities; libraries, archives, museums and other cultural activities; rental and operative leasing activities; real estate activities; activities concerning lotteries, betting, gambling houses; Sports, entertainment and leisure activities; construction of buildings; Mining of metal ores; Manufacture of other transport equipment; Manufacture of leather and related products; Manufacture of motor vehicles, trailers and semi-trailers; Manufacture of furniture; Tobacco industry; Metallurgy; Advertising and market research: 100%
Manufacture of clothing, manufacture of leather and fur articles: 98,48%
Manufacture of fabricated metal products (except machinery and equipment): 93,98%
Manufacture of other non-metallic mineral products: 92,85%
Food service activities: 90,91%
Manufacture of machinery and equipment NCA: 89,48%
Textile industries: 86,77%
Other personal service activities: 83,46%
Wholesale trade (except of motor vehicles and motorcycles): 67,23%
Manufacture of rubber and plastic products: 63,67%.
Unavailability of manpower.
Considering the analyses and remediation plans structured to protect the SCC, it is possible to structure What If models oriented to predict the consequences linked to the lack of a supply.
In relation to the manpower issue, for example, it is possible to structure time-oriented models that consider the negative effects of the manpower.
The Domino Effect methodology applied to manpower aims to study and quantify the consequences of a negative event that causes a lack of personnel and/or supply chain. The model is configured as a visualization of the propagation over time of the negative effects caused by the unavailability of a certain percentage of company personnel.
Such a predictive model can allow the decision maker to simulate different crisis scenarios resulting from the loss of personnel based on the formal organizational structure of the company. In order for the model to be effective, however, it will be essential to feed the model and the collection of information starting from the analysis of the organizational chart and the company function chart.
Information is needed that can be traced back to the following organizational areas:
Administration (ADM)
Actors in charge of Crisis Management (CM)
Functions that have relationships with critical suppliers (SUP)
Business (BSS)
Commercial (COM).
The holistic evolution of this model consists in describing the interdependencies between different sectors starting from the simulation of a disservice concerning a sector. The generic example below can be applied to a single reality in order to understand what long-term effects the lack of manpower, considered as a distinguished sector, could have on the operational continuity of the organization itself (Figure 2).
Manpower cascading effect on organizational areas.
The severity of the dependency corresponds to the extent to which the Quality of Service (QoS) perceived by the user is deteriorated. Depending on the item, the degradation can be measured by the variation of some specific parameters (coverage, signal reception, delivery time, etc.) with respect to the normal QoS values. In general, the measures that allow to characterize the QoS can be traced back to the general concepts of availability and capacity: the quality with which the service is provided can be described by quantifying the quantity of items provided in comparison to the demand and the time in which the service is actually available. The choice of the temporal moments in which to sample the phenomenon varies according to the item represented.
Metrics commonly agreed to in these cases include: Abandonment Rate; ASA (Average Speed to Answer); TSF (Time Service Factor); FCR (First-Call Resolution); TAT (Turn-Around Time); TRT (total resolution time); MTTR (Mean Time To Recover).
Starting from the elaboration of matrices that consider dependency relations, to represent a domino effect map it is necessary to apply a “filter” based on the degradation level of the service. an item will be considered compromised (and therefore will be represented in the domino effect map) only if the QoS degradation will be higher than a certain threshold, so the service is not considered acceptable (outage).
Various methods are described in the literature to perform this assessment. In general, the most common approaches consist in identifying some indicators that describe the various aspects of the consequences caused by an out of service event.
These indicators can fall into the following categories:
number of people (evaluated in terms of people impacted by the disruption)
economic damage (assessed in terms of the extent of economic losses and/or deterioration of products or services)
effects on public opinion (assessed in terms of impact on public confidence, physical suffering, and disruption of daily life).
Simulation of interdependencies and graph-based model to understand critical infrastructure interdependencies are proposed in literature [24, 25, 26, 27].
The graphical output here proposed (Figure 3) from the described model consists of dependency trees, time-oriented, that describe the collapse of the internal structure of an organization following the manpower “sector” unavailability. This model can be applied to a single organization based on its SC analysis starting considering one or more products and services sectors.
Manpower dependency tree.
By re-analyzing the ISTAT indices and considering the main sectors activated by the sectors impacted by the manpower shortage, it is possible to identify which related sectors have been most impacted by service interruptions than those listed above.
The sectors impacted indirectly by the shortage of manpower compared with the interruptions of those impacted directly are as follows:
Rental and management of owned or leased properties
Legal and accounting activities
Road freight transport, removal and pipeline transport
Financial service activities (except insurance and pension funding)
Wholesale
Manufacture of fabricated metal products (except machinery and equipment)
As we can see in Figure 4, some sectors such as Financial Services Activities that did not undergo significant effects during the first phase of the lockdown, are subject to an indirect impact due to the activity suspension of their main suppliers.
Index of indirect impact on SCC for other sectors not highly affected by unavailability of manpower.
The Augustus method can be considered as another concrete approaches to Critical Infrastructure protection.
The Method is a tool used by the Civil Protection Department of the Italian Republic for emergency planning. The Augustus Method was created in order to equip the Italian Civil Protection Service with a unified strategy for planning the Civil Protection assistance at various levels of competence.
This method is named after the Roman Emperor Augustus (27 B.C. to 14 A.D.), who affirmed that: “
This approach to the complexity of modern reality was structured and adapted by Elvezio Galanti, who considers the “emergency” (a public situation of particular difficulty and danger) an “organism” with its own life and composed by physiological functions (endocrine system, cardiology, etc.), each one specialized in its own field in which normally carries out its ordinary activity. In the context of civil protection, the “organism” is defined as the territory in which they normally act, and each one because of its specific functions (municipal, regional, health, transport, etc.). In the event of a disaster, these activities must all work together and in synergy.
The Augustus Methodology highlights, therefore, a fundamental aspect of the functioning of the Italian Civil Protection: its systemic nature. A complex apparatus made up of different elements and different organizations, resulting from the functioning of different systems in interaction with each other and with the other organizational systems [28].
In the preventive design phase, the Civil Protection, first of all, must work to collect information (time of occurrence of an event, geological conformation, productive fabric, urban fabric, etc.), then it must proceed with basic examinations (hazard analysis, vulnerability analysis, etc.) and finally a first diagnosis will be made (scenario, i.e. what I expect to happen) and for this reason, facilities will be arranged (monitoring networks, cleaning of riverbeds, seismic adaptation of structures, etc.).
In the absence or in the impossibility of activating these protocols, minimum measures of confrontation will be taken through the constitution of a “resilient cell” to manage the “big 5”, i.e. five macro-areas in which the operational approach is divided into “acute emergency”. These are:
identification of sites per control room;
entry points for expected rescue;
reception areas and first assistance to the population;
identification of proximity sites to coordinate local interventions;
assistance to the population (health and management of any temporary camps for reception and stay).
In the “acute” emergency scenario the Augustus Method becomes a good practice to manage the situation through the identification of 14 basic support functions, or support, that match all the competent and specific institutional figures for each function at territorial level and that contribute to its ordinary and extraordinary functioning. These functions are usually involved during the emergency itself, while in the study phases prior to the emergency, such as forecasting and prevention, they are deactivated and delivered to their specific and ordinary institutional functioning. These functions are: F 1 - Technology and planning; F 2 - Health, social and veterinary assistance; F 3 - Mass-media and information; F 4 - Volunteering; F 5 - Materials and means; F 6 - Transport, traffic and roads; F 7 - Telecommunications; F 8 - Essential services; F 9 - Census of damage to persons and property; F 10 - Operational facilities; F 11 - Local authorities; F 12 - Hazardous materials; F 13 - Assistance to the population; F 14 - Coordination of operational centres.
The design of all coordinated activities and procedures of Civil Protection to respond to any disaster event that is expected in a specific territory is called “Emergency Plan”. The Emergency Plan must be implemented:
Forecasting and Prevention Programs
Information related to:
physical processes causing the risk conditions and their assessments
precursors
events
scenarios
available resources.
Therefore, it is necessary to represent graphically the information necessary for the characterization of possible risk scenarios for the implementation of intervention strategies for the rescue and management of the emergency, rationalizing and targeting the use of men and means.
According to the Method, the following conditions determine the success of a civil protection operation [29]:
unitary direction: the unitary direction of emergency operations is implemented through the coordination of a complex system and not in a sectoral vision of the intervention.
communication: constant exchange of information between the central and peripheral Civil Protection system.
resources: rational and timely use of the resources really available and the availability of the men and means suitable for intervention.
The Emergency Plan structured according to the Augustus Method must be able to answer the following questions:
what calamitous events may reasonably affect the municipality?
which people, facilities and services will be affected or damaged?
what operational organization is necessary to minimize the effects of the event with particular attention to the protection of human life?
to whom are the different responsibilities at the various levels of command and control for emergency management assigned?
To satisfy these needs, it is first of all necessary to define the risk scenarios on the basis of the vulnerability of the portion of the territory concerned (areas, population involved, damaged structures, etc.) in order to have a global and reliable picture of the expected event and therefore to be able to dimension in advance the operational response necessary to overcome the disaster with particular attention to the protection of human life (how many firefighters, how many volunteers, which command and control structures, which roads or escape routes, which shelter structures, health areas, etc.).
The Emergency Plan is therefore a working tool calibrated on a likely situation based on scientific knowledge of the state of risk of the territory, which can be updated and integrated with reference to the list of men and means, but especially when new knowledge is acquired on the conditions of risk involving different assessments of the scenarios, or even when new or additional monitoring and warning systems to the population are available [30].
On the provincial level, the Emergency Plan will identify, at an inter-municipal or provincial scale: on the one side the situations that can configure a more extensive emergency of the single municipality, on the other side the situations, even localized, of greater risk, pointing out, when necessary, the need for an in-depth study of some aspects related to the Municipal scale.
On municipal level, a more detailed level of information is needed to allow the operators of the various components of the Civil Protection to have a reference framework corresponding to the size of the expected event, the population involved, the alternative road system, possible escape routes, waiting areas, shelter, storage areas and so on. Considering that the risk present in a given territory may refer to different types of events (floods, earthquakes, landslides, etc.), the Emergency Plan must provide for one or more “risk scenarios”, which must or may correspond to different types of intervention.
The Italian Civil Protection assumes primary and decisive roles on the institutional scene of civil protection in Italy. This body sums up three fundamental structures at national level:
the Civil Protection Department at the Presidency of the Council of Ministers
the General Directorate of Civil Protection and Firefighting Services at the Ministry of the Interior
the National Seismic Service at the Department of National Technical Services (currently dependent on the Ministry of Public Works).
The Civil Protection plays a key role in the management of national emergencies but not only: the possibility of being activated by the Prefect (Prefetto) for emergencies and in particular cases also for events at local level, makes the Civil Protection an entity that can operate de facto across the board. The Prefect is the cornerstone of the command and coordination structure of the civil protection operational system.
Another key player is represented by the Mayor. He is the determining element in the operational chain of civil protection at municipal level in the assumption of all responsibilities related to civil protection tasks: from the preventive organization of control and monitoring activities to the adoption of emergency measures aimed primarily at safeguarding human life.
It is appropriate, at this point, to make one final consideration: the Emergency Plan is drawn up in any case on the basis of the scientific knowledge possessed at the time of writing, without waiting for studies in progress or future assignments or improvements. An “expeditious” plan, even if imprecise and precautionary, is better than no plan at all. As soon as possible, the Emergency Plan will be reviewed, improved, and completed with more data and more scientific bases.
The key concept of contingency planning is to try to predict all possible variables, however, it is necessary to be aware that it will always be possible, in any emergency, to face something unforeseen.
The coordination of the members of the National Service of Civil Protection is happening according to the provisions of the Augustus Method thanks to the synchronism of the representatives of each operational function (Health, Volunteering, Telecommunications, etc..) to interact directly with each other.
The intervention model adopted by civil protection for the management of the epidemiological emergency [31] based on the definition of the chain of command and control, the communication flow and the procedures to be activated in relation to the emergency state determined by the spread of the pandemic.
The chain of command and control includes the following levels of coordination:
National level: the Head of the Civil Protection Department ensures the coordination of the necessary interventions, making use of the Department, the components, and operational structures of the National Civil Protection Service, as well as implementing entities. At the Department of Civil Protection is active the Civil Protection Operational Committee, with the task of ensuring the contribution and support of the National Civil Protection System on the basis of the health indications defined by the Ministry of Health, which makes use of the ISS (Istituto Superiore Sanità) and the Scientific Technical Committee specifically established with the OCDPC 630/2020 at the Department.
Regional level: at all Regions must be activated a regional crisis unit, which operates in close connection with the SOR - Regional Operations Room, which must provide for the participation of the Regional Health Contact, which operates in connection with the Health Director of the local health agencies, and in constant contact with a representative of the Chief Prefecture, in order to ensure the connection with the other Prefectures - UTG of the regional territory.
Provincial level: in the provinces in which at least one person is positive for whom the source of transmission is unknown or in any case where there is a case not attributable to a person from an area already affected by the virus, as provided by art. 1, paragraph 1 of Decree-Law no. 6 of 23.02.2020, the Prefect or his delegate provides for the activation of the CCS - Rescue Coordination Centre
Municipal level: in the municipalities or areas in which at least one person is positive for whom the source of transmission is unknown or in any case where there is a case not attributable to a person from an area already affected by the aforementioned virus, as provided by art. 1 paragraph 1 of Decree-Law no. 6 of 23.02.2020, the Mayor or his delegate provides for the activation of the Municipal Operations Centre - COC of the municipality involved and neighboring municipalities in order to implement possible preventive actions.
Therefore, in order to cope with the pandemic and in accordance with the provisions of the Augustus Method, collaborative decision-making processes have been initiated in real time in the operational rooms of the various levels such as:
Centro Coordinamento dei Soccorsi (CCS) - Rescue Coordination Centre
Centro Operativo Comunale (COC) - Municipal Operations Centre
Centro Operativo Misto (COM) - Mixed Operations Centre.
The CCS is the main body at provincial level and is chaired by the Prefect or his delegate. By COC is meant the Municipal Operations Centre, responsible for the activities at municipal-local level, whose maximum point of reference is the Mayor or his delegate (Law 225/1992 - Art. 15). Finally, the COM is the Mixed Operations Centre. They can be more than one and set up ad hoc to be as close as possible to the place of the event.
Originally established as emergency operational centres (i.e. support and operational coordination structures set up and organized exclusively in the full management phase of the emergency following catastrophic events), over time the term has moved to a broader interpretation of the term which also involves structures and organizational divisions of one or more local administrations in the construction of the local civil protection system as well as emergency planning activities to be carried out in ordinary time.
In this emergency caused by the pandemic, a key role is played by the COC, which have been activated in many Italian municipalities [32].
Specifically, the Mayor makes use of the COC to ensure the direction and coordination of rescue and assistance services to the population within his municipal territory in relation to the declaration of the state of emergency issued by the Italian Government. The choice of the location of this Centre must be in earthquake-proof structures, in areas with easy access and not vulnerable to any kind of risk. These facilities must be equipped with a square of enough size to accommodate heavy vehicles and anything else needed in a state of emergency. The COC is responsible for the decision-making levels of the entire municipal structure, summarized in the trade union responsibilities referred to in the previous paragraphs; as a rule, the decision-making level is taken by the Mayor who, through a municipal civil protection system, identifies the actions and strategies necessary to try to keep the infection curve and morbidity index under control. The COC operates in a place of coordination called “operations room” where all the news related to the event converge and where decisions are taken to overcome it. In many municipalities, the COC has been activated by the Mayor as an immediate consequence of the increase in infections within the national territory, and not necessarily in the municipal one, and it will remain operational until the resolution of the pandemic crisis [33].
According to the Civil Protection Operational Measures for the management of the epidemiological emergency [31] actions and operational measures identified for each level of coordination, without prejudice to the provisions issued by the Ministry of Health, are as follows:
information to the population
activation of local volunteering, in connection with the levels of coordination above
organization of actions at the municipal level, in connection with the regional and provincial level, actions to ensure the continuity of essential services, as well as the collection of waste in areas affected, or that may be affected, by urgent measures of containment
organization of actions at the municipal level, in connection with what has been prepared at the regional level, actions aimed at ensuring the continuity of the supply of basic necessities (including fuel supplies) in the areas concerned, or that could be affected by urgent containment measures;
planning, or possible activation, of the actions of assistance to the population of the municipalities concerned, or that could be affected by urgent containment measures
planning and organization of home care services for persons in home quarantine (e.g., basic necessities, medicines, pre-packaged meals…), possibly carried out by personnel of volunteer organizations, appropriately trained.
At this point, it can be stated that the success of a civil protection operation can be achieved if three parameters are satisfied: coordination, communication, and resource management.
As with any crisis management strategy, resilience strategies must be planned and prepared during the “peace” period and then implemented, appropriately adapted, during crisis situations. The variable structure, and a proactive response, is what succeeds in giving us a continuity and dealing successfully with the complexity.
Labor shortages directly affected all those sectors that had to close due to the impossibility to convert their business using smart working. Some activities, although part of sectors not directly involved in the lockdown, were indirectly affected by labor shortages caused by the inability of seasonal and commuting staff to move. Finally, the indirect repercussions that have affected those activities that, while remaining operational, have suffered significant economic repercussions due to the interruption of their supply chain caused by the shortage of labor in other sectors.
To be considered in the degree of dependence that an organization might have on its suppliers, beyond its intrinsic resilience, is the degree of flexibility applicable to relations with the various suppliers.
To plan the SCCM it will be necessary to carry out Impact Analysis activities with the individual suppliers involved, distinguishing critical suppliers from non-critical suppliers. For all relationships with critical suppliers continuity can be determined by identifying a SCCM strategy to be agreed transparently with these suppliers. Some strategic approaches may be:
Reducing dependence on a supplier: direct engagement of alternative suppliers for a given service; increasing on-site stock holding; establishing alternative solutions.
Increased resilience: mitigation of losses; identification of a set of alternative suppliers; establishing mutual support policies with competitors.
Working with suppliers: creating partnerships with suppliers; setting performance standards (including through SLAs); monitoring and dealing with suppliers to increase their resilience; including SCCM requirements in supplier contracts.
The adoption of these measures will result in increasing control over the value chain in relation to an organization. In particular, the analysis carried out on the supplier chain gives visibility to the mapping of the interdependencies between the different sectors enabling an analysis that goes beyond the single organization.
Therefore, maximum flexibility and, at the same time, the ability to create the preconditions (e.g. through exercises) is needed to ensure that the best conditions for success are in place in these cases as well.
Moreover, most of all, the 2020 crisis confirmed the relevance of the human factor.
The Italian case is an example of how the set of private initiatives, the support of adequate policies of incentives and support from the State, together with a strong sense of solidarity with the population, can represent a positive reaction to a negative event, and that business strategies oriented towards business continuity are the basis for the development of resilience in the productive sector, and the resilience of the Critical Infrastructures.
Virus-induced cancers represent a huge burden, especially in developing countries. According to recent estimates from the International Agency for Research on Cancer (IARC), 16% of new cases of cancer worldwide are attributable to infections, of which 11% are viral infections. In sub-Saharan Africa, one-third of all cancers are infection-induced cancers [1]. Human papillomaviruses are small non-enveloped viruses (about 55 nm in diameter) of the Papillomaviridae family with a compact structure and a small circular genome (8000 base pairs), encoding 8–9 proteins depending on the genotype (LCR, L1, L2, E1, E2, E4, E5, E6, and E7) [2]. E5, E6, and E7 proteins are involved in cell proliferation and transformation [3, 4]. It is noteworthy that persistent infection with high oncogenic risk human papillomavirus (HR-HPV) can lead to precancerous lesions, which generally begin with slight modification (CIN 1), that can progress to more severe lesions such as CIN 2 then CIN 3 (carcinoma
In West Africa, the annual estimate of cervical cancer burden is 31,955 cases and 23,529 deaths [9]. However, most sexually active men and women can be infected with HR-HPV at some point in their lives, and persistent infection could lead to precancerous lesions and progress into invasive cancer [1, 5]. In addition, HPV infection can affect fertility in men [10, 11]. According to the World Health Organization (WHO), men genital infections with any type of HPV are estimated at least at 19.1% in sub-Saharan Africa [12].
In Burkina Faso, cervical cancer is the most commonly diagnosed cancer with an estimated incidence of 2517 cases and 2081 deaths per year [13]. In addition, otolaryngology and cervico-facial cancers are relatively frequent and account for 24.5% of this entity [14]. Gynecological cancers associated with persistent HR-HPV infection, therefore, threaten many African communities and economies, upsetting the trends of positive societal development. Although HR-HPV is the main causative agent of cervical cancer, other important cofactors (environmental or genetic) such as gene polymorphisms (E6, E7, MMP1, MMP3, TNF-alfa, and IL-18) are involved in the clearance and pathway of carcinogenesis [15].
HIV infection is an additional risk factor [16, 17] as well as some risky behaviors such as multiple sexual partners, especially among sex workers, leading to higher rates of cervical cancer [18] and increasing the risk of penile cancer in men [19]. Nevertheless, preventive measures through behavior modification, screening, and vaccination can significantly control these viral-induced cancers. To efficiently combat this pathology, it is, therefore, necessary to investigate whether the HR-HPV genotypes found in our populations, especially the most common in cancers cases, are covered by the available vaccines. To address this concern, the objective of the present study was to determine the distribution of HR-HPV genotypes in a general population including childbearing age women, teenage girls, HIV-infected women, women with high-grade precancerous lesions and invasive cervical cancer, sex workers, men, and histologically confirmed otolaryngology tumor (ear, nose, and throat) in Burkina Faso.
From 2013 to 2017, we carried out a large-scale, descriptive cross-sectional, and multicenter epidemiological study in Burkina Faso along with the retrospective data collection and analysis. The population of the present study consisted of 2386 participants, including eight (8) target groups: childbearing age women, teenage girls, HIV-infected women, sex workers, men, women with high-grade precancerous lesions (CIN 2/3), tissue from invasive cervical cancer, and histologically confirmed otolaryngology tumor (ear, nose, and throat cancers) in Burkina Faso.
The study was conducted in two phases: a descriptive cross-sectional study with 2025 participants made up of 1321 childbearing age women, 200 teenage girls, 183 HIV-infected women, 200 sex workers, and 124 men. We first focused on awareness-raising of HPV infection prevention and the risk of developing cervical cancer at several sites.
The goal after awareness-raising was to include in the target groups, all sexually active women (SAW) regardless of age who were not pregnant and provided informed consent to participate in the study. The exclusion was being in the menstruation period, during the study recruitment, and have had a total hysterectomy.
Prior to the samples collection, socio-demographic data, sexual behavior, HIV serology, level of knowledge about HPV and cervical cancer as well as associated diseases were collected using a standardized questionnaire. An individual collection card was used to collect clinical data of each sex worker in the study population. The privacy and confidentiality were respected through the generation of a unique code for each participant.
Midwives and gynecologists using a single-use speculum and sterile swab performed endocervical samples collection at the squamocolumnar junction. The following samples were taken:
from May 2009 to January 2010, 183 endocervical samples from women aged 20–53 years of age, who tested positive for anti-HIV antibodies at the stage of asymptomatic infection, were collected in three reference health centers accessible to all inhabitants of Ouagadougou [Saint Camille Hospital of Ouagadougou (HOSCO) and Pietro Annigoni Biomolecular Research Center (CERBA), two reference centers for people living with HIV/AIDS (PLWHIV), and Bogodogo University Hospital]. Participants were monitored at HOSCO and CERBA and were annually screened for cervical cancer.
from September to December 2013, 200 endocervical samples from teenage girls, aged 15–19, were collected in a youth health center (ABBF) of Ouagadougou. The participants were seen at gynecological consultation for voluntary HIV testing;
from December 2015 to September 2016, 124 sperm samples were collected in three medical clinics of Ouagadougou (Philadelphia, Sainte Elisabeth, and Sandof) after 3–6 days of abstinence according to the WHO recommendations. These male subjects aged 21–72 came for spermogram and spermocytogramanlyses;
from December 2015 to March 2017, 1321 endocervical samples from childbearing age women (15–76 years of age, general population), including 520 in Ouagadougou, 535 in the Hauts-Bassins region (Bobo and Orodara), and 266 in the Center-East region (Tenkodogo and Garango);
from June to August 2017, 200 endocervical samples from sex workers aged 16–50 years were enrolled in Ouagadougou.
The samples thus collected were frozen in a transport medium at −20°C except those from HIV+ women, which were stored at −80°C. The samples were then sent to the CERBA/LABIOGENE molecular biology and genetics laboratory for molecular biology analyzes. Following sampling in women, screening for precancerous lesions was performed using visual inspection of the cervix with acetic acid (VIA) or with Lugol’s iodine (VILI).
The second phase, a cross-sectional study with retrospective data collection, involved 358 samples. Using patients medical register available at the Department of Anatomy and Cytopathology of YalgadoOuedraogo University Hospital Center (CHU-YO), 118 cervical tissue specimens were selected based on high-grade (CIN 2/3) intraepithelial lesions diagnosis between February 2009 and May 2015 along with 112 cervical tissue specimens dated from 2009 to 2015 with a histological diagnosis of invasive cervical cancer.
According to the same protocol, we also included 128 histologically confirmed otolaryngology cancerous tissues dated from 2007 to 2017 in four health centers of Ouagadougou, CHU-YO, Shiphra, Sandof, and Philadelphia clinics. All these biopsy specimens were fixed in formalin and embedded in paraffin.
HR-HPV viral DNA was extracted using the DNA-Sorb-A kit (Sacace Biotechnologies, Como, Italy) from endocervical and sperm samples following the protocol provided by the manufacturer. Endocervical samples of HIV-positive women, DNA was extracted using bio solutions “INSTANT Virus DNA Kit” Analytkjena® (Italy). The extracted DNA was then quantified using UV spectrophotometry at 260 nm and stored at −20°C until PCR amplification.
In the cytopathology anatomy laboratory of the CHU-YO, the paraffin blocks containing a piece of biopsy were cut with a microtome to obtain five sections of about 20 μm thick. Tissues thus collected in sterile Eppendorf tubes were sent to the CERBA/LABIOGENE for molecular analyzes. DNA extraction was performed using the FFPE DNA Purification Kit, following the protocol provided by the manufacturer.
Each semen sample was assessed according to the following parameters: volume, motility, concentration, morphology, and vitality of spermatozoa, using an optical microscope.
Extracted DNA was amplified with “HPV Genotypes 14 Real-TM Quant” kit (Sacace Biotechnologies, Como, Italy) using Sacycler-96 Real-time PCR v.7.3 (SACACE Biotechnologies®). Fourteen HR-HPV genotypes (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) could be detected in a multiplex PCR procedure with β-globin gene as internal control.
Two different techniques were used to amplify the viral DNA extracted from samples of HIV+ women: PCR/Hybridization for the detection of HPV 6, 11, 16, 18, 45, 30’S and 50’S using the “HPV Blot STAR” kit from Diatech® (Italy), without discrimination of the HPV 30’S and 50’S genotypes, respectively. The second technique using the “HPV High-Risk Typing Real-TM” kit (SACACE biotechnologies®, Italy) allows specific detection of the following high-risk genotypes: 16, 18, 31, 39, 45, 59, 33, 35, 56, 51, 52, and 58. The amplification program was as follows: 1 cycle of 95°C for 15 minutes; 5 cycles of 95°C for 05 s, 60°C for 20s, 72°C for 15 s; 40 cycles of 95°C for 05 s, 60°C for 30s, and 72°C for 15 s.
Each phase of the present study received the approval of the Ethics Committee for Health Research of Burkina Faso (CERS) (n °2009-009/CR/135 of April 22, 2009 (HIV+); N2014-8-099 of August 6, 2014 (CIN2/3); Deliberation No. 2016-2102-0012 of 02/03/2016 (general population); No.2017-1026/MS/RCEN/DRSC (sex workers); No. 2014-8-099 (ICC); Ref.2017/CERBA/II-24/0019 of 24-02-2017 (otolaryngology samples) along with approbation of the regional health directorates (DRS) of the various target collection sites. Free and informed consent, anonymity, and confidentiality were strictly observed.
Statistical analysis of data was performed using IBM SPSS 21 and Epi Info v7.0 software. The Chi-square test was used for comparisons with a significant difference for
The present study focused on eight (8) target groups, including childbearing age women, adolescent girls, HIV-infected women, sex workers, men, high-grade precancerous lesions (CIN 2/3) cases, invasive cervical cancer, and histologically confirmed otolaryngology tumors in Burkina Faso. The mean age ranged from 18.7 ± 0.7 to 46.32 ± 12.76 years (Table 1).
Target groups | childbearing age women in the general population | Teenage girls | Sex workers | CIN 2/3 | ICC | HIV+ | Men | Otolaryngology cancers |
---|---|---|---|---|---|---|---|---|
Mean age (years) | 32.0 ± 10.1 | 18.7 ± 0.7 | 27.3 ± 0.4 | 41.5 ± 9.8 | 46.3 ± 12.8 | 33.9 ± 6.2 | 37.1 ± 7.6 | 41.0 ± 19.0 |
Range | 15–76 | 15–19 | 16–50 | 22–74 | 21–84 | 20–53 | 21–72 | 5–80 |
Mean age of target groups in the study population.
The general female population of the present study consisted of 1321 childbearing age women and 200 adolescent girls. Among them, only 142 (9.34%) had a university education while 951 (62.53%) were living with a partner. Most of them (61.34%) were over 18 years of age at first, and 43.19% never used a condom during sex. It is noteworthy that 40.89% of them had a history of STIs and 50.43% declared to be using contraception. Screening for precancerous lesions using VIA/VILI revealed 70 positive women (Table 2).
Characteristic | Target groups | |||
---|---|---|---|---|
Childbearing age women | Teenage girls | Women in the general population | ||
Educational level | Illiterate | 433 (32.78%) | 2 (1%) | 435 (28.6%) |
Primary | 293 (22.18%) | 58 (29%) | 351 (23.08%) | |
Secondary | 495 (37.47%) | 98 (49%) | 593 (38.98%) | |
University | 100 (7.57%) | 42 (21%) | 142 (9.34%) | |
Marital status | Married/cohabiting Single | 940 (71.16%) | 11 (5.5%) | 951 (62.53%) |
Widow | 325 (24.60%) | 189 (94.5%) | 514 (33.79%) | |
56 (4.24%) | 56 (3.68%) | |||
Age at first sexual intercourse | < 18 years | 452 (34.22%) | 102 (51%) | 554 (36.42%) |
≥ 18 years | 835 (63.21%) | 98 (49%) | 933 (61.34%) | |
No answer | 34 (2.57%) | 34 (2.24%) | ||
Condom use | Never | 633 (47.92%) | 24 (12%) | 657 (43.19%) |
Rarely | 263 (19.91%) | 102 (51%) | 365 (24%) | |
Always | 124 (9.39%) | 74 (37%) | 198 (13.02%) | |
No answer | 301 (22.78%) | 301 (19.79%) | ||
STIs history | Yes | 605 (45.80%) | 17 (8.5%) | 622 (40.89%) |
No | 716 (54.20%) | 183 (91.5%) | 899 (59.11%) | |
Use of means of contraception | Yes | 605 (45.80%) | 162 (81%) | 767 (50.43%) |
No | 716 (54.20%) | 38 (19%) | 754 (49.57%) | |
VIA/VILI+ | Positive | 58 (4.39%) | 12 (6%) | 70 (4.6%) |
Sociodemographic data and sexual behavior of the women general population.
The beta-globin gene used as an internal control was an essential factor for results validation in multiplex real-time PCR procedures for HR-HPV genotypes detection. Out of 118 CIN 2/3 tissue blocks samples, 43 positives for the beta-globin gene were considered valid while 65 samples were valid out of the 112 ICC specimens. Only valid samples were considered for the present study. HPV data were therefore available for 2264 valid samples out of 2386 recruited participants.
The prevalence of HR-HPV ranged from 15.63% to 72.31% based on the target population and nature of the samples. The overall prevalence was estimated at 39.05% (824/2264). As shown in Figure 1, a prevalence of 72.31% (
Prevalence of HR-HPV according to the target groups and nature of the samples in the study population.
The amplification kits used enabled us to essentially characterize the HR-HPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Table 3 shows the distribution of HR-HPV in descending order in the study population. Overall, varied distribution of HR-HPV genotypes was observed with predominance of non-HPV 16 and 18 genotypes (Table 3).
Target groups | Sample size | Prevalence of HR-HPV (CI 95%) | Most common HR-HPV | Absent genotypes |
---|---|---|---|---|
Childbearing age women in the general population | HPV 16 absent in hauts-bassins | |||
Teenage girls | ||||
Sex workers | ||||
HIV+ women | ||||
CIN 2/3 | HPV 16. 58. 66 | |||
ICC | HPV33; 66; 68 | |||
Otolaryngology cancers | HPV31;35;51;58;59; 66 and 68 | |||
Men | ||||
General population (women + men) | ||||
Target groups | ||||
Burkina Faso (Bilan) |
Genotypic distribution of HR-HPV in target groups.
NB: The general population consists of childbearing age women, adolescent girls, and men. The target population consists of sex workers, HIV+ women, CIN 2/3 cases, ICC cases, and otolaryngology cancers.
On the one hand, HPV 16 was particularly absent in childbearing age women from the Haut-Bassins region, in southwestern Burkina Faso, and in women with high-grade precancerous lesions (Table 3). On the other hand, HPV 18 was most common in ICC cases and HIV-positive women. In addition, HPV 56 was predominant in childbearing age women, otolaryngology cancers, and men. However, a predominance of HPV 68 was registered in sex workers and absent in ICC and otolaryngology cancers. It is noteworthy that HPV 56 was predominant in the general population as well as in the target groups (Table 3).
Table 4 shows the HR-HPV genotypes detected in the present study population and their prevalence in each target population. Considering the five most common HR-HPV genotypes found in the different target groups, HPV 16 presented a low proportion, especially in childbearing age women (1.82%), adolescent girls (5.2%), sex workers (2.7%), HIV + (4.9%), CIN 2/3 (0.0%). However, in decreasing order of frequency, it was the third genotype identified in otolaryngology cancers, the fourth in ICC, and the fifth in men. In HIV-positive women, a frequency of 2% of HPV6 infection was observed.
HR-HPV genotypes identified | HPV56 (7.60%) | HPV56 (7.80%) | HPV56 (8.70%) | HPV56 (1.43%) | HPV56 (45%) | 70.53% |
HPV18 (6.20%) | HPV18 (18.80%) | HPV18 (4.30%) | HPV18 (25.71%) | HPV18 (10%) | 65.01% | |
HPV39 (6.20%) | HPV39 (2.60%) | HPV39 (21.70%) | HPV39 (12.86%) | HPV39 (5%) | 48.36% | |
HPV45 (5.80%) | HPV45 (6.20%) | HPV45 (13%) | HPV45 (12.86%) | HPV45 (5%) | 42.86% | |
HPV31 (12%) | HPV31 (10.70%) | HPV31 (4.30%) | HPV31 (15.71%) | HPV31 (0%) | 42.71% | |
HPV35 (7.10%) | HPV35 (13.30%) | HPV35 (13%) | HPV35 (7.14%) | HPV35 (0%) | 40.54% | |
HPV33 (1.80%) | HPV33 (5.80%) | HPV33 (8.70%) | HPV33 (0%) | HPV33 (20%) | 36.30% | |
HPV52 (9.30%) | HPV52 (8.80%) | HPV52 (8.70%) | HPV52 (2.86%) | HPV52 (5%) | 34.66% | |
HPV16 (2.70%) | HPV16 (4.90%) | HPV16 (0%) | HPV16 (12.86%) | HPV16 (10%) | 30.46% | |
HPV51 (8.90%) | HPV51 (5.20%) | HPV51 (8.70%) | HPV51 (1.43%) | HPV51 (0%) | 24.23% | |
HPV58 (7.10%) | HPV58 (8.10%) | HPV58 (0%) | HPV58 (5.71%) | HPV58 (0%) | 20.91% | |
HPV68 (14.60%) | HPV68 (0%) | HPV68 (4.30%) | HPV68 (0%) | HPV68 (0%) | 18.90% | |
HPV59 (3.10%) | HPV59 (5.80%) | HPV59 (4.30%) | HPV59 (1.43%) | HPV59 (0%) | 14.63% | |
HPV66 (7.60%) | HPV66 (0%) | HPV66 (0%) | HPV66 (0%) | HPV66 (0%) | 7.60% | |
HR-HPV genotypes identified | HPV56 (15.94%) | HPV56 (8.80%) | HPV56 (20%) | 44.74% | ||
HPV52 (12.73%) | HPV52 (22.80%) | HPV52 (6%) | 41.53% | |||
HPV39 (8.25%) | HPV39 (13.20%) | HPV39 (11%) | 32.45% | |||
HPV59 (10.91%) | HPV59 (14%) | HPV59 (3%) | 27.91% | |||
HPV51 (7%) | HPV51 (10.30%) | HPV51 (6%) | 23.30% | |||
HPV35 (5.45%) | HPV35 (10.30%) | HPV35 (6%) | 21.75% | |||
HPV31 (3.36%) | HPV31 (3.60%) | HPV31 (11%) | 17.96% | |||
HPV18 (6.01%) | HPV18 (5.20%) | HPV18 (6%) | 17.21% | |||
HPV68 (5.17%) | HPV68 (0%) | HPV68 (11%) | 16.17% | |||
HPV16 (1.82%) | HPV16 (5.20%) | HPV16 (8%) | 15.02% | |||
HPV66 (11.05%) | HPV66 (0%) | HPV66 (3%) | 14.05% | |||
HPV58 (5.17%) | HPV58 (4.40%) | HPV58 (0%) | 9.57% | |||
HPV45 (5.03%) | HPV45 (1.50%) | HPV45 (3%) | 9.53% | |||
HPV33 (2.10%) | HPV33 (0.70%) | HPV33 (6%) | 8.80% |
Prevalence of HR-HPV in risk population, precancerous lesions, and cancer cases.
PCR screening in each target group revealed that among the 884 cases of HR-HPV infections, the number of genotypes per infected person ranged from 1 to 9 out of 14 genotypes tested. Single infection (isolated infection) ranged from 37.61 to 90.50% while multiple infection varied from 9.50 to 62.39% (Table 5).
Target groups | Presence of HR-HPV | Type of HR-HPV according to target groups | ||||
---|---|---|---|---|---|---|
HR-HPV − | HR-HPV+ | P-value | Single infections | Multiple infections | Number of HR-HPV genotypes per infected person | |
Childbearing age women n = 1321 | 64.57% (853/1321) | 35.40% (468/1321) | < 0.001 | 63.68% (298/468) | 36.32% (170/468) | 1–6 |
Teenage girls, | 58.5% (117/200) | 41.50% (83/200) | 0.001 | 57.80% (48/83) | 42.20% (35/83) | 1– 5 |
Sex workers, | 47% (94/200) | 53% (106/200) | 0.230 | 46.20% (49/106) | 53.80% (57/106) | 1–9 |
HIV+, | 36.06% (66/183) | 63.90% (117/183) | < 0.001 | 37.61% (44/117) | 62.39% (73/117) | 1–7 |
CIN 2/3, | 51.16% (22/43) | 48.80% (21/43) | 0.829 | 90.50% (19/21) | 9.50% (2/21) | 1–2 |
ICC, | 27.69% (18/65) | 72.31% (47/65) | < 0.001 | 65.96% (31/47) | 34.04% (16/47) | 1–4 |
Otolaryngology cancers, | 84.37% (1O8/128) | 15.63% (20/128) | 0.722 | 90% (18/20) | 10% (2/20) | 1–2 |
Men, | 82.26% (102/124) | 17.74% (22/124) | < 0.001 | — | — | — |
Total, | 60.95% (1380/2264) | 39.05% (884/2264) | <0.001 |
Prevalence of single and multiple infections in target groups.
The HR-HPV genotypes targeted by bivalent/quadrivalent HPV vaccines (HPV6/11/16/18) were identified in 7.83% of childbearing age women, 10.40% of adolescent girls, 8.90% of sex workers, 25.70% of HIV+ women, 4.30% of CIN 2/3, 38.57% of ICC cases, 14% of men, and 50% of otolaryngology cancer cases. The genotypes covered by the nonavalent vaccine (HPV6/11/16/18/31/33/45/52/58) were 36.22, 43.40, 44.90, 65.30, 39, 75.71, and 40%, respectively in childbearing age women, adolescent girls, sex workers, HIV-positive women, CIN 2/3, ICC, men, and otolaryngology cancer. HR-HPV not covered by bivalent, quadrivalent, or nonavalent HPV vaccines were observed with a higher prevalence in childbearing age women (63.18%), CIN 2/3 cases (61%), and men (60%) (Figure 2).
Prevalence of HR-HPV identified in the target groups of our study according to their coverage by available vaccines.
HPV is one of the carcinogenic viruses, sexually transmitted, widespread in the world with a high prevalence in developing countries especially in Sub-Saharan Africa where socio-cultural and behavioral factors which promote transmission prevail in several regions. In the present epidemiological study, including 2386 samples out of which 2264 were valid using the PCR technique, the overall prevalence of HR-HPV was 39.05% (824/2264). This prevalence is in line with those reported in previous studies supporting a global prevalence of 10.4% of HR-HPV infection [20] which can reach 36.5% in some developing countries [21, 22].
Epidemiological studies suggested a difference in the prevalence and distribution of HR-HPV genotypes in infected women according to regions and risk groups throughout the world [23, 24]. Our results support this variable prevalence and distribution of HR-HPV according to target populations and sample types.
Indeed, the prevalence of 35.40% of infection observed in the population of childbearing age women was lower than that reported in some studies from Tanzania (74%) [25] and Ethiopia (83.2%) [26] almost similar to that of a study conducted in England (35%) [27].
HR-HPV is the main etiologic agent responsible for ano-genital cancers including ICC and a prevalence of 100% could be expected in ICC cases. The high prevalence of 72.31% of HR-HPV infection in ICC cases found in this study was lower than the 100% reported in Gabon [28], 90,7% in Nigeria [29], and 83,2% in Malaysia [30]. The difference in the methodologies used could support the existence of false-negative samples as reported in a previous study by Tan et al. [30] in Malaysia.
Furthermore, sex workers and men, an important active group for the maintenance of HPV in the population, showed a high prevalence of HR-HPV in our study. For instance, some studies reported a significant association between HPV infection, high number of sexual partners, and history of STIs [31]. The prevalence of 53% found among sex workers in our study was higher than those of 51.5% and 26% reported respectively in Côte d’Ivoire [32] and Ghana [7]. In contrast, the infection rate of 17.74% in the men of our study population was lower than the 32.4% observed by Zhu et al. [33] in men with genital warts. These results support the fact that sex workers and men constitute a reservoir for the transmission of HR-HPV, hence the importance of awareness-raising among these risk populations about the screening for HPV infection.
Data analysis also showed that 48.80% (21/43) of women with high-grade precancerous lesions (CIN2/3) were infected with HR-HPV; a lower prevalence than the 91.9% reported in another study in a similar population [34]. These results could be explained by the higher rate of infection in women under 30 years old, especially in those of 25–29 and 60 years and over [35, 36, 37]. For instance, the mean age of women with CIN 2/3 in our study was 41.5 ± 9.8 years (22–74 years) against was 45.7 years in the study of Wang et al. (21–83 years old).
Several studies reported a high prevalence of HPV infection in HIV+ women [7, 38] as HIV is a well-known factor associated with an increased risk of HR-HPV persistence and multiple infections, and therefore, promote the occurrence of anogenital cancers. The prevalence of 63.90% of HR-HPV observed in this target group of the present study was similar to 65.5% in Ghana [39] but higher than the 36% reported in Nigeria [40] and 33.3% in Brazil [41]. Compared to non-HIV infected women in the general population, this high prevalence could be explained by the immunosuppression and confirm the role of HIV infection as an additional risk factor for the persistence of HR-HPV.
The infection rate of 41.5% found in adolescent girls was lower than the 66.7% observed in South Africa [32]. The difference in age range (15 to 19 years in our study versus 16 to 22 in the South African study) could explain the prevalence variation between the two studies especially when previous studies support that HR-HPV infection is higher in those less than 30 years of age [37].
In our study, HPV 56 was the most common genotype in childbearing age women, men, and otolaryngology cancers with predominance in the general population as well as target groups. This genotype is not covered by any available HPV vaccine, although it has been found in ICC and CIN 2/3 cases [29]. The same is true for HPV 68 which was the most common genotype in sex workers and the fourth common in men.
Since sexual transmission is possible between men and women, the presence of these genotypes in ICC and CIN 2/3 cases suggests a low clearance of the latter HR-HPV genotype in Burkina Faso.
HPV 18 was more common in HIV-positive women and ICC cases with a high frequency of 18.8 and 25.71% respectively. It was also present in CIN 2/3 up to 4.3 and 10% in otolaryngology cancers. Our results are in line with those of studies reporting that this persistent genotype is one of the most commonly found in cervical cancers [29].
Immunodeficiency of HIV-infected women coinfected with HPV 18 promotes high-grade precancerous lesions and the occurrence of invasive cancer of the cervix. It would therefore be necessary to strengthen surveillance through screening, treatment, and vaccination of HIV-infected women.
In addition, unlike studies reporting HPV 16 as the most common genotype throughout the world, especially in cervical cancers [13, 28, 30, 42, 43], this genotype was classified among the less frequent HPVs in our study. However, in ICC (12.86%), otolaryngology cancers (10%), and in men (8%), HPV 16 was not one of the most common genotypes but reached a frequency that required attention. The low prevalence of HPV-16/18 in our 2386 samples remains an enigma to be elucidated. It remains true that not only the distribution of the HPV genotypes would vary according to the continents, the zones, the countries, and the target populations but also the clearance and the borrowing of the pathway of the carcinogenesis induced by these viruses is modulated by genetic polymorphisms of their human hosts [44, 45]. Evidence from the literature support that the HPV16/18/31/33/35/45/52/58 genotypes are the most common genotypes found in 20% of cervical cancer cases worldwide [24].
The results of the present study also revealed a high prevalence of HR-HPV genotypes covered by the nonavalent vaccine (36.22–75.71%) as well as genotypes of HPV not covered by the vaccine (24.29–63,18%). It is noteworthy that some of the genotypes not covered by vaccine were found in high-grade precancerous lesions and cervical cancer cases [29, 46].
For effective prophylactic actions to control HPV infection, the present epidemiological study in Burkina Faso shows variable distribution of HR-HPV genotypes in the different target populations. Our results suggest that implementation of the nonavalent vaccine is important for HR-HPV infection control in Burkina Faso. Promotion of screening of men, especially for penile cancer and genital warts, and young boys vaccination programs are required since men are well-known reservoirs for HR-HPV dissemination.
The studies carried out in Burkina Faso show the circulation of fourteen high-risk HPV genotypes among different layers of the population. The prevalence of HPV infection and genotypes distribution varied among target groups with an overall predominance of non-HPV 16 and 18 genotypes. Moreover, the high-risk HPV genotypes found in Burkina Faso are not all covered by the available vaccines. It is however crucial and important to focus on vaccination using available and accessible vaccines for developing countries to reduce the disease incidence. Cervical cancer and other HPV-induced cancers remain a global public health concern. Strengthening the implementation of primary, secondary, and tertiary prevention strategies incorporating information-education-communication and awareness-raising, will allow effective control of HPV infection and its consequences in men and women.
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Thus, the sustainability of the cocoa economy is under threat as diseases of various statuses now constitute the most serious constraint to production. Most important among these is the black pod disease caused by Phytophthora genus with annual losses of 30–90% of the crop. This economically important pathogen is very diverse in nature and varied across growing countries including species such as palmivora, megakarya, capsici and citrophthora distinguished based on chromosome number, sporangial characteristics and pedicel length. World losses of 20–25% in cacao production are due to black pod disease, an estimate of 700,000 metric tons on global scale reducing global cocoa production. High cacao loss to diseases is a prime factor limiting production; consequently, significant effort is required to deal with problems associated with disease control to ensure a sustainable cacao. The effective and sustainable management of black pod disease requires integrated approach encompassing different control measures.",book:{id:"7005",slug:"theobroma-cacao-deploying-science-for-sustainability-of-global-cocoa-economy",title:"Theobroma Cacao",fullTitle:"Theobroma Cacao - Deploying Science for Sustainability of Global Cocoa Economy"},signatures:"Dele Adeniyi",authors:null}],mostDownloadedChaptersLast30Days:[{id:"65131",title:"Diversity of Cacao Pathogens and Impact on Yield and Global Production",slug:"diversity-of-cacao-pathogens-and-impact-on-yield-and-global-production",totalDownloads:1765,totalCrossrefCites:4,totalDimensionsCites:11,abstract:"Cacao, Theobroma cacao L., an important cash crop in foreign exchange earnings and also a major income source for many smallholder farmers in growing ecologies of West Africa. Global cocoa production has been rising fairly steadily over the years by increasing production in growing countries with most of the production taking place in areas of high pathogen biodiversity. Thus, the sustainability of the cocoa economy is under threat as diseases of various statuses now constitute the most serious constraint to production. Most important among these is the black pod disease caused by Phytophthora genus with annual losses of 30–90% of the crop. This economically important pathogen is very diverse in nature and varied across growing countries including species such as palmivora, megakarya, capsici and citrophthora distinguished based on chromosome number, sporangial characteristics and pedicel length. World losses of 20–25% in cacao production are due to black pod disease, an estimate of 700,000 metric tons on global scale reducing global cocoa production. High cacao loss to diseases is a prime factor limiting production; consequently, significant effort is required to deal with problems associated with disease control to ensure a sustainable cacao. The effective and sustainable management of black pod disease requires integrated approach encompassing different control measures.",book:{id:"7005",slug:"theobroma-cacao-deploying-science-for-sustainability-of-global-cocoa-economy",title:"Theobroma Cacao",fullTitle:"Theobroma Cacao - Deploying Science for Sustainability of Global Cocoa Economy"},signatures:"Dele Adeniyi",authors:null},{id:"67634",title:"Cacao Growth and Development Under Different Nursery and Field Conditions",slug:"cacao-growth-and-development-under-different-nursery-and-field-conditions",totalDownloads:1295,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Experiments were conducted between 2004 and 2018 to examine cacao growth, development, establishment and yield under varying experimental conditions comprised of seed mucilage handling before sowing, sowing methods and its effects on seedling growth and development, timing of mycorrhizal inoculation on root and shoot growth and development and effects of shade and dry season drip irrigation on growth and yield of field-grown cacao. Results show that cleaning cacao seed mucilage before sowing enhanced sprouting rate and percent germination. The use of manure mixed with sawdust and loamy soil aided excellent seed germination, seedling vigor and root development. Inoculating cacao seeds with arbuscular mycorrhizal fungi (AMF) at point of sowing and early stages in the nursery aided root development and enhanced field establishment and survival during the dry season. Dense shade retarded cacao growth and development during the rainy season, while no shade enhances optimum growth and canopy development. The use of drip irrigation strategies in young cacao plantations increased seedling survival from less than 45% under no irrigation to above 95% at the end of the second dry season. This showed that irrigation during dry season can significantly enhance cacao establishment and survival.",book:{id:"7005",slug:"theobroma-cacao-deploying-science-for-sustainability-of-global-cocoa-economy",title:"Theobroma Cacao",fullTitle:"Theobroma Cacao - Deploying Science for Sustainability of Global Cocoa Economy"},signatures:"Idowu Babadele Famuwagun and Samuel Ohi Agele",authors:null},{id:"68383",title:"Major Natural Vegetation in Coastal and Marine Wetlands: Edible Seaweeds",slug:"major-natural-vegetation-in-coastal-and-marine-wetlands-edible-seaweeds",totalDownloads:766,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"For thousands of years, seaweeds grown in coastal and marine have been used as food, materials and medicines by the people. Edible seaweeds directly consumed, especially in Asian, are used for preparing food due to the their components containing minerals, essential trace elements, and various natural compounds. At the last decades, they have been getting more and more attention in food and pharmaceutical industries because of their biological activities such as anti-cancer, anti-obesity, anti-diabetes, anti-microbial, and anti-oxidant activity. Therefore, in the present study, we have worked on to understand the structure of edible seaweeds. It is worthy to mention that they can be considered as source of some proteins, polyunsaturated fatty acids, minerals, vitamins, dietary fibers, antioxidants, and phytochemicals.",book:{id:"8667",slug:"plant-communities-and-their-environment",title:"Plant Communities and Their Environment",fullTitle:"Plant Communities and Their Environment"},signatures:"Ilknur Babahan, Birsen Kirim and Hamideh Mehr",authors:null},{id:"67540",title:"Aphid-Plant Interactions: Implications for Pest Management",slug:"aphid-plant-interactions-implications-for-pest-management",totalDownloads:1085,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"Aphids are important herbivores and important pest of many field and forest crops. They have specialized long and flexible stylets which are adapted to feeding on phloem sap. To establish successful feeding on host plant, they need to counter a range of both physical and chemical defenses. The defenses employed by plants can have direct effect on the aphid species through difficulty in establishing successful feeding due to the presence of trichomes, thick cell wall, etc. or effect on their biology with lethal consequences in extreme cases (direct defenses). In contrast to this, plants can attract natural enemies of aphids through the release of volatile compounds (the so-called “cry or call for help”) (indirect defense). The information on different defense strategies employed by plants can be utilized to enhance the level of resistance (R) to develop sustainable pest management strategies.",book:{id:"8667",slug:"plant-communities-and-their-environment",title:"Plant Communities and Their Environment",fullTitle:"Plant Communities and Their Environment"},signatures:"Sarwan Kumar",authors:null},{id:"72336",title:"Plant Phenology and An Assessment of the Effects Regarding Heavy Metals, Nanoparticles, and Nanotubes on Plant Development: Runner Bean, Artichoke, and Chickpea Seedlings",slug:"plant-phenology-and-an-assessment-of-the-effects-regarding-heavy-metals-nanoparticles-and-nanotubes-",totalDownloads:663,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The relationship between environmental pollution and nutrition in particular, which forms the basis of health, is fundamentally important for protecting human health. Therefore, the data obtained from the examination of how plants and animals consumed as food are affected by environmental pollution can be seen as an indicator of their effects on humans. On the other hand, the role of technology and nanotechnology in life has been increasing in this century, and a considerable amount of heavy metals, nanoparticles (NPs), and nanotubes (NTs) are released to the environment. The results of morphological or anatomical examination of runner bean (Phaseolus coccineus L) and artichoke (Cynara scolymus L.) plants subjected to copper (Cu) and lead (Pb) heavy metals and chickpea (Cicer arietinum L) plants subjected to Au nanoparticles and C70 single-walled carbon nanotubes (SWNTs) are presented with this study in the point of their phenological development process. The three taxa belonging to Fabaceae and Asteraceae families with high economic status and having flowers with characteristic features were chosen deliberately as representatives. This chapter presents a study that will shed light on future biomonitoring-based studies focusing on the impact of environmental pollution on plants phenology with economic value.",book:{id:"8667",slug:"plant-communities-and-their-environment",title:"Plant Communities and Their Environment",fullTitle:"Plant Communities and Their Environment"},signatures:"Feyza Candan",authors:[{id:"155281",title:"Associate Prof.",name:"Feyza",middleName:null,surname:"Candan",slug:"feyza-candan",fullName:"Feyza Candan"}]}],onlineFirstChaptersFilter:{topicId:"141",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. 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She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}}]},{type:"book",id:"7978",title:"Vitamin A",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7978.jpg",slug:"vitamin-a",publishedDate:"May 15th 2019",editedByType:"Edited by",bookSignature:"Leila Queiroz Zepka, Veridiana Vera de Rosso and Eduardo Jacob-Lopes",hash:"dad04a658ab9e3d851d23705980a688b",volumeInSeries:3,fullTitle:"Vitamin A",editors:[{id:"261969",title:"Dr.",name:"Leila",middleName:null,surname:"Queiroz Zepka",slug:"leila-queiroz-zepka",fullName:"Leila Queiroz Zepka",profilePictureURL:"https://mts.intechopen.com/storage/users/261969/images/system/261969.png",biography:"Prof. Dr. Leila Queiroz Zepka is currently an associate professor in the Department of Food Technology and Science, Federal University of Santa Maria, Brazil. 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He is especially interested in the genetic differentiation pattern and speciation process that correlate to the flashing pattern and mating behavior of some fireflies in Japan. He then worked for Olympus Corporation, a Japanese manufacturer of optics and imaging products, where he was involved in the development of luminescence technology and produced a bioluminescence microscope that is currently being used for gene expression analysis in chronobiology, neurobiology, and developmental biology. 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He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. 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He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. 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Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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