Studies reporting on structural variables in relation to outcomes for ovarian cancer
\r\n\tThis book will address the various modern, technical, and practical aspects of smart technology for capturing solar radiation and converting it into different forms of energy, as well as enabling it for renewables integration in energy generation and transformation, built environment, transportation, buildings, and agriculture.
\r\n\r\n\tThe book will cover the most recent developments, innovations and applications concerning the following topics:
\r\n\t• Solar radiation – Smart and enabling technologies for measurement, modelling, and forecasting
\r\n\tHigh-resolution measurement sensor and instrument technology (Pyranometers, Albedometers, Pyrheliometers, UV Radiometers, Sun Trackers, Spectroradiometer, Pyrgeometers, etc.), Artificial intelligence techniques for modelling and forecasting of solar radiation, Solar Irradiance forecast with satellite data, Solar potential analysis, Short-term forecasting of photovoltaic power and solar irradiance prediction with sky imagers.
\r\n\t• Renewable energy integration – Smart solutions for integration of RE in distributed generation, energy storage, and demand-side management.
\r\n\tIntegrated Photovoltaics: Smart technology for vehicle-integrated PV, Building Integrated PV, Agrivoltaics, Road-Integrated PV, Floating PV, Product-integrated PV.
\r\n\tRenewable Energy Applications in Built Environment and mobility: Solar cars, solar-powered electric charging stations, passive solar systems, solar heating, and cooling systems, building-integrated vegetation, multifunctional solar systems, solar pumps, solar lighting, solar shading, Natural lighting, Solar dryer, Greenhouse.
In Canada, ovarian cancer affects 2600 women and 1750 women die annually from this disease.[1] The case fatality rate for ovarian cancer is quite high at 0.67 because women usually present with wide-spread disease. Symptoms of ovarian cancer are non-specific, and there is no effective screening test which identifies ovarian cancer early, when the cure rate is highest.[2] When patients present with advanced disease, long term survival is elusive and the goals of care focus on increasing duration of survival and improving quality of life by managing symptoms of disease.
Ovarian cancer is usually managed with a combination of surgery and chemotherapy. The role of surgery is to make a histologic diagnosis, determine the extent of disease spread (staging) and remove as much disease as possible (debulking). The role of chemotherapy is to reverse the vascular permeability of tumour capillaries, thereby decreasing the presence of ascites and pleural effusions, and to cause cellular apoptosis of tumour cells, resulting in disease regression.
Evaluation of the patterns of care provided to patients with ovarian cancer in Ontario, Canada demonstrated a variety of specialists are involved in the delivery of surgery including gynaecologists, general surgeons and gynaecologic oncologists.[3] The delivery of chemotherapy can be provided by medical or gynaecologic oncologists. Surgery and/or chemotherapy can be delivered in low, medium or high volume centres in rural or urban settings and by teaching or non-teaching faculty.[3] This paper addresses the question of whether the context in which a woman receives care for her ovarian cancer affects her outcome.
The focus of this chapter falls within the rubric of quality of care. The Institute of Medicine has defined quality of care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”.[4] Good quality means providing patients with appropriate services in a technically competent manner, with good communication, shared decision making and cultural sensitivity.[4] Quality assurance can be defined as all those planned and systematic actions necessary to provide adequate confidence that a product or service will satisfy given requirements for quality.[5]
Donabedian originally coined the phrase quality of care.[6,7] He assessed quality of care by looking at the triad of
To demonstrate the concepts of structure, process and outcomes as ways to measure quality of care in ovarian cancer, we will review population-based studies published over the last 10 years. We have restricted our scope to population-based studies because they provide outcomes for the whole population in a region and avoid biases inherent with single institution studies (ie., related to socioeconomic status, race or comorbidities). As well, population-based studies allow us the opportunity to identify where variations in care may lead to superior outcomes for the population. If these processes and/or structures are incorporated into practice, they may lead to improved health outcomes.
A systematic search of the published English language literature from Jan 1, 2000 to Jun 29, 2012 was undertaken in order to present an unbiased view of the current population-based literature in the field of quality of care. Several key articles were identified[9-11] and MeSH terms from these references were used to create a search strategy for PubMed (Figure 1).
PubMed search strategy
The search yielded 1178 articles of which 172 were identified as potentially relevant by title and abstract. To be included the article had to include population-based data collection related to primary management of ovarian cancer. The article needed to report on structure or processes of care in relation to outcomes. Articles were excluded if they were reporting on screening for ovarian cancer, pre-cancerous or benign conditions; if they were focused solely on quality of life, biologic therapies, biomarkers and personalized medicine, survivorship or palliative care. We identified two systematic reviews of quality of care indicators.[12,13] However, in both cases the authors did not restrict their study inclusion to population-based reports, therefore these studies are not included in our analysis.
The 30 population-based studies in this review represent findings from many high-income countries, including Australia (1), Canada (3), USA (12), Austria (2), Finland (2), Germany (1), Netherlands (3), Norway (1), Switzerland (1), UK (3), and Japan (1). Twenty-five unique studies report the impact of structure on outcomes, and 13 studies report the impact of various processes on outcomes. Included are 91,866 patients.
The 5-year overall survival rate is the indicator of most interest to clinicians caring for patients with ovarian cancer. Other outcomes of interest include quality of life, patient satisfaction, and cost. However, when 5-year survival rates are so poor, surrogate outcomes, including progression-free survival (PFS), can be used to reflect small changes in outcomes that are important to patients and society. Changes in processes or structures that result in improved surrogate outcomes should eventually be reflected in improved 5-year survival rates. Surrogate outcomes in ovarian cancer include PFS and 30 or 60-day mortality.
In 25 unique population-based studies of quality of care in ovarian cancer, structural variables evaluated include a hospital’s annual ovarian cancer surgical volume, physician annual ovarian cancer surgical volume, hospital type (university affiliated vs community hospital), and physician type (gynaecologic oncologist, general gynaecologist, or general surgeon). These studies are listed in Table 1.
Studies evaluating hospital volume demonstrate hospitals with higher volumes of ovarian cancer surgery per year are often associated with better long-term survival (Table 2). The improvement in overall survival did not appear to be a reflection of peri-operative deaths, because the 30 and 60-day mortality was not affected by hospital volume in the studies evaluating those outcomes. The long-term survival advantage produced by high-volume hospitals is due to other differences in structures and processes of care in these institutions.
Studies evaluating physician volume did not demonstrate a uniform improvement in survival when high-volume physicians operated on patients with ovarian cancer (Table 3). Findings were inconclusive for both shorter and longer-term survival.
In just over half of the studies identified, hospitals classified as teaching facilities or university hospitals were associated with better short and long-term survival outcomes (Table 4). Usually these specialized facilities provide access to physicians with expertise in complicated gynaecologic oncology surgical procedures necessary for appropriate surgical management of ovarian cancer patients.
Studies evaluating physician specialization usually compare outcomes for patients operated by gynaecologic oncologists versus general gynaecologists versus general surgeons. Operation by a gynaecologic oncologist was associated in most studies with better outcomes in terms of long-term survival (Table 5). It is likely that general surgeons are more likely to perform emergency surgeries in advanced situations like bowel obstruction. However, the difference in outcomes persisted even after adjusting for prognostic factors like the Charlson comorbidity score.
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Stockton 2000[14]\n\t\t\t | \n\t\t\tUK | \n\t\t\tRetrospective database | \n\t\t\t989 | \n\t\t\tYes | \n\t\t
Olaitan 2001[15]\n\t\t\t | \n\t\t\tUK | \n\t\t\tProspective cohort | \n\t\t\t595 | \n\t\t\tn/a | \n\t\t
Carney 2002[16]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t734 | \n\t\t\tYes | \n\t\t
Elit 2002[17]\n\t\t\t | \n\t\t\tCanada | \n\t\t\tRetrospective database | \n\t\t\t3,815 | \n\t\t\tYes | \n\t\t
Grossi 2002[18]\n\t\t\t | \n\t\t\tAustralia | \n\t\t\tRetrospective database + chart review | \n\t\t\t434 | \n\t\t\tNo | \n\t\t
Kumpulainen 2002[19]\n\t\t\t | \n\t\t\tFinland | \n\t\t\tRetrospective database | \n\t\t\t3,851 | \n\t\t\tYes | \n\t\t
Cress 2003[20]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t1,088 | \n\t\t\tn/a | \n\t\t
Harlan 2003[21]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t1,167 | \n\t\t\tn/a | \n\t\t
Ioka 2004[22]\n\t\t\t | \n\t\t\tJapan | \n\t\t\tRetrospective database | \n\t\t\t2,450 | \n\t\t\tYes | \n\t\t
Diaz-Montez 2005[23]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t2,417 | \n\t\t\tn/a | \n\t\t
Bailey 2006[24]\n\t\t\t | \n\t\t\tUK | \n\t\t\tProspective cohort | \n\t\t\t361 | \n\t\t\tNo* | \n\t\t
Earle 2006[25]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t3,067 | \n\t\t\tYes | \n\t\t
Elit 2006[11]\n\t\t\t | \n\t\t\tCanada | \n\t\t\tRetrospective database | \n\t\t\t2,502 | \n\t\t\tNo | \n\t\t
Engelen 2006[26]\n\t\t\t | \n\t\t\tNetherlands | \n\t\t\tRetrospective database + chart review | \n\t\t\t632 | \n\t\t\tYes | \n\t\t
Goff 2006 and 2007[27,28]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t10,432 | \n\t\t\tn/a | \n\t\t
Kumpulainen 2006 and 2009[29,30]\n\t\t\t | \n\t\t\tFinland | \n\t\t\tProspective cohort | \n\t\t\t275 | \n\t\t\tYes | \n\t\t
Oberaigner 2006[31]\n\t\t\t | \n\t\t\tAustria | \n\t\t\tRetrospective database | \n\t\t\t911 | \n\t\t\tYes | \n\t\t
Paulsen 2006[32]\n\t\t\t | \n\t\t\tNorway | \n\t\t\tProspective registry | \n\t\t\t198 | \n\t\t\tYes | \n\t\t
Schrag 2006[33]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t2,952 | \n\t\t\tYes | \n\t\t
Elit 2008[34]\n\t\t\t | \n\t\t\tCanada | \n\t\t\tRetrospective database | \n\t\t\t1,341 | \n\t\t\tNo | \n\t\t
Bristow 2009[35]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t1,894 | \n\t\t\tYes | \n\t\t
Marth 2009[36]\n\t\t\t | \n\t\t\tAustria | \n\t\t\tProspective cohort | \n\t\t\t1,948 | \n\t\t\tYes | \n\t\t
Vernooij 2009[37]\n\t\t\t | \n\t\t\tNetherlands | \n\t\t\tRetrospective cohort | \n\t\t\t1,077 | \n\t\t\tYes | \n\t\t
Mercado 2010[38]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective cohort | \n\t\t\t31,897 | \n\t\t\tYes | \n\t\t
Rochon 2011[39]\n\t\t\t | \n\t\t\tGermany | \n\t\t\tProspective cohort | \n\t\t\t476 | \n\t\t\tNo | \n\t\t
Studies reporting on structural variables in relation to outcomes for ovarian cancer
n/a: not applicable—these studies used surrogate outcomes, *the authors of this study reported it was underpowed to find an association between structure and survival
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Overall survival | \n\t\t\t7 | \n\t\t\t3 | \n\t\t\t10 | \n\t\t
DFS | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t
30-day mortality | \n\t\t\t0 | \n\t\t\t2 | \n\t\t\t2 | \n\t\t
60-day mortality | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t
Relationship between hospital volume and patient outcomes
DFS: disease-free survival
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Survival | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t3 | \n\t\t
30-day mortality | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t3 | \n\t\t
60-day mortality | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t
Relationship between physician volume and patient outcomes
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Overall survival | \n\t\t\t4 | \n\t\t\t3 | \n\t\t\t7 | \n\t\t
30-day mortality | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t2 | \n\t\t
Relationship between hospital type and patient outcomes
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Overall survival | \n\t\t\t6 | \n\t\t\t3 | \n\t\t\t9 | \n\t\t
30-day mortality | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t2 | \n\t\t
Relationship between physician specialization and patient outcomes
Several studies have reported a link between structural variables (hospital volume, physician volume, hospital type and physician specialization) and outcomes. Population-based studies published over the past ten years identify more consistent evidence linking increased hospital volume and increased physician specialization with long-term outcomes than for other structural variables. Surgery by a gynecologic oncologist appears to provide superior outcomes in terms of long term survival. These studies pertain to the surgical management of patients with ovarian cancer. The single study looking at chemotherapy for ovarian cancer patients found no association between oncologist volume of chemotherapy and outcomes.[11] Of note, no study demonstrated worse outcomes with higher volumes or specialization of hospitals or physicians. Some jurisdictions have used these findings to implement a strategy of centralization of surgery for ovarian cancer in an effort to improve quality of surgical care and outcomes.[40,41]
There are important limitations in this data. Not all studies were able to obtain individual data to allow adjustment for every important confounding variable which can impact survival. The majority of these studies were retrospective or dependant on accurate data-entry into databases. It is possible some of the advantages observed for type or volume of provider may be due to more diligent data-entry and documentation of patient demographics, stage and treatment received. For example, teaching hospitals may have more accurate and detailed documentation of the surgical procedures provided to patients which may lead to an assumption that they provided more complete surgical care when in fact the differences were in documentation only. The use of re-operation as a surrogate outcome is questionable when discussing physician type, since more specialized physicians are typically the ones making the decision to perform a second operation and this decision is more likely to occur if the primary surgery was performed by a less specialized surgeon.
Evidence-based guidelines on the surgical care of women with ovarian cancer generally recommend hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. In early-stage disease, staging should be performed, including cytology, peritoneal biopsies, and pelvic and para-aortic lymphadenectomy. In late-stage disease, debulking should be performed, including the removal of all macroscopic tumour. This sometimes requires the use of bowel resection, splenectomy, diaphragmatic and peritoneal stripping.[42-44] Adjuvant or neoadjuvant chemotherapy with a combination of a platinum and a taxane agent has been the standard of care for epithelial ovarian cancers over the past ten years.[45] Appropriate surgery and chemotherapy have a demonstrated impact on outcomes for ovarian cancer patients and represent processes of care indicating quality.
Next we look at whether the processes evaluated in the literature are related to the four structural variables reported, and whether these impact on survival.
\n\t\t\t | \n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Adequate surgery | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t2 | \n\t\t
Optimal debulking | \n\t\t\t5 | \n\t\t\t1 | \n\t\t\t6 | \n\t\t
LND | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
Re-operation | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t2 | \n\t\t
Length of Stay | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t2 | \n\t\t
Complications | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t
Adjuvant chemotherapy | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t
Relationship between hospital volume and evidence-based processes
LND: lymph node dissection
Higher hospital volumes of ovarian cancer surgery were associated with better compliance to process steps in the optimal care of women with ovarian cancer (Table 6). These processes included: surgery according to guidelines (optimal debulking, lymph node dissection) and use of adjuvant chemotherapy.
\n\t\t\t | \n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
LND | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t2 | \n\t\t
Optimal debulking | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t
Length of stay | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t
Re-operation | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t2 | \n\t\t
Adjuvant chemotherapy | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t
Complications | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t
Length of Stay | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t
Relationship between physician volume and evidence-based processes
LND: lymph node dissection
Surgery by physicians with higher volumes of ovarian cancer surgeries was also associated with better compliance to process steps such as surgery according to guidelines and use of adjuvant chemotherapy (Table 7).
\n\t\t\t | \n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Optimal debulking | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
LND | \n\t\t\t6 | \n\t\t\t0 | \n\t\t\t6 | \n\t\t
Re-operation | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t
Adjuvant chemotherapy | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
Relationship between hospital type and evidence-based processes
LND: lymph node dissection
Type of hospital (ie. teaching versus non-teaching, academic versus community) where surgery for ovarian cancer is performed was clearly associated with more appropriate surgery and adjuvant chemotherapy in accordance with guidelines (Table 8).
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Optimal debulking | \n\t\t\t6 | \n\t\t\t0 | \n\t\t\t6 | \n\t\t
LND | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
Re-operation | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
Adjuvant chemotherapy | \n\t\t\t4 | \n\t\t\t0 | \n\t\t\t4 | \n\t\t
Relationship between physician specialization and evidence-based processes
LND: lymph node dissection
Physician specialization (ie., gynaecologic oncologist vs general gynaecologist vs general surgeon) was also associated with appropriate surgery and adjuvant chemotherapy in accordance with guidelines (Table 9).
In summary, 13 population-based studies involving 22,255 patients across 3 continents linked processes of care to improved survival. The relationship of important processes of care with survival is so clear that this work that has led to defining quality indicators for the treatment of ovarian cancer care. In Ontario, Canada, Gagliardi and colleagues[40] used the Delphi technique to define quality indicators. More recently, Verleye and the EORTC has defined and set surgical benchmarks for quality care in ovarian cancer (Table 11., Appendix).[46]
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t|
\n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | Surgery | \n\t\t\tChemo | \n\t\t
Bailey 2006[24]\n\t\t\t | \n\t\t\tUK | \n\t\t\tProspective cohort | \n\t\t\t361 | \n\t\t\tX | \n\t\t\t\n\t\t |
Chan 2008[47]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t8,372 | \n\t\t\tX | \n\t\t\t\n\t\t |
Elit 2006[11]\n\t\t\t | \n\t\t\tCanada | \n\t\t\tRetrospective database | \n\t\t\t2,502 | \n\t\t\tX | \n\t\t\tX | \n\t\t
Elit 2008[34]\n\t\t\t | \n\t\t\tCanada | \n\t\t\tRetrospective database | \n\t\t\t1,341 | \n\t\t\tX \n\t\t\t | \n\t\t\tX | \n\t\t
Engelen 2006[26]\n\t\t\t | \n\t\t\tNetherlands | \n\t\t\tRetrospective database + chart review | \n\t\t\t632 | \n\t\t\tX | \n\t\t\t\n\t\t |
Fairfield 2010[48]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t4,589 | \n\t\t\tX | \n\t\t\t\n\t\t |
Grossi 2002[18]\n\t\t\t | \n\t\t\tAustralia | \n\t\t\tRetrospective database + chart review | \n\t\t\t434 | \n\t\t\tX | \n\t\t\t\n\t\t |
Hershman 2004[49]\n\t\t\t | \n\t\t\tUSA | \n\t\t\tRetrospective database | \n\t\t\t236 | \n\t\t\t\n\t\t\t | X | \n\t\t
Maas 2005[50]\n\t\t\t | \n\t\t\tNetherlands | \n\t\t\tRetrospective database | \n\t\t\t1,116 | \n\t\t\tX | \n\t\t\tX | \n\t\t
Marth 2009[36]\n\t\t\t | \n\t\t\tAustria | \n\t\t\tProspective cohort | \n\t\t\t1,948 | \n\t\t\tX | \n\t\t\t\n\t\t |
Paulsen 2006[32]\n\t\t\t | \n\t\t\tNorway | \n\t\t\tProspective registry | \n\t\t\t198 | \n\t\t\tX | \n\t\t\tX | \n\t\t
Petignat 2007[51]\n\t\t\t | \n\t\t\tSwitzerland | \n\t\t\tRetrospective database | \n\t\t\t50 | \n\t\t\tX | \n\t\t\t\n\t\t |
Rochon 2011[39,52]\n\t\t\t | \n\t\t\tGermany | \n\t\t\tRetrospective database | \n\t\t\t476 | \n\t\t\tX | \n\t\t\tX | \n\t\t
Studies reporting on process variables in relation to outcomes in ovarian cancer
There are many processes considered by experts to be important in the care of women with ovarian cancer. These process variables have face validity but have not yet been clearly evaluated for their impact on outcomes in ovarian cancer. Additionally, the organizational structure for care provision is a complex construct; it is unclear what components contribute most positively to outcomes. We wish to focus on three variables that may or may not be related to survival but may impact treatment and decision making.
When making a diagnosis of ovarian cancer, the histology may be assessed by a pathologist, a pathologist with interest and experience in gynaecologic malignancies, or a subspecialist gynaecologic pathologist. Heatley[53] defines a pathologist as someone who has completed training and passed the appropriate examinations. A pathologist with a special interest (PSI) is a general pathologist who takes the lead in a subspecialty area within their department such as gynaecological pathology, attending meetings of specialist societies, participating in the appropriate subspecialist external quality assurance scheme, providing specialist opinions for colleagues in the department, and on occasion, neighbouring departments. A subspecialist pathologist is a pathologist with a special interest but who now, possibly after a period working as a general pathologist, devotes all or the vast majority of their time to one area of practice.[53] Subspecialisation leads to standardisation of pathology reports and improved communication of findings, participation in multidisciplinary tumour board meetings, enhanced knowledge and standards, decreased turnaround times, quality assurance of diagnoses, improved quality of resident training, ability to distinguish appropriate variation from the standard of care, and advancement of academic knowledge through participation in research.[54]
In gynaecologic oncology, there are several studies reporting up to a 16.9% discrepancy with the referral diagnosis when a PSI or a subspecialist gynaecologic pathologist provides a review of the original pathology.[55] In 4.7% -12% of cases there is a change in diagnosis which has a major therapeutic or prognostic implication.[55-58] Although these findings were from studies including all gynaecologic malignancies rather than ovarian cancer specifically, they demonstrate subspecialist pathology review has an important role to play in the care of patients with ovarian cancer. Verleye and colleagues[59] found that pathology reports for ovarian cancer surgery originating from high-volume centres and academic hospitals are of higher quality than those originating from lower volume or non-academic centres. The availability of subspecialist gynaecologic pathologists may be one structural aspect of care in these centres leading to better outcomes. The impact of expert pathology review in ovarian cancer needs to be evaluated as a process step that could impact survival.
Multidisciplinary care is an integrated team-based approach to cancer care where medical and allied health care professionals consider all relevant treatment options and collaboratively develop an individual treatment and care plan for each patient. Evidence in oncology suggests that multidisciplinary care leads to improved survival and quality of life, satisfaction with treatment, and mental well-being of clinicians.[60] An important component of multidisciplinary care is availability of regularly scheduled tumour board meetings[61] with participation of gynaecologic oncologists, pathologists, radiologists, radiation and medical oncologists, and allied health professionals with a special interest in care of gynaecologic oncology patients. Tumour board conferencing in Auckland City Hospital from 2005-2006 led to a 5.9% rate of major changes in patient management.[62] This resulted from radiologic review (major discrepancy rate 1.4%) and pathology review (major discrepancy rate of 4.5%) which led to identification of major diagnostic discrepancies. However, they could not quantify how the changes in diagnosis and management might impact patient outcomes. Santoso did a comparison of the initial gynecologic cancer diagnosis and management plan to the diagnosis and management plan after discussion at a multidisciplinary tumor board meeting. They showed that 6.9% of cases discussed at tumor board had changes made to the diagnosis or plan, and in 5% there were major changes in treatment.[63] The most convincing research suggesting care by a multidisciplinary team is a process that improves outcomes was published by Junor and colleagues using population-based data from Scotland. In a retrospective analysis of all 533 cases of ovarian cancer diagnosed in Scotland in 1987, referral to a multidisciplinary team was one of five factors significantly associated with improved 5 yr survival after adjusting for patient and disease characteristics (hazard ratio 0.60, p<0.001).[64]
Several studies have identified clinical trial participation as an institutional marker of quality care. In 1994, Stiller published a review of several cancer disease sites and found that across disease sites, patients treated as part of a clinical trial had better outcomes.[65] du Bois and colleagues evaluated outcomes in a population-based cohort of patients diagnosed with ovarian cancer in Germany in 2001.[52] After adjusting for disease stage, patients treated in an institution participating in multi-centre clinical trials had improved overall survival (35 months vs 25 months for patients with stage III-IV ovarian cancer treated at participating vs non-participating hospitals).[39,52] Notably, patients treated in participating hospitals had better outcomes even if they were not themselves participating in a trial. Patients treated in hospitals participating in trials were more likely to receive care in accordance with clinical practice guidelines including staging, debulking and combination chemotherapy where appropriate.[39] Trial participation at an individual patient level may indicate good performance status that can, in and of itself, lead to better outcomes. However, it appears all patients treated at hospitals participating in trials may benefit from improved outcomes. This is likely due to differences in processes of care at these institutions.
When geographic variation in outcomes exist at a population level, there are opportunities to assess whether changes in structures or processes of care could improve outcomes. There have been several strategies to improve outcome. One is to standardize care using evidence-based guidelines and techniques to optimize processes like a structured care path, whether in a paper chart or as part of an electronic medical record. Another approach to try to improve outcomes at a population level has been to centralize care. In some situations where care requires an experienced surgical team and highly developed perio-operative care, such as for the surgical management of pancreatic cancer, there is evidence that centralization of care to high-volume centres decreases 30-mortality.[66] However, not all reports are consistent with this finding.[67] Another strategy to improve outcomes is to focus on improving processes by the involvement of highly regarded opinion leaders providing education. More consistent improvement in processes of care has been noted using the audit and feedback system.[68] These approaches have been variously referred to as quality assessment, quality management quality improvement and knowledge translation. In this paper, we refer to quality assessment as the audit process whereby performance is measured and compared with a reference standard. Quality improvement includes the steps taken to actively change practice to improve adherence to processes and to improve outcomes.
Quality assurance and monitoring of outcomes is essential to allow for quality improvement initiatives. Regions, hospitals, and care providers must understand which outcomes are not reaching a targeted standard in order to identify structures and processes which may improve outcomes. Initiatives such as the International Cancer Benchmarking Partnership[69] have used population-based registry data to identify significant discrepancies in survival for women with ovarian cancer based on geographic location. Striking differences were observed, with women in Australia and Canada having significantly longer survival than women in the UK and Denmark after adjusting for stage.[70]
Measuring the quality of surgical procedures has lagged behind quality-assurance initiatives in other areas because of the difficulty in identifying parameters to evaluate.[71] Early studies suggested operative morbidity and mortality, adequacy of resection, local recurrence and survival as parameters to measure surgical quality.[71] However several of these factors are also highly influenced by the use of appropriate adjuvant therapy. Several programs have now begun systematically tracking outcomes for surgical oncology patients in an effort to identify areas where quality improvement measures should be implemented.
One such program is the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP).[72] This is a nationally validated, multi-specialty, risk-adjusted 30-day outcomes measurement program which originated in the Veterans Health Administration in 1991. Since 2004, NSQIP has been expanding and now includes more than 400 hospitals in the US, Canada, Lebanon and the UAE. The aim of the program is to provide institutions and surgeons with 30-day outcomes which can be used to compare performance to other institutions. Risk adjustment incorporates pre-operative comorbidities and intra-operative risk factors using hierarchical modelling. Twice per year, institutions are given a report with their risk-adjusted outcomes in the form of odds ratios, which can be used for bench-marking. After implementation of NSQIP in 10 Tennessee hospitals, significantly fewer surgical site infections, failed grafts and flaps, episodes of acute renal failure, and prolonged ventilation of more than 48 hours was achieved.[73] The ACS evaluated outcomes across all participating institutions from 2005 to 2007 and found 66% of hospitals showed improvement in 30-day mortality and 82% of hospitals achieved a reduction in complications after enrollment in the NSQIP program.[74] These improvements also led to significant cost savings. The remarkable success of this program will likely lead to further expansion.
Quality improvement naturally follows from quality assessment. Review of performance in terms of adherence to best-practices (processes of care) in a methodologically rigorous and transparent manner (quality assessment) can lead to improvement in outcomes if interventions are undertaken to improve areas of weakness in performance. Interventions based on quality assurance data attempt to improve processes of care in order to improve outcomes. A framework for quality improvement could include the following steps:[75]
Debate and select values and goals that will inform the effort
Select a clinical area requiring improvement
Select team members
Select relevant quality markers for improvement
Collect data for selected markers
Select and operationalize interventions to achieve improvements in markers
Re-evaluate, modify and repeat the steps
The American Society of Clinical Oncology (ASCO) initiated the Quality Oncology Practice Initiative (QOPI)[76] for US-based Hematology-Oncology practices in order to improve quality of cancer care by using measurement and feedback and by providing improvement tools. Processes of care indicative of quality were identified by a group of oncologists using consensus and clinical practice guidelines.[77] QOPI provides individual care providers with quality of care benchmarking information twice per year, allowing clinicians to make improvements within their own practices. Implementation of QOPI and sharing results with physicians at one academic oncology centre in the US led to significant improvements in several areas of quality.[78] Although this program is only available to medical oncology practices in the US, it serves as a good example of how measurement and feedback can lead to improvement in quality of care.
A quality management program was implemented in one German academic oncology centre in 2001 with the aim of improving the quality of surgery provided to patients with ovarian cancer.[79] The components of the quality management system included establishment of a prospective tumour registry, creation and training of dedicated surgical teams operating on patients with advanced ovarian cancer, inter-disciplinary surgical care, intra-operative second opinion by another gynecologic oncologist if the first surgeon did not believe debulking to microscopic residual disease was attainable, interdisciplinary management of complications, and quality conferences including assessment and benchmarking of morbidity and survival outcomes. This effort, along with a significant increase in the volume of ovarian cancer surgery performed at this centre over time, led to a significant improvement in processes and outcomes. Debulking to microscopic residual disease increased from 33% in 1997-2000, and 47% in 2001-2003, to 62% in 2004-2008. This led to median survival of 26 months for patients treated in 1997-2000, 37 months in 2000-2003 and to 45 months in 2004-2008 and 5-year survival in 24%, 34% and 36% of patients in the three time periods. Changes in both structures and processes of care were achieved using this quality management system, leading to improved survival for patients.[79]
A quality improvement program for the surgical care of patients with advanced ovarian cancer was implemented at the Mayo Clinic using an audit and feedback approach, with the aim of increasing the proportion of patients debulked to microscopic residual disease.[44] A surgical complexity score was developed to categorize the aggressiveness of the surgical approach.[80] The quality improvement program consisted of weekly conferences where patient outcomes and treatment approaches were discussed, confidential benchmarking allowing individual surgeons to see their rates of complete surgical debulking in comparison to peers, teaching fellows and staff how to perform techniques needed for complete debulking, and intra-operative mentoring of staff and fellows by surgeons experienced in advanced procedures. After the quality improvement program was implemented, rates of debulking to microscopic disease increased from 31% to 43%.
Knowledge translation is the science of moving knowledge into action.[81] Several studies across various disciplines in medicine have demonstrated many patients do not receive care known to improve outcomes.[81,82] One of the first groups to show this in ovarian cancer was Munstedt and colleagues who found a large proportion of patients treated in Hesse, Germany between 1997 and 2001 did not receive care recommended in national guidelines.[83] Knowledge translation aims to bridge the gap between what is known from research, and implementation of this knowledge in an effort to improve outcomes for patients and efficiency for the health care system.[81]
Knowledge translation has been described as a cycle, where a clinical problem is identified (possibly by quality assurance or monitoring efforts), processes of care are identified from research to address the problem, these processes are adapted to the local context and any barriers to implementation are identified and addressed, and the new processes are implemented. After implementation, adherence to the process is monitored, and final patient outcomes are evaluated.[81] Evaluation of outcomes and monitoring of processes may then identify additional clinical problems. If no evidence-based solution to the problem is identified, this leads to a need for additional research. In this way, new research informs clinical practice, and problems from clinical practice help to identify research priorities.[82]
A major focus of knowledge translation research is finding ways to change clinician and patient behaviour given the results of research. Simply publishing new findings in peer-reviewed journals, a method termed ‘diffusion’, is not adequate for wide-spread adoption of new processes.[84] Other methods that have been investigated include audit and feedback,[85] educational outreach by local opinion leaders,[86] and clinical decision support and reminder systems which can be integrated into computer-based patient-care platforms.[87] Audit and feedback, such as the ACS NSQIP or ASCO QOPI programs, are one of the most effective methods for behaviour change in clinicians.[68,88] An excellent overview of these methods has been published by Brouwers and colleagues, who performed a review of systematic reviews on knowledge translation interventions used in cancer control.[68] The science of knowledge translation is relatively new. As research methods continue to improve, strategies are expected to be refined.
Flow diagram for study selection
Women with ovarian cancer should be treated in institutions providing high quality care. Quality of care can be evaluated by examining the processes and structures of care leading to improved outcomes such as survival and quality of life.
In the US, there is a trend to link reimbursement for hospitals and care providers to clinical outcomes in an effort to improve quality of care.[72] Because of financial pressures in the health care system, this trend is expected to continue, since improvement in several metrics used to identify quality surgical care (such as decreased surgical site infections) can save a significant amount of money. Whether health systems are achieving value for money can only be assessed if performance is measured in a systematic way. Tracking outcomes with the use of population-based registries is an essential component of quality assurance, which allows for comparison of outcomes across jurisdictions.[71] Identifying variations in outcomes can then trigger specific quality improvement initiatives. Knowledge translation is the science of moving knowledge into action, and encompasses both quality assurance and quality improvement. The concepts underlying quality of care are essential information for health care providers caring for women with ovarian cancer given the current global focus on outcomes and value for money in health care systems.
Early-stage epithelial ovarian cancer | \n\t\t\t-Percent of patients with a suspicious ovarian mass undergoing staging laparotomy within 1 month after decision to treat or documented clinical or patient-related reason for delay -Percent of performed staging laparotomies for an ovarian mass suspected to be malignant performed through a vertical incision | \n\t\t
\n\t\t\t | Percent of performed staging laparotomies in which all of the following procedures are included: total hysterectomy, bilateral salpingo-oophorectomy, cytology of the peritoneal cavity, infracolic omentectomy, random peritoneal biopsies and systematic pelvic and para-aortic lymphadenectomy if medium or high risk features | \n\t\t
\n\t\t\t | Percent of surgery reports with documented presence or absence of cyst rupture before or during surgery | \n\t\t
\n\t\t\t | Percent of surgery reports with documented presence or absence of dense adhesions, percent of dense adhesions biopsied | \n\t\t
Primary debulking surgery in advanced-stage epithelial ovarian cancer | \n\t\t\tPercent of patients with advanced-stage ovarian cancer undergoing debulking laparotomy within 31 days after decision to treat or documented clinical or patient-related reason for delay | \n\t\t
\n\t\t\t | Percent of patients undergoing debulking surgery with the spread of disease fully assessed for operability at the start of study and initial findings documented in the operation notes | \n\t\t
\n\t\t\t | Percent of debulking operations including a hysterectomy, bilateral salpingo-oophorectomy and infracolic omentectomy when the surgeon considers optimal debulking feasible | \n\t\t
\n\t\t\t | Percent of debulking operations for advanced ovarian cancer at the end of which complete cytoreduction, defined as no macroscopic residual disease at the end of the operation, was achieved | \n\t\t
\n\t\t\t | Percent of debulking operations including a pelvic and para-aortic lymphadenectomy when otherwise complete debulking has been achieved | \n\t\t
\n\t\t\t | percent of debulking operations for which the size and location of residual disease at the end of the operation is documented in the operation notes | \n\t\t
EORTC benchmarks for quality surgical care in ovarian cancer[46]
The United Nations have ratified 17 goals of sustainable development, of which responsible consumption and production is directly, while economy, innovative industry, infrastructure, and climate action are indirectly related to circular economy and the need of sustainable production [1]. Sustainability in the processing industries can be applied along the main value chain, e.g. from metal extraction to metal recycling, but can also be applied to the associated waste materials. Copper and iron mining alone are estimated to generate yearly about 5 bn tons of tailings [2], i.e. the fraction of the processed ore, after extraction of the valuable minerals. Finding a way to successfully reuse vast amount of this material and other waste sources is a great step towards circular economy.
While recycling an initial waste or side-stream, the material can be upcycled, meaning the newly derived product is of higher intrinsic value and properties or downcycled, where the new material has lower value. A prominent example for downcycling is the reuse of plastic bottles as fleece and carpet material. The material has less intrinsic value, because the carbon chains of the plastic polymer are shortened. Geopolymerization of industrial side streams is an upcycling process, as the geopolymer (GP), utilized as concrete and binder, has a higher value than the initial industrial by-products. To obtain upcycling, energy is put into the system, however, since tailings have usually been milled, the material has already undergone energy intensive steps and can therefore readily be used as starting blocks for geopolymerization. Utilizing tailings for upcycling into GPs, is therefore beneficially in terms of waste management, process energy, and emission of greenhouse gases, as the energy used in the beneficiation process is passed onwards into the geopolymerization process. Upcycling often requires further energy sources to achieve higher valuable material. In geopolymeration or alkaline activation this means the addition of chemicals, and in some occasions, such as analcime tailings, the addition of thermal energy [3].
In this chapter the valorization of high volume, inorganic side streams from mining, chemical industries, steel processing, and waste incineration into new adsorbents useable for water treatment is discussed. The purpose is to show how the material undergoes value change from side stream to potentially highly functional material.
As every tailing and every ash has a different chemical and mineral composition, tailoring of the properties of resulting adsorbents is possible by careful choosing of precursor materials. Aluminosilicates form the backbone of the geopolymer structure, but ion exchange, channel size, and physical properties are affected by the minerals used for geopolymerization [4, 5, 6]. Lastly, by controlling of the geopolymerization conditions, also the macroscopic structures can be developed by using various manufacturing methods from foaming to granulation.
The ultimate goal of using GPs/AAMs in water purification is to be able to recover valuable materials such as nutrients or battery chemical metals from contaminant-rich wastewater streams. In other words, the target is to use one industrial side stream to recovery of valuable material from another side stream or waste water in order to multiply circular economy potential.
This section summarizes different types of aluminosilicate precursors, occuring naturally or derived from industrial processes. Materials, which are currently abundant and/or urgent to dispose of, fall within the ambit of the section, but cover only water treatment applications not geopolymer production for construction industry, e.g. substitutes for Portland cement or as tailings’ covering.
The composition of FA varies widely as it is derived initially from various primary sources: municipal waste/sludge co-incineration, different coal types, or subspecialized byproducts from industrial treatment plant (paper, forestry industry or agriculture). The combustion and cooling processes have profound impact on the characteristics of FA (particles size, shape, surface area, uniformity, etc.) as well as its composition and impurities’ inclusion.
Mainly, ASTM C 618 specification is applied to indicate the class of FA used for geopolymer preparation; however, a local/field or an unspecified labelling is also common. Coal FA (class F [8, 9] and C [10]) has been extensively considered as an aluminosilicate source for GP production, while the exploitation of biomass and co-incinerated FAs is less common [11, 12]. On the other hand, the utilization of these FAs particularly in the GP production for water treatment sector might be also beneficial. It would reduce the FA accumulation in landfills, and improve adsorbents’ LCA in comparison with metakaolin-based GPs.
Although FAs were studied as adsorptive materials previously [7, 13, 14], concerns on potential toxicity of impurities and convenience of use have encouraged to seek more suitable forms of FA-based materials for water treatment sector.
Pre-treatment of FAs and IBAs with various chemicals were suggested in order to reduce their toxicity and to meet the environment requirements of pristine materials or/and GPs/AAMs based on them [14, 25, 26, 27].
The accumulation of BOFS has become a significant issue due to its generation in large quantity, high disposal costs, and unsuitableness in cement industry due to high iron oxide content. Sarkar et al. adopted BOFS as a raw material for obtaining of GPs and investigated Ni2+ [39], Zn2+ [40], and F− [41] removal. BOFS was used by Sithole et al. as a precursor for AAM preparation [42, 43]. In order to achieve highly porous structures for percolation column tests, a foaming agent (hydrogen peroxide) was added.
Recently, much attention has also been paid on how zeolite could be synthesized from low-cost materials [70]. GP-zeolite composites and zeolite-like GPs are two different categories of adsorptive materials, which have recently attracted increased interest [71]. GP-zeolite composites are hybrid materials, unite the advantages of both constituents. The GP here serves as a durable support, while the zeolite provides a high surface area, porosity, and adsorption capacity. For instance, metakaolinite–zeolitic tuff GPs have been proposed in [72]. The report clearly showed the beneficial influence of the zeolitic tuff addition into a starting mixture on the microstructure and the adsorption potential of GPs. Andrejkovičová et al. [4] prepared metakaolin-based GPs blended with by 25, 50 and 75% of Nižný Hrabovec zeolite. It was shown that the zeolite particles are responsible for the higher amount of crystalline phases, producing a more compact and firm microstructure of blended GPs. The amount of blender has significant influence on the order of adsorbed metals and on the adsorption capacities of the formulations. Hayashi et al. [63] incorporated clinoptilolite into GPs though sol–gel protocol in order to further use of the resulting coatings for heavy metal ion adsorption.
It should be noted that zeolitic phase could be incorporated into GPs’ structures not only externally. Zeolite-like crystalline phases could be derived from synthesis routes through fusion method or even at moderate temperatures leading to zeolite-like GP structures. Javadian et al. [64] converted FA into a mesoporous aluminosilicate adsorbent through a fusion method at 600°C. Deng et al. showed that a hydrothermal synthesis of zeolite-like materials from IBA with higher crystallinity than through a fusion method is possible [73]. Similarly, Visa [74] converted FA into zeolite through a hydrothermal process. Rios et al. synthesized zeolite-like GPs from metakaoline at 100°C through the hydrothermal procedure [75]. Studies reported indicate that such materials have higher surface area and porosity than GPs/AAMs obtained through simple alkaline activation. Although the ultimate set of preferable conditions to form a GP instead of a zeolite are still under discussion, ratios Si:Al > 1.5 have been empirically established as providing more amorphous structures [60].
Not infrequently, industrial side streams cannot be used alone for geopolymerisation due to disharmonious Si/Al molar ratios. Therefore, by-products are commonly used as mixtures of aluminosilicate sources [76]. Table 1 summarizes the studies on different compositions of GPs/AAM that have been proposed for water and wastewater treatment applications. An afford was made to collect and match the precursors, synthetic protocol specificity, and distinctive characteristics resulting materials.
GP/AAM | Precursor/additives | Preparation method, prime oxide ratios | Surface Area/Pore Volume/Pore size | Type/form of GP | Ref. |
---|---|---|---|---|---|
MK-GP with TiO2 | MK | HT | 27.21 m2/g 0.207cm3/g 2.19 nm | Bulk | [77] |
MK-GP | MK | SSM | 53.95 m2/g 0.061 mL/g 5.38 nm | Porous/Spheres, 2–4 mm | [78] |
MK-GP | MK | AA Si/Al = 1.7 | ̶ | Bulk | [79] |
MK/Z-GP | MK Zeolitic tuff | AA SiO2/Al2O3 = 1 | ̶ | Bulk/Discs | [72] |
MK-GP | MK | AA Si/Al = | 12.21 m2/g 0.037cm3/g | Bulk | [80] |
MK-GP | MK SDS 0.06 wt% | SSM SiO2/Al2O3 = 1.6 | 53.95 m2/g 1.29 cm3/g 15 nm | Porous/spheres 2–4 mm | [81] |
MK/FA-GP | 2/3 MK 1/3 bioFA (w/w) | AA SiO2/Al2O3 H2O2 | ̶ | Porous/Monolith | [11] |
MK-GP | MK | AA foaming, SiO2/Al2O3 = 5 | ̶ | Foam/Powder <100 μm | [82] |
MK-GP/alginate hybrid | MK sodium alginate | AA + SSM SiO2/Al2O3 = 1.6 | 16.2 m2/g 0.05 mL/g 11.5 nm | Bulk/Spheres 2–4 mm | [83] |
MK-GP | MK | AA SiO2/Al2O3 = 3.2 | 39.24 m2/g | Bulk/Powder 150 μm | [84] |
MK-GP functionalized with CTAB | MK silica fume | AA CTAB | 216 m2/g 0.22 cm3/g | Bulk/rubbles, 1.5 mm | [85] |
MK/FA-GP | MK:FA 2:1 wt | AA | 7.9 m2/g | Porous/discs | [86] |
MK-GP | waste MK | AA SiO2/Al2O3 = 1.5 | ̶ | Bulk/Powder, granules | [59] |
MK-GP | MK | AA SiO2/Al2O3 = 3.2 | 39.24 m2/g | Bulk/Powder, 150 μm | [87] |
MK-GP activated with hull ash | MK BioFA TiO2 | SSM SiO2/Al2O3 = 3.18* | ̶ | Porous/Spheres 2–3 mm | [88] |
MK/FA-GP | MK:FA 50:50 wt% | SSM SDS | ̶ | Foam/ Spheres | [89] |
MK-GP/alginate-chitosan hybrid | MK alginate/chitosan | SSM AA 0.5 wt% H2O2, 1.5 wt% SDS | 230 m2/g 0.99 mL/g 35 μm | Porous/Spheres | [90] |
MK/FA-GP | MK FA class C 60:40 wt% | AA SiO2/Al2O3 = 2.7 | ̶ | Bulk/Powder 63–125 μm | [91] |
MK/BFS-GP | MK BFS 60:40 wt% | AA SiO2/Al2O3 = 3.1 | ̶ | Bulk/Powder 63–125 μm | [91] |
MK-GP | MK | AA SiO2/Al2O3 = 2.31** | ̶ | Bulk/Powder, 200 μm | [92] |
MK-GP/ coal gangue hybrid | MK gangue 50/50 wt% | AA SiO2/Al2O3 = 4.0 | 26.41 m2/g 0.330 cm3/g | Bulk | [93] |
MK-GP | MK | AA SiO2/Al2O3 = 2–8 | ̶ | Bulk/Pervious | [94] |
MK-GP | Waste MK Aluminum scrap recycling waste 1:1 (w/w) | AA SiO2/Al2O3 = 1.25** | 15.95 m2/g | Bulk/Granules 4–11.2 mm | [95] |
MK-GP | MK | AA | 8.16 m2/g 0.021 cm3/g 10.5 nm | Bulk/ Granules 0.5 mm | [96] |
MK-GP functionalized with HDTMABr | MK | AA HDTMABr | ̶ | Bulk/Powder, 53 μm | [97] |
MK-GP MK/aloxid ANA-GP ANA/aloxid-GP | MK analcime aluminum oxide | AA** MK-GP SiO2/Al2O3 = 3.96 MK/aloxid GP SiO2/Al2O3 = 2.13 ANA-GP SiO2/Al2O3 = 7.01 ANA/aloxid-GP SiO2/Al2O3 = 3.60 | MK-GP 19.97 m2/g 0.131 cm3/g 26.24 nm MK/aloxid GP 6.36 m2/g 0.036 cm3/g 23.18 nm ANA-GP 0.69 m2/g 0.003 cm3/g 21.69 nm ANA/aloxid-GP 38.29 m2/g 0.125 cm3/g 13.07 nm | Bulk/Powder, 63–125 μm | [50] |
MK/Z-GP | 25% MK 75% zeolite | AA SiO2/Al2O3 = 1 | 57.5 m2/g | Bulk | [4] |
MK-GP functionalized CTAB | Calcinated halloysite clay | Precipitation SiO2/Al2O3 = 2.91 CTAB/Cu2O/TiO2 | 34.8 m2/g 29.7 nm | Bulk | [98] |
MK-GP functionalized with CTAB | MK | AA CTAB | 26.45 m2/g 0.121 cm3/g 9.12 nm | Bulk/Powder, 125 μm | [99] |
MK-GP, magnetic hybride | MK Magnetite 5 wt% | AA SiO2/Al2O3 = 4.55* H2O2 | 19.5 m2/g 0.045cm3/g 10.4 nm | Porous | [100] |
MK/Silica-GP functionalized with Cr | MK silica fume 9:1 (w/w) | AA SiO2/Al2O3 = 1.90** | 30 nm | Bulk/Membrane | [101] |
MK-GP | MK | AA SiO2/Al2O3 = 2.14** | ̶ | Bulk/Powder, 355 μm | [102] |
MK/FA-GP | MK FA | AA SiO2/Al2O3 = 2.45** | 27 m2/g | Bulk/rubbl 1.0–0.3 mm | [103] |
MK-GP | MK | AA SiO2/Al2O3 = 4.0 | 21 m2/g 1252 mm3/g 0.32 μm | Bulk/Granules, 3 mm | [104] |
MK-GP alginate hybrid | MK sodium alginate TiO2 | SSM SiO2:Al2O3 = 4 | 20 m2/g 714 mm3/g 0.11 μm | Bulk/Spheres, 2 mm | [105] |
MK-GP/ magnetic hybrid | MK | AA SiO2/Al2O3 = 4.55 H2O2 | 42.92 m2/g 0.052cm3/g 4.88 nm | Porous | [106] |
MK-GP/LECA | MK LECA support | AA SiO2/Al2O3 = 1.5 | ̶ | Bulk/Granules, 4–8 mm | [107] |
MK/Biochar-GP | MK Biochar | AA H2O2 | 37.46 m2/g | Foam/membrane | [108] |
MK-GP functionalized with K4Fe(CN)6 | MK | AA SiO2/Al2O3 = 3.60 H2O2 | 35 m2/g 55 cm3/g | Foam | [109] |
MK-GP/graphene oxide hybrid | MK graphene oxide 10 wt% | AA SiO2/Al2O3 = 0.45 | ̶ | Bulk/ Particles, < 0.5 mm | [110] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 2.03 | ̶ | Bulk | [111] |
FA-GP | Fly ash, 75 μm | FM SiO2/Al2O3 = 1.98* | 8.22 m2/g 2.9 nm | Bulk/Powder | [64] |
FA-GP Iron-enriched | Calcinated FA, < 70 μm | FM SiO2/Al2O3 = 1.00 Fe2O3/Al2O3 = 0.151 | ̶ | Bulk | [112] |
FA-GP modified with iron | Coal fly ash | AA SiO2/Al2O3 = 1.43* | 162.38 m2/g 0.126 cm3/g 3.90 nm | Bulk/Powder | [113] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 4.61 | ̶ | Bulk/Powder, 71–90 μm | [9] |
FA/IOT -GP | Fly ash IOT 70:30 (w/w) | AA H2O2 | 6 nm - 360 μm | Porous/Cubes | [54] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 1.12** | 20.48 m2/g 19.62 nm 0.070 cm3/g | Bulk/Powder, 74 μm | [114] |
FA/Z-GP | Fly ash Fajustite | HT SiO2/Al2O3 = 0.69** | 174.35 m2/g 0.14 cm3/g 9.69 nm | Bulk/Powder, 74 μm | [114] |
FA-GP | Fly ash C | AA SiO2/Al2O3 = 3 | ̶ | Bulk/Powder | [115] |
FA-GP/LECA | Fly ash C LECA support | AA SiO2/Al2O3 = 1.5 | ̶ | Bulk/Granules, 4–8 mm | [107] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 5.36 | ̶ | Bulk/Powder, 71–90 μm | [116] |
FA-GP | Fly ash | HT | ̶ | Bulk | [117] |
FA/Z-GP | Fly ash BFS 4:1 (w/w) | HT SiO2/Al2O3 = 3.49* | ̶ | Bulk/Powder | [118] |
Fly ash/ iron oxide hybrid | Fly ash Fe2O3 5 wt% | AA SiO2/Al2O3 = 3.30** | 60.75 m2/g | Bulk/Powder, 50 μm | [119] |
FA-GP/Graphene hybrid | Fly ash graphene (1 wt%) | AA SiO2/Al2O3 = 3.41** | 20.41 m2/g 0.047 mL/g 9.73 nm | Bulk | [120] |
FA/BFS-GP | Fly ash BFS | HT SiO2/Al2O3 = 3.23* | 76.6 m2/g 0.24 cm3/g 12.5 nm | Bulk | [35] |
FA-GP | Boiler fly ash < 80 mesh | HT SiO2/Al2O3 = 2.75** | 27.51 m2/g 0.032 mL/g | Bulk | [121] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 3 | 29 m2/g 0.134 cm3/g | Bulk/Powder, < 74 μm | [122] |
FA-GP/Polyethersulfone hybrid | Fly ash | AA SiO2/Al2O3 = 3.05 | 168.3 m2/g | Bulk/Powder, 150 μm | [123] |
FA/Z-GP | Calcinated fly ash | SiO2/Al2O3 = 1.61** | ̶ | Bulk/Powder | [124] |
FA-GP | Fly ash | AA | 131.4 m2/g | Bulk/Powder, <105 μm | [125] |
FA-GP | Coal Fly ash | FM SiO2/Al2O3 = 1.25* | 93.8 m2/g 0.62 cm3/g | Bulk | [8] |
FA-GP | Fly ash silica | AA Si/Al = 2.2 | 31.87 m2/g 0.12 cm3/g 15.45 nm | Bulk/Powder, 125–212 μm | [126] |
FA-GP | Fly ash F, ≤ 177 μm | AA SiO2/Al2O3 = 2.97** | 30 m2/g 0.076 cm3g | Bulk | [127] |
FA/analcime-GP | Fly ash analcime | AA SiO2/Al2O3 = 2.10** | ̶ | Bulk/Membrane | [128] |
FA-GP | Fly ash | AA SiO2/Al2O3 = 5.42 | 35.97 m2/g 124 cm3/kg 9 nm | Bulk/Powder, 150 μm | [31] |
FA-GP | Rice husk ash, waste alum cans | HT SiO2/Al2O3 = 1.82* | 36.15 m2/g 0.097 mL/g 5.4 nm | Bulk | [129] |
FA-GP | Fly ash class C and F | AA SiO2/Al2O3 = 6.6** (class C) SiO2/Al2O3 = 10.9** (class F) | 2463.64 mm2/g | ̶ | [130] |
FA/MK-GP | bioFA MK 70:30 (w/w) | AA aluminum powder, anionic surfactant | 46.3 m2/g | Foam/Membrane | [131] |
IBA-GP/Graphene hybrid | Bottom ash graphene | AA 0.15 wt% Mn2+ 19.5 wt% CuO | 29.28 m2/g 0.1078 mL/g 14.77 nm | Bulk/ Particles, 0.180–0.315 mm | [132] |
BFS –GP | BFS | AA SiO2/Al2O3 = 4.40* | 64.5 m2/g 0.095 cm3/g 5.93 nm | Bulk/Powder, 63–125 μm | [32] |
BFS –GP | BFS | AA SiO2/Al2O3 = 3.2 | ̶ | Bulk/Powder, 63–125 μm | [115] |
BFS –GP/graphene hybrid | BFS graphene 0.01 wt% | AA SiO2/Al2O3 = 2.61* | 146.17 m2/g 0.161 mL/g 4.40 nm | Bulk/Powder, 250-315 μm | [133] |
BFS –GP/barium modified | BFS | AA SiO2/Al2O3 = 4.00** | 63.1 m2/g 0.070 cm3/g | Bulk/Powder, 63–125 μm | [134] |
BOFS-GP | BOFS | AA SiO2/Al2O3 = 11.5** | 30.84 m2/g 0.091 cm3/g 11.8 nm | Bulk/Particles, ∼0.1 mm | [39, 40] |
Slag-based GP | Slag | SSM SiO2/Al2O3 = 4.02* 0.3 wt% SDS | 100.9 m2/g 7 nm | Porous/Spheres, d ≈ 100 μm | [33] |
Silicomanganese slag-GP | Silicomanganese slag (NH4)6Mo7O24·4H2O | AA SiO2/Al2O3 = 1.44** | 51.79 m2/g 0.192 mL/g 10.30 nm | Bulk/Particles, 0.16–0.315 mm | [135] |
BOFS-GP modified with Ni(II) or Zn(II) | BOFS-GP | AA | Zn/LDS-GP 58.14 m2/g Ni/LDS-GP 53.42 m2/g LDS-GP 30.84 m2/g | Porous/Powder, ∼0.1 mm | [41] |
Slag-based GP | Slag | SSM SiO2/Al2O3 = 3.08* | 87.74 m2/g | Bulk/Spheres | [34] |
Slag-based GP/ Fe2O3-hybride | Slag | SSM SiO2/Al2O3 = 70.65** Fe2O3/Al2O3 = 188 Fe2O3/SiO2 = 2.66 | 233.8 m2/g | Bulk/Microspheres, 75–300 μm | [136] |
Steel slag/fly ash/analcime-GP | Steel slag fly ash | HT SiO2/Al2O3 = 2.01** | 27.25 m2/g 0.050 cm3/g 8.12 nm | Bulk | [137] |
BFS –GP | BFS | AA SiO2/Al2O3 = 5.26 | 23.56 m2/g 73 cm3/kg 7.8 nm | Bulk/Powder, 150 μm | [31] |
EAFS-GP | electric arc furnace slag | AA SiO2/Al2O3 = 2.02* | 6.5 m2/g 0.014 cm3/g 8.7 nm | Bulk/Powder | [38] |
BOFS-GP | Basic Oxygen furnace slag | AA H2O2 | ̶ | Porous | [43] |
Slag-GP/CeO loaded | Slag | SSM SiO2/Al2O3 = 3.31** | 186.40 m2/g 0.352 cm3/g 7.56 nm | Bulk/Sphere, 75–300 μm | [138] |
Clay-based GP | Kaolin | FM SiO2/Al2O3 = 1.88** | 51.3 m2/g 0.324 cm3/g 25.25 nm | Bulk/Powder | [58] |
clay/gangue microsphere -GP | Kaolin coal gangue 50/50 wt% | AA SiO2/Al2O3 = 4.0 | 39.74 m2/g 52.00 nm | Bulk/rubbles, 0.45–0.15 mm | [139] |
Clay-GP/Fe3O4 hybride | Calcined bentonite clay | AA | 2.32 m2/g 0.008 cm3/g 13.76 nm | Bulk/Powder | [61] |
Clay-GP | Lateritic clay, 58 μm | AA | 17.441 m2/g 0.005 cm3/g 1,4 nm | Bulk/Powder, 58 μm | [62] |
Natural tuff-GP | Volcanic tuff | AA SiO2/Al2O3 = 3.74** | ̶ | Bulk/Powder, < 200 μm | [140] |
Alumino silicate-GP | Alumino silicate powder | AA SiO2/Al2O3 = 4 | 50.1 m2/g 0.36 cm3/g 0.04 μm | Bulk/Monoliths or granules | [141] |
Synthetic GP | Chemosynthetic Al2O3-SiO2 powder | SSM SiO2/Al2O3 = 2 | ̶ | Bulk/Spheres | [142] |
Chitosan modified geopolymer | Aluminum salt and silica solution, chitosan | Precipitation SiO2/Al2O3 = 3.06** | ̶ | Bulk/Powder | [143] |
OTB-GP | Pyrophyllite mine waste samples | AA SiO2/Al2O3 = 2.39** | ̶ | Bulk/Powder, <45 μm | [55] |
OTB-GP | Gold mine waste | FM | 74.92 m2/g | Bulk | [144] |
OTB-GP | Gold mine tailings Al2O3 | FM | 74.916 m2/g | Bulk | [51] |
Municipal solid waste-GP | Sludges | FM SiO2/Al2O3 = 3.12** | 0.496 m2/g 9.98 nm | Bulk | [145] |
Municipal solid waste-GP | Municipal solid waste biochar | AA | 6.5 m2/g - - | Bulk | [146] |
Dolochar ash based geopolymer | Dolochar < 100 mesh | AA SiO2/Al2O3 = 4.97** | 49.91 m2/g 0.087 cm3/g 8,9 nm | Bulk/Particles, ≈ 0.1 mm | [147] |
GP/AAMs compositions for water and wastewater treatment reported in literature.
Calculated using the amounts of raw materials in the slurry.
Calculated using the XRF of product.
Originally, a basic composition applied for manufacturing GP/AAM adsorbents consisted of an alumosilicate precursor, an alkali, and an additional source of silicate in a form of water glass. Initially, both sodium and potassium forms of alkaline activators were used to induce geopolymerization. In the vast majority of the research reviewed, sodium alkaline and water glass are used in the activation process. It was shown by Bakharev that dissolution rates of the minerals was higher when a sodium form is used [148]. Luukkonen et al. [149] found that adsorption characteristics of metakaolin-based GP prepared with NaOH is better than with KOH in case of ammonium removal. An in-depth discussion of G chemistry and vivid explanations could be found in the latest reviews [57, 150, 151].
Forms and manufacturing techniques of GPs/AAMs for water treatment application are emerging and evolving constantly. In the first instance,
Despite the fact that the first identification of GPs as unconventional construction materials was in 1979 [158], broader applications of GPs/AAMs started in late 90s. Although GPs/AAMs are to be considered by some authors as an economic alternative to zeolites or activated carbons for water purification, the lack of real cases reported is obvious. To urge commercial importance, GP/AAM adsorbents should be readily available, economically feasible, steady in characteristics, and easily regenerated. Several comprehensive reviews on the GP/AAM materials for the water treatment sector have been published just recently [57, 150, 151, 153]. Therefore, in this section the bright and promising works will be highlighted as well as challenges and trends for future studies revealed.
In order to obtain adequate adsorption parameters, an excessive alkaline residue in GP/AAM should be washed out properly (pH 7 ± 0.5 within 24 h required) [159]. Otherwise, the increment of pH of aqueous solutions containing heavy metals will favor the hydroxide precipitation process, leading to wrong result interpretation. For porous GPs, washing away the excessive alkalis resulted in the increment of total porosity [11], which led to better performance. Moreover, excessive alkalis were used intentionally to neutralize AMD [42] and remove metal ions. However, a strict protocol must be followed to characterize newly designed materials.
Selective adsorption is relies on several factors such as a metal ion activity, hydration radius and free energy of hydration, and a pore size distribution of GP.
Geopolymerisation by itself could lead to the formation of new ion-exchange sites at the GP surface, but additives in composite formulations could have even higher influence the adsorption characteristics.
An ionic exchange reaction between the heavy metal ions and sodium ions has resulted in heavy metal removal by the metakaolin GP [159]. The adsorption selectivity of heavy metal ions by the GPs at pH 4 in multi-component solution was in the following order: Pb2+ > Cd2+ > Cu2+ > Cr3+, while qe [mg/g]: 100 > 76 > 55 > 10. The order of adsorption was in accordance with the hydrated radius and free energy of hydration for selected ions. However, the free energy of hydration and the activity for Cr3+ are all higher compared to those of other metals, though its adsorption rate does not correspond to the assumed order. The selectivity towards Cr3+ was be explained through its ionic status. When the pH exceeded 4, Cr3+ transforms to Cr(OH)2+, which might lead to its lower adsorption ability. It is also noted that at lower pH, the balancing ions present on the GP surface tend to be replaced by the hydrogen ions instead of the metal ions that lead to lower capacity at acidic pH.
Lopez et al. [5] investigated the selectivity of metakaolin-based GPs in multicomponent solutions (Pb2+, Cu2+, Cd2+, Ni2+, Zn2+ and Cs+). For a composition with Si/Al ratio 2, the best capacities and selectivity towards Pb2+ and Cs+ were observed. The adsorption selectivity for the mixture of metal ions was in the following order Cs+ > Pb2+ > Cu2+ > Zn2+ > Ni2+ > Cd2+, while qm [mg/g]: 43 > 35 > 15 > 3 > 1 > 2. The adsorption capacity for individual elements were higher: 57 mg Pb2+/g > 52 mg Cs+/g > 46 mg Cu2+/g > 14 mg Cd2+/g > 9 mg Zn2+/g > 4 mg Ni2+/g. Moreover, the effect of solution salinity (NaCl, 5% and 10%, wt) was studied, and no considerable effect on the adsorption order of metal ions or GP capacity in multi-composition solution was found. The authors presumed the existence of at least two types of binding sites with different affinities toward the metal ions to explain such a tolerance.
Selectivity of GP composites with zeolite filler was studied by Andrejkovičová et al. [4]. The highest adsorption was observed for Pb2+ for all the GPs obtained, while an adsorption order was as follows: Pb2+ > Cd2+ > Zn2+ > Cu2+ > Cr3+. The adsorption of Cu2+ and Cr3+ increased as the amount of metakaolin in the GP increased, whereas the composite with 25% zeolite doping had higher adsorption characteristics towards Pb2+, Cd2+ and Zn2+. GPs prepared from zeolitic tuff and kaolinitic soil by El-Eswed et al. [160] showed totally different order of adsorption: Cu2+ > Pb2+ > Ni2+ > Cd2+ > Zn2+. Moreover, the adsorption order strongly depended on the GP composition, although Cu2+ and Pb2+ adsorption has always prevailed.
The ability of BFS- and metakaolin-based GPs to remove Ni2+ and metalloids (As and Sb) in form of oxyanions was shown in [32]. Both adsorbents completely removed Ni2+ that most likely was associated with precipitation of its hydroxides on the GPs, while both metalloid oxyanions were adsorbed by BFS-GP equally. Another remarkable merit is that the adsorption capacities were obtained with real matrixes (spiked mine effluents), and were 4.42 mg/g, 0.52 mg/g, and 0.34 mg/g for Ni2+, As3+, and Sb3+, respectively. It is specified by the authors that the low capacities could be a result of competition of some matrix ions (Sr, Ca, Mg, Mn) with the target ions for binding sites.
Researches with increasing frequency pay attention to this problem and try to demonstrate the removal efficiencies with real samples. Removal of Ca2+ and Mg2+ from intact groundwater was examined in [58] on kaolin-based GP. With adsorbent dose of 1 g/L, the removal rate were 37.5% and 16.2% for Ca2+ and Mg2+, respectively. Metakaolin-based GP was tested by Kara et al. [87] for Mn2+ and Co2+ removal from real wastewater. The removal rates in real wastewater decreased from 97.5% to 53.01% and 94.6% to 39.12% for Co2+ and Mn2+, respectively. The results demonstrated that the adsorption performance affected negatively by the coexistence of some other cations and/or anions in the adsorption medium. Bentonite-based GPs were used for heavy metals removal from synthetic wastewater [61]. Porous biomass FA-based GPs were used in [129] for simultaneous removal of heavy metals from wastewater samples. Mixed FA/metakaoline-based GPs were used in [103] for Cu2+ removal from real wastewater. In the showcase, the adsorption capacity of GPs towards Cu2+ decreased by 27% as compared to synthetic samples. Sithole et al. treated acidic industrial effluents by FA/BOFS-based GPs [42, 43]. New GPs containing hollow gangue microsphere were applied for Zn2+ removal from smelting plant wastewater in [93]. At an adsorbent dose of 30 g/L, a complete Zn removal was observed. The distinctive aspect of the reported cases was that a complex composition of treated solutions is likely to decrease substantially capacity of the GP. Thus, the adsorption capacities obtained for the ideal laboratory conditions should be primary used as the guiding not decision-making parameters.
The removal of phosphorus was attempted in [10] with a pervious FA-based GP. The removal rate increased with the increase of pH. Up to 85% of phosphorus were removed from a treated wastewater. Simultaneous removal of ammonium and phosphate by composite metakaolin/BFS-based GPs was demonstrated in [91]. Phosphate removal was enhanced in presence of ammonium. At slightly alkaline conditions (pH 7–8), the removal rate towards phosphate ions was relatively high (>86%), whereas the ammonium removal up to 35% was also achieved. FA-, BFS- and fiber sludge GPs were investigated as promising adsorbents for phosphorous removal from diluted solutions. The capacities at initial phosphate concentration of 100 mg/L are 26 mg PO4/g for BFS-GP, 36 mg PO4/g for FAF-GP, and 43 mg PO4/g for FSHCa-GP [115].
Sulfate ions were removed by barium-modified BFS-based GPs [134]. Adsorption capacities were 91.1 and 119.0 mg SO4/g for model solution and mine effluent, respectively. The surface complexation or precipitation of barium sulfate were suggested as probable removal mechanisms.
Removal of halides by GPs/AAMs is an emerging topic. For this end, composite or functionalized materials are designed. Removal of F ̶ was demonstrated by slag-based GP microspheres modified with CeO [138], Fe2O3 [136], and bivalent metallic species [41] with capacities towards the contaminant 127.7 mg/g, 59.8 mg/g, and 60 mg/g (zinc impregnated BOFS-GP), respectively. A metakaolin-based GP functionalized by surfactant was developed for efficient removal of radioactive iodide [97]. High concentrations of competitive anions had limited influence on the adsorption process.
Oxidative degradation or photodegradation after adsorption have been specified by authors as primary mechanisms of organic pollutants’ removal. Although conventional GPs have been reported for these purposes [86, 89, 104, 126, 139], they would rather have had low adsorption/degradation characteristics. Hybrid or composite materials were proposed to improve the removal efficiency of organic pollutants. Thus, graphene [120, 132, 133, 165], TiO2 [88, 98, 105], CdS [142], various metal oxides [101, 106, 135] were introduced in GP matrix in order to enhance degradation abilities of resulting materials.
In last a few decades, significant improvements were made in both efficiency and economy in removal of metal(oid)s and other substances by adsorbents. Nevertheless, regeneration and recycling of used adsorbents, or recovery of the removed species from the desorbing agents are still rarely reported. For regeneration and reuse of GPs/AAMs, various possible regenerating agents such as acids, alkalis and chelating agents could be used. Only a few of the reported studies were focused on recovery of adsorbed (from saturated adsorbents) and desorbed (from regenerating agents) metals [11, 87, 96, 131]. However, for industrial application and success completion of new GP/AAM adsorbents on the market, research studies on number of adsorption–desorption cycles are in high demand. Moreover, revenues gathered from resource recovery options will have a decisive role in further technology implementation.
The regeneration of metakaolin-based GP by sodium chloride under alkaline conditions after ammonium adsorption for the first time were demonstrated in [152]. Three adsorption–desorption cycles were carried out with a steady removal efficiency. Sodium chloride and sulfate, potassium sulfate and phosphate were studied in [59] as regenerating agents for saturated metakaolin-based GPs. Sodium sulfate showed better results during five cycles under continuous sorption–desorption experiment, only 34% of an initial overall capacity of the GP were lost. Sodium chloride regenerant was also efficient, but only 55% of ammonium could be removed after 5th desorption cycle. The same adsorbents were used to test a nitrogen recovery option in a laboratory-scale demonstration setup [166]. The layout consisted of an adsorption/desorption unit and Liqui-Cel® membrane. A liquid phase obtained during adsorbent regeneration was purified in the membrane contactor in order to recover ammonium nitrogen as ammonium sulfate or phosphate. The purified regeneration solution was used repeatedly for further adsorbent regeneration. Several regeneration-purification cycles were conducted to estimate system sustainability and chemical consumption demand. Operational conditions of a membrane process such as shellside and lumenside feed flows, temperature, and pH were adjusted to gain maximal capacity of the setup. One membrane contactor (2.5 × 8-inch Liqui-Cel) was used under following operational conditions: 100 L/h shellside and 60 L/h lumenside feed flows, 40°C working temperature, pH ≥ 10. Technical sulfuric or phosphoric acids, up to 5%, were used as lumenside phases. The concentration of ammonium-content salt in a resulting received phase were 17% and 22% for phosphate and sulfate salt, respectively.
Metal recovery from GPs/AMMs via ion-exchange mechanism can only take place if physical adsorption occurred and the pH was low enough to prevent precipitation of metal hydroxide during adsorption process. Acids of over 0.1 M strength affect the structure of the GPs, and while metals are regenerated by acid washing, the reuse of adsorbents are diminished both in batch [11] as also in continuous mode [87, 167] experiments. Mild acid washing with 0.01 M H2SO4 or HNO3 removed metals from GPs efficiently in short time (1–2 h). It has also been shown that the adsorption capacity after mild acid washing could increase [131], which could be explained by exchange of Na+ with easier replaceable H+ cations. Selective desorption of copper has been observed by ammonia. A linear desorption ability with respect to ammonia concentration was observed, and complete desorption being possible by 10% ammonia solution [50, 61].
Sequential desorption tests of Cd2+ have been conducted on a loaded metakaolin GP, establishing the percentages of physically adsorbed, ion-exchangeable, EDTA extractable, and residual forms of metal [96]. The authors showed that physical adsorption is negligible, and ion-exchange with MgCl2 constituted to only 2–8% of adsorbed Cd2+. The bulk amount of Cd2+ adsorbed by the metakaolin GP was EDTA extractable, and the adsorbent remained 85% of its adsorption capacity after EDTA desorption for 5 cycles. Luukkonen [32] and Naghsh [58] suggested the efficient metal desorption by 5% NaCl. However, care must be taken since the balancing ions can form a positively charged film on the adsorbent surfaces. El Esweed et al. have achieved ion-exchange based desorption of Cu2+ by 0.1 M NaCl [160]. From all the studies reported, only Cd2+ has been shown to be desorbed at pH > 8 with NaOH solution, achieving 24–84% desorption [64].
An efficient use of GPs/AAMs in real wastewater treatment practices including economic evaluation is little investigated. Above all, these adsorbents show rather low selectivity, and therefore the ubiquitous metal ions (Na+, Ca2+, Mg2+, Fe3+) present in wastewater solutions demonstrate either competing interaction with the target ions, or the interaction has not been studied [57]. Additionally, for economic and ecological assessment is essential that the adsorbent would be regenerable [168]. To be economically successful, exhausted adsorbents need to pass the non-hazardous leaching criteria of the adsorbed materials, while the amount of waste regenerated should be as little as possible. This means that the adsorption-regeneration cycle needs to be performed as often as possible. And yet, afterwards the adsorbent needs to find end storage place, e.g. in tailing pond, or further use, e.g. as binder, filler, or soil amendment.
Adsorption capacity of a powdered GP is usually higher, but technical implementation of powdered forms requires precise dosing, contact vessel with stirring, solid–liquid separation step, and transfer of exhausted adsorbent to regeneration vessel. The powder can then be regenerated by addition of suitable regenerant, e.g. mild acid, separated, and dried prior to the next adsorption cycle.
Technically, the use of granular forms is an easier option. However, the size of the column vs. wastewater stream can easily become very large, as granules per se, are larger particles and adsorption is a surface process. This puts additional burden on geopolymer production as the overall capacity should be sufficient, and the granules will need to show suitable compressive strength to withstand the gravimetric pressure in the purification column. Conversely, regeneration is technically easily realized by counter flow of regeneration liquid through the column.
Economic evaluation therefore needs to take these considerations into account during CAPEX estimation. OPEX, in turn, is not only the ongoing replacement of exhausted adsorbent, electricity consumed, maintenance, staff, and regeneration chemicals, but also the transportation costs of adsorbents, which can be high at low adsorption capacity.
As a thought experiment, an example of 55 mg/g adsorption capacity of copper adsorbent, with 85% cycling capacity has a 47 mg/g adsorption capacity after desorption cycle, shall be considered. For a mine effluent or process water with 5 mg/L Cu2+ and a flow of 200 m3/h requires about 21 kg adsorbent per hour. The price of GPs is given as 1–1.5 € per kg [103], and as such the treatment costs of merely 1 h would be between 10 and 21 €. Regeneration up to 20 times gives more realistic cost factors, of 0.5–1 € per h, only for adsorbent costs. It becomes quickly clear that without regeneration, high efficiency, and selectivity GPs/AAMs will be too expensive for wastewater treatment.
Much work has been done on the adsorption properties of GPs/AAMs towards a wide variety of inorganic pollutants during the last decade. While the effect of competing ions in real water samples remain an issue, the incorporation of new composite materials and the tailoring of reaction conditions have a high potential to increase their selectivity as adsorbents. However, more and more authors have understood the need to regenerate adsorbents and research are being conducted on the recovery of valuable materials, such as metals or nutrients. The recovery of high energy products from side streams utilizing adsorbents made from industrial side streams, will bring circular economy towards the next level. It is also of interest, to cover the costs of water treatment by the revenue of removed materials. While still much work needs to be done, the authors remain confident, that GPs/AAMs will continue to have a prominent place in wastewater treatment.
The research was partially funded by European Regional Development Fund (Leverage from the EU, WaterPro project № A74635; Keski-Pohjanmaan liitto/Kainuun liitto/Pohjois-Pohjanmaan liitto) and by Maa- ja vesitekniikan tuki (№ 13-8271-17).
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After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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His fields of interest are anterior segment disease, keratoconus, glaucoma, corneal dystrophies, and cataracts. His research topics include\nintraocular lens power calculation, eye modification induced by refractive surgery, glaucoma progression, and validation of new diagnostic devices in ophthalmology. \nHe has published more than 100 papers in international and Italian scientific journals, more than 60 in journals with impact factors, and chapters in international and Italian books. He has also edited two international books and authored more than 150 communications or posters for the most important international and Italian ophthalmology conferences.",institutionString:'University of Campania "Luigi Vanvitelli"',institution:{name:'University of Campania "Luigi Vanvitelli"',institutionURL:null,country:{name:"Italy"}}}]},{type:"book",id:"7560",title:"Non-Invasive Diagnostic Methods",subtitle:"Image Processing",coverURL:"https://cdn.intechopen.com/books/images_new/7560.jpg",slug:"non-invasive-diagnostic-methods-image-processing",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Mariusz Marzec and Robert Koprowski",hash:"d92fd8cf5a90a47f2b8a310837a5600e",volumeInSeries:3,fullTitle:"Non-Invasive Diagnostic Methods - Image Processing",editors:[{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}},{id:"147824",title:"Mr.",name:"Pablo",middleName:null,surname:"Revuelta Sanz",slug:"pablo-revuelta-sanz",fullName:"Pablo Revuelta Sanz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"12",type:"subseries",title:"Human Physiology",keywords:"Anatomy, Cells, Organs, Systems, Homeostasis, Functions",scope:"Human physiology is the scientific exploration of the various functions (physical, biochemical, and mechanical properties) of humans, their organs, and their constituent cells. The endocrine and nervous systems play important roles in maintaining homeostasis in the human body. Integration, which is the biological basis of physiology, is achieved through communication between the many overlapping functions of the human body's systems, which takes place through electrical and chemical means. Much of the basis of our knowledge of human physiology has been provided by animal experiments. Because of the close relationship between structure and function, studies in human physiology and anatomy seek to understand the mechanisms that help the human body function. 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His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). His opinion is to attenuate sarcopenia by improving autophagic defects using nutrient- and pharmaceutical-based treatments.",institutionString:null,institution:{name:"Tokyo Institute of Technology",institutionURL:null,country:{name:"Japan"}}},editorTwo:null,editorThree:{id:"331519",title:"Dr.",name:"Kotomi",middleName:null,surname:"Sakai",slug:"kotomi-sakai",fullName:"Kotomi Sakai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000031QtFXQA0/Profile_Picture_1637053227318",biography:"Senior researcher Kotomi Sakai, Ph.D., MPH, works at the Research Organization of Science and Technology in Ritsumeikan University. She is a researcher in the geriatric rehabilitation and public health field. She received Ph.D. from Nihon University and MPH from St.Luke’s International University. Her main research interest is sarcopenia in older adults, especially its association with nutritional status. Additionally, to understand how to maintain and improve physical function in older adults, to conduct studies about the mechanism of sarcopenia and determine when possible interventions are needed.",institutionString:null,institution:{name:"Ritsumeikan University",institutionURL:null,country:{name:"Japan"}}},series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},editorialBoard:[{id:"213786",title:"Dr.",name:"Henrique P.",middleName:null,surname:"Neiva",slug:"henrique-p.-neiva",fullName:"Henrique P. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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