\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"169",leadTitle:null,fullTitle:"Remote Sensing of Biomass - Principles and Applications",title:"Remote Sensing of Biomass",subtitle:"Principles and Applications",reviewType:"peer-reviewed",abstract:"The accurate measurement of ecosystem biomass is of great importance in scientific, resource management and energy sectors. In particular, biomass is a direct measurement of carbon storage within an ecosystem and of great importance for carbon cycle science and carbon emission mitigation. Remote Sensing is the most accurate tool for global biomass measurements because of the ability to measure large areas. Current biomass estimates are derived primarily from ground-based samples, as compiled and reported in inventories and ecosystem samples. By using remote sensing technologies, we are able to scale up the sample values and supply wall to wall mapping of biomass. Three separate remote sensing technologies are available today to measure ecosystem biomass: passive optical, radar, and lidar. There are many measurement methodologies that range from the application driven to the most technologically cutting-edge. The goal of this book is to address the newest developments in biomass measurements, sensor development, field measurements and modeling. The chapters in this book are separated into five main sections.",isbn:null,printIsbn:"978-953-51-0313-4",pdfIsbn:"978-953-51-6177-6",doi:"10.5772/696",price:139,priceEur:155,priceUsd:179,slug:"remote-sensing-of-biomass-principles-and-applications",numberOfPages:336,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"c93637da5d1c8fcd07eda02777afab83",bookSignature:"Temilola Fatoyinbo",publishedDate:"March 28th 2012",coverURL:"https://cdn.intechopen.com/books/images_new/169.jpg",numberOfDownloads:38215,numberOfWosCitations:118,numberOfCrossrefCitations:55,numberOfCrossrefCitationsByBook:4,numberOfDimensionsCitations:140,numberOfDimensionsCitationsByBook:6,hasAltmetrics:1,numberOfTotalCitations:313,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 12th 2010",dateEndSecondStepPublish:"November 9th 2010",dateEndThirdStepPublish:"March 16th 2011",dateEndFourthStepPublish:"April 15th 2011",dateEndFifthStepPublish:"June 14th 2011",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"11875",title:"Dr.",name:"Lola",middleName:null,surname:"Fatoyinbo",slug:"lola-fatoyinbo",fullName:"Lola Fatoyinbo",profilePictureURL:"https://mts.intechopen.com/storage/users/11875/images/system/11875.jpg",biography:"Research Physical Scientist, Biospheric Sciences Laboratory, NASA GSFC \n\nDr. Lola Fatoyinbo studies forest ecology and ecosystem structure at the NASA Goddard Space Flight Center. Dr. Fatoyinbo’s current research focus is the fusion of optical, Synthetic Aperture Radar and lidar data to quantify forest structure, biomass, extent and degradation. Dr. Fatoyinbo has carried out extensive field and remote sensing research in tropical forest ecosystems of continental Africa, Madagascar and Latin America. She received her Bachelors in Biology in 2003 and her PhD in Environmental Sciences in 2008 from the University of Virginia. She then completed a NASA Postdoctoral Fellow within the Radar Science and Engineering Section at the Caltech - Jet Propulsion Laboratory, where her primary research focus was on using interferometric SAR data to quantify tropical forest extent, height and biomass through the development of radar-lidar fusion algorithms. Dr Fatoyinbo is now a research physical scientist at the NASA Goddard Space Flight Center in the Biospheric Sciences Laboratory.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"793",title:"Sustainable Energy Engineering",slug:"sustainable-energy-engineering"}],chapters:[{id:"33849",title:"Lidar Remote Sensing for Biomass Assessment",doi:"10.5772/17479",slug:"lidar-remote-sensing-for-biomass-assessment",totalDownloads:3010,totalCrossrefCites:4,totalDimensionsCites:12,hasAltmetrics:0,abstract:null,signatures:"Jacqueline Rosette, Juan Suárez, Ross Nelson, Sietse Los, Bruce Cook and Peter North",downloadPdfUrl:"/chapter/pdf-download/33849",previewPdfUrl:"/chapter/pdf-preview/33849",authors:[{id:"28463",title:"Dr.",name:"Jacqueline",surname:"Rosette",slug:"jacqueline-rosette",fullName:"Jacqueline Rosette"},{id:"39879",title:"Dr.",name:"Juan",surname:"Suárez",slug:"juan-suarez",fullName:"Juan Suárez"},{id:"39880",title:"Dr.",name:"Sietse",surname:"Los",slug:"sietse-los",fullName:"Sietse Los"},{id:"40828",title:"Dr.",name:"Peter",surname:"North",slug:"peter-north",fullName:"Peter North"},{id:"92404",title:"Dr.",name:"Ross",surname:"Nelson",slug:"ross-nelson",fullName:"Ross Nelson"},{id:"92405",title:"Dr.",name:"Bruce",surname:"Cook",slug:"bruce-cook",fullName:"Bruce Cook"}],corrections:null},{id:"33850",title:"Forest Structure Retrieval from Multi-Baseline SARs",doi:"10.5772/18650",slug:"forest-structure-retrieval-from-multi-baseline-sars",totalDownloads:2264,totalCrossrefCites:6,totalDimensionsCites:8,hasAltmetrics:0,abstract:null,signatures:"Stefano Tebaldini",downloadPdfUrl:"/chapter/pdf-download/33850",previewPdfUrl:"/chapter/pdf-preview/33850",authors:[{id:"32113",title:"Dr.",name:"Stefano",surname:"Tebaldini",slug:"stefano-tebaldini",fullName:"Stefano Tebaldini"}],corrections:null},{id:"33851",title:"Biomass Prediction in Tropical Forests: The Canopy Grain Approach",doi:"10.5772/17185",slug:"biomass-prediction-in-tropical-forest-the-canopy-grain-approach",totalDownloads:2405,totalCrossrefCites:6,totalDimensionsCites:20,hasAltmetrics:0,abstract:null,signatures:"Christophe Proisy, Nicolas Barbier, Michael Guéroult, Raphael Pélissier, Jean-Philippe Gastellu-Etchegorry, Eloi Grau and Pierre Couteron",downloadPdfUrl:"/chapter/pdf-download/33851",previewPdfUrl:"/chapter/pdf-preview/33851",authors:[{id:"27521",title:"Dr.",name:"Christophe",surname:"Proisy",slug:"christophe-proisy",fullName:"Christophe Proisy"},{id:"39750",title:"Dr.",name:"Nicolas",surname:"Barbier",slug:"nicolas-barbier",fullName:"Nicolas Barbier"},{id:"39751",title:"Dr.",name:"Pierre",surname:"Couteron",slug:"pierre-couteron",fullName:"Pierre Couteron"},{id:"39752",title:"Prof.",name:"Jean Philippe",surname:"Gastellu-Etchegorry",slug:"jean-philippe-gastellu-etchegorry",fullName:"Jean Philippe Gastellu-Etchegorry"},{id:"76888",title:"MSc.",name:"Michael",surname:"Guéroult",slug:"michael-gueroult",fullName:"Michael Guéroult"},{id:"95714",title:"Dr.",name:"Raphael",surname:"Pélissier",slug:"raphael-pelissier",fullName:"Raphael Pélissier"},{id:"111697",title:"MSc.",name:"Eloi",surname:"Grau",slug:"eloi-grau",fullName:"Eloi Grau"}],corrections:null},{id:"33852",title:"Remote Sensing of Biomass in the Miombo Woodlands of Southern Africa: Opportunities and Limitations for Research",doi:"10.5772/16608",slug:"remote-sensing-of-biomass-in-the-miombo-woodlands-of-southern-africa-opportunities-and-limitations-f",totalDownloads:3452,totalCrossrefCites:2,totalDimensionsCites:6,hasAltmetrics:0,abstract:null,signatures:"Natasha Ribeiro, Micas Cumbana, Faruk Mamugy and Aniceto Chaúque",downloadPdfUrl:"/chapter/pdf-download/33852",previewPdfUrl:"/chapter/pdf-preview/33852",authors:[{id:"25757",title:"Prof.",name:"Natasha",surname:"Ribeiro",slug:"natasha-ribeiro",fullName:"Natasha Ribeiro"},{id:"117104",title:"BSc.",name:"Aniceto",surname:"Chaúque",slug:"aniceto-chauque",fullName:"Aniceto Chaúque"},{id:"117105",title:"BSc.",name:"Faruk",surname:"Mamugy",slug:"faruk-mamugy",fullName:"Faruk Mamugy"},{id:"117106",title:"BSc.",name:"Micas",surname:"Cumbana",slug:"micas-cumbana",fullName:"Micas Cumbana"}],corrections:null},{id:"33897",title:"Ocean Color Remote Sensing of Phytoplankton Functional Types",doi:"10.5772/17174",slug:"remote-sensing-of-marine-phytoplankton-biomass",totalDownloads:4115,totalCrossrefCites:2,totalDimensionsCites:11,hasAltmetrics:0,abstract:null,signatures:"Tiffany A.H. 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Current evidence indicates that neuroplasticity extends across a hierarchy of organizational scales, from subcellular events, such as the regulation of synaptosomal vesicle pool sizes, to global brain activity, like that of motor skills. Indeed, the breadth of currently known neuroplastic mechanisms suggests that as knowledge of brain operation continues to grow new aspects of neuroplasticity will also continue to emerge. Recent findings, for example, indicate that neuroplasticity is also critical for higher order brain functioning, where it includes cognitive functions such as engram retrieval and pattern consolidation. This volume will highlight recent research into the brain's ability to shape itself through novel neuroplastic mechanisms and how this new knowledge is being used to benefit human health and wellbeing.
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From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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More and more people including children and adolescents are leading a sedentary lifestyle, which leads to a number of health problems. Overweightness and obesity are often accompanied by a lack of physical activity that can lead to more serious health problems, such as metabolic syndrome, type 2 diabetes, and hypertension. Lack of physical activity has also been found to be a major cause of morbidity [1] and mortality [2]. Overweight and obese individuals typically show abnormal cardiovascular function, and obesity has been found to be an independent risk factor for cardiovascular diseases, such as hypertension [3], type 2 diabetes, and cardiac complications (i.e., heart failure, heart disease). Obesity is associated with reduced life expectancy [4] and sudden death through its negative effect on the cardiovascular system [5]. Overweight and obese individuals usually develop hypertension. Compared to normal weight individuals, overweightness and obesity pose a potential risk for hypertension development in overweight individuals. It was found that a 10 kg excess in weight was associated with a 3 mmHg higher systolic and a 2–3 mmHg higher resting diastolic blood pressure. This can be translated into an estimated increased risk for coronary heart disease of 12% and an increased risk of stroke of 24% [6]. Alterations in the metabolic profile that are commonly found in overweight and obese individuals, such as dyslipidemia and hyperglycemia, can also lead to impairment in cardiac structure and function as adipose tissue accumulates [7]. It has been shown that left ventricular (LV) function and the ratio of the stroke index and LV end‐diastolic pressure are reduced with overweightness and obesity [8]. These changes show that depressed LV function has already occurred even in young overweight and obese individuals.
\nOverwhelming evidence indicates that regular physical activity in the form of both acute and regular aerobic exercise reduces the severity and occurrence of diseases related to unhealthy lifestyles. One single bout of acute exercise has been found to improve vascular function even in normotensive young healthy individuals with a family history of hypertension [9]. Whereas regular aerobic exercise has been shown to improve physical fitness (cardiorespiratory fitness) in addition to improving vascular function [10]. Having high levels of physical fitness, assessed through a sub‐maximal or maximal oxygen uptake test, is desirable as low cardiorespiratory fitness has been found to significantly increase the risk of cardiovascular diseases and mortality more so than other factors, such as hypertension, type 2 diabetes, and smoking, and regardless of body mass index [11]. High‐intensity interval training (HIIT) is a form of interval sprinting exercise typically performed on a stationary bike and has also been found to improve cardiac and metabolic health of young overweight males [12] and females [13]. Physical activity is so important that failure to lead a physically active lifestyle can result in several abnormalities such as high blood pressure, metabolic syndrome, and type 2 diabetes [14]. Baroreceptor sensitivity (BRS) has also been found to decrease with age [15, 16], being hypertensive [17] and being overweight and obese [18].
\nOverall, regular exercise results in improvement of the pathogenesis and symptoms of specific conditions that include chronic heart failure, coronary heart disease, dyslipidemia, hypertension, insulin resistance, intermittent claudication, obesity, and type 2 diabetes [19]. Other health benefits of regular aerobic exercise include improvement in balance, cognitive functioning, life expectancy, and overall quality of life [20, 21]. The beneficial effects of regular aerobic exercise have been well known. Thus, modification of a sedentary lifestyle by incorporating regular exercise is paramount for maintaining and improving health. Exercise is a powerful stimulus and can reduce the severity of several conditions with its effects being similar to many drug therapies. In this regard, exercise has now been widely accepted as medicine [22]. Therefore, the purpose of the chapter is to summarize the major autonomic, cardiovascular, and metabolic changes associated with being physically inactive. Then, the ability of differing forms of exercise (aerobic, interval sprinting, and resistance) to reverse these negative changes will be described.
\nA sedentary lifestyle, which is associated with overweightness and obesity, typically leads to an increased risk of cardiovascular disease. Currently, overweightness and obesity have been escalating at an alarming rate worldwide. Based on the World Health Organization (WHO, Global Health Observatory data) region data from 2010 to 2014 [23], the prevalence of overweightness (Figure 1) and obesity (Figure 2) for both males and females at the age of ≥18 years has significantly increased. The highest prevalence of overweightness and obesity, according to the WHO, was the Americas, followed by Europe and South Pacific, with Southeast Asia containing the lowest prevalence of overweightness and obesity. Also, women were more likely to be obese than men in 2014 in all WHO regions. Increased numbers of overweight and obese individuals put tremendous pressure and burden on healthcare providers and threatens world health in many countries. Approximately 20–30% of adults worldwide are categorized as clinically obese and numbers are progressively increasing [24, 25]. It has been well established that both high body mass index and a sedentary lifestyle are associated with greater risk of cardiovascular disease [26, 27].
\nPrevalence of overweight based on WHO region for both sexes 2010–2014.
Prevalence of obesity based on the WHO region for both sexes 2010–2014.
It has been shown that overweightness and obesity are accompanied by a cluster of cardiovascular risk factors, which is termed metabolic syndrome and includes hypertension, glucose intolerance, hypertriglyceridemia, and visceral obesity. These conditions occur in approximately one out of four adults over the age of 40 [28]. The metabolic syndrome is also associated with insulin resistance and endothelial dysfunction [29, 30]. It is believed that in child obesity, as fat mass increases, insulin resistance develops, which is a determinant of impaired metabolic function at early age [31]. Other health problems accompanying overweightness and obesity include cardiac autonomic dysfunction and endothelial dysfunction. Aberrant cardiac autonomic function has been found in obese children [32] and increased adiposity during childhood increases the risk of obesity, type 2 diabetes, and cardiovascular disease in adulthood [33, 34]. Endothelial dysfunction can be defined as inadequate endothelial‐mediated vasodilation, which is typically due to a deficiency of endothelial‐derived relaxing factor, nitric oxide (NO) synthesis, and/or release. It is believed that NO deficiency is a primary factor linking insulin resistance and endothelial dysfunction. Thus, it is clear that being sedentary results in increased cardiovascular disease risk, aberrant metabolic, cardiac, autonomic, and endothelial function.
\nIt has been well established that cardiac autonomic dysfunction is associated with conditions, such as overweight, obesity, and type 2 diabetes [35, 36]. The decline of cardiac autonomic function is typically influenced by an accumulation of visceral fat [37]. Lowered autonomic function was also found to be correlated with higher abdominal‐to‐peripheral body fat distribution measured by dual energy X‐ray absorptiometry in both young and old healthy men [38]. These results suggest that visceral obesity contributes to a decline in autonomic function. Also, young individuals with high abdominal adiposity seemed to undergo an early decline and a premature aging of autonomic function [37]. Thus, hypertension and high levels of central adiposity have an unfavorable effect on cardiac autonomic function, which is reflected by impaired heart rate variability (HRV) and baroreflex sensitivity (BRS).
\nHRV is a marker that is commonly used to assess cardiac autonomic function and can be defined as beat‐to‐beat variation in the heart rate of individuals possessing normal sinus rhythm [39]. HRV has been shown to be an indicant of healthy cardiac autonomic function as it has been found that reduced HRV predicts increased cardiovascular disease and mortality [40, 41]. High body mass index, which is commonly found in overweight and obese individuals, is also associated with reduced HRV, which contributes to decreased parasympathetic activity and increased sympathetic activity [42, 43]. BRS is another marker of cardiac autonomic function that provides information about the ability to increase parasympathetic or vagal activity and to decrease sympathetic activity in response to sudden increases in blood pressure [44]. BRS, which is typically reduced as people age, is an indicant of the body\'s autonomic nervous system sensitivity in responding to sudden blood pressure changes [44]. Low BRS is a marker of reduced compliance of the carotid artery [15, 16]. Overweight and obese individuals typically possess endothelial dysfunction that leads to reduced arterial compliance, which is accompanied with a low BRS compared to that of normal weight individuals. Lower BRS has also been found to be associated with high blood pressure, increased sympathetic activity, and diseases related to an unhealthy lifestyle. It seems that low HRV and BRS are affected by the accumulation of visceral fat and metabolic syndrome factors.
\nStudies have shown that obese children typically have decreased parasympathetic activity compared to normal weight children [45–49]. It has also been reported that an increased thickness of carotid intima‐media in obese children represents a very early sign of atherosclerosis [50]. It has also been found that the earliest signs of atherosclerosis development are lipid deposits in the intimal layer of systemic arteries (aorta), which have been found in children as early as 3 years old and in the coronary arteries of adolescents [51]. Another aberrant change possessed by overweight and obese individuals is high levels of leptin. Several studies have shown that positive correlations among leptin, insulin resistance, and blood pressure existed in overweight children [52, 53]. A reduction in adiposity level, however, brought about a reduction in leptin, which further improved metabolic health, by decreasing insulin, cardiovascular function, and blood pressure [52]. Adiponectin has a major anti‐inflammatory and anti‐atherogenic effect [54] and has been found to be three times higher in normal weight children compared to overweight and obese children [34]. A 1‐year follow‐up, following a 1‐year intervention, found that children with weight loss had similar adiponectin levels compared to normal weight children. Leptin levels, however, remained higher in overweight and obese children with weight loss. The increase in adiponectin appears to be an early biomarker of improvement in insulin sensitivity [34]. Thus, it is clear that overweightness and obesity in children result in early deposition of fat in the systemic arteries and thickening of arterial walls. These conditions can lead to more serious health complications later in their life if lifestyle modification is not introduced.
\nOverweight and obesity conditions not only result in metabolic dysfunction but also bring about vascular dysfunction. The balance between the ability of the vasculature (arterioles) to vasodilate and vasoconstrict is impaired with the development of overweightness and obesity. The loss of balance between vasodilators and vasoconstrictors is an indicant of endothelial dysfunction. Endothelial dysfunction is now regarded as a precursor of atherogenesis [55], which further leads to the development of atherosclerosis [56] and diabetic complications [57]. Arterial compliance, and its inverse arterial stiffness, can be defined as the ability of an artery to distend in response to intravascular (transmural) pressure [58] and is commonly termed as stiffening of the arteries. It is well known that overweight and obese individuals typically have high arterial stiffness [59], and this high arterial stiffness is associated with high body mass index and body fat [60]. Reduction in body mass index, however, has been found to be the strongest determinant of decreased arterial stiffness in severe obese young and middle‐aged adults [61].
\nArterial stiffness, which has been considered to be an independent predictor of cardiovascular disease, can be assessed through a reflection wave, commonly known as the augmentation index (AIx) and carotid femoral pulse wave velocity (PWVcf), which is considered to be the gold standard of arterial stiffness assessment. AIx, a reflection wave, is typically assessed by placing an applanation tonometry sensor (e.g., SphygmoCor) on either a radial or carotid artery. AIx then is derived from the ratio of augmented pressure (AP) and pulse pressure (PP), AP/PP [28]. PWVcf is obtained by dividing the distance from the carotid pulse and femoral pulse as measured by a tape measure by the time taken for the arterial pulse to propagate to the carotid and femoral arteries [62].
\nArterial stiffness, which is an indicant of the stiffening of the large arteries, increases with age, especially in central arteries, such as the aorta and carotid artery. Arterial stiffness has also been found to increase with overweightness and obesity, which leads to an increased risk of arteriosclerosis [63]. Overweight and obese children have been found to have high arterial stiffness, assessed through pulse wave velocity [64]. Similar findings were also found in young overweight individuals who had higher arterial stiffness levels compared to the normal weight individuals [62]. Hemodynamic changes accompanying overweightness and obesity include increased arterial wall stress, smooth muscle cell proliferation, thickening of vessel walls, and eventually reduced arterial compliance/increased arterial stiffness. Thickening of vessel walls is likely caused by increased total blood volume and cardiac output to compensate for the metabolic requirements of excess fat [65, 66]. Alterations of hemodynamics, together with other markers of obesity, including chronic inflammation and endothelial dysfunction, have been shown to contribute to the impairment of vasculature structure and function in obese individuals [67]. Thus, the development of arterial stiffness seems to be due to coping mechanisms by the body to meet the metabolic demands caused by excess fat gain. In overweight and obese children, this mechanism seems to develop very early on and carries on until adolescence and adulthood if interventions to reverse this condition are not introduced.
\nThe health benefits of regular aerobic exercise are well known. Physical activity has been ranked as one of the leading health interventions, which is used to reduce sedentary behavior in children, adolescents, and adults [68]. Currently, exercise guidelines include 150 minutes of exercise per week that consist of moderate and vigorous physical activity combined with resistance training. It has been shown that performing 150 minutes of regular exercise per week results in a reduction of mortality risk by 30% and a decreased risk of diabetes, cancer, depression, and stroke [69]. Despite the positive benefits of regular physical activity, however, many people do not comply with the minimum exercise requirements to maintain health. Lack of motivation and time constrains are possibly the underlying reasons of not performing regular exercise. The importance of regular physical activity is so overwhelming that exercise now has been regarded as medicine.
\nExercise has been widely used as preventative medicine to reduce the risk and incidence of cardiovascular and metabolic diseases related to sedentary and unhealthy living. Regular exercise has been shown to improve health and reduce the severity of diseases accompanying an unhealthy lifestyle. The benefits of exercise are overwhelming, and it has been shown that exercise can be used therapeutically for conditions, such as hypertension and insulin resistance [70], dyslipidemia [71, 72], type 2 diabetes, obesity [73], and endothelial dysfunction [74]. Exercise can also be used to improve cardiovascular and metabolic dysfunction that includes enhancing adipokine, cardiometabolic, and other clinical markers [75]. Thus, it is clear that exercise can be used as therapeutic or preventive medicine in order to alleviate lifestyle diseases.
\nThe types of exercise used in past research include aerobic exercise (continuous walking, jogging, and cycling), high‐intensity interval training (HIIT), and resistance training (e.g., weights). A study showed that either supervised or unsupervised aerobic exercise resulted in a reduction of body mass index in overweight and obese adolescents [76]. Whereas other studies have shown that moderate endurance training [77] and interval sprinting exercise [12] have a positive effect on HRV. Both HIIT and aerobic training have been used to induce improvement in HRV in different populations, such as young overweight individuals, type 2 diabetic patients, and older adults. Twenty minutes of HIIT on a stationary cycle ergometer, proceeded with 5 minutes of warm‐up and 5 minutes of cool‐down, three times per week, for 12 weeks have been found to improve parasympathetic activity [12] in young overweight males (Figure 3).
\nA study examining type 2 diabetic individuals has also found similar results when 30 minutes, four times per week for 12 weeks of HIIT training on a treadmill resulted in improvement in HRV by 19% [78]. This form of exercise consisted of 3 minutes of warm‐up, 6×2 minutes of high intensity at 80–90% of heart rate maximum, separated by 6 minutes of moderate intensity at 50–60% of heart rate maximum with 2‐minute recovery intervals, and 3 minutes of cool‐down. The improvement of HRV in type 2 diabetes is significant as exercise could potentially prevent type 2 diabetic patients progressing to a condition called diabetic neuropathy later in life. Another HIIT study also showed that HRV was significantly improved in older individuals, whose average age was 74 years, following 14 weeks of cycle ergometer HIIT exercise [79]. Thus, both continuous aerobic exercise and HIIT had positive effects on autonomic function by increasing HRV levels. However, HIIT is currently regarded as a type of exercise that is superior to a typical continuous moderate intensity of aerobic exercise in terms of time efficiency and clinical benefits. The effectiveness of HIIT has been well established in youth [80] and in overweight adult men [12] and women [13]. Twelve weeks of HIIT have shown to improve cardiovascular function, physical fitness, assessed through a maximal oxygen uptake test, and body composition in young overweight women [81]. It seems that both continuous steady state aerobic exercise and HIIT are beneficial for health.
\nHeart rate variability of overweight young males at pre and post 12 weeks of interval sprinting exercise. *Significant difference between groups,
Modification of HIIT protocols, however, may be needed to suit different populations. For example, HIIT to induce athlete performance would be different with the HIIT used to induce cardiovascular health in healthy sedentary or diseased individuals. Certain exercise effects or adaptations that occur following HIIT training may not occur or be apparent after regular aerobic exercise. Depending on health markers and conditions examined, the magnitude of change following aerobic exercise may be smaller than that of HIIT. For example, it has been demonstrated that arterial stiffness, assessed through PWV [82] and autonomic function [82] are normalized following HIIT in hypertensive individuals, but not following continuous moderate exercise. With HIIT training, the exercise drop‐out rate was found to be less [12, 83] compared to continuous steady state aerobic exercise. HIIT is also deemed to be superior in terms of improvement in cardiovascular health compared to regular aerobic exercise [84]. Thus, HIIT may be needed to be incorporated into daily life to induce extra health benefits. HIIT defined as repeated bouts of high‐intensity exercise interspersed by rest for 20–30 minutes has also been used to prevent or to reduce severity of diseases related to unhealthy lifestyles. HIIT has been found to improve cardiac and metabolic health of young overweight males [12] and females [83]. The AIx was found to be reduced by 4% (Figure 4), whereas PWVcf velocity was also reduced by 0.4 m.s-1 (Figure 5) following 12 weeks of HIIT in young overweight males [12].
\nAugmentation index of young overweight males at pre and post 12 weeks of interval sprinting exercise. *Significant difference between groups,
Pulse wave velocity of young overweight males at pre and post 12 weeks of interval sprinting exercise. *Significant difference between groups,
The HIIT employed was an 8‐s pedaling sprint at a cadence of 100–120 revolutions per minute (rpm) at 0.5–1 kg of load, followed by a period of lighter intensity exercise at a cadence of 30–40 rpm for 12 seconds, repeated for 20 minutes. Another type of HIIT included cycling on a stationary bike at 80–85% of maximal oxygen uptake for 4 minutes with 5‐minute rest intervals, repeated six to eight times [85]. HIIT has also been used in a number of clinical studies involving cardiac rehabilitation, chronic obstructive pulmonary disease, and intermittent claudication disease patients. Thus, a range of interval training exercise programs have been employed to improve cardiovascular and metabolic health.
\nResistance exercise is another type of exercise that contributes to cardiovascular and metabolic health. Participating in resistance exercise can maintain muscle mass that declines with aging. Acute resistance training has been found to reduce systolic blood pressure by 11 mmHg and mean arterial pressure by 12 mmHg and systolic blood pressure by 13 mmHg and mean arterial pressure by 12 mmHg with 40 and 80% maximum weight, respectively [86]. The mechanisms underlying this reduction in blood pressure following resistance training is thought to be due to an increased blood flow and shear stress that act on vascular endothelial cells. The increased muscle contraction leads to an increased production of nitric oxide, an important vasodilator [87]. It appears that this mechanism occurs independently of the exercise intensity employed [88].
\nThe effect of resistance training on arterial stiffness, however, is equivocal. Several studies [89, 90] have shown an unfavorable effect of resistance training on arterial stiffness, whereas others have shown no alteration in arterial stiffness [82, 91]. A reduction in central (increased arterial stiffness) but not peripheral arterial compliance was found following 4 months of resistance training in young and healthy middle‐aged men [89]. However, only brachial artery endothelial function was improved following 1 year of resistance training, but body mass index, body composition, blood lipids, and lean muscle mass improved [92]. A meta‐analysis [91] found that young adults had their arterial stiffness elevated from 14.3 to 20.1% following high‐intensity resistance training. In contrast, it has been shown that progressive high‐intensity resistance training without an increase in training volume did not alter arterial stiffness in young individuals [90]. Interestingly, the association between resistance training and arterial stiffness was not found in middle‐aged individuals [90]. Although high‐intensity resistance training has been found to increase arterial stiffness by 11.6%, moderate intensity resistance training did not seem to induce the same effect [90]. Another study showed an unexpected finding when improvement in the muscular strength of young individuals was inversely correlated with arterial stiffness [93]. This finding suggests that resistance training attenuates arterial stiffness. Different protocols and populations possibly could have contributed to the variability of results. Further studies looking at resistance training and arterial stiffness need to be carried out. Overall, regular HIIT is recommended, especially for people with time constraints. A combination of aerobic exercise and resistance training is also highly recommended as muscle wasting could occur with aging and a sedentary lifestyle.
\nA sedentary lifestyle leads to an increased risk of cardiovascular disease and dysfunction, such as high blood pressure, stiffening of the arteries, cardiac autonomic dysfunction, and metabolic dysfunction. If children become overweight or obese, these conditions described above appear to develop earlier. Lifestyle modification for children to avoid childhood obesity is paramount to further reduce the risk of health complications later in life. Therapeutic drug interventions can be introduced; however, overwhelming evidence suggests that regular exercise has been shown to prevent and to reduce the severity of disease‐related lifestyle. Exercise is a powerful stimulus that can reduce and prevent the occurrence of cardiovascular and metabolic dysfunction. Therefore, exercise indeed is medicine that can improve the quality of life. Both regular aerobic exercise and HIIT are beneficial for health. HIIT, in particular, is highly recommended, especially for people with time constraints, and HIIT combined with resistance training is potentially highly beneficial. People of all ages should be encouraged to incorporate regular exercise into their daily lifestyle.
\nKeratoconus is an asymmetric bilateral corneal disease, defined as noninflammatory in which the cornea changes its usual morphology and begins to cause a corneal thinning with protrusion of the thinnest area. It usually begins between the first and second decade of life, without predilection for sex, and progresses gradually until the third decade with deterioration of visual acuity in the form of irregular myopic astigmatism that does not improve with the usual existing correction measures (frame lenses or soft contact lenses) [1, 2].
\nHistopathological changes include disruption of Bowman’s layer, stromal and epithelial thinning, folding or rupture of Descemet’s membrane in severe cases, and a variable amount of scarring, especially in the anterior stroma, always with normal endothelium [2].
\nSome of the risk factors described are eye rubbing, asthma, a history of allergic rhinitis, or allergic conjunctivitis, as well as a family history of keratoconus, although there is no inheritance or genetic pattern involved so far [3, 4].
\nIn relation to the clinic, it is presented as a decrease in progressive visual acuity without improvement with correctors.
\nAbout the treatment, there are different approaches according to the objective planned. For correction of visual acuity in mild cases, it can be achieved for rigid gas-permeable lenses; in moderate to severe degrees, contact lenses are also used, but surgical techniques are added such as intrastromal rings, toric intraocular lenses, refractive phakic toric lens surgery, and lamellar and penetrating corneal transplants.
\nAbout progressive keratoconus there are two lines of treatment, as a first line to stop the progression of the disease and in the second instance to improve the visual acuity and quality of life of the patient. Currently the only FDA-approved treatment to stop the progression of the disease since April 18, 2016 is corneal collagen cross-linking (CXL) [4].
\n\n
Intrastromal corneal rings
Toric intraocular lenses of anterior and posterior chamber
Corneoscleral contact lens
Lamellar and penetrating corneal transplant
Keratoconus patients tend to be complicated to treat because they are forced to leave their glasses frequently due to oscillations in their refraction because their measurements are unstable and must continually adapt to new glasses or other types of devices to achieve an optimal visual acuity [5]. The visual correction of the keratoconus will depend on the stage in which it is found; in the early stages astigmatism can be corrected with glasses; however, when it is moderate to severe, contact lenses become the most appropriate option before placement of intrastromal rings or corneal transplantation [6].
\nContact lenses for the treatment of keratoconus were induced by Adolf Fick in 1888 [6]. The corneoscleral contact lens (CScL) are rigid oxygen-permeable gas lenses and are composed of fluorosilicone acrylate; these rest partially on the cornea and conjunctival tissue and are used to improve vision in patients with high or irregular astigmatism either secondary to keratoconus, marginal pellucid degeneration, keratoglobus, or posttransplant astigmatism, as well as other pathologies such as Steven-Johnson syndrome, scar pemphigoid, or graft versus host disease may require its use, and also for patients who do not tolerate conventional gas-permeable rigid lenses [7, 8].
\nThere are several types of contact lenses that can be used for the correction of visual acuity, astigmatism, and high-order aberrations in patients with keratoconus such as the corneoscleral contact lenses mentioned above, the mini-scleral contact lens (MSCL), the piggyback contact lens, and the rigid gas-permeable contact lens (RGPCL), being the hybrid contact lens (HCLs), soft toric lenses (STCLs), and corneoscleral contact lens (CScL) the most used for the correction of refractive error reporting excellent comfort and better vision with the corneoscleral contact lenses since the latter tends to be more accessible to use than conventional [5, 6, 9].
\nThere are two types of scleral lenses: those ventilated by air or fenestrated or those ventilated by fluid or not fenestrated; according to Rathi et al. [7], fenestrated lenses tend to compromise visual acuity because air bubbles can enter the visual axis altering vision, while this does not happen with non-fenestrated ones. There is a difference between mini-scleral lenses that have less corneal clearance but are likely to get stuck in the cornea due to the suction vacuum and its smaller diameter [7].
\nCorneoscleral contact lenses have factors that can affect your refractive performance such as the scleral or haptic portion that rests on the sclera and should be between 12.60 and 13.5 mm, the vault that is involved in the corneal and limbal clearance, the base curvature which should vary between 5.8 and 9.2 mm, the peripheral or scleral curves ranging from 5 to 6 to 11.4 mm, and the central optical portion that should be 0.20–0.27 mm more than the horizontal diameter of the iris, and its powers range from +20.00 to −25.00 D so that when making the calculation of the lens and its adjustment, these three factors must be taken into account [7, 8].
\nThe advantages of these lenses are that they are less mobile, focus better on the cornea, and have no contact with it so it does not cause irritation discomfort since they settle on the conjunctiva and the sclera; the ideal measures are between 15 and 17 mm of diameter or more. One of the advantages of this type of contact lenses is that they create a new ocular surface to compensate for the optical system so they must be filled with liquid before being placed and can be used for a longer time than conventional ones as long as the height of the vault is larger, so it is usually comfortable for some patients given the extended hours of use without complications [5, 6, 7, 10].
\nThe disadvantage of soft, silicone hydrogel and permeable gas lenses concerning scleral lenses is that they cannot neutralize irregular astigmatism, so they do not provide visual acuity as suitable as corneoscleral contact lenses [5, 6].
\nSoft toric lenses (STCLs) are limited for the correction of astigmatism in an irregular cornea but are comfortable and are only indicated in patients with early keratoconus [6]. The corneoscleral contact lenses correct astigmatism through the fluid reservoir, and the haptic should be aligned with the sclera to position it properly and avoid high-order aberrations and correct them [8, 10].
\nOn the other hand, RGPCL improves corneal irregularities through the tear layer between the lens and the anterior corneal surface and decreases higher-order aberrations because they provide a regular refractive surface but tend to be intolerable and are indicated in mild to moderate keratoconus. HCLs have a rigid central part and a soft peripheral part to reduce discomfort and improve visual acuity but still develop many complications. MSCL and CScL improve visual acuity, are comfortable, and delay the need for keratoplasty in the eyes with advanced keratoconus; these lenses rest in the sclera without touching the cornea or limbus but should be used with appropriate ophthalmic solutions to reduce turbidity [6, 8, 10].
\nIn the study of Saraç et al. [6], it was determined that the uncorrected visual acuity (UCVA) of users with MSCL, CScL, and RGPCL was greater than the users of STCL; topographic astigmatism in MSCL and CScL was greater than those of the STCL, but the cones that were in the center had a spectacle-corrected visual acuity (SCVA) lower. In conclusion, MSCL and CScL are good alternatives to RGPCL and HCL for the correction of visual acuity since it achieves more efficient levels of visual acuity than other types. The study it was also determined that patients undergoing corneal collagen crosslinking (CXL) had a better visual acuity than those who had not undergone this treatment, so that a condition to achieve adequate visual acuity can also be submitted to patients to this type of treatment and then adjust the contact lenses.
\nAccording to Montalt et al. [10], residual high-order aberrations remained high compared to normal eyes after the use of CScL; this study highlights that although spherical and high-order aberrations were improved after the use of CScL for 1 year, it is not clinically significant since they are only corrected at the time of use without anatomically modifying the cornea after use.
\nThe CScL has decreased the incidence of performing corneal transplants either PK or DALK; these contact lenses are used in mild to moderate keratoconus and constitute a conservative route for treatment, and their advantage is that they are reversible; however, its high cost and perhaps its difficulty in placement may limit its use in some patients. Patients should be informed about the total reversibility of CScL unless adequate visual acuity is not achieved, and the patient must be informed of the complications of transplantation, such as glaucoma, high post-keratoplasty astigmatism, ametropia, or anisometropia, that tend to be difficult to correct to provide a more appropriate visual correction [11].
\nThere are patients who, although they have implanted intracorneal lens segment (ICRS), will require a certain degree of visual correction, and in some cases corneoscleral contact lens, conventional or customized soft lenses, and rigid gas permeable, hybrid or piggyback contact lens can be complemented [8].
\nIt should be noted that after the insertion of the ICRS, the anterior and posterior cornea may undergo certain variations in its surface so that the visual quality, the increase in corneal aberrations, and the alteration of the contrast sensitivity can be affected by the irregularity that this ICRS tends to produce; one option is to place corneoscleral contact lens since acceptable visual acuities and decreased high-order aberrations or vertical coma have been achieved; therefore, despite the fact that the placement of ICRS can contribute to the treatment of keratoconus, they induce aberrations that the ICRS cannot control and can be complemented with CScL [8].
\nThe use of CScL showed no adverse effects such as corneal edema, compromised areas of the cornea, or corneal physiological deterioration. The visual quality was maintained; the number of hours of use of the lens and the comfort was adequate so it is a good option for additional correction in patients who require it [8].
\nThe intrastromal rings correspond to small circular segments of biocompatible material (polymethylmethacrylate (PMMA)), which are inserted into the corneal thickness, specifically in the stromal layer in order to regularize the surface and improve the main refractive defect. Several studies show successful results in relation to corneal remodeling, but the evidence is scarce to show effect on its progression [1].
\nIt is thought that the insertion of corneal implants results in a flattening of the corneal center with the consequent reduction of myopia and astigmatism that patients with keratoconus usually suffer, also generating a biomechanical support of the thin ectatic cornea. A tunnel is performed in the corneal stroma manually or assisted by femtosecond, and the intrastromal implant is inserted. This implant can be removed at any time, but usually they are removed only in case of complications or displacements of their original position [2].
\nChanges in the corneal structure can be explained by Barraquer’s law, in which when a material is added to the corneal periphery or the same amount of material is removed from the area of the central cornea, a flattening effect is achieved. On the other hand, when a material is added to the center or removed from the corneal periphery, the curvature of the surface protrudes. It is postulated that the corrective results vary according to the thickness and diameter of the segment [12].
\nEach segment has a double effect: one of flattening, through the virtual line that connects the two terms of the segments, and another of protrusion perpendicular to the line reached by the action of the ring established by the difference between the plane of the segment and the plane of the cornea in the insertion area. With this, each segment flattens the axis parallel to the line and protrudes the perpendicular axis, which is why the segments are implanted in the most protruding axis [12]. In addition, it has been seen that the most flattening action is greater when the arc is longer and, on the contrary, the protrusion action is greater when the arc is smaller. The general flattening is greater with thicker segments [13].
\nMost publications suggest that the indications for intrastromal segments are patients with moderate keratoconus with a clear optic zone and those who are intolerant of contact lenses. The upper limit of K max should not be greater than 60 D, the patient should not have any scar on the visual axis, and the cornea should be at least 350 mm thick by ultrasonic pachymetry in the optical zone or over the area in which the segments will be installed and the refractive error less than −6 D [14].
\nThe corneal segments can be implanted using manual techniques or assisted by femtosecond laser. It is believed that the creation of the mechanical tunnel is more complex and dependent on the skill of the surgeon; however, the technique with the femtosecond laser is faster and more precise, and with this a better reproducibility is achieved [15].
\nThere are few studies that describe visual and refractive results in relation to implant depth to date, which have delivered results without significant differences [16].
\nOn the other hand, several studies have evaluated with very good results the combination of cross-linking treatments and implants of intrastromal rings, because it is postulated that the first is the only effective treatment to stop the progression of the disease and the second for visual and refractive improvement without having a great implication in its progression [17, 18, 19, 20, 21]. ICRs combined with CXL showed that UDVA improved 0.12 logMAR at 12 months of follow-up, CDVA worsened 0.03 logMAR at 12 months of follow-up, but the mean sphere and cylinder component improved 3.03 ± 1.99 and 1.99 ± 0.96 D, respectively, at 12 months of follow-up. Keratometry improved 4.31 ± 2.62 D at 12 months of follow-up. Thus, UDVA, refraction, and keratometry improved to a greater degree than if only the ICR procedure was used [22].
\nRegarding the complications of the implant of rings, the systematic review by Izquierdo et al. [22] carried out in 1325 eyes showed that complications are rare but do occur. Intraoperative complications are mainly linked to the construction of the tunnel in manual techniques. Decentration of the segments, inadequate depth of the tunnel, and asymmetry of the segments are the most frequent. Postoperative complications include ring segment extrusion, corneal neovascularization, corneal haze, segment migration, corneal melting, and infectious keratitis, among others. Related to the combined procedure, the primary complications in the ICR group were white deposits (57 [5.75%]), epithelial defects (56 [5.65%]), extrusion (21 [2.11%]), decentration (14 [1.41%]), segment migration (6 [0.6%]), and halos and glare (6 [0.6%]). In the ICR and CXL group, the main complications were edema (17 [5.08%]), extrusion (2 [0.59%]), perforation (2 [0.59%]), and corneal melting (1 [0.29%]) [22].
\nSeveral surgical options have been reported for patients undergoing corneal transplants secondary to keratoconus with refractive errors that are difficult to correct or patients with keratoconus and virgin corneas that do not tolerate contact lenses or who want the independence of the glasses. The variety of treatment is wide, such as photorefractive keratectomy, corneal wavefront-guided customized ablation, corneal relaxing incisions, small incision lenticule extraction, or intrastromal corneal rings. However, the previous chamber iris-fixated phakic intraocular lens (ACIF-PIOL) has taken advantage of other correction techniques that can be provided to the patient for their safety and effectiveness [23].
\nThe toric Artisan (Ophtec BV) is a one-piece polymethylmethacrylate intraocular lens with a 5 mm optical zone, and a concave-convex shape is fixed to the iris and corrects a sphere from −23.00 D to +14.00 D and a cylinder of −1.00 D to −7.50 D. While the Artiflex toric intraocular lens (Ophtec BV) has a 6 mm optical zone and a concave-convex shape, it has a flexible polysiloxane optics and two rigid polymethyl methacrylate haptics and corrects spheres from −1.00 D to −13.50 D and cylinders −1.00 D to −5.00 D [24, 25].
\nThis technique has the advantage to preserve the integrity of the post-transplant graft, prevent tissue ablation, having no risk of postoperative turbidity, and correcting high degrees of spherical and astigmatic refraction, and they are stable, safe, and effective and can correct elevated refractive errors [24, 25, 26, 27].
\nIt should be noted that the treatment with anterior chamber phakic intraocular lens must be complemented with the corneal collagen cross-linking before implantation to maintain the keratometry and a stable refraction; these phakic lenses are indicated in patients with mild to moderate progressive keratoconus with regular myopic astigmatism. The implementation of pIOL 6 months after the corneal collagen cross-linking is recommended to consider changes in refractive errors and keratometry values that could alter the lens calculation [23, 24, 25, 28].
\nBefore placing the ACIF-PIOL, all sutures should be removed in the case of posttransplant patients, and the candidate patients must have a stable keratoconus; these are not recommended in patients with newly diagnosed keratoconus or young patients with progressive keratoconus [24, 25, 27]. The implementation of anterior chamber phakic intraocular lens can improve a UDVA from 20/40 to 20/20 according to the Snellen scale with a nonsignificant loss of endothelial cells; in the same way, an annual request is recommended for studies such as specular microscopy and anterior segment optical coherence tomography to monitor corneal changes [24, 28].
\nSome complications that may result from the implantation of this type of lens are endothelial cell damage, cataract formation, glare, haptic disintegration, pigmentary dispersion that can cause pigmentary glaucoma, and the corneal incision that can modify residual astigmatism, but they are very rare [26, 27].
\nIn general, visual rehabilitation in patients, after the insertion of the anterior chamber phakic intraocular lens, is quite rapid, with maximization of vision and an optimal focus within the eye, without serious complications, and can be considered as an alternative treatment before transplantation because it is less invasive [25, 26, 27].
\nThe implantable collamer lens (ICL; Visian; STAAR Surgical, Nidau, Switzerland), which is used as a posterior chamber pIOL, is made from collamer, a biocompatible hydrophilic copolymer of collagen and hydroxyethyl methacrylate with an ultraviolet light. The lens is implanted in phakic patients in the posterior chamber, between the iris and the anterior lens capsule, without making contact with it so as not to cause cataracts or any other complication. There are toric devices, and with spherical correction, the toric models (Visian TICL) were developed in 1998, but only in 2006 it gets approved by the FDA and marketed for use.
\nA toric ICL is typically indicated for the correction of myopia in adults aged 21–40y with myopia up to −18.0 diopters (D) with up to 6.0 D of astigmatism. Toric ICL cannot correct irregular corneal astigmatism; therefore, it is an alternative method to correct myopia and myopic astigmatism in the eyes with stable KC for partial visual rehabilitation.
\nToric models are identical in material, chromophore, haptic design, size, and thickness to spherical models. It has a central convex-concave optical zone with a cylindrical component intended to correct astigmatism. Usually with the identification by extended alignment marks that orient the surgeon with respect to the degrees and direction of rotation that he has to do in relation to the horizontal axis to achieve a correct alignment.
\nRegarding the calculation of the power of the ICL, it is performed with nomograms provided by the manufacturer according to the patient’s refraction, axial length, curvature and corneal thickness, distance to the vertex, depth of the anterior chamber, and the dimensions of white to white and of sulcus to sulcus, so as to determine the most appropriate ICL size for each patient.
\nA toric ICL corrects only spherical and cylindrical errors of refraction; it cannot correct HOAs caused by an irregular corneal shape. Patients who have a good spectacle-corrected visual acuity would benefit from toric ICL implantation. A toric ICL does not induce HOAs. The aberrations associated with an irregular cornea in KC that are uncorrected by the pIOL have an effect on the final visual quality. A phakic toric ICL can correct a high degree of myopic astigmatism without inducing new HOA. High corneal irregularity limits the potential visual acuity and may need another surgery to make the cornea more regular [29, 30].
\nAs we know, the cornea is a transparent dome-shaped surface that, from a microscopic point of view, is composed of six layers that from the outside inward correspond to the stratified epithelium that helps keep the ocular surface smooth and provides a barrier against the external injury; the Bowman layer, an acellular structure that does not regenerate after damage; the stroma, which has anatomical and biochemical properties that maintain the physical stability of the corneal shape and transparency; the Dua layer, which would measure only 15 μm thick and would be located between the stroma and Descemet’s membrane; the Descemet’s membrane, which is 10 μm thick and can be easily separated from the stroma regenerating rapidly after trauma; and finally the endothelium, a thin layer of cells that maintain the hydration of the corneal stroma in a gradual manner and contribute to maintaining corneal transparency [31].
\nDue to the layered or lamellar characteristic of the cornea and the partial or complete commitment of the disease or condition that leads to the decision to perform a corneal transplant, two types of management can be distinguished: those that involve all the corneal thickness and which are lamellar, depending on the layer of the cornea affected.
\nPenetrating corneal transplantation is a surgical procedure in which the entire corneal is replaced by healthy donated tissue [32]. In DALK, the epithelium, the Bowman membrane, and a small part of the stroma are replaced, leaving the Descemet’s membrane and the endothelium undamaged.
\nPenetrating keratoplasty (QPP) has been the technique traditionally used during the twentieth century, independent of the cause of the transplant requirement. The first technically successful cornea transplant with human graft was performed by Power et al. [33]; however, a loss of corneal transparency was recorded at approximately 20 days [34].
\nPenetrating technique has been associated with multiple surgical complications such as the risk of tissue rejection, infections, and high astigmatism related to the need to ensure a tight seal for the donor graft [35, 36, 37].
\nThe aforementioned complications, mainly graft rejection, have led to the development of new surgical techniques in which only the damaged cornea layer is replaced [32]. Lamellar techniques have been gaining popularity in recent decades and have involved preserving the healthy tissue of the recipient cornea by replacing only the compromised portion [38].
\nIf we consider that the visual loss that affects the person with visual disability and that requires a corneal transplant has repercussions in the psychological, social, and labor, severely affecting their quality of life, there is no doubt that vision is one of the most important aspects of the functional activity of people. Our society attaches great importance to visual communication, to the point that those people who cannot make full use of this sense begin to be marginalized from the world around them, directly or indirectly.
\nThe objective of the corneal transplant is to achieve an acceptable visual acuity with a minimum of retraction error and with a long duration. DALK was introduced by Eduardo Archila in 1984 [39]; it is a very innovative technique indicated for patients who have no compromise of the corneal endothelium or Descemet’s membrane and for mild cases of keratoconus [40, 41, 42, 43, 44, 45].
\nThis type of transplant consists of removing the diseased stroma from the cornea and separating it from the Descemet’s membrane and the Dua layer and replacing it with donor tissue [39, 43, 45, 46]. In the United States, according to the Eye Bank Association of America, DALK is the main indication of lamellar transplantation, accounting for 43.4% of cases, and in countries such as the United Kingdom, Singapore, and Australia, this technique has taken up the last 10 years [43].
\nThere have been several techniques that have been developed, such as manual dissection/delamination of the corneal stroma or separation of the DM from the stroma using intrastromal injection of fluid, viscoelastic, hydro-delamination, or a big-bubble [40, 43]. Hydro-dissection is better than the others because it allows an easier dissection of the deep stroma and is more controlled than the rest [41], while Romano et al. [43] concluded that there was no significant difference between manual dissection and the big-bubble technique. In the same way, it has been decided that the best technique is with which each surgeon has more experience [41].
\nFew of the advantages of this technique over penetrating keratoplasty (PKP) are the preservation of the host’s endothelium; a low rate of graft rejection; minimal loss of endothelial cells; lower postsurgical risk; a short term of steroid use during the postoperative period, reducing complications such as cataract, glaucoma, and late wound healing; and lower risk of intraocular infections; adding to this, Romano et al. [45] refer that it produces a stronger cornea, being less prone to spontaneous or posttraumatic wounds, as well as a longer graft survival than PKP [39, 43, 44, 47].
\nHowever, a fairly long learning curve is required, since the technique can be complicated for some surgeons, and the surgery time is longer than PKP; it also has unpredictable visual results compared to PKP since it takes between 6 and 12 months to reach an acceptable visual acuity and generate high degrees of spherical and astigmatic refractive errors, and this depends on the thickness of the stromal bed or the presence of folds in the Descemet’s membrane; there may also be graft tears that require conversion to PKP [42, 43, 44, 45, 46].
\nThe stromal bed is one of the factors that determine a good visual acuity after performing a DALK; several studies suggest that for better visual results, you should have a stromal bed less than 20 mm and not more than 65 mm, and these results are comparable to PKP [39, 45, 46, 47].
\nMoreover to the stromal bed and the folds in the Descemet’s membrane, other factors that can influence the variation of visual acuity and refractive errors have been determined, such as vitreous length, suture tension, the time at which sutures are removed, previous keratometric values, donor graft size, and donor-recipient disparity, which can modify the radius of corneal curvature [39, 40, 41, 42, 43, 44, 45, 48].
\nCorneal sutures are one of the most common morbidities in terms of poor visual acuity due to myopia and residual astigmatism that remain secondary to their withdrawal; in some studies it is said that residual myopia may become greater than in PK [40]. Therefore, it is recommended that suture removal be initiated in the 1st month of operation and maximum between 18 and 24 months postoperatively [42, 43, 44]. This will depend on postoperative topographic astigmatism, which generally varies from >4 D to 6 D, as well as the loosening of sutures or their degradation or vascularization, taking into account that in PKP, the sutures remain longer than in DALK [44, 45]; in any case, each patient should be assessed as graft dehiscence may occur that requires an early adjustment if they are not removed at the appropriate time [40, 42, 43].
\nRefractive errors are the first causes of patient dissatisfaction. The most common refractive error is myopia due to lengthening of the posterior segment of the eye [40, 44] and can vary from −3.00 to −13.00 D [46]. Javadi et al. [42] determined that the spherical refraction remained stable after 6 months of suture extraction and refer that the refractive instability of DALK may be secondary to the avascular vertical wound between the donor and the recipient causing changes in the wound architecture during healing and in some cases due to the recurrence of keratoconus.
\nAs for the spherical equivalent, Javadi et al. [42] indicate that the changes in it continued until 6 months after suture removal and remained stable afterward, in an average of 5 years, without changes in refractive astigmatism, and in some cases they recommend refractive surgery 6 months after the spherical equivalent is stabilized in patients who require it. Henein C et al. [48] conclude that the spherical equivalent did not vary between PK and DALK.
\nA preoperative UCVA of 20/100 and a preoperative BCVA of 20/40 are recommended for DALK since this could result in a postoperative UCVA of 20/50 and a BCVA of 20/25 to 20/20 preoperative in a period of 36 months [43]. Javadi et al. [42] said that the patients evaluated obtained a postoperative visual acuity from 20/30 to 20/40 at the end of the 60-month follow-up. And according to Huang et al. [44], there is no difference in refractive errors between DALK and PK and that a graft diameter size of 8.75–10.0 mm can achieve BCVA between 20/40 and 20/25 and less apparent astigmatism than grafts of 8 mm and less spherical aberrations [39]. According to Romano et al. [43], the DALK is comparable with PK in terms of BCVA and refractive results as is Henein et al. [48].
\nAccording to a systematic review by Henein et al. [48], it was shown that BCVA and UCVA at 12 months of follow-up favored PK more than DALK, while better postoperative refractive astigmatism, lower episodes of graft rejection, and greater graft survival supported DALK more than PKP. However, the spherical equivalent and the density of endothelial cells did not vary between these two transplant techniques. They also report that the potential factors for postoperative keratometric and refractive astigmatism are the disparity of the donor graft, the bed of the host, and the degree of preoperative ametropia as some authors conclude [42, 43, 44, 46, 48].
\nIt has been determined that factors such as central and peripheral corneal thickness, recipient trepanation size, surgical technique, duration of steroid administration and elevated intraocular pressure do not contribute to postoperative refractive outcomes [40, 42, 45].
\nIn a comparative study about visual results between DALK and PKP, it was determined that there were no significant differences in the best-corrected visual acuity between DALK and PKP at 12 and 24 months; however, patients who underwent DALK were more recorded nearsighted without changes in the cylinder, with greater spherical equivalent than PKP [43, 47].
\nSome complications that can result from DALK are perforations of the recipient bed, double anterior chamber, corneal opacities, stromal rejection, high astigmatism, vascularization and/or loosening of the sutures, and elevation of intraocular pressure, which are usually controlled, have a very low incidence, and tend to be less frequent than the PKP [45, 46, 47].
\nIn conclusion, according to several studies, DALK has many advantages over PKP for the treatment of mild or moderate keratoconus, with visual results that tend to be unpredictable but similar to PKP, with a lower incidence of graft rejections and postoperative complications.
\nUp to date, there are several treatments that improve visual acuity in patients with keratoconus. The best method should be selected according to the characteristics of each patient.
\nThe authors declare no conflict of interest.
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All published Book Chapters are licensed under a Creative Commons Attribution 3.0 Unported License. Monographs are licensed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license granted to all others. Our Copyright Policy aims to guarantee that original material is published while at the same time giving significant freedom to our Authors. IntechOpen upholds a flexible Copyright Policy meaning that there is no copyright transfer to the publisher and Authors hold exclusive copyright to their work.
\n\n\n\nWith the purpose of protecting our Authors' copyright and the transparent reuse of Open Access content, IntechOpen has developed an Attribution Policy for works published under Creative Commons licenses.
\n\n\n\nIntechOpen is committed to disseminating high-quality scientific research in a manner that exemplifies the best practice in scholarly publishing. IntechOpen is an official member of the Committee on Publication Ethics (COPE), which advocates the maintenance of the highest ethical standards for all parties involved in the act of publishing, including Authors, Academic Editors of the book, Peer Reviewers, the publisher and Societies, where applicable.
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\n\nAll scientific works are subject to Peer Review prior to publishing. IntechOpen is a member of the Committee on Publication Ethics (COPE) and all participating referees and Academic Editors are expected to review submitted scientific works in line with the COPE Ethical Guidelines for Peer Reviewers where applicable.
\n\n\n\nThe Internet has changed the dynamics of scholarly communication and publishing which is why we find it necessary to clearly indicate our stance on what we consider to be a published scientific work. A significant number of working papers, early drafts, and similar works in progress are shared openly online between members of the scientific community. It has become common practice for researchers to announce their work on a personal website or a blog in order to gather comments and suggestions from other researchers. Such works and online postings are ‘published’ in the sense that they are made publicly available, but this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. 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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This chapter tries to answer at least a few questions about corruption and the causes for it, its consequences and how to deal with it successfully.",book:{id:"6487",slug:"trade-and-global-market",title:"Trade and Global Market",fullTitle:"Trade and Global Market"},signatures:"Štefan Šumah",authors:[{id:"228073",title:"Mr.",name:"Stefan",middleName:null,surname:"Sumah",slug:"stefan-sumah",fullName:"Stefan Sumah"}]},{id:"55499",title:"Human Resources Management in Nonprofit Organizations: A Case Study of Istanbul Foundation for Culture and Arts",slug:"human-resources-management-in-nonprofit-organizations-a-case-study-of-istanbul-foundation-for-cultur",totalDownloads:2294,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The aim of this study is to investigate the efficiency and importance of human resources management in nonprofit organizations. The understanding was included to the literature as personnel management at the beginning of the twentieth century and it turned into an approach as human resources management in the 1980s. It could be observed that many organizations, which deem the human as the most critical stakeholder, adopt a traditional way of personnel management in operating human resources. The employees play a key role in the success of an organization. For this reason, subjects such as recruitment, training, development, career management, performance appraisal, occupational health, and safety are the fundamental functions of human resources management. The study examines to what extent these roles are evaluated through a case study. The subject matter of the study is the most powerful culture and art foundation in Turkey. Compared to many other nonprofit organizations, the foundation actively performs a variety of services within a year worldwide. The fact that the total number of employees might rise up to 800, including the field personnel, indicates the need of a good functioning human resources management. The human resources practices of the foundation are examined and evaluated within that scope.",book:{id:"5826",slug:"issues-of-human-resource-management",title:"Issues of Human Resource Management",fullTitle:"Issues of Human Resource Management"},signatures:"Beste Gökçe Parsehyan",authors:[{id:"189113",title:"Dr.",name:"Beste",middleName:null,surname:"Gokce Parsehyan",slug:"beste-gokce-parsehyan",fullName:"Beste Gokce Parsehyan"}]},{id:"59152",title:"Marketing Strategies for the Social Good",slug:"marketing-strategies-for-the-social-good",totalDownloads:1594,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Social network sites (SNS) have proven to be a good environment to promote and sell goods and services, but marketing is more than creating commercial strategies. Social marketing strategies can also be used to promote behavioral change and help individuals transform their lives, achieve well-being, and adopt prosocial behaviors. In this chapter, we seek to analyze with a netnographic study, how SNS are being employed by nonprofits and nongovernment organizations (NGOs) to enable citizens and consumers to participate in different programs and activities that promote social transformation and well-being. A particular interest is to identify how organizations are using behavioral economic tactics to nudge individuals and motivate them to engage in prosocial actions. By providing an understanding on how SNS can provide an adequate environment for the design of social marketing strategies, we believe our work has practical implications both for academicians and marketers who want to contribute in the transformation of consumer behavior and the achievement of well-being and social change.",book:{id:"6583",slug:"marketing",title:"Marketing",fullTitle:"Marketing"},signatures:"Alicia De La Pena",authors:[{id:"196878",title:"Dr.",name:"Alicia",middleName:null,surname:"De La Pena",slug:"alicia-de-la-pena",fullName:"Alicia De La Pena"}]}],onlineFirstChaptersFilter:{topicId:"4",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82405",title:"Does Board Structure Matter in CSR Spending of Commercial Banks? Empirical Evidence from an Emerging Economy",slug:"does-board-structure-matter-in-csr-spending-of-commercial-banks-empirical-evidence-from-an-emerging-",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.105589",abstract:"This chapter examines the impact of board elements on CSR spending by private commercial banks in an emerging economy, considering Bangladesh as a case. In doing so, we collected necessary data from the annual reports of 30 commercial banks listed on the Dhaka Stock Exchange, covering the period 2007–2020. In addition, we reviewed the patterns of CSR spending by commercial banks to understand the CSR universe in Bangladesh. We adopted the OLS model with two-way clustering to measure the effects of board elements on CSR spending. Our results confirm that factors, such as independent directors and board size, have a significant and positive relationship with CSR expenditures, while board gender deters the same. Also, board meetings do not have any significant connection with CSR spending. For control variables, factors, such as firm size and leverage, tend to promote the CSR spending of commercial banks, while profitability has no such relationship. As for the sectoral distribution of CSR funds, we found that although the absolute amount of CSR expenditures by banks has increased substantially over the years, they are primarily limited to health, education, natural disasters, and humanitarian activities. These findings are expected to have significant policy implications.",book:{id:"11602",title:"Corporate Social Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11602.jpg"},signatures:"Bishnu Kumar Adhikary and Ranjan Kumar Mitra"},{id:"82395",title:"Toward a Better Understanding of Green Human Resource Management’s Impact on Green Competitive Advantage: A Conceptual Model",slug:"toward-a-better-understanding-of-green-human-resource-management-s-impact-on-green-competitive-advan",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.105528",abstract:"Today, green human resource management (GHRM) has become a key business strategy where HRM plays an active role in the ongoing green movement. Thus, the topic of GHRM is of growing interest among management scholars. However, despite the theoretically important role of GHRM, relatively small number of research has been discovered so far about how GHRM, in companies striving to achieve environmental sustainability, could help them gain a green competitive advantage (GCA). Thus, based on the resource-based view (RBV) arguments, the main objective of this paper is to develop a conceptual model of the relationship between GHRM and green competitive advantage through green knowledge, green values, and green commitment. This model is expected to provide a strategic map that could be utilized by the practitioners and managers so that GHRM implementation can be more effective in contributing to green competitive advantage. Overall, the present article extends knowledge on the resource-based view by contributing to the literature on GHRM and its interactions with the main assets that lead to green competitive advantage.",book:{id:"11602",title:"Corporate Social Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11602.jpg"},signatures:"Hosna Hossari and Kaoutar Elfahli"},{id:"82394",title:"Learning by Doing Active Social Learning",slug:"learning-by-doing-active-social-learning",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.105523",abstract:"Project-based learning and future-based pedagogy are important and effective tools for teaching and learning in the twenty-first century. They are especially suited to instilling social activism among students, which is extremely valuable in today’s multicultural society. This study examined the impact of such learning among Arab and Jewish students and teachers in Israel. Following a collaborative program on social activism, in which students from different sectors worked together via digital platforms and face-to-face encounters, the impact of the program and its pedagogical tools were examined. The program, called Living in a Multicultural Society, reflects the mosaic of different people and communities, living side by side yet separated by religion, culture, and language. Through this program, students who may not have otherwise met worked together to learn, research, and create. This study was conducted using the mixed-method approach, whereby the qualitative data were gathered via interviews, and the quantitative data were collected through questionnaires. The findings show that this project-based learning program led to significant encounters, understandings, and co-operations between different sectors, and to meaningful end-products relating to social activism. This study enhances the concept that significant pedagogical processes increase students’ motivation, in-depth learning, and outcomes.",book:{id:"11481",title:"Active Learning - Research and Practice",coverURL:"https://cdn.intechopen.com/books/images_new/11481.jpg"},signatures:"Anat Raviv"},{id:"81785",title:"Social Distancing Disbanding Learner Groupings: A Case on Language Development",slug:"social-distancing-disbanding-learner-groupings-a-case-on-language-development",totalDownloads:4,totalDimensionsCites:0,doi:"10.5772/intechopen.104893",abstract:"Information sharing is a fundamental aspect in learning an unfamiliar, yet, an additional language, with specific regards to reading comprehension. Language teachers are faced with a task to monitor development, performance, and effectiveness in learner reading proficiencies. This chapter aims to measure if disbanding learner groupings as per the social distancing protocols brought about by COVID-19 restrictions has any impact on language enhancement. Henceforth, there are limited suggestions by literature in relation to disbanding learner groupings, yet improved reading proficiency is one of the crucial language aspects to be mastered for one to be a successful scholar. Nonetheless, this chapter aims to provide teaching strategies applied by English language teachers to necessitate transmitted learning in accordance with information sharing as learners are dependent on one another for language enhancement, thus leading to academic achievement.",book:{id:"10912",title:"Psychosocial, Educational, and Economic Impacts of COVID-19",coverURL:"https://cdn.intechopen.com/books/images_new/10912.jpg"},signatures:"Bulelwa Makena and Thandiswa Mpiti"},{id:"82248",title:"Sustainability and Excellence: Pillars for Business Survival",slug:"sustainability-and-excellence-pillars-for-business-survival",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.105420",abstract:"The chapter presents an overview of management models starting with self-assessment (ISO 9004) and continuing with the European Foundation for Quality Management (EFQM) Excellence Model. Stakeholders’ analysis and their needs and expectations diagnostic are the baseline for building sustainable businesses. Sustainability and excellence are connected, and particular details of these approaches’ implementation are presented. Partnership development appears a key principle in the EFQM model. Based on companies’ strategies analysis, a simplified model may be proposed in order to support business survival in changing environments. Some guidelines to allow assessment of excellence fundamentals implementation are given. Based on experience and without seeing as exhaustive, a summary sheet of possible approaches and deployments is given. This may be used as a practical tool to connect actions implemented in organizations with the excellence model enablers, so as to facilitate assessment to explore the performance maturity level. The same sequence of Plan-Do-Check-Act relates approaches stated by ISO 26000 and sustainability initiatives. Embedding excellence and sustainability into business strategic objectives allows the management to define the framework for competitive continuous improvement.",book:{id:"11476",title:"Globalization and Sustainability - Recent Advances, New Perspectives and Emerging Issues",coverURL:"https://cdn.intechopen.com/books/images_new/11476.jpg"},signatures:"Irina Severin, Maria Cristina Dijmarescu and Mihai Caramihai"},{id:"82269",title:"CSR Reporting and Blockchain Technology",slug:"csr-reporting-and-blockchain-technology",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.105512",abstract:"Blockchain technology is a public ledger that stores data in a chain of blocks which can radically improve the quality of our records from “records that might be trustworthy” to “records that trust is absolute”. This chapter explores one area that blockchain technology can radically transform but has not yet received significant attention. We evaluate the suitability of applying blockchain technology for corporate social responsibility (CSR) reporting. We demonstrate that blockchain technology is suitable in the context of CSR reporting since there is a strong need for an immutable common database shared among various stakeholders with potential trust issues. We also argue that blockchain technology does not completely eliminate existing trusted third parties such as governments, international organizations that provide CSR reporting standards, major CSR reporting assurance companies and major CSR infomediaries. In particular, blockchain technology can be used as a platform that integrates all traditional trusted third parties, transforms their functions, and reduces their drawbacks for advancing CSR reporting. 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The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"25",title:"Environmental Sciences",doi:"10.5772/intechopen.100362",issn:"2754-6713",scope:"
\r\n\tScientists have long researched to understand the environment and man’s place in it. The search for this knowledge grows in importance as rapid increases in population and economic development intensify humans’ stresses on ecosystems. Fortunately, rapid increases in multiple scientific areas are advancing our understanding of environmental sciences. Breakthroughs in computing, molecular biology, ecology, and sustainability science are enhancing our ability to utilize environmental sciences to address real-world problems.
\r\n\tThe four topics of this book series - Pollution; Environmental Resilience and Management; Ecosystems and Biodiversity; and Water Science - will address important areas of advancement in the environmental sciences. They will represent an excellent initial grouping of published works on these critical topics.
\r\n\tSustainable development focuses on linking economic development with environmental protection and social development to ensure future prosperity for people and the planet. To tackle global challenges of development and environment, the United Nations General Assembly in 2015 adopted the 17 Sustainable Development Goals. SDGs emphasize that environmental sustainability should be strongly linked to socio-economic development, which should be decoupled from escalating resource use and environmental degradation for the purpose of reducing environmental stress, enhancing human welfare, and improving regional equity. Moreover, sustainable development seeks a balance between human development and decrease in ecological/environmental marginal benefits. Under the increasing stress of climate change, many environmental problems have emerged causing severe impacts at both global and local scales, driving ecosystem service reduction and biodiversity loss. Humanity’s relationship with resource exploitation and environment protection is a major global concern, as new threats to human and environmental security emerge in the Anthropocene. Currently, the world is facing significant challenges in environmental sustainability to protect global environments and to restore degraded ecosystems, while maintaining human development with regional equality. Thus, environmental sustainability with healthy natural ecosystems is critical to maintaining human prosperity in our warming planet.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/94.jpg",hasOnlineFirst:!0,hasPublishedBooks:!1,annualVolume:11978,editor:{id:"61855",title:"Dr.",name:"Yixin",middleName:null,surname:"Zhang",slug:"yixin-zhang",fullName:"Yixin Zhang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYWJgQAO/Profile_Picture_2022-06-09T11:36:35.jpg",biography:"Professor Yixin Zhang is an aquatic ecologist with over 30 years of research and teaching experience in three continents (Asia, Europe, and North America) in Stream Ecology, Riparian Ecology, Urban Ecology, and Ecosystem Restoration and Aquatic Conservation, Human-Nature Interactions and Sustainability, Urbanization Impact on Aquatic Ecosystems. He got his Ph.D. in Animal Ecology at Umeå University in Sweden in 1998. He conducted postdoc research in stream ecology at the University of California at Santa Barbara in the USA. After that, he was a postdoc research fellow at the University of British Columbia in Canada to do research on large-scale stream experimental manipulation and watershed ecological survey in temperate rainforests of BC. He was a faculty member at the University of Hong Kong to run ecological research projects on aquatic insects, fishes, and newts in Tropical Asian streams. He also conducted research in streams, rivers, and caves in Texas, USA, to study the ecology of macroinvertebrates, big-claw river shrimp, fish, turtles, and bats. Current research interests include trophic flows across ecosystems; watershed impacts of land-use change on biodiversity and ecosystem functioning; ecological civilization and water resource management; urban ecology and urban/rural sustainable development.",institutionString:null,institution:{name:"Soochow University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null,series:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null},editorialBoard:null},onlineFirstChapters:{paginationCount:12,paginationItems:[{id:"82285",title:"Parvovirus Vectors: The Future of Gene Therapy",doi:"10.5772/intechopen.105085",signatures:"Megha Gupta",slug:"parvovirus-vectors-the-future-of-gene-therapy",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"81793",title:"Canine parvovirus-2: An Emerging Threat to Young Pets",doi:"10.5772/intechopen.104846",signatures:"Mithilesh Singh, Rajendran Manikandan, Ujjwal Kumar De, Vishal Chander, Babul Rudra Paul, Saravanan Ramakrishnan and Darshini Maramreddy",slug:"canine-parvovirus-2-an-emerging-threat-to-young-pets",totalDownloads:15,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"81271",title:"The Diversity of Parvovirus Telomeres",doi:"10.5772/intechopen.102684",signatures:"Marianne Laugel, Emilie Lecomte, Eduard Ayuso, Oumeya Adjali, Mathieu Mével and Magalie Penaud-Budloo",slug:"the-diversity-of-parvovirus-telomeres",totalDownloads:38,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"79209",title:"Virtual Physiology: A Tool for the 21st Century",doi:"10.5772/intechopen.99671",signatures:"Carmen Nóbrega, Maria Aires Pereira, Catarina Coelho, Isabel Brás, Ana Cristina Mega, Carla Santos, Fernando Esteves, Rita Cruz, Ana I. 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