",isbn:"978-1-80356-678-8",printIsbn:"978-1-80356-677-1",pdfIsbn:"978-1-80356-679-5",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"6dcb071a2e978694b6b1cb9c20afc1a3",bookSignature:"Prof. Hai-Zhi Song",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11494.jpg",keywords:"Electric Field Effect, Nano-Materials, Electric Field Design, Antenna, Microelectronics, Optoelectronics, Electric Field Stimulation, Brain and Nerve, Electric Field Imaging, Atomic Electric Field, Space Science, Climate",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 22nd 2022",dateEndSecondStepPublish:"May 26th 2022",dateEndThirdStepPublish:"July 25th 2022",dateEndFourthStepPublish:"October 13th 2022",dateEndFifthStepPublish:"December 12th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"a month",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"A pioneering researcher in the fields of new materials, optoelectronic devices, and quantum information processing, appointed vice director of the Science and Technology Committee of SWITP, author/co-author of more than 170 research papers, and holder of 40 patents.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"196114",title:"Prof.",name:"Hai-Zhi",middleName:null,surname:"Song",slug:"hai-zhi-song",fullName:"Hai-Zhi Song",profilePictureURL:"https://mts.intechopen.com/storage/users/196114/images/system/196114.jpg",biography:"Curriculum Vitae\n\nName: Hai-Zhi Song \nGender: male\nDate of Birth: Oct. 20, 1968\nPlace of Birth: Shanxi, China\nAffiliation and Address: \nSouthwest Institute of Technical Physics\nNo.7, Section 4, Renminnan Road, Chengdu 610041, China\nAnd\nInstitute of Fundamental and Frontier Sciences,\nUniversity of Electronic Science and Technology of China,\nNo. 4, Section 2, Jianshebei Road, Chengdu 610054, China\n\nWork Phone: +86-28-68180751, +86-28-83208728\nMobile Phone: +86-158-28239155\nFax: +86-28-83201896\nE-mail: hzsong1296@163.com, hzsong@uestc.edu.cn\n \nEducation \nSept, 1990 – July, 1995:Peking University, PhD, Thesis “Visible luminescence of porous silicon and its mechanism”, Researches on hydrogen-influenced Schottky diodes and silicon-based light-emitting materials. \nSept, 1986 – July, 1990:Nanjing University, Bachelor of Science, Thesis “Study of refractory metal silicides”, Research on Ohmic contact of semiconductors.\n\nWork Experience \nJuly, 1995 – Sept. 1997: Nanjing University, Nanjing, China, Postdoctoral Researcher, Research on silicon-based light-emitting materials. \nOct, 1997 – Sept. 1998: Catholic University Leuven, Leuven, Belgium, Visiting free Researcher, Research on amorphous semiconductors. \nOct, 1998 – Sept. 2001: Tsukuba University, Tsukuba, Japan, Assistant Professor, Research on semiconductor quantum dots. \nOct, 2001 – March 2012: Fujitsu Lab. Ltd., Atsugi, Japan, Researcher/Senior Researcher, Researches on Semiconductor Quantum Dots for Quantum Information, Semiconductor Optoelectronic Materials and Devices. \nApril, 2012 – March 2014: University of Tokyo, Tokyo, Japan, Senior Researcher, Researches on Quantum Information Processing Devices. \nApril, 2014 – now: Southwest Institute of Technical Physics, Chengdu, China, Professor, Researches on Semiconductor Optoelectronic Materials and Devices. \nJune, 2015 – now: University of Electronic Science and Technology, Chengdu, China, Professor, Researches on Nanoscaled Semiconductors and Quantum Information Processing Devices.\n \nAchievements\nSystematically studied the property of porous silicon materials and verified their mechanism; found green and ultraviolet luminescence, and clarified the multiple luminescence mechanisms of nanocrystalline-silicon embedded in SiO2, which is valuable to silicon-based optoelectronic integration; realized enhanced hole mobility in amorphous silicon, verified the existence of deep trap states in amorphous selenium, providing ways to improve amorphous optoelectronic materials. \nDiscovered lateral coupling between self-assembled quantum dots (QDs) and their tuning effect to 2D electron gas; illustrated and deeply explained the metal-insulator transition in 2D ordered QD arrays, all of which are worth in optoelectronic application of semiconductor QDs. \nDeveloped Sb-free technique to double the InAs/GaAs QD density and suppress the atomic interdiffusion, helped producing 1.3 um QD lasers, which won Japanese national prizes and had been merchandized; developed 1.06 um quantum-well lasers, which have been used to produce pure-green lasers robust against high temperature. \nFound a way to access buried QDs by scanning tunneling microscope; achieved a way to prepare diluted QDs by post-annealing and clarified its mechanisms; invented a technique to control the size and site of QDs by atomic-force microscopy lithography, and an apparatus to detect single electron spin states by optically-detected magnetic resonance; designed a few types of micropillar cavities applicable to realize 1.55 um highly-efficient, even coherent (strongly coupled) InAs/InP QD single photon sources; produced fiber-integrated photon-entangled sources, all of which are very useful to the applications of QDs in quantum information processing. \nDeveloped focal-plane single-photon avalanche detectors, providing central devices for 3D laser detecting and ranging system; explored antimonide middle- and long-wavelength infrared detectors and the surface plasmon enhancement effect in such detectors; advanced the acetone-sensing function of Eu-doped SnO2 nano-belt; found Nickle Phosphide serving as a good catalyst in hydrogen-producing. Realized a series of optoelectronic quantum devices for quantum information processing, such as fiber-integrated photon-pair-entangler, chiplet heralded single photon emitter, fiber quantum memories, quantum number generator, etc.\n\nHonor and Group Memberships \nSelected Scholar of the Recruitment Program of Global Experts, China\nEditorial member of “Laser Technology”\nEditorial member of “Journal of Electronic Science and Technology”\nEditorial member of “Internal J. Mat. Sci. Appl”\nMember of APS (American Physics Society)\nMember of OSA (Optical Society of America)\nPermanent Member of China Physical Science and Technology\nPermanent Member of the Chinese Optical Society\nTechnical committee member of PIERS, organizing a series of “quantum information processing and devices” sessions\nTechnical committee member of ICICM",institutionString:"Southwest University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Southwest University",institutionURL:null,country:{name:"China"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"20",title:"Physics",slug:"physics"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"453623",firstName:"Silvia",lastName:"Sabo",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/453623/images/20396_n.jpg",email:"silvia@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"8356",title:"Metastable, Spintronics Materials and Mechanics of Deformable Bodies",subtitle:"Recent Progress",isOpenForSubmission:!1,hash:"1550f1986ce9bcc0db87d407a8b47078",slug:"solid-state-physics-metastable-spintronics-materials-and-mechanics-of-deformable-bodies-recent-progress",bookSignature:"Subbarayan Sivasankaran, Pramoda Kumar Nayak and Ezgi Günay",coverURL:"https://cdn.intechopen.com/books/images_new/8356.jpg",editedByType:"Edited by",editors:[{id:"190989",title:"Dr.",name:"Subbarayan",surname:"Sivasankaran",slug:"subbarayan-sivasankaran",fullName:"Subbarayan Sivasankaran"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. 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1. Introduction
Individuals with autism spectrum disorders are often plagued with incontinence due to compromised sensory processing between the peripheral and central nervous system. Currently, a combination of the Azrin & Foxx method (1971) and operant conditioning are considered the standard protocol for toilet training children with developmental and intellectual disabilities including individuals with autism. Although programs that have been adapted to children with physical disabilities have resulted in successful toilet training in most cases, there is a considerable proportion of individuals with autism who have reached adulthood without being accomplished in bladder and bowel control. These individuals often reside in the spectrum of non-verbal with lower cognition levels (Dalrymple & Ruble, 1992) and exhibit not only incontinence but are challenged with abnormality in toileting such as encopresis, enuresis and fecal smearing. A lack of neurobiological data precluded conclusions regarding the development of, and abnormality in, toilet training individuals with autism. Existing literature is skewed towards treating the aforementioned issue as solely the domain of behavior. Whereas toilet training is both an inherently neurobiological and cultural phenomenon, society’s failure to comprehend and address the problem of some of our most vulnerable members in the autism spectrum reflect a still “Victorian-albeit taboo” in this fundamentally important issue in self-care. This chapter reviews the importance of independent self-care skills in family routines, and proposes a putative sensory-neural understanding of the toilet training-resistant cohort, which is largely unknown. Case studies of two children with autism demonstrate how sensory experiences may affect toilet training success.
2. Toilet training in autism
Toilet training is commonly delayed in Autism spectrum disorders (ASD). Dalrymple and Ruble (1992) surveyed 100 parents of clients with ASD (mean age = 19.5 years) and reported that 22% of them did not have full success with toileting. Research studies on toileting in autism have been scarce and are mainly single case studies (Kroeger & Sorensen, 2010). In general, toilet training in autism included: the teaching of hand-washing techniques and cleaning up strategies (Rumfelt-Wright, 2001; Furman, 2001), positive motivational practice, habituation to the bathroom (Cicero & Pfadt, 2002; Rockville, 2008) and the utilization of communication training component to promote self-initiated toileting (LeBlanc, 2005).
3. Impact of lack of independence in toileting in family’s life
Children with ASD exhibiting sensory processing issues often lack bladder and bowel control. This can impact family routines. Most notably, the families of children with ASD tended to avoid social participation more so than families with typically developing children (Bagby et al., 2012). Gray (1994) reports that social withdrawal is often a coping strategy for families with children on the autism spectrum who display inappropriate toileting behavior. Additionally, mothers of children with autism are less likely to work full-time than mothers of typically developing children (Porterfield, 2004). As schools and child-care facilities often reject children who are not independent with toileting, parental participation in activities outside of the homes may be further limited as a result of caregiving roles and extensive responsibilities.
4. Self-care skills in children with ASD: A brief overview
Most child care centers and inclusive preschools require children to be toilet trained before entering a certain grade level. For example, inclusive preschools in which prompted independent urination could occur during group lavatory trips at structured times. Children with ASD whom require diaper changes during the school days would be excluded from this classroom routine. As a longer period of seated time is expected for learning to occur, the children attending inclusive schools are required to maintain sufficient bladder and bowel control and to sustain basic self-care needs in order to adhere to environmental structures. Therefore, the ability of children to learn and refine performance of basic self-care tasks holds meaning not only for the children but also for their caregivers and teachers.
5. Neurobiology of toilet training
Without understanding how the body orchestrate the many events associated with going to the bathroom, it is not possible to progress in the field of intervention for individuals still struggling with containing themselves appropriately past the critical period for toilet training. This is because toilet training is a behavior that lies in the juncture between a biology that is involuntary and a biology governed by free will that is voluntary. In neurobiological terms, conscious control of urinary and anal continence requires an intact communication between the peripheral and central nervous system. Therefore, dysfunction of the nervous system would result in the loss of control of continence and could explain the prevalence of incontinence in individuals with compromised neurology such as autism. Micturition or the urge to urinate is dependent on the integrity of a center in the lumbo-sacral region of the cord with the bladder and urethra. Micturition takes place when the bladder and urethra sphincter hence stimulated transmits impulses via the ganglia to the cord. Whereas micturition can take place with the lower end of the cord alone, the voluntary control of micturition requires coordination with the central nervous system. Micturition reflex was evoked by filling the bladder and is mediated through sacral spinal region as illustrated in Figure 1. The micturition reflex arch involves the coordination from the spinal cord to the brainstem-cerebellum and back (Fowler et al., 2008). The micturition reflex arch composed of an afferent pathway from the urinary bladder to the lumbar and sacral region onto the spinal cord and to the pontine micturition center before connecting to higher centers in the brain. The afferent pathway is served by the pelvic nerve and hypogastric nerve which connects to the spinal cord before entering the brain. The efferent pathway, on the other hand, projects from the higher center of the brain through the periaqueductal gray area (PAG), travelling to the bladder, then to the lumbro-sacral parasympathetic center and finally to the sphincter muscle of the bladder via the pudendal nerve (Manto & Jissendi, 2012; see Figure 1). The pontine micturition center is thought to be the control center for micturition and is involuntary. The instinctual and involuntary aspects aside, there is a socio-cultural dimension of micturition and proceeds by conscious decision which develops through training. The voluntary center needs to recruit more elaborate coordination between the higher centers in the brain with the spinal cord. This conscious control of urination is thought to recruit higher cerebral centers including the medial prefrontal cortex, anterior cingulate cortex and insular cortex which will communicate with the pontine micturition center that mastermind toilet training. Figure 2 describes in detail the interplay of multiple systems that are involved in the conscious control of continence. As for for the control anal defecation: it is similar to the micturition reflex and work via the coordination of various anorectal physiology: action of sacral nerve stimulation, neurological control of the colon and anorectum and higher cerebral centers (Gourcerol et al., 2011).
Figure 2 illustrates the multi-level control systems that are required for the conscious control of bladder voiding. The PAG is recruited to connect lower spinal cord to the cerebral cortex. Since the cerebellum forms projections to the PAG via the pons, it is likely that sensory processing entering from the cerebellum convey information to the PAG and ultimately communicates with the cerebral cortex.
The neurobiology of continence control indicates that the frontal cortex and cerebellum is part of the essential circuit during the conscious control of continence. Successful toilet training should point toward the contribution of cognitive function and habituation that recruits the frontal cortex and the sensory components of the cerebellum. This paper strive to understand if the dual combination therapy targeting (i) cognitive and habituation training, and (ii) sensory modulation could result in positive outcomes for individuals resistant to traditional approaches to toilet training.
Figure 1.
Connections between the afferent pathway (from the bladder to the lumbro-sacral region and the spinal cord via the hypogastric and pelvic nerve) and the efferent pathway (from the brain through the PAG, the spinal cord and onto the sphincter muscle and bladder via the pudendal nerve) that gives rise to the involuntary control of micturition or bladder voiding (Adapted from Manto and Jissendi, 2012).
Figure 2.
Neural circuits involving the brain that forms voluntary control of micturition.
During the maximal storage of urine, the pressure against the bladder stimulates nervous reflex to the lumbro-sacral region and the spinal cord. This in turn activates the pontine micturition center that communicates with the higher brain center consisting namely of the medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), and the insular cortex (insular Cx) that promote the guarding reflex for continence. In response, the PAG sends information back to the spinal cord, lumbro-sacral region, bladder to contract the detrusor muscle in the bladder and relax the sphincter muscle in the urethra for voiding. The conscious sensation of bladder pressure and voiding requires the decision of the frontal cortex and the motor learning coordinated through the cerebellum and brainstem. It is the link between the higher centers in the brain with the lower center in the bladder-lumbro-sacral region that constitute the conscious control necessary for toilet training. In behavior terms, the motor and cognitive learning sub-served by the higher brain centers talks to the lower sensory-related processing in the bladder region to allow the individual to decide whether or not to void. When there is neurological damage as in spinal cord injury or hypothetically in neurodevelopmental disorders such as autism, there is a lack of information flow between the higher (frontal-cerebellum-brainstem) and lower centers (bladder-lumbo-sacral); it may be likely that individuals resistant to toilet training belong to this cohort.
6. Sensory processing in autism
Sensory functions play an important role in young children\'s daily performance. As defined in the Occupational Therapy Practice Framework: Domain and Process (American Occupational Therapy Association [AOTA], 2008), the client factors of sensory functions include touch, smell, taste, hearing, seeing, temperature, pressure, proprioceptive processing and vestibular function. Professionals and parents are recognizing that when young children have poor sensory processing functions, it can affect their sensorimotor, cognitive, and social development (Sears, 1994). ASD are associated with differences in sensory functions and affective response to sensory stimuli. Studies have shown that 70%-100% children with ASD exhibit sensory processing difficulties (Adamson, O\'Hare & Graham, 2006; Ben-Sasson et al., 2007; Tomchek & Dunn, 2007). Three sensory constructs (under-responsiveness, over-responsiveness, and sensation seeking) generally characterize the ASD population which are different than typically developing children (Ben-Sasson et al., 2009; Tomchek & Dunn, 2007). These sensory processing difficulties may further impact family routines and daily occupations, such as what a family chooses to do or not to do during family time and how the family prepares daily tasks (Bagby, Dickie & Baranek, 2012).
The cerebellum is strongly implicated in the control of continence by relaying sensory impulses from the sacral spinal regions to the higher centers. A dominant role of the cerebellum is the processing of sensory information through the cerebello-thalamo-cortical tract. Aberration in neuronal circuits of the cerebellum have been proposed (Yip et al., 2007, 2008, 2009) and could be an underlying factor for altered sensory sensitivity observed in individuals with ASD.
In addition, there is an association between the modes of sensory processing with temperament (Brock et al., 2012). The ASD population displays temperament scores distinct from typically developing children on most dimensions of temperament (such as activity, rhythmicity, adaptability, approach, distractibility, intensity, persistence, and threshold). Sensory under-responsiveness was associated with slowness to adapt, low reactivity, and low distractibility. Conversely, sensory over-responsiveness often accompanies hyperactivity, attention deficit and high distractability. A combination of increased sensory processing difficulties, especially in the areas of taste & smell sensitivity and movement-related sensory behavior, was associated with greater challenge in self-care skills, adaptive behaviors and emotional regulations (Lane, Young, Baker & Angley, 2010).
Successful integration of signals from various sensory systems is essential for daily functioning. Sensory processing powerfully influences the channel of information transfer necessary for the biology of continence. Sensory processing further contributes critical sensory integration and necessary motor skills for everyday activities and elaborates the temperament of the child, such as to dictate the affective and attentional capability, without which the behaviors associated with toileting could not be accomplished.
7. Analysis of sensory constructs related to toileting in children with ASD
Under-responsiveness: not aware of wet or stool diapers, not notice when hands are dirty or messy
Over-responsiveness or sensory sensitivity: overwhelmed by tactile inputs from underpants (or touch feelings of underwear edges), smell of urine, sight of fluorescent lights in bathroom, cold feel of toilet seat, loud noise associated with flushing, etc.
Sensation seeking: playing water, urine or stool in the toilet, playing water at the sink, turning on and off the lights in the bathroom, flushing toilet repeatedly
All of these sensory processing difficulties may make toilet training a challenge.
8. Analysis of motor and cognitive processing related to toileting in children with ASD
The cerebellum is a critical brain area for the relaying of sensory information to the cerebral cortex. Sensory information conveyed through motor movement is interpreted in the cerebral cortex, which eventually become stored as motor learning. The learning of motor skill is essential to daily self-help routine. In the cerebellum, the olivocerebellar pathway is a key pathway contributing to learning of motor skills. When the olivocerebellar circuit is deficient as reported in the autism literature (Blatt et al., 2010), it is expected that motor learning will correspondingly be impacted. The role of motor learning in neurodevelopmental disorders and its noticeable implications for the understanding and management of these patients has recently gained more attention (Manto & Jissendi, 2012).
It is common for children with ASD to exhibit deficits in sensory-motor processing such as apraxia. For example, complex motor planning and multiple sensory-motor steps are involved in self-care tasks such as undressing, toileting, cleaning up and hand-washing. The task of toileting requires children to utilize sufficient balance, trunk stability & gross motor skills to get on/off toilet seat and fine more coordination to dress & undress. Dressing or undressing is one specific activity within the self-care area commonly known as activity of daily living (ADL). Dressing independently as a child is important for demonstrating self-reliance (Christiansen & Matuska, 2004). Children with ASD often struggle completing these multiple sensory-motor steps related to toileting.
Independent toileting requires many motor skills that differ by gender, by the facility used, and by the type of clothing worn in different contexts followed by specific cultural norms. A child has to demonstrate his or her abilities to accomplish a series of sensory-motor activities. These activities often require a higher level of executive functioning to form an idea of motor sequences, and to perform a complex loop of motor planning & executions of movement patterns. The following paragraphs provide examples of motor and cognitive skills related to toileting:
Motor skills related to toileting: moving on and off the toilet; sufficient balancing skills; muscle strength, postural control, and trunk stability to sit safely on the toilet; shifting weight to wipe and to undress then dress after toileting; active range of motion to reach for toilet paper, to wipe the perineal area and to flush the toilet; fine motor skills and bilateral coordination to grasp toilet paper; somatosensory and proprioceptive skills to feel the hold/grasping of the toilet paper; directional movements to clean the perineal area; fine motor coordination to unfasten, remove, and refasten underwear and clothing. For boys who have insufficient gross motor skills and are lacking balancing skills or trunk stability may have a difficulty to stand in front of a urinal or direct urine into the toilet. Belts or additional accessories may also be worn, which would require additional eye-hand coordination and perceptual functions.
Cognitive functions in toileting: familiarizing the child to the environment of the toilet so that it is perceived as being a friendly place where one uses the toilet for actions associated with voiding and evacuation; establishing a habit of sitting on the toilet for a length of time; succesfully voiding and evacuating in the toilet and being reinforced positively; forming a habit of going to the toilet to void and evacuate; realizing the urge to void and independently going to the toilet; feeling the pressure to the bowel and independently making the trip to the toilet; performing the steps of voiding, evacuation, cleaning up oneself, handwashing and drying the hands.
9. Task analysis of toileting in children with ASD
Toilet hygiene is an important activity of daily living task as it relates to independence in daily functioning, self-identity, and social acceptance. The following paragraphs provide examples of how toileting may impact routines and psychosocial aspects in children with ASD:
Social Interaction and Imitation: interest in watching others perform certain tasks, then imitating “go potty”, in children with ASD less responsive to social rewards such as praise of “good job” for successful toileting might be a challenge.
Communication: ability to express a need to go to the bathroom. Boswell & Gray (2012) in TEACCH indicate the importance of having a communication system for children with ASD to initiate the toilet sequences, such as signaling that he needs to go to the bathroom; and have a back up plan in place when in a unfamiliar environment. Such plan may include an evaluation of the environmental contexts and incorporating “teachable moments" to teach the child how to use systematic communication tools, such as objects, pictures, or words to communicate in other settings.
Tasks in bathroom include: obtaining and using supplies, clothing management – undressing and dressing, maintaining toileting position, transferring to & from toileting position, cleaning body & maintaining posture & balance during cleaning, caring for menstrual needs (Christiansen & Matuska, 2004).
Teaching and practicing toilet hygiene: children with ASD who also exhibit tactile sensitivity may avoid hand-over-hand assistance to turn the water on and off at the sink during hand-washing (Kern, Wakeford & Aldridge, 2007; Dunn, 1997). With compromised motor planning and eye-hand coordination, the movement of turning on and off of light and water, or holding on the handle to flush toilet would be daunting for the children with ASD.
Change in routines associated with toileting: taking away diapers, wearing underpants.
Caregiving: there are certain caregiving stresses associated with toileting (Dalrymple & Ruble, 1992). When a child is toilet trained, financial and time benefits arise, such as money savings of diapers and wipes; available time from assisting toileting for caregivers to engage in other daily tasks (Lee, 2010).
The next paragraph implements, via case studies, the aforementioned task analysis involved in toilet training, including the motor skills and cgnitive domain. Case studies of two children who are siblings illustrate the success of toilet training in one child and a lack of independent toileting in another child; therefore, provide insight into factors that could hinder success.
10. Case studies utilizing the training protocol
The procedure is adapted from Azrin and Foxx (1971) and was carried out in the children’s home during the evening 4 hours before bedtime. The participants’ parents were interviewed prior to baseline collection and the habit journal was constructed based on the interview. In addition, the researcher compiled a journal recording the number and time of voids after meal-time and at each hour noting the baseline voiding pattern. The data was collected across two children, who are siblings, given the pseudo-name of Jim (10 year old male with a diagnosis of autism) and Bob (5 year old male also with autism) for anonymity. A schedule of reinforcers were noted and used for the protocol (see Table 1). Baseline data includes the frequency of voids per trip to the toilet. Both children were able to void, on occasion, upon verbal prompting but self-initiation was lacking. After baseline was taken, the toilet training program commenced. Unfortunately the training was not as intensive as would have been the ideal scenario. The training program was limited logistically by the children’s schedule and school commitment, resulting in the time allocated for the toilet training programme to be 3 hours per evening for twice a week. After 4 weeks at this level of contact time, voiding was 100% for both children (Figures 1 and 2). Follow up after the intervention was maintained at 100%. However, self-initiation was only observed in Bob but not in Jim. While both children have autism, Bob’s level of communication was superior to Jim in that Bob could independently express approximately 15 words. On the other hand, Jim was non-verbal and demonstrated less cognitive skills and receptive communication.
The protocol consists of first familiarizing the children to the toilet routine. Children were shown videos, pictures, songs of all aspects associated with toileting. After the multi-media exposure, children were encouraged to visit the bathroom, play with flushing the toilet, turn on and off the faucet, wash their hands with soap, dry with a towel and play with the toilet paper. The aim of the first stage is to allow the children to enjoy going to the bathroom. Stage 2 of the protocol is the child entering the bathroom in the presence of reinforcers so that the bathroom is viewed as a friendly place. Children sat on the toilet for 5 minutes with their favourite toy and activity. The time is increased to 10 minutes when children showed enthusiasm for the toilet sitting routine. When successful, implementation of the scheduled sitting begins. The routine of 15 minutes on the toilet followed by 15 minutes of break away from the toilet and bathroom was performed. To provide maximum opprtunity for voiding, children were given drinks every 15 minutes. In scheduled toilet sitting, the children were taught to undress by themselves from the waist down and continuously sit on the toilet without reinforcer. As they void, they were praised and reinforced with their favourite toy. As the percentage of voids increases, the children were given breaks even before the 15 minute-sitting time were up to instill the notion that once voiding has completed, it is time to leave the bathroom. Upon independent void, children were immediately rewarded with fun and interesting activities in another room.
\n\t\t
\n\t\t
\n\t\t\t
• Stage 1: Introduction to toilet through multi-media education, such as Elmo potty video, toilet training songs, Elmo coloring book, toilet training stories
\n\t\t
\n\t\t
\n\t\t\t
• Stage 2: 5 minutes on the toilet engaged in favourite activity, such as watching DVD, playing Lego®, or favourite toys
\n\t\t
\n\t\t
\n\t\t\t
• Stage 3: Extend to 10 minutes on the toilet engaged in favourite activity
\n\t\t
\n\t\t
\n\t\t\t
• Stage 4: 15 minutes uninterrupted toilet sitting while engaged in favourite activity
\n\t\t
\n\t\t
\n\t\t\t
• Stage 5: Hydrate with water every 15 minutes followed by routine 15 minutes toilet sitting
\n\t\t
\n\t\t
\n\t\t\t
• Stage 6: Toilet sitting for 15 minutes duration, without favourite activity, intervened with 15 minutes break. This is the scheduled 15 minutes on toilet and 15 minutes off toilet\n\t\t\t
\n\t\t
\n\t\t
\n\t\t\t
• Stage 7: Toilet sitting for 15 minutes noting successful voids and reinforcing with praise and 2 minutes of favourite activity as reinforcer and a break
\n\t\t
\n\t\t
\n\t\t\t
• Stage 8: When voiding is independent and successful, breaks are introduced into the 15 minutes toilet sitting and 15 minutes break routine extending the time of break
\n\t\t
\n\t
Table 1.
Protocol for Voiding
Figure 3.
Percentage of successful voids (3a) and percentage successful void upon self-initiation (3b) for Jim.
Figure 4.
Percentage of successful voids (4a) and percentage successful void upon self-initiation (4b) for Bob.
Jim and Bob differed in their outcomes in toilet training. While both children could complete the steps associated with toileting as shown in Figures 3a and 4a, only Bob could initiate the process independently and did not need to wear a diaper following intervention since Bob could initiate independently (see Figure 4b). The other child, Jim, could only void when prompted and failed to achieve the independence (Figure 3b) necessary in order for him to graduate from the diaper. A sensory profile analysis (elaborated in succeeding paragraphs) using the Sensory Profile and the Sensory Processing Measure (SPM) illustrated the difference in sensory processing between Bob and Jim. Bob, not only has better cognitive ability but also has better sensory processing which may contribute to a more intact neural circuit between the higher brain centers with the lower bladder-lumbro-sacral and spinal region. It is likely that an intact circuit predicts better outcomes in toilet training. Nevertheless, further sensory and cognitive training for Jim could help him eventually develop independence.
11. Evaluation Results and Summary Interpretation of Sensory Processing for the Case Studies
11.1. Sensory profile
Dunn, W. (1999).Sensory Profile user’s manual.San Antonio, TX:Psychological Corporation.
\n\t\t\t\t
The Sensory Profile Caregiver Questionnaire (SP; Dunn, 1999) is a widely used pediatric assessment that provides a standard method for professionals and caregivers to measure children’s (from 3-10 years of age) responses to sensory events in everyday experiences. Caregivers complete the questionnaire by reporting how frequently their children respond in the way described by each item, using a 5-point Likert scale (nearly never, seldom, occasionally, frequently, almost always). There are 125 items included in the profile
Cut off scores were determined by preparing a cumulative frequency distribution with the national research sample of children without disabilities (n = 1,037) (Dunn & Westman, 1997) and computing the raw scored cut scores for -1 SD and -2 SD. This was done for the SSP total score and for each section. Refer to the Summary section for representation of the raw scores for 1 SD and 2 SD below the mean.
, which are: (1) sensory processing, (2) modulation, and (3) behavioral & emotional responses. The sensory processing section includes six sensory systems (e.g., auditory, visual, vestibular, tactile, oral). The modulation section contains five item categories that measure children’s ability to regulate sensory inputs in order to produce an appropriate response to the context (Dunn, 1997). The summary scores are then classified as Typical Performance
Typical Performance is scores at or above the -1 SD point. This classification system is a statistical proportion usually represents about 84% of the norm. Section raw score totals that fall within this range indicate typical sensory processing abilities. This range indicates that the child performed no different than the 84% of the research sample of childrenwithout disabilities (n = 1,037).
, Probable Difference
Probable Difference is scores at or above the -2 SD point below the mean, but lower than -1 SD point below the mean. This classification system is a statistical proportion usually represents about 14% of the norm. Section raw score totals that fall within this range indicate questionable areas of sensory processing abilities. This range indicates that the child’s performance was between the 2nd and 16th percentile, representing 14% of the sample population.
, or Definite Difference
Definite Difference is scores below the -2 SD point below the mean. This classification system is a statistical proportion usually represents about 2% of the sample population. Section raw score totals that fall within this range indicate sensory processing difficulties. This range indicates that the child is performing like a child in the lowest 2% of the sample, when compared to the research sample of 1,037 children without disabilities.
in each sensory processing system. The Sensory Profile was given to Jim and Bob\'s caregiver to reveal the possible contribution of his sensory processing patterns to daily performance and/or functional challenges. The following paragraphs summarize Jim and Bob’s performance from the Sensory Profile.
11.2. Jim’s section & factor summaries
Jim has Probable Difference scores in the following areas:
Modulation Difficulty in Visual Processing: occasionally prefers to be in the dark; has difficulty putting puzzles together (as compared to same age children); has a hard time finding objects in competing backgrounds (for example, shoes in a messy room, favorite toy in the junk drawer); occasionally looks carefully or intensely at objects/people (such as stares); has trouble staying between the lines when coloring or when writing.
Modulation Difficulty in Touch Processing: doesn’t seem to notice when face or hands are messy (low registration); has difficulty standing in line or close to other people (tactile sensitivity); expresses discomfort at dental work or tooth brushing (for example, cries or fights); avoids getting messy (such as in paste, sand, finger paint, glue, tape).
Multisensory Processing: has difficulty paying attention; walks on toes.
Modulation Related to Body Position and Movement: fears falling or heights; seems accident-prone; hesitates going up or down curbs or steps (for example, in cautious, stops before moving).
Modulation of Movement Affecting Activity Level: Low Endurance/Tone; spends most of the day in sedentary play (for example, does quiet things); becomes overly excited during movement activity.
Modulation of Visual Input Affecting Emotional Responses & Activity Level: avoids eye contact; watches everyone when they move around the room; doesn’t notice when people come into the room.
Emotional/Social Responses: has trouble “growing up” (for example, reacts immaturely to situations); has definite fears; has difficulty making friends (for example, does not interact or participate in group play); doesn’t have a sense of humor.
Sensory Seeking: enjoys strange noises/seeks to make noise for noise’s sake; seeks out all kinds of movement activities.
Jim has Definite Difference scores in the following areas:
Auditory Hypersensitivity: responses negatively to unexpected or loud noises (for example, cries or hides at noise from vacuum cleaner, dog barking, hair dryer); has trouble completing tasks when the radio is on.
Seeking Vestibular Inputs: seeks all kinds of movement and this interferes with daily routines (for example, cannot sit still, fidgets); occasionally rocks in desk/chair/on floor.
Oral Motor Hypersensitivity and Dyspraxia: avoids certain tastes or food smells that are typically part of children’s diets; will only eat certain tastes (such as rice, fish & chicken); picky eater, especially regarding food textures.
Modulation Related to Endurance/Tone: cannot lift heavy objects; shows poor endurance & tires easily.
Modulation of Sensory Inputs Affecting Emotional/Social Responses and Daily Performance: such as Poor Registration and Oral Sensory Sensitivity; does perceive body language or facial expressions (for example, unable to interpret).
Behavioral Outcomes due to Challenges in Sensory Processing: such as Emotionally Reactive and Inattention/Distractibility
11.3. Bob’s section & factor summaries
Bob has Probable Difference scores in the following areas:
Sensory Seeking in Visual Processing: seeks all kinds of movement and this interferes with daily routines (for example, can’t sit still, fidgets, being whirled by adult, merry-go-rounds, playground equipment, moving toys, etc.).
Oral Motor Hypersensitivity and Dyspraxia: gags easily with food textures or food utensils in mouth; avoids certain tastes or food smells that are typically part of children’s diets; will only eat certain tastes (such as rice, fish, chicken & noodle); picky eater, especially regarding food textures.
Modulation Related to Body Position and Movement: seems accident-prone; hesitates going up or down curbs or steps (for example, in cautious, stops before moving); fears falling or heights; takes movement or climbing risks during play that compromise personal safety.
Sensory Seeking: enjoys strange noises/seeks to make noise for noise’s sake; seeks out all kinds of movement activities; becomes overly excited during movement activity; “on the go”.
Bob has Definite Difference scores in the following areas:
Modulation of Auditory Processing: holds hands over ears to protect ears from sound; responses negatively to unexpected or loud noises (for example, cries or hides at noise from vacuum cleaner, dog barking, hair dryer); has trouble completing tasks when the radio is on; appears to not hear what you say (for example, does not “tune-in” to what you say, appears to ignore you).
Multisensory Processing: has difficulty paying attention; looks away from tasks to notice all actions in the room.
Modulation of Movement Affecting Activity Level: spends most of the day in sedentary play (for example, does quiet things); becomes overly excited during movement activity; frequently “on the go”.
Modulation of Sensory Inputs Affecting Emotional/Social Responses and Daily Performance: express discomfort at dental work or tooth brushing; don’t seem to notice when face or hands are messy; has difficulty making friends (for example, does not interact or participate in group play); talks self through tasks; has trouble staying between the lines when coloring or when writing; has difficulty tolerating changes in routines.
Inattention/Distractibility: contributed by poor modulation of Auditory Processing
Low Registration: high pain tolerance; lack of temperature awareness; don’t seem to notice when face or hands are messy.
12. Sensory profile results
In comparison of Jim & Bob’s Sensory Profile results, Jim demonstrated multifaceted sensory processing and modulation difficulties in several areas, including: Low Endurance/Tone, Oral Sensory Sensitivity, Fine Motor/Perceptual Skills, Visual Processing, Vestibular Processing, and Modulation of Visual Input Affecting Emotional Responses and Activity Level. Despite showing a more organized sensory processing profile, Bob displays problems in Modulation of Movement Affecting Activity Level and Emotional/Social Responses. Through sensory motor activities, he demonstrates ideational dyspraxia and problems with motor planning, which are validated through his Sensory Profile by engaging in sedentary play. In comparison to Jim, who displays complex multi-sensory processing deficits, including somatodyspraxia, tactile, vestibular & proprioceptive among other sensorimotor deficits. This may help explaining Jim’s higher level of difficulties with activities of daily living (ADLs), including toileting.
Modulation of Sensory Input Affecting Emotional Responses
\n\t\t\t
10/20**
\n\t\t\t
11/20**
\n\t\t
\n\t\t
\n\t\t\t
Modulation of Visual Input Affecting Emotional Responses and Activity Level
\n\t\t\t
13/20*
\n\t\t\t
16/20
\n\t\t
\n\t\t
\n\t\t\t
\n\t\t\t\tBehavior and Emotional Responses\n\t\t\t
\n\t\t
\n\t\t
\n\t\t\t
Category
\n\t\t\t
Raw Score - Jim
\n\t\t\t
Raw Score - Bob
\n\t\t
\n\t\t
\n\t\t\t
Emotional/Social Responses
\n\t\t\t
55/85*
\n\t\t\t
43/85**
\n\t\t
\n\t\t
\n\t\t\t
Behavioral Outcomes of Sensory Processing
\n\t\t\t
15/30**
\n\t\t\t
15/30**
\n\t\t
\n\t\t
\n\t\t\t
Items Indicating Thresholds for Response
\n\t\t\t
13/15
\n\t\t\t
13/15
\n\t\t
\n\t
Table 2.
Comparison of Jim & Bob’s Sensory Profile results (comparing to children aged 3-10 years old):
No indication: Typical Performance
* Indicates Probable Difference
** Indicates Definite Difference
13. Sensory Processing Measure (SPM)
Parham, L. D., Ecker, C., Miller Kuhaneck, H., Henry, D. A., & Glennon, T. J. (2007). Sensory Processing Measure (SPM): Manual. Los Angeles, CA: Western Psychological Services.
\n\t\t\t
The Sensory Processing Measure (SPM) is an integrated system of rating scales that is used to assess children\'s response to sensory stimuli in various environments. The SPM consists of three forms: the Home Form, the Main Classroom Form, and the School Environments Form. The SPM is based on sensory integration theory (Ayres, 1972
Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.
, 1979
Ayres, A. J. (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services.
, 2005
Ayres, A. J. (2005). Sensory integration and the child, 25th anniversary edition. Los Angeles, CA: Western Psychological Services.
), which proposes that the integration and regulation of everyday sensory experiences is critical neurobehavioral process that affects development and function. Reponses of "never", "occasionally", "frequently", or "always" are given in answer to questions regarding areas of Social Participation, Vision, Hearing, Touch, Taste & Smell, Body Awareness, Balance & Motion, and Planning & Ideas. Results are converted to T scores, and compared to responses of typically developing children aged 3 to 12 years old. Scores are interpreted within ranges described as "typical" (within normal limits), "some problems" (*T score of 60-69), and "definite dysfunction" (**T score of 70-80). In addition to the Sensory Profile, Jim and Bob’s caregiver also completed Sensory Processing Measure (SPM) – Home Form
. This assessment is similar to the Sensory Profile, with additional information on Social Participation and Praxis (the ability to plan and organize movement).
Results of the SPM (Table 3) indicate Jim is experiencing definite dysfunction in the areas of Hearing, Motor Planning, and Social Participation. Some sensory problems are also indicated, including: Vision, Touch, Body Awareness, and Balance & Motion. Bob’s SPM results show fewer deficits in multi-sensory processing, with definite dysfunction in Motor Planning & Ideas. Some sensory problems are indicated, including: Vision, Hearing, Touch, Motor Planning, and Social Participation. In comparison of Jim & Bob’s Sensory Processing Measure results, Jim demonstrates more sensory deficits in multiple categories, especially in the areas of Social Participation, Hearing, and Body Awareness.
\n\t\t
\n\t\t
\n\t\t
\n\t\t
\n\t\t
\n\t\t
\n\t\t
\n\t\t
\n\t\t\t
\n\t\t\t
\n\t\t\t\tRaw Score\n\t\t\t
\n\t\t\t
\n\t\t\t\tT-Score\n\t\t\t
\n\t\t\t
\n\t\t\t\tPercentile\n\t\t\t
\n\t\t
\n\t\t
\n\t\t\t
\n\t\t\t\tArea of Assessment\n\t\t\t
\n\t\t\t
\n\t\t\t\tJim\n\t\t\t
\n\t\t\t
\n\t\t\t\tBob\n\t\t\t
\n\t\t\t
\n\t\t\t\tJim\n\t\t\t
\n\t\t\t
\n\t\t\t\tBob\n\t\t\t
\n\t\t\t
\n\t\t\t\tJim\n\t\t\t
\n\t\t\t
\n\t\t\t\tBob\n\t\t\t
\n\t\t
\n\t\t
\n\t\t\t
Social Participation
\n\t\t\t
38
\n\t\t\t
25
\n\t\t\t
80**
\n\t\t\t
65*
\n\t\t\t
"/>99
\n\t
93
\n
\n
\n\t
Vision
\n\t
23
\n\t
21
\n\t
69*
\n\t
68*
\n\t
97
\n\t
96
\n
\n
\n\t
Hearing
\n\t
20
\n\t
18
\n\t
71**
\n\t
69*
\n\t
98
\n\t
97
\n
\n
\n\t
Touch
\n\t
17
\n\t
21
\n\t
61*
\n\t
66*
\n\t
86
\n\t
95
\n
\n
\n\t
Body Awareness
\n\t
17
\n\t
14
\n\t
61*
\n\t
57
\n\t
86
\n\t
76
\n
\n
\n\t
Balance & Motion
\n\t
19
\n\t
20
\n\t
64*
\n\t
65*
\n\t
92
\n\t
93
\n
\n
\n\t
Planning/Ideas
\n\t
35
\n\t
25
\n\t
80**
\n\t
70**
\n\t
"/>99
\n
97.5
\n
\n
\n\t
Total
\n\t
104
\n\t
103
\n\t
67*
\n\t
67*
\n\t
95.5
\n\t
95.5
\n
\n
Table 3.
Comparison of Jim & Bob\'s Sensory Processing Measure (SPM): Home Report Results
T-Score of 40-59 indicates "typical performance"
*T-Score of 60-69 indicates "some problems"
**T-Score of 70-80 indicates "definite dysfunction"
Figure 5.
A summary T-Scores of Sensory Processing Measure (SPM) for Jim and Bob. Sensory processing areas are represented on the x-axis and T-Scores are indicated on the y-axis. The darkest shaded zone for the T-Scores between 70 and 80 represent definite dysfunction. Correspondingly, the lighter shaded zone between T-Scores of 60 and 70 indicate some problems. Note that although the total T-Scores for Jim and Bob is the same and fell under ”some problems”, Jim has a more complex sensory processing profile and somatosensory processing deficits as indicated on the above-mentioned Sensory Profile results.
14. Summary interpretation of Jim and Bob’s sensory processing
When a child has difficulty in a particular sensory system, it means that this form of sensory input would be confusing or upsetting to the child. As a result, the child may avoid situations that overload him with specific types of sensory stimuli or acting inappropriately when such stimuli are unavoidable. Problems in multisensory processing could cause a child to become easily agitated or distracted around busy environments & while experiencing new sensations. At times, the child may show emotional distresses and seem disorganized in their movement patterns or social interactions. In any case, difficulty with sensory inputs can interfere with the child’s ability to modulate emotions, behavior, and/or activity level appropriately in response to sensory stimuli in contexts and to complete important activities successfully.
The Sensory Profile & the Sensory Processing Measure scores reveal Jim and Bob’s sensory processing and modulation difficulties in multiple areas. Jim’s sensory modulation difficulties are more profound and complex than Bob (Table 2, Table 3 and Figure 5). For example, Jim demonstrates several sensory-based motor deficits and somatodyspraxia, including tactile defensiveness, poor endurance, low muscle tone, and lack of body awareness. His proximal joint instability, poor posture control & lack of trunk stability add to his uncoordinated movements & fatigue during gross motor tasks. In order to make sense of his body positions in space, Jim may exhibit excessive movements, grasp objects too tightly, or push too hard when engaging with everyday objects. In comparison, Bob’s ideational dyspraxia may contribute to his needs of repeating movement patterns to make sense of movement patterns. These sensory processing deficits would affect their attention to tasks, social participation and functional performance in daily routines, such as toileting.
Future directions
Much of the research studies on toilet training in autism has centered on operant conditioning, especially training protocols. Toilet training develops as a result of culture and is a condition of civilized living, but there may be reasons for examining an even earlier process. This process speaks of the inherent biological drive which communicates between lower and higher centers and is shaped by learning. In the population of ASD who may be cognitively impacted to a severe degree, independence in toileting is inhibited by the lack of sensory-neural integration. This chapter attempts to address the issue of sensory processing challenges in toilet training for the intervention of the resistant group. Toileting is an essential daily living skill which typically developing individuals often take for granted. It is in the lack of its skill acquisition that profoundly impacts the children with ASD, their families, caregivers and society as a whole.
Abbreviations
SOC = Social Participation
VIS = Vision
HEA = Hearing
TOU = Touch
BOD = Body Awareness
BAL = Balance and Motion
PLA = Motor Planning and Ideas
TOT = Total T-Scores
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Introduction",level:"1"},{id:"sec_2",title:"2. Toilet training in autism ",level:"1"},{id:"sec_3",title:"3. Impact of lack of independence in toileting in family’s life",level:"1"},{id:"sec_4",title:"4. Self-care skills in children with ASD: A brief overview ",level:"1"},{id:"sec_5",title:"5. Neurobiology of toilet training",level:"1"},{id:"sec_6",title:"6. Sensory processing in autism ",level:"1"},{id:"sec_7",title:"7. Analysis of sensory constructs related to toileting in children with ASD ",level:"1"},{id:"sec_8",title:"8. Analysis of motor and cognitive processing related to toileting in children with ASD ",level:"1"},{id:"sec_9",title:"9. Task analysis of toileting in children with ASD ",level:"1"},{id:"sec_10",title:"10. Case studies utilizing the training protocol",level:"1"},{id:"sec_11",title:"11. Evaluation Results and Summary Interpretation of Sensory Processing for the Case Studies",level:"1"},{id:"sec_11_2",title:"11.1. Sensory profileDunn, W. (1999).Sensory Profile user’s manual.San Antonio, TX:Psychological Corporation.\n\t\t\t\t",level:"2"},{id:"sec_12_2",title:"11.2. Jim’s section & factor summaries",level:"2"},{id:"sec_13_2",title:"11.3. Bob’s section & factor summaries",level:"2"},{id:"sec_15",title:"12. Sensory profile results",level:"1"},{id:"sec_16",title:"13. Sensory Processing Measure (SPM)Parham, L. D., Ecker, C., Miller Kuhaneck, H., Henry, D. A., & Glennon, T. J. (2007). Sensory Processing Measure (SPM): Manual. Los Angeles, CA: Western Psychological Services.\n\t\t\t",level:"1"},{id:"sec_17",title:"14. Summary interpretation of Jim and Bob’s sensory processing",level:"1"},{id:"sec_18",title:"Future directions",level:"1"},{id:"sec_19",title:"Abbreviations",level:"1"}],chapterReferences:[{id:"B1",body:'Adamson, A., O\'Hare, A., & Graham, C. (2006). Impairments in sensory modulation in children with autistic spectrum disorder. British Journal of Occupational Therapy, 68(8), 357-364.'},{id:"B2",body:'American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625–683. doi: 10.5014/ajot.62.6.625'},{id:"B3",body:'Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.'},{id:"B4",body:'Ayres, A. J. (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services.'},{id:"B5",body:'Ayres, A. J. (2005). Sensory integration and the child, 25th anniversary edition. Los Angeles, CA: Western Psychological Services.'},{id:"B6",body:'Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training in the institutionalized retarded. Journal of Applied Behavior Analysis, 4, 89-99.'},{id:"B7",body:'Bagby, M. S., Dickie, V. A., & Baranek, G. T. (2012). How sensory experiences of children with and without autism affect family occupations. American Journal of Occupational Therapy, 66, 78–86. doi: 10.5014/ajot.2012.000604'},{id:"B8",body:'Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Tager-Flusberg, H., Carter, A. S., Kadlec, M. B., & Dunn, W. (2007). Extreme sensory modulation behaviors in toddlers with autism spectrum disorders. American Journal of Occupational Therapy, 61, 584–592.'},{id:"B9",body:'Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 1-11.'},{id:"B10",body:'Blatt, G. J., Soghomonian, J. J., & Yip, J. (2010). Glutamic Acid Decarboxylase (GAD) as a Biomarker of GABAergic Activity in Autism: Impact on Cerebellar Circuitry and Function. In G. J. Blatt (Ed.), The Neurochemical Basis of Autism (1st ed.). New York; Springer. '},{id:"B11",body:'Boswell, S., & Gray, D. (2012). Applying structured teaching principles to toilet training. Retrieved May 4, 2012 from http://teacch.com/educational-approaches'},{id:"B12",body:'Brock, M. E., Freuler, A., Baranek, G. T., Watson, L. R., Poe, M. D., & Sabatino, A. (2012). Temperament and sensory features of children with autism. Journal of Developmental Disorders. Feb 25 (Epub ahead of print) doi: 10.1007/s10803-012-1472-5'},{id:"B13",body:'Cermak, S. A., Orsmond, G. I., Tager-Flusberg, H., Carter, A. S., Kadlec, M. B., & Dunn, W. (2007). Extreme sensory modulation behaviors in toddlers with autism spectrum disorders. American Journal of Occupational Therapy, 61, 584–592.'},{id:"B14",body:'Chapparo, C. J., & Hooper, E. (2005). Self-care at school: Perceptions of 6-year-old children. American Journal of Occupational Therapy, 59, 67–77. '},{id:"B15",body:'Christiansen, C. H., & Baum, C. M. (2005). The complexity of human occupation. In C. H. Christiansen, C. M. Baum, & J. Bass-Haugen (Eds.), Occupational therapy: Performance, participation, and well-being (3rd ed.) (p. 9). Thorofare, NJ: SLACK Inc. '},{id:"B16",body:'Christiansen, C. H., & Matuska, K. M. (2004). Ways of living: Self-care strategies for special needs (3rd ed.). Bethesda, MD: American Occupational Therapy Association. '},{id:"B17",body:'Cicero, F. R., & Pfadt, A. (2002). Investigation of a reinforcement-based toilet training procedure for children with autism. Research in Developmental Disabilities, 23, 319-331. '},{id:"B18",body:'Dalrymple, N. J., & Ruble, L. A. (1992). Toilet training and behaviors of people with autism: Parent views. Journal of Autism and Developmental Disorders, 22, 265-275.'},{id:"B19",body:'Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants & Young Children, 9(4), 23-35.'},{id:"B20",body:'Fowler, C. J., Griffiths, D. & de Groat, W. C. (2008). The neural control of micturition. Nat Rev Neurosci, 9(6), 453-466.'},{id:"B21",body:'Furman, A. (2001). Young children with autism spectrum disorder. Early Childhood Connections, 7(2), 43-49.'},{id:"B22",body:'Gourcerol, G., Vitton, V., Leroi, A. M., Michot, F., Abysique, A., & Bouvier, M. (2011). How sacral nerve stimulation works in patients with faecal incontinence. Colorectal Dis. 13(8), e203-11.'},{id:"B23",body:'Gray, D. E. (1994). Coping with autism: Stresses and strategies. Sociology of Health & Illness, 16(3), 275-302. '},{id:"B24",body:'Griffiths, D. J., Tadic, S. D., Schaefer, W., & Resnick, N. M. (2009). Cerebral control of the lower urinary tract: How age-related changes might predispose to urge incontinence. Neuroimage, 47(3), 981-6.'},{id:"B25",body:'Kellegrew, D. H. (1998). Creating opportunities for occupation: An intervention to promote the self-care independence of young children with special needs. American Journal of Occupational Therapy, 52, 457-465.'},{id:"B26",body:'Kellegrew, D. H. (2000). Constructing daily routines: A qualitative examination of mothers with young children disabilities. American Journal of Occupational Therapy, 54, 252-259.'},{id:"B27",body:'Kern, P., Wakeford, L., & Aldridge, D. (2007). Improving the performance of a young child with autism during self-care tasks using embedded song interventions: A case study. Music Therapy Perspectives, 25(1), 43-51.'},{id:"B28",body:'Kroeger, K., & Sorensen, R. (2010). A parent training model for toilet training children with autism. Journal of Intellectual Disability Research, 54, 556–567. doi: 10.1111/j.1365-2788.2010.01286.x'},{id:"B29",body:'Lane, A. E., Young, R. L., Baker, A. E. Z., & Angley, M. T. (2010). Sensory processing subtypes in autism: Association with adaptive behavior. Journal of Autism Developmental Disorder, 40, 112–122.'},{id:"B30",body:'LeBlanc, L. A., Carr, J. E., Crossett, S. E., Bennett, C. M., & Detweiler, D. D. (2005). Intensive outpatient behavioral treatment of primary urinary incontinence of children with autism. Focus on Autism and Other Developmental Disabilities, 20(2), 98-105.'},{id:"B31",body:'Lee, E. B. (2010). Toilet training and autism spectrum disorders. Nashville, TN: Vanderbilt University Medical Center.'},{id:"B32",body:'Manto, M. U., & Jissendi, P. (2012). Cerebellum: links between development, developmental disorders and motor learning. Front Neuroanat. 6, 1. Epub Jan. 23'},{id:"B33",body:'Parham, L. D., & Ecker, C. (2007). Sensory Processing Measure (SPM) Home Form. Los Angeles, CA: Western Psychological Services.'},{id:"B34",body:'Parham, L. D., Ecker, C., Miller Kuhaneck, H., Henry, D. A., & Glennon, T. J. (2007). Sensory Processing Measure (SPM): Manual. Los Angeles, CA: Western Psychological Services.'},{id:"B35",body:'Porterfield, S. L. (2002). Work choices of mothers in families with children with disabilities. Journal of Marriage and Family, 64, 972–981. '},{id:"B36",body:'Rockville, (2006). The effectiveness of different methods of toilet training for bowel and bladder control in agency for healthcare research & quality (US). Evidence Reports/Technology Assessments, No. 147; Bookshelf ID: NBK38232.'},{id:"B37",body:'Rogers, S. J., & D’Eugenio, D. B. (1991). Developmental Programming for Infants and Young Children: Vol. 1. Assessment and Application. Ann Arbor, MI; The University of Michigan Press.'},{id:"B38",body:'Rumfelt-Wright, C. S. (2001). Keeping it clean. All Together Now! (ATN), 7(2), 5-7.'},{id:"B39",body:'Sasa, M., & Yoshimura, N. (1994). Locus coeruleus noradrenergic neurons as a micturition center. Microsc Res Tech, 29(3), 226-30.'},{id:"B40",body:'Sears, C. (1994). Recognizing and coping with tactile defensiveness in young children. Infant & Young Children, 6(4), 46-53.'},{id:"B41",body:'Shelov, S., Altmann, T. R. (Eds.) (2009). Caring for Your Baby and Young Child: Birth to Age 5 (5th ed.). New York, NY: Bantam Books, American Academy of Pediatrics.'},{id:"B42",body:'Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: A comparative study using the Short Sensory Profile. American Journal of Occupational Therapy, 61, 190–200.'},{id:"B43",body:'Wheeler, M. (2007). Toilet training for individuals with autism or other developmental issues (2nd ed.). Arlington, TX: Future Horizons.'},{id:"B44",body:'Yip, J., Soghomonian, J. J., & Blatt, G. J. (2007). Decreased GAD67 mRNA levels in cerebellar Purkinje cells in autism: Pathophysiological implications. Acta Neuropathol, 113(5), 559-68. '},{id:"B45",body:'Yip, J., Soghomonian, J. J., & Blatt, G. J. (2008). Increased GAD67 mRNA levels in cerebellar interneurons in autism: Implications to Purkinje cell dysfunction. J Neurosci Research, 86(3), 525-530. '},{id:"B46",body:'Yip, J., Soghomonian, J. J., & Blatt, G. J. (2009). Decreased GAD65 mRNA levels in select subpopulations in the cerebellar dentate nuclei in autism: An in situ hybridization study. Autism Research, 2(1), 50-9.'}],footnotes:[{id:"fn1",explanation:"Dunn, W. (1999).Sensory Profile user’s manual.San Antonio, TX:Psychological Corporation."},{id:"fn2",explanation:"Cut off scores were determined by preparing a cumulative frequency distribution with the national research sample of children without disabilities (n = 1,037) (Dunn & Westman, 1997) and computing the raw scored cut scores for -1 SD and -2 SD. This was done for the SSP total score and for each section. Refer to the Summary section for representation of the raw scores for 1 SD and 2 SD below the mean."},{id:"fn3",explanation:"Typical Performance is scores at or above the -1 SD point. This classification system is a statistical proportion usually represents about 84% of the norm. Section raw score totals that fall within this range indicate typical sensory processing abilities. This range indicates that the child performed no different than the 84% of the research sample of childrenwithout disabilities (n = 1,037)."},{id:"fn4",explanation:"Probable Difference is scores at or above the -2 SD point below the mean, but lower than -1 SD point below the mean. This classification system is a statistical proportion usually represents about 14% of the norm. Section raw score totals that fall within this range indicate questionable areas of sensory processing abilities. This range indicates that the child’s performance was between the 2nd and 16th percentile, representing 14% of the sample population."},{id:"fn5",explanation:"Definite Difference is scores below the -2 SD point below the mean. This classification system is a statistical proportion usually represents about 2% of the sample population. Section raw score totals that fall within this range indicate sensory processing difficulties. This range indicates that the child is performing like a child in the lowest 2% of the sample, when compared to the research sample of 1,037 children without disabilities."},{id:"fn6",explanation:"Parham, L. D., Ecker, C., Miller Kuhaneck, H., Henry, D. A., & Glennon, T. J. (2007). Sensory Processing Measure (SPM): Manual. Los Angeles, CA: Western Psychological Services."},{id:"fn7",explanation:"Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services."},{id:"fn8",explanation:"Ayres, A. J. (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services."},{id:"fn9",explanation:"Ayres, A. J. (2005). Sensory integration and the child, 25th anniversary edition. Los Angeles, CA: Western Psychological Services."},{id:"fn10",explanation:"Parham, L. D., & Ecker, C. (2007). Sensory Processing Measure (SPM) Home Form. Los Angeles, CA: Western Psychological Services."}],contributors:[{corresp:null,contributorFullName:"Jane Yip",address:null,affiliation:'
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1. Introduction
Vapor-phase techniques are powerful approaches for the deposition of functional thin films of different materials, including metals and compounds such as oxides, nitrides, and even organic materials and composites onto a substrate [1, 2, 3]. There are two types of vapor deposition methods, namely physical and chemical. Physical vapor deposition (PVD) methods involve a change of state (i.e., evaporation and recondensation) of a source, and include, among other, sputtering, pulsed laser deposition or different evaporation approaches [4]. While PVD methods yield materials of high quality with tunable properties, they are performed in high vacuum and often high temperatures, using sophisticated equipment. Finally, the low vacuum process results in a line-of-sight type of coating (i.e., only taking place on the directly exposed surfaces.
The possibility to pattern and 3D print materials at different scales has a tremendous impact on many technologies and applications. Over the years. Different 3D printing approaches have been developed allowing such patterning. This include, to name a few, aerosol jet printing (also known as Maskless Mesoscale Materials Deposition or M3D) [5], ink jet and screen printing [6], laser chemical vapor deposition (LCVD) [7], laser-induced forward transfer (LIFT) [8, 9] or micro stereo lithography and multiphoton lithography [10]. The interested readers are encouraged to the cited references for more details on these methods. In this chapter, we focus on 3D printing approaches based on ALD. A brief introduction to CVD and ALD is thus presented next.
Chemical vapor deposition (CVD) approaches on the other hand rely on chemical reactions between different precursors on and over a surface. In conventional CVD, the precursors are injected in the reactor at the same time and the reaction is activated by heat (hot substrate) or by other energy sources, such as plasma. A scheme representing the reaction chamber is shown in Figure 1a [11]. This technique allows the deposition of high-quality films [12], and is largely used by the industry. Nonetheless, CVD is governed by the diffusion of the different gas precursors, and therefore, the deposition of extremely thin films with a thickness control at the sub-nanometer level [13], and the uniform coating of large areas or high-aspect-ratio/porous features is extremely difficult [14].
Figure 1.
(a) CVD mechanism where the precursor is adsorbed on the surface at relatively high-temperature followed by the film growth and a release of volatile byproducts, (b) ALD process: Schematic of one ALD cycle of monolayer growth. The first step consists in exposing the substrate to the precursor followed by a purge step to remove all the byproducts an excess precursor, then another step with a co-reactant agent and the final step in which the byproducts an excess precursors are purged again, (c) illustration of edge coverage for ALD, CVD, and PVD.
Such limitations prompted the development of an alternative method, namely, atomic layer deposition (ALD). ALD is indeed a CVD method but it is characterized by having the substrate exposed to the different precursors one at a time, and not simultaneously as in CVD. Thus, in typical ALD processes, a precursor is first injected in a deposition chamber where the substrate is located. The precursor can then react with active sites on the surface (i.e., undergoing a chemisorption) until the latter is saturated. A purge step is then applied to eliminate excess precursor and reaction byproducts. Then a second reactant is injected that will react with the preciously adsorbed layer. After the reaction is completed, again a purge step is necessary to eliminate excess reactant and reaction byproducts. Such an ALD cycle is shown in Figure 1b. As a result of this sequential exposure to the different reactants, the ALD process is surface-selective and self-terminating, which in turn offers unique control over film thickness at the angstrom level (i.e., a given growth per cycle, GPC, being obtained for each process as a function of the reactor geometry and precursors used) and allows the conformal coating of porous, complex and high-aspect-ratio substrates. The films are also compact and free of pinholes and can be obtained at low temperatures (even room temperature) due to the high reactivity of ALD precursors. The reader is referred to reviews and books dedicated to ALD for more information [1, 2, 3]. Figure 1c shows a sketch of the different types of coating obtained over the high-aspect-ratio features when using the different techniques discussed.
Over the years, the number of materials that can be deposited by ALD has grown enormously, including pure elements (e.g., metals), nitrides, sulfides, oxides, fluorides, etc. (see the atomic limits site, with includes an ALD materials database that is permanently being updated [15]). While at the origin the main motors of the ALD development were the deposition of homogeneous coatings over large areas or high aspect-ratio features, in the last years, there have been innovative developments in the ALD field that allow the localized and topological deposition of functional materials. This opens the door to its application as a new nano-to-macro 3D printing technology based on gas precursors. These recent developments, namely, area-selective deposition (ASD) and different spatial approaches, are presented in Sections 2 and 3, respectively. Finally, the unique assets of the ALD technique are ideal to tune the properties of pieces fabricated by conventional 3D printing approaches. Section 4 presents a brief overview of recent results on this line. The chapter finishes with some conclusive remarks.
2. Area-selective deposition (ASD)
For more than 50 years, the shrinking of microelectronic devices has involved successive steps of deposition, lithography and etching. Indeed, unlike building a house, it is not possible to directly draw the walls or pillars of a chip on a 300 mm substrate. It is therefore necessary to first cover the whole substrate with a thin layer, before removing part of it by the steps of lithography (to draw the object) and etching (to remove what should not remain on the surface). This is called a top-down approach. The reduction of the dimensions of microelectronic devices in the last 10 years to nanometric scales has greatly complicated these steps and increased their cost. Indeed, for many years, the wavelengths used to draw were greater than the desired line thickness. It was therefore necessary to make lithography more complex by integrating etching/deposition steps to achieve the desired dimensions, such as multi-patterning (Self Aligned Double or Quadrupole Patterning—SADP and SAQP). Thus, these steps allowing to obtain locally nanometric materials on the substrate are now complex, time-consuming and expensive. They must also be done with nanometric placement precision, which is already a real challenge.
The alternative solution to this increasingly complex approach is to deposit the material directly and selectively on the desired surface without having to resort to lithography steps. This so-called selective growth on a surface is a bottom-up approach and is known as area-selective deposition (ASD) [16, 17]. In an ideal ASD process, a thin film should be uniformly deposited in the desired growth region while no deposition should be observed in the desired no-growth region. This requires the use of a surface selective deposition process, with controlled growth at the atomic scale, and thus ALD is the one that seems to be the most adapted. Indeed, a growing number of researchers working on the ALD process are now trying to establish strategies from this process to have a material deposited selectively on a surface. The three main strategies are: (i) to use an inherent selectivity of the precursor/substrate couple [18, 19]; (ii) to block the growth on the no-growth area by a pre-deposition treatment [20, 21]; (iii) to promote the growth on the growth area by a pre-deposition treatment [22]. Whatever the strategy, we observe growth on all surfaces after a certain number of cycles, or at best, a little defectivity with nuclei on the no-growth area, i.e., the selectivity fades out during the successive ALD cycles. It was then proposed to regularly add the surface treatment step (passivation step) in the ALD cycles changing a cycle from a (treatment + AB) process to an (ABC) cycle with the treatment reinjected regularly [23]. Another proposed solution is to use super-cycles with the injection of etching steps every x ALD cycles, this is called ASD by super-cycles of deposition-etching [24, 25, 26, 27, 28]. In the end, with these different ASD strategies, passivation or super-cycles, [29] the possibility to deposit thin films of more than 10 nm on a previously selected surface has been successfully demonstrated. However, the additional steps (passivation, etching) increase the processing time. It takes more than 24 h for passivation by a self-assembled monolayer (SAM) using chemical baths. The insertion of etching steps in an ALD process also increases the processing time by a factor of 2–3 compared to a conventional ALD process. Finally, the insertion of passivation or etching chemistries can induce contamination of the deposited layer as well as process drifts (with for example a modification of the chemistry of the ALD reactor walls during the etching step). Nevertheless, ASD has the potential to deposit functional materials with complex 3D shapes and nanometric resolution, well beyond the possibilities offered by standard 3D printing methods. This can be done by different approaches, as shown in Figure 2.
Figure 2.
(a) Illustration of four different strategies for an area selective deposition where a is the growth area and B the no-growth area; (b–d) examples of ASD using deposition and etch: (b) TiO2 on TiN vs. Si/SiO2 (reprinted with permission) [25], (c) patterning at the microscale of TiO2 and W films (reprinted with permission) [30], and (d) topographical selective deposition of Ta2O5 on Si (reprinted with permission) [31].
Although, ASD offers a huge potential for the 3D printing of functional materials at resolutions orders of magnitude below what can be achieved with conventional 3D printing approaches, the different steps it implies (i.e., surface pre-pattering, regeneration of the selectivity) make them harder to work with. It would thus be desirable to develop an ALD approach that could allow the direct deposition of patterned materials. This can indeed be achieved, as detailed in the next section, by using different spatial approaches. The question that arises now is whether this approach can be used to develop ASD processes on larger surfaces and at dimensions that are no longer nanometric but micrometric or millimetric. The natural answer is yes. Indeed, an optimized ALD process is uniform across m-scale objects. Using a spatial ALD technology, we can then imagine selectively printing on a large surface with ALD: 3D printing. This is described in the next section.
3. 3D printing of functional materials based on spatial CVD/ALD approaches
As explained in the introduction, the unique assets of ALD are the result of having a surface-limited, self-terminated reaction between gas reactants and the surface of a substrate. To limit the reaction to the surface, the ALD is based in alternate exposures of the precursors to the substrate. Traditionally, this has been done by sequential injection of the precursors in a deposition chamber followed by purging steps, thus in a temporal approach, as detailed in Figure 1b above and in the scheme below (Figure 3a). An alternative approach consists in having a continuous injection of the different reactants but in different locations of the reactor, keeping them separated by a region of inert gas. Then, by alternatively exposing the substrate to the different regions, the ALD cycle is reproduced (Figure 3b). This approach is known as Spatial ALD (SALD) [33, 34, 35, 36]. The first advantage of processing in the spatial mode is that the process can become much faster (up to two orders of magnitude) since no purging step is required.
Figure 3.
(a) Schematic representation of the classical temporal ALD approach with the different characteristic steps of an ALD cycle: (1) injection of the first precursor, (2) purging step, (3) injection of the second precursor, (4) purging step, separated in time. (b) Schematic representation of the spatial ALD approach, where the precursors are injected continuously in the reaction chamber in different locations separated by an inert gas and the sample is exposed to the different regions to reproduce the ALD cycle. (c) Scheme of the close-proximity AP-SALD approach based on a manifold injection head: the precursors are carried out from the containers of the head where they are distributed in parallel alternative channels. (d) COMSOL simulation of the mass fraction of each precursor present in different areas of the substrate (left). In these cases the evacuation of the precursors is not efficient and thus cross-talk is observed, yielding a CVD reaction on the zones where the precursors meet (see COMSOL simulation in the center). If a deposition is made in static mode (i.e., without moving the substrate), 4 lines of oxide can be obtained, as shown in the optical image (right) where 4 lines of ZnO have been deposited on a Si wafer in this way (adapted from Ref. [32]).
The SALD concept is very versatile and can indeed be applied in different ways [33, 37]. SALD can even be performed at atmospheric pressure (i.e., no vacuum processing) and even in the open air (i.e., no deposition chamber), and this is sometimes referred to as Atmospheric-Pressure SALD (AP-SALD). This is the case of the close-proximity approach based on a manifold injection head, originally presented by Kodak [38]. In this particular approach, the different reactants are carried to the injection head where they are distributed along alternate parallel channels (Figure 3c) [39]. By proper design of the head, the different flows can be kept separated provided the substrate is at close proximity of the head (i.e., 50–200 μm). Then by scanning the substrate back and forth under the head the ALD cycles are achieved. It is worth noting that since the size and area of the deposition depend on the head size and substrate scan distance, this SALD approach can already be seen as an ASD approach at the cm scale.
Close-proximity SALD approaches based on injection heads have several extra appealing advantages. The first one is that deposition can be also performed in spatial CVD (SCVD) mode. Then, crosstalk between the different reactants above the surface of the substrate is allowed. In this case, the deposition rate can be faster, but care must be taken since the properties of the materials deposited could change [32]. The impact of the change in the film properties when passing from the SALD to SCVD mode has to be evaluated depending on the intended application, but several works have demonstrated that the SCVD can be used to deposit components for functional devices [40]. In addition, the possibility of having SCVD opens the door to a new ASD approach. Indeed, the CVD reaction can be located in different areas above the substrate. Figure 3d presents a computational fluid dynamics (CFD) simulation that shows the areas over the substrate where the different reactants meet and thus react when the deposition is performed in certain SCVD conditions. Then, by performing a static deposition (i.e., without the substrate scan that is needed to perform the spatial ALD cycles) growth of the films can be localized to the regions where the reactants meet (see the four ZnO lines obtained by this approach in Figure 3d). This constitutes a new alternative approach of ASD at a higher scale and much faster deposition rate than the traditional ASD approaches based on ALD that have been described in the previous section [32].
The second advantage of using a close-proximity SALD approach based on an injection head is that the system can be customized by simply modifying the injection head. While this is so, the modification and fabrication of the head can result very difficult, if not impossible, thus limiting the potential of the approach (see Figure 4a where the scheme of a standard SALD head is shown. It comprises several parts that need to be fabricated separately and then soldered, and the distribution of the different gas flows to the head is quite complex involving many pipes). To overcome this limitation, D. Muñoz-Rojas’ group at the Laboratoire des Matériaux et du Génie Physique (LMGP, Grenoble, France) has introduced the utilization of 3D printing for the fabrication of customized SALD injection heads [41]. This allows having more freedom to design the head and, for example, the gas distribution can be incorporated in the body of the head (Figure 4b and c) [41, 42, 43]. Plastic heads can be printed for depositions taking place at low temperatures while metal 3D printing is also possible for higher temperatures [44]. Thanks to 3D printing, the design of the heads can be easily customized. This is very convenient to easily modify the area of deposition, and also to have free-form patterns when performing SCVD with custom heads (Figure 4d) [41].
Figure 4.
(a) Scheme of a close-proximity SALD head made of several parts and fabricated by conventional approaches. (b) 3D scheme of a head design integrating the gas distribution for the different gases inside its body: metallic precursor in green, co-reactant in red, inert gas in blue and exhaust in black. (c) Head printed with clear resin where the distribution channels can be observed. (d) 3D scheme of a head designed for circular shape deposition in static SCVD mode. ZnO circles with different thicknesses are shown. (e) Picture of a printed SALD pen (left), bottom view of the concentric gas outlets in the SALD pen approach allowing deposition in any direction (right). (f) Scheme of the SALD pen installed in a 3D table. (g) Scheme of a SALD pen implemented in the XYZ table and drawing ZnO in a circular pattern. (h) LMGP initials on a Si wafer drawn with the 3D printed SALD pen (adapted with permission from Ref. [41]).
The possibility to deposit free-form patterns without having to modify the head for each design would also be appealing. This can indeed be done if instead of using parallel channels, the head is designed so that concentric channels are used. In this way, no matter which direction the head moves, the substrate will be exposed to the different reactants, thus leading to ALD film growth (Figure 4e). Such a head can again be readily implemented by 3D printing. D. Muñoz-Rojas’ group demonstrated that such a SALD pen can be printed and used to deposit free-form patterns when installed in an XYZ table, in this case with a resolution going down to several mm (Figure 4f-h) [41]. This represents a new 3D printing approach that is based on gas precursors and that offers nanometric resolution in Z. Here again, the resolution of the obtained patterns in X-Y depends on the head design and the possibility to scale it down. Indeed, the latter work by Midani et al. presented a similar concept in which sub-millimiter resolution was achieved by inserting a capillary in the central metal precursor channel of the SALD pen [45].
Certainly, the advances in the different 3D printing technologies will allow de fabrication of SALD heads with smaller channels, which will extend the possibilities of SALD for depositing patterns of functional materials down to the micrometer scale in X-Y.
4. ALD for conventional additive manufacturing: recent works involving the use of ALD to tune the surface and properties of 3D printed parts
Additive manufacturing (AM), also known as 3D printing, is recognized as a revolutionary technology, which has primarily been used in the field of engineering to create customized prototypes [46, 47, 48]. 3D printing has now become a subject of great interest and is extensively applied in many areas, such as prototyping, medicine [49] or aerospace [50], since it allows new products with complex geometries and microarchitecture (multiple pore shape and size) to be imagined, designed and fabricated. However, the material from which the designed products are made is still limited by the 3D-printing material itself. Even if the number of available materials that can be printed is expanding [48], most of the manufactured objects are made of polymer or stainless steel. Thus, a post-treatment may be required to control the nature and chemistry of the product surface and offer it its desired functionality. As illustrated in Figure 5 and discussed below, ALD is a highly appealing technique to expand the potential of 3D printing through coating or infiltration of the printed parts.
Figure 5.
Illustration of the combination of 3D printing and atomic layer processing. Depending on the 3D printed material, either a coating is obtained, allowing for the tuning of the surface properties (typical ALD); or inorganic components are introduced to the subsurface of the 3D objects (atomic layer infiltration, ALI [51, 52]), permitting the tuning of the matrix.
As seen previously, ALD can be used as an innovative and novel 3D printing route, to prepare customized and complex 3D structures at the nano-to-cm scale. In addition, this technology can also be used to precisely tune the surfaces of 3D printed objects that were manufactured using more “conventional” additive manufacturing approaches such as fused deposition modeling, inkjet printing, stereolithography, selective laser sintering (SLS), powder bed fusion or even bioprinting [46, 47, 48]. ALD allows the preparation of thin films with a sub-nanometer thickness control, high uniformity and excellent conformality even on high aspect ratios substrates, a unique capability, as discussed in the first section of this chapter [3, 53, 54, 55, 56, 57, 58]. As ALD allows the conformal coating of complex substrates with nanolayers made of an expanding number of materials [2, 15], such as oxides [59, 60], metals [61], nitrides [62] and sulfides [63], the combination of this route with 3D printing can be beneficial to a myriad of applications.
A large number of 3D printed objects are made of polymers, the current mainstream materials being ABS (acrylonitrile butadiene styrene) and PLA (polylactic acid). However, when performing ALD on 3D printed objects based on such polymeric materials, some considerations must be taken. The first obvious consideration is related to the ALD process temperature, which has to be lower than the polymer melting point. 3D printing materials such as ABS and PLA will already be deformed when the temperature is higher than 200°C. The ALD processes must therefore be compatible with rather low temperatures. Furthermore, as depicted by the review of Parsons and co-workers [64], the ALD precursors often infiltrate and react with polymeric substrates, which can alter the eventual 3D printed products. As shown by numerous studies, the risk of reaction between the polymer and the precursors increases with temperature and long exposures times. In addition, the presence of functional groups in the polymer chains also increases the potential infiltration of the ALD precursors [51, 52, 59, 64, 65, 66, 67, 68]. Thus, even if most of the ALD processes are compatible with the coating of 3D printed objects, these considerations must be taken into account and the processes have to be tuned accordingly to coat certain 3D printed materials. When the processes developed are compatible, the unique capability of ALD to coat complex objects with such control over the layer deposited, makes this route particularly relevant and attractive. This innovative combinatorial approach has been used for different and various applications, such as aerospace, photoelectrocatalysis, filtration, biomedicine, or solid-state batteries.
Kestila et al. combined polymeric additive manufacturing and an ALD-coating to produce satellite propulsion components with improved structural integrity and thermal resistance [69]. The components were made of two different polymers, namely acrylonitrile butadiene styrene (ABS) and polyamide, and were coated with alumina by ALD. The Al2O3 layer allowed to enhance the structural integrity for the polymeric restrictors and progressively smoothed out the PA surface improving the argon flow through the restrictor, which might be due to increased surface smoothness [69]. Heikinen et al. have recently shown that ALD of alumina on porous 3D printed ABS plastics permits to considerably lower their vacuum degassing. Nyman et al. have also confirmed the low outgassing of ABS, but also polyether ether ketone (PEEK), polycarbonate (PC), and nanodiamond-doped polylactide (ND-PLA) 3D printed materials with an Al2O3 ALD coating [70]. Thus, the combination of plastic 3D printing with ALD opens prospects for the fabrication of laboratory vacuum tools, and is also suited for spacecraft tools and in-space manufacturing applications [70, 71]. Moll et al. also coupled powder bed additive manufacturing with CVD and ALD of nitrides, to prepare 3D Ti-6Al-4 V structures highly resistant to high-temperature oxidizing environments. Coupling CVD and ALD on the 3D printed objects permitted to obtain thick coating and roughness reduction by CVD, and filling of narrow defects and reactivity mitigation by ALD [72].
Browne et al. employed additive manufacturing and ALD for photoelectrocatalysis, by depositing TiO2 onto 3D-printed electrodes. These electrodes were initially printed in inert stainless steel, and gained their catalytic functionality thanks to the ALD coating. The conformality allowed by ALD successfully permitted these 3D-printed electrodes to be used as photoanodes for water oxidation. The results presented have shown that the 3D-printed stainless steel electrode coated with ALD of TiO2 were considerably more active towards the water oxidation, and that the catalytic activity was enhanced by increasing the number of ALD cycles applied [73]. The team of Pumera et al. recently applied ALD to 3D-printed nanocarbon/polylactic acid electrodes to coat them with metal dichalcogenide MoS2 nanolayers [74]. The MoS2 coated electrodes were then successfully applied for photoelectrocatalytic hydrogen evolution reaction (HER). Recently the group of M. Bechelany from the Institut Européen des Membranes (IEM, Montpellier, France) has developed in collaboration with the University of Zaragoza the functionalization of 3D printed ABS filters with MOF (Metal-Organic Framework) for toxic gas removal [75]. The fabrication approach at low temperature includes ALD of Zinc oxide on the ABS 3D printed filter followed by the hydrothermal conversion of ZnO to ZIF-8, Zeolitic Imidazolate Framework. The obtained filters show a good adsorption performance for dimethyl methylphosphonate, thus demonstrating their potential for toxic gas capture applications. Such types of 3D printed filters with an active MOF layer could have a wide range of applications in environmental fields such as adsorption systems for removing toxic gases or water pollutants.
In the biomedical field, the combinatorial approach has been applied to prepare silver-coated titanium orthopedic implants. [76] Using the selective laser melting (SLM) 3D-printing technique, titanium orthopedic implants have been fabricated with intricate geometries. The surface chemistry of the prepared implants has then been modified by coating them with a silver nanolayer by ALD. The inhibition of bacterial colonization obtained thanks to the silver coating resulted in the drastic reduction of the pathogenic biofilm. This result, combined with the increase of the vascularization and the osseointegration observed, opens a new path to this combinatorial approach for clinical orthopedic applications [76]. The “pure marriage” between 3D printing and ALD has also been exploited by Xue et al., who tailored the surface of 3D printed plastic earplugs using plasma-assisted ALD [75]. By combining 3D printing, plasma-assisted ALD and hydrothermal process, they loaded a layer of ZnO nanoarrays on the surface of the earplugs and thus improved the antibacterial properties of the earplugs, which enhanced the safety of the ear devices. In addition, they have shown that the sound insulation performances were higher than those of traditional earplugs. Finally, the field of solid-state batteries benefited as well from the combination of 3D printing and ALD. For example, thanks to an innovative 3D-printing ink formulation, a cell-based on a 3D-printed stacked array of LLZ (Li7La3Zr2O12, a solid lithium conductor) and lithium electrodes was fabricated, and ALD of alumina has been performed at the surface of the LLZ to allow the wetting of lithium [77, 78]. The ability to 3D-print solid electrolytes enables the manufacturing of unique ordered structures, and ALD permits their efficient functionalization, improving the overall efficiency of the battery device.
These few selected studies demonstrate the great potential of combining additive manufacturing and ALD. The combinatorial approach allows the fast prototyping of functional products with the additional precise control over their surface chemistry. As depicted in the presented examples, the benefits of combining 3D printing and ALD nanocoatings can be applied to many complex surfaces, and the lack of materials that can be 3D printed is at least partially solved by the use of ALD coatings. Thus, this novel approach allows synthesizing precisely integrated and customized architectures with tailored surface performance, and/or eventually the bulk properties of the materials thanks to ALI, paving the way towards innovative and functional products, and opening prospects for many potential applications.
5. Conclusion
Although ALD was initially developed to exploit the possibility it offered to obtain continuous, pin-hole-free thin films even over large areas, in the last years there have been different approaches to perform ALD in a localized fashion, giving rise to the ASD field. As it has been discussed, these methods are based on different approaches allowing either a high spatial resolution in XY (at the nanometer) or simpler more direct approaches that provide direct patterning at the millimeter and micrometer level in XY. In any case, and given these approaches are based on the ALD method, the control in Z is nanometric. The possibility to have spatial control over the ALD process can be exploited as a new gas-based technique for the 3D printing of functional materials at different scales, providing a unique approach to the fabrication of functional materials with complex shapes. Beyond using ALD as a 3D printing technique in itself, the possibility it offers to coat (even infiltrate) complex shapes in a highly controlled way and with a large amount of different materials is ideal to nanoengineer the properties of pieces obtained by standard 3D printing approaches, thus expanding the range of applications that can be achieved. ALD should thus experience an important penetration in the 3D printing field in the coming years.
Acknowledgments
D.M.-R. acknowledges support from the European Union’s Horizon 2020 FETOPEN-1-2016-2017 research and innovation program under Grant Agreement 801464, and through the Marie Curie Actions (FP7/2007-2013, Grant Agreement No. 63111). The Agence Nationale de la Recherche (ANR, France) is also acknowledged for funding via the programs ANR-16-CE05-0021 (DESPATCH) and ANR-20-CE09-0008 (ALD4MEM). The French National Research Agency (in the framework of the “Investissements d’avenir” program (No. ANR-15-IDEX-02) through the project Eco-SESA) is acknowledged for a PhD Grant.
\n',keywords:"spatial atomic layer deposition, spatial chemical vapor deposition, area-selective deposition, atomic layer infiltration, surface nanoengineering, 3D printing of functional materials",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/80053.pdf",chapterXML:"https://mts.intechopen.com/source/xml/80053.xml",downloadPdfUrl:"/chapter/pdf-download/80053",previewPdfUrl:"/chapter/pdf-preview/80053",totalDownloads:81,totalViews:0,totalCrossrefCites:0,dateSubmitted:"November 19th 2021",dateReviewed:"December 1st 2021",datePrePublished:"March 2nd 2022",datePublished:null,dateFinished:"January 16th 2022",readingETA:"0",abstract:"Atomic layer deposition (ALD) is a chemical vapour deposition (CVD) method that allows the layer-by-layer growth of functional materials by exposing a surface to different precursors in an alternative fashion. Thus, thanks to gas-solid reactions that are substrate-limited and self-terminating, precise control over thickness below the nanometer level can be achieved. While ALD was originally developed to deposit uniform coatings over large areas and on high-aspect-ratio features, in recent years the possibility to perform ALD in a selective fashion has gained much attention, in what is known as area-selective deposition (ASD). ASD is indeed a novel 3D printing approach allowing the deposition of functional materials (for example metals to oxides, nitrides or sulfides) with nanometric resolution in Z. The chapter will present an introduction to ALD, which will be followed by the description of the different approaches currently being developed for the ASD of functional materials (including initial approaches such as surface pre-patterning or activation, and newer concepts based on spatial CVD/ALD). The chapter will also include a brief overview of recent works involving the use of ALD to tune the properties of 3D printed parts.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/80053",risUrl:"/chapter/ris/80053",signatures:"David Muñoz-Rojas, Matthieu Weber, Christophe Vallée, Chiara Crivello, Abderrahime Sekkat, Fidel Toldra-Reig and Mikhael Bechelany",book:{id:"10974",type:"book",title:"Advanced Additive Manufacturing",subtitle:null,fullTitle:"Advanced Additive Manufacturing",slug:null,publishedDate:null,bookSignature:"Prof. Igor V. Shishkovsky",coverURL:"https://cdn.intechopen.com/books/images_new/10974.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-83962-821-4",printIsbn:"978-1-83962-820-7",pdfIsbn:"978-1-83962-822-1",isAvailableForWebshopOrdering:!0,editors:[{id:"174257",title:"Prof.",name:"Igor V.",middleName:null,surname:"Shishkovsky",slug:"igor-v.-shishkovsky",fullName:"Igor V. Shishkovsky"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Area-selective deposition (ASD)",level:"1"},{id:"sec_3",title:"3. 3D printing of functional materials based on spatial CVD/ALD approaches",level:"1"},{id:"sec_4",title:"4. ALD for conventional additive manufacturing: recent works involving the use of ALD to tune the surface and properties of 3D printed parts",level:"1"},{id:"sec_5",title:"5. Conclusion",level:"1"},{id:"sec_6",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'Leskelä M, Mattinen M, Ritala M. Review article: Atomic layer deposition of optoelectronic materials. Journal of Vacuum Science and Technology B. 2019;37:030801'},{id:"B2",body:'Johnson RW, Hultqvist A, Bent SF. A brief review of atomic layer deposition: From fundamentals to applications. 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Role of precursor choice on area-selective atomic layer deposition. Chemistry of Materials. 2021;33:3926-3935'},{id:"B19",body:'Maeda E, Nabatame T, Hirose M, Inoue M, Ohi A, Ikeda N, et al. Correlation between SiO2 growth rate and difference in electronegativity of metal–oxide underlayers for plasma enhanced atomic layer deposition using tris(dimethylamino)silane precursor. Journal of Vacuum Science and Technology A. 2020;38:032409'},{id:"B20",body:'Yarbrough J, Shearer AB, Bent SF. Next generation nanopatterning using small molecule inhibitors for area-selective atomic layer deposition. Journal of Vacuum Science and Technology A. 2021;39:021002'},{id:"B21",body:'Liu T-L, Bent SF. Area-selective atomic layer deposition on chemically similar materials: Achieving selectivity on oxide/oxide patterns. Chemistry of Materials. 2021;33:513-523'},{id:"B22",body:'Singh JA, Thissen NFW, Kim W-H, Johnson H, Kessels WMM, Bol AA, et al. Area-selective atomic layer deposition of metal oxides on noble metals through catalytic oxygen activation. Chemistry of Materials. 2018;30:663-670'},{id:"B23",body:'Merkx MJM, Jongen RGJ, Mameli A, Lemaire PC, Sharma K, Hausmann DM, et al. Insight into the removal and reapplication of small inhibitor molecules during area-selective atomic layer deposition of SiO2. Journal of Vacuum Science and Technology A. 2021;39:012402'},{id:"B24",body:'Vallat R, Gassilloud R, Eychenne B, Vallée C. Selective deposition of Ta2O5 by adding plasma etching super-cycles in plasma enhanced atomic layer deposition steps. Journal of Vacuum Science and Technology A: Vacuum, Surfaces and Films. 2017;35:01B104'},{id:"B25",body:'Vallat R, Gassilloud R, Salicio O, El Hajjam K, Molas G, Pelissier B, et al. Area selective deposition of TiO2 by intercalation of plasma etching cycles in PEALD process: A bottom up approach for the simplification of 3D integration scheme. 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Univ. Grenoble Alpes, CNRS, Grenoble INP, LMGP, France
Institut Européen des Membranes, IEM, UMR-5635, ENSCM, CNRS, Univ Montpellier, France
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The Open Access model is applied to all of our publications and is designed to eliminate subscriptions and pay-per-view fees. This approach ensures free, immediate access to full text versions of your research.
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Proven world leader in Open Access book publishing with over 10 years experience
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The Open Access Publishing Fee (OAPF) is payable only after your book chapter, monograph or journal article is accepted for publication.
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OAPF Publishing Options
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1,400 GBP Chapter - Edited Volume
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850 GBP Chapter - Book Series Topic (Annual Volume)
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10,000 GBP Monograph - Long Form
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4,000 GBP Compacts Monograph - Short Form
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850 GBP Journal Article (Across Portfolio)
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During the launching phase journals do not charge an APC, rather they will be funded by IntechOpen.
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*These prices do not include Value-Added Tax (VAT). Residents of European Union countries need to add VAT based on the specific rate in their country of residence. Institutions and companies registered as VAT taxable entities in their own EU member state will not pay VAT as long as provision of the VAT registration number is made during the application process. This is made possible by the EU reverse charge method.
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Services included are:
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An online manuscript tracking system to facilitate your work
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Personal contact and support throughout the publishing process from your dedicated Author Service Manager
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Assurance that your manuscript meets the highest publishing standards
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English language copyediting and proofreading, including the correction of grammatical, spelling, and other common errors
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XML Typesetting and pagination - web (PDF, HTML) and print files preparation
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Discoverability - electronic citation and linking via DOI
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Permanent and unrestricted online access to your work
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What isn't covered by the Open Access Publishing Fee?
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If your manuscript:
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Exceeds the number of pages defined by the publishing guidelines, an additional fee per page may be required
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If a manuscript requires Heavy Editing or Language Polishing, this will incur additional fees.
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Your Author Service Manager will inform you of any items not covered by the OAPF and provide exact information regarding those additional costs before proceeding.
\n\n
Open Access Funding
\n\n
To explore funding opportunities and learn more about how you can finance your IntechOpen publication, go to our Open Access Funding page. IntechOpen offers expert assistance to all of its Authors. We can support you in approaching funding bodies and institutions in relation to publishing fees by providing information about compliance with the Open Access policies of your funder or institution. We can also assist with communicating the benefits of Open Access in order to support and strengthen your funding request and provide personal guidance through your application process. You can contact us at funders@intechopen.com for further details or assistance.
\n\n
For Authors who are still unable to obtain funding from their institutions or research funding bodies for individual projects, IntechOpen does offer the possibility of applying for a Waiver to offset some or all processing feed. Details regarding our Waiver Policy can be found here.
\n\n
Added Value of Publishing with IntechOpen
\n\n
Choosing to publish with IntechOpen ensures the following benefits:
\n\n
\n\t
Indexing and listing across major repositories, see details ...
\n\t
Long-term archiving
\n\t
Visibility on the world's strongest OA platform
\n\t
Live Performance Metrics to track readership and the impact of your chapter
\n\t
Dissemination and Promotion
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Benefits of Publishing with IntechOpen
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\n\t
Proven world leader in Open Access book publishing with over 10 years experience
\n\t
+5,700 OA books published
\n\t
Most competitive prices in the market
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Fully compliant with OA funding requirements
\n\t
Optimized processes that assure your research is made available to the scientific community without delay
\n\t
Personal support during every step of the publication process
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+184,650 citations in Web of Science databases
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Currently strongest OA platform with over 175 million downloads
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They bring people-centred care closer to the communities where they are needed most, thereby helping improve health outcomes and the overall cost-effectiveness of services. Nurses usually act as first responders to complex humanitarian crises and disasters; protectors and advocates for the community and communicators and co-ordinators within teams. Communication is a core component of sound relationships, collaboration and co-operation, which in turn are essential aspects of professional practice. The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. Increases in nursing communication can lessen medical errors and make a difference in positive patient outcomes. This chapter explores how effective communication and interpersonal skills can enhance professional nursing practice and nursing relationships with various stakeholders. It explains principles of communication, communication process, purpose of communication, types of communication, barriers to effective communication, models of communication and strategies of improving communication and guidelines for successful therapeutic interactions.",book:{id:"6615",slug:"nursing",title:"Nursing",fullTitle:"Nursing"},signatures:"Maureen Nokuthula Sibiya",authors:[{id:"73330",title:"Dr.",name:"Nokuthula",middleName:null,surname:"Sibiya",slug:"nokuthula-sibiya",fullName:"Nokuthula Sibiya"}]},{id:"24279",doi:"10.5772/19684",title:"Speculative Ethics: Valid Enterprise or Tragic Cul-De-Sac?",slug:"speculative-ethics-valid-enterprise-or-tragic-cul-de-sac-",totalDownloads:2540,totalCrossrefCites:8,totalDimensionsCites:9,abstract:null,book:{id:"250",slug:"bioethics-in-the-21st-century",title:"Bioethics in the 21st Century",fullTitle:"Bioethics in the 21st Century"},signatures:"Gareth Jones, Maja Whitaker and Michael King",authors:[{id:"35851",title:"Prof.",name:"Gareth",middleName:null,surname:"Jones",slug:"gareth-jones",fullName:"Gareth Jones"},{id:"47645",title:"Dr",name:"Michael",middleName:"Robert",surname:"King",slug:"michael-king",fullName:"Michael King"},{id:"47646",title:"Mrs.",name:"Maja",middleName:null,surname:"Whitaker",slug:"maja-whitaker",fullName:"Maja Whitaker"}]},{id:"31748",doi:"10.5772/33900",title:"Medical Ethics in Undergraduate Medical Education in Pakistan: Towards a Curricular Change",slug:"medical-ethics-in-undergraduate-medical-education-in-pakistan-towards-a-curricular-change-",totalDownloads:2766,totalCrossrefCites:1,totalDimensionsCites:6,abstract:null,book:{id:"1743",slug:"contemporary-issues-in-bioethics",title:"Contemporary Issues in Bioethics",fullTitle:"Contemporary Issues in Bioethics"},signatures:"Ayesha Shaikh and Naheed Humayun",authors:[{id:"97665",title:"Prof.",name:"Ayesha",middleName:null,surname:"Humayun",slug:"ayesha-humayun",fullName:"Ayesha Humayun"},{id:"104368",title:"Prof.",name:"Naheed",middleName:null,surname:"Humayun",slug:"naheed-humayun",fullName:"Naheed Humayun"}]},{id:"31743",doi:"10.5772/35001",title:"Neuroenhancement - A Controversial Topic in Contemporary Medical Ethics",slug:"neuroenhancement-a-controversial-topic-in-medical-ethics",totalDownloads:3921,totalCrossrefCites:3,totalDimensionsCites:6,abstract:null,book:{id:"1743",slug:"contemporary-issues-in-bioethics",title:"Contemporary Issues in Bioethics",fullTitle:"Contemporary Issues in Bioethics"},signatures:"Kirsten Brukamp and Dominik Gross",authors:[{id:"102555",title:"Dr.",name:"Kirsten",middleName:null,surname:"Brukamp",slug:"kirsten-brukamp",fullName:"Kirsten Brukamp"},{id:"105119",title:"Prof.",name:"Dominik",middleName:null,surname:"Groß",slug:"dominik-gross",fullName:"Dominik Groß"}]},{id:"19610",doi:"10.5772/20184",title:"Euthanasia: A Confounding and Intricate Issue",slug:"euthanasia-a-confounding-and-intricate-issue",totalDownloads:2829,totalCrossrefCites:4,totalDimensionsCites:6,abstract:null,book:{id:"242",slug:"euthanasia-the-good-death-controversy-in-humans-and-animals",title:"Euthanasia",fullTitle:'Euthanasia - The "Good Death" Controversy in Humans and Animals'},signatures:"Isabelle Marcoux",authors:[{id:"37725",title:"Prof.",name:"Isabelle",middleName:null,surname:"Marcoux",slug:"isabelle-marcoux",fullName:"Isabelle Marcoux"}]}],mostDownloadedChaptersLast30Days:[{id:"59779",title:"Effective Communication in Nursing",slug:"effective-communication-in-nursing",totalDownloads:9583,totalCrossrefCites:7,totalDimensionsCites:10,abstract:"Nurses are critical in the delivery of essential health services and are core in strengthening the health system. They bring people-centred care closer to the communities where they are needed most, thereby helping improve health outcomes and the overall cost-effectiveness of services. Nurses usually act as first responders to complex humanitarian crises and disasters; protectors and advocates for the community and communicators and co-ordinators within teams. Communication is a core component of sound relationships, collaboration and co-operation, which in turn are essential aspects of professional practice. The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. Increases in nursing communication can lessen medical errors and make a difference in positive patient outcomes. This chapter explores how effective communication and interpersonal skills can enhance professional nursing practice and nursing relationships with various stakeholders. It explains principles of communication, communication process, purpose of communication, types of communication, barriers to effective communication, models of communication and strategies of improving communication and guidelines for successful therapeutic interactions.",book:{id:"6615",slug:"nursing",title:"Nursing",fullTitle:"Nursing"},signatures:"Maureen Nokuthula Sibiya",authors:[{id:"73330",title:"Dr.",name:"Nokuthula",middleName:null,surname:"Sibiya",slug:"nokuthula-sibiya",fullName:"Nokuthula Sibiya"}]},{id:"19615",title:"Everything Under Control: How and When to Die - A Critical Analysis of the Arguments for Euthanasia",slug:"everything-under-control-how-and-when-to-die-a-critical-analysis-of-the-arguments-for-euthanasia",totalDownloads:6576,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"242",slug:"euthanasia-the-good-death-controversy-in-humans-and-animals",title:"Euthanasia",fullTitle:'Euthanasia - The "Good Death" Controversy in Humans and Animals'},signatures:"Josef Kuře",authors:[{id:"30926",title:"Prof.",name:"Josef",middleName:null,surname:"Kuře",slug:"josef-kure",fullName:"Josef Kuře"}]},{id:"19620",title:"Debate For and Against Euthanasia in the Control of Dog Populations",slug:"debate-for-and-against-euthanasia-in-the-control-of-dog-populations",totalDownloads:12576,totalCrossrefCites:0,totalDimensionsCites:2,abstract:null,book:{id:"242",slug:"euthanasia-the-good-death-controversy-in-humans-and-animals",title:"Euthanasia",fullTitle:'Euthanasia - The "Good Death" Controversy in Humans and Animals'},signatures:"Antonio Ortega-Pacheco and Matilde Jiménez-Coello",authors:[{id:"30340",title:"Dr.",name:"Matilde",middleName:null,surname:"Jimenez-Coello",slug:"matilde-jimenez-coello",fullName:"Matilde Jimenez-Coello"},{id:"30393",title:"Dr.",name:"Antonio",middleName:null,surname:"Ortega-Pacheco",slug:"antonio-ortega-pacheco",fullName:"Antonio Ortega-Pacheco"}]},{id:"61494",title:"Transcultural Nursing",slug:"transcultural-nursing",totalDownloads:2688,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"Culture is defined as the sum of all the material and spiritual values created in the process of social development and the tools that are used to create and hand these values down to next generations and show the extent of the man’s authority and control over their natural and social environment. The term “culture”, which diversifies in each community and so is experienced differently, also affects the way individuals perceive the phenomena such as health, illness, happiness, sadness and the manner these emotions are experienced. The term health, whose nature and meaning is highly variable across different cultures requires care involving cultural recognition, valueing and practice. The nursing profession, which plays an important role in the health team, is often based on a cultural phenomenon. The cultural values, beliefs and practices of the patient are an integral part of holistic nursing care. The aim of nursing is to provide a wholly caring and humanistic service respecting people’s cultural values and lifestyles. Nurses should offer an acceptable and affordable care for the individuals under the conditions of the day. Knowing what cultural practices are done in the target communities and identifying the cultural barriers to offering quality health care positively affects the caring process. Nurses should explore new ways of providing cultural care in multicultural societies, understand how culture affects health-illness definitions and build a bridge for the gap between the caring process and the individuals in different cultures.",book:{id:"6615",slug:"nursing",title:"Nursing",fullTitle:"Nursing"},signatures:"Vasfiye Bayram Değer",authors:[{id:"228268",title:"Associate Prof.",name:"Vasfiye",middleName:null,surname:"Bayram Değer",slug:"vasfiye-bayram-deger",fullName:"Vasfiye Bayram Değer"}]},{id:"72954",title:"Value-Based Healthcare",slug:"value-based-healthcare",totalDownloads:832,totalCrossrefCites:0,totalDimensionsCites:3,abstract:"Value-based healthcare is a new health-care model in which what is important is value to the patient. Value is a broad term, but in essence, it is the best outcome for the patient per dollar spent. To provide value to the patient, the medical practice should be centered around conditions and care cycles and the results must be measured. We now know that the model we have right now, the fee-for-service model, is not linked to quality of the patient. All around the world, many hospitals and clinics are making the transition to this value-based model. To provide the best for the patient, we must have the best medical evidence to follow. In the following chapter, we will cover a few aspects of value-based healthcare, its reimbursement model, the integrated practice units, and the information technology necessary to implement it.",book:{id:"9566",slug:"bioethics-in-medicine-and-society",title:"Bioethics in Medicine and Society",fullTitle:"Bioethics in Medicine and Society"},signatures:"Patrick Rech Ramos",authors:[{id:"321359",title:"Dr.",name:"Patrick",middleName:"Rech",surname:"Rech Ramos",slug:"patrick-rech-ramos",fullName:"Patrick Rech Ramos"}]}],onlineFirstChaptersFilter:{topicId:"167",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81683",title:"An Examination of Safe Injection Sites and Ethical Issues in Philadelphia, United States",slug:"an-examination-of-safe-injection-sites-and-ethical-issues-in-philadelphia-united-states",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.104565",abstract:"The opioid epidemic in the United States has been an ever-increasing public health crisis. Despite being a major issue in the United States for decades, relatively little action has been taken to address the opioid crisis. To mitigate the harm the opioid epidemic has caused in the United States, safe injection sites have emerged as a promising solution. Despite the exhaustive benefits of safe injection sites, including the reduction in the number of opioid overdose deaths, safe injection sites have faced opposition in the United States. Most of these concerns in the United States question the legality of safe injection sites, along with potential community implications. Through examining the ethics of safe injection sites from a Catholic social teaching perspective and performing an integrative literature review, safe injection sites are clearly ethical and would aid in respecting the dignity and life of people who inject drugs (PWID). With safe injection sites being ethical and recommendations in this paper to overcome concerns about safe injection sites, safe injection sites are a viable option to combat the opioid crisis in the United States.",book:{id:"10878",title:"Bioethical Issues in Healthcare",coverURL:"https://cdn.intechopen.com/books/images_new/10878.jpg"},signatures:"Peter A. Clark and David Grana"},{id:"80067",title:"The Risk of Inequality in Italian Healthcare Due to Covid-19",slug:"the-risk-of-inequality-in-italian-healthcare-due-to-covid-19",totalDownloads:63,totalDimensionsCites:0,doi:"10.5772/intechopen.97514",abstract:"The Italian National Health Service, characterized by the principles of universality, equality and fairness, has undergone changes over the years that have involved these essential characteristics. The decrease in financial resources was the first element that touched the Italian health organization. The spread of Covid-19 has attacked the balance of healthcare in Italy and put the equality of the entire care system at risk. The reform of the Italian health system, especially through the correct use of European financial resources, is the real test for the Italian health system of the future. It can be a moment of relaunch or the certification of a decline that jeopardizes constitutional rights.",book:{id:"10878",title:"Bioethical Issues in Healthcare",coverURL:"https://cdn.intechopen.com/books/images_new/10878.jpg"},signatures:"Carlo Ciardo"},{id:"79666",title:"Good Pharmacy Practice in India: Its Past, Present and Future with Need and Status in COVID 19",slug:"good-pharmacy-practice-in-india-its-past-present-and-future-with-need-and-status-in-covid-19",totalDownloads:150,totalDimensionsCites:0,doi:"10.5772/intechopen.100635",abstract:"The pandemic of COVID-19 has highlighted the importance of emergency preparedness and response (EP and R) in India’s education, training, capacity building, and infrastructure growth. Healthcare professionals, especially pharmacy professionals (PPs) in India, continued to provide drugs, supplies, and services during the pandemic. The public-private healthcare system in India is complicated and of varying quality. Patients face problems as a result of gaps in pharmacy practice education and training, as well as a lack of clarity about pharmacists’ positions. Job requirements and effective placement of healthcare professionals in patient care, as well as on (EP and R) task forces or policy representation, are complicated by this lack of distinction. We have also seen malpractice and spurious distribution in the healthcare and pharmaceutical domain in terms of personal protective kits, medications, injectable, life-saving oxygen, and other items during this unprecedented pandemic situation. A few of the incidents are as follows. The central division police in Bangalore (the Global BPO & IT Hub of India) booked a case of bed-blocking at a private hospital and arrested three people, one of whom is an Arogya Mitra (primary contact for the beneficiaries at every empaneled hospital care provider), for allegedly extorting ₹1.20 lakh from the son of a COVID-19 patient who later passed away. At least 178 COVID-19 patients in India have died because of oxygen shortage in recent weeks. Another 70 deaths have been attributed to an oxygen shortage by patients’ families, but this has been denied by the authorities. The Allahabad High court made a remark “Death of COVID patients due to non-supply of oxygen not less than genocide” on reports circulating on social media regarding the death of COVID-19 patients due to lack of oxygen in Lucknow and Meerut. A day ago, the Delhi police busted an industrial manufacturing unit in Uttarakhand’s Kotdwar where fake Remdesivir injections were being manufactured and arrested five people. These depict the ground reality and ethical standards of good pharmacy practice in this country. There is an utmost necessity to relook and re-establish the standards of pharmacy practice in healthcare setups available in each and every corner of the country in line with guidelines provided by the World Health Organization (WHO) and the International Pharmaceutical Federation (FIP). For that, the dependency and responsibilities are very high on healthcare professionals, particularly in this pandemic situation. The pharmacy zone is adaptable, evolving, and increasingly diverse, offering a wide range of work and management opportunities to execute. PPs are human service professionals whose responsibilities include safeguarding individuals by dispensing medications based on prescriptions. Representing the world’s third-largest medicinal services with active gathering, and in India, there are over 1,000,000 (1 million) enrolled PPs employed in various capacities and readily contributing to the country’s well-being. Pharmacy practice, which includes clinical, community, and hospital pharmacy, is referred to as total healthcare in its true sense. Through adaptation and implementation of GPP in healthcare setup, PPs form an essential link between physicians, nurses, and patients in the social community group, with an ultimate emphasis on patient well-being and protection. To instill quality and raise the standard in this chaotic situation there are strict measures required in the country. The International Pharmaceutical Federation and World Health Organization define good pharmacy practice (GPP) as practices that meet the personal needs of patients or those using pharmacy services by offering appropriate evidence-based care. In developed countries, pharmaceutical assistance is defined as a pharmaceutical practice model that involves attitudes, ethical values, behaviors, skills, appointments, and co-responsibility to prevent diseases, promote and recovery health in an integrated manner as part of the healthcare process, highlighting, among other, the requirement that the institution fully adopts the GPP. There is a need for a GPP Program designed by the Indian Govt. or its stakeholders in the context of the Indian healthcare system and adopting “new normal” due to the unprecedented event of COVID 19 and also raising the standard and importance of GPP for the healthcare professionals in the current scenario.",book:{id:"10878",title:"Bioethical Issues in Healthcare",coverURL:"https://cdn.intechopen.com/books/images_new/10878.jpg"},signatures:"Mrinmoy Roy"},{id:"79358",title:"Determination of Death: Ethical and Biomedical Update with International Consensus",slug:"determination-of-death-ethical-and-biomedical-update-with-international-consensus",totalDownloads:187,totalDimensionsCites:0,doi:"10.5772/intechopen.100604",abstract:"Humanity has been confronted with the concept and criteria of death for millennia and the line between life and death sustains to be debated. The profound change caused by life support technology and transplantation continues to challenge our notions of life and death. Despite scientific progress in the previous few decades, there remain big variations in diagnosis criteria applied in each country. Death is a process involving cessation of physiological function and determination of death is the final event in that process. Legally, a patient could be declared dead due to lack of brain function, and still may have a heartbeat when on a mechanical ventilator. Though there is no point in supporting ventilation in a dead person, withdrawing a ventilator before the legal criteria for death may involve the physician in both civil and criminal proceedings. To identify the moment of death is vital to avoid the use of unnecessary medical intervention on a patient who has already died and to ensure the organ donation process, clear and transparent. The age-old standard of determination of death is somatic standard and cardiopulmonary standard. Harvard report (1968) defines irreversible coma as a replacement criterion for death and prescribed clinical criteria for the permanently nonfunctioning brain. The current unifying concept of death: irreversible loss of the capacity for consciousness combined with irreversible loss of the capacity to breathe. WHO (2014) adopted minimum determinant death criteria, acceptable for medical practice globally, achieving international consensus on clinical criteria to maintain public trust and promote ethical practices that respect fundamental rights of individuals and minimize philosophical and biomedical debate in human death. AAN (2019) endorses that the brain death is the irreversible loss of all functions of the entire brain and equivalent to circulatory death.",book:{id:"10878",title:"Bioethical Issues in Healthcare",coverURL:"https://cdn.intechopen.com/books/images_new/10878.jpg"},signatures:"Md. Shah Alam Panna"},{id:"77450",title:"For a Model of Revision, Assistance and Care of Identities",slug:"for-a-model-of-revision-assistance-and-care-of-identities",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.98415",abstract:"The global crisis scenario has highlighted the weaknesses of advanced personal assistance and care systems, based on the absolute primacy of technical knowledge. Almost all health organizations have been challenged by the new Coronavirus. The universal system because it is realistically unable to reach everyone efficiently and effectively. The private model, albeit moderated by intentions of global care, because it is onerous and, in fact, not very inclusive. This study, without any pretense of completeness, thanks to an examination of the most well-known documents published by the organizations for the promotion of human health, both EU and international, highlights the essential aspects and purposes of some of the main models of health care, also identifying the critical issues and the remedies prepared. The main purpose of the text is to highlight and reflect on possible alternative solutions to the current strategies to combat the pandemic, implemented by the states. The probable contributing causes that have contributed to the spread of the new coronavirus and its variants globally and that have their roots in now dated issues are then analyzed. The lesson that the Pandemic teaches us is that “no one is saved alone” and that the problems of each family, social, national etc., represent the problems of everyone. The document concludes in the sense that, only through a new approach to individual and collective health care, marked by greater solidarity and respect for individual, specific identities and frailties, starting from those “hidden” in society (adolescents, elderly, of handicaps, immigrants, etc.) it will be possible to promote welfare systems that are more attentive to the needs imposed by the challenges of globalization and therefore really more effective, economical and efficient, and therefore more humane.",book:{id:"10878",title:"Bioethical Issues in Healthcare",coverURL:"https://cdn.intechopen.com/books/images_new/10878.jpg"},signatures:"Federico D’Angiolillo"},{id:"77679",title:"Compassion Versus Care in Healthcare Institutions: What’s the Difference?",slug:"compassion-versus-care-in-healthcare-institutions-what-s-the-difference",totalDownloads:97,totalDimensionsCites:0,doi:"10.5772/intechopen.97860",abstract:"In February 2013, the Francis Report outlined what it described as ‘systematic failings’ at Mid Staffordshire NHS Foundation Trust resulting in the death and suffering of many patients through neglect (in the UK context, hospitals can apply to gain foundation trust status. Foundation trust hospitals are part of the National Health Service (NHS) but are not directed by central government and have greater freedom to decide the way services are delivered. They adhere to core NHS principles of free medical treatment based on need and not the ability to pay.) A lack of compassion, particularly among nursing staff, was identified as one of the contributing factors to poor care. The NHS was founded on the core value of compassion that today is one of six values all NHS staff are expected to demonstrate. Frequently invoked as a means to ensuring good patient care, it is a concept that is contested by a number of writers who argue that such moral emotions are not only unnecessary but dangerous. The purpose of this work is to explore the difference between compassion and care (but not medical treatment) in the context of the NHS. The paper draws on the work of Anca Gheaus, who argues there is a distinction to be made between the two and that while it is possible to be compassionate towards everybody, the ability to care, is limited to fewer people and is a more intense and engaged activity. Regarded as the founding myth of the NHS, the work also draws on the parable of the Good Samaritan to make the distinction between the two concepts more visible, and argues the roles played by the Good Samaritan and the innkeeper, remain relevant to the workings of today’s healthcare system. It also reflects on the need for kindness within the system.",book:{id:"10878",title:"Bioethical Issues in Healthcare",coverURL:"https://cdn.intechopen.com/books/images_new/10878.jpg"},signatures:"Una P. 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Currently, he is a professor of Orthodontics. He holds a Certificate of Advanced Study type A in Technology of Biomaterials used in Dentistry (1995); Certificate of Advanced Study type B in Dento-Facial Orthopaedics (1997) from the Faculty of Dental Surgery, University Denis Diderot-Paris VII, France; Diploma of Advanced Study (DESA) in Biocompatibility of Biomaterials from the Faculty of Medicine and Pharmacy of Casablanca (2002); Certificate of Clinical Occlusodontics from the Faculty of Dentistry of Casablanca (2004); University Diploma of Biostatistics and Perceptual Health Measurement from the Faculty of Medicine and Pharmacy of Casablanca (2011); and a University Diploma of Pedagogy of Odontological Sciences from the Faculty of Dentistry of Casablanca (2013). 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. 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His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. 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He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. 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Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11404,editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",slug:"adriano-andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",biography:"Dr. Adriano de Oliveira Andrade graduated in Electrical Engineering at the Federal University of Goiás (Brazil) in 1997. He received his MSc and PhD in Biomedical Engineering respectively from the Federal University of Uberlândia (UFU, Brazil) in 2000 and from the University of Reading (UK) in 2005. He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). He was the head of the undergraduate program in Biomedical Engineering of the Federal University of Uberlândia (2015 - June/2019) and the head of the Centre for Innovation and Technology Assessment in Health (NIATS/UFU) since 2010. He is the head of the Postgraduate Program in Biomedical Engineering (UFU, July/2019 - to date). He was the secretary of the Parkinson's Disease Association of Uberlândia (2018-2019). Dr. Andrade's primary area of research is focused towards getting information from the neuromuscular system to understand its strategies of organization, adaptation and controlling in the context of motor neuron diseases. 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\r\n\tIn general, the harsher the environmental conditions in an ecosystem, the lower the biodiversity. Changes in the environment caused by human activity accelerate the impoverishment of biodiversity.
\r\n
\r\n\tBiodiversity refers to “the variability of living organisms from any source, including terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part; it includes diversity within each species, between species, and that of ecosystems”.
\r\n
\r\n\tBiodiversity provides food security and constitutes a gene pool for biotechnology, especially in the field of agriculture and medicine, and promotes the development of ecotourism.
\r\n
\r\n\tCurrently, biologists admit that we are witnessing the first phases of the seventh mass extinction caused by human intervention. It is estimated that the current rate of extinction is between a hundred and a thousand times faster than it was when man first appeared. The disappearance of species is caused not only by an accelerated rate of extinction, but also by a decrease in the rate of emergence of new species as human activities degrade the natural environment. The conservation of biological diversity is "a common concern of humanity" and an integral part of the development process. Its objectives are “the conservation of biological diversity, the sustainable use of its components, and the fair and equitable sharing of the benefits resulting from the use of genetic resources”.
\r\n
\r\n\tThe following are the main causes of biodiversity loss:
\r\n
\r\n\t• The destruction of natural habitats to expand urban and agricultural areas and to obtain timber, minerals and other natural resources.
\r\n
\r\n\t• The introduction of alien species into a habitat, whether intentionally or unintentionally which has an impact on the fauna and flora of the area, and as a result, they are reduced or become extinct.
\r\n
\r\n\t• Pollution from industrial and agricultural products, which devastate the fauna and flora, especially those in fresh water.
\r\n
\r\n\t• Global warming, which is seen as a threat to biological diversity, and will become increasingly important in the future.
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\r\n\tThe environment is subject to severe anthropic effects. Among them are those associated with pollution, resource extraction and overexploitation, loss of biodiversity, soil degradation, disorderly land occupation and planning, and many others. These anthropic effects could potentially be caused by any inadequate management of the environment. However, ecosystems have a resilience that makes them react to disturbances which mitigate the negative effects. It is critical to understand how ecosystems, natural and anthropized, including urban environments, respond to actions that have a negative influence and how they are managed. It is also important to establish when the limits marked by the resilience and the breaking point are achieved and when no return is possible. The main focus for the chapters is to cover the subjects such as understanding how the environment resilience works, the mechanisms involved, and how to manage them in order to improve our interactions with the environment and promote the use of adequate management practices such as those outlined in the United Nations’ Sustainable Development Goals.
\r\n\tPollution is caused by a wide variety of human activities and occurs in diverse forms, for example biological, chemical, et cetera. In recent years, significant efforts have been made to ensure that the environment is clean, that rigorous rules are implemented, and old laws are updated to reduce the risks towards humans and ecosystems. However, rapid industrialization and the need for more cultivable sources or habitable lands, for an increasing population, as well as fewer alternatives for waste disposal, make the pollution control tasks more challenging. Therefore, this topic will focus on assessing and managing environmental pollution. It will cover various subjects, including risk assessment due to the pollution of ecosystems, transport and fate of pollutants, restoration or remediation of polluted matrices, and efforts towards sustainable solutions to minimize environmental pollution.
\r\n\tWater is not only a crucial substance needed for biological life on Earth, but it is also a basic requirement for the existence and development of the human society. Owing to the importance of water to life on Earth, early researchers conducted numerous studies and analyses on the liquid form of water from the perspectives of chemistry, physics, earth science, and biology, and concluded that Earth is a "water polo". Water covers approximately 71% of Earth's surface. However, 97.2% of this water is seawater, 21.5% is icebergs and glaciers, and only 0.65% is freshwater that can be used directly by humans. As a result, the amount of water reserves available for human consumption is limited. The development, utilization, and protection of freshwater resources has become the focus of water science research for the continued improvement of human livelihoods and society.
\r\n
\r\n\tWater exists as solid, liquid, and gas within Earth’s atmosphere, lithosphere, and biosphere. Liquid water is used for a variety of purposes besides drinking, including power generation, ecology, landscaping, and shipping. Because water is involved in various environmental hydrological processes as well as numerous aspects of the economy and human society, the study of various phenomena in the hydrosphere, the laws governing their occurrence and development, the relationship between the hydrosphere and other spheres of Earth, and the relationship between water and social development, are all part of water science. Knowledge systems for water science are improving continuously. Water science has become a specialized field concerned with the identification of its physical, chemical, and biological properties. In addition, it reveals the laws of water distribution, movement, and circulation, and proposes methods and tools for water development, utilization, planning, management, and protection. Currently, the field of water science covers research related to topics such as hydrology, water resources and water environment. It also includes research on water related issues such as safety, engineering, economy, law, culture, information, and education.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/41.jpg",keywords:"Water, Water resources, Freshwater, Hydrological processes, Utilization, Protection"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:null,selectedSubseries:null},seriesLanding:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. 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He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. 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In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. This topic will closely deal with all emerging trends in this discipline.",annualVolume:11411,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null,editorialBoard:[{id:"241413",title:"Dr.",name:"Azhar",middleName:null,surname:"Rasul",fullName:"Azhar Rasul",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRT1oQAG/Profile_Picture_1635251978933",institutionString:null,institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}},{id:"178316",title:"Ph.D.",name:"Sergey",middleName:null,surname:"Sedykh",fullName:"Sergey Sedykh",profilePictureURL:"https://mts.intechopen.com/storage/users/178316/images/system/178316.jfif",institutionString:null,institution:{name:"Novosibirsk State University",institutionURL:null,country:{name:"Russia"}}}]},{id:"17",title:"Metabolism",keywords:"Biomolecules Metabolism, Energy Metabolism, Metabolic Pathways, Key Metabolic Enzymes, Metabolic Adaptation",scope:"Metabolism is frequently defined in biochemistry textbooks as the overall process that allows living systems to acquire and use the free energy they need for their vital functions or the chemical processes that occur within a living organism to maintain life. Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. The Proteomics topic aims to attract contributions on all aspects of MS-based proteomics that, by pushing the boundaries of MS capabilities, may address biological problems that have not been resolved yet.",annualVolume:11414,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null,editorialBoard:[{id:"72288",title:"Dr.",name:"Arli Aditya",middleName:null,surname:"Parikesit",fullName:"Arli Aditya Parikesit",profilePictureURL:"https://mts.intechopen.com/storage/users/72288/images/system/72288.jpg",institutionString:null,institution:{name:"Indonesia International Institute for Life Sciences",institutionURL:null,country:{name:"Indonesia"}}},{id:"40928",title:"Dr.",name:"Cesar",middleName:null,surname:"Lopez-Camarillo",fullName:"Cesar Lopez-Camarillo",profilePictureURL:"https://mts.intechopen.com/storage/users/40928/images/3884_n.png",institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",institutionURL:null,country:{name:"Mexico"}}},{id:"81926",title:"Dr.",name:"Shymaa",middleName:null,surname:"Enany",fullName:"Shymaa Enany",profilePictureURL:"https://mts.intechopen.com/storage/users/81926/images/system/81926.png",institutionString:"Suez Canal University",institution:{name:"Suez Canal University",institutionURL:null,country:{name:"Egypt"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/285699",hash:"",query:{},params:{id:"285699"},fullPath:"/profiles/285699",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()