Changes in Approach to Safety and Quality in Healthcare
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In 1993, after obtaining his Ph.D. degree (Molecular Biology) from Tokyo University, he joined Professor S. Tanuma\\'s Laboratory at Tokyo University of Science as an Assistant Professor. He obtained his second Ph.D. (Pharmaceutical Science) from Tokyo University of Science in 1999 and in 2000 was promoted to the position of Lecturer at Tokyo University of Science. Professor Uchiumi then went abroad as a post-doctoral researcher for the United States-Japan Cooperative Cancer Research Program in Professor E. Fanning’s Laboratory at Vanderbilt University, 2000-2001. 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Historically mental health services have been the poor cousin of health care services generally, and acute health care services specifically. At this time when quality in health care is occupying more space in the health care literature, it is opportune to review what inroads have been made as far as quality in delivery of mental health services.
This chapter will examine the movement towards quality management in health care and explore the divide between quality in general health care and quality in mental health care. After this, what is considered quality in delivery of mental health services is discussed and finally the challenges to quality in delivery of mental health services and methods to overcome these challenges are analysed.
The Australian national survey of mental health and wellbeing [1] estimated that 45% of Australians aged between 16-85 years, that is, approximately seven million people, experienced a mental disorder over the course of their lifetimes, while 20% experienced symptoms of a mental disorder over the the twelve months prior to the survey. Anxiety, affective and substance disorders were experienced by fourteen per cent, six per cent and five per cent of the population respectively [2].
Mental disorders are ranked third after cancer and cardiovascular in the major morbility and mortality disease burden groupings and mental disorders account for thirteen per cent of the total disease burden in Australia [3]. Generally the disease burden for mental illness is non-fatal with only 718 deaths in 2008, excluding suicide and dementia, due to mental illness as a result of substance abuse involving alcohol and heroin [4]. The most mental illness burden is attributable to anxiety, depression, alcohol abuse and personality disorders.
Mental health services are complex and the Australian government has divided them into groupings based on point of contact for treatment [5]. Mental health services consist of mental health-related care in general practice, in emergency departments, community mental health-related care and hospital outpatient services, ambulatory equivalent mental health-related admitted patient care, Medicare–subsidised psychiatrist and allied health services, admitted patient mental health-related care, residential mental health care, mental health-related supported accommodation assitance program services, support services for people with a psychiatric disability, and specialised mental health care facilities. These groupings are arranged from simple to more highly specialised treatment and accommodation arrangements and usually reflect the increasing seriousness of the impact of the mental health-related problem on the individual, family and society.
Australia spent $5.8 billion on mental health-related services during 2008-2009 [6] and this equated to an avergae annual increase of 4.8% on expenditures over the previous four years. The total health care expenditure in the same peiod was $112.8 billion with health taking up 9.0% of Australia’s Gross Domestic Product (GDP). If mental disease accounts for thirteen per cent of the burden of disease [3], then it is clear that mental health services are not getting a proportional allocation of Australian government health funds.
The United States spends far more proportionally on health care than most Western countries, spending 16 % of GDP in 2008-2009 amounting to $2.5 trillion [7]. Mental health care costs contribute to about 100million in 2003 which amounted to 6.2% to these health care costs [8]. Apart from these direct costs the indirect costs of mental illness are incurred through reduced labour supply, public income support payments, reduced educational attainment and costs associated with other consequences such as incarceration or homelessness. In fact serious mental illness is associated with the annual loss of earnings totally $193.2 billion [9].
In 2007-2009, an average annual 3.2 million or 8.6% of young adults aged 18-26years had some health ecpenses for mental disorders. Direct medical spending to treat mental health disorders in young adults totally $6.5 billion as a average annual cost [10]. According to the latest US Agency for Healthcare Research and Quality [11] treating America’s youth for mental disorders is the most expensive children’s medical condition, costing almost 9 billion dollars in 2006.
Mental ill health is the largest single cause of disability in the UK accounting for 23% of the overal burden of disease, compared to 16% each for cancer and cardiovascular disease [12]. In 2010-2011, The United Kingdom spent £118.58billion on health care which was approximately 8.7% of GDP [13], whereas the cost to the NHS for mental health problems and social care costs was over £21 billion a year. The economic and social costs of mental health problems is estimated at £102.5 billion in 2009-2010 [12]. However the majority of the impact of mental illness falls on patients and their families and amounts to costing about £53.6 billion a year. Mental health conditions tend to affect people early in life with 50% of cases occuring before 14 years.
Much of the work on quality in health services rests on the influential framework of Donabedian [14] which focused on three components: the structure of the services, the process of provider-client intervention, and the outcomes of the care. This is a comprehensive framework including public services and resources, providers, and consumers. However the movement towards quality management in health care only got traction some time after Donabedian’s framework because of the public concern about the apalling low level of quality of health care.
Patient safety started in 1999, when the Institute of Medicine, an agency of the US Government, issued the report, called
Between 44,000 and 98,000 Americans die each year from preventable medical errors in hospitals alone. That does not account for those who die from medical errors outside the hospital.
It is the equivalent to the number of people who would die if a jumbo jet crashed every day, and all its passengers died.
Medical errors cause more deaths than motor vehicle accidents, breast cancer or AIDS.
The report highlighted the reasons the reported deaths happened, calling for a shift from placing blame, to finding the reasons and fixing them. It further outlined a series of proactive recommendations for doing just that. The recommendations [15] from
Establishing a national focus to create leadership research tools and protocols to enhance the knowledge base about safety.
Identifying and learning from errors through immediate and strong mandatory reporting efforts as well as the encouragement of voluntary efforts both with the aims of making sure the system continues to be made safer for patients
Raising standards and expectations for improvements in safety through the action of oversight organisations group purchasers and professional groups.
Creating safety systems inside health care organisations through the implementation of safe practices at the delivery level. This level is the ultimate target of all recommendations.
The health care system is complex and Australia has developed a National Health Performance Framework that has been modified since its inception in 1999. The safety of the health care system has been defined by the National Health Performance Framework as the avoidance or reduction to acceptable limits of actual or potential harm from health care management or the environment in which health care is delivered. Similar definitions are in wide use in Australia. For instance, the former Australian Council for Safety and Quality in Health Care, replaced by the Australian Commission for Safety and Quality in Health Care, defined safety as the degree to which potential risk and unintended results are avoided or minimised. The WHO [16] developed a Conceptual Framework for the International Classification of Patient Safety in 2009 so that all health systems are talking the same language about patient safety.
Quality is a multi-faceted concept which can be defined in different ways. At a broad level, quality reflects the extent to which health care service or product produces a desired outcome [17]. At a more detailed level, the National Health Performance Framework views quality as a guiding principle in assessing how well the health system is performing in its mission to improve the health of Australians. The Framework\'s dimensions for the assessment of health system performance include effective, responsive, continuous, sustainable, efficiency, accessible and safety, all considered relevant to the quality of health care services. In its report Charting the Safety and Quality of Healthcare in Australia [18], the former Australian Council for Safety and Quality in Health Care presented information relating to the dimensions of effectiveness, appropriateness, accessibility and responsiveness as relevant to the quality of health care in Australia. Complementing the information on those dimensions was information on safety, and also on equity, or the degree to which all Australians could benefit equally from health care service provision.
Improvements in quality and safety in health care are important because of rising cost of health care and an increasing concern of poor value for money. In spite of the money and effort spent on health care, poor quality and variations in practice, medical errors, injuries and lack of accountability abound [19]. It is a dilemma to know where to begin because performance of health systems and quality of health care are often used interchangeably although there are differences. Nolte [20] differentiates between quality and performance by referring to the definition of ‘quality’ proposed by the US Institute of Medicine which is the ‘degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’ (1992) and definition of ‘performance’ suggested by Girard and Minvielle [21] as a broader, multidimensional concept that also includes dimensions of equity and efficiency.
In Australia there are National Standards for Mental Health Services [22] designed for implementation in public, private and NGO mental health services. The Australian Council of Healthcare Standards [23] is an independent not-for profit organisation. The Council reviews health care organisations and mental health services for perfomance, assessment and accreditation. It aims to provide a framework through the Evaluation and Quality Improvement Program (EQuIP) to deliver consumer centered services focussing on the continuum of care by providing systematic external peer review. The Council reviews mental health services against the National Standards for Mental Health Services and EQuIP.
The Standards within the National Standards for Mental Health Services [22] are:
Rights and Responsibilities
Safety
Consumer and Carer participation
Diversity Responsiveness
Promotion and Prevention
Consumers
Carers
Governance Leaderships and Management
Integration
Delivery of Care
Accreditation by meeting standards is a minimum requirement for mental healath services and healthcare generally. Accreditation is a static achievement that needs to be renewed every few years. In Australia 93% of public (that is 637 hospitals) and private hospitals (that is, 543 hospitals) are accreditated with either the Australian Council of Healthcare Standards, Business Excellence Australia, Quality Improvement Council or the certification of the International Organisaiton for Standardisation’s 9000 quality family [24]. Funding sources demand that health care facilities are accreditated. Being an accrediated hospital has not stopped significant problems in patient care.
The drive towards improvements in health care is faced with many challenges, such as countless providers and patients, institutions and communities, and incremental policies driven by experience and evidence rather than theory and ideology. Health system performance measurement and reporting are part of a global move for accountability and transparency in health services and consumer engagement and contribute to the continuous quality improvement cycle [25]. Quality improvements can occur without measurements, for example clinical guidelines, peer review, videoing consultations, and patient interviews, however, measurement is important to quality improvement.
Kohn, Corrigan, and Donaldson [26] consider health care to be a highly complex and tightly coupled system which are the types of systems that are more prone to accidents. In complex systems one component of the system may interact with multiple of the components of the system in sometimes unexpected and invisible ways. Complex systems are both specialised and interdependent. Coupling is a dynamic term that means there is no slack or buffer between two items. Large systems that are tightly coupled have more time dependent processes and sequences that are more fixed. Tight coupling contributes to more accidents because things unravel quickly and prevent errors from being intercepted or prevent speedy recovery from an event.
Latent errors or system failures, according to [26] pose the greatest threat to safety in a complex system because they lead to operator errors. They are failures built into the system and present long before the active error. Latent errors are difficult for people working in the system to see because they may be hidden in computers or layers of management and people become accustomed to working around the problems.
Such is the difficulty of getting health care right, [17] regard health care as characterised by islands of excellence in a sea of mediocrity. So there has been a steady increase in emphasis on continuous improvement of health care rather than leaving safety and quality to a static achievement of accreditation once every three or four years.
The approach to improvement in quality has been systemic and systematic, with the consumer perspective. Runciman, Merry, and Walton [17] have seven dimensions of quality in health care that involve:
Access
Efficacy and effectiveness
Efficiency
Safety
Timeliness
Acceptability
Appropriateness
These 7 dimensions operate at world international; state/national; organisational; team; clinicians; and patient levels.
Within health care there has been changes about safety and quality and managing problems that arise. Vincent [27] summarised these in a table:.
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t\tGenerally blame free reporting | \n\t\t
\n\t\t\t\t | \n\t\t\tIndividuals held to account where justified | \n\t\t
\n\t\t\t\t | \n\t\t\tAll database coordinated | \n\t\t
\n\t\t\t\t | \n\t\t\tRegular feedback to frontline staff | \n\t\t
\n\t\t\t\t | \n\t\t\tTeam based training more common | \n\t\t
\n\t\t\t\t | \n\t\t\tSystems approach to hazards and prevention | \n\t\t
\n\t\t\t\t | \n\t\t\tEmphasis on sustained risk management | \n\t\t
\n\t\t\t\t | \n\t\t\tPotential for replication of similar ADE recognised | \n\t\t
\n\t\t\t\t | \n\t\t\tRecognition that lessons may be relevant to others | \n\t\t
\n\t\t\t\t | \n\t\t\tTeam based learning and developing of non-technical skills | \n\t\t
Changes in Approach to Safety and Quality in Healthcare
Indicators are explicitly defined and measurable items referrring to structures processes and outcomes of care [28]. Developing and applying quality indicators is not easy. There are three types of indicators. Activity indicators measure how frequently an event happens. Quality indicators infer a judgement about the quality of care provided. Performance indicators are statistical devices for monitoring performance without any necessary inference about quality. Indicators do not provide answers but they are indicative of problems or may indicate good quality care.
Continuous improvement is a planned way of improving care for patients and carers step by step over time. The reflective cycle for continuous improvement follows the Plan-Do-Study-Act model of improvement of Langley, Nolan and Nolan [29]. Ferlie and Shortell [30] in discussing quality improvement in healthcare in the UK and the US, said that there are four essential core properties that must operate at individual, group/team, organisational and larger system level. These four essential core properties are: 1) leadership at all levels; 2) a pervasive culture that supports learning throughout the care process; 3) an emphasis on effective teams; and 4) greater use of information technologies for both continuous improvement work and external accountability.
Consumers‘ expectations of health care are certainly different from those of health care providers. As far as quality in health care is concerned [31] study found that consumers described quality in health care in terms of access to care, having competent and skilled providers, and recieving the proper treatment. From nurses consumers in the same study wanted caring behaviour, competence and skill, good communication and discussion about their condition.
Engagement with consumers in health care can occur at three levels [32]. Informed choice is the role that is most actively promoted for consumers and within that sphere shared decision making is promoted to a lesser extent. The two other levels of engagement are less often encouraged and supported. These levels deal with consumers as active participants in their care (co-producer role) and consumers evaluating the care they recieve (evaluator role).
Although speaking of health care reform in the United States, [33] take the importance of consumer engagement further and state that ‘engaging consumers is an essential component to health care reform‘. Consumers of higher education, higher incomes, no health insurance and good self reported health have higher levels of engagement with their health care. Interestingly, people with depression have lower levels of consumer engagement in thie health care. Hibbard and Cunningham’s research shows that consumers that are more involved in their health care have lower levels of unmet needs and recieve greater support from health care providers.
The value of consumers to the drive for quality in health care is part of incorporating the end user into the design and delivery of health services. Health services however are not like industrial complexes. [34] compares the quality improvement strategies in reshaping Toyota with quality attempts in health care. The problems for health care lie in providers not being able to anticipate that quality improvements will result in higher prices, increased volume or decreased costs.
[35] take the point about consumer involvement in quality in health care further and delineate five principles to improve the effectiveness and impact of public reporting in health care quality. These principles are:
Consumers must be convinced that health care quality problems are real that they have serious consequences and that quality can and should be improved.
Quality reporting must be standardised and universal
Consumers are given quality information that is relevnt and easy to use
Dissemination of quality information is improved
Purchasers reward quality improvements and providers create the information and organisational infrastructure to achieve them
Certainly, [36] were cautious about consumer led quality improvements in health care. These authors stressed that greater clarity has to be obtained about what consumer satisfaction with the health system (not just health treatments) is all about.
The UK has moved forward with consumer engagment in healthcare with the Care Quality Commission forming in 2009 as the independent regulator of health and adult social care in England. It replaced the Healthcare Commission, Commission of Social Care and the Mental Health Act Commission. Every year the Commission conducts patient surveys on the NHS Trusts throughout England. The survey is based on the Picker Patient Experience Questionnaire that has been validated across five countries in, Germany, Sweden, Switzerland and, Germany as well as the UK [37]. The dimensions of patients‘ experience in the Picker adult in-patient questionnaire are:
Information and education
Coordination of care
Physical comfort
Emotional support
Respect fro patient preference
Involvement of family and friends
Continuity and transition
Overall impression
The commission‘s patients survey compares the responses with previous years results and these reports are given back to the specific Trusts with comparison data from other Trusts. Trusts are expected to improve their performace because the Commission is the regulator and has a Judgement Framework and an Enforcement Policy.
Consumer input to improving mental health services has been recognised in the US with the development of the Consumer-Orientated Mental Health Report Card which is organised around prevention, access, appropriateness, and outcomes with consumer satisfaction included under each area and each of these areas is associated with indicators. The Mental Health Statistics Improvement Program [38] has taken the Consumer Orientated Mental Health Report Card and it has been adapted for use with inpatients, youths and families and translated into French and Spanish.
In an era when there is sustained political rhetoric in favour of consumers involvement in health care [39] the media’s interest in critical contributions is limited, preferring to sensationalise issues as part of the production of news [40]. However the media does have a legitimate role to play in health policy and health services within democratic societies.
The media is significant in the relationship between health decision makers and patients, providing a communication channel influencing the demand and supply of medical treatments sometimes reagardless of evidence of effectivenss, providing a voice for whistleblowers and a platform for patient safety disasters to be exposed. In reporting medical errors the media often takes the simple approach of blaming those doctors who fail to live up to some imaged medical paragon [41], and missing the failures of the poorly developed and managed health systems that allow these mistakes to occur.
There have been situations in which the media has been involved in the ongoing exposure of major health system failures such as Dr Jayant Patel in Queensland [42], Sydney Morning Herald‘s coverage of the Cambelltown and Camden hospitals problems in 2004 [43], and The Guardian‘s report of Professor Bolsin’s account of events at the Bristol Royal Infirmary in the 1990s [44]. Even the power of the press however, finds it hard to make much of an impression against the medical fraternity which is backed by the government. Most system failures take years to pass through the process of breakdown in patient safety, whistleblower, public exposure with the press, public inquiry and recommendations, to implementation of changes within the health system and system improvements to prevent the same problems occuring again. Not only does this process take years there are many casualities on the way as patients suffer and whistleblowers lose their jobs and their reputation‘s suffer as was the case with Professor Bolsin.
In 2002 the World Health Assembly urged the WHO and Member states to pay the closest possible attention to patient safety and in 2004 launched the WHO patient safety program with Sir Liam Donaldson as the WHO envoy for patient safety. The WHO definition of patient safety is simply: the absence of preventable harm to a patient during the process of healthcare. WHO patient safety has initiated two patient safety campaigns involving hand washing and a safety checklist to improve compliance with surgey standards and decrese complications.
One initiative of the WHO Patient Safety is Patients For Patient Safety (PFPS) [45]. Patient For Patient Safety (PFPS) is a collective voice of patients and consumers concerned about patient safety issues. This active process involves patients and consumers as partners in healthcare and operates in countries and globally.
The global burden of mental disorders is considerable. The [46] reports that as many as 450 million people suffer from a mental or behavioural disorder, nearly 1 million people commit suicide every year, four of the six leading causes of years lived with disability are due to neuropsychiatric disorders (depression, alcohol-use disorders, schizophrenia,and bipolar disorder) and those suffering from a mental illness are also victims of human rights violations, stigma and discrimination both inside and outside public institutions. The gap between the need for treatment for mental disorders and resources available is greater in developing countries than in developed countries. In developed countries between 44% and 70% of patients with mental disorders do not recieve treatment, whereas in developing countries the treatment gap is close to 90%.
Disadvantages are accumulative in health and mental functioning is fundamentally connected to physical and social functioning and health outcomes. Depression is often associated with chronic physical illness and requires comprehensive treatment to achieve the best physical outcomes. The family bears the burden of a family member with mental illness but the extent of this burden is hard to quantify. Sometimes the stigma associated with mental illness extends to the family and causes isolation and discrimination.
Reputable sources such as the [46] report situations of mental patients being chained as a form of treatment. The New York Times in 2009 reported examples of abuse during psychatric treatment in Kings County Hospital [47]. The political abuse of psychiatry which is the misuse of psychiatric diagnoses and treatment to obstruct the human rights of individuals is well documented in a recent review by [48].
The huge treatment gap in mental health in developing countries requires innovative thinking rather than repeating the clinic or hospital based patient management by specialist mental health professionals as occurs in Western countries. Vikram Patel [49], a psychiatrist from the London School of Hygiene and Tropical Medicine, said that mental health care in developing countries needs to shift treatment to appropriately trained and supervised lay people. The precise model of care for mental health in developing countries depends greatly on the local health system factors and in particular the state of the general health system and the political commitment to public health [50]. A great deal has to be done about mental health advocacy and raising the priority of mental health with donor agencies.
There is a complex interaction between poverty and mental disorders. Mental disoders are costly in terms of treatment and loss of productivity. Other factors such as low educational levels, poor housing and malnutrition contribute to common mental disorders. Povery contributes to mental disoders and mental disorders contribute to poverty. Similarly, work education, violence and trauma are linked in a vicious cycle to mental disorders [46].
Traditionally underserved groups include those who are geographically remote, those of disadvantaged socioeconomically minorities, people with disabilities, women and indigenous people, lesbian gay and bisexual people and the aged. Developing mental health services to meet the needs of these diverse and underserved groups has recieved increasing attention both globally with the Nations for Mental Health [51] final report (2002) and nationally.
The important issue about meeting the mental health needs of traditionally underserved groups is that no one approach is going to satisfy the needs of these widely diverse populations. However as research is acculmulating about health needs for these populations then strategies can be developed to promote mental health, prevent mental illness and provide treatments for early recovery and prevention of long term disability.
Health services that deal with mental illness have not be subjected to the same scrutiny as have health services that deal with physical illness. There are many reasons for this, not the least of which is the social stigma associated with mental illness. Patients in general health services who experience poor care have avenues to complain and have their complaints dealt with so that services can be improved. Patients in mental hospitals have the burden of social stigma to negotiate before complaining about poor care. Also, many general health services struggle to provide culturally competent services. For sufferers of mental illness the cultural differences between providers and mental health consumers can be a barrier to treatment and recovery.
In 2002 President Bush in the United States set up the New Freedom Commission on Mental Health because the health system should treat people with mental illness with the same urgecny as a physical illness. Bush identified three barriers to excelelnt care for those with mental illness: the stigma attached to mental illness, unfair limits that stems from inadequate health insurance, and a fragmented system for delivering services. The Commission [52] produced its report and tied its 19 recommendations to six goals: building greater understanding among Americans that mental health is essential to overall health; mental health care is consumer and family driven; eliminating disparities in the delivery of mental health services; early mental health screening assessment and referral to services is common practice; excellent mental health care is delivered and research is accellerated; and technology is used to access mental helth care and information.
Goal 1
Building greater understanding among Americans that mental health is essential to overall health;
Recommendations
Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention
Address mental heatlh with the same urgency as physical health
Goal 2
Mental health care is consumer and family driven;
Recommendations
Develop an individualised plan of care for every adult with the sersious mental illness and for every child with a serious emotional disturbance
Involve consumers and families fully in orienting the mental health system towards recovery
Align relevant federal programs to improve access and accountability for mental health services
Create a comprehensive state mental health plan
Protect and enhance the rights of people with mental illnesses
Goal 3
Eliminating disparities in the delivery of mental health services;
Recommendations
Improve access to high-quality care that is culturally competent
Imporve access to high-quality care in rural and geographically remote areas
Goal 4
Early mental health screening assessment and referral to sesrvices is common practice;
Recommendations
Promote the mental health of young children
Improve and expand school mental health programs
Screen for co-existing mental and substance use disorders and link with integrated treatment strategies
Screen for mental disorders in primary health care, across the life span, and connect to treatment and supports
Goal 5
Excellent mental health care is delivered and research is accellerated;
Recommendations
Accelerate research to promote recovery and resilience and ultimately to cure and prevent mental illness
Advance evidence based practices using dissemination and demonstration projects and create public-private partnerships to guide implementation
Improve and expand the workforce providing evidence-based mental health services
Develop the knowledge base in four understudied areas: disparities in mental health care; long term effects of medication, trauma and acute care
Goal 6
Technology is used to access mental helth care and information
Recommendations
Use health and information technology to improve access to and coordination of mental health care, especially in remote areas and underserved populations
Develop and implement integrated electronic health record and personal health information systems
The recommendations of the Commision may not have been fully implemented [53]. It has been, however, a line drawn in the sand stating that the system to provide services to treat mental illness was a shambles and that the mental health maze had to be transformed starting from community perceptions of mental health and eradicating stigma associated with mental illness treatment. The stigma of mental illness is pervasive. It limits people seeking care, influences the provider-client realtionship and impacts public funding of mental heatlh services.
Simpson and House [54] conducted a systematic review about involving users in the delivery and evaluation of mental health services. They found that the few comparative studies of users\' involvement that have been published indicate that involving users as employees, trainers, or researchers has no negative effect on services and may be of benefit.
The priority towards a limited biomedical model of medical training rather than an expanded bio-psycho-social model greatly impedes recognition of mental illness in primary health care. The biomedical model of medical education is reflective of the philosophy of medicine [55] and is reflective also of the dominance of physical acute health care in public funding of health services and health research.
In spite of the dominance of acute physical health care there have been some inroads made with mental health services as an area of academic interest. Although there are many journals that deal with mental health issues a smaller number deal specifically with mental health services. In 2006 the journal Mental Health Services Research combined with the journal of Administration and Policy in Mental Health under the editorship of Leonard Bickman to form Springer‘s Administration and Policy in Mental Health and Mental Health Services Research journal. Another Springer journal dealing with mental health services is the Journal of Behavioural Health Services and Research (JBHS&R).
There is an argument that the escalating cost of mental health services reflects the need for these services. There is also the argument that the cost of mental health services reflects an imbalance in budgetary allocation between treatment services and mental health promotion and mental illlness prevention programmes. Knapp McDaid and Parsonage [56] presented an imposing economic argument for mental health prevention programs having a beneficial impact on the economic burden of mental illness over the long term. Fifteen interventions were modelled. These were a range of health interventions across the life span that had evidence of their effectiveness. Some of these interventions were: health visiting to reduce post natal depression, school based interventions to reduce bullying, school based social and emotional programmes to prevent conduct problems in childhood, early detection of psychosis, workplace screening for depression, population-level suicide awareness training and intervention, and tackling medically unexplained symptoms. The estimated economic pay-offs per £ of expenditure from each of the models varied, with the sector involved such as the NHS, other public sector bodies and non- public sector impacts and the timeline considered such as short term (in the first year) through to long term (year 6 and beyond). Early intervention for conduct disorders had a 7.89 return on inventment per £1 expenditure, suicide training course provided to all GPs had a 43.99 return and workplace health promotion programmes had a 9.69 return on investment.
Preventive mental health strategies targeting families, schools, and workplaces could be developed to promote healthy child development, resilience, personal achievement, healthy relationships, career satisfaction, work-life balance and healthy ageing. Secondary specialist care in mental health services is urban and needs to be expanded to meet the needs of traditionally underserviced consumers.
The major challenge to quality in delivery of mental health services is the adequate diagnosis and treatment of mental illness in the primary care sector of health care services. After analysing the results of the US National Comorbidity Survey Replication study, [57] found that most people with mental disorders in the United States remained either untreated or poorly treated. They recommended that interventions were needed that enhanced treatment initiation and quality.
The internet as a menal health intervention and prevention tool is being explored more as adults and youth integrate the internet into their daily lives. Obviously the use of the internet can eliminate the stigma associated with accessing a real world facility and therapist. Emental health service is defined as including ’all forms of electronic mental health services delivered over the internet, ranging from informational and educational products to direct services offered by professionals’ [58].
Ybarra and Easton [59] provide an assessment of internet-based mental health interventions and were generally cautious but positive about their effectiveness. Transferring face to face mental health interventions to the internet presents challenges that have to be addressed. The health literacy level of the traditionally underserved populations which is usually lower than advantaged populations is an important issue that needs consideration, the marketing and presentation of mental health interventions will be in competition with the glitz of abundant websites, and the training of mental health professionals will have to change to encompass a different skill base that will be necessary for operating on the internet.
Mental health services lag behind general health services as far as seeking to develop a quality management approach to the delivery of mental health services. The global burden of mental illness on individuals, families, communities and the public purse is enormous and is beginning to be recognised. Funding for mental health services is not proportional to the impact of mental illness. The disconnenct between the need for mental health services and the services available is related to the prioritisation of physical acute health over mental health. This prioritisation relfects cultural attitudes towards mental illness which generally encompass various forms of stigmatisation of mental illness and ostrasizing the people and sometimes the families of those who suffer mental illness.
There are some signs globally and nationally that reducing the stigma of mental illness will lessen the burden of mental illness. As part of a social justice approach, there are movements to be more inclusive towards the mental health needs of the traditionally underserved populations. Prevention programs may have a beneficial impact on the economic burden of mental illness. The integration of the internet into the lives of so many people means that it may provide an opportunity for greater accessibility of more people to innovative mental health interventions.
Today, consumption of fossil fuels is dramatically increasing along with improvements of life such as industrialization processes with the increase of the world population. It has long been recognized that this excessive fossil fuel consumption not only leads to an increase in the rate of diminishing fossil fuel reserves, but it also has a significant adverse impact on the environment, resulting in increased health risks and the threat of global climate change [1]. The potentially most important environmental problem relating to energy and water resources is global climate change (global warming or the greenhouse effect). The increasing concentration of greenhouse gases such as carbon dioxide, methane, chlorofluorocarbons, halons, nitrous oxide, ozone, and peroxyacetylnitrate in the atmosphere is acting to trap heat radiated from Earth’s surface and is raising the surface temperature of Earth [2]. This climate change has an increasingly negative impact on water resources; causing a serious decrease in available water reserves in the world [3]. In order to solve this problem, researchers have been focused on new methods for optimum use of resources with new technologies which save energy and reduce water consumption.
When the energy consumption in textile enterprises are compared to other branches of industry, it can be seen that the textile industry is seen to be at a substantial level. It could also be note that finishing departments are the most energy consuming ones among the other parts of textile manufactories. 45–75% of the energy consumed in finishing departments is listed as wet processes, 15–40% for drying and fixing processes, 8–18% for other processes and ventilation. Electricity consumption is not much in finishing departments; however, heat energy and water consumption is at very high level [4, 5]. For this reason, energy and water-saving technologies play an important role in the machines and application methods used in finishing processes.
Although textile finishing processes can be applied in different material forms (fiber, tops, yarn, fabric etc.), the most common is fabric finishing. General expectations for all these finishing are having homogenous effect, non-damaged fibers, non-broken fabric, repeatable and economical process, low environmental impact and reduced energy and water consumption. Different application techniques are used in the studies related to give desired properties to textile materials. Most of these application techniques are wet processes. These wet processes include exhaustion, impregnation, vacuum application, maximum application techniques as well as spraying, coating, transfer and foam application methods which are among the low-liquor application techniques [6]. In addition to these methods, microencapsulation, plasma application, sol–gel technology and lamination techniques, which have become increasingly important in recent years, are also included in finishing applications.
Nowadays, the methods and techniques used in the textile industry are desired to be environmentally-friendly and to save water and energy besides the other requirements such as functionality, durability, repeatability and being cost-effective. With the increase of diversification of today’s industrial requirements, one functionality on the fabric may be insufficient to meet these requirements, therefore, although it varies according to area of utilization, being multifunctionality becomes more of an issue. In some cases, the fact that the fabric has more than one functionality on the whole surface entirely, regardless of front or back sides of the material, causes an increase in cost unnecessarily and also prevents showing sufficient efficiency in the area of use. For instance; for a sportswear outfit, the interior structure of the fabric is desired to be hydrophilic to absorb the sweat and water occurred during movement of the body, while the outer structure of the material is expected to water–oil-soil repellent. If the water repellency functionality is applied to the entire fabric, water repellant chemicals will act functional on the outer side of the fabric while it will serve as blocking barriers by preventing the absorption of sweat and water in the interior side of the material. This will not only bring on difficulties in use but also cause increased unnecessary cost during the finishing process of the material.
Since the conventional padding application methods, which are still in use widely today, do not allow the transfer of different chemicals to different sides, both sides of the fabric are treated with the same chemical substance and due to unnecessary material transfer, both the expected requirements cannot be fully met and cause an increase in costs. For this reason, it has emerged that some functionality needs to be applied to a single surface of the fabric.
Providing multifunctionality in a single-bath could have disadvantages in many respects that all the requested functionalities are mixed with each other in a single recipe and in the same bath. The first of these disadvantages is that all basic and auxiliary chemicals used in the same bath, belonging to different functionalities, may not be compatible with each other. Since the chemical structures of materials belonging to different functionalities are different, their mechanism of action is also different, and therefore problems may be encountered in providing a homogeneous mixture. The second of these disadvantages is that since all the chemicals are mixed with each other, the functionalities will be given in a mixed order regardless of the back or front face of the fabric, unfavorable functionality may be occurred on the undesired side or the requested efficiency is not achieved as expected or no functionality is obtained at a sufficient level. Therefore, due to all these problems and requirements, achieving multifunctionality by transferring more than one functionality to the same and/or different sides of the fabric in an effective and permanent way in accordance with the field of use has become a necessity both in industrial and academic terms.
There is a way of combining fabric layers with different functionalities by lamination methods or so, for obtaining multifunctionality, but because of each separate layer has own functionality, the endproduct takes up more space in terms of volume and increases the cost of the material. For this reason, multifunctionality in single-layer fabrics should be carried out by considering the requirements of providing mobility to the user, being useful and flexible, and saving in material costs.
Due to all the above-mentioned requirements in textile industries; advantages and disadvantages of existing conventional methods besides new generation finishing processes which focuses on reducing water and energy consumption mostly, are defined in this chapter.
Most of the textile finishing application techniques are wet processes. These wet processes can be listed as follows: exhausting process, impregnation, coating, transfer, spraying and foam application. It should be noted there is an optimum level of liquor application which is just high enough to ensure adequate distribution of the chemicals within the fabric. This critical add-on value (CAV) depends on fiber type, fabric construction and fabric pretreatment [6, 7, 8, 9, 10, 11]. The wet processes have been in use for a long time however; they have been updated in many ways nowadays; such as using new technologies in impregnation machines with lower wet pick-up ratios, providing homogenous application in new version of chemical foam application, removing the blockage occurred in nozzles of spraying machines. Minimum application methods, which focuses on reducing water and energy consumption, have an increased importance recently in finishing processes with a wide range of functionalities provided such as water–oil-soil repellency, flame retardancy, antibacterial efficiency and so many other functionalities due to their significant advantages over conventional methods. The application technologies including conventional ones and updated low-add-on finishing applications have been detailed in this review.
The essence of the application with the exhaustion method is that the product to be treated is in wet-process for a long time at the long liquor ratio. The liquor ratio in the studies according to the exhaustion method is in the range of 1:2–1:100. This method is also called full bath method or discontinue method. The fabric to be treated is placed in a bath and allowed to absorb the finishing agent from the bath until a chemical-balance is reached between the finishing agent on the fiber and the one in the bath. In order to provide sufficient and economical results in this method, it is essential that the finishing material used has an affinity towards the textile material. In other words, the finishing material dissolved or homogeneously dispersed in the bath should have a high desire to be withdrawn from the bath by the fibers.
Dyeing process can be carried out with textile fibers, yarns, fabrics or garments. However, there are reasons for dyeing different fiber forms. Fiber dyeing is used as a styling technique; natural fibers or staple synthetics are dyed in bundles or baskets. Dope or solution dyeing is the process where color is mixed into the polymer solution prior to fiber extrusion. Certain synthetics fibers such as polyethylene can only be colored using this technique. Yarn dyeing which is also a styling technique, is used to produce stripes, plaids, and some complex designs with 100% fiber content products. Beam dyeing is a technique where multiple yarns are wound side by side onto a single perforated beam. This can be a few hundred or even a few thousand yarns wound onto a single beam. Fabric or piece dyeing is the most cost efficient and highest productivity technique. Fabric dyeing machines include jet machines, dye becks, fabric beam, and jig dyeing machines. All of these machines as well as most of the yarn dyeing machines are batch or exhaust machines [12]. Some of the machines used in exhaustion method are shown in Figures 1 and 2 [10, 15].
Exhausting process machines in textile finishing (a) winch dyeing (b) beam dyeing [
Exhausting process machines in textile finishing (c) jigger dyeing (d) jet dyeing (e) over-flow dyeing machines [
Advantages:
Processing time, temperature and composition of the liquor (pH of the liquor, amount of electrolyte, auxiliary substances) can be adjusted as desired. Thus, the application speed (proper application of the dyestuff from the beginning) and the application amount (color fixation in dyeing) can be adjusted.
The process can be easily intervened and additional toning can be made. Therefore, it is easier to attach the result than the impregnation method.
It provides ease of operation as washing, bleaching, dyeing and finishing processes are carried out in the same machine.
Disadvantages:
The most important disadvantage is that the liquor ratio is long, so the consumption of water, finishing chemicals and energy (required for both heating and moving the liquor) is so high.
These are the discontinue methods that have long processing time (usually longer than 30 minutes).
It requires a hand work and long time for operating the machine before application [5, 6, 8, 9, 10, 15].
The application process, which is done by passing the textile product through the liquor in a bath within a short time (t < 30 seconds) and squeezing, is called impregnation (padding) method. After the fabric has been padded through the liquor and prior to being squeezed through the rollers of the padder, the liquor is distributed as follows: within the fibers; in the capillary regions-between the fibers; in the spaces between the yams; on the fabric surface [11, 15]. Two characteristics stand out in this method: short liquor ratio and short processing time. In impregnation method, it is important to not to use finishing chemicals that have affinities to the textile materials, or it should be at a very low level. As this is a continuous method, the concentration of the liquor absorbed by the product at the beginning should be same in the bath and at the end of the process. However, if finishing materials with high substantivity are used, the process results in with a tailing effect (when dyeing is done by padding method, gradual color change occurs along the fabric length because of the decrease in the concentration within time) [6, 9, 15]. Since most of the materials used in textile pretreatment do not show much substantivity towards fibers, unlike those used in dyeing, the most used application technique in these processes is impregnation. The types of impregnation machines work due to padding mechanism are shown in Figure 3. This method has also some disadvantages varied according to the types of the system, such as high concentration of finishing chemicals and long-time processing in pad-batch, tailing effect in pad-roll dyeing which is also labor intensive process, high energy consumption in pad-steam and necessity of an extra machine in pad-jig method which results in over costing investment. It should be also noted that high wet-pick-up ratios associated with the padding system are disadvantageous, not only because of the high thermal-drying and water consumption costs, but also because, during the evaporation of the liquor in thermal drying, the molecules of the applied substances tend to migrate from the inside to the outside of the fabric, leaving behind an uneven chemical distribution which leads to a decreased fabric durability of the functionality [5, 7, 15].
Impregnation machines (a) pad-dry-cure (b) pad-steam (c) pad-batch (d) pad-jig (e) pad-roll [
This method is divided into two as dry to wet impregnation and wet to wet impregnation. Since it is easier for a dry textile product to be absorbed in a bath containing finishing material (because the capillarity of the fibers is high due to its absorption ability), the dry-to-wet impregnation method works in shorter periods than wet-to-wet impregnation method. However; if a second wet finishing process is to be carried out after a wet finishing process, when the drying step is considered to be a very expensive intermediate process, the advantage of removing this part and saving energy indirectly will be achieved. Moreover, the risk of migration of the finishing chemicals which occur in drying process before the dyestuff/finishing agents are fixed on the fibers, could be prevented by removing this interim drying process in wet to wet impregnation [5, 15].
In this minimum (low wet-pick-up) application method made in special foulard, the fabric itself is not dipped into the bath. The liquor containing the finishing agent is taken by a rolling roller and transferred to the back surface of the fabric. That’s why we could see this type of finishing systems under the name of “Lick/Kiss Roll Applicators” [19]. Transferring is an application method that can be applied with high viscosity finishing liquors. Excess liquor on the transfer roller or fabric is scraped off with the help of doctor blades. The Figure 4 shows 4 different transfer systems, which differ in terms of the number of rollers, the location of the paddle and measurement techniques [6, 7, 9, 11, 15, 19]. The schematic representation of Triatex MA machine which uses on-line monitoring to control the wet pick-up values, has been shown in Figure 4d. The kiss roll rotational speed is automatically adjusted (with the help of β-rays measured by detectors) [15] relative to the fabric speed to maintain the desired wet pickup.
Different types of transfer (with lick/kiss roll applicators) finishing methods (a) and (b) two-roller with doctor blade type (c) three-roller transfer type (d) Triatex MA [
The amount of finishing agent transferred to the textile product is determined by following parameters; the structure of the transfer roller, condition of doctor blade and other rollers, viscosity of the liquid, the passing speed of the fabric and the rotation speed of the transfer roller. There are two big benefits of working with less liquor; firstly, energy savings as less water will need to be removed during subsequent drying and secondly, reduction of the risk of migration of dyestuffs or finishing substances that have not yet been fixed during drying. However; this method has also some disadvantages.
The main problem in the operations of this method is the inconsistency of the formation of a smooth liquor on the transfer roller. This homogenous formation is not only dependent on the structure of the roller surface, but it’s also closely related to the composition of the liquor.
The second problem is the disability to ensure that the same amount of liquor continuously applied to the textile material [11, 15, 19].
Spraying method in finishing process has been known and applied on textiles for a long time however; it has not been improved much for many years because of some difficulties in conventional (nozzle) spraying machines mentioned below:
It is difficult to apply the same amount of liquor all over the fabric continuously,
Nozzles are frequently clogged, especially when working with viscous chemicals.
A part of liquor sprayed in very fine particles is placed on other parts of the machine instead of the fabric, causes excessive pollution and unnecessary chemical loss.
Especially after the oil crisis in 1974, the spraying method has become updated with the increase in the importance of the application processes which has low wet-pick-up values. To overcome the difficulties in conventional spraying methods, indirect spray applications have been demonstrated by the Farmer Norton and Weko applicators. In these systems, the spray is generated by pumping the finishing solution by a proportioning pump from a well onto the center of a rapidly rotating set of spinning discs (Farmer Norton) or rotors (Weko) [7, 15, 19, 20]. In addition to have the main advantages of being in the minimum application system, spraying technology has some other advantages such as; being suitable for wet-to-wet applications, no tailing effect even if the chemicals have the affinity, ability to be applied on one or two sides of the fabric upon request [15, 20]. Weko Fluid application system has been shown in Figure 5.
WEKO-fluid application system [
Finishing liquors with high viscosity can be applied directly to one side of the fabric. As a result of such application, a large amount of finishing material can be transferred to the surface of the material and this process is also called “coating”, since the finishing agent mostly covers the surface of the material. The coating method is frequently used especially for producing artificial leather and waterproof finishing process. Multi-layered functional materials can be produced with different coating methods including direct (directly coating on to the fabric) and indirect (using for exp. silicone paper during coating) system [15, 21, 22, 23]. In Figure 6 illustrations of direct and indirect coating systems have been shown [23]. The basic mechanism of a direct coating method is spreading polymer on the textile material, in the form of thick liquid (viscous) or paste using a special knife called doctor blade [21]. The smoothness and the thickness of the applied layer are adjusted with the help of doctor blades.
(a) Direct coating system (three-roll coatings: Nip feed coating) (b) indirect coating system (transfer coating) [
In “blade on air” coating system, the fabric passing under the blade does not lean anywhere. Therefore, it is not possible to make thick and very smooth coatings with this type of coating. It is preferred for light coatings of loose woven fabrics. However; the coating material that passes to the other side of the fabric due to the loose texture, it contaminates the rubber band or roller under the blade and causes uneven coating. In “blade over the roller” system, the fabric that passes under the doctor blade is based on a rotating rubber or steel cylinder. The thickness of the layer applied in the coatings can be adjusted precisely. But on the other hand, since the cylinder cannot stretch; dust or fly can be trapped under the blade, causing soiling and forming drag lines [21].
There are some other coating processes used in the film and paper industries which require expensive equipment and which must be carried out on a large scale to be commercially viable. Among these are powder coating, vacuum deposition, electrostatic deposition and sputtering techniques. It is possible, for example, to produce highly reflective surfaces by these methods, but a smooth continuous surface is required and fabrics may not be suitable [21, 22].
The most important and interesting development in the application of finishing agents to textile products in the mid-1970s is undoubtedly the application methods with foam. Machines that enable working with foams instead of aqueous solutions have been put on the market because of increased energy costs in the textile industries. However, the application studies with foam, which developed very rapidly in the beginning, have entered a pause and had no significant improvement until 2010 [24].
Foam is a microheterogeneous colloidal mixture, short or long-lasting a metastable system in which the surface area is increased nearly 1000 times by inflating a liquid with a suitable gas (air), and therefore contains less liquid. Foam is obtained by dispersing the air in water as fine particles with the help of surfactants. If a surfactant is dissolved in aqueous solution and air bubbles are present in this solution, then a surfactant film covers the air bubbles. Air bubbles move towards the upper surface of the liquid which covered with a tenside film. Thereby, a second tenside film is formed around the upward air bubbles (Figure 7) In this way, the air bubble in which the liquid is located between the two tenside films surrounding, called a “foam cell” [7, 15, 24, 25].
Formation of a foam cell.
There are many types of foam application such as; open foam method (Horizontal pad foam, Knife-roll-over foam, Autofoam systems), offset open foam methods (Küsters Janus contact roller system and Monforts vacuum drum system), closed foam methods (FFT Foam Finishing Technology-Gaston County Dyeing Machine, CFS Chemical Foam System-Gaston System, Stork rotary screen foam applicator and Stork CFT Coating and Finishing Technology) have been shown in Figures 8–10 [24, 29, 30]. As seen in the figures, there have been much improvement in the profiles of foam applicators in time in order to prevent the problems such as non-uniform and uneven applications during processes. The case in point can be the improvement of CFS parabolic profile which has been developed to solve “dead foam” issue occurred in FFT. With the help of parabolic chamber, equal distance paths are covered from the point of foam inlet to the fabric surface so that the problem of wet and unfoamed parts occurred partly in FFT foamed fabrics have been solved [24, 29].
Types of foam application (a) horizontal pad foam (b) knife-roll-over foam [
Types of foam application (c) autofoam systems (d) Monforts vacuum drum system (e) Küsters Janus contact roller system [
Types of foam application (f) foam finishing technology (FFT) (g) chemical foaming system (CFS) [
For an effective foam application process, the followings should be taken into consideration:
The foam should not be collapsed during the time between it is taken from the foam generator and transferred to the fabric.
On the other hand, when the foam reaches out the textile product, it should collapse into the fabric as quickly as possible. Foam stability constitutes an important place in foam applications. Very stable foams play role in decreasing the penetration efficiency into the fabric whereas unstable foams cause uneven applications because of collapsing before the application. Therefore, foam cell should be in semi-stable form.
The foam and the tenside used in the application must have good compatibility with other chemical substances in the bath.
The foam to be used in a finishing process should always has the same form and the same concentration.
Another important point in foam application is that the foams should not have much water. If the foam that does not contain much water, it is transferred directly onto the fabric surface moving perpendicularly without spreading around the fabric surface. On the other hand, when the conventional finishing liquors first penetrated to the fabric, they spread parallel to the fabric surface by capillarity effect. For this reason, in conventional finishing applications such as in padding methods non-functional caked chemical residuals remained at the fibers intersections cause uneven application and nonhomogeneous penetration [15, 27].
Foam finishing is a versatile application system which could be very effective for bleaching, dyeing and varied finishing processes. It can be also used to apply different applications to the face and back side of the fabric in a single pass with dual-applicators. Multifunctional fabrics with increased durability against repeated washing and drying processes could be produced. As reported in the literature [24] that many combinations of functionalities such as face side flame retardant and water repellent whereas antibacterial back side of textile materials could be provided via foam finishing application. The most important advantage of this system is providing significant decrease in water consumption (up to 80%) due its lower wet-pick-up system. For cotton-rich fabrics, the wet pickup in foam finishing is typically between 15% and 35%, depending on the process, compared with 60% to 100% for a conventional pad application [27, 29, 30]. For synthetic fabrics, wet pick up ratio of foam application is in the range of 3–10% whereas it is 35–60% in conventional padding. Moreover, the energy consumed for heating and venting the air is significantly decreased due to lower wet-pick-up values. This reduction in time needed for pre-drying step (could be eliminated), also minimizes the migration of the chemicals. Since the amount of liquor taken is small in foam finishing, excessive swelling of the fibers is not possible. Since the fibers do not swell and the capillary channels do not expand too much, the transferred chemical substance is not carried to the surface with water during drying and remains where it is transferred. This is particularly effective in preventing the reduction of the abrasion resistance in the wrinkle recovery finishing. Since migration, that is, the accumulation of the chemical substance on the surface more than necessary during drying, is effective in the decrease in friction resistance. Foam application also potentially results in less waste water pollution than with traditional application methods. On the contrary of an aqueous pad system, the small liquor volumes required for foam application result in less waste during a changeover [15, 24, 27, 29, 31, 32, 33, 34].
Updated versions of foam application systems has offered better solutions to the basic problems encountered with the other low-add-on systems. The main problem of the low-add-on systems is the difficulty of distributing a relatively small quantity of liquor uniformly over a large surface of fabric, especially on hydrophilic fibers. In the case of low-add-on expression systems, a basic limitation is the inability to achieve wet-pick-up levels below the critical application value of the component fibers [7]. When compared to conventional methods, foam finishing provides homogeneous and effective chemical applications via controlled, uniform and repeatable foam formations.
If CFS foam machine is examined, it could be clearly seen that uniform and homogenous applications are achieved via performing correct systematic on the distance between the foam generator and applicator.
As shown in the Figure 11, the foam diameter increases as the foam formed in the CFS foam generator is transferred from high pressure to the low pressure on the way to the foam applicator. The pressure gradually decreases on the fabric surface and the foam penetrates the fabric. The distance between the foam generator and its applicator is critical for uniform foam formation.
Chemical foaming system (CFS) [
DG: Initially, the radius of the foam produced in the foam generator.
DA: The radius of the foam being transferred from the foam generator to the foam applicator.
DB: The radius of the foam at the foam applicator just before it penetrates to the fabric.
WG: Initially, the area covered by the liquid contained in the foam produced in the foam generator.
WA: The area covered by the liquid in the foam being transferred from the foam generator to the foam applicator.
WB: The area covered by the liquid in the foam just before it penetrates into the fabric, at the foam applicator.
Before the transfer process starts, the state between these parameters is WG > WA > WB and DG < DA < DB, while these equations are reversed as the pressure decreases gradually, and WG < WA < WB and DG > DA > DB becomes. Therefore, on the foam applicator, penetration to the fabric takes place evenly with maximum radius and minimum liquid area of the foam [27].
Considering the finishing methods used in the textile industry in general, conventional impregnation method is commonly used in the industry due to the low affinity of the chemicals used in the finishing processes. However, it has disadvantages such as high water and energy consumption, inability to apply different functionalities to face and back sides of the material and significant waste load. Extraction method is not included among the preferred methods because the chemicals used have affinity to the fabric, the operation times are long and the amount of water consumed is very high due to the long liquor ratio. Apart from these methods, transfer and coating methods are also available. Transfer methods with various types such as roller transfer or with doctor blades takes place in the minimum application methods. Likewise coating methods is in the low-liquor finishing applications with the types of blade coating, calendar coating, transfer and printing technique. However, both transfer and coating methods are not suitable for low viscosity chemicals. In coating and transferring methods, the effectivity of the application is directly related to the viscosity of the finishing agents, the construction and surface structure of textile material, production method of the material (woven, non-woven or knitted), weight of the textile, speed of the finishing method etc. So, it could be noted that they are not very flexible application techniques in a view of finishing agents and textile materials. Even if the direct spraying method had some problems in the past such as clogging of nozzles or excessive pollution on the machine, with the use of indirect systems such as discs or rotors, it has been much more improved. When the history of the foam application is examined, it could be clearly noticed that significant improvements have been carried out by time in order to make functional or multifunctional (via using dual-applicators) textiles via uniform applications (with developed applicator profiles) which provides reduction in water and energy consumption. Apart from these, there are various lamination techniques that can be used to obtain multifunctionality however; since the lamination process is based on the principle of combining fabric and polymer layers to form a composite material, any factor that prevents adhesion between the structures, low heat resistance of the materials or no resistivity for water and moisture can cause problems during applications.
Apart from these methods, there is also environmentally friendly techniques such as plasma technology, which is used in the textile industry and academic pilot studies, and gives functionality to the fabric with partly ionized gas or monomers without using water [35, 36, 37]. With this technology many researches have been carried out to provide functional textiles such as antibacterial cotton fabric supported by silver nanoparticules [38], water repellent and antimicrobial cotton/polyester blend [39], anti-bacterial and anti-static polyester fabric [40]. However, in this technology, the vacuum plasma method, which is quite effective, is a discontinuous method and could not be industrialized because it allows a very low size in terms of fabric length and width. The atmospheric plasma method, which is suitable for industrial use as the operating dimensions, is not as effective as vacuum plasma on porous textile surfaces. Microencapsulation technique, is also one of the effective methods used in textile applications. Microencapsulation technology involves the process by which small particles, mostly bioactive, are encapsulated in a wall consisting of a heterogeneous or homologous polymer matrix, which forms a complex known as a microcapsule [41, 42]. Microencapsulation helps to improve functional textile products such as fabrics with durable fragrances, UV-ray absorbing shirts, thermo-regulation vehicle seats, thermo-changeable dyed apparels, vitamin loaded fabrics as cosmototextiles or military uniforms with microcapsulated insecticides [42]. However, in order to transfer performed microcapsules onto the textile material, the capsulation method is continued with a conventional finishing method frequently (mostly padding) so that two-step applications are carried out with no significant reduction in water and energy consumption. Sol–gel technology, which is a method that can obtain macromolecules by taking advantage of the growth and development of polymers in a solvent, can also be an effective alternative in terms of giving functionality to textile materials. There have been lots of studies on sol–gel functionality such as self-cleaning superhydrophobic films [43], flame retardant and hydrophobic coatings on cotton fabrics [44], hydrophilic, antistatic and antimicrobial cotton and polyester fabrics [45]. However, it should be noted that the requirement of using solvents brings environmental threats and applying some special polymers increase input costs [46]. Nano-technology seems to be a significant alternative for achieving functional and multifunctional textile materials [35] however; in some cases, there have been still some issues of industrialization of nanoparticles because of producing them only in laboratory scale experiments. Studies about using liposomes in dyeing processes [47, 48, 49] photocatalytic reactions for bleaching process [50, 51] and layer-by-layer self-assembly technique for producing multifunctional multilayers [52, 53] have also been taken place in the literature but there has been no scientific clue reported in the literature for industrialization of these methods in textile manufactories.
The Edited Volume, also known as the IntechOpen Book, is an IntechOpen pioneered publishing product. Edited Volumes make up the core of our business - and as pioneers and developers of this Open Access book publishing format, we have helped change the way scholars and scientists publish their scientific papers - as scientific chapters.
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\\n\\nYOUR WORK, YOUR COPYRIGHT
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\n\nCURRENT PROJECTS
\n\nTo view current Open Access book projects that are Open for Submissions visit us here.
\n\nNot sure if this is the right publishing option for you? Feel free to contact us at book.department@intechopen.com.
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He is also a member of the editorial boards of the Journal of Electrical Engineering, Electronics, Control and Computer Science and Sustainability. Dr. Gaiceanu has been General Chairman of the IEEE International Symposium on Electrical and Electronics Engineering in the last six editions.",institutionString:'"Dunarea de Jos" University of Galati',institution:{name:'"Dunarea de Jos" University of Galati',country:{name:"Romania"}}},{id:"4519",title:"Prof.",name:"Jaydip",middleName:null,surname:"Sen",slug:"jaydip-sen",fullName:"Jaydip Sen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/4519/images/system/4519.jpeg",biography:"Jaydip Sen is associated with Praxis Business School, Kolkata, India, as a professor in the Department of Data Science. His research areas include security and privacy issues in computing and communication, intrusion detection systems, machine learning, deep learning, and artificial intelligence in the financial domain. 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He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:null},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:"Polytechnic University of Timişoara",institution:{name:"Polytechnic University of Timişoara",country:{name:"Romania"}}},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:null},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"414880",title:"Dr.",name:"Maryam",middleName:null,surname:"Vatankhah",slug:"maryam-vatankhah",fullName:"Maryam Vatankhah",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Borough of Manhattan Community College",country:{name:"United States of America"}}},{id:"414879",title:"Prof.",name:"Mohammad-Reza",middleName:null,surname:"Akbarzadeh-Totonchi",slug:"mohammad-reza-akbarzadeh-totonchi",fullName:"Mohammad-Reza Akbarzadeh-Totonchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ferdowsi University of Mashhad",country:{name:"Iran"}}},{id:"414878",title:"Prof.",name:"Reza",middleName:null,surname:"Fazel-Rezai",slug:"reza-fazel-rezai",fullName:"Reza Fazel-Rezai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"American Public University System",country:{name:"United States of America"}}},{id:"302698",title:"Dr.",name:"Yao",middleName:null,surname:"Shan",slug:"yao-shan",fullName:"Yao Shan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Dalian University of Technology",country:{name:"China"}}},{id:"125911",title:"Prof.",name:"Jia-Ching",middleName:null,surname:"Wang",slug:"jia-ching-wang",fullName:"Jia-Ching Wang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Central University",country:{name:"Taiwan"}}},{id:"357085",title:"Mr.",name:"P. Mohan",middleName:null,surname:"Anand",slug:"p.-mohan-anand",fullName:"P. Mohan Anand",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356696",title:"Ph.D. Student",name:"P.V.",middleName:null,surname:"Sai Charan",slug:"p.v.-sai-charan",fullName:"P.V. Sai Charan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"357086",title:"Prof.",name:"Sandeep K.",middleName:null,surname:"Shukla",slug:"sandeep-k.-shukla",fullName:"Sandeep K. Shukla",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356823",title:"MSc.",name:"Seonghee",middleName:null,surname:"Min",slug:"seonghee-min",fullName:"Seonghee Min",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Daegu University",country:{name:"Korea, South"}}},{id:"353307",title:"Prof.",name:"Yoosoo",middleName:null,surname:"Oh",slug:"yoosoo-oh",fullName:"Yoosoo Oh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Yoosoo Oh received his Bachelor's degree in the Department of Electronics and Engineering from Kyungpook National University in 2002. He obtained his Master’s degree in the Department of Information and Communications from Gwangju Institute of Science and Technology (GIST) in 2003. In 2010, he received his Ph.D. degree in the School of Information and Mechatronics from GIST. In the meantime, he was an executed team leader at Culture Technology Institute, GIST, 2010-2012. In 2011, he worked at Lancaster University, the UK as a visiting scholar. In September 2012, he joined Daegu University, where he is currently an associate professor in the School of ICT Conver, Daegu University. Also, he served as the Board of Directors of KSIIS since 2019, and HCI Korea since 2016. From 2017~2019, he worked as a center director of the Mixed Reality Convergence Research Center at Daegu University. From 2015-2017, He worked as a director in the Enterprise Supporting Office of LINC Project Group, Daegu University. His research interests include Activity Fusion & Reasoning, Machine Learning, Context-aware Middleware, Human-Computer Interaction, etc.",institutionString:null,institution:{name:"Daegu Gyeongbuk Institute of Science and Technology",country:{name:"Korea, South"}}},{id:"262719",title:"Dr.",name:"Esma",middleName:null,surname:"Ergüner Özkoç",slug:"esma-erguner-ozkoc",fullName:"Esma Ergüner Özkoç",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Başkent University",country:{name:"Turkey"}}},{id:"346530",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Kaya",slug:"ibrahim-kaya",fullName:"Ibrahim Kaya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"419199",title:"Dr.",name:"Qun",middleName:null,surname:"Yang",slug:"qun-yang",fullName:"Qun Yang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Auckland",country:{name:"New Zealand"}}},{id:"351158",title:"Prof.",name:"David W.",middleName:null,surname:"Anderson",slug:"david-w.-anderson",fullName:"David W. Anderson",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Calgary",country:{name:"Canada"}}}]}},subseries:{item:{id:"12",type:"subseries",title:"Human Physiology",keywords:"Anatomy, Cells, Organs, Systems, Homeostasis, Functions",scope:"Human physiology is the scientific exploration of the various functions (physical, biochemical, and mechanical properties) of humans, their organs, and their constituent cells. The endocrine and nervous systems play important roles in maintaining homeostasis in the human body. Integration, which is the biological basis of physiology, is achieved through communication between the many overlapping functions of the human body's systems, which takes place through electrical and chemical means. Much of the basis of our knowledge of human physiology has been provided by animal experiments. Because of the close relationship between structure and function, studies in human physiology and anatomy seek to understand the mechanisms that help the human body function. The series on human physiology deals with the various mechanisms of interaction between the various organs, nerves, and cells in the human body.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/12.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11408,editor:{id:"195829",title:"Prof.",name:"Kunihiro",middleName:null,surname:"Sakuma",slug:"kunihiro-sakuma",fullName:"Kunihiro Sakuma",profilePictureURL:"https://mts.intechopen.com/storage/users/195829/images/system/195829.jpg",biography:"Professor Kunihiro Sakuma, Ph.D., currently works in the Institute for Liberal Arts at the Tokyo Institute of Technology. He is a physiologist working in the field of skeletal muscle. He was awarded his sports science diploma in 1995 by the University of Tsukuba and began his scientific work at the Department of Physiology, Aichi Human Service Center, focusing on the molecular mechanism of congenital muscular dystrophy and normal muscle regeneration. His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). His opinion is to attenuate sarcopenia by improving autophagic defects using nutrient- and pharmaceutical-based treatments.",institutionString:null,institution:{name:"Tokyo Institute of Technology",institutionURL:null,country:{name:"Japan"}}},editorTwo:null,editorThree:{id:"331519",title:"Dr.",name:"Kotomi",middleName:null,surname:"Sakai",slug:"kotomi-sakai",fullName:"Kotomi Sakai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000031QtFXQA0/Profile_Picture_1637053227318",biography:"Senior researcher Kotomi Sakai, Ph.D., MPH, works at the Research Organization of Science and Technology in Ritsumeikan University. She is a researcher in the geriatric rehabilitation and public health field. She received Ph.D. from Nihon University and MPH from St.Luke’s International University. Her main research interest is sarcopenia in older adults, especially its association with nutritional status. 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