General use of analgesic drugs in the different types of pain in dentistry.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"6101",leadTitle:null,fullTitle:"Advances in Some Hypersonic Vehicles Technologies",title:"Advances in Some Hypersonic Vehicles Technologies",subtitle:null,reviewType:"peer-reviewed",abstract:"The book describes the recent progress in some hypersonic technologies such as the aerodynamic modeling and numerical simulations of rarefied flows, boundary layer receptivity, coupled aerodynamics, and heat transfer problems, including fluid-thermal-structure interactions and launcher aerodynamic design as well as other miscellaneous topics, such as porous ceramic composite phase change control system and vehicle profile, following LQR design. Both the researchers and the students should find the material useful in their work.",isbn:"978-953-51-3904-1",printIsbn:"978-953-51-3903-4",pdfIsbn:"978-953-51-4035-1",doi:"10.5772/intechopen.68209",price:119,priceEur:129,priceUsd:155,slug:"advances-in-some-hypersonic-vehicles-technologies",numberOfPages:184,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"5ecc3136420d6f6cc0de2da29f9d749c",bookSignature:"Ramesh K. Agarwal",publishedDate:"March 14th 2018",coverURL:"https://cdn.intechopen.com/books/images_new/6101.jpg",numberOfDownloads:8031,numberOfWosCitations:8,numberOfCrossrefCitations:5,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:12,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:25,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 20th 2017",dateEndSecondStepPublish:"May 18th 2017",dateEndThirdStepPublish:"November 19th 2017",dateEndFourthStepPublish:"December 19th 2017",dateEndFifthStepPublish:"February 19th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"38519",title:"Prof.",name:"Ramesh K.",middleName:null,surname:"Agarwal",slug:"ramesh-k.-agarwal",fullName:"Ramesh K. Agarwal",profilePictureURL:"https://mts.intechopen.com/storage/users/38519/images/system/38519.jpg",biography:"Professor Ramesh K. Agarwal is William Palm Professor of Engineering at Washington University in St. Louis, USA. From 1994 to 2001, he was Sam Bloomfield Distinguished Professor and Executive Director of the National Institute for Aviation Research at Wichita State University in Kansas. From 1978 to 1994, he worked in various scientific and managerial positions at McDonnell Douglas Research Laboratories in St. Louis; he became the Program Director and McDonnell Douglas Fellow in 1990. Dr. Agarwal received a PhD in Aeronautical Sciences from Stanford University in 1975, an MS in Aeronautical Engineering from the University of Minnesota in 1969, and a BS in Mechanical Engineering from the Indian Institute of Technology, Kharagpur, India in 1968. Dr. Agarwal has worked in computational fluid dynamics and its applications to problems in aerospace and mechanical engineering, and energy and the environment.",institutionString:"Washington University in St. Louis",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"5",totalChapterViews:"0",totalEditedBooks:"5",institution:{name:"Washington University in St. Louis",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"715",title:"Automotive Technology and Engineering",slug:"automotive-technology-and-engineering"}],chapters:[{id:"56897",title:"Numerical Simulation of Hypersonic Rarefied Flows Using the Second-Order Constitutive Model of the Boltzmann Equation",doi:"10.5772/intechopen.70657",slug:"numerical-simulation-of-hypersonic-rarefied-flows-using-the-second-order-constitutive-model-of-the-b",totalDownloads:1120,totalCrossrefCites:1,totalDimensionsCites:5,hasAltmetrics:0,abstract:"Various mathematical theories and simulation methods were developed in the past for describing gas flows in nonequilibrium, in particular, hypersonic rarefied regime. They range from the mesoscale models like the Boltzmann equation, the DSMC, and the high-order hydrodynamic equations. The moment equations can be derived by introducing the statistical averages in velocity space and then combining them with the Boltzmann kinetic equation. In this chapter, on the basis of Eu’s generalized hydrodynamics and the balanced closure recently developed by Myong, the second-order constitutive model of the Boltzmann equation applicable for numerical simulation of hypersonic rarefied flows is presented. Multi-dimensional computational models of the second-order constitutive equations are also developed based on the concept of decomposition and method of iterations. Finally, some practical applications of the second-order constitutive model to hypersonic rarefied flows like re-entry vehicles with complicated geometry are described.",signatures:"Rho Shin Myong",downloadPdfUrl:"/chapter/pdf-download/56897",previewPdfUrl:"/chapter/pdf-preview/56897",authors:[{id:"208064",title:"Prof.",name:"Rho Shin",surname:"Myong",slug:"rho-shin-myong",fullName:"Rho Shin Myong"}],corrections:null},{id:"56978",title:"Numerical Study of Hypersonic Boundary Layer Receptivity Characteristics Due to Freestream Pulse Waves",doi:"10.5772/intechopen.70660",slug:"numerical-study-of-hypersonic-boundary-layer-receptivity-characteristics-due-to-freestream-pulse-wav",totalDownloads:1024,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"A finite difference method is used to do direct numerical simulation (DNS) of hypersonic unsteady flowfield under the action of freestream pulse wave. The response of the hypersonic flowfield to freestream pulse wave is studied, and the generation and evolution characteristics of the boundary layer disturbance waves are discussed. The effects of the pulse wave types on the disturbance mode in the boundary layer are investigated. Results show that the freestream disturbance waves significantly change the shock standoff distance, the distribution of flowfield parameters and the thermodynamic state of boundary layer. In the nose area, the main disturbance modes in the boundary layer are distributed near the fundamental mode. With the evolution of disturbance along with streamwise, the main disturbance modes are transformed from the dominant state of the fundamental mode to the collective leadership state of the second order and the third order harmonic frequency. The intensity of bow shock has significant effects on both the fundamental mode and the harmonic modes in each order. The strong shear structure of boundary layer under different types of freestream pulse waves reveals different stability characteristics. The effects of different types of freestream pulse waves are significant on the distribution and evolution of disturbance modes. The narrowing of frequency band and the decreasing of main disturbance mode clusters exist in the boundary layer both for fast acoustic wave, slow acoustic wave and entropy wave.",signatures:"Xiaojun Tang, Juan Yu, Tianli Hui, Fenglong Yang and Wentao Yu",downloadPdfUrl:"/chapter/pdf-download/56978",previewPdfUrl:"/chapter/pdf-preview/56978",authors:[{id:"207757",title:"Dr.",name:"Xiaojun",surname:"Tang",slug:"xiaojun-tang",fullName:"Xiaojun Tang"},{id:"208040",title:"MSc.",name:"Tianli",surname:"Hui",slug:"tianli-hui",fullName:"Tianli Hui"},{id:"208041",title:"MSc.",name:"Fenglong",surname:"Yang",slug:"fenglong-yang",fullName:"Fenglong Yang"},{id:"208042",title:"MSc.",name:"Wentao",surname:"Yu",slug:"wentao-yu",fullName:"Wentao Yu"},{id:"219626",title:"Dr.",name:"Juan",surname:"Yu",slug:"juan-yu",fullName:"Juan Yu"}],corrections:null},{id:"57896",title:"Numerical Modeling of Hypersonic Aerodynamics and Heat Transfer Problems of the Martian Descent Modules",doi:"10.5772/intechopen.71666",slug:"numerical-modeling-of-hypersonic-aerodynamics-and-heat-transfer-problems-of-the-martian-descent-modu",totalDownloads:1231,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Computational fluid dynamics (CFD) is the important tool to analyze physics of fluids. Hypersonic flows over real space configurations represent a substantial problem from the point of view of the development of new and more effective mathematical models, numerical methods, and the use of computer systems. Governing equations for multi-component, multi-temperature, chemically reacting non-equilibrium radiant mixtures are the mathematical foundation for the study of vehicles entering in Martian atmosphere. Based on the kinetic equations for the distribution functions, an efficient three-temperature model suitable for Mars re-entry applications derived and used for the simulations of a non-equilibrium flow in a viscous shock layer near a space vehicle. The closed self-consistent description of a flow in terms of densities of species, macroscopic velocity, gas temperature, and three vibration temperatures are proposed. The transport properties in dissociating CO2 flows have been evaluated. The proposed model takes into account real structure of polyatomic CO2 molecules, non-equilibrium CO2 vibration excitation, different rates of various energy transitions, and chemical reactions. Numerical investigations of a flow past a frontal part of Mars Sample Return Orbiter (MSRO) and MARS EXPRESS vehicles descending in an atmosphere of Mars are presented. The radiation processes taking into account of non-equilibrium character are considered.",signatures:"Yuriy D. Shevelev",downloadPdfUrl:"/chapter/pdf-download/57896",previewPdfUrl:"/chapter/pdf-preview/57896",authors:[{id:"211450",title:"Prof.",name:"Yuriy",surname:"Shevelev",slug:"yuriy-shevelev",fullName:"Yuriy Shevelev"}],corrections:null},{id:"57048",title:"Launcher Aerodynamics: A Suitable Investigation Approach at Phase-A Design Level",doi:"10.5772/intechopen.70757",slug:"launcher-aerodynamics-a-suitable-investigation-approach-at-phase-a-design-level",totalDownloads:1100,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"This chapter deals with launcher aerodynamic design activities at phase-A level. The goal is to address the preliminary aerodynamic database of a typical launch vehicle configuration as input for launcher performances evaluations, control, sizing, and staging design activities. In this framework, different design approaches relying on both engineering and numerical methods are considered. Indeed, engineering-based aerodynamic analyses by means of a three-dimensional panel methods code, based on local surface inclination theory, were performed. Then, accuracy of design analysis increased using steady-state computational fluid dynamics with both Euler and Navier-Stokes approximations.",signatures:"Giuseppe Pezzella and Antonio Viviani",downloadPdfUrl:"/chapter/pdf-download/57048",previewPdfUrl:"/chapter/pdf-preview/57048",authors:[{id:"14939",title:"Prof.",name:"Giuseppe",surname:"Pezzella",slug:"giuseppe-pezzella",fullName:"Giuseppe Pezzella"},{id:"216136",title:"Prof.",name:"Antonio",surname:"Viviani",slug:"antonio-viviani",fullName:"Antonio Viviani"}],corrections:null},{id:"56962",title:"Modeling and Analysis of Fluid-Thermal-Structure Coupling Problems for Hypersonic Vehicles",doi:"10.5772/intechopen.70658",slug:"modeling-and-analysis-of-fluid-thermal-structure-coupling-problems-for-hypersonic-vehicles",totalDownloads:1134,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"To efficiently model fluid-thermal-structural problems for thermal protection design of hypersonic vehicles, a framework of Hypersonic Computational Coupling Dynamics (HyCCD) software integrates an independently developed program solving hypersonic aerthermodynamic simulation with a finite element analysis professional software. With the mathematical and physical description of multi-physics coupling mechanism, the corresponding efficient coupling strategies were proposed. Some representative coupling problems encountered in hypersonic vehicle were systematically analyzed to study the intrinsic fluid-thermal-structural coupling characteristics and mechanisms. The results can theoretically and technically support the studies on comprehensive performance assessment and optimization of thermal protection system and static or dynamic aerothermoelastic problem of hypersonic vehicles.",signatures:"Fang Chen, Shengtao Zhang and Hong Liu",downloadPdfUrl:"/chapter/pdf-download/56962",previewPdfUrl:"/chapter/pdf-preview/56962",authors:[{id:"131980",title:"Prof.",name:"Hong",surname:"Liu",slug:"hong-liu",fullName:"Hong Liu"},{id:"207025",title:"Dr.",name:"Fang",surname:"Chen",slug:"fang-chen",fullName:"Fang Chen"},{id:"207665",title:"Dr.",name:"Shengtao",surname:"Zhang",slug:"shengtao-zhang",fullName:"Shengtao Zhang"}],corrections:null},{id:"56939",title:"Hypersonic Vehicles Profile-Following Based on LQR Design Using Time-Varying Weighting Matrices",doi:"10.5772/intechopen.70659",slug:"hypersonic-vehicles-profile-following-based-on-lqr-design-using-time-varying-weighting-matrices",totalDownloads:1076,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"In the process of applying linear quadratic regulator (LQR) to solve aerial vehicle reentry reference trajectory guidance, to obtain better profile-following performance, the parameters of the aerial vehicle system can be used to calculate weighting matrices according to the Bryson principle. However, the traditional method is not applicable to various disturbances in hypersonic vehicles (HSV) which have particular dynamic characteristics. By calculating the weighting matrices constructed based on Bryson principle using time-varying parameters, a novel time-varying LQR design method is proposed to deal with the various disturbances in HSV reentry profile-following. Different from the previous approaches, the current states of the flight system are employed to calculate the parameters in weighting matrices. Simulation results are given to demonstrate that using the proposed approach in this chapter, performance of HSV profile-following can be improved significantly, and stronger robustness against different disturbances can be obtained.",signatures:"Jian Chen, Zihao Xiong, Zixuan Liang, Chen Bai, Ke Yi and Zhang\nRen",downloadPdfUrl:"/chapter/pdf-download/56939",previewPdfUrl:"/chapter/pdf-preview/56939",authors:[{id:"207244",title:"Prof.",name:"Jian",surname:"Chen",slug:"jian-chen",fullName:"Jian Chen"},{id:"210869",title:"Prof.",name:"Zhang",surname:"Ren",slug:"zhang-ren",fullName:"Zhang Ren"},{id:"219540",title:"Dr.",name:"Chen",surname:"Bai",slug:"chen-bai",fullName:"Chen Bai"},{id:"219613",title:"Dr.",name:"Zihao",surname:"Xiong",slug:"zihao-xiong",fullName:"Zihao Xiong"},{id:"219614",title:"Dr.",name:"Zixuan",surname:"Liang",slug:"zixuan-liang",fullName:"Zixuan Liang"},{id:"219615",title:"Dr.",name:"Ke",surname:"Yi",slug:"ke-yi",fullName:"Ke Yi"}],corrections:null},{id:"57021",title:"Porous Ceramic Matrix Phase Change Composites for Thermal Control Purposes of Hypersonic Vehicle",doi:"10.5772/intechopen.70863",slug:"porous-ceramic-matrix-phase-change-composites-for-thermal-control-purposes-of-hypersonic-vehicle",totalDownloads:1348,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Thermal control systems and heat insulation materials are required for a range of hypersonic vehicles ranging from ballistic reentry to hypersonic cruise vehicles, both within Earth’s atmosphere and non-Earth atmospheres. The combined thermodynamic/heat transfer relations of the phase change materials (PCMs) in silica nanoporous materials are developed to obtain mass, thickness, and temperature excursion as functions of percentage area of PCM under given maximum energy and thermal flux. The studies show that PCMs are one of the most preferred methods to thermal control applications that can effectively delay or modify the temperature rise of the surface of the aircrafts subjected to high thermal flux. This chapter also introduces the preparations of porous ceramic matrix phase change composite, putting PCMs to use in the internal thermal control materials for the hypersonic vehicles. Porous ceramic matrix serves as the supporting material, which provides structural strength and prevents the leakage of melted PCMs, and PCMs act as thermal absorb material limiting the temperature abruptly rising of the aircrafts. The structural pore properties of the silica matrix with different molar ratios of ethanol (EtOH)/tetraethoxysilane (TEOS) are investigated to determine suitable porous matrices for PCM. To adjust the pore structure of porous silica matrices with different molar ratios of EtOH and TEOS for PCM infiltration is mainly discussed. Furthermore, numerical and experimental studies are proposed to predict and investigate the thermal absorption characteristics of porous silica infiltrated with PCM for thermal control applications.",signatures:"Xiangfa Zhou",downloadPdfUrl:"/chapter/pdf-download/57021",previewPdfUrl:"/chapter/pdf-preview/57021",authors:[{id:"210631",title:"Dr.",name:"Xiangfa",surname:"Zhou",slug:"xiangfa-zhou",fullName:"Xiangfa Zhou"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"1992",title:"Recent Advances in Aircraft Technology",subtitle:null,isOpenForSubmission:!1,hash:"67fa903d68a094013f66d01b38882107",slug:"recent-advances-in-aircraft-technology",bookSignature:"Ramesh K. 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Different natural remedies with analgesic properties date back to ancient Egypt and Greeks, including Dioscorides and Hippocrates who prescribed the use of willow bark with salicylic acid as the main ingredient. In the late nineteenth century, three prototypes of today’s modern nonopioid antipyretic analgesics were discovered: acetaminophen and aspirin (formulated in 1895 by Frederick Bayer and Felix Hoffman) and phenazon, which still make up about 50% of the market of antipyretic analgesics worldwide [1]. Opiates such as morphine, which are derived from the opium poppy, were also used for thousands of years. Later on codeine, as a naturally methylated morphine, was isolated in France in 1830 by Jean-Pierre Robiquet. In 1937, German scientists Max Bockmuhl and Gustav Ehrhart synthesized methadone [2].
Pain is a subjective symptom signaling a requirement to act urgently and is usually associated with other subjective feelings such as anxiety, anger and discomfort. The expression of nature and intensity of pain is a subject of different patient-related characteristics. There are several patient factors having an impact in the patient’s interpretation of pain, such as gender, age, physiological factors and drug abuse history, neuropathic and other disease and psychological profile of individual humans [3].
Dental pain (toothache or odontalgia) is a common subjective complaint of dental patients following the different interventional procedures and dental diseases. Dental pain presents one of the most common causes (approximately 12%) of patients seeking emergency treatment in dental healthcare in the United States [4].
Odontogenic pain is a complex cascade process initiated from dental tissue damage and accompanied with heterogeneous neuronal stimuli as a consequence of neurovascular, neuroinflammation and morphologic reactions [5].
The development of new analgesics is a very dynamic process and nowadays clinicians have a greater range of agents in order to select the most efficient and safe analgesic therapy. Taking into consideration the period 1960–2009, 59 analgesics have been introduced and their use still remains important [6].
Analgesics are considered one of the most important drugs groups in dental practice considering the prescription rate, clinical efficacy, cost-effectiveness and safety profile of this drug group. According to this level of importance in dental clinical practice, there are different approaches to develop treatment algorithm and guidelines for dental pain treatment in order to rationalize the use of analgesics. The rationalization of analgesics use is an ongoing challenge, since some analgesics are over-the-counter (OTC) drugs and can be taken without medical prescription.
The management of dental pain in clinical practice is a complex part of dental care and requires high-level knowledge of analgesic pharmacology and implementing the standards of rational use.
There is a valuable evidence for significant relationship between nonrational use of analgesics and diminution of drug therapy, increased adverse drug reactions and socioeconomic consequences [7, 8].
Nevertheless, prescription of analgesic drugs for dental indications is often accompanied with challenges, which diminish the treatment success and increase the potential risk for serious adverse effects.
There are several reasons for the decrease in clinical efficacy of analgesic therapy, including the lack of real assessment and monitoring of pain by dentistry doctor, nonadequate quantification of subjective pain experienced by patients, lack of updated pharmacological knowledge of dental pain treatments, experience scarcity in safety profile of analgesic and insufficient knowledge regarding analgesic combinations. There is evidence that prescription errors with analgesic medicaments are substantially high and are a major cause of manifestations of analgesics side effects [9]. The percentage of analgesic-related prescription errors, as reported by Smith et al., is relatively high, with 29% in adult patients and in pediatric patients it is even higher at 59%. From total prescription percentage, 14% were serious or severe analgesic prescription errors with high harmful potential for patients, mainly in pediatric patients [10].
The prescription of analgesic drugs and treatment of dental pain is more complex when it is accompanied with other health disorders and diseases. In these cases, quantification of pain and its evaluation and treatment is a convoluted clinical challenge. The main complex challenges are patients with diabetes and other chronic diseases, patients with renal and hepatic insufficiency and patients with opioid addictive disorders [11, 12].
Pain has an impact in the quality of life of patients with complaints for prolonged experience of pain, it increases healthcare costs and it is a risk for progress to chronic pain with negative reflection in health and mental status of patients [13]. The experience of prolonged pain brings healthcare workers under more complex situations and the selection of appropriate pain treatment is more difficult [14].
Rational prescription of analgesics in dentistry involves the selection of appropriate pain reliever, right clinical indication, selection of adequate dosage and route of administration and implementation of cost-effectiveness and risk-benefits standards.
Hence, information with the objective of elaborating an analgesic’s utilization patterns is considered as of high relevance in order to optimize the pain treatment in dentistry.
Odontogenic pain due to periapical and pulpal disease is considered as the most frequent in dental health settings [15] and it is a warning sign and subjective perception of altered pulpodentinal tissue and periapical tissue. These two can be distinguished one from the other and this perception has an impact on the appropriate selection of analgesic drugs.
According to the course of clinical manifestation of the dental pain, it can be classified as acute or chronic and/or with and without malignant disease. Acute pain lasts from several hours to a number of days, while chronic pain can be present for several months and, if primary dental care is not applied, pain can last for years.
Acute pain is usually a reflection symptom of several clinical conditions such as dental trauma, inflammatory conditions of dental tissue and other related tissue structures, including the temporomandibular and masticatory muscle damages. There are several painful dental conditions indicating the analgesic use.
The characteristic of odontogenic pain is so-called referred pain, which means that the damage located in one part of dental tissue can be projected to another dental tissue. Dental referred pain is a complex clinical phenomenon, which requires a highly experienced dentist to diagnose and locate the primary source of pain [16].
The majority of clinical indications of analgesic prescriptions relate to the treatment of acute and chronic dental pain and adjunctive intraoperative and postoperative pain. Moreover, in dental practice associated procedures such as dental extractions require the use of pain reliever therapy [17].
In addition to the understanding of primary mechanism of pain, the dental clinician needs to quantify the perceived intensity of pain. These are preconditions to develop an effective strategy for the selection of efficacious and safe analgesic treatment. According to anticipated pain intensity, the dental pain can be mild, moderate and severe. This classification of dental pain intensity is crucial in the selection procedure of analgesic therapy for satisfactory relief of pain. In patients with mild dental pain, the first lines of analgesics are the nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs can be prescribed in over-the-counter doses and in some cases in combination with other analgesics such as paracetamol [18].
The drug of choice from NSAIDs group for the treatment of mild odontogenic pain is ibuprofen 200 mg or naproxen 200–225 mg individual dose. In patients with persistent mild dental pain, the combination of ibuprofen or naproxen with paracetamol is more effective than individual NSAID agents. Where NSAIDs are contraindicated, the appropriate choice is 500–1000 mg of paracetamol.
Acetyl salicylic acid is not the drug of choice for treatment of dental pain due to its interference with platelet aggregation and patients with heart disease receiving this drug should be treated with precautions.
In patients with moderate dental pain, the analgesic of choice is a NSAID used in pharmacological full doses. NSAIDs can be individually administered or in combination with aniline derivatives, such as mefenamic acid and meclofenamic acid. In some patients where NSAIDs are not effective in combination with paracetamol, a weak opioid analgesic can be considered. The individual dose of ibuprofen is 400 mg, while that of the naproxen is 500–550 mg. In patients where pain is not controlled effectively, the addition of full dose of paracetamol is recommended. If pain is still present, the addition of weak opioid agents in full doses is advised, i.e., codeine 30 mg, hydrocodone 5 mg [19].
In patients with severe dental pain, the pharmacological treatment consists usually of combinations of strong opioid analgesics with high doses of NSAID agents, with or without aniline derivatives. In such patients, treatment of pain should be under close supervision of the dental doctor due to a higher probability of adverse drug reactions. The first choice of drug is hydrocodone 10 mg, oxycodone 5 mg, codeine 60 mg, or tramadol 50–75 mg. Due to high potential of abuse, tramadol is not the drug of choice for the treatment of severe odontogenic pain. In patients with unsatisfactory level of pain control, the combination of full dose opioid agents and NSAIDs is recommended [20].
There are several factors that play a crucial role in the selection of analgesic drugs in dental pain treatment including:
Pathophysiological pain mechanism. This is a predictive factor in analgesic choice. Mechanisms include cancer metastases, postoperative dental pain, nerve root infiltration, nerve root infiltration, neuropathic pain, etc.
Patient age. The selection of analgesic is also determined by patient age. The administration of analgesics in children and elderly patients differs from adults patients. The use of a number of analgesics in children is limited due to unmaturated metabolism processes. The elderly usually require a restriction of analgesic dose due to decreased potential of metabolism and/or excretion with reflection in pharmacokinetics and pharmacodynamic of drugs.
Route of administration. This is determined by the general health condition of the patient, patient’s characteristics of disease, bioavailability and pharmaceutical formulation of the analgesic. Oral use of analgesics is recommended where it is possible. Controlled release of pharmaceutical formulations is more suitable for chronic pain than fast release forms.
Patients-related features. There are several conditions, which may affect the success of analgesic treatment in dental patients. The placebo effect should be considered carefully by dental doctors. Initially, the dental doctors should address the potential renal and hepatic toxic effect, including the gastrointestinal disturbances which may impact the pharmacokinetic and safety profile.
Experienced dental clinicians select a safe and effective analgesic therapy using individual drugs or different analgesic combinations to treat dental pain based on individual conditions. This selection in dental practice is not always simple due to numerous confounding factors related to the mechanism and clinical manifestation of pain [21].
Drug utilization studies are useful quantitative tools for feedback information of analgesic use and for identifying the measures for quality improvement of dental pain therapy. There is an increase in the rate of prescription of analgesics. The most popular analgesic drug group is NSAIDs, followed by acetaminophen, while opioid analgesics are reserved for high intensity dental pain. There is an increase in the prescribing of opioid analgesics or their combination with nonopioid analgesics in nontraumatic dental condition-related visits with more severe pain in the emergency departments [22, 23]. In one recent published study with a large cohort of patients, opioids such as hydrocodone (78%), followed by oxycodone (15.4%), propoxyphene (3.5%) and codeine (1.6%) were reported to be the most frequently prescribed analgesics after surgical extraction of teeth which requires dental care.
However, recently different studies reported a drop by 5.6% in the prescribing of opioids [24, 25]. Taking this into consideration, more should be done to prevent opioid abuse and dentists play an important role in this regard, helping to minimize opioid abuse by careful patient education and appropriate prescribing practice [26]. In mild to moderate acute dental pain, acetaminophen and NSAIDs are the most appropriate choices. COX-2 inhibitors may be considered for patients at risk of gastrointestinal disease or those taking blood thinners such as warfarin. Also, prescribers must be aware to decrease the use of maximum recommended doses and advocate shorter duration of treatment [27]. Ibuprofen was found to dominate over other analgesics [28–31]. This also applies to pediatric dentistry, whereby ibuprofen and paracetamol predominate in prescription rates [32].
However, there are controversial studies, which show that diclofenac or paracetamol may offer improved benefits. Moreover, in patients undergoing third molar surgery, nimesulide followed by diclofenac, ketoprofen and ibuprofen were the most prescribed NSAIDs.
In general, this difference in prescribing may be influenced by different practitioners in different countries, less reported side effects of medications and their effectiveness in different indications [33, 34].
The use of analgesics in general practice is regulated by marketing authorization instructions of drug regulatory agencies of the respective states. The number of analgesics in over-the-counter (OTC) drug group is permanently increasing and the consequence of this is the loss of active monitoring from health professionals.
Pain is a common factor for seeking dental advice but may also occur after different interventions. The dentist is responsible to create strategies for the management of different types of pain from the dental, oral, facial, or postoperative procedures. Nonopioid analgesics are available as “over-the-counter” medications and in U.S.A, 16 millions of these drugs are prescribed annually. There are fewer indications for opioids compared to nonopioid analgesics due to their side effects profile; these should be used with caution only in case of severe pain [21].
There are several OTC analgesics and the most used are ibuprofen, acetylsalicylic acid (aspirin), acetaminophen, ketoprofen and, recently, naproxen sodium. The main characteristic used to classify these analgesics within the OTC group is the dosage [35]. NSAIDs, including ibuprofen and naproxen, are used as nonprescription OTC analgesics in doses of 200–400 mg (1200 mg/d) and 440 mg (660 mg/d for maximum of 10 days), respectively. Also, acetaminophen is widely used as an OTC product which is used also in combination with hydrocodone, oxycodone, codeine and propoxyphene. Maximum doses of acetaminophen should not exceed 4000 mg and particular attention is paid to alcohol users, in whom this drug can cause hepatotoxicity [36, 37]. In general, ibuprofen is normally safe and effective for patients who use OTC analgesic, but it has also been shown that in a small percentage of patients who use OTC analgesics maximum doses are exceeded. More sophisticated research analyses are needed in this area to improve our understanding of dosing patterns of nonprescription analgesics. This requires improved patient education about nonprescription analgesic use and prevention of possible adverse events [38, 39]. In OTC NSAID analgesic users, more caution is necessary in the elderly or in patients with rheumatoid arthritis who are already taking NSAIDs, or low dose aspirin, ACEI or diuretics. The shortest duration of treatment is required and the lowest effective doses of NSAIDs are crucial in their efficacy and safety [40]. Due to this, close medical supervision is advisable.
NSAIDs exhibit their analgesic effect due to the inhibition of prostaglandin synthesis at the peripheral nerve endings, while opioids demonstrate their effect in central nervous system through its depression [41]. NSAIDs mechanism of action is through the inhibition of prostaglandin and thromboxane (eicosanoids) biosynthesis by inhibition of cyclooxygenase activity (COX-1 discovered by John Vane or COX-2 from Daniel Simmons) in reversible or irreversible fashion and dose-dependent manner competition of arachidonic acid. In the past four decades, many new drugs such as piroxicam, flurbiprofen, diclofenac, naproxen, ibuprofen, etoricoxib and celecoxib were introduced based on their COX activity. Their mechanism of action depends on whether they inhibit COX-1, COX-2, or both, which are responsible for the synthesis of different prostaglandins found in pathological situations (COX-2 is more expressed in inflammatory conditions). However, this inhibition also results in the loss of some protective effects of prostaglandins with respect to the gastrointestinal (COX-1), cardiovascular, platelet and renal function [42]. Taking this into consideration, COX-1 inhibitors are more prone to cause gastrointestinal bleeding, which can be prevented by a switch to COX-2 inhibitors. However, short-term use of the latter is recommended based on their cardiovascular side effects which results from the imbalance of PGI2 as antithrombic mediator and as one of the most important prostanoid in regulating homeostasis of the cardiovascular system and also TXA2 as prothrombic mediator [43–45]. Recently, there has been an increasing interest in their effects extended beyond COX enzymes and fascinating results have been shown in different pathologies such as cancer through major cellular signaling pathways, which mediate inflammatory response [46, 47].
Opioid mechanism of action is mediated via their affinity for μ, κ, δ and opioid receptor like-1 (ORL-1) which are G-protein-coupled opioid receptors acting on GABAergic neurotransmission, in CNS and throughout the body, by acting as agonists, weak agonists and partial agonists. These responses are mainly mediated from Gi proteins by closing N-type voltage-operated calcium channels and opening calcium-dependent inwardly rectifying potassium channels, which result in hyperpolarization and reduction in neuronal excitability. Another mediated effect is the decrease of intracellular cAMP, which modulates the release of substance P, a nociceptive neurotransmitter [48].
These receptors are activated also by endogenous ligands such as endorphins. It is shown that their action is also dose mediated by showing better efficacy when the dose increased. However, side effects should be taken into consideration. Most significant opioid effects are mediated through μ and κ receptors including for morphine and other semisynthetic and synthetic drugs such as meperidine, methadone, hydrocodone, oxycodone, fentanyl, buprenorphine, pentazocine and tramadol.
Pain management in dental practice is usually an unpredicted challenge and is highly related to individual patient response to pain, the expectations of the patient, pathophysiological mechanism of pain and selection of analgesic drugs. Pain relief is a very important precondition during interventional dental treatment and ensures a trustful and comfortable relationship between patients and the dental doctor [49].
Almost all dental procedures are accompanied by pain of different intensity, nature and length and treatment of pain pre- or postdental intervention is an integral part of dental treatment [27]. Efficient pain treatment during dentistry healthcare is mandatory for the achievement of desirable clinical outcome and successful dental clinical treatment. Usually in the preparation phase of patient, before the initiation of dentistry interventions, the use of local anesthesia ensures the control of patient pain [50].
The clinical evidence shows that local anesthesia results in the relief of pain during intraoperative dental period and shortly for postoperative pain and dental doctor should consider effective pain management during all stages of dental treatment. As the dental pathological process usually involves inflammation, the effect of local anesthesia is reduced due to prostaglandins interference with tetrodotoxin-resistant receptors, which diminishes the nerve responses to local anesthesia [51].
For effective dental pain management, dental doctors should address attention to disease, patient and finally to available nonpharmacological and pharmacologically effective treatment options.
The dental doctor should initially assess the pathological process of dental tissue in order to understand the mechanism of disease and to predict the health status of the patient. It is very important to define the etiology of the pathological process, especially to determine the eventual inflammatory response [52].
There is reported evidence that premedication with NSAIDs drugs such as ibuprofen or indomethacin significantly increases the level of alveolar nerve block anesthesia in dental interventions (78 and 62%) compared to placebo (32%) [53]. During the process of soft tissue trauma, a pain response occurs and this warrants the measures for pain treatment.
In dental operative procedure, preoperative administration of medication, including analgesic drugs, is recommended in order to diminish postoperative pain and to reduce the need for postoperative analgesic.
An effective strategy for dental pain treatment is based on the dynamic process of creation of a logical treatment map, which is built by the methodology of conceptualization to visualize the relationship between patient symptoms, dental interventions, therapeutic treatment and patient’s needs and expectations.
Furthermore, there is available misleading information showing that naproxen sodium has a superior analgesic efficacy compared with ibuprofen at postdose interval from 1 to 12 h [28, 54, 55]. The important analgesic agents for use in dentistry are also para-aminophenol derivative such as paracetamol (acetaminophen). Administration of individual paracetamol is recommended in mild form of dental pain only when the NSAIDs are contraindicated. Otherwise, there is clinical evidence showing that ibuprofen in doses 200–512 mg versus paracetamol 600–1000 mg is superior in relief of postoperative pain. The novel strategy for pain treatment is the use of combination containing ibuprofen and paracetamol. This combination is more effective than the effect of individual analgesic when taken at 6 h after dental intervention.
The evidence shows that the most frequent doses of respective analgesics prescribed in clinical practice are 400 mg for ibuprofen and 1000 mg for paracetamol [56]. For more intensive pain when the administration of individual NSAID analgesic or combination of NSAID and paracetamol are not effective, the administration of an opioid and NSAIDs is recommended. The analgesic effect achieved by this drug combination is higher than the doubling of dose of either analgesic administered alone [57].
There are several possibilities of combinations of nonnarcotic and narcotic analgesics, which might be effective for the treatment of dental pain. The mostly used analgesic combinations in dental pain management are acetaminophen-codeine (300 mg + 30 mg), oxycodone-ibuprofen (5 mg + 400 mg), or hydrocodone-acetaminophen (5 mg + 325 mg or 7.5 mg + 500 mg) [58]. The main paradigm for treatment of dental pain is the appropriate selection of effective analgesic, at lower possible dose with the lowest probability for side effects (Table 1).
Type of pain in dentistry | Analgesic drug | Dosing (Adults) | Adverse effects |
---|---|---|---|
Acute dental pain | Ibuprofen Ketoprofen Diclofenac Flurbiprofen Naproxen Sodium Acetaminophen Celecoxib Codeine/Acetaminophen | 200–400 mg every 6–8 h 25–75 mg tbl every 6–8 h 50 mg tbl. 3 times daily 50–100 mg tab every 8 h 500 mg, followed by 250 mg every 6–8 h 500–1000 mg 3 times daily 200 mg 2 times daily 30–60/325–650 mg every 4–6 h | Gastric ulceration-bleeding,diarrhea, hepatotoxicity,allergy, skin rashes,urticaria, cardiovascular-MI, atherothrombosis,CHF, ischemic stroke;Opioid side effects-respiratory depression, dependence, etc. |
Postoperative pain Periodontal surgery Orthodonic tooth movement Pain from pulpal or periapical tissues | Ibuprofen Ibuprofen/Acetaminophen Naproxen | 200–400 mg every 6–8 h (OTC)400/1000 mg every 6–8 h220 mg every 12 h (OTC) | NSAIDs associated side effects, however,OTC doses are better tolerated |
Dental surgery—impacted third molar surgery andDental surgery—dental root canal treatment | Diclofenac/Paracetamol Ibuprofen/Paracetamol | 100/1000 mg single oral dose with 8 h observation 600/1000 mg 30 minutes before procedure or after surgery | Nausea, drowsinessheadache |
After third molar extraction Oral surgical or endodontic treatment Temporomandibular disorders Nontraumatic dental Conditions with severe pain | Hydrocodone Oxycodone Codeine Tramadol | 10 mg every 4–6 h 5 mg every 6 h 60 mg every 6 h 50–75 mg 4–6 h | Nausea, sedation, dizziness, constipation, addiction,sleep disorders |
Intensive dental pain | Oxycodone/Ibuprofen Oxycodone/Acetaminophen Hydrocodone/Acetaminophen | 5/400 mg every 6 h 5/500 mg every 6 h 5/325 mg or 7.5/500 mg every 4–6 h | Nausea, sedation, dizziness,constipation, addiction,sleep disorders |
General use of analgesic drugs in the different types of pain in dentistry.
The strategy for dental pain treatment in elderly patients is generally the same as treatment of pain in general adult population with some differences due to age-related changes principally in physiology and pharmacokinetics in this group of patients. Clinical practice shows that elderly patients are more prone to feel the pain than adult patients and frequently are undertreated.
In the management of dental pain the clinician should consider several factors:
Age-related pharmacokinetic changes with reduced capacities of absorption, distribution, metabolism and excretion of drugs in general and analgesics in particular. This is the main reason why it is recommended that in elderly patients the dose of drugs should be reduced generally at three-fourths of dose of adult patients [59].
Decreased pharmacodynamic capacities of drugs due to age-related physiological changes expressed as alterations in receptor affinity, receptors number and postreceptor signaling pathways, which have an impact in the development of drug tolerance and dependency [60].
Multiple comorbidities, which require a higher number of drugs (polypharmacy) for pharmacological treatment with increased risk of drug interactions and side effects.
The frequency and intensity of pain reported by elderly patients might be reduced and not correspond with real pain assessment, especially when they suffer from dementia and other neurodegenerative diseases.
Patient adherence to drug therapy of elderly patients is usually decreased and support from family and nursing health care personnel should be considered.
The strategy of dental pain relief in elderly patients should be based on several principles and initially we should select the available nonpharmacological measure for pain treatment. If nonpharmacological options are ineffective we need to carefully select the appropriate analgesic drug considering the risk/benefit ratio. After selection of appropriate analgesic the initiation of therapy should start with dose titration starting with lowest dose increasing slowly to effective safe dose. The analgesic therapy should be monitored closely by dental clinicians in order to achieve a successful pain relief and to prevent the possible side effects. The course of analgesic therapy should be as short as possible and also need to be stopped in case of any sign of infectivity and persistency of pain.
For pain relief in elderly patients, the recommended analgesic drug is paracetamol. In case of hepatic or renal functional disorders, dose adaptation is recommended, while in terminal hepatic insufficiency, the administration of paracetamol is contraindicated, in this case the use of NSAIDs is preferred, but these patients need close monitoring. NSAID should be given to elderly patients in the lowest effective dose and in short periods of time in order to avoid the possible side effects of these analgesic drugs. In case of severe dental pain, the use of opioid analgesic is indicated. Usually, oral opioids in the lowest possible doses, such are tramadol and some others, are used. In order to use the opioid analgesic drugs in the lowest doses, the combination of paracetamol and tramadol or codeine is recommended. In elderly patients with intensive dental pain, the strong opioid of choice is morphine [61].
In clinical pediatric care, effective pain management is a standard routine approach and is mandatory in the modern concept of health care. It is accepted that the basic mechanism of pain in infants and children is substantially similar to adults with some exception in neonates related to some differences in physiological mechanism of pain, which is characterized with slower and less precise conduction of pain but without significant differences in pain perception [62].
Modern pain management for children addressing the medical conditions and surgical interventions and postoperative period has substantially advanced over the last two decades.
Advanced pain management strategy is based on two main directions, including the interventional pharmacological and nonpharmacological approach. The interventional pharmacological approach consists of the use of NSAIDs and other analgesics administered via different routes of administration (i.v. bolus administration, continuous infusion, rectal, transdermal and other routes of administration); local anesthetics, epidural anesthesia and peripheral nerve blockade. Nonpharmacological measures consist of health education of children and psychological approach to release the perception of fear and other behavioral problems in children patients, breathing techniques, hypnosis, transcutaneous electrical nerve stimulation, guided imagery, acupuncture, relaxation and other techniques to relieve the pain [63].
Pain management strategy in children consists of several principles, which reflect the differences between children and adult pain treatments. The strategy of pain relief should focus on the prevention of pain and this ensures better treatment success before painful procedures. Usually this starts with preparing the child and the family in advance, in order to reduce fear and anxiety before intervention and applying patient-controlled analgesia (PCA). In case of major surgical interventions the treatment of predicted pain after treatment in children can continue with oral analgesics depending on patient needs.
Dental clinicians should assess the pain intensity using the appropriate children pain scale. It is recommended to use the FLACC scale for pain measurement in pediatric patients aged 1 month to 3 years, while for children above 3–7 years the Wong-Baker pain rating scale is used (Figure 1), which has demonstrated to be more sensitive compared to visual analogue scale. For children above 7 years, the Visual Analogue/Numerical Rating Scale is used. A universal measuring tool does not exist but according to a systematic review FACES scale demonstrated to be effective in children from 3 to 12 years in which gradient of emotions cartoons are chosen by children based on their level of pain. There is also another measurement, such as Oucher pain scale, which does not differ much from the others, but it is more specific in different racial face expressions such as Caucasian, African American, Hispanic, First Nations Boy and Girl and Asian Boy and Girl [64–69].
Wong-Baker faces pain rating scale explains to the person that each face is for a person who has no pain (hurt), some, or a lot of pain by asking the person to choose that best describes how much pain he has.
Multimodal and multiapproach therapy is the cornerstone of pain management in children. This technique uses different analgesia and nonpharmacological complementary approach in order to enhance the pain control and minimize drug-induced adverse effects. This method supports the use of combined nonopioid (NSAIDS, other analgesic agents, local anesthetics, alpha2-adrenergic agonists, voltage-gated calcium channel alpha-2 delta-proteins) and opioid analgesics and other agents in smaller doses in order to prevent the clinical manifestations of drugs side effects [70]. Dosage calculations of analgesics for children are based on mg/kg body weight administered by intravenous, oral and rectal route, while intramuscular injections should be avoided. It is recommended that severe pain is treated by infusions, PCA and other routes of continuous analgesic administration.
Pain treatment options in neonates and premature infants should avoid the use of opioid analgesics. However, in cases when there is no other option, opioid analgesics should be closely monitored in intensive care units. In this group of infants, opioids are more prone to develop dependency and depression of cardiorespiratory functions.
The mainstream in pharmacological pain treatment consists of administration of NSAIDs, paracetamol. Usually it is recommended to use paracetamol (infant dose is 10–15 mg/kg/dose every 6–8 h, pediatric oral dose 10–15 mg/kg/dose every 4 h), ibuprofen (10 mg/kg/dose every 6 h) and diclofenac (1 mg/kg/tds or 1.5 mg/kg/bd, maximum daily dose is 3 mg/kg). While naproxen (2 years or older: 5 mg/kg orally twice a day; 12 years or older: 220 mg orally every 8–12 h) is indicated more in inflammatory diseases. In modalities of analgesic therapy combinations the dosage of individual analgesics are decreased.
For more intensive pain the use of opioids is recommended. Codeine (0.5–1 mg/kg every 4–6 h) is a weak opioid analgesic and to increase the analgesic effect it is often combined with paracetamol. However, FDA alerts about odeine use in children and it should be used with careful monitoring only in patients from which benefits outweigh the risks [71]. Another opioid analgesic for treatment of mild to severe dental pain in children is tramadol (1–1.5 mg/kg). For severe dental pain, the use of morphine (0.2–0.5 mg/kg q4–6 h) is recommended. Other alternatives to morphine are also considered, including fentanyl, hydromorphone, methadone and other opioid agents.
Other approaches to pain treatment of dental pain in children include the use of regional analgesia such as local anesthetic instillation, wound anesthetic infiltration, topical regional analgesia (lignocaine gel), peripheral nerve block and other methods. Dental pain management in children is complex and further improvements are needed to improve the efficacy and safety of pain treatment [72].
There is an increased risk for renal dysfunction in patients undergoing analgesic treatment, although moderate use is not associated with increased risk of renal disease or dysfunction [73]. Patients with renal failure should be carefully considered due to the increased risk of side effects in dental treatment and also when analgesic therapy is indicated. This requires consultation with the nephrologists or hepatologists for the grade of the disease and an important monitoring for clinical parameters which need to be observed. Regarding medication, dose adjustments need to be considered as an important step to reduce side effects or toxicity. For NSAIDs dose reduction or avoidance is also indicated in more advanced stages of renal failure. In aspirin, acetaminophen and ibuprofen treatment indications prolongation of dosing interval is recommended; however, dose reduction is recommended for diclofenac and naproxen. When the GFR is <10 mL/min avoidance need to be considered, excluding acetaminophen in intervals of 8–12 h. On the other side narcotic analgesics (morphine, fentanyl, codeine) are metabolized by the liver and usually do not require dose adjustment [74, 75]. But special caution should also be exercised in patients with end-stage renal disease without dialysis whereby the use of opioids such as codeine, dihydrocodeine, dextropropocyphene and hydrocodone is not recommended (tramadol may be used with caution). Also, only short-term treatment must be prescribed for morphine, diamorphine, or dose reduction in fentanyl by 25–50% or methadone 50–70% with specialist advice on prescribing and special care in the elderly due to highly variable pharmacokinetics [76, 77].
Due to pharmacokinetic changes in the elderly and reduced renal and metabolism capacity, acetaminophen is the drug of choice for the control of mild to moderate pain in doses of 500–1000 mg every 4 h. Moreover the overuse of this drug is related with side effects including acute liver failure, hepatotoxicity and in rare cases nephrotoxicity. Taking this into consideration, chronic dosing needs to be avoided in patients with decreased liver function or cirrhosis [78, 79]. In cirrhotic patients, NSAIDs should be avoided or used with extreme caution due to increased risk of gastrointestinal bleeding and risk of hepatotoxicity or acute hepatic decompensation or risk of renal failure.
For opioids, low dose of tramadol is considered as second choice in this group of patients after acetaminophen [80].
Opioid side effects are more common in hepatic impairment due to prolongation of their effects. Conversely, fentanyl and methadone pharmacokinetic is less affected by hepatic impairment. Fentanyl is recommended more than methadone. And also hydromorphone, morphine and oxicodone are other choices that are recommended with caution [81]. Consultation with specialist and also titration should be done slowly, monitoring of drug concentrations and adverse effects are crucial steps in the use of analgesics in dental management for patients with impairment of renal or hepatic functions (Table 2).
Population | Analgesic drug | Dosing | Adverse effects |
---|---|---|---|
Elderly | Acetaminophen (First choice in mild to moderate pain) | 500–1000 mg every 8 h (maximum 3 g)(reduce maximum dose 50–70% for adults with reduced hepatic function or alcohol abusers) | Gastric ulceration-bleeding; Abdominal pain; Hepatotoxicity and acute liver failure; Acute renal failure; Allergy; Skin, Rashes; Urticaria, Cardiovascular-Myrocardial infection, atherothrombosis, Chronic heart failure; Ischemic Stroke; More sensitive for opioids induced side effects. More pronounced drug interaction associated adverse effects. |
NSAIDs (Ibuprofen, Naproxen, Flurbiprofen, Ketorolac, Celecoxib) | Lowest effective dose for the shortest Possible time (It is recommended to use NSAIDss with PPIs to avoid gastrointestinal bleeding, or use celecoxib in patients with no significant risk factors for cardiovascular events) | ||
Opioids (Oxycodone, Hydrocodone, Tramadol)(moderate to severe pain) | Oxycodone 2.5 mg every 6 h Hydrocodone 5 mg every 6 h Tramadol 25 mg daily with increase every 2–3 days with 25 mg up to 100 mg. (It recommended 25–50% dose reduction from recommended dosage in adults and shortest possible time) | ||
Children | Acetaminophen Ibuprofen (age 2–12) Naproxen (age 2–12) | 10–15 mg/kg every 4–6 h 5–7 mg/kg every 8–12 h 5–10 mg/kg every 8–12 h | Acetaminophen hepatotoxicity in liver disorders Gastric irritation, ulceration, bleeding and perforation and clotting impairment from NSAIDs Codeine associated nausea, sedation, constipation, dependency. |
Codeine/Acetaminophen (3 days or less and only with careful monitoring and only in patients which benefits outweighs the risks) | 0.5–1 mg/kg every 4–6 h | ||
Morphine (Only in severe dental pain) | 0.2–0.5 mg/kg every 4–6 h | ||
Renal and hepatic insufficiency | Acetaminophen | 500–1000 mg every 6–8 h (no need for adjustment in renal insufficiency, reduce dose up to 2 g daily n cirrhosis | Coagulopathies from liver disease; Acute renal injury; Hepatotoxicity; NSAIDs and Opioid-associated side effects. |
Ibuprofen | 200–600 mg every 4–6 h (no need for adjustment in renal insufficiency, avoid or use with caution in hepatic insufficiency) | ||
Dihidrocodeine | 10–30 mg every 4–6 h (decrease dose 25% in renal insufficiency) | ||
Fentanyl | 12 mcg/h transdermal patch (only if patients have been taking other strong narcotic pain medicines for at least a week) |
Use of analgesic drugs in dentistry in special populations.
Evidence-based medicine strongly supports the evaluation of analgesic efficacy and safety. The majority of this research uses the third-molar extraction model of acute dental pain to determine relief of pain intensity over time with different available analgesics. The clinical efficacy of dental analgesics is focused on comparison of individual analgesics and placebo and monotherapy analgesics with combined therapy.
Efficacy and safety of analgesic drugs is shown to be enhanced through the use in combination due to the reduction of single drug component. Usually, the choice of analgesic is based on personal preference. In systematic reviews for dental and general surgical randomized controlled trials with naproxen, diclofenac and rofecoxib, they were shown to be superior compared to placebo and also COX-2 inhibitors demonstrated equipotent efficacy relative to NSAIDs.
Moreover in dental and orthopedic pain, valdecoxib, celecoxib, ibuprofen and acetaminophen alone or with oxycodone demonstrated superiority of COX-2 inhibitors compared to acetaminophen, but not to ibuprofen alone. Also, oral ibuprofen is significantly superior to placebo and when the doses were maximal the effect were enhanced.
When compared to diclofenac, ibuprofen was less efficacious even after showing a reduction by at least 50% of pain for 100% of patients participated. Acetaminophen was also proven to be similarly efficacious in general and orthopedic surgery and less effective in dental surgery compared to NSAIDs. When it is combined with opioids such as codeine or oxycodone, it was shown to be superior compared to placebo; however, it was more prone to side effect. The same was proven with tramadol alone.
In general, NSAIDs demonstrate higher efficacy in dental pain and are considered as the main alternative and drug of choice for dental pain. However, even though opioids are relatively less effective, they may be considered when NSAIDs are contraindicated and also different combination could be administered for some patients that require adequate pain relief [82].
Common reported adverse events of NSAIDs are dyspepsia, gastric ulceration-bleeding, diarrhea from COX-1 inhibitors, cardiovascular disease (congestive heart failure, atherothrombosis, myocardial infarction, ischemic stroke), reduced renal perfusion, or nephrotic syndrome accompanied with edema, acute kidney failure in rare cases from COX-2 inhibitors. Ibuprofen use in normal doses is one of the drugs with least risk or alternative option as selective COX-2 inhibitors. Acetaminophen adverse effects resulting from their higher dosage, chronic use, or in patient with liver disease includes liver toxicity, prolongation of prothrombine time, urticaria or skin rashes and acute renal tubular necrosis. Severe hepatotoxicity was reported in patients with risk factors such as HIV, hepatitis C and chronic alcohol users. In postoperative pain, a single dose usage and rational prescribing is demonstrated to be safe.
Moreover, narcotic analgesics have more frequent adverse effects and many patients abandoned treatment which make them poor choice in dental pain. When contemplating surgery, it is recommended to suppress NSAID medication from 1–2 to 4–5 days, which also depends on the drug type and dose regimen. Analgesic combination, which contains NSAIDs, is recommended to be used with caution only in short course for the acute dental pain [41, 83–86]. These above-mentioned side effects usually tend not to occur with the occasional use of NSAIDs, which makes these drugs safe in dental practice. NSAID usage for more than 10 days should be consulted with the practitioner. Even though they are considered relatively safe within the recommended dosage for use of up to 10 days, cautions should be exercised in NSAIDs-exacerbated respiratory disease, asthma, patients with prior myocardial infarction who are receiving antithrombotic therapy and those with a history of renal disease [87, 88].
Strategies to lower risk events for gastrointestinal toxicity from NSAIDs include the use of the lowest dose, switch to acetaminophen or COX-2 inhibitors, or antiulcer cotherapy use (PPI, H2-blockers, antacids, prostaglandins). Cardiovascular-related adverse effects have resulted in rofecoxib and valdecoxib being withdrawn from the market. However, uses were for a long period of time and dose dependent or even in short course of treatments for 10 days after bypass surgery. Currently, celecoxib, etoricoxib, lumiraxocib and parecoxib, with better cardiovascular risk profiles, are still in the market. Hence, NSAIDs may increase the risk for myocardial infarction, in particular those with more COX-2 selectivity such as diclofenac. Taking this into consideration, avoiding COX-2 inhibitors and following treatment with antiulcer drugs is recommended in high risk patients [82]. Ibuprofen and naproxen are considered the safest NSAIDs. Overall risk from analgesic used in dentistry is low and importantly when they are used in acute dental pain. Moreover, the most serious safety concerns about the use of opioids are the side effect profile which includes respiratory depression, dependence, sedation, euphoria, constipation, cognitive dysfunction, pruritus, nausea and immunologic and endocrine effects, which are more prone from μ receptor activity. Dependence is another challenge and this occurs more in severe acute, chronic and terminal pain for longer than a week and after repeated administration. Furthermore, tolerance to opioids is developed when higher doses are used.
Selective κ agonist such as nalbuphine is shown to be safer even though this should never be given to a patient who is dependent. Important care is recommended for codeine metabolism from CYP2D6 ultrarapid metabolizers, which are more prone to morphine-induced side effects or for CYP2D6 deficient or patient who are on inhibitors of this cytochrome may not produce analgesic effect of hydrocodone and oxycodone. Methadone has potential to cause cardiac arrhythmia. Due to this pretreatment and periodic cardiograms are recommended for patients suspected for drug interactions or increasing methadone dosing. Important care should also be taken with conversion of one opioid to another from opioid conversion tables (for example, morphine to methadone). Regarding treatment of withdrawal, partial agonists such as buprenorphine is recommended [19, 89].
Recently, there have been important developments in the investigation of lower addictive potential opioids such as tamper-resistant extended release, also opioid abuse screening tools, genetic testing and fMRIs for patients at risk of opioid abuse while maintaining treatments for patients with appropriate management.
Even though recent research has shown that a number of potential predictors for personalization of therapy exist, there is still insufficient evidence for opioid prescribing from patient’s characteristics. Data-based personalized prescribing of opioids for optimization of analgesic effectiveness and mitigate risks of opioid-related mortality and abuse is highly desirable with the potential to benefit patients by raising world clinical care and optimizing cost effectiveness of opioid analgesic therapy [90].
Analgesic monotherapy and combined therapy is shown in different clinical situations such as reducing pain in surgical procedures, periodontal and endodontic procedures which is documented also from different clinical trials. Many NSAIDs which are used in dental pain includes ibuprofen, aspirin, diflunisal, etodolac, mefenamic acid, ketoprofen, ketorolac and flubiprofen. Ibuprofen is the most commonly used in acute pain and is often prescribed as the first choice analgesic associated with its anti-inflammatory actions in the dentistry practice. Paracetamol acts in the central nervous system and it possesses analgesic and antipyretic effects. It is the first choice for patients who cannot tolerate NSAIDs. Higher doses such as 1000 mg are more favorable in the context of its efficacy and were comparable with ibuprofen.
There is strong evidence that combined analgesics therapy lead to greater efficacy and fewer adverse events compared with monotherapy of analgesics in higher doses. Different randomized controlled trials that compared combinations of several analgesics (NSAIDs and acetaminophen) revealed that the combination of acetaminophen with different NSAID drugs was more effective than either acetaminophen or individual NSAID alone [18, 91, 92].
Currently there are many combinations of paracetamol with other NSAIDs such as ibuprofen, ketoprofen and diclofenac and they have resulted in providing superior analgesia than using the drug alone. Otherwise in the patients with moderate to severe pain induced by postoperative pain, the combination of lower doses of ibuprofen with paracetamol has not shown benefits when compared with ibuprofen used alone. This is an indication that dosage choice is an important factor regarding its related combinations [93–95].
Naproxen is indicated in toothache and its pain relief efficacy is comparable with ibuprofen. It is comparable with etodolac, but less effective in swelling when compared with diclofenac when they were used in oral surgical procedures, including postoperative third molar surgery or orthodontic pain [96–98]. Diclofenac is used in moderate to severe pain following third molar extraction and it could be used in an intravenous form in risk population groups such as the elderly and renal insufficiency, postoperative anticoagulation which uses ketorolac as the only choice for the moderate to severe acute pain. Very similar effects were shown when transdermal diclofenac patches were used compared to oral administration [99, 100].
Due to safety concerns COX-2 selective inhibitors have been introduced as a safe alternative in dentistry practice with superior analgesic and inflammatory conditions in periodontal diseases and after oral surgery procedures. Etoricoxib and celecoxib groups were shown to be comparable to ibuprofen on its efficacy in the dental pulpal pain or postoperative pain relief, third molar surgery but superior toacetaminophene [101–103].
Their use is favorable in patients with upper-GI-complications, in the aspirin user for cardiovascular comorbidities, or those allergic to aspirin and perioperative settings due to their lack of properties over blood clotting. But they are limited to be used in such short periods including postoperative periods due to their cost effectiveness compared to other NSAIDs. Also, their long-term uses in the painful temporo mandibular joint disorders and chronic orofacial pain in the patients without cardiovascular risk factors could be considered as another therapeutic option [41, 104].
NSAIDs display major interactions when used alongside anticoagulant and antiplatelet effects of warfarin and clopidrogel, which results in enhancement of their effects and increased risk of bleeding. In this situation acetaminophen is an appropriate choice at the lowest possible dose, in short-term treatment only. Ibuprofen use in patients taking cardioprotective aspirin does not interfere with its antiplatelet activity, even though there are studies that demonstrate reduced cardioprotective benefits and increase gastrointestinal risk, in contrast to diclofenac or acetaminophen which did not influence effects of aspirin on platelet function [86]. Moreover, patients taking daily aspirin for cardiovascular disease prevention should avoid chronic use of ibuprofen and FDA recommends taking ibuprofen in intervals of more than 8 h before or more than 30 min after the immediate release of aspirin to reduce potential interaction in platelet function [40]. Concurrent use of NSAIDs with warfarin or corticosteroid may increase gastrointestinal risk. They also increase the risk of gastrointestinal ulceration in concomitant use with biphosphonates. Effects of antidiabetic sulfonylureas are increased with coadministration of NSAIDs.
A decrease of renal extraction of methotrexate is shown with the use of NSAIDs, which can bring to its toxicity. Also, the serum concentrations of lithium are raised and non-NSAID analgesic should be recommended. Additionally, fluconazole was shown to increase celecoxib concentration due to its metabolism inhibition.
Interactions with lesser significance are NSAIDs use with ACE inhibitors, diuretics, Ca-channel bBlockers and beta-blockers which results in diminished antihypertensive effects. However, short-term use does not pose a major risk in healthy individuals, but in hypertensive patients and especially in the elderly if the treatment will be continued for a long term a careful selection and close monitoring is required. Antacids were shown to decrease NSAIDs effects. NSAIDs are also found to interact with SSRIs (selective serotonin reuptake inhibitors) to increase the risk of bleeding including also upper gastrointestinal and postoperative bleeding [37, 105, 106]. Acetaminophen has very few drug interactions. Carbamazepine as metabolic inducer may decrease drug levels of acetaminophen. Its combination with alcohol or drugs that harm the liver may increase the risk for liver toxicity.
Dental practitioners should be aware of these interactions and use analgesic drug therapy within the limit of dosage or interval of use and in carefully considered combinations. Furthermore, they should avoid them when there is increased risk for toxicity [81, 107]. Narcotic analgesic interactions include antipsychotics (phenotiazines) which enhance their hypotensive effect and also CYP2D6 inhibitors (cimetidine, chlorpheniramine, fluoxetine and quinidine), which inhibit their effects including hydrocodone. Inhibitors or inducers of CYP3A4 cause clinical significant interactions when used with morphine, oxycodone and methadone by mediating opioid toxicity or impairment of pain treatment. Also, SSRIs and MAOIs effects are more associated with meperidine, methadone, tramadol, buprenorphine, oxycodone, hydrocodone, pentazocine and fentanyl, which may also result in the cause of the serotonin syndrome. Barbiturates may enhance their sedative effects. Also an increase of meperidine metabolism is induced by phenytoine. Taking this into consideration physicians should recognize and monitor patients carefully for drug interactions and possibly try to avoid polypharmacy [89, 108, 109].
Safe and effective dental pain management strategy requires an understanding of several factors. Pain is perceived differently by individual patients, depending on their biogenetic profile, gender, age, sociocultural attitudes, comedical and psychiatric conditions and several other factors [110]. Due to ethical consideration there are limited scientific data for drug efficacy in dental pain management and this is why it is important to challenge the work of clinicians in daily clinical practice. Dental clinicians assign a comprehensive practice that involves the pharmacological, biological and psychosocial aspects of pain management in order to ensure effective low risk pain treatment. Therefore, they need to implement and coordinate the extrapolated evidence base, knowledge, personal clinical experience and close monitoring of patients to achieve the effective balance of pain treatment in dental patients [11].
In general more attention should be paid by dental practitioners to reducing opioid drug abuse and monitoring of prescription and nonprescription uses of analgesics, improvement of drug choice alone or in combination, new analgesic alternatives and adjustment in course of treatment according to clinical needs. Also, individualization of therapy and dosage needs to be done carefully in the risk groups mentioned above, coupled with the need for adequate monitoring of drug interactions.
Over the ages, the world has been evolving in development and resources use, and this has led to enormous waste generation of different states (solid, liquid, and gas). The waste needs to be either treated or recycled, paving ways for different techniques for different wastes to be treated or recycled. One of the important resources on earth is water. It is used for everyday activities such as domestic, industrial, and commercial purposes. This has caused reduction in freshwater quantity globally and shortage in clean water supply because of pollution of the existing sources. Hence, different techniques and approaches are still being investigated that can provide adequate and sustainable freshwater. Distillation has been a promising process of separating components by heating/boiling, which causes evaporation, and cooling, which causes condensation. Distillation is a simple technique of converting liquid to vapor by heating and subsequently condensing it back to liquid after the vapor comes in contact with a cooler surface. Simple distillation may not be efficient for certain modes of treatment; therefore, some other advanced distillations were found like the fractional distillation for petroleum refining and multi-effect distillation (MED) for desalination. Generally, distillation is meant to separate a homogenous fluid mixture using the differences in the volatility or boiling point of the mixture’s components [1].
There are three definitions of distillation relevant to desalination. (a) Distillation is a process in which a liquid sample is volatilized into vapor that is later condensed into liquid with richer volatile components of the original sample. This can be achieved by heating, reducing pressure, or both. (b) Distillation is the process of separating a mixture of fluids using the differences in their boiling point or relative volatility. (c) Distillation is the application of heat to a liquid to cause its partial vaporization, and then, a separate vessel is used to collect the condensed vapor [2].
The cost for all distillation methods varies, but they have a similar process or working principle. The temperature difference allows water to evaporate even at 40°C leaving the dissolved solids behind, which require about 300°C to volatilize [3].
Distillation has various advantages such as (i) the capacity to take care of a wide range of feed flow rate range, meaning they can handle high and low flow rates contrary to some alternative techniques. For example, facultative, stabilization, oxidation, and maturation ponds all require a high flow rate of feed; (ii) it can remove various and lots of substances from feed concentrations. Numerous alternative treatments have different stages or include varied chemicals for a particular impurity removal. For example, alum is used mainly to reduce solids through coagulation and chlorine is used only for the elimination of pathogens; so, it cannot remove suspended solids or other impurities; (iii) it can produce water of very high quality (pure); this is contrary to other techniques that partially treat or only reduce the impurity level of the feed. Distillation is a very well-known technique for purification because of its robustness and versatility [1]. One of the major issues with distillation in desalination is the high energy demand for the process. Figure 1 shows a representation of the distillation process in desalination. After feedwater is transferred to the basin, the first step is the use of energy, mostly solar energy, to heat the basin water to cause it to evaporate to produce freshwater; the byproduct remains in the basin as brine solution, which can also be extracted.
Distillation process in desalination.
The aim of this chapter is to elaborate the principles and modes of distillation in desalination and analyze their types, improvements, features, challenges, limitation, cost, gap, and future improvements needed.
Despite distillation being widely used in various disciplines lately, it was first used for desalination by the people of Babylonia in Mesopotamia, which was found on the Akkadian tablet dated c. 1200 BCE. Later, Aristotle (384–322 BC) established a hypothesis that when saltwater evaporates, it forms vapor, which becomes sweet, and the condensate is salt free. Pliny the elder (AD 23–70) explained on the purification of seawater, specifically the Red Seawater
Furthermore, evidence of baked clay retorts and receivers was found at old Indian subcontinent cities; cities such as Taxila, Charsadda, and Shaikan Dheri in modern Pakistan show evidence that during early centuries distillation was practiced there. The distillers were locally called Gandhara stills and they could only produce weak liquor because they lacked efficient means for vapor collection at low heat. However, the first distinct use of distillation specifically for water (distill water) was in 200 CE by Alexander of Aphrodisia. The process continued for other liquids in the early Byzantine Egyptian during the third century under Zosimus of Panopolis [5].
In the eighth and ninth centuries, wine distillation was attributed to Arabic work by Al-Kindi and Al-Farabi, and some were found in the 28th book of Al-Zahrawi commonly known as Abulcasis. During the centuries mentioned earlier, some Medieval chemists such as Jabir ibn Hayyan known as Geber and Abu Bakr al- Razi known as Rhazes did rigorous experiments on distillation using various substances. Later in the twelfth century, a popular recipe known as aqua ardens, which means burning water, which in turn means ethanol, was produced by distilling wine with salt and by the end of the thirteenth century, it became very common in the Western European chemists [5].
In China, distillation started during Eastern Han Dynasty between the first and the second centuries, then in Southern Song between the tenth and thirteenth centuries from archeological findings, and then later in Jin between the twelfth and thirteenth centuries, although the process was predominantly related to the distillation of beverages. In the thirteenth and fourteenth centuries in Qinglong, Hebei Province of China, distillation of beverages was common during the Yaun Dynasty [4, 5].
The trend continued and up to 1500 and a German alchemist Hieronymus Braunschweig published a book called “The book of the Art of Distillation.” This was the first book on distillation and in 1512, the scope was expanded. In 1651, a book titled “Art of Distillation” was published by John French even though most of the work was from Hieronmus [5].
Alchemy later evolved into the science of chemistry, and local equipment such as alembic and retorts now became vessels or glassware in general terms. Until recently, some of the equipment like pot still made of different materials are still used for domestic production or in the manufacture of essential oils [4, 5].
In the modern or middle civilization, that is, during 1822, Anthony Perrier developed continuous still, which was later improved by Robert Stein in 1826. Aeneas Coffey further improved the still in 1830. His unit is referred to as the archetype of modern petrochemical unit. Ernest Solvay was the first to develop a distillation unit that specifically targeted ammonia removal (ammonia distillation) [5].
Currently in the twenty-first century, from the knowledge of the predecessors, various modifications were made to enhance the yield of the distillate. This led to the development of different types of desalination systems and an increase in their usage, especially to meet the need of providing water for workers on the sea or mining regions [6].
Distillation in water desalination is a technique Or excess salts from saline water. Other minerals and impurities are from seawater or brackish water also removed during desalination and this treatment process can be extended to wastewater, industrial water, rivers, streams, lake, pond, and groundwater/wells. These salts and minerals occurred because of salts. Two products are obtained after desalination—freshwater and brine, which is the waste or byproduct [7].
Desalination can alleviate the pressure on water resources and has the capacity to provide adequate clean water especially to coastal regions and is increasingly becoming an alternative for domestic and industrial freshwater supply. Desalination requires a large amount of energy; however, various energy types can be used for desalination, which makes it a good alternative. Figure 2 shows the different energy sources that can be used for desalination. They are categorized into nonrenewable energy sources, which include nuclear, coal, petroleum, natural gas, and hydrocarbons, while the renewable energy sources include wind, geothermal, solar, and biomass. The nonrenewable sources are sometimes expensive or in some cases, not environmentally friendly. On the other hand, renewable energy sources such as solar, wind, and geothermal can replace the renewable energy and are abundant and cost efficient to harness, particularly, solar energy that can be used even in rural areas [7].
Energy sources for desalination.
Globally, there are about 21,000 desalination plants, particularly in Saudi Arabia, United Arab Emirates, and Israel [8]. In the desalination field, distillation can occur as membrane desalination and nonmembrane (thermal) desalination. The membrane desalination is the type that is not a complete thermal process; that is, a membrane is needed to complete the process unlike the thermal (nonmembrane) process, which does not require such medium but undergoes complete thermal process. The membrane is a porous material with a thin film, which allows water molecules to pass through, while at the same time preventing salts, larger molecule, pathogens, and metals to pass through. The most common type of distillation in desalination is the membrane distillation. Membrane distillation majorly targets seawater and brackish water [9].
The membrane desalination process includes electrodialysis (ED) and reverse osmosis (RO), which are two major desalinations used recently. They are reverse osmosis and thermal desalination systems, which account for 63.7% and 34.2% of total capacity produced, respectively. The thermal desalination includes multi-effect desalination, multi-stage flash (MSF) desalination, humidification-dehumidification, vapor compression desalination (VCD), and solar still [9].
Distillation is an ancient method of desalination. It is a phase change process where the liquid known as feedwater, which is mostly seawater or brackish water, is heated to the gaseous state known as vapor and then condensed back to liquid. The condensed water is separated leaving behind brine (byproduct) during the process of evaporation and condensation. There are different distillation types in desalination, namely, solar distillation, multi-effect distillation, multi-stage flash distillation, vapor compression distillation, and membrane distillation.
Solar distillation imitates the natural hydrological cycle in which solar energy heats the water, causes it to evaporate, and the vapor upon encountering cool surface condenses (Figure 3). The condensate is mostly referred to as distillate, which is the freshwater produced, while the impurities left behind is called the brine, which is the byproduct [8]. The first solar distiller was built by Carlos Wilson in Las Salinas in Chile in the year 1872. The distillation principle in this method is that the sun heats the feedwater in the basin and the water molecule evaporates. When the evaporated water molecule (vapor) touches the still cover, which is usually cooler than the vapor, it then condenses to form droplets on the cover. The droplets keep increasing in size until they reach a size that they can slide down
Schematic diagram of solar distillation.
The major advantage of solar distillation is the free energy sources, which is the solar energy. There are other numerous advantages of this process such as design simplicity, low cost of fabrication, and maintenance. However, the major disadvantage of this process is the limitation of the sun at night and during cloudy or rainy times. The scale can easily corrode the basin as well. Sometimes, they do not adequately treat nutrient pollutants. In addition, the distillation rate is slow, and the yield is usually small in quantity compared to the other techniques. The average volume of water produced from conventional solar still is 0.8 liters per hour of sun per meter square [10]. In 2014, globally the cost of freshwater from solar distiller ranged between 0.019$/m3 and 0.02$/m3 depending on the shape of the still [11].
This process is like a continuous process for solar distillation. In this process, the feedwater is first pretreated; it then gets heated and evaporated in the first chamber or stage and the released energy from the condensation is used to heat the water in the second stage and continuously to the last stage after which post-treatment occurs and freshwater is obtained (Figure 4). This means that each flash process uses the energy from the previous vapor [8]. The process has several series of flash chambers. Unlike multi-effect distillation in multi-stage flash distillation, heating and boiling occur in the same vessel. The estimated unit cost of freshwater produced from MSF is 1.40$/m3 as of 2018 [12].
Schematic diagram of multi-stage flash distillation.
The advantage of this system is that it minimizes the operating cost because the heat released from each stage is being reused (waste heat). The second advantage is that the strength of the feedwater does not really affect the overall freshwater quality produced because of multiple distillation process for each chamber. Finally, a large quantity of freshwater is produced. The disadvantage of this process is the scale formation during heating, although the scale remains in the brine rather than the heating surface which majorly increases the maintenance cost and frequency but do not damage the system [3]. Features of MSF include Stages (spaces), heat exchanger, distillate collector, and brine heater.
The multi-effect distillation process involves spraying the feedwater on the pipe to heat the feedwater and generate steam. The steam is utilized to heat the subsequent feedwater and evaporate it to produce freshwater and brine as byproduct (Figure 5). The energy is obtained through a solar collector. Flat plat collector and evacuated tube collector are energy sources for small-scale MED, while parabolic trough collector or any collector that concentrates solar energy is used for large scale. MED is a very ancient process, and only at the first stage, the first steam is independently generated. Subsequent stages use the vapor from the first and previous stage as energy source. There are about 8 to 16 effects for most MED. More number of effects means more efficiency [13]. The goal of MED is to use same heat to evaporate more feedwater. That is, the heat from the first stage helps in evaporation in the second stage and the heat from the second stage aids evaporation in the third. At the same time, each stage evaporator acts as a condenser for each previous stage. This way, large latent heat of vaporization is reused several times before dissipating to the surrounding, but it is significant that the temperature of the first effect is lower than the boiler heating steam [3]. These energy sources when tapped from the sun are converted to electrical energy to provide heat for the pump.
The advantages of MED include low consumption of energy in comparison with other thermal techniques; it works at low temperature and concentration to minimize scaling and corrosion. Pretreatment is not essential. It is very reliable and have low maintenance costs. The disadvantage of this distillation process is that there is heat and pressure losses at each stage because the process is not adiabatic and this can reduce the freshwater yield. There is corrosion and erosion at the contact surfaces between the brine and heat exchanging surface [13]. In 2003, it was found out that the average cost of freshwater worldwide that is produced from MED is 1.00$/m3 which is lower than MSF [12]. Features of MSF include heat source, heat sink, stage and distillate collector, and a membrane (Figure 5).
Schematic diagram of MED in two stages.
This process requires a jet stream or mechanical compressor to compress the vapor above the liquid unlike MED and MSF that require energy sources such as crude oil, wind, natural gas, and so on. The compressed vapor supplies heat to the rest of the feedwater for evaporation. Even though the process is a complex type and is mostly used for small-scale distillation, it is far more effective than MED because one effect of VCD is almost as effective as 15 to 20 effects of MED. In Figure 6, the feedwater is preheated in the heat exchanger. Later, it is transferred to the tube of the evaporator where it is boiled, and the vapor goes to the mechanical compressor. The vapor is compressed by the mechanical compressor. The hot compressed water vapor is transferred back to the evaporator, which is condensed outside the tube at the same time supplying the heating energy required for boiling feedwater. The non-condensing gases are removed with the help of a vacuum pump or ejector [3].
Schematic diagram of VCD.
The advantages of this method are low operating and maintenance cost; it has a vast temperature range for operation; it is very efficient and reliable because it has good water recovery ratio and moderate energy consumption; and it is easy to use and maintain. The huge initial cost is a major disadvantage for this process. Second, it requires pretreatment to minimize fouling and scaling, and internal scaling can occur as a result of crystals accumulation in the pore [14]. Finally, quality materials are needed to prevent corrosion [15]. The average cost of freshwater produced from vapor compression distillation is 0.93$/m3 as at 2009 findings [16].
This process uses differences in temperature across the membrane to evaporate the feedwater and condensed the freshwater leaving the impurities, salts, and other minerals in the form of brine solution. The concept of membrane distillation is microfiltration, which allows only water molecules to pass through porous hydrophobic membrane [17]. Membrane distillation can use different low-grade energy sources like the sun or wind. The water molecules move from the region of high to low vapor pressure through the membrane. There are four methods by which the vapor is recovered through the membrane. The first is through the direct contact of the liquid phase with both sides of the membrane to obtain distillate and the condensation process is controlled by the thickness of the membrane (Figure 7). Although the heat loss in this method is higher than that in other methods because of continuous contact between the membrane, the hot feed and cold permeate. This method is called the direct contact membrane distillation. The second method is vapor withdrawal by using a vacuum on the permeate region; in this method, the process is like the first but for the introduction of the condenser and the sweep gas that differentiate them (Figure 8). This is also known as the sweep gas membrane distillation. The third method is having an external condensation and in this case, the vapor is removed by using an inert gas stream (Figure 9). This method is called vacuum membrane distillation [18]. The fourth method is the addition of air gap interposed between the condensation surface and the membrane (Figure 10). This process is called the air gap membrane distillation [19].
Schematic diagram of the direct contact membrane.
Schematic diagram of the sweep gas membrane.
Schematic diagram of the vacuum membrane.
Schematic diagram of air gap membrane.
The advantages of membrane distillation include a high-rate removal of macromolecules and other substances, lower operating temperature and pressure, unadulterated interaction between the membrane and the process, and reduction in vapor spaces. The main disadvantage of membrane distillation is membrane wetting, which is caused as a result of fouling and excessive liquid entry pressure [18]. In 2004, the average cost of freshwater from membrane distillation was 0.705$/m3 [20].
This section will focus on the first concept of distillation in desalination, improvements made on them till date, the merits, and their demerits as well as the challenges and limitations of all the mentioned distillation desalination systems experienced so far. The first developed distillation system is known as the conventional desalination system. The first step is fabrication of a basin, which is usually made of metal material. Then, the fabrication of the cover that is mainly glass material was used. The cover generally is in a triangular shape. Afterward, the glass cover is placed on the basin to form a closed system that will allow distillation/desalination. In ancient times, they did not know how to seal the bottom edges between the glass cover and the basin because of which there were high heat losses and a low yield. Later, the system was sealed with mostly silicone gel to prevent or minimize heat loss and increase the yield. This is a simple way for conventional desalination that can be replicated anywhere in the world. Table 1 shows the different types of distillation systems, the improvisation made, current challenges, and limitations, with possible future improvements.
Distillation desalination types | References | Present improvements | Challenges/limits | Gap/feature improvement |
---|---|---|---|---|
Solar Distillation | [21, 22, 23, 24, 25, 26, 27, 28] |
|
|
|
Multi-stage flash (MSF) | [29, 30, 31, 32, 33, 34, 35, 36] |
|
|
|
Multi-effect distillation | [29, 37, 38, 39, 40, 41, 42] |
|
|
|
Vapor compression | [43, 44, 45, 46, 47, 48, 49, 50, 51, 52] |
|
|
|
Membrane | [53, 54, 55, 56, 57, 58, 59, 60, 61, 62] |
|
|
|
Challenges, present improvements, and future prospective of distillation desalination types.
Distillation in desalination can occur in three different modes, although the third mode is a combination of the two independent modes. The first is the utilization of the solar irradiance directly from the sun causing heating/evaporation to the feedwater and condensation when it meets a cold surface. The second mode is the storage of the solar irradiance or any other sources of energy such as wind and geothermal to produce electricity that is used to heat and evaporate the feedwater and later condensed to obtain the distillate [18]. The third is the utilization of the solar irradiance directly and supplementing it with other energy sources that produce electricity or other forms of heating source to cause distillation.
Passive desalination or distillation is the cheapest and most used method even in rural regions. This is because of its simplicity and because it can work on its own. It uses only energy from the sun (solar irradiance) directly to heat the water leading to its evaporation, and the vapor condenses when it touches the cold surface. For this type of distillation to occur, an enclosed system is needed, which basically consists of a water basin and a transparent cover usually made of glass or plastic. It is then sealed to prevent vapor or heat loss [2].
The advantage of this process is that it has a cheap source of energy, as the energy comes directly from the sun. This energy is abundant in most regions and does not need conversion or storage. It is simple to fabricate, use, and maintain. It can produce very clean water for drinking and other purposes without the need for further treatment. However, the major disadvantage of this process is that it can operate only during the day when there is sunshine. At nighttime or rainy times, since there is no sun, it is not possible to carry out this process. Solar stills, solar chimneys, and humidification-dehumidification are examples of this process.
In active distillation, the same process is observed. In other words, there is heating, evaporation, and condensation of feedwater to obtain freshwater. It is just that in this case, the sources of energy are other sources such as wind, geothermal, or stored solar energy in photovoltaic cells, which are later converted to alternative current to supply the energy/heat for the distillation process.
Some of the advantages of this process include faster distillation, as the feedwater gets heated faster than it does in the passive method. The method can also be used either nighttime or daytime, especially during cloudy or rainy days when there is no solar radiation. Evident research carried out at Univerisiti Teknologi PETRONAS, Malaysia, shows that this method produces cleaner freshwater than passive and combined distillation. This method, however, has some challenges like more scale formation and higher and more expensive energy usage. It may require semi-skilled persons to operate some of these distillers.
Solar stills, solar chimneys, and humidification-dehumidification can also be used for this process. In addition, membrane desalination can also fall in this category, since some part of it involves phase change of the feed (distillation) with the aid of a membrane.
In the combined state, this is also operated during the daytime, where both solar irradiance and other energy sources such as photovoltaic, wind, and biomass are used simultaneously for distillation. This produces more freshwater than the first two mentioned methods because of the effect of combined efforts. This process increases the frequency of performing maintenance tasks, as corrosion and scale formation is high.
Historical evidence has shown that distillation has been an old technique for water purifications. Distillation in desalination has proven to be an effective technique for freshwater production. Various distillation types have a similar quality of distillate. However, they differ in distillate quantity. The mode of distillation can also have an impact on the quality of freshwater yield as evidently carried out in the laboratory where the active mode had cleaner water production. The distillation types in desalination have advantages and disadvantages over one another. Therefore, the quantity and quality of distillate needed determines the most appropriate distillation type to choose for the desalination process. Currently, there are numerous researches that are exploring on how to enhance the distillation process in desalination. There is still the need for technological advancement to enhance yield in the case of solar distillation and reduce cost, especially in the vapor compression desalination process. The carbon nanotube membrane has been a promising solution for membrane desalination and can be exploited further. Overall, desalination has been an effective and efficient solution to augment conventional clean water supply. If given proper attention, it can be a lasting solution for clean water supply.
The authors declare no conflict of interest.
The author wishes to thank Universiti Teknologi PETRONAS Malaysia in collaboration with Ahmadu Bello University, Zaria for providing an enabling environment and support. The author also wishes to appreciate the YUTP-MPSS with cost centers 015LC0-215.
Special thanks to Dr. Husna Takaijudin, APDR Balbir Singh Mahinder Singh, and APDR Kamaruzaman Wan Yusof for their mentorship and guidance.
ED | Electrodialysis |
RO | Reverse osmosis |
MSF | Multi-Stage flash distillation |
MED | Multi-effect distillation |
VCD | Vapor-compression distillation |
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Larsen",authors:[{id:"145353",title:"Dr.",name:"Naima",middleName:null,surname:"Saeed",slug:"naima-saeed",fullName:"Naima Saeed"},{id:"145425",title:"Prof.",name:"Odd",middleName:null,surname:"Larsen",slug:"odd-larsen",fullName:"Odd Larsen"}]},{id:"43940",doi:"10.5772/54377",title:"Models of Paradoxical Coincident Cost Degradation in Noncooperative Networks",slug:"models-of-paradoxical-coincident-cost-degradation-in-noncooperative-networks",totalDownloads:1752,totalCrossrefCites:1,totalDimensionsCites:2,abstract:null,book:{id:"2169",slug:"game-theory-relaunched",title:"Game Theory Relaunched",fullTitle:"Game Theory Relaunched"},signatures:"Hisao Kameda",authors:[{id:"12714",title:"Prof.",name:"Hisao",middleName:null,surname:"Kameda",slug:"hisao-kameda",fullName:"Hisao Kameda"}]},{id:"43915",doi:"10.5772/56106",title:"The Neumann-Morgenstern Project – Game Theory as a Formal Language for the Social Sciences",slug:"the-neumann-morgenstern-project-game-theory-as-a-formal-language-for-the-social-sciences",totalDownloads:5401,totalCrossrefCites:1,totalDimensionsCites:2,abstract:null,book:{id:"2169",slug:"game-theory-relaunched",title:"Game Theory Relaunched",fullTitle:"Game Theory Relaunched"},signatures:"Hardy Hanappi",authors:[{id:"145817",title:"Prof.",name:"Hardy",middleName:null,surname:"Hanappi",slug:"hardy-hanappi",fullName:"Hardy Hanappi"}]}],mostDownloadedChaptersLast30Days:[{id:"43920",title:"Models for Highway Cost Allocation",slug:"models-for-highway-cost-allocation",totalDownloads:3485,totalCrossrefCites:2,totalDimensionsCites:1,abstract:null,book:{id:"2169",slug:"game-theory-relaunched",title:"Game Theory Relaunched",fullTitle:"Game Theory Relaunched"},signatures:"Alberto Garcia-Diaz and Dong-Ju Lee",authors:[{id:"146465",title:"Dr.",name:"Alberto",middleName:null,surname:"Garcia-Diaz",slug:"alberto-garcia-diaz",fullName:"Alberto Garcia-Diaz"},{id:"147887",title:"Prof.",name:"DongJu",middleName:null,surname:"Lee",slug:"dongju-lee",fullName:"DongJu Lee"}]},{id:"60490",title:"Stochastic Leader-Follower Differential Game with Asymmetric Information",slug:"stochastic-leader-follower-differential-game-with-asymmetric-information",totalDownloads:879,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In this chapter, we discuss a leader-follower (also called Stackelberg) stochastic differential game with asymmetric information. Here the word “asymmetric” means that the available information of the follower is some sub-\n\nσ\n\n-algebra of that available to the leader, though they play as different roles in the classical literatures. Stackelberg equilibrium is represented by the stochastic versions of Pontryagin’s maximum principle and verification theorem with partial information. A linear-quadratic (LQ) leader-follower stochastic differential game with asymmetric information is studied as applications. If some system of Riccati equations is solvable, the Stackelberg equilibrium admits a state feedback representation.",book:{id:"6756",slug:"game-theory-applications-in-logistics-and-economy",title:"Game Theory",fullTitle:"Game Theory - Applications in Logistics and Economy"},signatures:"Jingtao Shi",authors:[{id:"147959",title:"Dr.",name:"Jingtao",middleName:null,surname:"Shi",slug:"jingtao-shi",fullName:"Jingtao Shi"}]},{id:"62516",title:"The Game Theory: Applications in the Wireless Networks",slug:"the-game-theory-applications-in-the-wireless-networks",totalDownloads:1464,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Recent years have witnessed a lot of applications in the computer science, especially in the area of the wireless networks. The applications can be divided into the following two main categories: applications in the network performance and those in the energy efficiency. The game theory is widely used to regulate the behavior of the users; therefore, the cooperation among the nodes can be achieved and the network performance can be improved when the game theory is utilized. On the other hand, the game theory is also adopted to control the media access control protocol or routing protocol; therefore, the energy exhaust owing to the data collision and long route can be reduced and the energy efficiency can be improved greatly. In this chapter, the applications in the network performance and the energy efficiency are reviewed. The state of the art in the applications of the game theory in wireless networks is pointed out. Finally, the future research direction of the game theory in the energy harvesting wireless sensor network is presented.",book:{id:"6756",slug:"game-theory-applications-in-logistics-and-economy",title:"Game Theory",fullTitle:"Game Theory - Applications in Logistics and Economy"},signatures:"Deyu Lin, Quan Wang and Pengfei Yang",authors:[{id:"258432",title:"Dr.",name:"Deyu",middleName:null,surname:"Lin",slug:"deyu-lin",fullName:"Deyu Lin"},{id:"259049",title:"Prof.",name:"Quan",middleName:null,surname:"Wang",slug:"quan-wang",fullName:"Quan Wang"},{id:"261098",title:"Dr.",name:"Pengfei",middleName:null,surname:"Yang",slug:"pengfei-yang",fullName:"Pengfei Yang"}]},{id:"63373",title:"Infinite Supermodularity and Preferences",slug:"infinite-supermodularity-and-preferences",totalDownloads:1004,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter studies the ordinal content of supermodularity on lattices. This chapter is a generalization of the famous study of binary relations over finite Boolean algebras obtained by Wong, Yao and Lingras. We study the implications of various types of supermodularity for preferences over finite lattices. We prove that preferences on a finite lattice merely respecting the lattice order cannot disentangle these usual economic assumptions of supermodularity and infinite supermodularity. More precisely, the existence of a supermodular representation is equivalent to the existence of an infinitely supermodular representation. In addition, the strict increasingness of a complete preorder on a finite lattice is equivalent to the existence of a strictly increasing and infinitely supermodular representation. For wide classes of binary relations, the ordinal contents of quasisupermodularity, supermodularity and infinite supermodularity are exactly the same. In the end, we extend our results from finite lattices to infinite lattices.",book:{id:"6756",slug:"game-theory-applications-in-logistics-and-economy",title:"Game Theory",fullTitle:"Game Theory - Applications in Logistics and Economy"},signatures:"Alain Chateauneuf, Vassili Vergopoulos and Jianbo Zhang",authors:[{id:"248905",title:"Prof.",name:"Jianbo",middleName:null,surname:"Zhang",slug:"jianbo-zhang",fullName:"Jianbo Zhang"},{id:"248908",title:"Prof.",name:"Alain",middleName:null,surname:"Chateauneuf",slug:"alain-chateauneuf",fullName:"Alain Chateauneuf"},{id:"248910",title:"Dr.",name:"Vassili",middleName:null,surname:"Vergopoulos",slug:"vassili-vergopoulos",fullName:"Vassili Vergopoulos"}]},{id:"60809",title:"Game Theory Application in Smart Energy Logistics and Economy",slug:"game-theory-application-in-smart-energy-logistics-and-economy",totalDownloads:1029,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In many parts of the world, energy sectors are transformed from conventional to the smart deregulated market structures. In such smart deregulated market environment, cooperative game theory can play a vital role for analyzing various smart deregulated market problems. As an optimization tool, cooperative game theory is very useful in smart energy logistics and economy analysis problem. The economy associated with smart deregulated structure can be better optimized and allocated with the help of cooperative game theory. Initially, due to regulated structure, there is no cooperation between different entities of energy sector. But after new market structure, all the entities are free to take their own decisions as an independent entity. Transmission open access of energy logistics is also comes into the picture, as all the generators and demands have the same right to access the transmission system. In this market situation, multiple utilities are using the same energy logistic network. This situation can be formulated as a cooperative game in which generators and demands are represented by players. This chapter deals with energy logistic cost allocation problems for a smart deregulated energy market. It is cooperative in nature as all the agents are using the same energy logistic network.",book:{id:"6756",slug:"game-theory-applications-in-logistics-and-economy",title:"Game Theory",fullTitle:"Game Theory - Applications in Logistics and Economy"},signatures:"Baseem Khan",authors:[{id:"240063",title:"Dr.",name:"Baseem",middleName:null,surname:"Khan",slug:"baseem-khan",fullName:"Baseem Khan"}]}],onlineFirstChaptersFilter:{topicId:"75",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"July 5th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). 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He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. 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Badria",profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",institutionString:"Mansoura University",institution:{name:"Mansoura University",institutionURL:null,country:{name:"Egypt"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9659",title:"Fibroblasts",subtitle:"Advances in Inflammation, Autoimmunity and Cancer",coverURL:"https://cdn.intechopen.com/books/images_new/9659.jpg",slug:"fibroblasts-advances-in-inflammation-autoimmunity-and-cancer",publishedDate:"December 22nd 2021",editedByType:"Edited by",bookSignature:"Mojca Frank Bertoncelj and Katja Lakota",hash:"926fa6446f6befbd363fc74971a56de2",volumeInSeries:25,fullTitle:"Fibroblasts - Advances in Inflammation, Autoimmunity and Cancer",editors:[{id:"328755",title:"Ph.D.",name:"Mojca",middleName:null,surname:"Frank Bertoncelj",slug:"mojca-frank-bertoncelj",fullName:"Mojca Frank Bertoncelj",profilePictureURL:"https://mts.intechopen.com/storage/users/328755/images/system/328755.jpg",institutionString:"BioMed X Institute",institution:{name:"University Hospital of Zurich",institutionURL:null,country:{name:"Switzerland"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"8977",title:"Protein Kinases",subtitle:"Promising Targets for Anticancer Drug Research",coverURL:"https://cdn.intechopen.com/books/images_new/8977.jpg",slug:"protein-kinases-promising-targets-for-anticancer-drug-research",publishedDate:"December 8th 2021",editedByType:"Edited by",bookSignature:"Rajesh Kumar Singh",hash:"6d200cc031706a565b554fdb1c478901",volumeInSeries:24,fullTitle:"Protein Kinases - Promising Targets for Anticancer Drug Research",editors:[{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"8018",title:"Extracellular Matrix",subtitle:"Developments and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/8018.jpg",slug:"extracellular-matrix-developments-and-therapeutics",publishedDate:"October 27th 2021",editedByType:"Edited by",bookSignature:"Rama Sashank Madhurapantula, Joseph Orgel P.R.O. and Zvi Loewy",hash:"c85e82851e80b40282ff9be99ddf2046",volumeInSeries:23,fullTitle:"Extracellular Matrix - Developments and Therapeutics",editors:[{id:"212416",title:"Dr.",name:"Rama Sashank",middleName:null,surname:"Madhurapantula",slug:"rama-sashank-madhurapantula",fullName:"Rama Sashank Madhurapantula",profilePictureURL:"https://mts.intechopen.com/storage/users/212416/images/system/212416.jpg",institutionString:"Illinois Institute of Technology",institution:{name:"Illinois Institute of Technology",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Proteomics",value:18,count:4},{group:"subseries",caption:"Metabolism",value:17,count:6},{group:"subseries",caption:"Cell and Molecular Biology",value:14,count:9},{group:"subseries",caption:"Chemical Biology",value:15,count:14}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:9},{group:"publicationYear",caption:"2021",value:2021,count:7},{group:"publicationYear",caption:"2020",value:2020,count:12},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:2}],authors:{paginationCount:250,paginationItems:[{id:"274452",title:"Dr.",name:"Yousif",middleName:"Mohamed",surname:"Abdallah",slug:"yousif-abdallah",fullName:"Yousif Abdallah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274452/images/8324_n.jpg",biography:"I certainly enjoyed my experience in Radiotherapy and Nuclear Medicine, particularly it has been in different institutions and hospitals with different Medical Cultures and allocated resources. Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:{name:"Medical University Plovdiv",country:{name:"Bulgaria"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"243698",title:"Dr.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:null,institution:null},{id:"7227",title:"Dr.",name:"Hiroaki",middleName:null,surname:"Matsui",slug:"hiroaki-matsui",fullName:"Hiroaki Matsui",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",country:{name:"Japan"}}},{id:"312999",title:"Dr.",name:"Bernard O.",middleName:null,surname:"Asimeng",slug:"bernard-o.-asimeng",fullName:"Bernard O. Asimeng",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}}]}},subseries:{item:{id:"25",type:"subseries",title:"Evolutionary Computation",keywords:"Genetic Algorithms, Genetic Programming, Evolutionary Programming, Evolution Strategies, Hybrid Algorithms, Bioinspired Metaheuristics, Ant Colony Optimization, Evolutionary Learning, Hyperparameter Optimization",scope:"Evolutionary computing is a paradigm that has grown dramatically in recent years. This group of bio-inspired metaheuristics solves multiple optimization problems by applying the metaphor of natural selection. It so far has solved problems such as resource allocation, routing, schedule planning, and engineering design. Moreover, in the field of machine learning, evolutionary computation has carved out a significant niche both in the generation of learning models and in the automatic design and optimization of hyperparameters in deep learning models. This collection aims to include quality volumes on various topics related to evolutionary algorithms and, alternatively, other metaheuristics of interest inspired by nature. For example, some of the issues of interest could be the following: Advances in evolutionary computation (Genetic algorithms, Genetic programming, Bio-inspired metaheuristics, Hybrid metaheuristics, Parallel ECs); Applications of evolutionary algorithms (Machine learning and Data Mining with EAs, Search-Based Software Engineering, Scheduling, and Planning Applications, Smart Transport Applications, Applications to Games, Image Analysis, Signal Processing and Pattern Recognition, Applications to Sustainability).",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11421,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,series:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403"},editorialBoard:[{id:"111683",title:"Prof.",name:"Elmer P.",middleName:"P.",surname:"Dadios",slug:"elmer-p.-dadios",fullName:"Elmer P. 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We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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