Domains of IMMPACT and VAPAIN.
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More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\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:"9430",leadTitle:null,fullTitle:"Sustainable Energy Investment - Technical, Market and Policy Innovations to Address Risk",title:"Sustainable Energy Investment",subtitle:"Technical, Market and Policy Innovations to Address Risk",reviewType:"peer-reviewed",abstract:"This book examines the technical, market, and policy innovations for unlocking sustainable investment in the energy sector. While finalizing this book, the COVID-19 pandemic is cutting a devastating swath through the global economy, causing the biggest fall in energy sector investment, exacerbating the global trade finance gap, worsening signs of growing income inequality, and devastating the health and livelihoods of millions. What is the parallel between the COVID-19 pandemic and the climate change crisis? The impacts of the global pandemic are expected to last for a few years, whereas those associated with the climate crisis will play out over several decades with potentially irreversible consequences. However, both show that the cost of inaction or delay in addressing the risks can lead to devastating outcomes or a greater probability of irreversible, catastrophic damages. In the context of sustainable energy investment and the transition to a low-carbon, climate-resilient economy, what ways can financial markets and institutions support net-zero-emission activities and the shift to a sustainable economy, including investment in energy efficiency, low-carbon and renewable energy technologies? This book provides students, policymakers, and energy investment professionals with the knowledge and theoretical tools necessary to address related questions in sustainable energy investment, risk management, and energy innovation agendas.",isbn:"978-1-83880-198-4",printIsbn:"978-1-83880-197-7",pdfIsbn:"978-1-83962-508-4",doi:"10.5772/intechopen.86093",price:119,priceEur:129,priceUsd:155,slug:"sustainable-energy-investment-technical-market-and-policy-innovations-to-address-risk",numberOfPages:260,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"944911e9a2154a0bf8b358cafc971f42",bookSignature:"Joseph Nyangon and John Byrne",publishedDate:"March 10th 2021",coverURL:"https://cdn.intechopen.com/books/images_new/9430.jpg",numberOfDownloads:4011,numberOfWosCitations:2,numberOfCrossrefCitations:5,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:9,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:16,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 28th 2019",dateEndSecondStepPublish:"May 30th 2019",dateEndThirdStepPublish:"July 30th 2019",dateEndFourthStepPublish:"September 30th 2019",dateEndFifthStepPublish:"November 30th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!0,featuredMarkup:null,editors:[{id:"225597",title:"Dr.",name:"Joseph",middleName:null,surname:"Nyangon",slug:"joseph-nyangon",fullName:"Joseph Nyangon",profilePictureURL:"https://mts.intechopen.com/storage/users/225597/images/system/225597.jpg",biography:"Dr. Joseph Nyangon is a senior researcher at the Center for Energy and Environmental Policy, University of Delaware. He is also a senior research fellow at the Foundation for Renewable Energy and Environment, a non-resident fellow of the Payne Institute at the Colorado School of Mines, and a research fellow in the Initiative for Sustainable Energy Policy at the Johns Hopkins University’s School of Advanced International Studies (SAIS). He holds a Ph.D., two master’s degrees, and an undergraduate degree focusing on energy economics, public policy, energy systems engineering and computing systems from Columbia University, the University of Delaware, among others. Dr. Nyangon’s practice focuses on applying optimization methods and econometric modeling techniques to evaluate electricity systems and generate insights to inform policy, risk pricing strategies, and planning decisions.",institutionString:"University of Delaware",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Delaware",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"245796",title:"Prof.",name:"John",middleName:null,surname:"Byrne",slug:"john-byrne",fullName:"John Byrne",profilePictureURL:"https://mts.intechopen.com/storage/users/245796/images/system/245796.jpeg",biography:"Dr. John Byrne has contributed to Working Group III of the United Nations-sponsored Intergovernmental Panel on Climate Change (IPCC) since 1992. Dr. Byrne is an advisor to the “Solar City Seoul” initiative, which is building 1 GWp of solar power on public buildings, parking facilities, and residential and commercial buildings. He is co-editor-in-chief of the invitation-only journal, WIREs Energy and Environment. He has published nineteen books and more than 170 research articles.",institutionString:"University of Delaware",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Delaware",institutionURL:null,country:{name:"United States of America"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"770",title:"Renewable Energy",slug:"engineering-energy-engineering-renewable-energy"}],chapters:[{id:"73728",title:"Introductory Chapter: Sustainable Energy Investment and the Transition to Renewable Energy-Powered Futures",doi:"10.5772/intechopen.94320",slug:"introductory-chapter-sustainable-energy-investment-and-the-transition-to-renewable-energy-powered-fu",totalDownloads:340,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Joseph Nyangon and John Byrne",downloadPdfUrl:"/chapter/pdf-download/73728",previewPdfUrl:"/chapter/pdf-preview/73728",authors:[{id:"225597",title:"Dr.",name:"Joseph",surname:"Nyangon",slug:"joseph-nyangon",fullName:"Joseph Nyangon"},{id:"245796",title:"Prof.",name:"John",surname:"Byrne",slug:"john-byrne",fullName:"John Byrne"}],corrections:null},{id:"73085",title:"Tackling the Risk of Stranded Electricity Assets with Machine Learning and Artificial Intelligence",doi:"10.5772/intechopen.93488",slug:"tackling-the-risk-of-stranded-electricity-assets-with-machine-learning-and-artificial-intelligence",totalDownloads:389,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:1,abstract:"The Paris Agreement on climate change requires nations to keep the global temperature within the 2°C carbon budget. Achieving this temperature target means stranding more than 80% of all proven fossil energy reserves as well as resulting in investments in such resources becoming stranded assets. At the implementation level, governments are experiencing technical, economic, and legal challenges in transitioning their economies to meet the 2°C temperature commitment through the nationally determined contributions (NDCs), let alone striving for the 1.5°C carbon budget, which translates into greenhouse gas emissions (GHG) gap. This chapter focuses on tackling the risks of stranded electricity assets using machine learning and artificial intelligence technologies. Stranded assets are not new in the energy sector; the physical impacts of climate change and the transition to a low-carbon economy have generally rendered redundant or obsolete electricity generation and storage assets. Low-carbon electricity systems, which come in variable and controllable forms, are essential to mitigating climate change. These systems present distinct opportunities for machine learning and artificial intelligence-powered techniques. This chapter considers the background to these issues. It discusses the asset stranding discourse and its implications to the energy sector and related infrastructure. The chapter concludes by outlining an interdisciplinary research agenda for mitigating the risks of stranded assets in electricity investments.",signatures:"Joseph Nyangon",downloadPdfUrl:"/chapter/pdf-download/73085",previewPdfUrl:"/chapter/pdf-preview/73085",authors:[{id:"225597",title:"Dr.",name:"Joseph",surname:"Nyangon",slug:"joseph-nyangon",fullName:"Joseph Nyangon"}],corrections:null},{id:"69358",title:"Risk Mitigation in Energy Efficiency Retrofit Projects Using Automated Performance Control",doi:"10.5772/intechopen.89476",slug:"risk-mitigation-in-energy-efficiency-retrofit-projects-using-automated-performance-control",totalDownloads:342,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Performance gap concerns limit investment in the building energy efficiency retrofit market. In particular, the ability of projects to deliver on promised energy savings is commonly drawn into question. Performance risk mitigation mainly occurs through energy saving performance guarantees. Contractual stipulations arrange the conditions of the guarantee, and ceteris paribus, a higher energy saving guarantee should reduce project performance risk. Therefore, methods that yield a higher energy saving guarantee could help accelerate the market. We review the ability of “smart,” automated, and connected technologies to: (a) intelligently monitor and control the performance of energy-consuming devices to reduce performance variations, (b) provide additional degrees of control over the project’s performance, and, by doing so, (c) motivate the energy services company (ESCO) to raise the energy saving guarantee. Our analysis finds that use of such automated performance control could significantly raise the energy saving guarantee, making projects more likely to succeed.",signatures:"Job Taminiau, John Byrne, Daniel Sanchez Carretero, Soojin Shin and Jing Xu",downloadPdfUrl:"/chapter/pdf-download/69358",previewPdfUrl:"/chapter/pdf-preview/69358",authors:[{id:"306657",title:"Ph.D.",name:"Job",surname:"Taminiau",slug:"job-taminiau",fullName:"Job Taminiau"},{id:"309663",title:"Prof.",name:"John",surname:"Byrne",slug:"john-byrne",fullName:"John Byrne"},{id:"310457",title:"Mr.",name:"Daniel",surname:"Sanchez Carretero",slug:"daniel-sanchez-carretero",fullName:"Daniel Sanchez Carretero"},{id:"310458",title:"Ms.",name:"Soojin",surname:"Shin",slug:"soojin-shin",fullName:"Soojin Shin"},{id:"310459",title:"Ms.",name:"Jing",surname:"Xu",slug:"jing-xu",fullName:"Jing Xu"}],corrections:null},{id:"72927",title:"Assessing Renewable Energy Loan Guarantees in the United States",doi:"10.5772/intechopen.93288",slug:"assessing-renewable-energy-loan-guarantees-in-the-united-states",totalDownloads:251,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Conceived as an idea to push financing toward underdeveloped clean energy technology to improve the environment, promote economic growth, and produce a more secure energy supply, the Title XVII loan guarantee program has likely failed to meet these objectives. Instead, it has been used as a political tool, exposed taxpayers to unnecessary risk, diverted funding from alternative clean energy investments, and primarily benefitted large, politically connected corporations.",signatures:"Ryan M. Yonk",downloadPdfUrl:"/chapter/pdf-download/72927",previewPdfUrl:"/chapter/pdf-preview/72927",authors:[{id:"196259",title:"Dr.",name:"Ryan Merlin",surname:"Yonk",slug:"ryan-merlin-yonk",fullName:"Ryan Merlin Yonk"}],corrections:null},{id:"71285",title:"Innovative Circular Business Models: A Case from the Italian Fashion Industry",doi:"10.5772/intechopen.91277",slug:"innovative-circular-business-models-a-case-from-the-italian-fashion-industry",totalDownloads:341,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Transition to a sustainable economy signed by a circular vision and culture asks firms for huge investments to innovate their own management, strategies, business models, products, and marketing approaches. The Agenda 2030 and the 17 Sustainable Development Goals (SDG) are an important framework for businesses to change their approach and contribute positively to the global movement to fight climate change. The question is what and how micro, small, and medium enterprises (MSMES) can contribute to reduce their impacts while creating more value for them and their stakeholders. This paper aims to answer to this question presenting a case study from Italy where an artisan small firm is innovating to create more positive impacts in circular terms. The focus will be on circular economy and the firms’ material and energy strategies. In doing so, the paper will try to answer the following questions: how easy is for micro and small firms to apply circular economy strategies to contribute to reduce their environmental impacts? Does their strategy coherently compose energy and material flows? The case study will refer to the fashion system in Italy.",signatures:"Marco Tortora and Giuseppe Tortora",downloadPdfUrl:"/chapter/pdf-download/71285",previewPdfUrl:"/chapter/pdf-preview/71285",authors:[{id:"303546",title:"Dr.",name:"Marco",surname:"Tortora",slug:"marco-tortora",fullName:"Marco Tortora"},{id:"311774",title:"Mr.",name:"Giuseppe",surname:"Tortora",slug:"giuseppe-tortora",fullName:"Giuseppe Tortora"}],corrections:null},{id:"70310",title:"Harnessing Small Country Collaboration Opportunities to Advance Energy Innovation and Joint Investments",doi:"10.5772/intechopen.90348",slug:"harnessing-small-country-collaboration-opportunities-to-advance-energy-innovation-and-joint-investme",totalDownloads:274,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Greater international collaboration is required to catalyze research and development (R&D) investment flows in energy technologies. Successful deployment of such technologies requires innovative funding mechanisms, intellectual property, and data-driven analyses to make smarter, sustainable investment decisions. As small countries are increasingly dealing with effects of climate change, some are projected to lose large portions of their economy. This chapter discusses ways that smaller countries, both in the developed and developing world, can harness international cooperation to advance energy innovation and mitigate such impact. In contrast to collaboration with larger countries, smaller country collaboration can build more agile, balanced partnerships in which participating countries co-develop and co-own R&D and training, and define pilot programs that target their own needs. Leveraging each other’s strengths, small countries can become catalysts for global change. Smaller country collaboration is explored through a proposed model of collaboration in energy innovation between Singapore and Estonia, often considered gateways to Southeast Asia and the EU plus Russia, respectively. Specifically, Singapore and Estonia have the opportunity to leverage each other’s startup ecosystems, innovation systems, knowledge-based economies, and regional markets to build a niche in clean energy technologies, particularly energy storage innovation, with potential global impact on larger markets.",signatures:"Anneliese Gegenheimer and Charles Michael Gegenheimer",downloadPdfUrl:"/chapter/pdf-download/70310",previewPdfUrl:"/chapter/pdf-preview/70310",authors:[{id:"309820",title:"Ms.",name:"Anneliese",surname:"Gegenheimer",slug:"anneliese-gegenheimer",fullName:"Anneliese Gegenheimer"},{id:"314737",title:"Dr.",name:"C. Michael",surname:"Gegenheimer",slug:"c.-michael-gegenheimer",fullName:"C. Michael Gegenheimer"}],corrections:null},{id:"71072",title:"Establishing Property Rights and Private Ownership: The Solution to Malinvestment in the Energy Sector in Developing Countries",doi:"10.5772/intechopen.91039",slug:"establishing-property-rights-and-private-ownership-the-solution-to-malinvestment-in-the-energy-secto",totalDownloads:310,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"There are over 800 million people in the world without access to modern forms of energy services, like electricity, cooking gas, and LPG. This has been called energy poverty. Most studies in the field of energy poverty address the issue from an absence of technological or financial resources perspective. They address the problem as energy in itself having an objective inherent value, more or less addressing the symptoms of the problem and not the problem itself. In this chapter, a new paradigm that addresses the problem of energy poverty and malinvestment is introduced. This paradigm, utilizing the theory of economic calculation and the use and exchange value embodied in the subjective value theory, makes a case for the importance of private property rights in the factors or means of production for modern forms or energy such as electricity. The Nigerian energy sector is used as a case study for this.",signatures:"Tam Kemabonta",downloadPdfUrl:"/chapter/pdf-download/71072",previewPdfUrl:"/chapter/pdf-preview/71072",authors:[{id:"293945",title:"M.Sc.",name:"Tam",surname:"Kemabonta",slug:"tam-kemabonta",fullName:"Tam Kemabonta"}],corrections:null},{id:"73957",title:"The Electrification-Appliance Uptake Gap: Assessing the Off-Grid Appliance Market in Rwanda Using the Multi-Tier Framework",doi:"10.5772/intechopen.93883",slug:"the-electrification-appliance-uptake-gap-assessing-the-off-grid-appliance-market-in-rwanda-using-the",totalDownloads:333,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"The structure of the electricity system includes universal access to electricity that is adequate, available, reliable, affordable, legal, convenient, healthy, and safe and the efficient (inefficient) use of the electricity. Quality of access also influences clean energy technologies and electrical appliance purchase, ownership, use and perceived value (uptake, hereafter). Also, improved uptake assists in closing systemic gaps between rural and urban areas and grid and off-grid communities. Rwanda is projected to attain full electrification by 2024 (inclusive of all sectors: consumptive, productive and services). In this context, the East African country has articulated support mechanisms for off-grid market players through technical assessments and siting incentives. However, studies that focus on characterising diffusion and uptake of clean energy technologies and electrical appliances in mini-grid sites (market) are crucial to understand the emerging trends in off-grid rural electrification. This chapter contributes to this emerging discourse by proposing a four-fold demand side characterisation approach which (i) conducts a systemic review of literature to identify emerging off-grid themes as they relate to the multi-tier framework (MTF) and vice-versa, (ii) uses existing data to characterise the off-grid market (based on a typical village load), (iii) demonstrates the tariff regime changes using two payment methodologies (willingness to pay (WTP) and ability to pay (ATP)) and (iv) projects the 2024–2032 consumptive energy demand (using a simplified relation between appliance, it’s rating and duration of use). Results of this characterisation demonstrate global and local level (glo-cal) literature gaps meriting a localised MTF assessment. The purpose of the localised assessment reported in this Chapter was therefore to understand appliance uptake gaps at the user level. The typical village load is basic (implying low energy demand). Ceteris paribus, higher WTP and ATP by users yield higher tariffs. However, a high ATP is a business sustainability determinant than a high WTP. Because energy consumption is also dependent on how efficiently it is used by those with access, the Chapter discusses appliance efficiency as a partial definition of sustainable energy and also as an example of sustainable energy. Then, demand stimulation pathways addressing wider systemic opportunities at the intersection of the theory of change and the theory of agency and risk reduction in markets, investments and policy (derisking markets, investments and policy) are discussed. The first pathway focuses on women and youth participation in productive use activities. The second pathway highlights strategies for appliance financing such as cost-sharing and micro-credit. The final pathway considers economic activity stimulation which has multiplier effects on energy demand and consequently energy-using appliances uptake. The implications for Sustainable Citizens and markets, investments and policy innovations are contextualised in the Sustainable Energy Utility business model.",signatures:"Olivia Muza",downloadPdfUrl:"/chapter/pdf-download/73957",previewPdfUrl:"/chapter/pdf-preview/73957",authors:[{id:"302281",title:"Ph.D. Student",name:"Olivia",surname:"Muza",slug:"olivia-muza",fullName:"Olivia Muza"}],corrections:null},{id:"71015",title:"Beyond the Hydrocarbon Economy: The Case of Algeria",doi:"10.5772/intechopen.91033",slug:"beyond-the-hydrocarbon-economy-the-case-of-algeria",totalDownloads:399,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The energy sector is vital to efforts to combat climate change as well as achieve economic development. The economy of many Middle East and North African (MENA) countries, such as Algeria, Iran, Qatar, Saudi Arabia, is completely based on hydrocarbons which represent the main source of the state revenue. Investing in renewable energy and efficiency is a winner strategy, allowing both to ensure the necessary availability of energy to cover the country’s domestic energy demand and to make more resources available for export to guarantee the state earnings. Renewable sources can be a solution for a transition to a more sustainable economy and a response to the economic stability of these countries affected by the volatility of oil prices. Such a strategy is reflected in improving the attractiveness of foreign investment in the renewable energy sector. Focusing on Algeria, in this article, we analyze the link between the Algerian economy and energy, underlining the current weakness. This work is partially based on the research financed by the meetMED project (WP 3.1) on barriers for domestic and international investors in the energy sector of Algeria.",signatures:"Cecilia Camporeale, Roberto Del Ciello and Mario Jorizzo",downloadPdfUrl:"/chapter/pdf-download/71015",previewPdfUrl:"/chapter/pdf-preview/71015",authors:[{id:"296882",title:"Dr.",name:"Mario",surname:"Jorizzo",slug:"mario-jorizzo",fullName:"Mario Jorizzo"},{id:"307387",title:"Dr.",name:"Cecilia",surname:"Camporeale",slug:"cecilia-camporeale",fullName:"Cecilia Camporeale"},{id:"307388",title:"Dr.",name:"ROBERTO",surname:"DEL CIELLO",slug:"roberto-del-ciello",fullName:"ROBERTO DEL CIELLO"}],corrections:null},{id:"70936",title:"Remotely Sensed Data for Assessment of Land Degradation Aspects, Emphases on Egyptian Case Studies",doi:"10.5772/intechopen.90999",slug:"remotely-sensed-data-for-assessment-of-land-degradation-aspects-emphases-on-egyptian-case-studies",totalDownloads:380,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Remote sensing and thematic data were used to provide comprehensive views of surface conditions related to land degradation and desertification, considered environmental extremes in arid and semi-arid regions. The current work applies techniques, starting with simple visual analyses up to a parametric methodology, adopted from the FAO/UNEP and UNESCO provisional methodology for assessment and mapping of soil degradation. Egyptian case studies are highlighted to insinuate on studied aspects. Variable satellite imageries (MSS, TM, and ETM) and aerial photographs were utilized to provide data on soil conditions, land cover, and land use. IDRISI and ArcGIS software were used to manage thematic data, while ERDAS IMAGIN was used to process satellite data and to derive the normalized difference vegetation index (NDVI) values. A GIS model was established to modify the universal soil loss equation (USLE) calculating the present state and risk of soil degradation. The study area is found exposed to slight hazard of water erosion, however, and to high risk of wind erosion. It is also threatened by a slight to high salinization and slight to moderate physical degradation. It is recommended to use a GIS in detailed and very detailed studies for evaluating soil potentiality in agricultural expansion areas.",signatures:"Abd-alla Gad",downloadPdfUrl:"/chapter/pdf-download/70936",previewPdfUrl:"/chapter/pdf-preview/70936",authors:[{id:"294002",title:"Prof.",name:"Abd-alla",surname:"Gad",slug:"abd-alla-gad",fullName:"Abd-alla Gad"}],corrections:null},{id:"72306",title:"Scaling Up Sustainable Biofuels for a Low-Carbon Future",doi:"10.5772/intechopen.92652",slug:"scaling-up-sustainable-biofuels-for-a-low-carbon-future",totalDownloads:351,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Fossil fuels oil, coal, and gas are valuable resources that are depleting day by day around the world and also imparting a negative impact on the environment. Biofuel because of its dynamic properties; its market values; and being sustainable, renewable, biodegradable, economic, non-pollutant, and abundant is an alternate source of energy. Each country can produce it independently, and because of these valuable properties biofuels have become superior over fossil fuels. This chapter gives a concise preface to biofuels and its impact on the environment. It includes definitions; classifications; impact on environment; implications; types of production techniques like chemical, biochemical, physical, and thermochemical techniques; types of resources like lignocellulosic-biomass, feedstock energy crops, algae, micro-algae, all kinds of solid wastes; and biofuels of prime importance like solid biofuels (biochar, solid biomass), gaseous biofuels (biogas, bio-syngas, and bio-hydrogen), and the most important liquid biofuels (bioethanol, biodiesel, and bio-oil). Due to increasing global warming and climate-changing conditions, in the near future biofuel being an environment-friendly resource of energy will be a substantial part of the world’s energy demand, with no or zero polluting agents.",signatures:"Tahira Shafique and Javeria Shafique",downloadPdfUrl:"/chapter/pdf-download/72306",previewPdfUrl:"/chapter/pdf-preview/72306",authors:[{id:"316563",title:"Dr.",name:"Tahira",surname:"Shafique",slug:"tahira-shafique",fullName:"Tahira Shafique"},{id:"320738",title:"Ms.",name:"Javeria",surname:"Shafique",slug:"javeria-shafique",fullName:"Javeria Shafique"}],corrections:null},{id:"70884",title:"City-Scale Decarbonization Strategy with Integrated Hydroelectricity-Powered Energy Systems: An Analysis of the Possibilities in Guadalajara, Mexico",doi:"10.5772/intechopen.90899",slug:"city-scale-decarbonization-strategy-with-integrated-hydroelectricity-powered-energy-systems-an-analy",totalDownloads:307,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"According to the UN, in the next 20 years, most of the world’s population will live in urban areas. Cities consume a high amount of resources, between this water, for their sustenance, hence the greatest necessity of sustainable development plans. What viable options or strategies can we consider in Latin America such that it can resist the economic, political, and social changes that it is facing? Through prospective studies, in case of Guadalajara, it is possible to determinate how water can generate clean energy, and which are the other strategic areas to empower the city through decarbonization with an interoperative and smart loop system of co-benefits. 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\r\n\tCurrently, numerous biomaterials-based studies are being conducted, including research into chitin and chitosan, the second most abundant polysaccharide after cellulose. Chitin is obtained at an industrial scale from a variety of natural sources including, crustacean and insect exoskeletons, fungi cell walls, squid pen, etc. Chitosan is biodegradable, biocompatible, non-toxic, water-soluble under acidic conditions, and linear cationic amino polysaccharide derived from the deacetylation of chitin. It contains free amino and hydroxyl groups that can be functionalized by binding with the cationic and anionic groups. It has numerous applications, especially in the environmental remediation, biomedical, pharmaceutical, agriculture, and food industries.
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These blood types are inherited from both parents. Antigens in the ABO blood group are complex carbohydrates, found in erythrocytes, lymphocytes, platelets, epithelial and endothelial cells, and organs such as the kidneys. Soluble forms of antigen are also synthesized and secreted by tissue cells [1]. The distribution of ABO blood groups in the population depends on race. For example, in India and Mexico, blood type O is the most common. If data from countries in the world are compared, in India and neighboring countries such as Bangladesh and Pakistan, groups O and B dominate, while populations in Europe and Africa are dominated by groups O and A. This comparison explains that the heterogeneity of blood groups in different places and populations is caused by genetic and environmental factors [2].
Initially, the importance of ABO blood type is needed to obtain a match between donor and recipient in the case of transfusion or organ transplantation. Furthermore, many studies reported the association of blood type with a certain disease, especially in the distinction between blood group O and non-O. The non-O blood type has been reported to be associated with several diseases, including cardiovascular disorders, and the incidence of venous thromboembolism (VTE). The first observation on the association between ABO blood type and VTE was made in 1963 by Dick et al. who found a statistically significant predominance of group A in 461 VTE patients [2, 3, 4, 5].
The non-O blood group was at higher risk of thromboembolism due to higher levels of von Willebrand factor (VWF) and factor VIII (FVIII). The rate of proteolytic clearance of VWF by a disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13 (ADAMTS-13) was relatively lower in plasma of the non-O blood group, resulting in a longer VWF half-life in the non-O plasma group than in the O plasma group. As a result, VWF levels were 25–30% higher in non-O group plasma than in group O plasma. High levels of VWF in non-O plasma always lead to increased FVIII levels due to the physiological role of VWF as carriers of FVIII and protecting it from the proteolytic effects of ADAMTS-13. Higher VWF and FVIII levels in subjects with non-O blood groups were strongly correlated with an increased risk of venous thrombosis, a situation that led to non-O blood type being assessed as a genetic risk factor for venous thromboembolism [6].
Wu et al. result in a meta-analysis study of the association between the ABO blood group and vascular disease, the combined odds ratio of the 21 studies analyzing VTE was 1.79 (95% CI, 1.56–2.05) for the non-O versus O group. In three studies in which blood type genotypes were performed, the combination A1 A1/A1 B/BB gave an odds ratio of 2.44 (95% CI 1.79–3.33), while the odds ratio for A1 O/BO/A2 B was 2.11 (95% CI 1.66–2.68), suggesting that the risk is related to the expression of the O(H) antigen [7].
These results are similar to the study of Spiezia et al. in a retrospective case–control study conducted on Italian patients with DVT and controls, which found that non-O blood group increased the risk of DVT by 2.2-fold than individuals with group O. An up to the 7-fold increased risk of VTE was observed when the condition inherited thrombophilic (factor V Leiden, prothrombin G20210A mutations, antithrombin, protein C and protein S deficiency) were associated with non-O blood group carriers compared with non-thrombophilic group-O carriers [4].
The data presented by Spiezia et al. cautioned that the high prevalence of non-O blood type in the general population appears to be one of the most important genetic risk factors for venous thrombosis. Like inherited thrombophilic factors (i.e., factor V Leiden and the prothrombin G20210A mutation), non-O blood types are responsible for a moderate increase in the risk of VTE, and, therefore, ABO blood group testing is recommended in individuals with thrombophilia to assess risk thrombotic [7].
The ABO blood group system was discovered by Landsteiner in 1900. A few years later, von Decastello and Sturly discovered the AB type. Landsteiner’s rule stipulates that normal individuals have ABO antibodies against an antigen not found on red blood cells. Individuals with blood type A have A antigens, do not have B antigens, therefore these individuals have B antibodies. On the other hand, individuals with blood group B have B antigens, do not have A antigens, therefore they have A antibodies. The four phenotypes were derived from the two main antigens (A and B) of the system. The phenotypes are group A, group B, group AB, and group O. Individuals with blood type AB means they have A, B antigens and do not have antibodies against A, B antigens. On the other hand, individuals with blood type O have antibodies against antigens A, B and do not have antigens A, B [1]. This classification is important for the sake of blood transfusions that must meet certain requirements.
The A and B alleles are located on chromosome 9 at the ABO locus, encoding the A- and B glycosyltransferase enzymes. ABO antigens can be found on blood cells, lymphocytes, platelets, most epithelial and endothelial cells, and organs such as the kidneys. Soluble forms of antigen can be synthesized and secreted by tissue cells. Soluble antigens can be detected in all body fluids except cerebrospinal fluid. The ABO antigen attached to red blood cells is in the form of glycolipid molecules or glycoproteins, while the main soluble form is the glycoprotein form. Discussion of the ABO antigen requires an understanding of the H antigen. The H gene is located on a different chromosome from the ABO genetic locus and plays a role in controlling the production of H antigen. In addition to the ABO and H genes, the expression of soluble ABO antigens is influenced by the inheritance of the Se gene. The Se gene genetically influences the formation of ABO antigens in saliva, tears, and other body fluids. Consequently, the occurrence and location of ABO antigens are influenced by three genetically independent loci: ABO, H, and Se [1].
The antigen-building block structure for A, B, and H antigens is an oligosaccharide chain attached to a carrier molecule either a protein or lipid. The oligosaccharide chain comprises four sugar molecules linked in simple linear forms or complex branched structures. The two-terminal sugars, d-galactose and N-acetylglucosamine, are coupled in two different configurations. When carbon number 1 of d-galactose is coupled with carbon number 3 of N-acetylglucosamine, the bond is symbolized as 1 → 3. When the number 1 carbon of d-galactose is coupled with the number 4 carbon of N-acetylglucosamine, the bond is described as β1 → 4. The structure of β1 → 4 is associated primarily with glycolipids and glycoproteins on the red cell membrane, the structure of β1 → 3 is located in body fluids and secretions [1].
This transferase catalyzes the addition of certain sugar residues so that the core structure of the H glycan precursor is converted to antigen A (GalNAc 1 → 3 [Fuc 1 → 2] Galβ 1 → 4 GlcNAc 1→), or antigen B (Gal 1–3 [Fuc 1–2] Galβ 1–4 GlcNAc 1-). As a result, the A and B structures are differentiated based on a single terminal sugar (N-acetylgalactosamine versus D-galactose respectively). Individual O groups lack A- or B-transferase activity result from the inactivation of the A1 glycosyltransferase gene, and the nonreducing ends of the corresponding glycans, and therefore continue to express the basic structure of the glycan H (Fuc 1–2] Galβ 1–4 GlcNAc 1-) at the ends of their oligosaccharide chains [8, 9]. Individuals who synthesize determinant A exclusively have blood type A and have genotypes AA or AO, individuals with blood group B are BB or BO, and individuals expressing one allele A and one B have genotype AB. Individuals with blood type O expressing inactive glycosyltransferase A/B have genotype OO. They express only the H antigen. In terms of nomenclature, blood group O includes the H antigen and sometimes the term ABO(H) is used [10].
Venous and arterial thrombotic disorders have different pathophysiological entities, as a result of anatomical differences and different clinical presentations. In particular, arterial thrombosis results from the phenomenon of platelet activation, whereas venous thrombosis is largely a matter of activation of the clotting system [1].
There are fundamental pathophysiological differences between arterial and venous thrombus. Arterial thrombi which are happened in small arteries and arterioles are occlusive. Thrombus that occurs in the ventricles of the heart and the great arteries and the aorta, the common carotid artery is nonocclusive. Arterial thrombus is formed in response to increased local shear and exposure to thrombogenic material in damaged vessels, occurs in high-pressure and high-flow systems. Arterial thrombus, referred to as white thrombus, due to consists mainly of platelets and a small amount of fibrin or red blood cells. Leukocytes are also actively recruited to platelet-rich arterial thrombi [11].
The differences from a clinical point of view are as follows: (1) hereditary hypercoagulation (occurs in the “thrombophilia” state), characterized by chronic hyperactivation of the coagulation system, this condition mainly associated with venous rather than arterial thrombosis; and (2) anticoagulant agents (e.g., heparin, warfarin) are usually used to prevent venous thrombosis, whereas antiplatelet agents (e.g., aspirin) are used to prevent arterial thrombosis. In both types of thrombus consists of platelets, fibrin, erythrocytes, and leukocytes with different compositions. Moreover, all thrombi are undergoing propagation, organization, embolization, lysis, and thrombosis, and this dynamic remodeling results in a changing composition [11].
Rudolph Virchow describes three conditions that induce thrombosis, called the Virchow triad. This triad includes endothelial injury, blood flow stasis or turbulence, and blood hypercoagulability. Abnormalities of one or more of these conditions more often manifest the occurrence of DVT. DVT after trauma is more common in conditions of stasis and endothelial injury while spontaneous DVT is more common in cases of hypercoagulability. Risk factors can be classified as acquired or genetic. Genetic risk factors can be divided into strong, moderate, and weak factors. Strong risk factors include deficiency of antithrombin, protein C and protein S. Moderate risk factors include factor V Leiden, prothrombin 20210A, non-O blood type, and fibrinogen 10034C > T. Weak genetic risk factors include fibrinogen variants, factor XIII, and factor XI [11, 12].
Normal wall shear rates range from 300 to 800/s in the large arteries and increase to about 500 to 1600/s in the arterial of microcirculation. However, in pathological stenotic vessels, the wall shear rate can be up to 10,000/s or even higher. The increased shear stress in the microenvironment of the atherosclerotic plaque area of the stenotic vessel is exacerbated by turbulent blood flow. This high hemodynamic force can activate platelets as they pass through the region. This abnormal flow can cause local endothelial dysfunction. High shear stress, especially with a marked shear gradient around the site of the stenosis, is sufficient to induce VWF from endothelial cells and binding of VWF to platelets via glycoprotein Ib-V-IX. This interaction does not occur in normal circulation, result mediating platelet adhesion to the intima surface and triggering platelet thrombus formation [11].
Heterogeneity is seen in the composition of atherothrombotic plaques, even within the same individual. In addition to plaque composition, differences in the basic structural features of the arteries contribute to differences in thrombogenic substrates. For example, the carotid and iliac arteries contain relatively more elastic fibers and proportionately fewer smooth muscle cells than the coronary arteries. Therefore, coronary artery thrombosis usually results in slightly stenotic, lipid-rich plaque, whereas carotid artery usually results in severe stenotic and high-risk plaque [11].
Venous thrombi are formed mainly from fibrin and red blood cells. Thrombogenic stimulation is caused by (1) stasis of veins, (2) activation of clotting factors, and (3) vascular damage. Anti-thrombogenic properties through mechanisms (1) inactivation of activated coagulation factors by natural inhibitors such as antithrombin and activated protein C, (2) elimination of activated coagulation factors and soluble fibrin polymer complexes by mononuclear phagocytic cells and liver, and (3) lysis of fibrin by enzymes fibrinolytic from plasma and endothelial cells [11].
In the adult group, the predisposition factors to VTE are increasing age, cancer, prolonged immobilization, stroke or paralysis, varicose veins, prolonged air travel, acute inflammatory bowel disease, rheumatic disease, and nephrotic syndrome, oral contraceptive pills, especially those containing third-generation progestins. In the pediatric group, the risk factors for thromboembolism are central venous lines, cancer, and chemotherapy [13].
Venous thrombi are almost always occlusive and can form casts of the vessels in which they arise. Unlike arterial thrombus, severe vascular damage is generally not found at the site of venous thrombosis. Therefore, in low-flow and low-pressure venous systems, decreased blood flow (stasis) and systemic activation of the coagulation cascade play a major pathophysiological role. Venous thrombi consist mostly of red blood cells trapped in fibrin and contain relatively few platelets; hence, they have been described pathologically as red thrombi [11].
The study of Sun et al. in 1412 patients with VTE (consisting of 600 DVT patients, 441 PE patients, and 371 patients having a diagnosis of DVT and PE) and 199,248 controls the results of VTE patients were significantly higher in the non-O blood group compared to all non-VTE discharge patients with OR 1.362 (95% confidence interval, 1.205-1.540). When the non-O group was classified into A, B, and AB and a pairwise comparison test was performed on VTE and non-VTE patients, the results were not statistically different [14].
ABO blood group has been recognized as a risk factor for thromboembolic diseases since the 1960s. Many studies have shown that the non-O group had a higher incidence of ischemic heart disease. ABO blood type is important in relation to VWF and FVII levels because in turn confer a clear risk of increased VTE especially in non-O blood groups which provide a higher increase. This association is less clear for CAD and MI but a similar pattern emerges with most studies finding group O to be at lower risk [15].
The Framingham Heart Study, and others, resulted in blood group A having an increased risk of CAD [16, 17, 18] and MI [19]. More specifically, blood type A is associated with early detection of CAD [19, 20] and predominates in patients with MI [21]. Another study reported that groups B [22, 23] or AB [24] had a higher incidence of CAD. In contrast, Mitchell [25] reported that cities with a higher prevalence of group O had higher rates of cardiovascular mortality and a study in India showed that blood type O increased the risk of CAD [26]. Further studies did not identify any association between blood type and CAD [27, 28]. Based on these inconsistent results, He et al. [29] conducted a meta-analysis found the highest risk of CAD was observed in blood group AB, followed by groups B, A, and O. This is similar to ABO-associated vWF/FVII levels which the highest in group AB, followed by groups B, A and O [18].
The theory proposed to explain the relationship between ABO blood group and CAD is as follows. Fibrinogen together with vWF activates platelet aggregation and adhesion which in turn plays a role in the development of atherosclerosis. On the other hand, blood group A has been reported to have higher cholesterol levels and lower lipoprotein density, this may explain the association with an increased risk of CAD. In addition, ABO loci have been reported to be associated with inflammatory-forming CAD, including intercellular adhesion molecule-1, soluble P selectin, soluble E selectin, and tumor necrosis factor-α. Meanwhile, the interaction between genetic factors (genes known to increase susceptibility to CAD and the ABO locus) and environmental factors still contribute to the risk of CAD and MI [15].
The incidence of VTE is more often due to factor VIII (FVIII) and von Willebrand Factor (VWF) levels are higher in the non-O blood group than in the O blood group. Moeller et al. comparing VWF and FVII levels in individuals with ABO phenotype found the following order O < A < B < AB for vWF levels and O < A < AB < B for FVII levels [30]. Nevertheless, Simangunsong et al. found no significant differences were present in factor VIII activity between A, B, and O blood types [31].
A blood type that is identical to high vWF, is an important genetic factor that explains around 30% of the variation in factor VIII levels. There is a relationship between factor VIII and vWF. However, attempts to find other genetic loci associated with high vWF and factor VIII levels have not been successful to date. Most likely, the high factor VIII levels are due to increased synthesis or decreased clearance of the vWF-factor VIII complex [32]. Furthermore, non-O blood groups are associated with increased arterial and venous thrombotic events possibly mediated by increased levels of von Willebrand factor and factor VIII in non-O blood groups [33].
Meanwhile, several studies have confirmed that the level of vWF is lower in people who have blood type O, therefore FVIII: C is reduced due to the stabilizing function of vWF as an FVIII: C carrier. Factor VIII affinity for vWF may also differ from individual to individual, which is genetically determined [30].
Blood group A is associated with an increased odds of major adverse cardiovascular events (MACE), whereas blood group O was associated with a reduction in the odds of MACE in patients with COVID19. These findings suggest an association between blood group type and cardiovascular complications in COVID-19. The biological mechanism behind the role of ABO blood groups in COVID-19 remains elusive. Natural anti-glycan ABO antibodies have been shown to inhibit SARS-CoV1 interaction of spike protein and angiotensin-converting enzyme 2 (ACE2) [33].
In the cellular experimental model approach, it can be proven that the binding of the SARS-CoV S protein with ACE2 on target cells can be blocked by anti-A antibodies in the blood group, because the S protein is synthesized by A-antigen-expressing cells, after transfection by cDNA glycosyltransferases. in accordance. When produced in cells expressing blood type A or B enzymes, SARS virions are decorated by appropriate glycan antigens, consequently, the presence of anti-A and anti-B antibodies in blood type O individuals can block the attachment and entry of the virus thereby preventing infection. Therefore, individuals with blood type O will have a lower risk of infection than non-O individuals. This phenomenon occurred during the 2003 Hong Kong SARS hospital outbreak, and a similar trend was recently observed for COVID-19 in China, the infectious SARS virions are decorated by glycan antigens corresponding to blood group A or B, and the presence of anti-A antibodies and anti-B in individuals with blood type O can prevent infection by blocking the attachment and entry of the virus [34, 35].
Vasan study used data on 1.1 million healthy blood donors from the binational database SCANDAT2 (Scandinavian Donations and Transfusions), which contains national data on blood donation and transfusion from Sweden and Denmark, to investigate the association between ABO blood type and arterial thrombotic events. or veins. And the results confirm that there is a consistent relationship between non-O blood type and VTE and cardiovascular events, with a greater risk in the venous. The proposed basic mechanisms driving this association include higher concentrations of factor VIII and von Willebrand factor in individuals with non-O blood types. This study provides strong evidence of a consistent relationship between the non-O blood group and VTE, and the incidence of cardiovascular thrombosis, with a greater risk of recurrence in non-O blood groups. Also, non-O blood groups confer an increased risk of thromboembolism, ABO blood groups may have a role in thrombosis risk assessment and could potentially be added to existing clinical prediction systems [5].
Sickle cell disease or what is known as sickle cell trait (SCT) in individuals will provide a risk of DVT even though it is weak. This potential risk will increase if the patient has a non-O blood group. This combined effect will increase the activation of clotting factors and increase the risk of DVT. Thus, caution should be exercised in co-inheritance of non-O blood group and SCT, in which case it should be paid attention to assess the risk profile of DVT in patients in Africa and other areas where SCT is common [6].
Non-group O patients have susceptibility and greater risk of VTE than patients of group O and have greater levels of von Willebrand factor (vWF) and factor VIII. The risk of VTE is probably related to the level of vWF and factor VIII. A, B, and H blood group antigens are expressed on N-glycans of VWF and influence the half-life of the protein (10 hours for group O and 25 hours for non-O subjects), explaining the greater levels in non-O patients [8].
In the report of Rejtő et al. who investigated the effect of ABO, VWF level, age on the variability of F VIII levels in 8 patients non-severe Hemophilia A results that ABO and VWF levels did not influence the variability of FVIII levels, whereas age had only a small influenced [36].
The coagulation process is under the control of several inhibitors which limit clot formation. A balance between procoagulants and anticoagulants is necessary for maintaining hemostasis. A thrombus is formed as a result of a disturbance in this balance. Thrombus is formed when the procoagulant activity of one of the coagulation factors is increased or the activity of one of the natural inhibitors is decreased, a condition called thrombophilia can occur in inherited deficiency of natural inhibitors, as well as with inherited gain-of-function mutations of some coagulation factors. The deficiency of natural inhibitors such as antithrombin, protein C and inherited protein S is a strong risk factor for venous thrombosis; they have little or no effect on arterial thrombosis. Antithrombin directly inhibits several activated coagulation factors, notably thrombin, and activated factor X, and the inhibitory effect is amplified by its binding to glycosaminoglycans on the endothelial surface carrying heparin-like activity. The effect of increasing the tendency for clot formation is especially in the venous system where the coagulation pathway (different from that of platelets) plays a major role. The anticoagulant protein C on the surface of the endothelium is very important in the down-regulation of thrombin formation. Activated protein C inactivates factor Va and factor VIIIa proteolytically, the two most important activated cofactors of the coagulation cascade, causing a slowdown in the rates of thrombin and fibrin formation. The inhibitory effect of activated protein C is accelerated by its main cofactor, protein S. Inherited deficiency of one of these inhibitors leads to increased thrombin formation, increasing susceptibility to VTE [37].
Ahmed et al. hypothesized that if Sickle Cell Trait was a risk factor for DVT, individuals with non-O blood group and SCT (Hb AS) would have a higher risk of DVT than those with non-O blood group and normal hemoglobin (Hb AA) phenotype. The results of this study indicate that SCT itself is a weak risk factor for DVT, but would have the potential to increase the risk of DVT in patients with non-O blood groups. Therefore, co-inheritance of SCT and non-O blood groups is an important risk factor for DVT [6].
The study of Vasan et al. results almost in all age groups, the incidence of VTEs and cardiovascular events is higher in non-O than O blood groups. The incidence rate ratio (IRR) was highest for the venous events, with all venous thrombotic events combined for individuals with non-O blood group compared with blood group O having an IRR of 1.80 (95% CI, 1.71–1.88). The risk patterns were similar for pulmonary embolism and deep vein thrombosis. Among arterial events, IRRs were generally lower with IRRs of 1.10 (95% CI, 1.05–1.14) for myocardial infarction and 1.07 (95% CI, 1.02–1.12) for stroke in individuals in non-O blood groups compared with those in blood group O [5].
ABO blood type is associated with the risk of thromboembolic diseases. Non-O blood type has a greater risk than O blood type. Thromboembolic events occur in both arteries and venous, which are venous more often, one of the causes is FVIII and VWF clearance in non-O blood groups are longer, results found high levels of both in the non-O blood group. While the manifestation of arterial thromboembolism commonly happened in cardiovascular diseases including coronary arterial disease and myocardial infarct.
No conflict of interest in this article.
ADAMTS-13 | a disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13 |
CAD | |
CI | confidence interval |
COVID-19 | Coronavirus disease-19 |
DVT | |
FVIII | |
Hb | hemoglobin |
IRR | |
MACE | major adverse cardiovascular events |
MI | |
PAR | population-attributable risk percent |
PE | |
PY | patient-year |
SCT | |
VTE | |
VWF |
Today, there is no controversy about considering acute and chronic pain based on a foundation of neurobiology influenced by and interacting with biological, psychological, and social/contextual factors [1, 2, 3]. Hence, modern clinical practice applies a biopsychosocial (BPS) framework in assessments and treatments [4, 5]. This approach is the result of developments that have occurred over the past 70 years.
Units dedicated to treat pain were developed in the USA based on physicians’ experiences with chronic pain in soldiers during and after World War Two. During this period, surgeons and anaesthesiologists attempted to alleviate both chronic and acute pain mainly using blockades and local anaesthesia [6]. Later, this type of unit expanded into Europe and Sweden. The first multidisciplinary pain clinic opened in the 1960s as a development of the pain clinic founded by John Bonica in the 1950s at the University of Washington in Seattle (USA) [7]. Bonica realised that patients with complex pain problems were not helped by single specialties, and during the 1950s he brought neurosurgeons, psychiatrists, and anaesthesiologists to his clinic. In 1959, Wilbert Fordyce, a psychologist hired by the Department of Physical Medicine and Rehabilitation at the same hospital, became interested in applying behavioural strategies in the assessments and treatments of chronic pain. Their collaboration led to the incorporation of psychologists in pain clinics and later other health care providers trained in different but related areas [6]. Bonica also led an international initiative that resulted in the formation of an association of researchers and clinicians dedicated to the understanding and treatment of pain (International Association for the Study of Pain, IASP).
In 1982, Fordyce’s psychological program and Bonica’s pain clinic merged under the direction of John Loeser [6]. Under this new arrangement, patients were evaluated and treated by teams, and the BPS model started to be used in pain programs. These early programs had to deal with medication problems and addiction, so inpatient treatment became the standard. During the 1970s, the number of multidisciplinary pain clinics following the example of Seattle’s clinic grew in the USA and later in Australia, New Zealand, and Europe. During the 1980s, psychologists began to add cognitive treatment strategies to the programs, which opened up treatment to a broader mix of patients. By 1990, cognitive-behavioural pain management programs were widespread and became the golden standard of care. During the 1980s and the 1990s, many studies focused on interdisciplinary pain programs (IPRPs), and new theories were launched [6, 8, 9].
The positive development in the USA slowed down at the beginning of 2000, and most units offering IPRPs closed their operations in the following decade, except for units in the Department of Veterans Affairs (VA). The Commission for the Accreditation of Rehabilitation Facilities (CARF) offers a specific set of standards that emphasise the interdisciplinary setting and the BPS model for the treatment of chronic pain. As the CARF standards remained focused on the BPS framework, the number of accredited programs illustrates the development in the USA. In 1998, there were 205 accredited chronic pain programs in the USA. By 2004, the number decreased to 125, 11 of which were VA programs [6]. These programs, excluding the VA IPRPs, decreased to 63 in 2010, 53 in 2015, and 32 in 2020 (Carolan Terrence, CARF, personal communication). However, outside the USA, the development has gone in the opposite direction. By the end of 1990 outside the USA, fewer than five tertiary pain units with CARF accredited pain programs were in operation; however, by 2021, this number had increased to 140 (CARF, personal communication). According to many reports, the decline in the USA was due to opioid use as a medication for chronic pain, but this approach, as the result of the opioid pandemic, is currently being replaced by initiatives to re-start IPRP.
Both evidence and clinical practice guided the development of how to face the problem of chronic pain—from viewing chronic pain as a symptom of underlying causes to viewing chronic pain as a dysfunction (i.e., from a biomedical approach to a biopsychosocial approach). Therefore, treatments have evolved from monodisciplinary to multidisciplinary treatments and from multidisciplinary treatments to interdisciplinary programs.
During the 1970s and 1980s, the novel approaches to chronic pain developed slowly in Sweden. As new methods and treatments were developed, national guidelines for chronic pain treatment were warranted. In 1994, an expert group formed by the Swedish National Board of Health and Welfare summarised the recommendations for treatment of chronic pain based on the International Association for the Study of Pain (IASP) guidelines and available evidence at the time. In 2006 and 2010, two compilations of evidence for chronic pain treatments, commissioned by the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU; see below), confirmed the conclusions of the 1994 report about appropriate methods and lack of evidence for methods still being used. In the 2006 and 2010 reports, one method was singled out as an evidence-based approach, the IPRP. These reports contributed to a governmental decision to financially support the development of IPRPs throughout Sweden. During this period, a registry for pain rehabilitation was formed through an initiative of the professions with the aim to analyse outcomes of pain rehabilitation. The registry with the support of the affiliated units and the national organisation of county councils (SKL) developed into a national quality registry that included all tertiary pain rehabilitation units as well as units operating at the primary care level.
In clinical practise, patients with complex chronic pain conditions with difficulties coping with their condition in daily life are referred to an IPRP. These patients’ ability to cope with their pain can be compromised by co-morbidities and/or their work situation. Often, these patients have tried monodisciplinary interventions and/or pharmacological treatments without marked improvements. The Swedish guidelines regarding indications for IPRP, which have been approved by several authorities and professional organisations, recommend that IPRP be offered to chronic pain patients with complex clinical presentations and when monodisciplinary interventions have not been effective [10].
In 2011, the IASP stated in the Declaration Montreal that ‘access to pain management is a fundamental human right’ [11]. This humanitarian approach is important; however, availability to IPRP is scarce, as mentioned above, in several parts of the world, and chronic pain is common in the general population—approximately 20% of the European and North American population has a significant chronic pain condition [12, 13]. In addition, as many patients with chronic pain rarely seek health care services, these patients seem to have adapted to their pain condition to lead lives with minor consequences to their function and well-being. This needs to be considered as IPRP is costly interventions in the short run and patients need to be fully invested in the process and very possibly have a sense of urgency to benefit from treatment and be motivated to engage in behavioural and cognitive change. The motivation to behavioural and cognitive change is fundamental as an indication for IPRP. For IPRP to be used with an ethical and humanitarian perspective, it needs to prioritise individuals who suffer from substantial consequences of their chronic pain condition regarding function, social, and/or psychological well-being.
The idea of treating chronic diseases with a broader approach than the biomedical approach was first launched by Engel in a biopsychosocial (BPS) model for the treatment of diseases, especially chronic diseases [14]. The model emphasises the mutual interactions between biological, psychological, and experiential or social factors that impact people’s perceptions of their overall health. This model lies at the core of the multidisciplinary and interdisciplinary approaches to the treatment of chronic pain. Similarities and differences between these approaches are described in detail elsewhere [7]. Although both rely on the BPS model, they differ regarding whether the goals of the professionals are integrated, whether professionals work collaboratively in teams, and whether their treatments are provided simultaneously or sequentially [9, 15]. The interdisciplinary treatment, which is based on the BPS approach [1], is the standard treatment used in IPRPs. According to IASP, interdisciplinary treatment is a:
The programs usually include experts working in an integrated manner with physical, social, psychological, and medical aspects to diminish the consequences of chronic pain in these or other areas [7, 16]. The principal components of IPRP are as follows:
a team assessment of the chronic pain problem and its consequences;
the establishment of a treatment plan, including interventions by different professions with goals to be achieved during the program;
communication between team members and between the team, the patient, and significant others;
deliveries of the different synchronised interventions of IPRP;
evaluation of the interventions;
documentation; and
a discharge process, including interaction with other stakeholders.
Other researchers have also identified the same content [17]. Although the areas covered by the interdisciplinary programs are well described elsewhere, there are very few descriptions of the interventions used in clinical practice in IPRPs, usually describing the interventions used in specific centres, such as Mayo Clinic or Chicago University Hospital [16]. In Sweden, it is possible to gather information on the interventions used in clinical practice from most of the IPRPs affiliated with the Swedish National Registry. Of the 39 affiliated units, 31 were included [18]. The usual contents of IPRP described by Swedish units are as follows:
dialogue and education (e.g., education, training in wellness and healthy living habits, meetings with families, video feedback, and couples therapy) and self-training (e.g., home lessons, activity diary, physical self-training, reflection time, and self-analysis);
activity training (activity training, graded activity training, and exposure training);
meetings (conferences with patients, rehabilitation team, vocational guidance, rehabilitation coordinator, goal-setting meetings, and meetings to check goal achievement);
cognitive behavioural therapy, other psychological treatments (e.g., supervised group therapy, pain or a stress coping course, psychological and social aspects, post-traumatic stress disorder (PTSD) treatment, and psychodynamic methods) and Acceptance and Commitment Therapy (ACT) (e.g., goal compass, training in ACT principles, and mindfulness);
relaxation techniques; and
physical exercise.
Only 14 of 31 programs reported using interventions in the workplace. All programs reported having follow-ups (1-year follow-up by mail or at the unit for completing the registry’s questionnaires). Usually, extra follow-up meetings were scheduled two to three months after discharge from rehabilitation (21 of 31 units).
The optimal composition of IPRP with respect to length, contacts with therapists, and intensity are insufficiently known according to a systematic review (SR) [19] and a meta-analysis (MA) [20]. The former concluded that because dose variables were not investigated separately in the RCTs, the reviewers could not disentangle the interrelationships between dose, content, and effects of IPRP on disability, work, and quality of life. Similarly, a longitudinal study of IPRP dosage (i.e., duration) could not establish an optimal dosage [21].
Generally, IPRP goals include improving important outcomes (4,5). There are several simultaneous general goals to be considered—decreased pain intensity and increased mental health; increased participation in work/studies and social life; and increased health and quality of life. These general goals are combined with the specific goals of the individual with chronic pain. Thus, goals should ideally be set at the level of the individual, the rehabilitation teams, and the socio-economic constraints. The latter is essential since IRRPs historically have been financial failures. For IRRP to prosper and receive funding, the considerable socio-economic costs of chronic pain need to be considered. Goals, such as return to work/studies and decrease in medication use, health care use, and surgery, will in the long run also benefit the individual move towards an active, independent lifestyle.
As chronic pain is a complex experience with possible adverse effects on function and social and psychological well-being, goal setting should include several aspects and involve a BPS perspective. The general goals for IPRPs are mentioned above. In addition to these goals, there is an increasing emphasis on cognitive areas that could mediate positive changes, such as catastrophizing, acceptance of the pain condition, avoidance of activity due to unrealistic concerns about harm, and expectations of pain treatment [22].
Researchers have debated whether pain intensity aspects should be amongst the main outcomes of pain treatments included in IPRP [23, 24, 25, 26]. Many patients consider reducing pain to be the most important aspect of treatments with respect to regaining a normal lifestyle; however, changing this view is considered an intrinsic component of IPRP. Many chronic pain patients eligible for IPRP have experienced how short-sighted attempts to control only pain intensity can lead to vicious cycles of increased physical and psychological disability and reduced quality of life. Thus, many IPRPs have largely adopted the idea of introducing acceptance as a cornerstone of the psychological component of IPRP (i.e., the willingness to experience pain as it is) and encouraging patients to set up activity-related rehabilitation goals and to risk initial pain flare-ups. This means that patients are advised against establishing pain reduction as the only or the most important goal. Paradoxically, in the long run, pain reduction is one of the more robust results of IPRP [27]. Nevertheless, in traditional CBT, a cornerstone and mainstream in IRPs, an array of strategies is presented, strategies that target the consequences of pain with non-pharmaceutical techniques for pain control.
The process of goal setting is vital and fundamental both for the individual and the team as goal setting has been shown to promote greater behavioural change across a wide range of behaviours [28]. At the individual level, a thorough assessment that is communicated to the patient and a collaborative goal-setting process will increase engagement and adherence to treatment. In addition, the rehabilitation team will benefit from formulating common goals for treatment, reviewing results, and improving plans to stay engaged and to be flexible. The latter should constitute an important goal for the team as role models for patients. Often, the goal is to attain goals that are SMART—i.e., Specified, Measurable, Attractive, Realistic, and Time-limited [29, 30]. However, possibly the most important quality for goals is to be personalised and agreed upon by the patient. The team should strive for a collaborative approach but must always bear in mind that the patient is in a more vulnerable position and might easily give in to goals that might, for example, not feel relevant or feel too demanding. Motivational Interviewing (MI) can be used to discover a patient’s motivation for a specific goal when a patient finds it difficult to specify goals. Patients are often more focused on avoiding unpleasant experiences and frequently the main wish of the patient is to be free of pain. As such, the goal-setting can constitute an acceptance of intervention as it models how to focus on the attainable and let go of the difficult to achieve a goal—i.e., pain relief.
Nevertheless, the SMART model for goal setting has lately been challenged by Acceptance and Commitment Therapy (ACT), the third wave CBT. ACT, which has increasingly been introduced in IRRP, emphasises identifying important values and not primarily setting specified, time-limited goals. However, the SMART model can be used as a step towards identifying important values.
The variety of interventions used at most IPRPs in a single country [18] is in itself a challenge when it comes to measuring the outcomes of IPRPs delivered in clinical settings. Nevertheless, the areas addressed correspond to the areas proposed by the BPS model. In addition to the variety of interventions within IPRPs, many tools have been used both by researchers and clinicians to assess patients and to measure IPRP outcomes. Two well-known initiatives to bring consensus into the areas of evaluating clinical trials, including IPRP are the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) [4, 31] and the validation and application of a patient-relevant core set of outcome domains to assess multimodal PAIN therapy (VAPAIN) initiatives (Table 1) [32].
IMMPACT’s domains | VAPAIN’s domains |
---|---|
Pain | Pain intensity and frequency |
Emotional function | Emotional well-being |
Physical function | Physical activity |
Productivity | |
Satisfaction with social roles and activities | |
Self-evaluation on overall improvement and satisfaction with the intervention | Patient’s perception of achieved treatments goals |
Symptom and side-effects of intervention | |
Participant disposition (including participation and discontinuation of participation) | Reasons for discontinuation of treatment |
Domains of IMMPACT and VAPAIN.
IMMPACT identifies relevant outcome domains for clinical studies and proposes reliable measurement tools for the study of treatments of chronic pain, including all possible modalities and approaches. IMMPACT has resulted in several studies evaluating clinical treatments. VAPAIN specifically targets IPRPs. These initiatives have some overlapping domains that are included in clinical trials (Table 1). VAPAINs focused on IPRPs led to the addition of two domains considered critical when the treatment is interdisciplinary—productivity and patient satisfaction with social roles and activities. VAPAIN renamed certain domains and extended their scope (e.g., the more inclusive ‘emotional well-being’ rather than ‘emotional function’).
A different approach taken by a Canadian research group focuses on the variables of interest for health care providers and the variables of interest for patients, according to lists of parameters from the Patient-Reported Outcomes Measurement Information System (PROMIS), the International Classification of Functioning, Disability and Health (ICF), and current guidelines [33]. Here, the initiative was to identify the set of variables that are important to both providers and patients. They triangulated the ICF and the PROMIS frameworks with the perspectives (both the patients’ and clinicians’ perspectives) and found a common list of ten variables—pain interference, pain intensity, physical function, sleep disturbance, anxiety, depression, ability to participate in social roles and activities, fatigue, sleep-related impairments, and self-efficacy. The authors conclude that these variables mirror the BPS model covering the physical, psychological, and social consequences of chronic pain on an individual’s life both from the perspective of people with chronic pain and the perspective of health care providers.
There is a need to develop clinically applicable, standardised, and accepted ways to evaluate IPRP. IPRP is a complex intervention with several general goals (see above) and is delivered by an interdisciplinary team of professionals in close collaboration with the patient and considering the patient’s specific goals. This is entirely different from a pharmacological intervention, which aims to alter a biochemical process to decrease pain intensity (Figure 1). In fact, an IPRP tries to influence several levels, including the behaviours of the patient with chronic pain. Hence, in clinical practice, there are several outcomes and to make things, even more, complicated the important goals for the individual patients may differ. Due to these circumstances, the concept of one or two primary outcomes and a few secondary outcomes applied in pharmacological randomised controlled trials (RCTs) do not reflect the complexity of IPRP. In a systematic review (SR) by SBU, the included RCTs on average had nine outcome variables and the variables were seldom divided into primary and secondary outcomes [23].
The complexity of IPRP versus a pharmacological intervention.
The evaluation of complex interventions, such as IPRP is not clear-cut [34]. Clinically applicable, standardised, and accepted ways to evaluate the multiple outcomes of IPRP in individual patients clinically and in trials, SRs/meta-analysis (MAs) and observational studies are lacking. If the changes in outcomes are intercorrelated (they often are, see below), it may be problematic to evaluate the outcome measures separately as sometimes is done [35]. In contrast, SBU defined a positive outcome of an RCT when the
Because evaluations of several outcomes often raise an issue of multiple comparisons, Bonferroni corrections may be recommended [42, 43]. This is a conservative approach when the number of tests increases and can reduce the chances to detect real treatment effects [42, 44, 45]. Moreover, such corrections are intended for corrections of
The available SRs and MAs indicate that IPRP is an evidence-based intervention. Table 2 lists and briefly describes the results of available SRs and MAs based on only RCTs according to Dragioti et al.’s [47] search strategy.
First author, year, and reference | Type | Patients | No. of RCTs* | Main results and comments |
---|---|---|---|---|
Nielson 2001 [48] | SR | CP with separate analysis for CLBP, FM, and other | 21 |
|
Guzman 2002 [49] | SR+MA | CLBP | 10 |
|
SBU 2006 [23] | SR | CP with separate analysis for FM | 46 |
|
van Geen 2007 [50] | SR | CLBP | 10 |
|
Scascighini 2008 [37] | SR | CP with separate analyses for CBLP and FM | 36 |
|
Norlund 2009 [51] | SR+MA | CLBP | 7 |
|
Häuser 2009 [52] | SR+MA | FM | 9 |
|
SBU 2010 [36] | SR | CP with separate analyses for CLBP and FM | Partial update of 2006 SBU**
| |
van Middelkoop 2011 [53] | SR+MA | CLBP | 83 |
|
Kamper 2014 [35] | SR+MA | CBLP | 41 |
|
Gianola 2018 [54] | SR+MA | CBLP | 22 | Partial reanalyses of Kamper et al.’s review [35] using minimal important differences units (MIDs). Using this approach, they concluded that IPRP led to improvements in an appreciable number of patients in the short- and medium-term after IPRP. In the long term, IPRP probably had little or no benefit for most patients. |
Casey 2020 [55] | SR+MA | CP | 27 |
|
Martinez-Calderon 2020 [56] | SR+MA | CP | 60 | Investigates the outcome pain self-efficacy.
|
Martinez-Calderon 2020 [57] | SR | CLBP | 61 | Investigates outcomes of fear.
|
Martinez-Calderon 2021 [58] | SR | FM | 12 | Investigates the outcome of pain-related fear.
|
Brief conclusions from Systematic Reviews (SR) and Meta-Analyses (MA) of IPRP identified using Dragioti et al.’s search strategy [47].
Not all RCTs may be used for the analyses of IPRP outcomes.
Note that GRADE was used in the 2010 SBU report but not in the 2006 SBU report.
SR = Systematic Review with narrative synthesis of data; MA = Meta-Analysis; RCT = Randomised Controlled Trial; IPRP = Interdisciplinary Pain Rehabilitation; CLBP = chronic low back pain; FM = fibromyalgia; CP = non-specific chronic pain conditions; TAU = treatment as usual; and WLC = waiting list controls.
SRs and MAs using several simultaneous outcomes report positive outcomes for IPRP for chronic pain conditions [23, 35, 36, 37, 48, 49, 52, 53, 55]. Studies using overall assessments of outcomes and therefore considering that IPRP is a complex intervention agree that IPRP has positive outcomes with moderate to strong evidence [23, 36, 37]. There is no consensus regarding the duration of the effects after IPRP (follow-up time) [23, 35, 36, 37, 48, 52, 53, 54, 55]. When outcome variables are evaluated independently, the outcomes associated with positive effects differ across studies [50, 53, 56, 57, 58]. Articles reporting results for fibromyalgia separately reported positive outcomes for IPRP. However, both evidence levels and follow-up periods (short, medium, or long term) differed [23, 36, 37, 52, 58]. The conclusions regarding the effects of IPRP on vocational variables, such as return to work (RTW) and sick leave were heterogenous according to these reviews [23, 35, 36, 48, 49, 50, 51].
The authors of these reviews identify several problems and limitations. Most SRs report that there is heterogeneity in study settings, interventions, and control groups. It is difficult to compare the patient groups included in the identified RCTs since there is no internationally accepted way to describe the patient groups. In addition, the number of comorbidities and duration of sick leave can differ, and external factors, such as the social security situation can differ considerably across studies from different countries and years. Some of the variables suggested by IMMPACT and VAPAIN can be useful for the development of a standardised set of variables that can be used to describe chronic pain patient cohorts [4, 31, 32]. Moreover, because there is no internationally accepted definition of IPRP, authors of SRs and MAs must create their own operational definitions to identify the relevant RCTs. In the quality assessments of RCTs, the issue of blinding might be problematic, and IPRP studies may be classified with lower quality since it is impossible to blind IPRP for patients. Different results in the reviews might also depend on the specific criteria for inclusion and the fact that parts of reviews are based on judgements of researchers.
The results from RCTs, SRs, and MAs must be confirmed in real-life consecutive flow of patients in clinical settings. Direct clinical application of the results from RCTs is not suitable in all situations as these studies might be associated with bias and the patients investigated in RCTs might not represent real-world patients (i.e., insufficient external validity) [59]. Hence, the results from RCTs and SRs must be confirmed in real-life settings, for example, using registry data. This methodology is labelled
Most real-world observational evaluations of IPRP are based on within-group analyses over time. However, such observational studies are often associated with bias. Creating an objection-free control group in clinical practice in association with registries of IPRP is ethically, economically, and practically impossible. To date, attempts using other types of registries for creating a control group have not been successful [61]. Fortunately, methods have been developed that emulate randomisations based on observational data, which allows comparisons between interventions [62]. Target trial emulations are increasingly applied (e.g., in clinical pharmacology, oncology, cardiovascular diseases, critical care, and rheumatology) and can under appropriate circumstances give valid effect estimations compared to RCTs [63, 64]. When target trial emulations can be adequately performed, they generally yield stronger evidence than other types of observational research designs [63]. However, these are not simple methods or without limitations and biases [65, 66, 67]. Although criticised, a first attempt has been made that focuses on sick leave associated with IPRP using data from the SQRP (see below) [68]. If further research and refinements of registries covering IPRP conclude that this methodology is applicable, it would be a great advantage. It would further increase the importance of registries for improving the clinical results of IPRP and other complex interventions for patients with serious chronic pain conditions.
There are usually two approaches to building a registry, and both influence the architecture and content of the registry. Registries are either built to answer research questions or to provide clinical evaluations to providers at each site. SQRP was built primarily around the second approach. The initiative to start SQRP was taken within the professionals’ network, the decision made by the leadership of the units delivering IPRP around 1997. Since its inception, in 1998, the registry has addressed the description of what was being offered at the clinical settings, the overall situation of the patients being admitted, and the changes reported in the included instruments at discharge and 1-year follow-up. Therefore, the SQRP has always worked very closely with the clinicians providing treatment as they are a source of knowledge to be used in the assessment of patients and the evaluation of their progress in the programs as well as describe data at the organization’s level. The general goals are given in Table 3.
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|
|
|
General goals of SQRP.
The registry aims to highlight data on structure, processes, and outcomes. Outcomes are retrieved at the individual, group, unit, and national levels (Table 4).
Type of intervention | |||
Number of registrations | |||
Time | |||
Reasons for discharge | |||
Level of the individual (patient profile and reports) | |||
Level of the unit (group reports) | |||
Level of the country (yearly reports) | |||
R 1 | |||
R 2 | |||
R 3 | |||
R 4 |
Clinical evaluations (levels of analysis).
R = Report.
Every year SQRP follows how the registry is used at the clinical level and promotes plans for improvements. Examples of improvement work, using measures of the registry (according to answers to the 2019 survey) are presented in Table 5.
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Examples of improvement work using measures of the registry.
An overview of the variables and instruments included in the registry (2021) is presented in Table 6. Hence, SQRP is mainly a patient-reported registry, including mostly patient-related outcome measures (PROM data) as well as patient-related evaluation measures (PREM data). The PREM variables concern satisfaction with reception/encounter, the site information, degree of participation in the rehabilitation plan, teamwork, and family participation in the program.
Type | Variables and instruments |
---|---|
Self-report and background information | |
Socio-demographic data | |
Work | |
Sick leave | |
Pain duration Pain extent | |
Attitude towards the future | |
Self-report, Instruments, and variables | |
Numeric Rating Pain Scale (NRPS) | |
The Hospital Anxiety and Depression Scale (HAD) | |
Multidimensional Pain Inventory (MPI) | |
Health-related life quality (RAND-36) | |
Perceived health (the EuroQol Group) (EQ-5D) | |
Chronic Pain Acceptance Questionnaire (CPAQ 8) | |
Insomnia Severity Index (ISI) | |
Perceived work ability index (WAI) | |
Kinesiophobia (TAMPA) | |
Perceived physical activity (3 items) | |
Changes in pain experience (retrospective items) | |
Changes in ability to handle life situations (retrospective items) | |
Patient satisfaction (six items) | |
Professional-evaluated variables | |
Diagnosis | |
Pain mechanisms | |
Expected future financial-support form | |
Swedish language ability | |
Rehabilitation plan |
Variables of SQRP.
The registry also includes self-reported background information. There are some variables that are evaluated by the professionals in the program (Table 6).
Some other Swedish quality registries were built to answer research questions and are now working to adapt the output of information to the needs of clinicians at the sites where healthcare is provided. On the other hand, SQRP has been working to improve its operations to allow for research questions to be explored by improving the validity of its information, reducing dropouts, and enhancing routines to avoid missing values and registration errors. In 2011, a national research network (SQRP research group) was formed through initiatives developed by the SQRP’s steering group. This group has developed different research programs focused on the registry, leading to grants from different research funds, dissertations, and many publications. In this way, SQRP is becoming a source of knowledge for researchers interested in finding answers to the complex interventions included and the heterogeneous group receiving treatment.
SQRP collects a large amount of self-reported mandatory data concerning pain aspects, psychological distress, interference, health aspects, etc. together with background data from patients referred to specialist pain care in Sweden. The information covering the BPS framework complements information included in the clinical assessments. To determine which variables are generally important in patients with chronic pain, one approach investigates variables important for health aspects.
Pain severity, pain interference, and pain intensity were the most important regressors of health (N > 37 000 patients at baseline) followed by two variables that focus on control of pain and coping with pain, and four variables (also significant) reflecting mood aspects according to a cross-sectional SQRP study (Figure 2) [69]. Extent and duration of pain, age, gender, and background variables were not significant regressors.
OPLS regression of health (EQ5D-index) using other self-reported variables at baseline as regressors. Only significant variables are shown. Data are from [
Another approach is to use PCA to identify variables associated with prominent variations—i.e., high scores. Pain aspects, such as intensity and interference, psychological distress, coping, and health aspects, are the most important and therefore carry the most information for the clinical presentation according to SQRP studies [70, 71].
It is a clinical experience that patients with the same diagnosis show considerable variations in their presentations and consequences. Therefore, in the context of improving outcomes of interventions, there is a great interest to identify relevant subgroups of chronic pain patients. Most studies have been hypothesis-driven with respect to the input variables for subgrouping. Based on some mandatory variables covering the BPS framework, two subgroups/clusters of patients have been identified from SQRP data (N = 37 100) [70]. The subgroup with the most intense pain intensity/severity had the worst situation regarding psychological distress, interference in daily life, and least life control [70]. Furthermore, according to variables not used as input variables, this subgroup had more pain extent (spreading of pain) and more people born outside Europe. Also, smaller SQRP studies report that the patient group is not homogenous and different subgroups have been identified [71, 72].
The Multidimensional Pain Inventory (MPI) classifies patients into subgroups [73, 74]. These subgroups—Adaptive Coper (AC), Dysfunctional (DYS), and Interpersonally Distressed (ID)—were identified in a large cohort from the SQRP (N = 34 513) and the validity of these subgroups of MPI was partially confirmed [75]. However, in contrast to results reported by Turk and Rudy, the subgroups differed in socio-demographic characteristics, pain duration, and pain extent [73]. Hence, factors other than psychosocial may be important for understanding MPI responses.
In an SQRP sample (N > 38 000), the presence of severe anxiety symptoms was detected in 39.5% and the corresponding outcome for depression was 35.2% according to established cut-offs for the Hospital Anxiety and Depression Scale (HAD) [70]. Although psychological distress was common, the strength of the intercorrelations between pain intensity and anxiety and depression scales of HAD were low. The explained variations (r2) were between 3 and 11%. Two SQRP studies from different times investigated the prevalence of clinical insomnia according to Insomnia Severity Index (ISI) and reported a prevalence between 65 and 66% [76, 77]. Hence, it is important to assess insomnia in patients with complex chronic pain. A network analysis (N = 2 241) reported that psychological variables, such as acceptance and depression mainly were associated with pain interference, whereas the associations with pain intensity and extent together with insomnia were weak [78]. These results taken together may be important for expectations about treatment results (i.e., improvements in psychological distress may not necessarily lead to important improvements in pain intensity).
The pain extent is registered using 36 predetermined anatomical regions in the SQRP, which were summarised and divided into four categories: 1–6 regions with pain (20.6% of patients), 7–12 regions (26.8%), 13–18 regions (22.0%), and 19–36 regions (30.6%) (N = 39 916) [79]. A higher extent of pain spreading was associated with a more severe clinical picture at baseline and longer pain duration with the strongest associations emerging in relation to health and pain aspects (pain intensity, pain interference, and pain duration) [79]; generally, there were at least medium effects sizes (ESs) when comparing the two extreme groups. A cross-sectional multivariate analysis found that pain spreading correlated strongest with general health, vitality, female gender, physical function, pain interference, pain intensity aspects, and pain duration [79].
Patients with chronic pain generally have a higher Body Mass Index (BMI) than healthy controls. Obese patients had a worse pain profile (e.g., pain intensity, pain extent, and pain duration) and more depressive and insomnia symptoms than normal-weight patients according to another SQRP study (N = 3 310) [80].
Most patients referred to the specialist departments in Sweden are women (about 70%). The reasons for this overrepresentation are unclear and are only partially explained by the higher chronic pain prevalence in the population [81, 82]. It is unclear whether sex/gender differences for pain severity exist [83, 84, 85]. According to SQRP data, there were generally small differences (generally insignificant ESs) in clinical presentation according to self-reported data between the two genders [86, 87]. Generally, patients born outside Europe had a more severe clinical picture than those born in Europe, for example, with respect to pain intensity and psychological distress (medium ESs) [87]. Patients with only an elementary school education generally reported a worse clinical situation than those with a university education (most variables small to medium ESs).
A cluster analysis using gender, country of birth (Europe vs. outside Europe), and education level (three categories) as input variables identified five subgroups—three subgroups of European women and different education levels, one subgroup of European men, and one subgroup of non-European men and women and different education levels [87]. Prominent differences in clinical presentations, such as pain intensity, psychological distress, interference, life control, and health aspects, were noted between European women with university education and the non-European subgroup (worst situation) (ESs generally medium to large). European women with only elementary school also displayed a worse situation than those with university education.
To summarise, patient groups referred to specialist pain care in Sweden are not homogenous with respect to clinical presentations as distinct subgroups are evident. The clinical presentations show clear associations with pain extent, BMI, and socio-demographic variables.
Not all patients assessed and registered at baseline in SQRP are selected or choose to participate in IPRP. Unfortunately, the registry does not contain data that can separate these two reasons and other possible reasons, nor does it collect detailed information about assessments, all interventions offered (including IPRP), the interventions’ contents and dosages, and patient-related preferences and choices. Assessments of patients, including establishing treatment plans, are clinically necessary and perceived as important by patients. The assessment including a treatment plan with follow-up in primary care per se appears to be associated with positive significant effects on several aspects of the clinical presentation [88]. However, the ESs were insignificant to small.
The Swedish guidelines recommend that IPRP at the specialist level is offered to chronic pain patients with complex clinical presentations, for example, with respect to comorbidities [10]. However, the subgroup with the most severe clinical situation was somewhat underrepresented [70, 89]. Similar results were found for the DYS subgroup of MPI, male gender, and the non-European subgroup [75, 87]. In agreement with this SQRP, data from two university hospital departments showed negative correlations between participation/selection and pain intensity but positive correlations with pain extent [90]. The reasons for these selections are currently unclear and further research is needed.
IPRP in clinical settings is associated with improvements on the group level with small to medium effect sizes for the majority of the mandatory self-reported outcome variables, for an overall score and retrospective items. Sick-leave data retrieved from the Swedish Social Insurance Agency database show important decreases after IPRP.
The outcomes of IPRP were investigated in a study of more than 14 000 patients (Table 7) [27]. Significant improvements were generally found except for one or two of the three scales of the second part of MPI (how husband/wife reacts when a patient has pain). Most outcomes showed small ESs and some outcomes were associated with moderate ESs (Table 2). For the pre vs. post-IPRP comparisons, three variables had moderate effects sizes—two pain intensity variables and vitality (Table 7). At the 12-month follow-up, the same pain intensity variables were associated with moderate effect sizes; this was also the case for pain interference and a health aspect (Table 6). The variables of the second part of MPI had insignificant ESs both post IPRP and at the 12-month follow-up.
Pre vs. post-IPRP | Pre vs. FU | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Pre | Post IPRP | Pre | FU | |||||||||
Outcome variables | Mean | SD | Mean | SD | ES | Mean | SD | Mean | SD | P-value | ES | |
NRS-7days | 6.86 | 1.72 | 5.95 | 2.09 | <0.001 | 0.45 | 6.84 | 1.72 | 5.78 | 2.32 | <0.001 | 0.47 |
HADS-Anxiety | 9.00 | 4.76 | 7.78 | 4.55 | <0.001 | 0.32 | 8.73 | 4.69 | 7.38 | 4.70 | <0.001 | 0.33 |
HADS-Depression | 8.49 | 4.44 | 6.70 | 4.31 | <0.001 | 0.47 | 8.18 | 4.37 | 6.74 | 4.66 | <0.001 | 0.35 |
MPI-Pain-severity | 4.39 | 0.93 | 3.87 | 1.16 | <0.001 | 4.36 | 0.91 | 3.71 | 1.33 | <0.001 | ||
MPI-Pain-interference | 4.38 | 1.02 | 3.94 | 1.19 | <0.001 | 0.49 | 4.34 | 1.02 | 3.73 | 1.37 | <0.001 | |
MPI-Life Control | 2.72 | 1.10 | 3.30 | 1.18 | <0.001 | 0.47 | 2.77 | 1.10 | 3.28 | 1.27 | <0.001 | 0.40 |
MPI-Distress | 3.46 | 1.26 | 2.89 | 1.38 | <0.001 | 0.42 | 3.42 | 1.27 | 2.92 | 1.45 | <0.001 | 0.35 |
MPI-Social support | 4.16 | 1.34 | 3.95 | 1.35 | <0.001 | 0.21 | 4.17 | 1.33 | 3.77 | 1.42 | <0.001 | 0.35 |
MPI-punish | 1.74 | 1.36 | 1.72 | 1.33 | 0.037 | 0.02 | 1.69 | 1.34 | 1.69 | 1.35 | 0.676 | 0.01 |
MPI-protect | 2.98 | 1.40 | 2.85 | 1.38 | <0.001 | 0.12 | 2.96 | 1.39 | 2.78 | 1.40 | <0.001 | 0.16 |
MPI-distract | 2.54 | 1.19 | 2.56 | 1.17 | 0.043 | 0.02 | 2.52 | 1.17 | 2.45 | 1.17 | <0.001 | 0.06 |
MPI-General activity index | 2.44 | 0.84 | 2.63 | 0.82 | <0.001 | 0.26 | 2.47 | 0.83 | 2.64 | 0.86 | <0.001 | 0.20 |
EQ-5D-index | 0.26 | 0.31 | 0.39 | 0.33 | <0.001 | 0.40 | 0.27 | 0.31 | 0.44 | 0.34 | <0.001 | |
EQ-VAS | 41.22 | 19.09 | 50.99 | 21.38 | <0.001 | 0.44 | 41.90 | 19.29 | 52.96 | 22.87 | <0.001 | 0.46 |
sf36-pf | 52.76 | 20.58 | 57.67 | 21.17 | <0.001 | 0.30 | 53.07 | 20.30 | 59.73 | 22.57 | <0.001 | 0.36 |
sf36-rp | 12.53 | 24.40 | 22.46 | 33.12 | <0.001 | 0.30 | 13.07 | 24.91 | 27.74 | 36.32 | <0.001 | 0.39 |
sf36-bp | 24.36 | 14.49 | 32.96 | 17.41 | <0.001 | 24.60 | 14.11 | 35.41 | 20.05 | <0.001 | ||
sf36-gh | 41.70 | 20.22 | 46.69 | 21.88 | <0.001 | 0.29 | 42.59 | 20.49 | 47.35 | 23.52 | <0.001 | 0.25 |
sf36-vt | 23.95 | 18.48 | 35.67 | 22.76 | <0.001 | 24.96 | 18.79 | 34.41 | 23.85 | <0.001 | 0.41 | |
sf36-sf | 47.29 | 25.19 | 54.93 | 25.91 | <0.001 | 0.30 | 48.95 | 25.50 | 57.66 | 27.05 | <0.001 | 0.32 |
sf36-re | 42.77 | 42.92 | 51.15 | 43.48 | <0.001 | 0.18 | 44.69 | 43.17 | 55.60 | 43.53 | <0.001 | 0.22 |
sf36-mh | 55.03 | 21.35 | 62.55 | 21.55 | <0.001 | 0.38 | 56.34 | 21.15 | 62.70 | 22.53 | <0.001 | 0.30 |
Mandatory outcome variables at baseline (pre) and immediately after IPRP (post IPRP) (left part; N = 12 999–14 772) and at baseline and at 12-month follow-up (FU) (right part; N = 7 784–8 904). Statistical comparisons are presented with effects sizes (ES, i.e., Cohen’s d). Effect sizes in bold were moderate, i.e., Cohen’s d ≥ 0.50. These data have been reported in Ringqvist et al. [27].
The effect sizes >0.50 are given in bold. The significance (p-values) are reported in the columns to the left of the columns concerning effect sizes. NRS-7days = Pain intensity as measured by a numeric rating scale for the previous 7 days; HADS = Hospital Anxiety and Depression Scale; MPI = Multidimensional Pain Inventory; EQ-5D-index = The index of the European quality of life instrument; EQ-VAS = The European quality of life instrument thermometer-like scale; sf36 = The Short Form (36) Health Survey; subscales; pf = physical functioning; rp = role limitations due to pf physical functioning; bp = bodily pain; gh = general health; vt = vitality; sf = social functioning; re = role limitations due to emotional problems; and mh = mental health.
In 2008, the Swedish government introduced a rehabilitation guarantee to enhance, for example, the implementation of IPRP in primary care. The SQRP created a module to collect data from IPRP in primary care. A relatively small study (N = 397) of the clinical presentation of the patients treated at this care level found that patients presented a considerable complexity [91]. A small study (N = 234) evaluated the outcomes of IPRP in primary care 1 year after discharge for 10 of the 11 variables selected. Eleven outcomes reflecting a BPS approach were evaluated 1 year after IPRP and 10 of these showed significant improvements although ESs were small (0.20–0.49) [92]. A cost-utility analysis indicated that IPRP in primary care was cost-effective [93].
The intercorrelations of changes in the 22 mandatory outcome variables (cf. Table 7) were investigated using PCAs [27]. Two groups of variables (components), which were not correlated, were identified; the first showed significant intercorrelations between changes in 18 of the outcomes and the second mainly reflected the changes in the second part of MPI together with changes in social support of MPI. Using the score of the first component, a Multivariate Improvement Score (MIS) was defined reflecting changes in the 18 variables [27]. A cluster analysis of MIS was made, and three clusters were identified; retrospectively their baseline situation was analysed. Cluster 1—overall the worst situation pre IPRP—showed the most positive improvements in MIS. Cluster 3—no changes or deterioration in MIS—had the best situation at baseline. Cluster 2 was an intermediary group at baseline and was associated with overall slightly positive MIS improvements [27].
Both post-IPRP and at 12-month follow-up patients retrospectively estimate the degree of positive change in pain and in their ability to handle life situations in general (both rated on five-point Likert scales from markedly increased pain/markedly worsened life situation (score 0) to markedly decreased pain/markedly improved (score 4) [27]. At both time points, most patients reported that their pain situation (57% at both time points), as well as their ability to handle their life situation, had improved (84 and 77%); the two most positive alternatives were added [27].
All patients undergoing IPRP registered in SQRP between 2007 and 2011 (n=7 297) were linked to the Swedish Social Insurance Agency database and the development of sick leave was analysed [94]. Sick-leave benefits increased during the year before IPRP and decreased after IPRP (analysed up to 2 years after) (Figure 3). These reductions in benefits were significant for both men and women. It was concluded that IPRP could positively influence sick-leave benefits for these patients regardless of their sick-leave situation, sex/gender, or policy changes.
Level of sick leave at 90–0 days before (T1) IPRP, 320–410 days after (T2) IPRP, and 775–985 days after (T3) IPRP; N = 7 297 (Rivano Fischer et al. [
A larger study of sick absence for patients included in SQRP (N = 44 241) showed similar results—i.e., sick absence increased from 17% 5 years before to 48% at assessment at the specialist department and thereafter decreased to 38% [95]. Sickness absence history was the strongest predictor of future sickness. Decreases in pain intensity/severity and pain interference but not increases in life control and social support or reduced affective stress during IPRP were associated with decreased risk of being on full-time sick leave 1 year later according to another SQRP study (N = 1 468) from a university department [96]. The same authors reported from a cohort of 2 784 patients that the subgroup DYS of MPI decreased after IPRP [97]. Those belonging to AC or ID had less full-time sick leave 1 year later and therefore the DYS profile was associated with long-term sick leave.
Decreases in sick leave after IPRP were reported in a target trial emulation study using SQRP data (N = 25 613) [68], but the results were not significantly better than for the comparison group. The article was the first target trial emulation attempt using SQRP data (see above). This study has been criticised for its heterogenous comparator group and lack of data concerning other interventions and patient preferences [98]. In addition, this critique emphasised that very complex processes may exist after the assessment when preparing and establishing the rehabilitation/treatment plan. Hence, registries such as SQRP need to collect detailed data concerning assessments, all interventions offered (including contents and dosages), as well as patient-related preferences. More details about the clinical departments might also be beneficial [18]. Perhaps one might expect more prominent decreases of sick leave in IPRP than in the comparison group. According to Swedish guidelines, IPRP should be offered to the most complex chronic pain patients, but those participating in IPRP had gross sick leave days the year before IPRP, so that is necessarily not a correct expectation.
Long-term opioid therapy (LTOT) for chronic pain is unfortunately common in clinical practise despite lack of evidence and serious adverse consequences [99, 100, 101, 102, 103]. At a university hospital reporting to SQRP, 30% of the patients referred to a clinical department used opioids daily [104]. These patients had higher pain intensity, more pain interference, lower quality of life, lower activity engagement, and less satisfaction with life than the other patients referred (medium ESs) [104]. Svanberg et al. investigated the opioid prescriptions 2 years after chronic pain patients were assessed for IPRP [105]. Opioid prescriptions were prescribed for 55% of the cohort (N = 1334). The odds of receiving LTOT were similar for those participating and not participating in IPRP. Patient characteristics at baseline/assessment in both these groups could predict LTOT. In those participating in IPRP, dysfunctional pain coping was a predictor; however, in those not participating in IPRP, pain intensity and depressive symptoms were predictors. Taken together, these studies indicate that long-term pharmacological treatment is not optimal for patients who are eligible for IPRP.
Evidence is contradictory when it comes to clinical presentation pre-treatment. A recent meta-analysis on prognostic factors for IPRP outcome demonstrated that both higher levels of general emotional distress and pain-specific cognitive behavioural factors were related to worse long-term (>6 months) physical functioning post-treatment [106]. However, a similar pattern was not displayed in two large-scale SQRP cohort studies where patients reporting higher levels of perceived disability and suffering displayed slightly greater improvement [27, 70]. Hence, those with the most severe clinical presentations at baseline will display the largest improvements found in SQRP studies [70, 71, 75].
Pain distribution (i.e., spreading of pain) is another factor that needs consideration. Cross-sectional population studies have reported that spreading of pain is significantly associated with pain intensity, depressive disorders, and poor health [107, 108]. In a recent large-scale SQRP cohort study, spreading of pain was associated with poorer outcomes of treatment, but the effects were in the small range [79]. Thus, spreading of pain is important for understanding chronic pain as an indicator of severity, as previously described, and to some extent as a predictor of the poorer outcome of IPRPs.
Psychosocial coping profiles with three subgroups have been derived from the MPI and are commonly used to aid in the assessment of patients with chronic pain. Based on a BPS approach to chronic pain, MPI and its subscales are sensitive to changes in the severity of chronic pain and predict sick leave. The dysfunctional (DYS) subgroup reports high pain severity, marked interference in daily life, high affective distress, low perception of life control, and low levels of activity. The adaptive coper (AC) subgroup is characterised by less severe pain, less interference with activities, less affective distress, and positive perceptions of life control and activity level. The interpersonally distressed (ID) subgroup has been described as perceiving low social support and non-supporting behaviours from significant others [109, 110, 111]. Some reports suggest that the DYS and/or ID subgroups have better treatment outcomes than the AC group [109, 112, 113, 114, 115, 116], whereas other studies have found no significant differences in outcomes amongst subgroups [110, 111, 117, 118, 119, 120, 121]. These results are supported by a large-scale cohort study from the SQRP: DYS and ID subgroups that had the most severe clinical presentation at baseline showed the largest improvement following IPRP [75].
The existing literature regarding sex differences in outcomes of IPRP is conflicting—women benefit more [84, 122, 123], no sex differences [124, 125, 126], and men benefit more [127, 128]. The outcomes of IPRPs in a primary care study were better in women than in men [92]. A recent large-scale cohort study from SQRP found sex differences in outcomes—women had slightly better results than men [87]. The conflicting results in the literature may be due to different cohorts investigated as well as the choice of outcomes.
An important principle in healthcare is equity (i.e., prioritization of healthcare based on the need of the patient); however, social contexts are seldom considered in studies [129]. Several studies have reported that prevalence of chronic pain, the severity of pain, and disability are inversely related to the socio-economic position and low education, male sex, and/or non-European origin (in European studies), which appear to be associated with lower participation rates and worse IPRP results [129, 130, 131, 132].
One-fifth of the European adult population lives with at least
As described in previous passages, results from IPRP demonstrate low to moderate effect sizes on outcomes with conflicting results concerning effects on RTW. Possible gains for the individual and society might be accomplished with improvements of routines and contents of IPRP. It is thus problematic that IPRP is somewhat heterogenous as this can constitute problems establishing strategies for improvements. As a comparison,
The results obtained by the SQRP show that the subgroup of patients with a relatively better clinical picture before IPRP had worse IPRP results than those with a more severe clinical picture [70]. The patient group with the more difficult clinical picture is most improved by IPRP but not so much that they reach the subgroup with a better clinical picture. Both circumstances indicate a need for the development of IPRP so that IPRP better matches the clinical picture. For example, individual treatments, short interventions, small group activities with different content to be selected for individual patients, individual treatments with the team as a backup, and closer communication with primary care to ensure that recommendations can improve the lives of patients without going through extensive IPRPs, which might be more appropriate for the less severe subgroups [15]. In the long run, this could mean that different IPRPs are available in clinical settings. In addition, the activated, mainly unknown, neurobiological pain mechanisms might not be sufficiently targeted by the various interventions in IPRP.
Early interventions might also improve results. The association between prominent pain extent (i.e., widespread pain) and pain duration supports the concept of early intervention as clinically important and an opportunity to possibly change prognosis with conceivable gains for the individual and society. Early interventions with psychological risk factor screening combined with protocols for active collaboration between caregivers and key stakeholders have been demonstrated to positively impact return to work [136].
Poorer results of IPRP in socially more challenged populations might suggest that equal care is not delivered. For example, IPRP in Sweden may not meet the needs of patients outside Europe. It has been suggested that in particularly non-Western backgrounds might be associated with other attitudes towards self-management interventions, passive symptom-focused management strategies, as well as pharmacological treatments [137], which could influence IPRP outcomes. Selection to participation in IPRP and outcomes might also be disadvantaged by different biases of professionals towards non-European patients and/or insufficient knowledge about immigration and other cultures. Lower socio-economic groups may differ from health professionals in culture, beliefs, and communication style, resulting in disadvantages and possibly feelings of inferiority. Carr and Moffet provocatively suggest that CBT interventions designed by middle-class health professionals are more suitable for middle-class patients [130]. Also, a common goal of IPRP is increased physical functioning; however, exercise and sports activities are less likely to be adopted by people in lower socio-economic groups than by people in higher socio-economic groups [138, 139, 140].
This raises important questions concerning fairness and equality. The combination of sex, education, and country of birth needs to be considered in the assessment of chronic pain patients and is important to consider when optimising the content and delivery of IPRP in clinical practice. IPRPs need to be adapted and educational elements fitted to meet different learning styles using techniques to increase retention of new information as described in textbooks, such as ‘Explain pain supercharged’ [141]. In addition, Carr and Moffet suggest that a useful starting point when considering how to improve treatments is the knowledge that people in socially-deprived areas endure higher levels of stress and lower perceived control [130]. Techniques are suggested to reduce stress and learned helplessness and include involving patients in shared decision-making of treatment, increased social support, incorporating individual coaching where the individual can learn to take more control, and additional validation where IPRPs are supplemented by phone calls between sessions. When attendance is challenged, audio and video material could be provided for patients unable to attend.
The patient group with chronic/persistent pain conditions referred to specialist care in Sweden are heterogenous and different subgroups exist. The clinical presentations show clear associations with the extent of pain spreading, BMI, and socio-demographic variables. IPRP is an evidence-based intervention for chronic pain patients who suffer from substantial consequences of their chronic pain condition regarding function, social, and/or psychological well-being. The intervention is complex and is delivered by an interdisciplinary team of professionals in close collaboration with the patient. Observational analyses of IPRP in clinical settings agree with the evidence presented in SRs and MAs. However, results differ amongst subgroups and benefits are not present for all patients. Interestingly, those with the most severe clinical presentation, according to registry data, an assessment benefit most from IPRP. Also, socio-economic factors can influence results and need to be addressed to warrant more equal opportunities for improvement in IPRP.
Units offering IPRPs differ in their strategies, services, and resources, both in intensity and duration, as well as in the degree of individual interventions opposed to group treatment. This diversity should be addressed by researchers and incorporated in studies by looking into the impact of referral flow, traditions, and the heterogeneity of the patients assessed. Methods other than randomised studies, such as emulated trials, repeated measured for patients (patients as controls) should be refined to enhance the potential gaining of analysing real-life information in registries.
There is thus room for enhancement of IPRP possibly by a more structured use of registries. Furthermore, pain registries should expand to cover a variety of clinical efforts designed to meet the individual needs of people with chronic pain and to deliver information about the effectiveness of these measures.
The authors declare no conflict of interest.
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",metaTitle:"About Open Access",metaDescription:"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges.\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.",metaKeywords:null,canonicalURL:"about-open-access",contentRaw:'[{"type":"htmlEditorComponent","content":"The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
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\\n\\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
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\\n\\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\\n\\nDigital Archiving Policy
\\n\\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\\n\\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\\n\\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\\n\\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\\n\\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
\\n\\n\\n"}]'},components:[{type:"htmlEditorComponent",content:'
The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\n\nDigital Archiving Policy
\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\n\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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Everyone must undergo this phase of life at his or her own time and pace. In the broader sense, ageing reflects all the changes taking place over the course of life. These changes start from birth—one grows, develops and attains maturity. To the young, ageing is exciting. Middle age is the time when people notice the age-related changes like greying of hair, wrinkled skin and a fair amount of physical decline. Even the healthiest, aesthetically fit cannot escape these changes. Slow and steady physical impairment and functional disability are noticed resulting in increased dependency in the period of old age. According to World Health Organization, ageing is a course of biological reality which starts at conception and ends with death. It has its own dynamics, much beyond human control. However, this process of ageing is also subject to the constructions by which each society makes sense of old age. In most of the developed countries, the age of 60 is considered equivalent to retirement age and it is said to be the beginning of old age. In this chapter, you understand the details of ageing processes and associated physiological changes.",book:{id:"6381",slug:"gerontology",title:"Gerontology",fullTitle:"Gerontology"},signatures:"Shilpa Amarya, Kalyani Singh and Manisha Sabharwal",authors:[{id:"226573",title:"Ph.D.",name:"Shilpa",middleName:null,surname:"Amarya",slug:"shilpa-amarya",fullName:"Shilpa Amarya"},{id:"226593",title:"Dr.",name:"Kalyani",middleName:null,surname:"Singh",slug:"kalyani-singh",fullName:"Kalyani Singh"},{id:"243264",title:"Dr.",name:"Manisha",middleName:null,surname:"Sabharwal",slug:"manisha-sabharwal",fullName:"Manisha Sabharwal"}]},{id:"55388",doi:"10.5772/intechopen.68944",title:"Beauty, Body Image, and the Media",slug:"beauty-body-image-and-the-media",totalDownloads:7768,totalCrossrefCites:5,totalDimensionsCites:12,abstract:"This chapter analyses the role of the mass media in people’s perceptions of beauty. We summarize the research literature on the mass media, both traditional media and online social media, and how they appear to interact with psychological factors to impact appearance concerns and body image disturbances. There is a strong support for the idea that traditional forms of media (e.g. magazines and music videos) affect perceptions of beauty and appearance concerns by leading women to internalize a very slender body type as ideal or beautiful. Rather than simply being passive recipients of unrealistic beauty ideals communicated to them via the media, a great number of individuals actually seek out idealized images in the media. Finally, we review what is known about the role of social media in impacting society’s perception of beauty and notions of idealized physical forms. Social media are more interactive than traditional media and the effects of self‐presentation strategies on perceptions of beauty have just begun to be studied. This is an emerging area of research that is of high relevance to researchers and clinicians interested in body image and appearance concerns.",book:{id:"5925",slug:"perception-of-beauty",title:"Perception of Beauty",fullTitle:"Perception of Beauty"},signatures:"Jennifer S. Mills, Amy Shannon and Jacqueline Hogue",authors:[{id:"202110",title:"Dr.",name:"Jennifer S.",middleName:null,surname:"Mills",slug:"jennifer-s.-mills",fullName:"Jennifer S. Mills"}]},{id:"59227",doi:"10.5772/intechopen.73385",title:"Differentiating Normal Cognitive Aging from Cognitive Impairment No Dementia: A Focus on Constructive and Visuospatial Abilities",slug:"differentiating-normal-cognitive-aging-from-cognitive-impairment-no-dementia-a-focus-on-constructive",totalDownloads:1353,totalCrossrefCites:3,totalDimensionsCites:6,abstract:"Constructive and visuospatial abilities in normal and in pathological aging (cognitive impairment, no dementia, CIND) are investigated. The sample includes 188 participants over 60 years of age, divided in 2 groups: healthy subjects (MMSE ≥28), without cognitive complaints, and individuals with CIND (MMSE between 24 and 27 and subjective cognitive complains). Drawing of cube and drawing of house, Benton Visual Retention Test (BVRT), and Block design are used to test the hypothesis that short visuoconstructive and visuospatial tests can distinguish normal from pathological cognitive aging in its very early stages. Results proved the discriminative sensitivity of BVRT general assessment criteria and of omissions and distortions in CIND. The diagnostic sensitivity of a modification of Moore and Wike [1984] scoring system for house and cube drawing tasks was confirmed as well. Drawing of cube and house could be used for quick screening of CIND in subjects over 60. Principal component analysis with oblimin rotation was performed to explore the different dimensions in the visuospatial and visuoconstructive abilities in old age. A four-factor structure was established, all four factors explaining 71% of the variance.",book:{id:"6381",slug:"gerontology",title:"Gerontology",fullTitle:"Gerontology"},signatures:"Radka Ivanova Massaldjieva",authors:[{id:"75907",title:"Associate Prof.",name:"Radka Ivanova",middleName:null,surname:"Massaldjieva",slug:"radka-ivanova-massaldjieva",fullName:"Radka Ivanova Massaldjieva"}]},{id:"59658",doi:"10.5772/intechopen.74748",title:"Ageing Better in the Netherlands",slug:"ageing-better-in-the-netherlands",totalDownloads:1193,totalCrossrefCites:1,totalDimensionsCites:4,abstract:"The Dutch National Care for the Elderly Programme was an initiative organized by the Netherlands Organisation for Health Research and Development (ZonMw) between 2008 and 2016. The aim of the programme was to collect knowledge about frail elderly, to assess their needs and to provide person-centred and integrated care better suited to their needs. The budget of EUR 88 million was provided by the Dutch Ministry of Health, Welfare and Sports. Putting the needs of elderly people at the heart of the programme and ensuring their active participation were key to the programme’s success. The programme outcomes included the establishment of eight geriatric networks around the medical universities with 650 organisations and the completion of 218 projects. These projects, involving 43,000 elderly people and 8500 central caregivers, resulted in the completion of 45 PhD theses and the publication of more than 400 articles and the development of 300 practice toolkits, one database and a website, www.beteroud.nl. The Dutch National Care for the Elderly Programme has since developed into a movement and continues under the consortium Ageing Better, made up of eight organisations. Through the use of ambassadors, Ageing Better promotes the message that ageing is not a disease but a new phase of life.",book:{id:"6381",slug:"gerontology",title:"Gerontology",fullTitle:"Gerontology"},signatures:"Betty Meyboom-de Jong, Klaske Wynia and Anjo Geluk-Bleumink",authors:[{id:"224997",title:"Emeritus Prof.",name:"Betty",middleName:null,surname:"Meyboom-De Jong",slug:"betty-meyboom-de-jong",fullName:"Betty Meyboom-De Jong"},{id:"232900",title:"Dr.",name:"Klaske",middleName:null,surname:"Wynia",slug:"klaske-wynia",fullName:"Klaske Wynia"},{id:"232901",title:"Mrs.",name:"Anjo",middleName:null,surname:"Geluk-Bleumink",slug:"anjo-geluk-bleumink",fullName:"Anjo Geluk-Bleumink"}]},{id:"55890",doi:"10.5772/intechopen.69529",title:"Mindfulness Meditation and the Perception of Beauty: Implications for an Ecological Well-Being",slug:"mindfulness-meditation-and-the-perception-of-beauty-implications-for-an-ecological-well-being",totalDownloads:1428,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Meditation is a first-person method for contemplating ourselves and the world, with more than 2500 years of history, rooted in the philosophical and contemplative traditions of the east. The present chapter aims to explore this worldview in order to demonstrate its relevance to our capacity for the appreciation of beauty. To this end, the aesthetic experience, the contemplative experience and their relationship with the practice of mindfulness are analysed. We suggest that the contemplative meditative experience bestows a state of consciousness and acceptance of life which places the practitioner in a progressive encounter with a self-concept that begins to detach from a static sense of the self and from the categories that define it, so that it may be experienced as an ongoing mental event, removed from cultural ideals of beauty or positivity. The result of this de-identification from the static self is a greater degree of psychological flexibility and a more genuine way of seeing the world, leading to a new perception of the self that is connected to an experience of freedom, and contributes to one’s own well-being, as well as to that of others and of the environment.",book:{id:"5925",slug:"perception-of-beauty",title:"Perception of Beauty",fullTitle:"Perception of Beauty"},signatures:"Álvaro I. Langer, Carlos Schmidt and Edwin Krogh",authors:[{id:"199843",title:"Dr.",name:"Álvaro",middleName:null,surname:"Langer",slug:"alvaro-langer",fullName:"Álvaro Langer"},{id:"201865",title:"MSc.",name:"Carlos",middleName:null,surname:"Schmidt",slug:"carlos-schmidt",fullName:"Carlos Schmidt"},{id:"201866",title:"Dr.",name:"Edwin",middleName:null,surname:"Krogh",slug:"edwin-krogh",fullName:"Edwin Krogh"}]}],mostDownloadedChaptersLast30Days:[{id:"60564",title:"Ageing Process and Physiological Changes",slug:"ageing-process-and-physiological-changes",totalDownloads:7024,totalCrossrefCites:19,totalDimensionsCites:34,abstract:"Ageing is a natural process. Everyone must undergo this phase of life at his or her own time and pace. In the broader sense, ageing reflects all the changes taking place over the course of life. These changes start from birth—one grows, develops and attains maturity. To the young, ageing is exciting. Middle age is the time when people notice the age-related changes like greying of hair, wrinkled skin and a fair amount of physical decline. Even the healthiest, aesthetically fit cannot escape these changes. Slow and steady physical impairment and functional disability are noticed resulting in increased dependency in the period of old age. According to World Health Organization, ageing is a course of biological reality which starts at conception and ends with death. It has its own dynamics, much beyond human control. However, this process of ageing is also subject to the constructions by which each society makes sense of old age. In most of the developed countries, the age of 60 is considered equivalent to retirement age and it is said to be the beginning of old age. In this chapter, you understand the details of ageing processes and associated physiological changes.",book:{id:"6381",slug:"gerontology",title:"Gerontology",fullTitle:"Gerontology"},signatures:"Shilpa Amarya, Kalyani Singh and Manisha Sabharwal",authors:[{id:"226573",title:"Ph.D.",name:"Shilpa",middleName:null,surname:"Amarya",slug:"shilpa-amarya",fullName:"Shilpa Amarya"},{id:"226593",title:"Dr.",name:"Kalyani",middleName:null,surname:"Singh",slug:"kalyani-singh",fullName:"Kalyani Singh"},{id:"243264",title:"Dr.",name:"Manisha",middleName:null,surname:"Sabharwal",slug:"manisha-sabharwal",fullName:"Manisha Sabharwal"}]},{id:"55388",title:"Beauty, Body Image, and the Media",slug:"beauty-body-image-and-the-media",totalDownloads:7775,totalCrossrefCites:5,totalDimensionsCites:12,abstract:"This chapter analyses the role of the mass media in people’s perceptions of beauty. We summarize the research literature on the mass media, both traditional media and online social media, and how they appear to interact with psychological factors to impact appearance concerns and body image disturbances. There is a strong support for the idea that traditional forms of media (e.g. magazines and music videos) affect perceptions of beauty and appearance concerns by leading women to internalize a very slender body type as ideal or beautiful. Rather than simply being passive recipients of unrealistic beauty ideals communicated to them via the media, a great number of individuals actually seek out idealized images in the media. Finally, we review what is known about the role of social media in impacting society’s perception of beauty and notions of idealized physical forms. Social media are more interactive than traditional media and the effects of self‐presentation strategies on perceptions of beauty have just begun to be studied. This is an emerging area of research that is of high relevance to researchers and clinicians interested in body image and appearance concerns.",book:{id:"5925",slug:"perception-of-beauty",title:"Perception of Beauty",fullTitle:"Perception of Beauty"},signatures:"Jennifer S. Mills, Amy Shannon and Jacqueline Hogue",authors:[{id:"202110",title:"Dr.",name:"Jennifer S.",middleName:null,surname:"Mills",slug:"jennifer-s.-mills",fullName:"Jennifer S. Mills"}]},{id:"56505",title:"Aesthetics of the Naked Human Body: From Pornography (Sexualised Lust Object) to Iconography (Aesthetics of Human Nobility and Wisdom) in an Anthropology of Physical Beauty",slug:"aesthetics-of-the-naked-human-body-from-pornography-sexualised-lust-object-to-iconography-aesthetics",totalDownloads:2102,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In many religious circles and philosophies of life, the human body is excluded from the realm of spirituality and meaning. Due to a dualistic approach, nudity is viewed as merely a physical and corporeal category. In social media, there is the real danger that the naked human body is exploited for commercial gain. Advertisements often leave the impression that the body, very specifically the genitals, is designed merely for physical desire and corporeal chemistry. They become easily objects for lust, excluded from the beauty of graceful existence and noble courage. It is argued that the naked human body is not designed for pornographic exploitation and promiscuous sensuality but for compassionate intimacy and nurturing care in order to instil a humane dimension in human and sexual encounters. In this regard, antiquity and the Michelangelesque perspective can contribute to a paradigm shift from abusive exploitation to the beauty of vulnerable sensitivity. In order to foster an integrative approach to theory formation in anthropology, the methodology of stereometric thinking is proposed.",book:{id:"5925",slug:"perception-of-beauty",title:"Perception of Beauty",fullTitle:"Perception of Beauty"},signatures:"Daniel J Louw",authors:[{id:"200645",title:"Prof.",name:"Daniel",middleName:"Johannes",surname:"Louw",slug:"daniel-louw",fullName:"Daniel Louw"}]},{id:"56059",title:"A Plastic Surgeon’s Perspective on Stereotyping and the Perception of Beauty",slug:"a-plastic-surgeon-s-perspective-on-stereotyping-and-the-perception-of-beauty",totalDownloads:1920,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"In the world of plastic surgery, misconceptions may lead to irrational requests or outcomes not appreciated by patients. Those who manage aesthetics should always listen and recognize the variability of cultural identities, desires, attitudes, anxieties and uncertainties of the patient. Emerging from a diversity of cultures and its transforming trends, the scope of cosmetic surgery and its practice reflect not only the individual’s personality, but also the culture as a whole. When counseling an individual, one has to recognize that even in groups of seemingly identical social or cultural standards; there are subtle differences in expectations. To illustrate the potential for inaccuracy of ethnic profiling in the field of plastic surgery authors quote their own work on Asian subjects and facial beauty and resort to experience of others. To reaffirm their opinion and to exemplify how sometimes “fine” differences in the perception of beauty exist, an original study that evaluates the preferences among selected groups of Latina women in respect to buttock aesthetics has been included. This dissertation will focus on how cultural factors influence beauty perception; strengthen the fact that beauty is in the eye of the beholder and how variable differences exist even between small subgroups.",book:{id:"5925",slug:"perception-of-beauty",title:"Perception of Beauty",fullTitle:"Perception of Beauty"},signatures:"Johanna D’Agostino and Marek Dobke",authors:[{id:"17590",title:"Dr.",name:"Marek K.",middleName:null,surname:"Dobke",slug:"marek-k.-dobke",fullName:"Marek K. Dobke"},{id:"201244",title:"Dr.",name:"Johanna",middleName:null,surname:"D'Agostino",slug:"johanna-d'agostino",fullName:"Johanna D'Agostino"}]},{id:"80326",title:"Anti-Senescence Therapy",slug:"anti-senescence-therapy",totalDownloads:111,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The development of therapeutic strategies aimed at the aging process of cells has attracted increasing attention in recent decades due to the involvement of this process in the development of many chronic and age-related diseases. Interestingly, preclinical studies have shown the success of a number of anti-aging approaches in the treatment of a range of chronic diseases. These approaches are directed against aging processes such as oxidative stress, telomerase shortening, inflammation, and deficient autophagy. Many strategies has been shown to be effective in delaying aging, including antiaging strategies based on establishing healthy lifestyle habits and pharmacological interventions aimed at disrupting senescent cells and senescent-associated secretory phenotype. Caloric restriction and intermittent fasting were reported to activate autophagy and reduce inflammation. In turn, immune-based strategies, senolytic agents, and senomorphics mediate their effects either by eliminating senescent cells through inducing apoptosis or by disrupting pathways by which senescent cells mediate their detrimental effects. In addition, given the association of the decline in the regenerative potential of stem cells with aging, many experimental and clinical studies indicate the effectiveness of stem cell transplantation in preventing or slowing the progress of age-related diseases by enhancing the repairing mechanisms and the secretion of many growth factors and cytokines.",book:{id:"10935",slug:null,title:"Mechanisms and Management of Senescence",fullTitle:"Mechanisms and Management of Senescence"},signatures:"Raghad Alshadidi",authors:null}],onlineFirstChaptersFilter:{topicId:"235",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82112",title:"Comparative Senescence and Lifespan",slug:"comparative-senescence-and-lifespan",totalDownloads:17,totalDimensionsCites:0,doi:"10.5772/intechopen.105137",abstract:"The word senescence is derived from the Latin word “senex” (meaning old). In biology, senescence is a process by which a cell ages and permanently stops dividing. Senescence is a natural universal phenomenon affecting all living organisms (e.g., humans, animals, and plants). It is the process of growing old (aging). The underlying mechanisms of senescence and aging at the cellular level are not fully understood. Senescence is a multifactorial process that can be induced by several stimuli including cellular stress, DNA damage, telomere shortening, and oncogene activation. The most popular theory to explain aging is the free radical theory. Senescence plays a role in the development of several age-related chronic diseases in humans (e.g., ischemic heart disease, osteoporosis, and cancer). Lifespan is a biological characteristic of every species. The lifespan of living organisms ranges from few hours (with mayfly) to potential eternity (with jellyfish and hydra). The maximum theoretical lifespan in humans is around 120 years. The lifespan in humans is influenced by multiple factors including genetic, epigenetic, lifestyle, environmental, metabolic, and endocrine factors. There are several ways to potentially extend the lifespan of humans and eventually surpass the maximum theoretical lifespan of 120 years. The tools that can be proposed include lifestyle, reduction of several life-threatening diseases and disabilities, hormonal replacement, antioxidants, autophagy inducers, senolytic drugs, stem cell therapy, and gene therapy.",book:{id:"10935",title:"Mechanisms and Management of Senescence",coverURL:"https://cdn.intechopen.com/books/images_new/10935.jpg"},signatures:"Hassan M. Heshmati"},{id:"81638",title:"Aging and Neuropsychiatric Disease: A General Overview of Prevalence and Trends",slug:"aging-and-neuropsychiatric-disease-a-general-overview-of-prevalence-and-trends",totalDownloads:30,totalDimensionsCites:0,doi:"10.5772/intechopen.103102",abstract:"The increasing trend of life-expectancy is becoming a significant demographic, societal and economic challenge. Currently, global number of people above sixty years of age is 900 million, while United Nations expect this number to rise to over 1.4 billion in 2030 and over 2.5 billion by 2050. Concordant to this trend, numerous physiological changes are associated with aging and brain-related ones are associated with neuropsychiatric diseases. The main goal of this chapter is to identify the most important neuropsychiatric diseases to assess in older patients to help to promote health and prevent diseases and complications associated with chronic illness, as these changes are progressive and require important psychological and setting-related social adjustments. Findings identify several health-aspects highly present in elderly: stroke, white matter lesions, dementia rise with age, changes in levels of neurotransmitters and hormones, depression as well as the bereavement following loss of the loved one, and the most common neurodegenerative disease—Alzheimer’s disease and Parkinson’s. In conclusion, studying the aging process should include all developmental, circumstantial, and individual aspects of aging. This offers opportunities to improve the health of elderly by using a wide range of skills and knowledge. Thus, further studies are necessary to elucidate what can be done do to improve the aging process and health of elderly in the future.",book:{id:"10935",title:"Mechanisms and Management of Senescence",coverURL:"https://cdn.intechopen.com/books/images_new/10935.jpg"},signatures:"Jelena Milić"},{id:"80326",title:"Anti-Senescence Therapy",slug:"anti-senescence-therapy",totalDownloads:111,totalDimensionsCites:0,doi:"10.5772/intechopen.101585",abstract:"The development of therapeutic strategies aimed at the aging process of cells has attracted increasing attention in recent decades due to the involvement of this process in the development of many chronic and age-related diseases. Interestingly, preclinical studies have shown the success of a number of anti-aging approaches in the treatment of a range of chronic diseases. These approaches are directed against aging processes such as oxidative stress, telomerase shortening, inflammation, and deficient autophagy. Many strategies has been shown to be effective in delaying aging, including antiaging strategies based on establishing healthy lifestyle habits and pharmacological interventions aimed at disrupting senescent cells and senescent-associated secretory phenotype. Caloric restriction and intermittent fasting were reported to activate autophagy and reduce inflammation. In turn, immune-based strategies, senolytic agents, and senomorphics mediate their effects either by eliminating senescent cells through inducing apoptosis or by disrupting pathways by which senescent cells mediate their detrimental effects. In addition, given the association of the decline in the regenerative potential of stem cells with aging, many experimental and clinical studies indicate the effectiveness of stem cell transplantation in preventing or slowing the progress of age-related diseases by enhancing the repairing mechanisms and the secretion of many growth factors and cytokines.",book:{id:"10935",title:"Mechanisms and Management of Senescence",coverURL:"https://cdn.intechopen.com/books/images_new/10935.jpg"},signatures:"Raghad Alshadidi"},{id:"79828",title:"Cellular Senescence in Bone",slug:"cellular-senescence-in-bone",totalDownloads:119,totalDimensionsCites:0,doi:"10.5772/intechopen.101803",abstract:"Senescence is an irreversible cell-cycle arrest process induced by environmental, genetic, and epigenetic factors. An accumulation of senescent cells in bone results in age-related disorders, and one of the common problems is osteoporosis. Deciphering the basic mechanisms contributing to the chronic ailments of aging may uncover new avenues for targeted treatment. This review focuses on the mechanisms and the most relevant research advancements in skeletal cellular senescence. To identify new options for the treatment or prevention of age-related chronic diseases, researchers have targeted hallmarks of aging, including telomere attrition, genomic instability, cellular senescence, and epigenetic alterations. First, this chapter provides an overview of the fundamentals of bone tissue, the causes of skeletal involution, and the role of cellular senescence in bone and bone diseases such as osteoporosis. Next, this review will discuss the utilization of pharmacological interventions in aging tissues and, more specifically, highlight the role of senescent cells to identify the most effective and safe strategies.",book:{id:"10935",title:"Mechanisms and Management of Senescence",coverURL:"https://cdn.intechopen.com/books/images_new/10935.jpg"},signatures:"Danielle Wang and Haitao Wang"},{id:"79668",title:"Identification of RNA Species That Bind to the hnRNP A1 in Normal and Senescent Human Fibroblasts",slug:"identification-of-rna-species-that-bind-to-the-hnrnp-a1-in-normal-and-senescent-human-fibroblasts",totalDownloads:81,totalDimensionsCites:0,doi:"10.5772/intechopen.101525",abstract:"hnRNP A1 is a member of the hnRNPs (heterogeneous nuclear ribonucleoproteins) family of proteins that play a central role in regulating genes responsible for cell proliferation, DNA repair, apoptosis, and telomere biogenesis. Previous studies have shown that hnRNPA1 had reduced protein levels and increased cytoplasmic accumulation in senescent human diploid fibroblasts. The consequence of reduced protein expression and altered cellular localization may account for the alterations in gene expression observed during senescence. There is limited information for gene targets of hnRNP A1 as well as its in vivo function. In these studies, we performed RNA co-immunoprecipitation experiments using hnRNP A1 as the target protein to identify potential mRNA species in ribonucleoprotein (RNP) complexes. Using this approach, we identified the human double minute 2 (HDM2) mRNA as a binding target for hnRNP A1 in young and senescent human diploid fibroblasts cells. It was also observed that alterations of hnRNP A1 expression modulate HDM2 mRNA levels in young IMR-90 cells. We also demonstrated that the levels of HDM2 mRNA increased with the downregulation of hnRNP A1 and decrease with the overexpression of hnRNP A1. Although we did not observe a significant decrease in HDM2 protein level, a concomitant increase in p53 protein level was detected with the overexpression of hnRNP A1. Our studies also show that hnRNP A1 directly interacts with HDM2 mRNA at a region corresponding to its 3′ UTR (untranslated region of a gene). The results from this study demonstrate that hnRNP A1 has a novel role in participating in the regulation of HDM2 gene expression.",book:{id:"10935",title:"Mechanisms and Management of Senescence",coverURL:"https://cdn.intechopen.com/books/images_new/10935.jpg"},signatures:"Heriberto Moran, Shanaz A. Ghandhi, Naoko Shimada and Karen Hubbard"},{id:"79295",title:"Genetic and Epigenetic Influences on Cutaneous Cellular Senescence",slug:"genetic-and-epigenetic-influences-on-cutaneous-cellular-senescence",totalDownloads:136,totalDimensionsCites:0,doi:"10.5772/intechopen.101152",abstract:"Skin is the largest human organ system, and its protective function is critical to survival. The epithelial, dermal, and subcutaneous compartments are heterogeneous mixtures of cell types, yet they all display age-related skin dysfunction through the accumulation of an altered phenotypic cellular state called senescence. Cellular senescence is triggered by complex and dynamic genetic and epigenetic processes. A senescence steady state is achieved in different cell types under various and overlapping conditions of chronological age, toxic injury, oxidative stress, replicative exhaustion, DNA damage, metabolic dysfunction, and chromosomal structural changes. These inputs lead to outputs of cell-cycle withdrawal and the appearance of a senescence-associated secretory phenotype, both of which accumulate as tissue pathology observed clinically in aged skin. This review details the influence of genetic and epigenetic factors that converge on normal cutaneous cellular processes to create the senescent state, thereby dictating the response of the skin to the forces of both intrinsic and extrinsic aging. From this work, it is clear that no single biomarker or process leads to senescence, but that it is a convergence of factors resulting in an overt aging phenotype.",book:{id:"10935",title:"Mechanisms and Management of Senescence",coverURL:"https://cdn.intechopen.com/books/images_new/10935.jpg"},signatures:"Tapash Jay Sarkar, Maiko Hermsmeier, Jessica L. Ross and G. Scott Herron"}],onlineFirstChaptersTotal:6},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:11,numberOfPublishedChapters:91,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:333,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:11,numberOfPublishedChapters:144,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:124,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:113,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:23,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:12,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:"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"}}}},{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"}}}}]},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:"August 17th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:11,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). In addition to a number of research articles, he has written two books, Computational Intelligence: An Introduction and Fundamentals of Computational Swarm Intelligence.",institutionString:null,institution:{name:"Stellenbosch University",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). 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. 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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. 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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. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"117248",title:"Dr.",name:"Andrew",middleName:null,surname:"Macnab",slug:"andrew-macnab",fullName:"Andrew Macnab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. 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Novel computational algorithms for image analysis, scene understanding, biometrics, deep learning and their software or hardware implementations for natural and medical images, robotics, VR/AR, applications are some research directions relevant to this topic.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11420,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. 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