Proportion of countries and population covered by the GODT database in the WHO regions. Year 2015 [17].
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
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With a contribution from multiple neighboring scientific disciplines, this book characterizes fundamental mechanisms, represents wide applications, and introduces state-of-the-art approaches in the modern sociolinguistic research. Three unique questions are asked and addressed by eight independent chapters: (1) the diversity and dynamics of the language use in multilingualism, human development, and organizational change; (2) the application of linguistic analysis to society, policy planning, and health education; and (3) the new approaches to sociolinguistics with an emphasis on communicative and cognitive aspects of language use.",isbn:"978-953-51-3334-6",printIsbn:"978-953-51-3333-9",pdfIsbn:"978-953-51-4764-0",doi:"10.5772/65156",price:119,priceEur:129,priceUsd:155,slug:"sociolinguistics-interdisciplinary-perspectives",numberOfPages:148,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"e87ee120f901a00564a230234d9e3ed5",bookSignature:"Xiaoming Jiang",publishedDate:"July 5th 2017",coverURL:"https://cdn.intechopen.com/books/images_new/5726.jpg",numberOfDownloads:13697,numberOfWosCitations:7,numberOfCrossrefCitations:8,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:11,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:26,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 7th 2016",dateEndSecondStepPublish:"November 7th 2016",dateEndThirdStepPublish:"February 15th 2017",dateEndFourthStepPublish:"March 27th 2017",dateEndFifthStepPublish:"May 29th 2017",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"189844",title:"Prof.",name:"Xiaoming",middleName:null,surname:"Jiang",slug:"xiaoming-jiang",fullName:"Xiaoming Jiang",profilePictureURL:"https://mts.intechopen.com/storage/users/189844/images/system/189844.jpg",biography:"Dr. Xiaoming Jiang is a professor at the Institute of Linguistics, Shanghai International Studies University, China. He obtained a BS in Psychology from East China Normal University and a Ph.D. in Cognitive Neuroscience from Peking University. He served as a research fellow at the School of Communication Sciences and Disorders, McGill University, Montreal, Quebec, Canada, and as a senior speech scientist in nuance communication. His research utilizes experimental methodologies to uncover social and interpersonal aspects of human communicative processes in both monolingual and multilingual contexts. While serving as guest editor for Frontiers in Psychology and Frontiers in Communication, he published nearly forty peer-reviewed articles as lead author in high-impact journals such as NeuroImage, Journal of Experimental Psychology: Human Perception and Performance, and Speech Communication.",institutionString:"Shanghai International Studies University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Shanghai International Studies University",institutionURL:null,country:{name:"China"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1340",title:"Multilingualism",slug:"multilingualism"}],chapters:[{id:"54680",title:"The Evolutionary Dynamics of the Mixe Language",doi:"10.5772/intechopen.68151",slug:"the-evolutionary-dynamics-of-the-mixe-language",totalDownloads:1131,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Mexico has been characterized by its great linguistic diversity concentrating 364 native linguistic variants from 11 native linguistic families. Unfortunately, the risk of disappearing of Mexican indigenous languages represents a problem for Mexican culture since they are precisely the medium through which cultural knowledge is transmitted. The risk of disappearing is reflected on a small number of native speakers and their geographical dispersion, the prevalence of adult speakers, and the tendency to abandon transmission strategies to youngest generations. The aim of this chapter is to analyze the impact of idiolect mutations on the evolutionary dynamics of the linguistic group Mixe in Camotlán, San Sebastian, Puxmetacán, Mazatlan, and Coatlán communities. First, we develop a conceptual model of the linguistic group Mixe as complex adaptive system, followed by the implementation of an agent-based simulation model in NetLogo, and finally, we analyze the evolutionary dynamics of the Mixe language, depending on the mutation rate of the idiolects. From the simulation analysis, we observe that when the mutation rate in idiolects is equal to zero, the Mixe language becomes homogenous. On the contrary, when the rate of mutations is equal to 100, a large number of language variants are generated and the risk of disappearing increases for Mixe language.",signatures:"Aida Huerta Barrientos",downloadPdfUrl:"/chapter/pdf-download/54680",previewPdfUrl:"/chapter/pdf-preview/54680",authors:[{id:"180108",title:"Prof.",name:"Aida",surname:"Huerta Barrientos",slug:"aida-huerta-barrientos",fullName:"Aida Huerta Barrientos"}],corrections:null},{id:"54552",title:"Language Evolution, Acquisition, Adaptation and Change",doi:"10.5772/67767",slug:"language-evolution-acquisition-adaptation-and-change",totalDownloads:2038,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"In the twenty‐first century, there are between 6000 and 8000 different languages spoken in the world, all of which are in a continuous state of evolving, by inter‐mixing or stagnating, growing or contracting. This occurs through changes in the population size of the people who use them, the frequency and form of their use in different media, through migration and through inter‐mixing with other languages. As Stadler et al. argue, human languages are a ‘culturally evolving trait’ and when it occurs language change is both sporadic and robust (faithfully replicated) and the main established variants are replaced by new variants. Only about 200 of these disparate languages are in written as well as spoken form, and most, except the popular ones like Mandarin, Spanish, English, Hindi, Arabic, Portuguese, Bengali, and Russian, are in decline of use. But how did language itself evolve and come to be the most important innate tool possessed by people? The complex issue of language evolution continues to perplex because of its associations with culture, social behaviour and the development of the human mind.",signatures:"Luke Strongman",downloadPdfUrl:"/chapter/pdf-download/54552",previewPdfUrl:"/chapter/pdf-preview/54552",authors:[{id:"189739",title:"Dr.",name:"Luke",surname:"Strongman",slug:"luke-strongman",fullName:"Luke Strongman"}],corrections:null},{id:"55966",title:"Adapting to Complexities in Dialogue",doi:"10.5772/intechopen.69683",slug:"adapting-to-complexities-in-dialogue",totalDownloads:1257,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"The world is getting a VUCA place. A world that is more volatile, uncertain, complex and ambiguous. Changing conditions can be seen at a global level, on the level of societies and organizations but also at a micro level of people. Dealing with differences requires awareness about our own world views, and an open mind to understand the viewpoint of others. For interaction to be productive, participants need to recognize the different voices that come into play. This ‘social complexity’ is a underlying aspect relevant for understanding how to cope with VUCA situations. The aim of this chapter is to describe the conversational processes that take place during interactions between different professionals in organizations. Applying the ‘ladder of complexity’ and discourse analysis in three cases reveal that different ‘voices’ can be distinguished in the process of organizational change. We promote incorporating sociolinguistics into the field of organizational change. Section 1 introduces the ‘playground’ we live in followed by different paradigms about communicating and change management. Section 3 introduces the ‘ladder of complexity’ aligning social complexity and dialogue. Section 4 describes 3 cases using discourse analysis to understand the interaction in conversations. Section 5 draws conclusions and give directions for future research.",signatures:"Jos H. Pieterse and Rombout van den Nieuwenhof",downloadPdfUrl:"/chapter/pdf-download/55966",previewPdfUrl:"/chapter/pdf-preview/55966",authors:[{id:"195831",title:"Dr.",name:"Jos",surname:"Pieterse",slug:"jos-pieterse",fullName:"Jos Pieterse"},{id:"196701",title:"Dr.",name:"Rombout",surname:"Van Den Nieuwenhof",slug:"rombout-van-den-nieuwenhof",fullName:"Rombout Van Den Nieuwenhof"}],corrections:null},{id:"55425",title:"Standard English for Empowerment in Multilingual Sub-Saharan Africa",doi:"10.5772/intechopen.68332",slug:"standard-english-for-empowerment-in-multilingual-sub-saharan-africa",totalDownloads:1222,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Standard English for empowerment in sub‐Saharan Africa is a complex issue for several reasons, chief of which is the slavery, colonial and neo‐colonial legacies in which English was deliberately packaged by early British explorers of the region. In line with explorer legacies, English has been largely administered for both general and literary purposes, which have tended to cast this language as a British colonial crown jewel. Consequently, sub‐Saharan Africa has used English for this limited educational purpose, ending up producing items the region does not consume and consuming items it does not produce. Using qualitative methods and critical discourse analysis (CDA) to analyse some of the archival material of one of the early British explorers to the southern part of the region—David Livingstone—the chapter presents some sociolinguistics findings. It then suggests how Standard English in content and language integrated learning (CLIL) can be used for mediating the ills of slavery, colonial and neo‐colonial legacies.",signatures:"Bernard Nchindila",downloadPdfUrl:"/chapter/pdf-download/55425",previewPdfUrl:"/chapter/pdf-preview/55425",authors:[{id:"196855",title:"Prof.",name:"Bernard",surname:"Nchindila",slug:"bernard-nchindila",fullName:"Bernard Nchindila"}],corrections:null},{id:"54872",title:"The Characteristics of Language Policy and Planning Research: An Overview",doi:"10.5772/intechopen.68152",slug:"the-characteristics-of-language-policy-and-planning-research-an-overview",totalDownloads:3596,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"This chapter has been compiled to provide an overview of the language policing and planning (LPP) field, particularly for new researchers who would like to pursue their MA or PhD. It aims to explore the following: the genesis of LPP from the 1950s to date, type of research questions pertinent to the field, methodology that can be applied, substantial literature review and case studies that have been carried out in LPP, ethnography of language policy and planning, the historical analysis approach and authorities in the field of LPP such as Hornberger, Johnson and Ricento.",signatures:"Prashneel Ravisan Goundar",downloadPdfUrl:"/chapter/pdf-download/54872",previewPdfUrl:"/chapter/pdf-preview/54872",authors:[{id:"195526",title:"Mr.",name:"Prashneel",surname:"Goundar",slug:"prashneel-goundar",fullName:"Prashneel Goundar"}],corrections:null},{id:"55034",title:"Critical Discourse Analysis Perspective on Norwegian Public Health Nursing Curriculum in a Time of Transition",doi:"10.5772/intechopen.68533",slug:"critical-discourse-analysis-perspective-on-norwegian-public-health-nursing-curriculum-in-a-time-of-t",totalDownloads:1670,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Discourse analysis is an area of social linguistics, which can advance social theory in the direction of language. Public health nurses are to perform health promotion and disease prevention work on an individual and population level. By identifying how features of different discourses are constructed and maintained, combining linguistics tools and social science perspectives, the purpose was to provide an understanding of the health promotion and disease prevention discourse in the public health nursing curriculum to reveal governmental strategies for public health nursing education in a time of transition. Fairclough’s three‐dimensional model of critical discourse analysis that consists of the analytical dimensions social events, social practices, and social structures was carried out. There is a linguistic‐discursive dialectic between the dimensions. The analysis revealed four discourses in the curriculum text: a contradictory health promotion and disease prevention discourse; a paternalistic meta‐discourse; a hegemonic individual discourse; and a hegemonic discourse for interdisciplinary collaboration. The results indicate a hegemonic disease prevention discourse, while the health promotion discourse being more disguised. The analysis revealed how language functions ideologically, and in line with the sociolinguistics, how the role of the language in the curriculum text can have consequences for the social work of public health nurses.",signatures:"Berit Misund Dahl",downloadPdfUrl:"/chapter/pdf-download/55034",previewPdfUrl:"/chapter/pdf-preview/55034",authors:[{id:"195508",title:"Dr.",name:"Berit Misund",surname:"Dahl",slug:"berit-misund-dahl",fullName:"Berit Misund Dahl"}],corrections:null},{id:"55107",title:"Time-Series Analysis of Video Comments on Social Media",doi:"10.5772/intechopen.68636",slug:"time-series-analysis-of-video-comments-on-social-media",totalDownloads:1436,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:1,abstract:"In this study, we propose a method to detect unfair rating cheat caused by multiple comment postings focusing on time-series analysis of the number of comments. We defined the videos that obtained a lot of comments by unfair cheat as ‘unfair video’ and defined the videos which obtained without unfair cheat as ‘popular video’. Specifically, our proposed method focused on the difference of chronological distributions of the comments between the popular videos and the unfair videos. As the evaluation result, our proposed method could obtain higher accuracy than that of the baseline method.",signatures:"Kazuyuki Matsumoto, Hayato Shimizu, Minoru Yoshida and Kenji\nKita",downloadPdfUrl:"/chapter/pdf-download/55107",previewPdfUrl:"/chapter/pdf-preview/55107",authors:[{id:"195756",title:"Dr.",name:"Kazuyuki",surname:"Matsumoto",slug:"kazuyuki-matsumoto",fullName:"Kazuyuki Matsumoto"}],corrections:null},{id:"56149",title:"Experimental Approaches to Socio‐Linguistics: Usage and Interpretation of Non‐Verbal and Verbal Expressions in Cross‐ Cultural Communication",doi:"10.5772/intechopen.69879",slug:"experimental-approaches-to-socio-linguistics-usage-and-interpretation-of-non-verbal-and-verbal-expre",totalDownloads:1349,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Social context shapes our behavior in interpersonal communication. In this chapter, I will address how experimental psychology contributes to the study of socio-linguistic processes, focusing on nonverbal and verbal processing in a cross-cultural or cross-linguistic communicative setting. A systematic review of the most up-to-date empirical studies will show: 1) the culturally-universal and culturally-specific encoding of emotion in speech. The acoustic cues that are commonly involved in discriminating basic emotions in vocal expressions across languages and the cross-linguistic variations in such encoding will be demonstrated; 2) the modulation of in-group and out-group status (e.g. inferred from speaker’s dialect, familiarity towards a language) on the encoding and decoding of speaker’s meaning; 3) the impact of cultural orientation and cultural learning on the interpretation of social and affective meaning, focusing on how immigration process shapes one’s language use and comprehension. I will highlight the significance of combining the research paradigms from experimental psychology with cognitive (neuro)science methodologies such as electrophysiological recording and functional magnetic resonance imaging, to address the relevant questions in cross-cultural communicative settings. The chapter is concluded by a future direction to study the socio-cultural bases of language and linguistic underpinnings of cultural behaviour.",signatures:"Xiaoming Jiang",downloadPdfUrl:"/chapter/pdf-download/56149",previewPdfUrl:"/chapter/pdf-preview/56149",authors:[{id:"189844",title:"Prof.",name:"Xiaoming",surname:"Jiang",slug:"xiaoming-jiang",fullName:"Xiaoming Jiang"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"10658",title:"Multilingualism",subtitle:"Interdisciplinary Topics",isOpenForSubmission:!1,hash:"a6bf171e05831c00f8687891ab1b10b5",slug:"multilingualism-interdisciplinary-topics",bookSignature:"Xiaoming Jiang",coverURL:"https://cdn.intechopen.com/books/images_new/10658.jpg",editedByType:"Edited by",editors:[{id:"189844",title:"Prof.",name:"Xiaoming",surname:"Jiang",slug:"xiaoming-jiang",fullName:"Xiaoming Jiang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9037",title:"Types of Nonverbal Communication",subtitle:null,isOpenForSubmission:!1,hash:"b0dbec02150cdf49e7a1d49326a35273",slug:"types-of-nonverbal-communication",bookSignature:"Xiaoming Jiang",coverURL:"https://cdn.intechopen.com/books/images_new/9037.jpg",editedByType:"Edited by",editors:[{id:"189844",title:"Prof.",name:"Xiaoming",surname:"Jiang",slug:"xiaoming-jiang",fullName:"Xiaoming Jiang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6201",title:"Multilingualism and Bilingualism",subtitle:null,isOpenForSubmission:!1,hash:"50d360789329236ddac7347ab54a66dc",slug:"multilingualism-and-bilingualism",bookSignature:"Beban Sammy Chumbow",coverURL:"https://cdn.intechopen.com/books/images_new/6201.jpg",editedByType:"Edited by",editors:[{id:"113835",title:"Prof.",name:"Sammy Beban",surname:"Chumbow",slug:"sammy-beban-chumbow",fullName:"Sammy Beban Chumbow"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. 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Transplantation programme is a complex healthcare service which entails huge costs and requires highly skilled health professionals, complex infrastructure and equipment, and well-articulated legal frameworks to enable its operationalization [1]. The need for appropriate interventions for organ failures in sub-Saharan Africa (SSA) is underscored by the high prevalence of end-organ diseases such as chronic kidney disease (CKD), chronic liver disease (CLD), chronic lung and heart diseases (interstitial lung disease, cystic fibrosis, cardiomyopathies and chronic rheumatic heart diseases) which cause increased morbidity and mortality. For example, Kaze
Globally, beside organs, tissues and cells (bone marrow cornea, etc.) are also transplanted. However, in SSA, apart from South Africa which also does liver and heart transplantation, the common organ transplanted is the kidney [3]. Though outcomes for transplantation have improved over the years due to better surgical techniques including minimal access surgeries, newer and better immunosuppressive medications, innovations in organ donation; improvement in transplant services is not apparent in SSA. Organ transplantation remains largely inaccessible and unaffordable to this population.
\nSub-Saharan Africa has a disproportionate burden of communicable diseases (CDs) and NCDs compared to other world regions [4]. Currently, NCDs are responsible for a large and increasing burden of death and disability in the region. World Health Organization (WHO) in 2018, documented that NCDs killed 41 million people per year accounting for 71% of the global deaths [5]. The ages most affected were 30 to 69 years age-group, belonging to the productive workforce of any population. People from low income countries (LICs) and lower-middle income countries (LMICs) accounted for most of these deaths approximating over 85%. Four of the five commonly quoted diseases i.e. the “Big Five” (cardiovascular diseases, cancers, respiratory diseases, diabetes mellitus (DM) and mental illness) that account for most NCD deaths are drivers of CKD. Several risk factors with multiplier effect on NCDs are tobacco use, physical inactivity, harmful use of alcohol and unhealthy diets. Communicable diseases, though less common in high income countries (HICs) and upper-middle income countries (UMICs) are still prevalent in LICs and LMICs prompting WHO to highlight the double burden of diseases in these regions [6]. Both CDs and NCDs culminate in end-organ disease underscoring the high prevalence of end-organ failures, disabilities and deaths in SSA (see Figure 1). Unfortunately, most countries in this region lack resources to cope.
\nCauses of deaths in sub Saharan Afirca 1990 and 2017 [from Institute for Health Metrics and Evaluation (IHME) data].
In 2014, Stanifer
Viral hepatitis is prevalent in Africa with high endemicity of Hepatitis B Virus (HBV) in SSA and Hepatitis C virus (HCV) in North Africa. Africa has approximately 60–100 million of the world’s 257 million viral hepatitis infections [13]. The WHO noted that between 1980 and 2010, cirrhosis-related deaths doubled in the region. The increasing burden of obesity and DM leading to non-alcoholic fatty liver disease contributes to high prevalence of CLD and end-stage liver disease (ESLD). Up to 40% of patients with chronic hepatitis may progress to liver cirrhosis and/or liver cancer [14] and without liver transplantation mortality is estimated at about 15% in one year [15]. All patients with ESLD will invariably require liver transplantation; however, liver transplants are uncommon in SSA.
\nThere is scant information on prevalence of other end organ failures such as heart, lung, and small bowel requiring organ transplantation in SSA.
\nThe WHO in collaboration with the Organización Nacional de Trasplantes of Spain set up the Global Observatory on Donation and Transplantation (GODT) with the mandate to document the distribution of organ transplantation programmes in the countries that report their data to the Observatory and to evaluate the access of transplantation activities worldwide [16]. Upon subsequent request of the World Health Assembly (Resolutions WHA57.18 and 63.22) that global data on the practices, safety, quality, efficacy, epidemiology and ethical issues of allogeneic transplantation be collected and documented, the GODT was inaugurated in 2007 [16]. This database has ensured provision of transparent and equitable monitoring of national transplant systems.
\nCurrently, according to the GODT database, [17], 139,024 solid organ transplants were reported globally in 2017: 90,306 kidney (36% from living donors), 32,348 liver (19.0% from living donors), 7881 heart, 6084 lung, 2243 pancreas and 162 small bowel transplants. Africa contributes the least number of transplant activity per continent and SSA the least number per WHO World region (Tables 1 and 2; Figure 2). Tables 1 and 2 show data from 2016 GODT Report.
\nRegion | \nCountries N | \nCountries with data N (%) | \nPopulation millions | \nPopulation with data millions (%) | \n
---|---|---|---|---|
AFR | \n46 | \n10 (21.7) | \n1139.1 | \n506.6 (44.5) | \n
AMR | \n35 | \n21 (60.0) | \n986.5 | \n968.5 (98.2) | \n
EMR | \n22 | \n15 (68.2) | \n656.1 | \n535 (81.5) | \n
EUR | \n53 | \n49 (92.5) | \n909.7 | \n904.2 (99.4) | \n
SEAR | \n11 | \n5 (45.5) | \n1928.4 | \n1408.8 (73.1) | \n
WPR | \n27 | \n11 (40.7) | \n1847.7 | \n1815.3 (98.3) | \n
Total | \n
Proportion of countries and population covered by the GODT database in the WHO regions. Year 2015 [17].
\n | Africa Region (AFR) | \nAmerica Region (AMR) | \nEastern Mediterranean Region (EMR) | \nEurope (EUR) | \nSouth East Asia Region (SEAR) | \nWestern Pacific Region (WPR) | \n
---|---|---|---|---|---|---|
Kidney | \n488 (1.0) | \n31,859 (32.9) | \n6127 (11.5) | \n26,131 (28.9) | \n7202 (5.1) | \n12,540 (6.9) | \n
Liver | \n67 (0.1) | \n10,426 (10.8) | \n1539 (2.9) | \n9582 (10.6) | \n1292 (0.9) | \n4853 (2.7) | \n
Heart | \n14 (0.03) | \n3604 (3.7) | \n135 (0.3) | \n2646 (2.9) | \n40 (0.03) | \n584 (0.3) | \n
Lung | \n12 (0.02) | \n2507 (2.6) | \n56 (0.1) | \n2007 (2.2) | \n1 (0.0) | \n463 (0.3) | \n
Pancreas | \n5 (0.01) | \n1236 (1.3) | \n24 (0.04) | \n890 (1.0) | \n1 (0.0) | \n143 (0.1) | \n
Small Bowel | \n0 (0.0) | \n147 (0.2) | \n4 (0.01) | \n43 (0.05) | \n0 (0.0) | \n1 (0.0) | \n
Total Organs | \n
Absolute numbers and rates of the organ transplant activities per WHO region. 2015 [17].
World map of transplantation in 2019 showing total sum of transplants [from global Observatory of Donation and Transplantation].
Kidney transplants are available in 102 countries; living kidney transplants in 98 countries and deceased donors in 76 countries [16]. Sixteen countries representing 6.6% of the global population perform only living donor kidney transplants. In SSA, a handful of countries carry out transplantation: South Africa, Sudan, Seychelles, Ivory Coast, Namibia, Nigeria, Kenya, Ghana, Tanzania, Mauritius, Ethiopia but only five countries (Ethiopia (0.34 pmp), Kenya (1.51 pmp), Nigeria (0.47 pmp), South Africa (6.81 pmp) and Sudan (6.58 pmp)) report their data to GODT (Figure 2).
\nSub-Saharan Africa is heterogeneous and has a population estimated at 1.1billion [18]. It is projected that countries in this region would account for more than half of the world’s growth by 2050 [19]. This geographical region fully or partially located south of the Sahara Desert occupies an area of about 24 million Km2 (Figure 3). It is made up of 47 countries divided into 4 WHO sub-regions. Most countries in this region belong to the LICs and LMICs according to World Bank Classification of economies and are also described as LRCs. Africa is the second largest and second most populous continent; SSA occupies about 80% of the continent [20]. Although the economic growth in Africa has been remarkable in recent years, the gap between the rich and poor is wide and many people still do not have access to basic amenities such as potable water, good sanitation and basic health services [20].
\nMap of Africa showing UN sub-regions.
The WHO defines health systems as “all organizations, people and actions whose primary intent is to promote, restore, or maintain health” [21]. In LRCs, these systems have long been weak and deficient in most aspects of healthcare delivery and therefore, there is persistent need to evaluate health system challenges at all levels [22]. Health security is a crucial public health issue. It is ensured when there is protection against any health threats and also involves ability to handle emerging new health conditions by adapting and developing new approaches [23]. The epidemics in recent years (SARS, MERS and Ebola) including the COVID-19 pandemic bring to the fore the inability of the health systems in SSA to cope with health crisis and other prevalent health conditions [24].
\nSome healthcare professionals have poor work ethics deriving from unsavory work environment and remunerations. Transplantation is a highly specialized service that entails full commitment of the workforce and long work hours. For a good transplant programme, the national health system and the hospitals have to commit to improving the skill set of the work force through adequate staff training and other development opportunities, incentivization of the programme and offering a very supportive work environment [25].
\nTraditions and cultures influence the mindset of a people; decision to access healthcare service is informed by many factors (accessibility, affordability, spirituality and religiosity, and knowledge of the disease condition) [26]. When ill, many people in LRCs seek alternative healthcare service including traditional health providers and religious institutions resulting in late presentation to hospitals [27].
\nIn 2018 and 2019, Africa’s economic growth was at 3.4% and was expected to rise to 3.9% and 4.1% in 2020 and 2021 respectively [28]. Amid the COVID-19 pandemic of 2020, the dynamics changed resulting in contraction of economies globally with expected 1.7% to 3.4% contraction of Africa’s economy [29].
\nThe 2001 Abuja Declaration recommended allocation of 15% of the annual national budget to the health sector; achieving this has been challenging [30]. In 2012, 6 countries met the target; and this reduced to 4 in 2014. Currently, the preferred indicator for health financing is the percentage gross domestic product (% GDP). To achieve universal health coverage (UHC), the World Health 2010 Report suggested that a national government has to spend at least 4–5% of GDP on health [31]. Whilst per capita expenditure on health in America and Europe were over $1800 in 2014, the per capita expenditure on health in Africa averaged only $51.6 [32]. Further analysis shows that over the same period, in Africa, general government health expenditure was less than 50% of the total health expenditure while other sources such as out of pocket (OOP) payments and external sources (from funders) accounted for over 50% [32]. In general, transplantation service largely depends on robust and adequate finances hence the programme thrives in HICs and UMICs.
\nThough, South Africa has the most advanced transplant programme in the continent, globally, their transplant activities remain lower than those of other countries with comparable economic capacity [35, 36]. South African liver programme has existed for about 2 decades and presently offers living-related liver transplantation. Other solid organ programmes available are combined kidney-pancreas and lung transplantation. Her donor programmes have advanced to extended criteria donors (ECD) and donors after circulatory death [37]. South Africa has high prevalence of HIV resulting in a huge HIV-positive population prompting Muller and colleagues to pioneer HIV-positive-to-positive transplant program in 2008 [38]. By 2018, this programme had successfully transplanted 43 kidneys from 25 deceased donors [39].
\nNo country in this sub-region has a transplant programme but Angola in March 2019 passed a law on human tissue, cell and organ transplant to enable transplantation [53].
\nIn SSA, the national programs for donation and transplantation of organs and tissues are slow and poorly developed and they are fraught with inadequacies in infrastructures, institutional support, and technical expertise [3]. These are attributed to the huge costs and complexity of transplantation, low GDP, lack of subsidy and dearth of facilities.
\nLoua
Programmes are classified into different stages of development of transplant services with those from HICs better developed than those from LMICs and LICs [54] (See Table 3).
\nStage | \nCharacteristic | \nCountry | \n
---|---|---|
I | \nNo existing transplant programme with little or no posttransplant and post-donation care. Transplant tourism is rife. | \nThe poorest countries of the world | \n
II | \nFaltering or poorly developed transplant programme offering only living-related donation, no nationally structured transplant program, and often no legislation. There is nonexistent deceased-donor program and proliferation of transplant tourism with little or no posttransplant and post-donation care. | \nCountries in sub-Saharan Africa and many other low- and middle-income countries | \n
III | \nFairly developed transplant programme offering mostly living-related donation with rudimentary deceased-donor program. Poorly developed kidney paired exchange and organ sharing programs, often with poor posttransplant and post-donation care. Some level of transplant tourism and moderate to long wait time. | \nMany countries in Asia, Central and South America, the Middle East, and North Africa | \n
IV | \nWell-developed structured transplant programme and accompanying legislation offering deceased donation, kidney paired exchange, and organ sharing programs with good posttransplant and post-donation care. Little transplant tourism and short to moderate wait times for transplant. | \nMany of the developed economies belong to this stage | \n
V | \nHighly developed and structured transplant programme and accompanying legislation offering mostly deceased donation, advanced donation/kidney paired exchange, and organ sharing programs with excellent posttransplant and post-donation care. There is no transplant tourism and short or no wait times for transplant. | \nUtopian | \n
Proposed staging for transplant stratification model (transplant transition) [54].
Careful evaluation of potential organ transplant recipients is necessary to detect co-existing illnesses that can adversely affect the prognosis of the transplantation. The subsisting clinical practice guidelines including the 2020 KDIGO guideline and the 2011 UK Renal Association Clinical Practice guideline (5th Edition) [55, 56] recommend the standard process of evaluation of prospective transplant recipients. Regardless of the recommendations of the practice guidelines, most transplant centres have their in-house protocols for transplant recipient evaluation. However, in SSA, the evaluation may be tailored to the available resources but should be efficient and cost-effective. The discussion below is typical for kidney transplant units in Nigeria but may apply to other organ transplantations and transplantations in other countries in the sub-region.
\nThe evaluation of such candidates involves risk/benefit assessment and they should have at least five-year life expectancy derived from age, gender and race of the individual [57]. Many clinicians, however, consider other factors including severity of life-threatening diseases, functional status, clinical experience and knowledge of the patient to determine suitability for organ transplantation.
\nThe workup evaluation includes: hematological, clinical chemistry, infection profile, diagnostic procedures, imaging and immunological tests. The list of relevant investigations is shown in Table 4.
\nBlood | \n\n
| \n
Radiology | \n\n
| \n
Urine | \n\n
| \n
Immunology | \n\n
| \n
Gynecological | \n\n
| \n
Other tests | \n\n
| \n
Workup for prospective organ transplant recipients.
Blood grouping establishes the candidate’s blood type and determines if further evaluation should proceed. Recipient and donor must be compatible. Complete blood count and clotting profile should be optimal.
\nAll candidates are assessed for presence of cardiac disease by history, physical examination and electrocardiogram. Recipients with cardiac disease, comorbidities that predispose to coronary artery disease (CAD), history of previous CAD or poor cardiac function are further assessed by cardiologists. Generally, contraindications for transplantation include severe heart disease (New York Heart Association [NYHA] Functional Class III/IV), severe CAD, left ventricular dysfunction [ejection fraction <30%] and severe valvular disease.
\nChest radiograph is required for all candidates while chest computerized tomography (CT) is reserved for current or former heavy smokers (≥ 30 pack-years). Candidates with lung disease are further evaluated by a pulmonologist. Severe irreversible obstructive or restrictive pulmonary diseases are contraindications for transplantation.
\nSub-Saharan Africa has high prevalence of tuberculosis (TB). It is therefore necessary to screen for TB in prospective organ recipients with a chest radiograph and purified protein derivative (PPD) skin test. Candidates with positive TB screening tests are treated before organ transplantation.
\nCandidates with history of peptic ulcer disease (PUD) are screened with oesophagogastroscopy and
Serological tests for potentially transmissible diseases, like HIV, HBV, HCV, cytomegalovirus (CMV), Epstein–Barr virus and varicella-zoster virus are usually performed, and appropriate management instituted when indicated.
\nRoutine cancer screening is done for all recipients. Chest radiograph is mandatory while chest CT is reserved for current or former heavy smokers. Ultrasonography is used for screening candidates at risk of renal cell carcinoma (dialysis >3 years, family history of renal cancer, acquired cystic disease, analgesic nephropathy). Those at risk of urinary bladder cancer (high-level exposure to cyclophosphamide, heavy smoking) require cystoscopy. Patients at risk of hepatocellular carcinoma are screened with ultrasonography and serum alpha fetoprotein. Colonoscopy is done to screen for bowel cancer and inflammatory bowel disease. Females undergo PAP smear and mammography to exclude cervical and breast cancer respectively.
\nObesity increases the risk of post-operative complications. Many transplant centres prefer a body mass index (BMI) of <30.
\nThese are very important aspects of the workup for prospective organ transplant recipients and will be discussed later.
\nDonor protection should always be taken into account during living donor selection and assessment. Organ donation should be altruistic, voluntary and never coerced. Donor evaluation is a multidisciplinary exercise, and is done before, during and after donation. Due to lack of requisite legislation, supporting infrastructure, religious and cultural beliefs, mostly living organ donations are done in SSA countries.
\nThere are risks associated with organ donation and consequently, potential donors should receive medical, surgical and psychological screening. Pre, intra, and post-operative care as well as structured post-donation follow up are important.
\nPotential donors should be healthy and neither too young nor too old. Medical history and physical examination could elicit risk factors for kidney disease such as: DM, hypertension, family history of kidney disease, herbal drug, non-steriodal anti-inflammatory drugs (NSAIDs), and other nephrotoxin use. History and/or presence of CLD could be suggested by jaundice and alcohol abuse. Also, history of psychiatric illness, malignancies, smoking and substance abuse, etc. should be sought and positive candidates excluded. Donors should not be morbidly obese and blood pressures should be <140/90 mmHg.
\nFor various investigations see Table 5.
\nParameters | \nRelevant indices | \n
---|---|
Age | \n>18, <60 years | \n
History | \nDiabetes mellitus, hypertension, nephrotoxins, alcohol and other substance abuse, cigarette smoking, psychiatric illness, malignancy | \n
Physical features | \nJaundice, pallor, BP >140/90 mmHg, BMI >35 | \n
\n | |
Hematological | \nFBC, PT/INR | \n
Chemistry | \nSEUCr, LFT, lipid profile, FBG, HBA1C, PSA, TFT | \n
Microbiology | \nUrinalysis, urine culture | \n
Serological/ immunological | \nHIV, Anti HCV, HBsAg, CMV, EBV, ABO blood group, HLA A, B and DR matching, HLA antibody cross- matching | \n
Imaging | \nUltrasound, CT angiography, | \n
Others | \nECG, Echocardiography | \n
Workup for potential organ transplant donors.
Absence of urinary markers of disease such as proteinuria, haematuria, pyuria and casts, may rule out kidney diseases in potential donors. Glomerular filtration rate (GFR) should ideally be measured but is often estimated using serum creatinine in most LRCs. Prospective donors are screened for chronic viral diseases. Notably, CMV positivity in a donor has implication for a CMV-negative recipient, who due to subsequent immunosuppressive drug use will likely succumb to its infection. Screening for TB (CXR, Mantoux test, sputum GeneXpert) is important in SSA because 1/3 of the population is infected with M. tuberculosis [58]. The ABO blood group compatibility with recipient is mandatory; however, Rhesus factor mismatch is not a major consideration for solid organ matching. There are many HLA antigens (Class I: HLA-A, B, and C; Class II: HLA-DR, DQ and DP), but the HLA A, B and DR are usually cross-matched between donors and recipients (i.e. tissue typing).HLA antibody cross-matching is important to prevent early graft rejection. It detects the presence of HLA antibodies in recipients that can react with donor’s lymphocytes, i.e. donor specific antibodies (DSA).
\nHLA antibody cross-matching was originally based on complement dependent cytotoxicity (CDC) assays. It is done with recipient’s serum on donor lymphocytes or pooled lymphocytes of previous donors within the transplant centre’s population to determine the Panel Reactive Antibodies (PRA). Reactive Antibodies (PRA). The PRA estimates the recipient’s chances of tolerating allografts from that population and is useful for deceased donation.
\nSolid phase assays, ELISA or flow cytometry (Luminex)-based are now available and preferred. Most transplant centres in SSA, outsource tissue typing and HLA antibody cross-matching. Protocols require at least two HLA antibody cross-matches, with the last, just before the transplant procedure.
\nImaging evaluation using ultrasonography and doppler in prospective donors should demonstrate normal kidneys (sizes and echotexture) and renal blood flow.
\nThe CT-angiography helps to rule out solitary kidney or detect the presence of multiple or abnormal renal arteries, which have surgical implications for nephrectomy in donors and anastomoses in recipients.
\nCounseling donors on short and long-term risks associated with organ donation is necessary. Possible complications such as pain, post-operative infections, blood loss, deep venous thrombosis and pulmonary embolism can occur. Studies have shown that peri-operative mortality and morbidity during organ donation, are about 0.03% and 10% respectively [59]. Some studies show that with careful selection, kidney donors live long, although hypertension, proteinuria and reduced GFR can occur over time [60]. The risk of ESKD following kidney donation is about 0.3% [61]. Emotional consequences after organ donation should be anticipated therefore psychosocial assessment should be independently organized by the transplant team before and after donation.
\nMany transplantation programmes in SSA adopt protocols from established and experienced centres.
\nAccording to US Organ Procurement and Transplantation Network (OPTN) guidelines, living donor follow-up is done at discharge (or at 6 weeks), 1 year and 2 years [62]. Parameters monitored include weight, blood pressure, lipid profile, kidney and liver functions. Healthy eating, regular exercise and the dangers of substance abuse are emphasized. After uneventful 2 years, donor follow-up is continued by the primary care physicians but for those with adverse outcomes appropriate referral is made. Post-donation follow-up is important for donor safety and wellbeing to enable diagnosis and treatment of co-morbidities.
\nIn transplantation, recipients, donors and their families are faced with various challenges including psychological and behavioral issues. Evaluation is essential in the following aspects: candidate and donor selection, counseling, pre- and post-transplant assessment, patient, caregiver and family adjustments to transplant and issues related to psyche of transplant staff.
\nVarious factors exert neuropsychiatric effects in transplantation. Studies link significant neuropsychiatric adverse effects to cyclosporine, tacrolimus, steroids and other components of treatment. Therefore, psychosocial issues should be considered and addressed in order to achieve a successful transplant.
\nPsychosocial evaluation of patients for transplant include [63]:
Patient profile: relationships, education, work and legal history
Expectations from the surgery
Organ failure: cause, complications, course, adherence to treatment
Ways of coping with the illness
Support network: caregivers, family, friends, faith organizations and employers
Psychiatric history: extant, past and family.
Substance abuse history
Mental status exam: neuropsychiatric tests
Ability to give informed consent
There are known stressors before and after transplantation including depression and hopelessness, anxiety, uncertainty and aggression. These may be followed by hope, and confidence in an unpredictable pattern as recipients gradually process adaptation to the new situation.
\nAfter Transplantation, recipients pass through three phases of adaptation [64]:
“Foreign body” phase: the organ feels strange to the recipient. Persecution anxiety or idealization could arise. The organ could be seen as fragile and precious, thereby generating excessive protective feelings towards it.
“Partial incorporation” phase: recipient begins to integrate the organ.
“Total incorporation” phase: recipient is no longer aware of the organ.
In the long-term postoperative period, medication side effects and associated comorbidities become central stressors affecting the recipients’ quality of life (QOL). The most bothersome stressors are work related, like farming, schooling, etc. [65]. Recipients might feel stressed by the strict adherence to the medical regimen. This, in turn, can compromise their adherence after transplantation. Financial problems and legal disputes constitute other possible sources of psychological strain with health or pension insurance agencies, where available.
\nEnabling transplant recipients commence productive employment constitutes the main goal of transplantation and is considered an indicator of societal participation [66]. Globally, data show that 18% - 86% of recipients return to work or find new employment. [67, 68] but no data is available for SSA.
\nMultiple factors motivating donors include intrinsic factors (e.g., desire to relieve another’s suffering or to act in accordance with religious convictions) and extrinsic factors (social pressures or perceived norms) that may operate simultaneously. The combination of motivational forces differs depending on whether and how the donor is related to the recipient.
\nMost living donors use two decision-making strategies: [69]: “moral” which involves awareness that one’s actions can affect another [70] and “rational” which is focused on gathering relevant information, evaluating alternatives, selecting an alternative, and implementing the decision.
\nPotential donors’ psychological stability has been one of the greatest concerns for living transplant programmes, particularly in the context of unrelated donation. The willingness or desire to donate to a stranger has been historically viewed with suspicion [71, 72]. Studies suggest that most potential donors do not suffer from mental illness [73, 74]. Many donors have reported positive feelings about donation however, a few have observed psychological distress, anxiety and depression. Thus, it becomes critical to identify, and mitigate key risk factors for these poorer outcomes: non-first degree relatives [75, 76], ambivalent donors [76, 77] and “black sheep” donors (persons who donate in order to compensate for past wrong doings or to restore their position in the family) are at higher risk for poorer post-donation psychosocial outcomes [76, 77].
\nThe donor kidney angiogram is decisive in selecting the kidney to be harvested. The larger kidney with better blood flow is left for the donor. Minimal access donor nephrectomy and robot-assisted renal engraftment reduce postoperative complications. These, however, are not easily available in most LRCs.
\n\nThe harvested kidney is covered in ice slush, wrapped in gauze piece and preserved in ice container as organ perfusion machine is not readily available in the sub-region.
\nKidneys with multiple arteries are avoided but if inevitable, arteries are anastomosed side to side, end to side, or separately onto the external iliac artery (Figure 4). The right external iliac vessels are more superficial than the left and this side is frequently preferred for the first renal engraftment.
\nDonor angiogram with multiple left renal arteries.
Anti-reflux uretero-cystostomy is performed over a size 4Fg double J-ureteric stent (Figure 5).
\nEnd-to-side donor-recipient arterial anastomosis with kidney wrapped in gauze piece packed with saline ice slush.
Immunosuppressive regimen is divided into induction and maintenance phases.
\nThis is required to prevent acute rejection. Due to sensitization from blood transfusions, previous pregnancies (females) and increased susceptibility to graft rejection (in blacks) recipients undergo induction [81]. A combination of anti-thymocyte globulin (ATG) and methylprednisolone is often used. Prior to this, patients receive pretreatment with acetaminophen and antihistamines to prevent cytokine release syndrome associated with ATG.
\nBiologic agents (Alemtuzumab, Basiliximab, Daclizumab) may be used when available in less sensitized patients.
\nTo prevent allograft rejection, maintenance immunosuppression is achieved with a combination of low dose corticosteroid (prednisolone is widely in available SSA), an antiproliferative agent (mycophenolate mofetil (MMF) or azathioprine) and a calcineurin inhibitor (CNI) (tacrolimus (TAC) or cyclosporine (CYP)). Tacrolimus has shown superiority over cyclosporine in improving graft survival and preventing acute rejection. Thus, TAC remains an integral part of the common post- transplant immunosuppressive combination [82]. The initiating dose is titrated to achieve a trough level of 8-10 ng/ml in the first three months post-transplant.
\nProphylaxis against bacteria, fungi and viruses are commenced within this time.
\nFirst day post-surgery, emphasis is on haemodynamic and respiratory stability as well as urine output. By the first week, good graft function should have been established and urethral catheter is removed.
\nWithin this period opportunistic infections are anticipated and appropriate measures taken. The ureteric stent is removed within 4 – 6 weeks.
\nAbsence of transplant registries in SSA precludes transplant data availability. However, between 2010 and 2015, a hospital in South Africa documented recipient survival at 1 and 5 years as 90.4% and 83.1% and that of graft 89.4% and 80% respectively [83].
\nOrgan donation and transplantation in SSA is fraught with numerous challenges including costs of treatment, inadequate infrastructure and equipment, dearth of highly skilled health professionals, and lack of well-articulated ethico-legal framework and policies [3].
\nCost of kidney transplant varies from country to country. For example, the cost is estimated at about $32,000 in Nigeria [84], $18,775 in Ghana [85], and $10,000 in Tanzania [20].
\nSource of funding for organ and tissue donation and transplant depends on the country: public sources in Ethiopia, Ghana, Mali, Seychelles and Comoros but private in Nigeria, Burkina Faso, Madagascar and 10 other countries SeeTable 6. Most recipients pay OOP either personally or by relatives, employers and to a lesser extent philanthropists [45]. While the National insurance pays two-thirds of the transplant cost in Kenya [47], it is free in Tanzania [51].
\nIndicator | \nCountries | \n
---|---|
Countries with functional transplantation programmes | \n|
Functional transplantation programmes from living donors | \nAlgeria, Côte d’Ivoire, Ethiopia, Ghana, Kenya, Namibia, Nigeria, United Republic of Tanzania, Uganda, South Africa | \n
No. of transplant centres in the region | \n|
Kidney centres | \nAlgeria, Côte d’Ivoire, Ethiopia, Ghana, Kenya, Namibia, Nigeria, United Republic of Tanzania, Uganda | \n
Corneal centres | \nKenya, Nigeria, South Africa | \n
Bone marrow centres | \nNigeria, South Africa | \n
Liver centres | \nSouth Africa | \n
Heart centres | \nSouth Africa, others perform open heart surgeries | \n
Countries having legal requirements | \n|
Legal requirements in place covering organ donations and/or transplantations | \nBurkina Faso, Comoros, Côte d’Ivoire, Ethiopia, Kenya, Mauritius, Namibia, Nigeria, Rwanda, Senegal, Sudan, United Republic of Tanzania, Uganda, Zimbabwe | \n
Governments intended to adopt new legal requirements | \nCameroon, Chad, Eswatini, Ghana, Guinea, Madagascar, Mali, Mozambique | \n
No legislations in place | \nAngola, Benin, Burundi, Cabo Verde, Congo, Eritrea, Gabon, Guinea Bissau, Seychelles, Sierra Leone | \n
Legal requirements in place to inform living donors on the risks of the operation | \nComoros, Ethiopia, Kenya, Mali, Nigeria, Rwanda, Senegal, Seychelles, United Republic of Tanzania, Uganda | \n
Legal restrictions on the coverage of donation costs for living donors | \nComoros, Mali, Rwanda, Senegal | \n
Legal requirement to follow-up on the outcomes of living donors | \nEthiopia, Mali, Senegal, Seychelles | \n
Legal requirement to provide care to living donors in case of adverse or medical consequences | \nEthiopia, Senegal, Seychelles | \n
Prohibition of organ trafficking/transplant commercialization | \nBurkina Faso, Comoros, Côte d’Ivoire, Mali, Namibia, Nigeria, Rwanda, Senegal | \n
Legal permit and regulation of financial incentives for living donors | \nNone | \n
Import or export of organs authorized | \nGhana, Namibia, Rwanda | \n
Import or export of organs explicitly prohibited | \nBurkina Faso, Seychelles | \n
Legal requirements for organ and tissue donations from living donorsa\n | \nBurkina Faso, Comoros, Côte d’Ivoire, Kenya, Mali, Nigeria, Rwanda, Senegal, Seychelles, United Republic of Tanzania, Uganda | \n
No. of countries having an organization and management system | \n|
Authorization for transplant services | \nBurkina Faso, Comoros, Côte d’Ivoire, Ethiopia, Ghana, Guinea, Kenya, Madagascar, Mali, Nigeria, Senegal, Uganda, Zimbabwe | \n
Ethics Committees at the national or local level | \nBurkina Faso, Comoros, Côte d’Ivoire, Ethiopia, Gabon, Kenya, Mali, Nigeria, Rwanda, Senegal | \n
Government recognized authority at the national level | \nAlgeria, Côte d’Ivoire, Ethiopia, Ghana, Kenya, Mali, Nigeria, Senegal, Uganda | \n
Setting up protocols, guidelines, recommendations | \nComoros, Côte d’Ivoire, Ethiopia, Mali, Senegal | \n
Transplant follow-up registries for post-transplant living donor and for recipients | \nCôte d’Ivoire, Ethiopia, Namibia, Uganda | \n
Affiliation with an international organ allocation organization | \nNone | \n
Cooperation framework to allow transplantation abroad | \nCôte d’Ivoire, Ethiopia, Kenya, Namibia, United Republic of Tanzania, Uganda | \n
Training programme for staff in place | \nCôte d’Ivoire, Ethiopia | \n
Source of funding | \n|
Public | \nComoros, Ethiopia, Ghana, Mali, Seychelles, United Republic of Tanzania | \n
Private | \nCôte d’Ivoire, Ghana, Nigeria | \n
Public and Private | \nKenya, Namibia, South Africa, Uganda | \n
Not Specified | \nEswatini, Gabon, Zimbabwe | \n
Aspects of transplantation programmes in SSA modified from Loua
Post-transplant maintenance of immunosuppression is a major challenge. This is exigent since therapy must be individualized. Two perspectives associated with immunosuppression in SSA include:
Availability, affordability and patient’s adherence to prescription.
Therapeutic drug monitoring (TDM).
Adequate immunosuppression is key to allograft survival. In patients who pay OOP, prohibitive costs of medications may have negative impact on their finances. Furthermore, side effects of medications affect their health-related QOL. In many LRCs, these medicines are imported at high cost and not readily available. These contribute to poor adherence with subsequent allograft rejection and graft loss.
\nDespite their impactful role in improving transplant outcome and graft survival, immunosuppressive medicines exhibit narrow therapeutic range between levels that inhibit rejection and toxic levels hence TDM is often required. Establishing a patient’s dose requirements in the immediate post – surgery period and avoiding over immunosuppression remains a challenge. Calcineurin inhibitors have variable pharmacokinetics [86, 87, 88, 89]. While ethnic differences have not been demonstrated in pharmacokinetics of MMF and AZA, African Americans have been shown to have 20–50% lower oral bioavailability for TAC, CYP, sirolimus and everolimus and as such require higher drug doses than Caucasians [90, 91]. This has been attributed to genetic polymorphism of key enzymes in the metabolism of these medications [90]. Genetic profiling is not readily done in SSA hence, TDM is essential. This attracts huge costs for the health system and for patients who pay OOP. It is imperative to tailor medications to patient’s need. Some countries do not have the capacity to analyze drug levels, so patient’s blood samples are sent overseas for analysis. Within the first-year post-transplant, TDM is done at least twice during timed follow-up visit for patients coming from rural and urban areas. However, more frequent monitoring is done when indicated. During emergency presentation for allograft dysfunction, patients are admitted, samples for TDM sent out and other possible causes of allograft dysfunction are excluded or managed if present. Decision to increase drug dosage is often delayed till TDM result is available but dose reduction or withdrawal can be done in the presence of overt signs and symptoms suggestive of toxicity. For subsequent years, TDM is done as indicated.
\nTissue typing, cross-matching and some viral studies, which are major aspects of patient preparation, are done overseas. This tends to delay the procedure and leads to an increase in the cost of transplantation. Adequate histological evaluation of biopsy specimens are largely unavailable, making prompt management of rejections and infections problematic.
\nHealth-workforce is the backbone of any health care system. Transplantation involves collaboration of many health professionals (nephrologists, transplant surgeons, urologists, renal nurses, pathologists, etc.). Worldwide transplant workforce and training capacity remain unknown. Of the 47 countries in SSA, only 15 (32.6%) had data on the number of nephrologists in their countries. Nigeria and South Africa have the greatest number of nephrologists with rates <10 per 10,000 population while others have < two per 10,000 population [3]. The situation is worse for other specialists involved in transplantation. Opportunities for training and employment have caused brain drain to developed countries from LRCs [3].
\nDespite the burden of ESKD in SSA, only few countries have sustained transplant programmes [20]. There are only 62 centres across 7 countries in SSA [3]. Nigeria with a population of 206 million has 15 renal transplant centres (RTCs) with majority recording low activities ranging 1–5 transplants per year (Personal Communication). South Africa with a population of 59.37 million (2020) has 14 RTCs and did 250 to 450 kidney transplants annually between 1991 and 2015 [35].
\nScarcity of organs for transplantation is a multi-factorial global problem. Living donors remain the major source of organs for transplantation in SSA with largely non-existent deceased donor programmes. This has resulted in the persistent dearth of organs in the face of continuous rise in demand [92]. Unavailable storage facilities, poor knowledge about transplantation, socio-cultural and religious beliefs (which discourage living organ donation, view deceased organ donation as a taboo or an act of mutilating the dead with violation of the person’s dignity [84]) contribute to shortage of organs [93].
\nThere is pervading poverty in SSA with US bureau of statistics reporting rates of 87.8%, 56.9%, 40.1%, 40% and 36.1% in Uganda, Ghana, Nigeria, Cameroun and Kenya respectively [94]. In Nigeria, 85% of ESKD patients earn between $800–7333 annually making kidney transplantation unaffordable [27, 95]. Although unemployment rate in SSA averages 6.2%, many are underemployed and earn low income [96].
\nMost transplant centres are located in urban cities or state capitals reducing accessibility to rural dwellers [3, 41].
\nChristianity, Islam and African traditional religion are the major faiths in SSA. Interplay of faith, religion and cultural attitudes and their relationship with views on organ donation is complex. Response to illness as God’s will negates organ donation or reception. Belief in resurrection and reincarnation precludes organ donation since the ‘new body’ may have some missing parts. Desecration of the body of the deceased is reported as a factor prohibiting family members from donating body parts of their deceased relatives.
\nFunctional organizational mechanism for transplant programmes including authorization for transplant services; ethics committees, guidelines and protocols, etc. are few in the region [41, 93]. Additionally, transplant is not sufficiently integrated into national health services and collaboration between SSA countries is limited.
\nAbsence of functional and reliable registries militate against planning and implementation of policies due to lack of data. Most countries do not include performance indicators for organ donation and transplantation in their national health information systems. In addition, there is insufficient multisectoral (schools, transport departments, NGOs, Civil Society Organizations, etc.) involvement in transplantation programmes in SSA.
\nSome countries have legislation for organ donation and transplantation while others are in various stages of developing theirs (Table 6). The weak regulatory frameworks observed in these countries are often insufficient to ensure the effective oversight needed for the implementation of quality standards for organ transplantation.
\nThe Declaration of Istanbul defines organ transplant tourism as travel for transplantation involving trafficking in persons, for the purpose of organ removal. Organ trafficking is defined as
Transplantation holds lots of opportunities which if well harnessed can improve healthcare in SSA.
\nFor sustainable transplantation programme, individuals, community and governmental commitment and collaboration are required. Availability of organs can be increased through heightened public enlightenment campaigns emphasizing preventive medicine and change in the community’s organ donation perception. This can be achieved by partnering with religious bodies, individual, family and community education, inclusion of transplantation and donation in school syllabus, alliance with the department of motor vehicles (DMV) and novel donation programmes (kidney paired donation, extended criteria organ donation and altruistic non-directed donation).
\nTransplantation has significant medico-legal implications requiring robust legal framework. This should cover organ donation legitimacy, regulatory bodies, criteria and processes of accreditation, certification and standardization of transplant centres [98]. Transplantation programmes afford SSA opportunities to learn and adapt legislation from other regions. In 2008, Israeli parliament accepted two laws from their Ministry of Health - the Brain-Respiratory Death for determination of brain death and the Organ transplantation laws [99]. These laws defined the ethical, legal and organizational aspects of organ donation, allocation and transplantation with prioritization of registered donors, donor reimbursement and life insurance [99]. These and stoppage of illegal TT reimbursement significantly increased living and deceased organ donation by 2011 [99, 100].
\nThe Multidisciplinary nature of transplant programmes demands highly skilled manpower often not obtainable in many parts of SSA, hence the need for collaboration with advanced transplant centres. Such patnership enables capacity development and training of specialized workforce which will serve the local and sister institutions.
\nSuccessful transplantation requires protocols for recipient and donor care. Transplant centres in LRCs can develop or adapt protocols from advanced centres, international organizations like United Network for Organ Sharing, Donation and Transplant Institute etc. National registries of organ transplant and outcomes are essential for documentation of transplant activities, reporting of short and long-term outcomes, and for planning and budgeting.
\nEach country should establish a sustainable transplant programme. Development of such services will curb organ trafficking and TT [101]. It entails infrastructural, legislative and manpower development with national government’s political will [35, 102]. A well-defined mode of funding which includes transplantation in national health insurance coverage ensures sustainability.
\nTransplantation programme can be established in a staged fashion [101]: enacting transplantation related laws and regulations, capacity building, extensive public enlightenment campaigns and transplant beginning with live-donor and subsequently, deceased-donor.
\nModels that can be adapted include:
\nIn the Pakistani model [103, 104], following intense public enlightenment, the community assumed ownership of the programme through donations as individuals, communities and NGOs. Government provided 30–40% of required cost, infrastructure, staff training and emolument enabling patients to receive free nephrology and transplantation care plus post-transplant rehabilitation. Accountability, transparency and equity ensured the success of this model.
\nFollowing development of indigenous transplant programme in 1985, there was an unwieldy transplant waiting list necessitating government-sponsored live-unrelated transplant with donor compensation [105]. This programme successfully eliminated waiting list by 1999 increasing kidney transplantation to 28 pmp per year. The Dialysis and Transplant Patients Association facilitated donor-recipient matching excluding third party. Donors also received government-funded life health insurance and gifts. Government additionally supported importation and free distribution of immunosuppressive medications to recipients. Deceased donor transplantation has steadily increased since 2000.
\nThese models emphasize the indispensable roles of community, government and NGOs in ensuring the existence of a sustainable transplantation programme.
\nThe World Health Assembly (WHA) adopted resolutions WHA57.18 and WHA63.22 [106, 107], and the WHO guiding principles on human cell, tissue and organ transplantation to guide transplantation programmes and activities [108]. The United Nations General assembly adopted these resolutions to strengthen and promote effective measures and international cooperation to prevent and combat organ trafficking [109]. The Istanbul declaration on organ trafficking and TT recommends a legal and professional framework to govern organ donation and transplantation activities, transparent regulatory oversight system to ensure donor and recipient safety, enforce standards and prohibit unethical practices in all countries [97]. A Task Force to check unwholesome practices in transplantation was set up and inaugurated by WHO in 2017 [110].
\nDuring the 2013 Global Alliance of Transplantation (GAT) meeting organized by Southern African Transplant Society in Durban [3], the transplantation society (TTS) sponsored a meeting for countries in SSA to assess the need for and ability to optimize or develop local transplant programmes. In 2015, the South African Renal Society–African Association of Nephrology in collaboration with European Renal Association-European Dialysis and Transplant Association held a pre-congress workshop to encourage SSA countries to develop renal registries [111]. Attempts at establishing renal registries in SSA have met with challenges. The International Society of Nephrology (ISN) is supporting establishment of renal registries worldwide through her SHARing Expertise (https://www.theisn.org/initiatives/data-collection/). Leveraging on such programmes can help SSA countries establish reliable registries.
\nTo improve kidney disease patients’ care and capacity building worldwide, ISN pioneers these programs: fellowship, ISN continuing medical education, sister renal centre (SRC), sister transplant centre (STC) and educational ambassadors programme. Through ISN- TTS-STC program, ISN encourages establishment and development of transplant centres (www.theisn.org/programs). In ISN- TTS STC programme, SSA centres (emerging centres) can partner with developed centres (supporting centre) for capacity building through institutional and exchange train-ing programmes at no cost to the individual or his home institution. This partnership is superior to the intermittent use of paid expatriates in some SSA countries.
\nImprovement in the transplant landscape of SSA can be achieved by adapting models that have proven successful in LRCs such as those of Pakistan and Iran. Implementing the 2007 World Health Organization Regional Consultation recommendations: establishment of national legal framework and self-sufficient organ donation and transplantation in each country, transparent transplantation practices, and prevention of commercialized transplantation and TT will improve transplantation programmes in SSA. Also, adopting the WHO Regional Committee for Africa’s proposed actions on organ transplantation for member states and establishment of national registries for organ transplantation in each country are needed.
\nSub-Saharan Africa, comprising of 47 countries and occupying an area of about 24 million Km2 is heterogeneous with estimated population of 1.1 billion people. Most of the countries belong to the LICs and LMICs according to World Bank Classification of economies. This region has a high prevalence of end-organ diseases including CKD, CLD, chronic lung diseases and chronic heart diseases resulting from CDs and NCDs.
\nAlthough South Africa performed Africa’s first kidney transplant in 1966 and pioneered heart transplantation in 1967, SSA lags behind the developed world in transplant activity. According to WHO, SSA contributes the least number of transplant activity per WHO World region. Cost of treatment, low GDP, inadequate infrastructural and institutional support, dearth of facilities and technical expertise and absence of subsidy have all adversely affected organ donation and transplantation.
\nThe health-care systems in SSA are weak and deficient. Peoples’ decision to access healthcare services is influenced by knowledge of the disease condition, accessibility to health-care facility, affordability, religious and trado-cultural practices. Many people in LRCs patronize alternative healthcare service including traditional health providers and religious institutions as first choice resulting in late presentation to hospitals.
\nThese challenges can be surmounted by adopting the 2007 World Health Organization Regional Consultation recommendations of establishment of national legal framework, self-sufficient organ donation and transplantation in each country, transparent transplantation practice, and prevention of commercialized transplantation and TT. In addition, establishment of national registries of organ transplantation is essential.
\nIn the last century there have been significant changes in the field of Health Care Delivery (both in Private and Public) System and in the functioning of academic institutions. On one hand there have been rapid progress in the both fields but at the same time new challenges have also emerged. With the advent of market economy and globalization both demographic transition and epidemiological transition have led to widening health disparities between rich and poor segments of the society and also poor access of health care to marginalized segment of population and also at times to the rural area. It is expected from the academic institutes to bring a change in the health status of the community, they serve as well as to create a demand to provide high quality and cost -effective health system. Thus, the social responsiveness, social responsibility and social accountability has posed a significant challenge to academic health institutions [1, 2].
There is a substantial inequity in terms of health and development progress among the rural population in India. Among the states those are doing well, there also remain pockets where not much has changed since independence in 1947. This inequity further worsens with every passing year, resultant health being has become one of the major determinants for worsening inequity. In India paying for health care has become a major source of impoverishment for the poor and even for the middle class. In this situation the Gandhian Philosophy of serving the underserved & reaching the unreached has become more important. The Medical Institutes can make, the Gandhian Dream- “people’s health in people’s hand”, a reality.
Mahatma Gandhi was always for “Swaraj” meaning by self – rule where villagers would be able to exercise authority/control on the happenings around them in the field of social, culture, education, health and agriculture etc. Thus, it is clear that Gandhiji’s “Swaraj” was to empower the village community in order to ensure that, they have controlled on the happenings around them. Gandhian vision of ideal village or village Swaraj is that it is a complete republic, independent of its neighbours for its own wants and yet interdependent for many others in which dependence is necessary. (3, 4)
At Mahatma Gandhi Institute of Medical Sciences, we have strived hard to improve the quality, equity, relevance, and cost -effectiveness in the health care delivery in order to discharge our social responsibility. The medical institutes capacity is judged on the basis of their response and interaction with constantly evolving health systems and the community in order to produce medical graduate who has sense of social responsibility. The big question is if our medical institutes are prepared for this? Are they ready and willing to shoulder the responsibility so as to contribute to the development of healthier society? (6).
The experts believe that incorporating this fundamental issue in the institute mission may be a stepping stone towards ensuring that thee medical institutes discharge their Socially Accountability that is deeply nested at MGIMS in all its activities related to health care both at institution level and at community level. The medical students both, under-graduates and post-graduates experience the social responsibility while working both at institute level & with the community and at times they also participate actively. (7)
Under “social responsibility” the medical education program focuses on producing a “good “practitioner, leaving the onus on respective medical institute to define which competences are the most appropriate to meet health needs of patients. Under “social responsiveness”, the medical education program focuses on attaining the clearly defined competences that are defined from an objective analysis of people’s health needs. Under “social accountability”, the medical education program aims to produce health system change agents that would have a greater impact on health system performance and ultimately on people’s health status, implying a quest for innovative practice modalities combining individual and population based services. (9, 10)
The available evidence suggests that implementing such a social accountability framework is feasible and yields the desired results of producing socially responsive competent medical physicians. (11). We therefore share the experience of implementing community based medical education for more than five decades at Mahatma Gandhi Institute of Medical Sciences (MGIMS) Sewagram. Our humble submission is that the attempt at MGIMS is not the most perfect model and may have its own limitations and flaws.
The literature search on community oriented medical education, Gandhian Philosophy & Social accountability was conducted. Further, qualitative methodology was adopted to draw inferences based on personal interaction & interviews and discussion with faculty & supportive staff at Mahatma Gandhi Institute of Medical Sciences, Sewagram, with health care providers, with public health system, with community members representing various community based organizations, local panchayat members and with village level health functionaries like Accredited Social Health Activist (ASHA) and Anganwadi Workers (AWW). Wherever required available secondary information was also utilized. It also includes personal experience of the Author over last 27 years at MGIMS.
The Mahatma Gandhi Institute of Medical Sciences, is India’s first rural medical college. Nestled in the karmbhoomi (work place) of Mahatma Gandhi, at Sewagram. The institute was stated in Gandhi Centenary Year 1969.
The vision of the institute is to develop a replicable model of community oriented medical education which is responsive to the changing needs and is rooted in an ethos of professional excellence. The Mahatma Gandhi Institute of Medical Sciences, Sewagram is committed to develop high standard of medical education, research and health care by adopting holistic approach, integrating modern medicines with traditional Indian system of medicine. The institute in committed to provide the affordable health care to the marginalized & underserved community especially underprivileged segment of society from the rural area.
When Mahatma Gandhi left Sabarmati Ashram and set up his ashram at Sewagram in 1936, the epicenter of India’s independence struggle shifted to this obscure village in Maharashtra. In 1944, when Gandhiji returned from his last imprisonment at Aga Khan Palace, Sewagram was experiencing a number of epidemics. In this situation, Bapu had no use of the guest house built for his guests. He got it converted into a dispensary, and later, into a 15 bedded hospital for women and children. It was christened “Kasturba Hospital” in memory of Kasturba Gandhi, who had passed away in 1942. Kasturba Hospital has the distinction of being the only hospital in the country started by the Father of the Nation himself.
Dr. Sushila Nayar, who joined Mahatma Gandhi in the year 1939 as his personal physician and in independent India she joined as Union Health Minister with then Prime Minister of India Pandit Jawaharlal Nehru in 1962. When Shri. Lal Bahadur Shastri, who had a rural background, became Prime Minister he desired to start a medical college in the rural area which can deliver the rural oriented medical education. Dr. Sushila Nayar took this as a challenge and in the process Mahatma Gandhi Institute of Medical Sciences was started in 1969 in the Gandhi Centenary year as experimentation in the medical education to create a rural bias amongst the medical students.
MGIMS is 50-years-old now. From a 15 bedded hospital in 1944, the Kasturba hospital has gradually grown into a 934-bedded hospital. The institute also runs a 50-bedded Dr. Sushila Nayar Hospital, in the tribal areas, in Melghat 250 kms away from Sewagram.
The various innovations have been developed at MGIMS to create the social consciousness among the medical students- Figure 1.
Medical education - innovations.
The few important innovations are:
At MGIMS, Students are admitted in undergraduate medical course (MBBS) from all over the country and are selected on the basis of a common eligibility examination at National Level. Soon after admission to the Institute, students attend a 15-day orientation course in Gandhi Ashram (Where Gandhiji lived from 1934 to 1946) to learn about a value system based on Gandhian ideology. The students during the Orientation Camp live in Gandhi’s Ashram and have to follow all routine of the Ashram, viz. – participation in morning and evening all religion prayer, participation in Sharamdan and community activities like spinning yarn which is popularly known as Khadi. The students are oriented towards value of dignity of labor (Sharamdan), religious tolerance and simple living and high thinking. The students are also taught relevance of Gandhian Thoughts/Philosophy in medical education with special context to personal hygiene, balance diet & nutrition and environmental health with the help of renown Gandhians who are specially invited and shares their experiences and interact with the students. The students are also exposed to the importance of Yoga, meditation and nature care as well as on spiritual health which was near & dear to Gandhiji.
During the camp students are also provided an orientation towards institute’s Code of Conducts which are:
Wearing Khadi (hand woven) clothes
Eschewing Non- Vegetarian food, smoking, alcoholic drinks, intoxicating drugs
Participation in all religion prayer and Sharamdan
Non-observance of untouchability
Equal respects to all religion
The medical graduates in India are trained mainly in tertiary care hospitals where they become completely dependent on technology. The villages of India need the doctors who have to rely on their own knowledge, skill with sound community orientation, clinical competence and good communication skills. The Social Service Camp is an attempt to achieve the objective of the Institute and to expose the students how to provide value based and cost- effective medical education especially in rural and resource constrained setting.
The camp is organized as a two weeks residential camp during the first year of M.B.B.S. course. Every year a new village is selected for organizing the camp. The criteria for the selection of the village includes:
So far 51 villages have been covered. Each student is allotted 3–5 families consisting of 15 to 20 individuals. The students make a detailed study in the allotted families with the help of a journal of Community Medicine Practice under the guidance of faculty, Post Graduate students and Para Medical staff of the DCM.
The students visit the allotted families in the morning as well as in the evening to collect the information related to their socio-economic status, environmental and housing conditions, dietary pattern, immunization status of the children, addictions, personal habits and health status of every individual of the family etc. They also learn about the customs, ethnic groups. Community based organizations working at the village level and facilities available in the village level. During the camp, the demonstration of chlorination of wells, construction of soakage pits and smokeless chulah (furnace) etc. are also given.
During these camps, the students get so much acquainted with the families as if they are the members of the adopted families. During the social Service Camp all residents of the village are examined and are subjected to blood, urine and stool investigations. Wherever it is required, they are provided advice or treatment, in the general outpatient clinic in the village itself. Those who require specialist attention are referred to the specialist clinics which are organized in the camp daily in the afternoon. Again, specialist provide their advice or treatment, if it is so required, patient is referred to Kasturba Hospital, Sewagram for admission/special investigations. The health care is totally free of cost during the camp period.
The students also carry out the diet survey in the family and calculate the calorie and nutrients intake of individuals under the supervision of the teachers.
The students are trained on how to communicate with the villagers and are given briefing about the various models, charts, exhibits placed in the exhibition hall. Later they bring the family members to the exhibition hall and educate them with the help of the charts and models under the guidance of the Health Educator.
After the Social Service Camp, for the next three years, the students visit their adopted village every month on a fixed Saturday. In the first year of their visits, the students study personal hygiene, basic sanitation, housing, immunization, diet, nutrition, growth and development.
During the subsequent period, the students are given exercised related to maternal, newborn & child health, growth & development, breast & complimentary feeding, antenatal & postnatal care and Nutrition education. Consideration is given to health education involving teaching aids developed by the students themselves and to fertility control.
In the final year of their visits, the students perform exercises pertaining to local endemic diseases and their association with environmental sanitation, housing, vectors, personal hygiene, safe drinking water and develop IEC material on preventive measures. The role of village level health providers & VHNSC are also studied by the students. (11)
The students are introduced to Qualitative methods and PLA tools during Social Service Camp. They are explained the qualitative techniques and also demonstrated how to apply those techniques in the villages to understand the views, perceptions, expressions and opinions of the villagers about a topic. The students are exposed to the PLA tools such as Social Mapping, transect walk, Venn diagram, Seasonal Calendar, Force Field Analysis and Focus Group Discussion.
Family visits are the mainstay of Social Service Camp. The morning and evening hours are allotted for family visits where they interview family members regarding nutrition, hygiene adolescent health geriatric health and other related issues. This help them in developing rapport with the family, empathy and communication skills. They are prepared for these visits through having sessions on communications skills - active listening, reflecting, importance of asking open ended question, appreciation, empathy and not being judgmental through role plays. They are also taught about age specific communication; i.e. how to communicate with different age group. During the camp duration the students convince and mobilize the families allotted to them to avail the benefit of screening and curative services provided in the camp. This helps them to practice persuasive communication and negotiation skill. The students also get opportunity to negotiate behavior change with the family member in their subsequent monthly village visits.
During the social service camp, formal interactive sessions are also arranged on topics related
The villagers understand the importance of environmental sanitation as the villagers have been trained for how to chlorinate the well water, how to dispose waste water, garbage and refuse. They are motivated to construct soak pits, sanitary latrines and smokeless chulah etc.
Villagers realize the importance and practice of proper hand washing before cooking and before eating.
The health seeking behaviour of the family is changed. During illness they seek medical help as early as possible from the nearest health facility.
They understand how to take care during pregnancy, postnatal period and care of children.
The home delivery has been almost abolished.
The villagers do not allow their daughters to marry before reaching the age of 18 years.
The adolescent girls and women have been educated for the gender specific hygiene practice.
Breastfeeding practices and immunization coverage have improved.
The villagers become aware of various communicable and non-communicable diseases, diet and nutrition and immunization etc.
The ROME camp for two weeks is organized for students, after 2nd Professional examination. This time students stay at one of the Rural Health Training Centres of MGIMS, Sewagram. The camp is organized with the objectives:
to expose students to the organization & functioning of health care delivery system and implementation of national health programs at PHC level
to make students understand the role of family and social environment in the disease causation and health care seeking practice
to expose students to community health need assessment methods
During this camp, the visits are arranged for students to different levels of health care facilities and to interact with health care providers. Over the years we started involving the district level Programme Officers/Managers including District Health Officer and Civil Surgeon, Wardha for providing practical teaching to the medical students during the camp. They also share their experiences related to various facilitation factors, barriers and challenges in the implementation of health programme. Usually the clinical case presentation for undergraduate students are taken place in the premises of the hospital but taking the advantage of ROME camp, community based clinical case presentation at family level are organized under the supervision of the faculty members from the clinical specialties. Thus, students understand the role of social and environmental factors in health and diseases. They are also exposed to the various socio-cultural factors and established community practices in the village which have strong bearing on health and diseases as well as with the health seeking behaviors of the community. The students are also given opportunity to plan, collect the data, analyze it and write the report on small community-based surveys on various priority health issues related to community health needs.
While working with the students in the field, in 1995 few students approached me requesting that they have to understand the reason & ways to handle certain issues related to allotted families in the adopted villages. Consequently, using participative approach, we decided to introduce an exercise on Essential National Health Research” with the undergraduate medical students. Accordingly, a two days’ workshop on Research Methodology was organized to give an overview on Research Methodology. At the same time, the students in the group (3 to 5 students) were asked to find out the health problems in the allotted families in the villages. In the second stage, students prioritized the health problems and reached to consensus about the priority health problem to be addressed. In group, the students were taught how to convert the health problem to researchable question followed by developing a research protocol including literature search, objective of research and detail methodology and then the students conduct research projects in the groups under the guidance of faculty members of the department of Community Medicine.
Initially, a few students were interested to conduct research in hospital setup. However, they were motivated to take up the research topic in the field. The emphasis was given to undertake simple intervention which may sometime require behavioural change process so that the family members get full advantage of research. It has been highly satisfying both for students & for the community. Thus, in true sense a prototype of action research in the field has been developed the undergraduate students which has been refined during last 20 years and the process of undertaking research project is continuing in the adopted villages on voluntary basis.
Interns are posted for three months at both rural health training centre & urban health training centre out of their twelve months internship training programme. The interns are exposed to primary health care delivery & Kiran clinics so that they can sharpen their clinical competence with limited diagnostic facilities. They also interact with CBOs & VHNSC to appreciate their role in health promotion and disease prevention.
For last 8 years we are providing rural orientation to the undergraduate and postgraduate nursing students on rotation basis at our Rural Health Training Center, Anji and Urban Health Center, Wardha.
During their posting at RHTC they work very closely with Primary Health Center staff in the delivery of RMNCH programme. They also assist PHC staff in conducting deliveries. They visit to rural community and interact with CBOs & VHNSC. The faculty posted at Rural Health Training Center supervises their activities and conduct academical sessions in the afternoon. During the posting they are also given a small project either in School or in the community on priority health issues.
Similarly, during their posting at Urban Health Training Center, they are allotted few families in the field. Under guidance of faculty and social workers they conduct family study and present their brief report in the end of posting. The students are also posted at OPD of the Center for clinical exposure in rotation.
In 1994 Mahatma Gandhi Institute of Medical Sciences, Sewagram decided that those who desired to do Postgraduate Programme at MGIMS will have to serve for two years at a designated rural site. At MGIMS we selected nearly about 100 rural sites which were managed mainly by NGOs on “No Profit No Loss” basis and serving the marginalized community in the underserved rural area. We could able to identify these sites in every part of country. The students are posted at these sites on voluntary basis and while the doctors are working in the rural area, they are closely monitored by the faculty members of MGIMS on quarterly basis and sometime the visits are paid to the NGOs sites to ensure the proper utilization of manpower.
On successful completion of two years’ programme, the students were given admission to various PG programmes. At MGIMS presently we have PG programmes in all basic medical disciplines However the Government has come out with the National Entrance Examination for admission to PG programmes and we have to keep this Scheme in abeyance while our request to continue with the Scheme is pending with the appropriate authority.
In order to discharge the social responsibility of an academic institution, we have developed an interface between Mahatma Gandhi Institute of Medical Sciences, Sewagram with District Health System and Community. This interface is being utilized to have an integrated approach in the health care and research programme in the field. Over the years we have taken confidence building measures with the health system and have developed mutually beneficial partnership and in the process, we are working very closely with Primary Health Centres, Sub-Centres and Community Health Centres in the field. MGIMS play an important role in capacity building of health care providers on various health and health related issues and the District Health System in return has contributed significantly by supporting the community-based health care delivery and research as well as in teaching and training including during the Social Service Camp and ROME Camp. In the process, Institute has developed two Rural Health Training Centres at Anji and Bhidi and Urban Health Training Centre at Gandhi Memorial Leprosy Foundation, Wardha. These Centres act as a bridge between MGIMS and District Health System in discharging social responsibilities of MGIMS in providing health care to the marginalized rural population and promoting community-based research by the faculty members of MGIMS, Sewagram. All clinical faculties of MGIMS, Sewagram are regularly visiting these Centres on periodic basis to extend specialist health care at Primary Health Centres. Consequently, the MGIMS has signed a Memorandum of Understanding with the District Health System to manage two Primary Health Centres at Anji and Talegaon in rural area and two Primary Health Centres in the city of Wardha in urban area two years back which has further strengthened the partnership.
The DCM is involved in providing services to 100 villages in Wardha Block since 1985. Based on the experience over the years we promoted various community-based organizations (CBOs) and built up their capacity for promoting health action in the community. Initially we interacted mainly with the Village Panchayats (Local Bodies) and once we developed a good understanding with the Panchayat, we started promoting CBOs. Over the years two important CBOs which have been promoted are –.
In the initial years we used to visit the villages while delivering the health education in the community. We noticed that every time we visited the community, a different set of people gathered. Hence, we decided to develop Women Self Help Groups on the guidelines of National Agriculture Bank for Rural Development (NABARD). These groups are informal groups and don’t require any formal registration, however, number has to be restricted to 20 members. In the initial years, we spent a considerable time using SHG only for economic empowerment of women and to provide them relief from the moneylenders. These Self-Help Groups collect token monthly subscription from the members and utilized the collected amount for internal lending. Once the groups have a certain amount of money, then bank provide them a formal linkage by which they are eligible for the bank loan to undertake small income generation activities. Over the years these SHGs have been proved as good example of micro financing at community level. Once these groups’ financially stabilized, we started introducing health agenda in their activities by providing them relevant information in a phased manner. At present the DCM has nearly 300 Self Help Groups in the field practice area and promoting health action on various health and health related issues in the community.
The members of Self-Help Groups prompted to help adolescent girls who don’t have proper information related to menstrual hygiene and suffering rampantly with anemia. Accordingly, we started organizing community based Adolescent Girls Groups known as Kishori Panchayat. These groups are mainly involved in adolescent to Adolescent health programme. They have been oriented towards various adolescent health issues, maternal health, child survivals, environmental health and family life education as well as on RTI/STD/HIV control. These girls in turn also trained their peers and younger adolescent girls in the villages.
Later on, we have developed these girls’ groups on the bases of activities of the Rashtriya Kishor Swastha Karyakram (National Adolescent Health Programme). At present we are linking these community based adolescent activities with the school based adolescent health programme to ensure sustainability. Additionally, two Adolescent Health Resource Centers have been developed at our Rural Health Training Centers at Anji and Bhidi which acts as reference centers for both for community based and school based adolescent health programmes.
Mahatma Gandhi Institute of Medical Sciences, Sewagram is committed to provide accessible and affordable health care, primarily to underprivileged rural communities. In the community health needs assessment (using both quantitative, qualitative and participatory methods) in 60 villages, the findings emerged that the delivery of Primary Health Care was available at Primary Health Centre (PHC) or Sub-centre level but not at the village level. Villagers had to travel a long distance for seeking primary health care even for the basic ailments and it costed them a lot. Apart from the direct health expenditure on consultation, medicines or investigations, patients had to forego their daily wages and spend on transportation. The VHNSCs of respective village recommended to establish a village-based clinic, to cater to the unmet need of providing primary health care at the village level especially directed towards marginalized, poor and vulnerable section of the society- women, children and elders.
The Kiran clinics were started in selected villages under the CLICS (Community Led Initiative for Child Survival) program in 2004 to meet the health needs as defined above. The pre-condition set by Department of Community Medicine (DCM) for partnering with the VHNSC to establish a clinic was that at least 60% of the population of the village should contribute to the Village health fund. This was done to ensure financial sustainability of the clinic in the long run. Apart from providing curative services, preventive and promotive services are also provided through the clinic. It is an attempt to overcome constraints that affect access to care like distance, transport and availability of services of basic health care facility.
Usually services given under any research-project stop after project ends, Kiran clinics have sustained through community-ownership for a period of more than 15-years, which, is a testimony to simple but robust and transparent management and reflects the
Quality health services are provided in the Kiran clinic. One diabetic patient showed his satisfaction saying “Doctors and sister give psychological support along with quality treatment. I am 100% satisfied with services given at very low cost.” (12)
In our field practice area, 23 such clinics have been established. The cost comparison in terms of doctor’s fee, cost of drugs, transport, and lost wages has been strongly in favor of the Kiran Clinic (approximately 64 rupees at the Kiran Clinic versus 390 rupees for treatment outside the village which is a savings of almost 350 rupees.)”
In the Kiran clinic only, generic drugs are being purchased and made available to the patients at no-profit, no-loss basis to ensure affordability Apart from organizing clinic, the VHNSCs also ensure the quality of services at the clinic. Again, the DCM supplied them with a tool in the form of a QA checklist which covers a number of quality parameters from the presence of health care providers to adequate infrastructure and logistics, including drugs. The charges and the cost of treatment for the patient are also under scrutiny, as is the client satisfaction based on simple exit interviews. To top it all, it also looks into equity issues - whether the clinic manages to reach out to the disadvantaged and marginalized in the community, including the women and children.
The Kiran Clinics also act as hub for Health promotion by providing Growth monitoring, Antenatal care, Screening for Hypertension and Diabetes and also provide support in organization of VHND (Village Health Nutrition Day) at Village level. Thus, it offers a promise for new and innovative health initiatives.
The community is engaged at every stage (planning, implementation and evaluation) in the functioning of Kiran clinics and has been able to successfully run the clinics for the last 15 years. The committee has flexibility and authority to make necessary changes in functioning of the clinic, e.g. addition of new services, registration fees, drug price and incentive to village volunteer etc. Over the years, the committees have taken several decisions to improve the services through these clinics as per demand of the community; e.g. addition of new services like treatment of non-communicable diseases and other health promotion activities.
Community dialogue, voluntary participation, empowerment of people and involving them in decision making have been crucial for ensuring ownership. One member of VHNSC expressed her gratitude saying -
DCM continuously engages with PRI members in all villages in its field practice area. Orientation sessions are organized through the Rural and Urban Health Training Centres to empower the PRI and VHNSC members for health action at the community level. Due to its continuous engagement with VHNSC, in most of the villages in the field practice area, monthly meetings of VHNSC members are ensured.
VHNSC has a vital role in decentralized health planning and monitoring. NHM envisaged VHNSC to function adequately with involvement of community members and promote people’s participation in the planning process. However, there should be a tool which facilitates in planning, implementation according to village specific health plan, and community monitoring of health services at the village level. (13)
Mahatma Gandhi Institute of Medical Sciences (MGIMS) has developed a community-led approach and ensures the provision of high quality and affordable health care with emphasis on maternal and child health, in partnership with local community and health system. The strategy is to empower the communities to manage and own village-based primary health care. The DCM has initiated various community-based organizations in the villages – self-help groups of women, adolescents groups (more than 60 in numbers) and empowered Village Health, Nutrition & Sanitation Committees (VHNSC) in every village in a systematic manner.
The programme uses the Integrated Model of Communication for Social Change (IMCFSC) to guide its BCC activities. IMCFSC uses an iterative process where ‘community dialogue’ and ‘collective action’ work together to produce social change as shown in Figure 2. (14) The VHNSC have been empowered for health planning, organization of Immunization Day, monitoring of the health functionaries, and they work in close collaboration with the local health system and democratic body. There is an effort to link health and developmental activities at the village level.
integrated model of communication for social change.
Formal interaction of medical and nursing students with community-based organizations is arranged during their village visit; they witness the activities of community-based organizations. This helps aspiring doctors understand the role of individuals, families and communities in preventing diseases, maintaining and promoting health, and improving health-seeking behaviour.
Based on our experience of working with VHNSC it can be inferred that most VHNSCs are moving in right direction by addressing social determinants of health for which they have been empowered to recognized the social determinants of health being important in improving the health of the community as a whole, however it require continuous support, hand holding and monitoring from both public health system and other stakeholders. (15)
Community based organization will be the key to bring about the overall development of the villages. Most importantly, communities need to control the process. The ultimate goal is for communities to have the confidence and competence to make informed choices from a range of appropriate options for sustainable and equitable development. The need of the hour is to bring about a holistic change in the lives of beneficiaries among the villagers by uplifting their socioeconomic and health status through effective linkages through community, governmental and other developmental agencies. The VHNSC should be able to prepare an Integrated Village Development Plan with technical guidance from local organizations/agencies. (16)
As a part of their social responsibility, medical colleges needs to play the role of catalyst to bring all the stakeholders (Villages level committees, PRI members, Health functionaries – ASHA, AWW, ANM, MPWs, School students and teachers, NGOs etc..) on one platform and make an integrated plan for development of villages in their community development block area. Capacity building of the community and household will be pivotal if sustainable development is to be ensured and the Gandhian dream of Gram Swaraj is to be realized.
At present we have developed an interface between community, health system & MGIMS, which requires further nurturing in a manner that all three stakeholders sustain their commitment. The MGIMS has discharging its role to nurture & further develop this partnership in order to discharge its social responsibility in short term & social accountability in long term.
Author is thankful to all his collogues in the department of Community Medicine At MGIMS, Sewagram for their direct or indirect contribution.
“The author declares no conflict of interest.”
ANC | Ante-natal care |
ANMs | Auxiliary Nurse Midwives |
CBE | Community Based Education |
CBOs | Community Based Organization |
CLICS | Community Led Initiative for Child Survival |
DCM | Department of Community Medicine |
IMCFSC | Integrated Model of Communication for Social Change |
MCH | Maternal and Child health |
MGIMS | Mahatma Gandhi Institute of Medical Sciences |
NHM | National Health Mission |
OPD | Out Patient Department |
PHCs | Primary Health Centres |
PLA | Participatory Learning & Action |
PNC | Post-natal care |
RHTC | Rural Health & Training Centre |
ROME | Reorientation of Medical Education |
SDG | Social Determinants of Health |
SHGs | Self Help Groups |
UHC | Urban Health Centre |
VHNSC | Village Health Nutrition and Sanitation Committee |
VHND | Village Health and Nutrition Day |
WHO | World Health Organization |
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Some systems are highly affected by a small fraction of influential nodes. Number of fast and efficient spreaders in a network is much less compared to the number of ordinary members. Information about the influential spreaders is significant in the planning for the control of propagation of critical pieces of information in a social or information network. Identifying important members who act as the fastest and efficient spreaders is the focal theme of a large number of research papers. Researchers have identified approximately 10 different methods for this purpose. Degree centrality, closeness centrality, betweenness centrality, k‐core decomposition, mixed degree decomposition, improved k‐shell decomposition, etc., are some of these methods. 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Classification and prediction of decision problems can be solved with the use of a decision tree, which is a graph-based method of machine learning. In the presented approach, attribute-value system and quality function deployment (QFD) were used for decision problem analysis and training dataset preparation. A decision tree was applied for generating decision rules.",book:{id:"5842",slug:"graph-theory-advanced-algorithms-and-applications",title:"Graph Theory",fullTitle:"Graph Theory - Advanced Algorithms and Applications"},signatures:"Izabela Kutschenreiter-Praszkiewicz",authors:[{id:"218951",title:"Associate Prof.",name:"Izabela",middleName:null,surname:"Kutschenreiter-Praszkiewicz",slug:"izabela-kutschenreiter-praszkiewicz",fullName:"Izabela Kutschenreiter-Praszkiewicz"}]},{id:"72140",doi:"10.5772/intechopen.91972",title:"Comparative Study of Algorithms Metaheuristics Based Applied to the Solution of the Capacitated Vehicle Routing Problem",slug:"comparative-study-of-algorithms-metaheuristics-based-applied-to-the-solution-of-the-capacitated-vehi",totalDownloads:685,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"This chapter presents the best-known heuristics and metaheuristics that are applied to solve the capacitated vehicle routing problem (CVRP), which is the generalization of the TSP, in which the nodes are visited by more than one route. To find out which algorithm obtains better results, there are 30 test instances used, which are grouped into 3 sets of problems according to the position of the nodes. The study begins with an economic impact analysis of the transportation sector in companies, which represents up to 20% of the final cost of the product. 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Vertex degrees deg(v) are always finite but the trees contain infinite paths (vi)i≥0. A concrete group theoretic model of the rooted in-trees T(R) is introduced by representing vertices by isomorphism classes of finite p-groups G, for a fixed prime p, and directed edges by epimorphisms π: G → πG of finite p-groups with characteristic kernels ker(π). The weight of a vertex G is realized by its nuclear rank n(G) and the weight of a directed edge π is realized by its step size s(π)=logp(#ker(π)). These invariants are essential for understanding the phenomenon of multifurcation. Pattern recognition methods are used for finding finite subgraphs which repeat indefinitely. Several periodicities admit the reduction of the complete infinite graph to finite patterns. The proof is based on infinite limit groups and successive group extensions. It is underpinned by several explicit algorithms. As a final application, it is shown that fork topologies, arising from repeated multifurcations, provide a convenient description of complex navigation paths through the trees, which are of the greatest importance for recent progress in determining p-class field towers of algebraic number fields.",book:{id:"5842",slug:"graph-theory-advanced-algorithms-and-applications",title:"Graph Theory",fullTitle:"Graph Theory - Advanced Algorithms and Applications"},signatures:"Daniel C. Mayer",authors:[{id:"198580",title:"Dr.",name:"Daniel C.",middleName:null,surname:"Mayer",slug:"daniel-c.-mayer",fullName:"Daniel C. Mayer"}]},{id:"57771",doi:"10.5772/intechopen.71774",title:"Governance Modeling: Dimensionality and Conjugacy",slug:"governance-modeling-dimensionality-and-conjugacy",totalDownloads:1347,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"The Q-analysis governance approach and the use of simplicial complexes—type of hypergraph—allow to introduce the formal concepts of dimension and conjugacy between the network of entities involved in governance (typically organizations) and the networks of those attributes taken into account (e.g. their competences), which offer a specific angle of analysis. The different sources of existing data (e.g. textual corpora) to feed the analysis of governance—environmental in particular—are mentioned, their reliability is briefly discussed and the required pre-processing steps are identified in the perspective of evidence-based analyses. Various indices are constructed and evaluated to characterize the context of governance as a whole, at mesoscale, or locally, i.e. at the level of each of the entities and each of the attributes considered. The analysis of ideal-type stylizing boundary cases provides useful references to the analysis of concrete systems of governance and to the interpretation of their empirically observed properties. The use of this governance modeling approach is illustrated by the analysis of a health-environment governance system in Southeast Asia, in the context of a One Health approach.",book:{id:"5842",slug:"graph-theory-advanced-algorithms-and-applications",title:"Graph Theory",fullTitle:"Graph Theory - Advanced Algorithms and Applications"},signatures:"Pierre Mazzega, Claire Lajaunie and Etienne Fieux",authors:[{id:"220099",title:"Dr.",name:"Pierre",middleName:null,surname:"Mazzega",slug:"pierre-mazzega",fullName:"Pierre Mazzega"},{id:"220102",title:"Dr.",name:"Claire",middleName:null,surname:"Lajaunie",slug:"claire-lajaunie",fullName:"Claire Lajaunie"},{id:"220103",title:"Prof.",name:"Etienne",middleName:null,surname:"Fieux",slug:"etienne-fieux",fullName:"Etienne Fieux"}]}],mostDownloadedChaptersLast30Days:[{id:"71899",title:"Moments of Catalan Triangle Numbers",slug:"moments-of-catalan-triangle-numbers",totalDownloads:572,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In this chapter, we consider the Catalan numbers, \n\n\nC\nn\n\n=\n\n1\n\nn\n+\n1\n\n\n\n\n\n\n2\nn\n\n\n\n\nn\n\n\n\n\n\n, and two of their generalizations, Catalan triangle numbers, \n\n\nB\n\nn\n,\nk\n\n\n\n and \n\n\nA\n\nn\n,\nk\n\n\n\n, for \n\nn\n,\nk\n∈\nN\n\n. They are combinatorial numbers and present interesting properties as recursive formulae, generating functions and combinatorial interpretations. We treat the moments of these Catalan triangle numbers, i.e., with the following sums: \n\n\n∑\n\nk\n=\n1\n\nn\n\n\nk\nm\n\n\nB\n\nn\n,\nk\n\nj\n\n,\n\n∑\n\nk\n=\n1\n\n\nn\n+\n1\n\n\n\n\n\n2\nk\n−\n1\n\n\nm\n\n\nA\n\nn\n,\nk\n\nj\n\n,\n\n for \n\nj\n,\nn\n∈\nN\n\n and \n\nm\n∈\nN\n∪\n\n0\n\n\n. We present their closed expressions for some values of \n\nm\n\n and \n\nj\n\n. Alternating sums are also considered for particular powers. Other famous integer sequences are studied in Section 3, and its connection with Catalan triangle numbers are given in Section 4. Finally we conjecture some properties of divisibility of moments and alternating sums of powers in the last section.",book:{id:"8142",slug:"number-theory-and-its-applications",title:"Number Theory and Its Applications",fullTitle:"Number Theory and Its Applications"},signatures:"Pedro J. Miana and Natalia Romero",authors:null},{id:"55642",title:"Monophonic Distance in Graphs",slug:"monophonic-distance-in-graphs",totalDownloads:1551,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"For any two vertices u and v in a connected graph G, a u − v path is a monophonic path if it contains no chords, and the monophonic distance dm(u, v) is the length of a longest u − v monophonic path in G. For any vertex v in G, the monophonic eccentricity of v is em(v) = max {dm(u, v) : u ∈ V}. The subgraph induced by the vertices of G having minimum monophonic eccentricity is the monophonic center of G, and it is proved that every graph is the monophonic center of some graph. Also it is proved that the monophonic center of every connected graph G lies in some block of G. With regard to convexity, this monophonic distance is the basis of some detour monophonic parameters such as detour monophonic number, upper detour monophonic number, forcing detour monophonic number, etc. The concept of detour monophonic sets and detour monophonic numbers by fixing a vertex of a graph would be introduced and discussed. Various interesting results based on these parameters are also discussed in this chapter.",book:{id:"5842",slug:"graph-theory-advanced-algorithms-and-applications",title:"Graph Theory",fullTitle:"Graph Theory - Advanced Algorithms and Applications"},signatures:"P. Titus and A.P. Santhakumaran",authors:[{id:"198301",title:"Dr.",name:"P.",middleName:null,surname:"Titus",slug:"p.-titus",fullName:"P. Titus"},{id:"199035",title:"Prof.",name:"A. P.",middleName:null,surname:"Santhakumaran",slug:"a.-p.-santhakumaran",fullName:"A. P. Santhakumaran"}]},{id:"71501",title:"Accelerating DNA Computing via PLP-qPCR Answer Read out to Solve Traveling Salesman Problems",slug:"accelerating-dna-computing-via-plp-qpcr-answer-read-out-to-solve-traveling-salesman-problems",totalDownloads:824,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"An asymmetric, fully-connected 8-city traveling salesman problem (TSP) was solved by DNA computing using the ordered node pair abundance (ONPA) approach through the use of pair ligation probe quantitative real time polymerase chain reaction (PLP-qPCR). The validity of using ONPA to derive the optimal answer was confirmed by in silico computing using a reverse-engineering method to reconstruct the complete tours in the feasible answer set from the measured ONPA. The high specificity of the sequence-tagged hybridization, and ligation that results from the use of PLPs significantly increased the accuracy of answer determination in DNA computing. When combined with the high throughput efficiency of qPCR, the time required to identify the optimal answer to the TSP was reduced from days to 25 min.",book:{id:"8241",slug:"novel-trends-in-the-traveling-salesman-problem",title:"Novel Trends in the Traveling Salesman Problem",fullTitle:"Novel Trends in the Traveling Salesman Problem"},signatures:"Fusheng Xiong, Michael Kuby and Wayne D. 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The first case of inverted pendulum refers to an amphi-hinge pendulum that possesses distributed mass and stiffness along its height, while the second case of inverted pendulum refers to an inverted pendulum with distributed mass and stiffness along its height. These vertical pendulums have infinity number of degree of freedoms. Based on the free vibration of the above-mentioned pendulums according to partial differential equation, a mathematically equivalent three-degree of freedom system is given for each case, where its equivalent mass matrix is analytically formulated with reference on specific mass locations along the pendulum height. Using the three DoF model, the first three fundamental frequencies of the real pendulum can be identified with very good accuracy. Furthermore, taking account the 3 × 3 mass matrix, it is possible to estimate the possible pendulum damages using a known technique of identification mode-shapes via records of response accelerations. Moreover, the way of instrumentation with a local network by three accelerometers is given via the above-mentioned three degrees of freedom.",book:{id:"8142",slug:"number-theory-and-its-applications",title:"Number Theory and Its Applications",fullTitle:"Number Theory and Its Applications"},signatures:"Triantafyllos K. Makarios",authors:[{id:"69418",title:"Prof.",name:"Triantafyllos",middleName:"Konstantinos",surname:"Makarios",slug:"triantafyllos-makarios",fullName:"Triantafyllos Makarios"}]},{id:"57940",title:"Graph-Based Decision Making in Industry",slug:"graph-based-decision-making-in-industry",totalDownloads:1725,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"Decision-making in industry can be focused on different types of problems. Classification and prediction of decision problems can be solved with the use of a decision tree, which is a graph-based method of machine learning. In the presented approach, attribute-value system and quality function deployment (QFD) were used for decision problem analysis and training dataset preparation. 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He was elected a Yangtze River Scholars Distinguished Professor in 2013, a member of the International Statistical Institute (ISI) in 2016, a member of the board of the International Chinese Statistical Association (ICSA) in 2018, and a fellow of the Institute of Mathematical Statistics (IMS) in 2021. He received the ICSA Outstanding Service Award in 2018 and the National Science Foundation for Distinguished Young Scholars of China in 2012. He serves as a member of the editorial board of Statistics and Its Interface and Journal of Systems Science and Complexity. He is also a field editor for Communications in Mathematics and Statistics. His research interests include biostatistics, empirical likelihood, missing data analysis, variable selection, high-dimensional data analysis, Bayesian statistics, and data science. He has published more than 190 research papers and authored five books.",institutionString:"Yunnan University",institution:{name:"Yunnan University",country:{name:"China"}}},{id:"1177",title:"Prof.",name:"António",middleName:"J. R.",surname:"José Ribeiro Neves",slug:"antonio-jose-ribeiro-neves",fullName:"António José Ribeiro Neves",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1177/images/system/1177.jpg",biography:"Prof. António J. R. Neves received a Ph.D. in Electrical Engineering from the University of Aveiro, Portugal, in 2007. Since 2002, he has been a researcher at the Institute of Electronics and Informatics Engineering of Aveiro. Since 2007, he has been an assistant professor in the Department of Electronics, Telecommunications, and Informatics, University of Aveiro. He is the director of the undergraduate course on Electrical and Computers Engineering and the vice-director of the master’s degree in Electronics and Telecommunications Engineering. He is an IEEE Senior Member and a member of several other research organizations worldwide. His main research interests are computer vision, intelligent systems, robotics, and image and video processing. He has participated in or coordinated several research projects and received more than thirty-five awards. He has 161 publications to his credit, including books, book chapters, journal articles, and conference papers. He has vast experience as a reviewer of several journals and conferences. As a professor, Dr. Neves has supervised several Ph.D. and master’s students and was involved in more than twenty-five different courses.",institutionString:null,institution:{name:"University of Aveiro",country:{name:"Portugal"}}},{id:"11317",title:"Dr.",name:"Francisco",middleName:null,surname:"Javier Gallegos-Funes",slug:"francisco-javier-gallegos-funes",fullName:"Francisco Javier Gallegos-Funes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/11317/images/system/11317.png",biography:"Francisco J. Gallegos-Funes received his Ph.D. in Communications and Electronics from the Instituto Politécnico Nacional de México (National Polytechnic Institute of Mexico) in 2003. He is currently an associate professor in the Escuela Superior de Ingeniería Mecánica y Eléctrica (Mechanical and Electrical Engineering Higher School) at the same institute. His areas of scientific interest are signal and image processing, filtering, steganography, segmentation, pattern recognition, biomedical signal processing, sensors, and real-time applications.",institutionString:"Instituto Politécnico Nacional",institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"428449",title:"Dr.",name:"Ronaldo",middleName:null,surname:"Ferreira",slug:"ronaldo-ferreira",fullName:"Ronaldo Ferreira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/428449/images/21449_n.png",biography:null,institutionString:null,institution:{name:"University of Aveiro",country:{name:"Portugal"}}},{id:"165328",title:"Dr.",name:"Vahid",middleName:null,surname:"Asadpour",slug:"vahid-asadpour",fullName:"Vahid Asadpour",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/165328/images/system/165328.jpg",biography:"Vahid Asadpour, MS, Ph.D., is currently with the Department of Research and Evaluation, Kaiser Permanente Southern California. He has both an MS and Ph.D. in Biomedical Engineering. He was previously a research scientist at the University of California Los Angeles (UCLA) and visiting professor and researcher at the University of North Dakota. He is currently working in artificial intelligence and its applications in medical signal processing. In addition, he is using digital signal processing in medical imaging and speech processing. Dr. Asadpour has developed brain-computer interfacing algorithms and has published books, book chapters, and several journal and conference papers in this field and other areas of intelligent signal processing. He has also designed medical devices, including a laser Doppler monitoring system.",institutionString:"Kaiser Permanente Southern California",institution:null},{id:"169608",title:"Prof.",name:"Marian",middleName:null,surname:"Găiceanu",slug:"marian-gaiceanu",fullName:"Marian Găiceanu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/169608/images/system/169608.png",biography:"Prof. Dr. Marian Gaiceanu graduated from the Naval and Electrical Engineering Faculty, Dunarea de Jos University of Galati, Romania, in 1997. He received a Ph.D. (Magna Cum Laude) in Electrical Engineering in 2002. Since 2017, Dr. Gaiceanu has been a Ph.D. supervisor for students in Electrical Engineering. He has been employed at Dunarea de Jos University of Galati since 1996, where he is currently a professor. Dr. Gaiceanu is a member of the National Council for Attesting Titles, Diplomas and Certificates, an expert of the Executive Agency for Higher Education, Research Funding, and a member of the Senate of the Dunarea de Jos University of Galati. He has been the head of the Integrated Energy Conversion Systems and Advanced Control of Complex Processes Research Center, Romania, since 2016. He has conducted several projects in power converter systems for electrical drives, power quality, PEM and SOFC fuel cell power converters for utilities, electric vehicles, and marine applications with the Department of Regulation and Control, SIEI S.pA. (2002–2004) and the Polytechnic University of Turin, Italy (2002–2004, 2006–2007). He is a member of the Institute of Electrical and Electronics Engineers (IEEE) and cofounder-member of the IEEE Power Electronics Romanian Chapter. He is a guest editor at Energies and an academic book editor for IntechOpen. He is also a member of the editorial boards of the Journal of Electrical Engineering, Electronics, Control and Computer Science and Sustainability. Dr. Gaiceanu has been General Chairman of the IEEE International Symposium on Electrical and Electronics Engineering in the last six editions.",institutionString:'"Dunarea de Jos" University of Galati',institution:{name:'"Dunarea de Jos" University of Galati',country:{name:"Romania"}}},{id:"4519",title:"Prof.",name:"Jaydip",middleName:null,surname:"Sen",slug:"jaydip-sen",fullName:"Jaydip Sen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/4519/images/system/4519.jpeg",biography:"Jaydip Sen is associated with Praxis Business School, Kolkata, India, as a professor in the Department of Data Science. His research areas include security and privacy issues in computing and communication, intrusion detection systems, machine learning, deep learning, and artificial intelligence in the financial domain. He has more than 200 publications in reputed international journals, refereed conference proceedings, and 20 book chapters in books published by internationally renowned publishing houses, such as Springer, CRC press, IGI Global, etc. Currently, he is serving on the editorial board of the prestigious journal Frontiers in Communications and Networks and in the technical program committees of a number of high-ranked international conferences organized by the IEEE, USA, and the ACM, USA. He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:{name:"Association for Computing Machinery",country:{name:"United States of America"}}},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:'"Politechnica" University Timişoara',institution:null},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:null,institution:null},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. 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