The modified Medical Research Council Breathlessness (mMRC) score.
\r\n\t(i) Quantum dots of very high-quality optical applications, Quantum dot light-emitting diodes (QD-LED) and ‘QD-White LED’, Quantum dot photodetectors (QDPs), Quantum dot solar cells (Photovoltaics).
\r\n\r\n\t(ii) Quantum Computing (quantum bits or ‘qubits’), (vii) The Future of Quantum Dots (broad range of real-time applications, magnetic quantum dots & graphene quantum dots), Superconducting Loop, Quantum Entanglement, Quantum Fingerprints.
\r\n\r\n\t(iii) Biomedical and Environmental Applications (to study intracellular processes, tumor targeting, in vivo observation of cell trafficking, diagnostics and cellular imaging at high resolutions), Bioconjugation, Cell Imaging, Photoelectrochemical Immunosensor, Membranes and Bacterial Cells, Resonance Energy-Transfer Processes, Evaluation of Drinking Water Quality, Water and Wastewater Treatment, Pollutant Control.
",isbn:"978-1-80356-594-1",printIsbn:"978-1-80356-593-4",pdfIsbn:"978-1-80356-595-8",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"0dd5611c62c91569bd2819e68852002a",bookSignature:"Prof. Jagannathan Thirumalai",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11756.jpg",keywords:"LED, Organic LEDs, Dyes & Pigments, Solar Cells, Laser Photonics, Electronic Switching Devices, Qubits, Josephson Junction, Bioconjugation, Cell Imaging, Photoelectrochemical Immunosensor, Membranes, and Bacterial Cells",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 16th 2022",dateEndSecondStepPublish:"May 27th 2022",dateEndThirdStepPublish:"July 26th 2022",dateEndFourthStepPublish:"October 14th 2022",dateEndFifthStepPublish:"December 13th 2022",remainingDaysToSecondStep:"10 days",secondStepPassed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Dr. J. Thirumalai received his Ph.D. from Alagappa University, Karaikudi, He was also awarded the Post-doctoral Fellowship from Pohang University of Science and Technology (POSTECH), the Republic of Korea. His research interests focus on luminescence, self-assembled nanomaterials, and thin-film optoelectronic devices. He has published more than 60 SCOPUS/ISI indexed papers and 11 book chapters, edited 4 books, and member of several national and international societies like RSC, OSA, etc. His h-index is 19.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"99242",title:"Prof.",name:"Jagannathan",middleName:null,surname:"Thirumalai",slug:"jagannathan-thirumalai",fullName:"Jagannathan Thirumalai",profilePictureURL:"https://mts.intechopen.com/storage/users/99242/images/system/99242.png",biography:"Dr. J. Thirumalai received his Ph.D. from Alagappa University, Karaikudi in 2010. He was also awarded the Post-doctoral Fellowship from Pohang University of Science and Technology (POSTECH), Republic of Korea, in 2013. He worked as Assistant Professor of Physics, B.S. Abdur Rahman University, Chennai, India (2011 to 2016). Currently, he is working as Senior Assistant Professor of Physics, Srinivasa Ramanujan Centre, SASTRA Deemed University, Kumbakonam (T.N.), India. His research interests focus on luminescence, self-assembled nanomaterials, and thin film opto-electronic devices. He has published more than 60 SCOPUS/ISI indexed papers and 11 book chapters, edited 4 books and member in several national and international societies like RSC, OSA, etc. Currently, he served as a principal investigator for a funded project towards the application of luminescence based thin film opto-electronic devices, funded by the Science and Engineering Research Board (SERB), India. As an expert in opto-electronics and nanotechnology area, he has been invited as external and internal examiners to MSc and PhD theses, invited to give talk in some forum, review papers for international and national journals.",institutionString:"SASTRA University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"10",totalChapterViews:"0",totalEditedBooks:"6",institution:null}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"17",title:"Nanotechnology and Nanomaterials",slug:"nanotechnology-and-nanomaterials"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"347258",firstName:"Marica",lastName:"Novakovic",middleName:null,title:"Ms.",imageUrl:"//cdnintech.com/web/frontend/www/assets/author.svg",email:"marica@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"5348",title:"Luminescence",subtitle:"An 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In this direction, in the last decade, many authors have studied the benefits in properties that could be obtained when combining CeO2 nanoparticles with polymers. For instance, catalytic [1, 2, 3], thermal [4], mechanical [5, 6], optical [7, 8, 9], anticorrosion [10, 11, 12], and barrier properties [13] of polymers have been considerably improved with the incorporation of CeO2 nanoparticles. Moreover, CeO2 nanocomposites can find application in many different fields such as chemi-sensors and photocatalyst for environmental applications [14, 15, 16], temperature and humidity sensors [17] or extractants for yttrium ions [18].
Taking advantage of the excellent UV absorption capacity of the CeO2 nanoparticles, it is really interesting to incorporate these nanoparticles into polymer matrices in the field of outdoor clear coatings. Waterborne acrylic polymers, synthesized mainly by emulsion polymerization process, are widely used as protective coatings for different surfaces due to their low toxicity and good quality film forming properties [19]. However, the main drawback of these coatings is the photodegradation they suffer under UV light. Traditionally, organic UV absorbers and hindered amine light stabilizers (HALS) were used, but due to the increasing environmental pressure to reduce the volatile organic compounds (VOC) content in coatings, the use of metal oxides such as TiO2 [20, 21], ZnO [22, 23] and CeO2 [24, 25] have been considered as an attractive alternative. All of them absorb radiation around 400 nm [26] and posses a band gap energy of around 3 eV [27], which makes them good candidates for UV absorption purposes. There are some works in which TiO2 [28, 29, 30, 31] and ZnO [32, 33, 34, 35] nanoparticles have been incorporated into polymer matrixes to improve the UV absorbance capacity of the coating. Nevertheless, the photocatalytic activity of CeO2 nanoparticles is lower than that of TiO2 and ZnO [36], which might prevent a faster degradation of the acrylic coatings due to the presence of the metal oxide, making CeO2 nanoparticles ideal candidates for their incorporation into waterborne acrylic coatings.
In waterborne hybrid coatings, the final morphology of the hybrid system is governed by the different nature of the inorganic nanoparticles and polymer. Therefore, the control of the morphology of the hybrid system is challenging. The compatibility between both phases (thermodynamics) as well as the polymerization process (kinetics) will define the final morphology of the nanocomposite and thus, the final application [37]. In the literature a variety of CeO2 nanoparticles (hydrophilic or hydrophobically modified) have been incorporated following different polymerization processes.
For instance, Fischer [2] and Mari [3] synthesized CeO2/polystyrene (PS) and CeO2/polymethylmethacrylate (PMMA) hybrids with raspberry like morphology, following the same procedure. They synthesized PS and PMMA latexes incorporating active groups (acrylic, methacrylic or phosphate groups) on the surface of either the PS or PMMA polymer particles, synthesized previously by minimemulsion polymerization. These active groups served as nucleating agents for the crystallization of the CeO2. As the CeO2 nanoparticles were generated in the surface of the polymer particles, this morphology was very favorable to take advantage of the catalytic behavior of the CeO2, giving for instance very efficient catalyst for the hydration reaction of 2-cyanopiridine to 2-picolinamide.
Another possibility to obtain pickering morphology is to use the inorganic nanoparticles to stabilize the polymer particles. CeO2 nanoparticles were used as pickering stabilizers in the miniemulsion polymerization of acrylates by Zgheib et al. [38]. It was found that at least 35 wt% of CeO2 nanoparticles were necessary to obtain stable hybrid latexes at intermediate solids content (25 wt%). Therefore, the large amount of nanoparticles used and the solids content obtained, limited their application as coating. However, using other inorganic nanoparticles, such as SiO2 or TiO2, it has been possible to obtain high solids content latexes [39]. The ability of these hybrid nanocomposites with Pickering morphology as protective coatings [40, 41] has been successfully proved.
Hawkett was the first one adsorbing amphiphilic macro-RAFT agents on the surface of inorganic nanoparticles and starting the polymerization from the macro-RAFT agents to obtain encapsulation of the inorganic nanoparticles [42, 43]. Garnier [44, 45], Warrant [46] and Zgheib [47] followed this method to encapsulate CeO2 nanoparticles. The hybrid acrylic/ CeO2 latexes were obtained by semibatch emulsion polymerization starting the polymerization from the macro-RAFT agent modified CeO2 nanoparticles. In general, good distribution of the CeO2 nanoparticles in the polymer particles was obtained and the CeO2 nanoparticles were located close to particle-aqueous phase interface and even encapsulated in some examples.
In this Chapter, a polymerization approach to produce waterborne hybrid (polymer/CeO2) dispersions with encapsulated CeO2 nanoparticles will be presented. The prediction of the evolution of the morphology during the polymerization will be illustrated by means of a mathematical model and finally the UV absorbing properties of the clear coatings produced from these hybrid latexes and the potential photochemical degradation of the coatings will be discussed.
In the production of waterborne binders (for coatings), emulsion polymerization is the most popular process. However, when it comes into hybrid waterborne binders, miniemulsion polymerization emerged as an alternative process, to overcome the limitations of emulsion polymerization when the inorganic material must be incorporated into the polymer particles [48, 49, 50]. Moreover, equilibrium morphology simulations have demonstrated that if the nanoparticles present good wettability in the monomer phase, they can be encapsulated in monomer nanodroplets and hence hybrid latexes with encapsulated morphology can be produced [51].
The approach presented here to produce waterborne acrylic/CeO2 nanocomposite dispersions uses a two-step seeded semibatch (mini)emulsion polymerization process. The approach is well suited to produce hybrid latexes with CeO2 contents spanning between 0.5 and 5 wt% based on the polymer [52, 53]. In the first step, hybrid seed particles are synthesized by batch miniemulsion polymerization. In the second step the solids content and the final concentration of the CeO2 nanoparticles can be tuned by controlling the composition of the feed of the semibatch process. Two feeding strategies can be used:
Neat monomer preemulsion feeding. A preemulsion is fed containing monomers, emulsifier and water, to grow the already formed seed hybrid particles. In this case, all the CeO2 nanoparticles present in the final hybrid are only added in the seed prepared in the first step. Hybrid latexes with 40–50% solids content were synthesized [53, 54] with CeO2 contents up to 1 wt% in the final hybrid composite.
Hybrid monomer/CeO2 miniemulsion feeding. The same formulation of the miniemulsion used to synthesize the seed is used as feed allowing higher concentration of CeO2 in the final latex. Hybrid latexes with CeO2 contents up to 5 wt% were obtained at 40% of solids content [55].
Figure 1 presents the transmission electron microscopy (TEM) images of relevant latexes with low (1 wt%) and high (5 wt%) content of CeO2 nanoparticles produced using the two feeding strategies discussed above, respectively. As it can be seen, the polymer particle size distribution (PSD) obtained by both feeding strategies is different. Even if the PSD obtained for the hybrid seed is the same for both cases, with particles around 100 nm, the final PSD differs depending on the feeding strategy. When neat monomer preemulsion is fed (Figure 1a) the final PSD is narrow, suggesting lack of secondary nucleation during the semibatch process. Nevertheless, the PSD obtained when feeding the miniemulsion (second strategy) is broader, as particles between 25 and 600 nm can be found (Figure 1b). This is related to the miniemulsion stability and to the monomer droplet nucleation efficiency in the reactor. According to Rodriguez et al., the nucleation efficiency in a seeded semibatch miniemulsion polymerization is related to the stability of the miniemulsion fed (the higher the stability, the higher the nucleation of the entering droplets), and also to the ratio of the number of entering droplets with respect to the number of particles in the seed (the higher this ratio, the higher the number of fed droplets nucleate because their efficiency for capturing radical is higher) [56]. In Figure 1b, very small polymer particles can be seen containing nanoceria, which is an indication that hybrid monomer droplets serve as monomer reservoirs when they enter into the reactor, but they do not lose their identity and finally they end up nucleating [55, 57].
(a) Cryo-TEM image and (b) TEM image of the latexes, (c) and (d) CeO2 aggregate size distributions in the hybrid latex and (e) and (f) TEM of the hybrid films for the sample containing 1% CeO2 and 40% SC produced by neat monomer preemulsion feeding strategy (a,c,e) and for the sample containing 5% CeO2 and 40% SC synthesized using the hybrid miniemulsion feeding (b,d,f).
In any case, the CeO2 nanoparticles (darker spots) are all present in the polymer particles in both cases (Figure 1a and b), and no one is present in the continuous water phase. It can be seen that the CeO2 nanoparticles aggregates are more centered in the polymer particles synthesized using the first strategy whereas they are more close to the border of the polymer particle in the hybrids synthesized using the second strategy. The difference comes from the feeding strategy used in each case. When the neat monomer preemulsion strategy is used, the monomer entering the reactor in the semicontinuous process covers de hybrid seed particles containing the CeO2 nanoparticles. However, in the case of the miniemulsion feeding, a large fraction of the entering hybrid droplets nucleates, and hence not all the fed monomer is used to grow the seed particles and as a consequence CeO2 nanoparticles aggregates are not fully encapsulated.
Nevertheless, the encapsulation of inorganic nanoparticles inside polymer particles cannot be proved just by TEM images, as sometimes the micrographs are not conclusive enough. Therefore, TEM Tomography studies were carried out to a representative area of the hybrid latexes prepared following the seeded semibatch (mini)emulsion strategy presented so far. The results demonstrated that the CeO2 nanoparticles were surrounded by polymer in all directions in both, the seed and the final polymer particles, demonstrating beyond any doubt the encapsulated morphology [54].
Furthermore, it is remarkable that every polymer particle contains one CeO2 nanoparticle aggregate in average. In Figure 1a and b it can be seen that the number of polymer particles with zero, two and three nanoparticles is very small. It is observed that the CeO2 aggregate size increases with the nanoceria content in the formulation of the hybrid nanocomposite; namely, the higher the CeO2 content, the larger the aggregates. Figure 1c and d presents the quantification of the CeO2 aggregate sizes in the hybrid latexes containing 1 and 5% of CeO2 nanoparticles. As it can be seen, aggregate sizes between 3 and 73 nm can be found for the hybrid latex containing 1% of CeO2 nanoparticles, whereas aggregate sizes between 3 and 123 nm can be found for the nanocomposite containing 5% of CeO2 nanoparticles. Volume average aggregate sizes are 26 and 50 nm, respectively. However, it should be mentioned that the initial average size of the CeO2 nanoparticles dispersed in the monomer mixture was 12 nm (measured by dynamic light scattering). Therefore, it seems that all the nanoparticles present in each monomer droplet aggregate during the first stages of the polymerization process to form a CeO2 aggregate per polymer particle. This effect will be discussed deeply in the following section.
One of the main advantages of having inorganic nanoparticles encapsulated in polymer particles is the lack of agglomeration during the film formation process, obtaining homogeneous distribution of the nanoparticles in the polymeric film and avoiding their leaching during the lifetime of the coating. Figure 1e and f show the hybrid films obtained after drying hybrid latexes with 1 and 5% of CeO2 nanoparticles. It can be seen that after film formation the nanoceria aggregates are homogeneously dispersed in the polymer matrix in both cases. The average CeO2 aggregate size was also analyzed and it was found that the average size in volume of the CeO2 nanoparticles in the film is 26 nm for the film containing 1% of CeO2 and 46 nm for the film with 5% of CeO2. Therefore, the average size of the CeO2 aggregates does not change during the film formation process in which the polymer particles coalesce between them, indicating that the encapsulation is an efficient method to avoid the agglomeration of the inorganic nanoparticles in the final film.
The morphology obtained in a hybrid nanocomposite may affect directly the final application of the composite material as it has been shown in Section 1 of this chapter. The particle morphology will develop during the polymerization and the final particle morphology will be determined by the interplay of thermodynamics and kinetics. The equilibrium morphology is the one that minimizes the total interfacial energy (
where, Aij and 𝜸ij are the interfacial area and interfacial tensions respectively, between phase i and j, where P, I and W are polymer (monomer), inorganic material, and aqueous phase, respectively. In this particular case the CeO2 inorganic nanoparticles were previously modified in order to make them hydrophobic and more compatible with the monomers, so the interfacial tension 𝜸II should be very low because when the inorganic particles come into contact, the contact occurs between the same hydrophobic materials. Neglecting 𝜸II, Eq. (1) reduces to an equation that has the same mathematical form that the equation used to calculate equilibrium morphologies of two phase polymer-polymer systems [58, 59, 60]. Using the morphology map developed in these studies, Asua showed a similar one (see Figure 2) adapted to a polymer/inorganic system [61], where the gray phase represents the inorganic material and the white the polymer (monomer).
Morphology map and evolution of the particle morphology for (a) acrylic/CeO2 monomer droplets, (b) 1% monomer conversion, (c) 8% monomer conversion, (d) 18% monomer conversion, (e) 40% monomer conversion, and (f) 100% conversion. Reprinted from [
According to this morphology map presented in Figure 2, the possible equilibrium morphologies that can be obtained in a polymer/inorganic hybrid nanocomposite are core-shell (encapsulated), inverted core-shell, hemispherical or separated particles. During the miniemulsion polymerization, the system and thus, the composition of the monomer droplets, are changing as polymerization proceeds. The monomer becomes polymer, initiator or other compounds may incorporate into the polymer and grafting might occur between the polymer being formed and the inorganic material. All these factors will alter the interfacial tensions between the phases and hence, the final equilibrium morphology. In this way, it would be possible to shift from encapsulated morphologies in the initial miniemulsion to hemispherical or separated phases after polymerization. There are some examples in the literature in which the initiator type [62, 63], emulsifier amount [64] and monomer type [65] variations affected strongly the final particle morphology.
In order to analyze the effect that polymerization may have on the morphology of the system described in this chapter, the evolution of the acrylic/CeO2 nanocomposite is followed during the polymerization process (the hybrid seed preparation by batch miniemulsion polymerization) by cryo-TEM, analyzing samples withdrawn from the reactor at different monomer conversion, and the morphology map (Figure 2) is used as a reference to explain the different morphologies obtained, even if some of the morphologies presented are not at equilibrium. It can be observed that at the beginning in the miniemulsion, the CeO2 nanoparticles are well dispersed in the monomer droplets (Figure 2a). This means that the compatibility of the nanoceria with the monomer mixture is really good in the monomer droplets or in other words, that the interfacial tension between the acrylic monomers and the inorganic material, 𝜸IP, is low and the interfacial tension between the CeO2 nanoparticles and water, 𝜸IW, is high. This morphology is presented by the core-shell morphology on the left side where 𝜸IP/ 𝜸PW < 1 and | 𝜸PW- 𝜸IP|/ 𝜸IW < 1. It should be mentioned that the nanoparticles are sterically stabilized by the hydrophobic modification they bear in the monomer droplets.
In Figure 2b the acrylic/CeO2 nanocomposite system at 1% of conversion is shown. The morphology observed is completely different, as the nanoparticles tend to aggregate, which means that the incompatibility between the newly formed polymer and the surface of the CeO2 nanoparticles has increased or that 𝜸IP has become higher. This change in the morphology with the presence of polymer is observed too when the acrylic/CeO2 hybrid miniemulsion is prepared adding a polymer in order to increase the stability of the miniemulsion [66]. At 8% of conversion, the difference becomes more evident, the nanoparticles are more aggregated and they tend to move towards the border of the polymer particles. The fraction of the polymer increases and thus, 𝜸IP increases. This way, the equilibrium morphology evolves following the red arrow crossing to the hemispherical region as shown in Figure 2. At 18 and 40% of conversion the CeO2 aggregates are more compact and most of the aggregates are situated in the border of the polymer particle (equilibrium position). It should be mentioned that all these morphologies are not at equilibrium, since more than one nanoceria aggregate can be found in the polymer particles. However, when full conversion is achieved, one single aggregate can be seen in each polymer particle, which corresponds to the hemispherical equilibrium morphology.
In the literature there are some mathematical models to predict equilibrium morphologies of hybrid systems [51, 59, 61]. However, these models are not enough to explain the evolution of the acrylic/CeO2 hybrid nanocomposites, since equilibrium morphology is not obtained until 40% of conversion is reached. Recently, Hamzelou et al. [67] developed a mathematical model for the dynamic evolution of this particular nanocomposite system. This approach provides the distribution of particle morphologies in the whole population of polymer particles. The distribution of particle morphologies is described by a distribution of clusters of CeO2 nanoparticles (aggregates) dispersed in the monomer phase (see Figure 3). According to their position in the particles, the clusters are divided into two different categories: those at equilibrium positions (red dashed line in Figure 3) and clusters at non-equilibrium positions (blue line in Figure 3). Thermodynamics are used to calculate the equilibrium morphology and all relevant kinetic events of the system including cluster nucleation, polymerization, polymer diffusion and cluster aggregation are taken into account. Figure 3 shows the simulated weight distributions for the CeO2 aggregates (clusters). It is shown that at 1% of conversion, most of the nanoceria aggregates are in nonequilibrium positions. At 18% of conversion, most of the aggregates are at equilibrium, however, in some of the polymer particles more than one aggregate can be found. At 100% conversion all the nanoceria aggregates are in equilibrium. TEM-like images are generated and they can be compared to the cryo-TEM images presented in Figure 2. It can be seen that CeO2 nanoparticles aggregates follow the same evolution in the experimental cryo-TEM images and in the TEM-like images generated from the model.
Simulated weight distributions (m and n represent aggregates in non-equilibrium and equilibrium positions, respectively) and the TEM-like images obtained from the distributions. Reprinted from [
To summarize, the morphology evolution of the whole acrylic/CeO2 nanocomposite is as follows. During the first step, homogeneous distribution of the CeO2 nanoparticles in the monomer droplets is obtained in the hybrid miniemulsion. During the miniemulsion polymerization, the CeO2 nanoparticles aggregate and migrate to the surface of the polymer particles. Up to 40% of conversion, the concentration of monomer is high enough and the nanoparticles are able to move inside the monomer droplets towards equilibrium positions. Thus, the nanoceria aggregates are at the edge of the polymer particles, mostly surrounded by polymer, but not always encapsulated [66]. During the second step (neat monomer feeding), the migration of the CeO2 aggregates is constrained due to the high internal viscosity of the particles. The monomer feeding is done under starved conditions and thus, the seed hybrid particles are covered by a shell of polymer leading to an encapsulated morphology. The proposed mechanism is graphically described in Figure 4.
Schematic representation of the morphology evolution of the acrylic/CeO2 nanocomposite system.
One of the main reasons to incorporate the CeO2 nanoparticles into waterborne clear coatings is their excellent UV absorption capacity. This can be assessed by measuring the UV absorbance of 50 μm thick hybrid films. It should be mentioned that all the hybrid films are transparent and yellowish (Figure 5). The color of the films increases with the CeO2 nanoparticle content from 1 to 5 wt% and hence, the transparency decreases. Even if the dispersion of the nanoparticles is good in all the hybrid films, the large sizes measured for the hybrid film containing 5% of CeO2 nanoparticle affect the transparency.
Picture of films cast at room temperature for different CeO2 loadings: (a) 0% CeO2, (b) 1% CeO2 and (c) 5% CeO2.
Figure 6 shows that the UV absorption of the hybrid films is higher in the presence of the nanoceria in the whole spectrum range (250–600 nm), but the absorption enhancement is most noticeable above 300 nm, where the pristine copolymer absorption is negligible. Furthermore, the higher the amount of CeO2 nanoparticles, the higher the absorption. However, scattering is observed for the film containing 5% of CeO2 nanoparticles due to the large size of aggregates obtained for this nanocomposite.
UV–vis absorption capacity of 50 μm hybrid films.
Photodegradation of the hybrid film is a major concern due to the photocatalytic activity of the CeO2 nanoparticles. In the literature, the photodegradation of hybrid acrylic coatings has been studied in different substrates such as glass, stone or wood [68, 69, 70, 71]. In these cases, the hybrid film was tested in a substrate and there might be two sources of radicals. One coming from the substrate and the other one from the nanoparticles present in the polymer matrix. To skip this problem the degradation behavior of the bare acrylic/CeO2 hybrid films was analyzed. Accelerated weathering tests were conducted in a solar box, for the nanocomposite film without nanoparticles and for the one containing 1% of CeO2. Different properties of the hybrid films exposed to UV light were measured [72]. Thermal properties reveal one step thermal degradation (around 380°C) and negligible changes in the glass transition temperature (Tg) values for all the hybrid films before and after the exposure. Regarding the microstructure, molecular weight distributions (MWD) and the formation of cross-linked or gel structures were also analyzed. The results show that there is degradation of the polymeric film since the cross-linked fraction increases in the films, but there is no additional effect in the films containing metal oxide nanoparticles. On the other hand, neither the Fourier Transform Infrared Spectra (FTIR) nor the TEM micrographs show any significant difference in the films. It is therefore concluded that the possible photodegradation that CeO2 nanoparticles may produce in the bare hybrid films is negligible, owing to the similar properties obtained for the blank film and the hybrid film containing 1% CeO2 nanoparticles after the UV irradiation.
To study the effect of different metal oxides nanoparticles, a nanocomposite film with 1% ZnO nanoparticles was also synthesized following the same seeded semibatch polymerization approach as described in Section 2 [34]. The morphology obtained in the final hybrid films was different to that obtained for the CeO2 hybrid films. The ZnO nanoparticles aggregate sizes were much bigger (~75 nm), preventing the homogeneous distribution of the nanoparticles in the film. However, the acrylic/ ZnO hybrid films presented higher UV absorption above 350 nm than the counterpart hybrids with CeO2. In the photodegradation studies carried out in the work mentioned above [72], even if it is known that the photocatalytic activity of the ZnO is larger than that of the CeO2, as it was mentioned in the introduction, the behavior of the hybrid films containing both types of nanoparticles did not differ significantly.
A polymerization strategy to synthesize waterborne hybrid acrylic/CeO2 nanocomposites for their application as UV blocking coatings has been discussed in this Chapter. The designed two-step polymerization approach is able to produce different loadings of CeO2 nanoparticles with industrially relevant solids content. Moreover, the strategy ensures the encapsulation of the nanoparticles in the polymer particles that avoids agglomeration during film formation process and provides good UV absorption properties, making these coatings good candidates as clear coats for outdoor applications. A mathematical model developed to predict the evolution of the particle morphology for polymer-polymer systems has been applied for the polymer-CeO2 hybrids and it is able to predict the evolution of the morphology of the two stage semicontinuous polymerization opening the door to the use of the model for optimization and control of waterborne polymer-inorganic particle morphology purposes.
The designed strategy opens the possibility to encapsulate other nanoparticles and extend the application region. The incorporation of hydrophobically modified ZnO nanoparticles has also been tested, providing film forming hybrid latexes with improved UV absorption capacity [73]. Moreover, with the incorporation of a fluorinated monomer to the acrylic/ZnO hybrid system, anticorrosion properties have been improved. It was demonstrated that the incorporation of the ZnO nanoparticles by blending was not enough to improve the corrosion protection, whereas when the nanoparticles were encapsulated and hence, well distributed in the polymeric film, the benefits were substantial [74]. Recently, many authors’ investigation has been directed to improve anticorrosion properties with the incorporation of CeO2 nanoparticles. For instance, polyurethane coatings containing CNT/CeO2 [10], polyacrylic acid/CeO2 coatings [11], CeO2/graphene-epoxy nanocomposite coatings [12] and water based polyurethane/ CeO2 coatings [13]. None of these works obtained encapsulated morphology and hence, the possible aggregation of the nanoparticles during film formation and leaching could be a problem, even though the anticorrosion properties were improved in all the cases. This means that combining the strategy developed in this work, with the appropriate monomers and the anticorrosion properties that CeO2 nanoparticles exhibit in all the works mentioned above, synergetic effects could be obtained making these nanocomposites ideal candidates for corrosion protection.
Very recently, De San Luis et al. [75] incorporated quantum dots into core-shell particles made of polystyrene/divinyl benzene (DVB) as core and PMMA/DVB as shell. The cross-linked polymeric phases were synthesized in two stages following the strategy developed in this Chapter. Thanks to the encapsulated morphology obtained, the fluorescence emission of the QD containing core-shell particles was preserved for more time than any other work published so far. The same authors incorporated CeO2 nanoparticles obtaining PS/QD/CeO2/PMMA hybrid particles. Interestingly, the films casted from these hybrid particles exhibit increasing fluorescence under sunlight exposure [76]. This opens the possibility to use CeO2 nanoparticles to enhance the optical properties of different technological devices.
Financial support from the Basque Government ELKARTEK KK-2016/00030 and KK-2017/00089 is greatly acknowledged. Miren Aguirre thanks the financial support given by the European Union (Woodlife project FP7-NMP-2009-SMALL-246434), the UPV/EHU (2984/2014) “Doktore berriak kontratatzeko eta horiek doktorego ondoko prestakuntza programetan sartzeko laguntza” and also the financial support received from Ministerio de Economía y Competitividad de España, Juan de la Cierva en Formación (FJCI-2014-22336). The SGIker UPV/EHU for the electron microscopy facilities of the Gipuzkoa unit is acknowledged. Programa de Grupos Consolidados from the Basque Government (IT999-16) is also gratefully acknowledged.
Chronic obstructive pulmonary disease (COPD) is among the five leading causes of death in developed world [1]. Prevalence of COPD is constantly increasing. COPD has a high impact on patients’ wellbeing, healthcare utilization, and mortality [2] and causes a substantial and increasing economic and social burden [3, 4]. Cigarette smoking is clearly the predominant cause but other environmental agents including biomass fuel and air pollution may play a role as well. Common symptoms of COPD patients are chronic and progressive dyspnea, cough, and sputum production. These symptoms can be disabling and lead to activity limitation and ultimately inability to work and take care of themselves [5]. This vicious circle of inactivity that begins with breathlessness is because of peripheral muscle dysfunction [6], and dynamic hyperinflation [7].
\nFor several decades, treatment of COPD has been focused on smoking cessation, and pharmacological but with ever-increasing literature, intense exercise programs like pulmonary rehabilitation (PR) have become an integral part of management of COPD [8]. PR has been shown to be the most effective non-pharmacological intervention for improving health status in COPD patients and has become a standard of care for these patients [2]. PR and pharmacological therapy are not competitive but rather, must work closely together, if they are to result in a more successful outcome [9].
\nDespite increasing awareness on positive impact of rehabilitation in COPD, it remains underutilized in most countries. Lack of understanding on the benefits of a PR program, in addition to the incremental cost to the management, has hindered the widespread adoption of comprehensive PR for COPD patients [9]. This chapter aims at highlighting the impact of PR on patients with COPD, focusing on the clinical usefulness of PR. We also hope to stimulate primary care and pulmonary physicians to use PR more often.
\nPhysical therapy has been incorporated into the treatment of pulmonary patients as far back as the First World War. Winifred Linton, a British nurse, first felt the need for physical therapy while treating traumatic respiratory complications during the war. Following the war, she entered physical therapy training and began to teach localized breathing exercises to other physical therapists (PTs) and surgeons at the Royal Brompton Hospital in London. A few physical therapists in the United States were instructed in airway clearance techniques and began to use and teach them to patients during the polio epidemic of the 1940s [10, 11]. Rehabilitation programs for patients with COPD have existed for more than three decades and were incorporated into ATS official statement in 1981 [12]. Comprehensive and multidisciplinary approach to the pulmonary rehabilitation programs have remained the key to its success over several years. It involves a team effort from physical therapist, respiratory therapist, nurses, physician and other support staff.
\nPulmonary rehabilitation has been defined as a comprehensive program which is individual patient focused and includes exercise training, education, and behavior change. It has been found to help improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors [13].
\nPulmonary rehabilitation has demonstrated physiological, symptom reducing, psychosocial, and health economic benefits in multiple outcome areas for patients with chronic respiratory diseases [14]. PR is appropriate for most patients with COPD. Improved functional exercise capacity and health-related quality of life has been demonstrated across all grades of COPD severity, although the evidence is strong in patients with moderate to severe disease [15].
\nBeside respiratory symptoms of dyspnea, COPD has been established to have extra-pulmonary manifestations. Some on them involve skeletal muscle dysfunction which results from physical inactivity and systemic inflammation in addition to hypoxemia, undernutrition, oxidative stress and systemic corticosteroid [16, 17].
\nPeripheral muscle dysfunction seen in COPD patients is a result of multitude of pathophysiological changes occurring in the skeletal muscles. Skeletal muscles in COPD patient have decreased oxidative capacity that can lead to early lactic academia [18, 19, 20], decreased muscle fiber volume [21], redistribution of the muscle fiber type (from type 1 to type 2 fibers) [21, 22, 23], and abnormal muscle fiber capillarization [23]. These changes in the structure and functioning of the skeletal muscles can lead to higher concentration of lactate for a given work. This in turn can lead to increased ventilation, resulting in dynamic hyperinflation and overall increased ventilator burden. With muscle dysfunction there is a limitation in the activity and promotion of a sedentary lifestyle. A sedentary lifestyle inevitably leads to social isolation, depression and physical deconditioning. Exacerbations of COPD also promote the reduction of exercise performance, dyspnea, and the loss of Health-related quality of life (HRQoL) [24].
\nPR has no direct impact on lung mechanics or gas exchange [25]. Rather, it optimizes the function of other body systems so that the effect of lung dysfunction is minimized [26]. A comprehensive PR program can help COPD patients gradually improving muscle function by changing muscle biochemical structure. This leads to improved tolerance for higher work load in the patients [27]. PR additionally reduces the central perception of dyspnea and dynamic hyperinflation [28].
\nA usual pulmonary rehabilitation program can range anywhere from 6 weeks to 12 weeks at various centers which incorporate aerobic exercise, education, muscle strengthening etc. Usually patients undergo supervised training 2–3 times a week, for 30–60 minutes in each session. This could include any regimen for endurance training, interval training, resistance/strength training, walking exercises, flexibility, inspiratory muscle training and/or neuromuscular electrical stimulation. The interventions are individualized to maximize personal functional gains.
\nThere are several benefits of PR not limited to improvement in symptoms like dyspnea, exercise tolerance and overall health status in stable patients.
\nPR results in reduction in symptoms of dyspnea and leg discomfort. Patients notice improved limb muscle strength and endurance. Most patients also experience improved functional capacity with more independence in activities of daily living (ADLs) [29]. In a Cochrane review [30] including 23 randomized controlled trials, PR was found to relieve dyspnea, and fatigue, improved emotional function and patient’s sense of control over their condition. All these improvements were large and statistically significant.
\nThere has been increasing interest in physical activity, as inactivity has been linked with reduced survival, poorer quality of life and increased healthcare utilization [31]. In the same Cochrane review as above [30], patients were noted to have improved exercise capacity. Other studies from Griffith’s et al. and Singh et al. have suggested similar findings [32, 33].
\nPR has also been found to reduce unscheduled healthcare visits, COPD exacerbation and hospitalization in some literature [34]. Rubi et al. reported reduction in COPD exacerbation, hospitalization and days of hospitalization in 82 consecutive patients [35]. In fact, there is some literature to suggest reduced hospitalization in patients participating in PR programs immediately after acute exacerbation of COPD (AECOPD) beginning within 1 week of discharge [36].
\nAnxiety and depression affect significantly in COPD patients leading to worse patient centered outcomes. Tselebis et al. conducted study in 101 consecutive patients and noted that psychological morbidity was improved with participation in PR program irrespective of severity of the disease (COPD) [37]. This was confirmed in a meta-analysis of six RCTs which indicated that pulmonary rehabilitation was more effective than standard care for the reduction of anxiety and depression [38].
\nHRQoL was noted to be significantly improved in patients with COPD participating in PR as well [34, 39]. The St. Georges Respiratory Questionnaire Scores were used in a meta-analysis, which showed significant improvement in HRQoL following pulmonary rehabilitation [40]. An early RCT compared pulmonary rehabilitation with education alone and demonstrated that self-efficacy improved in the intervention group [41].
\nCOPD patients have been known to have improved mortality with cessation of smoking. There is some signal that an association exists between completion of PR and survival based on a retrospective analysis involving 1515 patients [42]. But a systematic review conducted of two randomized control trials showed significant survival benefit at 1 year in one trial but no significant benefit with another study at end of 3 years. Neither of the study was powered to really derive the desired outcome [43].
\nPatients with chronic lung condition who have symptomatic shortness of breath limiting their physical activity despite optimal medical management should be considered for pulmonary rehabilitation [44]. Patients with chronic diseases other than lung such as heart failure, musculoskeletal disease have the same benefit form pulmonary rehabilitation as patients with disabling lung conditions like chronic obstructive pulmonary disease, restrictive lung disease, and pulmonary hypertension. Pulmonary rehabilitation can markedly change the course of the disease if provided at an earlier stage of disease. This is due to improved exercise tolerance and physical activity, reduced exacerbations and improved self-efficacy and behavior change after pulmonary rehabilitation. [45]
\nOne of the most important indicator for referral to pulmonary rehabilitation is based on the modified Medical Research Council Breathlessness (mMRC) score (see Table 1) [46]. The mMRC scale is a 0–4 grade scale used to establish levels of perceived respiratory disability. It allows patients to indicate the extent to which their breathlessness affects their mobility [45, 46].
\nGrade | \nLevel of breathlessness with the activities | \n
---|---|
0 | \nNo shortness of breath except on strenuous exercise | \n
1 | \nShort of breath when walking on an incline | \n
2 | \nWalks slower than contemporaries on a level ground because of shortness of breath or has to stop due to breathlessness when walking up at own pace | \n
3 | \nStops for breath when walking 100 m or after a few minutes on level ground | \n
4 | \nToo short of breath to leave the house, or short of breath when dressing and undressing | \n
The modified Medical Research Council Breathlessness (mMRC) score.
It has been strongly recommended that patients with an mMRC dyspnea score of 2–4 who are functionally limited by breathlessness should be referred for pulmonary rehabilitation. However, benefits of pulmonary rehabilitation have also been seen in patients with an mMRC dyspnea score of 1 who are functionally limited by breathlessness. Patients with COPD who have an mMRC score of 4 achieve similar benefits from the pulmonary rehabilitation as those with a lower breathlessness score [47].
\nOther frequent indications for referral to a pulmonary rehabilitation program include poor functional status, physical deconditioning, chronic fatigue, poor health-related quality of life and difficulty performing activities of daily living. Patients who are requiring increased use of medical resources due to frequent exacerbations, hospitalizations and emergency room visits also benefit from pulmonary rehabilitation.
\nCandidates for lung volume reduction surgery for severe emphysema or for lung transplantation are also good candidates for PR [48]. Patients with COPD have shown improvements following a pulmonary rehabilitation program irrespective of their age or gender [49, 50, 51].
\nLevel of functional impairment [47, 52, 53] or disease severity does not affect the benefits seen in COPD patients with pulmonary rehabilitation program [54, 55]. A program of PR may be proposed in stable COPD as well as immediately after COPD exacerbation [56].
\nThere are very few exclusion criteria for a referral to pulmonary rehabilitation, which includes patients with the following conditions [45, 46]:
Unstable cardiovascular disease, uncontrolled diabetes and an ongoing orthopedic illness that will refrain patient from exercising.
Inability to do exercise safely because of any other medical illness like severe arthritis, severe peripheral vascular disease.
Untreated psychiatric illness and cognitive impairment which makes it hard for patients to follow directions are other reasons for not referring a patient to pulmonary rehabilitation.
Lack of motivation is another exclusion criterion for pulmonary rehabilitation.
Adherence to pulmonary rehabilitation program is critical to see the ongoing benefits from the program. However, non- adherence and high dropout rate of 20–30% is reported in the studies listing predictive factors of non-adherence to pulmonary rehabilitation. These factors include [52, 53, 57, 58]:
Even though current smokers obtain the same benefits from pulmonary rehabilitation, smokers generally have poor adherence to pulmonary rehab than ex-smokers. Active smoking status is not an absolute contraindication for pulmonary rehabilitation. Patients are encouraged to undergo smoking cessation prior to pulmonary rehabilitation.
Depression and social isolation.
Lower quadriceps strength.
COPD patients with higher mMRC score and frequent exacerbations.
Long commute to pulmonary rehabilitation and lack of transport.
Cost of pulmonary rehabilitation.
Every patient referred for pulmonary rehabilitation should be thoroughly evaluated prior to initiation of the program. Majority of the patients have a regular pulmonary physician managing the lung disease. As a part of the management, pulmonary physicians refer the patient for pulmonary rehabilitation to supplement the pharmacological treatment. These patients when present to the pulmonary rehabilitation have already undergone an evaluation of symptoms and physical examination. Regardless, it is a good practice to perform a thorough evaluation of patient’s medical problems, laboratory results, social habits and specific medications. This should be accompanied by a comprehensive physical examination with estimation of patient’s functional capacity. In most of the pulmonary rehabilitation program, this assessment is performed by the physical therapists. If a pulmonologist is an integral part of the program, the physician can do this work up.
\nPrior to initiation of the pulmonary rehabilitation program, a careful appraisal of patient’s pulmonary disease and current severity should be done. For COPD patients this will include the duration of their symptoms, current symptomatology, mMRC score [46], smoking history, pulmonary function testing, arterial blood gas analysis, inhaler therapy, oxygen supplementation and non-invasive ventilation prescription. It is imperative that a special attention should be paid to patient’s co morbidities. This is essential as several other medical problems may have impact on patient’s disease course and exercise capacity. These may include obesity, OSA, diabetes, cardiovascular co morbidities, hypertension, osteoarthritis, pulmonary hypertension, peripheral vascular disease and malignancy.
\nA detailed pre rehab assessment enables the physical therapist to devise an individualized treatment plan for the patients. This strategy is particularly helpful for patients with advanced disease, low exercise tolerance, special healthcare needs such as high oxygen requirements, pacemaker or defibrillators, walkers and cane. Information gathered at the beginning of the program will help set realistic individualized goals and alert the provider regarding the possibility of adverse effects.
\nPhysical examination at the beginning of the pulmonary rehabilitation program is centered on measurements of patient’s functional status and capacity to handle additional physical stress. Most relevant for COPD patients will be an examination of muscle wasting, joint mobility, postural deformities, and cardio-respiratory examination. Results of this examination allows physical therapist to gauge individual patient’s tolerance and potential areas of improvement.
\nAn important component of physical examination is nutritional assessment. This commonly includes measurement of weight, height and BMI. Both being underweight and overweight in a COPD patient can be detrimental. Excess weight can lead to extrinsic restriction on lung capacity as well as increased work of breathing. Weight loss and muscle wasting is a poor prognostic factor in COPD patients [59, 60, 61].
\nPertinent respiratory examination in patients with COPD is directed at ability of the patients to clear their respiratory secretions, use of accessory muscles of respiration, breathing pattern, adventitious sounds on auscultation such as wheezing and crepitation. A knowledge of patients’ respiratory status will help develop an educational plan regarding self-management, medication compliance and respiratory muscle training.
\nReduced functional capacity due to physical deconditioning is widespread in COPD patients. This is multifactorial with poor nutritional status, systemic inflammation, cardiovascular comorbidities, postural deformities and osteoporosis [62] Interviewing the patient to ascertain their capacity to perform ADLs, sustained exercise and risk of falls is essential. Several questionnaires have also been used to objectively measure individual patient’s baseline functionality. A few examples include: the Functional Independence Measure (FIM), the Assessment of Motor and Process Skills (AMPS), and a Functional Capacity Evaluation (FCE) [63].
\nApart from questionnaire, various exercise tests can be used to gauge individual patient’s functional capacity. These exercise tests can be done as field walking tests, on bicycle ergometer or on treadmill. In most hospital, simple walk testing can be cost effective and practical. Walk tests are considered more reflective of daily functionality of a COPD patient. Some of the commonly employed walk tests include the 6-minute walk test (6MWT) and the incremental shuttle walk testing. Standardized protocols have been established for performing the 6MWT. If done as per the set protocol, this walk test is highly reproducible and reliable test for both diagnostic and prognostic purposes. In this test, patient walk back and forth on a 30-m distance marked hallway at their own pace for 6 minutes. During the test, distance walked, vital signs, oxygen desaturation, development of dyspnea using a visual analog scale is measured [64]. The incremental shuttle walk test is performed on a 10 m marked course. It is a paced walk test to assess symptom limited maximal exercise capacity. Test is continued until patient develops symptoms of dyspnea or for 20 minutes, whichever occurs first. This is a valid and popular testing in various resource limited clinical settings [45].
\nIf in addition to the functional limitation specific problems are identified by the physical therapists, various other tests may need to be performed. These tests address the muscle weakness, gait disturbances, and include balance testing and sit-to-stand tests [65].
\nAfter an initial assessment, patient is enrolled into a pulmonary rehabilitation program. The basic aim of such a program in any COPD patient is to assist them in performing essential daily activities with independence. Independence comes from reduction in dyspnea and fatigue. COPD patient are inadvertently caught in a downward spiral where dyspnea is leading to inactivity, which in turn leads to physical deconditioning and decreased capacity to handle day-to-day stress. To save the patient from this downward spiral a pulmonary rehabilitation program focuses on improving the cardiorespiratory endurance, muscle strength, body flexibility and respiratory muscle training. With an individualized patient’s clinical analysis and examination, a specific therapy plan can be built for each patient. This plan is intended to establish patient specific goals and focus on areas of functional limitation, which need to improve to achieve those goals. As the COPD patients undergo pulmonary rehabilitation, improvement in their physical deconditioning and exercise capacity needs to be measured and documented. This is achieved by using a variety of parameters, such as quantity of exercise performed or improvement in perception of dyspnea, symptoms, heart rate during exertion. Any changes seen in these parameters will be suggestive of patient’s improved capacity to handle the physical stress. As discussed earlier in the chapter walk tests and questionnaires can provide an objective measure of functional improvement for COPD patients undergoing pulmonary rehabilitation.
\nPhysical exercise training in COPD patients can be delivered in two forms: Continuous high intensity aerobic endurance training or an interval training, which alternates high intensity aerobics with low intensity exercises [66]. Continuous high intensity regimen of endurance training can be administered with constant load or incremental load. It has been shown that high intensity aerobic training (70–80% of peak work rate), will result in maximal improvement in physical fitness by increasing oxygen consumption, delaying anaerobic threshold and decreasing heart rate for a given exercise rate [27, 62, 67, 68, 69].
\nIn patients with advanced COPD and persistent dyspnea a high intensity endurance training is difficult to sustain. These patients can be provided with interval endurance training. In this approach, high intensity aerobic training in short bouts (30–180 s) is alternated with low intensity exercises (leading to a subjective experience of exertion between 4 and 6 on the modified Borg scale) or rest [70, 71, 72, 73, 74].
\nEven though there may be less appreciable gains in aerobic parameters, this training approach has proven to be effective in improving exercise endurance in COPD patients [42, 75]. Interval endurance training leads to lesser degree of pulmonary hyperinflation allowing patients to exercise longer without excessive dyspnea. COPD patients may more easily adapt a lower intensity exercise regimen in their daily life. The choice of regimen is ultimately based on both therapist and patient preference.
\nEndurance training is delivered using various modalities including walking (treadmill or supported ground walking with walker or wheelchair), cycling, rowing, and swimming or modified aerobic dancing. It is recommended to provide this training 3–5 times per week at an intensity aimed at a Borg Dyspnea score of 4–6 (moderate level of exercise) [26, 44, 48, 67, 69, 76, 77, 78, 79]. Exercise sessions can last from 30 to 120 minutes, with at least 30 minutes of continuous aerobic activity, based on each patient’s capacity [26, 46, 79, 80]. General recommendation for the frequency of pulmonary rehabilitation is two supervised exercise sessions a week with third unsupervised session based on the available resources [44, 81, 82]. A minimum of 12 exercise sessions or 4 weeks of rehabilitation program is essential to achieve any improvement in physical fitness. Program length can be increased up to 72 weeks if patient is inclined and insurance coverage is favorable [48, 83, 84]. While shorter (6–8 weeks) pulmonary rehabilitation programs are more cost effective and widespread, longer duration programs have shown sustained beneficial effects. This is mostly due to fact that longer duration programs not only lead to physiological changes but also behavioral changes [85].
\nMore specific for COPD patients it is recommended to check oxyhemoglobin saturation both prior to the start of the exercise and at peak work rate. This will not only help to ascertain the need for oxygen supplementation but also guide both therapist and the patient to know appropriate level to use with different intensity of work. Similarly, a careful attention on patient’s bronchodilator therapy, both long acting and short acting, is essential during the program. Patients may require administration of short acting bronchodilator at the beginning of the exercises or during the workout. For a successful outcome of endurance training it is important that patient gets trained on similar oxygen delivery device that they use at home and are on optimal management of COPD. A stable respiratory function will allow the patients to tolerate higher intensity workout for longer duration.
\nApart from improvement in endurance, COPD patients benefit from increase in their muscle strength [26, 83, 86, 87] . Increased muscle strength provides the patients with an ability to handle the ADLs better, improves their gait and reduce fall risk, thereby making them more independent [88]. A recent meta-analysis investigating different methods of PR in COPD showed greater improvement in HRQoL by adding strength training than endurance training alone [89]. Physiologically improving muscle strength in COPD patients can lead to increase in physical endurance, 6-minute walk distance and maximum oxygen consumption [90, 91]. Strength training is most beneficial if directed at muscles involved in functional living. This involves training muscles in upper and lower extremities as well as the trunk.
\nIt has been well proven that exercise training of the lower extremities leads to significant improvement in ambulatory stamina in COPD patients [42, 67, 92, 93, 94]. This is because lower extremities suffer most from disease-related muscular dystrophy in COPD patients. Additionally increasing lower extremity strength can reduce falls and maintain bone mineral density in COPD patients [45]. General recommendation to improve lower extremity strength is to provide resistance training with 2–4 sets of 10–15 repetitions of each exercise, for 2–3 days per week. Selection of weight for this type of resistance training workout is individualized based on patient’s capacity. Increment in the weight is done gradually once patient is able to accomplish all sets of exercise with a prescribed weight [45]. Lower extremity training can be achieved using walking, bicycling with incremental loads, stair climbing, swimming, weight machines or elastic bands. Choice is driven by available resources at the training site.
\nPatients suffering from COPD who have hyperinflation and flattened diaphragm have limitation in using their upper extremities to perform ADLs. Elevation of arms can result in increased ventilatory and metabolic demands in COPD patients with low respiratory reserves. This is thought to be because some of the upper extremity muscles also serve as accessory muscles of respiration [95, 96, 97]. Majority of the published literature on pulmonary rehabilitation suggests beneficial effect of upper extremity training in COPD patients. Some of the observed benefits of this training include improved upper extremity strength, which is task specific, decreased ventilatory demands and more independence in performing ADLs. Despite these observed benefits, optimal prescription of upper extremity training remains unclear.
\nPhysical therapists have to be mindful that in training the upper extremities, COPD patients may have elevated ventilatory work, asynchronous breathing and more dyspnea for the level of work. It is prudent to start with low resistance and frequent repetitions before gradually increasing the weight [81]. Upper extremity and trunk muscle strength training is achieved by using light weights (dumbbells, elastic bands), weight machines for stronger patients, rowing machines etc. Several of these instruments can also provide aerobic exercise training thereby improving both strength and endurance in the upper extremities.
\nPhysical therapists may provide training of upper and lower extremities on alternate days to improve patient tolerance. Progressive improvement in muscle strength is documented using standardized lifting tests, incremental resistive load tolerated by the patient and increased capacity in performing ADLs efficiently [86].
\nMany COPD patients suffer from modification in the structure of their chest wall due to hyperinflation, hypertrophy of the accessory respiratory muscles and physical inactivity. This further leads to changes in the posture and reduced mobility. To prevent this from happening, COPD patients undergo flexibility training as a part of the pulmonary rehabilitation program.
\nFlexibility exercises lead to improved mobility by increasing joint range of motion, reducing joint stiffness, better posture and increment in vital capacity [45]. Gentle stretching exercises with full body movements, coordinated with breathing techniques are appropriate for COPD patients [65, 98, 99].
\nThis kind of workout teaches the patient the influence of body movements on respiration. Since these exercises are done at a slower pace without any resistive loads, they can be used during warm up or cool down periods of the program. Limited research has been done on adequate duration and intensity of stretching exercises. General recommendation are to perform stretching of major muscle groups in the upper and lower extremities 2–3 days per week at the minimum [100]. Benefits of this training can be measured by documenting reduction in subjective perception of stiffness, reduced incidence of back pain and joint injuries.
\nTo provide a holistic care, every pulmonary rehabilitation program should incorporate patient education. It has been well proven that COPD patients who are well aware about the nature of their disease, its management and long-term implications are able to cope with both the disease and treatment better [101]. Education about the disease empowers the COPD patients to better recognize their symptoms, make lifestyle changes and get involved in the management of the disease. This leads to increased motivation to participate in pulmonary rehabilitation and adhere to the exercise regimen.
\nAt the beginning of the rehabilitation program, individual educational needs of each patient are identified. This is continuously reassessed while the patients are undergoing the rehabilitation program. Instead of a didactic teaching, a patient centered and self-management teaching approach focusing on lifelong behavioral changes are adopted these days [45]. Specifically for COPD patients, a collaborative self-management plan which helps them in an identification of symptoms of onset of an exacerbation, make treatment modification and to communicate early with a healthcare provider, is highly beneficial in the long run [102]. Patient education runs alongside the exercise training. It is meant to supplement the knowledge gaps and instill confidence in the principles of ongoing training. Various topics regarding disease and its management are covered with utilization of the expertise of various specialists.
\nExacerbation of COPD is an additional burden on patient’s already weakened functional capacity. It leads to hospitalization, further inactivity, deterioration of lung capacity and mortality. It may also disrupt any advances the patient may have made in improving their exercise capacity and muscle strength [45, 46]. There is an emerging data suggesting that there is benefit in instituting and/or continuing with pulmonary rehabilitation during hospital admission or within a month of hospital discharge. An early initiation of pulmonary rehabilitation reduces risk of re-hospitalization and improves overall symptoms without any adverse effects [103].
\nA pulmonary rehabilitation program incorporating occupational therapy is important in COPD patients [104, 105]. Occupational therapy assists COPD patients with development of specific strategies to perform ADLs with least expenditure of energy [106]. With conservation of energy expenditure, there is an improvement in subjective perception of breathlessness, increased efficiency in performing daily basic activities, elevated sense of control and better social engagement [104, 105, 106, 107]. Occupational therapy skills even though simple in principle, require a learning process, which is achieved through a multidisciplinary rehabilitation program. There is an ever-increasing evidence that improvement in occupation performance of COPD patients lead to a holistic improvement in their health [108]. Occupational therapist can also instruct COPD patient to use wheeled walking aids, which can result in increased functional autonomy, ventilatory capacity and waling efficiency [109, 110, 111, 112]. Since this therapy has a major impact on social networking of COPD patients, it serves well to involve patient’s family and friends [113].
\nBody composition in COPD patients may change as the disease severity progresses. While obesity predominates in the milder stages of the disease, patients with advanced disease and emphysema tend to be underweight and have generalized muscle wasting [114, 115]. Factors other than the lung disease itself, which can lead to this shift, includes inactivity, systemic inflammation, osteoporosis and glucocorticoids use. Studies have shown an increase in mortality in COPD patients who are underweight, independent of their disease severity [116, 117]. These patients with decreased fat free mass have higher limitation to exercise tolerance and thereby reported a decreased HRQoL status in comparison to COPD patients with normal weight [118, 119, 120, 121]. Various studies have shown a survival benefit with weight gain as low as 2 kg or by increase in one body mass index unit [116, 117]. This is why nutritional education are particularly essential in rehabilitation of COPD patients.
\nEvery pulmonary rehabilitation program should include nutritional screening with measurement of BMI at the least. A more comprehensive program may also include fat free mass estimate using skinfold anthropometry or bioimpedance analysis. Estimation of osteoporosis can be done using dual energy X-ray absorptiometry (DEXA) scanning. Improvement of nutritional status requires a multi-pronged approach with utilization of both physiologic and pharmacological interventions. Endurance and strength training as described previously in this chapter can improve muscle mass as well as bone strength. Nutritional interventions include adding nutritional supplementation to patient’s diet with emphasis on adequate protein intake to maintain or restore lean body mass. Patients who are unable to eat large meals due to dyspnea can switch to frequent small meals. It has been shown that a 6-month intervention involving dietary counseling, nutritional supplementation and positive reinforcement led to a significant weight gain in advanced COPD patients [60].
\nMany COPD patients who are referred to pulmonary rehabilitation suffer from depression and anxiety [45, 122]. Recent studies have estimated prevalence of depressed mood in about 45% and anxiety in 32% of patients with moderate to advanced COPD [123, 124, 125]. Dyspnea on exertion leads to fear and anxiety anytime a COPD patient has to exercise. This severely limits their social interaction and eventually leads to depression. COPD patients can suffer from hopelessness, sense of isolation and lack of motivation. It is essential to assess the presence of depressed mood during initial evaluation in a pulmonary rehabilitation program. Family and caregiver involvement is advisable to assess the social support system for the patient.
\nIdentifying the mood disorders and deficit in the social support is an integral part of the program [114]. Patients in need can be provided with psychological and social support, which works to elevate mood, positive thinking and adaptive behavior towards disease and its management. This also improves the compliance with the pulmonary rehabilitation program. Psychological support can be provided by the physical therapist but often require a psychologist or a psychiatrist involvement.
\nVarious models of PR have been adopted worldwide. An outpatient or hospital based-outpatient setting is the most widely used model to deliver PR to COPD patient in the developed countries [126]. Current body of evidence regarding effectiveness of PR in COPD patients is based on this model. In recent years an alternative model where the site of delivery of PR is at home has been studied. Home based PR setting provides the benefit of exercise training in a familiar setting to a larger patient population. Specifically for patients with severe COPD dependent on long term oxygen therapy, this model of PR has been shown to be both safe and effective [127, 128]. While home based PR model offers convenience, it lacks the group dynamics which an outpatient model can offer. Group therapy leads to socialization, mood elevation and positive reinforcement. Additionally a home based program does not have a multidisciplinary and comprehensive structure of a hospital based outpatient setting. At the present time, choice of location of PR is dependent on patient preference, disease severity and regional availability of resources.
\nSeveral COPD patients with advanced lung disease who are bed bound or wheelchair bound are unable to participate in a conventional pulmonary rehabilitation program. To help these patients, a new modality of transcutaneous neuromuscular electrical stimulation (NMES) has been devised recently [129, 130, 131]. This technology involves application of low amplitude electric current via electrodes transcutaneously to the targeted muscle groups by depolarizing motor neurons. Low intensity electric current (10–100 mA) is delivered at stimulation frequencies between 8 and 120 Hz for duration of 250–400 ms. Although no large RCTs are available, a recent meta-analysis did report improvement in quadriceps strength and exercise capacity with NMES. Unfortunately, no significant improvement in HRQoL in moderate to severe COPD was seen [132]. Apart from debilitated COPD patients, this technology has been recommended for use during COPD exacerbation, as it has low impact on ventilation, heart rate and dyspnea [133, 134].
\nA pulmonary rehabilitation programs for COPD patients usually includes respiratory muscle training. The goal of this training is to improve the abnormal breathing pattern, which may result due to increased work of breathing, chest wall changes and poor breathing habits in COPD patients [135, 136, 137, 138]. The most commonly applied approach is through the endurance and strength training. [26]. Exercise training can lead to increase in minute ventilation, which leads to an increase in work of breathing. Constant controlled aerobic exercises of upper and lower extremities can lead to a recurrent stimulation to respiratory muscles. This helps the COPD patients to modify their breathing patterns on a day-to-day basis as well as be better prepared for an exacerbation.
\nApart from exercise training, specific breathing exercises such as diaphragmatic breathing, paced breathing with exercises and pursed lip breathing has been proven to be beneficial in COPD patients. Diaphragm, which is the main inspiratory muscle, is flattened and ineffective in patients with hyperinflated lungs. This puts these patients at a mechanical disadvantage to adequately maintain and increase their minute ventilation. COPD patients who undergo the training to improve the coordination of their diaphragmatic muscle tend to fare better overall [139].
\nMany patients with emphysema self-discover the method of purse lip breathing for faster recovery from shortness of breath post exercise. Other patients can be instructed regarding this method. It helps patients to increase alveolar ventilation, tidal volume and CO2 removal. It also leads to slow expiratory flow and decreased respiratory rate [140]. Using the same principle, respiratory muscles can be trained by using resistive breathing devices. This can be particularly useful in patients who continue to have dyspnea despite optimal medical management.
\nAdditionally COPD patients specifically with chronic bronchitis occasionally have ineffectual cough leading to difficulty in respiratory secretion clearance. Instructions on special coughing techniques (huffing, autogenic drainage) combined with oscillating expiratory breathing devices (Acapella, In-exsufflator) can prove effective [141]. Patients can be instructed to perform daily chest physiotherapy to assist in respiratory secretion clearance through postural drainage techniques [142]. A meta-analysis of 32 studies focusing on respiratory muscle training showed that it leads to improvement in respiratory muscle strength, exercise capacity and perception of exertional dyspnea [143].
\nThe beneficial effects of a comprehensive pulmonary rehabilitation program are not sustained beyond 12 months [32, 42, 144, 145]. On the other hand, repeating a pulmonary rehabilitation programs has not been found to be an effective treatment option [146]. Considering this, it is challenging to maintain the changes made in physical activity and lifestyle due to a pulmonary rehabilitation. Although there is a lack of data on maintenance programs, some centers do provide these in the hope to achieve prolonged benefits gathered in a successful rehabilitation program. There are no set guidelines to establish an optimal strategy for providing maintenance pulmonary rehabilitation. Additionally other factors such as lack of transportation to the PR center, disruption of daily life routine, absence of family support, perception regarding gains from the PR program, have impact on patient’s participation in the post PR programs. A recent multicenter RCT studying the long term (3 year) maintenance program after PR in severe COPD patients, showed a sustained beneficial effect on BODE index and 6MWD at 24 months. Although, the effect vanished beyond 2 years as at end of study only 66% of COPD patients were still adherent with the maintenance program [147].
\nVarious methods adopted to provide therapy beyond a comprehensive program include weekly telephone contacts, home exercise training with or without weekly-supervised outpatient sessions and recurrent PR program [146, 148, 149, 150, 151]. A recent meta-analysis analyzing post-PR exercise program in COPD patients suggested that such a program even though effective in maintaining a good exercise capacity with the 6 months of PR, loses its benefit beyond 1 year and has no impact on HRQoL [152]. The patient population and the interventions used were variable and results of this study need to be interpreted cautiously.
\nSince the structure of the most effective maintenance program remains elusive, it is important at this time to encourage the COPD patients to continue with healthy lifestyle changes. This can be achieved by a concerted effort of the PR staff, family members, and patients’ healthcare team. Those COPD patients who continue with the exercise routine and lifestyle changes they had learnt in the PR program tend to accumulate gains in physical endurance and psychological functioning [153].
\nPulmonary rehabilitation has a major role in the management of patients with chronic lung conditions especially COPD. The need for more convenient and efficient programs using new technology would be beneficial for patients. Tele-rehabilitation to deliver rehabilitation services over telemedicine using internet or phone can provides services to patients who live in remote areas without access to transportation. Tele-rehabilitation allows video conferencing between a central control unit and a patient at home. This will also deliver health services to patients with disability who cannot travel long distances for rehabilitation programs. Both mobile phones and video conferencing have used in few studies deliver rehabilitation services. The studies have demonstrated good compliance, decrease in exacerbations and hospitalizations, improved exercise capacity and quality of life [154, 155]. Benefits of telemonitoring in COPD patients have been described in a systemic review that showed decrease in hospitalizations and emergency room visits using telephone support for telerehabilitation [156].
\nA comprehensive multimodality pulmonary rehabilitation program is becoming an essential part of the management of COPD patients. It is not only cost effective but also scientifically proven to improve patients’ symptoms and functionality. With a gradual increase in daily activity, COPD patients are able to achieve higher HRQoL compared to pharmacotherapy alone. Despite these proven benefits, widespread utilization of PR remains poor. Multiple factors, including; physician unfamiliarity of benefits of PR, patient compliance with the exercise regimen and insurance coverage contribute to this gap. With the increasing prevalence of COPD worldwide, a safe and effective option like PR needs to be actively promoted and utilized.
\nApart from standardized exercise regimens and strength training, the emphasis of an effective PR program is on behavioral modification. This result in long lasting, positive changes on the disease course. In addition, empowering the COPD patients by educating them about disease, smoking cessation and nutrition is a crucial step in the right direction. Development of home based or telerehabilitation services may assist in reducing the disparity in access to PR for many more COPD patients.
\nAuthors declare no conflicts of interest.
\n chronic obstructive pulmonary disease acute exacerbation of chronic obstructive pulmonary disease pulmonary rehabilitation health-related quality of life randomized controlled trial neuromuscular electrical stimulation activities of daily living modified Medical Research Council 6 minute walk test functional independence measure assessment of motor and process skills functional capacity evaluation dual energy X-ray absorptiometry body mass index, airflow obstruction, dyspnea and exercise capacity
"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges".
\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.
",metaTitle:"About Open Access",metaDescription:"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges.\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.",metaKeywords:null,canonicalURL:"about-open-access",contentRaw:'[{"type":"htmlEditorComponent","content":"The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\\n\\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\\n\\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nOAI-PMH
\\n\\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\\n\\nLicense
\\n\\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\\n\\nPeer Review Policies
\\n\\nAll scientific works are Peer Reviewed prior to publishing. Read more
\\n\\nOA Publishing Fees
\\n\\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\\n\\nDigital Archiving Policy
\\n\\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\\n\\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\\n\\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\\n\\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\\n\\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\n\nDigital Archiving Policy
\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\n\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. 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Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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