*3.1.1 Mn-doped CdSe quantum dots*

CdSe QDs is n-type intrinsically, and a flagship candidate in nanoscale research history shows several novel properties as a member of the II-VI binary semiconductor group. It was attractive to the researchers to demonstrate various optoelectronic applications as its energy band overlaps nicely with the solar energy spectrum [41]. The fundamental properties of CdSe are enhanced via doping, which further increases its demand in the semiconductor industry. However, doping of CdSe by Mn2+ ions is challenging due to the self-purification effect, as reported by Erwin *et al.* [27, 29, 42]. The doping process is mainly governed by the surface kinetic effect. Microwave heating helps one to have exquisite control over this surface kinetics that eases the doping process.

Meladom *et al.* developed a robust synthesis protocol for efficient doping of Mn2+ into CdSe QDs in an aqueous medium with mild microwave heating as a final step [17]. A household microwave oven was used to heat the CdSe QDs solution for 60 seconds duration with the set point of 450 W (operational frequency 2.45 GHz). This heating step was repeated three times by giving 5 minutes intervals. The motivation was to tune the electrical conductivity of CdSe QDs thin film by varying doping concentration only as the size of QDs kept similar for all the samples. Microwave heating improves the quality of QDs in terms of optical properties, which was confirmed by recording UV–vis absorbance and photoluminescence both excitation and emission spectra, as shown in **Figure 6(a)** and **(b)**, respectively. In all the cases, peak intensities were enhanced and bandwidth reduced, which indicates the reduction of surface defects of QDs. The chemical composition of the doped CdSe QDs sample was confirmed with X-ray photoelectron spectroscopy (XPS), energydispersive X-ray spectroscopy (EDS), and inductively coupled plasma - atomic emission spectroscopy (ICP-AES) measurements data. XPS result confirmed the efficient incorporation of Mn atoms as dopants inside the host CdSe QDs (**Figure 7**).

#### *3.1.2 More examples on doped binary nanocrystals*

Microwave-assisted synthesis has also been utilized by many research groups around the world to dope various other binary II-VI semiconductor-based nanocrystals. Molaei *et al.* reported the synthesis of copper (Cu) doped ZnSe nanocrystals in the aqueous medium to study the doping effect on the optical properties [43]. Synthesis of Mn2+ ion-doped ZnS quantum dots was reported by Joicy *et al.* using a rapid microwave irradiation step without any surfactants, which showed photocatalytic activity by observing photodegradation of methyl orange dye under

#### **Figure 6.**

*Electronic UV–vis (a) and photoluminescence (b) spectrum of Mn2+ doped CdSe QDs sample with and without microwave irradiation [17].*

#### **Figure 7.**

*(a) Survey scan of the X-ray photoelectron spectrum of 2% Mn2+-doped CdSe QDs. (b, c) high-resolution spectrum of Cd 3d electrons depicting doublet splitting with binding energies separated by 6.9 eV and Se 3d, respectively. (d) the high-resolution spectrum of Mn 2p core electrons showing doublet splitting with binding energy separated by 10.9 eV [17].*

UV light irradiation [44]. Here, the zinc blende crystal phase of ZnS was important for the efficient incorporation of Mn atoms. In the same year, Zhu *et al* reported the synthesis of of Mn-doped ZnS via green and rapid microwave-assisted approach and they also developed indapamide drug detector by recording room-temperature phosphorescence (RTP) with that doped material [45].

Later, Zhang *et al.* reported the aqueous synthesis of Mn and Cu doped ZnSe QDs by microwave radiation with higher quantum yields (QYs) and they have further extended this work to grow the white-light-emitting ZnSe/ZnS core/shell QDs via the co-doping of Mn and Cu [46]. Lead sulphide (PbS) QD are still emerging various applications in optoelectronics and its property was further tuned with a

**89**

*Doping of Semiconductors at Nanoscale with Microwave Heating (Overview)*

silver (Ag) atom doping. It is also reported by Shkir *et al.* that the bandgap of PbS QDs was increased with Ag atom incorporation, which was predicted without mentioning the influence of size variation between the samples used [47]. Recently, another work reported on facile microwave synthesis of CdS quantum dots doped with Cr atoms as impurity doping and they have studied various properties like

Various metal oxides nanomaterials play a major role in the development of different novel daily life applications in the fields of display, sensors, medicine, biomedical devices, agriculture, information technology, optical, energy, electronics, and so on. Efforts are ongoing to tune their properties and applications further with incorporating impurity as dopants. For that reason, microwave heating based synthesis protocols is developing as a potential alternative to the conventional heating based growth process. Kar *et al.* developed a microwave synthesis of rare-earth element Eu3+ doped tin oxide (SnO2) to tune the optical and electrical properties of the host [49]. Jamatia *et al*. reported the microwave-assisted synthesis of Fe doped ZnO nanoparticles to show their application in polymer light-emitting diodes [50]. The wurtzite hexagonal crystal phase of ZnO nanoparticles and incorporation of the Fe dopant into the host ZnO crystal lattice was confirmed via X-ray diffraction analysis. This report claimed that the bandgap modification of ZnO via Fe doping is estimated from the Tauc plot without considering the influence of size. Similarly, many spinel structured metal oxides were also doped with different transition metal ions via microwave heating based synthesis technique with tunable structural, morphological, optical, vibrational, and magnetic properties and different potential applications like phosphor-based forensic testing and many more [51–54]. Interestingly, Er3+ doped α-Fe2O3 and Fe doped TiO2 nanoparticles were synthesized successfully with the help of microwave heating to study their crystal structure and optical properties [55, 56]. Recently, Yathisha *et al*. reported Zn2+ doped MgO nanoparticles utilizing microwave combustion route to study the influence on photovoltaic properties [57]. Therefore, microwave heating could explore further as a low-cost alternative synthesis protocol to design a new variant of nanomaterials.

*DOI: http://dx.doi.org/10.5772/intechopen.95558*

*3.1.3 Doped oxide nanomaterials*

structural, opto-dielectric, electrical, and so on [48].

*3.1.4 Lanthanide ion doped lanthanum trifluoride (LaF3)*

**3.2 Doping of carbon based nanomaterials**

Lanthanum trifluoride (LaF3) is an ionic compound that is utilized as core-shellup conversion nanoparticles (UCNPs) for different filed of applications like sensing, biomedical, and solar cells. Tek *et al*. reported Yb3+ ion-doped (active) and undoped (inert) LaF3 shell coatings on a 20% Yb, 2% Tm codoped hexagonal phase LaF3 core with the help of microwave -assisted synthesis route [58]. They observed higher optical enhancement of inert shell compared with the active shell at all prominent emission peaks, which is explained with the energy band diagram indicating the

Carbon-based materials like graphene can also be doped via microwave (MW) heating. Since the nanocarbon materials are found to be sensitive to microwave radiation [59, 60], the technique of MW heating was employed in the modification of graphene materials. It is also reported that by the use of microwave heating, hollow carbon nanospheres can be synthesized within a short time which can be effectively used as a host material for doping [61, 62]. **Figure 9** shows the

energy transfer pathways for the Yb3+ and Tm3+ − co-doping (**Figure 8**).

#### *Doping of Semiconductors at Nanoscale with Microwave Heating (Overview) DOI: http://dx.doi.org/10.5772/intechopen.95558*

silver (Ag) atom doping. It is also reported by Shkir *et al.* that the bandgap of PbS QDs was increased with Ag atom incorporation, which was predicted without mentioning the influence of size variation between the samples used [47]. Recently, another work reported on facile microwave synthesis of CdS quantum dots doped with Cr atoms as impurity doping and they have studied various properties like structural, opto-dielectric, electrical, and so on [48].


4.1.3. Growth

Growth FSCs apply widely available skills, technology and information to create differentiated products, in addition to leveraging economies of scale and scope. Consumers pay a premium for differentiated products, but there is price-based competition in this category. Product differentiation is achieved through following procedures required to establish one or more product/process attributions, such as certified organic, non-GMO, fair trade, etc. Firms that occupy this quadrant exploit existing industrial technologies and skills to produce differentiated products efficiently [56]. In some respects, products in this space may be labeled with attributes that also appear to differentiate the Niche quadrant (e.g., local, pasture-raised). What distinguishes Growth from Niche in this respect is the ability to achieve industrial scale and efficiency. What is striking, in comparing the bundle of quality conventions present in Mainstream with those in Growth, is that each quadrant applies the same set of conventions; the distinguishing feature is the *prioritization* of conventions. As conveyed by its name, the Growth quadrant competes by offering one or more product claims or attributes that are highly desirable by consumers and therefore fulfill the public convention. Such differentiation, however, must occur at industrial scale in order to be competitive. The essential tradeoff associated with the Growth quadrant is between the level of product differentiation and industrial scale in widely available and well-understood processes. In other words, there may be an upper limit to the firm's ability to create differentiated attributes without moving into specialized processes, which require the firm to explore rather than exploit.


2.3.2. DYSKIMOT

The DYSKIMOT sensor is a MARG sensor based on the Micro-Electro-Mechanical Systems (MEMS) IMU LSM9DS1 (SparkFun, 14 €), with a mass of 10.44 gr and size of 3 × 3 cm (Figure 3A,C). It is composed of 3-axis accelerometer, gyrometer and magnetometer, plus a temperature sensor (Figure 3B). These internal components respectively measure acceleration (in [g], ±16 [g]), angular velocity (in [◦/s], ±2000 [◦/s]) and magnetic field (in [gauss], ±16 [gauss]).The apparatus can operate between −40 ◦C and +85 ◦C. The sensitivity depends on the sensor and on the selected range; detailed information is given in the datasheet (https://www.st.com/en/mems-and-sensors/lsm9ds1.html). For example, the gyrometer sensitivity is 8.75 10−3 ◦/s /LSB at the range ± 245 ◦/s, i.e., the range we use in the present study. Communication with other electronic components is made via serial peripheral interface bus (SPI) or inter-integrated circuit (I2C) protocol. The data recorded at a sampling frequency *f* = 100 Hz are transmitted to a PC via an Arduino Uno Rev 3 (23 €) and a USB cable (RS232 serial link). That sampling frequency was actually the maximal reachable with the devices used. The Arduino contains the data recovery program, using the SparkFun library provided for this sensor, and transfers them to a home-made acquisition software.

**Figure 3.** (**A**) Micro Electro-Mechanical Systems (MEMS). (**B**) 3-axis accelerometer, a 3-axis gyrometer, a 3-axis magnetometer and a temperature sensor. (**C**) Dimension of the DYSKIMOT.

The DYSKIMOT sensor was placed in front of the helmet (Figure 1C) with the X-axis in the vertical direction (inferior-superior axis). The Y-axis was aligned with participant's mediolateral axis at the beginning of the test and the Z-axis was aligned with the antero-posterior axis. This choice has two advantages. From a clinical point of view it is the most reliable position to record cervical axial rotation as shown in [33]. From an algorithmic point a view, the sensor orientation is such that the relevant information about the DidRen Test is fully contained in the X-component of angular velocity measured by the gyroscope. The latter time series was denoted ω*i*. A trapezoidal integration gave the head's rotation angles θ*i*, where the constant of integration was chosen such that the angle was zero at the beginning of the test. The derivative α*i* = ω*i*+*n*−ω*i*−*n* 2.*n*.Δ*t* with *n* = 5 and Δ*t* = 1/*f* provided the head's angular acceleration. Angles computed from the gyroscope showed a linear drift. Since the DidRen Laser Test consists of quasi-periodic rotations of 30◦ around a neutral position, a straightforward way of removing the drift is to subtract the least square regression line from the time series θ*i*. Notice that Elite (DYSKIMOT) time series are written with (without) a bar.

Before using the DYSKIMOT in this study, a test was performed using a sensor attached to a servo motor (see Figure 4) to mimic the sequence of the cervical axial rotation during the DidRen test, i.e., angles from 30◦ to the left and right by going back through the 0 angle (Figure 4). The servo motor with an Arduino Uno Rev 3, was programmed to perform the sequence repeatedly. The result can be seen in Figure 5. The sensor was kept static during the first 20 s of the test. The linear drift is clearly observable on the raw angular data and the parameters of this line are computed by a least squares regression. Then comes the activation of the actuator and the beginning of the sequence (around 25 s) started. The fitted linear drift was eventually subtracted from the raw angular data. Such a procedure is satisfactory for time series displaying the typical behavior of the DidRen Laser Test (Figure 5). Such a procedure may actually work in all cases, including non-periodic tests. The regression line parameters may even be stored provided they do not change over time or with temperature. We checked that the drift stays linear at larger time scales (30 min).

#### *2.4. Data Analysis*

Signals from DYSKIMOT and Elite were synchronized by an external digital trigger (National Instrument, Austin TX, United States). Since the frequencies of both sensors were different (100 Hz vs 200 Hz), the accuracy of the synchronisation of the time series θ, ω, α (Elite) and θ, ω, α (DYSKIMOT) is in the order of 5 ms.

**Figure 4.** (**A**) Servo motor + housing adapted to its axis to fix the MARG. (**B**) Angle = 0◦, (**C**) Angle = +30◦, (**D**) Angle = −30◦.

**Figure 5.** Example of linear drift due to integration of DYSKIMOT's raw angular velocity (red line) and correction of the drift of the test angle Z with the servo motor (blue line). The corrected angle (blue line) is obtained by subtraction of the regression line to the raw angle. This plot has been obtained by fixing the DYSKIMOT sensor on a servo motor (MG995, Tower Pro) performing successive and opposite rotations of amplitude 30◦.

Then the following parameters were calculated during each cycle and averaged on the 5 cycles achieved by each participant, see Figures 6 and 7 for a graphical illustration of our computational procedure: (1) angle (range of motion, in ◦); (2) peak angular velocity (maximum angular velocity reached, in ◦s−1); average angular velocity (in ◦s−1); (3) peak angular acceleration (maximum angular acceleration reached, in ◦s−2); (4) peak angular deceleration (minimum angular acceleration reached, in ◦s−2). The beginning of all cycles has been manually marked by one of the authors (RH) within a homemade software that performed the averages over the 5 cycles for each trial. The peak value of a given time series Xi has been computed to be max(Xi) unless the maximal value was judged to be an artefact by visual inspection of the curves. Then, the value below this maximum was retained.

Although our goal was to measure the agreement between Elite and DYSKIMOT sensors for ND and NDP participants, the computed parameters were of clinical interest, as neck velocity during fast rotation can discriminate between nonspecific neck pain and healthy control [13,14].

A Passing–Bablok regression [34], which allows to compare the DYSKIMOT vs Elite data, was performed on the individual values of the parameters for DP and NDP simultaneously so that the agreement between both sensors could be appraised and summarized by a "calibration line".

**Figure 6.** Typical plots of variables analyzed during one right rotation in a DP (34 years, Male, NDI = 22, NRPS = 5) and an NDP (25 years, Male, NDI = 0, NPRS = 0): (**A**) Angle; (**B**) Angular velocity; (**C**) Angular acceleration. Elite curves (dotted lines) can be compared to DYSKIMOT ones (solid lines). Computed parameters are illustrated by blue (Elite) or red (DYSKIMOT) arrows. (1) angle; (2) peak angular velocity; (3) peak angular acceleration; (4) peak angular deceleration.

**Figure 7.** Typical traces of the head motion during the 5 cycles of the DidRen Laser Test showing comparison of Elite (red line) and DYSKIMOT (Blue line) angle discrepancies. In (**A**), the best angle agreement between Elite and DYSKIMOT (difference = 0.6◦, mean angle during 5 cycles = 25.7◦) in an DP (34 years, male, NDI=22, NPRS = 5), and in (**B**) the worst agreement (difference = 4.0◦, mean angle during 5 cycles = 27.5◦) in a NDP (22 years, male, NDI = 0, NPRS = 0). Cursors indicating the beginning (grey) and end (green) of one axial rotation movement are shown.

A two-way ANOVA was then used to assess potential differences between the two systems (System factor: Elite or DYSKIMOT) and between the groups (Status factor: NDP or DP) for the parameters mentioned above. When the ANOVA indicated significant interaction, a post hoc Holm-Sidak analysis with pairwise multiple comparisons was carried out. Significance was fixed at *p* < 0.05 and all statistical procedures were performed with SigmaPlot 13 (Systat Software, Inc).

Finally, a dynamic time warping (DTW) analysis (without windowing) was carried out on the z-normalized data and the Euclidian DTW distances between the time series angle θ, θ, angular velocity (ω, ω), angular acceleration (α, α) for DYSKIMOT and Elite were calculated for all the participants and then averaged. The z-normalization consisted in replacing a time series *X* by *X*−*E*(*X*) *SD*(*X*) , *E* and *SD* denoting the average and standard deviation respectively.

The Passing–Bablok regressions and the DTW were performed by using R v3.4.2 and the packages mcr and dtw.

It is worth saying that the accuracy of synchronization is not a matter of concern: the parameters have been independently computed from Elite and DYSKIMOT time series, and no locality constraint has been added in the DTW procedure through a window parameter. Synchronization was mainly a facilitating tool for graphical exploration of the data.


**7. Possible connection of gut microbiome and behavior; microbiome and behavioral abnormalities in ASD**

The intestinal microbiome participates in the development of the HPA axis (Sudo et al., 2004) and is critical to the development of appropriate stress response later in life, which occurs during a narrow, critical developmental window. This process involves both the regulation of the levels of brain derived neurotrophic factor (BDNF) and NMDA receptors (Sudo et al., 2004). The microbiome also plays an important role in anxiety-like behavior (Messaoudi et al., 2011), depressive behaviors (Neufield et al., 2011; Messaoudi et al., 2011), but the effects are diminished in vagatomized animals, suggesting either the direct communication between the bacteria and the brain (Bravo et al., 2011) or through the brain-gut axis. The latter possibility is an indirect action of bacteria on an afferent vagal pathway via gut immune, endocrine and enteric nervous system (ENS) controlling mechanisms.

Animal studies have also shown that stress can change the composition of the microbiome, where the changes are associated with increased vulnerability to inflammatory stimuli in the GIT (Gareau et al., 2006); here the microbiome plays an important role in memory dysfunction (Gareau et al., 2011). Stress is known to inhibit gut contraction, one of the crucial defense strategies against bacterial colonization of gut mucosa. Early psychological trauma of maternal separation resulted in persistent mucosal barrier dysfunction in neonatal rats, including host defense to luminal bacteria, by mechanisms involving peripheral CRH receptors (Gareau et al., 2006).

Oral antibiotics disrupt the microbiome and favor environment for opportunistic bacteria. *Clostridium tetani*, an anaerobic bacillus produces a potent neurotoxin, tetanus neurotoxin (TeNT) that is transported by the vagus nerve from the GI to the CNS. In the brain TeNT disrupts the release of neurotransmitters by the proteolytic cleavage of synaptobrevin, a synaptic vesicle membrane protein. This inhibition may be related to a variety of behavioral deficits characteristic of autism. Some children with autism treated with anti-clostridia antibiotics have shown a reduction in stereotyped behavior (Bolte, 1998).


**Author details**

Yuanlong Cui1,2\*, Saffa Riffat1 , Elmer Theo1 , Tugba Gurler1 , Xuan Xue3 and Zohreh Soleimani2

1 Department of Architecture and Built Environment, The University of Nottingham, Nottingham, UK

2 School of Built Environment, College of Engineering and Technology, University of Derby, Derby, UK

3 School of Pharmacy, The University of Nottingham, Nottingham, UK

\*Address all correspondence to<EMAIL_ADDRESS>
© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


**2. Gamification in learning platform: study**

As a part of routine life, games not only entertain users, but also represent their behaviors also. The same can be used in e-learning by applying crux to learn and get a maximum number of the process. The techniques in games tend to provide simplification to learning approaches. The customization of e-learning processes with this approach can make it easy as ever. It is the use of gameplay mechanics used for Non-game applications where any process can be gamified. Its main goal is to engage learners by using gamification techniques in routine Teaching-Learning Processes. By keeping attention to the integration of tasks, we can motivate learners too [3].

To engage users in learning gamification is an efficient approach which can make content more attractive. B.J. Fogg argues that people respond to computers as they were persons, especially when gaming. To trigger certain behavior, it needs to be motivated. Gamification also extends the social interaction with other users. Fogg explains that when people perceive social presence, they naturally respond in social ways and have feelings of empathy or anger, or following social rules such as taking turns [3].

Gamification is mainly for usage of gamifying features in other than games, applications also, predominantly consumer is focused on the web-based the platform and mobile application too. Gartner Group predicts gamification will be a key trend that every CIO, IT planner and enterprise architect must be aware of as it relates to business. As the view of the gamified learning approach through a context-aware mobile learning environment, which gives motivation to students for learning by developing and implementing gamification strategies by using questionnaire with the help of a Smartphone and its functions. Pre and post-test results demonstrated that use of gamification increases the throughput of the overall process. Further, they revealed a positive relationship between learning achievement and motivation [4].

**2.1. Gamification for campuses learning**

to design ineffectual ways of fun learning [9].

• Duo Lingo: language learning from Web translates.

• Goal Book: Individual students learning Plans together

• Course Hero: Teacher and Student Interactions in Online • Brain scape: Confidence on Basis of Repetition from games • Socrative 101: Mobile interaction among Teacher & Student [9]

**2.2. Top 10 productivity application uses gamification**

from the small goals [10].

• Habitica (HabitRPG)

• Super Better

• Epic Win

• Doable

• ABCya • FunBrain

• Carmen Sandiego [10]

• To-Doist Karma

• Task Hammer

• Chore Wars • Mind Bloom • Fitocracy • Smarty Pig

• Coursera: Interactive Education from your Home • Mr. Pai's Class: The Digitally Assistance for a Class

• Ribbon Hero: Teach how to use Microsoft Office and learning.

• Class Dojo: Class learning becomes Game of Rewards & Feedback assessment

• The World Peace Game: Game-based Simulation for Classroom learning

Major fact is objective in attempting to sustain good communications for supporting feedback and strengthening learning platform, instructors, student's users, this collectively interactive model between all users and good level of control features in gaming to engage users, helps

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The main focus and practical usage of gamification toward help people their productivity plan and manageable task and challenges into reality. So the consistent way is to achieve it

A game-informed approach being a learning activity, it recognizably uses game-like elements. The process of engaging new approaches to teaching and delivering personalized, context-sensitive content, via the game-informed, technology-supported, learning activities, has been reported to have significant beneficial effects on the academic outcomes of students in primary schools. Gamification still needs to pay attention to individual learners and their performances by using two approaches to learn the games and gamification of educational contents. Where learning for games refer to the use of digital games for learning purposes. Gamification is "the use of game design elements in non-gaming contexts" [4].

Personalized Gamification: In order to personalize gamification as: applications that are plugged into another application without being essential. Giroux et al. Describe epiphytic features as follows: i) such system cannot be existent without a host system, ii) the hosting system can able to exist without epiphyte iii) both can have independent presences in the network, and finally, such system cannot affects its hosting application [5].

As video games are becoming more popular among games, there is huge potential to use it for gamification of learning content. Social networking, gamification and traditional e-learning approaches are compared. Participants in novel approaches get better results concerning skill acquisition. The traditional approach yields better results for knowledge acquisition. Students' attitude toward the new tools is positive. Participation rates are low challenging assumptions found in current literature. With best use of social networking in e-learning, gamification is the use of game-thinking and playful design in non-game contexts, has only shown its potential as a motivational tool [6].

The effects of a gamification plug-in deployed in a learning management system were compared to those of a social networking site in the same educational setting. We found that both approaches presented better performance than a traditional e-learning approach in terms of academic achievement for practical assignments, but that, when it came to assessing knowledge, the traditional e-learning approach was better. Also challenging current assumptions, participation rates and scores remained low with the new tools, although students' attitudes were positive. [7] Even if there are many negative views toward games, there are great advantages and benefits of it to engage and incorporate features that are extremely compelling. Online learning is assessed using studying time. Numerous numbers of connections and many other parameters have its impact. IoT allows interaction among various physical spaces to learn the problem objectively and communicate among themselves. The connection between device endpoint to all users to make smart i-campus to produces effective campus outcomes [8].

### **2.1. Gamification for campuses learning**

application too. Gartner Group predicts gamification will be a key trend that every CIO, IT planner and enterprise architect must be aware of as it relates to business. As the view of the gamified learning approach through a context-aware mobile learning environment, which gives motivation to students for learning by developing and implementing gamification strategies by using questionnaire with the help of a Smartphone and its functions. Pre and post-test results demonstrated that use of gamification increases the throughput of the overall process. Further, they revealed a positive relationship between learning

A game-informed approach being a learning activity, it recognizably uses game-like elements. The process of engaging new approaches to teaching and delivering personalized, context-sensitive content, via the game-informed, technology-supported, learning activities, has been reported to have significant beneficial effects on the academic outcomes of students in primary schools. Gamification still needs to pay attention to individual learners and their performances by using two approaches to learn the games and gamification of educational contents. Where learning for games refer to the use of digital games for learning purposes. Gamification is "the use of game design elements in non-gaming

Personalized Gamification: In order to personalize gamification as: applications that are plugged into another application without being essential. Giroux et al. Describe epiphytic features as follows: i) such system cannot be existent without a host system, ii) the hosting system can able to exist without epiphyte iii) both can have independent presences in the

As video games are becoming more popular among games, there is huge potential to use it for gamification of learning content. Social networking, gamification and traditional e-learning approaches are compared. Participants in novel approaches get better results concerning skill acquisition. The traditional approach yields better results for knowledge acquisition. Students' attitude toward the new tools is positive. Participation rates are low challenging assumptions found in current literature. With best use of social networking in e-learning, gamification is the use of game-thinking and playful design in non-game contexts, has only

The effects of a gamification plug-in deployed in a learning management system were compared to those of a social networking site in the same educational setting. We found that both approaches presented better performance than a traditional e-learning approach in terms of academic achievement for practical assignments, but that, when it came to assessing knowledge, the traditional e-learning approach was better. Also challenging current assumptions, participation rates and scores remained low with the new tools, although students' attitudes were positive. [7] Even if there are many negative views toward games, there are great advantages and benefits of it to engage and incorporate features that are extremely compelling. Online learning is assessed using studying time. Numerous numbers of connections and many other parameters have its impact. IoT allows interaction among various physical spaces to learn the problem objectively and communicate among themselves. The connection between device endpoint to all users to make smart i-campus to produces effec-

network, and finally, such system cannot affects its hosting application [5].

shown its potential as a motivational tool [6].

tive campus outcomes [8].

achievement and motivation [4].

contexts" [4].

88 Trends in E-learning

Major fact is objective in attempting to sustain good communications for supporting feedback and strengthening learning platform, instructors, student's users, this collectively interactive model between all users and good level of control features in gaming to engage users, helps to design ineffectual ways of fun learning [9].

#### **2.2. Top 10 productivity application uses gamification**

The main focus and practical usage of gamification toward help people their productivity plan and manageable task and challenges into reality. So the consistent way is to achieve it from the small goals [10].

As digital signage come out at the top of second priority because technology is comparatively less expensive and very simple to implement. The objective of institutions to use signage like to include directing their students, to deliver weather data and news updates, information, provides an activity to engage users and post menus and major things are used for communication during an emergency situation. Smart lighting to automatically brighten for the presence of the populace and also can able to generate self-reports of its maintenance require-

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As per experts predicts and expect the various outcomes from IoT like which includes for better accessibility for innovative resources, to increase the student engagement and to extend higher capacity in data analytic prediction. Some HE user's benefited from technology like

User's expectation from cost reduction, very but a few percents of the respondents realize about cost savings. In the same manner, 54% forecast for increasing capacity in data analytics platform and only 27% achieved in data analytics. As a major element of this smart campus is a data analytics toward explorations for benefits in more decision-making. Saving time expectation is higher in data management on the basis of streamlining data records (**Figure 3**). As per CDE reports students getting more benefits from smart campus, teaching faculty and non-administrative too. So every new innovation from i-campus for classrooms and teaching tool for faculties are in terms of creating higher engagement to the experiences of all student users. And also for all stakeholders, the satisfaction level is good in i-campus new initiatives

ments and helps to improve energy efficiency.

which are important for successes (**Figure 4**).

**Figure 3.** Smart technology usage: CDE surveys among 138 higher education [12].

experiencing from the IoT platform.

**Figure 2.** Gamification frameworks –Octalysis. [11].

Octalysis – Gamification Framework: Octalysis is Gamification Framework I shaped past 10 years of gamification-based research work. It's translated into nine languages globally and become necessary literature for Gamification model domain worldwide. [11] (**Figure 2**).


**2.3 Implant-corrected kennedy (ICK) classification system for partially edentulous arches**

One of the simple classification systems for RPD supported with implants or implants and natural teeth is Implant-Corrected Kennedy (ICK) classification system for partially edentulous arches by Al-Johany et al. [5]. The ICK is based on the Kennedy classification system and the Applegate eight rules (Applegate–Kennedy system) [6]. According to the ICK classification system coding guidelines, the Kennedy classification comes first, followed by the number of modification spaces (Applegate rules). Finally, round brackets enclose # followed by the implant's or implants' position will be added, **Figures 10–18**.

**Figure 10.** *ICK I (# 25).*

**Figure 11.** *ICK II mod 2 (# 33, 36). Direct retainer is going to be constructed on 28.*

**Figure 12.** *ICK II mod 3 (# 13, 23). Direct retainer is going to be constructed on 28.*

**Figure 13.** *ICK II mod 1 (# 16, 13, 23).*


**Author details**

Krassimir Metodiev1\*, Paula Lazarova2,3, Jon Kyte2 , Gunnar Kvalheim2 and Jahn Nesland2

\*Address all correspondence to<EMAIL_ADDRESS>
1 Dept. Preclinical and Clinical Sciences, Medical University, Varna, Bulgaria

2 Inst. Cancer Research, Univ. Hospital "Radium", Oslo, Norway

3 Clinical Laboratory, Univ. Hospital "St. Anna", Varna, Bulgaria

#### **References**

**Immunoediting, Immunosurveillance, Tumor-induced Immunosuppression and Immunoresistance, Immunomodulation, Immunotherapy, and Immunonutrition in Personalized and Precision Cancer Medicine**

John N. Giannios

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Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/61772

#### **Abstract**

Cancer immunoediting is composed of three phases: elimination, equilibrium, and es‐ cape. Tumor cells, which successfully navigate these phases, are capable of evading de‐ struction by the immunity system of the host. Furthermore, there are different types of nonimmune surveillance against tumors, including genetic surveillance, which is based on DNA repair and checkpoint control, intracellular surveillance related to apoptosis or type I PCD, intercellular surveillance linked to the tumor microenvironment, and epigenetic surveillance related to the structure of chromatin, and specifically the strin‐ gency of imprinting. Circumventing immune destruction is one of the hallmarks of cancer pathogenesis, in addition to evading growth suppressors, deregulating cellular energetics, enabling replicative immortality, inducing angiogenesis, activating invasion and metastasis, sustaining proliferative signaling, and resisting cell death, which may lead to the uncontrollable promotion of tumor burden at the expense of the immune system. Although immunoediting may eliminate tumor cells with alterations in their antigenic epitope profile, many immunoresistant variants escape from the immune sys‐ tem of the host by various immunosuppressive molecular and cellular mechanisms. There are many immunomodulatory effects of targeted therapies that can circumvent tumor-mediated immunosuppression, improving the effector T-cell function, which en‐ hances eradication of targeted tumors. Another even more efficient antitumor strategy consists of combining targeted therapies with immunotherapies, which exert many an‐ titumor synergies. The subsequent complex interplay of targeted anticancer agents and immunotherapy may sensitize tumor cells to immune-mediated eradication with longlasting immunotherapeutic effects, which may inhibit induction of tumor dormancy. These combinatorial immunotherapies with targeted therapies can be used as neoadju‐

© 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

vants and adjuvant treatments with conventional anticancer strategies, such as surgical debulking, radiation therapy, and chemotherapy. In conventional anticancer treatment, the chemotherapeutic-induced immunosuppression inhibits the anticancer efficiency of cell therapies, which are based on activated lymphocytes for eradication of tumor cells, enhancing susceptibility to infections. The majority of conventional chemotherapeutic agents interfere with hematopoiesis and subsequently with the immune system, affect‐ ing the surveillance of cancer cells leading to the promotion of tumor development and growth. Furthermore, cancer surgery causes tremendous alterations in the neuroendo‐ crine, metabolic, and immune systems constituting the stress response, which may lead to infection and cancer recurrence. Generally by using an integrative medicine immu‐ notherapeutic approach, where alternative medicine practice which follows a multitar‐ geted and bidirectional regulation may compensate for deficiencies of conventional orthodox western medicine, which is characterized by specificity, we may achieve a synergistic effect concerning circumvention of tumor-induced immunosuppression and enhancement of antitumor immunomodulation followed by minimization or elim‐ ination of side effects, prolonging the survival rate of advanced stage and metastatic cancer patients promoting their quality of life. The key is to treat each cancer patient under a personalized evidence-based medicine approach, which must rely on clinom‐ ics, including transcriptomics, genomics, immunomics, lipidomics, glycomics, proteo‐ mics, metabolomics, nutrigenomics, and mainly epigenomics whose alterations in their noncoding RNA genes are reversible especially with immunonutrition. The precise im‐ munotherapeutic approach against cancer may act synergistically with conventional anticancer therapies, such as surgery, chemotherapy, and radiotherapy combined with therapies based on molecular targeting, which are tailored for each patient on a phar‐ macogenomic basis, and they can be combined with nanomedicine for specific molecu‐ lar targeting and circumvention of biological milieu interactions, which may enhance tremendously therapeutic efficacy with simultaneous reduction of systemic toxicity.

**Keywords:** Immunosurveillance, immunoediting, tumor-induced immunosuppression, immunoresistance, immunomodulation, immunotherapy, immunonutrition, personal‐ ized or precision cancer medicine, evidence-based medicine, omics

#### **1. Introduction**

The strategies to fight cancer are composed of mechanisms including surgery since 1600 BC, physics including radiotherapy since 1896, chemistry including chemotherapy since 1942, and biology including immunotherapy since 1976. Although immunotherapy has a long history that has been evaluated for more than a century, only recently has it entered a renaissance phase with anticancer biological agents, including the first monoclonal antibody approved in 1997, interleukin-2 (IL-2) cytokine approved in 1998, the first cellular immunotherapy as therapeutic vaccine approved in 2010, and the first checkpoint inhibitor approved in 2011, which has been succeeded by many more approved immunotherapeutic agents [1]. The cancer immunosurveillance hypothesis proposed by Ehrlich in 1909, modified by Burnet and Thomas in 1957, refers to the immunological resistance of the host against cancer development.