\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"163",leadTitle:null,fullTitle:"Ultrasound Imaging - Medical Applications",title:"Ultrasound Imaging",subtitle:"Medical Applications",reviewType:"peer-reviewed",abstract:"This book provides an overview of ultrafast ultrasound imaging, 3D high-quality ultrasonic imaging, correction of phase aberrations in medical ultrasound images, etc. \n\nSeveral interesting medical and clinical applications areas are also discussed in the book, like the use of three dimensional ultrasound imaging in evaluation of Asherman's syndrome, the role of 3D ultrasound in assessment of endometrial receptivity and follicular vascularity to predict the quality oocyte, ultrasound imaging in vascular diseases and the fetal palate, clinical application of ultrasound molecular imaging, Doppler abdominal ultrasound in small animals and so on.",isbn:null,printIsbn:"978-953-307-279-1",pdfIsbn:"978-953-51-6452-4",doi:"10.5772/689",price:139,priceEur:155,priceUsd:179,slug:"ultrasound-imaging-medical-applications",numberOfPages:344,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"aa3c22596ff5852287143fe66a643289",bookSignature:"Igor V. 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Minin received a B.A. in Physics from the Novosibirsk State University, a PhD in Physics from Tomsk State University in 1987 and a Doctor of science from NSTU in 2002. Currently he is a full Professor in the Department of Information Protection at Novosibirsk State Technical University (NSTU), Russia. From 1982 to 2001 he was Chief Research Scientist at the Institute of Applied Physics, Novosibirsk, Russia. Dr. Minin’s research interests are in the areas of diffractive optics and antenna experiment (including explosive plasma antenna), millimeter wave and THz photonics and nanophotonics, information security, detection of hidden weapons as well as development of antiterrorism devices, experiment technologies, explosive physics. He is a member of SPIE, COST-284 and COST-ic0603 and he is the author of several books and book chapters in technical publications. For his work Dr. Minin was awarded the Commendation for Excellence in Technical Communications (LaserFocusWorld, 2003) and commendation by the Minister of Defense of Russia, 2000.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Tomsk Polytechnic University",institutionURL:null,country:{name:"Russia"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"123258",title:"Dr.",name:"Igor",middleName:null,surname:"Minin",slug:"igor-minin",fullName:"Igor Minin",profilePictureURL:"https://mts.intechopen.com/storage/users/123258/images/1782_n.jpg",biography:"Igor V. Minin is a full Professor in the Department of Information Protection at Novosibirsk State Technical University (NSTU), Russia. Dr. Minin received a B.A. in Physics from the Novosibirsk State University, a PhD in Physics from Leningrad Electro-Technical University in 1986. and a Doctor of science from NSTU in 2002. Dr. Minin has over twenty years of international industrial and academic experience and has played key roles in a number of projects including 3D millimeter wave real-time imaging and antiterrorism applications. He is the author or coauthor of approximately 350 research articles, seven monographers (including Diffractive optics of millimeter waves (IOP Publisher, Boston-London, 2004), Basic Principles of Fresnel Antenna Arrays (Springer, 2008)), and has been awarded 24 patents and inventions. 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In the last decades, due to the modern lifestyle, the progresses in industry and technology had led to an important increase in the amount and type of wastes. The problem of waste accumulation every year is all over the world. These industrial and agricultural wastes are by-products, slag, rice husk ash, bagasse, fly ash, cement dust, brick dust, sludge, glass, tires, etc. The wastes represent a major problem for the environment because the air pollution (the dust and very fine particles which spread in the atmosphere) and leaching toxic chemicals (arsenic, beryllium, boron, cadmium, cobalt, lead, manganese, mercury, molybdenum, selenium, strontium, thallium, hydrocarbon compounds, etc.) when are dumped in landfills, quarries, rivers or oceans. The capitalization of waste is difficult because of their variety, as well as their unknown properties over time.
Lately, the environmental sustainability became an important problem from the point of view of natural resources and that of wastes. The construction and the building materials sectors are involved in both processes: building industry is the largest user of natural materials and in addition a large amount of wastes results from the demolition of constructions.
The building material industry is a domain of interest for using the wastes and researchers have tried to produce new construction materials incorporating wastes. The new generation of building materials is developing on other theories in concordance with the sustainability of environment.
Concrete is obtained from natural aggregates, cement and water, compounds which make it a cheap material and easy to produce anywhere. Usually, ordinary concrete contains about 12% cement, 8% water and 80% aggregates by mass. Aggregates and water are from natural resources, only cement must be produced in fabrics, processes which are polluted the environment (for producing 1 m3 of concrete a quantity of 480 kg of CO2 is liberated in the atmosphere). For reducing the aggregate and cement consumption, the replacing materials obtained from wastes were studied.
Because the cement industry is responsible for 5-7% of worldwide emission of CO2, (which means 1.6 billion tons of carbon dioxide into the atmosphere), in preparing concrete, the cement dosage can be reduced by using mineral additions, strategy that also can contribute to environment protection by preserving the energy and consume the huge quantities of wastes.
Near cement concrete other building materials are obtained by using wastes, such as: high strength concrete, which has in the mix different additions (silica fume, fly ash, etc.), asphalt concrete, bricks, pavements, roof tiles, prefabricated units, claddings, etc.
Some building materials are totally obtained from wastes, such as “green” materials. The new concept of green buildings offers more energy-and resource efficiency. This concept means the greening of building industry by using only green materials. The technologies of obtaining green materials are available, but their use in construction industry is limited.
The building material and construction industry is one of the principal users of wastes in the processes for obtaining materials or products, for constructing bridges or highways, in soil stabilization, in hydraulic construction, etc. From environmental considerations an extensive waste utilization in construction is recommended, although particular wastes may be too risky to use.
For many years a lot of wastes have been accumulated in the entire world and they influenced the environment and people life. The necessity of eliminating or at least, reduction of huge quantities of wastes is a priority of researches. Their use in the building material and construction industry is a one of the possibilities which can help to keep the environment clean.
In the building material industry there are used a lot of types of wastes, which can be classified as follows:
The by-products which are used in construction are:
Another source of sludge and slag is from steel industry and they are generated as waste material or byproduct. They contain considerable quantities of valuable metals and materials. Different technologies are used for recovering the metallic parts, such as: classification, magnetic separation, leaching, roasting, etc. The wastes are then transformed in different sorts of waste, such as powder, conglomerate, etc. function the necessity of applied technology for a better use of natural resources and environment protection.
The paper industry that uses recycled paper as raw materials has as by-product paper sludge, which has a high content of calcium carbonate, organic materials and other minerals. Because its pozzolanic activity, the paper sludge can be used as cementitious materials in building industry.
In Romania annually great fly ash (FA) quantities resulted: in 1980 resulted 15 million tons of FA, in 1985 obtained 30 million tons, and after 1990 the FA quantities decreased because the electricity consumes reduced. In our area annually resulted around 21740 tons of ashes (fly and bottom ashes). In the last twenty years resulted approximately 500 million tons of fly ash, from that a small part is capitalized. The FA unused is disposal on the landfill [7].
Toxic substances in the waste - including arsenic, mercury, chromium, and cadmium - can contaminate drinking water supplies and damage vital human organs and the nervous system. Ecosystems are also been damaged by the disposal of coal plant waste.
Fly ash produces environmental damage by causing air and water pollution on a large scale while the cost of storage of this waste is very high. The most serious problem is the hazard to atmosphere and underground water quality which would be a potential risk to the health and property of citizens and cause a huge stress to the economic and environmental system [7].
Another source of fly ash waste is from the solid waste incineration technology which is used in big cities of the world because its effectiveness in volume reduction, weight reduction and toxicity reduction, and also in energy and resource conservation. However, this technology produces fine fly ash residue which is equivalent to 2-5% of the original waste according to the Chinese researchers [8]. The municipal solid waste incineration (MSWI) fly ash can be used as raw material in sintering and preparing calcium sulphoaluminate cement (CSA), which had similar properties as the control cement [8].
Biodegradable waste can be decomposed in a short period of time, under the natural conditions into the basic compounds, usually micro-organisms, bacteria, etc. This type of waste is found in municipal solid waste and is resulting from food, paper, biodegradable materials, etc. The wastes which are decomposed in the absence of oxygen are also considered as biodegradable waste and here are included wastes from manure, sewage, animal fat, palm fruit bunch, sugar bagasse, banana leaves, etc [1].
At the Iasi municipal sewage water treatment station, one of the greatest from Romania, a flow of 4.2 m3/s has been processed daily, the sludge resulted by processing reaching an amount of about 3,600 t/day.
The fermentated sludge of the Iasi municipal treatment station had a neutral reaction and content in organic carbon of 29 - 34 %. The concentration of nitric nitrogen is low (0.16 - 0.42 ppm) and that of ammoniacal nitrogen between 24 and 830 ppm. The total content in macronutrients (N, P, K, Ca, Mg) from fermented sludge is 1.37 % N total, 1.19 % P total, 4.45 % K total, the calcium content is higher (3.12 %) and organic S and Mg have normal values comparable to those from soils.
The total content in heavy metals (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn) of fermentated sludge is low, comparable to the one from soils, and under values of maximum admitted values in sludges, in order to be used as fertilizers for soils. Bacterial and fungic microflora of sludges has similar values to the ones of composts, size and composition of microorganism populations were very close to the ones of soils. The lack of bacteria from Salmonella group and a low number of coliform bacteria made a fertilizing material without contamination danger caused by pathogenic microflora from the fermentated sludge. Because the soils from the Moldavian area, most of them placed on slope lands, are poor in organic matter and nutrients, these sludge, adequately used, could be a substitute for a great part of expensive technological consumptions (mineral nutrients) and contribute to the improvement in organic matter content from soil.
All technical stages in the minerals exploitation have an important impact on the environment and community life; the dust waste is very aggressive in the atmosphere, in water and soil because of the fine particle and toxic elements. The huge noise from technological processes is also an inconvenient for the community.
In the industry of building materials the raw materials are used in natural state and as processed materials (case in which they are transformed in other materials (lime, cement, plaster, additives, etc). Among the raw materials there are: clay, calcareous, gypsum, dolomite, marble, mica, granite, etc. Natural aggregates are obtained from gravel from river or from quarry. Because the aggregates are used in different sorts as sizes, the natural aggregates are usually crushed for obtaining an imposed granulometry. A lot of powder waste remains after aggregate selection and their disposal affect the vegetation of the environment.
Construction wastes are obtained during the building process or after demolition. Different types of materials such as bricks, concrete, mortar, wood, steel rebar, insulation material, electrical wiring, plastic materials, glass, iron plate, tile, sanitary pieces, etc. which can be unused or damaged. According to specialty literature about 10% to 15% of materials are lost from the total building material, quantity which varies from site to site [4]. The uncontrolled disposal of this waste is very dangerous for the environment because building materials can contain toxic substances such as lead, asbestos, aluminum, etc.
The recycling demolished waste as aggregate in ordinary concrete offers a solution to the preservation of natural resources and the disposal of construction residues.
The concrete became a more interesting building material because it has improved its properties and also it is suitable for combining with different types of wastes. The presence of additions and/or fibers is also important because it can improve the performances of concrete or they allow the use of smaller quantities of cement.
The use of different waste in the concrete mix or for obtaining new types of concretes had as result the development of a new type of construction materials: green materials. In this category is included inorganic polymer concrete which is obtained predominantly from industrial waste materials. Concrete of any type had been used as it is or in combination with other materials, the most known being the steel with which had resulted reinforced concrete and prestressed concrete, that are still today very common and useful in construction industry. Polymer concrete is a new type of concrete in which the cement is replaced by a polymer. A high variety of waste are used for obtaining concretes of different requirements related to strength, to chemical resistance, with high durability, rapid hardening, etc.
An important way to use the wastes is to introduce them as a powder or filler in the composition of construction materials (cement, concrete, asphalt, etc.) or to use as aggregates (concrete or bricks from demolition can be used as an aggregate, steel slag can be transformed into aggregates, etc.). Concrete is one type of building material that can incorporate many types of waste such as silica fume, fly ash, cinder, husk, tires, glass, etc. Concrete is used for obtaining structural elements and constructions of any type.
In the ordinary cement concrete or polymer concrete, silica fume is added in different percentages, as replacement or not of cement, for improving the properties, in particular the compressive strength, durability characteristics, bond strength [10, 11]. These good effects of silica fume on the concrete are resulting from the fact that the particles of silica fume are very small and also from the pozzolana reaction of silica fume with cement paste components. In the behavior of structural elements it was observed according to experimental studies, that the failure of beams was improved, the concrete with silica fume had a better behavior to shear force, the number of cracks in tension zone at failure was reduced, which indicate that elements are less destroyed at failure [11].
In the hydraulic constructions, concrete with silica fume responds better to requirements of hydraulic construction because this concrete has a better behavior to frost-thaw cycles, to abrasion, cavitation, is resistant to chemical attack and it is less permeable, facts which result in a smaller dosage of cement.
Silica fume is also used for obtaining other types of concrete, such as self-compacting concrete, fiber reinforced concrete, polymer concrete. In the case of polymer concrete from experimental studies it was concluded that the increase in compressive strength is not too much as in the case of tensile strength.
Also the addition of silica fume decreased the content of polymer, which is an expensive material [2, 12]. The good behavior of concretes with silica fume can be used for realizing hybrid elements for constructions such as beam or columns, to which the tension zone is realized of polymer concrete, that has a better behavior in tension, and the compression zone of high strength concrete, having in view the better behavior of concrete in compression [11].
Slag cements are used in concrete structures because it gives some advantages, such as: less carbon dioxide emission, during the production, lower hydration heat during hardening, low permeability and good resistance to sulphate attack [13].
Ground granulated Blast Furnace Slag (GGBFS) improves the flexural strength and compressive strength of concrete and asphalt mixes, which recommend its use in roads, highways, pavements, hydraulic constructions, etc. Ground granulated slag is used in producing cement concrete as mix compound of the concrete or as component of cement. The use of ground granulated slag as component of concrete has the advantage of using it in different dosages, which is important in obtaining desired properties. Ground granulated slag can be used in obtaining Portland blastfurnace cement, which contains up to 5% until 95% of filler. Also, this type of waste can be used in preparing concrete as cementitious material due to its hydraulic property. In this case the fineness of ground granulated slag must appropriate to that of cement or even greater. The use of ground granulated slag used in obtaining concrete is benefic for the environment, but also it improves some properties of concrete such as: fresh concrete has a better workability, structure of hardened concrete is more compact, that resulting in increasing the long term strengths and durability. The content of ground granulated slag in the mix and its fineness depend on the purpose for which it is used in obtaining specific properties of concrete. Research studies reported a replacement of cement with dosages between 10 and 80% from the cement mass. The smaller quantities of waste are for increasing mechanical properties and high dosages are for improvement the resistance to chemical attack [14, 15].
The ground granulated blast furnace slag is also used in asphalt concrete for roads, highways, pavements, etc. An important utilization in the last time is to obtain high performance concretes, with improved durability, which is required in bridges, marine constructions, hydraulic dams, etc.
Another possibility of consuming ground granulated slag waste is to manufacture fibers which can be used in production of insulation material as slag wool [16].
Experimental studies on concrete with aggregates obtained of steel slag had shown that this type of waste can be used in road construction or in infrastructure works because the presence of steel increased the density of hardened concrete. Good mechanical properties were obtained in the case of cement concrete and polymer concrete with slag aggregates and addition of silica fume [3].
The paper sludge is used for obtaining blended cements which contain 90% Portland cement and 10% waste. Also, the paper making waste can be processed to obtain a composition of cellulose fibers and clay which is suitable to use as insulating material or as filler in building materials [17, 18].
The utilization of paper waste sludge obtained from a paper industry, as a replacement to the mineral filler in various concrete mixes was experimentally analyzed [18]. Concrete mixes containing various contents of the waste (3, 5, 8 and 10%) were studied and the results shown a recommended replacement of sand of about 5% for obtaining concrete for masonry construction.
The fly ash utilization is diversified in time and referring to construction industry this waste is used in: cement and concrete manufacturing, production of bricks, tiles and pavements, lightweight aggregates, etc. The new researches used fly ash in obtaining eco-concrete, which eliminated from the mix the cement, the geopolymer obtained being a material more friendlily with the environment. Although a large proportion of global FA is used by the building industry, there is a still proportion which is disposed of in ponds or landfills [4].
In the cement production the fly ash is used in the composition, in different quantities and the cement obtained are named composite cements [6].
In the cement-concrete production, a part of cement is replaced with different dosages of fly ash, normal dosages being between 10-40% and up to 75%. The advantages of using fly ash in concrete are given by the reduction of cement dosage, and also by the beneficial effects which improve concrete properties (mechanical strength and durability resistance), reduce bleeding, reduce cracking, decrease the heat during hardening of concrete [4, 19]. Experimental studies on cement concrete with fly ash shown that the addition of fiber, near fly ash is beneficial in improving the properties. Statistical optimization of mechanical properties for a concrete with 10% replacement of cement recommended for example for glass fiber type, a percentage of 1% from the concrete mass and a length of fiber of 35 mm in the case of compressive strength and higher percentages and smaller length, in the case of tensile strengths.
In obtaining the inorganic polymer concrete, which is a “green” material, fly ash that is considered alkali activated cement, replaces totally the cement from the mix. In fly ash-based geopolymer binder, fly ash reacts with an alkaline solution and the geopolymer paste acts as only binder for aggregates. The basic ingredients of fly ash-based geopolymer concrete are fly ash, sodium hydroxide, sodium silicate, fine aggregates and coarse aggregates [20].
The formulation of high-performance materials that are stronger and more durable than conventional cement-based materials has emerged as an issue of considerable importance in the construction industry. It is possible to utilize fly ash to produce a high-performance material at a potentially lower cost and without compromising its structural integrity. The high-performance polymer concrete made with fly-ash fillers presents the compressive strength, flexural strength, creep deformation and bond strength with values bigger than that of Portland cement concrete. Even in the case of fly ash the polymer dosage can be higher than in the case of other additions, the mechanical properties are increased in comparison with polymer concrete without addition. The use of fly ash as an aggregate in polymer concrete is very promising because it could be used as an overlay in pavement, bridges, and runways or in precast applications such as utility, transportation, and hydraulic components [21].
Industrial fly ash is also used for the production of low-strength material, also known as ‘flowable fill’. It is used as a replacement of compacted soil in cases where the application of the latter is difficult or impossible. Also other wastes such as the cement kiln dust, asphalt dust, coal fly ash, coal bottom ash and quarry waste are used for preparing low-strength building materials. The content of these wastes in the mix is between 25-50%.
One of the methods of consuming
The use of sewage sludge as an organic fertilizer has become of particular interest in the light of the EU Directive concerning the use of sewage sludge, which creates the need for cleaner production technology.
Sewage sludge can be an alternative for the protection of ecosystems. Firstly, sludge-borne organic matter is a crucial factor in improving aggregate stability and water holding capacity of soils, so that the risk of erosion may be reduced. Secondly, sludge-borne nutrients can make sewage sludge an excellent and cheap organic fertilizer for the crops [22]. However, the presence of inorganic and organic contaminants can hider such use of sewage sludge [23]. Moreover, it is well known that the application of organic materials to soil can sequester C, and thus contributes to the improvement of reduction of CO2 in the atmosphere.
The sludge or the ashes obtained by burning the sludge can be used for obtaining ceramic products such as tile, brick block, pavement, etc. Several works have been carried out in this field [24]. The results from these works concluded that the use of treatment plant sludge as an additional component in a construction material, Portland cement concrete, is possible. The characteristics of sludge were evaluated. Also, it was necessary to analyze other properties such as the origin of the sludge, the components used, and the compatibility of the sludge within the cement matrix and the production of samples. Studies were conducted on the effect of sewage sludge ash on the workability of cement mortars.
A nonlinear reduction of workability in mortars containing sewage ash was observed. In their researches Monzo et. al. [24] reported the influence of sewage sludge ash (SSA) on the properties of cement mortar: a reduction of workability when a part of cement is replaced by sludge ash because it’s higher water absorbtion characteristic. Studies on pozzolanic activity of SSA have shown that it contributed to the improved of compressed strength, but its effect is influenced by the sulfur content. The high sulfur content of sewage waste seems to have little influence on compressive strength of mortars containing sewage ash.
Moreover, Casanova et al. [25] observed that cement degradation processes had been observed when gypsum contaminated aggregates or sulfide-bearing aggregates are used in concrete mix.
The sludge or the ashes obtained by burning the sludge can be used for obtaining ceramic products such as tile, brick block, pavement, etc.
The sewage sludge ash can also is used as replacement of sand addition to brick clays which presented a high resistance to fire than normal brick clays.
Sewage sludge can be converted into slag, and as glass materials it is used to produce crystallized glass for ceramics technology.
From the environment point of view, the researchers Cenni at al. [26] studied the possibility of using fly ash resulted from co-firing of coal and sewage slag as additive in bilding materials, because the European standards forbid their use. Their studies shown that the ash from co-firing contained components such as unburned carbon, alkali, magnesium oxide, etc. with a reduced concentration as standard requirements. The authors required modifications in European standards for limiting elements that can be unfavorable by using them in building materials. Fytily and Zabaniotou [27] re-analyzed in a review article the use of sewage sludge in construction industry. Other use, such as incineration of sewage sludge is another way for consuming this waste, but it needs a rigorous control of gas compounds which depends on the technology that is used.
The inert mineral waste resulted from quarries, from industrial processes can be used as aggregate or fine part in obtaining building materials and construction products. In any type of concrete these waste can replace different sorts of aggregates, contributing to preservation of natural resources.
The research studies in this domain shown that in building material industry a lot of inert waste can be used, such as granite, marble, limestone in the production of different materials: concrete, bricks, prefabricated elements, etc. The use of marble and granite waste in concrete preparing has shown that they improved the mechanical properties, workability and chemical resistance of concrete [28]. The polymer concrete with marble waste is of great interest because the marble addition or the marble used as aggregates improve the properties of concrete and contribute to a reduction of polymer content. The marble waste can also be used in the production of other building materials, such as ceramic products, where can be used as mix component, or in asphalt production as aggregate sort.
The construction sector produces high quantities of wastes, over80% being solid waste which is dumped. Some of these wastes may have particular health, safety and environmental concern, such as, asbestos materials with lead-based paint coating and lighting waste. These materials are not included in the present review.
Until now, the construction practice was thought unsustainable because, not only it is consuming enormous quantities of stone, sand and drinking water, but also huge quantities of cement [4]. Modern reinforced concrete structures begin to deteriorate in 10 to 20 years. So, an important problem of concrete structures is that of increasing their durability. New types of concretes obtained by using Portland cement replacement materials and recycling the concrete removed from structures will contribute to the sustainability of building material industry [29]. Also, it must realize that the resources for construction industry are limited and the new technologies of obtaining building material must be based on the existing wastes.
The construction wastes are easier for recycling because they were parts of constructed buildings and as raw materials they were analyzed as raw materials. The concrete from demolition can be used as aggregate. Recycled-aggregate concrete is prepared by completely substituting of natural aggregates [30]. In many cases in the concrete mix there are also used superplasticizers and supplementary cementing materials (for example fly ash). Also, in the recycled-aggregate concrete mix, the cement can be replaces by fly ash or other by-product.
The other materials resulted from constructions such as wood, masonry, metal, plastic, fiber glass, polystyrene granules, etc. can be used in building industry. In the category of “green concrete” which means a concrete with waste, they are introduce in the mix different additions, some as filler. Cement concrete with wood waste is a concrete of low strength, and with characteristics of a lightweight concrete. In the case of cement concrete with polystyrene granules, experimental studies shown that the mechanical characteristics can be comparable with that of an ordinary concrete, even the density indicates a lightweight concrete [3]. A specific property of cement concrete with polystyrene is that of elastic behavior of material under loads, in the case of high dosages of polystyrene.
The concrete with polystyrene spheres was studied from a long time, and near the fact that it is a lightweight concrete other advantages recommend its use in construction. Concrete with polystyrene can be prepared in site or to obtain prefabricated units in factories. The properties of concrete with polystyrene are influenced by polystyrene dosage and by the size of granule. It has been shown that these properties can be significantly improved by adding steel fibers or additions (silica fume, fly ash, etc.) in the concrete matrix or by decreasing expanded polystyrene sphere size.
The polystyrene waste can be also used in manufacturing lightweight concrete blocks or surface units, with improved thermal insulating properties, by introducing the polystyrene sphere as lightweight aggregate in the concrete mix [33].
The used tires are occupying a large landfill space and generate important problems to the society: one is that of hazard fire which is almost impossible to extinguish and the other is related to the people health. The European Association of Tyres and Rubber producers had estimated in 2009 that a quantity of 3.2 millions of tons of used tyres, from which 96% were re-used: 18% were retreated, 38% were recycled and 40% were used for burning in production of energy [32]. In Romania the recovery ratio is under 10%, in this context capitalization is a challenge for researchers.
The wastes of tyres are used in different purposes: for fixing and sealing soils in agricultural domain, in hydraulic domain (retaining walls, breakwaters), etc. [32].
The tyre waste can be used in natural form, cut in aggregates or in powder. Rubber aggregate is often used in construction works for obtaining light concrete or for road pavements. The experimental studies showed a percentage of around 25% from the mass for obtaining properties comparable with that of ordinary concrete. Higher quantities of tire waste result in decrease of mechanical properties [34]. The rubber increases the capacity to absorb energy from impacts, thus reducing the damage from collisions and increases the deformability and ductility of concrete. Rubber granulate is used for kindergarten play areas.
Once asphalt-rubber mixtures started to be regulated in the 1990s their use in pavements for roads and highways increased significantly [4]. The main advantages of pavements containing tires are their greater resistance to temperature variations and frost-thaw cycles, reduced noise, lower maintenance costs, a better drainage and an increase service life.
In different types of concrete the tire waste is used in various ways. In the concrete mix, the aggregates can be replaced by rubber particles in dosages between 0 - 45 % by volume. As indicated in the literature the concrete with used tire presented an decrease in mechanical characteristics, the use domain of materials obtained with this type of waste presents some advantages which derive from good damping properties, good thermal and acoustic performances [17].
In this direction, obtaining tough materials can be realized by introducing rubber particles in any mix. Concrete of any type is a brittle material. Small quantities of rubber in combination with other additions, can contribute to a better behavior of concrete, without affecting its mechanical properties.
Waste tire can be used as powder in obtaining cement concrete, polymer concrete, concrete with fibers, etc. Tire powder can be introduced in the mix as filler or to replace a part of fine aggregates. In the case of epoxy polymer concrete with powder of tire waste the experimental tests shown that the concrete is lightweight concrete with low mechanical properties, that recommend this concrete for pavement, prefabricated elements for sound protection, thermal insulation, etc [34]. Also this type of concrete showed a very good behavior to attack of chemical agents, abrasion resistance, so its use as floor in chemical industry or as pavements can be a possibility.
Waste tire can be used also in combination with other materials, such as glass fiber reinforced composite, in this case the tire waste being used as replacement of sand and for a better protection against pollution caused by noise. This composite can be used as façade panels for the cover of different buildings.
Rubber tires can be used in embakement as a lightweight filling material for soil reinforcement.
The various applications of fiber reinforced concrete such as shotcrete in underground works, precast products, architectural panels, hydraulic constructions, etc. had contributed to the rapid development of this new building material.
Wastes from agricultural activities are in very high quantities, especially in some places of the world and they are another source of environment pollution and social problems because their accumulation in landfills and uncontrolled burning.
Natural cellulosic fibers can be used in the design and manufacturing of composite materials. The natural cellulosic fibers are bagasse from sugar cane, banana trunk from the banana plant and coconut coir from the coconut husk. The banana fiber exhibited the highest ash, carbon and cellulose content, hardness and tensile strength, while coconut the highest lignin content [40]. In combination with other additions, the concrete prepared with natural fibers exhibits good mechanical properties.
The useful life of a material in place, however, is always related to the particular combination of environmental factors to which it is subjected, so that durability, or service life, must always be related to the particular conditions involved.
In the last years, the degradation of environment is more pronounced because the measures of protecting the surrounding natural places were not respected and maybe, not understood. The increase of population, the huge energy which is needed, the development of industrial processes, all these resulted in a higher consumption of natural resources, more wastes and a higher pollution [41].
New building materials have developed because the new tendencies of obtaining eco-materials and protection of natural resources [42]. There are many years since when the cement industry has incorporated significant quantities of wastes (silica fume, fly ash, blast furnace slag, metakaolin, ceramic waste, etc.) because energetic, economic and environmental protection reasons. In recent years, alternative additions - bagasse ash, bamboo leaf ash, paper sludge, have been studied as components of eco-cements. The new generation of building materials which are combined with different types of wastes can offer a possibility of consuming disposal materials and reduce the environment pollution.
Also, the development of composite construction materials with low thermal conductivity using wastes will be an interesting alternative that would solve simultaneously energy and environment concerns [43].
The concrete of any type can be obtained by adding wastes, with experimental studies and statistical optimization, which help to characterize the new materials.
The developments in building materials must be sustainable and in the same time they ensure a ratio cost-energy that satisfy the modern requirements. The addition of wastes to concrete can improve or diminish some properties of the material. Therefore, a combination of wastes is often used or other materials are introduced into the composition to compensate for any disadvantages. These materials can be fibers of different types or lengths (steel, glass, polyester, carbon, bore, textile, etc.) or nanomaterials (nanotubes of carbon, nanoargillaceous materials, etc.).
New building materials based on nano-materials will develop and will influence the construction sector. Waste can be used for producing nanopowder or other nano-products which by using new nanotechnologies allow obtaining a new generation of cement based materials, more durable, with higher mechanical properties or even with desired properties, such as electrical conductivity as well as temperature, etc [44]. Today, nanotechnologies are in pre-exploration stage and must find application from experimental research to applications.
Construction composite materials are developing on the base of new researches in the recycling domain as an innovative option with environmental, economic and performance benefits.
Health promotion in schools has progressed rapidly since its inception in the last century, expanding from a traditional approach of health education in schools to its conceptualization as the Settings Approach to Health Promoting Schools (HPS). The concept draws on the five priority action areas for health improvement outlined by the Ottawa Charter for Health Promotion [1] applied to the schools setting and was piloted in Europe in the early 1990s by the European Network of Health Promoting Schools (ENHPS), which is now present in more than 43 European countries in the region [2].
The concept involves a whole-of-school approach to conducting health promotion and education in school communities, by capitalizing on its organizational potential to foster physical, social–emotional and psychological conditions for health as well as improved educational outcomes, and has been defined as “a school that constantly strengthens its capacity as a safe and healthy setting for living, learning and working” [3]. The HPS approach and related whole-of-school approaches to health have been associated with considerable improvements in many domains of health, well-being, nutrition and functioning [4].
In South Africa, the HPS concept was introduced in 1994 and guidelines drafted to comprehensively address school health in an attempt to redress the imbalances of the past [5]. South Africa adopted the conceptual framework of the HPS Network focusing on the school environment, community involvement, policy development and health and social services. By 2006, schools in all nine provinces were identifying themselves as health promoting schools [6]. A review on HPS conducted by Mukoma and Flisher [7] suggested that schools could successfully implement HPS, but no evaluation of HPS in Africa could be found.
A School Health Policy and Implementation Guideline document developed by the National Department of Health provided guidance for the implementation of health promotion activities through the 2015–2019 National Health Promotion Policy and Strategy [8]. The strategy, however, did not detail the systematic approach prescribed by WHO for initiating HPS, pointing to a weakness in the implementation of HPS that can be attributed partly to the system itself and partly to the quality of HPS concept implementation. Research was warranted to identify the causes of these weaknesses and to intervene by developing, implementing, and evaluating HPS initiatives.
In 2018, WHO/UNESCO announced an initiative to make every school a “health-promoting school, which included a commitment to develop global standards and indicators for HPS and to support their implementation [9]. These global standards and indicators were designed to be used by all stakeholders involved in identifying, planning, funding, implementing, monitoring, and evaluating the HPS approach and are applicable to any whole-of-school approach to health [10]. According to WHO [9], the whole-school approach is thus “an approach which goes beyond the learning and teaching in the classroom to pervade all aspects of the life of a school”.
Although the HPS approach was introduced more than 25 years ago and has been promoted worldwide, the objective of a fully embedded, sustainable HPS system has only been implemented and sustained at scale in few countries [11]. Even fewer have effected institutional changes to make health promotion an integrated, sustainable part of the education system. Experts identified the lack of systematic support, the limited resources and common understanding as major barriers to HPS intervention [11]. These challenges are more pronounced in resource–limited settings, including South Africa and other settings in the global South.
Inadequate competency on the part of school authorities has been identified as a leading cause of HPS not being implemented and sustained at scale, in particular in resource–limited settings [12]. Health promotion competency frameworks spell out these ‘competencies’, which were defined as a combination of attributes that enable individuals to perform a set of tasks to an appropriate standard, such as knowledge, abilities, skills and attitudes [9]. The development of the global health promotion workforce brought renewed interest in identifying competencies for effective health promotion practice and education [13].
With a view of building health promotion capacity and workforce development, the identification of competencies is an important strategy for developing consensus around key requirements for effective health promotion practice [13]. A competent workforce which has the necessary knowledge, skills, and abilities to translate policy, theory and research into action is key to the growth and development of global health promotion [12]. Competencies provide a useful base for health promotion training and academic preparation, and guide the development of professional standards and systems of quality assurance in the field [12].
The literature on health promotion and health education competencies is repleted with frameworks and how they are developed. Discussion of the contexts influencing competency development, the value of the competency approach and the relationship between competencies and health promotion professionalization is also encountered [13]. The use of competencies for educational and practice settings is however less well defined when applied to HPS, particularly in resource–limited settings, and more research is needed to advance this field.
It is against this backdrop, that this chapter outlines the development of two HPS programs in South Africa, guided by work from doctoral research and a round table discussion on core health promotion competencies. The chapter focuses on: (a) the development, implementation, and evaluation of a HPS training program for high school educators in the Limpopo Province, guided by assessment of priority needs; and (b) factors influencing HPS implementation in three secondary schools in Cape Town. Attention is paid to training program objectives, learning outcomes, and critical cross-field outcomes related to introducing the HPS concept, empowerment of educators to initiate HPS and evaluate program design and implementation, and the key role of external actors and school stakeholders in designing and implementing HPS in these settings.
The first case study describes the capacity building of educators to enable HPS in Limpopo. The province is the northernmost part of South Africa and a typical developing region with a big gap between poor and rich residents, especially in rural areas. The population consists of several ethnic groups distinguished by culture, language, and race (97.3% black) and traditional leaders and chiefs still form a strong backbone of the political landscape. The study was conducted in the Mankweng area, a township adjacent to the University of Limpopo (pop 33,738) with eleven public high schools which fall under the control of the Department of Basic Education.
The study was informed by a needs assessment to inform the development of the HPS training program and guided by an eco-holistic framework for developing data collection instruments and the constructs of health promotion practice applicability in South African schools. The framework consisted of four external and five internal constructs that are interlinked in a dynamic interaction, highlighting the existence of, and interrelationship between factors at local, regional, national, and global level that influence HPS structure and development. The findings can guide future researchers in exploring skills among program planners and policy makers and how these skills influence health promotion practice in rural communities [14].
The needs assessment used a sequential explanatory design with mixed method research, including a survey questionnaire for quantitative data collection among a representative sample of grade 9–11 learners (n=828) from eight randomly selected public schools in the area; semi-structured interviews with four key informants and in-depth interviews with seven student representatives. Ethics approval was granted by the Turfloop Research Ethics Committee and permission to conduct the study in the schools granted by the Department of Basic Education and other stakeholders. Informed consent was obtained in writing from the participants as well as parents of learners under the age of 18 years. Anonymity and confidentiality were guaranteed throughout the study.
The questionnaire included sections related to demographic and socioeconomic indicators, risk behavior, physical school environment and school climate and ethos. The questionnaire had been used in previous research in the area where its internal consistency had been established [15]; translated in the local language (Sepedi); and, administered by a trained researcher. The interview topic guide was grounded in the quantitative results. Instruments were pilot-tested before data collection and analysis was done descriptively for quantitative data and using Tesch’s open coding technique for qualitative data analysis [16].
The most common
Factors related to the
Existing policies within the school environment provide for a course of action to address the social challenges faced by learners. Examples are the revised Integrated School Health Policy (2012) with a health education component on substance abuse. The policy was developed to support learners to adopt health-promoting behaviors, but very little change has been observed, questioning the actual implementation of programs for optimal health. Educators only received training on programs such as Life Skills and HIV & AIDS Education, which is primarily located in the Life Orientation (LO) learning area/subject [22].
District office staff cannot visit and support schools often and effectively enough to ensure good quality education. Lack of skills, monitoring and accountability lead to poor policy implementation, inferior training of teachers and bureaucrats. Once-off interventions implemented by different service providers, including the Department of Health, Social Development, Education, and non-governmental organizations, is an approach that fails to bring behavior change among learners, and the LO curriculum does not take into account implementation of HPS, which requires skills that the LO educators do not possess [23].
The LO curriculum emphasizes the importance of skills, values and attitudes, and participation in physical activities and community initiatives, which are all elements of HPS [23]. Skills development of educators is therefore crucial to identify needs and implement continuous school-based programs such as the HPS initiative prescribed by WHO [24] to address health risk behavior that derail learners from achieving their educational goals. Selecting a priority issue can be used as a meaningful point of entry to guide HPS program development, using a sequence of well-defined steps outlined in the next section.
A training program was developed to train educators in HPS in the study setting, based on a needs assessment, and comprising two-sessions that could be offered as a one to five days’ workshop to ensure that relevant learning was addressed depending on the availability of educators. The first session introduced the HPS concept, and the training program goals, aligned to the WHO Information Series on School health, local action: Creating a Health Promoting School [24]. The second session covered the five steps of initiating HPS, using principles of adult learning guided by Knowles’ theory of pedagogy and andragogy [25]. Next, guidelines for implementation of the training program were developed, followed by its implementation and evaluation.
The training program was designed to provide educators with a practical guide to HPS implementation and to achieve HPS accreditation in the Mankweng area using a series of five steps (Box 1).
HPS training program implementation.
Step 1: Understand what HPS is; solicit and achieve administrative and senior management buy-in and support; understand that HPS is a whole-school approach which needs ongoing support and commitment from school leaders.
Step 2: Create a task team to lead and coordinate health promotion activities. Key stakeholders should be represented on this group, including teachers, non-teaching staff, students, parents, and community members. The task team must share the workload, be involved in decision making and implementation, and conduct an audit of current needs and health promoting actions in line with the six components of the HPS framework [26].
Step 3: Establish agreed upon goals, objectives, and activities; develop strategies to achieve the goals with the available resources; develop a HPS Charter to symbolize the commitment of the school, setting out the school’s principles and targets, and enabling the school to celebrate its achievements in health promotion. Staff should have opportunities to attend professional development programs and present and discuss their school initiatives with others.
Step 4: Take action, develop plans, and allocate tasks to different individuals according to their experiences and background. Engaging the community by identifying some individuals who have the skills to support HPS; create a supportive environment for HPS to flourish and support inter-sectoral collaboration.
Step 5: Monitoring and evaluation of all processes determining whether the goals and objectives for the identified priority areas are met. Methods must be identified to assess if planned activities and their implementation have been materialized. The school can be launched as HPS to showcase continuous strengthening of capacity to make schools a healthy setting to work, learn and live. Continuously assess if the five steps of HPS implementation are followed.
Training program objectives, learning outcomes and critical cross-field outcomes focused on: introduction of the HPS concept and its benefits to educators; discussion of the association between health and education within school settings and the need for HPS; selecting priority problems as entry points to HPS training; introducing the steps to be followed when implementing HPS; and evaluating the training program. Learning outcomes were based on these objectives and described accordingly.
Although this was not a formal training program with any National Qualifications Framework level, as expected by the South African Qualifications Authority (SAQA) [27], critical cross-field outcomes (CCFOs) were considered important to guide the lifelong HPS related learning of educators. CCFOs are generic outcomes that inform teaching and learning, and they are deemed critical for building capacity for life-long learning. CCFOs related to this HPS training program were integrated in the material and methodology of the facilitator, and emphasized promotion of active, exploratory, and self-directed learning among educators [26].
Educators should, for example, be able to: identify problems; formulate responses that demonstrate responsible decision-making where critical, and creative thinking; consider different ways of collecting and analyzing data, and evaluating information; work effectively in team, organization and the community; apply scientific skills and show accountability for creating a healthy school environment and looking after the health of others; and understand their environment as a set of interrelated systems by recognizing that problem-solving contexts do not exist in isolation [26].
Development of the HPS training program was informed by the WHO Information Series on HPS [24] and guided by Knowles’ theory [25] around adult learning, which is based on the principles outlined below and adapted to the program (Box 2) [26].
HPS training program principles.
Adult learners have a well-established sense of self which differs from previous life stages. It is equally important that educators as adults have their say in the training and autonomy in what they learn to keep their interest.
Adults have past experiences, and the training program needs to feed into what they already know to be effective. Sharing of these experiences has to form part of the learning.
As adults, educators, are purpose driven and motivated to learn when they see the relevance of the taught material. Hence only those who are willing to learn should attend the training as theory indicates that they will learn well.
Internal motivation drives adults to develop their own ways of learning based on problem solving. Adults should not be expected to recite content but rather apply content in practice.
During training, mistakes often become a valuable teacher. Learning happens when adults are allowed to explore the subject and learn from their mistakes.
Adults need to play an active role in helping to design the course, personalize learning paths and select activities that are relevant to them and their work.
The training with educators included data collection which reflected the current situation at participating schools. The focus was directed at risks the learners faced. HPS appeared to be a new concept to participants, and both learners and educators confirmed there were no programs and activities at their school focusing on learner health risk behavior, except for the nutrition program and physical activities, which were done occasionally in some schools outside examination time, and where social workers were deployed at school.
Program activities were based on the principles of adult learning outlined above and included assessment of participants’ expectation of the training program as well as alignment with HPS training program content; explanation of the program topics and its relevance to HPS; sharing of experiences; ranking of health risk behaviors in the respective school settings; and a round of discussion to clarify areas of concern. These activities allowed participants to freely express themselves and engage in the HPS training program using Knowles’ principles of adult learning, including building internal motivation, and capitalizing on individual experiences.
Participants rated the training program as good to excellent, indicating that the training program was an eye opener to responsibilities, which they were not aware of [26]. Participants did not know that there were formal initiatives which could assist schools, parents, learners, and educators to address challenges hampering teaching and learning at school and enhance school health [26]. Educators agreed that their expectations had been met and the imparted knowledge would improve their ability to perform their jobs. They indicated that the training was well planned, informative, empowering, technical, and relevant for application in their school contexts.
In the Western Cape, an HPS project was conducted driven by the need to reduce the spread of TB and HIV in secondary schools. The project was funded by the Centers for Disease Control and Prevention and conducted over a period of three and a half years in a resource-limited area with high rates of TB and HIV close to the University of the Western Cape (UWC). The project team comprised an educational psychologist; two members from the Faculty of Education; two from Physiotherapy & Occupational Therapy; one from the School of Public Health; and a school doctor employed by the Provincial Department of Health. This diverse range of expertise and experience was an advantage as it drew on different paradigms because of the different backgrounds.
After an initial workshop to introduce the HPS concept and approach, a series of workshops was held in each school at the start of the project with teachers, students, and parents, as well as a workshop with all schools together [28]. The aim of the first workshop was to identify the needs in the school community around health and well-being, while the second workshop focused on TB and HIV [28]. In groups, participants brainstormed what was already in place to address the challenges of TB and HIV. Using the information from the two workshops, each school subsequently drew up its own plan of action, bearing in mind what was realistically achievable.
Although the funding aimed at capacity development for TB and HIV prevention, the project team used this as an entry point for HPS implementation. The focus was on generic capacity building across the schools. Once the participants became familiar with the HPS approach and the social determinants of TB and HIV, they developed their own agendas based on their perceived relevance and priority [28]. The value of these workshops was that teachers, students, and parents (to a lesser extent) worked together towards realizing the goal of HPS project implementation because they were receptive to its benefits.
The project team subscribed to certain processes and approaches to facilitate HPS implementation. A HPS committee was formed at each school comprising of teachers, students, and parents (to some extent). A member of the UWC team was appointed to each school to guide implementation via monthly meetings with the HPS committee and separate
A participatory approach was used based on the Appreciative Inquiry technique, which applies a positive stance and builds on organizational strengths to encourage growth and development [29]. For example, the HPS committees were asked to draw a dream tree depicting their ambition and a mapping exercise to outline the available resources. The teams worked with those who were receptive and eager to be involved and remained flexible in allowing schools to advance at their own pace and focus on their own plans.
A student camp was held each year focusing on leadership and empowerment to build capacity among students to implement HPS and develop as an individual. The value of the camp was that students were encouraged to explore and reflect on their feelings and capabilities independently of teachers or parents—an opportunity they did not often have. The camp was facilitated by members of the UWC team in addition to other organizations with expertise in youth development, communications, team building and TB and HIV.
Studies report that schools often lack the skills and competence to implement any health-promoting change, and hence need external catalysts for change [30, 31]. In this project, the UWC team was perceived as crucial for facilitating implementation. Apart from some financial and material support, they provided technical assistance, e.g., through workshops and skills development activities. Some teachers attended a short course at UWC to improve their HPS skills. The team also provided mentorship, guidance, education, and problem solving with the local HPS school committee.
The team was also seen as giving direction while receiving first-hand information of what was happening in the external and internal social context of the school. The nature of the collaboration of the UWC team with the school was in keeping with the settings approach of using a participatory bottom-up approach right from the start of the project, and its role was perceived as resulting in a valuable relationship with the school:
Relationship building was also a key role of the school facilitator, who confirmed that through constant in-person interaction a good relationship had been established with the HPS group and the school in general. The facilitator claimed that this contact provided an opportunity to feel the rhythm of the school, enabling to fit in with the way the school functioned. The facilitator felt that this was necessary to consolidate HPS and keep it on the school agenda, a finding which is consistent with other studies on the guiding and supporting role of school health advisors [30].
The findings of this study indicate that as initiators of the HPS concept, one of the key roles of the UWC team was to ascertain that the HPS concept was understood as a
The team acknowledged that the school knew what was best for them and were “experts” in terms of their own contexts. The team saw reciprocal learning as being crucial to a shared understanding of HPS and its requirements, which was especially important in view of applying a settings approach. The team worked with different actors in the school system (principal, teachers, parents, and students) which allowed them to gain a better understanding of the context and degrees of commitment of the actors and to gain their trust, which is a key aspect of collaborative work [32].
In keeping with the settings approach, the team further networked with external organizations and institutions that could provide services and resources that were conducive to HPS implementation. Implementation of the HPS program was however influenced by internal and contextual factors, which compromised how it was able to effectively implement the integration of HPS as a whole-school approach, all of which could have an impact on whether HPS was to be sustainable in this context [28].
In this project, capacity building of students was key to facilitate participation in HPS project implementation. Capacity building resulted not only in personal benefits but also contributed to a positive implementation climate by creating an empowering environment. Students from the participating schools attended the leadership camps where skills were developed to implement HPS. In two schools, students were able to put these leadership and other skills to use by taking some responsibility and fulfilling certain roles for HPS.
Although it was clear from this project that students across participating schools had gained knowledge and an understanding of health in its holistic sense, and were committed to the implementation of HPS, findings also indicated that student action differed from school to school. The levels of competence and involvement varied and were influenced by school climate and culture, the internal support received from the headmaster and other staff members, peers, the principal, and the external support received from the UWC team and other external agents.
Student empowerment indeed carries an understanding that, while students have a sense of agency, they need support and guidance from their teachers to support the implementation climate. In this study, students worked closely with the teachers they trusted, who respected and accepted them as persons and who listened to their ideas. This demonstrates the powerful role teachers can play in providing opportunities for students to realize their potential, which happens rarely because of the community context and school culture of excluding students from decision-making [33].
It was evident from the study that, where the students had specific, clearly defined roles in the HPS project, they had a sense of purpose and felt valued since they were trying to make a meaningful difference [28]. Being seen as resources or assets rather than cases increases the chance of empowerment among young people as they will be seen as having the skills and knowledge to bring about change for themselves [32]. Where students are perceived as unequal partners, they may feel disempowered and consequently could become disengaged from HPS [34].
The benefits of HPS involvement for teachers were not evident in this study. This could be because teacher involvement carried more responsibilities than for students or other staff. The benefits for teachers hence cannot be perceived to be similar as for students who only seemed to gain from their involvement, while for some teachers it may have added to their workload. It has been recommended that capacity building for teachers should indeed not only aim at implementing HPS, but also at encouraging and gaining support from and working in partnership with, their peers and other actors [50].
Although some efforts were done by school facilitators to facilitate partnerships through mentoring and guiding of students and teachers, other contextual factors negatively influenced the ability to fully implement HPS as a whole- school approach, including a strike by teachers, and work and personal commitments. One attempt at building capacity among staff was when the UWC team shared the results of their HPS school climate survey with individual schools, giving staff an opportunity to engage and assess how they could integrate it into the curriculum and other school functions.
At the workshop, participants seemed to fully engage with the information, and teachers discussed how they could use it across the curriculum. The UWC team made further attempts to build the capacities of the teachers and staff directly involved in HPS, including organizing a camp to develop understanding of the HPS concept and process and facilitating a short course on HPS, which was attended by some teachers [28]. The activities took place during school holidays, which also meant that teachers had to compromise on their free time to be able to attend the training.
The fact they did this willingly reflects their readiness for change and commitment to building HPS capacity. On the other hand, teachers were not given an opportunity to further build their capacity or put into practice their acquired skills as part of the normal school operations. This might have resulted in teachers feeling less valued for their work and hence not taking ownership of the program [28]. If HPS would have been implemented as a whole-school approach, time would have been allocated to build capacity for HPS implementation by leadership and management.
A key finding related to capacity building was the challenge of continuity due to staff turnover. This had repercussions in terms of the quality of implementation and sustainability, especially if the leaving staff member carried a high responsibility for HPS implementation. This again could have been averted if a whole-school approach had been taken. Where responsibilities were shared, the potential for integration in the school life was greater. Therefore, leadership capacity must be built at different levels to complement, and, if required, succeed those in leadership positions.
In the last decades, HPS has become widely accepted as the gold standard for implementing health promotion in school environments, and evidence has indicated its effectiveness [35]. In South Africa, the concept has gained traction since the advent of democracy and the two case studies described in this chapter are testimony to that. The case studies describe attempts to implement HPS in disadvantaged communities based on its value system by imparting knowledge and understanding of the concept; building capacity in terms of leadership and management skills; and communication with, and empowerment of students and educators.
Taken together, these competencies are in line with the set of core competencies for health promotion as outlined in existing competency frameworks, e.g., the Galway Consensus Statement for Health Promotion Competencies [36]. The core domains of competency agreed to in the Consensus Statement are catalyzing change, leadership, assessment, planning, implementation, evaluation, advocacy, and partnerships, all of which were adhered to a greater or lesser extent in the case studies described above. In Limpopo, educators were trained through a rigorous process of induction into HPS concept and methodology, showing proof of acquired competencies in terms of HPS knowledge and understanding. In Cape Town, the focus was on capacity building, and HPS implementation highlighted the key role of students as agents of change.
In the latter study, students showcased their role based on their newly acquired competencies of leadership and project management skills. Constant communication of school-based facilitators with the local HPS committee was also found to facilitate HPS implementation and enabled continuous buy-in and sustained implementation. In addition, results indicate that the UWC team consciously tried to practice cultural humility by not setting the agenda [37], which minimizes the power balance between partners [38], including professionals and communities, by valuing lay knowledge [39] and cultivating mutual respect [40].
The value placed on communication and cultural humility were also found to be core health promotion competencies for South Africa as identified in a round table on core competencies for health promotion organized at UWC in 2014. The round table gathered stakeholders involved in health promotion from academia, government, and civil society and found that the existing core competency frameworks, with particular attention to the CompHP Core Competencies Framework for Health Promotion [41] were useful, but lacked some specific competencies for the region.
Participants at the round table also concluded that health promotion training in South Africa should match the need for specific skills and that service training should be developed next to academic curricula. Attention towards cultural competency and health literacy and knowledge management were considered equally important as the higher outlined core competency domains. To meet these expectations, strategic engagement between training institutions, government and civil society was deemed necessary to formulate the appropriate competencies.
In the above-described case studies, the aim was to build capacity in terms of HPS implementation; and to instill confidence and competencies to implement and sustain HPS even after support of the external facilitators ceased. Studies suggest that teacher training and professional development are required to enable them to act as catalysts for change [42, 43, 44, 45]. Similarly, capacity building of students was found to be crucial for HPS implementation in the second case study. The findings indeed show that capacity building of students resulted not only in personal gains, but contributed to a positive HPS implementation climate [46].
Many studies report that schools do not have the skills and competence to achieve health-promoting changes, and hence need external catalysts for change [30, 31]. For example, universities have been found to play an important role as external catalysts by creating a supportive climate for HPS implementation in schools [40, 47, 48].The first case study shows that the development, implementation and evaluation of a HPS Training Program provides evidence that skills development of school educators improves HPS knowledge and understanding and creates an enabling environment where students learn how to control health risks and practice health behaviour [26].
The HPS program also assisted learners to achieve educational outcomes and enhance the health and well-being of all those involved [26]. The Training Program improved knowledge, understanding and skills around HPS, and addressed health risks, physical and environmental challenges, the school climate, and ethos issues of implementing a whole-of-school approach.
The second study also revealed how the program assisted actors at different levels of the school system to identify the link between what they were already doing and the HPS approach [28]. Where a link to existing practice and processes was in place, it was easier to integrate new initiatives such as HPS [45]. Seeing these links increased the readiness for change, although this understanding was not enough for the schools to achieve full integration of HPS. One of the values implicit in the settings approach was also participation of those affected or targeted for health promotion initiatives, including teachers and students, as described in the two case studies.
The UWC team acted as an external catalyst, ensuring that the HPS concept was understood as a whole-school approach and implemented in the best way that suited the school and implementers. The team saw its role as facilitative and enabling, rather than effecting HPS implementation. The team used reciprocal learning to achieve a shared understanding of what HPS entails, which was especially appropriate in terms of the settings approach, in which different stakeholders (principal, teachers, parents and students) were invited to gain more understanding of the context and degrees of commitment of these actors. This also allowed to gain their trust, which is important in collaborative working [32]. With this knowledge, the team was able to ascertain what the schools’ concerns were and what was needed, and through HPS strategies attempted to respond to some of these issues in partnership with the different actors [40, 49], consistent with the settings approach and the practice of cultural humility.
Although teachers in the second case study attempted to empower students and implement HPS, they lacked the skills to do so. They were not supported by the school or education authorities to develop these skills [28]. Even teachers who attended the short course were not supported, indicating that HPS is not a high-ranking priority and showcasing the barriers teachers and students face when trying to implement HPS. Hence the question of how realistic any HPS approach can be, considering the diverse needs and heterogeneity within a particular school, comes to mind. This could also be the reason why some teachers and students did not become involved in HPS.
In the South Africa education sector, health issues are addressed mainly as part of the life skills curriculum with little room and time for active student participation and critical reflection. A top-down approach to education is typically used, which does not allow much space for teachers and students to experiment with HPS. There seems to be a lack of political will from the education and health sectors to work collaboratively towards the health and well-being of young people, which highlight the difficulty of implementing HPS as a whole school approach, raising the question of whether it is idealistic to achieve HPS in a context such as of the above-described case studies.
The implication for HPS in South Africa is that, unless there is sufficient political will to create an environment in which a whole school HPS approach can be realized and its value and potential appreciated by all stakeholders, it will be an uphill battle for those wanting to implement HPS. Using incremental changes can be an effective lever to achieve organizational readiness for change, starting with marginal changes in activities and the commitment of those involved [28]. Once the changes are visible schools could be tempted to attempt more complex changes. Hence striving towards implementation of HPS as a whole school approach is a goal worth pursuing for South African youth to be able to make a meaningful contribution to society.
This chapter described two case studies of HPS implementation in South Africa. The first case study showed how the implementation of a HPS training program for educators in the Mankweng Education Circuit, Limpopo Province, could be used for skills development of educators in addressing problems that typically interfere with teaching and learning. Recognizing that the entire school community is important, educators were encouraged to initiate HPS programs. Educators agreed that instead of inviting professionals for ad hoc support, they wanted to develop a sustainable program to empower learners to take care of their own health behavior.
The second case study highlighted the significant contribution that students can make in HPS implementation. Students were found to be key assets with the potential to take responsibility for many practices and processes of program implementation. Student participation and building leadership capacity should hence be a major aim of HPS implementation in secondary schools. If students are given enough autonomy, they can develop a sense of agency and ability, which is especially important in view of the heavy workload of teachers who usually carry the bulk of HPS implementation.
Taken together, the case studies illustrate the role of competency building among both educators and students to implement HPS programs in secondary schools that result in capacity and motivation to transform the educational environment in South Africa into an environment that enables educators and learners to achieve their full health potential.
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This problematic is particularly relevant with medical imaging data, where linear techniques are frequently unsuitable for capturing variations in anatomical structures. In many cases, there is enough structure in the data (CT, MRI, ultrasound) so a lower dimensional object can describe the degrees of freedom, such as in a manifold structure. Still, complex, multivariate distributions tend to demonstrate highly variable structural topologies that are impossible to capture with a single manifold learning algorithm. This chapter will present recent techniques developed in manifold theory for medical imaging analysis, to allow for statistical organ shape modeling, image segmentation and registration from the concept of navigation of manifolds, classification, as well as disease prediction models based on discriminant manifolds. We will present the theoretical basis of these works, with illustrative results on their applications from various organs and pathologies, including neurodegenerative diseases and spinal deformities.",book:{id:"7342",slug:"manifolds-ii-theory-and-applications",title:"Manifolds II",fullTitle:"Manifolds II - Theory and Applications"},signatures:"Samuel Kadoury",authors:null},{id:"52886",doi:"10.5772/65903",title:"Head Pose Estimation via Manifold Learning",slug:"head-pose-estimation-via-manifold-learning",totalDownloads:1824,totalCrossrefCites:4,totalDimensionsCites:3,abstract:"For the last decades, manifold learning has shown its advantage of efficient non-linear dimensionality reduction in data analysis. 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His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,annualVolume:11421,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. 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