\r\n\tAt the same time, many diseases such as autoimmune diseases, eating and reproductive disorders emerge in the first time or symptoms peak in this period. For this reason, it is very important to know adolescence and to follow the healthy progress of the physiological period. Early diagnosis and treatment of problems that may be problematic in this period or later life is important.
\r\n\tThis book focuses on the normal physiological development and diseases of the whole adolescence period. I hope this book will help understand adolescents and solve their problems.
Quantum cascade lasers (QCLs) are based on a fundamentally different principle to ‘classic’ semiconductor lasers, that is, they use only one type of charge carriers, electrons, using intersubband transitions, so they can be called unipolar lasers. QCLs were conceived in the early 1970s. First, Esaki and Tsu [1] fabricated the first one-dimensional periodic potential multilayer by periodically varying the composition during epitaxial growth (superlattice). Later, QCLs were proposed by Kazarinov and Suris [2] and finally first demonstrated at Bell Laboratories in 1994 by Faist et al. [3]. Using superlattices leads to both quantum confinement and tunnelling phenomena, the basic processes in QCLs operation.
\nA conventional laser diode generates light by a single photon that is generated from an electron interband transition; this means that a high-energy electron in the conduction band recombines with a hole in the valence band, being the energy of the photon determined by the band-gap energy of the material system used. However, QCLs do not use bulk semiconductor materials in their optically active region, but a periodic series of thin layers of varying material composition forming a superlattice, which leads to an electric potential that changes across the length of the device (one-dimensional multiple quantum well confinement), splitting the band-permitted energies into a number of discrete electronic subbands, making electrons cascade down a series of identical energy steps built into the material during crystal growth, and emitting a photon at every step, unlike diode lasers, which emit only one photon over the equivalent cycle. With an appropriate design of the thickness of these layers, population inversion is achieved between discrete conduction band-excited states in the coupled quantum wells by the control of tunnelling, making laser emission possible. Therefore, the position of energy levels is mainly determined by the thickness of the layers, rather than the material, and thus allowing tuning the emission wavelength of QCLs over a wide range in the same material system. Thus, one electron emits a photon during every intersubband transition within the quantum well (QW) in the superlattice, and then can tunnel into the next period of the structure where another electron can be emitted, leading QCLs to outperform diode lasers operating at the same wavelength by a factor even greater than 1000 in terms of power.
\nClassically, a QCL is made of a periodic repetition of active sections, which consist of tunnel-coupled quantum wells and injector, where a miniband is formed. As Figure 1 shows [4], from the injector miniband the electrons are injected into the upper laser energy level (4) of the active section, where the laser transition takes place. Afterwards, the lower laser energy level (3) is emptied by longitudinal optical emissions (LO emissions) and the electrons enter the next step by tunnelling.
\nTypical conduction band structure of a QCL [
Combining materials in the active region, QCLs could be designed to emit at any wavelength over a wide range of the spectrum [5], as the emission wavelength is determined by quantum confinement. Figure 2 shows a typical QCL in operation and some commercial examples. These structures are typically grown using either molecular beam epitaxy (MBE) or metal-organic chemical vapour deposition (MOCVD), being the most used growth mechanisms utilized to grow the alternated different semiconductor layers required for heterostructures fabrication on to a substrate. Ever since the first QCL was fabricated using InGaAs/InAlAs grown over InP substrate [1], other materials have been used in order to fabricate QCL structures, such as GaAs/AlGaAs, InGaAs/AlAsSb, InAs/AlSb, Si/SiGe and GaN-based materials, such as AlGaN/GaN and AlN/GaN.
\nLeft: the invisible beam from a high-power quantum cascade laser lights a match in its path. The laser is 2.25 mm long and 17 μm wide, being placed in a cryostat at liquid-nitrogen temperature and emits an optical power in excess of 200 mW from each facet at a wavelength of 8.0 μm. Similar devices emit up to 600 mW at room temperature in pulsed mode. Right: front: mid-IR lasers (4–10 μm) for trace-gas analysis and IR molecular spectroscopy in the front; back: set-up examples.
First commercialized a decade later of their first demonstration [6], the key features of these lasers reside in the fact of their high optical power output and, on the other hand, their tuning range and room-temperature operation. Spectroscopy applications are related to gas detection and analysers (pollutants, components, etc.). Other practical uses include industrial control, plasma chemistry and detection, such as collision avoidance radar or poor visibility-driving condition aids. Finally, the 3 to 5μm atmospheric window would make QCLs perfect candidates for substitution of optical fibre in high-speed and free-space communications.
\nThe main particularity in QCLs is the fact that instead of using bulk semiconductor materials in their optically active region, a periodic series of thin layers are used, that is, superlattices, consisting of a number of quantum well—barrier system equally spaced, introducing a multiple quantum well (MQW) leading to one-dimensional confinement allowing an electric potential variation (band splitting) that results in a number of discrete electronic subbands. In order to achieve the population inversion required for laser emission, it is necessary for a proper thickness and composition layer design. These confined energy levels depend on the layer thickness, so the tunability of the emission within the same material relies, in principle, on thickness variation, although multiwavelength QCLs emit by means of different materials within the same structure and multiple resonators [7, 8].
\nIn classical semiconductor laser diodes, electrons and holes recombine across the band gap, thus, generating one photon per e−-h+ pair recombined. However, in QCLs this is not the case, as an electron in the conduction band within a QW emits one photon whenever it undergoes an intersubband transition, that is, thermalization into lower-energy levels, emitting one photon. This electron could tunnel into the next period of the structure, where the mentioned transition happens again emitting another photon. This phenomenon of a single electron emitting multiple photons as it passes through different periods of the structure is called cascade, making the quantum efficiency of QCLs greater than unity and leading to their high optical output power.
\nThree-level intersubband transition and scatterings considered in most QCLs.
QCLs are usually three-level lasers, whose level transitions are depicted in Figure 3. In these lasers, the wave function formation is faster than scattering between states; hence, the time-independent solutions of the Schrödinger equation can be applied, so the system can be modelled using rate equations. Each subband,
where
where
hence,
The scattering rate between two subbands strongly depends upon the overlap of the wave functions and energy spacing between the subbands. In order to decrease
Tunable semiconductor lasers can be produced by using multiple resonators or multisection injection devices [10–12]. In fact, tunable QCLs have been demonstrated [7] some time ago. Moreover, a QCL with a heterogeneous cascade containing two substacks previously optimized to emit at 5.2 and 8.0 μm, respectively, was presented by Gmachl et al. [13]. On the other hand, single-mode tunable QC distributed feedback lasers emitting between 4.6 and 4.7μm wavelength have been reported [14]. These lasers were pulsed, continuously tunable single-mode emission and were achieved from 90 to 300 K with a tuning range of 65 nm and a peak output power of approximately 100 mW at room temperature—so the lasers described by Pellandini et al. [12], Gmachl et al. [13] and Köhler et al. [14] were laser sources for the mid-infrared region. In order to realize near-infrared QCLs, optical non-linearity in intersubband lasers has been used to design such lasers emitting at 4.76 μm, with third harmonic and second harmonic generation at 1.59 and 2.38 μm, respectively [15].
\nThe first QCL in 1994 used InAlAs as the cladding layers due to its low refractive index of around 3.20. The core region, which includes active and injector regions, usually has 500 stacking layers consisting of alternative InGaAs and InAlAs layers with total thickness about 1.5–2.5 μm. The average refractive index in this region can be calculated according to the volume fraction of these two constituent materials and is often around 3.35, which is clearly higher than the cladding layers [16]. The confinement factor with typical Np of approximately 30 is usually around 0.5. To reduce the optical loss, the cladding layers are usually doped with a low concentration of 5 × 1016 cm−3 and the separate confinement heterostructures (SCHs) are implemented with InGaAs of high refractive index to increase the optical confinement factors. In later designs, the InAlAs cladding layers were replaced by InP because it has a lower refractive index of around 3.10 and a higher thermal conductivity for better heat treatment, which is a critical step for the device performance [16].
\nSo far, the emission wavelength of QCLs has been extended from the near infrared (around 100 THz) to terahertz regimes. While the longest demonstrated wavelength is 1.6–1.8 THz with GaAs/Al0.1Ga0.9As system at 80 K under continuous-wave (CW) operation [17], the shortest wavelength has been extended to 3 μm with In0.53Ga0.47As/AlAs0.56Sb0.44 system at 300 K under pulsed operation [18]. The highest output power of short-wavelength QCL (4.6 μm) under CW operation at room temperature has been demonstrated (100 mW and maximum temperature 105°C). All of these state-of-the-art QCLs have been grown by MBE so far, but for industry MOCVD is preferable for mass production. As a result, attempts have been made to grow QCLs by MOCVD. Until now, there are only three groups successfully reporting the growth of QCLs by MOCVD: an InP-based QCL (
QCLs provide one possible method of realizing high-efficiency light emitters in indirect band gap materials such as silicon. Electroluminescence at terahertz frequencies from Si/SiGe intrasubband transitions has been demonstrated [24], and recently silicide low-loss (down to 2 cm−1) waveguides were designed [25, 26]. Figure 4 shows a transmission electron microscopy (TEM) image from a Si/SiGe QCL.
\nTEM image from a Si/SiGe quantum cascade structure, consisting of 600 periods of 6.5 nm Si 0.7Ge0.3 quantum wells with 2-nm strained-Si barriers, all grown on top of a Si0.8Ge0.2 virtual substrate. The quantum cascade laser has a total thickness of 5 mm.
Although GaN-based materials have not been employed to fabricate QCLs, they are also promising materials to be used as such devices. III–V nitrides are known in their wurtzite structure to possess a large spontaneous polarization and piezoelectric constants. As a result, two-dimensional (2D) charges build up at nitride heterointerfaces where the polarization discontinuities occur, causing strong built-in electric fields [27]. Furthermore, GaN is a material with large LO-phonon energy, leading to a thermal population reduction of the lower laser state, a feature desirable for high-temperature operation of terahertz QCLs, as proposed by Diehl et al. [21]. On the other hand, ultrafast LO-phonon scattering in GAN/AlGaN QWs can be useful in order to rapidly depopulate the lower laser state [28, 29]. Lastly, the large LO-phonon energy can also increase the lifetime of the upper laser state by reducing the relaxation of electrons with higher in-plane kinetic energy via emission of a LO phonon. Using low-pressure MOCVD, GaN/AlGaN active regions for QCLs have been grown by Huang et al. [30]. GaN/AlGaN active layers are depicted in Figure 5.
\nFinally, typical phonon frequency redshift is a key indicator of good periodicity of MOVPE-grown GaN/AlGaN QCL structures, 822 cm−1 in the superlattice has been measured, indicating a redshift with respect to the single AlGaN layer [31].
\nAlN/GaN compound is another possible material to be used to fabricate quantum cascade structures. A suitable method of fabrication is hot-wall epitaxy (HWE) [32], a low-cost, convenient and scalable technique, where the epitaxial layers are grown under conditions as near as possible to thermodynamic equilibrium, allowing a minimum material loss. Inoue et al. [33] grew short-period superlattices consisting of five periods of GaN wells of 10 (or nine) molecular layers (MLs) each with 1 ML AlN barriers, which was designed to emit photons at a wavelength within the mid-infrared range (around 5 μm) [34, 35].
\nSchematic diagram of the AlGaN QCL active layer structure (left) and cross-sectional TEM (right) of the 20-period GaN/AlGaN MQW MQL structure.
We could say that QCLs, in short, are eligible to those applications where a powerful and reliable mid-infrared source is required. For instance, most chemical compounds have their fundamental modes in the mid-infrared region (3–15 μm) of the electromagnetic spectrum, thus making this range of paramount importance for gas sensing and spectroscopy applications. The so-called two ‘atmospheric windows’ are two windows corresponding to the ranges 3–5 and 8–12 μm, at which the atmosphere happens to show a high transparency leading to remote sensing and detection in those windows. In this section, a brief description of the current applications of QCLs is elaborated, being summarized as subsequently.
\nMost trace gases of importance, from products of fossil fuel burning to constituents of human breath, have telltale absorption features in this wavelength range, that is, their ‘fingerprint’ region of the spectrum, as a result of molecular rotational-vibrational transitions [16]. Narrow-linewidth, tunable semiconductor lasers in this wavelength range are used to spectrally map out and qualitatively and quantitatively detect these trace gases, by a measurement technique called tunable infrared laser diode absorption spectroscopy (TILDAS) [36]. A schematic representation of a TILDAS is shown in Figure 6. The advantage of TILDAS is its high sensitivity and specificity, usually combined with the advantages of the solid-state device approach.
\n\nThis technique has been successfully introduced in distributed feedback quantum cascade laser (DFB-QCL) structures [37]. DFB-QCLs were first introduced in 1997 [38], providing continuously tunable single-mode laser output, and were demonstrated for the first time in trace-gas sensing applications 1 year later [37]. DFB-QCLs operate as follows: a grating with period
where
Depiction of a tunable infrared laser diode absorption spectroscopy (TILDAS).
In direct absorption measurements, the change in intensity of a beam is recorded as the latter crosses a sampling cell where the chemical to be detected is contained, making this measurement technique quite simple. In a version of this technique, the light interacts with the substance through the evanescent field of a waveguide or an optical fibre.
\nNamjou et al. [37] used the first DFB-QCL for gas detection purposes. The laser was operated at room-temperature conditions in order to measure mid-infrared (1 around 7.8 μm) absorption spectra of gases N2O and CH4, diluted in N2 and prepared in a 10-cm long single pass gas cell, using a wavelength-modulation technique. The noise equivalent sensitivity limit of the measurement was 50 ppm. Sharpe et al. [39] used a DFB-QCL emitting at 5.2 and 8.5 μm to carry out direct absorption measurements of NO and NH3, respectively. Williams et al. [40] measured the intrinsic linewidth of several DFB-QCLs emitting at around 8 μm, by observing fluctuation of the collected optical intensity when the laser beam was passing through a sample cell containing N2O, with a well-known absorption features as the laser was being tuned to the side of one such absorption line. Finally, Kosterev et al. [41] developed a variable-duty cycle and quasi-CW frequency-scanning technique for DFB-QCLs, which relieves many of the thermally induced effects of pulsed operation. Combining this laser with a 100-m multipass gas cell and zero-air background subtraction, a detection sensitivity close to 1 ppb concentration levels was achieved; these authors also demonstrated, by using QC-DFB lasers, high-sensitivity detection of simple molecules when a spectral resolution of approximately 300 MHz is sufficient [42].
\nCavity ring-down spectroscopy (CRDS) is used to measure the concentration of some light-absorbing substance, typically a gas. A short pulse of laser light is injected into the cavity, bouncing back and forth between the mirrors facing each other that make up the cavity. Typically 0.1% of the laser light comes out of the cavity and can be measured whenever the light hits one of the mirrors. Hence, as some light is lost on each reflection, the amount of light hitting the mirror decreases each time, leaking a percentage through. An absorbent medium is placed in the cavity, making light undergo fewer detections before it is extinguished. In short, CRDS measures the time it takes for the light to drop for a certain percentage of its original amount, and this ring-down time can be converted to a concentration, having two main advantages: fluctuations in the laser do not affect the measurement (the ring-down time does not depend upon the brightness of the laser), and due to its long pathlength, it is very sensitive, since the light reflects many times between the mirrors.
\nPaldus et al. [43] reported the use of a 126 mW CW operated DFB-QCL emitting at around 8.5 μm for CRDS of ammonia diluted in nitrogen. A sensitivity of 3.4 × 10−9 cm−1 Hz-1/2 was achieved for ammonia in nitrogen at standard temperature and pressure, which corresponds to a detection limit of 0.25 ppbv.
\nThe photoacoustic effect was discovered in 1880 by Alexander Graham Bell, who showed that thin discs emit sound when exposed to a beam of sunlight that was quickly interrupted with a rotating slotted disc. The absorbed energy from the light was transformed into kinetic energy in the sample and so a local heating and a pressure wave of sound arose. Later, Bell demonstrated the fact that materials exposed to different regions of the solar spectrum, that is, infrared and ultraviolet, can produce sounds too. Hence, by measuring the sound at different wavelengths, a photoacoustic spectrum from a sample can be recorded, so that it can be used to identify the absorbing components of the sample. This technique can be used to study solids, liquids and gases.
\nOne of the uses of photoacoustic spectroscopy is the study of gas concentrations at the parts per billion or even parts per trillion levels. Although most photoacoustic detectors do not differ much from the original Bell’s set-up, some enhancements have been incorporated in order to increase the sensitivity, such as enclosing the gaseous sample in a cylindrical chamber, and amplifying the sound signal by tuning the modulation frequency to an acoustic resonance of the sample cell, by using high-sensitive microphones together with lock-in techniques and utilizing intense lasers instead of sunlight to illuminate the sample.
\nPaldus et al. [44] reported photoacoustic spectroscopy on NH3 and H2O diluted in N2 using a CW DFB-QCL emitting at a wavelength of 8.5 μm. The noise-limited minimum detectable concentration of NH3 was 100 ppbv for an integration time of 1 s. Lastly, Nägele et al. [45] built a multicomponent (ethane, methanol and ethanol) trace-gas monitoring system using QCLs as pump sources and a multipass photoacoustic cell.
\nOther types of spectroscopies have also been used in the context of QCLs detection.
\nFirst, lamb-dip spectroscopy is a useful technique to study the spectra from polyatomic molecules. When a monochromatic light with a given wavelength passes through a chemical cell in a set-up similar to that depicted in Figure 6, a Gaussian absorption spectrum centred in the wavelength comes up. If we measure the absorption of a light beam (probe beam) by passing through two beams (pump and probe beams) of the same wavelength from opposite directions, by using a beam splitter, a less intense absorption is observed at that wavelength. This reduction in intensity appears as a dip, the so-called lamb-dip, and its position gives the location of the transition wavelength having no Doppler shift (Doppler-free in the absorption curve). Samman et al. [46] used a CW-operated DFB-QCL emitting at around 5.2 mm to obtain sub-Doppler resolution-limited saturation features in a lamb-dip experiment on NO. These lamb dips appeared as transition spikes with full-width at half maximum (FWHM) values around 4.3 MHz.
\nGittins et al. [47] used a multimode Fabry-Perot-type QCL emitting at around 8.0 μm wavelength for quantitative backscatter absorption measurements on isopropanol vapour. They developed and employed a pseudorandom code modulation of the laser, and explored its use for different absorption LIDAR (laser infrared detection and ranging).
\nFinally, Sonnenfroh et al. [48] used DFB-QCLs (1 around 5.4 μm) in quasi-CW mode close to room temperature in conjunction with a balanced radiometric detection technique to achieve high sensitivity, whereas Hvozdara et al. [49] demonstrated the first use of a GaAs-based QCL for gas-sensing applications.
\nDrug detection is another important application field of QCL-based detection systems [50]. Lu et al. [51] demonstrated, by integrating an optoelectronic terahertz microsource into a glass-substrated microchip within the near-field distance, a compact, label-free and non-invasive microbiosensing terahertz device that allowed detection of illicit drug powders with weight in the order of the nanogram.
\nThe detection of explosive fingerprints is of great importance for security reasons. The detection of such substances has a number of drawbacks as explosive molecules are heavy, complex and have thousands of rotational and vibrational transitions. Furthermore, broadband features with no separation observed at low pressures happen in measured transmission spectra. Different explosives have, therefore, unique terahertz spectral fingerprints. Williams et al. [52] developed a high-power QCL emitting at around 4.4 THz. These lasers are based on a resonant-phonon depopulation scheme, and use a semi-insulating surface-plasmon waveguide. They managed a maximum power of ∼248 and 138 mW pulsed and CW, respectively. van Neste et al. [53] have used two QCLs operating simultaneously with tunable wavelength windows matching the absorption peaks of analytes in order to improve sensitivities of standoff spectroscopy techniques, leading to a sensitivity of 100 ng/cm2 and a standoff detection distance of 20 m for surface-adsorbed analytes such as explosives and tributyl phosphate.
\nMolecular plasmas are tools in plasma-enhanced chemical vapour deposition and in etching systems to deposit or remove thin films. The analysis of the precursor gas fragmentation and the monitoring of plasma reaction products is the key to an improved understanding and control of these chemical-active discharges. This observation can be done by using absorption spectroscopy methods in the mid-infrared spectral region. Recently, a QCL-based absorption spectroscopic system, the quantum cascade laser measurement and control system (Q-MACS), was developed and used to study industrial process plasmas and for environmental studies, and its applicability for monitoring online processes has been proven [54].
\nFinally, QCLs are also applied to aerospace and military uses. For instance, the first of a new generation of miniature tunable laser mid-IR spectrometers operating at room temperature for in situ measurement of atmospheric and evolved planetary gases started to develop not too long ago. These devices are based on newly available room-temperature QCL sources in the 3–12μm wavelength region and have immediate applications to Mars, Titan, Venus and Europa missions, being operated on a descending or penetrating probe, lander, rover or aerobot, and would consume only a few watts of power, with a weight less than 1 kg [55]. Furthermore, features of QCL make them good laser sources to carry out non-destructive-imaging engine combustors, where failure mechanisms, engine performance in aircraft and moisture content in jet fuel are examined. A low thermal noise background is required for such purpose, and ceramic ports exist already on such platforms transparent to terahertz radiation. Scale model radar cross-section experiments have also been carried out in the aerospace industry, to replace the bulky and extremely inefficient molecular lasers with QCLs, at the University of Massachusetts Lowell Sub-Millimetre Wave Laboratory [56], to perform scale model radar cross-section measurements for phenomenology and target-recognition database formation.
\nThe infrared spectrum is also used in the aerospace industry for detection purposes, for instance, in the infrared scene generation, which is presently a critical technology for testing of infrared-imaging systems, for example, in infrared-guided missile systems, and QCLs could have an application in this technology to replace large- and slow-response ‘resistor banks’ with tailored design QCLs, to mimic the thermal background of a given scene [57]. Moreover, coherent transceiver using a terahertz quantum cascade laser (TQCL) as the transmitter and an optically pumped molecular laser as the local oscillator has been used for imaging purposes along with inverse synthetic aperture radar (ISAR), in which the range of the target was limited by the TQCL power (around 10–4 W) and indoor atmospheric attenuation at 2.408 THz, leading to a coherence length of the transmitter of up to several hundred metres [58].
\nQCLs are also currently facing a number of challenges, which will be summarized below.
\nFirst, the extensions of the wavelength range into the far-infrared. Rochat et al. [59] grew far-infrared QC structures based on a vertical transition active region emitting at l around 76 μm. This is a challenging issue, so long as population inversion is difficult to attain for such long wavelengths. Energy levels are generally so close that selective injection into a single level is difficult. Furthermore, LO-phonon scattering is replaced by electron-electron scattering as the dominant electron relaxation mechanism, which is more difficult to model accurately. Moreover, wavewide losses are expected to be high, although even very low-temperature QCL operation would be a great accomplishment due to the lack of narrow band and high-power compact sources in the far-infrared wavelength range. In fact, temperature is a key player when it is required to achieve a certain emission wavelength as Figure 7 shows.
\nOperating temperature plot as a function of the emission wavelength/frequency for QCLs [
Another challenge would also be to fibre-optic wavelengths. In fact, the fabrication of large optical waveguides, powers of 14 and 5 W at respective temperatures of 15 and 280 K, is demonstrated at a wavelength of approximately 5.2 μm [61].
\nOn the other side of the IR spectrum, reaching shorter wavelengths is another motivation for a more selection of materials. Work on this respect has also be done on GaN-based devices [61], with Gmachl et al. [62] having measured intersubband optical absorption in narrow (15–30 Å wide), GaN/AlGaN quantum wells grown by MBE on sapphire substrate. Peak absorption wavelengths ranged from 4.2 μm for 30Å wide wells to 1.77 μm for a 15Å wide well. On the other hand, Iizuka et al. [63] reported ultrafast intersubband relaxation (less than 150 fs) at a wavelength of 4.5 μm in Al0.65Ga0.35N/GaN MQWs, with as many as 200 QWs, making this result promising for fabrication ultrafast optical switches.
\nDoping level of the active region is a key optimization parameter that determines maximum drive current, optical losses and threshold current. Faist et al. [61] presented a systematic change of the active region doping in an InAlAs-InGaAs/InP lasers emitting at 9 μm. On the other hand, the wavelength tunability of each QC-DFB laser is especially limited to cover the entire molecular absorption spectrum of volatile organic compounds and hydrocarbons, which could be addressed by separating the gain medium from the wavelength-selective element [61].
\nOther challenges involve the low conversion efficiencies (<1%) between electrical and optical power, also known as wall plug efficiency (WPE) [64], and also the unavoidable fact that far-infrared (terahertz) QCLs lack proper performance at room-temperature operation. Belkin et al. [65] have recently reviewed recent research that has led to a new class of QCL light sources that has overcome these limitations leading to room-temperature operation in the terahertz spectral range, with nearly 2 mW of optical power and significant tunability by using intra-cavity THz difference-frequency generation (DFG) in dual-wavelength mid-IR QCLs. However, Lu et al. [66] recently presented a strong-coupled strain-balanced quantum cascade laser design for efficient THz generation based on intra-cavity difference-frequency generation, demonstrating continuous-wave, single-mode THz emissions with a wide-frequency tuning range of 2.06–4.35 THz and an output power up to 4.2 μW at room temperature from two monolithic three-section sampled grating distributed feedback-distributed Bragg reflector lasers.
\nFurthermore, Burghoff et al. [67] demonstrated frequency combs based on terahertz QCLs, combining high power of lasers with the broadband capabilities of pulsed sources. By fully exploiting the quantum-mechanically broadened gain spectrum available to these lasers, 5 mW of terahertz power spread across 70 laser lines can be generated. Therefore, the radiation is sufficiently powerful to be detected by Schottky-diode mixers, and will lead to compact terahertz spectrometers.
\nAbout gas detection, Harrer et al. [68] combined the operation mode and low-divergence emission from QCLs with two-dimensional array integration with multiple emission and detection frequencies leading to detecting propane concentrations of 0–70 and 0–90% for isobutane at a laser operation wavelength of 6.5 μm using a 10 cm gas cell in double-pass configuration.
\nFinally, possibly the best way to assess the current state of the art for volume production of QCLs is to start from the market requirement from the end-user point of view. An example is the continuous emission monitoring (CEM) market, which includes engine emission and power-plant stack monitoring, is fiercely competitive, with a range of different gas-sensing technologies, such as Fourier transform spectrometry, chemiluminescence, non-dispersive infrared, and so on, each trying to increase its market share. Among these technologies, QCL-based gas sensor technology is still in its infancy, since although predictions indicate a great improvement in performance, much demonstration and convincing is still required in this conservative market. Moreover, it is difficult to justify a system whose price is above the market, despite better performance, due to the risk of an unproven and new technology. Hence, a QCL device might be priced below the market, which can have negative consequences that can reach the component supplier. Customers are usually reluctant to acquire a new sensor having other well-proven systems already in the market. Therefore, demonstration of the unique advantages of the QCL-based devices is often necessary, including specifications, performance, mean time to failure (MTTF) parameters, traceability and warranty period with a significant impact [69]. Implementation of high-volume production and proper validation processes on QCLs are producing positive outcomes. Along with a noticeable improvement in gas-sensing performance parameters, volume-cost reduction is allowing QCL systems price decrease to meet market demands. By consistently tackling the challenges of the QCL volume manufacturing, carrying out severe testing procedures, implementing quality-control systems and reaching adequate device costing, QCL developers and manufacturers can complete and come into the marketplace.
\nFinally, continuing to build consumer confidence in QCL commercial products, it should be easier for customers to digest the unavoidable contract ‘warranty’ and ‘product liability’ clauses found in supply contracts [69].
\nIn this chapter, an overview of quantum cascade lasers (QCLs) is presented. A historical introduction is first introduced. The basic features of QCLs are outlined, as well as a brief description of the issues that this work deals with. The operation and fundamentals of QCLs are also described. An analysis of the operation of these structures is included. Basically, the use of superlattices and tunability due to the layer thickness are the key features, in conjunction with the intersubband tunnelling transition – cascade. The QCLs are usually three-level lasers. Rate equations are also included. Furthermore, introducing a graphical brief timeline (Figure 8), including some of the most important milestones achieved in the world of QCL, would be helpful in this section.
\n\nAn overview over the materials used for these devices is also included, that is, InGaAs and InAlAs layers, InAs/AlSb, Si/SiGe and GaN-based.
\nQCLs have a wide range of applications: first, trace-gas detection by optical methods in the mid-infrared, the great suitability of the TILDAS techniques and DFB-QCLs in trace-gas-sensing applications.
\nAchievements of QCLs over time.
Cavity ring-down spectroscopy is another technique used for gas detection and briefly described above. QCLs are also applied in photoacoustic spectroscopy, to study gas concentrations at the parts per billion or even parts per trillion levels. Applications in gas detection using QCLs with other types of spectroscopy and variations, such as lamb-dip spectroscopy, radiometric detection techniques, and so on, are mentioned.
\nThe latest advances in QCL applications are also described. The extension of the wavelength range into the far-infrared but also shorter wavelengths, fibre-optic wavelengths and fabrication of large optical waveguides, doping issues, room-temperature operation problems, frequency combs based on terahertz devices, new insights on gas detection and finally current state of the art for volume production of QCLs are mentioned.
\nThe chromosomal abnormalities account for a considerable part of the anomalies of the intrauterine fetus. Chromosomal abnormalities are the numerical (aneuploidies) and structural anomalies, which can be demonstrated by special methods of examination. The numerical and structural anomalies can be duplications/trisomies, deletions/monosomies, and other rearrangements on the chromosomes.
The autosomal trisomies and unbalanced rearrangements might cause severe multiple malformation syndromes and mental retardation. The rate of the intrauterine deaths is high. They cause mainly severe diseases; in some cases they are associated with anomalies which are incompatible with the postnatal life.
Besides the age, a history of aneuploidy, and noninvasive tests, positive ultrasound findings—which could be major structural abnormalities or minor ultrasound markers—can be an indicator for chromosome analysis [1].
As the first-trimester nuchal edemas (nuchal translucency, NT), the second-trimester nuchal edemas (nuchal thickening, nuchal fold, NF) also elevate the risk of chromosome abnormalities. It is important to distinguish nuchal edema and cystic hygroma (CH), and in the case of nonimmune hydrops (NH), it is also important to discuss cases with or without cystic hygroma separately.
Abnormalities with subcutaneous edema (nonimmune hydrops (NH), cystic hygroma, nuchal edema) increase the risk of chromosome abnormalities. They may warn of a possible intrauterine infection; in the case of nonimmune hydrops, for example, parvovirus B19 infection may occur. They may also be indicative of other pathologies accompanied with fetal anemia, including thalassemia, twin-to-twin transfusion, and disorders of fetal circulation and abnormal anatomy of the fetal heart.
In the second trimester, we examine the thickened nuchal fold (nuchal thickening, NF) in the horizontal section, level with the cerebellum and also containing the cavum septum pellucidum and the cisterna magna. This method, in contrast to the one used in the first trimester, measures the thickness of the soft tissue from the external aspect of the skin to the external aspect of the bone. Authors suggest 5 mm as a cutoff value [2, 3]. A large nuchal translucency detected in the first trimester is a non-specific malformation, and in most cases it resolves during the second trimester of the pregnancy, although it might persist in certain cases to show a picture of nuchal thickening. It indicates an increased risk of trisomy 21 (Down syndrome) [4].
Benacerraf et al. were the first in drawing the attention to the fact that the nuchal fold or nuchal thickening (≥6 mm) observed during the ultrasound examination in the second trimester increases the risk of Down syndrome [4].
Numerous authors carried out similar examinations, subsequently demonstrating different results. Gray and Crane [3] tried to determine the proper cutoff values of nuchal thickening. They formulated two groups according to the size of the pregnancy, putting the values measured in weeks 14–18 to the first group and the data of weeks 19–24 to the second group. Considering the examinations, the suggested cutoff value in the first group (weeks 14–18) is ≥5 mm, and in the second group (weeks 19–24), it is ≥6 mm [5]. In their investigations, Gray and Crane [3] detected pathological karyotypes in 12 out of 47 cases (25.53%). Analyzing 23 cases, DeVore and Alfi found pathological karyotypes in 9 cases (39.13%) [6].
Other authors detected pathological karyotypes in 10% of second-trimester nuchal edema. Grandjean and Sarramon [7] processed the data of 3308 ultrasound examinations, with the help of 12 centers, and they found nuchal thickening in 38% of the cases of trisomy 21. According to the records of 12 centers, they performed karyotyping of 295 pregnancies in the second trimester with nuchal thickening. They found abnormal chromosomes in 22 cases (7.46%), 17 of these were trisomy 21 (5.76%) [7]. Gonen et al. [8] carried out karyotyping in 573 cases because of positive ultrasound findings during ultrasound examinations in the second trimester. There were 38 chromosome analyses carried out due to nuchal thickenings; in one case they found an abnormal karyotype (2.63%) [8]. Zimmer et al. discussed their cases of early second-trimester nuchal edema in 43 out of 1254 cases (3.43%); they detected pathological karyotypes, trisomy 21 being the chief cause in 27 cases, while other pathological karyotypes were blamed in 16 cases [9].
Beke et al. [10] showed a value within 10% in the case of nuchal fold (thickening) measured in the second trimester. A total of 254 cases of chromosomal examination was performed for second-trimester nuchal edema, and in 14 cases, an abnormal karyotype was detected (5.51%). With the highest frequency, monosomy X occurred (nine cases, 3.54%), while in three cases trisomy 21, in 1-1 cases trisomy 18 (Edwards syndrome), and another chromosome abnormality were detected [10].
Cystic hygroma is observable in the first and second trimesters. It can be differentiated from nuchal translucency and nuchal thickening by the clearly isolated fluid space and the typical medial line septation shown on ultrasound examination [11, 12]. Cystic hygroma often persists and is often associated with aneuploidy (mainly monosomy X), other abnormalities, and fetal loss [12].
In the case of cystic hygroma, the risk of the chromosome abnormality is even higher than in cases of nuchal thickening. Bronshtein et al. found chromosome anomalies in 6 of 106 nonseptated cases (5.66%), whereas the risk of the chromosome abnormality in the 25 septated cases was 72% [12].
Nadel et al. [13] examined in separate groups those cases where the cystic hygroma occurred by itself (isolated) and those where it was a part of the hydrops phenomenon. In cases of individually occurring 26 hygromas, there were chromosome abnormalities in 12 cases (46.15%), while in hydrops-associated cases (37 cases), they found 31 chromosome anomalies (83.78%) [13]. Due to cystic hygroma, Gonen et al. detected 15 cases of pathological (abnormal) karyotype in 182 cases (8.24%) [8]. Sohn and Gast [14] found 20 cases of abnormal karyotype of the 57 cystic hygroma cases (35.09%). There were 11 cases of monosomy X (Turner syndrome), 5 cases of trisomy 21, and 4 cases of trisomy 18 [14]. Taipale et al. carried out karyotyping in 76 cases of cystic hygroma, and they found chromosome abnormalities in 18 cases (23.68%), monosomy X in 5 cases, trisomy 21 in 7 cases, and trisomy 13 (Patau syndrome) and trisomy 18 in 6 cases [15].
Beke et al. [10] had a similar result. In terms of isolated cystic hygroma, fetal chromosome examinations were performed in 27 cases, and in 13 cases abnormal karyotypes were detected (48.15%). When cystic hygroma was associated with hydrops, a total of 13 cases was investigated, and 7 cases of chromosomal abnormalities (53.85%) were detected [10].
In the first and early second trimesters, Rosati and Guariglia [16] examined the volume of cystic hygromas by volumetric calculations. They also analyzed the proportion of associated chromosomal abnormalities, and in 8 of 14 septated cases, they detected pathological karyotypes (57.14%), whereas four pathological karyotypes (21.05%) were seen in the 19 nonseptated cases. In summary, the 12 patients with chromosomal abnormalities (36.36%) were divided as follows: trisomy 21 in 6 patients, monosomy X in 4 cases, and trisomy 18 and 13 in 1 case each [16]. Examining the septated and nonseptated cases together, Tanriverdi et al. found 13 pathological karyotypes (56.52%) among the 23 karyotyped patients [17]. Donnenfeld et al. applied karyotyping and fluorescent in situ hybridization (FISH) in the chromosomal investigation of the cells in the sample obtained from the fluid of the cystic hygroma and could justify monosomy X in 86% [18].
Examining a total of 218 fetuses with subcutaneous edema, Gezer et al. [19] found that nuchal fold, cystic hygroma, and nonimmune hydrops could be significant markers for abnormal chromosome numbers. Of these 218 cases, 71 (32.57%) were diagnosed with abnormal karyotype. The percentage breakdown in 71 cases was as follows: 37% monosomy X, 44% trisomy 21, 15% trisomy 18, and 4% trisomy 13 [19].
Similarly to cystic hygroma, nonimmune hydrops can be observed both in the first and second trimesters and is often associated with aneuploidy (monosomy X or trisomy 21) and fetal loss [13].
Nicolaides et al. studied 37 cases in 1986 and demonstrated 12 cases of chromosome anomalies (32.43%) [20]. Gembruch et al. found 17 abnormal karyotypes examining 45 hydrops cases (37.78%), 10 cases of monosomy X (1 mosaic form), 6 cases of trisomy 21, and 1 case of trisomy 18 [21].
Boyd and Keeling [22] and Anandakumar et al. [23] found X-monosomies in 50% of the demonstrated chromosome abnormalities. Boyd and Keeling [22] found 11 X-monosomies of the 22 cases of chromosome anomalies of the 72 nonimmune hydrops cases (30.56%), while Anandakumar et al. [23] carried out karyotyping in cases of 100 hydrops-affected fetuses and demonstrated 5 cases of X-monosomies of 10 abnormal cases (10%).
Schwanitz et al. examined in separate groups the nonimmune hydrops cases associated with cystic hygroma and the individually occurring ones. When it was associated with cystic hygroma, abnormal karyotypes were demonstrated in 54.39%; without cystic hygroma this rate was 27.69% [24].
Has carried out investigations into nonimmune hydrops in the first trimester and found 9 pathological karyotypes (47.37%) out of 19 cases [25].
In the case of nonimmune hydrops, Beke et al. found chromosomal abnormalities in 4 out of 20 cases (20%), in each case monosomy X [10].
In the case of ventriculomegaly, a greater than normal amount of liquor expands the ventricular system. Cerebrospinal fluid may be overproduced, impaired, or obstructed. Increased pressure leads to thinning of the brain, creating hydrocephalus internus. Hydrocephalus externus is referred to as the proliferation of liquor in the subarachnoid space. Ultrasound first shows the expansion of the posterior horn of the side chamber. In cases of choroid plexus cyst and other cranial malformations, the risk of chromosomal abnormalities is also elevated.
In cases of cerebral anomalies, we define ventricular dilatation (ventriculomegaly) as a lateral ventricle with a diameter ≥ 10 mm. The ventricle of normal male fetuses is mildly wider (average 6.4 mm) than of the ventricle of normal female fetuses (average 5.8 mm) [26]. Ventriculomegaly increases the incidence rate of aneuploidy (trisomy 21 and other aneuploidies) [27, 28].
Several authors were examining ventriculomegaly as one possible marker of the fetal chromosome abnormalities in the second trimester. Nicolaides et al. carried out karyotyping in 9 cases because of fetal ventriculomegaly, examining this among other anomalies, and they found chromosome abnormalities in 2 cases (22.22%) [20]. Following this, Mahony et al. [28] found 1 case of 20 ventriculomegalies (5%); Bromley et al. [27] observed 5 cases of chromosome anomalies examining 44 cases of ventriculomegaly (11.36%). The study of Gonen et al. [8] also extended to more anomalies; as a part of it, they carried out karyotyping in 25 cases of ventriculomegalies and found no abnormal karyotypes. Terry et al. [29] detected abnormal chromosomes in 3 cases of the 25 examined fetuses (12%).
Beke et al. [30] found different karyotypes in 26 (6.25%) out of the 416 examined fetuses. If ventriculomegaly was isolated (191 cases), the rate of the chromosome abnormality was 3.7% (7 cases). In four cases, trisomy 21 was detected, in two cases monosomy X, and in one case trisomy 18. Lateral ventricular dilation (ventriculomegaly) was associated with other ultrasound findings in 225 cases, and in 19 of these, there were chromosome abnormalities detected (8.4%). The distribution of pathological (abnormal) karyotypes was as follows: 4-4 cases of monosomy X and 47, XXY karyotype (Klinefelter syndrome), 3-3 cases of trisomy 21 and trisomy 18, and 1-1 case of trisomy 13, 47,XXX, 47,XYY, 49,XXXY karyotypes and triploidy were detected. We found a higher rate in cases of bilateral anomaly (ventriculomegaly) (8.6%) than in unilateral cases (4.6%) [30].
According to the data of more authors, the choroid plexus cysts (CPC) mainly increase the risk for trisomy 18 [31, 32]. According to certain studies, the risk level does not depend on whether the anomaly is unilateral or bilateral, but other studies show that the larger the anomaly (>10 mm), the higher the risk [33, 34]. Certain authors suggest the 2–2.5 mm cutoff value [35], while others determined the 5 mm limiting value [33]. The cysts resolve practically every time, so the absence of the anomaly on a repeated ultrasound examination does not indicate a decrease in the risk [36].
Chudleigh et al. were the first who described cysts in the fetal choroid plexus [37]. Nicolaides et al. were the first who drew attention to the connection between the positive ultrasound finding of choroid plexus cysts and chromosome abnormalities, through a study including a small number of cases [20]. Thereafter, more authors demonstrated that fetal choroid plexus cysts mainly increase the risk of trisomy 18 and, to a lesser degree, the risk of trisomy 21.
Achiron et al. demonstrated 2 trisomy 18 cases from chromosome analysis of 30 CPC cases (6.67%); in 1 case the CPC was associated with other ultrasound anomalies [38]. Platt et al. found 4 cases of chromosome abnormalities from 62 cases (6.45%), in 3 cases it was trisomy 18, and in 1 case it was trisomy 21 [39]. Nadel et al. demonstrated 12 cases (5.13%) of abnormal chromosomes from a larger number of cases (234 cases), 11 of which were trisomy 18 (4.7%) and 1 case of triploidy, but from 234 cases there were 220 cases of isolated CPC, and in these cases they did not detect any chromosome abnormalities [40].
Walkinshaw et al. demonstrated 4 cases (2.63%) of chromosome anomalies out of 152 isolated CPC cases, 3 cases trisomy 18 (1.97%) and 1 case trisomy 21 [33]. Nava et al. found eight chromosome abnormalities in 176 cases (4.55%), 4 cases of trisomy 18 (2.27%), 2 cases of trisomy 21 (1.14%), 1 case of 47, XXY karyotype, and 1 case of another chromosome anomaly [41]. From the trisomy 18 cases, there was one case of isolated choroid plexus cyst, while in three cases the abnormality was associated with other ultrasound findings. Gonen et al. in 1995 demonstrated no abnormalities in the course of intrauterine karyotyping of 108 CPC cases [8].
Gray et al. performed karyotyping in 208 cases, and they detected abnormal karyotypes in 7 cases; each case was trisomy 18 (3.37%) [34]. Bakos et al. found 3 abnormal karyotypes out of 108 examined cases (2.78), 1 case was trisomy 18, and 1 case was trisomy 13 and one inversion of chromosome 9 [42].
Chitty et al. [43] with a larger number of cases found chromosome abnormalities in 14 cases (2.13%). They examined separately the isolated cases and the cases associated with other ultrasound anomalies. In 603 cases, the choroid plexus cyst was not associated with other ultrasound abnormalities, and in 3 cases (0.5%), they found abnormal karyotypes (each was trisomy 18); in 55 cases the abnormality was associated with other ultrasound findings, and in 11 cases (20%), they detected abnormal karyotypes (in 9 cases trisomy 18, in one case trisomy 21, and in 1 case 47,XXX karyotype) [43]. With a similarly large number of cases, Ghidini et al. examined the incidence of chromosome abnormalities in cases of choroid plexus cysts, they only examined the isolated cases (765 cases), and they found abnormal karyotypes (trisomy 18) in 13 cases (1.7%) [44].
Coco et al. [45] in 2004 examined separately the isolated cases and those associated with other abnormalities, the cases associated with minor and major ultrasound anomalies. The rate of abnormal karyotypes was 0.55% in total. In isolated cases (311 cases) and in associated cases with minor anomalies (43 cases), they did not find any abnormal karyotypes. In the two detected cases of trisomy 18, the choroid plexus cyst was associated with major anomalies (16.67% from 12 cases) [45]. Sahinoglu et al. [46] performed karyotyping in 109 cases due to choroid plexus cyst, 3.67% of the patients had an abnormal karyotype, in 102 cases, it was isolated anomaly, and in 3 cases they found chromosome abnormalities (2.94%). In seven cases, the choroid plexus cysts were associated with other ultrasound anomalies, and they found chromosome abnormality in one case (14.29%); in all the detected four cases, the abnormal karyotype was trisomy 18.
According to a 2008 study, of the 435 cases identified by CPC, 390 undertook karyotyping. Of these, anomalies were found in 14 fetuses (3.59%), with the highest frequency being trisomy 18 (6 cases, 1.54%); in 1 case trisomy 21 (1, 0.26%) and 1 case trisomy 9 (0.26%) were detected. The incidence of monosomy X was 0.77% (3 cases). In one case, 47, XXY karyotype (0.26%) and in two cases other chromosomal abnormalities (0.51%) were confirmed (46,XX/46,XY and 46,XY/47,XXY/47,XYY mosaicism). Of the cases studied, other ultrasound abnormalities associated with the plexus cyst were found in 178 pregnancies, and 7 abnormal karyotypes were found (3.93%), 5 cases of trisomy 18, and 2 cases of monosomy X. Choroid plexus cyst occurred as an isolated anomaly in 212 pregnancies (it was not associated with any other fetal ultrasound findings (anomalies) and/or poly/oligohydramnios), and 7 chromosome abnormalities (3.3%) were found, one of which was trisomy 18, 1 case trisomy 21, 1 case trisomy 9, 1 case monosomy X, and 1 case 47,XXY karyotype. The incidence of chromosome abnormalities was also similar in the case of unilateral and bilateral CPC; chromosome abnormalities were detected in the case of unilateral (3.3%) and in the case of bilateral anomalies (3.9%) [47].
Other cranial and cerebral anomalies (holoprosencephaly, agenesis or dysgenesis of the corpus callosum, Dandy-Walker malformation, and cleft lip or palate) according to observations increase the risk of chromosome abnormalities, but they do not increase the risk of trisomy 21 [48]. A strawberry-shaped head mainly increases the risk of trisomy 18 [49].
Benacerraf et al. reported five cases already in 1984, where they found intrauterine cleft lip and palate and holoprosencephaly during the ultrasound examinations, and the chromosome analysis verified trisomy 13 in two cases (33.33%) [50].
Both Parant et al. [51] and later Tongsong et al. [52] reported 12 cases where they diagnosed intrauterine holoprosencephaly. The karyotyping in Parant et al. [51]’s study verified trisomy 13 in four cases (33.33%); in Tongsong et al. [52]’s study, there were three cases of trisomies found (25%); in two cases it was trisomy 13 (16.67%), and in one case it was trisomy 18 (8.33%). Bullen et al. reported in their study (2001) 68 cases of holoprosencephaly, they made karyotyping in 52 cases, where they found an abnormal karyotype in 38% (from 20 cases in 15 cases it was trisomy 13, in 2 cases trisomy 18, and in 3 cases other chromosome anomalies, from which in 2 cases they recognized the deletion of the long arm of chromosome 13) [53]. Studying the etiology of the holoprosencephaly, besides the maternal diabetes and trisomy 13, there are also monogenic types [54].
In cases of cleft lip and/or palate, Perrotin et al. [55] demonstrated in their study that in those cases they examined, there were no chromosome anomalies provided the abnormality was isolated (14 cases), and when they detected it together with other positive ultrasound findings, the incidence rate of the chromosome abnormalities was high. In 26 cases, there were 15 chromosome anomalies (57.69%), in 8 cases trisomy 13, and in 5 cases trisomy 18 [55].
Aletebi and Fung [56] studied the abnormalities of the fossa posterior region, including the enlarged cisterna magna, the Dandy-Walker malformation, and the fossa posterior cyst. They found chromosome abnormalities (trisomy 18) in 1 of 15 cases (6.67%) [56].
Similarly, Beke et al. found in their study that the frequency of chromosome abnormalities was similar to other cranial abnormalities; with 44 fetuses being examined, they detected chromosome abnormalities in 7 cases (15.91%) [30].
The aim of Nazer Herrera et al. [57] was to estimate the prevalence of holoprosencephaly in relation to births. It turned out that this disorder occurred with low frequency in Chile, but it was associated with a high proportion of trisomy 13: occurring in 10.91% of the cases examined (6 out of 55 cases) [57].
In another study, this anatomical disorder and chromosome abnormalities were associated with a high proportion. According to a study in Japan, five out of seven holoprosencephaly cases (71.43%) showed the following differences: two children with trisomy 18, two children with trisomy 13, and one with 45,X karyotype [58].
The use of fetal echocardiography may further increase the importance of second-trimester ultrasound examinations for screening for chromosomal anomalies. This is particularly true in those cases where screening tests were not available in the first trimester or the pregnancy was only recognized later.
In the fetal heart, the echogenic intracardiac focus is observable in 3–4% of normal pregnancies [59]; according to some studies, this rate might reach 10% in the Asian population [60]. Its incidence, by some authors, increases the risk of trisomy 21 [61, 62, 63, 64, 65] and, according to some studies, trisomy 13 [66]. According to some literature data, the risk is higher if the anomaly is observable in both ventricles [61].
Bromley et al. [61, 62] examined in their studies (reported in 1995 and 1998) the correlation between the chromosome anomalies and the echogenic intracardiac focus detected during the ultrasound examinations. In 1995 they studied 66 cases and found trisomy 21 in 4 cases (6.06%) [61]. Chromosome abnormalities were found in 14 cases (4.83%) with a higher number of cases (290). In 1998, they examined 290 pregnancies in two groups and detected chromosome abnormalities (mainly trisomy 21) in 6.4% (125 cases) in that group where the maternal age was ≥35 years, and in the age group under 35 years (165 cases), this rate was 3.64% [62]. Winter et al. demonstrated in their similar report 16 cases of trisomy 21 of the studied 163 cases (9.28%) [65].
In a 2005 publication, the echogenic papillary muscle showed abnormal karyotype only when it was associated with other anomalies (4.69%), not in isolated cases [30].
Many authors investigated the correlation among the chromosome abnormalities and the ventricular septal defect (VSD) and the atrioventricular septal defect (AVSD). In some cases, the authors managed the cases discovered in the second trimester or later in pregnancy (third trimester) and the cases diagnosed after birth as aggregated data. Hajdu et al. studied 21 cases of AVSD and found chromosome anomalies in 9 cases (42.86%); 7 of these were trisomy 21, 1 case trisomy 18, and 1 case trisomy 22 [67].
Tennstedt et al. [68] analyzed all those cases where the fetopathological examination verified cardiac malformation, and there were ultrasound examinations and karyotyping during the pregnancy (altogether 129 cases). A total of 36 fetuses had VSD, and 21 fetuses had AVSD. In cases of VSD, there were 15 fetuses (41.67%) with detected chromosome anomalies (8 cases of trisomy 21, 4 cases of trisomy 18, 1 case of trisomy 13, 2 cases of other abnormalities). If AVSD occurred, the incidence rate of the chromosome anomalies was 61.9% (from 13 cases, 9 trisomy 21 and 3 trisomy 18, and in 1 case other anomaly) [68]. Delisle et al. [69] studied the incidence of the chromosome abnormalities in cases of AVSD detected by ultrasound examinations during pregnancy, and from the 38 cases, they found 22 (57.89%) with chromosome anomalies (19 cases of trisomy 21, 1 case of trisomy 18, 1 case of trisomy 13, and 1 case of other positive finding). Paladini et al. [70] reported a study about the risk of chromosome abnormalities in cases of all cardiac (heart and large blood vessels) anomalies. In case of ventricular septal defect, the incidence rate of the chromosome anomalies was 45.33% (34 of 75 cases), and in case of atrioventricular septal defect, this rate was 80% (32 of 40 cases) [70]. From the 34 VSD cases, there were 14 cases of trisomy 21 (18.67%), 16 cases of trisomy 18 (21.33%), 2 cases of monosomy X (2.67%), and 2 other anomalies detectable. The distribution of the 32 abnormal karyotypes in case of AVSD was the following: 26 cases of trisomy 21 (65%), 3 cases of trisomy 18 (7.5%), and 3 other anomalies.
In their work, Beke et al. found abnormalities in 4 out of 18 fetuses with VSD (22.22%), including 2 cases of trisomy 18 (11.11%) and 1 case of trisomy 13 (5.56%) as well as 1 case of another anomaly [30].
Hajdu et al. [71] later, in 2005 in the case of AVSD, the frequency of the abnormal karyotypes was 66.67%. They studied 39 cases of AVSD and found chromosome anomalies in 19 cases (66.67%); 19 of these were trisomy 21, 6 cases trisomy 18, and 1 case trisomy 22 [71].
A 2006 study dealt with the VSD-related clinical characteristics of the Moroccan pediatric population, among others. The 44 patients involved in the research were between 2 and 3 years old. Six of them (13.64%) had Down syndrome. VSD patients who were later subjected to surgical correction were more likely to be able to avoid irreversible pulmonary artery hypertension [72].
According to another, Chinese publication, the association of trisomy 21 is also high in the case of complete AVSD (CAVSD). In a group of 35 patients with this type of anatomical deviation, Zhong et al. performed chromosome tests in 15 cases. A total of 13 chromosome abnormalities (86.67%) have been reported, of which 11 patients with Down syndrome have been identified [73].
Relatively few studies deal with long-term follow-up of Fallot tetralogy cases. According to Shuhaiber et al., the prospects can be positive for those who are being treated surgically in the case of the disease. In their study, however, they also refer to the related VSD and the high proportion of trisomy 21 (80.33%, according to their calculations) in their combined occurrence [74].
In cases of other cardiac abnormalities and anomalies of the large blood vessels, the risk of chromosome abnormality is increased [75]. Paladini et al. [70] studied the incidence of the chromosome anomalies in cases of other cardiac and large blood vessel malformations. In the case of coarctation of the aorta, the incidence rate of abnormal chromosomes was 48.28%; in the case of double outlet right ventricle, it was 26.32%; in the case of hypoplastic left heart syndrome, it was 13.51%; in the case of truncus arteriosus, it was 33.33%; in the case of Fallot tetralogy, it was 45%; and in the case of atrial septal defect, there were no abnormal karyotypes found [70].
Other researchers also produced statistics for other heart disorders. Chromosome abnormalities were detected in six cases when investigating 33 fetuses [30].
Only a few authors studied the isolated hydrothorax. Nicolaides carried out karyotyping in three cases because of isolated hydrothorax, in connection with an invasive intervention (blood gained by fetoscopy) performed due to other positive ultrasound findings, and found abnormal karyotype in one case [20]. Estoff et al. carried out karyotyping in 11 cases because of isolated hydrothorax, and in 1 case they found an abnormal karyotype (trisomy 21, 9.09%) [76]. In other studies, in two out of six (33.33%) cases, one case of trisomy 18 (16.67%) and one case of monosomy X (16.67%) associations were observed [30].
In the case of diaphragmatic hernia, abdominal organs appear in the chest due to a discontinuity in the compartment. About 90% of the lesion is on the left. The aperture of the compartment is not traceable; the abdominal organs of the fetus (liver, stomach, and intestines) appear in the chest, which dislocate the mediastinum and the heart. Chest space narrowing may lead to severe lung hypoplasia.
In cases of an omphalocele, organs (typically the intestines, stomach, and liver) protrude through the opening into the umbilical cord; the opening is in the center (median) of the abdominal wall, where the umbilical cord meets the abdomen.
Among the abdominal wall malformations, gastroschisis is a full-thickness defect of the abdominal wall, typically to the right of the umbilical cord, not including it. Through the open abdominal cavity, the small and large intestines protrude; there is no amnioperitoneal membrane covering the exposed organs.
During the ultrasound screening, the “double bubble” is a characteristic sign of duodenal atresia. The two “bubbles” are the distended stomach and dilated proximal duodenum.
Regarding anomalies of the abdominal wall and abdomen, the structural malformations associated with chromosome abnormalities are omphalocele and duodenal atresia. In cases with echogenic bowel—which is a marker and not necessarily abnormal in itself—the risk of trisomy 21 is higher [77, 78, 79, 80]. The etiology of echogenic bowel could be other rare abnormalities (cystic fibrosis, atresia) in addition to the more frequent intrauterine infections [81].
Blancato et al. [82] demonstrated earlier (1992) by in situ hybridization the occurrence of tissue-specific mosaicism in some cases of diaphragmatic hernia. While during lymphocyte culturing there are no detectable anomalies (blood samples via cordocentesis or blood testing of the newborn), in cases of fibroblast samples (genetic amniocentesis and dermal biopsy), 12p isochromosome can be found. Donnenfeld et al. [83] carried out chromosome analysis in 15 cases of diaphragmatic hernia. In all cases they performed lymphocyte culturing (in 14 cases of fetal cordocentesis) in addition to the fibroblast tests. They found chromosome anomalies in seven cases (46.67%), of which there were three cases of trisomy 18, three cases of 12p mosaicism, and one case of other abnormality [83]. From the seven cases of anomalies, there were two with different results of the cells of different origins due to the mosaicism, and the 12p isochromosome was only detectable from the fibroblasts (amniocentesis and dermal biopsy) and not from the lymphocytes gained from the blood. In five cases, the examinations of the lymphocytes and the fibroblasts gave the same results (three cases of trisomy 18, one case of unbalanced translocation, and one case of 12p isochromosome). Huddy et al. studied 35 cases of diaphragmatic hernia, they examined the outcome of the pregnancy and the related abnormalities, and they found chromosome anomalies in 4 cases altogether (11.43%), of which 2 were trisomy 18 [84].
Many authors studied the abdominal malformations and the other anomalies associated with them. According to all data of the literature, the omphalocele (or exomphalos) is associated with chromosome abnormalities in high rates, mainly with trisomy 18, and in smaller proportion with trisomy 13.
Mann et al. in their study of obstetrical events associated with abdominal malformations reported 7 cases of chromosome abnormalities of 19 cases of omphalocele (36.84%) [85]. Rabe et al. processed the results of similar number of ultrasonographic screening during pregnancy, and in 17 omphalocele cases, they have found 6 chromosome anomalies (35.29%) [86]. Nicolaides et al. in 1986 with a smaller number of cases (8 chromosome abnormalities of 12 cases) [20] and later Gilbert and Nicolaides in 1987 with 19 chromosome anomalies of 35 cases demonstrated [87] that the omphalocele detected by ultrasonographic screening increases the risk of chromosome abnormalities.
Many other scientists verified the results of these studies. Nyberg et al. [88] demonstrated chromosome abnormalities in 10 of 26 cases (38.46%), Holzgreve et al. [89] in 5 of 10 cases (50%), Rizzo et al. [90] in 7 of 12 cases (58.33%), and Fogel et al. [91] in 5 of 37 cases. In their recent study with a higher number of cases, Nicolaides et al. detected abnormal karyotypes in 42 of 116 omphalocele cases (36.21%); 32 cases of these were trisomy 18 (27.59%) and in 7 cases trisomy 13 (6.03%) [92]. Snijders et al. [93] found in higher rate abnormal karyotype, mainly trisomy 18, in 12 of 18 cases (66.67%). The following studies demonstrated almost the same results, Dillon and Renwick [94] in 12 of 43 cases (27.91%), Axt et al. [95] in 7 of 26 cases (26.92%), and Rankin et al. [96] in 30 of 98 cases (30.61%), while Stoll et al. [97] have found abnormal karyotypes in 17 cases out of 58 cases (29.31%). The majority of the abnormal karyotypes were trisomy 18. Axt et al. found the risk of chromosome abnormalities four times higher when the liver was placed intracorporeally than when in the extracorporal placement [95]. Barisic et al. [98] processed the data of 19 European centers and described 34 abnormal karyotypes in total for 137 omphalocele cases (24.82%). Most of the chromosomal abnormalities were trisomy 18 (21 cases, 15.33%); they described a lower rate of trisomy 13 (5 cases, 3.65%), one case of trisomy 21 and monosomy X, two cases of triploidy, and four cases of other chromosomal abnormalities. Salihu et al. [99] processed 29 cases, and 3 abnormal karyotypes were detected (10.34%); in all cases the liver was located intracorporeally.
In the study of Beke et al., out of 21 fetuses diagnosed with omphalocele, two cases (9.52%) were associated with different karyotypes, 1 case trisomy 18, and 1 case trisomy 13 [30].
Many investigators studied the gastroschisis cases in parallel with the omphalocele screenings, even though some of the studies were carried out with a smaller number of cases, so the results are not consistent. Rankin et al. found 1 case of chromosome abnormality in 133 gastroschisis cases (trisomy 13, 0.75%) [96]. Barisic et al. [98] also found abnormal karyotypes in 1.89% at a higher number of cases; they described chromosomal abnormalities in 2 out of the total 106 cases, of which 1 was trisomy 21 and the other was trisomy 13.
Other studies with a smaller number of cases did not indicate chromosome abnormalities; Mann et al. [85] studied 10 cases, Nicolaides et al. [20, 92] 3 and 26 cases, Dillon et al. [94] 56 cases, and Axt et al. [95] 18 cases, and they could not detect any abnormal karyotype. Stoll et al. [97] studied 47 cases of gastroschisis, while Salihu et al. [99] described 15 cases; in these cases there were no abnormal karyotypes detected.
Gastroschisis is often associated with other anomalies. Along with polyhydramnios, special attention should be paid to the ultrasound examination of the fetus. This was observed by Ozawa et al. [100] in a study involving the analysis of 52 fetuses. A quarter of them had trisomy (13 cases, 25%), particularly high rates of Edwards syndrome detected in 10 cases, while Patau syndrome in 2 cases and trisomy 21 in 1 case [100].
In contrast, Stoll et al. [101] diagnosed only one fetus with chromosome abnormality in the case of gastroschisis (trisomy 21) representing 1.16% of the patients studied. They also stated that the etiology of omphalocele and gastroschisis is unclear and their pathogenesis is controversial [101].
The ultrasonographic mark of the duodenal obstruction is the “double bubble.” The disease is not always detected intrauterine; therefore some investigators involved the subsequently proven, postnatal cases to their study. Studies demonstrated that it mainly increases the risk of trisomy 21. Nicolaides et al. studied 23 cases and found chromosome abnormalities in 10 cases (43.48%) [92]. Bailey et al. detected 15 cases of chromosome anomalies of the 138 cases (trisomy 21) (10.87%) [102]. This rate at Heydanus et al. was 7 abnormal karyotypes out of 29 cases (24.14%), 6 of which were trisomy 21 [103]. Lawrence et al. found 11 cases of chromosome anomalies of also 29 cases (37.93%), in 8 cases trisomy 21 [104]. Beke et al. found abnormalities in 2 out of 17 studied cases (11.76%), including a trisomy 21 [30].
It is controversial in international literature whether the karyotyping is justified in cases of echogenic bowel. Nyberg et al. was the first to draw the attention to the echogenic bowel increasing mainly the risk of trisomy 21 [105]. Subsequently Scioscia et al. reported 6 cases of chromosome abnormalities of 22 chromosome analyses associated with echogenic bowel (27.27%); in 5 cases trisomy 21 and in 1 case trisomy 18 were found [79]. Bromley et al. carried out 50 karyotyping associated with echogenic bowel and detected abnormal chromosomes in eight cases (16%), six cases of trisomy 21, one case of trisomy 13, and one case of monosomy X [77]. Sipes et al. studied seven cases and detected one case (14.3%) of trisomy 18 [81].
There were two greater studies fully investigating the expectable risk in association with echogenic bowel.
Slotnick and Abuhamad [106] separately screened the different measures of echogenity in their study published in Lancet, classifying them this way: grade1, mild increase of echogenity; grade2, moderate increase; and grade3, pronounced increase. They carried out altogether 145 karyotyping because of echogenic bowel and found abnormal karyotypes (all trisomy 21) in eight cases (5.5%). There were 6 cases of trisomy 21 of the 24 grade3 cases (25%), 2 positive cases of the 81 grade2 cases (2.47%), and no chromosome abnormalities of the 40 cases of grade1. They also studied the incidence of cystic fibrosis, they found 5 cases at grade3 and 2 cases at grade2, and they did not detect any cystic fibrosis at grade1 [106].
Strocker et al. [80] studied those cases separately, where the increasing bowel echogenity was associated with other malformations. They detected abnormal karyotypes in 15 cases of altogether 131 cases (11.45%). In 62 cases, the echogenic bowel was not associated with other positive ultrasonographic findings; in this group, there were 5 chromosome anomalies found, in 4 cases trisomy 21 (6.45%) and 47, XXY karyotype in 1 case. In the other group, there were 69 cases associated with other ultrasonographic findings; 10 of these cases carried chromosome abnormalities, 8 cases trisomy 21 (11.59), 1 case triploidy, and 1 case deletion X [80].
According to the observation of Beke et al., chromosome abnormalities were detected in only 3 out of 53 cases (5.66%), when the ultrasound image of the echogenic bowel was not isolated but associated with other defects [30].
Nicolaides et al. [92] also examined other abdominal malformations. In his study there were 24 cases of karyotyping due to lack of a visible stomach, and he found an abnormal karyotype in 18 cases (75%). In other 24 cases of chromosome analyses due to intestinal dilatation, there was 1 with abnormality (4.17%) [92].
Pyelectasis is the dilatation of only the renal pelvis and the calyces, in milder cases, while when the parenchyma is also affected by the longer lasting compression (becoming thinner), hydronephrosis develops. Obstructions of the urinary tract usually result in the dilatation of the proximal sections. Obstruction of the ureteropelvic junction is the main cause of hydronephrosis in the neonates.
According to some authors, an increase in the size of the renal pelvis elevates the risk of aneuploidies (mainly trisomy 21) [107, 108, 109, 110]. We measure the renal pelvis in a horizontal section in the anteroposterior (AP) direction. We define renal pelvis dilatation (pyelectasis) as a pelvis with an AP dimension ≥5 mm. Hydronephrosis (a renal pelvis ≥10 mm) and enlarged, echogenic kidneys increase the risk of trisomy 13.
Benacerraf et al. [107] studied 210 cases of fetuses with pyelectasis. They found trisomy 21 in 7 of the 210 cases (3.33%). The suggested criteria for pyelectasis were the following cutoff values, ≥4 mm until week 20 and ≥5 mm in weeks 21–30, and after week 30 the limit should be ≥7 mm [107]. Corteville et al. studied 127 cases and detected chromosome abnormalities in 7 cases (5.51%), 4 of these were trisomy 21 (3.15%) [109]. They suggested that until week 33 the cutoff value should be ≥4 mm; after week 33 this limit would be ≥7 mm. Under comparable conditions (121 cases, similar cutoff values), Wickstrom et al. found chromosome anomalies in three cases (2.48%), two of which were trisomy 21 (1.65%) [111].
Nicolaides et al. reported in their study 35 abnormal karyotypes that are found in cases of 258 fetuses with pyelectasis (13.57%) [92]. Their recommended cutoff value was ≥5 mm as a criteria for pyelectasis. Chudleigh et al. carried out chromosome analysis using 5 mm cutoff value in 737 cases of fetal pyelectasis. Studying the results of the karyotyping, they found abnormal chromosomes in 12 cases (1.63%), and 6 of these were trisomy 21 (0.81%) [108]. Besides less number of cases, other scientists did not verify the higher rate of chromosome anomalies. Gonen et al. found no abnormal karyotypes in 58 cases of fetal pyelectasis [8].
Beke et al. [30] processed 302 cases, of which 7 (2.32%) were found to have abnormalities. Of these, 1-1 cases of trisomy 21 and trisomy 18, two cases of monosomy X, and three cases of other chromosome abnormalities were found [30].
According to the findings of a 2006 study, contrary to previous opinions that male fetuses had a higher rate of chromosome abnormalities associated with pyelectasis, they refuted this. According to this new article by Bronstein et al. [112], there is no significant difference between the sexes in the karyotype associated with the anatomical disorder. When investigating 672 cases, 35 (5.21%) cases of abnormal karyotype occurred [112].
Based on Coco’s and Jeanty [113]’s findings, pyelectasis alone does not justify an amniocentesis if it is not associated with anatomical and other abnormalities. However, 3.01% of their cases were associated with chromosome abnormalities as well [113].
Measuring the length of fetal femur and more recently the humerus is part of the biometric test. Following the limbs of the fetus, the joints, the hands, and the feet and their deviations can be brought into the field of vision. Limb disorders may appear independently or as part of syndromes, causing extensive ossification anomalies. Most disorders can be rarely recognized prenatally.
On the basis of several studies of cases with shortened long bones (femur and humerus), the incidence rate for the abnormal karyotypes is elevated. According to the literature, a shortened humerus is a more sensitive indicator. Mainly the risk of trisomy 21 increases [114, 115, 116, 117].
Studying the long bones, the main ambition of the investigators was to determine the proper method to estimate the measure of the retardation in growth, which increases the risk of chromosome abnormalities. The two main methods are fundamentally different. Some investigators calculate with the observed/expected ratio (O/E ratio) and determine the proper cutoff value by expressing the quotient in percentile (≤0.91) [8, 115]. Other scientists calculate on the basis of the quotient of biparietal diameter (BPD) and femur length (FL) (BPD/FL) and consider abnormal the measure of >1.5 SD [114]. Calculating with both methods, most investigators found significant differences between the fetal groups of normal chromosomes and those with chromosome abnormalities. According to some authors, the difference was not significant [118, 119].
Nyberg et al. [115] examined separately the parameters (O/E ratio) in the case of the humerus and femur and suggested the following cutoff values: humerus ≤0.89 and femur ≤0.91. If both the femur and the humerus are shortened according to the given cutoff values, the risk of trisomy 21 increased 11-fold [115].
Recent studies include both methods. In their report Snijders et al. draw the attention to the fact that although they found significant differences using both methods (O/E ratio, BPD/FL) between fetal groups of normal karyotype and trisomy 21, the screenings before week 18 of gestation are less suitable to predict trisomy 21 [116]. Vergani et al. [117] did not find a significant difference between measuring the O/E ratio and using the BPD/FL method; the difference reached the significance limit (p = 0.04). According to their report, the measurement of femur length is connected with the population, and each center should determine the cutoff values dependent on the population on their own [117].
According to a study, chromosome abnormalities occurred in 16% in cases of shortened tubular (long) bones, including 8% of trisomy 18 and 4-4% of monosomy X and trisomy 21 [30].
A Danish publication processed the data of 2718 fetuses detected with shortened femur between the gestational weeks of 17–22, of which 2.5% had chromosome abnormalities. In 11 cases, trisomy 21, in 3 cases trisomy 13, and in 8 cases trisomy 18 were found. Chromosome abnormalities were associated with a higher proportion of these anatomical disorders in the second trimester than the first trimester [120].
Other malformations of the extremities increase the risk of trisomy 21 (clinodactyly, widened pelvic angle, sandal gap), trisomy 13 (postaxial polydactyly, clubbed or rocker-bottom feet), and trisomy 18 (clenched hands, overlapping digits, radial aplasia, limb shortening, clubbed feet) [48].
Ultrasound examinations play an important role during pregnancy, by drawing the attention to the suspect of a possible abnormality. The prenatal screening of minor ultrasound signs and major ultrasound anomalies and diagnostics is a very important part of the health service. The intrauterine screening and diagnostic methods, the ultrasound screening during the pregnancy, and the cytogenetic and molecular genetic examinations in the genetic centers made the early, intrauterine diagnosis of the chromosomal abnormalities possible.
The authors declare no conflict of interest.
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Shohel"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"1330",title:"Ethnic Studies",slug:"ethnic-studies",parent:{id:"275",title:"Social History",slug:"social-history"},numberOfBooks:2,numberOfSeries:0,numberOfAuthorsAndEditors:26,numberOfWosCitations:10,numberOfCrossrefCitations:13,numberOfDimensionsCitations:15,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicId:"1330",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"8522",title:"Indigenous, Aboriginal, Fugitive and Ethnic Groups Around the Globe",subtitle:null,isOpenForSubmission:!1,hash:"500f04edfaf31487a6637ec914cff04d",slug:"indigenous-aboriginal-fugitive-and-ethnic-groups-around-the-globe",bookSignature:"Liat Klain-Gabbay",coverURL:"https://cdn.intechopen.com/books/images_new/8522.jpg",editedByType:"Edited by",editors:[{id:"257515",title:"Dr.",name:"Liat",middleName:null,surname:"Klain Gabbay",slug:"liat-klain-gabbay",fullName:"Liat Klain Gabbay"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5866",title:"Indigenous People",subtitle:null,isOpenForSubmission:!1,hash:"855fd54af0a1f830ea8d0ee1519387dc",slug:"indigenous-people",bookSignature:"Purushothaman Venkatesan",coverURL:"https://cdn.intechopen.com/books/images_new/5866.jpg",editedByType:"Edited by",editors:[{id:"198936",title:"Dr.",name:"Purushothaman",middleName:null,surname:"Venkatesan",slug:"purushothaman-venkatesan",fullName:"Purushothaman Venkatesan"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:2,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"56259",doi:"10.5772/intechopen.69889",title:"Indigenous Knowledge Systems for Appropriate Technology Development",slug:"indigenous-knowledge-systems-for-appropriate-technology-development",totalDownloads:4035,totalCrossrefCites:6,totalDimensionsCites:7,abstract:"Indigenous knowledge systems (IKS) comprises knowledge developed within indigenous societies, independent of, and prior to, the advent of the modern scientific knowledge system (MSKS). Examples of IKS such as Ayurveda from India and Acupuncture from China are well known. IK covers diverse areas of importance for society, spanning issues concerned with the quality of life - from agriculture and water to health. The IK resident in India and China have high relevance to rural life, especially given the level of engagement with agricultural and health technologies. The goal is to establish a heuristic whereby IK can be reviewed and evaluated within particular contexts to determine if the IKS can lead to the development of appropriate technology (AT) addressing that need sustainably. Although much work on cataloguing and documenting IKS has been completed in these two countries, a paucity of attention has been paid to the scientific rationale and technological content of these IKS. Evaluation of many indigenous technologies reveal that many of these technologies can be classified as ‘appropriate’, focused on basic needs of water, sanitation and agriculture, and many have origins in IKS that survived. Thus, IKS must be validated, exploited and integrated into AT innovation and development.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"John Tharakan",authors:[{id:"198534",title:"Prof.",name:"John",middleName:null,surname:"Tharakan",slug:"john-tharakan",fullName:"John Tharakan"}]},{id:"56510",doi:"10.5772/intechopen.69890",title:"Role of Traditional Ethnobotanical Knowledge and Indigenous Institutions in Sustainable Land Management in Western Highlands of Kenya",slug:"role-of-traditional-ethnobotanical-knowledge-and-indigenous-institutions-in-sustainable-land-managem",totalDownloads:2572,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"The objective of this chapter is to elucidate the relevance of indigenous knowledge and institutions in natural resource management using western highlands of Kenya as a case study. The research design was a mixed method, combining qualitative and quantitative methods. A total of 350 individuals (comprising farmers, herbalists and charcoal burners) from households were interviewed using a structured questionnaire, 50 in-depth interviews and 35 focus group discussions. The results show that indigenous knowledge and institutions play a significant role in conserving natural resources in the study area. There was gender differentiation in knowledge attitude and practice (KAP) of indigenous knowledge as applied to sustainable land management. It is recommended that deliberate efforts should be put in place by the County Governments to scale up the roles of indigenous institutions in managing natural resources in the study area.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Chris A. Shisanya",authors:[{id:"200734",title:"Prof.",name:"Chris",middleName:null,surname:"Shisanya",slug:"chris-shisanya",fullName:"Chris Shisanya"}]},{id:"56426",doi:"10.5772/intechopen.70104",title:"Indigenous Resource Management Practices and the Local Social-Cultural Context: An Insight towards Self-Directed Resource Management by People who ‘Coexist’ with Supernatural Agents",slug:"indigenous-resource-management-practices-and-the-local-social-cultural-context-an-insight-towards-se",totalDownloads:1733,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"In recent arguments in the governance of natural resource management, effectiveness and desirability of collaborative management among various stakeholder including indigenous people has been recognized. In the context of Indonesia, the reformation movement has stimulated the growth of a new perception of indigenous people’s rights to their land in the country. This recent transition presents a growing opportunity for indigenous people who live in nature-rich areas (national parks, etc.) to collaborate with ‘outside stakeholders’ such as governmental agencies, scholars and environmental NGOs in natural resource management. In such situations, it is necessary to deeply understand the value of indigenous resource management (IRM) practices to promote self-directed and effective resource management. This chapter focuses on local forest resource management and its suitability in the local social-cultural context in central Seram, east Indonesia. First, I describe how the well-structured forest resource use is constructed and maintained through the indigenous resource management practices based on ‘supernatural enforce mechanism’. After that, I investigate what social-ecological roles the IRM in Amanioho has, and how IRM practices relate to the social-cultural context of an upland community in central Seram. Then, I discuss the possible future applications for achieving self-directed resource management by people who ‘coexist’ with supernatural agents.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Masatoshi Sasaoka",authors:[{id:"198898",title:"Dr.",name:"Masatoshi",middleName:null,surname:"Sasaoka",slug:"masatoshi-sasaoka",fullName:"Masatoshi Sasaoka"}]},{id:"56601",doi:"10.5772/intechopen.69887",title:"Revisiting Indigenous Biotic and Abiotic Weather Forecasting for Possible Integration with Scientific Weather Prediction: A Case from the Borana People of South Ethiopia",slug:"revisiting-indigenous-biotic-and-abiotic-weather-forecasting-for-possible-integration-with-scientifi",totalDownloads:1639,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"This study assesses how Borana herders make weather forecast using abiotic and biotic indicators. Survey questionnaire, observations, focus group discussions, and key informant interview were employed to obtain data. Field data were analyzed and interpreted using appropriate analytical tools and procedures. The result revealed that the Borana herders have time-tested weather forecasting experience of using astrological, intestinal, plant, and animal body language indicators. Astrological and intestinal readings that need special training and local expertise are known as Urgii Elaltus and Uchuu, respectively. Forecast information is disseminated using the Borana sociocultural institutions. Based on the disseminated forecast information, the Borana herders take measures such as strengthening enclosure, storing hay, migrating with animals, destocking, and changing schedules of social and cultural festivities such as wedding. The precision and credibility of traditional weather forecast steadily declined and led to repeated faulty predictions. Poor documentation and knowledge transfer system, influence of religion and modern education, premature death of forecast experts, and expansion of alcoholism were identified as causes undermining the vitality of Borana indigenous weather forecast. It is high time that the tenets of indigenous weather forecasting be assessed scientifically and be integrated into the modern science of weather forecasting before they vanish.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Desalegn Yayeh Ayal",authors:[{id:"198164",title:"Dr.",name:"Desalegn",middleName:"Yayeh",surname:"Ayal",slug:"desalegn-ayal",fullName:"Desalegn Ayal"}]},{id:"67479",doi:"10.5772/intechopen.86677",title:"Exploring Aboriginal Identity in Australia and Building Resilience",slug:"exploring-aboriginal-identity-in-australia-and-building-resilience",totalDownloads:1307,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter will discuss the challenges faced by Aboriginal people seeking recognition of their identity as Indigenous Australians. It will explore government policies, their impact on identity formation and the ongoing impact of colonisation on education and health outcomes for Indigenous people in Australia. The issues raised will include historical and contemporary experiences as well personal values and attitudes. The strategies and programs introduced within educational settings as part of an inclusive practice regime will be highlighted. Aboriginal people have faced many challenges, and continue to do so in postcolonial times, including challenges to their identity.",book:{id:"8522",slug:"indigenous-aboriginal-fugitive-and-ethnic-groups-around-the-globe",title:"Indigenous, Aboriginal, Fugitive and Ethnic Groups Around the Globe",fullTitle:"Indigenous, Aboriginal, Fugitive and Ethnic Groups Around the Globe"},signatures:"Clair Andersen",authors:[{id:"296447",title:"Associate Prof.",name:"Clair",middleName:null,surname:"Andersen",slug:"clair-andersen",fullName:"Clair Andersen"}]}],mostDownloadedChaptersLast30Days:[{id:"56426",title:"Indigenous Resource Management Practices and the Local Social-Cultural Context: An Insight towards Self-Directed Resource Management by People who ‘Coexist’ with Supernatural Agents",slug:"indigenous-resource-management-practices-and-the-local-social-cultural-context-an-insight-towards-se",totalDownloads:1737,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"In recent arguments in the governance of natural resource management, effectiveness and desirability of collaborative management among various stakeholder including indigenous people has been recognized. In the context of Indonesia, the reformation movement has stimulated the growth of a new perception of indigenous people’s rights to their land in the country. This recent transition presents a growing opportunity for indigenous people who live in nature-rich areas (national parks, etc.) to collaborate with ‘outside stakeholders’ such as governmental agencies, scholars and environmental NGOs in natural resource management. In such situations, it is necessary to deeply understand the value of indigenous resource management (IRM) practices to promote self-directed and effective resource management. This chapter focuses on local forest resource management and its suitability in the local social-cultural context in central Seram, east Indonesia. First, I describe how the well-structured forest resource use is constructed and maintained through the indigenous resource management practices based on ‘supernatural enforce mechanism’. After that, I investigate what social-ecological roles the IRM in Amanioho has, and how IRM practices relate to the social-cultural context of an upland community in central Seram. Then, I discuss the possible future applications for achieving self-directed resource management by people who ‘coexist’ with supernatural agents.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Masatoshi Sasaoka",authors:[{id:"198898",title:"Dr.",name:"Masatoshi",middleName:null,surname:"Sasaoka",slug:"masatoshi-sasaoka",fullName:"Masatoshi Sasaoka"}]},{id:"56259",title:"Indigenous Knowledge Systems for Appropriate Technology Development",slug:"indigenous-knowledge-systems-for-appropriate-technology-development",totalDownloads:4043,totalCrossrefCites:6,totalDimensionsCites:7,abstract:"Indigenous knowledge systems (IKS) comprises knowledge developed within indigenous societies, independent of, and prior to, the advent of the modern scientific knowledge system (MSKS). Examples of IKS such as Ayurveda from India and Acupuncture from China are well known. IK covers diverse areas of importance for society, spanning issues concerned with the quality of life - from agriculture and water to health. The IK resident in India and China have high relevance to rural life, especially given the level of engagement with agricultural and health technologies. The goal is to establish a heuristic whereby IK can be reviewed and evaluated within particular contexts to determine if the IKS can lead to the development of appropriate technology (AT) addressing that need sustainably. Although much work on cataloguing and documenting IKS has been completed in these two countries, a paucity of attention has been paid to the scientific rationale and technological content of these IKS. Evaluation of many indigenous technologies reveal that many of these technologies can be classified as ‘appropriate’, focused on basic needs of water, sanitation and agriculture, and many have origins in IKS that survived. Thus, IKS must be validated, exploited and integrated into AT innovation and development.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"John Tharakan",authors:[{id:"198534",title:"Prof.",name:"John",middleName:null,surname:"Tharakan",slug:"john-tharakan",fullName:"John Tharakan"}]},{id:"56510",title:"Role of Traditional Ethnobotanical Knowledge and Indigenous Institutions in Sustainable Land Management in Western Highlands of Kenya",slug:"role-of-traditional-ethnobotanical-knowledge-and-indigenous-institutions-in-sustainable-land-managem",totalDownloads:2574,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"The objective of this chapter is to elucidate the relevance of indigenous knowledge and institutions in natural resource management using western highlands of Kenya as a case study. The research design was a mixed method, combining qualitative and quantitative methods. A total of 350 individuals (comprising farmers, herbalists and charcoal burners) from households were interviewed using a structured questionnaire, 50 in-depth interviews and 35 focus group discussions. The results show that indigenous knowledge and institutions play a significant role in conserving natural resources in the study area. There was gender differentiation in knowledge attitude and practice (KAP) of indigenous knowledge as applied to sustainable land management. It is recommended that deliberate efforts should be put in place by the County Governments to scale up the roles of indigenous institutions in managing natural resources in the study area.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Chris A. Shisanya",authors:[{id:"200734",title:"Prof.",name:"Chris",middleName:null,surname:"Shisanya",slug:"chris-shisanya",fullName:"Chris Shisanya"}]},{id:"56296",title:"Empowering Namibian Indigenous People through Entrepreneurship: The Case from the Nama People",slug:"empowering-namibian-indigenous-people-through-entrepreneurship-the-case-from-the-nama-people",totalDownloads:1595,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The challenge emanating from the colonial and apartheid regimes on the Nama people of Namibia have not only resulted in them losing nearly half of its population, but they also appeared to have lost their social identity. To that end we continually find convergences and divergences in clothing and accessories, food, traditional dances, homes, and traditional beauty cosmetics, between the past and present. This chapter seeks to explore whether the Nama people have always used money to acquire the aforementioned past? If not, what have they done right in the past to acquire all these items? These are one of the few questions this chapter seeks to explore and understand, and the role Nama entrepreneurial activities play for their own socio-economic advancement. Critical discourse can lead to a better understanding and appreciation of entrepreneurship among indigenous people in Namibia. This will in turn result in an enhanced understanding of the role entrepreneurship and culture can play in both a local and international context. After a brief introduction to Namibia and the Nama people, the cultural values and entrepreneurial initiatives of the Nama people are discussed, followed by discussions, recommendations and conclusions. Research methods employed were in-depth interviews and participant observation.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Wilfred Isak April, Daniel Ileni Itenge, Josef Petrus Van der\nWesthuizen and Lazarus Shimwaningi Emvula",authors:[{id:"110034",title:"Dr.",name:"Wilfred",middleName:"Isak",surname:"April",slug:"wilfred-april",fullName:"Wilfred April"},{id:"204208",title:"Mr.",name:"Daniel",middleName:"Ileni",surname:"Itenge",slug:"daniel-itenge",fullName:"Daniel Itenge"},{id:"204209",title:"Mr.",name:"Lazarus",middleName:null,surname:"Emvula",slug:"lazarus-emvula",fullName:"Lazarus Emvula"},{id:"204916",title:"Mr.",name:"Josef",middleName:"P.",surname:"Van Der Westhuizen",slug:"josef-van-der-westhuizen",fullName:"Josef Van Der Westhuizen"}]},{id:"55689",title:"Usages and Customs of the Indigenous Communities in Favour of the Reduction of the Digital Divide: A Case Study of the Ñuu Savi People",slug:"usages-and-customs-of-the-indigenous-communities-in-favour-of-the-reduction-of-the-digital-divide-a-",totalDownloads:1247,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This research is of ethnographic nature, focusing on the study of the Ñuu Savi people (people of the rain), also called the Mixtec people, of pre-Columbian origin belonging to the Mixteca Region of the state of Oaxaca, Mexico. On the basis of sociocultural theory and the theory of the diffusion and adoption of technological innovations, the study on the cultural identity of the ethnolinguistic group, whose social platform is the “uses and customs,” is carried out. As a result of this research, the descriptive analysis is presented, detailing the effect of information and communication technologies (ICTs) on the situation of the vulnerable and disadvantaged group. Likewise, cultural elements have been identified that allow the formulation of a model for the development and inclusion of the ethnic minority. An educational strategy is designed and implemented through the model. However, in the process of implementing the educational strategy, it was observed that the Ñuu Savi people experience a conjunctural stage where technological adoption coexists with some beliefs, aptitudes, and attitudes, characteristic of its form of government of “uses and customs,” which create sociocultural barriers that make social and digital inclusion difficult.",book:{id:"5866",slug:"indigenous-people",title:"Indigenous People",fullTitle:"Indigenous People"},signatures:"Olivia Allende-Hernández and Jesús Salinas",authors:[{id:"198235",title:"Dr.",name:"Olivia",middleName:null,surname:"Allende-Hernández",slug:"olivia-allende-hernandez",fullName:"Olivia Allende-Hernández"},{id:"201435",title:"Dr.",name:"Jesús",middleName:null,surname:"Salinas",slug:"jesus-salinas",fullName:"Jesús Salinas"}]}],onlineFirstChaptersFilter:{topicId:"1330",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:287,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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