Topical hemostatic agents.
\r\n\tThis book will intend to look at different migrant patterns, voluntary and involuntary migration, over the last three centuries. What influenced people to leave their home countries, family, and friends and settle somewhere else? The book may include histories of the 19th century, consider tragedies and movements activated by political events in the 20th century, and/or look at recent events of the 21st century. Push and pull factors are important points. While most of us may be influenced in a negative way by the current happenings in Eastern Europe, the Russian invasion and resulting tragedies also demonstrate some very positive human traits – the preparedness of Ukraine’s surrounding countries to help those in need and to provide a safe place for the present.
\r\n\tWhether one looks at voluntary or involuntary migration into any country, after a period of adjustment, migrants do play a positive role. The research found that migrants contribute to the economy (food, shelter, employment, tax) and enrich a country’s cultural norms. Prerequisites for successful settlements are that the host society adopts a tolerant approach and that the migrants recognize the law and the language of the host country. Nothing is ever easy or without controversy, but I am a migrant (German Australian), and life in Australia has been relatively harmonious. Issues that could be considered in the book are multicultural societies (do monocultural societies still exist?) and theories of acculturation versus integration (settlement processes).
\r\n\tTwo further issues are very important in relation to human migration. There is climate change, global warming, and the environment, which clearly affect people’s movement. Small island populations are very concerned about rising sea levels. 2021 has also seen floods costing human lives: Turkey (August 2021), Brazil (December 2021), Chile (January 2021), and South India (November 2021), to name but a few. In Australia (March 2022), farms and whole townships in New South Wales and Queensland have been flooded for the second time in five years, and plans to resettle these towns are considered. Official and social media provide ample coverage of the events, which leads me to the next issue. There is today’s very important role of the media, of the official and social media. We are constantly bombarded with images of human war tragedies and flood victims. People in industrialized, western countries must be the best-informed populace. How far do the images and up-to-date TV news influence us, make us change our behavior, and perhaps even consider us more generous than we have been?
\r\n\tClimate change and the media are relatively new to the human migration debate, but both issues play important parts, and some interesting discussions are appreciated.
\r\n\t
By introducing students to the fundamentals of robotics in an informal, playful setting, extracurricular school laboratories are an effective way to encourage interest in computer science or other technology-related topics. In working with LEGO Mindstorms, a set of soft- and hardware to build programmable robots, they get a chance to learn on a cognitive, emotional, and haptic level. Unfortunately, not every pupil is able to participate in courses like these due to a lack of accessibility. For example, Ludi states that “awareness of potential career paths and access to adequate preparation remain barriers to students who are visually impaired” [1]. For pupils who are visually impaired or blind, it is essentially impossible to fully participate in a programming process or in building a robot.
The Center for Learning and Knowledge Management, in conjunction with the Institute of Information Management in Mechanical Engineering of RWTH Aachen University and a group of experts, set out to develop a special and accessible course for the visually impaired and blind students. The experts consulted a group of psychologists, school and university teachers, and experts in the field of accessibility as well as in robotics. They took the original course design from an existing robotics course for high school students and transformed it into an accessible course design. The original course consists of theoretical input about building robots and programming as well as the subsequent practical phases, in which the students apply their knowledge on EV3 roboters. At the beginning of each course, the robotic equipment is explained and the problem that needs to be solved is presented. The students—in compliance with the supervisors—then analyze the problem and identify the necessary steps to be taken and in doing so, the desired outcomes of the experiment are met. The applied combination of both theoretical and practical factors has proven to facilitate an authentic learning environment and strong learning results [2]. However, developing a new and adequate course simply by applying technical adjustments is not sufficient. Therefore, all changes applied to the course went hand in hand with an adjustment of teaching and learning strategies.
When designing a programming course for pupils with disabilities, it is crucial to develop these strategies as well as a list of the required tools as a first step. From the gathered findings, the resulting new course design allows students who are visually impaired to participate in the same courses and benefit from the same experiences—such as programming and building a robot—as their fellow pupils. This paper will present an overview of types of visual impairment, different lab settings and an insight into the original course design. This will be followed by results from the expert design workshops in terms of technical and didactic adjustments to the course. Finally, the paper will conclude with the full development cycle of the courses at RWTH Aachen University from design to testing, implementation, and further development.
Vision, as one of our five senses, enables us to learn about our environment. Being able to see not only helps us to orientate ourselves but also shapes our perception of the world and all it has to offer. Not everyone, however, possesses full vision. “Many people have some type of visual problem at some point in their lives” [3]. Some minor problems can occur, for instance: in seeing objects that are far away (near-sightedness) or that are extremely close or in very small print (far-sightedness). “These types of conditions are often easily treated with eyeglasses or contact lenses” [3].
According to the World Health Organization (WHO), apart from these minor eye problems, “285 million people are estimated to be visually impaired worldwide: 39 million are blind and 246 have low vision” [4]. Other key facts from the WHO about visual impairment state that around “90% of the world\'s visually impaired live in low-income settings,” “82% of people living with blindness are aged 50 and above” and that 80% of all visual impairment can be prevented or cured [4]. Many people worldwide are only visually impaired because they do not have access to reading aids or medical care in general; most people with visual impairment come from low-income or developing countries. “Globally, uncorrected refractive errors are the main cause of moderate and severe visual impairment; cataracts remain the leading cause of blindness in middle- and low-income countries” [4]. The risk of going blind is estimated to be 10 times higher in developing countries than in industrialized countries [5]. In comparison to persons with low vision, persons who suffer from blindness face additional challenges. These can manifest themselves in social challenges by the difficulty of participation in social activities and events, navigation and orientation in unfamiliar environments as well as difficulties in using technology such as computers and smartphones. Although many people with blindness use tools such as blind rods, screen readers, and other helpful measures, not everyone has the financial background or even enough self-esteem to counterbalance the previously mentioned disadvantages.
According to the National Eye Institute in the United States, “less familiar visual impairments include:
Retinitis pigmentosa,
In contrast, there are no reliable numbers of visually impaired children and teenagers in Germany. Nevertheless, visual impairment is a big issue and causes imbalances, particularly in education, higher education and career opportunities, especially in Science, Technology, Engineering and Mathematics (STEM) focused education. The robotics courses for students with visual impairment or blindness at RWTH Aachen therefore aim to overcome these inequalities.
The current technological developments being triggered by Industry 4.0—the combination of industrial production with modern means of communication—as well as digitalization in general pose major challenges for robotic education; hence, the demand for students from fields affiliated with science, technology, engineering, mathematics, and robotics in particular is steadily increasing. Due to concern related to this increasing demand for future engineers and the significance of qualitative scientific and technological education, universities and other seats of learning are focusing on secondary school students. Hence, since 1990, school labs have been an important component of German universities [6, 7].
Student laboratories are extracurricular educational institutions, which allow children, pupils, and students to experience science. New devices and technology can be used and tested for clear understanding and unconventional learning of modern research techniques. These laboratories often focus on natural science fields and foster insight from range of topics in a field of study. Extracurricular learning venues of universities, which are concerned with robotic science are often available exclusively for students and scientists. Furthermore, many schools do not have the resources to purchase devices and equipment in order to implement laboratories in class. The school laboratories of RWTH Aachen University, in contrast, focus on those pupils and younger students and enable them to discover distinct capabilities while learning by testing and playing.
Around the globe, there are laboratories available that also work in equal or related fields of robotics, though very few are constantly available for secondary school students. This is largely due to the fact that equipment is often very expensive, difficult to acquire, and too conceptually complex for young persons to use. The special challenge of the RoboScope (http://www.robo-scope.de/home.html) of RWTH Aachen University is to give students—both sighted as well as visually impaired or blind—something that inspires them and makes them curious. By giving them an achievable, yet challenging task, it aims to foster a desire to work in a respective field of engineering. In the following, a few examples of robotics labs for students in different parts of Germany will be presented.
Other universities like the Technical University of Hamburg/Harburg cooperate with companies to encourage pupils to learn programming skills. For instance, they offer seven different courses based on interests and experiences at the university, which may consist of weekly meetings at the school or participation in a voluntary project team. In different modules, such as a trial course, pupils learn while using LEGO Mindstorms robots and basic graphic programming. In higher modules, they get introduced to programming languages like C and C++, soldering and building a LEGO-Mindstorm robot [8].
The concept of offering certain courses based on a student’s interests and experiences is also common across other universities or institutions. The Technical University of Kaiserlautern provides three different classes, from basic programming to getting a robot to follow lines in a labyrinth up to a course in preparation for a robotics tournament. The main field of attention lies in sensor technology with the aid of tactile, light, and ultrasonic sensors [9].
The “TUMLab,” the Technical University of Munich’s lab situated in the German Museum, offers a similar course based on this technology. In five different modules, pupils get to know diverse sensors and how to apply them ingeniously. Herein, lies the main goal of getting a robot to find its way around autonomously [10].
The “Technikum29” in Kelkheim-Hornau in Germany offers a workshop for learning about and using sensors, branches, subprograms, busses, interrupts, and how to develop logical decisions and games using a Raspberry Pi and similar single-board computers. As a distinguishing factor from the robotics summer camp of the University of Darmstadt, which focuses on ages 10–14, the Technikum29 requires its participants to be at least 14 years old. At the robotics summer camp, younger pupils learn to communicate using Bluetooth technologies and to build their own robot with a LEGO Mindstorms packet. Older pupils get to discover and solve problems and tasks given from the instructors, who are computer science students at the University of Darmstadt. Both courses take place during 1 week of the summer holiday and have included children with disabilities since 2013 [11].
In Switzerland, the ETH Zürich focuses on preschool children and offers a “Bee-Bot” kit that consists of a child-friendly bee-shaped robot. Teachers can rent six small robots, playing cards, and teaching accessories such as activity mats and charging stations for 2 weeks. The small robots are programmable with four buttons and can be moved over a map easily. Before renting those sets, teachers get a short workshop at ETH where they learn about basic robotic science.
Elementary schools can participate in a similar project. Teachers are trained by a research team from ETH, who also give advice and support while using the technology in the classroom. Topics of this project are the concept of computational thinking and the functionality of robots. Lessons are arranged as project-based learning, and pupils learn to program robots playfully.
A different project of the ETH is the “RoboMINT” in which children learn to build a robot. In a “Dancebot course,” pupils learn to solder and program a dance-choreography for the robot they have built. A second course uses small lights attached to a robot and a camera with long time exposure to draw a picture. For the picture, the robot uses a coded paper to follow lines. The sets can be rented for free [12].
The DNA Learning Center (DNALC), which is promoted by the United States of America’s Cold Spring Harbor Laboratory, a private, not-for-profit research and education institution at the forefront of molecular biology and genetics, offers class field trips and summer schools devoted entirely to public genetics education [13].
Besides RWTH Aachen University and the Technikum29, the Bayer Science & Education Foundation has provided Anna-Freud-School in Cologne with an accessible laboratory for pupils. Laboratory equipment and computerized workplaces were purchased with the budget of 22,000 Euros. These new features allow children with disabilities to work on projects independently and to identify and nurture talents early. In this way, the school is able to promote pupils who are physically disabled or have a chronic or psychosomatic illness. The Foundation supports projects, which are used to complement lessons in school and to draw interest in natural science and technology [14].
The Perkins School for the Blind in Massachusetts (USA) offers short courses in robotics for secondary school students (Grades 6–10), who can learn about the highly sought-after skills of mechanical and electrical engineering, computers, math, and science. Participants work with their peers and knowledgeable staff to build basic robots and program them to complete simple tasks. Inconveniently, though, this course is currently not offered on a regular basis.
Learning about robotics is an enjoyable and exciting way for students to increase knowledge in the areas of science, mathematics, and technology and provide students with an opportunity to gain first insights. Our extensive research has shown that around the globe, there are laboratories available that also work in equal or related fields of robotics, though very few are both constantly available for students and offering a chance at hands-on experience.
To foster an interest in STEM-fields, it is necessary to involve pupils in the process of programming a robot playfully. Technical universities in Germany and Switzerland already offer a broad range of courses for pupils to learn basic programming starting at a young age. In recent years, reform efforts in science curriculum have stressed the integration of educational technology into teaching and learning purposes. Teachers and educators face the challenge and the chance to explore inventive ways in which new technologies can be utilized to improve accessibility to science for students with visual impairments. Integrating students with disabilities in student laboratories is an effort that not only encourages interest in STEM-fields but also shows these individuals opportunities for their future careers. Technological resources for people who are visually impaired, like Braille generating software, Braille printers, screen-reader software, and speech synthesizers, already exist.
Teachers, educators, and educational institutions need to realize the student-oriented benefits and put more effort into accommodating students with (visual) impairments in STEM education. An awareness, and furthermore, an understanding of the academic needs of students with (visual) impairments are essential in striving toward this goal. Unless many institutions and educators stress the need to integrate students with (visual) impairments in their scientific programs, there is still a long way to go. Fully accessible participation in science will be beneficial for all students and a rewarding experience for teachers.
At RWTH Aachen University, high school students are given the chance to gain insight by using LEGO Mindstorms construction sets in a school laboratory and constructing and programming various robot models. They are using the graphical programming interface NXT-G to discover an easy introduction to programming, since it is suitable for nonprofessionals [15].
To prepare and motivate students for a future career in robotics, the course program allows students to try their hand at building, programming, and testing robots in a highly interactive and playful environment. In order to captivate students, the course allows them to create either a “rescue robot” [16] that can search for virtual victims in a simulated rescue mission or a “rattlesnake” that snaps shut when someone crosses its field of vision. The choice of the scenario is subject to the age of the students—lower grades create a rattlesnake, (which is easier to build and to program) while junior and senior classes go on a more complex rescue mission. The four main phases of the course are: the introduction, which gives basic information; the construction; the programming process; and the reflection or evaluation phase. To follow along a learning process, the underlying didactic course concept focuses on individual practical, experimental, and playful experiences [15]. In accordance with the feedback of the course participants, this course design was chosen to build up an extracurricular learning venue for students with visual impairment and blindness to give them first insights into robotics.
The educational laboratory is not located at the students’ respective schools; rather, it has been set up at RWTH Aachen University. This allows high school students to take a peek into the daily routine at university and is also meant to facilitate the decision-making process when it comes to choosing further steps after graduating from high school [17].
To facilitate the process of redesigning the robotics course in order to reach a higher level of accessibility for students with visual impairment as well as blindness, researchers from RWTH Aachen University invited a team of interdisciplinary experts to a series of workshops. The roadmap of the redesign was developed within these workshops. The main goal was defined as follows: to identify the key aspects of required adjustments.
During the workshops, the participants gradually developed a grid of these requirements. In a first step, they divided the course into its individual phases based on the established approach by Vieritz et al. [18]. They used the different phases of the course and analyzed the requirements and necessary adjustments for each individual part compared to those of the original course design. These phases consist of the introductory part, the construction phase, the programming phase and the phase for reflection. Combining their different experiences and testing single elements by simulating specific eye dysfunctions, the experts came to results in terms of requirements for each phase. These results are presented and discussed in the chapters below, which are divided into technical as well as didactic adjustments. At the end of chapter three, the developed grid gives a summarized overview of the results from the workshops.
According to the results of the design workshops, the identified requirements especially include auxiliary means, which can be summed up as objects, software, and computer settings. There are a lot of different eye dysfunctions which call for support by varying objects, for example, magnifiers and common magnifying glasses. Other important objects for different phases of the course are cameras and reading devices, printed handouts for every phase, additional lighting for the building process, and sorting boxes for robot components.
In terms of software, screen readers such as JAWS or Dolphin, graphic programming using, for example, NXT-G [14] as well as textual programming using, for example, JBrick [19, 20] should be provided in the programming phase. Additionally, the computers and provided worktables should allow adjustments of graphic contrast on computer screens. Nevertheless, there is no “universal remedy” for increasing accessibility. In preparation of the course, the teaching staff needs to communicate with the participants to be prepared for any special requirements the students might have.
Since not every measure taken is helpful for every sort of handicap and not all changes can be made at once, it is necessary to differentiate between the types of visual impairment. In the presented case, a fundamental distinction between different degrees of visual impairment up to sightlessness has been the essential groundwork for further research and course development. To reach full accessibility for the pupils, advancements and changes must be made gradually. This methodology has proven to be a very helpful approach in the process of designing the new course. Some degrees of visual impairment, for example, are even contrary to one another [1], so there is an increasing demand for different technical as well as didactic approaches in each course to reduce or extinguish existing barriers for all participating students.
As a first result and requirement, printed manuals with regard to font size should be provided within the first three phases: the introductory part, the construction, and the programming phase. This allows students with less severe visual impairment to be able to reread instructions at their individual pace.
Time has also proven to be one major but often underestimated factor [21]. Students who have visual impairments need to be given more time to work on their tasks in terms of reading instructions, following presentations as well as building and programming. The more severe the impairment, the more time will be needed to finish a task. Kabátová et al. [21] found that test participants who were wearing glasses that simulate an eye dysfunction needed four times as long to finish the assigned task without the glasses. Therefore, they come to the subjective conclusion that the time necessary for a traditional course design should be multiplied by a factor of at least four. Further research and evaluations of the course will have to prove whether that factor needs to be adjusted.
Another important adjustment relates to the teacher-student ratio. It has to be increased compared to traditional course designs, which of course takes up additional time and resources on the teaching end. The required ratio can differ vastly, as students have very diverse needs in terms of support. As we also know from Silva et al., even students without handicap perceive and process experiences in different preferred ways [22]. As a result, the instructors need to provide a high level of flexibility regarding supervision and must provide support throughout the course. Lastly, the supervisors identified pre-sorting the sorting boxes used in the construction phase as a helpful measure in the building process, which no longer excludes students with visual impairments from the haptic and tangible experience of building a robot themselves. Every course is highly influenced by diverse aspects, and a thorough preparation and awareness of all possibilities and influences as well as a pre-analysis of the expected target group of each course proves to be the key to a successful course design. Figure 2 sums up the results from the workshop in a grid.
Results from the workshop: requirements for the new course design.
After an implementation of the workshop and the guidelines, robotics courses were conducted in cooperation with the Berufsförderungswerk Soest and teenagers of the Johannes-Kepler-School in Laurensberg. An excursion into the mode of operation and programming of industrial robots was made for the course’s participants.
The robotics courses for visually impaired teenagers were perceived very well and were therefore asked to be offered to young people who are blind. Since the robots could not be programmed with the LabView-based programming language NXT-G, a different setup was required for the course. The “Blindenstudienanstalt Marburg” was visited for preparation in June 2014. Since the sense of touch system is the most important part for people who are blind, the “burrowing” in Lego boxes and the “building” of the robots are the most important components of the course regarding blind-pedagogical aspects. On top, a spoken construction guide is provided to the students as an audio book. The written construction manual was examined by the teachers of the “Blindenstudienanstalt Marburg” and was then tested in the course. Figures 3–6 show impressions of the prepared soft- and hardware as well as students in the course programming a robot.
Prepared Lego Mindstorm system for students who are blind.
Secondary school student who is blind programming a robot.
Prepared software for the robotics course for students who are visually impaired: textual instructions.
Prepared software for the robotics course for students who are visually impaired: illustrated instructions.
In 2015, the robotics courses for students who are blind were implemented in cooperation with the Blindenstudienanstalt Marburg. The building instructions, which were previously unusably for people who are blind, were converted into a spoken building instruction. The instructions themselves were then read out by a free screen-reading program NVDA via a voice output system to create real-world conditions. The program code was read out or put out via a Braille display reader, which allowed even the programming and integration of sensors with conditions, loops, and queries. The robotics courses for pupils with visual impairments are frequently requested by different classes and are met with great enthusiasm. Usually, the course takes place between two and five times a year. Furthermore, teachers can request the developed materials, rent LEGO Mindstorm robots, and ask for advice on how to conduct the courses on their own.
The evaluation of the courses took place verbally and was later put onto paper. With the help of statistical evaluation methods, feedback can be recorded quantitatively in order to validate the success of the measure or to adapt it. In addition to inquiries such as “How did you like the lecture/the programming/the difficulty of the tasks/the course schedule?” (6-degree scale from 1 = very good to 6 = not satisfying) or “How did you like the day?” (3-degree scale from 1 = too easy to 3 = too difficult), the questionnaire includes open questions that allow room for comments and suggestions for improvement.
The pupils (n = 8) mentioned, on a 6-degree scale, that the presentation was very exciting (Median = 1.25), that the programming had been very good (M = 1) and that they learned something (M = 1.13). Every pupil also said that they enjoyed the course and that he/she would like to visit the course again. Some of the students mentioned in the open questions section that they wanted a successor program, which will be developed as a consecutive step. Due to the small sample size, the statistical power of the results is reduced and statistical relevance of the quantitative data needs to be discussed. However, from a qualitative point of view with regard to the frequently given feedback, the analysis showed that the students’ enthusiasm, interest, and appreciation for the courses were high among both teachers and students.
To keep up the interest in STEM-fields, it is necessary to involve pupils in the process of programming playfully. Technical universities in Germany and Switzerland already offer a broad range of basic programming courses for pupils starting at young age. Additionally, to encourage applied computer science in school, some institutions offer robot kits and teaching materials. Integrating students with visual impairment or blindness in student laboratories is a chance to not only encourage interest in STEM-fields but also to show these individuals opportunities for the future. Science curriculum reform efforts have emphasized the integration of educational technology into teaching and learning purposes in the past years. Teachers and educators are asked to explore further ways in which new technologies could be utilized to improve access to science for students with visual impairments.
The paper has described the process of redesigning of a robotics course from an educational robotics laboratory to increase accessibility of the course for students with visual impairments. The evaluation of the workshop has informed a concept for the redesign, which has been implemented and is currently being tested in a second run with various groups of students with visual impairments. The developed grid of the workshop suggests that adjustments to the designated phases of the lecture can provide a higher level of accessibility. A first anecdotal but enthusiastic assessment from the students who participated leads to the assumption that the applied suggested changes were successful.
Nevertheless, a huge part of the adjustments requires a consideration for the unique needs and requirements that the specific dysfunctions of the target group bring about. At this point in the research, there is no catch-all solution to the challenge. The evaluation of the designed courses will allow for a thorough analysis, serve the pursuit of continuous improvement, and be the key to future research. Additionally, to broaden the range of accessibility, further research will have to focus on full accessibility not only for those students who are blind but also for those with other impairments, such as hearing and physical disabilities.
In conclusion, teacher, educators, and educational institutions should realize and promote the student-oriented benefits and devote additional effort toward accommodating students with (visual) impairments in STEM education. An awareness, and furthermore, an understanding of the academic needs of students with (visual) impairments are essential in striving toward this goal.
Though many institutions and educators stress the need to integrate students with (visual) impairments in their scientific programs, there is still room for improvement. Ensuring that full participation in science is possible for everyone will be beneficial for all students and a rewarding experience for teachers.
Part of this chapter has been taken from our earlier work cited in Stehling V, Schuster K, Richert A, Jeschke S. Access all areas: Designing a hands-on robotics course for visually impaired high school students. In: Proceedings part II of the HCI International 2015; 2–7 August 2015; Los Angeles, USA. Communications in Computer and Information Science. Cham: Springer International Publishing; 2015. pp. 430-435.
Control of bleeding wounds has always been a priority in managing injured patients, and providers have used numerous adjuncts to staunch bleeding for decades, with variable success. The earliest use of topical hemostatic agents dates from the end of the nineteenth century when thrombin was used by boxers and barbers to control bleeding from lacerations [1]. Almost a century before the clotting cascade was completely elucidated, in 1909 Bergel had described using topical fibrin to stop surgical bleeding [2, 3, 4]. Subsequently, surgeons utilized fibrinogen in plasma as well as bovine thrombin to assist in a variety of surgical scenarios, including nerve repair and skin grafting [5, 6]. Commercial products first became available in Europe in 1972, but the Food and Drug Administration did not approve fibrin sealants in the United States until 1998 [3]. Over the course of time, numerous other types of hemostatic agents have been developed, each unique in their load bearing capacity, biomechanical properties, handling, derivation, and application [7].
Cutaneous and mucous membrane bleeding are common presentations to emergency departments. Data from the National Hospital Ambulatory Medical Care Survey in 2002 estimated that there were 7.27 million emergency department visits for lacerations, representing approximately 6.6% of all emergency department visits [8], and data from HCUP National Emergency Department Survey in 2013 estimated about 7 million emergency department visits or 5.2% of all visits for lacerations [9]. There are no data to quantify how many of these visits are associated with uncontrolled or major bleeding. The mainstays of treating bleeding remain the simple application of direct pressure with a pressure bandage and application of tourniquet if hemostasis is unable to be obtained. However, there are times that application of hemostatic agents can assist in bleeding control. In the modern era, with widespread use of anticoagulant and antiplatelet agents, as well as physiologically induced coagulopathies from liver disease and uremia, development of topical hemostatic agents to assist in terminating complex bleeding scenarios has become important.
We will briefly review classes of tissue adhesives, topical hemostatic agents, and the best practice data regarding each in the setting of the emergency department. We will provide common clinical bleeding scenarios and the application of these materials in those situations.
Topical hemostatic agents generally fall into one of two categories: the physical agents that work by providing a physical substrate which promotes hemostasis and the biologically active agents that enhance coagulation at the site of action(Table 1). In the emergency department, topical hemostatic agents are primarily used as adjuvant therapy to direct pressure to stop persistent bleeding from lacerations and abrasions that are not amenable to suture control, such as distal fingertip avulsions, flap lacerations with avulsion of the flap, and skin tears in the elderly. As well, topical hemostatic agents can be used to assist with persistent bleeding from nasal mucosa, gingival tissue after tooth extraction, and from vascular bleeding sites such as persistently bleeding dialysis access sites or bleeding lower extremity varices.
Product | Manufacturer | |
---|---|---|
Gelatin matrix | Gelfoam® | Pfizer Inc., New York, NY, USA |
Surgifoam® | Ethicon Inc., Somerville, NJ, USA | |
Floseal® | Baxter International, Deerfield, IL, USA | |
Oxidized regenerated cellulose | Surgicel® | Ethicon Inc., Somerville, NJ, USA |
SafeGauze® | Medicom, Montreal, QC, Canada | |
Microporous polysaccharide spheres | Arista® AH | CR Bard Inc., Murray Hill, NJ, USA |
Microfibrillar collagen | Avitene® | CR Bard Inc., Murray Hill, NJ, USA |
Chitosan | HemCon® | Tricol Biomedical Inc., Portland, OR, USA |
Chitoflex® | Tricol Biomedical Inc., Portland, OR, USA | |
TraumaStat® | Ore-Medix, LLC Company, Lebanon, OR, USA | |
Celox® | Medtrade Products LLC., Crewe, UK | |
ChitoSAM® | Sam Medical, Tualatin, OR, USA | |
Axiostat® | Axio Biosolutions PVT LTD. Gujarat, India | |
Topical thrombin | Thrombin JMI® | Pfizer Inc., New York, NY, USA |
Tranexamic acid (TXA) | Multiple generics | |
Cyklokapron® 100 mg/ml | Pfizer Inc., New York, NY, USA | |
Erfa Tranexamic® 100 mg/ml | Erfa Canada 2012, Inc., Montreal, QC, Canada | |
Kaolin | QuickClot® | Z-Medica LLC., Wallingford, CT, USA |
Topical hemostatic agents.
Little data exists to suggest superiority of a single agent over others, and often selection of an agent is based on availability, familiarity with its use, patient and wound characteristics, and cost.
Gelfoam® and Surgifoam® are porcine derived, non-soluble, gelatin matrices that are in a compressed sponge form [10, 11]. They can be cut to appropriate size for application and when applied to bleeding sites are able to absorb 45 times their weight in whole blood. Floseal® is a combination of bovine-derived, liquid gelatin matrix and human-derived thrombin that is supplied in a syringe with an applicator tip that assists with mixing the components and application at the site of bleeding [12]. The mechanism of action of gelatin matrix is poorly understood but is thought to be due to its physical properties, providing a structural support for clot formation rather than a direct effect on the clotting cascade. In clinical use, these agents are appropriate for topical application to persistently bleeding sites, such as dental extraction sites, in the management of epistaxis, and in fingertip avulsion injuries. These agents typically have minimal tissue reaction and are absorbed within 6 weeks when placed within soft tissues or liquified and absorbed within 2–5 days when applied to bleeding mucosal sites.
Little data exists studying the efficacy of gelatin matrices for bleeding complications in the emergency department setting. In a small prospective, randomized study of patients who failed anterior packing for epistaxis, Floseal® application demonstrated equal rates of hemostatic control as repeat anterior packing by a specialist, and lower, but not statistically significant, rates of hospitalization [13]. A larger, prospective randomized sample of patients with epistaxis managed initially with Floseal® versus anterior packing demonstrated that Floseal® was associated with improved patient satisfaction and less rebleeding [14]. In a small convenience sample of patients presenting with posterior epistaxis, Floseal® was successfully used to control bleeding in 80% of patients at a significantly reduced cost when compared to surgery, posterior packing with hospital admission, and embolization [15].
Complications from gelatin matrix applications are reported to be minimal but include the potential to form a nidus for infection or abscess formation, foreign body reactions with encapsulation of reactive fluid, and toxic shock when used in nasal application.
Surgicel® is a sterile, knitted, absorbable fabric produced from plant cellulose. The mechanism of action of Surgicel® is poorly understood, but is thought to produce a mechanical scaffolding for clot formation rather than have a direct effect on the clotting cascade [16]. In clinical use, these agents are appropriate for topical application to persistently bleeding sites, such as dental extraction sites and in the management of epistaxis. As opposed to the gelatin matrices, which can be used wet or dried, the efficacy of Surgicel® is superior if it is applied dry to the area of bleeding, so it may not be appropriate for use with topical thrombin. As Surgicel® undergoes reaction with the tissue, it produces an acidic environment, which has been demonstrated to have in vivo bactericidal properties. The acidic environment that it produces may impair wound healing, perhaps making it a less optimal choice for controlling bleeding in large areas of tissue avulsion. Complications of its use have primarily reported to be localized tissue reactions.
Arista® AH is a powder hemostatic agent derived from plant polysaccharides. The mechanism of action of Arista® is poorly understood, but is thought to produce a mechanical scaffolding for clot formation rather than have a direct effect on the clotting cascade [17]. Its powdered form has limited use in an emergency department environment.
Avitene® is a microfibrillar collagen hemostat available as a sponge, sheet, and powder. The collagen matrix of Avitene® is thought to promote platelet activation, inducing clot formation [18]. Avitene® has been on the market for more than 40 years and has widespread applications in surgical hemostasis and epistaxis treatment.
Chitosan is a naturally occurring polycationic polysaccharide derived from multiple sources including shrimp, crabs, and certain fungi. The hemostatic mechanism of chitosan is incompletely understood, but is thought to include gelatinous aggregation of red blood cells, platelet activation, and contact system activation [19].
In a case series of 35 patients on antiplatelet agents or anticoagulants who failed initial management with cautery and nasal packing, 32 patients were successfully treated with application of a foam anterior pack wrapped in a chitosan sheet [20]. A small study of 40 patients on oral anticoagulation undergoing multiple tooth extractions compared a site treated with a chitosan pledget with a site treated with gauze and pressure and found decreased bleeding times and decreased postoperative pain in the chitosan treated site [21]. Another small study of 20 patients on oral anticoagulants undergoing dental extraction of multiple teeth found that the extraction sites treated with chitosan had shorter bleeding times than control extraction sites treated with a collagen matrix plug [22].
Thrombin is a protein which is part of the clotting cascade and has the effect of activating fibrinogen to fibrin, which is essential for clot formation, as well as activating platelets. Several formulations exist on the market, and thrombin can be of bovine or human origin. Topical thrombin can be applied to mucosal bleeding sites such as dental sites and epistaxis or can be applied topically. Additionally, topical thrombin can be used in conjunction with gelatin matrix sponges. No clinical trials comparing efficacy to other techniques have been published. Because these products are derived from other species or individuals, the primary complications include sensitivity reactions or rarely antibody formation against factor V, resulting in life-threatening bleeding complications [23].
Tranexamic acid is a synthetic derivative of the amino acid lysine that inhibits fibrinolysis by reversibly blocking the interaction of plasminogen with the lysine fragments on fibrin. The intravenous formulation of TXA is typically 100 mg/ml, which is equivalent to a 10% solution. Intravenous TXA formulations can be used topically as adjuvant treatment for patients with epistaxis, oral bleeding, or bleeding from topical sites.
A randomized controlled trial of 216 patients who were randomized to receive an anterior nasal packing soaked in 5 ml of 10% solution versus lidocaine plus epinephrine found that those treated with TXA had more rapid resolution of bleeding and earlier emergency department discharge [24]. A study of 124 patients taking antiplatelet agents who were randomized to TXA versus anterior packing also found more rapid resolution of bleeding as well as decreased visits for rebleeding [25]. A retrospective analysis of oral bleeding in 542 patients demonstrated improvement in bleeding in patients treated with TXA-soaked gauze and compression over use of gauze alone [26]. A systematic review of 5 studies including 252 patients taking oral anticoagulants undergoing dental procedures found that TXA was significantly protective against bleeding with a RR of 0.13 (95% CI 0.05–0.36; p < 0.0001) [27]. In addition to using the intravenous formulation of TXA topically, a paste of TXA can be made by crushing several 650 mg TXA tablets and adding small aliquots of saline to form the paste.
Kaolin is an inorganic mineral that has been demonstrated to promote activation of Factor XII, which is the first step in the activation of the intrinsic pathway of the clotting cascade. Kaolin-impregnated gauze is primary developed for controlling hemorrhage from external wounds in non-compressible sites in the setting of military and civilian trauma.
Little data exists evaluating the effectiveness of kaolin gauze in humans. In swine models of uncontrolled hemorrhage, QuickClot® outperformed comparative hemostatic agents in terms of survival [28].
Although the manufacturer states that there are no complications with the use of QuickClot® because it is not biologically derived, there is a case report of thermal burn with its use [29].
When it comes to primary wound closure, skin adhesives have several advantages over traditional suture repair. They bond quickly, resulting in saved time on the part of the physician performing the repair, and they are less painful than standard suture repair [30, 31]. They do not require a second visit for suture removal, saving the patient time and reducing the burden to the health-care system [30]. The closure is strong, similar in strength to healed tissue at 7 days post-repair [30]. In addition, the closure with tissue adhesives is cosmetically similar to that achieved with standard suture closure [31]. Tissue adhesives are more expensive than suture materials, but that cost is offset by the inherent costs associated with physician time to suture, bandaging, and repeat visit for suture removal [32]. In a busy and unpredictable emergency department, this time saving is essential.
Unlike topical hemostatic agents, which are often natural polymers, tissue adhesives used for wound closure in the emergency department are primarily synthetic polymers [33]. This is largely due to their high tensile strength, flexibility, and ability to form mechanical bonds [33]. The three primary classes of tissue adhesives used for wound closure are polyurethane-based tissue adhesives, polyethylene glycol-based tissue adhesives, and cyanoacrylate synthetic glues [33].
Polyurethane-based tissue adhesives are not commonly used in emergency practice, although they do have applications in surgical practice. The isocyanate pre-polymers in the adhesive bond to the amines in tissue proteins, forming a urea bond [3]. Historically, there have been issues with polyurethane-based tissue adhesive toxicity (including thrombosis and hemolysis) and long setup time [3], but they are undergoing development currently using various concentrations of castor oil and other additives to optimize their surgical adhesive properties [34, 35]. Although there is currently some application of these adhesives in the operating theater in renal, plastics, and orthopedic surgery, they are not currently used for traumatic injuries typically seen in the emergency department. As they have shown promise in reducing seroma formation in surgical wounds, they may have applications for larger traumatic wounds in the future.
Polyethylene-based adhesives are not currently typically used in emergency practice. Like polyurethane-based adhesives, they are primarily used inside the body, with current uses most commonly related to sealing lung surgical sites and preventing dural leaks after neurosurgery [36]. These adhesives have a very fast setup time and are strong and biodegradable [36]. They have potential for emergency department application in the future.
Cyanoacrylate synthetic glues are by far the most common tissue adhesives used for wound repair in emergency departments (Table 2). These glues were initially developed during attempts to make a clear plastic. Initially, they were too brittle and caused significant inflammation to tissue but subsequently underwent tremendous redesign over the course of decades prior to their final approval by the FDA in the form of 2-octyl cyanoacrylate in the late 1990s [3, 30]. Cyanoacrylate glues are monomers that react upon contact with water on tissue in an exothermic reaction, causing them to polymerize across the wound edges, allowing healing to take place below. These agents are also antimicrobial, which is an additional advantage [3, 30, 32].
Product | Manufacturer | |
---|---|---|
Cyanoacrylate synthetic glues | Dermabond® | Ethicon Inc., Somerville, NJ, USA |
Histoacryl® | BBraun, Melsungen, Germany | |
SurgiSeal® | Adhezion Biomedical LLC., Reading, PA, USA | |
Periacryl® | GluStitch, Delta, BC, Canada | |
Glu-Stitch® | GluStitch, Delta, BC, Canada | |
Indermil® | Surgical Specialties, Frenchs Forest, NSW, Australia |
Tissue adhesives.
Cyanoacrylate glues have the tensile strength of 5-0 suture, and they reach their maximal bonding strength 2.5 min after application [30]. Given these properties, it stands to reason that wounds most appropriate for glue repair are wounds that would require a suture strength of 5-0 or 6-0. Therefore, cyanoacrylate synthetic glues are not recommended for wounds under tension such as those crossing joint lines, highly gaping wounds, or wounds in very moist areas of the body [30, 32]. It is acceptable to use tissue adhesive glue on wounds that require deep sutures to reduce tension and gaping on the wound, so long as after those sutures are placed, the wound would be appropriate for closure with 5-0 or 6-0 suture. Cosmetically, cyanoacrylate has similar outcomes to standard sutures in appropriately chosen lacerations but a slightly higher risk of dehiscence [30, 31].
Tissue adhesive should be applied to an appropriately cleaned and dry wound. The wound edges should be approximated, and the adhesive should be applied over the approximated edges three to four times [30]. The hydroxyl ions in the wound edges activate the adhesive and seal the wound. The adhesive should never be introduced into the wound. In addition to causing an exothermic reaction because of the amount of moisture, it creates a foreign body reaction, with tissue inflammation and poor healing [30, 32]. Tissue adhesives should therefore not be used on heavily contaminated wounds, bites, macerated wounds, or wounds that are complex and difficult to approximate [30, 31, 32].
Cyanoacrylate glues are used in oral surgery practice, but their use for dental injuries in the emergency department is currently off-label. Nevertheless, tissue adhesives have found a niche in emergency department management of dental injuries. In the setting of an acutely fractured tooth involving exposed dentin (which is extremely painful), standard of care is to cover the exposed fracture site with calcium hydroxide paste. If this is unavailable, some providers advocate for using cyanoacrylate glue to cover the exposed dentin, as it controls pain and can be removed without difficulty using a solvent in the dentist’s office [37, 38]. One study also evaluated the use of cyanoacrylate for pain control in carious teeth, which found it effective for pain control [38]. Cyanoacrylate has antimicrobial properties, which provides theoretical benefits in these settings. However, cyanoacrylate has not been studied for safety in these scenarios, nor has it been assessed for adverse events, only for pain control. Therefore, the physician needs to be aware that any use of cyanoacrylate in treatment of dental fractures in the emergency department setting is not evidence-based.
In patients with avulsed and replanted teeth or in those with subluxed teeth, cyanoacrylate can be useful in splinting the injured tooth.
Topical hemostatic agents, tissue adhesives, and sealants may have adverse effects usually related to the composition of the agent, location of placement of the agent, and the absorption times of the agent. Slowly degrading products can serve as a nidus for infection especially if excessive amounts are used. In many cases, these agents are used in confined places and can then lead to compression of surrounding structures. Many of the complications associated with these agents are related to surgical uses rather than emergency department applications [39].
Air embolism is a rare complication that has been reported with the use of injectable agents such as spray thrombin or fibrin sealant. Care must be taken when spraying these objects so as not to exceed recommended pressures and to spray at an appropriate distance from the affected tissue. There are no reported cases of air embolism secondary to use of an atomizer, as may be used with TXA [40, 41, 42].
Wound infection may be associated with the use of topical hemostatic agents. It is difficult to analyze the risk of infection due solely to hemostatic agents versus due to confounding factors. Adverse factors, such as type and location of wound, foreign body material in the wound, and etiology of the wound, all play a role in development of wound infection. If a patient has other systemic symptoms that need to be addressed and needs urgent or emergent wound closure, that too can play a role in development of wound infection. The risk of infection, as it relates to hemostatic agents, can be minimized by cleaning the wound thoroughly and removing excess topical agent after hemostasis is achieved.
Impaired wound healing may be due to failure to effectively close the wound, dehiscence of the wound repair, and excessive amounts of hemostatic agent being used. When excessive amount of agent is used, as in cyanoacrylate closure, increased metabolites can form and cause an inflammatory response in the surrounding tissue which leads to poor wound healing [43].
Hypotension has been reported in some individuals receiving injections of bovine-derived products, such as thrombin. The hypotension is believed to occur with higher than normal concentrations of bovine thrombin but has been noted to be mostly transient lasting less than a minute. The hypotension does respond to epinephrine, if needed, and can be avoided by reducing the amount of bovine thrombin used and compression of injection sites [44, 45, 46].
Anaphylaxis and allergic reactions are also mostly related to bovine-derived products. These products must be avoided in individuals with a history of prior anaphylactic reactions to plasma products or IgA deficiency [47].
Infectious disease transmission is a potential complication when any products using blood components are used, and transmission may be more likely when hemostatic agents are used in an aerosolized form. Though there is a theoretical risk of viral transmission, including HIV and hepatitis, with topical hemostatic agents, there have been no reported cases in the last 20 years [48].
Vascular thrombosis is also a theoretical risk; however, there is no increased rate of vascular or graft thrombosis with the use of topical hemostatic agents. Great care must be taken not to inject these agents into a blood vessel or opened vessel [49, 50].
An immune-mediated bleeding diathesis can occur with the use of bovine thrombin preparations. The diathesis occurs due to development of a factor V deficiency secondary to an antibovine factor V antibody that cross-reacts with endogenous factor V. The risk of this complication can be reduced by using human thrombin. If patients have prior exposure to a bovine thrombin, antibodies may persist for years, and if known bovine thrombin should be avoided [51, 52].
Much of the literature found on uses of topical hemostatic agents for bleeding involves surgical and perioperative indications. However, different bleeding scenarios may present to the emergency department where topical adhesives and hemostatic agents may be of benefit. We will discuss some of these indications, including cutaneous bleeding, varicosity bleeding, AV fistula bleeding, post-tooth extraction bleeding, and epistaxis.
Approximately 6 million minor wounds are treated in emergency departments in the United States every year. Most cutaneous bleeding occurs due to lacerations of the skin. These lacerations can be caused by blunt or penetrating trauma to the epidermal and dermal layers. Management of these minor wounds has three goals: control of bleeding, avoidance of infection, and cosmetically acceptable, functional scars. Many factors contribute to management of these wounds. The wound must be assessed, and factors such as age of injury, mechanism of injury, extent of wound, neurovascular injury, and location of wound all play a role in determining the type of closure employed. Hemostasis of these wounds must be accomplished, and most times simple pressure for 10–15 min can achieve this. Persistent bleeding may require lidocaine with epinephrine injected or applied to the wound. In those cases where bleeding is difficult to stop, the direct application of surgical absorbable gelatin foam (Gelfoam®) to the wound is an alternative method of achieving hemostasis. Gelfoam®, however, should not be used in infected wounds or at the skin closure site because it may delay healing. After achieving hemostasis, wounds may require debridement, irrigation, and foreign body removal. Once the wound has been adequately assessed and prepared, primary closure with suture, staples, skin tape, or topical adhesive may be utilized. The most common topical adhesives used in the emergency department are cyanoacrylate synthetic glues. These offer tensile strength equivalent to 5-0 sutures. They have similar cosmetic outcomes to sutures but do have a slightly higher risk of dehiscence [53, 54, 55].
Varicose veins are dilated, elongated, tortuous, subcutaneous veins 3 mm or greater in diameter. They may involve the saphenous veins, saphenous tributaries, or superficial leg veins. Complications of varicose veins most commonly include superficial vein thrombosis and bleeding and, though uncommon, may require immediate attention. Varicose veins located near bony prominences are more prone to hemorrhage, and bleeding is usually due to minor trauma. Hemorrhage, in most cases, can be controlled with direct pressure and elevation of the leg. When these measures fail to sufficiently control bleeding, injections with lidocaine with epinephrine, suturing, and topical hemostatic agents may be helpful. Though no formal studies have specifically looked at topical agents to help with varicose bleeding, anecdotally, the use of topical thrombin, TXA, and absorbable gelatin foam may stop bleeding or control it until more definitive surgical interventions can be performed [56, 57].
Arteriovenous (AV) fistula is the vascular access preferred for long-term hemodialysis in patients with end-stage renal disease. Hemodialysis accesses are subject to complications such as clotting, stenosis, infection, and hemorrhage. Access complications are common among hemodialysis patients, but they are usually not life-threatening. Fatal vascular access hemorrhage is very rare with an incidence of only 0.4%, but when these patients present to the emergency department, various measures can be employed in order to control the bleeding until definitive measures can be taken, usually by a vascular surgeon. Most of the literature regarding fistula bleeding is related to intraoperative bleeding which can be controlled with suturing, topical thrombin, and cellulose gelatin foam. Extrapolating this data, one could conclude that emergency department management of AV fistula bleeding should involve direct pressure to the site of bleeding with the aid of topical thrombin products and gelatin foam products. Definitive treatment usually will involve suture repair done by a vascular surgeon either in the emergency department or operating room [58].
Post-extraction bleeding is a recognized, frequently encountered complication in dental practices. It is defined as bleeding that continues beyond 8–12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0 to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue hematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders, or excessive fibrinolysis. There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes. Many of these patients will present to the emergency department with their bleeding complications. In addition to treating systemic causes, many techniques can be employed to control the local etiologies of the bleeding. Surgical interventions mainly involve suturing of the site. In addition, nonsurgical hemostatic measures can be employed as well as combination therapy with surgical and nonsurgical techniques. Nonsurgical measures commonly include hemostatic agents such as oxidized cellulose, gel foam, thrombin, collagen fleeces, cyanoacrylate glue, acrylic or surgical splints, and local antifibrinolytic solutions, such as tranexamic acid mouthwash [59].
Epistaxis is a common problem encountered in the emergency department. It occurs in up to 60% of the general population; however, 10% or fewer seek medical attention. Epistaxis can be classified as anterior with the common source of bleeding being Kiesselbach’s plexus or posterior with the source being the sphenopalatine artery. Initial treatment at home or in the emergency department include conservative measures such as blowing the nose to remove clots, using vasoconstrictive sprays such as oxymetazoline, applying steady pressure for 10 minutes, placing cold compresses on the bridge of the nose, placing a cotton pledget in the nostril, and having the patient bend forward so as not to accumulate blood in the oropharynx. When these measures fail, more invasive measures can be used such as cautery, nasal packing with tampons, gauze, or balloon catheters. There has recently been more literature regarding the use of thrombogenic foams and gels as well as the use of TXA as an adjunct to these measures. Fibrin glue is a safe and effective addition and has been shown to be as effective as cautery and packing [60]. Thrombin gel, such as Floseal, was associated with an absolute 26% lower rebleeding rate compared with nasal packing and was easier to insert and judged more satisfactory by both providers and patients in a randomized trial of 70 patients with acute anterior nosebleeds [14]. In another prospective study, FloSeal® effectively controlled posterior bleeds in 8 of 10 patients whose initial packing failed [61]. Surgicel® and Gelfoam® are common conformable hemostatic materials and have been described in reviews or small case series as useful in nasal bleeding refractory to cautery [62]. These materials can be trimmed to an appropriate size and then applied directly to the bleeding source. Tranexamic acid has been studied for epistaxis and has shown some benefit in both short-term cessation of bleeding and decreasing rates of rebleeding. There was also a trend towards improved control of bleeding when directly compared to nasal packing alone. The delivery of TXA can be done by using an atomizer and/or saturating nasal tampons with topical application of 500 mg of the IV formulation (TXA 100 mg/ml). Care must be taken in patients with higher risk of systemic thrombosis as systemic absorption may be variable when TXA is applied to the nasal mucosa [63].
A number of products are available to assist in topical hemostasis. The choice of which product to use is based partly on availability as well as the particular application. Similarly, there are multiple tissue adhesives available on the market, but the provider will likely be limited to one or two different products.
The authors declare no conflicts of interest to disclose.
"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges".
\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.
",metaTitle:"About Open Access",metaDescription:"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges.\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.",metaKeywords:null,canonicalURL:"about-open-access",contentRaw:'[{"type":"htmlEditorComponent","content":"The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\\n\\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\\n\\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nOAI-PMH
\\n\\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\\n\\nLicense
\\n\\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\\n\\nPeer Review Policies
\\n\\nAll scientific works are Peer Reviewed prior to publishing. Read more
\\n\\nOA Publishing Fees
\\n\\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\\n\\nDigital Archiving Policy
\\n\\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\\n\\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\\n\\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\\n\\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
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The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\n\nDigital Archiving Policy
\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\n\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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Luna-Muñoz and M.A.\nMeraz-Ríos",authors:[{id:"42225",title:"Dr.",name:"Jose",middleName:null,surname:"Luna-Muñoz",slug:"jose-luna-munoz",fullName:"Jose Luna-Muñoz"},{id:"114746",title:"Dr.",name:"Marco",middleName:null,surname:"Meraz-Ríos",slug:"marco-meraz-rios",fullName:"Marco Meraz-Ríos"},{id:"169616",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Cardenas-Aguayo",slug:"maria-del-carmen-cardenas-aguayo",fullName:"Maria del Carmen Cardenas-Aguayo"},{id:"169857",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Silva-Lucero",slug:"maria-del-carmen-silva-lucero",fullName:"Maria del Carmen Silva-Lucero"},{id:"169858",title:"Dr.",name:"Maribel",middleName:null,surname:"Cortes-Ortiz",slug:"maribel-cortes-ortiz",fullName:"Maribel Cortes-Ortiz"},{id:"169859",title:"Dr.",name:"Berenice",middleName:null,surname:"Jimenez-Ramos",slug:"berenice-jimenez-ramos",fullName:"Berenice Jimenez-Ramos"},{id:"169860",title:"Dr.",name:"Laura",middleName:null,surname:"Gomez-Virgilio",slug:"laura-gomez-virgilio",fullName:"Laura Gomez-Virgilio"},{id:"169861",title:"Dr.",name:"Gerardo",middleName:null,surname:"Ramirez-Rodriguez",slug:"gerardo-ramirez-rodriguez",fullName:"Gerardo Ramirez-Rodriguez"},{id:"169862",title:"Dr.",name:"Eduardo",middleName:null,surname:"Vera-Arroyo",slug:"eduardo-vera-arroyo",fullName:"Eduardo Vera-Arroyo"},{id:"169863",title:"Dr.",name:"Rosana Sofia",middleName:null,surname:"Fiorentino-Perez",slug:"rosana-sofia-fiorentino-perez",fullName:"Rosana Sofia Fiorentino-Perez"},{id:"169864",title:"Dr.",name:"Ubaldo",middleName:null,surname:"Garcia",slug:"ubaldo-garcia",fullName:"Ubaldo Garcia"}]},{id:"41589",doi:"10.5772/50323",title:"The Role of the Amygdala in Anxiety Disorders",slug:"the-role-of-the-amygdala-in-anxiety-disorders",totalDownloads:9720,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"2599",slug:"the-amygdala-a-discrete-multitasking-manager",title:"The Amygdala",fullTitle:"The Amygdala - A Discrete Multitasking Manager"},signatures:"Gina L. Forster, Andrew M. Novick, Jamie L. Scholl and Michael J. Watt",authors:[{id:"145620",title:"Dr.",name:"Gina",middleName:null,surname:"Forster",slug:"gina-forster",fullName:"Gina Forster"},{id:"146553",title:"BSc.",name:"Andrew",middleName:null,surname:"Novick",slug:"andrew-novick",fullName:"Andrew Novick"},{id:"146554",title:"MSc.",name:"Jamie",middleName:null,surname:"Scholl",slug:"jamie-scholl",fullName:"Jamie Scholl"},{id:"146555",title:"Dr.",name:"Michael",middleName:null,surname:"Watt",slug:"michael-watt",fullName:"Michael Watt"}]},{id:"26258",doi:"10.5772/28300",title:"Excitotoxicity and Oxidative Stress in Acute Ischemic Stroke",slug:"excitotoxicity-and-oxidative-stress-in-acute-ischemic-stroke",totalDownloads:7187,totalCrossrefCites:6,totalDimensionsCites:26,abstract:null,book:{id:"931",slug:"acute-ischemic-stroke",title:"Acute Ischemic Stroke",fullTitle:"Acute Ischemic Stroke"},signatures:"Ramón Rama Bretón and Julio César García Rodríguez",authors:[{id:"73430",title:"Prof.",name:"Ramon",middleName:null,surname:"Rama",slug:"ramon-rama",fullName:"Ramon Rama"},{id:"124643",title:"Prof.",name:"Julio Cesar",middleName:null,surname:"García",slug:"julio-cesar-garcia",fullName:"Julio Cesar García"}]},{id:"62072",doi:"10.5772/intechopen.78695",title:"Brain-Computer Interface and Motor Imagery Training: The Role of Visual Feedback and Embodiment",slug:"brain-computer-interface-and-motor-imagery-training-the-role-of-visual-feedback-and-embodiment",totalDownloads:1456,totalCrossrefCites:13,totalDimensionsCites:24,abstract:"Controlling a brain-computer interface (BCI) is a difficult task that requires extensive training. Particularly in the case of motor imagery BCIs, users may need several training sessions before they learn how to generate desired brain activity and reach an acceptable performance. A typical training protocol for such BCIs includes execution of a motor imagery task by the user, followed by presentation of an extending bar or a moving object on a computer screen. In this chapter, we discuss the importance of a visual feedback that resembles human actions, the effect of human factors such as confidence and motivation, and the role of embodiment in the learning process of a motor imagery task. Our results from a series of experiments in which users BCI-operated a humanlike android robot confirm that realistic visual feedback can induce a sense of embodiment, which promotes a significant learning of the motor imagery task in a short amount of time. We review the impact of humanlike visual feedback in optimized modulation of brain activity by the BCI users.",book:{id:"6610",slug:"evolving-bci-therapy-engaging-brain-state-dynamics",title:"Evolving BCI Therapy",fullTitle:"Evolving BCI Therapy - Engaging Brain State Dynamics"},signatures:"Maryam Alimardani, Shuichi Nishio and Hiroshi Ishiguro",authors:[{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro"},{id:"231131",title:"Dr.",name:"Maryam",middleName:null,surname:"Alimardani",slug:"maryam-alimardani",fullName:"Maryam Alimardani"},{id:"231134",title:"Dr.",name:"Shuichi",middleName:null,surname:"Nishio",slug:"shuichi-nishio",fullName:"Shuichi Nishio"}]}],mostDownloadedChaptersLast30Days:[{id:"29764",title:"Underlying Causes of Paresthesia",slug:"underlying-causes-of-paresthesia",totalDownloads:192987,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"1069",slug:"paresthesia",title:"Paresthesia",fullTitle:"Paresthesia"},signatures:"Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar and Alexander R. Vaccaro",authors:[{id:"91165",title:"Prof.",name:"Vafa",middleName:null,surname:"Rahimi-Movaghar",slug:"vafa-rahimi-movaghar",fullName:"Vafa Rahimi-Movaghar"}]},{id:"63258",title:"Anatomy and Function of the Hypothalamus",slug:"anatomy-and-function-of-the-hypothalamus",totalDownloads:4596,totalCrossrefCites:6,totalDimensionsCites:12,abstract:"The hypothalamus is a small but important area of the brain formed by various nucleus and nervous fibers. Through its neuronal connections, it is involved in many complex functions of the organism such as vegetative system control, homeostasis of the organism, thermoregulation, and also in adjusting the emotional behavior. The hypothalamus is involved in different daily activities like eating or drinking, in the control of the body’s temperature and energy maintenance, and in the process of memorizing. It also modulates the endocrine system through its connections with the pituitary gland. Precise anatomical description along with a correct characterization of the component structures is essential for understanding its functions.",book:{id:"6331",slug:"hypothalamus-in-health-and-diseases",title:"Hypothalamus in Health and Diseases",fullTitle:"Hypothalamus in Health and Diseases"},signatures:"Miana Gabriela Pop, Carmen Crivii and Iulian Opincariu",authors:null},{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3523,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"35802",title:"Cross-Cultural/Linguistic Differences in the Prevalence of Developmental Dyslexia and the Hypothesis of Granularity and Transparency",slug:"cross-cultural-linguistic-differences-in-the-prevalence-of-developmental-dyslexia-and-the-hypothesis",totalDownloads:3609,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"673",slug:"dyslexia-a-comprehensive-and-international-approach",title:"Dyslexia",fullTitle:"Dyslexia - A Comprehensive and International Approach"},signatures:"Taeko N. Wydell",authors:[{id:"87489",title:"Prof.",name:"Taeko",middleName:"N.",surname:"Wydell",slug:"taeko-wydell",fullName:"Taeko Wydell"}]},{id:"58597",title:"Testosterone and Erectile Function: A Review of Evidence from Basic Research",slug:"testosterone-and-erectile-function-a-review-of-evidence-from-basic-research",totalDownloads:1349,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Androgens are essential for male physical activity and normal erectile function. Hence, age-related testosterone deficiency, known as late-onset hypogonadism (LOH), is considered a risk factor for erectile dysfunction (ED). This chapter summarizes relevant basic research reports examining the effects of testosterone on erectile function. Testosterone affects several organs and is especially active on the erectile tissue. The mechanism of testosterone deficiency effects on erectile function and the results of testosterone replacement therapy (TRT) have been well studied. Testosterone affects nitric oxide (NO) production and phosphodiesterase type 5 (PDE-5) expression in the corpus cavernosum through molecular pathways, preserves smooth muscle contractility by regulating both contraction and relaxation, and maintains the structure of the corpus cavernosum. Interestingly, testosterone deficiency has relationship to neurological diseases, which leads to ED. Testosterone replacement therapy is widely used to treat patients with testosterone deficiency; however, this treatment might also induce some problems. Basic research suggests that PDE-5 inhibitors, L-citrulline, and/or resveratrol therapy might be effective therapeutic options for testosterone deficiency-induced ED. Future research should confirm these findings through more specific experiments using molecular tools and may shed more light on endocrine-related ED and its possible treatments.",book:{id:"5994",slug:"sex-hormones-in-neurodegenerative-processes-and-diseases",title:"Sex Hormones in Neurodegenerative Processes and Diseases",fullTitle:"Sex Hormones in Neurodegenerative Processes and Diseases"},signatures:"Tomoya Kataoka and Kazunori Kimura",authors:[{id:"219042",title:"Ph.D.",name:"Tomoya",middleName:null,surname:"Kataoka",slug:"tomoya-kataoka",fullName:"Tomoya Kataoka"},{id:"229066",title:"Prof.",name:"Kazunori",middleName:null,surname:"Kimura",slug:"kazunori-kimura",fullName:"Kazunori Kimura"}]}],onlineFirstChaptersFilter:{topicId:"18",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82319",title:"Traumatic Optic Neuropathy",slug:"traumatic-optic-neuropathy",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.104731",abstract:"Traumatic optic neuropathy (TON) is a specific neurological sequence of traumatic brain injury (TBI). It has a different mechanism than other most neurologic complications of head trauma and its consequences can be devastating. The damage can be from direct penetrating trauma or bone fracture injuring the optic nerve directly or secondary to indirect blunt trauma (usually causing traction). The diagnosis of TON is based on the clinical history and examination findings indicative of optic neuropathy, especially the presence of defective pupillary light response. TON can cause only mild vision loss but, in some cases, severe vision loss is present. Imaging findings can support the diagnosis, and provide information on the mechanism as well as treatment options. The treatment options include observation alone, systemic steroids, erythropoietin, surgical decompression of the optic canal, or combination. The evidence base for these various treatment options is controversial and each treatment has its side effects and risks. Poor prognostic factors include poor visual acuity at presentation, loss of consciousness, no improvement in vision in the first 48 hours, and evidence of optic canal fractures on neuroimaging.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Ainat Klein and Wahbi Wahbi"},{id:"82203",title:"Resting-State Brain Network Analysis Methods and Applications",slug:"resting-state-brain-network-analysis-methods-and-applications",totalDownloads:20,totalDimensionsCites:0,doi:"10.5772/intechopen.104827",abstract:"Resting-state fMRI has been widely applied in clinical research. Brain networks constructed by functional connectivity can reveal alterations related to disease and treatment. One of the major concerns of brain network application under clinical situations is how to analyze groups of data to find the potential biomarkers that can aid in diagnosis. In this paper, we briefly review common methods to construct brain networks from resting-state fMRI data, including different ways of the node definition and edge calculation. We focus on using a brain atlas to define nodes and estimate edges by static and dynamic functional connectivity. The directed connectivity method is also mentioned. We then discuss the challenges and pitfalls when analyzing groups of brain networks, including functional connectivity alterations, graph theory attributes analysis, and network-based statistics. Finally, we review the clinical application of resting-state fMRI in neurorehabilitation of spinal cord injury patients and stroke patients, the research on the mechanism and early diagnosis of neurodegenerative diseases, such as multiple system atrophy, as well as the research on brain functional network alteration of glioma patients.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Yunxiang Ge and Weibei Dou"},{id:"82099",title:"Recent Advances in the Development of Biofluid-Based Prognostic Biomarkers of Diffuse Axonal Injury",slug:"recent-advances-in-the-development-of-biofluid-based-prognostic-biomarkers-of-diffuse-axonal-injury",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.104933",abstract:"Even though head injury is a silent pandemic of the century producing immense social and economic impact, predictive models have not been established to develop strategies promoting the development of reliable diagnostic tools and effective therapeutics capable of improving the prognosis. Diffuse axonal injury (DAI) is a type of traumatic brain injury (TBI) that results from a blunt injury to the brain. Discovering biomarkers for DAI have been a matter of debate and research. A number of studies have reported biomarkers that are correlated with severity of TBI but no conclusive and reproducible clinical evidence regarding the same has been put forward till now. Additionally, many DAI biomarkers have limitations so that they cannot be generalized for universal applications. The properties of these biomarkers should be extensively researched along with the development of novel biomarkers to aid important clinical decisions for the benefit of the society. This chapter summarizes the existing biofluid-based biomarkers, critically examines their limitations and highlights the possibilities of a few novel biomolecules as prognostic biomarkers of DAI.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Vinu V. Gopal, Rinku Raj Mullasseril and Goutam Chandra"},{id:"81998",title:"Understanding the Neuropathophysiology of Psychiatry Disorder Using Transcranial Magnetic Stimulation",slug:"understanding-the-neuropathophysiology-of-psychiatry-disorder-using-transcranial-magnetic-stimulatio",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.103748",abstract:"Transcranial magnetic stimulation (TMS) is a safe and non-invasive tool that allows researchers to probe and modulate intracortical circuits. The most important aspect of TMS is its ability to directly stimulate the cortical neurons, generating action potentials, without much effect on intervening tissue. This property can be leveraged to provide insight into the pathophysiology of various neuropsychiatric disorders. Using multiple patterns of stimulations (single, paired, or repetitive), different neurophysiological parameters can be elicited. Various TMS protocol helps in understanding the neurobiological basis of disorder and specific behaviors by allowing direct probing of the cortical areas and their interconnected networks. While single-pulse TMS can provide insight into the excitability and integrity of the corticospinal tract, paired-pulse TMS (ppTMS) can provide further insight into cortico-cortical connections and repetitive TMS (rTMS) into cortical mapping and modulating plasticity.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Jitender Jakhar, Manish Sarkar and Nand Kumar"},{id:"81646",title:"Cortical Plasticity under Ketamine: From Synapse to Map",slug:"cortical-plasticity-under-ketamine-from-synapse-to-map",totalDownloads:17,totalDimensionsCites:0,doi:"10.5772/intechopen.104787",abstract:"Sensory systems need to process signals in a highly dynamic way to efficiently respond to variations in the animal’s environment. For instance, several studies showed that the visual system is subject to neuroplasticity since the neurons’ firing changes according to stimulus properties. This dynamic information processing might be supported by a network reorganization. Since antidepressants influence neurotransmission, they can be used to explore synaptic plasticity sustaining cortical map reorganization. To this goal, we investigated in the primary visual cortex (V1 of mouse and cat), the impact of ketamine on neuroplasticity through changes in neuronal orientation selectivity and the functional connectivity between V1 cells, using cross correlation analyses. We found that ketamine affects cortical orientation selectivity and alters the functional connectivity within an assembly. These data clearly highlight the role of the antidepressant drugs in inducing or modeling short-term plasticity in V1 which suggests that cortical processing is optimized and adapted to the properties of the stimulus.",book:{id:"11374",title:"Sensory Nervous System - Computational Neuroimaging Investigations of Topographical Organization in Human Sensory Cortex",coverURL:"https://cdn.intechopen.com/books/images_new/11374.jpg"},signatures:"Ouelhazi Afef, Rudy Lussiez and Molotchnikoff Stephane"},{id:"81582",title:"The Role of Cognitive Reserve in Executive Functioning and Its Relationship to Cognitive Decline and Dementia",slug:"the-role-of-cognitive-reserve-in-executive-functioning-and-its-relationship-to-cognitive-decline-and",totalDownloads:30,totalDimensionsCites:0,doi:"10.5772/intechopen.104646",abstract:"In this chapter, we explore how cognitive reserve is implicated in coping with the negative consequences of brain pathology and age-related cognitive decline. Individual differences in cognitive performance are based on different brain mechanisms (neural reserve and neural compensation), and reflect, among others, the effect of education, occupational attainment, leisure activities, and social involvement. These cognitive reserve proxies have been extensively associated with efficient executive functioning. We discuss and focus particularly on the compensation mechanisms related to the frontal lobe and its protective role, in maintaining cognitive performance in old age or even mitigating the clinical expression of dementia.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Gabriela Álvares-Pereira, Carolina Maruta and Maria Vânia Silva-Nunes"}],onlineFirstChaptersTotal:13},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:320,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:133,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:107,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:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:17,numberOfOpenTopics:5,numberOfUpcomingTopics:0,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. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"July 5th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). In addition to a number of research articles, he has written two books, Computational Intelligence: An Introduction and Fundamentals of Computational Swarm Intelligence.",institutionString:null,institution:{name:"Stellenbosch University",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:9,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. 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Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",institutionURL:null,country:{name:"Canada"}}}]}]},openForSubmissionBooks:{paginationCount:3,paginationItems:[{id:"11570",title:"Influenza - New Approaches",coverURL:"https://cdn.intechopen.com/books/images_new/11570.jpg",hash:"157b379b9d7a4bf5e2cc7a742f155a44",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 10th 2022",isOpenForSubmission:!0,editors:[{id:"139889",title:"Dr.",name:"Seyyed Shamsadin",surname:"Athari",slug:"seyyed-shamsadin-athari",fullName:"Seyyed Shamsadin Athari"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11569",title:"Bacterial Sexually Transmitted Infections - New Findings, Diagnosis, Treatment, and Prevention",coverURL:"https://cdn.intechopen.com/books/images_new/11569.jpg",hash:"069d6142ecb0d46d14920102d48c0e9d",secondStepPassed:!0,currentStepOfPublishingProcess:3,submissionDeadline:"May 31st 2022",isOpenForSubmission:!0,editors:[{id:"189561",title:"Dr.",name:"Mihaela Laura",surname:"Vica",slug:"mihaela-laura-vica",fullName:"Mihaela Laura Vica"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{id:"11568",title:"Staphylococcal Infections - Recent Advances and Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11568.jpg",hash:"92c881664d1921c7f2d0fee34b78cd08",secondStepPassed:!1,currentStepOfPublishingProcess:2,submissionDeadline:"July 8th 2022",isOpenForSubmission:!0,editors:[{id:"59719",title:"Dr.",name:"Jaime",surname:"Bustos-Martínez",slug:"jaime-bustos-martinez",fullName:"Jaime Bustos-Martínez"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{},subseriesFiltersForOFChapters:[],publishedBooks:{},subseriesFiltersForPublishedBooks:[],publicationYearFilters:[],authors:{paginationCount:301,paginationItems:[{id:"116250",title:"Dr.",name:"Nima",middleName:null,surname:"Rezaei",slug:"nima-rezaei",fullName:"Nima Rezaei",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/116250/images/system/116250.jpg",biography:"Professor Nima Rezaei obtained an MD from Tehran University of Medical Sciences, Iran. He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. 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