Defining sepsis based on systemic inflammatory response syndrome (SIRS): Adapted from the 1992 ACCP/SCCM consensus statement [6].
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IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
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\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
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\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
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\r\n\r\n\tThis book volume intends to highlight the advances made in dipteran biology, their development, and physiological systems. Various biochemical, molecular, and bioinformatic tools to study the dipteran diversity in nature will be focused upon. A special Chapter on dipteran disease vectors and the status of diseases transmitted by them worldwide will throw light upon their vector competence and significance. The conventional and advanced strategies employed in their management using chemical and biorational products; their bio-efficacy; and mode of action at the physiological, biochemical, and molecular level will be covered along with challenges in the field and future perspectives.
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Dr. Kumar is a member of the National Academy of Vector-Borne Diseases, The Indian Science Congress, and the Scientific Advisory Board, Virginia, USA.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"177117",title:"Prof.",name:"Sarita",middleName:null,surname:"Kumar",slug:"sarita-kumar",fullName:"Sarita Kumar",profilePictureURL:"https://mts.intechopen.com/storage/users/177117/images/system/177117.jpg",biography:"Dr. Sarita Kumar is a Professor of Zoology at Acharya Narendra Dev College, University of Delhi. In over 29 years of teaching, academics, administration, and 30 years of research experience; she has contributed immensely to education at every level. She works in the area of ‘Insect pest and vector control’, and is credited with 60+ research publications, over 80 presentations/publications in National/International Conferences, and 8 e-book research chapters. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"117",title:"Artificial Neural Networks",subtitle:"Methodological Advances and Biomedical Applications",isOpenForSubmission:!1,hash:null,slug:"artificial-neural-networks-methodological-advances-and-biomedical-applications",bookSignature:"Kenji Suzuki",coverURL:"https://cdn.intechopen.com/books/images_new/117.jpg",editedByType:"Edited by",editors:[{id:"3095",title:"Prof.",name:"Kenji",surname:"Suzuki",slug:"kenji-suzuki",fullName:"Kenji Suzuki"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3828",title:"Application of Nanotechnology in Drug Delivery",subtitle:null,isOpenForSubmission:!1,hash:"51a27e7adbfafcfedb6e9683f209cba4",slug:"application-of-nanotechnology-in-drug-delivery",bookSignature:"Ali Demir Sezer",coverURL:"https://cdn.intechopen.com/books/images_new/3828.jpg",editedByType:"Edited by",editors:[{id:"62389",title:"PhD.",name:"Ali Demir",surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"74247",title:"Evaluation and Treatment of Elevated Temperature in the Emergency Department",doi:"10.5772/intechopen.94899",slug:"evaluation-and-treatment-of-elevated-temperature-in-the-emergency-department",body:'Elevated core body temperature is a common vital sign abnormality in the emergency department (ED) that can be caused by fever or hyperthermia. While both
Fever results from a pyrogen-mediated alteration in the set point of the thermoregulatory system in the anterior hypothalamus [1]. The interaction of endogenous and exogenous pyrogens with the hypothalamus results in increased production of prostaglandins, which act on temperature-sensitive neurons and lead to increased core temperature [1] Infection is the most common cause of fever, accounting for 74% of fevers in hospitalized patients [3]. Other processes that produce endogenous pyrogens, such as malignancy and ischemia, account for the majority of the remaining sources of fever in hospitalized medical patients [4].
Despite significant emphasis by the Centers of Medicare and Medicaid Services (CMS) on the rapid identification and treatment of sepsis, there is no gold standard definition for the spectrum of sepsis syndromes. In actuality, sepsis is a complex and poorly understood process despite two centuries of research into its mechanisms. Sepsis is thought to result from a dysregulated and overexaggerated immune response to infection [5]. However, the complexity of sepsis and the variability in its presentation has thus far defied the creation of a gold standard definition, despite nearly three decades of attempts. The first definition of sepsis spectrum disorders was published in 1992 as a joint consensus statement between the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) [6]. This first consensus definition defined the presence sepsis spectrum disorders on elements of the patient’s systemic inflammatory response syndrome (SIRS) (Table 1) [6]. This definition had poor sensitivity and specificity for sepsis spectrum disorders, and multiple guidelines have since attempted to revise these initial definitions, with variable success in increasing the sensitivity and specificity. The most recent consensus definition, Sepsis-3, was published in 2016 by SSCM and the European Society of Intensive Care Medicine (ESCIM) and defined the sepsis spectrum disorders by the presence of infection and two or more elements of the quick Sequential Organ Failure Assessment (qSOFA) [7]. The Sepsis-3 consensus definitions are outlined in Table 2 below [7].
Two or more of the following: Temperature > 38°C or < 36°C Heart rate > 90 beats per minute Respiratory rate > 20 breaths per minute or PaCO2 < 32 mmHg White blood cell count >12,000 cu/mm, <4000 cu/mm, >10% bands | |
Two SIRS criteria in the setting of known or suspected infection. | |
Sepsis and end-organ dysfunction | |
Sepsis with a systolic blood pressure < 90 mmHg or > 40 mmHg decrease in baseline systolic blood pressure |
Defining sepsis based on systemic inflammatory response syndrome (SIRS): Adapted from the 1992 ACCP/SCCM consensus statement [6].
Altered mental status Systolic blood pressure < 90 mmHg Respiratory rate ≥ 22 breaths per minute |
Quick sequential organ failure assessment criteria (qSOFA) [7]: sepsis-3 defines sepsis as infection with two or more of the components listed below.
The Surviving Sepsis Campaign (SSC) guidelines offer recommendations for the resuscitation of patients with suspected sepsis spectrum disorders [8]. However, while these guidelines can provide an overview for the care of these patients, treatment should always be primarily guided by repeated clinical assessment and reassessment of these patients. Current guidelines recommend the continuous administration of crystalloid fluids as long as hemodynamic factors continue to improve [8] If 30 ml/kg ideal body weight (IBW) balanced crystalloid fluids does not achieve a MAP ≥65 mm Hg, a vasoactive agent should be started [8]. Norepinephrine is currently the vasopressor of choice patients with septic shock [8]. The cornerstone of management of sepsis spectrum disorders is prompt source control through administration of antimicrobials or, if necessary, surgical intervention [8]. Cultures should be collected before the first dose of antimicrobial medications; culture collection should not delay source control interventions [8]. In the emergency department, early broad-spectrum antimicrobial therapy should be initiated based on the pathogen profile of the suspected site of infection, the patient’s prior culture results and susceptibilities, and local pathogen prevalence and resistance patterns. The spectrum of the antimicrobial agents can be narrowed as culture results become available or the patient presentation changes. Input from clinical pharmacists in the ED can assist in optimizing the initial antimicrobial choice and has been shown to decrease time to antibiotic administration, improve antibiotic stewardship, and improve patient outcomes [9, 10, 11, 12].
Infections of the lower respiratory and urinary tracts comprise the majority of sepsis presentations to the ED. Community-acquired pneumonia (CAP) can be caused by a variety of bacterial and viral pathogens, with
Infections of the urinary tract account for 40% of cases of nosocomial sepsis and the risk of infection is greatest in patients with structural or functional genitourinary abnormalities [16]. Sepsis from urinary source is more common in females [17]. Uncomplicated cystitis and pyelonephritis in women is typically caused by
A comprehensive physical examination is of utmost importance in patients with a potential musculoskeletal infection as laboratory evaluation in these patients is generally non-diagnostic. Poor circulation and neuropathy are important risk factors for the development of musculoskeletal infections, and, as such, patients may not be able localize the source of their infection. Examination should include turning the patient to examine the back, palpation of the large joints, and examination of the feet and genitourinary regions for skin changes, which are often the only clue to the presence of a musculoskeletal infection [20, 21]. Comparison with the contralateral side can help to provide a baseline with which to compare for abnormalities. Practitioners should also evaluate for the presence of decubitus ulcers, which can become a nidus for osteomyelitis or bacteremia. Crepitus or pain out of proportion to examination should prompt concern for necrotizing soft tissue infection. Erythema, swelling, or pain with passive motion in a joint are concerning for a septic joint, with the knee and hip being the most common sources [22]. Risk factors for musculoskeletal infections include vasculopathy, diabetes, surgery, and immunocompromise [20].
Infectious pericarditis, myocarditis, and endocarditis as causes of sepsis can be easily missed in the emergency department due to their often subtle and variable presentations. Acute infectious pericarditis describes infection of the fibrous tissue encasing the heart and the base of the aorta and vena cava. Echoviruses and coxsackie A and B viruses account for nearly 90% of cases of infective pericarditis, with bacterial, parasitic, and fungal organisms accounting for the minority of cases [23]. The most common bacterial pathogens implicated in infective pericarditis are
Meningitis is an infection of the meningeal lining of the central nervous system by bacteria, viruses, or fungi, with bacterial causes accounting the highest global burden [26]. Encephalitis describes infection of the cerebral parenchyma with a pathogen.
Infections of the spinal column are an important diagnostic consideration in all patients presenting to the ED with back pain. Potential sources of infection in the spinal column include vertebral osteomyelitis, discitis, and epidural abscess. These infections are commonly missed, as there is remarkable variability in patient presentation and fever is seen in only half of these patients [33, 34, 35] Neurologic deficits likewise may or may not be present [33, 34, 35]. Risk factors for infections of the spinal column include immunocompromise, recent instrumentation, spinal implants, and use of intravenous drugs [35]. Magnetic resonance imaging (MRI) is the preferred imaging study in patients with suspected spinal column infection [35]. If MRI is unavailable, CT myelography can also be used [35].
Causes of intraabdominal sepsis include abdominal and pelvic abscesses, pelvic inflammatory disease, spontaneous bacterial peritonitis, cholecystitis or cholangitis, ruptured hollow viscus, or infection of the gastrointestinal tract. While abdominal sources for sepsis are common in the ED, the diagnosis may be hampered by examination difficulties secondary to the patient’s mental status or body habitus. Altered consciousness can impede a patient’s ability to localize their discomfort, and many abdominal pathologies have no manifestations on external visual examination. As such, a thorough abdominal examination is of vital importance in altered patients. Although these patients may be unable to verbalize discomfort, absent bowel sounds, abdominal distention, or abdominal rigidity on examination can be clues to the presence of intraabdominal pathology [36, 37, 38]. Additionally, grimacing, guarding, or reflex tachycardia can be useful indicators of pain in patients are altered or obtunded [36, 37, 38]. Pelvic examination should be done if a pelvic source is suspected or if there is concern for toxic shock syndrome secondary to a retained vaginal foreign body [38].
Indwelling devices such as urinary catheters, ports, pacers, and long-term intravenous access are associated with an increased risk of infection. Examination of these devices is an important part of the physical examination of the septic patient. Erythema or purulence at the exit site is specific for infection but these signs of not sensitive for the presence of device-associated infection. In fact, less than 5% of dialysis line-associated bacteremia was found to have associated purulent exit site drainage [39]. Because physical examination findings are often absent, it is important to keep device-associated infection in the differential in septic patients. If infection is suspected, the device should be removed as soon as clinically possible and cultured [39, 40, 41].
While a reflexive diagnosis of sepsis is tempting for the ill-appearing patient with an elevated temperature, it is important to consider conditions that mimic sepsis which are often both life-threatening and reversible. Unlike the fever associated with sepsis, the majority of these sepsis mimics have elevated temperature as a result of hyperthermia, which occurs secondary to dysfunction of the hypothalamic thermoregulatory system [1]. If an infectious source cannot be found in a seemingly septic patient or the patient is not improving with antibiotics and fluids, it is important to broaden the differential to conditions that cause hyperthermia (Table 3).
NMS is a life-threatening syndrome of altered mental status, autonomic instability, hyperthermia, and muscle rigidity associated with the use of dopaminergic antagonists. “Lead pipe” rigidity is the hallmark physical examination finding in NMS and can be severe enough to precipitate rhabdomyolysis. Most commonly, NMS occurs with the use of dopaminergic antagonists used in the treatment of psychiatric disorders and nausea, but NMS can also be precipitated by may be caused withdrawal from dopaminergic medications, such as those used in the treatment of Parkinson’s disease [42, 43]. First generation antipsychotic medications are the most commonly implicated in NMS, with haloperidol and fluphenazine having the highest risk [42]. Risk factors for the development of NMS include higher medication doses, recent or rapid dose escalation, and parenteral medication administration [42]. The highest risk of NMS is within two weeks of medication initiation but this syndrome develop at any time during the treatment timeline [44]. A review of the patient’s medications is typically needed to make the diagnosis. The cornerstone of management of NMS is supportive, with discontinuation of the suspected offending agent, support of the cardiopulmonary system, maintenance of normothermia and euvolemia, and prevention of complications including deep venous thrombosis, acute renal failure, and cardiac dysrhythmias [42, 43, 44]. In cases of severe muscle rigidity not responding to supportive treatment, intravenous dantrolene sodium or oral bromocriptine mesylate should be considered [44].
SS is a syndrome of altered mentation, neuromuscular abnormalities, and autonomic hyperactivity caused by excess serotonin levels [45]. The most commonly implicated medications in SS include linezolid, fentanyl, and selective serotonin reuptake inhibitor (SSRIs) [46]. The neuromuscular abnormalities associated with SS can include hyperreflexia, clonus, or muscle rigidity, and, as with NMS, these may be severe enough to which may lead to rhabdomyolysis [45, 46]. SS is a clinical diagnosis based on patient presentation, and there is no laboratory test or imaging study to confirm the diagnosis [45]. The Hunter criteria for serotonin syndrome is one outline the clinical criteria needed to make the diagnosis [47]. Like NMS, management of SS is primarily supportive. If this is insufficient or ineffective, use of cyproheptadine can be used under the consultation of a toxicologist [45]. If neuromuscular paralysis is need to control neuromuscular rigidity or facilitate intubation, only nondepolarizing agents should be used, as depolarizing agents may exacerbate the hyperkalemia precipitated by the neuromuscular abnormalities of SS [45, 46].
Suspect serotonin syndrome if the patient has taken a serotonergic agent and has one of the symptom complexes outlined below (Table 4).
Condition | Presentation | Management |
---|---|---|
Neuroleptic malignant syndrome | Delirium, hyperthermia, tachycardia, rigidity | Supportive, dantrolene sodium, bromocriptine |
Serotonin syndrome | Delirium, hyperthermia, tachycardia, hyperreflexia/clonus. | Supportive, consider cyproheptadine |
Malignant hyperthermia | Hyperthermia, tachycardia, hypercarbia, muscle rigidity in the setting of volatile anesthetic or depolarizing muscle relaxants | Dantrolene sodium, cooling measures, treatment of hyperkalemia |
Salicylate toxicity | Delirium, hyperthermia, tachycardia, hyperpnea, gastrointestinal irritation, tinnitus, triple acid–base disturbance | Sodium bicarbonate |
Anticholinergic toxicity | Delirium, tachycardia, dilated nonreactive pupils, urinary retention, anhidrotic hyperthermia | Supportive |
Sympathomimetic toxicity or withdrawal from sympathetic antagonists | Delirium, tachycardia, hyperthermia, hypertension, dilated reactive pupils | Benzodiazepines |
Thyroid storm | Tachycardia, hyperthermia, agitation, lid-lag, ophthalmopathy, hand tremor. | Beta-blocker, thionamide, steroids |
Non-exertional heat stroke | Fever, tachycardia, neurologic manifestations | Evaporative and convective cooling |
Hyperthermic sepsis mimics, their presentation, and their management.
Spontaneous clonus |
Inducible clonus AND agitation OR diaphoresis |
Ocular clonus AND agitation OR diaphoresis |
Tremor AND hyperreflexia |
Hypertonia, temperature > 38°C AND ocular OR inducible clonus |
Hunter criteria for serotonin syndrome [47].
MH is a genetic disorder which results in a hypermetabolic response to volatile anesthetics and depolarizing muscle relaxants [48]. This pathologic response to these medications results from caused the release of excessive calcium from the sarcoplasmic reticulum, which leads to uncoupling of oxidative phosphorylation, the release of heat, and a rise in metabolic rate [49]. MH presents with hyperthermia, tachycardia, hypercarbia, increased oxygen consumption, and muscle rigidity following the administration of a volatile anesthetic or depolarizing muscle relaxants. In the ED, MH is most likely to present following an intubation using succinylcholine and MH should be a diagnostic consideration in a patients with acute decompensation following intubation. MH is treated with intravenous dantrolene loaded at a dose of 2.5 mg/kg followed by boluses of 1 mg/kg until symptoms resolution [48]. Aggressive cardiopulmonary support, maintenance of normothermia and euvolemia, and treatment of electrolyte derangements is likewise important.
Aspirin ingestion is the most common cause of salicylate toxicity, but other common sources include Oil of Wintergreen, some wart removers, and keratolytics [50]. Salicylate toxicity is an important sepsis mimic, as patients with salicylate toxicity will have tachycardia, tachypnea, elevated temperature, and lactic acidosis. These symptoms occur secondary to salicylate interference with aerobic metabolism [50]. The classically described triad of salicylate toxicity is hyperpnea, tinnitus, and gastrointestinal irritation [51]. Gastrointestinal symptoms vary and can include abdominal pain, nausea, vomiting, and diarrhea. Tinnitus associated with salicylate toxicity may be described as hearing loss rather than “ringing in the ears” by patients and may be a difficult symptom to elicit if the patient is altered or obtunded [51]. Laboratory testing in salicylate toxicity will show a classic “triple acid-base disorder.” This includes a respiratory alkalosis from hyperventilation, a compensatory non-gap metabolic acidosis, and an anion-gap metabolic acidosis from secondary to lactic acid accumulation [51]. Management is through systemic alkalinization with sodium bicarbonate [52].
Anticholinergic substances are ubiquitous in both pharmaceutical compounds and nature. Commonly encountered causes of anticholinergic toxicity include ingestion of antihistamine medications, tricyclic antidepressants, jimson weed, and tainted recreational drugs. Anticholinergic toxicity can easily be mistake for sepsis, as these patients present with high temperature, delirium, and tachycardia [53]. A distinguishing feature of anticholinergic toxicity is the presence of anhidrotic hyperthermia, in contrast to septic patients who are febrile and diaphoretic [53]. This is a result of anticholinergic blockade of sweat glands, preventing homeostatic hydrosis in response to elevated core temperature [53, 54]. Other clinical findings in anticholinergic toxicity include dry mucus membranes, dilated, non-reactive pupils and urinary retention [53]. The management of anticholinergic toxicity is primarily supportive. Benzodiazepines should be used for agitation or seizures [54]. Physostigmine, an anticholinesterase inhibitor, can be used as an antidote for anticholinergic toxicity under the consultation of a toxicologist [54].
Overstimulation of the sympathetic nervous system can occur through direct agonism of the sympathetic receptors or withdrawal from substances that act as sympathetic antagonists [55]. Common sympathomimetic compounds encountered in the ED include cocaine, phencyclidine, and amphetamines. Withdrawal from alcohol or benzodiazepines can also result in sympathetic overstimulation [56]. Symptoms of sympathomimetic toxicity hyperthermia, tachycardia delirium, and reactive mydriasis [55]. Hyperthermia in sympathetic overstimulation results from direct agonism of alpha receptors as well as heat released by associated psychomotor agitation [55]. Benzodiazepines are mainstay of management of both sympathomimetic toxicity and withdrawal from antisympathetic agents [55].
Thyroid storm is the most severe manifestation of thyrotoxicosis and can be caused by overdose of therapeutic thyroid hormone or may present in patients with underlying thyrotoxicosis, seemingly unprovoked or may be precipitated by trauma, infection, childbirth, or other acute events [57]. Symptoms of thyroid storm include delirium, hyperthermia, diarrhea, and tachydysrhythmias, which can be severe enough to cause cardiovascular collapse and hemodynamic compromise [57, 58]. Liver failure may also occur [57]. The diagnostic laboratory abnormality in thyroid storm a severely low or undetectable thyroid stimulating hormone (TSH). Physical examination findings concerning for thyroid storm are those classically seen in hyperthyroidism and include ophthalmopathy, lid lag, thyromegaly, hand tremor, and global hyperreflexia [57, 58]. ED management of includes immediate treatment with a beta blocker, a thionamide, and glucocorticoids [59]. An iodine preparation should be given an hour after the administration of the thionamide, to prevent the iodine being used as substrate for the synthesis of more thyroid hormone [59]. If an infection is suspected as the cause of thyroid storm, broad-spectrum empiric antibiotics should be administered.
Heat stroke is condition of elevated core body temperature with associated central nervous system dysfunction, commonly encephalopathy [60]. Heat stroke can be broadly divided into non-exertional and exertional. Non-exertional heat stroke classically affects older individuals with comorbidities that result in impaired thermoregulation, prevent access to adequate hydration, or inhibit removal from a hot environment [60]. In contrast, exertional heat stroke is more likely to occur in young, healthy individuals in the setting of exertion that overwhelms homeostatic thermoregulatory mechanisms. Heat stroke is a clinical diagnosis of exclusion made based on elevated body temperature (generally >40°C), central nervous system dysfunction (classically encephalopathy), and a history of exposure to severe environmental heat or excessive exertion [60]. Evaporative and convective cooling are the treatments of choice and should be initiated as soon as the diagnosis is made to improve morbidity and mortality [61, 62]. Common cooling methods used in the ED include ice water immersion, cooled fluid lavage, and evaporative cooling [61, 62]. In cases of refractory hyperthermia, dantrolene can be used as salvage therapy but its efficacy in this clinical context is uncertain [63, 64].
Elevated core temperature can be the result of either fever or hyperthermia. Fever is mor common and is typically caused by infections of the respiratory or urinary tracts. Other potential sources of infection include musculoskeletal, cardiac, neurological, and intra-abdominal as well as infection from indwelling medical devices. Treatment of patients with elevated core temperature should begin with fluids, empiric antimicrobials, and source control. If treatment of infection is ineffective or if the presentation is inconsistent with the presence of infection, the differential diagnosis should be expanded to consider conditions that cause hyperthermia as the cause of elevated core temperature. Such sepsis mimics include toxicity from medications and illicit substances, neuroleptic malignant syndrome, serotonin syndrome, malignant hyperthermia, thyroid storm, and heat stroke. Identification of these mimics as the source of elevated temperature leads to earlier diagnosis and improved prognosis in these patients.
Among the linguistic theories and approaches, the discussion of language acquisition and second language learning has been conducted for a span of a few decades by two groups of theorists: the Chomskyan linguistic generative structuralists and the functional psychologists’ cognitive linguistics. Generative linguists believe in the existence of autonomous modules for language acquisition in the mind and claim that most of the grammar is not learned from the environment and communication, but arises from an innate universal grammar (UG). In contrast, functional theorists state that grammar is not transferable to the child or anyone else but arises from the functions of the language. Associating with the concepts underlying forms of a language, cognitive linguistics claims that knowledge of a particular language results from language use and that grammar is understood by conceptualization. Cognitive development includes all skills a child attains throughout his life. Cognitive skills matter because they lead to thinking and learning. Without skills such as remembering, numeracy, thinking, learning, reasoning, problem-solving, comparison-making, and decision-making, a child is at risk of falling behind. Cognitive developments matter from childhood to adulthood.
As two different approaches in theoretical linguistics, usage-based and universal grammar-based (UG-based) are two theories in language learning from various perspectives: the former focuses on the influence of experience, input, and frequency in language learning (i.e., cognitive linguistics), while the latter emphasizes the existence of an innate universal grammar and a set of rules as underlying basis for the formation of correct grammatical sentences (i.e., generative grammar).
Based on generative linguistics, language acquisition emerges from a combination of rules which will form grammatical sentences. Generative grammar (proposed by Chomsky in 1950s) arises from an innate universal grammar. Generativists believe that environmental input and language use has no effect on learning grammar. Taylor [1] further explains “acquisition, thus, became a matter of the ‘setting’ of ‘parameters’ provided by Universal Grammar, something which, it was assumed, would be possible on only minimal exposure to data” (pp. 573–4). Believing in the existence of an innate system of rules, generativists claim that universal grammar provides “the possible parameters for language and uses parameter-setting approach depending on which specific language is involved” (pp. 1141–2) [2]. It is claimed that language function is analytically separate from language structures.
UG-based approach claims that children have got a prior language knowledge “… which enables them to achieve an adult grammar on the basis of limited evidence” (p. 2) [3]. However, [3] points out, since 1990s, another model of input-driven approach was formed, usage-based theory of language learning, and it became so popular that UG-based approach was considered an outdated theory.
Aligning to cognitive linguistics, a usage-based linguistics (proposed by [4]) is “a form of linguistic analysis, that is, that takes into account not just grammatical structure, but that sees this structure as arising from and interacting with actual language use (p. 17) [5]. Based on this theory “… input is a rich source of information for identifying grammatical regularities and children have a remarkable ability to perform complex computations over statistical information displayed in the input” (p. 3) [3]. This theory argues that linguistic structures result from experience [6]. Tomasello [7] (as cited in [8]) states that language and language acquisition are usage-based and its structure emerges from using language.
Kang [3] points out that empiricists do not believe in the innate knowledge of language; supporting the input-driven language learning approach, they claim that language learning is based on sense and experience. They also state that child’s input is systematic and regular which helps him/her to understand the system of the target language by the use of inductive reasoning. Frequency of language input is a major factor in providing the child with the information she/he needs in learning a target language: “…the more frequently a certain linguistic expression is available to the child, the easier it is for the child to learn it [9, 10, 11, 12]” (p. 1) [3].
Kemmer and Barlow [13] also discusses two traditions that focus on language use that are usage-based: (1) firthian tradition, emphasizing on the role of context and social aspects, and (2) enunciativist linguistics, focusing on the speech act. “A Usage-Based model is one in which the speaker’s linguistic system is fundamentally grounded in ‘usage events’ instances of a speaker’s producing and understanding language” (p. iix) [13]. Langacker [14] (as cited in [13]) characterizes usage-based model with three features: maximality, non-reductivity, and being bottom-up. Accordingly, the mind is capable of analyzing complex structures in multiple ways, resulting in the production of both specific and general patterns through usage. The first two features imply the redundancy and massiveness of the grammar, and the bottom-up feature determines that general patterns emerge from specific ones and specific patterns are the result of experience.
As [13] points out, usage-based accounts are experience-driven, and frequency of items is an important factor and an inseparable part of language learning, especially in forming and understanding structures and operations; “… Usage-Based events play a double role in the system: they both result from and also shape the linguistic system itself in a kind of feedback loop” (p. viii). In usage-based accounts, language is learned by data observation in the actual use of language. From Langacker’s [4] viewpoint, in usage-based model “substantial importance is given to the actual use of the linguistic system and a speaker’s knowledge of this use; grammar is held responsible for a speaker’s knowledge of the full range of linguistic conventions (p. 494)” (p. 2) [13]. Kemmer and Barlow [13] claims that “through repetition, even a highly complex event can coalesce into a well-rehearsed routine that is easily elicited and reliably executed” (p. 3).
From Croft’s [15] point of view, in usage-based models language use specifies grammatical representations: “the Usage-Based model is a model of grammatical representation in which language use determines grammatical representation. Specifically, frequency of use and similarity of form and meaning are the determining factors for the structure of grammatical knowledge in the mind” (p. 499). According to Langacker, usage-based model “focuses on the actual use of the linguistic system and a speaker’s knowledge of this use …, it claims that linguistic units are abstracted from usage events, that is, the actual instance of language use” (p. 1142) [2].
In usage-based models, frequency of usage plays a big role in the production, language comprehension, and grammaticality of the patterns. The two mentioned types of frequency are token and type frequency. Token frequency “is how often particular words or specific phrases appear in the input” (p. 166) [16]. As [15] defines “Token frequency is the frequency of occurrence in language use of individual tokens of a grammatical type, such as English regular past tense forms” (p. 499). Quoting from [15, 17] states that how much a form like irregular word forms entrenches in the learner’s mind is a token frequency function. Type frequency is defined as “how many different lexical items can be applied to a certain pattern, paradigm or construction” (p. 166) [16], or it is referred as “the frequency of word types that conform to a schema” (p. 499) [15]. The regular past inflection is mentioned to have high type frequency because it is applicable to a large number of different verbs [15, 16].
According to [18], usage-based approaches are input-dependent, and in this theory, “frequency” is considered as the language rule which results from structure analysis in language input. Zyzik [18] states that there must be enough input so that the learner can learn whatever she/he needs: “… it must be abundant enough for the learner to abstract regularities from concrete exemplars of language use” (p. 54), such as native competence which is gained after lifetime attention to the L1 input. Ellis [16] (cited in [18]) points out that in order to achieve native fluency at the L2, there must be huge amounts of language input so that the learners can choose and analyze the words and sequences they prefer. In input-based accounts, children are expected to follow input patterns by experience and environmental effects [19], and the grammatical relations result from the co-occurrence of language functions and forms [20].
Zyzik [18] also states that based on usage-based theory, insufficient input and little access to abundant and implicit input like L1 are the reasons that ultimate attainment cannot be achieved by L2 learners. She points out that “lack of exposure to sufficiently rich and varied input” (p. 56) is the cause of poverty of stimuli. She mentions that very few studies have been conducted on the quality and quantity of input in instructed settings. She claims that with the help of input frequency, the L2 learner should be able to pick up the abstract regularities from the exposure to the abundant and rich input. According to her, in SLA settings, high-frequency items (i.e., the forms and structures that abundantly emerge in the language input) cause no learning problems; the focus should be on the low-frequency forms in the input.
There is this conflict between the supporters and the opponents of these two approaches (i.e., UG- and usage-based) whether language learning is done on the basis of the input exposure and experience or by the help of the innate knowledge of learners, and still it is not clear whether grammatical learning is usage-based.
There are a number of studies that contrasted usage-based and UG-based conditions in empirical studies.
To compare usage-based and UG-based approaches, Kang [3] studied scrambling and multiple nominative case marking as the two syntactic structures among Korean children. The results of his study showed that child’s speech to a great extent resembles adult’s; both mentioned structures were used very little in the children’s speech because their frequencies in parents’ speech were low which shows that child’s grammar is a reflection of the adult’s. This frequency match between child and adult’s speech supports the input-driven approach. But examining the same idea in the experimental group showed that though scrambling was absent in the children’s input, it was eventually used and learnt, and this rejected the role of input-driven approach. Hence, [3] proposes the existence of an innate knowledge among children which is in support of the UG-based approach.
To delve into the acquisition process in the two theories of UG and usage-based theory, Zyzik [18] studies some problematic linguistic structures in both first and second languages (such as want-to contraction, yes/no formation, and pronoun interpretation) and synthesizes some input constructs (such as frequency effects, the poverty of stimuli, and other cases). According to her, input is not enough for learning some complex structures. In addition to input, learners must have grammatical competence (“innately intuitive knowledge”). She says that learners cannot gain ultimate attainment when the input they receive is impoverished or insufficient. Then by rejecting the poverty of stimuli idea of the usage-based theory, she concludes that “…the input is rich enough for children to acquire all the properties of language if mechanisms such as item-based learning, competition among forms, indirect negative evidence and sensitivity to frequency are given serious consideration” (p. 57). She proposes UG-based as competing approach in the L2 acquisition.
Rothman and Guijarro-Fuentes [21] studied the role of input quality in naturalistic (UG-based) and instructional (usage-based) settings. They state that there is a difference between age of acquisition and the critical period hypothesis. At the age of acquisition process, the focus is on input. Since input causes acquisition, when to be exposed to the significant input is of great importance. They point out that there is a correlation between age of exposure to the native input and age of the first significant exposure, no matter whether the input comes from a naturalistic or instructed context.
Rothman and Guijarro-Fuentes [21] further states that clearly learners in L2 instructed settings receive less amount of input than those who are learning the target language in a naturalistic language learning setting because in naturalistic settings, learners have access to the native speakers outside the class. Thus, as they claim, the quality of input is introduced as one of the main variables which shows the differences between the two learning settings: different amounts of input result in different competence outcomes. However, as they claim learners in instructed settings receive better input quality; the input includes syntactically, semantically, and morphologically accurate structures, while in naturalistic settings learners receive nonstandard input. This highlights the importance of the instructed input in formal classes in foreign language learning settings. They point out that some of the linguistic properties are not acquired from input due to the poverty of the stimuli. These properties are obtained by language universals. Another point raised is that in instructed language learning settings, teachers themselves are L2 learners which are very common in non-English speaking countries. They emphasized that age of acquisition is neglected among different variables in adult language acquisition. It is decided that input quality causes differences in naturalistic and instructional settings.
Francis [22] investigated the role of the foreign language learners’ attention and awareness on their language acquisition. He considered one of the input enhancement techniques, “input flooding”, which bombards learners with great amounts of target items. It was used to explore the extent of the acquisition of two of the copulative verbs in Spanish. The participants were divided into experimental and control groups and were tested by these tasks: grammaticality judgment, written production, and picture description. T-tests were used for analyzing the data, and the scores between and within groups were compared. Data analysis revealed that input flood had no significant effect on the acquisition of the two mentioned verbs. He believes that to come to a final conclusion, the input flood on the acquisition of these two verbs was not sufficient. It is suggested to consider simple structures in input flood and in longer treatment periods; being exposed to more structures of the target forms can make a big change on the effect of the input flood on the learners’ proficiency level.
Yet another study contrasted UG-based and usage-based in the case of [23] where she studies the correction feedback in L2 speech production from the viewpoints of the two opposing theories: cognitive-interactionist and nativist. According to nativists, language acquisition device (LAD) is inherent in all human beings, and positive evidence is vital for studying the development of a second language. Nativists believe language acquisition is purely implicit, and by corrective feedback learners are informed which structures are unacceptable, while according to cognitive interactionists, learning is both explicit and implicit, and “the information obtained through feedback may serve as input data for explicit rule-learning or subsequent implicit learning” (p. 2) [23]. Li discusses different ways of error correction and defines explicit correction and recast as the ‘input-providing feedback’, while repetition, elicitation, metalinguistic clue and clarification are identified as ‘output-prompting feedback’. In conclusion, [23] provides useful types of feedback to the teachers; for teaching new linguistic structures, input-driven feedbacks such as recasting is suggested, while in teaching previously learned linguistic structures, where deep cognitive processing is involved, output-prompting feedback like self-correction is recommended.
Nativists and cognitivists could not provide sufficient evidence and proofs to specify which approach controls syntax acquisition process, so in [24], Al-Balushi presents a new avenue. He claims that looking at the syntax acquisition from second language learning perspective shows the accessibility of UG by adult L2 learners by using analytical and verbal abilities. He suggests researchers examine the structures and constructions which are neither found in the learner’s L1 grammar nor in L2 input. Then it would be easier to find out whether learners’ performance is based on experience or not. As [24] addresses, there are still remaining questions about the involvement of UG in language acquisition process and its extent. The role of linguistic data or language input in language acquisition and whether UG can be a compensation for the impoverished input are the topics yet to be studied and investigated.
In a study by [24] on child language acquisition process, it was further discussed that children use strategies, mechanisms, and pragmatic inferences to comprehend lexical symbols of adults. As he points out, cognitive and social processes both assist children because there are similar semantic relations (like action and agent) in all cultures. Exposure to linguistic input enables children to formulate word classes of nouns and verbs in positions they have not experienced before. As a result, cognitivists believe language is acquired by more cognitive components. However, since the language of a child is a reflection of caregiver or experimental learning situations, syntax acquisition can be referred to usage-based and experience-based approaches [24]. This has implications on future research in second language acquisition.
There are various studies relating to input exposure and effective factors in second language learning and acquisition. The next section is a review of studies focusing on the effect of early input, the effect of late input, and the effect of environmental input.
Some researchers believe that receiving language input at an early age has positive effects on the learning process. Borovsky [25] believes that early language input has a great influence on increasing lexical proficiency level and having less linguistic input exposure causes learning problems. She states that because of the effect of receiving early input, cognitive mechanism of children is different in the word learning process; children find the relationship between words and their usage by the use of categorization. She also mentions that an increase in the linguistic input has a positive effect on the children’s vocabulary learning process.
Kharkhurin [26] hypothesizes that in the early years, cognitive process of the bilingual children causes mental construction which results in cognitive advantages later in their lives. When a target language is learnt early, better underlying concepts are formed, and there will be a better relationship between learner’s linguistic and conceptual knowledge.
Huttenlocher et al. [27] points out that normal children learn basic syntactic structures at early ages, but there are variations in the rate and course of acquisition especially when the structures are more complex. They also mention that there is a relation between language input and learners’ skills in some parts of syntax. They hypothesized that some skills which were not related to language input at early ages can be influential later.
It is believed that when the L1 is more established at the time of first exposure to the L2, it will interfere more with the L2 production. Flege [28] (as cited in [29]) states that the problems that adults encounter in the learning process is not because of “normal neural maturation” but because of the L1 interference. Iverson et al. [30] (as cited in [29]) mentions when the L1 becomes more developed, the learner faces more problems. So they suggest an early start of the L2 because till L1 categories are not fully established, the L2 learner will have an easier learning process.
Krashen et al. [31] (as cited in [32]) claims that starting younger makes learners more successful and can result in native-like performance. Nevertheless, as they mention, late learners learn faster.
Munoz [33] states that since late starters have a faster rate of development, further exposure allows them to catch up with the early starters especially regarding literacy-related skills. Late starters achieve similar proficiency levels in shorter periods of time.
Frediani [34] studied the effect of the age of onset and the amount of instruction on EFL learners’ proficiency in Argentina. 7–8-year-olds were compared with 12–13-year-olds. Considering the instructional time, the study shows that though late starters had fewer instruction hours, their cognitive maturity helped them to overcome the problems in language learning.
It is believed that being exposed to the target language outside the formal situations influences the learning process. Borovsky [25] states that early linguistic experience of children at home is correlated with their linguistic input ability at school: when their home environment is linguistically enriched, they learn new words faster.
The results of the study by [27] show that child’s syntax is highly related to the input variations; there is a critical relationship between teacher’s and parents’ syntactic input and child’s syntactic growth. The effect of the teacher’s input is significant not at the beginning of the school year, but over the years, and those who provide language input for the child as a learner play a big role in the learning process of syntax. They found individual differences between children’s skills and a correlation between these differences and parents’ complexity of speech.
Aukrust [35] states that “children can and do learn language as well as other socio-cognitive skills from keenly observing the interactions of others and listening in on talk” (p. 18). Beals [36] (as cited in [35]) points out that children whose mothers used more words in conversations had a bigger size of the vocabulary.
A brief look at relevant studies to input exposure as most studies indicated usage-based has significant links to second language acquisition.
Title | Author(s) | Results |
---|---|---|
The effect of early input | Borovsky [25] | Early language input has a great influence on increasing lexical proficiency, and less input causes learning problems |
Kharkhurin [26] | By learning a target language early, underlying concepts are formed and a better relationship shapes between learners’ linguistic and conceptual knowledge | |
Huttenlocher et al. [27] | There is a relationship between language input and learners’ skills in some parts of syntax | |
Fledge ([28] cited in [29]) | Adults’ learning problems are because of L1 interference | |
Iverson et al. ([30] cited in [29]) | To have an easier L2 learning process before L1 categories are fully established, an early L2 start is suggested | |
Krashen, Long, and Scarcella ([31] cited in [32]) | Starting younger makes learners more successful and can result in native-like performance | |
The effect of late input | Munoz [33] | Since late learners have a faster rate of development, further exposure allows them to gain better literacy skills in shorter periods of time |
Frediani [34] | Late starters, with fewer instruction hours, overcome language learning problems because of their cognitive maturity | |
The role of environmental input | Borovsky [25] | A linguistically enriched environment helps learning new words faster |
Huttenlocher et al. [27] | There is a critical relationship between teacher’s and parents’ syntactic input and child’s syntactic growth which arises over years | |
Aukrust [35] | Children learn language like other socio-cognitive skills by observing and listening to the interaction of others | |
Age influence in language learning | Penfield and Roberts [37] | Language learning is under the influence of an influential period in early childhood called critical period (i.e., CP) |
Bettoni-Techio [38] | There is no fixed agreement on the onset and offset of language learning, but puberty is the offset | |
Perani et al. [39] | Age is an influential factor in language learning, and late learners are less proficient than early ones | |
Singleton [40] | Native-like level can be gained before age 7 | |
Dimroth [41] | Starting at lower levels in primary schools is suggested to increase better learning/acquisition attainment. | |
Larson-Hall [42] | Early starting age can be advantageous only if individuals acquire a significant amount of input | |
Huang [43] | Learners’ first exposure to English and school teaching time is significantly correlated with their accuracy of the studied vowels. In addition, the formal instruction of English at an earlier age is suggested | |
The ineffectiveness of critical period | Munoz ([44] cited in [42]) | No advantage for earlier starters was observed in this study; attitudes and motivation were the only advantageous parts for early starters |
Bialystok and Hakuta [45] | Older learners transfer more than younger ones, and they can gain native-like attainment | |
Slabakova [46] | Critical period has no effect on semantics | |
Burstall ([47] cited in [42]) | No effective age influence was found on the performance of early starters in this study |
Language input has been studied from various perspectives to clarify its role in the teaching and learning process so that better learning contexts will be provided for language learners. The amount and length of receiving linguistic input can have a determining role in better learning, especially in foreign language settings that are mostly input-dependent.
There is tension between the supporters and the opponents of these two approaches (i.e., UG- and usage-based) on whether language learning is done on the basis of the input exposure and experience or by the help of the innate knowledge of learners, and still it is not clear whether grammatical learning is usage-based or universal grammar-based. What is certain, at this juncture, is that it is worthwhile investigating the following parameters and variables: the role of different types of frequency of L2 input (such as type and token frequency), the role of L1 transfer, the impact of L1 frequency on the learners’ performance data, L1 and L2 co-occurrence probabilities, the interaction of the L1 in L2 input, and the impact of L1 on L2 proficiency levels. For reliable results, learners should be selected from different age groups and language learning settings (both second language learning settings and foreign language learning settings). It cannot be overly emphasized that sufficient numbers of participants should be considered for these studies as well to have valid outcomes that can be applicable to other contexts and situations. These considerations will certainly help scholars in the pursuit of an answer to the usage-based or universal grammar-based debate. On whether the success of second language acquisition is a result of the innate knowledge or is a result of usage-based experience, the positive effect of the length of exposure shows that grammatical learning can be claimed to be usage-based, but further research by larger groups of learners with early exposure are needed to support this.
We would like to thank the Malaysian Ministry of Education for providing the financial support for the research and authorship of this article. Research grant coded FRGS/1/2018/SS09/UKM/02/.
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This chapter describes a tiered approach to NFM, commencing with strategic modelling to identify a range of NFM opportunities (tree-planting, distributed runoff attenuation features, and soil structure improvements), and their potential benefits, before engagement with catchment partners, and prioritisation of areas for more detailed hydrological modelling and uncertainty analysis. NFM measures pose some fundamental challenges in modelling their contribution to flood risk management because they are often highly distributed, can influence multiple catchment processes, and evidence for their effectiveness at the large scale is uncertain. This demands we model the ‘upstream’ in more detail so that we can assess the effectiveness of many small-scale changes at the large-scale. We demonstrate an approach to address these challenges employing the fast, high resolution, fully-distributed inundation model JFLOW, and visualisation of potential benefits in map form. These are used to engage catchment managers who can prioritise areas for potential deployment of NFM measures, where more detailed modelling may be targeted. We then demonstrate a framework applying the semi-distributed Dynamic TOPMODEL in which uncertainty plays an integral role in the decision-making process.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Barry Hankin, Peter Metcalfe, David Johnson, Nick A. Chappell,\nTrevor Page, Iain Craigen, Rob Lamb and Keith Beven",authors:[{id:"203276",title:"Dr.",name:"Barry",middleName:null,surname:"Hankin",slug:"barry-hankin",fullName:"Barry Hankin"}]},{id:"55369",doi:"10.5772/intechopen.68924",title:"One- and Two-Dimensional Hydrological Modelling and Their Uncertainties",slug:"one-and-two-dimensional-hydrological-modelling-and-their-uncertainties",totalDownloads:2718,totalCrossrefCites:3,totalDimensionsCites:12,abstract:"Earth processes, which occur in land, air and ocean in different environment and at different scales, are very complex. Flooding is also a part of the complex processes, which need to be assessed accurately to know the accurate spatial and temporal changes of flooding and their causes. Hydrological modelling has been used by several researchers in river and floodplain modelling for flood analysis. In this chapter, factors affecting flash flood, possible options of basic input parameters in one- and two-dimensional hydrological models in data sparse environment, some case studies and uncertainty in hydrological modelling were discussed. This discussion will help the readers to understand the flooding factors, selection of input parameters in data sparse environment, a brief insight of one- and two-dimensional hydrological models and uncertainties in their input and model parameters and model structures.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Mohd Talha Anees, Khiruddin Abdullah, Mohd Nawawi Mohd\nNordin, Nik Norulaini Nik Ab Rahman, Muhammad Izzuddin Syakir\nand Mohd. Omar Abdul Kadir",authors:[{id:"11196",title:"Dr.",name:"Khiruddin",middleName:null,surname:"Abdullah",slug:"khiruddin-abdullah",fullName:"Khiruddin Abdullah"},{id:"151303",title:"Prof.",name:"Nik Norulaini",middleName:null,surname:"Ab Rahman",slug:"nik-norulaini-ab-rahman",fullName:"Nik Norulaini Ab Rahman"},{id:"151344",title:"Prof.",name:"Mohd Omar",middleName:null,surname:"Ab Kadir",slug:"mohd-omar-ab-kadir",fullName:"Mohd Omar Ab Kadir"},{id:"201647",title:"Mr.",name:"Mohd Talha",middleName:null,surname:"Anees",slug:"mohd-talha-anees",fullName:"Mohd Talha Anees"},{id:"203217",title:"Prof.",name:"Mohd Nawawi",middleName:null,surname:"Mohd Nordin",slug:"mohd-nawawi-mohd-nordin",fullName:"Mohd Nawawi Mohd Nordin"},{id:"203218",title:"Dr.",name:"Muhammad Izzuddin",middleName:null,surname:"Syakir Ishak",slug:"muhammad-izzuddin-syakir-ishak",fullName:"Muhammad Izzuddin Syakir Ishak"}]},{id:"55735",doi:"10.5772/intechopen.69139",title:"Understanding Flood Risk Management in Asia: Concepts and Challenges",slug:"understanding-flood-risk-management-in-asia-concepts-and-challenges",totalDownloads:1941,totalCrossrefCites:6,totalDimensionsCites:11,abstract:"In this chapter, an attempt is made to review the behavior of flood in Asian region and mechanism of flood risk management adopted among Asian nations. Flood is the most frequent natural disaster at present and vulnerability is widespread across the globe. Though, Asian region is on a knife-edge. Distribution of natural disasters in Asia followed by economic damage and human killing is illustrated in this chapter. In addition, discourse of China, Pakistan, India, Bangladesh, Indonesia, Nepal, Vietnam, and Sri Lanka on flood risk management is examined. Flood risk management policies framed by these nations over the period of time are synthesized. Research and investment on forecasting, planning, preparedness, assessment, evaluation, and mitigation of flood risk are explained. This synthesis can present a pathway for better response and flood management for debated Asian countries through filling the identified policy gaps. This chapter also urges a need of holistic and inter-countries research and cross country analysis followed by increased funding for sustainable management of risk.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Saleem Ashraf, Muhammad Luqman, Muhammad Iftikhar, Ijaz\nAshraf and Zakaria Yousaf Hassan",authors:[{id:"202027",title:"Dr.",name:"Muhammad Saleem",middleName:null,surname:"Ashraf",slug:"muhammad-saleem-ashraf",fullName:"Muhammad Saleem Ashraf"}]},{id:"45003",doi:"10.5772/55472",title:"Impact of Hurricane Katrina on the Louisiana HIV/AIDS Epidemic: A Socio-Ecological Perspective",slug:"impact-of-hurricane-katrina-on-the-louisiana-hiv-aids-epidemic-a-socio-ecological-perspective",totalDownloads:1909,totalCrossrefCites:2,totalDimensionsCites:6,abstract:null,book:{id:"3507",slug:"natural-disasters-multifaceted-aspects-in-management-and-impact-assessment",title:"Natural Disasters",fullTitle:"Natural Disasters - Multifaceted Aspects in Management and Impact Assessment"},signatures:"William T. Robinson",authors:[{id:"161386",title:"Associate Prof.",name:"William",middleName:null,surname:"Robinson",slug:"william-robinson",fullName:"William Robinson"}]},{id:"55628",doi:"10.5772/intechopen.68912",title:"Flood Risk Mapping in the Amazon",slug:"flood-risk-mapping-in-the-amazon",totalDownloads:1639,totalCrossrefCites:3,totalDimensionsCites:6,abstract:"Floods are part of the natural and cultural life in the Amazon. However, the issues and management of fluvial-disaster risks are poorly studied. Among the reasons for the lack of studies, the Amazon region has several gaps in information ranging from inadequate regional maps to spatially unsystematic local data. Flood patterns differ in urban and rural areas. Severe large-scale flooding took place during the previous and the current decades, such as those that occurred in 2009 and 2012. Between 1991 and 2010, official recorded data indicate about 3,292,888 people were affected in 6 regional states of the Amazon (Acre, Amapá, Amazonas, Pará, Rondônia, and Roraima) considering 7 different hazards. Because of the extensive damages, the national government started a mapping program for cities in Brazil that have a history of facing significant flood risks. The aim of this chapter is to analyse the flood-risk mapping conditions in the Amazon.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Milena Marília Nogueira de Andrade, Iris Celeste Nascimento\nBandeira, Dianne Danielle Farias Fonseca, Paulo Eduardo Silva\nBezerra, Ádanna de Souza Andrade and Rodrigo Silva de Oliveira",authors:[{id:"203296",title:"Dr.",name:"Milena",middleName:"Marília Nogueira De",surname:"Andrade",slug:"milena-andrade",fullName:"Milena Andrade"},{id:"203302",title:"MSc.",name:"Iris Celeste Nascimento",middleName:null,surname:"Bandeira",slug:"iris-celeste-nascimento-bandeira",fullName:"Iris Celeste Nascimento Bandeira"},{id:"203352",title:"Mr.",name:"Paulo Eduardo Silva",middleName:null,surname:"Bezerra",slug:"paulo-eduardo-silva-bezerra",fullName:"Paulo Eduardo Silva Bezerra"},{id:"203353",title:"Mrs.",name:"Ádanna",middleName:null,surname:"Andrade",slug:"adanna-andrade",fullName:"Ádanna Andrade"},{id:"203354",title:"Mr.",name:"Rodrigo",middleName:null,surname:"Oliveira",slug:"rodrigo-oliveira",fullName:"Rodrigo Oliveira"},{id:"203421",title:"Mrs.",name:"Dianne",middleName:null,surname:"Fonseca",slug:"dianne-fonseca",fullName:"Dianne Fonseca"}]}],mostDownloadedChaptersLast30Days:[{id:"56370",title:"Flood Risk Management in Mexico",slug:"flood-risk-management-in-mexico",totalDownloads:1575,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Mexico receives an average annual rainfall of 740 mm, which are distributed in the hydrological cycle as follows: 72% evapotranspiration, 21% becomes runoff and 6% as aquifer recharge. Within the Mexican territory, exist a great diversity of climates and high spatial and temporal variability in water resources availability. In the period 2000–2015, damages from hydrometeorological phenomena in Mexico represented between 60 and 99% of total damages and losses at national level due to natural and socioorganizational events. Considering global climate change impact on the selection, design and implementation of flood control measures, represents a major challenge, since the level of certainty regarding its influence on the variables involved, remains insufficient. This chapter provides a description of the main elements directly linked to flooding in México, such as a high spatial and temporal variability in water resources availability and presence of tropical cyclones in both coasts and climate change. A brief summary of the main disasters caused by hydrometeorological phenomena, the annual cost of the damages, the main non‐structural measures for flood control and the intervention from the Mexican Institute of Water Technology in the use, development and spread of technology focused on flood risk management are also included.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Felipe I. Arreguín-Cortés and Claudia Elizabeth Cervantes-Jaimes",authors:[{id:"203037",title:"Dr.",name:"Felipe I.",middleName:null,surname:"Arreguin-Cortés",slug:"felipe-i.-arreguin-cortes",fullName:"Felipe I. Arreguin-Cortés"},{id:"204319",title:"M.Sc.",name:"Claudia Elizabeth",middleName:null,surname:"Cervantes-Jaimes",slug:"claudia-elizabeth-cervantes-jaimes",fullName:"Claudia Elizabeth Cervantes-Jaimes"}]},{id:"55369",title:"One- and Two-Dimensional Hydrological Modelling and Their Uncertainties",slug:"one-and-two-dimensional-hydrological-modelling-and-their-uncertainties",totalDownloads:2716,totalCrossrefCites:3,totalDimensionsCites:12,abstract:"Earth processes, which occur in land, air and ocean in different environment and at different scales, are very complex. Flooding is also a part of the complex processes, which need to be assessed accurately to know the accurate spatial and temporal changes of flooding and their causes. Hydrological modelling has been used by several researchers in river and floodplain modelling for flood analysis. In this chapter, factors affecting flash flood, possible options of basic input parameters in one- and two-dimensional hydrological models in data sparse environment, some case studies and uncertainty in hydrological modelling were discussed. This discussion will help the readers to understand the flooding factors, selection of input parameters in data sparse environment, a brief insight of one- and two-dimensional hydrological models and uncertainties in their input and model parameters and model structures.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Mohd Talha Anees, Khiruddin Abdullah, Mohd Nawawi Mohd\nNordin, Nik Norulaini Nik Ab Rahman, Muhammad Izzuddin Syakir\nand Mohd. Omar Abdul Kadir",authors:[{id:"11196",title:"Dr.",name:"Khiruddin",middleName:null,surname:"Abdullah",slug:"khiruddin-abdullah",fullName:"Khiruddin Abdullah"},{id:"151303",title:"Prof.",name:"Nik Norulaini",middleName:null,surname:"Ab Rahman",slug:"nik-norulaini-ab-rahman",fullName:"Nik Norulaini Ab Rahman"},{id:"151344",title:"Prof.",name:"Mohd Omar",middleName:null,surname:"Ab Kadir",slug:"mohd-omar-ab-kadir",fullName:"Mohd Omar Ab Kadir"},{id:"201647",title:"Mr.",name:"Mohd Talha",middleName:null,surname:"Anees",slug:"mohd-talha-anees",fullName:"Mohd Talha Anees"},{id:"203217",title:"Prof.",name:"Mohd Nawawi",middleName:null,surname:"Mohd Nordin",slug:"mohd-nawawi-mohd-nordin",fullName:"Mohd Nawawi Mohd Nordin"},{id:"203218",title:"Dr.",name:"Muhammad Izzuddin",middleName:null,surname:"Syakir Ishak",slug:"muhammad-izzuddin-syakir-ishak",fullName:"Muhammad Izzuddin Syakir Ishak"}]},{id:"55139",title:"Estimating Flood Quantiles on the Basis of Multi-Event Rainfall Simulation",slug:"estimating-flood-quantiles-on-the-basis-of-multi-event-rainfall-simulation",totalDownloads:1391,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter provides an insight into a new approach to estimating the flood quantiles based on rainfall-runoff modelling using multiple rainfall events. The approach is based on the prior knowledge about the probability distribution of annual maximum daily totals of rainfall in catchments, random disaggregation of the totals into hourly values and rainfall-runoff modelling. The new presented method called MESEF (Multi-Event Simulation of Extreme Flood) combines design event method based on single-rainfall event modelling and continuous simulation method used for estimating the maximum discharges of a given exceedance probability using rainfall-runoff models. The MESEF method considers varied moisture conditions in model catchment before the occurrence of rainfalls. To verify the efficiency of the proposed method, a comparison was carried out between the values of flood quantiles estimated by the MESEF method and the flood quantiles estimated by direct method. The proposed approach was tested in two catchments in the Upper Vistula River basin. The results of the MESEF method in both catchments were satisfactory; however, in order to verify its effectiveness, more research is needed within catchments of diverse features and landscape. Special attention should be paid to the proportion of moisture conditions that is a crucial factor in future use of the MESEF method in uncontrolled catchments.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Elżbieta Jarosińska and Katarzyna Pierzga",authors:[{id:"202772",title:"Ph.D.",name:"Elżbieta",middleName:null,surname:"Jarosińska",slug:"elzbieta-jarosinska",fullName:"Elżbieta Jarosińska"},{id:"202833",title:"MSc.",name:"Katarzyna",middleName:null,surname:"Pierzga",slug:"katarzyna-pierzga",fullName:"Katarzyna Pierzga"}]},{id:"55735",title:"Understanding Flood Risk Management in Asia: Concepts and Challenges",slug:"understanding-flood-risk-management-in-asia-concepts-and-challenges",totalDownloads:1936,totalCrossrefCites:6,totalDimensionsCites:10,abstract:"In this chapter, an attempt is made to review the behavior of flood in Asian region and mechanism of flood risk management adopted among Asian nations. Flood is the most frequent natural disaster at present and vulnerability is widespread across the globe. Though, Asian region is on a knife-edge. Distribution of natural disasters in Asia followed by economic damage and human killing is illustrated in this chapter. In addition, discourse of China, Pakistan, India, Bangladesh, Indonesia, Nepal, Vietnam, and Sri Lanka on flood risk management is examined. Flood risk management policies framed by these nations over the period of time are synthesized. Research and investment on forecasting, planning, preparedness, assessment, evaluation, and mitigation of flood risk are explained. This synthesis can present a pathway for better response and flood management for debated Asian countries through filling the identified policy gaps. This chapter also urges a need of holistic and inter-countries research and cross country analysis followed by increased funding for sustainable management of risk.",book:{id:"6018",slug:"flood-risk-management",title:"Flood Risk Management",fullTitle:"Flood Risk Management"},signatures:"Saleem Ashraf, Muhammad Luqman, Muhammad Iftikhar, Ijaz\nAshraf and Zakaria Yousaf Hassan",authors:[{id:"202027",title:"Dr.",name:"Muhammad Saleem",middleName:null,surname:"Ashraf",slug:"muhammad-saleem-ashraf",fullName:"Muhammad Saleem Ashraf"}]},{id:"71247",title:"Dealing with Local Tsunami on Pakistan Coast",slug:"dealing-with-local-tsunami-on-pakistan-coast",totalDownloads:592,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Tsunami originating from a local source can arrive at Pakistan coastline within minutes. In the absence of a comprehensive and well-coordinated management plan, the fast-approaching tsunami might wreak havoc on the coast. To combat such a threat, a wide range of short- and long-term mitigation measures are needed to be taken by several government and private sector organizations as well as security agencies. Around 1000-km coastline is divided administratively into two provinces of Baluchistan and Sindh and further into seven districts. Most of the coastal communities were severely affected by an earthquake of magnitude 8+ on 28 November 1945 followed by a devastating tsunami. In contrast to the level of posed hazard and multiple-fold increase in vulnerabilities since then, the risk mitigation efforts are trivial and least coordinated. It is important to provide stakeholders with a set of prerequisite information and guidelines on standardized format to develop their organizational strategies and course of action for earthquake and tsunami risk mitigation in a well-coordinated manner, from local to the national level.",book:{id:"8979",slug:"tsunami-damage-assessment-and-medical-triage",title:"Tsunami",fullTitle:"Tsunami - Damage Assessment and Medical Triage"},signatures:"Ghazala Naeem",authors:[{id:"193736",title:"Ms.",name:"Ghazala",middleName:null,surname:"Naeem",slug:"ghazala-naeem",fullName:"Ghazala Naeem"}]}],onlineFirstChaptersFilter:{topicId:"665",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],testimonialsList:[]},series:{item:{id:"22",title:"Business, Management and Economics",doi:"10.5772/intechopen.100359",issn:"2753-894X",scope:"\r\n\tThis series will provide a comprehensive overview of recent research trends in business and management, economics, and marketing. Topics will include asset liability management, financial consequences of the financial crisis and covid-19, financial accounting, mergers and acquisitions, management accounting, SMEs, financial markets, corporate finance and governance, managerial technology and innovation, resource management and sustainable development, social entrepreneurship, corporate responsibility, ethics and accountability, microeconomics, labour economics, macroeconomics, public economics, financial economics, econometrics, direct marketing, creative marketing, internet marketing, market planning and forecasting, brand management, market segmentation and targeting and other topics under business and management. This book series will focus on various aspects of business and management whose in-depth understanding is critical for business and company management to function effectively during this uncertain time of financial crisis, Covid-19 pandemic, and military activity in Europe.
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