Selected Legionnaires’ disease outbreak in 2019.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"10908",leadTitle:null,fullTitle:"Advances in Decision Making",title:"Advances in Decision Making",subtitle:null,reviewType:"peer-reviewed",abstract:"This book presents a comprehensive overview of the principles and practices of decision-making. It highlights the interface between engineering/technology and the organizational, administrative, and planning abilities of decision-making. The chapters address decision-making using real-world case studies. They also discuss decision-making theory as well as relevant analysis techniques. The book blends computational techniques, dynamic analysis, probabilistic methods, and mathematical optimization techniques to support the analysis of multi-criteria decision-making problems with defined constraints and requirements.",isbn:"978-1-83969-497-4",printIsbn:"978-1-83969-496-7",pdfIsbn:"978-1-83969-498-1",doi:null,price:119,priceEur:129,priceUsd:155,slug:"advances-in-decision-making",numberOfPages:190,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"126486f7f91e18e2e3539a32c38be7b1",bookSignature:"Fausto Pedro García Márquez",publishedDate:"July 27th 2022",coverURL:"https://cdn.intechopen.com/books/images_new/10908.jpg",numberOfDownloads:1478,numberOfWosCitations:0,numberOfCrossrefCitations:1,numberOfCrossrefCitationsByBook:null,numberOfDimensionsCitations:1,numberOfDimensionsCitationsByBook:null,hasAltmetrics:0,numberOfTotalCitations:2,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 11th 2021",dateEndSecondStepPublish:"March 11th 2021",dateEndThirdStepPublish:"May 10th 2021",dateEndFourthStepPublish:"July 29th 2021",dateEndFifthStepPublish:"September 27th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"22844",title:"Prof.",name:"Fausto Pedro",middleName:null,surname:"García Márquez",slug:"fausto-pedro-garcia-marquez",fullName:"Fausto Pedro García Márquez",profilePictureURL:"https://mts.intechopen.com/storage/users/22844/images/system/22844.png",biography:"Fausto Pedro García Márquez is a full professor at the University of Castilla–La Mancha (UCLM), Spain, an honorary senior\nresearch fellow at Birmingham University, UK, and a lecturer\nat the Postgraduate European Institute. In 2013/2014, he was\na senior manager at Accenture. He obtained his European\nPh.D. with maximum distinction. He is the recipient of several\nawards from various organizations, including the International\nSociety of Management Science and Engineering Management (ICMSEM). He\nhas published more than 170 journal papers and authored and edited 40 books,\n90 book chapters, and 6 patents. He is an editor for five international journals and\na committee member of more than sixty conferences. He has been the Principal\nInvestigator of more than 150 projects both national and international. His main\ninterests include artificial intelligence, maintenance, management, renewable\nenergy, transport, advanced analytics, and data science",institutionString:"University of Castile-La Mancha",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"12",totalChapterViews:"0",totalEditedBooks:"12",institution:{name:"University of Castile-La Mancha",institutionURL:null,country:{name:"Spain"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"433",title:"Decision Making",slug:"decision-making"}],chapters:[{id:"81401",title:"Introductory Chapter: Introduction to Advances in Decision-Making",doi:"10.5772/intechopen.104550",slug:"introductory-chapter-introduction-to-advances-in-decision-making",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Fausto Pedro García Márquez",downloadPdfUrl:"/chapter/pdf-download/81401",previewPdfUrl:"/chapter/pdf-preview/81401",authors:[{id:"22844",title:"Prof.",name:"Fausto Pedro",surname:"García Márquez",slug:"fausto-pedro-garcia-marquez",fullName:"Fausto Pedro García Márquez"}],corrections:null},{id:"77944",title:"Cognitive Decision-Making in Dynamic Systems: When the Objectivity (of the Processing) Does Not Guarantee the Validity (of the Choice of Action)",doi:"10.5772/intechopen.98937",slug:"cognitive-decision-making-in-dynamic-systems-when-the-objectivity-of-the-processing-does-not-guarant",totalDownloads:108,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Since around 1970, academic studies on decision-making have changed in nature. Whereas they used to be laboratory studies of selected situations giving rise to the expression of individual choices, nowadays studies focus on real situations. These situations are processed in their natural contexts at the time they occur. The decisions to be made concern generally social problems (for instance forest fires, maritime pollution or global warming). This mutation in the nature of situations studied requires a paradigm shift, which leads to elaborate decisions in complex, dynamic and evolving systems, even sometimes resilient to human actions implemented to control them. This chapter analyses, at individual and group level (crisis units), cognitive difficulties encountered by decision-makers in handling such situations. These situations consist in treating information by assigning them, from the outset, meanings (sometimes personal). This is done by looking for temporary interactions, while respecting the global nature of the situation, by focusing on knowing the properties of context as well as those of the temporal evolution of the system concerned. This chapter analyses a case study for which urgent and fundamental decisions could not be taken and proposes an interpretation in terms of paradigms. Previous studies noted that the decision in complex systems, could entail paradoxes. This study on the decision-making dynamic shows that seeking objectivity, as defined under its current intangible form, does not produce a significant increase in the validity of choices made.",signatures:"Bernard Cadet",downloadPdfUrl:"/chapter/pdf-download/77944",previewPdfUrl:"/chapter/pdf-preview/77944",authors:[{id:"232726",title:"Emeritus Prof.",name:"Bernard",surname:"Cadet",slug:"bernard-cadet",fullName:"Bernard Cadet"}],corrections:null},{id:"78344",title:"Single-Period Capacity and Demand Allocation Decision Making under Uncertainty",doi:"10.5772/intechopen.98777",slug:"single-period-capacity-and-demand-allocation-decision-making-under-uncertainty",totalDownloads:128,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The newsvendor model deals with a single-period capacity allocation problem under uncertainty. The real world examples include perishable products (e.g., fish, vegetable), holiday-related products (e.g., Easter, Christmas, Halloween), seasonal products (e.g., fashion), and promotional products. This section addresses three newsvendor models: traditional newsvendor, inverse newsvendor, and sequential newsvendor models. The main decision under the traditional newsvendor setting is capacity allocation (i.e., how much to order), whereas the main decision under the inverse newsvendor setting is demand allocation (i.e., how many customers to be served) under the fixed capacity. This section demonstrates how to compare profit maximization approach to customer-oriented approach under the traditional newsvendor. The inverse newsvendor applies to revenue management for the hospitality industry. The sequential newsvendor model determines the optimal sequence when the number of customers to be served (determined by the inverse newsvendor model) is given. Normal distribution is considered for analytical solution and numerical studies. In addition, a discrete distribution is considered for numerical studies.",signatures:"Sangdo Choi",downloadPdfUrl:"/chapter/pdf-download/78344",previewPdfUrl:"/chapter/pdf-preview/78344",authors:[{id:"352160",title:"Associate Prof.",name:"Sangdo",surname:"Choi",slug:"sangdo-choi",fullName:"Sangdo Choi"}],corrections:null},{id:"77449",title:"Decision Making in the Context of Natural Disasters Based on a Geographic Information System and the Internet of Things (IoT)",doi:"10.5772/intechopen.98778",slug:"decision-making-in-the-context-of-natural-disasters-based-on-a-geographic-information-system-and-the",totalDownloads:193,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Decisions within the company, managers in countries or regions are made by one or more groups of decision-makers. The management of natural disasters involves several specialized decision-makers (experts, firefighters, police officers, drivers,). The aim of the chapter is to improve decision making in the context of natural disasters situation. Zero risk in the world does not exist due to natural phenomena that occur randomly and appear suddenly. It is essential to manage the risks in the situation of natural disasters and also to confront the influence of natural disasters on the phenomenon of Soil-Structure Interaction. For this, this chapter presents a conceptual architecture of a knowledge base to manage the risks of natural disasters remotely by a Geographic Information system (GIS) and embedded systems. This architecture is based on the integration of data via different sources of information (GIS, satellites, electronic sensors and comments from experts). To properly manage this information, this chapter uses the ontology of Soil-Structure Interaction With Agents External (OSSIWAE) in the context of the Internet of Things (IoT). A case study is conducted on a prototype of a model for building a structure three-story for testing the usability of the proposed architecture.",signatures:"Aissa Bensattalah, Rachid Chalal, Tahar Hassaine Daouadji and Tayeb Bensattalah",downloadPdfUrl:"/chapter/pdf-download/77449",previewPdfUrl:"/chapter/pdf-preview/77449",authors:[{id:"176815",title:"Prof.",name:"Tahar",surname:"Hassaine Daouadji",slug:"tahar-hassaine-daouadji",fullName:"Tahar Hassaine Daouadji"},{id:"352539",title:"Dr.",name:"Aissa",surname:"Bensattalah",slug:"aissa-bensattalah",fullName:"Aissa Bensattalah"},{id:"418154",title:"Prof.",name:"Rachid",surname:"Chalal",slug:"rachid-chalal",fullName:"Rachid Chalal"},{id:"418157",title:"Dr.",name:"Tayeb",surname:"Bensattalah",slug:"tayeb-bensattalah",fullName:"Tayeb Bensattalah"}],corrections:null},{id:"79051",title:"Comparison of Cross-Entropy Based MCDM Approach for Selection of Material in Sugar Industry",doi:"10.5772/intechopen.98242",slug:"comparison-of-cross-entropy-based-mcdm-approach-for-selection-of-material-in-sugar-industry",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"One of the major problems faced in engineering is the selection of the material which is most suitable for the product. Material selection from a large number with diverse mechanical, physical and chemical properties and choosing the best material which is the most satisfying for making the job is a very complex process. Material selection is important as it determines durability, reliability and cost of the product. Selection of suitable material which gives maximum performance with minimum cost is often observed to be a multi-criterion decision-making (MCDM) problem with different objectives. This chapter presents an integrated approach to select the suitable material to be used as base of induction cookware which can give maximum performance with minimum cost. In the integrated approach the weights of the criteria are computed using the cross-entropy method and ranking of the alternatives is done using the different MCDM methods. The methods are further illustrated with an example and the result obtained from different cross-entropy MCDM methods are compared for finding the most suitable method for serving the purpose.",signatures:"Syed Abou Iltaf Hussain, Himanshu Chandra and Uttam Kumar Mandal",downloadPdfUrl:"/chapter/pdf-download/79051",previewPdfUrl:"/chapter/pdf-preview/79051",authors:[{id:"323219",title:"Mr.",name:"Syed Abou Iltaf",surname:"Hussain",slug:"syed-abou-iltaf-hussain",fullName:"Syed Abou Iltaf Hussain"},{id:"353726",title:"Dr.",name:"Uttam Kumar",surname:"Mandal",slug:"uttam-kumar-mandal",fullName:"Uttam Kumar Mandal"},{id:"353728",title:"Mr.",name:"Himanshu",surname:"Chandra",slug:"himanshu-chandra",fullName:"Himanshu Chandra"}],corrections:null},{id:"79039",title:"Plithogenic SWARA-TOPSIS Decision Making on Food Processing Methods with Different Normalization Techniques",doi:"10.5772/intechopen.100548",slug:"plithogenic-swara-topsis-decision-making-on-food-processing-methods-with-different-normalization-tec",totalDownloads:108,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Decision making (DM) is a process of choosing the optimal alternative with the maximum extent of criteria satisfaction. The challenging aspect in making optimal decisions is the suitable choice of multi-criteria decision-making (MCDM) methods that consider the initial input as the expert’s opinion on criteria satisfaction by the alternatives. This initial decision-making matrix representation discriminates MCDM as fuzzy, intuitionistic, neutrosophic to handle the decision-making environment that is characterized by uncertainty, impreciseness, and indeterminacy, respectively. A generalized kind of representation by plithogenic sets optimizes the decision-making risks. This chapter aims in developing SWARA-TOPSIS with plithogenic representations and discusses the efficiency of this integrated approach over the method of TOPSIS with equal criterion weight. A comparative analysis of four different normalization techniques is likewise made. The proposed plithogenic integrated MCDM model is validated with the decision making on four food processing methods. The final ranks of the alternatives are also compared under the proposed plithogenic SWARA-TOPSIS and TOPSIS models with different normalization techniques. The results witness the efficiency of the proposed model over the existing models.",signatures:"Nivetha Martin",downloadPdfUrl:"/chapter/pdf-download/79039",previewPdfUrl:"/chapter/pdf-preview/79039",authors:[{id:"352979",title:"Dr.",name:"Nivetha",surname:"Martin",slug:"nivetha-martin",fullName:"Nivetha Martin"}],corrections:null},{id:"78057",title:"Innovation Methodologies to Activate Inclusive Growth in the Organization",doi:"10.5772/intechopen.99150",slug:"innovation-methodologies-to-activate-inclusive-growth-in-the-organization",totalDownloads:143,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Digitalization is transforming the way we move and produce, encouraging the industry to use the best available technologies focusing on people. Non technological innovations, especially, Workplace Innovation (WI) will play a key role in the digital revolution and acceleration of the technological advances, improving the competitiveness of the companies. This draws attention to the importance of the innovation culture and employee engagement focused on improving employee motivation and working conditions, thereby improving labor productivity, organizational efficiency, innovation capacity, market reactivity, and, as a result, business competitiveness. WI is a combination of structural and cultural practices that boosts employees’ participation, improving the quality of work and organizational performance. These strategies aim to promote innovative work behavior to create, introduce and apply new ideas, processes and products. To address these issues this chapter analyses WI in rail sector and defines WI Scheme for rail sector. A theoretical background is presented based on a sample of 203 railway entities across European Union (EU). Then, data analysis and results are examined and the guide to implement WI scheme is defined. Finally, the results of the research, including limitations and concluding remarks are discussed.",signatures:"Garazi Carranza Ruiz de Loizaga and Begoña Sanchez Gonzalez",downloadPdfUrl:"/chapter/pdf-download/78057",previewPdfUrl:"/chapter/pdf-preview/78057",authors:[{id:"414695",title:"Dr.",name:"Garazi",surname:"Carranza Ruiz de Loizaga",slug:"garazi-carranza-ruiz-de-loizaga",fullName:"Garazi Carranza Ruiz de Loizaga"},{id:"418249",title:"Mrs.",name:"Begoña",surname:"Sanchez Gonzalez",slug:"begona-sanchez-gonzalez",fullName:"Begoña Sanchez Gonzalez"}],corrections:null},{id:"76443",title:"Improved Probabilistic Frequent Itemset Analysis Strategy of Learning Behaviors Based on Eclat Framework",doi:"10.5772/intechopen.97219",slug:"improved-probabilistic-frequent-itemset-analysis-strategy-of-learning-behaviors-based-on-eclat-frame",totalDownloads:285,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Interactive learning environment is the key support for education decision making, the corresponding analytics and methodology are the important part of educational technology research and development. As an important part and the research challenge, learning behaviors are uncertain and produce complex data relationships, which makes the learning analysis process more difficult. This chapter studies the feasibility of Eclat framework applying in educational decision making and get the corresponding the data analysis results. We take probabilistic frequent itemsets and association rules as research objectives, extract and standardize multiple data subsets; Based on Eclat framework, using data vertical format, we design and improve the models and algorithms in the process of data management and processing. The results show that the improved models and algorithms are effective and feasible. On the premise of ensuring robustness and stability, the mining quality of probabilistic frequent itemsets and association rules is guaranteed, which is conducive to the construction of key execution topology of learning behaviors, and improves the accuracy and reliability of data association analysis and decision prediction. The whole analysis methods and demonstration processes can provide references for the study of interactive learning environment, as well as decision suggestions and predictive feedback.",signatures:"Xiaona Xia",downloadPdfUrl:"/chapter/pdf-download/76443",previewPdfUrl:"/chapter/pdf-preview/76443",authors:[{id:"350744",title:"Prof.",name:"Xiaona",surname:"Xia",slug:"xiaona-xia",fullName:"Xiaona Xia"}],corrections:null},{id:"79147",title:"The Application of Simple Additive Bayesian Allocation Network Process in System Obsolescence",doi:"10.5772/intechopen.98530",slug:"the-application-of-simple-additive-bayesian-allocation-network-process-in-system-obsolescence",totalDownloads:154,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In designing a system, multi-dimensional obsolescence design criteria such as Scheduling; Reliability, Availability, Maintainability; Performance and Functionality; and Costs affect its overall lifespan. This work examines the impacts of these factors on systems during the design phase using a new application called the Simple Additive Bayesian Allocation Network Process (SABANP). The application uses a combination of Multi-Criteria Decision Making (MCDM) methodology and a Bayesian Belief Network to address the impact of obsolescence on a system. Unlike the requirement of weights that are prevalent in the analysis of MCDM, this application does not require weights. Moreover, this application accounts for functional dependencies of criteria, which is not possible with the MCDM methodologies. A case study was conducted using military and civilian experts. Data were collected on systems’ obsolescence criteria and analyzed using the application to make trade-off decisions. The results show that the application can address complex obsolescence decisions that are both quantitative and qualitative. Expert validation showed that SABANP successfully identified the best system for mitigating obsolescence.",signatures:"Oluwatomi Adetunji",downloadPdfUrl:"/chapter/pdf-download/79147",previewPdfUrl:"/chapter/pdf-preview/79147",authors:[{id:"349375",title:"Dr.",name:"Oluwatomi",surname:"Adetunji",slug:"oluwatomi-adetunji",fullName:"Oluwatomi Adetunji"}],corrections:null},{id:"79217",title:"Political Leadership and Financial Emoluments: A Case of Developing Countries",doi:"10.5772/intechopen.97524",slug:"political-leadership-and-financial-emoluments-a-case-of-developing-countries",totalDownloads:102,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The theoretical concept of political leadership would have to be the most elusive and fluid concept of leadership. It has within its authority dominated policies, influenced security- intelligence, shaped intellectual-cultures, inspired citizens-aspirations and has directed the trajectory of nation-states and sovereignties within international governance and global affairs. The political behaviors of developing nations through foreign policies, national interests and diplomacy have been a reflection of the authority of their political leadership; regime after regime. There are no best-kept secret to the fundamental strengths and weaknesses of political Leadership other than the influential impact of the political leader’s self-empowerment, self-leadership and self-legacy. Political Leadership is fundamentally controlled by the polices of choices where decisions meet actions and authoritarian powers redefines humanity. The elusive extent, and fluid depth of political influence through the impact of governance does not measure -up to the assurance of humanity in most developing countries around the world. The political consciousness and idiosyncrasies of most individuals over the years have contributed none or fewer interests to the study, the justification, and the analytical reasoning of the influence of political leadership. This new study and the assertive findings on this chapter are aimed to pragmatically educate, inspire, and reignite the zealousness of visionary leadership, through the consciousness of humanity. The intellectual assertions in this chapter are envisioned to create, expand and illuminate the distinctive reality between of our profound empirical knowledge, theoretical beliefs and interpretive researches on the conceptual understanding of political leadership. The topics in this chapter are aimed to create an endless stream to the consciousness of political leadership and financial gains to the betterment of humanity. It expands the understanding of political leadership through psychological lens beyond the titles, offices and political display of power. Political leadership in developing countries can improve and offer better outcomes in todays world, when humanity meets the consciousness of political leadership in financial prosperity. The societal divisions of ethnicity, wealth and the polarization of political ideologies into sets of beliefs, questions the influential impact of political leadership. As political leaders govern and navigate through their leadership goals, aspirations and visions more often than not, the traits of their ethnic identity, individuality and beliefs constantly create struggles with their understanding and acceptance of humanity as a whole.",signatures:"Daniels Aide Okun and Osama Ose Iyawe",downloadPdfUrl:"/chapter/pdf-download/79217",previewPdfUrl:"/chapter/pdf-preview/79217",authors:[{id:"333785",title:"Ph.D.",name:"Daniels Aide",surname:"Okun",slug:"daniels-aide-okun",fullName:"Daniels Aide Okun"},{id:"333787",title:"Prof.",name:"Osama Ose",surname:"Iyawe",slug:"osama-ose-iyawe",fullName:"Osama Ose Iyawe"}],corrections:null},{id:"77502",title:"New Technologies and Decision-Making for the Military",doi:"10.5772/intechopen.98849",slug:"new-technologies-and-decision-making-for-the-military",totalDownloads:238,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter aims at reviewing the concept of decision-making on the battlefield for military leaders. Thus, it intends to address the changes implied by the use of new technologies (such as Robots, AI) that will gradually invade the battlefield. The leader of tomorrow will have to quickly manage remote information and keep control of high performance automated systems integrating a certain form of autonomy, including lethal autonomous weapon systems. He must ensure that a global meaning is given to the military action taking place on the battlefield. He has to be able to command to achieve his goals.",signatures:"Gérard de Boisboissel",downloadPdfUrl:"/chapter/pdf-download/77502",previewPdfUrl:"/chapter/pdf-preview/77502",authors:[{id:"351406",title:"Dr.Ing.",name:"Gérard",surname:"de Boisboissel",slug:"gerard-de-boisboissel",fullName:"Gérard de Boisboissel"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"9332",title:"Application of Decision Science in Business and Management",subtitle:null,isOpenForSubmission:!1,hash:"72ccbc5aab28621bad2e810c4bd5bd53",slug:"application-of-decision-science-in-business-and-management",bookSignature:"Fausto Pedro García Márquez",coverURL:"https://cdn.intechopen.com/books/images_new/9332.jpg",editedByType:"Edited by",editors:[{id:"22844",title:"Prof.",name:"Fausto Pedro",surname:"García Márquez",slug:"fausto-pedro-garcia-marquez",fullName:"Fausto Pedro García 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The care of the patient in the intensive care unit (ICU) is expensive and poses a significant economic burden on the healthcare [3, 4]. In the early part of the twentieth century, the intensive care units were taking care of patients with respiratory failure related to polio. With the advancement of technology and medicine, patients with multiple comorbidities are now being admitted in the ICU. A study by the World Health Organization (WHO) found that 51% of the patients in the ICU have infections [5]. The risk of infection among patients on a mechanical ventilation is 6- to 21-fold higher. Surprisingly, the risk of ICU-acquired infections among low- and middle-income countries was found to be 2–3 times higher than the ICU-acquired infections among ICU patients in developed countries [5, 6]. With the advent of invasive monitoring and therapeutic devices, the incidence and prevalence of the infection have increased, and we have seen a significant increase in antibiotic use and multidrug-resistant (MDR) infections [7]. Infectious conditions, sepsis, and septic shock continue to be responsible for significant morbidity and mortality [7]. Increased MDR infection has now become a global threat. Two million cases and 23,000 deaths each year are attributable to MDR infection in the USA alone, according to the Centers for Disease Control and Prevention (CDC) [8, 9]. In addition, inappropriate use of the antibiotics not only leads to increase in MDR but costs the healthcare $27–42 billion annually [8, 9, 10]. The central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) have also been associated with significant nosocomial infection [11]. With significant efforts from the regulatory agency as well as the healthcare organization and providers, a significant decrease in CLABSI and CAUTI has been seen [1, 12]. Education and antibiotic stewardship programs have been recommended by the CDC in 2014. In 2017, a survey by the National Healthcare Safety Network found that the number of hospitals with antibiotic stewardship program (ASP) has increased to 76.4%. Still 25% of the hospitals do not have ASP. As of September 2019, the ASP is required by the Centers for Medicare and Medicaid Services (CMS) as part of the patient care reimbursement. With this new regulatory requirement by the CMS, it is expected that the ASP in hospitals will reach close to 100% [13].
\nIn this book, we will also be addressing Legionnaires’ disease in detail. Legionnaires’ disease is a bacterial infection caused by Gram-negative bacteria, usually found in freshwater [14]. It can lead to severe pneumonia which can be fatal (Legionnaires’ disease), but milder and subclinical infection forms (Pontiac fever) do exist [14, 15]. This disease is much more common than we think. Approximately, 10,000 patients are hospitalized every year with Legionnaires’ disease in the USA alone. Legionnaires’ disease also creates a public health concern. It is usually transmitted by inhaling the mist or via the cooling and water system issues. There have been numerous Legionnaires’ disease outbreaks over the decades, and the number seems to be increasing [16]. In the 1970s there were five outbreaks, in the 1980s seven, in the 1990s four, and in the 2000s ten. From 2010 to 2018, there were 23 outbreaks. In the year 2019 alone, there were seven outbreaks (shown in Table 1). These reported outbreaks represent just the tip of the iceberg, as not all of them are reported. Moreover, reports from the developing countries are almost nonexistent. The fatalities from Legionnaires’ disease range from 0 to 75% [16]. The longevity, multiple invasive devices, increase in transplants, immunocompromised status, aging population, and increase in travels all pose a significant risk of increased outbreaks and high fatality rates. Research and education need to be done in this area. In this book, we will try to address the epidemiology, clinical and therapeutic as it pertains to disease as well as clinical scenario and treatment of Legionnaires’ disease among immunocompromised host.
\nCountry | \nCity/state | \nSource | \nCases | \nMortality | \nFatality rate | \n
---|---|---|---|---|---|
London, England [17] | \nWestminster | \nVia. water system | \n3 | \n0 | \n0 | \n
Belgium [18] | \nEvergem | \nCooling towers | \n32 | \n2 | \n6.7% | \n
USA [18] | \nOhio, New Jersey, Michigan | \nUnknown? Flint Michigan water crisis | \n32 | \n6 | \n18.75% | \n
USA [18] | \nAtlanta, Georgia (in Sheraton Hotel) | \nWater system | \n66 | \n1 | \n1.5% | \n
USA [18] | \nFletcher, North Carolina | \nHot tub display | \n141 | \n4 | \n2.83 | \n
Canada [18] | \nMoncton, New Brunswick | \nUnknown | \n16 | \nN/A | \n— | \n
USA [18] | \nBatavia, Illinois | \n\n | 13 | \nN/A | \n— | \n
Selected Legionnaires’ disease outbreak in 2019.
There are a number of factors that influence patient outcome in trauma and orthopedic surgery in relation to hemorrhage. These can include patient factors, for example anticoagulant and antiplatelet medications, coagulopathies and other conditions, as well as surgical factors such as bony bleeding, large surgical incisions, diffuse venous bleeding and unseen sources of bleeding [1, 2].
Trauma still remains a leading worldwide cause of morbidity and mortality [3] and despite various developments over the years, hemorrhagic shock from trauma continues to form one part of the terrible triad contributing to mortality in both the military and civilian settings [4].
Effective hemostasis during surgery is advantageous to the surgeon as it prevents diffuse bleeding from capillaries and venules obscuring the surgical field and adding to operation time and infection risk [5, 6].
Significant blood loss has been associated with increased need for allogeneic and autologous blood transfusion [2, 7, 8]. These are associated with attendant risks including nosocomial infections [9], transfusion-related injury and fluid overload [10, 11]. In fact blood transfusion is an independent risk factor for infection, respiratory complications and the need for critical care support in traumatic injuries and resulted in a twofold increase in complications and critical care admissions, with more than two units of blood transfusion [7]. The risk of major perioperative complications is also increased with high intraoperative blood loss [2, 12, 13]. Therefore, patient outcome is optimal when the balance between bleeding and clotting is maintained during surgery such that tissue perfusion is adequate without excessive blood loss [5, 6].
Hemostasis in regard to trauma and surgery is a highly regulated process, maintaining flow through vessels at the same time as the thrombotic response to tissue damage is occurring [14], thereby ensuring tissue perfusion and limiting blood loss. The process is a complex interaction between vascular endothelium, platelets, the coagulation and fibrinolytic systems [15, 16].
Following injury, a temporary vascular smooth muscle contraction occurs in an attempt to stem blood flow. Endothelial disruption exposes the subendothelial layer and circulating Von Willebrand factor attaches to the site of injury. Surface glycoproteins also adhere to platelet surfaces. The subendothelial collagen activates adhering platelets and their surface receptors then bind circulating fibrinogen, forming a soft platelet plug comprising aggregated platelets and fibrinogen [14]. The adhering platelets secrete humoral factors including serotonin, prostaglandins and thromboxane that maintain a reduced blood flow, creating an environment that is conducive to clot formation at the site of bleeding. At the same time, circulating coagulating factors produced by the liver are activated in a series of precisely controlled sequential and dependant reactions [14, 17].
The final common pathway is the activation of thrombin that leads to conversion of soluble plasma fibrinogen to insoluble fibrin. The complex of activated factor XIII and fibrin results in cross-linking of fibrin monomers to form a stable clot [17].
Broadly speaking, there are mechanical, thermal, pharmacological and topical methods of hemorrhage control [2, 6, 8, 17, 18, 19, 20].
Mechanical methods include direct pressure, ligating clips and staples, sutures, fabric pads and gauze while hemostatic scalpels and lasers also reduce bleeding during surgery [6, 7, 17]. However, these methods have their drawbacks with respect to certain situations. The location of bleeding is particularly important with respect to orthopedics and in particular trauma. Bony surface bleeding and bleeding from the intramedullary canals are almost impossible to control with mechanical methods. Inflamed or friable tissues may contain a dense network of friable capillaries may prove a challenge [1, 2, 7]. Junctional bleeding in trauma may be potentially catastrophic and its control may not be amenable to the above methods.
The use of pharmacological methods can be a useful adjunct to other methods in these circumstances [7]. These may include epinephrine, desmopressin, tranexamic acid, vitamin K, aminocaproic acid and others.
In some situations though, even the above methods are ineffective or impractical [15] and hence the development of topical hemostatic agents. These are a diverse group of agents of varying composition and mechanisms of action. They can be versatile in the sense that when blood loss is minimal, they can be used sparingly and when there is severe blood loss then more liberal application could be an option [2]. They may be applied directly to the bleeding site and prevent or reduce continuous and unrelenting bleeding intraoperatively and postoperatively [2] and their topical nature broadly avoids the systemic adverse effects associated with systemic hemostatic medications including thrombosis [8].
Topical hemostasis is defined as a process that acts locally to stop bleeding from damaged vessels [21]. Recent and continuing developments have focused on agents that can be used as adjuncts to control bleeding during surgical procedures and control residual problematic bleeding if conventional methods fail. Broadly speaking, topical hemostats can be divided into three types [17, 20].
Passive—where the mechanism of action is to provide a physical scaffold around which platelets can aggregate. These act through contact activation and promote platelet aggregation so a clot can form. Examples include collagen, cellulose and gelatins.
Active—these have biological activity and their mechanism of action is actively influencing the clotting cascade to promote clot formation [17, 20]. These usually contain thrombin in one form or another [14].
Combined—combination of passive product with thrombin.
Contact activation occurs between receptors on platelets and collagen, promoting platelet aggregation [15, 17]. Preparation includes collagen sponges, pastes and powders [15, 17] and is obtained mainly from bovine sources [15], making it potentially immunogenic. In fact a 2–4% allergy in the total population to bovine collagen has been reported in the literature [22] (Table 1).
Hemostatic agent | Examples | Manufacturer |
---|---|---|
Collagen-based products | Avitene | Davol/BD BARD |
Helistat/Helitene | Integra Lifesciences | |
Instat/Ultrafoam | Ethicon, Johnson & Johnson | |
Oxidized cellulose | Surgicel Fibrillar | Ethicon, Johnson & Johnson |
Surgicel Nu-Knit | Ethicon, Johnson & Johnson | |
Gelatin-based products | Gelfoam | Pharmacia Corp, Pfizer |
Surgifoam | Johnson & Johnson | |
Polysaccharide spheres | Arista AH | BD BARD |
Passive hemostats.
The active ingredient in this product is oxidized regenerated cellulose (ORC). Its exact mechanism of action is poorly understood but contact activation is thought to play a part [15]. Often at reoperation, previously used ORC is visible, indicating reduced absorption and poor biodegradability, although this may be related to the amount used and the site of implantation [8]. For this reason, only the minimum possible amount to be used is indicated and it is recommended that the product be removed once hemostasis is achieved and before definitive closure [6, 8].
Their mechanism of action involves swelling while in contact with blood, providing a tamponade effect in confined spaces and restoring blood flow, and thereby producing a stable scaffold around which clots can form [17]. This does make it suitable for irregular wounds [6] and confined spaces [17]. However, it tends to stick to instruments when soaked with blood, making it difficult to handle and does not form a tight bond with the bleeding surface and can hence easily be dislodged [17].
Active agents have biological activity and actively participate in the coagulation cascade to induce clot formation at the site of bleeding [20]. They include thrombin, which comes into play in the last stages of the clotting cascade, converting circulating fibrinogen to a fibrin clot [17, 23]. Hence a significant advantage of thrombin is that its action is less susceptible to coagulopathies caused by clotting factor or platelet dysfunction [17]. Its activity constitutes the final steps in the clotting cascade and therefore it bypasses the initial steps in the cascade. Therefore, other aspects of the clotting cascade can be dysfunctional without significantly impairing the local hemostatic activity of thrombin [20].
Thrombin-based products are therefore excellent adjuncts in the presence of congenital and acquired coagulation and platelet disorders and in the presence of pharmacological and antiplatelet agents that are increasingly being used in the general population [5, 17]. Circulating fibrinogen is necessary for hemostasis to occur by active agents as thrombin converts it into insoluble fibrin that forms part of the clot. Therefore in rare cases of fibrinogen deficiency, clotting by thrombin-based products is impaired [17, 23].
These accomplish their action by bypassing the coagulation cascade to the final steps and converting fibrinogen to fibrin [24]. A fibrin precursor and thrombin stored in two separate adjacent syringes (dual syringe kit) with a single lumen enables delivery and mixing of these agents in the lumen and onto the surgical site, causing thrombin to cleave the fibrin precursor, resulting in fibrin monomers that polymerize at the site into a soluble mesh stabilized into a stable clot by factor XIII at the tissue surface [25]. Previously, bovine thrombin was used, which has recently been replaced by human thrombin [26] and more recently autologous human thrombin. Autologous fibrin sealants overcome the risk of allogeneic blood products, for example one is a patient-derived fibrin sealant utilizing the patient’s own blood as a source of fibrinogen and prothrombin and mixing it with an alkaline buffer solution to lower the pH, activating endogenous prothrombin [24] (Table 2).
Biosurgical | Examples | Manufacturer |
---|---|---|
Liquid fibrin adhesives | Tiseel | Baxter |
Evicel | Ethicon, Johnson & Johnson | |
Crosseal | Ethicon, Johnson & Johnson | |
Floseal | Baxter | |
Fibrin patches | Tachosil | Takeda |
Platelet gels | Vitagel | Orthovita |
Glutaraldehyde cross-linked albumin | BioGlue | Cryolife |
Sealants and adhesives.
These are a combination of thrombin, calcium and platelet-rich plasma, usually obtained from autologous sources using centrifugation systems that produce platelet-rich plasma. Platelets provide growth factors to stimulate wound healing and contribute to the strength of the clot [27].
These systems however rely on an intact coagulation system and may not be as effective in patients on antiplatelet or anticoagulant medications [27]. Also the extraction systems are expensive and there is a risk of contamination.
In addition to not requiring normal clotting mechanisms to work as mentioned before, active hemostats may offer other advantages. With many passive hemostatic agents, degeneration and reabsorption are a problem. This necessitates their removal from the surgical site prior to closure. With thrombin, this is not the case as degeneration and resorption of the resulting fibrin clot is achieved as part of wound healing [1, 8]. Thrombin and combination products also have a rapid onset of action with hemostasis being achieved within 10 min in most patients [7, 17, 28, 29]. Studies have shown that combining an active hemostat within a hemostatic product accelerates clotting. In a comparison of collagen-based products at different bleeding sites after surgical tumor resection, the combination of a collagen-thrombin product (n = 23) achieved complete hemostasis three times faster than the collagen sponge alone (n = 30). The median time to hemostasis was 78 seconds versus 243 seconds respectively (p < 0.001) [30]. Furthermore, approximately 80% achieved complete hemostasis within 2 min with an active topical hemostatic agent compared with only one-third of patients receiving a passive topical hemostatic agent [31]. Active hemostats are also very versatile and can come in various forms. These include sprays that can be advantageous in covering large bleeding surfaces quickly without the need for tamponade [31], and the concentration of thrombin in the formulation can also be varied depending on the severity and type of bleeding. Surgeons can use them in multiple ways during a single procedure due to their flexibility and range of delivery options [20]. Although bovine sources of thrombin may induce antibodies in hosts, this has not manifest itself as a major problem in the clinical setting [1, 32].
It has been shown that the terrible triad of hypothermia, coagulopathy and acidosis are associated with increased mortality in multiple trauma patients and that infection and multiple organ failure are other potential complications arising from severe blood loss [33, 34]. About a quarter of patients presenting to trauma centers have an established coagulopathy secondary to hemorrhage [35] with attendant risks of significant complications. Multiple defects in hemostasis can occur in combat injuries and as such, conventional methods of hemostasis may not be possible. Time is of the essence in these situations and non-transfusional approaches to hemostasis and the use of biosurgicals may be indicated [36, 37, 38, 39].
The combat setting has proved a challenging environment in many different ways in terms of management of hemorrhage. The tissue available for controlling life-threatening hemorrhage may be limited, the wound severity and the possibility of multiple injuries make the situation uniquely challenging [40]. Most combat injuries are penetrating in nature and a large proportion are limb wounds. Mortality from hemorrhage from these kinds of wounds is potentially preventable [36, 41, 42].
In the combat setting, the three principal sites of lethal hemorrhage are truncal (67%), junctional (19%) and extremity (14%). A report from the National Trauma Database suggests that the mortality from isolated lower limb extremity trauma with arterial injury is 2.8% with a 6.6% amputation rate [38]. Tourniquets can be used for these isolated injuries and their use in the military and civilian setting is supported by the Hartford consensus [39] and by the American College of Surgeons Committee on Trauma [38].
Junctional injuries (neck, axilla, groin and perineum) form a significant proportion of trauma in a combat setting and may damage the large vascular structures. These types of injuries are difficult to compress and are not amenable to tourniquet control [43, 44]. Topical hemostatic agents that have been developed in the last two decades [36, 45] can play a vital role in controlling severe bleeding in these situations and increase survival [33, 46] and have thus been listed as optional basic equipment for ambulances [39]. In addition, in a combat setting, more complex types of wound patterns are encountered than in a civilian setting, including blast injuries, which may be more amenable to topical hemostasis.
In 2003, USAIR [47] introduced guidelines of what should constitute the perfect hemostatic agent for use in the prehospital and battlefield settings [33, 41, 47, 48, 49] that included the following: being able to stop large vessel and arterial bleeding within 2 min of application, ability to be delivered through a pool of blood when applied, ready to use with no need for on-site preparation, simple enough to use by the wounded victim or a paramedic with minimal training, light weight and durable with a minimum 2-year shelf life in extreme environmental conditions, safe to use with no risk of injury to tissues or transmission of infection and inexpensive [41, 45, 50, 51]. In addition, hemostatic dressings need to be conformable and flexible enough due to the irregular shape, depth and wound configurations caused by modern explosive devices [40, 48].
These include gelatin [52], oxidized cellulose [53] and collagen and plant-derived polysaccharide spheres [54]. These agents are not biologically active and rely on the patients’ endogenous fibrin production for hemostasis. They provide a scaffold for platelet activation and aggregation, absorbing fluid several times their own weight to form a matrix at the site of hemorrhage, activating the extrinsic coagulation pathway and allowing clotting to occur. This makes them suitable only for patients in whom the coagulation system is intact [55, 56]. In fact in the absence of some coagulation factors, these agents may not be effective [53, 56]. They can be used as first line due to their ready availability and favorable cost-effectiveness, mostly as adjuncts with direct pressure at bleeding sites to control minimal residual hemorrhage [56].
These agents act by forming a physical matrix that stimulates platelet aggregation and degranulation to release factors that encourage clot formation [55].
Cellulose is a homopolysaccharide made by polymerization of glucopyranose molecules through glucosidic bonds. Surgical oxidized cellulose is either regenerated where organized fibers are formed prior to oxidation (regenerated ORC), or non-regenerated, with unorganized fibers prior to oxidation [55]. ORC conforms more rapidly to the surrounding environment. Surgical oxidized cellulose offers several favorable properties in hemostasis including bactericidal activity, good biocompatibility and ease of use [55]. It is usually resorbed but can take anywhere between 2 and 6 weeks depending on the amount used, the degree of saturation with blood and the tissue bed. The excess material may also cause foreign body reactions and granuloma formation without biodegradation and complicate radiological and clinical diagnoses of abscess, residual or recurrent tumor and granuloma [55, 57, 58]. For this reason, the minimal effective amount should be used and excess material removed prior to definitive closure. In addition, these products should not be used or left in place close to nerves, ureters, intestinal and vascular structures due to the risk of local inflammatory reactions and ischemia [55].
These can be used in combination with active agents such as thrombin in adhesives, or in a stand-alone manner. They are usually of bovine or porcine origin and act at the terminal stages of clotting to facilitate fibrin clot formation and are highly absorptive, forming a mechanical matrix for the clot to adhere to [55, 59]. They are quite versatile and available as sponges, powders or granules and are usually completely resorbed in 4–6 weeks [59]. It is important to use the minimum amount necessary to achieve hemostasis and to remove excess because part of the mechanism of action is swelling to cause a tamponade effect and this could potentially cause compression and necrosis in surrounding tissues if packed in tight spaces. This is particularly important around neural tissue and in bony spaces [59]. They are also useful in irregular wounds and surgical cavities as they can expand and fill these irregular spaces.
Mucoporous polysaccharide hemispheres are among a relatively new class of hemostatic agents derived from plant starch. Their mechanism of action includes absorbing water and the low-molecular weight components of blood, hence concentrating platelets and clotting factors in the vicinity, thereby enhancing local clotting processes [58, 60]. They have been used safely in cardiothoracic and neurospinal surgery.
These are active formulations containing mostly two agents—human purified fibrinogen and thrombin. They may also have added other compounds such as factor XIII, fibronectin and antifibrinolytics such as aprotinin used previously and tranexamic acid currently [61]. However, formulations without tranexamic acid or aprotinin are available to avoid hypersensitivity associated with aprotinin and neurotoxicity associated with tranexamic acid [62, 63] (Table 2).
These products are available in liquid or low-viscosity forms (fibrin glues) or as part of stiff collagen fleece (fibrin patches) [55]. Once applied, their mechanism of action is cleavage of fibrinogen to fibrin monomers by thrombin, which also activates factor XIII and the complex fibrin matrix forms the clot [55]. Calcium is required in both these steps and then the clot is eventually resorbed via the fibrinolytic pathway [25]. Generally, they connect atraumatically to tissues and form a barrier to leakage and bleeding through covalent polymerization between themselves and adjacent tissue [55]. Chiara et al. set out the properties of an sealant as being strong, rapid to adhere, flexible, sterile, without toxicity, biologically inert, biocompatible and able to be used in relatively wet environments with low thrombogenicity [55].
True sealants are of two types: synthetic (PEG-based or cyanoacrylates) [53, 60, 64, 65, 66, 67] or semisynthetic glutaraldehyde [68] (Table 2).
True sealants are cross-linking sealants that polymerize through nonenzymatic reactions, free of the need for the presence of blood or coagulation factors although some do have some coagulation factors within them. Both can be used to control residual ooze [53, 67].
PEG sealants are composed of polyethylene glycol and come in both flowing form as well as pads or fleeces. They should be avoided in kidney disease due to the renal clearance of polyethylene glycol and may contain allergenic components such as human albumin that can also lead to the theoretical risk of disease transmission [55].
Cyanoacrylates are products generally used for skin closure or lacerations in areas of low skin tension, for example scalp wounds. They are synthetic sealants that rapidly polymerize with water acting as the catalyst. There are two formulations: octyl-2-cyanocrylate and N-Butyl-2-cyanoacrylate. In a systematic review looking at octyl-2-cyanoacrylate, there were no differences in infections, wound dehiscence or cosmetic appearance when compared with other methods of closure [65]. Polymerization generates heat and therefore the amount used should be just enough and should certainly be avoided in delicate areas such as the spinal canal and neural tissue [55, 65]. Below the skin, a foreign body reaction may occur [65] and intravascular use is contraindicated due to the risk of systemic embolization [55].
Semisynthetic sealants otherwise known as bioglues are compounds of semisynthetic glutaraldehyde—bovine albumin-based sealant. Proteins on the surface of bleeding human tissue link with those of bovine albumin in the bioglue, causing a sealant effect [55]. Within synthetic graft materials, bioglue permeates interstices within the graft matrix [69], making it suitable for sealing anastomotic sites and decreasing postop bleeding [70].
These can be used as an adjunct to surgical hemostasis to improve residual moderate bleeding [55]. They are usually applied by double syringe systems. Each component is located in a separate section of the syringe, which then combine in a single lumen. They subsequently are applied using a blunt needle or spray tips in cases of large bleeding surface areas to the bleeding surgical site [25, 61]. Since the components bypass the initial steps in the extrinsic coagulation pathway, they can be used in achieving hemostasis in patients with congenital or acquired bleeding disorders such as hemophilia and patients on anticoagulants or antiplatelet medications [25, 62, 71] (Table 2).
They do have some drawbacks including the risk of thrombosis if injected intravascularly, hypotension and death and the risk of air embolization with the use of gas-driven sprayers [55]. In addition, the cost of sealants is significant and hence they are not recommended for use except in particular situations where indicated, for example in those with coagulation disorders [61]. One cost-effectiveness analysis done in the United Kingdom in patients undergoing total knee replacement on Quixil, one of the commercial brands, in addition to conventional hemostatic agents estimated that the use of a 5-ml dose of Quixil in addition to conventional hemostatic methods was cost saving in comparison to conventional methods alone. But the use of a 10-ml dose increased the cost substantially and they recommended that liquid fibrin adhesives only be used in selected cases [25]. They have however been found to be effective. Echave et al. [59] carried out a systematic review of 27 studies on the effectiveness of human gelatin-thrombin matrix sealant in different surgical fields including orthopedics. All 27 studies demonstrated that this sealant was associated with a significantly higher rate of successful hemostasis, and a shorter time to achieve it (p < 0.001) in comparison to other alternatives when conventional methods failed.
These products are also available as patches, for example Tachosil. They may have slightly different components but all of them have essentially the same mechanism of action, offering mechanical support with either collagen, oxidized cellulose/polyglactin 910 matrix, binding coagulation factors, allowing better adherence to bleeding tissue even in the presence of brisk bleeding, preventing the so-called “streaming effect” observed with fluid adhesives [72, 73, 74]. Tachosil is a ready-to-use fixed combination of equine collagen patch on one side and coated with coagulation factors, human fibrinogen and human thrombin on the other side [55]. Fibrin-pad and PGA-felt are absorbable hemostats composed of polyglactin 910, oxidized regenerated cellulose, thrombin and fibrinogen shown to be effective in a variety of tissue types [25, 72] and can rapidly achieve hemostasis in brisk bleeding in the retroperitoneum and pelvis, compared with the standard of care [72, 73] (Table 2).
Junctional hemorrhage is a significant problem in major trauma especially on the battlefield and often conventional methods such as tourniquets are ineffective [55]. In this respect, science has led to the development of products that are effective options in these circumstances and they can be divided into factor concentrators [75], procoagulants [76] and mucoadhesives [77] (Table 3).
Biosurgical | Examples | Manufacturer |
---|---|---|
Zeolite dressings | QuikClot & QuikClot ACS | Z-Medica |
Smectite dressings | WoundStat | TraumaCure Inc. |
Kaolin dressings | QuikClot Combat Gauze | Z-Medica |
Rapid Deployment Hemostat | Marine Polymer Technologies | |
Celox | Med Trade Products, UK | |
Trauma Stat | OreMedix | |
Fibrin dressings | Dry fibrin sealant dressing (DFSD) | American Red Cross |
Hemostatic dressings.
These are compounds of either zeolite (microporous crystalline aluminum silicate) or smectite (a nonmetallic clay mineral sodium, calcium and aluminum silicate). Examples include QuikClot (Z-Medica LLC, CT,USA) and QuikClot ACS (advanced clotting sponge), Traumadex (Medafor Inc., MN, USA) and self-expanding hemostatic polymer (SEHP) [35]. As the group name suggests these agents rapidly absorb the fluid content of blood. The resulting effect is an increase in relative concentration of its cellular and protein content and therefore clot formation. Water molecules are held in its pores by hydrogen bonds and this results in a relative local increase in concentration of platelets and clotting factors [35]. The first generation of QuikClot was designed as granules that were poured onto the bleeding wound. A high efficiency rate of 92% was demonstrated in a series of 103 patients in the military and civilian setting. There were eight patients in which hemorrhage was not effectively controlled with QC in coagulopathic patients where it was used as a last resort [75]. There were also some side effects of QC including intense exothermic reaction and scar formation from foreign body reaction [75]. Animal and early human studies on QC revealed thermal injury, poor biodegradability and foreign body reactions as the main drawbacks of QC [78, 79, 80]. In fact temperature generated by QuikClot in contact with aqueous components of blood at bleeding wounds has been measured to reach and average of 61°C with a potential rise to 76°C [78].
QuikClot has been compared to other hemostatic agents including HemCon (HemCon Medical Technologies Inc., OR, USA) in a military setting in multiple patients injured after explosions and gunshot wounds [81]. In this study, QC was effective but thermal injury was an issue. This has also been investigated in other studies by McMannus et al. [82] in the combat setting and evidence suggests that the greater the amount of blood and the more the QC applied, the greater is the risk of thermal injury. Thus currently it is only recommended for external use and the minimum amount required to achieve effective hemostasis is recommended.
QuikClot ACS is a newer generation of product made by larger zeolite beads packaged into mesh bags. This makes it easier to pack into cavities and irregular wounds often found on the battlefield and at junctional sites of hemorrhage and in cavities [55] and is claimed to produce much less of an exothermic reaction [75, 78] although there is a lack of studies with sufficient numbers to confirm this unequivocally [41].
Self-expanding hemostatic polymer (SEHP) is a dual action factor concentrator. Its mechanism of action results from its extremely potent absorptive capacity following absorption of the fluid component of blood and its ability to expand to conform to large irregular cavities and spaces, exerting a tamponade effect [35]. The other action is the effect of the polymer absorbing the liquid phase of blood into its matrix, thereby leading to a relative increase in concentration of platelets and coagulation factors at the site of bleeding, thereby promoting clotting [83, 84].
Woundstat is a compound of smectite granules that come in granular form. Its mechanism of action is absorption of the aqueous phase of blood, forming a clay substance that adheres to bleeding tissue and acts as a sealant and also concentrates clotting factors and blood cells locally, contributing to hemostasis. Granules are negatively charged and activate the intrinsic pathway as well [85, 86, 87].
These are products where the basic component is chitosan, which is a polymer derived from crustacean chitin. It is a complex biodegradable carbohydrate [55]. The mechanism of action appears to be related to highly positively charged chitosan interacting electronically with negatively charged cell membranes of erythrocytes. The product adheres strongly to tissues and seals bleeding wounds [77, 88, 89]. Examples include HemCon (HemCon Med Tech, Portland, OR) and Celox (Med. Trade Products, UK).
Celox is a chitosan-based adhesive, which is biodegradable and causes absorption of the aqueous phase and the advancement of red blood cell bonding. The positively charged Celox binds negatively charged red blood cells independently of the body’s clotting system, resulting in clot formation without the exothermic reaction associated with certain factor concentrators like QuikClot [35]. Its action is independent of the body’s clotting system, a property that makes it useful in patients requiring antiplatelet or anticoagulant medications or in the presence of coagulopathy and its local action means that it is not associated with distant clot formation. It is also reported to be very versatile, being available in granular and bandage forms and easy to remove from the wound after its clot formation activity is complete [49, 90, 91, 92]. HemCon, however, does have a hard consistency and is made in a square shape. Therefore, it works best on flat bleeding surfaces rather than deep irregular wounds [79, 83]. Wedmore et al. [77] looked at a series of patients with prehospital combative injuries where chitosan-based products had been used externally in chest, groin, buttock and abdominal wounds in 25 patients, 35 extremity wounds and neck and facial wounds in 4 cases. In about two-thirds of cases, the chitosan dressings were used following failure of hemostasis using only gauze with 100% success. In 97% of cases, bleeding stopped or hemostasis was improved, with failure only occurring in two cases attributed to blind stuffing of bandages into large cavitational injuries [77].
Trauma Stat is another chitosan-based derivative that was developed in collaboration with the United States Army, in which the mechanism of action involves positive charges in the amine groups on the chitosan molecule interacting with negative charges on the red blood cell membranes and in addition the adsorption of chitosan for fibrinogen and plasma proteins [79, 93].
Te Grotenhuis carried out a study of 66 patients in which conventional treatment with gauze and compression failed to control excessive bleeding or where conventional treatment was unlikely to achieve hemostasis. Complete cessation of hemorrhage including arterial hemorrhage occurred in 70% using the HemCon ChitoGauze, and reduction in hemorrhage occurred in 20% of patients despite 21 patients being on anticoagulants or having a clotting disorder and no adverse events occurred [88].
Due to the fact that chitosan is derived from crustaceans, there is a theoretical risk of allergenic reactions in patients allergic to shellfish. However in a study of 19 patients who had a positive IgE test to shellfish, none of the patients demonstrated a positive skin prick test to chitosan powder or expressed a reaction to HemCon bandage during serial bandage challenges, indicating favorable but not completely risk-free use of these products [94].
Chitosan-based dressings are also easy to remove after hemostasis has been achieved [41] and are known to have some antimicrobial properties [41, 95].
Their mechanism of action is mainly to deliver factors that promote coagulation into the bleeding wound. Examples are dry fibrin sealant dressing (DFSD) and QuikClot Combat Gauze (QCG) [70, 96, 97]. QCG is a surgical gauze coated with kaolin. On contact with injured endothelium, kaolin activates the extrinsic pathway, enhancing coagulation and promoting hemostasis. It is not degradable and needs to be removed from the wound following achievement of hemostasis [76].
Kaolin-based products have been used in a military setting and have demonstrated good results in both junctional and non-junctional hemorrhage [76]. In the above study, Shina et al. retrospectively reviewed 133 kaolin-based dressings applied to 122 military patients. 27% were for junctional hemorrhage with a success rate of 88% while the rest were extremity trauma where the success rate was 92%.
In addition to problems specific to certain types of hemostatic agents, there are also general drawbacks.
The hemostats that contain biological agents, usually the active hemostats, can be associated with the risk of disease transmission. For example, DFSD has the theoretical risk of viral disease transmission and hence has not achieved FDA approval.
Some agents have handling characteristics that are beneficial in certain situations. For example agents that have a granular nature can be used for complex irregular wounds with multiple bleeding points. However, the handling characteristics are difficult and they are difficult to apply in combat situations [89]. In addition, many agents are nonabsorbable and need to be removed after hemostasis is achieved. This may be difficult with some agents and require multiple washouts. Granular agents also have the potential to enter the vascular system and occlude the distal parts of vessels, causing endothelial injury and intravascular coagulation [41]. This has been demonstrated by Kheirabadi et al. [89] in their study, and for these reasons a bandage/gauze form of hemostatic agent is preferable as being safer for hemorrhage control, avoiding intravascular complications [38].
Any chapter on hemostasis in trauma and orthopedics is incomplete without the mention of tranexamic acid. This drug has been shown to be effective in reducing mortality due to bleeding in both the military and civilian setting.
The CRASH-2 (Clinical Randomization of an Antibrinolytic in Severe Hemorrhage-2) trial was a multicenter trial involving 40 centers looking at 20,211 adult trauma patients with significant bleeding who were randomized to two arms. One arm received TA within the first 3 hours of trauma and the other received placebo. The study demonstrated a reduction in mortality risk due to any cause from 14.5% compared with 16% in the placebo group (p < 0.001), with no increase in vasoocclusive events such as pulmonary embolism or myocardial infarction (0.3% versus 0.5% p-0.096) [98].
The MATTER (Military Application of Tranexamic Acid in Trauma) study looked at 896 patients with severe combat injuries and demonstrated a 6.5% absolute risk reduction in mortality in these patients with the use of tranexamic acid [99].
Both these studies have recommended incorporation of intravenous tranexamic acid into clinical practice [24].
Joint replacements are major procedures in elective orthopedics and can be associated with significant blood loss and increased transfusion requirements if appropriate steps are not taken to mitigate against this. In addition to the conventional methods of blood management including preoperative optimization, tourniquets if appropriate, intraoperative techniques such as cell saver and cauterization, topical and pharmacological hemostats and biosurgicals may offer some excellent solutions to reduce the transfusion requirements and achieve hemostasis.
A few studies have looked at human-derived fibrin sealants in total knee replacement [100, 101, 102]. A multicenter randomized control trial looking at 58 patients who underwent total knee replacement demonstrated a reduced postoperative blood loss, reduced postoperative decrease in hemoglobin and calculated blood loss in patients in whom fibrin sealant was used compared with that in the standard group (20% compared with the standard 83% p = 0.004) [100]. Another study that showed benefit was done by Dhillon et al. [25]. Results from other studies have been equivocal and have not demonstrated any clear difference.
In total hip arthroplasty, the use of fibrin sealants has been associated with reducing blood loss but inconsistent results have been demonstrated with regard to reduction in postoperative transfusion requirements [24, 103, 104, 105].
Multiple studies have looked at platelet gels in arthroplasty surgery. The evidence has been inconsistent in many. One randomized control trial looking at 100 total knee replacements did demonstrate significantly lower transfusion requirements in patients in whom platelet gels were used [106].
Desmopressin is a synthetic analog of anti-diuretic hormone. Its mechanism of action is to increase the levels of factor VIII and Von Willebrand factor, thereby enhancing primary hemostasis and platelet aggregation and adherence. This makes it suitable as a blood management strategy in patients with platelet dysfunction or other clotting disorders such as Von Willebrand’s disease and hemophilia A [107, 108]. It has also been used in healthy individuals for reducing postoperative bleeding in total hip and knee replacement surgery [109]. Six randomized placebo-controlled trials addressing the use of desmopressin in total hip and knee arthroplasty have been undertaken [110, 111, 112, 113, 114, 115]; however, evidence suggests that desmopressin is not significantly effective in reducing blood loss or transfusion requirements in these patients [24].
There are a number of good-quality randomized control trials that support the use of tranexamic acid in reducing blood loss and transfusion requirements in both knee and hip arthroplasty surgery [24]. There is however considerable amount of heterogeneity between the trials with regard to methods of delivery including single intravenous bolus dose, repeated boluses, prolonged infusion or intraarticular injection [116], and also differing dosing regimes [117]. In total knee arthroplasty, it has been shown that one intraoperative dose is sufficiently effective in reducing transfusion requirements and postoperative bleeding [118]. With the theoretical risk of intravascular thrombosis, intraarticular injection of tranexamic acid was investigated and compared to placebo and the studies showed reduction in blood loss but no reduction in transfusion rates [101, 119, 120]. Only one RCT by Seo et al. [121] showed a reduction in transfusion requirements with intraarticular (20%) rather than intravenous (34%) or placebo (94%). The evidence in total hip replacement with regard to intraarticular tranexamic acid is less convincing than in knee arthroplasty and more studies are needed.
With regard to aminocaproic acid, three RCTs did demonstrate benefit in hip and knee replacement surgery in terms of reducing blood loss in comparison with placebo. However, with regard to reducing transfusion requirements the evidence is much less convincing [24, 122, 123, 124].
Spine surgery presents a few unique challenges that limit the products that can be used for hemostasis in these situations. One of them is the friability of neural tissue and secondly the fact that the spinal cord and nerve roots are enclosed in rigid bony spaces that limit the kinds of hemostats that can be used due to the potential of swelling and compression of neural tissue in a rigid space. In addition, there is the potential for neurotoxicity with certain agents.
Cerebrospinal fluid leaks are a common source of postoperative morbidity in patients who have undergone spinal surgery. The morbidity burden includes severe postural headaches, vomiting, dizziness, photophobia, tinnitus, pseudomeningoceles and the risk of meningitis. It is therefore important that when dural tears occur or when an iatrogenic durotomy is created a water tight repair is essential. PEG hydrogel sealant has been found to be a safe effective way to augment dural closure and prevent these complications. A prospective study by Kim et al. [66] demonstrated that augmentation of standard dural closure techniques with this sealant in patients had significantly higher rates of watertight closure than with controls (100% and 64.3% respectively), without statistical differences in cerebrospinal fluid leaks, infections or wound healing. Complications due to swelling of polyethylene glycol and nerve compression were not demonstrated in this study but this remains a possibility. This led to the development of low-swell PEG hydrogel sealant (Duraseal) [55] and has been found to be safe and effective in a 3-to-1 randomized single-blind multicenter trial in which 100% of patients who had this low-swell formulation achieved watertight dural closure. Another study has also shown that BioGlue (semisynthetic glutaraldehyde-bovine albumin sealant) is safe and cost-effective in proximity to neurological structures despite previous concerns. Miscusi et al. [125] demonstrated a watertight dural closure in 23 patients requiring dural repair, with no incidence of neurological or infection related complications.
Collagen and gelatin-based products can be used to achieve hemostasis in spinal surgery. Xu et al. [64] carried out a study on 92 patients undergoing spinal fusion surgery and concluded that collagen-based products are superior to gelatin-based products in achieving hemostasis in spine surgery, with lower blood loss and postoperative drain volume.
Oxidized regenerated cellulose has been used for hemostasis in spine surgery. However when used around or in foramina with rigid bony walls, the swelling of small portions of the cellulose material may lead to significant mass effect and neural compression 1 day after surgery as demonstrated by Menovsky et al. [126] and may lead to rapid neurological deterioration. Therefore this material should be removed after hemostasis has been achieved prior to closure.
As mentioned before, liquid fibrin sealants can be used in spine surgery for hemostasis, but those containing tranexamic acid may be associated with neurotoxicity and should not be used if CSF leak or dural tear is present [55].
Topical hemostats and biosurgicals are a diverse group of compounds that have been developed and can be used in different situations as part of a comprehensive blood management program to limit the amount of blood loss. Trauma and orthopedics as a specialty also presents some unique challenges, with operations having significant blood loss and in trauma, junctional injuries on the battlefield with hemorrhage that is hard to control by conventional means. In addition, patients may be complex and frequently have platelet or coagulation disorders that preclude the use of certain classes of hemostatic agents. As mentioned before, these compounds are diverse, with different mechanisms of actions and indications, both in an elective and an emergency trauma setting. A comprehensive knowledge of these products is essential in modern-day trauma and orthopedic practice.
Despite recent developments, the perfect hemostatic or biosurgical agent still remains elusive and each of these products has their own drawbacks, side effects and unique indications and future research will hopefully continue to improve on these.
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\n\nThe first step in obtaining funds for your Open Access publication begins with your institution or library. IntechOpen’s publishing standards align with most institutional funding programs. Our advice is to petition your institution for help in financing your Open Access publication.
\n\nHowever, as Open Access becomes a more commonly used publishing option for the dissemination of scientific and scholarly content, in addition to institutions, there are a growing number of funders who allow the use of grants for covering OA publication costs, or have established separate funds for the same purpose.
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. 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Here, the main purpose of cooperative control protocol is to track a time-variant reference trajectory while maintaining a desired formation. The reference trajectory is defined to a leader, which has at least one information connection with one of the agents in the network. The design procedure includes a robust adaptive law for estimating the unknown nonlinear terms of each agent’s dynamics in a model-free format, that is, without the use of any regressors. Moreover, an observer is designed to have an approximation on the values of control parameters for the leader at the agents without connection to the leader. The entire design procedure is analysed successfully for the stability using Lyapunov stability theorem. Finally, the simulation results for the application of the proposed method on a network of nonholonomic wheeled mobile robots (WMR) are presented. Desirable leader-following tracking and geometric formation control performance have been successfully demonstrated through simulated group of wheeled mobile robots.",book:{id:"5996",slug:"multi-agent-systems",title:"Multi-agent Systems",fullTitle:"Multi-agent Systems"},signatures:"Muhammad Nasiruddin bin Mahyuddin and Ali Safaei",authors:[{id:"204129",title:"Dr.",name:"Muhammad Nasiruddin",middleName:null,surname:"Mahyuddin",slug:"muhammad-nasiruddin-mahyuddin",fullName:"Muhammad Nasiruddin Mahyuddin"},{id:"206489",title:"Mr.",name:"Ali",middleName:null,surname:"Safaei",slug:"ali-safaei",fullName:"Ali Safaei"}]},{id:"56255",doi:"10.5772/intechopen.69844",title:"Time Critical Mass Evacuation Simulation Combining A Multi- Agent System and High-Performance Computing",slug:"time-critical-mass-evacuation-simulation-combining-a-multi-agent-system-and-high-performance-computi",totalDownloads:1413,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter presents an application of multi-agent systems to simulate tsunami-triggered mass evacuations of large urban areas. 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The agents, which mimic the heterogeneous crowd of evacuees, are composed of different combinations of basic constituent functions for modelling interaction with each other and environment, decision-making, etc. The results of tuning and validating of constituent functions for pedestrian-pedestrian, car-car and car-pedestrian interactions are presented. A scalable high-performance computing (HPC) extension to address the high-computational demand of complex agents and high-resolution model of environment is briefly explained. Finally, demonstrative applications that highlight the need for including sub-meter details in the environment, different modes of evacuation and behavioural differences are presented.",book:{id:"5996",slug:"multi-agent-systems",title:"Multi-agent Systems",fullTitle:"Multi-agent Systems"},signatures:"Leonel Aguilar, Maddegedara Lalith and Muneo Hori",authors:[{id:"203530",title:"Prof.",name:"Maddgedara",middleName:null,surname:"Lalith",slug:"maddgedara-lalith",fullName:"Maddgedara Lalith"},{id:"204168",title:"Dr.",name:"Leonel",middleName:null,surname:"Aguilar",slug:"leonel-aguilar",fullName:"Leonel Aguilar"},{id:"204169",title:"Prof.",name:"Muneo",middleName:null,surname:"Hori",slug:"muneo-hori",fullName:"Muneo Hori"}]},{id:"56327",doi:"10.5772/intechopen.69845",title:"Motion Coordination Problems with Collision Avoidance for Multi-Agent Systems",slug:"motion-coordination-problems-with-collision-avoidance-for-multi-agent-systems",totalDownloads:1406,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter studies the collision avoidance problem in the motion coordination control strategies for multi-agent systems. The proposed control strategies are decentralised, since agents have no global knowledge of the goal to achieve, knowing only the position and velocity of some agents. These control strategies allow a set of mobile agents achieve formations, formation tracking and containment. For the collision avoidance, we add a repulsive vector field of the unstable focus type to the motion coordination control strategies. We use formation graphs to represent interactions between agents. The results are presented for the front points of differential-drive mobile robots. The theoretical results are verified by numerical simulation.",book:{id:"5996",slug:"multi-agent-systems",title:"Multi-agent Systems",fullTitle:"Multi-agent Systems"},signatures:"Jesús Santiaguillo-Salinas and Eduardo Aranda-Bricaire",authors:[{id:"16943",title:"Prof.",name:"Eduardo",middleName:null,surname:"Aranda-Bricaire",slug:"eduardo-aranda-bricaire",fullName:"Eduardo Aranda-Bricaire"},{id:"204125",title:"Ph.D.",name:"Jesús",middleName:null,surname:"Santiaguillo-Salinas",slug:"jesus-santiaguillo-salinas",fullName:"Jesús Santiaguillo-Salinas"}]}],mostDownloadedChaptersLast30Days:[{id:"56573",title:"Introductory Chapter: Multi-Agent Systems",slug:"introductory-chapter-multi-agent-systems",totalDownloads:2429,totalCrossrefCites:5,totalDimensionsCites:10,abstract:null,book:{id:"5996",slug:"multi-agent-systems",title:"Multi-agent Systems",fullTitle:"Multi-agent Systems"},signatures:"Jorge Rocha, Inês Boavida-Portugal and Eduardo Gomes",authors:[{id:"145918",title:"Ph.D.",name:"Jorge",middleName:null,surname:"Rocha",slug:"jorge-rocha",fullName:"Jorge Rocha"},{id:"214969",title:"Prof.",name:"Inês",middleName:null,surname:"Boavida-Portugal",slug:"ines-boavida-portugal",fullName:"Inês Boavida-Portugal"},{id:"214971",title:"MSc.",name:"Eduardo",middleName:null,surname:"Gomes",slug:"eduardo-gomes",fullName:"Eduardo Gomes"}]},{id:"55920",title:"Hybrid Architecture to Support Context‐Aware Systems",slug:"hybrid-architecture-to-support-context-aware-systems",totalDownloads:1644,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Any system that is said to be context‐aware is capable of monitoring continuously the surrounding environment, that is, capable of prompt reaction to events and changing conditions of the environment. The main objective of a context‐aware system is to be continuously recognizing the state of the environment and the users present, in order to adjust the environment to an ideal state and to provide personalized information and services to users considering the user profile. In this chapter, we describe an architecture that relies on the incorporation of intelligent multi‐agent systems (MAS), sensor networks, mobile sensors, actuators, Web services and ontologies. We describe the interaction of these technologies into the architecture aiming at facilitating the construction of context‐aware systems.",book:{id:"5996",slug:"multi-agent-systems",title:"Multi-agent Systems",fullTitle:"Multi-agent Systems"},signatures:"Maricela Bravo, José A. Reyes‐Ortiz, Leonardo Sánchez‐Martínez\nand Roberto A. Alcántara‐Ramírez",authors:[{id:"204084",title:"Dr.",name:"Maricela",middleName:null,surname:"Bravo",slug:"maricela-bravo",fullName:"Maricela Bravo"},{id:"204085",title:"Dr.",name:"Alejandro",middleName:null,surname:"Reyes",slug:"alejandro-reyes",fullName:"Alejandro Reyes"},{id:"204086",title:"Dr.",name:"Leonardo",middleName:null,surname:"Sánchez",slug:"leonardo-sanchez",fullName:"Leonardo Sánchez"},{id:"204087",title:"MSc.",name:"Roberto",middleName:null,surname:"Alcántara-Ramírez",slug:"roberto-alcantara-ramirez",fullName:"Roberto Alcántara-Ramírez"}]},{id:"56184",title:"Multiagent Systems in Automotive Applications",slug:"multiagent-systems-in-automotive-applications",totalDownloads:1773,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The multiagent systems have proved to be a useful tool in the design of solutions to problems of distributed nature. In a distributed system, it is possible that the data, the control actions or even both, be distributed. The concept of agent is a suitable notion for capturing situations where the global knowledge about the status of a system is complex or even impossible to acquire in a single entity. In automotive applications, there exist a great number of scenarios of distributed nature, such as the traffic coordination, routes load balancing problems, traffic negotiation among the infrastructure and cars, to mention a few. Even more, the autonomous driving features of the new generation of cars will require the new methods of car to car communication, car to infrastructure negotiation, and even infrastructure to infrastructure communication. This chapter proposes the application of multiagent system techniques to some problems in the automotive field.",book:{id:"5996",slug:"multi-agent-systems",title:"Multi-agent Systems",fullTitle:"Multi-agent Systems"},signatures:"Raul Campos‐Rodriguez, Luis Gonzalez‐Jimenez, Francisco\nCervantes‐Alvarez, Francisco Amezcua‐Garcia and Miguel\nFernandez‐Garcia",authors:[{id:"178524",title:"Dr.",name:"Raul",middleName:null,surname:"Campos-Rodriguez",slug:"raul-campos-rodriguez",fullName:"Raul Campos-Rodriguez"},{id:"204584",title:"Dr.",name:"Francisco",middleName:null,surname:"Cervantes Alvarez",slug:"francisco-cervantes-alvarez",fullName:"Francisco Cervantes Alvarez"},{id:"204586",title:"Mr.",name:"Francisco",middleName:null,surname:"Amezcua Garcia",slug:"francisco-amezcua-garcia",fullName:"Francisco Amezcua Garcia"},{id:"204587",title:"BSc.",name:"Miguel",middleName:null,surname:"Fernandez Garcia",slug:"miguel-fernandez-garcia",fullName:"Miguel Fernandez Garcia"},{id:"207383",title:"Dr.",name:"Luis",middleName:null,surname:"Gonzalez-Jimenez",slug:"luis-gonzalez-jimenez",fullName:"Luis Gonzalez-Jimenez"}]},{id:"56297",title:"Multiagent System for Image Mining",slug:"multiagent-system-for-image-mining",totalDownloads:1381,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The overdone growth, wide availability, and demands for remote sensing databases combined with human limits to analyze such huge datasets lead to a need to investigate tools, techniques, methodologies, and theories capable of assisting humans at extracting knowledge. Image mining arises as a solution to extract implicit knowledge intelligently and semiautomatically or other patterns not explicitly stored in the huge image databases. However, spatial databases are among the ones with the fastest growth due to the volume of spatial information produced many times a day, demanding the investigation of other means for knowledge extraction. Multiagent systems are composed of multiple computing elements known as agents that interact to pursuit their goals. Agents have been used to explore information in the distributed, open, large, and heterogeneous platforms. Agent mining is a potential technology that studies ways of interaction and integration between data mining and agents. This area brought advances to the technologies involved such as theories, methodologies, and solutions to solve relevant issues more precisely, accurately and faster. AgentGeo is evidence of this, a multiagent system of satellite image mining that, promotes advances in the state of the art of agent mining, since it relevant functions to extract knowledge from spatial databases.",book:{id:"5996",slug:"multi-agent-systems",title:"Multi-agent Systems",fullTitle:"Multi-agent Systems"},signatures:"Nicksson Ckayo Arrais de Freitas and Marcelino Pereira dos Santos\nSilva",authors:[{id:"203201",title:"B.Sc.",name:"Nicksson",middleName:"Ckayo Arrais",surname:"De Freitas",slug:"nicksson-de-freitas",fullName:"Nicksson De Freitas"},{id:"203204",title:"Dr.",name:"Marcelino",middleName:null,surname:"Silva",slug:"marcelino-silva",fullName:"Marcelino Silva"}]},{id:"56255",title:"Time Critical Mass Evacuation Simulation Combining A Multi- Agent System and High-Performance Computing",slug:"time-critical-mass-evacuation-simulation-combining-a-multi-agent-system-and-high-performance-computi",totalDownloads:1413,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter presents an application of multi-agent systems to simulate tsunami-triggered mass evacuations of large urban areas. The main objective is to quantitatively evaluate various strategies to accelerate evacuation in case of a tsunami with a short arrival time, taking most influential factors into account. Considering the large number of lives in fatal danger, instead of widely used simple agents in 1D networks, we use a high-resolution model of environment and complex agents so that wide range of influencing factors can be taken into account. A brief description of the multi-agent system is provided using a mathematical framework as means to easily and unambiguously refer to the main components of the system. The environment of the multi-agent system, which mimics the physical world of evacuees, is modelled as a hybrid of a high-resolution grid and a graph connecting traversable spaces. This hybrid of raster and vector data structures enables modelling large domain in a scalable manner. The agents, which mimic the heterogeneous crowd of evacuees, are composed of different combinations of basic constituent functions for modelling interaction with each other and environment, decision-making, etc. The results of tuning and validating of constituent functions for pedestrian-pedestrian, car-car and car-pedestrian interactions are presented. A scalable high-performance computing (HPC) extension to address the high-computational demand of complex agents and high-resolution model of environment is briefly explained. Finally, demonstrative applications that highlight the need for including sub-meter details in the environment, different modes of evacuation and behavioural differences are presented.",book:{id:"5996",slug:"multi-agent-systems",title:"Multi-agent Systems",fullTitle:"Multi-agent Systems"},signatures:"Leonel Aguilar, Maddegedara Lalith and Muneo Hori",authors:[{id:"203530",title:"Prof.",name:"Maddgedara",middleName:null,surname:"Lalith",slug:"maddgedara-lalith",fullName:"Maddgedara Lalith"},{id:"204168",title:"Dr.",name:"Leonel",middleName:null,surname:"Aguilar",slug:"leonel-aguilar",fullName:"Leonel Aguilar"},{id:"204169",title:"Prof.",name:"Muneo",middleName:null,surname:"Hori",slug:"muneo-hori",fullName:"Muneo Hori"}]}],onlineFirstChaptersFilter:{topicId:"526",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,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:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",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:"25",title:"Environmental Sciences",doi:"10.5772/intechopen.100362",issn:"2754-6713",scope:"\r\n\tScientists have long researched to understand the environment and man’s place in it. The search for this knowledge grows in importance as rapid increases in population and economic development intensify humans’ stresses on ecosystems. Fortunately, rapid increases in multiple scientific areas are advancing our understanding of environmental sciences. 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\r\n\tThe four topics of this book series - Pollution; Environmental Resilience and Management; Ecosystems and Biodiversity; and Water Science - will address important areas of advancement in the environmental sciences. They will represent an excellent initial grouping of published works on these critical topics.