Embryologic derivates of the gastrointestinal tract.
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More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"3302",leadTitle:null,fullTitle:"New Research Directions in DNA Repair",title:"New Research Directions in DNA Repair",subtitle:null,reviewType:"peer-reviewed",abstract:"This book is intended for students and scientists working in the field of DNA repair. Select topics are presented here to illustrate novel concepts in DNA repair, the cross-talks between DNA repair and other fundamental cellular processes, and clinical translational efforts based on paradigms established in DNA repair. The book should serve as a supplementary text in courses and seminars as well as a general reference for biologists with an interest in DNA repair.",isbn:null,printIsbn:"978-953-51-1114-6",pdfIsbn:"978-953-51-5375-7",doi:"10.5772/46014",price:159,priceEur:175,priceUsd:205,slug:"new-research-directions-in-dna-repair",numberOfPages:674,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"1370d613ce38c993753a3dd25f102a3c",bookSignature:"Clark Chen",publishedDate:"May 22nd 2013",coverURL:"https://cdn.intechopen.com/books/images_new/3302.jpg",numberOfDownloads:58991,numberOfWosCitations:91,numberOfCrossrefCitations:57,numberOfCrossrefCitationsByBook:2,numberOfDimensionsCitations:128,numberOfDimensionsCitationsByBook:2,hasAltmetrics:1,numberOfTotalCitations:276,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 17th 2012",dateEndSecondStepPublish:"May 8th 2012",dateEndThirdStepPublish:"August 12th 2012",dateEndFourthStepPublish:"November 10th 2012",dateEndFifthStepPublish:"December 10th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"62462",title:"Prof.",name:"Clark",middleName:null,surname:"Chen",slug:"clark-chen",fullName:"Clark Chen",profilePictureURL:"https://mts.intechopen.com/storage/users/62462/images/1731_n.jpg",biography:"Dr. Clark C. Chen received his B.S. from Stanford University in 1992, M.S. from Columbia University in 1993, and his M.D.-Ph.D. from Harvard Medical School in 2001. He completed his neurosurgery training at the Massachusetts General Hospital and subsequently completed independent fellowships in stereotactic neurosurgery and radiosurgery. Dr. Chen previously served as the director of Clinical Neuro-Oncology at the Beth Israel Deaconess Medical Center before his current role as the Director of Stereotactic and Radiosurgery and Co-Director of Surgical Neuro-Oncology at the University of California, San Diego. Dr. Chen’s research is directed at identifying alterations in DNA repair pathways as they relate to brain cancer therapy. 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Image satellite sensors acquire huge volumes of imagery to be processed and stored in big archives. An example of such an archive is the German Remote Sensing Data Center (DFD) at Oberpfaffenhofen, Germany, that receives about hundreds of GigaBytes of data per day entailing 104 GigaBytes in the repository. To provide access to this data, web applications have been developed, e.g. the DLR EOWEB http://eoweb.dlr.de:8080/servlets/template/welcome/entryPage.vm. http://www.alexandria.ucsb.edu/adl/. http://clients.alexandria.ucsb.edu/globetrotter/ http://webclient.alexandria.ucsb.edu/client/gaz/adl/index.jsp.
At the conference on database techniques for pictorial applications that took place in 1979 in Florence, Italy, the pursued aim was the integration of databases with image processing. This idea evolved, in 1990, promoting a new field, called Content Based Image Retrieval (CBIR). In 1998, CBIR got married with Data Mining and Knowledge Database Discovery (KDD) emerging, in 2000, the Image Information Mining (IIM) field. This new domain requires expertise in image processing, database organization, pattern recognition, content-based retrieval and data mining: image processing indicates the understanding and extraction of patterns from a single image; content-based retrieval is characterized by retrieving images from the archive based on their semantic and visual contents; spatial data mining denotes the extraction of spatial relationships and patterns from remote sensed images not explicitly stored in an spatial database. An IIM system provides users the capability to deal with large collections of images by accessing into large image databases and also to extract and infer knowledge about patterns hidden in the images, so that the set of relevant images is dynamic, subjective and unknown. It enables the communication between heterogeneous source of information and users with diverse interests at high semantic abstraction.
\n\t\t\tIn general, an IIM system presents two fundamental modules: a computationally expensive component where image processing and classification algorithms are executed, and an interactive part, where queries are introduced by the user and relevant images are retrieved. Fig. 1 represents the typical flow of a data in an IIM system: original data arrive at a feature extraction module, where main image characteristics are computed; then, these features are compressed and indexed in a database; in a second module, the archive is queried by the user for similar features computing similarity measurements for optimal image retrieval.
\n\t\t\tImage Information Mining system architecture.
This chapter begins describing the generic concept and modules of an IIM system architecture, and Sec. 0 presents an overview of existing IIM systems.
\n\t\tAs depicted in Fig. 1, the generic concept of an IIM system requires several processing modules: extraction of properties from images, reduction and content indexation and communication between users and system. In this section, we present the state of the art of these modules giving an overview of existing techniques in these fields.
\n\t\t\tIn general, by image we understand picture, thus relating it to the (human) visual perception and understanding. A picture is characterized by its primitive features such as colour, texture or shape at different scales. Thus, an image will be represented as a multidimensional feature vector acting as signature. Some classical techniques to characterize an image are the following:
\n\t\t\t\tColour: Colour information has been an important feature in image processing and computer vision. There exist different colour models or colour spaces, each one being useful for a specific application. A digital imaging system typically represents colour images in red, green, blue using the RGB space. Another one related with the perception of the colours by human beings is the HSV (Hue, Saturation and Intensity) colour space. This one describes the property of the surface reflecting the light (hue), measures the colourfulness or whiteness (saturation) and the brightness (intensity) of colours. Often a full colour image providing the three colours (RGB) in each pixel is needed, being essential to interpolate missing colours with the information of neighbouring pixels. There are nonadaptive algorithms (Ray & Acharya, 2005) as nearest neighbour replication and bilinear interpolation, and adaptive algorithms (Ray & Acharya, 2005) based on pattern matching or edge sensing interpolation. On the other side, a common practise in image processing is the statistical analysis of colour histograms, due to the strong correlation between objects and colour in an image.
Texture: Texture is a very interesting feature to characterize the spatial structure of an image. This is an active research field where parametric and non parametric methods are applied. Haralick’s co-occurrence (Shanmugam et al., 1973) technique based on the computation of the gray-level co-occurrence matrix for several values of displacement, orientation and image quantization levels is an effective method in texture analysis. Other algorithms based on wavelet transformations as the computation of Gabor filter (Maillot et al., 2005) can also be applied.
Shape: Shape of objects must be invariant to translation, rotation and scale of the image and is characterized in two senses: boundary-based, that considers the object outer contour, and region-based, where the whole shape region of the object is analyzed. In this sense, Fourier descriptors are suitable for transforming boundaries into shape features, and moment invariants for the extraction of geometric object region. A modified Fourier descriptor that preserves the invariance of geometric transformations and noise is proposed in (She et al., 1998). A common practise before applying shape techniques is to segment the image in small regions. Comaniciu (Comaniciu & Meer, 2002) presents this approach based on the mean shift method for density gradients estimation.
Topology: topological properties of an image such as number of connected or disconnected components, do not change when an image is rotated, scaled, translated, stretched or deformed. One example of characterizing an image through its topological properties is the computation of the Euler number (Ray & Acharya, 2005). It is defined as the difference between number of connected components and number of holes in a binary image. An extension of the Euler number defined for binary images is the Euler vector (Ray & Acharya, 2005) that can be applied to gray-level images. Segmentation techniques may also help in the extraction of topological features.
In the CBIR and IIM domain, the concept of multidimensional indexing differs from the one in a traditional database management system. In here, an index consists of the structure that provides access to the database in terms of record organization. In IIM, once an N-dimensional feature vector is obtained, images are assigned to a suitable content based description extracted from these features. These content descriptors are then organized into a data structure for retrieval.
\n\t\t\t\tIn multidimensional indexing, the following items must be considered:
\n\t\t\t\tReduction of dimensionality: Due to the huge amount of images and extracted features, normally the dimensionality of the information at the indexing step is very high. This complicates the management of the feature vector rendering its computation very expensive. For this reason, mechanisms for reducing the dimension of the feature space must be considered. Among these methods, Karhunen-Loève transform (Ray & Acharya, 2005) and the Discrete Cosine Transform (DCT) (Khayam, 2003), (Watson, 1994) are often considered.
Clustering: Extracted features with similar content must be grouped together through a classification algorithm. In this case, pixels containing similar features belong to the same class. Existing clustering techniques can be classified into two main groups: distance-based and model-based (Zhong & Ghosh, 2003) approaches. In the first group, we mention methods based on Euclidean and Mahalanobis distances, and to the second group belongs algorithms based on an a priori specified model, such as Gaussian mixture models or Markov chains.
Data structure for content based retrieval: Once a clustering algorithm is performed, a data structure for indexing descriptors to semantic content must be selected. The common used methods are tree-based indexing techniques, as multidimensional binary search trees or R-trees, and hashing-based ones.
Usually CBIR is limited by the semantic gap existing between signal classes and semantic labels. Li et al. (Li & Bretschneider, 2006) propose a context sensitive Bayesian network to infer the semantic concept of regions or classes. Semantic score functions based on region features (spectral and texture) are computed to link semantic concepts to regions. Tusk et al. (Tusk et al., 2002) suggest a Bayesian framework to cope with the semantic gap problem. They introduce a visual grammar that builds a hierarchical semantic model from pixel level to region and scene levels. Pixel-level characteristic provides classification by automatic fusion of primitive features; then, at region-level through a segmentation algorithm land cover labels are defined; and scene-level represents the spatial relationship among regions. Thus, the visual grammar consists of two learning steps, where naive Bayesian classifiers are applied: a probabilistic link between features and semantic labels, and a fuzzy modelling to link regions and scenes. Once the visual grammar is built, the image classification process aims at finding representative region groups that describe the scene. The procedure consists of modelling the labelled regions by a Dirichlet distribution based on the number of training examples containing a certain region group, and then, assigning the best matching class to image by using the maximum a-posteriori rule.
\n\t\t\t\tIn order to provide the system the ability to search at query-time for images with similar features, a similarity metric for the comparison of objects or image properties must be defined. If we want a realistic measure, computer and human judgments of similarity should be generally correlated. If this condition is not met, images returned by the system will not be those desired by the user. These techniques are often based on distances or on a specific domain as histogram intersection, neural networks, shape measures or graph matching. Queries like ”retrieve images containing an specific content” or ”retrieve images that do not contain a particular object” can be asked to a CBIR system.
\n\t\t\tThe main problem of using feature vectors for querying images with similar content is that often, the appearance of an image does not correspond to its semantic meaning, making the returned images only partially responds to the users query. Therefore, at object or region level, the highest level of abstraction, an image is represented by its objects, and a semantic label is assigned to each of them.
\n\t\t\t\tA common used technique to provide regions with semantic meaning is the manual annotation that, combined with a powerful segmentation method, can result in a good meaningful classification. Comaniciu (Comaniciu & Meer, 2002) proposes a colour image segmentation algorithm based on the mean shift that estimates density gradients, using a simple nonparametric procedure. Then, the users interactively identify the segmented regions by labelling the features. Because of hand-annotating images is tedious and human expensive, methods for learning image representations directly from data are investigated.
\n\t\t\t\tFei-Fei and Perona (Fei-Fei & Perona) propose a Bayesian hierarchical model to learn and recognize natural scene categories through intermediate “themes”. In there, the most complete scene category dataset found in the literature is used. An image is modelled as a collection of local patches (regions). Each patch is represented by a codeword from a large vocabulary of them obtained from all categories training examples. For each codewords in each category, a Bayesian hierarchical model is learnt, building a collection of Bayesian models. Then, to provide semantic meaning to an unknown image, first the image codewords are extracted, and then, they are compared with the predefined models, assigning the one which fits best. The main problem of the proposed algorithm is that, although it can learn intermediate themes of scenes with neither supervision nor human intervention, the categories are fixed, being not able to assign semantic meaning to other ones.
\n\t\t\t\tAnother method that uses predefined lexicon of semantic concepts as trained data is the semantic pathfinder for multimedia indexing (Seinstra et al., 2006). In here, given a pattern
\n\t\t\t\t\tMaillot et al. (Maillot et al., 2005) propose a learning approach based on two steps: a feature selection step that chooses the most characterizing features for better visual concept detection, and a training phase using a Support Vector Machine (SVM), where positive and negative samples are required. Trying to solve the weaknesses of the learning approach like the lack of learning the spatial structure of semantic concepts, a further step is given, storing the visual knowledge that is the link between semantic concepts and sensor data in a symbol. This link is modelled as a fuzzy linguistic variable that enables the representation of imprecision, thus the image features are fuzzified a priori by a human expert, providing spatial relation representations and spatial reasoning.
\n\t\t\t\tIn these articles, we find two facts that we try to avoid: On one hand, the lack of generalization by using a predefined lexicon when trying to link data with semantic classes. The use of a semantic lexicon is useful when we arrange an a priori and limited knowledge, and, on the other hand, the need of experts in the application domain to manually label the regions of interest.
\n\t\t\t\tAn important issue to arrange while assigning semantic meaning to a combination of classes is the data fusion. Li and Bretschneider (Li & Bretschneider, 2006) propose a method where combination of feature vectors for the interactive learning phase is carried out. They propose an intermediate step between region pairs (clusters from k-means algorithm) and semantic concepts, called code pairs. To classify the low-level feature vectors into a set of codes that form a codebook, the Generalised Lloyd Algorithm is used. Each image is encoded by an individual subset of these codes, based on the low-level features of its regions.
\n\t\t\t\tSignal classes are objective and depend on feature data and not on semantics. Chang et al. (Chang et al., 2002) propose a semantic clustering. This is a parallel solution considering semantics in the clustering phase. In the article, a first level of semantics dividing an image in semantic high category clusters, as for instance, grass, water and agriculture is provided. Then, each cluster is divided in feature subclusters as texture, colour or shape. Finally, for each subcluster, a semantic meaning is assigned.
\n\t\t\t\tIn terms of classification of multiple features in an interactive way, there exist few methods in the literature. Chang et al. (Chang et al., 2002) describe the design of a multilayer neural network model to merge the results of basic queries on individual features. The input to the neural network is the set of similarity measurements for different feature classes and the output is the overall similarity of the image. To train the neural network and find the weights, a set of similar images for the positive examples and a set of non similar ones for the negative examples must be provided. Once the network is trained, it can be used to merge heterogeneous features.
\n\t\t\t\tTo finish this review in semantic learning, we have to mention the kind of semantic knowledge we can extract from EO data. The semantic knowledge depends on image scale, and the scale capacity to observe is limited by sensor resolution. It is important to understand the difference between scale and resolution. The term of sensor resolution is a property of the sensor, while the scale is a property of an object in the image. Fig. 2 depicts the correspondence between knowledge that can be extracted for a specific image scale, corresponding small objects with a scale of 10 meters and big ones with a scale of thousands of meters. The hierarchical representation of extracted knowledge enables answering questions like which sensor is more accurate to a particular domain or which are the features that better explain the data.
\n\t\t\tKnowledge level in the hierarchy to be extracted depending on the image scale.
Often an IIM system requires a communication between human and machine while performing interactive learning for CBIR. In the interaction loop, the user provides training examples showing his interest, and the system answers by highlighting some regions on retrieved data, with a collection of images that fits the query or with statistical similarity measures. These responses are labelled as relevance feedback, whose aim is to adapt the search to the user interest and to optimize the search criterion for a faster retrieval.
\n\t\t\t\tLi and Bretschneider (Li & Bretschneider, 2006) propose a composite relevance feedback approach which is computationally optimized. At a first step, a pseudo query image is formed combining all regions of the initial query with the positive examples provided by the user. In order to reduce the number of regions without loosing precision, a semantic score function is computed. On the other hand, to measure image-to-image similarities, they perform an integrated region matching.
\n\t\t\t\tIn order to reduce the response time while searching in large image collections, Cox et al. (Cox et al., 2000) developed a system, called PicHunter, based on a Bayesian relevance feedback algorithm. This method models the user reaction to a certain target image and infers the probability of the target image on the basis of the history of performed actions. Thus, the average number of man-machine interactions to locate the target image is reduced, speeding up the search.
\n\t\t\tAs IIM field is nowadays in its infancy, there are only a few systems that provide CBIR being under evaluation and further development. Aksoy (Aksoy, 2001) provides a survey of CBIR systems prior to 2001, and a more recent review is provided by Daschiel (Daschiel, 2004). In this section, we present several IIM systems for retrieval of remote sensed images, most of them being experimental ones.
\n\t\t\tLi (Li & Narayanan, 2004) proposes a system, able to retrieve integrated spectral and spatial information from remote sensing imagery. Spatial features are obtained by extracting textural characteristics using Gabor wavelet coefficients, and spectral information by Support Vector Machines (SVM) classification. Then, the feature space is clustered through an optimized version of k-means approach. The resulting classification is maintained in a two schemes database: an image database where images are stored and an Object-Oriented Database (OODB) where feature vectors and the pointers to the corresponding images are stored. The main advantage of an OODB is the mapping facility between an object oriented programming language as Java or C++, and the OODB structures through supported Application Programming Interfaces (API). The system has the ability of processing a new image in online mode, in such a way that an image which is not still in the archive is processed and clustered in an interactive form.
\n\t\t\tFeature extraction is an important part of IIM systems, however, it is computationally expensive, and usually generates a high volume of data. A possible solution would be to compute only those relevant features for describing a particular concept, but how to discriminate between relevant and irrelevant features? The Rapid Image Information Mining (RIIM) prototype (Shah et al., 2007) is a Java based framework that provides an interface for exploration of remotely sensed imagery based on its content. Particularly, it puts a focus on the management of coastal disaster. Its ingestion chain begins with the generation of tiles and an unsupervised segmentation algorithm. Once tiles are segmented, a feature extraction composed of two parts is performed: a first module consists of a genetic algorithm for the selection of a particular set of features that better identifies a specific semantic class. A second module generates feature models through genetic algorithms. Thus, if the user provides a query with a semantic class of interest, feature extraction will be only performed over the optimal features for the prediction, speeding up the ingestion of new images. The last step consists of applying a SVM approach for classification. While executing a semantic query, the system computes automatically the confidence value of a selected region and facilitates the retrieval of regions whose confidence is above a particular threshold.
\n\t\t\tThe IKONA system http://www-rocq.inria.fr/cgibin/imedia/cbir-gen.cgi
IKONA can be applied not only for EO applications, but also for face detection or signature recognition. The server-side architecture is implemented in C++ and the client software in Java, making it independent from the platform where it runs. The only prerequisite on the client is to have installed a Java Virtual Machine.
\n\t\t\tThe Query by Image Content (QBIC) http://wwwqbic.almaden.ibm.com/
Photobook (Picard et al., 1994) developed by MIT, is another content-based image and image sequences retrieval, whose principle is to compress images for a quick query-time performance, reserving essential image similarities. Reaching this aim, the interactive search will be efficient. Thus, for characterization of object classes preserving its geometrical properties, an approach derived from the Karhunen-Loève transform is applied. However, for texture features a method based on the Wold decomposition that separates structured and random texture components is used. In order to link data to classes, a method based on colour difference provides an efficient way to discriminate between foreground objects and image background. After that, shape, appearance, motion and texture of theses foreground objects can be analyzed and ingested in the database together with a description. To assign a semantic label or multiple ones to regions, several human-machine interactions are performed, and through a relevance feedback, the system learns the relations between image regions and semantic content.
\n\t\t\tVisiMine system (Aksoy et al., 2002), (Tusk et al., 2002) is an interactive mining system for analysis of remotely sensed data. VisiMine is able to distinguish between pixel, region and tile levels of features, providing several feature extraction algorithms for each level. Pixel level features describe spectral and textural information; regions are characterized by their boundary, shape and size; tile or scene level features describe the spectrum and textural information of the whole image scene. The applied techniques for extracting texture features are Gabor wavelets and Haralick’s co-ocurrence, image moments are computed for geometrical properties extraction, and k-medoid and k-means methods are considered for clustering features. Both methods perform a partition of the set of objects into clusters, but with k-means, further detailed in chapter 6, each object belongs to the cluster with nearest mean, being the centroid of the cluster the mean of the objects belonging to it. However, with k-medoid the center of the cluster, called medoid, is the object, whose average distance to all the objects in the cluster is minimal. Thus, the center of each cluster in k-medoid method is a member of the data set, whereas the centroid of each cluster in k-means method could not belong to the set. Besides the clustering algorithms, general statistics measures as histograms, maximum, minimum, mean and standard deviation of pixel characteristics for regions and tiles are computed. In the training phase, naive Bayesian classifiers and decision trees are used. An important factor of VisiMine system is its connectivity to SPLUS, an interactive environment for graphics, data analysis, statistics and mathematical computing that contains over 3000 statistical functions for scientific data analysis. The functionality of VisiMine includes also generic image processing tools, such as histogram equalization, spectral balancing, false colours, masking or multiband spectral mixing, and data mining tools, such as data clustering, classification models or prediction of land cover types.
\n\t\t\tGeoIRIS (Scott et al., 2007) is another IIM system that includes automatic feature extraction at tile level, such as spectral, textural and shape characteristics, and object level as high dimensional database indexing and visual content mining. It offers the possibility to query the archive by image example, object, relationship between objects and semantics. The key point of the system is the ability to merge information from heterogeneous sources creating maps and imagery dynamically.
\n\t\t\tFinally, Knowledge-driven Information Mining (KIM) (Datcu & Seidel, 1999), (Pelizzari et al., 2003) and later versions of Knowledge Enabled Services (KES) and Knowledge–centred Earth Observation (KEO) http://earth.esa.int/rtd/events/esa-eusc 2004/; http://earth.esa.int/rtd/events/esa-eusc 2005/, http://earth.esa.int/rtd/events/esa-eusc 2006/;
Congenital malformations involving the gastrointestinal tract (GIT) can be broadly divided into upper and lower gut abnormalities (Table 1). Upper pathology involves the foregut tubes, which are proximal to the ligament of Treitz: the esophagus, stomach, duodenum, pancreas and hepatobiliary tract. Lower GIT anomalies include the mid and hindgut structures: the jejunum and ileum, which constitute the small bowel, the colon and anorectal malformations. Congenital anomalies can further be classified based on whether the defect is structural or functional. Structural anomalies result from either defective embryogenesis or intrauterine complications, such as ischemia. Functional defects have normal anatomy but disrupted flow of GIT contents. In most cases, structural defects adversely impact functional capability. This chapter reviews the clinical presentation, diagnostic work up and surgical management of upper and lower GIT congenital anomalies.
Anatomic relation | Embryonic source | Blood supply | Viscera | |
---|---|---|---|---|
Upper gastrointestinal tract | Proximal to ligament of Treitz | Foregut | Celiac axis | Esophagus Stomach Duodenum Biliary ducts Liver Pancreas |
Lower gastrointestinal tract | Distal to ligament of Treitz | Midgut | SMA | Jejunum Ileum Cecum Ascending colon Proximal 2/3 transverse colon |
Hindgut | IMA | Distal 1/3 transverse colon Descending colon Sigmoid colon Rectum Anal canal |
Embryologic derivates of the gastrointestinal tract.
SMA: superior mesenteric artery; IMA: inferior mesenteric artery.
During the fourth week of gestation, the embryonic ventral foregut differentiates into the esophagus and trachea. Muscular and neurovascular development of the esophagus is complete by the end of ninth week of gestation. It is likely that esophageal malformations result from errors during this developmental time period.
EA/TEF is categorized into five types and clinical presentation varies depending on the type of pathology (Figure 1). Type A is the most common (90% cases) and consists of proximal EA with a distal TEF. Type B consists solely of proximal EA (no fistula) whereas type C only has a TEF (no atresia). Type D has both a proximal and distal TEF in the setting of atresia. Type E consists of proximal EA with TEF and a distal esophageal pouch. Types D and E are exceedingly rare.
Types of tracheoesophageal fistulae depicted as figures A-E.
The infant will exhibit drooling and attempts at feeding will result in coughing, choking and regurgitation. Since types B and E have a proximal obstruction without distal fistulization, the infant will have a scaphoid abdomen and gas will not be seen in the bowel distally on radiograph. Type C may present with recurrent aspiration pneumonia and may not be diagnosed until later in life.
Prenatal ultrasound will demonstrate polyhydramnios and the blind end of the esophageal pouch may be visualized. After birth, unsuccessful attempt at passage of an oro- or nasogastric tube is diagnostic. The tip of the tube will be seen in the esophageal pouch on radiography.
Because of the VACTERL phenomenon (vertebral, anal, cardiac, tracheoesophageal, renal and limb deformities), renal and cardiac ultrasounds as well as plains films of the spine and limbs must be obtained to determine the presence of any other anomalies. An echocardiogram is particularly essential to ensure that the aortic arch is in its normal left-sided anatomic location because this impacts operative planning. Ventricular septal defect is the most common anomaly associated with EA/TEF.
Ideally, EA/TEF is corrected in a single procedure. Staged procedure, beginning with decompressive gastrostomy and fistula takedown, followed by esophageal reconstruction at a later date, is reserved for those too unstable to tolerate general anesthesia due to respiratory or cardiac defects. Infants with long gap atresia also undergo delayed repair to allow elongation of the proximal and distal esophageal ends.
In current practice, the minimally invasive approach using video assisted thoracoscopy is preferred to open thoracotomy. If the open approach is employed, a right posterolateral thoracotomy incision is made at the fourth intercostal space, sparing the serratus anterior and latissimus dorsi muscles. Extrapleural dissection is carried until the azygous vein is encountered, which is then divided. In the case of type A, the lower esophageal pouch and its associated fistula are identified. The fistula is resected. The proximal esophageal pouch is then mobilized to establish tension free continuity between the two ends. If a proximal fistula is present, this is ligated prior to mobilization. The esophagus is reconstructed via a single layer end-to-end anastomosis. A chest tube is placed and remains until post-operative esophogram confirms patency of the anastomosis. Anastomotic leaks tend to heal without intervention and are managed by continuation of chest tube and antibiotics.
Thoracoscopic approach has led to improved outcomes and most infants grow to lead fairly normal lives, given the lack of concurrent anomalies such as cardiac defects. Most commonly, gastroesophageal reflux (GER) and esophageal strictures are lifelong issues endured by the patient. GER may be asymptomatic or lead to persistent cough, respiratory problems or esophageal stricturing. Primary management is medical with anti-reflux medications and prokinetics. Surgical correction of GER with fundoplication is last resort. Esophageal strictures may form many years after repair and are best managed by endoscopic dilation. Recurrent or refractory esophageal strictures require surgical resection and re-anastomosis.
It results due to the failure of duodenal recanalization and most commonly occurs in the second portion of the duodenum distal to ampulla of Vater but any segment can be affected.
Emesis and feeding intolerance occurs in the first 24–48 h of life. The type of emesis—bilious versus non—depends on the location of atresia relative to the major duodenal papilla. If obstruction is distal to it, infant will exhibit bilious emesis. Obstruction proximal to the ampulla causes non-bilious emesis. Abdomen will not be distended due to proximal nature of obstruction. A palpable mass in the epigastrium may be appreciated on physical exam.
The “double bubble” on abdominal x-ray indicates air in stomach and duodenum but not in distal small bowel and colon. An UGI series must be obtained to rule out malrotation, which can also present with bilious emesis early in life and is a surgical emergency. UGI may reveal a duodenal web, which is an intraluminal diverticulum that appears as an elongated, conical silhouette resembling a “windsock”. Echocardiogram and renal ultrasound are performed to rule out any other defects as there is an association with trisomy 21 and its related complications.
“The diamond D”, Diamond Duodenoduodenostomy—A transverse incision is made in the proximal widened duodenum and a longitudinal incision in the distal tapered portion of the duodenum (Figure 2). The anastomosis is created in a diamond shape to facilitate mucosal abutment between the two incongruent duodenal diameters. During repair, evaluation for duodenal web must be performed because they are not always identified on pre-operative UGI and can cause persistent obstruction if not corrected. If present, a longitudinal duodenotomy is performed over the area of the web and it is excised. Careful attention must be paid to its location relative to the major duodenal papilla so as to not disrupt the integrity of the ampulla of Vater. The duodenotomy is closed in a transverse fashion to avoid narrowing of the lumen.
Diamond duodenoduodenostomy for duodenal atresia repair.
There tend to be few, if any, long term complications following correction of duodenal atresia. Persistent obstruction may indicate missed duodenal web and requires re-operation. Delayed gastric emptying may occur in the early postoperative period and does not warrant any intervention; most cases resolve with time and enteral feedings can be advanced in small volumes as tolerated.
The exact etiology is unknown. Exposure to erythromycin has been implicated as a risk factor [1].
It is characterized with feeding intolerance and non-bilious emesis that becomes projectile over time; usually presenting around 2–4 weeks of life, however, may not present up until 6–12 weeks. Emesis is non-bilious because the site of obstruction, the pylorus, is proximal to the ampulla of Vater. It tends to occur in first born Caucasian males.
On physical exam, may be able to palpate an “olive like” firm, mobile mass in the right upper quadrant or epigastrium, however this is often difficult to appreciate on a restless infant. Abdomen is otherwise soft and non-distended. Ultrasound is diagnostic and demonstrates a pyloric channel length ≥ 16 mm, wall ≥4 mm in thickness.
Repeated vomiting of gastric acid (HCl) leads to hypochloremia, alkalosis and dehydration. Hypovolemia stimulates aldosterone secretion with resultant sodium resorption and potassium secretion. Thus, the infant’s laboratory panel will reveal hypochloremic, hypokalemic metabolic alkalosis. Hydrogen is shifted extracellularly in exchange for potassium to correct the acid–base imbalance, exacerbating hypokalemia. Eventually, worsening hypokalemia stimulates the renal hydrogen-potassium pump to resorb potassium and secrete hydrogen, resulting in acidic urine. This is termed “paradoxical aciduria” because bicarbonate secretion should take precedence in an alkalotic state, but the nephrons prioritize correction of potassium at the expense of hydrogen loss instead.
Pyloric stenosis is not a surgical emergency and operative intervention is deferred until electrolytes have normalized, ideally, chloride >95, bicarbonate <30. As the primary metabolic derangements are caused by volume and gastric juice loss, resuscitation should be initiated with 10-20 cc/kg normal saline boluses. Once volume status has been adequately restored and urine output robust, potassium containing fluids (D5 1/2NS + 10 K/L) are administered at maintenance rate.
The Ramstedt pyloromytomy was historically carried out through a right subcostal transverse incision however the laparoscopic approach is becoming preferred in current practice. A longitudinal incision along the anterior surface of the pylorus is carried down through the serosa and hypertrophied muscle until the submucosa protrudes, much like slicing the tough outer skin of a grape until the smooth inner flesh is encountered. The length of the myotomy extends from the antrum of the stomach proximally to the pyloric vein of Mayo distally, which designates the junction of the pylorus and proximal duodenum. Oral feeding may be initiated 6–8 h post-operatively and advanced as tolerated.
Long term results from pyloromyotomy are excellent and few infants, if any, have residual complications. Incomplete myotomy can present with persistent feeding intolerance in the peri-operative period and requires re-operation.
The pathophysiology is unknown. Between 4 and 10 weeks of gestation, the extrahepatic biliary tract develops from the hepatic diverticulum. This occurs normally. In the post-natal period, there appears to be an inflammatory process that causes fibrosis of the extrahepatic biliary ducts [2].
Worsening jaundice unamenable to phototherapy during the first 2 weeks of life, subsequently demonstrating unrelenting direct hyperbilirubinemia are characteristic. Laboratory values are consistent with biliary obstruction and demonstrate direct hyperbilirubinemia and elevated alkaline phosphatase. Signs of cholestasis, dark urine and light or gray colored stools are present.
Hepatobiliary technetium-99 iminodiacetic acid scan (99-Tc IDA) has highest sensitivity and specificity [2]. Normally, the radiotracer is taken up by hepatocytes and readily excreted into the intestines via the biliary ducts. In biliary atresia, technetium will be taken up by the liver normally, but obstruction of the extrahepatic ducts prevents outflow of radiotracer into the duodenum. Abdominal ultrasound may reveal a small or obliterated gallbladder. Magnetic resonance cholangiopancreatography (MRCP) is also be helpful in ruling out intrahepatic atresia or choledocal cysts.
Expeditious operative intervention is imperative as liver damage can be attenuated, even reversed, and chance of survival improved with early biliary decompression. Beyond 3–4 months, irreversible liver damage may preclude successful outcome. The Kasai portoenterostomy is the procedure of choice. First, an intraoperative cholangiogram is performed to delineate the anatomy of the biliary tree and confirm the diagnosis. A liver biopsy is obtained to document degree of liver damage. Next, the fibrotic common bile duct is dissected from the hepatoduodenal ligament up to the level of the porta hepatis and excised. An approximately 20 cm limb of jejunum is brought up in a retrocolic fashion and a Roux-en-Y hepaticojejunostomy is created.
Successful, long term establishment of bile flow correlates with earlier surgical intervention. Infants aged <60 days at time of surgery have best results. Approximately one-third of children undergoing portoenterostomy have a 10-year or greater survival, while the rest will ultimately succumb to liver failure and require transplant. Other indications for liver transplant include presence of intrahepatic atresia, fat soluble vitamin deficiencies causing failure to thrive and variceal bleeding secondary to portal hypertension. 5-year survival following liver transplant ranges from 75 to 95% [2].
Apart from progressive liver failure, cholangitis is another major post-operative complication occurring in as much as 50% of patients who undergo portoenterostomy [2]. Decreased bile flow indicated by elevated total bilirubin in the setting of fever and leukocytosis is essentially diagnostic of cholangitis until proven otherwise. It is managed with IV antibiotics and fluid resuscitation.
Etiology is unknown. Aberrant pancreaticobiliary junction near the duodenal wall has been suggested [3].
Infants present with symptoms of biliary obstruction: progressive jaundice, dark urine, light colored stools. A tender abdominal mass may be palpated in the right upper quadrant. Laboratory values will be consistent with biliary obstruction and demonstrate elevated direct bilirubin and alkaline phosphatase. Patients may also present with cholangitis or pancreatitis.
While abdominal ultrasound and hepatobiliary 99-Tc IDA scan are useful, MRCP best delineates the anatomy of the biliary tree and is the diagnostic test of choice. There are five types (Figure 3). Type 1 is the most common and presents as saccular or fusiform dilation of the common bile duct (CBD; Figure 3A). Intrahepatic ducts are normal. Type 2 is an isolated CBD diverticulum (Figure 3B). Type 3 is a choledochocele, in which there is cystic dilation of the supra-duodenal CBD, prior to its junction with the pancreatic duct (Figure 3C). In type 4 disease, intra- and extra-hepatic bile ducts are dilated whereas in type 5 disease only intra-hepatic ducts are dilated (Figures 3D,E).
Normal anatomy of the hepatobiliary tree and its relationship to the pancreas and duodenum. (A) Choledocal cyst type 1: fusiform dilation of the extrahepatic duct common bile duct. (B) Choledocal cyst type 2: isolated diverticulum off the common bile duct. (C) Choledocal cyst type 3: supraduodenal choledococele. (D) Choledocal cyst type 4: cystic dilation of intra- and extra-hepatic bile ducts. (E) Choledocal cyst type 5, dilation of intra-hepatic ducts only.
Given the risk of cholangiocarcinoma, highest in types I and IV, surgical intervention is indicated at the time of diagnosis of any type of choledochal cyst. The approach depends on type of lesion. For type 1 cysts, primary cyst excision with cholecystectomy and roux-en-Y hepaticojejunostomy reconstruction is procedure of choice. Type 2 disease is managed by simple diverticulectomy. Type 3 is managed by transduodenal cyst excision or marsupialization and sphincteroplasty. Types 4 and 5 may be treated by anatomic hepatic resection based on the extent and location of disease, however, liver transplantation is ultimately required in most cases.
Excision of choledocal cysts result in excellent long-term outcomes with few major complications. Biliary tract malignancy, the most feared complication, may occur with incomplete excision. Cholangitis, stricture formation and choledocolithiasis are lesser significant complications that are managed medically and endoscopically, respectively.
Midgut development begins around the fifth week of gestation. The midgut starts as a vertical tube and has two connections: a ventral connection to the yolk sac via the omphalomesenteric (vitelline) duct and a dorsal attachment to the posterior abdominal wall, the mesentery [4, 5, 6]. The dorsal mesentery is the conduit for the superior mesenteric artery (SMA), which buds from the aorta, and delivers blood to the midgut. The lengthening gut tube outgrows the confines of the abdominal cavity and consequently herniates into the umbilical cord. As it elongates, it rotates 90° in a clockwise direction relative to the embryo (counterclockwise if visualized from the front). The midgut tube continues to grow extra-abdominally during gestational weeks 6–10. Around week 10, it retracts back into the abdominal cavity, rotating another 180° while doing so. Final intra-abdominal growth and fixation ensue, placing the cecum in the right lower quadrant and the duodeno-jejunal junction to the left of the upper midline, inferior to the SMA. The mesentery broadens, fanning out from its root in the posterior abdominal wall, to support the blood vessels and lymphatics that serve the jejunum, ileum, cecum/appendix, ascending colon and proximal 2/3 of the transverse colon. It is believed that ischemic events during this period cause jejunoileal atresia.
Atresia causes a structural obstruction that prevents passage of meconium in the first 24–48 h of life and results in bilious emesis. On physical exam, the abdomen will be distended.
Jejunoileal atresia is classified into four types (Figures 4A–E). Type 1 is an intraluminal web with intact mesentery (Figure 4A). The seromuscular layers of bowel remain in continuity. Type 2 also has an intact mesentery, but the two ends of bowel are disconnected by a fibrous cord (Figure 4B). Type 3a has a small v-shaped mesenteric defect that separates two blind ends of bowel (Figure 4C). In type 3b disease, known as an “apple-peel” or “Christmas-tree” deformity, a large mesenteric defect separates the proximal and distal ends of bowel. The proximal pouch is very dilated, and the distal collapsed bowel is supplied by a small vessel around which it repeatedly winds (Figure 4D). Type 4 consists of numerous blind ended segments of bowel with discontinuous mesentery, appearing as a “string of sausages” (Figure 4E).
(A) Type 1 jejunoileal atresia. (B) Type 2 jejunoileal atresia. (C) Type 3a jejunoileal atresia. (D) Type 3b jejunoileal atresia. (E) Type 4 jejunoileal atresia.
Abdominal x-ray will reveal dilated portions of bowel proximal to the site of obstruction with collapsed loops and paucity of air in the distal bowel. Contrast enema will demonstrate an abrupt transition from the filling to non-filling segments of small bowel and the colon will be appear small, <1 cm diameter, due to lack of use. In all cases of bilious emesis, an UGI series is warranted to rule out malrotation, a surgical emergency. UGI will reveal contrast filling in the stomach and proximal bowel, with abrupt cessation of contrast filling at the point of atresia.
Initial management begins with insertion of an oro- or nasogastric tube for bowel decompression and fluid resuscitation. Resection of atretic segments with end-to-end anastomoses is the procedure of choice; however, this can prove quite difficult in cases where ends of bowel are greatly mismatched in diameter. In such circumstances, the anastomosis is created in a fashion similar to duodenoduodenostomy in which the smaller end of bowel is incised longitudinally along its anti-mesenteric border to fit the end of the larger caliber bowel. Prior to completing the anastomosis, the entire length of the bowel must be inspected to ensure there are no intraluminal webs or fenestrations that may cause persistent obstruction. The goal is to resect all defunct bowel segments while maintaining enough length to ensure adequate resorptive capacity. If the ileocecal valve is spared, enteral nutrition can be tolerated with as little as 15–20 cm of small bowel. Otherwise, a length of approximately 40 cm is required [4]. Mesenteric defects are closed, taking care not to disrupt the feeding blood vessels.
Intestinal dysmotility, even in infants that have adequate remaining bowel length, may occur for many weeks following repair. Infants with short bowel syndrome, those with less than 40 cm, often require long term parenteral nutrition, which itself carries risks of sepsis and liver damage. Nonetheless, overall mortality is low and related to co-morbidities, such as low birth weight and/or cardiac defects.
As described above, normal 270° rotation and fixation of the midgut fails to occur [4, 5, 6, 7]. This lack of rotation positions the duodenum and small bowel to the right of the midline and the large bowel to the left. The cecum remains anterior to the duodenum and is tethered to the abdominal wall by lateral peritoneal attachments. These lateral peritoneal attachments, known as Ladd’s bands, compress the duodenum, thereby causing obstruction and resultant bilious emesis. The root of the mesentery is narrowed and may potentially act as fulcrum around which the bowel can twist (“volvulize”), thereby kinking the SMA and causing ischemia (Figure 5).
Intestinal malrotation showing abnormal position of cecum and Ladd’s bands
Acute malrotation with midgut volvulus presents with feeding intolerance and bilious emesis, usually around the first week of life. Abdominal rigidity, overlying erythema are signs of peritonitis and indicate ischemic bowel. Abdominal distention will not be present given the very proximal nature of pathology. As feeding intolerance and bilious emesis are symptoms of multiple pathologies, a high index of suspicion is required to make this diagnosis.
An abdominal X-ray is typically first obtained, though rarely helpful in establishing the diagnosis. Any concern for malrotation mandates a prompt UGI. A normal study will reveal contrast exiting the pylorus, descending through the second portion of the duodenum and crossing the midline through the third portion of the duodenum into the small bowel. Thus, a normal “C-loop” will be visualized. An abnormal study will demonstrate contrast exiting the pylorus and descending straight down to the right of the midline into the small bowel.
Once the diagnosis of acute malrotation is made, the patient is taken emergently to the operating room for detorsion and evaluation of bowel viability. Fluid resuscitation, insertion of oro- or nasogastric tube for decompression and administration of intravenous antibiotics have ideally been implemented prior to surgical intervention. The bowel is eviscerated and detorsed in a counterclockwise direction, fanning out its mesentery. Ladd’s bands are incised to release the obstruction. Any frankly necrotic appearing bowel is resected, while dusky bowel can be re-evaluated and usually salvaged in a second look operation 24–48 h later. Ends of healthy, viable bowel can be anastomosed, otherwise stomas are placed. A prophylactic appendectomy is performed to eliminate the possibility of appendicitis in the future. If a second look operation is required, the abdomen is left open and covered with a temporary sterile dressing; if not, it is closed.
Without significant intestinal necrosis requiring resection, outcomes following correction of malrotation are quite favorable. Infants grow normally and do not have any major adverse sequelae. Rarely, adhesive small bowel obstruction may occur years later, however any operation carries this risk.
This condition occurs as a result of the failure of the omphalomesenteric (vitelline) duct to completely involute between weeks 5–7 of gestation (Figure 6).
Omphalocele (left) and gastroschisis (right). The herniated intestine is covered with a sac with umbilical cord attached to it in omphalocele, while the intestinal loops in gastroschisis herniate through a defect on the right side of umbilicus and are not covered.
Meckel’s diverticulum is the most common congenital GIT malformation and the most common cause of painless lower intestinal bleeding in children. It usually presents by the age of 2 years, but presentation can be delayed into the teenage years. There is a male predominance. The bleeding is typically brisk and bright red. Laboratory values will demonstrate anemia. A fibrous cord connecting the diverticulum to the abdominal wall may be present and can act as a point around which bowel can obstruct, twist or intussuscept. In such cases, the child will present with abdominal pain and distention, inability to pass flatus or move their bowels.
Technetium-99 pertechnate scintigraphy (“Meckel’s scan”) localizes the bleeding ulcer. The diverticulum is typically found within 2 feet proximal to the ileocecal valve, on the anti-mesenteric side of the ileum and contains heterotopic mucosa, usually that of gastric or pancreatic in origin. Ulceration and bleeding occur secondary to acid secretion from the heterotopic mucosa. It is a true diverticulum involving all four layers of the bowel.
If bleeding is the presenting symptom, ileal resection with primary anastomosis is the procedure of choice. Segmental resection is also indicated in cases complicated by diverticulitis, perforation, obstruction, volvulus or if the base of the diverticulum is very wide. Simple diverticulectomy may be performed if the neck of the diverticulum is narrow, or if diverticulitis does not involve the base.
Resection of Meckel’s diverticulum has an excellent prognosis without major long term post-operative complications.
These are congenital defects of the abdominal wall, not of the gastrointestinal tract itself, but are discussed because they are associated with malrotation (Figure 6).
Numerous physical characteristics differentiate omphalocele from gastroschisis. The abdominal wall defect in omphalocele is midline, versus to the right of the umbilicus in gastroschisis. Defects tend to be smaller in gastroschisis, typically ≤3 cm. In comparison, omphaloceles can vary widely in diameter, ranging in size from 2 to 15 cm. Larger defects allow for herniation of more organs, namely the liver and spleen. This rarely, if at all, occurs in gastroschisis. Herniated contents are covered by an amniotic sac in omphalocele but not in gastroschisis. Exposure of the bowel to amniotic fluid during gestation causes the bowel to become thickened and the mesentery fibrotic whereas bowel is normal in omphalocele since it is protected by the overlying sac. Lastly, omphalocele has a higher association with chromosomal abnormalities and other congenital anomalies compared gastroschisis. Intestinal atresia may be seen in gastroschisis.
These defects may be appreciated on pre-natal ultrasound and are therefore expected upon delivery. Chest radiography, echocardiogram and renal ultrasound are performed to rule out associated anomalies in the case of omphalocele, as is karyotyping though this may have been performed prenatally.
Exposure of intestinal contents to the environment can result in significant insensible losses. Initial management aims to maintain adequate volume status and body temperature. The infant is placed under a warmer, fluid resuscitation commenced, and urinary catheter inserted to strictly monitor volume status. Oro- or naso-gastric tube is placed for bowel decompression. Intestinal contents are wrapped in a moist, sterile plastic dressing to prevent evaporative losses. In the case of omphalocele, care must be taken to prevent rupture of the protective sac. The goals of operation are to return the herniated contents into the abdominal cavity and close the defect. If this is unable to be accomplished either because the infant is too unstable to be taken to the operating room or because there is high risk of abdominal compartment syndrome, a silo can be sutured in place over the herniated viscera and contents gradually reduced. Daily manual reduction can be performed bedside, gently as tolerated, with complete reduction usually achieved over 3–7 days. The resultant ventral hernia is repaired once all viscera have been reduced and the infant deemed fit to tolerate general anesthesia.
Given the protective nature of the overlying sac in omphalocele, infants typically have normal bowel function following reduction and abdominal wall repair. Long term complications are related to concomitant congenital defects. In contrast, patients with gastroschisis, especially if they also have intestinal atresia, are subject to dysmotility, malabsorption and are at increased risk of developing necrotizing enterocolitis. These infants often require long term parenteral nutrition following surgical correction.
Aganglionosis of the myenteric plexus due to failure of neural crest cell migration during weeks 6–12 of embryonic development. Most often occurs in the rectum though any portion and, rarely, the entire bowel can be affected. The myenteric plexus lies in between the outer longitudinal and inner circular muscle layers of the colon and is responsible for peristalsis.
Aganglionosis results in a functional obstruction manifesting as failure to pass meconium within first 24 h of life. Abdominal distention may be present. Rectal stimulation causes explosive passage of air and stool. Because disease is distal, infant will likely be able to tolerate oral intake though may have intermittent episodes of bilious emesis. Less severe disease may not manifest until later in childhood, up to 2–3 years of age, with chronic constipation. There is an association with trisomy 21. Therefore, work up includes echocardiogram to rule out concomitant cardiac defects.
Gold standard is suction rectal biopsy, which demonstrates aganglionosis of the myenteric plexus. Biopsy should be obtained 1–1.5 cm proximal from the dentate line to ensure rectal specimen is obtained. Pathology will reveal unmyelinated nerve fibers with hypertrophied endings that stain darkly with acetylcholinesterase. Abdominal X-ray shows dilated proximal bowel with collapsed distal colon. Contrast enema is helpful in distinguishing transition zone between affected and normal colon however, gross anatomic distinction does not always correlate with histopathology [8].
Although various operative methods have been described, the fundamental principle of each procedure is the same: to establish continuity between the normal, ganglionic segments of bowel. In the past, multi-stage operations beginning with decompressive colostomy followed by definitive repair was common. Nowadays, single-stage laparoscopic approach is preferred. Regardless of procedure, however, intra-operative frozen section must be performed to confirm the presence of normal ganglionic colon prior to anastomosis, otherwise dysfunction will continue post-operatively.
The rectum/aganglionic segment is dissected circumferentially, everted through the anus and resected. Normal colon is pulled down and a low end-to-end colorectal anastomosis is created.
The aganglionic portion of bowel is bypassed and a posterior end to side anastomosis is created between the innervated segments of colon and distal rectum. The rectum is stapled at the proximal margin of disease. An incision is made in the distal posterior wall of the rectal stump approximately 1 cm superior to the dentate line. The innervated colon is pulled down through the presacral space and then anastomosed in an end-to-side fashion to the distal posterior rectal wall. The defunct rectal stump is left in place.
Circumferential endorectal dissection of rectal mucosa and submucosa, followed by evagination of these layers through the anus for resection. A rectal muscular channel remains, and innervated colon is intussuscepted through the remaining rectal muscular channel. A colorectal anastomosis is performed at the distal end of the muscular channel [9].
No single procedure has been shown to be superior to other in terms of long-term outcomes, and up to 90% patients will have relatively normal bowel function following repair. Although results tend to be quite favorable, one significant cause of significant morbidity and mortality is Hirschsprung’s enterocolitis. While the exact etiology of this entity is unknown, bacterial overgrowth and translocation appear to be implicated. Patients present with fever, abdominal distention and diarrhea. Management consists of fluid resuscitation, IV antibiotics and rectal irrigation. Refractory cases require surgical decompression with a proximal ostomy. Other complications such as anastomotic leak, stricture, abscess, wound infection and obstruction occur in up to 10% cases [1].
During the 5th week of gestation, the midline urorectal septum descends in a caudal direction toward the cloaca and divides into ventral and dorsal portions. The ventral bud becomes the urogenital sinus, which develops into the urethra and bladder. The dorsal bud becomes the rectum and anal membrane. The anal membrane involutes around week 8, thereby forming the anus. Dysgenesis can occur at any time point, allowing for variability in clinical presentation.
An anatomical distinction based on the pathology’s relation to the levator ani muscle complex was first described by Pena. The levator ani complex supports the pelvic floor and is composed of three striated muscles: the puborectalis, the pubococcygeus and the iliococcygeus. The puborectalis encircles the base of the rectum, helps to form the external anal sphincter and thereby plays an integral role in regulating defecation. Anorectal dysgenesis above the levator ani muscles is considered a “high” lesion. Conversely, lesions inferior to the levator ani complex are termed “low” malformations. Generally speaking, higher malformations tend to cause more severe issues with controlling defecation as the neuromuscular development between the levator ani complex and growing recto-anus is compromised to a greater degree.
Failure to pass meconium in the first 24–48 h of life. Physical exam will reveal abdominal distention and absence of anus. A subtle opening in the perineum through which small amounts of meconium pass may be present and indicates an anoperineal fistula in the setting of a low imperforate anus. This is the most common pathology seen. In females, low lesions may also be associated with a rectovestibular fistula, and meconium may be expressed through the vagina. Elimination of meconium during urination indicates rectourethral or rectovesicular fistula and a high rectal pouch.
Diagnosis is made upon physical examination of the perineum. Historically, an invertogram was performed to evaluate the length of atresia. In this study, a radiopaque marker is placed on the infant’s bottom, where the anus would normally be located, and the infant is placed in a head down position to allow air to ascend at the most inferior point in the rectum. Lateral films of the pelvis are then obtained. The distance between the marker and distal rectum indicate the level of pathology—high vs. low. Now, ultrasound is preferred.
Anorectal malformations are part of the VACTERL syndrome and most commonly associated with concomitant genitourinary defects. In addition to a renal ultrasound, a voiding cystourethrogram should be obtained, especially if a rectourethral/rectovesicular fistula is suspected as this can help delineate the tract. Plains films of the chest, limbs and spine as well as an echocardiogram help identify the presence of other anomalies. Any other life-threatening co-morbidities take precedence, and a temporary diverting ostomy can be placed until definitive repair can be safely performed, usually between 8 and 12 months of age.
Posterior sagittal anorectoplasty (PSARP) is the surgical procedure performed. The infant is placed in a prone jack-knife position. If a perineal fistula is present, an incision is made around the fistula and carried posteriorly toward the coccyx. If no perineal fistula is present, the incision starts inferior to the coccyx and is carried down to the perineum. It is imperative to remain midline. This is ensured by visualizing striated muscle fibers, which run perpendicular to the incision. If fat is encountered during the dissection, this indicates that the operator has deviated from midline and entered the lateral ischioanal/ischiorectal space. The rectum is identified by its overlying glistening fascia and then freed circumferentially, beginning posteriorly and advancing anteriorly until the fistula is encountered. The fistula is resected. After the fistula is taken down, the anterior rectal wall is freed from its surrounding structures. In females, the anterior rectum lies in close proximity to the posterior vaginal wall and in males, the prostate and bladder. The anterior rectal wall is gently dissected off these structures up to the peritoneal reflection. Complete, circumferential dissection of the rectum will allow for tension-free pull down and anastomosis. The rectum is situated in its anatomic position in the muscle complex. The muscle complex is repaired around the properly positioned rectum and the neoanus is created by suturing mucosa to the perineum.
Long terms outcomes are dependent on the level of pathology—high versus low anorectal dysgenesis—and the extent of neuromuscular development of the levator ani complex and rectum. Almost all children will require some degree of lifestyle modifications to manage fecal incontinence or, conversely, chronic constipation. This is achieved by strict bowel regimens with enemas or cathartics. In more severe cases, a cecostomy or appendicostomy may be required to allow for daily antegrade enemas. Worst case scenarios may necessitate a diverting ostomy.
The contribution of Natalia Louise Smith is greatly appreciated for drawing the figures numbered as 1-to-6.
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\\n\\nAll Terms refer to the offer, acceptance, and consideration of payment necessary to provide assistance to the Client in the most appropriate manner, whether by formal meetings of a fixed duration, or by any other agreed means, for the express purpose of meeting the Client’s needs in respect of provision of the Company’s stated services/products, and in accordance with, and subject to, the prevailing laws of the United Kingdom.
\\n\\nAny use of the above terminology, or other words in the singular, plural, capitalization and/or he/she or they, are taken as interchangeable.
\\n\\nUnless otherwise stated, IntechOpen and/or its licensors own the intellectual property rights for all materials on www.intechopen.com. All intellectual property rights are reserved. You may view, download, share, link and print pages from www.intechopen.com for your own personal use, subject to the restrictions set out in these Terms and Conditions.
\\n\\nWe employ the use of cookies. By using the IntechOpen website you consent to the use of cookies in accordance with IntechOpen’s Privacy Policy. Most modern day interactive websites use cookies to enable the retrieval of user details for each visit. On our site, cookies are predominantly used to enable functionality and ease of use for those visiting the site.
\\n\\nIn no circumstances shall IntechOpen or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption) arising out of the use, or inability to use, the materials on IntechOpen's websites, even if IntechOpen or an IntechOpen authorized representative has been notified orally or in writing of the possibility of such damage. Some jurisdictions do not allow limitations on implied warranties, or limitations of liability for consequential or incidental damages; consequently, these limitations may not apply to you.
\\n\\nIntechopen.com website content and services are provided on an "AS IS" and an "AS AVAILABLE" basis. Material appearing on www.intechopen.com could include minor technical, typographical, or photographic errors. IntechOpen may make changes to any material contained on its website at any time without notice.
\\n\\nIntechOpen has no formal affiliation to any external sites that link to www.intechopen.com, unless otherwise specifically stated. As such, it is not responsible for content that appears on any such sites. The inclusion of any link to IntechOpen does not imply endorsement by IntechOpen. Use of any such linked website is done solely at the user's own discretion.
\\n\\nWe reserve the right of ownership over our entire website www.intechopen.com, and all contents. By using our services, you agree to remove all links to our website immediately upon request. We also reserve the right to amend these Terms and Conditions and our linking policy at any time. By continuing to link to our website, you agree to be bound to, and abide by, these linking Terms and Conditions.
\\n\\nIf you find any link on our website, or any linked website, objectionable for any reason, please Contact Us. We will consider all requests to remove links but will have no obligation to do so.
\\n\\nWithout prior approval and express written permission, you may not create frames around our web pages or use other techniques that alter in any way the visual presentation or appearance of our website.
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\\n\\nThese Terms and Conditions are governed by and construed in accordance with the laws of the United Kingdom and you irrevocably submit to the exclusive jurisdiction of the courts in London, United Kingdom.
\\n\\nCroatian version of Terms and Conditions available here
\\n"}]'},components:[{type:"htmlEditorComponent",content:'By accessing the website at www.intechopen.com you are agreeing to be bound by these Terms of Service, all applicable laws and regulations, and agree that you are responsible for compliance with any applicable local laws. Use and/or access to this site is based on full agreement and compliance of these Terms. All materials contained on this website are protected by applicable copyright and trademark laws.
\n\nThe following terminology applies to these Terms and Conditions, Privacy Statement, Disclaimer Notice, and any or all Agreements:
\n\n“Client”, “Customer”, “You” and “Your” refers to you, the person accessing this website and accepting the Company’s Terms and Conditions;
\n\n“The Company”, “Ourselves”, “We”, “Our” and “Us”, refers to our Company, IntechOpen;
\n\n“Party”, “Parties”, or “Us”, refers to both the Client and ourselves, or either the Client or ourselves.
\n\nAll Terms refer to the offer, acceptance, and consideration of payment necessary to provide assistance to the Client in the most appropriate manner, whether by formal meetings of a fixed duration, or by any other agreed means, for the express purpose of meeting the Client’s needs in respect of provision of the Company’s stated services/products, and in accordance with, and subject to, the prevailing laws of the United Kingdom.
\n\nAny use of the above terminology, or other words in the singular, plural, capitalization and/or he/she or they, are taken as interchangeable.
\n\nUnless otherwise stated, IntechOpen and/or its licensors own the intellectual property rights for all materials on www.intechopen.com. All intellectual property rights are reserved. You may view, download, share, link and print pages from www.intechopen.com for your own personal use, subject to the restrictions set out in these Terms and Conditions.
\n\nWe employ the use of cookies. By using the IntechOpen website you consent to the use of cookies in accordance with IntechOpen’s Privacy Policy. Most modern day interactive websites use cookies to enable the retrieval of user details for each visit. On our site, cookies are predominantly used to enable functionality and ease of use for those visiting the site.
\n\nIn no circumstances shall IntechOpen or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption) arising out of the use, or inability to use, the materials on IntechOpen's websites, even if IntechOpen or an IntechOpen authorized representative has been notified orally or in writing of the possibility of such damage. Some jurisdictions do not allow limitations on implied warranties, or limitations of liability for consequential or incidental damages; consequently, these limitations may not apply to you.
\n\nIntechopen.com website content and services are provided on an "AS IS" and an "AS AVAILABLE" basis. Material appearing on www.intechopen.com could include minor technical, typographical, or photographic errors. IntechOpen may make changes to any material contained on its website at any time without notice.
\n\nIntechOpen has no formal affiliation to any external sites that link to www.intechopen.com, unless otherwise specifically stated. As such, it is not responsible for content that appears on any such sites. The inclusion of any link to IntechOpen does not imply endorsement by IntechOpen. Use of any such linked website is done solely at the user's own discretion.
\n\nWe reserve the right of ownership over our entire website www.intechopen.com, and all contents. By using our services, you agree to remove all links to our website immediately upon request. We also reserve the right to amend these Terms and Conditions and our linking policy at any time. By continuing to link to our website, you agree to be bound to, and abide by, these linking Terms and Conditions.
\n\nIf you find any link on our website, or any linked website, objectionable for any reason, please Contact Us. We will consider all requests to remove links but will have no obligation to do so.
\n\nWithout prior approval and express written permission, you may not create frames around our web pages or use other techniques that alter in any way the visual presentation or appearance of our website.
\n\nIntechOpen may revise its Terms of Service for its website at any time without notice. By using this website, you are agreeing to be bound by the current version of all Terms at the time of use.
\n\nThese Terms and Conditions are governed by and construed in accordance with the laws of the United Kingdom and you irrevocably submit to the exclusive jurisdiction of the courts in London, United Kingdom.
\n\nCroatian version of Terms and Conditions available here
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The understanding was included to the literature as personnel management at the beginning of the twentieth century and it turned into an approach as human resources management in the 1980s. It could be observed that many organizations, which deem the human as the most critical stakeholder, adopt a traditional way of personnel management in operating human resources. The employees play a key role in the success of an organization. For this reason, subjects such as recruitment, training, development, career management, performance appraisal, occupational health, and safety are the fundamental functions of human resources management. The study examines to what extent these roles are evaluated through a case study. The subject matter of the study is the most powerful culture and art foundation in Turkey. Compared to many other nonprofit organizations, the foundation actively performs a variety of services within a year worldwide. 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Social marketing strategies can also be used to promote behavioral change and help individuals transform their lives, achieve well-being, and adopt prosocial behaviors. In this chapter, we seek to analyze with a netnographic study, how SNS are being employed by nonprofits and nongovernment organizations (NGOs) to enable citizens and consumers to participate in different programs and activities that promote social transformation and well-being. A particular interest is to identify how organizations are using behavioral economic tactics to nudge individuals and motivate them to engage in prosocial actions. By providing an understanding on how SNS can provide an adequate environment for the design of social marketing strategies, we believe our work has practical implications both for academicians and marketers who want to contribute in the transformation of consumer behavior and the achievement of well-being and social change.",book:{id:"6583",slug:"marketing",title:"Marketing",fullTitle:"Marketing"},signatures:"Alicia De La Pena",authors:[{id:"196878",title:"Dr.",name:"Alicia",middleName:null,surname:"De La Pena",slug:"alicia-de-la-pena",fullName:"Alicia De La Pena"}]}],onlineFirstChaptersFilter:{topicId:"4",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82382",title:"A Cultural Approach in the Synchronous Class in English Teaching and Learning",slug:"a-cultural-approach-in-the-synchronous-class-in-english-teaching-and-learning",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.105553",abstract:"If culture is defined as a way of training to obtain knowledge through educational channels, the concept is associated with educability. Therefore, teaching cognitive, attitudinal, and procedural knowledge directly indicates teaching and learning culture to acquire norms and patterns of sociocultural behavior. The purpose of this study was: to debate about the way interaction among students and teachers in synchronous classes based on life’s materials, topics, and methods, and critical or reflective thinking can be adapted by the teacher to the students’ closest environment to communicate in English as an international language. If a language is taught, spoken, and learned in the country, culture surrounding the context is taught. If this language is not spoken in the place, the knowledge system also transmits norms and values, different from those of the language. So, the students get, culturally and socially, modes of action, principles, and knowledge through international language learning. Thus, teaching and learning English as an international language means the way possible interaction has opportunities for every student’s growth and the way their personality formation gets integral results. English taught and learned as an international language denotes reaching the students’ world and needs to communicate in English as a meaningful international language.",book:{id:"10662",title:"Pedagogy - Challenges, Recent Advances, New Perspectives, and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10662.jpg"},signatures:"Ned Vito Quevedo Arnaiz, Nemis García Arias and Fredy Pablo Cañizares Galarza"},{id:"82470",title:"The Effect of COVID-19 on the Quality of Life of Care Workers: Challenges for Social Services Leaders",slug:"the-effect-of-covid-19-on-the-quality-of-life-of-care-workers-challenges-for-social-services-leaders",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.105603",abstract:"Stressful situations are likely to impact health and social care workers’ quality of life negatively. Indeed, mental, physical, and emotional health problems have been reported in relation to the effects of the COVID-19 pandemic on the quality of life of health care workers. Instead of health care workers’ reality, and despite the care sector’s relevance, studies of the effects of COVID-19 on the quality of life of care workers have not been sufficiently explored. Recognizing the effect of COVID on the quality of life of care workers will collaborate with leaders of organizations, social work practitioners, and academics in the design of policies that promote better working conditions. Therefore, during 2021, a study was carried out in Chile where 150 social services and care workers were surveyed in Chile using a version of COV19-QoL in Spanish. The impact of COVID on quality of life is described, and the challenges that this reality implies to social service leaders are presented.",book:{id:"11095",title:"Social Work - Perspectives on Leadership and Organisation",coverURL:"https://cdn.intechopen.com/books/images_new/11095.jpg"},signatures:"Magdalena Calderón-Orellana, Alejandra Inostroza and Paula Miranda Sánchez"},{id:"82448",title:"Virus World Vulnerability: A Critical Reading of Gender and Performance in Bo Burnham’s “Inside” (2021)",slug:"virus-world-vulnerability-a-critical-reading-of-gender-and-performance-in-bo-burnham-s-inside-2021",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.105182",abstract:"Through an engagement with the seminal work of Raewyn Connell on masculinities and hegemonic masculinity, this chapter argues for the hegemonic norm as producing behaviour among men that can be traced in multiple male subjectivities. The argument is that men respond to the prevailing masculine norm by enacting self-protective disavowal—a complex psychological process that involves the reordering of reality in the interests of the maintenance of power, and one that is seen in cases of both legitimate and imagined threats to the self and the body. Self-protective disavowal is at the core of the Same Shit phenomenon—the idea that while the experience of masculinity varies across culture and position in the gender order, self-protective disavowal is a constant that leads to predicable patterns among men. The discussion then explores deliberate vulnerability as a kind of anti-protective disavowal in Bo Burnham’s INSIDE, a complex, undefinable ‘special’ released on Netflix in 2021. The chapter considers Burnham’s work as a departure from self-protective disavowal and Same Shit masculinity through deliberate vulnerability and critically evaluates the value of this alternative, especially given the nihilism that reigns over the work and calls into question the validity of uncritically romanticization of alternatives.",book:{id:"10540",title:"Masculinity Studies - An Interdisciplinary Approach",coverURL:"https://cdn.intechopen.com/books/images_new/10540.jpg"},signatures:"Chris McWade"},{id:"82454",title:"Prospects and Pitfalls Experienced by Social Workers Working in a Confounding Environment in a South African Setting",slug:"prospects-and-pitfalls-experienced-by-social-workers-working-in-a-confounding-environment-in-a-south",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.105604",abstract:"While social workers are professionally and aptly placed to facilitate a turn-around environment rife with a conglomeration of challenges such as poverty, ignorance, and diseases, the chapter discusses the developmental prospects and pitfalls that confound their practice in South Africa. Opportunely, social work interventions continue to gain developmental mileage through increased training of social workers, their increased deployment in various versatile domains of social and economic development and increased widening of the scope of social work research, especially current research in fields such as HIV/AIDS and coronavirus. On the other side of the coin, the chapter discusses social work pitfalls attributed to professional curricular gaps as social work continue to follow a western-centric curriculum; the presence of various metaphysical beliefs and myths that weaken or derail social work interventions and a weaker research environment to offer a plausible and timely solution to the prevalent problems. The chapter concludes by calling for a paradigm shift in the social work curriculum as well as its indigenization to productively respond to the South African socio-cultural and geographical milieu.",book:{id:"11095",title:"Social Work - Perspectives on Leadership and Organisation",coverURL:"https://cdn.intechopen.com/books/images_new/11095.jpg"},signatures:"Simon Murote Kang’ethe"},{id:"82425",title:"Financial Reporting and Analysis of Tesla Green Technology in the United States Market",slug:"financial-reporting-and-analysis-of-tesla-green-technology-in-the-united-states-market",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.105065",abstract:"This study aims to discuss and analyze the financial position and performance of the US Tesla green technology company in the United States. This study uses a case study approach, financial data, and website methodologies to collect and analyze the research data. The case study is Tesla, Inc., which is a US electric vehicle and clean energy company based in Austin, Texas. Tesla is a green technology company that produces and designs electric cars, battery energy storage from home to grid-scale, solar roof tiles and solar panels, and related products and services. Tesla is growing fastly by introducing new green products, and it is now one of the world’s most valuable enterprises. It has a high market capitalization of almost US$1 trillion to become the world’s most valuable automaker. This study concludes that Tesla has changed their strategy to become the most worldwide sales of purely battery electric vehicles, capturing 23% of the market and 16% of the plug-in electric battery in the market for 2020. It has also developed a significant installer of photovoltaic systems through its subsidiary Tesla Energy in the United States. One of the largest global battery energy-storage systems suppliers is Tesla Energy, with 3.99 gigawatt-hours installed in 2021.",book:{id:"11251",title:"Banking and Accounting",coverURL:"https://cdn.intechopen.com/books/images_new/11251.jpg"},signatures:"Nizar Mohammad Alsharari"},{id:"82427",title:"Our Globalization Era among Success, Obstacles and Doubts",slug:"our-globalization-era-among-success-obstacles-and-doubts",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.105545",abstract:"In the last decades, the never-ending and unlimited expanding of both international economies and operations became globalization. Among its main features, one could recall the enormous increase of world macro-economic quantities (Gross World Product, Inter-continental Trade, FDI), as well as financial values (public debts and currency printing). The chapter tries to quantify them, by a statistical analysis of historical data (Section 1). Section 2 is dedicated to the strategic problems of firms, in particular the threats and opportunities for (inter) national firms willing to become global, and obstacles are included in Section 3. This given, it deals with the behavior of countries from the political and juridical points of view, and those ones passed form initial perplexities, distaste, or even hostility to a favorable behavior. Conclusions (Section 4) recall both the problematic alternative for globalized companies between “the world as our next door” and their social responsibilities and the similar problem for host countries, between socioeconomic advantages and protection of local workers, resources, and environment.",book:{id:"11476",title:"Globalization and Sustainability - Recent Advances, New Perspectives and Emerging Issues",coverURL:"https://cdn.intechopen.com/books/images_new/11476.jpg"},signatures:"Arnaldo Canziani, Annalisa Baldissera and Ahmad Kahwaji"}],onlineFirstChaptersTotal:282},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:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"June 11th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). 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He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. His research interests include intelligent and embedded systems.",institutionString:"Universidad Autonoma de Queretaro",institution:{name:"Autonomous University of Queretaro",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"27",title:"Multi-Agent Systems",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",isOpenForSubmission:!0,editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",slug:"mehmet-aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",biography:"Dr. Mehmet Emin Aydin is a Senior Lecturer with the Department of Computer Science and Creative Technology, the University of the West of England, Bristol, UK. His research interests include swarm intelligence, parallel and distributed metaheuristics, machine learning, intelligent agents and multi-agent systems, resource planning, scheduling and optimization, combinatorial optimization. Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. He has served as guest editor for a number of special issues of peer-reviewed international journals.",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:19,paginationItems:[{id:"82196",title:"Multi-Features Assisted Age Invariant Face Recognition and Retrieval Using CNN with Scale Invariant Heat Kernel Signature",doi:"10.5772/intechopen.104944",signatures:"Kamarajugadda Kishore Kumar and Movva Pavani",slug:"multi-features-assisted-age-invariant-face-recognition-and-retrieval-using-cnn-with-scale-invariant-",totalDownloads:6,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Pattern Recognition - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/11442.jpg",subseries:{id:"26",title:"Machine Learning and Data Mining"}}},{id:"82063",title:"Evaluating Similarities and Differences between Machine Learning and Traditional Statistical Modeling in Healthcare Analytics",doi:"10.5772/intechopen.105116",signatures:"Michele Bennett, Ewa J. 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(Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. 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He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. 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He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. 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He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. 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He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}},{id:"441116",title:"Dr.",name:"Jovanka M.",middleName:null,surname:"Voyich",slug:"jovanka-m.-voyich",fullName:"Jovanka M. 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The emergence of any viral disease is hard to anticipate, which often contributes to death. A viral disease can be defined as an infectious disease that has recently appeared within a population or exists in nature with the rapid expansion of incident or geographic range. This series will focus on various crucial factors related to emerging viral infectious diseases, including epidemiology, pathogenesis, host immune response, clinical manifestations, diagnosis, treatment, and clinical recommendations for managing viral infectious diseases, highlighting the recent issues with future directions for effective therapeutic strategies.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11402,editor:{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. 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