Preoperative patient-related risk factors for conversion of laparoscopic cholecystectomy to open surgery.
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"9444",leadTitle:null,fullTitle:"Ischemic Stroke",title:"Ischemic Stroke",subtitle:null,reviewType:"peer-reviewed",abstract:"Stroke continues to be a major public health issue. It is the third leading cause of death and disability across the globe. Its early identification and treatment along with prevention are major issues that confront a treating physician. We have understood the importance of early intervention and of the quote ‘time is brain’. Our endeavor now should be directed to the public at large and paramedics in particular. Although a stroke is a common condition, the availability of neurologists or stroke specialists is quite scarce. Today, management of a suspected case of stroke is done by a specialist team of medical and paramedical personnel. Advances in imaging, newer therapeutic agents, and endovascular management have revolutionized the management. Currently, we are witnessing a new era in the management of strokes and I am hopeful that continued research will get us to a satisfactory solution. This book along with another book from IntechOpen titled ‘Ischemic Stroke of Brain’ aims to improve the understanding of stroke medicine for postgraduate medical students in medicine and neurology who have an interest in stroke care.",isbn:"978-1-83962-395-0",printIsbn:"978-1-83962-394-3",pdfIsbn:"978-1-83962-396-7",doi:"10.5772/intechopen.86623",price:119,priceEur:129,priceUsd:155,slug:"ischemic-stroke",numberOfPages:130,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"a24752137cbc5f228a3479e02a6a3d10",bookSignature:"Pratap Sanchetee",publishedDate:"March 24th 2021",coverURL:"https://cdn.intechopen.com/books/images_new/9444.jpg",numberOfDownloads:4543,numberOfWosCitations:0,numberOfCrossrefCitations:4,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:7,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:11,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 26th 2019",dateEndSecondStepPublish:"March 3rd 2020",dateEndThirdStepPublish:"May 2nd 2020",dateEndFourthStepPublish:"July 21st 2020",dateEndFifthStepPublish:"September 19th 2020",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"206518",title:"Dr.",name:"Pratap",middleName:null,surname:"Sanchetee",slug:"pratap-sanchetee",fullName:"Pratap Sanchetee",profilePictureURL:"https://mts.intechopen.com/storage/users/206518/images/system/206518.jpg",biography:"Dr. Pratap Sanchetee is a first batch alumnus of Dr. SN Medical College, Jodhpur, and achieved his MBBS in 1970. Subsequently, he received his MD diploma (Medicine) from the University of Rajasthan in 1974, and DM (Neurology) from the Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh in 1985. He served in the Armed Forces India as a Physician and Neurologist for 24 years and retired as Lt Col in 1998. From 1994 to 1998, he also served as an Associate Professor, Armed Forces Medical College, Pune. He was awarded Chief of Army Staff’s Commendation in 1980. Since 1998, he has been pursuing clinical practice in neurology at various hospitals at Jodhpur and at Guwahati Assam. He has been a Visiting Professor, Ph.D. guide, and advisor to Jain Visva Bharti University (JVBI) and Bhagwan Mahaveer International Research Centre (BMIRC), Ladnun, Rajasthan since 2009. He is a Director of Research at the Spiritual Training Research Foundation (STRF), Mumbai, India. His areas of active interest are the mind as an interface between soul and body, meditation and the brain, and delivery of neurology care in society. Dr. Sanchetee has a life membership of 9 national associations. He is the editor of four books and has published 112 original papers, chapters, and review articles in national and international journals. He is currently the Chairperson of the 'Tropical Neurology Subsection' of the Indian Academy of Neurology. He regularly participates in national and international conferences and presents academic papers. He was an executive editor of the Medical Journal Armed Forces India and Journal of Indian Academy of Geriatrics.",institutionString:"Sanchetee Hospital & Research Institute",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"2",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1056",title:"Neurology",slug:"neurology"}],chapters:[{id:"74822",title:"Current Trends in Stroke Rehabilitation",doi:"10.5772/intechopen.95576",slug:"current-trends-in-stroke-rehabilitation",totalDownloads:746,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Stroke remains a leading cause of adult disability. The social, physical and psychological consequences of stroke are devastating. With better understanding of causation and breakthrough advances in management, we are witnessing a greater population of stroke survivors with varying neurological and functional deficits. Poststroke rehabilitation is a multi-disciplinary and multi-modal endeavor and not a ‘one size fits all’ intervention. A combination of interventions may be better suited to treat motor and sensory impairments, cognitive problems and psychological issues. There is great interest in exploring novel rehabilitation technologies to augment conventional therapies to reduce neurological disability and improve function. Yoga and spirituality, though ancient practices, are finding a bigger role in field of rehabilitation. In spite of good potentials for recovery, these rehabilitative measures are underutilized and major barriers are limited availability, geographical distance, high cost and lack of awareness about its benefits. While conventional measures are well engraved, this article review the recent concepts in stroke rehabilitation.",signatures:"Pratap Sanchetee",downloadPdfUrl:"/chapter/pdf-download/74822",previewPdfUrl:"/chapter/pdf-preview/74822",authors:[{id:"206518",title:"Dr.",name:"Pratap",surname:"Sanchetee",slug:"pratap-sanchetee",fullName:"Pratap Sanchetee"}],corrections:null},{id:"72380",title:"Ischemic Stroke in Young Adults: Practical Diagnosis Guide",doi:"10.5772/intechopen.92671",slug:"ischemic-stroke-in-young-adults-practical-diagnosis-guide",totalDownloads:1078,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"With its increasing incidence in younger population and as a leading cause of disability, ischemic stroke represents a real public health problem. This chapter aims to evaluate the most common risk factors and causes for ischemic stroke in the young. Though some are identical to those found in older patients, most of them are specific to this population segment. Furthermore, another objective is to provide some guidance in approaching the case based on some important clinical clues. Due to the lack of universal management guidelines, it is up to the physician to judge the particularities of each case and to carry out the variety of investigations necessary for determining the cause.",signatures:"Diana Mihai, Florentina Cristina Plesa, Any Docu Axelerad, Alice Munteanu, Minerva Claudia Ghinescu and Carmen Adella Sirbu",downloadPdfUrl:"/chapter/pdf-download/72380",previewPdfUrl:"/chapter/pdf-preview/72380",authors:[{id:"318289",title:"Associate Prof.",name:"Carmen",surname:"Adella Sirbu",slug:"carmen-adella-sirbu",fullName:"Carmen Adella Sirbu"},{id:"318767",title:"Ms.",name:"Diana",surname:"Mihai",slug:"diana-mihai",fullName:"Diana Mihai"},{id:"320565",title:"Dr.",name:"Cristina Florentina",surname:"Plesa",slug:"cristina-florentina-plesa",fullName:"Cristina Florentina Plesa"},{id:"320566",title:"Dr.",name:"Any Docu",surname:"Axelerad",slug:"any-docu-axelerad",fullName:"Any Docu Axelerad"},{id:"320567",title:"Dr.",name:"Alice Elena",surname:"Munteanu",slug:"alice-elena-munteanu",fullName:"Alice Elena Munteanu"},{id:"320568",title:"Dr.",name:"Claudia Minerva",surname:"Ghinescu",slug:"claudia-minerva-ghinescu",fullName:"Claudia Minerva Ghinescu"}],corrections:null},{id:"72351",title:"Vascular Aphasias",doi:"10.5772/intechopen.92691",slug:"vascular-aphasias",totalDownloads:720,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Aphasia represents an acquired central disorder of language that impairs a person’s ability to understand and/or produce spoken and written language, caused by lesions situated usually in the dominant (left) cerebral hemisphere, in right-handed persons. Aphasia has a prevalence of 25–30% in acute ischemic stroke (vascular aphasia). It is considered as an important stroke severity marker, being associated with a higher risk of mortality, poor functional prognosis, and augmented risk of vascular dementia. The assessment of aphasias in clinical practice is based on classical analysis of oral production and comprehension. The language disturbances are frequently combined into aphasic syndromes which are components of different vascular syndromes that may evolve/involve rapidly at the acute stage of ischemic stroke. The main determinant of the type of vascular aphasia is the infarct location (especially left middle cerebral artery territory). Recent studies at the hyperacute stage of ischemic stroke have observed features of aphasia, have reanalyzed its neuroanatomy using new imaging techniques, and have shown that aphasias have a parallel course to that of cortico-subcortical hypoperfusion. Thus, the reversal of hypoperfusion, following recanalization (spontaneous or secondary to thrombolysis or thrombectomy), is associated with resolution of aphasia. Speech therapy is needed as soon as permitted by clinical condition.",signatures:"Dragoș Cătălin Jianu, Silviana Nina Jianu, Ligia Petrica, Traian Flavius Dan and Georgiana Munteanu",downloadPdfUrl:"/chapter/pdf-download/72351",previewPdfUrl:"/chapter/pdf-preview/72351",authors:[{id:"45925",title:"Prof.",name:"Dragoș",surname:"Cătălin Jianu",slug:"dragos-catalin-jianu",fullName:"Dragoș Cătălin Jianu"},{id:"55071",title:"Dr.",name:"Silviana Nina",surname:"Jianu",slug:"silviana-nina-jianu",fullName:"Silviana Nina Jianu"},{id:"241849",title:"Dr.",name:"Traian Flavius",surname:"Dan",slug:"traian-flavius-dan",fullName:"Traian Flavius Dan"},{id:"241852",title:"Dr.",name:"Georgiana",surname:"Munteanu",slug:"georgiana-munteanu",fullName:"Georgiana Munteanu"},{id:"318785",title:"Prof.",name:"Ligia",surname:"Petrica",slug:"ligia-petrica",fullName:"Ligia Petrica"}],corrections:null},{id:"72708",title:"Telestroke: A New Paradigm",doi:"10.5772/intechopen.92831",slug:"telestroke-a-new-paradigm",totalDownloads:646,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Stroke is one of the leading causes of death and disability across the world. With the development of new modalities of treatment, including the use of intravenous tissue plasminogen activator and mechanical thrombectomy, clinical outcomes have improved in patients with acute ischemic strokes. However, these interventions are time dependent, and there exists a great disparity between the rural and urban parts of the world in terms of the availability of neurologists and these lifesaving treatment options. Telestroke networks utilize digital technology for two-way, high-resolution video teleconferencing to help abate these disparities by bringing safe, efficient, and cost-effective care to underserved communities in the United States and around the world.",signatures:"Rohan Sharma, Krishna Nalleballe, Nidhi Kapoor, Vasuki Dandu, Karthika Veerapaneni, Sisira Yadala, Madhu Jasti, Suman Siddamreddy, Sanjeeva Onteddu and Aliza Brown",downloadPdfUrl:"/chapter/pdf-download/72708",previewPdfUrl:"/chapter/pdf-preview/72708",authors:[{id:"319857",title:"Ph.D.",name:"Aliza",surname:"Brown",slug:"aliza-brown",fullName:"Aliza Brown"},{id:"319923",title:"Dr.",name:"Krishna",surname:"Nalleballe",slug:"krishna-nalleballe",fullName:"Krishna Nalleballe"},{id:"320987",title:"Dr.",name:"Rohan",surname:"Sharma",slug:"rohan-sharma",fullName:"Rohan Sharma"},{id:"320988",title:"Dr.",name:"Nidhi",surname:"Kapoor",slug:"nidhi-kapoor",fullName:"Nidhi Kapoor"},{id:"320989",title:"Dr.",name:"Karthika",surname:"Veerapaneni",slug:"karthika-veerapaneni",fullName:"Karthika Veerapaneni"},{id:"320990",title:"Dr.",name:"Sisira",surname:"Yadala",slug:"sisira-yadala",fullName:"Sisira Yadala"},{id:"320991",title:"Dr.",name:"Sanjeeva",surname:"Onteddu",slug:"sanjeeva-onteddu",fullName:"Sanjeeva Onteddu"},{id:"320992",title:"Dr.",name:"Vasuki",surname:"Dandu",slug:"vasuki-dandu",fullName:"Vasuki Dandu"},{id:"320994",title:"Dr.",name:"Madhu",surname:"Jasti",slug:"madhu-jasti",fullName:"Madhu Jasti"},{id:"320995",title:"Dr.",name:"Suman",surname:"Siddamreddy",slug:"suman-siddamreddy",fullName:"Suman Siddamreddy"}],corrections:null},{id:"72501",title:"The Treatment of Acute Stroke",doi:"10.5772/intechopen.92763",slug:"the-treatment-of-acute-stroke",totalDownloads:687,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Stroke is a major public health issue, because of its high incidence rate, high case fatality rate, risk of residual physical and neuropsychological disabilities, and direct and indirect costs. Many strokes are preventable and treatable in the acute stage, provided that patients are admitted soon enough. The term stroke covers a wide range of heterogeneous disorders, depending on the severity of the clinical presentation, from transient deficits to severe cases with coma and early death; the underlying mechanism, i.e., cerebral ischemia, parenchymal hemorrhage, subdural hemorrhage, or subarachnoid hemorrhage (SAH); and the cause, i.e., atherosclerosis, cardioembolism, small-vessel occlusion, rare vasculopathies and undetermined causes in cerebral ischemia, or vascular malformations, cerebral amyloid angiopathies, small-vessel diseases, rare vasculopathies and undetermined causes in parenchymal hemorrhages. This chapter will focus only on acute cerebral ischemia and parenchymal hemorrhage. We will cover the general assessment of stroke patients, the complications that can occur in the acute stage, the treatment of acute stroke, and finally a few situations that require specific managements and where evidence-based data are scarce.",signatures:"Irina Alexandrovna Savvina and Anna Olegovna Petrova",downloadPdfUrl:"/chapter/pdf-download/72501",previewPdfUrl:"/chapter/pdf-preview/72501",authors:[{id:"318757",title:"Associate Prof.",name:"Irina Alexandrovna",surname:"Savvina",slug:"irina-alexandrovna-savvina",fullName:"Irina Alexandrovna Savvina"},{id:"319118",title:"Dr.",name:"Anna Olegovna",surname:"Petrova",slug:"anna-olegovna-petrova",fullName:"Anna Olegovna Petrova"}],corrections:null},{id:"70917",title:"Vinpocetine and Ischemic Stroke",doi:"10.5772/intechopen.90551",slug:"vinpocetine-and-ischemic-stroke",totalDownloads:667,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:1,abstract:"Vinpocetine (VPN) is a synthetic ethyl-ester derivative of the alkaloid apovincamine from Vinca minor leaves. VPN is a selective inhibitor of phosphodiesterase type 1 (PDE1) has potential neurological effects through inhibition of voltage gated sodium channel and reduction of neuronal calcium influx. VPN have noteworthy antioxidant, anti-inflammatory and anti-apoptotic effects with inhibitory effect on glial and astrocyte cells during and following ischemic stroke (IS). VPN is effective as an adjuvant therapy in the management of epilepsy; it reduces seizure frequency by 50% in a dose of 2 mg/kg/day. VPN improves psychomotor performances through modulation of brain monoamine pathway mainly on dopamine and serotonin, which play an integral role in attenuation of depressive symptoms. VPN recover cognitive functions and spatial memory through inhibition of hippocampal and cortical PDE-1with augmentation of cAMP/cGMP ratio, enhancement of cholinergic neurotransmission and inhibition of neuronal inflammatory mediators. Therefore, VPN is an effective agent in the management of ischemic stroke and plays an integral role in the prevention and attenuation of post-stroke epilepsy, depression and cognitive deficit through direct cAMP/cGMP-dependent pathway or indirectly through anti-inflammatory and anti-oxidant effects.",signatures:"Hayder M. Al-kuraishy and Ali I. Al-Gareeb",downloadPdfUrl:"/chapter/pdf-download/70917",previewPdfUrl:"/chapter/pdf-preview/70917",authors:[{id:"306350",title:"Prof.",name:"Hayder M.",surname:"Al-kuraishy",slug:"hayder-m.-al-kuraishy",fullName:"Hayder M. Al-kuraishy"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6789",title:"Ischemic Stroke of Brain",subtitle:null,isOpenForSubmission:!1,hash:"c63002a8b0e07111f925c3e8b313d721",slug:"ischemic-stroke-of-brain",bookSignature:"Pratap Sanchetee",coverURL:"https://cdn.intechopen.com/books/images_new/6789.jpg",editedByType:"Edited by",editors:[{id:"206518",title:"Dr.",name:"Pratap",surname:"Sanchetee",slug:"pratap-sanchetee",fullName:"Pratap Sanchetee"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"745",title:"Neurodegenerative Diseases",subtitle:"Processes, Prevention, Protection and 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In the United States, an estimated 11.8 million people aged between 20 and 74 years have gallbladder (GB) stones [3]. Yearly approximately 1–2% of patients with silent gallstones develop symptoms and require treatment (Figure 1) [4–6]. Acute cholecystitis (AC) accounts for 20% of patients presented to hospital with right upper quadrant pain, which in patients with significant co-morbidities and in the elderly is associated with 2–3% mortality [5, 7, 8]. In the United States, in 2009, cholecystitis was the underlying cause of death in 2009 patients and a contributing cause of death in 3295 patients accounting for a mortality crude rate of 0.7 per 100,000 patients [9]. In the same country, GB disease is one of the most common inpatient diagnosis that accounts for more than 260,000 hospital admissions and annual health care provider expenditure exceeding $3.03 billion [9].
\nLife-table analysis of the outcome of silent gallstone disease. The fractions along the abscissa show the number of people developing biliary pain over the number at risk (adapted from Gracie and Ransohoff [
Laparoscopic cholecystectomy (LC) is considered as the “gold standard” surgical technique for treatment of GB disease [10]. Conversion of LC to open surgery (CTO) is used to prevent intra-abdominal organ injury (IOI), for common bile duct (CBD) exploration and to repair IOI.
\nThe aim of this chapter is to review risk factors and predictive models for CTO, and surgical quality outcome measures.
\nLC is the minimally invasive surgical operation that was introduced in clinical practice by Erich Muehe of Boeblingen, Germany, in 1985 [11]. LC can be performed with the conventional four-port or three-port technique.
\nCompared to the conventional open cholecystectomy (OC), LC has decreased post-operative pain, decreased respiratory function dysfunction, reduced post-operative ileus, earlier oral fluid and food intake, better cosmesis, reduced patient’s hospital stay, fastened post-operative recovery and lowered morbidity and mortality [12–14].
\nA meta-analysis comparing LC with the small-incision OC (the length of incision of less than 8 cm) demonstrated that both techniques had similar rates of mortality; intraoperative, minor and severe post-operative complications (without bile duct injuries, BDI); BDI; total complications; and post-operative convalescence [15]. A subgroup analysis of high-quality trials showed a shorter operative time for the small-incision OC than LC (weighted mean difference, random effects 16.4 min, 95% CI: 8.9–23.8 min) [15]. Compared with the small-incision OC, the self-reported quality of life up to 30 days after LC is higher; 2326 (95% CI: 2187–2391) and 2411 (95% CI: 2334–2502), respectively,
Main disadvantages of LC compared to the conventional OC and small-incision OC are a lack of a three-dimensional view, narrow field of laparoscopic vision, inconvenience with liver retraction, insufficient tactile sensations due to manipulation with long laparoscopic instruments and difficulties with instruments placement and manoeuvring [17–19].
\nAnother significant limitation of LC is an increased risk of IOI, including bile duct injury (BDI) [20, 21]. In the United States, approximately 750,000 LCs are performed annually [22]. With the incidence of major BDI during LC fluctuating between 0.4 and 2%, it is expected that 3000 to 15,000 patients will suffer from iatrogenic BDI [21, 23, 24]. Major BDI is associated with significant morbidity, mortality and socioeconomic burden [21].
\nThe primary indication for CTO is to prevent IOI. CTO can also be used for CBD exploration, to repair cholecysto-intestinal fistula and to perform an extended OC in patients with gallbladder cancer. In addition, CTO is performed to control haemorrhage and repair single or multiple IOI [25, 26].
\nCompared to LC, CTO is associated with an increased morbidity and mortality. A clinical audit of 7242 LCs for AC performed in the United States between 2005 and 2011 showed that compared to the LC group, patients who underwent CTO had higher rates of surgical site infection (1.8 versus 9.2%,
As high rate of CTO and IOI can diminish clinical benefits and cost-effectiveness of LC, identification of preoperative and intraoperative patient-dependent and surgeon-related risk factors for CTO can be used for development of risk stratification models and refinement of the management. This will keep CTO at low rates and maintain benefits of minimally invasive GB surgery.
\nPreoperative patient-related risk factors for CTO have been extensively investigated and identified. In previous studies, the advanced age has been shown to be a risk factor for CTO [25, 27, 28]. In a meta-analysis, Yang et al. demonstrated that age >65 years is associated with a twofold increase in CTO rate (odds ratio (OR) = 1.8; 95% confidence interval (CI): 1.4–2.5;
Preoperative patient-related risk factors for CTO | \nOR | \n95 CI | \nReferences | \n|
---|---|---|---|---|
Advanced age (>65 years) | \n1.8 | \n1.4–2.5 | \n<0.0001 | \n[29] | \n
Male | \n2.8 | \n1.1–6.6 | \n0.037 | \n[32] | \n
Clinical diagnosis of AC | \n8 | \n6.1–10.5 | \n<0.00005 | \n[35] | \n
Duration of AC >72 h | \n3.1 | \n1.2–7.7 | \n0.0072 | \n[37] | \n
Repeated attacks of AC, 2 | \n7.9 | \n1.5–76.8 | \n<0.0052 | \n[41] | \n
Diabetes mellitus | \n2.5 | \n1.3–4.4 | \n0.003 | \n[43] | \n
Obesity, BMI >30 kg/m2 | \n7.6 | \n4.1–14 | \n<0.001 | \n[52] | \n
Previous upper abdominal surgery | \n20.4 | \n2.4–927.4 | \n0.0007 | \n[50] | \n
Post-ERC/ES, 16 weeks | \n3 | \n1.2–7.4 | \n0.009 | \n[57] | \n
WCC 11 109/L | \n4 | \n2.5–6.1 | \n<0.00005 | \n[25] | \n
Elevated CRP, 10 mg/L | \n1.05 | \n1.01–1.09 | \n0.014 | \n[37] | \n
Elevated total bilirubin | \n6.5 | \n4.1–10.2 | \n<0.00005 | \n[64] | \n
Alkaline phosphatase (>135 U/L) | \n7 | \n3.6–14 | \n<0.00001 | \n[52] | \n
Gallbladder wall thickness, mm | \n2 | \n1.7–2.3 | \n<0.00005 | \n[52] | \n
Pericholecystic fluid on US | \n26 | \n5.0–166.1 | \n<0.00005 | \n[41] | \n
ASA score >2 | \n2.5 | \n1.3–4.6 | \n0.004 | \n[66] | \n
Preoperative patient-related risk factors for conversion of laparoscopic cholecystectomy to open surgery.
A. Local signs of inflammation, etc.: | \n
(1) Murphy’s sign, (2) RUQ mass/pain/tenderness | \n
B. Systemic signs of inflammation, etc.: | \n
(1) Fever, (2) raised WCC, (3) elevated CRP | \n
C. Imaging findings: imaging findings characteristic of acute cholecystitis | \n
(1) Trans-abdominal ultrasound findings: | \n
Positive sonographic Murphy sign (ultrasound transducer elicited tenderness on gentle pressure over the gallbladder | \n
Thickened gallbladder wall (>4 mm, provided there is no congestive heart failure, chronic liver disease and ascites) | \n
Marked distension of the gallbladder (long axis diameter >80 mm, short axis diameter >40 mm) | \n
Gallstone impacted in Hartman’s pouch; biliary sludge, pericholecystic fluid collection | \n
Sonolucent halo in the gallbladder wall | \n
(2) CT findings: | \n
Gallbladder distension | \n
Gallbladder subserosal oedema | \n
Gallbladder wall thickening | \n
Pericholecystic stranding, fluid collection | \n
(3) Magnetic resonance imaging findings: | \n
Cystic duct stone | \n
Intraluminal sludge | \n
Pericholecystic high signal | \n
Gallbladder distension | \n
Gallbladder wall thickening, abnormal signal intensity and oedematous stratification | \n
(4) Tc-HIDA scan findings: | \n
Non-visualized gallbladder within 1 h | \n
“Rim sign” (increased pericholecystic hepatic radioactivity) | \n
Suspected diagnosis: One item in A + one item in B | \n
Definite diagnosis: One item in A + one item in B + C | \n
The 2013 Tokyo guidelines diagnostic criteria for acute cholecystitis (modified from Yokoe et al. [34]).
Male gender is a well-recognized risk factor for difficult LC and CTO [18, 25, 28, 29]. Males have more prominent adhesions between the GB and the omentum and surrounding internal organs, have a higher proportion of severe forms of AC on histological examination of the GB, have a higher CTO rate and require a longer operation time [31]. Two-stage LC male patients have a three times higher rate of CTO (OR = 2.8; 95% CI: 1.1–6.6,
Patients with the clinical diagnosis of AC and higher severity grades of AC carry more chances of CTO [25, 33, 34]. Diagnostic criteria for AC are presented in Table 2 [34]. AC patients have eight times higher risk of CTO than patients with uncomplicated gallstone disease (OR = 8.01; 95% CI: 6.1–10.5;
Grade I (mild) acute cholecystitis | \n
Does not meet the criteria of “grade III” or “grade II” acute cholecystitis. Grade I can also be defined as acute cholecystitis in a healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder, making cholecystectomy a safe and low-risk operative procedure | \n
Moderate (grade II) acute cholecystitis | \n
Grade II (moderate) acute cholecystitis | \n
Associated with any one of the following conditions: | \n
1. Elevated white cell count (>18,000/mm3) | \n
2. Palpable tender mass in the right upper quadrant | \n
3. Duration of complaints > 72 h | \n
4. Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis) | \n
Grade III (severe) acute cholecystitis | \n
Associated with dysfunction of any one of the following organs/systems: | \n
1. Cardiovascular dysfunction (hypotension requiring treatment with dopamine ≥5 mcg/kg/min, or any dose of norepinephrine) | \n
2. Neurological dysfunction (decreased level of consciousness) | \n
3. Respiratory dysfunction (PaO2/FiO2 ratio <300) | \n
4. Renal dysfunction (oliguria, creatinine >2.0 mg/dL) | \n
5. Hepatic dysfunction (PT-INR >1.5) | \n
6. Haematological dysfunction (platelet count <100,000/mm3) | \n
The 2013 Tokyo guidelines severity grading for acute cholecystitis (adapted from Yokoe et al. [34]).
The longer the duration of untreated AC, the greater is the risk for CTO [27]. Asai et al. showed that 12 of 29 (41.4%) patients in the CTO group and 36 of 196 (18.4%) patients in LC group had symptoms of AC for longer than 72 h (
Repeated attacks of AC are associated with difficult LC and CTO [38–40]. When compared to AC patients with less than two previous episodes, patients with at least two past attacks of AC have an eightfold increase in the difficulty of LC (OR = 7.9; 95% CI: 3.4–18.2;
Diabetes mellitus (DM) has been consistently shown to be associated with CTO [18, 25, 42]. Diabetics undergoing LC have a 2.5 times higher risk for CTO than nondiabetic patients (OR = 2.5; 95% CI: 1.3–4.4,
Obesity (body mass index (BMI) > 30 kg/m2) is not only a risk factor for CTO but also associated with major BDI [18, 28, 50, 51]. Obese patients undergoing LC have an eightfold higher risk of CTO than non-obese patients (OR = 7.6; 95% CI: 4.1–14;
Previous surgery above the umbilicus is a risk factor for CTO [52, 54]. In Lee’s study, 7 (17%) of 41 patients from the CTO group and 1 (1%) of 100 patients from the LC group had a history of previous upper abdominal surgery [50]. This estimates the risk for CTO for patients with the past history of upper abdominal surgery 20 times higher than for those without previous surgery above the umbilicus (OR = 20.4, 95% CI: 2.4–927.4;
The risk of CTO is also higher in patients following endoscopic retrograde cholangiography with sphincterotomy (ERC/ES) for CBD stone clearance [54–56]. A two-stage LC after 15 weeks following ERC/ES increases the rate of CTO three times (RR = 2.7, 95% CI: 1.4–5.5,
Thickened gallbladder wall on ultrasound (US) of the upper abdomen is associated with CTO [25, 28]. The risk of CTO doubles with every millimetre increase in gallbladder wall thickness (OR = 2; 95% CI: 1.7–2.3;
The presence of pericholecystic fluid on imaging of the abdomen increases the risk of CTO by 26 times (OR = 26; 95% CI: 5.0–166.1;
An elevated white cell count (WCC) is a predictor of CTO [28]. Compared to the LC group, the CTO group had a higher proportion of patients with leucocytosis, defined as WCC ≥ 11 × 109/L, 161 (12.7%) of 1265 patients versus 41 (36.6%) of 112 patients, respectively,
Histopathology of acute cholecystitis | \nWCC cut-off (95 CI) | \nCRP cut-off (95 CI) | \nAUC of WCC (95 CI) | \nAUC of CRP (95 CI) | \n|
---|---|---|---|---|---|
Overall AC | \n9.15 (8.7–9.6) | \n30.5 (10.2–50.8) | \n0.83 (0.79–0.87) | \n0.94 (0.92–0.97) | \n<0.00005 | \n
Mild AC | \n9.01 (8.7–9.32) | \n26.5 (13.6–39.4) | \n0.79 (0.74–0.84) | \n0.93 (0.9–0.95) | \n<0.00005 | \n
Moderate-severe AC | \n11.05 (10.22–11.88) | \n67 (61.9–72.1) | \n0.92 (0.88–0.97) | \n0.99 (0.97–1.0) | \n0.0093 | \n
Acute on chronic cholecystitis | \n9.15 (8.81–9.49) | \n26.5 (15.72–37.28) | \n0.72 (0.65–0.79) | \n0.87 (0.82–0.92) | \n0.0004 | \n
Acute edematous cholecystitis | \n9.05 (8.29–9.81) | \n30.5 (3.34–51.68) | \n0.78 (0.69–0.87) | \n0.93 (0.87–0.99) | \n0.0001 | \n
Acute necrotizing cholecystitis | \n9.05 (6.97–11.12) | \n57.5 (34.74–80.26) | \n0.89 (0.83–0.95) | \n0.97 (0.94–1.0) | \n0.0149 | \n
Acute suppurative cholecystitis | \n9.15 (7.96–10.34) | \n92 (76.43–111.57) | \n0.82 (0.67–0.97) | \n1.0 (1.0–1.0) | \n0.0189 | \n
Acute gangrenous cholecystitis | \n11.65 (10.63–12.67) | \n67 (61.78–72.22) | \n0.93 (0.89–0.98) | \n0.99 (0.97–1.0) | \n0.0375 | \n
Pericholecystic abscess/ gallbladder perforation | \n9.15 (7.82–10.48) | \n86 (66.28–105.72) | \n0.89 (0.76–1.0) | \n1.0 (1.0–1.0) | \n0.0852 | \n
Cut-off values and areas under receiver operating characteristic curve of CRP and WCC in acute cholecystitis (adapted from Beliaev et al. [63]).
\n
An elevated C-reactive protein (CRP) level also predicts CTO [62]. Every 10 mg/L increase in CRP concentration, the rate of CTO increases by 5% (OR = 1.05; 95% CI: 1.01–1.09;
Deranged liver function tests predict CTO [28, 64]. Patients with elevated concentrations of total bilirubin and alkaline phosphatase (>135 U/L) have seven times higher risk of CTO, OR = 6.5 (95% CI: 4.1–10.2;
An increasing ASA score has been shown in multiple studies to be an independent risk factor for CTO [25, 27, 28, 52, 62, 66]. Patients with ASA score of 3 have 2.5 times odds of CTO (OR = 2.5; 95% CI: 1.3–4.6) than those with ASA score of 1 (
To prevent IOI during LC, when the surgeon encounters dense intra-abdominal adhesions, extensive inflammatory changes around the gallbladder, haemorrhage, inability to grasp and retract a friable gallbladder with forceps, CTO is advised [67].
\nSevere intra-abdominal adhesions make laparoscopic dissection very difficult and are associated with a fivefold increase in CTO risk (OR = 5.2; 95% CI: 1.9–14.4;
Critical view of safety. The arrowhead shows detachment of the lowest part of the gallbladder from the gallbladder bed, the smaller arrow depicts the cystic artery and the larger arrow points at the cystic duct.
Intense inflammatory infiltrate in the Calot’s triangle makes identification of the cystic duct and cystic artery very challenging predisposing patients to iatrogenic BDI and uncontrollable bleeding [32, 35]. To prevent BDI, CTO is directed when one of three fundamentals of the critical view of safety cannot be ascertained [30, 68]. These essentials include the clearance of the Calot’s triangle from adipose and fibrous tissue, detachment of the lowest part of the gallbladder from the GB bed and identification of the cystic duct and cystic artery going into the gallbladder (Figure 2) [69]. Alternatively, when the surgeon encounters severe inflammatory or desmoplastic reaction in the Calot’s triangle laparoscopic subtotal cholecystectomy can be performed [70–72].
\nUnclear biliary anatomy is another reason for CTO [20]. Instead, intraoperative cholangiography (IOC) can be used to prevent misidentification of the cystic duct and prevent BDI [73, 74]. Failure of the contrast to opacify the common hepatic duct and the right and left hepatic ducts would signal the surgeon that the CBD, not the cystic duct, has been cannulated [74]. The use of IOC is associated with a 62% reduction in CTO rate (OR = 0.38, 95% CI: 0.17–0.94;
Intraoperative patient-related risk factors for CTO | \n
Adhesions caused by previous upper abdominal operations | \n
Adhesions in the upper abdomen caused by severe pericholecystic tissue inflammation | \n
Enlarged fatty liver (steatohepatitis) restricting access and inability to elevate gallbladder to dissect Calot’s triangle | \n
Intra-hepatic gallbladder | \n
Necrotic gallbladder wall | \n
Thickened sclerotic gallbladder wall/porcelain gallbladder | \n
Gallbladder perforation with biliary peritonitis | \n
Large gallbladder stone impacted in Hartman’s pouch/Mirizzi syndrome | \n
Fibrosis of tissue in Calot’s triangle | \n
Severe inflammation in Calot’s triangle | \n
Uncontrollable bleeding from cystic artery, hepatic artery, gallbladder bed | \n
Cholecysto-intestinal fistula | \n
Unclear biliary anatomy | \n
Choledocholithiasis requiring open CBD exploration | \n
Suspicion of gallbladder cancer | \n
Intra-abdominal organs injury | \n
Intolerance of intraperitoneal carbon dioxide insufflation | \n
Intraoperative patient-related risk factors that may require conversion of laparoscopic cholecystectomy to open surgery.
CTO is performed when open CBD exploration and stone clearance is required provided CBD stones cannot be removed laparoscopically or post-operatively by ERC/ES [20, 76, 77]. Furthermore, CTO is advised for an open repair of intraoperatively diagnosed IOI [20, 25]. Infrequently, CTO is necessary when the patient is not able to tolerate 12 mm Hg intraperitoneal carbon dioxide insufflation pressure and develops premature ventricular beats and bradycardia with hypotension [20].
\nIntraoperative patient-related risk factors that may require conversion of laparoscopic cholecystectomy to open surgery are presented in Table 5.
\nSurgeon’s knowledge, laparoscopic fellowship training, operative experience and skills in laparoscopic surgery play an important role in timely recognition of the need for CTO and are important predictors for CTO [49, 74, 75, 78]. Surgical registrars (postgraduate year 4–5) have a twofold higher rate of CTO (OR = 1.7; 95% CI: 1.1–2.5;
Importantly, there is statistically significant inverse correlation between surgeons’ LC volume and the rate of CTO (
Few predictive models have been developed to help the surgeon make an early CTO decision. Lipman et al. found that variables such as male gender, WCC ≥ 11 × 109/L, low albumin, pericholecystic fluid on US, the presence of diabetes mellitus and elevated total bilirubin independently predict CTO. These risk factors were included into the model which has the AUC of 83%. The authors showed that if none of these risk factors were present, the risk of conversion is 2%, but when six risk factors were present, the risk of conversion escalated to 90% [25].
\nKama et al. presented a CTO risk scoring model consisting of a constant (-20) and six variables with their coefficients, age ≥60 years (coefficient of 5), male gender (11), previous upper abdominal surgery (8), abdominal tenderness (9), thickness of gallbladder wall >4 mm on US (13) and the clinical diagnosis of AC (15) [83]. The final risk score for CTO (RSCLO) is the sum of the constant and coefficients of the risk factors that are present in an individual patient. The RSCLO can take a value between −20 and 41. An operation with RSCLO exceeding −3 is considered difficult [84].
\nGoonawardena et al. proposed a CTO prediction model that is constructed on five independent variables, previous upper abdominal surgery, obesity (BMI > 30 kg/m2) and the presence of choledocholithiasis, impacted stone at the Hartmann’s pouch and GB wall thickening on the trans-abdominal US [52].
\nSugrue et al. developed an intraoperative 10-point scoring system for an assessment of the difficulty in LC [85]. A score of <2 indicates mild degree difficulty, 2–4 moderate, 5–7 severe and 8–10 the extreme difficulty of LC [85].
\nThese predictive models have limitations. They have not been tested on an independent sample. Therefore, their real-life predictive ability is unknown. In addition, these models excluded surgeon-related risk factors. Thus, it is difficult to tailor management of high-risk for CTO patients according to an available hepato-biliary expertise.
\nPatient-reported outcome measures including generic (the Short Form 36 (SF-36) Health Survey, Nottingham Health Profile), preference-based (European Quality of Life Questionnaire, EQ-5D) and condition-specific instruments (Otago Gallstones Condition-Specific Questionnaire, Gastrointestinal Quality of Life Index, Abdominal Surgery Impact Scale and Gallstone Impact Checklist) as well as economic evaluations (cost–minimization analysis, cost–consequence analysis, cost–effectiveness analysis, cost–utility analysis and cost–benefit analysis) can also be used as outcome measures.
\nLC is the treatment of choice for symptomatic GB disease, which in some patients requires CTO. CTO risk stratification based on patient- and surgeon-dependent variables may allow a better patient’s management to keep CTO at low rates and maintain benefits of minimally invasive GB surgery. The absence of an association between CTO and IOI is an important surgical safety indicator that demonstrates that CTO is used as a safety strategy rather than an emergency measure to repair iatrogenic IOI and control haemorrhage.
\nWhile much research has been undertaken on the neural mechanisms and effect of trauma-induced amnesia, it is suggested that much less attention has been applied to the more covert and pervasive types of trauma and long-term effects of psychogenic amnesia among indigenous Australians. This chapter is essentially a study in the application of social neuroscience in the psycho-social trauma frequently associated with childhood. The objective of this social neuroscience research is to understand the epidemiology of amnesia and related neurophysiological systems that underpin the traumatic social background of indigenous Australians, and is intended to further understanding.
This article analyses themes underlying the causes of childhood trauma, considers the impact leading to amnesia, available diagnosis and mitigation. The material was informed by a review of epidemiological literature on psycho-social trauma present in indigenous Australians with consideration given to international literature to determine the elements of collective and mass trauma studies which correlate to indigenous communities in Australia. Psychogenic amnesia as a specific mental disorder has not been recorded in the data history of indigenous and non-indigenous hospitalizations. Consideration has therefore been given to the group of mood and neurotic disorders within which psychogenic amnesia lies in particular arising from stress levels. This article will contemplate memory disorders by considering memory disturbances, relationships to functionality and frequency, before turning to aspects of therapeutic interventions and culturally safe approaches.
The use of social neuroscience in exploring the incidence of amnesia caused by emotional and psychological trauma among indigenous Australians will provide broader consideration of the causal attributes of more prevalent levels of suffering among indigenous Australians as compared to non-indigenous Australians [1]. Social neuroscience perspectives on childhood trauma unite the concept that the brain responds to stress and abuse, as social behaviors stem from brain development [2]. Consideration may then be given to development of best therapeutic practices to promote healing and recovery from the damage caused to brain development by adverse experiences.
It cannot be emphasized enough that the colonialist practices of dispossession, child removal, suppression of indigenous social practices, stolen heritages and oppressive government policies, resulted in long-term intergenerational trauma that is still experienced today [3]. Ongoing social inequalities are particularly apparent across health outcomes [4, 5].
Current statistics indicate there are approximately 800,000 indigenous Australians, equating to 2.8% of the Australian population [6] (Figure 1).
Incidence of higher levels of distress among indigenous Australians compared to non-indigenous population. For indigenous Australians, the comparative distress levels are not only higher for all the four reported time periods but also show a trend of increasing levels of disparity for each consecutive period. Data for this chart were derived from Australian government report: Overcoming indigenous disadvantage 2016 [
The health and welfare outcomes are significantly disproportionate as indigenous Australians experience disease at a far higher rate than non-indigenous Australians. Of these diseases, the group of mental health disorders has one of the highest disparity ratio. This group represents disorders relating to stress, anxiety, depression, alcohol and drug use, and the autism spectrum [5]. To understand the impact of trauma, the issues raised above may be viewed through Historical Trauma theory. This conceptual theory is based on the premise that where a particular population has been historically subjected to long periods of mass trauma (such as colonialism, genocide, slavery, and abuse) then higher incidents of poor health outcomes remain present for many generations to follow [8]. In Australia, this is evidenced by the health disparities currently present [9, 10]. Once primary trauma occurs, the intergenerational effect is amplified by the risks associated with increased vulnerability to secondary trauma identified above. As a result, a pattern of trauma is often established in family and community groups which can be viewed through the current statistics that evidence Australian indigenous children end up in out-of-home care at a greater rate than non-indigenous children and disproportionately high rates of fatal self-harm [11, 12].
For this review, research papers were retrieved from the following databases and search engines: the Centre for Independent Studies (CIS), ProQuest, PubMed, ScienceDirect, Scopus, and Springer Link. The following: “trauma,” “childhood trauma,” “intergenerational trauma,” “indigenous,” “aboriginal,” “retrograde amnesia of psychogenic origins,” “dissociative and psychogenic amnesia,” “mental health,” “indigenous connection to country” together with “quantitative,” “statistical” and “social neuroscience” were used as keywords to filter results. Other keywords to filter results were “over policing,” “detention,” and “close the gap.” Search areas were restricted to clinical neurological science and sociology reporting on amnesia across indigenous Australians with results analyzed on the basis of the last two decades, geographical location, and types of intervention. Statistical evidence was sought from the Australian Bureau of Statistics (ABS) National Health Survey, 2014–2015, National Aboriginal and Torres Strait Islander Social Survey, 2014–2015 and Australian Institute of Health and Welfare (AIHW). Criteria for inclusion in this review were studies from the last two decades to capture political and social changes and were written in the English language. When the effect of mass trauma was analyzed for indigenous Australians on the basis of population and global geographical location, it was observed that New Zealand studies were most relevant to this review.
The exclusion criteria were reviews outside recent neurological memory loss and general indigenous research not relevant to Australian indigenous issues and papers not written in English. Research papers were also limited based on health specific records, identification of indigenous people, diagnosis mixed with other preexisting conditions. Also excluded, were reviews relating to memory loss as a result of accidents, sports, and direct physical damage to the brain, as the scope of this article focusses upon retrograde amnesia of psychogenic origins.
Data used in this article has been derived from Australian Government sources with the figures extrapolated from mental health statistics, in particular mood and neurotic disorders in which dissociative and psychogenic amnesia appears to draw conclusions.
Indigenous Australians have a higher incidence of distress indicative of social and psychological trauma than non-indigenous Australians. The legacy of trauma continues to exist in indigenous life with lived experience of psychological, sexual and physical abuse (including domestic violence), alcohol and substance abuse, over-policing, dissociation from family due to out-of-home care, continuing discrimination and racism, perpetuating the cycle. The effects are hard to quantify as directly supporting statistical evidence is limited [9, 10]. The greater incidence of distress trauma present in indigenous communities correlates to a higher incidence of amnesia compared to non-indigenous counterparts.
To better understand the nature of memory and how memory loss occurs in various types of amnesia, existing knowledge about human memory and a description of the various types of amnesia relevant to this article are set out below.
All memory types have two dimensions, time and content. Considering the time dimension, memory is categorized into a further four categories based on its content. Firstly, the shortest term memory type, which lasts a second or less, described as sensory memory, here sensory receptors capture the sensation momentarily to be filed into a longer-term memory section [13]. There are five sensory receptors which provide input to sensory memory: iconic or visual, echoic or auditory, haptic or touch-based, olfactory or smell related, and a taste receptor. Secondly, there is working memory, also referred to as primary or active memory which last less than a minute. Thirdly, there is the long-term memory, the loss of which is essentially the primary subject of this article [13]. The contents of long-term memory are categorized into two main types; one is explicit or conscious memory, sometimes also referred to as declarative memory, and implicit or unconscious memory, also known as procedural memory. The explicit or conscious memory is generally subtyped into episodic memory where events and experience are recorded; and semantic memory where general facts and concepts are recorded. Episodic memory is referred to episodic autobiographical memory (EAM), if the episode recorded relates to personal experiences [14, 15].
Other memory types such as prospective memory relate to processing future tasks and have little to do with recollection of past events. Autonoetic consciousness, however, is regarded as an anchor, or sense of self, in that all past experiences or exposures over a person’s lifetime are able to be retrieved and reflected upon [14, 16]. Conversely, semantic memory refers to the process of collecting general knowledge, allowing for recall of rudimentary facts and common knowledge, learned during the course of an individual’s existence, not drawn from personal experiences but is interconnected with culture [14].
Independent case studies have demonstrated that both episodic and semantic memories may be lost and, given the right time and circumstances, these memories may be recovered at a later date [14]. In one case it was observed that a patient experiencing retrograde amnesia caused by a mild head trauma exacerbated by work stressors was unable to access episodic and semantic memories. Over a period of several months, the patient was observed to be able to recall some semantics until full access to his blocked memories was established. In this case, to determine full recovery the patient was required to demonstrate competency in three faculties; ability to sense time, be aware of subjective autonoetic chronology and be aware of the presence of his own self through that chronology [14]. Neuroscience research relating to the experience, absorption, and memory of various episodes in life has found little evidence of early infantile episodic memory and given the development of the brain, early episodic and autobiographical memory during infancy does not happen. It is generally agreed that these memories occur after the age of 3 years [15].
For indigenous Australians, associations with family, community, land and wellbeing are crucial; individual land ownership is not an indigenous concept. Memories are formed through “storytelling” as a form of continuous oral tradition of recording and preserving history and importance of connection to land and country [17]. Intimate knowledge of country forms a strong connection that is inherent to indigenous identity and sustains wellbeing across spiritual, physical, social and cultural perspectives. Caring for country means participating in interrelated activities which aim to promote ecological, spiritual and human health and wellbeing. Loss of autonoetic consciousness interrupts such connection to country and as such, impacts upon health and wellbeing, not just for an individual but often for a community [1, 18]. The impact of amnesia results in lost inheritance for future generations.
Whilst it is acknowledged that memory loss may occur as a result of accidents, sports, and direct physical damage to the brain, the scope of this article is centered upon retrograde amnesia of psychogenic origins. Retrograde amnesia is the inability to recall long-term memory, mainly episodic and autobiographical, and is caused by extreme psychological trauma typified by that experienced by indigenous Australians [19]. In severe cases, anterograde amnesia may occur preventing the formation of any further memories after the experience of an episode of severe psychogenic trauma and, although atypical, may also be accompanied by loss of semantic and factual memories [19]. Dissociative amnesia, a subtype of psychogenic amnesia, is usually triggered by a traumatic event and is illustrated by retrospective memory gaps, the inability to recall personal information, often of a traumatic or stressful nature and is too explicit to be ascribed to forgetfulness or fatigue [20]. This article will also specifically consider indigenous childhood trauma of psychogenic origins that causes the removal of painful memories from parts of the brain that are responsible for memory function. The removal of such painful memories is considered a defense mechanism to extreme emotional and psychological stress. Dissociative amnesia may also have accompanying indications of depression and anxiety, with associated displays of impulsive aggressive behaviour, self-mutilation and suicidal ideation [21, 22].
Historically, incidents of amnesia associated with memory lapses and forgetfulness have been linked to physical, emotional, and spiritual welfare and often hypothesized through a philosophical lens [23]. Historically, memory loss was attributed to neurological disorders and physical head injuries, metabolic dysregulation, substance abuse, other acute or chronic brain illnesses. Following much debate, amnesia was identified as a memory disorder with further specificity distinguishing retrograde and anterograde categories [23]. Amnesia as a clinical feature was critical to the development of notions of dissociation of conscious from subconscious recall, and differentiation of neurogenically-based from psychogenic-based amnesia became central to understanding post-traumatic states [21].
Memory functionality has been found to improve when events recorded by the brain are emotionally arousing. These events tend to enable the human brain to absorb and recall events more effectively, over a longer period of time. The use of corticosteroids or cortisol, the main form of long-term stress hormones, has been considered to enhance or increase the brain’s memory capacity [24]. Conversely, persistently high levels of the stress hormone cortisol, common among indigenous people can be detrimental to long-term health, mental health and, wellbeing of the individual and community [25, 26]. Episodic memory appears to be affected when the Hypothalamus-pituitary-adrenal (HPA) axis records higher amounts of glucocorticoids, released from the adrenal cortex, when stress is experienced which impacts the regions inside the brain. Central to the above is that episodic memory is not just impaired, but more specifically its access and retrieval is temporarily blocked [27].
The repression of memory, whether consciously practiced or chemically induced, is considered to be a suitable coping mechanism for trauma-related or acute stress and has been observed to be good practice for sufferers of myocardial infarction [28]. The benefits of memory repression were realized whilst researching prevention, delayed onset, or reduction in the severity of post-traumatic stress disorders (PTSD) [29]. Although trauma-induced amnesia does not increase a person’s functionality, intellect or powers of execution, it has been found to reduce stress disorders. The defense mechanism in the brain that induces amnesia after a severe episode of trauma has the protective effect of reducing the likelihood of PTSD, autism spectrum disorder and other associated side effects [29].
No agreed treatment is available for psychogenic dissociative amnesia nor any methodology in place that may lead to rehabilitation. It is suggested that this is one area where complimentary intensive research in neurophysiology may improve understanding of the disorder and produce a feasible solution to improve the quality of life for those afflicted [30]. The inherent danger in dissociative amnesia is that it statistically points to increased risk of self-harm, suicide, and life-long loss of cognitive functionality. The detection and prevalence of dissociative amnesia varies broadly nationally and internationally, making it harder to define and detect let alone attempt to mitigate its effects [30].
Consequently, this article will correlate neurophysiological research with social and demographic research pertaining to indigenous Australians to detect the presence and epidemiology of psychogenic amnesiacs. The platform of social neuroscience, where such convergence occurs, is considered a suitable area of study as outlined further below.
Humans are social in nature and create evolving social structures based on an individual social grouping and the creation and evolution of accompanying cultures. These social structures have influenced the evolution of human neurobiological systems and accompanying effects on genes, cells, neural networks, and hormones. Social neuroscience is a study of the connection of the two systems as they coexist and co-influence [31]. Human neurobiological makeup has assisted in the various social constructs humans have built around themselves, which have then influenced and mutated human biology [31]. Social neuroscience is a relatively new area of academic inquiry which allows for greater understanding into the co-dependency and confluence of biological and social sciences. Insights into the cause and effect of psychological events on human neurophysiology validate the need for further research into social neuroscience [32].
Neuroscience research provides evidence that traumatic psychogenic amnesia, not directly associated with physical brain damage, impacts upon brain functions following the use of a neuroimaging technique called positron emission tomography (PET) [33]. It has been observed that a psychogenic amnesiac has different parts of the brain activated compared to non-amnesiacs in that the amygdala and other regions of the brain showed increased activity [19]. This leads to the suggestion that limbic functions and limbic cortical functions are affected by psychogenic amnesia and in case studies, patients recorded as having experienced traumatic psychogenic amnesia, also demonstrate cognitive impairments in attention, execution and intellectual capabilities [34].
Research into trauma related amnesia in relation to indigenous people can be a sensitive issue. Much has been written about indigenous health with criticism around the research methodology, theoretical perspectives, and evaluations of programs. It is clear the “closing the gap” strategy is struggling to have a major impact on the ambitious targets set by the Australian Government [35]. Reflective practices between cultures often present different philosophical and theoretical perspectives and discrete communication and language add complexity to the problems faced. The interpretation of incidence of amnesia among indigenous Australians can aggravate the segregation of the two cultures [36]. Interventions should be in the context of the use of traditional learning processes to view health and wellbeing from traditional healing perspectives with sound solutions for the future [36]. Comparative New Zealand research into therapeutic interventions for indigenous mental health, demonstrated that treatment based on the premise that a holistic view of wellbeing which is congruent with culture, customs and values integrating aspects of spirituality, provides a greater individual sense of self and place, and should be considered in any treatment plan [37].
Within the last decade, there appears to have been a shift in the narrative around acknowledging that not all aspects of indigenous culture is positive. Recent discourse by prominent female indigenous leaders has provided a sincere snapshot into some of the continuing health issues [38]. It is conceded that indigenous communities are often desensitized to a culture of violence, with many assaults going unreported, and violence deemed the norm [39]. It is also felt that the very nature of the traditional culture continues to maintain the dominant rights for men to control women [38]. These adverse aspects of culture are regarded as detrimental to finding solutions to better health outcomes.
There is an urgent need for better evaluation of indigenous policies and programs nationally to assess outcomes. There is a lack of reliable national data reporting on how health and wellbeing measures are based. Evidence shows that when programs are well researched, supported by effective community targeting and engagement, then outcomes are positive [39]. One example of this is in relation to petrol sniffing and the implementation of OPAL fuel (a low aromatic fuel) substitution for petrol. This program resulted in a dramatic reduction in ailments arising from petrol sniffing [40]. Improved data collection around patient consultation, diagnosis, referrals to specialists, and outcome of referrals is required to better understand the impact of amnesia [41].
The concept of culture plays an important part in both the social and biological sciences as culture enables a community to make sense of their world and impacts treatment outcomes. Research provides that the biogenetic, environmental and cultural influences impact collectively on cognitive development affecting behaviour [42]. It cannot be emphasized enough that through culture, people are able to place themselves and self-identify, as such traditional healing methods should form part of health strategies and be framed through cultural messaging [43]. It has been suggested that two fields of research practice have dominated debates around health and wellbeing, one view suggests that factors such as income, socioeconomic hierarchy, and social status provide indicators of risk of disease, the second view, held by health psychologists, anthropologists and sociologists, is that risk of disease is associated with stressors and the ability of an individual or community to cope with such stressors [32]. Therefore health and wellbeing are impacted by historical legacies and politics; and the passage of time directly affects how culture shapes health trends in relation to indigenous people.
Testing for amnesia is often unreliable as it is frequently associated with cognitive dysfunction identified through impairment of learning and executive functions [44]. Cognitive dysfunction is also ubiquitous with high rates of poor health, diseases, substance abuse, domestic violence, psychological stress, and trauma, as reported widely among indigenous Australians. Tests are also often based on Western premise and not tuned for cultural nuances [45]. Alcohol and substance abuse, in general, is one of the most reported concerns among indigenous Australians with misuse often resulting in impairment and toxic harm to organs and tissues, with premature aging and death. Being in a state of intoxication diminishes coordination, cognition, perception and promotes dependency [46]. It has been established that alcohol abuse alters the structure of the brain through degeneration of the cerebral cortex, and causes changes to the hypothalamus and cerebellum [47]. These changes directly impact cognitive processes associated with learning, memory, attention, rational thinking, and impulse control [48, 49]. The abuse of alcohol may cause complications giving rise to neuropsychological disorders, cancer, cardiovascular, diabetes and infectious diseases, injuries whilst intoxicated, and fetal disorders [44, 47]. Poverty and economic stress arising from poor educational outcomes, and unemployment can cause additional psychogenic trauma impacting mental health causing anxiety and depression [41]. As previously outlined, stress triggers hormonal action on the nervous system to produce a biological uninhibited reaction which often translates into violence or abuse. Continuously high stress levels lead to heightened states of hypersensitivity undermining positive health leading to mood disorders such as depression, anxiety and aggression, diabetes and high blood pressure and potentially resultant amnesia [50].
Recent research into dissociative identity disorders supports the finding that highly stressful events during childhood development produce a neurological response to intolerable stress which results in the deconstruction of self-identity [51]. Stress-induced trauma may arise from physical and emotional abuse or neglect, disturbed attachment, and boundary violations with the resultant effect amplified as a result of familial, societal and cultural factors [52]. As a biopsychosocial concept, dissociative identity disorder has been validated as a chronic psychiatric disorder arising from intolerable stress and trauma grounded on interpersonal non-assimilation, cognitive and neurobiological responses and as such warrants further comparative research [51].
Research has provided insights into how stress interacts with long-term potentiation (LTP), long-term depression (LTD), stress, and memory on the hippocampus, amygdala and prefrontal cortex [53]. These three regions of the brain are impacted in time from stress-related, trauma-inducing events so that immediate impact is temporarily followed by a medium-term, then a longer term effect [54]. In relation to the hippocampus, the LTP is engaged and activated for a short period of time. After this early period lasting no more than a few minutes, LTP activity is blocked and a period of memory consolidation occurs for up to half an hour [54, 55]. During this period of consolidation new memories are suppressed and LTP is disengaged. In the amygdala region, LTP is engaged for a longer-period and emergency decision making is enabled and action is taken [54]. The prefrontal cortex reacts differently compared to the hippocampus and amygdala in that LTP is temporarily impaired, attention is divided and multitasking is enabled. After a period lasting a few minutes to an hour normal LTP induction is restored. These concurrent effects on the three parts of the brain induced by traumatic events not only show how strong psychological and emotional events induce high levels of stress, resulting in short-, medium- and long-term effects but also result in longer-term phenotype changes in their physiological structure [54]. Further evidence of the impact of trauma on neurophysiological structures is provided by PET data, which illustrates that the right hemisphere of the brain is affected by these events and visual areas of the brain are activated, directly related to the extent of trauma [19, 33, 34].
In severe cases of trauma-related stress, both retrograde and anterograde memories are affected along with overall impairment of mental and physical health [26, 55]. Studies relating to the frequency of dissociative and psychogenic amnesia have been carried out in 16 countries with rates of prevalence in different countries varying from 0.2 to 7.3% [56]. This large variation in the epidemiology may partly be explained by a lack of standard testing. Therefore, combining social research with neuroimaging data and neurobiological studies of this disorder is suggested to improve understanding of the debilitating impact on its sufferers, and indigenous Australian communities in general [56].
Access to appropriate treatment is problematic given the lack of accurate testing, diagnosis and reporting. Frequently, the correlation between a patient’s symptoms and traumatic experiences are not explored in depth as existing diagnostic tools are used to analyze and problem-solve which may only result in partial treatments [44]. Often trauma is treated by prescribing medicines for insomnia, anxiety and depression without understanding the etiology of the trauma condition [12, 51, 52]. There is also an increase in interventions from agencies in relation to emotional abuse, neglect and exposure to domestic violence and the need to mitigate risk to children. Again, although the paramount protection of children is the overriding concern, interventions do not address underlying issues associated with trauma and to a certain extent, perpetuate the effects [50].
According to the 2012–2013 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) 30% of people over 18 years old reported high or very high levels of psychological distress. Indigenous people were approximately three times likely to have experienced very high levels of psychological distress across age groups [57]. As previously mentioned, stress can impact on cognitive function and produce mental health issues. Cognitive processes affected in mood disorders include impairment of working memory, abstract reasoning, sustained attention, visuomotor skills and verbal memory [45, 53, 58]. Figure 2 below demonstrates varying levels of high distress experienced by various age groups among indigenous and non-indigenous Australians, exemplifying the huge mental health disparity between the two communities.
Levels of distress in indigenous versus non-indigenous Australians across time and age-groups. Indigenous Australians aged 35–44 years record the highest levels of distress and non-indigenous Australians aged 55+ years record the lowest levels of distress. As time passes, stress levels appear to be increasing in all age groups in indigenous Australians and decreasing or stable in non-indigenous. Data for this chart were derived from Australian government report: Overcoming indigenous disadvantage 2016 [
Childhood psychogenic trauma can be experienced in a multitude of ways. Although many indigenous children grow up in stable and loving homes, those exposed to secondary trauma, develop coping mechanisms [59]. Long-term stress arising from direct forms of psychogenic trauma and indirect transgenerational trauma gives rise to a continuous stream of cortisol. These high levels of cortisol result in the body disabling the cortisol receptors in an attempt to disengage itself from painful events. When high levels of cortisol are present in childhood, it results in children feeling withdrawn and inactive with an associated lack of stimulation [25]. Conversely, responding to the similar circumstances of high stress and unabated levels of cortisol, some children may display highly sensitive and alert behavior which eventually takes a toll on their long-term health [25]. In either case, recurring levels of stress produce psychiatric damage that continues into adulthood. The impact is then perpetuated at community levels displaying across their mental and physical health. Further, sensory emotional and physical flashbacks of repeated traumatic experiences including diagnosed post-traumatic stress disorders produce further disordered memory function. Flashbacks are more likely to occur when a person is upset, stressed or aroused by any association with the traumatic event [52].
Within indigenous Australian culture, traditional values still control communities and maintain the dominant rights of indigenous males over females. Negative aspects of this culture are associated with the intersection of customs and law whereby customary law allows for the sexual assault of under-age girls who are “promised wives” to men and suffer an early cessation of childhood [60]. Family violence also has a significant impact on the health and welfare of individuals, families, and communities [38, 61]. In some Australian jurisdictions, police records indicate indigenous women were physically assaulted up to 11.4 times more frequently than non-Indigenous women with reports of domestic and family violence by a current partner also considerably higher than for non-indigenous women [7]. Hospitalizations for indigenous women for non-fatal family violence-related assaults were also significantly higher at 32 times the rate of non-Indigenous females [7]. Hospitalizations among indigenous population due to mental health disorders are twice as high as non-indigenous Australians as shown in Figure 3 below.
All mental health hospitalizations for indigenous versus non-indigenous Australians over time indicating significant variation in population. Data for this chart were derived from Australian government report: Overcoming indigenous disadvantage 2016 [
In understanding the ongoing legacy related to trauma, consideration needs to be given to the number of children in kinship care. Kinship carers are often in an older age group, are economically poorer, with reduced health, and lower levels of education than foster carers and may appear to perpetuate the pattern of disadvantage [62]. The number of indigenous children in kinship care has grown at more than twice the rate of children in foster and residential care with some suggestions that this has been driven by increased demands for care, a shortage of foster carers, and reduction in costs [63].
Attention must also be placed on the enduring disproportionate rates of indigenous arrests, detention, and over-policing evident in many indigenous communities. The 1991 establishment of the Royal Commission into Aboriginal Deaths in Custody confirms that treatment of indigenous people in the criminal justice system was considered of national importance and left no doubt as to concerns about inappropriate violence perpetrated by Police [64, 65, 66]. More recent concerns raised by the New South Wales Ombudsman still suggest a disproportionate level of interaction, over-policing and use of Tasers against indigenous people [67].
Research has shown that often individual experiences of trauma underscore difficulties in recovery as the effects of trauma compound within a community on which an individual has depended, and the community becomes fragmented and disconnected [9]. An individual diagnosis of psychogenic amnesia may be better served if consideration is given to collective community trauma; individual treatment may result in disconnection from community and loss of self-connection [9]. Studies indicate that adopting evidence-based principles of family and community healing, developed internationally in mass communal disaster situations, may assist in conceptualizing a more informed response to the wellbeing for indigenous Australian communities [9].
It is acknowledged that treatment for trauma-induced amnesia is in early stages of development with robust data not readily available. It is evident that health practitioners working with indigenous Australians affected by trauma need to modify their programs to suit individual traumatic experiences and operate from a “trauma-informed” community perspective [59]. Culturally competent staff accept that trauma is individualized, and that therapeutic care must be customized for the individual to meet holistic and ecological needs [59]. Medical concepts in plain English or local language should replace technical specialist language within cross-cultural settings with the use of “story” central to shared understanding. As a society, we have a responsibility to ensure children have the opportunity to heal from trauma and have a responsibility to ensure all appropriate services and treatment methods are provided to achieve this [42].
In 2015, the Australian Government released the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 which outlines actions and strategies to be undertaken by the Government and other key stakeholders to execute the priorities [68]. Priorities include access to primary health care for early intervention to prevent hospitalizations and avoidable deaths and improved mental health outcomes. The Plan acknowledges that mental health has implications for incidence of domestic violence, substance abuse imprisonment and family disconnections and seeks a reduction in suicide and self-harm rates [68]. The Plan indicates that rates of family and community violence were unchanged between 2002 and 2014–2015 (around 22%), and risky long-term alcohol use in 2014–2015 was similar to 2002 [68]. Of concern, is that the proportion of adults reporting high levels of psychological distress increased from 27% in 2004–2005 to 33% in 2014–2015 (as shown in Figure 1), and hospitalizations for self-harm increased by 56% over this period. The proportion of adults reporting substance misuse in the previous 12 months increased from 23% in 2002 to 31% in 2014–2015 [5, 68] (Figure 4).
Mental health hospitalizations by gender for indigenous versus non-indigenous Australians for a reported period and shows increased levels of hospitalizations for both male and female indigenous. Male indigenous hospitalizations show more than twice the level as compared to non-indigenous. Female indigenous have higher levels of hospitalizations than non-indigenous but less than male indigenous which raises possible concerns over reporting. Data for this chart were derived from Australian government report: Overcoming indigenous disadvantage 2016 [
It has been inspiring to see organizations implement Reconciliation Action Plans driving collective action to implement change for positive indigenous Australian health outcomes. It has been acknowledged that indigenous patient safety is inextricably linked with cultural safety and that currently, no agreed national definition of cultural safety exists [69]. Despite this some organizations have informed the view that cultural safety should be defined as the individual and institutional knowledge, skills, attitudes, and competencies needed to deliver optimal equitable health care for indigenous people [69].
The perspective of trauma-informed health care may change the lens on treatment plans for indigenous people presenting with mental illness [70, 71]. For change to occur, local indigenous communities and regional areas must be in control of determining health needs and responsible for assessing the outcome in conjunction with health professionals [72, 73]. Indigenous Australians have a “right to a good life” and past uncoordinated approaches to tackle the problems of poor health outcomes has led to a culture of low expectations [74].
This chapter has considered the psycho-social trauma and epidemiology of amnesia associated with childhood and intergenerational trauma prevalent among indigenous Australians, from the social neuroscience perspective. The legacy of destruction imposed on indigenous Australian by violence and assimilation has had severe long-term consequences contributing to the tragic health inequality present in indigenous Australian’s today. The insights derived from this review indicate that the complex effects of psycho-social trauma induced amnesia should be considered in any treatment plan.
It is clear there is strong need to understand the meaning of trauma recovery in the indigenous context which differs from non-indigenous interpretations, and acknowledgment that wellbeing of indigenous people has to take into account genetic and environmental influences. Indigenous people suffering from psycho-social trauma-induced amnesia often experience additional complex factors of social disconnection. Open discussions need to address cultural dimensions that value past, present and preservation of knowledge. Taking a deeper look at the underlying causal factors of amnesia may allow consideration of a greater range of treatment options across a multitude of social neurological science disciplines may go towards informing funding for further research and training.
The author declares no conflict of interest.
This chapter generally uses the term “indigenous Australians” to describe Aboriginal and Torres Strait Islander Australians, as Australia’s first peoples, and “non-indigenous Australians” to refer to Australians of other backgrounds, except where quoting other sources.
The Internet has irrevocably changed the dynamics of scholarly communication and publishing. Consequently, we find it necessary to indicate, unambiguously, our definition of what we consider to be a published scientific work.
",metaTitle:"Prior Publication Policy",metaDescription:"Prior Publication Policy",metaKeywords:null,canonicalURL:"/page/prior-publication-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"A significant number of working papers, early drafts, and similar work in progress are openly shared online between members of the scientific community. It has become common to announce one’s own research on a personal website or a blog to gather comments and suggestions from other researchers. Such works and online postings are, indeed, published in the sense that they are made publicly available. However, this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
\\n\\nThe significance of Peer Review cannot be overstated when it comes to defining, in our terms, what constitutes a published scientific work. Peer Review is widely considered to be the cornerstone of modern publishing processes and the key value-adding contribution to a scholarly manuscript that a publisher can make.
\\n\\nOther than the issue of originality, research misconduct is another major issue that all publishers have to address. IntechOpen’s Retraction & Correction Policy and various publication ethics guidelines identify both redundant publication and (self)plagiarism to fall within the definition of research misconduct, thus constituting grounds for rejection or the issue of a Retraction if the work has already been published.
\\n\\nIn order to facilitate the tracking of a manuscript’s publishing history and its development from its earliest draft to the manuscript submitted, we encourage Authors to disclose any instances of a manuscript’s prior publication, whether it be through a conference presentation, a newspaper article, a working paper publicly available in a repository or a blog post.
\\n\\nA note to the Academic Editor containing detailed information about a submitted manuscript’s previous public availability is the preferred means of reporting prior publication. This helps us determine if there are any earlier versions of a manuscript that should be disclosed to our readers or if any of those earlier versions should be cited and listed in a manuscript’s references.
\\n\\nSome basic information about the editorial treatment of different varieties of prior publication is laid out below:
\\n\\n1. CONFERENCE PAPERS & PRESENTATIONS
\\n\\nGiven that conference papers and presentations generally pass through some sort of peer or editorial review, we consider them to be published in the accepted scholarly sense, particularly if they are published as a part of conference proceedings.
\\n\\nAll submitted manuscripts originating from a previously published conference paper must contain at least 50% of new original content to be accepted for review and considered for publication.
\\n\\nAuthors are required to report any links their manuscript might have with their earlier conference papers and presentations in a note to the Academic Editor, as well as in the manuscript itself. Additionally, Authors should obtain any necessary permissions from the publisher of their conference paper if copyright transfer occurred during the publishing process. Failure to do so may prevent Us from publishing an otherwise worthy work.
\\n\\n2. NEWSPAPER & MAGAZINE ARTICLES
\\n\\nNewspaper and magazine articles usually do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense. Articles appearing in newspapers and magazines rarely possess the depth and structure characteristic of scholarly articles.
\\n\\nSubmitted manuscripts stemming from a previous newspaper or magazine article will be accepted for review and considered for publication. However, Authors are strongly advised to report any such publication in an accompanying note to the External Editor.
\\n\\nAs with the conference papers and presentations, Authors should obtain any necessary permissions from the newspaper or magazine that published the work, and indicate that they have done so in a note to the External Editor.
\\n\\n3. GREY LITERATURE
\\n\\nWhite papers, working papers, technical reports and all other forms of papers which fall within the scope of the ‘Luxembourg definition’ of grey literature do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense.
\\n\\nAlthough such papers are regularly made publicly available via personal websites and institutional repositories, their general purpose is to gather comments and feedback from Authors’ colleagues in order to further improve a manuscript intended for future publication.
\\n\\nWhen submitting their work, Authors are required to disclose the existence of any publicly available earlier drafts in a note to the Academic Editor. In cases where earlier drafts of the submitted version of the manuscript are publicly available, any overlap between the versions will generally not be considered an instance of self-plagiarism.
\\n\\n4. SOCIAL MEDIA, BLOG & MESSAGE BOARD POSTINGS
\\n\\nWe feel that social media, blogs and message boards are generally used with the same intention as grey literature, to formulate ideas for a manuscript and gather early feedback from like-minded researchers in order to improve a particular piece of work before submitting it for publication. Therefore, we do not consider such internet postings to be publication in the scholarly sense.
\\n\\nNevertheless, Authors are encouraged to disclose the existence of any internet postings in which they outline and describe their research or posted passages of their manuscripts in a note to the Academic Editor. Please note that we will not strictly enforce this request in the same way that we would instructions we consider to be part of our conditions of acceptance for publication. We understand that it may be difficult to keep track of all one’s internet postings in which the researcher´s current work might be mentioned.
\\n\\nIn cases where there is any overlap between the Author´s submitted manuscript and related internet postings, we will generally not consider it to be an instance of self-plagiarism. This also holds true for any co-Author as well.
\\n\\nFor more information on this policy please contact permissions@intechopen.com.
\\n\\nPolicy last updated: 2017-03-20
\\n"}]'},components:[{type:"htmlEditorComponent",content:'A significant number of working papers, early drafts, and similar work in progress are openly shared online between members of the scientific community. It has become common to announce one’s own research on a personal website or a blog to gather comments and suggestions from other researchers. Such works and online postings are, indeed, published in the sense that they are made publicly available. However, this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
\n\nThe significance of Peer Review cannot be overstated when it comes to defining, in our terms, what constitutes a published scientific work. Peer Review is widely considered to be the cornerstone of modern publishing processes and the key value-adding contribution to a scholarly manuscript that a publisher can make.
\n\nOther than the issue of originality, research misconduct is another major issue that all publishers have to address. IntechOpen’s Retraction & Correction Policy and various publication ethics guidelines identify both redundant publication and (self)plagiarism to fall within the definition of research misconduct, thus constituting grounds for rejection or the issue of a Retraction if the work has already been published.
\n\nIn order to facilitate the tracking of a manuscript’s publishing history and its development from its earliest draft to the manuscript submitted, we encourage Authors to disclose any instances of a manuscript’s prior publication, whether it be through a conference presentation, a newspaper article, a working paper publicly available in a repository or a blog post.
\n\nA note to the Academic Editor containing detailed information about a submitted manuscript’s previous public availability is the preferred means of reporting prior publication. This helps us determine if there are any earlier versions of a manuscript that should be disclosed to our readers or if any of those earlier versions should be cited and listed in a manuscript’s references.
\n\nSome basic information about the editorial treatment of different varieties of prior publication is laid out below:
\n\n1. CONFERENCE PAPERS & PRESENTATIONS
\n\nGiven that conference papers and presentations generally pass through some sort of peer or editorial review, we consider them to be published in the accepted scholarly sense, particularly if they are published as a part of conference proceedings.
\n\nAll submitted manuscripts originating from a previously published conference paper must contain at least 50% of new original content to be accepted for review and considered for publication.
\n\nAuthors are required to report any links their manuscript might have with their earlier conference papers and presentations in a note to the Academic Editor, as well as in the manuscript itself. Additionally, Authors should obtain any necessary permissions from the publisher of their conference paper if copyright transfer occurred during the publishing process. Failure to do so may prevent Us from publishing an otherwise worthy work.
\n\n2. NEWSPAPER & MAGAZINE ARTICLES
\n\nNewspaper and magazine articles usually do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense. Articles appearing in newspapers and magazines rarely possess the depth and structure characteristic of scholarly articles.
\n\nSubmitted manuscripts stemming from a previous newspaper or magazine article will be accepted for review and considered for publication. However, Authors are strongly advised to report any such publication in an accompanying note to the External Editor.
\n\nAs with the conference papers and presentations, Authors should obtain any necessary permissions from the newspaper or magazine that published the work, and indicate that they have done so in a note to the External Editor.
\n\n3. GREY LITERATURE
\n\nWhite papers, working papers, technical reports and all other forms of papers which fall within the scope of the ‘Luxembourg definition’ of grey literature do not pass through any extensive peer or editorial review and we do not consider them to be published in the scholarly sense.
\n\nAlthough such papers are regularly made publicly available via personal websites and institutional repositories, their general purpose is to gather comments and feedback from Authors’ colleagues in order to further improve a manuscript intended for future publication.
\n\nWhen submitting their work, Authors are required to disclose the existence of any publicly available earlier drafts in a note to the Academic Editor. In cases where earlier drafts of the submitted version of the manuscript are publicly available, any overlap between the versions will generally not be considered an instance of self-plagiarism.
\n\n4. SOCIAL MEDIA, BLOG & MESSAGE BOARD POSTINGS
\n\nWe feel that social media, blogs and message boards are generally used with the same intention as grey literature, to formulate ideas for a manuscript and gather early feedback from like-minded researchers in order to improve a particular piece of work before submitting it for publication. Therefore, we do not consider such internet postings to be publication in the scholarly sense.
\n\nNevertheless, Authors are encouraged to disclose the existence of any internet postings in which they outline and describe their research or posted passages of their manuscripts in a note to the Academic Editor. Please note that we will not strictly enforce this request in the same way that we would instructions we consider to be part of our conditions of acceptance for publication. We understand that it may be difficult to keep track of all one’s internet postings in which the researcher´s current work might be mentioned.
\n\nIn cases where there is any overlap between the Author´s submitted manuscript and related internet postings, we will generally not consider it to be an instance of self-plagiarism. This also holds true for any co-Author as well.
\n\nFor more information on this policy please contact permissions@intechopen.com.
\n\nPolicy last updated: 2017-03-20
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From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. 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However, the goal of reaching so-called “breakeven” energy conditions, whereby the energy produced from a fusion reaction is greater than the energy put in, is yet to be demonstrated. It is the role of ITER, an international collaborative experimental reactor, to achieve breakeven conditions and to demonstrate technologies that will allow fusion to be realized as a viable energy source. However, with significant delays and cost overruns to ITER, there has been increased interest in the development of other fusion reactor concepts, particularly by private-sector start-ups, all of which are exploring the possibility of an accelerated route to fusion. This chapter gives a comprehensive overview of nuclear fusion science, and provides an account of current approaches and their progress towards the realization of future fusion energy power plants. The range of technical issues, associated technology development challenges and future commercial opportunities are explored, with a focus on magnetic confinement approaches.",book:{id:"6838",slug:"power-plants-in-the-industry",title:"Power Plants in the Industry",fullTitle:"Power Plants in the Industry"},signatures:"Shutaro Takeda and Richard Pearson",authors:[{id:"251254",title:"Prof.",name:"Shutaro",middleName:null,surname:"Takeda",slug:"shutaro-takeda",fullName:"Shutaro Takeda"},{id:"262366",title:"Mr.",name:"Richard",middleName:null,surname:"Pearson",slug:"richard-pearson",fullName:"Richard Pearson"}]},{id:"71264",doi:"10.5772/intechopen.90939",title:"Fast-Spectrum Fluoride Molten Salt Reactor (FFMSR) with Ultimately Reduced Radiotoxicity of Nuclear Wastes",slug:"fast-spectrum-fluoride-molten-salt-reactor-ffmsr-with-ultimately-reduced-radiotoxicity-of-nuclear-wa",totalDownloads:978,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"A mixture of NaF-KF-UF4 eutectic and NaF-KF-TRUF3 eutectic containing heavy elements as much as 2.8 g/cc makes a fast-spectrum molten salt reactor based upon the U-Pu cycle available without a blanket. It does not object breeding but a stable operation without fissile makeup under practical contingencies. It is highly integrated with online dry chemical processes based on “selective oxide precipitation” to create a U-Pu cycle to provide as low as 0.01% leakage of TRU and nominated as the FFMSR. This certifies that the radiotoxicity of HLW for 1500 effective full power days (EFPD) operation can be equivalent to 405 tons of depleted uranium after 500 years cooling without Partition and Transmutation (P&T). A certain amount of U-TRU mixture recovered from LWR spent fuel is loaded after the initial criticality until U-Pu equilibrium but the fixed amount of 238U only thereafter. The TRU inventory in an FFMSR stays at an equilibrium perpetually. Accumulation of spent fuel of an LWR for 55 years should afford to start up the identical thermal capacity of FFMSR and to keep operation hypothetically until running out of 238U. Full deployment of the FFMSR should make the entire fuel cycle infrastructures needless except the HLW disposal site.",book:{id:"9888",slug:"nuclear-power-plants-the-processes-from-the-cradle-to-the-grave",title:"Nuclear Power Plants",fullTitle:"Nuclear Power Plants - The Processes from the Cradle to the Grave"},signatures:"Yasuo Hirose",authors:[{id:"315264",title:"Dr.",name:"Yasuo",middleName:null,surname:"Hirose",slug:"yasuo-hirose",fullName:"Yasuo Hirose"}]},{id:"72177",doi:"10.5772/intechopen.92547",title:"Nuclear Power Plant or Solar Power Plant",slug:"nuclear-power-plant-or-solar-power-plant",totalDownloads:701,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Both solar energy and nuclear energy face significant economic challenges. Sustainable energy costs have traditionally been greater than any of those associated with the growth of fossil fuel power generation, although the costs of renewable energy technologies (especially photovoltaic) have dropped. Furthermore, capital costs remain a big challenge in the nuclear generation. In many nations, the cost of building small nuclear power plants is quite large due to time, technology, and environmental and safety challenges for consumers. Such problems might not be as big for state-owned corporations or controlled industries for which utilities have quick access to cheap resources, and this partially explains why the interest for nuclear reactors in Asia is far greater than in the United States or Europe. Learning could help decrease costs for both types of technologies, but the track record for learning-by-doing in the nuclear sector is not good.",book:{id:"9888",slug:"nuclear-power-plants-the-processes-from-the-cradle-to-the-grave",title:"Nuclear Power Plants",fullTitle:"Nuclear Power Plants - The Processes from the Cradle to the Grave"},signatures:"Mostafa Esmaeili Shayan and Farzaneh Ghasemzadeh",authors:[{id:"317852",title:"Ph.D.",name:"Mostafa",middleName:null,surname:"Esmaeili Shayan",slug:"mostafa-esmaeili-shayan",fullName:"Mostafa Esmaeili Shayan"},{id:"319145",title:"Prof.",name:"Farzaneh",middleName:null,surname:"Ghasemzadeh",slug:"farzaneh-ghasemzadeh",fullName:"Farzaneh Ghasemzadeh"}]},{id:"54655",doi:"10.5772/67858",title:"Key Technical Performance Indicators for Power Plants",slug:"key-technical-performance-indicators-for-power-plants",totalDownloads:3359,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"In this chapter, we will underline the importance of the key performance indicators (KPIs) computation for power plants’ management. The main scope of the KPIs is to continuously monitor and improve the business and technological processes. Such indicators show the efficiency of a process or a system in relation with norms, targets or plans. They usually provide investors and stakeholders a better image regarding location, equipment technology, layout and design, solar and wind exposure in case of renewable energy sources and maintenance strategies. We will present the most important KPIs such as energy performance index, compensated performance ratio, power performance index, yield, and performance, and we will compare these KPIs in terms of relevance and propose a set of new KPIs relevant for maintenance activities. We will also present a case study of a business intelligence (BI) dashboard developed for renewable power plant operation in order to analyze the KPIs. The BI solution contains a data level for data management, an analytical model with KPI framework and forecasting methods based on artificial neural networks (ANN) for estimating the generated energy from renewable energy sources and an interactive dashboard for advanced analytics and decision support.",book:{id:"5807",slug:"recent-improvements-of-power-plants-management-and-technology",title:"Recent Improvements of Power Plants Management and Technology",fullTitle:"Recent Improvements of Power Plants Management and Technology"},signatures:"Simona Vasilica Oprea and Adela Bâra",authors:[{id:"139804",title:"Prof.",name:"Adela",middleName:null,surname:"Bara",slug:"adela-bara",fullName:"Adela Bara"},{id:"188586",title:"Dr.",name:"Simona Vasilica",middleName:null,surname:"Oprea",slug:"simona-vasilica-oprea",fullName:"Simona Vasilica Oprea"}]},{id:"55841",doi:"10.5772/intechopen.68772",title:"Risk Assessment of NPP Safety in Case of Emergency Situations on Technology",slug:"risk-assessment-of-npp-safety-in-case-of-emergency-situations-on-technology",totalDownloads:1355,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"The last accidents of the nuclear power plant (NPP) in Chernobyl and Fukushima give us the new inspiration to verify the safety level of the NPP structures. This paper presents the new requirements to test the safety and reliability of the NPP structures due to the recent accidents in the world. The IAEA in Vienna required in the document ‘Stress tests’ the verification of the safety of the NPP structures under impact of the extreme loads as the earthquakes, the extreme climatic actions and the technology accidents. The new recommendations to load combinations and design criteria were defined. The risk assessment to verify the safety and reliability of the NPP structures based on probabilistic and nonlinear analysis is presented. The uncertainties of material model (behaviour of the reinforcement and liner, concrete cracking and crushing), degradation effects, the loads level (dead and live loads, extreme climatic and accidental temperature and overpressure) as well as other effects following from the inaccuracy of the calculated model and numerical methods were taken into account in the response surface method (RSM) method. The results of the deterministic and probabilistic analysis of the NPP structures are presented.",book:{id:"5807",slug:"recent-improvements-of-power-plants-management-and-technology",title:"Recent Improvements of Power Plants Management and Technology",fullTitle:"Recent Improvements of Power Plants Management and Technology"},signatures:"Juraj Králik",authors:[{id:"139600",title:"Prof.",name:"Juraj",middleName:null,surname:"Králik",slug:"juraj-kralik",fullName:"Juraj Králik"}]}],mostDownloadedChaptersLast30Days:[{id:"54655",title:"Key Technical Performance Indicators for Power Plants",slug:"key-technical-performance-indicators-for-power-plants",totalDownloads:3355,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"In this chapter, we will underline the importance of the key performance indicators (KPIs) computation for power plants’ management. The main scope of the KPIs is to continuously monitor and improve the business and technological processes. Such indicators show the efficiency of a process or a system in relation with norms, targets or plans. They usually provide investors and stakeholders a better image regarding location, equipment technology, layout and design, solar and wind exposure in case of renewable energy sources and maintenance strategies. We will present the most important KPIs such as energy performance index, compensated performance ratio, power performance index, yield, and performance, and we will compare these KPIs in terms of relevance and propose a set of new KPIs relevant for maintenance activities. We will also present a case study of a business intelligence (BI) dashboard developed for renewable power plant operation in order to analyze the KPIs. The BI solution contains a data level for data management, an analytical model with KPI framework and forecasting methods based on artificial neural networks (ANN) for estimating the generated energy from renewable energy sources and an interactive dashboard for advanced analytics and decision support.",book:{id:"5807",slug:"recent-improvements-of-power-plants-management-and-technology",title:"Recent Improvements of Power Plants Management and Technology",fullTitle:"Recent Improvements of Power Plants Management and Technology"},signatures:"Simona Vasilica Oprea and Adela Bâra",authors:[{id:"139804",title:"Prof.",name:"Adela",middleName:null,surname:"Bara",slug:"adela-bara",fullName:"Adela Bara"},{id:"188586",title:"Dr.",name:"Simona Vasilica",middleName:null,surname:"Oprea",slug:"simona-vasilica-oprea",fullName:"Simona Vasilica Oprea"}]},{id:"55019",title:"Spatial Aspects of Environmental Impact of Power Plants",slug:"spatial-aspects-of-environmental-impact-of-power-plants",totalDownloads:1323,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Strategic Environmental Assessment (SEA) is one of the key instruments for implementing sustainable development strategies in planning in general, namely for analysing and assessing the spatial development concepts, in this case in the field of energy and planning of power plants. The SEA in energy sector planning has become a tool for considering the benefits and consequences of the proposed changes in space, also taking into account the capacity of space to sustain the implementation of the planned activities. This chapter examines the multi-criteria evaluation (MCE) method for carrying out an SEA for the power plants in Energy Sector Development Strategy of the Republic of Serbia (case study). The MCE method has found its use in the analysis and assessment of the energy sector spatial impacts on the environment and elements of sustainable development and, in this context, also considering the importance of impacts, spatial dispersion of impacts, their probability and frequency of occurrence, along with the elaboration of the obtained results in a specific, simple and unambiguous way. The chapter focuses on the consideration of aspects of environmental impact of all kinds of power plants, without taking into account the details regarding other aspects of energy sector development that are dealt with in the case study.",book:{id:"5807",slug:"recent-improvements-of-power-plants-management-and-technology",title:"Recent Improvements of Power Plants Management and Technology",fullTitle:"Recent Improvements of Power Plants Management and Technology"},signatures:"Boško Josimović and Saša Milijić",authors:[{id:"125578",title:"Dr.",name:"Bosko",middleName:null,surname:"Josimovic",slug:"bosko-josimovic",fullName:"Bosko Josimovic"},{id:"200736",title:"Dr.",name:"Sasa",middleName:null,surname:"Milijic",slug:"sasa-milijic",fullName:"Sasa Milijic"}]},{id:"64317",title:"Hybrid Power Plants: A Case Study",slug:"hybrid-power-plants-a-case-study",totalDownloads:1161,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Energy can be treated as an essential element for the development of society. Therefore, aspects like process’ efficiency and environmental impacts must be considered when choosing the supply source. In Brazil, an event showed the fragility of a system that relies on in only one source to attend their necessities; a truckers strike made the whole country stop. The energy sector has a similar situation; more than 60% of Brazilian energetic matrix is represented by one source, hydroelectric power plants. The availability of solar radiation and wind in Brazil makes it possible to diversify its energetic matrix. Thus, the aim of this study is investigating the potential of hybrid solar-wind power plants in two basins of Minas Gerais—Brazil, São Francisco Basin and Jequitinhonha Basin, as well as compare their viabilities in order to address social issues. By analyzing INMET database and economic factors, the study has shown that it is feasible to implement renewable power plants in the basins of the study area, whether individually (solar or wind energy) or hybrid system. It shows in addition that hybrid system should be prioritized, since it presents lower cost, when compared to solar power plant, and more reliability due to seasonality of both sources.",book:{id:"6838",slug:"power-plants-in-the-industry",title:"Power Plants in the Industry",fullTitle:"Power Plants in the Industry"},signatures:"Eduarda Moreira Nascimento, Júnio de Souza Damasceno and\nSabrinne Kelly Souza",authors:[{id:"252477",title:"Dr.",name:"Junio",middleName:null,surname:"Damasceno",slug:"junio-damasceno",fullName:"Junio Damasceno"},{id:"262354",title:"Ms.",name:"Sabrinne",middleName:"Kelly",surname:"Souza",slug:"sabrinne-souza",fullName:"Sabrinne Souza"},{id:"262363",title:"BSc.",name:"Eduarda",middleName:null,surname:"Nascimento",slug:"eduarda-nascimento",fullName:"Eduarda Nascimento"}]},{id:"58753",title:"Detection of Malfunctions and Abnormal Working Conditions of a Coal Mill",slug:"detection-of-malfunctions-and-abnormal-working-conditions-of-a-coal-mill",totalDownloads:1161,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Coal mill malfunctions are some of the most common causes of failing to keep the power plant crucial operating parameters or even unplanned power plant shutdowns. Therefore, an algorithm has been developed that enable online detection of abnormal conditions and malfunctions of an operating mill. Based on calculated diagnostic signals and defined thresholds, this algorithm informs about abnormal operating conditions. Diagnostic signals represent the difference between the measured and the modeled values of two selected mill operating parameters. Models of mill motor current and outlet temperature of pulverized fuel were developed based on the linear regression theory. Various data analysis and feature selection procedures have been performed to obtain the best possible model. The model based on linear regression has been compared with two alternative models. The algorithm validation was carried out based on historical data containing values of operating parameters from 10 months of mill operation. Historical data were downloaded from distributed control system (DCS) of a 200-MW coal-fired power plant. Tests carried out on historical data show that this algorithm can be successfully used to detect certain abnormal conditions and malfunctions of the operating mill, such as feeder blockage, lack of coal and mill overload.",book:{id:"6332",slug:"thermal-power-plants-new-trends-and-recent-developments",title:"Thermal Power Plants",fullTitle:"Thermal Power Plants - New Trends and Recent Developments"},signatures:"Teresa Kurek, Konrad Wojdan, Daniel Nabagło and Konrad Świrski",authors:[{id:"179942",title:"MSc.",name:"Daniel",middleName:null,surname:"Nabagło",slug:"daniel-nabaglo",fullName:"Daniel Nabagło"},{id:"212957",title:"Dr.",name:"Teresa",middleName:null,surname:"Kurek",slug:"teresa-kurek",fullName:"Teresa Kurek"},{id:"212961",title:"Dr.",name:"Konrad",middleName:null,surname:"Wojdan",slug:"konrad-wojdan",fullName:"Konrad Wojdan"},{id:"212962",title:"Prof.",name:"Konrad",middleName:null,surname:"Świrski",slug:"konrad-swirski",fullName:"Konrad Świrski"},{id:"212963",title:"MSc.",name:"Łukasz",middleName:null,surname:"Śladewski",slug:"lukasz-sladewski",fullName:"Łukasz Śladewski"}]},{id:"72177",title:"Nuclear Power Plant or Solar Power Plant",slug:"nuclear-power-plant-or-solar-power-plant",totalDownloads:700,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Both solar energy and nuclear energy face significant economic challenges. Sustainable energy costs have traditionally been greater than any of those associated with the growth of fossil fuel power generation, although the costs of renewable energy technologies (especially photovoltaic) have dropped. Furthermore, capital costs remain a big challenge in the nuclear generation. In many nations, the cost of building small nuclear power plants is quite large due to time, technology, and environmental and safety challenges for consumers. Such problems might not be as big for state-owned corporations or controlled industries for which utilities have quick access to cheap resources, and this partially explains why the interest for nuclear reactors in Asia is far greater than in the United States or Europe. Learning could help decrease costs for both types of technologies, but the track record for learning-by-doing in the nuclear sector is not good.",book:{id:"9888",slug:"nuclear-power-plants-the-processes-from-the-cradle-to-the-grave",title:"Nuclear Power Plants",fullTitle:"Nuclear Power Plants - The Processes from the Cradle to the Grave"},signatures:"Mostafa Esmaeili Shayan and Farzaneh Ghasemzadeh",authors:[{id:"317852",title:"Ph.D.",name:"Mostafa",middleName:null,surname:"Esmaeili Shayan",slug:"mostafa-esmaeili-shayan",fullName:"Mostafa Esmaeili Shayan"},{id:"319145",title:"Prof.",name:"Farzaneh",middleName:null,surname:"Ghasemzadeh",slug:"farzaneh-ghasemzadeh",fullName:"Farzaneh Ghasemzadeh"}]}],onlineFirstChaptersFilter:{topicId:"803",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"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"}}}},{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"}}}}]},series:{item:{id:"13",title:"Veterinary Medicine and Science",doi:"10.5772/intechopen.73681",issn:"2632-0517",scope:"Paralleling similar advances in the medical field, astounding advances occurred in Veterinary Medicine and Science in recent decades. These advances have helped foster better support for animal health, more humane animal production, and a better understanding of the physiology of endangered species to improve the assisted reproductive technologies or the pathogenesis of certain diseases, where animals can be used as models for human diseases (like cancer, degenerative diseases or fertility), and even as a guarantee of public health. Bridging Human, Animal, and Environmental health, the holistic and integrative “One Health” concept intimately associates the developments within those fields, projecting its advancements into practice. This book series aims to tackle various animal-related medicine and sciences fields, providing thematic volumes consisting of high-quality significant research directed to researchers and postgraduates. It aims to give us a glimpse into the new accomplishments in the Veterinary Medicine and Science field. 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After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. 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A dynamic career research platform which is based on the thematic areas of comparative vertebrate physiology, stress endocrinology, reproductive endocrinology, animal health and welfare, and conservation biology. \nEdward has supervised 40 research students and published over 60 peer reviewed research.",institutionString:null,institution:{name:"University of Queensland",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null},{id:"20",title:"Animal Nutrition",coverUrl:"https://cdn.intechopen.com/series_topics/covers/20.jpg",isOpenForSubmission:!0,editor:{id:"175967",title:"Dr.",name:"Manuel",middleName:null,surname:"Gonzalez Ronquillo",slug:"manuel-gonzalez-ronquillo",fullName:"Manuel Gonzalez Ronquillo",profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",biography:"Dr. Manuel González Ronquillo obtained his doctorate degree from the University of Zaragoza, Spain, in 2001. He is a research professor at the Faculty of Veterinary Medicine and Animal Husbandry, Autonomous University of the State of Mexico. He is also a level-2 researcher. He received a Fulbright-Garcia Robles fellowship for a postdoctoral stay at the US Dairy Forage Research Center, Madison, Wisconsin, USA in 2008–2009. He received grants from Alianza del Pacifico for a stay at the University of Magallanes, Chile, in 2014, and from Consejo Nacional de Ciencia y Tecnología (CONACyT) to work in the Food and Agriculture Organization’s Animal Production and Health Division (AGA), Rome, Italy, in 2014–2015. He has collaborated with researchers from different countries and published ninety-eight journal articles. He teaches various degree courses in zootechnics, sheep production, and agricultural sciences and natural resources.\n\nDr. Ronquillo’s research focuses on the evaluation of sustainable animal diets (StAnD), using native resources of the region, decreasing carbon footprint, and applying meta-analysis and mathematical models for a better understanding of animal production.",institutionString:null,institution:{name:"Universidad Autónoma del Estado de México",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"28",title:"Animal Reproductive Biology and Technology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/28.jpg",isOpenForSubmission:!0,editor:{id:"177225",title:"Prof.",name:"Rosa Maria Lino Neto",middleName:null,surname:"Pereira",slug:"rosa-maria-lino-neto-pereira",fullName:"Rosa Maria Lino Neto Pereira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9wkQAC/Profile_Picture_1624519982291",biography:"Rosa Maria Lino Neto Pereira (DVM, MsC, PhD and) is currently a researcher at the Genetic Resources and Biotechnology Unit of the National Institute of Agrarian and Veterinarian Research (INIAV, Portugal). 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She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",institutionURL:null,country:{name:"Portugal"}}}]},{type:"book",id:"7144",title:"Veterinary Anatomy and Physiology",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7144.jpg",slug:"veterinary-anatomy-and-physiology",publishedDate:"March 13th 2019",editedByType:"Edited by",bookSignature:"Catrin Sian Rutland and Valentina Kubale",hash:"75cdacb570e0e6d15a5f6e69640d87c9",volumeInSeries:2,fullTitle:"Veterinary Anatomy and Physiology",editors:[{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",institutionURL:null,country:{name:"United Kingdom"}}}]},{type:"book",id:"8524",title:"Lactation in Farm Animals",subtitle:"Biology, Physiological Basis, Nutritional Requirements, and Modelization",coverURL:"https://cdn.intechopen.com/books/images_new/8524.jpg",slug:"lactation-in-farm-animals-biology-physiological-basis-nutritional-requirements-and-modelization",publishedDate:"January 22nd 2020",editedByType:"Edited by",bookSignature:"Naceur M'Hamdi",hash:"2aa2a9a0ec13040bbf0455e34625504e",volumeInSeries:3,fullTitle:"Lactation in Farm Animals - Biology, Physiological Basis, Nutritional Requirements, and Modelization",editors:[{id:"73376",title:"Dr.",name:"Naceur",middleName:null,surname:"M'Hamdi",slug:"naceur-m'hamdi",fullName:"Naceur M'Hamdi",profilePictureURL:"https://mts.intechopen.com/storage/users/73376/images/system/73376.jpg",biography:"Naceur M’HAMDI is Associate Professor at the National Agronomic Institute of Tunisia, University of Carthage. He is also Member of the Laboratory of genetic, animal and feed resource and member of Animal science Department of INAT. He graduated from Higher School of Agriculture of Mateur, University of Carthage, in 2002 and completed his masters in 2006. Dr. M’HAMDI completed his PhD thesis in Genetic welfare indicators of dairy cattle at Higher Institute of Agronomy of Chott-Meriem, University of Sousse, in 2011. 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