Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
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We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\n
Throughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\n
We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
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After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. 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In the past, Pan et al. proposed two algorithms to find the optimal locations of base stations in two-tiered wireless sensor networks. Their approaches assumed the initial energy and the energy-consumption parameters were the same for all application nodes. If any of the above parameters were not the same, their approaches could not work. Recently, the PSO technique has been widely used in finding nearly optimal solutions for optimization problems. In this paper, an algorithm based on particle swarm optimization (PSO) is thus proposed for general power-consumption constraints. The proposed approach can search for nearly optimal BS locations in heterogeneous sensor networks, where application nodes may own different data transmission rates, initial energies and parameter values. Experimental results also show the good performance of the proposed PSO approach and the effects of the parameters on the results. The proposed algorithm can thus help find good BS locations to reduce power consumption and maximize network lifetime in two-tiered wireless sensor networks. 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\r\n\tThis book is about the various diseases that could result due to exposure to different kinds of occupational settings. Usually, it is difficult to link certain diseases to specific occupations due to a longer latency period. However, compelling shreds of evidence are required to establish the strong relationship between the diseases and the occupations that may actually lead to the occurrence of those diseases.
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She is an active researcher in the field of occupational health and industrial safety. Also, she is a graduate member of the Institution of Occupational Safety and Health (IOSH).",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"311189",title:"Dr.",name:"Kavitha",middleName:null,surname:"Palaniappan",slug:"kavitha-palaniappan",fullName:"Kavitha Palaniappan",profilePictureURL:"https://mts.intechopen.com/storage/users/311189/images/system/311189.jpg",biography:"Associate Professor Dr. Kavitha Palaniappan is the academic director at Newcastle Australia Institute of Higher Education (Singapore), a wholly-owned entity of the University of Newcastle, Australia. She teaches the program of Bachelor of Environmental and Occupational Health and Safety (BEnvOHS). Apart from teaching, Dr. Palaniappan is also actively involved in multi-disciplinary research, including the prevalence of psychosocial illnesses and their impacts on society, economy and country. She also researches alternative therapies to enhance sleep, yoga and its health benefits, the toxicity of nanomaterials, exposure measurements and hygiene requirements for nano-titanium dioxide, exposure to nano-silver in mattresses and beddings and their health effects, associations between seasonal patterns, climate variables, and dengue risks in Singapore. 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\n\t\t\t
1. Introduction
\n\t\t\t
Urinary tract infections (UTIs) and their complications represent one of the most common causes of medical consultation with high cost to medical services and high morbidity and mortality. Urinary stones are another medical challenge that represents an acute or chronic clinical setting for patients requiring most of the time active treatment, either as an invasive or as a non-invasive management, thus increasing costs and risks. The combination of both clinical scenarios —urinary tract infection and urinary stone— is common and can trigger a systemic inflammatory response syndrome (SIRS) before, during or after medical treatment (i.e. antibiotics) and/or surgical manipulation of infected urinary stones. It is believed that SIRS is due to the release of endotoxins from infected urinary stones, developing endotoxemia, bacteremia and urosepsis. If not controlled, multiple organ failure syndrome (MOF) and death of the patient may occur. Urologists are familiar with these scenarios where not only prevention and diagnosis but also an early and appropriated treatment is crucial. Unfortunately, the use of prophylactic antibiotics does not guarantee prevention of these fatalities. The aim of this chapter is to review the evidence of possible endotoxin release during invasive and non-invasive treatment of infected urinary stones as a trigger of SIRS and sepsis.
\n\t\t
\n\t\t
\n\t\t\t
2. Urinary tract infections
\n\t\t\t
Urinary tract infections are the second most frequent infections in developed countries and uropathogenic Escherichia coli (E. coli) a non-urea-splitting bacterium represents 80 % of uncomplicated UTIs (Oelschlaeger et al., 2002). There is a geographic variation about E. coli and several other Gram-negative, as well as Gram-positive bacteria and fungi causing complicated and uncomplicated UTIs among specific populations. Virulence of bacteria causing UTIs is determinant for progression of the disease. Some virulence factors in uropathogenic E. Coli, as adhesins (Type 1 pili, Dr-family pili, P fimbriae, F1C fimbriae, S fimbriae) and toxins (CNF1, Hemolysin and Sat) (Oelschlaeger et al., 2002), could explain the systemic forms of invasion of the bloodstream by some Enterobacteriaceae in possible synergism with the release of endotoxins that may result in SIRS and urosepsis. These virulence factors are reviewed elsewhere in this book.
\n\t\t\t
\n\t\t\t\t
2.1. Urinary bacterial epidemiology
\n\t\t\t\t
Urinary tract infections in Western countries are mainly caused by E. coli (90 %), Proteus spp, Klebsiella spp, and Pseudomonas spp (McRae & Shortliffe, 2000; Bochud & Calandra, 2003). Variation in proportions and specific populations have been reported and described (Foxman, 2003; Savas et al., 2006). Bacterial resistance is another important issue that increases morbidity and mortality. For further details and specific information about bacterial epidemiology in UTIs we invite the reader to consult other sections of this book.
\n\t\t\t\t
\n\t\t\t\t\t
2.1.1. Endotoxins
\n\t\t\t\t\t
To invade hosts, bacteria use a variety of substances, some of them are essential for their survival. In Gram-negative bacteria, specific molecular patterns composed of lipid and sugar moieties represent some of the most toxic virulence factors of bacterial origin. Structurally classified as lipopolysaccharides (LPS), these substances have no chemical homologs among human cells, and are known as endotoxins, to denote their ability for causing fever, shock and organ injury when released in mammalian endothelial vessels (Beutler, 2000). The presence of endotoxins in the blood-stream is named endotoxemia and can trigger SIRS. LPS have specific structural motifs which are typical of different bacterial species. However, all of them are known to induce endotoxemia and sepsis (Bochud & Calandra, 2003). Endotoxins are known to be recognized by cell-surface proteins, the LPS receptors, which are widely distributed in animals as part of their immune systems (from insects to vertebrates). However, a strong inflammatory reaction after LPS recognition is restricted to a handful of species, including humans (Beutler, 2000). According to numerous studies in cellular and animal models, recognition of LPS by their receptors initiate a cascade of intracellular signals guiding the secretion of pro-inflammatory mediators (Beutler, 2000; Triantafilou & Triantafilou, 2005). An emerging concern is the toxicity of LPS after microbial death, especially in the context of hospital-acquired infections. In fact, released LPS keep their full toxic potential, unless inactivation processes take place in the host to degrade endotoxins (Munford et al., 2009).
\n\t\t\t\t
\n\t\t\t
\n\t\t
\n\t\t
\n\t\t\t
3. Urinary stones
\n\t\t\t
Urinary stones have been reported in human history since antiquity. Traditionally, stones have been classified according to their main mineral content. The etiology of urinary stones is wide, including chronic dehydration, urinary tract malformations, obstructed uropathy, metabolic diseases (i.e. hyperparathyroidism, gout, and obesity), foreign body inside urinary tract, infections, etc. The risk for stone disease in patients of developed countries is close to 10 % life-long. An increase in the incidence of stone disease related with changes in the life style, modifications on the diet, morbid obesity surgery syndrome and new drugs has been reported in Western countries in recent years. For example, in the United States, an increase of 37 % in stone disease was observed over the last 20 years (Straub & Hautmann, 2005). A variation in the frequency and in the composition of the minerals forming the urinary stones was also observed.
\n\t\t\t
There is a large variety of urinary stone compositions. If the main component is more than 80 % of the total mass, the stone is named “pure”. If the main component is at least 50 % of the stone, it is named mixed. In Western countries, struvite stones used to represent 15-30 % of cases. Nowadays only 2 % of stones are struvite (McALeer et al., 2003; Kramer et al., 2000). The explanation of that decrease is unknown. In developing countries and Eastern countries there is a large variation among incidence, prevalence and stone composition. For example, in India a report including 1050 urinary calculi from surgically treated patients (900 renal and 150 ureteral) revealed 93.04 % oxalate calcium stones (80 % calcium oxalate monohydrate [COM] and 20 % calcium oxalate dihydrate [COD]), 1.92 % struvite stones, 1.48 % apatite stones, 0.95 % uric acid stones and 2.96 % mixed stones. Surprisingly, 89.98 % of the staghorn stones consisted of oxalates and only 4.2 % were struvite (Ansari et al., 2005). A study in Japan showed that the most common stone composition was struvite (32.1 %) and mixed calcium oxalate phosphate (22.2 %) (Akagashi et al., 2004). These differences could be explained by variations in ethnics, epigenetics, geographical area, diet, life-style, and different metabolism.
\n\t\t\t
\n\t\t\t\t
3.1. Infected stones
\n\t\t\t\t
It has been suggested that urinary stones can be infected mainly in two ways. Stones develop due to several mechanisms which may or may not be associated to obstructive uropathy (i.e. hyperparathyroidism). The first way in which a stone can be infected is by ascending bacteria. Once the stone is formed, ascending bacteria may reach its surface, invade the interstice and become part of it (Takeuchi et al., 1984; Abrahams & Stoller, 2003). Adherence of new minerals could cover and paste bacteria layers. In this case, the stone acts as a reservoir for bacteria. Due to the poor penetration of drugs into the stone matrix the action of antibiotics is limited (Prabakharan et al., 1999). This phenomenon can be the reason of bacterial resistance, repeated, chronic or complicated UTIs in several patients, therefore increasing the risk of urosepsis. The most possible scenario according to the most frequent stone component and urinary bacteria in our Western world is a calcium stone infected with E. coli. In this case, the urinary stone forms first and gets infected by bacteria afterwards.
\n\t\t\t\t
The second scenario is that bacteria living inside the urinary tract and causing chronic UTIs produce the stones. These bacteria are named urea-splitting bacteria. Members of this group are Proteus, Klebsiella, Pseudomonas, Providencia, Serratia spp, Staphylococcus aureus and Ureaplasma urealyticum, among others. P. mirabilis accounts for more than half of all urease-positive urinary infections (Kramer et al., 2000). Urea-splitting bacteria change the urine pH (> 7.2) and allow easier precipitation of phosphate with several compounds, mainly ammonium and magnesium (Abrahams & Stoller, 2003). The result is a compound phosphate named struvite (magnesium-ammonium-phosphate [MAP] stones and/or triple phosphate stones). Another type of phosphate stones are apatite stones (calcium phosphate). The terms “infectious stones” or “infection stones” are used as synonymous of struvite stones and represent up to 15 % of all stones sent for analysis in the Western world (Kramer et al., 2000). Infected stones that contain struvite may originate de novo, but often pre-existing stones are infected with urea-splitting bacteria (Kramer et al., 2000). There is evidence that urinary tract infections caused by urease-producing microorganisms are not exclusively related to the formation of struvite stones. Considering this scenario, Proteus mirabilis and struvite stones are the most likely combination. In this case, the risk for urosepsis is also patent.
\n\t\t\t\t
It has been suggested that some agents named nanobacteria could have a role in the development of calcium-based urinary stones (Kajander & Çiftçioglu, 1998); however, this is not yet well established (Kramer et al., 2000). A prevalence of nanobacteria in 0.5 % of 1000 stones was reported; but nanobacteria are still difficult to identify (Abrahams & Stoller, 2003).
\n\t\t\t\t
\n\t\t\t\t\t
3.1.1. Bacterial epidemiology of infected urinary stones
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Urinary stone cultures from fragments retrieved during stone surgery were not a common practice until recently. Negative urine culture before urinary surgery was considered safe. In general urology it has been a routine to have a negative midstream urine culture before doing any endoscopic procedure. Recent studies suggest that voiding urine culture is not representative of upper urinary tract pelvis infection or pelvis infected stone bacteria (Mariappan & Loong, 2004; Mariappan et al., 2005a). A group of 73 patients with unilateral stone-obstructed ureter were treated with ureterorenoscopy and lithotripsy. Midstream urine (MSU) sample culture and sensitivity were performed the morning of the endoscopic surgery. During the procedure a pelvis urine sample and stone fragments were collected for culture and sensitivity with an aseptic technique in a retrograde approach. The authors reported that 25 (34.3 %) patients had positive stone culture, 43 (58.9 %) had positive pelvic urine and 21 (28.8 %) had positive MSU culture. The most common isolated bacterium was E coli. The MSU culture and sensitivity test had 30.2 % sensitivity and 73 % specificity to detect pelvic urine culture and sensitivity. The same test had a low positive predictive value and negative predictive value in relation to infected pelvic urine (positive predictive value = 0.62, negative predictive value = 0.42) (Mariappan & Loong, 2004). According to these authors, in case of a ureteral obstructive uropathy secondary to a stone, MSU culture and sensitivity do not represent infected urine proximal to the obstruction or infected stone. Stone components were not analyzed. In conclusion, pelvic urine and stone cultures were considered as a more appropriate indicator of upper urinary tract infection. Collection of the obstructed urine for culture and sensitivity are recommended.
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\n\t\t\t\t\t\tMariappan and colleagues (2005a) studied a group of 54 patients with renal stones who were candidates for percutaneous nephrolithotomy (PCNL). Various specimens were collected for culture and sensitivity, i.e., MSU sample, bladder urine sample, renal pelvic urine sample and crushed stone sample. The objective of the study was to identify the most predictive analysis of urosepsis. MSU culture was positive in 11.1 % of cases, stone culture was positive in 35.2 % and pelvic urine was positive in 20.4 % of cases. A wide variety of bacteria were isolated. In 37 % of the patients SIRS was developed and 5.5 % experienced septic shock. Pelvic urine culture predicted infected stones better than bladder urine culture. Patients with infected stones or pelvic urine were found to be at a relative risk for urosepsis that was at least four times greater (P = 0.0009). The authors concluded that positive stone and pelvic urine are better predictors of potential urosepsis than bladder urine and recommend routine collections of these specimens. Stone components were not analyzed. The bacterial epidemiology of infected urinary stones also depend on differences in geographic area, strains, bacterial resistance, bacterial virulence, exposure to some kind of antibiotics and environment.
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4. Sepsis and urosepsis
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Sepsis is an extreme health condition that threatens life of patients with a high cost for the healthcare systems. Reports from US and European surveys have estimated that severe sepsis accounts for 2–11 % of all admissions to hospitals or intensive care units. The most common microbes isolated from patients with severe sepsis and septic shock are Gram negative bacilli (mainly E. coli, Klebsiella species and Pseudomonas aeruginosa) and Gram positive cocci (mainly Staphylococci and Streptpcocci spp). Most cases of Gram negative sepsis are caused by E coli and Klebsiella species followed by P. aeruginosa. Infections usually occur in the lung, abdomen, bloodstream, or urinary tract (Bochud & Calandra, 2003). In a trial performed in an intensive care unit with 142 septic patients having a urinary catheter, urosepsis occurred in 15.8 % of them (Rosser et al., 1999). Urosepsis in adults comprises approximately 25 % of all sepsis cases and in most cases is due to complicated urinary tract infections (Wagenlehner et al., 2007). An incidence of sepsis associated with obstructed uropathy and urinary stones treated surgically has also been reported in 1.28 % of cases (O\'Keeffe et al., 1993). Rao et al. (1991) found an incidence of septic shock after endoscopic manipulation for urinary stone in about 1% of treated patients. Sepsis is an advanced stage of uncontrolled systemic inflammatory response syndrome that may turn toward irreversible multiple organ failure and death.
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5. Endotoxins and sepsis
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Activation of local and systemic metabolic response to trauma and SIRS is mainly caused by activation of IL-1 and tumor necrosis factor-α (TNF-α). It is well established that after recognition by cognate receptors, LPS trigger the synthesis and release of pro-inflammatory cytokines (Triantafilou & Triantafilou, 2005). Once IL-1 and TNF are secreted, they activate several other reactions like complement factors, exacerbating the host inflammatory response. As a consequence, MOF or death may result. In vitro human blood monocytes produce IL-1 and TNF-α when they are exposed to 25 to 50 pg/mL of endotoxin concentration. These endotoxin levels have been reported in the bloodstream of patients during septic shock (Dinarello & Cannon, 1993). In a clinical report of 97 consecutive patients, 56 % developed sepsis syndrome with about 26 pg/mL of TNF-α.; 37 % had 20 pg/mL of IL-1 and in 80 %, 415 pg/mL of IL-6 was detected, including a LPS mean concentration of 2.6 endotoxin units (EU)/mL (1 EU/mL = 0.6 ng/mL) (Casey et al., 1993). The level of procalcitonin has also been used as a sepsis marker. Another assay with healthy volunteers demonstrated elevation of procalcitonin (peak up to about 4 ng/mL at 6 hours) after I.V. administration of 4 ng/kg of body weight of endotoxin derived from E coli 0113:H10:k (Dandona et al., 1994). In a new human model of low grade inflammation, 10 healthy male subjects were exposed to 3 ng/kg body weight of endotoxin (LPS) derived from E. coli in I.V. bolus injection versus I.V. infusion during 4 hours. Results revealed that TNF-α, IL-6 and neutrophil response were earlier and more pronounced in the bolus trial, suggesting that sudden release of endotoxins triggers faster and higher release of cytokines and inflammatory mediators similar to sepsis. Changes in cytokines measured in the infusion trial would be a more representative model of human systemic low-grade inflammation in chronic disease (Taudorf et al., 2007).
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6. Infected urinary stones and urosepsis
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In a study on 700 patients, the prevalence of sepsis related with obstructed uropathy and urinary stones treated surgically was 1.28 %. These nine patients developed SIRS and sepsis during 6 hours postoperative. Although males and females were treated in roughly equal proportions, all of the patients who developed severe sepsis were females. There were six deaths accounting for 66 % mortality (O\'Keeffe et al., 1993). Septic shock following urinary stone manipulation was reported with an incidence of 1 % and mortality up to 80 % (Rao et al., 1991).
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In an effort to predict septicemia following endourological manipulation for stones in the upper urinary tract, 117 patients were studied and classified according to the procedure performed (Rao et al., 1991): Percutaneous nephrolithotomy, push-back/push-bang procedure, double-J and extracorporeal shock wave lithotripsy (SWL), ureteroscopy, SWL alone and only cystoscopy. Blood samples for bacterial culture, endotoxin and tumor necrosis factor assay were collected before, at onset, at the end and one hour after completing the procedure. Preoperative bacteriuria was present in 35 % of the patients. The mean endotoxin level of the entire group —except the cystoscopy group— was 16.2 pg/mL (range 11 to 58.3 pg/mL). In the cystoscopy group the mean endotoxin level was 11.7 pg/mL (range 11 to 12.2 pg/mL). All patients (16) with preoperative endotoxemia had increased levels of endotoxin detected in subsequent samples (mean increase 15 pg/mL, range 0.5 to 64 pg/mL). The tumor necrosis factor was greater than 15 pg/mL in four cases preoperatively. Postoperatively there was elevation of the tumor necrosis factor only in 12 patients. The authors reported that in case of upper urinary tract manipulation, the risk of bacteremia was higher. The risk was greatest after performing the push-back method and least after cystoscopy. Combination of preoperative endotoxemia, bacteriuria and the type of procedure had 85 % of sensitivity, 84 % of specificity and a positive predictive value of 52 % for the development of postoperative bacteremia. A total of 41 patients had pyrexia and 17 patients had rigors and fever 2 to 3 hours after the end of the procedure. No patient suffered septic shock; however, this complication developed in a female patient one week after percutaneous nephrolithotomy. Serum endotoxin and tumor necrosis factor levels after admission of this patient to the intensive care unit were 67.7 pg/mL and 3,827.5 pg/mL, respectively (Rao et al., 1991).
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Measurements of LPS were done in 34 renal stones, stored for several months and classified as infection stones (16), i.e., struvite and calcium apatite, and non-infection stones (18) composed of 50 % calcium oxalate monohydrate (McALeer et al., 2003). All stones were weighed, aseptically crushed and aliquots were tested for endotoxins. Four stones of each group were aseptically washed and crushed separately. Washed materials and crushed stones were processed in MacConkey agar culture to recover bacteria colonizing the stones. Mean endotoxin concentration in the infection group was 12,223 ng per gram of stone and 340.3 ng per gram of stone in the non-infection group. The difference was statistically significant (P = 0.001). These results reveal an almost 36 times higher concentration of endotoxins in the infection stones. No living bacteria were recovered on the MacConkey plates from crushed stones from neither group. The authors concluded that large amounts of endotoxins can be found in infected renal stones even months after they were removed from the body, and long after viable bacteria could be detected. Furthermore, endotoxin may remain after bacteria are no longer viable or have been killed with antibiotic therapy (Munford et al., 2009). Non-infectious stones can also contain endotoxin but in a lower amount (McALeer et al., 2003). McALeer et al. (2002) published a case report of an 8 year old boy with a left staghorn calculus treated with holmium laser percutaneous nephrolithotripsy (PCNL). Culture specific antibiotic were administered to the patient, both orally and intravenously, before, during and after surgery. Intraoperative fluid and pleural fluid cultures (urologists lost percutaneous access from lower pole calyx with intraperitoneal extravasation and pleural effusions) were obtained. A urine culture was performed before and after stone manipulation. All samples grew a few colonies of Proteus mirabilis. Blood cultures were requested but could not be obtained; serum endotoxin results could not be obtained either. Two hours after procedure the patient developed disseminated intravascular coagulopathy. Twelve hours after stone manipulations the patient died despite aggressive support care. Stone composition was apatite (80%) and struvite (10%). Post-mortem culture of the stone grew several colonies of Proteus mirabilis. The assay of the stone fragments for endotoxin showed concentrations of 285,600 pg per gram, suggesting that endotoxemia can induce sepsis syndrome without concomitant bacteremia. The authors concluded that the outstanding endotoxin concentration of the renal stone was the source of the fatal outcome.
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There is not a general consensus on how to best prevent sepsis in patients undergoing surgical treatment of urinary stones. Pre-surgical, trans-surgical and post-surgical strategies have been proposed. The combination of multiple factors can prevent, trigger or worsen sepsis. For example, control of metabolic or cardiopulmonary diseases is important. Although antibiotic prophylaxis does not completely avoid the risk of developing sepsis, it is a recommendation for stone surgery according to the American Urological Association (AUA) and the European Association of Urology (EAU) guidelines on urinary tract infection (Grabe et al., 2011; Wolf et al., 2010). It is suggested to define an antibiotic prophylaxis according to local bacterial populations, resistance and antibiotic sensitivity patterns. In a prospective controlled trial, Mariappan et al. (2006) and Bag et al. (2011) reported the beneficial use of one week ciprofloxacin and nitrofurantoin regimen respectively, before percutaneous nephrolithotomy. Furthermore it has been found that renal stones larger than 20 mm are more likely to be culture positive (Mariappan et al., 2005a; 2005b). Mariappan and colleagues (2005a) suggested to obtain pelvic urine and stone samples for culture and sensitivity as a routine during surgical stone procedures, with the aim of administering proper antibiotic regimen if later urosepsis develops. If an unusual urine sample (i.e. turbidity, foully) is obtained, culture and sensitivity is a must. In this case, a nephrostomy tube should be left in place and the initial procedure rescheduled until sterile urine is confirmed.
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An increase of pressure inside the urinary tract system generated by the irrigation fluid results in a potential bacterial and endotoxin translocation into the bloodstream. Auge et al. (2004) reported significant reduction in urinary tract pressures using ureteral access sheath if working both in distal ureter and inside the renal pelvis. Bacteria and likely endotoxins may emerge from several kinds of urinary stones and not exclusively from struvite stones (Hugosson et al., 1990; McALeer et al., 2003). In post-surgical stage, the most critical evidences of SIRS are during the first 6 hours post-procedure and seem to correlate with cytokines release into the bloodstream after endotoxin stimulus (Dandona et al., 1994; O\'Keeffe et al., 1993; Rao et al., 1991; Taudorf et al., 2007). It has been suggested that if other causes of SIRS different than infection (i.e. cardiogenic or pulmonary events, atelectasis, hypovolemia and pain) have been ruled out and if SIRS persists, then sepsis could be the explanation (Monga, 2005). Close vital signs and symptoms monitoring and high suspicious index for sepsis is crucial at this stage. Once urosepsis is diagnosed, an early tissue oxygenation, appropriate initial antibiotic therapy, inotropic and nutritional support with invasive monitoring at intensive therapy unit is required. Empirical broad-spectrum antibiotics regimen is prescribed according to local bacteria, sensitivity and resistance patterns. If cultures were performed from bladder urine, pelvis urine or stone sample, direct therapy must be installed as soon as results are obtained (Mariappan et al., 2005b). Wagenlehner and his group (2007) reported that the treatment of urosepsis comprises four major aspects: Early goal-directed therapy, optimal pharmacodynamics exposure to antimicrobials both in blood and in the urinary tract, control of complicating factors in the urinary tract and specific sepsis therapy. They considered that interdisciplinary approach is necessary to achieve an optimal goal of treatment. At any of these stages, it is very important to act as soon as possible if any evidence of initial SIRS and urosepsis is addressed. It is necessary to instruct the patient and relatives once discharged from the hospital, that if SIRS develops, urgent evaluation in an emergency unit is crucial (Rao et al., 1991). There is no doubt that further research is required and that several other issues have to be considered; however, these do not fall within the scope of this chapter.
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7. Research on bacterial suspensions and extracorporeal shock wave lithotripsy
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Several articles report the bactericidal effect of shock waves in vitro; however, results remain controversial. Elbers et al. (1988) observed no effect of shock waves on calculi inoculated with urease-positive calculogenic bacteria. Bacteria from different genera and species have different resistances to physical, chemical and environmental factors; such variations in bacteria may determine the degree of susceptibility to shock waves. For instance, we have previously found that shock wave-induced cavitation contributes to L. monocytogenes, S. typhimurium and E. coli O157:H7 inactivation; however, L. monocytogenes was more sensitive to shock waves than E. coli O157:H7 (Alvarez et al., 2004). Kerfoot and colleagues (1992) found no effect of shock wave application on S. aureus; however von Eiff et al. (2000) reported inactivation of a different strain of the same bacteria. Similarly, whereas Ohshima et al. (1992) observed no effect of shock waves on the viability of E. coli strains DSM 1077 and JM 109/pKPDH2, Loske et al. (1999) reported inactivation of E. coli strain ATCC 10536. Patel et al. (2005) reported no effect of shock waves on a five-stain cocktail of E. coli O157:H7, whereas Podolak et al. (2005) reported shock wave inactivation of a slightly different cocktail of the same E. coli. Various shock wave generators were used by these authors, which may explain their different results. When performing in vitro exposure of bacteria in suspension by shock waves generated with electrohydraulic shock wave generators, the electromagnetic radiation produced at the spark gap contributes to microorganism inactivation. During SWL this radiation (visible and UV) does not penetrate into the calculus. Besides, electromagnetic radiation, compression, tensile stress, and cavitation may also damage bacteria. Cavitation is produced by the trailing tensile pulse of the shock wave. A cloud of bubbles forms at the focus of every lithotripter after the passage of each shock wave. During collapse, they create secondary shock waves, powerful jet blasts of fluid (microjets), high temperature gradients, and free radicals (Crum, 1988). If a second shock wave is sent during, or shortly after, the stable phase of the bubbles, their collapse can be intensified. This technique, referred to as “tandem SWL” has proven to reduce in vivo SWL treatment time by 50 % (Fernández et al., 2009). To test the efficiency of tandem shock waves to inactivate bacteria, Alvarez and colleagues (2008) used an experimental piezoelectric tandem shock wave generator that generates two shock waves shifted in time. The effects of single and tandem shock waves on the viability of L. monocytogenes and E. coli O157:H7 suspensions were studied. Tandem shock waves were generated at delays of 450 and 900 microseconds. No effect on bacteria viability was reported after exposure to 8,000 single shock waves, but significant bacteria inactivation was reported after 3,400 tandem shock waves. The delay yielding the highest inactivation was 900 microseconds.
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8. Research with stone models
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Efforts to develop an ideal stone model have been done worldwide to perform in vitro and in vivo fragmentation tests exposing artificial stone models to different lithotripter energy settings. To study the inactivation of bacteria by shock waves and the bactericidal effect of different intracorporeal lithotripters, we developed an artificial calcium sulphate stone model infected homogenously with E. coli, a mixed struvite-calcium sulphate stone infected with P. mirabilis and a calcium sulphate stone infected with P. mirabilis.
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8.1. The bactericidal effect of intracorporeal lithotripters
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Only a few authors report results on the interaction of infected urinary stones with intracorporeal lithotripters. Artificial kidney stones, infected with E. coli, were manufactured by our research group to evaluate the bactericidal effect of shock waves, and the differences on intra-bacterial protein release produced by four different intracorporeal lithotripters. The stone models were exposed to a holmium laser, an electrohydraulic, a pneumatic and an ultrasonic intracorporeal lithotripter using two energy settings. Non-infected control stones were manufactured by casting a mixture of gypsum cement, Velmix-stone (Kerr Division of Syborn Corp., Romulus, MI, USA) and distilled water in cylindrical molds (diameter = 10 mm, height = 10 mm). A saline solution containing E. coli was used instead of distilled water to manufacture the infected stones. Cells were obtained in the stationary phase of growth. Stones were placed on a copper mesh with 1.8 mm by 1.8 mm openings at the bottom of a specially designed lucite test tube. The lucite tube was placed inside a standard laboratory test tube, containing 10 mL of saline solution. The tip of the lithotripter was introduced inside the lucite tube (see Figure 1). Five infected stones were fragmented with each lithotripter at each energy level (low and high) during a fixed time. After treatment all remaining stone fragments were crushed with a hand press. The suspension containing stone powder and bacteria was centrifuged, serially diluted and incubated on agar plates. Viable counts were made by plating on trypticase soy agar supplemented with 0.6 % (w/v) yeast extract (TSAY). Bactericidal action was defined as the logarithmic difference of colony forming units (CFU) per milliliter between untreated and treated stones. To study the effect of the lithotripters on bacteria living outside the stone, an E. coli suspension was exposed to the action of each lithotripter, using the same energy settings and exposure times as for infected stones. The process was repeated five times for each lithotripter at each energy setting. Stone fragmentation of infected stones was repeated as described before, in order to measure the release of protein (LPS) as a result of in vitro lithotripsy. After treatment, certain amount of the suspension was centrifuged and placed inside a spectrophotometer to measure absorbance at 280 nm. Results revealed that the variation in the amount of bacteria inside the stones was not significant. Complete inactivation resulted with the electrohydraulic lithotripter at both energy levels. No difference was observed between inactivation obtained with the other lithotripters at their low energy settings. Increasing the energy resulted in higher bacteria inactivation for the laser, pneumatic and ultrasonic lithotripter. The laser lithotripter produced the lowest bacteria inactivation. Inactivation increased as the energy setting of the laser, pneumatic and ultrasonic lithotripter was changed from low to high. No bacteria inactivation was observed using the pneumatic lithotripter in an E. coli suspension alone. No viable bacteria could be observed after using the laser, the electrohydraulic and the ultrasonic lithotripter in the infected suspension (without stone). Maximum protein release occurred at low energy with the electrohydraulic lithotripter and protein was denaturized by this lithotripter at the high energy setting. No difference was observed between the amount of protein released with the laser, the pneumatic, and the ultrasonic lithotripters at both energy levels. The four lithotripters inactivated more than 99 % of the initial amount of bacteria; however, this antibacterial effect does not necessarily indicate that lithotripters sterilize stone fragments. The presence of free endotoxins liberated from bacteria after lithotripsy may increase the risk of sepsis. These findings could explain local and systemic inflammation response by the immune system of some patients developing in SIRS and sepsis (Gutiérrez et al., 2008).
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Figure 1.
Photograph of the special lucite test tube with copper mesh bottom (not seen) placed inside a standard glass laboratory test tube during in vitro fragmentation of an artificial infected kidney stone with a laser lithotripter.
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Our group also studied the effect of the four above-mentioned intracorporeal lithotripters on the bacterial inactivation of artificial struvite stones inoculated with Proteus mirabilis. Again two energy settings were tested with each lithotripter, with exception of the pneumatic lithotripter, which was used only at one intensity. Calcium sulphate stones and struvite-gypsum stones were manufactured and homogeneously infected with P. mirabilis. Details on the methodology of producing infected stones can be found in the literature (Gutiérrez et al., 2008; Gómez-Núñez et al., 2009). Infected calcium sulphate and infected struvite-gypsum stones were exposed to each device at each intensity level until complete fragmentation. The treatment time was dependant on the lithotripter and the intensity level. After in vitro lithotripsy, the suspension containing stone debris and P. mirabilis was diluted and incubated on agar plates. A sham group of non-treated infected stones was crushed with a hand press to determine the amount of bacteria surviving inside the artificial stones. The whole experiment was repeated three times. The initial viable count in the sham group was about 6.02 log10 CFU/mL. Results revealed that all lithotripters inactivated a high percentage of P. mirabilis. No statistically significant difference was observed between calcium sulphate and infected struvite-gypsum stones (Gómez-Núñez et al., 2009). Prabakharan and colleagues (1999) reported an in vitro assay using 46 “natural” struvite stone models (fragments), sterilized in an autoclave and reinfected with P. mirabilis, coming from patients treated for urinary stones. The stones were exposed to shock waves generated with an extracorporeal lithotripter, as well as to the action of an ultrasonic, an electrohydraulic, a pneumatic, and a Holium:YAG laser intracorporeal lithotripter. No bacterial inactivation was observed, except for the laser intracorporeal lithotripter. A possible lack of this trial could be the variability of stone shape, composition, and non-homogeneous bacteria colonization of the stone.
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In conclusion, it seems that the stone material plays a minor role regarding bacterial inactivation due to intracorporeal lithotripsy. Furthermore, according to our results, intracorporeal lithotripters are very harmful to bacteria; however, whether bacterial destruction is desirable or not is still unknown.
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8.2. The bactericidal effect of extracorporeal lithotripters
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A reduction in bacteriuria and resolution of urinary tract infection after SWL has been reported by several authors (Beck & Riehle, 1991; Gerdesmeyer et al., 2005; Michaels et al., 1988; Pode et al., 1988); however, it is not known if the stone protects bacteria or if other mechanisms, such as shear, contribute to the bactericidal effect of shock waves. To answer these questions, infected stones were exposed in vitro to shock waves from both an electrohydraulic and a piezoelectric lithotripter. Energy comparable to that used in SWL was used, so that the stress on the bacteria was similar to that experienced by bacteria living inside calculi during shock wave treatment. Two types of artificial kidney stones (soft and hard) were manufactured by mixing different amounts of gypsum cement and Velmix-stone, as explained in the previous section. In this case the length and diameter of the models were about 7 mm and 8 mm, respectively. Salmonella enterica serovar typhimurium in the stationary phase of growth was used to inoculate the stones. Stones to be treated were placed inside a translucent polypropylene bag, filled with deionized water, heat sealed, and centered at the lithotripter focus. All fragments from shock wave treated stones, as well as a set of intact control stones, were completely crushed using a hand press until stone powder was obtained. All bags were opened and dilutions of the suspension containing stone powder and bacteria were inoculated on TSAY plates and incubated at 35 ºC. About 29 % of all bacteria were inactivated with the piezoelectric lithotripter and 14 % with the electrohydraulic lithotripter. This study demonstrated that the bactericidal action of shock waves is weaker inside the stones than in the fluid outside them (Quintero et al., 2008). Whether it is desirable for a lithotripter to inactivate instead of destroying bacteria is still to be answered.
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9. Conclusions
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Sepsis is a serious health condition with high mortality and cost. Advances in the manufacture of standardized infected stone models and in vitro assays could help to better understand the pathophysiology of sepsis associated to urinary tract infection alone and UTIs with infected stones. In vitro fragmentation of artificial stones could also help to understand and prevent the pathophysiology and phases of Gram negative sepsis. According to our initial results, living bacteria infecting urinary stones release endotoxins as part of their metabolic activity or as a consequence of bacteria lysis during intracorporeal and extracorporeal lithotripsy. Bacteria fragments could be a source of endotoxin even in the case of urine voiding and urine pelvis negative cultures. Further research related with release of LPS during lithotripsy and its relation with triggering sepsis is urgently needed. Absorption of LPS into the bloodstream by reflux due to open pyelolymphatic and pyelovenous channels during obstructive uropathy, bacterial translocation, interaction with lithotripters, increased irrigation pressure during endoscopic surgery, and rupture of the hemato-urinary barrier (microtrauma) should be studied. On the other hand, recent investigations (Soriano et al., 2005; Opal, 2003) have been revealing valuable information about sepsis mediators, such as cytokines, including tumor necrosis factor (TNF), interferons, complement factors or nitric oxide, anti-LPS host hydrolases, and bacterial factors. Translational studies focusing clinical strategies based on benchmark discoveries regarding LPS-triggered toxemia therefore represent a major task for the urologist. The main highlights of this chapter are summarized in Table 1.
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\n\t\t\t\t\t\t\tHighlights\n\t\t\t\t\t\t
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During sepsis, a 25 - 50 pg/mL LPS concentration has been reported in the bloodstream. LPS concentrations of up to 285,600 pg per gram stone have been reported in a fatal case of urosepsis. Release of LPS has been observed after in vitro lithotripsy to infected artificial kidney stones. \n\t\t\t\t\t\t\tIn vitro application of conventional single-pulse shock waves revealed a limited bactericidal effect against bacteria in suspension and bacteria inoculated inside artificial stones. \n\t\t\t\t\t\t\tIn vitro application of tandem shock waves to bacterial suspensions inactivates bacteria efficiently. \n\t\t\t\t\t\t\tIn vitro intracorporeal lithotripsy revealed an outstanding effect against bacteria in artificial infected urinary stones. The bactericidal effect of both extra- and intracorporeal lithotripsy should be studied carefully due the possible release of large amounts of LPS. Under certain circumstances, this initial evidence could explain triggering of SIRS, urosepsis and MOF. \n\t\t\t\t\t\t
The authors would like to thank Carmen Clapp, Carmen Wacher-Rodarte, Eduardo Fernández-Escartín, Concepción Arredondo, Olivia Vázquez, Marisol Moreno, Daniel Marín, Mauricio Díaz-Muñóz, Rodolfo Galeana, Arturo Méndez, and René Preza for important assistance. This research was supported by the PAPIIT-UNAM grant IN108410.
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\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/19323.pdf",chapterXML:"https://mts.intechopen.com/source/xml/19323.xml",downloadPdfUrl:"/chapter/pdf-download/19323",previewPdfUrl:"/chapter/pdf-preview/19323",totalDownloads:6049,totalViews:409,totalCrossrefCites:1,totalDimensionsCites:6,totalAltmetricsMentions:0,introChapter:null,impactScore:4,impactScorePercentile:91,impactScoreQuartile:4,hasAltmetrics:0,dateSubmitted:"November 17th 2010",dateReviewed:"May 23rd 2011",datePrePublished:null,datePublished:"September 6th 2011",dateFinished:null,readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/19323",risUrl:"/chapter/ris/19323",book:{id:"370",slug:"clinical-management-of-complicated-urinary-tract-infection"},signatures:"Joel Gustavo Gómez-Núñez, Ulises M. Alvarez, Francisco Fernández, Jorge Gutiérrez-Aceves, Luz María López-Marín and Achim M. Loske",authors:[{id:"45804",title:"Dr.",name:"Joel Gustavo",middleName:null,surname:"Gómez-Núñez",fullName:"Joel Gustavo Gómez-Núñez",slug:"joel-gustavo-gomez-nunez",email:"gusgo@cucs.udg.mx",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"87052",title:"Dr.",name:"Luz",middleName:"Maria",surname:"López-Marín",fullName:"Luz López-Marín",slug:"luz-lopez-marin",email:"lmlm@unam.mx",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"National Autonomous University of Mexico",institutionURL:null,country:{name:"Mexico"}}},{id:"105701",title:"MSc.",name:"Ulises M.",middleName:null,surname:"Alvarez",fullName:"Ulises M. Alvarez",slug:"ulises-m.-alvarez",email:"uma@fata.unam.mx",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"105702",title:"MSc.",name:"Francisco",middleName:null,surname:"Fernández",fullName:"Francisco Fernández",slug:"francisco-fernandez",email:"francisco@fata.unam.mx",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"National Autonomous University of Mexico",institutionURL:null,country:{name:"Mexico"}}},{id:"105703",title:"Dr.",name:"Jorge",middleName:null,surname:"Gutiérrez-Aceves",fullName:"Jorge Gutiérrez-Aceves",slug:"jorge-gutierrez-aceves",email:"jorgeg@endourologia.com.mx",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"University of Guadalajara",institutionURL:null,country:{name:"Mexico"}}},{id:"105704",title:"Dr.",name:"Achim M.",middleName:null,surname:"Loske",fullName:"Achim M. Loske",slug:"achim-m.-loske",email:"loske@fata.unam.mx",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"National Autonomous University of Mexico",institutionURL:null,country:{name:"Mexico"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Urinary tract infections",level:"1"},{id:"sec_2_2",title:"2.1. Urinary bacterial epidemiology",level:"2"},{id:"sec_2_3",title:"2.1.1. Endotoxins",level:"3"},{id:"sec_5",title:"3. Urinary stones",level:"1"},{id:"sec_5_2",title:"3.1. Infected stones",level:"2"},{id:"sec_5_3",title:"3.1.1. Bacterial epidemiology of infected urinary stones",level:"3"},{id:"sec_8",title:"4. Sepsis and urosepsis",level:"1"},{id:"sec_9",title:"5. Endotoxins and sepsis",level:"1"},{id:"sec_10",title:"6. Infected urinary stones and urosepsis",level:"1"},{id:"sec_11",title:"7. Research on bacterial suspensions and extracorporeal shock wave lithotripsy",level:"1"},{id:"sec_12",title:"8. Research with stone models",level:"1"},{id:"sec_12_2",title:"8.1. The bactericidal effect of intracorporeal lithotripters",level:"2"},{id:"sec_13_2",title:"8.2. The bactericidal effect of extracorporeal lithotripters",level:"2"},{id:"sec_15",title:"9. 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Clinical and Vaccine Immunology\n\t\t\t\t\t14\n\t\t\t\t\t3\n\t\t\t\t\t250\n\t\t\t\t\t255\n\t\t\t\t\n\t\t\t'},{id:"B54",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tTriantafilou\n\t\t\t\t\t\t\tM.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tTriantafilou\n\t\t\t\t\t\t\tK.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t2005\n\t\t\t\t\tThe dynamics of LPS recognition: complex orchestration of multiple receptors.\n\t\t\t\t\tJournal of Endotoxin Research\n\t\t\t\t\t11\n\t\t\t\t\t1\n\t\t\t\t\t5\n\t\t\t\t\t11\n\t\t\t\t\n\t\t\t'},{id:"B55",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tvon\n\t\t\t\t\t\t\tEiff. C.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tOverbeck\n\t\t\t\t\t\t\tJ.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHaupts\n\t\t\t\t\t\t\tG.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tHerrmann\n\t\t\t\t\t\t\tM.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tWinckler\n\t\t\t\t\t\t\tS.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tRichter\n\t\t\t\t\t\t\tK. D.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tPeters\n\t\t\t\t\t\t\tG.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSpiegel\n\t\t\t\t\t\t\tH. U.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t2000Bactericidal effect of extracorporeal shock waves on Staphylococcus aureus. Journal of Medical Microbiology 49\n\t\t\t\t\t709\n\t\t\t\t\t712\n\t\t\t\t\n\t\t\t'},{id:"B56",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tWagenlehner\n\t\t\t\t\t\t\tF. M.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tWeidner\n\t\t\t\t\t\t\tW.\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tNaber\n\t\t\t\t\t\t\tK. G.\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t2007\n\t\t\t\t\tOptimal management of urosepsis from the urological perspective\n\t\t\t\t\tInternational Journal of Antimicrobial Agents\n\t\t\t\t\t30\n\t\t\t\t\t5\n\t\t\t\t\t390\n\t\t\t\t\t397\n\t\t\t\t\n\t\t\t'},{id:"B57",body:'\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tWolf\n\t\t\t\t\t\t\tJ. S. .\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tChairman\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t2010Best Practice Policy Statement on Urologic Surgery antimicrobial prophylaxis. In: American Urological Association (AUA) Date of access: May 18th, available from: http://www.auanet.org/content/media/antimicroprop08.pdf\n\t\t\t'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Joel Gustavo Gómez-Núñez",address:null,affiliation:'
Nuevo Hospital Civil de Guadalajara, Universidad de Guadalajara, Guadalajara Jal. and Instituto de Endourología, Hospital Puerta de Hierro, Zapopan Jal., México
'},{corresp:null,contributorFullName:"Ulises M. Alvarez",address:null,affiliation:'
Posgrado en Ciencias Químicas, Facultad de Química, Universidad Nacional Autónoma de México, México
Nuevo Hospital Civil de Guadalajara, Universidad de Guadalajara, Guadalajara Jal. and Instituto de Endourología, Hospital Puerta de Hierro, Zapopan Jal., México
'},{corresp:null,contributorFullName:"Luz María López-Marín",address:null,affiliation:'
Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México, México
'},{corresp:null,contributorFullName:"Achim M. Loske",address:null,affiliation:'
Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México, México
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1. Introduction
Replace the entirety of this text with the introduction to your chapter. The introduction section should provide a context for your manuscript and should be numbered as first heading. When preparing the introduction, please bear in mind that some readers will not be experts in your field of research.
Cultural heritage is situated in both natural and semi-natural environments, as well as in highly urban environments, where various activities can accelerate the transformation of the area and have a negative impact on the quality and use of the cultural heritage. Therefore, spatial development policy is crucial in protecting, managing and increasing the value of such areas, primarily through the adoption and implementation of appropriate planning solutions and measures. In addition, the interaction between different sectoral policies and the coordination of their territorial impacts is important.
These generally accepted positions point to the key role of spatial and urban planning in the sustainable development and protection of cultural heritage. With these starting points, the authors use spatial plans as the research subject in this paper, analyzing the methodology of their development and content. The hypothetical assumptions of this research are that the method of planning in an area of cultural heritage differs depending on the type and level of the spatial plan. Furthermore, it is possible to identify aspects of protection and sustainable development in the plans, with the protection of cultural assets clearly dominating in planning practice. Finally, the hypothetical assumptions are concluded with the authors’ views that the protection and the development of cultural heritage are not integrated with landscape planning, and that the aspect of implementation is insufficiently addressed in plans.
One of the basic principles of sustainable spatial development is the principle of increasing cultural heritage stock as a development factor [1, 2], which includes increasing the value of cultural heritage. This is one of the most significant contributions to economic development and the strengthening of regional identity, achieved by means of increasing the attractiveness of sites for investors, tourists and the public. Spatial development policy should contribute to the integrated management of cultural heritage, based on the idea of the development process of protection and conservation, while respecting the needs of modern society. Many countries in Europe have monuments that follow the traces of different schools of art and artistic movements, which requires the development of a common approach in conservation, restoration and use, initiating programs of “great cultural routes”. In many countries, there are types of cultural heritage that, due to historical changes, events and changes in borders, do not belong to only one but to a larger number of nations, language communities and religious groups, some of which no longer live in those regions. Spatial development policy must preserve and respect the memories of each nationality, language community and religious group, which have created a specific type of cultural heritage.
International documents adopted in the last decade [3] which refer to the protection, planning and management of cultural heritage emphasize a contextual approach that considers the expansion of the object of protection, from individual monuments to wider spatial units. They underline the need for integrating conservation, management and planning strategies for historic urban areas with development and planning documents. In addition, the concept of protecting areas of cultural heritage and their surroundings is closely connected to the issues of planning and protecting landscapes, with special significance given to the integration of landscape development into spatial planning and other sectoral policies, as well as the implementation of integrated policies aimed at the protection, management and planning of areas of cultural heritage.
Based on the above, it seems that the current procedures for protection and planning with regard to cultural heritage can and must be improved, particularly concerning the development aspects of protection, implementation, coordination with other sectoral policies and others. The analysis of previous experiences and the possibility of improving the process of spatial planning in the field of cultural heritage are the main goals of this paper.
2. Literature review
Consulting the most recent scientific literature, i.e., papers published in the last five years, the authors consider that the greatest preoccupation is on themes related to planning within protected natural areas, while studies covering the relationship between planning actions and restrictions related to the protection of cultural and historical heritage are scarce. On the other hand, it is clear that this topic is by no means exhausted and requires further analysis, especially from the aspect of developing sustainable tourism and strategies for actively protecting and promoting valuable monuments.
Some studies concentrate on the topic of the cultural landscape as the broadest concept: “Cultural landscapes are poorly inventoried and evaluated in protected natural areas. But there is a novel procedure to assess cultural landscape features and their cultural values in the major protected areas. After identifying a set of culturally modified land cover types and habitat types the GIS-based survey, with a set of 12 cultural attributes (involving cultural heritage values, traditional land uses and aesthetic quality) indicators were scored to assess these “cultural values” in each site. Gradient maps were produced to express an initial nation-wide site ranking profile. Heatmaps help link instead of solely rank culturally valuable sites that are in proximity to each other, showcasing site clusters of outstanding value. These analyses help define the level of “culturalness” of each site based on human-modified landscape and habitat types and provide a baseline review of cultural values in protected natural areas. This screening-level survey identifies the protected areas that may require special attention for managing cultural elements-of-diversity” [4].
Other authors focus on the use of modern GIS technologies for displaying locations and their overlapping areas of interest and restrictions, as well as for tracking the number of visits: “New technologies are used in mapping not only of heritage locations but also about visitation and expressed interest” [5]. Massiveness certainly brings profit, but it reduces the quality of the experience, so it is necessary to change the concept and approach: “Visitor management planning is a new concept, tool and strategy of sustainable tourism and ecotourism. The importance of this concept is in the new approach to tourism in natural and heritage protected areas of the country, which means implementing a completely different philosophy of tourism” [6].
It is the number of visits that has become a key factor for some locations, because the excessive crowds resulting from the huge interest of tourists, so-called “overtourism”, causes negative effects, and instead of contributing to the presentation and sustainability of valuable monuments, it leads to its degradation [7]. The authors cite a number of examples and offer recommendations for overcoming such situations. One of the causes of excessive tourism can be cruising destinations, if the distribution of visitors is not properly dosed. On the other hand, tours on the Danube Corridor can be seen as having great potential as an opportunity, which has contributed to the strategic planning of 9 new locations for passenger ports, in addition to the existing 5, primarily in the immediate vicinity of cultural and historical sites: “In the Podunavlje area in Serbia, significant attractions are located in vibrant urban centers such as Belgrade and Novi Sad, with seven fortresses from north to east downstream, including Bač, Petrovaradin, Beograd, Smederevo, Ram, Golubac, and Kladovo (Fetislam). There are also 21 archeological sites, the most significant of which are the Vinča and Lepenski Vir sites from prehistoric times, along with the city of Viminacium, Emperor Trajan’s road, bridge and stone board with inscriptions from the Roman period. Apart from these landmarks, two national parks (Fruška Gora and Ðerdap), several other parks, special nature reserves, nature monuments, and areas with significant characteristics are situated in the surrounding areas and are protected areas” [8].
Participation of the public and stakeholders in the planning process itself, and the harmonization of the needs of contemporary life and development of tourism with the limitations arising from protection regimes are also significant issues: “Most studies on community participation in tourism planning only advocate the importance of the concept and/or identify barriers without articulating the required actions or strategies to actually promote community participation. Six strategies emerged as major prerequisites to achieve full and active community participation in tourism planning associated with protected areas are: public awareness and education; capacity building; creation of linkages; use of appropriate participation methods; involvement of appropriate local community organisations and decentralisation and coordination of relevant management organisations” [9]. Proper implementation of the participation procedure and transparency of the planning process are the guarantee of quality implementations of plans in the future [10, 11, 12, 13, 14]. The general conclusion is that some global topics, as well as practical experience, can be used with certain adjustments to the situation and systemic frameworks in the Republic of Serbia.
3. System of sustainable development and protection of cultural heritage in the Republic of Serbia
The basic framework for the protection and sustainable development of cultural heritage in the Republic of Serbia is determined by the Law on Cultural Property [15] and the Law on Planning and Construction [16]. In accordance with the Law on Cultural Property, cultural heritage is made up of objects and creations of material and spiritual culture of general interest, which are under appropriate protection. They are divided into movable and immovable cultural heritage. Depending on the physical, artistic, cultural and historical characteristics, immovable cultural heritage is: cultural monuments (buildings/architectural objects or units), whole cultural and historical spatial units (part of an urban or rural settlement in which there are multiple cultural assets), archeological sites and landmarks (space related to an event or person of significance in history).
According to their significance, they can be: uncategorized cultural heritage, cultural heritage of great importance and cultural heritage of exceptional importance. Cultural heritage of exceptional importance has one of the following characteristics: special significance for the social, historical and cultural development of the people; it testifies to crucial historical events and personalities; it presents unique examples of the creativity of its time; it has a great influence on the development of society, culture, technology and science; or it has exceptional artistic and esthetic value. Cultural heritage of great importance has one of the following characteristics: it is significant for a certain area or period; it testifies to the phenomena or conditions of social, cultural and historical development; it testifies to significant events and prominent figures in history.
When an architectural object is declared as immovable cultural heritage, its protected environment is determined, which has the same protection status as the object itself.
These elements indicate the dominant aspect of protecting cultural heritage. However, the issue of their sustainable development (presentation, use), spatial aspects and integration with other activities and functions in space are determined by the Law on Planning and Construction. As basic principles in the arrangement and use of space, the law defines the protection and sustainable use of immovable cultural heritage, and the preservation of customs and traditions, as well as the specifics of the landscape.
The system of planning documents consists of the spatial plan of the Republic of Serbia, regional spatial plans and spatial plans for special purpose areas adopted at the national or regional level, as well as the spatial plans of local self-government units and urban plans adopted at the local level. Each of the listed plans in the hierarchy must be harmonized with the higher order plan (wider area).
The spatial plan of the Republic of Serbia is the basic planning document for spatial development, which has a strategic development function, and contains measures for the protection, arrangement and improvement of cultural heritage (scale of graphic attachments 1: 300,000). Regional spatial plans are prepared for larger spatial units of an administrative character and are focused on regional development goals and projects (scale of graphic attachments 1: 50,000). Spatial plans for special purpose areas are prepared for areas of national interest that require a special regime of organization, arrangement, use and protection of space, and especially for areas of cultural and historical units and environmental value. Their specificity is that they can contain all the detailed elements of urban plans (different sizes, up to 1: 1,000) and that they are directly implemented by applying the rules of arrangement and construction, with the possibility of resolving property relations if necessary.
Bearing in mind the basic elements of this system, the authors conducted research on a case study of three spatial plans which in terms of their methodology and content make up the planning system of protection and sustainable development of cultural heritage in Serbia.
Further, the paper presents only some of the key elements that indicate the aspect of protecting immovable cultural heritage and its surroundings in plans, while the analysis included the entire spatial plans and the documentation on which their development was based.
4. Analysis of the sustainable development and protection of the cultural heritage in spatial plans
4.1 Spatial plan of the Republic of Serbia from 2021 to 2035
The Spatial Plan of the Republic of Serbia from 2021 to 2035 [17] concerns the entire territory of Serbia, which covers 88,488 km2. As one of the important aspects of spatial development, it deals with cultural heritage. According to the available information of the Institute for the Protection of Cultural Monuments from 2020 [18], it consists of a total of 2592 immovable cultural assets of various types and significance (Table 1, Figure 1).
Importante Cultural assets
Exceptional importante
Great importante
Untategorized tultural assets
Total
Cultural monument
155
512
1566
2233
Spatial cultural/historieal unit
11
28
47
86
Arclieological site
18
25
151
194
Landmark
16
17
46
79
Total
200
582
1810
2592
Table 1.
Immovable cultural assets in Serbia by type and category in 2020.
Figure 1.
Thematic map of the protection of immovable cultural heritage in the spatial plan of the Republic of Serbia from 2021 to 2035. Source: Spatial plan of the republic of Serbia from 2021 to 2035 – Draft, Ministry of Construction, transport and infrastructure, April 2021.
In addition to these, there are 12 sites (or 6 entries) under UNESCO protection in Serbia: Stari Ras medieval complex of monuments and Sopoćani Monastery, 4 medieval monasteries of the Serbian Orthodox Church in Kosovo and Metohija (Visoki Dečani, Patriarchate of Peć, Bogorodica Ljeviška, Gračanica), the remains of the Felix Romuliana Palace (Gamzigrad) and three sites of medieval tombstones known as the Stećak tombstones. In addition, 11 more sites have been suggested for entry: 1 monastery, 3 national parks and 1 nature reserve, 1 archeological site, 1 historical location, 1 settlement, 1 fortress, 1 rare natural phenomenon, and one cultural belt (the Danubian Limes).
The general aim of spatial development in the field of the protection, arrangement and use of cultural heritage is the affirmation of cultural heritage as a valuable resource for sustainable development and as a factor of national and regional, urban and rural identity. Some of its specific objectives are the development of an integrative and territorial approach to the protection, arrangement and sustainable use of cultural heritage as well as the introduction of a typological approach, and the characterization of space at the level of areas, settlements and smaller units.
This spatial plan treats cultural heritage as an inseparable part of the living environment (natural and created), seeing it in correlation with its immediate environment and the way it fits into the functions that meet the needs of modern users. The following are recommended: applying the concept of protection in urban planning, introducing contextual analysis and valorizing building stock, and the spatial audits of individual locations. In order to preserve the identity of urban and rural settlements in Serbia, it is necessary to protect, present and affirm the material remains and influences of various civilizations that inhabited the Balkan Peninsula (Roman, Byzantine, Ottoman and modern European civilizations, including the socialist period).
Bearing in mind that this is a national planning document that is indirectly implemented through other spatial plans, this plan defines a set of guidelines for the lower levels of planning.
Guidelines for cultural monuments - chronological and topographic gaps should be a priority in the valorization and revalorization of cultural monuments which, perhaps more than other immovable cultural heritage, provide a cross-section of complex civilizational trends in the area. Their preservation, study, restoration and popularization will be performed in a coordinated and integrated manner through the process of spatial and sectoral planning (in tourism, the protection of cultural monuments, etc.).
Guidelines for spatial cultural/historical units - when determining spatial cultural/historical units and their treatment in planning documents, it is necessary to respect the criteria of scientific assessments with regard to the artistic, cultural, historical and other values of the immovable cultural heritage that belong to the unit. Alongside the protection, arrangement and sustainable use of cultural heritage, it is necessary to include categories in accordance with international recommendations and standards [19, 20], such as: historic buildings and ensembles; urban and rural settlements/historic towns and villages; agricultural, industrial and technological properties; military properties; cultural landscapes, parks and gardens; cultural routes; burial monuments and sites; modern heritage, etc.
Within the current planning procedures, it is necessary to valorize the wider environment of cultural heritage in order to determine the space that is relevant for experiencing and presenting it. In that sense, it is necessary to protect the appearance, scenery, spatial configuration of the entire area, landscape and units that belong to the protection zones. Cultural heritage can be spatially connected by defining cultural areas and cultural routes at the international, national, regional and local levels.
Guidelines for archeological sites - indicate an approach to site protection which must be adapted to the site’s specific characteristics. For sites in areas that are not developed, there is an option of implementing protection by preparing a planning document. No construction or buried infrastructure can be planned in these areas. Preventive archeological research is also recommended as part of the planning process in response to proposed development solutions that could jeopardize archeological resources. Preventive archeological research should also be carried out in order to identify and record elements of archeological heritage that would be abandoned and/or destroyed as a result of development, especially when it comes to the construction of dams, roads, railways and other similar structures.
Guidelines for landmarks - it is necessary to conduct a revalorization of both already identified landmarks and landmarks whose memorial and historical value is dominant. As traces of historical events, all immovable cultural heritage of this kind should be treated equally.
The concept of the protection, arrangement and sustainable use of landscapes can be added to the mentioned elements in the planned treatment of immovable cultural heritage. One of the key elements in this is the protection and sustainable use of natural resources, natural and cultural assets, and their connection in space (local, regional, national ecological and cultural networks).
Depending on the degree and type of modification, the dominant processes that control a given space, and the character of human influence on the landscape, the territory of Serbia is classified into natural and cultural landscapes.
Cultural landscapes are divided into rural and urban landscapes, depending on the character of the modification of the landscape structure, the predominant manner of land use, the network, the type of settlement and the population density. Rural landscapes, in a structural sense, show natural characteristics that are close to the landscape. They have a lower population density and extensive land use, and rural settlements are an organic part of the natural environment. Urban landscapes are completely modified natural or rural landscape that are formed and function in relation to the needs of the urban way of life. They are zones of urban development (metropolitan areas, agglomerations, urban centers of the development axis).
Cultural landscapes may belong to the following categories: (1) designed cultural landscapes; (2) organic and relict cultural landscapes; and (3) associative cultural landscapes that possess esthetic, symbolic and spiritual value for the human community.
The spatial plan further defines guidelines for achieving the target quality of rural and urban areas. In rural areas, sustainable development is based on recognizing, protecting and improving their specific character, existing value and landscape capacities. In the development of spatial and urban plans, it is necessary to ensure: the preservation of the landscape pattern based on the specific composition and configuration, land use, the ratio of built and open space, regulation of construction and landscaping in accordance with tradition; an appropriate purpose of space and protection of the local identity; the integral protection of cultural and natural heritage and their adequate presentation for tourism, taking protection regimes into account; the affirmation and creation of the architectural identity of a settlement, based on the preservation and revitalization of traditional architecture, as well as on new construction that increases attractiveness; the formation of an ethno settlement as a museum of rural vernacular architecture, which is typical for the character of the landscape and its use for tourist purposes; prescribing morphological, ecological and landscape-shaping rules of arrangement and rules of construction.
The development of urban landscapes is based on the fact that these will continue to be the landscapes with the greatest dynamic of change. In the development of spatial and urban plans, it is necessary to provide: regulated construction and spatial planning in accordance with the target quality and character of the landscape, the specifics of the development of the urban landscape as a whole and development of individual settlements; directed expansion of urban settlements and planned construction in accordance with the demands of preserving cultural and natural heritage, the rational use of urban construction land and giving priority to urban renewal, recycling and construction within the already existing urban matrix; the preservation of open spaces and elements of nature in urban centers, the activation of abandoned and devastated spaces and the formation of a network of public spaces that connect natural and cultural assets.
4.2 Regional spatial plan of the Kolubara and Mačva administrative districts
The Regional Spatial Plan of the Kolubara and Mačva Administrative Districts [21] covers an area of 5,746 km2, i.e. an area of 14 local government units. One of its basic aims is to define the protection, preservation and presentation of cultural assets, in order for them to be included in the tourist offer and to establish a regional and local cultural identity.
In the area of the spatial plan a total of 219 immovable cultural assets are protected, of which 7 are of exceptional importance, 20 of great importance and 192 are uncategorized (of which there are 190 cultural monuments, 6 spatial cultural/historical units, 16 archeological sites and 7 landmarks).
Its main aim is elaborated through a number of specific objectives, such as: establishing integrative protection and cultural property management; undertaking urgent action to conserve, restore and revitalize the most valuable and most endangered heritage; determining and arranging the protected environment surrounding the immovable cultural heritage; integrating the protection and presentation of cultural assets in the development of the tourist offer of an area (transit and touring of cultural routes).
The basic planning commitment is the adequate protection of cultural heritage, which includes taking general measures. For archeological sites - categorizing the most valuable sites; more efficiently protecting cave archeological sites within the integral protection of natural areas of river canyons; infrastructural equipping and arranging the space covered by archeological sites; establishing archeological parks for individual sites; and determining the zones of archeological sites of regional significance.
For cultural monuments - complete technical protection, along with the renovation of individual buildings; preserving the basic properties and constructive, stylistic and typological characteristics, especially of buildings of sacral and technical architecture; presenting cultural monuments without disturbing their cultural and historical properties; recording and valorizing immovable cultural heritage, with priority given to valorizing vernacular buildings, commercial buildings, technical culture buildings and newer urban architecture; recording, valorizing and determining cultural monuments dedicated to the liberation wars of the Republic of Serbia, primarily during World War I; bringing sacral cultural monuments to an exclusively sacral purpose and liturgical needs; etc.
For spatial cultural/historical units - revalorizing and determining the categorization of individual units, as well as re-examining the validity of the boundaries of the wider protection zone for the old bazaar (City of Valjevo); implementing measures for the technical protection of a whole village (Bebića Luka), remediating and reconstructing buildings of vernacular architecture, with the introduction of modern construction and architectural elements that do not violate the integrity and authenticity of the buildings or the whole unit; defining the degree of reconstructive and remedial interventions and conservation conditions for the technical protection and presentation of buildings within individual cultural and historical units; defining restricted traffic zones and pedestrian zones in urban areas; etc.
For landmarks - intensive and systematic research and documenting of landmarks, memorials, cemeteries and tombstones; identifying commercial users; stimulating the construction of a complex within the area of a landmark to which endangered objects of vernacular architecture would be transferred; removing unplanned objects in the wider protection zone of the landmark; etc.
In addition, the basic planning commitment is to adequately present and affirm the immovable cultural assets as generators of tourism and overall development. The plan singles out particular heritage and areas that should enjoy special treatment, regardless of their current status of protection. This refers to the characteristic objects and traditions that are part of the architectural heritage - vernacular architecture (design elements, building materials, method of use), traditions and the intangible associations connected with them.
A special role in the integration of a comprehensive tourist offer is played by the possibility of forming “cultural routes” which will present immovable and intangible cultural heritage, and make connections with other types of tourist offers. Two cultural trails of international importance are planned, one through the towns of Sabac and Loznica and the other which partly follows the course of the Drina River. In addition, the plan identifies potential cultural routes of national, interregional, regional and local significance, such as the routes insurgents took during the First and Second Serbian Uprising, routes of battles and victims during the First World War, rural life through time, old mining routes and more.
This plan does not define more detailed measures, rules of arrangement or construction in the vicinity of cultural heritage, neither does it define any significant elements regarding the implementation of these solutions.
4.3 Spatial plan for the special purpose area of the landscape of outstanding features: Ovčar-Kablar Gorge
This spatial plan [22] covers a total area of 97.5 km2, i.e., the Ovčar-Kablar Gorge landscape of outstanding features (protected natural heritage) and the Ovčar-Kablar Monasteries (22.8 km2 of protected area, 74.7 km2 of unprotected area).
Unlike the previously analyzed plans, which were prepared for administratively determined areas and in which the protection and development of cultural heritage is only one of many aspects, the following are the specific focus of this spatial plan:
The Ovčar-Kablar Gorge landscape of outstanding features, protected as a natural asset, with a level III protection regime on an area of about 1,700 ha and a level II protection regime on about 550 ha within six separate spatial units;
The buildings and surroundings of the cultural monuments of great importance (monasteries) and other cultural/historical heritage within the unit of the Ovčar-Kablar Monasteries (future spatial cultural/historical units);
Spaces with the purpose of: (1) tourism, recreation and sports, especially paragliding on Ovčar Mountain; (2) integral presentations of the most attractive areas, especially the Zagrađe meander zone of the West Morava River, which is considered to be a center of cultural, natural and tourist potential.
In the area of the spatial plan, in the Ovčar-Kablar Gorge, there are 11 shrines (nine active monasteries), which is why it is often called the Serbian Mount Athos. Four monasteries have the status of established cultural monuments, which are categorized as immovable cultural heritage of great importance.
It is envisaged that the sustainable development of the special purpose areas will be based on the protection, improvement and use of natural and cultural heritage, the development of tourism, sports and recreation and the functional integration of the protected area and the wider environment.
This ensures the permanent and integrated protection of the buildings and surroundings of cultural monuments and other cultural and historical heritage, as well as their traffic and infrastructural arrangement and equipment, the creation of other spatial conditions for their presentation to the public, and the development of religious tourism.
The spatial plan analytically determines the space for declaring the future spatial, cultural and historical unit of Ovčar-Kablar Monasteries as immovable cultural heritage. It establishes measures of protection within three regimes that are spatially identified as: level I protection regime (strict protection) – courtyard of the cultural monument, with a total area of about 1.12 ha; level II protection regime (ambiental protection) – the courtyard and surroundings of the other monasteries, with a total area about 66.66 ha; level III protection regime (general protection) - the remainder of the Ovčar-Kablar Monasteries unit, with an area of about 2,211.22 ha.
The main measures in the level I protection regime are: banning the construction of facilities, except for the reconstruction, extension and maintenance of monastic housing and auxiliary facilities, technical protection, restoration and maintenance of church buildings, and the reconstruction and maintenance of energy and communal infrastructure; prohibiting other works, except for the appropriate landscape and horticultural arrangement, and protection from the harmful effects of water and landslides; controlled visits to church festivals and cultural events.
The main measures of the level II protection regime are: banning the construction of facilities, except for monastic farm facilities; the reconstruction and maintenance of traffic, energy and communal infrastructure; maintaining weekend facilities; the prohibition of works, except for agriculture, forestry, landscaping and protection from the harmful effects of water and landslides; conducting archeological, natural and other research; arranging and maintaining hiking and other walking trails; banning activities, except for church festivals, cultural events, controlled tourist visitor movement, hiking and cycling, limited and controlled motor vehicle traffic, etc.
The main measures of the level III protection regime are largely in line with the measures established for the level III protection regime for natural heritage, which include: banning the construction of facilities that may cause damage or destroy the material contents of the cultural heritage or may have adverse effects on the landscape features; banning the opening of quarries and the exploitation of mineral resources other than thermal waters and banning or restricting the use of other natural resources.
Archeological sites and buildings of vernacular architecture are an important segment of cultural heritage, and their properties, chronology and significance can be judged with certainty only on the basis of systematic archeological research or the appropriate research of their architecture and construction, as well as their cultural and historical features. For these reasons, detailed and systematic research of the overall cultural heritage of the protected area is recommended.
The cultural and religious tourism zone is formed by all of the monastery complexes with level I and II protection regimes, including the access roads, and the hiking, and bicycle paths that connect them. In the cultural and religious tourism zone, the reconstruction and equipping of the existing parking lots and construction of new ones on the access roads is planned, as well as equipping the local, forest and field roads with signs. For monasteries along the river, providing access from the water area should be considered, which can be done by setting up a pier for adequate vessels.
In the area of the monastery, which is covered by a detailed planning elaboration (Figure 2), the basic purpose of the space is religious buildings and complexes. This primary purpose also includes the detailed purposes of the courtyard and the monastery farm. Within the detailed purpose of the courtyard, there are temples, bell towers and monastery residences - residential buildings with accompanying auxiliary buildings. The detailed purpose of the monastery farm covers economic and agricultural buildings and areas of the monastery. The immediate surroundings of the monastery largely consist of monastery forests, in which no construction is allowed.
Figure 2.
Map of the detailed planning of the Blagoveštenje monastery. Source: Regulation on determining the spatial plan for the special purpose area of Ovčar-Kablar Gorge landscape of exceptional features (official gazette, No. 46/19).
Having these protection regimes in mind, the plan gives more detailed rules of arrangement and construction, which mostly refer to roads and infrastructure systems, while all further rules relating to cultural monuments are determined through conditions set by the competent protection institute.
5. Discussion on the implementation of sustainable development and protection for the cultural heritage in spatial plans
In order to consider the issues of implementing the sustainable development and protection of cultural assets in the spatial plans analyzed, the authors use and build on previous research on the implementation model for spatial plans [11, 12, 23], as follows:
The theoretical definition that the model of implementation of a spatial plan is a simplified representation of a set of related planning decisions on actions in the future, which reflects logical, functional and time coherent planning action, depending on the type and methods of planning;
The model of implementation has its own elements, which are determined by a set of planning actions in the broadest possible sense, starting from general decisions, through relatively firm target propositions, to very definite statements in terms of content, time and space. The elements of the model go beyond the plan itself as a document (phase of the planning process), and in addition to the mentioned planning elements, they also include “postplanning elements” defined by the plan (carried out later) and all the necessary elements of monitoring;
Depending on the type and method of planning, several types of spatial plan implementation models have been singled out, and the implementation model of spatial protection has been analyzed and applied in practice for the purpose of spatial protection.
According to the authors, the research presented in this paper has a special significance, because it refers to the issues of sustainable development and protection of cultural property that have not been subject to such analyses so far. Previous analyses of the implementation model have included protected areas of natural resources and water sources, but not protected areas of cultural heritage.
Furthermore, in their analysis, the authors thematically separate and analyze three aspects (Table 2), namely: (1) the protection of cultural heritage and its environment in a narrower sense (P); (2) the development of cultural heritage, i.e. primarily those elements related to the rules of their arrangement, presentation and inclusion in tourist activities (D); and (3) integrating the protection and development of cultural assets into landscape planning and protection (L).
Spatial Plans
I Planning elements
II Post-planning elements
III Monitoring eL
Strategic framework
General goals
Specific goals
Planning solutions
Dynamic framework
Measures and instruments
Participants (subjects)
Monitoring system
Evaluation (indicators)
Institutional and organzational aspects
Priority planning solutions (4 years)
Medium-term and long-term stages
Planning-programming
Organizational
Normative-legal
Financial
1.
Spatial Plan of the Republic of Serbia from 2021 to 2035
P D L
P D L
P D L
P D L
P D
P D L
P D L
P L
P L
P
P
P
2.
Regional Spatial Plan of the Kolubara and Mačva Administrative Districts
P D
P D
PD
P D
P D
P D
P
P D
P D
3.
Spatial Plan for the Special Purpose Area “Ovčarsko-kablarska klisura”
P D L
P D L
P D
P D
P D
P D
P D L
P D
P
P
P – protection, D – development, L – landscape.
Table 2.
Elements of the implementation model for the protection and development of landscapes in the spatial plans analyzed.
The Spatial Plan of the Republic of Serbia has applied the largest number of elements of the implementation model, those relating both to protection and to developing cultural heritage and landscape planning (a total of 27 elements). The specificity this plan is the large number of recognized elements relating to landscapes from all three plans, as well as the definition of the monitoring elements that are missing in other plans. Therefore, it can be concluded that a general approach has been applied in this plan, which is justified having in mind that it belongs to the national level of planning.
In The Regional Spatial Plan for the area of Kolubara and Mačva administrative districts, the fewest elements of the implementation model were applied (a total of 17 elements). The specificity of this plan is that it does not integrate the protection and development of cultural heritage in the planning and protection of landscapes, that is, there is a complete lack of any elements related to the theme of landscapes. Elements of the protection and development of cultural heritage are equally applied in this plan. Since this type of plan is focused on the goals and projects of regional development, i.e. the regional approach to planning, further elaboration on all missing elements is possible and necessary through the local level of planning.
In The Spatial Plan for the Special Purpose Area of the Landscape of Outstanding Features Ovčar-Kablar Gorge, a combination of the implementation elements of all three aspects (a total of 21 elements) was applied. However, the fewest elements are related to the integration of cultural heritage in landscape planning and protection, and they refer only to the general strategic framework, general goals, and planning and program measures for implementation, indicating that these were not sufficiently considered. Elements that relate to the protection and development of cultural goods are relatively evenly distributed. This kind of approach to planning can be characterized as special (as indicated by the name and subject of the plan) and is determined by the need to protect and plan the development of both the protected natural area and the future protected area of cultural monuments.
After analyzing all three plans, the basic conclusion is that general planning elements (strategic framework, goals, planning solutions) are dominant, that there are fewer post-planning elements (dynamics, implementation measures), and that there is a marked lack of elements related to the implementation of monitoring. Further analysis in this direction is not necessary, as it would be largely focused on the legislative framework, procedures and assessment of the quality of the plans, which is not the subject of this paper.
In the opinion of the authors, the most important conclusion concerns the relationship between aspects of protecting cultural heritage, its sustainable development and its integration into planning and protecting landscapes. Out of all these elements recognized in the plans, most concern the protection of cultural heritage, of which there are 31, followed by the elements of development (rules of arrangement, presentation and tourism), of which there are 23, but only 11 elements concerning the integration of cultural heritage in landscape planning and protection. This points towards the basic conclusion of the research, that protecting cultural assets and their environment in the narrower sense dominates the planning practice of Serbia, which is in itself justified and necessary. However, this does not sufficiently consider and plan for the sustainable development of cultural heritage, because there is insufficient elaboration of elements that would indicate the rules of construction and spatial planning in their environment, along with their unification and further planning development integrated with tourism (cultural routes, tourist areas, etc.). This is even more pronounced when considering the aspect of integrating the protection and development of cultural heritage into the planning and protection of landscapes, which is not developed in the practice of planning in Serbia. Indeed, it is considered only in a general and declarative manner, and only in individual cases.
6. Conclusions
Alongside the starting point that spatial (and urban) planning is of key importance for the sustainable development and protection of cultural heritage, this paper aimed to, based on the analysis of previous experiences, point out the need and possibilities for further improving the spatial planning process.
The fact is that in the current practice, cultural heritage is not clearly articulated as a development resource, and the connection and harmonization of policies for protection, arrangement and use of cultural heritage has not been achieved, especially in the case of the cultural landscapes and areas mentioned here. The Law on Cultural Property is not sufficiently harmonized with international recommendations, and does not recognize categories of the cultural landscape. The plans mainly include data on the number and category of cultural assets, as well as measures for their protection, obtained from the competent protection services.
The case study of three spatial plans confirmed the basic hypothetical assumptions of the research, that the methods used to plan areas of cultural heritage differ depending on the type and level of the spatial plan. The plans identify aspects of protection and the sustainable development of cultural heritage, and also in part their integration with landscape planning, but with obvious important shortcomings.
A key conclusion was reached based on this analysis, namely that there is no dominant and developed concept of protecting cultural heritage that has evolved into a system of comprehensive and adequate planning for its sustainable development. Therefore, in the coming period, it is necessary to improve planning methods and techniques in order to fully consider the sustainable development of cultural heritage in spatial plans. The first step in this can be the detailed planning and definition of all of the necessary rules for the arrangement and construction of space (urbanistic rules) in the vicinity of cultural heritage (protected or wider), the application of which would enable the construction of traffic and infrastructure systems, tourist facilities and infrastructure, and even those elements which reinforce the very aspect of protection from new activities in the environment. This would enable adequate presentation of cultural heritage, and the spatial connection and definition of cultural areas and cultural routes at the international, national, regional and local levels.
Such spatial planning would be a really key instrument in the implementation of European policies, which emphasize a contextual approach and expansion with regard to the subject of protection, from individual monuments to wider spatial units, as well as the need to integrate conservation and protection strategies with development and planning documents, and others.
In addition to the above, it can be further concluded that the lack of integration between protection policy and the development of cultural heritage in the planning and protection of landscapes is even more pronounced. It is interesting to note that the analysis indicated that this type of integration is only found in the Spatial Plan of the Republic of Serbia, i.e., at the national level of planning. The planning and protection of landscapes are not considered in other spatial plans. This further raises issues and needs for improvement, not only with regard to planning, but also legal regulations that should make integrated aspects of protection and development of cultural assets mandatory in landscape planning.
Based on the examples analyzed here, one gets the impression that in practice only the integration of the protection and development of cultural heritage with the protection of natural heritage has been truly achieved, that is, the integration of different aspects of protection.
Finally, all the above findings presented by the authors in this paper need to be further researched and scientifically shaped. The shortcoming of this research could be its small scientific sample of three spatial plans. With an increase in the number of spatial plans analyzed, i.e. the number of cultural assets and the area where they are located, it is certain that the research results would be more precise and significant. Indeed, that is the imperative of the planner in the period ahead.
Finally, in the opinion of the authors, this analysis of models and elements of implementing plans also highlights those general shortcomings in the plans that need to be eliminated and solved by improving planning methodology. This relates not only to the issue of the protection and sustainable development of cultural heritage, but also to numerous other aspects and subjects of planning (the economy, traffic, settlement networks, regional development, rural development, etc.). It especially refers to the concretization of planning solutions, determination of priorities, measures and instruments of implementation, and in particular elements for monitoring the implementation of spatial plans. The more precisely defined the implementation framework of spatial plans, the greater their role in integrating the protection and sustainable development of cultural heritage with other aspects of development.
Conflict of interest
There is no conflict of interest.
\n',keywords:"Cultural heritage, spatial plan, protection, sustainable development, landscape, implementation",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/78130.pdf",chapterXML:"https://mts.intechopen.com/source/xml/78130.xml",downloadPdfUrl:"/chapter/pdf-download/78130",previewPdfUrl:"/chapter/pdf-preview/78130",totalDownloads:145,totalViews:0,totalCrossrefCites:0,dateSubmitted:"May 31st 2021",dateReviewed:"June 24th 2021",datePrePublished:"August 17th 2021",datePublished:null,dateFinished:"August 17th 2021",readingETA:"0",abstract:"The starting point in this paper is the position that spatial and urban planning has a key role in sustainable development and the protection of cultural heritage. The planning method used in areas of cultural heritage differs depending on the type and level of the spatial plan. It is possible to identify aspects of protection and sustainable development in plans, with the protection of cultural heritage dominating in practice. Research was carried out on a case study of three spatial plans at different levels, which both in terms of their methodology and content make up the planning system for the protection and sustainable development of cultural heritage in Serbia. The comparative analysis of the plans includes three aspects: protection, the sustainable development of cultural heritage, and the integration of cultural heritage into the planning and protection of landscapes. The implementation models of the spatial plans were considered. The main conclusion of the paper is that the concept of protecting cultural heritage has not evolved into a system of comprehensive and adequate planning for its sustainable development, nor is it sufficiently integrated with the planning and protection of landscapes. The paper provides guidelines for improving both the methodology of spatial planning and the concept of the sustainable development and protection of cultural heritage in spatial plans.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/78130",risUrl:"/chapter/ris/78130",signatures:"Nebojša Stefanović and Nataša Danilović Hristić",book:{id:"10660",type:"book",title:"Heritage - New Paradigm",subtitle:null,fullTitle:"Heritage - New Paradigm",slug:null,publishedDate:null,bookSignature:"Prof. Daniela Turcanu-Carutiu",coverURL:"https://cdn.intechopen.com/books/images_new/10660.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-83969-621-3",printIsbn:"978-1-83969-620-6",pdfIsbn:"978-1-83969-622-0",isAvailableForWebshopOrdering:!0,editors:[{id:"176482",title:"Prof.",name:"Daniela",middleName:null,surname:"Turcanu-Carutiu",slug:"daniela-turcanu-carutiu",fullName:"Daniela Turcanu-Carutiu"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Literature review",level:"1"},{id:"sec_3",title:"3. System of sustainable development and protection of cultural heritage in the Republic of Serbia",level:"1"},{id:"sec_4",title:"4. Analysis of the sustainable development and protection of the cultural heritage in spatial plans",level:"1"},{id:"sec_4_2",title:"4.1 Spatial plan of the Republic of Serbia from 2021 to 2035",level:"2"},{id:"sec_5_2",title:"4.2 Regional spatial plan of the Kolubara and Mačva administrative districts",level:"2"},{id:"sec_6_2",title:"4.3 Spatial plan for the special purpose area of the landscape of outstanding features: Ovčar-Kablar Gorge",level:"2"},{id:"sec_8",title:"5. Discussion on the implementation of sustainable development and protection for the cultural heritage in spatial plans",level:"1"},{id:"sec_9",title:"6. Conclusions",level:"1"},{id:"sec_13",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'European Spatial Development Perspective ESDP (Towards Balanced and Sustainable Development of the Territory of the European Union), Agreed at the Informal Council of Ministers responsible for Spatial Planning, Potsdam, may 1999. – Published by the European Commission'},{id:"B2",body:'Guiding Principles for Sustainable Spatial Development of the European Continent", 12th Session of the European Conference of Ministers responsible for Regional Planning (CEMAT), September 2000, Hanover'},{id:"B3",body:'Territorial Agenda of the European Union 2020, 2011'},{id:"B4",body:'Vlami, V., Kokkoris, I. P., Zogaris, S., Cartalis, C., Kehayias, G., Dimopoulos, P. Cultural landscapes and attributes of “culturalness” in protected areas: An exploratory assessment in Greece. 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Sustainability, Special Issue "Cultural and Creative Tourism Developments: Past, Present and Future" 12, 10297: 1-19 DOI: 10.3390/su12241029, ISSN 2071-1050'},{id:"B9",body:'Bello, F. G., Lovelock, B., Carr, N. Enhancing community participation in tourism planning associated with protected areas in developing countries: Lessons from Malawi. Tourism and Hospitality Research 2018, Vol. 18(3): 309-320 DOI: 10.1177/1467358416647763'},{id:"B10",body:'Danilović Hristić, N., Stefanović N. The Role of Public Insight in Urban Planning Process: Increasing Efficiency and Effectiveness. Spatium International Review, 30, 2013: 33-39, ISSN 14 50-569X'},{id:"B11",body:'Stefanović, N., Danilović Hristić, N., Milijić, S. (2015) Implementation Model of Planning Rules in Spatial Plans. Spatium International Review, 33, ISSN 14 50-569X, No. 33, 2015: 62-68 DOI: 10.2298/SPAT1533062S'},{id:"B12",body:'Stefanović N., Danilović Hristić, N., Krunić, N. (2017) Comparative analysis of elements and models of implementation in local-level spatial plans in Serbia. Spatium International Review, No 37: 58-67. DOI:10.2298/SPAT1737058S'},{id:"B13",body:'Stefanović N., Danilović Hristić, N., Srnić D. (2018) A Methodological Framework for the Integrated Planning of the Protection and Development of the Natural Resource Areas in Serbia - Case Study of the Spatial Plans for the Special Purpose Area for the Protected Natural Areas. Spatium International Review, No 40: 25-32. DOI: 10.2298/SPAT18400255'},{id:"B14",body:'Graovac, A., Danilović Hristić, N., Stefanović N. Technical and Logical Methods for Improving the Process of Urban Planning in Serbia, SPATIUM International Review, No 38, 2017: 27-34. DOI: 10.2298/SPAT1738027G'},{id:"B15",body:'Law on Cultural Heritage, Official Gazette of the Republic of Serbia No. 71/94, 52/11-and other laws, 99/11-and other laws, 6/20-and other laws. Original in Serbian [Zakon o kulturnim dobrima, "Službeni glasnik Republike Srbije" br. 71/94, 52/11dr. zakon 99/11dr. zakon, 6/20dr. zakon.]'},{id:"B16",body:'Law on Planning and Construction, Official Gazette of the Republic of Serbia No. 72/09, 81/09-amendment, 64/10-US, 24/11, 121/12, 42/13-US, 50/13-US, 98/13-US, 132/14, 83/18, 31/19, 37/19-and other laws, 9/20. Original in Serbian [Zakon o planiranju i izgradnji, "Službeni glasnik Republike Srbije" br. 72/09, 81/09-ispravka, 64/10-US, 24/11, 121/12, 42/13-US, 50/13-US, 98/13-US, 132/14, 83/18, 31/19, 37/19-dr. zakon 9/20.]'},{id:"B17",body:'Spatial Plan of the Republic of Serbia from 2021. to 2035. – Draft, Ministry of civil engineering, traffic and infrastructure, April 2021, Belgrade. Original in Serbian [Prostorni plan Republike Srbije od 2021. do 2035. godine – Nacrta, Ministarstvo građevinarstva, saobraćaja i infrastrukture, april 2021, Beograd]'},{id:"B18",body:'Conditions of the Republic Institute for Cultural Heritage Protection, 2020'},{id:"B19",body:'Recommendation on the Historic Urban Landscape, UNESCO, 2011'},{id:"B20",body:'The World Heritage List: Filling the Gaps-an Action Plan for the Future, An Analysis by ICOMOS, 2004'},{id:"B21",body:'Regional Spatial Plan of the Kolubara and Mačva Administrative Districts, Official Gazette of the Republic of Serbia No. 12/14. Original in Serbian [Regionalni prostorni plan za područje Kolubarskog i Mačvanskog upravnog okruga, "Službeni glasnik Republike Srbije" br. 12/14]'},{id:"B22",body:'Spatial Plan for the Special Purpose Area of the Landscape of Outstanding Features "Ovčarsko-kablarska klisura", Official Gazette of the Republic of Serbia No. 46/19. Original in Serbian [Prostorni plan područja posebne namene predela izuzetnih odlika „Ovčarsko-kablarska klisura“, "Službeni glasnik Republike Srbije" br. 46/19]'},{id:"B23",body:'Stefanović, N., Josimović, B., Danilović Hristić, N. (2018) Models of Implementation of Spatial Plans – Theoretical Approach and Case Studies for Spatial Plans for the Special Purpose Area, In: Ergen, Y. (Ed.) An Overview of Urban and Regional Planning, IntechOpen, London, Chapter 4, pp. 59-81, ISBN 978-1-78984-835-9, Print ISBN: 978-1-78984-834-2, DOI: 10.5772/intechopen.78242'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Nebojša Stefanović",address:null,affiliation:'
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Institute of Architecture and Urban and Spatial Planning of Serbia, Belgrade, Serbia
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He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. 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He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. 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He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. 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He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. 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He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. 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Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:{name:"Association for Computing Machinery",country:{name:"United States of America"}}},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:'"Politechnica" University Timişoara',institution:null},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:null,institution:null},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"417317",title:"Mrs.",name:"Chiedza",middleName:null,surname:"Elvina Mashiri",slug:"chiedza-elvina-mashiri",fullName:"Chiedza Elvina Mashiri",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"352140",title:"Dr.",name:"Edina",middleName:null,surname:"Chandiwana",slug:"edina-chandiwana",fullName:"Edina Chandiwana",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"342259",title:"B.Sc.",name:"Leonard",middleName:null,surname:"Mushunje",slug:"leonard-mushunje",fullName:"Leonard Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"347042",title:"Mr.",name:"Maxwell",middleName:null,surname:"Mashasha",slug:"maxwell-mashasha",fullName:"Maxwell Mashasha",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"2941",title:"Dr.",name:"Alberto J.",middleName:"Jorge",surname:"Rosales-Silva",slug:"alberto-j.-rosales-silva",fullName:"Alberto J. Rosales-Silva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"437913",title:"Dr.",name:"Guillermo",middleName:null,surname:"Urriolagoitia-Sosa",slug:"guillermo-urriolagoitia-sosa",fullName:"Guillermo Urriolagoitia-Sosa",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"435126",title:"Prof.",name:"Joaquim",middleName:null,surname:"José de Castro Ferreira",slug:"joaquim-jose-de-castro-ferreira",fullName:"Joaquim José de Castro Ferreira",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Aveiro",country:{name:"Portugal"}}},{id:"437899",title:"MSc.",name:"Miguel Angel",middleName:null,surname:"Ángel Castillo-Martínez",slug:"miguel-angel-angel-castillo-martinez",fullName:"Miguel Angel Ángel Castillo-Martínez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"289955",title:"Dr.",name:"Raja",middleName:null,surname:"Kishor Duggirala",slug:"raja-kishor-duggirala",fullName:"Raja Kishor Duggirala",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jawaharlal Nehru Technological University, Hyderabad",country:{name:"India"}}}]}},subseries:{item:{id:"23",type:"subseries",title:"Computational Neuroscience",keywords:"Single-Neuron Modeling, Sensory Processing, Motor Control, Memory and Synaptic Pasticity, Attention, Identification, Categorization, Discrimination, Learning, Development, Axonal Patterning and Guidance, Neural Architecture, Behaviours and Dynamics of Networks, Cognition and the Neuroscientific Basis of Consciousness",scope:"Computational neuroscience focuses on biologically realistic abstractions and models validated and solved through computational simulations to understand principles for the development, structure, physiology, and ability of the nervous system. This topic is dedicated to biologically plausible descriptions and computational models - at various abstraction levels - of neurons and neural systems. This includes, but is not limited to: single-neuron modeling, sensory processing, motor control, memory, and synaptic plasticity, attention, identification, categorization, discrimination, learning, development, axonal patterning, guidance, neural architecture, behaviors, and dynamics of networks, cognition and the neuroscientific basis of consciousness. 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Ongoing issues, recent advances, and future diagnostic approaches and therapeutic strategies will also be discussed. This book series will focus on various aspects and properties of infectious diseases whose deep understanding is essential for safeguarding the human race from losing resources and economies due to pathogens.",coverUrl:"https://cdn.intechopen.com/series/covers/6.jpg",latestPublicationDate:"August 16th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:4,numberOfPublishedChapters:124,numberOfPublishedBooks:13,editor:{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). 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In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},subseries:[{id:"3",title:"Bacterial Infectious Diseases",keywords:"Antibiotics, Biofilm, Antibiotic Resistance, Host-microbiota Relationship, Treatment, Diagnostic Tools",scope:"
\r\n\tThe era of antibiotics led us to the illusion that the problem of bacterial infection is over. However, bacterial flexibility and adaptation mechanisms allow them to survive and grow in extreme conditions. The best example is the formation of a sophisticated society of bacteria defined as a biofilm. Understanding the mechanism of bacterial biofilm formation has changed our perception of the development of bacterial infection but successfully eradicating biofilm remains a challenge. Considering the above, it is not surprising that bacteria remain a major public health threat despite the development of many groups of antibiotics. Additionally, increasing prevalence of acquired antibiotic resistance forces us to realize that we are far from controlling the development of bacterial infections. On the other hand, many infections are endogenous and result from an unbalanced relationship between the host and the microorganism. The increasing use of immunosuppressants, such as chemotherapy or organ transplantation, increases the incidence of patients highly susceptible to bacterial infections in the population.
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\r\n\tThis topic will focus on the current challenges and advantages in the diagnosis and treatment of bacterial infections. We will discuss the host-microbiota relationship, the treatment of chronic infections due to biofilm formation, and the development of new diagnostic tools to rapidly distinguish between colonization and probable infection.
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