EC and pH of soil in different depths on 5th May 2011
\\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\\nWe 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
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'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\nThroughout 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\nReleased 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\nWe 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
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"984",leadTitle:null,fullTitle:"Current Concepts in Plastic Surgery",title:"Current Concepts in Plastic Surgery",subtitle:null,reviewType:"peer-reviewed",abstract:'Plastic surgery continues to be a rapidly growing field in medicine. 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In this chapter, an innovative study has been carried out by using compost and specific bacteria (Halo Bacteria) to restore the high saline soil damaged by Tsunami occurred on 11th March, 2011 at the Tohoku Area in Japan.
A disaster is the tragedy of a natural or human-made hazard (a hazard is a situation which poses a level of threat to life, health, property, or environment) that negatively affects society or environment. A natural disaster is a consequence when a natural hazard (e.g., volcanic eruption or earthquake) affects humans. Tsunamis and earthquakes are two of the most dangerous and yet most common hazards to affect population centers and economic infrastructures worldwide. Generally, tsunami flooding results from a train of long-period waves that can rapidly travel long distances from where they were generated by deep-ocean earthquakes, submarine landslides, volcanic eruptions, or asteroid impacts [1, 2, 3]. Due to tsunami the sea water carry sediments along with salt itself. There have been many studies on recent and ancient tsunami deposits. These include descriptions of tsunami deposits in coastal lake, estuary, lagoon, bay floor and shelf environments and even the farmland [4,5]. The mega earthquake and consequent tsunami had caused a great damage to not only human life and infrastructure but also the agricultural land and the crops in Tohoku region, Japan. The after math of the tsunami has created many problems to environment and geo-environment of these affected areas. Soil pollution and high salinity which caused the farmland unusable for cultivation is one of the major geo-environmental problems. The objective of this study is to get an idea about the extent of soil chemical properties change due to tsunami and to apply bioremediation approach to salinity control of the agricultural land.
The sea water inundated the large areas of agricultural land causing the excessive saline in the soil.
Salinity of soils is the condition of soils that have a high salt content. The predominant salt is normally sodium chloride (NaCl). As a result, saline soils are therefore also
Mechanism of salinity affected soil and plant interaction
Figure 1 shows the mechanisms of salinity affected soil and plant interaction. Salinity becomes a problem when enough salts accumulate in the root zone to negatively affect plant growth. Excess salts in the root zone hinder plant roots from withdrawing water from surrounding soil. This lowers the amount of water available to the plant, regardless of the amount of water actually in the root zone. For example, when plant growth is compared in two identical soils with the same moisture levels, one soil receiving salty water and the other receiving salt-free water, plants are able to use more water from the soil receiving salt-free water. Although the water is not held tighter to the soil in saline environments, the presence of salt in the water causes plants to exert more energy extracting water from the soil. The main point is that excess salinity in soil water can decrease plant available water and cause plant stress. So, high salinity of soil is very dangerous for the plant as most of the plants can not survive in that soil condition.
Salt accumulated on the surface of the tsunami sediment in Tohoku area, Japan
Figure 2 shows the salt accumulation on the surface of the soil after the tsunami in Tohuku area in Japan. For the case of tsunami, a vast area of the land area goes under sea water. And the accumulation of salt after the tsunami water caused a serious damage to the geo-environment. Soil water salinity can affect soil physical properties by causing fine particles to bind together into aggregates. This process is known as flocculation and is beneficial in terms of soil aeration, root penetration, and root growth. Although increasing soil solution salinity has a positive effect on soil aggregation and stabilization, at high levels salinity can have negative and potentially lethal effects on plants. As a result, salinity cannot be increased to maintain soil structure without considering potential impacts on plant health.
The great east Japan Earthquake (Higashi Nihon Daishinsai in Japanese) was a magnitude 9.0 undersea mega thrust earthquake off the coast of Japan that occurred at 14:46:23 JST on Friday, 11 March 2011.The location of the epicenter (38.3220 N, 142.3690 E) of this earthquake is about 70 kilometers east of the Oshika Peninsula of Tohoku and the hypocenter at an underwater depth of approximately 32 km. It was the most powerful known earthquake to have hit Japan, and one of the five most powerful earthquakes in the world overall since modern record-keeping began in 1900. The earthquake triggered extremely destructive tsunami waves of around 40 m in Miyako, Iwate prefecture and in some cases travelling up to 10 km inland. In addition to loss of life and destruction of infrastructure, the tsunami caused a number of nuclear accidents in the power plant in Fukushima which caused evacuation zones affecting hundreds of thousands of residents. The sea water inundated the large areas of agricultural land causing the excessive saline in the soil.
The field test of soil for its chemical analysis was conducted in Rikuzentakata city of Iwate prefecture, Japan. Fig. 3 shows the damaged area in Rikuzentakata city [9]. This city was one the major affected areas by the tsunami on 11th March, 2011. Fig. 4 shows the place of investigation on 5th May, 2011. Fig. 5 shows the place of soil investigation on 30th June, 2011.
The pH and EC (Electric Conductivity) of the damaged agricultural land were measured by the digital pH meter (Horiba, D-54SE). The electrical conductivity of the soil was also measured by using digital EC meter (Oakton, PCSTEST35). The salinity of the soil can be calculated by the value of electrical conductivity.
Map of Japan indicating the study area and soil investigation area
The place of soil investigation on 5 May 2011 in Rikuzentakata area
The place of soil investigation on 30th June 2011 in Rikuzentakata area
The soil of the Rikuzentakata was very fertile. The farmers used to cultivate different types of crops including the corn and vegetables. The average moisture content of the soil was around 25 %. However, due to the tsunami water inundated the large areas of the Rikuzentakata, a huge amount of submarine sediments come along with the sea water and settled on the agricultural land along with different types of tsunami debris. The sediment of the tsunami also brought some kinds of toxic materials which were settled under the sea over a long period of time. The sediment is mainly a clay but some sandy particles were also found in different parts of the area.
Tsunami Sediment deposited on the vast area in tohoku, Japan
The aim of soil salinity control is to prevent soil degradation by salinization and reclaim already salty (saline) soils.
Various attempts are now carrying out to control the salinity of the agricultural land. The primary method of controlling soil salinity is to permit 10-20% of the irrigation water to leach the soil, be drained and discharged through an appropriate drainage system.
The salt concentration of the drainage water is normally 5 to 10 times higher than that of the irrigation water, thus salt export matches salt import and it will not accumulate. However, it will take a long time and efforts for such kind of design of the salinity removal from the saline soil [7,8].
In this study, an innovative idea has been taken for reducing the salt concentration from the soil of the agricultural areas by bioremediation. By using the halo bacteria with the compost the bioremediation was carried out.
It was possible to increase a volume of the compost by mixing rice bran, oil cakes, grinds of fish bones and water in a specific ratio. Total 30 kg compost was made. Further, it had increased up to 300 kg. After mixing each material, temperature of the compost increased at 48 ˚C for 2 days and turned over for aeration (Figs. 7 and 8).
Preparing compost by mixing rice bran, oil cakes, grinds of fish bones and water
Compost by mixing rice bran, oil cakes, grinds of fish bones and water after 3 days
Then, the compost containing the halo bacteria had been applied in the large areas of Rikuzentakata of Iwate Prefecture which was affected by sea water inundation due to tsunami. Due to bacterial activities, the salinity of the agricultural areas would have been reduced as well as compost would supply some nutrients and organics to the soil.
\n\t\t\t\t | \n\t\t||||||||||
Depth | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t3 | \n\t\t\t4 | \n\t\t\t5 | \n\t\t\t6 | \n\t\t\t7 | \n\t\t\t8 | \n\t\t\t9 | \n\t\t\t10 | \n\t\t
5cm | \n\t\t\t1.51 | \n\t\t\t0.36 | \n\t\t\t0.39 | \n\t\t\t1.49 | \n\t\t\t1.26 | \n\t\t\t0.47 | \n\t\t\t1.20 | \n\t\t\t1.77 | \n\t\t\t1.01 | \n\t\t\t0.25 | \n\t\t
10cm | \n\t\t\t3.04 | \n\t\t\t2.00 | \n\t\t\t1.94 | \n\t\t\t2.93 | \n\t\t\t3.16 | \n\t\t\t1.32 | \n\t\t\t2.77 | \n\t\t\t3.43 | \n\t\t\t1.83 | \n\t\t\t1.15 | \n\t\t
15cm | \n\t\t\t2.23 | \n\t\t\t2.43 | \n\t\t\t2.81 | \n\t\t\t4.03 | \n\t\t\t2.21 | \n\t\t\t1.84 | \n\t\t\t0.97 | \n\t\t\t3.46 | \n\t\t\t2.4 | \n\t\t\t2.25 | \n\t\t
\n\t\t\t\t | \n\t\t||||||||||
Depth | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t3 | \n\t\t\t4 | \n\t\t\t5 | \n\t\t\t6 | \n\t\t\t7 | \n\t\t\t8 | \n\t\t\t9 | \n\t\t\t10 | \n\t\t
5cm | \n\t\t\t7.21 | \n\t\t\t8.47 | \n\t\t\t8.06 | \n\t\t\t7.55 | \n\t\t\t7.22 | \n\t\t\t8.39 | \n\t\t\t7.71 | \n\t\t\t7.62 | \n\t\t\t7.19 | \n\t\t\t8.27 | \n\t\t
10cm | \n\t\t\t5.75 | \n\t\t\t5.68 | \n\t\t\t6.5 | \n\t\t\t5.78 | \n\t\t\t5.71 | \n\t\t\t6.57 | \n\t\t\t5.98 | \n\t\t\t5.6 | \n\t\t\t6.74 | \n\t\t\t6.52 | \n\t\t
15cm | \n\t\t\t6.22 | \n\t\t\t5.48 | \n\t\t\t5.69 | \n\t\t\t5.2 | \n\t\t\t6.13 | \n\t\t\t5.84 | \n\t\t\t7.12 | \n\t\t\t5.64 | \n\t\t\t5.77 | \n\t\t\t5.82 | \n\t\t
EC and pH of soil in different depths on 5th May 2011
EC and pH of soil in different depths on 30th June, 2011
In order to confirm the effect of the compost, an artificial saline soil was made by mixing natural salt. The original EC of the soil is 2.85 mS/cm. The compost with Halo bacteria of 1g and rice bran of 15 g were mixed into the soil of 500 cm3. The rice bran is a material for accelerate growth of the bacteria. After the incubation, a value of EC is measured. Fig. 9 shows the result of EC for the soil mixed with the compost. It is clear that EC of the soil with salt is decreased by mixing the compost with Halo bacteria. It is estimated that 25% of salt can be reduced by mixing the compost for 7 days in this bioremediation.
Relationship between electric conductivity and curing period on soil with salt
The bioremediation of the saline soil is possible by using the home made compost. The way of making the compost is easy and less costly. So, this method of remediation can be used in many developing countries in the world. The benefit of this bioremediation is that the cost during the process of bioremediation is very low compare to other method of salinity management of agricultural soil currently used.
Soil investigation at the site was performed on March 2012. Table 3 shows comparison of electric conductivity of the soils before and after the restoration by the compost. Due to the rail fall and vegetation of sunflower, the salt concentration decreased gradually and the highest EC at the site was 0.25 mS/cm on September 2011. The value of EC decreased furthermore on March 2012.The effect of bioremediation is understood in the field, however, the exact amount of the bioremediation is difficult to measure in the field as the natural environmental effects have the influence on the soil properties in the wide areas of the Rikuzentakata.
\n\t\t\t\t | \n\t\t|||||||
Date | \n\t\t\tA | \n\t\t\tB | \n\t\t\tC | \n\t\t\tD | \n\t\t\tE | \n\t\t\tF | \n\t\t\tG | \n\t\t
30/9/2011 | \n\t\t\t0.174 | \n\t\t\t0.213 | \n\t\t\t0.211 | \n\t\t\t0.249 | \n\t\t\t0.186 | \n\t\t\t0.203 | \n\t\t\t0.226 | \n\t\t
12/3/2012 | \n\t\t\t0.016 | \n\t\t\t0.017 | \n\t\t\t0.018 | \n\t\t\t0.143 | \n\t\t\t0.017 | \n\t\t\t0.016 | \n\t\t\t0.017 | \n\t\t
Comparison of electric conductivity of the soils before and after bioremediation
Some substances known to have toxic properties have been introduced into the environment through man-made activities. These substances range in degree of toxicity and danger to human health. Many of these substances either immediately or ultimately come in contact with or are sequestered by soil. Conventional methods to remove, reduce, or mitigate toxic substances introduced into soil or ground water via anthropogenic activities and processes include pump and treat systems, soil vapor extraction, incineration, and containment. Utility of each of these conventional methods of treatment of contaminated soil and/or water suffers from recognizable drawbacks and may involve some level of risk.
The mechanism of bioremediation of the salt affected agricultural land is illustrated in the Figure 10. It is seen that the bacteria mixing with compost help to release the salt element from the soil surface due to the microbial activities. When the effects of bioremediation were taken place then the salt removed easily from the surface with the help of rain water or snow melting.
Mechanism of salt removal from tsunami affected soil by bioremediation
The salt in the soil particle can be easily removed by this bioremediation. So this mechanism to remove the salt from the saline soil can be used not only for the tsunami affected areas but also in the coastal areas in different countries in where the sea level rise caused by global warming is a real threatening matter for the local population.
Salinity is an important land degradation problem. Soil salinity can be reduced by leaching soluble salts out of soil with excess irrigation water. Soil salinity control involves watertable control and flushing in combination with tile drainage or another form of subsurface drainage however, if the vast area is affected by salinity then it is really difficult to treat that soil as the fresh waster needed to wash the soil will need a huge amount of money. So bioremediation of saline soil is a better option as the compost can supply some nutrients as well to the soil. High levels of soil salinity can be tolerated if salt-tolerant plants are grown. Sensitive crops lose their vigor already in slightly saline soils, most crops are negatively affected by (moderately) saline soils, and only salinity resistant crops can stay alive in severely saline soils.
A high salt level interferes with the germination of new seeds. Salinity acts like drought on plants, preventing roots from performing their osmotic activity where water and nutrients move from an area of low concentration into an area of high concentration. Therefore, because of the salt levels in the soil, water and nutrients cannot move into the plant roots.
As soil salinity levels increase, the stress on germinating seedlings also increases. Perennial plants seem to handle salinity better than annual plants. In some cases, salinity also has a toxic effect on plants because of the high concentration of certain salts in the soil. Salinity prevents the plants from uptaking the proper balance of nutrients they require for healthy growth. So, in our bioremediation of saline soil, we can easily provide the sufficient nutrients as well as to restore the salinity affected soil for a vast area generally affected by tsunami in a reasonable cost.
The mega earthquake and consequent huge tsunami has done a great damage to the entire areas of the pacific regions in Tohoku, Japan. The sea water which covered the agricultural lands in these areas has created a critical situation for the farmers. The farmers have lost not only the crops they were cultivating but also the soil of the agricultural field had been seriously damaged by the sea water, salinity and other pollutants. The pH value and EC value of the soil in these areas are considered as the higher value in terms of safer limit for the regular crops. To reclaim this saline soil, compost containing the Halo bacteria had been applied as an approach of bioremediation. The Halo bacteria used the excessive salts from the soil and consequently can reduce the salinity problem which was proved in the laboratory test. This compost can also provide necessary nutrients to the soil and plant. So, bioremediation by compost to restore the tsunami damaged saline soil proved to be an efficient and can be applicable in other parts of the world especially developing countries which are suffering by the sea level rise problems.
Spinal cord injury (SCI) is attributable to trauma caused by accidents like car crashes, falls or sports such as diving or gymnastics, and violent causes like gunshots or injuries by cold weapon [1] and also caused by nontraumatic causes like primary or metastatic tumors, compressive myelopathy such as cervical spondylotic myelopathy, neurodegenerative diseases such as motor neuron disease, autoimmune diseases like multiple sclerosis, infections such as epidural abscess, and vascular diseases such as medullary infarction, as well as genetic causes, for example, spinal muscular atrophy [2] that affect spinal cord motor and sensory function, also causing neurogenic bladder or bowel.
\nThe global prevalence rate, including both traumatic and nontraumatic causes, is 40–80 cases per million people; however 90% of cases are due to traumatic causes, with a male-to-female ratio of 2:1, respectively [3], presenting with a bimodal age peak of young people and 60-year-old people [4]. To estimate the economic burden, the first year after injury treatment cost is estimated to be $334,170 USD rising to $1,023,924 USD [5]. The main causes of SCI are vehicle accidents, falls, violence [6], compressive myelopathy, tumors, and multiple sclerosis [2]. Most damaged anatomical regions are the lower cervical spine, cervicothoracic union, and thoracic-lumbar union [6]. Prognosis depends on the level of injury [4].
\nTo the present day, there are no medical or surgical procedures to reverse neurological damage in SCI patients; therefore new rehabilitation strategies have been designed to avoid deterioration in many patient scopes. This process has to be coordinated by a multidisciplinary SCI expert team so that biopsychosocial impact on patients is reduced.
\nThere are several tools to assess the patient with SCI; some of them are the following, ASIA scale, Spinal Cord Independence Measure (SCIM) scale, Walking Index for Spinal Cord Injury II (WISCI II) scale, and Short-Form Health Survey (SF-36) quality of life test, which will be discussed in detail below. These are very useful instruments that ease decision-making on treatment and rehabilitation, taking into consideration patient capacity and expectations to integrate into society.
\nThis scale developed by the American Spinal Injury Association is considered the gold standard for SCI clinical evaluation. The scale significance relies on its capacity to determine the level of injury, whether it is a complete or incomplete injury, predict prognosis, and serve as guidance for treatment.
\nIt consists of the examination of dermatomes and myotomes. For evaluation of sensory function, 28 key dermatomes are explored using a piece of cotton and a monofilament. For motor examination, five upper and five lower key muscle groups are evaluated. S4 and S5 dermatome evaluation is useful to determine if the injury is complete or incomplete by looking for external anal sphincter contraction and anal pressure sense.
\nPatients are classified from A, which means an injury is complete, to E, where patients have normal functionality (Table 1). This tool provides a long-term reliable prognosis, but it does not take into account pain and spasticity [7, 8].
\nComplete | \nNo motor and sensory function | \n|
Incomplete | \nSensory function preserved. No motor function below the level of injury, including S4-S5 level | \n|
Incomplete | \nMotor function preserved below the level of injury and more than half of the key muscles below the level of injury with less than 3/5 strength | \n|
Incomplete | \nMotor function preserved below the level of injury and at least half of key muscles with strength more than 3/5 | \n|
Normal | \nNormal sensory and motor function | \n
ASIA scale.
According to this scale, an accurate prognosis can be established if a 72-h post-injury evaluation is made. 80% of patients with an A-type injury will remain in this classification; meanwhile, 10% will convert into a B-type injury and the 10% remaining will convert into a C-type injury; from the conversion percentage, only 14% of the patients will gain some aided gait capacity. Patients with B-type injury are considered to gain 33% of gait capacity, C-type injury patients will gain approximately 75% of gait capacity, and D-type injury patients will have a very good prognosis since most of them will be able to walk in 1-year post-injury [9, 10].
\nThe Spinal Cord Independence Measure is a tool that assesses an SCI patient capacity to perform daily life activities. This instrument evaluates 19 areas and contains 4 subscales: self-caring (0–20 points), breathing and sphincter control (0–40 points), room and bathroom mobility (0–10 points), and interior and exterior mobility (0–30 points). Besides these subscales, feeding, bed mobility, pressure ulcer prevention, and transfer from wheelchair to the car and floor are included [11].
\nThe maximum score to obtain is 100 points; a high score means that the patient is independent for daily life activities. This is a self-assessment tool, so there is no need for qualified personnel to evaluate it [12].
\nThe Walking Index for Spinal Cord Injury II is a reliable and trustworthy tool to measure walking improvement in SCI patients [13]. It comprises 21 levels that evaluate gait, considering the use of walking aids. It goes from 0 (the patient is not able to walk) to 20 (the patient walks at least 10 m without crutches or assistance) [14].
\nThe Short-Form Health Survey questionnaire is a nonspecific generic test broadly used to evaluate the quality of life, considering both positive and negative subjects, in patients with chronic conditions and mobility diseases [15]. It is easy to answer and takes approximately 5 to 10 min.
\nThe test comprises 36 items, divided into 8 subscales that evaluate the following areas: physical function (10 items), role limitations due to physical issues (4 items), pain (2 items), general health appreciation (5 items), vitality (4 items), social function (2 items), role limitations due to emotional issues (3 items), mental health (5 items), and an additional item that compares actual health with previous year perception of health [16]. Many studies have found with this instrument that SCI has a negative influence on the quality of life of patients [17].
\nSCI is a neurological condition that demands a long rehabilitation period, coordinated by a multidisciplinary team because of the damage that it entails. To avoid complications as much as possible, to improve function, and to achieve the most independence, numerous rehabilitation strategies have been shown in many studies to have an impact in patient recovery; some of them are the following: strength, range of movement and stretching exercises, functional electrical stimulation (FES), epidural electrical stimulation (EES) of the spinal cord, occupational therapy, dry needling, and exoskeleton.
\nRange of movement refers to the normal movement of a joint; hence range of movement exercises are those that promote joint mobility and flexibility.
\nStudies have observed that these exercises improve function for daily life activities [18], prevent contractures, protect tenodesis effect [19], strengthen paralyzed muscles, promote nerve and cerebral remodeling, and improve spinal microenvironment and functional prognosis [20]. For protection of the joint structure and preservation of muscle tone, sandbags, pillows, or orthotics are usually used. Exercise is important for strengthening the muscles of the upper limbs, emphasizing on rotation of the shoulders for the use of crutches or wheelchair. These exercises will help in the mobilization and independence in daily life activities. In patients with incomplete SCI, walking potential is high, so sitting, parallel bars, and balance exercises should be done [19].
\nFunctional electrical stimulation is a technique that artificially activates sensory-motor systems through electrical current pulses, producing action potentials in afferent and efferent neural pathways to stimulate muscles and generate movement [21]. This procedure is added to other therapies to increase mobility, sensory feedback, and muscle activity to decrease atrophy. It also provides cardiorespiratory fitness; improves posture and trunk stability [22]; prevents contractures, pressure ulcers, and orthostatic hypotension [23]; promotes nerve restoration; and prevents peripheral nerve deterioration [24].
\nFunctional electrical stimulation is a technique that artificially activates sensory-motor systems through electrical current pulses, producing action potentials in afferent and efferent neural pathways to stimulate muscles and generate movement [21]. The main elements of a FES system are the battery, an electronic stimulator, control unit, wiring, and electrodes. The controller can work through a switch, joystick, or voice. There are different types of electrodes, superficial, intramuscular percutaneous, implantable, and epimysial; however the commercially available are the superficial ones, which should be placed over the skin above the nerves to be stimulated; the rest of the electrodes are for research purpose only. The electrodes must be of low-impedance, flexible, and easy to don and doff [22]. The electrical parameters of these systems are waveforms, amplitude, pulse width, reciprocity, ramp, and duration; all of these are combined to generate an electrical current and must be adjusted to achieve the desired response [22, 23].
\nIt is important to evaluate the patient to determine if he or she is a candidate for this therapy. Some exclusion criteria for FES are the following: if the patient has an electrical implantable device, history of cancer, osteomyelitis, epilepsy, and thrombosis [23].
\nFES systems can be applied to different sites. In patients with cervical SCI, hand function recovery is the main priority, so there are FES systems developed for the upper limb that work through neuroprosthetics with a stimulator for forearm and hand muscles; patients with injuries at C5-C6 level can benefit with this therapy. The only commercially available systems for the upper limb are NESSH200 and Compex. NESSH200 consists of an adjustable wrist prosthetic with five electrodes for finger flexors and extensors, allowing handgrip [24, 25]. There are FES systems for lower limbs that allow sitting and mobility. The best candidates for this therapy are patients with injuries at T4-T12 level, which have more impact in patients with incomplete injuries. The FES neuroprosthetics for the lower limbs stimulate the knees and hips [24]. A commercially available FES system in the USA is the Parastep, which works through 4–6 channels to stimulate the quadriceps and gluteal muscles. Battery is placed on the waist and controls are over a walker [25]. FES cycling systems are also commercially available; one of them is developed by Restorative Therapies, Inc. [24] and the other one, ERGYS, developed by Therapeutic Technologies, Inc. which has six electrodes to stimulate the quadriceps, hamstrings, and gluteal muscles [22].
\nThis procedure is added to other therapies to increase mobility, sensory feedback, and muscle activity to decrease atrophy. It also provides cardiorespiratory fitness; improves posture and trunk stability [26]; prevents contractures, pressure ulcers, and orthostatic hypotension [27]; promotes nerve restoration; and prevents peripheral nerve deterioration [28].
\nThis strategy requires a device to be implanted through a laminectomy over the dura mater of the spinal cord [25]. The device delivers a rhythmical afferent electrical current to posterior nerve roots to activate central circuits that regulate movement, pain, and the cardiorespiratory system [22].
\nIt is believed that EES activates two pathways: The first one stimulates afferent dorsal pathways that synapse with motor neurons; the second pathway directly stimulates motor neurons through stimulation of efferent motor nerves [26].
\nStudies in SCI patients have shown that this strategy decreases fatigue [25], improves cardiovascular and respiratory fitness, increases lean body mass, and improves bladder voiding [26]. The main disadvantage of EES is that it requires surgery for device insertion, which implicates the risk of infection, hematoma, or injury because of the device [25].
\nThis experimental strategy requires a device to be implanted through a laminectomy over the dura mater of the spinal cord [29]. The device delivers a rhythmical afferent electrical current to posterior nerve roots to activate central circuits that regulate movement, pain, and the cardiorespiratory system [26].
\nIt is believed that EES activates two pathways: The first one stimulates afferent dorsal pathways that synapse with motor neurons; the second pathway directly stimulates motor neurons through stimulation of efferent motor nerves [30].
\nStudies in SCI patients have shown that this strategy decreases fatigue [29], improves cardiovascular and respiratory fitness, increases lean body mass, and improves bladder voiding [30]. The main disadvantages of EES are that it requires surgery for device insertion, which implicates the risk of infection, hematoma, or injury because of the device [29], it is expensive, and it does not yet establish a standard number of sessions and parameter configurations since multiple studies have shown that outcomes vary in each patient due to SCI heterogeneity [30].
\nIt is worth mentioning that this technique is used merely for research purpose only and it is not approved by health authorities. The evidence that exists to date is not enough to justify its use, since it has been studied only in specific small cohorts of patients or single patients with SCI and there are no clinical trials with this method [29, 30].
\nTENS is a high- and low-frequency electrical current therapy. It is used for pain management, but many other benefits have been observed, such as balance and proprioception improvement and spasticity decrease [31]. To date, its mechanism of action is unknown; however, different theories assume it works by modulating inhibitory spinal circuits, by activating afferent neurons, or by inducing central nervous system plasticity [32]. When applying it, it is necessary to consider electrode positioning, frequency, and pulse intensity; though, there is not a consensus on how long sessions should last and how much frequency has to be applied. The main advantages of this therapy are that it is low cost, it is easy to apply since the patient can do it by himself/herself, and there are no side effects reported yet [31, 33].
\nOccupational therapy is a crucial process in rehabilitation since it eases societal role finding [19]. It focuses on enhancing daily life activity execution and fine movement, by searching for total independence or performing compensatory strategies to adapt [34, 35, 36] as well as patient’s environment adaption (home, transportation, or workplace) to achieve total inclusion with its remaining abilities.
\nIt demands equipment and techniques for transferring from one surface to another, dressing, bathing, grooming, feeding, cooking, respiratory exercises, and vesical and intestinal control. Besides, it also trains on wheelchair use and provides counseling for house modification like ramp addition, bath chair incorporation, and current insulation [34, 37].
\nDry needling is an invasive procedure that consists of reaching muscle myofascial trigger points (MTPs) with a needle [38]. MTPs are small, tense muscle nodules that cause pain, cause weakness, and limit range of motion [39].
\nIt is considered that dry needling stimulation inhibits spontaneous electrical activity in MTPs by diminishing the availability of acetylcholine in the motor end plate (it is believed that MTP originates here); consequently, muscle fiber relaxes, promoting pain and spasticity reduction and improving gait speed and stability in patients with incomplete injury [39, 40]. It is worth mentioning that more studies have to be made to set the frequency, duration, and intensity of sessions to obtain desirable outcomes [41].
\nExoskeletons are battery-powered robotic devices that adjust to the patients’ limbs; it can be operated with manual or oral control or micromovement detector to ease mobility and gait [26, 34].
\nTwo main objectives of exoskeletons are promoting recovery through repeated movements to increase neural plasticity and assist mobility [42]. ReWalk™ and Indego™ are two community use exoskeletons [43] that enable walking, sitting, and climbing stairs up and down [44, 45]. Their use has shown improvements in quality of life, body composition, bone density, neuropathic pain, and spasticity [42] and an increase in gait speed [43], number of steps, and distance test before and after 90 days of training [34]. Restraints for certain users are height, weight, articular rigidity, and high cost ($80,000 USD) [43].
\nElectrical stimulation outcome measurement can be performed through different methods, depending on the evaluated function. After FES, cycling outcomes can be measured by tridimensional analysis of the gait, estimation of oxygen consumption by indirect calorimetry, and muscle tone evaluation with Modified Ashworth Scale [46]. To evaluate outcomes after EES, the following methods can be applied: Motor activity can be evaluated by electromyography and motor tasks, the cardiovascular status might be evaluated by blood pressure measurement after tilt table testing; sexual performance can be assessed by the achievement of orgasm, and for bladder control evaluation, the Neurogenic Bladder Symptom Score (NBSS) can be applied, or post-void residual volume and voluntary urination capacity can be evaluated [47]. In other studies, the outcomes have been measured through motor task performance such as sitting and balance, body fat mass measurement, and respiratory function or inspiratory function by coughing; all cases are compared before and after therapy application [30].
\nCardiovascular rehabilitation is critical because daily life activities are not enough to preserve cardiovascular health. It is estimated that the prevalence of cardiovascular diseases in patients with SCI is 60–70% and these represent, just as in able population, the main cause of death [48]. Besides, if the level of injury is higher, so will be the sedentarism and risk [49]. Another detail to consider is that SCI patients have a higher risk of complications such as thromboembolism, autonomic dysreflexia (AD), orthostatic hypotension, pain, and cardiac atrophy [34].
\nFor cardiovascular status enhancement in the SCI patient, it is suggested to: (1) do body weight-supported training for it has advantageous effects on cardiac rhythm and blood pressure; (2) do upper limb exercise with moderate to strenuous intensity 3 days a week for at least 6 weeks; and (3) train with functional electrical stimulation 3 days a week for at least 2 months. This kind of training improves the patient lipid profile because it reduces triglycerides and LDL cholesterol [48].
\nAfter a long resting period, patients may suffer orthostatic hypotension. Training with a tilt table can be useful to get patients used to a vertical position, with a gradual beginning until tolerance of position is achieved. Afterward, patients should sit on the border of the bed by their own 3 or 4 times a day to keep balance. This is important because the position is needed for wheelchair use [19].
\nFor optimal glycemic control, aerobic exercise and EES 30 min a day for at least 3 times a week for 8 weeks is recommended [48].
\nAutonomic dysreflexia consists of a sudden blood pressure elevation caused by stimuli such as bladder overdistension or lack of bowel voiding, tight clothes, or pressure ulcers.
\nAD is considered when systolic blood pressure increases to 20–40 mmHg over the baseline. This usually occurs in patients with injuries in or over T6 level. AD happens because the previously mentioned stimuli start an uncontrolled adrenergic response due to an abnormal supraspinal regulatory signal, causing blood pressure elevation and bradycardia as a compensatory response.
\nAD is an emergency since it can cause serious complications such as hypertensive encephalopathy, seizures, cardiac arrest, or even death. To prevent patients from AD, stimuli should be avoided. Some pharmacological treatments used are nitrates, nifedipine, prazosin, capsaicin, and botulinum toxin for refractory cases [50, 51].
\nPulmonary rehabilitation is critical in the acute and chronic phases of SCI, particularly in patients with high-level injuries because there are respiratory muscle paralysis limiting thoracic expansion, low pulmonary volumes, and weak cough [52]. Previously mentioned issues cause hypoventilation, mucus plugs, surfactant decrease, pneumonia, atelectasis, or respiratory failure that may result in death if not properly cared [53].
\nAdditionally, due to respiratory mechanics compromise, certain voice characteristics are affected such as less syllable production per breathing, less volume, and more roughness [54].
\nThe next section discusses the strategies to improve pulmonary function: (1) postural changes and early mobilization; (2) breathing techniques, spontaneous cough, and cough aid; (3) secretion management and respiratory muscle training [19, 34, 53]; and (4) pulmonary percussion and vibration therapy [26].
\nNeurofacilitation techniques are frequently used in patients who suffered a stroke but these can also be applied to patients with SCI. It consists of a group of techniques whose main objectives are functionality recovering through noninvasive neuropsychological stimulation, promoting nerve regeneration, and neural systems reorganization [55]. Some of these techniques are mentioned below.
\nIt is useful for upper limb rehabilitation. It consists of repeatedly training the limb mobility; meanwhile the contralateral limb is immobilized. However, there has to be some mobility remaining to be applied [55].
\nThis is a functional movement training in which the patient stands over a treadmill with a harness, aided by therapists to move the legs and keep balance. It can be beneficial since it is an aerobic exercise [55].
\nBobath method consists of a group of complex, specific, and individualized techniques based on postural control and task execution, taking advantage of neuromuscular plasticity to achieve problem-solving in people with movement disorders. It is possible to control posture, reduce spasticity, increase muscle tone, and improve standing ability through this method [56, 57].
\nUp to 80% of patients with SCI suffer neurogenic bladder as a result of detrusor hyperactivity disorder, sphincter dyssynergia, or detrusor areflexia; they have an increased risk of urinary incontinence, recurrent infections, vesicoureteral reflux, and renal and bladder lithiasis [58].
\nMost of the patients will need management for dry, incomplete voiding, to ensure the low-pressure reservoir function of the bladder. This management begins with anticholinergic medication and intermittent catheterization; patients who failed these treatments need more invasive treatments such as sphincterotomy, botulinum toxin applications, and stent insertion [59].
\nImaging and urodynamic studies should be performed for the initial evaluation of the patient [60]. Catheterization techniques are detailed below.
\nThis is the most used method for bladder drainage without the need for a permanent catheter. A catheter is inserted in an interval of 4–6 h. It prevents complications such as hydronephrosis and kidney and bladder stones. It must be done by patients who have enough manual ability (writing and feeding) or a caregiver willing to do it [60].
\nIt consists of the insertion of a suprapubic or urethral catheter. This catheterization is suggested for patients with poor manual ability, cognitive deficits, and limited assistance [60].
\nIt is the application of suprapubic pressure for drainage of the bladder. It is used when the bladder is flaccid or when it is necessary to increase the contraction; the Valsalva method is also used to drain the bladder [60].
\nTransurethral sphincterotomy, stent colocation, or ileocystoplasty can be done.
\nNeurogenic bowel dysfunction occurs 95% of the time as constipation and 75% as fecal incontinence. Hemorrhoids, abdominal pain, prolapse, rectal bleeding, and anal fissures also occur and can trigger episodes of autonomic dysreflexia.
\nThe management of this dysfunction requires a history of bowel habits in addition to a complete physical examination [61]. It is recommended to establish a schedule to defecate in a comfortable position, implementing changes in diet and lifestyle before using laxatives or suppositories. The caregiver must perform an examination or digital stimulation; manual removal of feces is also preferable [60, 61]. Enemas are another treatment [62].
\nAfter SCI, sexual function is affected since it alters the motor, sensory, and autonomous functionality, and its importance relies in the fact that the number of patients with SCI is young in a childbearing age. There is damage to male fertility, vaginal lubrication, erection, and ejaculation [63].
\nThe causes of sexual dysfunction are multifactorial: altered sensitivity, erectile dysfunction, and side effects of medical therapy.
\nIn men with SCI, some dysfunctions can present as a delayed orgasm, erectile or ejaculatory disorder, seminal abnormalities such as hypomotility, or low sperm viability [64].
\nIt is a questionnaire designed to assess the sexual function and satisfaction in men. This instrument includes 10 questions where physical and emotional aspects are considered; scores go from 0 to 100 points [65].
\nAdministration of phosphodiesterase-5 inhibitors is helpful in inhibition of guanosine monophosphate degradation causing smooth muscle relaxation. Other methods are intracavernous application of phentolamine, papaverine, and alprostadil or intraurethral application of alprostadil [64].
\nVibratory stimulation can be done until antegrade ejaculation is achieved. Another method is electroejaculation, which electrically stimulates prostatic nerves and muscles and seminal vesicles; if retrograde ejaculation occurs, a catheter is needed to collect residual semen from the bladder [64].
\nIn women, sexual function after SCI has not been sufficiently studied as in male dysfunction. Sexual rehabilitation in women focuses on psychological matters and sphincter control during sexual activities. In addition, vaginal lubrication depends on neurological factors and vascular factors [66, 67].
\nSCI causes an alteration in the microenvironment of the skin, causing excessive sweating, thinning, onychogryphosis, paronychia, tinea, seborrheic dermatitis, and cellulitis [68, 69]; besides, keeping the same position for a long time damages the integrity causing pressure ulcers [70].
\nPressure ulcers are the result of applying pressure to tissue over a bone prominence, exceeding the 12–32 mmHg capillary pressure collapsing the capillaries and causing ischemia. Pressure ulcers represent a major problem for patients with SCI in the acute and chronic stages, also considering the cost involved in treatment [71]. For correct management, pressure must be decreased, and special mattresses, heel protectors, and turns and transfers are recommended. Regarding turns, these must be done in intervals of 2–4 h. Lateral positioning should be limited to minimize pressure on bony prominences. When the patient is in supine position, the bed must incline less than 30° or the limbs must be elevated. Patients using a wheelchair should be trained to distribute pressure by tilting at intervals of 15–30 min [62].
\nSince life expectancy in patients with SCI has been prolonged, the incidence of metabolic syndrome, diabetes, cardiovascular diseases, but also malnutrition has increased substantially; therefore, it is important to make a nutritional plan.
\nThere are no nutritional guidelines for patients with SCI; however, the following general measures are suggested:
Abundant consumption of fruits and vegetables to obtain fiber and avoid constipation; it is recommended to adjust the amount of it to avoid bloating and diarrhea.
Plenty intake of water (minimum 1.5 l).
Protein consumption of 0.8 g/kg per day is recommended, and if a pressure ulcer is present, this amount can be 1.2 g/kg, rising up to 2 g/kg if the ulcers are grade III or IV. The purpose of increasing protein consumption is to decrease the negative nitrogen balance, which is greater in acute stages of the disease; it is also helpful in preserving muscle mass and avoiding glucose intolerance. Liquid protein supplements that contain leucine may be recommended.
High-fat diets should be avoided since the patient lipid profile is altered and predisposes to metabolic syndrome.
Omega-3 is recommended because of its neuro- and cardioprotective effects; however more studies are required.
Micronutrients such as vitamins A, B5, D, E, and C and biotin and minerals such as calcium, chlorine, magnesium, and potassium are usually low consumed, so their intake should increase to improve glucose metabolism.
Nutritional plans must be individualized according to the objectives, the age of the patient, and the level of the injury [72, 73].
\nPsychological management after SCI is essential for the patient in order to return to activities of daily living. After an injury, there are many psychological stages in the readjustment process: shock and denial, depression, anxiety, anger, negotiation, and adaptation.
\nPsychological rehabilitation should start in the intensive care unit because the patient can experience disorientation, depression, anxiety, and sensory and sleep deprivation.
\nPsychotherapy groups are helpful to provide emotional support, educate in the development of new skills, and minimize social aversion. Similarly, family psychotherapy groups make it easier for the family to adjust to the new situation since similar emotional reactions also occur in them [74].
\nThis rehabilitation begins since the patient is admitted to the hospital until the stabilization. It can be a period of 6–12 weeks, depending on the existence of complications. Rehabilitation in the acute phase is important to increase the patient strength and stability for postural adaptation and orthostatic hypotension [19, 28]. Passive exercises have been observed to decrease the risk of spasticity [43]. Other early interventions in rehabilitation are bed mobility with rotation at 2–3-h intervals to prevent pressure ulcers [19, 34].
\nThis rehabilitation is focused on the patient capacity to reintegrate into society. The goals are aimed to develop motor skills such as walking, transferring using the upper limbs, and wheelchair use [28], restore psychological status as much as possible, and perform occupational therapy [19].
\nDespite the fact that most of the patients with SCI want to be able to walk again, the goals of rehabilitation are mainly focused on restoring quality of life [75], and these should be individualized according to the ASIA classification.
\nThe following functional goals can be considered in the first 5 months according to the level of injury (time may vary depending on the patient ASIA classification he/she has):
C4: independence with a motorized wheelchair, partial or assisted ventilation, and dependence on activities of daily living.
C5: independence with a motorized wheelchair with hand control; may require extra respiratory care, performance of some activities of daily living, adapted driving is possible.
C6: independence with a manual wheelchair, assistance in transfer with a sliding table, control of supporting points, can do certain activities of daily life; extension of the wrist is possible; adapted driving is possible.
C7: this is a key level for wheelchair mobility, independent transfers without sliding board support.
C8-L2: advanced wheelchair skills, independent daily life activities, driving with adaptations.
L3 and lower: home and community ambulation with aid devices, independence in daily life activities [19, 34].
SCI is a relevant health issue because of the impact it has on the patient, his/her family, and health system. Even though there is active research for treatment development, being surgical or medical, in order to achieve motor recovery, in the present time, there are only treatments to reduce the damage after SCI and prevent future damage so none of this therapies are curative; one of this treatments is rehabilitation, which must be coordinated by a multidisciplinary team to reduce possible complications that may arise.
\nTo achieve better outcomes at clinical level, it is recommended to perform an integral rehabilitation therapy that combines different strategies, for example, functional, transcutaneous, or epidural electrical stimulation in addition to musculoskeletal rehabilitation exercises to decrease complications associated with this pathology. It is important to emphasize that some rehabilitation strategies have not yet been approved by health authorities for commercial use and to date have only shown results in very small populations with very particular characteristics, which impede their general application in patients with SCI, in addition to the heterogeneity of spinal cord injuries due to the level of injury, age, treatments used before, or time since injury.
\nThe ultimate goal of these interventions is to achieve patient’s societal reintegration and become independent in most of the activities according to the severity of their condition; therefore improving and updating these strategies create opportunities for novel innovative research, as well as implementing rehabilitation strategies as a complement for regenerative pharmacological and non-pharmacological strategies for the SCI patient.
\nIntechOpen's Authorship Policy is based on ICMJE criteria for authorship. An Author, one must:
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The HWBI contains eight domains representing social, economic and environmental well-being. These domains include 25 indicators comprised of 80 metrics and 22 social, economic and environmental services. The application of the HWBI has been made for the nation as a whole at the county level and two alternative applications have been made to represent key populations within the overall US population—Native Americans and children. A number of advances have been made to estimate the values of metrics for counties where no data is available and one such estimator—MERLIN—is discussed. Finally, efforts to make the index into an interactive web site are described.",book:{id:"5761",slug:"quality-of-life-and-quality-of-working-life",title:"Quality of Life and Quality of Working Life",fullTitle:"Quality of Life and Quality of Working Life"},signatures:"J. Kevin Summers, Lisa M. Smith, Linda C. Harwell and Kyle D. Buck",authors:[{id:"197485",title:"Dr.",name:"J. 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The Framework of Achievement Bests provides an explanatory account of a person’s optimal best practice from his/her actual best. Another aspect emphasizes on the saliency of the psychological process of optimization, which is central to our understanding of person’s optimal functioning in a subject matter. Achieving an exceptional level of best practice (e.g. achieving excellent grades in mathematics) does not exist in isolation, but rather depends on the potent impact of optimization. This chapter, theoretical in nature, focuses on an in‐depth examination of the expansion of the Framework of Achievement Bests. Our discussion of the Framework of Achievement Bests, reflecting a methodical conceptualization, is benchmarked against another notable theory for understanding, namely: Martin Seligman’s PERMA theory. 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Emotional charge also presents a moderate positive correlation with work-related stress, as well as physical charge and psychological distress. Work-life balance is negatively correlated with physical charge, emotional charge, work-related stress, psychological distress, and burnout. We observed also that 43.6% of the professors reported high levels of work-related stress in their everyday work. The precariousness of university teaching is associated with three main elements, which we defined as the tripod of the precarization of university teaching work. It consists of academic productivism, excess of administrative work and bureaucratic activities, and inadequate working conditions. The operating dynamics of this tripod effect professors’ well-being, their QWL, and even the quality of the work they develop in public universities.",book:{id:"5761",slug:"quality-of-life-and-quality-of-working-life",title:"Quality of Life and Quality of Working Life",fullTitle:"Quality of Life and Quality of Working Life"},signatures:"Alessandro Vinicius de Paula and Ana Alice Vilas Boas",authors:[{id:"175373",title:"Dr.",name:"Ana Alice",middleName:null,surname:"Vilas Boas",slug:"ana-alice-vilas-boas",fullName:"Ana Alice Vilas Boas"},{id:"196534",title:"Dr.",name:"Alessandro Vinicius",middleName:null,surname:"De Paula",slug:"alessandro-vinicius-de-paula",fullName:"Alessandro Vinicius De Paula"}]},{id:"55530",doi:"10.5772/intechopen.69151",title:"Quality of Life and Physical Activity: Their Relationship with Physical and Psychological Well-Being",slug:"quality-of-life-and-physical-activity-their-relationship-with-physical-and-psychological-well-being",totalDownloads:1946,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"Many studies have been focused on the analysis of different factors that relate to the quality of life. And those studies have found a clear relationship between the quality of life, psychological well-being, and health. It is important to know those relationships and to know factors that can improve these three aspects simultaneously. And one of the most important factors is the realization of physical activity on a regular basis. This study analyzes the effect of physical activity on improving the quality of life (physical health and well-being) and its relationship with psychological well-being through two studies. One was a randomized clinical trial involving 98 low-risk incident cases of acute coronary syndrome, who were randomly assigned to an unsupervised walking program or a cycle ergometer exercise program. The other study is an expost-facto investigation with a total of 841 healthy subjects. We apply them questionnaires to measure subjective well-being, satisfaction with life, positive and negative affect, Short Form-36 Health Survey (SF-36), and the specific Velasco-del Barrio questionnaire for post-myocardial infarction. 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The index we create is a unique and data‐driven approach to calculating quality of life. In the chapter, we explain the process that leads us to selecting our five indicators: public safety, health, economic development, infrastructure, and education. Each indicator breaks apart into subindicators. This chapter theoretically and statistically verifies our chosen indicators. First, we develop theoretical arguments explaining the connections between quality of life and our indicators. Then, we perform confirmatory factor analyses on our index to empirically verify our theoretical arguments for why each component should be included in the index. Further, we finally verify our theory and index using survey results. We use only publicly available data to facilitate replication by others. The results of our confirmatory factor analysis provide statistical evidence for our choice of indicators in measuring quality of life. Our findings indicate that those measuring quality of life must account for the roles of: public safety, health, economic development, infrastructure, and education. Most importantly, our results indicate that our index is a valid measure of quality of life.",book:{id:"5761",slug:"quality-of-life-and-quality-of-working-life",title:"Quality of Life and Quality of Working Life",fullTitle:"Quality of Life and Quality of Working Life"},signatures:"Ryan M. Yonk, Josh T. Smith and Arthur R. 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The index we create is a unique and data‐driven approach to calculating quality of life. In the chapter, we explain the process that leads us to selecting our five indicators: public safety, health, economic development, infrastructure, and education. Each indicator breaks apart into subindicators. This chapter theoretically and statistically verifies our chosen indicators. First, we develop theoretical arguments explaining the connections between quality of life and our indicators. Then, we perform confirmatory factor analyses on our index to empirically verify our theoretical arguments for why each component should be included in the index. Further, we finally verify our theory and index using survey results. We use only publicly available data to facilitate replication by others. The results of our confirmatory factor analysis provide statistical evidence for our choice of indicators in measuring quality of life. Our findings indicate that those measuring quality of life must account for the roles of: public safety, health, economic development, infrastructure, and education. Most importantly, our results indicate that our index is a valid measure of quality of life.",book:{id:"5761",slug:"quality-of-life-and-quality-of-working-life",title:"Quality of Life and Quality of Working Life",fullTitle:"Quality of Life and Quality of Working Life"},signatures:"Ryan M. Yonk, Josh T. Smith and Arthur R. Wardle",authors:[{id:"196259",title:"Dr.",name:"Ryan Merlin",middleName:null,surname:"Yonk",slug:"ryan-merlin-yonk",fullName:"Ryan Merlin Yonk"},{id:"197814",title:"Mr.",name:"Joshua",middleName:null,surname:"Smith",slug:"joshua-smith",fullName:"Joshua Smith"}]},{id:"54549",title:"Physical and Psychical Well-Being and Stress: The Perspectives of Leaders and Employees",slug:"physical-and-psychical-well-being-and-stress-the-perspectives-of-leaders-and-employees",totalDownloads:1458,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Stress among employees is a significant issue in each organization and society because of its costs on individual, organizational, and society levels. Addressing and reducing stress is thus an important goal, which leads humans to well-being. The main role of managing stress at work belongs to leaders. Their leadership can have effects on the level of stress of employees as well as for themselves. They also decide about their systemic approaches for overcoming stress within organizations. We therefore conducted a stress (qualitative and quantitative) research of employees and leaders within organizations with the main goal to find out the differences between their stresses. The main purpose of this article was to research stress among leaders and employees and to compare their perceived physical and psychical well-being (and stress). For this purpose, we used descriptive statistics and Mann-Whitney U-test. We confirmed that (1) leaders report a higher frequency of some kinds of the daily work stress than employees, (2) on average, leaders were more frequently under pressure than employees, (3) on average, leaders had more frequently satisfying sleep than employees, and (4) on average, employees could use their strong points at work less frequently than leaders.",book:{id:"5761",slug:"quality-of-life-and-quality-of-working-life",title:"Quality of Life and Quality of Working Life",fullTitle:"Quality of Life and Quality of Working Life"},signatures:"Simona Šarotar Žižek and Vesna Čančer",authors:[{id:"192730",title:"Associate Prof.",name:"Simona",middleName:null,surname:"Šarotar Žižek",slug:"simona-sarotar-zizek",fullName:"Simona Šarotar Žižek"},{id:"197783",title:"Dr.",name:"Vesna",middleName:null,surname:"Čančer",slug:"vesna-cancer",fullName:"Vesna Čančer"}]},{id:"55015",title:"The Mammoth Task of Realising the Right to Life: A South African Perspective",slug:"the-mammoth-task-of-realising-the-right-to-life-a-south-african-perspective",totalDownloads:1543,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Concentrating on South Africa, this chapter critically scrutinises the realisation of everyone's right to life as guaranteed in section 11 of the Constitution of the Republic of South Africa. Although the right to life is explored within the ambit of an international legal framework, realising the right to life in South Africa, with its history of demeaning the value of the life of the majority of its inhabitants in the past, forms the main pivot of discussion. It is argued that, despite the 1996 Constitution's promise to heal these past divisions and improve the quality of life of all citizens and free each person's potential, the State has been ambivalent about realising everyone's right to life. As part of post‐apartheid transformation, the State has, on the one hand, made substantial progresses in creating a supporting and legal environment for the attainment of a better life for some of its inhabitants. On the other hand, reality still reflects poignantly flaws in freeing everyone's potential, thus highlighting the mammoth task that lies ahead.",book:{id:"5761",slug:"quality-of-life-and-quality-of-working-life",title:"Quality of Life and Quality of Working Life",fullTitle:"Quality of Life and Quality of Working Life"},signatures:"Erika M. Serfontein",authors:[{id:"196203",title:"Prof.",name:"Erika",middleName:null,surname:"Serfontein",slug:"erika-serfontein",fullName:"Erika Serfontein"}]},{id:"54570",title:"Exploring the Antecedents of Happiness: Reconceptualization of Human Needs with Glasser's Choice Theory",slug:"exploring-the-antecedents-of-happiness-reconceptualization-of-human-needs-with-glasser-s-choice-theo",totalDownloads:1597,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"This chapter aims to present a review about the antecedents of happiness by using human needs perspective. The chapter briefly includes the definition of happiness as a scientific matter, definition of the need theories approach for explaining the antecedents of happiness, definitions and discussions about the major need theories and reconceptualization of human needs with Glasser’s Choice Theory, and also empirical studies that investigate the relationship between basic needs satisfaction and happiness. It is also thought that the conclusion obtained from this chapter will encourage researchers to investigate the antecedents of happiness with Glasser’s conceptual framework and also invite researchers to study in a new research area with a new conceptual perspective.",book:{id:"5761",slug:"quality-of-life-and-quality-of-working-life",title:"Quality of Life and Quality of Working Life",fullTitle:"Quality of Life and Quality of Working Life"},signatures:"Turgut Turkdogan",authors:[{id:"197018",title:"Ph.D.",name:"Turgut",middleName:null,surname:"Turkdogan",slug:"turgut-turkdogan",fullName:"Turgut Turkdogan"}]}],onlineFirstChaptersFilter:{topicId:"1338",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:287,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"25",title:"Environmental Sciences",doi:"10.5772/intechopen.100362",issn:"2754-6713",scope:"\r\n\tScientists have long researched to understand the environment and man’s place in it. The search for this knowledge grows in importance as rapid increases in population and economic development intensify humans’ stresses on ecosystems. Fortunately, rapid increases in multiple scientific areas are advancing our understanding of environmental sciences. 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\r\n\tThe four topics of this book series - Pollution; Environmental Resilience and Management; Ecosystems and Biodiversity; and Water Science - will address important areas of advancement in the environmental sciences. They will represent an excellent initial grouping of published works on these critical topics.