\r\n\tThis book will describe the self-assembly of materials and supramolecular chemistry design principles for a broad spectrum of materials, including bio-inspired amphiphiles, metal oxides, metal nanoparticles, and organic-inorganic hybrid materials. It will provide fundamental concepts of self-assembly design approaches and supramolecular chemistry principles for research ideas in nanotechnology applications. The book will focus on three main themes, which include: the self-assembly and supramolecular chemistry of amphiplies by coordination programming, the supramolecular structures and devices of inorganic materials, and the assembly-disassembly of organic-inorganic hybrid materials. The contributing chapters will be written by leading scientists in their field, with the hope that this book will provide a foundation on supramolecular chemistry principles to students and active researchers who are interested in nanoscience and nanoengineering fields.
",isbn:"978-1-83969-702-9",printIsbn:"978-1-83969-701-2",pdfIsbn:"978-1-83969-703-6",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"e9cc643ae0a219e91e445a1e61b33a22",bookSignature:"Prof. Hemali Rathnayake and Dr. Gayani Pathiraja",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11908.jpg",keywords:"Amphiphiles, Artificial Siderophores, Coordination Chemistry, Self-Assembly Design, Supramolecular Structures, Metal Oxides, Metal Particles, 2D Inorganic Materials, Supramolecular Devices, Stimuli-Responsive Materials, Assembly-Disassembly Design, Superstructures",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 27th 2022",dateEndSecondStepPublish:"May 25th 2022",dateEndThirdStepPublish:"July 24th 2022",dateEndFourthStepPublish:"October 12th 2022",dateEndFifthStepPublish:"December 11th 2022",remainingDaysToSecondStep:"5 days",secondStepPassed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Dr. Rathnayake is a pioneering researcher in self-assembly and supramolecular chemistry, with a Ph.D. from the University of Massachusetts Amherst, US. 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1. Clinical vignette
An 84‐year‐old female presented to the emergency department (ED) for evaluation of left hip pain after a fall at her locked dementia unit. The patient could not ambulate and had a bruise over her left hip. Radiograph demonstrated a left hip fracture and orthopedic consultation was requested for evaluation of a hip fracture by the ED resident. The on‐call orthopedic resident after discussion with the orthopedic attending recommended placement of a single compression hip screw for treatment of the hip fracture and requested the internal medicine hospitalist service admit the patient for medical management of the patient’s dementia and diabetes prior to operative repair of the hip. The internal medicine hospitalist service admitted the patient for preoperative clearance prior to repair of her hip fracture. When approached by the orthopedic surgery resident the next day for signed consent for operative hip repair, the patient signed consent for operative repair of her hip. On arrival in the preoperative area during surgical time out, the patient confirmed that the right hip would be operatively repaired. After operative repair of the right hip, the patient returned to the hospitalist service with a request for initiation of enoxaparin anticoagulation to prevent deep venous thrombosis. Postoperative X‐ray demonstrated single compression hip screw in the right hip with a persistent left hip subcapsular fracture. Three days after the operation, the patient developed acute hypoxia, CT angiogram of the chest documented pulmonary embolism; the on‐call hospitalist noted there had been no initiation of prophylactic enoxaparin postoperatively. On return to the floor prior to the initiation of anticoagulation for pulmonary embolism, the patient became severely dyspneic and hypoxic followed by pulseless electrical activity cardiac arrest; resuscitation efforts failed to return spontaneous circulation and the patient expired.
Allegation: The ED, orthopedic, hospitalist physicians, and staff were implicated in the wrong side operative repair of the left hip fracture and in the failure to initiate anticoagulation prophylaxis. The orthopedic and hospitalist physicians were implicated in the failure to initiate anticoagulation prophylaxis for deep venous thrombosis. At trial, attestation from the hospitalist and orthopedic physicians alleged that ED consultation for the right hip had been ordered.
Disposition: Pretrial mediation prior to the court case resulted in a large monetary settlement on behalf of the plaintiff’s heirs.
2. Introduction
Healthcare organizations and providers struggle with the process of communicating crucial patient information from one caregiver to the next, or from one team of caregivers to another [1]. The delivery of medical care relies on effective, succinct, and ongoing communication between healthcare providers, called handoffs [2]. These clinical handoffs, also known as sign outs, shift reports, or handovers, take place throughout the healthcare system between multiple providers with various clinical responsibilities. Patient handoffs are complex, multifaceted events that occur at the beginning or end of clinical shifts [3]. Handoffs involve the transfer of professional responsibility and accountability for some or all aspects of care for the patient or groups of patients to another clinician or clinical team on a temporary or permanent basis [4]. Handoffs have the potential for deleterious clinical impact if inadequately done. Only recently has data become available that demonstrate improvements in handoffs reduce the rate of subsequent clinical care error [5].
This clinical vignette and subsequent discussion focuses on physician, particularly the resident physician in training, transfer of care: handoff complications, barriers to effective handoffs, regulatory agencies input on handoff improvement, standardization of the handoff process, assessment of the quality of handoff, handoff error avoidance, and improving the quality of handoff.
3. Transitions of care: handoff definition
The Joint Commission (TJC) defines handoff as: a means to provide accurate information about a patient’s care, treatment, and services; current physical condition; and any recent or anticipated changes in clinical course. Accurate information communicated during handoff must be accurate in order to meet safety goals [6]. The goal of quality handover of care is to ensure continuity of care and high‐quality, safe care decision making in a specific physical and cultural environment. More than merely the passive transfer of information, optimum handoffs necessitate the efficient communication of information among participants [3]. Expansion of duty hour restrictions for resident physician trainees in North America have increased handoff frequency, augmented the potential for ineffectual handoff‐induced complications, and stimulated the need for new interventions to improve handover quality [7]. The shift from the traditional model of continuous inpatient medicine to a team‐based model has further focused attention on patient handoffs [3]. Interunit handoffs, such as the transition from the ED to the inpatient setting, have special challenges, such as changes in personnel, provider specialty, and hospital location [8]. Over the last decade, considerable attention has been given on interventions to optimize the handoff process by enhancing patient safety in order to improve outcomes; adaptation of some enhancements were gleaned from industries such as nuclear power and space aviation in which transition errors also result in serious consequences [9, 10].
4. Insufficient handoffs induce complications
The Institute of Medicine attributes a substantial proportion of preventable adverse events to communication errors during handover [11]. The Agency for Healthcare Research and Quality identifies handoff communication miscues as implicated in surgical errors [12] and as a consequential cause of malpractice claims. TJC has correlated ineffective care transitions to higher rates of readmission [4]. Communication and handoff snafus are among the root causes of nearly two‐thirds of potentially significant, preventable adverse clinical outcomes in hospitals [13, 14].
The consequences of substandard handoffs include: delays in therapy, inappropriate treatment, adverse events, care task omissions, increased hospital length of stay, avoidable readmissions, increased costs, and inefficiency from reevaluation [15]. Omissions of clinically important on‐call issues by fatigued on‐call residents when transferring care to the daytime team at the end of shifts are major contributors to miscommunications and can result in care implementation delays and adverse events [16]. Insufficient handoff communication result in incomplete, inaccurate, and omitted data and effectuate informational ambiguities between the departing and oncoming providers. Examples of information loss during handoffs are failure to communicate: drug allergy, critical comorbidity, relevant history, or current treatments. Distortion of patient history can result in: wrong medication dose, wrong surgical site, or incorrect diagnosis [10]. Cognitive load of handoff exceeding working memory capacity of the departing or oncoming physicians can further exacerbate information loss or distortion [9]. Omitted and undocumented issues introduce risk for delays in expeditious follow‐up of clinically relevant overnight issues. Research by Devlin et al. demonstrated that only 14% of clinically important issues from the overnight clinical shifts had an accompanying progress note from the on‐call trainee in the patient’s medical record [16]. Discontinuity of care secondary to ineffectual handoffs has been correlated with longer hospital stays and increased costs [3]. The morning handover process is highly variable and unreliable and often occurs in a chaotic clinical care environment. On‐call trainees fail to hand over numerous clinically important issues to the daytime team and frequently do not document their assessments and responses to the on‐call issue in the medical records. These omissions have the potential to cause unnecessary delays and may result in a lack of follow‐up for important patient issues [16].
5. Barriers to effective handoffs
Communication miscues and omissions, the most frequently numerated barrier to effective patient transition of care [17], correspond with the lack of consensus about the elements of effective handoff [2]. Substantial variability exists across, and sometimes within, institutions regarding preferred formats and processes for verbal and written handoffs. Research of residency training programs nationally indicate that handoff standardization has not been aggressively implemented and evaluated among residency training programs or implemented with variable compliance [2, 18].
Clinical staff often utilize handoffs as an avenue for socialization, education, and emotional support to facilitate integration and staff cohesion; while these activities have merit, they divert attention from effective patient communication [8]. Resident physicians participating in patient handoffs may not interact regularly with each other, may be located in different parts of the healthcare systems, may have different skill and experience levels, or may come from different clinical backgrounds [3]. Adherence to hierarchical norms between junior and senior residents or attendings can further exacerbate relational communication barriers reflecting differences across levels of training or between clinician types in the willingness to engage in interactive questioning strategies to assertively challenge erroneous assumptions and actions during a handover with peers [7, 17]. Entrenchment of handoff routines in departmental or hospital mores may require transformational change of an institution’s culture in order to improve them [19].
6. Regulatory agencies’ input to enhance handoff
In 2010, TJC incorporated the patient handoff into its health facility accreditation standards and has encouraged improving and standardizing transitions of care as a national safety goal via implementation of a standardized approach to handoff communications, including an opportunity to ask and respond to questions [3, 20]. TJC’s National Patient Safety Goals document contains specific guidelines for the handoff process, many drawn from other high‐risk industries: interactive communications, “read‐back” and “repeat‐back” practices, verifying up‐to‐date and accurate information, limited interruptions, a process for verification, and an opportunity to review any relevant historical data. The Accreditation Council for Graduate Medical Education (ACGME) recently mandated that residency programs provide formal educational programs about patient care transitions and that faculty monitor ensure adequate handoff skills through direct observation [3, 19, 21]. TJC, the ACGME, and the Society of Hospital Medicine jointly encourage compliance with a structured format for verbally communicating information utilizing an ordered acronym mnemonic, SBAR: (1) Situation, (2) Background, (3) Assessment, and (4) Recommendation [7].
7. Standardization of patient handoff
House staff judge that strategies for handoff standardization most valuably improve quality of handoff and resident physician satisfaction with transition of care [16]. Most emergency medicine (EM) residency directors agree that standardized handoffs have the potential to reduce errors during transition of care, yet the majority of EM residency programs do not have a policy or a procedure regarding handoffs [17]. Didactic and interactive sessions teach key principles, and communication techniques of verbal and written handoffs utilizing mnemonics and checklists have shown to benefit in improving quality and standardization of handoff communications [19]. The SBAR mnemonic benefits handoff communication because of its simplicity, it provides a consistent framework for handoff scenarios, it can be utilized by different care providers, and it emphasizes on the clinician’s assessment and response [16, 22]. Checklists have been effective in several different clinical settings in terms of decreasing medical errors and morbidity; utilization of checklists have the potential to improve the transfer of care process as well [23, 22]. Just as documentation in the electronic medical record about clinically important issues while on‐call facilitates communication, a structured, written clinical summary, such as a checklist, by the outgoing clinical team presented to the oncoming team facilitates understanding of critical issues regarding patient care during transition of care in a standardized way.
Starmer et al. objectively demonstrated improved outcomes via an educational intervention utilizing a structured resident handoff bundle to standardize inpatient handovers in care thereby decreasing medical error in multiple institutions [13]. The bundle included three major elements: team training by using focused TeamSTEPPS communication strategies, implementation of a standardized template for the written or printed computerized handoff document, and introduction of several evidence‐based verbal handoff processes, specifically I‐PASS, an acronym mnemonic [10]. TeamSTEPPS, a teamwork system developed jointly by the Department of Defense and the Agency for Healthcare Research and Quality, works to improve institutional collaboration and communication relating to patient safety [20]. Starmer et al. instituted an I‐PASS mnemonic to provide a consistent, structured format for communicating handoff information: I—Illness severity, P—Patient summary, A—Action list, S—Situation awareness and contingency planning, S—Synthesis by receiver [10].
8. Assessing quality and competency of handoffs
The ACGME requires that residency programs assess the competency of trainees in handoff communication. Detecting discrepancies between levels of quality of handoff communication requires training and is made more complicated by the existence of few standardized methods for assessing the competency of sign‐out communication [3, 10, 24]. Horwitz et al. developed an evaluation tool for direct observation of house staff and hospitalists during sign out that generates quantifiable data of handoff assessment and performs consistently across different institutions and among both trainees and attendings [24]. Horwitz et al. utilized peers to conduct handoff assessments, reasoning that peers familiarity with the handoff issues would recognize miscues that external evaluators might miss [24]. Starmer et al., as part of their standardized sign‐out bundle, developed direct observation assessment tools for assessment of quality of the departing and oncoming clinicians’ adherence to the components of their handoff protocol and verbal engagement with one another [19].
9. Simulation improves handoff experience
Simulation activities provide residents opportunities to practice handoff skills prior to clinical practice. Patient care simulation enhances skill acquisition and behavioral modification through practice and reflection. The incorporation of illustrative videos and role‐play simulations into the handoff education curriculum can simulate both ideal and less‐than‐ideal handoff behaviors. Learners rotate the roles of giving, receiving, observing, and evaluating patient handoff [19]. Research has demonstrated that the most efficacious elements of patient handoff simulation include use of trigger videos reviewing particularly challenging handoff scenarios. The opportunity to practice giving and receiving handoffs utilizing new skills during simulation exercises enhances handoff performance in the clinical arena [19].
10. Increasing awareness of handoff culture
Communicating a vision of improved handoffs through institutionalizing an intervention to improve handoffs enhances awareness of this patient safety intervention. Understanding the complex social structures in which residents and attending physicians work, as well as the unwritten rules that govern the handoff of patient responsibilities, must be accounted for because interdisciplinary trust enables negotiating shared care plans and mitigates conflict to encourage a safer transition of patient care [8]. Training programs should introduce new or expand existing handover curricula to raise awareness about the distinct entity of transitions of care and to improve the communication process during this period [16]. Starmer et al. created a Campaign Subcommittee, which was charged with “branding” I‐PASS, their acronym for their handoff improvement intervention, to support the communication, implementation, and sustainability of their handoff curriculum. Recognizing the importance of local agents of change, Starmer et al. conducted focus groups with residents and other stakeholders from seven different institutions to develop “advertising” strategies to encourage adherence to their handoff protocol [19]. To remind clinicians about key handoff concepts, they created point‐of‐care references, including pocket reference cards and computer monitor frames with handoff mnemonic details. Recruiting teams of faculty champions, respected faculty members actively involved in patient care and resident education, encouraged rapid and early adoption of the handoff curriculum [19].
11. Active communication enhances handoffs
Active communication strategies by the oncoming clinician improve patient safety by detecting erroneous assessments and actions, thereby confronting diagnostic momentum and fixation bias [7]. Face‐to‐face group handoff, an active communication strategy, enriches the quality of handoffs more than a reliance on written or electronic notes [16]. Face‐to‐face verbal communication with interactive questioning and updates from oncoming and departing clinicians facilitate these discussions [25]. A vibrant, encouraging communications culture, characterized by openness to and willingness of clinicians, regardless of the level of training, to speak up, to ask questions, and to provide feedback, enhances quality of transfer of information and inculcates a culture of safety among both departing and oncoming clinical teams [4]. The oncoming clinician summarizing the handoff dialogue and restating key actions as part of a standardized handoff bundle has demonstrated benefit in patient outcomes [10]. These clinical team meetings during transition of care promote meaningful dialogue and engender an opportunity to identify and correct errors in real time [3]. Minimizing distractions, limiting interruptions such as nonurgent pages (e.g., ask nursing and allied health staff to defer nonurgent pages), and providing a dedicated space for handover will further supplement end‐of‐shift patient management discussions [16].
12. Culture of collaboration and professionalism to improve handoffs
Medical professionalism includes a commitment to collaboration to quality clinical decision making, prudent medical error surveillance, and the voluntary reporting of adverse events [3]. Proactive discussion of pitfalls during shift change can impact potential for medical miscues by the oncoming providers during shift changes. A collaborative culture facilitates handoff of responsibility between the departing and oncoming providers by requests for assistance, by voicing clinical concerns, and by clarifying issues through bidirectional conversations. This process creates a shared mental model of the patient’s clinical conditional and plan of care [4]. Oncoming clinicians foster the assumption of clinical responsibility by personally reassessing the patient and informing the patient of his or her evaluation with updated results during walking rounds at the conclusion of patient handover [23].
13. Summary
Effective transitions of care facilitate teams of multiple clinicians to deliver secure and effective care without compromising the continuity of care [26]. At a minimum, departing clinicians should provide patient identification, diagnostic summary, the patient’s current condition and trajectory, a plan of care, a prioritized to‐do list, and a plan for anticipated events. The oncoming clinicians should be able to understand likely contingencies and changes in the patient’s condition [3]. To ensure regulatory compliance and improve patient security, educating residents and medical students to effectively perform patient handoffs offers synergistic benefits, including patient safety, continuity of care, and professionalism through teamwork [3]. Best practices ensure communication of essential information including: structured face‐to‐face and written sign‐out, interactive questioning, and checklists in distraction free settings [9]. A culture of professionalism can mitigate errors and procedural violations that arise primarily from aberrant mental processes such as forgetfulness, inattention, low motivation, carelessness, or negligence [8]. A shared common language utilizing a standardized regimen protocol for patient transitions of care communications across all provider types and practice settings will promote a culture of patient safety and enhance patient outcomes [22].
\n',keywords:"physician fatigue, resident duty hour restrictions, night float, physician burn out, resident education",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/56241.pdf",chapterXML:"https://mts.intechopen.com/source/xml/56241.xml",downloadPdfUrl:"/chapter/pdf-download/56241",previewPdfUrl:"/chapter/pdf-preview/56241",totalDownloads:1386,totalViews:188,totalCrossrefCites:0,totalDimensionsCites:1,totalAltmetricsMentions:0,impactScore:1,impactScorePercentile:64,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"October 12th 2016",dateReviewed:"April 21st 2017",datePrePublished:null,datePublished:"September 13th 2017",dateFinished:"June 26th 2017",readingETA:"0",abstract:"The delivery of medical care relies on effective, succinct, and ongoing communication between healthcare providers, called handoffs. Handoffs involve the transfer of professional responsibility and accountability for aspects of care for patients to another clinician or clinical team on a temporary or permanent basis. Handoffs have the potential for deleterious clinical impact if inadequately done. Only recently has data become available that demonstrate improvements in handoffs reduce the rate of subsequent clinical care error. This clinical vignette and subsequent discussion focuses on physician, particularly the resident physician in training, transfer of care: handoff complications, barriers to effective handoffs, regulatory agencies’ input on handoff improvement, standardization of the handoff process, assessment of the quality of handoff, handoff error avoidance, and improving the quality of handoff.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/56241",risUrl:"/chapter/ris/56241",book:{id:"5948",slug:"vignettes-in-patient-safety-volume-1"},signatures:"Philip Salen",authors:[{id:"198023",title:"M.D.",name:"Philip",middleName:null,surname:"Salen",fullName:"Philip Salen",slug:"philip-salen",email:"philip.salen@sluhn.org",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Clinical vignette",level:"1"},{id:"sec_2",title:"2. Introduction",level:"1"},{id:"sec_3",title:"3. Transitions of care: handoff definition",level:"1"},{id:"sec_4",title:"4. Insufficient handoffs induce complications",level:"1"},{id:"sec_5",title:"5. Barriers to effective handoffs",level:"1"},{id:"sec_6",title:"6. Regulatory agencies’ input to enhance handoff",level:"1"},{id:"sec_7",title:"7. Standardization of patient handoff",level:"1"},{id:"sec_8",title:"8. Assessing quality and competency of handoffs",level:"1"},{id:"sec_9",title:"9. Simulation improves handoff experience",level:"1"},{id:"sec_10",title:"10. Increasing awareness of handoff culture",level:"1"},{id:"sec_11",title:"11. Active communication enhances handoffs",level:"1"},{id:"sec_12",title:"12. Culture of collaboration and professionalism to improve handoffs",level:"1"},{id:"sec_13",title:"13. Summary",level:"1"}],chapterReferences:[{id:"B1",body:'Project Detail. The Center for Transforming Healthcare [Internet]. Available from: http://www.centerfortransforminghealthcare.org/projects/detail.aspx?Project=1 [Accessed: March 5, 2017]'},{id:"B2",body:'Hern Jr HG, Gallahue FE, Burns BD, Druck J, Jones J, Kessler C, et al. Handoff practices in emergency medicine: Are we making progress? Academic Emergency Medicine. 2016;23:197‐201. DOI: 10.1111/acem.12867'},{id:"B3",body:'Wohlauer MV, Arora VM, Horwitz LI, Bass EJ, Mahar SE, Philibert I, et al. The patient handoff: A comprehensive curricular blueprint for resident education to improve continuity of care. Academic Medicine. 2012;87:411‐418. DOI: 10.1097/ACM.0b013e318248e766'},{id:"B4",body:'Lee S‐H, Phan PH, Dorman T, Weaver SJ, Pronovost PJ. Handoffs, safety culture, and practices: Evidence from the hospital survey on patient safety culture. BMC Health Services Research. 2016;16:254. DOI: 10.1186/s12913‐016‐1502‐7'},{id:"B5",body:'Horwitz LI. Does improving handoffs reduce medical error rates? JAMA. 2013;310:2255‐2256. DOI: 10.1001/jama.2013.281827'},{id:"B6",body:'Tapia NM, Fallon SC, Brandt ML, Scott BG, Suliburk JW. Assessment and standardization of resident handoff practices: PACT project. Journal of Surgical Research. 2013;184:71‐77. DOI: 10.1016/j.jss.2013.04.063'},{id:"B7",body:'Rayo MF, Mount‐Campbell AF, O’Brien JM, White SE, Butz A, Evans K, et al. Interactive questioning in critical care during handovers: A transcript analysis of communication behaviours by physicians, nurses and nurse practitioners. BMJ Quality & Safety. 2014;23:483‐489. DOI: 10.1136/bmjqs‐2013‐002341'},{id:"B8",body:'Smith CJ, Britigan DH, Lyden E, Anderson N, Welniak TJ, Wadman MC. Interunit handoffs from emergency department to inpatient care: A cross‐sectional survey of physicians at a university medical center. Journal of Hospital Medicine. 2015;10:711‐717. DOI: 10.1002/jhm.2431'},{id:"B9",body:'Young JQ, Irby DM, Barilla‐LaBarca M‐L, Ten Cate O, O’Sullivan PS. Measuring cognitive load: Mixed results from a handover simulation for medical students. Perspectives on Medical Education. 2016;5:24‐32. DOI: 10.1007/s40037‐015‐0240‐6'},{id:"B10",body:'Starmer AJ, Spector ND, Srivastava R, Allen AD, Landrigan CP, Sectish TC. I‐PASS, a mnemonic to standardize verbal handoffs. Pediatrics. 2012;129:201‐204. DOI: 10.1542/peds.2011‐2966'},{id:"B11",body:'Rourke L, Amin A, Boyington C, Ao P, Frolova N. Improving residents’ handovers through just‐in‐time training for structured communication. BMJ Quality Improvement Reports. 2016;5:1-3. DOI: 10.1136/bmjquality.u209900.w4090'},{id:"B12",body:'Cohen MD, Hilligoss B, Kajdacsy‐Balla Amaral AC. A handoff is not a telegram: An understanding of the patient is co‐constructed. Critical Care. 2012;16:303. DOI: 10.1186/cc10536'},{id:"B13",body:'Starmer AJ, Sectish TC, Simon DW, Keohane C, McSweeney ME, Chung EY, et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA. 2013;310:2262‐2270. DOI: 10.1001/jama.2013.281961'},{id:"B14",body:'Cohen MD, Hilligoss PB. The published literature on handoffs in hospitals: Deficiencies identified in an extensive review. Quality & Safety in Health Care. 2010;19:493‐497. DOI: 10.1136/qshc.2009.033480'},{id:"B15",body:'Joint Commission Center For Improving Transitions of Care: Hand‐off communications. In: center for transforming healthcare.org [Internet]. Available from: http://www.centerfortransforminghealthcare.org/'},{id:"B16",body:'Devlin MK, Kozij NK, Kiss A, Richardson L, Wong BM. Morning handover of on‐call issues: Opportunities for improvement. JAMA Internal Medicine. 2014;174:1‐7. DOI: 10.1001/jamainternmed.2014.3033'},{id:"B17",body:'Riesenberg LA, Leitzsch J, Massucci JL, Jaeger J, Rosenfeld JC, Patow C, et al. Residents’ and attending physicians’ handoffs: A systematic review of the literature. Academic Medicine. 2009;84:1775‐1787. DOI: 10.1097/ACM.0b013e3181bf51a6'},{id:"B18",body:'Lee S, Jordan J, Hern H, Kessler C, Promes S, Krzyzaniak S, et al. Transition of care practices from emergency department to inpatient: A survey data and the development of algorithm. The Western Journal of Emergency Medicine. 2016;28(1):86-92. Available: http://escholarship.org/uc/item/0xc35653'},{id:"B19",body:'Starmer AJ, O’Toole JK, Rosenbluth G, Calaman S, Balmer D, West DC, et al. Development, implementation, and dissemination of the I‐PASS handoff curriculum: A multisite educational intervention to improve patient handoffs. Academic Medicine. 2014;89:876‐884. DOI: 10.1097/ACM.0000000000000264'},{id:"B20",body:'TeamSTEPPS Fundamentals Course: Module 3. Communication | Agency for Healthcare Research & Quality [Internet]. Available from: https://www.ahrq.gov/teamstepps/instructor/fundamentals/module3/igcommunication.html [Accessed: February 10, 2017]'},{id:"B21",body:'Defective Hand‐Off Communication forces Defendant Physician & Hospital to Settle Lawsuit: MagMutual [Internet]. 2015. Available from: https://www.magmutual.com/learning/claimslesson/defective‐hand‐communication‐forces‐defendant‐physician‐hospital‐settle [Accessed: March 5, 2017]'},{id:"B22",body:'Lee SY, Dong L, Lim YH, Poh CL, Lim WS. SBAR: Towards a common interprofessional team‐based communication tool. Medical Education. 2016;50:1167‐1168. DOI: 10.1111/medu.13171'},{id:"B23",body:'Milano A, Salen P, Stankewicz H. 290 The impact of a standardized checklist on transition of care during emergency physician change of shift. Annals of Emergency Medicine. Elsevier. 2016;68:S113. http://www.annemergmed.com/article/S0196‐0644(16)30763‐6/abstract'},{id:"B24",body:'Horwitz LI, Rand D, Staisiunas P, Van Ness PH, Araujo KLB, Banerjee SS, et al. Development of a handoff evaluation tool for shift‐to‐shift physician handoffs: The Handoff CEX. Journal of Hospital Medicine. 2013;8:191‐200. DOI: 10.1002/jhm.2023'},{id:"B25",body:'Patterson ES, Roth EM, Woods DD, Chow R, Gomes JO. Handoff strategies in settings with high consequences for failure: Lessons for health care operations. International Journal for Quality in Health Care. 2004;16:125‐132. Available: http://www.ncbi.nlm.nih.gov/pubmed/15051706'},{id:"B26",body:'Colvin MO, Eisen LA, Gong MN. Improving the patient handoff process in the intensive care unit: Keys to reducing errors and improving outcomes. Seminars in Respiratory and Critical Care Medicine. 2016;37:96‐106. DOI: 10.1055/s‐0035‐1570351'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Philip Salen",address:"philip.salen@sluhn.org",affiliation:'
St. Luke’s University Hospital EM Residency, St. Luke’s University Hospital, Bethlehem, PA, USA
'}],corrections:null},book:{id:"5948",type:"book",title:"Vignettes in Patient Safety",subtitle:"Volume 1",fullTitle:"Vignettes in Patient Safety - Volume 1",slug:"vignettes-in-patient-safety-volume-1",publishedDate:"September 13th 2017",bookSignature:"Michael S. Firstenberg and Stanislaw P. Stawicki",coverURL:"https://cdn.intechopen.com/books/images_new/5948.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-953-51-3520-3",printIsbn:"978-953-51-3519-7",pdfIsbn:"978-953-51-4653-7",reviewType:"peer-reviewed",numberOfWosCitations:16,isAvailableForWebshopOrdering:!0,editors:[{id:"64343",title:"Dr.",name:"Michael S.",middleName:null,surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"181694",title:"Dr.",name:"Stanislaw P.",middleName:null,surname:"Stawicki",slug:"stanislaw-p.-stawicki",fullName:"Stanislaw P. Stawicki"},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1135"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"55601",type:"chapter",title:"Introductory Chapter: The Decades Long Quest Continues Toward Better, Safer Healthcare Systems",slug:"introductory-chapter-the-decades-long-quest-continues-toward-better-safer-healthcare-systems",totalDownloads:1545,totalCrossrefCites:13,signatures:"Stanislaw P. Stawicki and Michael S. Firstenberg",reviewType:"peer-reviewed",authors:[{id:"64343",title:"Dr.",name:"Michael S.",middleName:null,surname:"Firstenberg",fullName:"Michael S. Firstenberg",slug:"michael-s.-firstenberg"},{id:"181694",title:"Dr.",name:"Stanislaw P.",middleName:null,surname:"Stawicki",fullName:"Stanislaw P. Stawicki",slug:"stanislaw-p.-stawicki"}]},{id:"56329",type:"chapter",title:"Improving Childbirth and Maternal Care - How to Foster the Use of Good Practices for Patient Safety",slug:"improving-childbirth-and-maternal-care-how-to-foster-the-use-of-good-practices-for-patient-safety",totalDownloads:1307,totalCrossrefCites:0,signatures:"Barbara Labella, Roberta De Blasi, Vanda Raho, Giulia De Matteis,\nQuinto Tozzi and Giovanni Caracci",reviewType:"peer-reviewed",authors:[{id:"200247",title:"Ph.D.",name:"Barbara",middleName:null,surname:"Labella",fullName:"Barbara Labella",slug:"barbara-labella"},{id:"201687",title:"MSc.",name:"Giovanni",middleName:null,surname:"Caracci",fullName:"Giovanni Caracci",slug:"giovanni-caracci"},{id:"201693",title:"MSc.",name:"Roberta",middleName:null,surname:"De Blasi",fullName:"Roberta De Blasi",slug:"roberta-de-blasi"},{id:"201694",title:"MSc.",name:"Giulia",middleName:null,surname:"De Matteis",fullName:"Giulia De Matteis",slug:"giulia-de-matteis"},{id:"201695",title:"MSc.",name:"Quinto",middleName:null,surname:"Tozzi",fullName:"Quinto Tozzi",slug:"quinto-tozzi"},{id:"205155",title:"MSc.",name:"Vanda",middleName:null,surname:"Raho",fullName:"Vanda Raho",slug:"vanda-raho"}]},{id:"56241",type:"chapter",title:"Transitions of Care: Complications and Solutions",slug:"transitions-of-care-complications-and-solutions",totalDownloads:1386,totalCrossrefCites:0,signatures:"Philip Salen",reviewType:"peer-reviewed",authors:[{id:"198023",title:"M.D.",name:"Philip",middleName:null,surname:"Salen",fullName:"Philip Salen",slug:"philip-salen"}]},{id:"55307",type:"chapter",title:"Dangers of Polypharmacy",slug:"dangers-of-polypharmacy",totalDownloads:1758,totalCrossrefCites:4,signatures:"Pamela L. Valenza, Thomas C. McGinley, James Feldman, Pritiben\nPatel, Kristine Cornejo, Najmus Liang, Roopa Anmolsingh and\nNoble McNaughton",reviewType:"peer-reviewed",authors:[{id:"197829",title:"Dr.",name:"Pamela",middleName:"L.",surname:"Valenza",fullName:"Pamela Valenza",slug:"pamela-valenza"}]},{id:"55550",type:"chapter",title:"Wrong Patient, Wrong Drug: An Unfortunate Confluence of Events",slug:"wrong-patient-wrong-drug-an-unfortunate-confluence-of-events",totalDownloads:1043,totalCrossrefCites:1,signatures:"Anna Njarlangattil Thomas, Danielle Belser, Stephanie Rabenold,\nOmalara Olabisi Bamgbelu, Amaravani Mandalapu, Michael\nPipestone, Alaa‐Eldin A Mira and Ric Baxter",reviewType:"peer-reviewed",authors:[{id:"188527",title:"Dr.",name:"Ric",middleName:null,surname:"Baxter",fullName:"Ric Baxter",slug:"ric-baxter"},{id:"197822",title:"Dr.",name:"Alaa-Eldin",middleName:"A.",surname:"Mira",fullName:"Alaa-Eldin Mira",slug:"alaa-eldin-mira"},{id:"202212",title:"Dr.",name:"Anna",middleName:null,surname:"Thomas",fullName:"Anna Thomas",slug:"anna-thomas"},{id:"207003",title:"Dr.",name:"Danielle",middleName:null,surname:"Belser",fullName:"Danielle Belser",slug:"danielle-belser"},{id:"207004",title:"Dr.",name:"Stephanie",middleName:null,surname:"Rabenold",fullName:"Stephanie Rabenold",slug:"stephanie-rabenold"},{id:"207005",title:"Dr.",name:"Omalara",middleName:null,surname:"Bamgbelu",fullName:"Omalara Bamgbelu",slug:"omalara-bamgbelu"},{id:"207006",title:"Dr.",name:"Amaravani",middleName:null,surname:"Mandalapu",fullName:"Amaravani Mandalapu",slug:"amaravani-mandalapu"},{id:"207007",title:"Dr.",name:"Michael",middleName:null,surname:"Pipestone",fullName:"Michael Pipestone",slug:"michael-pipestone"}]},{id:"56035",type:"chapter",title:"Inadequate Decontamination Procedures: Sepsis Following Uneventful Endoscopy",slug:"inadequate-decontamination-procedures-sepsis-following-uneventful-endoscopy",totalDownloads:1243,totalCrossrefCites:0,signatures:"Ellyn A. 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Hromatka and Weidun Alan Guo",reviewType:"peer-reviewed",authors:[{id:"197826",title:"Dr.",name:"Weidun Alan",middleName:null,surname:"Guo",fullName:"Weidun Alan Guo",slug:"weidun-alan-guo"},{id:"207014",title:"Dr.",name:"Kathleen",middleName:null,surname:"Hromatka",fullName:"Kathleen Hromatka",slug:"kathleen-hromatka"}]},{id:"56565",type:"chapter",title:"Pressure Injury in the ICU: Major Reconstructive Surgery Required",slug:"pressure-injury-in-the-icu-major-reconstructive-surgery-required",totalDownloads:1667,totalCrossrefCites:0,signatures:"Ashley Jordan",reviewType:"peer-reviewed",authors:[{id:"197827",title:"Dr.",name:"Ashley",middleName:null,surname:"Jordan",fullName:"Ashley Jordan",slug:"ashley-jordan"}]},{id:"56101",type:"chapter",title:"Wrong Blood Type: Transfusion Reaction",slug:"wrong-blood-type-transfusion-reaction",totalDownloads:1407,totalCrossrefCites:0,signatures:"Holly Ringhauser and James Cipolla",reviewType:"peer-reviewed",authors:[{id:"187661",title:"Dr.",name:"James",middleName:null,surname:"Cipolla",fullName:"James Cipolla",slug:"james-cipolla"}]},{id:"56069",type:"chapter",title:"Patient Self-Harm in the Emergency Department: An Evidence- Based Approach",slug:"patient-self-harm-in-the-emergency-department-an-evidence-based-approach",totalDownloads:1971,totalCrossrefCites:1,signatures:"Ronya Silmi, Joshua Luster, Jacqueline Seoane, Stanislaw P.\nStawicki, Thomas J. 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1. Introduction
Safe, enduring, sustainable built environments are of great interest to planners, designers, governmental organizations, and citizens. Yet yearly across the globe, built environments are destroyed by tsunamis, hurricanes, earthquakes, wildfires, tornadoes, volcanoes, flooding, landslides, avalanches, and other environmental hazards. The loss of life and damage to property is extensive. As each event occurs, scholars study the cause of the event, the extent of the damage, and impact upon the environment. For example, Foxworthy and Hill describe the cataclysmic event of the Mount St. Helens volcanic eruption of 1980—this event was only a relatively small volcanic eruption [1]. Ekey recounts the extent and damage of the 1988 Yellowstone fire; while Daniel and Ferguson edited a series of papers discussing the knowledge concerning wildfires and the urban interface [2, 3]. Stanley Changnon edited a document describing the extensive flooding event in the Mississippi River Basin of 1993 [4]. Numerous authors describe earthquake events ranging from events in relative wilderness to urban areas [5, 6, 7, 8, 9]. Margot Keam Cleary describes many more events of the twentieth century, noting avalanches, hurricanes/typhoons/cyclones, tornados, and tsunami/tidal waves [10]. In addition, authors have described catastrophic events such a meteorite collisions and atmospheric poisoning leading to changes in the composition and structure of the biosphere [11]. Each event would raise public awareness, but for many in the planning and design community, environmental hazards and the long term suitability of a building site were of minor importance when compared to issue of landscape conservation, design beauty, economics, and short term functionality [12, 13]. To illustrate this perspective, in the United States of America, Falling Water/Kaufman House, design by the acclaimed American architect of the twentieth century Frank Lloyd Wright in about 1935 is considered to be one of the great pieces of architecture for that century; yet in a 100 year flood, the waters of the seemingly serene creek rise to the mid-level of the living room (Figure 1) [11].
By the 1960s, planners and designers in the United States of America explored approaches to place built environment facilities in safe zones compatible with the structural ecology of the area, as illustrated by the barrier islands study of Ian McHarg and placing structures outside the path of avalanche zones at Snowbird, Utah by Dan Kiley [14, 15]. Landscape architects had expanded their work to encompass landscape planning studies, something that had not been widely practiced since efforts earlier in the twentieth century by Warren Manning [11]. For example, the complete land area and some aquatic habitats of the state of Hawaii have been completely planned and zoned with assistance of the professional design firm EDAW, led by Garrett Eckbo (the “E” in EDAW). The landscape is divided into areas for housing, recreation, grazing, crop production, forestry, armed services usage, conservation, and for use by the native Hawaiian people. The plan included considerations for mitigating the effects of three natural hazards: earthquakes, tsunamis, and volcanoes [16, 17]. This general approach was applied by Burley and Burley to a study site in Colorado, to determine safe building environments against wildlife, avalanche, rock fall, and flooding. They determined that in their study area, there was no safe site [18]. This interest extended to other areas in the world, as Feng et al. examined building site safety in the Wenchuan are of China and in the central Philippines in post-earthquake settings developing an index to assess and determine the resiliency of the setting to save lives [19]. But in many respects, response to landscape hazards in planning and design had been practiced by some in other parts of the world, long before Americans began to study such topics. For example, in Tokyo, Japan, the Kiyosumi Garden, developed in 1878–1885 was created as a safe-haven in post-earthquake events and together with a nearby public park, remains as a post-earthquake safe-haven and was used as a safe haven during the allied/American bombings of Tokyo in 1945, Figure 2 [20]. Similar work concerning safe haven open space has been recently studied in the Chinese province of Fujian [21, 22, 23]. These examples illustrate that at times investigators, public officials, and concerned citizens have occasionally/sporadically addressed hazards in the built environment; however, interest in this topic has increased.
Community resilience is an increasingly addressed issue worldwide, as it encompasses a widespread usage of resources by community members that allows them to thrive in a constant state of change and unpredictability [24]. As climate change develops into an increasingly more harmful and destructive force, communities need to be able to withstand and recover from these devastating effects. Presented as an opportunity to face vulnerability with resilience, climate change is the quintessential factor which immediately is threatening both our natural and human systems. The need to establish, enhance and promote tools for the overall health and safety of communities is increasing; thus, Community Resilience Assessment (CRA) tools have continued to evolve over the course of the twenty-first century [25]. Resilience, a term consisting of varying definitions, is composed of the same underlying concept of a mix of natural and mechanical systems with the ability to adapt to extreme shocks and uncertainty [26]. When creating and planning a design, policy makers, developers, landscape architects, and other professionals involved in the process, all play a vital role in the implementation of community resilience. Although many are currently aware of the effects and future possibilities environmental change and landscape hazards, there are also many who are not thinking about the essential planning steps needed to be able to withstand these effects.
In an attempt to depict a dynamic system responding to hazards and change that is not necessarily in balance, Graham A. Tobin cohesively created a conceptual framework for analysis of sustainability and resilience that consists of three separate heuristic normative theories (meaning based upon expert opinion): a mitigation model, recovery model, and structural-cognitive model [27]. Collectively, these provide an in-depth look at the realities of implementing a sustainable and resilient framework that demonstrates the difficulties such as local context, social and political activities, and economic concerns. Tobin’s ideas have been adapted from the works of Waugh and Mazmanian and Sabatier [28, 29]. In order to prevent high levels of exposure and risk, acts of prevention are critical to a community’s success in the complete cycle hazard recovery and resilience. An example given are the mitigation policies that ensure specific conditions are met when implementing design standards of flood embankments and levee systems. Thus, a physical action is being taken towards the overall community resilience instead of the issue remaining theoretical which does not provide any measurable outcome. These conditions were then condensed into six major priorities for successful implementation: (1) sound theory with causal linkages to assure reasonable goals; (2) tasks and programs must be assigned to sympathetic agencies with adequate resources; (3) leaders must have managerial and political skills; (4) clear policy objectives with long term commitments; (5) organized constituency support; (6) no undermining of the policy over time [27]. Overall, these conditions and goals must be clearly articulated in order to provide safety, resilience, and resources over time to a wide variety of communities.
The state-of-the art concerning landscape hazards suggests that there is a wider concern across the public and professional ability and interest in assessing and implementing plans and design related to this issue. Still, the effort is case by case, city by city, and region by region. Rarely has there been an examination of a broad set of hazards for a substantially large area. Reporting of hazard events is often in the national and international news cycle. As this article is being completed, the wildfires of Australia are in the news [30]. In some respects there is no comprehensive study because no governmental agency is fully/completely responsible to address planning and design for all types of hazards (the most comprehensive agency responds to hazards in the United States, the Federal Emergency Management Agency (FEMA) advising the public concern advanced preparation for some types of hazards such as earthquakes, wildfires, tornados, and hurricanes). Unfortunately no investigatory team has been funded to examine this issue in the same manner as Warren Manning, who lived from 1860 to 1838, who prepared a national comprehensive conservation management plan for the United States (Figures 3 and 4) [31]. He did not examine landscape hazards. But if he was living today, maybe it would be an issue that he might address.
We wondered if it was possible to address the lower 48 states concerning a multiplicity of landscape hazards to gain a more comprehensive understanding of the issues facing the built environment and long-term sustainability of building sites? In our investigation we were curious about: are there only small areas that merit hazard planning and design?; are there numerous and extensive areas that are relatively safe zones?; and what is the situation in the lower 48 states?
2. Methodology
To conduct the study, the team examined the same basic setting as Warren Manning [31]. The investigatory team gathered public data concerning a set of landscape hazards across the lower 48 of the United States, including: earthquakes, wildfires, hurricanes, tornados, flooding, volcanoes, radon, air pollution, avalanche, landslides, sinkholes, and blizzards [32, 33, 34, 35, 36, 37, 38, 39, 40]. The maps were drawn in layers with three values: high risk (medium gray with a 10–200 year time frame), moderate risk (light gray 500 year time frame), and low risk (white great than 500 year time frame), similar to Burley and Burley [18]and McHarg [14]. The model to compile the maps in a series of overlays was similar to Johnson and Burley, where the most hazardous value (a medium gray) across the overlays determined the hazard risk for a location [41]. Only locations with no high (medium gray) or moderate hazard rating (light gray) would receive a low (near white) hazard rating [41]. Locations with no value in the hazardous rating and with a maximum of a moderate rating would appear in the results map a moderate rating. For example, a site with a moderate earthquake score and all other scores being low, would be rated as a moderate (light gray) hazardous area. No effort was made to derive weighted maps or maps with linear combinations. As of yet, no investigator has demonstrated that the hazard layers should be combine in some latent dimension or equation. Although in the future, investigators might explore statistical relationships amongst the variables, as other investigators had done in visual quality and soil reclamation studies [42, 43]. The late Phil Lewis did discover that wetlands, slopes that require protection, and recreational lands covaried forming corridors, suggesting a latent dimension in environmental conservation and recreation to for greenways [44]. But so far, no such work has been accomplished with hazard data. In this hazard study the resulting map in this investigation may appear with many levels of gray (darker indicate many hazards and white indicating no hazards).
3. Results
The resultant map (Figure 5) contained approximately 83% of the study area with high and moderate hazard ratings. The locations with a fair expanse of low ratings occurred in the rain shadow (east) of the Rocky Mountains on the western edge of the Northern Great Plains from west Texas to Montana and a smaller swath of land in the upper Midwest (Michigan, Wisconsin, northern Minnesota). A patchwork of lighter gray also occurs on the west side of the Appalachian Mountain in the Tennessee and Ohio River valleys north towards Pennsylvania and New York. However, there is no truly completely safe site. Smaller, county sized patches of relatively low hazard areas occur in the mountain west.
When the environmental hazards are combined together, it become clear that much of the landscape will encounter some sort of hazard that may affect the built environment. The map suggests that over a 200 year period (10 generations), most sites will encounter some sort of hazard. While for any one generation, a group of individuals or community may experience no hazard event, in the higher hazard areas, events may be frequent across generations. The map in Figure 5 indicates that much of the country will face repeated events and that there are relatively few refuges. This may be a surprise to some citizens and public officials who may expect their environments to remain stable and safe long term. The map suggests that building sites may be disturbed, even destroyed at a frequent rate, meaning within 10 generations. The disturbance probability is much greater than for just some unlucky locations such as in the San Francisco area, the gulf coast in the south east, or in and near Yellowstone National Park.
What does this mean for the built environment? For long term sustainability, care and thought may have to be given to mitigating the expected forthcoming event. Building codes and site design may have to reflect minimizing damage and sustaining life.
Figure 6 presents a map containing United Nations Educational, Scientific and Cultural Organization (UNESCO) Biosphere and Cultural Heritage areas, plus National Parks, and other historic landscape architectural sites described by Newton, Tobey, and Burley and Machemer [11, 12, 13].
The map illustrated in Figure 6 suggests that many valued natural environments, cultural sites and other valued landscapes are in zones that will be exposed to disturbance. Only a few sites on the Great Plains or in northern Michigan and Minnesota may be in areas with little change from hazards. Change is coming. Often individuals may assume that these sites may remain undisturbed and unaffected for many centuries. But the truth may be that many of these sites will encounter events much sooner than expected. Very few sites may have the longevity that the Pyramids of Giza in Egypt have endured. After all, the other six wonders of the world are in ruins [11]. Even places like central Michigan exposed to few events, over the last 12,000 years endured mile high glaciers, large fluctuations in the level of the Great Lakes, the extinctions of mammoths (Mammuthus primigenius (Blumenbach, 1799 [originally Elephas])) and mastodons (Mammut americanum Kerr 1792), the migration of vegetation from the south, the clearing for forests, the coming of urbanization, the automobile, and the invasion of exotic species [11].
In this study, there are more variables that could be included, such as water or soil pollution, or the impacts of various climate change scenarios. In addition, it could be debated about how the variables were classified and combined, or possibly a different base map for a certain variable could be used. Other investigators could generate variations on the results. This study is not definitive.
The environmental dangers to building sites are real and extend to nations around the world (Figure 7). The recent eruption of the Taal volcano in the Philippines illustrates the dangers to the built environment as it is an earthquake zone and volcano hazard area [45]. This is the same area that was hit by Typhoon Phanfone (Ursula) in late December 2019 [46].
Planners and designers are engaging issues related to examining larger landscapes. This engagement facilitates understanding factors, forces, and influences upon the built environment. In this investigation, it was discovered that much of the study area will experience hazards events that will perturb the built environment, sooner than some might expect. To be sustainable or resilient may mean that these disturbances may require thoughtful adjustment by citizens, government officials, the construction industry, and planning/design professionals. Landscape architecture has become a profession engaged in examining broader environmental concerns beyond site planning and detailed design.
Conflict of interest
The authors declare no conflict of interest.
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In our study, we examined these forces across the lower 48 states of the United States of America. We applied geographic information system (GIS) technology to identify areas of extreme hazard and areas of low risk. Our investigation indicated that most of our study area (approximately 83%) was exposed to highly reoccurring destructive forces and that only relatively small patches (Upper Midwest-portions of Michigan, Wisconsin, and Minnesota) and thin stretches (Rocky Mountain Front Range—eastern Montana, Wyoming, and eastern Colorado) of land were relatively secure from these forces. This means that in the long term, much of the study area is not safe from disturbances that will destroy much of the built environment, challenging notions of sustainability for numerous metropolitan areas, United Nations Educational, Scientific, and Cultural Organization (UNESCO) Biosphere Reserves, UNESCO World Heritage Sites, National Parks, other noted historic sites.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/71180",risUrl:"/chapter/ris/71180",signatures:"Yoichi Kunii, Paige O’Keefe, Jon Burley, Luis Loures and Marifaye Regina Villanueva",book:{id:"9845",type:"book",title:"Landscape Architecture",subtitle:"Processes and Practices Towards Sustainable Development",fullTitle:"Landscape Architecture - Processes and Practices Towards Sustainable Development",slug:"landscape-architecture-processes-and-practices-towards-sustainable-development",publishedDate:"September 22nd 2021",bookSignature:"Luís Loures and Mustafa Ergen",coverURL:"https://cdn.intechopen.com/books/images_new/9845.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83968-377-0",printIsbn:"978-1-83968-376-3",pdfIsbn:"978-1-83968-378-7",isAvailableForWebshopOrdering:!0,editors:[{id:"108118",title:"Dr.",name:"Luis",middleName:null,surname:"Loures",slug:"luis-loures",fullName:"Luis Loures"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"95281",title:"Dr.",name:"Jon",middleName:null,surname:"Bryan Burley",fullName:"Jon Bryan Burley",slug:"jon-bryan-burley",email:"burleyj@msu.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Michigan State University",institutionURL:null,country:{name:"United States of America"}}},{id:"108118",title:"Dr.",name:"Luis",middleName:null,surname:"Loures",fullName:"Luis Loures",slug:"luis-loures",email:"lcloures@ipportalegre.pt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/108118/images/system/108118.JPEG",institution:{name:"Polytechnic Institute of Portalegre",institutionURL:null,country:{name:"Portugal"}}},{id:"268436",title:"Dr.",name:"Yoichi",middleName:null,surname:"Kunii",fullName:"Yoichi Kunii",slug:"yoichi-kunii",email:"y3kunii@nodai.ac.jp",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"317637",title:"Ms.",name:"Paige",middleName:null,surname:"O'Keefe",fullName:"Paige O'Keefe",slug:"paige-o'keefe",email:"paigeokeefe1@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Michigan State University",institutionURL:null,country:{name:"United States of America"}}},{id:"411663",title:"Dr.",name:"Marifaye Regina",middleName:null,surname:"Villanueva",fullName:"Marifaye Regina Villanueva",slug:"marifaye-regina-villanueva",email:"dummy+411663@intechopen.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Methodology",level:"1"},{id:"sec_3",title:"3. Results",level:"1"},{id:"sec_4",title:"4. Discussion",level:"1"},{id:"sec_5",title:"5. Conclusion",level:"1"},{id:"sec_9",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Foxworthy BL, Hill M. Volcanic Eruptions of 1980 at Mount St. Helens the First 100 Days. Washington, DC: US Department of the Interior; 1982. Geological Survey 1249'},{id:"B2",body:'Ekey R. Yellowstone on Fire! Billings. Montana, USA: Billings Gazette; 1989'},{id:"B3",body:'Daniel TC, Ferguson IS, editors. Integrating research on hazards in fire-prone environments: Reconciling biological and human values in the wildland/urban interface. In: Proceedings of the U.S.—Australia Workshop. Melbourne, Australia: The United States Man and the Biosphere Program; 1989'},{id:"B4",body:'Changnon SA, editor. The Great Flood of 1993: Causes, Impacts, and Responses. 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Honolulu, Hawaii, USA: State of Hawaii Land Use Commission; 1969'},{id:"B17",body:'Armstrong RW, editor. Atlas of Hawaii. Honolulu. Hawaii, USA: The University of Hawaii Press; 1973'},{id:"B18",body:'Burley JB, Burley CJ. A risk assessment of landscape hazards for building sites in the front range of Colorado. Landscape Research. 1996;21(2):137-158. DOI: 10.1080/01426399608706482'},{id:"B19",body:'Feng M, Burley JB, Machemer T, Korkmaz A, Villanueva MR. Earthquake spatial mitigation: Wenchuan China and Los Banos, Philippines case studies. GSTF Journal of Engineering Technology (JET). 2018;5(2):10'},{id:"B20",body:'Tokyo Metropolitan Park Association. Kiyosumi Gardens. Tokyo, Japan: Tokyo Metropolitan Park Association; undated'},{id:"B21",body:'Hong T, Yang W, Zheng Y. Evaluation on the function of urban green space emergency shelter based on AHP. Journal of Fujian Forestry Science Technology. 2013;40(1):133-137'},{id:"B22",body:'Hong T, Wu R, Guo M, Zheng Y. Division of the green space shelter based on the weighted Voronoi diagram. Journal of Northwest Forestry. 2013;28(3):255-259'},{id:"B23",body:'Hong T, Wu R, Song S, Guo M, Zheng Y. GIS based analysis on engergency shelters capacity of urban greenspaces in Sanming City. Journal of Southwest Forestry College. 2103;33(1):55-59'},{id:"B24",body:'Magis K. Community resilience: An indicator of social sustainability. Society and Natural Resources. 2010;23(5):401-416. DOI: 10.1080/08941920903305674'},{id:"B25",body:'Sharifi A. A critical review of selected tools for assessing community resilience. Ecological Indicators. 2016;69(1):629-647. DOI: 10.1016/j.ecolind.2016.05.023'},{id:"B26",body:'Baek J, Meroni A, Manzini E. A socio-technical approach to design for community resilience: A framework for analysis and design goal forming. Design Studies. 2015;40(6):60-84. DOI: 10.1016/j.destud.2015.06.004'},{id:"B27",body:'Tobin G. Sustainability and community resilience: The holy grail of hazards planning? Environmental Hazards. 1999;19(2):13-25'},{id:"B28",body:'Waugh WL Jr. Disaster management for the new millennium: U.S. and Canada politics, policymaking, administration and analysis of emergency management. In: Waugh WL Jr, Sylves RT, editors. Disaster Management in the U.S. and Canada: The Politics, Policymaking, Administration, and Analysis of Emergency Management. Vol. 1996. Springfield, Illinois, USA: Charles C. Thomas Publishers; 1996. pp. 344-359. (Chapter XVI)'},{id:"B29",body:'Mazmanian DA, Sabatier PA. Implementation and Public Policy. Glenview, Illinois, USA: Scott Foresman; 1983. Public policy analysis and management series'},{id:"B30",body:'Yeung J. Millions of Animals Are Dying from the Australian Fires, and the Environment Will Suffer for Years to Come [Internet]. Atlanta, Georgia, USA: CNN; 2020. Available from: https://www.cnn.com/2020/01/07/australia/australia-fire-wildlife-deaths-intl-hnk-scli/index.html'},{id:"B31",body:'Manning W. A National Plan. North Billerica, Massachusetts: USA unpublished draft; 1923. p. 427'},{id:"B32",body:'United States Geological Survey. Frequency of Damaging Earthquake Shaking Around the U.S. [map]. Washington, D.C., USA: United States Geological Survey; 2014'},{id:"B33",body:'National Interagency Fire Center. Wildfire Activity by County 1994-2013 [Map]. Boise, Idaho, USA: National Interagency Fire Center; 2015'},{id:"B34",body:'Federal Emergency Management Agency, editor. Tornado Activity in the United States [Map]. FEMA 320. 3rd ed. Washington, D.C., USA: Federal Emergency Management Agency; 2008'},{id:"B35",body:'National Oceanic and Atmospheric Administration. U.S. Spring Flood Risk [Map]. Washington, D.C., USA: U.S. Department of Commerce, National Oceanic and Atmospheric Administration; 2017. p. 2017'},{id:"B36",body:'United States Geological Survey. Volcanic Hazards (Based on Activity in the Last 15,000 Years) [Map]. Washington, D.C., USA: United States Geological Survey; Undated'},{id:"B37",body:'Environmental Protection Agency. EPA Map of Radon Zones [Map]. Washington, D.C., USA: Environmental Protection Agency; 1993'},{id:"B38",body:'Galloway DL, Jones DR, Ingebritsen SE. Lands Subsidence in the United States. Washington, D. C: U.S. Geological Survey, Circular 1182;'},{id:"B39",body:'Radbruch-Hall DH, Colton R, Davies WE, Lucchitta I, Skipp BA, Varnes DJ. Landslide Overview Map of the Conterminous United States [Map]. Washington, D.C., USA: United States Geological Survey; 1978'},{id:"B40",body:'Schwartz RM, Schmidlin TW. Climatology of blizzards in the conterminous United States, 19592000. American Meteorological Society. 2002;15:1765-1772. Blizzards by County, 1959-2000'},{id:"B41",body:'Johnson R, Burley JB. Snowy range ski resort: An illustration of GIS planning principles. Landscape Architectural Review. 1990;9(1):15-18'},{id:"B42",body:'Burley JB. Visual and ecological environmental quality model for transportation planning and design. Transportation Research Record. 1997;1549:54-60'},{id:"B43",body:'Burley JB, Thomsen C, Kenkel N. Development of an agricultural productivity model to reclaim surface mines in Clay County, Minnesota. Environmental Management. 1989;13(5):631-638'},{id:"B44",body:'Lewis P. Quality corridors in Wisconsin. Landscape Architecture Quarterly. 1964;52(2):275-282'},{id:"B45",body:'Rusydy I, Faustino-Eslava DV, Muksin U, Gallardo-Zafra R, Aguirre JJC, Bantanyan NC, Alam L, Dakey S. Building vulnerability and human loss assessment in different earthquake intensity and time: A case study of the University of the Philippines, Los Banos (UPLB) campus. 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UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
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He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:49,paginationItems:[{id:"80495",title:"Iron in Cell Metabolism and Disease",doi:"10.5772/intechopen.101908",signatures:"Eeka Prabhakar",slug:"iron-in-cell-metabolism-and-disease",totalDownloads:1,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Iron Metabolism - Iron a Double‐Edged Sword",coverURL:"https://cdn.intechopen.com/books/images_new/10842.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81799",title:"Cross Talk of Purinergic and Immune Signaling: Implication in Inflammatory and Pathogenic Diseases",doi:"10.5772/intechopen.104978",signatures:"Richa Rai",slug:"cross-talk-of-purinergic-and-immune-signaling-implication-in-inflammatory-and-pathogenic-diseases",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81764",title:"Involvement of the Purinergic System in Cell Death in Models of Retinopathies",doi:"10.5772/intechopen.103935",signatures:"Douglas Penaforte Cruz, Marinna Garcia Repossi and Lucianne Fragel Madeira",slug:"involvement-of-the-purinergic-system-in-cell-death-in-models-of-retinopathies",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81756",title:"Alteration of Cytokines Level and Oxidative Stress Parameters in COVID-19",doi:"10.5772/intechopen.104950",signatures:"Marija Petrusevska, Emilija Atanasovska, Dragica Zendelovska, Aleksandar Eftimov and Katerina Spasovska",slug:"alteration-of-cytokines-level-and-oxidative-stress-parameters-in-covid-19",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}}]},overviewPagePublishedBooks:{paginationCount:27,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science and Technology from the Department of Chemistry, National University of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013. She relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the National Institute of Fundamental Studies from April 2013 to October 2016. She was a senior lecturer on a temporary basis at the Department of Food Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is currently Deputy Principal of the Australian College of Business and Technology – Kandy Campus, Sri Lanka. 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Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}}]},{type:"book",id:"7978",title:"Vitamin A",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7978.jpg",slug:"vitamin-a",publishedDate:"May 15th 2019",editedByType:"Edited by",bookSignature:"Leila Queiroz Zepka, Veridiana Vera de Rosso and Eduardo Jacob-Lopes",hash:"dad04a658ab9e3d851d23705980a688b",volumeInSeries:3,fullTitle:"Vitamin A",editors:[{id:"261969",title:"Dr.",name:"Leila",middleName:null,surname:"Queiroz Zepka",slug:"leila-queiroz-zepka",fullName:"Leila Queiroz Zepka",profilePictureURL:"https://mts.intechopen.com/storage/users/261969/images/system/261969.png",biography:"Prof. Dr. Leila Queiroz Zepka is currently an associate professor in the Department of Food Technology and Science, Federal University of Santa Maria, Brazil. She has more than fifteen years of teaching and research experience. She has published more than 550 scientific publications/communications, including 15 books, 50 book chapters, 100 original research papers, 380 research communications in national and international conferences, and 12 patents. She is a member of the editorial board of five journals and acts as a reviewer for several national and international journals. Her research interests include microalgal biotechnology with an emphasis on microalgae-based products.",institutionString:"Universidade Federal de Santa Maria",institution:{name:"Universidade Federal de Santa Maria",institutionURL:null,country:{name:"Brazil"}}}]},{type:"book",id:"7953",title:"Bioluminescence",subtitle:"Analytical Applications and Basic Biology",coverURL:"https://cdn.intechopen.com/books/images_new/7953.jpg",slug:"bioluminescence-analytical-applications-and-basic-biology",publishedDate:"September 25th 2019",editedByType:"Edited by",bookSignature:"Hirobumi Suzuki",hash:"3a8efa00b71abea11bf01973dc589979",volumeInSeries:4,fullTitle:"Bioluminescence - Analytical Applications and Basic Biology",editors:[{id:"185746",title:"Dr.",name:"Hirobumi",middleName:null,surname:"Suzuki",slug:"hirobumi-suzuki",fullName:"Hirobumi Suzuki",profilePictureURL:"https://mts.intechopen.com/storage/users/185746/images/system/185746.png",biography:"Dr. Hirobumi Suzuki received his Ph.D. in 1997 from Tokyo Metropolitan University, Japan, where he studied firefly phylogeny and the evolution of mating systems. He is especially interested in the genetic differentiation pattern and speciation process that correlate to the flashing pattern and mating behavior of some fireflies in Japan. He then worked for Olympus Corporation, a Japanese manufacturer of optics and imaging products, where he was involved in the development of luminescence technology and produced a bioluminescence microscope that is currently being used for gene expression analysis in chronobiology, neurobiology, and developmental biology. Dr. Suzuki currently serves as a visiting researcher at Kogakuin University, Japan, and also a vice president of the Japan Firefly Society.",institutionString:"Kogakuin University",institution:null}]}]},openForSubmissionBooks:{},onlineFirstChapters:{},subseriesFiltersForOFChapters:[],publishedBooks:{},subseriesFiltersForPublishedBooks:[],publicationYearFilters:[],authors:{paginationCount:617,paginationItems:[{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/158492/images/system/158492.jpeg",biography:"Prof. Dr. Yusuf Tutar conducts his research at the Hamidiye Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Division of Biochemistry, University of Health Sciences, Turkey. He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNVJQA4/Profile_Picture_2022-03-07T13:23:04.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. His research interests include biochemistry, oxidative stress, reactive species, antioxidants, lipid peroxidation, inflammation, reproductive hormones, phenolic compounds, female infertility.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Associate Prof.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/15648_n.jpg",biography:"Dr. Mohd Aftab Siddiqui is currently working as Assistant Professor in the Faculty of Pharmacy, Integral University, Lucknow for the last 6 years. He has completed his Doctor in Philosophy (Pharmacology) in 2020 from Integral University, Lucknow. He completed his Bachelor in Pharmacy in 2013 and Master in Pharmacy (Pharmacology) in 2015 from Integral University, Lucknow. He is the gold medalist in Bachelor and Master degree. He qualified GPAT -2013, GPAT -2014, and GPAT 2015. His area of research is Pharmacological screening of herbal drugs/ natural products in liver and cardiac diseases. He has guided many M. Pharm. research projects. He has many national and international publications.",institutionString:"Integral University",institution:null},{id:"255360",title:"Dr.",name:"Usama",middleName:null,surname:"Ahmad",slug:"usama-ahmad",fullName:"Usama Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255360/images/system/255360.png",biography:"Dr. Usama Ahmad holds a specialization in Pharmaceutics from Amity University, Lucknow, India. He received his Ph.D. degree from Integral University. Currently, he’s working as an Assistant Professor of Pharmaceutics in the Faculty of Pharmacy, Integral University. From 2013 to 2014 he worked on a research project funded by SERB-DST, Government of India. He has a rich publication record with more than 32 original articles published in reputed journals, 3 edited books, 5 book chapters, and a number of scientific articles published in ‘Ingredients South Asia Magazine’ and ‘QualPharma Magazine’. He is a member of the American Association for Cancer Research, International Association for the Study of Lung Cancer, and the British Society for Nanomedicine. Dr. Ahmad’s research focus is on the development of nanoformulations to facilitate the delivery of drugs that aim to provide practical solutions to current healthcare problems.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. Dr. Khullar has a keen research interest in genetics of hypertension, and is currently studying pharmacogenetics of hypertension.",institutionString:"Post Graduate Institute of Medical Education and Research",institution:{name:"Post Graduate Institute of Medical Education and Research",country:{name:"India"}}},{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/223233/images/system/223233.png",biography:"Xianquan Zhan received his MD and Ph.D. in Preventive Medicine at West China University of Medical Sciences. He received his post-doctoral training in oncology and cancer proteomics at the Central South University, China, and the University of Tennessee Health Science Center (UTHSC), USA. He worked at UTHSC and the Cleveland Clinic in 2001–2012 and achieved the rank of associate professor at UTHSC. Currently, he is a full professor at Central South University and Shandong First Medical University, and an advisor to MS/PhD students and postdoctoral fellows. He is also a fellow of the Royal Society of Medicine and European Association for Predictive Preventive Personalized Medicine (EPMA), a national representative of EPMA, and a member of the American Society of Clinical Oncology (ASCO) and the American Association for the Advancement of Sciences (AAAS). He is also the editor in chief of International Journal of Chronic Diseases & Therapy, an associate editor of EPMA Journal, Frontiers in Endocrinology, and BMC Medical Genomics, and a guest editor of Mass Spectrometry Reviews, Frontiers in Endocrinology, EPMA Journal, and Oxidative Medicine and Cellular Longevity. He has published more than 148 articles, 28 book chapters, 6 books, and 2 US patents in the field of clinical proteomics and biomarkers.",institutionString:"Shandong First Medical University",institution:{name:"Affiliated Hospital of Shandong Academy of Medical Sciences",country:{name:"China"}}},{id:"297507",title:"Dr.",name:"Charles",middleName:"Elias",surname:"Assmann",slug:"charles-assmann",fullName:"Charles Assmann",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/297507/images/system/297507.jpg",biography:"Charles Elias Assmann is a biologist from Federal University of Santa Maria (UFSM, Brazil), who spent some time abroad at the Ludwig-Maximilians-Universität München (LMU, Germany). He has Masters Degree in Biochemistry (UFSM), and is currently a PhD student at Biochemistry at the Department of Biochemistry and Molecular Biology of the UFSM. His areas of expertise include: Biochemistry, Molecular Biology, Enzymology, Genetics and Toxicology. He is currently working on the following subjects: Aluminium toxicity, Neuroinflammation, Oxidative stress and Purinergic system. Since 2011 he has presented more than 80 abstracts in scientific proceedings of national and international meetings. Since 2014, he has published more than 20 peer reviewed papers (including 4 reviews, 3 in Portuguese) and 2 book chapters. He has also been a reviewer of international journals and ad hoc reviewer of scientific committees from Brazilian Universities.",institutionString:"Universidade Federal de Santa Maria",institution:{name:"Universidade Federal de Santa Maria",country:{name:"Brazil"}}},{id:"217850",title:"Dr.",name:"Margarete Dulce",middleName:null,surname:"Bagatini",slug:"margarete-dulce-bagatini",fullName:"Margarete Dulce Bagatini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217850/images/system/217850.jpeg",biography:"Dr. Margarete Dulce Bagatini is an associate professor at the Federal University of Fronteira Sul/Brazil. She has a degree in Pharmacy and a PhD in Biological Sciences: Toxicological Biochemistry. She is a member of the UFFS Research Advisory Committee\nand a member of the Biovitta Research Institute. She is currently:\nthe leader of the research group: Biological and Clinical Studies\nin Human Pathologies, professor of postgraduate program in\nBiochemistry at UFSC and postgraduate program in Science and Food Technology at\nUFFS. She has experience in the area of pharmacy and clinical analysis, acting mainly\non the following topics: oxidative stress, the purinergic system and human pathologies, being a reviewer of several international journals and books.",institutionString:"Universidade Federal da Fronteira Sul",institution:{name:"Universidade Federal da Fronteira Sul",country:{name:"Brazil"}}},{id:"226275",title:"Ph.D.",name:"Metin",middleName:null,surname:"Budak",slug:"metin-budak",fullName:"Metin Budak",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226275/images/system/226275.jfif",biography:"Metin Budak, MSc, PhD is an Assistant Professor at Trakya University, Faculty of Medicine. He has been Head of the Molecular Research Lab at Prof. Mirko Tos Ear and Hearing Research Center since 2018. His specializations are biophysics, epigenetics, genetics, and methylation mechanisms. He has published around 25 peer-reviewed papers, 2 book chapters, and 28 abstracts. He is a member of the Clinical Research Ethics Committee and Quantification and Consideration Committee of Medicine Faculty. His research area is the role of methylation during gene transcription, chromatin packages DNA within the cell and DNA repair, replication, recombination, and gene transcription. His research focuses on how the cell overcomes chromatin structure and methylation to allow access to the underlying DNA and enable normal cellular function.",institutionString:"Trakya University",institution:{name:"Trakya University",country:{name:"Turkey"}}},{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",slug:"anca-pantea-stoian",fullName:"Anca Pantea Stoian",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",biography:"Anca Pantea Stoian is a specialist in diabetes, nutrition, and metabolic diseases as well as health food hygiene. She also has competency in general ultrasonography.\n\nShe is an associate professor in the Diabetes, Nutrition and Metabolic Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. She has been chief of the Hygiene Department, Faculty of Dentistry, at the same university since 2019. Her interests include micro and macrovascular complications in diabetes and new therapies. Her research activities focus on nutritional intervention in chronic pathology, as well as cardio-renal-metabolic risk assessment, and diabetes in cancer. She is currently engaged in developing new therapies and technological tools for screening, prevention, and patient education in diabetes. \n\nShe is a member of the European Association for the Study of Diabetes, Cardiometabolic Academy, CEDA, Romanian Society of Diabetes, Nutrition and Metabolic Diseases, Romanian Diabetes Federation, and Association for Renal Metabolic and Nutrition studies. She has authored or co-authored 160 papers in national and international peer-reviewed journals.",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",country:{name:"Romania"}}},{id:"279792",title:"Dr.",name:"João",middleName:null,surname:"Cotas",slug:"joao-cotas",fullName:"João Cotas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/279792/images/system/279792.jpg",biography:"Graduate and master in Biology from the University of Coimbra.\n\nI am a research fellow at the Macroalgae Laboratory Unit, in the MARE-UC – Marine and Environmental Sciences Centre of the University of Coimbra. My principal function is the collection, extraction and purification of macroalgae compounds, chemical and bioactive characterization of the compounds and algae extracts and development of new methodologies in marine biotechnology area. \nI am associated in two projects: one consists on discovery of natural compounds for oncobiology. The other project is the about the natural compounds/products for agricultural area.\n\nPublications:\nCotas, J.; Figueirinha, A.; Pereira, L.; Batista, T. 2018. An analysis of the effects of salinity on Fucus ceranoides (Ochrophyta, Phaeophyceae), in the Mondego River (Portugal). Journal of Oceanology and Limnology. in press. DOI: 10.1007/s00343-019-8111-3",institutionString:"Faculty of Sciences and Technology of University of Coimbra",institution:null},{id:"279788",title:"Dr.",name:"Leonel",middleName:null,surname:"Pereira",slug:"leonel-pereira",fullName:"Leonel Pereira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/279788/images/system/279788.jpg",biography:"Leonel Pereira has an undergraduate degree in Biology, a Ph.D. in Biology (specialty in Cell Biology), and a Habilitation degree in Biosciences (specialization in Biotechnology) from the Faculty of Science and Technology, University of Coimbra, Portugal, where he is currently a professor. In addition to teaching at this university, he is an integrated researcher at the Marine and Environmental Sciences Center (MARE), Portugal. His interests include marine biodiversity (algae), marine biotechnology (algae bioactive compounds), and marine ecology (environmental assessment). Since 2008, he has been the author and editor of the electronic publication MACOI – Portuguese Seaweeds Website (www.seaweeds.uc.pt). He is also a member of the editorial boards of several scientific journals. Dr. Pereira has edited or authored more than 20 books, 100 journal articles, and 45 book chapters. He has given more than 100 lectures and oral communications at various national and international scientific events. He is the coordinator of several national and international research projects. In 1998, he received the Francisco de Holanda Award (Honorable Mention) and, more recently, the Mar Rei D. Carlos award (18th edition). He is also a winner of the 2016 CHOICE Award for an outstanding academic title for his book Edible Seaweeds of the World. In 2020, Dr. Pereira received an Honorable Mention for the Impact of International Publications from the Web of Science",institutionString:"University of Coimbra",institution:{name:"University of Coimbra",country:{name:"Portugal"}}},{id:"61946",title:"Dr.",name:"Carol",middleName:null,surname:"Bernstein",slug:"carol-bernstein",fullName:"Carol Bernstein",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/61946/images/system/61946.jpg",biography:"Carol Bernstein received her PhD in Genetics from the University of California (Davis). She was a faculty member at the University of Arizona College of Medicine for 43 years, retiring in 2011. Her research interests focus on DNA damage and its underlying role in sex, aging and in the early steps of initiation and progression to cancer. In her research, she had used organisms including bacteriophage T4, Neurospora crassa, Schizosaccharomyces pombe and mice, as well as human cells and tissues. She authored or co-authored more than 140 scientific publications, including articles in major peer reviewed journals, book chapters, invited reviews and one book.",institutionString:"University of Arizona",institution:{name:"University of Arizona",country:{name:"United States of America"}}},{id:"182258",title:"Dr.",name:"Ademar",middleName:"Pereira",surname:"Serra",slug:"ademar-serra",fullName:"Ademar Serra",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/182258/images/system/182258.jpeg",biography:"Dr. Serra studied Agronomy on Universidade Federal de Mato Grosso do Sul (UFMS) (2005). He received master degree in Agronomy, Crop Science (Soil fertility and plant nutrition) (2007) by Universidade Federal da Grande Dourados (UFGD), and PhD in agronomy (Soil fertility and plant nutrition) (2011) from Universidade Federal da Grande Dourados / Escola Superior de Agricultura Luiz de Queiroz (UFGD/ESALQ-USP). Dr. Serra is currently working at Brazilian Agricultural Research Corporation (EMBRAPA). His research focus is on mineral nutrition of plants, crop science and soil science. Dr. Serra\\'s current projects are soil organic matter, soil phosphorus fractions, compositional nutrient diagnosis (CND) and isometric log ratio (ilr) transformation in compositional data analysis.",institutionString:"Brazilian Agricultural Research Corporation",institution:{name:"Brazilian Agricultural Research Corporation",country:{name:"Brazil"}}}]}},subseries:{item:{id:"7",type:"subseries",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. 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His research interests are focused on modern imaging methods used in medicine and pharmacy, including in particular hyperspectral imaging, dynamic thermovision analysis, high-resolution ultrasound, as well as other techniques such as EPR, NMR and hemispheric directional reflectance. Author of over 100 scientific works, patents and industrial designs. Expert of the Polish National Center for Research and Development, Member of the Investment Committee in the Bridge Alfa NCBiR program, expert of the Polish Ministry of Funds and Regional Policy, Polish Medical Research Agency. Editor-in-chief of the journal in the field of aesthetic medicine and dermatology - Aesthetica.",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,series:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343"},editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",slug:"alexandros-tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",slug:"lulu-wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",slug:"reda-r.-gharieb",fullName:"Reda R. 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