Bleeding risk score during neuroaxial blocks (adapted from reference 18)
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"11120",leadTitle:null,fullTitle:"Environmental Impact and Remediation of Heavy Metals",title:"Environmental Impact and Remediation of Heavy Metals",subtitle:null,reviewType:"peer-reviewed",abstract:"Heavy metals are a group of metals and metalloids that includes transition metals, lanthanides, and actinides. When released into water, these elements have toxic effects on water quality and surface sediments, affecting environmental parameters such as pH and temperature. Therefore, metals that are harmful to aquatic and terrestrial ecosystems pose a significant threat to plants, animals, and human health. As such, there is increased interest in mitigating the harmful environmental impacts of heavy metals. This book provides a comprehensive overview of heavy metals, their impacts on water, soil, food crops, and cosmetics, and techniques for their remediation. It is organized into three sections: “Heavy Metals and Their Effects on the Environment,” “Evaluation of Heavy Metals and Their Risks to Irrigation Water,” and “Remediation of Heavy Metals.”",isbn:"978-1-80355-526-3",printIsbn:"978-1-80355-525-6",pdfIsbn:"978-1-80355-527-0",doi:"10.5772/intechopen.97895",price:139,priceEur:155,priceUsd:179,slug:"environmental-impact-and-remediation-of-heavy-metals",numberOfPages:316,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"9e77514288e7394f1e6cd13481af3509",bookSignature:"Hosam M. Saleh and Amal I. Hassan",publishedDate:"June 23rd 2022",coverURL:"https://cdn.intechopen.com/books/images_new/11120.jpg",numberOfDownloads:1118,numberOfWosCitations:0,numberOfCrossrefCitations:3,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:5,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:8,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 16th 2021",dateEndSecondStepPublish:"October 14th 2021",dateEndThirdStepPublish:"December 13th 2021",dateEndFourthStepPublish:"March 3rd 2022",dateEndFifthStepPublish:"May 2nd 2022",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"144691",title:"Prof.",name:"Hosam M.",middleName:null,surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh",profilePictureURL:"https://mts.intechopen.com/storage/users/144691/images/system/144691.png",biography:"Hosam M. Saleh is a Professor of Radioactive Waste Management in the Radioisotope Department, Atomic Energy Authority, Egypt. He obtained an MSc and Ph.D. in Physical Chemistry from Cairo University, Egypt. He has more than 25 years of experience in hazardous waste management with an emphasis on treatment and developing new matrixes for the immobilization of these wastes. He is also interested in studying innovative economic and environmentally friendly techniques for the management of hazardous and radioactive wastes. He has authored many peer-reviewed scientific papers and chapters and served as an editor of several books. He was selected among the top 2% of scientists in the world according to the Stanford University report for 2020 and 2021.",institutionString:"Egyptian Atomic Energy Authority",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"15",totalChapterViews:"0",totalEditedBooks:"14",institution:{name:"Egyptian Atomic Energy Authority",institutionURL:null,country:{name:"Egypt"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"218811",title:"Prof.",name:"Amal I.",middleName:null,surname:"Hassan",slug:"amal-i.-hassan",fullName:"Amal I. Hassan",profilePictureURL:"https://mts.intechopen.com/storage/users/218811/images/system/218811.png",biography:"Amal I. Hassan is a Professor of Animal Physiology, Department of Radioisotopes, Nuclear Research Center, Atomic Energy Authority, Egypt. She has authored many peer-reviewed papers on chronic disease problems. She is a referee, reviewer, and editorial board member for several international scientific journals. She received a Certificate of Excellence in international scientific research arbitration from Publons. She was also selected for inclusion in Who’s Who in 2014, 2015, and 2016.",institutionString:"Egyptian Atomic Energy Authority",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"National Research Centre",institutionURL:null,country:{name:"Egypt"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"133",title:"Environmental Pollution",slug:"environmental-pollution"}],chapters:[{id:"81083",title:"Heavy Metal’s Environmental Impact",doi:"10.5772/intechopen.103907",slug:"heavy-metal-s-environmental-impact",totalDownloads:69,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Heavy metals are inorganic elements with something like a density of more than 5 g/cm3. Essential and non-essential heavy metals were divided into two groups based on their toxicity. Heavy metals, unlike organic pollutants, are non-biodegradable and tend to accumulate in living things. Many heavy metal ions are hazardous or carcinogenic. The majority of heavy metals, such as cadmium, copper, and zinc, are linked to pollution and hazardous concerns. There are more than 50 elements categorized as heavy metals, with 17 of them being extremely hazardous and easily accessible. Metal pollutants are often non-degradable and have no recognized homeostasis mechanism. Their mere presence in aquatic habitats is enough to have a direct or indirect impact on living systems. The anthropogenic pollution of heavy metals in ancient mining regions refers to areas where the concentration of one or more heavy metals exceeds normal values. Heavy metals disrupt cellular organelles and components in biological systems. Nanoscale zero-valent iron is a promising alternative for heavy metal cleanup. Heavy metal ions are poisonous, non-degradable, and tend to bioaccumulate and biomagnify. The purpose of this chapter is to display some heavy metals and the environmental impact of these minerals, which includes soil, plants, and humans.",signatures:"Riyam N. Khalef, Amal I. Hassan and Hosam M. Saleh",downloadPdfUrl:"/chapter/pdf-download/81083",previewPdfUrl:"/chapter/pdf-preview/81083",authors:[{id:"144691",title:"Prof.",name:"Hosam M.",surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"},{id:"218811",title:"Prof.",name:"Amal I.",surname:"Hassan",slug:"amal-i.-hassan",fullName:"Amal I. Hassan"},{id:"443543",title:"Ms.",name:"Riyam N.",surname:"Khalef",slug:"riyam-n.-khalef",fullName:"Riyam N. Khalef"}],corrections:null},{id:"80161",title:"Toxicity of Heavy Metals",doi:"10.5772/intechopen.102441",slug:"toxicity-of-heavy-metals",totalDownloads:131,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Heavy metals are elements who exist naturally in the environment, but rapid urbanization and industrialization led to increased levels of these metals. These metals can reach the human body through food, water or air, where they have the property to accumulate in various tissues and organs for long periods of time and to produce serious effects on certain organs and the proper functioning of the body. Studies have also shown that heavy metals can have important effects, including on plants or animals. Their toxicity is dependent on factors such as dose, route of exposure, time of exposure, level of concentration, as well as age, gender, genetics, and nutritional status of exposed individuals. There is a growing interest from researchers to detect various physical, physical-chemical or microbiological methods to reduce or eliminate the presence of these metals, especially from surface or wastewater, which are mainly responsible for food contamination. This chapter present the main characteristics of heavy metals, the sources of contamination of exposure, as well as their toxicity on some environmental segments and especially on living organisms.",signatures:"Elena Loredana Ungureanu and Gabriel Mustatea",downloadPdfUrl:"/chapter/pdf-download/80161",previewPdfUrl:"/chapter/pdf-preview/80161",authors:[{id:"441033",title:"Dr.Ing.",name:"Gabriel",surname:"Mustatea",slug:"gabriel-mustatea",fullName:"Gabriel Mustatea"},{id:"441034",title:"Mrs.",name:"Elena Loredana",surname:"Ungureanu",slug:"elena-loredana-ungureanu",fullName:"Elena Loredana Ungureanu"}],corrections:null},{id:"80259",title:"Influence of Heavy Metals on Quality of Raw Materials, Animal Products, and Human and Animal Health Status",doi:"10.5772/intechopen.102497",slug:"influence-of-heavy-metals-on-quality-of-raw-materials-animal-products-and-human-and-animal-health-st",totalDownloads:88,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Heavy metals constitute one of the threats to the natural environment and the health of living organisms. The sources of contamination of the environment with heavy metals are mainly industry, thermal and chemical processing of mineral resources, burning of coal, gases and liquid fuels, municipal economy (rubbish dumps, sewage), and agriculture consuming mineral fertilizers, plant protection agents, utilizing huge loads of pollution accompanying animal production. Accumulation of toxic elements in plant tissues leads to disturbances in plant reproduction and thus to lowering of their nutritional value. In humans and animals, in turn, it may cause poisoning and the occurrence of various disorders and diseases, including cancer. There are different ways to reduce the penetration of heavy metals into crops and deactivation in animal organisms—by using the tolerance of plants to heavy metals, cleaning the environment through phytoremediation, the use of antagonistic type interactions to reduce bioaccumulation in animal tissues, as well as the properties of compounds of organic and mineral origin. The aim of the chapter is to present the problems of environmental pollution and accumulation of heavy metals (mainly cadmium, mercury, and lead) in tissues of farm animals, their impact on human and animal health, as well as the possibility of inactivation of heavy metals in animal organisms.",signatures:"Anna Bartkowiak",downloadPdfUrl:"/chapter/pdf-download/80259",previewPdfUrl:"/chapter/pdf-preview/80259",authors:[{id:"442764",title:"Associate Prof.",name:"Anna",surname:"Bartkowiak",slug:"anna-bartkowiak",fullName:"Anna Bartkowiak"}],corrections:null},{id:"80088",title:"Heavy Metal Contamination of Food Crops: Transportation via Food Chain, Human Consumption, Toxicity and Management Strategies",doi:"10.5772/intechopen.101938",slug:"heavy-metal-contamination-of-food-crops-transportation-via-food-chain-human-consumption-toxicity-and",totalDownloads:162,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Food security is a major concern that requires sustained advancement both statistically and on the basis of Qualitative assessment. In recent years, antagonistic impacts of unforeseen toxins have impacted the quality of crops and have created a burden on human lives. Heavy metals (e.g., Hg, As, Pb, Cd, and Cr) can affect humans, adding to dreariness and in severe cases even death. It additionally investigates the conceivable geological routes of heavy metals in the surrounding subsystems. The top-to-the-bottom conversation is additionally offered on physiological/atomic movement systems engaged with the take-up of metallic foreign substances inside food crops. At long last, the board procedures are proposed to recapture maintainability in soil–food subsystems. This paper reflects the contamination of the food crops with heavy metals, the way of transport of heavy metal to food crops, degree of toxicity after consumption and the strategies to maintain the problem.",signatures:"Vanisree C.R., Mahipal Singh Sankhla, Prashant Singh, Ekta B. Jadhav, Rohit Kumar Verma, Kumud Kant Awasthi, Garima Awasthi and Varad Nagar",downloadPdfUrl:"/chapter/pdf-download/80088",previewPdfUrl:"/chapter/pdf-preview/80088",authors:[{id:"192924",title:"Dr.",name:"Garima",surname:"Awasthi",slug:"garima-awasthi",fullName:"Garima Awasthi"},{id:"317319",title:"Mr.",name:"Mahipal Singh",surname:"Sankhla",slug:"mahipal-singh-sankhla",fullName:"Mahipal Singh Sankhla"},{id:"444060",title:"Ms.",name:"Vanisree",surname:"C. R.",slug:"vanisree-c.-r.",fullName:"Vanisree C. R."},{id:"444884",title:"Mr.",name:"Prashant",surname:"Singh",slug:"prashant-singh",fullName:"Prashant Singh"},{id:"447006",title:"Dr.",name:"Kumud Kant",surname:"Awasthi",slug:"kumud-kant-awasthi",fullName:"Kumud Kant Awasthi"},{id:"447007",title:"Ms.",name:"Ekta B.",surname:"Jadhav",slug:"ekta-b.-jadhav",fullName:"Ekta B. Jadhav"},{id:"447009",title:"Mr.",name:"Varad",surname:"Nagar",slug:"varad-nagar",fullName:"Varad Nagar"},{id:"447010",title:"Mr.",name:"Rohit Kumar",surname:"Verma",slug:"rohit-kumar-verma",fullName:"Rohit Kumar Verma"}],corrections:null},{id:"79951",title:"Soil-Skeleton and Soil-Water Heavy Metal Contamination by Finite Element Modelling with Freundlich Isotherm Adsorption Parameters",doi:"10.5772/intechopen.101828",slug:"soil-skeleton-and-soil-water-heavy-metal-contamination-by-finite-element-modelling-with-freundlich-i",totalDownloads:90,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"World research results indicate that untreated leachate contains high contents of heavy metals (HM) that are likely to pollute the soil and groundwater (GW) environment and contribute to the increase of HMs in soil and GW. The Freundlich isotherm adsorption parameters are essential to soil input parameters for modelling of HMs’ transport to access the soil skeleton and soil pore water contamination by HMs. Finite element (FE) modelling of advection-dispersion transport of HMs by GW movement along with Freundlich isotherm adsorption parameters which continuously change with space in the model domain and with time is sophisticated to accurately evaluate the HMs’ concentrations in soil skeleton and pore water. The chapter describes the background of the existing isotherm adsorption theory, the adaptation of the Freundlich isotherm adsorption in the soil skeleton and soil pore water contamination by HMs, method of determination of the Freundlich isotherm adsorption parameters, the FE procedure of modelling of advection-dispersion transport of HMs by GW movement in general and along with Freundlich isotherm adsorption parameters in particular. A case study modelling has been demonstrated.",signatures:"Nguyen Van Hoang",downloadPdfUrl:"/chapter/pdf-download/79951",previewPdfUrl:"/chapter/pdf-preview/79951",authors:[{id:"439161",title:"Associate Prof.",name:"Hoang",surname:"Nguyen Van",slug:"hoang-nguyen-van",fullName:"Hoang Nguyen Van"}],corrections:null},{id:"80722",title:"Microwave Vitrification of Hazardous Sludge by Şırnak Asphaltite Slime, Shale and Sewage Sludge – Landfill Management by Vitrified Char Sand",doi:"10.5772/intechopen.101888",slug:"microwave-vitrification-of-hazardous-sludge-by-rnak-asphaltite-slime-shale-and-sewage-sludge-landfil",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Mazıdağı Etibakır Cu ore leaching waste stockpiles, land soil and groundwater in the field should be controlled for seepages to avoid the acidic flow of solute containing the heavy metals of Pb, Cu and Zn. The heavy metal-associated liquor from Electrowinning Plant and Sulphuric acid Dissolution units threats the neighborhood in the town. Cu and Co are recovered by electrolysis and acidic solutions of Cu leaching are spent. According to this concern of waste management, a method commonly used, “vitrification of sludge,” among others such as special cementing or bituminous pasting may be used in the waste disposal and even ground stabilization. However, mixing that with glassy powder and further vitrification furnace heating yield a vitrified form of waste sludge, covered by glazed matter avoiding contact with water in the landfill. In this study, sodium silicate is used as a binder in the vitrification mixture with the sludge at 14% water under microwave radiation. The dissolved contents of Pb Zn and Fe in the yielded vitrified briquette are determined. Additionally, the strength of vitrified briquettes is investigated in terms of vitrification parameters of microwave radiation.",signatures:"Yildırım İsmail Tosun",downloadPdfUrl:"/chapter/pdf-download/80722",previewPdfUrl:"/chapter/pdf-preview/80722",authors:[{id:"200229",title:"Dr.",name:"Yıldırım",surname:"İsmail Tosun",slug:"yildirim-ismail-tosun",fullName:"Yıldırım İsmail Tosun"}],corrections:null},{id:"80103",title:"Heavy Metals in Cosmetics",doi:"10.5772/intechopen.102406",slug:"heavy-metals-in-cosmetics",totalDownloads:212,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"This review provides a comprehensive insight into the content of five heavy metals found in cosmetics and their effects at the site of application and on several organs via the dermal route of administration. Regulation of these products is very limited with little information on limits of these metals at the disposition of manufacturers. Lead and arsenic are considered to be contaminants in cosmetics whereas cadmium may be present as a coloring agent besides being a contaminant. Nickel is notorious for its association with allergic chronic dermatitis. Though mercury is rarely present in cosmetics, it has been found in significant quantities in skin lightening creams. A multi-variate meta-analysis was conducted to determine the relationships between the five metals and any possible differences between the sixteen categories of formulations used for facial and body skin care and cosmetic purposes. In general, lipsticks, eye shadows, face paints, make-up foundation and skin lightening creams exhibited a high amount of heavy metals superior to the levels of these metals in other facial and body products. The outcome of this analysis urges regulators and manufacturers to consider routine monitoring for the presence of these metals in cosmetics.",signatures:"Tamara Attard and Everaldo Attard",downloadPdfUrl:"/chapter/pdf-download/80103",previewPdfUrl:"/chapter/pdf-preview/80103",authors:[{id:"81688",title:"Prof.",name:"Everaldo",surname:"Attard",slug:"everaldo-attard",fullName:"Everaldo Attard"},{id:"443284",title:"Ms.",name:"Tamara",surname:"Attard",slug:"tamara-attard",fullName:"Tamara Attard"}],corrections:null},{id:"81354",title:"Concentration Levels of Heavy Metals and Selected Ions in the Irrigation Water: The Case of Little Akaki River, Addis Ababa, Ethiopia",doi:"10.5772/intechopen.103677",slug:"concentration-levels-of-heavy-metals-and-selected-ions-in-the-irrigation-water-the-case-of-little-ak",totalDownloads:59,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Irrigable water resources have been challenged by the contamination of heavy metals and unwanted ions that impair plant growth and human health. It impaired the quality of edible fruit & vegetables. The objective of this study was to determine the concentration of heavy metals (Pb, Cd, Cr, and Cu) and selected ions (chloride, Na, Mg, Ca), and to evaluate its suitability for irrigation use. Water samples were collected from three various locations (the upstream, middle stream, and downstream) of the river. Temperature (T), EC, pH, and total dissolved solids (TDS) were tested onsite using handheld multiparameter testing equipment, while the heavy metals (Pb, Cd, Cr, and Cu) and selected ions (Chloride, Na, Mg, and Ca) of the water sample were analyzed using (ICP-OES). ANOVA test was conducted to examine the concentration variations of heavy metals and selected ions between the sampling locations along the river. The concentrations of (Pb and Cd) were found (2.5–3.9), (0.03–0.4) mg/L respectively, and (Cr and Cu) were below the detectible limit of the (ICP-OES) equipment. Cadmium (Cd) was found to be higher than the permissible limit of FAO (0.01mg/L) for irrigation water. There was no significant variation of heavy metals and selected ions between the sampling locations.",signatures:"Mekonnen M. Tarekegn and Getaneh L. Weldekidan",downloadPdfUrl:"/chapter/pdf-download/81354",previewPdfUrl:"/chapter/pdf-preview/81354",authors:[{id:"243172",title:"Ph.D. Student",name:"Mekonnen M.",surname:"Tarekegn",slug:"mekonnen-m.-tarekegn",fullName:"Mekonnen M. Tarekegn"},{id:"452070",title:"Mr.",name:"Getaneh L.",surname:"Weldekidan",slug:"getaneh-l.-weldekidan",fullName:"Getaneh L. Weldekidan"}],corrections:null},{id:"80534",title:"Toxicants in Water: Hydrochemical Appraisal of Toxic Metals Concentration and Seasonal Variation in Drinking Water Quality in Oil and Gas Field Area of Rivers State, Nigeria",doi:"10.5772/intechopen.102656",slug:"toxicants-in-water-hydrochemical-appraisal-of-toxic-metals-concentration-and-seasonal-variation-in-d",totalDownloads:72,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Groundwater pollution is a major issue in many tropical countries. Governments at all levels are doing little or nothing to supply inhabitants with clean and accessible water, particularly in Nigeria’s Niger Delta region. This study compares differences in water quality parameters in the study area (determine the level of pollutions in the different sites). The investigation made use of standard analytical methodologies. All sampling, conservation, transportation as well as analysis followed the usual APHA procedures (2012). To prevent degradation of the organic substances, all obtained samples were transferred to the laboratory, while keeping in an icebox. Result shows that during wet season, the mean values obtained for water quality parameters were significantly lower in site 9 compared with that obtained in other sites (p < 0.05) with the exemptions of temperature, DO, BOD, COD, acidity, TH, TDS, K, Mg, Zn, Mn, Cd, Pb, Cu, Cr, NH3, NO2, NO3, Ni though slightly lower in most cases in site 9 were not significantly different (p > 0.05) and both alkalinity and SO4 which were significantly higher in site 9 than site 1 (p < 0.05). Result obtained during dry season reveals that there is no remarkable difference in pH, acidity, Pb and Ni between the nine sites (p > 0.05) while other water quality parameters were significantly lower in site 9 than other sites excluding Cl and Mg which were both significantly higher in site 9 than site 8 (p < 0.05). Extra efforts must be made to completely understand the hydrogeochemical properties and appropriateness of groundwater in Nigeria’s core Niger Delta region in order to ensure quality groundwater supply for varied applications. As a result, this research will contribute to the establishment of a quantitative understanding of the effects of many causes on groundwater level changes in every aquifer worldwide. This analysis also reinforces a useful resource for scholars, activists, and public officials looking to improve community awareness, planning, and performance. The verdicts will serve as a valuable guideline for policymakers, the Ministry of Water Resources, and development practitioners, as they highlight the need for appropriate approaches to mitigating toxic elements of water resource contamination in the core Niger Delta in order to protect public health from carcinogenic and non-carcinogenic risks.",signatures:"Morufu Olalekan Raimi, Henry Olawale Sawyerr, Ifeanyichukwu Clinton Ezekwe and Salako Gabriel",downloadPdfUrl:"/chapter/pdf-download/80534",previewPdfUrl:"/chapter/pdf-preview/80534",authors:[{id:"338653",title:"Dr.",name:"Morufu",surname:"Olalekan Raimi",slug:"morufu-olalekan-raimi",fullName:"Morufu Olalekan Raimi"},{id:"447559",title:"Dr.",name:"Henry Olawale",surname:"Sawyerr",slug:"henry-olawale-sawyerr",fullName:"Henry Olawale Sawyerr"},{id:"447560",title:"Dr.",name:"Ifeanyichukwu Clinton",surname:"Ezekwe",slug:"ifeanyichukwu-clinton-ezekwe",fullName:"Ifeanyichukwu Clinton Ezekwe"},{id:"447561",title:"Dr.",name:"Salako",surname:"Gabriel",slug:"salako-gabriel",fullName:"Salako Gabriel"}],corrections:null},{id:"80837",title:"Effect of Mining on Heavy Metals Toxicity and Health Risk in Selected Rivers of Ghana",doi:"10.5772/intechopen.102093",slug:"effect-of-mining-on-heavy-metals-toxicity-and-health-risk-in-selected-rivers-of-ghana",totalDownloads:13,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Heavy metal contamination of selected rivers in the mining areas of Ghana was studied. In the study, 44 composite water samples were collected, digested, and analyzed for selected metals using ICP-MS. The average concentrations (mg/L) of heavy metals from the pristine sites ranged from 0.003 (As) to 0.929 (Fe), and the mining sites ranged from 0.002 (Pb) to 20.355 (Fe). Generally, the metals were within the WHO and USEPA acceptable limits except Al, Fe, As, Cr, and Mn. Hazard quotients for ingestion (HQing) and dermal contact from pristine and mining sites ranged from 0.838 (Cr) to 3.00 × 10−4 (Cu) and from 0.181 (As) to 2.40 × 10−6 (Cu), respectively. The carcinogenic risks (CRs) for ingestion were within standard limit (10−6 to 10−4). However, Arsenic showed high CRing above the acceptable limit (1.83 × 10−2). The CRs for dermal contact range from 4.22 x 10−8 to 1.44 x 10−9 (Cr) and from 7.34 x 10−8 to 5.65 x 10−9 (Pb). Carcinogenic risk values for As in the mining areas raise carcinogenic concerns for the residents in the studied areas. PROMETHEE and GAIA indicate major contribution of the metals from the mining. Multivariate PCA and cluster analysis suggest anthropogenic activities as the major source of the metal toxicity of the mine rivers.",signatures:"George Yaw Hadzi",downloadPdfUrl:"/chapter/pdf-download/80837",previewPdfUrl:"/chapter/pdf-preview/80837",authors:[{id:"438819",title:"Ph.D.",name:"George",surname:"Hadzi",slug:"george-hadzi",fullName:"George Hadzi"}],corrections:null},{id:"80885",title:"Distribution of Potentially Toxic Elements in Water, Sediment and Soils in the Riparian Zones around a Kraft Pulp and Paper Mill in Western Kenya",doi:"10.5772/intechopen.102440",slug:"distribution-of-potentially-toxic-elements-in-water-sediment-and-soils-in-the-riparian-zones-around-",totalDownloads:47,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter discusses the impact of effluent discharge on the distribution of potentially toxic elements (Pb, Cd, Cu and Zn) in water, sediments and soils near a Kraft mill in Western Kenya. Potentially Toxic Elements (PTEs) concentrations were determined at three sites: Water Intake Point, Effluent Discharge Point and Downstream Point. The mill liquid effluent parameters and gaseous emissions were also characterized. One-way ANOVA was used to analyze the spatial differences in PTEs concentrations. Principal component analysis determined the correlations between the proximity to the Kraft mill and the PTEs in soils, water and sediments. In riverine soils, Cd was 0.78 ± 0.01 mg/kg, while Pb was 94.38 ± 9.65 mg/kg. In sediments, the concentration was 16.81 ± 2.46 mg/kg for Zn, 6.16 ± 0.72 mg/kg for Cd and 75.28 ± 5.97 mg/kg for Pb. In water, Zn was 0.26 ± 0.038 mg/L, Cu was 0.75 ± 0.11 mg/L, Cd was 0.05 ± 0.004 mg/L and Pb was 1.26 ± 9.65 mg/L. The spatial distributions of PTEs in soils near the factory and across the river may have resulted from the factory’s effluent discharge and gaseous emissions. These findings should help formulate more stringent industrial effluent management programs in Western Kenya.",signatures:"Elijah S. Omutange, Julius O. Manyala, Anne N. Wekesa, Odipo Osano, Thomas Munyao, Alfred A. Otieno and Lazare Etiégni",downloadPdfUrl:"/chapter/pdf-download/80885",previewPdfUrl:"/chapter/pdf-preview/80885",authors:[{id:"93186",title:"Prof.",name:"Lazare",surname:"Etiégni",slug:"lazare-etiegni",fullName:"Lazare Etiégni"},{id:"442779",title:"Dr.",name:"Elijah",surname:"S. Omutange",slug:"elijah-s.-omutange",fullName:"Elijah S. Omutange"},{id:"449678",title:"Prof.",name:"Julius",surname:"O. Manyala",slug:"julius-o.-manyala",fullName:"Julius O. Manyala"},{id:"449679",title:"Ms.",name:"Anne",surname:"N. Wekesa",slug:"anne-n.-wekesa",fullName:"Anne N. Wekesa"},{id:"449681",title:"Prof.",name:"Odipo",surname:"Osano",slug:"odipo-osano",fullName:"Odipo Osano"},{id:"449682",title:"Dr.",name:"Thomas",surname:"Munyao",slug:"thomas-munyao",fullName:"Thomas Munyao"},{id:"449683",title:"Mr.",name:"Alfred",surname:"A. Otieno",slug:"alfred-a.-otieno",fullName:"Alfred A. Otieno"}],corrections:null},{id:"81825",title:"Quantification of Heavy Metal Levels in Sediments of the “Palizada” River in a Protected Natural Area of Southeastern Mexico",doi:"10.5772/intechopen.104657",slug:"quantification-of-heavy-metal-levels-in-sediments-of-the-palizada-river-in-a-protected-natural-area-",totalDownloads:18,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter shows the results of the determination of the levels of Copper (Cu), Iron (Fe), Magnesium (Mg), Manganese (Mn), and Cadmium (Cd) in sediments of the “Palizada River”; evaluated by atomic absorption. The results show high levels of Fe, Mg, and Mn concerning previous studies and are directly related to agricultural and livestock activities in the area. The metal-metal correlation analysis show significant values, suggesting that the generation source is the same. Some of the pollutants produced by industrial or population centers; end up in natural water bodies; by different physical processes, such as precipitation, complex formation, and others. These contaminants can bioaccumulate in aquatic organisms and reach humans through the food chain. Certain heavy metals such as cadmium (Cd) produced by human activities have been found in the oceans and the tissues of different organisms; which constitutes a risk for consumption; Cd is classified as an element that predisposes to the presence of Cancer. Therefore, the study of sediments is fundamental for determining the degree of contamination of an ecosystem.",signatures:"Carlos Montalvo, Claudia A. Aguilar, Yunuen Canedo, Alejandro Ruiz, Brenda Zermeño, Ruby S. Gines and Rosa M. Cerón",downloadPdfUrl:"/chapter/pdf-download/81825",previewPdfUrl:"/chapter/pdf-preview/81825",authors:[{id:"92446",title:"Dr.",name:"Rosa M.",surname:"Cerón",slug:"rosa-m.-ceron",fullName:"Rosa M. Cerón"},{id:"194857",title:"Dr.",name:"Alejandro",surname:"Ruiz",slug:"alejandro-ruiz",fullName:"Alejandro Ruiz"},{id:"194858",title:"Dr.",name:"Yunuen",surname:"Canedo",slug:"yunuen-canedo",fullName:"Yunuen Canedo"},{id:"200465",title:"Dr.",name:"Carlos",surname:"Montalvo",slug:"carlos-montalvo",fullName:"Carlos Montalvo"},{id:"327934",title:"Dr.",name:"Claudia A.",surname:"Aguilar",slug:"claudia-a.-aguilar",fullName:"Claudia A. Aguilar"},{id:"458393",title:"Dr.",name:"Brenda",surname:"Zermeño",slug:"brenda-zermeno",fullName:"Brenda Zermeño"},{id:"458394",title:"Dr.",name:"Ruby S.",surname:"Gines",slug:"ruby-s.-gines",fullName:"Ruby S. Gines"}],corrections:null},{id:"80277",title:"Leaching Technology for Precious Heavy Metal Recapture through (HCI + HNO3) and (HCI + H2SO4) from E-Waste",doi:"10.5772/intechopen.102347",slug:"leaching-technology-for-precious-heavy-metal-recapture-through-hci-hno-sub-3-sub-and-hci-h-sub-2-sub",totalDownloads:83,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The rapid growth of information technology and industrialization are the key components for the development of electronic equipment, and their inevitable role in human day-to-day life has an important stint in the generation of electronic waste (e-waste). This waste has far-reaching environmental and health consequences. One such e-waste printed circuit board (PCB) contains significant amounts of valuable heavy metals such as copper (Cu), lead (Pb), zinc (Zn), nickel (Ni), and others that can be extracted through various metallurgical routes. Recovery and recycle of heavy metal ions is a major challenge to prevent environmental contamination. The present study discusses the current e-waste scenario, health impacts and treatment methods in detail, and also presents experimental results of recovery of heavy metals from printed circuit boards (PCBs) by leaching using aqua regia (HCI + HNO3 and HCI + H2SO4). Under varying conditions such as specified conditions of 80°C, 0.05 mm of thickness, 3 hrs of contacttime, 80rpm shaking speed, and concentration of PCB sample of 0.5 g ml−1, it results in the composition of extracted heavy metal ions in such a way that 97.59% of copper, 96.59% of lead, 94.66% of tin, and 96.64% of zinc, respectively. The recovery of heavy metal ions from PCBs has an important leading contribution in electronic waste management and the result shows a higher rate.",signatures:"Murugesan Manikkampatti Palanisamy, Akilamudhan Palaniappan, VenkataRatnam Myneni, Padmapriya Veerappan and Minar Mohamed Lebba",downloadPdfUrl:"/chapter/pdf-download/80277",previewPdfUrl:"/chapter/pdf-preview/80277",authors:[{id:"439165",title:"Dr.",name:"Murugesan Manikkampatti",surname:"Palanisamy",slug:"murugesan-manikkampatti-palanisamy",fullName:"Murugesan Manikkampatti Palanisamy"},{id:"480935",title:"Dr.",name:"Akilamudhan",surname:"Palaniappan",slug:"akilamudhan-palaniappan",fullName:"Akilamudhan Palaniappan"},{id:"480936",title:"Dr.",name:"VenkataRatnam",surname:"Myneni",slug:"venkataratnam-myneni",fullName:"VenkataRatnam Myneni"},{id:"480937",title:"Dr.",name:"Padmapriya",surname:"Veerappan",slug:"padmapriya-veerappan",fullName:"Padmapriya Veerappan"},{id:"480938",title:"Dr.",name:"Minar",surname:"Mohamed Lebba",slug:"minar-mohamed-lebba",fullName:"Minar Mohamed Lebba"}],corrections:null},{id:"80488",title:"Phytoextraction of Zn(II) and Cu(II) by Canna indica: Related Physiological Effects",doi:"10.5772/intechopen.102450",slug:"phytoextraction-of-zn-ii-and-cu-ii-by-em-canna-indica-em-related-physiological-effects",totalDownloads:60,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Phytoremediation is a technique for treatment areas with medium or low heavy metals concentrations. A pot experiment was carried out to determine the usefulness of Canna indica L. as phytoremediator species. The plants were treated with three increasing Zn(II) and Cu(II) solutions. 21 days later, dry weight, relative membrane conductivity, chlorophyll, carotene, malondialdehyde, soluble proteins, proline, and Zn(II) and Cu(II) contents were measured. Zn(II) and Cu (II) treatments caused a decline in the dry weight, chlorophyll, carotene, and soluble proteins content, whereas the relative conductivity, malondialdehyde, and proline content showed the opposite pattern. The bioaccumulation reached values approximately 48 and 15 times higher (5293 mg kg−1 and 1425 mg kg−1), compared with the control, for Zn(II) and Cu(II), respectively. Our results suggest that this species can be used for the phytoremediation of polluted soils with moderate concentrations of Zn(II) and Cu(II).",signatures:"Josefina Plaza Cazón, Matías Gonzalez and Marcela Ruscitti",downloadPdfUrl:"/chapter/pdf-download/80488",previewPdfUrl:"/chapter/pdf-preview/80488",authors:[{id:"441934",title:"Dr.",name:"Josefina",surname:"Plaza Cazón",slug:"josefina-plaza-cazon",fullName:"Josefina Plaza Cazón"},{id:"441935",title:"MSc.",name:"Matias",surname:"Gonzalez",slug:"matias-gonzalez",fullName:"Matias Gonzalez"},{id:"441937",title:"Dr.",name:"Marcela",surname:"Ruscitti",slug:"marcela-ruscitti",fullName:"Marcela Ruscitti"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6534",title:"Heavy Metals",subtitle:null,isOpenForSubmission:!1,hash:"a7573426a162c18f39acc575c1e69f67",slug:"heavy-metals",bookSignature:"Hosam El-Din M. Saleh and Refaat F. Aglan",coverURL:"https://cdn.intechopen.com/books/images_new/6534.jpg",editedByType:"Edited by",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2383",title:"Polyester",subtitle:null,isOpenForSubmission:!1,hash:"79fd9d6314f8e1abd60d7e21896ce878",slug:"polyester",bookSignature:"Hosam El-Din M. Saleh",coverURL:"https://cdn.intechopen.com/books/images_new/2383.jpg",editedByType:"Edited by",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. 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Abdel Rahman",coverURL:"https://cdn.intechopen.com/books/images_new/6513.jpg",editedByType:"Edited by",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7640",title:"Perspective of Carbon Nanotubes",subtitle:null,isOpenForSubmission:!1,hash:"8b85a9957fad5206369eadf0c1ffa27d",slug:"perspective-of-carbon-nanotubes",bookSignature:"Hosam El-Din Saleh and Said Moawad Mohamed El-Sheikh",coverURL:"https://cdn.intechopen.com/books/images_new/7640.jpg",editedByType:"Edited by",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. 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Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6847",title:"Characterizations of Some Composite Materials",subtitle:null,isOpenForSubmission:!1,hash:"f0869b3bb91cf9acb7e69004b1bd17ec",slug:"characterizations-of-some-composite-materials",bookSignature:"Hosam El-Din M. Saleh and Martin Koller",coverURL:"https://cdn.intechopen.com/books/images_new/6847.jpg",editedByType:"Edited by",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9873",title:"Strategies of Sustainable Solid Waste Management",subtitle:null,isOpenForSubmission:!1,hash:"59b5ceeeedaf7449a30629923569388c",slug:"strategies-of-sustainable-solid-waste-management",bookSignature:"Hosam M. Saleh",coverURL:"https://cdn.intechopen.com/books/images_new/9873.jpg",editedByType:"Edited by",editors:[{id:"144691",title:"Prof.",name:"Hosam M.",surname:"Saleh",slug:"hosam-m.-saleh",fullName:"Hosam M. Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],ofsBooks:[]},correction:{item:{id:"79356",slug:"corrigendum-to-hypoxia-angiogenesis-and-atherogenesis",title:"Corrigendum to: Hypoxia, Angiogenesis and Atherogenesis",doi:null,correctionPDFUrl:"https://cdn.intechopen.com/pdfs/79243.pdf\r\n",downloadPdfUrl:"/chapter/pdf-download/79243",previewPdfUrl:"/chapter/pdf-preview/79243",totalDownloads:null,totalCrossrefCites:null,bibtexUrl:"/chapter/bibtex/79243",risUrl:"/chapter/ris/79243",chapter:{id:"53523",slug:"hypoxia-angiogenesis-and-atherogenesis",signatures:"Lamia Heikal and Gordon Ferns",dateSubmitted:"September 6th 2016",dateReviewed:"November 3rd 2016",datePrePublished:null,datePublished:"April 5th 2017",book:{id:"5682",title:"Physiologic and Pathologic Angiogenesis",subtitle:"Signaling Mechanisms and Targeted Therapy",fullTitle:"Physiologic and Pathologic Angiogenesis - Signaling Mechanisms and Targeted Therapy",slug:"physiologic-and-pathologic-angiogenesis-signaling-mechanisms-and-targeted-therapy",publishedDate:"April 5th 2017",bookSignature:"Dan Simionescu and Agneta Simionescu",coverURL:"https://cdn.intechopen.com/books/images_new/5682.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"66196",title:"Dr.",name:"Dan",middleName:"T.",surname:"Simionescu",slug:"dan-simionescu",fullName:"Dan Simionescu"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"195461",title:"Dr.",name:"Lamia",middleName:null,surname:"Heikal",fullName:"Lamia Heikal",slug:"lamia-heikal",email:"l.heikal@bsms.ac.uk",position:null,institution:{name:"Brighton and Sussex Medical School",institutionURL:null,country:{name:"United Kingdom"}}},{id:"199995",title:"Prof.",name:"Gordon",middleName:null,surname:"Ferns",fullName:"Gordon Ferns",slug:"gordon-ferns",email:"g.ferns@bsms.ac.uk",position:null,institution:{name:"University of Sussex",institutionURL:null,country:{name:"United Kingdom"}}}]}},chapter:{id:"53523",slug:"hypoxia-angiogenesis-and-atherogenesis",signatures:"Lamia Heikal and Gordon Ferns",dateSubmitted:"September 6th 2016",dateReviewed:"November 3rd 2016",datePrePublished:null,datePublished:"April 5th 2017",book:{id:"5682",title:"Physiologic and Pathologic Angiogenesis",subtitle:"Signaling Mechanisms and Targeted Therapy",fullTitle:"Physiologic and Pathologic Angiogenesis - Signaling Mechanisms and Targeted Therapy",slug:"physiologic-and-pathologic-angiogenesis-signaling-mechanisms-and-targeted-therapy",publishedDate:"April 5th 2017",bookSignature:"Dan Simionescu and Agneta Simionescu",coverURL:"https://cdn.intechopen.com/books/images_new/5682.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"66196",title:"Dr.",name:"Dan",middleName:"T.",surname:"Simionescu",slug:"dan-simionescu",fullName:"Dan Simionescu"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"195461",title:"Dr.",name:"Lamia",middleName:null,surname:"Heikal",fullName:"Lamia Heikal",slug:"lamia-heikal",email:"l.heikal@bsms.ac.uk",position:null,institution:{name:"Brighton and Sussex Medical School",institutionURL:null,country:{name:"United Kingdom"}}},{id:"199995",title:"Prof.",name:"Gordon",middleName:null,surname:"Ferns",fullName:"Gordon Ferns",slug:"gordon-ferns",email:"g.ferns@bsms.ac.uk",position:null,institution:{name:"University of Sussex",institutionURL:null,country:{name:"United Kingdom"}}}]},book:{id:"5682",title:"Physiologic and Pathologic Angiogenesis",subtitle:"Signaling Mechanisms and Targeted Therapy",fullTitle:"Physiologic and Pathologic Angiogenesis - Signaling Mechanisms and Targeted Therapy",slug:"physiologic-and-pathologic-angiogenesis-signaling-mechanisms-and-targeted-therapy",publishedDate:"April 5th 2017",bookSignature:"Dan Simionescu and Agneta Simionescu",coverURL:"https://cdn.intechopen.com/books/images_new/5682.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"66196",title:"Dr.",name:"Dan",middleName:"T.",surname:"Simionescu",slug:"dan-simionescu",fullName:"Dan Simionescu"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"1847",leadTitle:null,title:"Theoretical and Methodological Approaches to Social Sciences and Knowledge Management",subtitle:null,reviewType:"peer-reviewed",abstract:"This is a unique and groundbreaking collection of questions and answers coming from higher education institutions on diverse fields and across a wide spectrum of countries and cultures. It creates routes for further innovation, collaboration amidst the Sciences (both Natural and Social), the Humanities, and the private and public sectors of society. 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Intravertebral haematomas may occur in the epidural or subdural space. Generally speaking all intravertebral haematomas are also referred as "spinal haematomas". It is an infrequently described complication of neuroaxial anaesthesia techniques. It has been described in the literature in patients with a deranged coagulation profile in the form of systemic diseases (e.g. chronic renal failure, liver failure) or anticoagulant therapy. In this chapter we will discuss spinal haematomas as a devastating complication of the neuroaxial anaesthesia techniques.
Spinal haematoma is the accumulation of blood in the potential space between the dura and bone. It can be a complication of neuroaxial anaesthesia techniques, especially in those patients with a deranged coagulation profile due to systemic diseases (e.g. hepatic diseases, renal failure) or anticoagulant therapy. It is more common in the patients treated with anticoagulants, thrombocytopenia, or in patients with alcoholic liver disease.
Advanced liver disease, with associated portal hypertension and hypersplenism, thrombocytopenia, platelet dysfunction, reduced production of clotting factors, increased clotting factor consumption, and increased fibrinolysis may also increase the risk of bleeding. Before neuroaxial anaesthesia is planned, it is very important to detect liver diseases. The laboratory tests needed are; haemoglobin, PT, aPTT, INR, platelet count, platelet function analysis, and fibrinogen level. Dunn et al. reported that in a case with renal disease also causes haemostatic defects due to defects in platelets, subendothelial metabolism, and platelet vessel interactions. The metabolism of antiplatelet drugs and low-molecular-weight heparins is also reduced during kidney failure. Coagulation profile tests; bleeding time, PT, PTT, must be performed in all patients with renal failure. Grejda and colleagues reported a case with clotting abnormalities, apparently due to chronic renal failure, who developed paraplegia after spinal anaesthesia secondary to spinal hematoma formation [1, 2].
Malnutrition, fat malabsorption, antibiotic usage, and liver disease may be cause for vitamin k deficiency. Vitamin k deficit leads to a reduction of microsomal carboxylase, a liver enzyme dependent on vitamin k activity, which induce lack of converting factors II, VII, IX, and X into their functionally active forms and consequently, a bleeding diathesis. The clinical findings in these patients are melena, hematuria, ecchymoses and haematomas. In the patient at-risk of bleeding it is recommended to give vitamin k supplements hours prior to a procedure [3].
Other considered factors favouring the formation of a spinal haematoma include: trauma, thrombolysis, lumbar puncture, disc herniation and the vertebral procedures, epidural or spinal anaesthesia, coagulopathy or bleeding diathesis, hepatic disease with portal hypertension, and vascular malformations. Less common causes include systemic lupus erythematosus, ankylosing spondylitis, rheumatoid arthritis, Paget\'s disease in vertebral bones, Valsalva manoeuvre and hypertension. In 40 to 50% of spinal haematomas there was not an apparent underlying cause [4].
The haemorrhage into the spinal canal frequently occurs in the epidural space due to epidural venous plexus rupture (Baston venous plexus), however arterial haemorrhage may also occur [5, 6]. Nevertheless, the main source of bleeding (arterial or venous) is controversial. Spinal haematoma can be seen quickly with arterial bleeding and can lead to neural trauma and ischemia. However, when aetiology is the needle or the epidural catheter, the spinal haematoma may become symptomatic after a few days, so this situation suggests that the cause is not arterial bleeding. Therefore, spinal haematomas are mostly venous because there are no valves in the epidural venous plexus and the pressure in the epidural space is low. Venous plexus blood flow can be reversed with physical activity and the sudden increases in intra-abdominal and intrathoracic pressure (Valsalva manoeuvre). Epidural venous pressure elevation and hemodynamic changes in pregnancy can also cause rupture on the venous vessel walls. Venous bleeding accumulates slowly, but it can theoretically tamponade the epidural space before exceeding the spinal cord perfusion pressure. Thus, the whole clinical situation may not be clearly understood. The amount of blood causing cord ischemia is variable, and it depends on the speed of blood accumulation. Interestingly, most of the blood volume of the haematomas associated with low-molecular-weight heparin (LMWH) is less than the injected blood volume for epidural patch [7].
The region of spinal haematoma is often at cervical and thoracic vertebrae level, spreading throughout the thoracolumbar spine. Most of the spinal haematomas are seen at the dorsal dural sac, because it adheres to the posterior longitudinal ligament at the front of the spinal canal. Posterior or posterolateral thoracic or lumbar regions are often involved. Usually the haematoma is limited to a few vertebral level [4].
In the current literature, the incidence of spinal haematoma is about 1/150,000 epidural anaesthesia and 1/220,000 for spinal anaesthesia [7]. From 1906 to 1994, there were 61 spinal haematoma cases reported associated with epidural or spinal anaesthesia [5]. 87% of the patients had haemostatic abnormalities, traumatic or difficult needle insertion attempt, and in 33% of these cases had more than one risk factor. What is relevant is that only 38% of patients had partial or complete neurological recovery. A retrospective study from China reviewed medical records from 1954 to 2008 and found an incidence of 2.14/100.000 (95% confidence interval: 0.44-6.25/100.000) of spinal haematomas after neuraxial blockade. The presence of bacterial infection and the need of emergency surgery were found to increase the risk of epidural haematoma. In general, the risk of major bleeding were multifactorial and increased with age (and associated with abnormalities of the spinal cord or vertebral column), the presence of coagulopathy, anticoagulation (especially standard heparin or LMWH), traumatic needle or catheter insertion. There is a correlation between early decompression surgeries with a better neurological recovery. [8] If laminectomy is performed within 8 hours after the onset of neurological dysfunctions, spinal cord ischemia tends to be reversible [9]. Spinal haematomas are responsible for about half of all spinal cord injuries [10].
The true incidence of neurological dysfunction due to hemorrhagic complications associated with neuroaxial block is not known. Importantly, postoperative numbness or weakness are typically thought to be secondary to the injected local anaesthetic, therefore the diagnosis of cord ischemia may be delayed. On the other hand, patient proper care rarely have the standard level of treatment (1/13 cases), and health care costs are very high. It is impossible to identify the exact risk factors of spinal haematomas from case series. However, the incidence of large surveillance studies (including spinal haematoma) investigated the frequency of high-and low-risk groups are identified. An epidemiological study from Sweden for a 10 years period with 1,260,000 spinal and 450,000 epidural blocks was investigated for serious neurological complications [9]. There were 33 spinal haematoma cases, and from those 24 cases were women and 25 cases were associated with epidural technique. The risk is lower in young women (for epidural analgesia, 1/200,000) than older women (for knee arthroplasty, 1/3,600). Similarly, in women, the risk of spinal haematoma with a hip fracture surgery under spinal anaesthesia (1/22,000) is higher than all spinal anaesthesia (1/480,000) [7, 9].
Needle placement into the spinal or epidural space may damage an epidural vein or artery and causes spinal haematoma formation. Irritation of nerve roots in the epidural space results in acute back pain, and may also cause spinal compression. Impairing vibration, two point discrimination, and position sense are the first clinical findings because the posterior spinal columns are the first structure to be affected. If the cortical spinal motor tracts are compromised resulting from expanded haematoma, the patient becomes paraplegic. The last clinical findings are pain, temperature changes, and light touch alterations because the anterior lateral spinal thalamic tract is the last structure to be affected [11].
The patient is usually very disturbed, and has often severe, localized and constant low back pain. In addition, a radicular component mimicking disc herniation can be seen. Weakness, drowsiness, urinary or faecal incontinence may be accompanied. In most cases, pain starts spontaneously, but sometimes pain can be associated with minor symptoms such as defecation, lifting, coughing and sneezing. Spinal cord and nerve root dysfunction, depending on the level of the lesion develops quickly and rapidly progression to paraparesis or paraplegia. Low back pain increases with increasing intraspinal pressure manoeuvres that stretching along the spine such as cough, sneeze and percussion. Depending on the size and location of the spinal haematoma the physical findings includes unilateral or bilateral weakness, sensory loss with unilateral or bilateral radicular paresthesia, deep tendon reflexes in the form of various modifications and changes in the bladder and anal sphincter tone.
Lumbar epidural haematoma may mimic an acute disc herniation. Epidural haematoma due to neuroaxial anaesthesia or lumbar puncture may represent new or progressive postoperative neurological symptoms. A time delay in return of loss of sensory or motor (with or without back pain) function after spinal or epidural block, are pathognomonic signals of spinal haematoma, and until proven otherwise, treatment should be considered [4].
Spinal epidural haematoma is usually diagnosed based on the acute neurological deficits, a rapid loss of motor and sensorial function, paraplegia, quadriplegia, or autonomic dysfunction. Quite often patients have acute radiating pain, sensory nerve root or spinal cord compression and focal neurologic deficit. Postoperative epidural haematoma is usually seen in the first 24-48 hours after the neuraxial block. Back pain and lower limb weakness as well as sensory deficit should alert the clinician to the presence of a central compressing lesion. Early clinical signs of pain or focal neurologic deficit are found in the postoperative period. Any new or progressive neurological symptoms or bowel and bladder incontinence require rapid clinical evaluation and diagnostic studies. If a new or progressive neurologic deficit is observed during epidural analgesia infusion, this requires an immediate discontinuation. The epidural catheter is left in place, and no more local anaesthetics are injected because of an early warning signs may be masked by their injection. If an epidural infusion causes the neurological findings, the return of sensory and motor function should be noted when the local anaesthetic effect wear off. On the other hand, speedy radiographic imaging studies and a neurosurgical consultation should be carried out. If there is an acute neurological deficit with low back pain, nerve root and spinal cord compression. An urgent assessment should be made to distinguish situations that mimic spinal haematoma such as epidural abscess, spinal cord disease, neoplasia, and acute herniated disc. Also, new or progressive neurological manifestations includes muscular or ligamentous injury related to needle placement, postoperative surgical neuropraxia, prolonged or exaggerated neuroaxial block, anterior spinal artery syndrome, and pre-existing undiagnosed neurological disorder need to be discarded.
Complete blood counts including platelets should be done, and the presence of infection should be investigated. Prothrombin time, aPTT, and INR are very useful to study bleeding diathesis
Urgent radiographic diagnostic studies are essential to avoid delay in surgical treatment of spinal haematomas. Magnetic resonance imaging (MRI) is the preferred method due to the rapid and non-invasive technique. MRI can detect presence of the spinal haematoma and location of associated vascular malformation; define the degree of compression of the cord. Also, the age of the haematoma can be diagnosed by MRI. Chronological MRI characteristics of spinal haematoma are similar to intracranial haemorrhage. In hyper acute period (first 6 hours), presence of spinal haematoma is seen isointense in T1-weighted images and mildly hyperintense and heterogeneity in T2-weighted images. In acute period (7-72 hours) hematoma is still isointense on T1-weighted images and begin to hypointense on T2-weighted images. This depends on intracellular deoxyhemoglobine and T2 becomes shorter. With the increase in the concentration of metahemoglobin, haematoma T1 and T2 hyperintense also starts to become homogeneous [4]. (Figure 1).
Sagital T1 MRI showing an epidural haematoma (h) due to an epidural block in an anticoagulated patient. Courtesy of www.anestesia-dolor.org
Epidural haematoma may be diagnosed by conventional CT, but if the thecal sac or spinal cord haematoma is isodense and if the upper thoracic region image quality is affected by artefacts the result may falsely negative. Also, CT may not be diagnostic for thoracic spinal level because the resolution is high contrast between the vertebral bone area and lung parenchyma.
Conventional angiography may be required to demonstrate a vascular malformation. Myelography and CT were used in the diagnosis of epidural hematomas, but they are not specific, invasive, and can worsen the clinical condition [4].
Neuraxial anaesthesia should be avoided in patients who are receiving anticoagulants drugs, patients suspected of bleeding diathesis, thrombolysis or after recent lumbar puncture. Anaesthesiologists should be constantly up to date regarding information on anticoagulation protocols, new anticoagulant medications and the guidelines for regional anaesthesia in this clinical scenario. Antithrombotic therapy in patients receiving neuroaxial block and/or catheter removal needs special timing for the procedure. It should be based on patient regional anaesthesia benefit ratio versus risk of spinal haematoma.
Although some case reports mention that patients with epidural haematoma had been treated successfully with conservative methods, the treatment protocol should be decompressive surgery [12, 13]. Successful non operative treatment has been reported mainly at the level of the cauda equina and in patients with mild neurological symptoms. Most reports of spinal haematomas with neurologic symptoms improved when they were treated with immediate laminectomy; however, the decision of surgery belongs to the neurosurgeon. The most important factors for neurological recovery after a spinal haematoma are preoperative neurological deficit and operative interval. Neurological outcome is related to the time between clinical symptoms and surgical decompression. Early recognition is needed. The clinical symptoms are back pain (radicular), bladder dysfunction and sensory and, more often, motor deficits. These symptoms should initiate immediate further diagnostic efforts. Magnetic resonance imaging is the most appropriate tool. If transport of the patient to a hospital with MRI would prolong the start of surgical therapy considerably, other diagnostic means such as myelography or computed tomography should be considered. Immediate surgical decompression in the case of epidural haematoma is the best way to achieve neurological restitution. Most of the patients with good recovery had less than eight hours delay from the onset of symptoms to surgery [14].
If surgery is delayed, prognosis is poor [15]. For a full neurologic recovery the time interval between the onset of paralysis and surgery should not be more than 8 hours. Neurological improvement without surgery is rare, and consultation for decompression surgery should not be delayed. Overall mortality is 8%. Functional recovery is associated with the duration of symptoms, and the healing is seldom after 72 hours after symptoms have begun [16]. The prognosis for neurological recovery and neurological dysfunction primary depends on the duration of the patient\'s preoperative neurological status. Improvement is due to early diagnosis, hence neurological and neurosurgical consultation should be done as soon as possible. Neurological complications of spinal haematoma include paraplegia, spasticity, neuropathic pain, and urinary and anal sphincter dysfunction.
The clinician performing neuroaxial anaesthesia must be aware of the potential bleeding complication of these procedures. Most cases of spinal haematomas associated with neuroaxial anaesthesia (epidural/spinal) are related to thromboprophylaxis.The American Society of Regional Anesthesia has published guidelines addressing the risk of bleeding and haematomas following neuroaxial techniques in anticoagulated patients, cases receiving antithrombotic or thrombolytic therapy. That will be discussed in detail later in this chapter [10].
Ho et al. [17] summarized in ten steps the safety precautions to minimize the risk of spinal haematoma following epidural catheterization during cardiac surgery:
Normalization of coagulation before needle or catheter insertion
Avoidance of repeated attempts
Postponement of surgery for 24 hours after bloody tap
Needle or catheter insertion 1 hour before systemic heparinization
Optimization of haemostasis after cardiopulmonary bypass
Removal of epidural catheter only after normal haemostasis has been restored postoperatively
Close neurologic surveillance
Using midline approach technique
Administration of saline solution through the needle to distend the epidural space before insertion of the catheter
Neuroaxial instrumentation postoperatively only after normalization of coagulation.
Raj and colleagues [18] have developed a bleeding risk score, which estimated based on the potential hazards of bleeding, associated with specific anticoagulants and bleeding disorders. In this scoring system each factor count as one point; the target structure is near a major vascular or neurological structure or is in a confined space. The other factors are the calibre of the needle, the use of fluoroscopy and contrast media, and the use of aspiration are factors that influence the risk and recognition of bleeding, and a “single shot” procedure. The clinician should be made a decision to cancel or carry out the procedure according to the bleeding risk score (Table 1) and overall risk stratification (Table 2)
• Proximity to significant vascular structures | \n\t\t\t1 | \n\t\t
• Proximity to significant neurological structures | \n\t\t\t1 | \n\t\t
• Target in a confined space | \n\t\t\t1 | \n\t\t
• Use of a sharp, rather than blunt needle to reach target | \n\t\t\t1 | \n\t\t
• Multiple passages | \n\t\t\t1 | \n\t\t
• Contrast not used, if applicable | \n\t\t\t1 | \n\t\t
• Fluoroscopy not used, if applicable | \n\t\t\t1 | \n\t\t
• Aspiration not performed or presence of blood at needle hub | \n\t\t\t1 | \n\t\t
• Needle size larger than 20 gauge | \n\t\t\t1 | \n\t\t
• Continuous, not single shot procedure | \n\t\t\t1 | \n\t\t
Bleeding risk score during neuroaxial blocks (adapted from reference 18)
0-4 | \n\t\t\t5-6 | \n\t\t\t7-10 | \n\t\t|
Low | \n\t\t\tMedium | \n\t\t\tHigh | \n\t\t
Overall risk stratification according to the bleeding risk score
In 2008 the American College of Chest Physicians (ACCP), 8th Antithrombotic and Thrombolytic Therapy Conference issued a statement [19]. Recommendations from this report are summarized in Table 3.
These recommendations have brought new challenges for the management of patients with neuraxial block. In general, the long-range high degree thromboprophylaxis is recommended. Acceptable alternative guide to ACCP is Surgical Care Improvement Project (SCIP; www.qualitynet.org). In addition, American Academy of Orthopaedic Surgeons (AAOS) has published a guide in 2007 for surgical bleeding associated with thromboprophylaxis for deep vein thrombosis in patients undergoing hip surgery to prevent pulmonary embolism (www.aaos.org / guidelines.pdf). In general, the AAOS guideline is more conservative and recommends routine mechanical prophylaxis and aggressive chemoprophylaxis in high-risk patients [10].
Understanding of mechanism of blood coagulation, pharmacological properties and clinical studies of anticoagulation and antiplatelet medication reduced the risk of spinal haematoma in neuroaxial blocks.
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Low risk ∙ Minor surgery in mobile patients ∙ Medical patients who are fully mobile | \n\t\t\t<10 | \n\t\t\tNot specific thromboprophylaxis Early and aggressive ambulation | \n\t\t
Middle risk ∙ Most of gynecological or urological patients ∙ Internal medicine patients: in bed, middle VTE risk+high bleeding risk | \n\t\t\t10–40 | \n\t\t\tDMWH (on recommended doses), LDUH or fondaparinux Mechanical thromboprophylaxis | \n\t\t
High risk ∙ Hip and knee arthroplasty, hip surgery ∙ Major trauma, spinal cord injury, high VTE risk + high bleeding risk | \n\t\t\t40–80 | \n\t\t\tDMWH (on recommended doses), fondaparinux, oral vitamin K antagonist (INR 2–3) Mechanical thromboprophylaxis | \n\t\t
The risk of thromboembolism and recommended thromboprophylaxis for patients in hospital stay [19].
* Asymptomatic DVT rates with objective diagnostic screening in patients not receiving thromboprophylaxis.
† mechanical thromboprophylaxis: intermittent pneumatics pressure, venous foot pump, and/or Anti-embolism Stockings, Low molecular weight heparin (LMWH), LDUH: low dose unfractioned heparin,INR, international normalized ratio, VTE: venous thromboemboli
Thrombolytic agents actively dissolve the fibrin clots. Exogenous plasminogen activators (streptokinase and urokinase) are drugs used to dissolve thrombus, and also affect circulating plasminogen that is decreasing the plasminogen and fibrin levels. Recombinant tissue-type plasminogen activator (rt-PA) is more fibrin selective and has less impact on the level of circulating plasminogen. Clot lysis leads to increase the fibrin degradation products, they also inhibit platelet aggregation and has anticoagulant effect. About one day after the administration of thrombolytic agents the haemostasis is altered. Fibrinogen is the latest improved factor. In addition to fibrinolytic agent, these patients often receive intravenous heparin and clopidogrel or aspirin in order to keep 1.5-2 times higher than the normal aPTT level. There are spinal haematomas case reports in patients taking thrombolytic agents while had an epidural catheter placed [7, 9].
The contraindication guidelines for thrombolytic agents suggests that if these drugs are taken, a needle insertion attempt should not be done during the following 10 days. Although there is no precise data for a neuroaxial block attempt after stopping the drugs [7, 9].
Patients receiving fibrinolytic or thrombolytic drugs should be considered if spinal or epidural anaesthesia are thought to be applied.
Patients receiving fibrinolytic or thrombolytic therapy, there is no suggestion a definite time for the withdrawal of the epidural catheter. Fibrinogen level measurement may be useful to assess residual thrombolytic effect.
Patients have different sensitivities to anticoagulants. In very sensitive patients the effect of anticoagulants drugs is more potent and longer after their discontinuation. Prothrombin time (PT) is up to 20% higher with a single dose of 3 to 5 mg of warfarin. The patients with resistance to these drugs have shorter duration of anticoagulation. Factors that increase the sensitivity to heparin and warfarin include general medical condition, diet, > 65 years old, female gender, excessive surgical blood loss, liver, or heart, or kidney diseases [7].
Anaesthetic management of patients receiving preoperative warfarin depends on the dosage and the treatment time. In patients with chronic oral anticoagulation, PT and INR levels take 3-5 days to return to normal values after anticoagulants discontinuation. Theoretically, PT and INR will be affected more factor VII activity (factor VII half-life of 6-8 hours), the time to return to normal PT and INR, factor II and X levels may not be sufficient for haemostasis. If INR is within the normal range, vitamin k dependent factors are typically normal. Thus, the coagulation should returns to normal range before the neuraxial block [10]. Although after warfarin discontinuation PT/INR are back to normal, the residual (subclinical) warfarin anticoagulant effect may be seen postoperatively [9]. Depending on the time of warfarin initiation factor half-life: Factor VII: 6-8 hours, Factor IX: 24 hours, Factor X: 25-60 hours, Factor II: 50-80 hours.
The correlation between vitamin k dependent coagulation factors and INR should be known for the proper management of regional anaesthesia. In patients with congenital factors II, IX and X deficits, activity levels of each factor for hemostasis should be normal or at least reach to 40%. If any clotting factor level are 20-40% below of their normal values, bleeding may occur. Factor VII and X activities are sensitive to PT and INR, but factor II activity is less sensitive to them. Because factor VII have a relatively short half-life, PT and INR may increased in 24-36 hours.
When factor VII activity is approximately 55% the INR can be longer (INR > 1.2). If INR is 1.5 the activity of factor VII is about 40%. If INR is <1.5 the haemostasis should be normal. However, prolonged PT/INR with factor VII activity may range from normal to very low levels. Neuraxial catheterization is safe with normal PT/INR, but with prolonged PT/INR is difficult to interpret for VII factor activity, and as much as 10% of the epidural catheters are withdrawn early and unnecessary [6]. Adequate anaesthesia management of patients receiving warfarin has to be based on the proper knowledge of the anticoagulant pharmacology, vitamin-K-dependent factors levels, and in the experience of reported cases of spinal haematoma [10]. Proper time for withdrawal of the neuroaxial catheter is controversial. Nearly 6,000 patients who received preoperative oral anticoagulants with spinal or epidural catheters is examined with four studies [7, 21].This study showed that responses of patients with warfarin have been highly variable. Up to 48 hours after initiation of treatment PT may not be prolonged, but even after a single dose, PT prolongation occurred in significant number of patients. Larger doses (> 5 mg of warfarin) increases these findings. To avoid excessive PT prolongation, you should assess daily levels [10].
Oral anticoagulation is stopped before neuraxial block, and normalization of PT is verified.
PT and INR are monitored daily.
When the vitamin-K dependent factors are adequate (INR <1.5), neuraxial catheters can be pulled out.
There is no definite recommendation when INR values are >1.5-<3.0 regarding the withdrawal of neuraxial catheters. Neurological condition should be carefully evaluated until INR stabilized, and the neuraxial catheters should be cautiously withdrawn.
If INR > 3, warfarin should be avoided. There is no definite recommendation regarding the withdrawal of neuraxial catheters (eg. partial or complete recovery of the anticoagulant effect of warfarin, or it can be interrupt until recovery of spontaneous haemostasis).
In high risk patients (acute thromboembolism), full systemic heparinization is given until a normal aPTT level is doubled. However, in vascular interventions, intravenous mid-level dosage of heparin (~5000 units) is given intraoperatively. Systemic heparinization in patients with spinal or epidural catheters were found to be safe in more than 4000 patients. Spinal haematomas were detected in 2% of these patients after diagnostic lumbar procedures and heparinization. In patients with anticoagulation within concomitant use of aspirin or anticoagulant therapy, after traumatic needle attempt or after a week of this attempt are defined as risk factors for spinal haematoma [7].
In general, a large number studies and clinical experience of regional anaesthesia techniques do not predict the risk of spinal haematoma during the use of systemic heparinization. However, they have stated that such events are not rare as previously thought, and if there is a suspicion for spinal haematoma diagnostic processes should be done as early as possible [10].
In patients receiving high-dose intraoperative systemic heparin, particularly in cardiac surgery. Epidural and spinal anaesthesia and analgesia has gained popularity and has not been reported cases of spinal haematomas. The possibility of epidural haematoma in these patients is for epidural anaesthesia 1/1528, and for spinal anaesthesia 1/3610 [9].
In a study conducted on 9000 patients that received subcutaneous heparin and applied spinal or epidural anaesthesia no spinal haematoma was reported. In patients receiving low-dose heparin, only four spinal haematoma has been reported after neuraxial block, epidural anaesthesia technique was applied in three of them [9]. Neuraxial block security for these patients is not known [19].
Regional anaesthesia and intravenous heparin for vascular surgery can be considered under the following conditions:
After needle or catheter attempt intravenous heparin is delayed by 1 hour.
Prolonged anticoagulation increases the risk of spinal haematoma, especially in combination with other anticoagulants or thrombolytic agents. If systematic anticoagulation is given when the patient has an epidural catheter, its withdrawn has to be delayed 2-4 hours after discontinuation of heparin, and after the coagulation status is evaluated.
The catheter is withdrawn one hour before administration of heparin.
If total daily dose < 10 000 units, there is no contraindication to neuraxial techniques if subcutaneous standard heparin is given. The risk of spinal haematoma with higher doses are uncertain; neurological follow-up is done on an individual basis and is closely evaluated.
In patients receiving subcutaneous heparin > 5 days serial platelet counts should be performed.
Enoxaparin was the first approved LMWH by the FDA in 1993. Between 1993-1997, 30 cases of spinal haematoma were seen in patients receiving LMWH and undergoing spinal or epidural anaesthesia. In 1997, the FDA has started to investigate these cases. In addition, all LMWH and heparinoid manufacturers were warned [9].
Anesthesia and Anticoagulation Neuroaxial consensus conference (1998) described 45 spinal haematoma cases associated with LMWH, in 40 of these patients neuraxial anaesthesia was implicated. Severe radicular back pain was not manifest symptoms, but most patients had incipient numbness, weakness, and bowel or bladder dysfunction. Median time between the treatment start with LMWH and neurological dysfunction development was 3 days, and the mean time between onset of symptoms and laminectomy was more than 24 hours. Bad or good neurological recovery were seen in less than 1/3 patients.
The risk of spinal haematoma due to LMWH, neuraxial techniques, and the prevalence of reported cases, with continuous epidural anaesthesia was reported in approximately 1/3000, with spinal anaesthesia 1:40,000. However, the cases are probably more. About 60 cases have been reported between the years of 1993-1998 by the FDA. The Second Consensus Conference 1998-2002, reported 13 spinal haematoma cases related to neuraxial block. In addition to LMWH, 5 patients received ketorolac, one patient was taking ibuprofen, and one patient received intravenous unfractionated heparin. Spinal anaesthesia in 3 cases, and 10 patients underwent epidural anaesthesia while receiving LMWH. Thus, the reported characteristics of patients are supported previously recommendations that epidural catheter withdrawal before starting LMWH thromboprophylaxis and other antiplatelet or anticoagulant medication [9]. (Table 4).
Female gender | \n\t\t|
Elderly | \n\t\t|
Ankylosing spondylitis or spinal stenosis | \n\t\t|
Renal failure | \n\t\t|
Traumatic needle/catheter placement | \n\t\t|
More risk in epidural compared with spinal technique | \n\t\t|
Epidural catheter placement during LMWH therapy | \n\t\t|
Early preoperative (or intraoperative) LMWH therapy | \n\t\t|
Early postoperative LMWH therapy | \n\t\t|
Concomitant antiplatelet or anticoagulant medications | \n\t\t|
Twice daily LMWH administration | \n\t\t
Patient, anaesthetic, and LMWH dosing variables associated with spinal haematoma [7]
The effect of renal function cannot be completely evaluated. The anticoagulant effect increased in serious renal failure and half-life is prolonged from 4-6 hours to 16 hours [22].
Efforts to determine the indications for LMWH are continuing. LMWH is not a good choice for patients receiving chronic warfarin therapy, and is indicated for pregnant women, in patients with prosthetic heart valve and atrial fibrillation, and in patients with a history and existing hypercoagulable states. LMWH dose for the treatment of DVT is higher than dosage of prophylaxis. The needle must be inserted at least 24 hours after last dose [9].
Perioperative management of patients receiving LMWH requires coordination and communication. In addition, even if there is a protocol the patient dose may not be closely followed. LMWH is not recommended with other antiplatelet or oral anticoagulant drugs.
Neuraxial techniques should be applied at least 10-12 hours after thromboprophylaxis dose and 24 hours after high therapeutic dose of the LMWH.
Two doses per day, the first dose of LMWH should be given at least 24 hours after the operation, regardless of the anaesthetic technique, and only if there is adequate hemostasis.
Remove the catheter before starting LMWH thromboprophylaxis.
The first dose of LMWH should be given at least 2 hours after withdrawal of catheter, and after 24 hours insertion of needle or catheter.
The interval between the insertion of needle or catheter with the first dose of LMWH should be 6-8 hours. The other dose should not be given within 24 hours after the first dose.
Antiplatelet drugs includes the nonsteroidal anti-inflammatory drugs (NSAIDs), thienopyridine, and glycoprotein IIb/IIIa inhibitors, seldom used as agents for primary thromboprophylaxis. It is important to note the pharmacologic differences among the drugs with antiplatelet effects. Many orthopaedic patients are chronic NSAIDs (aspirin, ibuprofen, ketorolac, and naproxen) users. Three of the 61 reported patients who developed spinal haematoma after spinal or epidural anaesthesia were taking antiplatelet therapy. Many studies of these drugs showed that they are relatively safe for neuraxial block in obstetric, surgical, or pain clinic patients [10, 23]. Clinician also should be alert in heparinized patients who also take antiplatelet agents as possible increased risk of spinal haematoma. Ticlopidine and clopidogrel are from thienopyridine group, and are also platelet aggregation inhibitors. These agents inhibit the platelet-fibrinogen binding and then impair platelet-platelet interaction [9]. This effect is irreversible during the platelets life time. Platelet dysfunction lasts 5-7 days for clopidogrel and 10-14 days after ticlopidine. Clopidogrel\'in completely normal clotting dose range need not secure due to the block. Prasugrel is a new thienopyridine drug and inhibits platelets faster and sustained. It is used only for percutaneous coronary intervention in acute coronary syndromes in the United States of America.
Platelet glycoprotein IIb/IIIa receptor antagonists (abciximab, eptifibatide and tirofiban) impair platelet aggregation, platelet-fibrinogen binding and platelet-platelet interaction. Time to normal platelet aggregation following discontinuation of therapy ranges from 8 hours (eptifibatide, tirofiban) to 24 to 48 hours (abciximab). During therapy with GP IIb/IIIa antagonists, labeling precautions recommend that puncture of noncompressible sites and “epidural” procedures be avoided [9].
If antiplatelet drugs are taken together with other anticoagulants, bleeding risk is high.
NSAIDs alone does not a significant risk factor for spinal haematoma in epidural or spinal anaesthesia.
Platelet function should be return to normal before neuroaxial block in patients receiving ticlopidine, clopidogrel, and platelet GP IIb/IIIa receptor antagonists. Platelet aggregation was returning to normal after discontinuation of the drug: 14 days for ticlopidine; 5-7 days for clopidogrel; 7-10 days for prasugrel. The effects of GP IIb/IIIa inhibitors are terminated between 8 hours (eptifibatide and tirofiban) with 48 hours (abciximab).
The use of herbal products in surgical patients is frequent, and sometimes the patients also may disguise their use of them. Polypharmacy and physiological changes lead to morbidity and mortality in the perioperative period. The bleeding may be seen due to garlic, ginkgo, ginseng and ginseng-warfarin interaction. These commercial products are not yet sufficiently under control, therefore, unexpected and adverse reactions may be seen, and in particular, and the anaesthesiologist should be familiar the effects of these agents [9].
Herbal remedies does not pose any additional risk for spinal haematoma in epidural or spinal anaesthesia. There is not a fully accepted test to assess the adequacy of haemostasis for the herbal products. Inquiry and evaluation should be performed preoperatively. There is no data evaluating the combination of herbal therapy with other anticoagulants. However, an increased risk of bleeding with the drugs that effect on hemostasis system.
Fondaparinux is a synthetic pentasaccharide, the FDA approved in 2001, makes antithrombotic effect by the inhibition of factor Xa. Plasma half-life of 21 hours, 6 hours after the operation is given once daily. Spinal haematomas have not been reported with its use, but it must be used very carefully. The actual risk of spinal haematoma to fondaparinux is unknown.
Neuraxial techniques should be applied carefully until an adequate clinical information is obtained (single pass through with a needle, the use of atraumatic needle, avoidance from neuraxial catheter). If the precautions are not possible,another method of prevention should be considered.
Dabigatran etexilate reversibly inhibits clot bound thrombin. It is a prodrug, gastrointestinal absorption and bioavailability is about 5%. After being absorbed, esterases returned it the active metabolite, dabigatran. A single dose of dabigatran has a half-life of 8 hours, with multiple doses is 17 hours. Daily dose of the drug is suitable. It is contraindicated in patients with renal failure, because 80 % of the drug is excreted unchanged from the kidney. Spinal haematomas are not reported but currently data are insufficient. It is currently used only in non-valvular atrial fibrillation [7].
Dabigatran should be discontinued 7 days before the neuraxial block, because of the long half-life, and irreversible effect. Neuraxial catheters should be withdrawn at least 6 hours prior to initiation of treatment with dabigatran [22].
Rivaroxaban is a potent, selective and reversible, orally active factor Xa inhibitor. Oral bioavailability is approximately 80%. Maximum inhibitory effect is seen in 1-4 hours and the inhibition lasts 12 hours. Antithrombotic effect is measured by PT, aPTT, and Heptest. It is excreted through kidney and intestine, therefore in patients with renal failure is contraindicated. The half-life is 9 hours, but in the elderly last up to 13 hours. Clinical studies showed that rivaroxaban (5-40 mg a day, the first dose 6-8 hours after surgery) a similar effect with enoxaparin (40 mg given 12 hours before surgery). Although spinal haematoma is not reported, it must be use cautiously because of the longer half-life [10].
According to the European guidelines, neuroaxial block can be applied after 22 to 26 hours of discontinuation of rivaroxaban. If there is renal failure this interval will be longer. Neuraxial catheters are contraindicated. Postoperative rivaroxaban treatment should be started at least 4-6 hours after the spinal block [22].
It is known that the most important serious complication of neuraxial blocks is spinal haematoma, but the risk is not identified for plexus and peripheral blocks. Few serious complications have been reported. In patients received antiplatelet or anticoagulant agents, major bleeding is reported after lumbar sympathetic block, or psoas compartment block. Neurological damage has not been reported. The Neuroaxial Anesthesia and Anticoagulation Consensus Statement are also used for the peripheral and plexus blocks [9, 10]
In the differential diagnosis of postoperative new or progressive neurologic symptoms, surgical neuropraxia, prolonged or exaggerated neuraxial block, anterior spinal artery syndrome, epidural abscess, recurrence and existing undiagnosed neurological condition, neurological disorders and spinal haematoma should be considered. Immediate post-operative onset of symptoms is rare. Spinal haematomas rarely can be seen as "prolonged" in the form of blocks [5, 6]. The time between the start of thromboprophylaxis with the entry of the needle is important for neurological dysfunction. Complete paralysis develops within 10-15 hours after the start of neurological deficits. Clinical assessment should be focused on the recognition of reversible or treatable causes. Thus, if any new or progressive neurological symptoms are seen during epidural analgesia, infusion must be promptly stopped (catheter is left) and the local anaesthetic effect and of volume effect is ruled out. If the neurological deficit is due tothelocal anaesthetic and/or volume effects, the deficit is often return quickly,and it should be noted. Neurological recovery is due to early diagnosis and intervention, radiographic imaging, preferably MRI should be done as soon as possible. In terms of the need for emergency surgery, neurosurgery consultation should be requested immediately. Interestingly, all spinal haematomas do not require emergency surgery, spontaneous healing have also been reported [5, 6]. However, the decision of an emergent surgery or observation belongs to the neurosurgeon. Neurological outcome for most patients are worse in all series. In addition, if there is more than 8 hours after onset of the symptoms, a full recovery usually has not been realized. Generally, bleeding after peripheral techniques is less common than neuraxial haematoma, and often appears as hypovolemia not neural deficit. The decide for surgery or observation for neuraxial haematoma or bleeding is based on the presence and severity of neural deficit.
Spinal hematoma is a haemorrhage in the spinal or epidural space that develops with forming a heterogeneous group of disorders. Haematoma can be acute, chronic, spontaneous, traumatic or iatrogenic. It is especially related to medication or disease associated with coagulopathy. MRI is a special importance in diagnosis. Delay of surgery may rapidly worsen the clinical outcome, so the surgery should be done urgently.
Spinal haematomas are rare and potentially reversible spinal cord compression. Early diagnosis is essential for a full recovery. Spinal haematomas can occur in the absence of identifiable risk factors. The clinician should be alert for the new neurological signs. Spinal cord and root compression are potentially reversible. If the treatment is done quickly healing is complete. Continuous surveillance of risk identification, assessment and training up to date information for the physician should be done constantly for spinal and epidural blocks. The introduction of new anticoagulants and antiplatelet agents, and the complex balance between thromboembolic events and hemorrhagic complications with regional anaesthesia or analgesia requirement requires an evaluation of the indications for patient. Thus, the antithrombotic therapy in patients receiving spinal or epidural anaesthesia or analgesia, timing of catheter removal should be evaluated basis on the patient\'s situations. If there is an unacceptable risk, alternative anaesthesia or analgesia techniques should be considered. The patient\'s coagulation status should be optimized and the level of anticoagulation should be carefully monitored during epidural catheterization. If there is a significant increase in the risk of spinal haematoma, the catheter should not be removed. Identification of risk factors and the publication of the guidelines does not eliminate the complication of spinal haematoma. It is reported that spinal haematoma may develop in patients treated in accordance with the guidelines [24, 25]. United States [10] Europe [26] and the Nordic countries [27, 28] have published guidelines. Closely monitored of the patient to detect early neurological dysfunction is very important to recognize and attempt to fast decompression. Not only try to prevent of spinal haematoma, but also should be focused to make the best of the neurological consequences [7, 10].
Summary of the clinical key points
The clinician should have a high index of suspicion at all times in any patient who has undergone spinal anaesthesia and who exhibits any sign or symptom of a neuraxial haematoma
Adequate monitoring, follow-up, and immediately treatment are essential in patients on anticoagulants who are receiving neuraxial blocks
Early recognition of epidural haematoma
Physical examination: vibration and position ability in the lower extremities. Pain, temperature, and light touch (last sensory modalities), Assessing rectal tone.
If a new or progressive neurologic deficit are observed during epidural analgesia infusion, it requires immediate discontinuation and the catheter is left in place
Urgent radiographic diagnostic studies: MRI (more sensitive and preferred method), Conventional CT, conventional angiography, myelography and CT
Differential diagnosis: Epidural abscess, spinal cord disease, neoplasia, muscular or ligamentous injury related to needle placement, postoperative surgical neuropraxia, prolonged or exaggerated neuroaxial block, anterior spinal artery syndrome, and pre-existing undiagnosed neurological disorder
Emergency neurosurgical evaluation for surgical decompression.
In early 2020 the Coronavirus worldwide pandemic set into motion a sudden mass movement from traditional face to face instruction to remote teaching. The sudden transformation in instructional delivery presented many challenges to education agencies, administrators, teachers, students, and families. Several challenges were encountered, including access to technology devices, access to internet service, and access to and proficiency in the use of virtual platforms for teaching and learning. This chapter presents one pedagogical approach informed by sociocultural and sociolinguistic theoretical frameworks, where one teacher educator offers how to use language as a social semiotic tool in virtual science instruction to engage culturally and linguistically diverse students in science learning. This teacher educator integrates content, language, and technology as one way to actively engage CLD students in learning through science-specific disciplinary language for experiencing scientific phenomena to make sense of it through language. Teachers are invited to apply the pedagogical approach offered to engage students in remote science learning through the use of common scientific discourse practices, such as constructing science explanations. The theoretical framework informing the approach explains the constructs and significance of mediation, zone of proximal development (ZPD), interaction, and Systemic Functional Linguistics (SFL) to put into practice in lesson delivery for virtual implementation.
In this chapter, the author integrates sociocultural and sociolinguistic theoretical frameworks to propose a pedagogical approach in virtual science instruction. The integration of the two frameworks proposes a pedagogical approach on how to utilize language as a social semiotic tool for sense making in science remote instruction. Systemic Functional Linguistics (SFL) offers one genre for sense-making in science, the explanation genre. The theoretical framing is described next.
In [1], sociocultural theory is concerned with how individual mental functioning is related to historical, cultural, and institutional context. “Hence, the focus of the sociocultural perspective is on the roles that participation in social interactions and culturally organized activities play in influencing psychological development” ([1], p. 1). According to sociocultural theory [1], learners participate in activities and internalize the effects of working together and in the process acquire knowledge and strategies of the world and culture. Wertsch and Lantolf [2, 3]. identified that the human mind is mediated through the use of culturally constructed tools and signs, which are also known as semiotics. Semiotics include physical tools and symbolic artifacts. According to [4], physical tools help humans mediate experience of their physical world through concrete tools (e.g., computers, objects, layout of built environments), whereas symbolic tools (e.g., language, literacy, concepts, numeracy) help mediate the individual’s connection to the social world. Through the use of both types of tools, humans mediate their individual experience to their social and material world for sense-making. Thus, in science teaching it is important to identify the physical tools (diagrams, maps, models, etc.) and symbolic tools (language, literacy, concepts, etc.) to help students make sense of their learning as they interact with scientific phenomena in similar ways that scientific communities do.
Further, Vygotsky [5] defines the
Since the language of scientific communities requires specific uses of it in the discipline, it is also important to highlight constructs within sociolinguistic theory for utilizing language resources for sense-making.
Hudson ([6], p. 4) defines sociolinguistics as “the study of language in relation to society, implying (intentionally) that sociolinguistics is part of the study of language.” In this chapter it is important to note the intentional use of language as a symbolic tool for sense making and interacting in science. In doing so, the author will highlight common structural language forms or genres frequently used by the scientific community to make sense of their scientific worlds. The author accentuates the specific genre of science explanations as a social semiotic tool for sense making. First, social semiotics is concerned with meaning making and how language users make sense or meaning through language. SFL [7], proposes that language resources are shaped by how they are used by people to make meaning in the social function of language through three metafunctions: (1) ideational, (2) interpersonal, and (3) textual. The ideational metafunction is concerned with what is going on in the world to reflect experiential meaning about the world. The interpersonal metafunction relates to the use of language resources to interact with others. Lastly, the textual metafunction of language offers grammatical resources that work together to help language users create coherent and cohesive texts (written or oral). The textual metafunction links the ideational and interpersonal metafunctions to create a unified text [8].
Since this chapter offers a pedagogical approach for science teachers to use language as a social semiotic tool in science teaching, the author offers a few traditional common texts used for science sense making. One of the most frequently used texts are lab procedures, which traditionally include step by step instructions for carrying out a lab investigation. Another text may be a report, which would serve to communicate the findings of a lab investigation. These are more traditional in nature and more typical of taking place during face-to-face instruction and lab investigating activities. However, when scientists communicate inquiry investigations, they often do so using explanation and argumentative texts which serve the purpose to explain processes and cause-effect relationships intended to persuade their audience, which includes other members of the scientific community. Regardless of the text type at hand, one feature of frequently used science texts is that they include highly abstract and technical language. It is important for science learners to experience and interact with scientific phenomena to make sense of it before being expected to communicate through highly specialized science language. In this chapter the author offers one pedagogical approach using one specific science genre (text) to scaffold the content and language tasks for CLD students. The approach offers teachers lesson design components to consider when planning the content and language tasks that will assist students to construct science explanations. Since the Coronavirus pandemic has transformed the way of instruction in face to face and remote instruction, I offer this approach as one to be planned for remote instruction, but that could also benefit those teachers using hybrid modes of instruction as many are returning to face to face instruction.
The pedagogical approach offered here is one intended to integrate content and language learning for mediating science learning to ‘do science’ and ‘talk science.’ As mentioned previously, one text type (genre) will be highlighted in this chapter as a language resource to mediate experience in science learning through the use of physical tools (online simulations) and symbolic tools (language). First, this author proposes the structural layout of the social semiotic tool of explanation texts in science. They can be sequential in nature to explain how a process occurs or they can be causal in that they explain cause-effect relationships. Thus, one item to consider in lesson design (online or face to face) is the language tasks students will engage in when constructing science explanations to interact with their peers and teacher. In sequential explanations, Humphrey et al. [8] describe these as the phases of a process in sequence to reveal how a process occurs (e.g., the process explained in the water cycle through each phase), whereas causal explanations may explain sequence but also why the process occurs (e.g., heat’s effect in each phase of the water cycle).
One instructional process commonly used in teaching is the 5E cycle. The 5E cycle includes the following instructional processes a teacher plans to provide experiential learning opportunities to students: (1) engage-teachers work to gain an understanding of students’ prior knowledge; (2) explore-students actively explore new concepts through hands-on activities (or virtual hands-on learning experiences); (3) explain-helping students organize new knowledge and ask clarifying questions for what they learned during the explore phase; (4) elaborate-students apply what new knowledge they have learned; and (5) evaluate-teachers plan for assessment or observation to determine if the core concepts of the lesson have been clearly understood by students. This author wants to focus on the explore and explain phases of this learning model for instructional planning that provides students with opportunities to ‘do science’ and ‘talk science’.
While language as a social semiotic tool is important for sense making and activities reflecting how students do this through the construction of science explanations, equally important is the experiential component of interacting with science phenomena. In face-to-face teaching this happens mostly during lab investigations, where students are afforded hands-on experience with lab equipment, substances, and manipulation of variables in lab investigations to observe and measure the effect of these. In remote teaching, the physical hands-on experience is not possible. However, virtual hands-on tools can be used in place of physical tools for students to engage in learning during the explore phase. One example of such a tool can be virtual simulations. The sudden mass movement required many education stakeholders to explore the availability of virtual resources for remote teaching. Some examples include learning management systems (BlackBoard, Canvas, Moodle), while there are also synchronous teaching technology applications (Zoom, Microsoft Teams, nearpod, Padlet), in addition to game-based learning applications such as Kahoot and online simulations (PhET, Gizmo, CloudLabs STEM) to name a few.
When planning for student-centered learning this pedagogical approach focuses on three aspects to learning so that students (including students from culturally and linguistically diverse backgrounds) are afforded multiple ways to interact with the content learned. One way is frequent experience opportunities with the content. Questions to consider are: (1) How will students interact with the content (visually, orally, videos, simulations)?; (2) What is the language of instruction and what language supports are afforded to CLD students who are not native speakers of a majority language? and (3) What are the intended conceptual and linguistic outcomes that are expected? A response to question three can be addressed by the specific formulation of content and language objectives to determine supports required to answer questions one and two. Technology is then utilized as a tool for exposing students to content and the use of virtual platforms for actively engaging students in the content to produce content and language outcomes. One of the greatest challenges as all educators moved to remote instruction in early 2020 was engaging students. One affordance in learning how to navigate this challenge is the growth in technology literacy and professional development for effective remote instruction that engages students. Thus, a central component when planning a lesson is to consider the specific content and language objectives that can be observed and measured during instruction and what technology platforms and applications will support students’ interaction with the content and language to participate in disciplinary language use about the content via multiple modes of communication. Since explanations is the genre (text) of choice in this pedagogical approach. The author will describe the structural and grammatical features of science explanations for teacher planning.
As previously mentioned, one way to distinguish between the structural features of two common forms of explanations is by considering whether they describe a process or whether they describe a cause-effect relationship about science phenomena. Process or sequential explanations serve as intentional linguistic scaffolding for causal explanations. Thus, in science instructional design one might consider, what processes students will be learning in a lesson. One common type of process can be cycles, as in the water, or carbon dioxide cycle. Another type of process can be chemical processes (e.g., condensation, precipitation, evaporation, chemical changes, etc.) Let us take one content and learning objective as an example of the approach offered in this chapter.
Content objective: students will identify chemical changes in a chemical reaction.
Language objective: students will explain why the chemical changes occurred.
For the content objective, identification of chemical changes involves identifying chemical processes (e.g., rotting, burning, rusting, etc.). Taking the example of the burning of sugar, one can observe that there are specific observations that can be made when burning sugar (color change, temperature change, phase change, etc.). A sequential explanation may include the observations made when heat was applied to sugar. One example of a sequential explanation may be the following:
Sequential explanation:
The underlined portion of the above explanation is one way to measure the outcomes intended by the content objective (i.e., burning). The language objective now requires a causal explanation, which can be a sequential explanation plus a causal component. Notice that the sequential explanation offers a sequence of events of how the burning of sugar occurred. A causal component would require answering why the chemical process of burning occurred. In this case the increase in heat (cause) resulted in the formation of caramelized sugar (effect). One commonly used causal explanation framework utilized in science teaching and learning is the
Interaction being a critical component of both sociocultural theory and sociolinguistics for individuals to mediate human experience of the world requires providing opportunities where students can become active participants of science discourse. Since, explanations are one genre (text) commonly used in scientific communities, providing students opportunities to construct science explanations about science phenomena affords them ways to begin learning to use language in similar ways to scientific communities. The construction of science explanations in the example above is a prime example of how science texts, as in the use of the CER explanation framework, require a carefully constructed text that is coherently and cohesively organized to communicate meaning. This is symbolic of the textual metafunction of SFL. Equally important though is the interpersonal metafunction of SFL for using language as a social semiotic tool for sense-making. Science learners, as text composers, must consider who their intended audience is and what the subject matter is to communicate meaning via science explanations. Under these circumstances, students communicate with other students and with the teacher about science-specific concepts and phenomena. Thus, teachers are encouraged to be very intentional in their planning of interaction opportunities to promote student-student interaction in addition to student-teacher interaction. It is important that the interaction opportunities be aligned to both the content and language objectives of the lesson. Interaction opportunities were one of the most experienced pedagogical challenges when the sudden movement to remote instruction was made. Platforms like Zoom permitted the use of breakout rooms, as one way to promote student-student interaction. However, it became quite difficult for the teacher to go from one breakout room to another, and while students were in breakout rooms, teachers were not able to view what interaction might have been occurring in other breakout rooms where the teacher was not present. Because of this, this author proposes the integration of technology platforms and applications that permit the technology resources to promote student-student, student-teacher, and teacher-student interaction in more concurrently visible ways. Some applications that capture the live interaction in whole virtual group (versus small break out groups) are described next.
Padlet is an interactive platform that gives the teacher access to all student communications. The comment posting feature captures language outcomes in written form. In doing so, students are able to post their science explanations. The platform permits the use of videos and links to online simulations for students to interact with content. Padlet also allows the ability to post voice memos. When working with students of CLD backgrounds, such as second language learners (SLL), posting comments onto a Padlet gives SLLs opportunities to develop their writing skills, whereas voice memos, affords them oral language opportunities and practice with listening comprehension. Further, this application provides students with opportunities to mediate science learning using language as a social semiotic tool to make sense of their learning experienced. Other applications such as nearpod have similar features, while online simulations offered by PhET offer great virtual hands-on experience for students to interact with the content via online simulations.
Returning to the content and language objectives component for planning a virtual hands-on lesson, one must also consider the exploration phase of the 5E lesson cycle to intentionally decide what experiences to provide students with to scaffold their learning at the actual development level and assist them to advance to the next potential development level. This must happen at both the conceptual and linguistic levels. Recalling that the use of physical tools provides external mediation opportunities for students, language (specifically the language function of explaining) is one that can be internalized in some form of actual development for SLLs but should always be scaffolding the language tasks at potential developmental levels for second language learning. This approach promotes both content and language development through intentional planning.
In the use of sequential and causal explanations aforementioned, it is important that conceptually, students understand a process first before expected to understand causal conditions of manipulating a process for a specific outcome (effect) to occur. This level of scaffolded instruction targets both conceptual understanding and linguistic communication to experience science and communicate about science phenomena experienced. Further, for CLD students who are learners of a second language, linguistic scaffolding also develops their language competence and proficiency over time, hence why language practice through interaction opportunities are so critical for this student.
The integrated sociocultural and sociolinguistic theoretical framework informs a pedagogical approach where constructs like mediation, zone of proximal development, and interaction suggest using language as a social semiotic tool for science sense-making. Through the three metafunctions of language in SFL—ideational, interpersonal, textual—and the genre of science explanations, teachers use this integrated approach to intentionally plan for the targeted learning experiences in the
Implications for research suggest instructional interventions designed to measure second language learner conceptual and linguistic outcomes. Such interventions would inform intentional content and language teaching through measurement of fidelity of implementation. Interventions would measure student-intended content and language outcomes for CLD students. Additionally, instructional interventions would explore the effect of conceptual and linguistic scaffolding and their removal as students move from one knowledge development level to another. Lastly, interventions using this approach would help further inform the use of technology to enhance students’ opportunities to explore science learning and communicate via discipline specific language use.
One limitation of this chapter is that the author centers only on one specific genre—explanations. Constructing arguments and the language skill of engaging argumentation not only requires the use of explanations, but also requires the use of persuasive language resources to persuade the scientific community and continue the construction of new scientific knowledge. In a classroom, students should also experience opportunities to engage in argumentation to experience different ways of knowing or epistemologies between them and their peers, but also ways to evaluate their own learning and refine their conceptual understanding of science phenomena.
This chapter concludes with the components of a pedagogical approach in virtual science teaching that aims to provide virtual hands-on content and language practice for culturally and linguistically diverse (CLD) students, such as SLLs, to ‘do science’ and ‘talk science’. The author featured the use of technology applications in which teachers create opportunities for SLL students to interact with online simulations and use the CER explanations framework to construct oral/written scientific explanations. Constructing scientific explanations is a discourse practice in scientific communities used to communicate understanding and findings about inquiry investigations and make contributions to science knowledge construction. Sociocultural and sociolinguistic theories informed the pedagogical approach presented to better understand how language is used as social semiotic tool for sense-making. The sociocultural theoretical constructs of mediation and zone of proximal development informed the instructional process used in the explore and explain phases of the 5E learning cycle to create opportunities for CLD students to make sense of science phenomena. Sociolinguistic theory informs the use of language in the ideational, interpersonal, and textual functions through Systemic Functional Linguistics to propose how students can interact with content and explain science phenomena in coherent and cohesive ways.
The authors declare no conflict of interest.
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. 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H. Gulrez, Saphwan Al-Assaf and Glyn O Phillips",authors:[{id:"58120",title:"Prof.",name:"Saphwan",middleName:null,surname:"Al-Assaf",slug:"saphwan-al-assaf",fullName:"Saphwan Al-Assaf"}]}],mostDownloadedChaptersLast30Days:[{id:"35255",title:"Mechanical Transmissions Parameter Modelling",slug:"mechanical-transmissions-parameter-modelling",totalDownloads:7442,totalCrossrefCites:1,totalDimensionsCites:2,abstract:null,book:{id:"1982",slug:"mechanical-engineering",title:"Mechanical Engineering",fullTitle:"Mechanical Engineering"},signatures:"Isad Saric, Nedzad Repcic and Adil Muminovic",authors:[{id:"101313",title:"Prof.",name:"Isad",middleName:null,surname:"Saric",slug:"isad-saric",fullName:"Isad Saric"}]},{id:"68505",title:"Research Design and Methodology",slug:"research-design-and-methodology",totalDownloads:25128,totalCrossrefCites:9,totalDimensionsCites:18,abstract:"There are a number of approaches used in this research method design. The purpose of this chapter is to design the methodology of the research approach through mixed types of research techniques. The research approach also supports the researcher on how to come across the research result findings. In this chapter, the general design of the research and the methods used for data collection are explained in detail. It includes three main parts. The first part gives a highlight about the dissertation design. The second part discusses about qualitative and quantitative data collection methods. The last part illustrates the general research framework. The purpose of this section is to indicate how the research was conducted throughout the study periods.",book:{id:"8511",slug:"cyberspace",title:"Cyberspace",fullTitle:"Cyberspace"},signatures:"Kassu Jilcha Sileyew",authors:[{id:"292841",title:"Ph.D.",name:"Kassu",middleName:null,surname:"Jilcha Sileyew",slug:"kassu-jilcha-sileyew",fullName:"Kassu Jilcha Sileyew"}]},{id:"67558",title:"Polymerase Chain Reaction (PCR): Principle and Applications",slug:"polymerase-chain-reaction-pcr-principle-and-applications",totalDownloads:10667,totalCrossrefCites:8,totalDimensionsCites:18,abstract:"The characterization of the diversity of species living within ecosystems is of major scientific interest to understand the functioning of these ecosystems. It is also becoming a societal issue since it is necessary to implement the conservation or even the restoration of biodiversity. Historically, species have been described and characterized on the basis of morphological criteria, which are closely linked by environmental conditions or which find their limits especially in groups where they are difficult to access, as is the case for many species of microorganisms. The need to understand the molecular mechanisms in species has made the PCR an indispensable tool for understanding the functioning of these biological systems. A number of markers are now available to detect nuclear DNA polymorphisms. In genetic diversity studies, the most frequently used markers are microsatellites. The study of biological complexity is a new frontier that requires high-throughput molecular technology, high speed computer memory, new approaches to data analysis, and the integration of interdisciplinary skills.",book:{id:"7728",slug:"synthetic-biology-new-interdisciplinary-science",title:"Synthetic Biology",fullTitle:"Synthetic Biology - New Interdisciplinary Science"},signatures:"Karim Kadri",authors:[{id:"290766",title:"Dr.",name:"Kadri",middleName:null,surname:"Karim",slug:"kadri-karim",fullName:"Kadri Karim"}]},{id:"62059",title:"Types of HVAC Systems",slug:"types-of-hvac-systems",totalDownloads:12438,totalCrossrefCites:8,totalDimensionsCites:14,abstract:"HVAC systems are milestones of building mechanical systems that provide thermal comfort for occupants accompanied with indoor air quality. HVAC systems can be classified into central and local systems according to multiple zones, location, and distribution. Primary HVAC equipment includes heating equipment, ventilation equipment, and cooling or air-conditioning equipment. Central HVAC systems locate away from buildings in a central equipment room and deliver the conditioned air by a delivery ductwork system. Central HVAC systems contain all-air, air-water, all-water systems. Two systems should be considered as central such as heating and cooling panels and water-source heat pumps. Local HVAC systems can be located inside a conditioned zone or adjacent to it and no requirement for ductwork. Local systems include local heating, local air-conditioning, local ventilation, and split systems.",book:{id:"6807",slug:"hvac-system",title:"HVAC System",fullTitle:"HVAC System"},signatures:"Shaimaa Seyam",authors:[{id:"247650",title:"M.Sc.",name:"Shaimaa",middleName:null,surname:"Seyam",slug:"shaimaa-seyam",fullName:"Shaimaa Seyam"},{id:"257733",title:"MSc.",name:"Shaimaa",middleName:null,surname:"Seyam",slug:"shaimaa-seyam",fullName:"Shaimaa Seyam"},{id:"395618",title:"Dr.",name:"Shaimaa",middleName:null,surname:"Seyam",slug:"shaimaa-seyam",fullName:"Shaimaa Seyam"}]},{id:"70315",title:"Some Basic and Key Issues of Switched-Reluctance Machine Systems",slug:"some-basic-and-key-issues-of-switched-reluctance-machine-systems",totalDownloads:1264,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Although switched-reluctance machine (SRM) possesses many structural advantages and application potential, it is rather difficult to successfully control with high performance being comparable to other machines. Many critical affairs must be properly treated to obtain the improved operating characteristics. This chapter presents the basic and key technologies of switched-reluctance machine in motor and generator operations. The contents in this chapter include: (1) structures and governing equations of SRM; (2) some commonly used SRM converters; (3) estimation of key parameters and performance evaluation of SRM drive; (4) commutation scheme, current control scheme, and speed control scheme of SRM drive; (5) some commonly used front-end converters and their operation controls for SRM drive; (6) reversible and regenerative braking operation controls for SRM drive; (7) some tuning issues for SRM drive; (8) operation control and some tuning issues of switched-reluctance generators; and (9) experimental application exploration for SRM systems—(a) wind generator and microgrid and (b) EV SRM drive.",book:{id:"8899",slug:"modelling-and-control-of-switched-reluctance-machines",title:"Modelling and Control of Switched Reluctance Machines",fullTitle:"Modelling and Control of Switched Reluctance Machines"},signatures:"Chang-Ming Liaw, Min-Ze Lu, Ping-Hong Jhou and Kuan-Yu Chou",authors:[{id:"37616",title:"Prof.",name:"Chang-Ming",middleName:null,surname:"Liaw",slug:"chang-ming-liaw",fullName:"Chang-Ming Liaw"},{id:"306461",title:"Mr.",name:"Min-Ze",middleName:null,surname:"Lu",slug:"min-ze-lu",fullName:"Min-Ze Lu"},{id:"306463",title:"Mr.",name:"Ping-Hong",middleName:null,surname:"Jhou",slug:"ping-hong-jhou",fullName:"Ping-Hong Jhou"},{id:"306464",title:"Mr.",name:"Kuan-Yu",middleName:null,surname:"Chou",slug:"kuan-yu-chou",fullName:"Kuan-Yu Chou"}]}],onlineFirstChaptersFilter:{topicId:"1",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"83011",title:"E-Waste Management in Different Countries: Strategies, Impacts, and Determinants",slug:"e-waste-management-in-different-countries-strategies-impacts-and-determinants",totalDownloads:3,totalDimensionsCites:null,doi:"10.5772/intechopen.106644",abstract:"Over the last two decades, the electronic equipment has increased dramatically around the world, which causes increasing in e-waste as well. This increasing has affected the environment badly. E-waste disposal has become one of the most critical issues and concerns have raised of it because most of these products do not biodegrade easily and they are toxic. Different strategies have been followed in many countries in order to solve the e-waste problem. Understanding these strategies can help to plan better for e-waste management correctly. Awareness of people about the e-waste impacts is crucial, because it can ensure people participation in managing the e waste process. This research has carried out in order to introduce to the e-waste impacts on environment and human health, and the importance of people awareness about these impacts. In addition, it shows many strategies that have been used in different countries to manage the e-waste, choosing the successful one to focus in order to benefit from it. Furthermore, a surveying has been carried out to exam people awareness in Iraq about the e-waste impacts. Finally, recommendations to manage e-waste successfully have been added.",book:{id:"11533",title:"Advances in Green Electronics Technologies",coverURL:"https://cdn.intechopen.com/books/images_new/11533.jpg"},signatures:"Shireen Ibrahim Mohammed"},{id:"83044",title:"Fatigue Behavior of Reinforced Welded Hand-Holes in Aluminum Light Poles with a Change in Detail Geometry",slug:"fatigue-behavior-of-reinforced-welded-hand-holes-in-aluminum-light-poles-with-a-change-in-detail-geo",totalDownloads:0,totalDimensionsCites:null,doi:"10.5772/intechopen.106342",abstract:"Welded aluminum light poles often contain hand-holes. These hand-holes are used to give access for electrical wiring installation and maintenance purposes. Wind load may cause light poles to be loaded in a cyclic manner. This cyclic loading can cause localized fatigue cracking around the hand-hole. Fatigue failure around hand-holes has been observed in the field, but studies surrounding the resistance of the hand-holes are few and far between. This study included four-point bending fatigue tests on welded aluminum poles containing hand-holes. Eight welded aluminum specimens, each with two hand-holes, were tested in fatigue. These 16 details were loaded at the same stress range. Each specimen had a slightly different geometry or treatment applied to the hand hole. These different details mimicked traditional reinforced hand holes, similar to those evaluated in previous studies. Changes in the treatment and/or geometry included milling the inside of hole, milling the inside of the hole as well as the cast insert prior to welding, and milling the cast insert itself prior to welding. Among the 16 details tested, 15 failed as a result of fatigue cracking. It was found that specimen failure would originated in the throat of the fillet weld and then proceeded to propagate into the reinforcement ring/casting. A finite element analysis was used in addition to the experimental study.",book:{id:"12056",title:"Structural Health Monitoring",coverURL:"https://cdn.intechopen.com/books/images_new/12056.jpg"},signatures:"Cameron R. Rusnak and Craig C. Menzemer"},{id:"83048",title:"Structural, Magnetic, and Magnetodielectric Properties of Bi-Based Modified Ceramic Composites",slug:"structural-magnetic-and-magnetodielectric-properties-of-bi-based-modified-ceramic-composites",totalDownloads:0,totalDimensionsCites:null,doi:"10.5772/intechopen.106569",abstract:"In this chapter, we introduce a promising composite material, which can be used as a potential candidate in the field of charge storage, sensors, and spintronic devices. The structural, magnetic, and magnetodielectric properties of the pure cum composite samples are investigated. The Rietveld refinement of the X-ray data confirmed the presence of a single (A21am) and mixed phases (A21am + R-3c + Pbam) in the pure and composite sample, correspondingly. The SEM microstructure suggests the contrasting nature of the homogeneous and heterogeneous distribution of grains in the corresponding pure and composite sample. The magnetic properties of the composite sample increase due to the enhanced exchange interaction between the different magnetic ions. The frequency-dependent dielectric subjected to a constant magnetic field indicates the signature of magnetodielectric (MD) coupling for both the samples. The field variation of the MD loop shows the symmetric hysteresis loop in the composite due to the addition of magnetostrictive La0.67Sr0.33MnO3 and the non-collinear antiferromagnetic Bi2Fe4O9 phase. The maximum value of MD% (~0.12%) is enhanced by ~13 times in the composite than in the pure sample. Therefore, the improved MD coupling and symmetric switching of the MD loop of the composite make it a suitable candidate for low power consumption storage devices.",book:{id:"11117",title:"Smart and Advanced Ceramics and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11117.jpg"},signatures:"Rasmita Jena, Kouru Chandrakanta and Anil Kumar Singh"},{id:"83032",title:"Introductory Chapter: Solar Photovoltaic Energy",slug:"introductory-chapter-solar-photovoltaic-energy",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.106259",abstract:null,book:{id:"9862",title:"Solar Radiation - Measurements, Modeling and Forecasting for Photovoltaic Solar Energy Applications",coverURL:"https://cdn.intechopen.com/books/images_new/9862.jpg"},signatures:"Mohammadreza Aghaei, Amir Nedaei, Aref Eskandari and Jafar Milimonfared"},{id:"83028",title:"Construction and Modification of Copper Current Collectors for Improved Li Metal Batteries",slug:"construction-and-modification-of-copper-current-collectors-for-improved-li-metal-batteries",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.106540",abstract:"Metallic Lithium have gained great attention for its high theoretical specific capacity. But continuous growth of Li dendrites upon cycling might cause low coulombic efficiency and serious security issues. Construction of advanced 3D Cu current collectors to regulate Li plating/stripping and improve battery performance is considered as one effective promising strategy. In this chapter, we will discuss the roles and requirements of current collectors in lithium metal batteries. Then methods (dealloying, powder-sintering and 3D printing) employed for construction of 3D Cu current collector and implementation of surface modification (lithiophilic sites and coating layers) will be illustrated. At last, future opportunities of Cu current collectors will be lifted out.",book:{id:"11179",title:"Lithium-Ion Batteries - Recent Advanced and Emerging Topics",coverURL:"https://cdn.intechopen.com/books/images_new/11179.jpg"},signatures:"Shunrui Luo and Kai Pei"},{id:"83021",title:"Valorization of Forest Waste for the Production of Dio-oils for Biofuel and Biodiesel",slug:"valorization-of-forest-waste-for-the-production-of-dio-oils-for-biofuel-and-biodiesel",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.105366",abstract:"Biomass is a renewable energy source to generate heat and electricity through the enhancement of various organic materials. Cistus slow pyrolysis of seeds and shells was carried out in a fixed bed reactor to determine the effect of pyrolysis temperature, heating rate, and particle size on the performance of pyrolysis. Therefore, pyrolysis experiments were performed at different temperatures, ranging from 300 to 500°C, with heating rates varying from 10 to 70°C.min−1 for shells and 7 to 28°C.min−1 for seeds. The particle sizes of samples range from 0.3 to 3.5 mm for shells and 0.075 to 1.2 mm for seeds. The highest yield of liquid products (53.31% for shells; 52.24% for seeds) was obtained at a pyrolysis temperature of 450°C and a heating rate of 40°C.min−1 for shells and 21°C.min−1 for seeds. The functional groups and chemical compounds present in the bio-oil obtained under optimal conditions were identified by FTIR. The calorific value of the bio-oil was equal to 37.05 and 37.93 MJ.kg−1 for shells and seeds, respectively. The obtained results show that the bio-oil from the pyrolysis of Cistus shells and seeds could be used as a renewable fuel or a source of pharmaceutical and chemical raw material.",book:{id:"11533",title:"Advances in Green Electronics Technologies",coverURL:"https://cdn.intechopen.com/books/images_new/11533.jpg"},signatures:"Hammadi el Farissi"}],onlineFirstChaptersTotal:806},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. 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"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). 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. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. 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. 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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:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",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"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. 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She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}}]}},subseries:{item:{id:"3",type:"subseries",title:"Bacterial Infectious Diseases",keywords:"Antibiotics, Biofilm, Antibiotic Resistance, Host-microbiota Relationship, Treatment, Diagnostic Tools",scope:"