Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
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We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
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Throughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\n
We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\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:"7059",leadTitle:null,fullTitle:"Amyloid Diseases",title:"Amyloid Diseases",subtitle:null,reviewType:"peer-reviewed",abstract:"Neurodegenerative diseases are severe, rapidly developing, and currently incurable conditions that result in progressive degeneration and the death of neurons. This causes dementia, movement problems, and essentially loss of personal identity. Amyloids attempts to answer the following questions: (1) why do we develop these severe neurodegenerative diseases? (2) what histological and physiological changes are observed upon development and progression of these diseases? and (3) how can we treat amyloid-associated diseases?",isbn:"978-1-78985-382-7",printIsbn:"978-1-78985-381-0",pdfIsbn:"978-1-83881-132-7",doi:"10.5772/intechopen.73821",price:119,priceEur:129,priceUsd:155,slug:"amyloid-diseases",numberOfPages:242,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"d9a197d34d3d6006af726d577060f928",bookSignature:"Dmitry Kurouski",publishedDate:"August 7th 2019",coverURL:"https://cdn.intechopen.com/books/images_new/7059.jpg",numberOfDownloads:13589,numberOfWosCitations:5,numberOfCrossrefCitations:8,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:19,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:32,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 27th 2018",dateEndSecondStepPublish:"October 8th 2018",dateEndThirdStepPublish:"December 7th 2018",dateEndFourthStepPublish:"February 25th 2019",dateEndFifthStepPublish:"April 26th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"264297",title:"Dr.",name:"Dmitry",middleName:null,surname:"Kurouski",slug:"dmitry-kurouski",fullName:"Dmitry Kurouski",profilePictureURL:"https://mts.intechopen.com/storage/users/264297/images/system/264297.JPG",biography:"Dmitry Kurouski earned an MS in Biochemistry from Belarusian State University, Belarus, and a Ph.D. (Distinguished Dissertation) in Analytical Chemistry from SUNY Albany, New York. After completing a postdoc in the laboratory of Professor Richard P. Van Duyne at Northwestern University, Illinois, Dr. Kurouski joined Boehringer Ingelheim Pharmaceuticals, where he worked as Senior Research Scientist. In 2017, Dr. Kurouski joined the Biochemistry and Biophysics Department of Texas A&M University as Assistant Professor. His research focuses on the nanoscale characterization of biological and photocatalytic systems using tip-enhanced Raman spectroscopy (TERS) and atomic force microscope infrared spectroscopy (AFM-IR).",institutionString:"Texas A&M University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Texas A&M University",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"178",title:"Endocrinology",slug:"medicine-endocrinology"}],chapters:[{id:"64910",title:"The Clinical Spectrum of Amyloidosis",doi:"10.5772/intechopen.82763",slug:"the-clinical-spectrum-of-amyloidosis",totalDownloads:1312,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Amyloidosis is a group of disorders that share a common pathobiology: in each case, a protein that exhibits misfolding is deposited in one or multiple organs leading to disruption in organ function. These amyloid proteins are recognized as amorphous pink material in Hematoxylin and Eosin staining, with confirmation by staining with Congo red and yellow or green birefringence under polarized light microscope. To date at least 36 different types of amyloid proteins have been identified. Worldwide, AA amyloidosis is the most common type, and this occurs secondary to chronic inflammatory disease states—such as chronic infections and rheumatological disorders. In western countries, the incidence of AA amyloidosis is decreasing, and AL is the most common type of amyloidosis, characterized by amyloid due to light chain deposition. ATTR amyloidosis, which can be either hereditary or acquired, is a unique variant of systemic amyloidosis that results from mutations in the transthyretin (TTR) gene. Our review will focus on clinical features of the most common systemic amyloidosis, with a detailed review on evaluation and management of AA, AL and ATTR amyloidosis.",signatures:"Aswanth Reddy, Enrique Ballesteros and Jonathan Scott Harrison",downloadPdfUrl:"/chapter/pdf-download/64910",previewPdfUrl:"/chapter/pdf-preview/64910",authors:[{id:"267372",title:"Prof.",name:"Jonathan",surname:"Harrison",slug:"jonathan-harrison",fullName:"Jonathan Harrison"},{id:"283311",title:"Dr.",name:"Aswanth",surname:"Reddy",slug:"aswanth-reddy",fullName:"Aswanth Reddy"},{id:"285338",title:"Dr.",name:"Enrique",surname:"Ballesteros",slug:"enrique-ballesteros",fullName:"Enrique Ballesteros"}],corrections:null},{id:"66228",title:"Amyloidosis: Systems-Based Therapies",doi:"10.5772/intechopen.85201",slug:"amyloidosis-systems-based-therapies",totalDownloads:865,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In this chapter, the authors will discuss the epidemiology and clinical presentations of amyloidosis. The main body of this chapter will concentrate on treatment options, both FDA-approved and experimental, specific to the various forms of amyloidosis. Since this set of diseases can affect multiple organ systems, we tackle the therapeutic avenues and the current challenges in each system under clinical investigation, including neurological, psychiatric, gastrointestinal, cardiovascular, endocrine, renal and hematologic, in addition to options for palliative treatment for severe symptom management and improved quality of life. Several recent groundbreaking discoveries have opened up the potential for successful treatment of peripheral and central neurological amyloidoses making this an exciting and evolving field.",signatures:"Eileen Ly, Anu Stephen, Yasmeen Alhomsy, Asal Homayouni, Joshua Fisher, Kayla Sheehan, Prashanth Venkataraman, Quinto Gesiotto, Matthew Habib and Matthew Zabel",downloadPdfUrl:"/chapter/pdf-download/66228",previewPdfUrl:"/chapter/pdf-preview/66228",authors:[{id:"232127",title:"Dr.",name:"Matthew",surname:"Zabel",slug:"matthew-zabel",fullName:"Matthew Zabel"},{id:"284963",title:"MSc.",name:"Kayla",surname:"Sheehan",slug:"kayla-sheehan",fullName:"Kayla Sheehan"},{id:"285159",title:"BSc.",name:"Yasmeen",surname:"Alhomsy",slug:"yasmeen-alhomsy",fullName:"Yasmeen Alhomsy"},{id:"285160",title:"MSc.",name:"Quinto",surname:"Gesiotto",slug:"quinto-gesiotto",fullName:"Quinto Gesiotto"},{id:"285162",title:"BSc.",name:"Eileen",surname:"Ly",slug:"eileen-ly",fullName:"Eileen Ly"},{id:"285164",title:"MSc.",name:"Anu",surname:"Stephen",slug:"anu-stephen",fullName:"Anu Stephen"},{id:"285165",title:"BSc.",name:"Asal",surname:"Homayouni",slug:"asal-homayouni",fullName:"Asal Homayouni"},{id:"285166",title:"MSc.",name:"Joshua",surname:"Fisher",slug:"joshua-fisher",fullName:"Joshua Fisher"},{id:"285168",title:"BSc.",name:"Prashanth",surname:"Venkataraman",slug:"prashanth-venkataraman",fullName:"Prashanth Venkataraman"},{id:"285169",title:"BSc.",name:"Matthew",surname:"Habib",slug:"matthew-habib",fullName:"Matthew Habib"}],corrections:null},{id:"64236",title:"The Role of Inflammation in Amyloid Diseases",doi:"10.5772/intechopen.81888",slug:"the-role-of-inflammation-in-amyloid-diseases",totalDownloads:1051,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Amyloid diseases are characterized by the abnormal accumulation of proteinaceous aggregates (amyloid fibrils or plaques) in tissues and organs. This class of diseases is also characterized by the presence of inflammation. Amyloid fibrils arise from the partial denaturing and unfolding of native proteins. The accumulation of amyloid fibrils causes tissue damage and elicits local and nonlocal immune cell infiltration into tissue and proinflammatory cytokine production. Moreover, these conditions fuel a vicious cycle that can increase amyloid production and create an environment of chronic inflammation. A chronically inflamed tissue rapidly deteriorates and loses its function. In this chapter, we will discuss important data gathered over the years describing the role of inflammation in amyloid diseases. We will describe how inflammation begins and how it affects disease progression for major amyloid diseases, such as Alzheimer’s disease (AD) and hereditary TTR amyloidosis (hATTR). Lastly, we will discuss the recent advancements in treatments for amyloid diseases and how they address inflammation in affected patients.",signatures:"Estefania P. Azevedo and Debora Foguel",downloadPdfUrl:"/chapter/pdf-download/64236",previewPdfUrl:"/chapter/pdf-preview/64236",authors:[{id:"45002",title:"Dr.",name:"Debora",surname:"Foguel",slug:"debora-foguel",fullName:"Debora Foguel"},{id:"266464",title:"Dr.",name:"Estefania",surname:"Azevedo",slug:"estefania-azevedo",fullName:"Estefania Azevedo"}],corrections:null},{id:"65517",title:"Pathologic Findings of Amyloidosis: Recent Advances",doi:"10.5772/intechopen.84268",slug:"pathologic-findings-of-amyloidosis-recent-advances",totalDownloads:1265,totalCrossrefCites:2,totalDimensionsCites:6,hasAltmetrics:0,abstract:"Amyloids are aggregations of misfolded protein, which creates fibrillary structures. Unlike normally folded proteins, misfolded fibrils are insoluble and deposited extracellularly or intracellularly. The pathologic mechanism is still unclear, but resultant toxic oligomers within the tissue are known to damage the tissue via aberrant protein interactions. This condition has been known as amyloidosis. Different kinds of amyloid protein may cause similar or different clinical signs and symptoms, largely depending on the target organ it is deposited. However, because treatments and prognoses of each type are different drastically, it is critical to distinguish them and determine the specific type of amyloidosis. The confirmation and typing of amyloid heavily depend on pathologic examination of tissue. The gold standard method for the former is a Congo red staining and birefringence under polarized microscopy. The conventional way for the latter is immunohistochemistry (IHC), where most of the amyloid types can be classified. However, electron microscopy, mass spectrometry, or other molecular methods are required for typing some amyloids that are difficult to identify through IHC. In this chapter, we will describe basic concepts of amyloidosis and pathologic findings of amyloid deposition, including atypical structural deposition. Furthermore, we will review methodologies for amyloid typing briefly.",signatures:"Moon Joo Kim, Donghwa Baek, Luan Truong and Jae Y. Ro",downloadPdfUrl:"/chapter/pdf-download/65517",previewPdfUrl:"/chapter/pdf-preview/65517",authors:[{id:"265784",title:"Dr.",name:"Luan",surname:"Truong",slug:"luan-truong",fullName:"Luan Truong"},{id:"288705",title:"Prof.",name:"Jae Y.",surname:"Ro",slug:"jae-y.-ro",fullName:"Jae Y. Ro"},{id:"288711",title:"M.D.",name:"Moon Joo",surname:"Kim",slug:"moon-joo-kim",fullName:"Moon Joo Kim"},{id:"288820",title:"Dr.",name:"Donghwa",surname:"Baek",slug:"donghwa-baek",fullName:"Donghwa Baek"}],corrections:null},{id:"64253",title:"Renal Amyloidosis",doi:"10.5772/intechopen.81677",slug:"renal-amyloidosis",totalDownloads:1034,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Modern amyloid nomenclature, based on the amyloid fibril proteins, includes 31 types of amyloidosis. Renal involvement is commonly seen in AA, AL, and several other hereditary and acquired amyloidoses. AA amyloidosis, constituting up to 45% of all systemic amyloidosis cases, is associated with wide variety of chronic inflammatory conditions. The precursor protein of the fibrils in AA amyloidosis is an apolipoprotein, called serum amyloid A, and produced in the liver in response to proinflammatory cytokines. AL amyloidosis is actually known to be the most common form of systemic amyloidosis in the Western countries. In this type of amyloidosis the precursor proteins are monoclonal immunoglobulin light chains, produced by plasma cell clone. Clinical diagnosis of AA and AL systemic amyloidosis is based on the presence of proteinuria or nephrotic syndrome and impaired kidney function in patients with extrarenal manifestations. Kidney biopsy is crucial for the diagnostics, and while Congo red staining with examination of Congo-positive material in the polarized light is confirmative for amyloidosis as such, immune staining, helpful to distinguish AA and AL types, guides treatment strategies. In cases when neither AA nor AL amyloidosis are confirmed, one should consider rare types of amyloidosis—ALECT2, AapolA, AFib or ALys.",signatures:"Elena Zakharova",downloadPdfUrl:"/chapter/pdf-download/64253",previewPdfUrl:"/chapter/pdf-preview/64253",authors:[{id:"267797",title:"Ph.D.",name:"Elena",surname:"Zakharova",slug:"elena-zakharova",fullName:"Elena Zakharova"}],corrections:null},{id:"65662",title:"Neurological Manifestations of Transthyretin-Related Amyloidosis",doi:"10.5772/intechopen.84470",slug:"neurological-manifestations-of-transthyretin-related-amyloidosis",totalDownloads:1159,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Transthyretin related amyloidosis (ATTR) results from the tissue deposition of misfolded mutant or wild-type transthyretin (TTR). Involvement of nervous system often heralds the onset of ATTR. Familial ATTR is because of mutations in the TTR gene which lead to destabilization of the tetrameric structure of TTR and generation of amyloidogenic monomers, tissue deposition of which causes end organ injury specially neuropathy and cardiomyopathy. Peripheral neuropathy is typically axonal with early involvement of the autonomic nerves. Wild-type TTR (ATTRwt), is a common cause of cardiomyopathy in the elderly and may play a role in the pathogenesis of carpal tunnel syndrome and spinal stenosis in that age group. Diagnosis of ATTR is made by demonstrating tissue amyloid deposits, then proving that the amyloid deposits consist of mutant or wild-type TTR, which necessitates assessment of TTR gene sequencing. Disease modifying treatments have become available for ATTR through liver transplantation, stabilization of the TTR molecule (diflunisal and tafamidis) and suppressing the gene expression of TTR (inotersen and patisiran).",signatures:"Kourosh Rezania and Laleh Saadat",downloadPdfUrl:"/chapter/pdf-download/65662",previewPdfUrl:"/chapter/pdf-preview/65662",authors:[{id:"143549",title:"Dr.",name:"Kourosh",surname:"Rezania",slug:"kourosh-rezania",fullName:"Kourosh Rezania"},{id:"290876",title:"Dr.",name:"Laleh",surname:"Saadat",slug:"laleh-saadat",fullName:"Laleh Saadat"}],corrections:null},{id:"64034",title:"Serum Amyloid A and Immunomodulation",doi:"10.5772/intechopen.81617",slug:"serum-amyloid-a-and-immunomodulation",totalDownloads:1242,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Serum amyloid A1 (SAA1), a major isoform of acute-phase SAA, is a well-known precursor of amyloid A (AA) that contributes to secondary amyloidosis with its tissue deposition. Acute-phase SAA is also a biomarker of inflammation. Recent studies have focused on the roles for acute-phase SAA in the regulation of immunity and inflammation. In vitro characterization of recombinant human SAA identified its chemotactic and cytokine-like properties, whereas the use of SAA isoform-specific transgenic and knockout mice has led to the discovery of new functions of SAA proteins in host defense and tissue homeostasis. Characterization of SAA-derived peptides has shown that fragments of SAA, generated through proteolysis, are bioactive and may contribute to a growing list of functions related to inflammation. This chapter summarizes recent progress in the studies of acute-phase SAA and its fragments in inflammation and immunomodulation.",signatures:"Yu Fan, Chi Teng Vong and Richard D. Ye",downloadPdfUrl:"/chapter/pdf-download/64034",previewPdfUrl:"/chapter/pdf-preview/64034",authors:[{id:"267982",title:"Prof.",name:"Richard",surname:"Ye",slug:"richard-ye",fullName:"Richard Ye"},{id:"275523",title:"Ms.",name:"Yu",surname:"Fan",slug:"yu-fan",fullName:"Yu Fan"},{id:"275525",title:"Dr.",name:"Chi Teng",surname:"Vong",slug:"chi-teng-vong",fullName:"Chi Teng Vong"}],corrections:null},{id:"64581",title:"Neuropathology of Traumatic Brain Injury and Its Role in the Development of Alzheimer’s Disease",doi:"10.5772/intechopen.81945",slug:"neuropathology-of-traumatic-brain-injury-and-its-role-in-the-development-of-alzheimer-s-disease",totalDownloads:1638,totalCrossrefCites:1,totalDimensionsCites:4,hasAltmetrics:1,abstract:"The devastating deficiencies that result from brain injury stem from multiple overlapping mechanisms, exacerbated by the fact that there are no effective treatments. Traumatic brain injury (TBI) is recognized as the most influential environmental risk factor for neurodegenerative disease later in life, including dementia of Alzheimer’s disease (AD)-type. However, exactly how TBI triggers and strengthens the neurodegenerative cascade of events in AD remains controversial. Amyloid deposits and fibril precursor protein are extracellular in systemic amyloid A (AA) amyloidosis. In this chapter, I will discuss the neuropathology following TBI connected to AD. Additionally, I critically review recent animal and human studies regarding how brain trauma affects the potential risks factors for AD progression. Furthermore, it will be shown investigate the principal pathological features of dementia or AD, specifically focusing on axonal damage and consequent cleavage of the amyloid precursor protein (APP), amyloid β plaque formation, or phosphorylation and aggregation of tau, neurofibrillary tangles formation, and TDP-43 accumulation. In summary, despite recent progress more studies are required to (1) further understanding of the basic mechanisms and pathophysiology of TBI, (2) elucidate the precise association between TBI and neurodegenerative disease, and (3) to identify treatments and therapies that can mitigate long-term consequences.",signatures:"Sonia Villapol",downloadPdfUrl:"/chapter/pdf-download/64581",previewPdfUrl:"/chapter/pdf-preview/64581",authors:[{id:"152212",title:"Dr.",name:"Sonia",surname:"Villapol",slug:"sonia-villapol",fullName:"Sonia Villapol"}],corrections:null},{id:"66980",title:'Inhibition of Protein Fibrillation by Hydrogen Sulfide1',doi:"10.5772/intechopen.86221",slug:"inhibition-of-protein-fibrillation-by-hydrogen-sulfide-xref-rid-fn1-ref-type-fn-sup-1-sup-xref-",totalDownloads:898,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Amyloid fibrils are misfolded proteins, which are often associated with various neurodegenerative diseases such as Alzheimer’s. The amount of hydrogen sulfide (H2S) is known to be reduced in the brain tissue of people diagnosed with Alzheimer’s disease relative to that of healthy individuals. Hen Egg-White Lysozyme (HEWL) forms typical β-sheet-rich fibrils during 70 minutes at low pH and high temperatures. These results are consistent with the ThT findings that β-sheets structure is also present in myoglobin (Mb), and hemoglobin (Hb) in the presence of 45% TFE. The addition of H2S in the process completely inhibits the formation of amyloid fibrils in HEWL, Mb, and Hb as revealed by several spectroscopic techniques. Non-resonance Raman bands corresponding to disulfide (RSSR) vibrational modes in the 550-500 cm-1 spectral range decreases in intensity and is accompanied by the appearance of a new 490 cm-1 band assigned to the trisulfide group (RSSSR). Intrinsic tryptophan fluorescence shows a partial denaturation of HEWL containing trisulfide bonds. Overall, the Mb and Hb result ties excellent with the HEWL data showing that the presence of H2S during these proteins fibrillation processes protects the α-helical protein structures, preventing the formation of amyloids in these different proteins moieties.",signatures:"Manuel F. Rosario-Alomar, Tatiana Quiñones-Ruiz, Dmitry Kurouski, Valentin Sereda, Eduardo DeBarros-Ferreira, Lorraine De Jesús-Kim, Samuel Hernández-Rivera, Dmitri V. Zagorevski, Leishla M. Cruz-Collazo, Igor K. Lednev and Juan López-Garriga",downloadPdfUrl:"/chapter/pdf-download/66980",previewPdfUrl:"/chapter/pdf-preview/66980",authors:[{id:"180684",title:"Dr.",name:"Juan",surname:"Lopez-Garriga",slug:"juan-lopez-garriga",fullName:"Juan Lopez-Garriga"},{id:"183396",title:"Prof.",name:"Igor",surname:"Lednev",slug:"igor-lednev",fullName:"Igor Lednev"},{id:"288811",title:"Mr.",name:"Manuel",surname:"Rosario-Alomar",slug:"manuel-rosario-alomar",fullName:"Manuel Rosario-Alomar"},{id:"288812",title:"Mrs.",name:"Tatiana",surname:"Quiñones-Ruiz",slug:"tatiana-quinones-ruiz",fullName:"Tatiana Quiñones-Ruiz"},{id:"288813",title:"Ph.D. Student",name:"Leishla",surname:"Cruz-Collazo",slug:"leishla-cruz-collazo",fullName:"Leishla Cruz-Collazo"}],corrections:null},{id:"64516",title:"Pathophysiology of Amyloid Fibril Formation",doi:"10.5772/intechopen.81965",slug:"pathophysiology-of-amyloid-fibril-formation",totalDownloads:944,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"All amyloid comprises fibrillar polymers of tightly associated protein monomers. Central to the fibril structure is a highly ordered β-pleated sheet domain although this interacting region may only be a relatively short stretch of each constituent polypeptide chain. Fibril formation begins as a nucleation event based either on the constituent monomer protein or its proteolytic fragment(s). The resulting fibrils are generally chemically inert and very stable.",signatures:"George H. Sack Jr.",downloadPdfUrl:"/chapter/pdf-download/64516",previewPdfUrl:"/chapter/pdf-preview/64516",authors:[{id:"269035",title:"Dr.",name:"George",surname:"Sack",slug:"george-sack",fullName:"George Sack"}],corrections:null},{id:"65449",title:"Neuroprotective Function of Non-Proteolytic Amyloid-β Chaperones in Alzheimer’s Disease",doi:"10.5772/intechopen.84238",slug:"neuroprotective-function-of-non-proteolytic-amyloid-chaperones-in-alzheimer-s-disease",totalDownloads:916,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:1,abstract:"This chapter attempts to explore protective role of chaperone proteins in the neurodegenerative diseases caused by amyloidosis. These chaperones prevent amyloid pathology either directly, through chemical interactions with amyloidogenic species to mediate their refolding, solubilization and degradation, or indirectly, by scavenging reactive oxygen species produced as by-products of amyloid aggregation. Here we focus on structural and morphological changes during aggregation of amyloids which have been identified using Nuclear magnetic resonance spectroscopy, X-ray crystallography, Electron microscopy, Atomic force microscopy and other biophysical techniques as well as interactions between chaperone proteins and amyloid moieties. Non-proteolytic chaperones mediate amyloid clearance and metabolism through conformational changes due to proximity binding. In this chapter, we delineate these interactions as well as the molecular mechanism of chaperones used to sequester ROS products of amyloidosis with focus on amyloid-β peptides associated with the Alzheimer’s disease.",signatures:"Bhargy Sharma and Konstantin Pervushin",downloadPdfUrl:"/chapter/pdf-download/65449",previewPdfUrl:"/chapter/pdf-preview/65449",authors:[{id:"284742",title:"Ph.D. Student",name:"Bhargy",surname:"Sharma",slug:"bhargy-sharma",fullName:"Bhargy Sharma"},{id:"284765",title:"Dr.",name:"Konstantin",surname:"Pervushin",slug:"konstantin-pervushin",fullName:"Konstantin Pervushin"}],corrections:null},{id:"65800",title:"Diabetes Mellitus and Amyloid Beta Protein Pathology in Dementia",doi:"10.5772/intechopen.84473",slug:"diabetes-mellitus-and-amyloid-beta-protein-pathology-in-dementia",totalDownloads:1266,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Amyloidosis is a pathological condition which consists on the accumulation of fibrillar proteins. This disease is characterized by extracellular amyloid deposits with a clinical variability depending on the affected tissue. Histopathological evidence indicates that diabetes mellitus type 2 (DM2) induces dementia development, specifically Alzheimer’s disease (AD). It has been demonstrated in animal subjects that there is a possibility that aberrant signaling of insulin is a key factor in the induction of the pathology of AD. Recently, there has been newly emerged evidence regarding the relationship between the pathogenesis of Parkinson’s disease (PD) and insulin resistance. On another note, the importance of the amyloid deposits in the patients’ pancreas with DM2 was evidenced by the discovery of islets of amyloid polypeptide. This has generated interest in the search of the etiopathogenic role of DM2 in the carbohydrates’ metabolism. 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\r\n\tTendons are the biological and mechanical interface between muscles and bones. Their physiological role is to transfer the force of the muscle contraction to joint movements. As such, the structure of tendons has semi-elastic properties due to their connective tissue content and therefore are prone to inflammatory degeneration and structural failure that cause high disabling effects, primarily pain and impaired joint function.
\r\n
\r\n\tThis book will be the academic forum to discuss the causes and the advances in the current understanding and treatment of structural pathologies involving tendons related to mechanical and inflammatory aspects of tendon pathologies.
\r\n
\r\n\tOn the mechanical part, the book will present the current approach to traumatic and degenerative tears of rotator cuff tendons, Achilles tendon and peroneal tendons injuries and degeneration, traumatic injuries to proximal and distal biceps tendons, tendon ruptures in hand and wrist, etc. The particular interest is to describe the recent development in tissue engineering techniques for biological approaches for tendon repair and healing enhancement. Surgical advances to treat tendon ruptures are highly preferred to be discussed in the book.
\r\n
\r\n\tAdditionally, discussion on advances in pharmacological approaches for inflammatory conditions involving tendons is an integral part of this project, especially regarding the molecular basis of anti-inflammatory agents for tendinitis treatment.
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1. Introduction
Psychoanalytic and psychiatric practices have often got me in touch with people displaying a disproportionate fear of infectious diseases. They wastes their life among washing and cleaning rituals, but can get back no sense of safeness. The patient’s partner or relatives – at length even the patient himself – get to realize his anxiety about infectious risk is clearly unrealistic and that he is wasting all of his existential energy. So, in the end a professional help is sought, and a psychiatric diagnosis is formulated, which generally includes phobic neurosis or hypochondriasis.
Anxiety about inter-human contact has a long story and no doubt antedates our modern understanding of the etiology of infectious diseases. In primitive or archaic societies contact with certain members of the community was associated with the violation of severe religious prohibitions. The anthropological literature speaks of taboos [1, 2]. In the caste system, which till now has a substantial impact on Indian social structure, the even indirect contact with members of inferior castes is bound to elicit a dangerous pollution.
In Europe the culturally accepted representation of pollution had gone through several stages over time. Medieval Christianity focused on improperly polluted sexual contacts. The water of Greek-Roman ritual purifications gave so way to the sacrament of Penance, which included magical components and often featured a compulsive quality.
In modern societies the danger associated with inter-human contact has often been equated with an infectious threat. So the feared contagion diffused by supposed plague spreaders has repeatedly replaced sexuality as a paradigm of pollution. In his masterpiece, I Promessi Sposi, Alessandro Manzoni [3] taught the readers how the populace is permanently willing to unleash against guiltless minorities whenever health and physical life are supposedly endangered.
Nowadays, humanity is confronted again after decades with an infectious disease characterized by significant morbidity and mortality rates, particularly so in older people. And fear grows more and more. Epidemiologists, the government, the media, and the public opinion are racing in the pledge for more and more restrictive measures which put severe limits to individual freedom.
Hostility among citizens is increasing by the day. Older retired women use to blame the rare pedestrians when they fail to properly wear their face masks; fierce checkout girls spell detailed hygienic regulation to fearful consumers; zealous citizens report to the police their neighbour for any supposed violation of lock-down measures; young people with substantial internet skills expose innocent runners or reckless children to mediatic shame.
No doubt: the SARS COVID-19 Coronavirus had yielded a deep and dramatic cultural change. The epidemic mitigation measures have called for an interpersonal distancing which is unprecedented in western history. Social and economic problems which have been tripping European governments over the last decades have been suddenly put aside, while public wealth has been wasted without reserve in the unfortunately useless attempt to stop the spread of the disease.
In a recent book [4], the well-known philosopher Gorgio Agamben formulated the coronavirus epidemic within the framework of German theory of the state as a state of exception [5], an emergency against which the constitutional guarantees appear as absolutely irrelevant, needless concern for trifler jurists. Freedom, social justice, religious experience and the whole lore of values on which our society is based – values which could be established only through long and bloody struggles – have suddenly lost all of their importance.
Fear has gained a core position in current socially shared representation of human reality. The politicians, the media and the public opinion have unanimously agreed that all the social structure and the economic organization should be rapidly reformulated according to illness prevention needs.
Just as in primitive or early modern societies, contagion, contact and fear occupy the centre stage. Hypochondriac anxieties have begun to spill out of the corner where modern thought and the advancements of medicine had confined them. The phobic parts of personality have taken control of contemporary culture.
So, in XXI century advanced societies, hypochondriasis becomes the official, or rather the single accepted thought, and severe opponents of critical thinking call for a strict censorship of any dissent.
The dissidents have been the victim of a savage mediatic campaign which associates them explicitly to neo-Nazi’s intellectuals. Just as the latter strive to negate the width of Hitler instigated butchery of Jews during World War II, the opponents of the health related state of exception would be negationsists, i.e. obviously insane or even demented people [6].
Against such a background several eminent psychoanalyst have taken sides. They have openly blamed dissidents. They have suggested psychoanalysis gives up its traditional option for neutrality and enlists beside traditional institutional powers in the repression of dissent.
Over the last years a greater integration of psychoanalysis within the healthcare system has been authoritatively advocated [7]. Now Austin Ratner [8], an advisor to the American Psychoanalytic Association advocacy, public information, messaging, and branding task force, stated that psychoanalysis should contribute to fostering the citizens’ widest consensus to contagion preventing measures.
In Italy, many mediatically prominent psychoanalysts are sharply critical of the opponents of the government. Massimo Recalcati (“I paradossi della tirannia sanitaria” La Stampa, October 13th, 2020) writes that lockdown critics fall prey of an “underestimation of the clinical and epidemical severity of the virus”. The opponents of institutional power would be only immoral “libertines”, unable to tolerate the wise limits which political institutions have to pose to an unrestrained freedom.
In an interview to the TV network La7 Umberto Galimberti does not hesitate to name the dissidents mad and delirious. “With lunatics you can’t easily discuss. Can you persuade those who deny reality that reality is different? It is very difficult”. Meanwhile, from the pages of Il Sole - 24 Ore Vittorio Lingiardi and Guido Giovanardi summon all psychoanalytic colleagues to join forces against any dissent to the management of the pandemic emergency.
Lingiardi and Giovanardi have no doubts: any opposition to infection prevention measures “increases the number of cases and deaths due to coronavirus infections” and is dependent on a primitive mental functioning, where denial is a basic defense mechanism. Psychoanalysis should therefore leave her century old withdrawal from the political arena and become “a force for social change” merging within public health institutions with the aim to reeducate and free from their own neuroses the scanty army of the dissidents.
Sarantis Thanopolus, current President of the Italian Psychoanalytic Society, in an article for the Huffington Post, Italian edition, chose a more balanced position. He believes psychoanalysts should stick to a mainly clinical attitude and be available to treat both patients denying the severity of the epidemic risk and the phobic excesses which the pandemic emergency might induce in predisposed subjects.
2. Mental health and social control
How could this deep change be brought about? How could psychoanalysis turn into a compliant device for the management of public opinion? In order to answer this question we will now cast a look at the history of the relations between professionals and praxes of mental health, on one side, and control of socially improper behaviors, on the other.
Our review will begin with the late Middle Ages. In the year 1321, authorities close to the King of France began to spread (obviously forged) evidence that a dangerous international plot was underway ([9], p 5–28). The plot would have been supported by Islamic powers along the Mediterranean coasts and maybe by international Jewish elites.
The plot was aiming to overthrow legitimate Christian sovereigns and establish a new rule. The inquirers had no doubt about the main agents in the conspiracy: people living at the margins and all the more dangerous as suffering from an infectious disease. The Pope couldn’t but yield to the overwhelming evidence and authorized the civil servants to take appropriate action.
The lepers’ slaughter began in June, 1321, in several cities. The outraged populace took active part in the repression of the rascals, enthusiastically welcomed the authorities’ recommendations and, should these prove late, initiated the rampage without waiting for “a judge or a bailiff”.
As could be expected, such a wide slaughter could not be completed. The surviving lepers were therefore permanently confined within ad hoc institutions. Focault [10] taught us that in the Baroque age lunatics will become the heirs of these very places devoted to seclusion and control.
Official psychiatric narratives celebrates Philippe Pinel as the man who gave back freedom to lunatics, in 1795. Actually Pinel released lunatics from workhouses where their behavior had been controlled and their vices punished, but their psychiatric condition had never been treated. However, in the state hospital which succeeded to workhouses as a place for the specialized treatment of mental disorders, behavioral control rapidly reemerged as a basic institutional goal. In Italy, it took to Franco Basaglia decades of political fight to obtain a law who banned psychiatric hospitals, in 1978.
Psychiatrists in clinical practice know all too well that to the general public madness has always amounted to a frightful ghost, a gloomy, lurking danger which needs to be put under control at all costs. I will not discuss here the upsetting condition of contemporary psychiatric care in Italy or elsewhere, but none will deny that the control of improper behavior still stays a core concern of psychiatric services.
Today, against the background of epidemic emergencies, from psychiatric and psychoanalytic institutions something more is required than the sole enforcement of social norms. Nowadays, mental health professionals are called to substantially contribute to the establishment of an unrestricted compliance with institutionally proposed beliefs and ethical values.
This more ambitious social goal is however no complete novelty either. The reader may consider the role psychiatric services played in Soviet Russia as a device for the repression of political dissent [11]. In Soviet society the control of dissent relied on two concurrent and cooperating paradigms: the criminal justice and the mental health services. The Art. 70 in Soviet Criminal Code of 1958 included the crime of “Disorders and anti-Soviet propaganda”. In addition, the “Dissemination of fabrications known to be false, which defame the Soviet political and social system” was the focus of the Art. 190–1, introduced in 1967.
The harsh juridical procedures were integrated by mental health interventions. A large number of dissidents were classified as suffering with mental disorders and relegated into psychiatric institutions. On a descriptive perspective, heterodox political ideas were interpreted in terms of delusion of reform, while the diagnostic category of latent schizophrenia was the most relied upon in order to justify compulsory admissions.
In the most perfect society the world over, opposition to government was obviously evidence of madness. As Khrushchev wrote on the Pravda of May 24th, 1959:
Can there be diseases, nervous disorders among certain people in a Communist society? Evidently yes. If that is so, then there will also be offences, which are characteristic of people with abnormal minds. Of those who might start calling for opposition to Communism on this basis, we can say that clearly their mental state is not normal.
The parallel between Khrushchev’s thoughts and Galimberti’s unsympathetic devaluation of lock-down opponents is obvious and dismaying. In Soviet Russia political violence and repression were everyday means to enforce consensus. We do hope they will not soon infiltrate the democratic West, too.
3. Negation and negationism
Propaganda, no less than advertisement, thrives on a skillful distortion of language. Psychoanalytic theory and practice, on the other hand, requires extreme accuracy in word selection and use. Before we develop further our review of the role of psychoanalysis with reference to health related negationism vs. conformism, we need discuss briefly some words which are relevant to the issue.
Denial may refer to both internal and external reality. This may create substantial confusion. So, in order to be more accurate, we’d better rely on the original German terms. The Verneigung [12] is a defense mechanism. It withdraws from knowledge a content of the Unconscious through a direct negation. Here is an example from Freud’s: “Sie fragen, wer diese Person im traum sein kann. Die Mutter ist es nicht” (“You ask me who such person in the dream might be. It’s not mother”, ([12], p 11)). The Verneinung do not remove a piece of information from reality (e.g., about virus lethality), it focuses on unconscious contents. It can in no way be associated with health prevention measures dissent.
The concept of Verleugnung was introduced by Freud in 1923 (Die Realitätverlust bei Neurose und Psychose, ([13], p 365)) and was further discussed in 1927 (Fetischismus, ([14], p 311 ff.)). Verleugnung tackles unpleasant realities and perceptions by directly disavowing them. In Fetischismus Freud mentioned two patients refusing to acknowledge their father’s death.
Verleugnung is a primitive defense mechanism and is typically associated with schizophrenia or severe paraphilias. It operates on factual, universally shared realities, not on political or philosophical beliefs. It cannot help understand neither the socially spread dissent to illness prevention measures nor the poor trust in political institutions.
We may mention here Schizophrenic Negativism. It is a symptom of schizophrenia. It implies the refuse to perform what is required by the visiting physician. It is a symptom of a dysfunction of will, not of thought or cognition.
Let us finally come to the historical Negationism or Shoah Denial, a concept to which several supporters of educational psychoanalysis have associated any opposition to the epidemic mitigation measures. Shoah Negationism or Denial is an ideology purported by Neo-Nazi intellectuals. It denies the extent of the butchery of the Hebrew people which was implemented by Nazi institutions during World War II.
From a psychoanalytic point of view, Shoah Denial amounts to a sadistic interpersonal strategy. It aims to elicit the maximum possible emotional pain in the political enemies, through the downplaying and pollution of their most intimate and traumatic collective memories. It should not be misunderstood as a defense mechanism.
How can we then realistically describe social movements opposing pandemia mitigating measures? Which words could be the most appropriate? The core issue with preventive measure oppositions is no doubt the dissent with reference to the prevailing representations of and solution to the epidemic phenomenon, as are proposed by media and by scientific and political institutions. Dissent is the attitude of those who disagree with the prevailing ideology in a specific community.
Over the course of history, the citizens have ranged again and again along opposite poles: Catholic and Lutherans, fascists and antifascists, patriots and reactionary clericals, supporters of Stalinist Communism and democratic activists, and, nowadays, supporters of political freedom and advocates of sanitary ideology. Such ideology and identity polarization can be understood from a psychoanalytic point of view as a function of the defense mechanisms of splitting and projection into the adversary of one’s own anxieties.
As for the opponents to the government policies and to prevailing social organization, a masochistic identification may play a significant role. This is particularly obvious whenever opposition implies facing overwhelming threats, like was the case for Christian undergoing martyrdom, for various national heroes wasting their life for the good of their community, to Solzhenitsyn in the Gulag or Cato the Younger choosing freedom over life.
In the next section we will try to formulate a more articulated model which could help us better understand the splitting which has recently appeared within contemporary society and the harshness displayed by the two opposing sides.
4. Biological viruses and emotional viruses
What happened to contemporary man? How could a whole society get ill with fear? Can psychoanalysis contribute to the understanding of the changes which the Coronavirus pandemic has yielded in our society and of the amazing consensus which the ideology of social distancing has won the world over?
Wilfred Bion clinical and theoretical work during and after World War II cast an original light on regressive phenomena in groups [15]. Whenever a group experiences distress and helplessness, it regresses to primitive functioning patterns where emotional exchange and the search for the truth are replaced by Super-ego imperatives and prejudice.
Bion termed such patterns basic assumptions. Under such perspective the flooding of the social space by an irresistible feeling of fear can be associated in Bion’s system with the basic assumption of fight or flight, where the unconscious fantasies shared within the group are annihilated by the experience of an overwhelming threat.
At the core of contemporary society an enigmatic and ominous threat is lurking, then. What frightens contemporary man? Why do as much or even more dangerous social threats – you may think of terrorism, nuclear war, climate change or cancer – exert a much milder impact on our emotional social life than an infectious disease? Which gloomy resonance can a respiratory virus elicit in Western cultural space?
In order to answer such questions we must firstly remember that modernity relies on a specific epistemological option: our society and our culture have explicitly opted for a strict and rigid materialistic reductionism. This has brought about an inevitable devaluation of emotional experiences and an underestimation of their role in the society and in the individuals’ lives. Under this perspective, the pain associated with experiences of separation has been the object of a particularly fierce denial.
The life cycle brings about an inevitable amount of emotional pain (cfr. [16]). Growth implies more or less traumatic separations. Aging undermines adult’s social and family roles. Even in the hyper-medicalized society of antibiotics, vaccines and organ transplants, illness and death stay embedded in the human condition and are followed by an inevitable trail of suffering in the family and the community.
Against such experiences, contemporary culture has tried to put up an impassable wall, through the activation of massive defensive mechanisms. It has isolated and sterilized death within the hospital container. Has hidden corpses in far-flung crematoria.
We all know the impact such cultural structures have had on the elaboration of the response to Coronavirus epidemic. Besides, the distancing between generations, but also within the sexual couple, which is so obvious in contemporary society, dates back to some decades before virologists have agitated the threat of intrafamilial contagion.
The ever increasing and now undisputed success of the paradigm of the nuclear family and the concurrent spread of permanent celibacy give evidence of a widely shared fear and uneasiness with close interpersonal relationships and amount to an exasperated response to the issue of interpersonal and couple conflicts.
No human interaction, though, can be immune from a meaningful exchange of emotions: happy, but more often sad ones. Any contact within the couple or the family conveys not only viruses but also an unavoidable burden of anxiety, pain, conflicts and fears. This is the very contagion which frightens contemporary men: the emotions which arise in interpersonal interactions.
No safety measure, though, no surgical or FPP3 mask can spare us this emotional contagion. From the toil of interpersonal relationships can only the most extreme autism free us. Or death.
We will now report a psychoanalytic case, which may offer some further insight in the phenomenon of pandemic related anxiety and the use of social distancing as a way to regulate emotional distance in relationship.
5. Nedda and social distance
COVID pandemic stroke during the third year in Nedda’s second analytic experience with me. Nedda – then about 50 years old - had been referred to me for a depressive state some years earlier. Her first treatment segment had been focused on her interpersonal patterns. The analytic work had revealed a severely dependent oral structure with inability to handle separation from mother and sisters within a large family.
Since the first consultation, Nedda’s imposing appearance had given further evidence of a severe dysfunction in her oral libidinal organization. Her severe obesity seemed to have stripped her body from the most obvious female shape markers. Her dressing style, her attitude and her behavior all concurred in reassuring the interviewer that she represented no sexual challenge or opportunity. In fact, she was compliant with every social norm or widespread ethical ideal, and made every effort to let the interviewer feel at ease and in control. She never questioned treatment rules and conventions.
In the first treatment segment the interpersonal sources of depressive symptoms had been a major concern and interpretative interventions had been limited to the more superficial components of transference. Nearly two years elapsed before Nedda sought again my help.
In the second treatment segment, the question of weight control took the foreground in sessions for a while. Due to her obesity, she experienced severe abdominal problems, which required surgical treatment. For a few weeks, she attended self-help meetings for eating disorders. However, at the time of the onset of COVID-19 epidemic in Italy, the issue of weight control had already slipped back in the background or, rather, it had even been forgotten.
Nedda was now completely focused on her unique marital relationship. Consistently with her developmental pattern, the relation was very close, nearly suffocating, and the spouses’ social interactions outside the couple were limited to immediate relatives. A single medication supported intercourse, on the wedding night, had been extremely dissatisfying, and was followed by no other attempt over 15 years. Nedda and her husband used to spend all of their free time in their apartment, but their relationship was strained, with chronic hostility and coldness, and occasional rage outbursts.
Nedda seemed absolutely unaware of her contribution to the permanent sexual inhibition in the couple. Her husband’s poor availability to undergo treatment for a possibly somatically based impotence was to her the undisputable evidence of his guilty indifference. While never considering the option of becoming a mother through artificial insemination, she laid on him all the blame for her having missed the experience of motherhood.
She consumed sessions after sessions in complaining of her husband’s insensitivity. If her house was usually in a mess and the furniture had never been completed this was due only to her husband’s insufficient motivation and general fear of responsibility. Consistently, Nedda believed her consistent devaluation and coldness had no impact on the chronic depression he had been suffering for years. This highly ambivalent but obviously symbiotic lifestyle was bound to get even more strained due to the impact of COVID 19, as we will soon see.
Sessions with Nedda used to develop along one of two possible patterns. In the first pattern, which we might term warm, Nedda flooded the office with her emotions and words. Outrage and blame were the prevailing affects.
The object of blame might vary: the boss, a colleague, a sister or a sister in law. Usually, the husband seemed to carry most of the guilt. When a session unfolded according to this warm pattern I had limited room available for my interventions.
Generally, the misdeeds of the guilty character were described in detail and took most of the session. I had only the option to listen in silence or ask for some additional information. Whenever I could finally have a chance to offer an interpretative intervention, Nedda would immediately got overcome by emotionality and tears.
In the subsequent session or sessions, Nedda would typically appear quiet and satisfied. She would waste the session in trivial chatter, which offered no meaningful material for my interventions. I will term this second associative pattern a cold pattern. During cold sessions I often felt uninvolved and needed a substantial effort to keep adequate attention.
At the time COVID-19 epidemic reached our country, I was dissatisfied with Nedda’s treatment. I could envisage no clear goal or therapeutic pathway. I began to believe Nedda was unable to sustain any interpretative work. She apparently came to the sessions to the only aim of checking my continuing availability and keeping at bay any interpretative effort by me.
COVID pandemic unavoidably had a substantial impact on the therapeutic relation. As a physician spending some hours a week in an inpatient psychiatric facility, located within a general hospital, I expectedly got ill with Coronavirus syndrome early, even days before the epidemic had been officially recognized in Italy by local health authorities. I could personally inform Nedda of my condition, which kept me from meeting her in session for some time. Nedda had no difficulty in getting back to analytic work as soon as I had recovered.
While back in my office, I felt clearly relived by my somewhat easy recovery. Although I needed no hospital treatment, the experience of a potentially lethal condition is bound to bring about a closer awareness of the reality of death. In the first session after the interruption, I often realized my interventions included a measure of basically improper optimism about the epidemic, which gave evidence of the activation of manic defenses.
Nedda’s behavior in session showed a clear compliance with what she guessed were my unconscious expectations. Neither then nor later she showed any hesitation in attending sessions with me, and the treatment was suspended only over a short time period, when a general ban on outpatient health services was enforced by authorities for epidemiological reasons.
However, in her life outside the analytic situation, Nedda stuck to the opposite attitude with reference to contagion prevention. As time went by and the morbidity and lethality associated with the COVID 19 disease came to be more and more apparent, Nedda’s social isolation got absolute.
She worked only on a remote working basis. She left her house only to purchase food. She meticulously disinfected each shopping bag. She ceased meeting any relatives of her, including her old mother.
At the time the illness was ravaging in Italy, her life choices were far from exceptional within the general population. However, as the months elapsed, most citizens kept to the restrictions suggested by official health institutions and avoided any further preventive procedures.
Nedda, on the other hand, continued to lead an extremely secluded life. At length she got back to office every now and then, but met her mother and sisters only in a couple of instances (two funerals) over an entire year. She had no other human contact beside her husband. However, oddly enough, particularly as the media were emphasizing the epidemiological risk associated with healthcare professionals, Nedda never questioned meeting me regularly in sessions. Nedda used to enter the room with some hesitation, as if she feared the contact with me might be actually the cause of an infection, but once inside she seemed to lose any inhibition, and even occasionally dropped her face mask as a matter of course.
I will now report a sequence of sessions which yielded novel insights into Nedda’s specific transference patterns and into the anxieties elicited in her by the COVID pandemic. Nedda began a session by reporting how the COVID pandemic had painfully affected her own life. She particularly missed very much a chance to meet again her mother physically. I pointed out to her that the COVID-19 epidemic had led her to a nearly complete withdrawal from social and even family life, but that she apparently didn’t fear meeting with a physician in occasional clinical contact with COVID patients.
Nedda felt the need to justify herself. She had not forgot her mother. She got in touch with her daily on the phone. Beside, the choice for a definitive physical distancing from her had not been completely her own, and had actually been forced on her by her youngest sister. Nedda had always described the latter as aggressive and authoritarian. Against her will, no one in the family, and particularly Nedda, dared to act.
I told Nedda that the COVID-19 pandemic had dramatically changed her own life. She had lost the relationships which had meant so much, which had even meant all to her till some months earlier. I acknowledged her view that her sister’s pressure had been a meaningful factor but formulated the hypothesis that she was less in need of contact with her relatives than before.
The patient acknowledged only that she felt some annoyance towards her sister. She had felt rejected in a couple of episodes. She did not appeared particularly moved or interested by my comments.
Some sessions elapsed and Nedda entered my office in a state of deep distress. After some unsubstantial interpersonal memories, she focused on her husband. She was fed up with him. She reported that he had been withdrawn and depressed for a couple of weeks. She was not willing to put up with him any longer, and in fact she had been more explicitly aggressive and devaluing towards him than ever.
Nedda went on reporting that during a quarrel her husband had even put his hands at her neck, and could only with difficulty control the drive to chock her. I, too, found some difficulty in controlling my countertransferential response to the patient’s communication.
I felt the patient was in some way provoking me no less than her husband. She was apparently precipitating an explosive couple conflict which could prove dramatically dangerous. After years of analysis, she was still turning more to acting out than to associations in the analytic room as a communication device. I could exteriorly control my helplessness feelings and shared with the patient my concern for her health and even life. Nedda spent most of the last part of the session in tears but did not express any manifest comment on my intervention.
In the following session things were different. Nedda was outraged and flooded the room with savage blaming. The focus was no more the husband, though, rather myself. In a way disregarding my manifest comment on the dangers she was exposed to, she relied on an intuitive insight into my countertransferential feelings. To her I was implicitly siding with her husband, a violent, murderous man. I wasn’t defending her from him, even when her own life was at stake.
At the time, Nedda’s transference was obviously dominated by an oedipal unconscious fantasy where a heroic knight was bound to rescue her from the hand of an impotent but murderous father. Nedda’s fantasy may also have included a dawning awareness that her enormous body would never allow her to compete with mother’s beauty and erotic power.
Nedda talked in a loud voice and vomited her blames on me one after the other. For several minutes I was unable to stop her complaint. I felt both hurt by her authoritarian projective blames and helpless. Finally, I commented that she was realizing psychoanalysis, particularly psychoanalysis with myself, was different from what she expected and maybe even from what she could actually need.
She was looking for someone to encourage, support and praise her, someone who could show agreement with all she made and said. I admitted a relation like that – which we can here characterize as regressive and narcissistic – could temporarily ease her emotional pain, but made clear that psychoanalysis was something different.
It amounted to an interaction with a professional who has his own identity, and just because of that can offer novel views and open new doors. This was the only way genuine interpersonal change might be brought about.
The intervention proved able to loose tension in the session. The patient told me she didn’t need now to interrupt the treatment as she had decided before entering the office.
To me the session had been extremely informative and had offered the elements I was badly in need to properly formulate Nedda’s transference. I was now in the position to answer some questions: Why had Neddda exceeded authorities’ recommendations and turned to a phobic avoidance of most human interactions? Why did she meet her analyst with no apparent anxiety and even occasionally and deliberately pull off her face mask?
In fact, Nedda feared nothing more than an object, an interpersonal object. After weaning she had never accepted her mother could no more directly answer her oral emotional needs. And had turned to concrete, material nourishment in order to sustain the fantasy of an omnipotent mother which was indefinitely available to her oral wishes.
Her regressive oral inner world was at ease with self-object and only with self-objects. A male sexualized object did not frighten her because of his valuable gifts or his ability to elicit libidinal forces within her body. Rather, she deeply feared the emotional exchange which any interaction with an external object is bound to yield. An object has his own wishes, fears and memories. An object hosts his own fantasies within his own inner world. An object can receive projections, can react empathically, but may also be withdrawn, hurt or enraged.
In the transference, she was often unable to resist her own oral greed. She felt forced to close distance to the analyst, to meet at last a human being, to find a listener to her pain. Such transference wish brought about warm sessions, where communication in the analytic situation was intense.
However, this very transference communication and exchange was bound to enhance her deep fears. Her need to be fully in control in any interpersonal relationship was severely threatened. She felt helpless, exposed, dependent on the transference object for her emotional well-being. To her, human interactions included then a virus, an emotional contagion. In the cold sessions which systematically followed the warm ones, she wore again an emotional mask and meaningful communication got restricted.
In Nedda’s case, exaggerated illness prevention measures amounted to a strategy to control interpersonal interactions and keep at bay her unlimited interpersonal greed. The severe social and interpersonal withdrawal Nedda had gone through in the third analytic year was not based on health related concerns. It was Nedda’s strategy to shelter herself from the threats implied by close interpersonal relationships and particularly by the transference relationship.
Nedda’s case teaches us that the primitive part of personality may be continuously concerned with the emotion elicited by interpersonal relationships. The resulting persistent conflict between the unlimited longing for close interactions with significant others and the concomitant fear of being flooded with projections by the interpersonal objects has played a significant role all through human history. We have mentioned above how widely shared cultural representations and institutions offer evidence that inter-human contact is dangerous. Contemporary society enhanced concern with the threat of infectious diseases, a concern which dates back much earlier than coronavirus epidemic, is very likely to thrive on this very unconscious threat.
To a psychoanalytic eye, the general public representations of compliance vs. nonadherence to prevention measures are massively infiltrated by socially shared unconscious phantasies based on the dangers of interpersonal contact. As both clinically active and theoretically informed psychoanalysts, we are consistently called to understand the unconscious roots of these very phenomena.
6. Psychoanalysis and freedom
Sigmund Freud developed psychoanalysis as an antidote against the hypocrite moralism of Victorian Europe. Freud believed that the freedom with which he had been able to explore human sexuality was the most important source of the opposition psychoanalysis met in the to him contemporary culture.
Psychoanalysis still remains a theory and a practice which allow those who have been silenced to open their mouth at last, which lend to the repressed unconscious contents an unexpected freedom of speech. Psychoanalysis is a subversive discipline.
Psychoanalysis has always been unwelcomed in totalitarian regimes. In Soviet Russia it was banned altogether [17]. In Nazi Germany it underwent a process of Gleichschaltung (integration) within Nazi state institutions, and was submitted to the leadership of Mathias Göring, the cousin of the infamous Hermann Göring, Hitler’s close co-worker [18].
Within the framework of the dramatic reality we are currently experiencing, psychoanalysts, no less than other citizens, can agree with various different preventive strategies and support various political forces. They must always remember, however, that the psychoanalytic endeavor implies a position of strict neutrality vis-a-vis political and social issues.
In Tatbestandsdiagnostik und Psychoanalyse, Freud [19] wrote that psychoanalysis is a sui generis science of the inner world, i.e., of the wishes and representations which haunts the patient’s unconscious. Psychoanalysis can in no way contribute to the testing of factual reality. It can validate no political or ideological statement.
Freud believed psychoanalysis thrived on the search for truth ([20], p 94), but psychoanalytic truth is never an external, objective truth. It’s always a subjective truth, better a dyadic truth, which is piecemeal constructed within any specific patient-analyst couple.
In order to effectively reach such subjective truth, the psychoanalyst is required to keep to a position of strict neutrality with reference to the object of his investigation. There’s no doubt: a psychoanalyst will never be able to enroll his or her professional skill in the service of any ideology or social model, however valuable to the society at large it might be, without permanently infringing his or her professional ethic.
\n',keywords:"Psychoanalysis, Adherence to medical advice, Ethic, COVID-19 Psychological Sequelae, COVID-19 mitigation measures",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/76606.pdf",chapterXML:"https://mts.intechopen.com/source/xml/76606.xml",downloadPdfUrl:"/chapter/pdf-download/76606",previewPdfUrl:"/chapter/pdf-preview/76606",totalDownloads:298,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,introChapter:null,impactScore:0,impactScorePercentile:33,impactScoreQuartile:2,hasAltmetrics:0,dateSubmitted:"February 5th 2021",dateReviewed:"April 15th 2021",datePrePublished:"May 5th 2021",datePublished:"November 3rd 2021",dateFinished:"May 5th 2021",readingETA:"0",abstract:"Mitigation measures required by Covid-19 pandemic have posed severe restrictions on individual freedom and have been met with persistent opposition in minority circles. As non-adherence to preventive measures is believed to increase health risks for the society at large, dissent from official policies has been a source of concern. Within this framework several eminent psychoanalysts have suggested psychoanalysis should be enrolled as a component of health related public opinion campaigns. The chapter will discuss the historical relation between mental health institutions and social control strategies and will formulate a psychoanalytic model of the social dialectic associated with the Coronavirus pandemic. The model will allow the author to offer grounded ethical perspectives on the issue.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/76606",risUrl:"/chapter/ris/76606",book:{id:"10814",slug:"anxiety-uncertainty-and-resilience-during-the-pandemic-period-anthropological-and-psychological-perspectives"},signatures:"Paolo Azzone",authors:[{id:"324882",title:"Dr.",name:"Paolo",middleName:null,surname:"Azzone",fullName:"Paolo Azzone",slug:"paolo-azzone",email:"paoloazzone@hotmail.com",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/324882/images/system/324882.jpg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Mental health and social control",level:"1"},{id:"sec_3",title:"3. Negation and negationism",level:"1"},{id:"sec_4",title:"4. Biological viruses and emotional viruses",level:"1"},{id:"sec_5",title:"5. Nedda and social distance",level:"1"},{id:"sec_6",title:"6. Psychoanalysis and freedom",level:"1"}],chapterReferences:[{id:"B1",body:'Douglas M. Purity and Danger: An Analysis of Concepts of Pollution and Taboo. Abingdon-on-Thames: Routledge and Kegan Paul; 1966.'},{id:"B2",body:'Freud S. Totem und Tabu. Wien: Verlag Hugo Heller & C.ie; 1913. Also as Bibring E, Hoffer W, Kris E, Isakower O, editors. Gesammelte Werke. IX Band. London: Imago Publishing; 1940.'},{id:"B3",body:'Manzoni A. I Promessi Sposi. Milano: Guglielmini Redaelli; 1840.'},{id:"B4",body:'Agamben G. Homo Sacer (1995-2015). Edizione integrale. Macerata: Quodlibet; 2018.'},{id:"B5",body:'Schmitt C. Politische Theologie: Vier Kapitel zur Lehre von der Souveränität. Munchen & Leipzig: Duncker & Humblot; 1922.'},{id:"B6",body:'Miller BL. Science denial and COVID conspiracy theories: Potential neurological mechanisms and possible responses. JAMA. 2020;324(22):2255-2256.'},{id:"B7",body:'Holinger PC, Spira NE, Barrett D, Barrett TF. 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Archiv für Kriminalanthropologie und Kriminalistik. 1906;26. Also in Bibring E, Hoffer W, Kris E, Isakower O, editors. Gesammelte Werke. VII Band. London: Imago Publishing; 1941. p. 3-15.'},{id:"B20",body:'Freud S. Die endliche und die unendliche Analyse. Internationale Zeitschrift für Psychoanalyse. 1937;23:209-240. Also in Bibring E, Hoffer W, Kris E, Isakower O, editors. Gesammelte Werke. XVI Band. London: Imago Publishing; 1950. p. 59-99.'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Paolo Azzone",address:"paoloazzone@hotmail.com",affiliation:'
Unit for the Outpatient Treatment of Forensic Psychiatric Patients, ASST-Rhodense Hospital, Milan, Italy
'}],corrections:null},book:{id:"10814",type:"book",title:"Anxiety, Uncertainty, and Resilience During the Pandemic Period",subtitle:"Anthropological and Psychological Perspectives",fullTitle:"Anxiety, Uncertainty, and Resilience During the Pandemic Period - Anthropological and Psychological Perspectives",slug:"anxiety-uncertainty-and-resilience-during-the-pandemic-period-anthropological-and-psychological-perspectives",publishedDate:"November 3rd 2021",bookSignature:"Fabio Gabrielli and Floriana Irtelli",coverURL:"https://cdn.intechopen.com/books/images_new/10814.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83968-126-4",printIsbn:"978-1-83968-119-6",pdfIsbn:"978-1-83968-215-5",reviewType:"peer-reviewed",numberOfWosCitations:3,isAvailableForWebshopOrdering:!0,editors:[{id:"259407",title:"Prof.",name:"Fabio",middleName:null,surname:"Gabrielli",slug:"fabio-gabrielli",fullName:"Fabio Gabrielli"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"174641",title:"Dr.",name:"Floriana",middleName:null,surname:"Irtelli",slug:"floriana-irtelli",fullName:"Floriana Irtelli"},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"278"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"76565",type:"chapter",title:"Introductory Chapter: The Transition from Distress to Acceptance of Human Frailty - 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Wagner",reviewType:"peer-reviewed",authors:[{id:"281898",title:"M.Sc.",name:"Hamilton Lima",middleName:null,surname:"Wagner",fullName:"Hamilton Lima Wagner",slug:"hamilton-lima-wagner"}]},{id:"77064",type:"chapter",title:"Adversity, Uncertainty and Elevated Symptoms of Obsessive Compulsive Disorder: A New Understanding through Resiliency and Positive Psychotherapy",slug:"adversity-uncertainty-and-elevated-symptoms-of-obsessive-compulsive-disorder-a-new-understanding-thr",totalDownloads:301,totalCrossrefCites:0,signatures:"Sevgi Güney",reviewType:"peer-reviewed",authors:[{id:"110081",title:"Ph.D.",name:"Sevgi",middleName:null,surname:"Güney",fullName:"Sevgi Güney",slug:"sevgi-guney"}]},{id:"77908",type:"chapter",title:"Anxiety, Uncertainty and Resilience during the Pandemic Period-Anthropological and Psychological 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Shivananda Manohar, Rajesh Raman and Bindu Annigeri",reviewType:"peer-reviewed",authors:[{id:"317387",title:"Dr.",name:"J. Shivananda",middleName:null,surname:"Manohar",fullName:"J. 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1. Introduction
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Social isolation experienced by young people refers to a state in which social interactions with others are limited or even absent for a long period of time. This can take place as a result of involuntary circumstances such as school bullying, peer exclusion, hospitalization, institutionalization, or absence/incarceration of family members or alternatively by voluntary social withdrawal from interacting with others to avoid bullying, frustration, social anxiety, or stress [1, 2]. In the discipline of developmental psychology, involuntary social withdrawal is considered equivalent to social isolation or school disaffection suffered by children and adolescents particularly in educational settings, who are characterized by apparent shyness, asocialness, unsociability, aloneness, and peer avoidance [3]. Social isolation resulted from peer exclusion may not necessarily lead to a sense of loneliness particularly when young people feel that some intimate others and adult mentors are still around to listen and help. However, when the quantity of interpersonal network is limited and the quality of social support is inadequate, socially withdrawn children and adolescents are more at risk of failing to develop appropriate social and interpersonal skills for engaging in positive interaction with peers in school or community settings. When objective social isolation is further perpetuated as a consequence of involuntary peer exclusion or voluntary social withdrawal as the last resort to react against unfavorable circumstances beyond one’s control, loneliness understood as a subjective experience or as “perceived social isolation” would take place [4, 5].
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Unlike those student counterparts experiencing a state of social isolation and a sense of loneliness who are usually the targets of study in developmental psychology/psychopathology, this chapter focuses on discussing social isolation experienced by young people in social withdrawal as atomistic individuals, who seclude at home and lead a hermetic way of life without making face-to-face social contacts or having social relationships and interactions with the world other than their family members for a protracted period of time [5, 6]. Young people experiencing social isolation in the form of social withdrawal are characterized by their socially avoidant behavior and their invisibility from the care of helping professionals and the scrutiny of the public [7, 8], who are labeled as “hikikomori” (i.e., young hermits) in Japan [9] and as “hidden youth” in Hong Kong [10]. Young people who seclude themselves at home are asocial in behavioral and relational terms and thus silently trapped in the state of asocialness without enjoying much emotional and instrumental support. However, in the case of young people who are having a psychiatric problem, physical illness, or disability, which has prevented them from participating in the community, they would not be considered as “pure” or “primary” social withdrawal cases. They are instead regarded as secondary social withdrawal cases as a consequence of primary psychiatric or physical problems [11]. In other words, social withdrawal is not primarily a mental health or disability problem, but an anomic behavioral response to difficulties encountered by young people [12]. However, it is entirely possible for primary social withdrawal cases to develop symptoms of depression or social anxiety if they are left alone and feel alone at home for an incredibly long period of time without receiving any professional service.
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This chapter first defines social withdrawal experienced by youth with reference to four parameters so as to highlight the nature of social isolation confronted by these young people who are turned invisible, voiceless, and disengaged. Informed by the principle of “starting where the client is,” we then discuss different forms of in-home and community-based social work intervention targeted to self-secluded young people who are socially isolated from others other than their family. By using the empirical data drawn from a longitudinal study of youth with social withdrawal experience at home, the next session addresses the importance of interdisciplinary research and practice which is deemed important to facilitate young people to regain a sense of agency and a sense of expectancy for overcoming social isolation and its alienating relational and health outcomes. Before drawing a conclusion, we highlight the importance of advocacy work and its relationship with interdisciplinary research and practice.
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2. Parameters for defining the state of social withdrawal
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The first two are the interlocking parameters of time and place; the third one is the lack of face-to-face contacts and interactions other than family members; and the final one is the deprivation of a legitimate social status [4].
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2.1 First two parameters: time and place
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According to the Japanese government, social withdrawal or hikikomori in Japanese is a state where people seclude themselves at home for 6 months or more [13]. The length of time is important for temporary seclusion and solitude at home; if it is planned and preferred, it can be productive in nature, which may enhance one’s knowledge of one’s self and identity and the social environment, and provide relief from the pressures involved in interacting with other people in daily life and regain an orientation for leading a healthy and purposeful life ahead. Nowadays with the use of advanced computer and communication technology, working at home has become commonplace. Nobody will assume that the practice of home office is a manifestation of social withdrawal or social isolation. However, spending more than 6 months at home without working on designated tasks or having a clear purpose will likely cause anxious and lonely feelings [5]. The home or even a small room is largely the space where young people in social withdrawal spend their time and life. However, they may step out of the home boundary for a stroll alone on a silent street at midnight to avoid meeting or greeting neighbors or go out on their own to buy stuff at a corner store at a time when few people or customers are anticipated [8]. Self-seclusion at home was in the first place taken by young people as a viable solution, if not the last resort, to escape from experiencing frustrations such as school bullying, job-seeking failures, parental marital discord, and so on and do the things they prefer doing on their own. To avoid conflicts with the family and the parents in particular, it is not unusual for youth secluded at home to sleep throughout the day and stay awake at night to play online games or watch television alone [5, 7, 8]. However, the longer the period they seclude themselves at home, the more likely they will feel locked in time and space as if time was running slow [5]. Simply imagining that stepping out of their homebound cocoon into a community or public place will lead to a heightening sense of anxiety and insecurity will become an insurmountable barrier to reducing the further perpetuation of social isolation experienced in both an objective and subjective manner.
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2.2 Third parameter: lack of face-to-face contacts and interactions
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Most of the youth respondents were happy with their secluded lives in the first few months as they could take a break without being interfered, play online games, surf the Internet, and do many other things they were fond of doing. Nevertheless, dispensing with social relationships with others for a long time has deskilled young people in the sense that it leads them to forget how to engage in normal interactions and relationships with others and, accordingly, heightens their anxiety to venture into the community [5, 8]. As shown in research studies in Japan, hikikomori dare not go out the home on their own for fear of having eye contacts with distant others or to respond to normal social greetings with neighbors or friends [14]. To avoid conflicts with the family and the parents in particular, it is not unusual for youth secluded at home to sleep throughout the day and stay awake at night to play online games or watch television alone [5, 7, 8]. Mallett argued that home is a “socio-spatial system,” where social relations are shaped and reproduced [15]. In the case of extended social withdrawal, the confined space of home causes the inter-generational relationship to spiral further downward. In case of worsened relationship with parents and family members, young people suffering from extended social withdrawal at home may just retreat to their own tiny room with a modest level of interaction with their family. Worse comes to worse, they may even decline eating with the family and take a few biscuits or a cup of instant noodle in their own tiny safe cocoon on a daily basis [6], which is, however, harmful to their health in terms of poor diet and lack of physical exercises [16, 17].
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An extended absence of a variety of face-to-face contacts and interactions at home and beyond the home boundary is likely to lead to the deskilling of young people in relation to intimate others such as parents, siblings, and friends and outsiders such as neighbors and strangers. The longer the period of social withdrawal, the higher the likelihood young people will find it difficult to read facial expressions, respond to causal greetings, and engage in causal chats, which in turn results in a downward spiral or vicious cycle of social isolation. Being confined at home without interacting with people face to face does not preclude the possibility of young people’s interaction with previous close friends and “virtual others” on the Internet platform. They may have online chatting with peers and ex-classmates on an occasional basis particularly in the beginning phase of self-isolation. But they would likely stop doing so when their ex-peers’ pacing and environment of life have become so different from theirs. Self-secluded individuals at home may chat with online players even though without knowing them personally. Virtual online interaction may be interpreted as a manifestation of their desire to make contact with the outside world. This kind of “virtual chatting,” however, is not conducive to developing trustful relationship particularly in view of the lack of offline interaction and companionship [5].
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2.3 Fourth parameter: deprivation of a legitimate social status
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Unlike their student counterparts suffering from social isolation in school settings, young people in social withdrawal at home do not lead a life with a social status as a student, worker, or trainee. They are instead labeled as NEET youth who are socially excluded from the institution of education, employment, or training. After staying for a long while without resuming study at school, going out to find a job in the labor market, or learning something useful in nearby community center, conflicts with their parents and siblings will take place. The conflict taking place on the same generation and across generations in the family context is usually focused on achieving a legitimate youth status as a student, worker, or trainee just like their normal youth counterparts. However, the concern of the family is different from that of the focal person who is too anxious and frightened to map out their transition to a socially legitimate social status. The following verbatim quotes from the first author’s field data are representative of clients’ reactions against practitioners or outsiders’ intrusions into their safe “cocoon” [6]:
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As for the school worker, since he works in the school, he must speak for the school. So I did not want to talk to him. And the other one […] I did not know where he came from […] he did not look like a social worker. He looked like a construction worker […] I was very scared and ran into my room. At last, he talked to my mom instead of talking to me, saying something that I did not want to hear at all. I just hope that he will never come to disturb me again. (Sam, a client with social withdrawal experience)
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I did not know where they had come from. I just thought they must be the allies of my parents. I can still remember that woman just asked me to stop surfing the internet and listen to her bullshit […] Another woman just told me “[I] would make my mom unhappy and disappointed if [I] kept on staying at home” […] She did not attempt to listen to me or understand my worries. (Peter, a client with social withdrawal experience)
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What is obvious is that making a transition from the state of NEET to that of engagement in education, employment, or training will be a long rugged journey characterized by ups and downs. Unlike their NEET counterparts with antisocial behavior, self-secluded and socially isolated home hermits are characterized by their asocial, non-prosocial, and socially avoidant behavior. NEET is just an umbrella term which covers a wide spectrum of youth behaviors, ranging from antisocial to asocial. Many of these NEET youth just look like normal youth with sociable and prosocial behavior with the only exception of whether making a successful transition to work or study.
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However, without enjoying a socially legitimate social status as a student, worker, or trainee, it does not mean that these self-secluded and finally socially isolated youth at home are not engaged in activities at all. Many of them were surfing information related to heritage and ecology preservation, leading an eco-friendly life at home, helping out household chores to reduce the care burden of their mother, and developing interest on their own by ongoing googling and/or practice at home, e.g., photo-taking, pet care, handicraft, production of eco-friendly stuff for domestic use, etc. [5, 6, 7, 8]. The next session discusses in what way these home-based activities undertaken by secluded youth are taken as interaction points for rapport building and intervention in a space the latter feel secure.
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3. Intervention for engagement and facilitating youth transition to the community
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The perpetuation of social isolation is not only personal but also structural. If social isolation of youth with chronic social withdrawal experience is to be overcome, social inclusion with concerted efforts made on personal, interpersonal, and structural levels have to be made. Viewed from a social exclusion perspective, the purpose of antisocial exclusion policy and measures paving for the way for social inclusion is to address two interrelated dimensions: exclusion from work and exclusion from social relations [18]. To take a step further, Walker and Walker further argue that social exclusion should be understood “as a dynamic process of being shut out, fully or partially, from any of the social, economic, political or cultural systems which determine the social integration of a person in society” [19]. That is, the structural causes of various forms of social exclusion or disengagement experienced by disadvantaged youth have to be thoroughly addressed even though each of their unique strengths, interests, experiences, and dreams, which are embedded into their transition stories, has to be taken into account.
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3.1 Home-based rapport building and interventions: start where the client is
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Following aforementioned discussion, professional interventions designed for facilitating youth transition to the world of study, work, or training for those who have been trapped in alienating circumstances of self-seclusion and social isolation in a tiny home space for so long should not be taken as the goal of intervention in the beginning phase. Instead, what matters most in the initial stage of intervention is to build up rapport or initial trust with involuntary, vulnerable, secluded clients who are resistant to visitors and strangers. In the case of outreaching young hermits, the social work motto “to start where the client is” can be read in a literal sense of taking home as a secure place for initial interaction and intervention. Home-based intervention is more than home visitations, and it involves activities with a modest level of conversations or dialogue [20]. Before doing any home visiting, it is considered strategic to listen to the concern of the family and the client’s mother in particular who was usually the one to seek for help from social workers. At the meantime, helping professionals such as social workers, counselors, or youth workers have to seek relevant information about the client, e.g., personal particulars, length of self-seclusion at home, daily routines or activities, personal interest, relationship with family members, etc.
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According to the practice wisdom of experienced social workers, it took on average nine contacts for building up an initial working relationship with each youth client, including but not restricted to home visiting, celebrating client’s birthday or doing festival celebration at home, presenting a small gift with the name of the client on it, telephone chatting, leaving behind a handwritten note for Internet or mobile phone contact, texting by using text messaging apps, etc. [5, 6, 7, 8]. In the first few home visitations, social workers usually go in pair, as the primary social worker was to initiate interaction with or minimal conversations with the client on something he or she felt interested about, and the other worker was to talk with other family members outside the home environment particularly when they were moralizing the issue or blaming their child. The underlying principle is to start where the client is, which is understood in two interlocking senses: the first of which is to talk about something different from the family’s primary concern or about the previous traumatic experience of the client; and the second is to be sensitive to the home environment in terms of both statics and dynamics of which the former refers to family photos, pictures, toys, books, magazines, gifts, souvenirs, etc., whereas the latter refers to family conversations and interactions, activities, or interests that the client was engaged in such as cooking, making desserts, taking care of a pet or two, cleaning goldfish tanks, taking photos of the street, playing online game, etc. Acknowledging the skills and knowledge involved in undertaking all these interest activities or daily routines can open up a space for engaging secluded youth in social interaction and minimal conversations that they have not experienced for so long.
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In a home setting, the artifacts available for providing clues to possible talking points include family ornaments, souvenirs, furniture, and so on. In case of difficulties to engage in direct conversation with clients because of their resistance to visitors, it was through talking about artifacts or pictures in the living room that the parents, usually the mothers, were able to elicit happy memories with their beloved children in relation to their unique strengths and abilities. As most of the cases of the first authors’ studies were of working class background, their living space was tiny, and the partitioned walls in the clients’ homes were not a barrier to their overhearing conversations taking place in the living room. The explicit absence of clients, hidden away from any interaction with social workers as strangers, did not rule out their implicit presence in hearing what is said positive about them. This could help youth clients recall the previous harmonious relationship with their family. These conversations provide a contrast with more recent and current stories filled with frustration, conflict, and anger. This indirect intervention approach can at least help build up an initial working relationship with clients’ family and may arouse clients’ curiosity about the friendly attitude of helping professionals.
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Starting where the clients are does not mean ending up where they are. After gaining initial trust with the worker, the client could be invited to initiate some ideas that they would like to pursue at home, for example, learn to develop one’s interest at home in the presence of the worker perhaps with the company and instruction from a youth mentor or try out some new interest that they could not afford to do or dare to dream of doing so, e.g., learn to play magic, keyboard, drum, or guitar, use recycled materials for handicraft making, or even do home-based volunteering or simple paid job by designing a poster for promoting an agency’s program targeted to others in need [5]. In this sense, secluded youth at home could develop a sense of agency and a sense of contribution which are all good for rebuilding their self-esteem.
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Another innovative means to build initial rapport at clients’ homes is to work with animal-assisted therapists or practitioners to use a therapy dog for doing home visitations and interactions. In accordance to the verbatim drawn from a study of the first author, a social worker working with youth in social withdrawal made a related remark as follows:
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The dog is called “Fat Fat,” which is a tiny dog. Fat Fat is very nice and friendly…Tiny dogs are more acceptable for home visitations, as security guards usually turned a blind eye to this. It’s harder if we use therapy dogs of a bigger size...Fat Fat was shortsighted, and he was used to smell and greet others at close distance. Whenever he smelt the presence of young people at proximity, the latter would feel less on guard…. (Adrian, a social worker).
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Affective relations with pet or therapeutic animals go beyond the conventional understanding of human relations [21]. The interaction process with the therapy dog Fat Fat opened up the space for dialogues between clients and social workers. The clients were less defensive to relate to social workers as visitors, since the focus of conversation was around the therapy dog rather than taking clients as the focus of concern. The use of therapeutic dogs is not only effective for icebreaking and building trust and rapport with social workers but also affective by giving youth clients a sense of warmth and a sense of touch that they had not experienced with their family members and any others outside the home for so long.
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3.2 Community-based interventions: interest-based and client-centered interventions
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As to youth with extended self-seclusion experience, anywhere beyond the home environment is a groan zone where they find it risky and uncomfortable. The longer these isolated young people stay at home without making any face-to-face contacts and interactions with others in the community, the more difficult they will find it to make a move outside their comfort zone. One of the effective ways to give these young people an incentive to destabilize their sense of “homeboundedness” is for their entrusted social worker to accompany them to do an unfinished task or two they aspired to settle. The needs and tasks may be as simple as fixing a computer, enjoying a trip to the countryside, having a haircut, buying something in nearby commercial arcade, seeing some heritage buildings, taking photos of beautiful flowers, etc. Acknowledging clients’ intention to do or settle something beyond their home environment, though seemingly minute to the rest of the world, can serve as a starting point for making a breakthrough against home confinement, spatially and mentally. Social workers can make use of this opportunity to facilitate homebound youth to plan ahead, make decision, and do mental rehearsal for the tasks they would like to pursue with the company and support from social workers. The experience of venturing into the community can provide secluded youth a solid base for driving out their fear and anxiety for meeting strangers outside their home environment and reflecting on the experience for drawing learnings that could be applied for the next outing.
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NGOs with a drop-in corner or activity rooms can provide homebound youth an ideal setting to learn new things of interest to them, as the service environment has given tangible resources and mentoring support that are conducive to rebuilding the trust of homebound youth to outsiders. That is, the focus is placed on interest-based learning for satisfying their learning needs and resuming normal social interactions with others rather than on seeking formal educational or vocational qualifications which were too demanding to them. Another advantage of giving young people with social withdrawal experience a variety of choices of one-off events or short-term courses with just a few sessions is to give them a chance to make decision on their own, try out new things without making any commitment, and make new friends who may have the same interests or the same background of having self-seclusion and social isolation experience. In an environment that is relatively free of name-calling, teasing, and testing out behaviors, and in an environment where people are more sympathetic and supportive to each other, young people with shyness or social phobia are more able to develop sociable and prosocial behaviors for exploring and experimenting informal relationships in the real world. This reminds social workers the importance of working with youth clients in a professional yet informal manner which can provide them a secure place for appreciating and building informal and faithful peer relations that will last much longer than formal worker-client relationship [5].
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In another career intervention program supervised by the first author, young people with seclusion experience were invited to visit shelter dogs which had abused or abandoned experience before and engaged in human-canine activities designed to promote a positive relationship between humans and animals. Narrative review is used to help youth participants explore the values, attitudes, skills, and knowledge involved in caring for sheltered dogs and find meaning in life. Young people reported that a reciprocal relationship was experienced in the process of caring for the dogs, which offered trust, acceptance, unconditional love, and nonjudgmental contact. The youth participants offered love, care, companionship, and a secure interacting environment for the dogs, which encouraged them to believe in their ability to care for living beings. A positive self-identity with a greater sense of achievement and self-worth was built up. The interaction was also beneficial to the dogs as they became trusting, confident, and accepting of human care. Such a positive response from the dogs further reinforced a sense of contribution among the youth participants. Many of them were inspired to explore animal care work and to promote animal welfare. The program also supported young people to become mentors, to share their transformations with new members of the program and with parents, teachers, and other community stakeholders. And through the provision of workplace learning and mentoring opportunities, they were facilitated to explore about the possibility of continuing doing volunteering in animal care and animal rights and developing a vocational career related to animal care or pet care industries. In a career and life adventure planning project funded by the Hong Kong Jockey Club Charities Trust which is the number one donor in Hong Kong, the experience to date shows that when young people such as those with chronic social withdrawal experience are provided an enabling environment with resources, opportunities, and networks, they can archive, reflect, and develop their own set of transferable values, attitudes, skills, and knowledge across different domains of paid and unpaid work experiences [22] and define their own meaningful career roadmap; they can and will make positive contributions toward a better and more inclusive world [23].
\n
\n
\n
3.3 Interdisciplinary collaboration across healthcare and social care disciplines for research and youth engagement
\n
In a brand-new interdisciplinary study conducted by a team of academics and researchers of the background of nursing and social work professions in Hong Kong, a total of 104 youth clients with social withdrawal experience were invited to participate in a research study as respondents by means of completing a set of questionnaires and going through some anthropometric and physical measurements. Measurements were taken by a well-trained nursing student, which include body weight, height, length and width of ears, blood pressure, pulse rate, respiratory rate, and waist and hip circumference which were recorded and used for calculating the body mass index and waist-hip ratio. This interdisciplinary study across nursing and social work professions is the first ever study studying the physical health aspects of hikikomori [17].
\n
This group of youth respondents living with a hikikomori lifestyle was found to have a high incidence of prehypertension and hypertension, which were correlated with the weight gains during the course of their secluded life at home. The length of hikikomori duration was associated with a shift of body weight from underweight to overweight and obesity and also with elevated blood pressure. This may be resulted from their unhealthy diets and distorted sleep patterns over the course of extended social withdrawal. Over 1 year, the respondents showed improvement in health measures including reduced blood pressure levels and waist-hip ratios. Most surprisingly, the prevalence of hypertension was significantly reduced from 15.4 to 9.0% over 1 year, which was below the 12.6% adult prevalence of diagnosed hypertension [24] and the 12.8% age-specific prevalence for young people aged 15–34 [25]. The prevalence of prehypertension also slightly dropped from 31.7 to 29.1% [17]. In 12 months’ time, they also witnessed an upward trend of practicing moderate-intensity exercises among the respondents.
\n
This positive change in terms of health actions taken by the respondents could be related to two episodes of experiences. First, the respondents were informed by the nursing researcher the measures in an archived format immediately after the physical assessment, which could trigger their health awareness and their eagerness to take actions to make improvements for the next round of follow-up assessments 6 and 12 months after. Second, although social workers are not health professionals by themselves, they can use the archived record as a talking point and remind their clients to lead a healthy lifestyle by doing more exercises and developing healthier diet habits. That is, taking actions for making improvement with health and physical measures to impress oneself and others over time is considered conducive to creating a sense of expectancy among the respondents. The practice of using archived records for talking and reminder purpose consistent with the health belief model which emphasizes beholders’ awareness of threat perception (risk) and positive initiatives (opportunity) is the key to trigger appropriate actions for realizing positive health outcomes [26, 27]. This implies that promoting interdisciplinary collaboration across healthcare and social care disciplines is not only good for breeding new ideas for conducting research studies but also for producing health measures in the form of visible archive for engaging secluded youth to develop a sense of expectancy and a sense of agency for making improvements with their lifestyle and health outcomes.
\n
As viewed from the nursing perspective, the focus is placed on providing care using a holistic approach and with interdisciplinary collaboration to ensure the best possible outcome for the client. Nursing care models and the “nursing process” help guide and organize how care is provided to clients. As demonstrated in the aforementioned interdisciplinary study of youth living a hikikomori lifestyle, the youth group showed interest to make improvement of their own health, which coincides with the principles of the McGill model of nursing where the client’s health is improved by means of actively engaging them in the learning process of their care [28]. The aforementioned study identified many health risks of the youth group such as prehypertension, hypertension, obesity, an unhealthy diet, and disrupted sleep patterns [17]. If these were the health focuses for the client, the nursing intervention would be to provide health education or promotion knowledge to clients in order to help them make an informed choice regarding their care or activity performed on a daily basis. Any application of an holistic approach to care in future study should also address the health concerns of the clients’ family, understand their family dynamics, identify any environmental factors that may affect or help the clients, locate health resources and initiate referrals as appropriate, ensure clients’ exercise of autonomy, facilitate communication between the interdisciplinary healthcare team and the clients, while ensuring professionalism, ethical practice and confidentiality.
\n
In cooperation with other healthcare professionals, nursing interventions offer access to empirical health data as well as clients’ specimens for a better understanding of the pathophysiology. Biomedical scientists look into the potential biomarkers for making accurate diagnosis and to explain the pathological pathways, in order to allow for effective medical treatments. Recently, based on the assumption of avoidant personality disorder as the most common comorbidity of hikikomori, a medical team has evaluated 101 blood specimens obtained from 46 males and 55 females. Results of this study suggested two gender-different biomarkers potential for explaining the biological basis of hikikomori, namely, uric acid (UA) in men and high-density lipoprotein cholesterol (HDL-C) in women, which were expressed in lower serum levels than with healthy controls [29]. This has opened up a new page in this field of research with increasing trend of the hikikomori prevalence worldwide.
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4. Advocacy work
\n
Socially withdrawn youth suffering from social isolation have not been able to receive regular targeted funding support from the Social Welfare Department (SWD) which is responsible for allocating and administering the bulk of government-funded social welfare services in Hong Kong, whether in statutory, governmental, or NGO settings. On many different occasions, SWD bureaucrats just replied that integrated youth service teams are capable of outreaching secluded youth in the community. These integrated teams are established to provide a wide range of services including children and youth center services, school social work services, and outreaching youth work under one management to meet the multifarious needs of children and youth aged 6–24. However, as these homebound cases are very much demanding of time and effort, and the integrated teams are under pressure to deliver sufficient service output to satisfy the Funding and Service Agreement requirements of the SWD, this invisible group of atomistic individuals would be subject to the risk of receiving inadequate attention and services from integrated teams. Wong argued that government inaction on this specific “hidden problem” which does not upset the community like their street counterparts with antisocial behavior has resulted in ironing out the diversity and differences of NEET youth [6], thus reproducing the inverse care law: availability of services tends to vary inversely with the need of the population served [30]. Advocating for a concerted social policy and more financial and manpower resources to set up separate teams all over Hong Kong to outreach young people in social withdrawal can prevent extended social isolation and consequential poor physical and mental health outcomes from taking place. With the consolidation of practice wisdom and evidence-based practice developed on interdisciplinary collaboration platforms with input from a diversity of health and social care professionals such as social workers, teachers, nurses, doctors, animal-assisted therapists, physiotherapists, physical exercise experts, etc., and with resources, opportunities, and networks by means of engaging multiple stakeholders including employers, parents, and mentors, youth with chronic social withdrawal and social isolation experience can be facilitated to make a transition into the community as a student, trainee, or worker in the conventional sense or as a lifelong learner eager to be engaged in paid and unpaid work experiences and other life-wide experiences in order to map out their career pathway with life’s deep meanings.
\n
All this does not rule out the possibility that with the support of solid research work and studies, social workers and youth work practitioners can share their practice wisdom and evidence-based practices with their professional counterparts working in school, center-wise, and other community-based settings. And it is entirely possible for different professional parties to work in a collaborative manner to involve multiple stakeholders including employers to provide seamless provision of services ranging from a variety of home-based interventions to a plurality of initiatives and measures including interest development, workplace learning, and other on-the-job and corporate mentoring programs.
\n
\n
\n
5. Concluding remarks
\n
Social isolation experienced by young people in the form of extended or chronic social withdrawal at home for a protracted period of time is characterized by its invisibility and inaccessibility to adequate social provisions. For each single and unique case of youth with social withdrawal experience, helping professionals have to address the temporal, spatial, relational, and status-wise parameters in a comprehensive manner in order to map out the context and direction of professional intervention.
\n
However, self-seclusion with resulted stagnation in transition to a legitimate social status does not imply any clientele inactivity at home. Starting where the clients are is to stay tuned with their current interest, routines, and activities they do at home, which can provide the basis for interaction, rapport building, and modest level of conversations. This can help scaffold their further interest- and activity-based learning at home and pave the way for pursuing beyond home learning and fulfilling unfinished tasks in the community.
\n
Individual young people have to learn to interact with others, kick off learning momentum, develop a healthy diet, do exercises, step out their alienating comfort zone, reengage with the community, try out workplace learning, map out their career roadmap, and make contributions to others and the community, but it will not be effective if they are confronted with blaming-the-victim discourses and circumstances unfavorable for realizing their abilities, strengths, and aspirations. Examples of such circumstances include the inadequacy of structural and institutional support; the lack of institutional, organizational, and professional flexibility; the lack of social networks and social capital; the lack of cross-sectoral and interdisciplinary collaboration; and the lack of the provision of an enabling environment where young people can enjoy access to resources, opportunities, and networks for reflecting and developing transferable values, attitudes, skills, and knowledge across different life domains.
\n
Giving young people an enabling environment by means of engaging the participation and involvement of multiple stakeholders for the sake of enhancing youth’s agency, esteem and expectancy can nourish their hopes and raise their aspirations. Again, it is important to seek research funding support to conduct empirical interdisciplinary research studies that could address both the personal and the structural aspects of social withdrawal and social isolation and deliver an analysis of problems and interventions. The causes of social isolation of young people in the form of extended social withdrawal at home are both personal and structural, and thus the conceptualization and delivery of viable measures and interventions have to address both personal and structural dimensions [5, 31]. Interdisciplinary collaboration in terms of practice and research is expected to play a growing important role to do advocacy along this line in the journey ahead.
\n
\n
Acknowledgments
\n
The empirical findings were drawn from a number of research projects supported by the following funding bodies: the Health and Medical Research Fund (Project No. 13144071) from the Food and Health Bureau of Hong Kong, the General Research Fund (Project No. GRF/244707) from the Research Grants Council of Hong Kong, the Faculty Research Grant (Project No. FRG/05-06/I-01-30-05-101) from Hong Kong Baptist University, and the Trust-Initiated Project Fund (Project No. HKBU/HKJCCT-33-14-211) from the Hong Kong Jockey Club Charities Trust.
\n
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"social isolation, social withdrawal, home-based intervention, community-based intervention, youth, enabling environment, expectancy",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/67246.pdf",chapterXML:"https://mts.intechopen.com/source/xml/67246.xml",downloadPdfUrl:"/chapter/pdf-download/67246",previewPdfUrl:"/chapter/pdf-preview/67246",totalDownloads:929,totalViews:0,totalCrossrefCites:2,dateSubmitted:"February 8th 2019",dateReviewed:"April 24th 2019",datePrePublished:"June 6th 2019",datePublished:"April 8th 2020",dateFinished:"May 21st 2019",readingETA:"0",abstract:"This chapter offers a critical analysis of social isolation experienced by youth in social withdrawal, who lead a hermetic way of life characterized by self-isolation or seclusion by retreating themselves at home from the rest of the world for a protracted period of time. The alienating experience of social withdrawal is defined with reference to four parameters, namely, time, place, social relations, and social status. By using these parameters, helping professionals can distinguish those who are in the state of social withdrawal at home from those who are not and map out the directions and context that NGOs and helping professionals have to thoroughly address if social isolation is to be overcome and reengagement of secluded youth is to be achieved. By conducting thorough literature review and using relevant empirical data drawn from the first author’s studies and a longitudinal cohort study of secluded youth in Hong Kong, the authors argue that it is important to start where they are and deliver both home-based and community-based interventions so as to give them an enabling environment where they can cultivate a sense of agency and a sense of expectancy for making a breakthrough against social isolation with the support of interdisciplinary research and practice.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/67246",risUrl:"/chapter/ris/67246",signatures:"Victor Wong, John Yuen, Xuebing Su and Jolene Yung",book:{id:"7818",type:"book",title:"Social Isolation",subtitle:"An Interdisciplinary View",fullTitle:"Social Isolation - An Interdisciplinary View",slug:"social-isolation-an-interdisciplinary-view",publishedDate:"April 8th 2020",bookSignature:"Rosalba Morese, Sara Palermo and Raffaella Fiorella",coverURL:"https://cdn.intechopen.com/books/images_new/7818.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-78984-759-8",printIsbn:"978-1-78984-758-1",pdfIsbn:"978-1-83880-426-8",isAvailableForWebshopOrdering:!0,editors:[{id:"214435",title:"Dr.",name:"Rosalba",middleName:null,surname:"Morese",slug:"rosalba-morese",fullName:"Rosalba Morese"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Parameters for defining the state of social withdrawal",level:"1"},{id:"sec_2_2",title:"2.1 First two parameters: time and place",level:"2"},{id:"sec_3_2",title:"2.2 Third parameter: lack of face-to-face contacts and interactions",level:"2"},{id:"sec_4_2",title:"2.3 Fourth parameter: deprivation of a legitimate social status",level:"2"},{id:"sec_6",title:"3. Intervention for engagement and facilitating youth transition to the community",level:"1"},{id:"sec_6_2",title:"3.1 Home-based rapport building and interventions: start where the client is",level:"2"},{id:"sec_7_2",title:"3.2 Community-based interventions: interest-based and client-centered interventions",level:"2"},{id:"sec_8_2",title:"3.3 Interdisciplinary collaboration across healthcare and social care disciplines for research and youth engagement",level:"2"},{id:"sec_10",title:"4. Advocacy work",level:"1"},{id:"sec_11",title:"5. Concluding remarks",level:"1"},{id:"sec_12",title:"Acknowledgments",level:"1"},{id:"sec_15",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'\nMatthews TJB. The pervasive impact of social isolation and loneliness in young people: An epidemiological, longitudinal and genetically-sensitive study [thesis]. London, UK: King\'s College London; 2017. Available from: https://core.ac.uk/download/pdf/96763292.pdf\n\n'},{id:"B2",body:'\nMorese R, Defedele M, Nervo J. I teach you to quarrel-empathy and mediation: Tools for preventing bullying. In: Socialization: A Multidimensional Perspective. London: IntechOpen; 2018. DOI: 10.5772/intechopen.76882\n'},{id:"B3",body:'\nCoplan RJ, Rubin KH. Social withdrawal and shyness in childhood: History, theories, definitions and assessments. In: Rubin KH, Coplan RJ, editors. The Development of Shyness and Social Withdrawal. New York: The Guilford Press; 2010. pp. 3-22. DOI: 10.1177/0165025409103874\n'},{id:"B4",body:'\nCacioppo S, Grippo AJ, London S, Goossens L, Cacioppo JT. Loneliness: Clinical import and interventions. Perspectives on Psychological Science. 2015;10:238-249. DOI: 10.1177/1745691615570616\n'},{id:"B5",body:'\nWong V. Youth locked in time and space? Defining features of social withdrawal and practice implications. Journal of Social Work Practice. 2009;23:337-352. DOI: 10.1080/02650530903102692\n'},{id:"B6",body:'\nWong V, Ying W. Social withdrawal of young people in Hong Kong: A social exclusion perspective. The Hong Kong Journal of Social Work. 2006;40:61-91. DOI: 10.1142/S0219246206000064\n'},{id:"B7",body:'\nWong V. Social withdrawal as invisible youth disengagement: Government inaction and NGO responses in Hong Kong. International Journal of Sociology and Social Policy. 2012;32:415-430. DOI: 10.1108/01443331211249057\n'},{id:"B8",body:'\nWong V. Social work with youth in social withdrawal: In-home and beyond-home intervention modalities. China Journal of Social Work. 2014;7:161-174. DOI: 10.1080/17525098.2014.921211\n'},{id:"B9",body:'\nHattori Y. Social withdrawal in Japanese youth: A case study of thirty-five hikikomori clients. Journal of Trauma Practice. 2005;4:181-201. DOI: 10.1300/J189v04n03_01\n'},{id:"B10",body:'\nChan HY, Lo TW. Hidden youth services: What Hong Kong can learn from Japan. Children and Youth Services Review. 2014;42:118-126. DOI: 10.1016/j.childyouth.2014.03.021\n'},{id:"B11",body:'\nSuwa M, Suzuki K, Hara K, Watanabe H, Takahashi T. Family features in primary social withdrawal among young adults. Psychiatry and Clinical Neurosciences. 2003;57:586-594. DOI: 10.1046/j.1440-1819.2003.01172.x\n'},{id:"B12",body:'\nFurlong A. The Japanese hikikomori phenomenon: Acute social withdrawal among young people. The Sociological Review. 2008;56:309-325. DOI: 10.1111%2Fj.1467-954X.2008.00790.x\n'},{id:"B13",body:'\nKaneko S. Japan’s ‘socially withdrawn youths’ and time constrains in Japanese society: Management and conceptualization of time in a support group for ‘hikikomori’. Time & Society. 2006;15:233-249. DOI: 10.1177/0961463X06067034\n'},{id:"B14",body:'\nOgino T. Managing categorization and social withdrawal in Japan: Rehabilitation process in a private support group for hikikomorians. International Journal of Japanese Sociology. 2004;13:120-133. DOI: 10.1111/j.1475-6781.2004.00057.x\n'},{id:"B15",body:'\nMallett S. Understanding home: A critical review of the literature. The Sociological Review. 2004;52:62-89. DOI: 10.1111/j.1467-954X.2004.00442.x\n'},{id:"B16",body:'\nYuen JWM, Yan YKY, Wong VCW, Tam WWS, So KW, Chien WT. A physical health profile of youths living with a “hikikomori” lifestyle. International Journal of Environmental Research and Public Health. 2018;15:315. DOI: 10.3390/ijerph15020315\n'},{id:"B17",body:'\nYuen JWM, Wong VCW, Tam WWS, So KW, Chien WT. A one-year prospective follow-up study on the health profile of hikikomori living in Hong Kong. International Journal of Environmental Research and Public Heatlh. 2019;16:546. DOI: 10.3390/ijerph16040546\n'},{id:"B18",body:'\nRoberts K. Youth unemployment and social exclusion. In: Pole C, Pilcher J, Williams J, editors. Young People in Transition: Becoming Citizens? New York: Palgrave MacMillan; 2005. pp. 116-135. DOI: 10.1057/9780230597778\n'},{id:"B19",body:'\nWalker A, Walker C, editors. Britain Divided: The Growth of Social Exclusion in the 1980s and 1990s. London: Child Poverty Action Group; 1997\n'},{id:"B20",body:'\nWaisbrod N, Buchbinder E, Possick C. In-home intervention with families in distress: Changing places to promote change. Social Work. 2012;57:121-131. DOI: 10.1093/sw/sws020\n'},{id:"B21",body:'\nMcFarlane C. Relational sociology: Theoretical inhumanism, and the problem of the nonhuman. In: Powell C, Dépelteau F, editors. Conceptualizing Relational Sociology: Ontological and Theoretical Issues. New York: Palgrave Macmillan; 2013. pp. 45-66. DOI: 10.1057/9781137342652\n'},{id:"B22",body:'\nWong V, Yip TCY. Promoting change: The “expanded notion of work” as a proactive response to the social justice issues in career development practice. In: Hooley T, Sultana R, Thomsen R, editors. Career Guidance for Emancipation: Reclaiming Justice for the Multitude. London: Routledge; 2019. pp. 64-80. DOI: 10.1111/1467-9566.12548\n'},{id:"B23",body:'\nThe Hong Kong Jockey Club Charities Trust. CLAP for Youth @ JC: A Career & Life Adventure Planning Programme [Internet]. 2018. Available from: https://www.clapforyouth.org.hk/wp-content/uploads/2018/09/JC-CLAP-Case-Study.pdf\n\n'},{id:"B24",body:'\nChan HY, Lo TW. Quality of life of the hidden youth in Hong Kong. Applied Research in Quality of Life. 2014;9:951-969. DOI: 10.1007/s11482-013-9279-x\n'},{id:"B25",body:'\nTeychenne M, Ball K, Salmon J. Sedentary behavior and depression among adults: A review. International Journal of Behavioral Medicine. 2010;17:246-254. DOI: 10.1007/s12529-010-9075-z\n'},{id:"B26",body:'\nCarpenter CJ. A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Communication. 2010;25:661-669. DOI: 10.1080/10410236.2010.521906\n'},{id:"B27",body:'\nAbraham C, Sheeran P. The health belief model. In: Conner M, Norma P, editors. Predicting Health Behaviour: Research and Practice with Social Cognition Models. 2nd ed. New York: Open University Press; 2005. pp. 28-80. DOI: 10.0335/21776.3\n'},{id:"B28",body:'\nGottlieb L, Rowat K. The McGill model of nursing: A practice derived model. Advances in Nursing Science. 1987;9:51-61. DOI: 10.1097/00012272-198707000-00008\n'},{id:"B29",body:'\nKohei H et al. Blood biomarkers of hikikomori, a severe social withdrawal syndrome. Scientific Reports. 2018;8:2884. DOI: 10.1038/s4159-018-21260-w\n'},{id:"B30",body:'\nHart JT. The inverse care law. The Lancet. 1971;297:405-412. DOI: S014067367192410X\n'},{id:"B31",body:'\nMorese R, Palermo S, Nervo J. Socialization: A Multidimensional Perspective. London: IntechOpen; 2018. DOI: 10.5772/65537\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Victor Wong",address:"vicwong@hkbu.edu.hk",affiliation:'
Department of Social Work, Hong Kong Baptist University, Hong Kong
School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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All Works published by IntechOpen prior to October 2011 are licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported license (CC BY-BC-SA 3.0). Works published after October 2011 are licensed under a Creative Commons Attribution 3.0 Unported license (CC BY 3.0), the latter allowing for the broadest possible reuse of published material.
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All Works licensed under CC BY-BC-SA 3.0 can be freely translated and used for non-commercial purposes. Works licensed under CC BY 3.0 license can be freely translated and used for both commercial and non-commercial purposes.
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A Book in its entirety, or a significant part of a Book, cannot be translated freely without specific written consent by the publisher. Requests for permission can be made at permissions@intechopen.com.
All Works licensed under CC BY-BC-SA 3.0 can be freely translated and used for non-commercial purposes. Works licensed under CC BY 3.0 license can be freely translated and used for both commercial and non-commercial purposes.
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Book Chapters
\n\n
All translated Chapters have to be properly attributed in accordance with the requirements included in IntechOpen's Attribution Policy. Besides proper attribution translated sections of Works must include the following sentence: "This is an unofficial translation of a work published by IntechOpen. The publisher has not endorsed this translation".
\n\n
Books and all other compilations
\n\n
All rights to Books and other compilations are reserved by IntechOpen. The copyright to Books and other compilations is subject to a Copyright separate from any that exists in the included Works.
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Climate change occurs as a result of an imbalance between incoming and outgoing radiation in the atmosphere. The global mean temperatures may increase up to 5.4°C by 2100. Climate change is mainly caused by humans, especially through increased greenhouse gas emissions. Climate change is recognized as a serious threat to ecosystem, biodiversity, and health. It is associated with alterations in the physical environment of the planet Earth. Climate change affects life around the globe. It impacts plants and animals, with consequences for the survival of the species. In humans, climate change has multiple deleterious consequences. Climate change creates water and food insecurity, increased morbidity/mortality, and population movement. Vulnerable populations (e.g., children, elderly, indigenous, and poor) are disproportionately affected. Personalized adaptation to the consequences of climate change and preventive measures are key challenges for the society. Policymakers must implement the appropriate strategies, especially in the vulnerable populations.",book:{id:"9664",slug:"environmental-issues-and-sustainable-development",title:"Environmental Issues and Sustainable Development",fullTitle:"Environmental Issues and Sustainable Development"},signatures:"Hassan M. Heshmati",authors:[{id:"313921",title:"Dr.",name:"Hassan M.",middleName:null,surname:"Heshmati",slug:"hassan-m.-heshmati",fullName:"Hassan M. 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As a result, the optimal formula is obtained with 300 g of mycorrhizal and rhizobium strains + 500 g of black soil + 200 g of potato peel crust, which has an effective antagonistic capacity of 100% in pea cultivation, 90% in the barley, and 85% in the potato, besides that it achieves a biotisation in the cultivation of peas of 95%, in the barley 100% and in the potato 90%.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"Henry Juan Javier Ninahuaman and Grimaldo Quispe Santivañez"},{id:"82542",title:"Effects of Veld Degradation on Biomass Production in the Arable Lands of South Africa",slug:"effects-of-veld-degradation-on-biomass-production-in-the-arable-lands-of-south-africa",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.102605",abstract:"This paper reviews the impacts of veld degradation on species diversity, veld ecological condition. The major focus of this review is to assess the major critical factors that contributeto veld degradation. It is imperative to revitalize information on the effects of veld degradation in the South African pastoral farming systems. Current studies have indicated the limited research gaps that identify the adverse effects of veld degradation on species composition and biomass production. Grazing behavior in different grazing patterns has not been clear. Finally, this review will assist farmers, policymakers, and pastoralists to broaden their knowledge on policy development, and appropriate the veld management practices, coping measures of veld degradation, particularly those from resource-poor communities. Whereby, livestock production is the focus for food security and poverty alleviation. However, the use of legumes intercropped with temperate grass species can improve animal performance and herbage production during critical periods. The review further evaluates the veld management practices and their ability in providing adequate foliar cover with the use of the edible perennial grass plant that ensures long-term sustainable production with maximum economic returns during critical grazing seasons.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"Nkosikhona Madolo and Francis B. Lewu"},{id:"82330",title:"Advances in Bioenergy Production Using Fast Pyrolysis and Hydrothermal Processing",slug:"advances-in-bioenergy-production-using-fast-pyrolysis-and-hydrothermal-processing",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.105185",abstract:"This chapter provides an overview of current efforts and advances as well as environmental and economic aspects of fast pyrolysis and hydrothermal processing, which are potential technologies for bioenergy production, mainly bio-oil and syngas. Biomass is presently the primary bioenergy resource in the world. The chapter presents a brief discussion of sources and compositions of biomass. Biomass is converted to various products using thermochemical conversions. Pyrolysis is a thermochemical process that converts biomass into carbon-rich solid residue, condensable vapors, and non-condensable gases in the absence of oxygen. It is a promising technology for converting biomass into renewable biofuels with environmental and economic advantages. Pyrolysis processes are classified based on their operating conditions and desired products. Two thermochemical processes, fast pyrolysis and hydrothermal processing are reviewed. Fast pyrolysis produces a higher quantity and quality of bio-oil and syngas than slow and intermediate pyrolysis processes. Hydrothermal processing converts wet biomass into carbonaceous biofuel. The ability to produce higher-value bioenergy by these pyrolysis technologies depends on the feedstock and operating condition of the pyrolysis processes. This chapter will present the most promising features of fast pyrolysis and hydrothermal processing along with their optimal pyrolysis conditions in maximizing the production of biofuels.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"Meegalla R. Chandraratne and Asfaw Gezae Daful"},{id:"81162",title:"Economic Assessment of Biomass Based Power Generation",slug:"economic-assessment-of-biomass-based-power-generation",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.103692",abstract:"Biomass based power generation systems can play a significant role to alleviate energy crisis and reduce fossil fuel dependency in the countries that possess abundance of agricultural and forest biomass resources. Particularly the countries to go for biomass energy in a large scale must know power and energy potential for biomass based commercial production with proper economic assessment of the possibilities. In-depth knowledge is must to assess the profitability and sustainability of the projects. Profitability measures how the investment in the project can be secured to have an ensured surplus to be shared by the stake holders and sustainability ensures the long-term existence in the business with a positive trend of gaining market share day by day or simply to be in the business. This chapter will present the details of the economic assessment of biomass- based energy projects in terms of net present value (NPV), internal rate of return (IRR), discounted payback period (DPB), and cost of energy. The economic profitability measure is a must before advancing to a venture whether it is self-financed or loan financed. So, it is hoped that readers of the chapter should develop a proper evaluation capability and know how to analyze the biomass-based energy projects.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"A.B.M. Abdul Malek"},{id:"80542",title:"Comparative Analysis of Biodiesel Production from Different Potential Feedstocks in the Philippines",slug:"comparative-analysis-of-biodiesel-production-from-different-potential-feedstocks-in-the-philippines",totalDownloads:31,totalDimensionsCites:0,doi:"10.5772/intechopen.102724",abstract:"In response to the worsening crisis on energy security and climate change, the Philippine Biofuels Law (Republic Act 9367) was enacted which mandates the blending of biodiesel to petroleum diesel sold in the country. Primarily, feedstock and pricing concerns led to stagnant growth of the Philippine biodiesel industry. Hence, viability of different potential biodiesel feedstocks such as coconut, oil palm, and soybean (first generation), jatropha and used cooking oil (second generation), and microalgae (third generation) was assessed through extensive research and developments. Among these sources, oil palm is regarded as the best complementary feedstock to coconut due to its high biodiesel productivity of 376 million liters per year. Oil palm biodiesel production in the Philippines was also found to have a low carbon footprint of 1.80 kg CO2e per liter and a GHG reduction potential of 42%, which corresponds to a GHG savings of about 1.05 million metric tons CO2e per year for a 5% blending mandate in 2025. Additionally, a low biodiesel selling price of about Php 33.26 per liter can be achieved from using this feedstock for biodiesel production. Hence, use of a low cost and readily available feedstock coupled with established processing technologies and pricing mechanisms will help boost the biodiesel industry in the Philippines.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"Rona Joyce B. Landoy, Rex B. Demafelis, Bernadette T. Magadia and Anna Elaine D. Matanguihan"},{id:"80493",title:"Conventional and Unconventional Transformation of Cocoa Pod Husks into Value-Added Products",slug:"conventional-and-unconventional-transformation-of-cocoa-pod-husks-into-value-added-products",totalDownloads:42,totalDimensionsCites:0,doi:"10.5772/intechopen.102606",abstract:"The drive for a sustainable society and a circular economy has motivated researchers around the globe to turn to the transformation of renewable raw materials like biomass into value-added products that are akin or superior to their fossil counterparts. Among these biomass raw materials, cocoa pod husks (CPH) which is the non-edible portion of cocoa (ca. 70–75% weight of the while cocoa fruit) remains a promising bio-resource raw material for the production high-value added chemicals but yet largely underexploited. Currently, the most popular applications of CPH involves its use as low-value application products such as animal feed, raw material for soap making, and activated carbon. However, the rich source of lignocellulosic content, pectin, and phenolic compounds of CPH means it could be used as raw materials for the production industrially relevant platform chemicals with high potential in the agrochemicals, pharmaceutical, and food industries, if efficient transformations routes are developed by scientists. In this chapter, we will shed light on some of the works related to the transformation of CPH into various value-added products. An economic evaluation of the transformation of cocoa pod husk into relevant chemicals and products is also discussed.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"Martina Francisca Baidoo, Nana Yaw Asiedu, Lawrence Darkwah, David Arhin-Dodoo, Jun Zhao, Francois Jerome and Prince Nana Amaniampong"}],onlineFirstChaptersTotal:17},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:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"25",title:"Environmental Sciences",doi:"10.5772/intechopen.100362",issn:"2754-6713",scope:"
\r\n\tScientists have long researched to understand the environment and man’s place in it. The search for this knowledge grows in importance as rapid increases in population and economic development intensify humans’ stresses on ecosystems. Fortunately, rapid increases in multiple scientific areas are advancing our understanding of environmental sciences. Breakthroughs in computing, molecular biology, ecology, and sustainability science are enhancing our ability to utilize environmental sciences to address real-world problems. \r\n\tThe four topics of this book series - Pollution; Environmental Resilience and Management; Ecosystems and Biodiversity; and Water Science - will address important areas of advancement in the environmental sciences. They will represent an excellent initial grouping of published works on these critical topics.
",coverUrl:"https://cdn.intechopen.com/series/covers/25.jpg",latestPublicationDate:"August 8th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:1,editor:{id:"197485",title:"Dr.",name:"J. Kevin",middleName:null,surname:"Summers",slug:"j.-kevin-summers",fullName:"J. Kevin Summers",profilePictureURL:"https://mts.intechopen.com/storage/users/197485/images/system/197485.jpg",biography:"J. Kevin Summers is a Senior Research Ecologist at the Environmental Protection Agency’s (EPA) Gulf Ecosystem Measurement and Modeling Division. He is currently working with colleagues in the Sustainable and Healthy Communities Program to develop an index of community resilience to natural hazards, an index of human well-being that can be linked to changes in the ecosystem, social and economic services, and a community sustainability tool for communities with populations under 40,000. He leads research efforts for indicator and indices development. Dr. Summers is a systems ecologist and began his career at the EPA in 1989 and has worked in various programs and capacities. This includes leading the National Coastal Assessment in collaboration with the Office of Water which culminated in the award-winning National Coastal Condition Report series (four volumes between 2001 and 2012), and which integrates water quality, sediment quality, habitat, and biological data to assess the ecosystem condition of the United States estuaries. He was acting National Program Director for Ecology for the EPA between 2004 and 2006. He has authored approximately 150 peer-reviewed journal articles, book chapters, and reports and has received many awards for technical accomplishments from the EPA and from outside of the agency. Dr. Summers holds a BA in Zoology and Psychology, an MA in Ecology, and Ph.D. in Systems Ecology/Biology.",institutionString:null,institution:{name:"Environmental Protection Agency",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:9,paginationItems:[{id:"38",title:"Pollution",coverUrl:"https://cdn.intechopen.com/series_topics/covers/38.jpg",editor:{id:"110740",title:"Dr.",name:"Ismail M.M.",middleName:null,surname:"Rahman",slug:"ismail-m.m.-rahman",fullName:"Ismail M.M. Rahman",profilePictureURL:"https://mts.intechopen.com/storage/users/110740/images/2319_n.jpg",biography:"Ismail Md. Mofizur Rahman (Ismail M. M. Rahman) assumed his current responsibilities as an Associate Professor at the Institute of Environmental Radioactivity, Fukushima University, Japan, in Oct 2015. He also has an honorary appointment to serve as a Collaborative Professor at Kanazawa University, Japan, from Mar 2015 to the present. \nFormerly, Dr. Rahman was a faculty member of the University of Chittagong, Bangladesh, affiliated with the Department of Chemistry (Oct 2002 to Mar 2012) and the Department of Applied Chemistry and Chemical Engineering (Mar 2012 to Sep 2015). Dr. Rahman was also adjunctly attached with Kanazawa University, Japan (Visiting Research Professor, Dec 2014 to Mar 2015; JSPS Postdoctoral Research Fellow, Apr 2012 to Mar 2014), and Tokyo Institute of Technology, Japan (TokyoTech-UNESCO Research Fellow, Oct 2004–Sep 2005). \nHe received his Ph.D. degree in Environmental Analytical Chemistry from Kanazawa University, Japan (2011). He also achieved a Diploma in Environment from the Tokyo Institute of Technology, Japan (2005). Besides, he has an M.Sc. degree in Applied Chemistry and a B.Sc. degree in Chemistry, all from the University of Chittagong, Bangladesh. \nDr. Rahman’s research interest includes the study of the fate and behavior of environmental pollutants in the biosphere; design of low energy and low burden environmental improvement (remediation) technology; implementation of sustainable waste management practices for treatment, handling, reuse, and ultimate residual disposition of solid wastes; nature and type of interactions in organic liquid mixtures for process engineering design applications.",institutionString:null,institution:{name:"Fukushima University",institutionURL:null,country:{name:"Japan"}}},editorTwo:{id:"201020",title:"Dr.",name:"Zinnat Ara",middleName:null,surname:"Begum",slug:"zinnat-ara-begum",fullName:"Zinnat Ara Begum",profilePictureURL:"https://mts.intechopen.com/storage/users/201020/images/system/201020.jpeg",biography:"Zinnat A. Begum received her Ph.D. in Environmental Analytical Chemistry from Kanazawa University in 2012. She achieved her Master of Science (M.Sc.) degree with a major in Applied Chemistry and a Bachelor of Science (B.Sc.) in Chemistry, all from the University of Chittagong, Bangladesh. Her work affiliations include Fukushima University, Japan (Visiting Research Fellow, Institute of Environmental Radioactivity: Mar 2016 to present), Southern University Bangladesh (Assistant Professor, Department of Civil Engineering: Jan 2015 to present), and Kanazawa University, Japan (Postdoctoral Fellow, Institute of Science and Engineering: Oct 2012 to Mar 2014; Research fellow, Venture Business Laboratory, Advanced Science and Social Co-Creation Promotion Organization: Apr 2018 to Mar 2021). The research focus of Dr. Zinnat includes the effect of the relative stability of metal-chelator complexes in the environmental remediation process designs and the development of eco-friendly soil washing techniques using biodegradable chelators.",institutionString:null,institution:{name:"Fukushima University",institutionURL:null,country:{name:"Japan"}}},editorThree:null,editorialBoard:[{id:"252368",title:"Dr.",name:"Meng-Chuan",middleName:null,surname:"Ong",slug:"meng-chuan-ong",fullName:"Meng-Chuan Ong",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRVotQAG/Profile_Picture_2022-05-20T12:04:28.jpg",institutionString:null,institution:{name:"Universiti Malaysia Terengganu",institutionURL:null,country:{name:"Malaysia"}}},{id:"63465",title:"Prof.",name:"Mohamed Nageeb",middleName:null,surname:"Rashed",slug:"mohamed-nageeb-rashed",fullName:"Mohamed Nageeb Rashed",profilePictureURL:"https://mts.intechopen.com/storage/users/63465/images/system/63465.gif",institutionString:null,institution:{name:"Aswan University",institutionURL:null,country:{name:"Egypt"}}},{id:"187907",title:"Dr.",name:"Olga",middleName:null,surname:"Anne",slug:"olga-anne",fullName:"Olga Anne",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBE5QAO/Profile_Picture_2022-04-07T09:42:13.png",institutionString:null,institution:{name:"Klaipeda State University of Applied Sciences",institutionURL:null,country:{name:"Lithuania"}}}]},{id:"39",title:"Environmental Resilience and Management",coverUrl:"https://cdn.intechopen.com/series_topics/covers/39.jpg",editor:{id:"137040",title:"Prof.",name:"Jose",middleName:null,surname:"Navarro-Pedreño",slug:"jose-navarro-pedreno",fullName:"Jose Navarro-Pedreño",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRAXrQAO/Profile_Picture_2022-03-09T15:50:19.jpg",biography:"Full professor at University Miguel Hernández of Elche, Spain, previously working at the University of Alicante, Autonomous University of Madrid and Polytechnic University of Valencia. Graduate in Sciences (Chemist), graduate in Geography and History (Geography), master in Water Management, Treatment, master in Fertilizers and Environment and master in Environmental Management; Ph.D. in Environmental Sciences. His research is focused on soil-water and waste-environment relations, mainly on soil-water and soil-waste interactions under different management and waste reuse. His work is reflected in more than 230 communications presented in national and international conferences and congresses, 29 invited lectures from universities, associations and government agencies. Prof. Navarro-Pedreño is also a director of the Ph.D. Program Environment and Sustainability (2012-present) and a member of several societies among which are the Spanish Society of Soil Science, International Union of Soil Sciences, European Society for Soil Conservation, DessertNet and the Spanish Royal Society of Chemistry.",institutionString:"Miguel Hernández University of Elche, Spain",institution:{name:"Miguel Hernandez University",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"177015",title:"Prof.",name:"Elke Jurandy",middleName:null,surname:"Bran Nogueira Cardoso",slug:"elke-jurandy-bran-nogueira-cardoso",fullName:"Elke Jurandy Bran Nogueira Cardoso",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRGxzQAG/Profile_Picture_2022-03-25T08:32:33.jpg",institutionString:"Universidade de São Paulo, Brazil",institution:null},{id:"147289",title:"Prof.",name:"Francisco",middleName:null,surname:"Guevara-Hernández",slug:"francisco-guevara-hernandez",fullName:"Francisco Guevara-Hernández",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRCgVQAW/Profile_Picture_2022-06-27T11:25:21.png",institutionString:null,institution:{name:"Autonomous University of Chiapas",institutionURL:null,country:{name:"Mexico"}}},{id:"246299",title:"Dr.",name:"Maria Belén",middleName:null,surname:"Almendro-Candel",slug:"maria-belen-almendro-candel",fullName:"Maria Belén Almendro-Candel",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRUGxQAO/Profile_Picture_2022-07-26T14:57:26.jpg",institutionString:null,institution:{name:"Miguel Hernandez University",institutionURL:null,country:{name:"Spain"}}},{id:"211260",title:"Dr.",name:"Sandra",middleName:null,surname:"Ricart",slug:"sandra-ricart",fullName:"Sandra Ricart",profilePictureURL:"https://mts.intechopen.com/storage/users/211260/images/system/211260.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}}]},{id:"40",title:"Ecosystems and Biodiversity",coverUrl:"https://cdn.intechopen.com/series_topics/covers/40.jpg",editor:{id:"209149",title:"Prof.",name:"Salustiano",middleName:null,surname:"Mato",slug:"salustiano-mato",fullName:"Salustiano Mato",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRLREQA4/Profile_Picture_2022-03-31T10:23:50.png",biography:"Salustiano Mato de la Iglesia (Santiago de Compostela, 1960) is a doctor in biology from the University of Santiago and a Professor of zoology at the Department of Ecology and Animal Biology at the University of Vigo. He has developed his research activity in the fields of fauna and soil ecology, and in the treatment of organic waste, having been the founder and principal investigator of the Environmental Biotechnology Group of the University of Vigo.\r\nHis research activity in the field of Environmental Biotechnology has been focused on the development of novel organic waste treatment systems through composting. The result of this line of work are three invention patents and various scientific and technical publications in prestigious international journals.",institutionString:null,institution:{name:"University of Vigo",institutionURL:null,country:{name:"Spain"}}},editorTwo:{id:"60498",title:"Prof.",name:"Josefina",middleName:null,surname:"Garrido",slug:"josefina-garrido",fullName:"Josefina Garrido",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRj1VQAS/Profile_Picture_2022-03-31T10:06:51.jpg",biography:"Josefina Garrido González (Paradela de Abeleda, Ourense 1959), is a doctor in biology from the University of León and a Professor of Zoology at the Department of Ecology and Animal Biology at the University of Vigo. She has focused her research activity on the taxonomy, fauna and ecology of aquatic beetles, in addition to other lines of research such as the conservation of biodiversity in freshwater ecosystems; conservation of protected areas (Red Natura 2000) and assessment of the effectiveness of wetlands as priority areas for the conservation of aquatic invertebrates; studies of water quality in freshwater ecosystems through biological indicators and physicochemical parameters; surveillance and research of vector arthropods and invasive alien species.",institutionString:null,institution:{name:"University of Vigo",institutionURL:null,country:{name:"Spain"}}},editorThree:{id:"464288",title:"Dr.",name:"Francisco",middleName:null,surname:"Ramil",slug:"francisco-ramil",fullName:"Francisco Ramil",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003RI7lHQAT/Profile_Picture_2022-03-31T10:15:35.png",biography:"Fran Ramil Blanco (Porto de Espasante, A Coruña, 1960), is a doctor in biology from the University of Santiago de Compostela and a Professor of Zoology at the Department of Ecology and Animal Biology at the University of Vigo. His research activity is linked to the taxonomy, fauna and ecology of marine benthic invertebrates and especially the Cnidarian group. Since 2004, he has been part of the EcoAfrik project, aimed at the study, protection and conservation of biodiversity and benthic habitats in West Africa. He also participated in the study of vulnerable marine ecosystems associated with seamounts in the South Atlantic and is involved in training young African researchers in the field of marine research.",institutionString:null,institution:{name:"University of Vigo",institutionURL:null,country:{name:"Spain"}}},editorialBoard:[{id:"220987",title:"Dr.",name:"António",middleName:"Onofre",surname:"Soares",slug:"antonio-soares",fullName:"António Soares",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNtzQAG/Profile_Picture_1644499672340",institutionString:null,institution:{name:"University of the Azores",institutionURL:null,country:{name:"Portugal"}}},{id:"276688",title:"Prof.",name:"Mohammed Latif",middleName:null,surname:"Khan",slug:"mohammed-latif-khan",fullName:"Mohammed Latif Khan",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcCZQA0/Profile_Picture_2022-07-15T15:04:17.jpg",institutionString:"Dr. Harisngh Gour Central University, India",institution:null}]},{id:"41",title:"Water Science",coverUrl:"https://cdn.intechopen.com/series_topics/covers/41.jpg",editor:{id:"349630",title:"Dr.",name:"Yizi",middleName:null,surname:"Shang",slug:"yizi-shang",fullName:"Yizi Shang",profilePictureURL:"https://mts.intechopen.com/storage/users/349630/images/system/349630.jpg",biography:"Prof. Dr. Yizi Shang is a pioneering researcher in hydrology and water resources who has devoted his research career to promoting the conservation and protection of water resources for sustainable development. He is presently associate editor of Water International (official journal of the International Water Resources Association). He was also invited to serve as an associate editor for special issues of the Journal of the American Water Resources Association. He has served as an editorial member for international journals such as Hydrology, Journal of Ecology & Natural Resources, and Hydro Science & Marine Engineering, among others. He has chaired or acted as a technical committee member for twenty-five international forums (conferences). Dr. Shang graduated from Tsinghua University, China, in 2010 with a Ph.D. in Engineering. Prior to that, he worked as a research fellow at Harvard University from 2008 to 2009. Dr. Shang serves as a senior research engineer at the China Institute of Water Resources and Hydropower Research (IWHR) and was awarded as a distinguished researcher at National Taiwan University in 2017.",institutionString:"China Institute of Water Resources and Hydropower Research",institution:{name:"China Institute of Water Resources and Hydropower Research",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"216491",title:"Dr.",name:"Charalampos",middleName:null,surname:"Skoulikaris",slug:"charalampos-skoulikaris",fullName:"Charalampos Skoulikaris",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRMsbQAG/Profile_Picture_2022-04-21T09:31:55.jpg",institutionString:null,institution:{name:"Aristotle University of Thessaloniki",institutionURL:null,country:{name:"Greece"}}},{id:"300124",title:"Prof.",name:"Thomas",middleName:null,surname:"Shahady",slug:"thomas-shahady",fullName:"Thomas Shahady",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002kuIgmQAE/Profile_Picture_2022-03-18T07:32:10.jpg",institutionString:null,institution:{name:"Lynchburg College",institutionURL:null,country:{name:"United States of America"}}}]}]},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:12,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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