Conditions that impede a kidney biopsy.
\r\n\tRecent advances regarding pathogenesis, cardiovascular risk assessment, prediction of damage, and recent advances in treatment, including tolerogenic and biological agents, are welcome to be included in this book. Relevant contributions regarding standard therapies and their optimal use, as well as the role of new therapeutic options, either in combination with previous agents or alone are of interest.
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Dr. Lionaki obtained her MD from the National and Kapodistrian University of Athens and has a Ph.D. degree in \"Membranous Nephropathy”. She is an expert in the field of 'Glomerular Diseases' as a result of a fellowship for more than 2 years at the Nephrology Department of the University of North Carolina, at Chapel Hill in the USA.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"213115",title:"M.D.",name:"Sophia",middleName:null,surname:"Lionaki",slug:"sophia-lionaki",fullName:"Sophia Lionaki",profilePictureURL:"https://mts.intechopen.com/storage/users/213115/images/system/213115.png",biography:"Sophia Lionaki, MD, PhD is an Assistant Professor In Nephrology in the National and Kapodistrian University of Athens, Greece. She obtained her MD from National and Kapodistrian University of Athens, Greece in 1996 and has a Ph.D degree on \"Membranous Nephropathy”. She is an expert in the field of 'Glomerular Diseases' as a result of a fellowship for more than 2 years at the Nephrology Department of the University of North Carolina, at Chapel Hill in USA under the mentorship of Professors Ronald J. Falk and J.Charles Jennette. \nHer research interests include: ANCA vasculitis and glomerulonephritis, lupus nephritis, primary glomerulonephritides, immunology of the kidney.",institutionString:"National and Kapodistrian University of Athens",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"National and Kapodistrian University of Athens",institutionURL:null,country:{name:"Greece"}}}],coeditorOne:{id:"451879",title:"Dr.",name:"Minas",middleName:null,surname:"Karagiannis",slug:"minas-karagiannis",fullName:"Minas Karagiannis",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:"National and Kapodistrian University of Athens",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"National and Kapodistrian University of Athens",institutionURL:null,country:{name:"Greece"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:[{id:"82899",title:"Anti-Non-Bilayer Phospholipid Arrangement Antibodies Trigger an Autoimmune Disease Similar to Systemic Lupus Erythematosus in Mice",slug:"anti-non-bilayer-phospholipid-arrangement-antibodies-trigger-an-autoimmune-disease-similar-to-system",totalDownloads:7,totalCrossrefCites:0,authors:[null]},{id:"82748",title:"Recent Advances in SLE Treatment Including Biologic Therapies",slug:"recent-advances-in-sle-treatment-including-biologic-therapies",totalDownloads:7,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"444316",firstName:"Blanka",lastName:"Gugic",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/444316/images/20016_n.jpg",email:"blanka@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. 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AKI has numerous hemodynamic, inflammatory, toxic, and obstructive causes, which, when diagnosed and treated early, can be reversed, thereby avoiding permanent damage [1, 2]. CKD, however, is the clinical detection of a progressive, irreversible loss of kidney function, for which the aim of therapy is to minimize the progression of the disease [2].
Percutaneous kidney biopsy has become part of clinical practice in nephrology, as it enables the diagnosis, prognostic assessment, and therapeutic guidance of kidney diseases [3, 4]. Since its advent in the 1950s, advances have been achieved in the technique to improve the diagnostic yield and minimize complications [5].
The indication for a kidney biopsy is determined mainly by signs and symptoms [4]. The global rate of biopsy (number of procedures per million [ppm]) in native kidneys ranges from more than 250 ppm in Australia to less than 75 ppm in the United States. This divergence in kidney biopsy rates is influenced by the prevalence of kidney disease as well as different opinions regarding the value of the procedure in terms of diagnosis, prognosis, and therapy [6].
The main objectives that lead to the indication for kidney biopsy are the need for a precise diagnosis and treatment, the need to determine the degree of activity and chronicity of the lesion in order to establish the prognosis and possible response to treatment, and the evaluation of genetic diseases [6]. The diagnostic contribution of a kidney biopsy is undeniable in cases of nephrotic syndrome, systemic disease kidney failure, unexplained AKI, and transplanted kidney dysfunction [7].
For cases of idiopathic nephrotic syndrome in adults and children older than 6 years of age, the indication for a kidney biopsy is extremely important, as the findings often influence therapeutic decision-making [8]. In a prospective study involving 276 biopsies of native kidneys, the diagnosis resulting from the biopsy influenced the management of 86% of cases of nephrotic syndrome [9]. However, there is a variety of clinical situations of nephrotic syndrome for which a kidney biopsy is not generally performed at the time of diagnosis, such as in cases of children between 1 and 6 years of age due to the high prevalence of minimal change disease [10, 11]. In such situations, corticotherapy is indicated and biopsy is only performed in cases of therapeutic failure or the appearance of another sign or symptom not associated with minimal change disease [11]. Biopsy is also not performed initially in cases of secondary nephrotic disease clearly associated with the introduction of a medication known to cause this condition, such as non-steroidal anti-inflammatory drugs, gold salts, pamidronate, penicillamine, and lithium. This group includes patients with longstanding diabetes with gradual proteinuria progression, those with morbid obesity and slowly increasing proteinuria accompanied or not by diabetes and worsening kidney function, those with systemic diseases such as primary or secondary amyloidosis in which the diagnosis can be made through less invasive methods, such as adipose tissue biopsy, and patients known to have malignant diseases involving nephrotic syndrome [6]. Patients with nephrotic syndrome generally exhibit hematuria, proteinuria, hypertension, and renal dysfunction, and the condition is also often associated with systemic diseases. Therefore, kidney biopsy contributes to the diagnosis, therapeutic decision-making, and classification of the disease (e.g., systemic lupus erythematosus). In suspected cases of post-streptococcal glomerulonephritis, biopsy is only recommended when a gradual worsening in serum levels of creatinine, prolonged hypocomplementemia, and recurring hematuria are observed [6, 7].
Cases of systemic diseases with kidney failure include non-nephrotic proteinuria, isolated glomerular hematuria, and unexplained CKD. Protein is a marker and factor related to the progression of kidney disease. Studies have demonstrated a relation between the degree of proteinuria and the progression of CKD in cases of non-nephrotic proteinuria [7]. Thus, many nephrologists routinely perform a kidney biopsy in patients with higher non-nephrotic proteinuria (1–2 g/day) in the absence of another clinical condition that might explain the findings (e.g., diabetes mellitus or hypertension). However, in situations of low-grade proteinuria (500–1000 mg/day) in the absence of glomerular hematuria, altered kidney function, and clinical/serological evidence of a systemic disease, a biopsy is generally not performed [6]. Biopsy in cases of isolated glomerular hematuria remains controversial, as the procedure exerts little influence on therapeutic decision-making. When performed, the conditions most often encountered are Alport syndrome, thin basement membrane nephropathy, and immunoglobulin A nephropathy. In a prospective analysis, biopsy influenced the therapeutic decision-making in only one of the 36 procedures performed [9]. For patients with unexplained CKD, a kidney biopsy can provide important information, despite the greater risk of complication. In cases of exacerbated CKD, a biopsy may reveal lesions that can be treated and reversed. Moreover, a biopsy can contribute important knowledge to clinical management in cases of the need for a kidney transplant [7].
For patients with unexplained AKI, biopsy is indicated in cases of an uncertain etiology and can influence clinical management in 71% of cases [9]. Biopsy is also particularly useful for early or late-onset dysfunction of a renal graft. In cases of acute graft dysfunction, the procedure enables confirming the diagnosis of rejection and specifying the pathological mechanism (acute cellular rejection or anti-body mediated rejection). Late biopsies also furnish essential information to assist in differentiating the causes of chronic nephropathy of the graft, such as chronic rejection, transplant glomerulopathy, nephrotoxicity, viral disease, lymphoproliferative diseases, and relapse of the base disease. The simplicity of the technical procedure and richness of the diagnostic and prognostic information make biopsy indispensable to the follow-up of renal grafts [7].
Contraindications for kidney biopsy may be absolute or relative. For percutaneous kidney biopsies, absolute contraindications include uncontrolled severe hypertension, the inability of the patient to cooperate with the biopsy, having only one kidney, and uncontrollable hemorrhagic diathesis, whereas relative contraindications include severe azotemia, anatomic kidney abnormalities, anticoagulation, pregnancy, and urinary tract infection [3].
Kidney biopsies can be guided by different imaging methods, the most common of which are ultrasound (US) and computed tomography (CT) due to their good performance and broad availability. In contrast, magnetic resonance is employed little due to the greater cost and need for specific material. The choice between US and CT should be individualized and based on the physician’s experience, kidney volume, location of the biopsy site, patient’s clinical condition, and the availability of the equipment. US is generally the imaging method of choice for guiding a kidney biopsy, since it enables obtaining samples from virtually any site and visualizing the needle in real time. It also does not expose the patient to radiation, can be performed in any environment, including at the bedside, and enables the continual monitoring of any pre-operative complications. It is also the method of choice for post-procedure follow-up, enabling the early detection of complications [4].
To be successful, US-guided kidney biopsy requires specific conditions. The patient must be placed in ventral decubitus on the examining table and the procedure must be performed in a sterile environment. The transducer should be covered with a sterile film. There are specific transducer covers on the market, but a sterile glove can be used in cases of emergency. Antisepsis should be performed on the entire side of the back corresponding to the kidney to be biopsied. The selection of the puncture site is determined by US considering the best path (least distance between the skin and renal capsule and the absence of vascular structures and/or interposed intestinal loops). This region in the center of the US image ensures the safest path for the biopsy and provides better control and resolution of the image.
Once the region to be punctured has been defined, the skin at the puncture site is anesthetized and the area of anesthesia is then extended to the deep layers, preferably reaching the perirenal layers, including adjacencies external to Gerota’s fascia and the renal capsule. An alternative is the use of a long 18G peripheral intravenous catheter with the administration of 20 ml of anesthetic solution (10 ml of 2% xylocaine with no vasoconstrictor +10 ml of 0.9% saline solution or bi-distilled water). The entire anesthetic procedure as well as the subsequent steps should be guided by US. Some authors prefer performing a biopsy with their hands free. The two techniques (with or without US) have the same rates of minor and major complications and obtain adequate material for analysis, but the hands-free method requires greater experience and has a somewhat slower learning curve [1, 12]. Next, the biopsy needle is aligned with the transducer (when US is used) and introduced at a 45° angle to the skin. To ensure the safety of the procedure and control of complications, both the needle and its path should be kept within the US viewing field. The path to follow with the needle in the renal parenchyma should only involve the renal cortex (glomerular region), without transfixing the renal medulla, which contributes little to the study and has large-caliber vessels that could be associated with vascular complications; this also avoids the occurrence of injury to the renal calyces and pelvis [4, 13]. The number of fragments to collect depends on the number and types of exams requested as well as the presence of the pathologist during the exam, who may express opinions regarding the quality of the specimen collected. In procedures without the presence of a pathologist, two fragments are normally collected for each exam solicited.
Different needle calibers, lengths, and tip shapes are available on the market for the collection of material for microscopic analysis. Thin-needle punctures are performed with calibers ranging from 20 to 25, whereas thick-needle biopsies are performed with 14- to 19-gauge needles. Authors state that thin needles provide smaller fragments for analysis, but the fragments have similar quality and anatomopathological interpretation to those obtained with thick needles. Nonetheless, larger fragments enable a more complete study of renal pathologies. Moreover, although a smaller caliber is related to a lower rate of complications stemming from the procedure, it does not assist in the renal evaluation [14]. Along with a core biopsy needle (thick needle), coaxial needles can be used, which have a larger diameter with sufficient inner diameter to enable the navigation of the core biopsy needle in its interior. The use of coaxial needle kits avoids multiple punctures of the capsule, as this mechanism enables acquiring several tissue samples with a single perforation, which reduces the procedure time. However, portions of the organ cannot be sampled with this method and the use of such needles increases the cost of the procedure. The use of coaxial needles enables the operator to easily embolize the needle path with an absorbable gelatin sponge when removing the outer needle at the end of the procedure. This embolization promoted by the coaxial method is believed to reduce the risks of post-biopsy bleeding, but this characteristic is reported to not be an advantage of the method. Thus, both the coaxial and non-coaxial techniques do not appear to influence the bleeding complication rate [15]. The use of spring-loaded tools is currently recommended. These needles are classified based on the form of discharge into the tissue: automatic or semi-automatic (disposable). Such tools are reported to be more effective and safer than classic percutaneous renal biopsies that use the Tru-Cut or Vim-Silverman needle. Automatic tools are more economical, since only part of the kit is disposable. However, the disadvantage is the lower control over the progression of the needle during discharge and capture of the fragment as well as the longer procedure time due to the increase in the number of preparation steps of the needle/spring-loaded tool with the risk of contamination. Semi-automatic tools are more costly due to the fact that the entire system is disposable. The advantages are the security in maintaining all material sterile throughout all steps of the procedure, greater control over the advancing of the needle for the extraction of the fragment, the possibility of checking the intralesional position prior to discharge, and the reduction in procedure time, since no preparation of the needle and spring-loaded tool is needed.
Prior to presenting the biopsy technique to the patient or legal guardian, it is advisable to consult with the physician in charge of the procedure. This moment orientates the patient and family regarding the risks, benefits, and preparation for the procedure. It is also possible to identify possible techniques linked to the peculiarities of each patient, such as having a physical disability that precludes the standard position, deforming kyphoscoliosis, scars, skin diseases, and anxiety disorders. To ensure a successful examination, it is of extreme importance to evaluate recent laboratory exams (within the previous 30 days) and determine the patient’s health condition. Patients should meet basic criteria before being submitted to the procedure (Table 1). If a patient does not meet the minimum requirements, the procedure should be rescheduled until after the base disorder has been corrected. For patients with an urgent need for the procedure, immediate corrective measures should be assessed. For instance, plasma and platelet transfusion may be options in cases of a high international normalized ratio (INR) and low platelet count, respectively. An imaging study should be performed prior to the kidney biopsy to gain knowledge on renal anatomy and determine the presence of ectopias, congenital dysplasia, or polycystic kidneys.
Criteria that impede a kidney biopsy |
---|
Clotting disorders characterized by prothrombin activity <60% |
INR > 1.3 |
Platelet count <60,000/mm3 |
Use of anticoagulant |
Systolic BP > 140 mm Hg |
Urinary infection |
Acute persistent cough |
Skin lesions at puncture site |
Altered mental state |
Conditions that impede a kidney biopsy.
A kidney biopsy is an important diagnostic tool and considered the “gold standard” for the best definition of the majority of nephropathies. It is capable of changing the clinical diagnosis approximately 50% of the time and changing the therapy to be administered approximately 40% of the time [16]. For this to happen, however, an adequate sample must be obtained.
A 19-gauge needle generally furnishes very small, narrow specimens that are often inadequate for the assessment of vessels. Thus, smaller needles, such as 18 or 16 gauge, are advisable [17, 18]. Depending on the needle used, the difference in the obtainment of glomeruli can be as high as 300% [19]. The quantity of glomeruli needed for a secure diagnosis depends mainly on the diagnostic hypothesis and the clinical condition of the patient. For virtual exclusion (with greater than 95% certainty) of the diagnosis of focal segmental glomerulosclerosis, it is essential to have at least 25 glomeruli representing the juxtamedullary portion, as the focal disease affects some glomeruli while sparing others of morphological abnormalities seen with light microscopy and a good sample is important to the best definition of the disease [20]. In contrast, the diagnosis can be confirmed with a single glomerulus for other diseases, such as membranous glomerulopathy, in which diffuse morphological changes are similar in all glomeruli. For still other diseases, such as myeloma nephropathy, the diagnosis is essentially confirmed with representation of the medullary portion. In the analysis of transplanted kidney tissue, the aim is to achieve at least two core fragments exhibiting at least 7–10 glomeruli, two arteries, and the medullary portion (minimum assessment criteria defined by the Banff Meeting) [21].
In the evaluation of most glomerulopathies by light microscopy or immunofluorescence microscopy, 8–10 glomeruli are needed [22]. During the US-guided removal of the fragment, the evaluation of a pathologist is very important, as he/she is capable of determining the adequacy of the sample. The examination of the fresh material determines its sufficiency (quantity of glomeruli) for testing the main clinical hypotheses and provides information on medullary representation as well as the representation of larger vessels (Figure 1).
Ultrasound-guided kidney biopsy. Fragment stored in 0.9% NaCl and analyzed under a light microscope. Renal medulla with medullary rays and characteristic striation. Multiple small round structures (glomeruli) distributed in renal cortex—some paler, others congested with numerous red blood cells (details of two glomerular structures).
After determining the ideal amount of material and its representation of the renal parenchyma, the pathologist stores the samples in specific solutions for different analyses. The solutions should not come into contact with each other, as this would render the subsequent analyses unviable. The largest portion of the fragments should be allocated to light microscopy analysis. The most widely used fixatives are 10% neutral buffered formalin, paraformaldehyde, and Bouin’s solution. In these media, the sample remains viable for analysis for several days. However, earlier histological processing results in analyses of better quality. For the analysis of antigens, such as IgG, IgM, IgA, complement components C3 and Cq1, fibrinogen as well as κ and λ chains, immunofluorescence microscopy should be used. Therefore, the sample should be stored in 0.9% saline solution—if the collection site is near the analysis site—and kept chilled (but not frozen) to obtain the best possible results. If rapid analysis (within several hours) is not possible, the sample should be placed in a transport solution, such as Michel’s or Zeus solution. Although this solution preserves the sample for several days, better results are achieved the earlier the sample is taken for analysis, with poor or even impossible results if the sample is analyzed 5–7 days after being collected [23]. For transmission electron microscopy, a small portion is needed of the cortical parenchyma, with two glomeruli. This analysis is essential to the evaluation of podocytopathies, thin basement membrane disease, and metabolic disease. The fragments should be fixed within minutes after collection in a specific solution (glutaraldehyde or Karnovsky’s solution). In the presence of a pathologist, a small portion may be acquired (1 and 2 mm) and fragmented until obtaining the quantity of glomeruli needed. This material should be placed in a buffered solution after fixation (1–2 days after collection), as the aim of the analysis is to examine the ultrastructure, such as the cytoplasmic membrane, reticulum, and immune deposits, which are lost if not fixed soon enough.
When a biopsy is performed without the presence of a nephropathologist, it is advisable to remove at least one fragment (if possible, two) from the renal parenchyma for each solution. Immunohistochemical analysis for the study of C4d, polyomavirus, adenovirus, cytomegalovirus, PLA2R, IgG4, etc. should be performed with material embedded in paraffin, which is preserved for light microscopy.
A kidney biopsy is considered a minimally invasive method but is not without complications. Depending on the severity, such events are classified as minor and major, which require different forms of treatment (Table 2). Minor complications include hematuria, small perirenal hematomas, arteriovenous fistulas, and pain, all of which normally resolve spontaneously [24]. Major complications include massive bleeding with hemodynamic instability, voluminous perirenal hematomas with refractory disabling pain, and important hematuria with obstruction of the urinary tract by clots. In such cases, management is normally necessary.
Complications | Management |
---|---|
Disabling intense pain | Optimization of analgesia (use of opioids) |
Hemodynamic instability with blood transfusion | Endovascular treatment (embolization) |
Clot obstructing urinary tract | Irrigation with three-way probe |
Arteriovenous fistula | Conservative |
Hematuria | Hydration |
Post-biopsy complication and proper management for each.
Among all forms of complication, bleeding is the most frequent and occurs mainly within the first 12–24 hours after the procedure in nearly all patients [4, 25]. Microscopic hematuria, mild low back pain, and a slight drop in the hemoglobin concentration are frequent findings and should not be considered complications [25]. However, the persistence of these symptoms for more than a week may require a detailed investigation with imaging exams. Post-biopsy chronic hypertension, the puncture of other organs, and perirenal soft part infections have been described but are very rare.
The literature reports variable complication rates, generally ranging from 5 to 16%, with macroscopic hematuria in 3–9% of cases and the need for transfusions in 0.1–3.0% of cases [14, 26, 27, 28, 29]. In such cases, an exploratory ultrasound examination should be performed (Figure 2). Burstein et al. found post-biopsy complications in 14.3% of patients, with 6.6% considered minor and another 7.7% considered major (hemorrhages requiring blood transfusion or another approach) [28]. González-Michaca et al. found major complications in 2.4% of patients and minor complications in 8.65%, the most frequent of which was perirenal hematoma [30, 31]. Native kidneys tend to have a lower complication rate than transplanted kidneys (13.9 and 24.4%, respectively) [32].
Exploratory ultrasound performed on patient with gross hematuria, 24 hours after percutaneous native kidney biopsy. (A and B) Multiple pelvic blood clots (arrow) after renal biopsy.
After a kidney biopsy, patients should remain in observation for at least 4 hours. They are placed at absolute rest in dorsal decubitus and are monitored in this period with the constant evaluation of vital signs. It is also advisable to perform renal ultrasound 1 hour after the procedure in all patients submitted to percutaneous kidney biopsy. The aim of this measure is to evaluate the biopsied area and anticipate possible post-procedure complications, thereby enabling immediate, effective therapeutic support (Figure 3 and Figure 4).
Perirenal hematoma, an hour after percutaneous native kidney biopsy. Computed tomography (CT) scan slices of the abdomen revealed voluminous perirenal hematoma (yellow circle), on the left side. (A and B) Axial scan slices. (C) Coronal scan slice. (D) Coronal scan slice.
Post-biopsy procedures and management.
The volume of the perirenal hematoma formed and the complication rates associated with this procedure have a direct relation of proportionality. Hematomas formed in the first hour after the procedure with volumes greater than 40 ml are related to a greater risk of developing major complications [14] (Figure 5). For cases of minor complications, the patient should receive clear orientation regarding the expected benign evolution of the case and receive medication for the symptoms based on individual need. These patients should be required to return after 7 days for a follow-up ultrasound and definitive discharge of the case if no imaging abnormalities are found and there are no new complaints. In cases of hemodynamic instability, the patient should receive adequate clinical measures at an intensive care unit, followed by an angiographic study. Digital angiography remains the gold standard for the anatomic study of the renal arteries, but computed tomography angiography (angiotomography) has gained popularity, offering comparable accuracy and the advantage of evaluating not only the lumen, but its walls and other visceral changes [32].
Perirenal hematoma, observed an hour after percutaneous native kidney biopsy. (A) Longitudinal ultrasonography exhibiting hematoma area near the posteroinferior border of the left kidney. (B and C) Longitudinal (line 1) and transversal dimension on ultrasound (line 2 and 3) estimated the final volume of 216.73 ml of hematoma area. LK, left kidney; H, hematoma.
After renal vascular mapping and if signs of active bleeding are identified (active escape of contrast medium, pseudoaneurysms, or arteriovenous fistulas), endovascular treatment is indicated, which is a minimally invasive procedure that should be performed by an interventionist radiologist or professional who is duly trained and certified in endovascular techniques (Figure 6). The procedure can be performed through femoral or radial artery access, always initiated with an anatomic study of the renal arteries and respective variations. When a probable focal hemorrhage is identified, superselective arteriography is performed in a coaxial system with a microcatheter and microguide, followed by superselective embolization techniques performed on the compromised vessel. For interventional treatment, the selection of appropriate embolic agents for superselective embolization is the key to achieving desirable outcomes (Figure 7). Embolic agents include PVA particles, coils, and gelatin sponge strips, which can be used either alone or in combination [33]. The de-vascularized area will suffer infarction, which could cause a momentary change in renal function. Thus, more selective catheterism leads to a lower risk of this complication. Pseudoaneurysms are pulsating masses at puncture sites due to the rupture of the arterial wall and extravasation of blood, generally associated with local pain and hematoma. Hemodynamic instability and a drop in hemoglobin concentration may be related to the rupture of pseudoaneurysms. The treatment for pseudoaneurysms and arteriovenous fistulas is recommended for persistent bleeding for more than 72 hours or in cases of the accentuated loss of kidney function after the procedure. It should be stressed that most pseudoaneurysms less than 2.0 cm and arteriovenous fistulas progress with thrombosis and spontaneous resolution within 4 weeks, making conservative treatment the conduct of choice in cases without hemodynamic instability. Patients should remain in intensive care for at least 24 hours after the procedure and a follow-up imaging method should be performed prior to the decision regarding the discharge of these patients.
Renal arteriography, 2 hours after percutaneous native kidney biopsy. (A) Pre-embolization arteriography revealed pseudoaneurysm in a lower renal pole (yellow arrow). (B) Post-embolization superselective arteriography revealed absence of pseudoaneurysm with preservation of the local vasculature (yellow arrow).
Endovascular embolization. (A) A catheter is inserted into femoral artery, by the groin area to access vessels of the kidney and into vascular rupture site. (B) Rupture in arterial blood vessel, which will receive a catheter and embolization material to achieve occlusion.
Imaging-guided renal biopsy is a useful tool for the evaluation and management of renal diseases. This chapter summarizes that percutaneous ultrasound-guided renal biopsy is a safe technique which allows the evaluation of renal disease but is associated with post-biopsy complications. We discuss indications and approach to imaging-guided percutaneous renal biopsies as well as complications and management associated with this.
We thank Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Hospital Santa Casa de Belo Horizonte, Brazil and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.
The authors declare no conflict of interest.
Developing sustainable cities is currently one of the greatest global challenges. Cities face a wide range of social, environmental, and economic challenges that require change. The majority of Western cities possess unique cultural and architectural qualities, strong social inclusion forces, and exceptional economic development opportunities. Cities are centers of knowledge and sources of growth and innovation [1]. As the population influx places new demands on the physical structures, residents, and city management, the need to think across disciplines and sectors arises. At this stage, the use of analytical interpretation is required, which is a sophisticated analysis that inputs evidence for all parameters involved in the investigation process [2]. The keynote speaker “Jan Gehl’s” message was that human beings can only achieve sustainable urban development if we start with the people living in cities. A human being can build high-rise buildings with green roofs, green walls, and high-energy efficiency [3], but that does not necessarily mean that the cities are pleasant to live in [4]. Green sustainability, as a broad concept, must have a strong social element [5]. Additionally, Gehl pointed out that if many children reside in a big city—and you see them in the urban space—it is often an excellent city to live in, a livable city [3, 6]. According to an article published by Emma Lauridsen, there are now 29 residential areas in Denmark that meet the new ghetto criteria, which is eight more than last year. Three of the areas are located in the municipality of Aarhus, which are the same as last year, namely, Gellerupparken or “Toveshøj, Bispehaven,” and “Skovgårdsparken.” One of the new features of this year’s ghetto list is that both Gellerupparken or “Toveshøj” and “Bispehaven” are on a whole new list of “hard ghettos.” A hard ghetto area is defined as a residential area that has been on the ghetto list for the past 4 years. It also entails a requirement to submit a development plan by June 1 of the next year that shows how the residential area should meet the need to reduce the proportion of public housing to a maximum of 40% [7]. It is necessary to develop a concept for improving the formation of public spaces, taking into account the complexity of the influential factors. In scientific studies, only certain aspects of this problem are considered. The urban area is the territory where the interaction between space and the person takes place, where the person’s spatial behavior is formed, and this largely depends on how the person relates to this place, whether it is emotionally attractive to him.
The city becomes not just buildings, roads, parks, fences, abandoned corners, water pipes, and cable networks, but it grows as an especial interaction among citizens, contacts, social relationships, direct, and indirect communication interactions [8]. Social sustainability revolves around the human factor as a crucial prerequisite for a sustainable city and a sustainable society. The government’s sustainability strategy thus describes the concept in terms of everyone participating in social development and possessing real equal opportunities, regardless of background [9]. Focused and sustained work on social sustainability helps to ensure diversity, democracy, and equality in our cities. As urban settlements have grown, the visual environment has become more monotonous and typical (the country has been faced with the task of solving the housing problem). The quality of public space—its architecture, equipment, design, as well as its level of accessibility and openness to the different needs of the residents—has a direct impact on the number of users and the quality of life in the city [9, 10]. Therefore, its features can affect residents’ activation. To identify the relationship between the forms of activities favored by city residents and the features of public spaces in which they are undertaken, a binary classification has been made. The first approach divides activity spaces into formal and informal ones, while the second one categorizes the different needs of their users according to their age and physical abilities. Every effort should be made to integrate all groups, irrespective of their social and economic situation, age, gender, cultural background, and physical skills, and find a place for them in urban public spaces. Sports and recreation, thanks to the values they bring, can be a handy tool for social inclusion and integration. The design of physically activating public spaces should also constitute an expression of these values [11].
The current unsatisfactory ecological and esthetic state of many objects in the urban environment reduces the social efficiency of city spaces, which requires professional intervention, especially in the process of forming the subject-spatial environment of actively exploited public spaces [12]. They represent the nodes of the most significant social and communication activity of the population. Such spaces include, first of all, urban squares, which are quite diverse in their functional purpose. As the city develops, their existing spatial and spatial structure becomes less effective in terms of providing a comfortable, ecological environment with positive esthetic characteristics [13]. An urban area for people should be livable, safe, attractive, sustainable, and healthy [14]. This is a city where people often want to be on the street and spend time outside the home and office, where most residents can move freely on foot or by bicycle and other environmentally friendly vehicles, and where it is pleasant and comfortable to be at any time of the day. Classification and operative analysis are the leading instrumental procedures used to determine the critical thinking model, which places expectations into requests to detect whether a given right is factual or untrue [15]. Based on this concept, it is necessary to identify several criteria for a successful and high-quality public space and to lay the foundation of our research and future architectural projects:
Pedestrian friendliness
Visual appeal
Original atmosphere
The appearance of positive emotions and desire to linger in visitors
Sociality: orientation to different user groups, a variety of social groups, activities, modes of use, functions
Open access for all, inclusiveness
Rich symbolic content
Buildings are profane elements that give rise to social spaces, time as an “event” in the mythological sense. Therefore, space is not exclusively the physical extension but rather the sacred place in which the individual manifests and updates itself.
A participatory or participatory approach implies that experts in public spaces are architects, designers, and their end users, residents. All of them may have a different experience in using the place, habits, needs, and ideas about how this place should be, and these ideas do not always coincide with the vision of the designer. This raises some difficulties: it takes time and effort to determine how each space function, by whom and at what time of day it is in demand, what kind of people are there, and what their needs are and how they imagine the future of this space [16]. The collected data are analyzed, and project proposals are created on their basis. Despite the additional cost of time and resources, the participatory approach has several essential advantages. First, inclusion of the end user in the design process from the very beginning increases the sustainability of the project: it is more likely that people will feel a personal connection with the place and maintain it in good condition—this reduces the risk of vandalism. Second, the joint creative process helps people get to know each other, establish good neighborly relations, and form local communities [17, 18]. Third, in joint design, its participants begin to better understand the decisions that are made; they have an understanding of how the object will be used. In the long run, such projects strengthen the personal connection of people with a city or district: when people know that the city is developing with their participation and taking into account their needs and interests and when they feel a part of the local community, their perception of the whole city changes for the better—activating public space by creating public space to be more attractive. Examples of attractive spaces can be amazing gardens, squares, and museums, as well as monumental heritage buildings, which attract the public through their history but also by what they represent in memory of the city. Unfortunately, however, aggressive or rather desolate spaces are found by the present researchers because of many buildings left in comparison, which are not renovated or not restored.
A sustainable city is socially linked by the fact that there are democratic spaces where people can meet, regardless of social, economic, and cultural backgrounds, and which provide the opportunity for development and accessibility for all citizens of the city [19]. When a city has many offerings for both everyday life and when something unusual happens, it becomes more vibrant and attractive—this can also help increase the quality of life of the citizens of the city. In addition, a socially sustainable city opens up the possibility that citizens’ health is supported in the form of urban spaces designed for physical activity and socializing [20]. For residents, this can help improve health but also cohesion between people who might not otherwise meet. Concurrently, an urban and residential area must be perceived as sufficiently safe and attractive that there is a healthy and natural exchange with the surroundings and that different people want to visit, stay, and settle there. Social sustainability means creating the necessary framework in the city for vulnerable groups, both in the city space itself or in the form of hostels and housing for vulnerable groups [21]. The socially sustainable city prevents the exclusion of the city’s communities and ensures that the foundations of social action for vulnerable citizens are present.
Gellerupparken is part of the large suburban carpet that surrounds old Aarhus. Its characteristics are the major roads that frame individual neighborhoods in the suburbs. The suburban environment is lost and looser, the orientation of the landscape is weak, and the sense of place is the same [22]. Gellerupparken is characterized by either having an arbitrary landscape between buildings or by having a landscape that is growing and is entirely out of proportion to the buildings. It appears as a densely packed landscape area with far too many small blind pockets and dark hooks. Figure 1 shows the location of Gellerupparken in Aarhus city.
Gellerupparken in Aarhus city and placing in Denmark.
Human beings have always wanted to shape nature and to be surrounded by the elements of nature (trees, shrubs, grasses, rocks, water, etc.), to harmonize them and to integrate them into the created artificial environment, which has marked the culture and traditions of the people concerned [23]. Aarhus is the country’s second largest city, representing a reliable and positively charged magnet for tourists and residents from all over the region, and it neither can nor should be changed, but Gellerupparken could develop into another positive flagship in the area. Today, Gellerupparken is highly dominated by housing, and there is not much to look for other than the residents. The residents, who have at least one reason to be in the area, are looking for more life and activity over a broad front. Despite the blocks of flats, Gellerupparken and the surrounding area is a very scenic area with a lake (perhaps with an upcoming bathing beach) and hill scenery. There is a tremendous voluntary commitment and a wide range of different associations and organizations. Additionally, two large and very diverse shopping centers could be conceived into a larger urban life-oriented whole. However, most importantly, like other residential areas, Gellerupparken has the highest strength of being an area characterized by so many different nationalities, languages, ethnicities, cultures, and religions. Diversity and diversity seen as a resource are the area’s distinctive features (see Figure 2). The potentials are thus presented to create an attractive district, where both a resident and a visitor can have many unique experiences.
Gellerupparken design, directions, functions, and scale.
Approximately 7000 people live in Gellerupparken alone and approximately 20,000 in the whole of Aarhus West, which corresponds to a medium-sized Danish city [23]. In cities of this population size, there are far more shops, education, entertainment and entertainment than in western Aarhus, and it is, therefore, reasonable to assume that there will be more urban-like activities in this area. Such development should not be seen as an attempt to compete with Aarhus, but the offers and activities in the Gellerupparken must represent a new and exciting addition to Aarhus. Gellerupparken must utilize its strength by being one of Denmark’s largest multiethnic boroughs, and this distinctive character must be exploited and made a landmark. Among immigrants and refugees in general, there is a great desire to establish themselves as independent entrepreneurs, which is also the case in Gellerupparken, where there has been a surprisingly large amount of courage and creativity in terms of entrepreneurship. There is also a tendency for entrepreneurs in Gellerupparken and the surrounding area to start spreading across several business areas so that businesses other than pizzerias and green merchants are also established. It has also been proven that a strength of this area is its different ethnic background than Danish, which can facilitate beneficial collaborations with suppliers in the country of origin.
It is essential to ensure social diversity in public residential areas so that citizens with economic, social or integration challenges do not concentrate to a large extent in specific areas or neighborhoods [24]. Therefore, efforts have been made for several years to ensure a better balance in the so-called exposed residential areas, where such imbalance is a reality. The intention of this process, through outreach, is to listen to how the civic groups representing the area believe that a citizen involvement process must take place, partly because they feel invited to have an opinion regarding this issue and partly so that they can see that they have a real impact on how a debate about urban development develops. The experience gained from this process is gathered in a recommendation for how a future process towards a citizen-involved process of urban development can look for Gellerupparken and its surrounding areas. The process must also result in a series of instructions for several specific projects that will be supported and with which people are willing to proceed. A significant factor for a successful strategy to improve the future of citizens in vulnerable residential areas is the involvement of local citizens and local anchoring of the process [25]. It is only possible to find the right strategy by asking the citizens, after which it is only possible to implement the strategy by continuing to involve, motivate, and support the local population. Therefore, it is essential for the implementation of improvements in the housing area that citizens become engaged and motivated to take responsibility for the process, a process that will be new to a large part of the citizens with different ethnic backgrounds in the area and therefore a process with significant challenges, which is very crucial for the effectiveness and sustainability of the change.
In recent years, in the public debate on urban development and citizen involvement, there seems to be growing doubt as to whether the efforts to date will adequately respond to the challenges that are increasingly faced by larger cities. The criticism herein often focuses on existing efforts being reactive in the sense that they typically focus on solving acute problems, whereby the area’s resources are often ignored, and the long-term development perspective fades [26]. It is clear from this debate that this tradition need-/problem-based approach to urban development often has several unintended adverse side effects, whereby efforts often create clients rather than active citizens—thus increasing reliance on external assistance in the district. According to McKnight [27], development assistance based on external assistance is a central part of this negative spiral, because local institutions and organizations are thereby pacified and lose functionality, which means that the district gradually loses its power of action and attracts resourceful citizens. With this in mind, it is therefore essential in urban development to allow the district to revitalize itself “from the inside” through local institutions and organizations actively using their existing resources and anchoring in the area to create quality of life and increase the attractiveness of the area. In this context, this process must take place in an autonomous manner for which the area’s institutions are responsible—thus assuming ownership—for its creation. From empirical results, it is a central and well-documented point [27]. The above information is a necessity if the desired development process is to achieve sustainability that goes beyond consultancy assistance. If this is to be successful, then the development process must use an optic with a radically different focus than the problem-oriented approach. In this situation, the resource-based approach to urban development (asset-based community development) is one of the most well-founded [26]. Suggestions have been proposed for a development methodology that addresses the above issues as well as potentials, such as the method developed by McKnight [27]. Based on comparative studies of urban development methodologies—and their success rates—the following starting point for urban development is employed:
Communities and boroughs can create development themselves by identifying and utilizing existing (but often unrecognized) resources in new ways. This process requires the borough’s actors explicitly focus on finding—and using—the area’s resources [26, 27].
Thus, according to [26], the resource-based approach to urban development can be summarized in the description below [28]:
ABCD is an asset-based approach that uses methods to draw out strengths and successes in a community’s shared history as its starting point for change (as in
Among all the assets that exist in the community, ABCD pays particular attention to the assets inherent in social relationships, as evidenced in formal and informal associations and networks (recognized in research on
ABCD’s community-driven approach is in keeping with the principles and practice of
ABCD is a strategy directed towards sustainable economic development that is community-driven. The reference to community economic development theory is therefore relevant to ABCD strategy.
ABCD, as a strategy for sustainable economic development, relies on linkages between community-level actors and macrolevel actors in public and private sectors. In fostering these linkages, ABCD also fosters active citizenship engagement to ensure access to public goods and services and to ensure the accountability of local government. It, therefore, contributes to and benefits from a strengthened
Practical work on urban development from this perspective is based on several methodologies that are defined based on the above basic thinking. In this context, a particularly useful tool must be highlighted, which exemplifies the above starting point and thus can be used in development processes to promote resource-based development. One method of involving and engaging the citizen is, according to the American example, to apply a method called appreciative inquiry. The strength of this approach is that it is based on existing resources and potentials. All areas have positive sides and potentials, but it is often necessary to tend to overlook them and focus on the problems instead. People will naturally feel far more committed and eager to take responsibility if they are met with recognition and an attitude that they are a resource rather than a problem. Simultaneously, an appreciative and curious study of local citizens’ experiences and opinions about the area will encourage far more participation than a laid back expert attitude. The proposal for a strategy to improve exposed residential areas, therefore, derives solely from the ideas, wishes, and narratives of citizens who either live or work in the area. Citizens have been asked several times and in many different ways about their perception of the area and possible proposals for change in the future. No strategy has been adopted without the support of citizens, and it has always been possible to come up with amendments to both the primary strategy and the most concrete sub-proposals. Amendments, new ideas, and criticisms have been taken seriously and attempted to be incorporated. This approach has slowed down the process, but a human being cannot think that it can be avoided in any way—nor the future process.
Another aspect of the recognizable approach is that it encourages seeing opportunities, allowing the process participants to talk about hopes and dreams for the future. People’s need to be recognized and heard, as well as the ability to imagine the best possible imaginable, releases a tremendous amount of energy when given room for it, an energy that is all too often lost in rapid decision-making and political power struggles. This brief presentation of the methodological approach is intended as part of the proposal for a strategy for the development of vulnerable residential areas. It is used extensively in Gellerupparken and other residential areas, and it is no doubt that an appreciative and positive approach will awaken people’s desire to participate, which is an invaluable resource. Without citizens’ involvement and local roots, development cannot be reversed. Additionally, as a basis for this answer, proposals for change lie in the establishment of close cooperation between book associations, business, and local authorities, which will be discussed in more detail later.
Appreciative inquiry (AI)—or friendly conversation—is a critical methodology in resource-based urban development. It is a transformative approach to change that focuses on collaboration and identifying and working with the positive aspects of organizations, or communities, rather than the problems [29]. This method is based on several research findings, all of which demonstrate that our notions about the future are mainly decisive for our present actions. Therefore, it is essential to focus on strengths and successes as a basis for development rather than problems and shortcomings [30]. What the appreciative approach seeks is to achieve the transformation of a culture from one that sees itself in largely negative terms, and moreover, is, therefore, inclined to become locked into its contrary construction of itself—to one that sees itself as having within it the capacity to enrich and enhance the quality of life of all its stakeholders—and therefore move towards this appreciative construction of itself [30]. AI as a development methodology is, thus, as illustrated below, in sharp contrast to traditional problem-/need-oriented perspectives in terms of the resource-oriented starting point. Table 1 shows the explicative board based on the “release recognition” model.
Problem and lack of thinking | Resource and value thinking | |
---|---|---|
Focus | Attention to problems, errors, and shortcomings | Attention to resources, values, and dreams |
Intention | To solve the problem | Creating the future |
Method |
|
|
An explicative board based on the “release recognition” model.
The world-renowned Imagine Chicago project (see: www.imaginechicago.org) is an inspiring example of how AI and the resource-based approach have been used to revitalize Chicago neighborhoods characterized by ghetto education through the application of the above principles. The experience of this project, which exemplifies the resource-based approach, has attracted international attention and points to the efforts of the future. With the above starting point, innovative research and international experience seem to be promising with respect to working with citizen-involving processes in Gellerupparken and the surrounding area. This means that we see citizen involvement as citizen-driven development processes. In this perspective, the successful citizen engagement process will have two significant benefits:
In terms of yield, the process metaphorically described results in answers to important questions from the citizens of the area. Thus, the process makes a positive difference in the lives of citizens. Furthermore, this difference must be sufficiently significant that the citizens themselves will take responsibility for the continued sustainability of the result.
Process wise: Through the process, the involved parties increase their acting competence and position, so that they are strengthened with respect to similar processes in the future.
This understanding is basically in harmony with the city of Aarhus model of citizen involvement:
Citizen involvement must be based on the values of the Aarhus municipality.
Citizen involvement is a mandatory consideration in the initial phase of a task.
Citizens have a minimum right to be heard.
If an existing plan is changed, it must state why the “agreement” is being changed.
Citizens must have real opportunities to participate.
The private involvement in the development of the municipality or local areas must be promoted.
Cooperation with councils, associations, and organizations must be maintained and developed.
Processes, methods, and professional competence must be continually evaluated and developed.
The understanding of citizen involvement on which this report is based can, based on the Aarhus model, be understood as an effort to explain and translate points 5–7 into a concrete basis for action. We strive to develop methods to create real citizen-driven processes, whereby, through interaction with local actors, we establish a self-sustaining practice that continuously promotes the development of local areas. This endeavor requires that, concerning the Aarhus model, we must perceive citizen involvement in a broader perspective. Generally, citizen involvement is perceived as a means of achieving a given content goal. However, this understanding does not include any focus on building the capacity of citizens to be able to handle similar challenges in the local area independently in the future. Ultimately, the development process itself does not then necessarily create more active citizens.
In contrast, development processes in which this aspect is not considered, as pointed out in the above section, entail significant risks for citizens to be positioned as clients. With this starting point, we, therefore, consider citizen involvement as a process with a dual objective; a result must be created that is an answer to an essential question of the citizens. Simultaneously, the process must develop the trading skills of the parties involved. This understanding is translated into the following procedure for adjacent writing.
Initially, the process is aimed at engaging in dialog with the various actors who must be seen as part of the area’s residents and associations. The goal here is to embrace as broadly as possible to ensure that no one is excluded from this new trust-building process. Our entry into these conversations is partly through existing networks and partly through outreach work. The purpose of the conversations is as follows:
Creating mutual trust, which in this context is understood as follows: the people to whom we talk should feel that we have a genuine interest in listening to what they have to say about the area and what dreams they have for the future.
They are creating and exploring opportunities for citizen involvement processes based on the good experiences of citizen involvement processes of resource persons1. As previously pointed out, this focus is essential to ensure that recommendations for future processes are based on structures and processes that have proven sustainable in the area rather than general normative directions.
To ensure these results, the conversations are structured as appreciating interviews. This implies that the focus of the conversation is focused on resources and success based on the assumption that there may be a significant trader’s potential. We are investigating what works are doing well to be able to extend these processes even more in the future. With this starting point, the following interview guide is constructed, on which the interviews are based.
What have you experienced contributing to creating successful citizen engagement processes?
What was crucial to the success of the process?
What resources contributed?
What have you experienced creating a process that people feel invited to join?
What in the past has been particularly effective in getting residents to speak?
How did you ensure that everyone experienced being heard?
What have you experienced in creating a trust?
How can we use these good experiences to create successful citizen engagement processes in the future?
An integral part of the discussions is also an explicit focus on which actors and groups resource persons find important to involve in the process. In this way, the individual interview generates, so to speak, the next as we subsequently contact the said persons and groups and invite them to participate in the interviews. Alongside the interview process, two meetings are held with city representatives, which are also designed around the above structure. Finally, a joint day is held for citizens, associations and organizations in the Gellerupparken area.
In total, hundreds of qualitative interviews, as well as a group interview, have been conducted through the interview process. In the following section, the central themes from the qualitative interviews are presented. An interpretation of the conducted interviews is based on the themes below, on which the interviews were structured.
Factors that help to create successful citizen engagement processes
Factors that create a process that people feel invited to join
From good experiences to citizen involvement processes in the future
Broadly speaking, two key themes from the experience of the resource persons seem to be crucial to the successful citizen engagement process. First and foremost, the subject of the process is concrete and relevant. Second, the process itself is completed with strong local anchorage in the area.
Throughout the interviews, it is pointed out that successful citizen engagement processes are characterized by their being perceived as concrete and relevant to the participants. This means that the topic is not abstract but is based on the daily lives and interests of the citizens. This point is reflected in the observation of the consistent emphasis that residents of the area come to meetings largely because of specific matters that interest them. Thus, the focus of successful processes is directed towards themes that have a significant influence on the daily life of the residents. The question in this context is, of course, what is contained in the specific and relevant process. This question seems to be answered from another perspective. Citizens will greatly assess participation in the process based on whether they can acquire a real, visible, and noticeable benefit from it in their daily lives. The following topics are, by extension, highlighted as particularly appealing:
Health: How can we live healthily?
Family: How can we create well-functioning families?
Leisure time: How can we ensure that children and young people have active leisure time?
Relationships: How can we create new relationships with each other?
To conclude the interview process, a joint day was held in the Nordgård School hall. Citizens, associations, networks, and organizations in the area were invited. During the day, the following questions were examined: What important questions about the area will help us get closer to our hopes and dreams for the area, are we concerned? The above focus on “the close” topics are supported here by the questions raised by the participants in a future day as crucial for the future of Gellerupparken.
In addition to the abovementioned thematic themes, the interviewees pointed to several procedural issues that they perceived as crucial for the initiated processes to gain a foothold in the area. Here, the interviewees point to the following factors as crucial:
That is, a particular desire is taken from the citizens. Several of the interviewees emphasized that it is essential that the specific wishes of the citizens trigger the initiated processes. Throughout the process, this means that the citizens are willing to take ownership of the process. This is highlighted as particularly important as the interviewees feel that external actors are continually seeking to initiate a large number of projects in the area. The consequences of these well-intentioned projects are general project fatigue, and local players in the area lose the courage to engage.
As the resources of the citizens are providing a basis, as an essential success factor, it is emphasized that the strengths of the citizens are based on whether they feel at home. People would very much like to participate and contribute if they are allowed to use the skills they possess.
Existing structures based on existing structures. You gain a lot by connecting to existing structures in the area. It is ethnic associations and formal and informal networks that form an essential part of the social structure of the area. The involvement of these structures is crucial, as the networks partly possess significant resources that can be used to create development in the area. Furthermore, networks have more or less influence as opinion-makers. The assumption of starting from existing structures also highlights the advantageous links to existing activities and offers in this area as well as places where people are already arriving.
In citizen engagement processes, it is essential that people have the experience that they are welcome to participate as well as experience that their participation is significant. This phenomenon is reflected in the following section, where resource persons point to the following factors as crucial.
To ensure participation in the citizen involvement processes, the citizens must be aware of the possibility of participation [24]. In this context, the interviewees focus on several areas they perceive as crucial for ensuring connection to the respective processes. In general, written communication is emphasized only as an enterprise when it is linked to local resources. This can be, for example, through pamphlets distributed by staff at the health and local center or library. Likewise, the residential magazine,
An essential theme about citizen engagement processes is whether the citizens feel invited to participate in them. A key prerequisite for this is, according to the resource persons, that citizens understand what the process is about. Here, direct contact also proves crucial. Concerning activities for young people under the auspices of the association, this means in particular that the actors must assume some form of a supervisory role. The guidance counselor takes the young ones by the hand and accompanies them to the association for the first time. The parents are invited; they are presented to the coach and the association. The possibilities that exist in the associations, how an association works, and the applicable rules are explained so there is no fear of the unknown. In this context, the importance of the direct meeting between the association and the young person is again emphasized with a focus on the concrete benefits of being active in associations. Concerning any language barriers, it is pointed out that the use of interpreters is a significant factor that enables the participation of groups of citizens who have difficulties with Danish. This institution allows the involvement of people who would otherwise have said nothing. Furthermore, good experiences with the involvement of bilingual resource persons with immigrant backgrounds are highlighted as necessary for contact with citizens. They are good at outreach and have their fingers on the pulse of what is occurring.
Part of the strategy is to transform some homes into different types of occupations. For example, the ground floor of a residential look could be arranged for small shops, cafes, or workshops, which may create some new jobs. However, first and foremost, it will soften the massive housing block and create a whole new social life (see Figure 3). Another way in which the housing blocks could be used to attract other citizens is to furnish luxury apartments or hotel rooms on the upper floors with views of the city and the lake. In the long term, luxury holiday stays in Gellerupparken could be arranged with bathing and sailing on Lake Brabrand, as well as food and culture from all over the world. The idea of making a hotel in Gellerupparken has met with great optimism from both the “Brabrand Business Association” and the “Brabrand Housing Association.” There are several larger companies in the area, which also have branches and employees from many other countries. These companies could benefit significantly from the proximity of a high standard hotel with a burgeoning international business and research environment.
Concrete ideas of inhabitants with indication of the potential position.
Resource people emphasize, in light of the above, that it is essential that citizens have the necessary confidence in the process. In this context, this can be observed as the belief that the process ultimately results in something good. The most important factor for gaining the trust of citizens in the area is by showing that, through their dedicated work, you are passionate about doing good for the people.
Residents from the urban zone desire more opportunities for activities and social gathering, especially in the evening hours, when Bazar West and City Vest are closed. These two very different shopping centers provide the framework for a large part of the social life in the district. The requirements are as follows:
A pedestrian street in the middle of Gellerupparken
Many enjoyable activities for the citizens in the area
Gain better knowledge and more relationships with outside citizens
Urban zones evolved through dialog in several different contexts. They must have the courage to dream and see opportunities: a strategy to control and regulate citizens’ opportunities to settle wherever they want. Through physical and social changes in the residential areas, which build on the citizens own ideas and commitment, the residential areas must be changed so that they become better places to live and move to both for residents and others. Public spaces are also useful as sleeping areas because they create new scenarios for spending time in the area, make it multifunctional, and make living there more intense and exciting. To solve the problem of alienation, the dullness and uniformity of the urban environment must be addressed by saturating it with colors, events, and emotions, creating places for communication and interaction with others and thereby helping to expand the network of acquaintances among neighbors. Thus, instead of a city for cars, it must assume a new understanding like a city for people. Additionally, public spaces solve the monocentric problem: when there are leisure opportunities right next to the house, there is no need to search for them in the city center. Simultaneously, it attracts the interest of residents of other parts of the city and tourists to the district, subsequently attracting investments in the form of small businesses. The idea is to transform the requirement for a functional space into an attractive and activate urban space, where the following table shows the meaning of the two concepts (see Table 2).
Attractive urban space | Functional urban space |
---|---|
I feel safe | |
I can find the way easily | |
I can use urban furniture safely | |
The urban open spaces are excellent | |
I can enjoy my time in green areas | |
I can access all the spaces in a wheelchair |
The different understandings of functional and attractive urban spaces.
In Denmark, there is a particular risk that increasing population segregation will have severe consequences for the development of society. Some residential areas have such high concentrations of contact beneficiaries and people with ethnic minority backgrounds that they are almost small isolated communities. A strategy to reverse this tendency may, in various ways, be an attempt to control and regulate citizens’ opportunities to settle wherever they want. This strategy will, of course, be able to change a certain percentage of the population composition in the exposed housing areas, but for the many children and young people who will continue to grow up without knowing any ethnic Danes, without knowing someone who has a Danish education and perhaps without knowing anyone who has had a job for a long time, this strategy will not suffice. Children and young people, who make up approximately 40% of the residents in the exposed housing areas, need to be a focus when designing a strategy against ghetto isolation. These many children and young people must feel that Danish society takes them and their future seriously and wants to give them more than a hand in their efforts to become better at Danish, attain an education and secure a job. Through physical and social changes in the residential areas, which are based on the citizens’ ideas and commitment, the residential areas must be changed so that they become better places to live and move for both residents and others. Based on stories and ideas from the citizens of Gellerupparken, this chapter will present a strategy to improve the future of residential areas, which aims to make Gellerupparken an attractive district for the people who live, work, and move into the area and for all others. Outside people may never have been to Gellerupparken but nevertheless have a negative image of the residential area. For a long time, our group has worked and stayed in the area and talked to many of the area’s residents and fire souls. The principal idea is to exert a determined effort to make the residential area attractive neighborhoods with far more activities and functions, which are based as much as possible on the area’s distinctive character and the citizens’ initiative. Researchers believe that this strategy will positively impact residents’ everyday lives and views of themselves, but it is equally important that the neighbors of Gellerupparken and all other citizens in the area will observe a changed and attractive neighborhood. BL has already shown an interest in investing in the transformation of housing into, for example, commercial premises, public service functions, or cultural purposes. In this chapter some of the suggestions will be presented received by the research group from the citizens of Gellerupparken concerning how to create more urban life in the residential area. A strategy for improving exposed residential areas must be broad and multifaceted, but it must simultaneously also be carried out in the right way to obtain the best possible effect. It must be believed that it is essential to examine the resources and positive aspects of the residential areas and allow them to serve as the basis for a process of change.
The exposed residential areas are typically located just outside major cities: cities with lots of life, rides, functions, activity, and diversity. Many people are attracted to the city in connection with either work or leisure. They meet in the city, get to know new people, have fun relaxing, or take advantage of the city’s numerous opportunities for shopping, education, and work, among others, and the existing vegetation, geology, and topography all engage in recreating a part of a unique microclimate for every site [31]. It is in the city you are social and show who you are. In an area where there is nothing but housing and very few city’s features and opportunities, a man is private, himself, and has no reason to leave home unless it is to leave the area. Figure 4 embodies an architect vision of creation activating areas in the north part of “Gellerupparken.” This is where inhabitants spend their free time but typically not with new people.
An architect’s imagination of creation activating areas in the north part of “Gellerupparken.”
By drawing inspiration from the pulse, energy, and life of the city, residential areas can be made more attractive and given an identity that will affect both the residents and citizens living nearby. It is far from only the commercial part of the city, which is interesting and which can create positive development as a concept [32]. An increasing number of educational institutions, culture, and arts, as well as alternative venues and social spaces adapted to different age groups, genders, and interests must also be wholeheartedly devoted. How can it be, for example, that in Aarhus you will find cafes that make money by standing out from the crowd with hookahs and Persian rugs? In many residential areas with a very diverse resident mix, much more can be done to create a different atmosphere of security and togetherness derived from the residents’ own countries of origin. For example, a coffee shop could be made with coffee and tea from all over the world (see Figure 5).
An architect’s imagination of creation activating areas in the central part of “Gellerupparken.”
The city’s many spaces in the form of parks and squares provide intensity and security that is lacking in the residential areas, where there is often too much space between blocks because nothing is invited to stay. The whole city needs to be brought into play, not just the demarcated residential area. The residential areas must be opened up both physically and mentally to become attractive, welcoming and part of a larger whole. The residential area must be able to offer more than just one dwelling. The features and opportunities must be made visible and make the residential area a place where citizens of the city center and other suburbs can also experience something different and exciting (see Figure 6).
An architect’s imagination of creation activating areas in the significant part of “Gellerupparken.”
Diversity and diversity are and will become even more of the future’s most valuable resources and potentials for development and innovation. Companies that live by innovation know that a mixed staff is crucial to the company’s ability to think in new and creative ways. In residential areas with a more significant proportion of citizens with different backgrounds than Danish, there is excellent potential for establishing networks for the development of new ideas. In this context, devising several specific suggestions on how to create more urban life in residential areas is required. This will be based on Gellerupparken and the opportunities for change offered in this area.
There is a desire from several local citizens, housing, and business associations for more opportunities for activities and social interactions, especially in the evening hours when Bazar West and City West are closed. These two very different shopping centers provide the framework for much of the social life in the district, but after 10 p.m., they are closed. When the centers close, it is almost impossible to just buy a cup of coffee without having to go to Aarhus C. An obvious place for these city life activities is on the stretch between City West and Bazar West, where there is already a well-traveled footpath, but another location could also provide the same result. These thoughts of more urban life have led to the idea of developing a pedestrian street in the middle of Gellerupparken, which on the one hand can create life and activity for the citizens of the area, but on the other hand, it can attract people from the outside. In this way, there are several enjoyable activities available to the citizens of the area, which is especially important in the evening hours, where for many people there is a kind of void. Furthermore, it will be possible for citizens in the area to gain better knowledge and additional relationships with outside citizens and vice versa. As the idea has evolved through dialog in several different contexts, a working group has emerged that is still growing. In particular, some voluntary architects have shown great interest, and they have been of great help in the idea of development and visualization of the group’s and citizens’ proposals for urban development. The citizens who have been presented with the idea have welcomed it and have shown a great desire to contribute their suggestions and wishes. The urban area is not comparable to the area in Aarhus. It is more about creating a basis for life and security, squares, squares, shops, and cafes in selected sections, perhaps a concept area, association rooms, workshops, and institutions, among others. The proposal is intended as a holistic and pervasive effort over a long period, bringing citizens, housing associations, local associations, business, and public bodies together, with the common goal of creating more urban life both physically and socially. However, it is also an obvious opportunity to start with something slightly smaller and perhaps to bet on one of the following concrete proposals. Green open spaces promote a sustainable development process [33]. In this area, the elderly and the young can meet and get to know each other better. Together, they can harness the potential of the area. Moreover, a hub, a city street, can be established. Around this are placed several functions (public and private). These features can be established and rented out on different terms. Our mission is to improve the business and social life of Gellerupparken, generate a more functional and urban area, and develop a more attractive connection along with the new Gellerupparken pedestrian axis.
A better connection between the two only commercial centers in the district could create a whole new area, where people from the more traditional Danish shopping center City West will feel more invited to experience more of the district and perhaps meet at a cafe midway with some of the residents or other merchants from the more Middle Eastern Inspired Bazar West (see Figure 7). This shopping center is seen as a way in which the area’s closure can be broken. Some traffic already exists on the path between the two commercial centers, but more area needs to be opened up so that more outsiders acquire an interest in what is happening between the housing blocks. In addition to housing, there are several other features of the line that are proliferating and need more and new premises and facilities. There is a school, a sports hall, a local center, a resident’s house, and a library, which has already been expanded with numerous side features such as health information with midwives and dentists, public information, a job corner, and a contact point for young people, among others. Furthermore, in the area around the bazaar, there are a large number of companies with a total of approximately 4000 employees. This business area has the potential to develop in the future, and more exciting urban life could contribute positively to this development. There are endless opportunities and synergies in creating a common strategy for residential, commercial, and urban areas. Here, a small selection of the wishes and ideas that have emerged in dialog with the citizens is presented. There is broad support for establishing several places with the opportunity for friendly and entertaining leisure activities. The appendices present the answers to this question, illustrating the opportunities in the area and encourage people to dream and think differently.
An overview of a new pedestrian axis with open activity space potentials.
Another part of the strategy is to place both existing and new public functions in the area so that more people who do not live in the area enter the area daily, such as educational institutions.
One of the main reasons many of the residents of vulnerable residential areas do not have a job is that they have no education or leave school very early. Some explanations for the lack of education are that the young people in vulnerable housing areas lack knowledge about the available modes of education and someone to tell them what it is like to study. Many young people do not know anyone with a more extended education and, therefore, do not have anyone to ask for advice. Education becomes something foreign and unknown. When neither family nor friends have experience with the education system, it is difficult for the young person to hold onto an education in which everything is foreign and new. It is very likely to open up a new group of young people in education if they can choose the student life without having to altogether leave the safe and familiar environment in the housing area. This phenomenon also applies to a host of other public functions. However, it must be pointed out that further research of the subject is required to answer whether integration is improved by allowing residents in the exposed housing areas to stay more within the area—some researchers will think the opposite.
The research, therefore, proposes that several relevant educational institutions can be placed in residential areas, thereby increasing young people’s knowledge of education and reducing fear. One could imagine many forms of education that could be advantageously placed in exposed residential areas. In particular, there are new opportunities in investing in programs that have an international character. It could be an international high school specializing in languages and foreign cultures. One could also imagine that a department of the School of Business for International Trade, Export, and Entrepreneurship could find a new target group in Gellerupparken.
First and foremost, it is expected that the citizens of residential areas will benefit from a strategy that aims for more urban life, as it will be more interesting to live in a neighborhood with more amenities and a more expansive social life. Next, the place identity will change so that citizens acquire a more favorable impression of their area. In the longer term, there is tremendous potential in making residential areas such as Gellerupparken a neighborhood with attractive offers for residents, visitors, and tourists, on the one hand, and students, researchers, and business, on the other hand. The greater urban life created in Gellerupparken can make it a gathering point in Denmark for trade and exchange abroad. In connection with the business park and an upcoming hotel for business travelers, a particularly attractive college could be implemented, focusing mainly on international students. It is required to envision an environment where companies, educational institutions, business associations, and housing associations work together to create several exciting educational and internships across all nationalities and utilize the many contacts it will provide to the world. Much can be done to create more favorable conditions for businesses and educators in the area, including various kinds of modern facilities such as suitable cheap premises, IT, and quick access to the highway [34]. Additionally, companies could assume a particular form of the social contract, where, for example, the housing association provides premises, parking, canteen arrangement, and other features for the company to create new jobs or internships for citizens of the local area (see Figure 8). Furthermore, contracts can be made with students at colleges, which offer several benefits towards assuming greater social responsibility for the area by, for example, offering homework help, legal aid, help with job applications, etc. It is crucial to create positive stories about the district, highlight the successes, and build on the area’s unique characteristics and potentials, which in the long term will make Gellerupparken an attraction and thus give its citizens the pride that comes with living in an area that is known for something special.
Views of Gellerupparken imagined by a group of architect companies.
Thus, an integrated approach to design is essential, which includes a detailed, comprehensive study of the territory; work in an interdisciplinary team consisting of architects, city planners, sociologists, anthropologists, and other specialists; and, finally, “participativeness” in the form of the participation of local residents in the research process and design, taking into account their interests and needs. The creation of an objective sustainable public space requires recognition of the significance of the space, such as follows:
Space as practice: the most important side of Heidegger’s specialty, of “being-in-the-world,” is the practical one. Therefore, each individual is capable of producing spaces daily, depending on the concrete situations they encounter, culture, and predisposition [35].
Space as a possibility: the hermeneutics of space developed by Heidegger in “Sein und Zeit” is an attempt to escape the classic alternative objective space/subjective space.
Space as an event: depending on the activities it encompasses, the character of a public space can be changed—a place of revolts, place of ceremonies, place of democratic meeting, etc. [36].
Space is considered to be the limited three-dimensional space in which all objects are located and in which all events take place.
An attractive public space becomes an essential issue in the city design process, where the requirement to create high-quality public spaces does not boil down to ordinary beautification, as is often understood by the city administration and developers. Based on qualitative interviews with resource persons in the area, the following themes can be highlighted as crucial for creating successful citizen engagement processes. Fundamentally, it is crucial for participation that the subject of the process is concrete and relevant. Here, it is the close things that count.
Furthermore, people must have the experience that they are welcome to participate as well as experience that their participation is significant. Resource people emphasize that, in light of the above, it is essential that citizens have the fundamental confidence that the process will lead to a real and noticeable result. Furthermore, emphasizing the resources of the citizens involved is a critical success factor. The resource persons consistently point out that these elements can be ensured by the process being rooted in the local structures and based on the area’s resources. For such a goal to be realized in Gellerupparken, it will be essential to create a framework that ensures that actors in as well as outside the area are involved in resource-based interaction with each other. The development of improvement courses for these parties is proposed to create a holistic and robust process in the area. These experiences indicate that, concerning the efforts of external teams, the focus shifts from the subject of the process to instead supporting the process itself. The ultimate goal is that the parties involved build up competencies that generally increase the area’s capacity to independently create a development. The aim of this type of development process is thus to create a framework in which the local actors develop independent acting skills by working on themes that they find essential.
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This study provides, on the other hand, a global vision of the family starting for their fortuitous discovery, the synthesis of their derivatives, their mechanism of action widely known nowadays, the actual classification according to the chemical structure and pharmacokinetic properties, and their uses and indications, the traditional and the new ones. On the other hand,the study is focused in the mainly problems of benzodiazepines, depedence, and tolerance, many times led by a misuse of the patient, wrong prescriptions, or extended treatments. A withdrawal program is proposed that includes the important factors or criteria to success, with a slow and gradual reduction of these drugs, avoiding relapse or severe adverse effects. New lines of research related to benzodiazepines are taken into account, which not only include the new therapeutic uses but also the adverse effects in short and long term. 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This study provides, on the other hand, a global vision of the family starting for their fortuitous discovery, the synthesis of their derivatives, their mechanism of action widely known nowadays, the actual classification according to the chemical structure and pharmacokinetic properties, and their uses and indications, the traditional and the new ones. On the other hand,the study is focused in the mainly problems of benzodiazepines, depedence, and tolerance, many times led by a misuse of the patient, wrong prescriptions, or extended treatments. A withdrawal program is proposed that includes the important factors or criteria to success, with a slow and gradual reduction of these drugs, avoiding relapse or severe adverse effects. New lines of research related to benzodiazepines are taken into account, which not only include the new therapeutic uses but also the adverse effects in short and long term. They are also analyzed the new discoveries concerning the nonbenzodiazepine drugs due to the close relation they have with benzodiazepines.",book:{id:"7518",slug:"medicinal-chemistry",title:"Medicinal Chemistry",fullTitle:"Medicinal Chemistry"},signatures:"Elisabet Batlle, Enric Lizano, Miquel Viñas and Maria Dolors Pujol",authors:[{id:"252409",title:"Prof.",name:"Maria Dolors",middleName:null,surname:"Pujol",slug:"maria-dolors-pujol",fullName:"Maria Dolors Pujol"},{id:"262535",title:"Dr.",name:"Elisabet",middleName:null,surname:"Batlle",slug:"elisabet-batlle",fullName:"Elisabet Batlle"},{id:"262756",title:"Mr.",name:"Enric",middleName:null,surname:"Lizano",slug:"enric-lizano",fullName:"Enric Lizano"},{id:"274188",title:"Dr.",name:"Miquel",middleName:null,surname:"Viñas",slug:"miquel-vinas",fullName:"Miquel Viñas"}]},{id:"62512",title:"Introductory Chapter: Biopharmaceuticals",slug:"introductory-chapter-biopharmaceuticals",totalDownloads:2515,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"6787",slug:"biopharmaceuticals",title:"Biopharmaceuticals",fullTitle:"Biopharmaceuticals"},signatures:"Yuan-Chuan Chen and Ming-Kung Yeh",authors:[{id:"180299",title:"Dr.",name:"Ming-Kung",middleName:null,surname:"Yeh",slug:"ming-kung-yeh",fullName:"Ming-Kung Yeh"},{id:"185559",title:"Dr.",name:"Yuan-Chuan",middleName:null,surname:"Chen",slug:"yuan-chuan-chen",fullName:"Yuan-Chuan Chen"}]},{id:"62568",title:"Characterization of Biopharmaceuticals Focusing on Antibody Therapeutics",slug:"characterization-of-biopharmaceuticals-focusing-on-antibody-therapeutics",totalDownloads:2384,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Biopharmaceuticals are highly complex molecules and also require high quality for safety and efficacy in human uses. For well-characterized products, the desired level of quality should be monitored and controlled during the manufacturing processes. A series of workflow for analytical characterization should be applied for product quality throughout those processes. In this chapter, several analytical techniques are introduced for assessing characteristics of biopharmaceuticals focusing on monoclonal antibodies (mAbs). Analytical characterization for primary structure was performed by mass spectrometry (MS), and assessment of post-translational modifications (PTMs) was done by conventional approaches. The analytical assessments were also done by multi-attribute method (MAM) approach using mass spectrometer (MS), and the performance of MAM was compared to conventional approaches.",book:{id:"6787",slug:"biopharmaceuticals",title:"Biopharmaceuticals",fullTitle:"Biopharmaceuticals"},signatures:"Woojeong Kim, Kui Hyun Kang and Jung-Keun Suh",authors:[{id:"241304",title:"Prof.",name:"Jung-Keun",middleName:null,surname:"Suh",slug:"jung-keun-suh",fullName:"Jung-Keun Suh"},{id:"258673",title:"MSc.",name:"Woojeong",middleName:null,surname:"Kim",slug:"woojeong-kim",fullName:"Woojeong Kim"},{id:"258674",title:"Dr.",name:"Kui Hyun",middleName:null,surname:"Kang",slug:"kui-hyun-kang",fullName:"Kui Hyun Kang"}]},{id:"62647",title:"Indomethacin from Anti-Inflammatory to Anticancer Agent",slug:"indomethacin-from-anti-inflammatory-to-anticancer-agent",totalDownloads:1351,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"The chapter “Indomethacin from Anti-inflammatory to Anticancer Agent” covers the recent reports regarding the implication of COX-2/PGE2 in multiple cancer cell proliferation to emphasize the anticancer potential of COX-inhibitors including indomethacin and to reveal that the reduction of PGE2 production interferes with the cancer cell proliferation belongs to multiple cancer cell types. Impressively, indomethacin is involved in antiproliferative and apoptotic actions against cancer cell types via COX-2-independent mechanisms to highlight indomethacin as promising anticancer agent with dual actions to control the cancer cell proliferation. The cardiovascular complications result from diaryl heterocycle sulfonamide/methylsulfone selective COX-2 inhibitors upon reduction in PGE2 and PGI2 production that affects the vascular tone limits the use of Celecoxib as chemopreventive agent against recurrence of colorectal carcinoma cells. Kinetic profile of indomethacin against COX-2 showed obvious difference from that of selective COX-2 inhibitors in which it recovered completely from the enzyme after long time of incubation while COX-2 inhibitors did not recover to impress that this might be implicated in the cardiovascular toxicity of the selective inhibitors. This raised the concern to develop the indomethacin from nonselective COX- to selective COX-2-inhibitors and to assert whether the cardiac complications are from pharmacological class effect or chemical class effect.",book:{id:"7518",slug:"medicinal-chemistry",title:"Medicinal Chemistry",fullTitle:"Medicinal Chemistry"},signatures:"Shaymaa Emam Kassab",authors:[{id:"251335",title:"Dr.",name:"Shaymaa",middleName:null,surname:"Kassab",slug:"shaymaa-kassab",fullName:"Shaymaa Kassab"}]},{id:"63789",title:"Clinical Pharmacokinetics of Clavulanic Acid, a Novel β- Lactamase Isolated from Streptomyces clavuligerus and Its Variability",slug:"clinical-pharmacokinetics-of-clavulanic-acid-a-novel-lactamase-isolated-from-streptomyces-clavuliger",totalDownloads:1135,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"The clavulanic acid derived by fermentation of Streptomyces clavuligerus and possessed the capability to inactivate a broad range of β-lactamase enzymes. A complex physicochemical process involves the binding of clavulanic acid to β-lactamases in which clavulanic acid itself deplete irreversibly along with β-lactamase enzyme rendering amoxicillin spared which otherwise would hydrolyze by an enzyme. It is therefore termed as ‘suicide ‘inhibitor for β-lactamases. We discussed here pharmacokinetic parameters and identified factors responsible for the variability of absorption of clavulanic acid. The results based on individual plasma concentration-time curve of amoxicillin and clavulanic acid in an open, randomized, two-way crossover study involving 10 healthy male subjects administered with two amoxiclav formulations.",book:{id:"7518",slug:"medicinal-chemistry",title:"Medicinal Chemistry",fullTitle:"Medicinal Chemistry"},signatures:"Anab Fatima, Mohammad Jiyad Shaikh, Hina Zahid, Ishart Younus,\nSheikh Abdul Khaliq and Farah Khalid",authors:[{id:"225358",title:"Dr.",name:"Muhammad Jiyad",middleName:null,surname:"Shaikh",slug:"muhammad-jiyad-shaikh",fullName:"Muhammad Jiyad Shaikh"},{id:"231412",title:"Dr.",name:"Anab",middleName:null,surname:"Fatima",slug:"anab-fatima",fullName:"Anab Fatima"},{id:"243371",title:"Dr.",name:"Hina",middleName:null,surname:"Zahid",slug:"hina-zahid",fullName:"Hina Zahid"},{id:"243372",title:"Dr.",name:"Ishart",middleName:null,surname:"Younus",slug:"ishart-younus",fullName:"Ishart Younus"},{id:"243373",title:"Dr.",name:"Sheikh Abdul",middleName:null,surname:"Khaliq",slug:"sheikh-abdul-khaliq",fullName:"Sheikh Abdul Khaliq"},{id:"243374",title:"Dr.",name:"Farah",middleName:null,surname:"Khalid",slug:"farah-khalid",fullName:"Farah Khalid"}]}],onlineFirstChaptersFilter:{topicId:"218",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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She holds a degree in Dentistry from the Federal University of Alfenas (UNIFAL), while her specialization and professional improvement in Stomatology took place at Hospital Heliopolis (São Paulo, SP). Her qualifications are: a specialist in Dental Imaging and Radiology, Master in Dentistry (Periodontics) from the University of São Paulo (FORP-USP, Ribeirão Preto, SP), and Doctor (Ph.D.) in Dentistry (Stomatology Clinic) from Hospital São Lucas of the Pontifical Catholic University of Rio Grande do Sul (HSL-PUCRS, Porto Alegre, RS). She held a postdoctoral internship at the Federal University from Jequitinhonha and Mucuri Valleys (UFVJM, Diamantina, MG). She is currently a member of the Brazilian Society for Dental Research (SBPqO) and the Brazilian Society of Stomatology and Pathology (SOBEP). Dr. Marinho's experience in Dentistry mainly covers the following subjects: oral diagnosis, oral radiology; oral medicine; lesions and oral infections; oral pathology, laser therapy and epidemiological studies.",institutionString:null,institution:{name:"State University of Paraíba",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"267724",title:"Prof.",name:"Febronia",middleName:null,surname:"Kahabuka",slug:"febronia-kahabuka",fullName:"Febronia Kahabuka",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZpJQAW/Profile_Picture_2022-06-27T12:00:42.JPG",institutionString:"Muhimbili University of Health and Allied Sciences, Tanzania",institution:{name:"Muhimbili University of Health and Allied Sciences",institutionURL:null,country:{name:"Tanzania"}}},{id:"70530",title:"Dr.",name:"Márcio",middleName:"Campos",surname:"Oliveira",slug:"marcio-oliveira",fullName:"Márcio Oliveira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRm0AQAS/Profile_Picture_2022-08-01T12:34:46.jpg",institutionString:null,institution:{name:"State University of Feira de Santana",institutionURL:null,country:{name:"Brazil"}}}]},{id:"2",title:"Prosthodontics and Implant Dentistry",coverUrl:"https://cdn.intechopen.com/series_topics/covers/2.jpg",editor:{id:"179568",title:"Associate Prof.",name:"Wen Lin",middleName:null,surname:"Chai",slug:"wen-lin-chai",fullName:"Wen Lin Chai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRHGAQA4/Profile_Picture_2022-05-23T14:31:12.png",biography:"Professor Dr. Chai Wen Lin is currently a lecturer at the Department of Restorative Dentistry, Faculty of Dentistry of the University of Malaya. She obtained a Master of Dental Science in 2006 and a Ph.D. in 2011. Her Ph.D. research work on the soft tissue-implant interface at the University of Sheffield has yielded several important publications in the key implant journals. She was awarded an Excellent Exchange Award by the University of Sheffield which gave her the opportunity to work at the famous Faculty of Dentistry of the University of Gothenburg, Sweden, under the tutelage of Prof. Peter Thomsen. In 2016, she was appointed as a visiting scholar at UCLA, USA, with attachment in Hospital Dentistry, and involvement in research work related to zirconia implant. In 2016, her contribution to dentistry was recognized by the Royal College of Surgeon of Edinburgh with her being awarded a Fellowship in Dental Surgery. She has authored numerous papers published both in local and international journals. She was the Editor of the Malaysian Dental Journal for several years. 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His passion for teaching then led him to join the faculty of dentistry at University Malaya and he has since became a valuable lecturer and clinical specialist in the Department of Restorative Dentistry. He is currently the removable prosthodontic undergraduate year 3 coordinator, head of the undergraduate module on occlusion and a member of the multidisciplinary team for the TMD clinic. He has previous membership in the British Society for Restorative Dentistry, the Malaysian Association of Aesthetic Dentistry and he is currently a lifetime member of the Malaysian Association for Prosthodontics. Currently, he is also the examiner for the Restorative Specialty Membership Examinations, Royal College of Surgeons, England. He has authored and co-authored handful of both local and international journal articles. His main interest is in prosthodontics, dental material, TMD and regenerative dentistry.",institutionString:null,institution:{name:"University of Malaya",institutionURL:null,country:{name:"Malaysia"}}},editorThree:null,editorialBoard:null}]},overviewPageOFChapters:{paginationCount:20,paginationItems:[{id:"82991",title:"Diseases of the Canine Prostate Gland",doi:"10.5772/intechopen.105835",signatures:"Sabine Schäfer-Somi",slug:"diseases-of-the-canine-prostate-gland",totalDownloads:0,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"82956",title:"Potential Substitutes of Antibiotics for Swine and Poultry Production",doi:"10.5772/intechopen.106081",signatures:"Ho Trung Thong, Le Nu Anh Thu and Ho Viet Duc",slug:"potential-substitutes-of-antibiotics-for-swine-and-poultry-production",totalDownloads:1,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Antibiotics and Probiotics in Animal Food - Impact and Regulation",coverURL:"https://cdn.intechopen.com/books/images_new/11578.jpg",subseries:{id:"20",title:"Animal Nutrition"}}},{id:"82905",title:"A Review of Application Strategies and Efficacy of Probiotics in Pet Food",doi:"10.5772/intechopen.105829",signatures:"Heather Acuff and Charles G. 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She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. 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He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}}]}},subseries:{item:{id:"24",type:"subseries",title:"Computer Vision",keywords:"Image Analysis, Scene Understanding, Biometrics, Deep Learning, Software Implementation, Hardware Implementation, Natural Images, Medical Images, Robotics, VR/AR",scope:"The scope of this topic is to disseminate the recent advances in the rapidly growing field of computer vision from both the theoretical and practical points of view. Novel computational algorithms for image analysis, scene understanding, biometrics, deep learning and their software or hardware implementations for natural and medical images, robotics, VR/AR, applications are some research directions relevant to this topic.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",hasOnlineFirst:!0,hasPublishedBooks:!1,annualVolume:11420,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). 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