Methods of screening and its detection rate.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"7182",leadTitle:null,fullTitle:"Scars",title:"Scars",subtitle:null,reviewType:"peer-reviewed",abstract:"SCARS is an updated and comprehensive overview focused on the pathological scarring process. The chapters are written by international authors, researchers, and clinical practitioners with an interest in scars and united in a valuable study. The book aims at providing a guideline for the diagnosis and treatment of scars, as well as opening research paths for future developments.",isbn:"978-1-83881-892-0",printIsbn:"978-1-83880-934-8",pdfIsbn:"978-1-83881-893-7",doi:"10.5772/intechopen.73982",price:100,priceEur:109,priceUsd:129,slug:"scars",numberOfPages:96,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"3dd0cf7e0a901faabc35677b3eaefaac",bookSignature:"Anca Chiriac",publishedDate:"September 11th 2019",coverURL:"https://cdn.intechopen.com/books/images_new/7182.jpg",numberOfDownloads:8363,numberOfWosCitations:0,numberOfCrossrefCitations:4,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:5,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:9,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"August 29th 2018",dateEndSecondStepPublish:"October 16th 2018",dateEndThirdStepPublish:"December 15th 2018",dateEndFourthStepPublish:"March 5th 2019",dateEndFifthStepPublish:"May 4th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"193329",title:"Prof.",name:"Anca",middleName:null,surname:"Chiriac",slug:"anca-chiriac",fullName:"Anca Chiriac",profilePictureURL:"https://mts.intechopen.com/storage/users/193329/images/system/193329.jpeg",biography:"Dr. Anca Chiriac, MD, PhD, is a clinical dermatologist whose research interests are focused on psoriasis, clinical aspects, and pathogenic mechanisms. Dr. Anca Chiriac received her MD degree from Grigore T. Popa University of Medicine and Pharmacy in 1991 and PhD degree in 2005 in Medicine from Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. She completed her postdoctoral studies at Necker-Enfants Malades Hospital, Paris, France; Ed. Herriot Hospital Lyon, France; and A. Sygros Hospital University of Athens, European Center for Allergy and Research Foundation Berlin, Germany. From 2013, she is a professor of Dermatology at Apollonia University, Iasi, and an associate researcher at P. Poni Institute of Macromolecular Chemistry, Romanian Academy. She has published over 150 articles and book chapters and has been involved in many international research projects.",institutionString:"Apollonia University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Apollonia University",institutionURL:null,country:{name:"Romania"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"175",title:"Dermatology",slug:"dermatology"}],chapters:[{id:"67087",title:"Introductory Chapter: Scars",doi:"10.5772/intechopen.86397",slug:"introductory-chapter-scars",totalDownloads:804,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Anca Chiriac",downloadPdfUrl:"/chapter/pdf-download/67087",previewPdfUrl:"/chapter/pdf-preview/67087",authors:[{id:"193329",title:"Prof.",name:"Anca",surname:"Chiriac",slug:"anca-chiriac",fullName:"Anca Chiriac"}],corrections:null},{id:"66375",title:"Scarring After Burn Injury",doi:"10.5772/intechopen.85411",slug:"scarring-after-burn-injury",totalDownloads:1466,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"Burn injury is a trauma that has variable scarring outcomes dependent on both the size and the depth of the burn. This chapter will discuss the pathophysiology of wound healing by both primary and secondary intention and its applicability to burn wounds. The importance of accurate assessment of burn depth and its impact on the primary treatment and subsequent scar outcome will be explored. Special anatomic areas such as the face, hands and neck will be highlighted. Skin grafting and skin substitutes as treatment options will be reviewed. Improvements in burn care have enabled people to survive larger burns that may once have proved fatal. The emphasis of treatment, once healing has been achieved, is now focused upon rehabilitation and scar management. Scar management strategies including pressure garments and silicone therapy are highlighted along with secondary scar revision strategies.",signatures:"Lindsay Damkat-Thomas and John Edward Greenwood",downloadPdfUrl:"/chapter/pdf-download/66375",previewPdfUrl:"/chapter/pdf-preview/66375",authors:[{id:"280005",title:"Dr.",name:"Lindsay",surname:"Damkat-Thomas",slug:"lindsay-damkat-thomas",fullName:"Lindsay Damkat-Thomas"},{id:"280575",title:"Dr.",name:"John E.",surname:"Greenwood",slug:"john-e.-greenwood",fullName:"John E. Greenwood"}],corrections:null},{id:"65309",title:"The Specificities of Electrical Burn Healing",doi:"10.5772/intechopen.83582",slug:"the-specificities-of-electrical-burn-healing",totalDownloads:908,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Electrical burns are a major cause of bodily harm due to the mechanism and effect of the lesions. This prompts us to study these lesions and their management in order to reduce the morbidity caused by this type of accident. In the event of an electric chock accident, the treatment is medico-surgical and is composed of two main phases: acute phase when general treatment is essential and subacute phase when local treatment is implemented. The study shows that conventional emergency decompression does not appear to reduce the amputation rate, the use of local and locoregional flaps in the initial phase (<21 days) carries a significant risk of suffering and necrosis, and also antithrombotic prevention or the use of flaps does not seem to have an impact on healing delays.",signatures:"Iyadh Ghorbel, Slim Moalla, Amal Abid, Amir Karra and Khalil Ennouri",downloadPdfUrl:"/chapter/pdf-download/65309",previewPdfUrl:"/chapter/pdf-preview/65309",authors:[{id:"279979",title:"Dr.",name:"Iyadh",surname:"Ghorbel",slug:"iyadh-ghorbel",fullName:"Iyadh Ghorbel"},{id:"289577",title:"Dr.",name:"Slim",surname:"Moalla",slug:"slim-moalla",fullName:"Slim Moalla"},{id:"289578",title:"Dr.",name:"Amal",surname:"Abid",slug:"amal-abid",fullName:"Amal Abid"},{id:"289579",title:"Dr.",name:"Amir",surname:"Karra",slug:"amir-karra",fullName:"Amir Karra"},{id:"289580",title:"Prof.",name:"Khalil",surname:"Ennouri",slug:"khalil-ennouri",fullName:"Khalil Ennouri"}],corrections:null},{id:"68308",title:"Endometriosis of Postoperative Scar",doi:"10.5772/intechopen.88246",slug:"endometriosis-of-postoperative-scar",totalDownloads:1024,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Endometriosis is seen in women during their reproductive age, where functional endometrial glands of the uterus and stromal component are observed outside the uterine cavity. Endometriosis in an operative scar is a rare event following mainly obstetric and gynecologic operation. Typical signs of scar endometriosis are cyclic pain and swelling tumor in the scar after obstetric or gynecologic operations. We present 24 cases of scar endometriosis with discussion and emphasis on variants of clinical signs, differential diagnostic, methods of treatment, and prevention.",signatures:"Andrei Plotski",downloadPdfUrl:"/chapter/pdf-download/68308",previewPdfUrl:"/chapter/pdf-preview/68308",authors:[{id:"272136",title:"Ph.D.",name:"Andrei",surname:"Plotski",slug:"andrei-plotski",fullName:"Andrei Plotski"}],corrections:null},{id:"65397",title:"Keloids and Hypertrophic Scars Can Now Be Treated Completely by Multimodal Therapy, Including Surgery, Followed by Radiation and Corticosteroid Tape/Plaster",doi:"10.5772/intechopen.84178",slug:"keloids-and-hypertrophic-scars-can-now-be-treated-completely-by-multimodal-therapy-including-surgery",totalDownloads:3110,totalCrossrefCites:3,totalDimensionsCites:4,hasAltmetrics:1,abstract:"Keloids and hypertrophic scars are fibroproliferative disorders of the skin. Research over the last decade has markedly improved our understanding of the pathogenesis of these scars, in particular, the fact that both disorders are caused by prolonged inflammation that prevents the orderly healing of injured or irritated skin. This protracted inflammatory response is due to genetic, systemic, and local risk factors. Genetic factors include single nucleotide polymorphisms, while systemic factors include hypertension, pregnancy-related and other hormones, and aberrant cytokine levels. An important local factor is the mechanical force (tension) on the scar. These observations have greatly aided the development of therapies for these once-intractable scars. As a result, these scars are now regarded as being completely treatable. At present, we believe that the following combination of three therapies most reliably achieves a complete cure: surgery followed by radiation and the prolonged daily use of corticosteroid tape/plaster.",signatures:"Rei Ogawa",downloadPdfUrl:"/chapter/pdf-download/65397",previewPdfUrl:"/chapter/pdf-preview/65397",authors:[{id:"45225",title:"Dr.",name:"Rei",surname:"Ogawa",slug:"rei-ogawa",fullName:"Rei Ogawa"}],corrections:null},{id:"65514",title:"Scars: A New Point of View in Plastic Surgery",doi:"10.5772/intechopen.84127",slug:"scars-a-new-point-of-view-in-plastic-surgery",totalDownloads:1051,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The issue of achieving esthetically pleasing surgical scars has gained prominence in recent years, with the emergence of the concept of the “imperceptible scar,” which is expected by patients of not only cosmetic but also reconstructive surgery. Current research in reconstructive surgery focuses on obtaining high-quality results in the minimum number of steps, with a view to “doing it right the first time.” However, there is no uniform approach to scar treatment, which is partly due to a lack of consensus regarding the most effective healing methods. This chapter aims at shedding new light to discussion by putting forward two different procedures that enhance scar results in cosmetic and reconstructive surgeries by applying a topical treatment with active ingredients and by combining cadaver and artificial skin as dermal substitutes, respectively. The effectiveness of these treatments is shown by means of objective, quantifiable data collected as a result of studies and postoperative follow-ups carried out at Hospital Alemán in Buenos Aires.",signatures:"Gustavo E. 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\r\n\tImmune checkpoint inhibitors (ICI) such as anti-PD-1 and anti-PD-L1 are major FDA-approved monoclonal antibodies that are utilized for many hard-to-treat cancers. Though these drugs have shown progression-free survival in many cancer types, the patient response to ICI is still low i.e. <40% indicating that several immune checkpoint molecules within the tumor microenvironment are playing a role in the respective treatment dynamics. Of these, Natural killer (NK) cells immune checkpoint molecules are emerging as new targets of therapy. Several NK receptors and immune checkpoints have been documented to play a role in immune escape and tumor progression. Therefore, identification and targeting of NK immune checkpoint molecules to restore cell cytotoxicity and induction of robust anti-tumor response is an area of cutting-edge research globally. On the other hand, the identification of NK markers as potential predictive and prognostic biomarkers can serve as an important tool for the stratification of patients on immunotherapy. Therefore, knowledge on NK cell-based immune checkpoints can pave the way for personalized cancer therapeutics.
",isbn:"978-1-80356-591-0",printIsbn:"978-1-80356-590-3",pdfIsbn:"978-1-80356-592-7",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"65dc94eb0a8dd733522f67d95b2c2d48",bookSignature:"Dr. Afsheen Raza",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11680.jpg",keywords:"Inhibitory Receptors, NK Cells, Activating Receptors, Tumor Immune Escape, Cancer Immunotherapy, Mechanisms of Targeting, Checkpoint Cells Targeting, Clinical Trials, Biomarkers, Immune Checkpoint Cells, Immune Checkpoint Inhibitors, Future Perspectives",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 16th 2022",dateEndSecondStepPublish:"May 25th 2022",dateEndThirdStepPublish:"July 24th 2022",dateEndFourthStepPublish:"October 12th 2022",dateEndFifthStepPublish:"December 11th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"8 hours",secondStepPassed:!1,areRegistrationsClosed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Dr. Raza has been trained in Cancer Biology and Therapeutics at Harvard Medical School, USA, and in Molecular Biology at Aga Khan University. She has more than 10 years of research experience and 30+ peer-reviewed publications in high-impact journals. She serves as Academic Editor for the PLOS ONE Journal and has acted as a reviewer for several journals including the Journal of Translational Medicine, the Journal of Cancer Management and Research, and the Journal of Cancer Drug Resistance.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"339296",title:"Dr.",name:"Afsheen",middleName:null,surname:"Raza",slug:"afsheen-raza",fullName:"Afsheen Raza",profilePictureURL:"https://mts.intechopen.com/storage/users/339296/images/system/339296.jpg",biography:"Dr. Afsheen Raza is a research scientist with extensive experience in cutting-edge molecular biology/immunology research and cancer clinical trials currently working at the Translational Cancer Research Institute of National Center of Cancer Care and Research (NCCCR) and Hamad Medical Corporation, Qatar. She is trained in Cancer Biology and Therapeutics at Harvard Medical School, USA, and in Molecular Biology at Aga Khan University. She has extensive experience in conducting large study grants and clinical trials. Her primary research focuses on studying tumor-host immune interactions to immunotherapeutic strategies and is also engaged in establishing immune-monitoring platforms/analytical tools to evaluate novel immune-modulators and cancer antigen-specific immune cells that will serve as a foundation for translational research. Apart from 10 years of research experience and 39+ peer-reviewed publications in high-impact journals, Dr. Raza has authored a book chapter and is a reviewer for several journals. She is Internationally recognized for her scientific contribution to cancer immunology and immunotherapy – Academic Editor for PLOS ONE journal, Guest Editor for prestigious journal of Frontiers in Immunology and Special Collection in Biomarker Insight for SAGE Publishing. She has six years of experience in mentoring and supervising Masters and Ph.D. students in their research projects and in teaching immunology and molecular biology curriculum and lab techniques to rotating clinical fellows from Hematology, Immunology, and Allergy programs.\nh-index=14 , ORCID ID: https://orcid.org/ 0000-0002-0264-3304",institutionString:"Hamad Medical Corporation",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Hamad Medical Corporation",institutionURL:null,country:{name:"Qatar"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"19",title:"Pharmacology, Toxicology and Pharmaceutical Science",slug:"pharmacology-toxicology-and-pharmaceutical-science"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"225753",firstName:"Marina",lastName:"Dusevic",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/225753/images/7224_n.png",email:"marina.d@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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Although these areas overlap, depending upon the use of techniques and their applications, both have peculiar characteristics. While the focus of bioengineering is the implementation of engineering principles and design concepts in biology, biotechnology is more focused on the natural sciences [2].
\nThese fields, today considered priority, are the fruit of strategies from various areas that aim to benefit humanity and its environment. Biotechnology and bioengineering, however, despite growing attention in recent decades, are not a new science. Humans have been developing them since the earliest beginnings, mainly in food production. Some ancestral examples include the preparation of fermented beverages from cereals in Babylon and Egypt (8000 to 6000 years BC); the production of bread, using ferment in Egypt (4000 years BC); and wine production in Greece (2000 years BC). Historically, the use of these traditional techniques in this period of history is called discoveries, and not development, once the underlying scientific principles were not understood [3, 4].
\nIndeed today, the biotechnology and bioengineering based on scientific progress find applications in several areas, including agriculture, livestock, human health, preservation of the environment, and manufacturing industry [5]. This wide applicability was only possible due to the combination of several fields of knowledge that include biochemistry, physiology, genetics, microbiology, virology, botany, zoology, ecology, computer science, and chemical engineering.
\nTherefore, this is a field of work typically multidisciplinary, which makes the effective collaboration and integration of professionals from different areas of knowledge absolutely indispensable so that all potential of biotechnology and bioengineering can be exploited. The interface between these fields is now understood not only as a “science” to learn about nature but also as a “technology” of susceptible alteration. The intersection between biotechnology and bioengineering and its kindred disciplines proved their economic importance, being capable to expand and promote the manufacture of products and services, besides modifying processes in favor of human benefit [6, 7, 8].
\nThe current scenario points for biotechnology and bioengineering as being the main technology of the twenty-first century should be absorbed by the general public. Undoubtedly, knowledge of the principles of vital processes already achieved will proportionate changes significant in the society. Therefore, it is important to ensure a broad awareness of what these two fields of knowledge involve and what the consequences of accepting or rejecting the innovations [9].
\nThus, the chapters presented in this book are intended to help provide a deeper understanding about the recent progresses on biotechnology and bioengineering contributing substantially to the consolidation of bio-based processes and products.
\nAneuploidies are Trisomy21 (“Down syndrome”, T21), Trisomy18 (Edward syndrome, T18), trisomy13 (Patau syndrome, T13), monosomy (turner syndrome, monosomy) and triploidy. “Down syndrome” is more focused than other aneuploidy due to Trisomy 13 and 18 are lethal, do not have very long-term consequences, and almost all cases have major structural abnormalities and can be identified on the basis of these features. Where as in T21 the ultrasound and laboratory findings are subtle and nonspecific. Special effort has to be made to identify these nonspecific features and analyse their importance. Identification of T21 is based on these subtle abnormal structures i.e., ultrasound markers and abnormal biochemistry (low PAPP-A and raised β-HCG). The abortion rate in monosomy X is 98% and Edwards is 86% whereas “Down syndrome” is only 30%. Not only this Downs is the commonest congenital cause of mental disability with long life span and need life-long family support. The incidence is 1in 800 pregnancies. Downs can lead to considerable ill health, although some individual may have only mild problems and can lead relatively normal lives. Having baby with “Down syndrome” is likely to have significant impact on family life. There is currently no known cure. A significant number of parents would opt for terminating such a pregnancy or if they want to continue prior information would benefit for preparing for such a baby. Downs occur due to non-disjunction type (Errors in meiosis). Translocation type and mosaic type which is rare.
In 1862 & 1887 Langdon Down noted that common characteristics of patients with trisomy 21 are skin deficient in elasticity, giving the impression of being too large for the body, and face is flat, broad and destitute of prominence. The cheeks are roundish and extended laterally. The eyes are obliquely placed, and internal canthi more than normally distanced from one another. The palpebral fissure is very narrow. The tongue is long, thick and much roughened. The nose is small. In 1987 B Benacerraf [1], told that this loose skin can be seen in mid trimester scan at 20 weeks as a thickening of skin at the back of neck in axial view of skull in trans cerebellar plane which was defined as nuchal fold. After 5 years it was realized that the excess skin of individuals with Down’s syndrome can be visualized by ultrasonography as increased nuchal translucency in the third month of intrauterine life [2]. About 75% of trisomy 21 fetuses have increased nuchal translucency (NT) and 60–70% have absent nasal bone.
Aneuploidy increases with advancing maternal age. So, increasing the maternal age increases the risk. in the early 1970s, the screening was based only on the association with advanced maternal age. In late 1980s not only maternal age but also found that the concentration of various fetoplacental products in the maternal circulation has taken into account for screening. At 16 weeks of gestation the median maternal serum concentrations of alpha-fetoprotein (AFP), un-conjugated estriol (μE3), human chorionic gonadotropin (HCG) (free- β and total
Aneuploidy screening Approach: observed Detection rates.
“Down syndrome” can be diagnosed during pregnancy. Diagnostic tests are invasive and have an inherent miscarriage rate, however, small they are also expensive. Screening tests can identify a large number of patients who would benefit from diagnostic testing thus reducing risks and costs. Screening tests by definition, cannot identify all accepted pregnancies. First trimester screening is far more effective than later screening. Aneuploidy screening should be offered to all the pregnant women.
Screening tests that are performed in the first and second trimesters include integrated, sequential and contingent screening. The basic types are 1) first trimester combined screening the components in this are Nuchal translucency (NT), PAPP-A and β-HCG. The detection rate is 85–95%. If you add nasal bone and other ultrasound features to this the detection rate increases 93–96%. 2) Triple test the components are β-HCG, MS-AFP and unconjugated Estriol. The detection rate is only 60–65%. 3) Quadruple test β-HCG, MS-AFP, unconjugated Estriol and inhibin A. the detection rate is 70–75%. 4) Penta screen includes hyper glycosylated HCG in addition to quadruple test. If patient come for screening in first trimester, first trimester combined screening is advised, if she comes at 14-20 weeks quadruple test, if she comes at both first and second trimester integrated test is best for screening (Table 1).
Methods of screening | Detection rate | False-positive rate |
---|---|---|
Maternal age(MA) | 30% | 5% |
MA+ fetal nuchal translucency(NT) | 75–80% | 5% |
MA+ serum free β-hCG and PAPP-A | 60–70% | 5% |
MA + NT + free β-hCG and PAPP-A (combined Test) | 85–95% | 5% |
Combined Test+ nasal bone or tricuspid flow or ductus venosus flow | 93–96% | 2.5% |
MA + serum AFP,hCG, μE3(triple test) | 60–65% | 5% |
MA + serum AFP,free β-hCG, μE3, inhibin A(Quadruple test) | 70–75% | 5% |
MA + NT + PAPP-A(11-13 weeks) + quadruple test | 90–94% | 5% |
Nicolaides KH. Screening for fetal aneuplodies at 11t013weeks.Prenat Diagn 2011;31:7–15. |
Methods of screening and its detection rate.
Integrated test:-Integrate the First trimester PAPP-A, Free β-HCG and NT analyte screening followed by a second trimmester Quad screen and receives a single screen test result. The detection rate of this test is 90–94%. Limitations includes the withholding of first trimester screening test results until the second trimester which delay the management option.
Sequential screening: - these are two types one is stepwise another one is contingent model. These methods were developed to maintain a high detection rate. in step wise sequential model it can be achieved by using the combined first and second trimester screening approach while also reporting the patients first trimester screening test risk, which allows for earlier management options. If first trimester test result is higher than lab derived positive screening cutoff, we can offer them the diagnostic test or NIPT, and the screening protocol is discontinued. If the patient has a lower risk can counseled and proceed to quad screening in the second trimester. Sequential screening has a detection rate of 91–93% with a positive screening test result rate of 4–5% [5, 6, 7].
Contingent model classifies aneuploidy risk as high, intermediate or low on the basis of first trimester screening test results. High risk patients are offered cell free DNA screening or diagnostic testing with CVS and for low risk women further screening or testing is not recommended. Only those with intermediate risk are offered second trimester screening.
Every woman has a risk that her fetus has a chromosomal abnormality.
to calculate the individual risk, the clinical information which is necessary to take into account the background or a priori risk, depends on maternal age, weight the ethnicity (in terms of south Asian, east Asian, south east Asian black or Caucasian), IVF, number of fetuses diabetes and smoking. This information should be combined with ultrasound information and biochemistry. Which is based on crown rump length, NT, PAPP-A, free β-HCG. Then make calculation by a series of factors or likelihood ratios, which depend on the results of a series of screening tests carried out during the course of the pregnancy to determine the patient-specific risk. A priori risk established by maternal age has been adjusted successfully by NT screening. This has been one of the most important elements of aneuploidy screening as it resulted in a significant reduction in unnecessary invasive testing on pregnant women with advanced maternal age. If you add rest of the ultrasound features like nasal bone, ductus venosus and tricuspid regurgitation which can increase the rate of detection.
Genetic sonogram has been used to screen for Aneuploidy by using specific findings. In this approach seeks major structural abnormalities and minor ultrasonographic soft markers. These Soft markers are minor ultrasound abnormalities, considered as variants of normal, they do not constitute a structural defect. Presence of Soft markers are indicative of an increased age adjusted risk of an underlying fetal aneuploidy or some non- chromosomal abnormalities. So, these are also a priori risk. Detection of soft markers increase the risk for aneuploidy by constant proportion (likelihood ratio LR). Absence of these markers lower the risk (Negative predictive value NPV). These were decided after a meta-analysis study of second trimester markers for trisomy21 [8], (Table 2).
Marker | LR+(95%CI) | LR-(95%CI) | LR isolated marker* |
---|---|---|---|
Intra cardiac echogenic focus | 5.83(5.02–6.77) | 0.80(0.75–0.86) | 0.95 |
Ventriculomegaly | 27.52(13.61–55.68) | 0.94(0.91–0.98) | 3.81 |
Increased nuchal fold | 23.30(14.35–37.83) | 0.80(0.74–0.85) | 3.79 |
Echogenic bowel | 11.44(9.05–14.47) | 0.90(0.86–0.94) | 1.65 |
Mild Hydronephrosis | 7.63(6.11–9.51) | 0.92(0.89–0.96) | 1.08 |
Short humerus | 4.81(3.49–6.62) | 0.74(0.63-o.88) | 0.78 |
Short femur | 3.72(2.79–4.97) | 0.80(0.73–0.88) | 0.61 |
ARSA | 21.48(11.48–40.19) | 0.71(0.57–0.88) | 3.94 |
Absent or hypoplastic nasal bone | 23.27(14.23–38.06) | 0.46(0.36–0.58) | 6.58 |
Meta-analysis of 2nd trimester markers for trisomy21-M. Agathokleous et al.
Every time a test is carried out the
If a systematic second- trimester ultrasound examination demonstrates the absence of all major defects and markers, there is a 7.7fold reduction in risk for trisomy 21. Detection of any one of the markers during the scan should stimulate the sonographer to look for all other markers or defects. Post-test odds for trisomy 21 is derived by multiplying the pre-test odds by the positive LR for each detected marker and the negative LR for each marker demonstrated to be absent.
In Sequenitial screening first do the first trimester combined screening test identify the risk based on this risk if it is high risk do the invasive procedure (CVS) or NIPT. If there is false positive and false negetive results then you need to combine with quadraple test and sequentially calcuate the risk as the false positive rate is very very low.
First trimester markers are pregnancy associated plasma protein A (PAPP-A), Free β Human chorianic gonadotropin (β-HCG) where as second trimester markers are Alpha fetoprotein (AFP) Unconjugated oestriol (μE3), Total human chorianic gonadotropin (HCG) and inhibin-A.
The PAPP-A level is low in T21 which is about half of euploid pregnancies. β-HCG levels are double that of unaffected pregnancies. The concentrations of these markers vary with gestational age. In first trimester PAPP-A increases and free β-HCG decreases. In second trimester AFP and μE3 increase HCG and inhibin-A will decreases before 17 weeks after that it may increas. The measurements of these markers may vary between laboratories. In account of this variation the concentration of each marker is expressed as multiple of median for unaffected pregnancies of the same gestational age (MoM).
provision of a high-quality first trimester screening service significantly enhances the autonomy of pregnant women [10].
The gestation should be 11–13 + 6 weeks and the fetal crown–rump length should be 45–84 mm. Criteria for the Standardized Measurement of the Nuchal translucency at 11–13 + 6 weeks are- fetus must be in the midsagittal plane. The image must be magnified so, that it is filled by the fetal head, neck and upper thorax, the magnification should be as large as possible and each slight movement of the callipers should produce only a 0.1 mm change in the measurement. The fetal neck must be in neutral position, it should not be flexed, and not hyperextended. Amnion must be seen separate from NT line. The margins of NT edges must be clear enough for proper placement of the callipers (Figure 2). The + callipers on the ultrasound must be used to perform the NT measurement. Electronic callipers must be placed on the inner borders of the nuchal line space with none of the horizontal crossbar itself protruding into the space and the callipers must be placed perpendicular to the fetal long axis. Measurement must be obtained at the widest space of the NT. Cord round the neck may be present in 5–10% of cases which may produce a falsely increased NT. In such cases, the measurements of NT above and below the cord are different so, the average of these two measurements should be appropriate for calculating risk. One of the studies involving 96,127 pregnancies, at a crown rump length of 45 mm the median and 95th centile was 1.2 and 2.1 mm and the crown rump length of 84 mm were 1.9 and 2.7 mm [11]. The average NT in aneuploidy is about 2.5 mm above the normal median for crown-rump length. In Turner syndrome, the median NT is about 8 mm above the normal median.
Normal NT and nasal bone.
It may be present, absent or hypoplastic. In the normal fetus between the 11th and early 12th week of gestation, the nasal bone may appear poorly ossified or absent [12]. In such cases, it is recommended to repeat the measurement one week later [12]. Nasal bone hypoplasia is calculated as BPD/NBL ratio if >11 than hypoplasia. Several studies have demonstrated a high association between absent nasal bone at 11–13 + 6 weeks and trisomy 21, as well as other chromosomal abnormalities [13]. Criteria for the Standardized Measurement of the Nasal Bone at 11–13 + 6 weeks are mid sagittal view of face with the magnification of the image should be such that the fetal head and thorax occupy the whole screen. Mid sagittal face is defined by the presence of the echogenic tip of the nose and rectangular shape of the palate anteriorly, the translucent diencephalon in the center, and the nuchal membrane posteriorly. Minor deviations may cause non-visualization of the tip of the nose and visibility of the zygomatic process of the maxilla. The ultrasound transducer should be parallel to the direction of the nose and it should be gently tilted from side to side to ensure that the Nasal bone is seen separate from the skin (Figure 2). The echogenicity of NB should be greater than the overlying skin. Three distinct lines are noted in nasal bone demonstration: the first two lines are horizontal and parallel to each other where the top line represents the skin and bottom line is the NB. Third one represents the tip of the nose. When the NB line appears as a thin and less echogenic than the overlying skin, which suggests that the NB is not yet ossified, and it is classified as being absent (Figure 5) [12].
Normal ductus venosus.
Normal tricuspid valve.
Criteria for the Standardized Measurement of DV at 11–13 + 6 weeks are the magnification of the image should be such that the fetal head and thorax should occupy the whole screen. Right ventral mid sagittal view of fetal trunk should be obtained. Color flow mapping of umbilical vein DV and fetal heart should be demonstrated. Pulse doppler sample volume should be small (0.5–1.0 mm) and it should be placed in the yellowish aliasing area. Insonation angle should be less than 30degrees [12]. The filter should be set at a low frequency (50-70 Hz). Sweep speed should be high (2-3 cm/s) so that the waveforms are spread allowing better assessment of the A wave (Figure 3). Ductus venosus shows biphasic wave form with low pulsatility and antegrade flow in the diastolic components (a wave) throughout cardiac cycle. Normal ductus venosus Doppler waveforms show a positive a-wave, whereas the presence of an absent or reversed a-wave defines abnormal ductus venosus waveforms. The presence of high pulsatility or reverse flow of the a-wave in the first trimester increases the risk for chromosomal anomalies, cardiac defects, and the occurrence of twin-twin transfusion syndrome in monochorianic twins. Abnormal flow in the ductus venosus in about 80% of trisomy 21 fetuses and in about 5% of chromosomally normal fetuses [13].
Color and pulsed Doppler examination across the tricuspid valve is commonly used in the first trimester to assess for the presence of tricuspid valve regurgitation (TR). The presence of TR in the first trimester has been associated with chromosomal abnormalities [14, 15]. In the first trimester, TR is found in less than 5% of chromosomally normal fetuses, in more than 65% of fetuses with trisomy 21, and in more than 30% of fetuses with trisomy 18 [14]. Interrogation of other cardiac valves with color or pulsed Doppler is reserved for fetuses at risk for valve obstruction or when a cardiac malformation is suspected. Criteria for tricuspid valve evaluation at 11–13 + 6 weeks are- image should be such that the fetal thorax occupies most of the image (Figure 4). heart should be in apical position. Sample volume should be 2-3 mm should be positioned across the tricuspid valve with an angle should be less than 30 degrees from the direction of the interventricular septum. Significant TR is defined when regurgitation is more than half of the systole with velocity of >60 cm/s. The sweep speed should be 2-3 cm/s so that the wave forms are widely spread for better assessment. The tricuspid valve could be in sufficient in one or more of its three cusps, so, therefore the sample volume should be placed across the valve at least three times in an attempt to interrogate the complete valve [12].
Absent nasal bone.
It has been reported that high peak velocities in the hepatic artery are present in the first trimester in fetuses at risk for trisomy 21.
They are absent nasal bone, Aberrant subclavian artery, ventriculomegaly, increased Nuchal fold, Echogenic bowel loops, mild hydronephrosis, echogenic intra cardiac foci, short femur short humerus, choroid plexus cysts, single umbilical artery.
Major or minor abnormalities are found in about 75% of fetuses with trisomy 21 and in 10–15% of chromosomally normal fetuses. The Genetic sonogram is a targeted ultrasound looking for major abnormalities as well as minor markers for aneuploidy. Over the years these minor markers are being looked into and things like widened pelvic angle sandal gap deformity is going out of favour and is getting replaced by ARSA, pre nasal thickness and FMF angle. Absence of these markers decreases the risk of downs by around 70–80% but does not completely rule out Downs and hence Absence gives additional reassurance to the patient.
In first step when a soft marker is identified thoroughly search for other soft markers and structural abnormalities. In second step calculate the risk of aneuploidy based on likelihood ratios. This risk is calculated against background risk based maternal age alone or in combination with First trimester combined screening or second trimester quadruple test.
In second and third trimesters of pregnancy, abnormal accumulation of fluid behind the fetal neck can be known as nuchal cystic hygroma or nuchal edema. In about 75% of fetuses with cystic hygroma, there is a chromosomal abnormality and, in about 95% of cases, the abnormality is Turner syndrome. Chromosomal abnormalities are found in about one-third of the fetuses of nuchal edema and, in about 75% of cases, the abnormality is trisomy 21 or 18. Edema is also associated with fetal cardiovascular and pulmonary defects, skeletal dysplasia, congenital infections and metabolic and haematological disorders; The positive LR is 23.3 and negative LR is 0.8. Nuchal index is considered by some, because this is associated with gestational age. Nuchal index is (mean nuchal fold/mean BPD) x100 where the value of 11 or greater has a sensitivity of 50% and specificity of 96% (Figure 6).
Nuchal oedema.
occurs in 0.5to 1.4%. four vessels arise from the aortic arch where the right subclavian artery arises from distal part of the aortic arch and courses behind the oesophagus and trachea to the right upper arm (Figure 7). ARSA is present in 1% of euploid fetuses and 24% of trisomy 21. ARSA is associated with other conotruncal anomalies increases the risk of microdeletion 22Q11 and other syndromes. The positive LR is 21.5 and negative LR is 0.71. when it is isolated LR is 3.9 times.
ARSA.
This may be due to Swallowed blood, Cystic fibrosis or maternal infections. It may be also associated with congenital malformations of the bowel more so of upper GI lesions. And other perinatal complications, including fetal growth restriction. We have to also look for Ascites and bowel dilatation. Diagnosis of echogenic bowel should be confirmed by low frequency transducer, reduced Gain and without use of harmonics. Echogenicity should be equal to or more than bone (Figure 8). Grade 2 similar to bone echogenicity Grade 3 is more than bone. The positive LR of this is 11.4 and negative LR is 0.9.
Echogenic bowel loops.
Short Femur and humerus is when the measurement is below 5th percentile for gestational age or measured/expected ratio < 0.9. The positive LR is 3.72 and negative LR is 0.8. regarding short humerus is the humerus measuring <2.5% or measured/expected ratio < 0.89. The Positive LR is 4.81 and negative LR is 0.74.
usually noted at region of papillary muscle 88% in Lt ventricle, 5%in rt. ventricle and 7% in biventricular. The echogenicity should be comparable to bone. Grading of EICF - Grade 2 similar echogenicity of bone and grade 3 more denser than bone (Figure 9). EICF in RV, biventricular, multiple and bright EICF are more associated with aneuploidy, when compared to solitary LV EICF. The positive LR is 5.83 and negative LR is 0.8.
EICF.
Normal ventricular measurements are <10 mm. If it is defined as mild ventriculomegaly when measurement is between 10 and 15 mm. (Figure 10). The overall prevalence of chromosomal defects in fetal ventriculomegaly is about 10% and the commonest chromosomal defects are trisomies 21, 18, 13 and triploidy. The positive LR is 27.52and negative LR is0.94.
Mild ventriculomegaly.
pelvic AP diameter measuring >4 mm and it should be measured in transverse section in 12 clock or 6 clock position. The positive LR is 7.6 and negative LR is 0.92 (Figure 11).
Pyelectasis.
There are other soft markers also those doesn’t have any likely hood ratio but they are important and common in our practise but they are not a part of screening protocol. They are the choroid plexus cysts and single umbilical artery, sandal gap toes, short ears, clinodactyly, increased iliac angle. Not only this Duodenal atresia and small membranous VSD (Figure 12) is also be associated with aneuploidy [16].
Small membranous VSD.
they may be round or oval. May be unilateral or bilateral. They may be large or small. Commonly seen between 16 and 21 weeks by 23 week start undergoing regression. After 25–26 weeks uncommon to see. More commonly associated with trisomy 18. LR for trisomy 18 when isolated is 1.1–1.5.
No strong association with aneuploidy. Usually associated with fetal cardiac, renal anomalies and oesophageal atresia (Figure 13).
Single umbilical artery.
In normal fetuses, the pre nasal thickness is small and the nasal bone is relatively long, resulting in a ratio of approximately 0.6 [17]. In trisomy 21 fetuses in the first trimester, the prenasal thickness increases, whereas the nasal bone length decreases, resulting in a ratio > 0.8 [17].
Other names for NIPT are NIPS- non-invasive prenatal screening, cfDNA- cell free DNA. The test is based upon the presence of fetal cell-free DNA in the maternal circulation. Placental cell apoptosis releases into the maternal circulation as small DNA fragments (150-200 bp) that can be detected from >7 weeks of gestation [18]. It is estimated that about 2–20% of circulating cfDNA in the maternal circulation is fetal in origin [18]. So, about 1 in 103–107nucleated cells in maternal blood are fetal which can be enriched to about 1in 10–100 by techniques such as magnetic cell sorting (MACS) or fluorescence activated cell sorting (FACS) after attachment of magnetically labelled or fluorescent antibodies on to specific fetal cell surface markers. However, with the use of fluorescent
1)
2)
3)
Factors that is associated with an increased risk of “Down syndrome” are higher maternal age, a parental translocation involving chromosome 21, previous child with T21, significant ultrasound findings and a positive screening test result. In pregnancies with T21 fetuses, the maternal serum concentration of free β-HCG is about twice (about 2MoM) as high and PAPP-A is reduced to half (about 0.5 MoM) compared to euploid pregnancies. Although NT measurement alone identifies about 75–80% of T21 fetuses, the combination of NT with maternal biomarkers in the first trimester increases the T21 detection rate to 85–95%, while keeping the false-positive rate at 5%. AFP is decreased in T21.
In addition to NT, other sensitive first trimester ultrasound markers of T21 include absence or hypoplasia of the nasal bone (60–70%), increased impedance to flow in the ductus venosus (about 80%), tricuspid regurgitation, cardiac malformations (atrioventricular septal defect) with or without generalized edema, aberrant right subclavian artery and echogenic intracardiac focus. Increased fronto maxillary fascial angle (short maxilla in 25%), renal pylectasis and echogenic bowel loops are also soft markers for “Down syndrome” (Table 3) (Figures 14–18).
Trisomy21 | Trisomy18 | Trisomy13 | Triploidy | Turner | |
---|---|---|---|---|---|
Ventriculomegaly | + | + | + | + | |
Holoprocencephaly | + | ||||
Choroid plexus cyst | + | ||||
Dandy walker complex | + | + | |||
Fascial cleft | + | + | |||
micrognathia | + | + | |||
Nasal hypoplasia | + | ||||
Nuchal edema | + | + | + | ||
Cystic hygroma | + | ||||
Diaphragmatic hernia | + | + | |||
Cardiac defect | + | + | + | + | + |
Exomphalos | + | + | |||
Duodenal atresia | + | ||||
Esophageal atresia | + | + | |||
Renal defects | + | + | + | + | + |
Short limbs | + | + | + | + | |
Clinodactyly | + | ||||
Overlapping fingers | + | ||||
polydactyly | + | ||||
syndactyly | + | ||||
Talipes | + | + | + | ||
Fetal growth restriction | + | + | + |
In second trimester scan the soft markers in Trisomy 21 are nasal hypoplasia, increased nuchal fold thickness, intracardiac echogenic foci, echogenic bowel, hydronephrosis, shortening of the femur and more so of the humerus. It may also be associate with cardiac defects, duodenal atresia, sandal gap and clinodactyly or mid-phalanx hypoplasia of the fifth finger. Trisomy 21 is found in about 40% of cases of duodenal atresia.
T21 Fetus of 12 weeks 3 days showing normal NT with AFNB and Tricuspid regurgitation.
T21 fetus of 13 weeks 5 days showing increased NT with Omphalocele.
T21 fetus showing Increased NT with dilated posterior fossa and reverse flow in ductus venosus.
T21 with Atrioventricular septal defect with duodenal atresia(double bubble sign) and cleft lip with palate.
T21 with Absent nasal bone with EIC, ARSA and club foot.
Thickened NT is a common first trimester findings in Aneuploidy. In T18 and T13, NT median values were shown to be 5.5 and 4.0 mm, respectively [16, 27]. Reduced PAPP-A value in both trisomies noted with a median value of 0.2 MoM for T18 and 0.3 MoM for T13. Free β-HCG values are decreased whereas it is increased in T21. In T18 and T13 median values of free β-HCG 0.2 MoM and 0.5 MoM, respectively. T18 or T13 is often first suspected by the presence of typical ultrasound features, rather than by biochemical screening (Figures 19–25). single umbilical artery is found 80% fetuses with T18 and in about 3% of chromosomally normal fetuses [28]. There is 7fold increased risk of T18 associated with single umbilical artery noted. Presence of megacystis After taking into account maternal age and fetal NT the increases the likelihood for trisomy 13 or 18 by a factor of 6.7.
T18 12 weeks 1 day showing increased NT, absent nasal bone, cleft lip and palate and Congenital talipes equinovarus.
T18 fetus of 15 weeks gestational age with Holoprocencephaly and radial ray abnormality.
T18 fetus showing normal NT with dilated posterior fossa and single umbilical artery at 13 weeks 2 days followup 3D at 16 weeks 4 days with vermian rotation and incread Brainstem vermian angle.
Fetus of T18 showing Diaphragmatic hernia, choroid plexus cysts and bilateral rocker bottom foot at 21 weeks 5 days gestation.
15 weeks 5 days fetus of T13 showing holoprocencephaly, club hands and aborted fetus showing midline cleft with proboscis anophthalmia and bilateral club hands.
Megacystits with increased NT of 12 weeks 1 day T13 fetus.
15 weeks 3 days fetus showing micrognathia with polydactyly and syndactyly. In another fetus of 14 weeks 2 days 3D showing increased NT with posterior fossa dilatation and micrognathia in T13 cases.
Presence of exomphalos in association with T18 in first trimester is 60% compared about 30% at mid gestation and 15% in neonates. Trisomy 13 and Turner syndrome are associated with tachycardia, whereas in trisomy 18 and triploidy there is fetal bradycardia [29]. pulsatile flow in the umbilical vein is noted in 90% of fetuses in T18 and T13 where as 25% of chromosomally normal fetuses. The prevalence of chromosomal defects in Dandy walker -complex is about 40%, mainly in trisomies 18, 13 and triploidy.
20% 0f diaphragmatic hernia is associated with chromosomal defects mainly withTrisomy18. Heart abnormalities are found in more than 90% of fetuses with trisomy 18 or 13 and 40% of those with trisomy 21 or Turner syndrome. 30% and 15% cases of Exomphalos at mid gestation and in neonates are associated with Chromosomal defects, mainly trisomies 18 and 13. The prevalence of chromosomal defects is four-times higher when the exomphalos sac contains only bowel than in cases where the liver is included. Prenatally 20% of oesophageal atresia cases are associated with chromosomal defects, mainly trisomy 18. Polydactyly is associated with trisomy 13, overlapping fingers, Talipes and rocker bottom feet are associated with trisomy 18. Usually, Trisomy 18 and triploidy are associated with moderately severe growth restriction whereas trisomy 13, Turner syndrome with mild growth restriction and in trisomy 21 growth is essentially normal [30]. In second trimester scan Trisomy 18 is associated with strawberry-shaped head, choroid plexus cysts, absent corpus callosum, enlarged cisterna magna, facial cleft, micrognathia, nuchal edema, heart defects, esophageal atresia, diaphragmatic hernia and usually exomphalos with bowel only in the sac. The other associated findings are single umbilical artery, renal abnormalities, echogenic bowel, myelomeningocele, growth restriction and shortening of the limbs, radial aplasia, overlapping fingers and talipes or rocker bottom feet.
Trisomy 13 is associated with microcephaly, holoprosencephaly, facial abnormalities, cardiac abnormalities, exomphalos, enlarged and echogenic kidneys and post axial polydactyly.
NT has a median value of 7.8 mm [16] and has often been described as a cystic hygroma (Figure 26). The occurrence of monosomy X is not related to maternal age. Typically, lymphatic disturbances in turner syndrome are not limited to the neck region but involve the whole body including the presence of skin edema, hydrothorax and ascites. Generally Normal Nasal bone is present in fetuses with monosomy X [31]. Normal maternal serum-free β-HCG (1.1 MoM) and low PAPP-A is noted (0.49 MoM) [32]. Typical sonographic features in monosomy X includes large nuchal cystic hygromas, generalised edema, mild pleural effusions and ascites, cardiac abnormalities like left ventricular outflow tract obstruction, fetal tachycardia and renal anomalies such as the presence of horseshoe kidneys.
2 different cases of turners syndrome with generalised edema and cystic hygroma.
In triploidy, there is a complete additional haploid set of chromosomes resulting in 69 chromosomes in each cell instead of 46 chromosomes. The additional haploid set can be of paternal or maternal origin. The “paternal” type is called diandric triploidy and the “maternal” type is called digynic triploidy. These two types show different features, which can be often differentiated on ultrasound. The typical pattern of diandric triploidy includes the presence of a normally grown fetus with molar placenta, whereas in digynic triploidy, severe growth restriction is noted with a small but not molar placenta. Profile of biochemistry is different in both types due to these placental differences. Diandric triploidy is associated with increased maternal serum-free β-HCG and mildly decreased PAPP-A and in digynic triploidy which is associated with markedly decreased maternal serum free β-HCG and PAPP-A. Significantly short CRL with marked difference in size between the abdominal and head circumference, typically of more than 2 weeks of gestational age [33] which is a pathognomonic sign of digynic triploidy (Figure 27). In second trimester scan Triploidy where the extra set of chromosomes is paternally derived is associated with a molar placenta and the pregnancy rarely persists beyond 20 weeks. When there is a double maternal chromosome contribution, the pregnancy may persist into the third trimester (Figure 27). Commonly there is mild ventriculomegaly, micrognathia, cardiac abnormalities, myelomeningocele, syndactyly, and ‘hitch-hiker’ toe deformity (Figure 28).
Two fetuses of Digynic Triploidy showing short CRL with size difference in abdominal head circumference.
Live fetus at 22 weeks 4 days with Molar changes in placenta in a diandric triploidy.
The risk for trisomies in women who have had a previous fetus or child with a trisomy is higher than the one expected on the basis of their age alone.
when we have only CRL, NT, maternal age without biochemical markers there are calculators where we can enter these measurements, we get the risk assessment for downs at the time of birth- Pregnancy calculators- EDD. We can do same thing with only 2nd trimester markers without biochemical or first trimester screen results for this we will take the LR+ value of each marker present and LR- values of all absent markers and multiple all of these to get the LR for combination [8].
Instead if we find any soft markers we enter the same into the excel sheet provided by [8] M. Agathokleous et al. Excel sheet for downs.
Meta- analysis of second-trimester markers for trisomy21 [8] M. Agathokleous et al., ultrasound obstet Gynecol 2013;41:247–261.
For example:-.
when we get the measurements, we apply the same into the calculators and get the risk assessment for downs at the time of birth. It is given as in 1 in -------.
>1in 19(high risk): offer invasive testing.
>1in 50(high risk): offer NIPT/Invasive testing.
<1in 1000(Low risk): Back to routine second trimester genetic sonogram.
1in 50-1in 999(intermediate risk): Assess NB, DV, TR and recalculate risk+/-NIPT.
New cut-of risk for downs as 1:250, borderline between 251 and 1000, and less risk if <1:1001.
First trimester between 11 and 13 weeks 6 days scan evaluate NT, nasal bone along with Tricuspid valve regurgitation, a wave in Ductus Venosus and other major structural defects. Not only this detail cardiac evaluation should be done. If there is no abnormality repeat scan at 18–22 weeks may be recommended. In the second trimester scan look for soft markers, if there is any marker or abnormality detailed anatomy scan and echocardiography. In case of most isolated markers including intra cardiac echogenic focus, echogenic Bowel, mild hydronephrosis and short femur, there is only a small effect on modifying the pre-test odds.
All these are only screening protocols they are not diagnostic so, fetal karyotyping option is aways open to either risk groups.
Previous affected Pregnancy.
In women who had a previous pregnancy with trisomy 21, the risk of recurrence in the subsequent pregnancy is 0.75% higher than the maternal and gestational age-related risk for trisomy 21 at the time of testing. Recurrence is chromosome specific. If a previous pregnancy is T21 the result will be classified as screen positive regardless of level of screening markers. Risk is calculated which takes account of a women’s age at the time of her previous pregnancy with “Down syndrome” for the risk calculation.
“Down syndrome” may be non-disjunction type (95%) where there is a recurrence rate of 1% where as in translocation type like (21–21) if either parent is carrying same type of translocation then there is 100% rate of recurrence.
If there is h/o prior affected downs child screening test is not reassuring her so, better to go for direct invasive testing if she comes at first trimester go for CVS.
In Twin gestation.
Dichorionic twin- Free β-HCG and PAPP-A levels are nearly twice as high as singleton. Calculate the risk for each fetus based on maternal age and fetal NT. If one fetus the NT is increased look for other markers. Detection rate is 75–80%.
In monozygotic twins’ risk is same as singleton pregnancies.
In monochorionic twin pregnancies raised NT is an early manifestation of TTTS. So, false positive rate will be increased. Free beta HCG and PAPP-A levels are lower than dichorionic twin to twin transfusion syndrome as well as for chromosomal abnormality.
Calculate the risk of each fetus based on NT, serum biochemistry and then the average risk between the two fetuses is considered as whole.
No method is accurate for screening of fetal aneuploidy as it is in singleton pregnancy.
Appropriate Models for aneuploidy detection:
Age (not recommended).
CRL & NIPT (Ideal for first trimester, misses advantages of first trimester scan and expensive)
Age, CRL & NT (skill)
Age & Biochemistry (poor detection rate)
Age + CRL + Maternal factors +NT + PAPP-A + HCG (combined test)
Age + Maternal factors + CRL + NT + Additional markers + Biochemistry (enhanced sensitivity and low FPR but need time and skill)
First trimester combined test + second trimester Quad (sequential or integrated)
First trimester Quad: Age + historical factors + PAPP-A + βHCG + PIGF +AFP (risk for pre-eclampsia and NTD)
First trimester Penta: Combined test + Nasal bone + AFP + DIA + PIGF (high detection rate and low FPR).
In the economically privileged patient first trimester screening should include an 11–14 weeks complete assessment with first trimester combined screen, PIGF and NIPT. For population screening is by combined screening. Woman with positive screen test result should be counselled and offered the option of diagnostic testing. Those who have a negative test results should be counselled regarding their lower adjusted risk. Even if a woman has low risk results, she may choose diagnostic testing later in pregnancy whenever there is fetal anomalies or markers on follow-up sonography.
The authors wish to express thanks to all parentages involved for giving permission to collect the presented data. The authors also wish to express their thanks to Dr. Ashok Khurana, Dr. TLN Praveen and Dr. Krishna Gopal for the source of information.
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\\n\\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
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\\n\\nAll scientific works are Peer Reviewed prior to publishing. Read more
\\n\\nOA Publishing Fees
\\n\\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\\n\\nDigital Archiving Policy
\\n\\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\\n\\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\\n\\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\\n\\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\\n\\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\n\nDigital Archiving Policy
\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\n\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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Therefore, this chapter deals with the philosophical systems and paradigms of scientific research, the epistemology, evaluating understanding and application of various theories and practices used in the scientific research. The key components of the scientific research paradigm are highlighted. 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Studies in gamification area are examined based on certain different criteria in this study and content analysis method was used in order to identify trends in this area. Web of Science were scanned through using gamification as keyword without year restriction. A total number of 313 studies were regarded as appropriate for the aim of the study and examined. It is seen that research in this area have begun in 2011 and increased every year. It is also seen that motivational theories are mostly preferred in the studies conducted in gamification area. It was determined that goal-duty, reward and progression sticks are the mostly used components as game components. It is seen that gamification applications are frequently preferred in virtual environment, simulation and augmented reality learning environments after mobile environments and in parallel with these, they are also preferred in learning areas such as public, service, food and health. 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Often in the implementation practice of companies’ social responsibility, there can be attention focus on one or even several very significant activities, which indicated that the organization has not yet assimilated the valuable content of this idea and is developing its activity by ignoring a very important principle of inner maturity.",book:{id:"5791",slug:"management-culture-and-corporate-social-responsibility",title:"Management Culture and Corporate Social Responsibility",fullTitle:"Management Culture and Corporate Social Responsibility"},signatures:"Pranas Žukauskas, Jolita Vveinhardt and Regina Andriukaitienė",authors:[{id:"179629",title:"Prof.",name:"Jolita",middleName:null,surname:"Vveinhardt",slug:"jolita-vveinhardt",fullName:"Jolita Vveinhardt"}]}],mostDownloadedChaptersLast30Days:[{id:"58890",title:"Philosophy and Paradigm of Scientific Research",slug:"philosophy-and-paradigm-of-scientific-research",totalDownloads:13557,totalCrossrefCites:8,totalDimensionsCites:15,abstract:"Before carrying out the empirical analysis of the role of management culture in corporate social responsibility, identification of the philosophical approach and the paradigm on which the research carried out is based is necessary. 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There is a detailed description of how and what ethical principles were followed on the different stages of the research.",book:{id:"5791",slug:"management-culture-and-corporate-social-responsibility",title:"Management Culture and Corporate Social Responsibility",fullTitle:"Management Culture and Corporate Social Responsibility"},signatures:"Pranas Žukauskas, Jolita Vveinhardt and Regina Andriukaitienė",authors:[{id:"179629",title:"Prof.",name:"Jolita",middleName:null,surname:"Vveinhardt",slug:"jolita-vveinhardt",fullName:"Jolita Vveinhardt"}]},{id:"58883",title:"Corporate Social Responsibility as the Organization’s Commitment against Stakeholders",slug:"corporate-social-responsibility-as-the-organization-s-commitment-against-stakeholders",totalDownloads:3038,totalCrossrefCites:4,totalDimensionsCites:7,abstract:"Depending on society culture, traditions, and era, understanding of companies’ social responsibility might vary. In this part, we distinguish definitions of companies’ social responsibility and discuss the roles of stakeholders. Relations between the stakeholders are discussed in the context of social capital development. We emphasize that commitment against the interested subjects can be a long-term company policy, dictated by values of an organization, rather than the strategy in the activity market. Often in the implementation practice of companies’ social responsibility, there can be attention focus on one or even several very significant activities, which indicated that the organization has not yet assimilated the valuable content of this idea and is developing its activity by ignoring a very important principle of inner maturity.",book:{id:"5791",slug:"management-culture-and-corporate-social-responsibility",title:"Management Culture and Corporate Social Responsibility",fullTitle:"Management Culture and Corporate Social Responsibility"},signatures:"Pranas Žukauskas, Jolita Vveinhardt and Regina Andriukaitienė",authors:[{id:"179629",title:"Prof.",name:"Jolita",middleName:null,surname:"Vveinhardt",slug:"jolita-vveinhardt",fullName:"Jolita Vveinhardt"}]},{id:"59034",title:"Structure of Research Design: Expert Evaluation",slug:"structure-of-research-design-expert-evaluation",totalDownloads:1127,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter presents the research design/plan. Methodological choice of quantitative and qualitative research is substantiated, and principles of design and verification of the research instrument are described. Individual stages of the research are presented in detail by describing their consistency in respect of the main objective. Statistical calculations to substantiate the reliability of the research instrument are presented and key aspects of the organization of research are described.",book:{id:"5791",slug:"management-culture-and-corporate-social-responsibility",title:"Management Culture and Corporate Social Responsibility",fullTitle:"Management Culture and Corporate Social Responsibility"},signatures:"Pranas Žukauskas, Jolita Vveinhardt and Regina Andriukaitienė",authors:[{id:"179629",title:"Prof.",name:"Jolita",middleName:null,surname:"Vveinhardt",slug:"jolita-vveinhardt",fullName:"Jolita Vveinhardt"}]},{id:"59158",title:"Professional Social Responsibility in Engineering",slug:"professional-social-responsibility-in-engineering",totalDownloads:2825,totalCrossrefCites:5,totalDimensionsCites:6,abstract:"This chapter presents a range of viewpoints on the social responsibilities of the engineering profession. These social responsibilities of the engineering profession are in many ways synonymous with macroethics. Analysis of the engineering codes of ethics and educational requirements are used to support these arguments, and are compared with the perceptions of engineering students and working engineers. The social responsibilities of engineers include human safety and environmental protection in engineering designs. But it may extend further to include pro bono work and considerations of social justice issues. Research has found that perceptions of the professional social responsibilities of engineers vary across different countries/cultures, engineering disciplines (e.g., mechanical versus environmental engineers) and by gender. The impact of engineering education and broader college experiences on evolving notions of professional social responsibility will be described, in particular community engagement. Concerns about decreasing commitment to socially responsible engineering among college students, a so-called “culture of disengagement” will be presented, as well of the interaction of students’ social goals for engineering and leaving engineering studies.",book:{id:"6630",slug:"social-responsibility",title:"Social Responsibility",fullTitle:"Social Responsibility"},signatures:"Angela R. Bielefeldt",authors:[{id:"234418",title:"Prof.",name:"Angela",middleName:null,surname:"Bielefeldt",slug:"angela-bielefeldt",fullName:"Angela Bielefeldt"}]}],onlineFirstChaptersFilter:{topicId:"281",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81281",title:"Sexual Assault Crisis Center: The First Interdisciplinary Effort in Turkey",slug:"sexual-assault-crisis-center-the-first-interdisciplinary-effort-in-turkey",totalDownloads:17,totalDimensionsCites:0,doi:"10.5772/intechopen.104531",abstract:"Sexual violence and assault has a wide range of negative consequences that affect the victims for the rest of their lives. Proper medical as well as psychological care is essential for the survivors who have experienced a traumatic process. One-step institutions that deal with all related issues following the victimization are established in various countries. We took the responsibility to organize such a center for the first time in our country. The designed “Sexual Assault Crisis Center” is active in legal history taking, medical-forensic examination, professional evidence collection by trained personnel, and detailed evidence analysis (DNA, drugs of abuse, trace evidence, etc.). Thus, the victims do not have to go to various institutions one after the other to prove the case. Care providers, law officers, and the legal system are satisfied with the outcomes. An organized collaboration of different organizations is archived to the benefit of the sufferer. Furthermore, a training program for four different related parties, such as medical doctors, nurses, psychologists, and healthcare managers, has been developed in order to train other personnel for the sustainability of the project. The basic aim is to develop this first model as a prototype and contribute to its spreading throughout the country.",book:{id:"10207",title:"Sexual Abuse - An Interdisciplinary Approach",coverURL:"https://cdn.intechopen.com/books/images_new/10207.jpg"},signatures:"Taner Güven, Sotirios Kalfoglou and Ersi Kalfoğlu"},{id:"81201",title:"Cultural Competence as a Response to Structural Racism in Latino Substance Use and Access to Care in the United States",slug:"cultural-competence-as-a-response-to-structural-racism-in-latino-substance-use-and-access-to-care-in",totalDownloads:22,totalDimensionsCites:0,doi:"10.5772/intechopen.103710",abstract:"Disparities in substance use disorders (SUD) and access to treatment among individuals identified as Latino/Hispanic have become a significant public health issue in the United States. National efforts to identify, understand, and eliminate such disparities have highlighted the role of structural racism in Latino health. In this chapter, we offer a critical review of how Latino substance use and access to care may be impacted by discrimination, acculturation stress, and other mechanisms of structural racism. As structural racism is represented by policies, systems, structures, and norms that deny and/or minimize cultural strengths and disempower culturally diverse groups and their attempts to invest in their wellness, we highlight how cultural competence may reduce the risk of SUD and may enhance access to treatment among Latinos. We conclude by highlighting policies and responsive organizational practices that may improve Latino health.",book:{id:"10914",title:"Effective Elimination of Structural Racism",coverURL:"https://cdn.intechopen.com/books/images_new/10914.jpg"},signatures:"Erick Guerrero, Tenie Khachikian, Richard C. Cervantes, Charles Kaplan, Rene D. Olate and Jennifer B. Unger"},{id:"79081",title:"A Review on Corporate Social Responsibility (CSR) Constructs and Theoretical Debate in Pakistan",slug:"a-review-on-corporate-social-responsibility-csr-constructs-and-theoretical-debate-in-pakistan",totalDownloads:44,totalDimensionsCites:0,doi:"10.5772/intechopen.100195",abstract:"The purpose of this research paper is to review the complete CSR literature laying emphasis on CSR constructs and the theoretical perspectives in Pakistan. Collation of existing empirical and exploratory research has been used to make arguments about current status of academic CSR research. A total of sixty-five published articles on CSR from 2000 to 2021 have been reviewed. A thorough overview of CSR constructs highlighted that overall, the CSR constructs are not properly developed, and theoretical foundations are lacking. Corporate donations and philanthropy captured as CSR construct are still familiar among the researchers. It has been observed that the most recent literature is approaching towards maturity. The findings suggest that the lack of adequate explanation of theoretical foundations mislead the interpretation of results. There is partial support in the literature that CSR pays to the firms, as is depicted by the positive relationship between CSR and the facets investigated by the researchers but thorough emphasis is required on CSR measurement. The research can serve as basis for the beginning of an extensive exploration of CSR through the lens of theoretical perspectives and the strong theoretical foundations can result in a mature CSR construct and major contribution in the body of literature.",book:{id:"10755",title:"Corporate Governance - Recent Advances and Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/10755.jpg"},signatures:"Zaheer Alam and Kashif Rashid"},{id:"79486",title:"Corporate Governance and Reporting in Contexts of Social Justice and Equity, Deconstructing the Case of Historically Disadvantaged Universities in South Africa",slug:"corporate-governance-and-reporting-in-contexts-of-social-justice-and-equity-deconstructing-the-case-",totalDownloads:38,totalDimensionsCites:0,doi:"10.5772/intechopen.101188",abstract:"Historically disadvantaged universities in South Africa seem to grapple with corporate governance reporting issues, which continue to engender a state of perpetual crisis for them. In response, the National Department of Higher Education and Training has had to come up with interventions such as replacing university councils by administration regimes. The objective of this study was to examine and critique the underlying conditions that allow for the governance crisis to continue unabated while the government interventions seem to be in place. I adopted a mixed method approach to structure the study coherently and logically. Data sources were predominantly institutional reports about the selected cases, which remain as public records. By employing a critical realist lens and its positions about deep ontology, stratified reality, emergence and multi-causation, I could deconstruct the concept of corporate governance as generally written about in the mainstream literature. Results suggest that the source of the crisis derives from the complexity about corporate governance and reporting in relation to not only roles and responsibilities but also in terms of the ideas, beliefs, and values thereof, which therefore constitute the contradictions of position and practice. The discussion highlights the value of understanding transformative agency as the practical alternative to what should be advances in corporate governance and reporting.",book:{id:"10755",title:"Corporate Governance - Recent Advances and Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/10755.jpg"},signatures:"Valindawo Valile M. Dwayi"},{id:"80262",title:"Recent Advances in Corporate Governance: A Global View",slug:"recent-advances-in-corporate-governance-a-global-view",totalDownloads:99,totalDimensionsCites:0,doi:"10.5772/intechopen.100135",abstract:"Corporate governance is a system of legal approach by which corporates are directed and controlled. The basic focus is on structures of corporate entities, monitoring and directing them for mitigating risks that have been raised due to misdeeds of various factors. The corporate failures such as those of Enron, Xerox, WorldCom, Satyam, and the ones that followed suit, among other things, highlight shortcomings about internal controls, the institution of boards, functioning of board committees disclosures, transparency, reporting standards, and enhancing stakeholder’s confidence. Since 2001, emphasis has been laid down on the governance mechanism to be reinforced to retrieve accuracy and reliability. Over the years, several initiatives have been undertaken by the policymakers, governments, regulators, and the private sector to reform corporate governance. The global business model of geopolitical affairs, social and regulatory compliance, and cyber security are some of the key elements that have radically transformed corporate governance’s thrust in the present-day corporate context. This paper aims to study the advances in corporate governance practices in terms of its nuances related to board diversity and its evaluation; shareholder activism; environment, social and governance (ESG), and enterprise risk management (ERM).",book:{id:"10755",title:"Corporate Governance - Recent Advances and Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/10755.jpg"},signatures:"J. Kiranmai and R.K. Mishra"},{id:"78657",title:"Creative Living off the Margins of the Niger Delta: Implications for Corporate Governance",slug:"creative-living-off-the-margins-of-the-niger-delta-implications-for-corporate-governance",totalDownloads:53,totalDimensionsCites:0,doi:"10.5772/intechopen.100134",abstract:"The distribution and privatization channels of the wealth from Niger Delta’s oil and gas resources are multiple. The main channels excessively favor mainly office holders, international entrepreneurs and their contractors. The rest of the population, or the less favored majority will have to cut their share of the wealth via the alternative channels which may include violent insurgencies. This work focuses on one of these alternative channels, where an Igbo community creatively sustain their access to the oil wealth. An ethnographic study of Egbema, shows that the local population modify their traditional practices to sustain the flow of the oil wealth. This modifying capacity was manifest when they creatively transformed a fishing festival that was traditionally celebrated exclusively, into a public fish bazaar. This was done to keep hold of the money received as compensation for the land expropriated for oil extraction by Shell Petroleum Development Company (SPDC). This has implications for corporate governance, especially with regard to the relationship between companies and other stakeholders.",book:{id:"10755",title:"Corporate Governance - Recent Advances and Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/10755.jpg"},signatures:"Stanislaus E. 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