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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\n'}],latestNews:[{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"},{slug:"intechopen-identified-as-one-of-the-most-significant-contributor-to-oa-book-growth-in-doab-20210809",title:"IntechOpen Identified as One of the Most Significant Contributors to OA Book Growth in DOAB"}]},book:{item:{type:"book",id:"734",leadTitle:null,fullTitle:"Muscular Dystrophy",title:"Muscular Dystrophy",subtitle:null,reviewType:"peer-reviewed",abstract:"With more than 30 different types and subtypes known and many more yet to be classified and characterized, muscular dystrophy is a highly heterogeneous group of inherited neuromuscular disorders. This book provides a comprehensive overview of the various types of muscular dystrophies, genes associated with each subtype, disease diagnosis, management as well as available treatment options. Though each different type and subtype of muscular dystrophy is associated with a different causative gene, the majority of them have overlapping clinical presentations, making molecular diagnosis inevitable for both disease diagnosis as well as patient management. This book discusses the currently available diagnostic approaches that have revolutionized clinical research. Pathophysiology of the different muscular dystrophies, multifaceted functions of the involved genes as well as efforts towards diagnosis and effective patient management, are also discussed. Adding value to the book are the included reports on ongoing studies that show a promise for future therapeutic strategies.",isbn:null,printIsbn:"978-953-51-0603-6",pdfIsbn:"978-953-51-6994-9",doi:"10.5772/1242",price:159,priceEur:175,priceUsd:205,slug:"muscular-dystrophy",numberOfPages:556,isOpenForSubmission:!1,isInWos:1,isInBkci:!1,hash:"d6d8a96e17938c02e9611481a3b4bff8",bookSignature:"Madhuri Hegde\tand Arunkanth Ankala",publishedDate:"May 9th 2012",coverURL:"https://cdn.intechopen.com/books/images_new/734.jpg",numberOfDownloads:82621,numberOfWosCitations:39,numberOfCrossrefCitations:23,numberOfCrossrefCitationsByBook:3,numberOfDimensionsCitations:53,numberOfDimensionsCitationsByBook:3,hasAltmetrics:0,numberOfTotalCitations:115,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 8th 2011",dateEndSecondStepPublish:"April 5th 2011",dateEndThirdStepPublish:"August 10th 2011",dateEndFourthStepPublish:"September 9th 2011",dateEndFifthStepPublish:"January 7th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"87795",title:"Dr.",name:"Madhuri",middleName:null,surname:"Hegde",slug:"madhuri-hegde",fullName:"Madhuri Hegde",profilePictureURL:"https://mts.intechopen.com/storage/users/87795/images/2548_n.png",biography:"Dr. Hegde is an Associate Professor/ Scientific Director at Emory Genetics Laboratory in the Department of Human Genetics. She received a B.Sc. and a M.Sc. from the University of Bombay, India, and a Ph.D. from the University of Auckland, New Zealand. She performed post doctoral studies at Baylor College of Medicine and is board certified in Clinical Molecular Genetics. The primary focus of her clinical work is the development of high-throughput sequencing strategies for rare disorders using sequence capture technologies, robotics, next generation sequencing, oligonucleotide array platforms, robotics and predictive analysis tools. Her research is focused on functional analysis of sequence variants in disease associated genes specifically for muscular dystrophies, with an ultimate goal of creating an algorithm for clinical interpretation of novel sequence variants. She is also involved in identifying novel disease genes using next-generation tools and a laboratory developed bridged whole exome sequencing approach.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Emory University",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"89359",title:"Dr.",name:"Arunkanth",middleName:null,surname:"Ankala",slug:"arunkanth-ankala",fullName:"Arunkanth Ankala",profilePictureURL:"https://mts.intechopen.com/storage/users/89359/images/2547_n.jpg",biography:"Dr. Ankala is an Assistant Professor of Human Genetics at Emory University and a Director of Molecular Genetics at Emory Genetics Laboratory. After receiving a Masters degree in Biochemistry from Bharatidasan University, India, he pursued his PhD at Mississippi State University in Molecular Biology. Later, he moved on to perform post-doctoral studies at Emory University School of Medicine in the department of Human Genetics. The primary focus of his clinical research work has been the elucidation of mechanisms underpinning the high frequency of intragenic deletions and duplications in human DMD gene causing Duchenne Muscular Dystrophy. His broader research interest has been the discovery of new disease causing genes associated with different muscular dystrophies especially congenital muscular dystrophies and limb-girdle muscular dystrophies. 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",isbn:"978-1-80356-576-7",printIsbn:"978-1-80356-575-0",pdfIsbn:"978-1-80356-577-4",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"4c3e68adcaeaa44f9fbfe9bb19bdd55b",bookSignature:"Dr. Yuri Kim",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11504.jpg",keywords:"Separation Theorem, Extended Kalman Filter, Covariance Matrix, Riccati Equation, FBGM, Analytical Implementation Forms, Physical Implementation Forms, Steady State Filter, Inertial Navigation System, Global Positioning System, Controllability, Multisensory Navigation",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 15th 2022",dateEndSecondStepPublish:"April 12th 2022",dateEndThirdStepPublish:"June 11th 2022",dateEndFourthStepPublish:"August 30th 2022",dateEndFifthStepPublish:"October 29th 2022",remainingDaysToSecondStep:"a month",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Prof. Y.V. Kim is a Doctor of Technical Science, having a broad and wealthy international scientific, engineering, and teaching experience, obtained in the former USSR, Israel, and Canada. He has many scientific publications and implemented inventions dedicated to Aerospace GN&C.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"316140",title:"Dr.",name:"Yuri",middleName:null,surname:"Kim",slug:"yuri-kim",fullName:"Yuri Kim",profilePictureURL:"https://mts.intechopen.com/storage/users/316140/images/system/316140.jpg",biography:"Yuri Kim\n24 Buttenut, Gatineau, QC, Canada\nTel : 1-(514)- 466-1033, e-mail: yurikim@hotmail.ca\n\nHIGHLIGHTS OF QUALIFICATIONS:\n\nExperienced scientist, engineer and manager with internationally recognized achievements in area of Aerospace Avionics, (GN&C); Analysis, design (HW&SW), integration, testing and operation for various aerospace platforms and missions. \n\nGained a broad experience in preparation of technical documents for Joint (Industry-Customer) State Commissions for the acceptance (commissioning) of Aerospace Avionics, Navigation and Special application experimental equipment for further serial production, and operational support. Last works have been dedicated to R&D projects developing new Satellite Navigation Control Technology and customer support of Canadian satellites Control system design.\n\n\nACADEMIC DEGREES:\n\n 1991 *Doctor of Technical Science Diploma in Aerospace Vehicles Guidance \n Navigation and Control \n Scientific Council of State Institute of Automatic Systems, Ministry of Aviation\n Industry of USSR, Moscow\n (Recognized by Canadian Professional Counsel of Engineers) \n1982 * Senior Scientific Fellow Diploma in Gyroscopes and Navigation systems \n Capital Certification Commission of Scientists, Ministry of High Education of\n USSR, Moscow.\n (Recognized by Canadian Professional Counsel of Engineers)\n1974 * Candidate of Technical Science Diploma in Aerospace Navigation\n and Control Systems (Accredited as Ph.D by York University, Toronto.)\n Scientific Council of Moscow Aviation Institute, Moscow.\n1970 * Engineer Electromechanic Diploma in Gyro and Navigation systems,\n Faculty of Flight Apparatuses Control Systems, Moscow Aviation Institute, \n Moscow (Accredited as between Masters Degree and Bachelor Degree by\n York University, Toronto).\n1965 * Radio and TV Systems Technician Certificate, Dnepropetrovsk Technical School \n of preparation of technical specialists for Soviet Army, Military Aviation and \n Navy.\n\nMILITARY EDUCATION:\n\n1970 * Engineer in ballistic rocket control system, Military Faculty of MAI, last rank senior engineer-lieutenant (in reserve)\n\n\n\nEMPLOYMENT HISTORY:\nA. GOVERNMENT\n\nAt present - Canadian Space Agency, Space Science and Technology Division, David Florida Laboratory\n\n Senior Aerospace System engineer \n\n° Performing, developing and supporting phases of design, testing, commissioning and \n operation for space vehicle orbit and attitude control systems, in particular: Tecsas, Scope, \n J2Sat, Small satellite, M3Msat, Cassiopea, Neossat, RCM, PCW\n\n° Reviewing and commenting on Attitude Control systems design documentations, related to \n all phases of system development commissioning and operation\n \n° Supporting Aerospace Industry R&D projects funding by CSA (STDP) as Scientific\n Authority, in particular: Microwheel (Dynacon), LOCOOS (NGC), PCW (Bristol)\n\n° Providing expertise on new initiatives for Space Exploration and Utilization regarding \n Attitude and Orbital Control and possible development of Canadian space launcher\n\n° Developing basic mathematical (Simulink/Matlab) simulator for developing the \n requirements and expected performance of AODCS for new space vehicles\n\n° Developing new basic technology (based on Kalman Filter) for satellite attitude\n determination and sensor calibration, developing of FF test-bed equipment and GPS \n navigation in environment of CSA laboratory, developing of methods of ACS sensors\n calibration, measuring and compensation of satellite residual magnetic moment, experimental determination of satellite inertia matrix during ACS integration tests\n\n° Interacting with Space Industry and Universities in the problems, related to development of \n new methods and systems for space vehicle attitude and orbit determination and control\n \n° Sharing with International Aerospace community CSA achievements and experience in\n development of new technologies and methods for space vehicle attitude and orbit \n determination and control through publications, presentations and participation in scientific\n conferences, meetings and symposiums as well as maintaining an awareness about new \n technological advancements\n \n° Providing professional training for students and post. Graduates in the area of Orbital and\n Attitude Dynamic and Control\n\nB. INDUSTRIAL\n\nSept. 1998 – Feb. 1999 – Olympia Engineering Ltd. (Toronto)\n\nResearch and Development Engineer\n\n•\tDevelopment of measuring instrument for measuring remote measuring of micro- deformations of machinery (milling machine) equipment\n•\tResearch and testing of differential GPS survey equipment and antennas in environment of industrial facility for developing a new remote method for the measuring of machinery micro-deformations\n\n\n\n\nFeb.1999 – Jun.2002 – Saskatoon Engineering Division of Calian Company, \n Radarsat-1 Operation Team (CSA, Montreal)\n\nAttitude Control System Analyst\n\n•\tWorking as RADARSAT-1 Attitude Control System Analyst performing day-to-day operation TLM data analysis; reporting, monitoring and solving ACS flight anomaly problems, maintaining ACS software and performance \n•\tAuthor of many reports (see attached list of publications), devoted to solving of Radarsat-1 non-benign Safe Hold Mode problem, Momentum Wheel failure problems and improvement of the performance of attitude determination method with Magnetometer and Sun Sensor (back up, ADM3 mode for the case of potential failure of Horizon Scanner).\n•\tPreparation and implementation of the solution for RADARSAT-1 operation without failed Momentum Wheels, that saved the satellite mission after the wheel failures\n(This work was prolonged after in CSA and awarded by the Canadian Government Award for the invention used by the Government)\n•\tDesign and implementation of new dynamic simulators (based on Simulink\ntoolbox) for Radarsat-1 ACS for operation support\n•\tPreparation for operation of new Canadian satellites Scisat and RADARSAT-2 \n\n\n\nJan. 1994 – Sep. 1997 – Israel Aviation Industry (IAI factories: TASHAN, LAHAV)\n\nAvionics system engineer\n\n•\tResearch and preliminary design of the Special Data Fusion System for a fighter-interceptor\n•\tIntegration of Inertial Navigation System with Global Position System into Upgraded Avionics Suit and installation in aircraft cockpit for A/C – trainer T-38\n\nNov. 1977 – Apr. 1993 – Moscow Research and Design Institute of Electromechanic and Automatic (formerly P/B: M5537, presently “Aviapribor” Corporation)\n\n \nHead of Division (R&D in Pilot-Navigation Systems)\n\n•\tLeadership of the Division, performing planning, financial and methodological duties, related to this position, reporting to the R&D deputy director of the Institute\n•\tResponsibility for Pilot-Navigation System integration, interaction, tests and transferring for serial production and operational support\n•\tInitiation and methodical leadership of innovative research and development projects\n•\tReviewing, commenting and implementation of Technical standards and Navigation norms\nas well as sharing progressive methods and results within Aerospace organizations within former USSR\n \n Head of Department (INS and Flight Management System SW Development)\n\n•\tLeadership and performing of duties of Head of Department \n•\tResponsibility for the prospective research and preliminary design of the Inertial Navigation Systems (INS) and Flight Management Systems (FMS)\n•\tDesign of the INS and FMS algorithms and simulation of expected performance\n•\tDevelopment of INS/FMS flight code\n•\tDevelopment of test procedures and simulators for FMS, and pilot nav.complexis for aircrafts \n•\tResponsibility for system performance analysis in the ground and flight tests\n\n Head of Sector (System Flight Test data analysis) \n\n•\tLeadership of the Sector\n•\tDevelopment of ground and flight test simulation procedures and requirements for test equipment and simulators, for flight test aircraft measuring equipment, installation and recorded data processing\n•\tDesign of Estimation and Identification algorithms for ground and flight data processing\n•\tTest data analysis, preparation of test results analysis reports and conclusions\n\n Senior Scientific Fellow\n\n•\tResearch, development and principal design of the special Suboptimal Kalman Filter for the fusion of data of various navigation sensors for aviation and space platforms\n•\tDevelopment of new Guidance and Navigation methods for aviation and space platforms\n•\tAnalysis of INS and FMS performance in ground and flight tests\n\nC. ACADEMIC \n\n1977–1993 – Moscow Aviation Institute, Moscow Institute of Instrument -\n Making, Aviation Industry Ministry Upgrade Qualification Institute\n(Part Time) Professor, Associate professor, Chairmen of State Diploma Commission,\n Member of Scientific Council\n•\tLecturer of the disciplines: Applied Oscillation, Theory (MIIM), Design of Instruments (MIIM), Integrated Navigation Systems (MUQI)\n•\tChairman of the State Diploma Commission -Gyro Instruments and Systems (MAI)\n•\tLeadership of postgraduates, participation in sessions of Scientific Council (MAI)\n•\tMethodical management of cathedra of Orientation and Navigation in MAI \n\n2009 McGill University, Montreal\n\nPart time lecturer for course (in English): Aircraft Performance, Stability and Control\n\n1970–1977 – Moscow Aviation Institute \n(Full Time) Associate Professor, Senior Researcher, Assistant Lecturer \n•\tLecturer of the courses: Spacecraft orbital mechanics and attitude determination and control, Inertial Navigation Systems, Gyro Instruments and Systems\n•\tResearch and development of suboptimal robust estimation methods for navigation data processing\n•\tResponsibility for the navigation systems laboratory\n•\tDeputy head of cathedra of Orientation and Navigation\n\nFIELDS OF THEORETICAL AND METHODOLOGIC EXPERTISE:\n \n•\tSpace vehicle Orbit and Attitude determination and control\n•\tGyro instruments and systems\n•\tRadio navigation systems\n•\tInertial Navigation systems\n•\tAirplane Navigation and Control\n•\tAnalytical mechanics \n•\tApplied oscillation theory\n•\tAutomatic control theory\n•\tStochastic estimation theory\n\nENGINEERING EXPERIENCE:\n\n•\tFlight and laboratory tests of Aerospace Avionics Equipment\n•\tDistribution of mission requirements between Aerospace vehicle subsystems, definition of functions and ICD \n•\tSpacecraft operation and performance maintenance\n•\tAvionics system (hardware and software) development and testing (autonomously and integration)\n•\tInertial navigation systems\n•\t Development of Avionics for Soviet Military aircrafts: Tu-142, Tu-95MC, An-124, An-70, A-40, Soviet Space shuttle “Buran” (responsibility for preliminary design of radio-navigation automatic landing system), \n•\tIsrael (IAI) upgrade of Avionics system for T-38 (USA Air force trainer) \n•\tOperation and modification in space Canadian Satellite RADARSAT-1 Attitude Control system\n•\tParticipation in commissioning of ACS of Canadian Satellite Scisat\n•\tDevelopment of a generic mathematical simulator for satellite AODCS analysis and simulation of expected performance for a family of Canadian new generation small satellites\n\nSCIENTIFIC EXPERIENCE:\n\n•\tTheoretical and experimental investigation in the fields of S/C Orbital and Attitude Control\n•\tKalman Filter suboptimization and robust guarantee estimation theory development: authorship of new Suboptimal Kalman Filter modification, methods of INS correction and calibration, Geomagnetic Inertial Navigation System\n•\tResearch in areas of ACS and INS sensors development, their performance improvement\n•\tVarious Avionics Systems Mathematical models development and mathematical and semi-natural simulation\n•\tCoordination of research and development projects related to Aerospace equipment performed by Universities and Industries\n•\tScientific reports and articles reviewing and editorship \n•\tMembership in Scientific Counsels and Commissions\n•\tTutorship of under-graduate, graduated and post -graduate students \n\n•\tScientific reports and inventions in the field of GN&C for aircraft and spacecraft methods development \n•\tSeveral articles dedicated to the development of new methods in estimation theory: new suboptimal Kalman Filter with limited growth of the memory, observability and factor of state vector components estimation, guaranteed ellipsoidal estimation and stochastic estimation comparison \n\nLANGUAGES:\n \n•\tEnglish, Russian, Ukrainian, Hebrew, French (beginning level)\n•\tProgramming languages: Matlab/Simulinc/С",institutionString:"Canadian Space Agency",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Canadian Space Agency",institutionURL:null,country:{name:"Canada"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"15",title:"Mathematics",slug:"mathematics"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"453623",firstName:"Silvia",lastName:"Sabo",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/453623/images/20396_n.jpg",email:"silvia@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"314",title:"Regenerative Medicine and Tissue Engineering",subtitle:"Cells and Biomaterials",isOpenForSubmission:!1,hash:"bb67e80e480c86bb8315458012d65686",slug:"regenerative-medicine-and-tissue-engineering-cells-and-biomaterials",bookSignature:"Daniel Eberli",coverURL:"https://cdn.intechopen.com/books/images_new/314.jpg",editedByType:"Edited by",editors:[{id:"6495",title:"Dr.",name:"Daniel",surname:"Eberli",slug:"daniel-eberli",fullName:"Daniel Eberli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"872",title:"Organic Pollutants Ten Years After the Stockholm Convention",subtitle:"Environmental and Analytical Update",isOpenForSubmission:!1,hash:"f01dc7077e1d23f3d8f5454985cafa0a",slug:"organic-pollutants-ten-years-after-the-stockholm-convention-environmental-and-analytical-update",bookSignature:"Tomasz Puzyn and Aleksandra Mostrag-Szlichtyng",coverURL:"https://cdn.intechopen.com/books/images_new/872.jpg",editedByType:"Edited by",editors:[{id:"84887",title:"Dr.",name:"Tomasz",surname:"Puzyn",slug:"tomasz-puzyn",fullName:"Tomasz Puzyn"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"74955",title:"Central Composite Design for Response Surface Methodology and Its Application in Pharmacy",doi:"10.5772/intechopen.95835",slug:"central-composite-design-for-response-surface-methodology-and-its-application-in-pharmacy",body:'Any optimization process is achieving by going through certain phases, i.e., Screening; where identification of significant and important factor is important [1]; Improvement; where factors need to be identified which is near to optimum, Response surface design [2]; where optimum or best product has been designing by response surface method (RSM) by quantifying the relationship between one or more measured responses and vital input factor [3]. It is always been a tedious tasks to choice a suitable experimental design, which can easily explain many response variables. Such variables often end as quadratic surface model. For such kind of interpretation central composite design can be an excellent choice. In the process of Optimization and finding the best possible product from the ongoing batches, an experimental design called the central composite design (CCD) concept has emerged [4]. The CCDmodel is an integral part of response surface mythology. The biggest advantage of this type of optimization model is, it is more accurate, and no need for a three-level factorial experiment for building a second-order quadratic model [5]. After excising the CCDmodel within the experiment, a linear regression model has been used to construct the model, and coadded values have been used [6]. The CCDmodel is otherwise called A Box-Wilson Central Composite Design. In this design, the center points are eventually augmented with the group of “star points” that allows estimation of curvature [7]. If the distance from the center of the design space to a factorial point is ±1 unit for each factor, the distance from the center of the design space to a star point is ± α with ׀α׀ > 1 [8]. The precise value of α depends on certain specific properties required for the design. Since there are many factors available in the CCD model, therefore, the possibility of more than two or many star points within the model is more palpable. The star points represent lower and higher extreme values. The CCD model allows to extends 2 level factors, which have been widely used in response surface modeling and Optimization. As far as pharmaceutical research is a concerned, much scientific research has been carried out in recent times in this direction. As per Krishna Veni
However, in this book chapter, an attempt was made to highlight the basics of the CCD model and to corelate the concepts of CCD with suitable case studies, which could increase the readers’ inquisitiveness.
After necessary Screening, the various factors and subsequent interactions of the experiment were identified [11].
The priority was given to the established various level of characteristics
Upon Optimization, the best suitable model has been selected [12].
The appropriate model, which is ideal for experimental design, can also be chosen [13].
To performed experimental studies, it is necessary to incept tangible factors and values which are needed to analyze systematically [14]
The selected model can be validated
There is a provision where if the data are not satisfactory, then another model of the experimental equation and experimental design is preferred. While pursuing the study, the aforementioned point c,d, and f need to be repeated until a suitable model is obtained, which is an acceptable representation of the data [15].
If required, a graphical representation of the surface is generated.
The first-order model for the Optimization can be depicted as:
For quadratic or second-order model, if nonlinearity was reported, then the following equation was incorporated:
The factor must be very at level three while activating to fit the second-order model [16]. It was observed that, during the dictation of center point and two-level design, the quadratic terms can be identified, but it cannot be adequately estimated [17]. In Figure 1, the condition at which the Optimization can occur was explained, i.e., Optimization can be confirmed when second order model can be optioned from statistical outcomes and which coincide with the optimum value. During the factorial design experiment, it is preferable to avoid three-level designs as chances of an increase in the number of runs would be more [16].
Optimization condition.
For CCDDesign and Box–Behnken Design, second-order models are widely used. The analyzing aspect of these two designs can be explained by the following equation:
The above equation represents the quadratic model, which is near to the Optimization.
In this equation, Y = Dependent variables or Outcome variables or estimated responses, X1 = independent variables, b0 = overall mean response or intercept constant, b1 = regression model coefficients, K = number of independent variables, ϵ = error.
Put into words, a mathematical model to the observed values of the dependent variables y, that indicates:
Main effects for factor X1……. Xk
Their interactions (X1X2, X1X3…., Xk − 1, Xk)
Their quadratic components (X12,……Xk2). No assumptions are made concerning the levels of the factors, and you can analyze any set of continuous values for the factors.
Based on the outcomes and empirical models from various experimental design, the central composite design gives us a direction to logically think and exercised multivariable analysis [18]. Three design points are prerequisite to establishing a second-order polynomial equation in CCDmodel [19]. When two levels of fractional factorial design need to be established, then 2k should have possible +1 and − 1 levels of factors. In similar patterns, 2 k needs to be calculated, which can be otherwise called star points, and α forms the center to generate quadratic terms. The center point of the CCD., the model, provides an excellent independent estimation of experimental error.
Where N is the actual number of experiments, n is a number of repetition and k is the number of different factors which were incorporated within the study. Eventually, the CCD model can be best explained by the design of an expert (Version 11.0) software. The various steps involved in central composite design (CCD) was discussed in Figure 2.
Central composite design flow diagram.
To determine the local axial point, it is necessary to identify the alpha value in the CCD model. Depending on the alpha vale design can face cantered, rotatable, orthogonal. The alpha value can be calculated using the following equation:
If α value comes equals 1, the position of axial points stands within the factorial region. This is otherwise called a face-centered design, with three levels of factors that need to be kept in the design matrix. To calculate and analyze experimental results from response surface methodology, a polynomial equation needs to be implemented to study the correlation between dependent and independent variables.
The Box and Wilson design or CCD model comprising of factorial1, factorial2, and factorial3 design [20]. The star point outside the domine and the center point, representing the experimental domine, helps determine the response surface plot [21]. By estimating the precision of surface responses, the value of α can be determined; where star design is ± α. There are three types of CCD; the α can be determined according to the calculation possibilities and the required precision, which can be obtained from surface responses. The α value’s positioning determines the quality of the design or estimation. The rate by design is identified by determining the position of the points [22]. The precision of the estimation influence by the number of trials at the center of the domine. The quality by design approach is necessary to estimate the coefficients’ variability and responses [23]. One key aspect is rotatability or iso-variance per-rotation, which means that the prediction error is identical from all the points to the center points from the same distance [24]. Eventually, the center composite design was classified into three types:
In central composite design, the levels of the factors eventually stand on the edge.
The CCD model (Figure 3) is always magnate with corner points, which was represented in red dots. From the center point (blue), the extract points are constrained from the sides (green dots). In this CCD model, each factor would have 5 levels. The star points are establishing new extremes for the low and high settings for all factors. These designs having circular, spherical or hyperspherical symmetry and required 5 levels for each factor. Supplementing an already existing factor or factorial design with a start point can produce the design. The Circumscribed (CCC) was found to be a rotatable design [25].
CCDmodel.
When the limit is specified for factor settings, the CCI design utilized the factor setting as star points and created a factorial design within those limits [26, 27]. In other words, CCI design is a modified version of CCC design, where CCC design has been divided by α to generate the CCI model. Eventually, CCC and CCI were found to be a rotational model (Figure 4).
Comparison of the three types of central composite designs.
In this design, for each face of the factorial space, star points are the center point. Therefore. α = ±1. This variable requires 3 levels of each factor [28]. The face cantered designs (CCF) are a non-rotatable design (Figure 4).
In Figure 4, with two factors, three types of center composite design are used. From this design, one thing is clearly evidenced that; CCI explores the smallest process space, and CCC enjoys the largest process space. The CCC models looking like a sphere rotates around the factorial cube.
Alpha (α) value can be defined as the calculated distance of each individual axial point (star point) from the center in the center composite design [29]. If Alpha (α) is less than 1, which indicates the axial point must be a cube, and if it is greater than 1, it indicates it is outside the cube. In central composite design, each factor has five levels, i.e., Extreme high or otherwise called a star point, higher point, center point, low point, and finally, extreme low star point. Figures 5 and 6 describe how to select the total number of experimental runs for the CCD model as well as how to design two factors factorial design (Table 1
(A) Parts of CCD (B) Total number of experimental runs required in the CCDmodel; where K = number of variables and r = fraction of full factorial. Thus, two-factor central composite design, the number of experimental runs is; 22 + 2(2) +1 = 9.
Schematic presentation of two-factor central composite design.
Number of factors | α value related to ±1 |
---|---|
2 | ±1.414 |
3 | ±1.682 |
4 | ±2 |
5 | ±2.378 |
6 | ±2.828 |
Number of factors and α value.
α = (Number of factorial runs)1/4.
= (2k or 2k−r) ¼.
If K (number of factors) =2.
Alpha (α) = (22)1/4 = 22/4 = 21/2 = 1.414.
Uncoded value of – α = (Coded value × L) + C.
= (−1.414 × 30) + 60 = 17.58.
Uncoded vale of + α = (Coded value× L) + C = (1.414 × 30) + 60 = 102.42 (Table 2
Level of factor | The temperature in ° C | Pressure in bar |
---|---|---|
-α (Lowest) | 17.58 | 2.93 |
−1 (Lower) | 30 | 5 |
0 (Centre point) | 60 | 10 |
+1 (High) | 90 | 15 |
+α (Highest) | 102.42 | 17.07 |
α value of one experiment.
It turns out to be the extension of 2 level factorial or fractional factorial design [21]
To estimate nonlinearity of responses in the given data set
Helps to estimate curvature in obtained continuous responses
Maximum information in a minimum experimental trial
Reduction in the number of trials required to estimate the squared terms in the second-order model
They have been widely used in response to surface modeling and Optimization (Tables 3 and 4)
No. | Factor A | Factor B | |
---|---|---|---|
1. | −1 | -1 | |
2. | 1 | -1 | |
3. | -1 | 1 | |
4 | 1 | 1 | |
5. | −1.44 | 0 | |
6. | 1.414 | 0 | |
7. | 0 | −1.414 | |
8. | 0 | 1.414 | |
9. | 0 | 0 |
Design matrix for 2 factors central composite design [30].
No. | Factor A | Factor B | Factor C | |
---|---|---|---|---|
−1 | −1 | −1 | ||
1 | −1 | −1 | ||
−1 | 1 | −1 | ||
1 | 1 | −1 | ||
−1 | −1 | 1 | ||
1 | −1 | 1 | ||
−1 | 1 | 1 | ||
1 | 1 | 1 | ||
−1.682 | 0 | 0 | ||
1.682 | 0 | 0 | ||
0 | −1.682 | 0 | ||
0 | 1.682 | 0 | ||
0 | 0 | −1.682 | ||
0 | 0 | 1.682 | ||
0 | 0 | 0 |
Design matrix for three factors central composite design [31].
It was observed that the star points are outside the hypercube, so the number of levels that have to be adjusted for every factor is five instead of three, and sometimes it is not easy to achieve the adjusted values of factors [32].
Depending upon the Design, the squared terms in the model will not be orthogonal to each other.
Inability to estimate individual interaction terms, i.e., linear by quadratic or quadratic by quadratic.
Same examples of CCDoptimization in recent experimental conditions are mentioned in Table 5.
Title of the research | Author and Year | Model utilized | Variables taken | Findings | References |
---|---|---|---|---|---|
Development and optimization of baicalin-loaded solid lipid nanoparticles prepared by coacervation method using central composite design | Jifu Hao .et.a.l (2012) | central composite design | A two-factor five-level central composite design (CCD) was introduced. | The composition of optimal formulation was determined as 0.69% (w/v) lipid and 26.64% (w/w) drug/lipid ratio. The results showed that the optimal formulation of baicalin-loaded SLN had entrapment efficiency (EE) of 88.29%, particle size of 347.3 nm and polydispersity index (PDI) of 0.169. | |
Formulation, Development and Optimization of Propranolol Mucoadhesive Bilayer Tablets by Using Central Composite Design and its In Vitro Studies | Asif MASSUD | Angle of repose, compressibility index, bulk and tapped densities, Hausner’s ratio for powders and granules were performed. | Mucoadhesive tablets with adequate mucoadhesion by adopting a new oral drug delivery concept Power was successfully developed to prevent liver degradation and propranololol enhancement Bioavailability Availability | [34] | |
Statistical Analysis of the Tensile Strength of Coal Fly Ash Concrete with Fibers Using Central Composite Design | Barbuta Marinela, et al. (2015) | CCD, Response Surface Method (RSM.) | Length, percentage, The total number of tests were statistically established taking into account the number of independent variables, the type of analyze that was done and the type of experimental plan that was chosen | DOE is a structured, organized method that is used to determine the relationship between the different factors affecting a process and the output of that process. Analysis of variance (ANOVA) is a common method used to compare the relative strength of two related models | [35] |
Response surface modeling of lead (׀׀) removal by graphene oxide-Fe3O4 nanocomposite using a central composite design | Khazaei Mohammad et al. (2016) | CCD, RSM (Response Surface Methodology) | 4 independent variables: initial pH of Solution, nanocomposite dosage, contact time, initial lead ion concentration | Quadratic and reduced models were examined to correlate the variables with the removal efficiency of Magnetic Graphene Oxide. According to ANOVA, influential factors were pH and contact time. | [36] |
Optimization of ferulic acid production from banana stem waste using central composite design | Sharif Nurul Shareena Aqmar Mohd (2017) | CCD, RSM (Response Surface Methodology) | Ratio of water to Banana stem waste (BSW), incubation time (hrs) | The RSM-CCD method optimize the hydrolysis conditions for maximum ferulic acid production. Hence, B.S.W. is proven useful and highly feasible for producing good quality natural products. | [37] |
Central Composite Design Optimization of Zinc Removal from Contaminated Soil, Using Citric Acid as Biodegradable Chelant | Asadzadeh Farrokh et al. (2018) | CCD, RSM. | Citric acid concentration, pH, washing time | RSM based CCD is a promising tool for modeling and optimizing Zn removal from the contaminated soil using citric acid. It was found that pH and citric acid conc. Are the significant parameters in Zn removal process. | [38] |
Removal of reactive red-198 dye using chitosan as an adsorbent: Optimization by Central composite design coupled with response surface methodology | Haffad Hassan et al. (2019) | C.C.D., Langmuir isotherm model, pseudo-second-order equation | pH,Concentration, temperature | Chitosan material based shrimp cells have countless opportunities in use of waste water treatment. The major effect is played by pH | [39] |
Mixture optimization of high-strength blended concrete using central composite design | Hassan Wan Nur Firdaus Wan et al. (2020) | CCD, RSM. | Micro and Nano Palm Oil Fuel Ash (POFA.) | Mixture optimization of high-strength blended concrete using central composite Design, Run 1, containing 10% micro POFA and 2% nano POFA, showed the highest flexural strength | [40] |
Examples of CC demployed for the optimization.
As per S. Bhattacharya., (2020) studies [41] varius independent variables viz., entrapment efficacy percentage, zeta potential, particle size, percentage of calmative drug release of a polymeric nanoparticle formulation was evaluated and optimized using central composite design (CCD); which was interpreted by Design Expert (Stat-Ease; version 11.0) software. Upon considering the alpha point at 1.68179, in this 21 baches experimental design, 4 factors, and 2 levels were considered (Table 6). Based on the optimization surface plot batch with desired particle size, zeta potential, cumulative drug release (%) entrapment efficacy (%) were selected for further characterization studies. Table 7 indicating critical quality attributes and necessary process attributes that affect the outcomes of the nanoparticles. By using polynomial equations and a 3-dimensional surface plot, the effects of critical process parameters on essential attributes of quality were examined Figure 7.
S. No | Factors | Low Value | High Value |
---|---|---|---|
1 | Homogenization speed (rpm) | 10000 | 15000 |
2 | 10 | 15 | |
3 | Surfactant Concentration (%) | 1 | 1.25 |
4 | Polymer concentration (mg/mL) | 3 | 6 |
Critical process parameters that influence various critical quality attributes.
S. No | Critical Quality Attributes | Desired constrained |
---|---|---|
1 | Particle Size (nm) | Finest |
2 | Zeta Potential (mV) | Finest |
3 | Cumulative drug release (%) | Moderately high |
4 | Entrapment efficacy (%) | Supreme |
Desired construction of critical quality attributes.
(A-D) represents the surface plot identifying the effects of critical process parameters on essential attributes of quality.
From this CCDmodel, the following polynomial equations can be derived:
By considering A as homogenization speed, B as homogenization time, C as surfacetant concentration (%) and D as polymeric concentration; respectively, the polynomial Eqs. 6, 7, 8, & 9 can be interpreted. From these polynomial equations, critical process parameters of qualifiable effects on essential attributes can be determined. It can easily predict from the polynomial Eq. 6, that particle size of the polymeric nanoparticles can be increased, when homogenization time & speed and surfactant concentration decrease. The elevated negative co-efficient in homogenization speed of polynomial Eq. 6, indicates it has a significant influence on particle size. Higher shearing stress during elevated homogenization time & speed could lead to mass transfer between the particles, ultimately resulting in nucleation and smaller particle size. From Eq. 7, it can be predict that homogenization time & surfactant concentration has antagonistic effects on zeta potential and homogenization speed has an agonistic effect on zeta potential. In a similar fashion equation 8, shows homogenization speed & surfactant concentration has an agonistic effect on cumulative drug release (%) at 80th hours. From Eq. 9 it was clear that entrapment efficacy (%) increases with increases of homogenization speed, homogenization time & surfactant concentration.
As per Jaleh Varshosaz
This book chapter’s main agenda was to enlighten the present approaches and recent optimization research activities based on the CCD model, as specially for pharmaceutical product development. The CCDmodel is useful for modeling and analyzing programs in which the response of interest influences several variables. The CCDmodel can be considered as a robust statistical tool for process optimization. The best part of CCDis, as compared to Plackett–Burman design, a limited number of experiments are required with less computational experience. The biggest challenge of the CCDmodel is finding the critical factor. Central composite designs are beneficial in sequential experiments because you can often build on previous factorial experiments by adding axial and center points.
The author is like to acknowledge the help and motivation of Dr. R.S. Gaud, Director, SVKM’s NMIMS. Deemed-to-be University, Shirpur Campus, for providing excellent research facilities and profound inspiration while drafting this book chapter. The author is also like to acknowledge his own original research publication entitled “Fabrication and characterization of chitosan-based polymeric nanoparticles of Imatinib for colorectal cancer targeting application”; for taking inputs from that article while drafting this book chapter.
The author declares that the author has no competing interests.
Since 1967, when Rene Favalaro performed the first CABG, using saphenous vein graft (SVG) on an arrested heart [1], at Cleveland clinic, till 1985, when Buffallo [2] and Bennetti [3], published their OPCAB report, on-pump CABG was considered the CCAB. In fact, their publication kindled the fire to develop OPCAB in many surgeons around the world.
Conventional CABG was the gold standard all over the world for the last five decades, probably even now in most of countries. As going on Cardiopulmonary bypass (CPB), stopping the heart and performing the anastomosis on a bloodless and motionless heart was quite a reproducible surgical technique by most of coronary surgeons around the world. This was performed by connecting the heart to the heart-lung machine, using a cross-clamp on the aorta, and giving Cardioplegia (CP), in the root of the aorta (antegrade CP), or into the coronary sinus (retrograde CP). Then the distal coronary anastomosis was performed in a bloodless and motionless heart. Here, only surgical anastomosis was to be mastered. This became very popular, and this became the CCAB. But with the advent of coronary angioplasty and stenting and the arrival of drug-eluting stents, the number of patients having complications on the HLM started to surface. Basically, the inherent effects of the pump, the inflammatory response, and the development of stroke in the diseased aorta, where cannulations had to be done, and where the cross-clamp had to be used, all became dreaded complications of CABG, and so the number of patients coming for CABG reduced. Cardiologists became the gatekeepers, and so it was time for a change to happen. Hence, with the idea of OPCAB mooted by the South American duo, we in the east started working on how to perform CABG without the use of HLM.
Then in the late 1990s in Utrecht, Netherland, OCTOPUS, the stabilizer was developed, which paved the way for OPCAB to become a reality [4].
Unlike in on-pump CABG, in OPCAB we had to modify our anesthetic technique, to maintain adequate hemodynamics all through surgery. We in fact stop beta blockers on the day of surgery. The main difference between on-pump and off-pump surgery is that in on-pump if the patient crashes during induction, we can go on CPB and revive the patient. We routinely use an internal jugular four-lumen cannula and a radial and femoral arterial line before starting surgery. The femoral arterial line is used to insert the IABP when needed. In OPCAB the anesthetist has to be very vigilant to make sure we do not drop the pressures below a mean of 75 mm of mercury (Hg), all through the procedure. The mean pressure has to be maintained by using small doses of vasopressors, as and when required. Especially when the heart is positioned. It’s with a combination of table movement and the use of these vasopressors judiciously, that the anesthetist maintains hemodynamics all through the procedure. The anesthesia is usually maintained by a combination of Fentanyl, Midazolam, Dexmedetomedine, and muscle relaxant cisatracurium. All coronary patients have an infusion of Lasix, during surgery. Routinely our patients are ventilated postoperatively overnight. Once stable, they are weaned and extubated in the morning.
In the nineties, surgeons including us were trying our hand at stabilizing the square centimeter of myocardium that needed to be grafted, using all sorts of instrumentation, which obviously was not reproducible. Then we used to use injection of Adenosine to stop the heartbeat during the crucial stich on the heel and the toes and restart the heart using pacing wires, etc. Again this technique did not work too.
Only after the Octopus stabilizers came, we could start performing OPCABs routinely. The intracoronary shunts were a very important invention that paved the way for routine use of OPCABs as a procedure of choice.
Initially, our thought was to reduce the heartbeats so that we would have less movement of the heart and we had more time to place our sutures properly. But then we noticed that after using too much of beta blockers, we needed inotropes to get the heart going in the post-operative period. This we had to tackle by stopping these beta blockers on the day of surgery. As we developed a technique of using Injection Atropine to increase the heart rate, then slowing it down, which improved our hemodynamics, and our stabilizers would do their job by mechanically stopping the movement. This technique was useful for all our anterior wall grafting.
Then came the issue of grafting the lateral and posterior wall vessels. So, for the lateral wall vessels, we routinely open the right pleura and then cut the pericardium down to the Inferior vena cava (IVC). This allows the right heart to fall into the right chest, while the heart is lifted and verticalized to visualize the lateral wall vessels. Earlier we used the Positioners to lift the apex and tilt the heart, but off late, with experience, we use a deep pericardial stitch [5] to lift the heart up to get easy access to the lateral wall. By doing so the hemodynamics are maintained. Then the stabilizer is placed at the respective positions and the grafting progressed.
Positioning is important for grafting all these vessels. For the posterior wall, the table is lifted up, and then the head end is dropped as in Trendelenburg position.
If the heart flops too much to the right pleura, then a pericardial stay is used on the detached right pleura to keep the heart vertical. Wet sponges are used to position the heart in the lateral side. Now with the heart positioned, the stabilizer is used to stabilize either the PDA or the PLV as planned. And the grafting progressed as usual.
If the right coronary artery (RCA) is to be grafted, we use a stabilizer with suction pods so that that area to be grafted on the RCA is stabilized and lifted up a bit. So, to say, that, we don’t use suction on the pods either for the LAD or the circumflex coronary artery grafts. usually.
For grafting the RCA, we usually use 2 snares of 5.0 prolene suture, one proximal and one distal to the proposed site of the coronary incision. Once the snares are placed, the coronary opening is made and the shunt inserted, then the snares are released, and the grafting is performed as usual. For RCA grafts, the pacing wires are kept ready in case the heart slow.
Usually, the top-end of the vein grafts are performed using a side clamp on the aorta. But in the case of patients with disease aorta, applying a side clamp will lead to dispersing the plaques into the cerebral vessels and causing the stroke. Hence, in patients with the diseased aorta, we had invented our own top-end anastomosing device, the Vettaths anastomotic obturator (VAO) [6]. This has been patented and has been extensively used by us to perform the top end of more than five hundred patients. This has been published in different journals [7]. This is quite useful and does not increase the cost of surgery.
Coming to the top-end anastomosis technique, when we have a patient with chronic renal failure, either on dialysis or with just elevated renal function, OPCAB is more excellent than going on the pump. In such patients, we try and avoid hypotension as much as possible. In case we need to avoid the hypotension completely, then we use the VAO, where we can still maintain the systolic pressure above 100 mm of Hg. But if the creatinine is below 2 mg/dl, and the ascending aorta is not diseased, then when we use a side clamp, we maintain the systolic pressure between 85 and 90 and perform only one top end of the vein graft, and the other is hooked on to this vein graft as a piggyback. This is such that the mean pressure is attained between, 75 and 80 mm of Hg all the time.
Vettath’s technique of mammary patch for diffusely disease LAD without endarterectomy [8]
This is yet another of our innovative technique, in patients who present with diffuse CAD in young age and are deemed inoperable in most centers and are ischemic. We have also published this technique in many journals and are readily available online [8]. The videos are also available in YouTube. The good thing about these techniques are that these patients are able to live a comfortable life without any symptoms. This is a common disease seen in the youth in this part of the world, where stenting is not possible.
Intra-aortic balloon pump is the most accessible left ventricular assist device that has been in use since its development by Christenson [9, 10]. He had proposed to use the IABP postoperatively initially and later proposed to use it even preoperatively, to stabilize the heart and give a rest to the myocardium, by increasing the coronary flow.
In 2016 [11] we published an article explaining our modification of the role of IABP in OPCAB, which we are still practicing, till date. We have not used IABP, since the day before surgery so far. When the patient is very ischemic with severe ST changes and with hemodynamic instability and complaining of chest pain before induction, we have inserted the IABP, through the Femoral arterial line, which we use to monitor the arterial pressure routinely. This is inflated and this augments the coronary perfusion, thereby preventing ischemia. We give 5000IU of injection heparin to insert this under local anesthesia. Though this is a rare occurrence, we have had to do this in spite of our excellent anesthesia techniques, which we have also standardized over the last two decades.
Most of the time we just insert the femoral arterial line after induction, even in patients with tight left main stenosis, if the patient is hemodynamically stable during induction and is able to maintain a mean blood pressure above 75 mm of mercury(Hg). Hence the use of IABP comes mostly while grafting the lateral wall vessels, that too only in big ischemic obtuse marginal with tight stenosis, proximally and having a dynamic mitral regurgitation noticed in echo preoperatively.
Our grafting techniques are pretty standard, as we first take down the LIMA, skeletonized (https://www.youtube.com/watch?v=m7mYWLQsDAE). Then Heparin is given and flow assessed. The radial artery is used for circumflex vessels sometimes. The long saphenous vein is taken as a skip technique, taking care not to cause intimal injury.
Once the LIMA is anastomosed to the LAD, most of the time patient becomes stable. We are then able to lift the heart and position it to expose the lateral wall, using the stitch in the deep pericardial well. If the pulmonary artery pressure goes up by looking at it or we feel that the heart has started distending and is slowing down, we immediately take the packs out and release the LIMA stitch and increase the heart rate after lifting the head end up, like an anti-Trendelenburg position. This is exactly what the patient would do in his bed when he develops chest pain. Hereby, the left ventricular end-diastolic pressure comes down and reduces the sub-endocardial ischemia. Now the heart looks better. If this is not working, we insert the IABP, without the sheath and inflate it and keep it going till the distal anastomosis of the circumflex vessels are done. We then go in and perform the top end anastomosis, either using a side clamp or the VAO, whichever is found necessary. While performing the top end anastomosis, the IABP is usually in a standby position. Usually, after the top end is performed and the side clamp removed the heart jumps back to normal hemodynamics, and we are able to perform the usual PDA anastomosis even without the IABP. Hence after all the grafting is done, we reverse the Heparin with protamine. After 5 minutes of Heparin reversal, we are usually able to remove the IABP, after inserting another femoral arterial line in the opposite side. This technique has been useful in the sense that we have avoided the conversion on to the HLM in most of the patients. So, to say, over the last 14 years, we had to go on to the heart-lung machine only once. That too, when the patient developed uncontrollable arrhythmia. This patient ended up having the IABP being taken to the cardiac surgical ICU with the patient. Other than this all the IABPs if used in the operation theatre are removed in the OT itself.
From | To | No. of OPCAB | Conversion | IABP | Mortality |
---|---|---|---|---|---|
Jul-02 | Dec-02 | 47 | 0 | 0 | 0 |
Jan-03 | Dec-03 | 177 | 12 | 0 | 0 |
Jan-04 | Dec-04 | 238 | 6 | 0 | 1 |
Jan-05 | Dec-05 | 299 | 0 | 0 | 3 |
Jan-06 | Dec-06 | 284 | 0 | 4 | 5 |
Jan-07 | Dec-07 | 260 | 1 | 8 | 0 |
Jan-08 | Dec-08 | 225 | 0 | 11 | 2 |
Jan-09 | Dec-09 | 280 | 0 | 8 | 0 |
Jan-10 | Dec-10 | 358 | 0 | 22 | 0 |
Jan-11 | Dec-11 | 413 | 0 | 24 | 0 |
Jan-12 | Dec-12 | 425 | 0 | 23 | 2 |
Jan-13 | Dec-13 | 429 | 0 | 18 | 2 |
Jan-14 | Dec-14 | 312 | 0 | 6 | 3 |
Jan-15 | Dec-15 | 317 | 0 | 6 | 2 |
Jan-16 | Dec-16 | 228 | 0 | 11 | 3 |
Jan-17 | Dec-17 | 109 | 0 | 0 | 0 |
Jan-18 | Dec-18 | 196 | 0 | 0 | 0 |
Jan-19 | Dec-19 | 212 | 1 | 7 | 3 |
Jan-20 | Dec-20 | 128 | 0 | 2 | 2 |
Jan-21 | Dec-21 | 159 | 0 | 1 | 3 |
7/4/2002 | 12/31/2021 | 5096 | 20 (0.39%) | 151 (2.96%) | 31 (0.60%) |
This is our modification of IABP, which we have been following. (Chart) [11].
Any cardiac surgeon who is interested in becoming an off-pump surgeon, has to first become good on-pump surgeon, and must have an excellent result on-pump, only then should he venture to perform OPCAB.
A perfect coronary anastomosis is the gold standard of CABG. How it\'s achieved is the prerogative of the surgeon. And depends upon his skill and mindset. Once he is able to dissect a perfect Internal mammary artery, first left and next the right, and to harvest the radial artery and the saphenous veins in that order, and then perform the anastomosis with them, on the pump, only then should he go off-pump.
It is important for the surgeon to visit a good OPCAB center and spend some time there to see how they do it and then try to transfer the technique to his practice.
We started this journey 20 years ago and it took us more than five hundred OPCABs to standardize our technique. When we started off, we were prepared for all eventualities, like going back on pump, whenever we felt it was not safe, or when hemodynamics became bad. Our technique has been elaborated in previous chapters we have published [12].
We had developed our own OPCAB stabilizer, the simple Indian-made stabilizer (SIMS), which has been sent for patenting in 2015. The video link of OPCAB using SIMS in youTube- https://www.youtube.com/playlist?list=PLmvb6npEfabinhlatq8IYLBz8WlHo8bu1
We have been routinely using it for all our surgeries over the last thousand five hundred cases. For the last hundred-odd cases. This stabilizer is shown in Figure 1 below.
Shows SIMS with the new Pods.
We started off with first retaining the aortic cannula alone, then when we became confident, that was out as well. And gradually went on and on, and after 20 years and 5000 odd cases, we have had to convert to the heart-lung machine in only one patient in the last 14 years. The reason was the patient developed uncontrolled arrhythmia and could not stabilize with IABP.
Minimally invasive and Robotic OPCABs would be the future of coronary revascularization. Though we have performed quite a few of them in this center itself, with multiple grafts, the risk and results are not that as we have in midline sternotomy. Hence, we have set it aside for single or maximum double grafts. We have also developed our own stabilizer for minimally invasive OPCAB too (Figure 2).
Shows the modified SIMS for MICS OPCAB.
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Samim Al Azad and Slimane Ed-dafali",coverURL:"https://cdn.intechopen.com/books/images_new/11392.jpg",editedByType:"Edited by",publishedDate:"May 11th 2022",editors:[{id:"418514",title:"Dr.",name:"Muhammad",middleName:null,surname:"Mohiuddin",slug:"muhammad-mohiuddin",fullName:"Muhammad Mohiuddin"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10400",title:"The Application of Ant Colony Optimization",subtitle:null,isOpenForSubmission:!1,hash:"f4fdfd07ee1ab99fb7c740d6d0c144c6",slug:"the-application-of-ant-colony-optimization",bookSignature:"Ali Soofastaei",coverURL:"https://cdn.intechopen.com/books/images_new/10400.jpg",editedByType:"Edited by",publishedDate:"May 11th 2022",editors:[{id:"257455",title:"Dr.",name:"Ali",middleName:null,surname:"Soofastaei",slug:"ali-soofastaei",fullName:"Ali Soofastaei"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10915",title:"Leadership",subtitle:"New Insights",isOpenForSubmission:!1,hash:"0d72e79892f2a020cee66a52d09de5a4",slug:"leadership-new-insights",bookSignature:"Mário Franco",coverURL:"https://cdn.intechopen.com/books/images_new/10915.jpg",editedByType:"Edited by",publishedDate:"May 11th 2022",editors:[{id:"105529",title:"Dr.",name:"Mário",middleName:null,surname:"Franco",slug:"mario-franco",fullName:"Mário Franco"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10683",title:"Technological Innovations and Advances in Hydropower Engineering",subtitle:null,isOpenForSubmission:!1,hash:"7ce7ad8768bd2cad155470fe1fd883f4",slug:"technological-innovations-and-advances-in-hydropower-engineering",bookSignature:"Yizi Shang, Ling Shang and Xiaofei Li",coverURL:"https://cdn.intechopen.com/books/images_new/10683.jpg",editedByType:"Edited by",publishedDate:"May 11th 2022",editors:[{id:"349630",title:"Dr.",name:"Yizi",middleName:null,surname:"Shang",slug:"yizi-shang",fullName:"Yizi Shang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7102",title:"Pneumonia",subtitle:null,isOpenForSubmission:!1,hash:"9fd70142814192dcec58a176749f1b60",slug:"pneumonia",bookSignature:"Nima Rezaei",coverURL:"https://cdn.intechopen.com/books/images_new/7102.jpg",editedByType:"Edited by",publishedDate:"May 11th 2022",editors:[{id:"116250",title:"Dr.",name:"Nima",middleName:null,surname:"Rezaei",slug:"nima-rezaei",fullName:"Nima Rezaei"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9670",title:"Current Trends in Wheat Research",subtitle:null,isOpenForSubmission:!1,hash:"89d795987f1747a76eee532700d2093d",slug:"current-trends-in-wheat-research",bookSignature:"Mahmood-ur-Rahman Ansari",coverURL:"https://cdn.intechopen.com/books/images_new/9670.jpg",editedByType:"Edited by",publishedDate:"May 11th 2022",editors:[{id:"185476",title:"Dr.",name:"Mahmood-ur-Rahman",middleName:null,surname:"Ansari",slug:"mahmood-ur-rahman-ansari",fullName:"Mahmood-ur-Rahman Ansari"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"238",title:"Psycholinguistics",slug:"psycholinguistics",parent:{id:"21",title:"Psychology",slug:"psychology"},numberOfBooks:2,numberOfSeries:0,numberOfAuthorsAndEditors:55,numberOfWosCitations:15,numberOfCrossrefCitations:29,numberOfDimensionsCitations:86,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicId:"238",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"7311",title:"Cognitive and Intermedial Semiotics",subtitle:null,isOpenForSubmission:!1,hash:"2b7d636f6a78bfa31a39bab658a4b18c",slug:"cognitive-and-intermedial-semiotics",bookSignature:"Marta Silvera-Roig and Asunción López-Varela Azcárate",coverURL:"https://cdn.intechopen.com/books/images_new/7311.jpg",editedByType:"Edited by",editors:[{id:"302728",title:"Dr.",name:"Marta",middleName:null,surname:"Silvera-Roig",slug:"marta-silvera-roig",fullName:"Marta Silvera-Roig"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5957",title:"Advances in Speech-language Pathology",subtitle:null,isOpenForSubmission:!1,hash:"0aa9183a00d31fd1970187a4452a62d8",slug:"advances-in-speech-language-pathology",bookSignature:"Fernanda Dreux M. Fernandes",coverURL:"https://cdn.intechopen.com/books/images_new/5957.jpg",editedByType:"Edited by",editors:[{id:"28286",title:"Dr.",name:"Fernanda Dreux Miranda",middleName:null,surname:"Fernandes",slug:"fernanda-dreux-miranda-fernandes",fullName:"Fernanda Dreux Miranda Fernandes"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:2,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"56330",doi:"10.5772/intechopen.69932",title:"Russian Scientific Trends on Specific Language Impairment in Childhood",slug:"russian-scientific-trends-on-specific-language-impairment-in-childhood",totalDownloads:1924,totalCrossrefCites:0,totalDimensionsCites:23,abstract:"In Russia, there are many decades of experience in the scientific study of the problem of impaired language development in children. Today, the term “Systemic speech-and-language underdevelopment (SLU)” has firmly established in Russian science and practice, implying a complex developmental disorder of speech and language in children with a primary normal hearing and a conserved intellect, in which the main components of the language system are violated: vocabulary, grammar, phonetics, and, as a consequence, dialogic and monologic speech. Traditionally, a differentiated level-by-level analysis of the speech and language abilities of children is used. The variability of the manifestations and severity of speech-and-language disorders were initially systematized and characterized in four levels of underdevelopment: from the complete absence of phrase speech to the availability of simple and complex sentences with lexico-grammatical errors. Effective algorithms of speech therapist work with SLU are introduced. The effectiveness of the application of these models and algorithms on the material of various language groups is proved.",book:{id:"5957",slug:"advances-in-speech-language-pathology",title:"Advances in Speech-language Pathology",fullTitle:"Advances in Speech-language Pathology"},signatures:"Tatiana Tumanova and Tatiana Filicheva",authors:[{id:"204529",title:"Dr.",name:"Tatiana Volodarovna",middleName:null,surname:"Tumanova",slug:"tatiana-volodarovna-tumanova",fullName:"Tatiana Volodarovna Tumanova"},{id:"208704",title:"Dr.",name:"Tatiana Borisovna",middleName:null,surname:"Filicheva",slug:"tatiana-borisovna-filicheva",fullName:"Tatiana Borisovna Filicheva"}]},{id:"56560",doi:"10.5772/intechopen.70235",title:"The Role of Speech and Language Therapist in Autism Spectrum Disorders Intervention – An Inclusive Approach",slug:"the-role-of-speech-and-language-therapist-in-autism-spectrum-disorders-intervention-an-inclusive-app",totalDownloads:2271,totalCrossrefCites:2,totalDimensionsCites:16,abstract:"The chapter describes the possibilities of involving a speech-language therapist in the assessment of the pragmatic level of communication in autism spectrum disorders (ASD), where one of the most frequently impaired areas is communication pragmatics. These difficulties lead to a disruption of social interaction, which might be one of the obstacles to speech-language intervention in these children. The text is based on an originally developed testing material aimed at selected pragmatic-oriented communication situations relating to everyday activities and real life. Based on a comparison of domestic and international resources in this area, as well as mediated and own empirical experience, our assessment approach is based on the conclusion that pragmatics can be understood in different contexts and perspectives. The text presents the results of a partial survey comparing the performance of children with ASD and children with typical development. The assessment focused on the children’s election of the correct picture of a pair of pictures that represent usual communication and social situations. The results of the research suggest fewer incorrect responses in children with ASD and in different areas compared with children with typical development. However, the results of a qualitative analysis indicate a necessity to expand the assessment of communication pragmatics by adding an individually specific qualitative analysis of children’s performance.",book:{id:"5957",slug:"advances-in-speech-language-pathology",title:"Advances in Speech-language Pathology",fullTitle:"Advances in Speech-language Pathology"},signatures:"Kateřina Vitásková and Lucie Kytnarová",authors:[{id:"203061",title:"Associate Prof.",name:"Kateřina",middleName:null,surname:"Vitásková",slug:"katerina-vitaskova",fullName:"Kateřina Vitásková"},{id:"212035",title:"MSc.",name:"Lucie",middleName:null,surname:"Kytnarová",slug:"lucie-kytnarova",fullName:"Lucie Kytnarová"}]},{id:"56266",doi:"10.5772/intechopen.69894",title:"Discourse: Assessment and Therapy",slug:"discourse-assessment-and-therapy",totalDownloads:3061,totalCrossrefCites:7,totalDimensionsCites:9,abstract:"Discourse is essential for interaction and for the expression of ideas, feelings and opinions. Telling personal stories, such as talking about your day or recounting what happened in the playground, is essential for communication and establishing relationships. However, due to their language impairments, people with aphasia (PWA) and children with developmental language disorder (DLD) often have problems with everyday discourse which impact on their lives more widely. While improvement in language skills is supported by speech-language pathology (therapy), it tends to focus on smaller linguistic components, such as single words and sentences. This chapter outlines how speakers construct discourse in everyday situations and focuses on the meanings that people use discourse to convey, as well as the lexical and grammatical resources they use to convey these meanings. Current methods for discourse analysis will be outlined and key developments in narrative discourse production therapy will be reviewed.",book:{id:"5957",slug:"advances-in-speech-language-pathology",title:"Advances in Speech-language Pathology",fullTitle:"Advances in Speech-language Pathology"},signatures:"Lucy T. Dipper and Madeleine Pritchard",authors:[{id:"201158",title:"Dr.",name:"Lucy",middleName:null,surname:"Dipper",slug:"lucy-dipper",fullName:"Lucy Dipper"},{id:"208542",title:"Dr.",name:"Madeleine",middleName:null,surname:"Pritchard",slug:"madeleine-pritchard",fullName:"Madeleine Pritchard"}]},{id:"70186",doi:"10.5772/intechopen.90173",title:"Computational Model for the Construction of Cognitive Maps",slug:"computational-model-for-the-construction-of-cognitive-maps",totalDownloads:734,totalCrossrefCites:5,totalDimensionsCites:7,abstract:"The chapter considers an option for solving the problem of storing data in the Web environment and providing an access to the data, taking into account their semantics, i.e., in accordance with the nature of the tasks solved by users of different classes. The proposed solution is based on the use of presentation of the data in the form of semantic networks. As the main technical tool for describing access methods, the chapter proposes cognitive maps (CMs), which can also be considered as semantic networks of special type. When access is done, the presentation of information consistent with the semantic description of the user is provided. The suggested method of constructing CMs is based on the intensional logic. The solution is presented in the form of a computational model, which provides for the construction of CM’s dependence on the parameter. The proposed method of parametrization makes it possible to take into account the semantic characteristics of users of various classes. Some CM constructions for problem domain description are presented. A method for semantically oriented naming of CMs is proposed. The method is based on building of a functor of special type.",book:{id:"7311",slug:"cognitive-and-intermedial-semiotics",title:"Cognitive and Intermedial Semiotics",fullTitle:"Cognitive and Intermedial Semiotics"},signatures:"Larisa Yu. Ismailova, Sergey V. Kosikov and Viacheslav E. Wolfengagen",authors:[{id:"299703",title:"Dr.",name:"Larisa",middleName:"Yusifovna",surname:"Ismailova",slug:"larisa-ismailova",fullName:"Larisa Ismailova"},{id:"299704",title:"Prof.",name:"Viacheslav",middleName:null,surname:"Wolfengagen",slug:"viacheslav-wolfengagen",fullName:"Viacheslav Wolfengagen"},{id:"299711",title:"Mr.",name:"Sergey V.",middleName:null,surname:"Kosikov",slug:"sergey-v.-kosikov",fullName:"Sergey V. Kosikov"}]},{id:"56698",doi:"10.5772/intechopen.70107",title:"Risk Factors for Speech-Language Pathologies in Children",slug:"risk-factors-for-speech-language-pathologies-in-children",totalDownloads:1573,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"Risk factors are understood to encompass “aspects of individual behavior or lifestyle, environmental exposure, hereditary or congenital characteristics that are associated with a health related condition”. These are conditions that increase the chances of the child presenting speech-language disorders and that can be avoided, controlled, or treated. Risk is defined as the chance of a child exposed to certain factors (environmental or biological) to acquire or develop speech-language disorders. The objectives of the present study were: to identify the risk factors for speech-language disorders in children up to five years of age and to verify the relationship between risk factors and speech-language diagnostic hypotheses. The aspects of being male gender, prematurity, shyness, being an only child or youngest child, presenting deleterious oral habits, having a family history of speech-language disorders, and use of licit or illicit drugs during pregnancy seem to be the factors that should draw the attention of the health professionals in child development. Therefore, the monitoring of children who have these risk factors should be performed in order to promote the necessary stimulation and the construction of healthy environments.",book:{id:"5957",slug:"advances-in-speech-language-pathology",title:"Advances in Speech-language Pathology",fullTitle:"Advances in Speech-language Pathology"},signatures:"Daniela Regina Molini-Avejonas, Laís Vignati Ferreira and Cibelle\nAlbuquerque de La Higuera Amato",authors:[{id:"38599",title:"Prof.",name:"Daniela",middleName:null,surname:"Molini-Avejonas",slug:"daniela-molini-avejonas",fullName:"Daniela Molini-Avejonas"},{id:"204612",title:"Prof.",name:"Cibelle",middleName:null,surname:"Amato",slug:"cibelle-amato",fullName:"Cibelle Amato"},{id:"210543",title:"Ms.",name:"Laís",middleName:null,surname:"Ferreira",slug:"lais-ferreira",fullName:"Laís Ferreira"}]}],mostDownloadedChaptersLast30Days:[{id:"56698",title:"Risk Factors for Speech-Language Pathologies in Children",slug:"risk-factors-for-speech-language-pathologies-in-children",totalDownloads:1576,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"Risk factors are understood to encompass “aspects of individual behavior or lifestyle, environmental exposure, hereditary or congenital characteristics that are associated with a health related condition”. These are conditions that increase the chances of the child presenting speech-language disorders and that can be avoided, controlled, or treated. Risk is defined as the chance of a child exposed to certain factors (environmental or biological) to acquire or develop speech-language disorders. The objectives of the present study were: to identify the risk factors for speech-language disorders in children up to five years of age and to verify the relationship between risk factors and speech-language diagnostic hypotheses. The aspects of being male gender, prematurity, shyness, being an only child or youngest child, presenting deleterious oral habits, having a family history of speech-language disorders, and use of licit or illicit drugs during pregnancy seem to be the factors that should draw the attention of the health professionals in child development. Therefore, the monitoring of children who have these risk factors should be performed in order to promote the necessary stimulation and the construction of healthy environments.",book:{id:"5957",slug:"advances-in-speech-language-pathology",title:"Advances in Speech-language Pathology",fullTitle:"Advances in Speech-language Pathology"},signatures:"Daniela Regina Molini-Avejonas, Laís Vignati Ferreira and Cibelle\nAlbuquerque de La Higuera Amato",authors:[{id:"38599",title:"Prof.",name:"Daniela",middleName:null,surname:"Molini-Avejonas",slug:"daniela-molini-avejonas",fullName:"Daniela Molini-Avejonas"},{id:"204612",title:"Prof.",name:"Cibelle",middleName:null,surname:"Amato",slug:"cibelle-amato",fullName:"Cibelle Amato"},{id:"210543",title:"Ms.",name:"Laís",middleName:null,surname:"Ferreira",slug:"lais-ferreira",fullName:"Laís Ferreira"}]},{id:"56385",title:"Formulaic Language: The Building Block of Aphasic Speech",slug:"formulaic-language-the-building-block-of-aphasic-speech",totalDownloads:1837,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Aphasia is a condition that may appear when parts of the brain (Broca’s or Wernicke’s area) responsible for language production and processing are damaged. In most cases, patients have the left side of their brain affected. Thus, formulaic language remains intact in most cases. During speech therapy, this can be a solid base to build on. Formulaic language consists of formulas that are fixed phrases, stereotypes that behave as a single-unit lexical item. They have a significant role in language acquisition and fluent discourse production. These ready-made parts of speech are stored in the long-term memory. Studies suggest that the processing of formulaic language engages right hemisphere areas of the brain. Due to their language impairment, people with aphasia often have a lower quality of life, consequently social and professional integration for them being problematic. The investigation of preserved patterns, such as formulaic language and impairments related to different aspects of discourse, may provide insights both for clinical practice and for cognitive science, therefore, facilitating a more efficient approach to treatment.",book:{id:"5957",slug:"advances-in-speech-language-pathology",title:"Advances in Speech-language Pathology",fullTitle:"Advances in Speech-language Pathology"},signatures:"Annamária Győrfi",authors:[{id:"200880",title:"Dr.",name:"Annamaria",middleName:null,surname:"Gyorfi",slug:"annamaria-gyorfi",fullName:"Annamaria Gyorfi"}]},{id:"72178",title:"Cognitive Semiotics and Conceptual Blend: A Case Study from The Crying of Lot 49",slug:"cognitive-semiotics-and-conceptual-blend-a-case-study-from-em-the-crying-of-lot-49-em-",totalDownloads:703,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Cognitive semiotics has been defined by the linguist Jordan Zlatev as “the need to unify or at least to ‘defragment’ our world-views, the need to come to terms with increasingly higher levels of dynamism and complexity”. If we consider, as it is clear from the second cognitive revolution, when embodiment claimed its leading role, that meaning emerges from the constant interaction of body-brain-environment, we need to redefine the field that asks “what is meaning and how does it emerge.” New theories about metaphors as neural nodes and image schemas would shed light over the emergence of meaning in human communication, and, to do so, the study of conceptual blends as essential cognitive tools and as an integrative theory should be put in the center of the debate. In words of Brandt and Brandt, “blends occur as signs and are therefore a natural subject of cognitive semiotics”. Here, we will represent the emergence of meaning in a blend from the highly dynamic and complex narrative The Crying of Lot 49 by Pynchon and propose a conceptual story (or mental space sequence of the story) of the mentioned blend.",book:{id:"7311",slug:"cognitive-and-intermedial-semiotics",title:"Cognitive and Intermedial Semiotics",fullTitle:"Cognitive and Intermedial Semiotics"},signatures:"Marta Silvera-Roig",authors:[{id:"302728",title:"Dr.",name:"Marta",middleName:null,surname:"Silvera-Roig",slug:"marta-silvera-roig",fullName:"Marta Silvera-Roig"}]},{id:"56266",title:"Discourse: Assessment and Therapy",slug:"discourse-assessment-and-therapy",totalDownloads:3063,totalCrossrefCites:7,totalDimensionsCites:9,abstract:"Discourse is essential for interaction and for the expression of ideas, feelings and opinions. Telling personal stories, such as talking about your day or recounting what happened in the playground, is essential for communication and establishing relationships. However, due to their language impairments, people with aphasia (PWA) and children with developmental language disorder (DLD) often have problems with everyday discourse which impact on their lives more widely. While improvement in language skills is supported by speech-language pathology (therapy), it tends to focus on smaller linguistic components, such as single words and sentences. This chapter outlines how speakers construct discourse in everyday situations and focuses on the meanings that people use discourse to convey, as well as the lexical and grammatical resources they use to convey these meanings. Current methods for discourse analysis will be outlined and key developments in narrative discourse production therapy will be reviewed.",book:{id:"5957",slug:"advances-in-speech-language-pathology",title:"Advances in Speech-language Pathology",fullTitle:"Advances in Speech-language Pathology"},signatures:"Lucy T. Dipper and Madeleine Pritchard",authors:[{id:"201158",title:"Dr.",name:"Lucy",middleName:null,surname:"Dipper",slug:"lucy-dipper",fullName:"Lucy Dipper"},{id:"208542",title:"Dr.",name:"Madeleine",middleName:null,surname:"Pritchard",slug:"madeleine-pritchard",fullName:"Madeleine Pritchard"}]},{id:"56414",title:"Evidence for Speech Sound Disorder (SSD) Assessment",slug:"evidence-for-speech-sound-disorder-ssd-assessment",totalDownloads:1608,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Comprehensive studies on aspects related to the assessment of different biomedical parameters (acoustic and laryngeal signs and oral airflow amplitude), as well as parameters for speech disorders, articulation rate, speech inconsistency, and speech stimulability, are essential for better professional practice and to understand misarticulations in children with speech sound disorders (SSDs). Different equipments that enable noninvasive collection and analysis of data have become more common in speech-language pathology practice. Studies recently conducted by our research group have emphasized the evaluation of auditory-perceptual processing by means of assessments of central auditory processing, electrophysiology of hearing—considering that pure-tone, speech audiometry, and tympanometry are routinely used with children during the diagnostic phase and motor speech production performed by acoustic analysis of speech, electroglottography, aerodynamic measures, and ultrasound tongue imaging. This chapter presents the recent advances observed in studies with Brazilian-Portuguese speakers aiming to improve the assessment of speech sound disorders and to understand better the relationship between the different processing mechanisms involved in speech.",book:{id:"5957",slug:"advances-in-speech-language-pathology",title:"Advances in Speech-language Pathology",fullTitle:"Advances in Speech-language Pathology"},signatures:"Haydée Fiszbein Wertzner, Danira T. Francisco, Tatiane F. Barrozo\nand Luciana O. Pagan-Neves",authors:[{id:"204570",title:"Prof.",name:"Haydée",middleName:null,surname:"Wertzner",slug:"haydee-wertzner",fullName:"Haydée Wertzner"},{id:"204572",title:"MSc.",name:"Danira",middleName:null,surname:"Francisco",slug:"danira-francisco",fullName:"Danira Francisco"},{id:"204573",title:"MSc.",name:"Tatiane",middleName:null,surname:"Barrozo",slug:"tatiane-barrozo",fullName:"Tatiane Barrozo"},{id:"204574",title:"Dr.",name:"Luciana",middleName:null,surname:"Pagan-Neves",slug:"luciana-pagan-neves",fullName:"Luciana Pagan-Neves"}]}],onlineFirstChaptersFilter:{topicId:"238",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81605",title:"Primary Progressive Aphasia (PPA)",slug:"primary-progressive-aphasia-ppa",totalDownloads:12,totalDimensionsCites:0,doi:"10.5772/intechopen.104291",abstract:"Primary progressive aphasia (PPA) is a rare neurological condition that affects an individual’s ability to communicate. PPA is a syndrome characterized by a ‘progressive worsening of language with preservation of the activities of daily living and evidence of relatively normal non-verbal abilities on neuropsychological testing’. It commonly appears initially as a disorder of speaking (an articulatory problem) progressing to nearly total inability to speak in its most severe stage, while comprehension remains relatively preserved. This chapter provides an overview of the characteristic features of PPA, its classification, assessment, and rehabilitation options.",book:{id:"10889",title:"Aphasia Compendium",coverURL:"https://cdn.intechopen.com/books/images_new/10889.jpg"},signatures:"Yashaswini Channabasave Gowda and Hema Nagaraj"},{id:"79833",title:"A Comprehensive Overview of Broca’s Aphasia after Ischemic Stroke",slug:"a-comprehensive-overview-of-broca-s-aphasia-after-ischemic-stroke",totalDownloads:105,totalDimensionsCites:0,doi:"10.5772/intechopen.101560",abstract:"Aphasia denotes an acquired central disorder of language, which alters patient’s ability of understanding and/or producing spoken and written language. The main cause of aphasia is represented by ischemic stroke. The language disturbances are frequently combined into aphasic syndromes, contained in different vascular syndromes, which may suffer evolution/involution in the acute stage of ischemic stroke. The main determining factor of the vascular aphasia’s form is the infarct location. Broca’s aphasia is a non-fluent aphasia, comprising a wide range of symptoms (articulatory disturbances, paraphasias, agrammatism, anomia, and discrete comprehension disorders of spoken and written language) and is considered the third most common form of acute vascular aphasia, after global and Wernicke’s aphasia. It is caused by a lesion situated in the dominant cerebral hemisphere (the left one in right-handed persons), in those cortical regions vascularized by the superior division of the left middle cerebral artery (Broca’s area, the rolandic operculum, the insular cortex, subjacent white matter, centrum semiovale, the caudate nucleus head, the putamen, and the periventricular areas). The role of this chapter is to present the most important acquirements in the field of language and neurologic examination, diagnosis, and therapy of the patient with Broca’s aphasia secondary to ischemic stroke.",book:{id:"10889",title:"Aphasia Compendium",coverURL:"https://cdn.intechopen.com/books/images_new/10889.jpg"},signatures:"Dragoș Cătălin Jianu, Tihomir V. Ilic, Silviana Nina Jianu, Any Docu Axelerad, Claudiu Dumitru Bîrdac, Traian Flavius Dan, Anca Elena Gogu and Georgiana Munteanu"},{id:"79482",title:"The Importance of Aphasia Communication Groups",slug:"the-importance-of-aphasia-communication-groups",totalDownloads:151,totalDimensionsCites:1,doi:"10.5772/intechopen.101059",abstract:"Chronic aphasia is linked to poor functional recovery, depression, and social isolation. In the exploration of the above factors, the role of aphasia communication groups has evolved. Aphasia communication groups for stroke survivors with chronic aphasia and their communication buddies are gaining clinical importance. Communication buddies can be family members, friends, carers, health professionals, and speech and language therapy students who serve as communication facilitators for each group member. Group members share experiences on stroke and aphasia by using technology/tablets and the total communication approach. The benefits or outcomes of group involvement are measured by assessment of functional communication, individual self-ratings of the impact of aphasia on communication, and quality of life after stroke. The use of the communication buddy system, total communication approach, and systematic evaluations enables therapists to measure the effectiveness and efficacy of communication groups in terms of functional communication, social inclusion, and quality of life.",book:{id:"10889",title:"Aphasia Compendium",coverURL:"https://cdn.intechopen.com/books/images_new/10889.jpg"},signatures:"Marina Charalambous and Maria Kambanaros"},{id:"79728",title:"Imaging of Vascular Aphasia",slug:"imaging-of-vascular-aphasia",totalDownloads:98,totalDimensionsCites:0,doi:"10.5772/intechopen.101581",abstract:"Brain imaging is essential for the diagnosis of acute stroke and vascular aphasia. Magnetic resonance imaging (MRI) is the modality of choice for the etiological diagnosis of aphasia, the assessment of its severity, and the prediction of recovery. Diffusion weighted imaging is used to detect, localize, and quantify the extension of the irreversibly injured brain tissue called ischemic core. Perfusion weighted imaging (from MRI or CT) is useful to assess the extension of hypoperfused but salvageable tissue called penumbra. Functional imaging (positron emission tomography (PET), functional MRI (fMRI)) may help predicting recovery and is useful for the understanding of language networks and individual variability. This chapter is meant to review the state of the art of morphological and functional imaging of vascular aphasia and to illustrate the MRI profiles of different aphasic syndromes.",book:{id:"10889",title:"Aphasia Compendium",coverURL:"https://cdn.intechopen.com/books/images_new/10889.jpg"},signatures:"Loïc Duron, Augustin Lecler, Dragoș Cătălin Jianu, Raphaël Sadik and Julien Savatovsky"},{id:"79364",title:"Contributions of Linguistics to the Study of Aphasias: Focus on Discursive Approaches",slug:"contributions-of-linguistics-to-the-study-of-aphasias-focus-on-discursive-approaches",totalDownloads:88,totalDimensionsCites:0,doi:"10.5772/intechopen.101058",abstract:"The chapter aims to present and discuss the contributions of Linguistics to the study of aphasias, especially regarding the power of discursive theories to subsidize language assessment and therapeutic follow-up with aphasic individuals. Jakobson, in 1956, based on Saussure’s approach and on Luria’s neuropsychological theory, was the first scholar to call for the participation of linguists in this field, once “aphasia is a problem of language”. Nonetheless, aphasia does not disturb only linguistic formal levels – phonetical-phonological, syntactic, lexical-semantic –, but also pragmatic and discursive aspects of language that are constitutive of meaning processes involved in the social use of language. Unfortunately, more traditional approaches to language assessment and to the follow-up work are exclusively based on metalinguistic tasks, which do not take into consideration the subjective and contextual aspects of language functioning. The experience we have acquired over more than thirty years within the field of Neurolinguistics has shown that qualitative longitudinal researches – mainly case studies – are a privileged locus to seek for evidences of how the linguistic levels are impacted in the several forms of aphasia. Such understanding, in turn, favor the therapeutic work towards more contextualized activities, in order to help the individuals to reorganize their linguistic-cognitive processes.",book:{id:"10889",title:"Aphasia Compendium",coverURL:"https://cdn.intechopen.com/books/images_new/10889.jpg"},signatures:"Rosana do Carmo Novaes-Pinto and Arnaldo Rodrigues de Lima"},{id:"79198",title:"Treatment Approaches for Word Retrieval Deficits in Persons with Aphasia: Recent Advances",slug:"treatment-approaches-for-word-retrieval-deficits-in-persons-with-aphasia-recent-advances",totalDownloads:131,totalDimensionsCites:0,doi:"10.5772/intechopen.100828",abstract:"Word retrieval deficit is found to be one of the most persistent symptoms reported among the constellation of symptoms exhibited by persons with aphasia (PWAs). This deficit restraints the persons with aphasia to perform with ease across day-to-day conversations. As a consequence, PWAs fail to communicate their desired ideas or thoughts. Word retrieval is an intricate process as it entails various levels of processing. In addition, word retrieval breakdown can occur at multiple levels (semantic level or lexical-semantic level, or phonological level). Thus, there is a need for speech-language pathologists (SLPs) to treat this deficit through effective treatment approaches. In recent decades, semantic feature analysis, verb network strengthening treatment, and phonological component analysis have received greater focus and importance in treating word retrieval deficits. Many studies confirmed that the use of these treatment approaches on PWAs possesses a pivotal role in remediating word retrieval deficits.",book:{id:"10889",title:"Aphasia Compendium",coverURL:"https://cdn.intechopen.com/books/images_new/10889.jpg"},signatures:"Deepak Puttanna, Akshaya Swamy, Sathyapal Puri Goswami and Abhishek Budiguppe Panchakshari"}],onlineFirstChaptersTotal:7},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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